    [Senate Hearing 109-286]
    [From the U.S. Government Publishing Office]

                                                     S. Hrg. 109-286, Pt. 6

                                                            Senate Hearings

                                     Before the Committee on Appropriations

    _______________________________________________________________________

                                                      Departments of Labor,

                                                 Health and Human Services,

                                                     Education, and Related

                                                    Agencies Appropriations

                                                           Fiscal Year 2007

                                             109th CONGRESS, SECOND SESSION

                                                          H.R. 5647/S. 3807

    PART 6
            DEPARTMENT OF EDUCATION
            DEPARTMENT OF HEALTH AND HUMAN SERVICES
            NONDEPARTMENTAL WITNESSES

                                                     S. Hrg. 109-286, Pt. 6

    DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
                  AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2007

    =======================================================================

                                    HEARINGS

                                    before a

                              SUBCOMMITTEE OF THE

                COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE

                           ONE HUNDRED NINTH CONGRESS

                                 SECOND SESSION

                                       on

                               H.R. 5647/S. 3807

     AN ACT MAKING APPROPRIATIONS FOR THE DEPARTMENTS OF LABOR, HEALTH AND
    HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES FOR THE FISCAL YEAR
               ENDING SEPTEMBER 30, 2007, AND FOR OTHER PURPOSES

                                   __________

                              PART 6 (Pages 000)

                            Department of Education
                    Department of Health and Human Services
                           Nondepartmental Witnesses

                                   __________

             Printed for the use of the Committee on Appropriations

       Available via the World Wide Web: http://www.gpoaccess.gov/
                              congress/index.html

                                   __________

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                          COMMITTEE ON APPROPRIATIONS

                      THAD COCHRAN, Mississippi, Chairman
    TED STEVENS, Alaska                  ROBERT C. BYRD, West Virginia
    ARLEN SPECTER, Pennsylvania          DANIEL K. INOUYE, Hawaii
    PETE V. DOMENICI, New Mexico         PATRICK J. LEAHY, Vermont
    CHRISTOPHER S. BOND, Missouri        TOM HARKIN, Iowa
    MITCH McCONNELL, Kentucky            BARBARA A. MIKULSKI, Maryland
    CONRAD BURNS, Montana                HARRY REID, Nevada
    RICHARD C. SHELBY, Alabama           HERB KOHL, Wisconsin
    JUDD GREGG, New Hampshire            PATTY MURRAY, Washington
    ROBERT F. BENNETT, Utah              BYRON L. DORGAN, North Dakota
    LARRY CRAIG, Idaho                   DIANNE FEINSTEIN, California
    KAY BAILEY HUTCHISON, Texas          RICHARD J. DURBIN, Illinois
    MIKE DeWINE, Ohio                    TIM JOHNSON, South Dakota
    SAM BROWNBACK, Kansas                MARY L. LANDRIEU, Louisiana
    WAYNE ALLARD, Colorado
                        J. Keith Kennedy, Staff Director
                  Terrence E. Sauvain, Minority Staff Director
                                     ------

       Subcommittee on Departments of Labor, Health and Human Services,
                        Education, and Related Agencies

                     ARLEN SPECTER, Pennsylvania, Chairman
    THAD COCHRAN, Mississippi            TOM HARKIN, Iowa
    JUDD GREGG, New Hampshire            DANIEL K. INOUYE, Hawaii
    LARRY CRAIG, Idaho                   HARRY REID, Nevada
    KAY BAILEY HUTCHISON, Texas          HERB KOHL, Wisconsin
    TED STEVENS, Alaska                  PATTY MURRAY, Washington
    MIKE DeWINE, Ohio                    MARY L. LANDRIEU, Louisiana
    RICHARD C. SHELBY, Alabama           RICHARD J. DURBIN, Illinois
                                         ROBERT C. BYRD, West Virginia (Ex
                                             officio)

                               Professional Staff

                                Bettilou Taylor
                                  Jim Sourwine
                                  Mark Laisch
                             Sudip Shrikant Parikh
                                  Candice Ngo
                                 Lisa Bernhardt
                            Ellen Murray (Minority)
                             Erik Fatemi (Minority)
                          Adrienne Hallett (Minority)

                                C O N T E N T S

                                  ----------

                            Wednesday, March 1, 2006

                                                                       Page

    Department of Education: Office of the Secretary.................     1

                             Wednesday, May 3, 2006

    Department of Health and Human Services: Office of the Secretary.    61

                              Friday, May 19, 2006

    Department of Health and Human Services: National Institutes of
      Health.........................................................   105

                           Nondepartmental Witnesses

    Department of Labor..............................................   301
    Department of Health and Human Services..........................   315
    National Institutes of Health....................................   384
    Department of Education..........................................   538
    Related Agencies.................................................   575

    DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
                  AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2007

                                  ----------

                            WEDNESDAY, MARCH 1, 2006

                                           U.S. Senate,
               Subcommittee of the Committee on Appropriations,
                                                        Washington, DC.
        The subcommittee met at 10:45 a.m., in room SD-124, Dirksen
    Senate Office Building, Hon. Arlen Specter (chairman)
    presiding.
        Present: Senators Specter, Craig, Harkin, Kohl, Murray, and
    Landrieu.

                            DEPARTMENT OF EDUCATION

                            Office of the Secretary

    STATEMENT OF HON. MARGARET SPELLINGS, SECRETARY
    ACCOMPANIED BY: THOMAS SKELLY, DIRECTOR, BUDGET SERVICE

                   opening statement of senator arlen specter

        Senator Specter. Good morning Ladies, and Gentlemen, the
    subcommittee on Labor, Health and Human Services, and Education
    will now proceed with our hearing on the budget from the
    Department of Education. I regret our delayed start, but we
    just finished a vote on the PATRIOT Act, and Senator Harkin was
    on the floor and should be here I think, shortly. Scheduling
    has been complicated because of this vote. As you know we had
    moved the time from 9:30 to 11:00 and then back to 10:30 and we
    don't like to keep people waiting, especially the Secretary of
    Education. But we welcome you here, Madam Secretary.
        You were confirmed on January 20, 2005. You have extensive
    experience working for the President when he had been a
    Governor; you were Assistant to the Secretary for Domestic
    Policy. You were Senior Advisor to then Governor Bush with
    responsibilities for developing and implementing the Governor's
    education policy. You are a graduate of the University of
    Houston, with a bachelor's degree in political science and
    journalism.

                               prepared statement

        Madam Secretary, I shall be relatively brief because of our
    time here, our late start. Without objection, my written
    statement will be included in the record. As you and I have
    talked briefly earlier this week, I'm concerned about the
    overall budget. We had a budget for this subcommittee, which
    has in addition to the Department of Education, Health and
    Human Services and Labor, which fell about $8 billion short
    when you figure the cuts and take into account, inflation. I
    know that it is difficult as a loyal member of the
    administration when you have the policies working up through
    the Office of Management and Budget. But as I said to you in
    our telephone conversation, and as I've said repeatedly, I
    think there's a real need for someone in your position to be a
    tough advocate for your Department. Education is simply under
    funded. When I took a look at the President's budget, we're
    always asked for comment and I wanted to be definitive and
    brief and chose the word scandalous which I think it is. I know
    the President, the administration have tremendous problems in
    many, many areas but when you have so much money for the
    National Institutes for Health, and the Centers for Disease
    Control and Prevention, and Worker Safety, and Mine Safety, and
    important education programs, it's simply insufficient to have
    continual cuts on discretionary programs. We're regrettably
    moving to a system where there will be no discretionary funding
    at all. We'll all be out of jobs. The Appropriations Committee,
    which used to be--was once a powerful committee.
        [The statement follows:]
                  Prepared Statement of Senator Arlen Specter
        This morning, the Subcommittee on Labor, Health and Human Services,
    and Education will discuss the President's $54.410 billion 2007 budget
    request for the Department of Education. We are delighted to have
    before us the distinguished Secretary of Education, the Honorable
    Margaret Spellings, our Nation's 8th Secretary of Education.
        Madam Secretary, your impressive biography clearly illustrates your
    abilities and potential for leading this important Department. Being a
    mother of two school-age daughters gives you important insights into
    your other job as Secretary of Education.
        This subcommittee is pleased to see several shared priorities
    funded in the fiscal year 2007 budget including the $200 million
    request for school improvement grants, $380 million for the American
    Competitiveness Initiative, and additional funding for foreign language
    instruction and the Advanced Placement Program.
        However, I am concerned that the budget is $2.1 billion below the
    fiscal year 2006 level and that there are 42 program eliminations. For
    example, $303 million currently available for Gear-Up, which provides
    for the transition from seventh grade to college; $1.2 billion for
    State grants for vocational and technical education programs; and $23
    million for correctional education programs all are proposed for
    elimination. The Pell Grant maximum award is frozen at $4,050 for the
    fifth year in a row.
        I know, Madam Secretary, that you can appreciate the difficult
    tradeoffs that this subcommittee will need to negotiate in the coming
    months as we balance the competing pressures of biomedical research,
    worker protection programs and continued investment in our Nation's
    youth. Madam Secretary, I look forward to working with you to craft an
    appropriations bill that maintains our commitment to fiscal restraint
    while preserving funding for high priority programs.

        Senator Specter. Senator Landrieu, would you care to be
    acting ranking and make an opening statement?

                     STATEMENT OF SENATOR MARY L. LANDRIEU

        Senator Landrieu. Thank you, Mr. Chairman.
        Senator Specter. Or not be acting, just make an opening
    statement.

                    DEPARTMENT LAUDED FOR HURRICANE RESPONSE

        Senator Landrieu. It's hard shoes to fill, but I will make
    an opening statement. Just very briefly because I appreciate
    that we want to hear our witness. But I wanted, Mr. Chairman,
    to be here this morning to give compliments to this
    Department--being mindful of what you said and agreeing with
    the level of funding which I'll get back to in a minute. Which
    I fully agree is scandalous. But Madam Secretary, your
    Department has been really a model of partnership for the State
    of Louisiana through the most difficult time that our State has
    experienced. I spoke to the Secretary, Mr. Chairman, privately
    before to let her know that if every Department of the Federal
    Government had worked this honestly, this reliably, with us we
    would not be experiencing the problems that we're experiencing
    now. In all of the calls, and I had thousands of calls about
    Katrina and Rita and the devastation that occurred, not one
    call did my office receive from any school or university in the
    country or from any parent saying they couldn't find a place
    for their child, or their young person to go to school. Number
    one, because the word went out across the country, please take
    the 330,000 children that showed up for school on Friday; the
    hurricane hit on Sunday, and they had no school to go to on
    Monday.
        Mr. Chairman, it's a credit to the education establishment
    in this country that almost to my knowledge, every high school
    student, every elementary school student, and every college
    student that wanted to, found a place to continue their
    education of the last 6 months, and Madam Secretary, I think
    you deserve a lot of credit for that.
        Second, the quickness in which we were able in a bipartisan
    way, we were able to implement with the chairman's help and
    assistance the special funding for getting our schools back up
    and started also is a great model. Having said that, we still
    have many problems as you know. We're hoping the new school
    system that emerges in New Orleans can be a model for the
    Nation as it emerges as a network of public charter schools and
    we're going to need your ongoing help and commitment to that
    end.
        We do have problems with FEMA in terms of reimbursing and
    not reimbursing for school construction, we've lost over 100
    school buildings, Mr. Chairman, which is a great strain on any
    system, to have to try to build the physical plants as well as
    the internal operations. But I did want to start with that and
    then finally say, having said that, the overall budget for the
    Nation is just not sufficient to meet the new standards and
    challenges that we have set for our schools as we struggle to
    provide excellence, opportunity, no guarantee Madam Secretary,
    but an opportunity.

                                TITLE I FUNDING

        Title I funding, is the only Title that helps poor and
    lower middle-income children get the resources they need; to
    have the kinds of schools they need to be excellent. With that
    funding decreasing I don't know how our poor counties and
    middle-income counties that are struggling can meet the targets
    of No Child Left Behind, which means closing that achievement
    gap. So that's what I'm going to focus on in the committee and,
    Mr. Chairman, I thank you very much.
        Senator Specter. Well thank you very much, Senator
    Landrieu. Well welcome again, Madam Secretary, the floor is
    yours, and we look forward to your testimony.

                  SUMMARY STATEMENT OF HON. MARGARET SPELLINGS

        Secretary Spellings. Thank you very much, Mr. Chairman. It
    does seem like all roads lead to you today, and so I'm at your
    service, and thank you for all your work that you're doing, not
    only in this arena, but in many others.

                EDUCATION FUNDS DISBURSED FOR HURRICANE RECOVERY

        Senator Landrieu, thank you for your very generous
    comments. I appreciate the opportunity to be here and your
    support. Let me begin first, by thanking all of you for your
    work on behalf of the victims of hurricanes Rita and Katrina.
    As Senator Landrieu has talked about, we've worked a lot on
    that. After you passed the Hurricane Education Recovery Act in
    December, we sent immediately $250 million to Louisiana,
    Mississippi, Texas, and Alabama to help re-open schools in the
    region. That was in addition to $20 million that we sent to
    help open, or re-open, charter schools for affected students in
    Louisiana, and more than $200 million that we sent to help
    college students in the region. We'll be sending another $500
    million in aid to these States in the coming days, and we've
    been consulting with experts at the Federal, State, and local
    levels, reviewing records from tax data, property loss data,
    and insurance claims, to make sure that this money is allocated
    fairly.
        We'll also be providing $645 million to reimburse districts
    all over the country for the cost of educating displaced
    students, as they've done so welcomingly, and so well. We've
    been working with States to help accelerate this process and to
    identify the number of displaced students so we can begin
    sending this money to schools.

                   FISCAL YEAR 2007 EDUCATION BUDGET REQUEST

        But today I'm here to talk about the President's budget,
    and it's more important than ever that we spend taxpayer
    dollars wisely and well. Since taking office in 2001, the
    President has worked with you to increase funding for education
    by about 30 percent. The new budget increases education
    spending in key areas, but, as you've observed, not across the
    board. I know together we have a very tough job ahead. The
    programs you make funding decisions for are discretionary and
    you don't have much room to maneuver. It's only getting harder
    to fund priorities and reduce the deficit, because of the
    rising cost of entitlement spending.

                      AMERICAN COMPETITIVENESS INITIATIVE

        At the same time, as policymakers we must focus on results.
    We've looked at data to see what policies are working for
    students, and where we can save taxpayers money or work more
    efficiently and effectively by eliminating and consolidating
    less effective programs. Raising student achievement is always
    our watch word. The President's new American Competitiveness
    Initiative would devote $380 million to strengthen K-12 math
    and science education. Overall the Department of Education will
    increase funding for its programs in these critical fields by
    51 percent. The President has asked me to form a national math
    panel of experts to help us bring together the best research on
    proven strategies for teaching math; just as we've done in
    reading. His budget includes $250 million for a new program
    called Math Now, that will help elementary and middle school
    students develop the academic foundation to eventually take
    higher-level classes in high school, such as Advanced Placement
    courses. The trouble today is that more than a third of our
    high schools offer no AP classes and that needs to change,
    especially when we know that students are going to need these
    skills in a world where 90 percent of the fastest growing jobs
    require postsecondary education.
        The President has also called for $122 million to prepare
    an additional 70,000 teachers to lead Advanced Placement and
    International Baccalaureate classes in math, science, and
    critical foreign languages. The budget includes $25 million to
    help recruit 30,000 math and science professionals to become
    adjunct high school teachers in these critical areas.
        I know there are concerns about resources, but in reality
    we have resources available around these priorities. Currently
    13 different government agencies spend about $2.8 billion on
    207 different programs for math and science. The problem is
    that these programs are in their own silos with little or no
    coordination with No Child Left Behind and its goals for
    raising student achievement. It's a 1,000 flowers blooming and
    maybe even a few weeds throughout the Government.
        We should align these efforts with the principles of No
    Child Left Behind by continuing to hold schools accountable for
    getting students to grade-level proficiency by 2014, and by
    giving local policymakers and educators resources, authority,
    and the research base to do what's best.

                   SCHOOL IMPROVEMENT AND HIGH SCHOOL REFORM

        Thanks to No Child Left Behind, we've reached a point where
    we have the data to see what's working in our schools and what
    needs to work better. We're proposing a new $200 million School
    Improvement program to help States use what we've learned to
    turn around schools in need of improvement. Now we must build
    on the foundations of the NCLB law, which is working in grades
    three through eight, to extend the benefits of assessment and
    accountability for results into our high schools, with the
    President's $1.5 billion high school reform proposal. There's a
    wide and growing consensus that we have a problem in our high
    schools and we must work together to address these issues. A
    high school diploma must be a record of achievement and not
    just a certificate of attendance. If we raise the bar, our
    students will rise to the challenge just as they always have,
    but we must give them the skills to compete.

                               PREPARED STATEMENT

        Thank you. I'd be glad to answer any questions. With me
    today is Tom Skelly, our Budget Director, who tells me he's
    been doing this since 1976. So he knows what he's doing by now.
        [The statement follows:]
                 Prepared Statement of Hon. Margaret Spellings
        Mr. Chairman and Members of the Committee. Thank you for this
    opportunity to testify on behalf of the President's 2007 budget for
    education. I know you have received our Congressional justifications
    and other background materials laying out the details of our request,
    so I will concentrate on a few key highlights.
        President Bush is requesting $54.4 billion in discretionary
    appropriations for the Department of Education in fiscal year 2007. We
    are proposing significant increases in key areas, as well as
    substantial savings from reductions in lower priorities. The result
    would be a discretionary total that is up more than $12 billion, or 29
    percent, since fiscal year 2001.
        We know the 2007 budget process will involve difficult trade-offs
    among existing programs, just as was the case with the 2006
    appropriations bill. In 2006, we saw that this Subcommittee was willing
    to balance funding for priority programs with reductions and
    eliminations in other activities, and we hope you will take the same
    approach in 2007.
        For example, our budget would save $3.5 billion by eliminating
    funding for 42 programs. These reductions and terminations reflect the
    Administration's longstanding goal of providing local control,
    streamlining government to avoid unnecessary duplication, and targeting
    taxpayer dollars to those programs with the greatest promise of
    improving student outcomes. Let me add that we very much appreciate the
    efforts of this Subcommittee last year in eliminating five Department
    programs, and making significant reductions in several others, in order
    to better target existing resources. We look forward to working with
    you on this goal again this year.
                      a broad emphasis on competitiveness
        President Bush has made ensuring American competitiveness in the
    global economy a strong priority in his overall 2007 budget, primarily
    through his American Competitiveness Initiative. Several of the
    increases in the Department's request are part of that Initiative, and
    I'll say more about them in a minute, but I think most of you would
    agree that we need to address the competitiveness issue in America's
    schools now, this year. This is why most of our major increases for
    2007--not just those included in the President's Initiative--are aimed
    at keeping our students, and our workforce, competitive for the 21st
    century.
        In that context, a key proposal for 2007 is a renewed request for
    High School Reform, a $1.5 billion initiative to support a wide range
    of locally determined reforms aimed at ensuring that every student not
    only graduates from high school, but graduates with the skills to
    succeed in either college or the workforce. The High School Reform
    proposal also would require States to assess students, in reading or
    language arts and math, at two additional grades in high school. NCLB
    currently requires assessments in these subjects for just one high
    school grade. We believe the additional assessments are needed to
    increase accountability and give parents and teachers the information
    they need to keep all students on track toward graduation. And more
    generally, these assessments will help researchers and policymakers
    understand more about what works and what doesn't work in our high
    schools, a key goal when about 1 million high school students a year
    drop out, at great cost to our economy and society. Too many students
    drop out, and too many of them are minorities.
        We also are seeking $100 million for the Striving Readers program,
    which is applying the lessons of the successful Reading First model,
    which translates research into practice to improve reading instruction
    for young children, at the secondary school level. The $70 million
    increase for this program would expand support for the development and
    implementation of research-based methods for improving the skills of
    teenage students who are reading below grade level, and who otherwise
    might end up dropping out of school. It's hard to compete with anyone
    if you don't finish high school.
                                math and science
        A critical new focus for 2007 is on improving student achievement
    in math and science from the early grades through high school, and the
    President is seeking $380 million in new funding to support this goal
    through his American Competitiveness Initiative (ACI). That total
    includes $250 million for two proposed programs we call Math Now, one
    focused on developing and implementing proven instructional practices
    for students in grades K-6, and one to support research-based
    interventions for middle school students. Both initiatives would be
    guided by the recommendations of a National Mathematics Panel that I
    will appoint soon, and that will be charged with identifying essential
    math content and sound instructional principles, just as the National
    Reading Panel did for reading instruction.
        Another key ACI request is a $90 million increase for the Advanced
    Placement program, to expand incentives for training teachers and
    encouraging students, particularly in high-poverty schools, to take
    high-level Advanced Placement and International Baccalaureate courses
    in math, science, and critical foreign languages. We also are proposing
    a new requirement for State or private-sector matching funds to expand
    the reach of the AP program, so that we can train an estimated 70,000
    teachers over the next five years. Over the long term, this proposal
    would increase the number of students taking AP-IB exams in math,
    science, and critical foreign languages from 380,000 today to 1.5
    million in 2012, and triple the number of students passing these tests
    to 700,000 by 2012.
        I believe that increasing the number of American students studying
    and gaining fluency in critical foreign languages is essential not only
    for our national security, as suggested by the President's National
    Security Language Initiative, but also to maintain our economic
    competitiveness. That's why I'm very pleased that our request includes
    $35 million in new funds for a package of proposals that would
    encourage more students to master a critical foreign language. The
    largest proposal is $24 million for Advancing America Through Foreign
    Language Partnerships, a new program that would link postsecondary
    institutions with school districts to support language learning from
    kindergarten through high school, as well as advanced language study at
    the postsecondary level.
                 building state capacity for school improvement
        We continue to make good progress in implementing No Child Left
    Behind, with scores on State assessments up significantly across the
    country, and the National Assessment of Educational Progress showing
    real improvements in closing achievement gaps, especially in the early
    grades addressed by key NCLB programs like Title I and Reading First.
    Our 2007 request would help maintain that positive momentum, while
    providing a new push in the area of school improvement. Our budget
    would provide $12.7 billion for Title I Grants to Local Educational
    Agencies, which is the foundation of NCLB, while funding a $200 million
    School Improvement Grants program. This initiative would help States to
    establish and expand the statewide systems of improvement and support
    that are essential to the long-term success of NCLB. If we're going to
    reach the 100-percent proficiency goal by 2013-14, we need to make
    continuous improvement our watchword, and our request would help States
    do just that.
        Our request also would support additional options for students
    enrolled in schools that have been identified for restructuring--these
    are chronically low-performing schools that have not made adequate
    yearly progress under NCLB for at least 5 years. The $100 million
    America's Opportunity Scholarships for Kids program would permit the
    parents of such students to transfer their children to a private school
    or to obtain intensive tutoring or other supplemental services,
    including after-school and summer-school instruction. The President
    believes that for accountability to be meaningful, there must be real
    consequences for schools and real options for students and parents.
                                 other programs
        The 2007 budget would provide a $100 million increase for the
    reauthorized Special Education Grants to States program, for a total
    increase of $4.3 billion, or 69 percent, over the past five years. We
    also would maintain a $4,050 Pell Grant maximum award with a $12.7
    billion request for that program, while continuing to support the new
    Academic Competitiveness Grants and National SMART Grants program. I
    want to thank the Members of this Subcommittee, along with your
    colleagues in the House, for supporting these critical new grant
    programs. In particular, SMART Grants complement the President's
    American Competitiveness Initiative by awarding up to $4,000 annually
    to third- and fourth-year postsecondary students majoring in physical,
    life, or computer sciences, mathematics, technology, engineering, or a
    critical foreign language.
                                   conclusion
        These highlights of our 2007 request show that within the very
    tight constraints required by the need to reduce the Federal budget
    deficit in a time of war, we are proposing a strong education budget,
    one that will maintain and even accelerate progress under No Child Left
    Behind, while making key new investments in critical areas designed to
    ensure our future competitiveness in the 21st century global economy.
        I will be happy to answer any questions you may have.

                  FISCAL YEAR 2007 EDUCATION BUDGET PRIORITIES

        Senator Specter. Thank you very much, Madam Secretary. I
    begin with the questions which I posed in the letter which I
    sent to you, last month. I focus at the outset on the proposed
    budget for the Department of Education, being $2.1 billion
    below last year. The Department has highlighted rising test
    scores, a narrowing of the achievement gaps since the passage
    of No Child Left Behind, and the increase in Federal funding
    that has accomplished those results. What are the prospects for
    continued progress with the budget cuts which are in your
    proposal?
        Secretary Spellings. Well Senator, I think there are a
    couple of answers to that. One is that the priorities of No
    Child Left Behind are indeed funded in the President's budget--
    the emphasis on reading, the emphasis on teacher development,
    the emphasis on Title I. Then there are the additional
    resources that we are requesting for school improvement--the
    $200 million that we need as the No Child Left Behind law
    matures--as well as the investment in competitiveness, and in
    high schools, and in math and science. So I think that where we
    have resources we've focused them on the goals of No Child Left
    Behind. Second, I would say that a lot of the infrastructure
    that was needed to be put in place to do No Child Left Behind,
    such as assessments, and reading curriculum reform and those
    sorts of things, has been done, and now we're turning our
    attention to the maturing of No Child Left Behind and these
    other priorities.
        Senator Specter. The difficulty, Madam Secretary, is that
    there are cuts in a lot of programs which impact the students
    whom you're trying to deal with in No Child Left Behind. You're
    robbing Peter to pay Paul, really. When you have a net decrease
    of $2.1 billion and you have the inflation factor as well, it
    just seems to me that it's impossible to make it up with the
    shuffling that you're suggesting.

                 PUBLIC SCHOOL CHOICE AND SUPPLEMENTAL SERVICES

        What is the situation with the repeated public comments
    about the difficulty of moving students from one school which
    is not satisfactory to other schools? We see constant
    complaints that the recipient school districts are unable to
    accommodate the students, that that has not really been a
    practical or realistic program?
        Secretary Spellings. Let me make a couple of comments about
    that, Senator. First, I've observed that also. We have about a
    10 percent take-up, if you will: 2 million students are
    eligible for supplemental services, and about 200,000 students
    are seeking those options. So we must do a better job of making
    sure those options for parents are real. But one of the things
    I think I've learned, and we're piloting strategies in various
    places around the country, is, does it make more sense--and we
    ought to get some data about this--to allow students to get
    extra intervention and supplemental services before the public
    school choice options are used. So we're testing that theory in
    Chicago, Los Angeles, New York, and some districts in Virginia
    will also test that out. Does it make more sense, before we
    ship them off to other schools, to get them additional
    remediation. That's why the President's call for an additional
    $100 million for either choice, or ramped up supplemental
    services, makes a lot of sense.
        Senator Specter. But you still are letting them choose to
    go to another district, aren't you?
        Secretary Spellings. The public school choice options, yes,
    are still in place. But what I'm saying is, perhaps parents
    would be equally satisfied or more satisfied to receive
    supplemental services first.
        Senator Specter. Well, are you saying that in all
    situations where children want to move from an inferior school
    to a better school that there are remedial programs to
    discourage their moving?
        Secretary Spellings. Well, I'm saying that perhaps in the
    meantime, as we address these choice issues, that getting
    remediation in a particular skill or subject, quickly and
    readily available, convenient----
        Senator Specter. Well, are you talking about something
    which is realistic, so that we have inferior schools in those
    situations, all of those situations, or almost all of those
    situations, or most of those situations, you have remedial
    programs to discourage going to another school?
        Secretary Spellings. Well, I think it's a range of
    fallibility if you will. I mean, some of these schools are
    chronically low performing and that's why we need to spend $200
    million to make sure that real school restructuring takes
    place.

                     EFFECTIVENESS OF SUPPLEMENTAL SERVICES

        Senator Specter. Madam Secretary, my time is almost up and
    I'm going to observe the time. But the question really is, is
    that a palliative and a fig leaf, or does it really work?
        Secretary Spellings. I think supplemental services can work
    very well educationally for kids.
        Senator Specter. Can. But do they, are they? Are there
    sufficient supplemental services to pick up on this very
    critical program problem?
        Secretary Spellings. In some places there are, and in some
    places there are not, Senator. Clearly, I agree.
        Senator Specter. Well, that's not satisfactory. My red
    light went on, so I'm going to yield at this point to
    distinguished ranking member Senator Harkin.
        Senator Harkin. Thank you very much Mr. Chairman, I
    apologize for being late, I'll just forgo my opening statement
    and ask that it be made a part of the record, if that's okay.
        Senator Specter. Without objection, it will be made part of
    the record.
        [The statement follows:]
                    Prepared Statement of Senator Tom Harkin
        Good morning, Madam Secretary. I don't get to see you that often in
    person, so I want to take this opportunity to commend you for the steps
    you've taken to make the No Child Left Behind Act more flexible.
    There's still room for improvement, but you're responding to the
    concerns that many people have with this law, and you deserve credit
    for that.
        Today, however, our focus is on the President's proposed budget for
    education. And I must speak frankly: I don't see how anyone in this
    administration can defend it.
        This budget would cut federal education spending by $2.1 billion.
    That's the largest cut, in dollars, in the 26-year history of the
    Education Department. And it comes on the heels of a $600 million cut
    in fiscal year 2006--the first cut in a decade.
        It looks to me as if this administration has basically given up on
    the three programs that matter most to the Nation's students--Title I,
    IDEA, and Pell.
        Title I is the cornerstone program for the No Child Left Behind
    Act. It's the program that targets aid to the students who are most at
    risk of failing. That's why NCLB calls for a $2.2 billion increase for
    Title I this year. But how much more does the President ask for? Zero.
    It's flat funded.
        This administration has also given up on funding for students with
    disabilities. In fact, it's moving in the wrong direction. In fiscal
    year 2005, the federal government provided 19 percent of the average
    per-pupil expenditure toward the costs of special education. This year,
    fiscal year 2006, it went down to 18 percent. Next year, under this
    budget, it would go down again, to 17 percent. As the federal share
    goes down, states and local districts have to pick up more of the tab.
    And we all know what that means--higher property taxes.
        This administration has also given up on student aid. Under this
    budget, the maximum Pell Grant award would be frozen at $4,050, the
    same level as four years ago. I wonder if there are any colleges in
    America that charge the same amount for tuition that they did four
    years ago. I doubt it. It gets tougher and tougher all the time for
    low- and middle-income families to afford college, but this
    administration doesn't seem to care.
        It's as if the President said, ``Well, I spent a little money on
    education during the first couple years of my administration. So much
    for that. I'm done.''
        So if there's nothing in this budget for Title I, Pell, and IDEA,
    what is there? Unfortunately, a lot of the ``same old, same old.''
        Once again, the President proposes a high school reform initiative.
    But as far as I'm concerned, it's dead on arrival. The President asked
    for it last year, Congress rejected it, and the same thing will happen
    again this year, as long as it's contingent on eliminating the Perkins
    vocational ed program.
        And speaking of eliminations, the budget zeroes out 42 programs in
    all. Forty-one of them are programs you tried, unsuccessfully, to
    eliminate in the past. Congress restored the funding for them last
    year, and I can tell you right now, we'll restore funding for almost
    all of them again this year.
        Like I said, more of the ``same old, same old.''
        There are really only two new initiatives in this budget of any
    significance: the Math Now programs, which cost a total of $250
    million, and the Title I School Improvement Grants, which are budgeted
    for $200 million.
        I happen to like both of these ideas. In fact, I was the first
    Member of Congress to include funding for School Improvement Grants in
    an appropriations bill. In fiscal year 2003, when I was chairman of
    this subcommittee, I included $100 million for this program in the
    Senate Labor-HHS bill. It didn't end up getting funded, but I'd like to
    see it happen.
        But where will the money come from to fund these new initiatives? I
    guarantee you: We're going to restore the TRIO programs that this
    budget would eliminate. There's enormous bipartisan support for TRIO.
    So that's $456 million that we've got to find from somewhere. We're
    going to restore GEAR-UP, at $303 million. We're going to restore the
    Robert C. Byrd Scholarships, at $41 million. We're going to restore the
    counseling programs, at $35 million. I created that program, so I can
    assure you that Congress will save it.
        I could go on and on, program after program. But here's the bottom
    line: Unless the President helps up find more money overall for
    education, his new initiatives are simply not going to get funded, at
    least not anywhere close to the levels he wants.
        I've served on this subcommittee as ranking member or chairman
    since 1989, so I know what I'm talking about. If you want us to fund
    these presidential initiatives, you're going to have to work with us to
    get our congressional priorities funded as well.
        Again, Madam Secretary, I want to welcome you to the subcommittee.
    I look orward to hearing your testimony.

                  NO CHILD LEFT BEHIND FLEXIBILITY PROVISIONS

        Senator Harkin. Madam Secretary, welcome. First a
    compliment before I get into the other stuff, if you don't
    mind; I don't see you that often, I just want to take the
    opportunity to commend you for the steps that you've taken to
    make the No Child Left Behind Act more flexible. That has
    always been a sore point, and I appreciate that. There's I
    think, still some room for improvement. But I think you were
    responding to the concerns that many people have with this law,
    and I think you deserve credit for that--to get that
    flexibility in there. But that's aside from today.

              FISCAL YEAR 2007 EDUCATION DEPARTMENT BUDGET REQUEST

        We're talking about the budget. I guess my first question
    was, the budget that you've sent up for our subcommittee on
    education, would you Madam Secretary, like to see it passed
    exactly as you sent it up?
        Secretary Spellings. Well, Senator, as you know, we propose
    and you dispose. It's a process between the two of us, we
    seldom end up--you know, you all seldom enact exactly what the
    President sends up. I mean obviously----
        Senator Harkin. I'm just asking you. Do you back it? Do you
    back it as you sent it up?
        Secretary Spellings. Certainly. I support the President's
    budget.
        Senator Harkin. Does your boss the President back it as it
    was sent up.
        Secretary Spellings. Yes, he does.
        Senator Harkin. So he wants it enacted just like that?
        Secretary Spellings. Well, I think he believes that this is
    the smartest, best allocation of resources, given all the
    various priorities in the Government.

                         PROPOSED EDUCATION BUDGET CUTS

        Senator Harkin. I just want to get that clear for the
    record. That this isn't just some little game, that this is a
    budget that your boss the President of the United States,
    proposed to us, and this is how he'd like to see it enacted and
    so would you, Madam Secretary. Here is the biggest cut in
    Federal education spending, $2.1 billion in the 26 year history
    of the Education Department. Do you disagree with that?
        Secretary Spellings. Well, Senator----
        Senator Harkin. Is that figure correct, or not?
        Secretary Spellings. I can't remember the exact figure, the
    $2.1----
        Senator Harkin. That's what I have; I just want to make
    sure we're on the same page.
        Mr. Skelly. It's the biggest since 1988. So not 26 years.
        Senator Harkin. So what year was the bigger cut?
        Mr. Skelly. 1988.
        Senator Harkin. 1988 was a bigger cut?
        Mr. Skelly. In dollars and in percentage.
        Senator Harkin. In dollars and in percentage, in 1988.
        Mr. Skelly. Yes sir.
        Senator Harkin. Okay, so I was off a few years. Then we had
    a $600 million cut in fiscal year 2006. Right?
        Mr. Skelly. That's right, Senator.
        [Clerk's Note.--Senator Harkin was correct. The proposed
    cut of $2.1 billion would be the largest reduction in the 26-
    year history of the Education Department. The cut in 1988 was
    larger as a percentage of the total budget, but not in
    dollars.]

                             TITLE I GRANTS TO LEAS

        Senator Harkin. Okay. I just want to make sure we're on the
    same page. Now let's turn to Title I, cornerstone program of
    the No Child Left Behind Act. Madam Secretary, I read your
    testimony, you said it was the cornerstone.
        Secretary Spellings. I do.
        Senator Harkin. No Child Left Behind calls for a $2.2
    billion increase for Title I this year, how much did the
    President ask for? Zero. Flat funded.
        Secretary Spellings. As well----
        Senator Harkin. That's quite a cornerstone.
        Secretary Spellings. As well as some additional resources
    that attach to No Child Left Behind, like $200 million for
    school improvement.
        Senator Harkin. But Title I is the cornerstone, you say
    that. When it's flat funded and when No Child Left Behind Act
    calls for a $2.21 billion increase for Title I this year,
    something's wrong with the cornerstone.

                               SPECIAL EDUCATION

        Special education, Republicans and Democrats for years have
    been saying we've got to get it to the 40 percent level, you
    know what I'm talking about.
        Secretary Spellings. Right, I do.
        Senator Harkin. We've talked about it; we've had votes on
    it, Senate Resolutions that are 100 to nothing, or 99 to 1 or
    something like that, about doing this. Well, we've been inching
    up the last few years, under the leadership of Senator Specter.
    We've been getting it up; we've gone up to 19 percent. An all
    time high. Last year we went back to 18, under this budget we
    go back to 17 percent.
        I don't know how you can see this as any kind of progress
    at all on how the administration can support this.

                                  PELL GRANTS

        Student aid Pell Grants are now frozen at $4,050, the same
    as 4 years ago. Can you name me one college in the United
    States where the tuition is the same this year as it was 4
    years ago? There isn't such a place. Yet the Pell Grant's
    frozen at that. These are for the poorest of kids. I mean you
    know what you have to do to qualify for a Pell Grant?
        Secretary Spellings. I do.
        Senator Harkin. You just about have to have nothing to
    qualify for a Pell Grant. But yet, the President talks about
    his competitiveness initiative. Sounds great, we all believe in
    that, but is it just competitiveness just for the kids of
    wealthy families, or families who can get loans and stuff like
    that; how about competitiveness for the kids that qualify for
    Pell Grants. What about them? What about their competitiveness?
    Where do they fit into this picture? Well--I just don't see how
    you can support that. I'm not saying it's all bad. There are
    some things that you got in there that are good. Some of the
    math and science stuff is okay. That's fine. Little bits and
    pieces here and there. But in total, I just can't imagine your
    support for that. I see my time is up now, and I didn't really
    get a question in, but I wanted to make sure that we were
    talking about apples and apples, and not oranges and apples and
    that kind of stuff, and maybe on the second round I can have a
    question about that. Thank you very much.
        Senator Specter. Thank you, Senator Harkin. Senator
    Landrieu.

                   EDUCATION RESPONSE FOR HURRICANE RECOVERY

        Senator Landrieu. As the ranking member is here--before you
    came in Senator, I was complimentary of the Department, of the
    great work that they have done for the Hurricane Katrina and
    Rita victims, and said what a reliable partner they've been. I
    want to thank you also, Senator Harkin, because without you and
    Senator Specter our education aid bill would not have passed
    the way it did, and I want to say how much we appreciate that.

                        FISCAL YEAR 2007 BUDGET REQUEST

        Having said that, I want to agree with what both the
    chairman and ranking member said; not only do I think this
    budget is scandalous in terms of short changing our goals,
    Madam Secretary, for No Child Left Behind, but it's
    disheartening and wholly inadequate. Disheartening for the army
    of people out there trying to close these achievement gaps,
    making the changes, pushing themselves to achieve excellence,
    only to find their budget is being cut. While Title I is flat
    funded dollar for dollar for last year, because it does not
    have an inflation factor and it's not taking into consideration
    the extra efforts being made to move these poor and low-income,
    and moderate-income children up, it really is short changing
    their ability.
        Last night I got to attend a function in Washington, the
    Youth National Guard Youth Challenge Program, that tries to
    focus on reaching the 33 million Americans between the ages of
    16 and 24 that do not have a high school diploma--33 million
    Americans between the ages of 16 and 24. Those numbers don't
    just pop, they are created by budgets like this that do not
    provide the support of children in those early grades so that
    they could get a diploma of achievement--they can read, and
    calculate at grade level.
        I know that as the Department's Secretary you're
    responsible for carrying out the President's budget. But I want
    to say as a Senator who is given choices between extending
    dividend tax cuts, reducing capital gains taxes, this is what
    is paying for those tax cuts. The short changing in education
    for children in Louisiana, Mississippi, the Gulf Coast,
    Arizona, in Pennsylvania, in Wisconsin, and in places in Iowa,
    and all places are paying for those tax cuts. I think it's too
    heavy of a price. I just want to go on record. It's too heavy
    of a price to pay. We end up paying for it, in you know,
    criminal justice systems. We end up paying it in mental health
    services. The taxpayer's don't get a break. The taxpayers just
    pick it up in a more painful, more expensive way. I don't know
    when we're going to learn that investment in early childhood
    education is giving children a fighting chance. There's no
    guarantee of success, but I want to say for the record and my
    time, and I'd like to ask you this question because only our
    Federal portion represents about 8 to 10 percent of the total.
    The States are picking up about 70 percent, is that correct
    Madam Secretary of Education, expenses at the State level?
        Secretary Spellings. It varies around the country.

                 EQUITABLE DISTRIBUTION OF EDUCATION RESOURCES

        Senator Landrieu. What is the Department doing to try to
    equalize or make more equitable the funding in the country,
    from our wealthier counties, to our poor counties? If you could
    just focus a minute of your answer. I know we haven't directed
    you as such. Title I attempts to try to equal--it's Congress'
    best attempt to try to give poor and middle income children the
    same resources available. But is this Department at all focused
    on that resource gap? There's an achievement gap, but there's a
    resource gap. Do you know what it is, can you just tell us, and
    give us a minute of what you're doing to try to close that gap?

                   DISTRIBUTION OF HIGHLY QUALIFIED PERSONNEL

        Secretary Spellings. Well, that's a great question and I
    think it manifests itself in a lot of ways. Highly qualified
    teachers: one of the dirty little secrets in education is that
    our most qualified people are in our least challenging
    environments and vice versa, and so as we implement No Child
    Left Behind we ought to look at how States and school districts
    allocate highly qualified personnel. The President's budget
    proposal on Advanced Placement (AP)--I talked about the 40
    percent of the high schools that offer no AP at all. I use the
    example in my speeches that in Fairfax County, Virginia, you
    can find schools with 20 plus AP classes, whereas in the
    District of Columbia, Ballou High School has just 3 or 4. Those
    are exactly the kinds of things that we need to address as part
    of either implementing No Child Left Behind or the resources
    that the President has asked for.
        No Child Left Behind--whether it's for special education
    students or limited English speakers--has focused educators on
    bottom line results for all kids and resources. Obviously, our
    Federal commitment has always been to our Nation's neediest
    students, and that's why we invest so much money in IDEA and
    Title I, to help level out those educational opportunities
    around the country. With respect to Title I, obviously the
    formula reflects the numbers of poor kids as they migrate
    around our country.

                    PER PUPIL EXPENDITURES ACROSS THE NATION

        Senator Landrieu. Just to conclude though, Mr. Chairman, we
    focus on the neediest. But I can say from--there are a lot of
    middle-income families now that would classify themselves as
    middle-income that are stretched and need help and as we
    continue to cut these programs back, we're touching the bottom
    5 or 7 percent, when we should be trying to help the bottom 40
    or 50 percent. Tom, I would like you just to submit for the
    record, the difference in resources from the poorest counties,
    to the wealthiest counties to give us an update for the record
    of this committee. I understand in some places it's like $3,000
    or $4,000 a child, and then in some counties we're spending
    $12,000-$14,000 a child. I know that we don't direct that
    funding, but we can you know recognize that while there's an
    achievement gap, there's a resource gap that this committee has
    an obligation to fix, or try to fix. Thank you.
        [The information follows:]
          Education Funding in High-Poverty and Low-Poverty Districts
        Average expenditures per student vary across local educational
    agencies (LEAs) from about $3,300 to over $20,000 per student,
    according to the 2003 Public Elementary-Secondary Education Finance
    Data compiled by the Census Bureau. Most of the largest and smallest
    figures are for very small school districts with limited enrollment.
    For example, of the 10 LEAs with expenditures per student between
    $3,000 and $4,000, only 1 had an enrollment of over 100 students. They
    are mostly small, rural school districts, including 5 in Nebraska and 3
    in Montana. However, even excluding the very small and rural school
    outliers, there is a significant difference in the per-student averages
    among the poorest and wealthiest LEAs (with ``poor'' and ``wealthy''
    defined on the basis of the percentage of school-aged children living
    in poverty). The 100 LEAs with the lowest poverty rates and enrollment
    of at least 1,000 had average expenditures of $9,585 per student, while
    the 100 LEAs with the highest poverty rates and enrollment of at least
    1,000 had average expenditures of $7,897 per student.
        Among the poorest LEAs, defined as those with poverty above 40
    percent, there are many sizable school districts with average
    expenditures well below the national average of about $8,100. For
    example, Roosevelt Elementary School District in Arizona, with a
    poverty rate over 45 percent and enrollment of 11,000, had an average
    expenditure per student of $5,900. Laredo Independent School District
    in Texas (45 percent poverty; enrollment of 24,000) had an average
    expenditure per student of $6,900. Greenville Public School District in
    Mississippi (42 percent poverty; enrollment of 7,400) had an average
    expenditure per student of $5,900. But there are also many poor
    districts with larger than average expenditures per student. These
    include Muskegon Heights School District in Michigan (44 percent
    poverty; $10,300 per student), Todd County, South Dakota (40 percent
    poverty; $11,500 per student) and Rochester City School District in New
    York (40 percent poverty; $12,711 per student).
        The same can be said for the wealthier school districts. There are
    examples of high per-student expenditures, such as Fairfax County,
    Virginia (6 percent poverty; $9,500 per student), Montgomery County,
    Maryland (7 percent poverty; $10,580 per student), and Cherry Hill, New
    Jersey (3 percent poverty; $11,300 per student) as well as examples of
    low per-student expenditures, such as Clay County, Florida (9 percent
    poverty; $5,600 per student), Scottsdale School District, Arizona (7
    percent poverty; $5,600 per student), and Alpine School District in
    Utah (9 percent poverty; $4,400 per student).
        While the spread is significant between the poorest and wealthiest
    districts, there is a more noticeable pattern among States. The 142
    LEAs with an average expenditure per-student below $5,000 are in only
    17 States, with the majority in Arizona, Oklahoma, Utah, Montana, and
    Nebraska. At the other end of the spectrum, half of the 200 LEAs with
    the highest average expenditure per student are in three States:
    California, New York, and New Jersey.

                           VOCATIONAL EDUCATION FUNDS

        Senator Specter. Thank you, Senator Landrieu. Senator Kohl.
        Senator Kohl. Thank you very much Mr. Chairman.
        Secretary Spellings; you'll recall that we spoke at last
    year's hearing about Perkins Vocational Education program.
    Perkins is very important to every State, but particularly my
    State. Wisconsin received almost $25 million in Perkins funds
    last year, and over 23,000 students benefit in my State from
    Perkins services. The vast majority of Perkins recipients in
    Wisconsin have gone on to graduate and obtain high skill, high
    wage jobs. Last year the President proposed to eliminate
    Perkins funding but the Congress refused to go along, as you
    know. The Senate voted to reauthorize Perkins by a vote of 99
    to nothing. We also worked to restore most of the funding cut
    by the President. One would think that these actions would have
    sent a very strong message to the President, and Senators in
    both parties feel strongly about Perkins. Yet once again, as
    you know, the President's proposed elimination of this vital
    program in 2007. Would you explain how he apparently is so out
    of touch with we here who live and work with the problem
    everyday in our States? Not just to reduce Perkins, which is
    unacceptable, but to eliminate Perkins, which seems to me to be
    incomprehensible.

                       INVESTMENT IN SECONDARY EDUCATION

        Secretary Spellings. Senator, yes I will. The President
    believes that we ought to gather up the resources that we spend
    in vocational education, TRIO, and GEAR UP and a number of our
    secondary school investments and create a high school reform
    program; a $1.5 billion high school initiative for States to
    use as they see fit, around graduation rates and enhanced
    achievement for all high school students, including additional
    accountability and the like. When and where vocational
    education programs, GEAR UP, TRIO, any of those programs work
    well, then States can and should--and I'm confident will--
    continue to invest in those. But I think we also have to look
    at our results of secondary education, and that is about half
    of the African American and Hispanic kids who start high school
    do not complete high school. When these resources and these
    programs are targeted to them I think we have to ask ourselves,
    are they working as well as they can be in the aggregate.
        Senator Kohl. Well, I don't think you've really answered
    the question, he still proposes eliminating Perkins and
    aggregating it all really in the final analysis results in
    cuts. But it's just done in a way that we don't really see how
    these cuts occur, but that's I believe pretty clear to most of
    us who look at this closely that aggregating really involves
    cutting. Madam Secretary, I supported the No Child Left Behind
    because it guaranteed flexibility and accountability would come
    with more Federal funding to make it work. Instead, funding
    levels have fallen billions of dollars short of what was
    authorized and these cuts as you know cause real hardships.
    Schools are being forced to cut staff and important programs
    like summer school, class size reductions, arts, physical
    education, and languages. Last year almost 11,000 schools
    failed to make adequately yearly progress under No Child Left
    Behind thus facing Federal sanctions. These schools will face
    even greater challenges as testing and teacher quality
    requirements go into full effect.
        So isn't it time to provide the funding that was promised
    so that we can give schools and students a real chance to
    succeed which was the premise behind No Child Left Behind, that
    there would be funding which is by all accounts not what was
    promised. Where do we go from here?

                         ALLOCATION OF BUDGET RESOURCES

        Secretary Spellings. I think what you'll find in the
    President's budget, and it is a tough budget no doubt about it,
    is that the resources are allocated around the core principles
    of No Child Left Behind, such as our sustained investments in
    Title I, in reading, in teacher quality, and the accountability
    features and achievement. That those are our most--that's our
    most urgent calling, and our highest priority for resources.

                                  PELL GRANTS

        Senator Kohl. Madam Secretary, the President's budget
    proposal also targets student aid programs for harmful cuts
    including a $4.6 billion reduction in funding for Pell Grants.
    The maximum Pell Grant award is again frozen at $4,050 for the
    fifth year in a row, despite rising tuition costs. These may
    just seem like numbers but they also have a real impact on
    students who are struggling to go to college. The University of
    Wisconsin in Madison alone dispersed $9.2 million in Pell
    Grants to 3,751 low-income students last year. In 1975 the Pell
    Grant recovered 80 percent of the costs of a 4-year public
    education in college and today that number is down to about 40
    percent. So my question is, how can this administration claim
    to want to make higher education a reality for low-income
    students while at the same time cut the very programs that
    would help them achieve that goal.
        Secretary Spellings. Well, let me respond in a couple of
    ways. One, while as you said the Pell Grant itself is still
    $4,050, the actual grant has not been cut. There will be about
    59,000 more students who will be taking advantage of Pell
    Grants. In addition to that, as part of the reconciliation that
    you all passed, there are additional resources for students who
    are studying in the critical areas of science, technology,
    engineering and math. Starting with about an additional $750
    for year one of their studies, going up to $4,000 by the fourth
    year if they pursue those particular fields. As you know, the
    Congress finally has eliminated the Pell shortfall that has
    vexed us for so long, which is most of that $4 billion that you
    spoke of, but I think what we know is that the community
    colleges, in particular, continue to be able to offer a full
    and complete education at the Pell Grant level. So it's a
    matter of students frequently starting there at community
    college as opposed to a State university. But the Pell Grant
    does remain stable at $4,050.

                               PREPARED STATEMENT

        Senator Kohl. Thank you, and before I turn it back to the
    chairman, my time has expired. When you keep a program like
    Pell Grants at the same level for 5 years, you are reducing its
    value, obviously. When I pointed out that the Pell Grant
    covered in 1975, 80 percent of your public education and today
    it's 40 percent, that describes the erosion of keeping the
    number at a constant level. Thank you so much, and thank you
    Mr. Chairman.
        [The statement follows:]
                    Prepared Statement of Senator Herb Kohl
        Thank you, Mr. Chairman. Secretary Spellings, I join my colleagues
    in welcoming you here today. You face a significant and challenging
    task in managing the Department of Education and I hope that we can
    work together to improve access to education for all Americans.
        I appreciate the difficult task you face in funding the many
    education priorities of our country. That job is more challenging, in
    our view, because this Administration has chosen budget and tax
    policies that have led to rising deficits and diminishing resources
    available for essential education programs.
        This budget is abysmal for the education community. It proposes the
    largest cut to federal education funding in the 26-year history of the
    Department. Students, educators, parents, and administrators all lose
    out under this budget. Funding for No Child Left Behind and Special
    Education, the main federal funding streams for our local school
    districts, are a far cry from their authorized levels. More
    specifically, funding for No Child Left Behind is $12.3 billion dollars
    below the authorization level, and IDEA is $6.3 billion short in 2007.
    In addition, over forty programs are slated for elimination, including
    funding for Career and Technical Education, Safe and Drug Free Schools,
    and TRIO programs.
        The President's budget should reflect our nation's priorities--but
    these are just a few examples of this budget being out of step with our
    values. I will continue to work with my colleagues to improve upon this
    budget. Madame Secretary, I hope that you will work with us to better
    meet our nation's education needs.

        Senator Specter. Thank you Senator Kohl, Senator Craig.

                      AMERICAN COMPETITIVENESS INITIATIVE

        Senator Craig. Mr. Chairman, thank you very much. Madam
    Secretary, I'm pleased you're with us this morning. First and
    foremost, I want to commend you and the President for including
    the American Competitiveness Initiative in his State of the
    Union. I thought that was critically important, and I'm looking
    forward to working with the Department of Education and in this
    instance the Department of Energy will have a fair chunk of
    that, and my colleagues in the implementation of many of those
    proposals. I think it's important. I think we can convince the
    American people it's important, that we remain competitive and
    that we design a system that allows us to do that. When we were
    holding hearings on that recently in the Energy committee I was
    likening it to our reaction to Sputnik. The Defense Education
    Act of the 1960s that followed and the tremendous--and the
    fallout, the positive fallout of that down through the decades,
    as we trained a generation of mathematicians, and scientists,
    all because we found ourselves not competitive in the real
    world in a cold war environment and out of that space
    initiative and everything else. Of course because the--what I
    believe is a national crisis we're in today as it relates to
    energy, we take that a lot easier because the lights are still
    on, and even though gas is more expensive at the pump, it's
    still there and we're adjusting accordingly even though it's
    costing us, you know, lots of jobs out there in the industrial
    sector today, and all that. The new world that we compete in is
    going to be ever demanding.
        We all know those stories, they are real and I'm glad to
    see the President out on the edge of that, pushing it. That's
    extremely important for us. In the context of doing that
    although, I think we have to shape budgets that begin to fit
    that and move us in those directions, and they are bits and
    pieces of all that we're talking about in order to meet the
    challenges laid out by the President in the Competitiveness
    Initiative. I believe that bringing professionals into the
    classrooms will be tremendous assets to our students. Yet the
    system is so rigid to allowing that to happen today that it
    almost, at the very beginning unless we break down some of
    those barriers towards the very initiative that's underway.
    What programs have been or are being implemented to ensure that
    professionals interested in teaching have the training they
    require, and do you believe the President's budget provides
    adequate funding to bring these professionals ultimately into
    the classroom to work alongside the educator in inspiring these
    young people into these different areas that are within the
    Competitiveness Initiative?

                            ADJUNCT TEACHERS PROGRAM

        Secretary Spellings. Thank you for that question. The
    President's budget calls for $25 million to start to seed some
    of this kind of activity, which we call Adjunct Teachers. We
    use this all the time in higher education, especially in
    community colleges, and it's very effective. Typically, people
    who are engaged in their own profession teach part time in
    higher education. Many of these students now, high school
    students, enjoy dual enrollment programs between community
    colleges and high schools, and they are already being served by
    the kind of professionals that you talk about. IBM has
    committed 1,200 engineers and other highly skilled
    professionals to make transitions into the teaching profession,
    so I do think there's an appetite and a willingness out there
    and a need--a dramatic need--for those sorts of competencies.
    We have some models to build on through Troops-to-Teachers,
    Teach for America, and some other programs that have taken mid-
    career professionals and helped them become effective teachers.
    But I think the notion is, let's be able to get some of our
    expertise and resources from the broad community around some of
    these 185 day, 10-month contract sort of structures, that we're
    so used to dealing with in education.

                 INNOVATIVE HIGH SCHOOL RESTRUCTURING IN IDAHO

        Senator Craig. I had the privilege, Mr. Chairman, of
    walking through a new high school in Idaho during this last
    recess. The largest building in our State from the standpoint
    of an educational institution, 2,200 students. I thought, oh my
    goodness, how can they possibly handle 2,200; surely they must
    be lost in the system, because I was thinking of the old
    models. But I walked into a school with academies, and the
    allowance to actually begin shaping from your freshman year on,
    some core competencies that move you then into community
    colleges, or into University settings. In the junior senior
    year, that nexus with the community college that you had--I
    spent a couple of hours there, spoke with the senior class, and
    walked out with a total different opinion. Or a sense of
    understanding as to these new structures, and in this
    particular school district which is the fastest growing in our
    State, they're building a new high school about every 2 years
    now, they're moving to this concept. They feel they can go to
    larger schools but they allow the student to actually identify
    with a much smaller unit within the school. It's impressive.
    It's happening at other places in the county. Idaho is not
    alone in it certainly, and it makes some very real sense, tied
    to this competitive initiative, and being able to move young
    people out earlier. Those who chose to, to get into that higher
    learning, frankly, can break through the rigidity of the
    current system that says, no, no this is the way we've always
    done it, we control it, so this is the way you're going to do
    it. If it isn't providing us with that level of training and
    talent, then we've got to break through it, and if you can't
    live within it, you get outside of it, I guess, and that's
    starting to happen in parts of Idaho where we have community
    college settings in which they can cooperate. That's a pretty
    exciting concept. But in doing so--and then transitioning them
    forward, there was concern about the Pell Grants and other
    tools to make sure that those students can carry on, and I'm
    looking at this budget concerned about obviously areas like the
    Federal Direct Student Loans and the Federal Family Education
    Loans, and all of those kind of things. Those tools are going
    to be in part a necessary component of any kind of
    competitiveness initiative to move these young people forward.
        Secretary Spellings. I agree with that.
        Senator Craig. Thank you.
        Secretary Spellings. Absolutely, Senator. I think I'd love
    to visit that school, I mean these are places as you said----
        Senator Craig. You want to visit it?
        Secretary Spellings. I would like to.
        Senator Craig. Fine, you'll get an invitation today.
        Secretary Spellings. Good.
        Senator Craig. We'd love to have you out.

                                ADJUNCT TEACHERS

        Secretary Spellings. Establishing the nexus between higher
    education and high school, that can be more efficient and more
    effective as we get these professionals who are working in the
    field, and who have this expertise, because we're frankly going
    to be very challenged to do it other ways.
        Senator Craig. Well, it's an exciting model, and as I say,
    there are many large schools across the country that are
    recognizing that high schools of 2,000, if not restructured,
    lose children.
        Secretary Spellings. Exactly.
        Senator Specter. Thank you very much, Senator Craig.
    Senator Murray.

                             SCHOOLS-WITHIN-SCHOOLS

        Senator Murray. Well, thank you very much Mr. Chairman, and
    Senator Craig, I'm delighted to hear that you went to that
    school. The Gates Foundation has been focusing on schools-
    within-schools, with some real successful programs.
        Senator Craig. If you'll let me interrupt. I'm not
    absolutely sure, but it's very possible they're participating
    in this one. Yes.

               ACADEMIC COMPETITIVENESS AND NATIONAL SMART GRANTS

        Senator Murray. Yeah. I agree with the focus on high
    schools. I think it's absolutely critical that we as a Nation
    really find out why we're losing kids at such dramatic rates.
    Those kinds of programs really make a difference. But let me,
    Madam Secretary, talk with you a minute about some of the
    academic competitive grants in the national science and
    mathematics act says to retain talent, the SMART grants. To
    receive those American competitive grants, students have to
    have completed what is called the rigorous secondary school
    program of study. Now I agree, as I said that we have to do
    everything we can to prepare students for the global economy
    they're going to be in. Whether--but I think a student's luck
    in where they attend high school, whether it's Senator Craig's
    or another one, shouldn't determine whether or not the Federal
    Government helps them attend college. CBO estimated that only
    9.9 percent of the Pell eligible students are going to be able
    to take advantage of those academic competitiveness and SMART
    grants in 2007. Now the maximum Pell Grant has not increased
    for 4 years despite as we all know tuition rising at our
    Nation's public colleges by over 7 percent last year. So if the
    $850 billion that those grants cost in 2007 were spent on Pell
    Grants, students would actually receive an additional $200 in
    aid that would have made a tremendous difference. I would like
    to find out from you, how you anticipate judging what
    constitutes a rigorous secondary school curriculum?

                        RIGOROUS HIGH SCHOOL CURRICULUM

        Secretary Spellings. That's a great question and we're
    struggling with that at the Department now. About a week ago,
    we had folks in from the Gates Foundation, from the National
    Governors Association, and from the Council of Chief State
    School Officers to look at and talk about what's the most
    appropriate way to do that while being very respectful of our
    prohibition at the Department of Education for prescribing
    curriculum. I certainly don't want to sit up here and look at
    high school course syllabi and so forth. So we're working on
    that right now. I mean, I think we know things that are widely
    accepted, like Advanced Placement, International Baccalaureate,
    and the State Scholar's program--that 14 States have already
    bought into place, i.e. their determination of a college-ready
    curriculum. For State Scholars this is 4 years of English, 3
    years of math and science, and 2 years of foreign language.
    We'll be announcing another 8 to 12 States that will be joining
    the State Scholars program soon. So States have come to terms
    largely, or are beginning to, with what they believe to be
    college-ready, so that, I hope, will be informative as we look
    at the Academic Competitiveness Grants.
        Senator Murray. Well, I appreciate the goal, but here we
    are in 2007 where less than 10 percent of the students are
    going to be eligible for these grants, and in tight budget
    times it seems to me that using those dollars to help all kids
    get $200 in aid, not just those who are lucky enough to attend
    a high school that works out to have a ``rigorous schedule.'' I
    just think it's something we have to manage. So I'm very
    concerned about a large amount of money funneling to a few kids
    who happen to be in the right high school, with the right
    curriculum, versus us being able to help all students with an
    additional $200 with the same pot of money. So it's just a
    budget issue in my mind. Obviously you've got a program you
    love, and you want to go down that road. But in tight budget
    times we have to say, are we going to help all kids out there,
    or just the ones who are lucky enough to have that somehow
    undefined yet rigorous curriculum.
        Secretary Spellings. Well, it's also obviously our
    responsibility to make sure that we have a college-ready
    curriculum, and this is why we need more Advanced Placement in
    more places, and so forth, making such a curriculum available
    to all kids everywhere.
        Senator Murray. Well, I think it's good to provide
    incentives to high schools to move towards a rigorous
    curriculum, I'm with you on that. But I don't want to see us
    use the kids as a tool. Because in the end they are the ones
    who are not going to be able to go to college based on where
    they went to school. I think it's so important that we provide
    that opportunity, but it's a philosophical debate.

                                  HEA TITLE IX

        I have limited time. I wanted to ask you about Title IX. On
    March 17, the Department released a new guidance on the
    interest prong of the three-part test which schools are using
    to show their compliance with Title IX. As you are aware, I
    have some really grave concerns about this new guidance,
    because I believe it sets a new low bar for compliance with the
    Federal Civil Rights Law. Schools would now be allowed to use
    an email survey to show their compliance with Title IX. The
    school would only have to send that survey to women. So, a lack
    of response at our universities where kids already have a lot
    to do, and may just say to heck with that, seems to me a very
    poor way to be determining compliance with Title IX. Now I know
    that it's used--surveys are used as part of compliance, but
    it's the sole means to making sure whether a school complies or
    not, to me seems really wrong headed.
        Now as you know there's a lot of concern over this new
    guidance, and there's a bipartisan group of Senators on the
    subcommittee who have asked for a report on the guidance and
    the use of surveys and I wanted to find out from you this
    morning what the status is of that?
        Secretary Spellings. We'll be completing that next month. I
    believe you all gave us a deadline for March sort of timeframe
    there. We will be completing it then. I do want to note that
    we've not had any complaints about the survey aspect yet, and
    frankly as you know it is a legitimate prong to ascertain
    interest. This is prong three.
        Senator Murray. But the sole prong is a problem.
        Secretary Spellings. We have about 116 schools around the
    country that do that now. But your report is due March 17, and
    we intend to meet that deadline.
        Senator Murray. Okay, well there's a lot of confusion on
    behalf of schools about the guidance. I want to know what your
    department is doing regarding technical assistance to schools
    on the guidance of that?
        Secretary Spellings. You have recently confirmed Stephanie
    Monroe as AS for OCR. I've had a vacancy in that job for a long
    time, and we are providing technical guidance around that
    issue. I'm a mother of two daughters, I'm very committed to
    their opportunities as well, and so----

                               PREPARED STATEMENT

        Senator Murray. Well, we all are. But if we base compliance
    on an e-mail survey to women in college expecting that their
    response back as students is going to decide whether or not a
    school is compliant, I think that is just not a very smart way
    to go. I'm going to continue to work with other likeminded
    Senators to make sure we don't somehow use that information to
    take away the ability of many young women in this country to be
    able to access sports in colleges.
        [The statement follows:]
                   Prepared Statement of Senator Patty Murray
        Secretary Spellings, thank you for coming today to talk with us
    about the President's fiscal year 2007 budget request for the
    Department of Education. I want to take this opportunity to say that I
    have always believed that the federal budget is more than just a
    compilation of numbers. Rather, it is a collective statement of the
    values and priorities of our nation. Looking at the figures included in
    the President's fiscal year 2007 budget request for the Department of
    Education--which is the largest cut in federal education funding in 26
    years--I have to say that I question the value that the President is
    placing on educating our nation's youth this year.
        As a country, we are required to articulate and defend our values
    and priorities, particularly as we undergo the annual budget process.
    While I share the President's stated commitment to preparing our nation
    and workforce for the competition of the 21st century, I am
    disheartened to see that his rhetoric about the importance of leaving
    no child behind is not matched by the budget numbers this
    administration put forward in its fiscal year 2007 request.
        I want to remind my colleagues that what we do in the next few
    weeks will affect us--and the American people--for a long time. The
    budget decisions we make now will either empower us--or tie our hands--
    when we turn to determining funding levels in this appropriations
    committee later this year. That is why I must say I strenuously object
    to the request put forward by the President.
        While it's true that the President's budget includes increased
    dollars for math and science education, these funds come at the expense
    of cuts or elimination to other important programs. I view new
    initiatives in math and science as complements to, but in no way
    substitutions for, the other federal education investments we have made
    over the past 40 years. While science and math competence are
    undoubtedly a critical piece of what our students need to compete
    globally, it cannot come at the expense of helping disadvantaged
    students succeed academically, investing in our high schools, and
    ensuring our college students have the financial means to attend
    postsecondary education.
        I am particularly disheartened that the administration continues to
    fall behind in meeting its commitments under the No Child Left Behind
    Act. The President's fiscal year 2007 request does not include any
    increases in NCLB's cornerstone program, Title I. The administration's
    decision to recommend level funding--at a time when requirements and
    accountability provisions for our schools continue to grow--essentially
    asks our schools to do more with less resources. This inconsistent
    messaging is disingenuous and unfair. What's worse, our students,
    parents, teachers and schools suffer as a result.
        I also want to express my concern about the High School Reform
    package the President is promoting. As you know, I have been an
    advocate for focusing federal education resources to our nation's high
    schools. That is why last year I introduced my Pathways for All
    Students to Succeed (PASS) Act, to provide targeted resources to our
    nation's high schools. The PASS Act would help America's teenagers
    graduate from high school, go on to college, and enter the working
    world with the skills they need to succeed.
        While I appreciate the President's interest in high school reform,
    the reality is that he elected to pay for these reforms by cutting
    important programs. The $1.475 billion he is proposing for his high
    school package doesn't come close to replacing the money we currently
    spend on the 42 programs, including vocational and technical education,
    GEAR UP and TRIO, proposed for elimination. At a time when 3,000
    students drop out of high school each and every school day and when
    half of our nation's African American and Latino students do not
    complete high school, we need to be doing more, not less, to make our
    high schools places where all students can learn.
        In addition to stemming the tide of high school dropouts, we must
    assist students in the transition from high school to college by
    providing financial resources to facilitate access to higher education.
    Yet recently the federal government cut $12.7 billion from student
    loans that help low- and middle-income families pay for college. This
    decision, during a year in which tuition and fees increased by 7.1
    percent for four-year public universities and 5.9 percent for private
    universities, does not reflect our national priorities. In the same
    vein, the value the President purports to place on higher education is
    not reflected in his budget, which level-funds the Pell Grant program
    for the fourth year in a row.
        As we work together in the next few weeks to prepare the budget
    resolution, I will do my best to ensure that the values and priorities
    of our nation and my state of Washington are reflected in the numbers
    to which we will hold ourselves. As a policymaker and parent, I know
    that American competitiveness demands a more comprehensive approach to
    education. We must match our rhetoric with the necessary resources to
    support all of our students, at all grade levels, in all subject areas.
    Our children--and our country--deserve nothing less.
        Thank you.

                      PROPOSED GEAR UP PROGRAM ELIMINATION

        Senator Specter. Thank you, Senator Murray. Madam
    Secretary, what participation did you have in the elimination
    of the program known as ``GEAR UP'' that's been in existence
    for about 7 years? On the ratings by OMB, they say ``GEAR UP''
    is based on successful models for increasing the college
    enrollment rate of at-risk students. Initial program results
    suggest that grantees have been more successful in increasing
    the percentage of students taking a more challenging course
    load, better preparing these students for future college
    enrollment.
        It was an idea advocated by Congressman Chaka Fattah, who
    has had a lot of experience in government in Philadelphia,
    where there are tough schools with a lot of dropouts and a lot
    of students with problems. It has been a program which has been
    funded principally out of the Senate that I have spoken about
    repeatedly. Let me ask you a two-part question. What do you
    think the chances are that ``GEAR UP'' is going to be dropped
    by the Congress? Second, what did you have to do with dropping
    it, if anything?
        Secretary Spellings. Well, Senator, first let me say that
    you know ``GEAR UP'' was invented in Houston, Texas, I mean
    when President Bush was Governor, we were strong supporters of
    it.
        Senator Specter. Does President Bush know that?
        Secretary Spellings. Yes. President Bush, then Governor
    Bush.
        Senator Specter. Does President Bush know it's being
    dropped?
        Secretary Spellings. I presume he does.
        Senator Specter. I'm going to tell him.
        Secretary Spellings. I presume he does.
        Senator Specter. Have you told him?
        Secretary Spellings. Yes, sir. But let me tell you what
    his----
        Senator Specter. No, no. Have you--well you can tell me,
    but first tell me, have you told him?
        Secretary Spellings. Have I told him specifically ``GEAR
    UP'' is not in the budget?
        Senator Specter. Yes, ma'am, specifically. Have you told
    him that ``GEAR UP'' has been dropped?
        Secretary Spellings. I don't believe that I have told him
    that specifically.
        Senator Specter. Do you know if anybody has told him that
    specifically?
        Secretary Spellings. I do not.
        Senator Specter. Get the President on the phone.
        Secretary Spellings. I certainly will tell him.

                            START OF GEAR UP PROGRAM

        Senator Specter. He calls me with some frequency when he
    wants Supreme Court Justices confirmed. Next time he calls, I'm
    going to parry him with this question about ``GEAR UP''; I
    didn't know it was started in Houston.
        Secretary Spellings. By Jim Ketelsen. The former CEO of
    Tenneco.
        Senator Specter. The first question I'm going to ask him
    is, Mr. President, do you know ``GEAR UP'' was started in
    Houston? Second question I'm going to ask him is, do you know
    that ``GEAR UP'' has been dropped? The third question is, do
    you know the Secretary of Education didn't personally tell you
    that it was being dropped?
        Secretary Spellings. You can tell him that.
        Senator Specter. Okay. It's your turn.

                         HIGH SCHOOL REFORM INITIATIVE

        Secretary Spellings. But let me say this, the President's
    philosophy here around this high school reform issue is that
    you need a block grant kind of program. That we ought to gather
    secondary school resources into a $1.5 billion title that we're
    saying would get results. That we shouldn't sit up here and
    say, here's how you should get results. Now I fully believe
    that in Houston, Texas, in Philadelphia, and places where these
    programs are working well, and effectively, they will continue
    to do those. I can't say that that's necessarily true in the
    aggregate. Where they're going to be effective they'll be
    maintained. I'm confident of that. The President's philosophy--
    --
        Senator Specter. How will they be maintained without
    funding?
        Secretary Spellings. They will be paid for then out of the
    high school initiative.
        Senator Specter. So you rob Peter to pay Paul, which is
    what I said on my last round of questions, I'll probably say it
    in my fourth round, too.
        Secretary Spellings. I mean, I guess you could look at it
    that way. We're gathering resources out of silos, out of
    specific prescribed programs.
        Senator Specter. So you think really, you ought to keep
    ``GEAR UP'' but under another name?
        Secretary Spellings. No. I'm saying that States and local
    school districts ought to have the opportunity to design and
    choose programs as they see fit, including GEAR UP, Vocational
    Education, or others.
        Senator Specter. But, when it's been a successful Federal
    program, and has all the backing from the Members of the House
    and Senate, why submit a budget which cuts it?
        Secretary Spellings. Well, I think the President believes
    that successful programs will be invested in with Federal
    dollars and maintained and enhanced at the State and local
    level.
        Senator Specter. Federal programs will be invested with
    Federal dollars and maintained, and enhanced at the State and
    local level?
        Secretary Spellings. That where--in Philadelphia where this
    is working well, they will use their high school resources to
    invest in ``GEAR UP'' and they'll probably use State and
    local----
        Senator Specter. What resources? They're strapped to the
    edge now.
        Secretary Spellings. Under the high school reform block
    grant, if you will, the $1.5 billion in Federal funds that
    would be invested in high school reform, this program would
    absolutely be an allowable purpose.

            FISCAL YEAR 2006 FUNDING LEVEL OF PROPOSED TERMINATIONS

        Senator Specter. Well, since that will happen I can rest
    easy seeing it cut, I guess. Except that I won't. Senator
    Harkin, why don't you do that on your time. Harkin wisely
    points out. What was it you wisely pointed out?
        Senator Harkin. That their reform package is $1.5 billion,
    but the total amount that gets cut out of all these other
    programs is $2.1 billion.
        Senator Specter. How about that, Madam Secretary?
        Secretary Spellings. Well, I think it's more like the $1.5
    billion that we have gathered up. I don't know what all the
    elements are that are in the $2 billion estimate that you have,
    Senator Harkin, but it depends on what's on the list, I guess,
    is the short answer.
        Senator Specter. Madam Secretary, you can see the smooth
    coordination. I frequently use the expression that when we
    change chairman and ranking member that it's a seamless passage
    of the gavel, which I now undertake to do, so that he can
    follow up on his Charlie McCarthy, Edgar Bergen question that I
    asked on his behalf. Senator Harkin.
        Senator Harkin. Wait a minute. Which one am I?
        Senator Specter. You're Edgar Bergen, I can tell you that.
        Senator Harkin. Okay, well, to follow up on this.
        Senator Specter. Secretary Spellings is too young to really
    know who either is.
        Secretary Spellings. I was just going to say you're dating
    yourselves. But I wasn't going to say anything.
        Senator Harkin. But to follow up on it, Madam Secretary. I
    understand the High School Initiative program is at $1.475
    billion. But there are 40 some programs that were eliminated.
    All the TRIO programs, Talent Search, Upward Bound, Smaller
    Learning Communities, that's $2.1 billion. So you've taken away
    $2.1 billion that goes out to these high schools, and saying
    now, here's $1.5 billion.

                         HIGH SCHOOL REFORM INITIATIVE

        Secretary Spellings. Here's the difference. Part of the
    Perkins Vocational Education Program goes into community
    colleges and is in the postsecondary education environment, if
    you will, and so the high school reform proposal at $1.5
    billion reflects the investments that are currently going to K-
    12 schools. The difference, the additional funds, can be found
    in community colleges, which is obviously higher education.
        Senator Harkin. Oh, so you're saying that Talent Search,
    Upward Bound and all those programs are now shifted somehow to
    community colleges?
        Secretary Spellings. No, sir. I'm saying that the Perkins
    Voc Ed Program, some of those resources end up in community
    colleges, some end up in high schools. Trio, GEAR UP, those
    sorts of programs that are high school programs, would, could
    be funded from the $1.5 billion high school side of it.
        Senator Harkin. Okay. I understand what you're saying now.
    Please understand what I'm saying, that you add up all those
    cuts in those programs, it's $2.1 billion. You replace that
    with $1.475 billion for your high school initiative. So when
    you say that schools, well, if they want to continue the
    successful programs, they could. Well, I guess what I would ask
    you to submit to this committee is which of these, is it 42
    programs, 40 some, I forget what it was, that you're asking to
    be eliminated--I mean, which of those are you saying are not
    successful?
        Secretary Spellings. Well----
        Senator Harkin. Which of them are not successful? Please.
        Secretary Spellings. We have a PART process that rates the
    programs. I certainly could give that PART list for the 42
    programs and will. The difference I want to say on the $2
    billion worth is that, in the Perkins Program, part of those
    resources go to community colleges, so the high school
    initiative at $1.5 billion is, it reflects the resources that
    are spent in K-12 schools.
        [The information follows:]
     OMB PART Ratings for Programs Proposed for Termination in the Fiscal
                            Year 2007 Budget Request
        OMB developed the Program Assessment Rating Tool (PART) in order to
    assess and improve program performance so that the Federal Government
    can achieve better results. Ratings are based on questions in four
    critical areas--purpose and design, strategic planning, management, and
    results and accountability. The answers to questions in each of the
    four areas result in numeric scores, which are combined to achieve an
    overall qualitative rating that ranges from Effective, to Moderately
    Effective, to Adequate, to Ineffective. Programs for which we have
    insufficient evidence from either performance data or rigorous program
    evaluations cannot be assessed and receive a PART rating of Results Not
    Demonstrated. PART assessments help our Department and OMB improve the
    performance of Federal programs by identifying flaws in program design,
    management, or implementation that undermine effectiveness. PART
    assessments also help inform funding decisions, but a program's PART
    rating would not dictate budget policy. For example, the Administration
    might not request funding for a program for which there is not a clear
    Federal role or which is duplicative of other programs, even if it is
    rated Effective or Moderately Effective.
        The following chart shows whether programs proposed for termination
    in the fiscal year 2007 budget request have been assessed using the
    PART, and if assessed, the year of the assessment and the rating the
    program received.

        OMB PART FINDINGS FOR EDUCATION DEPARTMENT DISCRETIONARY PROGRAMS
                  PROPOSED FOR TERMINATION IN FISCAL YEAR 2007
    ------------------------------------------------------------------------
                 Program                Year assessed         Rating \1\
    ------------------------------------------------------------------------
    TRIO Talent Search..............  2003/2005........  Moderately
                                                          Effective
    Comprehensive School Reform.....  2002.............  Adequate
    GEAR UP.........................  2003.............  Adequate
    Projects with Industry..........  2004.............  Adequate
    Even Start......................  2002.............  Ineffective
    Safe and Drug-Free Schools State  2002.............  Ineffective
     Grants.
    TRIO Upward Bound...............  2002.............  Ineffective
    Vocational Education State        2002.............  Ineffective
     Grants.
    B.J. Stupak Olympic Scholarships  2004.............  Results Not
                                                          Demonstrated
    Byrd Honors Scholarships........  2004.............  Results Not
                                                          Demonstrated
    Educational Technology State      2005.............  Results Not
     Grants.                                              Demonstrated
    Leveraging Educational            2004.............  Results Not
     Assistance Partnership.                              Demonstrated
    National Writing Project........  2004.............  Results Not
                                                          Demonstrated
    Parental Information and          2004.............  Results Not
     Resource Centers.                                    Demonstrated
    Smaller Learning Communities....  2005.............  Results Not
                                                          Demonstrated
    Teacher Quality Enhancement.....  2003.............  Results Not
                                                          Demonstrated
    Tech-Prep State Grants..........  2002.............  Results Not
                                                          Demonstrated
    Academies for American History     ................  Not Assessed
     and Civics.
    Arts in Education...............   ................  Not Assessed
    Civic Education.................    ...............  Not Assessed
    Close Up Fellowships............    ...............  Not Assessed
    Demonstration Projects for          ...............  Not Assessed
     Students with Disabilities.
    Elementary School Counseling....    ...............  Not Assessed
    Excellence in Economic Education    ...............  Not Assessed
    Exchanges with Historic Whaling    ................  Not Assessed
     and Trading Partners.
    Federal Perkins Loans               ...............  Not Assessed
     Cancellations.
    Foundations for Learning........    ...............  Not Assessed
    Javits Gifted and Talented......    ...............  Not Assessed
    Mental Health Integration in        ...............  Not Assessed
     Schools.
    Ready to Teach..................    ...............  Not Assessed
    Safe Drug-Free Schools Alcohol      ...............  Not Assessed
     Abuse Reduction.
    School Dropout Prevention.......    ...............  Not Assessed
    School Leadership...............    ...............  Not Assessed
    Star Schools....................    ...............  Not Assessed
    State Grants for Incarcerated       ...............  Not Assessed
     Youth Offenders.
    Thurgood Marshall Legal             ...............  Not Assessed
     Educational Opportunity Program.
    Underground Railroad Program....    ...............  Not Assessed
    Vocational Education National      ................  Not Assessed
     Programs.
    VR Migrant and Seasonal            ................  Not Assessed
     Farmworkers.
    VR Recreational Programs........   ................  Not Assessed
    VR Supported Employment State      ................  Not Assessed
     Grants.
    Women's Educational Equity......   ................  Not Assessed
    ------------------------------------------------------------------------
    \1\ Reflects the most recent rating for programs that were reassessed.

    NOTE: A total of 74 ED programs have been assessed since 2002 using the
      Program Assessment Rating Tool (PART); additional programs will be
      rated in the future.

        Senator Harkin. So in your opinion the $2.1 billion and
    $1.5 billion that's just money that normally goes to community
    colleges, is that right?
        Secretary Spellings. Yes, sir.
        Senator Harkin. Well, I'll have to take a look at that. I'm
    not certain about that one but give me some documents on that
    and I'll----
        Secretary Spellings. I'll definitely do that.
        Senator Harkin. Let me ask you, but one thing I did want to
    cover is this what's happening with special education. I said
    earlier it goes from 19 percent to 18 percent, now down to 17
    percent and, right, but here's the real problem, as bad as that
    is, there's another hit coming to these schools outside your
    jurisdiction but you should be cognizant of it, Medicaid pays
    for the cost of coverage services for eligible children with
    disabilities. School districts can be reimbursed by Medicaid
    for transportation costs they incur in providing services if
    this works. The administration wants to prohibit schools from
    getting reimbursed for transportation and in fiscal year 2007
    schools are expected to receive $615 million from Medicaid for
    that purpose. If this change goes through then they're going to
    have to pay the $615 million in transportation costs
    themselves. So while you might say that there's been a slight
    increase in IDEA funding from $10.583 to $10.683, a $100
    million increase, still not keeping up with inflation or
    anything, there's going to be another cut from Medicaid
    reimbursement for these kids. Where are these schools going to
    get that $615 million, $650 million, $615 million, can't read
    it, $615 million for transportation? Did I make myself clear?
        Secretary Spellings. You did. Senator, as you know, those
    are reimbursements through HHS and I'm sure you'll discuss that
    with Secretary Leavitt. My understanding is, those are places
    where they found a lot of fraud and abuse with respect to those
    reimbursements and, you know, with respect to IDEA funding
    overall we've had a 68.5 percent increase in funding since 2001
    and, you know, we continue investments on the education side
    for special education. With respect to the transportation
    funding, my understanding is that it's been a place where
    there's been some fraud and abuse and that that needs to be
    curtailed.
        Senator Harkin. I'm all for cutting fraud and abuse but
    when you disallow the whole thing, I mean, you're saying that
    every dollar's being abused. I mean, you're not saying it----
        Secretary Spelling. I'm just not very familiar with the
    particulars, since we don't run that program.
        Senator Harkin. You're not saying that but OMB or the
    administration's saying that and since there's a close
    correlation here between the two, between you and HHS on this,
    I mean, somehow we've got to bring that together because if we
    cut the $615 million COLA, that's going to be a big hit.

                     ESEA TITLE I PROPOSED FUNDING DECREASE

        Title I, let me just say one thing about Title I. Right now
    29 States will get less Title I funds under the budget, than
    they did last year. My State, Iowa, was one of 15 States that
    will get less Title I funding than they did 3 years ago in
    fiscal year 2004. On the district level it's even bleaker. This
    fiscal year was the third year in a row that most districts got
    less Title I funding than they did the year before. Fiscal year
    2007 will be the fourth straight year. In my State, two-thirds
    of Iowa districts got less Title I funding this year than they
    did 3 years ago. So how can you say you're giving schools
    enough money for No Child Left Behind when our budget once
    again cuts Title I funds the most to the districts?
        Secretary Spelling. Well, as you know, under Title I the
    distribution formulas follow the kids and the poorest kids as
    they move around and as those populations shift. There are also
    obviously States who are getting additional Title I resources
    owing to the distributional mechanics of Title I funds
    following those poorest, neediest kids.

                   SCHOOLS CATEGORIZED AS NEEDING IMPROVEMENT

        Senator Harkin. I'm told there are about 11,000 schools in
    this country that have been designated in need of improvement,
    is that about right?
        Secretary Spellings. That's sounds about right----
        Senator Harkin. 11,000.
        Secretary Spellings [continuing]. That sometimes gets
    characterized as failing schools. I think, you know, we all
    know that there are schools that need improvement when half the
    minority kids aren't getting out of high school. We have work
    to do with special ed students and limited English speakers and
    so on and so forth, so, it doesn't surprise me that 11,000
    schools need improvement.

                              ESEA TITLE I FUNDING

        Senator Harkin. Yeah, but again how are we going to help
    these schools when we're cutting Title I funding? I mean, you
    say it follows the kids around and I know poverty's gone up in
    some areas but I can tell you we still have, I suppose, kids in
    Iowa and rural areas and places like that that are getting cut
    out, because it's almost like you're assuming there's a static
    level of poor kids just goes to this level and they shift
    around but it always stays static, I mean the total number
    stays static. That's not true. I don't think there's any
    figures that show that. The number of poor kids in this country
    has gone up.
        Secretary Spellings. Right. That's why we supported
    increases in Title I for the poor through the course of the
    present administration.
        Senator Harkin. Well, we're getting less Title I money.
        Secretary Spellings. I'm talking about in the entirety of
    the President's term, Title I funding is up about 45 percent.
        Senator Harkin. Oh, I see. So it went up a couple of years
    in a row. Now we can sit back and we don't have to increase it
    any more.
        Secretary Spellings. Well, I'm not suggesting that we can
    sit back by any stretch but----
        Senator Harkin. We hear that when we double the funding for
    NIH and we got it up there, now we say, well they did that, now
    we don't have to worry any more and we just sit back. I think
    what we were doing in the first couple of years is trying to
    play catch-up ball in funding these kids in Title I. That
    doesn't mean it's remained static and I just think the program
    funds Title I.
        Secretary Spellings. Well, we've also called for $200
    million for School Improvement. You talked about the 11,000
    schools.
        Senator Harkin. I know about the $200 million. I just
    divide that out to 11,000, it's about $20,000 per district.
        Secretary Spellings. Well, I think we can learn from each
    other. I think States will be doing more systematic and
    systemic work at a State level that will leverage some of those
    resources.
        Senator Harkin. Our time is up. Madam Secretary, you said
    quite frankly in your opening statement that the Federal
    Government's role is providing help to States for under-
    privileged, poor kids and kids with disabilities. Well, this is
    it, right here, and I think we're shirking our responsibility
    in that area to provide that kind of help to the States. Thank
    you.

                   HIGH SCHOOL DROPOUTS--THE SILENT EPIDEMIC

        Senator Specter. Thank you, Senator Harkin. One final
    inquiry and, Madam Secretary, we're having votes about to
    begin, force back votes on the PATRIOT Act. The publication of
    The Silent Epidemic is out on dropouts--I see you nodding in
    the affirmative--thanks to the Gates Foundation on funding it,
    and it shows that about 3.5 million young people between the
    ages of 16 and 25 have dropped out of high school, were not in
    school in the year 2003, the most recent year in which such an
    estimate is available. What in the budget is being directed to
    that major problem?

                   ADDRESSING THE HIGH SCHOOL DROPOUT PROBLEM

        Secretary Spellings. Well, Senator, a few things. One, as
    that study observes, and I'm meeting with one of those authors
    of the report this afternoon, I think, of the things we know is
    that kids drop out because they don't have the necessary
    reading and deciphering skills, particularly reading skills, to
    do high-school-level work. That's why we support the Striving
    Readers Initiative for a $100 million, so we can take some of
    our reading research and extend it in the middle schools and
    get these kids caught up so that they can do more rigorous
    work. The other thing, as the report observes, and I think it
    speaks to boredom and a lack of rigor sometimes in high school,
    is that many of the students that drop out, you know, are
    passing. They are kids that are effective in attending school
    and they're just completely disengaged and tend not to find it
    very satisfying. So I think if we expand Advanced Placement, if
    we expand dual enrollment, and provide some of these things
    that are more engaging and more interesting and more rigorous,
    and more relevant to kids--I think those are some things we can
    do to guard against dropouts.
        Senator Specter. What do you think the prospects are of
    ameliorating that problem?
        Secretary Spellings. Well, I think it's, you know,
    obviously going to be a journey. I don't think this is
    something that happens overnight. I think we need to know more.
    This is why the President has called for enhanced
    accountability in high schools. We don't know very specifically
    as policy-makers what is it about high school that's working
    and not working and for whom. Is it reading? Is it rigor? Is
    it, you know, disengagement? Is it a lack of vocational----
        Senator Specter. How do you propose to find out?
        Secretary Spellings. Well, what the President has called
    for is additional accountability, more measurement in high
    school. We only test in one grade in high school. Typically
    States have elected to do that in the 10th or the 11th grade.
    So after 8th grade we lack information about what the state of
    high schools really is and an ability to parse that down for a
    policy tool.
        Senator Specter. Where the President has called for it,
    what has the response been?
        Secretary Spellings. Many States have put high school
    assessments in place. I would say half or so have a full
    complement of assessment through high school. That's the
    Governor's----

                  DEPARTMENT'S COMMENTS ON THE SILENT EPIDEMIC

        Senator Specter. Madam Secretary, we're going to have to
    recess here in a moment but what I would ask you to do is to
    give us your evaluation, your Department's evaluation of this
    report on dropouts and what is currently being done and what
    you think ought to be done. That's a gigantic problem which we
    really ought to address.
        Secretary Spellings. I agree.
        [The information follows:]
                                School Dropouts
        "The Silent Epidemic: Perspectives of High School Dropouts,'' a
    March 2006 report by Civic Enterprises in association with Peter D.
    Hart Research Associates for the Bill and Melinda Gates Foundation, is
    based on a series of focus group interviews conducted with young people
    aged 16-25 who identified themselves as high school dropouts from
    public schools in large cities, suburbs, and small towns. As the report
    notes, the study's purpose was to approach the dropout problem from the
    perspectives of the former students themselves, to better understand
    the lives and circumstances of students who drop out of high school and
    to help ground the research in the stories and their reflections.
        Though the study is primarily anecdotal and was not designed to be
    nationally representative, its findings are consistent with the
    Administration's emphasis on the need for high school reform in the
    2006 and 2007 President's Budget proposals, as well as the effort to
    bring more rigor to the high school curriculum through such initiatives
    as the expansion of support for Advanced Placement courses.
        For example, fully one-third of those surveyed said that they
    dropped out of high school because they were ``failing in school,'' and
    45 percent said they lacked academic preparation for the challenges of
    high school. In response, The Silent Epidemic recommended the
    development of ``early warning systems'' to help identify students at
    risk of failing in school, the provision of intensive assistance to
    struggling students, and research on what works in high school. The
    Administration's $1.5 billion High School Reform initiative, first
    proposed in the President's 2006 Budget, would address each of these
    recommendations. Grantees would use test scores of incoming high school
    students to identify those most at risk of not meeting State standards
    and potentially dropping out, develop individualized performance plans
    to meet student needs, and support research on specific interventions
    and strategies for improving student achievement in high school.
        The 2007 request also includes two other proposals specifically
    targeted to the needs of students like those discussed in The Silent
    Epidemic. First, a $70 million increase for the Striving Readers
    program would significantly expand the development and implementation
    of research-based interventions to improve the skills of teenage
    students who are reading significantly below grade level. And a new,
    $125 million Math Now for Middle School Students initiative would
    support research-based math interventions in middle schools.
        In addition, the proposed $90 million increase to expand the
    availability of Advanced Placement and International Baccalaureate
    programs in schools with large populations of low-income students would
    help ensure that such students are able to prepare for and successfully
    complete challenging, college-level curricula.
        Finally, the Department already has played a key leadership role in
    working with the National Governors Association (NGA) to reach a common
    definition for calculating high school graduation rates. In particular,
    the National Governors Association also agreed on the use, while States
    ramp up their own capacity for a long-term solution, of an Average
    Freshman Graduation Rate, an interim calculation developed by the
    Department to provide comparable State-level graduation data.
        The Department believes that momentum is building for a serious,
    nationwide effort to improve the performance of our high schools.
    President Bush has provided strong leadership in this area for the past
    two years, and The Silent Epidemic should contribute to that momentum
    and help persuade Congress that the time for action is now.

                       STATEMENT OF SENATOR THAD COCHRAN

        Senator Specter. We have received the prepared statement of
    Senator Thad Cochran which will be placed in the record.
        [The statement follows:]
                   Prepared Statement of Senator Thad Cochran
        Mr. Chairman, I welcome Secretary Spellings to the subcommittee and
    look forward to her testimony about the fiscal year 2007 Budget
    proposal for the Department of Education.
        I first want to thank the Secretary for her extraordinary efforts
    and those of her staff following Hurricane Katrina. The first questions
    our school superintendents in Mississippi had as they began recovering
    were about being able to comply with the No Child Left Behind standards
    and regulations. The Secretary showed understanding and compassion for
    the difficulties faced by these administrators who still are simply
    trying to get schools back in operation and students back in their
    classrooms. Her actions to waive and provide flexibility under these
    trying circumstances are greatly appreciated. Her visits to Southaven,
    Pass Christian, and Jackson and those of the Assistant Secretary for
    Elementary and Secondary Education, Henry Johnson to Biloxi and others
    to my State have been well received and again, appreciated. An
    especially helpful gesture to my staff was detailing Beverly Ward, a
    Department employee here in Washington, to my Mississippi Gulf Coast
    office. She is still there, and has helped to provide coordination,
    communication, and a sense of comfort to those in both K-12 and higher
    education. Thank you very much for that assistance, Madam Secretary.
        While the overall budget for the Department of Education is $2.2
    billion less than last year, I am happy to see the budget proposal
    includes continuation and even some increases in important programs
    such as, Title I grants to schools for disadvantaged students this is
    especially important in my State; an increase of $100 million for
    Special Education grants; continuation of Ready to Learn Television;
    and a $2 million increase in the Foreign Language Assistance Program
    grants to schools.
        The budget is challenging again this year, and the President has
    proposed a number of reductions and eliminations that include programs
    that have proven to be popular and successful, so we will work to find
    a consensus agreement on what and at what amounts programs should be
    funded. I note for example, the National Writing Project, Arts
    Education, Gifted Education, and Civic Education are among the proposed
    program eliminations. I'll be working with you, Mr. Chairman, in an
    effort to ensure those programs are continued.
        We will discuss the details of these programs over the next few
    months. As always, we begin the process of the appropriations cycle
    with a number of competing interests: those from the administration,
    members of this Committee, other Senators, and the members of the
    House. We will work to accommodate as many of those priorities as
    possible, and come to decisions as a committee that will reflect what
    we ascertain as the best course of action.

                         ADDITIONAL COMMITTEE QUESTIONS

        Senator Specter. There will be some additional questions
    which will be submitted for your response in the record.
        [The following questions were not asked at the hearing, but
    were submitted to the Department for response subsequent to the
    hearing:]
                  Questions Submitted by Senator Arlen Specter
                      american competitiveness initiative
        Question. The budget proposes to strengthen math and science
    achievement of K-12 students through a new $380 million American
    Competitiveness Initiative. I am a co-sponsor of S. 2198, which
    addresses many of the same issues identified in this Initiative. My
    concern is that this worthwhile Initiative is funded through reductions
    in programs that many members of Congress support. Can you explain how
    this budget will accommodate both this new initiative and the other
    priority programs of various members of Congress?
        Answer. We very much appreciate the strong support that you and
    other Members of the Senate have shown for our efforts to improve math
    and science education, as shown by the very similar goals of S. 2198
    and the ACI. As for your concerns about funding the ACI proposals, I
    would point out that at seven-tenths of 1 percent of our discretionary
    budget, the $380 million request for the ACI represents a modest,
    targeted approach to improving math and science education. The Congress
    should be able to finance this initiative by reducing funding for less
    needed or less effective programs. I understand very well that trade-
    offs will be required by the Congress to fund the ACI, because we made
    those very same trade-offs in preparing our 2007 request. At the same
    time, we know that in negotiating the 2006 appropriations bill, your
    Subcommittee demonstrated a willingness to balance funding for priority
    programs with reductions and eliminations in other activities. We hope
    to work with you to achieve that same kind of funding discipline for
    2007, and our request includes many examples of programs that could be
    reduced or eliminated to pay for new initiatives like the ACI.
                             federal perkins loans
        Question. Your budget includes $664 million in spending that is
    offset by the recall of the Federal contribution to the Perkins Loan
    program. During last year's session, the House and Senate Authorizing
    Committees agreed to extend the Perkins Loan program, not phase it out,
    as your budget assumes. Can you tell me how my subcommittee should
    make-up for the fact that this $664 million offset is not a viable
    mechanism for additional spending proposed in your budget request?
        Answer. The administration continues to believe needy students
    would be better served by redirecting Perkins Loan funds to more
    broadly available student aid programs, such as the Pell Grant, Federal
    Family Education Loan (FFEL), and Direct Loan programs. With the number
    of Perkins Loan institutions declining from 3,338 in academic year
    1983-84 to 1,796 in 2003-04 and with only 3 percent of students
    enrolled in postsecondary education receiving Perkins Loans each year,
    the Administration believes the Federal share of funds held by this
    small group of institutions would be more effective if used in a way
    that serves all eligible students regardless of institution.
    use of title i school improvement funds for comprehensive school reform
        Question. In the last two Department of Education Appropriations
    Acts, the conferees have included language in the statement of the
    managers which encourages the Secretary to notify States of a priority
    that they should place on the awarding of funds from the 4 percent
    school improvement. Can you explain what actions your Department has
    taken to comply with this language?
        Answer. On March 9, 2005, the Department sent an e-mail to Title I
    State directors to notify them of the provision in the fiscal year 2005
    appropriations report language and to inform them of the conditions
    that must be met for a State educational agency to use Title I school
    improvement funds for comprehensive school reform (CSR) projects. A
    Department official also discussed the directive at the Title I State
    directors' meeting last year.
        In addition, the Department has hosted three regional meetings of
    State Title I directors and State CSR directors to talk about capturing
    the lessons learned from CSR, building bridges between Title I and CSR,
    and leveraging statewide systems of support to disseminate information
    learned through CSR.
        The Department will hold a meeting this spring focused on building
    State capacity to improve schools using CSR and Title I to
    institutionalize what has been learned about working with high-
    performing, high-poverty schools. At the meeting Department staff will
    discuss the fiscal year 2006 report language about using Title I school
    improvement funds to support CSR projects.
           comprehensive school reform as school improvement strategy
        Question. Given that one rationale for the elimination of the
    Comprehensive School Reform program was that States could use funds
    under their 4 percent set asides for the same activities, do you have
    any evidence that States have made or will make subgrants that support
    comprehensive school reform activities in school districts, and if not,
    why not?
        Answer. We do not yet have any evidence, either from evaluation
    data or other reports, that States or school districts are using
    comprehensive school reform as part of their school improvement
    strategy. In part, this may reflect the progressive nature of the No
    Child Left Behind Act's (NCLB) school improvement requirements, which
    gradually move from school improvement plans in the first 2 years to
    replacement of curricula or staff under corrective action to
    alternative governance during restructuring. Comprehensive school
    reform generally represents the kind of thoroughgoing, fundamental
    change called for under corrective action and restructuring and, thus,
    may be adopted more frequently as increasing numbers of schools are
    subjected to these more stringent improvement measures.
        Also, while the school improvement requirements in NCLB are fairly
    prescriptive, they do not specifically mention comprehensive school
    reform as an improvement strategy. States and districts naturally look
    to the statute for guidance as to what they must do to support schools
    in the various stages of improvement, and will tend to adopt the
    specific remedies found there.
        Finally, comprehensive school reform is intensive and time-
    consuming and requires considerable technical assistance from States
    and school districts that have been focused in recent years on overall
    implementation of NCLB. As States establish and strengthen their
    statewide systems of support for LEA and school improvement, they are
    likely to gain greater capacity to support activities like
    comprehensive school reform. The President's School Improvement Grants
    proposal would support this kind of evolution in State-level
    improvement capabilities.
                      title i school improvement set-aside
        Question. In the fiscal year 2007 budget request, you have proposed
    overriding a provision in the No Child Left Behind Act to allow States
    to reduce the grants to local educational agencies below the amount
    they received in the 2006-2007 school year to generate sufficient funds
    under the 4 percent school improvement provision of the law. Could a
    State reduce the Title I grant funds of a school district identified
    for improvement and subgrant those funds to another district?
        Answer. Yes, that would be possible, but any such reduction would
    be very small. Under the Administration's proposal, all districts would
    contribute proportionately to the pool of funds available to support
    State and local school improvement, not just those districts receiving
    increased allocations under the Title I formulas. States would then
    subgrant 95 percent of those funds to school districts with schools
    identified for improvement, with priority on those districts with the
    greatest need for such funds and the strongest commitment to using them
    to raise the performance of the lowest-achieving schools. By the way,
    the hold-harmless also leads States to reduce allocations to districts
    identified for improvement and redirect funds to other districts; it
    simply does so by disproportionately taking funds from districts that
    otherwise qualify for more Title I funds.
       limitation on reduction of title i grants for school improvement
                                    purposes
        Question. Would this proposal establish any limit to the amount by
    which a State could reduce a school district's Title I grant?
        Answer. Yes, unlike current law, our proposal actually would limit
    any reduction for school improvement purposes to 4 percent. Under
    current law, districts that receive increased Title I funding often see
    their allocations reduced by more than 4 percent to make up for those
    districts protected by the hold-harmless.
        Question. If not, why do you believe that is unnecessary?
        Answer. As I said, our proposal actually would restore a meaningful
    limit to the State reservation for school improvement.
      title i school improvement funding generated by 4 percent set-aside
        Question. With more than 9,000 schools identified for improvement
    in the 2004-2005 school year, effective interventions that reduce this
    number and lead to improved student outcomes would help States and
    local school districts meet the goals of No Child Left Behind. How much
    funding has been generated and allocated under the 4 percent set-aside
    for each of the past 3 fiscal years?
        Answer. We do not have actual data on the amounts reserved and
    allocated by the States during this period. We estimate that States
    reserved and allocated for school improvement purposes approximately
    $484 million in fiscal year 2004 and $500 million in fiscal year 2005,
    and will reserve and allocate roughly $499 million in fiscal year 2006.
        Question. Is there any information about the reach of this funding
    and the number of schools identified for improvement, or on watch
    lists, that have not been assisted?
        Answer. Earlier this year, the Department published a report,
    ``Title I Accountability and School Improvement from 2001 to 2004,''
    which found that about 90 percent of school districts with schools
    identified for improvement reported that they provided at least some
    kinds of the assistance required by NCLB. At the same time, more than
    half of ``continuously identified schools'' (those identified for
    improvement throughout the period studied) reported that they did not
    receive more intensive assistance, such as assistance from a school
    support team or a school-based staff developer. The Department study
    also found, however, that State practices for allocating school
    improvement funds varied widely, partly because the study began prior
    to the implementation of No Child Left Behind, which brought
    significant changes to school improvement funding that were not fully
    implemented when the study was completed.
        The recently released report, ``National Assessment of Title I:
    Interim Report,'' found that less than three-quarters of districts with
    identified schools reported having the staff, expertise, time, or money
    to improve the performance of those schools.
        Question. Is there any information on how the 4 percent set-aside
    for school improvement funds have been used to remove schools from
    school improvement lists?
        Answer. We currently do not have data directly linking school
    improvement funding with success in exiting improvement status.
                     title i school improvement monitoring
        Question. Has the Department done any monitoring of the types of
    activities funded with the 4 percent school improvement set-aside
    established under the No Child Left Behind Act?
        Answer. Yes. The monitoring indicators used by ED's Title I
    monitoring team include a focus on whether SEAs have (1) reserved and
    allocated Title I Part A funds for school improvement activities, and
    (2) created and sustained a statewide system of support that provides
    technical assistance to schools identified for improvement. The SEA
    must provide documentation that it has established effective school
    support teams with members who are knowledgeable about scientifically
    based research and practices related to school improvement. Likewise,
    the SEA must provide documentation that the teams provide support to
    schools on such topics as the design and operation of the instructional
    program and strategies for improving student performance. Monitors also
    seek evidence that SEAs are ensuring that LEAs carry out their own
    school improvement activities.
        Another area reviewed is how the SEA distributes the 4 percent
    school improvement funds. Of the amount it reserves, the SEA must
    allocate not less than 95 percent directly to LEAs that operate schools
    identified for improvement to support improvement activities. In most
    cases, States are using these funds to provide special grants to
    support improvement in those schools. In a few instances, States, with
    the approval of the LEAs, directly provide improvement activities or
    arrange to provide them through regional educational centers.
        At the local level, ED's Title I monitors review how LEAs and
    schools are using the funds for improvement activities. This
    information is gleaned through interviews with LEA and school staffs.
        Question. In particular, has the Department monitored the use of
    funds for implementing required 2-year improvement plans incorporating
    strategies based on scientifically based research and addressing the
    specific issues that led to schools being identified for improvement?
        Answer. Yes. The monitoring indicators used by ED's Title I
    monitoring team seek information and evidence that the SEA has assisted
    LEAs in developing or identifying effective curricula aligned with
    State academic achievement standards and disseminated the curricula to
    each LEA and school within the State. Additionally, monitors review and
    discuss school improvement plans with LEA and school staffs to discern
    how these plans address the 10 required components under NCLB,
    including how the improvement plans incorporate strategies that are
    research based and strategies that address the specific issues that led
    to the school being identified for improvement.
      school improvement grants program and effective school improvement
                                   activities
        Question. What are your plans for using any knowledge generated
    through research on effective school improvement activities; and how
    will the fiscal year 2007 budget request support this goal?
        Answer. The new $200 million request for School Improvement Grants
    recognizes the critical need for State leadership and support in LEA
    and school improvement. While States currently reserve 4 percent of
    Title I, Part A allocations for school improvement activities--an
    amount totaling more than $500 million annually, they must subgrant 95
    percent of these funds to LEAs, leaving just $25 million available for
    State-level school improvement activities. The request would provide
    substantial new support for State-led LEA and school improvement
    efforts and would help build State capacity to carry out statutory
    improvement responsibilities.
        One research based approach that the Department is considering for
    the proposed School Improvement Grants program is requiring each State
    to use diagnostic assessments in schools that repeatedly fail to make
    adequate yearly progress. Such tests would help LEAs and schools
    clearly identify student strengths and weaknesses in a particular
    subject and develop appropriate instruction.
                       supplemental educational services
        Question. Budget documents supporting the budget request note that
    ``While many students attending schools identified for restructuring
    receive SES, the services tend to be of limited duration.'' How does
    the amount of funding generated from the appropriations for Title I
    Grants to LEAs under the 20 percent SES/choice requirement relate to
    this finding?
        Answer. The statement in the budget request simply reflects the
    reality that the duration and intensity of current supplemental
    educational services (SES) are limited by the statutory cap on per-
    pupil payments, with the current cap averaging about $1,500 nationally.
    There are other factors that affect the duration of services, such as
    the structure of SES programs and the actual costs charged by various
    providers, but the general point is that the America's Opportunity
    Scholarships for Kids proposal would roughly double the funding
    available for SES, from $1,500 to $3,000 and, therefore, greatly
    increase the intensity and duration of available services.
        Question. If limited funding is not the reason for such limited
    intensity, what are the primary causes of it?
        Answer. The premise of our budget request was to enable parents to
    purchase more extensive services with greater resources, and that
    students in schools identified for restructuring are likely to be those
    students who would most benefit from more extensive services than are
    available under current law.
        Question. What is the impact of this finding of limited intensity
    on the effectiveness of the SES activity?
        Answer. The SES program is still in its early years and we do not
    yet have meaningful impact data.
        Question. How is the Department monitoring the requirement in NCLB
    that requires low-achieving students to receive priority for services
    under choice and supplemental services options?
        Answer. ED's Title I monitors review documentation to show that the
    SEA has developed and disseminated guidance to LEAs outlining
    requirements for implementing public school choice and supplemental
    education services and that this guidance includes the requirement that
    low-achieving students receive priority for these services. At the LEA
    level, ED's Title I monitors review parent notification letters,
    guidance documents, LEA contracts with SES providers, and other
    documentation to determine if the LEA has complied with the required
    priority for providing the choice and SES options.
                supplemental educational services pilot program
        Question. You announced a number of pilots last year giving a
    select number of districts in need of improvement the flexibility to
    serve as supplemental educational service (SES) providers in exchange
    for greater student participation and achievement data. All of your
    other pilots invited interested States to ``apply'' before being
    offered this sort of flexibility. Can you explain how you selected the
    handful of districts that are in the SES pilot and why you circumvented
    States altogether and negotiated with districts directly?
        Answer. For each of the pilots that we started last year (allowing
    Chicago and Boston to be providers although they are districts in need
    of improvement and allowing four districts in Virginia to reverse the
    order of choice and SES), the Department discussed and sought approval
    from each of the States before the pilots began. In the case of the
    Virginia pilots, we negotiated directly with the State throughout the
    entire process. For Chicago and Boston, we sought and received approval
    from their respective States for participation in the pilot. As for
    selection of these particular districts for the pilots, in the case of
    Chicago and Boston we worked with the Council of the Great City Schools
    to help us identify districts that were willing and able to participate
    in the pilot. Virginia had been in communication with the Department
    about ways to strengthen SES in the State, and came to the Department
    with a formal request to reverse the order of choice and SES. It was
    the first State to do so, and we granted this flexibility on a trial
    basis.
                  selection of districts for ses pilot program
        Question. Why was Chicago selected as opposed to districts such as
    Pittsburgh or Philadelphia, for instance?
        Answer. As I mentioned, the Department worked with the Council of
    the Great City Schools to identify districts that had the ability to
    provide high-quality SES services and would meet the terms of the
    pilots. Pittsburgh and Philadelphia were not identified at the time as
    districts meeting these conditions.
       student participation and achievement under the ses pilot program
        Question. How many additional students are benefiting from each of
    the 3 pilots, which waive your regulation around prohibiting districts
    in need of improvement from serving as an SES provider?
        Answer. Chicago and Boston are the two districts participating in
    this pilot. New York City was invited to participate but declined for
    this year. In Chicago, approximately 55,000 students are participating
    in SES through Chicago's program and private providers' programs; this
    compares to about 40,000 last year. In Boston, about 3,700 are
    participating, compared to about 2,000 last year.
        Question. When will we be able to see the data on the benefits of
    SES on student achievement from these pilots?
        Answer. We anticipate that this summer, after the spring State
    assessment results are in, we should be able to collect data on student
    achievement.
        Question. How are you assuring high-quality tutoring programs in
    SES?
        Answer. As a condition of participation in these pilots, each
    district had to meet a set of guiding principles that the Department
    identified as key elements of high quality SES programs. These included
    communicating to parents about SES through multiple venues and in
    languages that parents could understand, holding extended windows for
    enrollment, and allowing providers to serve students at school
    facilities for a reasonable fee.
                       expansion of the ses pilot program
        Question. Do you plan to expand this pilot to additional districts
    in the next school year?
        Answer. We have monitored each of the pilot districts and collected
    data on their implementation this year. We are now in the process of
    reviewing these data and making determinations as to whether the
    Chicago, Boston, and Virginia pilots will continue, and whether
    additional sites will be added.
        Question. If you do plan to expand the pilot program, what will be
    the selection process and how many do you anticipate selecting?
        Answer. In the near future, we will be making determinations as to
    whether these pilots continue and the criteria we will use to select
    sites for participation.
        Question. Do you plan to put any additional requirements on school
    districts serving as SES providers and, if so, what changes might there
    be next year?
        Answer. We are considering whether to add any additional criteria
    to sites that participate in the pilots next year. We are using the
    information we have gained from this year's pilot sites to consider
    ways to strengthen the agreements with districts and help ensure that
    more students are receiving quality SES services.
                  america's opportunity scholarships for kids
        Question. The Department's budget includes $100 million for a
    proposed voucher program that could be used by students in schools
    identified for restructuring so that they can transfer to a private
    school or receive intensive tutoring services. Why does the budget
    request $100 million for vouchers for an estimated 2 percent of Title I
    schools and request no increase in the amount of funds available for
    the Title I grant program, the cornerstone of Federal assistance for
    helping disadvantaged students?
        Answer. Congress has invested nearly $200 billion in Title I Grants
    to LEAs over the past 40 years, including $12.7 billion in the current
    fiscal year. While we agree that Title I is the cornerstone of our
    efforts to improve the quality of elementary and secondary education,
    particularly for low-income and minority students in high-poverty
    schools, the size of the program limits the impact of additional
    funding available under current budget constraints. For example, the
    $100 million proposed by President Bush for the America's Opportunity
    Scholarships for Kids program represents less than one-tenth of one
    percent of the funding provided for Title I Grants to LEAs, and would
    have little or no impact when spread across 14,000 school districts.
    However, this amount is sufficient to permit a meaningful demonstration
    of the potential for expanded choice and tutoring options to improve
    the achievement of students attending chronically low-performing
    schools. Moreover, these funds would be targeted to the same students
    who are the focus of the Title I program and, in the case of students
    who select the tutoring option, would help improve the performance of
    Title I schools undergoing restructuring.
        Also, the President is requesting first-time funding for School
    Improvement Grants, which would provide an additional $200 million for
    State-led efforts to turn around low-performing school districts and
    schools. These funds would directly benefit participating Title I
    districts and schools that have been identified for improvement. For
    this reason, it is not entirely accurate to say that the President's
    2007 budget includes no increase in the amount of funds available for
    Title I.
                measuring performance of the impact aid program
        Question. The Administration has been undertaking an examination of
    how to measure performance under the Impact Aid program and has
    identified a model for estimating unmet need of eligible school
    districts. Please provide information on the findings of unmet need for
    various types of Impact Aid districts.
        Answer. In 2005, the Department created a simplified model to
    analyze the effectiveness of the Impact Aid formulas and, more
    specifically, address the question of whether or not funds are
    adequately compensating for a Federal presence and the associated tax
    burden. The Department sent a review and analysis of the model to the
    House and Senate Committees on Appropriations in January 2006.
        The report applied the simplified model to calculate the gap
    between available revenues to the LEA and the amount needed to fund
    schools at the State average per-pupil expenditure for Florida,
    Alabama, and Wyoming, three States for which adequate data were
    available. Comparing this gap to the actual payments made to Impact Aid
    districts revealed that there was very little correlation between the
    computation of local need from the simplified model and actual
    payments.
        The model incorporates tax data into the analysis and, while it
    brings us closer to being able to compute valid economic analyses of
    the program, because of data limitations the model has not yielded the
    desired results. In order to answer these questions properly, more
    sophisticated analysis with better data will likely be needed.
                       improving teacher quality programs
        Question. In November 2005, the Government Accountability Office
    released report GAO-06-25, which relates to State implementation of
    teacher qualification requirements of the No Child Left Behind Act.
    This report noted that some teachers who provide instruction in more
    than one core academic subject-such as special education teachers and
    those in rural schools-and secondary math and science teachers might
    not meet the teacher qualification requirement by the current deadline.
    What activities are funded currently and proposed in the fiscal year
    2007 budget to help States and districts ensure that all students are
    taught by a highly qualified teacher?
        Answer. In 2007, the administration is requesting funds for several
    programs that focus on improving teacher quality to help ensure that
    all teachers are highly qualified. These include: Improving Teacher
    Quality State Grants ($2.9 billion), Title I Grants to Local
    Educational Agencies ($624 million--the estimated professional
    development portion), Mathematics and Science Partnerships ($182.2
    million), Transition to Teaching ($44.5 million), Teaching of American
    History ($50 million), Troops-to-Teachers ($14.6 million), and Advanced
    Placement ($122.2 million).
                           highly qualified teachers
        Question. What specific steps will be taken to ensure that the
    disparity between the proportion of highly qualified teachers in lower
    income school districts and higher income schools is eliminated?
        Answer. The Elementary and Secondary Education Act (ESEA), as
    amended by the No Child Left Behind Act, establishes the important goal
    that all students be taught by a ``highly qualified teacher'' (HQT) who
    holds at least a bachelor's degree, has obtained full State
    certification, and has demonstrated knowledge in the core academic
    subjects he or she teaches. Further, the ESEA requires States and LEAs
    to include, in their annual report cards, information on the percentage
    of classes not taught by highly qualified teachers, disaggregated by
    high- and low-poverty schools. In addition, the Individuals with
    Disabilities Education Improvement Act of 2004 reinforced the NCLB goal
    by aligning the requirements for special education teachers with the
    NCLB requirements.
        The Department has been requiring States to submit data as part of
    their Consolidated State Performance Reports on the percentage of core
    academic classes taught by highly qualified teachers in high- and low-
    poverty schools, as well as the reasons why, for classes taught by
    teachers who are not highly qualified, the teacher is not highly
    qualified. In addition, States must have an equity plan in place to
    ensure that poor or minority children are not taught by inexperienced,
    unqualified, or out-of-field teachers at higher rates than are other
    children. The Department will be looking at States' progress in both of
    these areas this spring and summer. Although States and school
    districts are making significant progress in meeting the HQT
    requirement, there is still a lot of work to do to ensure that each
    State can meet the goal that every child is taught by a highly
    qualified teacher by the end of the 2005-2006 school year.
    Meeting the NCLB Highly Qualified Teacher Requirement
        In the Department's ongoing visits and communications with State
    and local officials, we are often asked what will happen if, despite
    their best efforts, districts cannot hire a highly qualified teacher
    for every class in a core academic subject by the end of the 2005-2006
    school year. Personnel decisions are made at the State and local
    levels, and the law relies on education leaders in the States to make
    the best educational decisions for improving student achievement. Last
    fall, I sent a letter to the chief State school officers to assure them
    that States that did not quite reach the 100 percent goal by the end of
    the 2005-2006 school year would not lose Federal funds if they were
    implementing the law and making a good-faith effort to reach the HQT
    goal in NCLB as soon as possible.
        The letter also stated that the Department will determine whether
    or not a State is implementing the law and making a good-faith effort
    to reach the HQT goal by examining four elements of implementation of
    the HQT requirements: (1) the State's definition of a ``highly
    qualified teacher,'' (2) how the State reports to parents and the
    public on classes taught by highly qualified teachers, (3) the
    completeness and accuracy of HQT data reported to the Department, and
    (4) the steps the State has taken to ensure that experienced and
    qualified teachers are equitably distributed among classrooms with poor
    and minority children and those with their peers. In addition, the
    Department will look at States' efforts to recruit, retain, and improve
    the quality of the teaching force. If States meet the law's
    requirements and the Department's expectations in these areas but fall
    short of having highly qualified teachers in every classroom, they will
    have the opportunity to negotiate and implement a revised plan for
    meeting the HQT goal by the end of the 2006-2007 school year. However,
    for States that either are not in compliance with the statutory HQT
    requirements or are not making a good-faith effort to meet the goal of
    having all teachers highly qualified, the Department reserves the right
    to take appropriate action, such as the withholding of funds.
    Departmental Review of States' Efforts to Meet the NCLB Highly
            Qualified Teacher Requirements
        In March 2006, I sent a follow-up letter to the chief State school
    officers with timelines and additional information about the
    Department's review of States' efforts to meet the HQT requirement. By
    the middle of May, the Department will assess States' Consolidated
    State Performance Report data for the 2004-2005 school year, HQT data
    for previous years, and supporting information that we have obtained
    through State monitoring visits and the review of publicly available
    records. The Department will then make determinations about whether the
    State is on track to meet the highly qualified teacher requirement.
        Using the protocol ``Assessing State Progress in Meeting the Highly
    Qualified Teacher Goal,'' the Department will determine whether each
    State's 2004-2005 data indicate that the State has a reasonable
    expectation of meeting the 100 percent HQT goal by the end of the 2005-
    06 school year and is faithfully implementing the law. If this is the
    case, the State may not be required to submit a revised plan, though it
    certainly may.
        It is likely, however, that the Department will request most States
    to submit a revised plan detailing the new steps they will take to
    reach the 100 percent HQT goal by the end of the 2006-2007 school year.
    As part of the plan, each State will explain how and when the SEA will
    complete the High Objective Uniform State Standard of Evaluation
    (HOUSSE) process for those teachers not new to the profession who were
    hired prior to the end of the 2005-2006 school year, and how the SEA
    will limit the use of HOUSSE procedures for teachers hired after the
    end of the 2005-2006 school year to those secondary school teachers
    teaching multiple subjects in eligible rural schools (who, if highly
    qualified in at least one subject at the time of hire, may use HOUSSE
    to demonstrate competence in additional subjects within 3 years), and
    those special education teachers teaching multiple subjects (who, if
    they are new to the profession and highly qualified in language arts,
    mathematics, or science at the time of hire, may use HOUSSE to
    demonstrate competence in additional subjects within 2 years). Peers
    and teacher-quality experts will review the State's revised plan and
    evaluate how effectively the plan addresses the State's challenges in
    reaching the 100 percent HQT goal.
    Corrective Steps for Districts not Meeting Highly Qualified Teacher
            Requirements
        Finally, if the Department determines that a State has not
    fulfilled its obligations under the statute and is not on track to have
    all teachers highly qualified by the end of the 2005-2006 school year,
    the Department will take corrective actions in addition to requiring
    the State to submit a revised plan.
        By the middle of May, the Department will notify States, in
    writing, of the results of the assessment of their HQT progress and
    will request the States, as appropriate, to submit revised plans.
    States will have until July 7 to submit their revised plans to the
    Department, and the Department then will determine whether a revised
    State plan is sufficient to attain the HQT goal in 2006-2007 and
    beyond. In August, the Department will begin a new cycle of State
    monitoring visits to ensure that States are implementing their revised
    plans.
       information dissemination on highly qualified teacher requirements
        Question. The report also identified some information dissemination
    challenges. What actions has the Department taken or planned for making
    helpful information available?
        Answer. The GAO report recommended that the Department ``explore
    ways to make the Web-based information on teacher qualification
    requirements more accessible to users of its Web site. Specifically,
    the Secretary may want to more prominently display the link to state
    teacher initiatives, as well as consider enhancing the capability of
    the search function.''
        As noted in the GAO report, the Department agrees with the
    recommendation and has been working to improve the Department's website
    so that it is more user friendly for teachers and officials who are
    trying to find information about the highly qualified teacher
    requirements. For example, the website now directs students, teachers,
    parents, and administrators to specific pages for materials of interest
    to them. The teacher page has a section that describes State and local
    initiatives to improve teacher quality, and both the teacher and
    administrator web pages have direct links to information about the
    highly qualified teacher provisions.
               states' reporting of highly qualified teacher data
        Question. The Congressional Justification states, ``The Department
    is not entirely confident that all States are reporting accurately on
    the highly qualified status of their teachers, particularly special
    education teachers.'' This statement is consistent with the Government
    Accountability Office's recent report regarding teacher quality issues.
    What actions are you taking to specifically address this issue and what
    plans do you have for future actions?
        Answer. Under the Improving Teacher Quality State Grants section of
    the congressional justification, we did report that the Department is
    not entirely confident that all States are reporting accurately on the
    highly qualified status of their teachers, particularly special
    education teachers. To address this concern, the Department has been
    working closely with States, especially through monitoring visits, to
    help them improve the quality of the data that they report. As of late
    March 2006, the Department has monitored all but three States
    concerning their highly qualified teacher status and will monitor the
    remaining States this spring.
        We will also be looking very carefully at States' efforts to report
    accurately HQT data this spring and summer when we review their
    progress in meeting the requirement that all teachers of core academic
    subjects be highly qualified by the end of the 2005-2006 school year.
    After that review, we will likely require many States to submit revised
    State plans, and we may take corrective actions against any States that
    are not making a good-faith effort to improve their data collection and
    reporting. The Department also plans to begin a new round of State
    monitoring visits late this summer.
        Question. How does your budget support your current and planned
    actions?
        Answer. The Department is planning to use Salaries and Expenses
    funds to review States' HQT data and their efforts towards meeting the
    goal of having all teachers of core academic subjects highly qualified.
              enforcement of highly qualified teachers requirement
        Question. In your October 21, 2005 policy letter regarding the
    ``highly qualified teacher'' issue, you assured States they would not
    lose Federal funds if they failed to meet the 100 percent requirement
    and were making a good faith effort to implement the law. One of the
    ways you will make such a determination is by evaluating whether States
    take action to ensure that inexperienced, unqualified, or out-of-field
    teachers do not teach poor or minority children at higher rates than
    other children. How are highly qualified teachers distributed currently
    between low-income and high-income school districts?
        Answer. States are reporting steady improvement towards meeting the
    goal of having all teachers of core academic subjects highly qualified
    by the end of the 2005-2006 school year. Data for the 2005-2006 school
    year will be reported in 2007. For 2003-2004, the data indicate that 81
    percent of core academic classes in high-poverty schools were taught by
    highly qualified teachers, an increase of 7 percentage points over the
    baseline of 74 in 2003. 2004 data for the percentage of core academic
    classes taught by highly qualified teachers in low-poverty, elementary,
    and secondary schools was 89 percent, 89 percent, and 84 percent,
    respectively.
     ensuring highly qualified teachers for students of all socioeconomic
                                     status
        Question. What steps is the Department taking to ensure
    socioeconomic status does not determine whether a student has access to
    a qualified teacher or not?
        Answer. For the Improving Teacher Quality State Grants program, the
    Department requires States to report on teachers' highly qualified
    status at the classroom level. For example, in the 2003-2004 school
    year, 81 percent of core academic classes in high-poverty schools were
    taught by highly qualified teachers. We believe that, by requiring
    States to report on all classrooms, we are sending the message that we
    expect all core academic teachers to be highly qualified, whether they
    are teaching in a high- or low-poverty school, or whether at the
    elementary- or secondary-school levels.
        As mentioned earlier, the Department will closely evaluate States'
    progress in meeting the HQT requirement this spring and summer as part
    of our determination of whether they are making a good-faith effort to
    meet the 100 percent objective. This will include a review of their
    Title I equity plans, which are meant to ensure that poor or minority
    children are not taught by inexperienced, unqualified, or out-of-field
    teachers at higher rates than are other children.
    federal efforts to address inequitable distribution of highly qualified
                            and unqualified teachers
        Question. How have States used Federal funds to address this issue?
        Answer. The Department sponsored a 2-day meeting for State
    coordinators in March 2006 that focused on the inequitable distribution
    of teachers who are unqualified, inexperienced, or out-of-field.
    Working with experts and researchers from the National Comprehensive
    Center for Teacher Quality (at Learning Point, Inc.), the Educational
    Testing Service, and the Council of Chief State School Officers, the
    Department provided the State coordinators with a series of written
    tools they can use to examine the inequity issue and begin to prepare
    State plans to address the issue. The Department also provided all of
    the States with a protocol that will be used to examine whether revised
    State plans, which must be provided to the Department this summer, will
    satisfactorily address this issue.
        For most States, this is the first time they will be preparing
    formal, written equity plans. In previous years, States had difficulty
    determining if there was an equity distribution problem, so they were
    unsure how to best address concerns about the unequal distribution of
    highly qualified teachers. The availability of valid data about the
    distribution of highly qualified teachers is now helping States to
    think about the problem and develop equity plans.
        Although States are just now developing their equity plans, many
    States already have incentive programs and strategies to encourage
    teachers to take on more challenging assignments. The Department is
    highlighting some of these strategies at the following weblink: http://
    www.teacherquality.us/Public/PublicHome.asp.
        teacher quality enhancement program and teacher recruitment and
                                   retention
        Question. In recent years, Congress has tried to affect teacher
    recruitment and retention through a number of legislative efforts,
    including scholarships for those who commit to teaching in certain
    geographic or content areas, loan forgiveness programs, and other
    efforts. In addition, there are new requirements that districts and
    States are trying ardently to meet as required by No Child Left
    Behind's ``highly qualified teacher'' provisions. Why is the Department
    acknowledging the crucial role teachers play in maintaining the
    country's competitiveness, while at the same time it is proposing
    elimination of the Higher Education Act's Teacher Quality Enhancement
    program? Can you explain these seemingly conflicting efforts?
        Answer. We do not believe that there is any conflict in the
    Department's efforts to improve teacher recruitment and retention and
    the Department's proposal to terminate duplicative programs, such as
    the Teacher Quality Enhancement program. The Department continues to
    recognize that the quality of the teacher is one of the most critical
    components in how well students achieve and that improving efforts to
    recruit and retain top quality teachers, especially in geographic and
    academic areas of high need, is critical to improving the overall
    quality of the Nation's teachers. The Department's proposal to
    terminate the Teacher Quality Enhancement program is based, in part, on
    the fact that State and local entities may already use funds they
    receive under a number of other Department programs to carry out the
    activities supported through the Teacher Quality Enhancement program.
    Both the Improving Teacher Quality State Grants program and the
    Transition to Teaching program include provisions designed to improve
    teacher recruitment and retention, including all of the activities that
    are allowable under the Teacher Quality Enhancement program. The
    Department's proposal to eliminate funding for the Teacher Quality
    Enhancement program would reduce unnecessary duplication, improve
    programmatic efficiency, and simplify the grant process for potential
    recipients.
                           data management initiative
        Question. The Government Accountability Office report (GAO), GAO-
    06-06, released in October 2005, included an assessment of the
    Department's efforts to identify performance-related data items that
    could be collected and reported by States that would promote the
    evaluation of the effectiveness of Federal programs. This report
    identified several challenges with respect to the participation of and
    perceived benefit for States and quality and consistency of data
    collected through the system. What is the Department's plan for
    addressing the challenges identified in the GAO report and how much
    funding is being allocated in fiscal year 2006 and requested in fiscal
    year 2007 for this initiative?
        Answer. The GAO report recommended that the Department develop a
    strategy to help States improve their ability to provide quality data.
    As described in the Corrective Action Plan we submitted to the GAO in
    response to their report, we have taken several steps to improve the
    quality of the data the Department collects. By the end of this fiscal
    year, we will have awarded nearly $50 million in grants to States under
    the Statewide Data Systems program to develop and implement statewide
    longitudinal data systems. The President's 2007 budget requests a $30
    million increase for this program.
        The National Center for Education Statistics is working with the
    staff of the Department's central database, the Education Data Exchange
    Network (EDEN), to provide technical support and oversight for our
    grantees. The Department provides additional technical assistance to
    States through the Data Quality and Standards Contract with the Council
    of Chief State School Officers. The Department is also a contributing
    partner in the Data Quality Campaign, a partnership of more than 10
    national organizations that helps States implement high-quality
    statewide information management systems. Finally, the Department has
    established a Partner Support Center that provides expert technical
    assistance to States on data submission processes and quality issues
    related to EDEN.
        The Department is conducting a rigorous assessment of the quality
    of our data collection and reporting. As part of this process, the
    Department recently announced the launch of EDFacts, a new reporting
    and analysis tool for data collected and compiled through sources such
    as EDEN. In 2006, $5.705 million is being allocated for enhancements to
    the EDFacts and EDEN systems, and $6.244 million is requested for 2007.
        Question. Specifically, how will these funds be utilized?
        Answer. These funds will be used to support the operation of the
    Partner Support Center, development of new enhancements for the EDEN
    and EDFacts systems (including this year's successful online collection
    of the Consolidated State Performance Report), maintenance of these
    systems, and development of new reports and tools that enhance program
    offices' efficient use of collected K-12 performance data.
                      foreign language assistance program
        Question. The budget proposes a $2 million increase for the Foreign
    Language Assistance program. Budget documents supporting this request
    state that beginning with the 2006 competition, the Department will
    focus this program on providing incentives for States and districts to
    provide instruction in critical needs language, especially those
    programs using technology. Please explain how the 2006 competition will
    be structured to address the issues raised in the fiscal year 2006
    Senate Committee Report and the Statement of the Managers accompanying
    the fiscal year 2006 Conference Report. Specifically, what type of
    priority are you proposing for the 2006 competition, and what is the
    complete list of foreign languages that will be eligible for such a
    priority?
        Answer. The Department is committed to ensuring that all school
    districts that demonstrate the capacity to successfully implement a
    program receive consideration for competitive grant funds. In response
    to the concerns raised both in the Senate Committee Report and the
    Statement of Managers that the poorest districts may be shut out of
    Foreign Language Assistance grants due to their inability provide the
    required 50 percent match, the Department has taken active steps to
    increase awareness of waiver availability for eligible grant
    applicants. The application package for grants includes detailed
    information about what resources may contribute to a grantee's matching
    requirement, and the Department considers waivers for any district that
    can demonstrate financial hardship. The program office also has
    expanded its outreach efforts to include details about the waiver
    process and eligibility on the Department's web page, at professional
    workshops, and in fact sheets about the program. The combination of
    improved grant application materials and increased public awareness
    about waivers will help ensure that disadvantaged districts are not
    precluded from participating in the program.
    Foreign Language Assistance Program--Critical Need Languages Priorty
        In addition to giving increased attention to grantees that may be
    eligible for waivers, the Department established a priority relating to
    critical need languages for the 2006 grant competition. In conjunction
    with the President's National Security Language Initiative, the
    Department will give preference to grant applicants that demonstrate
    the ability to build programs and courses in languages that have
    significant political or economic importance. The specific languages
    that have been identified as critical are Arabic, Chinese, Korean,
    Japanese, Russian, and the languages in the Indic, Iranian, and Turkic
    language families.
                                 arts education
        Question. The No Child Left Behind Act recognizes the arts as a
    core academic subject and studies show that the arts are proven to help
    close the achievement gap and improve essential academic skills. You
    have stated previously that a ``well-rounded curriculum that includes
    the arts and music contributes to higher academic achievement.'' If
    arts have been proven to be essential to the learning process, why has
    the President proposed the elimination of arts education in the fiscal
    year 2007 budget?
        Answer. Our request to zero-fund Arts in Education reflects the
    Administration's policy of increasing resources for high-priority
    programs by eliminating categorical programs that have narrow or
    limited effect. These categorical programs siphon off Federal resources
    that could be used by State and local educational agencies to improve
    the academic performance of all students.
        Districts desiring to implement arts education activities may use
    funds provided under other Federal programs. The Elementary and
    Secondary Education Act also provides LEAs with flexibility to
    consolidate certain Federal funds to carry out activities, including
    arts education programs, that best meet the needs of their district.
    For example, under the State and Local Transferability Act, most LEAs
    may transfer up to 50 percent of their formula allocations under
    various State formula grant programs to their allocations under: (1)
    any of the other authorized programs; or (2) Part A of Title I.
    Activities to support arts education are an allowable use of funds
    under the State Grants for Innovative Programs authority. Therefore, an
    LEA that wants to implement an arts education program may transfer
    funds from its allocations received under the authorized programs to
    its State Grants for Innovative Programs allocation, without having to
    go through a separate grant application process.
        In addition, under the Improving Teacher Quality State Grants
    program, local educational agencies can use their funds to implement
    professional development activities that improve the knowledge of
    teachers and principals in core academic subjects, including the arts.
    The flexibility that is available under these Federal programs provides
    additional justification for the Administration's policy of eliminating
    discrete categorical grant programs such as Arts in Education.
        Question. As a ``core academic subject,'' the arts should be
    included in all research and data collection. The No Child Left Behind
    Act and current Department of Education policy make it clear that
    decisions regarding education are made on the basis of research. The
    FRSS report, ``Arts in Education in Public Elementary and Secondary
    Schools,'' is the only research report produced by the Department on
    the status of how arts education is delivered in America's public
    schools. The last report was for data collected in the 1999-2000 school
    year and the fiscal year 2006 statement of the managers urges IES to
    repeat this comprehensive data collection and report. When is the
    Department planning on another round of data collection for an updated
    report, which will help study and improve access to the arts as a core
    academic subject?
        Answer. We agree that having periodic information about arts
    education is important. The next National Assessment of Educational
    Progress (NAEP) arts assessment is scheduled for 2008. It will be an
    8th-grade assessment that will include components for music, theater,
    and the visual arts, as was the case with the last arts assessment in
    1997. Work on the 2008 assessment began last year with item
    development, and we will conduct a field test this year.
        The Department has not budgeted for an arts education survey in the
    National Center for Education Statistics (NCES) Fast Response Survey
    program for fiscal year 2007. The expense of replicating a survey
    involving multiple samples of teachers in the visual arts, music, and
    dramatic arts is too great, given competing demands for funds and the
    costs of the ongoing data collection programs of NCES. The National
    Endowment for the Arts requested the earlier 1999-2000 arts education
    survey and paid for it in part.
             ready to teach program and math and science education
        Question. Madam Secretary, the fiscal year 2007 budget allocates
    $380 million for new or increased funding for math and science programs
    aimed at giving students the skills they need to become competitive
    workers in the global economy of the 21st century. Specifically, part
    of this funding is targeted to address the critical shortage of
    qualified teachers for math and science education, particularly in
    high-concentration areas for low-income students.
        The Ready To Teach program funds the development of digital
    educational content and online professional development in partnerships
    with the public television community. Congress has invested in this
    program over several years to ensure that it is easily accessible,
    flexible and tailored to local, State, and national standards. The most
    recent grant competition recognized the continued success of PBS
    TeacherLine service, and technology-based programs that offer a cost-
    effective complement to off-campus training. In a difficult budget
    environment, the Department should work to utilize the assets of
    programs such as Ready to Teach in its effort to strengthen math and
    science education, especially in the area of teacher training. How will
    the Department utilize this investment in advancing math and science
    education?
        Answer. The Department has no plans to utilize the Ready to Teach
    program to advance math and science education. There is limited
    information on the effectiveness of professional development activities
    supported through this small technology program. It's also not at all
    clear that nonprofit telecommunications entities, like Ready to Teach
    program grantees, are very well equipped to address the critical
    training and professional development and training needs of current and
    future math and science teachers.
        In past years, Ready to Teach has played a very limited role in
    helping schools and districts address professional development needs,
    and next to no role in actually providing teacher training. In light of
    recent research findings on the critical influence of highly qualified
    teachers on student learning, and the seriousness of the on-going
    teacher shortage crisis, the Administration believes that funds should
    not be provided for small categorical programs like this one that have
    limited impact and that siphon off Federal resources that could be used
    by States and districts to pursue more important goals.
                             ready to learn program
        Question. Madam Secretary, last year the Department restructured
    the Ready to Learn educational television program to focus solely on
    programming that teaches literacy, and eliminated much of the
    widespread community outreach portion of the program. We all agree that
    literacy proficiency is central to fulfilling the goals of No Child
    Left Behind, and we applaud the Administration's including funds for
    Ready to Learn in the Administration's budget request. However, the
    elimination of the outreach activities concerns many of us here in
    Congress. How does the Department plan to build upon the successes of
    the local outreach activities by public television stations across the
    country?
        Answer. Over the current 5-year budget period, the Department
    intends to dedicate approximately $20 million to support on-going Ready
    to Learn (RTL) community outreach activities. While it's true that the
    Department restructured the Ready to Learn educational television
    competition, it's not true that ``much of the widespread community
    outreach portion of the program'' was eliminated. In fiscal year 2005,
    the Department made three new awards under the Ready to Learn program,
    including one 5-year outreach award to the Corporation for Public
    Broadcasting (CPB). Under this outreach award, CPB will continue to
    work strategically with public television stations across the country
    to support a variety of local outreach activities.
     workshop approach to outreach and impact on student learning outcomes
        Question. A recent evaluation of ``the workshop approach'' to
    outreach supported by previous RTL grantees (entitled ``Using
    Television as a Teaching Tool: The Impacts of Ready to Learn Workshops
    on Parents, Educators, and the Children in Their Care'') suggests that
    RTL has yet to achieve intended results in key areas of outreach
    implementation. Although a link between RTL workshops and adults' self-
    reported behaviors at 3 and 6 months after the workshops was
    established, the effect sizes were small and the impacts on adult
    behaviors did not translate into impacts on children. This study
    concluded that the workshop approach to outreach had no measurable
    effects on student learning outcomes and only moderate impacts on
    parent/caregiver behaviors. As the study pointed out, enhancing
    children's school readiness to the point of significant, measurable
    improvement usually requires large investments in child-focused
    interventions over extended periods of time. Thus, it's not surprising
    that the workshops, which necessarily cannot be implemented at the
    level of intensity usually associated with most interventions that
    improve student-learning outcomes, showed no measurable effects on
    student behaviors and learning outcomes. Based on the findings of this
    rigorous 5-year evaluation, we believe that RTL outreach activities can
    be targeted far more effectively, to the end of ensuring that all
    children read on grade level by the third grade.
        Because outreach is such a critical component of the RTL program,
    under the new outreach award CPB plans to use the latest evidence from
    social marketing research to target their efforts more effectively. CPB
    will continue to rely heavily on community partnerships, and will
    strategically partner with public broadcasting stations as local
    community hubs. However, unlike in past outreach work, CPB will partner
    with PBS to promote public awareness of RTL at the national and local
    levels through press and media outlets such as newspapers, television,
    and radio, emphasizing those most likely to reach the target audience
    of low-income parents and caregivers.
        More specifically, isn't there a way to combine the educational
    television programming on PBS funded by Ready to Learn, with local
    workshops for parents and teachers and other outreach activities by
    local public stations, such as free book distribution.
        Answer. As indicated in our response to the previous question, a
    recent evaluation of ``the workshop approach'' to outreach supported by
    previous RTL grantees (entitled ``Using Television as a Teaching Tool:
    The Impacts of Ready to Learn Workshops on Parents, Educators, and the
    Children in Their Care'') suggests that RTL has yet to achieve intended
    results in key areas of outreach implementation. Based on this
    evaluation, we believe that RTL outreach activities can be targeted far
    more effectively, to the end of ensuring that all children read on
    grade level by the third grade.
        Under the new outreach award, CPB plans to change its outreach
    strategy by using the latest evidence from social marketing research to
    inform its work. CPB will continue to rely heavily on community
    partnerships, and will strategically partner with public broadcasting
    stations as local community hubs. However, unlike in past outreach
    work, CPB will partner with PBS to promote public awareness of RTL at
    the national and local levels through press and media outlets such as
    newspapers, television, and radio, emphasizing those most likely to
    reach the target audience of low-income parents and caregivers.
                      ready to learn continuation projects
        Question. Additionally, given the President's emerging initiative
    in math and science education, would you support a proposal to expand
    the focus of Ready to Learn to include, in addition to literacy, math
    and science education programming?
        Answer. All of the Ready To Learn funds requested for fiscal year
    2007 are needed to cover the continuation costs of current grantees,
    which were awarded 5-year grants in 2005. Both programming awards must
    focus on utilizing the principles of scientifically based reading
    research to improve literacy outcomes for young children, consistent
    with the priority established for last year's competition and the
    cooperative agreements. By 2010, however, when the awards under this
    program will be re-competed, it is possible that the research base on
    how children acquire math and science knowledge will be sufficiently
    well-developed to support the development of new children's educational
    programming in these areas.
       math and science education--math now program and math and science
                                  partnerships
        Question. The fiscal year 2007 budget proposes to establish Math
    Now for Elementary and Secondary School programs, which are intended to
    improve math instruction for elementary and middle school students.
    What is the potential overlap between the proposed math programs and
    the existing Math and Science Partnerships program?
        Answer. The administration believes that Mathematics and Science
    Partnerships, a formula-grant program that promotes strong teaching
    skills for elementary and secondary school teachers, is important for
    ensuring that all States have high-quality mathematics and science
    professional development programs that focus on implementing
    scientifically based research and technology into the curriculum.
        The Math Now programs, which will implement proven practices in
    mathematics instruction, including those recommended by the National
    Mathematics Panel, will go one step further by helping to ensure that
    American students are prepared to take and pass algebra courses in
    middle school, which will encourage them to take and pass higher-level
    mathematics and science courses in high school. They will focus more
    precisely than does Mathematics and Science Partnerships on the need to
    ensure that elementary-school students receive what the best research
    indicates is the most effective math instruction and for middle-school
    students who are struggling in math to receive the interventions they
    need.
      mathematics and science partnerships and math now program activities
        Question. The States have some flexibility on how they target those
    funds through their sub-granting process. Is there any information
    about the extent to which States have targeted funding to the same
    issues proposed to be addressed by these new programs?
        Answer. The Department began collecting data from States and
    partnerships this year that will describe how Mathematics and Science
    Partnerships (MSP) subgrantees are implementing the program. These data
    will include information about the kinds of activities MSP subgrantees
    are conducting with program funds, and the information should be
    available this summer.
        Although we do not have a better sense of the activities MSP
    grantees are conducting, it is possible that there may be some overlap
    between the MSP and Math Now programs. However, we expect that it will
    be minimal. For example, the MSP program focuses on providing
    professional development for mathematics and science teachers, while
    the Math Now programs would have several allowable uses of funds,
    including professional development, but focusing more on improving
    elementary-school math instruction and helping middle-school students
    who are significantly below grade level in math. The Math Now grantees
    would also implement instructional principles and promising practices
    developed by the National Mathematics Panel, which is not a requirement
    of MSP subgrantees.
                           national mathematics panel
        Question. The fiscal year 2007 President's budget proposes to
    establish a National Mathematics Panel to identify approaches and
    interventions that meet either the scientifically based research
    standard, as defined in the No Child Left Behind Act, or ``promising
    practices.'' How will the selections for the National Mathematics Panel
    be made, so that individuals with diverse backgrounds are represented
    on the panel?
        Answer. In order to ensure a diverse pool of expertise, the
    Secretary will appoint no more than 20 members from the public and
    private sectors, as well as no more than 10 members from the Department
    of Education and other Federal agencies to the National Mathematics
    Panel. Panel members may include researchers who study mathematics,
    professors of mathematics and mathematics education, professors of
    psychology and/or cognitive development, practicing teachers,
    principals, State or local education officials, parents, business
    leaders, foundation representatives, members of education associations,
    and other individuals selected on the basis of their expertise and
    experiences as appropriate.
        Question. How will ``promising practices'' be defined for purposes
    of identifying approaches and interventions?
        Answer. Once it has been convened, members of the National
    Mathematics Panel will meet and determine the appropriate definitions
    and methodology for their review and synthesis of the evidence base on
    mathematics education. One of their charges will be to recommend, based
    on the best available scientific evidence, instructional practices,
    programs, and materials that are effective for improving mathematics
    learning. Since the scientific evidence base in mathematics education
    is inadequate in many areas, we anticipate that the Panel will also
    provide guidance that will help States and districts determine which
    approaches and interventions have some evidence-even through it does
    not yet meet the standards for scientifically based research-that
    indicate that the interventions will improve student outcomes.
                       mathematics and science education
        Question. The President's Academic Competitiveness Initiative (ACI)
    clearly emphasizes the need for improved science, technology,
    engineering and mathematics (STEM) education. The Department of
    Education's 2007 budget request makes substantial improved mathematics
    education via the Math Now program, but does not make a comparable
    investment in science education. What is the Department's plan for
    investing in science education?
        Answer. Both mathematics and science are important subjects for our
    students to learn well if we are to remain competitive in the global
    economy. Because we need to set priorities within our budget, we are
    focusing on mathematics first through the Math Now programs.
    Mathematics is a ``gateway'' course for upper-level mathematics and
    science learning, so we believe that it is crucial for students to
    first have a firm foundation in mathematics. In addition, because Title
    I mathematics assessments are already in place (while the science
    assessments will not come on line until 2007-2008), we have an
    immediate source of information for measuring the effectiveness of new
    strategies in teaching mathematics, but not in science.
    Science Education Support
        Finally, the budget request includes either increases or level
    funding for a number of programs that focus on science, including
    Mathematics and Science Partnerships and Graduate Assistance in Areas
    of National Need. The new Advanced Placement and Adjunct Teacher Corps
    proposals would target science, in addition to mathematics and critical
    foreign languages. Other Department programs that allow grantees to
    focus on science include Transition to Teaching, Troop-to-Teachers, and
    Improving Teacher Quality State Grants.
                       investments in advanced placement
        Question. The fiscal year 2007 budget proposes to expand the reach
    of the Advanced Placement program by requiring grantees to offer
    incentives for teachers to become qualified to teach Advanced Placement
    and International Baccalaureate Organization classes in mathematics,
    science, and foreign languages and to teachers whose students pass
    tests in those subjects. The budget also proposes to require grantees
    to secure public and private matching funds to leverage the Federal
    investment. How much money does the Department expect the private
    sector to contribute toward the matching requirement for the Advanced
    Placement (AP) program?
        Answer. The Department expects the private sector to invest roughly
    $114 million in the AP program, which matches the Department's funding
    request for AP Incentive Grants. Based on conversations with potential
    donors, who are very excited about this initiative, we believe this
    assumption is realistic.
        Question. What is the basis for that projection?
        Answer. Conversations between Department officials and
    representatives of private companies indicate that very substantial
    non-governmental support will be forthcoming. Senior officials are
    encouraging supporters of the proposal to publicize their commitment,
    and we hope to provide more information in the coming weeks.
        Question. Please provide the same information for State
    contributions.
        Answer. The Department is aware that many States are already
    committed to investing in the AP program, and believe that States will
    contribute their support and resources to increasing low-income
    students' access to challenging coursework. Our expectation is that
    State and local funds will amount to approximately $114 million,
    resulting in roughly a one-third/one-third/one-third split in Federal,
    State and local, and private-sector contributions.
        Question. Also, does the Department plan to institute a
    maintenance-of-effort requirement for States; why or why not?
        Answer. No, because the statute already includes a ``supplement,
    not supplant'' provision, which will prevent the Federal funds from
    merely supplanting existing State and local efforts.
                      advanced placement incentive program
        Question. How will the Department ensure that the proposed
    incentive for teachers whose students pass AP/IB tests will not lead to
    the unintended consequence of discouraging students from taking these
    tests?
        Answer. Providing a bonus to teachers for each student who passes
    an AP test should be an incentive for teachers to get more students to
    take and pass AP exams. According to ``Do What Works: How Proven
    Practices Can Improve America's High Schools,'' written by Tom Luce,
    now our Assistant Secretary for Planning, Evaluation, and Policy
    Development, and Lee Thompson, the AP incentive program increased the
    number of students taking AP courses and passing AP exams in Texas. The
    Department's proposal would extend the opportunities granted to
    students in Texas to young people across America.
                              federal student aid
        Question. Budget documents supporting the recall of the Federal
    portion of repayments made under the Federal Perkins Loans program
    indicate that, ``the Administration believes the Federal share of funds
    held by this small group of institutions might more effectively help
    students if used in a way that serves all eligible students regardless
    of institution.'' In addition to the $664 million proposed recall of
    Perkins proceeds, the proposed budget includes a reduction of $436
    million in funding from the Student Financial Assistance account. How
    does the proposed budget more effectively serve all eligible students
    by recalling $664 million from the Perkins loans program and reducing
    the Student Financial Assistance account by $436 million?
        Answer. It is important to look at the Federal investment in
    student aid from a broad perspective. Overall, the President's Budget
    would build on student benefits included in the Higher Education
    Reconciliation Act (HERA) to provide a record $82 billion in new
    student grant and loan assistance in fiscal year 2007. The HERA created
    Academic Competitiveness Grants, a new need-based program supported
    with mandatory funding that will award annual grants of up to $1,300 to
    high-achieving first- and second-year students who have completed a
    rigorous high school curriculum or up to $4,000 for third- and fourth-
    year students majoring in mathematics, science, technology,
    engineering, or critical foreign languages. In 2007, the program would
    provide $850 million in grants to 600,000 low-income postsecondary
    students. Over 2006-2010, grant awards would total more than $4.5
    billion.
        In addition, the HERA makes student loans more affordable by
    phasing out student origination fees and fixing student interest rates
    at 6.8 percent, reducing the maximum rate from the previous 8.25
    percent. (If calculated today, the current variable rate formula--which
    will continue to apply for loans originated prior to July 1, 2006--
    would be 7.11 percent; if recent trends continue through June, the
    actual rate may be even higher.) The HERA also expands loan limits for
    first- and second-year students and graduate students and permanently
    expands loan forgiveness from $5,000 to $17,500 for math, science and
    special education teacher serving low-income communities.
        Within the Student Financial Assistance account itself, most of the
    $436 million reduction you mention reflects the effect of the new
    scoring rule for the Pell Grant program, which reduces the need for
    current year budget authority by allowing the use of excess funds from
    the previous fiscal year. The balance of the reduction reflects
    revised, lower estimates of fiscal year 2007 Pell Grant program costs
    and the elimination of two redundant, ineffective, or unnecessary
    programs: Federal Perkins Loans and Leveraging Education Assistance
    Partnerships.
                  commission on the future of higher education
        Question. Specifically, how will low- and middle-income students
    achieve the same access to postsecondary education as high-income
    students have, which is an objective of the Department of Education?
        Answer. In today's highly competitive global economy it is vital
    that no American student be denied access to effective postsecondary
    education due to high costs. Accordingly, in September 2005 the
    Secretary's Commission on the Future of Higher Education was created to
    examine how we as a Nation can keep higher education affordable and
    accessible. The Commission, made up of experienced leaders from
    education, business, and government, is holding a series of meetings
    around the country and gathering data from respected experts on higher
    education. A final report with the commission's findings is expected by
    August.
                          funding for higher education
        Question. In ``Cracks in the Education Pipeline: A Business
    Leader's Guide to Higher Education Reform,'' it is stated that low-
    income families, those with incomes in the bottom 40 percent of the
    earnings distribution, spend one-third of their income to send a child
    to community college and 43 percent to enroll in a public 4-year
    school. Further, the document states that, ``Student aid has the
    greatest impact when targeted on low-income students who otherwise
    would not enroll in college.'' What is proposed in this budget to help
    such families finance their goals for postsecondary education?
        Answer. The President's 2007 Budget for student aid builds on a
    number of significant accomplishments in 2006 to provide a record $82
    billion in assistance to more than 10 million students and parents.
    Adopting a proposal from the 2006 President's Budget, Congress
    appropriated $4.3 billion in mandatory funding in 2006 to eliminate a
    long-standing funding shortfall in the Pell Grant program, putting this
    vital program--the foundation of Federal need-based aid--on a firm
    financial footing after years of growing fiscal instability. Congress
    also adopted new budget rules proposed by the President to prevent
    shortfalls from occurring in the future. In addition, the Higher
    Education Reconciliation Act, signed by the President in February,
    would further help the neediest students by phasing out origination
    fees for Stafford Loans and providing over $4.5 billion over 5 years in
    new need-based Academic Competitiveness and SMART Grants.
            advancing america through foreign language partnerships
        Question. The fiscal year 2007 budget proposes a new program,
    through appropriations language, to establish partnerships between
    institutions of higher education and school districts that support
    programs of study in grades K-16 in critical need languages.
    Specifically, how will this proposed program complement existing
    Department programs, such as those authorized and funded under title VI
    of the Higher Education Act and the Fulbright-Hays Act?
        Answer. The Advancing America Through Foreign Language Partnerships
    program is intended to complement, not duplicate, existing Department
    programs that provide support for foreign language and areas studies
    education. Distinctive elements of the Advancing America Through
    Foreign Language Partnerships program, compared to the Title VI of the
    Higher Education Act and those authorized by the Mutual Educational and
    Cultural Exchange Act (Fulbright-Hays), include partnerships between
    institutions of higher education and school districts; the degree of
    focus on ``critical need languages'' such as Arabic, Chinese, Russian,
    Hindi, Farsi, and others; and unique language programs of study that
    enable successful students to advance from early learning in elementary
    school through advanced proficiency levels in high school to superior
    levels in college. The Title VI and Fulbright-Hays programs support 14
    distinct yet interrelated programs designed to strengthen the
    capability and performance of American education in foreign languages
    and in area and international studies in a number of world regions.
    These programs do not establish articulated programs of study in grades
    K-16 in critical need foreign languages.
        In addition, the objectives of this proposed program that relate to
    establishing fully articulated K-16 programs that produce college
    students who achieve a superior level of proficiency cannot be
    accomplished through grants to local and State educational agencies
    under the Department's Foreign Language Assistance program (FLAP). FLAP
    is focused on improving the quality of foreign language instruction in
    elementary and secondary schools. Institutions of higher education are
    not eligible to apply for funding under the FLAP program. Moreover,
    FLAP is not an appropriate vehicle for establishing the kind of
    partnerships needed between school districts and institutions of higher
    education to ensure an articulated curriculum and consistent goals and
    continual progress toward the required outcomes at all educational
    levels, including the postsecondary level.
        The Advancing America Through Foreign Language Partnerships program
    fits within the Department's mission and complements Title VI and other
    Department activities relating to the teaching and learning of foreign
    languages.
        advancing america through foreign language partnerships and dod
                     national flagship language initiative
        Question. How will this new program complement related programs
    administered by other Federal agencies?
        Answer. The Advancing America Through Foreign Language Partnerships
    program would operate following the model created under the National
    Flagship Language Initiative at the Department of Defense. The
    Administration seeks to expand on DOD's pilot K-16 Mandarin Chinese
    program by awarding an additional 24 grants to institutions of higher
    education for partnerships with school districts for programs of
    language study in a variety of languages critical to national security
    such as Arabic, Chinese, Russian, Hindi, Farsi, and others. The
    Administration is proposing that ED (and not DOD) undertake the
    expansion of this program because the goals of the program fit within
    the Department's mission and the program complements other ED
    activities relating to the teaching and learning of foreign languages.
    requirements of advancing america through foreign language partnerships
                                    grantees
        Question. Supporting budget documents note that applicants would
    have to demonstrate the long-term success of their project, as well as
    commit to a significant amount of cost sharing. Would you please
    provide more information about each of these proposed requirements?
        Answer. To address the need for skilled professionals with superior
    competency in foreign languages critical to U.S. national security,
    such as Arabic, Chinese, Russian, Hindi, Farsi, and others,
    participants in the Advancing America Through Foreign Language
    Partnerships program would be expected to make significant commitments.
    We would expect that institutions of higher education applying for
    grants would be able to identify each local educational agency partner
    and describe each partner's responsibilities (including how they would
    be involved in planning and implementing program curriculum, what
    resources they would provide, and how they would ensure continuity of
    student progress from elementary school to the postsecondary level).
    Participating institutions of higher education would be expected to
    work with partner school districts to develop and implement an
    articulated curriculum with consistent pedagogical philosophy and goals
    throughout all educational levels of the program. To ensure long-term
    success of the project, we would expect applicants to be able to
    describe in their applications how they would support and continue the
    program after the grant has expired, including how they would seek
    support from other sources, such as State and local government,
    foundations, and the private sector. We would also expect grantees to
    provide a non-Federal contribution, in cash or in kind, that would help
    carry out the activities supported by the grant.
                         statewide data systems program
        Question. The fiscal year 2007 budget requests $54.6 million for
    the Statewide Data Systems program, an increase of $30 million over the
    fiscal year 2006 amount. Budget documents supporting this request
    indicate that 14 States are receiving funds from this program, although
    all States need assistance to develop or refine and fully implement
    systems that allow them to track the progress of individual students
    statewide. Budget documents also state that the requested increase for
    fiscal year 2007 would focus on the issue accelerating the capacity of
    high schools to report and use accurate high school graduation and
    dropout data. How are States utilizing funds from fiscal year 2005 and
    fiscal year 2006?
        Answer. The Statewide Longitudinal Data Systems (SLDS) grant
    program is supporting State educational agencies in designing,
    developing, implementing, and using longitudinal individual student
    data and linking the student data to other contextual and management
    data, such as program, staffing, facilities, financial, early
    childhood, or post-secondary data. The resulting data systems will
    allow States to evaluate learning of all students and track the
    effectiveness of schools, programs, or interventions. Under the grant
    program, States are required to provide data and meaningful analyses
    back to local stakeholders, including teachers, principals, and
    districts. States are also required to develop ongoing evaluation
    procedures to ensure that the data collected are: (1) of high quality,
    (2) responsive to local information needs, and (3) useful for improving
    instruction and student learning.
        States receiving SLDS grant money are required to incorporate data
    from kindergarten to 12th grade in their data systems. Most have also
    proposed to incorporate preschool and even birth-to-preschool data.
    Similarly, most grantees propose to incorporate postsecondary data in
    their systems, spanning prekindergarten-16 and even prekindergarten-20.
    Some States will also link their data to those from non-education
    agencies, such health or labor. These longitudinal student data,
    especially with links to rich contextual data, will for the first time
    allow States and districts to reliably link student outcomes to
    different variables, including curricula, educational environment,
    funding, socioeconomic background, and other factors that affect
    student learning.
                      statewide longitudinal data systems
        Question. How does this proposed priority fit with the basic needs
    of States for developing longitudinal data systems?
        Answer. Statewide longitudinal data systems (SLDS) grants enable
    States to have more informative and reliable data on what is happening
    and what works in high schools, including the ability to evaluate and
    track how students' pre-high school experience affects how well they do
    in high school. These funds also enable States to understand how what
    happens in high school affects students' success in postsecondary
    education and/or employment. Grant funds support data system
    development and enhancements that enable States to conduct a wide range
    of rigorous longitudinal analyses, including computations of a standard
    four-year adjusted cohort graduation rate, as adopted by the National
    Governors Association (NGA). Most of the first cohort of grantee States
    have not collected and compiled these data before. Some States in the
    first cohort of grants can currently compute the NGA graduation rate,
    but these States still depend upon their grant funding to ensure the
    quality of their data collection.
        The requested increase in funding for this program will enable more
    States that do not currently have this capacity to collect data
    necessary for the computation of accurate high school graduation and
    dropout rates necessary data on high school. For States that already
    collect these data, the requested funding will enable them to connect
    all relevant data in one longitudinal data system with better and more
    efficient verification of data over time and across different
    educational and other data systems. In these States, the SLDS grant
    will result in better data faster.
                  national assessment of educational progress
        Question. The budget requests an additional $4 million to allow the
    Department to begin work on essential activities for implementing in
    2009 State-level assessments at the 12th grade level. What activities
    will be funded by this requested increase?
        Answer. The funds requested for fiscal year 2007 would be used to
    conduct validation studies to ensure that the assessment has predictive
    validity and is an appropriate measure of readiness for work,
    postsecondary education, or military service. The funds would also be
    used for the development and pilot testing of new mathematics and
    reading frameworks.
            12th grade naep initiative--reading and math assessments
        Question. What is the total cost of the 12th grade NAEP initiative,
    and what is the range of options being considered for implementing this
    new policy?
        Answer. Assuming that State participation is mandatory, the
    estimated total cost of the 12th grade State-level assessments in
    Reading and Math for 2009 would be $45 million above the current NAEP
    appropriation.
        The following chart presents estimated costs for an assessment in
    the 50 States, the District of Columbia, and Puerto Rico; as well as
    for a non-mandated assessment, with 45 States volunteering to
    participate; and for a pilot State assessment, with 10 States selected
    to participate. Once the development and phase-in of the 12th grade
    State-level assessments are complete, we estimate that the annual cost,
    beginning in 2010, of conducting State-level assessments in Reading and
    Mathematics would be $22.5 million for the mandatory scenario and $20.5
    million for the voluntary scenario.

                                        [Estimated cost, in millions of dollars]
    ----------------------------------------------------------------------------------------------------------------
                                                      12th Grade State-Level Reading and Math Assessments
                                          --------------------------------------------------------------------------
                     Year                       Mandatory (52            Voluntary (45              Pilot (10
                                                jurisdictions)           jurisdictions)           jurisdictions)
    ----------------------------------------------------------------------------------------------------------------
    2007.................................                      4.0                      4.0                      4.0
    2008.................................                     18.5                     18.5                      4.0
    2009.................................                     22.5                     18.5                      3.6
                                          --------------------------------------------------------------------------
          Total..........................                     45.0                     41.0                     11.6
    ----------------------------------------------------------------------------------------------------------------

                     office of communications and outreach
        Question. Budget documents supporting your fiscal year 2007 budget
    request indicate that staffing for communications and outreach will
    change from 14 FTE in 2005 to 140 in fiscal year 2006. Will you explain
    the need for 140 FTE's in this office, instead of utilizing these staff
    in grants monitoring and other program administration capacities?
        Answer. Staffing for communications and outreach did not increase
    from 14 to 140. The reason there appears to be an increase is that we
    took staff from other areas and consolidated them under a new
    centralized communications office. In an effort to better coordinate
    the communication functions of the Department to ensure clear,
    consistent communications, a new Office of Communications and Outreach
    (OCO) was created. It now includes the former Office of Public Affairs
    (OPA), most of the functions of the former Office of Intergovernmental
    and Interagency Affairs (OIIA) and the function of internal
    communications. The new Office of Communications and Outreach
    encompasses speechwriting, public affairs, web site, publications,
    event services, external affairs and the Secretary's 10 regional
    offices. The Office of Communications and Outreach is responsible for
    creating and distributing appropriate education materials to inform the
    work and decision-making of educators, policymakers, government
    officials, parents and students.
           department expenditures for public relations and outreach
        Question. How much did your Department spend on public relations
    and outreach in fiscal year 2005?
        Answer. In fiscal year 2005, the Department spent $1,132,246 on
    public relations and outreach, in procurement of items and services
    such as speeches and editing for senior staff, logistical outreach
    event support, webcasting, and the monthly ``Education News Parents Can
    Use'' satellite broadcasts.
        Question. How much do you plan to spend in fiscal year 2006 and
    fiscal year 2007, and what are the primary outcomes intended to be
    achieved by these expenditures?
        Answer. The Department plans on spending $1,025,000 in fiscal year
    2006 and $1,100,000 in fiscal year 2007 on public relations and
    outreach events which are designed to inform members of the public
    about No Child Left Behind and other Department programs, the monthly
    ``Education News Parents Can Use'' satellite broadcast, and technical
    support for webcasting.
        Each ``Education News Parents Can Us'' broadcast explains U.S.
    Department of Education programs to parents using practical, plain-
    language discussions of topics such as ensuring safe and drug free
    schools, teaching reading, serving students with disabilities, and
    using new education technology. Each broadcast offers this information
    in a format that features short segments, including one-on-one
    interviews, ``how-to'' demonstrations, and brief conversations with
    parents, educators, education experts, and community, business and
    religious leaders.
        Technical and production support is needed for the creation of high
    quality, live, or previously videotaped multi-media programs that can
    be broadcast over the Internet. These productions are for the purpose
    of raising the general public's awareness of and encouraging
    participation in programs associated with ED's education reform
    initiatives.
                                     ______

                Questions Submitted by Senator Daniel K. Inouye
                           native hawaiian education
        Question. First and foremost, I'd like to express my sincere
    appreciation for the continued funding of Native Hawaiian Education.
    This funding facilitated uninterrupted curricula development, teacher
    training and recruitment programs as well as scholarship offerings.
    Programs such as these allowed many young Hawaiians' the opportunity to
    fully realize their dreams. Through continued support of Native
    Hawaiian Vocational Education, countless individuals can now
    successfully enter, compete and advance in the ever-changing and
    competitive technological workplace.
        I would also like to extend my personal thanks to your Department
    administrators who have traveled to Hawaii to meet our local program
    coordinators and provide technical assistance to our remote
    communities. No doubt, your staff has seen first hand the tremendous
    impact and success these funded programs have had on the people of
    Hawaii.
        Madam Secretary, what are the indicators or measures your
    Department uses to manage existing competitive grantees under the
    Native Hawaiian Education Act?
        Answer. The Department has established three performance measures
    for the Native Hawaiian Education program authorized under Title VII of
    the ESEA. The measures are:
      --The percentage of teachers involved with professional development
            activities that address the unique educational needs of program
            participants.
      --The percentage of Native Hawaiian children participating in early
            education programs who improve on measures of school readiness
            and literacy.
      --The percentage of students participating in the program who meet or
            exceed proficiency standards in mathematics, science, or
            reading.
        The Department collects data on these measures through the annual
    performance reports submitted by grantees.
        Question. Please also describe the process by which these
    indicators were selected.
        Answer. The development of the performance indicators for the
    Native Hawaiian Education program was based on an analysis of the
    program's purpose, priorities and authorized activities, and how those
    align with the overall priorities and purpose of the No Child Left
    Behind Act. As the program authorizes a wide number of project
    activities, we also had to narrow somewhat the areas for performance
    measurement for the program, in order to minimize the burden of data
    collection and reporting. Since we were unable to arrive at one
    performance indicator that would be appropriate for all projects
    possible or allowed under the program, we conducted an analysis of
    grantee activities and goals. The analysis showed that most grantees
    are implementing projects around a small number of areas (early
    childhood, teacher professional development, and math and science
    education) and, thus, we developed indicators to track program
    performance in those areas.
                              women in technology
        Question. The Women in Technology (WIT) program originated in Maui
    5 years ago as a workforce development project initially funded through
    a grant from the U.S. Department of Labor. A core mission component of
    the program was to partner with educators and industry to create a
    pipeline from education to employment in science, technology,
    engineering and math. This concept was first introduced in our local
    middle and high schools, to increase the confidence and interest of
    under represented populations in math and science studies and expose
    them to educational and professional opportunities in high-tech
    professions. This was accomplished at no cost to the students.
        Elementary school is a critical time to begin outreach efforts to
    attract students into the science, technology, engineering and math
    pipeline. National research indicates that gender identities and
    stereotyping about career roles are set by age seven. One of the goals
    of Women in Technology includes training elementary school teachers in
    ``inquiry-based learning'' methods. In this method, teachers learn how
    to harness the natural inquisitive nature of their students and nurture
    it into scientific questions/hypothesis and self-directed activities to
    prove/disprove the students' questions. The inquiry-based activities
    are integrated into the teaching curriculum and align with grade level
    and standards. This method of teaching is well suited to children of
    both genders and stimulates all styles of learning. A pilot program,
    recently launched in Maui, included a professional development workshop
    for one dozen elementary teachers.
        Madam Secretary, Women In Technology is a critically important
    program to securing a more prosperous future for many young Hawaiians.
    So strong is my belief in the value of this program, that in years
    past, I sought funding for it via my earmarks. As such are no longer
    available, will the Department of Education provide funds for the
    expansion of science, technology, engineering and math ``inquiry-based
    learning'' curriculum and training to all elementary school teachers
    throughout the State of Hawaii?
        Answer. The agency operating the Women in Technology (WIT) program
    may pursue discretionary funding opportunities under a number of
    Department of Education programs that support activities such as the
    ones you describe. WIT may apply, for example, for funding under the
    Native Hawaiian Education program, which supports innovative projects
    to provide supplemental services that address the educational needs of
    Native Hawaiian children and adults. Authorized activities under that
    program include development and implementation of professional
    development programs to prepare teachers to address the unique needs of
    Native Hawaiian students.
        WIT may also be eligible for funding under the Mathematics and
    Science Partnerships program. Funds for the program are distributed to
    States based on a formula, and each State then administers a grant
    competition for the funds. The program supports State and local efforts
    to improve students' academic achievement in mathematics and science by
    promoting strong teaching skills for elementary and secondary school
    teachers, including integrating teaching methods based on
    scientifically based research and technology into the curriculum.
    Grantees may also use program funds to develop more rigorous
    mathematics and science curricula that are aligned with challenging
    State and local content standards; establish distance learning programs
    for mathematics and science teachers; and recruit individuals with
    mathematics, science, and engineering majors into the teaching
    profession through the use of signing and performance incentives,
    stipends, and scholarships. Professional development can include summer
    workshops, or institutes and programs, that bring mathematics and
    science teachers into contact with working scientists, mathematicians,
    and engineers in order to expand teachers' subject-matter knowledge.
    WIT administrators should contact the Hawaii Department of Education
    for information on applying for this program.
                                     ______

                    Questions Submitted by Senator Herb Kohl
                         special education full funding
        Question. Many of us here have worked hard every year to increase
    funding for Special Education. Year after year, school districts in
    Wisconsin tell me that this is one of their top concerns. But this
    year's budget is especially worrisome. It proposes to cut the Federal
    share of IDEA costs from 18 percent to 17 percent--that is less than
    half of the 40 percent ``full funding'' level that Congress committed
    to paying when IDEA was first adopted 31 years ago. This deliberate
    step backward begs the question: does this Administration plan to ever
    fully fund IDEA?
        Answer. Under the President's leadership, funding for the Grants to
    States program has increased by 67 percent since 2001. The President's
    2007 request for the Special Education--Grants to States program of
    $10.7 billion, which includes an increase of $100 million, would
    provide about 17 percent of the national average per pupil expenditure
    (APPE) for 6.9 million children with disabilities receiving special
    education, compared to about 14 percent of the APPE in 2001. No
    Administration has come close to requesting 40 percent of APPE, but
    this Administration has proposed record-high increases in funding for
    the program and has achieved record-high levels of the Federal
    contribution.
                       early childhood education funding
        Question. While I support the President's proposals to increase
    resources to support math and science education at the high school
    level, I am concerned about the decrease in funding for programs that
    support early childhood education. Research shows that 80 percent of
    brain development takes place during the first 3 years of a child's
    life. In light of this research, please explain the Administration's
    rationale for funneling resources away from programs that support our
    youngest learners--like the Foundations for Learning and Even Start
    programs--and putting those funds into our high school age programs.
        Answer. The Department remains dedicated to the goal of promoting
    cognitive development for all children, and the President's budget
    request reflects a strong commitment to programs that have a proven
    record of success in serving our Nation's youngest citizens. Neither
    Even Start nor Foundations for Learning has a track record of
    demonstrated effectiveness. While some local Even Start programs are
    successful at supporting the development of children's early academic
    skills, the program's overall reliance on the family literacy model has
    not been shown to be effective. In addition, the Foundations for
    Learning program is duplicative of other programs that serve very young
    children and its size precludes any large impact on the populations to
    which it is targeted. Other programs, such as Early Reading First and
    the Early Childhood Educator Professional Development program, focus on
    proven methods of addressing the cognitive development and school
    readiness needs of young children
                  perkins loans and other student aid programs
        Question. Not only does this budget cut Pell Grants, but it also
    calls for the elimination of the Federal Perkins loan program. This
    academic year, the University of Madison-Wisconsin served 5,202
    students with $13.2 million in Federal Perkins Loans. These loans
    helped students cover the gap between other financial aid and the
    actual cost of attendance. They are also a good option for low-income
    students because they are not dependent on credit history. Secretary
    Spellings, if Congress were to agree to the President's recommendation
    and eliminate Perkins loans, what do you suggest these students do to
    pay for higher education?
        Answer. First, to clarify, the President's Budget does not cut Pell
    Grants; current estimates indicate every eligible student would receive
    his or her full award under our proposal. The reduction in budget
    authority compared with fiscal year 2006 reflects the new scoring rule
    under which an estimated $273 million in unused funds from fiscal year
    2006 can be used to reduce the need for new appropriations, as well as
    a slight reduction in the estimated cost of the Pell Grant program.
        More broadly, even with the Perkins Loan proposal, student aid
    would increase under the President's Budget by more than $4.6 billion
    in fiscal year 2007 over the previous year, including $790 million in
    new need-based Academic Competitiveness and SMART Grants. In addition,
    student loans under the Federal Family Education Loan and Direct Loan
    programs will be a better bargain for borrowers due to lower interest
    rates and reduced origination fees.
               elementary and secondary school counseling program
        Question. School counselors play a vital role in the lives of
    American youths by providing guidance on issues both academic and
    personal. During times of war and the ongoing fear of terrorism, the
    need for effective school counseling is clearer than ever. In addition,
    counselors continue to guide students in career, academic and social
    development. That's why I am very concerned that the President's budget
    again eliminates funding for the School Counseling Program. In
    Wisconsin, each public school counselor oversees 461 students--a
    caseload that already leaves many students underserved.
        School counselors play an important role in helping students meet
    the goals of No Child Left Behind. Why would the Administration cut a
    program that is helping to make its signature education policy work?
        Answer. The budget request to eliminate funding for the Elementary
    and Secondary School Counseling program is part of an overall budget
    strategy to discontinue programs that duplicate other programs that may
    be carried out with flexible State formula grant funds, or that involve
    activities that are better or more appropriately supported through
    State, local, or private resources. Specifically, the 2007 budget
    proposes termination of 42 programs in order to free up almost $3.5
    billion (based on 2006 levels) for reallocation to higher-priority
    activities within the Department. These higher-priority activities
    include the Administration's $1.5 billion High School Reform
    Initiative. Under this Initiative, local educational agencies will be
    able to include student counseling services as part of the
    comprehensive strategies they adopt to raise high school achievement
    and eliminate gaps in achievement among subgroups of students.
        In addition, if school districts choose to do so, they may support
    counseling programs with the funds they receive under the State Grants
    for Innovative Programs authority, which allows them to implement
    programs that best meet their needs. Furthermore, the Elementary and
    Secondary Education Act (ESEA) provides school districts with
    additional flexibility to meet their own priorities by consolidating a
    sizable portion of their Federal funds from their allocations under
    certain State formula grant programs and using those funds under any
    other of these authorized programs. A school district that seeks to
    implement a school counseling program in some or all of its schools may
    use funds from those programs to do so.
                                     ______

                  Questions Submitted by Senator Patty Murray
                     academic competitiveness/smart grants
        Question. The fiscal year 2006 Budget Reconciliation bill created
    Academic Competitiveness grants and the National Science and
    Mathematics Access to Retain Talent (SMART) grants. To receive the
    Academic Competitiveness grants, students must have completed a
    rigorous secondary-school program of study. While I agree that we need
    to be doing all we can prepare students for a job in a global economy,
    a student's luck in where they attend high school shouldn't determine
    whether or not the Federal Government helps them attend college. The
    Congressional Budget Office has estimated that only 9.9 percent of Pell
    eligible students will be able to take advantage of the Academic
    Competitiveness and SMART grants in 2007.
        The maximum Pell grant has not increased for years despite tuition
    rising at our Nation's public colleges rising by over 7 percent last
    year. If the $850 million that these grants cost in fiscal year 2007
    were spent on Pell grants, students would receive an additional $200 in
    aid.
        How do you anticipate judging what constitutes a rigorous
    secondary-school curriculum?
        Answer. The Department of Education is working with all States to
    help them identify high school programs of study they can submit to the
    Secretary of Education for recognition as rigorous secondary programs
    of study. In addition, there will be alternative eligibility provisions
    for students from States that have not yet submitted designated
    programs to the Secretary. These State-identified, eligible rigorous
    secondary school programs or acceptable alternatives will soon be
    posted on a Department web site.
        Question. Particularly in such tight budget times, shouldn't we be
    spending our resources on helping all students attend college
    regardless of their circumstance, not benefiting the few who are lucky
    enough to attend the ``right'' high school?
        Answer. Taken together, the Federal student aid programs under the
    President's fiscal year 2007 budget request would provide over $82
    billion to students and families, much of it focused on the neediest
    Americans. Within this larger investment, we believe it is appropriate
    to target a portion of need-based aid--Academic Competitiveness/SMART
    Grant recipients must be eligible for a Pell Grant--to encourage the
    type of rigorous high school study and challenging college coursework
    that is linked to success both for individuals and, ultimately, for our
    Nation.
                                title ix report
        Question. On March 17, 2005, the Department of Education released
    new guidance on the interest prong of the three-part test which schools
    use to show compliance with Title IX in athletics. As you are aware, I
    have grave concerns about the new guidance because I believe it sets a
    new low bar for compliance with a Federal civil rights law. Schools
    would now be allowed to use an email survey to show compliance with
    Title IX. Further, the school would only have to send that survey to
    women and a lack of response could be determined as lack of interest in
    sports. Surveys have been used in the past to show compliance with
    Title IX, but not as a sole means and other factors such as emerging
    sports had to be taken into consideration.
        Because of concern over this new guidance, a bipartisan group of
    Senators on this subcommittee asked for a report on the guidance and
    use of surveys due March 17. What is the status of the requested
    report?
        Answer. The report in response to guidance and the use of surveys
    for Title IX was submitted to the Committee on March 17, 2006.
                         title ix technical assistance
        Question. Clearly, there is a lot of confusion on behalf of schools
    about this new guidance. What is the Department doing regarding
    technical assistance on the guidance?
        Answer. The Office for Civil Rights (OCR) regularly provides
    technical assistance on a variety of issues to interested parties,
    including elementary and secondary schools and colleges and
    universities. Assistance is an important method to help educational
    institutions achieve voluntary compliance with the civil rights laws
    and assist in preventing civil rights violations by educating schools
    about their responsibilities. OCR provides guidance through a variety
    of methods, including responses to thousands of requests for
    individualized technical assistance, via phone, email, or mail, each
    year from individuals, recipients, and groups representing recipients
    and beneficiaries. Our technical assistance also includes on-site
    consultations, conferences, training, community outreach, publishing
    and disseminating materials, through the Department's website and
    direct mailings, and issuing guidance.
        With respect to Title IX of the Education Amendments of 1972 (Title
    IX), the Department issued the Additional Clarification of
    Intercollegiate Athletics Policy (Additional Clarification) to clarify
    one method schools may choose to use to assess athletic interests and
    to provide a practical tool they may choose to use to conduct that
    assessment.
        To further assist schools, OCR has been and continues to actively
    seek out opportunities to provide technical assistance on a continuous
    basis. In the year since the Additional Clarification was issued, OCR
    has provided technical assistance on the Additional Clarification to
    more than a thousand coaches, athletic directors, Title IX coordinators
    and legal advisors, in addition to regularly providing individualized
    technical assistance. These presentations have included secondary
    schools, 2- and 4-year colleges and universities, and conferences
    sponsored by umbrella organizations responsible for developing and
    implementing the governing rules and procedures for national and
    regional athletics at the secondary, junior college, and 4-year college
    levels. We will continue to proactively seek out opportunities to
    educate recipients, educational and athletic organizations,
    administrators, parents and students regarding nondiscriminatory
    implementation of Title IX and the Additional Clarification.
                  america's opportunity scholarships for kids
        Question. The President's budget again proposes school vouchers
    through the America's Opportunity Scholarships for Kids program. The
    President's education budget also eliminates 42 programs. We often hear
    that the programs are proposed for elimination because they are
    ineffective. However, there is no evidence that private school vouchers
    do anything to improve achievement for any students. Further, we still
    have yet to see any real evaluation of achievement under the D.C.
    voucher program.
        In such a tight budget, how does the Administration justify
    spending $100 million on a program that has yet to be found effective?
        Answer. To offer the opportunity of a high-quality education to
    more students who attend schools in restructuring around the country,
    the Department proposes the creation of a national school choice
    program that gives parents the choice to send their children to any
    public or private schools that they believe would better serve their
    student's needs. Though it is too early to know the potential effects
    on academic achievement of the D.C. School Choice Incentive Program, we
    do know that the program has generated significant support among
    parents of students in low-performing schools in Washington, DC. The
    America's Opportunity Scholarships program would extend that option to
    parents whose children attend low-performing schools across the Nation.
    In addition, several research studies, such as ``Private School
    Vouchers and Student Achievement: An Evaluation of the Milwaukee
    Parental Choice Program'' by Cecilia Rouse, and Jay Greene's ``The
    Effect of School Choice: an Evaluation of the Charlotte Children's
    Scholarship Fund,'' suggest that participation in the private school
    choice programs leads to improvements in student achievement.
            impact of medicaid change on children with disabilities
        Question. The Department of Health and Human Services reflects a
    change in how Medicaid is dealt with at schools. While I understand
    this change is proposed in the HHS budget and not the Department of
    Education, the impact will be felt by students and schools. The HHS
    budget says that certain costs associated with services provided to
    special education students who are also on Medicaid will no longer be
    reimbursed to the schools through Medicaid. The estimated savings to
    HHS is over $600 million for fiscal year 2007 and the 10-year savings
    is over $9 billion. The President's budget proposes only a $100 million
    increase to IDEA. While we will certainly fight for increasing funding
    for IDEA and other education programs, given these tight budget times,
    I have a feeling IDEA won't receive $9 billion in the next 10 years.
        I am concerned that students will feel the impact of this change.
    The Federal Government has yet to live up to the promise of funding 40
    percent of the cost of educating a special education student and
    schools will not be able to absorb the costs associated with this
    change. Students will be told to get such services outside of school
    hours.
        How do you propose ensuring that students get all the necessary
    service they receive now if this change happens at HHS?
        Answer. The President's 2007 Budget includes a proposal that would
    prohibit Federal Medicaid reimbursement for Medicaid administrative
    activities performed in schools. It additionally provides that Federal
    Medicaid funds will no longer be available to pay for transportation
    required to be provided to children with disabilities by the
    Individuals with Disabilities Education Act. HHS has had long-standing
    concerns about improper billing by school districts for administrative
    costs and transportation services. Both the HHS Inspector General and
    the Government Accountability Office have identified these categories
    of expenses as susceptible to fraud and abuse. Schools would continue
    to be reimbursed for direct Medicaid services identified in an
    Individualized Education Program (IEP) or Individualized Family Service
    Plan (IFSP) and provided to Medicaid-eligible children, such as
    physical therapy, that are important to meeting the needs of Medicaid-
    eligible students with disabilities.
        A shift in funding responsibility for administrative and
    transportation costs associated with Medicaid eligible children with
    disabilities should not affect services for these children. State and
    local governments are responsible for ensuring that needed services are
    provided for all children with disabilities, regardless of whether they
    are Medicaid eligible. The change in policy would treat Medicaid
    eligible children with disabilities the same as other children with
    disabilities with regard to administrative and transportation costs.
    The Department of Education and HHS intend to work together to ensure
    that implementation of this change in policy is done in an orderly and
    sensible fashion.
                    21st century community learning centers
        Question. The President's budget would freeze funding for the 21st
    Century Community Learning Centers Program for the fifth year in a row.
    Furthermore, NCLB's fiscal year 2007 authorization level for the
    program is $2.5 billion. This is a program that enjoys extraordinary
    public and bipartisan congressional support. All of us hear from
    constituents who want and need more funding to develop more afterschool
    programs in their communities. These programs help working families,
    provide vital additional academic support to students and provide safe,
    supervised environments for kids afterschool--priorities that appear to
    match many of the President's major goals.
        With such diverse, bipartisan support, why has the Department
    continued to propose only $981 million for the program? That gap leaves
    the States, communities, families and students--as many as 1.4 million
    children--behind and more than 25 States unable to offer new grant
    opportunities in fiscal year 2005.
        Answer. The program does, indeed, enjoy bipartisan support in
    Congress, and we do receive many letters from Members asking us to
    increase funding. However, in a tight budget environment, we need to
    target the limited available funding on programs that show evidence of
    success or that have a strong potential to fill major unmet needs. The
    results of the only national evaluation of 21st Century Community
    Learning Centers were not very positive and did not present a case for
    increasing the funding. However, the Department's Institute of
    Education Sciences has launched a study of specific math and reading
    interventions that will determine after-school programs' potential
    impact on academic achievement. We will review the results of that
    study, and also the program performance results that States submit, in
    determining whether to request increases in future years.
                                civic education
        Question. As you know, we face a crisis today with young people who
    are disenchanted with politics; they are apathetic and cynical about
    Government and its institutions. I was disappointed to discover the
    elimination of the Education for Democracy Act in the President's
    budget request. This program funds domestic civic and international
    civic and economic education programs. The Civic Education program is
    successful in helping American students understand and appreciate
    fundamental values and principles of our Government.
        Can you comment on why a program that is consistent with the
    Administration's desire for American students to have a basic
    understanding and appreciation of the workings of our Nation's
    Government and politics along with its values and principles was
    eliminated in the President's budget?
        Answer. The Administration agrees that there is a critical need for
    education programs that effectively promote basic understanding and
    appreciation of the workings of our Nation's Government and politics,
    along with it values and principles. However, we question the efficacy
    and wisdom of statutorily mandating that 100 percent of funds available
    for domestic civic education activities must go to a single
    organization, particularly when so little is known about the efficacy
    of civic education interventions developed and supported by this
    organization. The Administration believes that a more effective
    approach to addressing the issue is to invest in programs that make
    competitive awards to local schools districts and other eligible
    entities to help create safe learning environments where students
    understand, care about, and act on core ethical and citizenship values,
    such as Character Education (which would receive $24.2 million under
    the President's request) and Safe Schools/Healthy Students (which would
    receive $79.2 million under the President's request).
        While the Civic Education program, as currently authorized,
    supports some worthwhile activities, there are no reliable measures of
    overall effectiveness of interventions supported using program funds.
    Studies and evaluations conducted by the Center for Civic Education
    provide limited information on program performance, but none are
    sufficiently rigorous to yield reliable information on the overall
    effectiveness or impact(s) of the various interventions supported
    through this program.
        The administration does not believe additional funding is necessary
    for the implementation of activities currently supported by the Center
    for Civic Education--an established non-profit organization with a
    broad network of program participants, alumni, volunteers, and
    financial supporters at the local, State, and national levels. The
    Center also has a long history of success raising additional support
    through such vehicles as selling program-related curricular materials,
    training and workshops, partnering with non-profit groups on core
    activities, lobbying, and seeking support from foundations.

                              SUBCOMMITTEE RECESS

        Senator Specter. Thank you very much. The subcommittee will
    stand in recess to reconvene at 10 a.m., Wednesday, May 3, in
    room SD-226. At that time we will hear testimony from the
    Honorable Michael Leavitt, Secretary, Department of Health and
    Human Services.
        [Whereupon, at 12 noon, Wednesday, March 1, the
    subcommittee was recessed, to reconvene at 10 a.m., Wednesday,
    May 3.]

    DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
                  AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2007

                                  ----------

                             WEDNESDAY, MAY 3, 2006

                                           U.S. Senate,
               Subcommittee of the Committee on Appropriations,
                                                        Washington, DC.
        The subcommittee met at 10:15 a.m., in room SD-226, Dirksen
    Senate Office Building, Hon. Arlen Specter (chairman)
    presiding.
        Present: Senators Specter, Craig, Harkin, Kohl, Murray, and
    Durbin.

                    DEPARTMENT OF HEALTH AND HUMAN SERVICES

                            Office of the Secretary

    STATEMENT OF HON. MICHAEL O. LEAVITT, SECRETARY

                   OPENING STATEMENT OF SENATOR ARLEN SPECTER

        Senator Specter. Good morning, ladies and gentlemen. The
    hearing for the Appropriations Subcommittee on Labor, Health
    and Human Services, Education, and Related Agencies will now
    proceed. I regret a little late start here, but we have been
    conferring with the distinguished Secretary of Health and Human
    Services, and we wanted to get some background information
    before coming into the public hearing. This is a very important
    hearing because it involves the budget for the Department of
    Health and Human Services, and health is our number one capital
    asset. Without health, none of us can function.
        I could give an extensive testimonial to that over the past
    year, but I'll save that for another day and instead focus on
    the proposals for Federal expenditures. I say at the outset, as
    I have said privately to the Secretary, that I am very
    disturbed at the reduction in funds for his Department. There
    is a $1.6 billion reduction in funding for the Department of
    Health and Human Services, and that follows a pattern of
    reductions for--the other departments which are within the
    purview of this subcommittee. There have been reductions of
    some $2.2 billion for the Department of Education, reductions
    for the Department of Labor so that effectively, from the
    year--fiscal year 2005 until the present time, we have a
    reduction of $15.7 billion, and that means that there are vital
    programs for health, vital programs for human services which
    are inadequately funded to start with and are now really
    effectively starved.
        The National Institutes of Health (NIH), which is the crown
    jewel of the Federal Government, is level funded, and that
    means taking into account inflation, there will be fewer grants
    made, and there have been enormous advances made by NIH. The
    leadership's been provided really from this subcommittee long
    before you became Secretary, Mr. Secretary. When we took the
    NIH budget from $12 to $29 billion, there have been remarkable
    advances in the research on Alzheimer's and Parkinson's and
    heart disease and cancer, but not enough.
        As we speak, a very distinguished Federal jurist who has
    been named the 101st Senator as suffering from prostate cancer,
    and I lost my Chief of Staff, Carey Lackman, a beautiful young
    woman of 48 recently from breast cancer. In 1970, President
    Nixon declared war on cancer. If we had devoted the resources
    to the war on cancer which we devote toward other wars, we
    would have conquered cancer. In the past year, I have made the
    Kleenex industry wealthy, Mr. Secretary. This is a lingering
    aspect of chemotherapy treatment, and that brings me back to
    personalizing it just for a paragraph or two, but had the war
    on cancer been fought vigorously, I wouldn't have gotten
    Hodgkin's, I believe. The chances are good I wouldn't have.
    Well, that's the backdrop of these hearings and my views.
        As I told you privately a few moments ago and I think it's
    worth repeating publicly, the President called in a number of
    committee chairmen last week for our views on what ought to be
    done, and when I had the opportunity to talk to the President,
    and I have had the opportunity to get to know President Bush
    rather well, he was in Pennsylvania 44 times in 2004 when he
    ran for reelection and I was up too, and I was with him on most
    of those occasions, and I have a very high regard for the
    President and the job he is doing notwithstanding the poll
    figures. Up close, he is very much engaged, very much on top of
    the job. The persona that comes through the news media is very
    very different. But at any rate, he is prepared to hear candid
    views even if they don't agree with his, and I told him about
    the $15.7 billion reduction in spending and told him what was
    happening in the National Institutes of Health. I know that you
    are not the President, and as you reminded me, you are not even
    the Director of the Office of Management and Budget (OMB), but
    you are the Secretary of Health and Human Services. What I am
    calling upon all of the candid officers where I have a
    chairmanship and can make a constructive suggestion is to carry
    this fight to the Director of OMB and carry this fight to the
    President, and no department is more important than yours. To
    have level funding for NIH and to have cuts in the Centers for
    Disease Control and Prevention (CDC) with all the work CDC has
    to undertake is just unacceptable.
        Well, I appreciate your being here, Mr. Secretary, and I
    genuinely appreciate the job you are doing--leaving the
    Governorship of Utah, coming to Washington, tackling really big
    issues, and this matter of pandemic flu is of gigantic
    importance. Senator Harkin has been the leader, and I have
    worked with him as his partner, and we have moved ahead against
    some problems to produce $6.6 billion in funding. The potential
    for the pandemic flu if it strikes could be calamitous. When it
    has struck this country and the world in the past, millions of
    people have died. That's a real danger, and I am pleased to see
    what you are doing and what you plan to do even with major
    announcements to come tomorrow. Senator Murray has a time
    conflict, and I will yield to her at this time.

                       STATEMENT OF SENATOR PATTY MURRAY

        Senator Murray. Well, thank you very much, Mr. Chairman. I
    am managing the floor for the Democrats in the supplemental and
    need to get back to the floor, and I appreciate the chairman
    yielding. I would second his statement and thank him for being
    the champion of NIH research, but also education and healthcare
    and all of the things that fall under the purview of this
    budget that you are presenting on behalf of the administration
    and echo his comments that investments in these diseases,
    investments in our future are absolutely critical to our Nation
    and the strength of our Nation in the future. I want to thank
    the chairman for his tremendous work on behalf of this and echo
    his sentiments that I am deeply concerned about the cuts that
    are coming. I can't stay for the questioning. I did want to
    submit some for the record and tell you personally that I have
    been out in the state talking to many seniors about the new
    Medicare Part D prescription drug benefit.

                       MEDICARE PART D DEADLINE EXTENSION

        Although I voted against it, I want it to work. I want our
    seniors to be able to sign up for this and make it work. I am
    very concerned about what I am hearing from seniors as this May
    15 deadline looms from seniors who can't get access or think
    they have signed up for something find out several weeks later
    they haven't. Many seniors are holding back signing up for it
    because they are worried about whether or not it's going to
    cover their drugs. I mean, you have heard all of it as well,
    and I hope that we can be thoughtful in our approach, and I
    would encourage you to look at extending the deadline--at least
    for those whose benefits don't begin until January of next year
    at the very minimum so that we don't cause a lot of seniors
    harm in the process. What I see is people signing up for these
    plans out of fear rather than out of knowledge. I think in the
    long run, we will all be hurt if that occurs, and I wanted to
    encourage you to work with us and continue to work with us. I
    know you are hearing some of the same things we are and really
    would like to see this--and to talk with you about that, but I
    specifically wanted to ask because we are now seeing seniors
    who signed up January 1 fall into the donut hole.
        There is tremendous concern about those seniors who had
    pharmacy assistance plans who had drugs before who signed up
    for a drug are now falling into that donut hole. Are they
    considered uninsured, or are they considered insured for the
    purposes of being covered under the pharmacy assistance plans--
    and would like to get you or your staff to work with us as we
    try to help those seniors through that challenge right now. But
    Mr. Chairman, I will submit questions for the record, but I
    would like you and all of us to seriously look at this May 15
    deadline and try and accommodate many of these seniors who are
    really having challenges who I think we don't want to lose in
    this process, and we want to make sure that we have given them
    a benefit and not given them some dire circumstances. So I
    appreciate the opportunity to throw that out there and look
    forward to working with you, Mr. Secretary.
        Senator Specter. Thank you, Senator Murray. Before yielding
    to Senator Craig, let me call upon our current distinguished
    ranking member for an opening statement. Before you walked in,
    Senator Harkin, I was praising you behind your back for your
    leadership--the number one leader on the funding for pandemic
    flu, and I said I was your partner, and the floor is yours.

                        STATEMENT OF SENATOR TOM HARKIN

        Senator Harkin. Well, that's kind of you, Mr. Chairman, but
    I just follow your lead--that's all. If some of the reflective
    glory comes up, I am--that's all right, that's fine with me.
    Mr. Chairman, first of all, I want to thank you for your great
    leadership in so many areas--of course in this area of health.
    There is no stronger champion for the National Institutes of
    Health than the Senator from Pennsylvania.
        I have been by his side in--well, it's now going on about
    16 years now. If it weren't for Senator Specter's great
    leadership, we would never have doubled the funding for NIH
    that we did in the late 1990s and put it up where it is. Now,
    of course, we have some problems now in making sure we continue
    that funding, and of course that's one of the problems that I
    have with the President's budget, and I am sure the chairman
    does also.
        Welcome the Secretary, and then we'll just get to some
    questions in at that time.
        Senator Specter. Okay. Thank you very much, Senator Harkin.
    Senator Craig?

                        STATEMENT OF SENATOR LARRY CRAIG

        Senator Craig. Well, Mr. Chairman, I want to welcome the
    Secretary, and I must say that these two gentlemen struggle
    mightily with a very tough budget that Congress and this Senate
    have always supported, but your environment and our environment
    is one that we are being increasingly squeezed out of
    discretionary monies by mandatory spending. Someday, we'll get
    brave enough to take it on in a responsible way. But until that
    time, the struggle of the chairman and the ranking member and
    this member will continue to go on because there has to be a
    sense of fiscal responsibility. I just came from the floor
    suggesting that the supplemental that we have got out there
    deserved to be vetoed by a President who had sent a message
    because it was about $10 billion out of line, and that's
    because we can't quit spending around here without a collective
    pressure being brought upon us. At the same time, there are
    priorities of spending that we get squeezed away from. I will
    say, Mr. Secretary, when I was home in the last recess, the
    good news--even though the Senator from Washington expresses
    continued concern about prescription drugs--is that you are
    having a phenomenal success, and I hope you will speak about it
    today. To stand up and bring on line a massive new program that
    this one is and to already be able to register the kinds of
    successes--someone said to me well, gee, it must have been
    pushed off the front page by the price of oil. I said no, it
    was pushed off the front page because there was less criticism
    today and more praise as the results come in. I hope you will
    share those with us. Deadlines are important to cause people to
    react and to analyze and to decide on decisions that are
    necessary for them to make in a confused world. I will lastly
    say a couple of weeks ago, I am walking through the security
    line at the Boise Airport, and the fellow checking my ID said
    Senator, there are too many decisions, too many choices in
    prescription drugs, and I said well, then you would have
    preferred that we would have mandated a single program for you?
    Oh no, not at all.
        Then I said you need to get with it. He said I am and
    laughed. I said you saving money? He said, a lot of money, but
    it was a tough choice. He said I really had to force myself to
    do a little studying. Thank you. I yield the floor.
        Senator Specter. Thank you very much, Senator Craig.
    Senator Durbin, would you care to make an opening statement?

                      STATEMENT OF SENATOR RICHARD DURBIN

                        MEDICARE PART D FORMULARY PRICES

        Senator Durbin. Mr. Chairman, thank you very much. I would
    just say briefly thank you, Mr. Secretary, for being here. I
    think you have an awesome responsibility and some very
    important programs that are under your control and leadership.
    I would say on Medicare Part D that I will not quarrel with the
    premise that offering senior citizens coverage for prescription
    drugs is a good thing. It keeps them healthy and independent,
    strong, and out of hospitals and nursing homes longer. That's
    what they need. I do believe, though, that in my State there
    are still over 300,000 people who haven't made that choice. I
    don't know if that number has come down significantly in the
    last few days, but they only have 2 weeks left before they face
    a penalty for not making a choice. It is also a fact that those
    who have made a choice in terms of their prescription drug plan
    are going to be somewhat surprised to learn that the prices are
    not locked in. The prices of the drugs--in fact, the
    formulary--the available drugs that you can purchase under a
    plan can change on a daily basis, which leads to some
    uncertainty about their future. Many of us felt that it would
    have been a better approach to allow Medicare to offer one
    universal plan which consumers could choose if they like, allow
    Medicare to bargain for deep discounts in drugs and to offer
    them nationwide. Then if private insurers wanted to compete,
    they would be allowed to. That position did not prevail. So, in
    Illinois, it meant some 45 different choices for prescription
    drug plans, and some seniors struggled with them. Many
    pharmacists continue to struggle with them as of today.

                                NIH BUDGET CUTS

        I would also want to echo what I know was said earlier by
    Senator Harkin. The pride that we have taken in Congress in the
    fact that the research money for the National Institutes of
    Health was doubled over a period of time. A former congressman
    from my State, John Porter, was the chairman of the
    Appropriations subcommittee that led that effort. He couldn't
    have made it without the cooperation and enthusiastic help from
    the Senate side, and I think that Senators Specter and Harkin
    are justifiably proud of that as well. But I am troubled that
    we have seen that growth in NIH research stall in last year's
    budget and this year's budget continues. It's hard for me to
    believe that we are now at full capacity in terms of research
    for new drugs in America. I do believe that we need to expand
    the horizons, expand the opportunities to find cures for
    diseases, and this budget does not reflect that, and I hope
    that you will address that issue.

                       MEDICAL PROFESSIONAL AVAILABILITY

        One other issue that troubles me is the availability of
    medical professionals. With an aging American population, with
    increased demands for medical help for all of us, we want to
    make certain that when we push the button in our room, a nurse
    will show up, that a good doctor will be there to tend to our
    needs, and I am worried that we are not keeping up with that
    demand for our society. Sadly, one of the ways that we
    supplement our need for medical professionals is to go
    overseas, and I have done it myself--to go to other countries
    that will send us these medical professionals. In most cases,
    these countries cannot afford to give up their own, but they do
    because of the lure of living in the United States and the
    attractive salaries that might be available for these medical
    professionals. The only morally responsible thing that we can
    do is to increase the number of medical professionals in
    America. When it came to the Nurse Reinvestment Act, which
    Senator Mikulski and others pushed forward, we have not
    adequately funded it, and I think we are going to pay a price
    for it in terms of medical professionals and this continuing
    brain drain on the poorest countries in the world that are
    sending us their medical professionals they desperately need.
        As tough as it may be to practice medicine in the inner
    city of Chicago, it could not compare to practicing it in the
    Congo where there is one doctor for every 160,000 people, one
    surgeon for every 3 million. That is an impossible situation,
    and we make it worse because we bring those medical
    professionals to the United States--many times at the expense
    of these countries. The responsible thing for us to do is to
    develop our own medical professionals to meet the needs in the
    future. I hope that you will be able to tell us that your
    budget addresses that. I look forward to your testimony, and
    thank you for joining us today.
        Senator Specter. Well, thank you, Senator Durbin. Well, we
    welcome you here, Secretary Leavitt, notwithstanding the
    opening statements of the Senators. You come to this position
    with a very distinguished record in public service--elected
    three times as Governor of the State of Utah, having served as
    Administrator for the Environmental Protection Agency and
    having taken over this very important job at the very beginning
    of the President's second term in late January 2005. We give
    you the floor, Mr. Secretary. Take as long as you like. Do not
    run the clock on the Secretary.

                  SUMMARY STATEMENT OF HON. MICHAEL O. LEAVITT

        Secretary Leavitt. Thank you, Senator. I will submit a
    formal statement for the record.
        Senator Specter. Your statement will be made a part of the
    record and any other prepared statement.

                          FISCAL YEAR 2007 HHS BUDGET

        Secretary Leavitt. You acknowledged in a very kind way my
    service--previously as Governor. I will tell you that I value
    every day I had that opportunity. However, I will also confess
    to you that earlier this week, I spoke with my colleagues at
    HHS and told them that I am among the few people I suspect in
    the world who can honestly say I can think of nothing that I
    would rather do in my life right now than exactly what I am
    doing. The issues here are demanding, but they are
    extraordinarily important to the people of this country and,
    may I say, the world. I say that with a sense of gratitude and
    humility with being in a position to have some impact on
    delivering on the most noble of aspirations that our country
    has--our desire to see cancer cured, to see other diseases
    cured as well, to find ways in which we can prepare ourselves
    for a pandemic influenza and to do the other things that are
    currently my responsibility. I just want you to know that these
    are difficult issues, but I am grateful for the opportunity to
    serve the American people. The budget that I'll reflect today
    is a big budget. It's $700 billion. $75.5 billion of that we
    refer to as discretionary. Senator Craig referenced the fact
    that that number is being squeezed by the fact that the rest of
    the budget continues to grow at an alarming rate. I have a new
    grandson. He is now 8 months old. When he turns 35, Medicare
    alone--one of the programs that I am responsible to manage--
    will be 8 percent of our gross domestic product. By the time he
    retires at age 65, it will be 11 percent. I think everyone in
    this room knows that any nation that has one program that pays
    for the healthcare of those who have concluded their careers
    will likely not be on the economic leader board. I am deeply
    concerned about that as others are. It is having the impact of
    constraining our discretionary budgets. The budget I am here
    today to discuss is a deficit reduction budget. It is $1.5
    billion less than the budget that I was here a year ago to
    discuss. You mentioned my 11 years as Governor. During that
    period of time, I was responsible as the chief executive of my
    State to balance that budget, and I know that any time you are
    doing a deficit reduction budget, you are dealing with programs
    that have been on the budget for a very good reason and you are
    having to basically offset good programs against good programs.
    There are no easy choices here. There will be disagreement on
    what the priorities should be. I acknowledge that, and my
    purpose today is only to tell you the basis on which I made
    decisions given the need for this deficit reduction budget. You
    will find new initiatives here, things that I believe are
    extraordinarily important and that are important to the
    President, things that you have talked about.
        One of the things I am concerned about is our investments.
    At NIH, for example, we are seeking level funding at NIH, but
    there are new initiatives at HHS--for example, what we call
    critical path. Despite the fact that we have doubled the NIH
    budget, the number of molecules that we are able to actually
    take into the marketplace has been cut almost in half during
    that period of time. What that tells me is that we have to
    change the regulatory process and find new tools. So, one of
    the new initiatives we call critical path is essentially 76
    science projects, if you will, to find new ways of measuring
    the efficacy and the safety of drugs that will allow us to
    dramatically improve that rather dismal statistic. You will see
    some Presidential initiatives here that will be familiar to
    you, such as a continued expansion of the community health
    centers. You will also see bioterrorism emphasized and pandemic
    influenza preparedness. I hope we'll have a chance to talk at
    some length about our preparation. It is a very important
    matter, and we are giving it the highest level of priority at
    HHS. I have laid out the discretionary budget and asked those
    who helped me prepare it to use a set of principles--some
    things you will see follow through this entire budget. Some of
    those would be a pause in construction of new buildings, for
    example. Another thing you will see is that there are programs
    whose purposes have been addressed in other areas. I have
    discovered, like in many departments of the Federal Government,
    there are silos. There are places that deal in one silo with a
    problem and places that deal with it in another, and I have
    done my best to try to bring them together, and what that has
    allowed me to do is to find a way to be more efficient. You
    will see some programs with carryover funds where I have taken
    those funds and put them into some other purpose.

                               PREPARED STATEMENT

        Those are the means by which I have done it. I laid out a
    group of principles. I have tried to target as opposed to
    looking at general problems. I have tried to work at prevention
    as opposed to just ongoing funding of dilemmas. I have tried to
    look for places where there was new innovation. We'll get a
    chance to talk about all of them. I won't take more time. I am
    anxious to get directly to your questions, but I do want to
    tell you how appreciative I am of the chance to serve the
    American people and to be here today to work with you to
    accomplish that same purpose.
        [The statement follows:]
                 Prepared Statement of Hon. Michael O. Leavitt
        Good morning, Mr. Chairman, Senator Harkin, and Members of the
    Committee. I am honored to be here today to present to you the
    President's fiscal year 2007 Budget for the Department of Health and
    Human Services (HHS).
        Over the past 5 years, the Department of Health and Human Services
    has worked to make America healthier and safer. Today, we look forward
    to building on that record of achievement. For that is what budgets
    are--investments in the future. The President and I are setting out a
    hopeful agenda for the upcoming fiscal year, one that strengthens
    America against potential threats, heeds the call of compassion,
    follows wise fiscal stewardship and advances our Nation's health.
        In his January 31 State of the Union Address, the President
    stressed that keeping America competitive requires us to be good
    stewards of tax dollars. I believe that the President's fiscal year
    2007 Budget takes important strides forward on national priorities
    while keeping us on track to cut the deficit in half by 2009. It
    protects the health of Americans against the threats of both
    bioterrorism and a possible influenza pandemic; provides care for those
    most in need; protects life, family and human dignity; enhances the
    long-term health of our citizens; and improves the human condition
    around the world. I would like to quickly highlight some key points of
    this budget.
        We are proposing new initiatives, such as expanded Health
    Information Technology and domestic HIV/AIDS testing and treatment that
    hold the promise for improving health care for all Americans. We are
    continuing funding for Presidential initiatives, including Health
    Centers, Access to Recovery, bioterrorism and pandemic influenza; and
    we are also maintaining effective programs such as the Indian Health
    Service, Head Start, and the National Institutes of Health.
        We are a Nation at war. That must not be forgotten. We have seen
    the harm that can be caused by a single anthrax-laced letter and we
    must be ready to respond to a similar emergency--or something even
    worse. To this end, the President's Budget calls for a four percent
    increase in bioterrorism spending in fiscal year 2007. That will bring
    the total budget up to $4.4 billion, an increase of $178 million over
    last year's level.
        This increase will enable us to accomplish a number of important
    tasks. We will improve our medical surge capacity; increase the
    medicines and supplies in the Strategic National Stockpile; support a
    mass casualty care initiative; and promote the advanced development of
    biodefense countermeasures to a stage of development so they can be
    considered for procurement under Project BioShield.
        We must also continue to prepare against a possible pandemic
    influenza outbreak. We appreciate your support of $2.3 billion for the
    second year of the President's Pandemic Influenza plan in the fiscal
    year 2006 Emergency Supplemental Appropriations Act for Defense, the
    Global War on Terror, and Hurricane Recovery. It is vital that this
    funding be allocated in the most effective manner possible to achieve
    our preparedness goals, including providing pandemic influenza vaccine
    to every man, woman and child within six months of detection of
    sustained human-to-human transmission of a bird flu virus; ensuring
    access to enough antiviral treatment courses sufficient for 25 percent
    of the U.S. population; and enhancing Federal, state and local as well
    as international public health infrastructure and preparedness. We also
    want to work with you to ensure that this funding is appropriated prior
    to October 1, 2006.
        The President's fiscal year 2007 budget also provides more than
    $350 million for important ongoing pandemic influenza activities such
    as safeguarding the Nation's food supply (FDA), global disease
    surveillance (CDC), and accelerating the development of vaccines, drugs
    and diagnostics (NIH).
        The budget includes a new initiative of $188 million to fight HIV/
    AIDS. These funds support the objective of testing for three million
    additional Americans for HIV/AIDS and providing treatment for those
    people who are on state waiting lists for AIDS medicine. This
    initiative will enhance ongoing efforts through HHS that total $16.7
    billion for HIV/AIDS research, prevention, and treatment this year.
        The budget maintains the NIH, and includes important increases for
    important crosscutting initiatives that will move us forward in our
    battle to treat and prevent disease--$49 million for the Genes,
    Environment and Health Initiative and $113 million for the Director's
    Roadmap. In addition, it contains an additional $10 million for the
    Food and Drug Administration to lead the way forward in the area of
    personalized medicine and improved drug safety.
        One of the most important themes in our budget is that it increases
    funding for initiatives that are designed to enhance the health of
    Americans for a long time to come. For instance, the President's Budget
    calls for an increase of nearly $60 million in the Health Information
    Technology Initiative. Among other things, these funds support the
    development of electronic health records (to help meet President Bush's
    goal for most Americans to have interoperable electronic health records
    by 2014); consumer empowerment; chronic care management; and
    Biosurveillance.
        The Budget also includes several initiatives to protect life,
    family and human dignity. These include, for example, $100 million in
    competitive matching grants to States for family formation and healthy
    marriage activities in TANF. The President's budget also promotes
    independence and choice for individuals through vouchers that increase
    access to substance abuse treatment.
        In the area of entitlement programs, I want to begin by
    congratulating you and other Members of Congress for having
    successfully enacted many needed reforms by passing the Deficit
    Reduction Act (DRA). DRA supports our commitment to sustainable growth
    rates in our important Medicare and Medicaid programs. It also
    strengthens the Child Support Enforcement program. The Deficit
    Reduction Act also achieves the notable accomplishment of reauthorizing
    Temporary Assistance for Needy Families (TANF), which has operated
    under a series of short-term extensions since the program expired in
    September 2002.
        Medicaid has a compassionate goal to which we are committed. Part
    of our obligation to the beneficiaries of this program is ensuring it
    remains available well into the future to provide the high-quality care
    they deserve. With its action on many of our proposals from last year
    in the Deficit Reduction Act, the Congress has made Medicaid a more
    sustainable program while improving care for beneficiaries. The
    President's Budget proposals build on the DRA and include a modest
    number of legislative proposals, which improve care and will save $1.5
    billion over 5 years in Medicaid and S-CHIP and several administrative
    proposals saving $12.2 billion over 5 years.
        This Administration has also pursued a steady course toward
    Medicare modernization. In just the past 3 years, we have brought
    Medicare into the 21st century by adding a prescription drug benefit
    and offering beneficiaries more health plan choices.
        Medicare's new prescription drug benefit represents the most
    significant improvement to senior health care benefits in 40 years. CMS
    has already exceeded the enrollment target with more than 30 million
    beneficiaries with drug coverage as of April 18, 2006. In addition,
    almost 6 million Medicare beneficiaries get drug coverage from other
    sources such as the Department of Veterans Affairs. This brings the
    total to approximately 35.8 million Medicare beneficiaries who are now
    receiving prescription drug coverage. In most cases, their coverage is
    either completely new or much better and much more secure than it was
    before.
        Savings from the prescription drug benefit have been greater than
    expected. CMS' Office of the Actuary initially estimated beneficiary
    premiums averaging $37 per month. Today, however, the average monthly
    premium is $25 a month. And in some parts of the country, beneficiaries
    are seeing premiums of less than $2 per month. In 2006, the Federal
    government is projected to spend about 20 percent less per person than
    first estimated, and over the next 5 years, payments are projected to
    be more than ten percent lower than first estimated. So taxpayers will
    see significant savings and State contributions will be about 25
    percent lower over the next decade for beneficiaries who are in both
    Medicaid and Medicare. All these savings result from the lower expected
    costs per beneficiary.
        Our work to modernize Medicare is not done. Rapid growth in
    Medicare spending over the long-term will place a substantial burden on
    future budgets and the economy. The President's fiscal year 2007 Budget
    includes a package of proposals that will save $36 billion over 5 years
    and continue Medicare's steady course toward financial security, higher
    quality, and greater efficiency.
        The bulk of these Medicare savings will come from proposals to
    adjust yearly payment updates for providers in an effort to recognize
    and encourage greater productivity. These proposals are consistent with
    the most recent recommendations of the Medicare Payment Advisory
    Commission. To ensure more appropriate Medicare payments, the Budget
    proposes changes to wheelchair and oxygen reimbursement, phase-out of
    bad debt payments, enhancing Medicare Secondary Payer provisions, and
    expanding competitive bidding to laboratory services. Building on
    initial steps in the Medicare Modernization Act, the Budget proposes to
    broaden the application of reduced premium subsidies for higher income
    beneficiaries. Finally, the President's Budget proposes to strengthen
    the Medicare Modernization Act provision that requires Trustees to
    issue a warning if the share of Medicare funded by general revenue
    exceeds 45 percent. The Budget would add a failsafe mechanism to
    protect Medicare's finances in the event that action is not taken to
    address the Trustees' warning. If legislation to address the Trustees'
    warning is not enacted, the Budget proposes to require automatic
    across-the-board cuts in Medicare payments. The Administration's
    proposal would ensure that action is taken to improve Medicare's
    sustainability.
        President Bush proposes total outlays of nearly $700 billion for
    Health and Human Services. That is an increase of more than $58 billion
    from 2006, or more than 9.1 percent.
        While overall spending will increase, HHS will also make its
    contribution to keeping America competitive. To meet the President's
    goal of cutting the deficit in half by 2009, we are decreasing HHS
    discretionary spending. Our non-emergency request for discretionary
    budget authority for programs under the jurisdiction of this
    Subcommittee totals $61.1 billion, a decrease of $1.6 billion below
    fiscal year 2006. The $2.3 billion for the cost of the next phase of
    the President's plan to prepare against an influenza pandemic that I
    discussed earlier is in addition to this amount.
        I recognize that every program is important to someone. But we had
    to make hard choices about well-intentioned programs. I understand that
    reasonable people can come to different conclusions about which
    programs are essential and which ones are not. That has been true with
    every budget I've ever been involved with. It remains true today. There
    is a tendency to assume that any reduction reflects a lack of caring.
    But cutting a program does not imply an absence of compassion. When
    there are fewer resources available, someone has to decide that it is
    better to do one thing rather than another, or to put more resources
    toward one goal instead of another.
        Government is very good at working toward some goals, but it is
    less efficient at pursuing others. Our budget reflects the areas that
    have the highest pay-off potential.
        To meet our goals, we have reduced or eliminated funding for
    programs whose purposes are duplicative of those addressed in other
    agencies. One example of this is Rural Health where we have proposed to
    reduce this program in the Health Resources and Services
    Administration. The Medicare Modernization Act contained several
    provisions to support rural health, including increased spending in
    rural America by $25 billion over 10 years. For example, it increases
    Medicare Critical Access Hospitals (CAH) payments to 101 percent of
    costs and broadens eligibility criteria for CAHs. Moreover, recognizing
    that Congress adopted many of our saving proposals last year, we are
    continuing to make performance-based reductions.
        Our programs can work even more effectively than they do today. We
    expect to be held accountable for spending the taxpayers' money more
    efficiently and effectively every year. To assist you, the
    Administration launched ExpectMore.gov, a website that provides candid
    information about programs that are successful and programs that fall
    short, and in both situations, what they are doing to improve their
    performance next year. I encourage the Members of this Committee and
    those interested in our programs to visit ExpectMore.gov, see how we
    are doing, and hold us accountable for improving.
        President Bush and I believe that America's best days are still
    before her. We are confident that we can continue to help Americans
    become healthier and more hopeful, live longer and better lives. Our
    fiscal year 2007 budget is forward-looking and reflects that hopeful
    outlook.
        Thank you for the opportunity to testify. I will be happy to answer
    your questions.

                              HISTORICAL PANDEMICS

        Senator Specter. Thank you very much, Mr. Secretary. We'll
    now go to the questioning by the Senators with 5-minute rounds.
    In the second round, Mr. Secretary, I intend to go into the
    budget cuts on the Centers for Disease Control and the National
    Institutes of Health and others which, as I have outlined
    earlier, I think totally unacceptable, but let me begin with
    the issue of the threat of the pandemic flu. There is a draft
    report, which has appeared publicly, where you are stockpiling
    75 million doses of antiviral drugs and 20 million doses of
    vaccines. There are projections that there could be as much as
    40 percent of the workforce absent. There are guidelines to
    keep people from congregating together. There is even a note
    about local police departments and National Guard would have
    the primary responsibility for keeping order, but the military
    would be available to assist. This sounds like a very, very
    stark situation. We know that when such disasters have occurred
    in the past, there have been millions who have been killed. One
    of the really important matters to be covered is to acquaint
    the public with what the problems are--that it may be difficult
    or dangerous to go to the grocery store, that it is important
    to have a supply of water, that there ought to be provisions
    made for a worst-case scenario. There have been articles, but
    they are buried in the newspapers, and I do not think that
    there is a real public understanding of the seriousness of this
    program. Now, what you are saying here today is going to be
    carried in the news media, and this hearing is being covered
    live on C-SPAN, so it is reaching people as we speak. Stark as
    it is, I think we ought to be very candid, very frank--brutally
    frank with the potential nature of the problem. Now, Mr.
    Secretary, what is the worst-case scenario? If it's as bad as
    it can be, how bad would that be?
        Secretary Leavitt. Mr. Chairman, pandemics happen. They
    have happened through all-time. You can date back to ancient
    Athens--25 percent of that city was wiped out because of
    disease. You can roll forward, and virtually every century, you
    will see two or three pandemics. In the 14th century--Black
    Death, perhaps the best known, killed 25 million people across
    Europe.
        Senator Specter. How many people died in the pandemic in
    the United States not long into the 20th century?
        Secretary Leavitt. Your point is a very good one. We have
    had 10 pandemics in the last 300 years. We have had three
    pandemics in the last 100 years. In 1968 and 1957--a lot of
    people got sick. Not many people died. In 1918, however, many
    people got sick and regrettably, millions died. If we were to
    have a pandemic of equal proportion to that which occurred in
    1918, roughly 90 million people in the United States would
    become ill. About half of those--45 million would become sick
    enough that they would require some form of serious medical
    attention, and about 2 million people, regrettably, would die.
        Senator Specter. Well, those are pretty stark figures--90
    million, about one-third--almost one-third of the population,
    and you say millions would die. What basic precautions should
    people take?

                        PANDEMIC INFLUENZA PREPAREDNESS

        Secretary Leavitt. Well, for that reason, the President has
    asked that we mobilize the country. I have committed that we
    would hold pandemic summits in all 50 States. So far, we have
    had 46 of them. We are mobilizing State and local governments.
    We are also working to develop a global monitoring system.
        Senator Specter. What should individual citizens do? Should
    individual citizens stock up on water? Should individual
    citizens stock up on food?
        Secretary Leavitt. Mr. Chairman, the preparation for a
    pandemic is essentially the same preparation that needs to
    occur in any disaster. It's a good idea to have some
    nonperishable food stored at your home. That would be true for
    a hurricane or a tornado. It would be a good idea for a
    bioterrorism event or a nuclear event. It would be true as well
    for a pandemic. It's a good idea to have a first aid kit and to
    have prescription drugs stocked up in a way that if you were to
    need your supply and couldn't get to the drug store that you
    would have it. It's a good idea to have thought through how you
    would deal with your children--if you had to alternate going to
    work with your spouse or if they both needed to stay home and
    you had to have some kind of caregiving process. It's a good
    idea to take the same precautions as in any other emergency
    situation.
        Senator Specter. The red light went on in the middle of
    your answer, and I intend to observe the red light meticulously
    because I ask all the members of the panel to do the same, and
    now I yield to Senator Harkin.

                      PANDEMIC INFLUENZA VACCINE STOCKPILE

        Senator Harkin. Thank you very much, Mr. Chairman. Again,
    welcome Mr. Secretary. Again, I just want to point out that
    this committee--the Senate went on record 73 to 27 on an
    amendment offered by Senator Specter on the budget to increase
    our budget allocation by $7 billion for health and education
    programs, much of which would go to this Department to make up
    for a lot of the cuts that we see in this budget. Of course, we
    don't have a budget yet. The House can't seem to pass one. So,
    I don't know what's going to happen on that later on down the
    pipe, but I am hopeful that that $7 billion that Senator
    Specter and 72 other Senators voted to support stays in there.
    If that's the case, then we can make up for some of the cuts
    that are in your budget that I think are just devastating--the
    cuts to Social Services Block Grants by $500 million,
    eliminating the Community Services Block Grant programs, the
    cuts--as you said, the level funding for NIH, which translates
    into cuts for some of NIH and for the Centers for Disease
    Control, the cuts on rural health programs, poison control
    centers, health professions trainings programs--all of these
    things all got cuts--all got cuts. Quite frankly, with the
    needs that we have out there, these cuts cannot stand, and
    that's why I am hopeful that we can get that $7 billion. Now, I
    want to follow up a little bit on the Avian Flu. I want to see
    if we can clarify the issue of stockpiling of antivirals. The
    World Health Organization recommended that countries stockpile
    sufficient antivirals to treat 25 percent of their populations.
    In your written statement, you concur with that goal. That
    would equate to about 80 million Americans. I understand that
    your Department has ordered or has on hand enough antivirals to
    treat about 26 million individuals, so that leaves about 50
    million--60 million short. I understand that you anticipate
    States will order 30 million courses of antivirals. The
    Government will subsidize that at 25 percent of the cost.
    States have been asked to place their orders with you by July--
    by this July. The final course of treatment will be ordered
    using pending funds--2007--next year funds. Well now, again, I
    laid that groundwork to say that--are there any States that
    have indicated that they will not be able to order these
    medications because they have a lack of funds or a lack of
    legislative authority to do so?
        Secretary Leavitt. No State has made that statement to us
    at this point.
        Senator Harkin. Okay. What is your plan if States don't
    order these treatments by July?
        Secretary Leavitt. We intend to acquire 50 million courses
    of antivirals.
        Senator Harkin. You mean 50 million over the 20 you have?
        Secretary Leavitt. Let me reconcile the entire amount and
    then give you the timeframes. We will have by the end of 2006
    the 26 million that you have spoken of. We will have by 2008,
    50 million that will have been purchased by Federal money and
    that will be available for distribution.
        Senator Harkin. Okay.

                    PANDEMIC INFLUENZA VACCINE DISTRIBUTION

        Secretary Leavitt. We will make a distribution of that 50
    million among the States on essentially a proportionate basis.
    So they will have that available to them in its entirety by the
    end of 2007. Each of the States then has an opportunity to
    supplement that--their proportionate share of that 50 million,
    and we will subsidize it by 25 percent up to their
    proportionate share of the remaining 31 million. We anticipated
    originally that we would ask States to make that decision by
    July. Since that information was provided to you, we have made
    a decision that we will allow them to buy off of our order and
    at the same time, deal directly with the manufacturer so that
    they could be more efficient rather than go through us.
        Senator Harkin. My time is running out. Mr. Secretary, in
    the case of a pandemic, State, and local health departments
    will have to distribute the vaccines. Are you encouraging
    States to organize mass vaccination exercises during this next
    flu season to get ready for that?
        Secretary Leavitt. We are.
        Senator Harkin. If so, will you allow the States to use a
    portion of the $350 million that we allocated for that to
    purchase annual flu vaccine?
        Secretary Leavitt. Actually, we would prefer that they
    utilize the $350 million to build up the public health
    infrastructure and to reach deep into the community to be able
    to do the kinds of things that Senator Specter was talking
    about.
        Senator Harkin. But isn't one way to do that is to purchase
    annual flu vaccine and put in place an infrastructure----
        Secretary Leavitt. Oh.
        Senator Harkin [continuing]. To distribute it? That's what
    I am saying.
        That's what I am talking about.
        Secretary Leavitt. I misunderstood your question.
        Senator Harkin. Yeah.
        Secretary Leavitt. At this point, we have not begun to
    distribute the stockpile of vaccine that we have. It is
    relatively small, but we will not release it until such time as
    we have seen person-to-person transmission.
        Senator Harkin. No, now we're--my time is running out, and
    that's not what I am talking about. What I am talking about is
    the annual flu vaccine.
        Secretary Leavitt. Oh.
        Senator Harkin. Is we put $350 million for--to build up
    State and local structures in case of a pandemic. One of the
    ways to test that to see if it works, to do it is to buy the
    annual flu vaccine and say okay, we are going to set up
    processes and methodologies to get that annual flu vaccine out.
        Secretary Leavitt. Third time is the charm, Senator. You
    got it.
        Senator Harkin. Okay.
        Secretary Leavitt. I think you finally reached me.
        Senator Harkin. So, my question--would they be allowed to
    use some of that $350 million to purchase the annual flu
    vaccine to test modalities out there to--how to get it out?
        Secretary Leavitt. I hadn't thought of that.
        Senator Harkin. Oh.
        Secretary Leavitt. It's a really interesting idea----
        Senator Harkin. Okay.
        Secretary Leavitt [continuing]. I'd be happy to give it
    some thought and respond back to you.
        Senator Harkin. I appreciate that. Thanks, Mr. Secretary.
    All right.
        [The information follows:]
                       Pandemic Influenza Infrastructure
        A major component of the $350 million allocated to States for
    pandemic influenza planning is for States to exercise their plans.
    States are permitted to use Public Health Emergency Preparedness
    cooperative agreement funds to purchase vaccine in limited quantities
    for the purpose of conducting drills and exercises. At this time, they
    are not permitted to purchase annual vaccine with the emergency
    supplemental funding for pandemic influenza preparedness. However, they
    may use some of these emergency supplemental funds during the influenza
    season as an opportunity to exercise mass vaccination plans.

        Senator Specter. Thank you, Senator Harkin. Senator Craig?

                            COMMUNITY HEALTH CENTERS

        Senator Craig. Thank you very much, Mr. Chairman. Mr.
    Secretary, during the Easter recess when I was back in Idaho, I
    visited a community health center, and I do that on a regular
    basis to see how it's working, who they are serving, how they
    are serving, and it is really one of those kind of unsung
    success stories out there that some of us fail to recognize.
    Obviously, this present--President hasn't failed to recognize
    that to lower income Americans, one way to serve them is making
    sure the door is open, and community health centers do that
    very well. This particular community health center in Nampa,
    Idaho told me that in the year, they had served over 25,000
    people, and the place was full, the parking lot was full, and
    the doctors and nurses there were very pleased with the work
    they were doing. Should this committee be concerned that
    expansion of new facilities coupled with a reduction in funds
    for training personnel to work in those facilities will slow
    the service--access to service in communities that need these
    facilities or worse--exacerbate shortages in medical personnel
    across the country?
        Secretary Leavitt. Mr. Senator, as I indicated earlier,
    this is one of the President's high priorities, and this budget
    includes funds to continue forward in his goal of providing
    1,200 new or expanded community health center sites. This
    includes enough for 300, 80 of which will be in the highest
    poverty counties. This is a passion for the President and for
    me, and we are working with every asset we have to continue
    moving it forward.
        Senator Craig. Okay. So as I said, funds as it relates to
    the training of personnel, we don't--you don't see that as a
    problem in relation to standing these up and facilitating them
    for service?
        Secretary Leavitt. As I speak with those who run and
    operate these in the same way that you have, there are always
    needs there.
        Senator Craig. Yeah.
        Secretary Leavitt. I would not want to say that we will
    have quenched that, but we do recognize that training is a
    component of it and want to meet those needs.

                        WELLNESS AND DISEASE PREVENTION

        Senator Craig. Okay. Mr. Secretary, myself and other
    Senators consistently over time have introduced legislation to
    authorize Medicare to cover medical nutritional therapy
    services for some beneficiaries. However, there is generally a
    cost associated with any legislation, and that usually gives us
    problems in this area. I am one who believes that good health
    oftentimes brings down costs as it relates to healthcare and
    that we ought to be increasing advocates of that instead of
    repairs of broken bodies, if you will, after the fact. Can you
    give me your general views based on your experience in
    implementing programs designed for health and wellness as
    opposed to programs designed to intervene or respond to long
    after diseases and ailments have onset?
        Secretary Leavitt. I believe, Senator, it should become our
    entire focus. When I say entire focus--until we begin to view
    wellness with the same passion we do treatment, not only will
    we not see improvement in our health, we will not see
    improvement in our fiscal health. I believe that is one of the
    reasons--in fact, one of the primary reasons, why the new Part
    D prescription drug benefit is such a historic point in time.
    For the first time, we have begun to provide for seniors the
    prescription drugs they need to stay healthy as opposed to
    simply treating them after they are sick. Over and over again,
    as I have traveled the country meeting with seniors, I have
    heard stories of people who have had heart operations, ulcer
    operations, and osteoporosis treatments that could have been
    prevented with a small amount of prescription drugs at the
    onset as opposed to the treatment at the end.

                           MEDICARE PART D ENROLLMENT

        Senator Craig. Well, my time is up, but you segued nicely
    from my request for a response as it relates to medical
    nutritional therapy and to prescription drugs. Could you for a
    moment give us some of the current figures as to where we are
    with participation as to where we thought we would be and some
    of the savings that are now already appearing on the scene?
        Secretary Leavitt. We anticipated that in the first year,
    we would see 28 to 30 million people enroll. We have now
    exceeded 30 million. We anticipate between now and the 15 of
    May that we will have--I don't know exactly of course, but
    another couple million. If you assume that that's 32 million,
    there are 42 million in total who are eligible. There are 6
    million who are getting coverage from either a private employer
    or some other source. If you add that 6 to the 32, you get 38.
    That would mean we have a shot at being able to have enrolled
    90 percent of every senior who is eligible for this benefit
    during the first year. That is a remarkable achievement in my
    mind, and it's a tribute not just to the Centers for Medicare
    and Medicaid Services (CMS), but to the thousands of
    pharmacists, the thousands of volunteers, the tens of thousands
    of people all over this country who have been involved in
    reaching out to seniors in their homes, in their places of
    worship, in their senior centers. The other good news is the
    cost is coming down. The program is getting better everyday.
    The cost is coming down, and we are getting people enrolled.
        Senator Craig. Thank you. It is a success story. We
    appreciate it.
        Senator Specter. Thank you very much, Senator Craig. Under
    the early bird rule, we turn to Senator Durbin.

                      MEDICARE PART D ENROLLMENT DEADLINE

        Senator Durbin. So, Mr. Secretary, there is more to the
    story, and here is the rest of the story. The Bush
    administration says that 35.8 million Medicare beneficiaries
    will have drug coverage as of mid-April. The truth is 75
    percent of those people--more than 26 million--already had
    prescription drug coverage before January 1 of this year
    through their employer, the VA or Medicaid. So there were 16
    million Medicare beneficiaries who previously did not have drug
    coverage. Only half or about 9 million have signed up for the
    benefit. Millions need more time. In my State of Illinois,
    606,000 people have not signed up for Part D, and the clock is
    ticking. It's less than 2 weeks away. Forty-five different plan
    choices, people--some of whom are flat on their back in nursing
    homes and in no position to make these choices--I think we have
    to acknowledge the obvious. Come May 15, the law will impose a
    penalty on a lot of people who did their best and just couldn't
    get this done, and I want to ask you point-blank do you think
    we ought to extend the signup deadline beyond May 15? Number
    two--should you allow senior citizens a do-over if they picked
    a bad plan that dropped the formulary, increased the cost? Do
    you think that that will be a reasonable way to deal with
    clearly a challenge that has not been met?
        Secretary Leavitt. Senator, millions of people--tens of
    millions of people--have prescription drug coverage who did not
    have it before. That is a great step forward, something I
    believe you would concur with. Let me again say that I believe
    that when May 15 comes, we will have reached roughly 90 percent
    of those who are eligible. Of the remaining 10 percent, about
    half of them will be a population that, granted, is very
    difficult to reach.
        Senator Durbin. But----
        Secretary Leavitt. We have had that problem--I want to
    answer your question. About half of them are in a low-income
    status, and we have granted them the ability if they qualify
    for the extra help--the people that you are most concerned
    about--we will not require that they wait until the next
    enrollment period. They will have no penalty, and they will
    have no wait.
        Senator Durbin. So increasing monthly premiums of 1 percent
    for every month past the deadline--are you going to waive that?
        Secretary Leavitt. If you are in fact a low-income eligible
    person, you will not have a penalty, and you will not be
    required to wait until the next enrollment period.
        Senator Durbin. Will the administration support extending
    the deadline beyond May 15?
        Secretary Leavitt. We believe that a deadline is necessary
    and that it is working. The Government actuary told us if we
    did not have a deadline, we would have substantially fewer
    people. We believe that the plan requires the time to mature.
    We think that the--that half of the people who are--who have
    yet to enroll will be eligible to enroll during that period
    once they have qualified for extra help.
        Senator Durbin. I think that we are missing the point here.
    Of the universe of people who did not have prescription drug
    coverage on January 1, some 25--let me get the figure correct
    here--25 percent of the Medicare beneficiaries, about 15
    percent of that number will have signed up by May 15, and 10
    percent will have not. So 60 percent of our goal will have been
    reached, but 40 percent not. You are shaking your head, but
    those are the numbers, and we get the report from your agency
    county by county. 606,000 people in my State, and we have done
    our best. What I say to you is I hope that you will understand
    their predicament, that the administration will relent and give
    these seniors a second chance to sign up without penalty.
    Second, if they have made a bad choice, I hope you will give
    them a chance to have a do-over, a makeover, support
    legislation that we have introduced. They can pick a plan that
    really is better for them. If I might ask one other question--
    I'm going to run out of time. I am worried about whether or not
    we are doing what we need to do for our children on our watch.
    I go to schools across my State, and I ask a simple question--
    how many here have someone in your family with asthma? You will
    see more than half the hands go up. You can tell by looking at
    the children we are dealing with obesity. We know that one out
    of every 160 children in America have autism at this point. How
    can we deal with these issues when we are facing a budget that
    is going to make such significant cuts in the Centers for
    Disease Control and Prevention, in the National Institutes of
    Health and that eliminates the NIH National Children's Study?
    How can we find out what's happening out there and really
    protect our children against what appears to be an onset of
    some terrible health challenges?

                          MEDICARE PART D PLAN CHOICE

        Secretary Leavitt. Senator, we do have an epidemic of
    obesity, particularly among our young people, and the Centers
    for Disease Control and Prevention does have a role as would
    many other agencies at HHS, and we are prepared to join with
    you in every way we can to assure that that occurs. It is a
    very serious problem. I would like to just mention one other
    thing on the choice of plans. A statistic I learned that I
    think you will find interesting--we did develop a standard plan
    that was recommended by the Congress. Only 10 percent of the
    more than 30 million people now have chosen that plan, which
    tells me that it was very important to people that they have a
    choice and that they are able to choose a plan that fits their
    situation. I know from signing a lot of people up that if they
    had just had to deal with the standard plan, no matter what it
    was, it would not have served them well. The plan will be
    simplified in the next version in the same way that the market
    has allowed for it to become better. We are all going to get
    better at this as time goes on. In 1965, Medicare became law.
    It got better in 1966. It got better in 1967. The plans are now
    maturing. The pharmacies are learning how to use the system.
    The consumers are now better informed. We are getting better at
    what we do. This is a very important milestone--undoubtedly the
    most important thing that's happened in healthcare in the last
    40 years.
        Senator Durbin. Thank you.
        Senator Specter. Thank you, Senator Durbin. Senator Kohl?

                         FDA GENERIC DRUG APPLICATIONS

        Senator Kohl. Thank you, Mr. Chairman. Mr. Secretary, the
    FDA currently has a backlog of more than 800 generic drug
    applications, which is an all-time high, and FDA officials
    expect a record number of generic applications this year and an
    even larger backlog. The Congressional Budget Office estimates
    the use of generics provides a savings of $8 to $10 billion to
    consumers every year, and that doesn't include the billions of
    dollars more of savings to hospitals, Medicare, and Medicaid. I
    believe it's now more important than ever that we speed less
    expensive generic drugs to market, and I would think that you
    agree. So do you support an increase in the FDA budget to help
    reduce this backlog, and how much do you believe the FDA needs
    to efficiently reduce the backlog and pass along the savings to
    our people and also to the Federal Government?
        Secretary Leavitt. Senator Kohl, I concur with you that
    there is a need to speed generic drugs to market. It is a good
    thing for consumers. It's a good thing for healthcare. We are
    taking steps to do just that--not only to speed them, but to
    prioritize them. The budget that I have proposed is the budget
    we have proposed. We think we can accomplish that within the
    budget that we have suggested.
        Senator Kohl. So you are not proposing any increase in the
    budget to help reduce this backlog?
        Secretary Leavitt. We are putting substantial focus on it,
    however, I will tell you, at FDA.
        Senator Kohl. I'd like to hope that's going to happen, that
    in fact we will get the kinds of numbers--increases that we
    need, that I think you believe we need, and you are saying that
    it's going to happen?
        Secretary Leavitt. Let me suggest one piece of information
    that might at least give you some insight into this. Of the 800
    applications, some of them are essentially for the same
    chemical or same molecule. So, we have begun to focus on those
    on in which there is not one generic or two generics. In other
    words, we want to get new generics into the market as opposed
    to a repeat of existing molecules that have been made available
    in some generic form. Now, we think we can do this better, and
    I think we have to.

                   ADMINISTRATION ON AGING (AOA) BUDGET CUTS

        Senator Kohl. Mr. Secretary, some of the most painful cuts
    in the budget are programs under the Administration on Aging,
    which takes a $28 million hit in programs like Meals On Wheels
    and family caregiver support services. That means that--well,
    in my State, Wisconsin senior population continues to grow from
    705,000 senior citizens in 2000 all the way up to 1.2 million
    senior citizens estimated for 2025. The budget does not account
    for the growth and the need for services. In addition, this
    budget proposes to eliminate Alzheimer's demonstration grants.
    In Wisconsin, the Alzheimer's Association is in its first year
    of a 3-year grant where they are working in Jefferson County on
    a program to open a dementia care clinic at a hospital in Fort
    Atkinson in Jefferson County. It is the first of its kind and
    the only one in the area, and they would lose their funding
    after this year should this budget prevail. So how do you
    explain your plan to cut these vital programs while at the same
    time our aging population is growing?
        Secretary Leavitt. Senator, you have listed a number of
    different areas, so let me do my best to respond to them and to
    give you a sense of what was going on in here when I made these
    decisions. I asked my budget team to essentially use a series
    of principles. One of them I asked them is to look for one-time
    funds. So part of that may be one-time funds where the project
    was completed and hence wasn't repeated. Another principle was
    looking for programs where purposes were involved in a number
    of different places at HHS. So, it's possible that some of
    those were there. There were also some funds that were carried
    over from existing programs that I didn't repeat. Now, I can't
    respond directly. If you'd like me to get to you specifically
    with those, I'd be happy to respond, but my guess is that we'll
    find that those principles are the ones that were involved in
    helping to make the decisions we did.
        Senator Kohl. I would like some more information on those
    particular programs.
        Secretary Leavitt. We'll be happy to respond to that.
        [The information follows:]
                        Alzheimer's Demonstration Grants
        For 14 years under the Alzheimer's Disease Demonstration Grant to
    States Program (ADDGS), demonstrations in almost every State have
    highlighted successful, effective approaches for serving people with
    Alzheimer's. Similar to Preventive Health Services, it is time to put
    these models and the lessons that have been learned to work by moving
    them in AoA's core services programs--especially the National Family
    Caregiver Support Progam--as a number of States have already done.
        The fiscal year 2007 President's budget includes the elimination of
    ADDGS. This reflects that demonstration projects for individual with
    Alzheimer's and their caregivers are ready to be incorporated into the
    core activities of the National Aging Services Network.

                                RURAL HEALTHCARE

        Senator Kohl. There are a number of programs in your
    Department aimed at bolstering rural health. Wisconsin, one of
    the biggest beneficiaries in the country, received over
    $600,000 from the Rural Hospital Flexibility Grant Program just
    last year. This funding is used at over 60 rural hospitals that
    serve anywhere from 10,000 to 12,000 patients every year. The
    President's budget proposes to eliminate the Rural Hospital
    Flexibility Grant Program, the rural and community access to
    emergency devices and area health education centers. So how are
    rural communities expected to meet their unique healthcare
    challenges when these very important resources are being
    severely diminished?
        Secretary Leavitt. I, like you, come from a State where
    rural medicine is a very important part of the social fabric of
    our State, and so I have become quite sensitive to this. We
    have adopted a slightly different strategy and that is to try
    to bolster the reimbursement rates for providers in those
    areas. I have also begun to look for places, frankly, where I
    wasn't able to justify or I wasn't able to see a result. We
    have invested about $25 billion through higher reimbursements
    in rural areas, and that's the way we are intending for many of
    those funds to be replaced.
        Senator Kohl. Thank you, Mr. Chairman.

                                CDC BUDGET CUTS

        Senator Specter. Thank you very much, Senator Kohl. On
    round two, we begin now with Mr. Secretary. With respect to the
    budget cuts, the Centers for Disease Control and Prevention has
    been cut by $67 million this year. They have enormous
    responsibilities in many many areas which I shall not
    enumerate, and now we are looking to give them even greater
    responsibilities if there should be a pandemic flu. Dr. Julie
    Gerberding, a very distinguished Director of CDC, has sat at
    your side testifying, preparing on this item. The physical
    plant of CDC was a shambles when I visited it several years
    ago. Prize-winning scientists were sitting in hallways, toxic
    materials were not under lock and key, and we have carved out
    funds within our existing budget to fund almost a billion and a
    half dollars. Immediately, Senator Harkin and I found $137
    million. Now, the budget has been cut from $159 million to $30
    million--a $129 million cut. I have been lobbied very heavily
    by people in the Atlanta community to find the funds, but I
    can't find money out of thin air. How can CDC be realistically
    cut and their physical plant not improved given the increased
    responsibilities that you as Secretary are calling on them to
    perform?
        Secretary Leavitt. Senator, may I acknowledge that the work
    that this committee has done to be supportive of CDC is not
    just noticeable, but revered, and I also acknowledge that the
    budget that we are presenting to you is reduced by $179
    million. Within that total reduction, the buildings and
    facilities as far as new construction does make up $129 million
    of that. We have felt in a budget with a reduction or a deficit
    that we have made substantial progress in this area.
        Senator Specter. Should we stop the rebuilding?
        Secretary Leavitt. Well, we believe that we are capable of
    pausing on what will be a long-term strategy to continue to
    improve the facilities. We have made substantial progress. They
    are remarkable facilities, and I want to express my enthusiasm
    for how much the campus has been improved, and I want to
    acknowledge as well the role of you and Senator Harkin in
    accomplishing that.
        Senator Specter. Let me ask you to submit the balance of
    your answer in writing so I can go onto NIH.
        [The information follows:]
                               CDC Physical Plant
        CDC has made remarkable progress on its Master Plan with $1.2
    billion invested to date to upgrade their facilities. Since 2000, CDC
    has initiated or completed the construction of more than 2.7 million
    gross square feet (gsf) of laboratory and facility space. For fiscal
    year 2007, we have included $30 million for repairs and improvements of
    CDC facilities.
        Consistent across HHS, our request focuses on finishing projects
    that are near completion and maintaining existing facilities. No funds
    are requested to initiate new construction.

                              NIH RESEARCH GRANTS

        Senator Specter. NIH tells us that there are going to be
    more than 800 applications--no, 656 fewer applications, fewer
    ideas submitted. I am worried that there may be some for breast
    cancer in that group or prostate cancer or Hodgkin's. How can
    the crown jewel of the Federal Government--perhaps the only
    jewel of the Federal Government be cut in funds?
        Secretary Leavitt. Senator, I want to tell you again I
    agree with you that funding new research ideas is a vital,
    important priority and that the fiscal year 2007 budget
    finances 275 more new grants. Now, one of the things you will
    see is that the actual number doesn't reflect it because a lot
    of expiring noncompeting grants diminish the number. When we
    implemented the effort that you instigated in this committee to
    double the amount of funding, there was a huge amount of new
    grants. So, what we are in is the first year where there are
    not as many non-competing continuation grants.
        Senator Specter. Well, there will be a lot of grant
    applications denied and a lot of existing grant applications
    denied. I get lots of letters, and one illustrates it from
    Pittsburgh--what am I going to do, Senator Specter, on the
    tremendous progress I am making if they are going to cut off
    the funding and the grant's going to be withdrawn? Really, Mr.
    Secretary, this--these are not issues that can be handled
    within the purview of the funds which you are allocated. We are
    going to have to have a fundamental reassessment as to
    priorities.
        My red light just went on, but you--the red light doesn't
    apply to you, Mr. Secretary, just to my questions.
        Secretary Leavitt. I'd like to acknowledge that we are
    working to find opportunities for new investigators and for new
    innovations, and one of the things we are doing, frankly, is
    reevaluating the grants. After they have been concluded, then
    people must recompete. In some cases, there are research
    projects that simply don't stack up to the opportunities
    because we have essentially been able to get the value from
    them that the peer review process believes would be to our
    advantage. So, we have begun to redeploy that into new grants.
    So, the actual number of new projects is higher than it appears
    because of the decline in the number of noncompeting grants.
    The red light's on, and I am sensitive to it.
        Senator Specter. Well, I turn now to the second round for
    Senator Harkin, and I am anxious to see if he follows his
    customary pattern of having really tough questions in the
    second round.
        Secretary Leavitt. I am going to watch that too.

                               NIH FUNDING LEVELS

        Senator Harkin. You're putting me on the spot here. Just to
    follow up on the distinguished chairman's line of questioning
    on NIH--when we worked hard in a bipartisan fashion with so
    many others to double the funding for NIH, it was not meant to
    just double it and then reach a plateau and plateau off. We did
    this because for years, it had been underfunded, and we wanted
    to get it back up to where it had been maybe 25 years ago and
    continue the funding up. It was not meant to get it up and say
    oh, now we can level off. That's what I see happening, and we
    are falling into the same pattern that we did 30 years ago when
    NIH all of a sudden had--it was getting out maybe 4 or 5 peer-
    reviewed grants per every 10 that came in--30 percent--40
    percent--50 percent. Now, we are getting down to 10 percent
    again. So it's like we're plateauing off again. So we are going
    to do this, and 10 years from now when we are probably gone,
    somebody will be kind of like well, we're going to have to
    double the funding again--not a good way to run things. So, I
    kind of plead with you use your counsels within the executive
    branch to tell them this is just not--this is not good. We--and
    I think that's why we had so much support for the amendment
    that Senator Specter offered on the $7 billion. A lot of it had
    to do with we are not going to let NIH fall into that same rut
    again. Well, that's a statement, and that's not a question--
    darn it. Well, I had another statement too.

                           PANDEMIC INFLUENZA VACCINE

        I won't get into that, but on the flu vaccine, I do want to
    follow up a little bit on that. I have legislation in that
    would provide for a free flu shot for everyone every year--free
    flu--the Federal Government just provides a free flu shot. Now,
    why is that? Well, I am thinking about the vaccines and the--we
    have to get the infrastructure up for the pandemic flu that
    may--a lot of signs say is coming. As you point out, we have
    pandemics every so often. The infrastructure is not there to
    deliver it. So, if you had a free flu shot for everyone every
    year, not only do you save 35,000 lives a year perhaps or at
    least a good portion of those, you save a lot of
    hospitalizations, you save a lot of money if everyone got a
    free flu shot every year. Plus you get the States in to think
    about how you get it out there. You know, how do we start
    inoculating people in Wal-Marts and sporting centers, high
    schools, maybe even churches--after church or synagogue, they
    could get inoculated. In other words, to set up a system so
    that if a pandemic hits--bang, you have got it there and you
    can get it out. So I hope that you will take a look at that and
    see if there is any merit to getting a free flu shot for
    everyone out there, and I don't know if you want to respond to
    that or not.
        Secretary Leavitt. I'd love to respond just briefly. I
    believe one of the side benefits of our pandemic preparedness
    is the ability to take the annual flu vaccine dilemma off the
    table forever.
        Senator Harkin. Yeah.
        Secretary Leavitt. We will have to have new capacity
    developed and have it operating continually to keep our
    capacity warm----
        Senator Harkin. That's right.
        Secretary Leavitt [continuing]. The best thing to develop--
    --
        Senator Harkin. That's right.
        Secretary Leavitt [continuing]. Would be new annual flu
    vaccine.
        Senator Harkin. That's right.
        Secretary Leavitt. So, I fully believe that we will see
    substantial increases in the availability of annual flu
    vaccine. How we distribute it, what the cost is and so forth
    will be a matter of policy, but we do need to increase it.

                               DISEASE PREVENTION

        Senator Harkin. Well, I appreciate that. I will continue to
    push that idea that we ought to just provide a free flu shot.
    It's about--I estimated about--well, if you figure the flu
    shot's about $10 for 200 million people, that's about $2
    billion a year, but then the lives you save, the decrease in
    hospitalizations--maybe won't cost that much, so you get a win
    on the other side. Let me follow up on Senator Craig's
    comments. I told him when he walked out I was going to follow
    up on that, and I think I heard you say this was--your primary
    concern is to get prevention out there. When you mentioned the
    Medicare, that 8 percent GDP now going to 11 percent, the
    answer is not just to provide more drugs for the elderly Part
    D, and I don't mean to get into that contest there, but the
    answer is just to start getting prevention earlier in life to
    our kids as they go through life. Now, you know I have been
    very concerned about child obesity, diet-related chronic
    diseases, and one of the areas I am particularly interested in
    is the junk food marketing that targets kids--its impact. Last
    December, the IOM report, ``Food Marketing to Children: Threat
    or Opportunity?'' was released in December. It outlined a
    series of policy recommendations for government, the food and
    beverage industry, schools, parents--designed to limit junk
    food marketing and instead to utilize the power of marketing to
    promote healthier diets. What's that got to do with you? Well,
    the final recommendation of IOM was for the Secretary of Health
    and Human Services to designate a responsible agency to
    formally monitor and report regularly on the progress of all of
    the recommendations in the report. On March 3 of this year, 14
    Members of the Senate wrote to you urging you to implement this
    final recommendation so that Congress can monitor the progress
    made or not made toward the goal to see whether we need to do
    something in that regard. Now again, I am not--don't want to
    put you on the spot. We have not heard back from you, but that
    was only March--that was March 3. But again, Mr. Secretary,
    does HHS have any plans to take the action recommended by the
    Institute of Medicine to appoint a monitoring body on food
    marketing to children? If you don't have that answer, just----
        Secretary Leavitt. I think I best respond to you----
        Senator Harkin. Respond to me.
        Secretary Leavitt [continuing]. In writing. I have read
    about your concern about this, and I have begun to make
    inquiries as to what the current status is.
        [The information follows:]
                  Institute of Medicine Policy Recommendations
        Obesity prevention is one of my top priorities. I have asked
    Assistant Secretary for Health, Dr. John Q. Agwunobi, to work with all
    of the HHS agencies and offices to explore this issue in depth, and
    consider appropriate actions consistent with existing authorities and
    available resources.
        In addition, last year HHS and the Federal Trade Commission (FTC)
    sponsored a joint workshop on the effects of food marketing on
    children. On May 2, HHS and the Federal Trade Commission released a
    report titled ``Perspectives on Marketing, Self-Regulation and
    Childhood Obesity'' that recognizes that advertising and marketing can
    play a positive role in encouraging sound nutrition and physical
    activity.
        The report includes a series of recommendations for food companies
    and the entertainment industry to assist Americans in identifying more
    nutritious, lower-calorie foods; increase efforts to educate parents
    and children about nutrition and fitness; and to bolster the self-
    regulatory strategies that are currently employed to monitor the
    marketing of food and beverages to youth. In addition, the Council of
    Better Business Bureaus and the National Advertising Review Council
    recently announced the formation of a working group effort to review
    and propose changes to the Children's Advertising Review Unit and its
    self-regulatory guidelines.

        Secretary Leavitt. Senator, could I just make one other
    quick statement on a previous matter?
        Senator Harkin. Sure.

                                  NIH RESEARCH

        Secretary Leavitt. I'd just like to acknowledge that--the
    commitment that I feel to maintain the momentum of the research
    we have going at NIH. I'll probably be the only one who will
    say this is a good performance, but I have worked hard in a
    deficit reduction budget to make sure that we kept it at least
    flat. That is maybe good news only to me, but I wanted to tell
    you I have worked hard on it and will continue to. I also
    believe that what Dr. Zerhouni is doing with respect to trans-
    institute projects with his Roadmap is a very important part of
    the future. I would like to see a greater percentage of the $30
    billion that we spend there every year for research on inter-
    institute projects on basic science where all of the Institutes
    will benefit. I think that's a more efficient way than simply
    allocating to whatever disease or body part institute it is to
    have their own project, and I would like at some point to work
    with this committee to create a means by which that could be
    accelerated. We need more cross-institute work. We need to have
    less siloed research, multidisciplined research is clearly
    where we will find success in the future.
        Senator Harkin. I appreciate that. That's good.

                            COMPASSION CAPITAL FUND

        Senator Specter. Thank you very much, Senator Harkin. Just
    one final question before we conclude the hearing--Mr.
    Secretary, I note that you and First Lady Laura Bush were in
    Pittsburgh to talk about the progress on the initiative in
    relating to gang control, a Capital Fund--Compassion Capital
    Fund program--antigang efforts through a community and faith-
    based organization back on March 7, 2005, and I would be
    interested to know what your thinking is on any progress there.
    The problem of gang warfare and shootings is epidemic and
    endemic. Just this morning, two teenagers were shot straight
    across from a high school in Philadelphia. The shootings are
    virtually a daily occurrence. Recently, there was a gunfight.
    Last week, two men were sentenced to life imprisonment for a
    massive gunfight outside an elementary school in February 2004
    which killed a 10-year-old. Are the funds made available
    through this new program that you and First Lady Laura Bush
    announced having any significant impact?
        Secretary Leavitt. We are nearing the point in our process
    of soliciting proposals. We have an obligation to come up and
    review it with the committee, and we intend to do that. I think
    at that point, we'll be in a position to evaluate together the
    kinds of things those funds are being used for. We are quite
    optimistic about it and hopeful that we can continue the
    momentum of the program.
        Senator Specter. Well, the announcement was sometime ago--
    March 7, 2005. Have any grants been made under the program in
    the intervening 15 months?
        Secretary Leavitt. We have not yet received proposals. We
    have an obligation to come to the committee to review them with
    you before we do that, and we will do so.
        Senator Specter. Well, we have put up a fair amount of
    money last year, and you are asking for $35 million more this
    year in a budget where there are cuts on some very vital
    programs, so we don't want to keep those funds held in
    abeyance. If they can be directed effectively to juvenile gang
    problems, we want to do that.
        Secretary Leavitt. Thank you.
        Senator Specter. But if the money is not going to be
    awarded so that we can see some positive results from those
    funds, we want to use them elsewhere. Mr. Secretary, thank you.
        Senator Harkin?

                            AGING SERVICES PROGRAMS

        Senator Harkin. There was one thing I just--thank you, Mr.
    Chairman--that I wanted to bring up before you left, Mr.
    Secretary. When we first met when you came into my office when
    your appointment was scheduled, one of the things I remember we
    talked about was Systems Change Grants. Shortly after the
    Olmstead decision by the Supreme Court, Senator Specter and I
    started working to provide funds to help States get
    deinstitutionalized or to prevent institutionalization, but get
    people to deinstitutionalize. The Olmstead decision said you
    know, we had to provide the least restrictive environment. So
    we started this program called Real Systems Change Grants, and
    we started putting money in it to implement these programs. I
    believe, from all that I have known about it, it has been a
    success year after year. But every year, we have to fight to
    put the money into it. Again this year, the budget eliminates
    funding for the grants again--once again, so we fight again to
    put it in. Now, I now read that you have a new program in the
    area--in the administration on aging called Choices for
    Independence. Your budget's notes say, ``It seeks to reduce the
    current systemic bias in favor of institutional care.'' Well,
    that's what we were doing under Systems Change Grants. So
    again, what's the difference? Is this new program meant to
    replace it, to supplement it? I don't understand, and what's
    the difference between the two programs? Why would you
    eliminate the Systemic Change programs that we have been
    funding and now come up with this new program?
        Secretary Leavitt. Our purpose is to continue a portion of
    it in the Administration on Aging. We do believe, as you have
    stated, the need for us to deinstitutionalize and to have
    people served in the communities and homes, and that's the
    purpose. Perhaps we could provide you with more detail.
        Senator Harkin. Well, provide me with more details because
    it's not just aging. I mean, these are people with--a lot of
    the time physical disabilities, sometimes with mental
    disabilities, sometimes with both, but which has been proven
    that in many cases can live in a community setting. But a lot
    of times, it takes an initial expenditure made to get that
    done. After they get out, they're fine. As you know, there is a
    bias in Medicaid. Medicaid will pay for someone to be in an
    institution, but that institution wants to live in a community,
    they don't get that Medicaid support.
        Secretary Leavitt. Something we'd like to change.
        Senator Harkin. Well, I would like to change that too.
    That's why we had this program. So I wish you would really look
    at that. We are mandated--Supreme Court mandated. We got to--
    they have got to deinstitutionalize. So, we need to change that
    bias in Medicaid, and I hope we can work with you to do that
    also to provide that, but I would like to know why this is
    different. You put it in aging, but it doesn't just cover
    aging, it covers everybody else. If you don't have it now----
        Secretary Leavitt. I have asked my staff to respond as
    quickly as possible.
        Senator Harkin. I'd appreciate that. Thank you very much,
    Mr. Secretary.
        Secretary Leavitt. Thank you.
        [The information follows:]
                            Aging Services Programs
        Thank you for this opportunity to clarify my remarks at the recent
    hearing. The Choices for Independence program ``complements'' the Real
    Choice Systems Change initiative. This is a very important distinction.
    Allow me to explain further how the two initiatives fit together.
        Since fiscal year fiscal year 2001, Congress has appropriated over
    $245 million for the Real Choice Systems Change (RCSC) Grants for
    Community Living. In implementing the RCSC program, the Centers for
    Medicare & Medicaid Services (CMS) has awarded over 297 grants to all
    50 States, the District of Columbia (DC), and two territories. In
    fiscal year 2006, Congress appropriated an additional $25 million to
    fund a new round of RCSC grants. States and other eligible
    organizations, in partnership with their disability and aging
    communities, have the opportunity through RCSC to submit proposals to
    design and construct systems infrastructure that will result in
    effective and enduring improvements in community long-term support
    systems. These system changes are designed to enable children and
    adults of any age who have a disability or long-term illness to:
      --Live in the most integrated community setting appropriate to their
            individual support requirements and preferences;
      --Exercise meaningful choices about their living environment, the
            providers of services they receive, the types of supports they
            use, and the manner by which services are provided; and
      --Obtain quality services in a manner as consistent as possible with
            their community living preferences and priorities.
        As one component of their RCSC efforts, beginning in fiscal year
    2003, CMS began partnering with the Administration on Aging (AoA) to
    fund States to develop Aging and Disability Resource Centers (ADRC) to
    streamline access to long-term supports for people with disabilities of
    all ages. Simplified access to services, as represented through the
    ADRC initiative, is a key element of a State's overall systems change
    efforts. AoA resources for the ADRC initiative have come from the Older
    Americans Act Title IV Discretionary funding.
        Choices for Independence builds on the Older American's Act unique
    mission, to help our Nation prepare for the aging of the baby boom
    generation. Like the Real Choice grants, Choices addresses issues
    facing Americans who need comprehensive home and community-based
    systems of long-term care to delay or avoid nursing home placement.
    Choices for Independence, like RCSC, is designed to promote home and
    community-based care. Choices will focus mainly on linking Older
    Americans with available services, improving consumer-directed care,
    promoting evidence-based disease prevention, and targeting individuals
    not yet eligible for Medicaid to help prevent them from spending down
    to eligibility. In this way, Choices will complement the work that Real
    Choice grants have so effectively begun to improve long-term care (LTC)
    service delivery systems at the State level. In fiscal year 2007, as
    CMS works to implement the Deficit Reduction Act of 2005 (DRA), they
    will continue working with States to reform their LTC delivery systems
    by building on the successful aspects of Real Choice Systems Change
    grants.
        The fiscal year 2007 budget for AoA essentially folds ADRCs into
    the Choices for Independence initiative. The fiscal year 2007 budget
    includes $28 million for Choices for Independence, including an
    estimated $12.5 million for ADRCs; at the same time, CMS is requesting
    no new funding for Real Choice Systems Change grants. After 5 years,
    these grants have made great strides in helping States make
    improvements to their home- and community-based health care delivery
    service systems. The initiative provided useful lessons that led to the
    development and implementation of the Money Follows the Person
    demonstration (focus is consumer-directed care) as well as the State
    plan options for home- and community-based services in the Deficit
    Reduction Act (DRA). While Choices for Independence does not currently
    assume funding from other agencies, AoA will continue to work closely
    on this initiative with CMS and the other HHS agencies that have been
    involved in the activities that led to its development.

        Senator Specter. Thank you very much, Secretary Leavitt.
    Thank you for what you are doing on the pandemic problem, and I
    urge you to do more on acquainting America with the nature of
    the worst-case scenario--how serious it could be and what
    people ought to be doing individually--and your efforts to stir
    up activity by state and local agencies to deal with the
    problem. I would appreciate your assistance, your thought on
    what we can do about these budget shortfalls and about what can
    be done on advocacy within the administration, within the
    Office of Management and Budget which has the final word here
    and really with the President himself. I think that there is
    not a recognition as to what this means on a lot of very
    difficult very important agencies like the Centers for Disease
    Control and Prevention. These cuts on so many of the health
    agencies are just unacceptable. We can't solve that this
    morning, and you can't solve it, and there may be--have to be
    some action on Congress somewhere to find something that can
    give so these cuts are not implemented. Thank you.

                         ADDITIONAL COMMITTEE QUESTIONS

        Senator Specter. There will be some additional questions
    which will be submitted for your response in the record.
        [The following questions were not asked at the hearing, but
    were submitted to the Department for response subsequent to the
    hearing:]
                  Questions Submitted by Senator Arlen Specter
                         health professionals training
        Question. Mr. Secretary, I am disappointed that the budget proposal
    again eliminates funding for health professions training at HRSA,
    particularly those programs focused on diversity. Why does the
    administration continue to neglect these programs which play such a
    vital role in the education of young minority students in the health
    professions? What do we need to do to get the administration to match
    the support for these programs that exists in the Congress?
        Answer. The administration prioritizes the distribution of health
    professionals by maintaining funding for the Nation Health Services
    Corps, which places physicians in underserved areas, at $126 million.
    There is no longer a supply problem for physicians. Improving access to
    health care takes a commitment to improve the distribution of health
    care providers so that they are serving in areas where there are unmet
    or under-met healthcare needs. Programs that place people in the
    communities that need them is the best investment. In fiscal year 2005,
    only 16 percent of health professionals supported by the Health
    Professions program entered practice in underserved areas.
                          medicare electronic payments
        Question. The President's budget includes a proposal to save $133
    million in Medicare by requiring all providers to accept electronic
    payments, submit electronic claims, and accept more electronic
    remittance advices. These savings are dependent upon virtually all
    providers doing this by October 1, 2006. While I laud the goal of
    increasing Medicare electronic transactions, I question how realistic
    this is given that the majority of providers in our Nation are in small
    practices or are solo practitioners. Many of these providers may not
    have computers in their office or may be reluctant to give up paper. If
    the savings are not realized, Medicare claims processing contractor
    budgets will be shortchanged in fiscal year 2007. Given that CMS
    recently instructed its claims processing contractors to institute a
    hiring freeze on both new and replacement hires, which I understand
    could last through the remainder of this year, and possibly into 2007
    in order to address current budget shortfalls, I am concerned with any
    proposal which could put their funding situation in further jeopardy.
    How does CMS intend to implement this proposal and achieve the
    estimated Medicare savings? What will the Agency do if the goal is not
    realized and the savings are not achieved?
        Answer. Senator, I appreciate your interest in our administrative
    processes. This proposal to save $133 million is part of an overall
    effort to modernize Medicare operations and administer this program
    more efficiently. We are working as expeditiously as possible to
    implement the proposal in 2006. It builds on laws that have already
    been in effect for several years including the Debt Collection
    Improvement Act (Public Law 104-134) which requires the government to
    issue payments electronically, and the Administrative Simplification
    Compliance Act or ASCA (Public Law 107-105) which requires most
    providers to submit Medicare claims electronically.
        CMS acknowledges that certain providers are exempt from the
    requirement to submit electronic claims and will continue to allow
    these providers to submit paper claims. However, CMS has asked the
    Medicare contractors to review providers submitting paper claims to see
    if they are actually entitled to the ASCA exemption. We expect that
    these reviews will contribute to the savings that CMS expects to
    realize next year. In addition, CMS has been taking a broad look at the
    full range of claims-related activities to see which could be
    streamlined or consolidated. For example, the Medicare contractors
    currently send beneficiaries a monthly Medicare Summary Notice (MSN)
    listing services provided. A few of these MSNs include a check to the
    beneficiary but most do not involve payment. CMS believes it could save
    between $15 and $30 million by sending these ``no pay'' MSNs quarterly,
    or maybe semi-annually, instead of monthly. Another potential area for
    saving resources without placing additional burdens on providers or the
    Medicare contractors is to require those providers who already bill
    electronically to receive other claims-related Medicare information and
    outputs electronically as well. CMS believes that it may be able to
    save $10 million from this initiative. While there are substantial
    amounts at stake, CMS is confident that it can become more efficient
    without jeopardizing the Medicare contractors' operations or burdening
    the providers.
                           medicare integrity program
        Question. CMS partners with private entities to administer the
    Medicare fee-for-service program. In addition to paying Medicare
    claims, handling appeals and answering beneficiary and provider
    inquiries, these contractors are the first line of defense against
    Medicare fraud and abuse. Unfortunately, the Medicare Integrity Program
    (MIP)--which is the portion of the budget that funds these critical
    anti-fraud activities--has been capped by statute since fiscal year
    2003. I am pleased the President's fiscal year 2007 proposal supports
    an increase for Medicare Part A and B Program Integrity efforts.
    However, I am concerned with funding for these activities this year.
    While I understanding there are no new dollars right now, I believe it
    is important to find ways for these contractors to operate more
    efficiently and effectively. One way to do this is for CMS to give
    these contractors greater flexibility to manage their MIP budgets.
    Currently, the Agency does not allow its contractors to transfer funds
    among MIP program lines if the total funds to be transferred exceed 5
    percent of the total funding. In these cases, the contractors must
    request approval from CMS, which can take months and exacerbate funding
    problems. This Committee included report language in our fiscal year
    2006 spending bill urging CMS to give its contractors this much needed
    budget flexibility. While CMS has granted its contractors flexibility
    to manage their program management budgets, they have not done so for
    MIP. Given the tight budgets contractors are currently facing with MIP
    dollars, will you consider giving these contractors greater flexibility
    so they can best manage their budgets to match programmatic needs?
        Answer. Although you are correct that the Health Insurance
    Portability and Accountability Act of 1996 (HIP AA) capped MIP funding
    at fiscal year 2003 levels, Congress provided an additional $100
    million in 1-year mandatory funding for fiscal year 2006 in the Deficit
    Reduction Act of 2005 (DRA) for the new Parts C and D workloads. As you
    stated, the fiscal year 2007 President's budget includes a proposal to
    increase MIP funding over the fiscal year 2003 capped level by
    $85,634,000 in discretionary funding.
        CMS requires all five major MIP functions (Medical Review, Benefit
    Integrity, Provider Education & Training, Provider Audit, and Medicare
    Secondary Payer) in order to have a robust arsenal in the fight against
    fraud, waste, and abuse. As you have noted, CMS is limited in its
    ability to shift MIP funds since we must ensure that a multi-faceted
    approach is maintained. In the last couple of years, CMS has increased
    this flexibility somewhat for the MIP contractors. For example,
    workload levels in Medical Review and Local Provider Education &
    Training (LPET) are scalable to a certain extent. During the budget
    formulation process, contractors determine the type and level of effort
    they will be able to provide given the available resources. As problem
    areas/issues surrounding their respective providers change, the
    contractors can revise their Medical Review and LPET strategies and
    shift the funding between the two functions as necessary.
        As a matter of routine, CMS expects the contractors to keep the
    agency informed of their changing resource requirements before they are
    in a deficit situation. CMS is then able to work with the contractors
    to identify workloads that can be altered or areas with surplus funding
    that can be shifted while still achieving CMS' goals and objectives. In
    limited cases, CMS is even able to provide additional funding.
                           office of minority health
        Question. Mr. Secretary, I am concerned that the budget proposal
    reduces funding for the Office of Minority Health by $10 million. In
    the face of a widening health status gap, how does the administration
    justify significantly reducing the budget of an office who's mission is
    to lead the Department in the elimination of health disparities.
        Also, in the fiscal year 2006 bill, the legislation calls for a
    renewed focus on OMH's support for historically black medical schools.
    Can you tell me the status of this effort?
        Answer. The Office of Minority Health (OMH), part of the Office of
    Public Health and Science (OPHS) in the Office of the Secretary,
    advises both the Secretary and OPHS on public health program activities
    affecting racial and ethnic minority populations. The fiscal year 2006
    appropriation for OMH included a one-time congressional earmark in the
    amount of $10 million, which was not continued in the fiscal year 2007
    President's budget.
        OMH recognizes the important role that historically black medical
    schools play in increasing minority representation in the healthcare
    workforce, and in providing needed services to minority communities.
    Therefore, OMH encourages minority serving institutions of higher
    education (including historically black medical schools) to apply for
    grant programs supported by the Department of Health and Human Services
    (HHS). In fiscal year 2006, OMH has received proposals from three
    historically black medical schools; these proposals are currently under
    review for funding consideration. In addition to its own support, OMH
    is also working with other HHS Operating Divisions to enhance
    Departmental opportunities to support these institutions.
                     nih sleep disorders conference report
        Question. Mr. Secretary, during the National Institutes of Health's
    Frontiers of Knowledge in Sleep and Sleep Disorders conference in March
    2004, Surgeon General Carmona gave remarks on the profound impact that
    chronic sleep loss and untreated sleep disorders have on all Americans
    and that dissemination of the existing body of medical knowledge
    regarding sleep and sleep disorders is critically important. What are
    the prospects for development of a Surgeon General's Report on Sleep
    and Sleep Disorders?
        Answer. The Office of the Surgeon General (OSG) is studying this
    topic as a potential subject for a Surgeon General's Workshop or
    Surgeon General's Conference. In addition to the comments he made at
    the March 2004 NIH conference on Sleep and Sleep Disorders, Surgeon
    General Carmona also provided information regarding healthy sleep
    habits in a December 29, 2005, press release, ``Tips for Parents of
    Teenagers,'' as part of The Year of the Healthy Child. In March 2006,
    OSG staff attended a scientific workshop on ``Sleep Loss and Obesity:
    Interacting Epidemics'' to gather more information and identify leaders
    in this field. In addition, OSG staff members have met with medical
    intern and resident advocates to discuss their prolonged work hours,
    and the potential impact on patient safety brought about by sleep loss
    in this population.
                          underage drinking prevention
        Question. In February, the Interagency Coordinating Committee on
    the Prevention of Underage Drinking (ICCPUD), led by SAMHSA, released
    ``A Comprehensive Plan for Preventing and Reducing Underage Drinking.''
    The plan sets three performance targets for 2009: reducing the
    prevalence of past month alcohol use by those aged 12-20 by 10 percent;
    reducing the prevalence of those aged 12-20 reporting binge alcohol use
    in the past 30 days by 10 percent; and increasing the average age of
    first use from 15.6 to 16.5. These are modest goals, and they expire in
    just 3 years. It is well recognized, however, that reducing underage
    drinking will take a concerted effort over many years--certainly more
    than 3--and no one should be satisfied with 10 percent reductions. Why
    didn't ICCPUD set more ambitious, longer-term targets? Would you
    consider doing so in your next annual report?
        Answer. The targets set forth in the Comprehensive Plan for
    Preventing and Reducing Underage Drinking are ambitious, yet
    achievable, particularly considering underage drinking rates have
    remained essentially unchanged for over a decade. The targets in the
    plan, which are to be measured over the 5 year period from 2004 to
    2009, represent an ambitious first step in addressing what has been a
    serious and persistent problem in our country. It is relevant to note
    that Mothers Against Drunk. Driving (MADD) has recently adopted targets
    that are in the same range, including a 3-year goal of reducing the
    proportion of 16 to 20 year olds who drink alcohol and/or engage in
    high risk drinking by 5 percent by 2008.
        While the Interagency Coordinating Committee on the Prevention of
    Underage Drinking (ICCPUD) and SAMHSA believe that the current 5-year
    performance targets set forth in the plan are ambitious, these targets
    will be revisited during the development of the next annual report.
        Question. One of the expected benefits of forming the ICCPUD was
    that it would result in fewer duplicative efforts in the area of
    underage drinking. The idea was that as the many Federal agencies with
    a stake in this problem learned about each other's efforts, they would
    discover where their efforts overlap and, as a result, eliminate
    redundancies. Has this occurred? Can you provide concrete examples in
    which agencies have streamlined their anti-drinking activities?
        Answer. Since the Interagency Coordinating Committee on the
    Prevention of Underage Drinking (ICCPUD) was created in 2004, the
    member agencies have worked together to conduct an inventory of Federal
    underage drinking programs, develop the Comprehensive Plan for
    Preventing and Reducing Underage Drinking and annual report, support a
    national meeting of the States, support town hall meetings across the
    country, and create a government-wide website. Through these
    activities, the member agencies have gained a greater understanding of
    the science related to underage drinking, as brought to the group by
    the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and
    have enhanced their understanding of each other's activities.
        The ICCPUD agencies are using this .knowledge to support each
    other's activities, as exemplified by the recent town hall meetings
    funded by SAMHSA. These meetings were used to distribute research
    developed by NIAAA, and were strongly supported by a number of key
    ICCPUD partners, including the Office of Juvenile Justice and
    Delinquency Prevention (OJJDP), the Office of Safe and Drug Free
    Schools (OSDFS), and the National Highway Traffic Safety Administration
    (NHTSA). Several of these agencies encouraged their regional and State
    counterparts to support and participate in the Town Hall meetings.
    NHTSA used the meetings broadly to encourage the use of the HBO
    documentary, SMASHED: Toxic Tales of Teens and Alcohol and its
    accompanying educational package to facilitate and stimulate dialogue
    about future evidence-based underage drinking prevention action in
    local communities.
        The Centers for Disease Control and Prevention (CDC) and SAMHSA
    Center for Substance Abuse Prevention (CSAP) were both considering
    alcohol epidemiological activities in the States. As a result of work
    with ICCPUD, each agency became aware of the others' plans and avoided
    duplication of effort. CDC contributed to the development of the
    request for proposals issued by CSAP. This collaboration ensured that
    the CSAP funded program will be consistent with CDC's efforts.
        Question. It is my understanding that the Surgeon General intends
    to issue a first-ever ``Call to Action'' on underage drinking
    prevention sometime this spring. What is the status of the ``Call to
    Action'' and its expected release date?
        Answer. A Call to Action working group has developed a draft Call
    to Action, which will be reviewed by the Interagency Coordinating
    Committee on the Prevention of Underage Drinking (ICCPUD) member
    agencies in addition to the Department of Health and Human Services.
    The Surgeon General is committed to releasing the Call to Action at the
    earliest possible time.
                        pandemic influenza preparedness
        Question. Congress has appropriated $350 million for assistance to
    the States and localities for pandemic preparedness. The goal of that
    program is to assure that all localities meet a minimal level of
    preparedness. Is the Department planning to create a single, core set
    of performance standards that all jurisdictions must strive to achieve
    with these funds?
        Answer. As part of the Public Health Emergency Preparedness
    Cooperative Agreement, CDC in conjunction with State and local public
    health agencies and laboratories, national partner organizations, and
    Federal agencies, developed performance measures for overall public
    health preparedness. These measures are for all-hazards, including
    pandemic influenza.
        Question. As part of the initial ($100 million) funding that the
    Department is allocating to localities for preparedness, grantees are
    expected to perform some kind of preparedness exercise. Will the
    Department be reviewing the after action reports from these exercises?
    And if so, what resources (financial and personnel) has the Department
    set aside to provide technical assistance to the States to help them
    mitigate the deficiencies found in these exercises?
        Answer. All States submitted draft pandemic influenza preparedness
    and response plans to CDC in July 2005. As part of the $100 million
    emergency supplemental funding, the Department, primarily through CDC
    project officers and Subject Matter Experts, will assist in developing,
    conducting, and evaluating various aspects of the pandemic influenza
    plans through the use of exercises. As part of the award of the
    remaining $250 million in pandemic influenza supplemental funding,
    States will receive funds to ``fill gaps'' identified during the
    initial round of support. ``Gaps'' will be identified through two
    processes: first, by analyzing a comprehensive assessment conducted by
    local health departments measuring the many components of comprehensive
    influenza preparedness, and second, by analyzing results of exercises.
    Ongoing technical assistance will by provided by CDC.
        Question. How much of the $350 million has been released to the
    States and localities? By when does the Department expect these
    jurisdictions to have spent the funds? When will the remaining $250
    million be made available to the States and localities? Is there an
    expectation that the total $350 million must be obligated or expended
    by the end of fiscal year 2006? If so, is this a realistic expectation?
        Answer. States were awarded $100 million on March 7, 2006 to
    conduct planning for pandemic influenza preparedness. Eighty percent of
    those funds were restricted pending receipt of their supplemental
    applications. The applications have been received and evaluated and CDC
    is in the process of releasing many of the restrictions. We anticipate
    releasing most of the remaining restrictions by May 17, 2006. The
    remaining $250 million will be awarded later this summer. CDC does not
    anticipate that all funds will be expended by the end of the budget
    period. Recipients of funding may request for consideration that
    carryover funds to be awarded the next budget year.
        Question. Given that one of the most critical aspects of
    preparedness will be the ability of local jurisdictions to rapidly
    distribute a pandemic vaccine, will the Department encourage States to
    organize mass vaccination exercises during the next flu season to test
    their distribution plans? If so, will the Department allow the States
    to use a portion of the $350 million to purchase annual flu vaccine?
        Answer. States are permitted to use Public Health Emergency
    Preparedness cooperative agreement funds to purchase vaccine in limited
    quantities for conducting drills and exercises. They are not permitted
    to purchase vaccine with the emergency supplemental funding for
    pandemic influenza preparedness. However, they may use some of these
    emergency supplemental funds during the influenza season as an
    opportunity to exercise mass vaccination plans.
                           pandemic influenza vaccine
        Question. The U.S. Government will be contributing to the expanded
    production capacity of several manufacturing companies, who will use
    that capacity to produce and market seasonal flu vaccine in the absence
    of a pandemic. Given this unprecedented public investment in private
    corporations, is the Department taking steps to assure that the price
    charged public programs (e.g., Medicaid, Medicare) for seasonal flu
    vaccine is reflective of this investment?
        Answer. Our goal is to be able to produce enough vaccine for every
    American within 6 months of a pandemic outbreak. To accomplish this
    goal, we have focused our efforts on developing a cell-based vaccine
    for influenza. Without this investment in new technologies, we will not
    be able to produce enough vaccine in the event of a pandemic. Another
    key element of our plan is to ensure that manufacturers expand capacity
    in the United States. It is our hope that these manufacturers will
    produce seasonal influenza vaccine in the absence of a pandemic,
    allowing us to provide coverage to more Americans.
                       pandemic influenza surge capacity
        Question. Which HHS agency is in charge of assuring States and
    localities create the surge capacity for treating people who become ill
    during a pandemic?
        Answer. The Office of Public Health and Emergency Preparedness
    (OPHEP) is the lead office in HHS for ensuring that States and
    localities create the surge capacity for treating people who become ill
    during a pandemic. OPHEP works closely with both HRSA and CDC to ensure
    that funding through the State and local cooperative agreements enhance
    surge capacity and pandemic influenza preparedness.
        Question. Is the Department providing specific guidance and
    performance measures with respect to creating surge capacity? Has the
    Department estimated the cost of creating a minimum level of surge
    capacity?
        Answer. An influenza pandemic in a large number of communities
    simultaneously would make the need for expanded medical surge capacity
    critical. The 2005 cooperative agreement guidance for the Health
    Resources and Services Administration (HRSA) National Bioterrorism
    Hospital Preparedness Program provided performance benchmarks on surge
    capacity, including influenza. Specifically, grantees are required to
    establish systems that, at a minimum, can provide triage treatment and
    initial stabilization, above the current daily staffed bed capacity,
    for the following classes of adult and pediatric patients requiring
    hospitalization within 3 hours in the wake of a terrorism incident or
    other public health emergency--500 cases per million population for
    patients with symptoms of acute infectious disease--especially
    smallpox, anthrax, plague, tularemia, and influenza.
        In addition, the National Strategy for Pandemic Influenza
    Implementation Plan released on May 3, 2006, includes guidance to
    Federal departments and agencies, State and local government, the
    private sector, and the public about how to prepare for a pandemic.
    With respect to surge capacity, the plan includes a number of actions
    (with performance measures) on which HHS will collaborate with our
    partners at the Federal, State, local, and tribal levels and in the
    private sector. These include developing protocols for changing
    clinical care algorithms in settings of severe medical surge (action
    6.3.4.1), strategies for and protocols for expanding hospital and home
    health care delivery capacity (action 6.3.4.2), policies and protocols
    for emergency reimbursement or enrollment in Medicaid and State
    Children's Health Insurance Program that are appropriate for a pandemic
    (action 6.3.4.3), and ensuring that Federal medical assets are prepared
    to deploy to augment State and local capacity (actions 6.3.4.3 to
    6.3.4.7). The Department is currently preparing the plan to implement
    these actions within the timelines specified in the National Strategy
    for Pandemic Influenza Implementation Plan.
               pandemic influenza preparedness plan implemention
        Question. While significant funds are being invested in
    preparedness, when a pandemic hits the costs for Federal, State, and
    local governments will be significantly higher. Has the Department made
    an estimate of what the cost would be to implement its pandemic
    preparedness plans? For example, is there an estimate for what the
    actual pandemic flu vaccine will cost once it is available? Has the
    Department asked States and localities to estimate the costs of
    responding to the pandemic, as opposed to planning for one?
        Answer. It will be difficult to estimate with certainty the costs
    of implementing our pandemic influenza plans because each State and
    local preparedness plan is unique and because we do not know if we will
    be responding to a mild or severe pandemic. We are currently focusing
    our efforts on preparing for a pandemic to mitigate costs during an
    outbreak by ensuring enough vaccine for every American six months after
    human-to-human transmission, enough antivirals for 25 percent of the
    population, and. a stockpile of 20 million courses of pre-pandemic
    vaccine: We are also enhancing domestic and international surveillance
    to quickly detect a pandemic to slow its spread. We are working closely
    with States and local communities as they plan for a pandemic and to
    exercise those plans.
                uninsured access to pandemic influenza treatment
        Question. Hospitals and other health care providers will bear the
    brunt of costs associated with a pandemic. During a pandemic we need to
    make sure that those who are uninsured are not deterred from seeking
    necessary care as early as possible. At the same time we don't want
    hospitals to have even higher levels of uncompensated care that could
    threaten their long-term financial viability. Has the Department
    considered what policies and funding might be needed to address this
    problem?
        Answer. As described in the National Strategy for Pandemic
    Influenza Implementation Plan, HHS will work with State Medicaid and
    SCHIP programs to ensure that Federal standards and requirements for
    reimbursement or enrollment are applied with the flexibilities
    appropriate to a pandemic, consistent with applicable law. In addition,
    we are also examining the recommendations of Federal Response to
    Hurricane Katrina: Lessons Learned report to determine what policies
    might be needed to respond to public health emergencies, including a
    pandemic.
                      pandemic influenza respirator masks
        Question. Last week the Institute of Medicine issued a report
    saying the respirator masks and surgical masks should not be re-used.
    The report also suggested that, as part of a larger strategy of
    infection control, N-95 respirator masks would offer some protection of
    health care workers. The WHO recommends use of these masks in a health
    care setting. How many N-95 masks does the United States now have
    stockpiled? How many N-95 masks are on order for the stockpile? Does
    the Department have an estimate of how many masks would be needed in
    the healthcare system during a pandemic, when manufacturing and
    distribution of such masks may be hard to accomplish?
        Answer. The Strategic National Stockpile has approximately 9.1
    million N-95 masks on hand and 98.4 million N-95 masks on order. The
    Centers for Disease Control and Prevention estimates that up to 1.5
    billion surgical masks and over 90 million N-95 respirators would be
    needed for the healthcare sector in the event of a severe pandemic. HHS
    purchased 150 million surgical masks and N-95 respirators in fiscal
    year 2006. The Federal Government, States, and the private sector share
    responsibility in ensuring an adequate level of preparedness. States
    have access to funding from Health Resources and Services
    Administration's (HRSA) National Bioterrorism Hospital Preparedness
    Program to address these surge capacity needs.
                           medicare integrity program
        Question. The Congress has provided significant funding, both
    mandatory and discretionary, to help CMS combat the unacceptably high
    payment error rate in the Medicare and Medicaid programs--literally
    hundreds of millions of dollars even after you have made some progress
    in reducing the error rate. Reportedly, over 90 percent of the Medicare
    Integrity Program funds, $720 million per year have been diverted to
    fiscal intermediaries and carriers doing routine claims processing,
    leaving about $50 million per year for the targeted error rate
    reduction contracts. What is the rationale for this diversion of
    resources from fraud and abuse activities?
        Answer. MIP funds are not used by fiscal intermediaries and
    carriers in the performance of routine claims processing. Separate
    funding under the Program Management account is set aside for that
    purpose. These contractors, however, have historically been the first
    line of defense in the fight against fraud and abuse. Under the MIP,
    they have conducted medical review, fraud review, cost report audit,
    provider education and other activities identified in the statute. All
    of these activities are intended to insure that payments are made
    properly and that inappropriate payments are recovered. Under the
    medical review/local provider education program, FIs and Carriers are
    evaluated on their ability to reduce the improper error rate.
        Additionally, a significant portion of the $720 million in MIP
    funding is used by a host of specialty contractors, most notably the
    Program Safeguard Contractors, whose sole focus is fraud and abuse
    activities.
                           medicare improper payments
        Question. The Congress just appropriated $100 million this year for
    fraud and abuse activities in the new Part D prescription drug program.
    What are the Department's plans for using this money to address payment
    errors in the Part D program? When do you intend to commit funds this
    fiscal year?
        Answer. The $100 million appropriated in the Deficit Reduction Act
    (DRA) will be used for many different purposes to maintain the
    integrity of the prescription drug benefit and fight against fraud and
    abuse from all sources. CMS is in the process of committing the funds
    provided in the DRA and plans on using all of the funds by the end of
    the fiscal year.
        CMS has developed a comprehensive plan for a Part D oversight
    program building off the approach that has worked successfully for Part
    A and Part B. CMS has established this plan in an effort to ensure that
    the funding provided in the DRA will help to combat fraud, waste, and
    abuse associated with the new prescription drug benefit. We have
    included strong safeguards in areas where we identified
    vulnerabilities, including eligibility, the bidding process,
    beneficiary plan, and retail pharmacy fraud, incentives to reduce cost
    and cost sharing, formulary development (kickbacks), and misuse of Part
    D beneficiary lists. This program will ensure that Part D contractors
    and other program stakeholders meet all applicable statutory,
    regulatory and program requirements.
        CMS is expanding its efforts in fighting fraud and abuse in
    Medicare by using State of the art systems designed to prevent problems
    and maintain integrity for the new Medicare prescription benefit. A
    portion of the funding appropriated in the DRA will be used to develop
    and/or maintain the following program integrity systems:
      --Risk Adjustment System (RAS).--The system intended to vary the
            Federal share of premiums based on factors that are beyond the
            control of the drug plan;
      --Medicare Advantage Prescription Drug (MARx) System.--A stand alone
            system that will include the processing of all enrollment/
            disenrollment transactions associated with the Part D Program;
      --The Drug Data Processing System (DDPS).--The system that collects,
            maintains, and processes information on all Medicare covered
            and non-covered drug events for Medicare beneficiaries
            participating in Part D; and
      --The Medicare Beneficiary Database (MBD).--The database that houses
            Medicare beneficiary enrollment information.
        CMS has contracted with program integrity contractors, known as
    Medicare Drug Integrity Contractors (MEDICs), to assist the Agency in
    overseeing the Medicare Part D program. Part of the $100 million will
    be used to establish and support three MEDICs in the regions, in
    addition to the Eligibility and Enrollment MEDIC that began on November
    15, 2005. The MEDIC contractors will:
      --Analyze data to find trends that may indicate fraud or abuse;
      --Begin to investigate potential fraudulent activities surrounding
            enrollment, the determination of eligibility, or the delivery
            of prescription drugs;
      --Investigate unusual activities that could be considered fraudulent
            as reported by CMS, contractors, or beneficiaries;
      --Conduct fraud complaint investigations; and
      --Develop and refer cases to the appropriate law enforcement agency
            as needed.
        In addition, CMS will support compliance activities to combat
    fraud, waste, and abuse in association with the drug benefit. These
    efforts will include the following strategies: (1) Part D compliance
    monitoring; (2) accreditation organization validation studies for
    Medicare Advantage plans; (3) Part D auditing; (4) other compliance and
    monitoring strategies; and (5) compliance and oversight training for
    Medicare Advantage plans.
        CMS continues to work to ensure the integrity and validity of the
    data for the prescription drug benefit. The funding provided in the DRA
    will be used to monitor and evaluate prescription drug plans and
    Medicare Advantage plans to maintain data integrity. CMS' monitoring
    activities will include reviewing the plans' pricing and formulary to
    ensure that they follow the guidelines that have been established. In
    addition, CMS will review the data by performing payment validation of
    the plans.
        CMS will also use part of the $100 million to comply with the
    improper Payments Information Act of 2002 (IPIA). CMS is building on
    its current program integrity efforts by implementing new steps to
    analyze program data to detect improper payments and potential areas of
    fraud and abuse in the Medicare and Medicaid programs more quickly and
    accurately. CMS is using these analyses to more effectively educate
    providers and beneficiaries about ways to prevent and minimize waste,
    fraud, and abuse. CMS' program integrity efforts are being expanded
    beyond fee-for-service Medicare to encompass oversight of Part D
    prescription drug benefit and the new Medicare Advantage plans.
        The last activity that will be supported by the funding provided in
    the DRA are audits. These audits will include financial audits of at
    least one-third of all Part D organizations' financial records
    including bids, data relating to Medicare utilization and allowable
    costs as mandated in the MMA. In addition, CMS will use the funding to
    audit one-third of the Medicare Advantage plans for adjusted community
    rates and perform various cost plan audits.
        Question. The fiscal year 2006 Senate bill and conference report
    encouraged CMS to move forward on a $3 million demonstration of the use
    of data fusion technology to detect payment error and fraud and abuse
    in the Medicare program. We understand that the agency is moving
    forward with a data fusion and analysis project to identify improper
    payments to providers from Medicare using data sources outside of
    current fraud recovery efforts. What can you do to get this program
    moving forward more quickly?
        Answer. CMS will be competing contracts among the MEDICs to support
    and develop the Integrated Data Repository and an overall data
    infrastructure to support CMS fraud, waste and abuse efforts. This
    effort requires significant resources and will be funded with the $3
    million referenced in the Senate and conference reports and through the
    1 year MIP funding provided in the DRA. We anticipate that this effort
    will integrate Medicare fee-for-service data, prescription drug data,
    and Medicaid data into one central repository.
                  cms--status of quality demonstration project
        Question. Mr. Secretary, last year alone there were over 1.3
    million new cases of cancer diagnosed in America--I can't think of a
    single family who hasn't had a friend or family member affected by this
    terrible disease. The status quo is simply not acceptable. The last 2
    years your department has taken targeted regulatory action to prevent
    any access disruption through a demonstration project to support the
    development of quality-based payment policy. I strongly urge you to
    continue this important program and begin to move towards a permanent
    funding solution that will preserve patient access to community cancer
    care. Do you have any updates for the committee as to the status of the
    quality demonstration project?
        Answer. CMS is very focused on creating a payment system that
    offers better support for the delivery of high-quality, low-cost care
    as well as improving the benefits available to America's seniors to
    prevent disease complications and live longer healthier lives. CMS has
    worked closely with the AMA, AQA, and MedP AC among others to develop
    consistent and effective ways to measure the quality of care.
        We believe the oncology community is pleased with the improvements
    made in this year's oncology demonstration project. This project will
    enable us to capture more specific information about cancer patients
    including their treatments and whether current cancer care represents
    best practices and is provided in accordance with accepted practice
    guidelines.
        After reviewing this year's data, we will be able to make decisions
    about the continuation of the demonstration project and what additional
    improvements or modifications are necessary for 2007.
                      cms--adequate provider reimbursement
        Question. Mr. Secretary, when it enacted MMA, Congress established
    ASP as the reimbursement metric for prescription drugs covered under
    Part B of Medicare. My concern is that CMS has continued to resist
    using its administrative discretion to correct an ASP calculation
    problem that thwarts the clear legislative intent underlying the shift
    to ASP-based reimbursement. I am referring to CMS's insistence that it
    cannot exclude the prompt pay discounts that manufacturers give
    wholesalers from the calculation of ASP because the term ``prompt pay
    discounts'' appears in the list of price concessions that the statute
    says are to be netted out when ASP is calculated.
        Wholesaler prompt pay discounts reward the timely completion of the
    wholesaler's product purchase from the manufacturer, constitute an
    integral part of the revenues received by wholesalers for their
    services, and, in my experience, are not passed on to the wholesalers'
    customers. By insisting that wholesaler prompt pay discounts be netted
    out of ASP, CMS has undermined Congress' intent that payment at ASP+6
    percent should cover physicians' drug acquisition costs, allow for a
    reasonable level of pricing variability in the nationwide drug market,
    and provide compensation for drug-related costs that are not separately
    reimbursed. In essence, by requiring the inclusion of wholesaler prompt
    pay discounts in the ASP calculation, CMS has converted physician
    payments for Part B drugs from the congressionally mandated level of
    ASP+6 percent to the lesser amount of ASP+4 percent.
        Based on the statute and congressional language offered at the time
    of its adoption, what is CMS' interpretation of congressional intent
    with regard to adequate provider reimbursement for drug reimbursement,
    and the application of the prompt pay discount to that reimbursement
    for oncology services?
        Answer. The Congress defined the ASP to be an average measure of
    sale prices across a broad range of classes of trade and, therefore,
    established that payments to providers represent average drug
    acquisition costs and not the actual cost experienced by a particular
    provider or specific class of trade. Further, in establishing that the
    payment rates are 106 percent of the ASP, Congress established a
    corridor above the average acquisition cost to address variations in
    actual costs.
        CMS interprets section 1847A(c)(3) to require manufacturers to
    deduct prompt pay discounts given on sales included in the ASP
    calculation from the ASP numerator (ASP=sales in dollars/units sold).
    The language in section 1847A(c)(3) is plain, ``In calculating the
    manufacturer's average sales price under this subsection, such price
    shall include volume discounts, prompt pay discounts, cash discounts,
    free goods that are contingent on any purchase requirement,
    chargebacks, and rebates (other than rebates under section 1927). For
    years after 2004, the Secretary may include in such price other price
    concessions, which may be based on recommendations of the Inspector
    General that would result in a reduction of the cost to the
    purchaser.''
        In the preamble to the CY 2006 Physician Fee Schedule final rule
    (70 FR 70224), we stated that we lack the statutory authority to permit
    manufacturers to exclude prompt pay discounts from the calculation of
    the ASP. We continue to believe the use of ``shall'' and the
    limitations on the discretion to include other price concessions in the
    statutory language do not provide administrative discretion to exclude
    a statutorily named price concession from the ASP calculation.
                            cms--prompt pay discount
        Question. What evidence is available to CMS that the prompt pay
    discount is being passed along to the provider of oncology services? If
    the prompt pay discount is not being passed along to providers, how
    does CMS achieve the congressional intent to rationalize provider
    payments with actual costs?
        Answer. CMS does not have evidence that prompt pay discounts are or
    are not being passed along to the providers of oncology services. CMS
    achieves the congressional intent by implementing the ASP methodology
    cited in section 1847A(c)(3).
                  cms--regulatory authority for reimbursement
        Question. Congress believes that CMS clearly has the administrative
    authority to put forward a regulation on provider reimbursement to
    resolve this issue. Does CMS share this view or is additional
    legislation necessary?
        Answer. CMS does not believe it has the regulatory authority to
    exclude prompt pay discounts from the ASP calculation. The ASP
    statutory language is plain and provides limitations on modifying price
    concessions. We believe the section l847A(c)(3) authority to adjust the
    price concessions is limited to those price concessions that would
    ultimately lower the ASP, whereas removing prompt pay discounts from
    the ASP calculation would increase Medicare expenditures.
                                     ______

                   Questions Submitted by Senator Tom Harkin
                                 medicare fraud
        Question. Mr. Secretary, as you know, I have a long record of
    fighting fraud, waste, and abuse in the Medicare and Medicaid programs.
    I know that CMS has addressed the issue of fraud in payments to
    suppliers for power wheelchairs. However, there is still concerns among
    legitimate suppliers that CMS is not doing enough to root out suppliers
    that are not legitimate.
        I understand that CMS is developing tougher quality and
    accreditation standards for suppliers. When will these standards be
    released? And what is CMS doing to make sure that they only issue
    supplier numbers to legitimate providers? Are CMS's efforts to root out
    fraud and abuse in this area being hampered by a lack of resources?
        Answer. CMS plans on issuing new draft quality standards for
    suppliers on its website this summer. CMS will then solicit accrediting
    organizations to review suppliers and assure that they meet the new
    quality standards. We anticipate that accreditation activities will
    start before the end of calendar year 2006. Currently, to ensure that
    only qualified suppliers are issued supplier numbers, we perform site
    visits prior to enrollment and re-enrollment (which is required every 3
    years). We also perform additional reviews of potentially questionable
    suppliers. These reviews focus on questionable suppliers located in
    geographic areas where there is a high concentration of fraud and
    suppliers who have questionable patterns of billing and/or high claims
    error rates.
                             cms--power wheelchairs
        Question. On April 6 of this year, CMS published a new final rule
    that requires that power wheelchairs suppliers review a beneficiary's
    medical records and determine if a physician's prescription is
    supported by medical evidence before a power mobility device will be
    prescribed. What documentation are suppliers required to verify before
    filling a prescription for a power mobility device? Will CMS issue
    guidance for suppliers on documentation requirements--including the
    level of specificity of the documentation--in order to clarify any
    ambiguities regarding filling a legitimate prescription?
        Answer. CMS would like to note that during the comment period of
    the interim rule, some suppliers noted that they were already
    experiencing a significant improvement in the timeliness, completeness
    and substantive content of medical record documentation submitted by
    physicians since the interim rule became effective. Along with the
    positive feedback from suppliers, CMS has not received any significant
    concerns from physician groups or other treating practitioners on this
    topic. In fact, one professional organization representing over 94,000
    physicians and medical students expressed support for the elimination
    of the certificates of medical necessity (CMNs) for power mobility
    devices (PMDs).
        As you are aware, the CMN for PMDs was eliminated. The CMN was
    originally designed to improve claims submission by allowing electronic
    transmission of certain data. Unfortunately, some in the industry saw
    the CMN as a substitute for evidence of a physician's independent
    comprehensive examination and analysis of whether a PMD was medically
    necessary. Despite CMS' and its contractors' statements to the
    contrary, these suppliers treated the CMN as the ultimate instrument in
    determining coverage. Some suppliers went so far as to hire physicians
    to fraudulently complete CMNs. Furthermore, our analysis of claims has
    found that in approximately 45 percent of cases, statements claimed in
    the CMNs were not supported by the source information in the patient's
    medical chart.
        Instead of a CMN, the Durable Medical Equipment Regional Carriers
    (DMERCs) will rely on the patient's medical chart to determine medical
    necessity. We are concerned that a one-page scripted form would not
    protect the Medicare program or its beneficiaries in the same way that
    source information culled directly from a patient's medical record
    would. The CMN did not help physicians or treating practitioners better
    document their patients' clinical needs for a PMD, it did not ensure
    that beneficiaries always received appropriate equipment, and it did
    not serve as an effective deterrent to fraud and abuse. We believe the
    beneficiary's physician or treating practitioner is in the best
    position to evaluate and document the beneficiary's clinical condition
    and PMD medical needs, and good medical practice requires that this
    evaluation be adequately documented. Thus, to minimize the
    documentation requirements for providers while assuring that
    documentation is adequate, physicians and treating practitioners will
    now prepare written prescriptions (as required by MMA section 302 and
    the final rule) and submit copies of relevant existing documentation
    from the beneficiary's medical record, rather than having to transcribe
    medical record information onto a separate form such as a CMN.
        The rule describes the information that must be included in the
    written prescription: beneficiary's name, date of the face-to-face
    examination, diagnoses and condition that the PMD is expected to
    modify, a description of the item being prescribed, the length of need,
    the prescribing physician's signature and date of signature. This model
    provides structure while maintaining appropriate flexibility for the
    prescribing physician or treating practitioner. Only about 10 percent
    of physicians and treating practitioners prescribe a PMD for a Medicare
    beneficiary in any given year, and the majority of those physicians and
    treating practitioners only prescribe one or two PMDs a year. Given the
    myriad of forms, brochures, requisitions and similar items in a typical
    physician's office, a requirement to have a specific prescription form
    handy in the event that it might be needed would impose an unnecessary
    burden on the physician and other treating practitioners when that form
    would only be needed once or twice a year for most prescribers, and
    never actually needed for the vast majority.
        Finally, the physician or treating practitioner must sign the
    prescription for the PMD and is, therefore, accountable for
    documentation of the medical need for the device. We believe that this
    required signature and source documents in the patient's chart
    effectively document the physician's attestation that the medical need
    for the device is legitimate.
        CMS and the DMERCs have provided extensive educational outreach to
    both suppliers and the medical community pertaining to the
    documentation requirements for PMDs. Examples of formal communication
    include CMS program instructions, Medlearn Matter articles, and DMERC
    supplier articles explaining the new responsibilities of suppliers. In
    addition, medical review activities vary depending on the situation
    under review. CMS cannot develop an all inclusive list of documents or
    information that Medicare contractors may request during audits. When
    requesting additional documentation, the DMERCs write to suppliers and
    ask for the specific documentation or information needed for a review.
    CMS has defined the circumstances under which contractors request
    additional information in the Program Integrity Manual. Local Coverage
    Determinations are issued by our contractors to describe in more detail
    the conditions under which Medicare payment is made. This additional
    documentation is only collected during the course of medical review
    audits and does not need to be collected for all claims.
                      medicaid/special education benefits
        Question. This question concerns Medicaid and special education. I
    asked Education Secretary Spellings about it at our hearing with her in
    March, but she said I needed to ask you, so I'd like to do that now.
        Under current law, Medicaid pays for the cost of covered services
    for eligible children with disabilities. School districts can also be
    reimbursed by Medicaid for the transportation and administrative costs
    they incur in providing these services. But now the administration
    wants to prohibit schools from getting reimbursed for those costs. In
    fiscal year 2007, schools are expected to receive $615 million from
    Medicaid for transportation and administrative costs. If this change
    goes through, they'll have to pay the $615 million themselves, and many
    will have great difficulty doing so. I'm concerned about this, because
    if schools can't pay the transportation costs to children with
    disabilities, the children won't end up getting the services.
        Does CMS plan to implement this cut? If so, where do you recommend
    that schools find the money to make up the difference?''
        Answer. Appropriate Medicaid services will continue to be
    reimbursed as allowed under current law. However, claiming for certain
    Medicaid services in school settings has proven to be prone to abuse
    and overpayments. Schools provide a wide range of medical services to
    students, which mayor may not be reimbursable under the Medicaid
    program. Problem areas include but are not limited to school bus
    transportation and administrative claiming, as well as direct medical
    services. The fiscal year 2007 budget proposes administrative actions
    to phase out Medicaid reimbursement for some services, including school
    bus transportation and administrative claiming related to Medicaid
    services provided in schools.
        According to section 1903(a)(7) of the Social Security Act (the
    Act), for the costs of any activities to be allowable and reimbursable
    under Medicaid, these activities must be ``found necessary by the
    Secretary for the proper and efficient administration of the plan''
    (referring to the Medicaid State Plan). Additional authority derives
    from section 1902(a)(17) of the Act, which requires that States take
    into consideration available resources. Through the authority of these
    statutes, the administration proposes to prohibit Federal reimbursement
    for transportation provided by or through schools to providers.
        HHS has had long-standing concerns about improper billing by school
    districts for administrative costs and transportation services. Both
    the Department's Inspector General and the General Accountability
    Office (GAO) have identified these categories of expenses as
    susceptible to fraud and abuse. GAO found weak and inconsistent
    controls over the review and approval of claims for school-based
    administrative activities that create an environment in which
    inappropriate claims generated excessive Medicaid reimbursements. Audit
    findings from States where the OIG conducted administrative claiming
    audits have shown egregious violations. Proper and accurate claiming
    for administrative services has not been carried out in compliance with
    applicable Medicaid regulations. Overall, the leading conclusions from
    these audits are that most States use an improper allocation
    methodology and insufficient attention is paid to the details of the
    claiming process.
        The fiscal year 2007 President's budget includes a regulatory
    proposal that would prohibit Federal Medicaid reimbursement for
    Medicaid administrative activities performed in schools. It
    additionally proposes that Federal Medicaid funds will no longer be
    available to pay for the transportation to and from school related to
    medical services provided through an Individualized Education Program
    (IEP) or Individualized Family Service Plan (IFSP).
        Schools would continue to be reimbursed for direct Medicaid
    services identified in an IEP or IFSP provided to Medicaid eligible
    children, such as physical therapy and occupational therapy that are
    important to meet the needs of Medicaid-eligible students with
    disabilities, as long as the providers meet Medicaid provider
    qualifications. CMS estimates that these proposals will save $0.6
    billion in fiscal year 2007 and $3.6 over 5 years.
                            special exposure cohorts
        Question. The Labor HHS Appropriations Act of 2006 (Public Law 109-
    149) requires NIOSH to prepare a report within 180 days of enactment
    evaluating whether there are additional radiosensitive cancers not
    already on the list of 22 cancers eligible for compensation under the
    Special Exposure Cohort provision of EEOICPA and RECA that should be
    eligible for compensation. Will NIOSH deliver this report to Congress
    on schedule?
        Will NIOSH solicit comments from experts in radiation epidemiology
    before submitting this report?
        Answer. NIOSH is currently working on finalizing this report and is
    seeking comments from a set of experts with diverse expertise and
    perspective, including experts in radiation epidemiology. The report
    will be peer-reviewed prior to submission. We are working as quickly as
    possible to obtain comments/edits from the outside reviewers to
    expedite the process.
        Question. The Office of Management and Budget recently issued a
    ``Passback'' memo to the Department of Labor, which called for options
    to ``contain the growth in benefits'' from new Special Exposure Cohorts
    under the Energy Employee Compensation law. To accomplish this, the
    memo outlines options including administration clearance of all Special
    Exposure Cohorts before a decision is made by you as Secretary of
    Health and Human Services. Has your Department formulated a legal and
    policy response to the OMB memo and if so, could you please share that
    response with the Committee?
        Answer. The National Institute for Occupational Safety and Health
    (NIOSH) is responsible for receiving and scientifically evaluating
    petitions from classes of workers seeking inclusion in EEOICP A's
    Special Exposure Cohort. NIOSH carries out this responsibility under
    regulations promulgated in May 2004, and amended in December 2005, to
    make the rule consistent with the amendments to EEOICPA contained in
    the Ronald W. Reagan National Defense Authorization Act for fiscal year
    2005. In fulfilling this duty, NIOSH evaluates the feasibility of
    scientifically estimating radiation dose for workers in the class that
    is petitioning for inclusion in the SEC. If a dose estimate is not
    feasible, NIOSH evaluates whether or not the health of the workers in
    the proposed SEC class was potentially endangered by their radiation
    exposure.
        NIOSH presents its scientific and technical evaluation findings and
    recommendations to the Presidentially appointed Advisory Board on
    Radiation and Worker Health (the Board), a chartered Federal Advisory
    Committee. The Board considers the NIOSH evaluation and then makes a
    recommendation to me to either add or not add the class of workers to
    the SEC. My decision about whether or not to add the class members to
    the SEC is based on the following: the requirements of the law and the
    above-mentioned regulations, the NIOSH findings and its recommendation
    to the Board, and the recommendation of the Board.
                                     ______

                Questions Submitted by Senator Daniel K. Inouye
                             health centers program
        Question. I would like to express my sincere appreciation to Dr.
    Elizabeth Duke for her continued support and interest in the extension
    of health care service delivery networks to the underserved residents
    in some of the most geographically isolated communities in Hawaii. In
    particular, I am pleased with consideration to the future establishment
    of a health center on Lana'i. Through the establishment of these health
    centers, significant improvements have been noted in access, quality,
    and continuity of care. All of which are integral to the early
    detection, diagnosis and intervention in a myriad of potentially
    debilitating diseases.
        Answer. Thank you for your support of our work in the Health
    Centers program. This program is integral to our mission to enhance the
    health and well-being of Americans by providing for effective health
    and human services
                    emergency medical services for children
        Question. As expressed last year, I am very concerned that once
    again the Emergency Medical Services for Children (EMSC) program has
    not been included in your budget. It can not be stressed often enough
    that the emergency care and resuscitation of children is uniquely
    different from adult resuscitation. One size does not fit all in the
    emergency care of children. There is great disparity in the quality and
    availability of emergency services for children across this country.
    While other programs are directed at ensuring the adequacy of adult
    emergency care services, this is the only program specifically directed
    at saving the lives of children. How does the Department plan to ensure
    that America's children receive the emergency care they deserve with no
    targeted funding?
        Answer. States, through the Maternal and Child Health Block Grant
    program, can continue to fund these specialized services.
                       baccalaureate to doctoral programs
        Question. A long-standing supporter of the National Institute for
    Nursing Research, I am pleased that the administration has continued
    funding of this program. However, what impact will the $1 million
    reduction have on the National Institute of Nursing Research's
    development of initiative that supports fast-track baccalaureate-to-
    doctoral programs? These programs were proposed to help increase the
    number of nursing faculty and in turn decrease the number of qualified
    nursing school candidates who were turned away in prior years.
        Answer. The overall reduction of $792,000 in the fiscal year 2007
    budget request of $136.6 million for the National Institute of Nursing
    Research (NINR) will have no impact on its programs that fast-track
    baccalaureate-to-doctoral nurses to increase the number of nursing
    investigators. These programs are supported within the Research
    Training mechanism in NINR, and the fiscal year 2007 President's budget
    maintains the current level of support of this activity. NINR remains
    committed to developing the next generation of nurse scientists. NINR
    encourages and supports strategies to change the career trajectory of
    nurse scientists. The Institute emphasizes early entry into research
    careers, including fast-track baccalaureate-to-doctoral programs, and
    supports pre-doctoral and postdoctoral nurses who are the future
    researchers and nursing faculty.
                                     ______

                    Questions Submitted by Senator Herb Kohl
                               generic drugs/fda
        Question. The FDA currently has a backlog of more than 800 generic
    drug applications--an all-time high--and FDA officials expect a record
    number of generic applications this year and an even larger backlog.
    The congressional Budget Office estimates the use of generics provides
    a savings of $8 to $10 billion to consumers every year, and that
    doesn't include the billions of dollars of savings to hospitals,
    Medicaid and Medicare. It is now more important than ever that we speed
    less expensive generic drugs to market.
        Secretary Leavitt, do you support an increase in the FDA budget to
    help reduce the backlog? How much do you believe the FDA needs to
    efficiently reduce the backlog and pass along the savings to Americans
    and the Federal Government?
        Answer. First, let me state that I understand that Congress and the
    public are concerned about the high cost of prescription drug products.
    I believe that generic drugs play a very important role in granting
    access to products that will benefit the health of consumers and the
    government. Prompt approval of generic drug product applications, also
    known as abbreviated new drug applications, or ANDAs, is imperative to
    making generic products available to American consumers at the earliest
    possible date. This has been a high priority for FDA as it has been for
    me during my time here at HHS. I believe that the process improvements
    that FDA is currently implementing along with the investments we
    continue to make in generic drugs offer the best promise for reducing
    ANDA review time.
        FDA has made significant investments to improve the generic drug
    review process with the funds appropriated by Congress. In fiscal year
    2007, FDA plans to spend $64.6 million relating to generic drugs,
    including $29 million in the Office of Generic Drugs, or OGD. This
    level represents an increase of more than 66 percent from the
    comparable fiscal year 2001 amount, which has resulted in a lower
    median review of 2 months.
        FDA has made significant process improvements to increase the
    efficiency of the ANDA review process. In fiscal year 2005, OGD focused
    on streamlining efforts and took steps to decrease the likelihood that
    applications will face multiple review cycles. OGD instituted
    additional enhancements to the review process such as early review of
    the drug master file as innovator patent and exclusivity periods come
    to an end, cluster reviews of multiple applications, and the early
    review of drug dissolution data.
        In fiscal year 2006, FDA is building on these process improvements.
    FDA began a major initiative to implement Question-based Review for
    assessment of chemistry, manufacturing, and controls data in ANDAs.
    This mechanism of assessment is consistent with the International
    Conference on Harmonization Common Technical Document and will enhance
    the quality of evaluation, accelerate the approval of generic drug
    applications, and reduce the need for supplemental applications for
    manufacturing changes.
        FDA's OGD will continue to institute efficiencies in the review
    process to facilitate the review and approval of ANDAs in fiscal year
    2007 and beyond. FDA will also continue to work closely with generic
    manufacturers and the generic drug trade association to educate the
    industry on how to submit applications that can be reviewed more
    efficiently and that take advantage of electronic efficiencies that
    speed application review. FDA will also work with new foreign firms
    entering the generic drug industry. It will take time for these new
    firms to understand the requirements for generic drug product
    applications. However, in the long-term, these efforts will shorten
    overall approval time and increase the number of ANDAs approved during
    the first cycle of review.
        With the process improvements stated above and the investments we
    continue to make in generic drugs, FDA will continue to reduce ANDA
    review time and deliver safe and effective generic drug products to the
    American public.
                        programs serving older americans
        Question. Some of the most painful cuts in this budget are programs
    under the administration on Aging, which takes a $28 million hit in
    programs like Meals on Wheels and Family Caregiver Support Services.
    That means that while Wisconsin's senior population continues to grow--
    from 705,000 senior citizens in 2000 to 730,000 seniors this year and
    1.2 million seniors by 2025--this budget does not account for the
    growth in the need for services.
        In addition, this budget proposes to eliminate Alzheimer
    Demonstration grants. The Wisconsin Alzheimer Association is in its
    first year of a 3-year grant, where they are working with Jefferson
    County to open a dementia care clinic at a hospital in Fort Atkinson.
    It is the first of its kind and the only one in the area. They would
    lose their funding after this year should this budget prevail.
        How do you explain the administration's plan to cut these vital
    programs when our aging population is growing?
        Answer. The fiscal year 2007 President's budget includes the
    elimination of the Alzheimer's Disease Demonstration Grant to States
    Program (ADDGS), Preventive Health Services program, and small cuts to
    other AoA programs including a reduction of $906,000 to Home-Delivered
    Nutrition Services and $1,980,000 to Family Caregiver Support Services.
    These reductions reflect an effort to reduce the deficit while focusing
    on programs that provide needed services most efficiently.
        For 14 years under ADDGS, demonstrations in almost every State have
    highlighted successful, effective approaches for serving people with
    Alzheimer's. Now, it is time to put these models and the lessons that
    have been learned to work by moving them into AoA's core services
    programs--especially the National Family Caregiver Support Program--as
    a number of States have already done.
        Preventive Health Services is a limited, formula-grant funding
    stream intended to foster the provision of health promotion/disease
    prevention services in the context of the core community-based long-
    term care services of the National Aging Services Network. AoA's
    proposal under the Choices for Independence initiative supports the
    same type of evidence-based health promotion and disease prevention.
        The Home-Delivered Nutrition Services and Caregiver Support
    Services programs have demonstrated efficiencies in leveraging Federal
    dollars. In addition, demonstrations such as Choices for Independence
    are aimed at increasing even further the efficiency of these programs.
    While reductions in Nutrition and Caregiver services reflect an effort
    to reduce the deficit, they also reflect an effort to target reductions
    in programs that have the greatest potential to maintain service
    delivery with fewer dollars.
                                  rural health
        Question. Secretary Leavitt, there are a number of programs within
    your Department aimed at bolstering rural health. Wisconsin, one of the
    biggest beneficiaries in the country, received over $600,000 from the
    Rural Hospital Flexibility Grant program last year. This funding is
    used at over 60 rural hospitals that serve anywhere from 10,000 to
    20,000 patients per year. The President's budget proposes to eliminate
    the Rural Hospital Flexibility Grant program, the Rural and Community
    Access to Emergency Devices, and Area Health Education Centers.
        How are rural communities expected to meet their unique health care
    challenges when their resources are being slashed?
        Answer. The Medicare Prescription Drug, Improvement and
    Modernization Act (MMA) will increase Medicare spending in rural
    America by $25 billion over the 10 years following MMA enactment,
    substantially increasing funding for hospitals and other rural health
    providers. This Act serves as a catalyst in rural communities by
    increasing payments to hospitals, health professionals and other
    services. In addition, the budget includes an additional $181 million
    to provide added direct health services to underserved communities
    through 302 new and expanded health center sites--about half of which
    are likely to be in rural areas.
                   medicare drug benefit enrollment deadline
        Question. Less than 2 weeks remain for most Medicare beneficiaries
    to sign up for prescription-drug coverage without penalty. Yet last
    week a Kaiser Family Foundation poll found that only 55 percent of
    seniors realize the deadline is May 15, and only 53 percent know
    enrolling after the deadline will cost 1 percent more per month.
    Earlier this year, the Senate voted to give you authority to extend the
    enrollment deadline, but the House has not yet acted. Do you support
    Congress passing legislation to extend the deadline?
        Answer. We are focused on enrolling people now, while the resources
    are in place to help beneficiaries get the savings and security of
    prescription drug coverage. According to the Office of the Actuary at
    CMS, keeping the current May 15th deadline encourages beneficiaries to
    take action and enroll. The actuaries believe that extending the
    deadline would likely decrease overall enrollment in 2006 as pressure
    on beneficiaries to enroll would be diminished. However, in light of
    the cost effects on our vulnerable populations, we have recently waived
    late-enrollment penalties for beneficiaries approved for low-income
    subsides if they enroll in a drug plan by the end of 2006.
        Proposals to extend the enrollment deadline beyond May 15 include
    no funding for Medicare to maintain the high level of enrollment
    support that is available right now. Beneficiaries should be encouraged
    to take advantage of outreach resources like the 1-800 MEDICARE
    telephone line. There are short waiting times now and individual, one-
    on-one counseling is available to help people select a coverage plan.
        Tens of thousands of beneficiaries are currently enrolling every
    day, and there is still time to enroll in a plan.
                     national institutes of health funding
        Question. The President's American Competitiveness Initiative
    states that sustained scientific advancement is the key to maintaining
    our competitive edge--and I agree with that. The President's fiscal
    year 2007 budget proposal commits $5.9 billion to research and
    education in basic science, that is the physical sciences--and I agree
    with that as well. What I don't understand is why the President would,
    in the same budget proposal, flat fund the National Institutes of
    Health and its research into health sciences and biotechnology. Other
    industrialized countries are making investments to make sure they get a
    piece of the growing biotech and health care sectors of the world
    economy--why aren't we?
        Answer. In fiscal year 2003, President Bush fulfilled his
    commitment to complete the historic doubling of the NIH budget, which
    grew from $13.6 billion in fiscal year 1998 to $27.2 billion in fiscal
    year 2003. During this 5-year period, NIH was able to fund nearly
    11,600 more research grants than it did before the doubling began,
    representing research ideas that are leading to vaccines, cures,
    treatments, and other fundamental scientific breakthroughs helping to
    open up even more new opportunities for improving human health.
        With the fiscal year 2007 budget request of $28.6 billion, the NIH
    budget will have grown by +$8.1 billion, or +40 percent, during this
    administration. While the fiscal year 2007 request for NIH is a
    straight-line from the fiscal year 2006 level, NIH plans to continue to
    make strategic investments in trans-NIH initiatives and priorities
    within its available funds. These include increased support for new
    investigators, new research project grants, and the NIH Roadmap for
    Medical Research, a new initiative on Genes, Health and the
    Environment, and expansion of the Clinical and Translational Science
    Award program launched in fiscal year 2006. The NIH budget also
    includes increased investments in national priorities related to
    developing biodefense countermeasures and pandemic influenza
    diagnostics, vaccines, and therapeutics. These initiatives will
    preserve our investment in biomedical research and support medical
    advancements that will make healthcare more predictive, personalized,
    and preemptive and thus, improve the length and quality of human life.
        NIH welcomes the proposed increase in funding for the physical
    sciences. Biomedical research is becoming increasingly multi-
    disciplinary, requiring both science and mathematics to conduct
    projects in emerging areas of great scientific promise, such as
    bioinformatics, computational biology, nanotechnology, tissue
    engineering, and biomedical diagnostic imaging, to name just a few.

                              SUBCOMMITTEE RECESS

        Senator Specter. Thank you all very much. The subcommittee
    will stand in recess to reconvene at 8:30 a.m., Friday, May 19,
    in room SD-192. At that time we will hear testimony from the
    Hon. Elias A. Zerhouni, M.D., Director, Department of Health
    and Human Services.
        [Whereupon, at 11:30 a.m., Wednesday, May 3, the
    subcommittee was recessed, to reconvene at 8:30 a.m., Friday,
    May 19.]

    DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
                  AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2007

                                  ----------

                              FRIDAY, MAY 19, 2006

                                           U.S. Senate,
               Subcommittee of the Committee on Appropriations,
                                                        Washington, DC.
        The subcommittee met, at 8:31 a.m., in room SD-192, Dirksen
    Senate Office Building, Hon. Arlen Specter (chairman)
    presiding.
        Present: Senators Specter, Shelby, and Harkin.

                    DEPARTMENT OF HEALTH AND HUMAN SERVICES

                         National Institutes of Health

    STATEMENT OF ELIAS A. ZERHOUNI, M.D., DIRECTOR
    ACCOMPANIED BY:
            JOHN E. NIEDERHUBER, M.D., ACTING DIRECTOR, NATIONAL CANCER
                INSTITUTE
            FRANCIS S. COLLINS, M.D., DIRECTOR, NATIONAL HUMAN GENOME
                RESEARCH INSTITUTE
            ANTHONY S. FAUCI, M.D., DIRECTOR, NATIONAL INSTITUTE OF ALLERGY
                AND INFECTIOUS DISEASES
            ELIZABETH G. NABEL, M.D., DIRECTOR, NATIONAL HEART, LUNG, AND
                BLOOD INSTITUTE

                   OPENING STATEMENT OF SENATOR ARLEN SPECTER

        Senator Specter. Good morning, ladies and gentlemen. The
    Appropriations Subcommittee on Labor, Health, Human Services,
    Education, and Related Agencies will proceed with this hearing
    on the National Institutes of Health, and the funding for these
    institutes. We have a rather unusual hearing this morning
    because we have asked representatives of groups advocating
    research on the major illnesses--heart, cancer, Alzheimer's,
    Parkinson's--some 20 in total, to underscore the difficulties
    facing medical research in the United States today.
        As it is well known, this subcommittee, Senator Harkin and
    I, have taken the lead on NIH funding, which has grown from $12
    billion to $29 billion over the past 10 years. Now we have seen
    the increases which we had structured by, candidly, robbing
    Peter to pay Paul. We have a very complex budget on this
    subcommittee which has to fund not only health but education,
    labor, worker safety, Head Start, the bulk of the social
    programs.
        Those programs have been cut in the last 2 fiscal years,
    taking into account actual cuts and inflation, cut by some
    $15.7 billion. The NIH, which I frequently say is the crown
    jewel of the Federal Government, if not the only jewel of the
    Federal Government, has been cut 10.4 percent in the last 2
    years. We find that in fiscal year 2006 there was an actual cut
    of almost $66 million.
        The funding for fiscal year 2007 is level by the
    administration. That means with the inflationary increase there
    is a decrease in the actual dollars which are available. That
    is just unacceptable in a country with an $11 trillion gross
    national product and a Federal budget of $2.8 trillion.
        The advances that have been made by medical science are
    really remarkable, but it takes funding to accomplish that.
    Something personal to me is the lack of adequate funding for
    the National Cancer Institute. In 1970 President Nixon declared
    war on cancer and if that war had been pursued with the same
    intensity as our other wars cancer would have been cured long
    ago.
        My chief of staff, Carey Lackman, a beautiful young woman
    of 48, died of cancer, breast cancer, recently. My son's
    partner's wife, a beautiful young woman, died of breast cancer.
    One of my best friends, Judge Edward Becker, one of the most
    distinguished jurists in America, is suffering great anguish
    and great pain as we speak from prostate cancer. I had a bout
    with Hodgkin's last year myself and if you see me dabbing my
    eyes that is one of the remnants of chemotherapy. Had the Nixon
    war on cancer been pursued, I think I would not have gotten
    Hodgkin's and Carey Lackman would not have died, Paula Klein
    would not have died, Ed Becker would not be in the dire straits
    he is today.
        It is just unconscionable that we are not doing more. That
    is tied to stem cell research. Again, Senator Harkin and I have
    taken the lead there with our legislation which would enable,
    authorize, take the bar away from the Federal Government
    supporting embryonic stem cell research. We had a meeting
    yesterday with Senator Frist, the Majority Leader. I believe we
    are going to have a vote very soon on our issue. It is doubtful
    that we have 67 to override a presidential veto and we are
    talking about organizing a march on The Mall. We would like to
    put 1 million people on The Mall in September, enough people on
    The Mall to be heard in the living quarters of the White House
    just a few blocks away, because the estimate of 110 million
    people being affected directly or indirectly by these ailments
    is enough to produce two-thirds to override a presidential veto
    if in fact the President carries out his statement that he will
    veto the bill.
        Well, we have a very long hearing today. We moved the
    hearing from 9:30 to 9:00 and then we moved it from 9:00 to
    8:30 because Senator Harkin has commitments in Iowa. I am a
    little more flexible. I only have to travel to Pennsylvania.
    But we have a hearing this afternoon in Philadelphia on campus
    safety. It is a very, very busy Congress and I think you have
    seen that from the activities on the confirmation of the
    Supreme Court justices and the immigration bill, the Patriot
    Act, and so many other things we are doing.
        But I do not believe there is any subject as important as
    this one. You keep hearing ``nothing more important.'' Well, we
    may be tied for first place. I do not think that it is true
    that there is no subject more important than this one. I do not
    think there is any subject as important as this one. This is
    number one. Without health there is nothing.
        Senator Harkin.

                        STATEMENT OF SENATOR TOM HARKIN

        Senator Harkin. Mr. Chairman, thank you very much for your
    very eloquent opening statement. I would ask that all my
    statement be made a part of the record. I will just comment on
    it here.
        First, let me thank you, Mr. Chairman, for your courageous
    leadership in this area of always fighting for the funding we
    need for NIH. You led the way on building the funding over
    those years. I was happy to backstop you and support you in
    that. It was a very courageous effort that you led on that.
        I thank you also for your courage in speaking out on the
    budget earlier this year and your continuing to speak out
    against the budget as it affects NIH.
        Let me also thank you for your own personal courage in
    battling Hodgkin's lymphoma last year and the example that you
    set in coming to work every day and holding the hearings in the
    Judiciary Committee and the Supreme Court nominees and taking
    it to the floor even while you were undergoing some pretty
    severe chemotherapy. So it was a great example, I think, of
    personal courage and we thank you for that.
        I would just remind everyone of what Senator Hatfield said.
    When Senator Hatfield left the Senate, he gave his final speech
    on the Senate floor. I will never forget. I was over there to
    listen to it. He said at the time, he said: It is not that the
    Russians are coming. He said: It is the viruses are coming, the
    viruses are coming. How prophetic, how prophetic.
        We did not work hard to double the funding of NIH to then
    have it plateau off for another 20 years. The idea was to get
    it back up where it had been in the 70s, where we had some 40-
    some percent of our peer reviewed grants approved and funded.
    That had fallen down and now I think it is down to about--I do
    not have it in front of me. I think it is down to about 19
    percent right now, the lowest ever, the lowest ever.
        The problem--not only is it a problem this year in terms of
    the budget--yes, it is 19 percent right now. About one out of
    every five is accepted for funding. I think that is having a
    ripple effect on researchers, it is having an effect on young
    people who are thinking about research as a lifetime avocation.
        But the problem is also looking ahead. As bad as this
    year's budget is, next year's could be worse. According to OMB
    projections, the administration will cut NIH by $800 million in
    2008 and make more cuts in 2009 and fiscal year 2010.
        Something has got to be done about this. Again, Senator
    Specter, you have been tremendously courageous in speaking out
    and trying to get a better deal for us on the budget. But we
    need to hear from you at NIH, but we also need to hear from the
    groups that are coming later, to tell the human side and give
    the human face as to what is happening to so many people in our
    society.

                               PREPARED STATEMENT

        I have a friend of mine who at this very moment is in the
    final stages of ALS disease. It is one of the worst things you
    can imagine. Yet we dither around and we cannot get stem cell
    research going in this country?
        Well, again, Mr. Chairman, thank you. It has been an honor
    to work with you.
        [The statement follows:]
                    Prepared Statement of Senator Tom Harkin
        Thank you, Mr. Chairman. You've led the way on NIH funding, and
    it's been a real honor working with you on this issue.
        Good morning, Dr. Zerhouni, and welcome. We're glad to have you
    back with us today.
        We need a strong NIH now more than ever, for so many reasons.
    First, our security as a Nation depends on it. We often think about
    security only in military terms. But in today's world, we need to be
    just as worried about the threats we face from a bioterrorism attack or
    pandemic flu. NIH research is critically important for protecting us in
    both of those areas.
        We also need NIH to help us through our health care crisis.
    Consider just one disease--Alzheimer's. It's been estimated that
    delaying the onset of Alzheimer's by just 5 years could save $50
    billion a year in medical costs. That would go a long way to solving
    our Medicare problems all by itself.
        We need NIH now, because we're on the cusp of so many exciting
    breakthroughs. Researchers are learning how to match drugs to
    individual patients, based on their genetic code. They're learning more
    about stem cell research. They're making discoveries about the
    interplay between our genes and the environment.
        What a shame, then, to get a budget like the one the President has
    sent us.
        His budget would level-fund NIH, one year after the first cut to
    this agency since 1970. Eighteen of the 19 institutes would get less
    funding than they did last year. The number of research project grants
    would drop by about 640. And the success rate for grant applications
    would remain at a record low of just 19 percent.
        We're at a point now where only 1 out of every 5 grant applications
    is accepted for funding. I'm sure there are a lot of young researchers
    out there who are wondering, ``Why bother applying to NIH? Why bother
    going into research at all?''
        Senator Specter and I didn't work so hard to double NIH funding
    just so we could watch the President cut it to the bone from then on
    out. But that seems to be the President's plan. As bad as this year's
    budget is, next year's will probably be even worse. According to OMB
    projections, the Administration will cut NIH by $800 million in fiscal
    year 2008, and make more cuts in fiscal year 2009 and fiscal year 2010.
        We're going to hear firsthand what the President's budget will mean
    for many diseases from our second group of speakers. I want to thank
    the representatives of the 20 advocacy groups that are with us today
    for taking the time to be here.
        Mr. Chairman, I look forward to the testimony.

        Senator Specter. Thank you very much, Senator Harkin. Thank
    you for your leadership on these issues and the partnership
    which I think has been very productive for our country.
        Senator Shelby.

                     STATEMENT OF SENATOR RICHARD C. SHELBY

        Senator Shelby. Thank you, Mr. Chairman. Mr. Chairman, I
    ask that my written statement be made part of the record and I
    will be brief.
        This is a very important hearing and I am here this morning
    to help you. I think the President, George W. Bush, is going to
    have to speak out on this issue, that is properly funding NIH
    medical research. We are falling behind and we cannot, because
    we have led the world. We continue to lead the world, although
    we are struggling as far as finances are concerned.
        Mr. Chairman, you and Senator Harkin, who are the leaders
    of this committee, I can tell you I am going to do everything I
    can. We are challenged in the research everywhere in
    biomedical, but in autoimmune areas there is a lot of hope
    there. I am particularly interested in the lupus area. We are
    challenged there. I am going to do everything I can as a member
    of the Appropriations Committee to help fund, properly fund,
    medical research through NIH. You have made a difference and
    you will make a tremendous difference in the future.

                               PREPARED STATEMENT

        But, as Senators Specter and Harkin both know, it is not
    going to be easy, but we cannot go backward. We cannot cede
    this to anybody else in the world. We are the leaders. We have
    got to stay there.
        Thank you, Mr. Chairman.
        [The statement follows:]
                Prepared Statement of Senator Richard C. Shelby
        Mr. Chairman, thank you for holding this important hearing today. I
    want to thank all of you for taking the time to be here today. It is
    vitally important for me to hear directly from you on what your
    agency's needs are, and the challenges you might face in the coming
    months. We as a Nation are facing a integral moment in funding critical
    research. Finding viable treatments and possible cures for many of our
    common afflictions is our most important goal, but I think early
    detection of disease is fundamentally important to containing costs in
    the long-term.
        As we begin to move forward in the appropriations process it is of
    the utmost importance that we ensure adequate funding for these
    indispensable research institutions. Millions of Americans rely on the
    life saving work they perform and it is imperative that we as
    appropriators fully support them.
        Federal funding for medical research is critical and while we have
    worked diligently to increase funding, more is left to do.
        I am hopeful that this hearing today will provide a forum to
    discuss the issues that must be addressed by researchers.
        Thank you for your time and I look forward to your testimony.

        Senator Specter. Thank you very much, Senator Shelby.
        We now welcome Dr. Elias Zerhouni, the Director of the
    National Institutes of Health. He had an illustrious career
    before coming to be the 15 Director of NIH. He had been
    executive vice dean at Johns Hopkins University School of
    Medicine, chair of the Department of Radiology and Radiological
    Science. He received his medical degree from the University of
    Algiers School of Medicine and completed his residency in
    diagnostic radiology at Johns Hopkins.
        Thank you for your leadership in this very vital area, Dr.
    Zerhouni, and we look forward to your testimony.

                   SUMMARY STATEMENT OF DR. ELIAS A. ZERHOUNI

        Dr. Zerhouni. Thank you, Mr. Chairman. Thank you, Senator
    Harkin, Senator Shelby. I submitted a written testimony. What I
    would like to do really is just summarize the salient points of
    the testimony, to allow as much time as possible for questions.
        Senator Specter. Thank you, Dr. Zerhouni.
        Dr. Zerhouni. What I would like to do is really direct your
    attention to the screens.

                      RETURN ON INVESTMENT ON NIH FUNDING

        What I would like to address are the fundamental questions
    that I think all of us would like to have an answer to, to be
    able to set policy for the future. First and foremost, what is
    the return on the American people's investment at the National
    Institutes of Health? Second, what has this NIH budget doubling
    delivered for the American people? Third, what is our future
    strategy? Where is NIH heading? When you talk about medical
    research it is important to understand that it is not a 100-
    meter dash, it is a marathon, and we have to sustain the effort
    over time.
        First, let me just remind everyone that biomedical research
    has delivered enormous returns to the American people. I am
    just going to give two examples here. Many more are in the
    testimony. In coronary heart disease, if you look at the
    progress over the past 30 years, there has been a 63 percent
    decrease in mortality. Over a million early deaths are averted
    every year because of the research of the past 30 years.
    Economists tell us that this is worth $2.6 trillion in economic
    return because a cohort of individuals who would have died in
    their 50s now do not and then can produce economic return. We
    have enormously exciting, effective strategies for not only
    curing, but preventing and ultimately eliminating coronary
    heart disease.
        Now, you may ask yourself, what was the investment that the
    American people, that each one of us made to achieve that?
    Well, over the past 30 years each one of us has spent about
    $3.70 per year for medical research related to coronary heart
    disease. If you look at the total cumulative total over 30
    years for heart research, it is $110 per person. I submit to
    you that medical research has delivered, for an investment that
    I think is extremely effective in its return.
        Cancer is another example. If you look at cancer--and you
    mentioned the war on cancer, Senator--for the first time in
    recorded history, this year we have a lower number of deaths
    from cancer in the United States, despite an increasing
    population and an increasing average age of the population. We
    have 10 million survivors. This is due to the advent of early
    screening, early detection, new therapies.
        What has this cost us? $8.60 per person per year over the
    past 30 years. The total investment for each one of us is $260
    over 30 years. I do not think there is an investment that I can
    describe that any agency can be as proud of as the National
    Institutes of Health is of its effectiveness. We have delivered
    not only better cures, but also a healthier life for Americans,
    who live now longer and healthier lives, with a disability rate
    that has dropped by 30 percent over the past 22 years because
    of improvements in bone health, in heart health, and many other
    advances.
        Since 1982 the disability rates have dropped by 30 percent
    and in the past 30 years American life expectancy has increased
    by over 6 years, from a total investment cumulative over 30
    years, of about $1,300 per American.
        This is not just what we have done in the past. We continue
    to deliver. If you look at just the advances of the past year--
    I am just going to take a few examples. If you look at the
    impact of the human genome and genomics, we identified over 20
    genes just in the past 12 months that relate to prostate cancer
    and the causes of prostate cancer, in mental health about
    obsessive compulsive disorder, and one of the most exciting
    ones is in vision disease, where we have found genes that may
    explain over 70 percent of cases of what we call age-related
    macular degeneration, the fastest rising cause of blindness in
    American seniors.
        Vaccines: We have the first global candidate vaccine on
    HIV/AIDS, that Dr. Fauci and his team developed. Yesterday the
    FDA approved the first preemptive cancer vaccine against
    cervical cancer. We have expanded the Avian Flu trials. We have
    one vaccine in trial and a second one in development. This
    would not have been possible without the support of Congress
    and your support here on this committee.
        But we realize that biomedical research must continue to
    deliver and we have a challenge in front of us. We all know
    that the rising cost of health care and the burden of disease
    is going to be a challenge for all of us. We see the curve. We
    see that it is not sustainable. Society spends about $7,100 per
    American per year on health care costs. The total NIH spending,
    $95 per American per year, has to do something, must do
    something, to change that picture.
        This is the vision of NIH. Our vision, all of us as
    scientists at NIH, is to use our investment and deliver a
    complete transformation of medicine, because if we keep
    practicing medicine the way we know it today, 25 years from now
    it just will not be sustainable. So discoveries and new ways of
    not only curing disease, but preventing disease, preempting
    disease altogether, is the key.
        We will do this through what we call the four P's of
    medicine. It will be more predictive because of our
    understanding of molecular events. It will be more personalized
    because we know that every one of us reacts differently to
    different diseases. It will have to be increasingly preemptive
    because this is where it is the least costly. But we cannot do
    this without the participation of everyone, and this is why we
    say the fourth P is, in the context of chronic diseases like
    diabetes or obesity, it will require us to include the patients
    as partners in this new medicine.

                              PREPARED STATEMENTS

        So my message is very simple. We have delivered, we
    continue to deliver, and we will deliver, and the return on
    investment is in my view one of the most remarkable returns
    that anyone can describe, and we will continue to do so. I am
    happy to take any questions.
        [The statements follow:]
                  Prepared Statement of Dr. Elias A. Zerhouni
        Mr. Chairman and distinguished members of the subcommittee, it is
    an honor and a privilege to appear before you today to present the
    National Institutes of Health (NIH) budget request for fiscal year 2007
    and discuss the priorities of NIH for this year and beyond.
                                 budget request
        The request for NIH is $28.4 billion in fiscal year 2007, the same
    as the fiscal year 2006 level for the Agency. The budget request will
    support the research programs managed by NIH's Institutes and Centers.
    At this budget level, NIH will increase the biodefense research program
    by $110 million for Advanced Development. Support for the Pandemic
    Influenza Preparedness Plan will increase by $17 million. We have also
    chosen to carefully invest in several trans-NIH strategic initiatives.
    The NIH Roadmap, an incubator for new ideas and initiatives that will
    accelerate the pace of discovery, increases by $113 million. We
    allocated $40 million to the Institutes and Centers to launch the
    Genes, Environment and Health Initiative to accelerate discovery of the
    major genetic and environmental factors for diseases that have a
    substantial public health impact. We have also directed $15 million to
    the new ``Pathway to Independence'' program to increase our support of
    new investigators.
        I will focus my testimony on the return of the investment in NIH
    for the American people. In particular, I will discuss how discoveries
    fueled by this investment are transforming the practice of medicine. We
    can now clearly envision an era when the treatment paradigm of medicine
    will increasingly become more predictive, personalized and preemptive.
    We will strike disease before it strikes us with the hope of greatly
    reducing overall costs to society. We expect to move away from the
    costly and predominantly curative model of today, which requires us to
    wait for the disease to occur before intervening. I will share with you
    the strategic vision of NIH and discuss the many management innovations
    we have implemented to ensure optimal stewardship of taxpayers'
    resources.
           selected accomplishments of nih and their impact on health
        The achievements of NIH and our private sector partners in medical
    research are difficult to overstate. According to the latest report on
    the Nation's health from the Centers for Disease Control and Prevention
    (CDC), life expectancy continues to rise, now at an unprecedented 78
    years for the total U.S. population. Since 1950, the age-adjusted death
    rate for the total population declined by a remarkable 43 percent. Life
    expectancy has increased by one year in every five for the past 30
    years. Americans are not only living longer, they are healthier. For
    instance, the disability rate of American seniors dropped by almost 30
    percent in the past 20 years, owing to a range of scientific advances.
        The following are samples of the many advances driven by the
    investment in NIH.
                 advances in cardiovascular disease and stroke
        Thirty years ago, it was common for a man or woman to suddenly die
    of a heart attack or stroke between the ages of 50 and 60. Had this
    trend continued unabated, today more than 1.6 million lives would have
    been lost per year. Fortunately, today the toll is much less. The death
    rates from cardiovascular disease have declined by 63 percent and by 70
    percent for stroke. Were it not for the ground-breaking research on the
    causes and treatment of heart disease, supported in large part by NIH,
    including recent developments such as drug coated stents, safe levels
    of blood pressure and cholesterol lowering therapies, heart attacks
    would still account for 1.2 to 1.3 million deaths per year instead of
    the actual 515,000 deaths experienced today. The estimated total
    cumulative investment in cardiovascular research at the NIH per
    American over the past 30 years, including the doubling period, is
    about $110, or about $4 for each American per year over the entire
    period.
                               advances in cancer
        The mortality rates of cancer, the second leading cause of death in
    the United States, have been falling for several years, and this year,
    for the first time in history, the absolute number of cancer deaths in
    the United States has decreased. More effective therapies have led to
    improved outcomes for more than 10 million American cancer survivors.
    With the increase in budgets between 1999 and 2003, the National Cancer
    Institute has stimulated a paradigm shift in cancer therapy. We are
    seeing the emergence of targeted therapies, with the unprecedented
    ability to use specific molecular targeting to treat tumors with novel
    agents. We can also detect and treat cancer at earlier stages. The
    National Cancer Institute's (NCI) Early Detection Research Network
    (EDRN), launched in 1999, has identified a number of biomarkers that
    allow for the earlier detection of breast, prostate, colon, lung and
    other cancers. This year, NCI, in collaboration with the Human Genome
    Research Institute, has launched a cancer genome pilot project to help
    further our understanding of the basic biology of cancer and identify
    additional treatment targets. The estimated total cumulative investment
    at the NCI per American over the past 30 years, including the doubling
    period, is about $258, or about $9 per American per year over the
    entire period.
                              advances in hiv/aids
        Without the development and testing of antiretroviral drugs, there
    would be no hope for patients with HIV/AIDS. The development of Highly
    Active Antiretroviral Therapies primarily resulted from the work of a
    large cadre of NIH-supported scientists and their counterparts in the
    pharmaceutical industry. Their discoveries about the cellular
    mechanisms of the disease have transformed AIDS into a manageable
    disease, preventing hundreds of thousands of hospitalizations and early
    deaths. To date, 21 antiretroviral drugs and 4 combination formulations
    have been approved by the FDA. Many more less toxic AIDS drugs are
    currently in development. Today, fewer than 50 HIV-infected babies are
    born each year in the United States, sparing 16,000 to 20,000 children
    from AIDS through the use of antiretroviral drugs to prevent mother-to-
    child transmission. Mother-to-child transmission rates in developing
    countries have declined by 40 percent with the use of drug therapy.
    With the introduction of these new drugs, economists estimate the
    aggregate potential value of improved survival has been nearly $400
    billion for those infected through 2000. They estimate the aggregate
    potential value for all past and future cohorts of individuals infected
    with HIV is almost $1.4 trillion.
        With the additional resources provided during the doubling of the
    NIH budget, we launched the Vaccine Production Program (VPP) Laboratory
    to efficiently translate candidate research vaccines, including HIV
    vaccines, into useable products. Since its inception in 2001, this
    program has overseen the manufacture of over 29 bulk pharmaceutical
    compounds formulated into 14 different vaccine products for HIV, as
    well as West Nile, SARS and Ebola Virus, and expanded our network of
    clinical trial sites across the globe. This program is enabling NIH to
    serve the needs of the American people in an age of global risks of
    infectious diseases.
               advances against the threat of pandemic influenza
        Thanks to fundamental advances in viral genomics and genetic
    engineering, NIH has been able to help in the development of
    countermeasures against both seasonal and pandemic influenza viruses.
    We now have a vaccine against the H5N1 virus and will develop a second
    one in conjunction with CDC. Without such a vaccine, and others under
    development and testing, we would be completely defenseless against the
    potential pandemic that threatens the entire world. We are investing in
    research and development to hasten the production process by converting
    from egg-based to cell culture-based vaccines. We are developing novel
    vaccine approaches using a variety of molecular biological techniques,
    and we launched discovery efforts for new anti-viral compounds against
    pandemic flu. We initiated a project to identify the genomes of
    thousands of human and avian influenza viruses, and, to date, 831
    influenza genome sequences from human isolates have been deposited in
    NIH's GenBank, allowing researchers across the world to better
    understand influenza viruses and develop countermeasures.
                       development of biodefense research
        Since 2001, NIH has directed more than $10 billion toward
    protecting the American public from bioterrorism. The 2001 intentional
    release of anthrax underscored the reality of a bioterrorism threat
    posed by other Category A agents such as smallpox, plague, tularemia,
    hemorrhagic fevers, and botulinum toxin. NIH responded swiftly.
    Promising vaccine candidates for Ebola and smallpox are currently in
    clinical trials. Identification of the three-dimensional structure of
    the anthrax toxin complex is fueling the search for compounds that
    block the toxin's effects, and the discovery of the key mechanism of
    Ebola virus cell entry prompted experiments demonstrating that Ebola
    infection could be blocked in laboratory tests. We continue to build a
    national biodefense research infrastructure that will position the
    Nation to respond even more quickly and precisely to bioterrorism.
                   advances in diabetes and related illnesses
        Nearly 21 million Americans have diabetes, a disease that can cause
    damage to multiple organs and lead to death. Without NIH research, the
    improvements of the past two decades in the therapies for diabetes
    would not have occurred. Through large prospective trials, made
    possible by the doubling of our budget, we have assessed the relative
    value of drug based approaches versus weight loss and physical
    activity, and showed it is possible to reduce the risk of type 2
    diabetes by 58 percent with lifestyle modifications alone.
        Diabetes can also result in vision loss. Four million American
    adults suffer from diabetic retinopathy, the outcome of damage to the
    tiny blood vessels in the light-sensitive retina lining the inside of
    the eye. Nearly a million have the advanced vision-threatening stage of
    the disease. The National Eye Institute completed a series of landmark
    clinical trials to develop novel treatments for diabetic retinopathy.
    Without these new treatments, 450,000 patients who have advanced
    disease today would otherwise likely be blind in 5 years. As a
    consequence, of those currently at risk, only 27,000 would progress to
    legal blindness, and only 9,000 would become blind today. In addition
    to reduced suffering and disability, the economic savings from these
    treatments will reach as much as $1.6 billion per year.
        As another example of payoff from recent NIH research, end-stage
    renal disease (ESRD)--kidney failure requiring dialysis or
    transplantation, a complication of diabetes and high blood pressure--
    results in direct federal expenditures of approximately $20 billion per
    year. Through the 1980s and 1990s, the incidence of ESRD nearly doubled
    each decade, but in the last five years overall rates have stabilized--
    and even declined in certain population groups. This improvement has
    been driven by monitoring for proteins in urine to prevent kidney
    disease or detect it in its early stages. Compared with earlier
    projections, the savings in federal health care expenditures are
    approximately $1 billion dollars per year.
        Without the investment in medical research, people with diabetes
    would be living shorter, less productive, and less hopeful lives.
                     advances in image-guided microsurgery
        Increases in the NIH budget allowed new investments in the use of
    imaging technologies like CAT scanning, MRI or ultrasonography for the
    development of new microsurgical techniques. These minimally invasive
    therapies are changing the fate of many patients, including patients
    with Parkinson's disease, through deep brain stimulation. These new
    techniques are also promising to revolutionize the treatment of
    epilepsy, a disease that affects over 2.7 million Americans. As we move
    forward with such research, we expect that surgery will become less
    invasive, more precise and less dangerous, with far less operative
    complications.
          advances in health information for scientists and the public
        The National Library of Medicine of the NIH provides the American
    public with high quality, reliable information. The NIH web sites
    (www.nih.gov) are now recognized by independent organizations as the
    most successful health related web sites, with over 2 million queries
    per day. Millions of patients and their families regularly consult NIH
    web sites for up to date information in English and Spanish, a
    capability made entirely possible by the doubling of the NIH budget.
    The web-based ClinicalTrials.gov represents a landmark effort to
    provide information to patients and physicians across the country on
    NIH-funded clinical trials.
        NIH also leads the research field in developing information
    technology for biomedical research. No biomedical scientist develops a
    project without first consulting the suite of powerful informational
    research tools available through the NIH National Library of Medicine's
    PubMed, a growing digital archive of peer-reviewed research articles
    and scientific databases.
                               new research tools
        NIH researchers have pioneered powerful new research tools and
    methods such as high throughput DNA sequencing, protein identification
    with mass spectrometry, gene expression arrays, the determination of
    thousands of new protein structures, and imaging technologies which
    were simply unavailable before the doubling of the NIH budget. A great
    illustration of the impact of these advances has been the
    identification of the cause of the SARS virus in less than a month and
    the current tracking of pandemic flu viruses. These tools have greatly
    accelerated the research process itself, spurred progress and spawned
    new discoveries in all areas of biomedical research. Perhaps nowhere
    else have these technological advances in imaging and genotyping
    elicited more excitement than in the field of mental and behavioral
    health, elucidating genes linked to schizophrenia, depression, bipolar
    disorder and anxiety. These discoveries are allowing for the first time
    direct visualization of brain structure and function to study the brain
    circuitry involved in thinking and a range of behaviors.
                  new diagnostic and therapeutic technologies
        Some of NIH's successes can be measured in new medical
    technologies. Advances in research are driving an increase in the
    number of technologies being licensed to companies for
    commercialization. In fiscal year 2004, there were thousands of active
    licenses between federally funded research institutions and companies
    worldwide. Out of these technologies, several thousand companies are
    making many new products that have an immeasurable impact on public
    health. Today, from NIH funded research, more than 300 new drug
    products and vaccines targeting more than 200 diseases--including
    various cancers, Alzheimer's disease, heart disease, diabetes, multiple
    sclerosis, AIDS and arthritis--are in clinical trials. These outcomes
    are accomplished through the on-going network of successful
    collaborations with our colleagues in private industry.
                         changing landscape of disease
        Disease and injury are constant threats to humankind and are never
    static. New diseases can emerge at any time, such as HIV/AIDS, SARS,
    Pandemic Flu, obesity or many other conditions. Bioterrorism did not
    figure significantly in the NIH agenda in 2001, but is now a top
    priority of the agency. Twenty years ago the impact of Alzheimer's
    disease was not fully appreciated, nor were its causes known.
        As the result of our success in preventing and treating acute and
    short term conditions such as heart attacks, stroke, cancer and many
    infectious diseases, we are living longer. Our increasingly older
    population faces the new challenge of multiple chronic conditions which
    now consume about 75 percent of healthcare expenditures. This shifting
    burden of health care from acute to chronic diseases is perhaps the
    greatest challenge we face.
        Health care costs in the United States have risen to more than $2
    trillion. The amount spent on health care per person has doubled, from
    $3,461 in 1993 to $7,110 today. The causes of health care inflation are
    varied and complex, requiring different, nation-wide solutions.
        We are in a race against the overwhelming human and economic
    consequences of disease. We can win this race, but only if we use
    research discoveries to transform medicine as we know it. Thanks to
    recent research advances, we can foresee a future of more effective
    medical treatment that might be less expensive than current practices.
           strategic vision for nih: from curative to preemptive care
        We are in an era of great scientific opportunity. Advances in our
    understanding of basic human biology allowed NIH to sequence the human
    genome by 2003, two years ahead of schedule, and to complete the
    Haplotype Map, showing the variation between individual humans, in
    October 2005, also ahead of plans. One of the greatest scientific
    achievements in history, the genome blueprint, along with work in
    systems biology and proteomics, are driving a revolutionary period in
    the life sciences. We are on the brink of transforming medical
    treatment in the 21st Century. Our hope is to usher in an era where
    medicine will be predictive, personalized and preemptive.
        Toward this goal, NIH is strategically investing in research to
    further our understanding of the fundamental causes of diseases at
    their earliest molecular stages so that we can reliably predict how and
    when a disease will develop and in whom. Because we now know that
    individuals respond differently to environmental changes according to
    their genetic endowment and their own behavioral responses, we can
    envision the ability to precisely target treatment on a personalized
    basis. Ultimately, this individualized approach, completely different
    than how we treat patients today, will allow us to preempt disease
    before it occurs.
        Consider, for instance, how better predictive and personalized
    treatments could improve the safety and effectiveness of drugs. As we
    know, drugs do not fall into the ``one size fits all'' category. The
    same drug can help one patient and harm another. Recent research shows
    that we will be increasingly able to know which patients will benefit
    from treatment and which patients might be harmed. This field of study
    is known as pharmacogenetics. Using the latest genomic data, enabled by
    the doubling of the NIH budget, the NIH established a Pharmacogenetic
    Research Network which is studying the interactions of drugs and
    molecules as well as the biological processes that eliminate compounds
    from the body. In the first five years of this program, the researchers
    in this network made numerous discoveries.
        For example, they learned that 10 percent of the North American
    population exhibits a genetic variation that puts them at high risk for
    life-threatening reactions to irinotecan, a cancer drug. We now know
    that patients with this variation should be given lower than prescribed
    doses of this successful drug, thus potentially saving their lives.
        NIH researchers also discovered variations in a gene involved in
    the body's response to more than half of all medications. Understanding
    these differences could explain critical individual as well as racial
    and ethnic differences in drug responses. Other genetic variations
    discovered by the NIH network will have an impact on asthma treatment,
    the risk of sudden death from irregular heartbeats and the proper use
    of blood thinning medications to avoid deadly bleeding complications.
        In another example of emerging personalized medicine, cancer
    researchers have developed a test that helps determine the risk of
    recurrence for women who were treated for early stage, estrogen-
    dependent breast cancer. This information can help a woman and her
    doctor decide whether she should receive chemotherapy in addition to
    standard hormonal therapy. This test has the potential to change
    medical practice by sparing tens of thousands of women each year the
    unnecessary and harmful side effects associated with chemotherapy at
    large potential cost savings.
                       rapid advances in the genomic era
        Because of a hundred fold reduction in the cost of genomic
    technology, we can now study, at affordable costs, the differences
    between patients who have a disease and their normal counterparts.
    Recently, this revolutionary approach led to the discovery of two
    previously unsuspected factors that can identify who is at risk and how
    to protect patients from age-related macular degeneration, an
    increasing cause of blindness in our aging population, with over 7
    million Americans at risk. Last month, a key transcription factor that
    may be responsible for a large percentage of cases of diabetes was
    discovered.
        These breakthroughs form the basis of our budget request for the
    Genes and Environment Initiative, supported by Secretary of Health and
    Human Services Michael Leavitt, because it will give us the
    unprecedented ability to discover, over the next three years, the
    potential causes of the 10 most common diseases afflicting the U.S.
    population. With this funding, if approved, we will also launch a
    technology development effort for enabling scientists to measure many
    types of environmental exposures at the individual level. Taken
    together, these efforts will lead to better understanding of the
    environmental and genetic factors in the development of many diseases.
        Imagine a world where we will be able to tell each patient whether
    they need to take action to preempt altogether the development of
    costly and painful diseases. Imagine telling them that they do not need
    to take expensive medications for life because they are not at risk of
    disease. A more predictive, personalized and preemptive form of
    medicine is no longer just a dream, but a vision to strive for as
    rapidly as we can.
                             management innovations
        NIH has an enormous and growing scope of mission. We conduct or
    support research on over 6,600 diseases and conditions, from the most
    common to the rarest. In 2005, more than 43,000 research grant
    applications went through our rigorous two-tiered review process, with
    about 22 percent of applications ultimately receiving funding.
        More than 80 percent of the NIH budget supports extramural research
    at 3,100 institutions around the world, employing about 200,000
    scientists and other research personnel. Another 10 percent of the
    budget goes into the NIH intramural program, consisting of
    approximately 6,000 scientists, where work is focused on public health
    priorities and cutting edge research. The hub of the intramural
    program, the NIH Clinical Center on the Bethesda campus, is the world's
    largest dedicated clinical research complex.
        NIH is spending $95 per American this year on medical research, and
    we need to make every dollar count. With the growth and increasing
    complexity of the agency, NIH has aggressively moved to transform its
    management strategies and decision-making processes. To streamline,
    harmonize and better coordinate decisions that affect the entire
    agency, in 2003, I established the NIH Steering Committee, composed of
    nine Institute Directors who serve on a rotating basis. Six working
    groups support the Steering Committee. This new governance structure
    has enabled greater coordination and harmonization between the 27
    Institutes and Centers at NIH.
        NIH has addressed the need for more robust means to oversee the
    vast NIH research portfolio, and plan and launch trans-NIH initiatives.
    While the NIH successfully developed important trans-NIH initiatives
    such as the Roadmap for Medical Research, the Strategic Plan for
    Obesity Research, and the Neuroscience Blueprint, the agency is now
    implementing even more rigorous and transparent processes and
    developing cutting-edge tools to analyze, assess and manage the array
    of research it supports. This will provide better information to
    support planning and priority-setting in areas of shared Institute and
    Center interests. To reinforce these accomplishments, NIH is
    establishing a new office within the Office of the Director--the Office
    of Portfolio Analysis and Strategic Initiatives (OPASI).
        Review of our programs by the Office of Management and Budget under
    the congressionally mandated Government Performance and Results Act
    (GPRA) provides evidence that our programs are effective. We have been
    rated in the top 15 percent of federal organizations.
        NIH's effective performance is reflected in recent scores as
    measured by the OMB Program Assessment Rating Tool (PART). In the
    fiscal year 2007 PART, the Buildings and Facilities Program and the
    Intramural Research Program both received the highest possible rating
    of effective, with scores of 96 percent and 90 percent, respectively.
    On the fiscal year 2006 PART, the NIH Extramural Research Program
    achieved a similarly high 89 percent. These high scores demonstrate
    exemplary management and substantial progress toward meeting NIH
    performance measures. To date, approximately 90 percent of NIH's budget
    has been PARTed and rated effective.
             translating discoveries into better medical treatment
        Rapidly translating our discoveries from the bench to the bedside
    is a top priority of the NIH. The opportunities have never been greater
    to use modern research methodologies such as genomics, proteomics,
    metabolomics, high sensitivity biochemical methods and other novel
    strategies to bring new insights to the study of human populations and
    more rapidly achieve the goal of making medicine predictive,
    personalized and preemptive.
        To accelerate progress, NIH recently introduced the institutional
    Clinical and Translational Science Award (CTSA). The CTSA program will
    stimulate institutions across the country in transforming Clinical and
    Translational Science in the U.S.A. to (1) captivate, advance, and
    nurture a cadre of well-trained multi- and inter-disciplinary
    investigators and research teams; (2) create an incubator for
    innovative research tools and information technologies; (3) synergize
    multi- and inter-disciplinary clinical and translational research; and
    (4) accelerate the application of new knowledge and techniques to
    clinical practice at the front lines of patient care.
                    training a new generation of scientists
        New visions require new talent. In times of constrained budgets the
    most important action NIH needs to take is to preserve the ability of
    young scientists with fresh ideas to enter the competitive world of NIH
    funding. To that effect, NIH has launched the new ``Pathway to
    Independence'' program which will support, for each of the next five
    years, 150 to 200 recently trained scientists conducting independent,
    innovative research.
                                   in summary
        Our Nation's investment in biomedical research has dramatically
    improved health outcomes. The return on the investment of the American
    people at NIH is nothing short of spectacular. Thanks to the support of
    Congress, we are able, through our science, to respond in record time
    to emerging threats such as SARS, Pandemic Flu and biodefense needs. We
    have learned how to decrease the incidence of many diseases and other
    disabilities for old and young Americans. The estimated total
    cumulative investment at the NIH per American over the past 30 years
    including the doubling period is about $1,334 or about $44 per American
    per year over the entire period. In return, Americans have gained over
    six years of life expectancy and are aging healthier than ever before.
        The President and Congress have wisely invested in biomedical
    research. We are acutely aware that NIH research is often the only hope
    for millions of people afflicted by disease. In the battle for health,
    NIH also believes that it needs to accelerate the pace of progress, as
    it is only through a fundamental transformation of medicine that
    solutions to the rising burden of healthcare will be found.
        I will be happy to answer any questions you may have.

                 Prepared Statement of Dr. John E. Niederhuber
        Mr. Chairman and Members of the Committee: I am please to present
    the fiscal year 2007 President's budget request for the National Cancer
    Institute (NCI). The fiscal year fiscal year 2007 budget includes
    $4,753,609,000, a decrease of $39,747,000 below the fiscal year 2006
    enacted level of $4,793,356,000 comparable for transfers proposed in
    the President's request.
                           our goal remains the same
        Four years ago, we put the NCI on a trajectory towards the
    Challenge Goal of eliminating suffering and death due to cancer as
    early as the year 2015. Since that time, we have vigorously and
    aggressively managed NCI's portfolio of investments in cancer research
    across that entire continuum of the process of cancer, whether we've
    been focusing on understanding genetic mutations that were responsible
    for susceptibility to cancer or focusing on issues that have to do with
    survivorship and living with, rather than dying from, cancer.
        NCI has been a major leader in the molecular metamorphosis of
    biomedical medicine that has benefited all fields of medical research.
    Without the Nation's support of NCI's pioneering role in funding
    research--including basic science, clinical trials, and translational
    investigations--into the molecular and genetic processes that underlie
    all disease and the training of new cancer researchers, it is unlikely
    that the advances we are seeing today in many health areas--from AIDS
    to macular degeneration--would have occurred at the pace they have.
    These leadership efforts must be sustained going forward.
        The Nation's past commitment to cancer research has proven its
    worth: mortality rates have declined for all cancers combined while
    incidence rates have stabilized or increased slightly, detection and
    treatments have improved, new therapeutic options offer startling
    promise. Today there are nearly 10 million cancer survivors in the
    United States compared to approximately 3 million cancer survivors in
    1971 when the National Cancer Act was established. Also, in 1971 fewer
    than half of those found to have cancer lived 5 years beyond their
    diagnosis; today the 5 year survival rate is 64 percent for adults and
    79 percent for children aged 14 or younger. The latter figure is truly
    remarkable given how few children survived even a couple of years after
    being diagnosed in the early 1970s. NCI's continued commitment is
    manifested today in far-reaching programs that have advanced our basic
    understanding of the genetic changes responsible for this dreaded
    disease. The Nation's investment and the actions of Congress are
    directly responsible for the development of a nation-wide network of 61
    NCI-designated cancer centers and a highly successful Community
    Clinical Oncology Program (CCOP), founded in 1983. Through the network
    of 64 CCOP grantees, community investigators participate actively in
    NCI-sponsored cancer prevention, control, and treatment clinical
    trials. These programs place cutting-edge research directly in
    communities and put access to cancer clinical trials into the hands of
    local physicians. Because of their participation in NCI trials,
    community clinicians more readily adopt new regimens, ensuring that
    these advances are rapidly made part of the standard of care.
        Recently, NCI's leadership team has initiated a series of site
    visits to innovative community-based cancer centers as potential models
    for a new NCI initiative, the Community Cancer Centers Program (CCCP).
    The CCCP would help foster replication of successful community models
    across the country, set the standards for multi-specialty state-of-the-
    art care, provide access to early phase clinical trials, and ultimately
    improve cancer care and outcomes. This program is especially designed
    to bring academic standards of care and clinical trials directly to the
    segments of our population who either through age or resources cannot
    leave their community.
                            a record of real success
        The past year in cancer research shows a record of substantial and
    heartening achievement. We are expanding our foundation of knowledge
    and the technical tools with which rapid advances can be made in
    understanding the mechanisms of cancer. We are exponentially increasing
    the opportunities to manage this lethal disease. Building on NCI-funded
    research, large-scale clinical trials in 2005 yielded results that will
    have profound effects in preventing and treating many cancers.
        For example, three different clinical trials showed that adding
    trastuzumab (Herceptin) to standard adjuvant chemotherapy
    significantly reduced the risk of recurrence in women with the early-
    stage breast cancer, HER-2/neu positive, which has an over expression
    of protein in the gene. Approximately 50,000 women in the United States
    are diagnosed with HER-2/neu positive breast cancer each year,
    representing about 20 percent of invasive breast cancers.
        Equally stunning results were seen in the trial of a vaccine that
    protects against two strains of human papillomavirus (HPV) that cause
    over 70 percent of cervical cancers, a disease that kills more than
    200,000 women each year, including many in developing countries. Study
    results concluded that women who received the vaccine during a 2-year
    study were protected against precancerous lesions caused by HPV. NCI
    made the initial discoveries linking HPV to cervical cancer, which led
    to creation and testing of HPV vaccines that are based on technology
    also developed at the Institute. It is an outstanding exemplar in this
    era of molecular medicine of how NCI's knowledge about the etiology of
    the disease enabled creation of a vaccine against a specific cancer.
        In January, an NCI-sponsored trial reported that women who received
    chemotherapy directly in their abdomens as part of treatment for
    advanced ovarian cancer lived more than a year longer than women who
    received the same chemotherapy intravenously. The findings confirm and
    expand recent research showing that intraperitoneal (IP) chemotherapy,
    which delivers drugs directly to the abdominal cavity through a
    catheter, can significantly increase survival for some women with the
    disease. As the results were made public, NCI issued a rare clinical
    announcement to raise awareness about IP chemotherapy for ovarian
    cancer among physicians and patients. The NCI announcement--the first
    since 1999--was warranted because IP chemotherapy is widely regarded as
    an old technology and previous trials have generated little interest
    among physicians. Ovarian cancer causes the most deaths of any
    gynecological cancer in the United States and frequently goes
    undetected until tumors spread beyond the ovaries.
        Another notable advance came last September with the announcement
    of results from the NCI-sponsored Digital Mammographic Imaging
    Screening Trial (DMIST). The study found that digital mammography is
    more accurate than film mammography for women with dense breasts, as
    well as for several other groups of women, including women under 50 and
    pre- and perimenopausal women. Overall, DMIST offers a model case study
    of how NCI can be an agent of change, pursuing new approaches to
    research, partnering with the private and public sectors, and fueling
    the development of technologies to achieve an important advance. It is
    particularly noteworthy that NCI and the American College of Radiology
    Imaging Network (ACRIN) secured the involvement in DMIST of four
    companies that developed and manufactured digital mammography machines
    for our use in clinical trials: Fischer Medical, Fuji Medical, General
    Electric Medical Systems, and Hologic.
        Finally, NCI has made strides to address the widespread disparities
    in cancer screening, treatment, and care for disadvantaged, mostly
    minority populations. One approach to closing this access gap is NCI's
    Patient Navigator Research Program, which relies on personal guides to
    shepherd disadvantaged cancer patients into standard care. NCI supports
    a number of Patient Navigator Program pilot projects in minority
    communities and about $24 million in grants will be awarded over the
    next 5 years as part of the program.
                   advanced technologies accelerate progress
        The technology revolution is speeding up and enabling the discovery
    process. Nanotechnology has emerged as a key strategy for imaging
    molecular features of cancer and will ultimately lead to personalized
    medicine. NCI's investment in nanotechnology is a powerful example of
    leveraging resources from the private sector through our Centers of
    Cancer Nanotechnology Excellence.
        Of equal significance, in December 2005 NCI and the National Human
    Genome Research Institute (NHGRI) launched The Cancer Genome Atlas
    (TCGA) Pilot Project, a comprehensive effort to accelerate
    understanding of the molecular basis of cancer and which evolved from
    the Human Genome Project (HGP). The TCGA Pilot Project will develop and
    test the science and technology needed to systematically identify the
    genetic changes in a small number of cancers.
        Additionally, NCI's cancer Biomedical Informatics Grid
    (caBIGTM) is creating a unifying technology platform or
    ``world-wide web'' for cancer research. caBIGTM is well on
    the way to its goal to create a network of interconnected data,
    applications, individuals, and institutions that will redefine how
    cancer research is conducted and care is provided. This initiative has
    also whetted considerable commercial interest.
                           interagency collaborations
        Addressing the cancer problem requires that NCI work across
    institutional and sector boundaries, share knowledge, and bring
    together the diverse members of the Department of Health and Human
    Services (DHHS) family of agencies, as well as other federal offices,
    that can help develop systems-based solutions to the cancer problem.
        The NCI and FDA Interagency Oncology Task Force (IOTF) continues to
    remove bottlenecks in the process of developing and approving safe,
    more effective cancer interventions. During 2005, IOTF helped foster
    the creation of two important initiatives: the Exploratory
    Investigational New Drug (IND) process to streamline the early clinical
    development of new drugs and biologics; and the NCI Regulatory Affairs
    Liaison position to help NCI-funded researchers navigate through FDA's
    IND application process. Both will help eliminate obstacles to the
    rapid development of promising new anticancer agents.
        DHHS Secretary Mike Leavitt announced last month the Oncology
    Biomarker Qualification Initiative (OBQI)--an unprecedented interagency
    agreement among NCI, FDA, and the Centers for Medicare and Medicaid
    Services (CMS) to collaborate on improving the development of cancer
    therapies and the outcomes for cancer patients through biomarker
    development and evaluation.
                                   conclusion
        We must do more to continue the acceleration of discovery,
    development, and delivery of the interventions that will hasten the
    transformation of our traditional view of cancer as a death sentence
    into a disease that we can prevent, eliminate, or control. This will be
    the legacy we leave our children.
        While progress is evident, there is much that remains to be
    accomplished. We are committed to face the challenge of making
    difficult choices between those programs that we will continue to grow
    and nurture and those that have already advanced our knowledge. The
    decisions will be science driven. This is an unprecedented era of
    discovery. The opportunities to apply powerful new technologies to
    advance our knowledge and the opportunities to change the course of
    cancer have never been greater.
                                     ______

                  Prepared Statement of Dr. Francis S. Collins
        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2007 President's budget request for the National Human
    Genome Research Institute (NHGRI). The fiscal year 2007 budget includes
    $482,942,000, a decrease of $3,107,000 from the fiscal year 2006
    enacted level of $486,049,000 comparable for transfers proposed in the
    President's request.
        On October 26, 2005, an international consortium of dedicated
    scientists from six countries, led by the NHGRI, published a new map of
    the human genome called ``HapMap'' that may prove even more powerful
    than the human genome sequence because of its medical applications.
        The Human Genome Project (HGP) spelled out the letters of the 99.9
    percent of the DNA code that we all share. The haplotype map, or HapMap
    for short, provides detailed knowledge of the 0.1 percent that
    represents variation in the genome. The HapMap reveals the way in which
    this genetic variation is organized into chromosomal neighborhoods and
    provides a powerful tool to uncover those spelling differences in the
    human instruction book that predispose some people to diabetes,
    Alzheimer's disease, heart disease, or cancer. As with the HGP, all of
    the data has been placed in the public domain.
        Since early deliberations about the HGP 20 years ago, scientists
    and physicians have dreamed of the day when we would be able to apply
    the tools of genomics to the diagnosis, treatment, and prevention of
    those common diseases that fill up our hospitals and clinics, causing
    untold suffering, misery, and premature death. The completion of the
    HapMap brings us a major step closer to the realization of that dream.
        The HapMap project could not have succeeded without the support of
    multiple NIH institutes, the U.S. Congress, and the dedication of more
    than 2,000 scientists across the world who delivered on every promise
    of the project. In fact, in its brief three-year life, this project
    produced a map three times more detailed than originally thought
    possible. The NHGRI and other NIH institutes can now move quickly to
    build on this success to discover the genetic and environmental factors
    that cause disease, and to utilize this information to develop better
    means of individualized prevention and treatment.
                           ongoing nhgri initiatives
    Use of Comparative Genomics to Understand the Human Genome
        The NHGRI continues to support the sequencing of the genomes of
    non-human species such as the chimpanzee, dog, and mouse because of
    what they tell us about the human genome. The first comprehensive
    comparison of the genetic blueprints of humans and chimpanzees,
    published in Nature to wide acclaim in September 2005, shows our
    closest living non-human relatives share identity with 96 percent of
    the human DNA sequence. The sequence of the dog genome was published in
    December 2005, revealing many interesting details about the remarkable
    diversity of man's best friend, and greatly empowering the ability to
    track down the genes involved in many chronic illnesses (like cancer)
    where dogs are excellent models for human disease.
    Sequencing technology advances, on the way to the $1,000 genome
        DNA sequencing enables a detailed description of the order of the
    chemical building blocks, or bases, in a given stretch of DNA, and is a
    powerful engine for biomedical research. Though DNA sequencing costs
    have dropped by three orders of magnitude since the start of the HGP,
    sequencing an individual's complete genome for medical purposes is
    still prohibitively expensive. Two bold new advances in sequencing
    technology recently developed by NHGRI-funded researchers promise to
    greatly reduce this cost. Ultimately, the NHGRI's vision is to cut the
    cost of whole-genome sequencing to $1,000 or less. If achieved, this
    would enable the sequencing of individual genomes as part of routine
    medical care, providing health care professionals with a more accurate
    means to predict disease, personalize treatment, and preempt the
    occurrence of illness.
    Knockout Mouse Project
        The technology to ``knockout'' or inactivate genes in mouse
    embryonic stem cells has led to many insights into human biology and
    disease. However, information about knockout mice have only been
    published and made available to the research community for about 10
    percent of the estimated 20,000 mouse genes. Recognizing the wealth of
    information that mouse knockouts can provide, the NHGRI coordinated an
    international meeting in 2003 to discuss the feasibility of a
    comprehensive project. These discussions have now resulted in a trans-
    NIH, coordinated, five-year cooperative research plan that will produce
    knockout mice for every mouse gene and make these mice available as a
    community resource.
    Chemical Genomics--Roadmap--Molecular Libraries and PubChem
        The NHGRI has taken a lead role in developing a trans-NIH chemical
    genomics initiative. This is part of the NIH Roadmap, and now offers
    public-sector researchers access to high throughput screening of
    libraries of small organic compounds that can be used as chemical
    probes to study the functions of genes, cells, and biochemical
    pathways. This powerful technology provides novel approaches to explore
    the functions of major components of the cells in health and disease.
    All the data generated for this project is stored in the new PubChem
    database at the National Library of Medicine.
    Bench-to-Bedside in Intramural Research--The Example of Progeria
        As just one example of the focus of the NHGRI intramural program on
    translational research, rapid advances have recently been achieved in
    the study of progeria, a rare genetic disease of childhood
    characterized by dramatic acceleration of aging. In 2003, NHGRI
    researchers discovered that progeria is caused by a single letter
    misspelling in a gene known as lamin A. The lamin A protein undergoes a
    particular modification known as farnesylation. That same modification
    activates the protein product of the famous ras oncogene; ten years of
    hard work has made available a class of cancer drugs that blocks this
    step. Remarkably, cell culture and mouse model experiments suggest
    these drugs may also have benefits for children with progeria. Serious
    consideration of a clinical trial is now underway, just three years
    after gene discovery.
    The Surgeon General's Family History Initiative
        Family medical history is a source of genetic information that can
    help more accurately determine an individual's risk for specific
    diseases. However, to date, this resource has been underutilized in
    health. To address this, Surgeon General Richard Carmona established
    the U.S. Surgeon General's Family History Initiative, a collaborative
    effort between a number of Department of Health and Human Services
    agencies, with leadership from NHGRI. The second annual National Family
    History Day was celebrated on Thanksgiving Day 2005, when a new and
    improved version of the software tool called ``My Family Health
    Portrait'' was released to help individuals compile their own family
    history information. This initiative should have an impact on patient-
    healthcare provider interaction, facilitating the development of more
    accurate family history information for patient medical records, and
    leading to more personalized and effective disease prevention and
    treatment strategies.
                             new nhgri initiatives
    The Genes and Environment Initiative (GEI) and the Genetic Association
            Information Network (GAIN).
        Just this February, the Department of Health and Human Services
    announced the creation of two related groundbreaking initiatives in
    which NHGRI will play a leading role, to speed up research on the
    causes of common diseases such as asthma, arthritis, the common
    cancers, diabetes, and Alzheimer's disease.
        The Genes and Environment Initiative (GEI) is a trans-NIH research
    effort to combine comprehensive genetic analysis and environmental
    technology development to understand the causes of common diseases. NIH
    will invest $68 million in GEI in fiscal year 2007. Using the newly
    derived HapMap, GEI will search for the specific DNA variations that
    are associated with an increased risk of common illnesses. For the more
    than a dozen disorders chosen for investigation under GEI, NIH will
    study roughly 1,000 cases and 1,000 controls will be studied. Finding
    the variants that predispose a person to common disease is one of the
    highest priorities of current biomedical research, as this will enable
    developing personalized medicine and identifying new drug targets.
        To ensure that GEI takes advantage of the wide breadth of expertise
    that is available on DNA variations for common disorders, NIH has begun
    partnering under the Genetic Association Information Network with the
    Foundation for the NIH, Pfizer, and Affymetrix to begin research on
    seven diseases during this fiscal year.
        But genes alone do not tell the whole story. Recent increases in
    chronic diseases like diabetes, childhood asthma, obesity or autism
    cannot be due to major shifts in the human gene pool as those changes
    take much more time to occur. They must be due to changes in the
    environment, including diet and physical activity, which may produce
    disease in genetically predisposed persons. Therefore, GEI will also
    invest in innovative new technologies/sensors to measure environmental
    toxins, dietary intake and physical activity, and using new tools of
    genomics, proteomics, and understanding metabolism rates to determine
    an individual's biological response to those influences.
    The Cancer Genome Atlas (TCGA)
        In December, the National Cancer Institute (NCI) and the National
    Human Genome Research Institute (NHGRI) jointly launched a very
    important new effort to accelerate our understanding of the molecular
    basis of cancer through the application of genome analysis
    technologies, including large-scale genome sequencing. Thanks to the
    tools and technologies developed by the Human Genome Project and recent
    advances in using genetic information to improve cancer diagnosis and
    treatment, it is now possible to envision a comprehensive effort to map
    the changes in the human genetic blueprint associated with all known
    forms of cancer. The overall effort, called The Cancer Genome Atlas,
    will begin in 2006 with a three year, pilot project totaling $100
    million to determine the feasibility of a full-scale effort to explore
    the universe of genomic changes involved in all types of human cancer.
    This atlas of genomic changes will provide: (1) new insights into the
    biological basis of cancer which in turn will lead to new tests to
    detect cancer in its early, most treatable stages; (2) new ways to
    predict which cancers will respond to which treatments; (3) new
    therapies to target cancer at its most vulnerable points; and (4)
    ultimately, new strategies to prevent cancer altogether.
                            other areas of interest
    Education of Health Care Professionals
        To enable the translation of basic genetic discoveries into health
    care practice, the NHGRI has developed numerous educational programs to
    prepare health care professionals for this revolution. Specifically,
    the NHGRI continues to play a lead role in the National Coalition for
    Health Professional Education in Genetics (NCHPEG), which is leading a
    national effort to achieve genetic literacy amongst health
    professionals. NHGRI also worked closely with the American Academy of
    Family Physicians, who featured genomic medicine as their educational
    focus for 2005.
    Minority Outreach Activities
        The NHGRI has been at the forefront of ensuring that minority
    scientists and students are equipped to meet the new challenges of
    genome research for the 21st century. The institute has sponsored new
    initiatives to reach out to diverse populations including research,
    education, and outreach collaborations on the role of genetic factors
    in health disparities. In conjunction with the National Council of La
    Raza, NHGRI has developed a community-based model education program for
    provision of genetics information to underserved Latino communities.
    NHGRI is also working with Alaska Native communities and the University
    of Washington to expand community-based education programs in Alaska
    Native communities.
    Genetic Nondiscrimination
        The NHGRI remains very concerned about the impact of potential
    genetic discrimination on research and clinical practice. Through many
    surveys and research projects funded by the Ethical, Legal, and Social
    Implication (ELSI) program of the Institute, it is clear many Americans
    remain concerned about the possible misuse of their genetic information
    by insurers or employers. In February 2005, the Senate unanimously
    passed the Genetic Information Nondiscrimination Act of 2005 (S. 306),
    which would address these concerns; the companion bill H.R. 1227 is now
    pending in the House. The Bush Administration has issued a Statement of
    Administrative Policy in support of the legislation. This issue remains
    a high priority for the Institute.
                                     ______

                   Prepared Statement of Dr. Anthony S. Fauci
        Mr. Chairman and Members of the Committee: I am pleased to present
    the President's budget request for the National Institute of Allergy
    and Infectious Diseases (NIAID) of the National Institutes of Health
    (NIH). The fiscal year 2007 budget of $4,395,496,000 includes an
    increase of $12,195,000 over the fiscal year 2006 appropriated level of
    $4,383,301,000, comparable for transfers proposed in the President's
    request.
        The mission of NIAID is to conduct and support research to
    understand, treat, and prevent infectious and immune-related diseases.
    Infectious diseases include well-known killers such as HIV/AIDS,
    malaria, and tuberculosis; emerging or re-emerging threats such as
    influenza; and ``deliberately emerging'' threats from potential agents
    of bioterrorism. Immune-related disorders include autoimmune diseases
    such as type 1 diabetes and rheumatoid arthritis as well as asthma,
    allergies, and problems associated with transplanted tissues and
    organs.
        NIAID has a two-fold mandate. First, NIAID must plan and execute a
    comprehensive and long-term basic and clinical research program on
    well-recognized endemic infectious and immune-mediated diseases.
    Second, and in this case it is unique among the NIH Institutes, it must
    respond quickly with targeted research to meet new and unexpected
    infectious disease threats as they arise, often in the form of public
    health emergencies. Part of the expansion of the NIAID research
    portfolio in recent years has been driven by unprecedented scientific
    opportunities in the core NIAID scientific disciplines of microbiology
    and immunology. Advances in these key fields have led to a better
    understanding of the human immune system and the mechanisms of
    infectious and immune-mediated diseases. But the scope of NIAID
    programs also has grown because of a growing realization that
    biomedical research is a key component of a successful response to new
    challenges posed by emerging and re-emerging infectious diseases such
    as pandemic influenza and HIV/AIDS, the threat of bioterrorism, and the
    increase in asthma prevalence among children.
                  emerging and re-emerging infectious diseases
        Despite advances in medicine and public health such as antibiotics,
    vaccines, and improved sanitation, the World Health Organization (WHO)
    estimates that infectious diseases still account for approximately 26
    percent of all deaths worldwide, including about two-thirds of all
    deaths among children younger than five years of age. Moreover, the
    pathogens we face are not static, but change dramatically over time as
    new microbes emerge and familiar ones re-emerge with new properties or
    in unusual settings.
        Influenza is perhaps the most pertinent example of a re-emerging
    disease. Influenza viruses continually accumulate small changes such
    that a new vaccine must be made for each influenza season. When a
    totally new influenza virus against which the global population has no
    natural immunity emerges, a worldwide pandemic can result if the new
    viruses are able to transmit efficiently between people. Three such
    pandemics occurred in the 20th century, in 1918, 1957, and 1968. The
    pandemics of 1957 and 1968 were severe infectious disease events that
    killed approximately two million and 700,000 people worldwide,
    respectively. The 1918-1919 pandemic, however, was catastrophic. Public
    health experts estimate that the 1918 pandemic killed more than 500,000
    people in the United States and more than 50 million people worldwide.
        The highly pathogenic H5N1 avian influenza virus currently found in
    domestic and migratory birds in Asia, Africa, the Middle East, and
    Europe is of great concern. Although H5N1 is primarily an animal
    pathogen, it nonetheless has infected more than 170 people; more than
    half of all confirmed H5N1 patients have died. At this time, the virus
    is not able to spread efficiently from animals to humans and is
    extremely inefficient in spreading from person to person, but the
    feared human influenza pandemic could become a reality if the H5N1
    virus mutates further or mixes its genes with human influenza viruses,
    remains highly virulent, and acquires the capability to spread
    efficiently from person to person.
        It is imperative that we prepare for the possibility that a new
    influenza virus will emerge to cause a 1918-like pandemic among human
    beings. It is important to note, however, that our ability to cope with
    a pandemic--with a sufficient supply of effective vaccines and
    antiviral drugs, effective infection control, and clear public
    communication--will to a large extent depend on how well we cope with
    seasonal influenza. It is clear that we have not yet optimized our
    preparedness and responsiveness to this recurring disease, which,
    according to estimates of the Centers for Disease Control and
    Prevention (CDC), kills an average of about 36,000 people in the United
    States each year. The serious vaccine shortage that occurred in the
    2004/05 influenza season underscored the difficulties we face in
    annually renewing the influenza vaccine supply, and highlights the
    pressing need to move toward adoption of newer vaccine manufacturing
    techniques and other strategies that can improve the surge capacity,
    flexibility and speed with which vaccines are made.
        NIAID supports numerous research projects that lay the foundation
    for improved influenza vaccine manufacturing methods, new categories of
    vaccines that work against multiple influenza strains, as well as the
    next generation of anti-influenza drugs. Some of these are basic
    research projects intended to increase our understanding of how animal
    and human influenza viruses replicate, interact with their hosts,
    stimulate immune responses, and evolve into new strains. Other projects
    are more targeted, such as a program to screen compounds for antiviral
    activity against influenza viruses. One particularly important effort
    is to develop a vaccine that raises immunity to parts of the influenza
    virus that do not vary from season to season. Not only would such a
    vaccine provide continued protection over multiple influenza seasons,
    it might also offer considerable protection against a newly-emerged
    pandemic influenza virus and thereby substantially improve our
    preparedness for pandemic threats.
        The Department of Health and Human Services (DHHS) Pandemic
    Influenza Response and Preparedness Plan designates NIAID as the lead
    agency for research and development efforts related to pandemic
    influenza. In this capacity, NIAID has developed and is clinically
    evaluating several candidate H5N1 vaccines, including inactivated and
    live-attenuated vaccines, as well as other strategies such as
    recombinant subunit and DNA vaccines. The potential benefits of NIAID
    research to the American public have been clear and immediate. The pre-
    pandemic H5N1 vaccine that is currently being stockpiled by DHHS was
    shown in clinical trials by NIAID to be safe and capable of inducing an
    immune response that would be predictive of being protective against
    the H5N1 virus. The dose of vaccine required for this protection,
    however, is high; and current NIAID studies are aimed at enhancing the
    response to lower doses of the H5N1 vaccine, particularly with the use
    of adjuvants, which are compounds that have been shown to enhance the
    immune response to vaccines. NIAID also conducts surveillance for the
    molecular evolution of influenza viruses among animals and humans in
    Asia and elsewhere, and tracks changes in the virus that might allow it
    to be transmitted more easily among people. The Institute also is
    evaluating new antiviral drugs against H5N1 influenza as well as
    combinations and varied doses of existing drugs. In addition, NIAID is
    working to establish a clinical trials network in Southeast Asia to
    conduct research on emerging infectious diseases, with an initial
    emphasis on influenza.
        Influenza is by no means the only emerging and re-emerging
    infectious disease threat that the world faces. For example, malaria is
    a substantial and growing problem compounded by the emergence of drug-
    resistant malaria parasites and insecticide-resistant mosquito vectors.
    NIAID supports a large malaria research portfolio; one recent study
    identified a specific parasite gene that is essential for full
    maturation of the parasites in mice. Disrupting this gene not only
    prevented the onset of disease in mice, but injection of the modified
    parasites stimulated an immune response that protected them from
    subsequent infection with unmodified, fully-virulent malaria parasites.
    This indicated that genetically attenuated parasites might be useful as
    a malaria vaccine in the future.
        Tuberculosis (TB) is an example of a microbial disease that has
    reemerged in recent years. Infection with Mycobacterium tuberculosis is
    estimated to be prevalent in one-third of the world's population and is
    especially common among persons infected with HIV. NIAID supports a
    large portfolio of research to develop new drugs, vaccines, and
    diagnostics for TB and to evaluate improved treatment and preventive
    regimens. Recently, two novel, engineered TB vaccines developed with
    NIAID support entered Phase I clinical trials in the United States.
    These promising candidates are the first new TB vaccines to be tested
    in people in more than 60 years. In addition, the Global Alliance for
    TB Drug Development and NIAID have collaborated to develop a promising
    new TB drug candidate, which is now being tested in clinical trials.
    NIAID also has made substantial research progress on West Nile Virus,
    multi-drug resistant tuberculosis (MDR-TB), SARS, and other new or re-
    emerging infections.
                               hiv/aids research
        HIV/AIDS was first recognized as an emerging disease only 25 years
    ago. Today it is a global catastrophe. According to the Joint United
    Nations Program on HIV/AIDS (UNAIDS), approximately 40 million people
    worldwide are living with HIV/AIDS, and their number is increasing by
    more than 5 million people every year--about 14,000 each day. In the
    United States, more than one million people are living with HIV/AIDS,
    and approximately 40,000 new infections occur annually. Worldwide, more
    than 25 million people with HIV have died since the pandemic began,
    including more than 520,000 in the United States. In 2004, there were 3
    million deaths worldwide due to HIV/AIDS. These statistics are grim
    reminders of the physical and emotional devastation to individuals,
    families, and communities coping with HIV/AIDS, and of the terrible
    impact of HIV/AIDS on regional and global security and the global
    economy.
        Development of a vaccine that protects against HIV/AIDS is one of
    the highest priorities of the NIAID. The scientific challenges that
    must be overcome, however, are extraordinary. Because the immune
    system, with rare exceptions, has not been shown to contain HIV on its
    own, an HIV vaccine will have to elicit an even stronger immune
    response than elicited by natural HIV infection if it is to prevent
    infection. To help meet these challenges, NIAID established the Center
    for HIV/AIDS Vaccine Immunology (CHAVI) in June 2005. CHAVI's mission
    is to tackle the fundamental immunological obstacles in HIV vaccine
    research and to design, develop, and test novel HIV vaccine candidates.
    The establishment of CHAVI complements NIAID's continued support of
    other innovative research projects conducted through a highly
    cooperative and collaborative global research and development program.
        Among many HIV vaccine research efforts, NIAID scientists have
    developed a two-part vaccination strategy, consisting of an initial
    (prime) vaccination followed by a later (boost) vaccination. The
    priming dose is a ``naked'' DNA vaccine, and the boost is a recombinant
    adenovirus vaccine, which is based on a highly attenuated version of a
    common cold virus. Both components contain genes from three different
    subtypes of HIV that together cause about 85 percent of all HIV
    infections around the world. An initial Phase I clinical trial showed
    that the pair of vaccines was well-tolerated and induced substantial
    immune responses. Building on these promising findings, NIAID recently
    launched a second phase of testing of this ``prime-boost'' strategy.
    This project is a collaboration between three international clinical
    trial networks--NIAID's HIV Vaccine Trials Network, the non-profit
    International AIDS Vaccine Initiative, and the U.S. Military HIV
    Research Program--and expands the safety and immunogenicity testing of
    the prime-boost strategy in the Americas, South Africa, and Eastern
    Africa. Also underway and slated to complete enrollment this year is
    the evaluation of a candidate adenoviral vaccine administered without a
    DNA vaccine to determine whether it may be useful alone in preventing
    HIV infection or disease.
        The use of potent combinations of anti-HIV drugs, many of which
    were developed with NIAID support, has dramatically reduced the numbers
    of AIDS deaths in industrialized countries. Most recently these drugs
    have had a major impact on several developing countries in sub-Saharan
    Africa, the Caribbean, South America and Asia, as drugs have become
    available to them. Indeed, these drug regimens have transformed the
    complexion of HIV/AIDS throughout the world, saving the lives of
    millions of people. These results are some of the most cogent examples
    of the practical benefits of NIH-supported research. But we cannot be
    complacent in our success. Anti-HIV drug regimens often cause serious
    side effects and frequently lose their effectiveness due to the
    emergence of resistant forms of HIV within a patient. Clinical research
    is moving new classes of AIDS drugs closer to market and defining how
    to optimally use currently licensed medications. Basic HIV research
    continues to uncover additional viral and cellular targets for therapy.
    For example, several potential drug targets have been identified by
    determining the mechanisms that HIV uses to gain entry into host cells.
    These include fusion inhibitors, the first of which was recently
    approved by the Food and Drug Administration (FDA). In addition,
    several inhibitors of the HIV enzyme that allows the virus to enter and
    integrate into an infected cell's genes have shown great promise in
    clinical trials.
                              biodefense research
        The potential use of biological agents in a terrorist attack is a
    serious threat to the citizens of our nation and the world. Research to
    mitigate this threat is a key focus of NIAID. The NIAID Strategic Plan
    for Biodefense Research, developed shortly after the terrorist attacks
    of 2001, outlines three essential pillars of the NIAID biodefense
    research program: infrastructure needed to safely conduct research on
    dangerous pathogens; basic research on microbes and host immune
    defenses that serves as the foundation for applied research; and
    targeted, milestone-driven development of medical countermeasures to
    create the vaccines, therapeutics and diagnostics that we would need in
    the event of a bioterror attack. Implementation of this plan enhances
    not only our preparedness for bioterrorism, but also for naturally
    occurring endemic and emerging infectious diseases. In addition, NIAID
    was recently given the role of coordinating and facilitating NIH
    research into countermeasures to mitigate harm to civilians from
    chemical and radiological/nuclear weapons. Other NIH Institutes and
    Centers will also contribute substantially to these efforts. The NIH
    Strategic Plan and Research Agenda for Medical Countermeasures against
    Radiological and Nuclear Threats was released in June 2005, and the NIH
    Strategic Plan and Research Agenda for Medical Countermeasures against
    Chemical Threats is scheduled to be released in mid-2006.
        Perhaps the most tangible signs of NIAID's biodefense research
    progress are the biocontainment research facilities now under
    construction, which will be capable of safely containing dangerous
    pathogens, enabling scientists to study such agents. For example,
    through its extramural program, NIAID is supporting the construction of
    two National Biocontainment Laboratories--capable of safely containing
    the most deadly pathogens--as well as thirteen Regional Biocontainment
    Laboratories nationwide. In addition, three intramural biocontainment
    labs--on the NIH campus, on the National Interagency Biodefense Campus
    at Fort Detrick in Fredrick, MD, and at the NIAID Rocky Mountain
    Laboratories in Hamilton, MT--are either complete or under
    construction. NIAID also has established a nationwide network of
    Regional Centers of Excellence (RCEs) for Biodefense and Emerging
    Infectious Diseases Research; two new RCE awards were announced on June
    1, 2005, bringing the total number of RCEs nationwide to ten.
        The investment in biodefense research has already yielded
    substantial dividends, some of which are of immediate benefit while
    others provide considerable promise for the future. Our basic research
    and clinical trials have already greatly increased our ability to
    respond to the threats of smallpox, anthrax, and Ebola with new and
    improved vaccines. For example, in November 2004, DHHS awarded a
    contract for the acquisition of 75 million doses of a new anthrax
    vaccine to be held in the Strategic National Stockpile. NIAID's support
    of the development of this vaccine was instrumental in making this
    initiative possible. In addition, NIAID-supported scientists recently
    discovered that a poxvirus infection may be halted by a cancer drug
    aimed not at the virus, but at the host cellular machinery that the
    virus needs to spread from cell to cell. Although much work remains,
    this research provides a lead to not only a new therapeutic approach to
    poxviruses such as smallpox, but also a means of circumventing
    antiviral drug resistance for other viruses. In another example of
    critical new discoveries, NIAID-supported scientists demonstrated that
    host cell proteins called cathepsins play an essential role in the
    Ebola virus' ability to enter and infect cells, and that inhibitors of
    cathepsin activity block viral entry and reduce the production of
    infectious Ebola viruses. This suggests that drugs that inhibit the
    activity of cathepsins might be useful as anti-Ebola therapies.
        NIAID's implementation of its Strategic Plan for Biodefense
    Research has been aided by the enactment of the Project BioShield Act
    of 2004. Project BioShield provides NIH additional flexibility in
    awarding contracts, cooperative agreements, and grants for research and
    development of critical medical countermeasures. The BioShield Act also
    provides NIH with streamlined personnel authority, which has allowed
    NIAID to hire highly-qualified individuals to fill key positions
    related to product development. Lastly, Project BioShield provides
    NIAID with additional authority for the construction of research
    facilities, which NIAID used to award grants in fiscal year 2005 for
    the construction of four Regional Biocontainment Laboratories.
                      research on immune-mediated diseases
        Autoimmune diseases, allergic diseases, asthma and other
    immunologic diseases are significant causes of chronic disease and
    disability in the United States and throughout the world. Autoimmune
    diseases affect 5 to 8 percent of the U.S. population; asthma and
    allergic diseases together are the sixth leading cause of chronic
    disease and disability in this country; and asthma is the leading cause
    of hospitalizations and school absences among children. A promising
    strategy to treat and prevent immune-mediated diseases is known as
    immune tolerance. Immune tolerance therapies are designed to preprogram
    immune cells in a highly specific fashion to eliminate injurious immune
    responses, such as those seen in autoimmune diseases, while preserving
    protective responses needed to fight infection. The NIAID has
    established a comprehensive program in immune tolerance research,
    including basic research, preclinical testing of promising strategies
    in nonhuman primates, and clinical evaluation through the Immune
    Tolerance Network (ITN), a consortium of more than 80 investigators in
    the United States, Canada, Western Europe, and Australia. Currently,
    NIAID is supporting more than 40 clinical trials of immune tolerance
    strategies to treat autoimmune diseases, allergic diseases, and
    transplant rejection.
        NIAID-supported research in immune-mediated diseases has led to
    significant advances in our understanding of how to manage these
    diseases. For example, NIAID-supported scientists recently identified
    novel ways to non-invasively assess the risk of kidney graft rejection
    by using immunologic and genetic biomarkers present in urine. If
    validated in larger studies, these biomarkers would allow physicians a
    non-invasive way to monitor transplant recipients for organ rejection,
    and intervene before organ injury, a significant advance in the
    clinical management of transplant patients.
        NIAID also remains committed to improving the health of children
    with asthma, particularly those who live in our Nation's inner cities.
    For example, NIAID-supported researchers recently published the results
    of a study on the effect of home-based interventions that reduce
    exposure to common allergens such as cockroaches, house dust mites, and
    tobacco smoke. The study found that the interventions resulted in 20
    percent fewer days with asthma symptoms and 14 percent fewer
    unscheduled clinic visits through the intervention year. We anticipate
    that our extensive research portfolio will continue to illuminate the
    causes of asthma and other immune-mediated conditions, and lead to new
    interventions to reduce the burden of these serious diseases.
                                   conclusion
        The research conducted at NIAID and at NIAID-sponsored laboratories
    encompasses a broad array of basic, applied and clinical studies. This
    research has resulted in tangible benefits to the American public and
    to individuals throughout the world. By supporting talented researchers
    and emphasizing a balance of basic studies and targeted research, we
    hope to continue to develop innovative technologies and treatments to
    combat a wide range of important diseases that afflict humanity.
                                     ______

                  Prepared Statement of Dr. Elizabeth G. Nabel
        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2007 President's Budget request for the National Heart,
    Lung, and Blood Institute (NHLBI). The fiscal year 2007 budget includes
    $2,901,012,000, a decrease of $20,745,000 over the fiscal year 2006
    enacted level of $2,921,757,000.
        The NHLBI was established as the National Heart Institute in 1948
    with a mandate ``to improve the health of the people of the United
    States'' through research on diseases of the heart and circulation. And
    that is exactly what we have done. I believe it is no exaggeration to
    claim that, over the past decades, biomedical research has made more
    progress in cardiovascular disease than in any other major chronic
    health problem. The impact on death rates alone constitutes a
    monumental validation of this country's public investment in the NIH
    and the NHLBI.
        The United States experienced an epidemic of coronary heart disease
    (CHD) during the twentieth century and, had the trend continued
    unabated, more than 1.6 million lives would be lost to CHD this year.
    In actuality, the toll will be less than 500,000 deaths, reflecting a
    63 percent decline in age-adjusted mortality since 1950.\1\  Mortality
    from stroke, the third most common cause of death in the United States,
    declined 70 percent over that time. The effect on longevity has been
    remarkable--looking just at recent data, we can see that between 1970
    and 2000 the life expectancy of the average American increased by 6
    years, and nearly 4 years of that gain was due to reductions in deaths
    from cardiovascular disease.
    ---------------------------------------------------------------------------
        \1\ Data in this statement regarding mortality and life expectancy
    are from U.S. Vital Statistics.
    ---------------------------------------------------------------------------
        Much of the reduction in death rates has come from improved
    treatments for CHD. Not so long ago, atherosclerosis followed an
    inexorable course and, once an artery became occluded, blood flow could
    not be restored. Increasingly sophisticated technological developments
    in revascularization--coronary artery bypass surgery (1968), balloon
    angioplasty (1977), stents (1994), and now ``drug-eluting'' stents--
    coupled with vastly improved diagnostic procedures and new medications,
    have literally given many patients a new lease on life. NHLBI-supported
    basic and applied research studies, as well as carefully designed
    clinical trials, have enabled scientists to develop these
    interventions, to assess their utility and safety, and to determine the
    characteristics of patients most likely to benefit from them. Millions
    of Americans suffer from cardiovascular disease, and this research has
    contributed enormously to our ability to help them live longer and
    healthier lives.
        We are equally pleased to reflect on improvements that have
    occurred in our ability to treat acute heart attacks. In past
    generations, doctors could only stand by while a heart attack ran its
    course and they had little to offer the patient but bed rest and a
    prognosis of rapid death or severely restricted life as a ``cardiac
    cripple.'' All that changed in the 1980s when scientists determined
    that most heart attacks occur because of a blood clot in an artery that
    feeds the heart. The development of thrombolytic--``clot-busting''--
    therapy followed. NHLBI-sponsored clinical trials of thrombolysis
    demonstrated that the procedure could limit the area of damaged heart
    muscle and decrease mortality. This was revolutionary, and it rapidly
    influenced how heart attack is treated.
        The greatest benefit of thrombolysis, however, accrues in the
    initial minutes and hours after onset of the attack and, unfortunately,
    many patients do not reach the emergency room in time. In the 1990s the
    NHLBI initiated a successful trial of community-based interventions to
    reduce delays in seeking and receiving treatment for heart attack
    symptoms. The knowledge gained was used to develop Act in Time to Heart
    Attack Signs, a far-reaching public education campaign launched by the
    NHLBI during the NIH budget doubling. Also during the doubling, the
    Institute began a pilot program at Suburban Hospital to test a new
    approach to diagnosing heart attack patients who may be candidates for
    thrombolytic therapy. For many patients arriving at the emergency room
    with chest pain, diagnosis requires measurement of enzymes that appear
    in the bloodstream only hours after the heart attack has occurred--too
    late for effective thrombolysis. The experimental program is having
    great success in using MRI (magnetic resonance imaging) technology to
    provide a diagnosis in about 35 minutes, and we believe it may form the
    basis for a better approach to delivering prompt therapy to patients
    who are likely to benefit from it. In light of recent evidence that
    thrombolytic therapy may benefit patients who experience a clot-based
    stroke, we have also teamed up with the National Institute of
    Neurological Disorders and Stroke to use MRI in evaluating patients who
    come to the emergency room with stroke symptoms.
        Let me mention some special efforts to improve treatment of
    coronary heart disease in a highly vulnerable population--patients with
    obesity and type II diabetes. Although there is near-universal optimism
    that a cure for diabetes will ultimately be found, in the meantime the
    majority of patients are suffering and dying from cardiovascular
    disease. We are working to identify approaches to prevent and treat
    these complications, and I am happy to note that the budget doubling
    enabled us to move forward with full funding of two major new clinical
    trials in this area. The ACCORD trial is testing the extent to which
    control of blood pressure, cholesterol, and glucose levels to
    thresholds beyond those that are currently recommended will reduce the
    occurrence of cardiovascular problems. The BARI-2D trial, focused on
    diabetic patients who already have coronary heart disease, is weighing
    the merits of revascularization versus medical treatment and, in
    addition, studying two different approaches to controlling blood sugar.
    These trials are effortful and expensive because they involve multiple
    complex issues in diabetes management. However, they address a critical
    public health need, given the escalating prevalence of obesity and
    diabetes in the United States, and many among us are likely to benefit
    from their findings.
        Much as we celebrate these advances in treatment, let me assure you
    that we have never lost sight of our ultimate objective--prevention.
    Indeed, we have had considerable success in identifying risk factors
    such as high blood pressure and cholesterol, developing and evaluating
    methods to control them, and translating the research findings into
    messages for health-care professionals, patients, and the general
    public. During the budget doubling, we launched The Heart Truth, an
    education campaign to raise awareness that heart disease is the leading
    cause of death in American women and call women to take action to
    reduce their risk of developing heart disease. Already we have evidence
    that the campaign's message, ``Heart disease doesn't care what you
    wear--it's the #1 killer of women,'' has raised awareness throughout
    the nation. Last June we launched We Can! (Ways to Enhance Children's
    Activity and Nutrition), a national education program to help children
    8-13 years of age stay at a healthy weight. We Can! offers parents and
    families tips and activities to encourage healthy eating, increase
    physical activity, and reduce sedentary or screen time. It also
    provides resources to help community groups and health professionals
    work toward these goals.
        Much of what we know about factors that put people at risk of
    developing cardiovascular diseases has come from the multigenerational
    Framingham Heart Study, begun in 1948. I am delighted to announce that
    the NHLBI, in conjunction with Boston University, recently unveiled a
    plan to take this study to the next level. Our new Framingham Genetic
    Research Study will entail up to 500,000 analyses of the DNA of 9,000
    study participants. By identifying genetic variations that relate
    strongly to participant characteristics (e.g., blood pressure and
    cholesterol levels, overweight and obesity) and to outcomes (e.g.,
    stroke, congestive heart failure, diabetes), we hope to refine our
    understanding of individual risk and identify carefully focused new
    strategies for treatment and prevention. We at the NHLBI share Dr.
    Zerhouni's vision of an approach to medical care that is predictive,
    personalized, and preemptive and we believe this new endeavor
    constitutes a major step toward realizing that goal.
                       pediatric heart and lung disorders
        Tremendous progress has been made in treating congenital
    cardiovascular malformations, the most common type of birth defect in
    the United States. Many of us remember when these conditions
    constituted a death sentence, but today we have an array of surgical
    and medical treatments, as well as reliable and effective methods for
    providing monitoring and support. As a result, more than 90 percent of
    these babies live to celebrate a first birthday. Indeed, the prognosis
    has improved so much that there are now more adults than children
    living with congenital heart defects, according to data from the Adult
    Congenital Heart Association. Nonetheless, congenital heart disease is
    still a major contributor to infant mortality and many challenges
    remain. Thanks to the budget doubling, we have been able to expand
    significantly our efforts in this area by funding two additional
    Specialized Centers of Research in Pediatric Cardiovascular Disease,
    establishing a clinical research network to enable rapid evaluation of
    new treatment approaches, and soliciting research proposals to develop
    devices for infants and children who experience cardiopulmonary failure
    and circulatory collapse.
        As recently as 35 years ago, many premature infants died within
    hours of birth from neonatal respiratory distress syndrome (RDS), a
    condition caused by lack of a substance called surfactant that keeps
    the lung's air sacs open for breathing. The NHLBI's long-term
    investment in basic, applied, and clinical research has nearly
    relegated neonatal RDS to history. With development of special
    ventilation techniques to sustain babies until their lungs matured,
    introduction of a prenatal test for lung maturity, and demonstration
    that antenatal corticosteroid treatment could accelerate lung
    maturation, U.S. deaths from this disorder fell 60 percent between 1970
    and 1984--from 10,000 to 4,000 per year. Then, in the 1980s, NHLBI-
    supported studies of surfactant structure, function, and regulation and
    efforts to identify the genes for surfactant proteins culminated in
    development of surfactant replacement products for testing in clinical
    trials. Since 1990, when two surfactant treatments were approved for
    widespread clinical use, neonatal RDS mortality has fallen more than 75
    percent, to about 1,000 deaths per year.
                                     asthma
        For centuries, asthma was viewed a bronchial spasm problem and
    treated--with limited success--as such. Our intensive research effort
    in recent years led to the realization that asthma is a manifestation
    of chronic inflammation and immune dysfunction. This insight
    revolutionized treatment, the mainstay of which now is anti-
    inflammatory medications to treat the underlying disease, with
    bronchodilators used chiefly for quick relief of symptoms. The NHLBI
    has also been a pioneer in development of self-management strategies
    and their application, especially for inner-city minority children;
    evidence indicates favorable effects on emergency room visits and
    school absences in this vulnerable population. Results of all these
    efforts are rapidly incorporated into national guidelines that set the
    standard for modern asthma management. Clinical research networks have
    proven invaluable for rapidly assessing new treatment strategies, and
    during the budget doubling we were able to renew our highly productive
    adult Asthma Clinical Research Network and initiate the Childhood
    Asthma Research and Education Network, which addresses pediatric
    asthma. We also began a program focused on severe asthma. These efforts
    are enabling us to make good on our promise to patients, ``Your asthma
    can be controlled--expect nothing less.'' And we are now talking with
    increasing confidence about curing asthma, going beyond the initial
    promise of asthma control.
                              sickle cell disease
        As recently as 1970, the average patient with sickle cell disease
    died in childhood. Today, life expectancy is about 45 years. NHLBI
    research has led to a standard of care that begins with screening of
    newborns, provides prophylaxis for potentially lethal childhood
    infections, and offers transfusion therapy to prevent stroke in high-
    risk children. A clinical trial demonstrated the value of the drug
    hydroxyurea in preventing painful crises, acute chest syndrome (a life-
    threatening respiratory complication), and need for transfusions in
    adult patients. With the budget doubling, we have been able to
    undertake a hydroxyurea trial in children, and also to assess the value
    of stem cell transplantation as a possible cure. Our hope and
    expectation is that further gains in longevity and quality of life will
    be achieved.
        I would be pleased to respond to any questions that the Committee
    may have.
                                     ______

    Prepared Statement of Dr. Duane Alexander, Director, National Institute
                     of Child Health and Human Development
        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2007 President's budget request for the National
    Institute of Child Health and Human Development (NICHD). The fiscal
    year 2007 budget includes $1,257,418,000, a decrease of $7,351,000 over
    the fiscal year 2006 enacted level of $1,264,769,000 comparable for
    transfers proposed in the President's request.
        The mission of the NICHD is vital to the NIH goal of ensuring the
    overall health and well-being of the American people. Our research
    focuses on both child health and human development. Increasingly,
    researchers are confirming that lifelong health and well-being are
    strongly influenced by events occurring early in life.
        Understanding human development evolves from understanding normal
    growth and change processes before birth through adulthood. It begins
    at the most basic molecular and cellular levels and encompasses
    cognitive, behavioral, physical and social development. By
    understanding what goes ``right,'' NICHD research provides clues as to
    what may go ``wrong,'' laying the critical scientific foundation not
    only for understanding many disease processes, but also for preventing
    them altogether.
                     fetal development: jump start on life
        We now know that both undernourished and obese mothers have
    children with increased risk of chronic disease later in life. This is
    a problem world wide and it is an increasing problem in the United
    States.
        To understand and reverse the epidemic of type 2 diabetes among
    young people, we need to look beyond their diet. The health and
    nutrition of the mother during fetal development influences not only
    how children function but also the later development of diabetes, high
    blood pressure, heart disease and other conditions. To better
    understand fetal origins of adult disease, researchers recently
    discovered links between birth weight and stress hormone (cortisol)
    levels in boys and girls who were small at birth, but healthy term
    babies. Cortisol helps to regulate blood pressure, energy production,
    and response to stress. The researchers found that the lower birth
    weight boys had higher levels of cortisol under stressful conditions
    compared to the higher birth weight boys. They found that the lower
    birth weight girls had higher cortisol levels at the beginning of the
    day. This discovery demonstrates how low birth weight can have lasting,
    yet different, effects on stress hormone levels in girls and boys.
    These alterations in cortisol may predispose children to obesity,
    hypertension, and glucose intolerance later in life.
                            predicting preeclampsia
        Preeclampsia is a sudden, dangerously high increase in high blood
    pressure that threatens the health of a pregnant woman and her fetus.
    Preeclampsia strikes without warning and can result in maternal
    seizures and even death. The researchers studying this condition found
    that women who, in mid-pregnancy, have a lower level of a substance
    known as placental growth factor were more likely to develop
    preeclampsia. This advance may lead to a screening test for
    preeclampsia and a treatment to help women avoid the condition.
              obstetric pharmacology--treatment for pregnant women
        Most drugs used to treat pregnant women are prescribed without full
    knowledge about safety and efficacy. In many cases, no data exists to
    predict how the drug's dynamics may interfere with a woman's pregnancy.
    To fill this knowledge gap, the NICHD has established the Obstetric-
    Fetal Pharmacology Research Units (OFPRU) Network to develop improved
    safety and efficacy drug information for pregnant women. One drug
    currently being studied is used to control gestational diabetes.
    Gestational diabetes affects up to 15 percent of all pregnancies
    according to the March of Dimes. The condition results from a sudden
    inability of the body to remove sugar from the blood. Untreated,
    gestational diabetes results in large, stocky babies who may cease
    breathing unexpectedly, have difficulty feeding, and must eat
    frequently to avoid seizures. Children of mothers with gestational
    diabetes are also likely to become obese during childhood and
    adulthood.
        For many years, physicians treated gestational diabetes with
    injections of insulin. Recently, however, physicians began treating
    pregnant women with glyburide, which stimulates the pancreas to
    gradually release small quantities of insulin. Many patients preferred
    the convenience of taking a pill to giving themselves an injection.
    Although many pregnant women have taken glyburide, no studies have ever
    tested the drug's effectiveness in treating gestational diabetes. A new
    study is examining the use of glyburide in pregnancy, to determine if
    the current dosing schedule is the most effective means to treat the
    disorder.
                            premature birth research
        Reducing preterm birth (PTB) is a major public health priority and
    a major research priority for this Institute. One out of eight infants
    in the United States is born preterm. This amounts to about 476,000
    infants a year. The March of Dimes estimates that babies born too soon
    or too small cost the U.S. health system $18.1 billion a year. Preterm
    infants face a number of serious health problems and life-threatening
    conditions. PTB accounts for nearly half of the neurological problems
    among newborns who are at risk of having learning disabilities and
    mental retardation. When preterm infants reach adulthood, they also
    face much higher risks of cardiovascular disease and diabetes.
        The NIH investment in preterm birth research is paying dividends.
    For the first time, we now have a method to reduce the risk of PTB for
    some women. One of our studies found that weekly injections of a
    synthetic form of progesterone reduces the chances of preterm delivery
    in women who had already given birth prematurely. For the first time,
    this research gives doctors an intervention that has been shown to be
    both safe and effective in reducing the risks of preterm birth. This
    discovery also illustrates how quickly research can be turned into
    practice. Shortly after this research was published, The American
    College of Obstetricians and Gynecologists recommended that all of
    their members use progesterone to prevent PTB for women with previous
    PTB. Another study found that pregnant women who have a condition known
    as bacterial vaginosis have a greater likelihood of delivering
    prematurely. For many years, these women have been treated with
    antibiotics. Contrary to existing clinical thinking, treating the
    infection with an antibiotic during pregnancy did not reduce the
    incidence of preterm birth. Still another NICHD study found that women
    with a condition known as trichomoniasis are also at increased risk for
    preterm delivery. The study found that giving antibiotics does not
    reduce the risk of preterm birth associated with infection; moreover,
    this treatment actually increased the preterm birth rate.
        The new knowledge gained from each of these three studies was
    created by one of the multidisciplinary clinical research networks
    supported by the NICHD. With these networks in place, NICHD scientists
    working with researchers around the country can answer important
    scientific questions quickly, and work through professional
    organizations to help clinicians translate the new knowledge into
    practice.
        The NICHD recently established the Genomics and Proteomics Network
    for Premature Birth Research. This new network will focus on the
    hereditary information in DNA and the structure and function of
    proteins to understand the underlying processes that lead to preterm
    birth.
              genes may hold the key to treating uterine fibroids
        Each year, more than 200,000 women in the United States undergo a
    hysterectomy to treat the chronic pain and abnormal bleeding caused by
    fibroids. Scientists are exploring alternative ways to treat fibroids
    without surgery. Previously, these researchers identified a molecule
    called transforming growth factor beta (TGF-b) that helps to regulate
    several processes including the growth of uterine fibroids. Using a
    powerful new technology, the researchers identified the different genes
    influenced by the growth factor in both normal and fibroid cells. The
    researchers then tested a gene therapy that appeared to block
    production and action of TGF-b. This insight may lead to novel, non-
    surgical therapeutic approaches, not only to prevent uterine fibroid
    growth, but also to treat other reproductive conditions.
                    buffergel shown to be safe contraceptive
        Researchers have made a major step forward in developing
    contraceptives that protect women against HIV. One product, BufferGel,
    can be used with a diaphragm, much like a conventional spermicide. The
    results of a recent study demonstrate that BufferGel is as effective at
    preventing pregnancy as is currently available spermicides. A study is
    now in progress to determine if BufferGel can reduce transmission of
    the AIDS virus.
              gene programs early development and neural migration
        NICHD researchers made a significant advance in understanding
    dyslexia. In an article that Science Magazine called one of the 10
    major breakthroughs in 2005, the researchers linked the developmental
    gene DCDC2 to dyslexia. This gene functions to control nerve cell
    migration in early brain development. This work suggests that genetic
    miscues alter brain biology in the womb in a way that predisposes
    people to problems later in life.
                       future research: newborn screening
        The NICHD Newborn Screening Initiative is moving forward in its
    effort to develop and employ the latest technology for improving the
    availability, accessibility, and quality of genetic and other
    diagnostic laboratory testing for rare diseases and conditions
    affecting newborns. Ultimately, this research could help identify at-
    risk infants as early as possible and provide the data needed to
    develop therapies for many of these conditions. As a cornerstone
    activity, the NICHD funded a major grant for developing and refining a
    newborn screening test for spinal muscular atrophy (SMA), a common
    fatal neuromuscular disease in children. The NICHD will soon be funding
    additional grants to increase understanding of conditions such as SMA
    or other genetic conditions.
                 mathematics and science cognition and learning
        The NICHD is enhancing its program to better understand the
    underlying developmental processes that allow children to learn math
    and science. One goal is to help researchers understand the
    developmental and cognitive processes needed to help children
    transition successfully from arithmetic to algebraic reasoning, a
    fundamental skill needed to allow children to advance their
    understanding of mathematical concepts. In turn, mastering math-related
    concepts such as recognizing patterns, representing relationships, and
    making generalizations is key to learning and understanding science.
    These critical program activities fill a major research need to clarify
    the cognitive factors needed for scientific thinking and learning.
                  community-based rehabilitation intervention
        The aging of the baby-boom generation and expected pressures on the
    U.S. health care system make research into effective therapies in
    community settings a high priority. Clinical trials of rehabilitation
    therapies have demonstrated the efficacy of novel interventions in
    preventing or significantly lessening disabling conditions associated
    with stroke, traumatic brain injury, and other disorders and
    conditions. Little is known, however, about whether and how well such
    therapies will work in less-controlled community practice settings.
    Scientists do not know whether--or how--efficacious rehabilitative
    therapies and even clinical trial design may need to be modified for
    community settings. To address these critical questions, the NICHD will
    solicit applications for clinical trials by scientists partnering with
    persons with disabilities, practitioners, and others in the community.
        Mr. Chairman and members of the Committee, the support you have
    shown for medical research has allowed scientists in research centers
    around the country to make discoveries that advance the health of
    women, children and families. I will be pleased to answer any
    questions.
                                     ______

    Prepared Statement of Dr. Barbara M. Alving, Acting Director, National
                         Center for Research Resources
        Mr. Chairman and Members of the Committee: It is a privilege to
    present to you, for the first time, as the Acting Director of the
    National Center for Research Resources (NCRR), the President's budget
    request for NCRR for fiscal year 2007, a sum of $1,098,242,000,
    including support for AIDS research, which reflects a net decrease of
    $859,000 over the comparable fiscal year 2006 appropriation.
        By developing and funding essential research resources, NCRR
    connects scientists with one another, as well as with patients and
    communities across the nation. These connections bring together
    innovative research teams and the power of shared resources,
    multiplying the opportunities to improve human health.
        These connections can be seen in the new institutional Clinical and
    Translational Science Awards program, launched in fiscal year 2006,
    which enables researchers to train and collaborate in new ways to move
    findings in the laboratory more quickly to patients. NCRR also is
    bringing patients, advocacy groups, and researchers together to fight
    rare diseases--a unique opportunity to combine patient information and
    support with research knowledge. Other programs are helping
    investigators to create technologies that will make research
    information more accessible and precise through various software tools
    and Internet connections.
        In addition, NCRR-supported technologies help researchers--located
    in isolated regions--share information that benefits underserved
    populations across the country. And at NCRR-supported primate research
    centers, investigators come together to study AIDS vaccines,
    Parkinson's, Alzheimer's, and many other diseases. Perhaps our most
    wide-ranging connections are made through science education--programs
    that reach young and old--on a diverse range of health-related issues.
        These are just a few of the programs that comprise NCRR's
    portfolio, but they illustrate how we are investing research dollars in
    order to bring the power of shared resources to communities and
    researchers across the nation and ultimately improve the health of
    Americans. I would now like to provide you with additional details
    about each of these exciting programs.
                 integrating clinical and translational science
        Recognizing that a well-integrated collaborative effort is needed
    to transform basic discoveries into improved medical care, NCRR has
    launched an important new initiative--the Clinical and Translational
    Science Awards (CTSAs)--on behalf of the NIH Roadmap for Medical
    Research. The CTSA Program was initiated to break existing barriers
    between basic and clinical sciences and, above all, to get people to
    work together to speed the delivery of improved health care to the
    public. Developed with extensive input from the scientific community,
    the CTSAs will help research institutions nationwide create an academic
    home for clinical and translational research, essentially generating
    what NIH Director Dr. Elias Zerhouni calls the ``glue'' that fills the
    gaps among scientists in multiple disciplines and thus forms a bridge
    between basic and clinical research.
        In ongoing dialogues with the scientific community, researchers
    also have told us that the CTSA initiative will allow them to
    strengthen the career development pipeline for clinical and
    translational researchers. At the same time, it will build partnerships
    with communities that will ensure that diverse populations, and
    clinical practitioners serving those populations, play an integral part
    in addressing the unique health challenges that they face. With the
    community's participation, the CTSAs will help to deliver improved
    medical care that meets the needs of these diverse patients and their
    communities.
                  creating partnerships: rare diseases network
        Another NCRR initiative--the Rare Diseases Clinical Research
    Network--illustrates the importance of bringing patients and
    researchers together. Headed by NCRR in partnership with the NIH Office
    of Rare Diseases, the network is truly a trans-NIH activity, with
    funding coming from five additional NIH institutes. The need for such a
    network is best appreciated when one considers the emotional toll a
    family faces when they find out that their child has a rare disease and
    the desperation they face when they search for medical resources. For
    example, Trish Hertzog, a mother from Philadelphia who agreed that we
    could tell her story to help others, can vividly recall the day her son
    Mathew was born more than a decade ago. Unbeknownst to anyone,
    including his doctors, this seemingly healthy newborn lacked a critical
    gene that helps to remove toxic substances from the body. Within two
    days of his birth, Mathew fell into a coma, as lethal levels of ammonia
    built up in his brain, and died within hours.
        Mathew Hertzog had inherited a rare condition known as a urea cycle
    disorder, which affects only about 1 in 30,000 children. Collectively,
    rare diseases affect about 25 million Americans, according to the
    National Organization for Rare Diseases. Research on rare diseases is
    especially challenging since few patients with the same condition can
    be recruited from any one clinical site.
        To improve outcomes and outreach, the Rare Diseases Clinical
    Research Network unites the efforts of researchers from multiple
    institutions and their patients nationwide. The Network's web site has
    become a source of information for the public, physicians, patients,
    and investigators about rare diseases. The site also contains a unique
    web-based contact registry for patients who wish to learn about
    clinical studies. With this Network now available, parents like Trish
    can obtain information about rare diseases and learn about
    participating in one of the initial clinical trials.
           widening the net: under-represented populations and areas
        NCRR is using the latest advances in technology to promote greater
    inclusion of under-represented minority and rural populations in
    research by boosting capacity in institutions and regions of the
    country that lack high-capacity, broad-bandwidth Internet connections.
    Some states--including Montana, Wyoming, Alaska, Idaho, Nevada, and
    Hawaii--lack access to advanced Internet applications, such as virtual
    laboratories, digital libraries, distance education, as well as
    advanced networking capabilities. This lack of resources hinders the
    ability of the institutions in these states to conduct collaborative,
    data-intensive biomedical studies. In the first phase of a national
    effort called IDeANet, NCRR is enhancing high-speed network
    connectivity in these five rural Western states and Hawaii, which will
    bring these areas on par with connectivity in the other parts of the
    country.
        This effort is part of the Institutional Development Award (IDeA)
    Program, which broadens the geographical distribution of NIH funding
    for biomedical research. Ultimately, IDeANet will expand to include
    NCRR's Research Centers in Minority Institutions Program, which
    enhances the research capacity and infrastructure at minority colleges
    and universities that offer doctorates in health sciences.
                     spurring advances through data sharing
        Through the Biomedical Informatics Research Network (BIRN), NCRR
    supports the integration of data, expertise, and unique technologies to
    spur scientific advances that would be difficult or impossible in the
    context of individual laboratories. To illustrate this point, five
    volunteer research participants traveled across the country to nine
    different sites to have their brains imaged via magnetic resonance
    imaging (MRI). The data that was collected contributed to a first-of-
    its-kind neuroimaging dataset that will enhance large-scale, multisite
    imaging studies for years to come. Scientists found that brain images
    from a single individual appeared surprisingly different when collected
    at different MRI centers--such variance would greatly hamper multi-site
    imaging studies. Through BIRN, scientists have recently developed
    software tools to standardize data and reduce this type of inter-site
    variability in brain scans. This collaboration is just one example of
    how BIRN contributes to solving complex health-related problems. While
    initial efforts are focusing on neuroimaging data, the tools and
    technologies developed by BIRN ultimately may be applied to other
    disciplines.
              providing critical links: nonhuman primate research
        Studies of nonhuman primates are indispensable to translational
    research, providing a critical link between small laboratory animals
    and human subjects. Many of today's life-saving interventions--
    including polio vaccines, AIDS-fighting drugs, and heart surgery
    techniques--depended on preliminary evaluation in nonhuman primates
    like the rhesus macaque. To support such studies, NCRR funds eight
    highly specialized research facilities known as the National Primate
    Research Centers, which bring together researchers with a variety of
    expertise, thereby contributing to studies of major human health
    issues, including cancer and neurodegenerative disorders.
        Because the nation currently lacks a sufficient number of
    clinically trained primate veterinarians, NCRR plans to support an
    initiative to attract and train graduate-level veterinarians in the
    procedures for conducting primate research. A well-trained veterinary
    research corps will enhance the country's capacity to respond to the
    emergence and spread of potentially deadly human diseases, such as
    severe acute respiratory syndrome (SARS), influenza, and hepatitis.
                     promoting science and health literacy
        By supporting collaborations among educators, researchers,
    community groups, museums, and other organizations, NCRR's Science
    Education Partnership Award program increases the public's
    understanding of medical research and delivers information about
    healthy living and career opportunities in science to children and the
    general public. For instance, a novel project at the University of
    Maryland is infusing physical education classes in grades 3-5 with
    science-enriched curriculum to enhance children's knowledge of the
    heart and other muscles and the importance of physical fitness. Another
    project, a partnership involving the University of Hawaii and
    culturally diverse local communities, is designed to enhance biomedical
    education and mentoring for children and their teachers on isolated
    Hawaiian islands. By providing students with opportunities to
    participate in hands-on, inquiry-based research projects, NCRR hopes to
    demystify science and make it more accessible to individuals throughout
    the nation.
                                   conclusion
        The future of medical care will depend on our commitment to bring
    together scientists with diverse expertise and to support research
    institutions with varying strengths and research capacities. At the
    same time, we must ensure the participation of researchers and patients
    who are from ethnically and geographically diverse communities and
    share the importance of medical research with educators and students.
    Our goal in the coming year is to enhance these collaborations,
    partnerships, and networks in order to bring the power of shared
    resources to researchers across the nation and maximize our research
    investments.
                                     ______

    Prepared Statement of Dr. Jeremy Berg, Director, National Institute of
                            General Medical Sciences
        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2007 President's budget request for the National
    Institute of General Medical Sciences (NIGMS). The fiscal year 2007
    budget includes $1,923,481,000, a decrease of $12,137,000 from the
    fiscal year 2006 enacted level of $1,935,618,000 comparable for
    transfers proposed in the President's request.
        NIGMS supports a broad spectrum of research central to the National
    Institutes of Health's mission of improving the nation's health. Over
    the years, this foundational work has led to important breakthroughs
    and treatments. Biophysical studies sparked the development of life-
    saving drugs for AIDS. Inventive burn and trauma research yielded the
    first artificial skin to treat severely burned patients. Most recently,
    research in pharmacogenetics led the Food and Drug Administration (FDA)
    to change the label of irinotecan, a drug approved in 1996 for
    colorectal, lung, and other cancers. The label now indicates that
    people with a certain genetic variation are at a greater risk for life-
    threatening reactions to the drug and encourages doctors to use a lower
    starting dose for those patients.
        In other areas, such as chemistry, groundbreaking basic research
    helped support drug development by the pharmaceutical industry. NIGMS'
    investment in this area was recognized with the 2005 Nobel Prize in
    chemistry, bringing the number of laureates whose research we have
    funded to 57. Long-time grantees Robert H. Grubbs, Ph.D., of the
    California Institute of Technology and Richard R. Schrock, Ph.D., of
    the Massachusetts Institute of Technology were honored for developing a
    revolutionary way of synthesizing new molecules. Their discoveries
    transformed a seemingly esoteric process into a practical tool that is
    now routinely used in the pharmaceutical industry and in other areas of
    the economy, including the plastics industry.
                           strengthening the pipeline
        In addition to providing stable research support to these chemists,
    NIGMS provided funds to support their transition from trainees to
    independent researchers. The Institute has a number of structured
    programs that offer thousands of trainees access to state-of-the-art
    resources, rigorous curricula, and high-quality ethics training. Each
    year, many scientists receiving NIGMS support launch independent
    careers and join the ranks of top-notch researchers in a wide range of
    scientific disciplines.
        Many creative contributions like the few I have highlighted above
    are the work of individual bright minds. However, as biomedical
    research converges and scientific fields meld together in new ways,
    researchers working in different areas need to combine their talent and
    expertise. Recognizing the dual need for teamwork and individual
    intellectual contribution, NIGMS has invested its resources wisely. In
    addition to funding a substantial number of individual investigators,
    we have broadened our investment by funding large, multidisciplinary
    scientific teams. These programs have served a truly catalytic role in
    tackling issues of great importance to public health, and I would like
    to describe some of their recent advances.
                         dawn of personalized medicine
        The NIGMS-led Pharmacogenetics Research Network (PGRN), a trans-NIH
    project consisting of 12 scientific teams, has just completed its first
    5 years of work with an impressive track record. For example, the
    treatment of childhood leukemia is improving due to the discovery that
    variations in two genes can predict which patients with the most common
    form of the disease have a higher risk of relapse. On the horizon is
    safer dosing of the widely used blood-thinning medicine Coumadin (also
    known as warfarin) due to the discovery that normal variation in two
    genes can put some patients at risk for excessive bleeding or for heart
    attacks and strokes. PGRN researchers have also made important strides
    in unraveling disparities in response to treatments for asthma, a
    disease that affects roughly 20 million Americans, according to the
    American Lung Association. Recent findings show that variation in just
    a few genes affects responses to two mainstay asthma therapies, inhaled
    steroids and beta-agonists. Genetic tests to detect these variations
    may be available within a year.
        Other payoffs from NIGMS investments in pharmacogenetics extend
    beyond implications for individual drug dosing. PGRN research has
    unexpectedly uncovered knowledge that can predict disease risk in
    subsets of patients, including those taking tamoxifen for breast cancer
    and beta-blockers for heart disease. Finally, NIGMS-sponsored research
    in pharmacogenetics is having an impact on policy. PGRN studies have
    played a role in the FDA's recent decision to develop new guidelines
    for personalized medicines. For example, an FDA program that allows
    manufacturers to submit pharmacogenetic data for review has seen a jump
    from six submissions to 25 in the space of 1 year.
                    teaming science for public health gains
        NIGMS' innovative ``glue grant'' program is a novel approach that
    brings together scientists from different disciplines to attack
    problems beyond the scope of an individual investigator but crucial to
    the future of the public health enterprise. One example of a recent
    glue grant advance is the discovery that genes can help explain why
    patients can have dramatically different reactions to traumatic injury.
    The NIGMS-funded Inflammation and the Host Response to Injury research
    group, which performed this study, will also release this year a set of
    standard operating procedures for the care of critically injured
    patients. This work, while still in the early stages, is moving ahead
    rapidly and will likely improve standards for treatment across the
    nation as well as facilitate the conduct of high-quality research in
    this important field.
        Many areas of basic biomedical research require an incubation
    period before results emerge and new knowledge is translated into the
    clinic. Both pharmacogenetics and much of the complex biology being
    investigated with glue grants are good examples, and the recent
    achievements I've described offer evidence that the wait has been worth
    it. However, in other circumstances NIGMS has invested basic research
    expertise in areas quite ripe for practical development. A case in
    point is the Models of Infectious Disease Agent Study (MIDAS), not yet
    2 years old, which has already made an important mark on the public
    health policy landscape. Several key papers have emerged from this
    highly interdisciplinary effort, and the program continues to be fluid,
    evolving to match public health needs. The MIDAS network is focusing on
    modeling the spread of influenza, and its models are providing key
    inputs to policy makers and health officials engaged in preparing for
    possible influenza pandemics.
                          value of a systems approach
        The ready application of MIDAS research to current flu preparedness
    efforts is apparent, but I'd like to point out that this research is a
    shining example of what may seem a more esoteric concept: systems
    biology. In fact, systems biology is a powerful and promising approach
    for investigating how to control the progression of diseases worldwide.
        Systems biology addresses how the parts of a complex network work
    together to produce the behavior of the overall system. The threads of
    systems biology are apparent in pharmacogenetics, which goes beyond the
    consideration of a drug and its target to examine other molecules that
    affect drug action and determine how apparently subtle variations in
    these molecules can affect drug efficacy and safety. In infectious
    disease modeling, the properties of an infectious agent are
    superimposed on the structure of society, from transportation networks
    to human behavior. Systems biological approaches require
    interdisciplinary teams of scientists working together toward a common
    goal that is often closer to practical applications than are the
    powerful, ``one component at a time'' approaches that have driven
    biomedical research so successfully over the past decades.
                               power of the mind
        Let me finish by returning to the contributions of individual
    minds. I'll highlight two relatively young scientists who have been
    recognized by the NIH Director's Pioneer Award program for their
    exceptional potential to make major breakthroughs.
        The first is Sunney Xie, Ph.D., of Harvard University. He is a
    pioneer in the development of methods that can see single biological
    molecules in action. Most biomedical experiments examine millions or
    more molecules, revealing the average behavior of all of them. While
    this information can be highly useful, many details are lost. Dr. Xie's
    methods, developed through an inspired application of techniques from
    physics and chemistry, look at the behavior of one molecule at a time.
    This is like being able to hear one conversation clearly rather than
    hearing the din of a room full of people all talking at once. As these
    methods mature, they have the potential to transform our understanding
    of how gene expression is controlled in normal and diseased cells.
        The second NIH Director's Pioneer Award winner I will mention is
    neurobiologist Erich Jarvis, Ph.D., of Duke University. Dr. Jarvis, an
    African American who grew up amid poverty, drugs, and violence in
    Harlem, seeks to unravel the mysteries of vocal learning. He is
    investigating this question using songbirds as a model system, and he
    has already made important strides in unlocking some of the complexity
    of one of biology's unexplored frontiers: the brain. Although his
    research falls outside the realm of the NIGMS mission and Dr. Jarvis is
    not currently an Institute grantee, I tell you his story for a
    different, very important reason. He is a terrific example of what we
    stand to lose if we do not continue to invest in the creative
    individual sparks of young scientists in our diverse society. At least
    part of Dr. Jarvis's rise to success can be attributed to chances he
    got in school. He participated in the NIGMS Minority Biomedical
    Research Support and Minority Access to Research Careers programs as an
    undergraduate at the City University of New York, Hunter College, where
    he received a bachelor's degree in biology and mathematics. He later
    earned a Ph.D. in molecular neurobiology and animal behavior from the
    Rockefeller University and today works at the forefront of an exciting
    discipline at the intersection of biomedical and behavioral research.
        The creative energies of potential biomedical researchers--not just
    those in fields traditionally related to biomedicine but also those in
    associated fields in the physical, mathematical, behavioral, and social
    sciences--will drive advances leading to improvements in human health
    for many years to come. Nurturing a diverse scientific workforce will
    enhance the vitality of our nation and improve the health of our
    children and their children.
        Thank you, Mr. Chairman. I would be pleased to answer any questions
    that the Committee may have.
                                     ______

        Prepared Statement of Dr. Patricia A. Grady, Director, National
                         Institute of Nursing Research
        Mr. Chairman and Members of the Committee: I appreciate the
    opportunity to present the fiscal year 2007 President's budget request
    for the National Institute of Nursing Research (NINR). The fiscal year
    2007 budget includes $136,550,000, a decrease of $792,000 over the
    fiscal year 2006 enacted level of $137,342,000 comparable for transfers
    proposed in the President's request.
        I am pleased to describe some of the exciting research of the
    National Institute of Nursing Research (NINR). NINR is charged with
    supporting research that establishes the scientific basis of quality
    patient care regardless of disease or health status. We fund research
    that affects individuals across the lifespan and all health care
    settings, especially the underserved.
        NINR is currently celebrating the 20th anniversary of its
    establishment at NIH. We have used this occasion not only to take stock
    of our accomplishments, but more importantly, to look toward the future
    role of NINR's research in today's increasingly complex health care
    environment. We are faced with an aging population at a time when our
    Nation is experiencing a shortage of nurses. We are also in an era of
    new technologies, which demands that nurses be technologically-savvy
    and able to adapt these new methods to a variety of patient populations
    and settings. This dynamic health care environment provides many
    opportunities for nursing research to address a variety of challenges
    and improve health care for all patients.
        Let me give you a few examples of how our research has improved
    lives and the promise it holds for the future.
                      healthy mothers and healthy children
        Sleep and Healthy Pregnancies.--Women often complain of fatigue and
    difficulty sleeping during pregnancy, especially as they approach
    delivery. Researchers studied women who slept less than 6 hours per
    night or who experienced frequent sleep disturbances during their
    pregnancy. These women had significantly longer labors and were 3-4
    times more likely to have a cesarean delivery than women who slept 7-8
    hours a night with fewer disruptions. These results highlight the
    importance of adequate sleep during pregnancy, and suggest a need for
    care providers to stress better sleeping habits to their pregnant
    patients.
        Children and Health Disparities.--In fiscal year 2007, NINR will
    solicit new intervention research proposals aimed at reducing health
    disparities among children. NINR is committed to reducing disparities
    in health care, but current research in this area often targets adults.
    Children who live in poverty have little access to health care, and
    these children are disproportionately from minority populations. NINR's
    effort to reduce disparities in child health will target such areas as:
    developing culturally-sensitive interventions to promote physical
    activity and healthy diets in children, reducing health risk factors in
    children that lead to poor health outcomes, and studying how gender and
    immigrant status affect child health and access to health care.
                      staying healthy throughout adulthood
        Culturally-sensitive Diet Intervention.--Diabetes is prevalent
    among rural African-Americans, and compliance with dietary self-
    management guidelines is often poor. In one study, NINR researchers
    tested a dietary intervention for diabetic African-Americans living in
    rural South Carolina. Through culturally-tailored classes that taught
    healthy food choices and low-fat cooking techniques, participants
    successfully lowered their body weight and fat intake. Other community-
    based interventions that include culturally-relevant components show
    similar successes. These types of programs may be important tools in
    promoting health and reducing health disparities.
        Heart Disease in Women.--Heart disease, the number one cause of
    death in the United States, is sometimes more difficult to diagnose in
    women than in men, because women can exhibit different symptoms of
    heart disease than men. Better ways of detecting heart disease are
    therefore needed. NINR investigators are currently developing and
    testing a new screening tool that could predict whether or not certain
    women are at risk for serious heart disease. The test takes into
    account the different symptoms that women with heart disease
    experience, and it factors in the diverse symptoms experienced by women
    of different races.
                 understanding aging and caring for the elderly
        Improving Self-management for the Elderly.--The aging American
    population has tremendous implications for our health care system.
    Better tools are needed to prevent and treat the health problems
    experienced by the elderly in a cost-effective manner. Improving self-
    management strategies is one way to decrease hospital and long-term
    care costs. Health professionals have developed telehealth programs
    that allow elderly patients to monitor and manage their symptoms at
    home by communicating with their providers over the phone or the
    internet. However, the effectiveness of telehealth interventions has
    not been well-studied. NINR investigators are currently testing a self-
    management telehealth intervention for patients with heart failure. The
    investigators will study questions such as: Is the intervention more
    effective than traditional methods of treatment? Are elderly patients
    willing to use the new technology? Do these techniques save money?
    Findings from these studies may help providers better use technology in
    self-management. This could ultimately lead to a higher quality of life
    for patients, and lower health care costs for consumers.
        Caregivers and Depression.--An aging population also means that an
    increasing number of spouses and children will be caring for their
    infirm partners or parents. In addition to significant economic and
    societal costs,\1\ caregiving may also have serious negative health
    impacts. Caregiving can often be a stressful and time-consuming
    experience for those who take on the responsibility. NINR has funded a
    wide range of studies to analyze the burdens experienced by caregivers
    and develop methods to alleviate these burdens. One group of NINR
    researchers surveyed over 2,000 female caregivers of elderly veterans
    with dementia and found that over one-third of the caregivers exhibited
    symptoms of depression. However, less than one in five of those with
    depression were using antidepressants; Caucasians were twice as likely
    as African-Americans to be taking such medications. These results
    suggest that caregivers should be routinely screened for depression and
    that better efforts may be needed to educate informal caregivers about
    the potential benefits of antidepressant therapy.
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        \1\ Langa KM, Chernew ME, Kabeto MU, Herzon AR, Ofstedal MB, Willis
    RJ, Wallace RB, Mucha LM, Straus WL, Fendrick AM, National Estimates of
    the Quantity and Cost of Informal Caregiving for the Elderly with
    Dementia. J Gen Intern Med 16: 770-778, 2001.
    ---------------------------------------------------------------------------
                    patients and families at the end of life
        The final stage of life is a challenging time for everyone
    involved, from the patient, to attending physicians and nurses, and to
    bereaved family and friends. NINR is the lead NIH institute for end-of-
    life research. We are charged with finding ways to improve end-of-life
    care for all involved and ensure that patients experience death with as
    much dignity and comfort as possible. We fund research on such topics
    as: better management of symptoms prior to death; improving
    communication between doctors, patients, and family members; and
    examining factors that influence end-of-life decision-making. NINR
    researchers continue to make important findings in these areas.
        Communicating with Families at the End of Life.--One study found
    that physicians in intensive care units often fail in communicating
    with family members when discussing the withholding or withdrawal of
    care from a dying patient. Problems included failures to listen to the
    concerns or address the emotions of the family members. Physicians also
    failed to properly explain the uses and purpose of palliative care or
    the ethical basis for deciding to remove life-prolonging therapies. A
    better awareness of these gaps can help physicians and nurses improve
    their communication skills for talking to families in difficult times.
                nursing shortages and training nurse researchers
        The current aging of our population comes at a time when the supply
    of nurses in the United States cannot meet the demand. In addition, new
    advances in medical technology require a more technologically-savvy
    nursing workforce. There was a shortage of approximately 168,000
    registered nurses in the United States in 2003, and this shortage is
    expected to top 1 million by 2020. The field of nursing research is
    experiencing the effects of this shortage. Fewer nurses mean fewer
    nurse researchers, and that means fewer nursing faculty.
        NINR continues to fund innovative initiatives to train new nurse
    researchers. Our Nursing Partnership Centers to Reduce Health
    Disparities partner research-intensive universities with minority-
    serving institutions to increase the number of researchers from
    underserved populations. We also continue to collaborate with
    universities on training students in fast-track baccalaureate-to-
    doctoral programs to speed the process of developing new nurse
    scientists and faculty.
                            ninr and the nih roadmap
        NINR has incorporated two key themes of the NIH Roadmap into its
    research agenda: Interdisciplinary Research Teams of the Future and Re-
    engineering the Clinical Research Enterprise. Historically, NINR has
    maintained a focus on interdisciplinary research, but increased
    collaborations made possible by the Roadmap have fully introduced
    nursing science to the rest of the scientific community. They have also
    enabled nurse scientists to expand the breadth of their own work.
    Because of the strongly clinical emphasis of the NINR research
    portfolio, the Roadmap's clinical research initiatives are ideally
    suited to NINR. We will actively pursue Roadmap initiatives that seek
    to develop new technologies to measure patient symptoms and quality of
    life, and others that strive to develop skilled clinical investigators
    with strong multidisciplinary backgrounds.
                                   conclusion
        In conclusion, NINR continues to discover effective approaches to
    meeting the challenges of today's dynamic health care environment,
    while looking ahead to meet the health care needs of tomorrow. We will
    strive to improve the quality of care and quality of life for all
    individuals, especially the underserved, regardless of age or disease.
    We will also train the next generation of leaders in nursing research.
    The past twenty years have demonstrated the power of nursing research.
    The future holds endless opportunities.
        Thank you, Mr. Chairman. I will be happy to answer any questions
    that the Committee might have.
                                     ______

        Prepared Statement of Dr. Richard J. Hodes, Director, National
                               Institute on Aging
        Mr. Chairman and Members of the Committee: The NIA is requesting an
    fiscal year 2007 budget of $1,039,828,000, a decrease of $6,803,000, or
    .6 percent below the fiscal year 2006 enacted level.
        Thank you for this opportunity to participate in today's hearing. I
    am Dr. Richard Hodes, Director of the National Institute on Aging, and
    I am pleased to be here today to tell you about our progress making and
    communicating scientific discoveries that will improve the health and
    well-being of older Americans.
        There are today approximately 35 million Americans ages 65 and
    over, according to the U.S. Bureau of the Census, and this number is
    expected to rise dramatically in the coming decades as members of the
    Baby Boom generation reach retirement age. These older Americans are
    more likely than at any other time in history to enjoy good health and
    an active lifestyle: Data from the National Long Term Care Survey
    (NLTCS) indicate that the rate of disability among older Americans
    dramatically declined from the 1980s through the mid 1990s, even among
    the ``oldest old,'' people age 85 and older. At the same time, however,
    the downward trend in disability among the elderly may be in danger of
    reversal. Data from the National Health Interview Survey show that,
    over the same period, the disability rate actually rose significantly
    for people ages 18-59, with the growing prevalence of obesity an
    important factor in this trend. Now, in fact, some demographers are
    forecasting a complete leveling-off of the disability decline in the
    coming decade.\1\
    ---------------------------------------------------------------------------
        \1\ Goldman DP et al. Consequences of Health Trends and Medical
    Innovations for the Future Elderly. Health Affairs online special issue
    ``Health and Spending of the Future Elderly.'' R5-R17, 2005.
    ---------------------------------------------------------------------------
        The mission of the National Institute on Aging (NIA) is to improve
    the health and well-being of older Americans through research. In
    support of its mission, the Institute conducts and supports an
    extensive program of research on all aspects of aging, from the basic
    cellular and molecular changes that occur as we age, to the prevention
    and treatment of common age-related conditions, to the behavioral and
    social aspects of growing older, including the demographic and economic
    implications of an aging society. In addition, the NIA is the lead
    Federal agency for research related to the all-important effort to
    prevent and treat Alzheimer's disease (AD). Finally, our education and
    outreach programs provide vital information to older people across the
    Nation on a wide variety of topics, including living with chronic
    conditions, maintaining optimal health, and caregiving.
               alzheimer's disease and the neuroscience of aging
        Alzheimer's disease is a devastating condition with a profound
    impact on individuals, families, the health care system, and society as
    a whole. Approximately 4.5 million Americans are currently battling AD,
    with annual costs for the disease estimated to exceed $100 billion.\2\
    Moreover, the rapid aging of the American population threatens to
    increase this burden significantly in the coming decades: By 2050, the
    number of Americans with AD could rise to some 13.2 million, an almost
    three-fold increase.\3\
    ---------------------------------------------------------------------------
        \2\ Data from the Alzheimer's Association. See also Ernst, RL; Hay,
    JW. ``The U.S. Economic and Social Costs of Alzheimer's Disease
    Revisited.'' American Journal of Public Health 1994; 84(8): 1261--1264.
    This study cites figures based on 1991 data, which were updated in the
    journal's press release to 1994 figures.
        \3\ Hebert, LE et al. ``Alzheimer Disease in the U.S. Population:
    Prevalence Estimates Using the 2000 Census.'' Archives of Neurology
    August 2003; 60 (8): 1119-1122.
    ---------------------------------------------------------------------------
        Dr. Zerhouni has told this Committee about the NIH's new paradigm
    for biomedical research that is ``predictive, personalized, and
    preemptive.'' This vision greatly informs the NIA's comprehensive
    program of Alzheimer's disease research. NIA-supported investigators
    conduct research on topics across the spectrum of AD-related inquiry,
    from basic brain biology to clinical trials of potential interventions.
    Through these studies, we are uncovering new predictors of individual
    risk for AD, and using this information, along with a greater
    understanding of specific pathways mediating disease processes, we are
    developing new approaches to prevention and treatment.
        Risk Factors and Early Diagnosis.--Population studies suggest that
    conditions affecting the circulatory system may be associated with
    higher risk for dementia, or that the presence of vascular disease may
    influence the progression of AD. One recent report indicated that AD
    dementia may be exacerbated by other cerebrovascular problems such as
    small strokes, while another linked untreated high blood pressure in
    mid-life with increased risk of dementia in later life. The possible
    association of diabetes, insulin resistance, and AD is garnering
    increased attention as well; recent findings from at least four long-
    term studies link diabetes with decline in cognitive function. The NIA
    recently funded two clinical trials to examine directly whether
    diabetes-related interventions might be effective in preventing or
    delaying cognitive decline or development of Alzheimer's disease.
        Research suggests that the earliest AD pathology begins to develop
    in the brain long before clinical symptoms yield a diagnosis; the
    ability to make an accurate early diagnosis of AD would be highly
    beneficial. Improvements in brain imaging, coupled with the development
    of more sensitive cognitive tests, are enabling us to diagnose AD in
    the research setting with greater precision than ever before. Imaging
    techniques may become important for a number of other reasons,
    particularly in helping investigators understand events unfolding in
    specific regions of the brain in the very early stages of Alzheimer's
    disease and in assessing the effectiveness of potential therapeutic
    strategies. To speed both the development of imaging techniques and the
    discovery of biological markers to detect Alzheimer's disease, the
    National Institute on Aging and other Federal partners, in conjunction
    with nine pharmaceutical/biotech companies, the Institute for the Study
    of Aging, and the Alzheimer's Association, announced the Alzheimer's
    Disease Neuroimaging Initiative in October 2004. The study will test
    whether serial MRI, PET, or other biological markers can be used in
    conjunction with clinical and neuropsychological assessment to measure
    earlier and with greater sensitivity the development and progression of
    mild cognitive impairment (MCI) and early Alzheimer's disease. This
    major public-private partnership could help researchers and clinicians
    develop new treatments and monitor their effectiveness as well as
    lessen the time and cost of clinical trials. The study, which is taking
    place at approximately 50 sites across the United States and Canada,
    began recruitment in late 2005; approximately 800 people ages 55 to 90
    will participate over the five years of the study.
        Prevention and Treatment.--Results of a growing number of studies
    are suggesting that diet and exercise may have significant benefits on
    not only physical but also cognitive health. For example, in one recent
    study, researchers related fruit and vegetable consumption among 13,388
    older women over a 10-16 year period to subsequent cognitive
    performance and found that women consuming the most green leafy
    vegetables experienced slower decline than women consuming the least
    amount. Long-term epidemiologic studies now also suggest that exercise
    may have a specific influence on aspects of cognitive decline, and
    researchers are hoping that clinical trials will be able to directly
    test the therapeutic value of exercise and diet for improved cognitive
    performance and, eventually, for reduced risk of AD. Small clinical
    trials currently are ongoing to test the effects of exercise on
    cognitive decline, both in older adults with normal cognition and in
    persons with mild cognitive impairment with memory decline; a larger
    trial that would include a cognitive component is in the planning
    stages. In addition, the planned Lifestyle Interventions and
    Independence for Elders (LIFE) study, which has been designed to
    determine whether physical exercise is effective for preventing major
    mobility disability or death, will include a cognitive component.
    Clinical trials are also ongoing to test the effects of a variety of
    dietary supplements, including antioxidants and alpha-lipoic acid, on
    cognition.
        Investigators are also searching for drugs that will be effective
    in stopping the progression of AD or, ultimately, preventing the
    disease altogether. Recently, investigators announced the discovery of
    the first agent shown to delay the clinical diagnosis of Alzheimer's in
    people with amnestic mild cognitive impairment, an MCI subtype strongly
    correlated with the later development of AD. The investigators found
    that individuals who took the drug donepezil (Aricept) were at reduced
    risk of progressing to a diagnosis of Alzheimer's disease during the
    first year of the trial, but by the end of the three-year study there
    was no benefit from the drug. Although donepezil's effects were
    limited, the results are nonetheless encouraging. And although too
    little is known about donepezil's long-term effects to support a
    recommendation for its routine use to forestall the diagnosis of AD in
    people with mild cognitive impairment, these findings do suggest that
    chemoprevention of AD is possible and support our hope that future
    clinical studies will lead to more significant progress.
                          other aging-related research
        Diseases of aging continue to affect many older men and women,
    seriously compromising their quality of life. Diseases and conditions
    currently under study at the NIA include:
        Obesity.--Overweight and obesity are widespread in the United
    States and are associated with an array of health problems, including
    heart disease, stroke, osteoarthritis, adult-onset diabetes, certain
    types of cancer and physical disability. NIH has assigned a high
    priority to research on obesity.
        These activities range from basic research on the genetic and
    biological mechanisms of overweight and obesity to human intervention
    studies. For example, recent studies of C. elegans, tiny worms
    frequently used for genetic studies, are providing important insights
    about fat regulation and storage that may that may be applicable in
    humans. NIA-supported researchers used RNA interference (RNAi), a
    technique in which genes are inactivated one at a time to determine
    their function, to screen the worm's genome and found some 417 genes
    involved with fat regulation and storage. Many of the genes they found
    have human counterparts, a number of which had not been previously
    implicated in the regulation of fat storage. The genes identified in C.
    elegans may ultimately suggest new targets for treating human obesity
    and its associated diseases.
        Research has also shown that many of the disabling conditions
    affecting older people could be diminished through regular exercise and
    that fitness affects mortality risk regardless of an individual's body
    fat. One study, which followed men 30-83 years of age for an average of
    eight years, found that within each category of body fatness, ``fit''
    men--as measured by exercise testing--were at a lower risk of death. In
    addition, among fit men, obesity was not significantly related to risk
    of death. In another study, low fitness increased mortality risk in men
    approximately fivefold for cardiovascular disease and threefold for
    all-cause mortality. Low fitness was associated with higher mortality
    in all weight groups.
        At a 2004 NIA and Centers for Medicare and Medicaid Services (CMS)
    sponsored workshop, researchers used published findings and trends to
    postulate that if the United States were able to prevent obesity until
    a person reaches 65 years of age by adjusting the body mass index for
    all cohorts entering Medicare, we could realize a significant decline
    in the percent with heart disease and diabetes, a significant increase
    in the percent without disability, and a cost savings to Medicare on
    the order of $10 billion annually over the subsequent 30 years.\4\
    ---------------------------------------------------------------------------
        \4\ Lakdawalla, DN et al. The Health and Cost Consequences of
    Obesity Among the Future Elderly. Health Affairs on line special issue
    ``Health and Spending of the Future Elderly.'' R30-41.
    ---------------------------------------------------------------------------
        Heart disease.--Each year over 1 million Americans undergo
    angioplasty,\5\ Aa procedure in which a long, thin tube attached to a
    tiny balloon is used to access and widen a blood vessel at the site of
    narrowing or blockage. However, a significant number of these
    individuals go on to experience restenosis, or gradual narrowing of the
    artery at the site of the blockage; this condition is aggravated by the
    implanting of stents (tiny metal scaffolds placed inside the artery to
    hold it open). Restenosis usually occurs within six months of
    angioplasty and results from the migration of cells from the middle of
    the arterial wall into the inner layer of the artery, where they
    multiply and block normal blood flow. Recognizing that cell division is
    crucial to the development of restenosis, NIA scientists tested the
    anticancer drug paclitaxel (Taxol), which arrests cell division, as a
    means of preventing the tissue growth that leads to vessel narrowing,
    and found that stents coated with paclitaxel can delay restenosis both
    safely and effectively. The investigators obtained a patent for these
    paclitaxel-coated stents, and a cooperative research and development
    agreement was established with private industry partners to begin
    clinical testing. Today, paclitaxel is one of only two drugs that, when
    applied to stents, have been shown to safely reduce the incidence of
    restenosis in humans. FDA approval of paclitaxel-coated stents was
    granted in March 2004, and currently over 70 percent of the drug-
    eluting stents used worldwide are paclitaxel-coated. Approximately 1.8
    million patients worldwide have received paclitaxel-coated stents to
    date.
    ---------------------------------------------------------------------------
        \5\ Data from the National Heart, Lung, and Blood Institute.
    ---------------------------------------------------------------------------
        Diabetes.--NIH investigators searching for potential treatments for
    type 2 diabetes conducted a study of the compound exendin-4, an analog
    of a hormone that is naturally released after eating and that can lower
    blood sugar in people with diabetes. The investigators found that
    exendin-4 is safe and effective, and in April 2004, the Food and Drug
    Administration approved exenatide (ByettaTM), a synthetic
    derivation of exendin-4, for the treatment of type 2 diabetes.
                      health communications and promotion
        The NIHSeniorHealth website continues to be a major initiative that
    enables the growing number of ``wired seniors'' to find credible aging-
    related health information in an online format that is compatible with
    their cognitive and visual needs, as evidenced by NIH-supported
    research. Conceived by NIA and jointly developed with the National
    Library of Medicine (NLM), the website now includes 26 health topics
    developed by eleven NIH Institutes. Each month, 52,000 unique visitors
    browse over a half a million pages. NIHSeniorHealth serves as a model
    for web designers seeking to make sites accessible to older adults. To
    increase the number of older adults skilled in searching for health
    information online, NIA has developed and is evaluating a senior-
    friendly Internet training curriculum geared around NIHSeniorHealth and
    NLM's MedlinePlus web site for those who train older individuals to use
    computers.
        Changes in public health policy may necessitate the development of
    new communications strategies and techniques targeted at older
    Americans, as was demonstrated with the passage of Medicare Part D, the
    ``prescription drug benefit'' for U.S. seniors. NIA-supported
    researchers are currently using established datasets to rapidly collect
    information and analyze patterns of use under Medicare Part D; their
    findings have been communicated to the CMS on an ongoing basis and will
    inform the creation of new strategies for tailored communications that
    will assist older Americans in understanding and maximizing use of this
    important new program.
        Thank you for the opportunity to testify before this Subcommittee.
    I would be happy to answer any questions you may have.
                                     ______

      Prepared Statement of Dr. Sharon Hrynkow, Acting Director, Fogarty
                              International Center
        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2007 President's Budget for the Fogarty International
    Center (FIC). The fiscal year 2007 budget includes $66,681,000, which
    reflects an increase of $303,000 over the fiscal year 2006 enacted
    level of $66,378,000 comparable for transfers proposed in the
    President's request.
        Forty-seven years ago, Congressman John E. Fogarty noted, ``Time
    and time again, it has been demonstrated that the goal of better health
    has the capacity to demolish geographic and political boundaries and to
    enter the hearts and minds of men, women, and children in the four
    corners of the earth. It is an issue which serves as a forceful
    reminder of the oneness, the essential brotherhood of man.''
    Congressman Fogarty, the visionary namesake of the National Institutes
    of Health's (NIH's) John E. Fogarty International Center for Advanced
    Study in the Health Sciences (Fogarty), recognized that when it comes
    to disease, we are truly one world. His words and those of his
    Congressional colleagues implored us to work for ``a healthy America,
    in a healthier world.''
        Today, Fogarty works to meet this goal in two ways: by supporting
    the whole of the NIH mission via international partnerships, and
    through the support of global health research and training programs
    aimed at improving the health of citizens in the United States and
    around the globe. As a nation, our interest in global health stems not
    only from humanitarian concerns, but also from an enlightened self-
    interest. Such interests involve protecting our nation from imported
    diseases, and political and economic considerations--healthy, stable
    countries make strong allies and trading partners. In addition, through
    partnerships with scientists from around the world, we are able to
    identify new strategies and new understandings of disease processes,
    including HIV/AIDS, tuberculosis, and chronic diseases such as heart
    disease, that affect us all. I welcome this opportunity to relate
    Fogarty's progress over the past year and proposed plans for fiscal
    year 2007. While Fogarty's programs span over 20 topical areas, I will
    focus on three exemplars in this summary.
                            battle against hiv/aids
        Fogarty continues to place a high priority on combating HIV/AIDS
    the deadliest pandemic of modern times. According to UNAIDS, an
    estimated 4.9 million people worldwide became newly infected with HIV
    in 2004--the highest number of new cases reported in any single year
    since the beginning of the pandemic. As the United States works to
    combat the spread of AIDS domestically and globally, trained scientists
    in countries hard-hit by AIDS are crucial allies in our fight. In the
    18-year history of Fogarty's flagship AIDS program, the AIDS
    International Research and Training Program (AITRP), Fogarty has helped
    train 2,000 health scientists, including Ph.D. and Masters level
    researchers from developing countries working on AIDS. More than 50,000
    have received short-course training in their home countries through
    this program. These scientists represent a substantial increase in the
    global capacity to fight AIDS and provide a wealth of allies in our
    international struggle.
        Haiti has the largest number of people living with AIDS in the
    Caribbean. For almost two decades, Fogarty has invested in research and
    public health infrastructure to combat the HIV/AIDS crisis there. Haiti
    has now begun to ``turn the corner on AIDS,'' according to Dr. Jean
    Pape, Haiti's leading AIDS researcher and long-standing Fogarty
    collaborator. As a result of Fogarty's work and that of partner
    agencies, HIV seroprevalence at a key sentinel site in Haiti dropped
    from 6.3 percent in 1993 to 2.9 percent in 2003.
        Due to this strong research base, Dr. Pape's institution received a
    grant from the President's Emergency Plan for AIDS Relief (PEPFAR),
    allowing 2,000 patients to receive antiretroviral therapy. An analysis
    of the first 1,000 patients at the one-year follow-up indicates
    outcomes comparable to those achieved in the United States in terms of
    survival; other indicators show reduced amounts of HIV in the blood of
    AIDS patients, as well as increased amounts of cells that are critical
    to staving off the impacts of HIV. None of this would have been
    possible without the vision and foresight of Fogarty, working hand in
    glove with NIH partners, including the National Institute of Allergy
    and Infectious Diseases.
        In fiscal year 2007, Fogarty plans to expand both major AIDS
    programs in its portfolio. The AITRP expansion would involve new U.S.
    universities, including minority institutions, important partners as we
    work to address global health challenges and the range of U.S.
    challenges on AIDS. In addition, Fogarty's new training program in
    clinical, operational and health services research would be expanded to
    build much needed expertise in monitoring and evaluating AIDS programs
    abroad.
    addressing the threat of emerging and re-emerging infectious diseases:
                           prediction and preemption
        Little is known about the ecological factors that lead to the
    emergence or re-emergence of infectious diseases, including potentially
    pandemic diseases such as avian flu. We do know that most new diseases
    come from animals, both wild and domesticated. But beyond that we have
    little ability to predict the emergence of new diseases, or how new or
    existing diseases spread among animals, and from animals to humans. To
    better understand the relationships between ecological factors that
    drive emergence and transmission of infectious agents, and to develop
    predictive models that would suggest practical modes to interrupt
    disease spread, Fogarty led the development of a unique interagency
    program on the Ecology of Infectious Diseases (EID). The EID program
    fills a critical gap in our national effort to protect the health of
    the public--both in the United States and globally--against the threat
    of epidemic and emerging infectious diseases. The program links
    microbiologists, veterinarians, physicians, ecologists, geospatial
    scientists, and mathematical modelers together into transdisciplinary
    teams to create new knowledge and new methods to predict and prevent
    the spread of infectious disease. In its first years of operation, the
    EID program has already linked experts from 23 countries and has
    supported publication of over 200 scientific articles on dozens of
    human and wildlife diseases, including schistosomiasis, Hanta virus,
    cholera, and severe acute respiratory syndrome (SARS).
        SARS was first reported in southern China in the winter of 2002-
    2003, and within a few months it had spread to over two dozen
    countries. Within a month of its discovery, SARS was recognized as a
    viral respiratory illness caused by a newly identified coronavirus
    (CoV), yet the origin of the virus and how it was initially transmitted
    to humans remained a mystery. Preliminary evidence suggested that the
    palm civet (a raccoon-like mammal common in live animal markets in
    southern China) might have spread the virus to humans. However, the
    occurrence of related viruses in bats led some to think these animals
    may have been involved. A team of Fogarty-funded researchers from the
    United States, China, and Australia collected and analyzed specimens
    from nine species of bats in their native habitats in southern China.
    The team studied the presence of antibodies to the SARS virus and
    performed genome sequencing of viral isolates from positive tissues,
    comparing these genome sequences to that of the SARS virus. Study
    results indicate that bats are the natural reservoir of the SARS virus,
    suggesting that palm civets played an intermediary role in human
    infections. These findings have major implications for development of
    public health strategies to combat the spread of SARS. In fiscal year
    2007, FIC expects to expand the EID program in terms of the number of
    projects supported and their scope, simultaneously increasing the focus
    on supporting translation of research findings and predictions into
    action.
        As we consider the daunting challenge of pandemic avian influenza,
    programs such as the EID can provide a critical component in our
    ability to predict and prevent emergence and transmission of this and
    other disease threats. The United States and its global partners will
    be better poised to make effective interventions to prevent the spread
    of avian flu through understanding of migration patterns of reservoir
    bird species, the interactions between humans, domestic animals and
    birds, and the pathogen dynamics in and among these hosts. We cannot
    predict the spread of this disease, in its current zoonotic form, using
    mathematical or statistical models if we do not support the fieldwork
    necessary to sample wild and domesticated birds (work done by
    ornithologists, veterinarians, and ecologists). The field data are
    useful only for post field analysis if we integrate them into
    predictive models. The interagency EID program is unique in its
    integration of these methods into interdisciplinary teams to understand
    the biology and predict disease emergence and transmission.
                       global burden of trauma and injury
        According to the World Health Organization (WHO), the numbers and
    the global burden due to trauma and injury are on the rise: more than
    1.2 million people are killed in traffic accidents annually, and up to
    50 million more are injured or disabled. If current trends continue,
    the number of people killed and injured on the world's roads will rise
    by more than 60 percent between 2000 and 2020. Almost 90 percent of
    deaths due to injuries take place in poorer countries--this is true for
    all forms of such trauma including road accidents, war, homicides, and
    suicides. And, according to the Association for Safe International Road
    Travel, road traffic accidents are the second leading cause of death
    for Americans abroad.
        To address this growing challenge, Fogarty, working closely with
    the Centers for Disease Control and Prevention, WHO, the Pan American
    Health Organization, and eight other NIH institutes, initiated a
    research training program to build the capacity of developing country
    investigators and institutions to conduct human trauma and injury
    research. The International Collaborative Trauma and Injury Research
    Training (ICTIRT) program involves collaborators from United States and
    developing country institutions to train the next generation in basic
    and applied science, the epidemiology of risk factors, acute care and
    survival, rehabilitation, and the long-term mental health consequences
    of trauma and injury, including civil strife. Benefits of this program
    will accrue not only to developing countries but, as low-cost and
    effective strategies are identified, to communities around the world.
    This program was initiated with awards in fiscal year 2005 and fiscal
    year 2006. We anticipate new awards in fiscal year 2006 and fiscal year
    2007.
                                   conclusion
        The programs and international initiatives of the Fogarty
    International Center are a living testament to the vision of
    Congressman John E. Fogarty. As we consider the daunting global
    challenges of AIDS, avian influenza and chronic problems, including
    obesity and mental health disorders, we understand the
    interconnectedness of the United States and the global community. These
    challenges require us to move forward with efficiency and diplomacy,
    for the benefit of the American people and the global community.
                                     ______

    Prepared Statement of Dr. Thomas R. Insel, Director, National Institute
                                of Mental Health
        Mr. Chairman and members of the Committee: I am pleased to present
    the fiscal year 2007 President's budget request for the National
    Institute of Mental Health (NIMH). The fiscal year 2007 budget includes
    $1,394,806,000, which reflects a decrease of $8,709,000 under the 2006
    enacted level of $1,403,515,000 comparable for transfers proposed in
    the President's request. In my statement, I will call to your attention
    our Nation's most prevalent mental and behavioral disorders and include
    a brief review of our research activities and accomplishments.
                       burden and cost of mental illness
        Mental disorders are common, chronic, and disabling. They cause
    more disability than any other class of communicable medical illness in
    American adults under age 45, according to the World Health
    Organization's Global Burden of Disease report. The National
    Comorbidity Survey Replication (NCS-R), funded by NIMH and released in
    May 2005, documents the prevalence and severity of specific mental
    disorders in the United States. The study shows that half of all
    lifetime cases of mental illness begin by age 14, making these the
    chronic diseases of the young. About 6 percent of the U.S. population
    is afflicted with a severely disabling mental disorder in a given year.
    Most troubling, this landmark study has demonstrated that despite
    effective treatments, there are long delays--sometimes decades--between
    first onset of symptoms and when people seek and receive treatment.
        The cost in human suffering from these mental diseases is
    compounded further by their economic burden. According to the
    President's New Freedom Commission on Mental Health (2003), individuals
    with serious mental illnesses represent the single largest diagnostic
    group (35 percent) on the Supplemental Security Income (SSI) rolls.
    Medicaid is the largest single payer of mental health services, with
    more than 50 percent of all mental health expenditures paid for by the
    public sector (including Medicaid, Medicare, state and local
    governments.
        The good news is that there now are some extraordinary new tools
    and technologies, such as neuroimaging and genomics, with which to
    address these urgent public health needs. Our major challenge is to
    integrate and translate basic research discoveries and technological
    advances into practical strategies that can help all communities,
    including children, the socioeconomically disadvantaged, and others
    facing barriers to mental health care.
                         envisioning personalized care
        Research efforts stemming from former President George Bush's
    proclamation of the 1990s as the Decade of the Brain established that
    mental disorders (autism, bipolar, depression, schizophrenia, and
    others) are brain disorders. The current decade is one in which many
    major candidate molecules, cells, and circuits for normal and abnormal
    brain function are being identified for the first time. Through these
    discoveries research will definitively identify the specific brain
    pathways that underlie each of the major mental disorders. By
    identifying the features of the brain that go awry in mental illnesses,
    we will have clear new targets to test how biological, behavioral, and
    environmental factors affect illness and to develop more effective
    interventions with the ultimate vision of delivering personalized care
    through pre-emptive treatments and strategic preventions.
        Currently, there are effective treatments for many mental disorders
    such as depression and anxiety disorders. Studies show that even from a
    business standpoint, treating these disorders is highly cost-effective;
    national business groups are encouraging employers to support such
    treatments in order to reduce healthcare costs while also improving
    productivity and reducing absenteeism.
        Not all treatments work for everyone, however, and clearly there
    remains room for improvement in both diagnosis and treatment. In mental
    disorders, just as in the rest of medicine, diagnosis should rely on
    detection of biomarkers of the specific disease, and treatments should
    be based on medication and/or behavioral interventions targeting
    specific brain regions and processes. For a person with mental illness,
    one can imagine that a future clinician would use a cognitive task
    together with neuroimaging and genetics to diagnose and select a
    specific treatment, just as a contemporary cardiologist uses a stress
    test and echocardiogram to diagnose ischemic heart disease and select
    the proper intervention.
        It is critical to realize that this vision does not mean designing
    exotic technologies for a few privileged patients. The ultimate goal is
    personalized or individualized care for a broad spectrum of people with
    mental disorders. Now, specific treatments for any given patient are
    largely developed through trial and error. As researchers learn more
    about the brain pathophysiology of mental disorders and related
    behavioral and environmental factors, treatments will become more
    specific. Early detection of mental illnesses will require a thorough
    understanding of the range of risks that affect brain processes, which
    in turn is based on a comprehensive understanding of genetics and
    experience.
                           practical clinical trials
        As noted above, we have treatments that are helpful for nearly all
    of the mental disorders. But these treatments are not optimal; recovery
    is often slow, incomplete, and compromised by adverse effects. Since we
    do not know who will respond completely and who will develop adverse
    effects, each clinician depends on trial and error with each patient.
    The Institute has developed practical clinical trials in more than
    10,000 patients to help clinicians individualize treatments. Practical
    clinical trials, or ``effectiveness studies,'' are designed to examine
    changes in symptoms and functioning, changes which are vital to
    determining whether a treatment improves quality of life, caregiving
    burden, or health service use. The designs of practical clinical trials
    help increase relevancy to real-world clinical practice to help
    clinicians answer the question: what is the best treatment for my
    patient? Each of the following NIMH-funded practical clinical trials
    provides results from the largest and longest studies of their kind.
        In the Clinical Antipsychotic Trials of Intervention Effectiveness
    (CATIE) Study, 1,432 schizophrenia patients from 56 sites, including
    private practices, community health care centers, and state facilities,
    were randomly assigned to treatment with one of five medications for 18
    months. In the first phase of analysis the study found that newer,
    ``atypical'' antipsychotics are not much more effective than older,
    conventional antipsychotics; however all the medications studied have
    unique side effect profiles, some of which include significant weight
    gain and metabolic side effects, thus increasing risk for diseases such
    as diabetes. Later phases of this study will examine crucial issues
    including effects of switching from one treatment to another, use of
    health services, and cost-effectiveness.
        Another example is the Treatment for Adolescents with Depression
    Study (TADS), which compared short- and longer-term effectiveness of
    medication and psychotherapy for depression in 439 adolescents. TADS
    was designed to test best-practice care for depression and was carried
    out by 13 academic and community clinics across the country.
    Researchers found that fluoxetine (a selective serotonin reuptake
    inhibitor) in combination with cognitive behavioral therapy was more
    effective against adolescent depression than either one alone. In
    addition, clinically significant suicidal thinking was greatly reduced
    in all four treatment groups, with those receiving medication combined
    with cognitive therapy showing the greatest reduction. This is an
    especially important finding, considering recent concerns that the use
    of antidepressant medications themselves may induce suicidal behavior
    in youths. This study shows that treatment leads to a significant
    improvement of depression overall. It is vital that all patients being
    treated for depression be closely monitored.
        The Sequenced Treatment Alternatives to Relieve Depression Trial
    (STAR-D) examines 4,041 adults with major depression, particularly
    those who previously showed poor outcomes to treatment, to see if
    switching medications or augmenting the initial drug be more likely to
    achieve a remission. The study, conducted at 41 sites coordinated by 14
    regional centers, will also answer how the side effects of the various
    medications compare and how psychotherapy compares with medication for
    treatment-resistant depression.
        In the Systematic Treatment Enhancement Program for Bipolar
    Disorder (STEP-BD) trial, 4,360 participants with bipolar disorder from
    20 private, state, and community practice sites underwent various
    treatment pathways to find the most effective long-term and acute
    treatments and ways to prevent relapse. In the first phase, slightly
    more than half of the first group of 1,469 participants (58 percent)
    achieved recovery. In addition, almost half of the recovery group had a
    recurrence during the follow-up period, and the majority (70 percent)
    of recurrences was characterized by a return to a depressive state. In
    the following phases of the trial, not yet published, various
    treatments will be tried such as mood-stabilizing medications,
    antidepressants, atypical antipsychotics, and various ``talk''
    therapies, to see which is best for acute treatment, long-term
    treatment, and prevention of relapse.
                      nimh initatives for fiscal year 2007
        To further advance the vision of personalized mental health care,
    NIMH will pursue two collaborative initiatives in fiscal year 2007. The
    first is the Autism Phenome Project, in collaboration with the NIH
    Autism Coordinating Committee, the Centers for Disease Control and
    Prevention, and the Department of Energy. Just as the Human Genome
    Project identified the sequence and organization of human DNA, the
    phenome project seeks to identify the various clinical characteristics
    (phenotypes) and subtypes of autism and autism spectrum disorders.
    Identifying specific phenotypic subtypes will aid research on genetic
    and other potential causes and suggest more specific approaches to
    treatment.
        The second collaborative initiative is with the Department of
    Defense (DOD) and the Department of Veterans Affairs (VA) to study the
    mental health needs of active duty, National Guard, and Reserve
    personnel including their transition to VA health services. In
    particular, representative groups of men and women will be studied over
    time to assess post-deployment adjustment difficulties (including post-
    traumatic mood and anxiety disorders, and substance use and abuse
    disorders), the development and effectiveness of early detection and
    intervention methods, and the possibility of decreasing the risk of
    developing chronic conditions, disability, and death in those with
    adjustment difficulties.
        These initiatives, in conjunction with the exciting research
    already underway, will enable NIMH to make significant gains in the
    upcoming years. We intend to realize our vision of translating basic
    research and technologies to improved diagnosis, treatment, and
    preventive strategies that will allow development of personalized
    mental health care for the millions of Americans affected by mental
    illnesses.
                                     ______

    Prepared Statement of Dr. Stephen I. Katz, Director, National Institute
               of Arthritis and Musculoskeletal and Skin Diseases
        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2007 President's budget request for the National
    Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
    The fiscal year 2007 budget includes $504,533,000, a decrease of
    $3,399,000 below the fiscal year 2006 enacted level of $507,932,000.
        The NIAMS was created by an Act of Congress nearly 20 years ago,
    and since its inception, the Institute has contributed to significant
    research progress in areas of public health importance across diseases
    that are common, costly, and have a major impact on quality of life,
    disability, and mortality. Research milestones in the history of the
    Institute include the development of life-saving treatments for kidney
    failure in patients with lupus, and ground-breaking work to uncover the
    genetic bases of periodic fever syndromes that affect both children and
    adults, among many others.
        Most recently, investments that NIAMS made as a result of the NIH
    budget doubling are bringing results that will directly benefit
    patients. These include support for large-scale clinical trials in
    areas of high public health impact, such as osteoporosis and back pain;
    efforts in biomarkers research and epidemiology studies for common
    conditions such as osteoarthritis, as well as uncommon, but often
    devastating, disorders such as scleroderma; and new initiatives in
    translational research for diseases such as muscular dystrophy. Looking
    to the future, NIAMS will continue its commitment to fund outstanding
    science across a broad spectrum to enable us to better understand,
    treat, and, ultimately, prevent diseases of the bones, joints, muscles,
    and skin.
                              preventive medicine
        The NIAMS has made significant investments in studies to identify
    risk factors and biomarkers of disease, in an effort to facilitate the
    early identification of signs and symptoms, and to develop
    interventions that are more effective. This is particularly important
    from a public health perspective for common conditions such as
    osteoporosis and osteoarthritis that already afflict tens of millions
    of Americans, and will affect even more as the U.S. population ages in
    the coming decades.
        In the area of osteoporosis, the NIAMS, along with the National
    Institute on Aging, has provided steady support for the Study of
    Osteoporotic Fractures (SOF), a multi-site clinical investigation to
    determine the risk factors for osteoporotic fractures in older women.
    Begun in 1986, SOF scientists recruited 9,704 white women aged 65 and
    older from 4 metropolitan areas for this study. In 1997, an additional
    662 African American women who are now seen with the original cohort
    were enrolled. Major contributions from this long-term study include
    the findings that bone mineral density (BMD) of the hip is the best
    predictor of all types of fractures, and that weight loss and parental
    history of hip fractures are among the most important risk factors for
    this condition. SOF investigators have also learned that the
    relationship of BMD and fracture risk is similar in white and African
    American women, but that at every level of BMD, fracture rates are 30
    to 40 percent lower in African American women. These insights are
    providing clinicians with important information about which women are
    at most risk for this debilitating disease, so that prevention
    strategies may be used more effectively. Similar epidemiological
    studies have now been launched to learn about risk factors for
    osteoporosis in men.
        With respect to osteoarthritis, the NIAMS partnered with the
    National Institute on Aging, several other NIH components, and four
    pharmaceutical companies in establishing the Osteoarthritis Initiative,
    a public-private partnership aimed at developing clinical research
    resources that support the discovery and evaluation of biomarkers and
    surrogate endpoints for osteoarthritis clinical trials. For the first
    time, a public-private partnership is bringing together new resources
    and commitments to help find biological markers for the onset and
    progression of osteoarthritis. Recruitment of participants is actively
    underway, and by the end of fiscal year 2005, more than 3,800
    participants have been recruited. One year follow-up measurements have
    been carried out on over 1,000 participants, and will continue for the
    next 4 years. All data and images collected will be available to
    researchers worldwide to help quicken the pace of scientific studies
    and biomarker identification. This consortium serves as a model for
    future endeavors that link the public and private sectors.
                                complex genetics
        The NIAMS is taking full advantage of the explosion of information
    related to genetics, genomics, and proteomics to pursue the causes of
    complex diseases, and how best to treat them. This includes recent work
    which identified a genetic variation that doubles the risk of
    developing rheumatoid arthritis. Scientists have long suspected that
    autoimmune diseases such as rheumatoid arthritis result from a
    combination of genetic and environmental factors. Now, a NIAMS-funded
    research team has identified a specific genetic variation, called a
    single nucleotide polymorphism or SNP, that increases rheumatoid
    arthritis risk twofold. The SNP is located within a gene that codes for
    a particular enzyme that is known to be involved in controlling the
    activation of white blood cells, called T cells, that play an important
    role in the body's immune system. Under normal conditions, the enzyme
    works as a negative regulator: it inactivates a specific signaling
    molecule which, in turn, interrupts the communications and keeps immune
    cells from becoming overactive. However, in cases where the SNP is
    present in one or both copies of a person's genes for this enzyme, the
    team found that the negative regulation by the enzyme appears to be
    inefficient, allowing T cells and other immune cells to respond too
    vigorously, causing increased inflammation and tissue damage. The
    implications of this finding go beyond a better understanding of
    rheumatoid arthritis risk. It may also help explain why different
    autoimmune diseases tend to run in families, since this gene variant is
    also found in diabetes and lupus.
        In other efforts, researchers have recently made breakthroughs in
    understanding the genetics underlying psoriasis, a chronic skin disease
    characterized by scaling and inflammation. This disorder occurs when
    skin cells rapidly pass from their origin below the surface of the skin
    and pile up on the surface before they have a chance to mature. Usually
    this movement (also called turnover) takes about a month, but in
    psoriasis it may occur in only a few days. Recent studies funded by the
    NIAMS are helping scientists and doctors to understand the disease
    process at the molecular level, and what role genes play in
    predisposing people toward psoriasis. In one such project, researchers
    investigated the role of both genes and the environment in psoriasis,
    psoriatic arthritis, and atopic dermatitis, another inflammatory skin
    condition. The researchers found similarities in genetic susceptibility
    for psoriasis and atopic dermatitis. As for psoriatic arthritis--a
    condition in which inflamed joints produce symptoms of arthritis for
    patients who have or will develop psoriasis--they found that the
    presence of modifier genes can indicate which people with psoriasis are
    also at risk for psoriatic arthritis.
                             translational research
        A key ingredient in research success is translation: work to bring
    insights from the laboratory bench to the patient bedside, and back
    again, with the ultimate goal of improving patient care and public
    health. In this vein, NIAMS has recently launched a new program to
    bring together basic and clinical scientists in a targeted and
    organized way. The Centers of Research Translation (CORT) program
    emphasizes the translation of results from basic to clinical studies,
    as well as translating findings from clinical research to enhance and
    focus the approaches used in basic studies--all with the goal of
    improving public health.
        This commitment to translational research is bringing results in
    many areas, including the field of muscular dystrophy research. NIAMS
    supports two of the six Senator Paul D. Wellstone Muscular Dystrophy
    Cooperative Research Centers: the first, at the University of
    Pittsburgh, focuses on gene and stem cell therapies to treat muscle
    disease; and the second, located at the University of Pennsylvania, is
    examining strategies to inhibit muscle degeneration and promote muscle
    growth. These centers promote side-by-side basic, translational, and
    clinical research; provide resources that can be used by the national
    muscular dystrophy and neuromuscular communities; and provide training
    and advice about muscle diseases for researchers and clinicians.
        The Institute has also launched new initiatives to encourage
    translational research in all forms of muscular dystrophy, and to
    stimulate career development opportunities for muscle disease
    researchers. These efforts are designed to facilitate the development
    of new and more effective treatments for muscular dystrophy, and to
    increase the number and quality of investigators in basic,
    translational, and clinical research focused on this disease.
                             regenerative medicine
        Regenerative medicine--a multidisciplinary field that involves the
    life, physical, and engineering sciences--is an emerging area of
    research that cuts across several NIAMS programs. For example,
    important advances have been made recently in the development of
    promising new polymers for cartilage repair. Cartilage is a tissue that
    lacks capacity for self-repair. However, multidisciplinary studies by
    biologists, engineers, physicians, and other are providing new
    strategies for treating degenerative cartilage that may result in
    treatments for articular cartilage lesions. Researchers funded by the
    NIAMS have developed a class of injectable materials based on a
    biodegradable polymer, OPF (oligo-polyethylene glycol fumarate), for
    cartilage tissue engineering. Short-term studies in experimental
    animals demonstrated excellent tissue filling and integration resulting
    from implantation of these materials into cartilage defects. The
    polymers were also designed to deliver bioactive molecules (such as
    growth factors) as well as cells (such as chondrocytes or progenitor
    cells) to cartilage lesions to enhance tissue repair. Early results
    show that chondrocytes remain viable, proliferate, and synthesize
    cartilage matrix components in these polymer gels. Taken together,
    these results indicate that OPF gels are promising materials for cell
    delivery in cartilage repair strategies.
                                   conclusion
        The scientific advances and innovative initiatives highlighted
    above paint a picture of research progress that has benefited millions
    of American children and adults. In the coming fiscal years, NIAMS will
    focus on strategic collaborations by building partnerships to pursue
    shared goals across public, academic, and private research entities. A
    primary example of such a coordinated effort is the Collaborative
    Initiative on Bone Strength. NIAMS--in conjunction with other NIH
    components, the Food and Drug Administration, and industry partners--is
    exploring a potential public-private collaboration on bone strength.
    The main goals of such an initiative would be to provide data
    supporting the use of new bone strength markers as surrogate endpoints
    for fractures in clinical trials, and to find measurements that predict
    risk of fracture more accurately than does bone density. This would
    facilitate the continued development and approval of new treatment
    alternatives to prevent fractures through the support of clinical
    trials that are smaller, shorter, and less expensive than current
    studies.
        Finally, NIAMS is placing a high priority on strengthening the
    pipeline of well-trained investigators across the Institute's areas of
    research interest. This commitment includes funding for the new NIH
    award program, ``Pathway to Independence,'' to support young
    investigators, as well as an enhanced emphasis on basic, translational,
    and clinical training at the major research centers supported by NIAMS.
    All of these activities are driven by our dedication to fulfill the
    mandate that Congress gave the Institute when it created NIAMS; namely,
    to reduce the burden of illness and to enrich the quality of life for
    all Americans affected by diseases within our mission.
                                     ______

     Prepared Statement of Raynard Kington, Deputy Director, Office of the
                                    Director
        Mr. Chairman, Members of the Committee: I am pleased to present the
    fiscal year 2007 President's budget request for the Office of the
    Director (OD). The fiscal year 2007 budget includes, $667,825,000, an
    increase of $140,259,000 over the fiscal year 2006 appropriation of
    $527,566,000 comparable for transfers proposed in the President's
    request. The OD provides leadership, coordination, and guidance in the
    formulation of policy and procedures related to biomedical research and
    research training programs. The OD also is responsible for a number of
    special programs and for management of centralized support services to
    the operations of the entire NIH.
        The OD guides and supports research by setting priorities;
    allocating funding among these priorities; developing policies based on
    scientific opportunities and ethical and legal considerations;
    maintaining peer review processes; providing oversight of grant and
    contract award functions and of intramural research; communicating
    health information to the public; facilitating the transfer of
    technology to the private sector; and providing fundamental management
    and administrative services such as budget and financial accounting,
    and personnel, property, and procurement management, administration of
    equal employment practices, and plant management services, including
    the implementation of environmental and public safety regulation. The
    principal OD offices providing these activities include the Office of
    Extramural Research (OER), the Office of Intramural Research (OIR), and
    the Offices of: Science Policy; Communications and Public Liaison;
    Legislative Policy and Analysis; Equal Opportunity; Budget; and
    Management. This request contains funds to support the functions of
    these offices. In addition, the OD also maintains several trans-NIH
    offices and programs to foster and encourage research on specific,
    important health needs. I will now discuss the budget request for the
    OD in greater detail.
                        nih roadmap for medical research
        Responding to 21st Century biomedical challenges, the NIH Roadmap
    for Medical Research serves as a test bed for trans-NIH programs
    designed to accelerate the pace and translation of biomedical
    discovery. Derived from stakeholder input, Roadmap initiatives are
    bearing fruit with infrastructure, tools and training programs that
    serve and intersect the needs of NIH research disciplines and missions.
    Several large initiatives follow a ``hub-and-spoke'' model that
    connects projects and research centers to one another and to the
    research community at large. For example, the National Centers of
    Biomedical Computing have created a networking `hub' to cooperatively
    develop a number of computing resources that are being followed quickly
    by investigator-initiated projects (spokes) that will use and assess
    these resources. Recognizing that gaps in scientific knowledge can be
    filled in many types of ways, the Roadmap invests in people with
    innovative, high-risk ideas and in programs and training to foster the
    development of new research teams and disciplines. Re-engineering of
    clinical research is also underway with efforts to harmonize research
    policies, develop tools to examine patient-reported outcomes, integrate
    clinical research networks, and accelerate multidisciplinary and
    translational research training. The NIH Roadmap for Medical Research
    is lowering barriers to biomedical research and harnessing the
    collective knowledge from multiple disciplines to make the next great
    leap forward in biomedical discovery. The fiscal year 2007 budget
    request for NIH Roadmap for Medical Research is $110,700,000, an
    increase of $28,530,000 over the fiscal year 2006 level.
                            office of aids research
        The Office of AIDS Research (OAR) plays a unique role at NIH,
    establishing a roadmap for the AIDS research program. OAR coordinates
    the scientific, budgetary, legislative, and policy elements of the NIH
    AIDS research program. Our response to the AIDS epidemic requires a
    unique and complex multi-institute, multi-disciplinary, global research
    program. Perhaps no other disease so thoroughly transcends every area
    of clinical medicine and basic scientific investigation, crossing the
    boundaries of the NIH Institutes and Centers. This diverse research
    portfolio demands an unprecedented level of scientific coordination and
    management of research funds to identify the highest priority areas of
    scientific opportunity, enhance collaboration, minimize duplication,
    and ensure that precious research dollars are invested effectively and
    efficiently, allowing NIH to pursue a united research front against the
    global AIDS epidemic. OAR oversees the development of the annual
    comprehensive trans-NIH AIDS-related research plan and budget, based on
    scientific consensus about the most compelling scientific priorities
    and opportunities that will lead to better therapies and prevention
    strategies for HIV disease. The Plan serves as the framework for
    developing the annual trans-AIDS research budget; for determining the
    use of AIDS-designated dollars; and for tracking and monitoring those
    expenditures. OAR also identifies and facilitates multi-institute
    participation in priority areas of research and facilitates NIH
    involvement in international AIDS research activities. The fiscal year
    2007 budget request for OAR is $59,290,000, which is a decrease if
    $1,000,000 below the fiscal year 2006 level.
                      office of research on women's health
        The Office of Research on Women's Health (ORWH), the focal point
    for women's health research for the Office of the Director,
    strengthens, enhances and supports research related to diseases,
    disorders, and conditions that affect women, and sex/gender studies on
    differences/similarities between men and women; ensures that women are
    appropriately represented in biomedical and biobehavioral research
    studies supported by the NIH to facilitate analyses by sex/gender; and
    develops opportunities for the advancement of women in biomedical
    careers and investigators in women's health research. ORWH is
    developing a novel initiative, entitled Advancing Novel Science in
    Women's Health Research (ANSWHR), with the NIH ICs to support
    innovative research in women's health and sex/gender issues. ORWH will
    continue funding for new or continuing programs through new RFAs for
    its highly successful interdisciplinary programs: Specialized Centers
    on Research (SCORs) Affecting Women's Health and Building
    Interdisciplinary Research Careers in Women's Health (BIRCWH).
    Reissuance of these interdisciplinary programs will insure the
    continuation of advances in sex and gender factors in women's health
    research and the mentored development of junior faculty by bridging
    advanced training with research independence resulting in more clinical
    researchers performing in women's health research. The fiscal year 2007
    budget request is $$40,949,000, which is the same as the fiscal year
    2006 level.
               office of behavioral and social sciences research
        The NIH's long history of funding behavioral and social sciences
    research has contributed significantly to our understanding, treatment,
    and prevention of disease and to the promotion of health and well-
    being. To further NIH's ability to capitalize on such opportunities,
    Congress established the Office of Behavioral and Social Sciences
    Research (OBSSR) to provide leadership in developing research programs
    that are likely to improve our understanding of processes underlying
    health and disease and to provide directions for intervention. OBSSR
    works to ensure that behavioral and social sciences research is
    integrated into the greater NIH health research enterprise.
        As Secretary Leavitt's announcement of the Genes, Environment and
    Health Initiative (GEHI) made clear, very little is known about how
    various characteristics of the environment interact with genetics to
    influence susceptibility to illness. The GEI's focus is interactions
    among genetics, environmental toxins and individual behaviors (dietary
    intake and physical activity) that influence the risk of developing a
    number of common diseases. Based on recommendations from an OBSSR-
    supported Institute of Medicine study examining the state of the
    science on gene-social environment interactions, OBSSR is collaborating
    with ICs to develop research initiatives at the interface of social and
    genetic factors and health. Moreover, the office is initiating training
    institutes in genetics for behavioral and social scientists to provide
    them with the expertise they need to function in interdisciplinary
    research teams working in this area.
        Another area of trans-NIH emphasis has been effective design,
    communication and implementation of health and clinical information to
    ensure optimal outcomes across groups of diverse stakeholders. OBSSR's
    participation in the ``Dissemination and Implementation Research in
    Health'' program will help identify and overcome many barriers to the
    widespread adoption of evidence-based social and behavioral
    interventions to treat and prevent illness. The promise of these
    efforts lies in their potential to improve treatment and prevention of
    illness, the use of these tools to address disparities in health
    outcomes, and the possibility of demonstrating opportunities for more
    cost-effective health policy and practice.
        To continue such groundbreaking work in the behavioral and social
    sciences, the fiscal year 2007 budget request for OBSSR is $26,121,000,
    the same amount as the fiscal year 2006 level.
                          office of disease prevention
        The primary mission of the Office of Disease Prevention (ODP) is to
    stimulate disease prevention research across the NIH and to coordinate
    and collaborate on related activities with other federal agencies as
    well as the private sector. There are several other offices within the
    ODP organizational structure.
        The Office of Medical Applications of Research (OMAR) has as its
    mission to work with NIH Institutes, Centers, and Offices to assess,
    translate and disseminate the results of biomedical research that can
    be used in the delivery of important health interventions to the
    public. The ODP has two additional specific programs/offices that place
    emphasis on particular aspects of the prevention and treatment of
    disease the Office of Dietary Supplements (ODS) and the Office of Rare
    Diseases (ORD).
        In fiscal year 2007, the ODS requests a budget of $26,807,000, the
    same amount as the fiscal year 2006 level. ODS promotes the scientific
    study of the use of dietary supplements by supporting investigator-
    initiated research, and stimulating research through the conduct of
    conferences and presentations at national and international meetings.
    Other current ODS efforts include:
      --Sponsorship of systematic reviews on the efficacy and safety of
            dietary supplements in reducing the risk of chronic diseases
            such as cancer and heart disease.
      --Collaborations for the development, validation, and dissemination
            of analytical methods and reference materials for dietary
            supplements.
      --Support for and development of databases of dietary supplement
            information including:
        --National Health and Nutrition Examination Survey (NHANES);
        --Collaboration with USDA to develop an analytically-based database
                of dietary supplement ingredients;
        --Plan to develop a dietary supplement label database;
        --International Bibliographic Information on Dietary Supplements
                (IBIDS);
        --CARDS, a database of federally funded research on dietary
                supplements.
      --Collaboration with other federal agencies to develop a coordinated
            approach to assessment of the health effects of bioactive
            factors in food and dietary supplements.
      --Publishing Fact Sheets on dietary supplements for consumers.
        Another component of ODP, the ORD, was formally established through
    the Rare Diseases Act of 2002, Public Law 107-280. The budget request
    for fiscal year 2007 for ORD is $15,548,000, the same amount as the
    fiscal year 2006 level. The following are highlights of ORD activities:
    (1) An Extramural Rare Diseases Clinical Research Network that involves
    10 consortia with 70 sites, and 30 patient support organizations for
    almost 50 rare diseases. Twenty-two clinical protocols have been
    approved and another 25 will be developed during 2006. (2) ORD provides
    support for 20 Bench-to-Bedside research projects in the NIH Intramural
    Research Program and supports collaborative research efforts with the
    National Human Genome Research Institute. (3) ORD also co-funds with
    the NIH institutes and centers approximately 80 to 100 scientific
    conferences per year to identify scientific opportunities or stimulate
    research where it is lagging or lacking. (4) To assist the rare
    diseases research community and patients with rare diseases, ORD
    initiated a pilot program to develop genetic tests from gene
    discoveries in the research laboratories to the clinic. (5) ORD is
    developing a Web-based database of rare diseases bio-specimen
    repositories in the United States to facilitate access to human
    biomaterials for research.
                          office of science education
        The Office of Science Education (OSE), within the Office of Science
    Policy, develops science education programs to enhance efforts to
    attract young people to biomedical and behavioral science careers and
    to improve science literacy in both adults and children. The OSE
    creates programs to improve science education in schools (the NIH
    Curriculum Supplement Series); creates programs that stimulate interest
    in health and medical science careers (LifeWorks Web site); creates
    programs to advance public understanding of medical science, research,
    and careers; and advises NIH leadership about science education issues.
    Programs target diverse populations including under-served communities,
    women, and minorities, with a special emphasis on the teachers of
    students from Kindergarten through grade 12. The OSE Web site is a
    central source of information about available education resources and
    programs, http://science.education.nih.gov. The fiscal year 2007 budget
    request for OSE is $3,839,000, the same as the fiscal year 2006 level.
                     loan repayment and scholarship program
        The NIH, through the Office of Loan Repayment and Scholarship
    (OLRS), administers the Loan Repayment and Undergraduate Scholarship
    Programs. The NIH Loan Repayment Programs (LRPs) seek to recruit and
    retain highly qualified physicians, dentists, and other health
    professionals with doctoral-level degrees to biomedical and behavioral
    research careers by countering the growing economic disincentives to
    embark on such careers, using as an incentive the repayment of
    educational loans. There are loan repayment programs designed to
    attract individuals to clinical research, pediatric research, health
    disparities research, and contraception and infertility research, and
    to attract individuals from disadvantaged backgrounds into clinical
    research. The AIDS, intramural Clinical, and General Research Loan
    Repayment Programs are designed to attract investigators and physicians
    to the NIH's intramural research and research training programs. The
    NIH Undergraduate Scholarship Program (UGSP) is a scholarship program
    designed to support and enhance the training of undergraduate students
    from disadvantaged backgrounds in biomedical research careers and
    employment at the NIH. For fiscal year 2006, the UGSP plans to award
    scholarships and provide funding for summer internship service pay-back
    for twenty (20) individuals and provide funding for twenty-one (21)
    individuals performing one-year service payback at a cost of $768,000.
    In fiscal year 2006, the Loan Repayment Program for Research Generally
    (GR-LRP) plans to award contracts to fifty-one (51) individuals
    entering into initial three-years contracts, and forty (40) contracts
    to individuals entering into one-year renewal contracts at a cost of
    $5,286,000. Lastly, the NIH Clinical Research Loan Repayment Program
    for Inidividuals from Disadvantaged Backgrounds (CR-LRP) plans to award
    contracts to two (2) individuals entering into initial two-year
    contracts, and ten (10) contracts to individuals entering into one-year
    renewal contracts at a cost of $483,000 in fiscal year 2006. The fiscal
    year 2007 budget request for OLRS is $7,141,000, the same as the fiscal
    year 2006 level.
             office of portfolio analysis and strategic initiatives
        In fiscal year 2005, the NIH established a new office within the
    Office of the Director, the Office of Portfolio Analysis and Strategic
    Initiatives (OPASI). The OPASI is made up of three divisions, focused
    on (1) resource development and analysis (including the development and
    deployment of knowledge management; (2) strategic coordination; and (3)
    evaluation and systematic assessments. Collectively, these three
    divisions identify and integrate information to support the planning
    and implementation of trans-NIH initiatives that address exceptional
    scientific opportunities and emerging public health needs. More
    specifically, OPASI is facilitating a ``functional integration'' of
    strategic planning and evaluation activities across the agency. The
    fiscal year 2007 budget request for OPASI is $3,000,000, an increase of
    $1,020,000 over the fiscal year 2006 level.
        When fully staffed by fiscal year 2008, OPASI will have
    approximately 72 FTEs. Thirteen existing FTEs transferred to OPASI in
    fiscal year 2006, and approximately 16 FTEs will be recruited during
    fiscal year 2006. The NIH is in the process of recruiting for a
    Director, OPASI and expects to fill this position in 2006. Funding for
    fiscal year 2007 will cover additional recruitments and Office
    operations in an amount consistent with OPASI's structure and
    responsibilities. In addition to salaries to support the FTEs, funding
    will be used to pay for contractual services, supplies, equipment,
    office rent and other services.
        Through these efforts, the NIH Director and the IC Directors will
    have access to more consistent information to improve coordination and
    facilitate collaboration across the agency, and to inform priority
    setting and budget decisions. The governance process for OPASI will
    likely be carried out by a new working group of the NIH Steering
    Committee, as described above. The group will be charged with
    monitoring the overall effectiveness of the office, advising on policy
    and planning issues, and forecasting the need for changes in OPASI's
    activities, among other areas.
        Thank you, Mr. Chairman for giving me the opportunity to present
    this statement; I will be pleased to answer questions that the
    Committee may have.
                                     ______

    Prepared Statement of Dr. Story C. Landis, Director, National Institute
                      of Neurological Disorders and Stroke
        Mr. Chairman and Members of the Committee, I am Story Landis,
    Director of the National Institute of Neurological Disorders and Stroke
    (NINDS). I am pleased to present the fiscal year 2007 President's
    budget request for NINDS.
        The mission of the NINDS is to reduce the burden of neurological
    disorders by developing ways to prevent or to treat these diseases.
    Epilepsy, autism, cerebral palsy, muscular dystrophy, spinal muscular
    atrophy (SMA), and hundreds of other disorders are first evident in
    infancy or childhood. Multiple sclerosis, spinal cord injury, migraine,
    and traumatic brain injury are among the many nervous system diseases
    that are prevalent in young adults. Stroke, dementias, chronic pain,
    and Parkinson's disease will increase, if unchecked, with the aging of
    our population. The impact of neurological disorders on people, on
    their families, and on our economy is immense.
                               clinical research
        The NINDS currently supports more than 1,000 clinical research
    projects, of which more than 125 are clinical trials of interventions
    to prevent or treat disease. Ongoing clinical trials are testing drugs,
    natural biological molecules, surgery, deep brain stimulation,
    hypothermia, radiation, immunotherapy, and behavioral therapies for
    disorders including amyotrophic lateral sclerosis (ALS), brain tumor,
    cerebral palsy, epilepsy, headache, Huntington's disease, multiple
    sclerosis, muscular dystrophy, myasthenia gravis, pain, Parkinson's
    disease, spinal muscular atrophy, stroke, Tourette syndrome, and
    traumatic brain injury.
        Last year an NINDS clinical trial showed that aspirin prevents
    stroke effectively for the many people with partially blocked arteries
    in the brain who have had a previous stroke or TIA (mini stroke).
    Aspirin works as well as warfarin, a drug that requires monthly
    monitoring and carries the risk of major hemorrhage and heart attack.
    This trial is another step in a long march of advances that guide
    physicians in preventing stroke in particular risk groups. The U.S.
    Centers for Disease Control and Prevention estimated that the death
    rate from stroke declined by 18.5 percent for the U.S. population from
    1993 to 2003, and progress is continuing with results like these.
        Each year also brings results from several NINDS preliminary
    clinical trials. Current drugs for Parkinson's disease ultimately fail
    because they do not halt the progressive death of brain cells that
    causes this disease. The Neuroprotection Exploratory Trials in
    Parkinson's Disease (NET-PD) is a network of 50 clinical centers
    throughout the United States that efficiently tests drugs to slow the
    underlying disease. NET-PD has completed phase II trials of four drugs
    that had been rigorously selected for testing from candidates suggested
    by scientists around the world, and just published the results of the
    first two. NET-PD will move quickly to a large, definitive clinical
    trial to test the safety and effectiveness of at least one of these
    drugs in preventing Parkinson's disease.
        In addition to clinical trials, other types of clinical studies
    lead to new treatment or prevention strategies. An epidemiological
    study this year found that men who exercised vigorously as young adults
    had a 50 percent lower risk of developing Parkinson's disease in later
    life than men who had low levels of physical activity. Other studies
    determined how to predict which patients with glioblastoma, a common
    and deadly brain tumor, will respond to a new class of anti-cancer
    drugs, and discovered why infant seizures do not respond to drugs that
    are effective in adults and what other drugs might work better.
        The NINDS Clinical Research Collaboration (CRC), now under
    development, will extend the reach of clinical research into more
    communities across the United States. The CRC engages community
    practice and academic neurologists to speed clinical studies; minimize
    costs; make clinical trials more accessible to diverse participants;
    facilitate trials of rare diseases; and improve transfer of research
    results to clinical practice in the community. Complementing the CRC,
    the NINDS is building a network to develop emergency treatments for
    neurological disorders. Stroke, seizures, traumatic brain and spinal
    cord injury, and other neurological disorders account for perhaps 5 to
    10 percent of all medical emergencies. This program brings together
    specialists in emergency medicine, neurological disease and clinical
    trials.
                        genes and neurological disorders
        In December, the journal Science chose the discovery of a gene
    defect that can cause Tourette syndrome as one of the 10 most important
    scientific advances of the year. Since the NIH budget doubling began,
    scientists have identified more than 100 genes associated with
    neurological diseases including ALS, ataxias, Batten disease, dyslexia,
    dystonia, epilepsy, muscular dystrophies, Parkinson's disease,
    peripheral nerve diseases, and spinal muscular atrophies.
        Gene discoveries often have a rapid impact on patients and
    families. They yield definitive DNA diagnostic tests that are faster,
    cheaper, and more accurate, and allow genetic counseling and attention
    to special risks of people with particular inherited disorders. For
    example, patients with ataxia used to undergo MRI brain scans,
    withdrawal of spinal fluid for analysis, tests for amino acids and
    organic acids, lipoprotein electrophoresis, urine heavy metal screens,
    thyroid function tests, and sometimes painful nerve or muscle biopsies
    to get a diagnosis, costing thousands of dollars over several months.
    Today, a commercially available DNA test can often give a definitive
    diagnosis of a genetic neurological disorder within a week for a few
    hundred dollars.
        Gene findings also jumpstart therapy development. Over the last
    year, studies of therapies in animal models, another benefit from gene
    discoveries, have shown promise for neurofibromatosis, muscular
    dystrophy, Fragile X syndrome, Huntington's disease, hereditary
    ataxias, and several other disorders. Therapies are already moving from
    animal models into NIH or private sector clinical trials, including
    ceftriaxone for ALS, anti-oxidants for ataxia-telangiectasia, myostain
    inhibitors and gentamicin for muscular dystrophy, and coenzyme Q10 for
    Huntington's disease. The pace is remarkable after decades without
    progress for many of these diseases.
        Knowing where and when genes are active is key to understanding the
    nervous system in health and disease. Most genes are active at some
    time and place in the brain, yet only a small fraction of these have
    been well characterized, so the NINDS initiated the GENSAT (Gene
    Expression Nervous System Atlas) to map gene activity in the brain
    across development. GENSAT also generates valuable research tools
    including strains of mice in which a visible marker is turned on where
    and when the gene of interest is active. Using these mice, scientists
    this year found new insights into Parkinson's disease that could not
    have been revealed without this resource. The studies showed that one
    of two previously undistinguishable types of nerve cells is selectively
    affected in Parkinson's disease, helped explain why brain movement
    control circuits malfunction, revealed the molecular mechanism that
    kills those cells, and identified a potential new target for drugs to
    slow Parkinson's disease.
                             translational research
        With the budget increases, the NINDS implemented major programs to
    move insights from basic research to practical therapies ready for
    testing in clinical trials, that is, translational research. The
    Cooperative Program for Translational Research supports research teams
    in academia and small companies. These milestone-driven, investigator-
    initiated projects are developing drug, stem cell, or gene therapies
    for Batten disease, Parkinson's disease, Huntington's disease, tuberous
    sclerosis, Duchenne muscular dystrophy, traumatic brain injury, and
    stroke, among other disorders.
        In another translational effort, the NINDS developed the SMA
    Project as a model program to expedite therapy development. The
    contract-based project is making encouraging progress towards its
    ambitious goal--having a drug for SMA ready for clinical trials by the
    end of 2007. A steering committee, with drug development expertise from
    industry, the FDA, academia, and the NIH, first developed a detailed
    drug development plan. To carry out the plan, the project then created
    a virtual drug development company with the tools and facilities for
    identifying ``lead compounds,'' chemically modifying leads into
    potentially improved compounds, testing drug candidates in cell and
    animal models, and coordinating the overall drug development scheme.
    More than 300 compounds have been prepared and are in testing. In 2007,
    the NINDS will address a major barrier in the development of drugs for
    other neurological diseases by extending the contract-based medicinal
    chemistry resource from the SMA Project. Medicinal chemists modify
    weakly active compounds so that drug development teams can test the new
    drugs for improved safety and effectiveness.
        NIH basic science stimulates therapy development in the private
    sector, as well as by the NIH. In the past year, private sector
    clinical studies of clotting Factors VII and VIIa have shown promise
    for serious and hard to treat strokes caused by bleeding in the brain.
    NIH research motivated those studies by showing that these strokes are
    followed by continued expansion of blood filled pockets in the brain,
    called hematomas, which contribute profoundly to disability and death.
    Private sector clinical trials in gene and cell therapies for
    Parkinson's disease begun this year also build upon NINDS research.
        Longstanding NINDS targeted therapy development programs also
    catalyze private sector efforts. For three decades, the Anticonvulsant
    Screening Program (ASP) has fostered industry development of drugs for
    epilepsy, including six drugs in widespread use and several more now in
    clinical testing. Drugs that emerged from the ASP testing program are
    also among the most effective treatments for chronic pain. NINDS
    initiatives begun last year and to begin in 2007 focus on animal models
    for testing drugs that block the development of epilepsy, work for
    treatment resistant epilepsy, and meet the special needs of pediatric
    and geriatric populations.
                             collaborative research
        The NINDS strongly encourages cooperative efforts among scientists
    and physicians from diverse disciplines, and works closely with other
    parts of the NIH, other government agencies, and non-governmental
    organizations, as well as with companies. As may be evident from the
    discussions of the Clinical Research Consortium, NET-PD, GENSAT, the
    Cooperative Program in Translational Research, and the SMA Project,
    most NINDS programs, whether focused on a particular disease or a
    scientific problem, emphasize collaboration. Other examples include
    research centers on muscular dystrophy, Parkinson's, autism, spinal
    cord injury, stroke and heath disparities, and resources including the
    Human Genetics Repository and the Microarray Consortium.
        The NIH Neurosciences Blueprint, begun in 2005, presents a
    framework to enhance cooperation across the NIH institutes that share
    an interest in diseases of the nervous system. Blueprint initiatives
    have focused on neuroscience tools, training in the neurobiology of
    disease for basic scientists, genome analysis, neuroimaging, genetic
    mouse models, core research facilities, and clinical assessment tools.
    In 2007, the Blueprint will focus on neurodegeneration, which
    contributes to many diseases.
        Among government agencies, the NINDS is working closely with the
    U.S. Army Medical Research Institute of Chemical Defense (USAMRICD)
    because many potential chemical terrorist agents affect the nervous
    system. Cooperative projects with the Veterans Administration include a
    major clinical trial of deep brain stimulation for Parkinson's disease.
    The NINDS also meets regularly with the FDA on stem cells and other
    biological therapies and works with the National Science Foundation on
    common interests including computational neuroscience and informatics.
        More than 300 non-governmental organizations (NGOs) focus on
    diseases within the mission of the NINDS. The World Parkinson
    Conference, held for the first time this February, and a major
    conference on epilepsy planned for March 2007 are two of many recent
    examples of cooperative efforts between NGOs and the NINDS. In June
    2005, the Institute brought together 75 representatives of NGOs at the
    NIH for a day of presentations, informal interaction, and group
    discussions. Based on the strong positive feedback from participants,
    the NINDS will hold similar meetings in the future to explore how we
    can work together in the future.
        Thank you, Mr. Chairman. I would be pleased answer questions from
    the Committee.
                                     ______

    Prepared Statement of Dr. Ting-Kai Li, Director, National Institute on
                          Alcohol Abuse and Alcoholism
        Mr. Chairman and members of the Committee: I am pleased to present
    the fiscal year 2007 President's budget request for the National
    Institute on Alcohol Abuse and Alcoholism (NIAAA). The fiscal year 2007
    budget includes $433,318,000, which reflects a decrease of $2,612,000
    over the fiscal year 2006 enacted level of $435,930,000 comparable for
    transfers proposed in the President's request.
        Alcohol consumption kills or disables thousands of Americans each
    year. The Centers for Disease Control and Prevention (CDC) reported in
    2005 that, in the mid-1990s, alcohol use and abuse were among the top
    ten causes of death and disability in the United States. CDC also
    ranked excessive alcohol consumption as the third leading preventable
    cause of death in 2001. Motor vehicle crashes are among the most
    visible consequences of alcohol use; CDC estimates that in 2003, 40
    percent of traffic deaths were alcohol-related. However, death and
    disability also result from alcohol-related diseases, such as liver
    cirrhosis, heart disease, stroke, dementia, and certain cancers.
        Despite these consequences, the majority of people who drink are
    able to do so without harm to themselves or others. One of the
    fundamental goals of alcohol research is to determine why some
    individuals cannot limit their drinking. Research has shown clearly
    that half of the risk for developing alcohol use disorders is a
    function of genes, while the other half can be traced to factors in the
    environment, such as family, friends, and culture. The measure of risk
    is not an either/or situation; genes and environmental factors interact
    and influence one another, even at the molecular level.
        Investigating the interplay of genes and environment is an
    important focus across the NIH, with implications for many of the most
    widespread, life-threatening, and costly health conditions affecting
    Americans. One of the exciting areas of research I would like to
    describe today has to do with how new tools we are developing to
    investigate this interaction between genes and environment can
    contribute to an understanding of alcohol dependence.
        As a starting point, we have already identified several genes that
    can raise or lower the risk of developing alcohol dependence. Variants
    in two families of genes that are involved directly in alcohol
    metabolism, for example, can lower risk. These genes encode enzymes
    that break down alcohol. Some people inherit enzyme variants that will
    result, if a person drinks, in especially high levels of a toxic
    byproduct of alcohol metabolism. These individuals feel sick when they
    drink; as a result, they are at lower risk of developing alcohol use
    disorders.
        Other genes that play a role in alcoholism risk encode the
    communication circuitry of brain messenger molecules, the receptors of
    neurotransmitters, a number of which have been linked to alcoholism and
    psychiatric disorders that co-occur frequently with alcoholism.
    Research suggests, for example, that genes for neurotransmitters
    involved in depression and anxiety are also, in some groups, related to
    alcoholism risk. Among the neurotransmitter systems for which research
    has reported a relationship between genes and alcoholism risk: GABA, a
    neurotransmitter that slows the pace of brain signaling and is known to
    be involved in the alcohol response; NPY, a brain protein involved in
    stress responses and memory; serotonin, a neurotransmitter involved in
    the regulation of mood; and brain opioids, which play a role in the
    sensation of pleasure.
        Variants in these neurotransmitter genes influence alcoholism risk
    by shaping how the brain responds to alcohol, regulating how pleasant
    the experience is, or how sedating. An important new direction of
    research has to do with investigating how the opposite can occur:
    alcohol can make lasting changes in genes in ways that can have
    profound effects on health.
        Epigenetics refers to heritable and long-term changes in gene
    function that occur without a change in DNA sequence. Such changes
    could be caused, for example, by elements in the environment, such as
    alcohol, changing how genes are translated into proteins, in other
    words, how the genes are expressed. Epigenetics can help us understand
    how alcohol has lasting effects on health.
        One of the ways alcohol and its metabolites can change gene
    expression is by modifying histones--proteins that intertwine with DNA.
    Stable modification of DNA can also occur. Both of these reactions can
    activate or silence the expression of genes. Alcohol through its
    metabolism contributes to or alters the level of at least two specific
    metabolites that are required for these chemical modifications.
        Epigenetic modifications may be transmitted as the cell divides.
    Thus, these modifications may persist throughout the lifespan.
    Epigenetic changes also have the potential to be passed on to the next
    generation, producing abnormalities in offspring. This research, at the
    forefront of progress in genetics and molecular biology, gives us an
    opportunity to understand the complex mechanisms by which an external
    environmental factor like alcohol interacts with biology. It promises
    to help explain why repeated exposure to alcohol can change permanently
    how a person responds thereafter to the substance, setting the stage
    for dependence. It can help explain why drinking during pregnancy can
    cause irreversible damage to the brain of a fetus. And it may help
    explain what underlies alcohol's destructive effects on such organs as
    the liver, pancreas, and brain, as well as its role in cancers
    associated with heavy alcohol exposure.
        Epigenetics research may also provide a means for investigating the
    long-term effects of alcohol consumption on adolescents. Alcohol is the
    drug most commonly used by youth. Adolescents who drink tend to do so
    intensively; according to 2005 data from the Monitoring the Future
    study, 11 percent of 8th graders, 21 percent of 10th graders, and 28
    percent of 12th graders report drinking 5 or more drinks in a row in
    the past two weeks. This ``binge'' drinking is a particularly hazardous
    pattern of drinking at any age. But during adolescence, when the brain
    is still undergoing developmental change, binge drinking may have
    particular dangers.
        Preliminary studies suggest that alcohol has the potential to
    disturb normal brain development in adolescence and young adulthood.
    NIAAA research has established that youth who begin to drink in their
    early teens are at greater risk later of developing alcohol dependence.
    This increased risk can be explained only partly by inherited
    biological risk factors, suggesting that early drinking itself causes
    changes that manifest themselves in future behavior. Data from NIAAA's
    National Epidemiologic Survey on Alcohol and Related Conditions has
    shown that most cases of alcoholism are established by age 25. This
    suggests that alcoholism, rather than being a disease of middle age, is
    a developmental disorder that has its roots in youth.
        An important NIAAA initiative is aimed at investigating the effects
    of alcohol, including epigenetic effects, on developing brain
    structures and systems that regulate behavior. It will address the
    mechanisms that underlie alcohol-related changes during brain
    development, the dosage and drinking patterns that result in changes,
    and the factors that promote or protect against these changes. An
    important aim of this research is to determine whether and how
    alterations in brain function influence lifetime risk for alcohol use
    disorders, particularly in vulnerable individuals.
        Improving our fundamental understanding of how the environment
    interacts with genes has many potential benefits. For example,
    knowledge of the genes that are related to risk for alcohol problems--
    and how variants of these genes might be manifest in physical or
    behavioral traits--can be used to assist in the identification of
    individuals at risk or, in other words, predict who is vulnerable.
    Understanding how alcohol interacts with genes will help define how an
    individual makes the transition from casual drinking to dependence; and
    how long term heavy drinking causes disease.
        Our growing body of knowledge about genes and the cellular
    processes they encode is providing targets for medications development.
    Genetics research is helping to show why no one medication will work in
    every person. The ultimate goal will be to personalize treatment--
    similar to the approach in diseases like hypertension or depression--by
    choosing from an array of medications the agent that is most effective
    for a given individual.
        Finally, among its most important potential benefits, the
    investigation of genes and environment will give us a clear picture of
    the impact of alcohol on the long-term health and behavior of
    adolescents. Understanding the mechanisms behind these persistent
    effects will make even more compelling the imperative to identify
    effective ways of preventing adolescents from consuming alcohol, not
    only to safeguard their health and well-being in youth, but to preempt
    the development of alcohol use problems in adulthood.
        Thank you Mr. Chairman. I would be pleased to answer any questions
    that the Committee may have.
                                     ______

      Prepared Statement of Dr. Donald A.B. Lindberg, Director, National
                              Library of Medicine
        Mr. Chairman and Members of the Committee: I am pleased to present
    the President's budget request for the National Library of Medicine
    (NLM) for fiscal year 2007, a sum of $313,269,000, which is $1,641,623
    less than the comparable fiscal year 2006 appropriation.
        Only a few years ago we frequently described the role of the
    National Library of Medicine almost entirely in the context of the
    medical literature--NLM collected and organized the books and journals
    that were then used in the process of making new discoveries that would
    be reported in yet more books and journals. That paradigm, although
    accurate as far as it goes, is no longer sufficient to describe the
    Library's role. Today, the NLM is at the hub of an interconnected world
    of an amazing amount of information, ranging from the published
    literature, to molecular sequence and genomic data, to descriptions of
    clinical trials, to still and moving medical images, to maps of
    chemical spills and other information used for emergency preparedness,
    and to authoritative research-based information prepared especially for
    the general public--for patients and their families and caregivers.
        The range of persons and institutions with which the Library
    interacts is staggering. A National Network of Libraries of Medicine,
    with more than five thousand members, extends the reach of NLM's
    services. Many medical organizations, publishers, academic
    institutions, government agencies, and libraries make data available to
    the world through the National Library of Medicine. The NLM, with a
    staff of experienced medical librarians, scientists, and health
    professionals, creates databases and other Web resources to ensure that
    high quality information is available to all, easily and without
    restriction. The bottom line of all this is that the Library operates
    the most-consulted scientific medical Web site in the world: two
    million people come to the Library's Web site--to learn about diseases,
    search the literature, connect with other information providers, and to
    download terabytes of data--every day.
        As a key member of the NIH research team, the Library works closely
    with scientists on the Bethesda campus and around the country. A prime
    example of this is the work of NLM's National Center for Biotechnology
    Information (NCBI) and the panoply of databases with genomic
    information contributed by NIH and NIH-supported scientists. This
    collaboration extends around the world, with partners at institutions
    in other nations contributing sequence and other data to the NCBI's
    databases. Another example of extensive collaboration is that several
    thousand public and private organizations have agreements with NLM to
    use the Visible Human Project datasets of anatomical information to
    create techniques and software used in teaching and research.
        But the Library is also a bricks and mortar facility on the campus
    of the National Institutes of Health. NLM has two reading rooms that
    are open to the public--one that serves the Library's remarkable
    collection of historical materials and a main reading room. An
    exhibition, ``Visible Proofs: Forensic Views of the Body,'' has just
    been opened in the Library's public area and will be visited by many
    thousands, including students from grade school up. Previous
    exhibitions are now touring the country, extending greatly the work of
    our history of medicine curators.
        A basic function of the National Library of Medicine is to serve as
    a ``court of last resort'' for seekers of medical information. With the
    world's largest collection--eight million items--the NLM is relied on
    by institutions and individuals around the globe.
                      information services for the public
        The Library's main portal for consumer health information is
    MedlinePlus, available in both English and Spanish. Much of this
    material is based on research done or sponsored by the NIH Institutes.
    MedlinePlus has more than 700 ``health topics,'' containing, for
    example, overview information, pertinent clinical trials, alternative
    medicine, prevention, management, therapies, current research, and the
    latest news from the print media. In addition to the health topics,
    there are medical dictionaries, a medical encyclopedia, directories of
    hospitals and providers, and interactive ``tutorials'' with images and
    sound. The newest addition to MedlinePlus is a series of surgical
    videos that show actual operations of common surgical procedures.
    Another new aspect of MedlinePlus is ``Go Local,'' that is, a service
    to link users from the MedlinePlus health topics to the health and
    social services in their community that are related to that topic.
        There are other popular NLM Web sites for the public.
    ClinicalTrials.gov was created to give everyone easy access to
    information about human research studies. The site contains information
    on more than 25,000 federally and privately supported trials. It
    includes summaries of the purpose of each study, the recruiting status,
    criteria for patient participation, location(s) of the trial and
    specific contact information. NIHSeniorHealth.gov is maintained by the
    Library in collaboration with the National Institute on Aging and other
    NIH Institutes. At present there are 22 topics of interest to seniors,
    including, for example, Alzheimer's Disease, balance problems, macular
    degeneration, shingles, and stroke. NIHSeniorHealth.gov contains
    information in a format that is especially usable by seniors, with, for
    example, large type, and it also has a ``talking'' function that allows
    users to listen as the text is read to them.
        NLM's Genetics Home Reference provides consumer-friendly summaries
    of genetic conditions and related genes and chromosomes. This
    information resource bridges consumer health information and scientific
    bioinformatics data, and it links to many existing resources, both at
    NLM and at other reliable sites. The Household Products Database
    provides easy-to-understand data in consumer-friendly language on the
    potential health effects of more than 2,000 ingredients contained in
    more than 6,000 common household products. The Household Products
    Database has proved to be popular with the media, and there have been a
    number of newspaper and magazine articles about it. Another consumer
    health site is the colorful Tox Town, which looks at an ordinary town
    and points out many harmful substances and environmental hazards that
    might exist there. Users can click on a town location, like a school,
    office, factory, or park and find information about the toxic chemicals
    that may be encountered there. Other versions are available for a big
    city, a farm, and the U.S.-Mexico border area. There is also a new
    special section with information on toxic chemicals and disaster health
    concerns in the wake of Hurricane Katrina and Hurricane Rita.
               information services for the scientific community
        The most frequently consulted online medical resource in the world
    is PubMed/Medline, an easily searchable database of more than 15
    million references and abstracts for medical journal articles from the
    1950s to the present. Usage of PubMed/Medline by the scientific and lay
    communities has grown considerably since it became free on the Web in
    1997, to over two million searches per day. PubMed also links to the
    sites of participating publishers so that users can retrieve full-text
    articles from 5,000 journals. Where links to electronic full text are
    not available, the user may use PubMed to place an online order for an
    article directly from a library in the National Network of Libraries of
    Medicine.
        PubMedCentral (PMC) is a Web-based repository of biomedical journal
    literature providing free and unrestricted access to the full-text of
    articles. This repository is based on a natural integration with the
    existing PubMed/Medline biomedical literature database of references
    and abstracts. Currently, PMC contains nearly 600,000 full-text
    articles. Recent additions have come from newly published material as
    well as from digitizing back issues that previously were only available
    in printed form. NIH's Public Access policy encourages scientists whose
    work is funded by the NIH to submit their manuscripts to PubMed
    Central. NLM's National Center for Biotechnology Information designed
    and implemented the NIH Manuscript Submission system, a quick and easy-
    to-use system for scientists to submit their manuscripts. Creating such
    digital archives as PubMedCentral to ensure that the world's biomedical
    literature is properly recorded and available for future generations,
    is an important NLM responsibility.
        Another heavily used scientific resource is a database of all
    publicly available DNA sequences, called GenBank. The NCBI, which
    maintains GenBank, has also created integrated retrieval tools that
    allow seamless searching of the sequence data and provide links to
    related sequences, bibliographic citations, and other resources. Such
    features allow GenBank to serve as a critical research tool in the
    analysis and discovery of gene function as well as discoveries that
    lead to identification and cures for a number of diseases. One recent
    example of the use of NCBI sequence databases was to identify the first
    polio case in the United States since 1999. The state health laboratory
    in Minnesota had isolated an unknown virus from a hospitalized child
    from an Amish community. The laboratory staff went to the Web, searched
    against the 55 million DNA sequences at NCBI, and found a match to the
    polio virus used in the Sabin oral vaccine. ``Bingo,'' said the
    laboratory's director, ``It was a 98 percent match. We knew we had
    nailed it.''
        A critical need in biomedical research, as identified in the NIH
    Roadmap Initiative, is a repository for what are called ``small
    molecules'' that are crucial in drug development. Small molecules are
    responsible for the most basic chemical processes that are essential
    for life and they often play an essential role in the attack of a
    pathogen, or in the cell's response to the attack. The new PubChem
    database, developed by the NCBI, links the small molecules to their
    biological functions and to the macromolecules with which they
    interact. At present, PubChem includes over 7.5 million records for
    small molecules with over 5 million molecular structures. These data
    have been contributed by public, academic, and commercial resources.
        The NCBI is also doing important work on other issues of current
    public concern. One of these is to provide an Influenza Virus Resource
    that links researchers working on vaccines to genomic data about the
    influenza virus. As the data accumulate and the analyses progress, the
    discoveries made will ultimately lead to better prediction of large-
    scale outbreaks, more effective vaccine design, and the saving of many
    human lives. Another area of NCBI work of topical interest is their
    development, in the aftermath of 9/11, of sophisticated software called
    OSIRIS. The software is now being tested within five collaborating
    forensic DNA laboratories to assist in the analysis and validation of
    forensic data and help identify victims from the Gulf Coast states in
    the aftermath of Katrina.
        A recently announced series of initiatives by several NIH
    Institutes directed at understanding the genetic factors underlying
    human disease will require the NCBI to play a key role. Several large-
    scale, long-term studies, such as the Framingham Heart Study, will be
    adding genetic information from participants to the clinical data
    already collected. NCBI has been selected by the Institutes to build
    the databases that will incorporate the clinical and genetic data, link
    them to the molecular and bibliographic resources at the NCBI and, for
    the first time, make these data available to the scientific and
    clinical research community.
        NLM remains the principal source of support nationally for research
    training in the field of biomedical informatics. This support is
    especially important as rapidly moving technology in health care and
    biomedical research requires investigators who understand biomedicine
    as well as fundamental problems of knowledge representation, decision
    support, and human-computer interface. Five-year institutional training
    grants from NLM support some 300 pre-doctoral, post-doctoral, and
    short-term trainees across the country.
                            other areas of interest
        The Library has an important role in developing standards for
    Electronic Health Records. As part of its Unified Medical Language
    System (UMLS) project, NLM creates vocabulary databases and software
    tools to assist informatics researchers and system developers in
    automated interpretation and integration of medical knowledge and
    health data. Chief among the UMLS resources is the Metathesaurus, which
    links and provides 4.7 million concept names for 1.2 million concepts
    from 114 vocabularies in a single database format. The UMLS serves as a
    common distribution vehicle for standard code sets and vocabularies
    needed for administrative transactions and electronic health records,
    as well as a resource for advanced natural language processing,
    automated indexing, and enhanced information retrieval. Building on its
    two decades of UMLS experience, the Library also serves as an HHS
    coordinating center for standard clinical vocabularies, such as the
    SNOMED CT clinical terminology. The Library works closely with the
    Office of the National Coordinator for Health Information Technology
    and other organizations to align health data standards into an
    effective interlocking set and to promote more rapid adoption of
    standards-based electronic health records to facilitate patient care,
    public health surveillance, and clinical research.
        Twenty years ago the National Library of Medicine published a long
    range plan that has proved to be of enormous benefit to the
    institution. Out of it grew such initiatives as the Visible Human
    Project, the National Center for Biotechnology Information, and the
    recommendation that the Library engage in an outreach campaign to reach
    minority and other underserved health professionals. The Library is now
    engaged in a similar planning exercise for the next decade. Leaders
    from across the spectrum of health and medicine are meeting at the
    Library to consider four major themes relating to resources and
    infrastructure, outreach to the underserved, support for clinical and
    public health systems, and support for genomics. The plan, which will
    be issued by the NLM Board of Regents and published later in 2006, will
    point the Library in the direction in which it can make its maximum
    contribution to society.
                                     ______

    Prepared Statement of Juanita M. Mildenberg, Acting Director, Office of
                 Research Facilities Development and Operations
        Mr. Chairman and Members of the Committee: I am pleased to present
    the President's budget request for the Buildings and Facilities (B&F)
    Program for fiscal year 2007, a sum of $81,081,000.
                          role in the research mission
        State-of-the-art facilities for scientific research and research
    support facilities are a vital part of the research enterprise. The
    National Institutes of Health's (NIH) Buildings and Facilities (B&F)
    program designs, constructs, repairs and improves the agency's
    portfolio of laboratory, clinical, animal, administrative and support
    facilities at its six installations in four states. These facilities
    house researchers from the NIH Institutes' and Centers' (ICs)
    intramural basic, translational, and clinical research programs;
    science administrators who oversee NIH's grants; the NIH leadership,
    and various programs that support agency operations. The fiscal year
    2007 B&F budget request focuses on the need for responsible utilization
    and stewardship of NIH's past and recent investments in the ``bricks
    and mortar'' of the research enterprise. In order to stay abreast of
    the changing needs of the NIH programs, it is imperative that we
    provide reliable, safe and secure research support facilities that are
    appropriately equipped, operated and maintained.
        The B&F budget request is the product of a comprehensive, corporate
    capital facilities planning process. This process begins with extensive
    consultation across the research community and the NIH's professional
    facilities staff. It works through the Facilities Working Group, an
    advisory committee to the NIH Steering Committee, and the HHS Capital
    Investment Review Board. Through this process, the program demand for
    more effective and efficient facilities designed to support current and
    emerging investigative techniques, technologies, and tools is
    integrated with, and balanced against, the need to repair, renovate,
    and improve the existing building stock to keep it in service and to
    optimize its utility.
        The fiscal year 2007 request provides the necessary funding support
    for the ongoing safety, renovation and repair, and related projects
    that are vital to proper stewardship of the entire portfolio.
        The fiscal year 2007 B&F budget request is organized among three
    broad Program Activities: Essential Safety and Regulatory Compliance,
    Repairs and Improvements and Construction. The fiscal year 2007 request
    provides funds for specific projects in each of the program areas. The
    projects and programs enumerated are the end result of the
    aforementioned NIH facilities planning process and are the NIH's
    capital facility priorities for fiscal year 2007.
                        fiscal year 2007 budget summary
        The fiscal year 2007 budget request for Buildings and Facilities is
    $81.1 million. The B&F request contains a total of $14.5 million for
    Essential Safety and Regulatory Compliance programs composed of $2
    million for the phased removal of asbestos from NIH buildings; $5
    million for the continuing upgrade of fire and life safety deficiencies
    of NIH buildings; $1.5 million to systematically remove existing
    barriers to persons with disabilities from the interior of NIH
    buildings; $1 million to allow for environmental remediation activities
    at NIH sites; and $5 million for the continued support of the
    rehabilitation of animal research facilities. In addition, the fiscal
    year 2007 request includes $65.9 million in Repairs and Improvements
    for the continuing program of repairs, improvements, and maintenance
    that is the vital means of maintaining the complex research facilities
    infrastructure of the NIH; and $700,000 in Construction for pre-project
    planning including concept development studies and analyses of NIH-wide
    facility projects proposed in the facilities plan.
        My colleagues and I will be happy to respond to any questions you
    may have.
                                     ______

      Prepared Statement of Dr. Roderic I. Pettigrew, Director, National
               Institute of Biomedical Imaging and Bioengineering
        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2007 President's budget request for the National
    Institute of Biomedical Imaging and Bioengineering (NIBIB). The fiscal
    year 2007 budget includes $294,850,000; a decrease of $1,960,000 over
    the fiscal year 2006 enacted level of $296,810,000 comparable for
    transfers proposed in the President's request.
                    bridging the physical and life sciences
        The mission of the NIBIB is to improve human health by leading the
    development and accelerating the application of biomedical
    technologies. The Institute is committed to integrating the engineering
    and physical sciences with the life sciences to advance basic research
    and medical care. To demonstrate our commitment, the NIBIB gives
    special consideration for funding to research grant applications that
    bridge and integrate the life and physical sciences.
                 translating technology into clinical practice
        Ultimately, the NIBIB seeks to translate research findings made in
    the laboratory into solutions that advance human health by reducing
    disease burden and improving quality of life. One highly successful
    example of a research and commercialization effort supported in part by
    the NIBIB is an automated, digital-imaging device called the ``array
    microscope.'' The system utilizes an array of 100 miniaturized
    objectives to produce a single, seamless sweep of a microscope slide of
    a histopathology sample. The result is a microscopic-level resolution,
    multi-colored digitized image of the pathology sample. The most
    immediate impact of this technology is expected to be in medical
    pathology. These ``virtual slides'' can be easily stored in a patient's
    record and can also be viewed over the Internet, providing immediate
    on-line access to expert second opinions.
        The recently released ``Quantum Project'' initiative is another
    example of how the NIBIB strives to support a more integrated and
    focused research agenda using multidisciplinary approaches to develop
    innovative and marketable technologies. The goal of this unique program
    is to make a ``quantum'' advance in healthcare by funding research on a
    specific project or projects that will translate into new technologies
    and modalities for the treatment, prevention and cure of disease or
    resolve a major health care problem within a reasonable time frame. In
    these ``bench to bedside'' partnerships, a team of interdisciplinary
    scientists will conduct collaborative research that will result in a
    prototype product that can be translated into clinical practice.
                  technologies to improve health care delivery
        With the advent of miniaturized devices and wireless communication,
    the way in which doctors care for patients has changed dramatically.
    Empowering clinicians to make decisions at the bedside, or the ``point-
    of-care,'' has the potential to significantly impact health care
    delivery and help address the challenges of health disparities. The
    success of such a shift relies on the development of portable
    diagnostic and monitoring devices for near-patient testing. The NIBIB
    has contributed to advances in this area by funding the development of
    sensor and microsystem technologies for point-of-care testing. These
    instruments combine multiple analytical functions into self-contained,
    portable devices that can be used by non-specialists to detect and
    diagnose disease, and can enable the selection and monitoring of
    optimal therapies. These advances limit the reliance on submission of
    samples to centralized laboratories and will make results more readily
    available within minutes as opposed to several hours or days, enabling
    clinicians to make decisions regarding treatment when these decisions
    can have the greatest impact. An example under development at the NIBIB
    is a handheld system for the rapid detection and identification of
    bacteria which cause urinary tract infections. The research team
    anticipates this test could become available in the next two to three
    years. To further capitalize on these advances, the NIBIB is planning
    an initiative to support research on critical areas for the development
    of other hand-held, diagnostic devices. These systems could reduce the
    cost of health care, much as integrated electronics have reduced the
    cost of computing, and greatly simplify and improve patient delivery of
    care.
                next generation minimally-invasive technologies
        Advances in imaging technologies have spurred new minimally-
    invasive procedures to accurately identify the site of disease and
    injury, provide tissue for a definitive diagnosis, administer treatment
    with minimal trauma, and monitor treatment responses. Image-guided
    interventions are not only more efficient in terms of time and cost,
    but their less invasive nature may result in fewer complications and
    less damage to tissue. For example, NIBIB investigators are developing
    new magnetic resonance imaging (MRI) techniques to detect and treat
    organ rejection non-invasively. The current standard for diagnosing and
    staging rejection is the biopsy, which is invasive, painful, and prone
    to sampling errors that can yield false negative results. The
    development of a non-invasive imaging-based method that can replace the
    biopsy is highly desirable.
        Over the next year, the NIBIB intends to expand its image-guided
    interventions program by supporting research on the development of
    technologies that allow the surgeon to visualize the patient
    seamlessly, in three-dimensional preoperative images; track
    intraoperative changes with real-time imaging; and restore a normal
    sense of touch through robotic tools with sensors for touch feedback,
    or haptics. This research may lead to new minimally-invasive surgical
    procedures with fewer complications, shorter hospital stays, and
    reduced costs. To plan for future initiatives in this area, the NIBIB
    recently organized an interagency retreat to identify high priority
    challenges that can serve as short- and long-term goals. Eight Federal
    agencies and nine NIH Institutes and Centers (ICs) participated in this
    retreat.
                                smedical robotic
        First generation surgical robots are already being installed in a
    number of operating rooms around the country. Although these robots
    can't perform surgery on their own, they are certainly lending a
    mechanical hand. Robots are being used in medicine because they allow
    for unprecedented control and precision of surgical instruments and
    reduce trauma to the patient, dramatically improving surgical outcomes
    and lowering health care costs. Robots are also being used in
    rehabilitation as they provide considerable opportunities to improve
    the quality of life for physically disabled people. For example, one of
    the most common stroke disabilities is a paralyzed arm. The NIBIB and
    the National Institute of Child Health and Human Development are
    jointly funding the development of two robotic devices that could
    accelerate rehabilitation of patients with paralyzed arms and reduce
    the cost of physical therapy. These devices can also treat people who
    have experienced catastrophic events, such as war injuries resulting in
    limb loss. Testing with stroke patients is expected to begin this year
    using one device.
        Traumatic injury or neurological diseases can also significantly
    alter or impair the lifestyle of an individual. To help patients lead
    more productive lives, NIBIB scientists are developing a non-invasive
    brain-computer interface to provide both communication and control
    functions. By recording brain waves from the scalp and then decoding
    them, this system allows people to move a cursor to spell words, and
    even to control a robotic arm. Initial efforts to test this new
    technology in the field are underway.
             nanotechnology for disease detection and drug delivery
        Detection of dormant metastatic tumor cells is a critical but
    elusive goal in cancer treatment. To find these cells, NIBIB
    researchers are developing non-invasive optical imaging techniques that
    are less costly and more accessible than MRI-based techniques and are
    free of the side effects associated with radioactive imaging agents.
    Microscopic or nanoscale ``bubbles,'' called polymerosomes, containing
    embedded fluorescent materials are the key to this new approach. These
    labeled bubbles are injected directly into a tumor and then imaged.
    Also in development are polymersomes that would deliver chemotherapy
    agents directly to a tumor. The surface of the bubble can carry a
    molecule that would bind to tumor cells, and its membrane would also
    hold fluorescent molecules for detection by optical imaging, with the
    chemotherapy ``payload' carried in the interior. One investigator has
    developed a special device which improves drug release by ultrasonic
    fragmentation of the bubble.
                     enhanced support for new investigators
        New investigators are the innovators of the future--they bring
    fresh ideas and technologies to existing biomedical research programs,
    and they pioneer new areas of investigation. Entry of new investigators
    into the ranks of independent, NIBIB-funded research is essential to
    the health of the biomedical imaging and bioengineering research
    enterprise. The NIBIB is specifically targeting new investigators for
    special funding consideration. This proved to be quite successful in
    the first year of this policy, and a continuation of this program is
    planned.
                            training for the future
        An important goal of the NIBIB is to train a new generation of
    researchers equipped to meet the modern needs of interdisciplinary and
    transdisciplinary research. Researchers trained in biomedical imaging
    and bioengineering must be able to demonstrate technical competency in
    multiple fields as well as the ability to think independently,
    communicate ideas effectively, work in teams, and contribute to a
    strong vision that transcends a narrow discipline. To this end, the
    NIBIB will work with the community to develop new programs that cross-
    train research scientists in the biological and quantitative sciences.
    For example, the NIBIB's Research Supplements to Promote Clinical
    Resident Research Experiences program has been very successful. This
    novel training mechanism is designed to serve as a ``first step'' in
    attracting outstanding clinicians into research careers related to the
    mission of the NIBIB by providing a one to two-year research
    opportunity during residency training.
        The NIBIB has also developed several public and private
    collaborations to catalyze research at this interface. For example, the
    NIBIB and the Howard Hughes Medical Institute partnered in a novel
    public-private partnership to stimulate the development of new
    interdisciplinary graduate training programs that integrate the
    physical, quantitative, and engineering sciences with the life
    sciences. This program will train a new generation of researchers,
    equipped to meet the challenges of the 21st Century.
                      nih roadmap for biomedical research
        An overarching goal of the NIH Roadmap is to facilitate the
    development of broad-based innovative, novel and multidisciplinary
    science and technology that has the potential to further advances in
    health care. This goal is well aligned with the NIBIB mission and is
    actively supported on a number of fronts. For example, over the last
    year NIBIB has been the lead Institute in a Roadmap initiative entitled
    ``Innovation in Molecular Imaging Probes.'' Molecular imaging
    approaches can be used to study cellular events and biochemical
    abnormalities. The major roadblocks to in vivo clinical applications of
    molecular imaging are the poor sensitivity and potential toxicity of
    the current probes. This initiative supports research programs that
    will circumvent these roadblocks.
                                 nih blueprint
        The Neuroscience Blueprint is a framework designed to enhance
    cooperative activities among the NIH ICs that support research on the
    nervous system. During the last year, NIBIB contributed to the
    development of a number of initiatives, leading or participating in
    three project teams. These initiatives aim to support research and
    development of imaging technology for high resolution imaging of neural
    activity that is reflected in electrophysiological signals; and to
    develop a framework to address the critical need for neuroimaging data
    and software tools sharing and integration. The NIBIB also participated
    in the development of neuroscience training initiatives.
                                     ______

    Prepared Statement of Dr. Griffin P. Rodgers, Acting Director, National
            Institute of Diabetes and Digestive and Kidney Diseases
        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2007 President's budget request for the National
    Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) a sum
    of $1,844,298,000, which includes $150,000,000 for the Special
    Appropriation for Research on Type 1 Diabetes through Sec. 330B of the
    Public Health Service Act. The NIDDK transfers some of these funds to
    other institutes of the NIH and to the Centers for Disease Control and
    Prevention (CDC). Adjusted for mandatory funds, this is an decrease of
    $10,627,000 from the fiscal year 2006 enacted level of $1,854,925,000
    comparable for transfers proposed in the President's request.
        The NIDDK supports research to combat a wide range of chronic
    health problems, including diabetes and other endocrine and metabolic
    diseases; diseases of the digestive system, kidneys, urinary tract; and
    blood; nutritional disorders; and obesity. Through vigorous research,
    initiated both by investigators and by the Institute, the NIDDK will
    continue to elucidate the fundamental biology underlying health and
    disease. We are pursuing new strategies for disease diagnosis,
    treatment, and ultimately, prevention and cure.
              preempting chronic diseases and their complications
        Chronic diseases pose some of the greatest health challenges to the
    Nation today. These diseases and their symptoms range in severity, but
    are often debilitating and sometimes fatal. Some impair fundamental
    body processes, such as metabolism, while others target the kidneys,
    liver, and other vital organs and systems. Though their causes and
    ultimate effects on health may differ, chronic diseases share the grim
    features of constant affliction and impaired quality-of-life. The
    burden of chronic diseases within NIDDK's research purview is immense.
    Recent estimates using national health survey data reveal that diabetes
    (type 1 and type 2) affects nearly 21 million Americans.\1\  About 20
    million Americans have chronically impaired kidney function, which
    places them at increased risk for irreversible kidney failure (end
    stage renal disease) and death.\2\  Digestive diseases, such as
    irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and
    liver and biliary diseases, wreak havoc with people's lives. ``Benign''
    diseases of the bladder and lower urinary tract, including urinary
    incontinence and prostate diseases, can be devastating. These chronic
    diseases also exact a heavy economic toll. For example, the healthcare
    and indirect costs of diabetes and its complications totaled $132
    billion in 2002.\3\ The painful, debilitating symptoms of IBS and the
    bladder disease interstitial cystitis (IC) result in loss of work and
    increased medical costs. Costs of chronic diseases that strike the
    digestive system, kidneys, and bladder run into the tens of billions of
    dollars.
    ---------------------------------------------------------------------------
        \1\ National Institute of Diabetes and Digestive and Kidney
    Diseases. National Diabetes Statistics fact sheet: general information
    and national estimates on diabetes in the United States, 2005.
    Bethesda, MD: U.S. Department of Health and Human Services, National
    Institute of Health, 2005
        \2\ The National Kidney Foundation http://www.kidney.org/
    kidneyDisease/. Accessed February 14, 2006.
        \3\ Hogan P, et al, Diabetes Care 26:917-932, 2003.
    ---------------------------------------------------------------------------
        The tremendous human and monetary costs of chronic disease are
    matched only by the extraordinary interventions often needed just to
    preserve life. Organ transplantation and kidney dialysis are but two
    examples. Although these are extreme measures for the sickest patients,
    they represent some of the victories achieved by biomedical research in
    reducing morbidity and mortality from advanced chronic disease. Our
    goal is to improve these treatments, while we simultaneously seek
    prevention strategies. For example, whole liver transplantation from
    deceased donors is a successful treatment for liver failure, but is
    limited by a shortage of donor organs. A new NIDDK clinical network
    (A2ALL) is maximizing this treatment option in adults by assessing the
    safety and outcomes, for both patients and donors, of new procedures
    that use partial liver transplants from living donors--thereby
    increasing the potential donor pool. Similarly, we are addressing the
    diminished quality-of-life and low five-year survival rates under
    current dialysis treatment, which is typically administered three times
    weekly. A new clinical trial will evaluate the effectiveness of daily
    dialysis.
                        importance of early intervention
        For persons already suffering from chronic disease, improved
    treatments will have great benefits. However, it is imperative that
    researchers find ways to intervene at the earliest possible stage of a
    disease. The goals for such research are to: (1) identify and use
    biological information, such as ``biomarkers,'' that can predict an
    individual's susceptibility to disease, disease progression, or disease
    complications--thereby enabling more tailored use of interventions; (2)
    find the most effective interventions to preempt the onset or course of
    disease; and (3) ensure that these predictive tools and interventions
    can be precisely targeted for the benefit of patients. New advances in
    science, technology, and public health research are making these goals
    realizable, with the prospect of significant improvements in public
    health. Examples of potential research payoffs include hepatitis C and
    diabetes complications. In the United States, hepatitis C infection
    affects an estimated 4 million people and is the leading cause of both
    liver cancer and liver failure due to end-stage cirrhosis. Patients who
    do not respond to standard medical therapy with interferon and
    ribavirin are at high risk of developing these severe health problems.
    Ideally, physicians should be able to predict likely ``non-responders''
    to current therapy and those at risk for disease progression, and then
    tailor interventions to them. While this is not yet possible, ongoing
    studies will help to move the field forward, including a major clinical
    trial (HALT-C) aimed at preventing end-stage cirrhosis and lowering
    risk of liver cancer in ``non-responders'' with advanced disease.
        Likewise, physicians would welcome new, precise methods for
    tailoring interventions to individuals with diabetes so as to reduce
    complications in those at greatest risk, while also lessening treatment
    burden. Landmark clinical trials have demonstrated that tight control
    of blood sugar levels in type 1 diabetes patients significantly reduces
    their overall risk of eye, kidney, nerve, and cardiovascular disease.
    Unfortunately, current therapies to achieve tight control also increase
    the risk of potentially life-threatening bouts of low blood sugar. If a
    simple method existed to identify patients who could tolerate
    ``looser'' control of blood sugar levels without an increased risk of
    complications, then therapy could be tailored accordingly. Pinpointing
    the underlying causes of diabetes complications will pave the way to
    such targeted interventions.
        Developing a more personalized approach to medical therapy requires
    a robust toolkit forged from research advances. Therefore, the NIDDK is
    continuing with new initiatives to accelerate translation of
    fundamental research into clinically useful applications. For example,
    we want to be able to stop early scarring of the liver and kidney--
    known as fibrosis--before it ignites a series of events leading to
    irreversible organ failure. The NIDDK is fostering new, non-invasive
    imaging methods to reveal fibrosis. Such techniques will enable
    physicians to diagnose, monitor and treat liver and kidney disease more
    effectively. For diseases within the NIDDK mission, we are also
    committed to the discovery of biomarkers--factors, such as molecules,
    that can be measured and used to monitor a patient's disease or
    response to therapy. A new translational initiative encourages research
    to develop and validate these biomarkers for clinical use.
        Critically important for predicting and preempting chronic
    diseases--such as polycystic kidney disease (PKD), focal segmental
    glomerulosclerosis (FSGS), kidney stones, IC, IBD, IBS, non-alcoholic
    steatohepatitis (NASH), and hepatitis B and C--is a thorough
    understanding of their natural history. For example, discovery of PKD
    genes has led to insights into the molecular defect underlying most
    cases of this disease. Promising new medical therapies are being
    explored to prevent or reduce cyst formation, and new trials (HALT-PKD)
    will now test approaches for preventing progressive kidney damage. In
    the kidney disease FSGS, we do yet know all the causative factors, but
    a better understanding of FSGS progression has enabled the NIDDK to
    undertake a trial of therapies to prevent or delay kidney failure in
    patients. A new international patient registry should increase our
    understanding of inherited causes of calcium oxalate kidney stones. The
    cause(s) of the bladder disease IC remains unknown, but studies of a
    promising biomarker from urine may lead to improved diagnosis and
    treatment for patients, as well as to new therapeutic options.
        Our efforts in digestive diseases will be guided by a long-range
    strategic research plan to be developed by a new National Commission,
    as well as by a recently completed Liver Disease Action Plan. We are
    already making progress on several fronts. In IBD, studies of a
    recently identified Crohn's disease susceptibility gene are pointing
    the way to new therapeutic options. Researchers are exploring the
    multiple physical and cognitive factors that appear to play a role in
    IBS. A new clinical research network is studying the biological basis
    of progression from a less serious form of non-alcoholic fatty liver
    disease to the fatty liver, liver inflammation and scarring of NASH,
    and will test strategies to prevent disease progression in both adults
    and children. Studies of the hepatitis B virus continue in order to
    optimize treatment options. A new system to replicate (``grow'')
    hepatitis C virus in the laboratory will significantly enhance research
    to test potential therapeutic targets and open the door to vaccine
    development--complementing ongoing trials such as HALT-C.
        Strikingly, research has revealed that obesity, with its
    comorbidities, is at the nexus of many chronic diseases. The high
    prevalence of obesity in the U.S. population, with nearly 31 percent of
    adults affected,\4\ bears directly on the millions affected with
    chronic diseases. Obese individuals are at increased risk of type 2
    diabetes, and obesity is linked to increased risk of NASH, as well as
    of ESRD via type 2 diabetes and high blood pressure. However, not all
    overweight and obese individuals will develop obesity-associated
    diseases. Age, gender, race, ethnicity, socio-economic status, and
    individual genetics are among the many factors that may influence risk.
    Through initiatives developed by the NIH Obesity Task Force and through
    NIDDK-led efforts, we are encouraging research studies to promote
    prevention and to identify which subsets of obese individuals are at
    risk for developing particular comorbidities, and, in turn, to tailor
    interventions accordingly.
    ---------------------------------------------------------------------------
        \4\ Flegal KM et al, JAMA 2002;288:1723-1727.
    ---------------------------------------------------------------------------
        Recent data offer promise that we may be able to stem the tide of
    obesity-related health problems. For example, analyses by the United
    States Renal Data System (USRDS) indicate that overall incidence rates
    of ESRD have stabilized in the United States, following a 20 year
    period of annual increases. This finding suggests that there has been a
    successful translation into medical practice of research-based
    knowledge important to preventing ESRD--the use of medications (ACE
    inhibitors) and the benefits of controlling blood sugar and blood
    pressure levels. Unfortunately, this positive result has not yet been
    seen across the entire U.S. population, in that ESRD continues to
    affect minority groups disproportionately. The National Kidney Disease
    Education Program (NKDEP) has a major campaign aimed at reducing the
    burden of kidney disease in African Americans, for whom the risk
    factors of high blood pressure, diabetes, and a family history are
    dangerous red flags. Through its working groups, the program is also
    promoting the standardized, routine reporting of serum creatinine--an
    indicator of kidney function. Use of this simple approach can
    facilitate early detection and treatment of impending or active chronic
    kidney disease in patients. Along the same lines, the National Diabetes
    Education Program (NDEP) has translated into a multi-faceted campaign
    for multiple audiences the impressive results of the Diabetes
    Prevention Program (DPP) clinical trial. This trial demonstrated that
    lifestyle changes--relatively moderate weight loss and increased
    physical activity--can reduce the risk of type 2 diabetes by 58 percent
    in persons at risk for the disease.
        Such hopeful results spur our efforts to further reduce the health
    burden of these chronic conditions through interventions to prevent
    obesity as early as possible. Prevention research needs to address the
    alarming rise in rates of pediatric overweight and obesity nationwide
    over the past three decades. A recent study indicates that
    approximately two million American adolescents have a prediabetic
    condition (IFG) strongly linked to obesity and overweight. Children and
    adolescents are being increasingly diagnosed with type 2 diabetes,
    NASH, and other obesity-associated conditions once found mainly in
    adults. To address key points of vulnerability early in life, the NIDDK
    is spearheading several initiatives, such as defining mechanisms by
    which maternal obesity and diabetes during pregnancy affect the future
    risk of obesity and other chronic diseases in offspring. Another
    initiative is focused on finding ways to prevent or manage weight gain
    in children. Moreover, the new ``HEALTHY'' trial will investigate
    whether a concerted, integrated program in middle schools will help
    reduce the prevalence of obesity-related harbingers of type 2 diabetes
    by improving cafeteria lunches, vending machine offerings, and physical
    education and promoting behavioral change. The tremendous success of
    the intensive lifestyle intervention for adults in the Diabetes
    Prevention Program provides hope that the HEALTHY trial may do the same
    for children.
        The Nation's investment in NIH-funded research offers enormous
    benefits, particularly the opportunity to preempt disease and reduce
    its lifelong costs, both human and economic. To this end, the NIDDK is
    harnessing new technologies, maximizing research investments, and
    capitalizing on new opportunities to achieve early, effective
    intervention for the many chronic diseases within its mission. Thank
    you, Mr. Chairman. I would be pleased to answer any questions that the
    Committee may have.
                                     ______

      Prepared Statement of Dr. John Ruffin, Director, National Center on
                     Minority Health and Health Disparities
        Mr. Chairman and Members of the Committee: I am pleased to present
    the President's budget request for the National Center on Minority
    Health and Health Disparities (NCMHD) for fiscal year 2007, a sum of
    $194,299,000, which represents a decrease of $1,106,000 over the
    comparable fiscal year 2006 appropriation.
        The overall health of the general American population has improved;
    yet as a Nation we continue to be challenged by disparities in health
    among racial and ethnic minority and other health disparity
    populations. There continues to be a disproportionate burden of
    illness, disability and premature death resulting from diseases and
    health conditions such as cancer, cardiovascular disease, HIV/AIDS,
    stroke, obesity, mental illness and diabetes, in these communities.
        The cause of health disparities is multi-factorial in nature. The
    complexity of health disparities merits a strategic, innovative, and
    multi-faceted attack. Genes, biology, culture, race environment,
    socioeconomics, and health behaviors all contribute to this complex
    public health crisis. Biomedical research is essential in transforming
    the health of this Nation. In order to have the greatest impact on
    improving the health of America's underserved populations, at NIH, we
    believe a new biomedical research paradigm is needed--one that is
    predictive, personalized and preemptive. We need a well-coordinated,
    interdisciplinary effort involving traditional as well as non-
    traditional partners to get to the crux of the health disparities
    crisis.
        The National Center on Minority Health and Health Disparities was
    established in 2000 to lead the Federal effort in health disparities
    research, research capacity building, and outreach. The NCMHD has
    always recognized the significance of partnerships in resolving health
    disparities. Our programs embody a strategy that emphasizes our efforts
    to build a biomedical research enterprise that is diverse, predictive,
    personalized, and preemptive.
        The NCMHD is committed to training a diverse biomedical research
    workforce to examine issues relevant to the disparities in health of
    America's rapidly increasing racial and ethnic minority populations.
    More than 600 promising research scientists across the country have
    received NCMHD loan repayment awards to conduct health disparities
    research and clinical research. Institutional capacity building has
    been an important area of focus. Through our endowments and research
    infrastructure program, we have funded almost 40 academic
    institutions--ore than half being minority-serving institutions. The
    funding is helping to equip the institutions, their faculty and
    students to engage in avant-garde biomedical research and training.
    Another integral element of our strategy is community participation.
    Our aim is to empower the community to address its own health problems.
    Our communities should include individuals other than patients, who
    must be actively engaged in research intervention and ultimately the
    translation and dissemination of research results into practical
    community tools.
        Advancements in science and technology offer hope for the future.
    The NCMHD has supplied more than 100 individuals, institutions, and
    small businesses with resources to conduct research to help answer some
    of the perplexing issues in health disparities. NCMHD is one of the few
    NIH Institutes or Centers (IC) that focuses on populations and not
    specific diseases or health conditions. Consequently, we have had the
    unique opportunity of partnering with all of the ICs over the past five
    years in our quest to eliminate health disparities. Our partnerships
    and our programs have allowed us to support research into many of the
    diseases and health conditions affecting racial/ethnic minority and
    other health disparity populations. It is through these programs and
    partnerships, that the NCMHD has been able to have far reaching effect
    in improving the health of the Nation's health disparity populations.
    We have made progress, but there is much more to be achieved.
                       health disparities research agenda
        A national health disparities research agenda is fundamental in
    eliminating health disparities. Healthy People 2010, the prevention
    strategy for the Nation, identified a number of health objectives to be
    achieved over a 10-year period. The elimination of health disparities
    among different segments of the population in the United States is one
    of the goals. We have five years left as a Nation to demonstrate how
    far we have come in attaining that goal. The NIH through the leadership
    of the NCMHD has been a principal player in advancing the goals of
    Healthy People 2010. The NCMHD coordinates the development of the
    evolving NIH health disparities research agenda--the NIH Health
    Disparities Strategic Plan. The Plan represents the trans-NIH health
    disparities vision and strategy. Through the Strategic Plan, the NIH
    can aggressively address health disparities by fostering pioneering
    partnerships and initiatives. The NCMHD, through the Institute of
    Medicine (IOM), initiated the five-year evaluation of the NIH Health
    Disparities Strategic Plan. The NCMHD, in collaboration with NIH
    leadership and the Secretary of Health and Human Services will address
    the recommendations of the IOM report in implementing and reshaping the
    NIH health disparities research agenda.
                        ncmhd health disparities efforts
        At the NCMHD, we are working to build an inclusive, collaborative,
    and adaptive biomedical and behavioral research enterprise to identify
    innovative diagnostics, treatments, and preventive strategies that will
    eliminate health disparities. NMCHD activities have been numerous and
    far-reaching. The newest NCMHD initiative is the Community-Based
    Participatory Research (CBPR) Program, which supports 25 institutions
    nationwide. The CBPR exemplifies a predictive, personalized and
    preemptive approach to eliminating health disparities. It is a three-
    part program that engages the community in all phases of the research
    process and is directed to a specific disease/health condition in a
    particular minority population. It starts with a three-year planning
    grant, followed by a five-year grant to conduct intervention research,
    and concludes with a three-year grant to disseminate the research
    information. The CBPR is a novel approach for the biomedical research
    enterprise, and we anticipate its potential in addressing health
    disparities through projects such as: Project GRACE: A Participatory
    Approach to Address Health Disparities in HIV/AIDS among African
    American Population; Partnership to Overcome Obesity in Hawaii; Project
    AsPIRE (Asian American Partnership in Research); The Healing of the
    Canoe (is aimed at planning, implementing and evaluating a community-
    based and culturally competent intervention to reduce health
    disparities and promote health in the Suquamish Tribe reservation
    community); and Partnership for a Hispanic Diabetes Prevention Program
    in Washington.
        The Centers of Excellence Program, ``Project EXPORT'' has been key
    in leading our effort in supporting the advancement of medical research
    and the transformation of the health care system. The program is
    creating new partnerships to enable institutions at all levels of
    capability to maximize their health disparities research, research
    training and community outreach efforts. The 73 Project EXPORT grantees
    have had a tremendous influence on creating more than 100 unique
    partnerships focused on health disparities. We have created an array of
    partnerships with entities such as hospitals; tribal groups; health
    plans; health centers; community and faith-based organizations; civic
    and non-profit health organizations; and local, city, and state
    governments. Biomedical research is important in understanding the
    underlying causes of health disparities, and how to prevent, diagnose
    and treat disease and disability. The research conducted by our Centers
    of Excellence will help to increase that understanding through projects
    such as: Perceived Discrimination in Healthcare among American Indian/
    Alaska Natives; Religious Outlook on Organ and Tissue Sharing;
    Inflammation and Asthma; Impact of Coronary Heart Disease Risk
    Perception on Health Behaviors and Physical Activity Assessment in
    Multi-Ethnic Women.
        The NCMHD Loan Repayment Programs support the goals of the new NIH
    Pathway to Independence Program by increasing the number of qualified
    health care professionals who conduct health disparities and clinical
    research. The programs promote a diverse and strong scientific
    workforce. Since its establishment, the Loan Repayment Program has made
    more than 600 new awards to researchers in research disciplines such as
    epidemiology, pharmacology, linguistics, etiology, health policy, and
    behavioral science. The program is fulfilling its Congressional intent
    with the majority of award recipients being from a health disparity
    population. The NCMHD is training research scientists and health
    professionals not only to deal with health disparities on the domestic
    level, but also globally. Through the Minority Health and Health
    Disparities International Research Training Program (MHIRT), 24
    academic institutions have developed international training
    opportunities in health disparities research for faculty and students.
    MHIRT participants will be exposed to research areas including cancer
    epidemiology, reproductive biology, parasitology, and ethnopharmacology
    in countries such as Ethiopia, Ghana, Jamaica, Dominican Republic,
    Australia, and Spain.
        The NCMHD commitment to enhancing research capacity at academic
    institutions is best demonstrated through its Research Endowment
    Program and its Research Infrastructure in Minority Institutions (RIMI)
    Program. The RIMI program is building research capacity in 21
    predominantly minority-serving academic institutions. The NCMHD
    provides endowment grants to eligible institutions to build minority
    health and other health disparities research and training capacity. The
    Endowment program has funded 16 institutions to strengthen teaching
    programs in the biomedical and behavioral sciences; establish endowed
    chairs and programs; obtain state-of-the-art equipment for instruction
    and research; and enhance the recruitment and retention of student and
    faculty from health disparity populations.
                            research collaborations
        The health disparities phenomenon is almost incomprehensible until
    it is humanized. Hurricane Katrina demonstrated the underlying national
    health crisis that continues to plague America's racial and ethnic
    minority and low-socio economic communities. In some cases, evacuees
    received medical treatment for the first time for chronic and life-
    threatening diseases, such as hypertension, cardiovascular diseases,
    diabetes, and mental health disorders.
        Community involvement and partnerships are critical to redress the
    devastation experienced by individuals caught in the path of Hurricane
    Katrina. The NCMHD is collaborating with the HHS Office of Minority
    Health on a HHS $12 million initiative to bring desperately needed
    health care services, information, and hope to racial and ethnic
    minority populations in the Gulf Coast region. The NCMHD provided $5.2
    million in funding to support that initiative. Our Centers of
    Excellence have also been mobilized to participate in the initiative to
    create a Regional Coordinating Center to build a research
    infrastructure for on-going efforts to eliminate health disparities in
    the hurricane-ravaged communities. Such an infrastructure would
    integrate research-based academic facilities, public health, primary
    care, and specialty care officials to engage in innovative approaches
    to relief activities, including developing and testing culturally
    relevant telemedicine response to mental health needs, and other acute
    and chronic diseases; instituting electronic health records for
    individuals in the region through partnerships with academic experts in
    practice-based research; and establishing effective community-based
    screening and surveillance systems to monitor health needs of
    individuals evacuated from hurricane-ravaged communities, as well as
    those returning to communities as they are re-built, with a special
    focus on exacerbations of existing health disparities.
        The NCMHD Visiting Faculty Program is a new program that is
    assisting researchers displaced by the hurricane. The program will help
    to bring displaced scientists who were employed at institutions in the
    Gulf Coast states to the NIH, so that they can continue their research
    efforts.
                                   conclusion
        During its initial five years the NCMHD has strived to be
    inclusive, creative, and adaptable to changing circumstances. The
    programs highlighted are but some examples of what is being done to
    eliminate health disparities. We need to build on these successes and
    further our activities. Toward this end, the NCMHD will sustain and
    expand its primary strategies. Research capacity building will continue
    to extend beyond academia to involve community and faith-based
    organizations, individuals, and businesses at the local and grassroots
    level. Training and the diversification of the health, scientific, and
    technological workforce will remain key areas of focus in developing
    innovative projects. Prevention, treatment, cultural competency, and
    healthcare delivery for urban and rural communities will continue to be
    approached aggressively.
        Through our vision of the future embodied in the NIH Health
    Disparities Strategic Plan, the NCMHD renews its commitment to build a
    solid and diverse national biomedical research enterprise of
    individuals and institutions dedicated to eliminating health
    disparities. With our NIH Institute and Center collaborations and our
    partnerships with scientific institutions and community-based
    organizations across the Nation, the NCMHD will advance scientific
    discovery to ensure the health of all Americans. All citizens should
    have an equal opportunity to live long, healthy and productive lives.
                                     ______

        Prepared Statement of Dr. David A. Schwartz, Director, National
                   Institute of Environmental Health Sciences
        Mr. Chairman and Members of the Committee: I am pleased to present
    the President's budget for the National Institute of Environmental
    Health Sciences (NIEHS) for fiscal year 2007, a sum of $637,323,000
    which reflects a decrease of $3,809,000 from the fiscal year 2006
    appropriation.
                                  introduction
        As the Director of NIEHS, I am grateful for this opportunity to
    present our vision for the Institute and environmental health sciences.
    Our vision at NIEHS is to prevent disease and improve human health by
    using environmental sciences to understand human biology and human
    disease. Environmental agents contribute to many conditions of public
    importance, including cancer, neurodevelopmental disorders, autoimmune
    diseases, and chronic lung disease. While many of our investigators are
    focused on understanding the causes of disease, we are also involved in
    studies of susceptibility, basic mechanisms of disease, and identifying
    novel approaches to intervention and disease prevention.
        Recent NIEHS-supported research illustrates the range of our
    Institute's science. In studying asthma, NIEHS scientists examined the
    mechanisms controlling the body's own system for achieving balance
    between airway constriction and airway relaxation. They discovered a
    natural bronchodilator, deficient in asthmatics, that relaxes the
    airway; absence of this enzyme in mice increases the development of
    allergen-induced asthma. In other work, investigators studied the role
    of supplements in preventing birth defects. While folate has been shown
    to prevent spina bifida, a defect in the spinal column, epidemiologists
    have now discovered that women who take folate supplements during
    pregnancy are at reduced risk of giving birth to a child with cleft lip
    and palate birth defects. Finally, NIEHS-supported studies have shown
    that short-term exposure to ozone can increase mortality rates. These
    studies demonstrated that a 10-part per billion (ppb) increase in the
    previous week's ozone was associated with a significant increase in
    cardiovascular and respiratory mortality.
                               current challenges
        Today, we find ourselves at a critical junction where new tools and
    opportunities for substantial scientific achievement intersect with our
    growing understanding of cellular and molecular mechanisms by which
    environmental exposures exert their effects. Our challenge is to take
    advantage of these advances and to forge new frontiers to improve our
    nation's health. To help ensure that the best opportunities are
    identified and funded, we have made several programmatic and scientific
    changes at the Institute since last April. Importantly, these changes
    are consistent with our strategic plan that we initiated ten months ago
    and have involved the efforts of many talented individuals across the
    country. Concurrently, we are engaged in developing critical
    partnerships to address areas of public health concern that involve the
    missions of multiple organizations.
                     integrative research on human disease
        Environmental health science is not limited to an organ system,
    disease or population, but spans the full spectrum of human health and
    disease. The interdisciplinary nature of our work requires the right
    mix of specialists. As NIEHS increases its focus on common human
    diseases, interdisciplinary teams of scientists will be needed to
    integrate clinical, epidemiological, and toxicological research with
    basic mechanistic studies. To optimize the creation of these
    interdisciplinary research teams, I have begun a number of programmatic
    changes. I have created an Office of Translational Biomedicine that
    will re-focus the NIEHS intramural and extramural programs so that our
    basic research discoveries can be rapidly applied to improvements in
    human health. In our division of extramural research, I have initiated
    a new program, DISCOVER (Disease Investigation for Specialized
    Clinically Oriented Ventures in Environmental Research), that brings
    together extramural scientists with expertise in basic, clinical, and
    population-based research to focus on a disease related to
    environmental exposures. Among intramural investigators, I have
    developed a new program, the Director's Challenge, that also supports
    multidisciplinary research teams to attack basic problems, like
    inflammation and oxidative stress, that can be induced by environmental
    exposures and can influence the development of many different diseases.
    I am re-engineering our Environmental Health Science Research Centers
    so that they include a clinical component in their research, thus
    enhancing the disease focus and relevance of these centers. I have also
    directed funds to build a new clinical research unit on campus so that
    our intramural research program can be integrated into human biology
    and human disease.
                     recruit and train the next generation
        A more integrative approach to understanding complex human diseases
    will require innovative scientists with the type of training that can
    take advantage of new technologies and research opportunities. NIEHS
    has initiated a number of changes that address our future workforce
    needs. We have re-engineered our existing training programs so that we
    can better identify and encourage promising students at all levels to
    pursue careers in environmental health research. The existing T32
    training grants program will be broadened to include other training
    opportunities in interdisciplinary research and genetics and genomics.
    We will also train physician-scientists by expanding our MD, PhD
    training program and by supporting young investigators in their
    transition to early faculty positions (developed a K12 training
    program. We have also instituted the Outstanding New Environmental
    Scientist, or ONES, award to help young, talented investigators make
    the transition from mentored to independent research. These grants will
    assist young scientists in launching innovative research programs
    focusing on problems of environmental exposures and human biology,
    human pathophysiology, and human disease by providing support for both
    the research and the start-up costs that are needed to establish a
    laboratory.
                        expand community-linked research
        The likelihood of exposure to environmental agents increases in
    economically disadvantaged communities and is associated with an excess
    disease burden in these communities. The NIEHS traditionally supports
    research relevant to understanding those health disparities and
    community concerns. We will continue to support research, both
    domestically and globally, that can offer insights into how to reduce
    exposures and disease in these settings. We will also be involved in
    developing quick responses to emerging environmental health issues,
    such as arose in the aftermath of Hurricane Katrina, when NIEHS
    launched a website that used a Global Information System to assess
    environmental hazards caused by the storm, as well as coordinated a
    local team of physicians and support staff to deliver medical care.
    Beginning in fiscal year 2006, NIEHS is planning to support a research
    program to investigate the health consequences of Hurricane Katrina.
    This project will examine the role of genes, the environment, and gene-
    environment interaction in the exacerbation of airway disease from
    exposure to mold and microbial toxins in New Orleans following
    Hurricane Katrina.
                      re-evaluate programmatic investments
        We have decided that investigator-initiated research needs to be
    prioritized at NIEHS and are rigorously re-evaluating other existing
    programs and approaches to determine if we need to re-conceptualize or
    eliminate some of these efforts. We have developed two new programs
    aimed at using environmental agents to understand basic mechanisms in
    human biology. One is the Epigenetics Initiative which explores
    intrauterine environmental and nutritional factors that can alter gene
    expression and generate developmental abnormalities or functional
    changes. The other is the Comparative Biology of Environmental Disease
    which uses novel ``-omics'' technologies and comparative biology
    approaches to study environmentally-relevant disease pathways. These
    studies will help us understand why people exposed to the same
    environmental stressors respond differently. Finally, we have
    reorganized the National Center for Toxicogenomics to insure a more
    timely and relevant product. In order to achieve these new programs and
    priorities, I have decided that the Comparative Mouse Genomics Centers
    Consortium has fulfilled its mission of infrastructure development and
    will not be re-competed.
          gene, environment and health initiative--a novel partnership
        Currently, we have inadequate techniques to precisely measure
    environmental exposures. This situation is in marked contrast to the
    robust tools that have been recently developed for the fields of
    genetics and genomics. To be able to assess the role that environmental
    exposures and genetic variation play in the risk of developing disease,
    we simply need more robust tools to measure the environmental exposures
    and the biological responses to these agents. While these tools are
    absolutely vital in moving the field of environmental health sciences
    forward, these tools will be invaluable to investigators in all areas
    of biomedical research. To further this goal, the NIH, with the support
    of the Secretary, has developed the Gene, Environment and Health
    Initiative. Our goal in this initiative is to develop tools to
    precisely measure individual biological responses to changes in our
    environment, diet, and activity level so that we can understand the
    relationship between various environmental exposures and human health
    and disease.
                      niehs strategic plan--a new outlook
        The NIEHS recently embarked on a strategic planning exercise, the
    final version of which can be viewed on our website and will soon be
    distributed in hardcopy. This document represents the efforts of many
    scientists and advocacy groups. I have been gratified by the intense
    interest and involvement from citizens and scientists throughout the
    country. This document is truly a national plan that represents our
    collective wisdom of where environmental health sciences needs to go in
    order to reap full benefit of our investments and opportunities. Many
    of the suggestions have already been incorporated into our new programs
    and we will continue to design programs that are responsive to this
    plan.
                                    summary
        The opportunities within environmental health sciences are greater
    than they have ever been. With our recent nationally supported
    strategic plan and the exciting partnerships that we are developing, it
    is my belief that environmental health sciences will continue to
    strengthen. With an improved relevance to major public health concerns,
    better technology for teasing out important environmental contributors
    to disease, an integrated approach to research, and a re-energized
    workforce, I expect the NIEHS to provide many of the important
    scientific advances of the future. Ultimately, this knowledge will be
    used to reduce the burden of many important diseases both in this
    country and abroad. I would be happy to answer any questions you might
    have.
                                     ______

       Prepared Statement of Dr. Paul A. Sieving, Director, National Eye
                                   Institute
        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2007 President's budget request for the National Eye
    Institute (NEI). The fiscal year 2007 budget includes $661,358,000,
    which reflects a decrease of $5,398,000 under the fiscal year 2006
    enacted level of $666,756,000 comparable for transfers proposed in the
    President's request.
        As the Director of the NEI it is my privilege to report on the
    progress laboratory and clinical scientists are making in combating
    blindness and visual impairment and about the unique opportunities that
    exist in the field of vision research.
                                retinal diseases
        Retinal diseases are a diverse set of sight-threatening conditions
    that include age-related macular degeneration (AMD), diabetic
    retinopathy, retinopathy of prematurity, retinitis pigmentosa, Usher's
    syndrome, ocular albinism, retinal detachment, uveitis (inflammation)
    and cancer (choroidal melanoma and retinoblastoma).
        Of these diseases, AMD is the most frequent cause of vision loss
    and legal blindness in older-age Americans, making it a research
    priority for the NEI. AMD causes degeneration of the macula, the
    central part of the retina that gives us fine, sharp visual detail. AMD
    is thought to result from the confluence of genetic predisposition and
    chronic exposure to environmental risk factors.
        On the genetic side of the equation, identifying subtle alterations
    in a gene or genes in AMD and other late onset diseases has been
    complicated by the fact that traditional genetic research strategies
    and tools are either inadequate or too cumbersome in their application.
    The development of more sophisticated genetic tools has enabled
    scientists to scan the entire human genome more quickly and
    efficiently. Using data from the Human Genome Project and the
    International HapMap Project, four different NEI supported laboratories
    identified a common variation in a gene called complement factor H
    (CFH) that accounts for an estimated 50 percent of the risk of
    developing AMD.
        The CFH protein regulates an inflammatory response that is
    typically triggered by infectious microbes. Alterations in the CFH gene
    are postulated to poorly regulate this response, leading to chronic,
    localized inflammation and ensuing damage to cells in the center of the
    retina, the macula, and its neighboring tissues. Inflammation is
    thought to play a role in many other common diseases such as
    Alzheimer's disease, Parkinson's disease, multiple sclerosis, kidney
    disease, stroke, and atherosclerosis. Although the cells, tissues, and
    molecular events in these diseases are diverse, they may share some
    common disease mechanisms that present an opportunity to cross
    pollinate findings from diverse research areas.
        The discovery of the CFH gene will allow researchers to create
    animal models and evaluate therapies that control chronic inflammation.
    The CFH gene also illustrates the potential of a new paradigm for
    medicine in the 21st century. This new paradigm holds that the practice
    of medicine should be preemptive, personal and predictive. The CFH gene
    presents the possibility to one day identify at-risk patients and
    intervene well before pathology is clinically detectable.
                  strabismus, amblyopia and visual processing
        Developmental disorders such as strabismus (misalignment of the
    eyes) and amblyopia (commonly known as ``lazy eye'') are among the most
    common eye conditions that affect the vision of children. It is
    estimated that 20 percent of preschool children ages 3-4 have these and
    other treatable eye conditions.\1\
    ---------------------------------------------------------------------------
        \1\ Comparison of preschool vision screening tests as administered
    by licensed eye are professionals in the Vision in Preschoolers Study.
    Ophthalmology 111(4):637-50, 2004.
    ---------------------------------------------------------------------------
        In an effort to identify children with treatable eye conditions,
    many states are developing guidelines for preschool screening programs.
    However, none of the commonly used vision tests have been evaluated in
    a research-based environment to establish their effectiveness. To
    address this issue, the NEI supported a large, multi-center study
    called the Vision in Preschoolers (VIP) Study to determine which tests
    and test conditions can effectively identify preschoolers in need of a
    comprehensive eye exam. Previously VIP Study researchers found that in
    the hands of licensed eye care professionals, the best performing tests
    were able to detect 90 percent of children with the most severe visual
    impairments. This year, VIP Study investigators found that specially
    trained nurses and lay people can achieve results that are comparable
    to screenings performed by licensed eye care professionals. Given that
    most eye screening programs rely on lay people and nurses, this finding
    validates the effectiveness of this approach.
                        glaucoma and optic neuropathies
        Glaucoma is a group of eye disorders that causes optic nerve damage
    that can lead to severe visual impairment or blindness. Elevated
    intraocular pressure (IOP) is frequently, but not always, associated
    with glaucoma. Glaucoma is a major public health problem and published
    studies find that the disease is three times higher in African
    Americans than in non-Hispanic whites.\2\
    ---------------------------------------------------------------------------
        \2\ The Eye Diseases Prevalence Research Group: Prevalence of open-
    angle glaucoma among adults in the United States. Arch Ophthalmol
    122:532-538, 2004.
    ---------------------------------------------------------------------------
        The defining event that leads to vision loss in all forms of
    glaucoma is the degeneration of retinal ganglion cells (RGC) in the
    back of the eye. These cells relay visual information to the brain
    through the optic nerve and their loss effectively severs the neural
    network that allows us to process visual information. However, little
    is known about the molecular events that result in RGC degeneration.
    Using high dose radiation and bone marrow rescue to explore
    inflammatory responses in an animal model of glaucoma, researchers
    unexpectedly discovered that this procedure prevents the loss of RGCs.
    The neuroprotection offered by this procedure was complete, highly
    reproducible, and lasting. Normally, by 12-14 months, these glaucoma
    susceptible mice have complete RGC loss. At 14 months, treated mice had
    no detectable signs of disease. Although the mechanism that offers
    neuroprotection is not yet known, researchers speculate that it is due
    to radiation, because the transferred bone marrow was genetically
    identical to the original bone marrow the mice were born with. This
    highly novel treatment protocol offers a tool to understand
    neurodegeneration and, with refinement, could have important
    implications for the treatment and prevention of neurodegenerative
    diseases.
                                corneal diseases
        The cornea is the transparent tissue at the front of the eye.
    Corneal disease and injuries are the leading cause of visits to eye
    care professionals, and are some of the most painful ocular disorders.
    In addition, approximately 25 percent of Americans have a refractive
    error known as myopia or nearsightedness that requires correction to
    achieve sharp vision; many others are far-sighted or have
    astigmatism.\3\
    ---------------------------------------------------------------------------
        \3\ The Eye Diseases Prevalence Research Group: The prevalence of
    refractive errors among adults in the United States, Western Europe,
    and Australia. Arch Ophthalmol. 122:495-505, 2004.
    ---------------------------------------------------------------------------
        Inflammation is a common immune response to injury and infection in
    the body. In the cornea, however, inflammation can cause extreme
    discomfort and result in vision loss. Nonetheless, the cornea retains a
    remarkable capacity for wound repair while actively suppressing an
    inflammatory response. Scientists have recently discovered that two
    lipids, lipoxin A4 (LXA4) and docosahexaenoic
    acid-derived neuroprotectin D1 (NPD1), are formed in the cornea and act
    as anti-inflammatory agents during corneal infection and wound healing.
    Topical treatment with LXA4 and NPD1 in mice with corneal
    injuries increased the rate of tissue repair and inhibited inflammation
    without impairing the recruitment of key immune leukocytes, which are
    normally associated with inflammation, into the wounded tissue.
    Moreover, a transgenic mouse that lacks these lipids exhibited delayed
    wound healing and attenuated leukocyte recruitment. The identification
    of these anti-inflammatory lipids in the cornea and their enhancement
    of wound healing by topical application suggest their use as
    therapeutic agents to overcome aberrant and damaging inflammatory
    responses in the eye.
                                    cataract
        Cataract, an opacity of the lens of the eye, interferes with vision
    and is the leading cause of blindness in developing countries. In the
    United States, cataract is also a major public health problem. The
    enormous economic burden of cataract will worsen significantly in
    coming decades as the American population ages.
        The lens is a dense, compact structure containing two cell types:
    metabolically active epithelial cells and quiescent fiber cells.
    Throughout the life-time of an individual, the lens carries out a
    process of continued growth with epithelial cells dividing and
    differentiating into fiber cells. During this process, the emerging
    fiber cells become denuded of organelles such as the nucleus and
    mitochondria. This process in part helps the lens achieve the high
    transparency needed for clear vision. Scientists have previously found
    that the lens uses proteins involved in a biological process called
    programmed cell death or apoptosis to rid lens fiber cells of their
    organelles. This past year, vision researchers have discovered the
    biologic process that regulates apoptosis such that it allows for the
    elimination of organelles without resulting in cell death.
        The process is termed Apoptosis-related Bcl-2 and Caspase-dependent
    (ABC) differentiation. In this process, a number of proteins that
    normally lead to cell death such as caspases--proteins that break-down
    internal cellular structures--are expressed to denude organelles. The
    caspase proteins are balanced by the simultaneous induction of pro-
    survival molecules such as bcl-2, a protein that binds to cell death
    proteins and inhibits further damage or death to fiber cells. The
    discovery of ABC differentiation in the lens will allow researchers to
    better understand lens cell renewal and determine whether faulty
    mechanisms in this process might lead to cataract formation.
                                  nih roadmap
        A goal of the NIH Roadmap Nanomedicine Initiative is to
    characterize quantitatively the molecular scale components or
    nanomachinery of cells and to precisely control and manipulate these
    molecules and supramolecular assemblies in living cells to improve
    human health. The NEI has a leadership role in implementing the NIH
    Roadmap Nanomedicine Initiative. Under this initiative, a Request for
    Applications (RFA) was prepared to award Nanomedicine Center Concept
    Development Awards. These concept development awards were created to
    allow applicants time and resources to develop the concept for a
    Nanomedicine Center that would address various issues in nanomedicine
    including, biomolecular dynamics, intracellular transport, and protein-
    protein interactions. Understanding these fundamental biologic
    processes at the nanoscale level will allow scientists to engineer
    molecular structures, assemblies, and organelles for treating diseased
    or damaged cells and tissues. Of the applications, four Nanomedicine
    Centers were awarded in fiscal year 2005. The Centers will be dedicated
    to understanding the nanobiology that underlies protein folding
    machinery; ion channels and ion transport proteins; synthetic signaling
    and motility systems; and mechanical biology. The NIH expects to fund
    additional Nanomedicine Centers in fiscal year 2006. The Nanomedicine
    Initiative will also benefit eye research in a more direct way. Current
    NEI grantees are exploring the use of nanotechnology to assist in
    corneal wound healing and drug delivery to the retina. Increased
    support of nanomedicine through the NIH Roadmap will undoubtedly speed
    progress in these areas.
                           nih neuroscience blueprint
        The NIH Neuroscience Blueprint is a collaborative effort among 15
    NIH institutes and centers to accelerate the pace of discovery and
    understanding in neurosciences research. In an effort to better
    understand all elements of the nervous system, the Blueprint will focus
    on the development of tools and resources that will facilitate research
    on the processes of development, neurodegeneration, and plasticity that
    underlie the health and disorders of the nervous system. One of the
    approaches to develop these tools and resources is a cellular level
    approach to discovering the key molecules involved in nervous system
    function. There is still a need to identify the location, the
    developmental timing, and the cellular function of most of the genes
    and proteins expressed in the brain. Mapping of the neurogenome is
    being conducted by creating and analyzing transgenic mice to map gene
    expression and activity to different cell types and regions of the
    mouse central nervous system. The NEI component of this effort will be
    to ensure that the genes involved in neurons of the complete visual
    system are included in the neurogenome map.
        Mr. Chairman, this concludes my prepared statement. I would be
    pleased to respond to any questions you or other members of the
    committee may have.
                                     ______

    Prepared Statement of Dr. Stephen E. Straus, Director, National Center
                   For Complementary And Alternative Medicine
        Mr. Chairman and Members of the Committee: I am pleased to present
    the President's fiscal year 2007 budget request for the National Center
    For Complementary And Alternative Medicine (NCCAM). The fiscal year
    2007 budget includes $120,554,000, a decrease of $911,000 over the
    comparable fiscal year 2006 appropriation of $121,465,000.
        NCCAM has made significant progress in discovering the potential of
    complementary and alternative medicine (CAM) to prevent and treat
    disease. During NCCAM's first 7 years, the Center has formed a research
    enterprise that addresses the challenges of conducting CAM research as
    well as training investigators, conducting outreach, and facilitating
    the integration of proven CAM therapies into the health care that
    Americans receive.
                               setting the course
        Through national surveys, we know that two-thirds of Americans are
    using some form of CAM each year. We are gaining understanding of which
    Americans use the various CAM modalities and for which health purposes.
    These patterns of CAM use will inform NCCAM's research priority setting
    in fiscal year 2007, along with guidance from two key documents:
      --The NCCAM Strategic Plan for 2005-2009 (developed with input from
            the public and scientific and medical communities nationwide);
            and
      --The Institute of Medicine's 2005 report, ``Complementary and
            Alternative Medicine in the United States.''
        In fiscal year 2007, NCCAM will again collaborate with the Centers
    for Disease Control and Prevention to support the National Health
    Interview Survey to capture changes in trends of the American public's
    use of CAM.
                        furthering the research mission
        Seven years of NCCAM investments in CAM research translate to the
    support of more than 1,200 projects (in research, training, and career
    development) at over 260 U.S. institutions. There has been a 20-fold
    increase in the number of CAM papers published in leading scientific
    journals by NCCAM grantees. In fiscal year 2007, building upon this
    strong foundation, NCCAM plans to further enhance CAM research in the
    following areas.
    A Flourishing Centers Program
        NCCAM has expanded and refined its approach to research centers. As
    a result, the Center now has a diverse cadre of multidisciplinary
    research centers at conventional and CAM institutions nationwide.
      --Centers of Excellence for Research on CAM.--Six centers with
            outstanding research records direct teams of CAM and
            conventional investigators to explore, using cutting-edge
            technologies, how CAM therapies may work.
      --Developmental Centers for Research on CAM.--Scientists and
            practitioners at 18 CAM and conventional institutions have
            forged research partnerships. In fiscal year 2007 there will be
            new Phase I developmental centers for CAM institutions just
            launching programs of research, and Phase II developmental
            centers for CAM institutions prepared to undertake more
            sophisticated research studies.
      --International Centers for Research on CAM.--Two centers support
            U.S. investigators who collaborate with experts in the
            traditional medical systems of their own countries, building
            research expertise and capacity abroad and providing foreign
            researchers with valuable experience in navigating the NIH
            grants system.
      --Botanical Research Centers.--Seven dietary supplement research
            centers focusing on studies of botanical products are funded by
            NCCAM and the NIH Office of Dietary Supplements. Research
            conducted by these centers will advance the scientific base of
            knowledge about the safety, effectiveness, and mechanisms of
            action of botanicals.
    Studies of Herbals and Other Dietary Supplements
        Herbals and other dietary supplements are widely used by the
    American public and they are a research priority for NCCAM. Studying
    botanicals, however, has presented special research challenges related
    to product characterization, standardization, and dosage. With the
    advice of experts in herbal medicine and leaders of the dietary
    supplement industry, NCCAM is improving product consistency for
    research studies and thus increasing the probability that the studies
    NCCAM funds will yield accurate findings.
        In this regard, the Center has developed research-quality cranberry
    products to use in studies of urinary tract infections and standardized
    an extract of milk thistle (silymarin), for study in patients with
    chronic viral hepatitis and non-alcohol-related steatohepatitis, a
    collaborative project with the National Institute of Diabetes and
    Digestive and Kidney Diseases.
        NCCAM has worked with several NIH partners to design, conduct, and
    fund large clinical trials of dietary supplements. The largest of these
    was reported in February 2006 in the New England Journal of Medicine: a
    4-year study (co-funded by the National Institute of Arthritis and
    Musculoskeletal and Skin Diseases) of glucosamine and chondroitin
    sulfate, two dietary supplements widely used by people with knee
    osteoarthritis. In this study, the two supplements combined did not
    provide statistically significant pain relief for all the participants,
    compared to placebo. However, a small subset of participants with
    moderate-to-severe pain had significant pain relief. An ancillary study
    is continuing to determine whether the combination of these supplements
    can prevent or delay further joint deterioration, a common long-term
    outcome for people with osteoarthritis.
    A Broad Research Portfolio
        There are hundreds of different practices, products, and approaches
    that comprise CAM. Thus, the research that NCCAM funds is wide-ranging.
    Areas that NCCAM will emphasize further in fiscal year 2007 include:
      --Manual therapies.--The mechanisms of action underlying the effects
            of manipulative and body-based therapies such as chiropractic
            and massage are little understood. Therefore, NCCAM is
            launching an initiative in fiscal year 2007 on the biology of
            manual therapies to better understand the effects of these
            techniques on the body.
      --Mind-body medicine.--One recent NCCAM-funded study found that tai
            chi combined with standard medical care benefits patients with
            chronic heart failure. Studies of meditation and mindfulness-
            based stress reduction in various health conditions are under
            way. NCCAM is also redirecting the focus of its intramural
            research program to emphasize studies of mind-body medicine.
      --Echinacea.--Research on echinacea is being done both because of the
            public health burden of the common cold and the public's
            widespread use of this natural product. A study of a single
            dosage of Echinacea purpurea to treat viral colds in healthy
            children was recently completed by an NCCAM grantee. A larger
            study is being undertaken in which a range of doses of this
            popular herb will be assessed for its ability to prevent colds
            in children.
      --Immune responses.--Many CAM interventions are believed to affect
            the immune system, either by enhancing its ability to thwart
            infection or by suppressing an overactive response, as occurs
            in autoimmune diseases. NCCAM is exploring the immune effects
            and basic mechanisms of action of various CAM modalities such
            as traditional Chinese herbal mixtures, ginseng, green tea, and
            Ginkgo biloba.
                   expanding training and career development
        There can be no significant CAM research progress without a
    sufficient cadre of investigators who are both skilled in rigorous
    research and knowledgeable about CAM practices. NCCAM has increased the
    number, quality, and diversity of the CAM research community using a
    variety of approaches and grant mechanisms. In fiscal year 2007, NCCAM
    will offer three new training opportunities: supplements to existing
    research grants, in order to attract more CAM practitioners into
    research endeavors; the CAM Practitioner Research Career Development
    Award, for CAM practitioners interested in research; and the NCCAM
    Career Transition Award, to help outstanding postdoctoral research
    fellows in their transition to an independent career in CAM research.
                           disseminating information
        From the outset, NCCAM has made it a priority to help
    practitioners, patients, and the public make informed decisions about
    CAM. The Center conducts outreach to public and professional audiences
    through a variety of channels: information clearinghouse, website,
    quarterly newsletter, conferences, Distinguished Lecture Series, and
    online continuing education. With the National Library of Medicine, the
    Center publishes CAM on PubMed, an online database of more than 400,000
    research papers on CAM.
                            facilitating integration
        NCCAM is committed to facilitating the integration of safe and
    effective CAM therapies into conventional medicine. One example of this
    effort is within the NIH itself. The Center is establishing a new
    Integrative Medicine Consult Service at the NIH Clinical Center, to
    provide integrative medical consultations and enrich patient care. In
    addition, NCCAM continues to provide CAM curriculum development grants
    to conventional medical, dental, and nursing schools.
                            collaborating across nih
        NCCAM continues its collaborations with other NIH Institutes and
    Centers, as a contributing member of the biomedical research community.
    For example, NCCAM is a partner in several of the NIH Roadmap for
    Medical Research initiatives, including the Exploratory Centers for
    Interdisciplinary Research. Also, by participating in efforts like the
    NIH Neuroscience Blueprint, the NIH Pain Consortium, and the Trans-NIH
    Obesity Initiative, NCCAM can accelerate efforts to unlock the
    potential of CAM therapies through these multidisciplinary research
    initiatives.
                           looking toward the future
        Mindful of the lessons learned in our first 7 years as an NIH
    Center, and with growing understanding of the scientific opportunities
    and public health priorities to be addressed with CAM approaches, NCCAM
    will continue to explore options to sustain and improve the health and
    well-being of the American people.
        Thank you, Mr. Chairman. I would be pleased to answer any questions
    that the Committee may have.
                                     ______

        Prepared Statement of Dr. Lawrence A. Tabak, Director, National
                 Institute of Dental and Craniofacial Research
        Mr. Chairman and Members of the Committee: I am pleased to present
    the President's budget request for the National Institute of Dental and
    Craniofacial Research (NIDCR) for fiscal year 2007. The fiscal year
    2007 budget includes $386,095,000, a decrease of $3,241,000 from the
    fiscal year 2006 level of $389,336,000, comparable for transfers
    proposed in the President's Request.
                 strengthening the evidence base in dental care
        Health care decisions should be guided by the preponderance of
    clinical research data, or evidence, whenever possible. This approach
    is known as ``evidence-based medicine'', a concept that has evolved
    into a driving force in healthcare.
        Recognizing the concept's value, dentistry also has embraced an
    evidence-based approach. Yet, having sufficient clinical data from
    which to build that base can be challenging. For some oral health
    problems, evidence-based approaches are possible; for many others,
    knowledge gaps must be filled before an evidence-based approach can
    take root. As the nation's leading supporter of oral, dental, and
    craniofacial research, the NIDCR is uniquely positioned to fill those
    gaps while continuing its efforts in the laboratory to develop new and
    even more effective ways to prevent, diagnose, and treat dental
    diseases. I would like to highlight over the next few minutes how the
    NIDCR is sowing the clinical seeds of progress to advance evidence-
    based dentistry in America and, above all, improve the nation's oral
    health.
                        practice-based research networks
        Healthcare providers sometimes comment that too often they are not
    included as participants in research, noting that their clinical
    experience and insight are significant assets to understand and address
    patients' most pressing health concerns. I believe that there is much
    to be gained from engaging clinical practitioners in research. That is
    why the NIDCR recently established three regional practice-based
    research networks (PBRNs) to investigate everyday issues in oral
    healthcare.
        Each PBRN involves 100 or more oral health practitioners who will
    propose and conduct studies of common dental procedures across a range
    of patient and clinical conditions. For example, some of the early
    investigations will gather data on methods dentists use to restore
    teeth with deep decay, and to assess caries risk. Each network will
    conduct 15 to 20 clinical studies over the next seven years. The PBRNs
    also will collect information to generate data on disease, treatment
    trends, and the prevalence of less common oral conditions.
        While the PBRNs aim high, their success will be rooted in their
    focus on real-world clinical issues and their ability to generate
    information that will be of immediate value to practitioners and
    patients alike. The studies will involve topics and procedures that
    clinicians themselves identify as relevant and in need of systematic
    research to help guide clinical decisions. I believe the PBRNs have the
    potential to generate a body of high quality clinical research data in
    a relatively short period of time. Most importantly, their research
    will substantially enhance the base of evidence clinicians can use to
    inform treatment decisions, translate newer information into daily
    practice, and directly affect and improve routine dental care.
                   greater emphasis on large clinical studies
        The nation's progress against heart disease, cancer, and infectious
    diseases has been accelerated by large clinical studies yielding
    results that can be generalized and can clarify the interplay of many
    variables. In dentistry, clinical research traditionally has involved
    smaller studies with fewer participants. The NIDCR is changing this
    trend by supporting larger clinical studies whose outcomes have the
    potential to fundamentally change dental practice and improve public
    health. I would like to tell you about some examples.
                     periodontal disease and preterm birth
        In the United States, about one in eight babies is born
    prematurely.\1\ Preterm babies can be so small and underdeveloped that
    they must remain hospitalized for months and, if they survive, spend
    years battling chronic health problems. This heartbreaking situation
    has spurred scientists to identify risk factors associated with
    premature births. Risk factors such as smoking, hypertension, and
    diabetes allow doctors to identify women who are more likely to deliver
    prematurely and to tailor their prenatal care. However, identification
    of risk factors is a work in progress. One in four of preterm births
    (more than 125,000 per year) occurs without any known explanation.\2\
    Scientists have assembled an intriguing body of preliminary evidence to
    suggest that women who have severe gum, or periodontal, disease during
    pregnancy are at increased risk of preterm delivery. This raises the
    question: Does treatment for periodontal disease during pregnancy help
    women reach full term and give birth to healthy babies?
    ---------------------------------------------------------------------------
        \1\ Martin JA, Hamilton BE, et al. Births: Final data for 2003.
    National vital statistics reports; vol. 54 no 2. Hyattsville, MD:
    National Center for Health Statistics. 2005.
        \2\ Offenbacher S, Katz V, et al. Periodontal infection as a
    possible risk factor for preterm low birth weight. J Periodontol, vol.
    67(10) p. 1103-13.
    ---------------------------------------------------------------------------
        The NIDCR is supporting the first large, controlled Phase III
    clinical trials to answer this important public health question. Two
    studies involve over 2,600 women of various racial, ethnic, and
    economic backgrounds. The first, called the Obstetrics and Periodontal
    Therapy (OPT) trial, will soon report its findings, providing for the
    first time the clinical data needed to offer sound scientific advice on
    this issue. The results of the second study, called the Maternal Oral
    Therapy to Reduce Obstetric Risk (MOTOR) trial, should be forthcoming
    next year.
                    better pain treatments for jaw condition
        Temporomandibular joint and muscle disorder (TMJMD) is an umbrella
    term for conditions affecting the area in and around the
    temporomandibular joint, or TMJ. The TMJs connect the jaw to the skull.
    Common symptoms of TMJMD include persistent pain in the jaw muscles,
    restricted jaw movement, and jaw locking.
        Although TMJ disorders vary in their duration and severity, for
    some people the pain becomes severe and permanent. NIDCR recently
    launched a large, seven-year clinical study to accelerate research on
    better pain-control treatments for TMJMDs. The study, called Orofacial
    Pain: Prospective Evaluation and Risk Assessment (OPPERA) will collect
    data on 3,200 healthy volunteers for three to five years to see how
    many develop TMJMD, opening a largely unexplored window from which to
    observe the early stages of the disorder. With this unique vantage
    point, they can gather data on key genetic, physiologic, and
    psychological variables involved in TMJMD pain, ultimately weaving the
    information into more effective treatments.
        Only a decade ago, a large study tracking the development of TMJMD
    over time would have been scientifically problematic, because little
    was known about the basic mechanisms of human pain. However, because
    progress in the basic sciences has fed the knowledge pipeline, pain
    researchers have now better defined the molecular circuitry involved in
    pain transmission, thereby providing the conceptual framework for this
    important clinical study.
                       molecular medicine and oral cancer
        In the fight against cancer, future weapons of choice likely will
    fall within the therapeutic category of molecular medicine. The concept
    builds on world-wide efforts to design cancer treatments targeting the
    precise molecules that drive the tumor process, leaving normal cells
    unscathed. As envisioned, molecular medicine will increase the benefits
    of treatment and limit greatly the unwanted side effects that now
    afflict cancer patients. For the vision to become reality, scientists
    first must learn to correctly identify distinctive features of the
    genetic and/or protein profiles of developing tumors. Much progress has
    been made in the laboratory, but the promise of molecular diagnostics
    remains largely unready for translation to patient care.
        An NIDCR-supported project that has successfully taken that
    critical step is a partnership between scientists, dental educators,
    and a community clinic in British Columbia. The partners have
    integrated molecular techniques with existing screening tools by
    combining certain molecular discoveries with clinical use of toluidine
    blue, a chemical dye used to determine whether or not to biopsy an
    abnormal growth. The technique hinges on laboratory work that showed an
    association in early oral lesions between toluidine blue retention and
    the presence of cells with distinct, cancer-predisposing chromosomal
    abnormalities. The program already has identified several people
    requiring treatment for oral cancer and pre-cancerous lesions.
                        dry mouth and radiation therapy
        Persistent dry mouth often occurs in head and neck cancer patients
    because radiation from the therapy damages the salivary glands. This
    irreversible, chronic dryness makes normal chewing and swallowing
    difficult, and leads to a range of painful oral diseases. Recently,
    NIDCR scientists teamed with researchers at the National Cancer
    Institute to develop an important new lead in protecting the salivary
    glands during radiation therapy to the head and neck. Their work
    involves a synthetic chemical called Tempol, which possesses a unique
    ability to protect cells against radiation. In mice, administration of
    Tempol 10 minutes prior to radiation therapy to the head and neck
    provided significant protection to the salivary glands. Critically,
    Tempol did not protect tumors from radiation, and thus did not diminish
    the beneficial effects of the radiation therapy. Future clinical trials
    in people are likely.
                reducing disparities in the nation's oral health
        Although the Nation's oral health has improved greatly over the
    past several decades, this progress has not been equally shared by
    millions of low income and underserved Americans. To help reverse this
    trend, the NIDCR supports five Centers for Research to Reduce Oral
    Health Disparities. The centers are designed to explore, understand,
    and improve the oral health of those who reside in underserved
    communities. The researchers seek creative but practical approaches
    that are inexpensive, can be easily applied, and are exportable to
    other underserved communities.
        This year, the Disparities Centers reported several noteworthy
    findings. For example, after a two-year clinical study, San Francisco
    researchers found that infants and small children who receive at least
    one fluoride varnish treatment per year can cut their dental caries
    rate in half. Fluoride varnish is a concentrated fluoride in a resin or
    synthetic base that is applied directly onto the teeth. The treatment
    is inexpensive and is more easily used with very small children than
    other preventive measures, such as dental sealants and mouth rinses.
        Meanwhile, the Disparities Center at the University of Washington
    is evaluating the oral health benefits of gum and candy sweetened with
    xylitol rather than caries-promoting sugars. Xylitol, a natural
    substance found in certain fruits, has been shown to fight tooth decay.
    The team is refining the optimal dose to satisfy taste and fight decay.
    Xylitol use exemplifies an easily adopted, self-administered,
    scientifically validated approach that may be useful in underserved
    populations.
                       improving the nation's oral health
        As these highlights demonstrate, the NIDCR has made a strong
    commitment to expand clinical research and to build the evidence base
    that will inform better clinical practice. At the same time, progress
    in basic science continues to provide new and exciting leads that can
    translate into large clinical trials, yielding results with the
    potential to transform dentistry and public health. Above all, the
    NIDCR seeks to find practical solutions to intractable problems and, in
    so doing, improve the Nation's oral health.
                                     ______

    Prepared Statement of Dr. Nora Volkow, Director, National Institute on
                                   Drug Abuse
        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2007 President's budget request for the National
    Institute on Drug Abuse (NIDA). The fiscal year 2007 budget estimate is
    $994,829,000, a decrease of $5,200,000 from the fiscal year 2006
    enacted level of $1,000,029,000, comparable for transfers proposed in
    the President's request.
                                  introduction
        The National Institute on Drug Abuse, within the National
    Institutes of Health (NIH), is once again pleased to report continuing
    declines in overall drug use among our Nation's youth. NIDA has focused
    much of its research on the vulnerable adolescent period of
    development, since this is when drug abuse typically takes hold and can
    bend a young life toward long-term drug abuse problems or addiction.
    Research findings elucidating the mechanisms of action and destructive
    consequences of drugs of abuse on the brain and body appear to be
    getting through to this population. For example, the 2005 Monitoring
    the Future (MTF) Survey of 8th, 10th, and 12th graders shows a dramatic
    19 percent reduction in use since 2001. However, areas of significant
    concern remain, including the alarmingly high rates of non-medical use
    of painkillers among 12th graders, the high rates of stimulant abuse
    among 12th graders, and the spread of methamphetamine abuse to new
    geographic areas of the country.
        Therefore, while we can acknowledge and appreciate the positive
    effects of evidence-based prevention and treatment efforts, we also
    recognize the need to keep pace with emergent problems. To this end,
    ongoing support of leading edge research by NIDA scientists continues
    to enhance innovative prevention and treatment interventions, while
    collaborations with other Institutes and public and private partners
    make optimal use of our research infrastructure.
             prescription drug abuse--the problem with painkillers
        According to the 2004 National Survey on Drug Use and Health,
    nearly three-fourths of the estimated 6 million people aged 12 and
    older who reported non-medical use of prescription psychoactive drugs
    said they abuse pain relievers in particular, with young adults (18-25)
    showing the greatest increases in lifetime use from 2002-2004. Even
    younger populations are involved, revealed by findings from NIDA's 2005
    MTF Survey.
        NIDA is tackling this growing problem from multiple angles, seeking
    to understand the factors that have brought us to this point so that we
    may reverse negative trends and stop new ones from emerging. Underlying
    factors include the fact that opioids are now among the most commonly
    prescribed medications, that society is more accepting of using
    medications to treat all kinds of health problems, and that the
    Internet provides greater access to prescription drugs.
        In response to these concerns, NIDA's new initiative on
    prescription opioids and treatment of pain is soliciting a broad range
    of preclinical and clinical studies from across the sciences. We will
    examine the basic mechanisms involved in pain and how their interaction
    with prescription painkillers influences addiction potential--for
    example, whether opiates are equally addictive to an individual in pain
    versus one who is not in pain. Research on the basic interactions
    between pain and opioid systems is needed to inform physicians about
    associated abuse risks and to guide their prescribing practices.
        Other strategies for reducing prescription painkiller abuse include
    developing alternative pain medications and promoting better delivery
    systems for painkillers to minimize abuse potential. Recent studies
    have identified a subset of cannabinoid receptors (i.e., CB2 receptors)
    as promising new targets for treating chronic pain from nervous system
    injury. In addition, because of their lack of activity in brain reward
    centers and diminished abuse liability, novel CB2-based medications
    present an attractive alternative for treating chronic pain.
    Buprenorphine/naloxone, a recently approved medication for the
    treatment of opioid addiction, represents another approach. Acting on
    the same brain receptors as drugs like heroin and morphine,
    buprenorphine does not produce the same high, physical dependence,
    harsh withdrawal symptoms, or dangerous side effects. Further, its
    unique formulation with naloxone, an opioid antagonist, produces severe
    withdrawal symptoms in addicts who inject it to get high, thereby
    lessening the likelihood of diversion while maintaining desired
    therapeutic properties. NIDA is planning a multiple trial study to
    evaluate the effectiveness of buprenorphine in the treatment of the
    pain patient who is addicted to his/her pain medication and to help
    develop guidelines on how to treat these types of patients.
                        genes, environment, and behavior
        A person's individual genome, or genetic makeup, plays an important
    role in determining his or her vulnerability to or protection against
    addiction. Studies of heredity have shown that about 40-60 percent of
    predisposition to substance abuse can be attributed to genetics, with
    environment impacting how those genes function or are expressed.
    Addiction is a quintessential gene-x-environment interaction disease:
    that is, a person must be exposed to drugs (environment) to become
    addicted, yet exposure alone is not determinative--genes interact with
    this environment to create a vulnerability to addiction. Growing
    knowledge about the dynamic interactions of genes with the environment
    confirm addiction as a complex and chronic disease of the brain with
    many contributors to its expression in individuals.
        NIDA is studying these interactions to see what they reveal about
    vulnerability to addiction and to other adverse effects of abused
    drugs. For example, one recent study found that carriers of a common
    variant of the COMT gene were more likely to exhibit psychotic symptoms
    and to develop schizophreniform disorder if they used marijuana.
        Thus, people with particular genes may suffer more harmful effects
    from drugs of abuse.
        To expedite the translation of findings that could help identify
    the location of genes that confer vulnerability or protection, NIDA is
    supporting innovative research to help design, develop, and market
    technology to conduct rapid behavioral throughput screens for
    identifying genetic vulnerability using animal models of drug abuse and
    addiction. This information could then become part of a database of
    candidate genes for drug abuse, for eventual mapping and for targeted
    therapeutic application. Advances in genetics research in addiction are
    already suggesting ways to tailor our interventions to have the
    greatest impact. For example, a recent study showed that distinct
    alleles of the dopamine receptor gene led to different outcomes
    according to the type of smoking cessation therapy used--bupropion or
    nicotine replacement therapy. Such findings provide a glimpse of a
    future in which a patient's genetic background will be a major factor
    in selecting the most appropriate therapeutic course of action.
        Other NIDA studies are also helping to unravel the ways in which
    environmental factors, such as stress, induce brain changes that
    interact with drugs of abuse and alter behavior. It is well known that
    stress is a major cause of relapse to drug abuse in recovering addicts
    and can prompt the release of a neurochemical, corticotrophin releasing
    factor (CRF). Recent research showed that in cocaine-exposed animals,
    stress-induced CRF triggered drug-seeking behavior, even as long as 3
    weeks after exposure. This research highlights the concept of
    persistent brain changes leaving individuals vulnerable to certain
    relapse triggers like stress. Moreover, stress may be common to a
    variety of conditions, including depression, anxiety, and some forms of
    overeating and obesity. By revealing the precise brain mechanisms
    involved in stress, our research can lead to treatments that for these
    conditions.
        We are also learning how environmental factors not only alter the
    expression but the structure of genes involved in brain function, which
    then influences an individual's behavior. Known as ``epigenetics,''
    this field gives researchers an opportunity to investigate gene-
    environment interactions, including the deleterious changes to brain
    circuits resulting from drug abuse. Understanding how drugs of abuse
    effect epigenetic changes may help in developing interventions to
    counter or prevent such changes. A recent study of demonstrated that
    cocaine caused significant structural changes to the DNA in regions
    containing genes implicated in shaping the brain's response to drugs of
    abuse; furthermore, in animals genetically engineered to minimize those
    changes, the rewarding effects of cocaine were dramatically reduced.
    These results show how gene-environment interactions can change the
    brain and drive behaviors associated with drug addiction. NIDA is
    supporting innovative research to help design, develop, and market
    technology to conduct rapid behavioral throughput screens for
    identifying gene/environment interactions.
                              social neuroscience
        NIDA is targeting the influence of social factors both in
    individual and group decision-making. This focus is critical not just
    to understanding drugs of abuse but other health behaviors as well. For
    instance, a social neurobiological perspective is being applied in NIDA
    studies investigating the mechanisms underlying adolescents' increased
    sensitivity to social influences (i.e., peers) and decreased
    sensitivity to negative consequences of their behavior that together
    make them particularly vulnerable to drug abuse.
        A recent NIDA request for research in the emerging field of social
    neuroscience is soliciting studies from basic to clinical science as we
    work to examine how neurobiology and the social environment interact in
    abuse and addiction processes (e.g., initiation, maintenance, relapse,
    and treatment). We now have the tools to see how genetics, epigenetics,
    and brain chemistry can change social behavior and how the social
    interactions of an individual can change his or her brain. For example,
    studies of early maternal behavior in animals demonstrated that
    offspring receiving low levels of care during their first week of life
    developed an over-responsive stress system that lasted a lifetime. In
    this case, genes responsible for regulating stress responses were
    ``silenced'' by environmental manipulation. Some of these changes can
    be reversed in adulthood by targeted intervention, making this research
    area ripe for developing approaches to counteract the effects of
    adverse environmental impacts, which in the case of stress are known to
    increase the risks for substance abuse.
        We are also committed to efforts to better characterize
    ``phenotypes'' of social environments and to understand their
    interaction with other vulnerabilities, such as genetics. One approach
    could include strategies such as mapping community risk factors for
    drug use (e.g., parental practices, family structure, school systems,
    socio-economic status, neighborhood characteristics, and drug
    availability) and to use that knowledge to inform us about mediators of
    the social stressors that elevate risk for drug abuse. A better
    understanding of this relationship is relevant both for the treatment
    of drug addiction and for psychotherapeutic interventions for mental
    illnesses, which also involve social aspects of human behavior.
                         drug addiction treatment works
        NIDA's research findings have demonstrated that drug addiction
    treatment works. Moreover, comprehensive treatments (i.e., those that
    include a combination of available medications, behavioral treatments,
    and job training and referral services) tailored to the needs of the
    individual patient have the highest success rates. We continue to work
    with the private sector to develop medications to use with behavioral
    therapies to treat drug addiction, and are pursuing collaborations with
    pharmaceutical companies to move novel and promising compounds forward
    to clinical evaluation. In addition, NIDA's initiative focusing on
    pilot clinical trials of new addiction medications will invigorate the
    field by helping investigators generate sufficient safety and efficacy
    data to support full-scale clinical trials and expedite the possible
    progression of novel medications to real-world use.
        Over the past year, we have made great progress in identifying
    potential medications for treating drug addiction, including addiction
    to stimulants such as cocaine and methamphetamine. Several promising
    compounds have been identified in animal studies, and initial clinical
    efficacy for drug abuse has been demonstrated for medications marketed
    for other uses: disulfiram, prescribed for alcoholism; modafinil, for
    treatment of narcolepsy; and gamma-vinyl GABA (not marketed in the
    United States) and topiramate, both used to treat seizure disorders.
    Progress is also being made in the area of vaccine development for
    cocaine and nicotine addiction, and Rimonabant, a cannabinoid receptor
    blocker is a promising candidate for treating marijuana addiction.
    Close to being approved for marketing by the pharmaceutical industry as
    a weight loss aid, Rimonabant may also have the potential to prevent
    relapse to cocaine, heroin, and methamphetamine abuse, and nicotine
    addiction. Marinol, another cannabinoid receptor agonist, may also show
    promise as a treatment for marijuana withdrawal symptoms.
        Interventions are also needed to treat comorbid mental disorders
    and addiction. For example, given that an estimated 15-30 percent of
    patients with substance abuse problems also suffer from comorbid ADHD,
    as found in research studies, NIDA has launched a large clinical study
    in our Clinical Trials Network (CTN) to test whether treatment of ADHD
    with methylphenidate, in parallel with treatment for substance abuse,
    will improve outcomes in those who suffer from both conditions.
        We are also developing drug abuse treatments for use in the
    criminal justice system. Our research findings show that drug treatment
    works even for people who enter it under legal mandate, with outcomes
    as favorable as for those who enter treatment voluntarily. To
    illustrate, in a Delaware Work Release study sponsored by NIDA, those
    who participated in prison-based treatment followed by aftercare were
    seven times more likely to be free of drugs after 3 years than those
    who received no treatment. Moreover, nearly 70 percent of those in the
    comprehensive drug treatment group remained arrest-free after 3 years--
    compared to only 30 percent in the no-treatment group. We are helping
    to integrate drug treatment into the criminal justice system and
    improve outcomes for offenders through our comprehensive Criminal
    Justice Drug Abuse Treatment Studies (CJ-DATS) initiative, undertaken
    in collaboration with Federal, state, and local criminal justice
    partners.
        NIDA research has demonstrated the value of drug addiction
    treatment programs in helping patients recover from the complex disease
    of addiction. Faith-based and community-centered programs are often
    part of long-term recovery, yet their effectiveness and role in
    delivering treatment needs to be studied more extensively. NIDA is
    conducting research to examine this role.
                       hiv/aids and minority disparities
        The latest data from the Centers for Disease Control and Prevention
    (CDC) suggest that the HIV/AIDS epidemic is evolving, with drug abuse
    still a major vector in its spread. Progress in treating injection drug
    abuse has helped to decrease HIV transmission among this highly
    vulnerable population, influenced by a multi-pronged approach including
    community-based outreach to reduce risky behaviors and development of
    medications such as methadone and buprenorphine to treat injecting drug
    users. But while this approach has helped reduce U.S. cases from this
    route of transmission, other countries, such as Russia and Southeast
    Asia, continue to report that injection drug abuse accounts for a large
    proportion of their HIV/AIDS cases. Thus NIDA is supporting
    international studies to promote HIV prevention practices and use of
    medications to treat drug addiction. Depot-Naltrexone is one such
    possibility, since it is a long-acting opioid antagonist medication
    expected to soon receive approval for treatment of alcohol addiction.
    Because efforts to decrease drug abuse also modify the behaviors that
    can lead to HIV transmission, we believe strongly that drug abuse
    treatment is HIV prevention.
        Early detection of HIV helps prevent HIV transmission and increase
    health and longevity. NIDA-supported research indicates that routine
    HIV screening, even among populations with prevalence rates as low as 1
    percent, is as cost effective as screening for other conditions such as
    breast cancer and high blood pressure. These findings have important
    public health implications, but require efforts to increase HIV
    screening acceptability (similar to mammography) in order to be
    effective.
        We are also deeply concerned about the disproportionate impact of
    HIV/AIDS on African Americans. For while they represent just 13 percent
    of the U.S. population, African Americans account for 42 percent of
    AIDS cases diagnosed since the start of the epidemic, according to CDC.
    In fact, data from the CDC's National Vital Statistics Report published
    in 2003 show that HIV/AIDS is the leading cause of death among all
    African Americans 25-44 years old, ahead of heart disease, accidents,
    cancer, and homicide.
        To address these disparities, NIDA is encouraging research on the
    nexus of drug abuse and HIV/AIDS among African Americans to understand
    the risk factors and the pathways between them and to develop
    culturally sensitive prevention and treatment programs for drug abuse
    and HIV/AIDS. We are committed to making sure this research is
    translated in a meaningful way.
                       from bench to bedside to community
        NIDA is proud of our myriad efforts to translate the results of our
    basic and clinical research on the brain and body effects, getting new
    treatments into the hands of providers who will use them, disseminating
    prevention messages to people who will hear them, and raising the
    awareness of people who can help change the course of drug abuse
    treatment in this country. Our audiences are many and include
    physicians, teens, teachers, judges, parents, and others.
        Through our physician outreach initiative, we are funding efforts
    to develop strategies for primary care physicians to better identify
    and serve drug abusing patients through use of science-based screening
    and brief interventions. We are also supporting development of a pilot
    judicial training curriculum in Cook County, Illinois, to help criminal
    court judges understand the neurobiology of addiction and the
    effectiveness of treatment. The goal of this program is to better
    inform judicial decision-making with regard to substance-abusing
    offenders. These efforts will be applied to the Federal court system as
    well. We also support grants to evaluate results from drug courts to
    achieve optimal dissemination and improve outcomes, and we will soon
    publish a book of treatment principles for application with individuals
    involved in the criminal justice system.
        Our education portfolio continues to grow and includes a wealth of
    materials, such as our NIDA Goes Back to School Initiative, a science
    education campaign to provide middle school students with information
    about how drugs work in the brain. An interactive website complements
    this effort, allowing students and teachers to easily obtain additional
    information about drugs of abuse. To help young people understand the
    risks of drug abuse leading to HIV infection, NIDA and our partnering
    organizations--including the American Academy of Child and Adolescent
    Psychiatry, the AIDS Alliance for Children, Youth, and Families, and
    the United Negro College Fund Special Programs Corporation--recently
    launched a multimedia educational campaign, including a public service
    announcement and website, to help young people ``learn the link''
    between drug abuse and HIV infection. We are translating these
    materials into Spanish and making them culturally relevant for
    different populations.
        We are also collaborating with our sister agency, the Substance
    Abuse and Mental Health Services Administration (SAMHSA) and with the
    National Institute of Mental Health on a new initiative to enhance the
    capacity of community-based providers of drug abuse treatment services.
    We continue to work with SAMHSA, supporting the development and
    dissemination of research-based products through their Addiction
    Technology Transfer Centers across the country, applying findings from
    our Clinical Trials Network and other research. And because addictive,
    psychiatric, and neurological disorders emerge from common neural
    substrates, a tremendous amount of inter-Institute collaboration has
    taken place--an approach we will continue to emphasize, given its
    ability to produce sharable findings and cost efficiencies.
                                   conclusion
        Our investment in basic and clinical research has changed the way
    people view drug abuse and addiction in this country. We now know how
    drugs work in the brain, their health consequences, how to treat people
    already addicted, and what constitutes effective prevention strategies.
    As science advances, NIDA's comprehensive research portfolio is
    strategically positioned to capitalize on new opportunities. We
    continue to make great strides in translating and disseminating the
    products of our research, so they can be used in real communities by
    people who need them, providing front-line clinicians around the
    country with the tools needed to reduce drug abuse and addiction in our
    Nation. To make the most of scarce resources, we depend on a rigorous
    planning and priority-setting process that not only supports our strong
    commitment to reducing drug abuse and HIV transmission in this country,
    but extends to other health fields represented by NIH. Sustaining the
    momentum of our efforts will lead to even more discoveries that will
    improve the health and safety of all Americans.
        Thank you, Mr. Chairman. I will be pleased to answer any questions
    the Committee may have.

                             IMPACT OF BUDGET CUTS

        Senator Specter. We will now proceed with questioning by
    the Senators, 5 minutes each.
        Dr. Zerhouni, you say you will continue to deliver. How is
    that possible when you have had more than a 10 percent
    decrease, considering inflation, which amounts to about $3
    billion? The comments that I hear relate to there being a
    panic, panic among the applicants for NIH research. How can you
    continue to deliver with that kind of a budget?
        Dr. Zerhouni. It is very important to realize that medical
    research cannot be funded through ups and down. We have to
    sustain the investment over time, and it is clear that medical
    research requires support for scientists. What is happening
    right now is that through the doubling we have generated a new
    generation of scientists. We have over a 50 percent increase in
    the number of scientists.
        Senator Specter. What is the consequence of the cut?
        Dr. Zerhouni. The consequence of the cut is very simple. If
    you keep investing below and lose purchasing power, the most
    important impact on research is loss of scientists. This is
    what we have seen in the past and this is what may happen again
    if we do not sustain our investment in medical research.

                      PREPAREDNESS FOR PANDEMIC INFLUENZA

        Senator Specter. Dr. Fauci, there is a great concern, as we
    all know, about pandemic influenza. This subcommittee has held
    a series of hearings on the subject. How are we doing? What are
    the prospects for being prepared if that wave should strike us
    in the United States?
        Dr. Fauci. From the standpoint of the scientific
    preparation for developing vaccines and drugs, from the last
    time I testified before you, Mr. Chairman, which was just a
    couple of months ago, we have made even more progress. We have,
    as you know, as Dr. Zerhouni alluded to, we have a vaccine that
    is currently in clinical trial in different age groups and
    demographic groups. We have tested it and published the results
    in healthy young adults. We have tested it in the elderly and
    in children. As I mentioned to you at the last hearing, the
    vaccine appears to be very well tolerated and induces an immune
    response that would be predictive of being protective.
        There is a big problem with it, though. The problem relates
    to the fact that the dose that is required to induce the level
    of immunity that you would predict would be protective is
    prohibitively high, which is leading us to the studies that are
    ongoing now, namely the use of what we call adjuvants, or
    compounds which expand the capability of the immune system to
    respond. Those studies are ongoing right now.

                         FUNDING FOR PANDEMIC INFLUENZA

        Senator Specter. Is the funding adequate?
        Dr. Fauci. We could do more with more funding, there is no
    doubt about that. I would be----
        Senator Specter. How much do you need?
        Dr. Fauci. It is difficult to put a number on it, except to
    say that----
        Senator Specter. Well, if you cannot put a number on it, we
    cannot.
        Dr. Fauci. Well, we need--for example, if I could bring one
    component up that I think would be of interest to this
    committee, is that we are currently pursuing rather
    aggressively the concept of what we call a universal influenza
    vaccine, namely a vaccine that cross-reacts from season to
    season and would also be protective against the pandemic flu.
        Senator Specter. Dr. Fauci, I am reluctant to cut off a
    witness with your distinctive record. Give us in writing what
    funding you need.
        Dr. Fauci. Okay, I could do that for you.
        [The information follows:]
                         Funding for Pandemic Influenza
        The National Institute of Allergy and Infectious Diseases (NIAID)
    supports a robust and diverse portfolio of research on influenza,
    including pandemic influenza. Many opportunities to accelerate the
    research and development of medical countermeasures against influenza
    as well as to advance our understanding of influenza viruses could be
    pursued in fiscal year 2007 and fiscal year 2008 should additional
    funds become available. In its professional judgment that is outside
    the context of other competing priorities, NIAID estimates that it
    could obligate an additional $212 million in influenza research in
    fiscal year 2007 above the budget request and an additional $458
    million in fiscal year 2008.
        NIAID could use such funds to accelerate research and development
    of antiviral drugs, vaccines, adjuvants, and diagnostics for influenza.
    For example, NIAID could accelerate the development and clinical
    testing of promising universal vaccine candidates, which could offer
    protection against multiple influenza virus strains, and the
    development of new and improved vaccine strategies for influenza such
    as recombinant subunit vaccines and gene-based vaccines that may allow
    for more rapid production of a vaccine against a pandemic strain of
    influenza, should one emerge. These additional funds also could
    facilitate the expansion of critical research resources, such as animal
    models and clinical trials infrastructure that are essential for the
    development of medical countermeasures against influenza.
        Underpinning efforts to develop medical interventions against
    pandemic influenza is research into the basic biology and disease-
    causing mechanisms of influenza viruses. With additional funding, NIAID
    could expand basic research in the areas of influenza virology,
    pathogenesis, epidemiology, immunology, genomics, proteomics, and
    systems biology as well as to expand international animal surveillance
    activities. This research is crucial to the development of antiviral
    drugs, vaccines, and diagnostics for influenza.

                              CANCER GENOME ATLAS

        Senator Specter. Let me turn now to Dr. Niederhuber with
    respect to the cancer-genomics initiative. Can that be
    implemented with the current funding? What do we need to
    successfully prosecute the war against cancer?
        Dr. Niederhuber. Well, Senator Specter, thank you. We are
    very committed, the National Cancer Institute, with our
    partner, the National Human Genome Research Institute, to
    initiate a pilot project on the Cancer Genome Atlas. Each
    Institute has committed $50 million from our existing resources
    to do that. This will be a pilot project which is helping us
    understand the technology needs, the technology advancements,
    and our ability to do this project.
        Senator Specter. Dr. Niederhuber, would you supplement your
    testimony today with a memorandum as to what you need as to
    that program and as to the war on cancer overall?
        Dr. Niederhuber. Absolutely, sir.
        Senator Specter. Give us a winning strategy for that war?
        Dr. Niederhuber. Absolutely.
        [The information follows:]
                              Cancer Genome Atlas
        The Cancer Genome Atlas program is the product of several years of
    investment by the NCI in the Cancer Genome Anatomy Project (C-GAP) and
    other large scale genomics programs, some of which were performed in
    collaboration with the NHGRI. These efforts culminated in 2003 with a
    report from the NCI's National Cancer Advisory Board (NCAB) which
    recommended that the two Institutes undertake a pilot program to
    determine the feasibility of systematically developing an ``atlas'' of
    all genetic alterations involved in cancer.
        Active planning for The Cancer Genome Atlas, or TCGA, began in the
    latter half of 2002 as a consequence of progress and convergence of
    science and advanced technologies in three distinct areas. First, the
    completion of the sequencing of the human genome provided for the first
    time in history a benchmark to begin to understand the effect of
    genetic changes on the etiology and progression of diseases such as
    cancer. Second, our years of investment in understanding cancer at the
    molecular level resulted in the discovery of some very important
    genetic changes in cancer cells that led to the development of targeted
    drugs such as Gleevec and Herceptin. Based on an understanding of the
    specific genetic alterations driving specific tumors, these targeted
    drugs allowed oncologists for the first time to target specific genetic
    alterations in patients with chronic myelogenous leukemia (CML) and
    breast cancer, respectively. Finally, the pace of technology
    development in analyzing all aspects of genes and their products is
    accelerating--setting the stage for large scale interrogation of the
    genome to understand the role of genetic mutation in diseases such as
    cancer. Interestingly, one of the major requirements for this project
    is the development of an unprecedented data management system and
    ultimately an accompanying database; NCI's investment in the Cancer
    Bioinformatics Grid (caBIG) over the past several years provides the
    advanced technology platform needed to meet this need.
        Cancer is a disease of changes in genes that occur over an
    individual's lifetime. Three kinds of genetic alterations contribute to
    cancer--those that occur in the DNA of egg or sperm and are passed from
    a parent to offspring (germline mutations), those that occur as a
    result of exposure to the environment (somatic mutations) and changes
    in DNA that lead to changes in genes that control proteins involved in
    transcription and translation. Additionally, changes in gene function
    can occur without a change in the sequence of DNA (epigenetic changes).
    TCGA will finally facilitate an in-depth understanding of how these
    types of genetic changes differ in terms of their role in an
    individual's inherited risk vs. those changes that arise from
    environmental exposure. It is the latter category of mutations that
    will allow scientists to obtain a clear picture of the impact of these
    somatic mutations on the major pathways that appear to drive many of
    the major hallmarks of cancer cells. Overall, the TCGA pilot project,
    much like the Human Genome Project, has the potential to create an
    unparalleled knowledge base, drive a new era of discovery by scientists
    from all fields of biomedical research and ultimately provide a new
    paradigm for the prevention, detection and treatment of chronic
    diseases such a cancer.
        The NCI and NHGRI believe strongly that TCGA is one of the most
    important projects undertaken in medicine to date. It leverages all
    that has gone before and for the first time will allow scientists to
    apply our understanding of the human genome sequence to cancer--a
    disease that will strike over 1.4 million Americans this year and kill
    over 560,000 at a cost of well over $190 billion. We are committed to
    getting this project underway within current budget constraints. The
    NCI has identified funds for redeployment from other projects, and the
    NHGRI will dedicate a large portion of its sequencing capacity to
    performing this first-ever large scale effort in medical sequencing.
        The information generated by the TCGA pilot project will provide
    the necessary scientific data by which the Institutes and the
    scientific community can evaluate the preliminary outcomes of the
    research.
        The convergence of our understanding of cancer at the molecular
    level, advanced genome analysis technologies, especially
    bioinformatics, and experience gained in the Human Genome Project,
    allow us to now undertake TCGA, a project that promises to contribute
    significantly to the development of 21st century medicine. Both the NCI
    and the NHGRI are committed to leveraging these strengths to ensure
    that we move forward toward our goal of personalized medicine for
    cancer and all diseases.
                       a winning strategy against cancer
        NCI has developed a Strategic Plan to reduce and eliminate the
    suffering and death due to cancer with the help of the scientific
    community. The Plan sets forth a framework within which NCI can use its
    funding, infrastructure, tools, and intellectual resources to lead and
    work with others. We set forth eight strategic objectives in the Plan
    and these will be instrumental in guiding our operational level plans
    and serve as an organizer for measuring and reporting progress. A
    complete description of the Strategic Plan can be found on NCI's web
    site at http://www.cancer.gov/aboutnci/2015.
        There are two basic tactics--preempting cancer and ensuring the
    best outcomes for all--embodied in the Plan's objectives.
        To preempt cancer at every opportunity, there are four strategic
    objectives:
      --Understand the causes and mechanisms of cancer;
      --Accelerate progress in cancer prevention;
      --Improve early detection and diagnosis; and
      --Develop effective and efficient treatments.
        To ensure the best outcomes for all, there are four strategic
    objectives:
      --Understand the factors that influence cancer outcomes;
      --Improve the quality of cancer care;
      --Improve the quality of life for cancer patients, survivors, and
            their families; and
      --Overcome cancer health disparities.
        To achieve these objectives requires numerous funding vehicles and
    support mechanisms throughout the cancer research community. The steps
    we could take in order to accelerate progress to eliminate the
    suffering and death due to cancer include:
      --Rapid development of an integrated technology initiative;
      --Deployment of a modern integrated clinical trials infrastructure;
      --Expansion and integration of the Cancer Centers program; and
      --Mechanisms and Flexibilities--streamlined procurement and review
            processes to acquire materials and services and coordination of
            licensing and patenting activities.
        An integrated advanced technology initiative for cancer could
    provide a linkage between the National Cancer Program and R&D
    initiatives being developed in selected national laboratories and
    advanced technology facilities located in more than 40 states and
    regions. Connected in real-time through a common bioinformatics grid,
    forming a ``network of networks'' of science, technology, and
    treatment, such an initiative could serve to accelerate the emerging
    discipline of molecular oncology. This would create a pipeline of new
    personalized cancer diagnostics and therapeutics from bench concept to
    bedside and community delivery. In the next few years, such an
    initiative could:
      --Accelerate the implementation of a nationwide high-end information
            technology grid for bioinformatics that could be uniquely
            adapted for real-time data sharing. NCI's pilot version, called
            caBIG, is slated for full-scale implementation this year and,
            during the pilot phase, was implemented among 50 Cancer
            Centers, FDA, and other organizations.
      --Develop a comprehensive biomarker discovery and validation program.
      --Foster the application of emerging technologies, such as
            nanotechnology, and integrate molecular agents with advanced
            imaging devices.
      --Accelerate a nationwide real-time medical information electronic
            system for research and medical data sharing using technologies
            and devices currently employed by the banking industry and
            large-scale commercial enterprises.
      --Enhance the discovery and validation of new targets of genes and
            proteins critical to cancer development.
        NCI could deploy a more modern and integrated infrastructure for
    cancer clinical trials. This clinical research infrastructure could:
      --Strengthen collaborations with industry, FDA, Centers for Medicare
            and Medicaid Services, and other public, private, academic, and
            patient advocacy organizations to oversee the conduct of cancer
            clinical trials.
      --Develop new infrastructure and procedures to standardize,
            coordinate, and track clinical trials development and accrual
            across all NCI-supported clinical trials.
      --Increase utilization of imaging tools in screening and therapy
            trials, evaluate new imaging probes and methodologies, enable
            access to the imaging data from trials in an electronic format,
            and facilitate evaluation of image-guided interventions.
      --Expand access and improve the timeliness for completion of the
            highest priority clinical studies.
      --Foster the development of a cadre of established clinical
            investigators who could work between bench and bedside.
      --Pilot new approaches and develop prototypes for clinical trials
            networks that could improve the efficiency, coordination, and
            integration of our national efforts.
      --Develop a common clinical trials informatics platform that could be
            made available to the full range of investigators working
            within the cancer clinical trials system.
        NCI plans to accelerate the expansion and integration of the NCI-
    designated Cancer Centers program, including the addition of 14 new
    Cancer Centers, increasing the number of centers to 75. The Cancer
    Centers program could:
      --Implement progressive bioinformatics and communication systems to
            achieve horizontal integration.
      --Fund additive programs in collaborative, multidisciplinary
            research, and require integration and sharing of results.
      --Broaden the geographic impact of the centers, networks, and
            consortia and vertically integrate them with community and
            regional health care delivery systems.
      --Improve the access of minority and underserved populations to
            state-of-the-art research and resources.
      --Create and strengthen partnerships with government agencies and
            community organizations.
      --Broadly provide expertise and other resources to caregivers,
            patients and families, and appropriate health agencies.
        In addition to appropriations, flexible legislative authorities
    related to exemptions from specific parts of current procurement, grant
    review and processing, and licensing and patenting rules could also
    help accelerate progress. A streamlined procurement process could
    facilitate the acquisition of materials and services to support the R&D
    activities. Technology development could also be enhanced by sufficient
    flexibility and integration to enable interactions among a wide array
    of laboratories and other entities. Expedited review procedures and
    workflow processing could help to award funds in sequence as needed.
    Coordination of the licensing and patenting activities among grantees,
    contractors, and the intramural program could also be useful for many
    of the multicomponent technology platforms that could be created
    through an advanced technology effort.

                             WOMEN'S HEART DISEASE

        Senator Specter. Let me turn now to Dr. Nabel. What have
    the results been with the Women's Health Study? With respect to
    heart disease, we know that women are affected differently. I
    want the record to note that my question ends with no red
    light, but you can proceed.
        Dr. Nabel. Thank you, Mr. Chairman.
        The women's health initiative was an important study
    conducted over 15 years with 161,000 women in this country ages
    50 to 79 participating. We gathered important information about
    heart disease, the number one killer of women in this country.
        From other studies, we realize that heart disease often
    manifests itself in women differently than men. We have come to
    recognize what those symptoms are. We have come to recognize
    that some of the diagnostic tests have to be different and we
    have come to recognize that some of the treatments have to be
    specifically focused towards women.
        These studies have given us a tremendous amount of
    information. We now have engaged in a very large public
    awareness education campaign and we are in the midst of helping
    women to understand what their risks are for heart disease and
    how to seek help when they need it.
        Senator Specter. Thank you.
        Senator Harkin.

                           NATIONAL CHILDREN'S STUDY

        Senator Harkin. Thank you, Mr. Chairman.
        Dr. Zerhouni, of all the proposed cuts in the budget there
    is one that I think may be discouraging than all the rest, and
    that is the planned elimination of the National Children's
    Study. We passed this legislation back in 2000. It was going to
    be the largest long-term study of children's health ever
    conducted in the United States. It was going to involve 100,000
    children from before birth to adulthood. The idea was to better
    understand the link between the environments where the children
    are raised and their physical and emotional health and
    development.
        We have already spent about $50 million planning the study,
    4 to 5 years of planning on it. Now I understand that the study
    is going to stop. Why is that?
        Dr. Zerhouni. Well, the study has had a pilot phase to
    evaluate feasibility. The issue really is, you are talking
    about a very long study with a large budgetary impact, and at
    the end it was just a matter of budgetary priorities which led
    to the decision of not completing the pilots at this time, but
    to look at other times when the budgets will be easier.
        Senator Harkin. I understand that the budgetary impact was
    $70 million. Is that correct or not?
        Dr. Zerhouni. If you look at--the $70 million is not just a
    1-year expenditure. In fact, you have to continue that
    expenditure. If you committed to that expenditure, Senator,
    then you have committed to the $3.2 billion or thereabouts
    total over the total study. Why? Because once you launch the
    study you have to continue recruitment of the 100,000 children,
    the parents, and so on.
        So if you look on the screen that tries to describe the
    evolution, it is $69 million in 2007, $111 million in 2008,
    $192 million, $194 million, and so on. So this is what led to
    the budgetary conclusion for these tight fiscal times.
    Committing to 2007 meant not just 2007, but a whole series of
    budgetary commitments, and in the context of projections it was
    very hard to see how it would fit in.

                           WOMEN'S HEALTH INITIATIVE

        Senator Harkin. Well, as you know, it was supposed to start
    by the end of this fiscal year.
        Dr. Nabel, how long was the women's health initiative
    study?
        Dr. Nabel. 15 years, Mr. Senator.
        Senator Harkin. 15 years.
        Dr. Nabel. Yes.
        Senator Harkin. Obviously, we got a lot of good information
    out of it.
        Dr. Nabel. We sure did.
        Senator Harkin. What did that cost, do you know?
        Dr. Nabel. In total, about $710 million.
        Senator Harkin. For the 15 years. How many women did it
    cover?
        Dr. Nabel. 161,000 women.
        Senator Harkin. This is 100,000 children and it was
    supposed to be how many years study? About 20----
        Dr. Zerhouni. 21 plus 4, so about 25 years, and about $3.2
    billion is the number I remember, but upwards of that.
        Senator Harkin. Well, it seems to me from the women's
    health initiative we learned the benefits of long-term studies,
    long-term longitudinal studies. It seems to me with everything
    that is impacting on obesity, to diabetes to mental health,
    kids and how they grow up, there is just a lot of things that
    need to be taken into account. If you do these studies, then
    you would be able to factor some of these things in after a
    longer period of time.
        I just find this very disturbing that we are cutting this
    program. I am hopeful that we can put this back in the budget.
    Maybe this is another result of the President's budget. I do
    not know. Is that what it is? I am just asking it rhetorically.
    I do not expect an answer, but I am just asking this
    rhetorically. If that is what it is, then we have got to find
    the money to put back in there.
        This did not just come up. This is something that we had
    talked about for a long time with your predecessor and others,
    about getting this very long-term study done. We just assumed,
    at least I did anyway, that it was on track and that we were
    going to do it, and all of a sudden this year it pops up and it
    is going to be eliminated. EPA was coming in on the study, I
    think, also CDC was also going to partner in the study, if I am
    not mistaken.
        Dr. Zerhouni. No, you are not mistaken, Senator. It was a
    trans-governmental study. It was not just an NIH study. It
    really involved 14 different departments. Environmental health
    was important, genetic health was important. Education was
    involved as well. So 14 Federal agencies were involved.
        Senator Harkin. Well, I am just wondering what kind of a
    priority would this be in the scheme of things. Is this just
    something that we can just drop out the bottom, or is this
    really an important study to be done? Is it important or not?
        Dr. Zerhouni. So the issue is really an issue of
    prioritization, and you have a pilot phase study so we can
    evaluate whether or not to go forward. But you mentioned
    yourself the critical factor of sustaining success rates, and
    so in the context of those decisions you can see where, in a
    constant sum budget, studies like this will have a large impact
    on success rates across the board. Therefore, when you look at
    the investments that medical schools and others have made over
    the doubling period, what we are seeing is a large increase in
    demand for grants at the time when the supply for grants is
    sort of flattening.
        So the real tension right now is, how do you sustain a
    vibrant research enterprise across the board and at the same
    time look at issues like this one, which is a very valid issue
    to look at? That is what the tension is and that is where the
    budgetary decisions came up.
        Senator Harkin. Thank you, Dr. Zerhouni.
        Thank you, Mr. Chairman.
        Senator Specter. Thank you very much, Senator Harkin.
        Senator Shelby.

                              AUTOIMMUNE DISEASES

        Senator Shelby. Thank you, Mr. Chairman.
        I want to, doctor, focus on the area of autoimmune,
    specifically lupus. It is estimated that 1.5 million Americans
    suffer from lupus. Ninety percent of those being diagnosed are
    women. This is a terribly painful disease, as you well know. It
    has been about 40 years, it is my understanding, since a new
    drug has been developed and approved for treatment of lupus. Is
    there any hope in sight for new treatment, because this is in
    the area, as I understand it, of autoimmune, in which you do a
    lot of research?
        So how do we--first, what do you see down the road there?
        Dr. Zerhouni. This is an excellent, excellent question, in
    a field of research, autoimmune disease, that affects 5 to 8
    percent of Americans. It is not just lupus, Senator.
        Senator Shelby. It is all autoimmune, is it not?
        Dr. Zerhouni. Right, it is all autoimmune. It is a whole
    category of diseases that we are now beginning to understand.
    Breakthroughs over the past year indicate that we may have
    actually developed technologies where we could develop--we
    could detect years before the disease really starts the markers
    of the disease and maybe intervene earlier.
        What I would like to do is ask my colleague Dr. Fauci, who
    is the Director of the National Institute of Allergy and
    Infectious Diseases, who has a lot of knowledge in autoimmune
    diseases, to perhaps address some of that.
        Senator Shelby. That would be good. Thank you, doctor.
        Dr. Fauci. Thank you, Dr. Zerhouni.
        Senator Shelby, there are some very promising areas in the
    whole arena of autoimmune diseases. There is still a long way
    to go, but, very briefly, as Dr. Zerhouni mentioned in his
    opening statement, it falls within that area of predictive and
    ultimately preemptive and preventive, in the sense that we now
    are developing rapidly, not only with lupus, much more
    sensitive diagnostic tests that can give you a feel for the
    ultimate evolution of an autoimmune disease.
        One among many therapeutic modalities that I would just
    submit for your consideration that we are very excited about is
    the whole area of what is called immune tolerance. Immune
    tolerance means that you manipulate the immune system to get it
    to not respond to a particular antigen. In other words, you
    tolerize it to it.
        This has been something that has been very exciting in
    animal studies. Now, with a network involving multiple
    institutes within the NIH, the immune tolerance network, we
    have been able to tolerize the body against rejecting
    transplanted organs. We found very rapidly that that can be
    applied to diseases of autoimmunity.

                                   PREDNISONE

        Senator Shelby. Is that what Prednisone does?
        Dr. Fauci. Well, Prednisone is a drug that dampens globally
    the immune system. But we are talking about when we talk about
    tolerance, specifically training the body either not to reject
    an organ that is transplanted or not to respond to tissues that
    are self tissues. Patients should not respond to self antigens,
    but for reasons that relate to genetic, environmental, and
    other factors, they inappropriately react against their own
    tissues.
        So now we try to tolerize them and dampen the immune
    response only specifically for the particular tissue that they
    are attacking, not general immunosuppression, because one of
    the real problems with treating any autoimmune disease, if you
    induce a global immunosuppression you have a lot of
    complications that relate to immunosuppressive therapy, much
    the way cancer patients have complications related to
    chemotherapy.

                                     LUPUS

        Senator Shelby. What could you say to the 1.5 million or
    more lupus sufferers out there right now in the pipeline?
        Dr. Zerhouni. Well, if I may, Dr. Fauci, I would like to
    show you the evolution of our investments in lupus research.
        What I want to tell you is that there is really hope
    because, one, we have made advances in genomics that allow us
    to now identify some genetic factors in patients with lupus.
    Two, we really understand the immune response very specifically
    and we believe that the T-cells that respond in lupus may be a
    target for treatments. We also have research that suggests that
    perhaps a viral connection exists as well.
        So over the past 2 years, 3 years, there has been a
    multiplication of new ideas thanks to the doubling and many
    people looking at it. What we intend to do is sustain it. We
    have ideas of how to in fact focus on autoimmune diseases
    across NIH and do the basic research across all institutes that
    will serve every one of these diseases.
        So, Senator, it is a difficult disease. It is not an easy
    disease. If you have known anyone with lupus----
        Senator Shelby. My wife.
        Dr. Zerhouni. I am sorry, Senator. I did not know about
    that. It is something that we really care about.
        Senator Shelby. Thank you very much.
        Mr. Chairman, thank you.

                                PROGRAM FUNDING

        Senator Specter. Thank you, Senator Shelby.
        Obviously, we would like to have a lot more time to go into
    greater detail on many subjects. But what we would appreciate
    your doing is giving us a supplemental memorandum as to what
    the cuts will mean for your ongoing programs. I would like to
    share that with all of our colleagues in the House. Second,
    what it would take to adequately fund the issues you are
    working on and what you could accomplish with the figure you
    put on as being adequate.
        Dr. Zerhouni, your statistics are very impressive and the
    showing of a trillion dollars in savings compared to a modest
    investment, that is the kind of things Congress needs to hear.
    That is the kind of things which impresses the Congress.
        [The information follows:]
                                Program Funding
        Within the context of a deficit-reduction budget, the President's
    Budget request had to weigh many competing priorities, and still
    proposed to hold spending for NIH at a straightlined level for fiscal
    year 2007. In fiscal year 2006, NIH reduced all noncompeting Research
    Project Grant (RPG) awards by -2.35 percent, and the average cost of
    competing RPGs was held at the fiscal year 2005 level. The fiscal year
    2007 President's Budget Request provides no inflationary increases for
    noncompeting continuation awards and holds the average cost of
    competing RPGs to the fiscal year 2006 level, which could lead to an
    erosion of the research buying power of NIH research projects. Within
    its available funds, however, NIH is supporting the highest priority
    research activities, including making strategic investments in
    biodefense, the NIH Roadmap, a new program for new investigators, and
    the Clinical and Translational Sciences Award program.
        If additional funds were available above these priorities, such as
    an increase for fiscal year 2007 above the Biomedical Research and
    Development Price Index inflator of 3.8 percent, NIH would be able
    restore the buying power of its research program, and fund additional
    projects, from basic, translational, and clinical research to
    therapeutic development and advanced technologies. All of these
    activities could serve to advance our understanding of the mechanisms
    underlying human health and disease and contribute to improving human
    health. Examples of projects that were not funded in the President's
    Budget Request, but could be undertaken are as follows:
        Large-scale Genome Study for Serious Mental Disorders.--This study
    could speed development of new effective treatments for the 13 million
    Americans suffering from seriously debilitating mental disorders that
    prevent people from participating in daily life at home, work, or
    social settings for over 80 days per year and results in early death or
    suicide for 30,000 individuals each year.
        Schizophrenia Treatment Research.--This proposed study could build
    on recent advances in schizophrenia treatment to determine whether an
    early intervention of aggressive pharmacotherapy, combined with focused
    rehabilitative efforts, can prevent long-term disability and suffering
    of schizophrenia, devastating mental illness affecting 2.4 million
    adult Americans.
        Protocols for Treating Autism Spectrum Disorders Early.--These
    studies could bolster efforts to determine the most effective treatment
    regimens to improve outcomes for children and families struggling with
    the life-long disability and pain of autism spectrum disorders.
        The Atherosclerosis Prevention Trial.--Although drugs to lower low-
    density lipoprotein (LDL) cholesterol levels are known to reduce the
    risk of major adverse cardiovascular events, it is not yet known
    whether additional benefits can be realized by lowering LDL cholesterol
    beyond current treatment guidelines. A multi-center, randomized
    clinical trial could determine whether aggressive lowering of low-
    density lipoprotein cholesterol beyond current treatment guidelines
    further reduces major adverse cardiovascular events.
        Program to Reduce Cardiovascular Disease Risk in Young Adults by
    Preventing Weight Gain.--Studies could develop and evaluate promising
    intervention approaches for preventing weight gain in young adults,
    which is a major risk factor for cardiovascular disease (CVD) and
    associated CVD risk factors including elevated cholesterol, high blood
    pressure, and diabetes.
        Systolic Blood Pressure Intervention Trial.--Although drug
    treatment to lower blood pressure, both systolic and diastolic, is
    known to reduce CVD mortality, it is not yet known whether additional
    benefits can be realized by lowering systolic pressures beyond current
    treatment guidelines. A multi-center trial could determine whether
    treating systolic blood pressure to a lower goal than currently
    recommended further reduces cardiovascular disease mortality and
    morbidity, particularly for those aged 50 years and older in whom
    systolic blood pressure is more strongly associated with CVD risk than
    diastolic blood pressure.

                      PREPAREDNESS FOR PANDEMIC INFLUENZA

        Senator Specter. Dr. Fauci, if you would supplement what
    you have testified to on pandemic flu. There is enormous
    concern in this country today and we would like to know to what
    extent are we prepared. Being prepared is a tough subject to
    answer, but to what extent are we prepared. When you say that
    more funding would be of material assistance, I think there is
    something that we are prepared to fund.
        Senator Harkin took the lead and put a figure of $7
    billion. We came close to $6 billion, and contracts have been
    let for five big companies for a billion dollars. It is scary.
    It could be devastating. So let us know, and this subcommittee
    is prepared to take the lead again.
        [The information follows:]
                      Preparedness for Pandemic Influenza
        The Department has made great strides to improve the Nation's
    preparedness for a pandemic influenza outbreak. For example, HHS has
    stockpiled roughly 8 million doses of vaccine against one H5N1 virus
    strain. Given, a two-dose vaccination schedule, this would allow
    vaccination of 4 million people. The Department also recently invested
    more than $1 billion in the development of cell-based vaccine
    technology; shifting from the current egg-based technology is critical
    to quickly producing vast quantities of vaccine should a pandemic
    develop. Our goal is to build the capacity to vaccinate all 300 million
    Americans within 6 months of a pandemic outbreak. The Strategic
    National Stockpile now contains sufficient antivirals to treat nearly 7
    million people, and with another 19 million courses on order, it should
    contain 26 million courses by the end of 2006. HHS is also enabling
    States and other entities to purchase up to 31 million antiviral
    treatment courses off of the Federal contract. Our goal is to have
    enough antivirals on hand for 25 percent of the population, or
    approximately 75 million individuals. In addition, we have purchased
    150 million N95 respirators, surgical masks and other personal
    protective equipment. Planning summits have been held in all but two
    States, and almost every State has either a draft or final pandemic flu
    plan in place. As Secretary Leavitt has stated, ``Preparation is a
    continuum. Every day we prepare brings us closer to being ready. We are
    better prepared than we were yesterday. And we must be better prepared
    tomorrow than we are today.''
        The National Institute of Allergy and Infectious Diseases (NIAID)
    is a major component of these preparation efforts. For example, NIAID
    has made progress in the development of an H5N1 influenza vaccine.
    NIAID-supported researchers at St. Jude Children's Research Hospital
    obtained a clinical isolate of a highly virulent H5N1 influenza virus
    in Vietnam in early 2004, and used a technique called reverse genetics
    to create a non-virulent vaccine reference strain from this isolate.
    NIAID then contracted with sanofi pasteur and Chiron Corporation (now
    Novartis) to manufacture pilot lots of the inactivated virus vaccine
    for use in clinical trials. The sanofi pasteur vaccine has been tested
    in healthy adults and is currently in clinical testing in healthy
    elderly people and children. The Chiron vaccine is currently in
    clinical testing in healthy adults.
        Results from the trial of the sanofi pasteur vaccine in healthy
    adults provide both good and sobering news. The good news is that the
    vaccine is well-tolerated, and induces an immune response that augurs
    well for protecting people against the H5N1 virus. The sobering news is
    that larger doses of the H5N1 vaccine than typically used for yearly
    influenza vaccine are needed to elicit immune responses in the majority
    of people that would be predictive of protection. However, preliminary
    results from a Phase I clinical trial of an H9N2 influenza vaccine
    candidate made by Chiron suggest that addition of an adjuvant--a
    vaccine component that increases the immune response--may help to
    reduce the required dose. Clinical trials of H5N1 candidates using
    adjuvants and other strategies to improve immune responses at lower
    doses of vaccine are ongoing or imminent.
        In addition, NIAID intramural researchers are working with
    colleagues from MedImmune, Inc. under a Cooperative Research and
    Development Agreement (CRADA) to produce and test multiple vaccine
    candidates for potential pandemic influenza strains, including H5N1
    strains. The researchers have developed three live-attenuated H5N1
    vaccine candidates, designed for nasal spray delivery, that have been
    shown to be protective in mice. The CRADA capitalizes on the long
    history of NIAID research and development of respiratory virus
    vaccines, including fundamental research that was key to the
    development of FluMist, the licensed nasal spray influenza vaccine
    manufactured by MedImmune. The researchers have produced a clinical lot
    of a candidate H5N1 vaccine based on a strain isolated in Vietnam in
    2004, and clinical trial of this vaccine is expected to begin later
    this year.
        NIAID also supports a number of basic and applied research projects
    that could lead to significant advances in the development and
    production of vaccines against potential pandemic strains of avian
    influenza. This includes investigation of cell culture-based vaccine
    production as an alternative to chicken egg-based vaccine production--
    as noted above, an endeavor to which the Department of Health and Human
    Services recently committed $1 billion that was awarded to several
    pharmaceutical companies. In addition, NIAID conducts and supports
    research into new vaccine platforms, including recombinant subunit
    vaccines, in which cultured cells are induced to make various influenza
    virus proteins that are then purified and used in a vaccine; gene-based
    vaccines, in which influenza genetic sequences are injected directly
    into a person to stimulate an immune response; and vector approaches
    that insert the genes of influenza virus into another non-virulent
    virus (the vector) and inject the vector vaccine as a carrier to
    present the influenza proteins to the vaccine recipient. For example, a
    gene-based influenza vaccine developed by researchers at the NIAID
    Vaccine Research Center is expected to enter Phase I clinical trials
    later in 2006.
        In addition to efforts to develop vaccines against potential
    pandemic influenza strains, NIAID is supporting basic and applied
    research to develop improved antiviral drugs against influenza. These
    efforts include a screening program for new drugs, as well as targeted
    drug development and clinical trials. NIAID-supported researchers are
    conducting studies of varying doses and combinations of existing
    antiviral medications, developing and testing long-acting next-
    generation antivirals, and evaluating novel drug targets for potential
    prevention and treatment of influenza using in vitro and animal models.
        Because a pandemic influenza virus could emerge anywhere in the
    world, NIAID helps to conduct global surveillance and molecular
    analysis of circulating influenza viruses. For example, NIAID funds a
    long-standing program to detect the emergence of influenza viruses with
    pandemic potential, in which researchers in Hong Kong and at St. Jude
    Children's Research Hospital collect and analyze influenza viruses from
    wild birds and other animals in Asia and North America and generate
    candidate vaccines against them.
        NIAID is also supporting a collaborative effort to release full
    genomic sequence information for several thousand influenza viruses to
    the public domain. More than 1,000 influenza viruses have been
    sequenced. Readily available sequence data will allow researchers to
    further study how influenza viruses evolve, spread, and cause disease,
    which may ultimately lead to improved methods of treatment and
    prevention; identify specific characteristics of previous pandemic
    strains, which may help focus preparedness efforts; and identify genes
    that are highly conserved among various strains, and therefore act as
    possible targets for broadly protective therapeutics or vaccines.
        Lastly, NIAID is collaborating with Oxford University, the Wellcome
    Trust and the World Health Organization to establish a small network of
    clinical sites in Southeast Asia to conduct clinical research on avian
    influenza and other emerging infectious diseases. A key purpose of the
    effort is to build an independent clinical research capacity in these
    countries. Five sites in Vietnam, four sites in Thailand and two in
    Jakarta will be established.

        Senator Specter. I had thought it would be helpful if you
    stayed to hear the other testimony, but now that we have given
    you this homework your time is too valuable. So we will stay
    and forge on alone.
        Thank you very much for coming in. Thank you for what you
    are doing for America and the world.
        Senator Shelby. Mr. Chairman, can I just take 1 second?
        Senator Specter. Certainly.
        Senator Shelby. I just want to commend you for bringing all
    these people together. This is a blue ribbon panel if I have
    ever seen one and I have seen a lot of panels in the Congress,
    as you have. We appreciate what NIH has done and we will be
    ashamed of ourselves if we do not properly fund you for the
    benefit of the American people.
        Senator Specter. That is high praise coming from Senator
    Shelby because he usually deals with bankers.
        Senator Specter. Senator Harkin.

                         MULTI-BUG APPROACH ON VACCINES

        Senator Harkin. Mr. Chairman, I want to thank the panel and
    all the people from NIH for coming down here today.
        Dr. Fauci, in your supplement that the chairman spoke to
    you about, I wanted to delve a little bit into the multi-bug
    approach on vaccines that I understand you are working on,
    rather than just the one bug, one vaccine approach. So I would
    like to know a little bit more about that and where that
    stands.
        Dr. Collins, in regards to--there is some interesting work
    going on in terms of the relating of genes and environment. I
    know you are doing some stuff on that and I would also like to
    be kind of brought up to speed on that, too, if you could
    submit that.
        Thank you.
        [The information follows:]
                         Multi-Bug Approach on Vaccines
        The National Institute of Allergy and Infectious Diseases (NIAID)
    is supporting research and development of alternate approaches to
    dealing with the threat of emerging and re-emerging infectious diseases
    such as influenza.
        For example, NIAID is pursuing the development of a ``universal
    vaccine'' that protects against multiple virus strains such as those
    resulting from antigenic drift associated with seasonal influenza and
    antigenic shift associated with pandemic influenza. As influenza
    viruses circulate, the genes that determine the structure of their
    surface proteins undergo small changes. Sometimes the change in the
    genes results in a slight change in the antigenic properties of the
    protein, a process commonly referred to as ``antigenic drift''.
    Antigenic drift is the basis for the changes in seasonal influenza
    observed during most years, and is the reason that we must update
    influenza vaccines annually. Influenza viruses also can change more
    dramatically. For example, viruses sometimes emerge that can jump
    species from natural reservoirs, such as wild ducks, to infect domestic
    poultry, farm animals, or humans. When an influenza virus jumps species
    from an animal, such as a chicken, to infect a human, the result is
    usually a ``dead-end'' infection that cannot readily spread further in
    the human population. However, mutations in the virus could develop
    that allow human-to-human transmission. Furthermore, if an avian
    influenza virus and another human influenza virus were to
    simultaneously co-infect a person or animal, the two viruses might swap
    genes, possibly resulting in a virus that is readily transmissible
    between humans, and against which the population would have no natural
    immunity. These types of significant changes in influenza viruses are
    referred to as ``antigenic shift.'' When an ``antigenic shift'' occurs,
    a global influenza pandemic can result. Historically, pandemic
    influenza is a proven threat. In the 20th century, influenza pandemics
    occurred in 1918, 1957, and 1968.
        The NIAID is supporting a number of research projects to develop a
    vaccine that induces a potent immune response to the common elements of
    the influenza virus that undergo very few changes from season to season
    and from strain to strain. Although this is a difficult task, such a
    ``universal'' influenza vaccine would not only provide continued
    protection over multiple seasons, it might also offer protection
    against a newly emerged pandemic influenza virus and thus substantially
    reduce the susceptibility of the population to infection by any
    influenza virus--making the country far less vulnerable to influenza
    viruses emerging from avian and other animal sources.
        One relatively stable element of the influenza virus is a protein
    called M2. The external portion of the M2 protein is very similar in
    influenza viruses from year to year and from strain to strain. A
    ``universal'' influenza vaccine targeting the M2 protein, or other
    conserved elements, could be protective against a range of influenza
    strains. NIAID-supported researchers have demonstrated that vaccines
    made with bioengineered versions of M2 can protect mice from lethal
    influenza virus. The scientists now are testing cross-reactivity
    between different species and strains of influenza, examining how long
    the immunity provided by these vaccines lasts, and evaluating whether
    the influenza viruses can evade these vaccines by developing mutations
    in their M2 proteins.
        In addition, researchers at the NIAID Vaccine Research Center (VRC)
    are developing and testing gene-based influenza vaccines that will
    protect against multiple strains of influenza. As a first step, initial
    candidate vaccines, each containing the gene encoding the hemagglutinin
    (H) surface protein of an influenza virus isolated from a recent human
    outbreak of influenza (H1N1, H3N2 or H5N1), have already shown promise
    in animal studies. VRC researchers plan to develop additional gene-
    based vaccines for all common variants of hemagglutinin, as well as
    other influenza viral proteins, such as nucleoprotein and the M2
    protein. In future, the VRC will incorporate both conserved and
    variable genes from multiple influenza strains into DNA and adenovirus
    vectors that can readily be produced by existing manufacturing
    processes.
        A second approach, while not technically a vaccine, is an immune
    enhancer which specifically targets a component of the immune system
    and enhances one's ability to respond to a broad range of microbial
    threats. Studies of the human innate immune system, which is comprised
    of ``first responder'' cells and other defenses that provide a first
    line of defense against a wide variety of pathogens, have been moving
    forward rapidly. These advances suggest it may be possible to develop a
    relatively small set of fast-acting, broad-spectrum countermeasures
    that can boost innate immune responses to many pathogens or toxins,
    including influenza. The capability to boost the innate immune system
    also could lead to the development of more powerful vaccine additives,
    called adjuvants, that can increase vaccine potency. The concept of
    immune enhancers has been demonstrated in early stage clinical studies,
    but requires further research and development to be applied to pandemic
    influenza vaccination.
                   Genes, Environment, and Health Initiative
        On February 8, 2006, HHS Secretary Leavitt announced that the
    President's budget proposal for fiscal year 2007 included $68 million
    for the Genes, Environment and Health Initiative (GEI), a research
    effort by the National Institutes of Health (NIH) to combine a type of
    genetic analysis and environmental technology development to understand
    the causes of common diseases such as asthma, arthritis, many types of
    cancer, diabetes, and Alzheimer's disease. This represents a $40
    million increase above the $28 million already planned for such efforts
    by the NIH for fiscal year 2007.
        If approved by Congress, $26 million of the requested $40 million
    increase in funding would go to genetic analysis and $14 million to the
    development of new tools to measure environmental exposures that affect
    health. The discoveries made through these efforts can potentially lead
    to profound advances in disease prevention and treatment. By seizing
    the historic opportunity provided by the Human Genome Project and the
    International HapMap Project, this initiative would speed the discovery
    of genetic risk factors for common diseases. But, as it has been said,
    genetics loads the gun; environment pulls the trigger. GEI will also
    provide markedly improved ways to measure and analyze the environmental
    contribution to disease, so that we can understand the complex
    interplay among genes and environment that is responsible for all human
    health and disease.
        The NIH has recently formed a Coordinating Committee of
    representatives from 13 Institutes and Centers that would develop the
    content, priorities, and implementation of the initiative, should it be
    approved by the Congress. Similar to the management of NIH Roadmap
    initiatives, specific functions of the Coordinating Committee include:
    (a) identification of research priorities and opportunities relevant to
    the program, (b) guidance and support of the development and
    implementation of specific research initiatives related to the program,
    (c) evaluation of proposals for specific activities to be conducted
    under the auspices of the program, and (d) facilitation of appropriate
    NIH-wide communication of program goals, initiatives, and findings. Two
    subcommittees have been formed, one to focus on the genetics component
    of GEI and the other to focus on its environmental component. These
    subcommittees will do the necessary planning for the proposed program
    during the current year and will be prepared to help administer the
    initiative, provided fiscal year 2007 funds are made available.
    Attached is a breakdown of the proposed budget for the initiative.
    Since the initiative is so early in its planning stages, the number of
    grants that would be awarded eventually is not known at this time.
        Through initiatives such as GEI, we stand on the threshold of
    creating a future that would revolutionize the practice of medicine by
    allowing us to predict disease, identify environmental triggers,
    develop more precise therapies and, ultimately, prevent the development
    of disease in the first place.

        Senator Specter. Thank you all very much.
        We turn now to our next panel: Dr. Knapp, Dr. Auerbach, Dr.
    Chao, Dr. Comstock, Dr. Emerson, Ms. Eng, and Dr. Fox.
        We have taken the unusual step of inviting 20 witnesses to
    this hearing to give us a bird's eye view or a thumbnail
    sketch, to mix metaphors, as to what is happening in specific
    lines of medical research. We have allocated as much time as we
    can, consistent with the schedule. It is not enough.
        Dr. Knapp represents the entire group on medical research
    and there has been an allocation of 3 minutes for him and an
    allocation for every other witness, regrettably, of only a
    minute and a half. But that is the best we can do, and you have
    submitted written statements, all of which will be made a part
    of the record, and that will give us an opportunity to have
    some insights on your views and what is happening in your
    specific fields.
        We are going to just indicate the group you are associated
    with, as opposed to going over your curriculum vitae's, which
    are all very, very impressive. Dr. Knapp, we start with you,
    representing the Ad Hoc Group for Medical Research.
    STATEMENT OF RICHARD M. KNAPP, M.D., CHAIR, AD HOC
                GROUP FOR MEDICAL RESEARCH
        Dr. Knapp. Good morning. My name is Dick Knapp and I chair
    the Ad Hoc Group for Medical Research.
        Mr. Chairman, all Americans owe you and Senator Harkin an
    enormous debt of gratitude for your unwavering commitment to
    medical research and your continued leadership in the support
    of the NIH, and we applaud your efforts to add funds to the
    2007 budget to permit a $2 billion increase in NIH funding.
        The President's budget claims to freeze NIH at the 2006
    level, but for almost all NIH institutes and centers this
    budget represents a cut, not a freeze. This budget proposal
    represents the fourth consecutive year that NIH funding has
    failed to keep pace with inflation. In inflation-adjusted
    dollars, as you pointed out, Mr. Chairman, this budget
    represents a loss of almost 11 percent of purchasing power
    since 2003.
        Mr. Chairman, we are well on our way to undoubling the NIH
    budget that you and your colleagues fought so hard to achieve.
    As you heard from Dr. Zerhouni, NIH-funded research is driving
    the transformation of the practice of medicine. At a time of
    unparalleled scientific opportunities and unprecedented health
    challenges, NIH should be positioned to support more research,
    not less. Yet, under this President's budget NIH would fund 10
    percent fewer competing research project grants in 2007 than 4
    years ago.
        Because new investigators are essential to NIH's future, as
    Dr. Zerhouni pointed out, NIH-sponsored training should be
    supported as a top priority. However, due to fiscal
    constraints, the NIH has been unable to meet the stipend
    recommendations it made in 2001, and the President's budget
    proposes no stipend increases in 2007.
        The flattening of the NIH budget also undermines the
    Nation's biomedical research infrastructure. Mr. Chairman, and
    you Senator Harkin have emphasized the need for increased
    support for the renovation and construction of extramural
    research facilities and the acquisition of state of the art
    laboratory instrumentation. Yet this budget again fails to
    request funds for the NIH extramural facilities program and the
    budget proposes to cut funding for shared instrumentation
    grants by nearly 8 percent below the level of 2005.
        This morning's witnesses will describe how NIH research has
    safeguarded and improved the lives of all Americans while at
    the same time serving as a catalyst for new products and
    technologies, creating skilled jobs and contributing to the
    Nation's economic growth.

                               PREPARED STATEMENT

        We share your concern that the continued flattening of the
    NIH budget threatens further progress in all of these areas.
    Thank you for the chance to be here.
        [The statement follows:]
                     Prepared Statement of Richard M. Knapp
        Mr. Chairman and members of the subcommittee, my name is Dick
    Knapp, and I chair the Ad Hoc Group for Medical Research Funding, a
    coalition of more than 300 patient and voluntary health groups, medical
    and scientific societies, academic and research organizations, and
    industry. The Ad Hoc Group is pleased to have the opportunity to
    provide an overview of the President's fiscal year 2007 budget for the
    National Institutes of Health (NIH).
        Mr. Chairman, the members of the Ad Hoc Group, and indeed, all
    Americans, owe you and Senator Harkin an enormous debt of gratitude for
    your unwavering commitment to medical research and your continued
    leadership in support for the NIH. We share your belief that much of
    what has been accomplished in the past half century to help save lives
    and improve the health of all Americans can be attributed, directly or
    indirectly, to the NIH. And we applaud your efforts to add funds to the
    fiscal year 2007 budget resolution to permit a $2 billion increase in
    the NIH budget. In January, the Ad Hoc Group joined four other major
    medical research advocacy groups in calling for the NIH budget to be
    increased by a minimum of $1.4 billion (5 percent) in fiscal year 2007.
        The President's budget for fiscal year 2007 proposes $28.35 billion
    in budget authority through this subcommittee for the NIH, which is an
    increase of less than $1 million over the current year's level. Much
    has been made of this proposal for flat funding. But for most areas of
    research, this budget represents a cut, not a freeze. Under the
    President's proposal, the fiscal year 2007 budgets for almost all NIH
    institutes and centers would be reduced below the fiscal year 2006
    levels.
        In addition, it is important to recognize that this year's budget
    is not a one-year aberration. The President's overall request is $64.5
    million less than what NIH received in fiscal year 2005, and the
    proposed budgets for most institutes and centers are between 1 and 1.5
    percent lower than two years ago. If adopted, the President's budget
    would represent the fourth consecutive year that NIH funding has failed
    to keep pace with inflation as measured by the Biomedical Research and
    Development Price Index. In fact, in terms of inflation-adjusted
    dollars, the President's budget represents a loss of 11 percent of
    purchasing power since 2003, as shown in the attached graph. Mr.
    Chairman, we are well on our way to ``undoubling'' the NIH budget that
    you and your colleagues fought so hard to achieve.
        It is the cumulative effect of this multi-year ``flattening'' of
    the NIH budget that is cause for concern. The flattening has had and
    would continue to have a severe impact across the pillars of NIH: basic
    research, translational and clinical research, research training, and
    the research infrastructure.
        NIH-funded researchers have blazed new trails for medical research.
    Basic research forms the knowledge foundation needed to achieve
    continued scientific advancement. And as you have heard from Dr.
    Zerhouni, the discoveries resulting from the investment in NIH-funded
    research are driving the transformation of the practice of medicine
    through the development of novel and personalized therapies, cures, and
    prevention strategies.
        According to the Congressional Justification accompanying the
    President's budget, in fiscal year 2007 NIH will be able to support
    37,671 total research project grants (RPGs). This is 1,570 fewer RPGs
    than NIH funded in fiscal year 2004. What is more critical is the
    reduction in the number of new and competing RPGs. Under the
    President's budget, NIH will be able to award 9,337 competing RPGs in
    fiscal year 2007, a decrease of 1,074 compared to fiscal year 2003.
    This is 10 percent reduction in just four years. At a time of
    unparalleled scientific opportunities and unprecedented health
    challenges, NIH should be positioned to support more research, not
    less.
        In addition, a key function of NIH is to support training awards to
    encourage new investigators into basic and clinical medical research
    careers. Because an influx of new investigators is essential to NIH's
    future, NIH-sponsored training opportunities should be supported as a
    top priority, with realistic funding levels for stipends, tuition, and
    benefits. Under the President's budget, the NIH will be able to support
    17,499 full-time training positions (FTTPs) in the Ruth L. Kirschstein
    National Research Service Award (NRSA) program. This is a reduction of
    139 since fiscal year 2005. Furthermore, in 2001 the NIH recommended
    increased stipend support for NRSA recipients; however, the agency has
    been unable to meet these objectives due to fiscal constraints. For
    example, stipends for pre-doctoral students and post-doctoral fellows
    have fallen significantly short of NIH's targets, and the President's
    budget provides no increases for stipends above the fiscal year 2006
    levels. How are we to continue to attract the best and brightest
    students with stipends that are unduly low in view of the high level of
    education and professional skills involved in biomedical research?
        The flattening of the NIH budget also undermines the nation's
    biomedical research infrastructure. NIH extramural research
    infrastructure grants are essential if research institutions are to
    update or replace aging research laboratories. Senator Harkin
    recognized the critical importance of the research infrastructure to
    the continued leadership of the United States in medical research when
    he championed the Twenty-First Century Research Laboratories Act, which
    was enacted in 2000. This legislation emphasized the need for increased
    support for the renovation and construction of extramural research
    facilities and the acquisition of state-of-the-art laboratory
    instrumentation. Yet once again, the President's budget fails to
    request funds for the peer-reviewed, competitively awarded, extramural
    research facilities grant program administered through NIH's National
    Center for Research Resources.
        Federal funding also is critical to equip core facilities at
    biomedical research institutions with state-of-the-art technologies.
    NIH administers two competitive grant programs that award funds to
    institutions to purchase present and emerging technologies: the Shared
    Instrumentation Grant Program for groups of NIH-supported investigators
    to obtain commercially-available equipment that costs more than
    $100,000; and the High-End Instrumentation Grant Program to acquire
    more expensive equipment, such as structural and functional imaging
    systems, electron microscopes, and supercomputers. These grants
    maximize the utility of federal research funds by allowing a number of
    scientists with similar instrumentation needs to share such equipment,
    and promote interactions among scientists, frequently across scientific
    disciplines, thereby catalyzing mutually rewarding new research
    collaborations. Yet, the President's budget proposes to reduce funding
    for these programs to $64.4 million, which is 7.7 percent below the
    fiscal year 2005 level.
        This morning's witnesses will give specific examples of how the
    research supported and conducted by NIH has had a profound and far-
    reaching impact on society in many important ways, serving as a
    catalyst for new products and technologies, creating skilled jobs,
    contributing to the nation's economic growth, and most importantly,
    safeguarding and improving the lives of all our citizens. Mr. Chairman,
    we share you concern that the continued flattening of the NIH budget as
    proposed by the President threatens further progress in all of these
    areas.

        Senator Specter. Thank you, Dr. Knapp.
        Dr. Judith Auerbach, representing the Foundation for AIDS
    Research.
    STATEMENT OF JUDITH AUERBACH, Ph.D., VICE PRESIDENT,
                PUBLIC POLICY AND PROGRAM DEVELOPMENT,
                AMFAR, THE FOUNDATION FOR AIDS RESEARCH
        Dr. Auerbach. Good morning, Mr. Chairman, and thank you
    very much. I am Judy Auerbach from amFAR and I will speak very
    quickly since we have only 90 seconds.
        There are now more than 1 million HIV-infected people in
    the United States and the rates of HIV infection have risen
    dramatically among vulnerable populations, including racial and
    ethnic minority women and men. To make headway in the fight
    against AIDS, we need a strong Federal commitment to research
    leading to more effective treatment and prevention methods.
        During the doubling of NIH's budget, the Agency was able to
    expand the knowledge base in basic research focusing on human
    immunology, macromolecular biology, structural biology, and
    behavioral research. This led to a dramatic increase in the
    number of vaccine and therapeutic candidates in the pipeline
    and to the implementation of crucial HIV prevention trials in
    populations most at risk of infection.
        But much of this progress is in jeopardy with current and
    proposed cuts. Factoring in the recent recalculation, AIDS
    research at NIH was cut by about 2.4 percent between 2005 and
    2006 and will be cut another 6 percent under the President's
    2007 request. This has grave consequences for grants overall,
    for expanded trials of promising prevention technologies and
    therap eutics, and for new and seasoned investigators.
        The number of R01's in AIDS research decreased by 5 percent
    in both numbers and dollars from 2005 to 2006 and would
    decrease even further in 2007. Under current budget
    constraints, it is anticipated that the AIDS clinical trials
    networks will be allocated only about 54 percent of what it is
    estimated they will need over the next 7 years. This means
    important effectiveness trials of new prevention technologies
    and new therapeutics will not be launched. Research institutes
    are losing potential new investigators and more experienced
    ones are demoralized, knowing that the majority of submissions
    are triaged and unscored and that funding is not likely until
    resubmission, even if then.
        So altogether this means that important AIDS research will
    not be undertaken and people at risk for or living with HIV and
    AIDS will not have access to lifesaving interventions.
        My time is over, so I will stop there. Thank you.
        Senator Specter. Thank you, Dr. Auerbach.
        Dr. Moses Chao, Christopher Reeve Foundation.
    STATEMENT OF MOSES CHAO, M.D., CHRISTOPHER REEVE
                FOUNDATION
        Dr. Chao. Thank you, Mr. Chairman.
        In the past 10 years we have witnessed a remarkable
    turnaround in neuroscience research. It used to be dogma that
    the adult spinal cord could not regenerate or recover from
    serious injury. But now through basic research we know of
    specific genes, proteins, and cells that can stimulate the
    repair of the spinal cord, and we are now ready to convert
    these findings into new therapies.
        But the United States is falling behind because of the
    decrease in NIH funding. The decrease has affected many
    scientists, including my own lab, because the level of funding
    has actually dropped to 10 percent. What that means is 1 out of
    10 grants is being funded and that has produced some drastic
    consequences, because many innovative applications and
    promising experiments are not supported or carried out.
        More distressingly, there is a huge negative impact on the
    recruitment of our next generation of young scientists because
    of this discouraging situation. So we believe that this is the
    time to invest in basic research to advance the progress that
    we have made in this area. Christopher Reeve often argued that
    what we learn about spinal cord regeneration has direct
    implications to many diseases, including glaucoma, Alzheimer's
    disease, and Parkinson's disease. Therefore, to put the brakes
    on funding basic research will interfere with new scientific
    discoveries that will be aimed at improving the health of all
    Americans.
        Thank you.
        Senator Specter. Thank you, Dr. Chao.
        Ms. Amy Comstock, Parkinson's Action Network.
    STATEMENT OF AMY L. COMSTOCK, CHIEF EXECUTIVE OFFICER,
                PARKINSON'S ACTION NETWORK
        Ms. Comstock. Good morning. Thank you, Chairman Specter and
    Senators Harkin and Shelby. I am Amy Comstock, the Chief
    Executive Officer of the Parkinson's Action Network, and I am
    here on behalf of Parkinson's patients, their families, and all
    of the national Parkinson's organizations.
        Parkinson's disease is now listed among the 15 leading
    causes of death in this country. Yet there is still no cure and
    no known treatments that even slow the progression of the
    disease. In fact, since the introduction of dopaminergic
    treatments nearly 50 years ago, our community is still
    struggling with mere variations of that treatment for this
    progressive disease.
        Even with the introduction of deep brain stimulation for
    Parkinson's disease, we are still only responding to the
    symptoms of the disease and not doing that very well sometimes,
    and certainly not for a long duration.
        So I am here this morning, quite frankly, to use the word
    that we are terrified of flat funding at NIH. Not only will
    flat funding eat into all forms of research currently under way
    at NIH, but we are particularly fearful that it will have a
    disproportionate impact on clinical and translational research,
    which is exactly the kind of research that we need the most.
        Clinical research is very expensive to conduct, but it is
    what we have to have in order for treatments to make it through
    the drug development pipeline and become available to patients.
    For example, there is a handful of drugs slated for clinical
    trials right now at NIH that in fact may be what we need so
    badly. They may be compounds that can slow the progression of
    the disease.

                               PREPARED STATEMENT

        We have to have these trials, but we cannot have them
    without funding. With flat funding, even if those trials are
    conducted--we have to do the math--other research would be cut
    at NIH. Therefore, we strongly support a minimum of 5 percent
    increase for NIH.
        Thank you.
        [The statement follows:]
                     Prepared Statement of Amy L. Comstock
        Thank you Chairman Specter, Ranking Member Harkin, and
    distinguished members of the Subcommittee for convening this hearing on
    NIH appropriations. I am the Chief Executive Officer of the Parkinson's
    Action Network (PAN). PAN represents the Parkinson's community,
    including the more than one million Americans currently fighting
    Parkinson's disease (PD), and their families, and the national
    Parkinson's organizations, such as The Michael J. Fox Foundation for
    Parkinson's Research, Parkinson's Disease Foundation, National
    Parkinson Foundation, Parkinson Alliance, and American Parkinson
    Disease Association.
        As I am sure you all you know, PAN was instrumental in helping
    garner Congressional support for this Subcommittee's doubling of the
    NIH budget over five years during the late 1990's and early in this
    decade. We continue to work in conjunction with so many to prevent the
    proposed freeze in funding for NIH. Flat-funding would, in effect,
    constitute a significant cut, as the Biomedical Research and
    Development Price Index (BRDPI) is estimated to have increased by 5.5
    percent for fiscal year 2005, and will likely increase by 4.1 percent
    for fiscal year 2006, and 3.8 percent in fiscal year 2007. Accordingly,
    in order to not lose ground in ongoing research, we support the medical
    research advocacy community's recommendation for a 5 percent increase
    above the fiscal year 2006 funding level for the National Institutes of
    Health.
        We cannot turn our backs on our most promising research, which may
    happen if this funding is not provided. The Parkinson's community is
    particularly concerned with several clinical trials that may be
    eliminated without sufficient funding and direction.
        These clinical trials are a part of a study going on at NIH right
    now that embody the kind of translational research most promising to
    the Parkinson's community and is desperately needed. NET-PD
    (Neuroprotection Exploratory Trials in Parkinson's Disease) is a trial
    to study compounds that may slow the progression of Parkinson's
    disease. Research into treatments that might slow progression is
    particularly important as current treatments for PD alleviate some
    symptoms but do not slow progression of the disease. Despite the
    potential value, this program may be halted or cut back if NIH does not
    receive adequate funding. Yet, NET-PD is exactly the kind of
    translational research that we strongly support NIH aggressively
    pursuing.
        We believe that there is hope for today's Parkinson's disease
    patients and their families. There are emerging therapies that should
    be pursued--even therapies that could potentially reverse the
    progression of the disease. These are the neuro-restorative therapies,
    such as neural growth factors, gene therapies, and tissue transplants
    including stem cells, which ultimately may restore function in patients
    suffering from Parkinson's disease as well as other neurodegenerative
    disorders. However, if this important research is not aggressively
    pursued it may take many more years than necessary to determine if this
    hopeful research may become much-needed therapies for today and
    tomorrow's Parkinson's patients.
        On behalf of the Parkinson's community, I thank you for your
    continued interest in Parkinson's disease issues and your support for
    better treatments and a cure for Parkinson's. I would be happy to
    answer any questions you may have.

        Senator Specter. Thank you, Ms. Comstock.
        We turn now to Dr. Steven Emerson on the cancer issue. Give
    my regards and thanks to Dr. John Glick, my oncologist.
    STATEMENT OF STEPHEN EMERSON, M.D., ASSOCIATE DIRECTOR
                FOR CLINICAL RESEARCH, ABRAMSON CANCER
                CENTER, UNIVERSITY OF PENNSYLVANIA HOSPITAL
        Dr. Emerson. Good morning, Chairman Specter, Senators
    Harkin and Shelby. My name is Steve Emerson. I am the associate
    director for clinical research at the Abramson Cancer Center at
    Penn. Our outgoing director, Dr. Glick, sends his regards. He
    is no stranger to this committee.
        First off, I want to thank you all for your continued
    support for the health and welfare of this country by means of
    health care research over the past several years. Without your
    support, we could not have done what we have done. In the area
    of cancer where I work, I have seen in the 25 years I have been
    working a change where 25 years ago a cancer diagnosis was
    uniformly and relatively quickly fatal, to now where over half
    the patients who walk in my office know that they will live at
    least 5 years, if not be cured of their cancer.
        But still we are only partway there and at this point
    cancer is still the largest cause of death in all Americans
    under the age of 85. It is still a huge killer. We have a long
    way to go.
        Now, you have heard a lot about the issues with the
    doubling of the budget and yet where we are with the flat
    budgets going forward. I want to concentrate on just one part
    of that. One of my roles at Penn is head of training and the
    mentoring of the next generation of investigators. What you see
    with the budget being flat is actually a reduction in all new
    R01's being funded to this year the eleventh percentile, next
    year much lower. This is one-third the level of funding in
    terms of numbers of grants and chances of getting funded that
    it was even 3 years ago, and that is going to get worse next
    year.
        Worse than that, the money per grant is being cut 30
    percent off even the best grants. So the funds going in for new
    research have plummeted. That is the source of the panic you
    are talking about. So for new investigators that we have all
    invested in, the outlook for them for careers, for taking care
    of all of us and for finding new cures, it is hard to convince
    them what the future is. If we do not correct this, all of the
    goodwill and investment we have made in the infrastructure with
    the road map, all the collaborative work, all the genomics and
    cancer that we have put this investment into will go to waste
    because we will not have a next generation of scientists to
    take advantage of it.

                               PREPARED STATEMENT

        So thank you all again in the past and in the future for
    your efforts on preserving the NIH budget and its mission.
    Thanks again.
        [The statement follows:]
                   Prepared Statement of Dr. Stephen Emerson
        Good Morning, Chairman Specter, Senator Harkin, and Members of the
    Subcommittee. I am Stephen Emerson, Associate Director for Clinical
    Research at the University of Pennsylvania's Abramson Cancer Center,
    one of NIH's original comprehensive cancer centers funded by the
    National Cancer Institute three decades ago. Our outgoing Director, Dr.
    John Glick, no stranger to this Subcommittee, extends his regards and
    regrets his schedule did not permit him to appear this morning.
        Thank you for the opportunity to speak with you today about efforts
    by scientists and clinicians in the ongoing fight against cancer, a
    disease that is the leading cause of death for Americans 85 years of
    age and younger. In the United States last year, 1 of every 4 deaths
    was from cancer. This illness claimed the lives of about 563,700
    Americans, with approximately 1.4 million new cancer cases diagnosed.
        These staggering figures should not, however, diminish the hope
    that exists for all those who fall victim to this disease from the
    dramatic progress we have made in this fight. When the Abramson Center
    opened its doors three decades ago, a cancer diagnosis was a near
    certain, imminent death sentence. But through the efforts of millions
    of people, and as a direct result of the steadfast support of this
    Subcommittee in robust funding for cancer research over the years,
    today about 60 percent of cancer patients can expect to live more than
    five years after diagnosis. Working with our colleagues in partnership
    with organizations like the American Cancer Society and the Friends of
    Cancer Research, there is an aggressive, day-to-day battle to reverse
    the devastating effect that cancer has on the lives of so many
    individuals and families--through research, prevention efforts and
    treatment.
        That effort, however, is under assault, and at great risk, if the
    President's fiscal year 2007 budget for the National Institutes of
    Health, and its proposed allocation for the National Cancer Institute,
    is not reversed. In the Bush 2007 budget proposal, the NCI is slated to
    receive $4.75 billion--a cut of nearly $40 million, or almost 1
    percent, below NCI's fiscal year 2006 level. That is a reduction of $70
    million cut from the fiscal year 2005 level and approximately $186
    million less than what the Congressional Budget Office estimates is
    necessary to maintain current projects, infrastructure and spending
    adjusted for inflation and other factors.
        Within the proposed levels for the NCI, virtually every major
    activity, other than activities for the NIH Roadmap initiative, would
    be reduced. Cancer research activities would be cut $50 million below
    the 2006 level, which itself was slightly reduced from the level
    allocated for 2005. Cancer biology research would be cut nearly $41
    million and research into the causes of cancer would be reduced more
    than $6 million. Overall support for the cancer centers would be
    reduced by more than $2 million, capping a two-year period of real
    decline in the NIH investment for its cancer centers. Even cancer
    control and prevention, one of the single most important areas in our
    efforts to combat this disease, is scheduled to be hit with a nearly
    $2.5 million reduction, reductions that amount to a cumulative decline
    of nearly $17 million over two years.
        These proposed reductions, which I know you oppose Mr. Chairman,
    completely contradict the Administration's stated goal of ending
    suffering and death from cancer by 2015. They fly in the face of the
    spiraling cost of cancer treatment, pegged at more than $72 billion
    annually in the United States, nearly five percent of all health care
    expenditures. And they send the wrong message to the nation at a time
    when the economic burden, excluding the costs for treatment, from
    cancer morbidity and premature mortality is a staggering $120 billion
    annually.
        For the community of scientists and clinicians who have dedicated
    their lives to the prevention, diagnosis and treatment of cancer, and
    who are the members of the team working in every state in our nation to
    meet that 2015 goal, these proposed cuts are both alarming and highly
    discouraging. If enacted, these funding levels would drop success rates
    for scientists proposing research project grants to the NCI to just 16
    percent--that is a 1 in 6 chance of obtaining funding. Such a level
    would mean a drop in the NCI grant success rate of more than 50 percent
    since 1998, and a drop of 43 percent since 2002. For NCI's R01 grants,
    the bread and butter mechanism for most NIH funded scientists, the
    payline for last year is even worse--just 11 percent. Reductions in
    2007 would only erode that level further.
        While older, more established research scientists will likely find
    a way to hold on to most of their core funds, the effect on young
    investigators--the seed corn of our future in this battle--is nothing
    short of devastating. The NIH New Investigators Committee presented
    data last December that showed the average age of a typical new NIH R01
    awardee with an M.D. degree had reached 44. At the same time, the
    percentage of new investigators in competing R01 Awards across NIH
    continues to decline to just 20 percent. For the NCI, the first-time
    investigator success rate for all grant mechanism is worse--just 11
    percent. For R01's, the success rate is again just 17 percent. The
    message these proposed cuts send is that for promising young biomedical
    professionals, a career focused on tackling cancer--whether in the
    fundamental study of genomics, proteomics, and biomarkers, or the more
    applied disciplines directed at generating new diagnostic or treatment
    regimes and devices--is not worth pursuing. The President's budget runs
    the risk of beginning the effective elimination of a whole generation
    of cancer scientists--at the very time when we are turning the corner
    on the fight against this disease.
        Those of us who have spent our lives focused on ending the scourge
    of this disease know that this Subcommittee--more so than any other in
    the U.S. Congress--led the fight for funds to double the NIH budget.
    And there has been tremendous progress against cancer as the number of
    people who died from cancer between 2002 and 2003 decreased for the
    first time, the year corresponding to the last of the large NIH budget
    increases. The Director of the NCI, in his testimony to this Committee
    last month, outlined a number of significant scientific breakthroughs
    in the treatment and diagnosis of breast, ovarian and cervical cancers
    in just the last year. These continue the remarkable success we have
    had in fighting the number two cause of death in the United States.
        The proposed 2007 budget cuts would help to unravel the progress
    this Subcommittee fought so hard to achieve in the doubling of NIH from
    1998-2003. We urge you to redouble your efforts to stop them, and
    provide a modest increase--perhaps an additional $300 million for the
    NCI in the coming year--to help offset declines enacted in 2006 and
    provide for most increases to sustain the pool of young scientists
    whose careers will hopefully be marked by the end of cancer as a
    scourge on so much of our nation and our world.
        Thank you for the chance to present my views to the Subcommittee.
    We would be happy to prepare responses to any questions you might have
    for the record.

        Senator Specter. Thank you, Dr. Emerson.
        Ms. Lauren A. Eng, Spinal Muscular Atrophy Foundation.
    STATEMENT OF LAUREN A. ENG, PRESIDENT, SPINAL MUSCULAR
                ATROPHY FOUNDATION
        Ms. Eng. My daughter is one of the 33,000 American children
    suffering from spinal muscular atrophy, the most common genetic
    killer of young children. One missing gene causes nerves and
    muscles to wither away and most children die by the age of 2.
    But there are many terrible diseases. What makes SMA remarkable
    is the imminence of treatment. SMA represents both the problem
    and the opportunity of drug development for orphan diseases.
    Half of Americans with illness suffer from rare diseases and
    for the vast majority of rare diseases, especially pediatric
    ones, money and scientific advances are wasted because
    discoveries do not move from the bench to the bedside.
        Because of scientific breakthroughs, NINDS chose SMA from
    its 600 diseases for a groundbreaking drug discovery program.
    The SMA project is a shining example that NIH can develop
    treatments and invest in further and basic science that is ripe
    and pays off. With less than $5 million a year, a group of
    potential drugs have already been identified. NIH has been a
    catalyst of advancing research and drug companies are
    interested. It achieved in 3 years what might have otherwise
    taken 10.

                               PREPARED STATEMENT

        But running an astonishing race is useless if you stop
    short of the finish line. Under the proposed budget,
    continuation of the program is at risk. There is funding to
    pursue one drug, but scientists believe at least three should
    be advanced, each costing $15 million to bring to trials. If
    NIH cannot fund this next step, it will have catastrophic
    effect. Academic and industry research will stop. We will have
    wasted the enormous investments and progress made in biomedical
    research, and for my child all of this is the difference
    between life and death.
        [The statement follows:]
                       Prepared Statement of Loren A. Eng
        I am Loren Eng, president of the Spinal Muscular Atrophy (SMA)
    Foundation and am here on behalf of the SMA Coalition. Most
    importantly, I am the mother of Arya Singh, who is one of the 30,000
    children in America dying from Spinal Muscular Atrophy.
        As you may know, SMA is a terrible disease. It is the most common
    genetic killer of babies and young children in America, and it is
    untreatable and fatal. It is often described as a genetic version of
    polio, or the children's equivalent of ALS. In children with SMA, one
    missing gene, and one missing protein causes motor neurons to die.
    Muscles weaken and wither away, leaving the bright minds of its young
    victims trapped by their failing bodies. Most children with SMA die
    within the first few years of life. Some are ``lucky'' and live longer,
    but face extreme disability and suffering.
        But there are many terrible diseases. What makes SMA remarkable is
    the ability to truly make a difference with a modest amount of money
    and smart strategy.
        SMA is a poster child for both the problem and the opportunity of
    drug development for rare pediatric diseases.
        For large diseases, the historical focus on basic science works
    well--large drug companies take that basic science and translate it
    into treatments that save lives.
        However, half of Americans with illness have smaller diseases, and
    for them the system has not worked. Breakthroughs are often achieved in
    basic science, but there are no large drug companies waiting to turn
    those breakthroughs into treatments. For a handful of smaller diseases,
    drug companies will only get involved at later stages where perceived
    risk is lower. But for most small diseases, the basic science is wasted
    because of the challenges of advances research from the bench to the
    bedside. This is especially true for rare pediatric diseases. Money is
    spent, but children still die.
        In the past decade, scientists studying SMA have achieved
    incredible breakthroughs, creating a unique opportunity to develop
    treatments. To its credit, NINDS has recognized the opportunity and
    taken steps to advance basic science with a revolutionary translational
    research effort.
        Just three years ago, the NINDS designated SMA, from among 600
    diseases, as the best candidate for a model new program to translate
    basic science into actual drugs and treatments. The SMA Project
    combined academic and industry expertise, and was a focused and
    strategic effort to translate remarkable science into real solutions.
        In just three years, and for less than $5 million per year, the SMA
    Project has brought us within reach of an effective treatment.
    Investigators have identified a group of potential drugs that may slow
    the progression of the disease. Despite a miniscule budget for the
    project, NINDS has made incredible strides in harnessing the
    community's efforts toward a near term treatment.
        Unfortunately, running a brilliant race is useless if you stop
    before the finish line, and that is what we fear is at risk of
    happening.
        I am not an expert in the federal budget but I do know that:
      --this model SMA program would never have been initiated under this
            budget,
      --the existing funding of just $5 million a year is at risk, and
      --the very success of the program is at risk.
        The next phase of the project is pre-IND studies but there is only
    enough funding to study JUST one compound. Project scientists say we
    need at least two to three, and each costs $2 million. For clinical
    trials we will need $10 to $15 million each.
        The leadership of the NIH has been a catalyst of incredible
    progress--it expects to advance research to a point when they can be
    ``handed off'' to drug companies to fully develop. For a fraction of
    the vast amounts spent on caring for SMA victims, we could develop
    treatments that would save them. With a modest amount of money and
    continued focus, we can save lives, and money.
        If NIH can not provide for these critical next steps, it will have
    a domino effect elsewhere:
      --Young investigators will not focus on SMA,
      --Existing non-government research will stall,
      --Industry will surely not engage, and
      --Other diseases like ALS and DMD will not reap the benefits of SMA
            research.
        The SMA Project has been a revolutionary effort and a shining
    example of how NIH cannot only fund basic research but actually DEVELOP
    TREATMENTS for deadly diseases.
        Through a solution driven approach, the NIH has achieved in 3 years
    what might have taken a decade. ``Smart investment'' could pay off in
    treatments that save lives. This is an incredible example of finding
    solutions, not just spending money. Of course, in this case, a
    ``solution'' means treatment that could save the lives and reduce the
    suffering of 30,000 children.
        We urge you not to stop short now when we are so close. Reducing
    funding for NIH, and for projects like the SMA Project will have
    devastating consequences--we will waste the enormous amounts of money
    that have been spent and progress that has been made. For our daughter,
    it could mean the difference between life and death.

        Senator Specter. Thank you, Ms. Eng.
        We turn now to Dr. Philip Fox, American Association for
    Dental Research.
    STATEMENT OF DR. PHILIP C. FOX, DIRECTOR OF CLINICAL
                RESEARCH, DEPARTMENT OF ORAL MEDICINE,
                CAROLINAS MEDICAL CENTER ON BEHALF OF THE
                AMERICAN ASSOCIATION FOR DENTAL RESEARCH
        Dr. Fox. Thank you, Mr. Chairman. I am Dr. Phil Fox and I
    am really representing the dental research community.
        I would like to highlight this morning some advances in
    salivary diagnostics, an area you have not heard much about.
    Diagnosis of most health conditions requires a blood or a urine
    sample and that may be invasive or painful to obtain. But now,
    after many years of research, saliva is poised to be used as a
    noninvasive diagnostic fluid for a number of oral and systemic
    conditions.
        Dental researchers have been able to amplify molecular
    signals that are present in saliva, heralding the advent of new
    tests that allow for earlier diagnosis than is currently
    possible. Saliva is already being used routinely for rapid
    noninvasive HIV diagnosis and saliva-based tests will soon be
    available to detect oral cancer. Further, saliva has the
    potential to detect exposure to chemical and biological weapons
    and is being looked at in autoimmune diseases as well.
        Now, most of this research is funded by the National
    Institute of Dental and Craniofacial Research, the NIDCR.
    However, as you have heard, the investment that is made in the
    NIH doubling is now at risk. I think that we have the research
    equivalent now of being all dressed up and nowhere to go.
        As a result of your past investment, there are many
    unprecedented opportunities in dental research. But the austere
    budget of the last 4 years has resulted in a steady decrease in
    new research grants and many young investigators who are
    leaving the field.
        Imagine a future in which a saliva sample is used for
    quick, painless and less expensive diagnostic tests and to
    monitor many systemic health conditions and exposure to
    chemical and biological weapons. Early diagnosis could save
    thousands of lives. We need you to sustain your commitment to
    NIH and to dental research in order to realize these
    unprecedented scientific opportunities.
        Thank you for your interest and support.
        Senator Specter. Thank you very much, Dr. Fox.
        Unless there is some question from the panel, we will turn
    now to our next group of experts.
        Thank you all very, very much.
        Dr. Knapp. Thank you.
        Dr. Emerson. Thank you.
        Senator Specter. We now call on Ms. Patricia Furlong, Dr.
    Sam Gandy, Ms. Ann Gibbons, Dr. Robert Goldstein, Dr. Lawrence
    Holzman, and Dr. Steven Houser.
        Thank you all very much for joining us. As is the situation
    with all of the witnesses, your full statements will be made a
    part of the record. We turn first to Ms. Patricia Furlong, who
    represents the Project on Muscular Dystrophy. Ms. Furlong.
    STATEMENT OF PATRICIA FURLONG, CO-FOUNDER AND CHIEF
                EXECUTIVE OFFICER, PARENT PROJECT MUSCULAR
                DYSTROPHY
        Ms. Furlong. Thank you very much, Senator Specter, Senator
    Harkin, and Senator Shelby. I so appreciate this opportunity to
    talk about NIH funding.
        I thought I would start by giving you three examples. In
    1999 a scientist from the University of Pennsylvania with NIH
    support looked at aminoglycosides to suppress premature stop
    codons. Premature stop codons in a genetic sentence could be
    interpreted as a period in the middle of a genetic sentence,
    creating the loss of a significant protein. These
    aminoglycosides are found to suppress a premature stop.
        This particular scientist went to industry and, again with
    his own NIH support, began high throughput screens. Today we
    have a drug in trial called PTC-124. This drug has implications
    for all genetic diseases in terms of a subset of the population
    with premature stops. It is currently in trial and
    demonstrating pharmacological activity in cystic fibrosis and
    in Duchenne muscular dystrophy we do not have the data. But
    this drug has sweeping potential results across the rare
    genetic disease community.
        In 2000 a scientist from Johns Hopkins University looked at
    muscle regulators and found that inhibiting myostatin would
    improve the bulk of the muscle and potentially the strength.
    This drug is currently in trial in muscular dystrophies FSH,
    Becker, and myotonic.
        In the year 2001, the Bowman-Burke inhibitor compound was
    looked at. It is a protease inhibitor that can slow or halt
    muscle degeneration in muscular dystrophy. It had been in trial
    in the National Cancer Institute and was halted, not because of
    any risk to the patient, but primarily due to lack of material.
    This drug is now going into trial through NIH funding in
    muscular dystrophy in January.

                               PREPARED STATEMENT

        It is these cures, potential treatments for all of us, that
    make such a difference in our lives. We ask you to commit to
    NIH funding to supply that NIH, that research enterprise, with
    the funding it needs to help all of us, to give us time with
    the people we love, and to help not only the American people
    but people across the world.
        Thank you.
        [The statement follows:]
                       Prepared Statement of Pat Furlong
        Good morning/afternoon Mr. Chairman and Members of the Committee,
    and thank you for this opportunity to testify on the NIH budget.
        My name is Pat Furlong, Co-Founder and CEO of Parent Project
    Muscular Dystrophy and the mother of two sons who battled Duchenne
    Muscular Dystrophy.
        Thanks to the significant amount of basic research funded by NIH in
    recent years, we are making encouraging progress in our quest to
    develop effective treatments for this always-fatal disease. Right now,
    we are in a Phase II clinical trial on a promising drug for a subset of
    patients with Duchenne muscular dystrophy, and potentially a subset of
    patients with many other genetic conditions.
        It's basic NIH-funded research that served as a foundation and
    provided the spark for this drug, and many other promising therapies
    that are in the works. Without adequate NIH funding to support basic
    research, the medical research tower will rise much lower before
    eventually buckling due to the tremendous strain placed on too few
    resources.
        We are particularly concerned about the negative impact the budget
    crunch will have on young investigators seeking to enter the field of
    Duchenne MD research. The budget limitations we have seen over the past
    few years have made it tremendously more difficult for young, first-
    time investigators with meritorious submissions to secure an R01 grant.
        I urge your panel and the entire Senate to continue to lead the way
    in restoring critically needed dollars to support basic NIH research.

        Senator Specter. Thank you very much, Ms. Furlong.
        We now turn to Dr. Sam Gandy, representing the Alzheimer's
    Association.
    STATEMENT OF SAM GANDY, M.D., Ph.D., CHAIR, MEDICAL AND
                SCIENTIFIC ADVISORY COUNCIL, ALZHEIMER'S
                ASSOCIATION
        Dr. Gandy. Mr. Chairman, members of the subcommittee: As a
    direct result of this subcommittee's leadership and foresight,
    scientists supported by the NIH have made enormous strides
    towards understanding Alzheimer's, a disease that affects 4.5
    million Americans today and will affect as many as 16 million
    in a few decades.
        For the first time in the history of medicine, we have
    Alzheimer's genes in hand and we can now contemplate rational
    therapy for Alzheimer's. With adequate resources, scientists
    will be able to develop medications that modify Alzheimer's
    pathology in as few as 3 years. Achieving that goal will
    relieve a major bottleneck and attract every major
    pharmaceutical company to begin bringing new drugs into human
    clinical trials.
        The current trajectory of NIH cuts threatens to arrest
    progress and devastate the upcoming generation of scientists.
    Current grants are now routinely cut by 18 percent. In my
    institution this is already causing layoffs and I see my
    students turning away from research careers. Budget cuts also
    mean that some of the most promising drug targets will go
    unstudied. An important new molecule was discovered just last
    month. Where will we find the resources to study its potential
    therapeutic value?

                               PREPARED STATEMENT

        The inescapable conclusion is that Federal budget cuts are
    killing more than programs. These cuts are killing the minds of
    millions of Americans. The threat of Alzheimer's is staggering
    in its scope. I urge you and your colleagues to act now to
    reverse the disastrous path upon which we find ourselves.
        Thank you very much for providing me with this opportunity
    to testify.
        [The statement follows:]
                        Prepared Statement of Sam Gandy
        Mr. Chairman and members of the Subcommittee, I appreciate the
    opportunity to be here to discuss Alzheimer's disease, a disease that,
    as we speak today, is robbing 4.5 million Americans of their abilities
    to form memories and thoughts. The disease will ultimately take the
    life of every one of these 4.5 million. Within a few decades, as many
    as 16 million Americans will have Alzheimer's, all of whom will
    eventually succumb to the disease, unless we all, together, take up the
    fight toward a cure or means of prevention.
        As a direct result of the leadership and foresight of this
    Subcommittee, the National Institutes of Health have played essential
    roles in developing and maintaining a cadre of American scientists such
    as myself who have made enormous strides toward understanding
    Alzheimer's and, for the first time in the history of medicine,
    contemplating rational interventions aimed at the underlying disease
    process We now know that Alzheimer's is a disease and not an inevitable
    consequence of aging. We have identified several key genetic mistakes
    that are so malignant that one single mistake in the DNA is sufficient
    to cause the complete picture of Alzheimer's. These DNA mistakes have
    been both necessary and sufficient to supply us with essential
    information that has eluded scientists for the century since Alois
    Alzheimer presented his landmark paper in Munich in 1906. For the first
    time in the history of medicine, we are now able mimic the earliest
    steps in the disease using chemicals, cells, or, most valuably, the
    lowly laboratory mouse. Human Alzheimer genes have enabled us not only
    to create in the laboratory a living brain with Alzheimer's, but,
    astoundingly, we are also now able to cure experimental Alzheimer's in
    the laboratory. These experimental therapies are now entering human
    trials so that we might translate these experimental cures into
    practical medicines for humans.
        To date, four drugs have been approved for treating the symptoms of
    Alzheimer's, but these drugs only help a few patients, and even then,
    only modestly and temporarily. Current Alzheimer drugs leave the basic
    underlying disease untouched and the natural progression from amnesia
    to death proceeds along the standard, predictable, inevitable, and
    cruel path that we know all too well. Yet, from the laboratory, for the
    first time, scientists and physicians see genuine, tangible,
    quantifiable hope. Most experts agree that with adequate resources,
    scientists will be able to develop medications that will modify
    Alzheimer's pathology within the next three years. If the prevailing
    wisdom about the root cause of the disease is validated, a major
    bottleneck will be relieved, and every major pharmaceutical company
    will begin bringing new drugs into human clinical trials.
        But that can only happen if you and your colleagues sustain the
    Alzheimer research enterprise. Alzheimer's drug development will
    certainly be stymied if Congress adopts the President's proposal, where
    for the fourth consecutive year the NIH budget fails to even keep pace
    with inflation.
        The NIH doubling process is directly responsible for the progress
    of Alzheimer's research as a field of study: the field has moved from a
    backwater of obscurity into perhaps the single most visible, most
    competitive, and most exciting research field in experimental
    neurology. Within three years after this Subcommittee first
    appropriated funds for Alzheimer's, the number of scientists drawn into
    this field of study increased three-fold. But because of budget cuts
    over the past three years we are already seeing talented scientists
    turning to other fields.
        The current trajectory of cuts threatens to devastate the upcoming
    generation of scientists. NIH funding of the scientists who populate
    the faculties of our universities is not simply used to buy test tubes
    and chemicals: those funds directly pay the salaries of scientists on
    these faculties. Draconian cuts will render these scientists and
    professors unemployable. And with the loss of this talent, we are
    postponing the day that we can eradicate this deadly disease.
        But perhaps most importantly, persistent budget cuts are shutting
    out opportunities to find ways to cure or prevent Alzheimer's disease.
    In 1998, NIH was funding 30 percent of top-rated grant applications.
    Today, the percentage of Alzheimer projects that actually receive
    funding is down to 18 percent. Some institutes are struggling to
    maintain 10 percent funding. This means that most scientific
    opportunities are being left on the table. It also means that some of
    the most promising clinical trials--the tools we need to translate
    basic research findings into effective clinical treatments--will be
    delayed or scrapped altogether. The inescapable conclusion, for me, at
    least, is that federal budget cuts are killing more than programs; they
    are killing the minds of millions of Americans.
        Mr. Chairman and Senator Harkin, I am certain that you both realize
    that we cannot be a strong nation unless we are a healthy nation. In
    fiscal year 2007, spending on all Medicare beneficiaries benefits will
    total $449.2 billion. Unless we find a way to prevent or cure
    Alzheimer's disease, in less than 25 years, the care of Medicare
    beneficiaries that is attributed to Alzheimer's alone will cost over
    $400 billion, roughly equivalent to today's entire Medicare budget. The
    threat is so enormous that the temptation is to just give in to
    nihilism and cynicism. I urge you and your colleagues to join us in
    resisting this temptation and act now to reverse the disastrous path
    upon which we find ourselves.
        Thank you for the opportunity to testify.

        Senator Specter. Thank you. Thank you, Dr. Gandy.
        Our next witness is Ms. Ann Gibbons, representing Autism
    Speaks.
    STATEMENT OF ANN GIBBONS, MEMBER, BOARD OF DIRECTORS,
                AUTISM SPEAKS
        Ms. Gibbons. I am the mother of a 17-year-old boy with
    autism and I am a member of the board of directors of Autism
    Speaks, and I am here to speak for those who cannot.
        Autism is our Nation's fastest growing developmental
    disorder, affecting 1 in 166 children, up more than tenfold
    from a decade ago and costing our Nation approximately $35
    billion annually. Autism has no known cause, no known cure, and
    few effective treatments. The incidence of autism has increased
    at epidemic proportions, but NIH funding for autism research
    has been frozen over the past 2 years and will remain so in the
    President's 2007 budget.
        Specifically, the first lost opportunity is developing new
    treatment standards for autism. This would support research on
    new or existing early interventions to establish common methods
    of verifiably effective treatment. Early intervention provides
    children with the best possible opportunity to develop in the
    most normal way possible, but not with the President's budget,
    where this critical research will not be funded.
        Another lost opportunity is defining the core features of
    autism, when it begins, its long-term course, and subtypes of
    the disorder that may exist on the autism spectrum.
    Understanding the common features of autism will lead to
    identification of its causes, both genetic and environmental,
    and identify better treatments or even prevention of the
    disease. The President's proposed budget will not fund this
    research.

                               PREPARED STATEMENT

        The incidence of autism will continue to grow, but funding
    for autism research will not. With the President's budget,
    opportunities will be lost, but the pain and suffering of
    autistic children and their families will continue to grow, as
    will the cost to society.
        I just want to thank you all for what you are doing for
    biomedical research.
        [The statement follows:]
                       Prepared Statement of Ann Gibbons
        Mr. Chairman, I am Ann Gibbons, a resident of Bethesda, Maryland, a
    member of the Board of Autism Speaks, and the mother of a 17-year-old
    son with autism.
        Autism Speaks was launched to help find a cure for autism by
    raising the funds to facilitate and quicken the pace of research, to
    raise public awareness of autism, and to give hope to all those who
    suffer from this disorder. Autism Speaks' goal is to give a voice to an
    entire community, to every family dealing with the hardships of autism.
    With its mergers with the National Alliance for Autism Research and the
    Autism Coalition for Research and Education, Autism Speaks now
    represents our nation's largest autism advocacy organization.
        In both of my roles, in my public capacity as an Autism Speaks
    board member and in my private role as a mother of an autistic child, I
    commend you, Mr. Chairman, for your leadership in promoting funding for
    biomedical research and support you in your efforts to secure increased
    funding for the National Institutes of Health this year.
        Funding for understanding the causes of and finding treatments for
    autism is sorely needed. Autism is our nation's fastest-growing
    developmental disorder, now affecting 1 in 166 children in the United
    States, up more than tenfold from just a decade ago. A Harvard School
    of Public Health professor, in a recent book, estimates that it can
    cost $3.2 million to care for an autistic person over the course of his
    or her lifetime, and by conservative estimates autism costs our society
    $35 billion annually in direct and indirect costs.
        Autism has no known cause, no known cure, and few effective
    treatments. And while NIH funding for autism may have tripled in the
    past decade to $100 million, that amount pales in comparison to the
    money spent for research on other diseases and disorders that affect
    fewer individuals.
        Autism research is poised at a turning point. While diagnoses are
    skyrocketing at epidemic rates, many areas of autism research stand on
    the verge of important findings. If adequately funded, this research
    could yield real progress on the diagnosis, treatment and cure for this
    disorder. The President's proposed freeze on NIH funding falls short on
    all counts, and would seriously impede the progress and promise of
    autism research.
        One turning point is the development of new treatment standards for
    autism spectrum disorder. This program would support research on new or
    existing interventions with the goals of establishing common methods of
    treatment and measurements of treatment efficacy. This study could
    hasten the ability to use existing treatments early to improve outcomes
    for children and families struggling with the disability of autism
    spectrum disorders. When autistic children do receive evidence-based
    early intervention service between ages 3 and 5, from 20 to 50 percent
    of them are able to go onto mainstream kindergarten. Early intervention
    is critical in order to provide children with autism the optimum
    opportunity to develop in the most normal way possible.
        Unfortunately, Mr. Chairman, the President's proposed budget for
    fiscal year 2007 will freeze funding for autism, and research leading
    to advances in autism intervention will not be possible.
        Another turning point is the need to define core features of
    autism, including when it begins, its long-term course, and subtypes of
    the disorder that may exist on what is known as the autism spectrum.
        Defining the features of autism could lead toward the long-term
    goal of finding genetic and non-genetic causes of autism and offering
    the possibility of providing better treatments or even prevention of
    the disease. It's also urgent that we better understand the genetic
    associations with autism so that research into the interaction of genes
    with the environment can be understood.
        With the budget proposed by President, this research will not be
    funded, and these advances cannot be made.
        With the President's budget, progress in understanding brain
    development and autism, one of the most devastating disorders affecting
    hundreds of thousands of children, will be slowed or halted. Scientists
    will be unable to realize the full potential of the latest scientific
    techniques, in neuroimaging and genetics technology.
        Mr. Chairman, autism, which the Centers for Disease Control and
    Prevention estimates now affects 300,000 American children between ages
    4 and 17, will continue to grow, with 3 children now being diagnosed
    ever hour. The pain and suffering of autistic children and their
    families will continue, as will the costs to society. But research on
    this devastating disorder will be stymied, progress on potential
    treatments and cures will be stymied as a result of the President
    proposed freeze on spending for biomedical research and on research on
    autism.
        Moreover, we will lose the opportunity to save an entire generation
    of children from this devastating disorder, which can lock people in
    their own worlds, unable to communicate with, and sometimes unable to
    experience the affection of those who love them.
        Mr. Chairman, thank you for giving me the opportunity to speak for
    those with autism and their families.

        Senator Specter. Thank you. Thank you very much, Ms.
    Gibbons.
        Our next witness is Dr. Robert Goldstein, representing the
    Juvenile Diabetes Research Foundation.
    STATEMENT OF ROBERT GOLDSTEIN, M.D., Ph.D., CHIEF
                SCIENTIFIC OFFICER, JUVENILE DIABETES
                RESEARCH FOUNDATION
        Dr. Goldstein. Thank you, Senators Specter, Harkin, and
    Shelby for this opportunity to testify. I am Robert Goldstein,
    the chief scientific officer for the Juvenile Diabetes Research
    Foundation.
        Without an increase in Federal funding for diabetes
    research, there will be a disproportionate impact on clinical
    translation research. Islet cell transplantation, a procedure
    that has been successfully done experimentally in nearly 600
    diabetes patients, will delay the--the NIH-sponsored clinical
    trials to expand this proven treatment out into the community
    will be seriously delayed.
        In the area of hypoglycemia, dangerously low blood sugar
    can lead to convulsions, coma, or even death. The Diabetes
    Research and Children's Network's efforts to assess new glucose
    monitoring technology will impact on the management of type 1
    diabetes in children.
        Diabetic retinopathy. Anti-angiogenesis drugs that can
    reverse diabetic retinopathy have been discovered, but clinical
    trials to extend and expand these findings to test new classes
    of drugs would be delayed or halted.
        Treatment of new onset of type 1 diabetes. Clinical trials
    using monoclonal antibodies have shown that insulin-secreting
    cells can be protected for up to 2 years. Support studies to
    determine how to prolong this effect, whether treatment prior
    to the onset can prevent diabetes, and whether these therapies
    can be given years after onset would be delayed or curtailed.
    Since type 1 diabetes is an autoimmune disease, this will
    impact understanding of other autoimmune diseases.

                               PREPARED STATEMENT

        Causes of type 1 diabetes. NIH-supported efforts to
    identify the genes responsible for susceptibility will be
    curtailed and delay our ability to effectively prevent disease
    in at-risk populations.
        Thank you for the opportunity to testify.
        [The statement follows:]
                     Prepared Statement of Robert Goldstein
        Chairman Specter, Ranking Member Harkin and Members of the
    Subcommittee, thank you for the opportunity to testify before you today
    regarding the many opportunities that will be lost without an increase
    in federal funding for diabetes research at the National Institutes of
    Health. I am Robert Goldstein, the Chief Scientific Officer for the
    Juvenile Diabetes Research Foundation International.
        In the past 25 years, the number of people with diabetes has more
    than doubled, so that today approximately 20.8 million Americans have
    diabetes. Evidence suggests that 1 in 3 Americans born in 2000 will
    develop diabetes during his or her lifetime. Diabetes is the 6th
    leading cause of death in the United States. The disease cost this
    country $132 billion in 2002, which is almost 5 times NIH's annual
    budget. Only research to better prevent, treat and cure diabetes will
    significantly impact these numbers.
        The Diabetes Research Working Group recommended $1.6 billion in
    fiscal year 2004--the last year of their study--to take advantage of
    the many diabetes research opportunities. We have used appropriations
    to build critical momentum for accelerating the delivery of therapies
    to people with diabetes. There have been major advances (see attached)
    and more importantly programs have been put in place that will insure
    continued advances. Yet funding today is $600 million short of this
    recommendation. Absent an increase in federal funding, this momentum
    will be lost and progress and solutions will be delayed. Specifically,
    the following areas of diabetes research will be seriously impacted:
        Islet Cell Transplantation.--Nearly 600 diabetes patients worldwide
    have now received islet transplants, and enough patients have been
    transplanted that long-term benefits can be documented. Islet cell
    transplants have resulted in significant benefits to people with very
    complicated forms of type 1 diabetes: for instance, at least half of
    the transplant recipients exhibit stabilization or reversal of their
    diabetic eye and nerve diseases. Overall, islet transplant patients
    report a significant improvement in their quality of life. However,
    challenges remain, and we need additional funding for NIH programs and
    NIH/CMS sponsored clinical trials to test new protocols and fully
    understand how to maximize this proven treatment so it is an
    appropriate therapy for all who suffer from type 1 diabetes.
        Hypoglycemia.--Hypoglycemia--episodes of dangerously low blood
    sugar--is the most feared acute complication of diabetes and can lead
    to shaking, convulsions, coma, or even death in extreme cases. Young
    diabetic children who may not be able to recognize or communicate the
    signs of impending hypoglycemia are especially vulnerable. Technologies
    coming onto the market in the near term have the ability to warn
    patients of hypoglycemia, and it is critical that the technology is
    suitable for use in children. The NIH has established the Diabetes
    Research in Children Network (DirecNet) to provide independent
    assessments of glucose monitoring technology and its impact on the
    management of type 1 diabetes in children, and this important work
    would be delayed without additional funds.
        Diabetic Retinopathy.--Diabetes is the leading cause of new
    blindness in working age adults; more than 8.5 million people in the
    United States have diabetic retinopathy or eye disease. Significant
    progress being made on the causes and pathogenesis of diabetic
    retinopathy is generating renewed hope for the prevention or reversal
    of eye disease. For the very first time anti-angiogenesis drugs that
    can actually reverse diabetic retinopathy, as opposed to simply halting
    further progression by means of laser treatment, have been discovered.
    The NIH-supported Diabetes Retinopathy Clinical Research Network
    (DRCR.Net) includes more than 150 collaborating physicians across the
    United States, and provides an organized platform for rapidly
    translating new therapeutic ideas from the research community into
    clinical testing in human patients. Clinical trials to test the
    pipeline of potential new drugs would be delayed, curtailed or halted
    without continued funding.
        Treatment of New Onset Type 1 diabetes.--By the time type 1
    diabetes is diagnosed, patients have already suffered a devastating
    autoimmune attack that has destroyed most of the insulin-producing beta
    cells of the pancreas. Research has shown that a patient's level of
    residual beta cell activity correlates with the ability to more easily
    maintain glucose levels close to normal and reduces the amount of
    insulin that must be injected. A prime research goal is to develop new
    therapies that will help newly diagnosed type 1 diabetes patients
    preserve remaining beta cells and possibly even dampen the immune
    system enough to allow the pancreas to regenerate new beta cells.
    Researchers have identified a drug that can effectively alter the
    clinical course of the disease. A short 1-2 week course of treatment
    with an antibody--named anti-CD3--helps patients maintain or increase
    their ability to produce insulin naturally for up to 18 months after
    diagnosis compared to a placebo. This treatment demonstrates the proof
    of principle that the clinical source of an established autoimmune
    disease can be significantly altered. This work could not have been
    done without the major advances in clinical trial platforms from
    several NIH sponsored programs, including:
      --Immune Tolerance Network, whose goals are to develop new therapies
            to treat/prevent autoimmune disease and to prevent or treat
            graft rejection in transplantation by inducing immune
            tolerance. Among the diseases under investigation by this
            collaborative effort include type 1 diabetes and islet
            transplantation; and
      --TRIAL NET which also supports studies aimed at both preventing
            further destruction of insulin secreting cells in new onset
            type 1 diabetes, as well as developing the means to prevent
            disease.
        More extensive studies to determine how long this effect can be
    maintained, and whether the addition of specific antigen therapy or
    other drugs can prolong this effect, will not occur without continued
    support. Similarly, large studies to determine whether early treatment
    prior to disease onset can prevent diabetes or whether these therapies
    can be given years after disease should be supported.
        Genetics and Environmental Causes of Type 1 Diabetes.--The best way
    to attack type 1 diabetes is to stop it before it ever starts, but this
    requires sophisticated knowledge of the underlying causes of disease.
    Ground breaking NIH efforts (T1DGC, TEDDY, TRIGR) to identify the genes
    responsible for susceptibility to type 1 diabetes coupled with the
    identification of environmental triggers (viruses, toxins, dietary
    factors) will be curtailed or abandoned without continued funding, and
    delay our ability to effectively prevent disease in at-risk
    populations.
        Diabetes research has demonstrated a strong return on the federal
    investment. Continued strong federal commitment is needed.
        Thank you again for the opportunity to appear before you today. I
    am happy to answer any questions you may have.
        NIH and Diabetes Research--A Strong Return on Federal Investment
        Diabetes affects more than 20 million adults and children in the
    United States, up to 7 percent of the population. In 2001,
    approximately $3.8 billion was spent on inpatient care for diabetes;
    two-thirds of those costs could have been saved with appropriate
    primary care for complications. A 2002 study estimated that diabetes--
    both type 1 and type 2--caused the U.S. economy $132 billion in direct
    medical costs and indirect costs such as disability, work loss, and
    premature mortality. The disease accounts for more than 30 percent of
    Medicare expenditures. Total diabetes costs are predicted to climb to
    as much as $192 billion per year by 2020.
        Beyond the economic impact is the personal toll that diabetes
    exacts. Individuals with diabetes have twice the prevalence of
    disability as persons without diabetes. In 2002, more than 176,000
    cases of permanent disability were attributed to diabetes at an
    estimated cost of $7.5 billion. That same year diabetes accounted for
    88 million disability days. Persons with diabetes are at greater risk
    for stroke, heart attack, blindness, kidney failure, limb amputation,
    nerve damage, severe dental disease, and complications of pregnancy.
    Type 1 diabetes can reduce a person's expected lifespan by as much as
    15 years.
        The Diabetes Control and Complications Trial (DCCT), a clinical
    trial of 1,441 people with type 1 diabetes, demonstrated that tight
    control of blood glucose through intensive insulin therapy could
    significantly reduce or delay many diabetic complications. This
    landmark finding spurred a shift in the daily management of type 1
    diabetes and energized research in the field. In 1996, at the
    conclusion of the DCCT, it was estimated that implementation of
    intensive insulin management in the entire U.S. diabetic population
    would save 920,000 years of sight, 691,000 years free from end stage
    kidney disease, 678,000 years free from amputation, and 611,000 years
    of life.
        Since the discovery of insulin more than 80 years ago, biomedical
    research has continued to improve the health and lives of diabetes
    patients. The research listed below demonstrates that the field of
    juvenile diabetes research is making advances worthy of a continued
    strong federal investment.
      --Advances in Islet Cell Transplantation.--Since 1999, almost 600
            diabetes patients worldwide have received islet transplants,
            and enough patients have been transplanted that long-term
            benefits are beginning to emerge. This procedure involves
            isolating the insulin-producing cells, called islet cells, from
            a donor pancreas, and injecting them into an adult who has
            juvenile diabetes. Islet cell transplants have resulted in
            significant benefits to people with very complicated forms of
            type 1 diabetes: for example, at least half of patients exhibit
            stabilization or reversal of their diabetic eye and nerve
            diseases. Overall, islet transplant patients report a
            significant improvement in their quality of life. Unfortunately
            this procedure cannot be used in children because the
            medications that need to be taken to prevent the body from
            rejecting these donated cells can have many side effects.
            Researchers are working to improve this procedure and to
            develop new techniques so that one day the procedure can be
            suitable for children with juvenile diabetes.
      --Treatment in new Onset Type 1 Diabetes.--Researchers have
            identified a drug, a monoclonal antibody, that can effectively
            alter the clinical course of type 1 diabetes: a short 1-2 week
            course of treatment with the antibody--named anti-CD3--helps
            patients maintain or increase their ability to produce insulin
            naturally for up to 18 months after diagnosis compared to a
            placebo. Treated patients required reduced insulin dosage, and
            better hemoglobin A1c levels. A larger phase II trial of this
            procedure is underway. These findings are significant because
            residual beta cell activity correlates with the ability to more
            easily maintain glucose levels close to normal, and to prevent
            the development of the devastating complications of diabetes.
            Anti-CD3 is at the leading edge of a robust pipeline of
            potential therapies for reversing new onset type 1 diabetes.
            The Type 1 Diabetes TrialNet was established in 2001 to ``fast
            track'' potential diabetes therapies into clinical trials.
      --Advances in Preventing Hypoglycemia.--Significant advances in
            glucose monitoring technology help patients to determine
            whether their blood sugars are falling (signaling the need to
            eat to avoid hypoglycemia) or rising (indicating the need for
            an insulin dose). Researchers have evidence that patients who
            use continuous glucose monitoring systems spend more time in
            the normal glucose range; a critical finding because short term
            variability in glucose levels may be as important as overall,
            long-term glucose control in predicting the risk of
            complications. In 2005, an NIH-funded study validated that
            newer-generation home blood glucose meters demonstrated a high
            degree of accuracy over a broad range of glucose concentrations
            in children with type 1 diabetes. The study was conducted by
            Diabetes Research in Children Network (DirecNet), a network of
            clinical centers that provides an independent assessment of
            glucose monitoring technology and its impact on the management
            of type 1 diabetes in children. DirecNet is now testing the new
            continuous glucose monitors, which will be the next wave in
            diabetes care and represent an essential step toward an
            artificial pancreas.
      --Reversing of Diabetic Retinopathy.--Diabetes is the leading cause
            of new blindness in working age adults. Laser treatment can
            reduce the risk of severe vision loss by 20 to 50 percent and
            saves up to $1.6 billion per year by preventing or treating
            diabetic eye disease. New research has discovered anti-
            angiogenesis drugs that can actually reverse diabetic
            retinopathy, as opposed to simply halting further progression
            by means of laser treatment. These and other new classes of
            drugs make up a pipeline that must be tested in clinical
            trials.
      --Preventing Cardiovascular Disease.--Adults with diabetes are two to
            four times more likely to have a stroke or to die from heart
            disease than adults without diabetes. Indeed, heart disease or
            stroke is the leading cause of death among patients with
            diabetes, accounting for 65 percent of deaths in this
            population. Blood pressure control reduces the risk of heart
            attack and stroke by 33 to 50 percent and the risk of other
            complications by as much as 33 percent. Nevertheless,
            additional research is necessary to understand the factors that
            contribute to increased cardiovascular risk. New findings to
            design new diagnostic tools that predict or detect the early
            onset of cardiovascular disease, develop new drugs or devices
            to reverse cardiovascular damage due to diabetes, and
            clinically test new therapies in large, randomized trials.
      --Slowing Onset and Progression of Kidney Disease.--Diabetes is the
            leading cause of kidney failure in the United States,
            accounting for 44 percent of new cases in 2002. Based on NIH-
            funded research, scientists have made great progress in
            developing methods that slow the onset and progression of
            kidney disease in people with diabetes. Drugs used to lower
            blood pressure (antihypertensive drugs) can slow the
            progression of kidney disease significantly. Two types of
            drugs, angiotensin-converting enzyme (ACE) inhibitors and
            angiotensin receptor blockers (ARBs), have proven effective in
            slowing the progression of kidney disease. Drugs that lower
            blood pressure, including ACE inhibitors or angiotensin
            receptor blockers (ARBs), decrease the onset of kidney disease
            by 30 to 70 percent.
      --Gaining an Understanding of Kidney Disease Susceptibility.--Some
            diabetic patients seem to be particularly susceptible to
            developing diabetic nephropathy, while others show no signs of
            kidney damage even after many years of living with diabetes.
            Researchers are actively investigating the genetic factors that
            influence an individual's susceptibility or resistance to
            diabetic nephropathy. The Genetics of Kidneys in Diabetes
            (GoKinD) Study has gathered more than 2,600 participants for
            the study of the genetic risk factors for type 1 diabetes and
            diabetic kidney disease. This sample and data collection will
            provide a resource to facilitate investigator-driven research
            into the genetic basis of diabetic kidney disease. Furthermore,
            GoKinD participants form the core of a population registry that
            could be recruited for future clinical trials.
      --Reducing Incidence of Diabetic Neuropathy.--Two-thirds of all
            diabetes patients suffer from some degree of nerve damage
            affecting organs throughout the body. This condition--known as
            diabetic neuropathy--results in loss of sensation, weakness, or
            pain in hands or feet, carpal tunnel syndrome, pain in the eyes
            or face, pain in the chest or abdomen, profuse sweating, loss
            of balance or coordination, slowed digestion of food or related
            gastrointestinal problems, urinary incontinence, erectile
            dysfunction, and a variety of other nerve problems. The
            inability to feel pain coupled with impaired wound healing
            often leads to non-healing foot ulcers and, ultimately,
            amputation of some part of the foot or leg. For this reason,
            diabetic neuropathy is the most common cause of non-traumatic
            lower limb amputation. Comprehensive foot care programs to
            detect and treat skin ulcers before they progress can reduce
            the rate of amputation by 45 to 85 percent.
      --Understanding Susceptibility to Disease.--The Type 1 Diabetes
            Genetics Consortium (T1DGC) will identify the genes responsible
            for susceptibility to type 1 diabetes, leading to a better
            understanding of pathways to disease. Researchers recently
            confirmed the discovery of a new gene that contributes to
            susceptibility to disease. The pathway controlled by this gene
            implicates it in other autoimmune diseases, not just type 1
            diabetes, underlining that common pathways may be involved in
            the development of autoimmunity. This understanding may lead to
            better diagnosis and new therapies to stop diabetes before it
            ever starts.
      --Identifying Environmental Causes of Type 1.--The Triggers and
            Environmental Determinants of Diabetes in Youth (TEDDY) study
            has screened more than 6,000 newborns to identify the
            environmental causes of type 1 diabetes in genetically
            susceptible individuals. Once completed, the TEDDY study will
            have amassed the largest data set and samples on newborns at
            risk autoimmunity and type 1 diabetes anywhere in the world.
      --Investigating Vaccine to Prevent Type 1.--Recent studies in animal
            models have raised the possibility that a ``vaccine'' may be
            able to prevent type 1 diabetes.
      --Monitoring Progression of Type 1 Onset.--Researchers have developed
            a means to non-invasively monitor the start and progression of
            insulitis, the inflammation of insulin producing cells, in
            mice, which may allow researchers to prediction whether and
            when individual people will develop type 1 diabetes in the
            future.
      --Regenerating of Insulin Producing Cells.--Replacement of the lost
            beta cells through either transplantation of islets from an
            external source or regeneration of islets within a patient's
            own pancreas is required to restore physiological control of
            glucose and cure type 1 diabetes. Development of regenerative
            treatments to restore beta cells without transplantation will
            require researchers to understand how beta cells are normally
            formed in the adult pancreas, and then use that information to
            identify molecular targets for drugs that can induce that
            process in diabetic patients. Researchers supported by the NIH
            Beta Cell Biology Consortium are now uncovering multiple
            pathways by which new beta cells are formed in the body. The
            work should help clarify how pancreatic beta cells develop, and
            it could potentially lead to successful treatments for both
            type 1 and type 2 diabetes.
      --Identifying Animal Models for Complication Studies.--The Animal
            Models of Diabetic Complications Consortium (AMDCC) has
            identified more than 70 animal models for the study of diabetic
            complications, including a number of promising models for type
            1 diabetic cardiomyopathy, nephropathy and neuropathy.

        Senator Specter. Thank you, Dr. Goldstein.
        We now turn to Dr. Lawrence Holzman, representing the
    NephCure Foundation.
    STATEMENT OF LAWRENCE B. HOLZMAN, M.D., CHAIRMAN,
                SCIENTIFIC ADVISORY BOARD, NEPHCURE
                FOUNDATION
        Dr. Holzman. Mr. Chairman and members of the subcommittee:
    Despite advances in dialysis and kidney transplantation, kidney
    failure remains a devastating diagnosis, carrying a survival
    prognosis similar to patients diagnosed with cancer and
    assuring a lifetime of severe medical complications.
        NIH-sponsored investigators have been really remarkably
    successful in advancing our understanding of kidney disease,
    with the goal of preserving and preventing kidney functional
    loss. For example, a recent revolution in our knowledge of the
    biology of the kidney filter has allowed the identification of
    several inherited diseases and promises to provide tools that
    will better allow us to diagnose and treat kidney failure in
    general.
        However, cutting the NIH budget for kidney disease research
    or even failing to keep up with inflationary costs threatens
    present research momentum. As an investigator and as a member
    of an NIH peer review committee that evaluates scientific
    proposals, I can assure you that the effects of a restricted
    NIH budget are already being felt. Threatened by a pay line at
    which only 12 percent of grant applications are funded,
    investigators are reluctant to take risks necessary to
    dramatically advance the field. Delays in funding outstanding
    proposals retard progress and result in loss of uniquely
    trained research personnel.

                               PREPARED STATEMENT

        Finally, despite NIH set-asides designed to protect junior
    investigators, our next generation of talented young people
    observe the anxiety created by funding uncertainty, make
    rational economic decisions, and turn away from a career in
    biomedical science.
        Therefore, we ask you to provide an increase of 5 percent
    in fiscal year 2007 to the NIDDK and to the NIH budget overall.
        Thank you for your attention.
        [The statement follows:]
                     Prepared Statement of Lawrence Holzman
        Mr. Chairman, and members of the Subcommittee, thank you for giving
    me this opportunity to come before you today. I am Dr. Lawrence
    Holzman, Associate Professor of Internal Medicine and Director of the
    NIH-sponsored Nephrology Training Program at the University of Michigan
    Medical School. I also serve as Chairman of the Scientific Advisory
    Board of the NephCure Foundation (NCF), a non-profit organization
    dedicated to fighting idiopathic nephrotic syndrome and focal segmental
    glomerulosclerosis (FSGS).
        Fifteen million Americans have significantly impaired kidney
    function and are at risk of loosing their kidney function entirely.
    Another 400,000 have already lost their kidney function. Despite NIH-
    sponsored advances in dialysis and kidney transplantation, kidney
    failure--due to common diseases such as diabetic kidney disease or
    hypertension, or due to relatively rare diseases such as focal
    segmental glomerulosclerosis--remains a devastating diagnosis. Kidney
    failure carries a shortened survival similar to that of many cancers
    and assures a lifetime of severe medical complications. The American
    people spend nearly $20 billion per year to provide medical care for
    these individuals alone. Undeniably, there remains a critical need to
    prevent patients from losing kidney function.
        Recognizing this need, NIH-sponsored investigators have made great
    strides in the basic science and clinical science of kidney disease,
    progress that has begun to slow the incidence of kidney failure. For
    example, during the past decade, a revolution in our understanding of
    the biology of the kidney filter sparked by initial successes in
    molecular genetics has allowed the identification of several inherited
    diseases of the kidney filter and promises to provide tools that will
    much better guide diagnosis and treatment of the patients who are
    likely to lose their kidneys. Dramatic advances in our understanding of
    the biology of cystic diseases of the kidney such as polycystic kidney
    disease has led to promising clinical trials of medications that might
    slow or prevent these diseases. For those patients that have already
    lost their native kidneys to disease, NIH-sponsored research has
    improved our understanding of the immune system, providing hope for
    kidney transplant patients who suffer the dangerous side effects of
    present day anti-rejection medications and who suffer from the
    knowledge that the average kidney transplant lasts only 11 years.
    Moreover, dialysis patients have improved quality of life because NIH
    sponsored clinical research has taught nephrologists how to better care
    for their patients.
        Cutting the NIH-budget for kidney disease research, or even failing
    to keep up with the inflation in costs for doing this research,
    immediately threatens the research momentum that was attained by
    doubling the NIH budget. As an independent investigator, and as member
    of an NIH peer review committee that evaluates independent-investigator
    initiated scientific proposals, I can assure you that the affects of a
    restricted NIH budget are already being felt in a real but difficult to
    quantify fashion. Threatened by a ``pay line'' at which only 12-14
    percent of grant applications are funded (rather than 24 percent just
    three years ago), investigators have become reluctant to take risks
    that must be taken in their research that would dramatically advance a
    field. Delays in funding outstanding proposals (because they must be
    recycled through the application process several times before they are
    funded) retard progress and result in the loss of talented and uniquely
    trained research personnel that cannot be readily replaced. Finally,
    despite NIH set asides designed to protect junior investigators, our
    next generation of talented young people observe the anxiety created by
    funding uncertainty, make rationale economic decisions, and turn away
    from a career in biomedical science, leaving the future of this science
    in jeopardy.
        NIH sponsored biomedical research is an American treasure that
    reaps multifold benefits; it is a treasure that must be nurtured and
    protected. Therefore, we ask you to provide an increase of 5 percent in
    fiscal year 2007 for the National Institute of Diabetes, Digestive, and
    Kidney Diseases (NIDDK), and the NIH overall.
        Thank you.

        Senator Specter. Thank you, Dr. Holzman.
        Our final witness on the panel is Dr. Steven Houser,
    representing the American Heart Association.
    STATEMENT OF STEVEN R. HOUSER, Ph.D., DIRECTOR,
                CARDIOVASCULAR RESEARCH CENTER, TEMPLE
                UNIVERSITY SCHOOL OF MEDICINE ON BEHALF OF
                THE AMERICAN HEART ASSOCIATION
        Dr. Houser. Thank you, Senator Specter and Senators Harkin
    and Shelby. I am an American Heart Association volunteer for
    the last 30 years. My day job is at a cardiovascular research
    group at Temple University School of Medicine in North
    Philadelphia. My NIH-funded research focuses on how we can fix
    broken hearts so that people can live healthier, happier lives.
        Thanks to your investments, I believe we are on the
    threshold of making wonderful discoveries that can be
    translated into novel therapies. My lab group works on a very
    simple concept. We have found that in every one of your hearts
    there are stem cells that are making new myocites and blood
    vessels all the time. I believe that we have the opportunity to
    figure out ways to take these cells from each of your hearts,
    expand them, prime them to repair your heart, and save them in
    case you ever need them if your heart becomes damaged.

                               PREPARED STATEMENT

        Unfortunately, the NIH cuts are limiting my ability and the
    ability of my collaborators in Pennsylvania, Iowa, which I just
    visited last week, and Alabama, where I will visit in about a
    month, to pursue these ideas. It is forcing me to cut my staff,
    train fewer people, lay off local workers. I think this has
    impact not just on science and medicine, but on the economies
    of the communities and the States that we are charged to serve.
        So thank you so much for all your hard work with respect to
    these issues, and I would be happy to answer any questions.
        [The statement follows:]
                     Prepared Statement of Steven R. Houser

                           SUMMARY OF RECOMMENDATIONS
    ------------------------------------------------------------------------
                            Agency                               Amount
    ------------------------------------------------------------------------
    National Institutes of Health........................    $29,800,000,000
        National Institutes of Health Heart Research.....      2,200,000,000
        National Institutes of Health Stroke Research....        357,000,000
            National Heart, Lung, and Blood Institute....      3,100,000,000
            National Institute of Neurological Disorders       1,600,000,000
             and Stroke..................................
    Agency for Healthcare Research and Quality...........        440,000,000
    Centers for Disease Control and Prevention (plus           8,500,000,000
     funding for pandemic influenza preparedness)........
        Heart Disease and Stroke Prevention Program......         55,000,000
    Health Resources and Services Administration: Rural            8,900,000
     and Community Access to Emergency Devices Program...
    Department of Education: Carol M. White Physical             100,000,000
     Education Program...................................
    ------------------------------------------------------------------------

        An estimated 71 million American adults suffer from heart disease,
    stroke, and other forms of cardiovascular disease. Nearly 2,500
    Americans die of cardiovascular disease each day--an average of one
    death every 35 seconds. Heart disease and stroke remain the first and
    third leading causes of death, respectively, for both men and women in
    the United States today and more than half of men and nearly 40 percent
    of women will develop cardiovascular disease during their lifetime. As
    the baby boom generation ages, the prevalence of cardiovascular disease
    will increase dramatically, because although this disease can strike at
    any stage of life--the likelihood increases with age. Deaths from heart
    disease alone are projected to increase by about 130 percent between
    2000 and 2050, according to one report.
        Cardiovascular disease also costs Americans an estimated $403
    billion in medical expenses and lost productivity in 2006--more than
    any other disease and more than the projected budget deficit for that
    year. As the population ages, the combination of demographics and high
    costs will result in a cardiovascular disease crisis with staggering
    implications for health care costs and quality of care.
        Although progress has been made in the treatment of cardiovascular
    disease, there is no cure. In fact, studies suggest that increased
    rates of diabetes, obesity and other risk factors may reverse four
    decades of declining mortality. The most prudent way to address this
    looming crisis is to simultaneously invest in prevention and in the
    development of more cost-effective treatments. Regretfully, the funding
    levels proposed by the President undermine efforts in both of these
    areas.
        When adjusted for biomedical research inflation, the proposed NIH
    budget for cardiovascular disease research is estimated to be 15
    percent lower in 2007 than in fiscal year 2003. Funding levels proposed
    in the budget for the CDC's Heart Disease and Stroke Prevention Program
    remain flat at a time when only 14 states receive the resources
    necessary to implement prevention programs and strategies. In addition,
    the Rural and Community Access to Emergency Devices Program,
    administered by the Health Resources and Services Administration, is
    terminated in the President's budget. This program provides grants to
    rural areas and communities to purchase and place AEDs in schools,
    churches, fire stations, and other locations to save the lives of
    cardiac arrest victims.
        Now is the wrong time to reduce our nation's investment in programs
    that prevent and treat America's leading and most costly cause of
    death. Solving a problem of this magnitude will require a significant
    public investment in these fiscally challenging times, but if we fail
    to take aggressive and deliberate action now--we will pay a terrible
    cost later--both in terms of health care expenditures and human lives.
    The following recommendations from the American Heart Association
    address this problem in a comprehensive but fiscally responsible
    manner.
          increase funding for the national institutes of health (nih)
        NIH-sponsored research has revolutionized patient care and holds
    the key to an eventual cure for all forms of cardiovascular disease.
    Research funded by the NIH also fuels innovation that generates
    economic growth and preserves our nation's role as a world leader in
    the biomedical and biotechnology industries. For fiscal year 2006, NIH
    funding was cut below the previous year's level for the first time in
    35 years. The President preserved this cut in his fiscal year 2007
    budget and reduced NIH further over the next five years by nearly 20
    percent. This five year cut reduces NIH resources in inflation adjusted
    terms by more than one-third from its peak in fiscal year 2003--the end
    of the historical five-year doubling of the NIH budget.
        Recommendation.--The AHA joins the research and patient advocacy
    community in recommending an fiscal year 2007 appropriation of $29.8
    billion for the NIH. This level, which represents a 5 percent increase
    over 2006, covers the increased costs of biomedical research inflation
    and provides additional resources to investigate emerging research
    opportunities.
               increase funding for nih heart and stroke research
        From 1993-2003, death rates from cardiovascular diseases have
    fallen by 22 percent, death rates from coronary heart disease have
    declined by 30 percent, and death rates from stroke have fallen by 19
    percent. NIH sponsored heart and stroke research has improved health
    outcomes and in some cases, lowered health care costs. Examples of
    recent NIH-supported research follow.
        Aspirin Prevents Another Type of Stroke.--Aspirin is as effective
    as, and safer than, the blood thinning drug warfarin in preventing
    intracranial arterial stenosis--which accounts for roughly 10 percent
    of all strokes. Aspirin is a low cost therapy that does not require the
    intricate and costly monitoring like the drug warfarin. Researchers
    estimate that use of aspirin rather than warfarin could cut health care
    costs by $20 million each year.
        Blood Test to Screen for Stroke Wins FDA Approval.--A blood test to
    screen for heart disease gained approval to predict stroke risk. The
    test scans the blood for levels of the enzyme lipoprotein-associated
    phospholipase A2, which are higher in potential stroke victims.
        Diuretics Again Initial Therapy for High Blood Pressure.--
    Continuing analyses of the Antihypertensive and Lipid-Lowering
    Treatment to Prevent Heart Attack Trial (ALLHAT) for diabetics, blacks
    and non-blacks with high blood pressure confirms, the initial
    conclusion that diuretics should be the initial high blood pressure
    treatment instead of newer, more costly drugs.
        Antibiotics do not Prevent Second Cardiovascular Events.--Results
    of clinical trials have shown that antibiotics are ineffective in
    preventing second events like heart attack, unstable chest pain and
    stroke in patients with existing heart disease. This finding was
    unanticipated.
        Slightly Elevated Blood Pressure Triples Heart Attack Risk.--
    Examining data from the Framingham Heart Study, researchers found that
    the 59 million Americans with prehypertension, blood pressures ranging
    from 120-139 over 80-89 mm Hg, are three times more likely to suffer a
    heart attack and nearly twice as likely to experience heart disease
    than those with normal blood pressure. Scientists estimate that
    aggressive treatment would prevent 47 percent of heart attacks.
        Although cardiovascular disease is the leading cause of death in
    the United States, the NIH heart and stroke research budget remains
    disproportionately under-funded compared to the burden of these
    diseases on society. Cardiovascular disease meets NIH's priority
    setting criteria (public health needs, scientific quality of research,
    scientific progress potential, portfolio diversification and adequate
    infrastructure support), yet only 7 percent of the NIH budget is
    invested in heart research and a mere 1 percent is dedicated to stroke.
    Adjusted for medical research inflation, resources for cardiovascular
    research will decline 15 percent since fiscal year 2003 if the
    President's budget is enacted. These declining resources are
    insufficient to support and expand current activities and to invest in
    promising initiatives to aggressively advance the battle against heart
    disease and stroke. Additional funds would be used in the following
    areas:
        Atherosclerosis Prevention Trial Network.--Atherosclerosis is a
    major risk factor for heart disease and stroke. With increased funding,
    the National Heart, Lung, and Blood Institute (NHLBI) could initiate a
    clinical trial to determine whether reducing low-density lipoprotein
    cholesterol, so-called ``bad'' cholesterol, to a level lower than
    currently recommended, reduces major cardiovascular disease events in
    healthy patients at high risk of heart disease and or stroke.
        Systolic Blood Pressure Intervention Trial.--High blood pressure is
    a major risk factor for heart disease, heart failure and stroke. More
    funding would allow the NHLBI to conduct a multicenter clinical trial
    to determine whether reducing systolic blood pressure to a lower level
    than currently recommended could prevent heart attacks and strokes.
        Preventing Weight Gain in Young Adults.--Young adults are at a high
    risk for weight gain. With more resources, NHLBI could develop and test
    innovative practical, cost-effective ways to prevent weight gain in
    young adults to prevent cardiovascular disease.
        Stroke is the No. 3 killer of Americans and a major cause of
    permanent disability. In addition to the elderly, stroke also strikes
    newborns, children and young adults. An estimated 700,000 Americans
    will suffer a stroke this year, and nearly 158,000 will die. Many of
    America's 5.5 million stroke survivors face debilitating physical and
    mental impairment, emotional distress and huge medical costs; about 1
    in 4 survivors are permanently disabled.
        As a result of fiscal year 2001 Congressional report language, the
    National Institute of Neurological Disorders and Stroke (NINDS)
    convened a Stroke Progress Review Group. A report from this group
    provides a long-range stroke strategic plan for stroke research that
    includes 5 research priorities and 7 resource priorities. Multiple
    scientific programs initiated since the report have made impressive
    progress; however, additional funding is needed to implement the plan.
    The fiscal year 2007 estimate for NINDS stroke research falls 50
    percent short of the target for implementation of that year of the
    plan. Additional funds would be used to conduct stroke research in the
    following areas:
        Stroke Translational Research.--Translational studies are vital to
    providing cutting-edge stroke treatment and prevention. Due to budget
    shortfalls, the NINDS has been forced to compress its Specialized
    Programs of Translational Research in Acute Stroke (SPOTRIAS) from the
    planned 10 extramural centers to the five currently funded. SPOTRIAS
    researchers facilitate translation of basic research into patient care
    and evaluate and treat victims rapidly after the onset of stroke
    symptoms.
        Neurological Emergencies Treatment Trials Network.--Limited
    resources will also force the NINDS to scale back its Neurological
    Emergencies Treatment Trials Network. This initiative is designed to
    develop a clinical research network of emergency medicine physicians,
    neurologists and neurosurgeons to develop more and improved treatments
    for acute neurological emergencies, such as stroke, through clinical
    trials.
        Stroke Education.--As a member of the Brain Attack Coalition--a
    group of organizations devoted to fighting stroke--the AHA works with
    the NINDS to increase public awareness of stroke symptoms and the need
    to call 9-1-1. Together, we initiated a public education campaign, Know
    Stroke: Know the Signs, Act in Time, and we are striving to develop
    systems to make tPA available to appropriate patients. In partnership
    with the CDC, the NINDS extended this campaign to launch a grassroots
    program called Know Stroke in the Community to enlist the aid of
    ``Stroke Champions'' who educate communities about stroke signs and
    symptoms. When these measures are implemented, stroke treatment will
    shift from supportive care to early brain-saving intervention.
    Additional funds are needed to educate the public and health providers
    about stroke.
        Recommendation.--The AHA recommends an fiscal year 2007
    appropriation of $2.2 billion for NIH heart research. We advocate for
    an appropriation of $3.068 billion for the NHLBI. And, we recommend
    $357 million for NIH stroke research. We advocate for an appropriation
    of $1.612 billion for the NINDS. These appropriations represent a 5
    percent increase over fiscal year 2006--commensurate with the
    Association's overall recommended funding increase for the NIH.
           increase funding at the centers for disease control (cdc)
        Basic research must be translated into easy-to-understand guidance
    so that people can apply it to their daily lives. Prevention is the
    best way to protect Americans' health and ease the financial burden of
    disease. Although the clinical literature indicates that increased and
    improved cardiovascular disease interventions can be highly successful,
    investigators have concluded that well-established strategies for
    combating cardiovascular disease are often not being implemented.
    Recent studies suggest that not smoking, maintaining a healthy weight,
    and avoiding diabetes, high blood pressure and high cholesterol, may
    add 10 years to life.
        The AHA commends Congress for supporting CDC's new Division for
    Heart Disease and Stroke Prevention, which provides funding to 33
    states to create programs to educate and prevent first and second
    instances of heart disease and stroke. These state-tailored programs
    facilitate collaboration among public and private sector partners to
    help individuals control high blood pressure, lower elevated
    cholesterol, learn heart disease and stroke signs and symptoms, call 9-
    1-1, improve emergency response and quality of care, and eliminate
    treatment disparities. Many of these programs have been successful in
    reducing risk factors--like high blood pressure.
        In fiscal year 2006, only 14 states received funding to implement
    these prevention programs. The remaining 19 states received funds for
    planning; which is now largely complete. Because cardiovascular disease
    remains the No. 1 killer in every state, each state needs basic
    implementation money for this program. However, current funding levels
    will not allow for the expansion of this program.
        Recommendation.--For fiscal year 2007, the AHA recommends an
    appropriation of $8.5 billion plus funding for pandemic influenza
    preparedness for the CDC, including a 10 percent increase over current
    funding to return chronic disease prevention to the same level as
    fiscal year 2002. Within that total, we recommend $55 million to expand
    the Heart Disease and Stroke Prevention Program. This funding level
    would allow the CDC to add up to 4 states to the program, allowing them
    to conduct a state-tailored plan, and elevate 4 more states from
    planning to program implementation, maintain the Paul Coverdell
    National Acute Stroke Registry, and start the development of a state-
    based cardiac arrest registry.
    restore funding for the rural and community access to emergency devices
                                    program
        The Rural and Community Access to Emergency Devices Program
    provides grants to states to train lay rescuers and first responders to
    use AEDs and buy and place them where cardiac arrests are likely to
    occur. During the first year of the program, 6,400 AEDs were purchased
    and 38,800 individuals were trained. AEDs have been placed in schools,
    faith-based and recreation facilities, nursing homes, and other
    locations in communities across our nation.
        About 94 percent of cardiac arrest victims die outside of a
    hospital. Immediate CPR and early defibrillation using an automated
    external defibrillator (AED) can more than double a victim's chance of
    survival. Small, easy-to-use AEDs can shock the heart back into normal
    rhythm. Placing AEDs in more public settings could save thousands of
    lives each year. Communities with comprehensive AED programs that
    include training of anticipated rescuers have achieved survival rates
    of 40 percent or higher.
        The Rural and Community Access to Emergency Devices Program is
    terminated in the President's fiscal year 2007 budget. The budget
    justification asserts that much of the demand for AEDs has been met,
    although between fiscal year 2002 and fiscal year 2004 less than half
    of the grant dollars requested by states for this lifesaving program
    were actually awarded.
        Recommendation.--For fiscal year 2007, the AHA recommends that the
    Subcommittee allocate $8.927 million for HRSA's Rural and Community
    Access to Emergency Devices Program to restore funding to its fiscal
    year 2005 level.
      increase funding for the agency for healthcare research and quality
                                     (ahrq)
        The AHRQ is a critical partner with the public and private health
    care sectors. This agency helps develop evidence-based information
    needed by consumers, providers, health plans and policymakers to
    improve health care decision making. Through its Effective Health Care
    Program, AHRQ supports research focusing on outcomes, comparative
    clinical effectiveness, and appropriateness of pharmaceuticals, devices
    and healthcare services for a number of conditions, including ischemic
    heart disease, stroke, and high blood pressure. The new research and
    comparative effectiveness reviews conducted and funded under this
    program will help address issues raised in the Institute of Medicine's
    (IOM) report: Crossing the Quality Chasm.
        The AHRQ's initiative on health information technology (HIT) is a
    key element to the nation's strategy to bring health care into the 21st
    century. This initiative includes more than $166 million in grants, and
    through these and other projects, AHRQ and its partners will help to
    identify challenges to HIT adoption and use, solutions and best
    practices, and tools that will help hospitals and clinicians
    successfully incorporate new HIT. To facilitate this effort, the AHRQ's
    National Resource Center for HIT provides the health care community
    with technical assistance and consulting services to HIT projects, and
    particularly focus on addressing challenges to HIT implementation in
    rural and small community settings.
        Recommendation.--The AHA joins with the Friends of AHRQ in
    advocating for an appropriation of $440 million for the AHRQ to advance
    health care quality, cut medical errors and expand the availability of
    health outcomes information.
      increase funding for the carol m. white physical education program
                                     (pep)
        Physical inactivity is a key risk factor for heart disease and
    stroke, but Youth Risk Behavior Surveillance data indicates that almost
    half of 12-21 year olds do not participate in any vigorous physical
    activity on a regular basis. Despite recent studies by Action for
    Healthy Kids and the Robert Wood Johnson Foundation showing that almost
    80 percent of parents support daily physical education (PE) in schools
    to help combat physical inactivity and teach life long skills, only 6-8
    percent of schools nationally offer daily PE. One of the primary
    barriers to providing PE is adequate financial resources for equipment,
    program development, and staff training. The Carol M. White Physical
    Education Program helps schools overcome this barrier by providing
    money for school-based physical education activities that teach life-
    long physical activity habits. PEP is the only federal program that
    directly supports PE in schools.
        Recommendation.--For fiscal year 2007, the AHA recommends an
    appropriation of $100 million for the Carol M. White Physical Education
    Program. This level of funding will allow the Department of Education
    to expand the program to more districts while maintaining funding for
    the duration of previously awarded grants.
        Although heart disease, stroke, and other cardiovascular disease
    are largely preventable, these diseases continue to exact a deadly toll
    on our nation. As baby boomers age, our nation faces an expanding
    cardiovascular disease crisis unless significant steps are taken. We
    urge the subcommittee to consider these recommendations for the fiscal
    year 2007 budget. Adequate funding of research, treatment and
    prevention programs will save lives and reduce rising health care
    costs.

        Senator Specter. Thank you very much, Dr. Houser.
        Senator Harkin, do you have any comment or question?
        Senator Harkin. Just one. I have a lot of questions for the
    panel, but just one that I just want to ask Dr. Goldstein. Give
    us just a few seconds on your view on the potential of stem
    cell, embryonic stem cell research to benefit juvenile
    diabetes, type 1 diabetes?
        Dr. Goldstein. We are extremely bullish, Senator Harkin, on
    the potential to create insulin-secreting cells that are fully
    functional and respond to glucose. Work has already carried the
    human embryonic stem cell work to the point of producing
    endoderm, which is the tissue that then can create the
    pancreas. Investigators in animal studies can instruct endoderm
    to make pancreas. If we can make pancreas, that will give us
    the precursor cells for beta cells and insulin-secreting cells.
        So we are extremely, extremely optimistic and wish the work
    could go forward with full speed.
        Senator Harkin. Thank you.
        Senator Specter. Senator Shelby, any comment or question?
        Senator Shelby. Yes.
        Is anyone on the panel dealing in the autoimmune area,
    especially dealing with lupus or lupus-related? Dr. Holzman, do
    you want to comment on where we are going? You heard the first
    panel earlier.
        Dr. Holzman. Actually, in this regard I am more the
    clinician dealing with patients on the front lines.
        Senator Shelby. That is very important, the clinical work.
        Dr. Holzman. I am a nephrologist, a person who deals with
    kidney disease, and see many of the most complicated patients
    with lupus and kidney disease. I can tell you first that these
    are patients who suffer dramatically, that their lives are
    spent worrying about not only dealing with the current flare,
    the current problem, but the probability that the disease will
    recur.
        I should say that, thanks to big investments by the NIH in
    clinical trials, there actually have been some new drugs, drugs
    that have actually been around for a while but now are proven
    safer and actually as effective as earlier, more dangerous
    drugs, such as cyclophosphamide. We are now using
    microphenalate moftil as a first-line drug for kidney lupus and
    with I think fairly good success.
        Senator Shelby. So you see a lot of hope there?
        Dr. Holzman. I see a lot of hope there. I think that we
    need to further invest using the latest technology and
    translational studies in this area.
        Senator Shelby. Thank you.
        Thank you, Mr. Chairman.
        Senator Specter. Thank you, Senator Shelby.
        Thank you very much, ladies and gentlemen.
        Senator Shelby. I think Dr. Goldstein was going to say
    something.
        Dr. Goldstein. Real quickly, Senator Shelby. I would just
    like to repeat something that Dr. Fauci said: the support of
    the Immune Tolerance Network, which is a clinical trial
    translation platform for autoimmune diseases, including lupus,
    type 1 diabetes, and others. We learn from each other, from the
    science. Choking that funding off is going to eliminate the
    possibility to do those cutting edge clinical trials.
        Senator Shelby. Thank you.
        Thank you.
        Senator Specter. Thank you very much, ladies and gentlemen.
    We very much appreciate your coming in.
        We now turn to panel three: Dr. Daniel Koo, Dr. Phil
    Landrigan, Mr. Emeran Mayer, Dr. Peter McDonnell, Ms. Sandra
    Raymond, Mr. Herman Taylor, Ms. Suzanne Vogel-Scibilia.
        Our first witness is Dr. Daniel Koo, represent the Deaf and
    Hard of Hearing Alliance, and Dr. Koo is accompanied by an
    interpreter. Dr. Koo, we begin with you.
    STATEMENT OF DANIEL KOO, M.D., ON BEHALF OF THE DEAF
                AND HARD OF HEARING ALLIANCE
        Dr. Koo [speaks through a sign language interpreter]. Mr.
    Chairman, members of the Subcommittee of Senate Appropriations:
    On behalf of the member organizations of the Deaf and Hard of
    Hearing Alliance----
        Senator Harkin. Excuse me. Could you speak into that just a
    little bit louder. I am having a hard time.
        Senator Specter. Senator Thurmond always would say: Bring
    the machine a little closer.
        Dr. Koo. Mr. Chairman and members of the Senate
    Appropriations Subcommittee: On behalf of the member
    organizations of the Deaf and Hard of Hearing Alliance, a
    coalition of professional and consumer organizations serving
    and representing people who are deaf and hard of hearing, it is
    my pleasure to be here with you this morning to discuss the
    President's budget request for NIH's National Institute on
    Deafness and Other Communication Disorders.
        My name is Dr. Koo. I am a postdoctoral fellow at
    Georgetown University conducting neuroimaging studies on
    language and literacy, supported by NIDCD.
        Fiscal year 2007's budget request for NIDCD is $1.9 million
    less compared to the fiscal year 2006 appropriation. The DHHA
    strongly urges Congress not to impose further cuts in NIH or
    NIDCD research funding and that Congress and the administration
    work together to ensure appropriate funding that does not
    compromise current and future research efforts. The DHHA
    applauds current research being conducted related to people who
    are deaf and hard of hearing, specifically the strategies to
    protect hearing, diagnose and prevent hearing loss, and explore
    genetic modifiers.
        However, we urge the NIDCD to continue to pursue and
    support studies that delve into the acquisition and learning of
    oral and-or visual languages, the various communication modes
    and educational settings.
        Cutting the funding most assuredly will prevent the
    expansion of research in this critical area of need. Funding
    support for NIDCD to date has allowed many scientists, like
    myself, to make significant advances in hearing research as
    well as related sensory and cognitive areas. With congressional
    support, the NIDCD can continue its important research that
    aids in preventing hearing loss as well as assisting those who
    are deaf or hard of hearing.

                               PREPARED STATEMENT

        With hearing loss expected to reach 40 million Americans
    within the next generation, scientific work taking place at NIH
    and NIDCD is too critical to the human condition to take a step
    backward at this time.
        Thank you.
        [The statement follows:]
                        Prepared Statement of Daniel Koo
        On behalf of the member organizations of the Deaf and Hard of
    Hearing Alliance, a coalition of professional and consumer
    organizations serving and representing people who are deaf or hard of
    hearing, it is my pleasure to be here with you this morning to discuss
    the President's budget request for the National Institutes of Health,
    specifically the National Institute on Deafness and Other Communication
    Disorders (NIDCD).
        My name is Daniel Koo. I am a post-doctoral fellow at Georgetown
    University conducting neuron-imaging studies on language and literacy
    supported by NIDCD.
        The fiscal year 2007 budget request for NIDCD is $391,556,000, a
    decrease of $1,902,000 compared to the fiscal year 2006 Appropriation.
    The DHHA strongly urges Congress not to impose further cuts in NIH or
    NIDCD research funding, and we ask that Congress and the Administration
    work together to ensure appropriate funding to ensure that current and
    future research efforts are not compromised. With hearing loss expected
    to affect 40 million within one generation, there has never been a time
    when research has been needed so much.
        The DHHA applauds the current research being conducted related to
    people who are deaf or hard of hearing, specifically the strategies to
    protect hearing, diagnose and prevent hearing loss, and explore genetic
    modifiers. However, we urge NIDCD to continue to pursue and support
    studies that delve into the acquisition and learning of oral and/or
    visual languages the necessary precursor to a variety of communication
    modes and settings. Cutting the funding will most assuredly prevent the
    expansion of research in this critical area of need.
        Funding support for NIDCD to date has allowed many scientists like
    myself to make significant advances in hearing research, as well as
    related sensory and cognitive areas that impact the human condition.
    With Congressional support the NIDCD can continue its important
    research that aids in preventing hearing loss as well as assisting
    those who are deaf or hard of hearing. The work taking place at NIH and
    NIDCD is too critical to the human condition to take a step backward at
    this time.
        Members of the Deaf and Hard of Hearing Alliance include: Alexander
    Graham Bell, Association for the Deaf & Hard of Hearing, American
    Academy of Audiology, American Academy of Otolaryngology-Head and Neck
    Surgery, American Speech-Language-Hearing Association, Conference of
    Educational Administrators of Schools & Programs for the Deaf, Council
    of American Instructors of the Deaf, Cued Language Network of America,
    Deafness Research Foundation, Hearing Loss Association of America,
    Media Access Group at WGBH, National Association of the Deaf, National
    Cued Speech Association, Registry of Interpreters for the Deaf,
    Testing, Evaluation, and Certification Unit, and Telecommunications for
    the Deaf, Inc.

        Senator Specter. Thank you very much, Dr. Koo.
        We now turn to Dr. Philip Landrigan, representing the
    Campaign for American Children's Health. Dr. Landrigan.
    STATEMENT OF PHILIP J. LANDRIGAN, M.D., MSc, FAAP,
                PRESIDENT, CAMPAIGN FOR AMERICAN CHILDREN'S
                HEALTH
        Dr. Landrigan. Good morning, Senator Specter, Senator
    Harkin, Senator Shelby. I'm Philip Landrigan, pediatrician at
    Mount Sinai Medical School in New York City, and I thank you
    for inviting me here this morning to come to speak in support
    of the National Children's Study.
        I'd like first of all to thank all of you for the great
    support that you've given the National Children's Study over
    the past 6 years since its inception in 2000, and thanks most
    particularly for the discussion that you had in support of the
    study just a few minutes ago this morning.
        The reason that this Nation needs the National Children's
    Study is that the children's study will give us information on
    the preventable environmental causes of the major diseases that
    afflict American children today--asthma, which has more than
    doubled; childhood brain cancer has gone up 40 percent; autism,
    you heard a few minutes ago has gone up remarkably; other
    learning disabilities.
        It's been said that the study is expensive and it is. But
    the diseases, the chronic diseases that the study will address,
    cost this Nation more than $600 billion a year. The very same
    logic that Dr. Zerhouni invoked this morning when he spoke of
    the great declines that have been achieved in heart disease
    because of the Framingham study, the women's health initiative,
    that same logic applies to the National Children's Study, and
    it's ironic that I chose to include the same image in my
    testimony as he used in his screen presentation this morning.

                               PREPARED STATEMENT

        If we fail to fund the National Children's Study it will be
    a major opportunity lost. The National Children's Study is our
    generation's best hope, indeed probably our only hope, to get
    on top of the chronic diseases in America's children.
        I thank you.
        [The statement follows:]
                   Prepared Statement of Philip J. Landrigan
        Good morning, Mr. Chairman and Members of the Subcommittee. I am
    Dr. Philip J. Landrigan. I am a pediatrician, Professor and Chairman of
    Community & Preventive Medicine, and Professor of Pediatrics at the
    Mount Sinai School of Medicine. I am Principal Investigator for the
    Queens, New York Vanguard Center of the National Children's Study. I am
    also President of the Campaign for American Children's Health, a not-
    for-profit organization committed to preserving the health of America's
    children by sustaining the National Children's Study.
        Why Do We Need the National Children's Study? The United States
    needs the National Children's Study because we desperately need the
    information the Study will provide on preventable causes of the major
    diseases that confront America's children today. Information from the
    National Children's Study will provide a blueprint for prevention. The
    diseases of greatest current concern in American children are:
      --Asthma, which has more than doubled in frequency since 1980 and
            become theleading cause of pediatric hospitalization and school
            absenteeism;
      --Birth defects, which are now the leading cause of infant death.
            Certain birthdefects, such as hypospadias, have doubled in
            frequency;
      --Neurodevelopmental disorders--autism, dyslexia, mental retardation,
            and attention deficit/hyperactivity disorder (ADHD). These
            conditions affect 5-10 percent of the 4 million babies born
            each year in the United States. Reported rates ofautism are
            increasing especially sharply--more than 20 percent per year;
      --Leukemia and brain cancer in children and testicular cancer in
            adolescents. Incidence rates of these malignancies have
            increased since the 1970s, despite declining rates of
            mortality. Testicular cancer has risen by 55 percent, and
            primarybrain cancer by 40 percent. Cancer is now the second
            leading cause of death in American children, surpassed only by
            traumatic injuries;
      --Preterm birth, which has increased in incidence by 27 percent since
            1981;
      --Obesity and its consequence, type 2 diabetes. Obesity has trebled
            in prevalencein the United States. Obesity has become common in
            even the youngest of our children, and for example, 41 percent
            of 5-year-olds entering kindergarten in the five boroughs of
            New York City in 2005 were overweight or frankly obese. The
            future toll of disease and premature death in these
            youngsters--from diabetes, heart disease, stroke and probably
            cancer--will be fearsome.
        We have a responsibility to safeguard our children. They are the
    most vulnerable among us, our most precious resource, and the hope for
    our future. But these rapidly rising rates of chronic disease threaten
    the health of our children and the future security of our nation.
        Indeed, concern is strong among the pediatric community that these
    rapidly rising rates of disease may create a situation unprecedented in
    the 200 years of our nation's history, in which our current generation
    of children may be the first American children ever not to enjoy a
    longer life span than the generation before them. In other words, if we
    do not support the necessary research--especially the National
    Children's Study--and if we fail to take needed preventive action, we
    are actually at risk of losing hard-won ground in children's health.
        What is the National Children's Study?--The National Children's
    Study is a prospective multi-year epidemiological study that will
    follow 100,000 American children, a nationally representative sample of
    all children born in the United States, from conception to age 21. The
    study will assess and evaluate the environmental exposures these
    children experience in the womb, in their homes, in their schools and
    in their communities. It will seek associations between environmental
    exposures and disease in children. The diseases of interest include all
    those listed above. The principal goal of the Study is to identify the
    preventable environmental causes of pediatric disease and to translate
    those findings into preventive action and improved health care.
        The National Children's Study was mandated by Congress through the
    Children's Health Act of 2000. The lead federal agency principally
    responsible for the Study is the National Institute of Child Health and
    Human Development. Other participating agencies include the National
    Institute of Environmental Health Sciences, the Environmental
    Protection Agency, and the Centers for Disease Control and Prevention.
        By working with pregnant women and couples, the Study will gather
    an unprecedented volume of high-quality data on how environmental
    factors acting either alone, or in combination with genetic factors,
    affect the health of infants and children. Examining a wide range of
    environmental factors--from air, water, and dust to what children eat
    and how often they see a doctor--the Study will help develop prevention
    strategies and cures for a wide range of childhood diseases. By
    collecting data nationwide the study can test theories and generate
    hypotheses that will inform biomedical research and he care of young
    patients for years to come. Simply put, this seminal effort will
    provide the foundation for children's healthcare in the 21st Century.
        The Unique Strengths of the National Children's Study.--Six aspects
    of the architecture of the National Children's Study make it a uniquely
    powerful tool for protecting the health of America's children:
        1. The National Children's Study is prospective in its Design.--The
    great strength of the prospective study design is that it permits
    unbiased assessment of children's exposures in real time as they
    actually occur, months or years before the onset of disease or
    dysfunction. Most previous studies have been forced to rely on
    inherently inaccurate retrospective reconstructions of past exposures
    in children who were already affected with disease. The prospective
    design obviates the need for recall. It is especially crucial for
    studies that require assessments of fetal and infant exposures, because
    these early exposures are typically very transitory and will be missed
    unless they are captured as they occur.
        2. The National Children's Study Will Employ the Very Latest Tools
    of Molecular Epidemiology.--Molecular epidemiology is a cutting-edge
    approach to population studies that incorporates highly specific
    biological markers of exposure, of individual susceptibility and of the
    precursor states of disease. Especially when it is embedded in a
    prospective study, molecular epidemiology is an extremely powerful
    instrument for assessing interactions between exposures and disease at
    the level of the individual child.
        3. The National Children's Study Will Incorporate State-of-the-Art
    Analyses of Gene-Environment Interactions.--Recognition is now
    widespread that gene-environment interactions are powerful determinants
    of disease in children. These interactions between the human genome and
    the environment start early in life, affect the health of our children,
    and set the stage for adult disorders. The heroic work of decoding the
    human genome has shown that only about 10-20 percent of disease in
    children is purely the result of genetic inheritance. The rest is the
    consequence of interplay between environmental exposures and
    genetically determined variations in individual susceptibility.
    Moreover, genetic inheritance by itself cannot account for the sharp
    recent increases that we have seen in incidence of pediatric disease.
        4. The National Children's Study Will Examine a Nationally
    Representative Sample of American Children.--Because the 100,000
    children to be enrolled in the Study will be statistically
    representative of all babies born in the United States during the five
    years of recruitment, findings from the Study can be directly
    extrapolated to the entire American population. We will not need to
    contend with enrollment that is skewed by geography, by socioeconomic
    status, by the occurrence of disease or by other factors that could
    blunt our ability to assess the links between environment and disease.
        5. Environmental Analyses in the National Children's Study will be
    conducted at the Centers for Disease Control and Prevention.--The CDC
    laboratories in Atlanta are the premier laboratories in this nation and
    the world for environmental analysis. Because the testing will be done
    at CDC it will be the best available, and the results will be
    unimpeachable.
        6. Samples Collected in the National Children's Study Will be
    Stored Securely and Will be Available for Analysis in the Future.--New
    tests and new hypotheses will undoubtedly arise in the years ahead.
    Previously unsuspected connections will be discovered between the
    environment, the human genome and disease in children. The stored
    specimens so painstakingly collected in the National Children's Study
    will be available for these future analyses.
        The Current State of the National Children's Study.--Congress has
    already laid a firm foundation for the National Children's Study.
    Between 2000 and 2005, the Congress invested more than $55 million to
    design the study and begin building the nationwide network necessary
    for its implementation.
        Seven Vanguard Centers and a Coordinating Center were designated in
    2005 at sites across the nation--in Pennsylvania, New York, North
    Carolina, Wisconsin, Minnesota, South Dakota, Utah and California--to
    test the necessary research guidelines--with plans to expand the
    program to 38 states and 105 communities nationwide.
        The tough job of designing and organizing is nearly complete.
    Funding for the Study this year will permit researchers to begin
    achieving the results that will make fundamental improvements in the
    health of America's children.
        To abandon the Study at this point would mean forgoing all of that
    dedication, all of that incredible effort, and all of the logistical
    preparation.
        The Study Will More Than Pay for Itself.--The National Children's
    Study will yield benefits that far outweigh its cost. It will be an
    extraordinarily worthwhile investment for our nation, and it can be
    justified even in a time of fiscal stress such as we face today.
        Six of the diseases that are the focus of the Study (obesity,
    injury, asthma, diabetes, autism and schizophrenia) cost America $642
    billion each year. If the Study were to produce even a 1 percent
    reduction in the cost of these diseases, it would save $6.4 billion
    annually, 50 times the average yearly costs of the Study itself.
        But in actuality, the benefits of the National Children's study
    will likely be far greater than a mere 1 percent reduction in the
    incidence of disease in children. The Framingham Heart Study, upon
    which the National Children's Study is modeled, is the prototype for
    longitudinal medical studies and the benefits that it has yielded have
    been enormous.
        The Framingham Study was launched in 1948, at a time when rates of
    heart disease and stroke in American men were skyrocketing, and the
    causes of those increases were poorly understood. The Framingham Study
    used path-breaking methods to identify risk factors for heart disease.
    It identified cigarette smoking, hypertension, diabetes, elevated
    cholesterol and elevated triglyceride levels as powerful risk factors
    for cardiovascular disease. These findings contributed powerfully to
    the 42 percent reduction in mortality rates from cardiovascular disease
    that we have achieved in this country over the past 5 decades (see
    Figure, next page).
        The data from Framingham have saved millions of lives--and billions
    of dollars in health care costs. The National Children's Study, which
    will focus on multiple childhood disorders, could be even more
    valuable.

        The National Children's Study will Yield Benefits in the Near-Term
    Future.--We do not need to wait 21 years for benefits to materialize
    from the National Children's Study. Valuable information will become
    available in a few years' time, as soon as the first babies in the
    Study are born.
        Consider, for example, data on premature births. The rate of U.S.
    premature births in 2003 was 12.3 percent, far higher than the 7
    percent rate in most western European countries. Hospital costs
    associated with a premature birth average $79,000, over 50 times more
    than the average $1,500 cost for a term birth. Just a 5 percent
    reduction in rates of prematurity would cut hospital costs by $1.6
    billion annually. Within just two years, that savings would match the
    full cost of the Study.
        The Study Enjoys Broad Support.--The Study enjoys a broad group of
    supporters, including The American Academy of Pediatrics; Easter Seals;
    the March of Dimes; the National Hispanic Medical Association; the
    National Association of County and City Health Officials; the National
    Rural Health Association; the Association of Women's Health, Obstetric
    and Neonatal Nurses; United Cerebral Palsy; the Spina Bifida
    Association of America; and the United States Conference of Catholic
    Bishops, just to name a few. This broad and diverse group recognizes
    the overwhelming benefits this Study will produce for America's
    children.
        Congress Should Fully Fund the National Children's Study.--Congress
    first authorized the National Children's Study in 2000, and has
    appropriated $55 million since then to design the Study, complete
    preparatory research, and designate the seven Vanguard sites that will
    conduct preliminary testing.
        This has been a wise investment that should not be abandoned just
    as the Study is about to bear fruit. Unfortunately, the Administration
    has not provided continued funding in the fiscal year 2007 budget, a
    decision which threatens to squander the investment already made and to
    throw away the multi-generational benefits the Study will yield.
        Funding for the Study this year requires a commitment of $69
    million. These funds will be used to begin enrolling children in the
    study. They will enable the NIH to continue establishing the 105 study
    sites around the country. We urge Congress to fully fund the National
    Children's Study. It is an investment in our children--and in America's
    future.
        The National Children's Study will give our nation the ability to
    understand the causes of chronic disease that cause so much suffering
    and death in our children. It will give us the information that we need
    on the environmental risk factors and the gene-environment interactions
    that are responsible for rising rates of morbidity and mortality. It
    will provide a blueprint for the prevention of disease and for the
    enhancement of the health in America's children today and in the
    future. It will be our legacy to the generations yet unborn.
        Thank you. I shall be pleased to answer your questions.

        Senator Specter. Thank you very much, Dr. Landrigan.
        We now turn to Dr. Emeran Mayer, representing the Digestive
    Disease National Coalition. Dr. Mayer.
    STATEMENT OF EMERAN A. MAYER, M.D., ON BEHALF OF THE
                DIGESTIVE DISEASE NATIONAL COALITION
        Dr. Mayer. Thank you, Senators Specter, Harkin, and Shelby,
    for this opportunity. I'm here on behalf of the Digestive
    Disease National Coalition, representing the International
    Foundation for Functional Gastrointestinal Disorders. I'm a
    gastroenterologist and director of an NIH-funded research
    center at UCLA dedicated to the study of functional
    gastrointestinal disorders.
        These disorders, specifically irritable bowel syndrome, or
    IBS, are the most common GI disorders in society. They're
    characterized by chronic abdominal pain and discomfort and
    affect women disproportionally. IBS's health care costs are $2
    billion annually and exceed $20 billion when indirect costs are
    included. Yet the cause of this disorder remains incompletely
    understood.
        During the past 10 years, NIDDK has helped advance
    biomedical research in the field, bringing us within reach for
    the first time of several IBS treatments with great potential.
    The NIDDK is embarking on a strategic planning process for
    digestive diseases in which IBS will be a critical component.
    This is essential to advance our understanding, improve
    treatments, and recruit new investigators for the disease.
        The President's proposed cuts to NIH will have a
    detrimental impact on research advancements in digestive
    diseases and specifically in IBS. Such cuts would slow our
    understanding of pathophysiological mechanisms and effective
    treatments, slow or eliminate pivotal clinical trials, and
    prevent the pharmaceutical industry to develop new treatments,
    and most importantly reduce the number of established
    investigators and send a shock wave to young investigators
    considering entering into this field.

                               PREPARED STATEMENT

        It is therefore essential to continue our investment into
    these programs that hold such promise at this point. I urge you
    therefore to prevent the proposed NIH budget cuts and to
    prevent the likely unraveling of all the progress that has been
    made during the past decade.
        Thank you for the opportunity to testify.
        [The statement follows:]
                     Prepared Statement of Emeran A. Mayer
        Chairman Specter and members of the Subcommittee, thank you for the
    opportunity to present testimony before you today on the effect that
    the President's fiscal year 2007 budget for the National Institutes of
    Health (NIH) will have on functional gastrointestinal and motility
    disorders research. My name is Dr. Emeran A. Mayer and I am here today
    representing the International Foundation for Functional
    Gastrointestinal Disorders' (IFFGD) Board of Directors and the IFFGD
    Advisory Board on behalf of the Digestive Disease National Coalition
    (DDNC). I am the Director of the UCLA Center for Neurovisceral Sciences
    & Women's Health (CNS), a translational research program recently
    funded by the NIH that is currently viewed as the leading integrated
    research program in the world in the area of functional digestive
    disorders.
        Functional gastrointestinal disorders, specifically irritable bowel
    syndrome or IBS, and motility disorders are the most common
    gastrointestinal disorders experienced in society and are present in
    about 25 percent of the U.S. population. The impact on the healthcare
    system and society in general is substantial. These disorders comprise
    about 40 percent of gastrointestinal problems for which patients seek
    health care and the frequency of work absenteeism as a result of these
    disorders is second only to the common cold. IBS health care costs to
    society are $2 billion annually and exceed $19 billion when indirect
    factors such as loss of work and productivity are considered. Although
    the cause of IBS is incompletely understood, we do know that this
    disorder needs a multidisciplinary approach in research and often
    treatment, in order to help the millions of patients suffering across
    the country.
        New knowledge on the mechanisms of these disorders, in particular
    in terms of dysregulation of the elaborate interactions between the
    nervous system and the digestive system, has resulted in
    neurophysiological and neuropharmacological investigations which have
    the potential to produce new pharmaceutical agents as well as disease
    management programs for treatment of these disorders.
        The National Institute of Diabetes and Digestive and Kidney
    Diseases (NIDDK) has been supporting research into the basic and
    translational mechanisms of functional GI disorders including IBS, in
    terms of individual research grants (R-01), career development grants
    to young investigators (K awards), and major support of two research
    centers, including our own at UCLA. These efforts during the past 10
    years have been essential in advancing biomedical research in the field
    and, for the first time, bringing us within reach of several novel
    pharmacological treatments with great potential for IBS. The NIDDK is
    in the process of embarking on a strategic planning process for
    digestive diseases, and IBS will be a critical component of this plan.
    Strategic planning is essential to advancing our understanding of this
    disease, determining improved treatment options for IBS sufferers, and
    assisting in the recruitment of new investigators to conduct IBS
    research.
        Cutting the budget for the NIH, as is proposed in the President's
    fiscal year 2007 budget, will have a detrimental impact on the research
    advancements in this important disease area that have been accomplished
    during the past several years. Specifically, such cuts would have an
    immediate impact in the following areas:
      --It will slow the elucidation of pathophysiological mechanisms and
            identification of novel targets, which will have a ripple
            effect on drug development by the pharmaceutical industry.
            There will be no new drug development without NIH funded basic
            and translational research.
      --It will slow or eliminate the execution of pivotal clinical trials
            of novel treatments for IBS.
      --Most importantly, it will slow strategic planning and reduce the
            number of young investigators dedicated to the field by
            starting an exodus of such individuals into jobs in the
            pharmaceutical industry and private practice. Such a reduction
            in the research base will take years to undo.
        Biomedical research, sponsored by the NIH, has advanced our
    understanding of countless diseases and disorders. It is important to
    continue our investment in these vital programs that hold such promise
    for our nation's future. Therefore, we ask you to provide an increase
    of 5 percent in fiscal year 2007 for the National Institute of Diabetes
    and Digestive and Kidney Diseases and for the NIH overall.

        Senator Specter. Thank you, Dr. Mayer.
        Our next witness is Dr. Peter McDonnell, representing the
    National Alliance for Eye and Vision Research. Dr. McDonnell.
    STATEMENT OF PETER McDONNELL, M.D., ON BEHALF OF THE
                NATIONAL ALLIANCE FOR EYE AND VISION
                RESEARCH
        Dr. McDonnell. Thank you, Chairman Specter, Senator Harkin,
    Senator Shelby.
        The President's proposed fiscal year 2007 budget would cut
    National Eye Institute funding by 0.8 percent, or $5.3 million.
    This will have a significant detrimental impact on the entire
    NEI research portfolio, especially research programs into age-
    related macular degeneration, AMD. As Dr. Zerhouni mentioned
    this morning, this is the leading cause of blindness now in the
    United States. It robs our seniors of their independence.
        I offer three examples. The NEI has identified variants of
    a gene associated with the body's inflammatory response
    responsible for 50 percent of the risk of developing AMD.
    Without adequate funding, NEI will not be able to develop
    diagnostics for early detection of at-risk individuals and
    conduct clinical studies with promising therapies, as well as
    study the impact of the inflammatory response and other
    degenerative eye diseases.
        The NEI has demonstrated that dietary zinc and anti-oxidant
    vitamins actually reduce vision loss in individuals at risk of
    developing AMD. Without adequate funding, NEI will not be able
    to proceed with follow-up clinical studies to identify
    additional dietary supplements used singly or in combination to
    demonstrate even greater protective effects against progression
    to advanced disease.
        NEI's research has resulted in the first generation of FDA-
    approved drugs to treat abnormal blood vessel growth in the wet
    form of AMD, halting further vision loss. NEI's ability to
    conduct clinical studies of these therapies in patients with
    macular edema associated with diabetes and diabetic retinopathy
    would also be jeopardized.
        Thank you, Mr. Chairman, and we appreciate the
    subcommittee's efforts to increase NIH and NEI funding in the
    fiscal year 2007 budget.
        Senator Specter. Thank you very much, Dr. McDonnell.
        We now turn to Ms. Sandra Raymond, representing the Lupus
    Foundation of America.
    STATEMENT OF SANDRA RAYMOND, ON BEHALF OF THE LUPUS
                FOUNDATION OF AMERICA
        Ms. Raymond. Good morning, Mr. Chairman, Senator Harkin,
    Senator Shelby.
        Lupus is the prototypical autoimmune disease, so an
    investment in lupus research may in fact produce answers to
    many other autoimmune diseases affecting more than 23 million
    Americans. In recent years, NIH has had funded studies that
    give us great hope that we are on the brink of major
    breakthroughs in lupus research.
        For example, one study, an adult stem cell transplantation
    study, is carried out on only the most severely ill of lupus
    patients, for whom all other treatments have failed. Fifty
    percent of these patients having the procedure had disease-free
    survival for 5 years.
        In another NIH-funded study, researchers identified a gene
    that plays a role in one of the immune system pathways meant to
    fight infection. In people with lupus, this pathway turns on,
    but never turns off.
        Mr. Chairman, should NIH appropriations be curtailed there
    may not be a future generation of scientists to do lupus
    research. Already the hint that funding may be reduced has
    caused leaders in our field to consider better funded areas.
    Cuts in NIH funding could bring to a standstill support of
    clinical trials and large observational studies in lupus and
    could limit research on those at highest risk for lupus, women
    of color.

                               PREPARED STATEMENT

        NIH-funded research currently in progress will lead to new
    and improved treatments for lupus. There has not been a new
    FDA-approved drug for lupus in almost 40 years and the drugs
    that our patients are currently taking are very harsh
    chemotherapies, chemotherapies in lupus as well as in cancer.
        Thank you.
        [The statement follows:]
          Prepared Statement of the Lupus Foundation of America, Inc.
        I am Dr. Michael Madaio, Chief of Nephrology, Professor of
    Medicine, Temple University School of Medicine and a lupus researcher.
    The Lupus Foundation of America, Inc. (LFA) appreciates the opportunity
    to submit written comments for the record regarding funding for lupus
    related programs for fiscal year 2007. The LFA is the nation's leading
    non-profit voluntary health organization dedicated to improving the
    diagnosis and treatment of lupus, supporting individuals and families
    affected by the disease, increasing awareness of lupus among health
    professionals and the public, and finding the causes and cure. As you
    may know, lupus is a debilitating, chronic autoimmune disease that
    causes inflammation and tissue damage to virtually any organ system; it
    can cause significant disability or even death. Lupus is the
    prototypical autoimmune disease; therefore, finding answers to
    questions about lupus may also provide understanding about other
    autoimmune diseases that affect 22 million Americans. The leaders and
    members of the LFA and the 1.5 to 2 million people suffering from lupus
    respectfully request for fiscal year 2007 $29.7 billion for the
    National Institutes of Health (NIH) to support lupus research.
    Specifically, we urge Congress to direct NIH to support and bolster
    lupus research across all relevant institutes, centers, and offices.
        I have been funded for lupus research for over 20 years. I am proud
    to be affiliated with the Lupus Foundation of America as a member of
    the Medical Scientific Advisory Board and Chairman of the Medical
    Advisory Board for the Southeastern Pennsylvania Chapter of the LFA.
    While I am a nephrologist, since my research and clinical practice is
    focused on lupus, I really work day-to-day within the realms of
    nephrology and rheumatology as well as other medical specialties and
    subspecialty areas. I understand the importance of biomedical research
    funding and the impact that federal research funding has had, does
    have, and can have on the lives of the 1.5 million people living with
    lupus and the 22 million Americans with other autoimmune diseases.
        After a tragic 40 year dearth of new treatments to manage this
    often debilitating and devastating disease, the good news is that we
    finally are on the brink of major breakthroughs, thanks to research
    sponsored by the National Institutes of Health. Exciting research and
    strides in treatments for people with lupus are on the horizon and a
    sustained investment now in lupus research will speed the day to better
    treatments and a cure. One exciting study, adult stem cell
    transplantation, was carried out on only the most severely ill of lupus
    patients for whom all other treatments have failed. Fifty percent of
    the patients having the procedure had disease free survival at 5 years.
    In another NIH funded study researchers identified a gene that plays a
    role in one of the immune system pathways meant to fight infection. In
    people with lupus this pathway turns on and never turns off. These
    findings and others will lead to effective ways of treating lupus and
    other autoimmune diseases affecting 23 million Americans.
        Specifically, I am conducting extensive research on lupus
    nephritis, which is kidney involvement in lupus disease. My field is
    advancing rapidly, due in large part to factors directly dependent on
    NIH funding:
      --the burgeoning growth in the number of new animal models, including
            a wealth of informative transgenic and gene-targeted mutants;
      --increased access to improved powerful technologies such as gene and
            protein arrays, now available at many institutions and to many
            investigators through NIH core facilities;
      --new technologies that permit successful query of the very small
            amounts of human tissue typically available from patients and,
            collaboration across disciplines and across institutions to
            bring crucial expertise together;
      --new insights into underlying biology and pathophysiology in
            immunity and lupus are constantly emerging;
      --technologies to identify biomarkers are improved and accessible;
            and
      --new approaches to therapy are being explored.
        These endeavors are bearing fruit but they are highly dependent on
    NIH funding.
        If funding for the NIH is cut or level funded, it could cripple or
    paralyze current lupus research efforts.
        As lupus is a systemic disease that can affect any organ or tissue
    elucidating pathogenesis (or cause) and treatments of lupus will have
    direct impact on many other autoimmune diseases (e.g. results and
    treatments translating to other diseases). Providing adequate resources
    to support lupus research will help the nation turn the corner on
    finding better treatments or a cure for lupus while also supporting
    breakthroughs and progress for other disease states. It is important to
    note that the corollary is true: cuts in lupus research funding also
    will have an adverse effect on progress for lupus and for progress in
    related diseases. Cuts in NIH funding could bring to a standstill
    support of clinical trials and large observational studies, and could
    curtail research on those at highest risk for lupus, women of color; it
    also could negatively impact pediatric research at a time when
    researchers have just begun to undertake studies in important new
    areas. Furthermore, insufficient federal funding also could slow much-
    needed genetic research when we are just discovering the critical
    components that may contribute to lupus and its effects. Therefore, it
    is critical that biomedical researchers be provided the necessary
    resources to continue seeking answers to the questions that will lead
    to better lupus treatments. Increased research funding will help
    deliver much-needed breakthroughs from the laboratory to patients in
    need.
        The National Institute of Arthritis and Musculoskeletal and Skin
    Diseases (NIAMS), the institute most involved in lupus research, is one
    of the smallest institutes at NIH. In the past 2 years there has been a
    decrease in research funding for NIAMS overall, with a 10 percent
    decrease in new research grants. Currently, only 12-15 percent of the
    grant applications submitted to NIAMS receives funding. Further cuts
    will cause this rate to drop precipitously to below 10 percent next
    year. Just 2 or 3 years ago, funding levels were at 25-30 percent. Cuts
    in research funding, coupled with the rate of biomedical research
    inflation (3-4 percent per year), further erode NIAMS' ability to fund
    lupus research grant applications at the rate necessary to begin making
    real progress. As such, an increase above the rate of biomedical
    research inflation is necessary to allow NIH to sustain and build on
    its research progress resulting from the recent budget doubling while
    avoiding the severe disruption to that progress that would result from
    a lesser increase or cut.
        Furthermore, in the proposed budget for NIAMS for 2007 there will
    be a loss of 10 training grants; each grant funds training for four
    physicians, mostly rheumatologists. Young and senior investigators
    alike are moving into other fields because of the lost of funding.
    Exacerbating the situation, medical schools are struggling financially
    due to public funding cuts thus eliminating any safety net for
    researchers that may have previously existed. As a result, young
    investigators are not attracted to lupus research which means there
    will be not be a future generation of lupus scientists and clinicians
    to do research. Moreover, after having attracted scientists to
    translational immunology in the last 5 to 10 years, when funding was
    increasing, there is now a possibility we could lose both the current
    and next generation of young investigators. Increased funding is
    necessary to support an adequate number of training grants. Without
    research and training funds lupus researchers might be forced to become
    private practice physicians instead, leading to an imbalance in the
    health care system: sufficient numbers of physicians to treat lupus
    patients, but no new treatments with which to care for them, and no
    researchers to develop the cures of tomorrow.
        We recognize and appreciate that Congress and the nation face
    unprecedented fiscal challenges; however, we cannot afford to lose
    ground in biomedical research at such a promising time. The LFA looks
    forward to working with the subcommittee and others in Congress to
    reduce and prevent the suffering caused by lupus. We stand ready to
    serve as a resource for any information you may need in this regard and
    thank you for this opportunity to submit written testimony for the
    record concerning fiscal year 2007 lupus related funding.

        Senator Specter. Thank you very much, Ms. Raymond.
        Our next witness is Dr. Herman Taylor, representing the
    Jackson Heart Study. Dr. Taylor.
    STATEMENT OF HERMAN A. TAYLOR, JR., M.D., ON BEHALF OF
                THE JACKSON HEART STUDY
        Dr. Taylor. Thank you, Mr. Chairman, and good morning,
    Senator Harkin, Senator Shelby. I am Herman Taylor, professor
    and cardiologist at the University of Mississippi Medical
    Center and also with appointments at Jackson State and Talugu
    College.
        I am proud this morning to come to you on behalf of the
    largest study of cardiovascular disease ever undertaken in the
    African American population. It is called the Jackson Heart
    Study. The NHLBI and the National Center for Minority Health
    and Health Disparities are the NIH entities that fund this
    groundbreaking work. We are not only doing research, but we are
    actively involved in training young people to be scientific
    leaders for tomorrow.
        We are accomplishing much, but our challenges are huge. A
    well documented and widening gap has opened up between blacks
    and other citizens of this country with respect to
    cardiovascular health. While most Americans have enjoyed a 40-
    year decline in death rates from cardiovascular disease, there
    has been virtually no change in the death rate from
    cardiovascular disease for African Americans in the State of
    Mississippi and certain other urban areas in other parts of the
    country share these equally dismal statistics.
        So while the Jackson Heart Study is a very heartening and
    wonderful undertaking, if the intent is to approach these
    disparities what we have done thus far can be compared to
    throwing a 10-foot rope to a man at the bottom of a 40-foot
    well. It is a great idea, it is a good intention, but it comes
    up short.

                               PREPARED STATEMENT

        If we consider the question of health disparities an
    important national priority, you have to ask yourself what if
    we were equal. Dr. David Satcher asked that question in a
    recent publication and he concluded, looking at CDC statistics,
    that last year 80,000 African Americans died unnecessary deaths
    compared to their white counterparts. In our State 1,200, our
    small southern State, 1,200 African Americans died
    unnecessarily.
        To reverse this trend, we must support research and extend
    the work of the Jackson Heart Study. Thank you.
        [The statement follows:]
                  Prepared Statement of Herman A. Taylor, Jr.
        I am proud to come to you today on behalf of the largest and most
    comprehensive study of CVD in the African American community ever
    conducted--the JHS. Through the generous support of 2 NIH components--
    NHLBI and the NCMHD--this ambitious and multifaceted project is
    emerging as a leading study on CV disease among African Americans.
    Besides its establishing a growing database of detailed health
    information and test results ranging from advanced images of the heart
    to genetics to measures of stress and psychological parameters, the JHS
    is also an incubator for the scientific leaders of tomorrow through our
    education and training programs that involve minority students in
    didactic classroom sessions and practical research experiences. And
    while we search for answers and train future leaders, we also are
    taking action NOW--to serve the community with important health
    information from our study as well as others.
        We are relatively new, born during the period of NIH budget
    doubling, and already we have accomplished much within the Jackson
    community and beyond. However, despite the promise of the JHS and our
    optimism over its impact, I come to you with a deep concern, summarized
    in the arresting quotes below.

        ``It has been discovered that the health of [blacks] in [parts of]
    Mississippi is deteriorating while the health standards for the nation
    are improving . . . .''--The Wall Street Journal

        ``Cardiovascular deaths in MS seem to be rising while they have
    fallen for the past 30 years for the rest of the country.''--
    Circulation (the official organ of the American Heart Association)

        These 2 quotes are distressing, whether you are African American or
    not, whether you are Mississippian or not. However, the magnitude of
    the problem they summarize becomes clearer when you consider that the
    two statements were made 32 years--a full generation--apart. The notion
    that in the richest country in the history of man, one location or
    group within its borders can be so singularly and peculiarly burdened
    from a largely preventable disease is barely credible. But it is true,
    and it has the status quo for around forty years.
        So while the JHS represents an inspired, timely effort of the NHLBI
    and the NCMHD, to freeze research efforts at the current levels of
    funding would be like throwing a 10 foot rope to a man at the bottom of
    a 40 foot hole. We come up short, and despite the right idea and a
    noble attempt, the problem of disparate CV health remains unsolved. To
    extend the reach of the JHS to its full potential, our Study and other
    complementary studies--and the investigators driving them--must thrive,
    and have support for their approaches and new ideas.
        The JHS contributes to extending the research lifeline in several
    important ways. First there is the core JHS Study itself. Classically
    designed in the pattern of the world famous Framingham Study, it offers
    a chance to Study a wide list of possible causes for poorer
    cardiovascular health among African Americans, to inform precise
    interventions that will reduce disparities. Funded through 2013 by
    NHLBI and NCMHD, it is a landmark undertaking. The JHS also is
    innovative in its list of partnering institutions. Besides the guidance
    and support of the NHLBI and the NCMHD, 3 local Jackson Institutions of
    higher learning take active part in making the JHS work--Jackson State
    University, University of Mississippi Medical Center, and Tougaloo
    College all have unique and vital roles in the Study. Comprising a team
    of 2 Historically Black institutions and a third predominantly
    minority-serving institution, this combination has been ground-braking
    and synergistic in the service of this population-based study of an
    African American population. Training of promising young talent from
    the affected population and participation of HBCU's in epidemiological
    research at the highest level is bearing fruit for the Nation in terms
    of a rising cadre of leaders in the relevant fields.
        However, the potential impact of the JHS is bigger than even this
    important core Study will provide. This is because not only is the JHS
    a Study in its own right, it is a platform for critical spin-off
    studies. These ``Ancillary Studies'' require secondary funding that is
    NOT a part of the JHS contract funding. A flat or declining NIH budget
    threatens these important studies, where much of the truly innovative
    work on health disparities could occur. For instance, nearly all of the
    genetics studies of heart disease in the JHS require this ancillary
    funding. The genetics of CVD may be the key in the lock of our
    understanding of much of the current epidemic. Implications of these
    studies may be huge for not only African Americans, but all people
    threatened by the nation's number one killer. Flat budget lines
    severely limit the opportunities for such important studies. This is
    especially devastating to new investigators, those who apply for the
    career development (K) awards that NHLBI has been so committed to
    funding. These young people are the cadre of scientists in whom we are
    investing our future hopes of American world leadership in health
    research, and the ultimate resolution of health disparities.
        The future of innovative science from the JHS is therefore tied in
    important ways to Ancillary studies (R01's) and career development (K)
    awards for new investigators. Holding the line on the NIH budget is to
    worsen a palpable threat scientists now feel--that of being squeezed
    out of a zero-sum game where more and more scientists are fighting each
    other and the rising cost of research in order to launch and sustain
    promising careers. This is especially devastating to new investigators,
    in whom we are investing our future hopes of American world leadership
    in health research.
        Therefore, the JHS at this point in its evolution can be thought of
    as a major platform for scientific discovery--an incredible growing
    database that is a national resource. If the growing brain trust of
    scientists--in Jackson as well as Boston, Bethesda, Minneapolis,
    Baltimore, New York, Chicago and elsewhere--who are showing active
    interest, receive funding for meritorious ideas, the JHS stands to
    produce important breakthroughs in our understanding of the CVD
    patterns seen in AA and others. However, if flat pay lines prevent the
    funding of new ideas for using this unparalleled resource, the
    trajectory of discovery will be blunted, the pace of advance slowed,
    and important scientific opportunity, squandered. And the wisdom shown
    by NCMHD and NHLBI in building this platform for discovery will be in
    many ways betrayed.
        We cannot afford to squander any opportunities to improve health
    overall and eliminate health disparities. I witness the impact of
    failed promises everyday. Among my patients, I see the end result of
    our incomplete understanding of heart disease: in young mothers whose
    hearts fail after childbirth for no good reason--though we have a name
    for it--peripartum cardiomyopathy--we don't understand it, and we don't
    understand why it afflicts Blacks more than other Americans. I see it
    in fathers with no known risk factors, but develop coronary disease
    anyway. I see it in people suffering from morbid obesity who not only
    are at increased risk for disease, but because of their size,
    therapeutic and diagnostic interventions themselves are technically
    much more difficult. Standard operations are often riskier, and
    sometimes impossible to perform. With 1,200 unnecessary deaths from CVD
    among AA in our small Southern state alone, deferring the dream of
    health equality only adds to our regional tragedy of health
    disparities. With 80,000 unnecessary deaths nationally among African
    Americans in 2004 (most from CVD) research retrenchment in the form of
    flat lining or cutting the research budget only defers finding answers
    that were needed yesterday for our Nation's health. An act of national
    compassion and strong resolve is necessary. I pray that this Congress
    and President will engage this great threat to the dream of a healthy,
    vigorous nation. It is in our compelling national interest to do so.
        Thank you, Mr. Chairman. I would be pleased to answer any questions
    that the Committee may have.

        Senator Specter. Thank you very much, Dr. Taylor.
        Our final witness is Dr. Suzanne Vogel-Scibilia,
    representing the National Alliance for Mental Illness.
    STATEMENT OF SUZANNE VOGEL-SCIBILIA, M.D., PRESIDENT,
                NATIONAL ALLIANCE ON MENTAL ILLNESS
        Dr. Vogel-Scibilia. Greetings from Beaver County,
    Pennsylvania, Senator Specter.
        I'm a volunteer with----
        Senator Specter. Whereabouts? Where?
        Dr. Vogel-Scibilia. Beaver.
        Senator Specter. Thank you.
        Dr. Vogel-Scibilia. I'm a volunteer at NAMI and the
    president of the National Alliance on Mental Illness, and I
    have been a practicing psychiatrist and a family member of
    persons with mental illness as well as a consumer with bipolar
    disorder myself. I have had periods of severe illness, but I
    have had a good recovery.
        Unfortunately, though, many people in our country have not
    yet achieved recovery. If Congress cuts funding at the NIMH as
    the President has suggested, we will have to continue to have
    millions of people in this country with chronic disability and
    a $40 billion loss in economic productivity each year alone for
    schizophrenia, not to mention other illnesses.
        Because of the past doubling of the research budget, NIMH
    has brought forth vitally important real world trials to impact
    the treatment of all persons with schizophrenia, bipolar
    disorder, and depression. Unfortunately, though, the future
    gains in medication and treatment options for this vital
    research will not be realized unless further medical support is
    given to these important studies. We will be unable to fund the
    United States whole genome studies for serious mental illness,
    which could transform the understanding of causes and risk
    factors for these devastating illnesses and open up new avenues
    of effective treatment.
        Last, we will be unable to advance schizophrenia and
    bipolar research progress. One example is in the understanding
    if early intervention and medication therapy and rehabilitation
    will prevent disability and morbidity for persons with new
    onset schizophrenia. We will also be unable to address and
    prevent the epidemic of suicide in this country, including a
    substantial number of our young people who die or are disabled
    before their life has truly started, and the elderly who are
    cheated from their retirement years.
        For myself, my children, and the people who belong to over
    1,100 affiliates of NAMI in the United States of America, we
    humbly thank you for all your reform to express our concerns
    and hope that research dollars will be provided to help those
    of us who suffer.
        Thank you very much.
        Senator Specter. Thank you very much, Dr. Vogel-Scibilia.
        One question, Dr. Taylor. When you say ``unnecessary
    deaths,'' how would you define that?
        Dr. Taylor. Yes. The term, sir, refers to deaths that you
    would not expect, given statistical projections, given the
    current level of care and our understanding of risk factors for
    cardiovascular disease. So these are people who--a certain
    number of people are expected to die, of course, from certain
    diseases, like heart disease, every year. Well, these are
    people who you would not expect to have died. Dr. Satcher and
    others have termed these ``unnecessary deaths.''
        Senator Specter. You are saying in effect that that is
    higher for blacks, African Americans, than others?
        Dr. Taylor. Senator, it is substantially higher. Again, the
    national prediction is that 80,000 of these deaths occur from a
    variety of causes and the lion's share of those deaths are due
    to cardiovascular causes.
        Senator Specter. What is the reason for the higher
    incidence of deaths among blacks?
        Dr. Taylor. Well, this is the principal focus of the
    Jackson Heart Study and studies like it, to figure that out.
    Clearly there are higher levels of risk factors, such as
    obesity, hypertension, diabetes. But one must ask the question,
    why are those risk factors higher? We cannot simply say, well,
    there is more hypertension, therefore we expect more deaths.
    The question is why is there more hypertension and related
    problems?
        Also, access to care clearly is a major part of this. But
    historically, African Americans as a group have been
    understudied with regards to what are the true determinants of
    poor health. Studies like the Jackson Heart Study and studies
    related to it I think will help unravel these questions and
    give us detail that we might not even suspect at this point.
    The Jackson Heart Study, for instance, includes studies into
    genetic underpinnings of various illnesses. But on the opposite
    end perhaps of the spectrum, we look very carefully at
    psychological determinants of ill health, at social and
    behavioral parameters that may also impact how well people do
    in terms of their overall health.
        Senator Specter. Senator Shelby.
        Senator Shelby. Thank you, Mr. Chairman.
        Ms. Raymond, what funding do we really need to sustain
    research into lupus at NIH in your judgment?
        Ms. Raymond. Well, presently the amount of funding now
    allocated is around $66 million. In order to really sustain and
    break through, I think we need $200 million.
        Senator Shelby. That is a lot of money.
        Ms. Raymond. A lot of money.
        Senator Shelby. But a lot of promise, too.
        Ms. Raymond. I think so. We have many deaths due to lupus.
        Senator Shelby. Absolutely.
        Ms. Raymond. It is a fatal disease. It is prototypical
    because it affects any organ system, any tissue system in the
    body.
        Senator Shelby. 90 percent of them are women, are they not?
        Ms. Raymond. 90 percent are women and a majority are women
    of color, African American, Hispanic, Asian, and Native
    Americans.
        Senator Shelby. Dr. McDonnell, macular degeneration. What
    is the real promise once you are diagnosed in that area?
        Dr. McDonnell. Well, Senator, this is now with the tidal
    wave of aging Americans, this has taken over from diabetes as
    the major cause of Americans to go blind. It is a progressive
    disease involving--it is almost our Alzheimer's or
    Parkinson's--a neuro- degenerative condition of the cells of
    the retina, of the back of the eye. The eye is part of the
    brain, and this progression occurs.
        Now we believe we have some dietary supplements that may
    slow the progression.
        Senator Shelby. What are these?
        Dr. McDonnell. Anti-oxidant vitamins and zinc have been
    shown, thanks to an NEI-funded study, to delay the progression
    to severe forms of the macular degeneration. Now, we have some
    treatments that can treat severe forms with blood vessels that
    are causing leakage and bleeding and scarring in the back of
    the retina. We also hope to be able to begin and expand upon
    studies of regenerative medicine using stem cells, such as
    would be done in other fields, to restore the cells that are
    lost or damaged from this disease.
        Senator Shelby. So there is great promise everywhere in
    biomedical research. It has just got to be properly funded. Is
    that the bottom line?
        Dr. McDonnell. I agree with that. As you heard, lupus also
    damages the eye. The eye is part of the brain. Fortunately, not
    all patients are afflicted in the eye, but we have patients go
    blind and we need the same treatments that would improve the
    kidney damage and brain damage of lupus also for our eye
    patients.
        Senator Shelby. Thank you.
        Mr. Chairman, thank you.
        Senator Specter. Thank you, Senator Shelby.
        Senator Harkin.
        Senator Harkin. Thank you, Mr. Chairman.
        Dr. Landrigan, thank you for bringing up the children's
    study. That is why I brought it up earlier. You talked about
    the benefits to children, but would it not also benefit adults
    also? I mean, obviously obese children have later complications
    as they grow older. Many of the things that happen to you in
    childhood you carry with you, especially mental health. If you
    have mental health problems early in life and they are not
    attended to, it can manifest itself later on.
        So I just wanted to draw you out a little bit on that in
    terms of the benefits of the children's study, not just to
    kids, but I think across the spectrum.
        Dr. Landrigan. Yes, Mr. Harkin, that is absolutely true.
    There is an expanding body of research, called the early
    origins of adult disease hypothesis. For example, slow fetal
    growth of the baby still in the mother's womb is associated in
    young adult life with an increased risk of diabetes,
    hypertension, and heart disease. There are some intriguing
    clues, more from animal studies than human at the moment, that
    early exposures to toxic chemicals may cause brain damage that
    does not become manifest in childhood, but shows up four, five,
    six decades later in the form of dementia or Parkinson's
    disease.
        So I think it is both to protect America's kids as well as
    future generations of adults that we are seeking the full
    funding for the study to be restored in fiscal year 2007, which
    would be $69 million, and also assurances that the study will
    continue to be funded in the years ahead. It will not succeed
    unless the funding for it is sustained.
        Senator Harkin. Thank you very much.
        Mr. Chairman, I do not have any further questions. I would
    just again for the record state, Mr. Chairman, that you and I
    and others on this committee had planned for this children's
    study. It was passed in 2000. A lot of planning went into this
    and forethought went into it to set up this long-term study,
    and I just cannot believe that we are just going to just stop
    it at this point in time.
        So we have just got to do everything we can to mandate, if
    we have to, mandate--I do not know if there is anyone here from
    OMB, but mandate--that this funding go forward this next year.
        Thank you very much.
        Senator Specter. Thank you. Thank you, Senator Harkin.
        I thank all of you. We are fighting. We put up a Specter-
    Harkin amendment and added $7 billion to the budget in the
    Senate. Unfortunately, that has not been accomplished in the
    House. We have added from that $7 billion $2 billion for the
    National Institutes of Health.
        But this is a battle that really has to be engaged in by
    110 million Americans who are suffering directly or indirectly
    from the kinds of illness which we have heard about here today.
        We thank you for coming in. This has been an impressive
    hearing because it puts a face on these ailments. They are sort
    of abstractions. They are not abstractions if your wife is
    suffering from them or a close relative or a close friend or
    you are suffering from them. They are not abstractions at all.
    But there has to be a very intense advocacy effort. We call it
    lobbying around here. It is really advocacy. Your organizations
    are very, very important in this advocacy effort. We thank you
    for what you are doing. But you have to contact your
    counterparts everywhere.
        The amendment which Senator Harkin and I sponsored won 73
    to 27, but there were 27 Senators who voted no and you ought to
    identify them and you ought to march on them in their cities,
    in their States, seriously, very, very seriously. It is a
    little hard, with all that Senator Harkin and I have to do--he
    has got to bounce out of here and go to Iowa for a meeting
    later today and I have got to conduct a hearing on campus
    violence in Philadelphia at 2 o'clock. I have not been in my
    office all week. I have been on the floor managing the
    immigration bill. Before that I was fully occupied with the
    Supreme Court nominations.
        But your groups are advocates and I would like to see that
    million person march. But it has got to be done. We are a
    democracy and people in Washington pay attention to people in
    their home States. If I get seven letters, I have got 12
    million constituents, I think it is significant. You have
    really got to be more politically active, not Democrat or
    Republican active, but active for these issues, active for NIH,
    active for stem cells.
        I am convinced there are cures for all of these ailments
    and we have the resources to do it. It is a question of how
    many doctors and hospitals and research scientists and
    dedicated people you have. It is not a matter of how many
    dollars you have. It is a matter of what your resources are.
    The money flow comes out of Washington to a large extent, also
    out of your State capitals.

                         ADDITIONAL COMMITTEE QUESTIONS

        There will be some additional questions which will be
    submitted for your response in the record.
        [The following questions were not asked at the hearing, but
    were submitted to the Department for response subsequent to the
    hearing:]
                  Questions Submitted by Senator Arlen Specter
                         liver disease research branch
        Question. Dr. Zerhouni, 3 years ago, the NIDDK established a Liver
    Diseases Research Branch within its Division of Digestive Diseases and
    Nutrition. Please explain the benefits of having a Research Branch
    dedicated to a specific area of research and describe how this Liver
    Disease Research Branch has succeeded in its mission.
        Answer. Research on diseases of the liver is a trans-NIH effort
    involving 19 institutes, centers, and offices. The National Institute
    of Diabetes and Digestive and Kidney Diseases (NIDDK) has lead
    responsibility for liver disease research at the NIH. Within the NIDDK,
    liver disease research is under the purview of the Division of
    Digestive Diseases and Nutrition. The Federal liver disease research
    effort has benefited greatly from the establishment in 2003 of an
    organizational entity within the NIDDK--the Liver Disease Research
    Branch--dedicated exclusively to this very important area. This new
    Branch was formed to focus and coordinate research efforts on critical
    areas relevant to liver and biliary disease, such as hepatitis and
    liver transplantation.
        Following a national search, Jay H. Hoofnagle, M.D., an
    internationally recognized authority in liver disease research, was
    appointed as Chief of this Branch. The NIDDK recruited an additional
    scientific Program Director with expertise in liver diseases to further
    support the efforts of the Branch. The Branch also includes scientific
    experts in the areas of viral hepatitis, clinical trials, epidemiology
    and data systems, genetics and genomics, and research training and
    career development.
        The Liver Disease Research Branch has accelerated research on liver
    disease supported by the NIDDK and has helped to coordinate and
    stimulate liver-related research efforts across the NIH and within
    other Federal agencies, such as the Centers for Disease Control and
    Prevention, the Department of Defense, the Bureau of Prisons, the Food
    and Drug Administration, and the Department of Veterans Affairs. An
    initial important task set for the Branch was to prepare the trans-NIH
    Action Plan for Liver Disease Research. The Plan provides an overview
    of the current burden of liver disease in the United States, the
    current level of NIH research funding in liver disease, and recent
    research advances. Importantly, the Plan also summarizes challenges to
    advancing liver disease research and delineates the major goals for
    future research. Specific goals for the next 10 years are defined for
    each of 16 topic areas in liver disease research.
        One mission of the Branch is to oversee the conduct of the Plan,
    which includes annual Progress Reviews to aid in its implementation
    through an ongoing assessment of progress and the need for further
    efforts to promote liver and biliary disease research. The Progress
    Review for 2005, the first year following release of the Action Plan,
    is available at: http://www.niddk.nih.gov/fund/divisions/ddn/ldrb/
    Progress_reviews.htm. The Branch also develops and coordinates future
    NIH efforts in liver disease research aimed at reaching the goals
    defined in the Plan.
        Thus, the Branch is succeeding in its mission to plan and direct
    the NIH program of liver research, as evidenced by an impressive array
    of initiatives that include major clinical trials and special program
    announcements in the areas of proteomics of the liver, biomarkers for
    liver disease, non-invasive tests for diagnosis and staging of liver
    disease, and ancillary studies linked to specific clinical trials,
    databases and cohort studies on liver disease (http://
    www.niddk.nih.gov/fund/program/DDN-list.htm#Liverprograms).
                      urology research strategic planning
        Question. Our conference report last year ``urged the NIDDK to
    continue to support and develop the `Urologic Diseases in America'
    report and to include urological complications as well as diabetes and
    obesity research initiatives.'' This language was included in response
    to concern that the NIH-wide Obesity Strategic Plan did not address
    urological issues such as, stress urinary incontinence or erectile
    dysfunction (ED), two conditions highly associated with obesity. These
    conditions severely affect quality of life and result in high medical
    costs. How do you ensure that all disciplines are represented in
    strategic planning?
        Answer. The NIH acts to ensure that its strategic planning efforts
    for research are comprehensive, inclusive, and evidence-based.
    Currently, strategic planning is conducted by the individual
    Institutes, Centers, and Offices of the NIH, as well as through trans-
    NIH and interagency mechanisms, as appropriate. The NIH Office of
    Portfolio Analysis and Strategic Initiatives, which I established
    recently, will have an instrumental role in facilitating both
    individual and trans-NIH strategic planning efforts through its planned
    activities.
        To ensure effective planning processes, the NIH seeks input from a
    wide array of stakeholders, including scientific experts,
    representatives from professional organizations, and patient advocates.
    For example, most strategic planning for urologic diseases research is
    conducted by the National Institute of Diabetes and Digestive and
    Kidney Diseases (NIDDK). In two major planning efforts, the NIDDK
    assembled large, multidisciplinary groups of scientists and medical
    professionals prominent in their fields and active in patient and
    professional societies related to bladder disease in 2002, and in
    pediatric urology in 2006. These groups were thus able to bring
    multiple perspectives to bear when reviewing progress in bladder
    disease and pediatric urology research, and to provide broad-based
    assessments of research needs and recommendations for future action,
    including recommendations regarding the impact of obesity and diabetes
    on certain urologic diseases. As a result, these groups' 2002 and 2006
    reports have served as a model for NIH planning for urologic diseases
    research and for trans-NIH collaborations in this area. Moreover, the
    NIDDK has continued to gather multidisciplinary expert groups to assist
    in more focused areas of research planning, such as prostate disease,
    and urologic diseases in women. All of these efforts are bolstered by
    the Urologic Diseases in America report, which has provided significant
    information related to major urologic diseases. The NIDDK is strongly
    committed to maintaining this program, and a research solicitation is
    being developed for the next phase of Urologic Diseases in America that
    will include assessment of the impact of diabetes and obesity on
    urologic diseases. Additional, ongoing assessments of research progress
    in urologic diseases through advisory group meetings, scientific
    conferences, and stakeholder input allow flexibility, capitalization on
    new research advances, and the opportunity to strategically address
    research gaps and barriers that may emerge or become evident over time.
        The Strategic Plan for NIH Obesity Research, developed by the NIH
    Obesity Research Task Force, similarly drew upon a broad base of
    scientific expertise within and external to NIH. The plan focuses, in
    part, on goals and strategies to break the link between obesity and its
    associated health conditions. Recommendations from this and other plans
    and from ongoing strategic planning efforts are reflected in NIH
    action. For example, the NIDDK has funded the Program to Reduce
    Incontinence by Diet and Exercise (PRIDE) study, which is examining the
    impact of weight loss on urinary incontinence in overweight and obese
    women. The benefits of considering multiple disciplines in research
    planning can be seen in research results. For example, the NIH-funded
    Diabetes Prevention Program recently found that weight loss improves
    bladder control in women with prediabetes. This new knowledge, that an
    intervention proven to reduce risk of type 2 diabetes can also reduce
    episodes of urinary incontinence, has the potential to improve health
    and quality of life for the large number of older American women who
    have both prediabetes and bladder control problems. The NIH has also
    been supporting a similar study in patients with type 1 diabetes who
    are participating in the Epidemiology of Diabetes Interventions and
    Complications study, to determine whether intensive control of blood
    sugar levels--an intervention proven to reduce risk of developing eye,
    kidney, nerve, and cardiovascular complications of diabetes--also
    reduces risk of urologic complications.
                        opasi trans-nih funding program
        Question. Dr. Zerhouni, you have initiated a new trans-NIH funding
    program, which requires each Institute and Center to contribute a fixed
    portion of their appropriations for cross-cutting research initiatives.
    Can this program move forward as planned in an environment of no real
    increases in NIH funding?
        Answer. The Administration has focused resources on our highest
    priority: protecting the citizens and our homeland. This underscores
    the importance of being as strategic as possible with NIH dollars to
    catalyze high-impact research. The time is right for NIH to take a more
    coordinated approach to the development and funding of trans-agency
    initiatives by asking each IC to pool a very small proportion of their
    appropriation in a Common Fund for shared needs. This is true not only
    because of the difficult budgets, but also because many of the most
    exciting scientific opportunities and pressing public health challenges
    we now face cut across the mission areas of multiple institutes and
    centers. Thus, the creation of this new trans-NIH funding stream will
    actually enable the NIH to be more proactive in addressing emerging
    scientific needs and opportunities; to fund high-risk, high-impact
    science; and to incubate and launch pilot efforts that have
    transforming potential for all of science.
                           the heart truth road show
        Question. As a member of the Congressional Heart and Stroke
    Coalition, I am concerned that heart disease remains the leading cause
    of death of women in the United States, but many women do not realize
    this fact. I know that for the past several years, the NIH has been
    working with the fashion industry in your Heart Truth Campaign to
    increase women's knowledge about their No. 1 killer and that the Heart
    Truth Road Show stopped in Pittsburgh recently. Please explain to the
    Committee about the progress of this initiative?
        Answer. The National Heart, Lung, and Blood Institute's (NHLBI) The
    Heart Truth campaign continues to flourish, extending the reach of the
    campaign in a variety of ways.
      --As the campaign ambassador, First Lady Laura Bush is leading the
            federal effort to give women a personal and urgent wake-up call
            about their risk of heart disease, participating in more than a
            dozen Heart Truth events around the nation over the past 3
            years.
      --Corporate partners, including General Mills, Minute Maid, and
            DermaDoctor, have featured the campaign's Red Dress (emblematic
            of the message ``Heart disease doesn't care what you wear; it's
            the killer of women'') on more than 60 million product
            packages. Johnson & Johnson, L'eggs hosiery, Benecol, Starkist
            Tuna, and Celestial Seasonings have promoted The Heart Truth
            campaign and Red Dress logo in newspaper advertising inserts,
            resulting in a combined circulation of 370 million.
      --The Red Dress Collection 2006 Fashion Show took place on the third
            annual National Wear Red Day--Friday, February 3, 2006. People
            throughout the country participated in the day's celebration to
            increase awareness of women's heart disease.
      --The Heart Truth Road Show visited shopping malls in Pittsburgh,
            Memphis, and Washington, DC, in the spring of 2006 to raise
            awareness about women and heart disease by helping participants
            learn about risk factors; providing free health screenings
            including blood pressure, body mass index, total blood
            cholesterol, and blood glucose; and disseminating educational
            materials.
      --The campaign launched ``Know The Heart Truth'' in April 2006, an
            initiative that is recruiting and training health advocates and
            educators in local communities to increase awareness about
            women and heart disease. The Heart Truth has also formed
            partnerships with leading organizations representing women of
            color to engage in national and local activities, including a
            faith-based initiative, to help women reduce their risk for
            heart disease.
        The impact of The Heart Truth campaign is already becoming
    apparent. Awareness of heart disease as the leading cause of death
    among American women increased from 34 percent in 2000 to 46 percent in
    2003 to 55 percent in 2005. A 2005 survey commissioned by WomenHeart
    found that 60 percent of U.S. women agreed that the Red Dress makes
    them want to learn more about heart disease. Twenty-five percent of
    women recalled the Red Dress as the national symbol for women and heart
    disease awareness and 45 percent agreed that it would prompt them to
    talk to their doctor and/or get a check-up. A Lifetime Television
    Women's Pulse Poll released in February 2006 showed that women are
    increasingly aware of the dangers of heart disease. Thirty-nine percent
    of survey participants recognized the Red Dress as the national symbol
    for women and heart disease awareness, up from 25 percent in 2005.
                                     stroke
        Question. Following up on language from last year's congressional
    report, please provide this Committee with highlights of implementation
    progress on the Stroke Progress Review Group report.
        Answer. In 2001, the NINDS convened the first meeting of the Stroke
    Progress Review Group (SPRG) to identify and prioritize scientific
    opportunities and needs in stroke research. One hundred forty prominent
    scientists, clinicians, patient advocates, and industry representatives
    participated and developed a set of scientific and resource
    recommendations that the NINDS assembled in a Report of the SPRG in
    2002. In 2003, the chairs of the SPRG meeting reprioritized their
    recommendations and identified a subset of high priorities for stroke
    research in an Implementation Report. Many of the following research
    activities address the scientific research and resource priorities
    identified by the SPRG in its 2002 Report and 2004 Implementation
    Report.
        The NINDS is funding a wide range of studies on the basic biology
    of stroke, including the role of the blood-brain barrier (BBB; the
    cellular barrier that controls the exchange of substances between the
    blood and the nervous system) and the neurovascular unit (NVU; the
    functional ``unit'' comprised by brain blood vessels, glial support
    cells, and neurons). Understanding the function of the NVU and the BBB
    in stroke is critical to developing strategies for treating and
    preventing stroke and related conditions such as vascular cognitive
    impairment (VCI). NINDS is supporting a variety of stroke-related
    studies focused on the roles of the NVU and the BBB under two recent
    Program Announcements with set-aside funding. To more fully understand
    the biological basis of VCI, the Institute held a workshop in June 2006
    to discuss the cell biology of VCI and develop recommendations to
    accelerate research in this area.
        To facilitate the translation of basic research findings into the
    clinical setting, NINDS is planning to expand its Specialized Programs
    of Translational Research in Acute Stroke to include seven programs
    across the country participating in clinical trials, training of
    research fellows, and translational research on stroke. In addition,
    NINDS released two new grant solicitations to address barriers to
    translational research in stroke.
        The NINDS also continues to fund many clinical trials involving
    potential interventions and preventive strategies for stroke. To
    improve outcomes for stroke patients in emergency-room settings, the
    NINDS is developing a Neurological Emergencies Treatment Trials (NETT)
    Network of emergency medicine physicians, neurologists, and
    neurosurgeons, and plans to fund the clinical coordinating center
    component of the NETT in fiscal year 2006. The Institute is also
    supporting research on the causes of stroke among high risk groups,
    improved methods for diagnosing stroke, and a range of educational
    outreach programs to increase awareness of stroke risk factors and
    symptoms.
        In September 2006, the NINDS will sponsor another meeting of the
    SPRG to assess research progress in stroke, evaluate current
    priorities, and identify new opportunities for advancing stroke
    research. Prior to the meeting, 16 working groups will assess progress
    and develop recommendations for future priorities on topics ranging
    from genetics of stroke to recovery and rehabilitation. NINDS solicited
    information from the stroke research community on research progress and
    remaining needs and research gaps, and will provide this feedback to
    the SPRG participants prior to their deliberations. Following the
    September meeting, the SPRG will produce a mid-course implementation
    report that reflects the current status of stroke research and
    identifies new priorities.
                   clinical and translational science awards
        Question. You have announced that by the year 2010, the GCRC
    program will have been phased out and the funding transferred to a new
    program. How are you going to assure that the CTSAs maintain or enhance
    services currently provided by the GCRCs including specialty nursing
    care, patient facilities, laboratory testing, and specialized
    monitoring and diagnostic capabilities?
        Answer. Applicants for the Clinical and Translational Science
    Awards (CTSAs) are asked to propose a center, department, or institute
    for clinical research that will transform the clinical and
    translational research environment at their institution. Up to $6
    million additional funds may be requested in addition to certain
    National Center for Research Resources (NCRR) and NIH Roadmap awards
    held by the institution at the time of application. These additional
    funds may be used to transform the local, regional, and national
    environment for clinical and translational science, thereby increasing
    the efficiency and speed of clinical and translational research. By
    introducing CTSAs as an increase in support, NIH is allowing applicants
    to retain such services as are currently provided by the General
    Clinical Research Centers (GCRCs) that they deem needed for their
    clinical research, such as inpatient and outpatient facilities,
    laboratory testing, and specialized monitoring and diagnostic
    capabilities.
        Question. You have announced that by the year 2010, the GCRC
    program will have been phased out and the funding transferred to a new
    program. How will you monitor the impact on the vitally important
    clinical research support currently provided to patients and
    investigators through the GCRCs?
        Answer. NIH staff review GCRC Annual Reports, communicate
    frequently with grantees, and attend annual meetings with Center
    grantees in Washington, DC. Clinical and Translational Science Awards
    likewise will submit Annual Reports and will establish Steering
    Committees on which NIH will be represented. These various tools and
    forums provide opportunities to assess the impact of the Clinical and
    Translational Science Awards and General Clinical Research Centers and
    will assure NIH of the requisite monitoring for impact on clinical
    research support.
        Question. You have announced that by the year 2010, the GCRC
    program will have been phased out and the funding transferred to a new
    program. Will institutions that lose their existing GCRC funding and do
    not receive CTSA awards be able to support patient-oriented research
    facilities and services?
        Answer. The 60 CTSAs that NIH plans to award could support over 90
    percent of the institutions that currently have GCRCs. Researchers that
    perform patient oriented research at institutions that do not receive
    CTSAs may apply for investigator-initiated NIH research supported by a
    variety of NIH grant mechanisms including Research Project and Research
    Program Projects and Centers grants. Additional sources of research
    support for investigators may come from Research Foundations,
    partnerships with industrial sponsors and institutional funds.
        Question. You have announced that by the year 2010, the GCRC
    program will have been phased out and the funding transferred to a new
    program. Will researchers in these institutions have to cancel planned
    patient-oriented research projects because of inadequate facilities?
    Certainly, the NIH budget is too constrained to provide this support
    through other competitive mechanisms.
        Answer. Researchers in the institutions that do not receive
    Clinical and Translational Science Awards may apply for investigator
    initiated NIH research supported by numerous NIH grant mechanisms
    including Research Project and Research Program Projects and Centers
    grants. Research Foundations, partnerships with industrial sponsors,
    and institutional funds may also provide additional sources of research
    support for investigators.
        Question. The K12 training mechanism is required for the CTSA
    award. Why isn't the GCRC M01 mechanism required? The RFA appears to
    marginalize the GCRCs and their functions, and I am concerned about
    that. Why not require the M01 mechanism in the CTSA award RFA in 2007?
        Answer. Applicants for a CTSA are required to include a Mentored
    Clinical Research Scholar Award (K12) component in their proposal so as
    to promote clinical and translational research as a distinct
    discipline. There is no requirement for applicants to be K12 awardees
    for them to apply for a CTSA. NCRR has not made an M01 award an
    eligibility requirement for a CTSA application in the expectation that
    certain new affiliations amongst institutions that do not currently
    hold an M01 award would be strong enough to compete successfully. CTSAs
    will support the discipline of clinical and translational science and
    the needs of its researchers, so applicants are encouraged to look
    beyond the constraints of M01 awards and to propose novel concepts,
    methodologies, and approaches that could be integrated into a
    comprehensive, effective, and efficient researcher-, trainee-, and
    participant-centered clinical research program.
        Question. Could NIH maintain a GCRC or mini-GCRC program for
    institutions that have had strong GCRCs, historically, but do not
    receive CTSA awards.
        Answer. NCRR has received wide support for the new CTSA program, so
    we believe that the purposes of clinical research will best be served
    by a smooth and uninterrupted transition. Several new consortia are
    expected to apply for CTSAs and clinical research at those sites that
    compete well in the peer review process should not be delayed by
    prolongation of the GCRC program. Retaining the GCRC program would
    limit the funding available for the CTSA program and NIH believes that
    this would be detrimental to the needs and interests of the majority of
    clinical investigators.
        Question. Have you considered the possibility of a ``pause'' after
    the second year of implementation to evaluate the effectiveness and
    impact of the new CTSA program before proceeding with additional
    awards?
        Answer. The combination of Annual Reports with Clinical and
    Translational Science Award Steering Committees will assure NIH of the
    requisite evaluation opportunities during their implementation. In the
    event that changes are required to optimize the award functionality,
    they can be made without the delays that would be incurred through a
    ``pause'' in making awards.
        Question. Do you have a fall-back plan if the budget is not
    sufficient to accommodate the implementation of the CTSA program as you
    envision it?
        Answer. Transformation of Clinical Research infrastructure programs
    from GCRCs to CTSAs will be funded principally by NCRR appropriated
    funds, with additional funds from the NIH Roadmap for Medical Research.
    The project period for CTSA grants is 5 years, and NIH is planning for
    an additional 5-year competitive renewal of these awards. The fiscal
    year 2006 funding level for the combined CTSA/GCRC program is
    $322,740,000 and their estimated fiscal year 2007 funding level is
    $361,200,000. NIH plans to award four to seven CTSAs in fiscal year
    2006, to increase the number of awards annually, and to have 60 CTSAs
    in place by 2012. While changes in Congressional Appropriations would
    affect both the GCRC and CTSA programs in parallel, the transformation
    of the GCRC program to CTSAs is occurring in response to user demand.
                           polycystic kidney disease
        Question. The Food and Drug Administration has granted ``Fast
    Track'' designation for Tolvaptan, a promising drug therapy designed to
    retard disease progression in polycystic kidney disease (PKD) and thus
    prevent kidney failure. What does the NIH plan to do to make the most
    of this discovery and foster the development of further PKD therapies?
        Answer. The NIH is committed to research that will pursue
    opportunities to combat polycystic kidney disease (PKD)--a serious,
    burdensome, and costly disease. Within the NIH, the National Institute
    of Diabetes and Digestive and Kidney Diseases (NIDDK) supports a
    diverse portfolio of basic and clinical research into the underlying
    biology of and possible therapies for PKD. The Interdisciplinary
    Centers for Polycystic Kidney Disease Research are important components
    of this research portfolio. The NIDDK recently renewed funding for four
    Centers for five additional years. Three of the Centers focus on the
    more common autosomal dominant PKD (ADPKD), and will explore
    extensively the basic and clinical functional changes seen in ADPKD.
    The fourth is a Research and Translational Core that focuses on
    autosomal recessive PKD (ARPKD) and will make available to
    investigators in the field a broad range of model research systems and
    reagents for the study of ARPKD.
        The Institute also has two other major research projects related to
    PKD--the HALT-PKD trial network, and the Consortium for Radiologic
    Imaging Studies of PKD (CRISP) cohort study. CRISP was established to
    develop innovative and standardized imaging techniques and analyses
    that would allow clinicians to reliably follow disease progression of
    ADPKD. This four-year study followed 240 PKD patients with annual
    glomerular filtration rate evaluation (a measure of kidney function),
    and magnetic resonance imaging to assess changes in kidney volume over
    time. The first phase of CRISP was recently completed, and the primary
    study results were published in the New England Journal of Medicine in
    May 2006 (NEJM 354: 2122-2130, 2006). Although the preliminary findings
    show promise for use of imaging methods and structural endpoints for
    tracking progression of ADPKD, the NIDDK has extended the CRISP cohort
    study for another five years, in order to collect additional structure
    and function data on enrolled subjects. Additional data from CRISP II
    will enable investigators to assess how reliably structural changes can
    predict functional kidney changes over time in ADPKD. The CRISP II
    investigators are currently developing the protocol for the next phase
    of the study.
        The Polycystic Kidney Disease Clinical Trials Network, co-funded by
    the PKD Foundation, is conducting two phase III-type studies in the
    HALT-PKD trial--one in patients with early kidney disease and another
    in patients with more advanced disease. HALT-PKD is testing whether
    blockade of the renin-aldosterone-angiotensin system, with angiotensin-
    converting enzyme inhibitor monotherapy or combination angiotensin-
    converting enzyme inhibitor and angiotensin receptor blocker, will slow
    the progression of ADPKD. A partnership was also negotiated with
    industry to provide medications for testing in these studies. The HALT-
    PKD trial in subjects with early kidney disease is novel in that it is
    implementing the CRISP imaging methods in order to determine how
    reliable the methods are for interventional studies in ADPKD. The
    ability to reliably implement imaging methods for trials of ADPKD will
    have a significant impact on planning future interventional studies of
    new therapeutics in this disease. The HALT-PKD studies began enrolling
    patients in January 2006, and will be the largest interventional trial
    ever conducted in ADPKD.
                        national primate research center
        Question. The fiscal year 2006 Labor-HHS-Education Appropriations
    bill provided the NIH Office of AIDS Research with up to $4 million to
    spend for construction or renovation necessary to expand a breeding
    colony for non-human primates for AIDS research, which is intended to
    be collaborative effort amongst the National Primate Research Centers.
    What progress has been made on that effort, and what is the expected
    completion date?
        Answer. Although the fiscal year 2006 bill allows the Office of
    AIDS Research (OAR) to utilize funds for construction for the national
    breeding resource facility, funds will not be used for that purpose in
    fiscal year 2006. In late fiscal year 2005, the Tulane National Primate
    Research Center successfully competed for the first phase of a national
    breeding resource facility project. However, construction capability in
    this region has been limited in the aftermath of Hurricane Katrina.
    Thus the second phase of this project has not proceeded as scheduled.
    Consequently, OAR cannot use this provision of the fiscal year 2006
    appropriations bill this year. Instead, OAR provided funds to NCRR to
    support AIDS-related research infrastructure needs and increased
    operating expenses, such as unanticipated high energy costs, at the
    National Primate Research Centers (NPRCs). A timeline for completing
    the national breeding resource facility project is being reassessed.
                                     ______

                   Questions Submitted by Senator Tom Harkin
                         collaboration among institutes
        Question. Dr. Zerhouni, one of the most common complaints I hear
    from advocacy groups is that they can't get multiple NIH institutes and
    centers (ICs) to work together on common goals. Consider diseases like
    scleroderma, neurofibromatosis or epilepsy, all of which fall under the
    jurisdictions of more than one IC. In each case, one IC might be
    designated as taking the lead on the disease, but other ICs also share
    the responsibility for conducting research on it. Too often,
    unfortunately, patients complain that the ICs don't collaborate.
    Sometimes the patients themselves practically have to drag a researcher
    from one institute into a meeting with a researcher from another
    institute, just to get them to talk.
        I know you're well aware of this problem. It's an issue that the
    National Academies addressed in its report on NIH's structure in 2003.
    What are you doing to improve the situation?
        Answer. In 2002, I began a process called the Roadmap for Medical
    Research that was designed to identify major opportunities and gaps in
    biomedical research that no single institute at NIH could tackle alone
    to make the biggest impact on the progress of medical research. A
    primary accomplishment of the Roadmap was internal ``functional
    integration'' of the 27 institutes and centers (IC) to plan, implement
    and fund initiatives that go beyond the mission of any one IC. These
    accomplishments led to creation of the Office of Portfolio Analysis and
    Strategic Initiatives (OPASI) which has begun to institutionalize these
    processes. The establishment of OPASI represents a major organizational
    change at NIH aimed primarily at addressing challenges in the
    coordination of biomedical research of benefit to every IC. Using a
    combination of approaches such as agency-encompassing portfolio
    analysis and establishment of a common fund for shared needs, OPASI
    will synergize diverse components of the NIH toward the attainment of
    common goals more efficiently. Continuing the tradition of the NIH
    Roadmap, this office will also support well-developed initiatives that
    address areas of science which do not clearly fall within the mission
    of any one IC or program office. This makes OPASI a natural space for
    NIH ICs to work together on broad-reaching opportunities which will
    impact multiple aspects of public health and disease intervention.
                             conflicts of interest
        Question. Last August, NIH announced the final ethics rules on
    conflicts of interest. What impact are they having on employee
    retention and recruitment, and on interactions between NIH scientists
    and outside associations, such as trade groups and scientific
    associations?
        Answer. Regarding Employee retention and recruitment. In the
    preamble to the final rule (published in August 2005), we stated that
    we would review the rule to ``evaluate continued adequacy and
    effectiveness in relation to current agency responsibilities.'' We are
    particularly interested in learning about any effects that the
    prohibited holding and outside activities provisions of the rule have
    had on hiring and retention. We are currently in the process of
    conducting a survey of current NIH employees, collecting their feedback
    related to the new regulations. In separate surveys in the coming
    months, we intend to ask former employees (those who left the NIH after
    January 1, 2005) and potential employees their opinions as well.
        Interactions between NIH scientists and outside associations, such
    as trade groups and scientific associations. The regulations do not
    affect official duty interactions that scientists may have with trade
    groups or scientific associations.
                                  pandemic flu
        Question. We are all concerned about how long it would take between
    the time that we detected a pandemic flu virus in the United States and
    when we could create a vaccine for it. Right now, if a pandemic were to
    occur, I understand that it would take almost six months to produce a
    vaccine, using our current egg-based methods.
        HHS recently invested $1 billion in the development of new cell-
    based technologies to produce a pandemic vaccine. We're all looking
    forward to the results. But even if successful, a cell-based vaccine
    would not be immediately available at the time of a pandemic.
        The current methods of vaccine development are commonly referred to
    as the ``one drug, one bug'' philosophy--develop a vaccine for each flu
    strain or strains. But that means that you have to identify the ``bug''
    or flu strain before you can begin to manufacture a vaccine. However, I
    have heard that there is work being done to develop a vaccine that
    would address all strains of the flu--a ``one drug, many bugs'' plan.
    Is NIH supporting this type of research? Does it have promise?
        Answer. The National Institute of Allergy and Infectious Diseases
    (NIAID) is supporting research and development of alternate approaches
    to dealing with the threat of emerging and re-emerging infectious
    diseases such as influenza.
        For example, NIAID is pursuing the development of a ``universal
    vaccine'' that protects against multiple virus strains such as those
    resulting from antigenic drift associated with seasonal influenza and
    antigenic shift associated with pandemic influenza. As influenza
    viruses circulate, the genes that determine the structure of their
    surface proteins undergo small changes. Sometimes the change in the
    genes results in a slight change in the antigenic properties of the
    protein, a process commonly referred to as ``antigenic drift.''
    Antigenic drift is the basis for the changes in seasonal influenza
    observed during most years, and is the reason that we must update
    influenza vaccines annually. Influenza viruses also can change more
    dramatically. For example, viruses sometimes emerge that can jump
    species from natural reservoirs, such as wild ducks, to infect domestic
    poultry, farm animals, or humans. When an influenza virus jumps species
    from an animal, such as a chicken, to infect a human, the result is
    usually a ``dead-end'' infection that cannot readily spread further in
    the human population. However, mutations in the virus could develop
    that allow human-to-human transmission. Furthermore, if an avian
    influenza virus and another human influenza virus were to
    simultaneously co-infect a person or animal, the two viruses might swap
    genes, possibly resulting in a virus that is readily transmissible
    between humans, and against which the population would have no natural
    immunity. These types of significant changes in influenza viruses are
    referred to as ``antigenic shift.'' When an ``antigenic shift'' occurs,
    a global influenza pandemic can result. Historically, pandemic
    influenza is a proven threat. In the 20th century, influenza pandemics
    occurred in 1918, 1957, and 1968.
        The NIAID is supporting a number of research projects to develop a
    vaccine that induces a potent immune response to the common elements of
    the influenza virus that undergo very few changes from season to season
    and from strain to strain. Although this is a difficult task, such a
    ``universal'' influenza vaccine would not only provide continued
    protection over multiple seasons, it might also offer protection
    against a newly emerged pandemic influenza virus and thus substantially
    reduce the susceptibility of the population to infection by any
    influenza virus--making the country far less vulnerable to influenza
    viruses emerging from avian and other animal sources.
        One relatively stable element of the influenza virus is a protein
    called M2. The external portion of the M2 protein is very similar in
    influenza viruses from year to year and from strain to strain. A
    ``universal'' influenza vaccine targeting the M2 protein, or other
    conserved elements, could be protective against a range of influenza
    strains. NIAID-supported researchers have demonstrated that vaccines
    made with bioengineered versions of M2 can protect mice from lethal
    influenza virus. The scientists now are testing cross-reactivity
    between different species and strains of influenza, examining how long
    the immunity provided by these vaccines lasts, and evaluating whether
    the influenza viruses can evade these vaccines by developing mutations
    in their M2 proteins.
        In addition, researchers at the NIAID Vaccine Research Center (VRC)
    are developing and testing gene-based influenza vaccines that will
    protect against multiple strains of influenza. As a first step, initial
    candidate vaccines, each containing the gene encoding the hemagglutinin
    (H) surface protein of an influenza virus isolated from a recent human
    outbreak of influenza (H1N1, H3N2 or H5N 1), have already shown promise
    in animal studies. VRC researchers plan to develop additional gene-
    based vaccines for all common variants of hemagglutinin, as well as
    other influenza viral proteins, such as nucleoprotein and the M2
    protein. In the future, the VRC will incorporate both conserved and
    variable genes from multiple influenza strains into DNA and adenovirus
    vectors that can readily be produced by existing manufacturing
    processes.
        A second approach, while not technically a vaccine, is an immune
    enhancer which specifically targets a component of the immune system
    and enhances one's ability to respond to a broad range of microbial
    threats. Studies of the human innate immune system, which is comprised
    of ``first responder'' cells and other defenses that provide a first
    line of defense against a wide variety of pathogens, have been moving
    forward rapidly. These advances suggest it may be possible to develop a
    relatively small set of fast-acting, broad-spectrum countermeasures
    that can boost innate immune responses to many pathogens or toxins,
    including influenza. The capability to boost the innate immune system
    also could lead to the development of more powerful vaccine additives,
    called adjuvants, that can increase vaccine potency. The concept of
    immune enhancers has been demonstrated in early. stage clinical
    studies, but requires further research and development to be applied to
    pandemic influenza vaccination.
                                     ______

                Questions Submitted by Senator Daniel K. Inouye
                         traditional healing practices
        Question. Last year, at my request, Dr. Donald Lindberg, Director
    of the National Library of Medicine, visited one of our Native Hawaiian
    Healing programs at Papa Ola Lokahi for the purpose of conducting
    ``listening circles'' to discuss the needs for preservation and
    documentation of traditional cultural healing practices. I am very
    interested in a report of his findings from this visit. I am most
    appreciative of the National Library of Medicine's continued interest
    and support of Native Hawaiian issues.
        Answer. Early this year NLM convened a working group to examine
    both the feasibility of an exhibition on Native health and healing, and
    NLM's role in collecting and preserving information about traditional
    medicine. As a result of this working group, NLM has reviewed its
    collection to develop policies, as well as examined its collection in
    these areas. Subsequently, the Library has made an effort to collect
    modern publications such as all the items in the Bishop Museum's
    (Honolulu, HI) current catalog as well as their out of print materials.
        In addition to purchasing standard published materials, NLM is also
    obtaining input from Native American (including Native Hawaiian)
    healers, leaders, educators, and others, on appropriate collection and
    preservation policies. Over the past year, since the series of
    Listening Circles the NLM participated in with different Native
    Peoples, NLM staff have met with many such individuals to gain insight
    into the issues of collecting and preserving information about
    traditional healing practices. For example, in February, NLM staff met
    with librarians and curators from the Bishop Museum, Hawaiian
    Historical Society, The Hawaiian Mission Children's Society Library,
    and the University of Hawaii to gather information to planning a larger
    follow-up meeting.
        This meeting, to include NLM staff, occurred in July 2006, and a
    report of findings from this visit will be prepared.
                          developing nurse researchers
        Question. A long-standing supporter of the National Institute for
    Nursing Research, I am pleased with the extensive array of research
    initiatives that have been undertaken by the Institute. I am
    particularly pleased with those endeavors that are directed at
    developing the pool of nurse researchers who also become nurse faculty.
    Another important initiative is training support for fast-track
    baccalaureate to doctoral program participants. I welcome news of the
    Institute's progress in facilitating research projects in rural areas
    that serve minority students via community colleges.
        Answer. NINR considers the development of nurse researchers and
    nurse faculty to be a fundamental component of its research mission.
    Indeed, developing nurse investigators will be an overarching goal in
    the Institute's new strategic plan for 2006-2010.
        Approximately 7 percent of NINR's budget supports the Institute's
    Centers programs, which are used to develop the nursing research
    infrastructure and train new investigators. In addition to our ten Core
    and nine Exploratory Centers, we have co-sponsored a joint initiative
    with the National Center on Minority Health and Health Disparities that
    supports partnerships between established, research-intensive
    institutions and growing, minority-serving institutions. These Nursing
    Partnership Centers on Reducing Health Disparities, involving 17
    schools of nursing, will increase health disparities research and
    broaden the diversity of the nurse scientist pool. Several of these
    Centers are located in rural areas or serve rural and other underserved
    populations. These Centers represent a major investment aimed at
    expanding the cadre of nurse scientists involved in health disparities
    research.
                       baccalaureate to doctoral programs
        Question. A long-standing supporter of the National Institute for
    Nursing Research, I am pleased that the Administration has continued
    funding of this program. However, what impact will the $1 million
    reduction have on the National Institute of Nursing Research's
    development of initiative that supports fast-track baccalaureate-to-
    doctoral programs? These programs were proposed to help increase the
    number of nursing faculty and in turn decrease the number of qualified
    nursing school candidates who were turned away in prior years.
        Answer. The overall reduction of $792,000 in the fiscal year 2007
    budget request of $136.6 million for the National Institute of Nursing
    Research (NINR) will have no impact on its programs that fast-track
    baccalaureate-to-doctoral nurses to increase the number of nursing
    investigators. These programs are supported within the Research
    Training mechanism in NINR, and the fiscal year 2007 President's Budget
    maintains the current level of support of this activity. NINR remains
    committed to developing the next generation of nurse scientists. NINR
    encourages and supports strategies to change the career trajectory of
    nurse scientists. The Institute emphasizes early entry into research
    careers, including fast-track baccalaureate-to-doctoral programs, and
    supports pre-doctoral and postdoctoral nurses who are the future
    researchers and nursing faculty.
                                 cancer centers
        Question. The National Cancer Institute has had great success and
    demonstrated value in its system of cancer centers across the country.
    When awarding core grants for cancer research, is attention paid to
    geographic and ethnic diversity to ensure that results will capture the
    often significant differences in outcomes among various ethnic groups
    and lifestyles?
        Answer. The NCI-designated Cancer Centers are vital parts of a
    national strategy to reduce the suffering and death due to cancer. The
    NCI Cancer Centers Program provides critical infrastructure for
    academic and research institutions throughout the United States that
    provide broad based, coordinated, interdisciplinary programs in cancer
    research. These institutions are characterized by scientific excellence
    and a capacity to integrate various research approaches focused on the
    problem of cancer. Generally, in order to become an NCI-designated
    Cancer Center, an institution must have a large cancer-relevant grant
    funding base; substantial institutional commitment in the form of
    space, resources, and authorities provided to the Center Director; a
    synergistic organization of transdisciplinary research across all
    scientific areas of the institution; and, specifically for
    comprehensive centers, community outreach, education, and training
    activities.
        While the NCI designation is based solely on an evaluation of the
    science, Centers deliver medical advances to patients and their
    families; provide state-of-the-art care and access to clinical trials;
    serve as the major training ground for new clinicians and researchers;
    and have the strong links with national, state, and local agencies and
    advocacy groups needed to address cancer issues most relevant to their
    communities.
        Examples of strategies focused on the geographic reach of Cancer
    Center services include:
      --Minority Institution/Cancer Center Partnership Programs (MI/CCP).--
            The MI/CCP, which partner Minority-Serving Institutions (MSIs)
            with existing NCI-designated Cancer Centers, was established in
            2000 to take maximum advantage of their respective expertise
            and experience. The program is designed to foster development
            of independent cancer research programs and minority career
            scientists in MSIs and to improve minority-focused outreach and
            training efforts in NCI-designated Cancer Centers.
            Participation in this program better positions MSIs to compete
            for independent NCI designation and/or to form equal and
            permanent research alliances with existing NCI-designated
            Cancer Centers. These partnerships are expected to enable the
            NCI-designated Cancer Centers to realize substantial progress
            in their efforts to implement effective research, outreach, and
            education programs that truly benefit minority populations.
      --Affiliations and Consortia.--Realizing that many institutions
            serving minorities may not have the research capability or the
            desire to apply for NCI designation independently, NCI revised
            the Cancer Center guidelines to encourage the development of
            affiliations and consortia. We specifically encourage
            consideration of partnerships that address cancer in minority
            and other underserved populations.
      --Emphasized Integration.--Through NCI's ``Discovery, Development,
            Delivery'' continuum, we expect the continued development of
            links between existing Cancer Centers, their affiliates and
            partners in research; as well as state, municipal, and
            community-based private organizations. NCI is actively seeking
            mechanisms to foster both vertical integration (i.e., from the
            Cancer Centers through the community layers they serve) and
            horizontal integration (i.e., across Cancer Centers and a
            nationwide network of public and private partners) of the
            benefits of cancer research. This integration provides a more
            unified approach to reducing cancer and cancer risk, and more
            uniform delivery of the benefits of cancer research into all
            communities.
        NCI recognizes that the Cancer Research Center of Hawaii is unique
    in the community it serves. NCI program staff regularly consults with
    existing NCI-designated centers on approaches for enhancing
    representation of underserved populations, and provides support and
    direction to Center and institutional leadership on how to maintain NCI
    designation; the latter activities are viewed as particularly critical
    for Centers with. significant minority and other undeserved
    populations.
        NCI continues to pay close attention to the Cancer Centers
    geographic placement. The latest planning grants for NCI Cancer
    Research Centers (an initial step to gaining designation) have gone to
    areas without an NCI-designated Center (University of Louisville,
    University of Oklahoma, Emory University, Medical University of South
    Carolina, and Howard University). The University of New Mexico, a
    former planning grant recipient, received Cancer Center designation
    last year. NCI also continues to advise emerging centers in a number of
    other underrepresented areas around the country on an informal basis.
        Additionally, the Cancer Centers themselves are increasingly
    establishing their own networks with community hospitals and private
    oncology practices and extending the benefits of care and clinical
    trials further into communities not previously reached.
                             consultation protocol
        Question. I am pleased that the National Library of Medicine and
    the National Cancer Institute have made substantial efforts to
    incorporate, within their program areas, resources to address Native
    Hawaiian health issues and concerns. The Secretary's latest directive
    on consultation directs the Intra-Department Council on Native American
    Affairs to incorporate Native Hawaiian health needs and concerns within
    the consultation framework for agencies within the Department of Health
    and Human Services similar to that afforded American Indians and Alaska
    Natives.
        Would the National Institutes of Health be willing to engage in
    discussions with Papa Ola Lokahi (Native Hawaiian Health Board) on how
    best the lessons learned working with the National Library of Medicine
    and the National Cancer Institute can be incorporated within all the
    Institutes of the National Institutes of Health to develop an agency-
    wide consultation protocol for the National Institutes of Health and
    Native Hawaiians similar to that afforded to American Indians and
    Alaska Natives?
        Answer. The NCMHD has established a trans-NIH Committee to work on
    the NIH implementation of the Department of Health and Human Services'
    tribal consultation policy. As the committee prepares the NIH-wide
    tribal consultation protocol, it will look at various best practice
    models among the Institutes and Centers, including the National Library
    of Medicine and National Cancer Institute's models for lessons learned
    that could be incorporated into the protocol and be beneficial to Papa
    Ola Lokahi and other Native Hawaiians. The NIH recognizes the
    importance of listening, dialoguing, and developing relationships prior
    to developing programs and services, and would be willing to hear the
    suggestions of Papa Ola Lokahi.
                                     ______

                   Questions Submitted by Senator Harry Reid
                         chronic fatigue syndrome (cfs)
        Question. How many Chronic Fatigue Syndrome (CFS) specific grant
    applications were received, reviewed and funded for fiscal year 2004
    and fiscal year 2005?
        Answer. In fiscal year 2004, 17 CFS-specific grant applications
    (R01) were received and reviewed; 2 were awarded. One P50, a
    specialized center, was received and awarded. One R13, a conference
    grant, was received and awarded. In fiscal year 2005, eight CFS-
    specific grant applications (R01) were received and reviewed; one was
    awarded. One K12, Physician Scientist Award, was received but not
    awarded.
        Question. Please provide a detailed list of the studies,
    institutions, lead researchers and individual grant amounts for all CFS
    studies funded in fiscal year 2004 and fiscal year 2005.
        Answer. The information requested is included in the following
    tables compiled by the OD Budget Office.

                                                          NATIONAL INSTITUTES FOR HEALTH--FUNDING FOR CHRONIC FATIGUE SYNDROME FISCAL YEAR 2004
                                                                                             [Whole dollars]
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                  IC                    Project number         Principal investigator                Institution             State                       Project title                       Amount
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    NHLBI.........................  5 RO1 HL045462........  COLLINS, TUCKER O...........  CHILDREN'S HOSPITAL (BOSTON)....  MA.....  TRANSCRIPTIONAL REGULATION OF E-SELECTIN............   $177,750
    NHLBI.........................  5 R01 HL054926........  ISCHIROPOUL OS, HARRY.......  CHILDREN'S HOSPITAL OF            PA.....  REACTIVE SPECIES IN VASCULAR DISEASE-INJURY             170,000
                                                                                           PHILADELPHIA.                              MECHANISMS.
    NHLBI.........................  5 R01 HL055591........  LOMASNEY, JON W.............  NORTHWESTERN UNIVERSITY.........  IL.....  MOLECULAR BASIS FOR PROTEIN-PHOSPHOLIPID INTERACTION    148,500
    NHLBI.........................  5 R01 HL056850........  CLEMMONS, DAVID R...........  UNIVERSITY OF NORTH CAROLINA      NC.....  MECHANISMS BY WHICH IGF-I STIMULATES SMOOTH MUSCLE      203,694
                                                                                           CHAPEL HILL.                               CELLS.
    NHLBI.........................  5 R01 HL059459........  FREEMAN, ROY................  BETH ISRAEL DEACONESS MEDICAL     MA.....  ORTHOSTATIC INTOLERANCE IN CFS......................    392,186
                                                                                           CENTER.
    NHLBI.........................  2 R01 HL061388........  CRANDALL, CRAIG G...........  UNIVERSITY OF TEXAS SW MED CTR/   TX.....  HEAT STRESS AND CIRCULATORY CONTROL.................     61,066
                                                                                           DALLAS.
    NHLBI.........................  5 R01 HL066007........  STEWART, JULIAN M...........  NEW YORK MEDICAL COLLEGE........  NY.....  CIRCULATORY DYSFUNCTION IN CHRONIC FATIGUE SYNDROME.    252,000
    NHLBI.........................  5 R0l HL067422........  CRANDALL, CRAIG G...........  UNIVERSITY OF TEXAS SW MED CTR/   TX.....  SKIN COOLING TO IMPROVE ORTHOSTATIC TOLERANCE.......    131,500
                                                                                           DALLAS.
    NHLBI.........................  5 RO1 HL070215........  CALDWELL, ROBERT W..........  MEDICAL COLLEGE OF GEORGIA......  GA.....  ENDOTHELIAL CELL DYSFUNCTION IN OXIDATIVE STRESS        125,562
                                                                                                                                      MODELS.
                                                                                                                                                                                          ----------
          TOTAL, NHLBI............  ......................  ............................  ................................  .......  ....................................................  1,662,258
                                                                                                                                                                                          ==========
    NINDS.........................  1R13NSO47105-01.......  HORTOBAGYI, TIBOR...........  EAST CAROLINA UNIVERSITY........  SC.....  INTERNATIONAL SYMPOSIUM ON MOTOR CONTROL USING TMS..      2,250
    NINDS.........................  5Z01NS002979-06.......  GOLDSTEIN, DAVID............  NINDS...........................  MD.....  CLINICAL NEUROCARDIOLOGY: CATECHOLAMINE SYSTEMS IN      531,506
                                                                                                                                      STRESS AND DISEASE.
                                                                                                                                                                                          ----------
          TOTAL, NINDS............  ......................  ............................  ................................  .......  ....................................................    533,756
                                                                                                                                                                                          ==========
    NIAID.........................  1 R01 AI05601401A1....  SULLIVAN, PATRICK F.........  UNIVERSITY OF NORTH CAROLINA      NC.....  MICROARRAYS & PROTEOMICS IN MZ TWINS DISCORDANT FOR     255,301
                                                                                           CHAPEL HILL.                               CFS.
    NIAID.........................  5 RO1 AI042403-07.....  BARANIUK, JAMES N...........  GEORGETOWN UNIVERSITY...........  DC.....  MECHANISMS OF RHINITIS IN CFS.......................    232,800
    NIAID.........................  5 R01 AI049720-05.....  JASON, LEONARD..............  DE PAUL UNIVERSITY..............  IL.....  ACTIVITY INTERVENTION FOR CHRONIC FATIGUE SYN- DROME    266,169
    NIAID.........................  5 R01 AI051270-03.....  TAM, PATRICIA E.............  UNIVERSITY OF MINNESOTA TWIN      MN.....  VIRAL DSRNA AS A MEDIATOR OF CHRONIC MUSCLE DISEASES    334,125
                                                                                           CITIES.
    NIAID.........................  2 RO1 AI054478-02.....  NATELSON, BENJAMIN H........  UNIV OF MED/DENT NJ NEWARK......  NJ.....  SLEEP AND CYTOKINES IN CHRONIC FATIGUE SYNDROME.....    334,904
                                                                                                                                                                                          ----------
          TOTAL, NIAID............  ......................  ............................  ................................  .......  ....................................................  1,423,299
                                                                                                                                                                                          ==========
    NICHD.........................  R01HD043301-02........  TAYLOR,RENE E R.............  UNIVERSITY OF ILLINOIS AT         IL.....  CHRONIC FATIGUE SYNDROME IN ADOLESCENTS.............    267,009
                                                                                           CHICAGO.
                                                                                                                                                                                          ----------
          TOTAL, NICHD............  ......................  ............................  ................................  .......  ....................................................    267,009
                                                                                                                                                                                          ==========
    NIAMS.........................  5-R01-AR-47678-03.....  BUCHWALD DEDRA S............  UNIVERSITY OF WASHINGTON........  WA.....  ARE FIBROMYALGIA AND CHIARI I MALFORMATION RELATED?.    146,712
                                                                                                                                                                                          ----------
          TOTAL, NIAMS............  ......................  ............................  ................................  .......  ....................................................    146,712
                                                                                                                                                                                          ==========
    NIMH..........................  5K23MH001961-04.......  FRIEDBERG, FRED.............  STATE UNIVERSITY NEW YORK STONY   NY.....  PSYCHIATRIC COMORBIDITY IN CHRONIC FATIGUE SYN-         148,923
                                                                                           BROOK.                                     DROME.
                                                                                                                                                                                          ----------
          TOTAL, NIMH.............  ......................  ............................  ................................  .......  ....................................................    148,923
                                                                                                                                                                                          ==========
    NINR..........................  R01-AI049720-05.......  LEONARD, JASON..............  DE PAUL UNIVERSITY..............  IL.....  ACTIVITY INTERVENTION FOR CHRONIC FATIGUE SYN-          100,000
                                                                                                                                      DROME.
                                                                                                                                                                                          ----------
          TOTAL, NINR.............  ......................  ............................  ................................  .......  ....................................................    100,000
                                                                                                                                                                                          ==========
    NCRR..........................  2M01RR000037-44.......  SMITH, MARK.................  UNIVERSITY OF WASHINGTON........  WA.....  THE EFFECT OF PARENTAL CHRONIC FATIGUE SYNDROME ON       29,494
                                                                                                                                      OFFSPRING.
    NCRR..........................  3P41RR002305-20S1.....  MCCULLY, KEVIN..............  UNIVERSITY OF PENNSYLVANIA......  PA.....  CHRONIC FATIGUE SYNDROME............................      5,742
    NCRR..........................  5M01RR000039-44.......  PAPANICOLA OU, DIMITRIS A...  EMORY UNIVERSITY................  GA.....  EFFECTS OF CORTICOTROPIN-RELEASING HORMONE INFUSION     179,251
                                                                                                                                      IN NORMAL FEMALES.
    NCRR..........................  5M01RR000042-44.......  WILLIAMS, DAVID A...........  UNIVERSITY OF MICHIGAN AT ANN     MI.....  SUBJECT REGISTRY: INTERDISCIPLINARY STUDIES OF            9,149
                                                                                           ARBOR.                                     CHRONIC MULTI-SYMPTOM ILLNESSES.
    NCRR..........................  5M01RR000046-44.......  LIGHT, KATHLEEN C...........  UNIVERSITY OF NORTH CAROLINA      NC.....  FACTORS IN ARTHRITIS, CFS, FIBROMYALGIA &                74,144
                                                                                           CHAPEL HILL.                               TEMPOROMANDIBULA R DISORDERS.
    NCRR..........................  5M01RR000052-43.......  ROWE, PETER C...............  JOHNS HOPKINS UNIVERSITY........  MD.....  DISORDERED RESPONSES TO ORTHOSTATIC STRESS IN . . .       7,991
                                                                                                                                      GULF WAR SYNDROME SYMPTOMS.
    NCRR..........................  5M01RR000052-43.......  SCHWARTZ, CINDY.............  JOHNS HOPKINS UNIVERSITY........  MD.....  MOVEMENT RESTRICTION AND FATIGUE IN CANCER SURVIVORS        157
    NCRR..........................  5M01RR002635-20.......  ADLER, GAIL.................  BRIGHAM AND WOMEN'S HOS- PITAL..  MA.....  IMMUNONEUROENDOC RINE RESPONSE TO TETANUS  TOXOID...      4,821
    NCRR..........................  5MO1RR010710-07.......  FRIEDBERG, FREDRICK.........  STATE UNIVERSITY NEW YORK STONY   NY.....  PSYCHIATRIC COMORBIDITY IN CHRONIC FATIGUE SYNDROME.    159,869
                                                                                           BROOK.
    NCRR..........................  5M01RRO10710-07.......  FRIEDBERG, FREDRICK.........  STATE UNIVERSITY NEW YORK STONY   NY.....  WHY DO PEOPLE DROP OUT OF SUPPORT GROUPS FOR CHRONIC      6,401
                                                                                           BROOK.                                     FATIGUE SYNDROME?.
    NCRR..........................  5M01RR016587-03.......  HURWITZ, BARRY..............  UNIVERSITY OF MIAMI-MEDICAL.....  FL.....  RBC MASS/AUTONOMIC NERVOUS SYSTEM/INTEGRITY/SY NCOPE    142,237
                                                                                                                                      IN CHRONIC FATIGUE SYNDROME.
    NCRR..........................  5P20RR011145-10.......  FRIEDMAN, THEODORE C........  CHARLES R. DREW UNIVERSITY OF     CA.....  USE OF VIAGRA TO ALTER SYMPTOMS IN PTS WITH CFS.....    118,851
                                                                                           MED & SCI.
    NCRR..........................  5P41RR008119-12.......  TARASOV, SERGEY G...........  UNIVERSITY OF MARYLAND BALT PROF  MD.....  SPECT & DNA BINDING OF NAPHTYLIMIDO IMIDAZOACRIDONE      43,966
                                                                                           SCHOOL.                                    WMC79 & RELATED COMPOUND.
    NCRR..........................  5P51RR000168-43.......  MADRAS, BERTHA K............  HARVARD UNIVERSITY (MEDICAL       MA.....  MOLECULAR TARGETS OF THE ANTI-NARCOLEPTIC DRUG           14,843
                                                                                           SCHOOL).                                   MODAFINIL.
    NCRR..........................  5R13RR017508-03.......  LAKOWICZ, JOSEPH R..........  UNIVERSITY OF MARYLAND BALT PROF  MD.....  CFS COURSE ON FLUORESCENCE SPECTROSCOPY: MICROSCOPY,      4,084
                                                                                           SCHOOL.                                    DATA ANALYSIS, FLUOROMETRY.
                                                                                                                                                                                          ----------
          TOTAL, NCRR.............  ......................  ............................  ................................  .......  ....................................................    801,000
                                                                                                                                                                                          ==========
    OD............................  1R01HD43301-02........  TAYLOR, RENEE...............  UNIVERSITY OF ILLINOIS, CHI-      IL.....  CFS.................................................    400,000
                                                                                           CAGO.
                                                                                                                                                                                          ----------
          TOTAL, OD...............  ......................  ............................  ................................  .......  ....................................................    400,000
                                                                                                                                                                                          ----------
          GRAND TOTAL.............  ......................  ............................  ................................  .......  ....................................................  5,482,957
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

                                                          NATIONAL INSTITUTES FOR HEALTH--FUNDING FOR CHRONIC FATIGUE SYNDROME FISCAL YEAR 2005
                                                                                             [Whole dollars]
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                  IC                      Project number         Principal investigator              Institution             State                       Project title                       Amount
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    NHLBI.........................  5 R01 HL045462...........  COLLINS, TUCKER O........  CHILDREN'S HOSPITAL BOSTON......  MA.....  TRANSCRIPTIONAL REGULATION OF E-SELECTIN............   $177,750
    NHLBI.........................  5 R01 HL054926...........  ISCHIROPOUL OS, HARRY....  CHILDREN'S HOSPITAL OF            PA.....  REACTIVE SPECIES IN VASCULAR DISEASE-INJURY             170,000
                                                                                           PHILADELPHIA.                              MECHANISMS.
    NHLBI.........................  5 R01 HL055591...........  LOMASNEY, JON W..........  NORTHWESTERN UNIVERSITY.........  IL.....  MOLECULAR BASIS FOR PROTEIN-PHOSPHOLIPID INTERACTION    148,500
    NHLBI.........................  5 R01 HL056850...........  CLEMMONS, DAVID R........  UNIVERSITY OF NORTH CAROLINA      NC.....  MECHANISMS BY WHICH IGF-I STIMULATES SMOOTH MUSCLE      209,541
                                                                                           CHAPEL.                                    CELLS.
    NHLBI.........................  5 R01 HL059459...........  FREEMAN, ROY.............  BETH ISRAEL DEACONESS MED- ICAL.  MA.....  ORTHOSTATIC INTOLERANCE IN CFS......................    403,952
    NHLBI.........................  5 RO1 HL061388...........  CRANDALL, CRAIG G........  UNIVERSITY OF TEXAS SW MED......  TX.....  HEAT STRESS AND CIRCULATORY CONTROL.................     47,164
    NHLBI.........................  5 R01 HL067422...........  CRANDALL, CRAIG G........  UNIVERSITY OF TEXAS SW MED......  TX.....  SKIN COOLING TO IMPROVE ORTHOSTATIC TOLERANCE.......    131,500
    NHLBI.........................  5 R01 HL070215...........  CALDWELL, ROBERT W.......  MEDICAL COLLEGE OF GEORGIA (MCG)  GA.....  ENDOTHELIAL CELL DYSFUNCTION IN OXIDATIVE STRESS        125,562
                                                                                                                                      MODELS.
                                                                                                                                                                                          ----------
          TOTAL, NHLBI............  .........................  .........................  ................................  .......  ....................................................  1,413,969
                                                                                                                                                                                          ==========
    NINDS.........................  5Z01NS002979-07..........  DAVID, GOLDSTEIN.........  NINDS INTRAMURAL RESEARCH         MD.....  CLINICAL NEUROCARDIOLOGY: CATECHOLAMINE SYSTEMS IN      559,424
                                                                                           PROGRAM.                                   STRESS AND DISEASE.
    NINDS.........................  9L30NS054198-02..........  FRANTOM, CATHERINE G.....  LOAN REPAYMENT..................  .......  NEURO-REHAB MEASUREMENT.............................      3,058
                                                                                                                                                                                          ----------
          TOTAL, NINDS............  .........................  .........................  ................................  .......  ....................................................    562,482
                                                                                                                                                                                          ==========
    NIAID.........................  5 R0l AI051270-04........  TAM, PATRICIA E..........  UNIVERSITY OF MINNESOTA TWIN      MN.....  VIRAL DSRNA AS A MEDIATOR OF CHRONIC MUSCLE DISEASES    349,860
                                                                                           CITIES.
    NIAID.........................  5 R01 AI054478-03........  NATELSON, BENJAMIN H.....  UNIV OF MED/DENT OF NJ-NJ         NJ.....  SLEEP AND CYTOKINES IN CHRONIC FATIGUE SYNDROME.....    673,289
                                                                                           MEDICAL SCHOOL.
    NIAID.........................  1 R01 A1055735-01A2......  JASON, LEONARD A.........  DE PAUL UNIVERSITY..............  IL.....  RISK FACTRORS ASSOCIATED WITH CFS AND CF PRO-           541,703
                                                                                                                                      GNOSIS.
    NIAID.........................  5 R01 AI056014-02........  SULLIVAN, PATRICK F......  UNIVERSITY OF NORTH CAROLINA      NC.....  MICROARRAYS & PROTEOMICS IN MZ TWINS DISCORDANT FOR     518,667
                                                                                           CHAPEL HILL.                               CFS.
                                                                                                                                                                                          ----------
          TOTAL, NIAID............  .........................  .........................  ................................  .......  ....................................................  2,083,519
                                                                                                                                                                                          ==========
    NICHD.........................  R01HD043301-03...........  TAYLOR, RENE E R.........  UNIVERSITY OF ILLINOIS AT         IL.....  CHRONIC FATIGUE SYNDROME IN ADOLESCENTS.............    268,159
                                                                                           CHICAGO.
                                                                                                                                                                                          ----------
          TOTAL, NICHD............  .........................  .........................  ................................  .......  ....................................................    268,159
                                                                                                                                                                                          ==========
    NIAMS.........................  5-RO1-AR-47678-04........  BUCHWALD DEDRA S.........  UNIVERSITY OF WASHINGTON........  WA.....  ARE FIBROMYALGIA AND CHIARI I MALFORMATION RELATED?.    127,983
                                                                                                                                                                                          ----------
          TOTAL, NIAMS............  .........................  .........................  ................................  .......  ....................................................    127,983
                                                                                                                                                                                          ==========
    NIMH..........................  5K23MH001961-05..........  FRIEDBERG, FRED..........  STATE UNIVERSITY NEW YORK STONY   NY.....  PSYCHIATRIC COMORBIDITY IN CHRONIC FATIGUE SYNDROME.    157,316
                                                                                           BROOK.
                                                                                                                                                                                          ----------
          TOTAL, NIMH.............  .........................  .........................  ................................  .......  ....................................................    157,316
                                                                                                                                                                                          ==========
    NCRR..........................  1M01RR020359-01..........  BARANIUK, JAMES N........  CHILDREN'S RESEARCH INSTI-  TUTE  DC.....  RHINITIS IN CHRONIC FATIGUE SYNDROME (CFS)..........      3,236
    NCRR..........................  2M01RR000052-44..........  SCHWARTZ, CINDY..........  JOHNS HOPKINS UNIVERSITY........  MD.....  MOVEMENT RESTRICTION AND FATIGUE IN CANCER SURVIVORS      1,246
    NCRR..........................  2P20RR011145-11..........  FRIEDMAN, THEODORE C.....  CHARLES R. DREW UNIVERSITY OF     CA.....  USE OF VIAGRA TO ALTER SYMPTOMS IN PTS WITH CFS.....     19,782
                                                                                           MED & SCI.
    NCRR..........................  2P41RR002305-21A1........  MCCULLY, KEVIN...........  UNIVERSITY OF PENNSYLVANIA......  PA.....  CHRONIC FATIGUE SYNDROME............................     16,453
    NCRR..........................  5M01RR000037-45..........  SMITH, MARK..............  UNIVERSITY OF WASHINGTON........  WA.....  THE EFFECT OF PARENTAL CHRONIC FATIGUE SYNDROME ON        6,418
                                                                                                                                      OFFSPRING.
    NCRR..........................  5M01RR000042-45..........  WILLIAMS, DAVID A........  UNIVERSITY OF MICHIGAN AT ANN     MI.....  SUBJECT REGISTRY: INTERDISCIPLINARY STUDIES OF           77,197
                                                                                           ARBOR.                                     CHRONIC MULTI-SYMPTOM ILLNESSES.
    NCRR..........................  5M01RR000046-45..........  LIGHT, KATHLEEN C........  UNIVERSITY OF NORTH CAROLINA      NC.....  FACTORS IN ARTHRITIS, CFS, FIBROMYALGIA &                17,907
                                                                                           CHAPEL HILL.                               TEMPOROMANDIBUL AR DISORDERS.
    NCRR..........................  5M01RR000048-44..........  TAYLOR, RENEE............  NORTHWESTERN UNIVERSITY.........  IL.....  A PROSPECTIVE STUDY OF CHRONIC FATIGUE SYNDROME IN       26,247
                                                                                                                                      ADOLESCENTS.
    NCRR..........................  5MO1RR000071-42..........  MATHEW, SANJAY...........  MOUNT SINAI SCHOOL OF MEDICINE    NY.....  MRS NEUROMETABOLITE S IN CHRONIC FATIGUE SYNDROME,       10,871
                                                                                           OF NYU.                                    GENERALIZED ANXIETY DISORDER.
    NCRR..........................  5MO1RRO10710-08..........  FRIEDBERG, FREDRICK......  STATE UNIVERSITY NEW YORK STONY   NY.....  PSYCHIATRIC COMORBIDITY IN CHRONIC FATIGUE SYNDROME.     48,251
                                                                                           BROOK.
    NCRR..........................  5MO1RRO10710-08..........  FRIEDBERG, FREDRICK......  STATE UNIVERSITY NEW YORK STONY   NY.....  WHY DO PEOPLE DROP OUT OF SUPPORT GROUPS FOR CHRONIC     42,683
                                                                                           BROOK.                                     FATIGUE SYNDROME?.
    NCRR..........................  5M01RR016587-04..........  HURWITZ, BARRY...........  UNIVERSITY OF MIAMI-MEDICAL.....  FL.....  RBC MASS/AUTONOMIC NERVOUS SYSTEM/INTEGRITY/SYNCOPE      28,827
                                                                                                                                      IN CHRONIC FATIGUE SYNDROME.
    NCRR..........................  5P41RR008119-13..........  NOWACZYK, KAZIMIERZ......  UNIVERSITY OF MARYLAND BALT PROF  MD.....  CFS COMPUTERS.......................................     20,687
                                                                                           SCHOOL.
    NCRR..........................  5P51 RR000168-44.........  MADRAS, BERTHA K.........  HARVARD UNIVERSITY (MEDICAL       MA.....  MOLECULAR TARGETS OF THE ANTI-NARCOLEPTIC DRUG          120,481
                                                                                           SCHOOL).                                   MODAFINIL.
    NCRR..........................  5R13RR017508-04..........  LAKOWICZ, JOSEPH R.......  UNIVERSITY OF MARYLAND BALT PROF  MD.....  CFS COURSE ON FLUORESCENCE SPECTROSCOPY: MICROSCOPY,      4,207
                                                                                           SCHOOL.                                    DATA ANALYSIS, FLUOROMETRY.
                                                                                                                                                                                          ----------
          TOTAL, NCRR.............  .........................  .........................  ................................  .......  ....................................................    444,493
                                                                                                                                                                                          ==========
    OD............................  1R01HD43301-03...........  TAYLOR, RENEE............  UNIVERSITY OF ILLINOIS AT         IL.....  CFS.................................................    300,000
                                                                                           CHICAGO.
    OD............................  1R01AI055735-01A2........  JASON, LEONARD...........  DE PAUL UNIVERSITY..............  IL.....  CFS.................................................    100,000
                                                                                                                                                                                          ----------
          TOTAL, OD...............  .........................  .........................  ................................  .......  ....................................................    400,000
                                                                                                                                                                                          ----------
          TOTAL, NIH..............  .........................  .........................  ................................  .......  ....................................................  5,457,921
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

        Question. NIH is expected to announce later this month the awards
    made in response to the 7/14/05 RFA for CFS. Will the studies funded
    under this RFA yield a true increase in the level of NIH research
    funding for CFS?
        Answer. Yes. The 7 new grants funded will infuse an additional
    several million dollars into the bottom line for CFS funding that has
    remained relatively constant in the $5.5-$6 million range over the past
    years. A projected $2 million is derived from the redirected funds of
    the ORWH budget to fund and co-fund studies through the ICs. The
    remainder will be provided by the NIAAA, NIAMS, NIEHS, and NINDS.
    Additionally, individual letters sent from the Tans-NIH Working Group
    for Research on Chronic Fatigue Syndrome encouraged the unsuccessful
    applicants to revise and submit their proposals under the standing CFS
    Program Announcement. Many have been in touch for advice and plan to
    resubmit. The announcement resulted in increased interest from many
    researchers who had not previously conducted research on CFS. They are
    now aware that NIH interest in CFS is broad based and that many
    disciplines can contribute. It is expected that this RFA, information
    on the new website, and contacts established with members of the CFSWG
    will lead to. a further increase in investigator initiated submissions.
        Question. You have been a strong advocate for more centralized
    power and discretion within the NIH Office of the Director for the
    Roadmap Initiative to identify major opportunities and gaps in research
    that no single institute at NIH can tackle alone but that the agency as
    a whole must address. CFS is a complex illness that affects the brain
    and multiple body systems and thus is an example of a condition that
    must be addressed by multiple institutes. The CDC is expected to
    announce that CFS affects more than four million adults in the United
    States. In 1999, responsibility for CFS was moved to the Office of the
    Director. What progress in NIH's approach to the study of CFS has been
    made since this move?
        Answer. Tremendous progress has been and will continue to be made
    in pursuing and further stimulating CFS research. This is accomplished
    through a trans-NIH Working Group for Research on CFS (CFSWG) that is
    chaired by the Office of Research on Women's Health (ORWH) in the
    Office of the Director and includes members from 13 different ICs. The
    CFSWG was established in April 2001 to develop an action plan to
    enhance the status of CFS research at the NIH and among the external
    scientific community. The Working Group first issued a program
    announcement based on recommendations from the Chronic Fatigue
    Syndrome, State of the Science Conference held in October 2000 that
    encouraged innovative and interdisciplinary CFS research. The CFSWG
    updated and reissued this announcement in 2005 based on the results of
    a second NIH-sponsored scientific workshop. This workshop, Neuro-Immune
    Mechanisms and Chronic Fatigue Syndrome: Will understanding central-
    mechanisms enhance the search for the causes, consequences and
    treatment of CFS?, was held in June 2003. Its proceedings were
    published in 2004 (NIH Publication No. 04-5497) and disseminated widely
    among the scientific community. The first issue of the new ORWH Science
    Series for the Public, informational fact sheets, is also derived from
    these proceedings. Also based on these proceedings, the ORWH and the
    CFSWG developed a request for applications (RFA) to explicate how the
    brain, as the mediator of the various body systems involved, fits into
    the schema for understanding CFS (RFA OD-06-002). This RFA specifically
    solicited proposals from multidisciplinary teams of scientists to
    develop an interdisciplinary approach to the mechanisms involved in CFS
    in men and women across the life span. Twenty-nine applications were
    received and are in process. All documents mentioned above as well as
    complete information about the NIH CFS program are available at http://
    orwh.od.nih.gov/cfs.html. All of the above demonstrate concerted trans-
    NIH efforts coordinated by an OD program office that is the focal point
    for research on women's health, ORWH, to engage the scientific
    community in addressing the many aspects of and increasing knowledge of
    CFS.
        Question. Has the move to the Office of the Director led to any
    real progress in multidisciplinary research? If so, what specifics can
    you point to?
        Answer. Yes. Collaborative achievements that include the
    development of an action plan to enhance the status of CFS research at
    the NIH and the products of this plan, such as trans-NIH Program
    Announcements, Requests for Applications, Scientific Workshops would
    not have been possible without the formation of a trans-NIH CFSWG
    chaired by the ORWH in the Office of the Director. The ORWH has had a
    long and successful track record for developing and leading
    interdisciplinary research and training initiatives on women's health
    and sex and gender factors in human health through its Coordinating
    Committee for Research on Women's Health (CCRWH), which brings together
    representatives from every institute and center to facilitate
    collaborative efforts. Similarly, the CFSWG, supported and led by the
    ORWH, is composed of representatives from 13 NIH institutes and centers
    with an interest in facilitating collaborative efforts to invigorate
    CFS research at the NIH.
        Question. How does the current status of CFS research within the
    NIH serve as a model for progress, based on more centralized authority
    within the Office of the Director or as a model for multidisciplinary
    approaches and the Roadmap.
        Answer. NIH has made steady progress towards an interdisciplinary
    approach to CFS through the efforts and function of an OD program
    office that was established to serve as the NIH focal point for the OD
    on women's health research. Therefore, the OD, through ORWH, was able
    to bring together diverse institutes to collaborate effectively in a
    trans-NIH initiative to enhance research on CFS. The ORWH also
    contributed staff and budget to these expanded research activities.
    This ORWH effort for CFS serves as an example of how an office within
    the OD can facilitate trans-NIH scientific initiatives that manifest
    real progress in research.
                                     ______

                    Questions Submitted by Senator Herb Kohl
                              alzheimer's disease
        Question. In April, the National Center for Health Statistics
    reported that the life expectancy of Americans has risen to 78 years--
    the highest it has ever been. However, they also reported that the
    death rate from Alzheimer's disease is increasing among the top 10
    causes of death in the United States. In light of the fact that the
    Baby Boom generation is entering the age of highest risk for
    Alzheimer's, shouldn't NIH be increasing, rather than reducing, its
    investment in Alzheimer's research?
        Answer. It should be noted that our fiscal year 2007 funding level
    for Alzheimer's disease is an estimate and reflects a reduction that is
    comparable to the reductions in the total budgets of the NIH ICs
    supporting research in this important area. At this time, it is not
    possible to be precise as to where available funding will be allocated.
    Funding decisions will be based on public health need, scientific and
    technological opportunity, and the peer review of research
    applications.
        As the Senator points out, with current trends, Alzheimer's disease
    will become an increasingly critical public health concern over the
    coming decades. To reverse this trend, it is critical that we explore
    all promising avenues of discovery and promote the translation of
    research results into interventions for the successful prevention,
    detection, diagnosis, and treatment of Alzheimer's disease. Alzheimer's
    disease research continues to be a high priority for NIH, and
    scientific opportunities in this area will be actively pursued within
    available resources.
                                    epilepsy
        Question. As you know, for years I have pushed NIH to work harder
    to develop better treatments and a cure for epilepsy. I have supported
    efforts by the National Institute of Neurological Disorders and Stroke
    to fund epilepsy research. However, many experts think we need a
    broader approach, with greater collaboration between NINDS and the
    National Institute on Mental Health, the National Institute on Child
    Health and Human Development, and other Institutes. What are you doing
    to guarantee that multi-Institute studies on epilepsy are developed and
    funded in the coming year?
        Answer. As the lead NIH Institute for epilepsy research, the
    National Institute of Neurological Disorders and Stroke (NINDS)
    coordinates epilepsy research efforts through the InterAgency Epilepsy
    Working Group. The Epilepsy Working Group is composed of scientific
    program staff from the NINDS, eight other Institutes, including the
    National Institute of Mental Health (NIMH) the National Institute of
    Child Health and Human Development (NICHD), and staff members from the
    Centers for Disease Control and Prevention. The Working Group
    facilitates coordination and collaboration among NIH Institutes. For
    example, NINDS and NIMH Epilepsy Working Group members collaborated
    with the American Epilepsy Society to sponsor an international workshop
    in May 2005 on treatment of nonepileptic seizures (NES), a
    neuropsychiatric seizure disorder. As a result of this meeting, the
    NIMH and the NINDS issued a request for applications on ``Collaborative
    Research on Mental and Neurological Disorders.''
        This initiative focused on co-morbidities between mental health and
    neurological disorders, including epilepsy.
        The NINDS and the NICHD have a long history of collaboration on
    epilepsy research. The NICHD funds the Mental Retardation Research
    Centers Program, a network of regional centers developed for research
    on mental retardation and related aspects of human development,
    including epilepsy. Many of the Centers also provide infrastructure for
    NINDS-supported epilepsy research projects. Both Institutes fully
    expect this successful collaboration to continue in the future.
        The NIMH, NICHD, and NINDS also collaborate in funding the Autism
    Research Network (ARN). The ARN is made up of eight collaborative
    research centers that focus on the causes, diagnosis, early detection,
    prevention, and treatment of autism. One of the network studies, ``A
    Longitudinal Assessment of Behavior Problems, Puberty, and Epilepsy''
    is designed to investigate which children with autism develop seizures
    and whether there are changes in behavior that either precede or follow
    the development of seizures.
        Question. As you know, NINDS held a successful epilepsy conference
    in 2000, where research benchmarks were developed and used to create a
    research agenda in epilepsy. It's my understanding that NINDS is
    planning a follow-up conference on Curing Epilepsy in March 2007. Will
    you ensure that representatives from other Institutes participate in
    the 2007 conference? What steps will you take after the conference to
    ensure that collaborative research is pursued in order to have the
    greatest impact for epilepsy patients?
        Answer. The NINDS has invited all the organizations represented on
    the InterAgency Epilepsy Working Group (IAEWG) to participate in
    planning and co-sponsoring the Curing Epilepsy 2007 conference. Co-
    morbidities, such as cognitive and psychological issues in children and
    adults with epilepsy, will be one of the major themes of the
    conference. Epilepsy co-morbidities often include behavioral problems,
    learning and memory difficulties, and depression. The NINDS expects
    that the conference will draw attention to the importance of these
    issues and will stimulate interdisciplinary investigation into the
    causes, treatment and prevention of epilepsy and its co-morbidities.
    The IAEWG will also consider the potential for collaborative activities
    in response to any recommendations that result from the Curing Epilepsy
    2007 conference.
                        age-related macular degeneration
        Question. You have publicly cited as an NIH ``breakthrough'' the
    discovery of a gene strongly associated with age-related macular
    degeneration (AMD). As you know, AMD is the leading cause of blindness
    in the United States, especially among our seniors, robbing them of
    their independence and quality of life. What does this finding mean for
    new treatments to stop or reverse this blinding eye disease? How will
    the National Eye Institute follow up on this exciting breakthrough when
    the President's budget proposes to cut NEI funding?
        Answer. National Eye Institute-sponsored investigators have made
    considerable progress since the recent discovery of the complement
    factor H (CFH) gene in age-related macular degeneration (AMD). NEI
    intramural researchers are initiating a phase I clinical trial to
    evaluate anti-inflammatory agents that may inhibit damaging immune
    responses potentially resulting from alterations in the CFH gene. NEI
    extramural and NIH intramural scientists discovered that alterations in
    a second gene in the inflammatory pathway, complement factor B, are
    also associated with AMD. Variations in these two genes can predict the
    clinical outcome in 74 percent of individuals with AMD. In addition,
    the NEI launched a new research initiative to further investigate the
    role of inflammation in AMD and other common eye diseases such as
    diabetic retinopathy and uveitis.
                            irritable bowel syndrome
        Question. For the last several years, the Appropriations Committee
    has asked the National Institute of Diabetes and Digestive and Kidney
    Diseases to develop a strategic plan for research into Irritable Bowel
    Syndrome. NIDDK has explained that the Institute [is] creating an
    overall digestive disease action plan and that IBS will be a
    significant part of it. Can you update us on NIDDK's progress on the
    digestive disease plan and explain how much attention IBS will receive?
        Answer. The NIH established a National Commission on Digestive
    Diseases in August 2005, based on the shared interest of the NIH and
    the Congress in advancing research on digestive diseases. One of the
    Commission's primary purposes is to develop a Long-Range Research Plan
    for Digestive Diseases, which will include plans for stimulating
    research on functional gastrointestinal (GI) and motility disorders
    such as irritable bowel syndrome (IBS). Within the NIH, the NIDDK has
    lead responsibility for digestive diseases research and supports a
    research portfolio in IBS and other types of functional GI and motility
    disorders. The NIDDK is providing leadership and support for this
    federally chartered Commission.
        As NIH Director, I appointed members of the Commission after a
    broad call for nominees with diverse scientific, professional, and
    personal experiences related to digestive diseases from within the
    academic and medical research and practice communities, patient and
    patient advocacy community, and the NIH and other Federal health
    agencies. The perspective of individuals with personal or professional
    interest in IBS and other types of functional GI and motility disorders
    is represented within the Commission.
        Commission members recently convened for their first meeting on
    June 12, 2006, and are currently finalizing topics for chapters of the
    Research Plan, one of which is expected to focus on IBS and related GI
    motility disorders research. The ultimate goal of the Commission's
    Research Plan is to improve the nation's health through advancing
    research on digestive diseases, such as IBS. The Research Plan will
    include: (1) information on the burden of disease on individuals and
    society; (2) examples of research advances that are generating new
    knowledge vital to understanding, treatment, and prevention; and (3)
    compelling opportunities for future NIH-funded research, which offer
    promise for reducing the burden of disease. This Research Plan will
    recommend promising research directions relevant to IBS and other types
    of functional GI and motility disorders, which will help guide the
    NIDDK, the NIH, and the investigative and lay community in the pursuit
    of the most productive research avenues.
        The Commission will rely on broad stakeholder input from members of
    the digestive diseases community to inform the Research Plan throughout
    its development. For example, Commission members are currently
    establishing Working Groups composed of individuals with expertise
    related to specific areas of digestive diseases research, who will
    provide input necessary for crafting a well-informed Research Plan. One
    of these Working Groups is expected to focus on functional GI and
    motility disorders, such as IBS, in addition to potential overlapping
    and synergistic efforts in this area on the part of other Working
    Groups. Other opportunities for broad stakeholder input into the
    Commission's activities will include public Commission meetings and an
    open comment period for public input on the draft Research Plan.
    Additional information on the Commission's ongoing activities can be
    found on its website at: http://NCDD.niddk.nih.gov.

                             CONCLUSION OF HEARINGS

        Senator Specter. So thank you for what you are doing. We
    appreciate your thanks to us, and we are going to do more and
    we ask you to do more. That concludes our hearings.
        [Whereupon, at 10:14 a.m., Friday, May 19, the hearings
    were concluded, and the subcommittee was recessed, to reconvene
    subject to the call of the Chair.]

    DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
                  AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2007

                                  ----------

                                           U.S. Senate,
               Subcommittee of the Committee on Appropriations,
                                                        Washington, DC.

                              DEPARTMENT OF LABOR

                            Office of the Secretary

        [The following questions were submitted to be answered for the
    record:]

                  Questions Submitted by Senator Arlen Specter

                                  mine safety
        Question. Congress has now passed bi-partisan mine safety
    legislation that contained many of the provisions in a bill I
    introduced on February 16, 2006. Congress has also passed a pending
    supplemental appropriations bill containing $35,600,000 to augment
    inspections of coal mines and to expand research to develop mine safety
    technology. How do you intend to implement these authorization and
    appropriation measures? What additional appropriations are necessary to
    fully implement the new authorization?
        During the hearing this Subcommittee held on January 23, 2006, on
    the Sago Mine disaster, I questioned the policy of the requiring mine
    representatives to be present during accident investigation interviews
    with miners. Although the legislation I introduced would prohibit this
    practice, it was not included in the consensus bill reported last week.
    Do you support such a provision?
        Answer. $25.6 million of the $35.6 million contained in the
    supplemental appropriation was appropriated to MSHA. The supplemental
    appropriation contains a provision requiring MSHA to submit a spending
    plan for these funds to the appropriations committees by July 15, 2006,
    and MSHA will comply with this provision. The remaining $10 million in
    supplemental funding was appropriated to NIOSH for expansion of
    research and mine safety technology, therefore NIOSH is the appropriate
    entity to answer questions regarding their plans for the use of those
    funds. With regard to additional appropriations necessary to fully
    implement the MINER Act, the MINER Act contains authorization for new
    grant programs but no funding for these programs has been appropriated.
    Many of the new MINER Act provisions do not require any additional
    funding. For example, the increase of the maximum civil penalty for
    flagrant violations and the implementation of minimum penalties for
    unwarrantable citations and orders, as well as the provision requiring
    every mine to have an Emergency Response Plan do not require any
    increases in funding.
        With regard to MSHA accident investigations, the Mine Act gives
    MSHA discretion to determine who may be present during accident
    investigation interviews with miners and other persons who may have
    relevant information. As you are aware, MSHA's longstanding past
    practice regarding interviews has generally included participation by
    the mine operator and the representative of miners. However, we have
    come to the conclusion that this process should be changed to conform
    to the process used by virtually all other law enforcement
    investigative agencies. We believe that witness interviews should be
    conducted with only federal, and where applicable, state authorities.
    Of course, witnesses would continue to have the option of having a
    personal representative of their choosing present during the interview.
    We believe that the time proven technique of interviewing witnesses
    separately and without additional persons present is the best method of
    eliciting useful information without fear of intimidation, and
    minimizes the ability of witnesses to modify their testimony in light
    of the knowledge gained from other witnesses. In fact, recent
    experience has demonstrated that the presence of third-parties could
    compromise the investigation, make witnesses less likely to cooperate,
    and result in premature release of information before all witness
    interviews are complete. Thus, we agree that participation in
    interviews by non-government personnel should be limited to a personal
    representative of the witness. Of course, MSHA will continue its
    practice of releasing all witness transcripts, except those requested
    under the Mine Act to be confidential, once the investigation has
    reached a stage where release would not impede or interfere with the
    investigation.
                               job corps funding
        Question. It has been more than 45 calendar days of continuous
    session of the Congress since the President proposed rescinding $75
    million of Job Corps construction and renovation funds. Have these
    funds now been released as required by the Congressional Budget and
    Impoundment Control Act?
        Answer. The $75 million in Construction, Rehabilitation, and
    Acquisition funds were not withheld from obligation, as noted in our
    May 30, 2006 letter to GAO on this matter, and remain available for
    obligation by the Office of Job Corps.
        Question. Your budget proposed to cut $62,578,000 from the Job
    Corps budget for program year 2007, which would result in 3,614 fewer
    students enrolled than in 2005. This would reduce funding, on
    inflation-adjusted basis, 8.5 percent below the level in 2005. How far
    below capacity would this put the 122 existing Job Corps centers?
        Answer. With the requested 2007 operating budget of $1,401,602,000,
    Job Corps will be able to maintain 42,863 year-around training slots,
    which represents 95.5 percent of the peak level that could be
    accommodated by our physical infrastructure.
                      reintegration of youthful offenders
        Question. Your budget once again zeroes out the program I was
    instrumental in creating, for training and employing of youthful
    offenders. Even after last November's conference agreement restored $49
    million for this program, the Administration immediately offered it up
    as an offset to help pay for December's Katrina supplement. Do you
    think this was an appropriate way to respond?
        Answer. The impacts of the Katrina and Rita hurricanes were
    unprecedented and the Administration carefully prioritized the use of
    available resources across government to fund relief and recovery
    efforts. The Youth Offender appropriation was only one of many offsets
    the Administration presented to Congress, and this is consistent with
    the Administration's proposal in the fiscal year 2007 and previous
    budgets to replace the Responsible Reintegration of Young Offenders
    program with the Prisoner Reentry Initiative, thereby increasing the
    program's overall scope and reach.
                      elimination of migrant job training
        Question. Both the House and the Senate appropriations committees
    have repeatedly rejected your proposal to eliminate the Migrant and
    Seasonal Farmworkers Program under the Workforce Investment Act. I
    think it's fair to say that Congress recognizes that it is unrealistic
    to expect states and localities to be responsible for a unique and
    difficult-to-serve migratory population that, from their point of view,
    is ``here today and gone tomorrow.'' It is also unfair to shift this
    burden to states when you are proposing to reduce the already limited
    job training resources that states have to serve their eligible local
    residents. If Congress understands this, why doesn't the Department?
        Answer. The Administration's fiscal year 2007 Budget proposal seeks
    to tap the workforce investment system's potential to serve more
    migrant and seasonal farmworkers by providing job training services to
    them through the One-Stop Career Center system, and turning to other,
    appropriate agencies to provide supportive services, housing, and other
    related assistance. Currently, the section 167 program provides
    employment and training services to only 10,000 of an estimated two
    million farmworkers, which demonstrates the need for a wider system
    approach.
        The Administration believes that providing services to farmworkers
    through the One-Stop system will increase the number served and have a
    positive employment and earnings impact on those who receive services.
                          impact of job training cuts
        Question. Your budget is based on the assumed enactment of a new
    Workforce Investment Act reauthorization proposal calling for Career
    Advancement Accounts, to be run through a consolidated workforce
    system, cutting nearly $700 million. Until the authorization
    legislation is changed, this Committee acts on the basis of extending
    current law. In the absence of law change, what impact will your budget
    proposals have on existing programs for youth, adults, dislocated
    workers, and the Employment Service? For example, the Pennsylvania
    Association of Workforce Investment Boards estimates the President's
    Budget would result in a 17 percent cut from current levels for the
    youth, adult and dislocated worker block grants. Do I have your
    assurance that you will not proceed administratively to implement
    proposals such as consolidated Career Accounts without Congressional
    approval?
        Answer. The President's Budget request does assume enactment of the
    Career Advancement Account (CAA) proposal, which would reduce overhead
    and administrative costs and focus more funding on training, thereby
    tripling the number of individuals receiving job training through the
    workforce investment system.
        In the absence of any legislation passed by Congress, states will
    continue to operate Workforce Investment Act programs and the
    Employment Service as currently authorized. The appropriation level
    provided by Congress is a separate issue from job training reform. We
    feel that CAAs are a more effective approach than the current workforce
    investment system, regardless of the funding level provided by
    Congress.
        Several states and local areas have expressed interest in piloting
    CAAs. We will work with these areas to develop a limited pilot that can
    be carried out under current law. However, statutory changes are
    necessary to achieve all of the reforms envisioned under the CAA
    proposal.
                            workforce training cuts
        Question. Your budget for workforce programs contains cuts of $506
    million for state grant programs, while increasing funding under
    national control by $107 million. How does this square with your
    legislative proposal to shift greater control of resources to the
    States?
        Answer. The President's fiscal year 2007 Budget proposes a minimal
    increase for programs under ``national control.'' The only activity
    that falls under this category that is proposed for additional funding
    is Unemployment Insurance National Activities, whereby an increase of
    $600,000 is requested to pay for activity related to processing
    separation documents and unemployment claims of former military service
    personnel.
        Furthermore, the fiscal year 2007 Budget request proposes
    initiatives that give greater control of funding to states and local
    areas. The Career Advancement Account proposal promotes state and local
    flexibility by streamlining and strengthening the One-Stop Career
    Center system and removing or simplifying statutory requirements that
    create rigidity and hinder flexibility in providing education and
    training opportunities to American workers. Also, the Administration
    included a streamlined program structure in its Older Americans Act
    reauthorization proposal, which would give states greater control over
    the Senior Community Service Employment Program (SCSEP) funds.
                               asbestos exposure
        Question. Madame Secretary, the fiscal year 2006 appropriation
    contained $2 million for the Employment Standards Administration to
    facilitate the expeditious startup of a system to resolve the claims of
    injury caused by asbestos exposure. How are these funds being used to
    shorten the lead-time for implementation of pending asbestos
    legislation?
        Answer. If the Asbestos legislation is enacted as currently
    written, the Department of Labor will be expected to manage a new and
    very substantial national benefits program involving the disbursement
    of billions of dollars in compensation to hundreds of thousands of
    individual asbestos claimants. The proposed time frame for implementing
    this legislation is extremely short, requiring immediate preparatory
    work and the up-front expenditure of resources to ensure that payments
    can begin being made to compensable claimants as quickly as possible.
        Given the status of the pending legislation, the $2 million is
    being used to analyze the proposed legislation and plan how to
    implement it in the event that it is passed. In the next phase, funding
    will be used for initial program start-up expenses in the areas of
    program design, acquisition of specialized expertise, technology, and
    infrastructure.
                     osha penalties for asbestos violations
        Question. I have introduced legislation (S. 668) to subject
    employers who willfully violate OSHA asbestos standards to fines at
    levels set by the Uniform Criminal Code as well as imprisonment of up
    to five years, or both. Currently OSHA provides for criminal penalties
    only in those cases where a willful violation of standards results in
    the death of a worker within six months after the violation is
    discovered. Do you agree that stronger enforcement action is needed
    against parties that violate OSHA asbestos enforcement rules?
        Answer. Currently, the OSH Act provides for criminal fines and
    imprisonment of up to six (6) months against an employer only where the
    employer's willful violation of a standard caused the death of an
    employee. In addition, criminal penalties exist against employers who
    make false statements to OSHA investigators or who unlawfully interfere
    with OSHA investigations. S. 668 provides that any willful violation of
    a standard issued under OSH Act section 6 with respect to control of
    occupational exposure to asbestos is punishable by fines under section
    3571 of Title 18, United States Code, and imprisonment in the case of a
    first offense, of up to five years. While we agree that occupational
    exposure to asbestos is a very serious health issue, we believe the
    current OSH Act and penalty structure provide the means and flexibility
    to address instances where penalties are warranted.
                                immigration bill
        Question. The Senate passed immigration legislation, S. 2611,
    contains a provision requiring the Secretary of Labor to certify that
    no United States workers are available for a specified position before
    employers can hire an alien for the job. Do you support this provision,
    and does your Department have sufficient resources to administer it?
        Answer. The Department supports the need to enact comprehensive
    immigration reform that creates a guest worker program and enhances the
    security of our borders. In his various speeches on immigration reform,
    the President has repeatedly noted that foreign workers should be
    allowed to take only those jobs that no U.S. worker is willing or
    available to perform. To implement this important program design
    feature, the Department will need to either establish a labor market
    test for domestic worker interest or create a mechanism whereby
    employers can attest that they have tested the labor market and been
    unable to find a U.S. worker to fill the job. If an attestation system
    is created, the Department would randomly audit employer attestations
    to ensure program integrity. We agree that the S. 2611 provision is
    consistent with the President's position and we support it accordingly.
    The administration will work with Congress as immigration legislation
    moves forward to ensure that the need for resources is addressed.
        Question. Your Department has the responsibility to prevent
    employer exploitation of undocumented workers, by enforcing minimum
    wage and overtime laws. To what extent is this effort discouraging
    illegal immigration?
        Answer. The strong enforcement of basic labor standards for all
    employees weakens the incentive to hire undocumented workers. Although
    it is difficult to quantify the extent to which labor standards
    enforcement deters or dissuades employers from hiring undocumented
    workers, most studies on the impact of illegal immigration acknowledge
    the importance of such enforcement as a key component in an overall
    strategy for addressing the problem.
        Question. What actions do Labor Department inspectors take when
    they come across evidence that a business unlawfully employs illegal
    immigrants?
        Answer. When the Wage and Hour Division (WHD) performs an
    investigation a complaint-based investigation, it does not seek
    evidence of the complainant's immigration status. WHD instituted this
    policy to avoid discouraging complaints from undocumented workers who
    might otherwise be reluctant to complain to WHD because of their
    immigration status.
        However, WHD investigators do perform directed investigations (non-
    complaint cases) to determine employers' compliance with their
    employment eligibility verification obligations (Forms I-9). In cases
    where it appears that violations have been committed, WHD refers the
    matter to DHS pursuant to a Memorandum of Understanding.
                             medical leave program
        Question. At your last appearance before this Committee on March
    15, 2005 you stated no final decision has been made with respect to
    revising regulations implementing the Family and Medical leave Act.
    What progress has been made addressing concerns of workers and
    employers that have resulted in so many lawsuits on the interpretation
    of when employers are eligible for leave under the law?
        Answer. The Department continues to review the issues raised by the
    Supreme Court's decision in Ragsdale v. Wolverine World Wide, Inc., as
    well as other court decisions, and the possibility of revisions to the
    FMLA regulations remains an item on the Department's regulatory agenda.
    No final decisions have yet been reached as to what, if any, changes
    might actually be proposed. If changes are proposed, the public will be
    provided ample opportunity to comment through the formal notice and
    comment rulemaking process.
                         re-allocation of unspent funds
        Question. Your budget proposed bill language that would take money
    away from states that have more than 30 percent unspent job training
    funds, yet you do not propose applying this principle to Dislocated
    Worker national reserve funds, which currently have unspent funds
    exceeding 50 percent. What is your justification for this?
        Answer. The Department always obligates all National Reserve monies
    to states during the program year for which such money was
    appropriated. Any unspent funds are unspent at the state and local
    level, not at the national level. This indicates that even more funds
    are available for expenditure by states and grantees.
                              rapid response funds
        Question. Currently, states use rapid response funds to provide
    immediate service to workers affected by a mass layoff, often before
    the workers are even laid off. Under your legislative proposal, states
    will need to apply to the Employment and Training Administration for
    rapid response funds as events occur. What are the reasons for keeping
    these funds at the national level, and having states apply for them
    each time they are faced with mass layoffs?
        Answer. The Department does not contemplate that a state would have
    to apply for funds each time there is a mass layoff or to only
    sporadically fund a state rapid response coordinator. Early
    intervention to provide information and assistance to workers to
    decrease the amount of time between actual layoff and re-employment is
    a key principle of the dislocated worker program. Rapid response is a
    key element of this early intervention strategy.
        States could demonstrate need and apply for rapid response funds at
    the beginning of the program year or throughout the program year. We
    will not propose that a state be required to submit an application for
    funding each time a dislocation event occurs.
        In spite of all the good work that has been done over the past
    fifteen years with dislocated worker rapid response funds, the
    Department has found that most company executives do not know about the
    type and quality of assistance available to them and their employees
    when closures or layoffs are contemplated. They have also reported that
    where they have layoffs in several states simultaneously, the levels
    and quality of assistance varies dramatically. ETA, in collaboration
    with state and local partners, has undertaken several initiatives in
    the auto, textile and defense industries recently to try to integrate
    services and develop more consistency. We believe a nationally-
    coordinated approach to delivering rapid response assistance by states
    can help bring the services to more workers and employers.
        The proposed mechanism will assist both the Department and the
    states to better manage scarce taxpayer resources by directing the bulk
    of the funds to the areas of need. For example, not all states
    experience major layoffs every year. Analyses of dislocated worker
    program expenditures reported by states have shown that the funds
    reserved for rapid response are consistently under-expended. In the
    aggregate, the rapid response carry-in funds from program year 2003 to
    2004, and from 2004 to 2005, was $136.7 million and $166 million,
    respectively. Through March 31, 2006, states reported accrued
    expenditures of just over $176 million of a total available of more
    than $342.5 million, or 51.4 percent of the total funds available.
    States are not required to retain the up to 25 percent authorized to be
    reserved for rapid response activities. They may include a portion of
    the funds in the amount allocated to local workforce investment boards
    for core, intensive and training services for dislocated workers, or
    they may award additional funds from the reserved amount to local areas
    that experience disasters, mass layoffs, plant closings or other events
    that precipitate substantial increases (defined by the state) in the
    number of unemployed workers.
                      comments on cecil roberts testimony
        Question. Mr. Cecil Roberts, President of the United Mine Workers
    of America, testified to this Committee that the penalties assessed by
    the Labor Department are designed to insure that mining remains
    profitable, even if the conditions are so hazardous the mine should be
    shut down. Do you believe that keeping a mine operating is more
    important than the safety of the miners?
        Answer. No, we do not believe that keeping a mine operating is more
    important than the safety of the miners who work in that mine. The Mine
    Act states in its opening section that ``the first priority of all in
    the coal or other mining industry must be the health and safety of its
    most precious resource--the miner.'' That is the premise on which the
    Mine Act is based and the reason for the existence of MSHA. The Mine
    Act contains provisions to withdraw miners until the hazard or
    violation is abated when there is an imminent danger to the health and
    safety of miners or an unwarrantable failure of an operator to comply
    with a mandatory health and safety standard. MSHA uses its withdrawal
    authority vigorously and appropriately.
        Under the Mine Act, MSHA has the authority to propose penalties for
    violations of the Act. MSHA does so in accordance with the six
    statutory criteria enacted by Congress in the Mine Act, including
    consideration of the effect of the proposed penalty on the operator's
    ability to stay in business. Consistent with the Administration's last
    three budget requests, Congress included a provision in the MINER Act
    to increase the maximum civil penalty for flagrant violations of the
    Mine Act to $220,000. Minimum penalties were also included for
    unwarrantable failure violations. The Department has announced that
    MSHA will be revising its regulations and proposing a new penalty
    formula to raise penalties for mine safety and health violations across
    the board. These higher penalties should provide a greater incentive to
    mine operators to comply with MSHA's safety standards.
                        older worker employment program
        Question. The Department has launched another national grant
    competition process for the Senior Community Service Employment Program
    despite not having the essential performance data that will not be
    available for new performance goals until September 2006. Since the
    current law directs that re-competition be conducted for non-
    performance by a grantee, on what basis do you deem this new round of
    competition to have sound data for assessing current or future grantee
    performance or capacity?
        Answer. The Department has been collecting performance data since
    the inception of the program, and has been collecting additional data
    on the new common performance measures since July 2004.
        Furthermore, according to the Title V of the Older Americans Act,
    competition is not limited to when grantees fail performance measures.
    Section 514(a) limits the award of SCSEP grants to no more than three
    years, thus requiring a selection of grantees within three years of the
    first competition. The issue of whether the Department can compete the
    SCSEP grants has also been addressed by the courts. The U.S. District
    Court of the District of Columbia held recently in Experience Works v.
    Chao, 267 F.Supp. 2d 93 (D.D.C. June 17, 2003), ``[t]he use of
    competitive procedures is a time-honored method for obtaining the most
    highly qualified awardees of government funds, for allowing new and
    innovative ideas and organizations to receive those funds, and for
    assuring public confidence in the integrity of the process to
    distribute government funds.''
        Finally, the current Solicitation for Grant Applications (SGA)
    clearly identifies the criteria against which applicants are assessed.
    All applicants will be rated using a ranking criterion based on points.
    This SGA requires that responses be thoughtful and reflect a strategic
    vision.
        The SGA evaluation criteria are as follows:
        1. Design and Governance--15 points
        2. Program and Grant Management Systems--10 points
        3. Financial Management System--10 points
        4. Program Service Delivery--40 points
        5. Performance Accountability--25 points
        Question. When the program was competed in 2003, this whole
    competition process--application, grading and transition--took almost 6
    months--including over 6 weeks for transitioning the participants
    affected. This time the new competition rules are much more complex,
    yet the whole process has been shortened to 4 months, leaving barely 3
    weeks for transition of these vulnerable participants--why the rush to
    get this done this way this year?
        Answer. This year's competition is not rushed. Applicants were
    given nearly the same amount of time this year as in the 2003
    competition to respond to the Solicitation for Grant Applications
    (SGA). In 2003, grantees were given 90 days to respond to the SGA, a
    time period which included Christmas. This year, the competition was
    announced in the Federal Register on March 2, and grantees were given
    until May 26 to respond, or 85 days.
        Further, once grants are awarded, grantees have 2 months in which
    to transition participants among grantees, a longer transition period
    than in 2003. As specified in the SGA, the transition period follows a
    1-month extension of current grants and will take place August 1-
    September 30, 2006. This means that the period from publication of the
    SGA (March 2) until the transition period ends (September 30) is
    approximately 7 months, 1 month longer than the 2003 competition.
        Question. The cost of transitioning thousands of participants
    nationwide among old and new sponsors will be significant. Subsequent
    to publication of the SGA in the Federal Register, the DOL website was
    amended to say, ``Transition cost should be submitted as an integral
    part of the budget and reflected on the other' cost category with a
    narrative explanation. Can you assure the Committee that services to
    enrollees will not be diminished as a result of incurred transitions
    costs?
        Answer. All current grantees were required to build transition
    costs into their budgets in the 2003 competition, and all applicants
    under the 2006 competition have also budgeted for transition costs.
    Further, the Department is prepared to assist grantees with additional
    costs associated with the transition, as it did following the
    transition after the 2003 competition. Program Year 2004 recaptured
    funds are available for this purpose.
        At the time of the 2003 competition, many participants and grantees
    were concerned about the transition effects upon participants. The
    Department can say with authority that every single participant was
    transitioned successfully. Competition does not need to cause any
    disruption among services participants receive.
        DOL has identified specific responsibilities for itself, national
    grantees and state grantees to ensure a smooth transition. DOL will
    provide orientation to all national grantees to provide information on
    program administration and management. DOL will begin regular
    conference calls between federal and regional DOL staff and national
    grantees to quickly address any transition issues. DOL will also
    provide assistance through a national call center, and provide on-site
    technical assistance as needed.
        Question. Your budget proposes to save $44 million in the Community
    Service Employment for Older American program through ``efficiencies
    related to program streamlining.'' What exactly is being proposed to
    save this amount?
        Answer. The Administration proposes that reauthorization of the
    Title V SCSEP program be based on five key reform principles: (1)
    helping meet employers' demands for skilled workers by attracting more
    older workers into the labor force, encouraging others to remain in the
    workforce, and by offering opportunities for older workers to update
    their skills; (2) making the One-Stop Career Center system effective
    for older individuals seeking to work or upgrade their skills,
    including better integrating services for older workers and assisting
    more older workers, regardless of income, to gain skills that are in
    demand; (3) tailoring services to meet the needs of individual older
    workers by providing a range of training experiences, including
    community service employment, on-the-job training and classroom
    training, depending on the individual's background and experience; (4)
    targeting SCSEP resources to those older workers most in need
    (primarily low-income older workers who lack the basic skills for
    private sector employment), while ensuring that others receive services
    through the One-Stop Career Center system; and (5) streamlining the
    program to make it easier to administer in order to improve program
    performance, serve more participants, and receive a return on
    investment for the federal taxpayers' dollar.
        In fiscal year 2007, savings from streamlining administration and
    other reforms will amount to an estimated $44 million in the first year
    of implementation. Specifically, we expect that savings will be
    achieved from the following reforms:
      --Revamping the SCSEP program structure so that states conduct a
            competition every three years to run the program in the state,
            which will simplify administration, eliminate duplication, and
            create a more comprehensive program.
      --Eliminating fringe benefits for program participants (except
            accident insurance or benefits that may be required by law) to
            reinforce the training aspect of the program.
      --Allowing SCSEP funding to be used for training (as opposed to
            wages) and allowing more flexible training options in addition
            to community service work experience.
        In addition to savings from reforms through reauthorization,
    savings will also be realized through the current grant competition.
    The current Solicitation for Grant Applications encourages a regional
    service delivery architecture that will reduce redundancy and
    fragmentation of service delivery areas by requiring that applicants
    apply to serve an entire county instead of a portion, and generally
    requiring that applicants apply to serve contiguous counties if
    multiple counties are served.
        It is important to note that the fiscal year 2007 request will
    continue to support 92,300 low-income elderly individuals, the same
    level as fiscal year 2006.
                         administration and management
        Question. Provide appropriations and full time equivalent staff for
    each of fiscal years 2003 through 2005 enacted, fiscal 2006 comparable,
    and fiscal 2007 budget request, for each of the components of the
    Administration and Management activity within the Departmental
    Management account, including: Department Budget Center; Center for
    Program Planning and Results; Human Resources Center; Information
    Technology Center; Civil Rights Center; Office of Security and
    Emergency Management and Business Operation Center. Provide the source,
    by Department of Labor agency and activity, of the FTE and funding for
    Working Capital Fund Programs, comparing fiscal year 2006 comparable
    with the fiscal year 2007 request.
        Answer. The information for Administration and Management follows:

                                   ADMINISTRATION AND MANAGEMENT BUDGET ACTIVITY DEPARTMENTAL MANAGEMENT SALARIES AND EXPENSES
                                                                      [Amount in thousands]
    --------------------------------------------------------------------------------------------------------------------------------------------------------
                                                  Fiscal year 2003      Fiscal year 2004      Fiscal year 2005      Fiscal year 2006      Fiscal year 2007
                                                       enacted               enacted               enacted             comparable              request
                      Agency                   -------------------------------------------------------------------------------------------------------------
                                                   AMT        FTE        AMT        FTE        AMT        FTE        AMT        FTE        AMT        FTE
    --------------------------------------------------------------------------------------------------------------------------------------------------------
    Center for Program Planning and Results...     $6,352          4     $6,076          9     $5,537          8     $5,438          8     $5,562          8
    Human Resources Center....................      3,650         23      3,473         23      3,502         24      3,445         24      3,573         24
    Information Technology Center.............     12,414         60     12,954         56     11,624         50      9,346         37      9,755         37
    Business Operation Center.................      2,652         16      2,026         14      1,959         11      1,778         11      1,825         11
    Office of Security and Emergency Mgmt.\1\.  .........  .........  .........  .........      6,944  .........      6,875  .........      1,893  .........
    Department Budget Center \2\..............  .........  .........      1,776         15      2,362         19      2,056         18      2,116         18
    Library...................................        714          2        719          2        754          1        754          1        782          1
    Federal Executive Board...................        170          2        173          2        176          2        206          2        210          2
    Assistant Secretary for Administration and      4,239          5      5,956          5      6,500         10      7,590         10      7,923         10
     Management...............................
    Civil Rights Center \3\...................      5,930         48      6,144         48      6,237         46      6,451         46      6,735         46
    --------------------------------------------------------------------------------------------------------------------------------------------------------
    \1\ Represents funding for Frances Perkins Building security enhancements. The fiscal year 2007 Request includes a comparative transfer of $5 million
      from this budget activity to the Working Capital Fund for upgrading security and continuity of operations capabilities for the Department.
    \2\ Department Budget Center was transferred to Administration and Management budget activity from the Chief Financial Officer budget activity in fiscal
      year 2004.
    \3\ CRC is funded from the Civil Rights Activity, rather than the Administration and Management Activity.

        The information for Working Capital Fund follows:

                   DOL AGENCY WORKING CAPITAL FUND ASSESSMENTS
                            [In thousands of dollars]
    ------------------------------------------------------------------------
                                                           Fiscal year
                                                   -------------------------
                                                        2006         2007
                                                      estimate     request
    ------------------------------------------------------------------------
    ETA...........................................       14,987       17,942
    ETA/TES.......................................        9,326        9,922
    ESA...........................................       37,620       44,021
    OSHA..........................................       22,851       25,235
    EBSA..........................................       10,054       11,463
    BLS...........................................       16,009       19,353
    OIG...........................................        4,097        4,685
    OSEC..........................................       14,458       16,730
    VETS..........................................        2,832        3,207
    SOL...........................................        6,396        6,646
    ILAB..........................................        1,984        2,228
    MSHA..........................................       11,237       13,564
    ODEP..........................................        1,250        1,305
    FPB repairs...................................          915          833
                                                   -------------------------
          Total...................................      154,016      177,134
    ------------------------------------------------------------------------

                               program direction
        Question. Provide appropriations and full time equivalent staffing
    for each of fiscal years 2003 through 2005 enacted, fiscal 2006
    comparable, and fiscal 2007 budget request, for each of the following
    components of the Program Direction and Support activity within the
    Departmental Management account: Office of the Secretary; Office of the
    Deputy Secretary; Office of Public Affairs; Office of the Assistant
    Secretary for Policy; Office of Congressional and Intergovernmental
    Affairs; Office of Small Business Programs; Office of Public Liaison;
    Office of the 21st Century Workforce; and the Center for Faith-Based
    and Community Initiatives.
        Answer. The information for Program Direction follows:

                                                                  PROGRAM DIRECTION AND SUPPORT
                                                                      [Amount in thousands]
    --------------------------------------------------------------------------------------------------------------------------------------------------------
                                                  Fiscal year 2003      Fiscal year 2004      Fiscal year 2005    Fiscal year 2006 \1\    Fiscal year 2007
                                                       enacted               enacted               enacted              comparable             request
                  PDS components               -------------------------------------------------------------------------------------------------------------
                                                   AMT        FTE        AMT        FTE        AMT        FTE        AMT        FTE        AMT        FTE
    --------------------------------------------------------------------------------------------------------------------------------------------------------
    Office of the Secretary...................     $3,669         17     $3,015         12     $4,639         21     $4,859         17     $5,068         20
    Office of the Deputy Secretary............      1,173          8      1,270          8      1,260          9      1,234          8      1,293          9
    Office of Small Business Programs.........      1,021          9      1,097          9      1,289          8      1,344          7      1,659          8
    Office of Public Liaison..................        840          8        895          7        949          6      1,004          6      1,072          6
    Office of Congressional and                     4,232         32      4,456         32      4,420         27      4,651         24      5,258         27
     Intergovernmental Affairs................
    Office of Public Affairs..................      4,003         26      5,861         35      3,612         28      3,772         26      4,812         28
    Office of the Assistant Secretary for          10,423         53      8,975         46      8,903         40      7,222         35      8,741         40
     Policy \2\...............................
    Office of the 21st Century Workforce......      1,019          8      1,049          8      1,041          6      1,040          6      1,092          6
    Center for Faith-Based & Community          .........  .........        593          5        605          6        633          6        800          6
     Initiatives..............................
    --------------------------------------------------------------------------------------------------------------------------------------------------------
    \1\ $28.5 million was appropriated in ETA Program Administration for Job Corps program salaries and expenses. These funds have been allotted to the
      Office of the Secretary to be used for the Job Corps program in accordance with Section 102 of Public Law 109-149.
    \2\ Includes ASP drug-free workplace funds.

                          built-in and program changes
        Question. Provide a table for each discretionary appropriation
    account, identifying by line-item, the built-in changes from the fiscal
    year 2006 adjusted level, and each program increase, to arrive at the
    fiscal year 2007 budget request level.
        Answer. The attached table reflects built-in increases and
    decreases, program increases and decreases, and finance changes,
    affecting each discretionary appropriation account from the fiscal year
    2006 adjusted level to the fiscal year 2007 budget request level.

                                                                       DEPARTMENT OF LABOR
                                                                    [In thousands of dollars]
    --------------------------------------------------------------------------------------------------------------------------------------------------------
                                                              Fiscal year         Built-In                 Program                               Fiscal year
                                                                  2006    ------------------------------------------------             Finance   2007 budget
               Discretionary Appropriation Account              adjusted                                                    Transfer   changes     request
                                                                 level     Increases   Decreases   Increases   Decreases                         current Law
    --------------------------------------------------------------------------------------------------------------------------------------------------------
    EMPLOYMENT & TRAINING ADMIN:
        TRAINING AND EMPLOYMENT SERVICES:
            Adult Employment and Training Activities........      857,079  .........  ...........  .........     -145,079  .........  .........      712,000
            Dislocated Worker Employment and Training           1,337,553  .........  ...........  .........     -222,971  .........  .........    1,114,582
             Activities.....................................
            Youth Activities................................      940,500  .........  ...........  .........     -100,000  .........  .........      840,500
                                                             ===============================================================================================
        Job Corps:
            Operations......................................    1,450,400      1,282  ...........  .........      -50,080  .........  .........    1,401,602
            Construction and Renovation.....................      106,920  .........  ...........  .........       -6,920  .........  .........      100,000
                                                             -----------------------------------------------------------------------------------------------
              Subtotal--Job Corps...........................    1,557,320      1,282  ...........  .........      -57,000  .........  .........    1,501,602
                                                             ===============================================================================================
        Responsible Reintegration for Young Offenders.......       49,104  .........  ...........  .........      -49,104  .........  .........  ...........
        Prisoner Re-entry...................................       19,642  .........  ...........  .........  ...........  .........  .........       19,642
        Native Americans....................................       53,696  .........  ...........  .........       -2,238  .........  .........       51,458
        Migrants and Seasonal Farmworkers...................       79,252  .........  ...........  .........      -79,252  .........  .........  ...........
                                                             ===============================================================================================
        National Programs:
            Pilots, Demonstrations and Research.............       29,700  .........  ...........  .........      -12,000  .........  .........       17,700
            Evaluation......................................        7,857  .........  ...........  .........       -2,936  .........  .........        4,921
            Denali Commission...............................        6,875  .........  ...........  .........       -6,875  .........  .........  ...........
            Other...........................................        1,980  .........  ...........  .........       -1,980  .........  .........  ...........
            Community College Initiative....................  ...........  .........  ...........    150,000  ...........  .........  .........      150,000
                                                             -----------------------------------------------------------------------------------------------
              Subtotal--National Programs...................       46,412  .........  ...........    150,000      -23,791  .........  .........      172,621
                                                             ===============================================================================================
        Job Corps Construction Balances Cancellation........  ...........  .........  ...........  .........      -75,000  .........  .........      -75,000
                                                             -----------------------------------------------------------------------------------------------
          Total--Training and Employment Services...........    4,940,558      1,282  ...........    150,000     -754,435  .........  .........    4,337,405
                                                             ===============================================================================================
        COMMUNITY SERVICE EMPLOYMENT........................      432,311  .........  ...........  .........  ...........  .........  .........      432,311
                                                             ===============================================================================================
        STATE UI & ES OPERATIONS:
            Unemployment Compensation (Trust Funds):
            State Operations................................    2,497,770    101,905  ...........     40,000  ...........  .........  .........    2,639,675
                AWIU........................................       41,580  .........      -41,580  .........  ...........  .........  .........  ...........
                National Activities.........................        9,900  .........  ...........        600  ...........  .........  .........       10,500
                                                             -----------------------------------------------------------------------------------------------
                  Subtotal--Unemp Comp......................    2,549,250    101,905      -41,580     40,600  ...........  .........  .........    2,650,175
                                                             ===============================================================================================
            Employment Service:
                Grants to States:
                    Federal funds...........................       22,883  .........  ...........  .........         -867  .........  .........       22,016
                    Trust funds.............................      693,000  .........  ...........  .........      -26,247  .........  .........      666,753
                National Activities (Trust Funds)...........       33,428  .........  ...........  .........         -510  .........  .........       32,918
                                                             -----------------------------------------------------------------------------------------------
                  Subtotal--Employment Service..............      749,311  .........  ...........  .........      -27,624  .........  .........      721,687
                                                             ===============================================================================================
                One Stop Career Centers /ALMIS..............       81,662  .........  ...........  .........      -17,807  .........  .........       63,855
                Work Incentives Grants......................       19,514  .........  ...........  .........      -19,514  .........  .........  ...........
                                                             -----------------------------------------------------------------------------------------------
                  Total--State UI & ES Operations...........    3,399,737    101,905      -41,580     40,600      -64,945  .........  .........    3,435,717
                                                             ===============================================================================================
        Program Administration:
            Adult Services..................................       43,360      1,716  ...........  .........  ...........  .........       -288       44,788
                Trust Funds.................................        7,846  .........  ...........  .........  ...........  .........        288        8,134
            Youth Services..................................       38,565      1,410  ...........  .........  ...........  .........  .........       39,975
            Workforce Security..............................        6,225      2,616  ...........  .........  ...........  .........     -2,415        6,426
                Trust Funds.................................       72,113  .........  ...........      6,000  ...........  .........      4,688       82,801
            Apprenticeship Training, Employer and Labor            21,538        800  ...........  .........  ...........  .........       -923       21,415
             Services.......................................
            Executive Direction.............................        6,956        320  ...........  .........  ...........  .........     -1,120        6,156
                Trust Funds.................................        2,090  .........  ...........  .........  ...........  .........       -231        1,859
                                                             -----------------------------------------------------------------------------------------------
                  Total--Program Administration.............      198,693      6,862  ...........      6,000  ...........  .........         -1      211,554
                                                             -----------------------------------------------------------------------------------------------
                  Total--ETA................................    8,971,299    110,049      -41,580    196,600     -819,380  .........         -1    8,416,987
                                                             ===============================================================================================
    EMPLOYEE BENEFITS SECURITY ADMINISTRATION:
        Enforcement & Participant Assisstance...............      111,604      3,794          -98      5,000  ...........  .........  .........      120,300
        Policy & Compliance Assistance......................       17,358        642  ...........  .........  ...........  .........  .........       18,000
        Executive Leadership, Program Oversight &                   5,044        229  ...........  .........  ...........  .........  .........        5,273
         Administration.....................................
                                                             -----------------------------------------------------------------------------------------------
          Total--EBSA.......................................      134,006      4,665          -98      5,000  ...........  .........  .........      143,573
                                                             ===============================================================================================
    EMPLOYMENT STANDARDS ADMIN.:
        Enforcement of Wage & Hour Standards................      166,408      5,170  ...........      6,000  ...........  .........  .........      177,578
        Office of Labor Management Standards................       45,912      1,974  ...........      4,520  ...........  .........  .........       52,406
        Federal Contractor EEO Standards....................       81,645      3,012  ...........  .........       -1,000  .........  .........       83,657
        Federal Programs for Workers' Comp..................       99,593      4,581  ...........  .........  ...........  .........  .........      104,174
        Trust Funds.........................................        2,034         42  ...........  .........  ...........  .........  .........        2,076
        Program Direction & Support.........................       17,253        550          400       -677  ...........  .........  .........       17,526
                                                             -----------------------------------------------------------------------------------------------
          Total--ESA........................................      412,845     15,329  ...........     10,920       -1,677  .........  .........      437,417
                                                             ===============================================================================================
    OCCUPATIONAL SAFETY & HEALTH:
        Safety & Health Standards...........................       16,462        430  ...........  .........  ...........  .........  .........       16,892
        Federal Enforcement.................................      173,430      6,503  ...........  .........  ...........  .........  .........      179,933
        State Programs......................................       91,093  .........  ...........  .........  ...........  .........  .........       91,093
        Technical Support...................................       21,435        957  ...........  .........  ...........  .........  .........       22,392
        Compliance Assistance:
            Compliance Assistance--Federal..................       72,545      1,396  ...........      2,616  ...........  .........  .........       76,557
            Compliance Assistance--State....................       53,357  .........  ...........  .........  ...........  .........  .........       53,357
            Training grants.................................       10,116  .........  ...........  .........      -10,116  .........  .........  ...........
                                                             -----------------------------------------------------------------------------------------------
              Subtotal--Compliance Assistance...............      136,018      1,396  ...........      2,616      -10,116  .........  .........      129,914
                                                             ===============================================================================================
        Safety and Health Statistics........................       24,253        521  ...........      7,500  ...........  .........  .........       32,274
        Executive Direction.................................       10,591        578  ...........  .........  ...........  .........  .........       11,169
                                                             -----------------------------------------------------------------------------------------------
          Total--OSHA.......................................      473,282     10,385  ...........     10,116      -10,116  .........  .........      483,667
                                                             ===============================================================================================
    MINE SAFETY & HEALTH ADMIN:
        Coal................................................      117,463      2,932  ...........  .........  ...........  .........  .........      120,395
        Metal/Nonmetal......................................       68,227      1,879  ...........  .........  ...........  .........  .........       70,106
        Standards Development...............................        2,485        173  ...........  .........  ...........  .........  .........        2,658
        Assessments.........................................        5,405        161  ...........  .........  ...........  .........  .........        5,566
        Educational Policy and Development..................       31,749      1,177  ...........  .........  ...........  .........  .........       32,926
        Technical Support...................................       25,609        804  ...........      1,000  ...........  .........  .........       27,413
        Program Eval & Info Resources.......................       15,532        203  ...........  .........  ...........  .........          1        5,735
        Program Administration..............................       11,938      1,099  ...........  .........  ...........  .........  .........       13,037
                                                             -----------------------------------------------------------------------------------------------
          Total--MSHA.......................................      278,408      8,428  ...........      1,000  ...........  .........  .........      287,836
                                                             ===============================================================================================
    BUREAU OF LABOR STATISTICS:
        Employment & Unemployment Statistics................      165,683      5,373  ...........  .........  ...........  .........  .........      171,056
        Labor Market Information (Trust Funds)..............       77,066      1,960  ...........  .........  ...........  .........  .........        7,026
        Prices and Cost of Living...........................      173,515      5,566  ...........      8,000  ...........  .........  .........      187,081
        Compensation and Working Conditions.................       81,052      2,808  ...........  .........  ...........  .........  .........       83,860
        Productivity and Technology.........................       10,777        341  ...........  .........  ...........  .........  .........       11,118
        Executive Direction & Staff Services................       30,235        912  ...........  .........  ...........  .........  .........       31,147
                                                             -----------------------------------------------------------------------------------------------
          Total--BLS........................................      538,328     16,960  ...........      8,000  ...........  .........  .........      563,288
                                                             ===============================================================================================
    DEPARTMENTAL MANAGEMENT:
        Program Direction and Support.......................       25,759      1,320         -152      2,868  ...........  .........  .........       29,795
        Departmental IT Cross Cut...........................       29,462  .........  ...........  .........          -57  .........  .........       29,405
        Departmental Management Cross Cut...................        1,683  .........  ...........  .........         -575  .........  .........        1,108
        Legal Services......................................       80,416      3,246  ...........      1,204  ...........  .........  .........       84,866
        Trust Funds.........................................          308         14  ...........  .........  ...........  .........  .........          322
        International Labor Affairs.........................       72,567        651          -26  .........      -60,829  .........  .........       12,363
        Administration & Management.........................       30,613      1,237           -4  .........         -100  .........  .........       31,746
        FPB Security Enhancements...........................        1,875         18  ...........  .........  ...........  .........  .........        1,893
        Adjudication........................................       27,243      1,700          -12  .........  ...........  .........  .........       28,931
        Women's Bureau......................................        9,763        456          -71  .........         -800  .........  .........        9,348
        Civil Rights Activities.............................        6,451        284  ...........  .........  ...........  .........  .........        6,735
        Chief Financial Officer.............................        5,340        239  ...........  .........  ...........  .........  .........        5,579
                                                             -----------------------------------------------------------------------------------------------
          Total--DM S&E.....................................      291,480      9,165         -265      4,072      -62,361  .........  .........      242,091
                                                             ===============================================================================================
    OFFICE OF DISABILITY EMPLOYMENT POLICY..................       27,695        558  ...........     -7,934  ...........  .........  .........       20,319
    VETERANS EMPLOYMENT AND TRAINING:
        State Administration Grants.........................      160,791        427  ...........  .........  ...........  .........  .........      161,218
        Federal Administration..............................       30,211      2,206  ...........  .........  ...........  .........  .........       32,417
        Nat'l Veterans Training Institute (NVTI)............        1,964          5  ...........  .........  ...........  .........  .........        1,969
        Homeless Veterans Program...........................       21,780         58  ...........  .........  ...........  .........  .........       21,838
        Veterans Workforce Investment Program...............        7,425         20  ...........  .........  ...........  .........  .........        7,445
                                                             -----------------------------------------------------------------------------------------------
          Total--VETS.......................................      222,171      2,716  ...........  .........  ...........  .........  .........      224,887
                                                             ===============================================================================================
    OFFICE OF INSPECTOR GENERAL:
        Program Activities..................................       65,744      2,329  ...........  .........  ...........  .........  .........       68,073
        Trust Funds.........................................        5,552        136  ...........  .........  ...........  .........  .........        5,688
                                                             -----------------------------------------------------------------------------------------------
          Total--OIG........................................       71,296      2,465  ...........  .........  ...........  .........  .........       73,761
                                                             ===============================================================================================
    Working Capital Fund....................................        6,168         16  ...........     13,954       -6,184  .........  .........       13,954
                                                             -----------------------------------------------------------------------------------------------
          Total--DM.........................................      618,810     14,920         -265     10,092      -68,545  .........  .........      575,012
                                                             -----------------------------------------------------------------------------------------------
          Total--Department of Labor........................   11,426,978    180,736      -41,943    241,728     -899,718  .........         -1   10,907,780
    --------------------------------------------------------------------------------------------------------------------------------------------------------

                            women in apprenticeship
        Question. The conference agreement on the fiscal year 2006 Labor
    Department appropriations legislation specified $982,000 for carrying
    out Public Law 102-530, the Women in Apprenticeship and Non-Traditional
    Occupations Act.
        What action is being taken to issue grants to community based
    organizations to encourage employment of women in apprenticeable
    occupations and nontraditional occupations?
        Answer. The Employment and Training Administration and the Women's
    Bureau have worked collaboratively to develop a Solicitation for Grant
    Applications (SGA). The SGA is currently going through Departmental
    clearance and we expect a notice announcing the SGA to be published in
    the Federal Register in August 2006.
               appalachian council/working for america institute
        Question. This subcommittee held a hearing on July 22, 2004, on the
    funding of the Appalachian Council and Working for America Institute.
    Despite that hearing, the Labor Department did not renew the contracts
    for these organizations, forcing Congress to earmark $2.2 million and
    $1.5 million, respectively, for their continued operation. I understand
    that funding has now run out, and I urge you to renew the contracts.
    Will you take another look at the organizations, and see what can be
    done to provide renewed funding?
        Answer. On February 1, 2005, the Department of Labor executed a
    $1,500,000 grant to the Working for America Institute (WAI). This grant
    will remain active until February 3, 2007. The Department of Labor
    continues to work closely with WAI to support the deliverables of their
    grant, including developing resources to support a well-skilled
    advanced manufacturing workforce.
        Job Corps funded the Appalachian Council for $2.2 million in
    February, 2005 and then renewed the funding in the amount of $2.2
    million in April, 2006. That funding is through March 31, 2007. An
    evaluation will be done to determine if additional funding will be
    provided based upon performance and funding availability.
                               job training staff
        Question. Your budget request for federal administration of
    Employment and Training Administration programs provided for 1,158
    direct full-time equivalent staff, compared to the current level of
    1,194 staff.
        Why are you requesting only a reduction of 14 federal staff when
    you are proposing to consolidate several job training programs into a
    single block grant to states?
        Answer. The Employment and Training Administration (ETA) fiscal
    year 2006 FTE level supported by appropriated funds is 1,180 (with an
    additional 16 FTE supported by fees and reimbursements). The ETA fiscal
    year 2007 Legislative Proposal FTE level (excluding FTE supported by
    fees and reimbursements) is 1,158. Compared with fiscal year 2006
    staffing, ETA's fiscal year 2007 Legislative Proposal represents a net
    reduction of 22 FTE--an addition of 7 FTE within Youth Services to
    support the proposed transfer of Youthbuild from the Department of
    Housing and Urban Development to ETA, and a reduction of 29 FTE in
    Workforce Security in anticipation of the enactment of a Foreign Labor
    Certification Permanent Program fee.
        ETA does not anticipate that the implementation of the Career
    Advancement Accounts (CAA) will have an immediate impact on ETA
    staffing levels. Assuming the passage of authorizing legislation in
    fiscal year 2007, a significant amount of effort by ETA staff will be
    required to transition from the current Workforce Investment Act (WIA)
    structure to a new CAA structure. Moreover, during the transition and
    until it is complete, the same or a similar level of effort that is
    currently provided will be necessary to continue national and regional
    Federal oversight required to administer WIA. The time necessary to
    implement the transition to a new CAA structure will also provide ample
    time for an orderly transition to an FTE level appropriate for the
    level of Federal oversight required to administer CAAs.
                              safe places in mines
        Question. The Commonwealth of Pennsylvania has begun an analysis of
    locating safe places in the mines for workers to seek refuge in case
    escape routes are blocked. These safe places could be permanent or
    portable. Do you intend to conduct a similar analysis nationwide?
        Answer. Section 13 of the MINER Act requires NIOSH to study various
    refuge alternatives in an underground coal mine environment and issue a
    report not later than 18 months after enactment of the Act. Not later
    than 180 days after the receipt of this report, the Secretary of Labor
    is required to provide a response to the two authorizing committees
    describing what actions, if any, the Secretary intends to take based on
    the report. The Department will comply with this statutory requirement.
                             competitiveness agenda
        Question. You propose cutting $653 million from workforce
    investment programs and another $27 million from the Employment
    Service, despite the fact that funding for workforce programs is $1
    billion below the funding level than when the President took over and
    there are one million more unemployed workers than there were in 2001.
    Isn't that approach inconsistent with a competitiveness agenda that is
    supposedly going to help America, and its workers, compete in the
    global economy?
        Answer. Although the President's fiscal year 2007 Budget request
    for the Employment and Training Administration is below the fiscal year
    2006 appropriation, it is a responsible budget that reflects the
    competitive demands for very limited resources for domestic programs
    and the need to eliminate waste and redundancy. The proposed reforms
    align with the competitiveness agenda by reforming the workforce
    investment system so that many more workers are trained, equipping them
    with the skills necessary to succeed in the 21st Century.
        The public workforce investment system could be structured to
    better meet the training challenges presented by the increased need for
    skills and competencies by workers. There exists a lack of integration,
    which causes too much money to be spent on competing bureaucracies,
    overhead costs, and unnecessary infrastructure, and not enough on
    meaningful skills training that leads to job growth and economic
    prosperity.
        Career Advancement Accounts, relative to the existing workforce
    investment system, will be more effective and flexible in meeting the
    demands of the global economy and in addressing the nation's workforce
    challenges. Career Advancement Accounts would mean a streamlined
    workforce investment system that gets more training dollars in the
    hands of workers and reduces costs by eliminating duplication across
    employment and training programs and lowering overhead costs. The
    greater efficiency from this redesign of the system will result in cost
    savings that account for much of the reduction in ETA's budget. More
    than triple the number of workers currently being trained would be
    trained under this proposal.
                                voucher proposal
        Question. You have proposed a new WIA reauthorization proposal
    calling for Career Advancement Accounts, i.e. vouchers, to be run
    through a consolidated workforce system overseen by the Governor,
    allowing him or her to choose to eliminate the local workforce system
    and the One Stop network. This is the third different reauthorization
    proposal you have made to the Congress, your previously two attempts to
    create a block grant for the Governor have been resoundingly rejected
    in both the House and Senate, which have consistently protected the
    local workforce delivery system as essential to helping our workers
    receiving training for jobs in the local economy. Knowing that this
    approach has been rejected twice before, isn't your budget proposal jut
    a smokescreen to provide a rationale for deep budget cuts to the
    workforce system?
        Answer. No. Under the Administration's proposal for Career
    Advancement Accounts, states can maintain One-Stop Career Centers to
    provide employment services to job seekers and employers, as well as
    access to Career Advancement Accounts, at these sites. Career
    Advancement Accounts are a more efficient and effective way to deliver
    job training that will result in more workers getting the skills they
    need with less overhead costs. We believe that with the constraints on
    discretionary spending and the promise of more than tripling the number
    of workers trained with this innovative new approach, Congress will
    take this proposal seriously. This proposal is consistent with the
    ``innovation'' agenda that has bi-partisan support in Congress.
        Workforce Investment Act (WIA) reauthorization has been pending in
    Congress for three years. No proposals have been either formally
    accepted or rejected. H.R. 27, which was passed by the House on March
    2, 2005, does consolidate the WIA Adult, WIA Dislocated Worker, and
    Employment Service funding streams, indicating interest on the part of
    Congress in streamlining programs as the Administration proposed.
                        rational for workforce training
        Question. You claim that only 200,000 are trained annually by the
    workforce system; however your data provides the smallest data pool
    possible to make your claim, as it only measures participants leaving
    training during a fiscal year. GAO estimates that over double this
    number, 416,000 receive training annually. Your own data provided in
    the Budget Justifications shows that over 15 million participants
    receive an array of training, intensive, or basic employment assistance
    annually through the workforce system. Isn't your budget request
    another example of using selective data to block grant and cut program
    funding?
        Answer. The important point is that 200,000 people complete and
    exit training per year with a $4 billion investment, meaning that too
    much money is being spent on low-cost services with little value to the
    customer. ETA uses actual data collected from the states in referencing
    number of people trained. The GAO study indicates that 40 percent of
    funds are used for training adults and dislocated workers, whereas ETA
    estimates this figure at 26 percent. This discrepancy occurs due to two
    primary differences in the measurements: (1) ETA is measuring exiters,
    or those that have actually completed training, while GAO is measuring
    training costs of all participants receiving training (meaning that
    people are ``double counted'' because their training may have occurred
    over two program years); and (2) ETA includes expenditures, while GAO
    includes both expenditures and obligations--obligations which may not
    result in someone actually being trained. The estimates by ETA and GAO
    are different because they look at distinctly different sets of cost
    estimates and individuals included in the count.
        The question also refers to the number of individuals served by the
    workforce investment system. The large majority of these participants
    are receiving only basic employment services, including self-services.
    The Career Advancement Accounts proposal would increase the number of
    individuals trained through the workforce investment system, while
    still providing basic employment services to job seekers.
                        elimination of migrant programs
        Question. For the third year in a row, you have proposed
    eliminating the Migrant and Seasonal Farmworker program authorized
    under WIA. You first proposed to work with states and local areas to
    ensure that migrant and seasonal farmworkers could access services
    through One-Stop Career Centers; despite the fact that your
    Department's data show that the program met its performance goals. Now
    you propose to give governors the flexibility to design how individuals
    will access information and Career Advancement Accounts or vouchers.
    How does the Administration propose to ensure that these individuals--
    some of America's neediest adults and their families--will be able to
    successfully navigate among service delivery systems that will differ
    from state to state and secure the job training and employment services
    that they need?
        Answer. The Administration's fiscal year 2007 Budget proposal seeks
    to tap the workforce investment system's potential to serve more
    migrant and seasonal farmworkers by providing job training services to
    them through the One-Stop Career Center system, and turning to other,
    appropriate agencies to provide supportive services, housing, and other
    related assistance. Currently, the section 167 program provides
    employment and training services to only 10,000 of an estimated 2
    million farmworkers, which demonstrates the need for a wider system
    approach.
        The Administration believes that providing services to farmworkers
    through the One-Stop system will increase the number served and have a
    positive employment and earnings impact on those who receive services.
        The Administration's fiscal year 2007 budget proposal seeks to take
    advantage of the One-Stop system's potential to better serve more
    migrant and seasonal farmworkers by helping them access the full array
    of employment and training services available from the seventeen
    federal programs delivered through the One-Stop system. While the
    proposal is to increase the amount of funding spent on training
    utilizing Career Advancement Accounts as the vehicle, the proposal also
    includes continued funding for core service delivery, including career
    guidance and job referrals, to any job seeker. Career Advancement
    Accounts can be used for a combination of remedial training leading to
    a diploma or GED in addition to post secondary education. We believe
    this combination of career guidance and training in the context of the
    One-Stop delivery system that connects workers to a wide array of
    services, including supportive services, can result in increased
    services to farmworkers and more positive employment and earnings
    impact on those farmworkers who receive services.
                            employment service cuts
        Question. You propose to cut the Employment Service by about $27
    million in fiscal year 2007 over and above a $96 million reduction in
    fiscal year 2006. You would give states the flexibility to determine
    how to provide basic employment services to America's workers and at
    the same time, absorb other costs that you propose to divest from the
    federal level--in labor market information products and services and
    dedicated professionals to help the disabled obtain employment. Past
    shortfalls in federal support have forced states to close local
    offices. With these deep cuts, states will be forced to shut down many
    more One Stop Career Centers that help match job seekers and employers
    seeking workers. How do you expect governors to be able to help an
    expected 14 million workers who need jobs and the thousands of
    employers looking for workers?
        Answer. The Department proposes to consolidate the Workforce
    Investment Act (WIA) programs for adults, dislocated workers, and
    youth, and the Wagner-Peyser funding stream into a single flexible
    grant that enables governors to utilize these resources strategically
    to both drive their economies and provide maximum training and
    employment opportunities for their citizens.
        The public workforce investment system, as currently constituted,
    is ill-equipped to meet the workforce challenges presented by the
    increased need for advanced skills and competencies in the 21st century
    economy. As one researcher has noted, ``As it now stands, employment
    services (and by extension the One-Stop system) is very far from being
    an effective labor exchange capable of assisting people surmount the
    challenges of today's job market.\1\ This is due, in part, to the lack
    of integration, which causes too much money to be spent on competing
    bureaucracies, overhead costs, and unnecessary infrastructure, and not
    enough on meaningful skills training that leads to job growth and
    economic prosperity. For example, while the Employment Service is
    intended to be the cornerstone of the One-Stop system under WIA, many
    states continue to have a separate network of Employment Service
    offices that offer the same ``core services'' that are available under
    WIA through One-Stop Career Centers.
    ---------------------------------------------------------------------------
        \1\ Osterman, Paul. ``Employment and Training Policies: New
    Directions for Less Skilled Adults.'' Paper prepared for the Urban
    Institute. October 2005. p.16.
    ---------------------------------------------------------------------------
        Furthermore, large amounts of state unexpended carryover funds
    still remain. In fiscal year 2004, unexpended funds from the WIA Adult,
    Dislocated Worker, and Youth programs totaled almost $1.2 billion and a
    similar amount is projected for fiscal year 2005, which ends on June
    30, 2006. Therefore, it is the Administration's position that through
    more efficient administration, integration of existing funding, and the
    effective use of currently available resources, states will not face
    the need to reduce services to the citizens generally or to populations
    with barriers to employment.
                             national reserve fund
        Question. Your proposal indicates that the Department would retain
    at the national level a portion of funds for a National Reserve Fund
    for unexpected emergencies before allocating funds for Career
    Advancement Accounts. What is the Department's estimate for this fund?
    And how would we distinguish the uses of these funds from the pilot,
    demonstration, and research account?
        Answer. Under the Career Advancement Account (CAA) proposal, the
    Department proposes to set aside funds for a National Reserve in a
    manner similar to the current Dislocated Worker National Reserve
    structure. The Department would reserve 7.5 percent of the
    appropriation provided by Congress for Career Advancement Accounts for
    the National Reserve. The Secretary would have the discretion to use
    this funding to quickly address unanticipated events, such as natural
    disasters, mass layoffs and plant closings, and the impacts of foreign
    trade. The National Reserve would also be used to provide technical
    assistance and for demonstration activities.
        The proposed use of Career Advancement Account National Reserve
    funds for demonstrations in addition to those carried out under pilots,
    demonstration and research budget authority is no different than the
    current structure. Under WIA section 171(d), up to ten percent of the
    National Reserve is used for dislocated worker projects. These
    demonstrations are in addition to the pilots, demonstrations and
    research authorized under WIA section 171(b). As it does now, the
    Department will maintain rigorous financial controls that track fund
    sources for all programs and activities.
                            rapid response services
        Question. Your consolidation proposal eliminates state resources
    set aside specifically for states to respond rapidly with information
    and services to workers who have received word of pending layoffs. You
    would require states to apply for funds from the National Reserve
    Account to provide such services. What justification do you provide
    states about requiring them to go through extra steps to provide rapid
    response services and gaining their confidence that the Department can
    respond to such requests in a timely manner?
        Answer. The Department does not contemplate that a state would have
    to apply for funds each time there is a mass layoff or to only
    sporadically fund a state rapid response coordinator. Early
    intervention to provide information and assistance to workers to
    decrease the amount of time between actual layoff and re-employment is
    a key principle of the dislocated worker program. Rapid response is a
    key element of this early intervention strategy.
        States could demonstrate need and apply for rapid response funds at
    the beginning of the program year or throughout the program year. We
    will not propose that a state be required to submit an application for
    funding each time a dislocation event occurs.
        In spite of all the good work that has been done over the past
    fifteen years with dislocated worker rapid response funds, the
    Department has found that most company executives do not know about the
    type and quality of assistance available to them and their employees
    when closures or layoffs are contemplated. They have also reported that
    where they have layoffs in several states simultaneously, the levels
    and quality of assistance varies dramatically. ETA, in collaboration
    with state and local partners, has undertaken several initiatives in
    the auto, textile and defense industries recently to try to integrate
    services and develop more consistency. We believe a nationally-
    coordinated approach to delivering rapid response assistance by states
    can help bring the services to more workers and employers.
        The proposed mechanism will assist both the Department and the
    states to better manage scarce taxpayer resources by directing the bulk
    of the funds to the areas of need. For example, not all states
    experience major layoffs every year. Analyses of dislocated worker
    program expenditures reported by states have shown that the funds
    reserved for rapid response are consistently under-expended. In the
    aggregate, the rapid response carry-in funds from program year 2003 to
    2004, and from 2004 to 2005, was $136.7 million and $166 million,
    respectively. Through March 31, 2006, states reported accrued
    expenditures of just over $176 million of a total available of more
    than $342.5 million, or 51.4 percent of the total funds available.
    States are not required to retain the up to 25 percent authorized to be
    reserved for rapid response activities. They may include a portion of
    the funds in the amount allocated to local workforce investment boards
    for core, intensive and training services for dislocated workers, or
    they may award additional funds from the reserved amount to local areas
    that experience disasters, mass layoffs, plant closings or other events
    that precipitate substantial increases (defined by the state) in the
    number of unemployed workers.
                              adult training funds
        Question. We need to upgrade the skills of our current workforce,
    including the low skilled on a broad base to increase economic growth
    and incomes. Recent data released from the National Assessment of Adult
    Literacy indicates that 14 percent of American adults had less than
    basic literacy skills--meaning they had a hard time locating easily
    identifiable information on commonplace material or following written
    instructions in simple documents. Your proposal would reduce adult
    training funds and turn the funds that are left into Career Advancement
    Accounts. It appears that low skilled adults who would compete with
    other workers for these vouchers may require combinations of
    assessment, career planning and developmental education services prior
    to being able to benefit from technical training. How will these
    individuals really fare under a system of capped vouchers and high
    pressure sales from many training providers?
        Answer. We agree there is a need to upgrade the skills of our
    current workforce, including those with low skills and literacy. State
    and local workforce systems set service priorities, and this will
    continue to be the case under the CAA proposal. These priorities will
    differ across the country, since demographics, labor markets and
    regional economies differ. By combining funding streams, our proposal
    will allow a more flexible response to these differences. Our proposal
    will triple the number of workers who currently are being trained by
    the workforce investment system.
        Assessment, career planning and developmental education services
    will continue to be accessed through One-Stop Career Centers, provided
    either through Workforce Investment Act funding or One-Stop partner
    programs. States will be responsible for determining eligible training
    providers within the state, as well as determining policies that govern
    those providers, such as policies to prevent false advertising and
    other abuses.
                            economic growth efforts
        Question. Your consolidation proposal, combined with sizable cuts
    and program eliminations, ironically puts states in the position of not
    being able to jump start or continue to nurture regional economic
    growth planning and collaboration activities that integrates economic
    development, workforce development and education systems. These
    activities are similar to those you are promoting through your new
    WIRED initiative. What do you say to states that want to move forward
    with such integrated economic growth efforts if they don't qualify for
    funds under federal rules?
        Answer. The proposals for consolidation of workforce programs are
    intended to provide maximum flexibility for states and regional
    economies to implement the type of workforce investment services that
    are needed in that specific region. We believe that our traditional
    thinking about how individual programs are funded is contributing to
    the persistent problem of siloed program services, with excessive funds
    being spent on overhead and bureaucracy, rather than addressing the
    workforce needs of a regional economy. If regional economic needs are
    to be effectively and comprehensively addressed, it will take many
    sources of funding, including funding from economic development
    agencies and educational institutions, and coordination across these
    funding streams. Therefore, the approach of making Federal funding for
    workforce services more flexible will contribute to integrated economic
    development efforts and the maximum leveraging of resources. Finally,
    the transformation of a regional economy is not dependent on Federal
    demonstration funding. What drives transformation is the collaborative
    leadership and strategic planning of economic development, research and
    development, capitalization, entrepreneurship and workforce development
    visionaries.
                      elimination of youth training grants
        Question. Your proposal to redesign the workforce delivery system
    eliminates WIA training grants for disadvantaged youth that are aimed
    at improving their education, employment, and earnings prospects. It is
    difficult to reconcile your proposed request when the President and you
    as well have focused on the need to raise the skills of young people in
    order to maintain our competitive edge in this new global economy. And
    from research--much funded by your Department, we know that an array of
    services is necessary to help disadvantaged youth complete their
    education, mature into solid citizens, and make the successful
    transition to work. By making these young people compete with adults
    for Career Advancement Accounts, aren't you really limiting their
    changes for future success?
        Answer. We agree that there should be an emphasis on raising the
    skills of young people in order to maintain our competitive edge in the
    global economy. Career Advancement Accounts will be available to out-
    of-school youth. Furthermore, states and localities will still be able
    to provide career counseling and other services to these out-of-school
    youth, and workforce information will be available to assist them in
    choosing careers in high growth industries and in determining
    appropriate training for those careers.
        Targeted programs and set-asides have led to multiple program
    silos, excessive overhead and bureaucracy, lack of coordination and
    integration, and only a modest number of people trained for the size of
    the workforce system investment. States and local areas will still be
    able to serve targeted groups, such as out-of-school youth, but will
    have more flexibility in using resources and not be subject to the
    often conflicting requirements of multiple programs or funding streams.
    Furthermore, consolidating funding streams will enable states and
    localities to better focus on the needs of their distinct populations,
    since labor force demographics and labor markets vary considerably
    across the country. The substantial number of requests for waivers to
    allow transfer of funds between programs indicates the need for more
    flexibility in this area than the current legislation allows.
                          career advancement accounts
        Question. A recent ETR article on the fiscal year 2007 budget
    request noted ``ETA officials said their legislative analysts believe
    this program--the consolidated Career Accounts proposal--can be
    implemented under current authorizing statues, but would be easier for
    states to embrace with program consolidation that would occur under the
    WIA reauthorization package put forward by House Republicans, HR 27.''
    It's my understanding that HR 27 has passed the House and is awaiting
    conference with the Senate. Please explain how, if the House already
    has a bill that is not consistent with your Career Advancement Accounts
    proposal, how you plan to accomplish this.
        Answer. As you indicate, the House has passed H.R. 27 and the
    Senate recently passed its version of Workforce Investment Act
    reauthorization legislation. H.R. 27 would implement many key
    components of the President's job training reform proposal, such as
    merging funding streams. We believe CAAs can be built upon this piece
    of legislation.
                        elimination of job bank program
        Question. The elimination of America's Job Bank is particularly
    troubling. It is the backbone for more than 20 state job banks as well
    as the electronic version of a national employment service. Thousands
    of job seekers get their work through AJB and thousands of employers
    use it. By your own Department's last count, over 138 million job
    searches were conducted on AJB for the year ending June 3, 2005 and
    over 9 million resume searches were conducted by employers during the
    same period. There were about 7.8 million job postings originated on
    AJB during that year, over 700,000 new resumes posted, and 55,000 new
    employer registrations. All of these activity counts are increases over
    the prior year. How can the United States have a modern public
    employment service without an electronic exchange?
        Answer. The Department of Labor considered numerous factors in
    coming to the decision to phase out America's Job Bank (AJB), which
    included looking at the larger environment in which AJB is operating
    and weighing the costs associated with running the system. Since the
    launch of AJB, the number of private sector Internet-based job banks
    (Career Builder, Monster, Yahoo! Hot Jobs, etc.) has proliferated,
    calling into question the need for a Federal government-sponsored
    national job bank. These private-sector electronic labor exchange
    systems are continuously improving and most, if not all, of these sites
    offer free services to job seekers. Current trends in the industry seem
    to indicate that some level of free service will also be offered to
    businesses/employers in the future and many employers who currently use
    AJB are already using these other job banks simultaneously to advertise
    their openings.
        In addition, it has been increasingly difficult, if not impossible,
    to keep America's Job Bank updated as technology has advanced. Also, as
    Internet technology and technical resources have become widespread and
    the costs associated with them have declined, state and local areas
    that previously relied on AJB for their Internet self-service labor
    exchange presence have built and operate job banks of their own that
    are not based on AJB and promote them to their job seeker and business
    customers rather than AJB.
        AJB is not the backbone for 20 state job banks, nor is there any
    evidence of widespread job gains as a result of using AJB. In fact, AJB
    is not used in most One-Stop Career Centers across the country.
                         proposed workforce legislation
        Question. The Administration plans to introduce legislation to
    reform the workforce investment system and create the Career
    Advancement Accounts (CAAs). If this legislation is not passed before
    fiscal year 2007, what would be the impact on services of the proposed
    15 percent funding reduction for workforce development programs?
        Answer. The President's Budget request assumes enactment of the
    Career Advancement Account (CAA) proposal, which would reduce overhead
    and administrative costs and focus more funding on training, thereby
    tripling the number of individuals receiving job training through the
    workforce investment system. In the absence of CAA legislation passed
    by Congress, the workforce investment system will continue to have
    siloed funding streams that result in duplicative costs.
        While states will be able to continue operating Workforce
    Investment Act programs and the Employment Service at the lower funding
    levels proposed by the Administration, these reduced levels, without
    the accompanying reforms, may result in decreases in the number of
    participants served through these programs, compared to the President's
    proposal.
        Question. States could administer the CAAs through ``community
    career centers'' at community colleges, public libraries, senior
    centers, and other locations, as well as through existing one-stop
    centers. Could this approach lead to the creation of a parallel system
    of job search and career assessment services, that duplicates what is
    already available through the one-stop centers? Could it lead to
    confusion among potential customers of the system, about where to go to
    access services?
        Answer. Under our proposal, states can maintain One-Stop Career
    Centers to provide employment services to job seekers and employers, as
    well as access to Career Advancement Accounts. States and localities
    would have the option of making employment services and access to
    Career Advancement Accounts available at additional sites in the
    community.
        Question. Will the existing state and local workforce boards have
    any role in administering the new program, or will they be disbanded?
    Similarly, will the programs that are currently mandatory partners in
    the one-stop system have any role in administering the CAAs?
        Answer. State and local Workforce Investment Boards will continue
    to exist and retain roles and functions similar to what they have under
    the current Workforce Investment Act. Similarly, the required partners
    will continue to participate in the One-Stop service delivery system,
    and have a role in setting local policy and providing oversight for the
    service delivery system. The specific role of the partner programs in
    administering Career Advancement Accounts (CAA) would be worked out
    under policies set by the state in setting up the CAA system.
        Question. How will the Labor Department calculate the amount of
    funds each state will receive for CAAs? Will there be a formula?
        Answer. There will be a formula for allotting Career Advancement
    Account funds to states, similar to the formulas that have been used to
    allot funds to states under current law. The specific formula proposal
    has not been finalized, but the final formula would be worked out
    between the Administration and Congress.
        Question. The CAA proposal assumes that individuals need minimal
    assessment and case management services to make good decisions about
    whether and how to use training funds. However, in implementing reform
    of the Trade Adjustment Assistance (TAA) program, you have emphasized
    the need to co-enroll TAA participants in WIA for case management, so
    that their training needs can be properly assessed. What is the basis
    for your decision to provide training funds with minimal case
    management funds, in the CAA proposal?
        Answer. The Department's ongoing evaluation of the Individual
    Training Account activity under the Workforce Investment Act shows that
    when an individual is provided more choice in training and counseling
    services, the individual is more likely to use an ITA for training and
    to enter training more quickly. Further, the individual's training
    selection tends to be similar to training programs selected by similar
    individuals who are required to receive counseling services and
    approval.
        We believe that up-front assessment (as contrasted with ongoing and
    costly case management) is what workers need, including those served
    under the TAA program. Assessments can be provided under the CAA
    proposal if needed, with over $700 million set aside for such services
    to complement training (22 percent of the total consolidated resources
    per state, roughly equivalent to the current Wagner-Peyser amount for
    core services). The purpose of such assessments is to properly gauge
    marketable skills and assist workers to reenter employment or identify
    training to fill gaps in marketable skills. Our demonstrations show
    that with this ``informed choice'' more people can receive actual
    training for jobs in the local labor market.
        Question. The new system would be designed based on lessons from
    the implementation of the Individual Training Account and Personal
    Reemployment Account (PRA) programs. What lessons specifically have
    been drawn from the implementation of those programs? What evaluations
    exist to support giving more control over training funds to
    individuals?
        Answer. CAAs provide individuals with increased customer choice and
    flexibility for selecting training and other services that are
    appropriate for them and are based in part on lessons learned from
    Individual Training Account (ITA) and Personal Reemployment Account
    (PRA) demonstrations.
        The ongoing evaluation of the ITA Experiment explored the use of
    increasing customer choice in the delivery of ITAs. Initial analysis
    from eight local boards participating in the experiment showed that
    when an individual was provided more customer choice in training and
    counseling services, the individual was more likely to accept an ITA
    for training, the individual's training selection tended to be similar
    to training programs selected by individuals required to receive
    counseling services and approval of programs, and the individual was
    more likely to enter training quickly. The final report, to be
    completed later this year, will provide a more in-depth analysis of the
    impacts of the three different ITA service approaches.
        The goals of PRAs are to provide individuals who are identified as
    most likely to exhaust Unemployment Compensation with a quicker return
    to work, direct access to training, greater customer choice and
    control, and better economic outcomes. Initial observations from the
    PRA Demonstration show that participating states were able to implement
    the PRAs generally as planned, with the first accounts offered in March
    2005. The evaluation of the PRA Demonstration is underway. An interim
    report, to be completed this year, will provide a more in-depth
    understanding of the implementation process. In the meantime, reports
    from states on best practices show that account mechanisms can be
    implemented, appropriate oversight can be maintained, and individual
    choice can provide greater access to needed services.
        Question. The CAA proposal includes performance measures that are
    similar to those now used to assess the adult and dislocated worker
    programs. However, with CAA funds going directly to individuals, who
    would be held accountable for performance outcomes--states or the local
    community career centers? Does it make sense to apply performance
    measures designed for adults (that focus on employment outcomes) to
    CAAs that are also used by youth? Currently, youth performance measures
    also consider educational goals.
        Answer. States will continue to negotiate performance targets and
    report to the Department of Labor on three primary outcome measures:
    (1) entered employment, (2) retention in employment, and (3) earnings.
    In addition, attainment of a degree or certificate, entry into training
    and education, and literacy and numeracy gains would be tracked as
    intermediate outcomes.
                              rapid response funds
        Question. Currently, states use rapid response funds to provide
    immediate service to workers affected by a mass layoff, often before
    the workers are even laid off. Under your legislative proposal, states
    will need to apply to The Employment and Training Administration for
    rapid response funds as events occur. What are the reasons for keeping
    these funds at the national level, and having states apply for them
    each time they are faced with a mass layoff? What effect will this
    approach have on states' ability to provide immediate rapid response
    services for mass layoffs?
        Answer. The Department does not contemplate that a state would have
    to apply for funds each time there is a mass layoff or to only
    sporadically fund a state rapid response coordinator. Early
    intervention to provide information and assistance to workers to
    decrease the amount of time between actual layoff and re-employment is
    a key principle of the dislocated worker program. Rapid response is a
    key element of this early intervention strategy.
        States could demonstrate need and apply for rapid response funds at
    the beginning of the program year or through the program year. We will
    not propose that a state be required to submit an application for
    funding each time a dislocation event occurs.
        In spite of all the good work that has been done over the past
    fifteen years with dislocated worker rapid response funds, the
    Department has found that most company executives do not know about the
    type and quality of assistance available to them and their employees
    when closures or layoffs are contemplated. They have also reported that
    where they have layoffs in several states simultaneously, the levels
    and quality of assistance varies dramatically. ETA, in collaboration
    with state and local partners, has undertaken several initiatives in
    the auto, textile and defense industries recently to try to integrate
    services and develop more consistency. We believe a national approach
    to delivering rapid response assistance by states can help bring the
    services to more workers and employers.
        The proposed mechanism will assist both the Department and the
    states to better manage scarce taxpayer resources by directing the bulk
    of the funds to the areas of need. For example, not all states
    experience major layoffs every year. Analyses of dislocated worker
    program expenditures reported by states have shown that the funds
    reserved for rapid response are consistently under-expended. In the
    aggregate, the rapid response carry-in funds from program year 2003 to
    2004, and from 2004 to 2005, was $136.7 million and $166 million,
    respectively. Through March 31, 2006, states reported accrued
    expenditures of just over $176 million of a total available of more
    than $342.5 million, or 51.4 percent of the total funds available.
    States are not required to retain the up to 25 percent authorized to be
    reserved for rapid response activities. They may include a portion of
    the funds in the amount allocated to local workforce investment boards
    for core, intensive and training services for dislocated workers, or
    they may award additional funds from the reserved amount to local areas
    that experience disasters, mass layoffs, plant closings or other events
    that precipitate substantial increases (defined by the state) in the
    number of unemployed workers.
                          foreign labor certification
        Question. There is an inherent unfairness to having some employers'
    applications from six years ago pending at the BEC and having new
    applications adjudicated in two months. These inordinate delays have
    caused and are causing serious prejudice to employers and employees
    alike. With this as background, please address the following issues:
        Answer. The Department published a final regulation implementing a
    new re-engineered Permanent Labor Certification Program effective March
    28, 2005. This regulation created a new faster and more efficient
    method for employers to have their applications processed. The
    regulation applies to all applications filed after its effective date.
    However, for applications previously filed up until March 27, 2005,
    those applications must be processed under the previous regulation. The
    process prescribed by the previous regulation takes considerably more
    time than the new one, despite efficiency measures we have introduced,
    e.g., technology, to streamline it as much as possible.
        Question. Congress has expressed a clear intention in the Child
    Status Protection Act to prevent government delays from separating
    families by having children turn 21 during the permanent residence
    processing. At the time Congress passed the CSPA, the existing scope of
    the DOL backlog was unanticipated. In light of the clear Congressional
    intention, why has the Department of Labor refused to expedite long-
    pending backlogged applications based upon a showing that the impact of
    the delay will forever prevent a child from becoming a permanent
    resident with his or her parents?
        Answer. We understand the Child Status Protection Act applies only
    to cases pending before the Department of Homeland Security. The
    Department of Labor strongly supports efforts to keep families
    together. The Department has determined this goal can best be
    accomplished by minimizing the amount of time it takes to process
    foreign labor certification applications. For this reason, the
    Department has consistently applied a first in/first out (FIFO) policy
    to cases in the Program Electronic Review Management (PERM) program.
    The FIFO policy prevents the need to make subjective decisions
    regarding which, if any, cases merit special consideration for
    expedition, thereby conserving resources and substantially reducing the
    amount of time that is required to process applications. It is ETA's
    longstanding policy to also process cases in the permanent labor
    certification program backlog on a ``First-In/First-Out'' basis within
    that system's various processing categories; for example Reduction in
    Recruitment (RIR) cases are in a separate processing queue from cases
    being handled through the traditional recruitment process (TR), but
    cases in each queue are processed on a ``First-In/First-Out'' basis. It
    has been ETA's established policy never to expedite cases bases on the
    specific circumstances of individual employers or aliens.
        Question. In addition to children aging out, other significant
    detriments to employers and employees exist in specific cases. Examples
    include inability to promote employees, loss of tuition benefits,
    inability to travel, inability for spouses to work, etc. Given that the
    delays are through no fault of the employer or the employee, why has
    the Department of Labor failed to establish a system for expediting
    worthy cases?
        Answer. The Department's policy of not expediting cases saves an
    enormous amount of limited resources since we do not have to evaluate
    the merits of each request to expedite across what potentially could be
    tens of thousands of cases. Furthermore, we believe some of the
    concerns you note arise from visa restrictions over which the
    Departments of State and Homeland Security have jurisdiction and not
    from any DOL permanent labor certification rules or requirements.
        The most equitable response to this complicated issue is to require
    strict adherence to our first-in/first-out policy under which all
    applicants are treated consistently. For every case considered for
    expedited consideration, an older case would be further delayed. Unlike
    the Department of Homeland Security, the Department of Labor does not
    have the legislative authority for a fee structure which allows for
    ``premium processing.''
        Currently, employers do not pay a fee to DOL for the processing of
    permanent foreign labor certification applications. Employers benefit
    significantly from the admission of foreign workers, and the efficient
    review of applications they receive under the new, streamlined process.
    The backlog system is not fully automated and therefore continues to
    function through a FIFO process. The Administration has included a
    proposal in the fiscal year 2007 budget to create a fee structure for
    the Permanent Labor Certification Program. We anticipate revenue from
    such fees would permit the assignment of additional staff, such that
    there should be no backlogs in the new PERM system.
        Question. Why has the Department of Labor made it so difficult and
    risky for employers to convert cases from the BEC to PERM? Seemingly,
    DOL has created the most restrictive rules possible to discourage these
    conversions, resulting in an unexpectedly low number of conversions and
    an unexpectedly high number of cases remaining at the BECs? Will DOL
    amend its rules to encourage conversions? Examples of improvements
    include eliminating the risk of the loss of priority date if a case is
    not eventually adjudicated to be ``identical''; eliminating the risk of
    loss of the ability to obtain seventh year H-1B extension if the case
    is not considered to be ``identical''; removing the ``identical''
    standard entirely; changing present procedures which involve audits of
    most or all of the conversion cases; eliminating the very extensive
    delays in adjudicating PERM conversion cases; and allowing cases at the
    BEC to remain pending until the approval of the PERM case (especially
    since a mere typographical error could result in a PERM case being
    denied).
        Answer. The Department is in the process of reviewing the rate at
    which cases have been converting from the old pre-PERM certification
    system to PERM. Employers currently have the option of re-filing the
    case if it meets the requirements of the PERM regulation. Those who
    wish to have the benefit of the new efficient processing system must
    meet the regulatory requirements of that rule. The Department does not
    have the resources to process identical cases under two different
    regulations implementing the permanent labor certification program,
    i.e., pre-PERM and post-PERM. Removing the ``identical'' standard under
    the PERM regulation would require a new rulemaking process and has the
    potential for trading backlogs between the Backlog Elimination Centers
    and the Department's National Processing Centers. We do not feel that
    this would be in the interests of employers or foreign workers. The new
    PERM system is much more efficient than the old system, but converting
    all old cases into new PERM cases would result in backlogs in PERM.
        Question. What is the plan for dealing with applications for which
    no 45 day letter was received by June 30? Will provisions be made for
    reconstructing lost files? When will employers be notified of these
    procedures?
        Answer. The BECs have taken extensive steps to ensure that all
    applications identified for transfer to the BECs have been shipped and
    received at their designated destination. However, because there may be
    some applications that for various reasons were never identified by the
    state agencies or ETA Regional Offices for shipment to the BECs, we are
    developing a process by which to handle those cases. Within the past
    two weeks, the Department posted a detailed set of Frequently Asked
    Questions (FAQs) on the foreign labor certification website which
    addresses procedures related to the 45-day letters http://
    www.ows.doleta.gov/foreign/#whatsnew.
        Due to the high demand for information and time and resource
    constraints, we believe that posting the information on our website is
    the best way for the entire public to have access to the information at
    the same time. These FAQs will provide procedures for employers in the
    event they have had a case closed through the non-receipt of a 45-day
    letter. Additional FAQs to cover these situations may be posted if
    appropriate at a later date.
        Question. What are the realistic expectations for adjudicating all
    BEC cases by September 30, 2007? How are these expectations impacted by
    losses of the top level people at the BEC in Pennsylvania? How has DOL
    factored into these expectations the lack of incentive for BEC
    employees to complete the cases on a timely basis since doing so will
    result in loss of their positions as of September 30, 2007?
        Answer. The Department has plans underway to fill all vacancies,
    both Federal and contractor staff, at the Philadelphia Backlog
    Elimination Center. Since establishing the two (2) backlog centers in
    July 2004, we have logged in all 360,000+ cases transferred to the
    backlog centers from the states, sent 45-day letters to all employers,
    and cleared over (157,473) cases from the centers. We intend to have
    all backlog cases under processing by September 30, 2007.

    DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
                  AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2007

                                  ----------

                                           U.S. Senate,
               Subcommittee of the Committee on Appropriations,
                                                        Washington, DC.

                           NONDEPARTMENTAL WITNESSES

        [Clerk's note.--The subcommittee was unable to hold
    hearings on nondepartmental witnesses. The statements and
    letters of those submitting written testimony are as follows:]

                              DEPARTMENT OF LABOR

       Prepared Statement of the National Association of Workforce Boards
        Chairman Specter, Ranking Member Harkin, and distinguished Members
    of the subcommittee, my name is Stephanie Powers, Chief Executive
    Officer of the National Association of Workforce Boards (NAWB). I am
    submitting this testimony on behalf of Leonard Wilson, Chairman of the
    Board of Directors of NAWB, and the Nation's workforce investment
    boards regarding fiscal year 2007 funding for programs authorized under
    the Workforce Investment Act (WIA). We appreciate this opportunity.
        Workforce Investment Boards (WIBs).--The Nation's 589 local, and 52
    State workforce boards provide strategic guidance and leadership for
    the design and implementation of the Nation's workforce investment
    system, which includes 2,000 comprehensive One-Stop Career Centers. The
    boards have approximately 13,000 private sector members who volunteer
    their time to insure that the workforce investment programs are
    connected with community economic development priorities and employers'
    needs.
        The Workforce Challenge in the United States.--More than at any
    time in our history, the American workplace demands a competitive and
    responsive workforce. The complex interplay of technology and
    globalization, coupled with profound demographic changes, have set in
    motion a set of difficult challenges to our economic prosperity.
    Business, political leaders, and policy experts often disagree as to
    the proper mix of monetary, trade, taxation, and regulatory policy to
    ensure prosperity in the years ahead. Nonetheless, virtually all the
    experts, public and private, agree that a key ingredient to our
    economic success lies in the capacity of the American workforce to
    offer knowledge, skills and innovation to the economy. Yet, the
    administration continues to propose potentially devastating reductions
    in funding, and policy changes for the Nation's workforce investment
    system that, if adopted, would virtually eliminate our workforce
    preparation infrastructure, and decimate United States efforts to
    maintain a skilled workforce.
        As your Committee examines the President's fiscal year 2007 budget
    proposal, and deliberates over workforce investment and employment
    services funding, the National Association of Workforce Boards
    respectfully asks that you: (1) Weigh the potentially devastating
    impact of the administration's budget and policy recommendations for
    WIA and the Wagner-Peyser Act; (2) Decide instead to enhance and build
    on strengths of locally-based, private sector-led Workforce Investment
    system and its successes; and (3) Invest, not disinvest in the Nation's
    workforce development system, funding programs authorized under WIA and
    the Wagner-Peyser Act at not less than the fiscal year 2005 funding
    levels.
        In 2006, we know that it is crucial for our workers to be ready,
    willing, and able to respond to the pace of America's changing
    workplace needs. On the demand side, employers must be ready to invest
    in the capacity of all workers, not just those already skilled and
    educated. Collectively, our Nation must commit resources at all levels,
    to raise the performance of students and workers at the bottom, while
    improving the performance of those in the middle and top. We must
    ensure that all low wage and structurally unemployed workers have the
    opportunity to gain new high-value skills, maintaining important
    transitional income support and health insurance while upgrading skills
    and changing careers. Our public policy investments need to embrace the
    realities of a 21st Century workplace and develop a system that will
    help our employers and workers compete successfully. Success for the
    future will depend not just on educating all Americans to much higher
    standards, but also to different standards.
        We believe that the complexity of what we are facing requires our
    Nation to maintain a strong Federal commitment to coherent and
    consistent public investment policies that address the needs of workers
    and employers alike. There will be a price to broad prosperity if we
    ignore the sum of these growing realities:
      --Broad Lack of Workforce Proficiency in Technology.--The Global
            Affairs Director of the Microsoft Corporation, Pamela Passman,
            in a recent speech at NAWB's annual conference, expressed her
            company's concerns about the ``readiness of the American
            workforce to embrace technology as an essential tool of the
            knowledge economy.'' She stressed that there is no concern with
            countries embracing technology, innovating, and investing in
            education and skills training, as long as America is doing the
            same. But she warned about the lack of proficiency of adults to
            search, comprehend, and use information (13 percent) and to
            perform computational tasks, despite the Nation's focus on
            improving math and science skills (13 percent). These
            deficiencies, if not quickly addressed, will hamper growth and
            innovation expansion for ``employers who are demanding more
            skills that revolve around knowledge creation, collaboration
            and communication, and analysis.''
      --A Growing Talent Shortage.--The well-regarded staffing company
            manpower asserts, in a recently released white paper entitled
            Confronting the Talent Crunch: What's Next States, ``There
            already is a talent shortage in many areas of the global labor
            force, a situation that will grow more widespread across more
            jobs over the next 10 years--and could threaten the engines of
            world economic growth and prosperity.'' The Bureau of Labor
            Statistics predicts a shortfall of 10 million workers in the
            United States by 2010, which may exert additional strain on the
            talent pool availability.
      --Demographic Reality #1: Aging Workforce.--The first of the baby
            boomers has turned 60 this year. Older workers will be leaving
            the workforce much faster than new workers are entering, and as
            they leave the workforce they will take with them an incredible
            wealth of education, talent, skills, experience, and
            traditional work ethic. For example, more than 50 percent of
            the current science and engineering workforce in the United
            States is approaching retirement. Given this, should we be
            concerned that China graduates four times as many engineers as
            the United States? Or that out of the 1.1 million high school
            seniors who took a college entrance exam, just under 6 percent
            indicated plans to pursue a degree in engineering--nearly a 33
            percent decrease in interest from the previous decade (Passman,
            2/27/06).
      --Demographic Reality #2.--Immigrants and Untapped Pools of Potential
            Workers. The future workforce will be far from homogeneous. The
            predicted growth in the American labor force will come largely
            from immigrants who are less likely to quickly replace the
            level of skills that will be departing with the boomers'
            exodus. If these trends continue, and they are predicted to do
            so, increasing workforce remedial interventions will be needed
            to deal with English language deficiencies and to boost basic
            education proficiencies. Employers will also need to be better
            prepared to provide various accommodations for both an aging
            workforce and people with disabilities who are likely to enter
            the workforce in greater numbers as technology and civil rights
            protections enable higher rates of their participation. The
            continued growth of working women will require more flexible
            working schedules and family leave policies as their child care
            and elder care responsibilities require them to balance work
            and family commitments.
        So the question looms, how can workers be assisted in navigating
    and managing their work lives in this complex global economy? Will
    companies be competitive without access to a higher-skilled workforce?
    And importantly, how should public policy respond to the realities of
    the societal changes and the vagaries of the global economy? The
    President acknowledged in his State of the Union message the increasing
    concern about national competitive challenges, but we regret that his
    budget proposal for workforce investment does not support his agenda in
    this area; in fact, it misses the mark. It is baffling why the
    administration would propose such deep cuts in the Nation's workforce
    investment programs in the face of mounting evidence, and their call
    for attention to American competitiveness. We should increase, not
    decrease these investments.
        The WIA system currently provides a wide range of vital services to
    over 16 million U.S. jobseekers and employers through its One-Stop
    delivery system, including labor market information, job search
    assistance, guidance and counseling services to help workers find the
    right jobs, and employers find the right employees. The system provides
    essential rapid response and transition assistance to dislocated
    workers; support services for individuals pursuing first time
    employment; and assistance for low-wage workers in search of career
    growth opportunities leading to self-sufficiency. It is designed to
    help jobseekers access the education and training they need to succeed
    in the new knowledge economy; to meet the skill needs of employers.
        According to the U.S. GAO, the WIA system spent over 40 percent of
    its funding in fiscal year 2003 on training for jobseekers in the
    United States, and this estimate did not take into account funds used
    to pay for computer lab workshops in software applications, basic
    keyboarding, computer skills training, and even certain adult basic
    education classes offered through the One-Stop delivery system. Nor did
    it take into account training arranged by the One-stops but not paid
    for with WIA funds.
        As your Committee deliberates on funding for the U.S. workforce
    investment system, and considers the President's 2007 budget proposal,
    we respectfully ask that you:
    (1) Enhance and Build on Workforce Investment Boards' Successes
        The United States' Council on Competitiveness and the experts who
    participated in its National Innovation Initiative identified
    innovation as the single most important factor in determining America's
    success through the 21st Century. They identified the key ingredients
    for innovation as talent, investment, and infrastructure, and urged the
    knitting together of these strands to foster new innovation ``hot
    spots'' in regions across the United States than can sustain jobs and
    wage growth. It is crucial to find ways bring businesses, workers,
    researchers, economic developers, entrepreneurs, educational and
    training institutions, and governments together, at the regional level,
    to identify and develop their strengths and capacity for innovation.
        In fact, the Workforce Investment Act is predicated on such a
    collaborative model. Many Workforce Boards across the country are
    already performing this convening/brokering role that is essential to
    regional economic prosperity. To eliminate funding for this work as
    proposed in the administration's fiscal year 2007 budget, would be to
    put a stop to what hundreds of local workforce investment boards from
    around the country have already begun--the building of collaborative
    regional, knowledge-based economies. Let me share some examples with
    you.
      --The Finger Lakes Workforce Investment Board.--In New York
            identified and developed career maps for photonics and
            biotechnology as potential growth sectors for a region in
            transition. The WIB with K-12 schools, the business community,
            community colleges and the Syracuse University School of
            Education identified the foundational skill standards for these
            industries and recommended steps for secondary schools to
            realign curricula in science, math and technology, as well as
            ways to build awareness of the career opportunities and
            pathways existing in these sectors.
      --The South Florida Workforce Investment Board.--That serves the
            Miami metro area served 7,648 employers and placed 69,634
            clients in jobs this past year. They calculate the return on
            investment to the community of $11.01 for every dollar of
            workforce funds invested. In an area of historically high
            unemployment, these results are the fruit of the partnerships
            that the WIB has fostered with economic development agencies,
            business and the community's public agencies.
      --The Brevard Workforce Development Board.has created an extensive
            menu of business services and targeted those growth industries
            such as healthcare, manufacturing, and Aerospace that are
            growing jobs in their community, which is one of the hottest
            job growth areas in the country. Their ability to continue this
            work would be diminished, if not eliminated, if the proposed
            budget cuts and Career Advancement Account proposals are
            enacted.
      --The Northwest Wisconsin Workforce Investment Board.--Developed the
            ``Talent Profiling System'' (TPS), a soft skills matching tool,
            to respond to the overwhelming requests of employers to find
            people that fit their jobs. Since its implementation, TPS has
            achieved results ranging from having the highest employer
            penetration rate in the State's 11 Workforce Development Areas
            to a decrease of $916.88 to $420.24 in cost-per-placement and
            realized $4.22 Return On Investment (ROI) for each tax dollar
            invested.
      --The North Central Texas Workforce Development Board.--Serves a
            fourteen county region with 1.6 million people that surrounds
            the Dallas/Fort Worth area. This board supports small
            businesses by serving as the HR department for small companies.
            In this vital role they provide personalized attention for
            recruiting and placement; applicant screening; and on-site
            assistance with interviewing. Services to small business such
            as these, the engine of economic growth, will be severely
            limited by 15 percent + reductions in funding and the Career
            Advancement Account proposal.
      --The Greater Peninsula Workforce Development Consortium.--In Newport
            News, Virginia created The Manufacturing Pipeline Partnership
            for their local manufacturers. Participating manufacturers have
            been able to significantly improve their hiring practices
            through this collaborative effort. Northrop Grumman Newport
            News was able to hire 922 workers in skilled trades' positions,
            Siemens VDO Automotive, hired 100 plus workers for crucial
            positions in their advanced technology production areas. The
            WIB and the partnership it convened is directly contributing to
            the long term economic vitality of the region. This would not
            have been possible without the WIB's convening role, and WIBs
            would effectively be eliminated by the administration's budget
            cuts.
    (2) Weigh the Potential Impact of Cuts on the Workforce Investment
            System and its Customers
        The administration's fiscal year 2007 budget proposes a new 15
    percent cut in funding for WIA and Wagner-Peyser. These reductions
    would be applied to a workforce investment system that has already
    sustained funding reductions over the years, and is stretched very
    thin. Simply put, our system cannot sustain any further cuts without
    having to close numerous One-Stop Centers throughout the country, and
    cut back on services provided to those in need (eg, dislocated workers,
    the structurally unemployed, low wage workers in search of self-
    sufficiency, at-risk youth, and employers).
        These negative consequences of funding reductions do not even take
    into account the potential devastation that would be caused by the
    administration's policy recommendations contained in the fiscal year
    2007 budget. In her testimony before your Committee, Secretary of Labor
    Elaine Chao indicated that the One-Stop delivery system would be
    preserved under the administration's fiscal year 2007 proposal. She
    stated this despite the fact that 75 percent of the funding for States
    under their consolidated proposal, would be required to be spent on
    Career Advancement Accounts--leaving less funding for all other system
    functions and services, than now provided for the Wagner-Peyser program
    alone.
        The real impact of the administration's proposal (in total) would
    be the elimination of most of the local Workforce Investment Boards
    around the country, and the closure of most of the One-Stop Centers.
    With only 22 percent of WIA and Wagner-Peyser funding, States would be
    forced to provide all remaining services other than training. Funds to
    engage the private sector, both through the boards and through business
    services would be immediately impacted. The loss of the private sector
    engagement and focus would be diametrically opposed to the original
    Congressional intent of WIA and to calls from the country's leaders on
    U.S. competitiveness. Discussions with our colleagues around the
    country indicate that the impact on the workforce system infrastructure
    would be dramatic and would effectively dismantle much of the strategic
    partnership work, employer outreach, and physical One-Stop
    infrastructure that the WIBs have spent the last 5 years crafting.
    Innovative programs developed in partnership with employers and
    economic development, such as incumbent worker, industry sector, career
    ladder, and layoff aversion programs would be abruptly halted. And
    tragically, the private-sector leadership of the workforce boards, that
    has taken us so long to build, would be dismantled and swept under the
    rug. We believe this leadership and participation should be cultivated,
    not marginalized, particularly at a time when business leadership and
    employer engagement in the system is growing. It would be hard to find
    many other Federal programs where the business community has such a
    direct role in determining how Federal tax dollars are used in local
    communities.
        When WIA was enacted in 1998, it was clear that Congress intended a
    significantly enhanced role for business vested in the Workforce
    Investment Boards. As WIA has matured these past 5 years, we believe
    that this strategic oversight has turned out to be a highly desirable
    value proposition and we urge Congress to continue a strong endorsement
    of the approach by maintaining and increasing WIA funding that insures
    the private sector's engagement in the public workforce system.
    (3) Invest, Not Disinvest
        We applaud the efforts of the subcommittee to provide funding for
    WIA at levels as close to constant as possible in these increasingly
    difficult budgetary times. NAWB knows that there are many pressures on
    the Federal budget and many legitimate requests for funding. However,
    we submit the competitive posture of the Nation needs to be placed at
    the top of the priority list, and urge you to fund WIA and Wagner-
    Peyser at the fiscal year 2005 levels.
        While the Department of Labor may claim there is excess unspent
    money in the WIA system to justify their recommended budget cuts, they,
    in fact, are not presenting the facts accurately. The GAO's 2002 study
    clearly disputed this claim. And since the original claims of slow
    expenditures and excessive carryover were made, the WIA system has
    significantly diminished system carryover to less than 30 percent of
    its accrued expenditures--the standard proposed by the administration
    for WIA reauthorization, and included in both the House and Senate WIA
    reauthorization bills.
        In summary, when WIA was enacted, it was intended to ensure that
    all Americans have access to the information, job search assistance,
    and training they need to qualify for good jobs, and to successfully
    manage their careers in the new economy of the 21st Century--we urge
    you not to turn your backs on America's workforce investments. . . .
    they are about our future prosperity, and ultimately our national
    security in the purest sense.
        Thank you for your support in the past, and for this opportunity to
    submit testimony.
                                     ______

            Prepared Statement of the National Job Corps Association
                 job corps worthy investment to america's youth
    Six Million Youth Eligible to Participate
        On behalf of the National Job Corps Association (NJCA), we want to
    thank the Labor, Health and Human Services and Education Appropriations
    Subcommittee for its unwavering dedication to Job Corps and the
    vulnerable disadvantaged young Americans it serves. We appreciate the
    Committee's strong support of Job Corps in fiscal year 2006. Not only
    did the Committee provide a funding increase, but it established Job
    Corps as an office reporting directly to the U.S. Secretary of Labor.
    With strong bipartisan support, Congress acknowledged Job Corps' 40-
    year track record of success by eliminating layers of bureaucracy and
    ensuring department-wide attention on America's most disadvantaged
    youth.
        Job Corps is a voluntary program that serves more than 60,000 young
    Americans each year, which is only about 1 percent of the nearly 6
    million disadvantaged youth that are eligible for Job Corps' services.
    Over the last four decades, Job Corps has built its reputation as the
    Nation's largest and most successful residential educational and
    vocational training program for economically disadvantaged youth, ages
    16 through 24. With millions of youth eligible and in need of Job Corps
    services, it is only with your help that Job Corps can remain a beacon
    of hope for many young Americans and an excellent example of our
    government's role in ensuring every American has a chance to succeed in
    the 21 century economy. Tony Pusateri, a Senior Vice President of
    Equity Residential in Plano, Texas and member of the National Apartment
    Association Education Institute observed: ``I've been around Washington
    and seen a lot of government programs that I didn't support, but Job
    Corps is one program . that I am proud my tax dollars go to.''
        Unfortunately, the administration's fiscal year 2007 budget request
    cuts Job Corps by $72 million from the fiscal year 2006 enacted level.
    We are deeply concerned that such a funding cut would force a drastic
    reduction in the number of youth Job Corps will be able to serve. While
    we encourage spending restraint by the U.S. Government, we also believe
    it is imperative to provide adequate funding to support the young
    Americans who are our Nation's future.
                          job corps operations funding
    Administration's Fiscal Year 2007 Budget Proposal
        The administration's proposal recommends funding Job Corps'
    operations account at $1.401 billion, a decrease of $64 million
    compared to the fiscal year 2006 appropriated levels. This level of
    funding amounts to a 7.8 percent decrease in Job Corps' real-dollar
    funding from fiscal year 2006.
        If the operations account were to be cut by $64 million, more than
    3,000 economically disadvantaged young Americans would be turned away
    from Job Corps. These vulnerable youth, though they have the desire,
    would not be able to enter Job Corps to complete their high school
    education and place themselves on a career path. As one of the few
    national job training programs that has shown consistent positive
    results, Job Corps has the ability to preserve economic prosperity by
    equipping thousands of high school dropouts, foster care youth, and
    other vulnerable youth with job skills to enter gainful employment and
    become responsible, productive citizens. This cut would limit the
    opportunities of vulnerable youth who are seeking a way to put
    themselves back on track for success.
    NJCA Fiscal Year 2007 Request
        The NJCA requests a total of $1.53 billion for Job Corps' fiscal
    year 2007 operations account to support at least 44,000 training slots
    and keep all Job Corps centers at full capacity. This amount is based
    on the Office of Management and Budget's (OMB) projected 3.3 percent
    rate of inflation between fiscal year 2006 and fiscal year 2007 as well
    as additional appropriations to support efforts to improve educational
    programs on Job Corps centers. The increase would (1) allow the 122 Job
    Corps centers across the country to operate at full capacity to ensure
    the programs serves as many eligible youth as possible; and (2) support
    the U.S. Department of Labor's efforts to ensure the program has the
    necessary resources to hire capable teachers and ensure the quality of
    its educational courses.
       job corps construction, rehabilitation and acquisition (cra) funds
    Administration's Fiscal Year 2007 Budget Proposal
        The administration's budget proposal recommends funding Job Corps'
    CRA account at $100 million, an $8 million reduction from fiscal year
    2006.
        As you know, Job Corps gives young people the opportunity to focus
    and learn in a safe, stable, and supportive environment. However, the
    average building on a Job Corps center is 47 years-old--20 years older
    than the construction industry's recommended lifespan. While the
    program is committed to addressing the backlog of repairs by developing
    a 10-year capital improvement plan to construct and repair facilities
    based on priority, it needs more funding resources.
    NJCA Fiscal Year 2007 Request
        With respect to Job Corps' capital account, the NJCA requests $130
    million in fiscal year 2007. These funds will be used to: repair dorms,
    classrooms, and other student facilities on existing Job Corps centers;
    replace deteriorated structures, especially those that threaten the
    safety and health or violate minimum building codes, including
    mechanical systems; continue to address the $700+ million backlog of
    construction and/or repair needs; and provide third year funding for
    incremental Job Corps expansion.
                                   conclusion
        As Job Corps looks to the future to train the next generation of
    youth, we hope you agree that it remains a Federal program worthy of
    America's attention and support. Seventy-four percent of Job Corps
    enrollees are high school dropouts. The typical Job Corps student reads
    slightly less than the 8th grade level. Most youth who attend Job Corps
    have never held a full-time job. Thirty-two percent come from families
    on public assistance. However, through targeted self paced learning and
    dedicated counselors and teachers, these youth graduate from Job Corps
    with well-documented improvements in their education and skill levels
    and more than 90 percent transition into employment, higher education
    or the military. Job Corps provides thousands of youth a second chance
    to achieve the American dream.
        The NJCA looks forward to working with the members of this
    Committee to ensure that thousands of disadvantaged young Americans
    will continue having the opportunity to lift themselves up through Job
    Corps. We have been encouraged by the Committee's support that have
    expanded and strengthened Job Corps over the years and hope that we
    will enjoy that support and confidence in fiscal year 2007 and into the
    future.
                                     ______

         Prepared Statement of the National Youth Employment Coalition
        The National Youth Employment Coalition (NYEC) is a network of over
    270 youth employment, education, and workforce development
    organizations dedicated to promoting policies and initiatives that help
    young people succeed in becoming lifelong learners, productive workers
    and self-sufficient citizens. NYEC works to improve the effectiveness
    of youth-serving organizations by informing and tracking policy;
    setting and promoting quality standards; promoting professional
    development; and building organizational capacity. We thank you for
    your previous support of programs that provide meaningful job training
    and youth development opportunities for young people and for the
    opportunity to submit this testimony.
        Youth development/employment programs must be adequately funded
    because our youth are facing a crisis that has profound implications
    for their lives, their futures, and our society at large. There are 2.4
    million low-income 16 to 24 year olds who left school without a diploma
    or received a diploma but are unemployed.
        Youth development/unemployment programs must be funded at a level
    commensurate with the need to develop a globally competitive and highly
    skilled workforce for the jobs of tomorrow and today. Youth face a
    crisis that has profound implications for the lives, their futures, and
    society at large. According to a report by Public/Private Ventures,
    ``nationwide, 15 million people between the ages of 16 and 24 are not
    prepared for high-wage employment. Inadequate education or training is
    a major reason.'' A report by the National Association of Manufacturers
    identified three simultaneous phenomena that together are transforming
    the American economy and its labor force: global pressures, relentless
    advances in technology, and demographic shifts that will result in ``a
    projected need for 10 million new skilled workers by 2020.''
        In the face of persistent youth unemployment and changes in the
    labor market which require more knowledge and skills, the
    administration's proposed 2007 budget for WIA and Employment Services
    programs, is a matter of serious concern. It calls for a 15 percent
    reduction in these important programs and perpetuates the downward
    trend that would leave employment and training programs $1 billion
    below funding levels of 5 years ago.
        Unless Congress rejects these proposals, many thousands of youth
    will continue to lack the opportunities and supports necessary to
    succeed in the 21st century workplace. NYEC urges you to increase
    investment in programs under the Workforce Investment Act (WIA) and to
    restore funds for Perkins Act programs, TRIO, and Gear-Up, and the
    Reintegration for Young Offenders Program.
        These programs are needed because unemployment among youth is
    unacceptably high. While adult unemployment averaged 5 percent in the
    last quarter of 2005, the unemployment rate among youth 16-19 was 16.1
    percent; more than three times as high. A recent study from
    Northeastern University's Center for Labor Market Studies found that
    between 2000 and 2004, the number of employed teens declined by nearly
    1.3 million.
        Since fiscal year 2002, our Nation has been in the process of
    disinvesting in youth employment and development programs. If this
    current round of cuts is implemented, investment in the WIA youth
    programs will have dropped by more than 38 percent from $1.4 billion in
    fiscal year 2002 to $841 million in fiscal year 2007. This when
    according to the National Center on Education and the Economy we need
    ``to invest in training on a scale that supports the well-being of the
    Nation's economy and so that it is not just a privilege for the lucky
    few.''
        The administration's disinvestment runs counter to its own
    philosophy of investing in programs that work and divesting from
    programs that do not work. These programs work. According to the U.S.
    Department of Labor's fiscal year 2005 Performance and Accountability
    Report, in Program Year 2004 (July 2004-June 2005), WIA programs
    exceeded the Department's target for Diploma Attainment among youth 14-
    18 (65 percent v. 53 percent), entry to employment for youth 19-21 (72
    percent v. 68 percent), and employment retention for youth 19-21 (82
    percent v. 79 percent).
        The only measure in which programs failed to meet or surpass the
    Department's target was in cost per participant. According to the
    Report (page 65), ``Average cost per participant was slightly higher
    than expected--$2,822 vs. a target of $2,663. However, consistent with
    ETA's vision for youth services, the program has served a higher
    proportion of out-of-school youth. Out-of-school youth are a more
    expensive population to serve, with a cost of $3,724 per participant,
    therefore the overall cost per participant increased over prior years.
    At the time the cost per participant target was estimated, DOL did not
    anticipate the full extent of increased expenditures on out-of-school
    youth.'' The Report also notes that ``Results for PY 2004 continue an
    upward trend that began with WIA implementation in 1998. All three
    outcome indicators have increased from PY 2003 and exceeded performance
    targets. Most important is the continued increase in high school
    diploma attainment, given the strong statistical correlation between
    educational attainment and success in the labor market.''
        It should be noted that even at $2,822 per participant, the cost is
    below the $3,000 assumed in the administration's proposed Career
    Advancement Accounts (CAA).
        Further, a recent study of comprehensive youth workforce
    development programs in 36 communities carried out by the Center for
    Law and Social Policy confirms that Federal investment makes a
    difference. It found that that between 2000 and 2005 these programs
    successfully connected out-of-work youth to approximately 18, 456 long
    term unsubsidized work opportunities; 23,652 internship opportunities;
    28,302 short-term unsubsidized jobs; and 23,478 training opportunities.
    The program reached 42 percent of the eligible target population and 62
    percent of the eligible out-of-school population.
        According to a 2004 report prepared by Northeastern University's
    Center for Labor Market Studies, there are 5.4 million 16 to 24-year-
    olds who left school without a diploma or received a diploma but are
    unemployed. About 44 percent of them are low-income. With more than
    540,000 students dropping out of high school each year the implications
    of this phenomenon are staggering:
      --The earnings gap widens with years of schooling and formal
            training. In 2003, earnings of male dropouts fell to $21,447;
            high school graduates earned an average of $32,266; and college
            graduates earned about $63,000 or triple that of dropouts. As a
            result, dropouts pay less taxes, are more likely to rely on
            public assistance, and to be part of the criminal justice
            system.
      --One expert estimates that the United States would save $41.8
            billion in health care costs if 2004's 600,000 dropouts were to
            advance an additional year in educational attainment.
      --Approximately 16 percent of all young men, ages 18-24, without a
            high school degree or GED are either incarcerated or on parole
            at any one point in time.
      --Three quarters of State prison inmates are high school dropouts, as
            are 59 percent of inmates in the Federal system.
      --Increasing the high school completion rate by 1 percent for all men
            aged 20-60 would save the United States $1.4 billion a year in
            reduced costs from crime.
      --The situation is even more dire in minority communities where as
            few as 20 percent of black teens are employed at any time,
            unemployment among young black men aged 16-24 not enrolled in
            school is about 50 percent, and approximately one-third of all
            young black men are involved with the criminal justice system
            at any given time.
        According to a paper by written by Professor Michael Wald and Tia
    Martinez for the Hewlett Foundation, ``over the past 25 years the
    situation for youth who fall off the ladder as they move to adulthood
    has gotten considerably worse.'' Nevertheless, inflation-adjusted
    spending for programs that target at-risk youth dropped by 63 percent
    from 1985 to 2003.
        Youth workforce development programs provide a wide range of
    services to improve educational achievement, prevent youth from
    dropping out of high school, and reengage youth who are out of school
    and out of work. NYEC believes that we must reverse the trend of
    disinvesting in youth employment and development and fund the WIA youth
    formula at $1 billion. While we support new programs that help youth
    prepare for jobs and careers and prevent them from leaving school,
    funding for untested initiatives like the CAA's should not come at the
    expense of successful programs that are already stretched to the
    breaking point.
        The administration's fiscal year 2007 budget also proposes to
    eliminate the Reintegration of Young Offenders Program. According to
    the Bureau of Justice Statistics, approximately 120,000 youth under the
    age of 18 are currently incarcerated in juvenile detention centers,
    State prisons, and local jails. Most will be released in the next few
    years.
        A 1998 study by Vanderbilt Professor Mark Cohen, estimated that
    each teen prevented from adopting a life of crime could save the Nation
    between $1.7 and $2.3 million. A report prepared in 2002 for the
    California State Senate Joint Committee on Prison and Construction
    Operations stated, ``Given the staggering cost of failure, it is hard
    to imagine any justifiable argument against providing education and
    services to this population.''
        Finally, the cost per participant pales in comparison with the cost
    of alternatives like incarceration. According to the Justice Policy
    Institute, for example, ``incarceration, particularly for juveniles, is
    an expensive proposition. Each year, capital costs to build new
    facilities run in the range of $100,000 per cell and operating costs
    typically exceed $60,000 per cell.'' The return on investment in the
    Young Offenders program will be returned many times over.
        While NYEC recognizes the administration's continuing commitment to
    helping prisoners successfully return to society, we are concerned that
    unless funds are specifically targeted to serving youth, the needs of
    adults will most often take precedence. At a minimum, funds currently
    targeted at court-involved youth under the Reintegration for Young
    Offenders Program should be restored to fiscal year 2003 levels ($54
    million).
        We support the goals of the President's ``American Competitiveness
    Initiative'' and his charge that ``We must continue to lead the world
    in human talent and creativity. Our greatest advantage . . . has always
    been our educated, hardworking, ambitious people--and we're going to
    keep that edge.'' Realizing that goal, however, requires investment in
    all our citizens.
        NYEC has many concerns about the CAA's. We are particularly
    concerned that the limit of $3,000 a year for up to 2 years will
    function as a cap that will prevent workers from receiving the best and
    most appropriate training. A June 2005 GAO Report on the Workforce
    Investment Act (GAO-05-650) revealed that only 8 percent Workforce
    Investment Boards cap their Individual Training Accounts at $3,000.
    Fully 63 percent impose caps of $5,000 or more and 35 percent have caps
    of $7,000 and up. Fifteen percent have no caps. While this could
    achieve DOL's goal of increasing the number of people trained, it would
    call the quality of much of that training into question.
        Without Federal investment in effective programs such as those
    supported by WIA youth formula funds, the Responsible Reintegration of
    Young Offenders program, and the education programs that provide
    meaningful pathways from high school to higher education, millions of
    young people will not make the successful transition into productive
    employment.
        We thank the Committee for its commitment to these important
    programs that prepare our youth to compete in the global marketplace of
    the 21st century. We look forward to working with you to strengthen our
    Nation's youth employment and youth development systems.
                                     ______

         Prepared Statement of the Oregon Human Development Corporation
        Honorable Chairman, Senator Arlen Specter, and Honorable Committee
    Members: I want to thank you for the opportunity to share information
    about the Workforce Investment Act, Section 167 (WIA 167) National
    Farmworker Jobs Program.
        My name is Ronald Hauge and I am the Executive Director of Oregon
    Human Development Corporation (OHDC), a not-for-profit organization
    that has provided education, training, and workforce development
    services for Oregon's migrant and seasonal farmworkers for more than 27
    years. Throughout this period Congress has supported focused workforce
    development services for migrant and seasonal farmworkers within the
    CETA, JTPA, and WIA Federal workforce initiatives. The underlying
    reason for this support has been the recognition that migrant and
    seasonal farmworkers have different characteristics and needs than
    conventional job seekers who use the Nation's workforce system, and
    that based on these differences specialized workforce services are
    necessary to effectively serve this population.
        The Department of Labor's own performance reports that show the WIA
    167 National Farmworker Jobs Program consistently among the higher
    performing workforce programs, yet the administration has tried to
    eliminate the WIA 167 for the last several years. It is only by
    congressional action that the WIA 167 program continues to exist. Each
    year this Committee has demonstrated its wisdom and priorities by
    supporting appropriations to preserve these effective workforce
    services. Accordingly, I want to thank the Honorable Chairman and
    Committee Members for your instrumental role in saving the program and
    maintaining these valuable investments for our Nation's agricultural
    workforce.
        At this time I would like to point out a few features of the WIA
    167 program that illustrate its importance.
                              program performance
        According the Department of Labor's performance reports the WIA 167
    program has achieved entered employment rates above 80 percent, job
    retention rates of 75 percent, and earnings gains above $4,000. This is
    unquestionably strong performance given that migrant and seasonal
    farmworkers are among the most difficult to serve job seekers in the
    workforce system, and that the program operates largely in rural areas
    with limited labor markets.
     integration of the wia 167 program into the one stop workforce system
        The WIA 167 programs in each State are integrated into the One Stop
    workforce system on a location-by-location basis. In Oregon, for
    example, OHDC has six service delivery offices and each of the offices
    is integrated into the local One Stop system by virtue of co-location
    or other planned systemic integration. OHDC WIA 167 staff are members
    of local Workforce Investment Boards in each service area.
        In Oregon, this integration is acknowledged at the State level and
    is well documented in the State of Oregon's Two-Year Plan for Title I
    of the Workforce Investment Act and the Wagner-Peyser Act. The plan
    states that ``strategies in Oregon to promote equal and effective
    access and service delivery and to promote enhancement and integration
    of services to MSFWs (migrant and seasonal farm workers) include Oregon
    Human Development WIA 167 staff have workspace in WorkSource Oregon
    centers and access rights to the MSFW customer base in each workforce
    area they serve. With this, they are able to identify from a broader
    base of MSFW customers those particularly interested in the intensive
    and training services they can offer and where other staff are able to
    understand more thoroughly the value added services offered by the WIA
    167 for enhanced referral of their customers; they are seen as a
    critical component to delivering workforce services to MSFWs.''
    (emphasis added)
                    few alternative options for farmworkers
        The mainstream One Stop workforce system is geared primarily toward
    meeting the ``demand'' needs of high growth/high demand industries--as
    part of larger economic development strategies. This leaves lower
    skilled, hard working farmworkers with few or no options to improve
    their skills and secure stable employment in the primary labor market.
    Accordingly, the WIA 167 program becomes the only viable workforce
    development option for most farmworkers, a place with culturally
    sensitive, bilingual staff who are experienced in serving farmworkers
    and who understand the needs of local employers. It is clear that
    without the WIA 167 program few farmworkers would receive any
    developmental benefit from the Nation's workforce system.
                             rural community asset
        The WIA 167 program is a real asset to rural communities. The
    program adds tangible service capacity and diversity to smaller rural
    One Stop workforce systems. The program can provide agricultural
    upgrade training to help agricultural employers enhance worker
    productivity and stability, thus extending the workforce development
    system's benefit into the agricultural industry. Also, the program can
    serve as a foundation to attract other services for farmworkers such as
    housing, literacy and language training, disaster services, and a
    variety of emergency services that help stabilize the agricultural
    labor force in local communities.
        As you can see, the WIA 167 National Farmworker Jobs Program is an
    effective, valuable, coordinated resource that not only benefits
    farmworkers, but also strengthens the Nation's One Stop workforce
    system and rural communities.
        Before closing I would like to share, in the words of OHDC
    workforce coordinators, the experience of two farmworkers who were
    assisted in Oregon Human Development Corporation's WIA 167 program.
    Jesus Ortiz \1\
    ---------------------------------------------------------------------------
        \1\ Editors Note.--Not real names.
    ---------------------------------------------------------------------------
        Worked with Glen Walters Nursery for a number of years but had been
    unable to advance because he did not have any formal education on how
    to supervise a crew. Most of his knowledge came from first hand
    experience in the general operation of his department and observing
    other supervisors. In November 2004 OHDC enrolled Jesus in the WIA 167
    National Farmworker Jobs Program. OHDC met with the employer and
    arranged to provide supervisory skills upgrade training to develop the
    supervisory skills of Jesus, with the understanding that Jesus would be
    promoted into a supervisory position following the training. Because
    Jesus had limited English language skills, OHDC provided the training
    in Spanish. Jesus completed the training, which was defined as ``a
    success'' by the employer, who promoted Jesus into a supervisory
    position. Jesus also received a wage increase that took his earnings
    from $7.45 per hour to $11.00 per hour. Now, Jesus not only has the
    knowledge foundation that makes him a more effective leader and
    supervisor, but he also has a better income that will dramatically
    improve his family's well being. It is important to note that this
    success story would not have been possible if OHDC's WIA 167 program
    had not been available to provide the training in Spanish--something
    not available from any other partner in the local One Stop workforce
    system.
    Antonio Sanchez \1\
    ---------------------------------------------------------------------------
        \1\ Editors Note.--Not real names.
    ---------------------------------------------------------------------------
        Enrolled in the WIA 167 program in October 2005 at OHDC's Woodburn
    office. Antonio is a married father of three children. Antonio had
    worked primarily in agricultural work since he was 18 years old. He was
    employed with a dairy since 2003, living in employer owned housing. At
    the dairy Antonio worked long hours and weekends (65-75 hours per week)
    earning a salary of $2,000 per month with no health or vacation
    benefits. Antonio was eager to start attending training classes
    available through the WIA 167 program--his primary goal was to obtain a
    Commercial Drivers License (CDL) and to secure a commercial driving
    job. Antonio completed job readiness, customer service, computer, CPR,
    and CDL trainings within a 6 month period, even though English was not
    his primary language. He was an active participant with a strong desire
    to learn as much as he could so he could secure employment that would
    offer him and his family health insurance benefits, a regular work
    schedule, and a good living wage so his family could purchase their own
    home. Upon obtaining his CDL, OHDC referred Antonio to a job interview
    with Sysco Food Service. According to the Sysco supervisor, Antonio
    made a great impression during his interview and was offered an entry
    level position starting at $12.13 an hour--and he will be given the
    opportunity to transition to a Truck Driver position earning more than
    $16.00 per hour. The position provides vacation and excellent health
    benefits, retirement and life insurance. The family is now in the
    process of purchasing a home of their own.
        These two examples illustrate how the WIA 167 program works for
    both farmworkers and employers.
        In closing, I want to thank you again for your ongoing concern for
    the Nation's agricultural workforce. Although there are many priorities
    the Committee must evaluate, this is not the time for the Nation to
    turn its back on our hard working farmworkers who produce and harvest
    much of the Nation's food and other agricultural products--and who
    contribute so much for our collective benefit. Therefore, I strongly
    urge the Committee to maintain or increase the appropriation for the
    WIA 167 National Farmworker Jobs Program in the 2007 budget.
                                     ______

        Prepared Statement of the Association of Farmworker Opportunity
                                    Programs
        Good morning Chairman Specter and members of the subcommittee. My
    name is David Strauss and I represent the 48 nonprofit and public
    agencies that provide job training and related services to our Nation's
    migrant and seasonal farmworkers. They perform these tasks with grants
    from the United States Department of Labor pursuant to Section 167 of
    the Workforce Investment Act. As you know, the administration has tried
    to eliminate this program for the last 5 years. You and the members of
    your subcommittee have led the way in maintaining it each year, and we
    thank you for your leadership.
        About 2.5 million people labor in the fields and farms of America,
    from Hawaii to Florida and Puerto Rico, from Maine to California.
    Estimates are that 85 percent of the fruits and vegetables we eat are
    hand harvested by farmworkers. The pay is extremely low: most
    farmworkers earn less than $12,000 per year. Few farmworkers receive
    the job-related benefits, such as health insurance and sick pay, which
    we all take for granted. In most States, agricultural workers are not
    even eligible for unemployment compensation. They live a tough life.
    Many workers travel hundreds, sometimes thousands of miles in search of
    work. They get paid only when they perform the work: if the weather is
    bad or the crop is not as plentiful as the farmer had hoped, they
    simply do not receive wages. They typically cannot afford decent
    housing. Their children have to struggle mightily to even complete
    their public school education. The dropout rate for farmworker youth,
    especially those who migrate with their parents, is enormous.
        For over 33 years the Federal Government has made and kept a
    commitment to these hardworking people. Special Federal programs were
    created to recognize the reality that farmworkers often cross State
    lines to work and live. Thus, we have migrant head start, migrant
    health, migrant education, and the job training effort called the
    National Farmworker Jobs Program. These all are federally funded and
    have guidelines that acknowledge that Governors should not be placed in
    a position of deciding whether or not agricultural workers qualify for
    these services under State residency or other localized requirements.
        Today, I want to explain the way some of our program operators and
    staff members helped farmworkers and other rural poor people during the
    aftermath of the hurricanes of 2005.
        When the winds and rains of Hurricanes Katrina and Rita ravaged the
    gulf States many impoverished groups suffered. Among the hardest hit
    were the area's migrant and seasonal farmworkers. Thousands lost their
    jobs and many saw their homes damaged or destroyed. With incomes
    typically far below the poverty line, most farmworkers have no safety
    cushion when disaster strikes. To make matters worse, language barriers
    and cultural isolation often prevent them from accessing emergency
    services delivered by mainstream providers.
        It is hard to picture the severe hardships created by the
    hurricanes. Potable water could not be obtained, food and fuel were
    unavailable, and electricity and telephone services interrupted. These
    deprivations continued for weeks. For many, the migrant and seasonal
    farmworker job-training agencies provided the only relief.
        It must be noted that the four agencies mentioned below can only
    use Federal migrant and seasonal farmworker job training and assistance
    funds for eligible farmworkers and their dependents. The head of
    household must demonstrate eligibility, which includes proof of work
    authorization or citizenship and evidence of a recent history of
    performing farmwork. For those ineligible for Federal services, the
    agencies found other resources. The  167 WIA agencies in the four
    States are funded solely through the DOL job training grants for
    farmworkers. Without Congress's 2005 appropriation for migrant and
    seasonal farmworker job training, those agencies' doors would have been
    closed and none of the assistance described below would have happened.
        Here is a summary of the  167 agencies' relief activities:
                                   louisiana
        Motivation, Education and Training, Inc. of Louisiana (MET) is the
    167 agency in that State. MET was on the ground in the Hammond, LA area
    a few days after the storm hit. That area had no electric power, or
    telephone service, gasoline, or clean water. MET set up an intake
    center in a trailer, powered by a generator. Staff provided emergency
    services to people who could not be reached by FEMA. Red Cross trucks
    brought water and ice. MET provided vouchers for food, clothing, rent
    and other items to over 300 families (made up of over 1,200 people) who
    otherwise might have starved or been rendered homeless. While much of
    the community infrastructure, was poorly supplied, the local Wal-Mart
    was well prepared for the needs of people affected by the storm, and
    MET worked out arrangements for the vouchers to be used there. The
    average voucher was about $370 per family. They continue to serve
    eligible families months after the storm. These vouchers are funded
    through the  167 program.
        Ineligible families are referred to the Quad Area Community Action
    Agency, which issues commodities and other goods.
                                  mississippi
        The Mississippi Delta Council for Farmworker Opportunities (MDC)
    was one of the few statewide nonprofit organizations to have a nearly
    intact network following the hurricane. Headquartered in Clarksdale,
    MDC gave out vouchers and other help to hundreds of seasonal as well as
    migrant farmworkers. Vouchers were issued to 330 eligible farmworkers
    and families, and commodities and other supplies were given to 331
    other people. Vouchers were provided through  167 WIA program funds.
        The commodity donations were made possible through the efforts of
    the  167 WIA agency in Tucson, Arizona: Portable Practical Educational
    Programs (PPEP). PPEP gathered its own resources, those from the League
    of United Latin American Citizens, and from World Care. PPEP led two
    caravans consisting of a total of 14 trucks loaded with relief supplies
    making the 1,200-mile journey from Tucson to Clarksdale. MDC located a
    warehouse in Clarksdale, and the supplies continue to be distributed
    from there to farmworkers and other rural poor families throughout
    affected counties and in places where evacuees from the Gulf Coast and
    the New Orleans area are sited. MDC is also shipping supplies to their
    colleagues at Telamon Alabama for use in the Mobile area. As in
    Louisiana, the people they are serving are mostly outside any area of
    help provided by FEMA or the Red Cross.
        MDC is currently assessing farmworker needs in the counties of
    Scott, Simpson, Smith, Forrest, Greene, and George. There appears to be
    a tremendous need for housing for farmworkers whose homes were
    devastated by the storms.
                                    alabama
        Telamon Alabama is the  167 WIA agency in that State. It has
    provided direct voucher services to at least 25 farmworker families
    dislocated by the storm, primarily in Baldwin County. They have
    assisted about 200 others. Very little presence of FEMA or the Red
    Cross is reported for the farmworker areas of that county. A particular
    problem is that the fishing industry on the coast was devastated.
    Shrimp harvesting businesses operated by Vietnamese immigrants and
    others were virtually wiped out by the storm. Telamon is limited by the
    amount of help it can provide in two ways: its  167 WIA grant is about
    half that of Mississippi and considerably less than Louisiana's. In
    addition, there are large numbers of undocumented farmworkers, and
    there are few resources for referral for them. Telamon is providing as
    many persons as they can with commodities that have been shipped in
    from Arizona.
                                    florida
        The counties in which farmworkers were most affected were not
    declared disaster areas. That restricted FEMA's involvement. The
    Florida Department of Education's Adult Migrant Programs (FDOE)
    operates the farmworker job-training program in Florida. FDOE funds a
    number of sites with  167 WIA subgrants. Those sites have assisted
    over 400 farmworkers and their families, primarily obtaining resources
    from the United Way agencies that use Community Services Block Grant
    funds. A number of private funds were set up in the aftermath of the
    2004 hurricanes, and these funds were used to alleviate suffering from
    these storms. The 400 farmworkers they have already assisted were
    working in nurseries that were wiped out by the storm. However, the
    avocado orchards that were to be harvested were severely damaged, and
    the planting season that farmworkers rely upon in late fall were
    delayed because of the wet conditions.
                                    summary
        In Alabama, Louisiana, and Mississippi, the agencies that operate
    the programs funded under  167 of the WIA served as primary relief
    sources for migrant and seasonal farmworkers and their families in the
    wake of Hurricanes Katrina and Rita. At least 1,800 farmworkers and
    family members have received emergency services to date, either in the
    form of vouchers or relief supplies. Hundreds of other people in those
    States and in Florida were referred to agencies funded to help storm
    victims. There are medium- and long-term problems that farmworkers will
    experience that are not yet fully known. Much farm labor housing in
    Mississippi and Alabama has been destroyed, and future prospects for
    employment in agriculture are unclear.
        It is crucial that these four organizations were in place when the
    rural poor of the affected areas needed them. Had the funding for these
    organizations ceased in 2005 as the Department of Labor recommended,
    thousands of hard-working, low-paid farmworkers and their families
    would face life-threatening deprivations. And the growers and farmers
    that rely on them would be facing a much more uncertain future as they
    try to rebuild their agricultural enterprises. Fortunately, despite
    DOL's attempts to eliminate this program since 2002, Members of
    Congress have had the foresight to sustain the migrant and seasonal
    job-training program.
        Without these grants, who would be there to serve the working poor
    in rural Louisiana, Mississippi, Alabama, and Florida during this
    terrible time?
                                     ______

          Prepared Statement of the Central Valley Opportunity Center
        Chairman Specter, and other members of the subcommittee, my name is
    Ernie Flores and I am the executive director of Central Valley
    Opportunity Center (CVOC). CVOC is the DOL WIA Title I Section 167
    grantee, and also a Community Action Agency, in Madera, Merced and
    Stanislaus counties in the central San Joaquin Valley of California. At
    this time I submit my testimony for your consideration and in support
    of continued funding for the WIA 167 program, operated as the National
    Farmworker Jobs Program (NFJP) in the DOL. As you are aware, for the
    past 5 years, the President's budget, and the DOL, have proposed to
    eliminate the funding for NFJP. If this were to happen, it would
    effectively end vital employment and training services, job
    stabilization services, and various educational services that migrant
    and seasonal farm workers require to either continue working in
    agriculture, or to transition into year round employment outside of
    agriculture. It should also be mentioned that the funding for the
    entire NFJP program is approximately $80 million. Unfortunately, this
    amount of funding only allows us to serve 3-5 percent of the eligible
    farmworkers in need of our services.
        Although the U.S. DOL has testified that farm workers could be
    served through the local One-Stop Centers, all partners in the One Stop
    system, including the One Stop operators and the 167 grantee One Stop
    partners, are in agreement that the One Stop system is not prepared to
    served farmworkers. The majority of farm workers have limited English
    proficiency, possess very little formal education and generally have
    very few marketable job skills. The only jobs program that is prepared
    to help farm workers overcome those types of barriers, and become or
    continue to be gainfully employed, is the WIA 167 NFJP.
        The U.S. DOL has also testified before Congress that the NFJP is
    ineffective and duplicates the work of other job training programs. As
    to effectiveness, the DOL's own internal performance reports document
    that the NFJP has attained the highest performance ratings, for all WIA
    employment programs in the areas of entered employment, wage gains, and
    retention in employment, during the past 4 quarters. As for
    duplication, the NFJP generally serves over 95 percent of all migrant
    and seasonal Farmworkers that are enrolled in any WIA programs during
    any 12 month program period. Any Farmworkers that are enrolled in other
    WIA programs are most likely co-enrolled into a NFJP WIA 167 program
    also.
        For the past 27 years CVOC has provided various employment,
    training and social service programs to migrant and seasonal farm
    workers and other low income persons in our three county service area
    in Central California. As is the case with all NFJP grantees, our field
    offices are easily accessible to Farmworkers since they are located in
    their communities. CVOC offers the following services under the NFJP
    grant:
                            employment and training
      --Outreach, assessment and enrollment
      --Case management/vocational guidance
      --Vocational training
        --Welding
        --Auto Mechanics
        --Cooking/Food preparation
        --General/Advance Business Occupations
        --Cashiering/Merchandising
        --Commercial Drivers License
      --English As a Second Language classes
      --General Equivalency Diploma classes
      --Supportive Services (child care, gas, food, housing)
      --Job Readiness Training
      --On the Job Training
      --Direct Job Placement
      --Indirect Job Placement
      --Active follow-up services
      --Retraining services
        In addition to these services, CVOC has leveraged resources with
    the help of the NFJP grant in order to provide farm workers with
    services such as energy payment assistance, emergency housing, food
    vouchers, medical & dental services and various other social services.
        In should be understood that there are no other programs in the WIA
    system that are prepared to meet the employment and training needs of
    migrant and seasonal farmworkers except for programs like CVOC, and the
    other grantees of the WIA NFJP. If these programs cease to operate as a
    nationally administered program, and funding is seriously cut or
    eliminated, there will literally be no employment and training services
    for migrant and seasonal farm workers.
        I sincerely implore you to continue the funding for the WIA 167
    NFJP so that together we can continue to do for the least of our
    brothers. So that farmworkers can also reap the harvest of the American
    dream.
        At this time I would like to share some of our ``success stories.''
    The stories clearly show how the lives of farmworkers, or their
    dependents, are forever changed for the better when they receive
    services from the National Farmworkers Jobs Programs grantees.
        Thank You.
    Isaura Gonzalez
        Before coming to CVOC, Isaura Gonzalez was a seasonal cannery
    worker at Michael Angelo Gourmet, where she was making $9.50/hr. This
    wage was not too bad considering she dropped out of school in the
    seventh grade. However, this was a temporary job and offered no
    benefits. Isaura came to CVOC with a dream. She wanted to obtain her
    General Education Diploma (GED) and find a year-round job with fringe
    benefits. Six months later, all her dreams became true! Isaura
    successfully completed the CVOC 22-week General Business Occupations
    course a month early and obtained her GED with an amazing score of
    2,910. This score is the highest ever in CVOC's history! She is now
    working for Hilmar Cheese Company as a Data Entry/Machine Operator
    Manager making $14.95/hr. She has fringe benefits and a year-round job.
    Recently, during her first quarter follow-up she said she was expecting
    a raise soon.
    Juan Hernandez
        He had just graduated from high school when he came to CVOC to
    register for the welding program in October of 2004. He was 18 years
    old, the dependent of a farm worker. He was very eager to learn welding
    because his uncle is a welder so he wanted to follow his uncle's
    footsteps. While he was in training, he was very punctual and the
    instructor was very happy to see how well he did and how eager he was
    to learn. After completing training, the Job Developer placed him as a
    welder at Gladden Equipment Erectors. His starting pay was $10.50 per
    hour and soon after, he began to travel to different States to work for
    the company. He sometimes spends a month traveling with the company.
    Today, he still works for the same company and earns $14.00 per hour.
    Hugo Sanchez
        Hugo had not graduated from high school when he came to CVOC to
    register for the Cashiering Program in March 2004. He was hoping to
    obtain his GED, enroll in ESL classes, and obtain a Vocational Training
    Certificate. While he was attending classroom training, he found the
    cashiering class was too easy for him so he decided to transfer to
    General Business Occupations (GBO) training. While in training, he
    obtained his GED, improved his English skills, and completed GBO
    training. After completing training, he started working as a temporary
    data entry teller at E & J Gallo Winery in August of 2004 earning
    $11.14 per hour. Since this job was temporary, he found another job. In
    November 2004, he started working at Foster Farms Dairy where he
    started earning $12.83 per hour. He continues to work for them and now
    earns $16.97 per hour. In May 2006 he will be making $18.90 per hour as
    the CAT supervisor
    Julian Diaz
        Before Julian Diaz came to CVOC, he was working as a farm worker
    and at Wal-Mart. Julian was living with his parents in Modesto Housing
    Authority's Public Housing. He wanted to become a welder and he
    discovered that CVOC offered this training. He saw the CVOC ad in the
    Modesto Bee and he decided to call. Julian began his 22-week training
    in welding in September of 2005. He completed his training on February
    24, 2006. Even though he finished all his exams in January, Julian
    decided to stay until February to gain more skills. He was a great
    student and attended class every day. His instructor was very pleased
    with his hard work. The instructor even helped him find work.
        Julian is now working as a welder at West-Mark in Atwater making
    $11.00 per hour. He will soon be receiving health benefits and 401k.
    Julian has achieved all the goals he hoped to achieve and is very happy
    that he chose CVOC for his training. Julian even went as far as calling
    the welding instructor in tears on his first day of work to express his
    gratitude for the training, job skills, tools, and the opportunity that
    was given to him.
                                     ______

                    DEPARTMENT OF HEALTH AND HUMAN SERVICES

                    Prepared Statement of the AIDS Institute
        The AIDS Institute, a national public policy research, advocacy,
    and education organization, is pleased to submit written comments to
    you in support of a number of critical HIV/AIDS and Hepatitis programs
    as part of the fiscal year 2007 Labor, Health, and Education and
    Related Services appropriation measure. We thank you for your
    consistent support of these programs over the years, and trust you will
    do your best to adequately fund them in the future in order to provide
    for, and protect the health of, many Americans.
                                    hiv/aids
        HIV/AIDS remains one of the world's worst health pandemics in the
    history of civilization. Worldwide, some 40 million people are infected
    with this incurable infectious disease, and 14,000 new infections occur
    each passing day. Tragically, AIDS has already claimed the lives of 25
    million people. Here in the United States, according to the CDC,
    944,305 people have been diagnosed with AIDS, and over 529,000 people
    have died through 2004. It is estimated there are more than 40,000 new
    infections in the United States each year. At the end of 2003, an
    estimated 1,039,000 to 1,185,000 persons in the United States were
    living with HIV/AIDS.
        Persons of minority races and ethnicities are disproportionately
    affected by HIV/AIDS. In 2003, African Americans, who make up
    approximately 12 percent of the U.S. population, accounted for half of
    the HIV/AIDS cases diagnosed. HIV/AIDS also disproportionately affects
    the poor, and about 70 percent of those infected rely on public health
    care financing.
        The U.S. Government has played a leading role in fighting the AIDS
    epidemic, both at home and abroad. The vast majority of the
    discretionary programs supporting HIV/AIDS efforts domestically and a
    portion of our Nation's contribution to the global AIDS effort are
    funded through your subcommittee. The AIDS Institute, working in
    coalition with other AIDS organizations, have developed realistic and
    practical funding request numbers for each of these domestic and global
    AIDS programs. The AIDS Institute asks that you do your best to
    adequately fund these programs at the requested level.
        We are keenly aware of the current budget constraints and competing
    interests for limited Federal dollars. Unfortunately, despite the
    growing need, almost all domestic HIV/AIDS programs in recent years
    have experienced funding decreases.
        This year, the President has proposed three new domestic HIV/AIDS
    initiatives by providing $70 million for getting prescription drugs to
    those who need them; $90 million for testing those who do not yet know
    their status; and $25 million to help raise the awareness of those who
    do not know they should be tested. The AIDS Institute applauds these
    initiatives and encourages the subcommittee to fund these increases.

                               RYAN WHITE CARE ACT
                            [In millions of dollars]
    ------------------------------------------------------------------------
                            Fiscal year                             Amount
    ------------------------------------------------------------------------
    2005.......................................................        2,048
    2006.......................................................        2,038
    2007 President's request...................................        2,133
    2007 community request.....................................        2,631
    ------------------------------------------------------------------------

        The centerpiece of the Federal Government's response to caring and
    treating low-income individuals with HIV/AIDS are those programs funded
    under the Ryan White CARE Act. CARE Act programs currently reach over
    571,000 low-income, uninsured, and underinsured people each year, most
    of who are from a racial or ethnic minority group. The majority of CARE
    Act funds support primary medical care and essential support services.
        Providing care and treatment for those who have HIV/AIDS is not
    only the compassionate thing to do, but it is cost-effective in the
    long run, and serves as a tool in prevention of HIV/AIDS.
        In recent years, with the exception of minor increases for the AIDS
    Drug Assistance Program (ADAP), CARE Act funding has decreased. Because
    of across the board recessions, flat funding has actually resulted in
    budget cuts for the past several years. We urge you to provide these
    vitally important programs with the community requested level of
    funding. Consider the following:
        (1) The caseload is increasing. People are living longer with HIV/
    AIDS due to lifesaving medications; there are 40,000 new infections
    each year; and the Federal Government has initiated increased testing
    programs to identify positive people-all of which will necessitate the
    need for more medical services and medications.
        (2) There is a greater financial burden on CARE Act programs. The
    price of healthcare, including medications, is increasing; non-profit
    organizations are struggling; Medicaid benefits are being scaled-back
    at the State level and significant Medicaid reductions recently passed
    the Congress.
        (3) Level or decreased funding for the CARE Act is impacting State
    and local governments grant awards. Because of reduced funding levels,
    34 out of the 51 largest cities affected by HIV/AIDS experienced cuts
    to their Title I awards this year. This is after 18 cities experienced
    cuts last year. Additionally, 41 States and territories received less
    money last year in their Title II base awards.
        (4) ADAP funding shortfalls are causing States to place clients on
    waiting lists, limiting drug formularies, and increasing eligibility
    requirements. In February 2006, nine States reported having waiting
    lists, totaling 791 people. Several ADAPs reported other cost
    containment measures, including formulary reductions (4), eligibility
    restrictions (2) and limiting annual client expenditures (2). Due to
    the small increase the ADAP program was given last year, additional
    severe restrictions are anticipated in many additional States across
    the country.
        (5) Two recent reports conclude there are a staggering number of
    people in the United States who are not receiving life-saving AIDS
    medications. The Institute of Medicine report ``Public Financing and
    Delivery of HIV/AIDS Care, Securing the Legacy of Ryan White''
    concluded that 233,069 people in the United States who know their HIV
    status do not have continuous access to Highly Active Antiretroviral
    Therapy (HAART). A study by the CDC titled, ``Estimated number of HIV-
    infected persons eligible for and receiving antiretroviral therapy,
    2003--United States'', reached similar conclusions. According to CDC's
    estimates, 212,000, or 44 percent of eligible people living with HIV/
    AIDS, aged 15-49 in the United States, are not receiving antiretroviral
    therapy. The report concludes, ``there is a substantial unmet health
    care need for antiretroviral therapy among HIV-infected persons in
    care.''
        This is a travesty in our own country. As we seek to provide
    lifesaving medications to those abroad, we must ensure we are providing
    medications to our own here in the United States.
        Fiscal Year 2007 Administration Initiative.--The AIDS Institute is
    in strong support of President Bush's proposed increase of $70 million
    for ``States in need to bridge the existing gaps in coverage for
    Americans waiting for life-saving medications. These funds would help
    the States end current waiting lists and help support care for
    additional patients.'' Since ADAP only received a funding increase of
    $2 million in fiscal year 2006 and the need number for fiscal year 2007
    is $197 million, the $70 million increase, while certainly not enough,
    is a welcome increase. We urge the Committee to approve this long
    overdue increase.
        Additionally, President Bush proposed an increase of additional $25
    million Title III Ryan White CARE Act funding ``to significantly
    strengthen outreach by local community and faith-based organizations in
    hardest hit areas. These grants would help raise awareness, increase
    early detection, combat stigma, and facilitate access to treatment,
    especially for African-American, Hispanic, Native American, and other
    minority community groups whose need is often greatest.'' This
    additional funding is also extremely worthy of funding, and the
    administration should be commended for its proposal.
        The AIDS Institute supports continued and increased funding for the
    Minority HIV/AIDS Initiative (MHAI). MHAI funds services nationwide
    that address the disproportionate impact that HIV has on communities of
    color.

         CENTERS FOR DISEASE CONTROL AND PREVENTION--HIV PREVENTION AND
                                  SURVEILLANCE
                            [In millions of dollars]
    ------------------------------------------------------------------------
                            Fiscal year                             Amount
    ------------------------------------------------------------------------
    2005.......................................................          662
    2006.......................................................          651
    2007 President's request...................................          740
    2007 community request.....................................        1,049
    ------------------------------------------------------------------------

        While the number of new HIV infections in the United States has
    greatly decreased since the 1980's, there are still an estimated 40,000
    new infections each year. Since AIDS is a preventable disease, these
    are 40,000 new infections annually that could have been prevented.
    Leading the Federal Government's campaign in AIDS prevention is the
    CDC. As with other domestic AIDS programs, funding is severely lagging,
    and the CDC is being asked to do more with fewer and fewer dollars. In
    fact, CDC's AIDS funding has declined in the last 4 years in a row. It
    is not surprising given the budget decreases, the administration's goal
    of reducing the infection rate in half by 2005 did not occur.
        Fiscal Year 2007 Administration Initiative.--The AIDS Institute is
    in strong support of President Bush's proposed increase of $90 million
    ``to the purchase and distribution of rapid HIV test kits, facilitating
    the testing of more than 3 million additional Americans. Test kits
    would be distributed in areas of the country with the highest rates of
    newly discovered HIV cases, and the highest suspected rates of
    undetected cases.'' A large portion of the funds would be used for the
    testing of prisoners and intravenous drug users, two groups with
    extremely high levels of infections. Knowledge of one's HIV status,
    particularly for high risk individuals, is an effective prevention
    tool. Approximately one quarter of the over 1 million people living
    with HIV in the United States (252,000 to 312,000 persons) are unaware
    of their HIV status. This initiative, if funded by the Congress, should
    help prevent future infections and bring additional people into
    lifesaving treatment and care. The AIDS Institute urges the Committee
    to fund this extremely worthy program.
        While The AIDS Institute supports increased testing programs, we do
    not support funding those efforts at the expense of prevention
    intervention programs. Funding for these programs are already under
    funded.
        We are pleased to hear that the new leadership of CDC's HIV
    prevention programs has pledged to make the CDC budget more
    transparent, and will better detail where the funds are being spent,
    and on what populations and programs. For far too long, this
    information has not been made available.
        Efforts to improve prevention methods and weed out non-effective
    programs should be a constant undertaking and be guided by science and
    fact based decision-making. It is for these reasons that The AIDS
    Institute opposes funding of abstinence-only until marriage programs,
    for which the President requested a $27 million increase. While we
    support abstinence-based prevention programs as part of a comprehensive
    prevention message, there is no scientific proof that abstinence-only
    programs work. On the contrary, they reject proven prevention tools,
    such as condoms, and fail to address the needs of homosexuals, who can
    not marry, and who remain greatly impacted by HIV/AIDS. Given that
    approximately one-half of all new infections in the United States are
    among those under the age of 25, it is essential that our youth be
    given the proper tools to prevent HIV infection.

                   NATIONAL INSTITUTES OF HEALTH-AIDS RESEARCH
                             [In million of dollars]
    ------------------------------------------------------------------------
                            Fiscal year                             Amount
    ------------------------------------------------------------------------
    2005.......................................................        2,921
    2006.......................................................        2,903
    2007 President's request...................................        2,888
    2007 community request.....................................        3,000
    ------------------------------------------------------------------------

        Through the NIH, research is conducted to: understand the AIDS
    virus and its complicated mutations; discover new drug treatments;
    develop a vaccine and other prevention programs such as microbicides;
    and ultimately, a cure. Much of this work at the NIH is done in
    cooperation with private funding and ingenuity. The critically
    important work performed by the NIH not only benefits those in the
    United States, but the entire world.
        This research has already helped in the development of many highly
    effective new drug treatments, prolonging the lives of millions of
    people. Undoubtedly, the commitment of the Congress and the
    administration to double NIH funding over the past 5 years has led to
    great advances. As neither a cure nor a vaccine exists, and patients
    continue to build resistance to existing medications, additional
    research in cooperation with private interests must continue. We are
    disappointed the President's budget is proposing a decrease of $15
    million in AIDS research for fiscal year 2007. We ask the Committee to
    fund NIH, including critical AIDS research, at the community requested
    level of $30 billion.
    Substance Abuse and Mental Health Services Administration
        It is widely known that many persons infected with HIV also
    experience drug abuse and/or mental health problems, and require the
    programs funded by SAMHSA. Given the growing need for services, we are
    disappointed that overall funding requested for SAMHSA is down by $71
    million, and the Center for Substance Abuse Treatment is being cut by
    $24 million, the Center for Substance Abuse Prevention is cut by $12
    million, and the Center for Mental Health Services is cut by $35
    million. We ask the Committee to reject these cuts, and adequately fund
    these programs.
                                viral hepatitis
        Viral Hepatitis, whether A, B, or C, are infectious diseases that
    also deserve special attention by the Federal Government and the
    subcommittee. According to the CDC, there are an estimated 1.25 million
    Americans chronically infected with Hepatitis B, and 73,000 new
    infections each year. Although there is no cure, a vaccine has been
    available since 1982, and there are a few treatment options available.
    An estimated 3.9 million (1.8 percent) Americans have been infected
    with Hepatitis C, of whom 2.7 million are chronically infected.
    Currently, there is no vaccine or cure, and very few treatment options
    available. It is believed that one-third of those infected with HIV are
    co-infected with Hepatitis C.
        Given these numbers, we are disappointed that the administration is
    proposing to cut the 317 Immunization Grant Program funds that serve as
    the major source in the public sector for at-risk adult immunizations.
    Instead of facing cuts, since the vaccines are relatively inexpensive,
    this cost-effective program should be significantly enhanced in order
    to protect people from Hepatitis A and B. We recommend funding the 317
    Program at $800 million for fiscal year 2007 in order to fully realize
    the public health benefits of immunization.
        The administration is also calling for decreased funding for Viral
    Hepatitis at the CDC. The program is currently funded at a level less
    than it was in fiscal year 2003, and falls way short of the $50 million
    that is needed. These funds are needed to establish a program to lower
    the incidence of Hepatitis C through education, outreach, and
    surveillance, and to support such initiatives as the CDC National
    Hepatitis C Prevention Strategy and the 2002 NIH Consensus Statement on
    the Management of Hepatitis C and accompanying recommendations.
        The AIDS Institute asks that you give great weight to our testimony
    and remember it as you deliberate over the fiscal year 2007
    appropriation bill. Should you have any questions or comments, feel
    free to contact Carl Schmid, Director of Federal Affairs, The AIDS
    Institute (202) 462-3042 or cschmid@theaidsinstitute.org. Thank you
    very much.
                                     ______

        Prepared Statement of the American Academy of Family Physicians
        The 94,000-member American Academy of Family Physicians submits
    this statement for the record to the Senate Appropriations Subcommittee
    on Labor/Health and Human Services, Education and Related Agencies. Our
    statement is made in support of the Section 747 Primary Care Medicine
    and Dentistry Cluster. The Academy also supports the Agency for
    Healthcare Research and Quality (AHRQ) and rural health programs.
                  brief background: training family physicians
        Section 747 within the Public Health Service Act is the only
    Federal program that funds training for family physicians. The law
    requires the program to meet two goals: (1) increase the number of
    primary care physicians (family physicians, general internists and
    general pediatricians) and (2) boost the number of people to provide
    care to the underserved. Regarding family medicine specifically,
    Section 747 offers competitive grants for training programs in medical
    school and in residency programs.
        The fiscal year 2006 spending bill provided $41 million to Section
    747, a figure that was a significant cut from the $88.8 million the
    cluster received in fiscal year 2005. And, unfortunately, the
    President's fiscal year 2007 budget proposed zero dollars for the
    program. We urge Congress to fund Section 747 at fiscal year 2005
    levels ($88.8 million).
                           who are family physicians?
        Family physicians are the specialists trained to provide
    comprehensive, coordinated and continuing care to patients of both
    genders and all ages and ethnicities, regardless of medical condition.
    These residency-trained, primary care physicians treat babies with ear
    infections, adolescents who are obese, adults with depression and
    seniors with multiple, chronic illnesses. And because they focus on
    prevention, primary care, and integrating care for their patients, they
    are able to treat illnesses early and cost-effectively. In addition,
    when necessary, family physicians help patients navigate our complex
    health system and find the right subspecialists. Finally, family
    physicians are distributed throughout the country in approximately the
    same proportion as the population: about one-quarter of all Americans
    live in rural areas and about 25 percent of family physicians practice
    there, as well.
        community health centers: understaffed with shortages of family
                                   physicians
        Over the last few years, the administration has made increasing the
    number of Community Health Centers (CHCs) a priority within its health
    care budget. Specifically, the President's fiscal year 2007 blueprint
    recommends an increase of $181 million for CHCs, which would increase
    funding to nearly $2 billion. These dollars would complete the
    administration's goal to create 1,200 health center sites around the
    Nation. While a laudable objective, this funding does not take into
    account staffing issues at these centers; the CHC dollars go primarily
    to so-called ``bricks and mortar,'' i.e., construction of the health
    care clinics.
        The additional funding recommended in the President's budget to
    build Community Health Centers, and the zero dollars proposed to train
    family physicians under Section 747, are a serious disconnect: primary
    care physicians make up nearly 90 percent of doctors working in CHCs--
    and most are family physicians. In short, without more family
    physicians, no one will be available to staff these new centers.
        This point was brought home in a March 1, 2006 article in the
    Journal of the American Medical Association (JAMA). The authors found
    that in 2004, CHCs were understaffed and could not fill all clinical
    positions (Rosenblatt, et al.). Rural health centers had more openings
    that took longer to fill than those in urban areas. More alarmingly,
    over 13 percent of family physician positions at CHCs were vacant.
        As the only Federal program that trains family physicians, funding
    for Section 747 is critical. Without Section 747 to train family
    physicians, CHCs staffing problems will get worse.
      section 747 produces doctors who work in chcs and serve in the nhsc
        A second study buttresses the importance of family physicians to
    CHCs and to the National Health Service Corps, which is another
    administration priority. An unpublished 2006 study from the University
    of California, San Francisco and the Robert Graham Center for Policy
    Studies in Family Medicine and Primary Care shows that medical schools
    that receive Section 747 dollars produce physicians who work in CHCs
    and serve in the National Health Service Corps compared to schools
    without this funding.
        The finding is particularly true for family physicians.
    Specifically, according to the study, nearly 4,000 family physicians
    and general practitioners were exposed to Title VII funding during
    medical school and subsequently chose to work in a CHC. Without this
    exposure, at least 750 fewer family physicians would have been working
    in a CHC in 2003. Coupled with the JAMA article, which shows that there
    are 600 vacancies for family physicians, without Section 747 funding,
    there would be twice as many vacancies in health centers.
                  lower health care costs and improved quality
        Section 747 plays a role in lowering our Nation's health care costs
    and increasing the quality of U.S. health care. For example, an article
    in Health Affairs (April 2004) demonstrated that States that spent more
    on Medicare had lower quality of care. While seemingly
    counterintuitive, the authors found two reasons for this result.
        The first reason was that expensive health care did not improve
    patient satisfaction or outcomes. The second reason was that the makeup
    of the health care workforce made a difference: more primary care
    doctors in a State meant higher quality care and lower cost. In
    contrast, more specialists and fewer generalists led to lower quality
    and higher costs. And, just a small increase in the number of primary
    care doctors in a State was associated with a large boost in that
    State's quality ranking.
        The first reason was that expensive health care did not improve
    patient satisfaction or outcomes. The second reason was that the makeup
    of the health care workforce made a difference: more primary care
    doctors in a State meant higher quality care and lower cost. In
    contrast, more specialists and fewer generalists led to lower quality
    and higher costs. And, just a small increase in the number of primary
    care doctors in a State was associated with a large boost in that
    State's quality ranking.
        An article in a March 2005 edition of Health Affairs, ``The Effects
    of Specialist Supply on Populations' Health: Assessing the Evidence''
    went even further. This piece stated that there was a ``negative
    relationship between the supply of primary care physicians and death
    from stroke, infant mortality and low-birthweight, and all-cause
    mortality.'' The article went on to say that just one more primary care
    physician per 10,000 people was associated with a decrease of 34.6
    deaths per 100,000 people.
        The article also cited breast cancer research for the State of
    Florida, which indicated that ``each tenth-percentile increase in
    primary care physician supply is associated with a statistically
    significant 4 percent increase in odds of early-stage breast cancer.''
    Statistics were similar for other types of cancers: there was a
    relationship between early identification of cancer and the supply of
    primary care physicians. Numerous other research was highlighted in the
    Health Affairs article that indicated a higher ratio of primary care
    physicians to populations led to better health outcomes. These data
    support the need for additional funding for Section 747, the only
    Federal program that produces primary care physicians.
         the overspecialized u.s. physician workforce: a world anomaly
        Unlike all other developed countries, the United States does not
    have a primary care-based health care system. While other developed
    countries have about equal numbers of primary care physicians and
    subspecialists, in the United States, less than one-third of the
    physician workforce is primary care.
        More disturbingly, compared to developed countries, the United
    States spends the most per capita on healthcare--but has some of the
    worst healthcare outcomes. More than 20 years of evidence have shown
    that a health system based on primary care produces greater health and
    economic benefits. Boosting support for Section 747, which funds
    training for family physicians and for other primary care disciplines,
    could improve the health of patients in the United States.
                  agency for healthcare, research and quality
        The Academy recommends $440 million for the Agency for Healthcare,
    Research and Quality (AHRQ). A major purpose of AHRQ is to conduct
    primary care and health services research geared to physician
    practices, health plans and policymakers. What this means is that the
    agency translates research findings from basic science entities like
    the National Institutes of Health (NIH) into information that doctors
    can use every day in their practices. Another key function of the
    agency is to support research on the conditions that affect most
    Americans.
        More recently, AHRQ has become the lead Federal agency for research
    on comparative clinical effectiveness; information technology; and
    patient safety. For example, the Medicare Modernization Act asked AHRQ
    to study the ``clinical effectiveness and appropriateness of specified
    health services and treatments,'' and to use this information to
    improve the quality and effectiveness of the costly Medicare, Medicaid
    and SCHIP programs. In fiscal year 2006, $15 million was appropriated
    by Congress for this purpose. This type of study on ``what works'' in
    clinical therapies is crucial in an era of skyrocketing health care
    costs and limited Federal dollars.
        Historically, however, AHRQ has been the lead agency to translate
    research into information for physicians and patients. Over the years,
    Congress has provided billions of dollars to the National Institutes of
    Health, which has resulted in important insights in preventing and
    curing major diseases. However, AHRQ's role has been to take this basic
    science and produce understandable, practical materials for the entire
    healthcare system. In short, AHRQ is the link between research and the
    patient care that Americans receive.
        In addition, AHRQ has long-supported research on conditions that
    affect most people. Most Americans get their medical care in doctors'
    offices and clinics. However, most medical research comes from the
    study of extremely ill patients in hospitals. AHRQ studies and supports
    research on the types of illness that trouble most people. In brief,
    AHRQ looks at the problems that bring people to their doctors every
    day--not the problems that send them to the hospital.
                             rural health programs
        Continued funding for rural programs is vital to provide adequate
    health care services to America's rural citizens. We support the
    Federal Office of Rural Health Policy; Area Health Education Centers;
    the Community and Migrant Health Center Program; and the NHSC. State
    rural health offices, funded through the National Health Services Corps
    budget, help States implement these programs so that rural residents
    benefit as much as urban patients.
                                   conclusion
        The Academy urges Congress to fund Section 747 at fiscal year 2005
    levels ($88.8 million). We believe that the two recent studies showing
    that Community Health Centers not only rely heavily on family
    physicians, but cannot fill all of their positions, and the data
    indicating the crucial role that primary care training plays in whether
    physicians practice in CHCs or serve in the NHSC, make an irrefutable
    case for funding Section 747. In addition, however, family physicians
    are critical to the health and well-being of everyone in the country.
    Finally, all of these studies, authored by different researchers, are
    consistent: Section 747 works.
        The AAFP also urges Congress to fund the Agency for Healthcare
    Research and Quality at $440 million; and support rural health
    programs. We thank you in advance for making these investments in
    America's healthcare system.
                                     ______

            Prepared Statement of the American Academy of Pediatrics
        There can be no denying that there have been numerous and
    significant successes in improving the health and well-being of
    America's children and adolescents, from even just decades ago. Infant
    and child mortality rates have been radically lowered. The number of 2-
    year-olds who have received the recommended series of immunizations is
    at an all-time high, while vaccine-preventable diseases such as
    measles, pertussis, and diphtheria have decreased by over 98 percent
    Teen pregnancy rates have declined by 27 percent over the last decade.
    Still, despite these successes, far too many children in America
    continue to suffer from disease, injury, abuse, racial and ethnic
    health disparities, or lack of access to quality care. And more than 9
    million children and adolescents through age 18 remain uninsured.
    Clearly there remains much work to do.
        As clinicians we not only diagnose and treat our patients, we must
    also promote strong preventive interventions to improve the overall
    health and well-being of all infants, children, adolescents and young
    adults. Likewise, as policy-makers, you have an integral role to play
    in improving the health of the next generation through adequate and
    sustained funding of vital Federal programs.
        The AAP, SAM and APA have identified three key priorities within
    this Committee's jurisdiction that are at the heart of improving the
    health and well-being of America's children and adolescents: access to
    health care, quality of health care, and immunizations.
                                     access
        We believe that all children and adolescents should have full
    access to comprehensive, age-appropriate, quality health care. From the
    ability to receive primary care from a pediatrician trained in the
    unique needs of children and adolescents, to timely access, to
    pediatric medical subspecialists and pediatric surgical specialists,
    America's children and adolescents deserve access to quality pediatric
    care in a medical home. Given the recent cuts to the Medicaid program
    and fiscal belt-tightening in the States, discretionary programs now
    more than ever provide a vital health care safety net for America's
    most vulnerable children and adolescents.
        Maternal and Child Health Block Grant.--The Maternal and Child
    Health (MCH) Block Grant Program at the Health Resources and Services
    Administration (HRSA) is the only Federal program exclusively dedicated
    to improving the health of all mothers and children. Nationwide, the
    MCH Block Grant Program provides preventive and primary care services
    to over 32 million women, infants, children, adolescents and children
    with special health care needs. In addition, the MCH Block Grant
    Program supports community programs around the country in their efforts
    to reduce infant mortality, prevent injury and violence, expand access
    to oral health care, and address racial and ethnic health disparities.
    Moreover, the MCH Block Grant Program includes efforts dedicated to
    addressing interdisciplinary training, services and research for
    adolescents' physical and mental health care needs, and supports
    programs for vulnerable adolescent populations, including health care
    initiatives for incarcerated and minority adolescents, and violence and
    suicide prevention. It also plays an important role in the
    implementation of the State Children's Health Insurance Program
    (SCHIP), which is critically important at a time when States are
    struggling with ongoing deficits and shifting costs. One of the many
    successful MCH Block Grant programs is the Healthy Tomorrows
    Partnership for Children Program, a public/private collaboration
    between the MCH Bureau and the American Academy of Pediatrics.
    Established in 1989, Healthy Tomorrows has supported over 140 family-
    centered, community-based initiatives in 44 States, including Ohio,
    Wisconsin, Texas, California, Kentucky, Rhode Island, and Maryland.
    These initiatives have addressed issues such as access to oral and
    mental health care, abstinence, injury prevention, and enhanced
    clinical services for chronic conditions such as asthma. To continue to
    foster these and other community-based solutions for local health
    problems, in fiscal year 2007 we strongly support an increase in
    funding for the MCH Block Grant Program to $724 million.
        Family Planning Services.--The family planning program, Title X of
    the Public Health Services Act, ensures that all teens have
    confidential access to valuable family planning resources. For every
    dollar spent on family planning through Title X, $3 is saved in
    pregnancy-related and newborn care costs to Medicaid. Title X--which
    does not provide funding for abortion services--provides critically
    needed preventive care services like pap tests, breast exams, and STI
    tests to millions of adolescents and women. But funding for Title X
    continues to fall well below the need. Over 9 million cases of STIs
    (almost half the total number) are in 15- to 24-year-olds, and over 30
    percent of women will become pregnant at least once before age 20. Teen
    pregnancy rates continue to vary over racial and ethnic groups, and
    nearly half (48 percent) of all teens say that they want more
    information from--and increased access to--sexual health care services.
    Responsible sexual decision-making, beginning with abstinence, is the
    surest way to protect against sexually transmitted infections and
    pregnancy. However, for adolescent patients who are already sexually
    active, confidential contraceptive services, screening and prevention
    strategies should be available. We therefore support a funding level in
    fiscal year 2007 of $375 million for Title X of the Public Health
    Service Act.
        Mental Health.--It is estimated that over 13 million children and
    adolescents have a mental health problem such as depression, ADHD, or
    an eating disorder, and for as many as 6 million this problem may be
    significant enough to disturb school attendance, interrupt social
    interactions, and disrupt family life. Despite these statistics, the
    National Institute of Mental Health (NIMH) estimates that 75-80 percent
    of these children fail to receive mental health specialty services, due
    to stigma and the lack of affordability of care and availability of
    specialists. Grants through the Children's Mental Health Services
    program have been instrumental in achieving decreased utilization of
    inpatient services, improvement in school attendance and lower law
    enforcement contact for children and adolescents. We recommend that
    $109.7 million be allocated in fiscal year 2007 for the Mental Health
    Services for Children program to continue these improvements for
    children and adolescents with mental health problems.
        Child Abuse and Neglect.--Health care providers play a crucial role
    in the prevention, identification, and treatment of child abuse and
    neglect. In spite of this fact, few Federal resources are dedicated to
    bringing the medical profession into full partnership with law
    enforcement, the judiciary, and social workers. We urge the
    subcommittee to provide an increase of $10 million in fiscal year 2007
    for the Center for Disease Control and Prevention's National Center for
    Injury Prevention and Control to establish a network of consortia to
    link and leverage health care professionals and resources to address--
    and ultimately prevent--child abuse and neglect.
        Health Professions Education and Training.--Critical to building a
    pediatric workforce to care for tomorrow's children and adolescents are
    the Training Grants in Primary Care Medicine and Dentistry, found in
    Title VII of the Public Health Service Act. These grants are the only
    Federal support targeted to the training of primary care professionals.
    They provide funding for innovative pediatric residency training,
    faculty development and post-doctoral programs throughout the country.
    For example, the Montefiore Medical Center in the South Bronx of New
    York City has used Title VII funds to support its Residency Training
    Program in Social Pediatrics (RPSP). Initiated in response to local
    needs to prepare physicians for the delivery of care to underserved
    populations and to practice specifically at Community Health Centers in
    the inner-city setting, RPSP simultaneously trains physicians in
    neighborhood health centers and in an academic hospital. Since its
    inception, RPSP has graduated over one hundred pediatricians, a large
    number of whom are women and minority physicians. Additionally, 79
    percent of all RPSP graduates report that they currently practice in
    community-oriented primary care settings serving predominately poor and
    minority inner-city populations. Another 10 percent of RPSP graduates
    report that they are involved in professional activities such as health
    administration and policy, including directing patient care in
    community health centers.
        Through the continuing efforts of this subcommittee, Title VII has
    provided a vital source of funding for critically important programs
    that educate and train tomorrow's generalist pediatricians in a variety
    of settings to be culturally competent and to meet the special health
    care needs of their communities. We recommend fiscal year 2007 funding
    of at least $40 million for General Internal Medicine/General
    Pediatrics. We also join with the Health Professions and Nursing
    Education Coalition in supporting an appropriation of at least $550
    million in total funding for Titles VII and VIII. We applaud the
    administration's support for the National Health Service Corps and
    Community Health Centers, key components with Title VII to ensuring an
    adequate distribution of health care providers across the country; but
    we emphasize the need for continued support of the training and
    education opportunities through Title VII for health care professionals
    who provide care for our Nation's communities.
        Independent Children's Teaching Hospitals.--Equally important to
    the future of pediatric education and research is the dilemma faced by
    independent children's teaching hospitals. In addition to providing
    critical care to the Nation's children, independent children's
    hospitals play a significant role in training tomorrow's pediatricians
    and pediatric subspecialists. Children's hospitals train 30 percent of
    all pediatricians, half of all pediatric subspecialists, and the
    majority of pediatric researchers. However, children's hospitals
    qualify for very limited Medicare support, the primary source of
    funding for graduate medical education in other inpatient environments.
    As a bipartisan Congress has recognized in the last several years,
    equitable funding for Children's Hospitals Graduate Medical Education
    (CHGME) is needed to continue the education and research programs in
    these child- and adolescent-centered settings. Since 2000, CHGME
    hospitals accounted for nearly 87 percent of the growth in pediatric
    subspecialty training programs and 68 percent of the growth in
    pediatric subspecialty fellows trained. We are extremely disappointed
    in the 67 percent reduction in funding for this vital program proposed
    by the administration, and join with the National Association of
    Children's Hospitals to restore funding of $303 million for the CHGME
    program in fiscal year 2007. The support for independent children's
    hospitals should not come, however, at the expense of valuable Title
    VII and VIII programs, including grant support for primary care
    training.
                                    quality
        Access to health care is only the first step in protecting the
    health of all children and adolescents. We must ensure that the care
    provided is of the highest quality. Robust Federal support for the wide
    array of quality improvement initiatives, including research, is needed
    if this goal is to be achieved.
        Emergency Services for Children.--One program that assists local
    communities in providing quality care to children in distress is the
    Emergency Medical Services for Children (EMSC) grant program. There are
    approximately 30 million child and adolescent visits to the Nation's
    emergency departments every year. Children under the age of 3 years
    account for most of these visits. Up to 20 percent of children needing
    emergency care have underlying medical conditions such as asthma,
    diabetes, sickle-cell disease, low birthweight, and bronchopulmonary
    dysplasia. A CDC report issued in February of 2006 reaffirmed that more
    hospitals must be properly equipped and clinicians must be educated and
    trained to manage these special health care needs in emergency
    situations. In addition, emergency systems must be equipped with the
    resources needed to care for this especially vulnerable population. In
    order to assist local communities in providing the best emergency care
    to children, we once again reject the administration's proposed
    elimination of the EMSC program and strongly urge that the EMSC program
    be maintained and adequately funded at $25 million in fiscal year 2007.
        Agency for Healthcare Research and Quality.--Quality of care rests
    on quality research--for new detection methods, new treatments, new
    technology and new applications of science. As the lead Federal agency
    on quality of care research, the Agency for Healthcare Research and
    Quality (AHRQ) provides the scientific basis to improve the quality of
    care, supports emerging critical issues in health care delivery and
    addresses the particular needs of priority populations, such as
    children. Substantial gaps still remain in what we know about health
    care needs for children and adolescents and how we can best address
    those needs. Children are often excluded from research that could
    address these issues. The AAP and endorsing organizations strongly
    support AHRQ's objective to encourage researchers to include children
    and adolescents as part of their research populations. We also support
    increasing AHRQ's efforts to build pediatric health services research
    capacity through career and faculty development awards and strong
    practice-based research networks. Additionally, AHRQ is focusing on
    initiatives in community and rural hospitals to reduce medical errors
    and to improve patient safety through innovative use of information
    technology--an initiative that we hope would include children's
    hospitals as well. Through its research and quality agenda, AHRQ
    continues to provide policymakers, health care providers, and patients
    with critical information needed to improve health care; therefore, we
    join with the Friends of AHRQ to recommend funding of $440 million for
    AHRQ in fiscal year 2007.
        National Institutes of Health.--Since its inception, the National
    Institutes of Health (NIH) has been an integral part of the public
    health continuum. NIH serves as a vital component in improving the
    Nation's health through research, both on and off the NIH campus, and
    in the training of researchers, including pediatric investigators. Over
    the years, NIH has made dramatic strides that directly impact the
    quality of life for infants, children and adolescents through
    biomedical and behavioral research. For example, NIH research has led
    to successfully decreasing infant death rates by over 70 percent,
    increasing the survival rates from respiratory distress syndrome, and
    dramatically reducing the transmission of HIV from infected mother to
    fetus and infant from 25 percent to just 1.5 percent. NIH is engaged in
    a comprehensive research initiative to address and explain the reasons
    for a major public health dilemma--the increasing number of obese and
    overweight children and adults in this country. Today U.S. teenagers
    are more overweight than young people in many other developed
    countries. And the Newborn Screening Initiative is moving forward to
    improve availability, accessibility, and quality of genetic tests for
    rare conditions that can be uncovered in newborns. The pediatric
    community applauds the prior commitment of Congress to maintain
    adequate funding for the NIH. We remain concerned, however, that the
    cumulative effect of several years of flat funding will stall or even
    set back the gains that were made under the years of the NIH's budget
    doubling. We urge you to sustain the momentum of scientific discovery.
    We support the recommendation of the Ad Hoc Group for Medical Research
    for a funding level in fiscal year 2007 of $29.75 billion. In addition,
    to ensure ongoing and adequate child and adolescent focused research,
    such as the National Children's Study (NCS) led by the National
    Institute for Child Health and Human Development (NICHD), we join with
    the Friends of NICHD Coalition in requesting $1.35 billion in fiscal
    year 2007. Moreover we recommend that the NCS be adequately funded in
    fiscal year 2007 at $69 million to begin the implementation phase of
    this important study. We are greatly disappointed by and reject the
    administration's proposal to phase out the NCS in 2007. This large
    longitudinal study, authorized in the Children's Health Act of 2000,
    will provide critical research and information on major causes of
    childhood illnesses such as premature birth, asthma, obesity,
    preventable injury, autism, development delay, mental illness, and
    learning disorders.
        We commend this committee's ongoing efforts to make pediatric
    research a priority at the highest level of the NIH. We urge continued
    Federal support of NIH efforts to increase pediatric biomedical and
    behavioral research, including such proven programs as targeted
    training and education opportunities and loan repayment. We recommend
    continued interest in and support for the Pediatric Research Initiative
    in the Office of the NIH Director and sufficient funding to continue
    the pediatric training grant and pediatric loan repayment programs both
    enacted in the Children's Health Act of 2000. This would ensure that we
    have adequately trained pediatric researchers in multiple disciplines
    that will not come at the expense of other important programs.
        Finally, as clinicians, we know first-hand the considerable
    benefits for children and society in securing properly studied and
    dosed medications. The benefits of pediatric drug testing are
    undisputed. Proper pediatric safety and dosing information reduces
    medical errors and adverse events, ultimately improving children's
    health and reducing health care costs. In a very conservative estimate,
    the FDA projects savings from pediatric testing of over $228 million a
    year in reduced hospitalization expenses for just five diseases
    affecting children. But until now there has been little incentive for
    drug companies to study off-patent drugs--older drugs that are
    critically needed therapies for children. The Research Fund for the
    Study of Drugs, created as part of the Best Pharmaceuticals for
    Children Act of 2002, provides support for these critical pediatric
    testing needs, but unfortunately is currently funded at an amount
    sufficient to test only a fraction of the NIH and FDA-designated
    ``priority'' drugs. Therefore, we urge the subcommittee to provide the
    NIH with sufficient funding to fund the study of generic (off-patent)
    and selected on-patent drugs for pediatric use.
        We believe that these requests represent the best and most reliable
    estimates of the level of funding needed to sustain the high standard
    of scientific achievement embodied by the NIH. However, we encourage
    Congress to explore all possible options to identify additional sources
    of funding needed to support these increases if we are to reach these
    funding goals while not weakening any other valuable component of the
    Public Health Service.
                                  immunization
        Immunization remains one of the greatest public health achievements
    of the last century, saving literally millions of lives. Thanks to the
    widespread use of vaccines, millions of children have avoided serious
    and often fatal diseases that previously devastated lives. Before
    immunization, polio paralyzed 10,000-25,000 children and adults,
    rubella (German measles) caused birth defects and mental retardation in
    as many as 20,000 newborns, and measles infected millions of children,
    killing 400-500 and leaving thousands with serious brain damage each
    year. Immunizations have reduced by more than 95 percent the cases of
    vaccine-preventable infectious diseases in this country. And some, like
    rubella, are virtually eliminated from North America, thanks to
    successful immunization programs.
        Pediatricians, working alongside public health professionals and
    other partners, have brought the United States its highest immunization
    coverage levels in history--over 92 percent of children received all
    vaccinations by school age in 2004-2005. We attribute this, in part, to
    the Vaccines for Children (VFC) Program, and encourage Congress to
    maintain its commitment to ensuring the program's viability. The VFC
    program combines the efforts of public health and private pediatricians
    and other health care professionals to accomplish and sustain vaccine
    coverage goals for both today's and tomorrow's vaccines. It removes
    vaccine cost as a barrier to immunization for some and reinforces the
    concept of vaccine delivery in a ``medical home.'' However, we are
    concerned that the administration's fiscal year 2007 budget once again
    has proposed to reduce funding for the Section 317 program by
    transferring funds from that program to expand VFC. This is
    shortsighted. Additional section 317 funding is necessary to provide
    the pneumococcal conjugate vaccine (PCV-7), a vaccine that prevents an
    infection of the brain covering, blood infections and approximately 7
    million ear infections a year, to those remaining States that currently
    do not provide it. Increased Section 317 funding also is needed to
    purchase the influenza vaccine--now recommended for children between
    the ages of 6 months and 5 years of age. This age cohort is
    increasingly susceptible to serious infection and the risk of
    hospitalization. And an increase in funding is needed to purchase the
    recently recommended rotavirus vaccine, tetanus-diptheria-pertussis
    (Tdap) vaccine for adolescents and the meningococcal conjugate vaccine
    (MCV). Meningococcal disease is a serious illness, caused by bacteria,
    with 10-15 percent of cases fatal and another 10-15 percent of cases
    resulting in permanent hearing loss, mental retardation, or loss of
    limbs.
        The public health infrastructure that now supports our national
    immunization efforts must not be jeopardized with insufficient funding.
    One of the conclusions of the 2000 Institute of Medicine report,
    Calling the Shots, was that unstable funding for State immunization
    programs threatens coverage levels for specific populations and age
    groups and vaccine safety. This continues to be true today. A strong
    and sufficient infrastructure is essential. For example, adolescents
    continue to be adversely affected by vaccine-preventable diseases
    (e.g., chicken pox, hepatitis B, measles and rubella). Comprehensive
    adolescent immunization activities at the national, State and local
    levels are needed to achieve national disease elimination goals. States
    and communities continue to be financially strapped and therefore, many
    continue to divert funds and health professionals from routine
    immunization clinics in order to accommodate anti-bioterrorism
    initiatives or now pandemic influenza. Moreover, continued investment
    in the CDC's immunization activities must be made to avoid the
    reoccurrence of childhood vaccine shortages by providing and adequately
    funding a national 6 month stockpile for all routine childhood
    vaccines--stockpiles of sufficient size to insure that significant and
    unexpected interruptions in manufacturing do not result in shortages
    for children.
        While the ultimate goal of immunizations clearly is eradication of
    disease, the immediate goal must be prevention of disease in
    individuals or groups. To this end, we strongly believe that CDC's
    efforts must be sustained. In fiscal year 2007, we recommend an overall
    increase in funding above fiscal year 2006 of $282 million to ensure
    that the CDC's National Immunization Program has the funding necessary
    to accommodate vaccine price increases, new disease preventable
    vaccines coming on the market, global immunization initiatives--
    including funds for polio eradication and the elimination of measles
    and rubella--and to continue to implement the recommendations developed
    by the IOM.
                                   conclusion
        We appreciate the opportunity to provide our recommendations for
    the coming fiscal year. As this subcommittee is once again faced with
    difficult choices and multiple priorities we know that as in the past
    years, you will not forget America's children and adolescents.
        Other recommendations for fiscal year 2007:

                     DEPARTMENT OF HEALTH AND HUMAN SERVICES
    ------------------------------------------------------------------------
                            Agency                               Amount
    ------------------------------------------------------------------------
    Centers for Disease Control and Prevention (total)....    $8,500,000,000
        Polio Eradication.................................       101,254,000
        Birth Defects, Disability and Health..............       135,000,000
        Newborn Hearing Screening Technical Assistance....         9,000,000
        National Violent Death Reporting System...........        10,000,000
        Folic Acid Education Campaign.....................         4,000,000
    Health Resources and Services Administration (total)..     7,500,000,000
        Newborn Hearing Screening Grants to States........        10,000,000
        Consolidated Community Health Centers.............     2,038,000,000
    Substance Abuse and Mental Health Services                 3,531,000,000
     Administration (total)...............................
    Indian Health Service (total).........................     3,361,000,000
    Food and Drug Administration (total)..................     1,566,000,000
    ------------------------------------------------------------------------

                                     ______

     Prepared Statement of the American Association of Colleges of Nursing
        The American Association of Colleges of Nursing (AACN) respectfully
    submits this statement highlighting funding priorities for nursing
    education and research programs in fiscal year 2007. AACN represents
    over 590 senior colleges and universities with baccalaureate and
    graduate nursing programs that include over 210,000 students and 11,000
    faculty members. These institutions are responsible for educating
    almost half of our Nation's registered nurses (RNs) and all of the
    nurse faculty and researchers. Nursing represents the largest health
    profession, with approximately 2.9 million dedicated, trusted
    professionals delivering primary, acute, and chronic care to millions
    of Americans.
                        the nationwide nursing shortage
        Our country continues to be challenged by a shortage of registered
    nurses that was first noted in 1998. This shortage is showing no signs
    of diminishing and demographics reveal that, unlike shortages in the
    past, it will affect health care delivery for the foreseeable future.
    In 2005, the American College of Healthcare Executives reported that 85
    percent of hospitals experienced a nursing shortage. The U.S. Bureau of
    Labor Statistics (BLS) has projected that our country will require an
    additional 1.2 million new and replacement registered nurses by 2014.
    Nursing has been identified by BLS as the fastest growing professional
    occupation in the country. However, according to the Health Resources
    and Services Administration (HRSA), the supply of RNs will drop 29
    percent below demand by 2020 unless deliberate action is taken to
    increase the number of nurses graduating each year and entering the
    workforce. Nursing vacancies exist throughout all health care sectors,
    including long-term care, home care, and public health. Among the
    Nation's 5,000 community health centers, the vacancy rate for RNs is 10
    percent and 9 percent for nurse practitioners. Even the Department of
    Veterans Affairs, the largest sole employer of RNs in the United
    States, has a 10 percent RN vacancy rate.
        Research clearly documents that patient safety is compromised
    without a sufficient number of RNs. In 2002, the Joint Commission on
    Accreditation of Healthcare Organizations (JCAHO) noted that the
    nursing shortage contributed to nearly a quarter of all unexpected
    incidents that adversely affect hospitalized patients. Since RNs
    comprise the largest component of a hospital workforce, shortages
    result in emergency room overcrowding and diversions, increased wait
    time for or cancellation of surgeries, discontinued patient care
    programs or reduced service hours, and delayed discharges.
        The nursing shortage also threatens homeland security and disaster
    preparedness efforts. The Government Accountability Office reported
    that local and State health officials cited the nursing shortage as an
    impediment to their preparedness efforts in 2003.
        These alarming facts are coupled with little change in contributing
    factors, such as the aging of America's population, the aging nurse
    workforce, high rates of RN retirement, and the increasing demand for
    high acuity health care services by chronically ill, medically complex
    patients. To ensure that every patient receives the safest, highest
    quality health care, Federal support must continue to play an integral
    role in our Nation's efforts to address the nursing shortage.
            current strategy: nursing workforce development programs
        Acknowledging the severity of the Nation's nursing shortage,
    Congress passed The Nurse Reinvestment Act of 2002. This legislation
    created new programs and expanded existing Nursing Workforce
    Development authorities. Administered by HRSA under Title VIII of the
    Public Health Service Act, these programs focus on the supply and
    distribution of RNs across the country. Programs support individual
    students in their nursing studies through loans, scholarships, and loan
    repayment programs. Title VIII programs stimulate innovation in nursing
    practice and bolster nursing education throughout the continuum, from
    entry-level preparation through graduate study. They are the largest
    source of Federal funding for nursing education assisting students,
    schools of nursing, and health systems in their efforts to educate,
    recruit, and retain RNs. In fiscal year 2005, these programs helped to
    educate 52,759 student nurses through individual and programmatic
    support.
        Funding for these authorities is insufficient to address the
    severity of the nursing shortage. Currently, Nursing Workforce
    Development Programs receive $149.68 million, down from $150.67 million
    in fiscal year 2005. During the nursing shortage in 1974, Congress
    appropriated $153 million for nursing education programs. Translated
    into today's dollars, that appropriation would total $615 million, more
    than four times the current level. However, it will take billions of
    dollars to resolve today's nursing shortage.
        AACN respectfully requests $175 million for Title VIII Nursing
    Workforce Development in fiscal year 2007, an additional $25.32 million
    over fiscal year 2006. New monies would expand nursing education,
    recruitment, and retention efforts to help resolve the nursing
    shortage.
    Colleges of Nursing Respond
        The approximately 1,500 schools of nursing nationwide have been
    working diligently to expand enrollments. AACN's 2005-2006 annual
    survey of 567 schools entitled, Enrollments and Graduations in
    Baccalaureate and Graduate Programs in Nursing, reveals that
    enrollments increased by 9.7 percent in entry-level baccalaureate
    nursing programs. This makes the fifth consecutive year of enrollment
    increases that can be attributed to a combination of Federal support
    through Nursing Workforce Development Programs, private sector
    marketing efforts, public-private partnerships providing additional
    resources to expand capacity of nursing programs, and State legislation
    targeting funds towards nursing scholarships and loan repayment.
        While impressive, these increases still cannot meet the demand. In
    the November 2003 issue of Health Affairs, Dr. Peter Buerhaus reported
    that nursing school enrollments would have to increase by at least 40
    percent annually just to replace those nurses who retire. Despite
    intensive efforts nationwide, AACN found that enrollments increased by
    a total of 57.2 percent, over the last 5 years in entry-level
    baccalaureate programs. Moreover, only 8.1 percent of RNs are under the
    age of 30, according to the 2004 National Sample Survey of Registered
    Nurses.
        Despite increasing enrollments and the escalating demand for RNs,
    U.S. schools of nursing still are forced to turn away eligible
    students. At least 41,683 qualified applications were turned away
    despite the increase in enrollments. This is a 27 percent increase from
    the over 32,797 denied admission in 2004, according to AACN data.
    Reasons cited for this denial are insufficient numbers of faculty,
    clinical sites, classroom space, clinical preceptors, and budget
    constraints. Over 73 percent of the schools surveyed cited the faculty
    shortage as the primary barrier to increasing enrollments. Some of
    these qualified students are placed on waiting lists for 2 years or
    more, but many good students are lost to the nursing profession.
    Bottleneck: The Nurse Faculty Shortage
        AACN believes that the most effective strategy to resolve the
    nursing shortage is addressing the underlying faculty shortage. HRSA
    reported in 2004 that just 13 percent of the RN workforce holds either
    a master's or doctoral degree, credentials required to teach. In 2003,
    there were 10,500 full-time masters and doctorally prepared faculty in
    baccalaureate and graduate nursing programs. Projections through 2012
    show that the faculty pool will shrink by at least 2,000 as compared to
    2003, even after accounting for retirements, resignations, and
    additional entrants. Note that these figures do not take into account
    the need for faculty in new or expanded programs, but only represent
    present staffing requirements. If the faculty vacancy rate holds
    steady, the deficit of nurse faculty is expected to swell to over 2,600
    unfilled positions in 2012.
        This situation will only worsen with time. The number of productive
    years for nurse educators will decrease as faculty age continues to
    climb, averaging 52 years in 2004. As such, significant numbers of
    faculty are expected to retire in the coming years, but there are not
    enough candidates in the pipeline to take their places. An average of
    410 individuals are awarded doctoral degrees in nursing each year, but
    almost a quarter (23 percent) take jobs outside of academic nursing. In
    2005, AACN found a faculty vacancy rate of 8.5 percent, which
    translates into an average of approximately 2 faculty vacancies per
    school of nursing. Of those vacancies, over half, (52.6 percent)
    required a doctoral degree. Higher compensation in clinical and private
    sector settings lures current and potential nurse educators away from
    the classroom. For example, the average salary of a nurse practitioner
    in an emergency department was $84,835, according to the 2005 National
    Salary Survey of Nurse Practitioners. However, the average salary for a
    nurse practitioner in academia was only $66,925, 26.8 percent less.
    Without sufficient nurse faculty, schools of nursing cannot expand
    enrollments.
        Reversing the Trend: Nurse Faculty Loan Program (Sec. 846A).--This
    trend can be reversed with additional appropriations for the Nurse
    Faculty Loan Program. Designed to increase the number of nurse faculty,
    schools of nursing receive grants to create a loan fund. To be eligible
    for these loans, students must pursue full-time study for a masters or
    doctoral degree. In exchange for teaching at a school of nursing, loan
    recipients will have up to 85 percent of their educational loans
    cancelled over a 4-year period. A student may receive a maximum loan
    award of $30,000 per academic year for tuition, books, fees, laboratory
    expenses, and other reasonable. educational costs. In fiscal year 2005,
    66 new grants were made to schools of nursing, and 26 grants were
    continued, totaling 92. These funds will support an estimated 475
    future nurse faculty members. In fiscal year 2006, $4.77 million was
    appropriated. However, if the current funding was doubled to almost $10
    million, based on fiscal year 2005 projections, colleges of nursing
    could educate over 900 future faculty. Further, with an average faculty
    to student ratio of 1:10, those 900 faculty could teach an additional
    9,000 nurses each year.
        Advanced Education Nursing Program (Sec. 811).--These grants
    support the majority of schools of nursing preparing graduate-level
    nurses, some of whom become faculty. Receiving $57.06 million in fiscal
    year 2006, this grant program helps schools of nursing, academic health
    centers, and other nonprofit entities improve the education and
    practice of nurse practitioners, nurse-midwives, nurse anesthetists,
    nurse educators, nurse administrators, public health nurses, and
    clinical nurse specialists. Out of the 88 applications reviewed for
    this program in fiscal year 2005, 43 new grants were awarded, and 114
    were continued. In addition, 422 schools of nursing received
    traineeship grants, which in turn directly supported 9,000 individual
    student nurses.
        The health system's increasing demand for primary care, increased
    utilization of case-management--particularly for chronic illnesses,
    prevention and cost-efficiency, and a shortage of physicians are
    driving the Nation's need for nurse practitioners, certified nurse-
    midwives, and other RNs with graduate education and advanced clinical
    skills, known as advanced practice registered nurses (APRNs). Mounting
    studies demonstrate the quality and cost effectiveness of APRN care.
    This is especially important for the 78 million aging Baby Boomers,
    whose demand for health care services will skyrocket in the near
    future. The rate of physician office visits by Medicare beneficiaries
    jumped 20.5 percent from 1992 to 2001, according to the Federal report
    Older Americans 2004: Key Indicators of Well-Being.
        Workforce Diversity Program (Sec. 821).--These grants prepare
    disadvantaged students to become nurses. As the United States becomes
    ever more heterogeneous, it is imperative that the composition of our
    nursing workforce mirrors this shift. According to the U.S. Census
    Bureau, roughly 30 percent of the population was reported as a racial
    or ethnic minority in 2000, but by 2050 that percentage will jump to
    over 52 percent. This program awards grants to schools of nursing and
    other entities seeking to increase access to nursing education for
    disadvantaged students, including those racial and ethnic minorities
    under-represented among RNs. Scholarships or stipends, pre-entry
    preparation, and retention activities are provided to enable students
    to complete their nursing education. In fiscal year 2005, 171
    applications were reviewed, from those 11 new grants were awarded and
    48 previously awarded grants were continued. These program funds
    assisted at least 6,344 students. Workforce Diversity received $16.11
    million in fiscal year 2006.
        At Risk: Nursing Student Loan Program (Sec. 835).--This revolving
    loan fund was established in 1964 to specifically target nursing
    workforce shortages. The Nursing Student Loan (NSL) program provides
    participating undergraduate or graduate nursing students with a maximum
    of $13,000 in loans at 5 percent interest. Schools of nursing
    participating in the NSL select recipients and determine the level of
    assistance provided, with a preference for those with financial need.
    New loans are made as existing loans are repaid. This program has not
    received additional appropriations since 1983. However, in fiscal year
    2005, the NSL provided financial assistance to 17,240 nursing students.
    In fiscal year 2005, Sec. 222 of the Consolidated Appropriations Act of
    2005 (Public Law 108-447) included language which stated: ``The
    unobligated balance of the Nursing Student Loan program authorized by
    section 835 of the Public Health Services Act is rescinded.'' As a
    result, the NSL gave back $6.1 million to the U.S. Treasury in July
    2005. In previous years, those funds were redistributed among
    participating institutions, increasing the amount of possible loans. A
    similar provision, in the fiscal year 2006 appropriations law will
    force the NSL to return even more funds to the Treasury that instead
    could have assisted nursing students in completing their education.
                     national institute of nursing research
        One of the 27 Institutes and Centers at the National Institutes, of
    Health (NIH), the efforts of the National Institute of Nursing Research
    (NINR) improve patient care and foster advances in nursing and other
    health professions' practice. These practices must be must constantly
    updated and validated based on rigorous, peer-reviewed research. The
    outcomes-based findings derived from NINR research are important to the
    future of the health care system and its ability to deliver safe, cost-
    effective, and high quality care. Through grants, research training,
    and interdisciplinary collaborations, NINR addresses care management of
    patients during illness and recovery, reduction of risks for disease
    and disability, promotion of healthy lifestyles, enhancement of quality
    of life in those with chronic illness, and care for individuals at the
    end of life. To advance this research, AACN requests a funding level of
    $150 million in fiscal year 2007, an additional $12.66 million over the
    $137.34 million NINR received in fiscal year 2006.
    NINR Addresses the Need for Translational and Clinical Research
        NINR emphasizes translational research, the means by which basic
    findings relating to behavior, molecules, and genes are tested in the
    clinical setting and translated into innovative medical practices and
    improvements in public health. Under the framework of the Roadmap
    Initiative, NINR and nurse researchers are addressing the development
    of new interdisciplinary research teams and enhanced clinical research
    to move the overall NIH portfolio of social, behavioral, and medical
    research forward in this coordinated and cohesive effort.
    NINR Addresses the Shortage of Nurse Researchers and Faculty
        NINR allocates 8 percent of its budget, a high proportion when
    compared to other NIH institutes, to research training to help develop
    the pool of nurse researchers. In fiscal year 2005, NINR training
    dollars supported 80 individual researchers and provided 155
    institutional awards, which in turn supported a number of nurse
    researchers at each site. Since nurse researchers often serve as
    faculty members for colleges of nursing, they are actively educating
    our next generation of RNs.
                   agency for healthcare research and quality
        While NIH supports biomedical research that improves health care by
    focusing on the cause, cure, and prevention of disease, the Agency for
    Healthcare Research and Quality (AHRQ) supports health systems
    research, collecting evidence-based information on health care
    outcomes. AHRQ research findings are used by patients, clinicians,
    health system decision makers, and public policymakers to guide health
    care delivery systems and patient care. The research supported by AHRQ
    not only improves the quality of health care services, but also helps
    people make more informed decisions about their health care. AACN joins
    the Friends of AHRQ in recommending a funding level of $440 million for
    fiscal year 2007, an additional $121.3 million over the fiscal year
    2006 level of $318.7 million.
    Health Systems Research at AHRQ Addresses Nurses' Role in Patient
            Safety
        AHRQ research has demonstrated that inefficient work processes,
    overwhelming workloads, extended work hours, and poor workplace designs
    create obstacles to providing patients safe, cost-effective, and high
    quality health care. The New England Journal of Medicine published a
    study of over 6 million patients in May 2002, that found hospitalized
    patients had better outcomes when the majority of their nursing care
    was provided by RNs. Decreased hours of RN care, stemming from the
    nursing shortage, correlated with longer hospital stays, increased
    incidence of urinary tract infections and gastrointestinal bleeding, as
    well as higher rates of pneumonia, shock, and cardiac arrest. When
    patients received additional hours of RN care, the death rates dropped
    for pneumonia, shock or cardiac arrest, upper gastrointestinal
    bleeding, sepsis, and deep venous thrombosis.
                                   conclusion
        AACN acknowledges the fiscal challenges that the subcommittee and
    the entire Congress must work within. However, the health needs of our
    Nation must be addressed by a dedicated, long-term vision for educating
    the new nursing workforce. Today, nurses must evaluate research that
    promotes evidence-based practice and utilize technical innovations in
    providing safe, high quality patient care. Research shows that patient
    care suffers and mortality rates increase in facilities without
    sufficient numbers of RNs. Without highly educated nurses, who will
    care for us when we must enter into our increasingly complex health
    care system?
                                     ______

         Prepared Statement of the American Association of Colleges of
                              Osteopathic Medicine
        On behalf of the American Association of Colleges of Osteopathic
    Medicine (AACOM) which represents the administrations, faculties and
    students of all twenty colleges of osteopathic medicine in the United
    States, I am pleased to present our views on the fiscal year 2007
    appropriations for health professions education programs under Title
    VII of the Public Health Service Act.
        First, we must express our profound concern at the devastating cuts
    proposed by the administration for Title VII programs in its fiscal
    year 2007 budget. The Bureau of Health Professions received $342
    million in cuts in the President's fiscal year 2007 proposal which is
    fully 46 prepared of its entire budget. While we support the $181
    million increase in the President's budget for Community Health
    Centers, the large funding decreases to the Title VII programs raises
    the question of whether there will be a sufficient number of health
    care providers to staff these clinics. The fiscal year 2007 cuts are in
    addition to the 12 programs that were eliminated in the fiscal year
    2006 appropriations bills, as well as other programs that received
    significant decreases in both years. Congress must not allow these
    draconian slashes to cripple the programs that assist health
    professions schools in training the workforce needed to care for our
    citizens in the 21st century.
        A study that recently appeared in the Journal of the American
    Medical Association recommends increased Titles VII and VIII support to
    alleviate provider shortages at Community Health Centers [Shortages of
    Medical Personnel at Community Health Centers: Implications for Planned
    Expansion, Roger A. Rosenblatt, C. Holly. A. Andrilla, Thomas Curtin;
    L. Gary Hart, Journal of the American Medical Association, JAMA
    2006;295:1042-1049]. The study found that Titles VII and VIII programs
    help ameliorate these shortages and maldistribution by training
    providers who are more likely to practice in rural and underserved
    communities.
        Health professions education programs under Title VII and nursing
    education programs under Title VIII are essential components of
    America's health care safety net. An adequate diverse, well-distributed
    and culturally competent health workforce is indispensable to our
    national readiness efforts. Colleges of osteopathic medicine have a
    long tradition of training primary care physicians who practice in
    rural and urban underserved areas.
        The health professions education programs under Title VII and the
    nursing education programs under Title VIII of the Public Health
    Service Act have been valuable in our efforts to continue to ensure
    this commitment. In Public Law 105-392, the Health Professions
    Education Partnership Act of 1998, forty-four different Federal health
    professions training programs were consolidated into seven clusters.
    These clusters provide support for training of primary care and dental
    providers; the establishment and operation of interdisciplinary
    community-based training activities; health professions workforce
    analysis; public health workforce development; nursing education; and
    student financial assistance. These programs are designed to meet the
    health care delivery needs of over 2,800 Health Professions Shortage
    Areas in the country. Many rural and disadvantaged populations depend
    on the health professionals trained by these programs at their only
    source of health care. For example, without the practicing family
    physicians who are currently in place, an additional 1,332 of the
    United States' 1,082 urban and rural counties would qualify for
    designation as primary care Health Professions Shortage Areas.
        Title VII programs have had a significant impact in reducing the
    Nation's Health Professions Shortage Areas. Indeed, a 1999 study
    estimated that if funding for Title VII programs were doubled the
    effect would be to eliminate the Nation's Health Professions Shortage
    Areas in as little as 6 years. [Politzer, RM, Hardwick, KC, Cultice,
    JM, Bazell, C. ``Eliminating Primary Care Health Professions Shortage
    Areas: The Impact of Title VII Generalist Physician Education,'' The
    Journal of Rural Health, 1999: 15(1): 11-19].
        A study by the Robert Graham Center showed that receipt of Title
    VII family medicine grants by medical schools produced more family
    physicians and more primary care doctors serving rural areas and health
    professions shortage areas. Over 69 percent of Title VII funded
    internal medicine graduates practice primary care after graduation.
    This rate is nearly twice that of programs not receiving Title VII
    funding.
        Among the programs within these clusters that have been especially
    important to enhancing osteopathic medical schools' ability to train
    the highest quality physicians are: General Internal Medicine
    Residencies; General Pediatric Residencies; Family Medicine Training;
    Preventive Medicine Residencies; Area Health Education Centers (AHECs);
    Health Education and Training Centers (HETCs); Health Careers
    Opportunities Programs (HCOP); and Centers of Excellence (COE)
    programs.
        In addition, three Title VII programs offer interdisciplinary
    training for all health professions. The Geriatric Education Centers
    (GEC) program provides grants to support collaborative arrangements
    involving several health professions schools and health facilities that
    provide training in the diagnosis, treatment and prevention of disease
    and other health concerns of the elderly. The Geriatric Training
    program for physicians, dentists, and mental health professionals (GT)
    provides for these professionals who plan to become faculty members.
    The Geriatric Academic Career Awards (GACA) support the career
    development of geriatricians in junior faculty positions who are
    committed to an academic career of teaching clinical geriatrics in
    medical schools.
        Accordingly, Mr. Chairman and Members of the subcommittee, AACOM
    recommends that the fiscal year 2007 funding levels for Titles VII
    Health Professions Education and VIII Nursing Education be
    $299,552,000. You will note that this is the same level as the Congress
    approved for fiscal year 2005.
        AACOM also strongly urges continuation of funding for the Council
    on Graduate Medical Education (COGME). Since its inception, COGME's
    diverse membership has given the health policy community an opportunity
    to discuss national workforce issues. The fifteen formal reports and
    multiple ancillary materials provided by COGME have offered important
    findings and observations in the rapidly changing health care
    environment and have argued for a system of graduate medical education
    that develops a physician workforce to meet the healthcare needs of the
    American people.
        Some of the more significant recommendations include:
      --Community-based education with an emphasis on primary care;
      --Continued progress toward a more representative participation of
            minorities in medicine;
      --The development and maintenance of a workforce planning
            infrastructure to improve the understanding of supply, need and
            demand forces;
      --The development of Federal-State partnerships to further workforce
            planning; and
      --Encouragement and support for medical education and health care
            delivery programs that increase the flow of physicians to rural
            areas, with an emphasis on the smaller, more remote
            communities.
        In summary, Mr. Chairman and Members of the subcommittee, health
    profession education programs under Title VII are an essential part of
    the healthcare safety net for all Americans. We respectfully urge you
    to restore funding for these programs at the fiscal year 2005 level.
    Please contact me or Michael J. Dyer, AACOM's Vice President for
    Government Relations at (301) 968-4152 if you have any questions.
                                     ______

             Prepared Statement of the American Nurses Association
        The American Nurses Association (ANA) appreciates this opportunity
    to comment on fiscal year 2007 appropriations for nursing education,
    workforce development, and research programs. Founded in 1896, ANA is
    the only full-service national association representing registered
    nurses (RNs). Through our 54 constituent member associations, ANA
    represents RNs across the Nation in all practice settings.
        The ANA gratefully acknowledges this subcommittee's history of
    support for nursing education and research. We appreciate your
    continued recognition of the important role nurses play in the delivery
    of quality health care services. This testimony will give you an update
    on the status of the nursing shortage, its impact on the Nation, and
    the outlook for the future.
                           the nursing shortage today
        The nursing shortage is far from solved. Here are a few quick
    facts:
      --According to American Hospital Association's 2005 Workforce Survey,
            109,000 nurses are needed immediately to fill vacancies at our
            Nation's hospitals. In addition, 40 percent of the hospitals
            surveyed reported that RN recruitment was more difficult in
            2004 than in 2003.
      --The Bureau of Labor Statistics reported in February of this year
            that registered nursing will have remarkable job growth in the
            time period spanning 2004-2014. During this time decade, the
            health care system will require more than 1.2 million new
            nurses.
      --The report issued by the Division of Nursing at the Health
            Resources and Services Administration in 2002 projects that,
            absent aggressive intervention, the supply of nurses in America
            will fall 29 percent below requirements by the year 2020.
        This growing nursing shortage is having a detrimental impact on the
    entire health care system. Numerous studies have shown that nursing
    shortages contribute to medical errors, poor patient outcomes, and
    increased mortality rates. A study published in the January/February
    2006 issue of Health Affairs showed that hospitals could avoid 6,700
    deaths per year by increasing the amount of RN care provided to their
    patients. This study, ``Nurse Staffing in Hospitals: Is There a
    Business Case for Quality?'' by Jack Needleman, Peter Buerhaus, Maureen
    Stewart, Katya Zelevinsky and Soeren Mattke, also revealed that
    hospitals could avoid 4 million hours worth of inpatient care by
    avoiding the complications associated with a shortage of RN care.
        This study built upon research published in the New England Journal
    of Medicine in May 2002. The 2002 research was based on a review of
    more than 6 million patients. It found that increased hours of RN care
    were associated with fewer ``failure-to-rescue'' deaths in hospitalized
    patients resulting from pneumonia, shock or cardiac arrest, upper
    gastrointestinal bleeding, sepsis and deep venous thrombosis.
        Research published in the October 23, 2002 Journal of the American
    Medical Association also demonstrated that more nurses at the bedside
    could save thousands of patient lives each year. In reviewing more than
    232,000 surgical patients at 168 hospitals, researchers from the
    University of Pennsylvania concluded that a patient's overall risk of
    death rose roughly 7 percent for each additional patient above four
    added to a nurse's workload.
        A Joint Commission on the Accreditation of Healthcare Organizations
    (JCAHO) study published in 2002 shows that the shortage of nurses
    contributes to nearly a quarter of all unexpected incidents that kill
    or injure hospitalized patients.
              the impact on preparedness and military health care
        This growing nursing shortage has effects well beyond traditional
    domestic health care. RNs are integral to everything from pandemic flu
    management, to terrorism preparedness, to veterans' health delivery, to
    disaster response. In the event of a terrorist attack or pandemic flu
    outbreak, nurses will be needed to evaluate patients, administer
    vaccines and medications, perform disease surveillance, and to train
    non-licensed staff. The GAO has repeatedly reported that the nursing
    shortage is complicating efforts at the State and local level to
    implement pandemic flu and bioterrorism preparedness efforts (see: GAO:
    03-654T, 03-769T, 04-458T, 05-760T, 05-863T). For instance, in May
    2003, the GAO testified, ``Five of the [seven] States we visited
    reported shortages of hospital medical staff, including nurses and
    physicians, necessary to increase response capacity in an emergency.''
    (GAO-03-769T).
        The nursing shortage is also stressing military health care
    delivery. The Army, Navy, and Air Force are offering new lucrative RN
    recruitment packages that include large sign-on bonuses, generous
    scholarships, and loan forgiveness packages. Yet, neither the Army nor
    the Air Force has met their active service nurse recruitment goals
    since the 1990s. On May 10, 2005, Army leaders warned the Senate
    Appropriations Committee that they were experiencing a 30 percent
    shortage of certified registered nurse anesthetists. In 2004, the Navy
    Nurse Corps recruitment fell 32 percent below target. Because the
    military holds the vast majority of its health care assets in the
    reserves, the reserve activation has been particularly hard on nursing.
    This ongoing nurse shortage is creating real concerns about the ability
    to deliver needed health care to today's military.
                     nursing workforce development programs
        Federal support for the Nursing Workforce Development Programs
    contained in Title VIII of the Public Health Service Act is
    unduplicated and essential. The 107th Congress recognized the
    detrimental impact of the developing nursing shortage and passed the
    Nurse Reinvestment Act (Public Law 107-205). This law improved the
    programs of Title VIII to meet the unique characteristics of today's
    shortage. This achievement holds the promise of recruiting new nurses
    into the profession, promoting career advancement within nursing and
    improving patient care delivery. This promise will not be met, however,
    without a significant investment.
        In fiscal year 2005, this subcommittee allocated $151 million in
    funding for Title VIII which supported 52,795 individual grants. In
    fiscal year 2006, you allocated $150 million for Title VIII. While ANA
    applauds your ongoing recognition for these nursing workforce
    development programs, we also recognize that these funding levels fail
    to meet the challenges of the growing nursing shortage. For instance,
    in fiscal year 2005, 4,465 RNs applied for the Nurse Education Loan
    Repayment Program (described fully below). Due to lack of funding, a
    mere 803 (18 percent) were approved.
        ANA strongly urges you to increase funding for Title VIII programs
    by at least $25 million to a total of $175 million in fiscal year 2007.
    This funding amount has been supported by a bipartisan group of 54
    Senators in a Dear Colleague sent to this subcommittee. The nursing
    shortage and its impact on the health care of the Nation demand this
    continued investment.
        In 1974, this subcommittee invested $153.6 million Title VIII.
    Inflated to today's dollars, this appropriation would equal $622.5
    million, more than four times the current appropriation. Certainly,
    today's shortage is more dire and systemic than that of the 1970's; it
    deserves an equivalent response.
        Title VIII includes the following program areas:
        Nursing Education Loan Repayment Program & Scholarships.--This line
    item is comprised of the Nurse Education Loan Repayment Program (NELRP)
    and the Nursing Scholarship Program (NSP), the Secretary of HHS has the
    authority to allocate funds between the two areas. In fiscal year 2006,
    the Nurse Education Loan Repayment Program and Scholarships received
    $31 million.
        The NELRP repays up to 85 percent of a RN's student loans in return
    for full-time practice in a facility with a critical nursing shortage.
    The NELRP nurse is required to work for at least 2 years in a
    designated facility during which time the NELRP repays 60 percent of
    the RN's student loan balance. If the nurse applies and is accepted for
    a third year, an additional 25 percent of the loan is repaid.
        The NELRP boasts a proven track record of delivering nurses to
    facilities hardest hit by the nursing shortage. HRSA has given NELRP
    funding preference to RNs who work in disproportionate share hospitals,
    skilled nursing facilities, federally-designated health centers, and
    departments of public health. However, lack of funding has hindered the
    full implementation of this program. As stated above, in fiscal year
    2005, 82 percent of the nurses willing to immediately begin practicing
    in facilities hardest hit by the shortage were turned away from this
    program due to lack of funding.
        The NSP offers funds to nursing students who, upon graduation,
    agree to work for at least 2 years in a health care facility with a
    critical shortage of nurses. Preference is given to students with the
    greatest financial need. Like the loan repayment program, the NSP has
    been stunted by a lack of funding. In fiscal year 2005, HRSA received
    6,563 applications for the nursing scholarship. Due to lack of funding,
    a mere 217 scholarships were awarded. Therefore, 97 percent of nursing
    students willing to work in facilities with a critical shortage were
    denied access to this program.
        Nurse Faculty Loan Program.--This program establishes a loan
    repayment fund within schools of nursing to increase the number of
    qualified nurse faculty. Nurses may use these funds to pursue a
    master's or doctoral degree. They must agree to teach at a school of
    nursing in exchange for cancellation of up to 85 percent of their
    educational loans, plus interest, over a 4-year period. Loans can cover
    the costs of tuition, fees, books, laboratory expenses, and other
    reasonable education expenses. In fiscal year 2006, this program
    received $4.8 million.
        This program is vital given the critical shortage of nursing
    faculty. America's schools of nursing cannot increase their capacity
    without an influx of new teaching staff. Last year, schools of nursing
    were forced to turn away tens of thousands of qualified applicants due
    largely to the lack of faculty. In fiscal year 2005, HRSA awarded 66
    nurse faculty loan repayments.
        Nurse Education, Practice, and Retention Grants.--This section is
    comprised of many programs designed to support entry-level nursing
    education and to enhance nursing practice. In fiscal year 2005, this
    line item supported 10,490 nursing students. All together, the Nurse
    Education, Practice, and Retention Grants received $37.3 million in
    fiscal year 2006.
        The education grants are designed to expand enrollments in
    baccalaureate nursing programs; develop internship and residency
    programs to enhance mentoring and specialty training, and; provide new
    technologies in education including distance learning.
        Practice grants currently support 18 Nurse Managed Clinics that
    provide primary health care in medically underserved communities;
    provide nursing students the skills necessary to practice in existing
    and emerging health systems, and; develop cultural competencies.
        Retention grant areas include career ladders and improved patient
    care delivery systems. The career ladders program supports education
    programs that assist individuals in obtaining the educational
    foundation required to enter the profession, and to promote career
    advancement within nursing. Enhancing patient care delivery system
    grants are designed to improve the nursing work environment. These
    grants help facilities to enhance collaboration and communication among
    nurses and other health care professionals, and to promote nurse
    involvement in the organizational and clinical decision-making
    processes of a health care facility. These best practices for nurse
    administration have been identified by the American Nurse Credentialing
    Center's Magnet Recognition Program . These practices have been shown
    to double nurse retention rates, increase nurse satisfaction, and
    improve patient care.
        Nursing Workforce Diversity.--This program provides funds to
    enhance diversity in nursing education and practice. It supports
    projects to increase nursing education opportunities for individuals
    from disadvantaged backgrounds--including racial and ethnic minorities,
    as well as individuals who are economically disadvantaged. In fiscal
    year 2006, these programs received $16 million.
        Racial and ethnic minorities currently comprise more than 25
    percent of the Nation's population and will comprise nearly 40 percent
    by the year 2020. However, only 10.6 percent of the RNs in the United
    States are self-identified as one or more of the racial and ethnic
    minority groups. Increasing cultural and ethnic diversity in nursing
    helps to address the prevention, treatment, and rehabilitation needs of
    an increasingly diverse population. For fiscal year 2005, HRSA received
    191 submissions for nursing workforce diversity grants. HRSA was able
    to fund 97 (50 percent of applications).
        Advanced Nurse Education.--Advanced practice registered nurses
    (APRNs) are nurses who have attained advanced expertise in the clinical
    management of health conditions. Typically, an APRN holds a master's
    degree with advanced didactic and clinical preparation beyond that of
    the RN. Most have practice experience as RNs prior to entering graduate
    school. Practice areas include, but are not limited to: anesthesiology,
    family medicine, gerontology, pediatrics, psychiatry, midwifery,
    neonatology, and women's & adult health. Title VIII grants have
    supported the development of virtually all initial State and regional
    outreach models using distance learning methodologies to provide
    advanced study opportunities for nurses in rural and remote areas. In
    fiscal year 2006, these programs received $57 million.
        These grants also provide traineeships for masters and doctoral
    students. Title VIII funds more than 60 percent of U.S. nurse
    practitioner education programs and assists 83 percent of nurse
    midwifery programs. Over 45 percent of the nurse anesthesia graduates
    supported by this program go on to practice in medically underserved
    communities. Many provide care to minority or disadvantaged patients.
    In fiscal year 2005, HRSA funded 81 advanced education nursing grants
    (89 percent of applications), 347 advanced education nursing
    traineeships (every application), and 75 nurse anesthetist traineeships
    (every application).
        Comprehensive Geriatric Education Grants.--This authority awards
    grants to train and educate nurses in providing health care to the
    elderly. Funds are used to train individuals who provide direct care
    for the elderly, to develop and disseminate geriatric nursing
    curriculum, to train faculty members in geriatrics, and to provide
    continuing education to nurses who provide geriatric care. In fiscal
    year 2006, these grants received $3.4 million.
        The growing number of elderly Americans and the impending health
    care needs of the baby boom generation make this program critically
    important. In fiscal year 2005, HRSA received 43 applications for
    comprehensive geriatric education grants. HRSA continued 17 previously
    awarded grants and awarded 11 new ones (65 percent of applications).
                 national institute of nursing research (ninr)
        ANA also urges the subcommittee to increase funding for the NINR,
    one of the institutes at the National Institutes of Health (NIH). This
    research is integral to improving the effectiveness of nursing care.
    Advances in nursing care arising from behavioral and biomedical
    research have shown excellent progress in reducing health care costs.
    Research programs supported by NINR address a number of critical public
    health and patient care questions. The research is driven by real and
    immediate problems currently facing patients and their families.
        Recent studies have illuminated the impact of placing a patient in
    long term care on the patient's family caregiver, the impact of
    maternal obesity prior to pregnancy on childhood weight problems, the
    difference in heart attack symptoms in women versus men, the most
    effective means to prevent infectious diseases in inner city
    households, and the incidence and risk factors for uterine rupture in
    pregnancies following cesarean section. NINR is leading the NIH
    research on end-of-life and palliative care. NINR is also the lowest
    funded institute at NIH. In fiscal year 2006, NINR received $137.3
    million. ANA recommends $150 million in fiscal year 2007 NINR funding.
                                   conclusion
        While ANA appreciates the continued support of this subcommittee,
    we are concerned that Title VIII funding levels have not been
    sufficient to address the growing nursing shortage. The nursing
    shortage will continue to worsen if significant investments are not
    made. Recent efforts have shown that aggressive and innovative
    recruitment efforts can help avert the impending nursing shortage--if
    they are adequately funded.
        ANA asks you to meet today's shortage with a relatively modest
    investment of $175 million in Title VIII programs. Additionally, an
    investment of $150 million in the NINR will help assure that these
    nurses are equipped with the information needed to provide the best
    care possible.
                                     ______

          Prepared Statement of Americans for Nursing Shortage Relief
        The undersigned organizations of the ANSR (Americans for Nursing
    Shortage Relief) Alliance greatly appreciate the opportunity to submit
    written testimony regarding fiscal year 2007 appropriations for Title
    VIII--Nursing Workforce Development Programs. The ANSR Alliance is
    comprised of fifty-one national nursing organizations that united in
    2001 to identify and promote creative strategies for addressing the
    nursing and nurse faculty shortages, including passage of the Nurse
    Reinvestment Act of 2002--an important first step in increasing the
    number of qualified nurses in America.
        ANSR stands ready to work with policymakers to advance programs and
    policies that will sustain and strengthen our Nation's nursing
    workforce. To ensure that our Nation has a sufficient and adequately
    prepared nursing workforce to provide quality care to every American
    well into the 21st century, ANSR advocates for the following:
      --At least $175 million in funding for Nursing Workforce Development
            Programs under Title VIII of the Public Health Service Act at
            the Health Resources and Services Administration (HRSA) in
            fiscal year 2007.
                              the nursing shortage
        Nurses play a critical role in this Nation's health care system.
    With an estimated 2.9 million licensed registered and advanced practice
    registered nurses (RNs and APRNs), nurses represent the largest
    occupational group of health care workers and provide patient care in
    virtually all locations in which health care is delivered. This coupled
    by their scope of practice areas make the nursing shortage an even more
    interesting challenge. Some facts to consider:
      --The nursing workforce is aging. In 1980, 26 percent of RNs were
            under the age of 30. Today, approximately 8 percent of RNs are
            under the age of 30 with the average nurse 46.8 years of age;
      --Approximately half of the RN workforce is expected to reach
            retirement age within the next 10 to 15 years. The average age
            of new RN graduates is almost 30 years.
      --The Bureau of Labor Statistics report (December, 2005) projected
            that registered nursing would create the second largest number
            of new jobs among all occupations within 9 years. In addition,
            employment of registered nurses is expected to grow much faster
            than average for all occupations through 2014. It is
            anticipated that approximately 703,000 additional jobs, for a
            total of 3,096,000, will be available for RNs by this date.
      --The national nursing shortage also is affecting our Nation's 7.6
            million veterans who receive care through the 1,300 Veterans
            Administration (VA) health care facilities;
      --Nearly 1,800 faculty members leave their positions every year due
            to factors of retirement or higher wages earned as a staff
            nurse. Fewer than 400 faculty candidates receive their doctoral
            degrees each year; and,
      --The number of full-time nurse faculty required to ``fill the
            nursing gap'' is approximately 40,000. Currently, the National
            League for Nursing estimates that there fewer than 10,000 full-
            time faculty members in the system.
          the nursing supply impacts america's emergency preparedness
        Nurses play a critical role as front-line, first-responders. When
    word of the devastation caused by Hurricanes Katrina and Rita spread,
    nurses across the country immediately volunteered in American Red Cross
    shelters, medical clinics, and hospitals throughout that area. Nurse
    midwives delivered babies in airplane hangars, and nurses trained in
    geriatric care assisted in caring for those evacuated from the comforts
    of their homes, assisted living facilities or nursing homes. Nurse
    practitioners diligently staffed temporary and permanent health care
    clinics to provide needed primary care to hurricane victims. In
    addition, many nurses realized their role in the comfort and support
    they offered as they listened to survivors recount their stories of
    pain and tragedy.
        These stories seem particularly relevant in demonstrating the
    contributions that nurses provide during tragedies, and should
    illustrate the need to ensure an adequate supply of all types of nurses
    in all parts of the country. Unless steps are taken now, the Nation's
    ability to respond to disasters will be further hindered by the growing
    nursing shortage. An investment in the nursing workforce is a step in
    the right direction to bolster our public health infrastructure and
    increase our Nation's health care readiness and emergency response
    capabilities.
                      the desperate need for nurse faculty
        After years of declining interest, the nursing profession is seeing
    the opposite occur. Many Americans have come to find nursing an
    attractive career because of job security, salary levels, and the
    opportunity to help others. However, the common theme among prospective
    nursing students is that due to a lack of a sufficient number of
    faculty they can face waiting periods of up to 3 years before
    matriculating. When all nursing programs are considered, the number of
    qualified applications turned away during the 2004-2005 academic year
    was estimated to be more than 147,000 by the National League for
    Nursing. Without sufficient support for current nurse faculty and
    adequate incentives to encourage more nurses to become faculty, nursing
    schools will fail to have the teaching infrastructure necessary to
    educate and train the next generation of nurses that the Nation so
    desperately needs.
                              the funding reality
        Enacted in 2002, the Nurse Reinvestment Act included new and
    expanded initiatives, including loan forgiveness, scholarships, career
    ladder opportunities, and public service announcements to advance
    nursing as a career. Despite the enactment of this critical measure,
    HRSA fails to have the resources necessary to meet the current and
    growing demands for our Nation's nursing workforce. For example, in
    fiscal year 2003, HRSA received 8,321 applications for the Nurse
    Education Loan Repayment Program but only had the funds to award 7
    percent (602) of all applications. Also in fiscal year 2003, HRSA
    received 4,512 applications for the Nursing Scholarship Program but
    only had funding to support a mere 2 percent (94) of all applications.
        The ANSR Alliance strongly urges this subcommittee to provide a
    minimum of $17,505 million in fiscal year 2007 to fund Title VIII--
    Nursing Workforce Development Programs. This level of investment will
    help leverage the HRSA resources to fund a higher rate of Nurse
    Education Loan Repayment and Nursing Scholarship applications, as well
    as implement other essential endeavors to sustain and boost our
    Nation's nursing workforce.
                                    summary

    ----------------------------------------------------------------------------------------------------------------
                                                                                   President's
                       Programmatic area                     Final fiscal year    budget fiscal      ANSR's request
                                                                    2006            year 2007
    ----------------------------------------------------------------------------------------------------------------
    Title VIII: Nurse Workforce Development Programs at           $149,000,000       $150,000,000       $175,000,000
     HRSA..................................................
    ----------------------------------------------------------------------------------------------------------------

                          ansr alliance organizations
        Academy of Medical-Surgical Nurses; American Academy of Ambulatory
    Care Nursing; American Academy of Nurse Practitioners; American
    Association of Critical-Care Nurses; American Association of Nurse
    Anesthetists; American Association of Occupational Health Nurses, Inc.;
    American College of Nurse-Midwives; American Organization of Nurse
    Executives; American Society for Pain Management Nursing; American
    Society of PeriAnesthesia Nurses; American Society of Plastic Surgical
    Nurses; Association of periOperative Registered Nurses; Association of
    Rehabilitation Nurses; Association of State and Territorial Directors
    of Nursing; Association of Women's Health, Obstetric and Neonatal
    Nurses; Dermatology Nurses' Association; Developmental Disabilities
    Nurses Association; Emergency Nurses Association; Infusion Nurses
    Society; National Association of Clinical Nurse Specialists; National
    Association of Nurse Massage Therapists; National Association of
    Orthopaedic Nurses; National Association of Pediatric Nurse
    Practitioners; National Association of School Nurses; National Black
    Nurses Association; National Conference of Gerontological Nurse
    Practitioners; National Council of State Boards of Nursing; National
    League for Nursing; National Student Nurses' Association; National
    Nursing Centers Consortium; National Organization of Nurse Practitioner
    Faculties; Nurses Organization of Veterans Affairs; Oncology Nursing
    Society; Society for Urologic Nurses and Associates; Society of Trauma
    Nurses; and Wound Ostomy Continence Nurses Society.
                                     ______

          Prepared Statement of the American Public Power Association
        The American Public Power Association (APPA) is the national
    service organization representing the interests of over 2,000 municipal
    and other State and locally owned utilities throughout the United
    States (all but Hawaii). Collectively, public power utilities deliver
    electricity to one of every seven electricity consumers (approximately
    43 million people), serving some of the Nation's largest cities.
    However, the vast majority of APPA's members serve communities with
    populations of 10,000 people or less.
        We appreciate the opportunity to submit this statement supporting
    funding for the Low-Income Home Energy Production Assistance Program
    (LIHEAP).
        APPA has consistently supported an increase in the authorization
    level for LIHEAP and supports the full authorization level of $5.1
    billion for fiscal year 2007 as enacted in the Energy Policy Act of
    2005.
        APPA is proud of the commitment that its members have made to their
    low-income customers. Many public power systems have low-income energy
    assistance programs based on community resources and needs. Our members
    realize the importance of having in place a well-designed low-income
    customer assistance program combined with energy efficiency and
    weatherization programs in order to help consumers minimize their
    energy bills and lower their requirements for assistance. While highly
    successful, these local initiatives must be coupled with a strong
    LIHEAP program to meet the growing needs of low-income customers. In
    the last several years, volatile home-heating oil and natural gas
    prices, severe winters, high utility bills as a result of dysfunctional
    wholesale electricity markets and the effects of the economic downturn
    have all contributed to an increased reliance on LIHEAP funds.
        Also when considering LIHEAP appropriations this year, we encourage
    the subcommittee to provide advanced funding for the program so that
    shortfalls do not occur in the winter months during the transition from
    one fiscal year to another. LIHEAP is one of the outstanding examples
    of a State-operated program with minimal requirements imposed by the
    Federal Government. Advanced funding for LIHEAP is critical to enabling
    States to optimally administer the program.
        Thank you again for this opportunity to relay our support for
    increased LIHEAP funding for fiscal year 2007. We look forward to a
    favorable outcome.
                                     ______

      Prepared Statement of the Association of Maternal and Child Health
                                    Programs
        The Association of Maternal and Child Health Programs (AMCHP) is a
    national, non-profit organization representing leaders of State public
    health programs for maternal and child health, including children with
    special health care needs, in all 50 States, the District of Columbia,
    and eight additional jurisdictions. Our members administer Title V
    Maternal and Child Health Services Block Grant funds to improve the
    health of mothers and children. We strongly urge you to restore funding
    for the MCH Block Grant to the fiscal year 2005 level of $724 million.
        First authorized in 1935, the MCH Block Grant provides for a wide
    range of health services and fosters prevention of disease and
    disabling conditions for over 32 million women and children across the
    country. Funds from the MCH Block Grant enable States to provide women
    with prenatal and postnatal care, screen newborns for genetic and
    hereditary conditions; support childhood immunizations; reduce infant
    mortality and developmentally handicapping conditions; and prevent
    childhood accidents and injuries. Block grant funding enables State
    agencies to tailor vital programs for women, children and families to
    the needs of each community, while ensuring that the programs meet
    national goals.
        Since the program's inception, it has evolved into a powerful
    Federal-State partnership. Each year, $600 million Federal are matched
    by over $5 billion in State funds for maternal and child health
    programs. These funds have enabled States to reach more than 80 percent
    of infants, 50 percent of pregnant women and 20 percent of children in
    the United States. Since 2000, the number of women and children served
    has increased by almost 5 million, an increase of 18 percent.
        In fiscal year 2006, $693 million was appropriated for the MCH
    Block Grant, $31 million below the fiscal year 2005 comparable
    appropriation. This loss of funds, as the number of women and children
    needing services continues to increase, will impact the ability of
    States to address areas of critical need. While President Bush
    recommended level funding for the MCH program in his budget request, he
    also recommended that Federal support for the Traumatic Brain Injury
    program, Universal Newborn Hearing Screening, Emergency Medical
    Services for Children and the Sickle Cell Anemia Demonstration Project
    be eliminated. If this recommendation were enacted without a
    commensurate increase in the block grant, States would be forced to
    shift MCH Block Grant funds away from other pressing health priorities
    to meet those addressed by these programs. We recommend that funding
    for these four valuable programs be restored, in addition to the
    restoration of the MCH Block Grant funding to the fiscal year 2005
    level.
        The flexibility of the block grant has allowed States to respond to
    emerging health issues that affect women and children, such as the
    rising infant mortality rates, particularly among minority populations,
    and the availability of newborn screening for a newly expanded range of
    diseases and disorders. Reducing the infant mortality rate is a goal of
    the MCH Block Grant program, which will be difficult to achieve if
    funding continues to erode. State maternal and child health programs
    coordinate newborn screening and follow-up services, activities to
    ensure that every infant born in this country receives screening tests
    that detect disorders that could result in death or permanent
    disabilities. The money spent on these screening programs saves lives,
    and preserves State and Federal Government dollars that would otherwise
    be spent on expensive, lifelong treatment and rehabilitative services
    for infants whose genetic disorders go undetected. Level funding of the
    MCH Block Grant will not allow States to meet the increasing demand for
    newborn screening services.
        Last year's budget cut has already had a real impact on State
    programs, threatening the quality and quantity of care these programs
    provide. The MCH Block Grant can not continue to do more with less.
    Consider the following descriptions of the impact these cuts are having
    at the State level:
      --In Iowa, the impact of the MCH Block Grant cut means that the State
            will not have the resources to address emerging public health
            issues, such as planning for a potential bird flu pandemic. It
            will, instead, be necessary to direct Title V resources toward
            continuing existing programs. Infant mental health, smoking
            cessation during pregnancy and obesity prevention programs will
            all be short-changed as a consequence.
      --Funding has been pulled from a large Healthy Communities Access
            Program project in Washoe County, Nevada because of this year's
            cuts just as it was making great inroads in systems development
            for access to care for low-income families in that county.
            Nevada has a community-based prenatal program that reached 600
            participants in its first year. Demand for services has tripled
            this year. Further cuts to the MCH Block Grant would
            necessitate cutting this program, so fewer pregnant women would
            be served. The MCH program has had to drop all its contracts
            with community coalitions to promote access to care, which has
            hampered the success of these activities.
      --Alabama lost $409,339 in block grant funding in fiscal year 2006.
            The Alabama MCH program has reduced staffing by attrition at
            both the central office and county office levels. Nursing and
            nursing assistants, administrative support, and epidemiology
            services and medical equipment and supplies have been affected.
      --In Washington State, reductions in the MCH Block grant, impact
            women and children by minimizing or eliminating local community
            activities. Many activities will either be eliminated or
            drastically scaled back, including early childhood programs,
            adolescent health care, mental health services, the Healthy
            Youth Survey, newborn hearing screening, and services for
            children with special health care needs. Multiple Federal cuts
            mean than many of the MCH partners will also be reducing
            efforts. With this reduction, Washington State will be moving
            back in time, not even maintaining the status quo.
      --In Michigan, cut backs in medical care and treatment for children
            with special health care needs will be necessary as a result of
            the $656,000 reduction in its allocation.
        The dramatic effects are not unique to Iowa, Nevada, Alabama,
    Washington State or Michigan, but affect all States and jurisdictions.
        AMCHP recognizes the fiscal restraints facing this subcommittee.
    Nevertheless, we can not stress enough what a dire situation MCH Block
    Grant cuts are creating, especially given the cuts in the Medicaid
    program and the fact that other safety net programs also face
    reductions. Title V programs play a valuable, complementary role to the
    SCHIP and Medicaid programs. As more women and children are forced out
    of the Medicaid program, they will turn to MCH programs to ensure that
    their health care needs are met. With increased demand for MCH Block
    Grant services, States will be forced to limit already stretched
    services to vulnerable populations.
        Our children are the future. Their needs should not be short-
    changed by budget limitations, but addressed effectively with adequate
    funding. The MCH Block Grant has a proven track record of effectiveness
    and supports health services for over 32 million Americans. We strongly
    urge you to restore funding for the MCH Block Grant to the fiscal year
    2005 level of $724 million.
                                     ______

     Prepared Statement of the Centers for Disease Control and Prevention
                                   Coalition
        The CDC Coalition is a nonpartisan coalition of more than 100
    groups committed to strengthening our Nation's prevention programs. Our
    mission is to ensure that health promotion and disease prevention are
    given top priority in Federal funding, to support a funding level for
    the Centers for Disease Control and Prevention (CDC) that enables it to
    carry out its prevention mission, and to assure an adequate translation
    of new research into effective State and local programs. Coalition
    member groups represent millions of public health workers, researchers,
    educators, and citizens served by CDC programs. We are grateful to be
    able to present our views to the subcommittee.
        The CDC Coalition continues to believe that Congress should support
    CDC as an agency--not just the individual programs that it funds. In
    the best judgment of the CDC Coalition--given the challenges and
    burdens of chronic disease, a potential influenza pandemic, terrorism,
    disaster preparedness, new and re-emerging infectious diseases and our
    many unmet public health needs and missed prevention opportunities--we
    believe the agency will require funding of at least $8.5 billion, plus
    sufficient funding to prepare the Nation against a potential influenza
    pandemic. This request reflects the support CDC will need to fulfill
    its core missions for fiscal year 2007, as well as funding for the
    Agency for Toxic Substances and Disease Registry and the Vaccines for
    Children program.
        The CDC Coalition appreciates the subcommittee's work over the
    years, including your recognition of the need to fund chronic disease
    prevention, infectious disease prevention and treatment, and
    environmental health programs at CDC. By translating research findings
    into effective intervention efforts, CDC has been a key source of
    funding for many of our State and local programs that aim to improve
    the health of communities. Perhaps more importantly, Federal funding
    through CDC provides the foundation for our State and local public
    health departments, supporting a trained workforce, laboratory capacity
    and public health education communications systems.
        CDC also serves as the command center for our Nation's public
    health defense system against emerging and reemerging infectious
    diseases. With the potential onset of a worldwide influenza pandemic,
    in addition to the many other natural and man-made threats that exist
    in the modern world, the CDC has become the Nation's--and the world's--
    expert resource and response center, coordinating communications and
    action and serving as the laboratory reference center. States and
    communities rely on CDC for accurate information and direction in a
    crisis or outbreak.
        Unfortunately, Congress cut overall CDC funding in fiscal year 2006
    for the first time in 25 years. And in fiscal year 2007, the President
    has proposed cutting CDC funding even more--more than 2 percent
    overall, and more than 4.5 percent to CDC's core programs. We are
    moving in the wrong direction, especially in these challenging times
    when public health is being asked to do more, not less. In light of the
    current workload placed on the public health service--in addition to
    the threat of emerging diseases such as the avian flu--it simply does
    not make any sense to cut the budget for CDC at a time when the threats
    to public health are so great. Funding public health outbreak by
    outbreak is not an effective way to ensure either preparedness or
    accountability. Until we are committed to a strong public health
    system, every crisis will force trade offs.
        CDC serves as the lead agency for bioterrorism preparedness and
    must receive sustained support for its preparedness programs in order
    for our Nation to meet future challenges. In the best judgment of CDC
    Coalition members, given the challenges of terrorism and disaster
    preparedness, and our many unmet public health needs and missed
    prevention opportunities, we support the proposed increase for anti-
    terrorism activities at CDC, including the increases for the Strategic
    National Stockpile and the new Botulinum Toxin Research funding.
    However, we strongly caution that the President's proposed level-
    funding of the State and local capacity grants continues to reflect a
    $95 million cut from fiscal year 2005 levels. We encourage the
    subcommittee to restore these cuts to ensure that our States and local
    communities can be prepared in the event of an act of terrorism.
        Heart disease remains the Nation's number one killer. In 2003,
    684,462 people died of heart disease (51 percent of them women),
    accounting for 28 percent of all U.S. deaths. Stroke is the third
    leading cause of death after heart disease and cancer, and is a leading
    cause of serious, long-term disability. In 2003, stroke killed 157,800
    people (61percent of them women), accounting for about 1 of every 15
    deaths. In 1998, the U.S. Congress provided funding for CDC to initiate
    a national, State-based heart disease and stroke prevention program
    with funding for eight States. Currently, 32 States and the District of
    Columbia are funded, 19 as capacity building programs and 14 as basic
    implementation programs. The CDC Coalition recommends $55 million for
    the Heart Disease and Stroke Prevention Program.
        The CDC funds proven programs addressing cancer prevention, early
    detection, and care. Cancer is the second most common cause of death in
    the United States. In 2006, about 1.4 million new cases of cancer will
    be diagnosed, and about 564,830 Americans--more than 1,500 people a
    day--are expected to die of the disease. The financial cost of cancer
    is also significant. According to the National Institutes of Health, in
    2005, the overall cost for cancer in the United States was nearly $210
    billion: $74 billion for direct medical costs, $17.5 billion for lost
    worker productivity due to illness, and $118.4 billion for lost worker
    productivity due to premature death.
        Among the ways the CDC is fighting cancer, it funds the National
    Breast and Cervical Cancer Early Detection Program that helps low-
    income, uninsured and medically underserved women gain access to
    lifesaving breast and cervical cancer screenings and provides a gateway
    to treatment upon diagnosis. CDC also funds grants to States to develop
    Comprehensive Cancer Control (CCC) plans, bringing together a broad
    partnership of public and private stakeholders to jointly set
    priorities and implement specific cancer prevention and control
    activities customized to address each State's particular needs. CDC
    also funds programs to raise awareness about colorectal, prostate,
    lung, ovarian and skin cancers, and the National Program of Cancer
    Registries, a critical registry for tracking cancer trends in all 50
    States. The CDC coalition recommends $427.5 million for the Cancer
    Prevention and Control activities of the CDC.
        Although more than 18 million Americans have diabetes, 5.2 million
    cases are undiagnosed. From 1980--2002, the number of people with
    diabetes in the United States more than doubled, from 5.8 million to
    13.3 million. Each year, 12,000--24,000 people with diabetes become
    blind, more than 42,800 develop kidney failure, and about 82,000 have
    leg, foot, or toe amputations. Preventive care such as routine eye and
    foot examinations, self-monitoring of blood glucose, and glycemic
    control could reduce these numbers. Without additional funds, most
    States will not be able to create programs based on these new data.
    States also will continue to need CDC funding for diabetes control
    programs that seek to reduce the complications associated with
    diabetes.
        Over the last 25 years, obesity rates have doubled among adults and
    children, and tripled in teens. Obesity, diet and inactivity are cross-
    cutting risk factors that contribute significantly to heart disease,
    cancer, stroke and diabetes. The CDC funds programs to encourage the
    consumption of fruits and vegetables, to get sufficient exercise, and
    to develop other habits of healthy nutrition and activity. The CDC
    Coalition recommends $70 million for CDC's Division of Nutrition and
    Physical Activity.
        Arthritis and chronic joint symptoms affect nearly 66 million
    Americans and they are the Nation's leading cause of disability. Early
    diagnosis and appropriate management of the disease can prevent much of
    the pain and disability associated it. The CDC Coalition recommends
    $14.4 million for the arthritis programs of the CDC.
        More than 400,000 people die prematurely every year due to tobacco
    use. The CDC's tobacco control efforts seek to prevent tobacco addition
    in the first place, as well as help those who want to quit. The CDC
    Coalition recommends $145 million for the CDC's tobacco control
    programs.
        Each day more than 4,000 young people try their first cigarette. At
    the same time, daily participation in high school physical education
    classes dropped from 42 percent in 1991 to 32 percent in 2001. Almost
    80 percent of young people do not eat the recommended number of
    servings of fruits and vegetables, while nearly 30 percent of young
    people are overweight or at risk of becoming overweight. And every
    year, almost 800,000 adolescents become pregnant and about 3 million
    become infected with a sexually transmitted disease. School health
    programs are one of the most efficient means of correcting these
    problems, shaping our Nation's future health, education, and social
    well-being. The CDC Coalition requests $34 million for CDC's Division
    of Adolescent and School Health (DASH) Coordinated School Health
    Program and $41.8 million for DASH's HIV prevention education programs.
        Public health programs delivered at the State and local level
    should be flexible to respond to State and local needs. Within an
    otherwise-categorical funding construct, the Preventive Health and
    Health Services Block Grant is the only source of flexible dollars for
    States and localities to address their unique public health needs. The
    track record of positive public health outcomes from Prevention Block
    Grant programs is strong, yet so many requests go unfunded. However,
    the President's budget proposes the elimination of the Preventive
    Health and Health Services Block Grant--again. We appreciate the work
    of the subcommittee to at least partially restore the fiscal year 2006
    elimination of the Block Grant. Nevertheless, the $20 million cut to
    the Block Grant in fiscal year 2006 reduces the States' ability to
    tailor Federal public health dollars to their specific needs. As States
    use their Prevention Block Grant dollars to address high priority needs
    such as emerging and chronic diseases, child safety seat programs,
    suicide prevention, smoke detector distribution and fire safety
    programs, adult immunization, oral health, worksite wellness,
    infectious disease outbreaks, food safety, emergency medical services,
    safe drinking water, and surveillance needs--we can scarcely understand
    why the Prevention Block Grant should be eliminated. We encourage the
    subcommittee to restore the cuts and fund the Prevention Block Grant at
    $132 million.
        Much of CDC's work in chronic disease prevention and health
    promotion is guided by its prevention research activities. Prevention
    research considers the factors associated with illness, disability, and
    injury, such as lifestyles or exposure to environmental toxins, and the
    best ways to address these factors and thereby promote health. By
    answering these questions, prevention research links biomedical
    research, which focuses on human physiology and disease treatment, to
    policies and public health interventions that promote wellness and
    reduce the need for treatment.
        CDC provides national leadership in helping control the HIV
    epidemic by working with community, State, national, and international
    partners in surveillance, research, prevention and evaluation
    activities. The CDC estimates that up to 1,185,000 Americans are living
    with HIV, one-quarter of whom are unaware of their infection. Also, the
    number of people living with HIV is increasing, as new drug therapies
    are keeping HIV-infected persons healthy longer and dramatically
    reducing the death rate. Prevention of HIV transmission is our best
    defense against the AIDS epidemic that has already killed over 500,000
    U.S. citizens and is devastating the populations of nations around the
    globe, and CDC's HIV prevention efforts must be expanded. The CDC
    Coalition recommends that a total of $1.05 billion be appropriated to
    the Division of HIV Prevention.
        The United States has the highest sexually transmitted diseases
    (STD) rates in the industrialized world. More than 18 million people
    contract STDs each year. In 1 year, our Nation spends over $8.4 billion
    to treat the symptoms and consequences of STDs. Elimination of STDs,
    especially syphilis, is now within our grasp. These welcome
    opportunities, if adequately funded now, will save millions in annual
    health care costs in the future. Untreated STDs contribute to infant
    mortality, infertility, and cervical cancer. State and local STD
    control programs depend heavily on CDC funding for their operational
    support.
        CDC conducts the National Health and Nutrition Examination Survey
    (NHANES), the only national source of objective health data to provide
    accurate estimates of diagnosed and undiagnosed medical conditions in
    the population. NHANES is a unique collaboration between CDC, the
    National Institutes of Health (NIH), and others to obtain data for
    biomedical research, public health, tracking of health indicators, and
    policy development. Through physical examinations, clinical and
    laboratory tests, and interviews, NHANES assesses the health status of
    adults and children in the United States. Mobile exam centers travel
    throughout the country to collect data on chronic conditions,
    nutritional status, medical risk factors (e.g., high cholesterol level,
    obesity, high blood pressure), dental health, vision, illicit drug use,
    blood lead levels, food safety, and other factors that are not possible
    to assess by use of interviews alone. Findings from this survey are
    essential for determining rates of major diseases and health conditions
    and developing public health policies and prevention interventions.
        We must address the growing disparity in the health of racial and
    ethnic minorities. CDC's REACH 2010 Demonstration Program, Racial and
    Ethnic Approaches to Community Health (REACH), helps States address
    these serious disparities in infant mortality, breast and cervical
    cancer, cardiovascular disease, diabetes, HIV/AIDS and immunizations.
    We encourage the subcommittee to provide adequate funds for CDC's REACH
    program.
        The CDC Coalition is requesting an appropriation of $49.75 million
    for Steps to a HealthierUS (STEPS) program. Additional resources will
    allow for the creation of programs in more States. Furthermore, while
    the President's budget request includes $1.5 million to support the
    YMCA Pioneering Healthier Communities initiative, $3 million is needed
    to continue to expand this important effort. This would enable
    additional communities to participate in this initiative, to allow on-
    going training for communities and to support a Center for Community
    Health Advancement at the CDC to assist the YMCA and other communities
    undertaking healthy lifestyle initiatives to prevent and control
    obesity and chronic disease.
        CDC oversees immunization programs for children, adolescents and
    adults, and is a global partner in the ongoing effort to eradicate
    polio worldwide. The value of adult immunization programs to improve
    length and quality of life, and to save health care costs, is realized
    through a number of CDC programs, but there is much work to be done and
    a need for sound funding to achieve our goals. Influenza vaccination
    levels remain low for adults. Levels are substantially lower for
    pneumococcal vaccination and significant racial and ethnic disparities
    in vaccination levels persist among the elderly. Childhood immunization
    programs at CDC also need a funding boost, to ensure sufficient
    purchase and delivery of the varicella and pneumococcal vaccines. In
    addition, developing functional immunization registries in all States
    will be less costly in the long run than maintaining the incomplete
    systems currently in place. The CDC Coalition requests $802.4 million
    for the National Immunization Program at CDC.
        Injuries are the leading cause of death in the United States for
    people ages 1-34. Of all injuries, those to the brain are most likely
    to result in death or permanent disability. Each year more than 50,000
    people die as a result of a brain injury and as many as 90,000 others
    are left with a long-term disability. A traumatic brain injury (TBI) is
    defined as a blow or jolt to the head or a penetrating head injury that
    disrupts the function of the brain. The Traumatic Brain Injury Act is
    the Nation's only law that was specifically designed to respond to this
    public health crisis. The Institute of Medicine reported this month
    that this law has been effective in addressing a wide variety of gaps
    in service system development. The CDC Coalition requests that the
    subcommittee restore $30 million in appropriations for TBI programs at
    CDC and at HRSA, which President Bush zeroed out. The monies would be
    allocated as follows: CDC--$9 million; HRSA State Grant Program--$15
    million; and HRSA Protection and Advocacy program--$6 million.
        Injury at work remains a leading cause of death and disability
    among U.S. workers. During the period from 1980 through 1995, at least
    93,338 workers in the United States died as a result of injuries
    suffered on the job, for an average of about 16 deaths per day. The
    Bureau of Labor Statistics (BLS) at the Department of Labor has
    identified 5,915 workplace deaths from acute traumatic injury in 2000.
    BLS also estimates that 5.7 million injuries to workers occurred in
    1997 alone; while NIOSH estimates that about 3.6 million occupational
    injuries were serious enough to be treated in hospital emergency rooms
    in 1998. The injury prevention and workforce protection initiatives of
    NIOSH need continued support.
        Of the 4 million babies born each year in the United States, 3
    percent are born with one or more birth defects. Birth defects are the
    leading cause of infant mortality, accounting for more than 20 percent
    of all infant deaths. Children with birth defects who survive often
    experience lifelong physical and mental disabilities. An estimated 54
    million people in the United States currently live with a disability,
    and 17 percent of children under the age of 18 have a developmental
    disability. Direct and indirect costs associated with disability exceed
    $300 billion.
        Created by the Children's Health Act of 2000 (Public Law 106-310),
    the National Center on Birth Defects and Developmental Disabilities
    (NCBDDD) at CDC conducts programs to protect and improve the health of
    children and adults by preventing birth defects and developmental
    disabilities; promoting optimal child development and health and
    wellness among children and adults with disabilities. We encourage the
    subcommittee to provide at least $135 million in fiscal year 2007
    funding for the NCBDDD. This would be a modest increase of $10 million
    and would further surveillance, research and prevention activities
    related to birth defects and developmental disabilities and improve the
    lives of those living with disabilities.
        We also encourage the subcommittee to provide $10 million for CDC's
    Environmental Public Health Services Branch to revitalize environmental
    public health services at the national, State, and local level. As with
    the public health workforce, the environmental health workforce is
    declining. Furthermore, the agencies that carry out these services are
    fragmented and their resources are stretched. These services are the
    backbone of public health and are essential to protecting and ensuring
    the health and well being of the American public from threats
    associated with West Nile virus, terrorism, E. coli and lead in
    drinking water.
        We appreciate the subcommittee's hard work in advocating for CDC
    programs in a climate of competing priorities. We encourage you to
    consider our request for $8.5 billion, plus sufficient funding to
    prepare for a possible influenza pandemic, for CDC in fiscal year 2007.
                                     ______

             Prepared Statement of the College of New Rochelle, NY
        Mr. Chairman and Members of the subcommittee, on behalf of The
    College of New Rochelle (CNR), and the thousands of New York City
    metropolitan area residents impacted by our programs each year, I am
    grateful for the opportunity to submit testimony to your committee
    regarding our Center for Wellness project.
            the national health care crisis: a need for the project
        Government sources report that one of the most important issues
    currently facing American society is the health care crisis. Among the
    reasons cited are the escalating costs of health care, an increasing
    lack of access to health insurance among the poor and middle class, an
    aging population and a growing national shortage of qualified nurses
    and other health care providers.
        Recent data shows the following:
      --Out of some 40 million Americans who are informal care givers, an
            estimated 72 percent are women;
      --Women represent 71 percent of Americans age 85+, the fastest
            growing segment of the population;
      --Almost two-thirds of Americans are overweight or obese;
      --One in three Americans born in the year 2000 will develop Type 2
            diabetes;
      --Surveys indicate that 28 percent of high school girls think they
            are overweight; 60 percent report trying to lose weight; 8
            percent suffer from anorexia or bulimia;
      --More than half of all Americans get too little physical activity;
      --Some 45 million Americans have no health insurance; and
      --Over 1 million new and replacement nurses will be needed nationwide
            by 2020.
        One significant health care issue is the individual's lack of
    attention to participation in self-care. Government experts emphasize
    the importance of widespread public awareness of basic health habits
    and preventative care, as well as support for those seeking
    preventative assistance in making better health and lifestyle choices.
    In order to keep the crisis from increasing, the U.S. Department of
    Health and Human Services, through the Office of Disease Prevention and
    Health Promotion, has launched a national initiative, Healthy People
    2010. Through its School of Nursing, and programs such as Healthy
    Campus 2010, CNR has been participating actively in HHS initiatives for
    many years, developing local health education programs which benefit
    students and New York City metropolitan area residents, and which help
    address national goals.
        The Office of Disease Prevention and Health Promotion has
    identified ten major public health issues based on their causal
    relationship to serious or chronic illnesses. These are: insufficient
    physical activity, overweight and obesity, decreasing environmental
    quality, tobacco use, substance abuse, irresponsible sexual behavior,
    mental health disorders, injury and violence, immunization
    deficiencies, and lack of access to health care. People of all socio-
    economic backgrounds are susceptible; however, the risk factors are
    even greater among the poor, the elderly and the uninsured.
        Moreover, recent studies reveal that those most at risk for
    developing chronic and life-threatening conditions are African
    Americans, Hispanics, and Asians--populations largely represented in
    the New York metropolitan area where CNR has six campus locations
    serving 7,000 students and many local residents.
             the national nursing shortage: cnr's school of nursing
        Compounding the health care crisis is the critical and
    unprecedented nationwide shortage of nurses--one that is uniquely
    different from previous shortages. Among the causes cited for this
    growing problem are an aging nursing workforce, increased job
    opportunities for women in other fields, and fundamental changes in how
    and in what setting patients are treated. A compelling statistic is the
    average age of nurses which is now over 45. A significant percentage of
    nurses currently employed will most likely retire just as the baby boom
    generation reaches Medicare age.
        According to a recent Federal survey an estimated 1 million new and
    replacement nurses will be needed nationwide by 2020. Government
    leaders are stressing the urgency of embarking on a national agenda to
    encourage more students to choose nursing as a career. Among their
    recommendations are the creation of incentives to recruit new
    candidates to the profession, and the broad-scale development of
    creative approaches for the continuing preparation and retention of
    skilled nurses.
        CNR's School of Nursing (SON), founded in 1976, belongs to the
    National League for Nursing and is accredited by the Commission on
    Collegiate Nursing Education. The School is ideally poised to assume a
    leadership role in enacting the national recommendations cited above.
    In recent years, the School has been especially successful in
    recruiting students (including many from disadvantaged backgrounds) and
    in fostering a lifelong commitment to nursing careers. Enrollment in
    SON has increased by 25 percent over the past 2 years. At present,
    there are 669 students enrolled in SON: 580 in the baccalaureate
    program and 89 in the masters program. SON programs are addressing the
    shortage by creating initial student access to the nursing profession
    and also by providing a career ladder for nurses seeking to advance
    their careers. Five separate programs are offered:
      --Undergraduate program leading to a Bachelor of Science Degree in
            Nursing (BSN);
      --Programs of study for registered nurses seeking either a BSN or a
            Master of Science Degree;
      --BSN program for those holding degrees in other fields;
      --Graduate program with several tracks leading to an MS Degree in
            Nursing; and
      --Several post-Master certificate programs.
        A pivotal function of CNR's multi-faceted Center for Wellness
    project includes the building of a new state-of-the-art facility on the
    College's New Rochelle campus, providing space for nursing and health
    education classes and events. This will heighten the visibility of
    nurses as educators as a crucial part of the nursing profession
    throughout the New York City area and beyond. The new facility and its
    related health and wellness education programs also hold much promise
    for drawing a greater number of students to SON as well as providing
    expanded access and opportunity for nurses seeking to acquire
    additional professional skills and/or further their careers.
             the center for wellness at the college of new rochelle
        The proposed Center for Wellness will be a state-of-the-art multi-
    purpose facility at the College's main campus and will house Nursing
    programs, Physical Education, Health Education and Health Services
    programs. The faculty will create a comprehensive center for the
    development and delivery of a broad range of integrated health and
    wellness education programs. The program will include a variety of
    health and educational activities in an intergenerational fashion to
    involve students, employees, and members of the surrounding community.
    Health seminars will cover a wide variety of issues including parenting
    and women's issues, smoking, diabetes, heart disease, nutrition and
    weight issues, sex education and assault issues, drug abuse prevention
    and treatment, and wellness education. The School of Nursing will offer
    courses and workshops in wellness and disease prevention, not only
    through the curriculum in the School of Nursing, but also to the
    students, staff and faculty in Westchester and at the branch campuses.
    The integrated wellness program will be supplemented with fitness and
    education programs targeted to specific populations such as the New
    Rochelle School District, the Senior Center of New Rochelle and the
    United Hebrew Home.
        The programs at the Center for Wellness will provide access to
    timely information and help foster lifelong healthy lifestyle choices
    among students, faculty and staff at the main campus and throughout the
    five metropolitan New York communities where CNR has city campus
    locations. At these city campuses, CNR will give busy low-income adult
    students access to wellness promotion, health maintenance and fitness
    programs on campus. For example, the College is working with the New
    York City health education program ``Take Care New York'' to educate
    all of our students on the necessity of a healthy lifestyle. CNR will
    also use distance learning technology so that faculty and staff at its
    campuses can share their own expertise, as well as that of national
    experts, with CNR students and community members.
        The College of New Rochelle recognizes that preventative health
    care is vital to our Nation's future. This Center will position CNR as
    a model institution for the development and delivery of innovative
    health and wellness education. CNR believes that this holistic approach
    to wellness will serve as motivation for more students to enter the
    field of nursing and thus begin to alleviate the nursing shortage. The
    programs, adaptable to the needs of many different communities and
    populations, will be able to be replicated at other institutions
    regionally and nationally.
        The total cost to establish the Center for Wellness is estimated at
    $25 million. Through the support of the subcommittee, The College of
    New Rochelle received funding through the Labor, HHS and Education
    Appropriations Bill in the amount of $200,000 in 2005. CNR has utilized
    this funding for the development of wellness education programs that
    have benefited CNR students, middle school students, and senior
    citizens from the area surrounding the New Rochelle Campus. In fiscal
    year 2007, The College hopes that the subcommittee can fund our request
    of $2.7 million to construct and equip the Center.
                                     ______

               Prepared Statement of the Diabetes Care Coalition
        Mr. Chairman and members of the Committee, thank you for the
    invitation today to discuss how government, private industry and non-
    governmental agencies can form innovative partnerships to address the
    epidemic of uncontrolled diabetes in America. This raging epidemic is
    simply too great a challenge for any but a collective effort.
        I know this subcommittee has little ability to change the fiscal
    reality that you must produce an appropriations bill that, for a second
    consecutive year, must reduce spending under your jurisdiction by
    multiple billions of dollars. This fiscal reality does not change the
    fact that one out of every three people with diabetes will suffer a
    heart attack by age 40, every day 144 Americans with diabetes will go
    blind, every hour three people with diabetes will undergo an
    amputation, and every minute 20 people with diabetes undergo kidney
    dialysis. The sad fact is most of these and other complications of
    diabetes are preventable through known interventions. But, not everyone
    living with diabetes is aware of some of the simple things they can do
    to monitor their disease and prevent some of these terrible
    consequences.
        My entire career has been dedicated to improving the care of people
    with diabetes, through research into the causes of diabetes
    complications, and how to improve diabetes care. I have been President
    of the American Diabetes Association, a member of the Coalition I
    represent today, and the founding Chairman of the private-public
    partnership of the National Diabetes Education Program (NDEP), which
    was funded by the National Institutes of Health and the Centers for
    Disease Control and Prevention (CDC) to improve the care of Americans
    with diabetes. I am also the Medical Advisor to the Diabetes Care
    Coalition (DCC) on whose behalf I am speaking today.
        As Dr. Gerberding told the House of Representatives Appropriations
    Subcommittee on Labor, Health and Human Services, Education, and
    Related Agencies in March 2006, ``where we invest, we can make a
    difference''. I am here today to tell you that the DCC is committing
    significant private sector resources to mount a critical public
    awareness campaign aimed at improving the health of individuals with
    diabetes. We are initiating discussions with experts at the CDC, and
    are excited about the potential opportunity to develop an innovative
    partnership with this world-renown agency to leverage scarce Federal
    resources, and combine our efforts with theirs, to immediately begin to
    reduce the burden of this rapidly growing disease.
        In this difficult fiscal environment where we are seeing the CDC
    budget cut this year by hundreds of millions of dollars, and the
    President's proposal to cut it again by almost $200 million next year,
    we believe it is imperative to encourage creative solutions to reach
    the millions of Americans living with diabetes with information that
    can ultimately prevent heart attacks, strokes, blindness, amputations,
    and other complications of this disease. The DCC represents what is
    truly a creative solution to combat the problem of uncontrolled
    diabetes.
        The DCC was born out of a recognition by its various participants
    that Americans with diabetes lack a basic understanding of how best to
    control their disease to reduce their risk of complications like heart
    attacks and strokes. The DCC's pilot ``Know Your A1C'' campaign
    represents a novel approach to empower people with diabetes to take
    personal responsibility by working with their diabetes healthcare team
    to manage the disease.
        Personally, I am concerned that the Federal Government's commitment
    to battling the epidemic of uncontrolled diabetes is under-funded and
    potentially losing ground. Since 2003, the CDC estimates that the
    prevalence of diabetes in America increased 14 percent. Over 20.8
    million adult Americans live with diabetes today compared to 18.2
    million in 2003. While I recognize the limitations on the Federal
    budget and the tough choices that have to be made in this Committee
    every day, now is not the time to approve declining budgets for our
    Federal programs that aim to prevent and manage diabetes.
        I do not want to overwhelm you with facts and figures, but it is
    clear from even a brief review that diabetes is about to overwhelm
    America's medical system. By providing you with perspective related to
    the reach of diabetes, I trust you will appreciate the need to invest
    in battling uncontrolled diabetes before its impact devastates our
    health system. The place our Nation needs to make this investment is
    here in your appropriations bill, in the CDC.
        Diabetes strikes across age groups, economic status, and ethnicity.
    Projections for the future are even more ominous. The Yale Schools of
    Public Health and Medicine project the population of Americans living
    with diabetes will increase two and a half times by 2025. Supporting
    this projection, the CDC estimates that 33 percent of all children and
    nearly one half of minority children born in the year 2000 will develop
    diabetes by 2050.
        The economic cost of diabetes is enormous. In 2002, the total
    economic impact of diabetes was $132 billion. Put another way, 1 out of
    every 10 health care dollars spent in the United States is spent on
    diabetes care and its complications. CMS estimates that 32 percent of
    the Medicare budget goes towards caring for Americans with diabetes--an
    amazing one-third of the entire Medicare program that is struggling
    with long-term solvency issues far more critical and a near-term fiscal
    crisis than Social Security solvency.
        The human costs of uncontrolled diabetes are more shocking:
      --2 out of 3 people with diabetes in America will die of a heart
            attack or stroke.
      --Diabetes is the leading cause of blindness, causing 12,000 to
            24,000 new cases each year.
      --Diabetes is the leading cause of kidney failure, accounting for 43
            percent of new cases in 2002.
      --More than 60 percent of non-traumatic lower-limb amputations occur
            in people with diabetes.
        Unfortunately, most diabetes patients are not controlling the risk
    factors that can keep them healthy. A1C is a compelling example of this
    trend. A1C is the single most important measure of glucose control over
    time and a proven risk factor for all major diabetes complications. A1C
    is a test that shows glucose control over the previous 3 months; sort
    of a diabetes batting average except that lower is better.
        Diabetes patients should know their A1C number and work to keep it
    in check--similar to blood pressure or cholesterol levels. The test is
    paid for by managed care, Medicare, and most private insurance plans;
    there are few financial barriers to being in the know.
        However, a recent study by the New York State Department of Health
    found that 89 percent of patients with diabetes did not know their A1C.
    Worse, even among those who knew their A1C, 80 percent had A1C's above
    the value deemed acceptable by all diabetes organizations. Nationally,
    the CDC estimates that 65 percent of all diabetes patients are out of
    control, defined by the CDC as ``an A1C level above 7.''
        I urge this Committee to consider, based on the dire state of
    diabetes in America, whether we can or should continue to overlook the
    basic diabetes care needs of Americans. The answer to me seems obvious;
    we must embark on an aggressive campaign to encourage Americans to
    manage diabetes to control its staggering human and financial costs
    that encompass all sectors of the American community.
        The DCC works to bridge the diabetes management knowledge gap by
    educating diabetes patients and their healthcare teams on ways to
    battle uncontrolled diabetes primarily through A1C awareness and
    management. Through public education in its initial test markets, the
    DCC aims to help diabetes patients take control of their disease and
    live longer, healthier lives--without the specter of heart attack,
    stroke, amputation, or kidney failure.
        The American Diabetes Association and the Juvenile Diabetes
    Research Foundation International are jointly leading the DCC's ``Know
    Your A1C'' campaign to battle uncontrolled diabetes in America.
    Providing financial support to this novel non-branded, public-private
    partnership are six of the world's leading pharmaceutical and medical
    device companies: Abbott Diabetes Care Inc., Becton, Dickinson and
    Company, LifeScan, Inc., Novo Nordisk Inc., Roche Diagnostics
    Corporation, and sanofi-aventis U.S. Inc.
        The ``Know Your A1C'' campaign is different from other public
    service campaigns. It encourages Americans and their families to
    control diabetes by focusing primarily on the message that patients
    need to know and to manage their A1C. Prior to launching its campaign,
    the DCC conducted research to determine the most effective way to
    encourage patients to manage diabetes and the findings supported a sole
    focus on A1C control.
        The campaign utilizes television, radio and print placements to
    reach families affected by diabetes in the pilot markets. While these
    placements consist of paid advertising today, beginning in late 2006,
    most of the effort will rely on public service announcements generated
    under an agreement with the Ad Council.
        The effort is enhanced by the sales teams of the corporate
    supporters who distribute unbranded educational materials into medical
    offices, clinical laboratories, pharmacies, diabetes educators' offices
    and any other location likely to be frequented by a person with
    diabetes in the pilot markets. The campaign also provides an order
    fulfillment system via 800 number allowing people to request basic
    materials associated with the campaign, a website and direct mail to
    healthcare professionals to ensure campaign materials have the broadest
    reach possible in the test markets.
        In 2006, the DCC will expand upon its 2005 ``Know Your A1C'' pilot
    program in Atlanta and Tampa. This year, the campaign will reach the
    television and radio markets of Atlanta, GA, Lexington, KY, Little
    Rock, AR and Memphis, TN.
        The DCC is expanding its focused campaign simply because it is
    proven to work. Consider some of these compelling highlights of the
    campaign's achievements in 2005 in Atlanta and Tampa.
      --An improvement in the number of patients with diabetes who report
            obtaining an A1C test in the past 3 months from a low of 25
            percent prior to campaign launch to an average of 52 percent
            during the campaign.
      --An increase in patient with diabetes understanding of A1C awareness
            from a low of 38 percent among people with diabetes prior to
            the launch of the campaign to an average of 54 percent by the
            end of the campaign; and
      --An increase in patient with diabetes understanding of what the A1C
            test measures from a low of 17 percent prior to the campaign to
            an average of 41 percent during the campaign.
        Based upon these results, the Ad Council will join the DCC to
    refine the ``Know Your A1C'' campaign and transform it from a regional
    effort into a national public service campaign. This campaign is
    expected to launch in late 2006. Plus, the campaign hopes to reach
    English and Spanish speaking populations. I hope you share in my
    enthusiasm for this program as it could potentially transform America's
    ambivalence towards the uncontrolled diabetes epidemic into a national
    call to action.
        We would like to build on the current NIH and CDC patient awareness
    campaigns and will soon talk to CDC about the best ways to work with it
    to improve patient awareness of A1C levels. This may include CDC
    support for needed patient and healthcare provider components that
    inform Americans with diabetes how they can and should manage the
    disease not presently part of the campaign. Components the DCC would
    like to incorporate in the campaign include more aggressive healthcare
    provider education tools, documents informing families how to help
    manage a family member's diabetes, information detailing steps patients
    can take for A1C control, components that speak more directly to multi-
    cultural audiences and a more robust order fulfillment program.
        While the Diabetes Care Coalition will provide an expanded national
    ``Know Your A1C'' campaign in late 2006 and the personnel necessary to
    distribute the materials associated with the campaign, a partnership
    with the Federal Government will enable us to expand and enhance our
    campaign. A public-private partnership will give us the expertise and
    funding needed to take the battle to all Americans and their healthcare
    teams to eliminate uncontrolled diabetes. This makes economic and
    humanitarian sense.
        Today, the DCC joins the American Diabetes Association in
    requesting an increase in the CDC diabetes prevention and control
    program by $20.8 million in fiscal year 2007. Given the scope and reach
    of diabetes, we believe this is a modest request even in this budget
    climate.
        We also encourage this Committee to urge the CDC to dedicate new
    and existing resources for its diabetes control program to battling
    uncontrolled diabetes. To best serve the American people, CDC must
    equally address both aspects of controlling this disease--primary
    prevention activities to stop new cases of diabetes, as well as
    secondary prevention activities to improve the health of the 20.8
    million people living with diabetes.
        Members of the Committee, the time to battle the epidemic of
    uncontrolled diabetes is now. If we miss this opportunity, America will
    lose substantial ground and run the risk of never getting the diabetes
    epidemic under control.
        Unfortunately, the 20.8 million Americans living with diabetes
    today represent ``the low water mark'' in the reach and scope of the
    disease. It is time to realize that diabetes is here to stay in America
    and to act in a way that accepts this truth. Please help empower
    Americans living with diabetes, and the growing numbers who will live
    with it tomorrow, to ``Know Your A1C'' by providing the CDC with the
    resources needed to battle the epidemic of uncontrolled diabetes.
        Thank you for your time and consideration.
                                     ______

            Prepared Statement of the InterTribal Bison Cooperative
                          introduction and background
        My name is Ervin Carlson, a Tribal Council member of the Blackfeet
    Tribe of Montana and President of the InterTribal Bison Cooperative.
    Please accept my sincere appreciation for this opportunity to submit
    testimony to the honorable members of the Appropriations Sub-Committee
    on Labor, Health and Human Services and Education. The InterTribal
    Bison Cooperative (ITBC) is a Native American non-profit organization,
    headquartered in Rapid City, South Dakota, comprised of 57 federally
    recognized Indian Tribes located within 19 States across the United
    States.
        Buffalo thrived in abundance on the plains of the United States for
    many centuries before they were hunted to near extinction in the 1800s.
    During this period of history, buffalo were critical to survival of the
    American Indian. Buffalo provided food, shelter, clothing and essential
    tools for Indian people and insured continuance of their subsistence
    way of life. Naturally, Indian people developed a strong spiritual and
    cultural respect for buffalo that has not diminished with the passage
    of time.
        Numerous tribes that were committed to preserving the sacred
    relationship between Indian people and buffalo established the ITBC as
    an effort to restore buffalo to Indian lands. ITBC focused upon raising
    buffalo on Indian Reservation lands that did not sustain other economic
    or agricultural projects. Significant portions of Indian Reservations
    consist of poor quality lands for farming or raising livestock.
    However, these wholly unproductive Reservation lands were and still are
    suitable for buffalo. ITBC began actively restoring buffalo to Indian
    lands after receiving funding in 1992 as an initiative of the Bush
    administration.
        Upon the successful restoration of buffalo to Indian lands,
    opportunities arose for Tribes to utilize buffalo for tribal economic
    development efforts. ITBC is now focused on efforts to assure that
    tribal buffalo projects are economically sustainable. Federal
    appropriations have allowed ITBC to successfully restore buffalo the
    tribal lands, thereby preserving the sacred relationship between Indian
    people and buffalo. The respect that Indian tribes have maintained for
    buffalo has fostered a serious commitment by ITBC member Tribes for
    successful buffalo herd development. The successful promotion of
    buffalo as a healthy food source will allow Tribes to utilize a
    culturally relevant resource as a means to achieve self-sufficiency.
            funding request for preventative health care initiative
        The InterTribal Bison Cooperative respectfully requests an
    appropriation for fiscal year 2007 in the amount of $2,000,000 in the
    form of an earmark to the Department of Health and Human Service
    Department's budget. ITBC intends to utilize the funds to conduct a
    national demonstration project focused on the delivery of bison meat to
    Native Americans suffering from diet related diseases.
        The Native American population currently suffers from the highest
    rates of Type 2 diabetes. The Indian population further suffers from
    high rates of cardio vascular disease and various other diet related
    diseases. Studies indicate that Type 2 diabetes commonly emerges when a
    population undergoes radical diet changes. Native Americans have been
    forced to abandon traditional diets rich in wild game, buffalo and
    plants and now have diets similar in composition to average American
    diets. More studies are needed on the traditional diets of Native
    Americans versus their modern day diets in relation to diabetes rates.
    However, based upon the current data available, it is safe to assume
    that disease rates of Native Americans are directly impacted by a
    genetic inability to effectively metabolize modern foods. More
    specifically, it is well accepted that the changing diet of Indians is
    a major factor in the diabetes epidemic in Indian Country.
        Approximately 65-70 percent of Indians living on Indian
    Reservations receive foods provided by the USDA Food Distribution
    Program on Indian Reservation (FDPIR) or from the USDA Food Stamp
    Program. The FDPIR food package is composed of approximately 58 percent
    carbohydrates, 14 percent proteins and 28 percent fats. Studies have
    shown that the FDPIR food package has not been compatible with the
    genetic compositions of Native Americans and has been a major factor in
    the high incidence of diet-related disease among Native Americans.
    Indians utilizing Food Stamps generally select a grain based diet and
    poorer quality protein sources such as high fat meats based upon
    economic reasons and the unavailability of higher quality protein food
    sources.
        Buffalo meat is low in fat and cholesterol and is compatible to the
    genetics of Indian people. ITBC intends to develop a health care
    initiative that would educate Indian Reservation families of the
    benefits of incorporating buffalo meat into their diets. In conjunction
    with educating Reservation families on the benefits of buffalo meat,
    ITBC intends to develop methods to make buffalo meat accessible for
    Indian families and to promote incorporation of buffalo into their
    diets. ITBC intends to coordinate with Reservation health care
    providers in nutritional studies of Reservation populations that
    incorporate buffalo meat into diet packages.
        ITBC believes that incorporating buffalo meat will positively
    impact the diets of Indian people living on Reservations. A healthy
    diet for Indian people that results in a lower incidence of diabetes
    and other diet related illnesses will reduce Indian Reservation health
    care costs and result in a savings for taxpayers.
              funding request for itbc training and labor program
        The InterTribal Bison Cooperative respectfully requests an
    appropriation for fiscal year 2007 in the amount of $500,000. This
    amount is $400,000 above the fiscal year 2006 appropriation for ITBC
    and is critical to maintain last years funding level and to develop
    ITBC's training and labor program.
        In fiscal year 2005, the ITBC and its member Tribes were funded at
    $100,000, a decrease of $200,000 from the previous year. ITBC is now
    requesting $500,000 for fiscal year 2007 for job training as part of
    ITBC's labor initiative. To insure the success of ITBC' s buffalo
    restoration efforts to Indian lands, training for the various jobs
    related to the buffalo projects is essential. Most member Tribes of
    ITBC have reservation unemployment rates of 72 percent. Jobs
    opportunities on most Indian Reservations are limited, low-paying, and
    often seasonal and temporary. The jobs created by buffalo restoration
    to Indian lands will positively impact Tribal unemployment rates and
    the overall Reservation poverty levels. Raising buffalo as an economic
    development effort requires skilled labor in permanent employment. ITBC
    has developed a job training program incorporating on-the-job training
    and work experience for youth that specifically addresses the unique
    needs of managing and maintaining buffalo. ITBC's training program
    further focuses on strengthening the economic development opportunities
    of buffalo restoration with training specific to meat processing,
    veterinary science, wildlife and biological services, infrastructure
    development, business and management training, and the overall
    development of a skilled workforce.
        Sufficient funding for job training is critical to the success of
    the buffalo restoration projects. The increase in funding will ensure
    that ITBC can provide job training, job growth training to ITBC member
    tribes. Without funding at the requested level, the buffalo restoration
    projects have less assurance of success.
                           itb goals and initiatives
        In addition to developing a preventative health care initiative,
    ITBC intends to continue with buffalo restoration efforts and the
    Tribal buffalo marketing initiative.
        In 1991, seven Indian Tribes had small buffalo herds, with a
    combined total of 1,500 animals. The herds were not utilized for
    economic development but were often maintained as wildlife only. During
    ITBC's relatively short 10-year tenure, it has been highly successful
    at developing existing buffalo herds and restoring buffalo to Indian
    lands that had no buffalo prior to 1991. Today, through the efforts of
    ITBC, over 35 Indian Tribes are engaged in raising over 15,000 buffalo.
    All buffalo operations are owned and managed by Tribes and many
    programs are close to achieving self-sufficiency and profit generation.
    ITBC's technical assistance is critical to ensure that the current
    Tribal buffalo projects gain self-sufficiency and become profit-
    generating. Further, ITBC's assistance is critical to those Tribes
    seeking to start a buffalo restoration effort.
        Through the efforts of ITBC, a new industry has developed on Indian
    reservations utilizing a culturally relevant resource. Hundreds of new
    jobs directly and indirectly revolving around the buffalo industry have
    been created. Tribal economies have benefited from the thousands of
    dollars generated and circulated on Indian Reservations.
                                   conclusion
        ITBC has proven highly successful since its establishment to
    restore buffalo to Indian Reservation lands to revive and protect the
    sacred relationship between buffalo and Indian Tribes. Further, ITBC
    has successfully promoted the utilization of a culturally significant
    resource for viable economic development.
        ITBC has assisted Tribes with the creation of new jobs, on-the-job
    training and job growth in the buffalo industry resulting in the
    generation of new money for tribal economies. ITBC is also actively
    developing strategies for marketing Tribally owned buffalo. Finally,
    and most critically for Tribal populations, ITBC is developing a
    preventive health care initiative to utilize buffalo meat as a healthy
    addition to Tribal family diets to reduce the incidence of diet-related
    illnesses.
        ITBC strongly urges you to support its request for a $2,000,000
    earmark to the Department of Health and Human Service Department's
    budget to develop the critically needed preventative health care
    initiative utilizing Tribally produced buffalo.
                                     ______

              Prepared Statement of the John B. Amos Cancer Center
        Mr. Chairman and members of the subcommittee, I appreciate the
    opportunity to submit testimony to the hearing record regarding the
    John B. Amos Cancer Center (JBACC) in Columbus, Georgia. JBACC is a
    comprehensive community cancer center designed to address the continuum
    of the disease from prevention and early detection through treatment,
    survivorship and palliation.
        Accredited by the Commission on Cancer, American College of
    Surgeons, JBACC's mission is to provide exceptional quality-driven
    care. Accordingly, we have opened a (49,620 sq. ft.) hospital-based
    cancer center located on its own campus and surrounded by meditation
    gardens. This unique facility is designed to address cancer along a
    disease management approach allowing patients, families, and the
    community at large to enter our services at any point in the disease
    process whether it is for education, diagnosis, treatment, or
    psychosocial support. Our outreach programs are a significant component
    of our action plan to improve the health of the region, as well.
    Further development of these programs is the reason I address you
    today.
        As you are aware, the John B. Amos Cancer Center received fiscal
    year 2005 Labor, HHS, and Education Appropriations. I would like to
    thank the subcommittee for this support and elaborate on the success of
    our programs thus far.
        Leveraging community and government support, we have developed
    extensive Breast and Cervical Cancer Screening Programs that allow us
    to reach many underserved areas of the 14 county region encompassing
    our service area. Community Health Advisors (CHAs) trained and educated
    by JBACC in collaboration with the West Georgia Cancer Coalition to
    address cancer education, prevention, and diagnostic care, assist in
    the facilitation of community screenings to maximize the effect of the
    screening events. These CHAs are native to the communities they serve
    and therefore possess intuitive knowledge necessary for conducting
    successful community screenings such as appropriate venues and
    marketing techniques for the respective population. Other factors, such
    as matching a bilingual CHA with Hispanic communities to increase
    accessibility and comfort levels are also considered.
        Screenings are conducted on a weekly basis in communities
    throughout the region. Rural communities are specifically targeted as
    screening sites at least once a month. A culturally diverse
    multidisciplinary team extends a comprehensive approach to providing
    care and access to services at these events. This is a level of service
    previously unattainable in some areas. The team includes a bilingual
    physician, a nurse practitioner, a nurse, a case manager, and clerical
    personnel. Additionally, volunteers are often available to set up
    educational materials. The CHAs often attend the events as well and may
    sometimes act as liaisons between patients and the JBACC staff.
        By the point at which many patients walk into the Amos Cancer
    Center facility, the disease has advanced to a stage at which treatment
    and cure is exceedingly difficult. Therefore, the primary goal of
    community screenings is to promote and make available early detection
    and treatment options. To this end, initial on-site exams are performed
    free of charge, regardless of ability to pay, to increase service
    accessibility. Abnormal exams are referred to care coordinators for
    referral for additional screenings or diagnostic testing, as
    applicable. Dependent upon the patient's schedule, this can usually be
    achieved with the same week as the initial screening. A surgical
    consult is provided 2 to 4 days after testing, if necessary. If further
    investigation is warranted, coordinators access the system to see that
    the patient's needs, including financial and psychological are met. The
    target timeline objective is two weeks from exam to diagnosis and
    treatment. Identification of cervical abnormalities is slightly more
    involved and requires a timeline of approximately 3.5 to 4 weeks.
        The outreach program is not limited to screenings. Educational
    programs and cancer prevention programs are provided to organizations
    throughout the region. These include breast health lectures provided to
    churches, sororities, and healthcare groups, and providing educational
    materials and interactive displays for cancer-themed events on local
    college campuses. These events reinforce the importance of early
    detection.
        We have developed a successful early detection outreach program.
    The requested funding of $2 million in fiscal year 2007 would allow us
    to expand the program to be even more effective within the fourteen
    county region in which 511,736 citizens reside. Expansion efforts would
    allow us to reach traditionally underserved populations by scheduling
    screenings in communities not yet familiar with our programs. This
    includes rural and urban areas in both Georgia and Alabama, some of
    which lie in the socio-economically deprived ``Black Belt''.
        In addition to the community screenings, funding would provide for
    the development of two permanent weekly cancer screening clinics. These
    clinics would allow citizens the peace of mind of the availability of
    set screening opportunities, rather than waiting for a local
    opportunity to occur.
        Funding from JBACC's fiscal year 2005 Labor, HHS, Education
    Appropriation was limited to breast and cervical cancer screening.
    However, we have identified a need and an opportunity within the
    community to focus on men's health issues as well, through prostate
    screenings. The requested funding would allow for the expansion of our
    outreach program to include this component. Incorporation of prostate
    screenings into our existing program could occur seamlessly. This would
    allow us to expand our focus to include a population previously not
    served in this capacity. Excluding skin cancers, prostate cancer is the
    most common cancer in American men. While the statistics regarding
    prostate cancer are staggering, early detection and more effective
    treatment methods have led to lower death rates in recent years. This
    further underscores the need for prostate screening programs in
    underserved areas to improve the health status of the region.
        The requested funding would also provide for colorectal screenings.
    This year, nearly 150,000 men and women will be diagnosed with
    colorectal cancer while approximately 56,000 will die from it. Once
    again, however, early detection and treatment are essential to
    increased survival rates. However, studies indicate that many people
    are often uncomfortable talking about the disease. They are also
    misguided on their risk factors and chance of getting the disease.
    Overcoming these obstacles to diagnosis and treatment can be achieved
    through community educational and screening opportunities.
        Mr. Chairman, John B. Amos Cancer Center is committed to improving
    the health of the region by addressing and embracing the Healthy People
    2010 focus areas of overall cancer deaths. Recognizing that to reach
    our goals we must design programs that engage the region in our early
    detection and screening programs, we have taken great strides to do so.
    We believe in the documented success of our outreach programs and hope
    that the subcommittee will provide $2 million toward program expansion.
    Through the expansion, we will reach underserved populations and reduce
    cancer mortality and morbidity, thereby improving the health of the
    region in accordance with the goals of the Department of Health and
    Human Services as well as this subcommittee.
                                     ______

                    Prepared Statement of Matria Healthcare
                  summary of fiscal year 2007 recommendations
      --Provide full funding in fiscal year 2007 for the Health and Human
            Services (HHS) Health Information Technology Initiative,
            including funding for the Office of the National Coordinator
            for Health Information Technology (ONCHIT) and the Agency for
            Healthcare Research and Quality (AHRQ).
      --Provide a 5 percent increase for fiscal year 2007 to the National
            Institutes of Health (NIH) budget. Within NIH, provide an
            increase of 5 percent to the National Library of Medicine
            (NLM).
      --Urge the National Coordinator for the Office of the National
            Coordinator for Health Information Technology (ONCHIT), the
            National Library of Medicine (NLM) at the National Institutes
            of Health (NIH), the Agency for Healthcare Research and Quality
            (AHRQ), and the Centers for Medicare and Medicaid Services
            (CMS) to conduct outreach activities to all public and private
            sector organizations which have demonstrated capabilities in
            health information technology, particularly to those who have
            demonstrated capabilities in disease management technology as
            it relates to saving health care dollars, and improving care
            for chronically ill individuals and the workforce.
        Chairman Specter and members of the subcommittee, thank you for the
    opportunity to present this written statement regarding the importance
    of health information technology, specifically as it relates to disease
    management technology, saving health care dollars, and improving care
    for chronically ill individuals and the workforce.
        Matria Healthcare is a national leader in disease management. Our
    disease management programs have been adopted by leading corporations,
    health plans, and State governments as a proven solution for reducing
    costs and improving health and productivity. Because 15 percent of the
    population typically drives 85 percent of healthcare costs, Matria
    believes the strongest, most effective healthcare solutions start with
    a strong disease management program to begin curbing costs immediately.
        The disease management component of Matria's health enhancement
    offering provides management programs for the Nation's most costly
    chronic diseases, episodic conditions, and issues affecting the
    psychosocial well-being of patients and has produced outcomes like no
    other provider. Matria's industry-leading TRAX technology platform
    represents the state-of-the-art in healthcare data warehousing and
    protocol-driven healthcare delivery. This platform is driving the
    clinical and financial outcome success of Matria in over one hundred
    Fortune 1000, health plan, and State government programs. Matria's
    technology platform is being utilized by members of the National
    Coordinator for Health Information Technology's Interoperability
    Consortium to successfully improve clinical outcomes and reduce
    healthcare expenditures amongst its employees.
        In April 2004, President Bush revealed his vision for the future of
    healthcare in the United States. The President's plan involves a health
    care system that puts the needs of the patient first, is more
    efficient, and is cost-effective. At this time, he established, within
    the Office of the Secretary of Health and Human Services, an Office of
    the National Coordinator for Health Information Technology (ONCHIT).
    Among other things, this office is meant to ensure that appropriate
    information is available to guide medical decisions, improve healthcare
    quality, reduce healthcare costs resulting from inefficiency, medical
    errors, inappropriate care, and incomplete information, promote a more
    efficient marketplace, greater competition, and increase in choice, and
    improve the coordination of care and information among hospitals,
    laboratories, physician offices, and other ambulatory care providers.
        Matria's health enhancement offerings are consistent with these
    goals of the President and the ONCHIT. In the transition towards a
    health care system where informed consumers will own their personal
    health records, health savings accounts, and health insurance, it is
    important for the Federal Government to partner with public and private
    sector organizations which have demonstrated capabilities in this
    arena.
        Health information technology will improve the practice of medicine
    and make it more efficient. The rapid implementation of secure and
    interoperable electronic health records will, for example,
    significantly improve the safety, quality, and cost-effectiveness of
    health care. To implement this vision, Matria urges the subcommittee to
    support the President's budget request of $116 million for the ONCHIT
    to provide strategic direction for development of a national
    interoperable health care system. Matria also encourages the
    subcommittee to support the $50 million Health Information Technology
    Initiative through the Agency for Healthcare Research and Quality
    (AHRQ) to accelerate the development, adoption, and diffusion of
    interoperable information technology in a range of health care
    settings. Additionally, Matria urges the subcommittee to provide a 5
    percent increase for fiscal year 2007 to the National Institutes of
    Health (NIH) budget, and within NIH, provide a proportional increase of
    5 percent to the National Library of Medicine (NLM).
        Finally, Matria encourages the subcommittee to urge the National
    Coordinator for the ONCHIT, NLM, AHRQ, and the Centers for Medicare and
    Medicaid Services (CMS) to conduct outreach activities to all public
    and private sector organizations which have demonstrated capabilities
    in health information technology, particularly to those who have
    demonstrated capabilities in disease management technology as it
    relates to saving health care dollars, and improving care for
    chronically ill individuals and the workforce.
        By working together, the goal of creating an efficient national
    healthcare system will be realized. Thank you for allowing me to submit
    this testimony to you today.
                                     ______

        Prepared Statement of the National Alliance to End Homelessness
        The National Alliance to End Homelessness (the Alliance) is a
    nonpartisan, nonprofit organization that has several thousand partner
    agencies and organizations across the country. These partners are local
    faith-based and community-based nonprofit organizations and public
    sector agencies that provide homeless people with shelter, transitional
    and permanent housing, and services such as substance abuse treatment,
    job training, and health and mental health care. In addition, we have
    supported over 220 State and local entities as they create 10 year
    plans to end homelessness. The Alliance represents a united effort to
    address the root causes of homelessness and challenge society's
    acceptance of homelessness as an inevitable by-product of American
    life.
        Overview.--Adequate social services program funding is essential to
    ending homelessness. Housing must be coupled with appropriate services
    such as health care, employment preparation, mental health and
    substance abuse treatment, child care, and youth directed programs to
    be effective. These programs were put to the test as social service
    agencies assisted Katrina evacuees. The Social Services Block Grant,
    the Community Services Block Grant, Projects for Assistance in
    Transition from Homelessness, Education for Homeless Children and Youth
    funded school liaisons and Health Care for the Homeless clinics among
    others were essential as the gulf coast residents overcame their
    housing crisis. These lessons illustrate how HHS, Labor, and Education
    programs can help those homeless due to other crises such as job loss
    or catastrophic illness.
                                     goals
        1. Moving Forward to End Homelessness.--By implementing 10 year
    plans to end homelessness, communities across America are ending
    homelessness. Communities are using Federal, State, and local funds to
    help homeless persons, some of whom have been homeless for years,
    maintain housing. It is important that this progress not be undermined.
    To this end, the Alliance recommends the following:
          A. Allocate $55 million for services in permanent supportive
            housing within SAMHSA's Center for Mental Health Services.
          B. Reject cuts to the Grants for the Benefit of Homeless
            Individuals/Treatment for Homeless Individuals (GBHI) and
            insure that additional local programs can access these funds.
          C. Increase funding to Projects for Assistance in Transition from
            Homelessness (PATH) to $65 million.
          D. Increase the Runaway and Homeless Youth Act Programs to $140
            million and reject detrimental policy recommendations.
          E. Fund Education for Homeless Children and Youth services at its
            full authorized level of $70 million.
          F. Increase funding for the Homeless Veterans Reintegration
            Program to $50 million.
        2. Connecting Homeless Families, Individuals, and Youth to
    Mainstream Services.--The estimated 3.5 million people who are homeless
    throughout a year depend on mainstream programs such as the ones below
    to live day to day and once housed, remain housed. These programs help
    address the complex situations persons experiencing homelessness are
    trying to overcome. The Alliance recommends the following to meet this
    goal:
          A. Fund the Social Services Block Grant at $1.7 billion, the same
            funding level as fiscal year 2006.
          B. Reject elimination of the Community Services Block Grant.
          C. Appropriate $171 million for the Health Care for the Homeless
            programs within the Health Resource Services Administration's
            Consolidated Health Centers program.
          D. Appropriate $60 million in education and training vouchers for
            youth exiting foster care under the Safe and Stable Families
            Program.
    Goal #1--Moving Forward to End Homelessness
                Support Services for Permanent Supportive Housing Projects
        The Alliance recommends allocating $55 million for services in
    permanent supportive housing within SAMHSA's Center for Mental Health
    Services. The administration has set a goal of ending chronic
    homelessness by 2012. We know this goal is attainable based on evidence
    based practices. For example, through the collaborative initiative
    grants program, HHS, the Department of Veterans Affairs, and HUD have
    funded programs and seen results. These eleven grants have ended
    homelessness for 550 people who cumulatively had over 5,000 years of
    homelessness. Unfortunately, funding for these grants will end in 2006.
    The President has proposed an increase of $209 million for the
    McKinney/Vento homelessness programs as part of the proposed fiscal
    year 2007 HUD budget to primarily pay for housing for those who are
    chronically homeless. No such investment has been included for HHS.
                Treatment for Homeless Individuals
        The Alliance recommends that Congress fully reject cuts in Grants
    for the Benefit of Homeless Individuals (GBHI) funding and work to
    strengthen the program for additional grantees. Maintaining programs
    such as GBHI is essential to achieving the President's goal of ending
    chronic homelessness by 2012. Mainstream health, welfare, addiction,
    and mental health programs often do not adequately serve homeless
    people. In 2003, the U.S. Department of Health and Human Services
    studied mainstream programs and their ability to serve chronically
    homeless populations. The report, entitled Ending Chronic Homelessness:
    Strategies for Action, explained that no mainstream program is
    comprehensive enough to adequately serve chronically homeless people.
    Thus, HHS included in the recommendations that future program budgets
    should focus on funding programs directed for chronic homelessness.
        There are a variety of reasons mainstream programs fail to
    adequately service people who are chronically homeless. Many programs
    simply lack the ability to fund or coordinate the full range of health,
    housing, and support services required to adequately help homeless
    people. Grants through the Treatment for Homeless Individuals/Grants
    for the Benefit of Homeless Individuals (GBHI) program help homeless
    service providers assemble services that meet the complex needs of
    their clients and maintain their housing.
                Projects for Transition Assistance from Homelessness (PATH)
        The Alliance recommends that Congress increase PATH funding to $65
    million.
        The PATH program provides homeless people with serious mental
    illnesses access to mental health services. PATH focuses on outreach to
    eligible consumers, followed by help in ensuring that those consumers
    are connected with mainstream services. Under the PATH formula grant,
    approximately 30 States share in the program's annual appropriations
    increases. The remaining States and territories receive the minimum
    grant of $300,000 for States and $50,000 for territories. These amounts
    have not been raised since the program was authorized in 1991. To
    account for inflation, the minimum allocation should be raised to
    $600,000 for States and $100,000 for territories. Amending the minimum
    allocation requires a legislative change. If the authorizing committees
    do not have sufficient time to address this issue, we hope that
    appropriators will explore ways to make the amendment through
    appropriations bill language.
                Runaway and Homeless Youth Programs
        The Alliance recommends funding the Runaway and Homeless Youth Act
    (RHYA) programs at $140 million. RHYA programs support cost-effective,
    community and faith-based organizations that protect youth from the
    harms of life on the streets. The problems of homeless and runaway
    youth are addressed by the Administration for Children and Families
    within HHS, which operates coordinated competitive grant programs like
    RHYA. The RHYA programs can either reunify youth safely with family or
    find alternative living arrangements. RHYA programs end homelessness
    by: engaging youth living on the street with Street Outreach Programs,
    quickly providing emergency shelter and family crisis counseling
    through the Basic Centers, or providing supportive housing that helps
    young people develop lifelong independent living skills through
    Transitional Living Programs.
                Education for Homeless Children and Youth
        The Alliance recommends funding Education for Homeless Children and
    Youth (EHCY) at its full authorized level of $70 million. The most
    important potential source of stability for these children is school.
    The mission of the Education for Homeless Children and Youth program is
    to ensure that homeless children can continue to attend school and
    thrive. A struggle for homeless service providers who serve families
    with children is to maintain the children's stability during a time
    when their lives are turned upside down. Even if new housing can be
    found in a short time, the lasting effects of a spell of homelessness
    can be devastating.
        The Education for Homeless Children and Youth program, within the
    Department of Education's Office of Elementary and Secondary Education,
    removes obstacles to enrollment and retention by establishing liaisons
    between schools and shelters and providing funding for transportation,
    tutoring, school supplies, and the coordination of statewide efforts to
    remove barriers.
                Homeless Veterans Reintegration Program (HVRP)
        The Alliance recommends that Congress increase HVRP funding to $50
    million.
        HVRP, within the Department of Labor's Veterans Employment and
    Training Service (VETS), provides competitive grants to community-
    based, faith-based, and public organizations to offer outreach, job
    placement, and supportive services to homeless veterans. HVRP is the
    primary employment services program accessible by homeless veterans and
    the only targeted employment program for any homeless subpopulation.
    The Department of Labor estimates that 8,750 homeless veterans will be
    served through HVRP at the fiscal year 2006 appropriation level of $22
    million. This figure represents just 2 percent of the overall homeless
    veteran population, which the Department of Veterans Affairs estimates
    numbers more than 400,000 over the course of a year. An appropriation
    at the authorized level of $50 million would enable HVRP grantees to
    reach approximately 19,866 homeless veterans.
    Goal #2--Connecting Homeless Families, Individuals and Youth to
            Mainstream Services
                Social Services Block Grant (SSBG)
        The Alliance recommends that Congress fully restore SSBG funding to
    its fiscal year 2006 level of $1.7 billion. Cuts to programs like the
    SSBG will create additional barriers for communities trying to achieve
    the President's goal of ending chronic homelessness by 2012. SSBG funds
    are essential for programs dedicated to ending homelessness. In
    particular, youth housing programs and permanent supportive housing
    providers often receive State, county, and local funds which originate
    from the SSBG. As the U.S. Department of Housing and Urban Development
    has focused its funding on housing, programs that provide both housing
    and social services have struggled to fund the service component of
    their programs. This gap is often closed using Federal programs such as
    SSBG.
                Community Services Block Grant (CSBG)
        The Alliance recommends that Congress fully restore CSBG funding to
    its fiscal year 2006 level of $630 million. Eliminating funding for the
    CSBG will destabilize the progress communities have made toward ending
    homelessness by not only ending services directly provided by CSBG
    funds but limiting a community's ability to access other Federal
    dollars such as those provided by HUD. This runs contrary to the
    President's stated goal of ending chronic homelessness by 2012.
    Community Action Agencies (CAAs) are directly involved in housing and
    homelessness services. In several communities, CAAs lead the Continuum
    of Care (CoC). CoCs coordinate local homeless service providers and the
    community's McKinney-Vento Homeless Assistance Grant application
    process with the Department of Housing and Urban Development.
        In the fiscal year 2004 Community Services Block Grant Information
    Systems report published by the U.S. Department of Health and Human
    Services, CAAs reported administering $207.4 million in Section 8
    vouchers, $30 million in Section 202 services \1\ and $271.1 million in
    other Department of Housing and Urban Development (HUD) programs which
    includes homeless program funding.\2\
    ---------------------------------------------------------------------------
        \1\ Section 202 is dedicated to housing from elderly and disabled
    individuals and families.
        \2\ U.S. Department of Health and Human Services, Administration of
    Children and Families. The Community Services Block Grant Fiscal Year
    2004 Statistical Report. Prepared by the National Association for State
    Community Services Programs.
    ---------------------------------------------------------------------------
                Health Care for the Homeless (HCH)
        The Alliance recommends $171 million, the amount recommended by the
    President, for HCH (8.7 percent of the $1.963 billion requested for the
    Consolidated Health Centers account). Persons living on the streets
    suffer from health problems resulting from or exacerbated by the
    conditions of being homeless, such as hypothermia, frostbite, and
    heatstroke. In addition, they often have infections of the respiratory
    and gastrointestinal systems, tuberculosis, vascular diseases such as
    leg ulcers, and hypertension.\3\ Health care for the homeless programs
    are vital to prevent these conditions from becoming fatal. Congress
    allocates 8.7 percent of the Consolidated Health Centers account for
    Health Care for the Homeless (HCH) projects. The HCH program has
    achieved significant success since its inception in 1987, but the
    health care needs Americans experiencing homelessness each year far
    exceed the service capacity of Health Care for the Homeless grantees.
    The President's fiscal year 2007 budget would create 15 to 20 new
    projects, serving an additional 25,000 to 30,000 people experiencing
    homelessness.
    ---------------------------------------------------------------------------
        \3\ Harris, Shirley N, Carol T. Mowbray and Andrea Solarz. Physical
    Health, Mental Health and Substance Abuse Problems of Shelter Users.
    Health and Social Work, Vol. 19, 1994.
    ---------------------------------------------------------------------------
                Foster Youth Education and Training Vouchers
        The Alliance recommends that Congress appropriate $60 million in
    education and training vouchers for youth exiting foster care under the
    Safe and Stable Families Program. The Education and Training Voucher
    Program offers funds to foster youth and former foster youth to enable
    them to attend colleges, universities and vocational training
    institutions. Students may receive up to $5,000 a year for college or
    vocational training education. The funds may be used for tuition,
    books, housing, or other qualified living expenses. Given the large
    number of people experiencing homelessness who have a foster care
    history, it is important to provide assistance such as these education
    and training vouchers to stabilize youth, prevent economic crisis, and
    prevent possible homelessness.
                                   conclusion
        Homelessness is not inevitable. As communities implement plans to
    end homelessness, they are struggling to find funding for the services
    homeless and formerly homeless clients need to maintain housing. The
    Federal investments in mental health services, substance abuse
    treatment, employment training, youth housing, and case management
    discussed above will help communities create stable housing programs
    and change social systems which will end homelessness for millions of
    Americans.
                                     ______

      Prepared Statement of the National Association of Community Health
                                    Centers
        On behalf of more than 1,000 health center grantees across the
    country serving more than 15 million patients, the National Association
    of Community Health Centers (NACHC) is pleased to submit this statement
    for the record, and thank the subcommittee for its continued support
    and investment in the Health Centers program.
                              about health centers
        Over more than 40 years, the Health Centers program has grown from
    a small demonstration project providing desperately needed primary care
    services in underserved communities to one of the fundamental elements
    of our Nation's health care safety net. Funding was approved in 1965
    for the first two neighborhood health center demonstration projects,
    one in Boston, Massachusetts, and the other in Mound Bayou,
    Mississippi.
        Today, America's health centers are helping communities meet
    escalating health needs and address costly and devastating health
    problems, from prenatal and infant health development to chronic
    illness (like diabetes and asthma), to mental health, substance
    addiction, domestic violence and HIV/AIDS. Health centers are the
    family doctor for 1 in 8 uninsured individuals, and 1 in every 5 low-
    income children. Health centers serve as the primary health care safety
    net for many communities across the country and the Federal grant
    program enables more low-income and uninsured patients to receive care
    each year.
        Every Federally Qualified Health Center (FQHC) is governed by a
    community board with a patient majority--a true patient democracy.
    Health centers are required to be located in a federally designated
    Medically Underserved Area (or MUA), and must provide a package of
    comprehensive primary care services to anyone who comes in the door,
    regardless of their ability to pay. At the typical health center,
    roughly one-quarter of the operating revenues are from the Federal
    grant; and just over 40 percent are from reimbursement through Federal
    insurance programs, principally Medicare and Medicaid. The balance of
    the revenues are from State and community partnerships, privately
    insured individuals, and patients ability to pay.
        The Health Centers program is administered by the Bureau of Primary
    Health Care (BPHC) at the Health Resources and Services Administration
    (HRSA), within the U.S. Department of Health and Human Services (HHS).
                               funding background
        The subcommittee has approved substantial funding increases for the
    Consolidated Health Centers program over the past several years
    resulting in a broad expansion effort to serve many of those that
    remain underserved in our country. Most recently, the increase in
    funding approved for fiscal year 2006 will help more than 600,000
    additional Americans gain access to effective, affordable primary and
    preventive care services offered by our Nation's Health Centers.
        Since 2001, the subcommittee has increased funding for Health
    Centers in order to stabilize existing centers and meet the goals of
    the President's initiative--1,200 new or expanded centers and an
    additional 6.1 million patients served by 2006. To date, the expansion
    has brought high-quality services to an additional 4 million Americans
    and has produced new or expanded facilities in over 800 communities
    nationwide. Even with the increases provided over the past several
    years, hundreds of communities submitted applications that received
    high ratings but could not be funded, due to lack of funds. There is
    clearly a tremendous need and a tremendous desire to expand health
    center services to new communities.
        The health centers program has succeeded in expanding access to
    primary and preventive care services in underserved communities across
    the country. The Office of Management and Budget rated the Health
    Centers program as one of the top 10 Federal programs, and the best
    competitive grant program within all of HHS. With additional resources,
    health centers stand ready to provide low-cost, highly effective care
    to millions more uninsured and underserved individuals and families.
                                fiscal year 2007
        In his fiscal year 2007 budget proposal, President Bush requested
    an increase for the Health Centers program of $181 million, for a total
    funding level of $1.963 billion in fiscal year 2007. NACHC strongly
    supports the President's requested increase for the program, which will
    continue the historic expansion of the Health Centers program into
    hundreds of additional communities nationwide.
        In 2005, President Bush called for ``a community health center in
    every poor county'' in America. NACHC strongly supports this goal and
    urges Congress to provide funds to begin this critical expansion
    effort. NACHC was encouraged that the administration did not recommend
    waiving the statutorily designated proportionality requirements for
    Migrant, Public Housing and Homeless Health Centers in order to
    implement this second expansion initiative.
        In addition to the expansion efforts, it is critical that Federal
    funding for health centers keep pace with the growing cost of
    delivering care. NACHC requests that the subcommittee designate $50
    million of any increase in funding to be used to make base grant
    adjustments for existing centers, allowing an average increase of 2.8
    percent in current health center grants, equal to the Medicare Economic
    Index. Under the subcommittee's leadership, Congress has provided base
    grant adjustments for existing centers in 5 out of the 7 previous
    fiscal years. A recent study by NACHC found that in the 2 years that
    these adjustments were not included in the Health Centers
    appropriation, the number of patient visits per grantee actually
    decreased.
        NACHC appreciates the subcommittee's leadership in stabilizing the
    Federal Tort Claims Act (FTCA) judgment fund for health centers in past
    years. For fiscal year 2007, the President has requested that
    $44,500,000 be appropriated for this purpose. This is the same funding
    level as last year, and NACHC expects it will be sufficient to cover
    FTCA claims in 2007.
        In 1997, Congress authorized and began funding the HRSA Loan
    Guarantee Program (LGP) for the construction, renovation, and
    modernization of health centers. Demand for this guarantee program has
    accelerated significantly in the last year. NACHC expects that at the
    current rate of usage, the remaining $5 million in credit subsidy will
    be entirely used during fiscal year 2006. In response that the success
    of this program, NACHC is requesting an additional $5 million be
    provided until expended for additional loan guarantees. The LGP has
    proven to be a vital resource for health centers across the country as
    they seek financing to fund the facilities necessary to accommodate the
    growth in patient visits resulting from recent expansion efforts.
        Finally, Health Centers support funding for other Federal programs
    that are integral to the continued expansion and strength of community
    health centers. These include:
      --$150 million for the National Health Service Corps, which is the
            largest source of health professionals for health centers;
      --$250 million for Title III of the Ryan White CARE Act, which
            provides grants to health centers and other safety net
            providers for outpatient early intervention services;
      --$550 million for Title VII and Title VIII Health Professions
            programs, particularly Area Health Education Centers, which
            bring together academic and community partners to improve the
            supply and distribution of health professionals in underserved
            communities.
      --$170 million for health information technology (HIT) resources
            through various programs at the Department of Health and Human
            Services. Health centers must have adequate resources through
            HHS to facilitate the utilization of electronic health records
            and other important HIT tools to promote health disparities
            reduction.
                                   conclusion
        America's health centers are grateful to the subcommittee for its
    ongoing efforts to support and stabilize the Health Centers program and
    to expand health centers' reach into more than 5,000 communities
    nationwide. As a result of those efforts, more than 15 million people
    have access to the affordable, effective primary care services that our
    Nation's health centers provide.
        We respectfully ask that the subcommittee continue that investment,
    as the work of caring for our uninsured and medically underserved is
    far from complete. Some 36 million Americans are still without regular
    access to medical services. America's health centers look forward to
    meeting that need and rising to the challenge of providing a health
    care system that works for all Americans. We look forward to working
    with you over the coming year to move toward that goal.
        If you need any additional information or have any questions
    related to health centers or NACHC, please do not hesitate to contact
    me or John Sawyer, Assistant Director of Federal Affairs, at (202) 331-
    4603, or via email at jsawyer@nachc.com.
                                     ______

      Prepared Statement of the National Association for State Community
                               Services Programs
        The National Association for State Community Services Programs
    (NASCSP) thanks this committee for its continued support of the
    Community Services Block Grant (CSBG), and seeks an appropriation of
    $650 million for the State grant portion of the CSBG, the same as its
    fiscal year 2004 appropriation. We are requesting that the CSBG funding
    be restored to the fiscal year 2004 level this year in order for the
    CSBG Network to continue addressing the long-term needs of those
    families affected by Hurricanes Katrina and Rita, those families
    transitioning from welfare to work, and to assist low-income workers in
    remaining at work through supportive services such as transportation
    and child care. It is essential that the CSBG funding be restored in
    full for fiscal year 2007. The across the board cuts the CSBG has
    experienced the past several years have decreased the ability of the
    CSBG Network to provide essential services to low-income Americans.
        In addition, NASCSP urges this Committee to eliminate all
    authorization language regarding the management of the CSBG from the
    fiscal year 2007 appropriation bill. In fiscal year 2006, the
    appropriations bill included authorization language regarding the use
    of the block grant at the State level. Specifically, the fiscal year
    2006 appropriations report included the following authorization
    language which conflicted with ``SEC. 675C. USES OF FUNDS (A)(3) of the
    Public Law 105-285: The Community Opportunities, Accountability, and
    Training and Educational Services Act of 1998 (the CSBG authorization
    law): ``That to the extent Community Services Block Grant funds are
    distributed as grant funds by a State to an eligible entity as provided
    under the Act, and have not been expended by such entity, they shall
    remain with such entity for carryover into the next fiscal year for
    expenditure by such entity consistent with program purposes.''
        The 1998 CSBG Authorization allows CSBG eligible entities to carry
    over up to 20 percent of funds but requires the State to recapture or
    redistribute any funds that exceed 20 percent. According to the 1998
    CSBG Authorization, once these funds are recaptured the State is to
    redistribute the excess funds to other low-income communities in dire
    need of additional funds. When language such as the above is placed in
    the Appropriations document, it overrides the Authorization language.
    The inclusion of such language in the appropriations report caused a
    hardship on States as they managed the block grant. Passing national
    legislation which contradicts the authorization language regarding the
    distribution of funds preempts the prerogative of States. NASCSP urges
    the committee to discourage the incorporation of authorization language
    in the appropriations act.
        NASCSP is the national association that represents State
    administrators of the Community Services Block Grant (CSBG), and State
    directors of the Department of Energy's Low-Income Weatherization
    Assistance Program.
                                   background
        The States believe the Community Services Block Grant (CSBG) is a
    unique block grant that has successfully devolved decision making to
    the local level. Federally funded with oversight at the State level,
    the CSBG has maintained a local network of nearly 1,100 agencies which
    coordinate nearly $9.7 billion in Federal, State, local, and private
    resources each year. Operating in 99 percent of counties in the Nation
    and serving nearly 15.2 million low-income persons, local agencies,
    known as Community Action Agencies (CAAs), provide services based on
    the characteristics of poverty in their communities. For one town, this
    might mean providing job placement and retention services; for another,
    developing affordable housing; in rural areas it might mean providing
    access to health services or developing a rural transportation system.
        Since its inception, the CSBG has shown how partnerships between
    States and local agencies benefit citizens in each State. We believe it
    should be looked to as a model of how the Federal Government can best
    promote self-sufficiency for low-income persons in a flexible,
    decentralized, non-bureaucratic and accountable way.
        Long before the creation of the Temporary Assistance for Needy
    Families (TANF) block grant, the CSBG was setting the standard for
    private-public partnerships that work to the betterment of local
    communities and low-income residents. Family oriented, while promoting
    economic development and individual self-sufficiency, the CSBG relies
    on an existing and experienced community-based service delivery system
    of CAAs and other non-profit organizations to produce results for its
    clients.
            major characteristics of the community services network
        Emergency Response.--CAAs are utilized by Federal and State
    emergency personnel as a frontline resource to deal with emergency
    situations such as floods, hurricanes and economic downturns. They are
    also relied on by citizens in their community to deal with individual
    family hardships, such as house fires or other emergencies.
        In fact, during and after Hurricane Katrina and Rita the State CSBG
    offices and local CAAs quickly mobilized to provide immediate and long-
    term assistance to over 355,000 evacuees. This immediate assistance
    included, but was not limited to, transportation, food, medical check-
    ups, housing, utility deposits, job placement, and clothing. State CSBG
    offices and CAAs across the country coordinated their relief efforts
    with other agencies providing disaster relief assistance such as FEMA,
    Red Cross, and other faith-based and community-based organizations.
        State CSBG offices through their local network of CAAs continue to
    provide the long-term assistance evacuees will need as they relocate
    and re-establish themselves through self-sufficiency and family
    development programs. These programs offer comprehensive approaches to
    selecting and offering supportive services that promote, empower and
    nurture the individuals and families seeking economic self-sufficiency.
    At a minimum, these approaches include:
      --A comprehensive assessment of the issues facing the family or
            family members and of the resources the family brings to
            address these issues;
      --A written plan for becoming more financially independent and self-
            supporting;
      --A comprehensive mix of services that are selected to help the
            participant implement the plan;
      --Professional staff members who are flexible and can establish
            trusting, long-term relationships with program participants;
            and
      --A formal methodology used to track and evaluate progress as well as
            to adjust the plan as needed.
        Additional information on the CSBG Network's Hurricane Katrina
    relief efforts may be found in the attached issue brief.
        Accountable.--The Federal Office of Community Services, State CSBG
    offices and CAAs have worked closely to develop a results-oriented
    management and accountability (ROMA) system. Through this system,
    individual agencies determine local priorities within six common
    national goals for CSBG and report on the outcomes that they achieved
    in their communities.
        Leveraging Capacity.--For every CSBG dollar they receive, CAAs
    leverage $4.87 in non-federal resources (State, local, and private) to
    coordinate efforts that improve the self-sufficiency of low-income
    persons and lead to the development of thriving communities.
        Volunteer Mobilization.--CAAs mobilize volunteers in large numbers.
    In fiscal year 2004, the most recent year for which data are available,
    the CAAs elicited more than 44 million hours of volunteer efforts, the
    equivalent of almost 21,182 full-time employees. Using just the minimum
    wage, these volunteer hours are valued at nearly $227 million.
        Locally Directed.--Tri-partite boards of directors guide CAAs.
    These boards consist of one-third elected officials, one-third low-
    income persons and one-third representatives from the private sector.
    The boards are responsible for establishing policy and approving
    business plans of the local agencies. Since these boards represent a
    cross-section of the local community, they guarantee that CAAs will be
    responsive to the needs of their community.
        Adaptability.--CAAs provide a flexible local presence that
    governors have mobilized to deal with emerging poverty issues.
        The statutory goal of the CSBG is to ameliorate the effects of
    poverty while at the same time working within the community to
    eliminate the causes of poverty. The primary goal of every CAA is self-
    sufficiency for its clients. Helping families become self-sufficient is
    a long-term process that requires multiple resources. This is why the
    partnership of Federal, State, local, and private enterprise has been
    so vital to the successes of the CAAs.
                            who does the csbg serve?
        National data compiled by NASCSP show that the CSBG serves a broad
    segment of low-income persons, particularly those who are not being
    reached by other programs and are not being served by welfare programs.
    Based on the most recently reported data, from fiscal year 2004:
      --More than 2.7 million customer families have incomes at or below
            the poverty level; 1.1 million customer families have incomes
            at or below 50 percent of the poverty guidelines. In 2004, the
            poverty level for a family of three was $15,670.
      --58 percent of adults have a high school diploma or equivalency
            certificate.
      --44 percent of all customer families are ``working poor'' and have
            wages or unemployment benefits as income.
      --23 percent depend on pensions and Social Security and are therefore
            poor, former workers.
      --Almost 430,000 families are TANF participants, 22 percent of the
            average monthly TANF caseload.
      --Nearly 60 percent of families assisted have children under 18 years
            of age.
                        what do local csbg agencies do?
        Since Community Action Agencies operate in rural areas as well as
    in urban areas, it is difficult to describe a typical Community Action
    Agency. However, one thing that is common to all is the goal of self-
    sufficiency for all of their clients. Reaching this goal may mean
    providing day care for a struggling single mother as she completes her
    General Equivalency Diploma (GED) certificate, moves through a
    community college course and finally is on her own supporting her
    family without Federal assistance. It may mean assisting a recovering
    substance abuser as he seeks employment. Many of the Community Action
    Agencies' clients are persons who are experiencing a one-time
    emergency. Others have lives of chaos brought about by many overlapping
    forces--a divorce, sudden death of a wage earner, illness, lack of a
    high school education, closing of a local factory or the loss of family
    farms.
        CAAs provide access to a variety of opportunities for their
    clients. Although they are not identical, most will provide some if not
    all of the services listed below:
      --a variety of crisis and emergency safety net services;
      --employment and training programs;
      --transportation and child care for low-income workers;
      --individual development accounts;
      --micro business development help for low-income entrepreneurs;
      --local community and economic development projects;
      --housing and weatherization services;
      --Head Start;
      --energy assistance programs;
      --nutrition programs;
      --family development programs; and
      --senior services.
        CSBG funds many of these services directly. Even more importantly,
    CSBG is the core funding which holds together a local delivery system
    able to respond effectively and efficiently, without a lot of red tape,
    to the needs of individual low-income households as well as to broader
    community needs. Without the CSBG, local agencies would not have the
    capacity to work in their communities developing local funding, private
    donations and volunteer services and running programs of far greater
    size and value than the actual CSBG dollars they receive.
        CAAs manage a host of other Federal, State and local programs which
    makes it possible to provide a one-stop location for persons whose
    problems are usually multi-faceted. Over half (52 percent) of the CAAs
    manage the Head Start program in their community. Using their unique
    position in the community, CAAs recruit additional volunteers, bring in
    local school department personnel, tap into religious groups for
    additional help, coordinate child care and bring needed health care
    services to Head Start centers. In many States they also manage the Low
    Income Home Energy Assistance Program (LIHEAP), raising additional
    funds from utilities for this vital program. CAAs may also administer
    the Weatherization Assistance Program and are able to mobilize funds
    for additional work on residences not directly related to energy
    savings that, for example, may keep a low-income elderly couple in
    their home. CAAs also coordinate the Weatherization Assistance Program
    with the Community Development Block Grant program to stretch Federal
    dollars and provide a greater return for tax dollars invested. They
    also administer the Women, Infants and Children (WIC) nutrition program
    as well as job training programs, substance abuse programs,
    transportation programs, domestic violence and homeless shelters, as
    well as food pantries.
                            examples of csbg at work
        Since 1994, CSBG has implemented Results-Oriented Management and
    Accountability practices whereby the effectiveness of programs is
    captured through the use of goals and outcomes measures. Below you will
    find the network's first nationally aggregated outcomes achieved by
    individuals, families and communities as a result of their
    participation in innovative CSBG programs during fiscal year 2004:
      --103,057 participants gained employment with the help of community
            action (49 States reporting);
      --13,313 participants obtained ``living wage'' employment with
            benefits (35 States reporting);
      --88,187 low-income participants obtained safe and affordable housing
            in support of employment stability (43 States reporting);
      --510,322 low-income households achieved an increase in non-
            employment financial assets, including tax credits, child
            support payments, and utility savings, as a result of community
            action ($133.5 million in aggregated savings);
      --5,645 families achieved home ownership as a result of community
            action assistance (41 States reporting);
      --56,283 low-income people obtained pre-employment skills and
            received training program certificates or diplomas (47 States
            reporting);
      --30,776 low-income people completed Adult Basic Education or GED
            coursework and received certificates or diplomas (40 States
            reporting);
      --9,647 low-income people completed post-secondary education and
            obtained a certificate or diploma (41 States reporting); and
      --2,284,577 new community opportunities and resources were created
            for low-income families as a result of community action work or
            advocacy, including ``living wage'' jobs, affordable and
            expanded public and private transportation, medical care, child
            care and development, new community centers, youth programs,
            increased business opportunity, food, and retail shopping in
            low-income neighborhoods (46 States reporting).
        All the above considered, NASCSP urges this committee to fund the
    CSBG grant to the States at $650 million.
                                     ______

             Prepared Statement of the National Consumer Law Center
        The National Consumer Law Center (NCLC),\1\ on behalf of our low-
    income clients,\2\ respectfully submits this testimony regarding the
    appropriation of funds for the Low Income Home Energy Assistance
    Program (LIHEAP) \3\ for fiscal year 2007. NCLC and our clients are
    strong supporters of LIHEAP, the primary safety net between low-income
    consumers and the disconnection of vital utility service. The high
    energy prices that squeeze the budgets of low-income households to the
    breaking point show no sign of abating. The recent National Energy
    Assistance Directors' Association (NEADA) national study on LIHEAP
    recipients documents the tremendous value of LIHEAP to low-income
    families as well as the severe sacrifices made by the poor to pay their
    home energy bills.\4\ Low-income families and fixed-income elderly
    clients continue to fall further behind as energy prices have reached a
    new, higher baseline. LIHEAP is essential for their safety and well
    being. We thank the subcommittee for its strong support of the LIHEAP
    program in the fiscal year 2006 appropriations process and, in light of
    the forecasted continued high energy prices, urge the subcommittee to
    consider fully appropriating LIHEAP at $5.1 billion in regular LIHEAP
    funds for fiscal year 2007, the amount authorized under the Energy
    Policy Act of 2005, with advance appropriations of the same amount for
    fiscal year 2008.
    ---------------------------------------------------------------------------
        \1\ The National Consumer Law Center (NCLC) is a nonprofit
    organization that represents the interests of low-income consumers on a
    broad range of issues, including access to adequate and affordable
    supplies of utility service for home heating and cooling. This
    testimony was prepared by Olivia Wein, staff attorney in NCLC's
    Washington, DC office.
        \2\ The Appalachian People's Action Coalition (Ohio); Texas Legal
    Services Center; Action, Inc. (Gloucester, MA); Action for Boston
    Community Development, Inc.
        \3\ 42 U.S.C.  8621 et seq.
        \4\ National Energy Assistance Directors Association, National
    Energy Assistance Survey (April 2004) (NEADA survey) available at
    www.neada.org.
    ---------------------------------------------------------------------------
        Home Energy Prices Are At An All-Time High.--Residential energy
    prices were expected to continue to rise this year, but the disruption
    in the Gulf fuel refineries by the hurricanes sent them skyrocketing.
    Consequently, paying home energy bills has been all the more difficult
    for fixed income seniors and low-income households and has made LIHEAP
    all the more important for these vulnerable families. The Center on
    Budget and Policy Priorities has acknowledged that this year marks the
    ``largest 1-year jump in home heating prices in three decades.'' \5\
    According to Guy Caruso, Administrator of the Energy Information
    Administration at the U.S. Department of Energy, ``several factors are
    driving up winter prices and expenditures: first, international factors
    such as low spare crude oil capacity and political tensions contribute
    to uncertainty and low supply growth for crude oil and high crude
    prices; second, recent hurricanes and associated disruptions exacerbate
    already tight markets in oil, petroleum products, and natural gas; and,
    finally, winter weather affects consumption and consequently household
    expenditures.'' \6\ The summer heat is also dangerous, especially for
    the elderly, the very young and those with chronic diseases.
    Unfortunately, the vast majority of newer electric generation plants
    rely on natural gas, thus tying electricity prices to the volatile
    natural gas prices. Taking all of these factors into account, it is
    obvious how critical LIHEAP's heating and cooling assistance is to the
    livelihood of so many families. The mounting increases in essential
    residential energy prices as illustrated in the chart below are putting
    more and more families' health and safety at risk.
    ---------------------------------------------------------------------------
        \5\ Center on Budget and Policy Priorities. ``Steep Spike in Energy
    Costs Increases Low-Income Households' Need For Help Paying Heating
    Bills This Winter'' (Oct. 6, 2005).
        \6\ Statement of Guy Caruso, Administrator for the Energy
    Information Administration, U.S. Department of Energy before the
    Committee on Energy and Natural Resources, United States Senate. Full
    Committee Hearing--Winter Fuels Outlook (Oct. 18, 2005).
    ---------------------------------------------------------------------------
        More Households Than Ever Cannot Keep Up With Costs Of Home
    Energy.--Although the costs of home energy have been a burden to most
    Americans, those with low incomes have been hurt the most. The salary
    for low-income Americans has stayed relatively flat while the cost of
    living has gone up, resulting in even more challenging struggles just
    to make ends meet for many families. According to Dr. Meg Power of
    Economic Opportunity Studies, families below 150 percent of the Federal
    poverty guideline spend on average about $1,470 on energy costs, about
    19 percent of their total yearly income. In 2005, however, low income
    families were expected to pay more than $1,650.\7\ Those prices will
    only go up for 2006. Having their heat switched off is a real
    possibility for numerous low-income households, and although there are
    winter utility shut-off moratoria in place for many States, not every
    home is protected against energy shut-offs in the middle of winter. As
    we approach the lifting of winter shut-off moratoria, we expect to see
    a wave of disconnections as households are unable to afford the cost of
    the energy bills. In the summer, the inability to keep the home cool
    can be lethal, especially to seniors. According to the CDC, in 2001 300
    deaths were caused by excessive heat exposure and seniors and young
    children are particularly vulnerable to heat stress.\8\ The CDC also
    notes that air-conditioning is the number one protective factor against
    heat-related illness and death.\9\
    ---------------------------------------------------------------------------
        \7\ Meg Power, PhD. Economic Opportunity Studies. ``Energy Bills of
    Low-Income Consumers in Fiscal Year 2005, The Resources Available to
    Help Them Pay, and the Impact on Their Household Budgets'' (Nov. 23,
    2004).
        \8\ CDC, ``Extreme Heat: A Prevention Guide to Promote Your
    Personal Health and Safety'' available at www.bt.cdc.gov/disasters/
    extremeheat/heat_guide.asp.
        \9\ Id.
    ---------------------------------------------------------------------------
        Iowa.--Despite milder winter temperatures this winter, the sharp
    rise in natural gas prices has set back a record number of low-income
    households in Iowa. The number of low-income households with past due
    energy accounts as of January 2006 is 14.7 percent higher than the same
    time last year and 162 percent higher than the number in January 1999.
    The total amount of arrearages of LIHEAP households has also grown
    sharply due to the increase in prices. By January 2006, the total
    amount of LIHEAP household arrearages had increased 32 percent from the
    same period in 2005 and 169 percent compared to the same period in
    1999. The total number of LIHEAP households increased 8 percent from
    this same period last year.\10\
    ---------------------------------------------------------------------------
        \10\ National Energy Assistance Directors, ``Est. Total Households
    Receiving LIHEAP Heating Assistance by State--Projected Applications
    for Fiscal Year 2006'' (2/13/06).
    ---------------------------------------------------------------------------
        Ohio.--In Ohio, the number of households entering into the State's
    low-income energy affordability program, the Percentage of Income
    Payment Program (PIPP), increased 23 percent from January 2005 to
    January 2006. The increase is even more dramatic at 84 percent, when
    comparing PIPP enrollment from January 2002 to January 2006. The total
    dollar arrearage amounts for PIPP customers also increased 27 percent
    from January 2005 to January 2006. Likewise, the total PIPP arrearages
    have increased dramatically, 84 percent, from January 2002 to January
    2006. Ohio's LIHEAP program expects to provide heating assistance to
    almost 5 percent more households in fiscal year 2006 than in fiscal
    year 2005 (and almost 30 percent more households when compared to Ohio
    households that received heating assistance in fiscal year 2002).\11\
    ---------------------------------------------------------------------------
        \11\ Based on date from the National Energy Assistance Directors,
    ``Est. Total Households Receiving LIHEAP Heating Assistance by State--
    Projected Applications for Fiscal Year 2006 (2/13/06)'' and ``Estimated
    Total Households Receiving LIHEAP Heating Assistance by State Actuals
    in 2002, 2003; Projected in 2004.'' Available at www.neada.org.
    ---------------------------------------------------------------------------
        Pennsylvania.--Utilities in Pennsylvania that are regulated by the
    Pennsylvania Public Utility Commission (PA PUC) have established
    universal service programs that assist utility customers in paying
    bills and reducing energy usage. Even with these programs, electric and
    natural gas utility customers find it difficult to keep pace with their
    energy burdens. The PA PUC estimates that approximately 21,000
    households entered the current heating season without heat-related
    utility service--this number includes about 4,000 households who are
    heating with potentially unsafe heating sources such as kerosene space
    heaters. This is an increase of 68 percent when compared to the average
    number entering the heating season without heat for the years 2000-
    2003. An additional 17,500 residences where service was previously
    terminated are now vacant.\12\ In 2005, the number of terminations
    increased 52 percent compared with terminations in 2004.\13\ As of
    January 2006, 17.48 percent of residential electric customers and 18.19
    percent of natural gas customers are overdue on their energy bills. As
    of February 2006, Pennsylvania projected serving 354,065 LIHEAP
    applicants in fiscal year 2005, an 8.2 percent increase over the prior
    year.\14\
    ---------------------------------------------------------------------------
        \12\ http://www.puc.state.pa.us/general/press_releases/
    press_releases.aspx?ShowPR=1435.
        \13\ http://www.puc.state.pa.us/general/pdf/Terminations_Table_Jan-
    Dec04-05.pdf
        \14\ http://www.neada.org/news/news060213_liheap06projections.pdf
    ---------------------------------------------------------------------------
        LIHEAP Helps These Vulnerable Households.--Growing utility
    arrearages for low-income households will only place these fragile
    households on a downward spiral towards disconnections. Adequate LIHEAP
    assistance can help families facing terminations, but, even more
    importantly, adequate LIHEAP appropriations can help struggling
    families maintain vital energy services and protect the health and
    safety of vulnerable seniors, families with young children or disabled
    family members. The recent NEADA national energy assistance survey
    found that 48 percent of LIHEAP recipients would have had their
    electricity or home heating fuel discontinued if LIHEAP had not been
    available.\15\
    ---------------------------------------------------------------------------
        \15\ NEADA Survey, Table 47.
    ---------------------------------------------------------------------------
        The Need For LIHEAP Is Greater Than Ever.--The continued sharp rise
    in residential energy prices is expected for the near future. The data
    from Iowa, Ohio and Pennsylvania, which are amongst the few States that
    collect residential utility customer payment data, show that even in a
    milder than normal winter, the prices have risen to such a degree that
    an increasing number of low-income households is falling behind. This
    year's dramatic rise in residential energy prices has yielded the
    greatest number of LIHEAP applications in 12 years.\16\ Last year, the
    number of eligible recipients for LIHEAP climbed to 32 million;
    however, only around 5 million were able to benefit from it.
    ---------------------------------------------------------------------------
        \16\ http://www.neada.org/news/news060213_liheap06projections.pdf.
    ---------------------------------------------------------------------------
        The Consequences Of Unaffordable Energy Bills Are Dire.--When
    people are unable to afford paying their home energy bills, many
    dangerous and unhealthy actions are often taken. Common practices
    include resorting to alternative heating sources, such as space
    heaters, ovens and burners, all of which are huge fire hazards;
    numerous deaths due to fires started by space heaters have already
    occurred this year and are a recurring problem every year. According to
    the U.S. Consumer Product Safety Commission, about 25,000 fires in
    homes are caused by space heaters and 300 people are killed because of
    them every year in the United States.\17\ Other dangerous practices
    include illegal gas hookups that create dangerous gas leaks, keeping
    the thermostat at unhealthy and sometimes hypothermic temperatures (and
    hyperthermic temperatures in the summer). Those who cannot afford their
    winter heating bill often face dire choices such as sacrificing food,
    medical care or prescription medicine.\18\ In the summer, the inability
    to afford cooling bills can result in heat-related deaths and illness.
    The loss of essential utility services can be devastating, especially
    for poor families that can find themselves facing the prospects of
    hypothermia in the winter, hyperthermia in the summer,\19\ eviction,
    property damage from frozen pipes, the use of dangerous alternative
    sources of heat,\20\ and the potential threat of the intervention of
    child welfare agencies.\21\ Studies have also demonstrated the clear
    links between homelessness and utility disconnections, as well as the
    connections between unaffordable utility service and the disruption to
    families and children's education. LIHEAP works to bring fuel costs
    within a manageable range for low-income households. There are other
    societal benefits to a strong LIHEAP. A recent study documents an
    association between receipt of LIHEAP assistance and a reduced
    incidence of undernutrition in young children.\22\
    ---------------------------------------------------------------------------
        \17\ U.S. Department of Energy: A Consumer's Guide to Energy
    Efficiency and Renewable Energy. http://www.eere.energy.gov/consumer/
    your_home/space_heating_cooling/index.cfm/mytopic=12600.
        \18\ NEADA Survey, Table 39. To pay their energy bills, 22 percent
    of LIHEAP recipients went without food, 38 percent went without medical
    or dental care, 30 percent did not fill or took less than the full dose
    of a prescribed medicine.
        \19\ From 2000 to 2003, approximately 50 percent-68 percent of
    heat-related deaths were 60 years old or older. Office of Climate,
    Water and Weather Services, Heat Related Fatalities by Age and Gender,
    reports for 2000--2003.
        \20\ In 1998 there were over 49,000 heating-equipment related home
    fires resulting in 388 deaths and 1,445 injuries and $515 million in
    property damage. National Fire Protection Association Fact Sheets on
    Home Heating, in United States Home Heating Fire Patterns and Trends,
    John H. Hall, Jr., NFPA, June 2001.
        \21\ Robert B. Swift, Rising Costs for Home Heating Fuel Could
    Spawn More Problems, Sunbury (PA) Item, Jan. 29, 2000.
        \22\ Pediatric Academic Societies, Publication #921, Platform
    Presentation, Epidemiology Session, May 6, 2003, Seattle, WA:
    Children's Sentinel Nutrition Assessment Program: Heat or Eat: Low
    Income Home Energy Assistance Program and Nutritional Risk Among
    Children < 3.
    ---------------------------------------------------------------------------
        People are putting themselves at risk when they do not have
    sufficient funds to pay their home energy bills, but LIHEAP can and
    does come to their aid and does greatly alleviate some of the hardship
    caused by high energy bills. With the assistance of LIHEAP, households
    will not have to make such unconscionable, dangerous sacrifices.
        The Need for Advance Appropriations is Critical.--The timing of the
    release of the LIHEAP block grant to the States is critical for the
    effective and efficient operation of the State programs. The normal
    appropriations process leaves very little time between enactment of the
    Labor-HHS-Education spending bill and the start of most States' heating
    programs. An advance appropriation is essential for States to determine
    income guidelines and benefit levels well ahead of time and for
    properly planning the components of their program year (e.g., amounts
    set aside for heating, cooling and emergency assistance,
    weatherization, self sufficiency and leveraging activities). Without
    advance appropriations, delayed passage of the spending bill can force
    States to open their winter heating program without knowledge of their
    final grant amount. Advance appropriations shield States from
    disruption of the start-up of their winter heating programs if there is
    a delay in the passage of the Labor-HHS-Education spending bill.
        LIHEAP Works.--LIHEAP is a targeted block grant that assists
    vulnerable low-income households with the costs of home energy.
    According to the U.S. Department of Health and Human Services, one-
    third of households receiving LIHEAP heating and cooling assistance had
    an elderly member; over 30 percent of households receiving heating and
    cooling assistance had a member with a disability; and almost one third
    of households receiving heating assistance and around a fifth of
    households receiving cooling assistance had young children. In fiscal
    year 2001, LIHEAP recipient households had a mean individual energy
    burden almost five times the energy burden for non-low income
    households.\23\ A While there are broad Federal guidelines for LIHEAP,
    States have the flexibility to tailor their programs to best meet their
    needs. Administrative costs are minimal--capped at 10 percent. This
    ensures that the vast majority of LIHEAP dollars are directed to energy
    assistance for low-income families.
    ---------------------------------------------------------------------------
        \23\ U.S. Department of Health and Human Services, Administration
    for Children and Families, Office of Community Services, Division of
    Family Assistance, LIHEAP Home Energy Notebook for Fiscal Year 2001
    (February 2003), Table A-2b, p. 49.
    ---------------------------------------------------------------------------
        The National Association of Regulatory Utility Commissioners
    (NARUC), the National Energy Assistance Directors Association and the
    National Fuel Funds Network also support fully funding the regular
    block grant LIHEAP program at $5.1 billion.
        Conclusion.--In light of the continued projected increase in
    residential energy costs and LIHEAP's continued demonstrated success in
    helping low-income families maintain access to vital energy service, we
    urge the subcommittee to appropriate $5.1 billion for the regular
    LIHEAP program in fiscal year 2007 as well as advance appropriations
    for fiscal year 2008 of $5.1 billion for the regular program. Thank you
    for consideration of our testimony.
                                     ______

              Prepared Statement of the National Kidney Foundation
        The National Kidney Foundation (NKF), a voluntary health
    organization whose membership includes patients and families; organ
    transplant recipients; families who have donated the organs of loved
    ones for transplantation and living organ donors; and health care
    professionals, is pleased to submit public witness testimony for the
    written record in support of fiscal year 2007 Appropriations.
        We are very appreciative of the $1,800,000 in funding that Congress
    provided in fiscal year 2006 to establish a Chronic Kidney Disease
    (CKD) program within the Centers for Disease Control and Prevention
    (CDC). As the subcommittee drafts the fiscal year 2007 Labor, Health
    and Human Services, and Education Appropriations Bill, we respectfully
    request your continued support for funding to expand these activities,
    as outlined below. Unfortunately, the administration did not request
    continued funding for this program in its 2007 Budget Request.
                        impact of chronic kidney disease
        The implications of kidney disease for the public are considerable,
    yet the average American is relatively unaware of its consequences.
    Twenty million Americans have CKD, and another 20 million are at risk
    of developing the disease, but most people with kidney disease do not
    know they have it and will not be diagnosed until it has threatened
    their health and even their lives. Individuals with diabetes or
    hypertension are especially vulnerable.
        Kidney disease is the 9th leading cause of death in the United
    States, and death by cardiovascular disease is 10 to 30 times higher in
    kidney dialysis patients than in the general population. Kidney disease
    is associated with 25 percent of the Medicare budget and 7 percent of
    the Medicare population has a diagnosis of kidney disease. Further, the
    number of individuals with end stage renal disease (ESRD), irreversible
    kidney failure requiring either dialysis or a transplant to remain
    alive, is expected to increase from 382,000 patients in 2000 to 712,000
    by 2015. Effective treatments are available to reduce morbidity and
    mortality resulting from kidney disease and its complications and to
    retard progression to kidney failure. However, CKD is not being
    detected sufficiently early to initiate treatment regimens and reduce
    death and disability. NKF believes a public health approach would
    contribute toward early detection and treatment, thereby reducing
    hardship and saving money and lives.
                              2006 cdc activities
        NKF is working closely with CDC to implement this program and we
    are very pleased with the progress to date. CDC intends to use the
    current-year appropriation to identify and coordinate sources for CKD
    data; propose solutions to fill data deficiencies; undertake a
    surveillance system feasibility study; fund pilot projects in selected
    States; and, organize an expert consensus conference to lay the
    groundwork for a Public Health Kidney Disease Strategic Plan. Earlier
    this year, CDC requested proposals to support the development of a
    comprehensive CKD surveillance system. The agency expects to award two
    grants in 2006 designed to identify sources of CKD data, as well as
    gaps and deficiencies in existing data. The program will also propose
    solutions to remedy deficiencies, including the execution of a
    feasibility study and pilot test for a surveillance system. Additional
    activities in 2006 will include studies of the economic benefit of CKD
    intervention.
                            fiscal year 2007 request
        A restoration of funding to the 2006 level would enable CDC to
    continue planning for capacity and infrastructure for a kidney disease
    epidemiology, research and health outcomes program and to institute a
    CKD surveillance system. We are hopeful for a funding increase over
    fiscal year 2006, which would enable the agency to expand the number
    and scope of grants to support State-based community demonstration
    projects for CKD detection and treatment, a core component of this CKD
    initiative. We envision this would include tracking the progression of
    CKD in patients who have been diagnosed, as well as identify the onset
    of kidney disease among individuals who are members of high risk
    groups.
        We thank you for your past support of this initiative and
    respectfully request your continued support, to enable CDC and the
    public health community to move forward to address the growing concern
    of Chronic Kidney Disease.
                                     ______

             Prepared Statement of the National League for Nursing
        The National League for Nursing (NLN)--representing more than 1,100
    nursing schools and health care agencies, some 17,000 individual
    members comprised of nurses, educators, administrators, public members,
    and 18 constituent leagues--appreciates the subcommittee's past support
    for nursing education and your continued recognition of the important
    role nurses play in the delivery of health care services.
        We, however, are concerned. Unless additional resources are
    expended, the advancements made by Congress to help alleviate the
    nursing shortage will be impeded owing to the currently proposed fiscal
    year 2007 appropriations level. The NLN advocates your continued
    support for Title VIII--Nursing Workforce Development Programs (Public
    Health Services Act), housed in the Health Resources and Services
    Administration (HRSA) with the congressionally prescribed mission of
    ensuring a sufficient supply of nurses. We urge you to fund the Title
    VIII programs at a minimum level of $175 million for fiscal year 2007.
    Placing this minimal funding request in perspective, note that during
    the last serious nursing shortage in 1974, Congress appropriated $153
    million for nurse education programs. In today's dollars that
    appropriation would equate to approximately $592 million, nearly four
    times the amount the Federal Government is spending on nurse education
    now.
        Today's nursing shortage is very real and very different from any
    experienced in the past. The existing shortage is evidenced by an aging
    workforce and too few people entering the profession. A critical factor
    exacerbating the national nurse-workforce deficiency is the declining
    number of qualified nurses available to teach future generations of
    registered nurses. The NLN's Faculty Survey conducted in 2002 concludes
    that not enough qualified nurse educators exist to teach the number of
    nurses necessary to ameliorate the nursing shortage.
        The NLN Survey found three trends influencing the future of nursing
    education over the next decade:
    The aging of the nurse faculty population
        An average of 1.3 full-time faculty members per program left their
    positions in nursing education in 2002. About half the survey
    respondents had at least one unfilled budgeted full-time faculty
    position and some had as many as 15 such positions. 36.5 percent of
    faculty who left their positions in the preceding year did so because
    of retirement; 8.6 percent of faculty were 61 years of age or older;
    and 75 percent of the current faculty population is expected to retire
    by 2019.
        Approximately 1,800 full-time faculty members leave their positions
    each year. About 10,000 master's level nurses graduate per year, 15
    percent of whom would have to enter teaching in order to maintain
    today's production level for generating the Nation's nurse workforce.
    Since this is highly unlikely, the gap between unfilled positions and
    the candidate pool is widening significantly.
    The increasing number of part-time faculty
        The number of part-time faculty has increased notably since 1996--
    nearly 17 percent in baccalaureate programs and 14 percent in associate
    degree programs. Part-time faculty now provides approximately 23
    percent of the estimated number of faculty FTEs.
        Part-time employees often are not an integral part of the design,
    implementation, and evaluation of the overall nursing education
    program. Many may hold other positions that often limit their
    availability to students. Further, many part-time faculty have not been
    prepared for the faculty role.
    The large number of nursing faculty who are not prepared at the
            doctoral level
        Approximately half the full-time faculties in baccalaureate and
    higher-degree programs hold a doctoral degree. In associate degree
    programs, doctorally-prepared faculty account for only 6.6 percent of
    the total faculty and the number is slightly more than 5 percent in
    diploma programs. Only 350 to 400 nursing students receive doctoral
    degrees each year and the pool of doctorally-prepared candidates for
    full-time nursing professorships is very limited.
        Educators without doctoral degrees may lack credibility within a
    university setting and have limited opportunities to assume leadership
    positions. Institutions with low numbers of doctorally-prepared
    educators may be less likely to obtain funds to support research or
    educational innovations. As important as educational incentives are for
    future practicing nurses, the scholarships for doctoral students who
    will instruct the next generation of nurses are even more critical.
        Since less than an adequate number of nurse educators currently
    teach in the education pipeline, the situation appears to be growing
    acute and is not expected to improve in the near future absent adequate
    intervention. In a survey of the 2004-2005 academic year conducted by
    the NLN, an estimated 147,000 qualified applications were turned away
    from nursing programs at all degree levels owing in large part to the
    lack of faculty necessary to teach this number of additional students.
    This number represents a 17.6 percent increase from the 2003-2004
    academic year. With an increasing application pool, a key priority in
    tackling the nurse shortage has to be scaling up the capacity to accept
    qualified applicants. Today's undersized supply of appropriately
    prepared nurses and nurse faculty does not bode well for meeting the
    needs of a diverse, aging population.
        Congress made an important step in passing the Nurse Reinvestment
    Act in 2002. The new monies used to fund loans and scholarships are
    appreciated. Yet, it has become abundantly clear that significantly
    more funding is required to even minimally meet the HRSA charge to
    support nursing students and schools of nursing so as to meet the
    existing and rising national needs for nurses. In fiscal year 2005,
    HRSA was forced to turn away 82 percent of the applicants for the Nurse
    Education Loan Repayment Program and more than 98 percent of the
    applicants for the Nursing Scholarship Program due to lack of adequate
    funding.
        Please do not allow the Nation to lose ground in the effort to
    remedy the nursing shortage. Fund Title VIII--Nursing Workforce
    Development Programs at a level commensurate with the severity of the
    health care crisis facing the Nation today. Your support will help
    ensure that nurses exist in the future who are prepared and qualified
    to take care of you, your family, and all those in this country who
    will need our care.
                                     ______

               Prepared Statement of the Oncology Nursing Society
        The Oncology Nursing Society (ONS) appreciates the opportunity to
    submit written comments for the record regarding fiscal year 2007
    funding for cancer and nursing related programs. ONS, the largest
    professional oncology group in the United States composed of more than
    33,000 nurses and other health professionals, exists to promote
    excellence in oncology nursing and the provision of quality care to
    those individuals affected by cancer. As part of its mission, the
    Society honors and maintains nursing's historical and essential
    commitment to advocacy for the public good.
        This year more than 1.4 million Americans will be diagnosed with
    cancer and more than 565,000 will lose their battle with this terrible
    disease. Despite these grim statistics, significant gains in the War
    Against Cancer have been made through our Nation's investment in cancer
    research and its application. Research holds the key to improved cancer
    prevention, early detection, diagnosis, and treatment, but such
    breakthroughs are meaningless unless we can deliver them to all
    Americans in need. Recent studies have reported 126,000 registered
    nurse vacancies in hospitals and 13,900 registered nurse vacancies in
    nursing homes. Moreover, a recent survey of ONS members found that the
    nursing shortage is having an adverse impact in oncology physician
    offices and hospital outpatient departments. Some respondents indicated
    that when a nurse leaves their practice that they are unable to hire a
    replacement due to the shortage--leaving them short-staffed and posing
    scheduling challenges for the practice and the patients. These
    vacancies in all care settings create significant barriers to ensuring
    access to quality care.
        To ensure that all people with cancer have access to the
    comprehensive, quality care they need and deserve, ONS advocates on-
    going and significant Federal funding for cancer research and
    application, as well as funding for programs that help ensure an
    adequate oncology nursing workforce to care for people with cancer. The
    Society stands ready to work with policymakers at the local, State, and
    Federal levels to advance policies and programs that will reduce and
    prevent suffering from cancer and sustain and strengthen the Nation's
    nursing workforce.
        securing and maintaining an adequate oncology nursing workforce
        Oncology nurses are on the front lines in the provision of quality
    cancer care for individuals with cancer--administering chemotherapy,
    managing patient therapies and side-effects, working with insurance
    companies to ensure that patients receive the appropriate treatment,
    providing counseling to patients and family members, and engaging in
    myriad other activities on behalf of people with cancer and their
    families. Cancer is a complex, multifaceted chronic disease, and people
    with cancer require specialty-nursing interventions at every step of
    the cancer experience. People with cancer are best served by nurses
    specialized in oncology care, who are certified in that specialty.
    Overall, age is the number one risk factor for developing cancer.
    Approximately 77 percent of all cancers are diagnosed at age 55 and
    older. Currently, Medicare beneficiaries account for more than 50
    percent of all cancer diagnoses and 64 percent of cancer deaths. Over
    the next 10 to 15 years the number of Medicare beneficiaries with
    cancer is estimated to double while, according to U.S. Department of
    Labor estimates, more than 1.1 million registered nursing vacancies
    will need to be filled by 2012 to meet growing patient demand and
    replace retiring nurses.
        As the overall number of nurses will drop precipitously in the
    coming years, we likely will experience a commensurate decrease in
    number of nurses trained in the specialty of oncology. With an
    increasing number of people with cancer needing high quality health
    care, coupled with an inadequate nursing workforce, our Nation could
    quickly face a cancer care crisis of serious proportion with limited
    access to quality cancer care, particularly in traditionally
    underserved areas. A study in the New England Journal of Medicine found
    that nursing shortages in hospitals are associated with a higher risk
    of complications--such as urinary tract infections and pneumonia,
    longer hospital stays, and even patient death. Without an adequate
    supply of nurses, there will not be enough qualified oncology nurses to
    provide the quality cancer care to a growing population of people in
    need and patient health and well-being could suffer.
        Further, of additional concern is that our Nation also will face a
    shortage of nurses available and able to conduct cancer research and
    clinical trials. With a shortage of cancer research nurses, progress
    against cancer will take longer because of scarce human resources
    coupled with the reality that some practices and cancer centers
    resources could be funneled away from cancer research to pay for the
    hiring and retention of oncology nurses to provide direct patient care.
    Without a sufficient supply of trained, educated, and experienced
    oncology nurses, our Nation may falter in its delivery and application
    of the benefits from our Federal investment in research.
        ONS has joined with others in the nursing community in advocating
    $175 million as the fiscal year 2007 funding level necessary to support
    implementation of the Nurse Reinvestment Act and the range of nursing
    workforce programs housed at the U.S. Health Resources and Services
    Administration (HRSA). Enacted in 2002, the Nurse Reinvestment Act
    included new and expanded initiatives, including loan forgiveness,
    scholarships, career ladder opportunities, and public service
    announcements to advance nursing as a career. Despite the enactment of
    this critical measure, HRSA fails to have the resources necessary to
    meet the current and growing demands for our Nation's nursing
    workforce. For example, in fiscal year 2005, HRSA was forced to turn
    away 82 percent of the applicants for the Nurse Education Loan
    Repayment Program and over 98 percent of the applicants for the Nursing
    Scholarship Program due to lack of adequate funding.
        While a number of years ago one of the biggest factors associated
    with the shortage was a lack of interested and qualified applicants,
    due to the efforts of the nursing community and other interested
    stakeholders, the number of applicants is growing. As such, now one of
    the greatest factors contributing to the shortage is that nursing
    programs are turning away qualified applicants to entry-level
    baccalaureate programs due to a shortage of nursing faculty. According
    to the American Association of Colleges of Nursing (AACN), at least
    32,617 of such qualified applicants were turned away in 2004 alone.
    Many of these qualified students are being placed on waiting lists that
    may be as long as 2 years or more. The National League for Nursing
    (NLN) released a preliminary report in December 2005 that showed that
    due to faculty shortages, in total schools of nursing were forced to
    reject more that 147,000 qualified applications for 2005, an 18 percent
    increase over 2004 figures. The number of full-time nursing faculty
    required to ``fill the nursing gap'' is approximately 40,000 and
    currently there are less than 20,000 full-time nursing faculty in the
    system. The nurse faculty shortage is only expected to worsen with time
    as faculty age continues to climb, averaging 52 years in 2004.
    Significant numbers of faculty are expected to retire in the coming
    years with insufficient numbers of candidates in the pipeline to take
    their places. If funded sufficiently, the components and programs of
    the Nurse Reinvestment Act will help address the multiple factors
    contributing to the nursing shortage.
        ONS strongly urges Congress to provide HRSA with a minimum of $175
    million in fiscal year 2007 to ensure that the agency has the resources
    necessary to fund a higher rate of nursing scholarships and loan
    repayment applications and support other essential endeavors to sustain
    and boost our Nation's nursing workforce. Nurses--along with patients,
    family members, hospitals, and others--have joined together in calling
    upon Congress to provide this essential level of funding. One Voice
    Against Cancer (OVAC), a collaboration of more than 45 national
    nonprofit organizations representing millions of Americans, also
    advocates $175 million for the Nurse Reinvestment Act in fiscal year
    2007. ONS and its allies have serious concerns that without full
    funding, the Nurse Reinvestment Act will prove an empty promise and the
    current and expected nursing shortage will worsen, and people will not
    have access to the quality care they need and deserve.
     boost our nation's investment in cancer prevention, early detection,
                                 and awareness
        Approximately two-thirds of cancer cases are preventable through
    lifestyle and behavioral factors and improved practice of cancer
    screening. Although the potential for reducing the human, economic, and
    social costs of cancer by focusing on prevention and early detection
    efforts remains great, our Nation does not invest sufficiently in these
    strategies. While as a Nation we spend almost a trillion dollars a year
    on our health care system, we only allocate approximately 1 percent of
    that amount for population-based prevention efforts. By 2020, cancer
    and other chronic disease expenditures will reach $1 trillion or 80
    percent of health care costs. The Nation must make significant and
    unprecedented Federal investments today to address the burden of cancer
    and other chronic diseases, and to reduce the demand on the healthcare
    system and diminish suffering in our Nation both for today and
    tomorrow.
        As the Nation's leading prevention agency, the Centers for Disease
    Control and Prevention (CDC) plays an important role in translating and
    delivering at the community level what is learned from research.
    Therefore, ONS joins with our partners in the cancer community--
    including OVAC--in calling on Congress to provide additional resources
    for the CDC to support and expand much-needed and proven effective
    cancer prevention, early detection, and risk reduction efforts.
    Specifically, ONS advocates the appropriation of $427.5 million in
    fiscal year 2007 for the CDC's comprehensive cancer, ovarian cancer,
    breast and cervical cancer early detection, cancer registries, prostate
    cancer, colorectal cancer, and skin cancer programs. ONS also urges a
    funding increase for the CDC's physical activity, nutrition, and
    tobacco-control programs to help reduce risk factors for developing
    cancer and other chronic diseases. ONS advocates the following fiscal
    year 2007 funding levels:
      --$250 million for the National Breast and Cervical Cancer Early
            Detection Program;
      --$65 million for the National Cancer Registries Program;
      --$25 million for the Colorectal Cancer Prevention and Control
            Initiative;
      --$50 million for the Comprehensive Cancer Control Initiative;
      --$20 million for the Prostate Cancer Control Initiative;
      --$5 million for the National Skin Cancer Prevention Education
            Program;
      --$7.5 million for the Ovarian Cancer Control Initiative;
      --$5 million for the Geraldine Ferraro Blood Cancer Program;
      --$145 million for the National Tobacco Control Program; and
      --$70 million for the Nutrition, Physical Activity, and Obesity
            Program.
                sustain and seize cancer research opportunities
        Our Nation has benefited immensely from past Federal investment in
    biomedical research at the National Institutes of Health (NIH). ONS has
    joined with the broader health community in advocating $29.7 billion
    for NIH in fiscal year 2007. This will allow NIH to sustain and build
    on its research progress resulting from the recent doubling of its
    budget while avoiding the severe disruption to that progress that would
    result from a minimal increase. Cancer research is producing
    extraordinary breakthroughs--leading to new therapies that translate
    into longer survival and improved quality of life for cancer patients.
    We have seen extraordinary advances in cancer research resulting from
    our national investment that have produced effective prevention, early
    detection and treatment methods for many cancers. To that end, ONS
    calls upon Congress to allocate $5.034 billion to the National Cancer
    Institute (NCI) in fiscal year 2007 to continue our battle against
    cancer.
        The National Institute of Nursing Research (NINR) supports basic
    and clinical research to establish a scientific basis for the care of
    individuals across the life span--from management of patients during
    illness and recovery to the reduction of risks for disease and
    disability and the promotion of healthy lifestyles. These efforts are
    crucial in translating scientific advances into cost-effective health
    care that does not compromise quality of care for patients.
    Additionally, NINR fosters collaborations with many other disciplines
    in areas of mutual interest such as long-term care for older people,
    the special needs of women across the life span, bioethical issues
    associated with genetic testing and counseling, and the impact of
    environmental influences on risk factors for chronic illnesses such as
    cancer. ONS joins with the nursing community in advocating an
    allocation of $150 million for NINR in fiscal year 2007.
                                   conclusion
        ONS stands ready to work with policymakers to advance policies and
    support programs that will reduce and prevent suffering from cancer and
    sustain and strengthen our Nation's nursing workforce. Moreover, ONS
    maintains a strong commitment to working with Members of Congress,
    other nursing societies, patient organizations, and other stakeholders
    to ensure that the oncology nurses of today continue to practice
    tomorrow and that we recruit and retain new oncology nurses to meet the
    unfortunate growing demand that we will face in the coming years. Thank
    you for this opportunity to discuss the fiscal year 2007 funding levels
    necessary to ensure that our Nation has a sufficient nursing workforce
    to care for the patients of today and tomorrow and that our Nation
    continues to make gains in our fight against cancer.
                                     ______

           Prepared Statement of the Pancreatic Cancer Action Network
        On behalf of The Pancreatic Cancer Action Network (PanCAN), I thank
    you for this opportunity to present written testimony to the Labor,
    Health and Human Services, and Education subcommittee of the House
    Appropriations Committee.
        PanCAN was founded in 1999 to focus national attention on the need
    to find the cure for pancreatic cancer. We provide public and
    professional education that embraces the urgent need for more research,
    effective treatments, prevention programs, and early detection methods.
    PanCAN is the first and only national patient based advocacy
    organization specifically focused on pancreatic cancer. We now have a
    full time staff of 30 individuals, and 90 ``Team Hope'' affiliates in
    communities across the country, comprised of thousands of volunteers
    who seek to increase awareness about this disease, raise funds, and
    voice their concern that there is a desperate need to find a cure for
    pancreatic cancer.
                        background on pancreatic cancer
        Every 17 minutes, someone in the United States dies form pancreatic
    cancer. It is the 4th leading cause of cancer death in the Untied
    States. The facts on pancreatic cancer are striking:
      --Over 33,730 Americans will be diagnosed with pancreatic cancer in
            2006, and 32,300 will die from this disease.
      --The 99 percent mortality rate is the highest of any cancer.
      --There are no early detection methods.
      --The average life expectancy after diagnosis with metastatic disease
            is just 3 to 6 months.
        Yet, despite these statistics, pancreatic cancer receives the least
    amount of research funding from the Federal Government of all major
    cancers. Federal funding for pancreatic cancer research totaled roughly
    $66 million in fiscal year 2005, a mere 1 percent of the National
    Cancer Institute's (NCI's) $4.825 billion research budget. While good
    progress is being made in early detection, research and treatment
    programs for some cancers, this is clearly not the case for pancreatic
    cancer.
        Pancreatic cancer is the deadliest cancer for one reason: limited
    Federal funding opportunities discourage researchers from pursuing
    pancreatic cancer as a focus. There are less than 15 fully-funded
    researchers nationwide who are specifically dedicated to this disease.
    The combination of few dollars and few researchers means there has been
    very little scientific progress.
        PanCAN has outlined opportunities below for the Federal Government
    to take specific actions to facilitate progress in combating this
    disease.
    Provide Adequate Funding Increases for Cancer Research, Prevention, and
            Treatment Programs
        Pancreatic cancer is the country's fourth leading cause of cancer
    death, killing over 33,730 people annually, yet it remains severely
    under-funded when comparing NCI funding levels for the top five cancers
    based on mortality. The NCI spent a reported $66 million on pancreatic
    cancer research in fiscal year 2005, yet the other four top cancers (in
    mortality) are funded at levels at least four times this amount.
    Further, the discrepancy in funding has existed for many years, only
    compounding this inconsistency.
        PanCAN supports the highest possible funding increase that Congress
    can provide for the National Institute of Health (NIH) and the NCI in
    fiscal year 2007. With additional funding for both the NIH and the NCI,
    new research grants can be awarded to fulfill the research goals
    identified by the NCI as essential to combating this disease. PanCAN is
    a member of the ``One Voice Against Cancer'' (OVAC) coalition which is
    comprised of more than 50 cancer advocacy organizations that have come
    together to support our common goal: increased Federal funding for
    cancer research, prevention and training programs that are funded
    through the NIH, NCI and Centers for Disease Control and Prevention
    (CDC).
        PanCAN wholeheartedly endorses OVAC's proposed fiscal year 2007
    funding requests that seek a 5 percent increase for both the NIH and
    NCI. We urge you to provide a minimum of $29.7 billion for the NIH in
    fiscal year 2007. Separate testimony submitted to the Committee by OVAC
    reiterates the need for additional Federal funding for biomedical
    research: ``The tremendous investment our Nation has made in the NIH
    has reaped remarkable returns and set the table for a period of
    unparalleled innovation in the fight against cancer and other diseases.
    For fiscal year 2007, OVAC joins with the broader public health
    community and urges Congress to provide $29.7 billion for the NIH. This
    is the minimal level of funding that will allow the NIH to maintain the
    current pace of discovery and innovation.''
        PanCAN also supports the NCI Director's Professional Judgment
    Budget, which calls for a total of $5.9 billion for the NCI in fiscal
    year 2007. Those within the agency and very knowledgeable of the
    research being conducted by the NCI have developed this plan and
    accompanying budget that seeks to investigate the most promising
    research available to the community at this time. We urge the Committee
    to do all that it can to support investments in biomedical research
    that will save lives. At a minimum, we urge the Committee to support a
    funding increase of 5 percent above last year's level for the NCI,
    which would bring the agency's fiscal year 2007 funding level to $5.034
    billion. This funding level would provide an additional $240 million to
    at least keep the existing level of research at the NCI moving forward
    at a stable pace and thus protect the current number of investigator
    grant awards from significant cuts.
    Ensure that Pancreatic Cancer Research is Not Compromised as the NCI
            Shifts its Focus from Disease Specific Research to More Global
            Science Initiatives
        Last year, PanCAN requested that the Committee oversee
    implementation of the short, medium, and long-term strategies as
    identified in the Pancreatic Cancer Progress Review (PRG). The PRG has
    been in place since September 2002 and yet, 4 years later, few of these
    strategies have been implemented. For this reason, PanCAN urges the
    Committee to require the NCI to implement, in fiscal year 2007, all of
    the outstanding strategies as identified in the NCI implementation plan
    for pancreatic cancer PRG recommendations.
        Through conversations and meetings with NCI leadership, we've
    learned about the shift in the NCI's focus on research. Disease
    specific science is being shelved in favor of sexier initiatives in the
    areas of nanotechnology, genomics, and the development of a biospecimen
    repository.
        As the NCI moves its scientific agenda forward in these three
    areas, PanCAN is concerned that critical resources will be taken away
    from the significant investments that have been made in research
    related to early detection, diagnosis and treatment protocols for
    specific cancers. Other cancers have achieved significant declines in
    their respective mortality rates after early detection protocols have
    been developed. Since there is no such tool for diagnosing pancreatic
    cancer early in its development, the mortality rates remain high, and
    tens of thousands of patients are lost each year. As the advocacy
    community for pancreatic cancer patients, we feel that the NCI cannot
    justify any reductions in funding for pancreatic cancer research until
    significant reductions are achieved in the mortality rate for this
    cancer.
        PanCAN urges the Committee to obtain assurance from the NCI that
    the cornerstone research of the agency will not be diminished as these
    new scientific initiatives are pursued. Further, PanCAN urges the
    Committee to direct the NCI to develop a written report that
    specifically details how these three major scientific initiatives will
    specifically advance pancreatic cancer research and submit this report
    to the Committee by April 1, 2007.
    Support Selected Opportunities for Advancement of Pancreatic Cancer
            Research to Capitalize on the Initial Investment of Disease
            Specific Research
        Identify genetic factors, environmental factors, and gene-
    environment interactions that contribute to pancreatic cancer
    development.
        Achieve a more complete understanding of the biology of the normal
    pancreas and the development of pancreatic adenocarcinoma and use this
    knowledge to improve prevention, early detection, and treatment
    interventions.
        Develop nationwide tissue and data repositories, molecular
    profiling resources, and bioinformatics tools for pancreatic cancer
    research. Use these resources to develop prevention and early detection
    interventions that are based on molecular features of pancreatic
    cancer.
        Establish models for the study of environmental factors, gene-
    environment interactions, chemoprevention, chemotherapy, radiation
    therapy, vaccines, and imaging to improve understanding of pancreatic
    cancer risk, prevention, diagnosis, and treatment.
        Identify and develop surveillance and diagnosis methods for early
    detection of pancreatic cancer and its precursors.
        Develop and establish sustained, expanded training and career
    development efforts in pancreatic cancer research and care to build a
    comprehensive, multidisciplinary research community focused on this
    disease.
        Mr. Chairman, the scientific community--through research--is making
    great progress in combating cancer. More people are surviving cancer
    today than any other time in history. Unfortunately, these achievements
    are not extended to the vast majority of pancreatic cancer patients. We
    urge you to provide America's world-renowned research enterprise with
    the funding levels necessary for investigators to continue to work
    their magic and develop screening protocols, effective treatments and
    therapies that will one day lead to the eradiation of all cancers--
    including pancreatic. To quote Congressman Clay Shaw (R-FL), a cancer
    patient, ``When you approach the finish line, you don't walk . . . you
    run!'' If the United States truly seeks to move forward with its
    ambitious goal to stop pain and death from cancer by 2015, it is
    imperative that Federal research programs be adequately funded to
    achieve this goal. On behalf of the 33,730 patients diagnosed with
    pancreatic cancer in 2006, I urge you to support increased funding for
    cancer research, treatment and prevention programs in your fiscal year
    2007 bill.
                                     ______

       Prepared Statement of People for the Ethical Treatment of Animals
        People for the Ethical Treatment of Animals (PETA) represents more
    than 1.3 million Americans who support the Federal Government's ongoing
    commitment to develop scientifically valid safety tests to protect
    human health and the environment from chemical hazards while reducing,
    and ultimately replacing, the use of animals. Thank you for the
    opportunity to present testimony relevant to the fiscal year 2007
    budget request for the National Institute of Environmental Health
    Sciences in relation to the National Toxicology Program (NTP).
                               history of the ntp
        The NTP was established in 1978 to provide information about
    potentially toxic chemicals and to coordinate toxicity testing programs
    within the Federal Government, strengthen the science of toxicology,
    and develop and validate improved testing methods. Three agencies form
    the core of the NTP: the National Institute of Environmental Health
    Sciences of the National Institutes of Health (NIEHS/NIH), the National
    Institute of Occupational Safety and Health of the Centers for Disease
    Control and Prevention (NIOSH/CDC), and the National Center for
    Toxicological Research of the Food and Drug Administration (NCTR/FDA).
    The NTP's activities are funded through the NIEHS at an annual level of
    approximately $500 to $600 million.\1\
    ---------------------------------------------------------------------------
        \1\ White House Office of Technology Assessment. Researching health
    risks. Washington, DC: EOP (1993).
    ---------------------------------------------------------------------------
                       ntp rodent cancer testing program
        During the 1960s and 70s, as vast numbers of new chemicals were
    being produced and used in agriculture, manufacturing, food
    preparation, and virtually every other aspect of modern life, the
    public became increasingly concerned that these chemicals were finding
    their way into the environment and food supply. Since much of the
    public anxiety regarding chemicals related to their potential to cause
    cancer, the Federal Government instituted a program to assess the
    cancer-causing potential of chemicals using rats and mice--on the
    assumption that rodent carcinogens could also present a cancer risk to
    humans. This rodent cancer-testing program began under the auspices of
    the National Cancer Institute, but has been managed by the NTP since
    its inception in 1968.
        A conventional NTP rodent cancer study takes approximately 5 years
    to design, conduct and interpret, consuming at least 860 animals and up
    to $4 million per chemical tested.\2\ The study exposes three groups of
    animals to three different doses of a test chemical, while a fourth
    group (known as the ``control'' group) receives no chemical exposure.
    The chemically exposed animals receive daily doses of a test substance
    for their entire 18- to 24-month life span. If these animals develop
    more tumors than the non-chemically exposed controls, this is taken as
    evidence that a chemical causes cancer. To date, the NTP has tested
    hundreds of substances in rodent cancer studies--including
    pharmaceuticals, pesticides, plastics, industrial chemicals, and even
    plant extracts--at a projected cost of more than 1 billion U.S.
    taxpayer dollars.\3\
    ---------------------------------------------------------------------------
        \2\ NIEHS Fact Sheet: The National Toxicology Program. Research
    Triangle Park, NC: NIEHS (1996).
        \3\ 502 lifetime cancer studies in rats and mice  $2-4
    million/study = $1-2 billion.
    ---------------------------------------------------------------------------
                            a history of controversy
        The NTP recently celebrated the publication of its 500th rodent
    cancer study as ``the gold standard in animal toxicology.'' \4\
    However, in contrast to the fanfare with which this announcement was
    made, the history of NTP rodent cancer studies is one of controversy
    spanning several decades, with top Federal officials admitting:
    ---------------------------------------------------------------------------
        \4\ NIEHS News Release: NTP completes 500th two-year rodent study
    and report; series is the gold standard of animal toxicology. 25 Jan
    2001. .
    ---------------------------------------------------------------------------
        ``The current 2-year rodent carcinogenicity study was never
    validated and there is little evidence supporting the repeatability and
    reproducibility of the current rodent carcinogenicity study.'' \5\
    ---------------------------------------------------------------------------
        \5\ Contrera JF, Jacobs AC, DeGeorge JJ. Carcinogenicity testing
    and the evaluation of regulatory requirements for pharmaceuticals.
    Regulatory Toxicology and Pharmacology 25, 130-145 (1997).
    ---------------------------------------------------------------------------
      --Drs. Joseph Contrera, Abigail Jacobs, and Joseph DeGeorge
        Food and Drug Administration, Center for Drug Evaluation and
    Research
        ``We have been concerned about the predictivity of 2-[year] [rodent
    cancer studies] for the past 10 [years], as our experience and
    knowledge have expanded.'' \6\
      --Drs. Bernard Schwetz and David Gaylor
        Food and Drug Administration, Office of the Director/National
    Center for Toxicological Research
        ``The problem is we don't know what the findings really mean.'' \7\
    ---------------------------------------------------------------------------
        \7\ Brinkley J. Many say lab-animal tests fail to measure human
    risk. The New York Times 1993 Mar 23;Sect A:1.
    ---------------------------------------------------------------------------
      --Dr. Robert Maronpot, chief, Laboratory of Experimental Pathology,
        National Institute of Environmental Health Sciences (NIEHS)
        ``Even if a chemical is found to be nontoxic in animal studies, the
    safety of the chemical cannot be assured.'' \8\
    ---------------------------------------------------------------------------
        \8\ Shane BS. Human reproductive hazards. Environmental Science and
    Technology 30, 1193 (1989).
    ---------------------------------------------------------------------------
      --Dr. Barbara Shane, NTP executive secretary
        ``I have to say we don't serve the American people very well right
    now.'' \6\
    ---------------------------------------------------------------------------
        \6\ Schwetz B, Gaylor D. New directions for predicting
    carcinogenesis. Molecular Carcinogenesis 20, 2 75-279 (1997).
    ---------------------------------------------------------------------------
      --Dr. Kenneth Olden, director, NTP & NIEHS (1991-2005)
                                peta's analysis
        PETA recently conducted an in-depth analysis of all 502 federally
    funded and conducted lifetime rodent cancer studies published on the
    NTP website as of January 2006.\9\ On the basis of this analysis,
    together with more than 25 years of published scientific literature on
    this subject, we have determined that:
    ---------------------------------------------------------------------------
        \9\ PETA's full report is available upon request or may be
    downloaded from http://www.stopanimaltests.com/u-ntp.asp.
    ---------------------------------------------------------------------------
      --The great majority of the U.S. Government's more than $1 billion
            investment in the NTP rodent cancer-testing program has
            produced little or no actual benefit, having been used to
            underwrite studies that:
        --Have been judged by the NTP itself to be ``inadequate'' or to
                produce ``equivocal'' (ambiguous) results, which are of no
                use to health authorities ($121 million).
        --Have produced such dubious and conflicting results that more than
                75 percent of tested chemicals remain either unclassified
                as to their cancer risk to humans, or are lumped into such
                meaningless categories as ``possible'' human carcinogens or
                ``unclassifiable'' as to human cancer risk--designations
                that do nothing to enhance public health or worker
                protection ($460-720 million).
        --Have been shown by other scientists to produce consistent and
                reproducible results only 57 percent of the time when the
                same chemicals are tested more than once using the same
                method--a result that could be achieved by simply tossing a
                coin.
      --Critical public health and worker protection measures related to
            cigarette smoke, asbestos, benzene, and other cancer-causing
            substances were delayed for many years because of misplaced
            trust in animal tests, which for years could not replicate
            cancerous effects that had already been documented in
            people.\10\ \11\ \12\ \13\ If standard animal tests failed to
            readily identify these well-known human carcinogens, how many
            other dangerous chemicals are Americans being exposed to today
            as a result of misleading animal data?
    ---------------------------------------------------------------------------
        \10\ Laskin S, Sellakumar AR. Models in chemical respiratory
    carcinogenesis. In: Karbe E, Park JF, eds. Experimental lung cancer:
    carcinogenesis and bioassays. New York: Springer-Verlag (1974).
        \11\ Rodelsperger K, Woitowitz H-J. Airborne fiber concentrations
    and lung burden compared to the tumor response in rats and humans
    exposed to asbestos. Annals of Occupational Hygiene 39, 715-725 (1995).
        \12\ DeLore P, Borgomono C. Acute leukemia following benzene
    poisoning. Journal de MAE1decin de Lyon 9, 227-236 (1928).
        \13\ De Marini DM and others. Benchmarks: alternative methods in
    toxicology. MA Mehlman, ed. Princeton, NJ: Princeton Scientific
    Publishing (1989).
    ---------------------------------------------------------------------------
      --Conversely, substances such as saccharin and ethyl acrylate (used
            in the manufacturing of latex paints and textiles) have been
            branded as ``probable'' human carcinogens and stigmatized on
            the basis of animal data later dismissed as irrelevant or
            otherwise inapplicable to humans.\14\ False alarms such as
            these can cost society billions in terms of loss of viable
            products in commerce, decreased international competitiveness,
            job loss, litigation, and unnecessary public anxiety.
    ---------------------------------------------------------------------------
        \14\ NIEHS Fact Sheet: The Report on Carcinogens--9th edition. 15
    May 2000. .
    ---------------------------------------------------------------------------
      --Lifetime cancer studies in rats and mice are so costly and
            inefficient that the NTP has only been able to conduct an
            average of 12 such studies per year over the past several
            decades. At this rate, it would take the NTP more than 32,000
            years, 68 million animals, and $160 billion to test the more
            than 80,000 environmental chemicals whose cancer-causing
            potential has not yet been specifically assessed.\15\
    ---------------------------------------------------------------------------
        \15\ Ward EM, Schulte PA, Bayard S, et al. Priorities for
    development of research methods in occupational cancer. Environmental
    Health Perspectives 111, 1-12 (2003).
    ---------------------------------------------------------------------------
        These findings call into question the wisdom of continued Federal
    appropriations to the NTP rodent cancer-testing program. Taxpayer
    dollars would be better spent developing more reliable, relevant, and
    cost-effective methods for assessing chemical safety.
                  ntp vision and roadmap for the 21st century
        The NTP itself appears to recognize the limitations of relying upon
    decades old and never validated toxicity studies. In 2003, the NTP
    articulated its ``vision'' to move toxicology from an observational to
    a predictive science with markedly reduced reliance on animal
    testing.\16\ Among the methods that the NTP has identified for further
    development are ``high throughput'' screens, which combine robotics and
    in vitro (cell-based) toxicology to create a system capable of rapidly
    and inexpensively screening tens of thousands of substances per year at
    multiple concentrations relevant to real-world human exposure levels.
    PETA believes that a ``battery'' of several in vitro tests--based on
    human tissues and mechanisms of cancer induction that are relevant to
    people (e.g., genetic damage, cell transformation, depression of the
    immune system, hormone imbalance, etc.) represents the most credible
    and viable approach to accurately identifying chemicals that pose a
    cancer risk to humans.
                           request for appropriations
        In order to more rapidly and effectively screen chemicals to detect
    those that present a cancer risk to humans, we respectfully urge the
    subcommittee to support increasing appropriations from within the
    existing NIEHS budget for the development and validation of efficient
    and economical non-animal test methods under the NTP's ``21st Century
    Vision'' program.\16\ Given the dubious value of the NTP rodent cancer-
    testing program, we respectfully recommend that funding of this program
    be discontinued and redirected instead to the NTP Vision program.
    ---------------------------------------------------------------------------
        \16\ Toxicology in the 21st Century: The Role of the National
    Toxicology Program. 24 Feb 2004. .
    ---------------------------------------------------------------------------
                     request for committee report language
        We also respectfully request that the subcommittee consider the
    following report language for the Senate Labor, Health and Human
    Services, Education and Related Agencies Appropriations bill:

        ``Not later than March 30, 2007, the Director of the NTP/NIEHS
    shall provide Congress with a report detailing the number of rodent
    lifetime cancer studies funded to date by the NTP/NCI which (i)
    produced results deemed to be equivocal and/or inadequate for
    classification as to human cancer risk, or (ii) have failed to provide
    a clear answer as to whether the substance tested presents a cancer
    risk to humans. The Director's report should detail the costs
    associated with such studies, and explain the NTP's continued reliance
    on rodent lifetime cancer studies in light of criticisms from senior
    Federal officials regarding their dubious validity and utility.''

        Thank you for the opportunity to submit this request on behalf of
    our more than 1.3 million members and supporters.
                                     ______

                       Prepared Statement of Project R&R
        Project R&R: Release and Restitution for Chimpanzees in U.S.
    Laboratories, whose advisory board of chimpanzee experts includes 12
    organizations with a combined membership of 500,000, respectfully
    submits testimony on our funding priority.
        We request that Federal funding for breeding chimpanzees for
    research, or for projects that require breeding, be terminated. We do
    so for the following reasons:
      --A ``surplus'' of chimpanzees has resulted from over-breeding in the
            1980s for HIV/AIDS research and later findings that they are a
            poor HIV/AIDS model.\1\
    ---------------------------------------------------------------------------
        \1\ National Research Council (1997) Chimpanzees in research:
    strategies for their ethical care, management and use. National
    Academies Press: Washington, D.C.
    ---------------------------------------------------------------------------
      --There are enough chimpanzees to address existing federally funded
            research.\2\
    ---------------------------------------------------------------------------
        \2\ Report of the Chimpanzee Management Plan Working Group to the
    National Advisory Research Resources Council; May 18, 2005.
    ---------------------------------------------------------------------------
      --As a result of the ``surplus,'' the government funds a national
            sanctuary system.\3\
    ---------------------------------------------------------------------------
        \3\ http://www.ncrr.nih.gov/compmed/cm_chimp.asp.
    ---------------------------------------------------------------------------
      --The current population costs about $11 million Federal per year.
      --Breeding more chimpanzees increases taxpayers' financial burden.
      --Expansion of the population compounds existing concerns about their
            quality of care.
      --While there is a breeding moratorium, NIH still funds research
            projects requiring breeding.\4\
    ---------------------------------------------------------------------------
        \4\ Ibid.
    ---------------------------------------------------------------------------
      --The public is concerned about the use of chimpanzees in research.
        Background.--Of an estimated 1,300 chimpanzees in laboratories in
    the United States today, approximately 850 are federally owned or
    supported. In the mid-1990s, the National Research Council (NRC) made
    recommendations to address the ``surplus'' that included a moratorium
    on breeding federally-owned or supported chimpanzees for at least 5
    years \5\ (implemented in 1995). The National Advisory Research
    Resources Council, which advises NCRR on funding activities, policies,
    and program, met on 09/15/05 and recommended that NCRR extend the
    moratorium to 12/07. The recommendation was accepted \6\--reasons
    included the high costs associated with care and the fact that
    chimpanzees are a poor model for human HIV research.\7\ \8\
    ---------------------------------------------------------------------------
        \5\ National Research Council (1997) Chimpanzees in research:
    strategies for their ethical care, management and use. National
    Academies Press: Washington, D.C.
        \6\ http://www.ncrr.nih.gov/compmed/cm_chimp.asp
        \7\ Muchmore, E., (2001) Chimpanzee models for human disease and
    immunobiology, Immunological Reviews, 183, 86-93.
        \8\ Reynolds, V., (1995) Moral issues in relation to chimpanzee
    field studies and experiments, Alternatives to Laboratory Animals, 23,
    621-625.
    ---------------------------------------------------------------------------
        Circumventing the moratorium.--Despite the moratorium, NIH funds
    research projects requiring breeding. For example, the National
    Institute of Allergy and Infectious Diseases (NIAID) maintains a
    contract with the New Iberia Research Center (NIRC) to provide 10 to 12
    infants annually for research. The 10 year contract entitled ``Leasing
    of chimpanzees for the conduct of research' was allotted over $22
    million ($3.9 million has been spent since 2002).\9\
    ---------------------------------------------------------------------------
        \9\ Source: http://dcis.hhs.gov/nih/nih_daily_active_web.html (See
    contract No. 272022754).
    ---------------------------------------------------------------------------
        NIRC has also received $5.47 million from 09/00 to 08/05 for a
    grant from NCRR to maintain 138 chimpanzees for breeding. NIH/NCRR
    spends more than $1 million annually to maintain the NIRC breeding
    colony.\10\ These grants result in $9 million going to breeding-related
    activities at NIRC alone since 2000.
    ---------------------------------------------------------------------------
        \10\ http://nirc.louisiana.edu/divisions/nihgrants.html
    ---------------------------------------------------------------------------
        Such expenditures circumvent the intent of the breeding moratorium,
    compelling the need to prevent the growing financial burden of
    increasing numbers of chimpanzees, particularly since, by the
    government's own admission, a ``surplus'' already exists.
        Costs for Chimpanzee Maintenance.--The cost of care for chimpanzees
    is a major concern, particularly with NIH's tightening budget. In 1995,
    the Institute for Laboratory Animal Research (ILAR) published a study
    that projected the future costs of maintaining chimpanzees in U.S.
    research.\11\ ILAR, a division of the National Academies of Science,
    functions as ``an advisor to the Federal Government, the biomedical
    research community, and the public.'' \12\
    ---------------------------------------------------------------------------
        \11\ Dyke, B., Williams-Blangero, S. et al, 1995 ``Future costs of
    chimpanzees in U.S. research institutions,'' ILAR Journal V37(4) http:/
    /dels.nas.edu/ilar_/ilarjournal/37_4/37_Future.shtml
        \12\ Institute for Laboratory Animal Research, website at http://
    dels.nas.edu/ilar_n/ilarhome/about.shtml
    ---------------------------------------------------------------------------
        The ILAR study examined the per diem costs of the existing
    population of chimpanzees at six facilities. Taking into account a
    variety of factors such as longevity, distribution of sex, and
    complexity of care, it projected costs of maintaining the present
    colony over the next 60 years. To account for inflation, an annual 4
    percent increase was incorporated, corresponding approximately to the
    Biomedical Research and Development Price Index.
        The results of the study indicated that the lifetime cost of
    maintaining chimpanzees over the next 60 years--the approximate
    lifespan of chimpanzees in captivity--will exceed $3.14 billion. The
    1995 projection, however, was based on a population of 1,447
    chimpanzees. The present population of federally owned or supported
    chimpanzees in 2006, due to implementation of the partial breeding
    moratorium in 1995 and the close of the Coulston Foundation in 2002,
    stands closer to 850. This represents approximately 59 percent of the
    1,447 number used in ILAR's projection. Thus we can estimate the cost
    of the existing colony to be $1.85 billion.
        The ILAR projection also concluded that the current 2006 annual
    costs would be approximately $18.8 million. Adjusting this number by 59
    percent results in $11 million spent in 2006 alone to maintain
    chimpanzees for research.
        It is important to note that $11 million represents only a partial
    estimate of the entire Federal expenditure for chimpanzee research. The
    total population of U.S. chimpanzees available for research is
    estimated at 1,300. Approximately 500 of these chimpanzees are
    privately owned. Privately owned chimpanzees are also partially funded
    by Federal research dollars. Therefore, the 2006 estimate of annual
    expenditure actually exceeds $11 million by an undetermined amount.
        Delivery of care.--USDA inspection reports indicate that facilities
    housing chimpanzees for research are not adequately meeting basic
    housing needs. Inspection reports for the NIRC 2004 showed some
    chimpanzees being housed in less than the minimal space requirements.
    The facility was given one year to correct the non-compliance, which
    needed to be further extended as construction of new housing facilities
    was still not completed. NIRC was also cited 7 times during its 12/04
    inspection for improperly sanitizing cages and living quarters, as well
    as for failing to provide adequate environment enhancement.
        Inspection reports filed on the Southwest Foundation for Biomedical
    Research and the Yerkes Primate Facility, both National Primate
    Research Centers, also demonstrate multiple non-compliant items for
    failing to keep chimpanzee areas in well-maintained condition, and
    failing to maintain safe facilities free of dangers due to disrepair.
        A poor model.--It is widely agreed within the scientific community
    that chimpanzees are a poor model for HIV. Years of research
    demonstrated that HIV-infected chimpanzees do not develop AIDS.
    Similarly, while chimpanzees are used in current hepatitis C research,
    they do not model the course of the human disease. The decoding of the
    chimpanzee genome pointed out similarities as well as differences
    between humans and chimpanzees. Some of those greatest differences
    relate to the immune system.\13\ Such differences question the validity
    of using chimpanzees in infectious disease research, further arguing
    the need to curb populations and costs.
    ---------------------------------------------------------------------------
        \13\ The Chimpanzee Sequencing and Analysis Consortium/Mikkelsen,
    TS, et al.,(1 September 2005) Initial sequence of the chimpanzee genome
    and comparison with the human genome, Nature 437, 69-87.
    ---------------------------------------------------------------------------
        Ethical concerns.--The U.S. public is concerned about the use of
    chimpanzees in research because of their intellectual, emotional and
    social similarities to humans. A 2005 poll conducted by the Humane
    Research Council revealed that 4 out of 5 (83 percent) of the U.S.
    public recognize chimpanzees as highly intelligent, social individuals
    who have an extensive capacity to communicate. A full 71 percent of
    Americans support the release of chimpanzees if they have been used in
    research for more than 10 years.\14\ A 2001 poll conducted by Zogby
    International showed that 90 percent of Americans believe it is
    unacceptable to confine chimpanzees in government-approved cages.\15\
    ---------------------------------------------------------------------------
        \14\ U.S. Public Opinion of Chimpanzee Research, Support for a Ban,
    and Related Issues, Prepared for the New England Anti-Vivisection
    Society, by the Humane Research Council, 2005.
        \15\ Public Opinion Poll, Prepared for the Chimpanzee
    Collaboratory, by Zogby International, 2001.
    ---------------------------------------------------------------------------
        Conclusion.--We respectfully request that the following language
    appear in the House Labor, Health and Human Services, Education and
    Related Agencies Appropriations Subcommittee Report for Fiscal Year
    2007:
        ``None of these funds shall be used for the breeding of chimpanzees
    or research projects that require the breeding of chimpanzees.''
        We hope the committee will accommodate this modest request that
    will save the government substantial money, benefit chimpanzees, and
    allay some concerns of the public at large. Thank you for your
    consideration.
                                     ______

                    Letter From Senator Pat Roberts, et al.
                                         Washington, DC, April 5, 2006.

    Hon. Arlen Specter, Chair,
    Hon. Tom Harkin, Ranking Member,
    Subcommittee on Labor, HHS, and Education, Senate Committee on
            Appropriations, Washington, DC
        Dear Chairman Specter and Ranking Member Harkin: As you begin your
    work on the fiscal year 2007 Labor, Health and Human Services, and
    Education Appropriations bill, we urge you to provide the same level of
    funding for Title VII health professional as was appropriated in fiscal
    year 2005 ($299,552,000). These programs provide direct financial
    support for health care workforce development and education. In
    addition, they are the only Federal programs designed to train
    providers in interdisciplinary setting to respond to the needs of
    special and underserved populations. They also work to increase
    minority representation in the health care workforce.
        The fiscal year 2006 Labor, Health and Human Services, Education
    Appropriations bill dramatically reduced funding for Title VII health
    professions programs, resulting in a 51 percent overall cut below
    fiscal year 2005. At a time of serious health professions shortages,
    this reduction has already had devastating effects on the country's
    neediest communities. By restoring funding to these programs to fiscal
    year 2005 levels, you will enable them to continue to improve the
    distribution, quality, and diversity of the health professions
    workforce.
        We respectfully urge you to restore funding to the Title VII
    programs in the fiscal year 2007 Labor, Health and Human Services, and
    Education appropriations bill. We greatly appreciate your consideration
    of the request.
                Sincerely,
                        Senators Pat Roberts, Jack Reed, Elizabeth Dole,
                                Daniel K. Akaka, Susan M. Collins, Lamar
                                Alexander, Richard Durbin, Sam Brownback,
                                Blanche L. Lincoln, Richard G. Lugar, James
                                M. Jeffords, Paul S. Sarbanes, Norm
                                Coleman, Charles E. Schumer, Byron L.
                                Dorgan, Frank R. Lautenberg, Dianne
                                Feinstein, Mark L. Pryor, Hillary Rodham
                                Clinton, Evan Bayh, Christopher J. Dodd,
                                Patrick J. Leahy, John F. Kerry, Tim
                                Johnson, Debbie Stabenow, Jon Kyl, Ken
                                Salazar, Bill Nelson, Benjamin E. Nelson,
                                Edward M. Kennedy, Robert Menendez, Barbara
                                A. Mikulski, Russell D. Feingold, George V.
                                Voinovich, Mary L. Lanorieu, Maria
                                Cantwell, Barack Obama, Joseph I.
                                Lieberman, Jeff Bingaman, Harry Reid, John
                                D. Rockefeller, IV, Conrad Burns, Barbara
                                Boxer, Mark Dayton, Lincoln Chafee, Patty
                                Murray, Christopher S. Bond, Carl Levin,
                                Mike DeWine, Chuck Hagel, John Warner,
                                Lindsey Graham, Richard M. Burr, James M.
                                Talent, Jeff Sessions, and Ron Wyden.
                                     ______

               Prepared Statement of the Spina Bifida Association
        On behalf of the more than 70,000 individuals and their families
    who are affected by Spina Bifida, the Spina Bifida Association (SBA)
    appreciates the opportunity to submit written testimony for the record
    regarding fiscal year 2007 funding for the National Spina Bifida
    Program and other related Spina Bifida initiatives. SBA is the national
    voluntary health agency working on behalf of people with Spina Bifida
    and their families through education, advocacy, research and service.
    The Association was founded in 1973 to address the needs of the Spina
    Bifida community and today serves as the representative of 56 chapters
    serving more than 125 communities nationwide. SBA stands ready to work
    with Members of Congress and other stakeholders to ensure our Nation
    takes all the steps necessary to reduce and prevent suffering from
    Spina Bifida.
                           background on spina bifida
        Spina Bifida, a neural tube defect (NTD), occurs when the spinal
    cord fails to close properly during the early stages of pregnancy,
    typically within the first few weeks of pregnancy and most often before
    the mother knows that she is pregnant. Over the course of the
    pregnancy--as the fetus grows--the spinal cord is exposed to the
    amniotic fluid which increasingly becomes toxic. It is believed that
    the exposure of the spinal cord to the toxic amniotic fluid erodes the
    spine and results in Spina Bifida. There are varying forms of Spina
    Bifida occurring from mild--with little or no noticeable disability--to
    severe--with limited movement and function. In addition, within each
    different form of Spina Bifida the effects can vary widely.
    Unfortunately, the most severe form of Spina Bifida occurs in 96
    percent of children born with this birth defect.
        The result of this neural tube defect is that most children with it
    suffer from a host of physical, psychological, and educational
    challenges--including paralysis, developmental delay, numerous
    surgeries, and living with a shunt in their skulls which seeks to
    ameliorate their condition by helping to relieve cranial pressure
    associated with spinal fluid that does not flow properly. As we have
    testified previously, the good news is that after decades of poor
    prognoses and short life expectancy, children with Spina Bifida are now
    living long enough to become adults with Spina Bifida. These gains in
    longevity principally are due to breakthroughs in research, combined
    with improvements generally in health care and treatment. However, with
    this extended life expectancy, our Nation and people with Spina Bifida
    now face new challenges--education, job training, independent living,
    health care for secondary conditions, aging concerns, among others.
    Despite these gains, individuals and families affected by Spina Bifida
    face many challenges--physical, emotional, and financial. Fortunately,
    with the advent of the National Spina Bifida Program 4 years ago,
    individuals and families affected by Spina Bifida now have a national
    resource to provide them with the support, information, and assistance
    they need and deserve.
        While the consumption of 400 micrograms of folic acid daily prior
    to becoming pregnant and throughout the first trimester of pregnancy,
    can help reduce the incidence of Spina Bifida by up to 75 percent,
    cases of Spina Bifida still occur and our Nation still must take steps
    to ensure that the tens of thousands of individuals living with Spina
    Bifida can live full, healthy, and productive lives. To ensure the
    highest quality-of-life possible, prevention interventions and
    treatment therapies must be identified, developed, and delivered to
    those in need.
                              cost of spina bifida
        It is important to note that the lifetime costs associated with a
    typical case of Spina Bifida--including medical care, special
    education, therapy services, and loss of earnings--are as much as $1
    million. The total societal cost of Spina Bifida is estimated to exceed
    $750 million per year, with just the Social Security Administration
    payments to individuals with Spina Bifida exceeding $82 million per
    year. Moreover, tens of millions of dollars are spent on medical care
    paid for by the Medicaid and Medicare Programs. Our Nation must do more
    to help reduce the emotional, financial, and physical toll of Spina
    Bifida on the individuals and families affected. Efforts to reduce and
    prevent suffering from Spina Bifida help to save money and save lives.
      improving quality-of-life through the national spina bifida program
        SBA has worked with Members of Congress to ensure that our Nation
    is taking all the steps possible to prevent Spina Bifida and diminish
    suffering for those currently living with this condition. With
    appropriate, affordable, and high-quality medical, physical, and
    emotional care, most people born with Spina Bifida likely will have a
    normal or near normal life expectancy. Ensuring access to these
    services is essential to improving the quality-of-life for those born
    with this birth defect.
        The National Spina Bifida Program at the National Center for Birth
    Defects and Developmental Disabilities (NCBDDD) at the Centers for
    Disease Control and Prevention (CDC) works on two critical levels--to
    reduce and prevent Spina Bifida incidence and morbidity and to improve
    quality-of-life for those living with Spina Bifida. The program seeks
    to ensure that what is known by scientists is practiced and experienced
    by the 70,000 individuals and families affected by Spina Bifida.
    Moreover, the National Spina Bifida Program works to improve the
    outlook for a life challenged by this complicated birth defect--
    principally identifying valuable therapies from in-utero throughout the
    lifespan and making them available and accessible to those in need.
        The National Spina Bifida Program serves as a national center for
    information and support to help ensure that individuals, families, and
    other caregivers, such as health professionals, have the most up-to-
    date information about effective interventions for the myriad primary
    and secondary conditions associated with Spina Bifida. Among many other
    activities, the program helps individuals with Spina Bifida and their
    families learn how to treat and prevent secondary health problems, such
    as bladder and bowel control difficulties, learning disabilities,
    depression, latex allergy, obesity, skin breakdown and social and
    sexual issues. Children with Spina Bifida often have learning
    disabilities and may have difficulty with paying attention, expressing
    or understanding language, and grasping reading and math. All of these
    problems can be treated or prevented, but only if those affected by
    Spina Bifida--and their caregivers--are properly educated and taught
    what they need to know to maintain the highest level of health and
    well-being possible. The National Spina Bifida Program's secondary
    prevention activities represent a tangible quality-of-life difference
    to the 70,000 individuals living with Spina Bifida with the goal being
    living well with Spina Bifida.
        In fiscal year 2006, Congress folded funding for a study on folic
    acid (also known as the ``China Study'') into the National Spina Bifida
    Program and provided $5.1 million in fiscal year 2006 (a final
    allocation of $5 million after the one percent across-the-board cut)
    for this new joint program. SBA appreciates Congressional interest and
    intent in ensuring that the CDC's folic acid and Spina Bifida
    activities are coordinated. SBA maintains a strong interest in working
    with NCBDDD and Members of the subcommittee to ensure that this new
    joint program fulfills Congressional intent and that the quality-of-
    life components of the National Spina Bifida Program receive adequate
    funding to support ongoing and expanded endeavors.
        SBA advocates that the National Spina Bifida Program receive $6
    million in fiscal year 2007 and that that sum be used to expand and
    continue to promote quality-of-life programs that support people with
    Spina Bifida so they can live fulfilling and productive lives. In its
    first 3 years, this program already has made a difference for our
    community and with additional resources it can expand its reach and
    provide additional assistance and hope to those with an affected loved
    one. Increasing funding for the National Spina Bifida Program will help
    ensure that our Nation continues to mount a comprehensive effort to
    prevent and reduce suffering from Spina Bifida.
                            preventing spina bifida
        While the exact cause of Spina Bifida is unknown, over the last
    decade, medical research has confirmed a link between a woman's folate
    level before pregnancy and the occurrence of Spina Bifida. Sixty
    million women are at-risk of having a child born with Spina Bifida and
    each year approximately 3,000 pregnancies in this country are affected
    by Spina Bifida, resulting in 1,500 births. As mentioned above, the
    consumption of 400 micrograms of folic acid daily prior to becoming
    pregnant and throughout the first trimester of pregnancy can help
    reduce incidence of Spina Bifida up to 75 percent. There are few public
    health challenges that our Nation can tackle and conquer by three-
    fourths in such a straightforward fashion. However, we must still be
    concerned with addressing the 25 percent of Spina Bifida cases that
    cannot be prevented by folic acid consumption, as well as ensuring that
    all women of childbearing age--particularly those most at-risk for a
    Spina Bifida pregnancy--consume adequate amounts of folic acid.
        The good news is that progress has been made in convincing women of
    the importance of folic acid consumption and the need to maintain diet
    rich in folic acid. Since 1968, the CDC has led the Nation in
    monitoring birth defects and developmental disabilities, linking these
    health outcomes with maternal and/or environmental factors that
    increase risk, and identifying effective means of reducing such risks.
    Former CDC Director Jeff Koplan has stated that the agency's folic acid
    prevention campaign has reduced neural tube defect births by 20
    percent. This public health success should be celebrated, but it is
    only half of the equation as approximately 3,000 pregnancies still are
    affected by this devastating birth defect. The Nation's public
    education campaign around folic acid consumption must be enhanced and
    broadened to reach segments of the population that have yet to heed
    this call--such an investment will help ensure that as many cases of
    Spina Bifida can be prevented as possible.
        SBA works collaboratively with CDC and the March of Dimes to
    increase awareness of the benefits of folic acid, particular for those
    at elevated risk of having a baby with neural tube defects (those who
    have Spina Bifida themselves or those who have already conceived a baby
    with Spina Bifida). With additional funding in fiscal year 2007 these
    activities could be expanded to reach the broader population in need of
    these public health education, health promotion, and disease prevention
    messages. SBA advocates that Congress provide additional funding to CDC
    to allow for a particular public health education and awareness focus
    on at-risk populations (e.g. Hispanic-Latino communities) and health
    professionals who can help disseminate information about the importance
    of folic acid consumption among women of childbearing age.
        In addition to a $6 million fiscal year 2007 allocation for the
    National Spina Bifida Program, SBA supports a fiscal year 2007
    allocation of $135 million for the NCBDDD so the agency can enhance its
    programs and initiatives to prevent birth defects and developmental
    disabilities and promote health and wellness among people with
    disabilities.
            improving health care for individuals with spina bifida
        The mission of the Agency for Healthcare Research and Quality
    (AHRQ) is to improve the outcomes and quality of health care; reduce
    its costs; improve patient safety; decrease medical errors; and broaden
    access to essential health services. The work conducted by the agency
    is vital to the evaluation of new treatments in order to ensure that
    individuals and their families living with Spina Bifida continue to
    receive the high quality health care that they need and deserve--SBA
    recommends that AHRQ receive $443 million in fiscal year 2007 so that
    it can continue to conduct follow-up efforts to evaluate Spina Bifida
    treatments, promulgate associated standards of care, and further the
    provision of evidence-based care stemming from the outcomes of the 2003
    Spina Bifida Research Conference.
             sustain and seize spina bifida research opportunities
        SBA seeks to support individuals and families affected by Spina
    Bifida, maximize the prevention of Spina Bifida, and ensure that all
    babies born with Spina Bifida have the greatest chance of survival and
    the highest quality-of-life--through the lifespan. When families
    recently diagnosed with a Spina Bifida pregnancy contact SBA, the
    organization puts them in touch with another family who has a child
    with the condition so they can learn of the joys and challenges of
    having a child with the birth defect. Unfortunately, traditionally when
    families have faced a Spina Bifida diagnosis they have had two
    difficult options. The first is to continue the pregnancy with the
    expectation of multiple surgeries for the child after birth, uncertain
    life expectancy, and many physical and developmental challenges and
    complications. The second, unfortunately, is to terminate the
    pregnancy. Fortunately, now there may be an important and effective
    third option.
        Since the late 1990s, doctors at three U.S. hospitals--Children's
    Hospital of Philadelphia, Vanderbilt University Medical Center in
    Nashville, and the University of California at San Francisco--have been
    operating before birth on fetuses diagnosed with Spina Bifida. In 2004,
    the University of North Carolina became the fourth hospital in the
    Nation to perform the in-utero operations. By closing the spinal lesion
    early in pregnancy, physicians believe they can minimize the damage
    created by fluid leaking from the spine, as well as limit by the harm
    done due to the spinal cord's contact with the amniotic fluid. Surgeons
    have found that closing the hole in the spine in this fashion before
    birth may correct breathing problems in 15 percent of the children
    receiving the procedure and may reduce the need for a shunt to drain
    fluid from the brain by between 33 percent and 50 percent.
        To determine whether or not this new procedure is safer and more
    effective than the traditional post-birth surgery to address the
    condition, the National Institute of Child Health and Human Development
    (NICHD) is conducting a large study involving the Children's Hospital
    of Philadelphia, Vanderbilt University Medical Center, and the
    University of California at San Francisco. While these three
    institutions have undertaken preliminary studies of the in-utero
    surgery technique, the overall and long-term effectiveness of this
    approach as compared to traditional therapy remains unknown. Given the
    potential for this surgery to ameliorate many of the conditions
    associated with Spina Bifida, we must do a better job of studying and
    evaluating this procedure, educating health care providers about this
    surgery as a potential option, and making information about it
    available to more families facing a Spina Bifida pregnancy.
        Additionally, the National Institute of Diabetes and Digestive and
    Kidney Diseases (NIDDK) is scheduled to host an interagency meeting in
    spring 2006 on urological complications. We are also excited to report
    that the National Institute of Neurological Disorders and Stroke
    (NINDS) has formed a trans-agency Spina Bifida Working Group. SBA looks
    forward to working with both agencies on these and other important
    Spina Bifida related initiatives.
        Our Nation has benefited immensely from our past Federal investment
    in biomedical research at the National Institutes of Health (NIH). SBA
    joins with the rest of the public health community in advocating that
    NIH receive $29.7 billion in fiscal year 2007. This funding will
    support applied and basic biomedical, psychosocial, educational, and
    rehabilitative research to improve the understanding of the etiology,
    prevention, cure and treatment of Spina Bifida and its related
    conditions. In addition, SBA urges the NIH to explore the following as
    they relate to individuals with Spina Bifida: assistive technology, in
    utero surgery, cost of care, women's and men's health, tethered spinal
    cord, hydrocephalus, latex allergies, and other related factors.
                                   conclusion
        SBA stands ready to work with policymakers to advance policies that
    will reduce and prevent suffering from Spina Bifida. Again, we thank
    you for the opportunity to present our views on funding for programs
    that will improve the quality-of-life for the 70,000 Americans and
    their families living with Spina Bifida and stand ready to answer any
    questions you may have.
                                     ______

               Prepared Statement of the Tuomey Healthcare System
        Mr. Chairman, and Members of the subcommittee, thank you for the
    opportunity to submit testimony regarding the need for a Bedside
    Medication Verification System and subsequently a Computerized
    Practitioner Order Entry and Clinical Decision Support System at Tuomey
    Healthcare System.
        For more than 90 years, Tuomey's growth and advancement have been
    guided by professionals who care deeply about the Sumter community and
    the individual healthcare needs of every person in it. From the small
    20-bed Sumter Hospital born out of Timothy Tuomey's gift in 1913 to a
    healthcare system of more than 1,600 employees and 266 beds, Tuomey's
    history has been one of compassion and resolve. It is propelled by a
    long-term vision for healthcare that's second to none and is enhanced
    by a deeply philanthropic mission.
        Since 2000, Tuomey has provided tens of millions of dollars in
    community services. And each year, we absorb almost $20 million in
    indigent care. Our employee base is tremendously dedicated to Sumter's
    health as well, as evidenced by their gift of close to $1 million since
    2000. Through all of this, Tuomey is committed to Sumter, and it shows
    in everything we do. In the last year, Tuomey has ranked in the 97th
    and 98th percentiles nationally in the Press Ganey customer
    satisfaction scores in the inpatient and ambulatory surgery center
    categories.
        The demand for Tuomey services will be further increased with the
    upcoming addition of approximately 850 service men and women to Shaw
    Air Force Base and the closing of the base's inpatient hospital. This
    equates to an approximate 3,000 person increase in total population to
    the Sumter community. To handle Tuomey's additional patient volume and
    to continue providing the quality care for which we are known, it is
    imperative we increase our inpatient capacity. Likewise, we must expand
    our women's and obstetrics service areas and our Emergency Department
    to meet the growing needs of this community. It is an expensive
    proposition, but one to which we are committed. It's the next step in
    our path to safeguarding this community's health.
        Plans are currently underway for the construction of a new 24-bed
    women's complex called The Tuomey Women's Center, expansion and
    enhancement of our nurseries, the addition of 22 general medical
    inpatient rooms, and the expansion of the Emergency Department. The
    total combined cost of these expansions and enhancements is $31.5
    million.
        High quality care and patient safety are the core elements of
    everything we do at Tuomey, utilizing technology where appropriate and
    cost effective. We have been a Meditech Information Systems customer
    since 1988, with virtually every department in our facility
    computerized, to include nursing documentation, radiology results,
    laboratory results and all financials. In July 2005, we went live with
    the McKesson Electronic Medical Record, which allows physicians to
    access patient information from anywhere with an internet connection,
    enhancing the timely delivery and continuity of care. However, even
    with the benefits gained from our technology, we still deal with the
    challenges of caring for sicker patients in a shorter period of time
    with limited financial resources and shortages of skilled labor. Like
    many other hospitals, a completely safe and accurate medication
    management process remains one of our most difficult challenges. In
    addition, the medication management process is one of the areas where
    technology can offer the greatest number of improvements in terms of
    patient safety and quality of care.
        In its 1999 report, ``To Err is Human: Building a Safer Health
    System,'' The Institute of Medicine (IOM) estimated that 44,000 to
    98,000 patients die each year from medical errors, of which the largest
    portion, up to one-third, has been linked to medication errors or
    adverse drug events (ADEs). A medication error can lead to increased
    charges and longer patient stays while adverse drug events can lead to
    patient injury and death. While there is a difference between
    medication errors and adverse drug events, Tuomey's goal is to avoid
    both and to consistently offer the highest quality care in the safest
    patient care environment possible.
        Medication administration safety is dependent on five basic safety
    checks: the correct patient, the correct drug, the correct dose, the
    correct route of administration and the correct time of administration.
    Any deviation from these five standards of medication administration
    practice can lead to medication errors and Adverse Drug Events. Given
    that there are now more than 17,000 brand and generic names for
    pharmaceuticals in North America and nurses are caring for sicker
    patients on shorter hospital stays, the implementation of automated
    systems to safeguard against human errors in all aspects of the
    medication administration process has reached a state of critical need
    at Tuomey.
        Currently, Tuomey is using an antiquated, yet not uncommon, system
    of medication ordering in which providers handwrite orders that are
    sent via pneumatic tube to a pharmacy location. The pharmacy staff
    deciphers the handwritten orders to the best of their human ability and
    sends the medications to the nursing staff that then rely on
    handwritten orders and the five rights of medication administration. In
    addition, the pharmacy charges the patient's account for the
    medications at the point the medications are dispensed from the
    pharmacy. The pharmacy is then responsible for crediting the patient's
    account if the medications are never taken.
        The failure rate for this type of system is staggering throughout
    the healthcare community. Physicians, pharmacists, nurses and support
    staff work long hours with fluctuating levels of stress. Experts have
    estimated that at least 38 percent of all medication errors take place
    at the bedside using manual handwritten systems like the one currently
    in use at Tuomey. There are simply too many distractions and too many
    chances for something to go wrong when completely relying on protocols
    and procedures to assure safe and accurate medication administration.
    It is important to note, though, that Tuomey has never been complacent
    with a system that puts any patient at risk. Tuomey has remained
    vigilant to the risks associated with its current medication
    administration process and has made many improvements and changes to
    the manual system to promote patient safety and accuracy.
        Unfortunately, for many years, there has not been a feasible
    alternative to the manual system. Technology and system availability
    have only recently reached a State worth investigating for true process
    improvement. Tuomey has investigated the currently available
    technologies and has identified viable solutions to improve the
    medication administration process. Bedside Medication Administration
    systems using barcode verification (BMV) and Computerized Physician
    Order Entry with Clinical Decision Support (CPOE/CDSS) have been
    identified as two systems that can greatly minimize the chance of
    errors and promote the highest quality care in the medication
    administration process.
        Bedside Medication Administration using barcode identification
    systems have consistently been shown to improve patient safety and
    patient billing in hospital sites throughout the country. The basic
    process for bar code medication administration systems begins with an
    initial positive identification of a patient by the nursing staff.
    After the initial identification, the patient is given a wristband with
    an identifying bar code. From that point forward, the patient will be
    identified via a scan of the wristband's bar code. Before administering
    any medication or performing a treatment, the patient must be
    identified to the system via the scan. By first correctly identifying
    the patient to the system, the nurse then allows the system to double
    check the other four rights before the actual administration.
        If a medication order has expired or been changed, the nurse is
    immediately alerted to avoid a possible medication error or Adverse
    Drug Event. The basic setup for the bar code medication administration
    system involves a laptop computer with a scanner linked to a hospital
    wireless network that runs the medication verification and patient
    billing systems. Accurate identification and correct order association
    assure patient safety and patient billing is accurately updated at the
    point of administration.
        Computerized Practitioner Order Entry (CPOE) and Clinical Decision
    Support System (CDSS) implementation at Tuomey will virtually eliminate
    the chance of error in the deciphering of handwritten orders and
    eliminate any need for transcription all together since providers will
    be entering all medication and treatment orders directly into the
    information system with alerts and warnings regarding allergies,
    duplications and dangerous interactions readily available. If the
    orders are accurately entered and double checked for safety, then the
    bedside point of administration system will accurately ensure the
    correctly entered orders are carried out safely and accurately as
    intended by the ordering clinicians. Nurses will ensure that all five
    standards of medication administration are correct and accurate using
    barcodes identifying both the medication and the patient.
        While Bedside Medication Verification and Computerized Practitioner
    Order Entry/Clinical Decision Support Systems are highly
    interdependent, staging of the implementations are vital to success.
    CPOE/CDSS cannot receive real-time feedback regarding medication
    administration without a Bedside Medication Verification system
    implemented and functioning. Likewise, Computerized Practitioner Order
    Entry (CPOE) and Clinical Decision Support System (CDSS) maturity lags
    behind Bedside Medication Verification due to the level of
    sophistication and logic design required. Any implementation strategy
    for Bedside Medication Verification and CPOE/CDSS at Tuomey Healthcare
    System must include plans to implement Bedside Medication Verification
    before moving to the other systems.
        In fiscal year 2007, we hope that the subcommittee will support our
    request for funding of $1.5 million in order to implement a Bedside
    Medication Verification system that will be Phase I of this entire
    project. It is our belief that we will be highly successful in this
    project and could serve as a resource and site for other health care
    organizations to learn from in enhancing the safety of all patients.
        As healthcare continues to evolve, so does Tuomey Healthcare
    System. We're here to anticipate the needs of the communities we serve,
    responding with proactive healthcare initiatives, such as the systems
    noted above. Our stable but consistent growth positions Tuomey as one
    of South Carolina's largest healthcare systems. Tuomey is committed to
    Sumter, and it shows in everything we do.
                                     ______

                         NATIONAL INSTITUTES OF HEALTH

      Prepared Statement of the American Association for Cancer Research
                                     (AACR)
        The number of cancer deaths is falling and the number of cancer
    survivors is increasing each year. This remarkable progress has
    occurred because of the advances in cancer research, discovery,
    detection, prevention, and treatment made possible, in part, by a
    strong and steady level of funding and commitment by the Federal
    Government.
        The National Cancer Program supports an incredible array of cancer
    research programs that shows great promise for benefit to patients with
    cancer. To sustain the research momentum that has been so carefully
    built up over the past decade--and to continue to give hope to those
    with cancer--the Congress must provide sufficient resources to preserve
    the scientific infrastructure and foster new discoveries.
        The American Association for Cancer Research (AACR) stands ready to
    contribute its share to accelerate our progress against this
    devastating disease. The AACR joins with other leaders in the cancer
    community to call upon the Congress to take the following actions to
    enable these invaluable programs to continue their contributions to
    improving the lives of patients with cancer and other life-threatening
    diseases:
        (1) Provide a 5 percent increase in funding for the National
    Institutes of Health to $29.75 billion for fiscal year 2007; and
        (2) Provide a 5 percent increase in funding for the National Cancer
    Institute to $5.03 billion for fiscal year 2007.
        Early this year, it was reported that the number of cancer deaths
    every year in the United States fell for the first time in more than 70
    years. Coupled with the fact that observed cancer death rates from all
    cancers combined dropped 1.1 percent each year from 1993 to 2002, these
    persistent declines in cancer mortality rates are evidence of the
    success of the National Cancer Program and its research, prevention,
    and treatment advances.
        Among these advances are a series of new targeted cancer therapies
    that have evolved from a process of rational drug design based upon our
    expanded understanding of the genetic basis of disease. For example,
    Herceptin became the first targeted therapy for breast cancer in 1997--
    it is an injectable antibody that targets and blocks the function of
    HER2 protein when it is overproduced in the body, which leads to
    cancer. In 2001, Gleevec became the first approved kinase inhibitor for
    cancer, shutting down the BCR-ABL kinase that causes chronic myeloid
    leukemia. These discoveries have led to a half-dozen other more recent
    drug approvals that are based upon these and other novel mechanisms of
    action.
        Exciting, life-saving scientific progress such as this will only
    continue if it is nurtured and sustained by an adequate level of
    Federal research investment. The American Association for Cancer
    Research (AACR) calls upon the President and the United States Congress
    to make the commitment to sustain this research momentum by increasing
    the appropriations for the National Institutes of Health (NIH) to
    $29.75 billion and the National Cancer Institute (NCI) to $5.03 billion
    for fiscal year 2007. Without such a commitment, promising research
    will be abandoned, new treatments may never come to fruition, and
    patients with cancer will lose the hope of enjoying a life beyond
    cancer.
        The AACR stands ready to contribute its share to accelerate our
    progress against this devastating disease. As AACR approaches its
    Centennial Year in 2007, with more than 24,000 members, it is well
    positioned to foster and facilitate the scientific developments that
    will underpin our forward movement in basic, translational, and
    clinical cancer research. Through its five prestigious scientific
    journals--including Cancer Research, the most frequently cited cancer
    journal in the world--AACR rapidly disseminates cutting-edge, peer-
    reviewed findings throughout the medical research community. AACR's
    Annual Meeting attracts more than 16,000 scientists worldwide to cross-
    disciplinary sessions led by the world's leading experts. The AACR has
    been at the forefront of the art of anticancer drug development and the
    science of cancer prevention, and originated the annual International
    Conference on Cancer Prevention Research. Through these high quality
    scientific meetings, along with prestigious awards and research
    training programs and grants, the AACR utilizes a multilayered approach
    to stimulate and foster the best science that will lead to the conquest
    of cancer.
        No single sector or entity alone can successfully tackle the
    complex set of diseases known as cancer. Academic scientists and
    clinicians have a large role to play in discovery and the translation
    of discoveries into standard clinical care. Biotechnology and
    pharmaceutical companies, with their vast research and development and
    manufacturing and distribution capabilities, are also essential for the
    smooth, efficient, and effective delivery of cancer medicines to
    hospitals and patients. Barriers or roadblocks in any aspect of the
    research, discovery, development, or delivery path will have an adverse
    impact on achieving the goal of conquering cancer and saving lives.
        Central to this multisector effort is the National Cancer Program
    and the fundamental and foundational work of the National Cancer
    Institute. For 35 years, because of the National Cancer Act, the NCI
    has spearheaded the research efforts that have led to the declining
    mortality rates we are experiencing today. The strategies underlying
    the National Cancer Program have been developed by the NCI in close
    collaboration with the cancer community. Each year the Director of the
    NCI engages in an open and transparent priority-setting process to
    develop a plan and budget proposal for the following year. It is
    reviewed by the cancer community and published each fall as The
    Nation's Investment in Cancer Research: A Plan and Budget Proposal. It
    is the definitive guide to how the NCI is using its funds and how it
    plans to spend additional funds should they become available.
        The scope and breadth of the activities in which the National
    Cancer Institute is engaged are truly remarkable. As the leader of the
    Nation's grand plan to attack cancer, the NCI must be provided with the
    resources necessary to carry out its mission on many different fronts
    and in many different ways. The five-year doubling of the budget of the
    NIH enabled the National Cancer Institute to begin to expand its
    activities into promising new areas that had been beyond its reach.
    However, since the completion of the budget doubling in 2003,
    negligible NCI budget increases (in the .5 to 2.6 percent range) and an
    actual hard budget cut in fiscal year 2006, have forced retrenchment
    and curtailing of some research.
        Our Nation's current investment in the National Cancer Institute
    supports a broad range of scientific research, infrastructure,
    communications structure, and technological advances. The AACR strongly
    supports continued and increased investments in these key areas as the
    surest way to guarantee progress against cancer. In particular, the
    AACR urges that the NCI maintain its focus on:
      --Research to understand the causes and mechanisms of cancer,
            including continued studies into the genetic, environmental,
            and lifestyle factors that contribute to cancer causation. This
            research includes population studies that identify cancer
            risks, studies of normal as well as abnormal biological
            functioning, and research on cellular and molecular mechanisms
            of cancer initiation, progression, and metastasis.
      --Research on new approaches to prevent or delay the onset of cancer,
            including nutrition, vaccination, and chemoprevention. This
            research should continue its emphasis on behavioral factors
            that affect cancer risk--poor diet, lack of physical activity,
            sun exposure, and tobacco use--and strategies to change these
            behaviors.
      --Research to improve early detection and diagnosis of cancer through
            the discovery and development of biomarkers and imaging
            techniques. This research includes using proteomic technologies
            to develop biomarker panels and anatomical and molecular
            imaging techniques to detect tumors and identify metastasis, as
            well as studying how patients accept and comply with cancer
            screening methods.
      --Research to discover, develop, and evaluate therapeutics for
            destroying or controlling cancer cells and metastasis. These
            include localized therapies--such as surgery or radiotherapy;
            systemic therapies--such as chemotherapy or vaccines;
            molecularly targeted therapies (such as Herceptin and Gleevec)
            directed at specific tumors or tissues; and combinations which
            are often more effective than either therapy alone.
      --Research to improve the quality of cancer care and the quality of
            life of cancer patients, including the development of ways to
            measure quality, the impact of aging on quality of care, health
            and lifestyle issues of cancer survivors, and the development
            and application of interventions to overcome cancer health
            disparities.
        The National Cancer Institute carries out this vast research
    portfolio through a wide variety of different vehicles and mechanisms
    in its research infrastructure. The AACR strongly favors continued and
    increased support for these areas to optimize the return on research
    dollars. In particular, the AACR recommends that the National Cancer
    Institute continue to utilize the following successful multisector
    approaches to implementing the National Cancer Program:
      --Extramural program supports independent scientists conducting
            research in universities, teaching hospitals, and other
            organizations outside the NIH. The largest portion of NCI
            research funds is devoted to this program. It supports a
            balanced portfolio of more than 7,000 research and training
            awards, as well as grants, cooperative agreements, and
            contracts with individual investigators, professional
            societies, and research institutions. Peer-reviewed research
            under this program includes genetic, epidemiological,
            behavioral, social, applied, and surveillance research, basic
            prevention science, cancer biomarkers, chemopreventive agent
            development, community oncology and prevention trials, early
            detection, nutrition science, organ system research, cancer
            diagnostics, imaging, drug development, and biometrics, among
            others.
        Thousands of AACR member scientists participate in and depend upon
    support from the extramural program to advance their research goals.
    Investigator-initiated scientific research is the engine driving new
    discoveries and advances in cancer research and it must remain at the
    forefront of efforts to conquer this disease. Funding for this aspect
    of the National Cancer Program must be maintained at a sufficiently
    high level to promote and advance research progress.
      --Training and Career Development to increase the number of
            scientists who specialize in the basic or clinical biomedical
            fields is a critical NCI function. Such investments foster the
            development of interdisciplinary teams and ensure a growing
            core of well trained investigators to focus on cancer.
      --Partnerships, including with other agencies, pharmaceutical
            companies, academia, and a wide variety of other organizations,
            are essential to leverage the limited resources of the NCI.
            Interagency agreements with the Food and Drug Administration
            and the Centers for Medicare and Medicaid Services have been
            highly successful in expediting new drug development and
            coverage for new treatments. The Academic Public Private
            Partnership Program (AP4) supports a new way of accelerating
            drug discovery and development through multiple partnerships.
      --Additional important means used by the National Cancer Institute to
            advance its cancer research agenda include Cancer Centers and
            Centers of Research Excellence at major academic and research
            institutions across the country; Networks and Consortia, such
            as the Early Detection Research Network; NCI-Supported Clinical
            Trials that involve more than 12,000 investigators; Cancer
            Surveillance through the voluminous data collected by the NCI
            Surveillance, Epidemiology, and End Results (SEER) program;
            Technology Development, including the cancer Biomedical
            Informatics Grid (caBIG) platform for sharing research data;
            and Communication, Education, and Dissemination of research
            progress directly to and for the benefit of the public and
            public health professionals.
        Through this wide array of effective mechanisms, the National
    Cancer Institute seeks to implement the ambitious research goals of the
    National Cancer Program. Each facet of the strategy is important and
    generates synergies with other facets to accomplish more than the
    apparent sum of the parts. Cuts to cancer research funding jeopardize
    multiple facets of the strategy and have a direct adverse impact on
    patients by delaying or halting development of promising treatments.
        To sustain the research momentum that has been so painstakingly
    built up over the past decade, the Congress must provide sufficient
    resources to preserve the current infrastructure and prevent its
    diminishment through inflation or other means. The American Association
    for Cancer Research and the cancer community, recognizing the many
    competing demands on the Federal budget, believe that, at a minimum, a
    5 percent increase for the NIH and the NCI, to $29.75 billion and $5.03
    billion respectively, will enable these valuable programs to continue
    in a strong, if not robust, way.
        To make a quantum push forward with our efforts against cancer, the
    Director of the National Cancer Institute has identified, with
    significant communitywide input, at least five additional areas and
    opportunities that the NCI is poised to exploit if the resources become
    available. By investing in these new strategic initiatives (at an
    additional cost of less than $800 million) the Congress will clearly
    demonstrate its strong commitment to making the conquest of cancer a
    national priority and a goal that is within our reach. Several of these
    areas for strategic new investments to accelerate our progress against
    cancer include:
      --Expand the Number of Cancer Centers to improve access for
            underserved populations and extend their outreach and
            collaboration capabilities.
      --Reengineer Cancer Clinical Trials through implementation of the
            recommendations of the Clinical Trials Working Group.
      --Link Science and Technology using a variety of new mechanisms and
            resources.
      --Integrate Cancer Science and encourage interdisciplinary team
            science across the biomedical research community.
        This Nation has the most sophisticated and highly developed
    biomedical research infrastructure in the world in the National
    Institutes of Health. A significant portion of that research investment
    is directed squarely at the cancer problem. Incredible progress has
    been made in understanding this disease and in devising cutting-edge
    approaches to preventing, controlling, and eliminating it. The pace of
    this research must be maintained to continue our record of advances
    that is leading to decreased mortality and improved patient care and
    outcomes.
        The American Association for Cancer Research respectfully requests
    the Congress to support, at a minimum, a 5 percent funding increase for
    the National Institutes of Health (to $29.75 billion) and the National
    Cancer Institute (to $5.03 billion) to preserve the ability of these
    successful institutions to continue their groundbreaking work toward
    the conquest of cancer for the benefit of all of our citizens.
                                     ______

    Prepared Statement of the American Association for Geriatric Psychiatry
        The American Association for Geriatric Psychiatry (AAGP)
    appreciates this opportunity to present its recommendations on issues
    related to fiscal year 2007 appropriations for mental health research
    and services. AAGP is a professional membership organization dedicated
    to promoting the mental health and well being of older Americans and
    improving the care of those with late-life mental disorders. AAGP's
    membership consists of approximately 2,000 geriatric psychiatrists as
    well as other health professionals who focus on the mental health
    problems faced by senior citizens.
        AAGP appreciates the work this subcommittee has done in recent
    years in support of funding for research and services in the area of
    mental health and aging through the National Institutes of Health (NIH)
    and the Substance Abuse and Mental Health Services Administration
    (SAMHSA). Although we generally agree with others in the mental health
    community about the importance of sustained and adequate Federal
    funding for mental health research and treatment, AAGP brings a unique
    perspective to these issues because of the elderly patient population
    served by our members.
        AAGP recognizes the Federal budget constraints that the
    subcommittee must consider in making allocations. At the same time, it
    is important to note that research dollars and better trained
    professionals can help avert a crisis in the delivery of mental health
    care to the elderly in future generations when more efficient and
    effective therapies are identified through research. In fact, the New
    England Journal of Medicine has just published an important study,
    funded by NIMH, that suggests we can significantly decrease relapse
    rates in depression--which lead to more physician visits and
    hospitalizations--by continuing these patients for longer periods on
    antidepressant medication. In addition, studies of the IMPACT model for
    treating late-life depression suggest that effective treatment of
    depression in primary care reduces the cost of general health care in
    those settings.
        Even as we note the important research being doing in the field,
    there are serious concerns, shared by AAGP and researchers, clinicians,
    and consumers that there exists a critical disparity between
    appropriations for research, training, and health services and the
    projected mental health needs of older Americans. This disparity is
    evident in the convergence of several key factors:
      --demographic projections inform us that, with the aging of the U.S.
            population, there will be an unprecedented increase in the
            burden of mental illness among aging persons, especially among
            the baby boom generation;
      --this growth in the proportion of older adults and the prevalence of
            mental illness is expected to have a major direct and indirect
            impact on general health service use and costs;
      --despite the fact that effective treatment exists, the current
            mental health needs of many older adults remain unmet;
      --the number of physicians being trained in geriatric mental health
            research and clinical care is insufficient to meet current
            needs, and this workforce shortfall is projected to become a
            crisis as the U.S. population ages over the next decade;
      --a major gap exists between research, mental health care policy, and
            service delivery; and
      --as funding for Federal health research has slowed across
            disciplines, the allocation of funds for research that focuses
            specifically on aging and mental health is disproportionately
            low, and woefully inadequate to deal with the impending crisis
            of mental health in older Americans.
        In this context, it is important to note actions relating to late
    life mental health addressed by the White House Conference on Aging,
    which was convened by President Bush in December 2005. Recognizing the
    current health and mental health needs of older Americans and the
    challenges awaiting as the Baby Boom generation ages, delegates placed
    mental health and geriatric health professional training issues at the
    forefront by voting them among their top 10 resolutions.
           demographic projections and the mental disorders of aging
        With the baby boom generation nearing retirement, the number of
    older Americans with mental disorders is certain to increase in the
    future. By the year 2010, there will be approximately 40 million people
    in the United States over the age of 65. Over 20 percent of those
    people will experience mental health problems. A national crisis in
    geriatric mental health care is emerging and has received recent
    attention in the medical literature. Action must be taken now to avert
    serious problems in the near future. While many different types of
    mental and behavioral disorders can occur late in life, they are not an
    inevitable part of the aging process, and continued research holds the
    promise of improving the mental health and quality of life for older
    Americans.
        The current number of health care practitioners, including
    physicians, who have training in geriatrics is inadequate. As the
    population ages, the number of older Americans experiencing mental
    problems will almost certainly increase. Since geriatric specialists
    are already in short supply, these demographic trends portend an
    intensifying shortage in the future. There must be a substantial public
    and private sector investment in geriatric education and training, with
    attention given to the importance of geriatric mental health needs. We
    will never have, nor will we need, a geriatric specialist for every
    older adult. However, without mainstreaming geriatrics into every
    aspect of medical school education and residency training, broad-based
    competence in geriatrics will never be achieved. There must be adequate
    funding to provide incentives to increase the number of academic
    geriatricians to train health professionals from a variety of
    disciplines, including geriatric medicine and geriatric psychiatry.
    This year's loss of all funding for geriatric health professions
    programs under Title VII of the Public Health Service Act is a stunning
    blow to this critical need, and AAGP urges the subcommittee to restore
    these programs.
        Current and projected economic costs of mental disorders alone are
    staggering. It is estimated that total costs associated with the care
    of patients with Alzheimer's disease is over $100 billion per year in
    the United States. Psychiatric symptoms (including depression,
    agitation, and psychotic symptoms) affect 30 to 40 percent of people
    with Alzheimer's and are associated with increased hospitalization,
    nursing home placement, and family burden. These psychiatric symptoms,
    associated with Alzheimer's disease, can increase the cost of treating
    these patients by more than 20 percent. Although NIA has supported
    extensive research on the cause and treatment of Alzheimer's, treatment
    of these behavioral and psychiatric symptoms has been neglected and
    should be supported through NIMH.
        Depression is another example of a common problem among older
    persons. Of the approximately 32 million Americans who have attained
    age 65, about 5 million suffer from depression, resulting in increased
    disability, general health care utilization, and increased risk of
    suicide. Depression is associated with poorer health outcomes and
    higher health care costs. Co-morbid depression with other medical
    conditions affects a greater use and cost of medications as well as
    increased use of health services (e.g., medical outpatient visits,
    emergency visits, and hospitalizations). For example, individuals with
    depression are admitted to the emergency room for hypertension,
    arthritis, and ulcers at nearly twice the rate of those without
    depression. Those individuals with depression are more likely to be
    hospitalized for hypertension, arthritis, and ulcers than those without
    depression. And, those with depression experience almost twice the
    number of medical visits for hypertension, arthritis and ulcers than
    those without depression. Finally, the cost of prescriptions and number
    of prescriptions for hypertension, arthritis, and ulcers were more than
    twice than those without depression.
        Older adults have the highest rate of suicide rate compared to any
    other age group. Comprising only 13 percent of the U.S. population,
    individuals age 65 and older account for 19 percent of all suicides.
    The suicide rate for those 85 and older is twice the national average.
    More than half of older persons who commit suicide visited their
    primary care physician in the prior month--a truly stunning statistic.
                      national institute of mental health
        In his fiscal year 2007 budget, the President proposed a decrease
    in funding for the National Institutes of Health (NIH), for the first
    time in 30 years. This decline in funding is likely to have a
    devastating impact on the ability of NIH to sustain the ongoing, multi-
    year research grants that have been initiated in recent years.
        AAGP would like to call to the subcommittee's attention the fact
    that, even in the years in which funding was increased for NIH and
    NIMH, these increases did not always translate into comparable
    increases in funding that specifically address problems of older
    adults. Data supplied to AAGP by NIMH indicates that while extramural
    research grants by NIMH increased 59 percent during the five-year
    period from fiscal year 1995 through fiscal year 2000 (from
    $485,140,000 in fiscal year 1995 to $771,765,000 in fiscal year 2000),
    NIMH grants for aging research increased at less than half that rate:
    only 27.2 percent during the same period (from $46,989,000 to
    $59,771,000). Furthermore, despite the fact that over the past 5 years,
    Congress, through committee report language, has specifically urged
    NIMH to increase research grant funding devoted to older adults, this
    has not occurred.
        AAGP is pleased that NIMH has recently renewed its emphasis on
    mental disorders among the elderly, and commends the recent creation of
    a new Aging Treatment and Prevention Intervention Research Branch at
    NIMH. AAGP would like the scope of this Branch increased into a
    comprehensive aging Branch that is responsible for all facets of
    clinical research, including translational, interventions, and disease-
    based psychopathology. The Branch should also be given adequate
    resources to fulfill its primary mission within NIMH.
        In addition to supporting research activities at NIMH, AAGP
    supports increased funding for research related to geriatric mental
    health at the other institutes of NIH that address issues relevant to
    mental health and aging, including the National Institute of Aging
    (NIA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA),
    the National Institute on Drug Abuse (NIDA), and the National Institute
    of Neurological Disorders and Stroke.
                       center for mental health services
        It is also critical that there be adequate funding for the mental
    health initiatives under the jurisdiction of the Center for Mental
    Health Services (CMHS) within SAMHSA. While research is of critical
    importance to a better future, the patients of today must also receive
    appropriate treatment for their mental health problems. SAMHSA provides
    funding to State and local mental health departments, which in turn
    provide community-based mental health services to Americans of all
    ages, without regard to the ability to pay. AAGP was pleased that the
    final budgets for the last 5 years have included $5 million for
    evidence-based mental health outreach and treatment to the elderly.
    AAGP worked with members of this subcommittee and its House counterpart
    on this initiative, which is a very important program for addressing
    the mental health needs of the Nation's senior citizens. Increasing
    this mental health outreach and treatment program must be a top
    priority, as it is the only Federally funded services program dedicated
    specifically to the mental health care of older adults.
        The greatest challenge for the future of mental health care for
    older Americans is to bridge the gap between scientific knowledge and
    clinical practice in the community, and to translate research into
    patient care. Adequate funding for this geriatric mental health
    services initiative is essential to disseminate and implement evidence-
    based practices in routine clinical settings across the States.
    Consequently, we would urge that the $5 million for mental health
    outreach and treatment for the elderly included in the CMHS budget for
    fiscal year 2005 be increased to $20 million for fiscal year 2006. Of
    that $20 million appropriation, AAGP believes that $10 million should
    be allocated to a National Evidence-Based Practices Program, which will
    disseminate and implement evidence-based mental health practices for
    older persons in usual care settings in the community. This program
    will provide the foundation for a longer-term national effort that will
    have a direct effect on the well-being and mental health of older
    Americans.
        The Community Mental Health Services Block Grant Program requires
    States and territories to include an annual plan for providing
    comprehensive community mental health services to adults with a serious
    mental illness and children with a serious emotional disturbance.
    Experience has demonstrated that States do not make adequate provisions
    for older adults. AAGP recommends that SAMHSA require these plans to
    include specific provisions for mental health services for older
    adults.
                  health resources and services administration
        Despite growing evidence of the need for more geriatric specialists
    to care for the nation's elderly population, a critical shortage
    persists. For fiscal year 2006, the Congress inexplicably eliminated
    all funding for the geriatric health professions program under Title
    VII of the Public Health Service Act. The loss of these programs could
    have a disastrous impact on physician workforce development over the
    next decade, with dangerous consequences for the growing population of
    older adults who will not have access to appropriate specialized care.
    The geriatric health professions program supports three important
    initiatives. The Geriatric Faculty Fellowship trains faculty in
    geriatric medicine, dentistry, and psychiatry. The Geriatric Academic
    Career Award program encourages newly trained geriatric specialists to
    move into academic medicine. The Geriatric Education Center (GEC)
    program provides grants to support collaborative arrangements that
    provide training in the diagnosis, treatment, and prevention of
    disease. In fiscal year 2005, these programs were funded at $31.5
    million, but, while they were funded in the Senate Appropriations bill
    for fiscal year 2006, the final legislation followed the House version,
    which eliminated funding for them. AAGP urges the subcommittee to
    restore funding to this program at fiscal year 2005 levels.
        The loss of these programs, just as the massive Baby Boomer
    generation are entering late life, will have a devastating effect on
    the Nation's ability to provide the kind of health care that will allow
    these seniors to be independent and productive as they age.
                                   conclusion
        Based on AAGP's assessment of the current need and future
    challenges of late life mental disorders, we submit the following
    fiscal year 2007 funding recommendations:
        1. The current rate of funding for aging grants at NIMH and CMHS is
    inadequate and should be increased to at least three times their
    current funding levels. In addition, the substantial projected increase
    in mental disorders in our aging population should be reflected in the
    budget process in terms of dollar amount of grants and absolute number
    of new grants.
        2. To help the country's elderly access necessary mental health
    care, previous years' funding of $5 million for evidence-based mental
    health outreach and treatment for the elderly within CMHS must be
    increased to $20 million.
        3. Funding for the geriatric health professions program under Title
    VII of the Public Health Service Act should be restored to fiscal year
    2005 levels.
        4. Both NIMH and CMHS must support adequate infrastructure and
    funding within both NIMH and CMHS to develop initiatives in aging
    research, to monitor the number and quality of applicants for aging
    research grants, to promote funding of meritorious projects, and to
    manage those grant portfolios.
        5. The scope of the recently formed Aging Treatment and Prevention
    Intervention Research Branch at NIMH should be increased to include all
    relevant clinical research, including translational, interventions, and
    disease-based psychopathology, and must receive NIMH's full support so
    it may fulfill its primary mission.
        AAGP looks forward to working with the members of this subcommittee
    and others in Congress to establish geriatric mental health research
    and services as a priority at appropriate agencies within the
    Department of Health and Human Services.
                                     ______

        Prepared Statement of the American Association of Immunologists
        The American Association of Immunologists (``AAI'') is pleased to
    have this opportunity to submit its views on fiscal year 2007 funding
    for the National Institutes of Health (NIH). AAI would like to thank
    the members of the subcommittee for their strong support for biomedical
    research, and in particular, express our great appreciation to the
    chairman, Senator Specter, and Ranking Member, Senator Harkin, for
    their extraordinary leadership and dedication to advancing biomedical
    research.
        The AAI is a not-for profit professional society representing more
    than 6,500 research scientists and physicians who are the world's
    leading experts on the immune system. While our members work in
    academia, government, and industry, most are among the more than
    200,000 research personnel affiliated with more than 3,000 institutions
    who depend on NIH funding to support their work.\1\ With approximately
    84 percent of NIH funds awarded to these individuals and institutions,
    NIH's funding level has a huge impact both on the advancement of
    biomedical research and on the local, State, and national economies.
    ---------------------------------------------------------------------------
        \1\ National Institutes of Health Fiscal Year 2007 Performance
    Budget Overview, pp.1-2. Many AAI members are medical school professors
    and researchers who receive grants from NIH, and in particular from the
    National Institute of Allergy and Infectious Diseases (NIAID) and the
    National Cancer Institute (NCI) (as well as other NIH Institutes and
    Centers), to support their research endeavors.
    ---------------------------------------------------------------------------
                          the importance of immunology
        Immunological research is crucial in a world increasingly at risk
    from infectious agents and chronic diseases.\2\ Basic research on the
    immune system provides a foundation for the development of diagnostics,
    vaccines, and therapeutics. Current efforts are focused on preventing
    and treating diseases caused by natural infectious agents, including
    influenza and avian flu, SARS, West Nile Virus, tuberculosis, and AIDS,
    as well as those that may be modified for use as agents of
    bioterrorism, including plague, smallpox, and anthrax. In addition,
    basic immunological research continues to be crucial in the development
    of increasingly effective approaches for treating chronic diseases,
    including cancer, autoimmune diseases, inflammatory disorders, and
    immunodeficiencies.
    ---------------------------------------------------------------------------
        \2\ Immunologists depend heavily on the use of animal models in
    their research. Without animal experimentation, theories about immune
    system function and treatments that might cure or prevent disease would
    have to be tested first on human subjects, something our society--and
    our scientists--would never countenance. Despite the clear necessity
    for animal research, we are experiencing both increasing regulatory
    burden in animal experimentation (eroding the return on NIH's
    investment), and threats from people and organizations that oppose such
    research. The legal and illegal methods used by some groups to further
    an animal-rights/anti-medical research agenda are diverting precious
    resources from our work, threatening the personal safety and security
    of scientists, and delaying the progress of important research now
    underway.
    ---------------------------------------------------------------------------
        The immune system works by recognizing and attacking ``foreign
    invaders'' (i.e., bacteria and viruses) inside the body. It also plays
    an important role in controlling the growth of tumor cells. The immune
    system can protect its host (human or animal) from illness or disease
    either entirely--by attacking and destroying the virus, bacterium, or
    tumor cell--or partially, resulting in a less serious illness. But even
    a healthy immune system cannot completely protect us from all threats
    that might cause disease. Moreover, the immune system also has a ``dark
    side'': it can lead to the rejection of transplanted organs or bone
    marrow and--if it is working improperly--can allow the body to attack
    itself instead of an invader, resulting in an ``auto-immune'' disease
    (e.g., Type 1 diabetes, multiple sclerosis, rheumatoid arthritis).
        Recent advances in immunology have allowed for revolutionary
    treatments. For example, therapeutic substances called ``biologics''
    have provided new, effective treatments for painful, debilitating and
    life-threatening diseases such as rheumatoid arthritis, inflammatory
    diseases, and cancer. Biologics that use modified human antibodies and
    cell receptors specifically target the substance (TNF) that causes
    joint destruction in rheumatoid arthritis, and the painful symptoms of
    psoriasis, and ankylosing spondylitis. An engineered antibody
    (herceptin) is being used to control the reoccurrence of breast cancer;
    resulting in a two-fold reduction in reoccurrence. Another monoclonal
    antibody and human protein--CTLA4Ig--has been dramatically effective in
    clinical trials treating prostate cancer and melanoma as well as
    showing promise as a treatment for lupus, arthritis, multiple
    sclerosis, and organ transplant rejection.
        Immunologists have also focused on improved approaches to vaccine
    development, including a vaccine for Hemophilius influenza type b. This
    vaccine has reduced the incidence of pediatric meningitis in the United
    States from approximately 20,000 to 200 cases per year. Our
    understanding of what makes an efficacious vaccine will be critical as
    we face future pandemics, be they natural, like avian flu, or altered
    pathogens that could be used for bioterrorism, like missilized anthrax.
        None of these advances could have been made without substantial
    public investment in basic immunological research. But even as we make
    huge strides, new threats emerge: immunologists are working feverishly
    to defend against bird flu and potential bioterrorism pathogens.
               the nih budget: trouble in the post-doubling years
        AAI is very grateful to this subcommittee and the Congress for
    doubling the NIH budget from fiscal year 1998 to fiscal year 2003. This
    ``doubling'' represented an unprecedented commitment by the Federal
    Government to preventing, treating, and curing disease, and has allowed
    scientists to begin new, cutting edge research made possible by recent
    advances in sequencing the genomes of humans, model organisms, and
    microbial pathogens that cause human and animal diseases.
        But scientific research takes time, and the doubling of the NIH
    budget will have been for naught if we are unable to complete ongoing
    studies or retain trained personnel. Indeed, the doubling has already
    been eroded. Since 2003, the annual increases in the NIH budget have
    not kept pace with biomedical research inflation.\3\ Moreover, the
    President's fiscal year 2007 ``flat'' budget would result in an
    effective decrease in the NIH budget, only the second time in 36 years
    that the NIH budget has been reduced. This would have a devastating
    effect:
    ---------------------------------------------------------------------------
        \3\ NIH funding increases/decreases since the doubling period ended
    [fiscal year 2004 (3.03 percent), fiscal year 2005 (2.18 percent) and
    fiscal year 2006 (-.12 percent)] have all been below the Biomedical
    Research and Development Price Index (``BRDPI''), a U.S. Department of
    Commerce (``DOC'') estimate of the cost of inflation for biomedical
    research. The BRDPI was developed by the DOC's Bureau of Economic
    Analysis under an agreement with NIH and is updated annually. It
    indicates how much the NIH budget must increase to maintain purchasing
    power. Projections for future years are prepared by the NIH Office of
    Science Policy.
    ---------------------------------------------------------------------------
        1. Key NIH Institutes could be forced to drop paylines even lower
    than the current, far too low 10-14 percent (significantly below the
    approximately 22 percent funded during the doubling); \4\
    ---------------------------------------------------------------------------
        \4\ AAI analyzed paylines of key NIH Institutes from fiscal year
    2000-fiscal year 2002; see www.nih.gov.
    ---------------------------------------------------------------------------
        2. There would be no inflationary increases for direct, recurring
    costs in non-competing Research Project Grants (RPGs), undermining
    NIH's fiscal year 2007 goal to ``preserve to the greatest extent
    possible the ability of scientists to obtain individual support for
    their research ideas.'' National Institutes of Health Summary of the
    Fiscal Year 2007 President's Budget February 6, 2006, p.3;
        3. It would have rapid, adverse repercussions on the future of the
    research enterprise. Our brightest young people will be deterred from
    pursuing biomedical research careers if their chances of receiving an
    NIH grant become even lower. If we cannot attract and retain the best
    young minds, the United States will lose its preeminence in science and
    technology to nations--including India, Singapore, China, and Korea--
    that are investing aggressively to compete.
        4. It would not permit increases in already inadequate stipends to
    pre- and post-doctoral fellows, and will undermine efforts to attract
    excellent scientists to NIH and to academia.
                          pandemic influenza/influenza
        Influenza leads to more than 200,000 hospitalizations and about
    36,000 deaths nationwide in an average year. Pandemic influenza could
    cause millions of deaths and hospitalizations. Despite these very real
    threats, the President's fiscal year 2007 NIH Budget includes an
    increase of only $17 million to support specific research initiatives
    focused on pandemic influenza, bringing total NIH spending on influenza
    to approximately $199 million (about $35 million over fiscal year
    2006).
        The vast majority of funds (more than $3 billion) appropriated to
    date under the Department of Health and Human Services Pandemic
    Influenza Preparedness Plan have been devoted to other pandemic
    influenza related activities (including production/procurement of
    vaccines/antivirals). While these public health efforts are extremely
    important, it is essential to realize that any existing pathogen that
    could cause influenza or pandemic influenza (e.g., bird flu) can
    mutate, rendering existing countermeasures ineffective. Since new
    influenza strains can quickly emerge, research to identify new
    pathogens, understand the immune response, and develop tools for
    protecting against the pathogen should never take a back seat to other
    pandemic influenza-related activities. The need for this research
    supports AAI's request for an increased budget for NIH.
                              biodefense research
        AAI supports the President's request for $1.891 billion for
    biodefense research, an increase of 6.2 percent over fiscal year 2006.
    NIH's fiscal year 2007 biodefense research priorities include
    continuing work on developing vaccines and treatments for anthrax,
    smallpox, plague, tularemia, hemorrhagic fevers, and botulinum toxin.
        NIH plans to direct $160 million to an Advanced Development Fund
    (``ADF'') within the Office of the NIH Director to ``support efforts to
    work with academia and industry to develop candidate countermeasures
    from the point of Investigation New Drug Application (INDA) to the
    level that these candidate countermeasures could be eligible for
    acquisition by Project Bioshield.'' AAI urges that the NIH Director
    work closely with the NIAID Director to ensure that the ADF focuses on
    NIH's traditional expertise in basic and translational research and not
    on activities relevant to commercial development or the manufacturing
    of a product.
        NIH also plans to spend $25 million to construct additional high
    containment laboratories at biosafety level (BSL) 3 and to renovate
    existing labs to meet current BSL-3 standards. (BSL-3 labs are
    necessary for the safe conduct of research on dangerous and infectious
    pathogens.) AAI recommends that these funds be used first for the
    renovation of existing labs; the construction of new labs may not be
    necessary with the limited research funding that may be available this
    year.
                             administrative issues
    1. Office of Portfolio Analysis and Strategic Initiatives
        AAI supports the newly formed Office of Portfolio Analysis and
    Strategic Initiatives (OPASI) as a way of better managing and analyzing
    NIH's portfolio. While we understand the need for a ``Common Fund'' to
    support OPASI, we believe that, in this difficult fiscal climate, such
    a fund should be limited and should grow no faster than the overall NIH
    budget.
    2. Research, Management and Support (RM&S)
        The President's fiscal year 2007 budget proposal for Research,
    Management and Services (RM&S), which supports the management,
    monitoring, and oversight of intramural and extramural research
    activities (including NIH's highly regarded peer review process),
    includes an increase of $14 million, or 1.3 percent. AAI supports an
    appropriate increase in the RM&S budget to ensure that it is sufficient
    (1) to enable NIH to supervise a portfolio of increasing size and
    complexity and (2) to ensure that NIH funds are well and properly
    spent.
    3. Outsourcing
        AAI continues to be concerned about the ``outsourcing'' of NIH
    jobs. While certain NIH jobs may be appropriate for such an approach,
    it should not be applied to program administration staff, many of whom
    are highly experienced and have historical knowledge and understanding
    of NIH programs and policies. Such outsourcing would result in the loss
    of a dedicated and capable workforce and reduce efficiency in the long
    run.
    aai's recommended budget increase for fiscal year 2007: 5 percent (1.2
                       percent above projected inflation)
        AAI strongly believes that we must increase the NIH budget now in
    order to capitalize on important advances that have resulted from the
    doubling. We urge this subcommittee to increase the NIH budget by 5
    percent ($1.4 billion) in fiscal year 2007, for a total budget of
    $29.75 billion. This increase, which is only 1.2 percent above the
    projected rate of biomedical research inflation, would enable
    researchers to capitalize on important advances that have resulted from
    the doubling, leading to increased translational and clinical
    applications. It would also assist efforts to attract and retain bright
    young American scientists to research careers.
                         the effective use of nih funds
        While AAI advocates a 5 percent increase in NIH funding, we agree
    that NIH should use its existing funds as effectively as possible. To
    that end, we recommend the following:
    (1) The ``NIH Roadmap for Biomedical Research'' (``NIH Roadmap'')
        AAI notes that the President's fiscal year 2007 budget request for
    the NIH Roadmap has grown to $443 million, an increase of $113 million
    over fiscal year 2006. While AAI supports this effort to fund
    multidisciplinary, interdisciplinary research and agrees that such
    research is an important part of biomedical research in the 21st
    century, we recommend that funds allocated to the NIH Roadmap not grow
    faster than the overall NIH budget and that all Roadmap funds,
    including the Director's Pioneer Awards, be awarded through a rigorous
    peer review process.
    (2) NIH ``Enhanced Access to Scientific Publications'' Policy
        AAI recommends that NIH partner with not-for-profit scientific
    publishers to provide enhanced public access to NIH-funded research
    results, rather than continuing an expensive effort to publish
    manuscripts itself. In this era of limited funds, NIH should work with
    these willing partners to ensure that its budget is used to support and
    advance research and not to duplicate services already provided by the
    private sector. AAI urges the subcommittee to support efforts underway
    between NIH and the not-for-profit scientific publishing community to
    develop a policy that will enhance public access while addressing the
    concerns of publishers.
    (3) Peer review and the independence of science
        Millions of lives--as well as the prudent use of taxpayer dollars--
    depend on government officials receiving--and taking--the very best and
    most independent scientific advice available. We urge this subcommittee
    to provide oversight which ensures that funds expended enhance the
    ability of scientists to provide independent scientific advice
    (particularly on government scientific advisory panels) and preserve
    independent peer review (including ensuring the review of scientific
    research results by peers through robust, independent scientific
    journals).
                                   conclusion
        AAI greatly appreciates this opportunity to testify and thanks the
    members of this subcommittee for your strong support for biomedical
    research, the NIH, and the scientists who devote their lives to
    preventing, treating, and curing disease. We look forward to working
    with you and hope that you will contact me or AAI if you have any
    questions or if we can be of assistance.
                                     ______

      Prepared Statement of the American Association of Nurse Anesthetists

                                     FISCAL YEAR 2007 APPROPRIATIONS REQUEST SUMMARY
    ----------------------------------------------------------------------------------------------------------------
                                               Fiscal year 2006         Fiscal year 2007      AANA fiscal year 2007
                                                    actual                   budget                  request
    ----------------------------------------------------------------------------------------------------------------
    HHS/HRSA/BHPr Title VIII Advanced      Awaiting grant           Grant allocations not    $4 million for nurse
     Education Nursing, Nurse Anesthetist   allocations.             specified.               anesthesia education
     Education Reserve.                    $3.5 million fiscal                               $65 million for
                                            year 2005.                                        advanced education
                                                                                              nursing
    Title VIII HRSA BHPr Nursing           $151,191,000             $150,000,000             $175,000,000
     Education Programs.
    ----------------------------------------------------------------------------------------------------------------

        The AANA is the professional association for more than 34,000
    Certified Registered Nurse Anesthetists (CRNAs) and student nurse
    anesthetists representing over 90 percent of the nurse anesthetists in
    the United States. Today, CRNAs are directly involved in approximately
    65 percent of all anesthetics given to patients each year in the United
    States. CRNA services include administering the anesthetic, monitoring
    the patient's vital signs, staying with the patient throughout the
    surgery, as well as providing acute and chronic pain management
    services. CRNAs provide anesthesia for a wide variety of surgical cases
    and are the sole anesthesia providers in almost 70 percent of rural
    hospitals, affording these medical facilities obstetrical, surgical,
    and trauma stabilization, and pain management capabilities. CRNAs work
    in every setting in which anesthesia is delivered including hospital
    surgical suites and obstetrical delivery rooms, ambulatory surgical
    centers (ASCs), pain management units and the offices of dentists,
    podiatrists and plastic surgeons.
        Nurse anesthetists are experienced and highly trained anesthesia
    professionals whose record of patient safety in the field of anesthesia
    was bolstered by the Institute of Medicine report that found in 2000,
    that anesthesia is 50 times safer than 20 years previous. (Kohn L.,
    Corrigan J., Donaldson M., ed. To Err is Human. Institute of Medicine,
    National Academy Press, Washington DC, 2000.) Nurse anesthetists
    continue to set for themselves the most rigorous continuing education
    and re-certification requirements in the field of anesthesia. Relative
    anesthesia patient safety outcomes are comparable among nurse
    anesthetists and anesthesiologists, with Pine having recently
    concluded, ``the type of anesthesia provider does not affect inpatient
    surgical mortality.'' (Pine, Michael MD et al. Surgical mortality and
    type of anesthesia provider. Journal of American Association of Nurse
    Anesthetists. Vol. 71, No. 2, p. 109-116. April 2003.) In addition, a
    recent AANA workforce study's data showed that CRNAs and
    anesthesiologists are substitutes in the production of surgeries.
    Through continual improvements in research, education, and practice,
    nurse anesthetists are vigilant in their efforts to ensure patient
    safety.
        CRNAs provide the lion's share of the anesthesia care required by
    our U.S. Armed Forces through active duty and the reserves, from here
    at home to the leading edge of the field of battle. In May 2003, at the
    beginning of ``Operation Iraqi Freedom'' 364 CRNAs were deployed to the
    Middle East to ensure military medical readiness capabilities. For
    decades, CRNAs have staffed ships, remote U.S. military bases, and
    forward surgical teams without physician anesthesiologist support.
          importance of title viii nurse anesthesia education funding
        The nurse anesthesia profession's chief request of the subcommittee
    is for $4 million to be reserved for nurse anesthesia education and $65
    million for advanced education nursing from the Title VIII program.
    This sustained funding is justified by two facts. First, there is a 12
    percent vacancy rate of nurse anesthetists in the United States
    impacting people's healthcare. And second, the Title VIII program,
    which has been strongly supported by members of this subcommittee in
    the past, is an effective means to help address the nurse anesthesia
    workforce demand. This demand for CRNAs is something that the nurse
    anesthesia profession addresses every day with success, and with the
    critical assistance of Federal funding through HHS' Title VIII
    appropriation.
        The increase in funding for advanced education nursing from $58
    million to $65 million is necessary to meet the continuing demand for
    nursing faculty and other advanced education nursing services
    throughout the United States. Only a limited number of new programs and
    traineeships can be funded each year at the current funding levels. The
    program provides for competitive grants and contracts to meet the costs
    of projects that support the enhancement of advanced nursing education
    and practice and traineeships for individuals in advanced nursing
    education programs. This funding is critical to the efforts to meet the
    nursing workforce needs of Americans who need healthcare.
        In 2003, the AANA conducted a nurse anesthesia workforce study that
    concluded a 12 percent vacancy rate in hospitals for CRNAs, and a lower
    vacancy rate in ambulatory surgical centers. The supply has increased
    in recent years, stimulated by increases in the number of CRNAs
    trained. However, these increases had not been enough to offset the
    number of retiring CRNAs. This trend, established in 2003, requires a
    continuous growth in the number of nurse anesthesia graduates to fill
    the vacancy rate. This is compounded by the rising number of Medicare-
    eligible Americans, from about 34 million today to more than 40 million
    in 2010, who will require the care that CRNAs provide.
        The problem is not that our 99 accredited programs of nurse
    anesthesia are failing to attract qualified applicants; it is that the
    programs are full. Each CRNA program continues to turn away qualified
    applicants--bachelor's educated registered nurses who had spent at
    least 1 year serving in an acute care environment. These CRNA schools
    are located all across the country including the following:

    ------------------------------------------------------------------------
                                                               Number of
                                                            accredited nurse
                            State                              anesthesia
                                                                programs
    ------------------------------------------------------------------------
    PA...................................................                 12
    FL...................................................                  6
    OH...................................................                  5
    TX...................................................                  5
    IL...................................................                  4
    NY...................................................                  4
    CA...................................................                  3
    CT...................................................                  3
    MD...................................................                  3
    RI...................................................                  2
    WI...................................................                  1
    ------------------------------------------------------------------------

        Recognizing the importance of nurse anesthetists to quality
    healthcare, the AANA has been working with the 99 accredited programs
    of nurse anesthesia to increase the number of qualified graduates. In
    addition, the AANA has worked with nursing and allied health deans to
    develop new CRNA programs.
        The Council on Certification of Nurse Anesthetists (CCNA) reports
    that in 1999, our schools produced 948 new graduates. In 2005, that
    number had increased to 1,790, an 89 percent increase in just 5 years.
    This growth is expected to continue. The CCNA projects CRNA programs to
    produce over 1,900 graduates in 2006.
        To truly meet the nurse anesthesia workforce challenge, the
    capacity and number of CRNA schools must continue to expand. With the
    help of competitively awarded grants supported by Title VIII funding,
    the nurse anesthesia profession is making significant progress,
    expanding both the number of clinical practice sites and the number of
    graduates.
        The AANA is pleased to report that this progress is extremely cost-
    effective from the standpoint of Federal funding. Anesthesia can be
    provided by nurse anesthetists, physician anesthesiologists, or by
    CRNAs and anesthesiologists working together. As mentioned earlier, it
    has been confirmed, ``the type of anesthesia provider does not affect
    inpatient surgical mortality.'' Yet, for what it costs to train just
    one anesthesiologist, several CRNAs may be educated to provide the same
    service with the same optimum level of safety. This represents a
    significant educational cost/benefit for supporting CRNA educational
    programs with Federal dollars vs. supporting other models of anesthesia
    education.
        To further demonstrate the effectiveness of the $3 million Title
    VIII investment in nurse anesthesia education, the AANA surveyed its
    CRNA program directors in 2003 to gauge the impact of the Title VIII
    funding. Of the eleven schools that had reported receiving competitive
    Title VIII Nurse Education and Practice Grants funding from 1998 to
    2003, the programs indicated an average increase of at least 15 CRNAs
    graduated per year. They also reported on average more than doubling
    their number of graduates, who provide care to patients during and
    following their education. Moreover, they reported producing additional
    CRNAs that went to serve in rural or medically underserved areas. Under
    both of these circumstances, an increased number of student nurse
    anesthetists and CRNAs are providing healthcare to the people of
    medically underserved America.
        We believe it is important for the subcommittee to allocate $4
    million for nurse anesthesia education for several reasons. First, as
    this testimony has documented, the funding is cost-effective and well
    needed. Second, the Title VIII authorization previously providing such
    a reserve expired in September 2002. Third, this particular funding is
    important because nurse anesthesia for rural and medically underserved
    America is not affected by increases in the budget for the National
    Health Service Corps and community health centers, since those
    initiatives are for delivering primary and not surgical healthcare.
    Lastly, this funding meets an overall objective to increase access to
    quality healthcare in medically underserved America.
           title viii funding for strengthening the nursing workforce
        The AANA joins a growing coalition of nursing organizations and
    others in support of the subcommittee providing a total of $175 million
    in fiscal year 2007 for nursing shortage relief through Title VIII.
    This amount is approximately $25 million over the fiscal year 2005
    level and over the President's fiscal year 2007 budget.
        Every district in America is familiar with the importance of
    nursing. The AANA is appreciative of the leadership of the subcommittee
    and the congressional support for the $5 million increase over the
    President's request in fiscal year 2005 for nurse education funding.
        America spends more than $2 trillion on healthcare this year, paid
    by private and public sources. About $298 billion accounted for
    Medicare outlays in 2005. Medicare directs about $8.7 billion of that
    to fund direct and indirect GME, with some 99 percent of that funding
    helping to educate physicians and allied health professionals, and
    about 1 percent to help educate nurses. For every present and future
    healthcare patient, Congress must put some focus on nurses and nurse
    anesthesia care.
        To ensure that America has access to nurse anesthesia care when
    needed, a sustained investment from Congress is necessary especially
    for the provision of services in rural and medically underserved
    America. Quality anesthesia care provided by CRNAs saves lives,
    promotes quality of life, and makes fiscal sense. This Federal support
    for nurse education will improve patient access to quality services and
    strengthen the Nation's healthcare delivery system.
        Thank you.
                                     ______

            Prepared Statement of the American College of Cardiology
        The American College of Cardiology appreciates the opportunity to
    provide the subcommittee with recommendations for fiscal year 2007
    funding for life-saving cardiovascular research and education.
        The ACC is a 33,000 member non-profit professional medical society
    and teaching institution whose purpose is to foster optimal
    cardiovascular care and disease prevention through professional
    education, promotion of research, and leadership in the development of
    standards and formulation of health care policy.
        Heart disease is the leading cause of death for both women and men
    in the United States, killing more than 900,000 Americans each year.
    More than 70 million Americans live with some form of heart disease.
    The economic impact of cardiovascular disease on the U.S. health care
    system continues to grow as the population ages. In 2005, heart disease
    and stroke were projected to cost the Nation $393 billion, including
    health care services, medications, and lost productivity.
        As the premier cardiovascular society, the ACC supports a strong
    Federal investment in research and public education that addresses the
    prevention, detection and treatment of cardiovascular disease. Current
    Federal research is providing breakthrough advances that fundamentally
    change our understanding of cardiovascular disease, leading to more
    effective treatments, decreased costs and increased quality of life for
    patients.
        For instance, a study published in the February 2006 issue of the
    Journal of the American College of Cardiology yielded important
    findings for women with coronary heart disease. Part of the National
    Heart, Lung, and Blood Institute (NHLBI)'s Women's Ischemia Syndrome
    Evaluation (WISE) study, researchers found that women with a condition
    called coronary microvascular syndrome often go undiagnosed for heart
    disease because dysfunction occurs in very small arteries of the heart
    and does not show up when physicians use standard tests. As a result of
    the missed diagnosis, women are not treated for angina and high
    cholesterol and remain at high risk for a heart attack. National
    Institutes of Health (NIH) studies like WISE are helping to unravel the
    mystery of cardiovascular disease in women and hold immediate
    implications for the treatment of women at risk for heart disease.
        The ACC is extremely concerned that the administration's budget
    request proposes no increase in funding for the NIH and cuts funding
    for many critical health programs. If instituted, the administration's
    budget would force the research community to scale back and even halt
    valuable initiatives. The ACC is encouraged that the Senate recently
    approved an amendment to its budget resolution that provides an extra
    $7 billion for key health and education programs.
                            funding recommendations
        The ACC urges Congress to support the following fiscal year 2007
    funding recommendations.
        National Institutes of Health: $29.849 billion.--Research conducted
    through the NIH has resulted in better diagnosis and treatment of
    cardiovascular disease, improving the quality of life for those living
    with the disease and lowering the number of deaths attributed to it.
        National Heart Lung and Blood Institute: $3.068 billion.--The NIH
    is doing critical research into the causes, treatment and prevention of
    cardiovascular disease through the NHLBI.
        Agency for Healthcare Research and Quality: $440 million.--The
    Agency for Healthcare Research and Quality (AHRQ)'s health services
    research complements the research of the NIH by helping cardiologists
    make choices about what treatments work best, for whom and when.
        CDC State Heart Disease and Stroke Prevention Program: $55
    million.--The Centers for Disease Control and Prevention (CDC) State
    Heart Disease and Stroke Prevention program's public education efforts
    is making strides in the prevention and early intervention of
    cardiovascular disease.
        HRSA Rural and Community AED Program: $9 million.--The Health
    Resources and Services Administration (HRSA) Rural and Community Access
    to Emergency Defibrillation program is saving lives by placing external
    defibrillators in public facilities.
                                    summary
        The ACC appreciates the subcommittee's past support for these
    important programs. The ACC urges Congress to provide a strong fiscal
    year 2007 investment in the cardiovascular research and education
    programs described above to continue the great strides being made in
    fighting cardiovascular disease. Should you have any questions, please
    contact Jennifer Brunelle at jbrunell@acc.org or (301) 581-3477.
                                     ______

        Prepared Statement of the American College of Obstetricians and
                                 Gynecologists
        The American College of Obstetricians and Gynecologists (ACOG),
    representing 49,000 physicians and partners in women's health care, is
    pleased to offer this statement to the House Committee on
    Appropriations, Subcommittee on Labor, Health and Human Services, and
    Education. We thank Chairman Regula, Ranking Member Obey, and the
    entire subcommittee for their leadership to continually address
    maternal and child health care services.
        The Nation has made important strides to improve women and
    children's health over the past several years, and ACOG is grateful to
    this Committee for its commitment to research. We look forward to
    working with the Members of this Committee to ensure that vital
    research continues to eliminate disease and to ensure valuable new
    treatment discoveries are implemented. The National Institutes of
    Health (NIH) has examined and determined many disease pathways, while
    the Health Resources and Services Administration (HRSA) and the Centers
    for Disease Control and Prevention (CDC) have been successful in
    translating research findings into valuable public health policy
    solutions. This dedicated commitment to elevate, promote and implement
    medical research faces an uncertain future at a time when scientists
    are on the cusp of new cures.
        It is essential that the Committee provide strong support for
    current studies, and for future advances, as well. We urge the
    Committee to support a an fiscal year 2007 appropriation of $29.75
    billion for the NIH, and $1.328 billion for the National Institute of
    Child Health and Human Development (NICHD), both a 5 percent increase
    over fiscal year 2006 levels. We also continue to support efforts to
    secure adequate funds for important public health programs at HRSA
    ($7.5 billion) and the CDC ($8.5 billion plus funding for pandemic
    influenza preparedness).Continued appropriations to these agencies will
    ensure ongoing and new research initiatives continue to yield positive
    results for women and children's health.
            national institutes of health--research leading the way
    Research at the NICHD
        The NICHD conducts research that holds great promise to improve
    maternal and fetal health and safety. With the support of Congress, the
    Institute has initiated research addressing the causes of cerebral
    palsy, gestational diabetes and pre-term birth. However, much more
    needs to be done to reduce the rates of maternal mortality and
    morbidity in the United States. More research is needed on such
    pregnancy-related issues as the impact of chronic conditions during
    pregnancy, racial and ethnic disparities in maternal mortality and
    morbidity, and drug safety with respect to pregnancy.
        A commitment to research in maternal health sheds light on a
    breadth of issues that save women's lives. Important research examining
    the following issues must continue:
                Reducing High Risk Pregnancies
        NICHD's Maternal Fetal Medicine Unit Network, working at 14 sites
    across the United States (University of Alabama, University of Texas-
    Houston, University of Texas-Southwestern, Wake Forest University,
    University of North Carolina, Brown University-Women and Infant's
    Hospital, Columbia University, Drexel University, University of
    Pittsburgh-Magee Women's Hospital, University of Utah, Northwestern
    University, Wayne State University, Case Western University, and Ohio
    State University), will help reduce the risks of cerebral palsy,
    caesarean deliveries, and gestational diabetes. This Network discovered
    that progesterone reduces preterm birth by one-third.
                Reducing the Risk of Perinatal HIV Transmission
        In the last 10 years, NICHD research has helped decrease the rate
    of perinatal HIV transmission from 27 percent to 1.2 percent. This
    advancement signals the near end to mother-to-child transmission of
    this deadly disease.
                Reducing the Effects of Pelvic Floor Disorders
        The Institute has made recent advancements in the area of pelvic
    floor disorders. The NICHD is investigating whether women that have
    undergone cesarean sections have fewer incidences of pelvic floor
    disorder than women who have delivered vaginally.
                Reducing the Prevalence of Premature Births
        NICHD is helping our Nation understand how adverse conditions and
    health disparities increase the risks of premature birth in high-risk
    racial groups.
                Drug Safety During Pregnancy
        The NICHD recently created the Obstetric and Pediatric Pharmacology
    Branch to measure drug metabolism during pregnancy.
    The Challenge of the Future: Attracting New Researchers
        Despite the NICHD's critical advancements, reduced funding has made
    it difficult for this research to continue, largely due to the lack of
    new investigators. Congressional programs such as the loan repayment
    program, the NIH Mentored Research Scientist Development Program for
    reproductive health, and a small grant program, all attract new
    researchers, but low pay lines make it difficult for the NICHD to
    maintain them. Due to the structure of the peer review system, previous
    grant recipients have an advantage because their grants require fewer
    funds. This makes it more difficult for new investigators to get into
    the system, jeopardizing the future of women's health research. We urge
    the Committee to significantly increase funding at the NICHD to
    maintain a high level of research innovation and excellence, in turn
    reducing the incidence of maternal morbidity and mortality and
    discovering cures for other chronic conditions.
          hrsa and cdc: turning research into public health solutions
        It is essential that we rapidly transform women's health research
    findings into public health solutions. HRSA and the CDC have created
    women and children's health outreach programs based on research
    conducted on infant mortality, birth defects, gynecological cancers,
    and a variety of other health issues.
        For example, research shows tobacco abuse and health disparities
    are risk factors for infant mortality. Healthy Start offers programs
    for States, which fund provider and community education programs that
    improve maternal health through tobacco cessation programs, and finds
    ways to decrease the infant mortality rate by investigating cultural
    and institutional health disparities. Research also shows that early
    screening and detection of certain strands of the human papilloma virus
    (HPV) may progress into cervical cancer. By screening thousands of low-
    income women who would not otherwise receive access to care; this CDC
    program has saved hundreds of lives.
    National Fetal Infant Mortality Review
        The Fetal and Infant Mortality Review (FIMR) is a cooperative
    Federal agreement between ACOG and the Maternal Child Health Bureau at
    HRSA. FIMR uses the expertise of ob-gyns and local health departments
    to find solutions to problems related to infant mortality. In light of
    the increase in the infant mortality rate for 2002, the FIMR program is
    vital to develop community-specific, culturally appropriate
    interventions. Today 220+ local programs in 42 States are implementing
    FIMR and finding it is a powerful tool to bring communities together to
    address the underlying problems that negatively affect the infant
    mortality rate.
        In order to meet the demand of the increasing number of FIMR
    programs, NFIMR must be able to continue its activities at an adequate
    funding level. A rigorous national evaluation of FIMR conducted by
    Johns Hopkins University has concluded that the FIMR methodology is an
    effective perinatal initiative. Based on that new research, FIMR can
    now be called an evidence based MCH intervention. All Healthy Start
    programs and every locality with disparities in infant outcomes should
    be actively encouraged to implement this FIMR process. We urge this
    Committee to recognize the many positive contributions of the FIMR
    program and ensure it remains a fully funded program within HRSA.
    Provider's Partnership
        Through May 2003, HRSA funded the Provider's Partnership, a
    cooperative agreement between the Federal Maternal and Child Health
    Bureau and ACOG. This Partnership includes a series of State-level
    projects initiated to address key women's health issues, while
    simultaneously building partnerships between ACOG Members and public
    health leadership.
        The Partnership works specifically with psychosocial issues that
    greatly impact the health and well-being of women. The morbidity and
    mortality attributed to issues such as a woman's depression, tobacco
    use, substance abuse and domestic violence are becoming increasingly
    apparent as they weigh on both the woman and her entire family. Without
    treatment, these psychosocial issues place a heavy financial burden on
    State and Federal resources. Obstetrician-gynecologists play a critical
    role in addressing these problems within their current practice;
    however because of the complexity and the importance of promptly
    linking at-risk women with appropriate services, responsibility for
    full psychosocial assessment and treatment cannot fall solely on
    obstetrician-gynecologists. Partnerships between women's health care
    physicians and State and community programs are needed that allow for
    integration of medical care with psychosocial services. Partnerships
    increase coordination thereby minimizing demands on both the behavioral
    health care system and individual providers. Provider's Partnership
    enables stakeholders to improve prevention interventions, so that later
    complications can be avoided.
        There are currently 30 State-level Partnership teams focused on
    depression in women, tobacco use, perinatal HIV transmission and oral
    health. These teams have been successful at surveying obstetric
    providers on their screening; counseling and referral practices for
    perinatal depression and tobacco use, the results of which have been
    the basis for the development of statewide legislative and practice
    policy guidelines; establishing pilot screening and intervention
    initiatives for depression in women; and instituting provider training
    and technical assistance for depression and tobacco use screening and
    intervention. Despite their successes, these teams still struggle for
    funds to offset administrative and program costs. Representatives from
    additional States have expressed an interest in developing an ACOG
    Provider's Partnership; however, any new efforts are being postponed
    until additional funding can be identified. We urge the committee to
    restore funding for the Partnership to fiscal year 2003 levels.
    The National Breast and Cervical Cancer Early Detection Program
            (NBCCEDP)
        The National Breast and Cervical Cancer Early Detection Program
    (NBCCEDP) administered by the CDC is an indispensable health program in
    helping underserved women gain access to screening programs for early
    detection of breast and cervical cancers. The NBCCEDP has served over
    2.5 million women and provided 5.8 million screening examinations.
    Early detection and treatment of breast and cervical cancers greatly
    increase a woman's odds of conquering these diseases. The President's
    fiscal year 2007 Budget recommends decreasing funding by $1.4 million,
    preventing access to these services for an estimated 4,000 women per
    year. We strongly urge the Committee to continue saving women's lives
    and prevent cuts to this vital program.
    National Center on Birth Defects and Developmental Disabilities
            (NCBDDD)
        Birth defects affect about one in every 33 babies born in the
    United States each year. Babies born with birth defects have a greater
    chance of illness and long term disability than babies without birth
    defects. According to the CDC, a great opportunity for further
    improvement lies in prevention strategies that, if implemented prior to
    conception, would result in additional improvement of pregnancy
    outcomes. A cooperative agreement between the NCBDDD and ACOG has
    resulted in increased provider knowledge of genetic screening and
    diagnostic tests, technical guidance on routine preconception care and
    prenatal genetic screening, and improved access to care for women with
    disabilities.
        Again, we would like to thank the Committee for its continued
    support in addressing the multiple factors that affect maternal and
    child health. We strongly urge this subcommittee to support increased
    funding for the NICHD, and renewed appropriations for the maternal
    child health programs at the CDC and HRSA. By continuing to translate
    research done at the NICHD into positive outreach programs such as the
    Provider's Partnership and the NBCCEDP, we can further improve our
    Nation's overall health.
                                     ______

            Prepared Statement of the American Diabetes Association
        Thank you for the opportunity to submit testimony on the importance
    of Federal funding for diabetes programs at the Centers for Disease
    Control and Prevention (CDC) and diabetes research at the National
    Institutes of Health (NIH).
        As the Nation's leading nonprofit health organization providing
    diabetes research, information and advocacy, the American Diabetes
    Association feels strongly that Federal funding for diabetes prevention
    and research efforts is critical not only for the 20.8 million
    Americans who currently have diabetes, but also for the more than 40
    million who have a condition known as ``pre-diabetes.''
        Diabetes is a serious disease, and is a contributing and underlying
    cause of many of the diseases on which the Federal Government spends
    the most health care dollars. In addition to the $132 billion in 2002
    dollars in direct and indirect costs spent solely on diabetes each
    year, diabetes is a significant cause of heart disease (which costs our
    Nation $258.5 billion each year), a significant cause of stroke ($57.9
    billion each year), and the leading cause of kidney disease ($40.3
    billion). Diabetes is also the leading cause of adult-onset blindness
    and lower limb amputations.
        Approximately 48,000 people suffering from diabetes live in each
    congressional district and the number of people living with diabetes in
    this country is growing at a shocking rate. In the last 2 years alone,
    diabetes prevalence in the United States has increased by 14 percent.
    The number of Americans with diabetes is now growing at a rate of 8
    percent per year and is the single most prevalent chronic illness among
    children. Because of the systemic havoc that diabetes wreaks throughout
    the body, it is no surprise that the life expectancy of a person with
    the disease averages 10-15 years less than that of the general
    population.
        As the statistics listed above illustrate, we are facing an
    epidemic of diabetes in this country, which if left unchecked could
    have significant implications for many future generations. A recent
    study of the diabetes epidemic in New York City warns that diabetes-
    caused heart attacks threatens to reverse the tremendous gains made in
    preventing deaths from heart disease. One of the authors of the study
    termed it ``a public health catastrophe.'' We know, for example, that
    in every 24 hour period, there will be 4,100 people diagnosed with
    diabetes, 230 amputations in people with diabetes, 120 people who enter
    end-stage kidney disease programs and 55 people who go blind. All told,
    there will be nearly 225,000 deaths from diabetes each year. That is
    the ultimate cost of underfunding research and prevention programs.
        While science continues to work towards finding a cure, we must
    first adequately fund the diabetes prevention and outreach work being
    done at the Centers for Disease Control and Prevention. Therefore, we
    are requesting:
      --At least a 10 percent increase over fiscal year 2006 levels for the
            CDC's Center on Chronic Disease Prevention and Health,
            including an additional $20.8 million increase for the CDC's
            Division of Diabetes Translation (DDT), only $1 for each
            American suffering from diabetes; and
      --Restoration of the Preventive Health & Health Services Block Grant.
        The CDC's Division of Diabetes Translation is critical to our
    national efforts to prevent and manage diabetes because they translate
    the research that has already been done to real programs at the
    community level. Currently, for every $1 that diabetes costs this
    country, the Federal Government invests less than $.01 to help
    Americans prevent and manage this deadly disease. This dynamic must be
    changed. While the Association strongly believes that significant
    funding is needed to fully fund programs in all 50 States, our request
    of $20.8 million will allow these critical programs to expand to an
    additional 10 States.
        In 2005 DDT provided support for more than 50 State- and
    territorial-based Diabetes Prevention and Control Programs (DPCPs) to
    increase outreach and education, and reduce the complications
    associated with diabetes. However, funding constraints required DDT to
    provide severely limited support to 22 States, 8 territories, and D.C.
    This level of funding, referred to as ``capacity building,'' allows a
    State to do surveillance, but is not enough for the State to do much--
    or anything--in the way of intervention.
        DDT was able to provide the higher level of support, ``basic
    implementation,'' to the other 28 States. At the basic implementation
    level, States are able to devise and execute community-level programs.
    With an additional $20.8 million over fiscal year 2006 funding levels,
    an additional 10 States could start to receive the substantial benefits
    of basic implementation programs.
        The basic implementation programs undoubtedly make a major impact
    on local communities. For example, the West Virginia DPCP has developed
    a model education training program in state-of-the-art diabetes care,
    and has established a work-site health promotion program for State
    employees. At the same time, by collaborating with the West Virginia
    Association of Diabetes Educators, the State has almost doubled the
    number of certified diabetes educators, and plans to expand that
    success to underserved rural areas through satellite training programs.
    Our goal is to make this a reality for the rest of the country, so that
    communities have the ability to invest in their future by investing in
    diabetes prevention and education.
        Without fully-funded diabetes programs and projects in all parts of
    the country, it will be exceedingly difficult--if not impossible--to
    control the escalating costs associated with diabetic complications and
    to stem the epidemic rise in diabetes rates. State DPCPs, when provided
    with enough funding, are proven programs that have been extremely
    successful in helping Americans prevent and manage their diabetes. In
    the Division of Diabetes Translation Program Review fiscal year 2004,
    the CDC stated, ``The Basic Implementation DPCPs serve as the backbone
    for our growing primary prevention efforts. These State programs are
    the key elements to our success in meeting the challenges of
    controlling and preventing diabetes.'' For example, the Texas DPCP
    contracts with local health departments, community health centers, and
    local non-profits to serve counties throughout the State. These
    programs have demonstrated success in promoting physical activity,
    weight and blood pressure control, and smoking cessation for those with
    diabetes. One of their programs, Coordinated Approach to Child Health
    (CATCH), is an elementary school program to increase activity levels,
    improve diets and reduce children's risk for obesity, a leading factor
    in the development of diabetes in children. Americans in every State
    should have access to such quality programs. Unfortunately, the
    Division's fiscal year 2006 budget of just over $63 million, and the
    President's request for a cut in fiscal year 2007 to $62.42 million,
    will prevent more counties and States from implementing programs such
    as the one described above.
        In addition to DPCP, the CDC's Division of Diabetes Translation
    also conducts other activities to help people currently living with
    diabetes. To put research into action, CDC works with NIH to jointly
    sponsor the National Diabetes Education Program (NDEP), which seeks to
    improve the treatment and outcomes of people with diabetes, promote
    early detection, and prevent the onset of diabetes. The CDC is also
    currently working to develop a National Public Health Vision Loss
    Prevention Program that will investigate the economic burden and
    strengthen the surveillance and research of this all-to-common
    complication of diabetes. In addition, CDC funds work at the National
    Diabetes Laboratory to support scientific studies that will improve the
    lives of people with diabetes. In fiscal year 2005, the Division of
    Diabetes Translation alone published 53 manuscripts on the care,
    prevention, and science of diabetes, including 17 abstracts.
        The Association appreciates the increased attention by Congress to
    diabetes research at the National Institutes of Health (NIH) in recent
    years. While there is not yet a cure for diabetes, researchers at NIH
    are working on a variety of projects that represent hope for the
    millions of individuals with Type 1 and Type 2 diabetes. The
    Association strongly encourages you to provide at least a 5 percent
    increase to the NIH to fulfill this promise. Unfortunately, while the
    death rate due to diabetes has increased by more than 40 percent in
    recent years, diabetes research funding has not kept pace. Indeed, from
    1987-2001, appropriated diabetes funding as a share of the overall NIH
    budget has dropped by more than 20 percent (from 3.9 percent to 2.9
    percent). While Congress had initially begun to address this
    discrepancy, the fiscal year 2006 budget reduced funding at the
    National Institutes of Diabetes, Digestive and Kidney Diseases (NIDDK)
    by $9 million. This is unconscionable when diabetes deaths continue to
    increase at such a rate. The Association believes that NIH research and
    CDC translational programs go hand in hand in the effort to combat the
    diabetes epidemic.
        The Association is also supportive of restoration of the CDC's
    Preventive Health & Health Services Block Grant (PBG). The PBG, which
    allows States to develop innovative health programs at the community
    level, received $99 million in fiscal year 2006, but is currently
    slated for no funding for fiscal year 2007. These programs have been
    very successful. In the State of Louisiana, the grants are used to
    train school based health personnel on the diagnosis and management of
    type 2 diabetes, and also to screen adolescents at significant risk for
    type 2 diabetes. There are 53 school based health centers in Louisiana
    that are directly assisted by this program. As the State continues to
    rebuild following Hurricane Katrina, it would be tragic to remove this
    small but critical piece of health infrastructure funding.
        The Association, and the millions of individuals with diabetes we
    represent, firmly believes that we could rapidly move toward curing,
    preventing, and managing this disease by increasing funding for
    diabetes programs and research both at CDC and NIH. Your leadership is
    essential to accomplishing this goal. As you are considering fiscal
    year 2007 funding, we ask you to remember that chronic diseases,
    including diabetes, account for nearly 70 percent of all health care
    costs as well as 70 percent of all deaths annually. Unfortunately, less
    than $1.25 per person is directed toward public health interventions
    focused on preventing the debilitating effects associated with chronic
    diseases, demonstrating that Federal investment in chronic disease
    prevention remains grossly inadequate. We cannot ignore those Americans
    who are currently living with diabetes and other diseases.
        In closing, the American Diabetes Association strongly urges the
    subcommittee and Congress to provide a 10 percent increase for the
    CDC's Center on Chronic Disease Prevention and Health, including a
    $20.8 million increase for the CDC's Division of Diabetes Translation,
    and to restore the Preventive Health & Health Services Block Grant.
    Providing this funding would be an important step towards empowering
    States to fight diabetes at the community level. Additionally, we urge
    the subcommittee to increase NIH funding by 5 percent to allow for an
    increased commitment to diabetes research.
        On behalf of the 20.8 million Americans with diabetes--a disease
    that crosses gender, race, ethnicity and political party; a disease
    that is among the most costly, debilitating, deadly and prevalent in
    our Nation; and a disease that is exploding throughout our Nation--
    thank you for the opportunity to submit this testimony. The American
    Diabetes Association is prepared to answer any questions you might have
    on these important issues.
                                     ______

          Prepared Statement of the American Foundation for the Blind
        Mr. Chairman and members of the subcommittee, my name is Paul
    Schroeder and I am the Vice President for Programs and Policy at the
    American Foundation for the Blind. Thank you for giving the American
    Foundation for the Blind (AFB) the opportunity to submit testimony to
    the subcommittee as you begin to consider funding priorities for fiscal
    year 2007. The AFB is a national non-profit organization with a
    commitment to enhancing and promoting the health, education,
    employment, and overall quality of life for people with vision loss.
        For nearly a century AFB has been expanding possibilities for
    people with vision loss by setting trends and devising innovative
    programs. For example, AFB works with the corporate sector to get the
    latest technologies that promote equal access into the hands of people
    who have vision loss. AFB also promotes the development and
    dissemination of new ideas and resources for service professionals, and
    AFB assists consumers with vision loss to maintain independent and
    healthy lives by providing them and their families with information
    about services and advice on purchasing decisions. In these and many
    other ways AFB continues to respond to the current needs of the vision
    loss community.
        The AFB, with headquarters in New York City, and a Public Policy
    Center in Washington, DC, also operates the National Center on Vision
    Loss in Dallas, TX, to help ensure that Americans with vision loss have
    information and access to all technologies needed to maintain their
    independence. This innovative resource center offers information,
    education, technology, and training--all under one roof and through the
    Internet--to create accessible living and work environments for people
    who are visually impaired. The AFB has launched a $2.4 million
    campaign--Project Independence--to expand and enhance the Dallas center
    and ensure it has national reach through web-based and other
    information dissemination programs. Also this year, the AFB has
    enhanced its efforts to promote health maintenance and prevention of
    secondary health conditions among those with vision loss. The testimony
    that follows will speak in more detail to this issue.
    recognizing the leadership of the subcommittee in support of americans
                               with disabilities
        According to the Institute of Medicine's 1991 report Disability in
    America: Toward a National Agenda for Prevention, ``disability is an
    issue that affects every individual, community, neighborhood and family
    in the United States.'' This statement remains equally true today. An
    estimated 54 million people in the United States currently live with a
    disability, including severe vision loss. There are approximately 10
    million Americans that are blind or have vision impairment, 6.5 million
    of whom are elderly. With the continued aging of the population, the
    number of elderly Americans affected by vision loss will only increase.
        Mr. Chairman, AFB commends the subcommittee's leadership and
    commitment to programs of interest and benefit to citizens with
    disabilities. Within the jurisdiction of the Labor, Health and Human
    Services, and Education Subcommittee are the vast majority of the
    Federal programs that support services to people with disabilities. The
    main focus of our testimony, however, is to highlight for the
    subcommittee the critically important work of the CDC's National Center
    on Birth Defects and Developmental Disabilities.
         the cdc's national center on birth defects and developmental
                                  disabilities
        Mr. Chairman, on behalf of the American Foundation for the Blind, I
    would like to commend the leadership of the CDC's National Center on
    Birth Defects and Developmental Disabilities (NCBDDD) for their hard
    work and dedication to their mission to promote the health and wellness
    of children and adults living with disabilities. We are particularly
    pleased and supportive of the Center's new focused initiatives to
    address the secondary health effects of people with vision loss and
    other disabilities.
        It has been widely documented that individuals with disabilities
    experience negative health, social, emotional, family, and community
    outcomes at higher rates than others. Sadly, 20.1 percent of people
    with disabilities lack health insurance, as compared to 17.8 percent of
    the general population. Moreover, secondary conditions such as heart
    disease, diabetes and stroke, all of which are modifiable and
    preventable, are also particularly acute among Americans with vision
    loss. For example, elderly Americans with vision loss have higher rates
    of depression, hypertension, heart disease, stroke, and physical
    injuries than people without these sensory impairments. Unique to
    individuals with vision loss is the risk of prescription errors
    stemming from inaccessible print labeling and/or instructions about
    safe administration of the drugs.
        These disparities in health have multiple consequences including
    the decreased ability to perform valued activities, participate in
    social roles including employment, and ever-escalating costs associated
    with deteriorating health conditions.
        Many Americans with vision impairment, however, could substantially
    improve their every day lives and prevent the onset of secondary
    conditions with appropriate health interventions and information. To
    ensure that this help is available, additional research to strengthen
    the evidence base for effective public health interventions needs to be
    conducted. In addition, substantially enhanced dissemination programs
    of these interventions through a website and other means accessible to
    people with vision loss is a vital component of such a program. Such a
    dedicated program would be of significant benefit to those facing
    vision loss and their families. The initiation of such a program at the
    National Center on Birth Defects and Developmental Disabilities would
    reduce health disparities and push forward the public health frontier
    in assisting people with blindness and vision loss.
                                recommendations
        Mr. Chairman, the administration's request for the National Center
    on Birth Defects and Developmental Disabilities is $110,481,000, a
    decrease of $14.28 million below fiscal year 2006 levels. If enacted,
    this would be the second year in a row that the incredibly important
    programs funded in this national Center received cuts. AFB strongly
    encourages the subcommittee to reverse these reductions and to
    specifically add $950,000 for a dedicated program to ameliorate and
    prevent secondary health conditions that affect individuals with vision
    loss. AFB would also encourage the subcommittee to support an expansion
    of the proposed Center on Vision Loss in Dallas, Texas.
                            summary and conclusions
        Mr. Chairman, again we wish to thank the subcommittee for its past
    leadership and commitment to disability issues. With your leadership
    much additional progress can be made to improve the lives and health of
    Americans with vision loss.
        Thank you for this opportunity to testify.
                                     ______

            Prepared Statement of the American Physiological Society
        The American Physiological Society (APS) thanks the subcommittee
    for its sustained support for the National Institutes of Health (NIH).
    The doubling of the agency budget that took place between fiscal years
    1996 and 2002 allowed the NIH to expand its efforts to address old and
    new challenges in biomedical science. Our Nation's investment in basic,
    translational, and clinical research plays an important role in the
    continued health and prosperity of our people. Increases in NIH funding
    have allowed researchers to explore scientific opportunities on an
    unprecedented scale. However, to build on existing knowledge and
    explore new areas, NIH must be able to provide research support for
    innovative ideas. In fiscal year 2006 the NIH budget was cut for the
    first time since 1970, and the administration's fiscal year 2007 budget
    proposal would keep the agency at the same level. Taking inflation into
    account, the President's budget plan represents another budget cut that
    will reduce the number of research grants funded. As funding falters,
    the best and brightest minds will turn away from careers in medical
    science. If NIH cannot fund new ideas, this will not only hamper
    efforts to find cures, it will also discourage up and coming
    researchers who could become the next generation of basic and clinical
    scientists. The APS urges you to make every effort to provide the NIH
    with a 5 percent funding increase so we can take advantage of more
    scientific opportunities that will lead to ways to alleviate the
    suffering and burdens of disease and strengthen the Nation's scientific
    workforce to face future challenges.
        The APS is a professional society dedicated to fostering research
    and education as well as the dissemination of scientific knowledge
    concerning how the organs and systems of the body work. The Society was
    founded in 1887 and now has more than 10,000 member physiologists
    across the United States. The APS offers these comments on the budget
    recognizing both the enormous financial challenges facing our Nation
    and the enormous opportunities before us to make progress against
    disease.
        NIH's task is both to cure specific diseases and to look broadly at
    scientific opportunities that may help us expand our understanding of
    biological problems that affect health. Basic research contributes to a
    body of knowledge whose importance will only be determined over time.
    Physiology, which is the study of biological function, provides the
    foundation for much of the translational research that turns
    discoveries into therapies and prevention strategies.
        One example of this is the lung disease cystic fibrosis. Over the
    last 20 years, the scientific community has made great leaps in
    understanding the role that genes play in the development of various
    diseases. The CFTR gene responsible for cystic fibrosis was identified
    in 1989. Since then, researchers have worked to gain a better
    understanding of what happens in the disease at the molecular level
    with the hope of developing a gene therapy that would prolong and
    improve patients' lives. One critical question was how much of the
    normal gene is necessary to improve lung function. In late 2005, NIH
    supported researchers at the University of Iowa published the results
    of experiments in which they delivered healthy copies of the CFTR gene
    to cultured lung cells taken from cystic fibrosis patients.\1\ They
    were then able to measure whether function improved with increasing
    amounts of gene product. Unexpectedly, delivery of low levels of the
    CFTR gene was more effective than very high doses. This type of
    experiment provides the foundation for designing safe and effective
    clinical treatments.
    ---------------------------------------------------------------------------
        \1\ S. L. Farmen et al., Am J Physiol Lung Cell Mol Physiol 289,
    L1123-30 (Dec. 2005).
    ---------------------------------------------------------------------------
        In addition to supporting research, the NIH must also address
    workforce issues to be sure our Nation's researchers are ready to meet
    the challenges they will face in the future. Last year the NIH
    announced a new program to encourage clinical and translational
    research at universities. The new Clinical and Translational Service
    Awards (CTSAs) will provide a total of $30 million in fiscal year 2006
    to develop new research and training programs at academic institutions
    around the country. This will allow researchers to capitalize on
    knowledge generated from basic research through the development of
    clinical applications and treatments.
        The NIH plays many critical roles in advancing biomedical research.
    It provides opportunities for individual researchers at universities
    and medical schools throughout the country to compete for research
    funds based upon the scientific merit of their ideas. NIH also carries
    out other functions including:
      --Sponsoring research training opportunities for young scientists and
            physicians;
      --Funding major collaborative initiatives that bring together
            multiple institutions with diverse resources;
      --Providing the public with up-to-date information about the latest
            research on various diseases and health conditions through
            individual institutes and online resources such as ``MedLine
            Plus'' and ClinicalTrials.gov;
      --Supporting unique science education programs, particularly for
            underserved minority students; and
      --Funding innovative research through the NIH Roadmap initiative.
        These activities are critical to moving science forward, and they
    are unique to the NIH. Another example is the newly developed Genes and
    Environment Initiative (GEI). The GEI is a multi-institute effort to
    identify genetic and environmental risk factors that contribute to
    common diseases such as asthma, diabetes, heart disease, cancer and
    Alzheimer's disease. The planned research will build on the Human
    Genome Project and take advantage of new technologies developed in the
    pursuit of basic research. With its wide range of expertise, the NIH is
    uniquely suited to undertake broad projects such as this.
        The examples listed above represent a select few examples from the
    NIH's extensive and outstanding portfolio. The APS joins the Federation
    of American Societies for Experimental Biology (FASEB) and the Ad Hoc
    Group for Medical Research Funding in urging that NIH be provided with
    a 5 percent funding increase in fiscal year 2007 to permit the agency
    to maintain its current wide-ranging and important research efforts.
    This forward-looking approach to our Nation's biomedical research
    efforts is much to be preferred over the administration's proposal to
    fund the agency at last year's level, which would force the NIH to
    contract its research portfolio, thus leaving many important projects
    unfunded.
                                     ______

         Prepared Statement of the Coalition of Northeastern Governors
        The Coalition of Northeastern Governors (CONEG) is pleased to
    provide this testimony for the record to the Senate Subcommittee on
    Labor, Health and Human Services, Education, and Related Agencies
    regarding fiscal year 2007 appropriations for the Low Income Home
    Energy Assistance Program (LIHEAP). The Governors appreciate the
    subcommittee's consistent support for the LIHEAP program. We also
    welcome the additional fiscal year 2006 funds recently provided by the
    Congress, even as we recognize the difficult challenges facing the
    subcommittee in this time of severe fiscal constraints. However, in
    light of sharply higher home energy prices, we request the subcommittee
    to provide the full authorized amount of $5.1 billion in regular fiscal
    year 2007 LIHEAP funding--to restore the purchasing power of the LIHEAP
    program. In addition, we request that the subcommittee provide
    contingency funds to address energy emergency situations.
        The continuing trend in rising prices for natural gas and home
    heating fuels is creating a growing home energy crisis for low-income
    citizens across the Nation. Low-income households, whose percentage of
    income spent on energy may be four times that of average households,
    can amass significant home energy debt that makes it difficult to
    purchase heating fuels or pay outstanding utility bills. High levels of
    accumulated arrearages owed by low-income households raise the prospect
    of hundreds of thousands of households cut off from utility service
    this spring.
        Particularly in the Northeast, which is heavily dependent on
    deliverable home heating fuels such as home heating oil, kerosene, and
    propane, price volatility has an especially perverse impact. These low-
    income households, without the disposable income to purchase fuels off-
    season, typically enter the market when both the demand for and price
    of fuels are high. Without access to LIHEAP assistance during the
    heating season, they may not be able to obtain any fuel at all, due to
    the collect-on-delivery business policy commonly used by fuel dealers.
    If LIHEAP benefit levels are too low, these households may not be able
    to afford the cost of the required minimum delivery.
        LIHEAP is a vital tool in making home energy more affordable for
    almost 5 million of the Nation's very low-income households faced with
    high energy burden--the elderly and disabled on fixed incomes and
    families with young children. Over the past 5 years, as the average
    price of home heating oil and natural gas more than doubled, the
    purchasing power of the LIHEAP grant has plummeted--undercutting the
    ability of the program to serve adequately these vulnerable households.
    States across the country in recent years have seen significant
    increases in their regular LIHEAP caseloads, as well as in requests for
    emergency crisis from those households in imminent danger of a utility
    or fuel service cut-off. The number of requests for LIHEAP assistance
    has reached its highest level in more than a decade. In response to the
    continually rising home energy costs and the growing crisis in this
    recent heating season, States across the country have stepped in to
    provide more than $450 million for low-income energy programs. In
    addition to regulatory actions, such as extending shut-off moratoria
    periods and limiting deposit and reconnection fees, many State public
    utility commissions have provided more than $100 million in assistance
    from funding sources such as public benefit funds or universal service
    funds.
        The LIHEAP program delivers maximum program dollars to households
    in need--the consequence of its administrative costs being among the
    lowest of human service programs. In the Northeast, States have
    incorporated various administrative strategies designed to minimize the
    amount of program funds used to operate the program. Innovative
    administrative strategies include the use of uniform application forms
    to determine program eligibility, establishment of a one-stop shopping
    approach for the delivery of LIHEAP and related programs, sharing
    administrative costs with other programs, and the use of mail
    recertification.
        The recent action by Congress to increase LIHEAP funding in fiscal
    year 2006 is a welcome and important step to begin restoring some of
    the lost LIHEAP purchasing power. However, the prospect of continued
    high and potentially volatile prices for home energy means that the
    projected need continues to outweigh available Federal and State
    funding. Even with these additional Federal and State funds, the value
    of the LIHEAP grant has been significantly reduced, defraying only a
    modest amount of a low-income household's total heating bill; and it
    reaches only a small percentage of the households that need assistance.
        Increased Federal funding is vital for LIHEAP to assist the
    Nation's vulnerable, low-income households faced with unaffordable home
    energy bills. An increase in the regular LIHEAP appropriation to the
    full authorized level of $5.1 billion for fiscal year 2007 in addition
    to contingency funds, will enable our States to help mitigate the
    potential life-threatening emergencies and economic hardship that
    confront the Nation's most vulnerable citizens. With these additional
    funds, States can provide assistance to more households in need, offer
    benefit levels that can make a meaningful reduction in their home
    energy burden, lessen the need for emergency crisis, plan and operate a
    more efficient program, and again make optimal use of leveraging and
    other cost-effective programs.
        We thank the subcommittee for this opportunity to share the views
    of the Coalition of Northeastern Governors, and we stand ready to
    provide you with any additional information on the importance of the
    Low Income Home Energy Assistance Program to the Northeast.
                                     ______

              Prepared Statement of the American Lung Association

                        SUMMARY: FUNDING RECOMMENDATIONS
                            [In millions of dollars]
    ------------------------------------------------------------------------
                               Agency                               Amount
    ------------------------------------------------------------------------
    National Institutes of Health..............................       30,205
        National Heart, Lung, and Blood Institute..............        3,099
        National Cancer Institute..............................        5,030
        National Institute of Allergy and Infectious Disease...        4,682
        National Institute of Environmental Health Sciences....          680
        National Institute of Nursing Research.................          146
        Fogarty International Center...........................           70
    Centers for Disease Control and Prevention.................        8,500
        National Institute for Occupational Safety and Health..          285
        Office on Smoking and Health...........................          145
        Environmental Health: Asthma Activities................           70
        Tuberculosis Control Programs..........................          252
    Influenza Pandemic.........................................        2,652
    ------------------------------------------------------------------------

        The American Lung Association is pleased to present our
    recommendations for programs in the Labor Health and Human Services and
    Education Appropriations Subcommittee purview. These appropriations
    will make a difference in the lives of millions of Americans who suffer
    from lung disease.
        The American Lung Association is one of the oldest voluntary health
    organizations in the United States, with a National Office and
    constituent associations around the country. Founded in 1904 to fight
    tuberculosis, the American Lung Association today fights lung disease
    in all its forms, with special emphasis on funding research for cures,
    promoting cleaner air and helping prevent kids from smoking. The Lung
    Association is funded by contributions from the public, along with
    gifts and grants from corporations, foundations and government
    agencies, and achieves its many successes through the work of thousands
    of committed volunteers and staff.
                            the toll of lung disease
        Each year, an estimated 349,000 Americans die of lung disease. Lung
    disease is America's number three killer, responsible for one in every
    seven deaths. More than 35 million Americans suffer from a chronic lung
    disease. Each year lung disease costs the economy an estimated $157.8
    billion. Lung diseases represent a spectrum of chronic and acute
    conditions that interfere with the lung's ability to extract oxygen
    from the atmosphere, protect against environmental or biological
    challenges and regulate a number of metabolic processes. Lung diseases
    include: asthma, chronic obstructive pulmonary disease, lung cancer,
    tuberculosis, pneumonia, influenza, sleep disordered breathing,
    pediatric lung disorders, occupational lung disease and sarcoidosis.
                     chronic obstructive pulmonary disease
        Chronic Obstructive Pulmonary Disease, or COPD, is a growing health
    problem. Yet it remains relatively unknown to most Americans and much
    of the research community. COPD refers to a group of largely
    preventable diseases, including emphysema and chronic bronchitis, that
    generally gradually limit the flow of air in the body. COPD is the
    fourth leading cause of death in the United States and worldwide.
        In 2004, the annual cost to the Nation for COPD was $37.2 billion.
    This includes $20.9 billion in direct health care expenditures, $8.9
    billion in indirect morbidity costs and $7.4 billion in indirect
    mortality costs. Medicare expenses for COPD beneficiaries were nearly
    2.5 times that of the expenditures for all other patients.
        It has been estimated that 11.4 million patients have been
    diagnosed with some form of COPD and as many as 24 million adults may
    suffer from its consequences. In 2004, an estimated 9 million Americans
    were diagnosed with chronic bronchitis by a health professional.
    Further, an estimated 3.6 million Americans have been diagnosed with
    emphysema in their lifetime. In 2002, 120,555 people in the United
    States died of COPD. Women have exceeded men in the number of deaths
    attributable to COPD since 2000. Over the past 30 years, the death rate
    due to COPD has doubled while the death rates for heart disease, cancer
    and stroke have decreased by over 50 percent.
        Today, COPD is treatable but not curable. Fortunately, promising
    research is on the horizon for COPD patients. Research on the genetic
    susceptibility underlying COPD is making progress. Research is also
    showing promise for reversing the damage to lung tissue caused by COPD.
        Despite these promising research leads, the American Lung
    Association believes that research resources committed to COPD are not
    commensurate with the impact COPD has on the United States and the
    world.
        The American Lung Association strongly recommends that the NIH and
    other Federal research programs commit additional resources to COPD
    research programs. In addition, there is a need for improved
    surveillance data on the disease. The Lung Association supports the CDC
    in gathering more information about COPD as part of the National Health
    and Nutrition Examination Survey, the Behavioral Risk Factor
    Surveillance System and other health surveys. This information will
    help public health professionals and researchers understand the disease
    better and lead to possible control of the disease.
                                  tobacco use
        Tobacco use is the leading preventable cause of death in the United
    States, killing more than 438,000 people every year. Smoking is
    responsible for one in five U.S. deaths. The direct health care and
    lost productivity costs of tobacco-caused disease and disability are
    also staggering, an estimated $167 billion each year. Taxpayers pay
    billions of dollars each year to treat tobacco-caused disease through
    federally funded health programs including Medicare and Medicaid.
        The CDC's Office on Smoking and Health provides significant
    technical assistance to States that are using tobacco settlement
    dollars to develop comprehensive and effective tobacco prevention
    programs, in addition to providing a small, yet essential, amount of
    Federal assistance directly to State tobacco control and prevention
    programs. States that currently fund comprehensive programs, as well as
    those seeking to develop programs, rely on CDC's expertise. Funds for
    tobacco prevention at CDC also are used to maintain comprehensive
    information on smoking and health and to support ongoing research on
    tobacco-related issues.
        We believe Congress should fund the type of youth tobacco
    prevention programs that science tells us are essential to counter the
    impact of tobacco company marketing to our kids. The American Lung
    Association strongly supports a minimum level of $145 million in fiscal
    year 2007 funding for the CDC's Office on Smoking and Health.
                                     asthma
        Asthma is a chronic lung disease in which the bronchial tubes
    become swollen and narrowed, preventing air from getting into or out of
    the lung. An estimated 30.2 million Americans have ever been diagnosed
    with asthma by a health professional. Approximately 20.5 million
    Americans currently have asthma, of which 11.7 million had an asthma
    attack in 2004. Asthma prevalence rates are 39 percent higher among
    African Americans than whites. Studies also suggest that Puerto Ricans
    have higher asthma prevalence rates and age-adjusted death rates than
    all other Hispanic subgroups.
        Asthma is expensive. The growth in the prevalence of asthma will
    have a significant impact on our Nation's health expenditures,
    especially Medicaid. Asthma incurs an estimated annual economic cost of
    $16.1 billion to our Nation. Asthma is the third leading cause of
    hospitalization among children under the age of 15. It is also the
    number one cause of school absences attributed to chronic conditions.
    The Federal response to asthma has three components: research, programs
    and planning. We are making progress on all three fronts but more must
    be done:
    Asthma Research
        Researchers are developing better ways to treat and manage chronic
    asthma. Two examples show why this should continue. Research supported
    by National Heart, Lung and Blood Institute (NHLBI) has shown that
    using corticosteroids to treat children with mild to moderate asthma is
    safe and effective, answering a parent's question about whether these
    effective drugs would stunt the growth of children who used them.
        Genetic research is also providing insights into asthma.
    Researchers in the NHLBI-supported Asthma Clinical Research Network
    have discovered that a genetic variation determines how well asthma
    patients will respond to the most common asthma medication, inhaled
    beta-agonists. This discovery will help physicians better target the
    drugs they proscribe.
    Asthma Programs
        Last year, Congress provided approximately $31.9 million for the
    Centers for Disease Control and Prevention (CDC) to conduct asthma
    programs. The American Lung Association recommends that CDC be provided
    $70 million in fiscal year 2007 to expand its asthma programs. This
    funding includes State asthma planning grants, which leverage small
    amounts of funding into more comprehensive State programs.
    Asthma Surveillance
        In addition to public education programs, the CDC has been piloting
    programs to determine how to establish a nationwide health-tracking
    system. The pilots have shown how to integrate different data to
    determine how pervasive asthma is in these communities. Congress needs
    to increase funding to create a nationwide health-tracking system,
    based on the localized pilots that are underway now.
                                  lung cancer
        An estimated 350,679 Americans are living with lung cancer. During
    2005, an estimated 172,570 new cases of lung cancer will be diagnosed.
    This year 163,510 Americans will die from lung cancer. Survival rates
    for lung cancer tend to be much lower than those of most other cancers.
    Men have higher rates of lung cancer than women. However, over the past
    30 years, the lung cancer age-adjusted incidence rate has decreased 9
    percent in males compared to an increase of 143 percent in females.
    Further, African Americans are more likely to develop and die from lung
    cancer than persons of any other racial group.
        Given the magnitude of lung cancer and the enormity of the death
    toll, the American Lung Association strongly recommends that the NIH
    and other Federal research programs commit additional resources to lung
    cancer research programs. We support increasing the National Cancer
    Institute budget to $5.003 billion.
                                   influenza
        Influenza is a highly contagious viral infection and one of the
    most severe illnesses of the winter season. It is responsible for an
    average of 200,000 hospitalizations and 36,000 deaths each year.
    Further, the emerging threat of a pandemic influenza is looming. Public
    health experts warn that over half a million Americans could die and
    over 2.3 million could be hospitalized if a moderately severe strain of
    a pandemic flu virus hits the United States. To prepare for a potential
    pandemic, the American Lung Association supports funding the Federal
    Pandemic Influenza Plan at the recommended level of $2.652 billion.
                                  tuberculosis
        Tuberculosis is an airborne infection caused by a bacterium,
    Mycobacterium tuberculosis (TB). TB primarily affects the lungs but can
    also affect other parts of the body, such as the brain, kidneys or
    spine. There are an estimated 10 million to 15 million Americans who
    carry latent TB infection. Each has the potential to develop active TB
    in the future. About 10 percent of these individuals will develop
    active TB disease at some point in their lives. In 2005, there were
    14,093 cases of active TB reported in the United States.
        The American Lung Association has endorsed the Institute of
    Medicine (IOM) report, Ending Neglect: The Elimination of Tuberculosis
    in the United States, IOM report and its recommendations on how to
    eliminate TB in the United States. While declining overall TB rates are
    good news, the emergence and spread of multi-drug resistant TB pose a
    significant threat to the public health of our Nation. Continued
    support is needed if the United States is going to continue progress
    toward the elimination of TB. We estimate it will cost $528 million for
    the CDC Tuberculosis Elimination Program to implement the report
    recommendations. We request that Congress increase funding for
    tuberculosis programs to $252 million for fiscal year 2007.
        The NIH also has a prominent role to play in the elimination of TB.
    Currently there is no highly effective vaccine to prevent TB
    transmission. However, the recent sequencing of the TB genome and other
    research advances has put the goal of an effective TB vaccine within
    reach. In addition, the American Lung Association encourages the
    subcommittee to fully fund the TB vaccine blueprint development effort
    at the National Institutes of Allergy and Infectious Disease (NIAID).
    Fogarty International Center TB Training Programs
        The Fogarty International Center (FIC) at NIH provides training
    grants to U.S. universities to teach AIDS treatment and research
    techniques to international physicians and researchers. Because of the
    link between AIDS and TB infection, FIC has created supplemental TB
    training grants for these institutions to train international health
    care professionals in the area of TB treatment and research. However,
    we believe TB training grants should not be offered exclusively to
    institutions that have received AIDS training grants. The TB grants
    program should be expanded and open to competition from all
    institutions. The American Lung Association recommends Congress provide
    $70 million for FIC to expand the TB training grant program from a
    supplemental grant to an open competition grant.
                              environmental health
        The National Institute of Environmental Health Sciences funds vital
    research on the impact of environmental influence on disease. The
    American Lung Association supports increasing the appropriation from
    this subcommittee to $680 million.
              researching and preventing occupational lung disease
        The American Lung Association recommends that the subcommittee
    provide $285 million for the National Institute for Occupational Safety
    and Health (NIOSH) at the CDC.
                                   conclusion
        In conclusion, Mr. Chairman, lung disease is a continuing, growing
    problem in the United States. It is America's number three killer,
    responsible for one in seven deaths. The lung disease death rate
    continues to climb. Mr. Chairman, the level of support this committee
    approves for lung disease programs should reflect the urgency
    illustrated by these numbers.
                                     ______

       Prepared Statement of the American Nephrology Nurses' Association
        The American Nephrology Nurses' Association (ANNA) appreciates the
    opportunity to submit written comments for the record regarding fiscal
    year 2007 funding to address the challenges that kidney disease and the
    nursing shortage are posing to the Nation. ANNA exists to advance
    nephrology nursing practice and positively influence outcomes for
    patients with kidney or other disease processes requiring replacement
    therapies through advocacy, scholarship, and excellence. ANNA consists
    of more than 12,000 registered nurses and other health care
    professionals with varying experience and expertise in such areas as
    hemodialysis, peritoneal dialysis, conservative management, continuous
    renal replacement therapies, chronic kidney disease, and renal
    transplantation.
        As part of our mission, we educate health professionals, the
    public, and policymakers to increase public awareness and understanding
    of the unique health care needs and challenges people with kidney
    disease face. Moreover, ANNA maintains a strong commitment to securing
    public policies and programs that help secure better treatments and
    care for individuals with kidney disease. ANNA specifically seeks to
    advance public and private efforts to improve treatment of kidney
    disease, reduce and prevent the onset of end stage renal disease
    (ESRD), and ensure that all people with kidney disease have access to
    the medical care and treatment options they need to live the highest
    quality of life possible.
        To that end, ANNA respectfully requests that Congress reject the
    President's proposed $11 million cut in funding for the National
    Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and
    instead support increased funding for diabetes and kidney disease
    research to find better treatments, preventive interventions, and
    develop a cure. NIDDK conducts and supports research on most of the
    more serious diseases affecting public health. The Institute supports
    much of the clinical research on the diseases of internal medicine and
    related subspecialty fields, as well as many basic science disciplines.
    Additional fiscal year 2007 funding for NIDDK will help advance our
    Nation's understanding of the risk factors associated with kidney
    disease, boost efforts to identify ways in which kidney disease can be
    reduced and prevented, and increase initiatives to improve care and
    treatment of individuals with chronic kidney disease as well as those
    with ESRD.
        The National Institute of Nursing Research (NINR) supports clinical
    and basic research to establish a scientific basis for the care of
    individuals across the life span-from management of patients during
    illness and recovery to the reduction of risks for disease and
    disability, the promotion of healthy lifestyles, promoting quality of
    life in those with chronic illness, and care for individuals at the end
    of life. NINR seeks to understand and ease the symptoms of acute and
    chronic illness, to prevent or delay the onset of disease or disability
    or slow its progression, to find effective approaches to achieving and
    sustaining good health, and to improve the clinical settings in which
    care is provided. Importantly, NINR research also focuses on the
    special needs of at-risk and under-served populations, with an emphasis
    on health disparities, such as those seen among the ESRD population.
    These efforts are crucial in the creation of scientific advances and
    their translation into cost-effective health care that does not
    compromise quality. ANNA is pleased to join with others in the nursing
    community in advocating a fiscal year 2007 allocation of $150 million
    for NINR.
        As you know, the Nation is facing a nursing shortage of
    unprecedented proportion. At the same time the nursing shortage is
    expected to worsen, the number of people with ESRD needing access to
    state-of-the-art treatment and care is estimated to increase
    significantly. More than 350,000 Americans have ESRD which gives the
    United States the highest incidence rate. As the population continues
    to grow and age and medical services advance, the need for nurses will
    continue to increase. A report issued by the U.S. Health Resources and
    Services Administration (HRSA), Projected Supply, Demand, and Shortages
    of Registered Nurses: 2000-2020, predicted that the nursing shortage is
    expected to grow to 29 percent by 2020, compared to a seven percent
    shortage in 2005. Nurses are crucial to the health of our Nation and
    those with ESRD.
        According to the U.S. Department of Health and Human Services
    (HHS), the nursing workforce programs housed at HRSA will support the
    recruitment, education, and retention of an estimated 36,750 nurses and
    nursing students and approximately 956 new loan repayments and
    scholarships among other activities. With additional funding in fiscal
    year 2007, the HRSA nursing workforce programs would have more
    sufficient resources to bolster the Nation's nursing workforce at a
    rate necessary to help stem the nursing shortage tide. To address this
    current and growing challenge in the health care delivery system, ANNA
    urges Congress to support the nursing community's request of $175
    million for the HRSA nursing workforce programs. Moreover, please note
    that ANNA supports the written testimony submitted by the Americans for
    Nursing Shortage Relief (ANSR) Alliance and respectfully requests your
    full and fair consideration of the funding allocations and issues
    outlined by ANSR.
        Please know that we understand that Congress has limited resources
    to allocate. However, we are concerned that without adequate funding
    for research and the Nation's nursing workforce, the Nation will falter
    in its efforts to diminish suffering from kidney disease and to provide
    quality nursing care to all in need. On behalf of ANNA's Board of
    Directors and the hundreds of thousands of individuals with kidney
    disease to whom we provide care, thank you for this opportunity to
    submit written testimony regarding the fiscal year 2007 funding levels
    necessary to ensure that our Nation adequately supports kidney disease
    research and the Nation's nursing workforce. Please feel free to
    contact us at any time; we are happy to be a resource to subcommittee
    members and your staff.
                                     ______

          Prepared Statement of the American Public Health Association
        The American Public Health Association (APHA) is the Nation's
    oldest, largest and most diverse organization of public health
    professionals in the world, dedicated to protecting all Americans and
    their communities from preventable, serious health threats and assuring
    community-based health promotion and disease prevention activities and
    preventive health services are universally accessible in the United
    States. We are pleased to submit our views on Federal funding for
    public health activities in fiscal year 2007.
             recommendations for funding the public health service
        The APHA's budget recommendation for overall funding for the Public
    Health Service includes funding for the Centers for Disease Control and
    Prevention (CDC), the Health Resources and Services Administration
    (HRSA), the Substance Abuse and Mental Health Services Administration
    (SAMHSA), the Agency for Healthcare Research and Quality (AHRQ), and
    the National Institutes of Health (NIH), as well as agencies outside
    the subcommittee's jurisdiction--the Food and Drug Administration (FDA)
    and the Indian Health Service (IHS). We encourage the subcommittee to
    restore $1 billion in funding cuts that occurred in fiscal year 2006,
    and reject the President's proposal to cut an additional $600 million
    from the Public Health Service.
                centers for disease control and prevention (cdc)
        The APHA believes that Congress should support CDC as an agency--
    not just the individual programs that it funds. We support a funding
    level for CDC that enables it to carry out its mission to protect and
    promote good health and to assure that research findings are translated
    into effective State and local programs.
        In the best professional judgment of the APHA, in conjunction with
    the CDC Coalition--given the challenges of terrorism and disaster
    preparedness, new and re-emerging infectious diseases, the epidemic of
    obesity, particularly among children, and our many unmet public health
    needs and missed prevention opportunities--we believe the agency will
    require funding of at least $8.5 billion, plus sufficient funding to
    prepare the Nation against a potential influenza pandemic. This request
    reflects the support CDC will need to fulfill its core missions for
    fiscal year 2007, as well as funding for the Agency for Toxic
    Substances and Disease Registry and the Vaccines for Children program.
        The APHA appreciates the subcommittee's work over the years,
    including your recognition of the need to fund chronic disease
    prevention, infectious disease prevention and treatment, and
    environmental health programs at CDC. By translating research findings
    into effective intervention efforts, CDC has been a key source of
    funding for many of our State and local programs that aim to improve
    the health of communities. Perhaps more importantly, Federal funding
    through CDC provides the foundation for our State and local public
    health departments, supporting a trained workforce, laboratory capacity
    and public health education communications systems.
        CDC also serves as the command center for our Nation's public
    health defense system against emerging and reemerging infectious
    diseases. With the potential onset of an influenza pandemic, in
    addition to the many other natural and man-made threats that exist in
    the modern world, the CDC has become the Nation's--and the world's--
    expert resource and response center, coordinating communications and
    action and serving as the laboratory reference center. States and
    communities rely on CDC for accurate information and direction in a
    crisis or outbreak.
        Unfortunately, Congress cut overall CDC funding in fiscal year 2006
    for the first time in 25 years. And in fiscal year 2007, the President
    has proposed cutting CDC funding even more--more than 2 percent
    overall, and more than 4.5 percent to CDC's core programs. We are
    moving in the wrong direction, especially in these challenging times
    when public health is being asked to do more, not less. In light of the
    current workload placed on the public health service--in addition to
    the threat of emerging diseases such as the avian flu--it simply does
    not make any sense to cut the budget for CDC at a time when the threats
    to public health are so great. Funding public health outbreak by
    outbreak is not an effective way to ensure either preparedness or
    accountability. Until we are committed to a strong public health
    system, every crisis will force trade offs.
        CDC serves as the lead agency for bioterrorism preparedness and
    must receive sustained support for its preparedness programs in order
    for our Nation to meet future challenges. APHA supports the proposed
    increase for anti-terrorism activities at CDC, including the increases
    for the Strategic National Stockpile and the new Botulinum Toxin
    Research funding. However, we strongly caution that the President's
    proposed level-funding of the State and local capacity grants continues
    to reflect a $95 million cut from fiscal year 2005 levels. We encourage
    the subcommittee to restore these cuts to ensure that our States and
    local communities can be prepared in the event of an act of terrorism.
        Unfortunately, the President's budget proposes the elimination of
    some very important CDC programs, like the Preventive Health and Health
    Services Block Grant. Within an otherwise-categorical funding
    construct, the Preventive Health and Health Services Block Grant is the
    only source of flexible dollars for States and localities to address
    their unique public health needs. The track record of positive public
    health outcomes from Prevention Block Grant programs is strong, yet so
    many requests go unfunded. However, the President's budget proposes the
    elimination of the Preventive Health and Health Services Block Grant--
    again. We appreciate the work of the subcommittee to at least partially
    restore the fiscal year 2006 elimination of the Block Grant.
    Nevertheless, the $20 million cut to the Block Grant in fiscal year
    2006 reduces the States' ability to tailor Federal public health
    dollars to their specific needs. As States use their Prevention Block
    Grant dollars to address high priority needs such as emerging and
    chronic diseases, child safety seat programs, suicide prevention, smoke
    detector distribution and fire safety programs, adult immunization,
    oral health, worksite wellness, infectious disease outbreaks, food
    safety, emergency medical services, safe drinking water, and
    surveillance needs--we can scarcely understand why the Prevention Block
    Grant should be eliminated. We encourage the subcommittee to restore
    the cuts and fund the Prevention Block Grant at $132 million.
        We also encourage the subcommittee to provide $10 million for CDC's
    Environmental Public Health Services Branch to revitalize environmental
    public health services at the national, State, and local level. As with
    the public health workforce, the environmental health workforce is
    declining. Furthermore, the agencies that carry out these services are
    fragmented and their resources are stretched. These services are the
    backbone of public health and are essential to protecting and ensuring
    the health and well being of the American public from threats
    associated with West Nile virus, terrorism, E. coli and lead in
    drinking water.
        We appreciate the subcommittee's hard work in advocating for CDC
    programs in a climate of competing priorities.
              health resources and services administration (hrsa)
        HRSA programs are designed to give all Americans access to the best
    available health care services. Through its programs in thousands of
    communities across the country, HRSA provides a health safety net for
    medically underserved individuals and families, including more than 45
    million Americans who lack health insurance; 50 million Americans who
    live in neighborhoods where primary health care services are scarce;
    African American infants, whose infant mortality rate is more than
    double that of whites; and the estimated 1 to 1.2 million people living
    with HIV/AIDS. Programs to support the underserved place HRSA on the
    front lines in erasing our Nation's racial/ethnic and rural/urban
    disparities in health status. HRSA funding goes where the need exists,
    in communities all over America. We support a growing trend in HRSA
    programs to increase flexibility of service delivery at the local
    level, necessary to tailor programs to the unique needs of America's
    many varied communities. The agency's overriding goal is to achieve 100
    percent access to health care, with zero disparities. In the best
    professional judgment of the APHA, to respond to this challenge, the
    agency will require an overall funding level of at least $7.5 billion
    for fiscal year 2007.
        The APHA is gravely concerned about a number of programs that are
    slated for deep cuts or elimination under the administration's budget
    proposal. Building on the HRSA programs that were cut or eliminated in
    the fiscal year 2006 appropriations bill, we strongly suggest that this
    trend is moving our Nation in the wrong direction. We urge the
    subcommittee to restore funding to HRSA programs that were cut last
    year, as well as ensure adequate funding for fiscal year 2007 by
    rejecting the proposed cuts contained in the President's budget.
        We express our dismay at the eroding support from the subcommittee
    for some of HRSA's programs over the last few years, including Health
    Professions programs, Area Health Education Centers, and the Maternal
    and Child Health block grant, among others. On top of the $250 million
    cut to the agency for fiscal year 2006, the President has proposed
    another $321 million overall cut from last year's appropriated level.
    Under the President's proposal, total cuts to HRSA since fiscal year
    2005 would reach more than $570 million, a devastating 8 percent cut in
    2 years. We urge the subcommittee to restore the fiscal year 2006 cuts,
    and reject the President's proposed cuts for fiscal year 2007.
        One program that has received consistent support from the
    subcommittee is the community-based health centers and National Health
    Service Corps-supported clinics, which form the backbone of the
    Nation's health safety net. More than 4,000 of these sites across the
    Nation provide needed primary and preventive care to 15 million poor
    and near-poor Americans. HRSA primary care centers include community
    health centers, migrant health centers, health care for the homeless
    programs, public housing primary care programs and school-based health
    centers. Health centers provide access to high-quality, family-
    oriented, culturally and linguistically competent primary care and
    preventive services, including mental and behavioral health, dental and
    support services. Nearly three-fourths of health center patients are
    uninsured or on Medicaid, two-thirds are people of color, and more than
    90 percent live below 200 percent of the poverty level. Additional
    primary care is provided by 2,700 clinicians in the National Health
    Service Corps. Corps members work in communities with a shortage of
    health professionals in exchange for scholarships and loan repayments.
    The APHA is pleased that the President has requested a significant
    increase for Community Health Centers for a total of $1.918 billion.
        Nevertheless, in the context of corresponding cuts to the Health
    Professions programs, we are left with some doubt about who, exactly,
    is going to staff all these new Community Health Centers. We are once
    again very concerned that the HRSA health professions programs under
    Title VII and VIII of the Public Health Service Act have landed on the
    chopping block. Today our Nation faces a widening gap between
    challenges to improve the health of Americans and the capacity of the
    public health workforce to meet those challenges. An adequate, diverse,
    well-distributed and culturally competent health workforce is
    indispensable to our national readiness efforts and to address critical
    health care needs. These programs help meet the health care delivery
    needs of the areas in this country with severe health professions
    shortages, at times serving as the only source of health care in many
    rural and disadvantaged communities. Therefore, the elimination of most
    funding for the Title VII health professions training programs and flat
    funding for Title VIII nurse training will only make certain that the
    needs of these medically underserved populations will not be met.
        Furthermore, we believe the elimination of the Healthy Community
    Access Program, universal newborn hearing screening programs, and the
    Emergency Medical Services for Children Program, will further undermine
    the availability of basic health services for some that are most in
    need--especially children. The Healthy Community Access Program is an
    example in which communities build partnerships among health care
    providers to deliver a broader range of health services to their
    neediest residents. This program of coordinated service delivery is
    innovative, not duplicative of other available programs, and therefore
    its elimination is of grave concern. Also, the proposed zero funding of
    universal newborn hearing screening programs in the administration's
    budget will likely cause many hearing impairments in infants to go
    undetected, which can negatively impact speech and language
    acquisition, academic achievement, and social and emotional
    development. The proposed elimination of the Emergency Medical Services
    for Children Program will likely halt the improvements made in recent
    years to pediatric emergency care, which will disproportionately affect
    children who are eligible for Medicaid and SCHIP, but not enrolled due
    to State enrollment limits and budgetary pressures, and therefore
    frequently use emergency health services.
        The Maternal and Child Health (MCH) Block Grant is operating for a
    second year with less funds than in fiscal year 2005, yet with greater
    needs among more pregnant women, infants, and children, particularly
    those with special health care needs. Furthermore, if programs like the
    Traumatic Brain Injury program, Universal Newborn Hearing Screening,
    and Emergency Medical Services for Children program are eliminated,
    those costs will be borne by the MCH Block Grant.
        We are pleased with the increases proposed by the President for
    programs under the Ryan White CARE Act, administered by HRSA's HIV/AIDS
    Bureau. The CARE Act programs are an important safety net, providing an
    estimated 571,000 people access to services and treatments each year.
    At a time when HIV/AIDS is the sixth leading cause of death for people
    who are 25 to 44 years old in the United States, and the number of new
    domestic HIV/AIDS cases is increasing, we support increased funding for
    Ryan White Act programs.
        Through its many programs and initiatives, HRSA helps countless
    individuals live healthier, more productive lives. As leaders of our
    Nation, this subcommittee decides what direction we will go in terms of
    delivering health care to those who need it most. The APHA believes
    that with adequate resources, HRSA is well positioned to meet these
    challenges as it continues to provide needed health care to the
    Nation's most vulnerable citizens. We encourage the subcommittee to
    restore the funds to these important public health programs and reject
    the proposed cuts in the President's budget.
               agency for healthcare research and quality (ahrq)
        We request a funding level of $440 million for the AHRQ for fiscal
    year 2007, an increase of $121 million over the enacted fiscal year
    2006 level. This level of funding is needed for the agency to fully
    carry out its congressional mandate to improve health care quality,
    including eliminating racial and ethnic disparities in health, reducing
    medical errors, and improving access and quality of care for children
    and persons with disabilities. The cuts proposed in the administration
    budget will severely hamper these efforts.
       substance abuse and mental health services administration (samhsa)
        The APHA supports a funding level of $3.466 billion for SAMHSA for
    fiscal year 2007, an increase of $107 million over the enacted fiscal
    year 2006 level. This funding level would provide support for substance
    abuse prevention and treatment programs, as well as continued efforts
    to address emerging substance abuse problems in adolescents, the nexus
    of substance abuse and mental health, and other serious threats to the
    mental health of Americans.
                      national institutes of health (nih)
        The APHA supports a funding level of $29.75 billion for the NIH for
    fiscal year 2007, an increase of $1.1 billion over the enacted fiscal
    year 2006 level. The translation of fundamental research conducted at
    NIH provides the basis for community based public health programs that
    help to prevent and treat disease.
                    department of health and human services
        The budget of the Office of Minority Health faced several years of
    decreasing budgets prior to last year. In fiscal year 2006, OMH
    received $56 million; and the proposed budget in fiscal year 2007 is
    $46 million. APHA is concerned that at a time when we have increasing
    evidence of disparities in health care delivery, access and health
    outcomes, the budget of OMH is getting cut. We support maintaining OMH
    funding at the fiscal year 2006 level.
                                   conclusion
        In closing, we emphasize that the public health system requires
    financial investments at every stage. Successes in biomedical research
    must be translated into tangible prevention opportunities, screening
    programs, lifestyle and behavior changes, and other interventions that
    are effective and available for everyone. While we have said this
    before, in the post-September 11th era, we need to apply this to our
    spending growth in terrorism and influenza preparedness as well. We
    must think in a broad and balanced way, leveraging homeland security
    programs and funding whenever possible to provide public health
    benefits as a matter of routine, rather than emergency.
        We thank the subcommittee for the opportunity to present our views
    on the fiscal year 2007 appropriations for public health service
    programs.
                                     ______

       Prepared Statement of the American Society for Clinical Pathology
           demand for qualified laboratory personnel outstrips supply
        On behalf of the American Society for Clinical Pathology (ASCP), a
    non-profit organization representing 140,000 pathologists, medical
    technologists, cytotechnologists and other medical laboratory
    professionals, we are submitting this written testimony regarding the
    Title VII Allied Health Professions program that is administered by the
    Health Resources and Services Administration (HRSA).
        Last year, funding for the Title VII Allied Health Professions
    program was cut by 68 percent. Funding for these programs, which
    provide seed money for the establishment and expansion of medical
    laboratory education training programs, was reduced from $300 million
    in fiscal 2005 to $94 million for the 2006 fiscal year. Funding for the
    allied health and other disciplines program was reduced from $11.8
    million to $4 million. Congress eliminated funding for the allied
    health special project grants that fund medical laboratory education
    programs under the Title VII of the Public Health Service Act. These
    programs represent a small portion of the funding provided by the
    Labor, Health and Humans Services, and Education Appropriations bill,
    but their importance to developing the next cadre of laboratory
    professionals can not be overstated.
        Because few patients have direct contact with the people who work
    in our Nation's medical laboratories, the important role these health
    care practitioners play in patient care often goes unnoticed. Not only
    is laboratory testing key to diagnosing patient health, but
    laboratories also help identify appropriate patient treatments. In
    fact, the results of diagnostic laboratory testing impact over 70
    percent of all healthcare treatment decisions. So, ensuring that our
    Nation's laboratories possess the laboratory professionals needed to
    accurately process laboratory testing demands is critical to patient
    health.
        Unfortunately, the United States continues to face a severe
    shortage of qualified laboratory personnel. The U.S. Department of
    Labor projects that approximately 15,000 medical laboratory
    professionals will be needed each year through 2014. Unfortunately,
    fewer than 5,000 individuals are graduating each year from accredited
    or approved educational training programs.
        Hardest hit by the shortage are rural areas and areas served by
    smaller hospitals. These areas are finding it increasingly difficult to
    recruit and retain qualified laboratory personnel. According to data
    gathered by the American Society for Clinical Pathology, half of all
    medical laboratories are reporting substantial difficulties hiring new
    testing personnel. It can often take a laboratory 6 to 12 months to
    hire an employee.
        Another cause for concern is the average age of the laboratory
    workforce, which has been increasing steadily over the past few years,
    reflecting the fact that the pace with which younger, newly trained
    laboratorians have entered the laboratory workforce has not kept pace
    with retirements. At 43.7, the average age of medical technologists is
    essentially the same as that of nurses (43.3). An aging workforce can
    be more vulnerable to the adverse health and safety risks associated
    with shift work. Moreover, as our Nation ages, estimates project that
    the demand for laboratory testing services may increase.
        Personnel turnover is also an increasing problem. With competition
    for laboratory personnel intensifying over the last year, turnover
    rates for some categories of laboratory personnel exceed 20 percent.
    Because of the difficulty in finding qualified staff, medical
    laboratories are increasingly turning to temporary staff (many of whom
    may already be working full- or part-time at another medical
    laboratory) to handle the patient testing workload.
        To make matters worse, our Nation's capacity to train new
    laboratory personnel has declined substantially over the past 10 years.
    According to the National Accrediting Agency for Clinical Laboratory
    Sciences, school closings in the last 5 years have reduced the number
    of medical technologists and medical laboratory technicians being
    trained annually. The number of individuals graduating from these
    educational programs has declined approximately 35 percent over the
    last 10 years, from 6,783 graduates in 1994 to 4,390 in 2004. Over the
    last 10 years, the number of educational programs for laboratory
    professionals has declined more than 30 percent, from 637 programs in
    1994 to 435 programs in 2004. For cytotechnologists, the number of
    educational programs has been reduced 25 percent over the last 10
    years, from 65 programs in 1994 to 49 programs in 2004. Only 260
    cytotechnologists graduate from these educational programs each year.
    Now with the devastating cuts to the Title VII programs, more programs
    may close.
        Besides reducing our ability to train new laboratorians quickly,
    these losses have an especially profound impact on rural areas, where
    prospective laboratory practitioners often seek training close to home.
    Wyoming, for example, has no accredited or approved medical laboratory
    educational programs. Not surprisingly, data provided by HRSA indicates
    Wyoming has one of the lowest concentrations of laboratory
    professionals per resident (66 per 100,000 residents) in the United
    States.
        ASCP believes that the Title VII Allied Health Education Programs
    have helped make a difference. For example, the University of Nebraska
    has for several years now offered a medical laboratory education
    program that has received funding under the allied health and other
    disciplines program. The University's program includes an effective
    distance training program that has served other nearby States as well.
    HRSA data indicates Nebraska has more than 128 laboratory professionals
    per 100,000 residents--almost twice the number of Wyoming and one of
    the highest concentrations of laboratory personnel in the United
    States. Because of cuts to the Title VII programs, Federal funding for
    the University of Nebraska's medical laboratory education program has
    been eliminated.
        Given that medical technologist and medical laboratory technician
    jobs have often been ranked among the best jobs by the Jobs Rated
    Almanac, we hope increasing funding for laboratory professionals
    education programs will help encourage more individuals to pursue
    rewarding careers in the medical laboratory. Your help in restoring
    funding for these important educational programs will make our shared
    goal of reversing the laboratory personnel shortage much more
    obtainable. ASCP joins with our colleagues in the Health Professions
    and Nursing Education Coalition to request that Congress appropriate
    $550 million for the Title VII programs.
                                     ______

          Prepared Statement of the American Society for Microbiology
        The American Society for Microbiology (ASM) is pleased to submit
    the following statement on the fiscal year 2007 appropriation for the
    National Institutes of Health (NIH). The ASM is the largest single life
    science Society with over 42,000 members who are involved in basic
    biomedical research, research and development activities, and
    diagnostic testing in university, industry, government and clinical
    laboratories.
        The ASM is deeply concerned that the President's proposed fiscal
    year 2007 budget falls far short of adequately funding biomedical
    research supported by the NIH. Under the President's fiscal year 2007
    budget request, 18 of the 19 Institute budgets are reduced in real
    dollars. These proposed reductions come at a time when more, not less,
    research is needed to address pressing health problems. Funding for the
    NIH in recent years has fallen substantially in constant dollars,
    foreshadowing a troubling future for biomedical research and for
    progress against health challenges from emerging and entrenched
    infectious diseases and chronic diseases. The continued toll on human
    life from chronic diseases, new threats from pandemic diseases and the
    potential dangers from bioterrorism make the ASM firmly believe that
    now is not the time to perpetuate the decline in funding of the past
    three fiscal years for the NIH. Biomedical research supported by the
    NIH is critical to the discovery of new knowledge and understanding
    which underpins development of medical treatments and vaccines. As the
    U.S. population ages and as global stability is threatened by
    pandemics, basic research which can only be supported by the NIH is
    essential to the well being of the world. However, basic biomedical
    research and the recruitment and training of the next generation of
    researchers will be weakened if funding for the NIH stagnates and does
    not keep pace with inflation for a fourth year.
        The ASM commends Congress for the past decades of substantial and
    sustained funding for the NIH, an investment which is key to global
    health and benefits all Americans medically and economically. The ASM
    is pleased that the Senate recently has taken steps to increase the NIH
    budget for fiscal year 2007. The ASM urges Congress to continue to
    recognize the medical, economic, and strategic importance of adequately
    funding the NIH and recommends at least a 5 percent increase for the
    NIH in fiscal year 2007, an appropriation of $29.75 billion. This level
    of funding is the minimum amount necessary to sustain the current rate
    of research progress and offset biomedical research inflation.
    biomedical research benefits public health preparedness and the economy
        In the past year, there have been tragic reminders that being
    unprepared protects neither the public health nor the economic and
    strategic interests of the United States. Increased support for
    biomedical research is needed because new knowledge and technology are
    the pillars of preparedness against biological threats. Each day we
    face local, national, and global threats to health, safety, and well-
    being. To counter these threats, the NIH's resources are focused on
    preserving and improving health in this country and elsewhere through
    innovative, cutting-edge research. Declining cancer, heart disease and
    stroke mortality, extended HIV/AIDS life expectancies, and massive
    genome databanks are evidence of the power of biomedical research.
    Research supported by the NIH is responding to the realities of 21st
    century medicine, developing predictive and preemptive medical
    capabilities to overcome expected health resource shortages and
    unforeseen dangers like newly identified microbial pathogens.
        Research funded by the NIH also contributes to the Nation's
    competitiveness and economic strength, which is clearly rooted in basic
    science that generates commercially viable products and technologies.
    Biomedical research advances scientific knowledge, expands the high-
    technology workforce of the Nation, and enhances innovation among the
    country's private sector companies. Roughly 84 percent of the proposed
    fiscal year 2007 NIH budget will support the extramural science
    community through research grants and contracts. This funding will
    sustain work by more than 200,000 research personnel affiliated with
    approximately 3,000 hospitals, universities, private companies, and
    other research facilities.
              infectious disease research needs increased support
        Inadequate increases in funding for biomedical research weakens our
    national defenses against infectious diseases, which despite some
    medical victories persist as the second leading cause of death
    worldwide, accounting for 26 percent of all deaths. Infectious diseases
    particularly affect years of healthy life lost because they cause
    approximately two-thirds of deaths among children less than 5 years of
    age. Our ability to combat infectious diseases depends on basic
    research of how microbes spread, how they are harbored in the
    environment, and how they cause disease. The National Institute of
    Allergy and Infectious Diseases (NIAID) supports research that is
    essential to developing strategies to prevent, diagnose and treat
    infectious diseases here and abroad. NIAID funding supports both
    intramural and extramural researchers in academia and the private
    sector searching for new therapies, diagnostics, vaccines, and other
    technologies that improve health care for infectious diseases. This
    critical work also focuses on high-priority homeland security
    initiatives, includes influenza preparedness and counter-bioterrorism.
    Unfortunately, the proposed fiscal year 2007 budget leaves funding for
    the NIAID flat, about $4.4 billion or 0.3 percent over the fiscal year
    2006 appropriation. With additional resources the NIAID could fund more
    promising initiatives and restore funding for research projects.
                        the threat of pandemic influenza
        Biomedical research and preparedness save lives and, in the case of
    pandemic influenza, the number of lives saved could be significant.
    Anticipating dire possibilities if the H5N1 avian influenza virus
    mutates sufficiently to move easily from human to human, the Department
    of Health and Human Services (DHHS) and other Federal agencies recently
    introduced the National Strategy for Pandemic Influenza. The ASM
    commends this plan as a prudent response to what could become a lethal
    global event. Fearsome pandemics have ravaged human populations three
    times in the past century: the 1918-1919 Spanish influenza that took
    more than 40 million lives worldwide, the 1957 Asian influenza, and the
    1968 Hong Kong influenza. Those unusually virulent viral strains
    contained genetic material from avian influenza viruses like the
    current H5N1 virus. Confirmed reports of H5N1 related deaths in birds
    and mammals are coming from an expanding list of nations, where
    millions of domestic and wild fowl have died or been destroyed. In just
    the 4 months since the introduction of the National Strategy for
    Pandemic Influenza, H5N1 has spread to 37 nations. At present about 186
    humans have contracted the disease, more than half of whom have died.
    Feared for their facile ability to infect and kill, influenza viruses
    are always with us. Every year, seasonal influenza causes 250,000 to
    500,000 deaths worldwide. In the United States, this highly
    communicable disease annually causes an average 36,000 deaths, more
    than 200,000 hospitalizations, and, when calculated with pneumonia, an
    estimated $37.5 billion in direct and indirect costs. Together
    influenza and pneumonia are the leading infectious cause of deaths in
    the United States, ranked seventh among all causes of death. The
    Centers for Disease Control and Prevention has estimated that if
    pandemic flu arrives in the United States, 90 million people will
    become ill and almost 2 million people could die. The global potential
    for profound loss, millions of human lives and billions in financial
    costs, clearly demands that our public health institutions be ready
    with the most effective preventive and therapeutic measures against
    influenza.
        The ASM strongly supports the critically important NIH influenza
    initiatives. Researchers sponsored by the NIAID are focusing on
    effective vaccines and antivirals as prioritized in the national
    strategic plan, which calls for pandemic vaccine within 6 months of
    detection, as well as enough antiviral treatment. Scientists supported
    by the NIAID have completed a successful clinical trial of an
    experimental inactivated H5N1 influenza vaccine. Research efforts in
    the DHHS Plan also include the development of new vaccine delivery
    systems and higher capacity cell-based production methods. Recent
    advances supported by the NIAID include the institute's Influenza
    Genome Project, collecting to date the full genomic sequences of more
    than 830 influenza viral isolates from human patients and building a
    repository databank for use by other scientists.
                      progress against infectious diseases
        There are numerous research programs at the NIH that battle a long
    and growing list of infectious diseases which deserve increased
    support. Biomedical research consistently yields new ways to treat or
    prevent diseases. The following are just a few examples of new science
    advances:
        Scientists supported by the NIAID have collaborated to develop a
    tissue culture cell system in which the whole hepatitis C virus can be
    grown, which will allow researchers to better understand how Hepatitis
    C Virus (HCV) replicates and causes infection. HCV is a major cause of
    chronic liver disease with over 170 million infected people worldwide
    and can progress to cirrhosis of the liver, leading to liver cancer and
    failure. Two studies by the NIAID have shown that anti-cancer drugs
    show promise as potential antiviral drugs and merit further
    exploration. A vaccine to protect adults and adolescents against
    illness due to Bordetella pertussis infection, or whooping cough, has
    proved more than 90 percent effective in a large-scale clinical trial,
    which could help stem the increase in pertussis cases in the United
    States. The NIAID has supported a clinical trial of a vaccine against
    pneumococcal disease, which is a major cause of illness and death in
    children worldwide.
        Biomedical research must remain focused on major killers like HIV/
    AIDS, tuberculosis and malaria, which together are responsible for more
    than 5 million deaths each year. Despite extensive prevention programs,
    an estimated 14,000 people are newly infected with HIV daily. Twenty-
    five years after physicians first described AIDS as a new disease, more
    than 40 million people are living with HIV. The bacterium that causes
    TB currently infects about one-third of the world's population. Multi-
    drug resistant (MDR) TB increased 13.3 percent in the United States
    from 2003 to 2004, the largest single year increase in MDR TB since
    l993, presenting significant challenges to treatment and control of TB
    in the United States and abroad. Extensively drug-resistant (XDR) TB
    has increased in the industrialized nations from 3 percent of MDR TB
    cases in 2000 to 11 percent in 2004. Two new engineered TB vaccines
    developed with support of the NIAID have entered clinical trials and a
    number of TB drug candidates are ready for clinical testing. Scientists
    continue to pursue a wealth of genomic data to understand malaria
    pathogenesis and to uncover new molecular targets for both drugs and
    vaccines for malaria which has an incidence of 300 to 500 million cases
    a year.
        The NIAID funds extensive, multifaceted programs focused on these
    devastating diseases. In the past year, advances include: the new
    Center for HIV/AIDS Vaccine Immunology to address what is proving to be
    the very difficult task of finding HIV vaccines, with clinical sites in
    England, Africa, and three U.S. States; a clinical trial of two topical
    microbicides to assess effectiveness in stopping HIV transmission; and
    detection of a cellular protein that helps the tuberculosis microbe
    resist standard antimicrobials.
                   emerging diseases and biodefense research
        A world influenced by rapid transit and global markets challenges
    not just U.S. competitiveness, but also our public health networks and
    our national sense of security. We no longer can view far-flung disease
    outbreaks as remote or theoretical threats to our well-being. The
    administration has requested $1.9 billion in fiscal year 2007 funding
    for the NIH's biodefense efforts in recognition that the ability to
    counter bioterrorism depends on progress in biomedical research and the
    support of scientific capacity to respond to new biological threats. In
    2005, the NIAID awarded two additional grants to research consortia
    aimed at new vaccines, therapies, and diagnostics, completing a
    national network of 10 Regional Centers of Excellence for the NIAID
    Biodefense and Emerging Infectious Diseases Research program. Research
    targets include anthrax, plague, smallpox, West Nile fever, botulism,
    hantaviruses, viral hemorrhagic fevers and many other less-common
    diseases. The NIAID also began clinical trials of an experimental DNA
    vaccine against the West Nile virus, which first appeared in the United
    States in 1999; two NIAID-supported teams identified how Nipah and
    Hendra viruses attack human and animal cells, both emerging viruses
    that cause serious respiratory and neurological disease; and NIAID
    researchers and their university partners determined which host-cell
    enzymes Ebola viruses can hijack to infect humans.
                                   conclusion
        To sustain the pace of research discovery, we must continue to
    enhance the research capacity and productivity of the Nation's
    biomedical research enterprise. We must be prepared for the predictable
    diseases and build sufficient research capacity to detect and respond
    quickly to unexpected health threats. The 2002-2003 outbreak of Severe
    Acute Respiratory Syndrome (SARS) is a prime example of this balance, a
    rapid international response occurred to the sudden reality of a novel
    pathogen, which spread to more than two dozen countries. Biomedical
    scientists drew upon vast reserves of earlier viral research and
    quickly developed three distinct SARS vaccines now being evaluated,
    with the first human clinical trial opening just 21 months after SARS
    appeared as a new disease. Increased funding for biomedical research
    will strengthen our public health preparedness, our technological
    competitive edge and our ability to improve the quality and length of
    life for people. We urge Congress to provide at least a 5 percent
    increase for the NIH budget for fiscal year 2007 to help accomplish
    these goals.
                                     ______

          Prepared Statement of the American Society for Microbiology
        The American Society for Microbiology (ASM) is submitting the
    following statement in support of increased funding for the Centers for
    Disease Control and Prevention (CDC) in fiscal year 2007. The ASM is
    the largest single life science society with over 42,000 members who
    are involved in research and diagnostic testing in university,
    industry, government and clinical laboratories.
        The fiscal year 2007 budget request would reduce funding for the
    CDC for the second year in a row. Excluding one-time emergency funding
    items, CDC core programs would be cut over 4 percent below the fiscal
    year 2006 level of funding, which was 4 percent below the fiscal year
    2005 budget. In view of the CDC's critical role in protecting the
    health and safety of the public, the cumulative two year reduction of
    funding of over 8 percent is cause for serious concern. The ASM
    recommends that Congress provide $8.5 billion plus sufficient funding
    for pandemic influenza preparedness for the CDC in fiscal year 2007.
    This level of funding will sustain core programs crucial to improving
    public health in the United States and overseas.
        The CDC works with partners in the United States and across the
    globe to monitor health status and trends, detect and investigate
    health problems, conduct research to enhance prevention, develop and
    advocate sound health policies, and foster safe and healthy
    environments. CDC capabilities must expand, not contract, as increasing
    worldwide connectivity brings global health concerns to the United
    States. Among the CDC's health protection goals are ``people prepared
    for emerging health threats'' and ``healthy people in a healthy
    world.'' Both will require continued, extensive efforts here and abroad
    and clearly need sustained funding to assure success.
                                cdc preparedness
        CDC leadership in public health requires readiness to respond to
    unexpected health crises, above and beyond the Agency's ability to
    guard day-to-day wellness of people. In fiscal year 2005, the CDC's
    Epidemic Intelligence Service (EIS) officers responded to 66 health
    outbreaks, eight of them in other countries, and personnel from the CDC
    assigned to State or local health departments conducted 367 field
    investigations. After Hurricane Katrina struck the Gulf Coast, the CDC
    quickly provided information critical to preserving health and created
    the Katrina Information Network, later called the Emergency Response
    Information Network. Within two weeks, the CDC posted nearly 200
    pertinent documents on its website (on infection control, first
    responder and volunteer safety, environmental issues and more). A
    commercial test kit for mold contamination, developed in 2003 by
    scientists of the CDC and a private biotech company, became a valuable
    assessment tool post-Katrina. Calls to the agency for rapid response
    generally involve infectious diseases, which persist as a principal
    concern of the CDC.
                               pandemic influenza
        Within the proposed fiscal year 2007 budget, pandemic influenza is
    a top-priority for funding for the CDC. The requested $188 million for
    pandemic preparedness would expand the CDC's participation in the
    Federal interagency National Strategy for Pandemic Influenza, the
    Federal agency plan to prevent, detect, and treat outbreaks of
    influenza. Since mid-2005, a virulent avian influenza virus (strain
    H5N1) has been moving more rapidly from nation to nation, killing
    millions of wild and domestic birds and causing concern that viral
    mutations might cause human-to-human transmission. Scientists recently
    found that the human virus strains responsible for three major
    pandemics in the 20th century contained genetic material derived from
    avian viruses. Thus far, human deaths from H5N1 have been relatively
    few, but those known to be infected suffer a high mortality rate.
    Globally, traditional seasonal influenza already kills 250,000 to
    500,000 each year; pandemic influenza could kill many millions.
    Although the H5N1 virus has not reached the United States, many health
    officials consider future outbreaks in this country to be inevitable.
    If viral mutations provoke a human pandemic, 15-35 percent of the U.S.
    population could be affected, exacting a large number of influenza
    deaths and economic losses of $71.3-$166.5 billion, according to the
    CDC's estimates.
        The proposed fiscal year 2007 funding for pandemic preparedness
    will continue fiscal year 2006 improvements in domestic disease
    surveillance, upgrades of quarantine stations at major ports of entry,
    and support of global surveillance and detection activities in endemic,
    epidemic, and other high-risk countries. The proposed budget would fund
    new resources to increase stocks of diagnostic reagents; establish
    laboratory facilities with appropriate biocontainment capabilities;
    develop models and risk-assessment tools to predict disease spread;
    increase seasonal flu vaccine production; establish a viral-genome
    reference library; and create an electronic registry to more
    effectively track, distribute and administer vaccines to the public.
    The CDC would conduct studies that examine human infections of animal
    influenza A viruses; an additional $2.8 million would streamline
    outbreak response in countries identified as needing special
    assistance; and nearly $20 million would help States administer more
    seasonal influenza vaccines and thus stimulate greater vaccine
    production by manufacturers.
        In the past year, Federal support for the CDC's influenza
    preparedness activities yielded promising testing and vaccine
    development innovations. Researchers developed a laboratory test to
    diagnose currently circulating A/H5 (Asian lineage) strains of
    influenza in patients, which was approved this February by the Food and
    Drug Administration. Using advanced molecular technology, the test
    gives preliminary results within four hours, compared to two to three
    days with previous testing. To more rapidly detect U.S. influenza
    outbreaks, the test is being distributed to laboratories within the
    national Laboratory Response Network (LRN), facilities in all 50 States
    with special training in molecular testing, biosafety, and containment
    procedures. The CDC also shared the new testing technology with the
    World Health Organization (WHO); the CDC is one of four WHO
    Collaborating Centers worldwide providing technical and logistical
    expertise on pandemic influenza. Using new genetic sequence
    information, scientists from the CDC also collaborated last year with
    Federal and academic researchers to reconstruct the virus responsible
    for an estimated 20 to 50 million people during the 1918-19 pandemic.
    The virus particles are being stored at the CDC, for use in expedited
    vaccine and antiviral drug development.
                              infectious diseases
        To protect public health, the CDC has a major responsibility for
    preventing and controlling infectious diseases, still a leading cause
    of death and disability in this country and worldwide. The ASM is
    particularly aware of the important role of the CDC in protecting
    against infectious diseases. The fiscal year 2007 budget request
    includes $245 million for infectious disease programs, from laboratory
    research and epidemic investigations to surveillance networks, public
    education programs and specialized training. Increased funding for
    infectious diseases is needed not only to maintain and expand funding
    for existing infectious disease problems, but also to respond to new
    infectious disease threats and emergencies. The CDC must be able and
    ready to respond to shifting challenges, as it has done in the past for
    emerging disease outbreaks. The public clearly expects and relies on
    the CDC for rapid response to disease threats and for accurate,
    science-based advice on health issues. After the agency consolidated
    all of its more than 40 health information hotlines and clearinghouses
    into one toll-free service last March, the consumer center handled
    nearly 500,000 calls during its first 9 months and continues to expand.
        Preventing and controlling serious infectious diseases in the
    United States depends on the CDC's scientific expertise and education
    outreach tailored for specific diseases. An example is the CDC program
    to prevent HIV/AIDS, sexually transmitted diseases, and tuberculosis,
    an ongoing multi-faceted effort that is allotted $1.0 billion in the
    administration's fiscal year 2007 request ($86 million more than fiscal
    year 2006). Tuberculosis continues to be a serious threat in the United
    States and worldwide, with a 13.3 percent increase in multi-drug
    resistant (MDR) TB in the United States from 2003 to 2004, the largest
    single year increase in MDR TB since 1993. An estimated 40,000
    individuals newly acquire HIV in the United States each year and far
    more effort to prevent new infections is needed. The prevalence of
    anti-retroviral resistance to therapy at the time of HIV diagnosis is
    also increasing rapidly and will result in dramatically increased
    morbidity and health care costs if more effective efforts at prevention
    are not implemented. In contrast, new pediatric HIV infections are
    decreasing in number and routine prenatal HIV testing planned by the
    CDC for fiscal year 2007 should decrease pediatric cases even further.
    The CDC's National Plan to Eliminate Syphilis, started in 1999,
    requires further support with syphilis rates among U.S. men
    unfortunately increasing in the United States.
        Preventive health in the United States met a major milestone last
    year, when government efforts finally eliminated rubella virus, the
    highly contagious agent of childhood measles. The ASM agrees with the
    CDC's fiscal year 2007 budgetary emphasis on vaccination, certainly one
    of the most efficient and effective methods to fight infectious
    diseases. The fiscal year 2007 $2.6 billion immunization program
    continues two established components to protect the Nation's children,
    the Vaccines for Children program that provides vaccines free to
    children in financial need (40 percent of all childhood vaccines
    purchased in the United States), and the Section 317 program,
    supporting State-managed immunization programs. Researchers from the
    CDC recently used computer modeling to evaluate economic benefits from
    this country's standard childhood immunization schedule, comprising
    seven vaccines for illnesses like diphtheria, mumps, and polio. They
    concluded that collectively the immunizations not only save thousands
    of lives each year, but also $10 billion in direct medical costs plus
    more than $40 billion in indirect costs.
        The CDC's protection of American health and safety reaches beyond
    national borders, facing infections that can migrate from one afflicted
    population to the next through global travel and commerce.
    International collaboration against pandemic influenza is a large-scale
    example, but one among many such responses. Last year, experts from the
    CDC worked with officials from the WHO and the Angola government to
    control an outbreak of Marburg hemorrhagic fever in that African
    nation, posting traveler alerts on its website and providing on-site
    laboratory and field investigative services.
        The proposed fiscal year 2007 budget requests $381 million for the
    CDC's global health activities, to improve detection and control of
    diseases such as HIV/AIDS, malaria, polio, and measles. In fiscal year
    2005, the CDC program Preventing Mother-and-Child HIV Transmission
    collaborated with other nations to screen 2 million pregnant women in
    15 countries, giving short-course antiretroviral prophylaxis to 125,000
    who tested HIV-positive. The fiscal year 2007 budget includes $122
    million in direct AIDS-related funding for ongoing prevention,
    treatment, and surveillance in 25 countries. From 1988 to 2004, global
    polio incidence declined by more than 99 percent, saving about 250,000
    lives and avoiding 5 million cases of childhood paralysis. Global
    deaths due to measles fell by 48 percent between 1999 and 2004.
        The National Laboratory Training Network (NLTN) is a unique
    training system sponsored by the CDC and the Association of Public
    Health Laboratories. The NLTN is solely dedicated to ensuring quality
    laboratory practice for testing of public health significance through
    relevant and timely continuing education offered in a variety of
    educational venues at a reasonable cost, often at no charge. The NLTN
    Continuing Education programs offer laboratories critical insights into
    public health needs while also ensuring high quality, cost-effective,
    and clinically relevant direct patient testing needs are met. The ASM
    strongly supports the continuation of the NLTN programs though the CDC.
                                  bioterrorism
        The possibility of bioterrorism persists as a principal focus for
    the CDC, and the fiscal year 2007 budget requests $1.7 billion to
    support ongoing programs, the Strategic National Stockpile (SNS),
    surveillance and quarantine efforts, laboratory research on high-risk
    pathogens like anthrax, and assistance to State and local governments.
    Since its creation in 1999, the SNS has expanded its inventory of
    vaccines, drugs, and other countermeasures, preparing for health crises
    like influenza pandemics, natural catastrophes like Hurricane Katrina,
    and biological, chemical, radiological, or nuclear terrorist attacks.
    Supplies can be delivered anywhere in the United States within 12 hours
    of an event. The SNS fiscal year 2007 request of $593 million increases
    the fiscal year 2006 appropriation by $70 million, nearly $50 million
    of which will finance portable hospital units under the Mass Casualty
    Initiative, for rapid deployment to expand local hospital capacity. The
    CDC's fiscal year 2007 bioterrorism strategy also includes funding to
    utilize a recent invention, a new mass spectrometry method from the
    CDC's Environmental Health Laboratory for detecting botulinum toxin in
    people and the Nation's milk supply within 15 seconds. The additional
    funds will improve the method to more rapidly detect anthrax lethal
    factor, ricin and other toxins that can be used as bioweapons, as well
    as fully exploit the method's ``fingerprinting'' of suspect toxins to
    determine their source.
        The ASM asks Congress to recognize and support the CDC's crucial
    activities by providing increased support for the CDC's core programs
    and pandemic influenza preparedness.
                                     ______

            Prepared Statement of the American Society of Nephrology
                                  introduction
        The American Society of Nephrology (ASN) is pleased to submit this
    statement for the record to the Senate Appropriations Subcommittee on
    Labor, Health and Human Services, and Education in support of the ASN's
    top funding and research priorities for fiscal year 2007.
        The ASN is a professional society of more than 10,000 researchers,
    physicians, and practitioners who are committed to the treatment,
    prevention, and cure of kidney disease. Specifically, the ASN is
    committed to enhance and assist the study and practice of nephrology,
    to provide a forum for the promulgation of research, and to meet the
    professional and continuing education needs of its members.
        The ASN statement focuses on those issues and programs that most
    immediately fall under the committee's jurisdiction and assist our
    members to fulfill their missions. We want to express our strong
    support for advancing programs supported by the National Institutes of
    Health (NIH) and Agency for Healthcare Research and Quality (AHRQ). The
    ASN thanks the subcommittee for its commitment and steadfast support of
    these programs.
                           the face of kidney disease
        Kidney disease is a major health problem in the United States, and
    along with Alzheimer's disease, the fastest growing cause of death in
    the United States. (CDC data). It is estimated that at least 15 million
    people have lost 50 percent of their kidney function without even
    knowing it and suffer from Chronic Kidney Disease (CKD). Another 20
    million more Americans are at increased risk of developing kidney
    disease. Sub clinical kidney disease has emerged recently as a major
    risk factor for CVD. The culmination of unimpeded progression is end
    stage renal disease (ESRD), a condition in which patients have
    permanent kidney failure, affects almost 400,000 Americans, and
    directly causes 50,000 deaths annually. In the past 10 years, the
    number of patients in the United States with ESRD has almost doubled.
    Although the largest age group having ESRD ranges from 45-64 years old,
    rates increase steadily for those between the ages of 65-74 and are
    disproportionately high in African-Americans. African-Americans
    represent about 32.4 percent of all patients treated for kidney failure
    in the United States and the risk of ESRD for middle-age African-
    American males with high blood pressure is six times that of their
    Caucasian counterparts.
                                 economic costs
        Although no dollar amount can be affixed to human suffering or the
    loss of human life, economic data can help to identify and quantify the
    current and projected future financial costs associated with ESRD. The
    2000 report of the United States Renal Data System indicates that the
    total Medicare ESRD program cost will more than double, surpassing $28
    billion, by 2010, as the prevalence of kidney failure is projected to
    double. The annual average cost per ESRD patient is approximately
    $55,000. These escalating costs serve to magnify the need to
    investigate new, and better apply, recently proven strategies for
    preventing progressive kidney disease.
        In short, we can treat and maintain patients who have lost their
    kidney function but the critical need is to prevent the loss of kidney
    function and its complications in the first place. Meeting this vital
    goal can only be accomplished through more concerted research and
    education.
                    major causes of end stage renal disease
        Diabetes, a disease that affects 17 million Americans, is the most
    common cause of ESRD in the United States. Nearly 34 percent of all
    Americans being treated for kidney failure have diabetes. Moreover,
    only 18 percent of people with diabetes survive 5 years after beginning
    treatment for kidney failure. With current projections that the
    epidemic of obesity-related diabetes mellitus will continue to soar, a
    dramatic increase in kidney disease is anticipated in the next 10
    years.
        Hypertension, or high blood pressure, is the next leading cause of
    ESRD, accounting for 23.6 percent of ESRD patients. Similar to
    diabetes, higher rates of hypertension can be found among certain age
    and ethnic groups. For example, hypertension is common among African-
    Americans (35 percent). It is also a disease of the aged and accounts
    for 37 percent of new ESRD cases in those 65 years old and above.
        Despite recent progress and discoveries regarding the major causes
    of ESRD, it is among many areas of disease research that remain under-
    investigated. Researchers agree that significant inroads in previously
    understudied sub-fields need to be made. Significant among them, more
    focus and direction need to be introduced into the general field of
    renal research and patient and physician education. These pressing
    factors provided the impetus for an informal dialogue on the resulting
    calls to action.
                            lack of public awareness
        A major problem with kidney disease is that it is largely a
    ``Silent Disease''. In fact, of the 15 million Americans who have lost
    at least half of their kidney function, the vast majority have no
    knowledge of their condition. While people with chronic kidney disease
    may not show any symptoms, this does not mean that they are not going
    to have long-term damage to their kidney function, requiring dialysis
    or a transplant. These people may also be especially vulnerable to
    cardiovascular disease. If these 15 million people were identified
    early, there are new therapies, particularly special blood pressure
    drugs known as ACE inhibitors, which could be prescribed with
    potentially significant benefits. In addition, vigorous treatment of
    hypertension and other complications that cause illnesses and loss of
    productivity could be administered to the patients.
        Given the cost to human life and to the Federal Government caused
    by ESRD specifically, as well as other forms of kidney disease, we urge
    this subcommittee to provide funding increases for kidney disease
    research.
                            kidney disease research
    National Institutes of Health (NIH)
        The ASN applauds Congress and members of the subcommittee for
    leading the bipartisan effort to double our investment in promising
    biomedical research supported and conducted by the NIH. NIH has served
    as a vital component in improving the Nation's health through research,
    both on and off the NIH campus, and in the training of research
    investigators, including nephrology researchers. Strides in biomedical
    discovery have had an impact on the quality of life for people with
    kidney disease. If we are to sustain this momentum and translate the
    promise of biomedical research into the reality of better health, this
    Nation must maintain its commitment to medical research. We support the
    recommendation of the Ad-Hoc Group for Medical Research Funding to add
    5 percent in fiscal year 2007 to the NIH budget for a total of $29.750
    billion.
        In fiscal year 2007, the NIH budget must grow by 3.5 percent, or
    nearly $1 billion, just to keep pace with inflation. Further, the NIH
    has ambitious plans for new initiatives to combat the health challenges
    of the future. To ensure that NIH's momentum is not further eroded, and
    to continue the fight against the diseases and disabilities that affect
    millions of Americans, the ASN will work with the administration and
    the Congress to seek an NIH budget of at least $30 billion for fiscal
    year 2007.
    National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK)
        Many recent advances have been made in our understanding into the
    causes and progression of renal failure, such as: how diabetes and
    hypertension affect the kidney and the mechanisms responsible for acute
    renal failure.
        Despite these advances, the number of people with renal failure and
    the numbers who die of renal failure continue to increase each year.
    Most alarming is the significant increase in diabetes, the most common
    cause of chronic kidney failure, and its relationship to kidney
    disease. The ASN believes the rising incidence and prevalence of
    diabetes-related kidney disease warrants additional recourses to
    improve our understanding of the relationship between kidney disease
    and diabetes.
        The NIDDK sponsors a number of activities that researchers hope
    will lead to improved detection, treatment and prevention of kidney
    disease and chronic kidney failure. To ensure ongoing kidney disease
    and kidney disease related research and important clinical trials
    infrastructure development we recommend a 5 percent increase for the
    NIDDK over fiscal year 2006 levels.
            asn research goals & recommendations for kidney disease
        In the fall of 2004, the ASN conducted a series of research
    retreats to develop priorities to combat the growing prevalence of
    kidney disease in the United States. The ASN joined experts, both
    within and outside the renal community, and identified five areas
    requiring attention: acute renal failure, diabetic nephropathy,
    hypertension, transplantation, and kidney-associated cardiovascular
    disease.
        The final research retreat report(s) highlighted priorities and
    contained three overriding recommendations. Theses include:
    1. Development of Core Centers for kidney disease research
        Expansion of the kidney research infrastructure in the United
    States can be achieved by vigorous funding of a program of kidney
    research core centers. Specifically, we propose that the number of
    kidney centers be increased with the goal of providing core facilities
    to support collaborative research on a local, regional and national
    level. It should be emphasized that such a program of competitively
    reviewed kidney core centers would facilitate investigator-initiated
    research in both laboratory and patient-oriented investigation. This
    approach is highly compatible with the collaborative research
    enterprise conceived in the NIH Road Map Initiative.
    2. Support programs/research initiatives that impact the understanding
            of the relationship between renal and cardiovascular disease
        It is now well recognized that chronic kidney dysfunction is an
    important risk factor for the development of cardiovascular disease. It
    is recommended that the NIDDK and NHLBI work cooperatively to support
    both basic and clinical science projects that will shed light on the
    pathogenesis of this relationship and to support the exploration of
    interventions that can decrease cardiovascular events in patients with
    CKD. Thus, we specifically propose that NHLBI should support
    investigator-initiated research grants in areas of kidney research with
    a direct relationship to cardiovascular disease. Similarly, NHLBI
    should work collaboratively with NIDDK to support the proposed program
    of kidney core research centers.
    3. Continued support and expansion of investigator initiated research
            projects
        In each of the five subjects there are areas of fundamental
    investigation that require the support of investigator initiated
    projects, if ultimately progress is to be made in the understanding of
    the basic mechanisms that underlie the diseases processes. It is
    recommended that there should be an expansion of support for research
    in the areas that lend themselves to this mechanism of funding, by
    encouraging applications with appropriate program announcements and
    requests for proposals. In addition to vigorous support for RO1 grants,
    continued funding of Concept Development and R21/R33 grants is
    essential to support development of investigator-initiated clinical
    studies in these areas of high priority. Such funding is critical to
    accelerate the transfer of new knowledge from the bench to the bedside.
        In summary, the ASN foresees the following important directions in
    the future of kidney disease research:
      --Continued research in acute renal failure, diabetic nephropathy,
            hypertension, transplantation, and kidney-associated
            cardiovascular disease;
      --The establishment of core centers for kidney disease research;
      --Persistent attention to the relationship between kidney disease and
            hypertension and collaboration between NIDDK and NHLBI;
      --Expansion of investigator initiated research projects.
        The ASN will strive to fulfill its mission statement and research
    recommendations (agenda). The ASN will remain active on Capitol Hill
    and assist members of Congress and the administration in their
    understanding of kidney disease and problems facing CKD and ESRD
    patients and the health care providers who serve them.
    Agency for Health Care Research and Quality (AHRQ)
        Complementing the medical research conducted at NIH, the AHRQ
    sponsors health services research designed to improve the quality of
    health care, decrease health care costs, and provide access to
    essential health care services by translating research into measurable
    improvements in the health care system. The AHRQ supports emerging
    critical issues in health care delivery and addresses the particular
    needs of priority populations, such as people with chronic diseases.
    The ASN firmly believes in the value of AHRQ's research and quality
    agenda, which continues to provide health care providers, policymakers,
    and patients with critical information needed to improve health care
    and treatment of chronic conditions such as kidney disease. The ASN
    supports the Friends of AHRQ recommendation of $440 million for AHRQ in
    fiscal year 2007.
                                   conclusion
        Currently, there is no cure for kidney disease. The progression of
    chronic renal failure can be slowed, but never reversed. Meanwhile,
    millions of Americans face a gradual decline in their quality of life
    because of kidney disease. In many cases, abnormalities associated with
    early stage chronic renal failure remain undetected and are not
    diagnosed until the late stages. In sum, chronic renal failure requires
    our serious and immediate attention.
        As practicing nephrologists, ASN members know firsthand the
    devastating effects of renal disease. ASN respectfully requests the
    subcommittees' continued support to enable the nephrology community to
    continue with its efforts to find better ways to treat and prevent
    kidney disease.
        Thank you for your continued support for medical research and
    kidney disease research. To obtain further information about ASN,
    please go to http://www.asn-online.org or contact Paul Smedberg, ASN
    Director of Policy & Public Affairs at 202-416-0646.
                                     ______

        Prepared Statement of the Association of Academic Health Centers
        The Association of Academic Health Centers (AAHC) is pleased to
    submit this statement for the record with its fiscal year 2007
    appropriations recommendations for a number of essential programs that
    are critical to improving health and health care delivery in our
    Nation.
        The AAHC, the national organization representing almost 100
    academic health centers, is dedicated to improving the Nation's health
    care system by mobilizing and enhancing the strengths and resources of
    the academic health center enterprise in health professions education,
    patient care, and research. An academic health center consists of an
    allopathic or osteopathic medical school, one or more other health
    professions schools or programs, and one or more owned or affiliated
    teaching hospitals, health systems, or other organized health care
    services. Our member institutions have enormous impact on their
    regions, the Nation, and the global economy.
                            the research enterprise
        AAHC member institutions are the infrastructure of the Nation's
    research enterprise. Academic health center researchers in both the
    basic and clinical sciences are pushing the bounds of science to
    advance progress in the diagnosis and treatment of myriad diseases and
    chronic illnesses. In addition, our institutions are engaged in a broad
    range of health services research contributing to improvements in the
    organization, financing, and delivery of health services.
        Our key partner in the nation's research achievements is the
    National Institutes of Health (NIH), which throughout its history has
    provided the necessary funding for basic science research and a wide
    array of projects to test clinical applications. Maintaining NIH's
    capabilities to carry out investigator-initiated research is absolutely
    critical to ensure that the Nation advances in health care, sustains
    the education and advancement of highly trained scientists, and builds
    the infrastructure for the conduct of research across the country. We
    believe that America's preeminence in science and its leading position
    in our global economy are tied closely to the Nation's investment in
    its research enterprise through the NIH.
        Over the past 3 years, increases in appropriations for the NIH have
    not kept pace with inflation. In fact, the administration's current
    proposal to freeze the NIH budget at a level that is more than 11
    percent below the 2003 funding level in constant dollars can only be
    viewed as threatening to the Nation. The practical effect of such
    funding is that NIH cannot sustain its ongoing efforts and at the same
    time support promising new research. The opportunity costs in terms of
    our capacity to reduce the burden of illness and improve patient
    outcomes are enormous. Disrupting ongoing research projects or failing
    to support promising new proposals is, in the long run, more costly
    than any short-term budget savings. The cost will be counted by the
    missed opportunities to mitigate or cure many conditions, reducing the
    quality of life for people throughout the world.
        We believe that the Congress must renew its commitment to the
    research enterprise, even in these times of budgetary restraint.
    Failure to do so means that with each passing year the NIH will support
    less internal and extramural research. We are very pleased that the
    Senate Budget Resolution for fiscal year 2007 provides for a $7 billion
    increase in overall discretionary dollars for health and education
    programs, including an assumption of at least $1 billion for the NIH.
    We are very grateful for the leadership of Senators Specter and Harkin
    who proposed an amendment to increase funding and argued persuasively
    for making this investment in the future of biomedical research. We
    strongly recommend that funding for the NIH in fiscal year 2007 be
    increased at least 5 percent or no less than the funding provided in
    fiscal year 2005 to prevent further erosion of its purchasing power.
                        the health professions workforce
        The health workforce must be viewed as a cornerstone of our
    Nation's well being. The health professions not only treat and care for
    patients but also represent an economic engine for the country.
    Unfortunately, the supply of health professionals is threatened. By
    most estimates, there are an insufficient number of health
    professionals to meet current and future demands. It has been estimated
    that the Nation will need approximately 3.5 million health care workers
    in addition to the 2 million workers to replace those who leave the
    workforce.
        Further, the geographic maldistribution of health professionals--
    especially primary care physicians and other non-physician
    practitioners--leaves large numbers of Americans without access to care
    with as many as 50 million people living in communities officially
    designated as health professions shortage areas. Of particular concern
    are estimated shortages in dentistry, medicine, nursing, pharmacy, and
    an array of allied health professionals that will likely increase with
    an aging population and potentially less migration of health
    professionals throughout the world.
        The health and economic prosperity of the Nation depend on an
    effective and well-trained health workforce. Key to ensuring an
    adequate supply is investment in the educational programs and the
    students who are pursing careers in the health professions. Moreover,
    these educational programs need to increasingly attract students who
    will practice in underserved areas--both during their training and
    afterward. At the same time, continuing education and distance learning
    programs must be maintained to connect practitioners with advances in
    care and provide opportunities for consultation and referral.
    Strengthening the health care delivery system in underserved areas is
    key to our efforts to improve the health of the Nation and eliminate
    the disparities in health outcomes that result from inadequate access
    to care.
        The cornerstone of efforts to address the maldistribution of health
    professionals, to train a diverse health professions workforce, and to
    promote access for elderly and other vulnerable populations has been
    the programs authorized under Title VII of the Public Health Service
    Act. These programs include targeted scholarships for disadvantaged
    students; initiatives at the secondary school level to prepare students
    for college-level programs in the allied health professions; direct
    support for programs in pharmacy, dentistry, geriatrics, pediatrics,
    and other primary care disciplines; and Area Health Education Centers
    and Health Education and Training Centers. In addition, Title VIII
    funds for nursing have been especially important in helping to address
    widespread and persistent shortages and to develop programs for much
    needed advanced practice nurses, including the faculty to direct these
    programs. Support for health professions programs has been unstable
    and, in the case of Title VII, was cut more than half this year--from
    $252 million in fiscal year 2005 to $99 million in fiscal year 2006.
        It is also important to note that cutting support for health
    professions education is likely to undermine current efforts to
    significantly expand community health centers. Staffing for these
    centers relies on primary care practitioners in the disciplines that
    are the focus of many of the programs in Titles VII and VIII. A recent
    study published in The Journal of the American Medical Association
    (March 1, 2006; Vol. 295, No. 9) found that workforce shortages ``may
    impede the expansion of the U.S. community health center safety net,
    particularly in rural areas.'' The study also recommends that funding
    for Title VII be bolstered as this is ``the only Federal program that
    exists to encourage the production of primary care clinicians likely to
    practice in underserved areas . . .''
        Reports from the member institutions of the AAHC confirm the
    adverse impact of further reductions in funding for Title VII. For
    example, at the University of Nebraska Medical Center, Title VII grants
    totaling $3.2 million were received in fiscal year 2005. These grants
    support the placement of behavioral health professionals in more than
    140 rural and other underserved settings providing over 5,000 annual
    behavioral health visits.
        In addition, the Nebraska Geriatric Education Center, supported by
    a Title VII grant, plays a key role in training professionals to meet
    the needs of older patients while at the same time expanding access to
    care for this population. Finally, the School of Allied Health and the
    primary care medicine programs at the University of Nebraska Medical
    Center depend on Title VII grants to increase the diversity of their
    student population and to provide teaching opportunities in sites
    serving rural and other underserved communities.
        Without continuing support from Title VII grants, California health
    professions training programs could lose approximately $18 million
    annually. Statewide programs in California train physicians to work in
    underserved areas such as rural and inner city clinics, teach medical
    Spanish and cultural awareness skills to health professionals, and work
    with community health workers in low-income neighborhoods to teach
    self-help skills to patients with diabetes and asthma.
        In North Carolina more than $12.5 million in Title VII grants were
    distributed to the University of North Carolina at Chapel Hill, Duke
    University, and Wake Forest University. These funds are used to train
    primary care physicians, dentists, geriatric specialists, physician
    assistants, and others. These programs have helped to recruit a diverse
    cadre of students as well as support the work of Area Health Education
    Centers which are linked to the universities and provide essential
    access to care in underserved areas.
        These are just a few examples of the valuable work that results
    from the Federal funding of Title VII. The administration's
    recommendations would virtually eliminate funding for these programs.
        Leaders of academic health centers nationwide confirm that these
    programs have made a difference in the nation's health. The Nation's
    return on its investment is clear. Title VII has succeeded in (1)
    supplying a workforce to serve populations in need, (2) enabling
    institutions and communities to recruit a diverse workforce, and (3)
    expanding access to care for many of the Nation's most vulnerable
    individuals.
        We strongly recommend that funding for Titles VII and VIII total
    $550 million for fiscal year 2007. This would help to off-set the $155
    million cut in place for this year and ensure that these critical
    programs can continue to address the urgent need to improve the health
    of our Nation.
                         hospital preparedness program
        The continuing threats from natural and/or terrorist events require
    our health system to be prepared to treat mass casualty events.
    Critical emergency care and inpatient surge capacity must be available
    across the country. Because of the financial condition of many public
    and non-profit hospitals, the cost of capital to undertake the
    necessary preparations for the treatment of large numbers of patients
    is beyond their reach. These funds make it possible for hospitals to
    build the infrastructure and surge capacity that is necessary to meet
    unknown, but potentially large, public health emergencies.
        We strongly support the administration's budget request for $474
    million for the hospital preparedness program to continue progress
    toward a more rapid and coherent response to these unpredictable
    circumstances.
                        state high-risk insurance pools
        The number of uninsured in America continues to grow as employers
    curtail or drop group coverage and many workers are forced to forego
    coverage. The AAHC has been at the forefront of efforts to address the
    crisis of the Nation's uninsured. This is an urgent problem and we are
    committed to supporting a range of approaches to make health coverage
    more accessible and affordable.
        One subset of the uninsured population involves individuals at risk
    for health care coverage because of one or more pre-existing health
    conditions. Some of these individuals have only been able to purchase
    coverage under the auspices of State high-risk health insurance pools
    because no other insurance product is available to them. State high-
    risk insurance pools are a vital pathway for those who have been
    excluded from the health insurance market because of their health
    status.
        Section 2745 of the Public Health Service Act authorizes a program
    of grants to the States for the establishment and operation of
    qualified high-risk health insurance pools. In the recently enacted
    Deficit Reduction Act, Congress extended this program and authorized
    $75 million for fiscal year 2007. Unfortunately, the President's budget
    does not recommend any funding for this important program. We urge the
    subcommittee to fund this grant program at the fully authorized amount
    of $75 million.
        We thank you for the opportunity to present our views and
    recommendations regarding funding for discretionary health programs in
    fiscal year 2007. Our member institutions are committed to improving
    the Nation's health and well-being, and we look forward to working with
    Chairman Specter and all members of the subcommittee. We are pleased to
    be available to provide information and answer questions at any time.
                                     ______

      Prepared Statement of the Association of American Cancer Institutes
        The Association of American Cancer Institutes (AACI), representing
    86 of the Nation's premier academic and free-standing cancer centers,
    appreciates the opportunity to submit this statement for consideration
    as the Labor-Health and Human Services Appropriations Subcommittee
    plans the fiscal year 2007 appropriations for the National Institutes
    of Health (NIH) and the National Cancer Institute (NCI).
                    america's investment in cancer research
        Thirty-five years ago, a diagnosis of cancer was largely a death
    sentence. Since then, our national investment in cancer research has
    reaped remarkable returns, including potential cancer vaccines,
    improved detection strategies, and targeted, less difficult therapies.
    The last several years have been particularly exciting for science and
    specifically for cancer research. Advances such as the sequencing of
    the human genome and improved insights about the genetics of cancer
    have led to promising new approaches to the prevention and treatment of
    cancer. Today, many patients are benefiting from targeted drug
    therapies, like Gleevec, Tarceva and Avastin that are more specific,
    less toxic and more effective. It is the support of the Nation's cancer
    research enterprise by the NCI, 80 percent \1\ of whose funds are spent
    at academic research institutions across the country, that has led to
    these discoveries.
    ---------------------------------------------------------------------------
        \1\ United States. Department of Health and Human Services. The
    Nation's Investment in Cancer Research. 2006. (http://plan.cancer.gov/
    pdf/nci_2007_plan.pdf)
    ---------------------------------------------------------------------------
        The President's 2007 budget proposal provides only level funding
    for the NIH and a $40 million cut for the NCI. This is of great concern
    to the Nation's cancer centers, which play a critical role in the
    progress against cancer, and are major hubs of State of the art cancer
    research, drug development, treatment, prevention and control. A
    depleted budget for NCI directly impacts the pace of scientific
    discovery and may mean that new ideas to combat cancer will go
    unexplored, and the development of novel cancer therapies will be
    seriously compromised. Reduced funding will also discourage the next
    generation of cancer researchers leading some to choose other fields.
    We are at a time of unprecedented opportunity to make a dramatic
    assault on cancer, and the hard-won momentum that has been achieved in
    recent years must be sustained. Otherwise, America risks losing an
    entire generation of ideas that could produce possible cures for the
    diseases we know as cancer.
                    cancer research: saving lives and money
        At the Nation's cancer institutes, we have demonstrated that cancer
    research saves lives. Cancer mortality rates decreased by 10 percent
    between 1991 and 2001, translating to as many as 321,000 lives saved
    \2\ and in 2003, the number of cancer deaths dropped for the first time
    since the war on cancer began. The death rate for all cancers combined
    is dropping about 1.1 percent per year, while the rate of new cancers
    is holding steady.\2\ The five-year relative survival rate for all
    cancers diagnosed between 1995 and 2000 is 64 percent, an increase from
    just 50 percent in the mid-1970s. Thanks to prevention research and the
    development of early detection technologies and new treatments, today,
    nearly 10 million Americans are cancer survivors.\2\
    ---------------------------------------------------------------------------
        \2\ Statistics from the American Cancer Society.
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        The financial cost of cancer is rising, but research advances help
    to mitigate cancer's annual price tag, which in 2005 was estimated at
    $210 billion, including $136 billion in lost productivity and over $70
    billion in direct medical costs.\3\ Tamoxifen, used to treat breast
    cancer, is saving $41,372 for each year of life gained in women 35 to
    49 years old; $68,349 for women 50 to 59 years old; and $74,981 for
    women 60 to 69 years old.\4\ The drug Cisplatin has translated to an
    increase in the survival rate for testicular cancer patients. The drug
    cost an estimated $56 million to develop and has already produced an
    annual return of $166 million in treatment savings.\5\ That research
    saves money is evident.
    ---------------------------------------------------------------------------
        \3\ Estimates from the National Heart, Lung and Blood Institute.
        \4\ United States Senate. Joint Economic Committee, Office of the
    Chairman, Connie Mack. The Benefits of Medical Research and the Role of
    NIH. 2000. (http://jec.senate.gov)
        \5\ Estimates from Lasker/Funding First. (www.fundingfirst.org)
    ---------------------------------------------------------------------------
       the nation's cancer centers: economic engines in their communities
        In addition to training the future workforce for cancer care and
    research, America's cancer centers themselves have direct economic
    impact, both locally and nationally. It is estimated that every dollar
    spent on research funding and patient activities at cancer centers
    translates to $2.50 to $3 invested in the local economy.\6\ In
    addition, the amount of research support and operating budgets that are
    leveraged through NCI-designated cancer centers support grant (CCSG)
    funding alone is striking. The total amount of research support is more
    than ten times the amount generated by the CCSG grants themselves.\7\
    By attracting patients from outside the community, constructing new
    laboratories and clinical facilities, recruiting new faculty and staff
    from outside the region who bring cutting-edge scientific, clinical and
    public health expertise to work in communities, and developing
    entrepreneurial opportunities in the biotech and pharmaceutical
    industries, cancer research centers serve as an economic stimulus and
    generate commerce in their communities.
    ---------------------------------------------------------------------------
        \6\ United States. Department of Commerce, Bureau of Economic
    Analysis. Regional Multipliers: A User Handbook for the Regional Input-
    Output Modeling System (RIMS II). 3rd ed. 1997.
        \7\ United States. National Cancer Institute. Advancing
    Translational Cancer Research: A Vision of the Cancer Center and SPORE
    Programs of the Future. 2003. (http://deainfo.nci.nih.gov/advisory/
    ncab/p30-p50/P30-P50final12feb03.pdf)
    ---------------------------------------------------------------------------
                united states: global leader in cancer research
        The United States is a world leader in the battle against cancer
    because of the Nation's past investment in cancer research, but our
    competitive edge will quickly erode without continued commitment.
    Sustained inquiry and scientific advancement are critical to
    maintaining our competitive stature. Failure to appropriate new funds
    for biomedical innovation and discovery threatens America's capacity to
    compete with emerging global economies and other countries are eager to
    take our place as the world's leader in biomedical research. The United
    States must significantly enhance its research and technical capacity
    to maintain our preeminent position.
                                   conclusion
        In summary, cancer research saves lives, saves money, stimulates
    economic growth at home and enhances U.S. competitiveness abroad.
    Federal investment in cancer research must remain a national priority.
    America must commit to sustaining the pace of cancer-related science so
    that new discoveries are translated into clinical benefit for all.
    Congress has the opportunity now to take an important leadership role
    in assuring that the NIH budget is increased in fiscal year 2007. We
    urge your support to increase this critically important funding.
                                     ______

         Prepared Statement of the Association of Independent Research
                                   Institutes
        The Association of Independent Research Institutes (AIRI)
    respectfully submits this written statement for the record of the U.S.
    Senate Appropriations Subcommittee on Labor, Health and Human Services,
    and Education. AIRI appreciates the commitment that the members of this
    Subcommittee have made to biomedical research through support for the
    National Institutes of Health (NIH).
        AIRI is a national organization of 86 independent, not-for-profit
    research institutes that perform basic and clinical research in the
    biological and behavioral sciences in 28 States. Our member institutes
    are private, stand-alone research centers that set their sights on the
    vast frontiers of medical science. AIRI institutes--many of which were
    originally established by generous philanthropists or from spin-offs of
    unique university research areas--tend to be relatively small in size,
    with budgets ranging from a few million to hundreds of millions of
    dollars. In addition, each AIRI institution is governed by its own
    independent Board of Directors, which allows our members to be
    structurally nimble and capable of adjusting their research programs to
    emerging areas of inquiry. While the primary function of AIRI
    institutes is research, most are also strongly involved in training the
    next generation of biomedical researchers. In a testament to the
    quality of research and innovative ideas that AIRI institutes bring to
    the national biomedical enterprise--our institutions consistently
    exceed the success rates of the overall NIH grantee pool, and receive
    about 11 percent of NIH's peer reviewed, competitively awarded
    extramural grants.
        The doubling of the NIH budget allowed the biomedical research
    community to accelerate solutions to human disease and disability. We
    have blazed new trails for medical research, diving into the
    intricacies of how the human body musters its defenses, and how those
    responses can be evaluated, enhanced, and modified. In addition, it
    helped us to realize new scientific management strategies such as
    fostering interdisciplinary research and creating new robust teams of
    scientists that, before the doubling, did not have scientific common
    ground. These research teams navigate the fast progressing research
    environment where there is an increasing need to integrate and
    aggregate basic research, computational capabilities, and clinical
    evidence into new cures more quickly. Further, the doubling has helped
    us to redefine health and healthcare goals based on scientific
    discoveries that were out of reach prior to the doubling. We now talk
    about disease and health care in terms of predictive, preventative and
    pre-emptive tactics.
        With flexible structures that are friendly to change, AIRI
    institutes are able to move amongst the new science partnerships that
    will transform America's health and health care in the 21st century.
    NIH has responded to the rapidly changing world by strategically
    framing the next generation of biomedical research through cross-
    cutting, interdisciplinary initiatives such as those supported in the
    NIH Roadmap, the NIH Neuroscience Blueprint, the new Clinical and
    Translational Science Award program and the new Genes, Environment and
    Health Initiative. AIRI institutes are innovators poised to foster
    partnerships that will nurture the collaborative environment necessary
    to successfully and efficiently conduct research within these evolving
    NIH frameworks.
        AIRI endorses the fiscal year 2007 Ad Hoc Group for Medical
    Research proposal to increase the NIH budget by five percent over the
    fiscal year 2006 level. We recognize that the current budget
    environment puts pressure on Congress to face difficult funding trade-
    offs; however, as this subcommittee works to define priorities for the
    year and set goals for the future, AIRI asks that you maintain your
    long-term commitment of support for NIH and its mission. The
    President's fiscal year 2007 budget would flat-fund NIH. The 5 percent
    increase for NIH supported by AIRI would not only allow the agency to
    sustain current programs but also invest in critical new initiatives.
    This would prevent NIH from falling behind the ``Innovation Index''--
    the rate of biomedical inflation as calculated in the Biomedical
    Research and Development Price Index (BRDPI) plus a modest investment
    in new initiatives.
        Using the fiscal year 2007 BRDPI projection as a base, NIH would
    require an increase of at least 3.8 percent over fiscal year 2006. AIRI
    strongly believes that an increase for NIH above BRDPI is justified by
    the health needs as well as current and burgeoning research
    capabilities of the Nation. An increase above BRDPI would allow new
    innovative ideas to be funded and would infuse existing programs to
    evolve as their research findings push them to higher levels of basic
    understanding, translation and clinical functionality.
        AIRI also hopes that the subcommittee will support programs and
    policies that foster a sustainable, biomedical research workforce. The
    biomedical research community is dependent upon a knowledgeable and
    skilled workforce to address current and future critical health
    research challenges. The cultivation and preservation of this workforce
    is dependent upon several factors, including the ability to: recruit
    scientists and students globally; train researchers both in basic and
    clinical biomedical research; focus on career development initiatives
    to recruit and retain researchers at critical stages; support new and
    young investigators; and maintain the NIH extramural investigator
    salary cap at Executive Level I. By again maintaining the NIH
    extramural investigator salary cap (the salary level that extramural
    researchers may apply toward their NIH grants) at Executive Level I in
    the fiscal year 2007 Appropriations bill, Congress will ensure that
    extramural investigators' salaries are competitive with the salary
    level for intramural researchers at NIH. As we work to enhance
    biomedical research capabilities, we should not impose barriers that
    would discourage talented people from committing to careers in
    research.
        In addition, AIRI urges Congress to support NIH-funded equipment
    and infrastructure programs. As the investment in medical research and
    the national biomedical research agenda have expanded, the need for
    acquisition and modernization of laboratory equipment and
    infrastructure has become critical. NIH equipment grants meet the
    specific infrastructure needs of research institutions to maximize
    productivity of their research grants.
        Medical research is a long-term process and, in order to meet the
    challenges of improving human health, we must not diminish our Federal
    commitment and investment. It is essential to sustain the momentum of
    NIH-funded research so that it continues to meet the goal of improving
    the health of all Americans. AIRI would like to thank the subcommittee
    for its important work to ensure the health of the Nation, and we
    appreciate this opportunity to present recommendations concerning the
    fiscal year 2007 Appropriations bill.
                                     ______

    Prepared Statement of the Association of Women's Health, Obstetric and
                            Neonatal Nurses (AWHONN)
        The Association of Women's Health, Obstetric and Neonatal Nurses
    (AWHONN) appreciates the opportunity to provide comment on the fiscal
    year 2007 appropriations for nursing education, research, and workforce
    development programs as well as programs designed to improve maternal
    and child health. AWHONN is a membership organization of 22,000 nurses,
    and it is our mission to promote the health and well-being of all women
    and newborns. AWHONN members are registered nurses, nurse
    practitioners, certified nurse-midwives, and clinical nurse specialists
    who work in hospitals, physicians' offices, universities, and community
    clinics throughout the United States.
              health resources and services administration (hrsa)
    AWHONN recommends a minimum of $7.5 billion in funding for HRSA
        AWHONN is deeply concerned by the President's budget request of a
    $255 million cut in fiscal year 2007 to HRSA. Through its many programs
    and new initiatives, HRSA helps countless individuals live healthier,
    more productive lives. In this day and age, rapid advances in research
    and technology promise unparalleled change in the Nation's health care
    delivery system. HRSA could be well positioned to meet these new
    challenges as it continues to provide for the Nation's most vulnerable
    citizens. In order to respond to these challenges, AWHONN asserts that
    HRSA will require an overall funding level of at least $7.5 billion for
    fiscal year 2007.
         title viii--nursing workforce development programs under hrsa
    AWHONN recommends a minimum of $175 million in funding for Title VIII
        Nursing workforce development programs are authorized under Title
    VIII of the Public Health Service Act. These programs are essential
    components of the American health care safety net, which brings
    critical services to our entire Nation. In addition, Title VIII
    programs are the only comprehensive Federal programs that provide
    annual funds for nursing education that help nursing schools and
    nursing students prepare to meet patient needs in a changing healthcare
    delivery system. These programs are also in institutions that train
    nurses for practice in medically underserved communities and Health
    Professional Shortage Areas. While the President's budget recommends
    level funding of Title VIII at $150 million for fiscal year 2007,
    AWHONN supports a minimum of $175 million in funding for Title VIII
    Nursing Workforce Development programs.
        In 2002, Congress enacted the Nurse Reinvestment Act that provides
    funding for new and expanded programs such as scholarship and repayment
    programs like the Nurse Education Loan Repayment Program (NELRP),
    career ladders, internships and residencies, retention programs, and
    faculty loans designed to encourage students to consider nursing, keep
    nurses in the field, and ensure that nurse educators are plentiful
    enough to educate future nurses that we desperately need. These new
    programs received an initial appropriation of $20 million in fiscal
    year 2003, which was in addition to $93 million in funding provided for
    existing Title VIII programming. Unfortunately, due to limited funding
    in the first 2 years of the new authorization, the loan and scholarship
    programs have not been as successful as they could be in providing
    support to students in nursing schools. For example, NELRP is a
    competitive program that repays 60 percent of the qualifying loan
    balance of registered nurses selected for funding in exchange for 2
    years of service at a critical shortage facility. In fiscal year 2005,
    HRSA made a total of 599 awards of this nature with an obligation of
    $19 million. These loans are imperative for continuing to bring nurses
    into underserved communities in addition to bringing nurses through
    their education and training years.
        Nurses are essential health care providers, and the nursing
    community seeks the support of this subcommittee for bolstering
    existing nursing programs and creating new ones for recruiting students
    into the nursing profession. In addition, AWHONN seeks development of
    qualified faculty members for educating new nurses, and we need to
    create career opportunities for retaining nurses as faculty. The entire
    nursing workforce needs strengthening. As a result, it will take long-
    term planning and innovative initiatives at the local, State, and
    Federal level to assure an adequate supply of a qualified nurse
    workforce for the Nation. Federal investment in nursing education and
    retention programs is critical for meeting the health care needs of our
    Nation.
                Increased funding for Title VIII will make a positive
                        impact on the nursing shortage
        Recent data from the Bureau of Health Professions, Division of
    Nursing's National Sample Survey of Registered Nurses--February 2002,
    confirm that of the approximately 2.9 million registered nurses in the
    Nation only 82 percent of these nurses work full-time or part-time in
    nursing. A dominant factor in this shortage is the impending retirement
    of up to 40 percent of the workforce by 2010. This surge in retirement
    will occur at the same time as the surging baby boomer population
    retires, which will noticeably cause an increase in demand for health
    care services and the services of registered nurses. In addition, the
    U.S. Bureau of Labor and Statistics detailed in February 2004 that
    registered nurses will have the largest projected 10-year job growth in
    the United States, with about 1 million new job openings by 2010.
        The shortage of registered nurses and the effect of this shortage
    on staffing levels, patient safety and quality care demands attention
    and a significant increase in funding to bolster and improve these
    programs. Nursing is the largest health profession, yet only one-fifth
    of one percent of Federal health funding is directed to nursing
    education. A significant increase in funding for these programs can
    help lay the groundwork for expanding the nursing workforce, through
    education and clinical training and retention programs.
                Increased funding for Title VIII will help fill the nursing
                        gap
        The nursing shortage is not confined solely to care providers, and
    this demand for providers is hindered by the growing shortage of
    nursing faculties. Nursing faculty continues to decrease in number.
    According to a 2005 survey on faculty vacancies from the American
    Association College of Nursing, the number of full-time nursing faculty
    required to ``fill the nursing gap'' is approximately 40,000.
    Currently, there are less than 20,000 full-time nursing faculty in the
    system. In 2004, nursing schools turned away more than 32,000 qualified
    applicants to entry-level baccalaureate and graduate nursing programs
    due to insufficient faculty, clinical sites, classroom space, clinical
    preceptors, and budget constraints, including almost 3,000 students who
    could potentially fill faculty roles. When all nursing programs are
    considered, the number turned away during the 2003-2004 academic year
    grows to more than 125,000 qualified applicants. Without sufficient
    support for current nursing faculty and adequate incentives to
    encourage more nurses to become faculty, nursing schools will fail to
    have the teaching infrastructure necessary to educate and train our
    next generation of nurses that we so desperately need.
        While the capacity to implement faculty development is currently
    available through Section 811 and Section 831, adequate funding and
    direction is needed to ensure that these programs are fully
    operational. Options to provide support for full-time doctoral study
    are essential to rapidly prepare the nurse educators of the future.
    AWHONN recommends that a portion of the funds be allocated for faculty
    development and mentoring.
                Increase funding for Title VIII will encourage advance
                        practice nursing.
        AWHONN recognizes the importance of the investment in advanced
    practice nursing programs. As in other professions, the advanced degree
    has become a necessary achievement for career advancement, and
    registered nurses who pursue the MSN degree are part of the cadre of
    nurses who go on to become faculty. Our Nation needs more nurses with
    basic training to enter the field, but focusing only on these nurses
    addresses only half the problem. The nursing shortage encompasses
    nursing faculty; both advanced practice nursing and basic nursing must
    receive additional funding but not one at the expense of the other.
          title v--maternal and child health bureau (mchb) under hrsa
    AWHONN recommends $850 million in funding for MCHB
        The Maternal and Child Health Bureau incorporates valuable programs
    like the Traumatic Brain Injury program, Universal Newborn Hearing
    Screening, Emergency Medical Services for Children and Healthy Start,
    which were zeroed out, and the Maternal and Child Health Block Grant
    (MCH) that was level funded. These programs provide comprehensive,
    preventive care for mothers and young children, as well as an array of
    coordinated services for children with special needs. In fact, MCH
    serves over 80 percent of all infants in the United States, half of all
    pregnant women, and 20 percent of all children.
                Restore Funding to the Universal Newborn Hearing Screening
        The Children's Health Act of 2000 authorized funding for grants and
    programs to improve State-based newborn screening. Newborn screening is
    a public health activity used for early identification of infants
    affected by certain genetic, metabolic, hormonal or functional
    conditions for which there are effective treatment or intervention.
    Screening detects disorders in newborns that, left untreated, can cause
    death, disability, mental retardation and other serious illnesses.
        Screening programs coordinated through MCHB help to ensure that
    every baby born in the United States receives, at a minimum, a
    universal core group of screening tests regardless of the State in
    which he or she is born. However, the administration again proposes
    eliminating universal newborn screening programs. It goes without
    saying that more disorders will go unnoticed if the affected newborns
    are not screened. AWHONN encourages the subcommittee to restore funding
    to the fiscal year 2006 level plus inflation for the newborn hearing
    screening program.
                      national institutes of health (nih)
    AWHONN recommends $29.75 billion in funding for the NIH
        Multiple institutes housed under the National Institutes of Health
    (NIH) serve valuable roles in helping promote the importance of nursing
    in the health care industry along with the health and well-being of
    women and newborns. While AWHONN applauds the doubling of NIH's budget
    over the years, the President's Budget signals a level funding of NIH
    programs for fiscal year 2007. By allowing level funding, America will
    most certainly loose its edge in biomedical research.
            national institute of nursing research (ninr) under nih
    AWHONN recommends $160 million in funding for NINR
        The National Institute of Nursing Research (NINR) engages in
    significant research affecting areas such as health disparities among
    ethnic groups, training opportunities for management of patient care
    and recovery, and telehealth interventions in rural/underserved
    populations. This research allows nurses to continually refine their
    practice and provide quality patient care.
        For example, NINR research is invaluable in contributing to
    improved health outcomes for women. Recent public awareness campaigns
    target differences in the manifestation of cardiovascular disease
    between men and women. The differing symptoms are the source of many
    missed diagnostic opportunities among women suffering from the disease,
    which is the primary killer of American women. Because of the emphasis
    on biomedical research in this country, there are few sources of funds
    for high-quality behavioral research for nursing other than NINR. It is
    critical that we increase funding in this area in an effort to optimize
    patient outcomes and decrease the need for extended hospitalization.
    While the President's budget recommended level funding for NINR at $137
    million, AWHONN requests $160 million for fiscal year 2007.
    national institute of child health and human development (nichd) under
                                      nih
    AWHONN recommends $1.328 billion in funding for NICHD
        The National Institute of Child Health and Human Development
    (NICHD) seeks to ensure that every baby is born healthy, that women
    suffer no adverse consequences from pregnancy, and that all children
    have the opportunity for a healthy and productive life unhampered by
    disease or disability. For example, with increased funding, NICHD could
    expand its use of the NICHD Maternal-Fetal Medicine Network to study
    ways to reduce the incidence of low birth weight. Prematurity/low birth
    weight is the second leading cause of infant mortality in the United
    States and the leading cause of death among African American infants.
    AWHONN, like many organizations directly involved in programs to
    improve the health of women and newborns, looks to NICHD to provide
    national initiatives, such as the Maternal-Fetal Medicine Network that
    assists with the care of pregnant women and babies.
     national institute of environmental health sciences (niehs) under nih
    AWHONN recommends $680 million for NIEHS
        Research conducted by the National Institute of Environmental
    Health Sciences (NIEHS) plays a critical role in what we know about the
    relationship between environmental exposures and the onset of diseases.
    Through the research sponsored by this Institute, we know that
    Parkinson's disease, breast cancer, birth defects, miscarriage, delayed
    or diminished cognitive function, infertility, asthma and many other
    diseases and ailments have confirmed environmental triggers. Our
    expanded knowledge, as a result, allows both policymakers and the
    general public to make important decisions about how to reduce toxin
    exposure and reduce the risk of disease and other negative health
    outcomes.
     indian health service (ihs) under the department of health and humans
                                 services (hhs)
    AWHONN recommends $5.54 billion in funding for IHS
        The Indian Health Service (IHS) is the principal Federal health
    care provider and health advocate for the American Indian and Alaska
    Native populations. The President's budget recognizes this importance
    by requesting an increase to the IHS budget of $124 million over the
    fiscal year 2006 level, bringing the total to $4 billion for fiscal
    year 2007. While AWHONN applauds this increase, we recommend further
    increased funding for IHS to fully achieve its goals.
        A recent study of Federal health care spending per capita found
    that the United States spends $3,803 per year per Federal prisoner,
    while spending about half that amount for a Native American: $1,914.
    Per capita health care spending for the U.S. general population is
    $5,065 per year. A significant increase in funding over fiscal year
    2006 spending levels is necessary for the Federal government to fulfill
    its responsibility to Indian Country and achieve its stated goals.
        While the nursing shortage continues nationwide, IHS has been
    disproportionately affected by the lack of RNs. IHS nurses are older,
    with an average age of 48, and nearly 80 percent of RNs are over the
    age of 40. Further, the average vacancy rate for RNs is 14 percent. IHS
    administers three interrelated scholarship programs designed to meet
    the health professional staffing needs of IHS and other health programs
    serving Indian people. These programs are severely under-funded.
    Targeted resources need to be invested in the IHS health professions
    programs in order to recruit and retain registered nurses in Indian
    Country.
           centers for disease control and prevention (cdc) under hhs
    AWHONN recommends $8.65 billion in funding for CDC
        The President's budget request funds the CDC at $8.2 billion for
    fiscal year 2007, a $179 million decrease over fiscal year 2006. It is
    critically important to increase funding for CDC. For example, CDC has
    been deeply involved in the prevention of birth defects through
    programs like the Folic Acid Education Campaign and the National Center
    on Birth Defects and Developmental Disabilities (NCBDDD) for over 30
    years. The public health impact of birth defects is tremendous. Of the
    four million babies born each year in the United States, approximately
    120,000 are born with a serious birth defect. CDC funds several
    programs critical to reducing the number of children born with birth
    defects, including funding to States for birth defects tracking
    systems. Due to lack of funds, in fiscal year 2005 CDC was only able to
    fund 15 States, which were down from 28 States in fiscal year 2004.
    Additional funding for these grants is needed to fund all of the States
    seeking CDC assistance for these critical surveillance programs.
        Overall, AWHONN urges the Subcommittee to at a minimum restore all
    cuts to programs from fiscal year 2006 and adjust for inflation.
    Funding the aforementioned agencies and their programs at this minimum
    level will at least allow them to effectively operate and achieve their
    stated mission. AWHONN thanks you for your time, and we greatly
    appreciate this opportunity submit testimony on these critical areas of
    funding.
                                     ______

     Prepared Statement of the Charles R. Drew University of Medicine and
                                    Science
                summary of recommendations for fiscal year 2007
      --Provide a 5 percent increase for fiscal year 2007 to the National
            Institutes of Health (NIH) and a proportional increase of 5
            percent to the individual institutes and centers, specifically,
            the National Cancer Institute (NCI), the National Center for
            Research Resources (NCRR), and the National Center on Minority
            Health and Health Disparities (NCMHD).
      --Continue to urge NCI to support the establishment of a
            collaborative minority health comprehensive research center at
            a historically minority institution in collaboration with the
            existing NCI Cancer Centers. Continue to urge NCRR and NCMHD to
            collaborate on the establishment of a minority health
            comprehensive research center.
      --Urge the Department of Health and Human Service, particularly the
            Office of Minority Health (OMH), to support a Health
            Professions Leadership Development and Support Program at
            Charles R. Drew University of Medicine and Science.
        Mr. Chairman and members of the subcommittee, thank you for the
    opportunity to present you with testimony. Charles R. Drew University
    of Medicine and Science is one of four predominantly minority medical
    schools in the country, and the only one located west of the
    Mississippi River. It is also one of the Hispanic serving institutions
    in California.
        Charles R. Drew University of Medicine and Science is located in
    the Watts-section of South Central Los Angeles, and has a mission of
    rendering quality medical education to underrepresented minority
    students, and, through its affiliation with the University of
    California Los Angeles (UCLA) at the co-located King-Drew Medical
    Center, Drew provides valuable health care services to the medically
    underserved community. Through innovative basic science, clinical, and
    health services research programs, Charles R. Drew University works to
    address the health and social issues that strike hardest and deepest
    among inner city and minority populations.
        The population of this medically underserved community is
    predominately African American and Hispanic. Many of these people would
    be without health care if not for the services provided by Charles R.
    Drew University of Medicine and Science. This record of service has led
    Charles R. Drew University (in partnership with UCLA School of
    Medicine) to be designated as a Health Resources and Services
    Administration Minority Center of Excellence.
                   research: a response to health disparities
        Racial and ethnic disparities in health outcomes for a multitude of
    major diseases in minority and underserved communities continue to
    plague this Nation that was built on a premise of equality. As
    articulated in the Institute of Medicine report entitled ``Unequal
    Treatment: Confronting Racial and Ethnic Disparities in Health Care'',
    this problem is not getting better on its own. For example, African
    American males develop cancer 15 percent more frequently than white
    males. Similarly, African American women are not as likely as white
    women to develop breast cancer, but are much more likely to die from
    the disease once it is detected. In fact, according to the American
    Cancer Society, those who are poor, lack health insurance, or otherwise
    have inadequate access to high-quality cancer care, typically
    experience high cancer incidence and mortality rates. Despite these
    devastating statistics, we still do not have the resources to try to
    combat cancer in our communities.
        In response to these findings and the high cancer rate in our own
    community, Charles R. Drew University of Medicine and Science has been
    working to build a Life Sciences Research Facility on its campus. The
    Center would specialize in providing not only medical treatment
    services for the community, but would also serve as a research
    facility, focusing on prevention and the development of new strategies
    in the fight against cancer. These strategies will be disseminated
    locally and nationally to communities at risk, as well as to others
    engaged in comprehensive cancer prevention programs.
        The Life Sciences Research Building will provide the additional
    laboratory and support space necessary for further progress and
    development of innovative research in the clinical, biological, and
    life sciences. The new, three story building will provide Drew with
    state-of-the-art, flexible, modern biomedical and bio-behavioral
    research space. The proposed structure will provide 40,000 gross square
    feet, which is a significant increase over existing facilities at the
    University. Current research activities will be enhanced by additional
    laboratory and support space. The facility will house the Life Sciences
    Institute, building upon Drew's demonstrated strengths in clinical
    research, health services research, and basic science research. The
    Life Sciences Research Building will allow researchers in the College
    of Medicine and in the College of Allied Health to capitalize on the
    explosion of knowledge in genetics and biology, epidemiology, and
    health care delivery while exploring the interface between health,
    social, and economic infrastructure, cultural attitudes, and
    legislative policy. The Institute will play a unifying role for the
    life sciences across the University by bringing researchers from a wide
    array of disciplines together under one roof to collaborate in forward-
    looking research aimed at improving the health and quality of life of
    medically underserved and low-income communities.
        Mr. Chairman, the support that this subcommittee has given to the
    National Institutes of Health (NIH) and its various institutes and
    centers has and continues to be invaluable to our university and our
    community. The dream of a state-of-the-art facility to aid in the fight
    against cancer and other diseases in our underserved community would be
    impossible without the resources of NIH.
        To help facilitate the establishment of the Life Sciences Research
    Building at Charles R. Drew University of Medicine and Science, the
    University is seeking support from the National Institutes of Health's
    National Center for Research Resources (NCRR), the National Center for
    Minority Health and Health Disparities (NCMHD), and the National Cancer
    Institute (NCI).
         health professions leadership development and support program
        A Health Professions Leadership Development & Support Program is
    designed to: (1) enhance faculty recruitment and retention support for
    academicians providing for the supervision, instruction, and guidance
    of resident physicians-in-training in underserved communities; and (2)
    provide financial stability for the Office of Graduate Medical
    Education (GME) to ensure the sustainability of this national priority
    area.
        This is a critical program for improving the minority pipeline as
    outlined in the recent report by a committee chaired by former
    Secretary of DHHS, Dr. Louis Sullivan titled ``Missing Persons:
    Minorities in the Health Professions September 20, 2004''. This report
    highlights the critical role played by institutions such as Drew
    University as a major training site for minority health care
    professionals and biomedical scientists. Specifically, this program
    will help to support the Drew University Graduate Medical Education
    program.
        The Program will be used by the University to augment and/or
    recruit physician leaders in Family Medicine, Pediatrics, Psychiatry,
    Surgery, Internal Medicine, and Obstetrics/Gynecology in response to
    the need to develop external, non-County residency rotations. The
    Surgery residency program was not renewed as of 2005, however, the
    University plans to reapply for a new program as part of its faculty
    recruitment plans. These actions coincide with the affiliated medical
    center's anticipated efforts to secure institutional approval from the
    Centers for Medicare and Medicaid Services (CMS) as well as the Joint
    Commission on the Accreditation of Healthcare Organizations (JCAHO).
                                   conclusion
        Despite our knowledge about racial/ethnic, socio-cultural and
    gender-based disparities in health outcomes, the ``gap'' continues to
    widen in most instances. Not only are minority and underserved
    communities burdened by higher disease rates, they are less likely to
    have access to quality care upon diagnosis. As you are aware, in many
    minority and underserved communities preventive care and/or research is
    completely inaccessible either due to distance or lack of facilities
    and expertise. This is a critical loss of untapped potential in both
    physical and intellectual contributions to the entire society.
        Even though institutions like Charles R. Drew are ideally situated
    (by location, population, and institutional commitment) for the study
    of conditions in which health disparities have been well documented,
    research is limited by the paucity of appropriate research facilities.
    With your help, the Life Sciences Research Facility will facilitate
    translation of insights gained through research into greater
    understanding of disparities.
        We look forward to working with you to lessen the burden of health
    disparities and working with the Department of Health and Human
    Services to address the residency training program issues at Charles R.
    Drew University.
        Mr. Chairman, thank you for the opportunity to present testimony on
    behalf of Charles R. Drew University of Medicine and Science.
                                     ______

              Prepared Statement of the Cooley's Anemia Foundation
                                    subject
        Mr. Somma's testimony thanks the subcommittee for the past support
    it has shown to the Cooley's Anemia Foundation and to the patients who
    are afflicted with this fatal genetic blood disease, also known as
    thalassemia. He urges the Committee to restore the funding cut in the
    President's budget from the Thalassemia Blood Safety Surveillance
    program at CDC. He discusses the importance of funding NIH research
    into this disease, particularly through NHLBI and NIDDK. He challenges
    the subcommittee to challenge the NIH to find the cure for thalassemia
    and, with it, for other similar diseases through a strong commitment to
    gene therapy. He urges continued support for the Thalassemia Clinical
    Research Network.
        Mr. Chairman and Members of the Subcommittee: Thank you for the
    opportunity to present this testimony to the subcommittee today. My
    name is Frank Somma. I live in Holmdel, New Jersey and I am honored to
    serve as the National President of the Cooley's Anemia Foundation. I
    speak to you in my capacity as a volunteer. As many members of this
    subcommittee know, Cooley's anemia, or thalassemia, is a fatal genetic
    blood disease.
        I could bog you down in a detailed scientific explanation of what
    happens physiologically when the human body cannot produce red blood
    cells in adequate numbers and of adequate quality to sustain life. I am
    not going to do that. The important thing for members of this
    subcommittee to remember about Cooley's anemia is that it is an
    incurable and fatal genetic blood disease. Period.
        I also understand that I can present you with five pages of single-
    spaced testimony. I am not going to do that either. Instead, I am
    respectfully going to address the following three issues in a clear and
    succinct manner.
      --The first is the immediate need to restore $2.0 million to the CDC
            to fund the thalassemia blood safety surveillance network.
      --The second issue is the equally critical need for this subcommittee
            to commit our government to the development of a focused gene
            therapy program that is designed to cure something.
      --The third issue is the urgent need to restore funding to NIH to
            assure the continuation of desperately needed research at NIDDK
            and for the Thalassemia Clinical Research Network at NHLBI.
    Blood Safety Surveillance
        Mr. Chairman, when a baby is diagnosed with Cooley's anemia, or
    thalassemia major, the standard of treatment is to begin that child on
    blood transfusions. I want to be very clear here that the treatment is
    not to give the child a blood transfusion; it is to begin a lifetime
    treatment regimen of such invasive and dangerous intervention. Our
    patients receive a blood transfusion every two weeks for the rest of
    their lives.
        Because Cooley's anemia patients are transfused so regularly, they
    are the early warning system for problems in the blood supply. If there
    is an emerging infection or other problem with the blood supply, it is
    our patients that will get it first.
        Please understand that nearly every patient over the age of 18
    today who has thalassemia major also has HIV or hepatitis C as a result
    of their transfusions--or did have it while they were still alive.
        Blood safety is a major national issue. Surgical and trauma
    patients often have no choice but to be transfused. And, it is done an
    emergency basis many times. Nothing is more important to the patient at
    the time of transfusion than that they can be confident that the blood
    being pumped into their veins is free from infectious agents.
        Utilizing the status of our patient population, the CDC has been
    monitoring the overall safety of the blood supply to this Nation and is
    prepared to issue an alert if a new virus or threat emerges. The blood
    safety surveillance program is currently operating very effectively
    through the Office of Hereditary Blood Diseases in the National Center
    for Birth Defects and Developmental Disability (NCBDDD) with about $2.0
    million in funding. Inexplicably, the President's budget eliminates the
    program, leaving the blood supply vulnerable to contamination by new
    viruses or mutated versions of old viruses, putting all Americans not
    just those with Cooley's Anemia at risk.
        We are respectfully requesting that the subcommittee restore this
    funding to the $2.0 million level that currently exists in order to
    continue to protect Americans from unnecessary infections and diseases
    that may occur in the blood supply.
    Gene Therapy
        Mr. Chairman, it has been a long time coming, but we are here to
    bring you some very good news about gene therapy. After a lot of false
    starts, we can now see a pathway for scientists to follow to help turn
    the promise of gene therapy into cures for single gene disorders. The
    problem to this point has not been one of science; it has been one of
    expectations. As a society, we forgot that science requires trial and
    error and that experiments are just that--experiments.
        Today, gene therapy is advancing at a rapid pace in the rest of the
    world. Exciting work is being undertaken in Japan and China, in the UK
    and in France. Unfortunately, it is showing less progress the United
    States of America . . . and that is not right. We are the international
    leaders in scientific research and, in a field like this--fraught with
    financial, scientific and ethical minefields--it is essential that
    America be the world leaders. We set the highest ethical and moral
    standards on every one of these issues. We protect human subjects best.
    It is simply too important to leave it to anyone else.
        For persons with a single cell mutation disorder like thalassemia
    or sickle cell disease or severe combined immune deficiency (SCID),
    gene therapy holds out great promise for a cure. In fact, the CAF has
    recently launched the CURE Campaign: Citizens United for Research
    Excellence. The theme of the campaign is ``It is Time to Cure
    Something.'' We are now learning so much about how to deliver healthy
    genes to unhealthy cells that we cannot turn back--nor can we as a
    Nation afford to let our friends in Europe and Asia race ahead of us in
    the areas of biomedical research and gene therapy.
        We hope that this Congress--speaking through this subcommittee--
    will do what we have done and dare the NIH and its grantees to ``cure
    something.'' You are investing nearly $29 billion of taxpayer money in
    this agency that houses the ``best and the brightest'' and that funds
    ``the best and the brightest.'' We as Americans must never stop
    striving to reach previously unimaginable heights. If that means that
    we have to shake up the status quo and create a new funding mechanism,
    let's do it. But let's not continue to follow the slow going
    incremental'' path of the past.
        We need to spend our tax dollars in a coordinated and focused
    manner that will maximize the chances that we will unlock the secrets
    of how to correct single gene defects. We are very close now, with an
    experiment currently being conducted--in France--that may be a
    breakthrough. It is time for the United States to step up and lead the
    world in this life-saving area of research.
    NIH and the Thalassemia Clinical Research Network
        Mr. Chairman, about 5 years ago, working closely with members of
    this subcommittee, the CAF convinced the NHLBI of the need to create a
    clinical research network that would allow the top researchers in the
    field to collaborate on desperately needed research projects using
    common protocols. Today, that network is up and running and is the
    focal point for thalassemia research, most of which takes place in
    academic medical centers throughout the country.
        However, there is a cloud hanging over this, and all other,
    research at NIH. As the Biomedical Research and Development Price Index
    continues to escalate, the buying power of a flat-funded NIH continues
    to decrease. There would be nothing wrong with this if we had cured
    thalassemia, and hemophilia, and cystic fibrosis, and all other genetic
    and non-genetic diseases. But that is not the case.
        There is an enormous amount of work to be done. And there is no one
    else to do it but our National Institutes of Health, with the support
    of our Congress and President.
        I urge the subcommittee to settle for nothing less than a 5 percent
    increase in funding for NIH so that the critical life saving research
    that is occurring there can continue. Some of our fellow citizens don't
    have another year to wait.
                                   conclusion
        As I indicated at the outset, Mr. Chairman, I am not interested in
    filling the air with words. Unfortunately, I don't have the luxury of
    time to do that. The Cooley's Anemia Foundation has three priorities
    this year:
      --Funding the blood safety surveillance program at CDC at $2.0
            million;
      --An enhanced focus on gene therapy designed to cure something; and,
      --A five percent increase in NIH funding to continue current vital
            research programs.
        Mr. Chairman, every night when I watch my beautiful, smart,
    talented 21 year old daughter Alicia put a needle under her skin to
    infuse a drug for 8-10 hours to remove the excess iron in her system
    from her bi-weekly blood transfusions, I know we can do better.
        Please excuse my passion, but this is the United States of America.
    I know we can prevent this disease from happening in newborns. I know
    we can improve the lives of those who currently have it. And, most
    importantly, I am absolutely certain we can cure it once and for all.
        You don't need five pages of testimony from me to do that. You just
    need to demand the very best from the very best--our scientists, our
    government, the patient advocacy community and ourselves.
        Thank you for your very kind attention and for all the support this
    committee has shown to our patients and their families over the years.
                                     ______

      Prepared Statement of the Crohn's and Colitis Foundation of America
                  summary of fiscal year 2007 recommendations
        (1) A 5 percent increase for the National Institute of Diabetes,
    and Digestive and Kidney Diseases, and the National Institute of
    Allergy and Infectious Diseases.
        (2) $700,000 for the National Inflammatory Bowel Disease
    Epidemiological Program at the Centers for Disease Control and
    Prevention.
        Mr. Chairman, thank you for the opportunity to submit testimony on
    behalf of the Crohn's and Colitis Foundation of America (CCFA). We
    greatly appreciate your leadership and the opportunity to work with you
    to improve the quality of life for our patients and families.
        My name is Kenneth Edmonds and I serve on the National Board of
    Trustees for the CCFA, the Nation's oldest and largest voluntary
    organization dedicated to finding a cure for and to seeking to prevent
    Crohn's disease and ulcerative colitis.
        Through research, education and support, CCFA is committed to
    improving the quality of life of children and adults affected by these
    diseases, collectively known as inflammatory bowel disease (IBD). I am
    one of them.
        IBD is a chronic disorder that causes inflammation of the digestive
    tract. It affects approximately 1.4 million Americans, 30 percent of
    whom are diagnosed in their childhood. IBD can cause persistent
    diarrhea, severe abdominal pain, fever, and, at times, rectal bleeding.
    If complications develop, it also can lead to, among other conditions,
    anemia, liver disease and colorectal cancer.
        Indeed, inflammatory bowel disease can be painful and debilitating.
    And, its impact is perhaps most devastating for children and
    adolescents, whose diagnoses often make them stand out at a time when
    they most want to fit in. Their disease can make them not only feel
    different, but look different as some adolescents with IBD may have
    delays in physical growth and puberty, causing them to appear younger
    and smaller than their peers. But, at any age, being diagnosed with IBD
    can bring change and challenge.
        The news of my diagnosis came not in one, sudden rush, but rather
    in a long, gradual backslide--and into a hospital bed. In retrospect, I
    exhibited typical signs of IBD as early as 1993 while a student in
    college. But, unfortunately, I responded to those signals like too many
    adolescents and young adults--I overlooked them.
        At the time, I experienced acute abdominal pain so sharp and sudden
    that I would double over. These cramps often came without warning,
    creating an intense urge to use the nearest bathroom. On these
    occasions and others, my stools had traces of blood.
        But, because I was young and active, I didn't think that much about
    it. And, I certainly didn't talk about it, to anyone. I chalked these
    brief episodes up to my regimen, rather than my abdomen. I figured that
    I just needed to add more greens to my diet and add more hours to my
    sleep.
        But, by 1996, after moving to Chicago, my symptoms had become too
    persistent, too serious and too severe to ignore. By the summer of that
    year, I had developed sores or ulcers on my tongue, making it difficult
    and painful to eat. I lost appetite and lost weight.
        In addition to the persistent diarrhea and acute cramps, I also had
    developed a tear (a fissure) in the lining of my anus, which caused
    excruciating pain and bleeding during bowel movements. I also suffered
    from severe exhaustion.
        As you can imagine, this was an agonizing predicament: I was losing
    weight, but could not eat. I was fatigued, but could not sleep. I had
    frequent, sudden bowel movements, but they caused sharp, piercing pain.
    Indeed, I had deteriorated dramatically; my condition relegating me to
    somewhere between bedridden and bathroom-bound.
        A misdiagnosis, three, long, withering weeks, and a plane ride
    later, I found myself in the Washington Hospital Center under the care
    of my uncle, a gastroenterologist here in the District. After a series
    of tests, x-rays and examinations, I was diagnosed with Crohn's colitis
    and prescribed medications for my symptoms. Since my hospitalization 10
    years ago, I am pleased to report that the disease has been in
    remission and I have enjoyed relatively good health.
        But, Mr. Chairman, IBD is a life-long disease. While there are drug
    therapies to treat symptoms, there is no medical cure. And, its cause
    is unknown.
        That's why CCFA's work has been so critical and groundbreaking.
                      recommendations for fiscal year 2007
    (1) National Institutes of Health
        In fact, CCFA has developed incredibly successful research
    partnerships with the NIH, forging longstanding collaborations with the
    National Institute of Diabetes and Digestive and Kidney Diseases
    (NIDDK), which sponsors the majority of IBD research, and the National
    Institute of Allergy and Infectious Diseases (NIAID). CCFA provides
    crucial ``seed-funding'' to researchers, helping investigators gather
    preliminary findings, which in turn enables them to pursue advanced IBD
    research projects through the NIH. This approach led to the
    identification of the first gene associated with Crohn's--a landmark
    breakthrough in understanding this disease.
        Mr. Chairman, CCFA's scientific leaders, with significant
    involvement from NIDDK, have developed an ambitious research agenda,
    titled ``Challenges in Inflammatory Bowel Disease'' that outlines and
    seeks to address the many opportunities that currently exist.
    Fortunately, the field of IBD is widely viewed within the scientific
    community as one of tremendous potential. To help capitalize on these
    opportunities, CCFA recommends that the subcommittee provide a 5
    percent increase in funding for NIDDK and NIAID in fiscal year 2007.
    Moreover, CCFA requests that the subcommittee encourage these two
    institutes to expand their IBD research portfolios at a similar rate.
    (2) Centers for Disease Control and Prevention
                IBD Epidemiology Program
        Mr. Chairman, CCFA estimates that 1.4 million people in the United
    States suffer from IBD, but there could be many more. We do not have an
    exact number due to these diseases' complexity and the difficulty in
    identifying them.
        We are extremely grateful for your leadership in providing funding
    over the past 2 years for an epidemiology program on IBD at the Centers
    for Disease Control and Prevention. This program is yielding valuable
    information about the prevalence of IBD in the United States and
    increasing our knowledge of the demographic characteristics of the IBD
    patient population. If we are able to generate an accurate analysis of
    the geographic makeup of the IBD patient population, it will provide us
    with invaluable clues about the potential causes of IBD.
        Unfortunately Mr. Chairman, the President has eliminated funding
    for this important program in his fiscal year 2007 budget for the CDC.
    CCFA encourages the subcommittee to restore support for the IBD
    Epidemiology Program at last year's level of $700,000.
        Once again Mr. Chairman, thank you for the opportunity to submit
    written testimony
                                     ______

         Prepared Statement of the Digestive Disease National Coalition
                  summary of fiscal year 2007 recommendations
      --Provide increased funding for the National Institutes of Health
            (NIH) at an increase of 5 percent over fiscal year 2006.
            Increase funding for the National Cancer Institute (NCI), the
            National Institute of Diabetes and Digestive and Kidney
            Diseases (NIDDK) and the National Institute of Allergy and
            Infectious Diseases (NIAID) by 5 percent.
      --Continue focus on digestive disease research and education at NIH,
            including the areas of Inflammatory Bowel Disease (IBD),
            Hepatitis and other liver diseases, Irritable Bowel Syndrome
            (IBS), Colorectal Cancer, Endoscopic Research, Pancreatic
            Cancer, Celiac Disease, and Hemochromatosis.
      --$30 million for the Centers for Disease Control and Prevention's
            (CDC) Hepatitis Prevention and Control activities.
      --$25 million for the Center for Disease Control and Prevention's
            (CDC) Colorectal Cancer Screening and Prevention Program.
        Chairman Specter, thank you for the opportunity to again submit
    testimony to the subcommittee. Founded in 1978, the Digestive Disease
    National Coalition (DDNC) is a voluntary health organization comprised
    of 23 professional societies and patient organizations concerned with
    the many diseases of the digestive tract. The Coalition has as its goal
    a desire to improve the health and the quality of life of the millions
    of Americans suffering from both acute and chronic digestive diseases.
        The DDNC promotes a strong Federal investment in digestive disease
    research, patient care, disease prevention, and public awareness. The
    DDNC is a broad coalition of groups representing disorders such as
    Inflammatory Bowel Disease (IBD), Hepatitis and other liver diseases,
    Irritable Bowel Syndrome (IBS), Pancreatic Cancer, Ulcers, Pediatric
    and Adult Gastroesophageal Reflux Disease, Colorectal Cancer, Celiac
    Disease, and Hemochromatosis.
        Mr. Chairman, the social and economic impact of digestive disease
    is enormous and difficult to grasp. Digestive disorders afflict
    approximately 65 million Americans. This results in 50 million visits
    to physicians, over 10 million hospitalizations, collectively 230
    million days of restricted activity. The total cost associated with
    digestive diseases has been conservatively estimated at $60 billion a
    year.
        The DDNC would like to thank the subcommittee for its past support
    of digestive disease research and prevention programs at the National
    Institutes of Health (NIH) and the Centers for Disease Control and
    Prevention (CDC). With respect to the coming fiscal year, the DDNC is
    recommending an increase of 5 percent to $30.1 billion for the National
    Institutes of Health (NIH) and all of its Institutes.
    Specifically the DDNC recommends
      --$5.35 billion for the National Cancer Institute (NCI).
      --$2 billion for the National Institute of Diabetes and Digestive and
            Kidney Disease (NIDDK).
      --$4.89 billion for the National Institute of Allergy and Infectious
            Diseases (NIAID).
        We at the DDNC respectfully request that any increase for NIH does
    not come at the expense of other Public Health Service agencies.
        With the competing and the challenging budgetary constraints the
    subcommittee currently operates under, the DDNC would like to highlight
    the research being accomplished by NIDDK which warrants the increase
    for NIH.
                           inflammatory bowel disease
        In the United States today about 1 million people suffer from
    Crohn's disease and ulcerative colitis, collectively known as
    Inflammatory Bowel Disease (IBD). These are serious diseases that
    affect the gastrointestinal tract causing bleeding, diarrhea, abdominal
    pain, and fever. Complications arising from IBD can include anemia,
    ulcers of the skin, eye disease, colon cancer, liver disease,
    arthritis, and osteoporosis. Crohn's disease and ulcerative colitis are
    not usually fatal but can be devastating. The cause of IBD is still
    unknown, but research has led to great breakthroughs in therapy.
        In recent years researchers have made significant progress in the
    fight against IBD. In 1998, the FDA approved the first drug ever
    specifically to fight Crohn's disease, a remarkable milestone. The DDNC
    encourages the subcommittee to continue its support of IBD research at
    NIDDK and NIAID at a level commensurate with the overall increase for
    each institute. The DDNC would like to applaud the NIDDK for its strong
    commitment to IBD research through the Inflammatory Bowel Disease
    Genetics Research Consortium. The DDNC urges the Consortium to continue
    its work in IBD research. Given the recent advancements in treatment
    for these diseases and the increased risk that IBD patients have for
    developing colorectal cancer, the DDNC strongly believes that
    generating improved epidemiological information on the IBD population
    is essential if we are to provide patients with the best possible care.
    Therefore the DDNC and its member organization the Crohn's and Colitis
    Foundation of America encourage the CDC to initiate a nationwide IBD
    surveillance and epidemiological program in fiscal year 2007.
                    hepatitis c: a looming threat to health
        It is estimated that there are over 4 million Americans who have
    been infected with Hepatitis C of which over 2.7 million remain
    chronically infected. About 10,000 die each year and the Centers for
    Disease Control and Prevention (CDC) estimates that the death rate will
    more than triple by 2010 unless there is additional research,
    education, and more effective treatments and public health
    interventions. Hepatitis C infection is the largest single cause for
    liver transplantation and one of the principal causes of liver cancer
    and cirrhosis. There is currently no vaccine for hepatitis C, and
    treatment has limited success, making the infection among the most
    costly diseases in terms of health care costs, lost wages, and reduced
    productivity. Patients who are older at the time of infection, those
    who continually ingest alcohol, and those co-infected with HIV
    demonstrate accelerated progression to more advanced liver disease.
        The DDNC applauds all the work NIH and CDC have accomplished over
    the past year in the areas of hepatitis and liver disease. The DDNC
    urges that funding be focused on expanding the capability of State
    health departments, particularly to enhance resources available to the
    hepatitis C State coordinators. The DDNC also urges that CDC increase
    the number of cooperative agreements with coalition partners to develop
    and distribute health education, communication, and training materials
    about prevention, diagnosis and medical management for hepatitis A, B,
    and C.
        The DDNC supports $30 million for the CDC's Hepatitis Prevention
    and Control activities. The hepatitis division at CDC supports the
    hepatitis C prevention strategy and other cooperative nationwide
    activities aimed at prevention and awareness of hepatitis A, B, and C.
    The DDNC also urges the CDC's leadership and support for the National
    Viral Hepatitis Roundtable to establish a comprehensive approach among
    all stakeholders for viral hepatitis prevention, education, strategic
    coordination, and advocacy.
                          colorectal cancer prevention
        Colorectal cancer is the third most commonly diagnosed cancer for
    both men and woman in the United States and the second leading cause of
    cancer-related deaths. Colorectal cancer affects men and women equally.
    According to the American Cancer Society, this year alone about 135,400
    individuals will be diagnosed with colorectal cancer, and of those
    diagnosed 56,700 patients will die. Although colorectal cancer is
    preventable and curable when polyps are detected early, a General
    Accounting Office report issued in March 2000 documented that less than
    10 percent of Medicare beneficiaries have been screened for colorectal
    cancer. This report revealed a tremendous need to inform the public
    about the availability of screening and educate health care providers
    about colorectal cancer screening guidelines. In 2003, the New York
    City Department of Health has recommended colonoscopy for everyone over
    age 50 to prevent colorectal cancer.
        The DDNC recommends a funding level of $25 million for the CDC's
    Colorectal Cancer Screening and Prevention Program. This important
    program supports enhanced colorectal screening and public awareness
    activities throughout the United States. The DDNC also supports the
    continued development of the CDC-supported National Colorectal Cancer
    Roundtable, which provides a forum among organizations concerned with
    colorectal cancer to develop and implement consistent prevention,
    screening, and awareness strategies.
                               pancreatic cancer
        In 2006, an estimated 33,730 people in the United States will be
    found to have pancreatic cancer and approximately 32,300 will die from
    the disease. Pancreatic cancer is the fifth leading cause of cancer
    death in men and women. Only 1 out of 4 patients will live 1 year after
    the cancer is found and only 1 out of 25 will survive 5 or more years.
    Although we do not know exactly what causes pancreatic cancer, several
    risk factors linked to the disease have been identified:
        (1) Age: Most people are over 60 years old when the cancer is
    found;
        (2) Sex: Men have pancreatic cancer more often than women;
        (3) Race: African Americans are more likely to develop pancreatic
    cancer than are white or Asian Americans;
        (4) Smoking;
        (5) Diet: Increased red meats and fats; and
        (6) Diabetes.
        The National Cancer Institute (NCI) has established a Pancreatic
    Cancer Progress Review Group charged with developing a detailed
    research agenda for the disease. The DDNC encourages the subcommittee
    to provide an increase for pancreatic cancer research at a level
    commensurate with the overall percentage increase for NCI and NIDDK.
                         irritable bowel syndrome (ibs)
        IBS is a disorder that affects an estimated 35 million Americans.
    The medical community has been slow in recognizing IBS as a legitimate
    disease and the burden of illness associated with it. Patients often
    see several doctors before they are given an accurate diagnosis. Once a
    diagnosis of IBS is made, medical treatment is limited because the
    medical community still does not understand the pathophysiology of the
    underlying conditions.
        Living with IBS is a challenge, patients face a life of learning to
    manage a chronic illness that is accompanied by pain and unrelenting
    gastrointestinal symptoms. Trying to learn how to manage the symptoms
    is not easy. There is a loss of spontaneity when symptoms may intrude
    at any time. IBS is an unpredictable disease. A patient can wake up in
    the morning feeling fine and within a short time encounter abdominal
    cramping to the point of being doubled over in pain and unable to
    function.
        The unpredictable bowel symptoms may make it next to impossible to
    leave your home. It is difficult to ease the pain that may repeatedly
    occur periodically throughout the day. A patient can become reluctant
    to eat for fear that just eating a meal will trigger symptoms all over
    again. IBS has a broad and significant impact on a person's quality of
    life. It strikes individuals from all walks of life and results in a
    significant toll of human suffering and disability.
        While there is much we don' understand about the causes and
    treatment of IBS, we do know that IBS is a chronic complex of systems
    affecting as many as one in five adults. In addition:
        (1) It is reported more by women than men;
        (2) It is the most common gastrointestinal diagnosis among
    gastroenterology practices in the United States;
        (3) It is a leading cause of worker absenteeism in the United
    States; and
        (4) It costs the U.S. Health Care System an estimated $8 billion
    annually.
        Mr. Chairman, much more can still be done to address the needs of
    the nearly 35 million Americans suffering from irritable bowel syndrome
    and other functional gastrointestinal disorders. The DDNC recommends
    that NIDDK increase its research portfolio on Functional
    Gastrointestinal Disorders and Motility Disorders.
                                 gastroparesis
        Gastroparesis, or paralysis of the stomach, refers to a stomach
    that empties slowly. Gastroparesis is characterized by symptoms from
    the delayed emptying of food, namely: bloating, nausea, vomiting or
    feeling full after eating only a small amount of food. Gastroparesis
    can occur as a result of several conditions; it can occur in up to 30
    percent to 50 percent of patients with diabetes mellitus. A person with
    diabetic gastroparesis may have episodes of high and low blood sugar
    levels due to the unpredictable emptying of food from the stomach,
    leading to diabetic complications. Other causes of gastroparesis
    include Parkinson's disease and some medications, especially narcotic
    pain medications. In many patients a cause of the gastroparesis cannot
    be found and the disorder is termed idiopathic gastroparesis. Over the
    last several years, as more is being found out about gastroparesis, it
    has become clear this condition affects many people and the condition
    can cause a wide range of symptoms of differing severity.
                                 celiac disease
        Celiac Disease is a life-long condition in which the body develops
    an allergy to gluten, a protein found in wheat, barley, and rye, which
    can result in damage to the small intestine. Celiac disease affects as
    many as 2 million Americans. Onset of the disease can occur at any age.
    The common symptoms of Celiac Disease include fatigue, anemia, chronic
    diarrhea or constipation, weight loss, and bone pain. The only
    treatment for celiac disease is strict adherence to a gluten-free diet.
    Undiagnosed and untreated celiac disease can lead to other disorders
    such as osteoporosis, infertility, neurological conditions, and in rare
    cases cancer. Persons with Celiac Disease often have other associated
    autoimmune disorders as well.
                          digestive disease commission
        In 1976, Congress enacted Public Law 94-562, which created a
    National Commission on Digestive Diseases. The Commission was charged
    with assessing the State of digestive diseases in the United States,
    identifying areas in which improvement in the management of digestive
    diseases can be accomplished and to create a long-range plan to
    recommend resources to effectively deal with such diseases. The
    Commission's subsequent report in 1979 laid the groundwork for
    significant progress in the area of digestive disease research. After
    almost 25 years, however, the burden of digestive diseases among the
    U.S. population remains substantial.
        The DDNC recognizes the creation of the National Commission on
    Digestive Diseases, and looks forward to working with the National
    Commission to address the numerous digestive disorders that remain in
    today's diverse population.
                                   conclusion
        The DDNC understands the challenging budgetary constraints and
    times we live in that this subcommittee is operating under, yet we hope
    you will carefully consider the tremendous benefits to be gained by
    supporting a strong research and education program at NIH and CDC.
    Millions of Americans are pinning their hopes for a better life, or
    even life itself, on digestive disease research conducted through the
    National Institutes of Health.
        Mr. Chairman, on behalf of the millions of digestive disease
    sufferers, we appreciate your consideration of the views of the
    Digestive Disease National Coalition. We look forward to working with
    you and your staff.
                      digestive disease national coalition
        The Digestive Disease National Coalition was founded 25 years ago.
    Since its inception, the goals of the coalition have remained the same:
    to work cooperatively to improve access to and the quality of digestive
    disease health care in order to promote the best possible medical
    outcome and quality of life for current and future patients with
    digestive diseases.
                                     ______

               Prepared Statement of the Doris Day Animal League
        The Doris Day Animal League represents 350,000 members and
    supporters nationwide who support a strong commitment by the Federal
    Government to research, development, standardization, validation and
    acceptance of non-animal and other alternative test methods. We are
    also submitting our testimony on behalf of the Humane Society of the
    United States and The Procter & Gamble Company. Thank you for the
    opportunity to present testimony relevant for the fiscal year 2007
    budget request for the National Institute of Environmental Health
    Sciences (NIEHS) for the fiscal year 2007 activities of the National
    Toxicology Program Center for the Evaluation of Alternative
    Toxicological Test Methods (NICEATM), the support center for the
    Interagency Coordinating Committee for the Validation of Alternative
    Test Methods (ICCVAM).
        In 2000, the passage of the ICCVAM Authorization Act into Public
    Law 106-545, created a new paradigm for the field of toxicology. It
    requires Federal regulatory agencies to ensure that new and revised
    animal and alternative test methods be scientifically validated prior
    to recommending or requiring use by industry. An internationally agreed
    upon definition of validation is supported by the 15 Federal regulatory
    and research agencies that compose the ICCVAM, including the EPA. The
    definition is: ``the process by which the reliability and relevance of
    a procedure are established for a specific use.''
                             function of the iccvam
        The ICCVAM performs an invaluable function for regulatory agencies,
    industry, public health and animal protection organizations by
    assessing the validation of new, revised and alternative toxicological
    test methods that have interagency application. After appropriate
    independent peer review of the test method, the ICCVAM recommends the
    test to the Federal regulatory agencies that regulate the particular
    endpoint the test measures. In turn, the Federal agencies maintain
    their authority to incorporate the validated test methods as
    appropriate for the agencies' regulatory mandates. This streamlined
    approach to assessment of validation of new, revised and alternative
    test methods has reduced the regulator burden of individual agencies,
    provided a ``one-stop shop'' for industry, animal protection, public
    health and environmental advocates for consideration of methods and set
    uniform criteria for what constitutes a validated test methods. In
    addition, from the perspective of animal protection advocates, ICCVAM
    can serve to appropriately assess test methods that can refine, reduce
    and replace the use of animals in toxicological testing. This function
    will provide credibility to the argument that scientifically validated
    alternative test methods, which refine, reduce or replace animals,
    should be expeditiously integrated into Federal toxicological
    regulations, requirements and recommendations.
                             history of the iccvam
        The ICCVAM is currently composed of representatives from the
    relevant Federal regulatory and research agencies. It was created from
    an initial mandate in the NIH Revitalization Act of 1993 for NIEHS to
    ``(a) establish criteria for the validation and regulatory acceptance
    of alternative testing methods, and (b) recommend a process through
    which scientifically validated alternative methods can be accepted for
    regulatory use.'' In 1994, NIEHS established the ad hoc ICCVAM to write
    a report that would recommend criteria and processes for validation and
    regulatory acceptance of toxicological testing methods that would be
    useful to Federal agencies and the scientific community. Through a
    series of public meetings, interested stakeholders and agency
    representatives from all 14 regulatory and research agencies, developed
    the NIH Publication No. 97-3981, ``Validation and Regulatory Acceptance
    of Toxicological Test Methods.'' This report, and subsequent revisions,
    has become the sound science guide for consideration of new, revised
    and alternative test methods by the Federal agencies and interested
    stakeholders.
        After publication of the report, the ad hoc ICCVAM moved to
    standing status under the NIEHS' NICEATM. Representatives from Federal
    regulatory and research agencies and their programs have continued to
    meet, with advice from the NICEATM's Advisory Committee and independent
    peer review committees, to assess the validation of new, revised and
    alternative toxicological methods. Since then, several methods have
    undergone rigorous assessment and are deemed scientifically valid and
    acceptable. In addition, the ICCVAM is working to streamline assessment
    of methods from the European Union (EU) that have already been
    validated for use within the EU. The open public comment process, input
    by interested stakeholders and the continued commitment by the Federal
    agencies has led to ICCVAM's success. It has resulted in a more
    coordinated review process for rigorous scientific assessment of the
    validation of new, revised and alternative test methods.
                           request for appropriations
        On December 19, 2000, the ``ICCVAM Authorization Act'' which makes
    the entity a permanent standing committee, was signed into Public Law
    No. 106-545. For several years, the NIEHS has provided financial
    resources to the NICEATM for ICCVAM's activities. In order to ensure
    that Federal regulatory agencies and their stakeholders benefit from
    the work of the ICCVAM, it is important for NIEHS to provide funding at
    an appropriate level. We respectfully request a fiscal year funding
    level of $4 million.
                     request for committee report language
        The NIEHS should support the NICEATM/ICCVAM in creating a five-year
    roadmap for assertively setting goals to prioritize ending the use of
    antiquated animal tests for specific endpoints. While the stream of
    methods forwarded to the ICCVAM for assessment has remained relatively
    steady, it is imperative that the ICCVAM take a more proactive role in
    isolating areas where new methods development is on the verge of
    replacing animal tests. These areas should form a collective call by
    the Federal agencies that compose ICCVAM to fund any necessary
    additional research, development, validation and validation assessment
    that is required to eliminate the animal methods. We also strongly urge
    the NICEATM/ICCVAM to closely coordinate research, development and
    validation efforts with its European counterpart, the European Centre
    for the Validation of Alternative Methods (ECVAM) to ensure the best
    use of available funds and sound science. This coordination should also
    reflect a willingness by the Federal agencies comprising ICCVAM to more
    readily accept validated test methods proposed by the ECVAM to ensure
    industry has a uniform approach to worldwide chemical safety
    evaluation.
        We also respectfully request the subcommittee consider the
    following report language for the Senate Labor, Health and Human
    Services, Education and Related Agencies Appropriations bill:
        ``The Committee commends the National Interagency Center for the
    Evaluation of Alternative Methods/Interagency Coordinating Committee on
    the Validation of Alternative Methods (NICEATM/ICCVAM) for its
    leadership role in the assessment of new, revised and alternative
    scientifically validated methods for the Federal government. The
    Committee also commends the National Toxicology Program (NTP) for
    finalizing its `Roadmap to Achieve the NTP Vision, A Toxicology Program
    for the 21st Century', which commits to `develop and validate improved
    testing methods and, where feasible, ensure that they reduce, refine or
    replace the use of animals' as one of its top four goals.
        ``The Committee directs the NICEATM/ICCVAM, in partnership with the
    relevant Federal agency program offices and the NTP, to build on the
    NTP Roadmap to create a 5-year plan to research, develop, translate and
    validate new and revised non-animal and other alternative assays for
    integration of relevant and reliable methods into the Federal agency
    testing programs. In this 5-year plan the Federal agency program
    offices shall be directed to identify areas of high priority for new
    and revised non-animal and alternative assays or batteries of those
    assays to create a path forward for the replacement, reduction and
    refinement of animal tests, when this is scientifically valid and
    appropriate. The Committee directs a transparent, public process for
    developing this plan and recommends the plan be presented to the
    Committee by November 15, 2007. Funding for developing the plan shall
    be from the NIEHS and the NTP, and shall not reduce the NICEATM/ICCVAM
    funding base.''
                                     ______

         Prepared Statement of the Dystonia Medical Research Foundation
                  summary of fiscal year 2007 recommendations
      --Provide increased funding for the National Institute of Health at
            an increase of 5 percent over fiscal year 2006. Increase
            funding for the National Institute of Neurological Disorders
            and Stroke (NINDS), the National Institute of Deafness and
            other Communication Disorders (NIDCD), and the National Eye
            Institute (NEI) by 5 percent.
      --Fiscal Year 2007 Recommendations for NIH
        --NIH: $30 billion
        --NINDS: $1.61 billion
        --NEI: $700.4 million
        --NIDCD: $412.7 million
      --Continue to accelerate funding for intramural and extramural
            dystonia research at NINDS.
      --Continue to expand NIDCD's intramural and extramural research on
            dysphonia.
      --Continue to expand NEI's intramural and extramural research on
            dystonia.
        Chairman Specter, thank you for the opportunity to submit testimony
    to the subcommittee on behalf of the Dystonia Medical Research
    Foundation (DMRF). Dystonia has affected the lives of many Americans
    and we are thankful to be able to provide for you our recommendations
    for fiscal year 2007 Federal funding with regards to dystonia research.
        Dystonia is a neurological disorder characterized by powerful and
    painful involuntary muscle spasms that causes the body to twist,
    repetitive jerking movements, and sustained postural deformities. There
    are several different variations of dystonia, including: focal
    dystonias which affect specific parts of the body, such as the arms,
    legs, neck, jaw, eyes, vocal cords; and generalized dystonia, affecting
    many parts of the body at the same time. Some forms of dystonia are
    genetic and others are caused by injury or illness. Dystonia does not
    affect a person's consciousness or intellect, but is a chronic and
    progressive movement disorder for which, at this time, there is no
    known cure. The Foundation estimates that some form of dystonia affects
    about 300,000 people in North America.
        Even though there is no known cure for dystonia, there are
    treatments to lessen the severity of the symptoms of the disease such
    as oral medications, botulinum toxin injections, and in some cases
    surgery. Having increased access to these medical therapies is becoming
    an increasing larger issue for the community as a whole.
        In the past few decades, dystonia researchers have made several
    exciting scientific advancements and have been able to rapidly turn
    laboratory and clinical research into diagnostic examinations and
    treatment procedures, directly benefiting those affected. Genetics, in
    particular, is opening up a new understanding into the cause and
    pathophysiology of the disorder. Thus far, 13 dystonia related genes or
    gene loci have been identified. In 1997, the DYT1 gene for childhood
    early onset dystonia was identified, and we now have a genetic test
    available to confirm diagnosis of this particular type of dystonia.
    Most recently, in 2002, the gene for myoclonus dystonia was identified.
    However the community is still without a diagnostic test and
    misdiagnosis still occurs too frequently.
        Deep brain stimulation is a surgical procedure that was originally
    developed to treat Parkinson's disease but is now being applied to
    severe cases of dystonia. Deep brain stimulation has drastically
    improved the lives of dozens of dystonia patients during the past few
    years. Individuals who were previously bedridden by muscle spasms and
    pain are able to walk without assistance, to speak clearly, to dress
    themselves, to get a driver's license, to date, to travel, and to live
    the life of an able-bodied person. Deep brain stimulation is currently
    used primarily to treat severe cases of generalized dystonia but its
    promising role in treating focal dystonias is being explored. Surgical
    interventions are a crucial and active area of dystonia research.
                        research, awareness, and support
        Now is an exciting time to be involved in dystonia research and
    awareness. Researchers are becoming more interested in movement
    disorders and dystonia at the National Institutes of Health (NIH), and
    research is yielding promising clues for better understanding and
    management of this disorder.
        One way the Dystonia Medical Research Foundation has advocated for
    more research on dystonia, is by funding ``seed'' grants to
    researchers. Thus far the Dystonia Foundation has funded over 415
    grants and fellowships totaling more than $21 million. Due to our
    advocacy there are a growing number of talented researchers dedicated
    to understanding the biochemistry of dystonia, genetic causes, new
    therapeutics and the necessity of an epidemiology study.
        Another primary goal of the Dystonia Foundation is education of
    both lay and medical audiences. The Foundation conducts regular medical
    workshops and patient symposiums to present, discuss, and disseminate
    comprehensive medical and research data on dystonia. In January 2001,
    NINDS co-sponsored a genetics and animal models meeting, designed to
    involve not only prominent researchers but inviting junior
    investigators to participate in the discussions. In September, 2005 NIH
    funded a workshop on ``Rehabilitation in Dystonia'' at which leading
    experts from neurosurgeons and neurologists to physical therapists,
    psychologists, and biomedial engineers argued for more aggressive
    research and the use of new concepts and tools in the treatment of
    dystonia and in 2006 NIH is funding a science workshop on the dystonia
    protein torsinA/Nuclear envelope. On June 6 & 7 a NINDS Research Agenda
    Workshop will take place.
        The Young Investigators Award Program and the Residency Program are
    in place to entice emerging medical professionals into the field of
    dystonia research and cultivate future dystonia experts.
        Since 1995, over 10,000 educational medical videos have been
    distributed to hospitals, medical and nursing schools, and at medical
    conventions. In addition to medical and coping publications, we have a
    children's video to educate families and increase public awareness of
    this devastating disorder in younger populations. Media awareness is
    conducted throughout the year, and especially during Dystonia Awareness
    Week, observed nationwide from June 4 through 11. Local volunteers have
    been successful in securing news stories on dystonia in local venues as
    well as national media shows such as Good Morning America, The Oprah
    Winfrey Show, and Maury Povich. Through his friendship with the mother
    of a dystonia patient, screen star Kirk Cameron has taken an interest
    in promoting dystonia awareness, and the Dystonia Foundation is in the
    process of investigating the possibility of a public service
    announcement and several appearances at fundraising events. In the Fall
    of 2006 the new dystonia documentary entitled TWISTED will be premiered
    on PBS.
        The Dystonia Foundation has over 100 chapters, support groups, and
    area contacts across North America. In addition, there are chairpersons
    whose mission is to promote awareness, children's advocacy,
    development, extension, Internet resources, leadership, medical
    education, and symposiums. Furthermore, patient symposiums are held
    internationally and regionally to provide the latest medical and coping
    information to dystonia patients and others interested in the disorder.
                 dystonia and the national institutes of health
        The Dystonia Medical Research Foundation recommends an increase to
    $31.6 billion or 5 percent for NIH overall, and a 5 percent increase
    for NINDS, and NIDCD. We at DMRF request that this increase for NIH
    does not come at the expense of other Public Health Service agencies.
        We also urge the subcommittee to recommend that NINDS provide the
    necessary funding for additional extramural research. There is also an
    imperative need for NINDS to increase its efforts to educate the public
    and medical community about dystonia through co-sponsorship of
    workshops and seminars. We also encourage the subcommittee to support
    NIDCD in its efforts to revamp its strategic planning process by
    implementing a Strategic Planning Group which will help NIDCD as they:
    consider applications for high program priority; develop program
    announcements and requests for applications; and develop new research
    areas in the Intramural Research Program.
        The National Institute of Neurological Disorders and Stroke (NINDS)
    awarded eleven grants for dystonia research in response to the Program
    Announcement, ``Studies into the Causes and Mechanisms of Dystonia''
    (August 2002). These awards covered a wide range of research areas,
    which included gene discovery, the genetics and genomics of dystonia,
    the development of animal models of primary and secondary dystonia,
    molecular and cellular studies inherited forms of dystonia,
    epidemiology studies, and brain imaging. In addition, the National
    Institute on Deafness and Other Communication Disorders (NIDCD) funded
    an eighth study on brainstem systems and their role in spasmodic
    dysphonia.
        DMRF also supports the many intramural researchers studying
    dystonia. Research includes: exploring improved clinical rating scales
    for dystonia, elevations of sensory motor training, utilizing Botox as
    a possible treatment for focal hand dystonia, characterization of
    abnormalities in sensory regions of the brain, treatments for spasmodic
    dysphonia, deep brain stimulation (the direct electrical stimulation of
    specific brain targets), non-invasive transcranial brain stimulation,
    anatomy imaging of the affect of dystonia on brain activity, and
    exploring the link between laryngitis and spasmodic dysphonia. The
    public awareness impact of pianist Leon Fleisher's treatment through
    the NIH intramural research program has had a tremendously positive
    impact.
        NINDS continues to work with dystonia research and voluntary
    disease groups in the community. In June 2005, NINDS sponsored a
    workshop on spasmodic dysphonia, which was held at the NIH and was
    supported by the NINDS and the NIH Office of Rare Diseases. NIH staff
    are currently drafting a white paper on the results of the meeting and
    future research opportunities for improving the diagnosis,
    understanding the pathogenesis, developing new treatments, and
    preventing spasmodic dysphonia. Another NINDS laboratory is
    investigating several neurodegenerative disorders, including a form of
    hereditary dystonia known as the Mohr-Tranebjaerg deafness-dystonia
    syndrome. This form of dystonia is inherited through the X chromosome.
    The NINDS laboratory is investigating how abnormalities in a specific
    protein lead to the death of affected cells.
        Dystonia is the third most common movement disorder after
    Parkinson's Disease and tremor, and effects many times more people than
    better known disorders such as Huntington's Disease, muscular dystrophy
    and ALS or Lou Gehrig's Disease. We ask that NINDS fund dystonia-
    specific extramural research at the same level that it supports
    research for other neurological movement disorders.
                                   conclusion
        The ultimate goal of the Dystonia Foundation is a cure for
    dystonia. Until that goal is realized, we are hungry for knowledge
    about the nature of dystonia and for more effective treatments with
    fewer side effects. We have amassed many exceptional and diligent
    researchers; who are committed to our goal, and our top priority is
    funding their very important research. But the Foundation cannot do it
    alone. We need Federal support through NIH to continue to fund quality
    scientific research and eliminate this debilitating disease.
        Combine the thwarting of scientific progress with the decreased
    access to therapies and all the progress of the last few years could be
    wiped away. We ask that you aggressively support medical research,
    specifically for movement disorders and brain research. By doing so,
    you are doing a tremendous service for my family and myself and to the
    hundreds of thousands of people and families affected by dystonia.
        Thank you very much.
                                     ______

                     Prepared Statement of the FSH Society
        Chairman Specter, Senator Harkin and members of the subcommittee, I
    am Daniel Perez, President & CEO of the FSH Society. The FSH Society is
    a non-profit volunteer health agency organized by patients for patients
    with facioscapulohumeral muscular dystrophy (FSHD). Our purpose is to
    be a resource for individuals and families with FSH muscular dystrophy
    (FSHD), represent them and advocate on their behalf. On behalf of the
    FSH Society and its members, thank you for this opportunity to testify.
        FSHD is the third most prevalent form of muscle disease and the
    second most prevalent adult muscular dystrophy. It affects 1/20,000
    people. For men, women, and children the major consequence of
    inheriting FSHD is a lifelong progressive and severe loss of all
    skeletal muscles. The FSH Society was created because of a need for a
    comprehensive resource for FSHD individuals and families. A world
    leader in combating muscular dystrophy it has provided well over a
    million dollars in seed grants to pioneering researchers worldwide and
    created an international collaborative network of patients and
    researchers. The Society relies entirely on private grants, donations
    and philanthropy. Since our establishment in 1991, our major focus has
    been to help facilitate Federal research agencies such as the National
    Institutes of Health (NIH) grow funding and programs for FSHD research.
    The Society has submitted 28 written and five oral testimonies to
    Senate and House Appropriations Subcommittees on Labor, Health, Human
    Services and Education on the need for more NIH funding on FSHD.
        The NIH often applauds the effort and dedication of the Society in
    expanding research efforts in FSHD and bringing additional attention to
    this dystrophy. We commend the Director of the NIH, Dr. Elias Zerhouni,
    for the significant efforts made by his agency in muscular dystrophy.
    Between 1987 and 2005, the overall NIH funding for dystrophy increased
    from $4.6 million to $39.3 million. Since 2000, the FSHD budget has
    increased from $400,000 to $2.1 million (fiscal year 2006 estimated).
    We applaud Dr. Stephen I. Katz, Director, National Institute of
    Arthritis and Musculoskeletal Disorders (NIAMS) and Chairman of the
    Muscular Dystrophy Coordinating Committee (MDCC), and John D. Porter,
    Program Director Muscular Dystrophy, National Institute of Neurological
    Disorders and Stroke (NINDS) and Executive Secretary MDCC, for their
    extraordinary comprehension, accuracy and for the speed in which the
    NIH Action Plan for Muscular Dystrophy was researched, compiled,
    written, and approved. The NIH is making significant investments to
    understand muscular dystrophy research needs and has made excellent
    choices in recruiting program staff with the ability to understand the
    extremely complex nature of muscular dystrophy. However, to this day,
    the NIH reports difficulty in growing and expanding its FSH muscular
    dystrophy research portfolio and in receiving sufficient numbers of
    investigator-submitted applications of high quality.
                       the md-care act, public law 107-84
        Congress enacted The Muscular Dystrophy Community Assistance,
    Research and Education Amendments of 2001 (the MD-CARE Act, Public Law
    107-84) that was signed into law on December 18, 2001. Both the Senate
    and House acted with force and clarity to mandate the NIH and other
    applicable Federal agencies, to immediately expand and intensify
    research on all forms of muscular dystrophy. The MD-CARE Act declared
    that: (1) the Director of the NIH work with the Directors of NIAMS,
    NINDS and NIH National Institute of Child Health and Human Development
    (NICHD) to expand and intensify research on all nine types of dystrophy
    described in the Act; (2) Centers of excellence for research should be
    established for all nine types of dystrophy; (3) a MDCC with two-thirds
    government and one-third public members be established to coordinate
    activities across NIH and other national research agencies on all forms
    of dystrophy; and; (4) the MDCC to submit a research action plan for
    conducting, and supporting research and education for all nine types of
    dystrophy. The MD-CARE Act also requires annual updates on research
    funding amounts by the Department of Health and Human Services (DHHS)
    for Duchenne, Myotonic, FSHD and other muscular dystrophies.
        In August 2004, the MDCC submitted an initial report for the NIH
    Muscular Dystrophy Research and Education Plan to Congress which was
    put through a more intensive planning process that involved external
    scientific experts in the field of muscular dystrophy and muscle
    disease. This detailed version of the MDCC ``Action Plan for the
    Muscular Dystrophies'' was submitted to Congress in December 2005.
        FSHD is prominently and well represented in the five sections of
    the NIH ``Action Plan for the Muscular Dystrophies.'' Three key
    sections for FSHD research are: Mechanisms Section, Research Objective
    3, ``Define the molecular pathogenetic mechanisms that lead to
    facioscapulohumeral muscular dystrophy''; Mechanisms Section, Research
    Objective 4, ``Establish mouse (and cellular) models for
    facioscapulohumeral muscular dystrophy, specific to emerging candidate
    genes and/or disease genomics, to understand the epigenetic mechanisms
    and for the development of novel intervention strategies''; and, the
    Infrastructure Section, Research Objective 13, ``Stimulate
    international collaborations and infrastructure sharing to ensure that
    opportunities are exploited and resources are used to maximum
    advantage, particularly in cases of novel opportunity or for the rare
    and/or understudied muscular dystrophies.'' The full description and
    text of research objective three in the mechanisms section illustrates
    that the NIH fully comprehends what needs to be done to achieve
    progress in FSHD.\1\
    ---------------------------------------------------------------------------
        \1\ NIH Action Plan for the Muscular Dystrophies, Mechanisms
    Section, Research Objective 3: ``Define the molecular pathogenetic
    mechanisms that lead to facioscapulohumeral muscular dystrophy,''
    December 2005.
        ``Defining the molecular mechanisms by which a reduction in repeats
    at the D4Z4 translates into the multi-system symptoms seen in
    facioscapulohumeral muscular dystrophy has been difficult. Elucidation
    of the function of the allelic variants (A and B) at D4Z4 may help
    advance understanding of disease mechanisms. If perturbations of
    chromatin structure and/or derepression of gene expression ultimately
    figure into pathogenesis, there are some other diseases that could help
    inform researchers in this field. A potentially important avenue of
    research is the analysis of the chromatin structure at the D4Z4 locus,
    including methylation and/or binding of specific repressors or
    activators. Such chromatin conformational changes have been suggested
    as a possible disease mechanism, presumably affecting the regulation of
    expression of other genes. Since the issue of altered regulation of
    genes in the vicinity of D4Z4 remains controversial, there is a need
    for careful studies using microarrays or other techniques, to determine
    if genes near the D4Z4 repeat units on chromosome 4q, or at more
    distant locations on this chromosome, are up-regulated or down-
    regulated in facioscapulohumeral muscular dystrophy. The expression and
    function of the D4Z4 gene, DUX4, should be analyzed. The association of
    4qter with the nuclear lamina and the potential role of this
    association upon gene expression profiles should be explored. Genetic
    causes for facioscapulohumeral muscular dystrophy, other than the D4Z4
    contraction (such as non-chromosome 4 linked cases), should be
    investigated in available patients.''
    ---------------------------------------------------------------------------
        It is absolutely clear that muscular dystrophy is a high priority
    for the NIH and it understands the research that needs be developed,
    funded and contracted. However, the dystrophies such as FSHD with
    complex etiology, low prevalence or that present unique scientific
    opportunity are getting far less funding than they deserve. FSHD is
    clearly deficient in projects and funding caused by it being a
    complicated disease with complex etiology that requires mastery to
    review grants or to undertake research. In the dystrophy area, the NIH
    believes that insight gained from studying a specific type of dystrophy
    will provide benefit for all of the muscular dystrophies. Sadly, that
    is not the case for FSHD.
              nih efforts on fsh muscular dystrophy (2000-present)
        NIH has supported several initiatives in recent years in dystrophy
    research and training. In response to the fiscal year 2000 report
    language, the NINDS, NIAMS and the NIH Office of Rare Diseases (ORD)
    held a research symposium in May 2000, in Bethesda, on the cause and
    treatment of FSH muscular dystrophy. The international team of
    researchers and NIH staff assembled research recommendations and
    directions that called for enhancing the understanding of the mechanism
    and molecular process associated with FSHD, strategies for exploring
    potential treatments and therapies, strategies to promote establishment
    of biomaterials registries and longitudinal and population based
    studies of FSHD, and a listing of required infrastructure and research
    resources.
        The findings of the conference on FSHD were used to create NIH
    solicitations. One request focused on exploratory and high risk
    research applications on FSH muscular dystrophy, and several other
    announcements were made for grant applications on therapeutic and
    pathogenic approaches for muscular dystrophy in which FSHD was
    mentioned.
        In September 2000, the NINDS and NIAMS issued a contract to
    establish and fund a National Registry for Myotonic and FSH Muscular
    Dystrophy based at the University of Rochester. Patients join the
    registry voluntarily by providing medical and family history data. The
    registry brings together FSHD patients and families seeking to
    participate in research with researchers seeking patients for research
    on the disorder.
        Several program announcements were issued to promote large scale
    clinical and translational research in muscular dystrophy, as called
    for in the MD-CARE Act, called the Senator Paul D. Wellstone Muscular
    Dystrophy Research Centers. One of these centers, at the University of
    Rochester, focuses on myotonic and FSH muscular dystrophy. One-quarter
    of this Wellstone MD CRC center focuses on the molecular pathology of
    FSHD and serves as a resource for cell lines, tissue biopsies,
    antibodies and data about gene expression. This Wellstone MD CRC core
    at Rochester is the only funding specific for FSHD in the six Wellstone
    MD CRCs.
        The MD-CARE Act provides that the Wellstone MD CRC centers are not
    to replace funding and projects in existing basic research portfolios.
    In addition to building national infrastructure for dystrophy research,
    the NIH is expanding research resources for FSHD by funding several
    basic research grants related to understanding the mechanism and
    pathology of FSH muscular dystrophy.
        One of these grantees, Rossella Tupler, supported by the FSH
    Society, helped bring about a momentous breakthrough in FSHD research.
    The prestigious scientific journal Nature made an advance online
    publication of ``Facioscapulohumeral muscular dystrophy in mice over-
    expressing FRG1'', by Davide Gabellini and Rossella Tupler, et al., on
    December 11, 2005. The Nature paper is a breakthrough on multiple
    levels, it: (1) creates an animal model for FSHD; (2) points to a gene,
    called FRG1, that causes FSHD; (3) identifies other genetic processes
    impacted by FRG1 over-expression involved in other major adult
    dystrophies; (4) shows that both the FRG1 gene and mis-expressed pre-
    mRNA intermediary products can be targeted and regulated by new and
    novel gene therapy techniques to correct expression levels; and (5)
    gives FSHD the hard target needed in order have better success in
    securing major funding from large agencies. They have demonstrated that
    transcriptional modulation of a gene from the region can produce an
    interesting, potentially relevant phenotype. This model can now be used
    to create conditional variants and ultimately move on to look for
    transcriptional suppressors of the phenotype.
        The NINDS, NIAMS and NICHD support career development and training
    awards for muscle biology and neuroscience through three program
    announcements for domestic and foreign investigators to help create a
    cadre of new scientists and researchers working on muscular dystrophy.
    The NINDS, NIAMS program officers in dystrophy are working diligently
    trying to help extramural researchers submit the highest quality
    applications.
        The NIH assisted Dr. Melanie Ehrlich of Tulane University, who was
    displaced by hurricane Katrina by offering a position in the NIAMS
    intramural research laboratory of Dr. Kuan Wang and granting
    supplemental relief funds to salvage her FSHD research.
                         nih muscular dystrophy funding
        However, in the 6 years since the MD-CARE Act was signed the NIH
    [NIAMS, NINDS, NICHD, NHGRI] funding for FSHD remains very small. Since
    2000, the overall NIH wide muscular dystrophy budget has increased from
    $12.6 million to $39.0 million in fiscal year 2007 estimated. Since
    2000, the FSHD budget has increased from $400,000 to $2.1 million in
    fiscal year 2007 estimated. In the past year, at least five basic
    research grant applications (R01s) were submitted on FSHD and none were
    chosen for funding! Though the international field of FSHD researcher
    is small, the researchers are absolutely top-rate, world class and
    certainly competitive with other NIH grant applicants. Five
    applications represents about 25-30 percent of the entire field of FSHD
    researchers with the standing and experience to submit a basic research
    grant. A significant amount of FSHD researchers are submitting grant
    applications!

                               NATIONAL INSTITUTES OF HEALTH (NIH) APPROPRIATIONS HISTORY
                                                  [Dollars in millions]
    ----------------------------------------------------------------------------------------------------------------
                                                                                                FSHD         FSHD
                Fiscal year             NIH overall  MD research   MD percent      FSHD      percent of   percent of
                                                                     of NIH      research        MD          NIH
    ----------------------------------------------------------------------------------------------------------------
    2000..............................      $17,821       $12.60        0.071        $0.40         3.18       0.0022
    2001..............................       20,458        21.00        0.103         0.50         2.38       0.0024
    2002..............................       23,296        27.60        0.118         1.30         4.71       0.0056
    2003..............................       27,067        39.10        0.144         1.50         3.83       0.0055
    2004..............................       27,887        38.70        0.139         2.20         5.67       0.0079
    2005..............................       28,494        39.50        0.139         2.00         5.06       0.0070
    2006..............................       28,428        39.3E        0.138         2.1E         5.31       0.0074
    2007E.............................       28,428        39.0E        0.137         2.1E         5.38       0.0074

    ----------------------------------------------------------------------------------------------------------------
    Source: NIH/OD Budget Office & NIH OCPL.

        NIAMS has one research contract for FSHD, the National Registry for
    Myotonic and FSH muscular dystrophy for $295,888 (fiscal year 2005).
    Its total muscular dystrophy portfolio for fiscal year 2005 was 57
    projects, including two Wellstone MD CRC components for a total of
    $17,136,343. FSHD was only 1.7 percent of NIAMS fiscal year 2005
    muscular dystrophy funding.
        NINDS reports three research grants, one intramural grant, one
    research contract, and one-quarter of a Wellstone CRC for FSHD for a
    total of $1,359,930 in fiscal year 2005. The total muscular dystrophy
    fiscal year 2005 portfolio reported for fiscal year 2005 was 33
    projects, including two Wellstone CRCs for a total of $11,987,219. FSHD
    was only 11.4 percent of NINDS fiscal year 2005 muscular dystrophy
    funding.
        NICHD reports that approximately ten percent of its $4,762,321
    fiscal year muscular dystrophy portfolio has some broad or general
    application to FSHD, but does not identify specific projects. The NICHD
    reports that $400,000 was spent on FSHD. The total muscular dystrophy
    fiscal year 2005 portfolio reported was 17 projects, including three
    Wellstone MD CRC components for a total of $4,762,321. FSHD was only
    8.4 percent of NICHD fiscal year 2005 dystrophy funding.
        The NIAMS, NINDS, NICHD, and NHGRI--the four lead institutes on
    muscular dystrophy--reported a combined total of 108 projects on
    muscular dystrophy totaling $34,285,883 in fiscal year 2005. Of that
    total amount facioscapulohumeral muscular dystrophy (FSHD) received
    $1,440,555 in directly titled funds for three grants, one contract and
    one-quarter of a Wellstone MD CRC.
        The NIH now has six Wellstone MD CRCs, which are approximately
    equivalent to 27 basic research grants (R01). One-quarter of one
    Wellstone, or one R01 equivalent, has direct relevance to FSHD. Only
    3.7 percent of the total Wellstone MD CRC expenditure is being spent on
    the second most prevalent adult muscular dystrophy or the third most
    prevalent form of muscular dystrophy affecting men, women and children.
                                    request
        Mr. Chairman and Members of the Committee, we request an
    appropriation of $10 million-$12.5 million to accomplish the FSH
    muscular dystrophy research plan as outlined by the NIH and submitted
    to the Congress. As a start, simply examining the scope of the work
    outlined in the NIH Action Plan for Muscular Dystrophy ``Mechanisms
    Section, Research Objective 3: Define the molecular pathogenetic
    mechanisms that lead to FSH muscular dystrophy,'' illustrates a
    requirement of at least 12 to 15 basic research grants (R01s) and/or
    high risk innovative research grants (R21s) that require $5 million-$6
    million to adequately fund them.
        We also request that the umbrella area of muscular dystrophy
    receive an appropriation commensurate with similar disease areas, and
    we request equity by starting with a doubling of the current $39
    million to $80 million to adequately fund the NIH research plan for
    dystrophy. NIH Disease Funding, Special Areas of Interest table shows
    that similar umbrella areas of health burden, scope, and impact such as
    Multiple Sclerosis ($109 million), Motor Neuron Disease ($57 million),
    Cystic Fibrosis ($89 million), Parkinson's ($223 million), and
    Huntington's ($48 million) receiving average funding levels of $105
    million. Muscular dystrophy affects hundreds of thousands of
    individuals, including family and friends.
        We understand that the NIH overall budget went down in fiscal year
    2006 to $28,428M from $28,494M and that Congress is strapped with other
    priorities. Chairman Specter, thank you for the constant and consistent
    support of biomedical research and for the NIH programs that offer hope
    for millions of sick and dying people. Mr. Chairman, members of the
    committee and members of Congress, the opportunities for FSHD research
    are greater than ever. The past year brought with it several major
    breakthroughs and discoveries and we are on the cusp of understanding
    FSHD and a never before seen class of disease. Now that we have a very
    refined plan of attack and research direction by the NIH, the need for
    funding is even greater. FSHD research needs to continue unabated and
    we remind you that there is no treatment or therapy for this
    devastating and crippling disease.
        We ask the subcommittee to appropriate in fiscal year 2007 $12.5
    million for FSH Muscular Dystrophy and $80 million for Muscular
    Dystrophy either as new money towards the overall NIH budget or as a
    requested allocation/re-allocation of resources internally within the
    NIH, to support the NIH stated plan of action to work on dystrophy. We
    thank the subcommittee for this opportunity to present our views.
                                     ______

              Prepared Statement of the Foster Grandparent Program
        Mr. Chairman and members of the subcommittee, thank you for the
    opportunity to submit this testimony in support of fiscal year 2007
    funding for the Foster Grandparent Program (FGP), the oldest and
    largest of the three programs known collectively as the National Senior
    Volunteer Corps, which are authorized by Title II of the Domestic
    Volunteer Service Act (DVSA) of 1973, as amended and administered by
    the Corporation for National and Community Service (CNS). NAFGPD is a
    membership-supported professional organization whose roster includes
    the majority of more than 350 directors, who administer Foster
    Grandparent Programs nationwide, as well as local sponsoring agencies
    and others who value and support the work of FGP.
        Mr. Chairman, I would like to begin by thanking you and the
    distinguished members of the subcommittee for your steadfast support of
    the Foster Grandparent Program. No matter what the circumstances, this
    subcommittee has always been there to protect the integrity and mission
    of our programs. Our volunteers and the children they serve across the
    country are the beneficiaries of your commitment to FGP, and for that
    we thank you. I also want to acknowledge your outstanding staff for
    their tireless work and very difficult job they have to ``make the
    numbers fit.''--an increasingly difficult task in this budget
    environment.
        NAFGPD remains concerned that the Corporation's fiscal year 2007
    request does not provide any new funding where it is needed most--in
    the field. All of us recognize the spending constraints placed on the
    President and, most importantly on you and the Appropriations
    Committee. However, in a time of such scarce Federal resources, NAFGPD
    believes strongly that any new funding should flow to our programs in
    the field where it is most urgently needed, not CNCS headquarters.
        This fiscal year 2007 budget request follows fiscal year 2006 in
    which FGP experienced a nearly $500,000 funding cut. The last time FGPs
    in the field realized any increases at all to cover the increased costs
    of doing business--especially in the area of transportation costs--was
    in fiscal year 2005; that increase amounted to a very small .84
    percent, when inflationary price increases have been averaging 2-3
    percent every year. FGP programs continue to face considerable stress
    in covering the rising costs of administering programs and maintaining
    program quality.
        NAFGPD respectfully requests two things of the subcommittee:
        (1) To provide $115.929 million for the Foster Grandparent Program
    in fiscal year 2007, an increase of $4.992 million over the fiscal year
    2006 level. This critical funding will ensure the continued viability
    of the Foster Grandparent Program, and allow for important expansion of
    this unique program. Specifically, this proposal would fund a 3 percent
    cost of living increase for every Foster Grandparent Program and
    expansion grants to existing programs that would add 370 new low-income
    senior volunteers to serve children;
        (2) To maintain current appropriations statutory language that
    prohibits CNCS from using funds in the bill to pay non-taxable stipend
    to volunteers whose incomes exceed 125 percent of the national poverty
    level. In its budget narrative, CNCS has again requested that this
    language be eliminated because it stifles innovation. In fact, CNCS has
    the ability to test any innovations they wish through demonstration
    activities--they just cannot pay a non-taxable stipend to volunteers
    whose incomes exceed 125 percent of the national poverty level.
    Congress has repeatedly over the last six years disavowed this practice
    and re-affirmed that the non-taxable stipend must be reserved for low-
    income volunteers. We ask that you again protect the mission of the
    Foster Grandparent and Senior Companion Programs--to enable low-income
    older people--to serve their communities by maintaining this important
    statutory language.
                                fgp: an overview
        Established in 1965, the Foster Grandparent Program was the first
    federally funded, organized program to engage older volunteers in
    significant service to others. From the 20 original programs based
    totally in institutions for children with severe mental and physical
    disabilities, FGP now comprises nearly 350 programs in every State and
    the District of Columbia, Puerto Rico, and the Virgin Islands. These
    programs are now primarily in community-based child caring agencies or
    organizations--where most special needs children can be found today--
    and are administered locally through a non-profit organization or
    agency and Advisory Council comprised of community citizens dedicated
    to FGP and its mission. FGP represents the best in the Federal
    partnership with local communities, with Federal dollars flowing
    directly to local sponsoring agencies, which in turn determine how the
    funds are used. Through this partnership and the flexibility of the
    program, FGP is able to meet the immediate needs of the local
    communities. This was demonstrated by Foster Grandparent Programs in
    communities that were impacted by the influx of Hurricane Katrina
    evacuees. Foster Grandparents rallied to provide services to children
    in shelters, child care centers, and schools.
        There are currently 38,700 Foster Grandparent volunteers who give
    over 36 million hours annually to more than 277,000 children. The
    Foster Grandparent Program is unique for several reasons. The program
    is one of only two volunteer programs in existence that enable seniors
    living on very limited incomes to serve their communities as volunteers
    by providing a small non-taxable stipend and other support which allow
    volunteers to serve at little or no cost to themselves. FGP volunteers
    provide intensive, consistent service--15 to 40 hours every week,
    usually four hours every day. FGP provides intensive pre-service
    orientation and at least 48 hours of ongoing training every year to
    keep volunteers current and informed on how to work with children who
    have special needs. And our volunteers provide one-to-one service to
    their assigned children, exactly what is required to help prepare our
    Nation's neediest children to become self-sufficient adults.
                              fgp: the volunteers
        The Foster Grandparent Program is a versatile, dynamic, and
    uniquely multi-purpose program. First, the program gives Americans 60
    years of age or older who are living on incomes at or less than 125
    percent of the poverty level the opportunity to serve 15 to 40 hours
    every week and use the talents, skills and wisdom they have accumulated
    over a lifetime to give back to the communities which nurtured them
    throughout their lives. Seniors in general are not valued or respected
    in today's society, and low-income seniors are particularly devalued
    because of their economic status. They are rarely asked by their
    communities to contribute through volunteering, because they are not
    traditionally those who participate in community activities.
        FGP actively seeks out these low-income seniors. We dare to ask
    them to serve, to give something back. And we help them to develop the
    additional skills they may need to function effectively in settings
    unfamiliar to them, like public schools, hospitals, childcare centers,
    and juvenile detention facilities. We also provide them with ongoing
    training and support throughout their tenure as Foster Grandparents.
    Through their service, our older volunteers say they feel and stay
    healthier, that they feel needed and productive. Most importantly, they
    leave to the next generation a legacy of skills, perspective and
    knowledge that has been learned the hard way--through experience.
        Within budgetary constraints, FGP is engaging older people who are
    not usually asked to serve and those usually considered as needing
    services rather than being able to serve: 86 percent are 65 or older
    and 45 percent come from various ethnic groups.
                               fgp: the children
        Through our volunteers, the Foster Grandparent Program also
    provides person-to-person service to children and youth under the age
    of 21 who have special or exceptional needs, many of whom face serious,
    often life-threatening challenges. With the changing dynamics in family
    life today, many children with disabilities and special needs lack a
    consistent, stable adult role model in their lives. The Foster
    Grandparent is very often the only person in a child's life who is
    there every day, who accepts the child, encourages him no matter how
    many mistakes the child makes, and focuses on the child's successes.
        Special needs of children served by Foster Grandparents include
    AIDS or addiction to crack or other drugs; abuse or neglect; physical,
    mental, or learning disabilities; speech, or other sensory
    disabilities; incarceration and terminal illness. Of the children
    served, 7 percent are abused or neglected, 26 percent have learning
    disabilities, and 11 percent have developmental delays. FGP focuses its
    resources in areas where they will have the most impact: early
    intervention services and literacy activities. Nationally, 85 percent
    of the children served by Foster Grandparents are under the age of 12,
    with 39 percent of these children age 5 or under. Foster Grandparents
    work intensively with these very young children to address their
    problems at as early an age as possible, before they enter school.
    Nearly one-half of FGP volunteers serve nearly 12 million hours
    annually addressing literacy and emergent-literacy problems with
    special needs children.
        Activities of the FGP volunteers with their assigned children
    include teaching parenting skills to teen parents; providing physical
    and emotional support to babies abandoned in hospitals; helping
    children with developmental, speech, or physical disabilities develop
    self-help skills; reinforcing reading and mathematics skills; and
    giving guidance and serving as mentors to incarcerated or other youth.
                            fgp: the volunteer sites
        The Foster Grandparent Program provides child-caring agencies and
    organizations offering services to special-needs children with a
    consistent, reliable, invaluable extra pair of hands 15 to 40 hours
    every week to assist in providing these services. Seventy-one percent
    of FGP volunteers serve in public and private schools as well as sites
    that provide early childhood pre-literacy services to very young
    children, including Head Start.
                          fgp: cost-effective service
        The Foster Grandparent Program serves local communities in a high
    quality, efficient and cost-effective manner, saving local communities
    money by helping our older volunteers stay independent and healthy and
    out of expensive in-home or institutional care. Using the Independent
    Sector's 2003 valuation for one hour of volunteer service ($17.19/
    hour), the value of the service given by Foster Grandparents annually
    is over $618 million, and represents a 5-fold return on the Federal
    dollars invested in FGP. The annual Federal cost for one Foster
    Grandparent is $3,800--less than $4 per hour.
        The value local communities place on FGP and its multifaceted
    services is evidenced by the large amount of cash and in-kind donations
    contributed by communities to support FGP. For example, FGP's fiscal
    year 2001 Federal allocation was matched with $40 million in non-
    Federal donations from States and local communities in which Foster
    Grandparents volunteer. This represents a non-Federal match of 42
    percent, or $.42 for every $1 in Federal funds invested--well over the
    10 percent local match required by law.
                    nafgpd's fiscal year 2007 budget request
        Given the dramatically expanding number of low-income seniors
    eligible to serve and the staggering number of troubled and challenged
    children in America today, we respectfully request that the
    subcommittee provide $115.929 million for the Foster Grandparent
    Program in fiscal year 2007, an increase of $4.992 million over fiscal
    year 2006. This critical funding will ensure the continued viability of
    the Foster Grandparent program, and allow for an expansion of this
    important program.
        The requested increase would be allocated for the following
    purposes, in order of priority:
        1. in accordance with the Domestic Volunteer Service Act (DVSA),
    designate one-third of the increase over the fiscal year 2006 level to
    fund Program of National Significance (PNS) expansion grants to allow
    existing FGP programs to expand the number of volunteers serving in
    areas of critical need as identified by Congress in the DVSA. This
    expansion of FGP was overwhelmingly supported and endorsed by White
    House Conference in Aging delegates at the recent 2005 Conference
    convened by the President.
        2. use all remaining funds to award an administrative cost increase
    of at least 3 percent to each existing Foster Grandparent Program in
    order to maintain quality, enable recruitment and sustain the work
    already being done by programs.
        This funding proposal will generate opportunities for approximately
    370 new low-income senior volunteers to contribute 390,000 hours of
    service annually to nearly 2,000 additional children with special needs
    through PNS grants to existing FGPs.
        We request that no funds be provided for Senior Demonstration.
    Language in the Corporation for National and Community Service's Budget
    Justification indicate that any demonstration funds awarded will again
    be used for programming that allows the payment of a stipend to
    individuals whose incomes exceed 125 percent of the national poverty
    level. In recognition of the fact that this practice has nothing to do
    with the true spirit of volunteerism, Congress has expressly prohibited
    this practice for the last 6 years in appropriations language; we
    request that this important language be maintained to protect the
    purpose of FGP and SCP: to enable low-income elders to serve their
    communities.
        The message is clear: (1) the population of low-income seniors
    available to volunteer 15 to 40 hours every week is increasing; (2)
    communities need and want more Foster Grandparent volunteers and more
    Foster Grandparent Programs. The subcommittee's continued investment in
    FGP now will pay off in savings realized later, as more seniors stay
    healthy and independent through volunteer service, as communities save
    tax dollars, and as children with special needs are helped to become
    contributing members of society.
        Mr. Chairman, in closing I would like to again thank you for the
    subcommittee's support and leadership for FGP over the years. NAFGPD
    takes great comfort in knowing you and your colleagues in Congress
    appreciate what our low-income senior volunteers accomplish every day
    in communities across the country.
                                     ______

        Prepared Statement of Friends of the National Institute on Aging
        Chairman Specter and members of the subcommittee, thank you for
    this opportunity to testify in support of increasing funding within the
    National Institutes of Health (NIH), and in particular within the
    National Institute on Aging (NIA).
        The Friends of the NIA is a relatively new coalition comprised of
    some 50 organizations from academia and the non-profit community. All
    of the groups comprising the Friends of the NIA conduct, fund or
    advocate for scientific efforts to improve the health and quality of
    life for Americans as they grow older. All of our groups support the
    continuation and expansion of biomedical, behavioral, and social
    science research within the NIA. The Friends of the NIA seeks to raise
    awareness about aging research and the important scientific progress
    supported and guided by the NIA. Our testimony not only addresses
    recent research advances funded by the NIA, but also points to missed
    opportunities if there is not growth in the NIA appropriation from
    Congress in fiscal year 2007.
        The NIA is dedicated to conducting biomedical, behavioral, and
    social science research in order to prevent disease and other problems
    of the aged, and to maintain the health and independence of older
    Americans. This research is all the more urgent because of the
    explosive growth of the older population in the United States. This
    year, the first wave of our largest generation--some 77 million members
    of the postwar Baby Boom generation--began turning aging 60. Currently
    there are some 36 million Americans aged 65 and older. That population
    is expected to double in size within the next 25 years, at which time
    nearly 20 percent of the American population will be older than age 65
    and eligible for old age assistance for health care under the Federal
    Medicare program (Federal Interagency Forum on Aging-Related Statistics
    2004, Older Americans). Of particular interest is the dramatic growth
    that is anticipated among those most at risk for disease and
    disability, people age 85 and over whose numbers are expected to grow
    from 4.3 million in 2000 to at least 19.4 million in 2050 (65+ in the
    United States: 2005, U.S. Census, 2006).
        This growing population presents many social and economic
    challenges as increasing numbers of Americans reach retirement age.
    This rapidly expanding population, many of whom will have multiple
    medical needs, will require substantial changes in health care
    delivery. Aging itself is not the cause of disease, disability, and
    frailty, but these conditions are influenced by age-related changes,
    lifestyle choices and rising risk factors. We also know that outside
    influences, such as economic, physical, environmental, and caregiving
    stresses increase vulnerability to disease, especially amongst the
    elderly. NIA has a broad research portfolio and is the only Institute
    that studies the normal changes associated with aging as well as
    pathological conditions from an interdisciplinary perspective.
    Understanding when and how changes occur as we age provides important
    clues for developing interventions that will prevent and treat
    diseases, and improve quality of life.
        In addition to participating in NIH-wide initiatives, NIA has made
    and supported many significant contributions of its own to the
    biomedical and psycho-social understanding of the aging processes and,
    through ongoing clinical trials, to the testing of promising
    interventions for the detection, treatment and prevention of many age-
    related conditions.
        The NIA is the lead Federal research agency for Alzheimer's disease
    (AD). AD is the most common cause of dementia and a serious threat to
    the Nation's health and economic well-being. Today, an estimated 4.5
    million Americans, 1 in 10 persons over age 65 and nearly one-half of
    those over 85, suffer from this debilitating disease. That toll is
    projected to increase to 5.1 million people by 2010 and 16 million by
    2050 (Hebert et al. 2003, Alzheimer's Disease in the U.S. Population).
    Over the next decade, Medicare spending on beneficiaries with AD will
    more than triple to $189 billion. Our concern is that flattened budgets
    for the NIH institutes are threatening major AD research initiatives.
    One example is the Alzheimer's Disease Neuroimaging Initiative (ADNI),
    launched in 2004 as a public/private partnership: the most
    comprehensive effort to date to identify neuroimaging strategies and
    biomarkers to identify the onset of mild cognitive impairment and early
    AD with greater sensitivity. The project currently involves
    approximately 50 sites across the United States and Canada and holds
    the promise of early diagnosis and subsequent interventions that could
    postpone or more effectively treat AD. The Genetics Initiative is
    another multi-site collaboration that is collecting, sharing, and
    analyzing data to complete the picture of genetic risk factors for AD.
    These programs offer enormous potential to identify AD and intervene
    early, but lack of adequate funding will prevent or slow realization of
    the full potential of these programs. With aging baby boomers on the
    horizon, we cannot afford this delay.
        Great strides have been made in AD. Only a few years ago, this
    disease could not be positively confirmed until autopsy. Now we can
    diagnose the disease in life with a high degree of certainty; we
    understand some of the basic mechanisms of the disease; and five
    approved drugs for treating symptoms are now approved with many new
    compounds being tested in publicly and industry-supported clinical
    trials.
        This is a critical time for investment not retrenchment. Scientists
    are poised to find effective ways to prevent, delay onset, and even
    treat this disease. If the onset of AD could be delayed by just two
    years, the AD afflicted population would remain at current size, even
    with the expected increases in senior population; a five-year delay of
    onset would cut the projected AD population in half.
        Other promising NIA biomedical research efforts into prominent
    diseases include research programs to discover new Parkinson's
    susceptibility genes; studies of age-related bone loss and
    osteoporosis; development of programs to assess genetic and
    environmental factors in racial and ethnic health differences
    simultaneously; and bone marrow failure diseases, all of which occur in
    higher incidence in people over 60.
        NIA's behavioral and social science research programs have been
    instrumental in providing crucial economic and demographic population
    information. NIA's Centers on the Demography of Aging, particularly
    their Health and Retirement Survey (HRS) and the National Long-Term
    Care Survey (NLTCS), provide critical data on the health and economic
    status of the older population. These data have been used by Congress
    to better understand the budgetary impact of population aging, as
    potential changes to public programs such as Social Security, Medicare,
    and Medicaid are deliberated. By using NLTCS data, investigators
    identified the declining rate of disability in older Americans first
    observed in the mid-1990s--a trend that has continued. This trend, if
    continued, could have momentous impact on reducing the need for costly
    long-term care. The Social Security Administration recognizes and co-
    funds the HRS as a ``Research Partner'' and posts the study on its home
    page to improve its availability to the public and to policymakers. In
    2005, the Center for Medicare and Medicaid Services (CMS) funded a
    supplemental survey using the HRS to provide timely information on who
    is likely to enroll in the new Medicare Part D prescription drug
    program and how those decisions are related to knowledge of the
    program, drug use and costs.
        There is building evidence that continued engagement in productive
    activities has a positive impact on health and life satisfaction. The
    experience and expertise of the new 65+ population offers great
    potential to help address workforce shortages as well as some of the
    critical social needs of our country. The NIA is working to build a
    research agenda that focuses on maximizing older workers' safety,
    health, productivity and life satisfaction--knowledge that this will be
    critical to developing sound national policies.
        NIA provides critical support for the training of new
    investigators. The reduction in funded proposals as a result of limited
    NIA budget will impact the ability to recruit and sustain an
    appropriate pool of qualified researchers in gerontology and
    geriatrics. Numerous reports have cited the need for more geriatricians
    and geriatric-trained professionals for our aging society. By 2030, the
    United States will need up to 36,000 geriatricians and will fall far
    short of that figure by as many as 25,000 unless effective steps are
    taken to train new providers (Medical Never-Never Land, Alliance for
    Aging Research, 2002). Further budget cuts will reduce funding
    available for training, and may force some leading researchers and
    practitioners to abandon gerontology as well as the mentoring of new
    professionals in the field.
        With bipartisan leadership in Congress, the NIH budget doubled
    between 1998 and 2003 ($13.6 to $27.3 billion). However, since 2003,
    funding for the NIH in real dollars has been on a downward trajectory.
    Under the President's proposed fiscal year 2007 budget, the NIA is
    slated to be decreased in real terms by $10 million. Further, in order
    to preserve clinical trials already underway, NIA will fund only 18
    percent of new grant proposals. This is down substantially from 28.5
    percent in 2003, and will not come close to supporting the more than 50
    percent of submitted applications that the NIA has determined to be
    highly promising. At the same time that the acceptance rate of new
    proposals is down, the funding levels of new grants has also dropped
    from years past. Moreover, even those grantees receiving funding face
    an average reduction from requested budgets by 18 percent across the
    board. (Fiscal Year 2007, National Institutes on Aging, Justification
    of Estimates for Appropriations Committees). Investigator-initiated
    research projects provide new breakthroughs in knowledge and treatment
    to benefit older Americans and their families. Declining budgets slow
    momentum and impact future research programs. For example, continued
    cuts will impact projects such as, the start up of new clinical trials
    in caloric restriction, testosterone supplementation in men, and
    lifestyle interventions and independence for elders, all of which have
    shown great potential for significant public health outcomes.
        The Friends of the National Institute on Aging recommend the
    following directives:
        (1) The time for research on aging is now if we are to achieve a
    healthier and more productive aging America. To further this goal, the
    Friends of the NIA endorse the recommendation issued by the Ad Hoc
    Group for Medical Research in calling for a 5 percent overall increase
    for the National Institutes of Health in fiscal year 2007.
        (2) NIA needs additional resources to support individual
    investigator awards, to avoid an 18 percent cut in its existing grants,
    and to sustain training and research opportunities for new
    investigators.
        Mr. Chairman, the Friends of the NIA thanks you for this
    opportunity to outline the challenges threats and opportunities that
    lie ahead as you consider appropriate funding for the NIH and the
    National Institute on Aging.
                                     ______

                Prepared Statement of Friends of NIDA Coalition
        The Friends of the National Institute on Drug Abuse (FoN), a
    burgeoning coalition of scientific and professional societies, patient
    groups, and other organizations committed to preventing and treating
    substance use disorders as well as understanding the causes and public
    health consequences of addiction, is pleased to provide testimony in
    support of the NIDA's extraordinary work. Pursuant to clause 2(g)4 of
    House Rule XI, the Coalition does not receive any Federal funds.
        Drug abuse is costly--to individuals and to our society as a whole.
    Smoking, alcohol abuse and illegal drugs cost this country more than
    $500 billion a year, with illicit drug use alone accounting for about
    $180 billion in health care, crime, productivity loss, incarceration,
    and drug enforcement. Beyond its monetary impact, drug and alcohol
    abuse tear at the very fabric of our society, often spreading
    infectious diseases and bringing about family disintegration, loss of
    employment, failure in school, domestic violence, child abuse, and
    other crimes. The good news is that treatment for drug abuse is
    effective and recovery from addiction is real for millions of Americans
    across the country. Preventing drug abuse and addiction and reducing
    these myriad adverse consequences in the ultimate aim of our Nation's
    investment in drug abuse research. Over the past three decades,
    scientific advances resulting from research have revolutionized our
    understanding of and approach to drug abuse and addiction.
        NODA supports a comprehensive research portfolio that spans the
    continuum of basic neuroscience, behavior and genetics research through
    applied health services research and epidemiology. While supporting
    research on the positive effects of evidence-based prevention and
    treatment efforts, NIDA also recognizes the need to keep pace with
    emergent problems. Research shows encouraging trends that NIDA's public
    education and awareness efforts are having an impact: For example, the
    2005 Monitoring the Future Survey of 8th, 10th, and 12th graders shows
    a dramatic 19 percent reduction in use since 2001. However, areas of
    significant concern remain. Some of NIDA's current research priorities
    include understanding more about methamphetamine and the brain,
    addressing the growing problem of prescription drug abuse, using drug
    abuse treatment to curtail the spread of HIV/AIDS, and encouraging
    collaborations that address comorbidity.
        Because of the critical importance of drug abuse research for the
    health and economy of our Nation, we write to you today to request your
    support for a 5 percent increase for NIDA in the fiscal 2007 Labor,
    Health and Human Services, Education and Related Agencies
    Appropriations bill. That would bring total funding for NIDA in fiscal
    2007 to $1,050,030,450. Recognizing that so many health research issues
    are inter-related, we also support a 5 percent increase for the
    National Institutes of Health overall, which would bring its total to
    $30 billion for fiscal 2007, This work deserves continuing, strong
    support from Congress. Below is a short list of significant NIDA
    accomplishments, challenges, and successes.
        Adolescent Brain Development--How Understanding the Brain Can
    Impact Prevention Efforts.--NIDA maintains a vigorous developmental
    research portfolio focused on adolescent populations. NIDA working
    collaboratively with other NIH Institutes has shown that the human
    brain does not fully develop until about age 25. This adds to the
    rationale for referring to addiction as a ``developmental disease;'' it
    often starts during the early developmental stages in adolescence and
    sometimes as early as childhood, a time when we know the brain is still
    developing. Having insight into how the human brain works, and
    understanding the biological underpinnings of risk taking among young
    people will help in developing more effective prevention programs. FoN
    believes NIDA should continue its emphasis on studying adolescent brain
    development to better understand how developmental processes and
    outcomes are affected by drug exposure, the environment and genetics.
        Medications Development.--NIDA has demonstrated leadership in the
    field of medications development by partnering with private industry to
    develop anti-addiction medications resulting in a new medication,
    buprenorphine, for opiate addiction. FoN recommends that NIDA continue
    its work with the private sector to develop much needed anti-addiction
    medications, for cocaine, methamphetamine, and marijuana dependence.
        Co-Occurring Disorders.--NIDA recognizes the need to to adequately
    address research questions related to co-occurring substance abuse and
    mental health problems. In particular, NIDA has developed robust
    collaborations with other agencies (such as NIAAA, NIMH and SAMHSA) to
    stimulate new research to develop effective strategies and to ensure
    the timely adoption and implementation of evidence-based practices for
    the prevention and treatment of co-occurring disorders. Through these
    initiatives, NIDA is supporting research to determine the most
    effective models of clinically appropriate treatment and how to bring
    them to communities with limited resources. FoN recognizes the
    imperative for continued funding of essential research into the nature
    of and improved treatment for these complex disorders and endorses
    these efforts.
        Drug Abuse and HIV/AIDS.--One of the most significant causes of HIV
    virus acquisition and transmission involves drug taking practices and
    related risk factors in different populations (e.g. criminal justice,
    pregnant women, minorities, and youth). Drug abuse prevention and
    treatment interventions have been shown to be effective in reducing HIV
    risk. FoN congratulates NIDA on its ``Drug Abuse and HIV--Learn the
    Link'' public awareness campaign, targeting young people, and believes
    NIDA should continue to support research that focuses on developing and
    testing drug-abuse related interventions designed to reduce the spread
    of HIV/AIDS.
        Emerging Drug Problems.--NIDA recognizes that drug use patterns are
    constantly changing and expends considerable effort to monitor drug use
    trends and to rapidly inform the public of emerging drug problems. FoN
    believes NIDA should continue supporting research that provides
    reliable data on emerging drug trends, particularly among youth and in
    major cities across the country and will continue its leadership role
    in alerting communities to new trends and creating awareness about
    these drugs.
        Reducing Prescription Drug Abuse.--NIDA research has documented
    continued increases in the numbers of people, especially young people,
    who use prescription drugs for non-medical purposes. Particular concern
    revolves around the inappropriate use of opiod analgesics--very
    powerful pain medications. FoN commends NIDA for its research focus in
    this area, and for the new Prescription Opioid Use and Abuse in the
    Treatment of Pain initiative. Research targeting a reduction in
    prescription drug abuse, particularly among our Nation's youth, will
    continue to be a priority for NIDA. Finally, FoN endorses NIDA's
    programmatic research designed to further the development of
    medications that are less likely to have abuse/addiction liability, and
    to develop prevention and treatment interventions for adolescents and
    adults who are abusing prescription drugs.
        Reducing Methamphetamine Abuse.--NIDA continues to recognize the
    epidemic abuse of methamphetamine across the United States.
    Methamphetamine abuse not only affects the users, but also the
    communities in which they live, especially due to the dangers
    associated with its production. FoN believes NIDA should continue to
    support research to address the broad medical consequences of
    methamphetamine abuse, and is encouraged by the evidence of treatment
    effectiveness in these populations. Topics of particular concern
    include: understanding the effects of prenatal exposure to
    methamphetamine, developing pharmacotherapies and behavioral therapies
    to treat methamphetamine addiction and information dissemination
    strategies to inform the public that treatment for methamphetamine
    addiction is effective.
        Reducing Inhalant Abuse.--FoN recognizes that inhalant use
    continues to be a significant problem among our youth. Inhalants pose a
    particularly significant problem since they are readily accessible,
    legal, and inexpensive. They also tend to be abused by younger teens
    and can be highly toxic and even lethal. FoN applauds NIDA's inhalant
    research portfolio and believes NIDA should continue its support of
    research on prevention and treatment of inhalant abuse, and to enhance
    public awareness on this issue.
        Long-Term Consequences of Marijuana Use.--NIDA research shows that
    marijuana can be detrimental to educational attainment, work
    performance, and cognitive function. However, more information is
    needed in order to assess the full impact of long-term marijuana use.
    Therefore, FoN recommends that NIDA continue to support efforts to
    assess the long-term consequences of marijuana use on cognitive
    abilities, achievement, and mental and physical health, as well as work
    with the private sector to develop medications focusing on marijuana
    addiction.
        Translating Research Into Practice.--FoN commends NIDA for its
    outreach and work with State substance abuse authorities to reduce the
    current 15- to 20-year lag between the discovery of an effective
    treatment intervention and its availability at the community level. In
    particular, FoN applauds NIDA for continuing its work with SAMHSA to
    strengthen State substance abuse agencies' capacity to support and
    engage in research that will foster statewide adoption of meritorious
    science-based policies and practices. FoN encourages NIDA to continue
    collaborative work with State substance abuse agencies to ensure that
    research findings are relevant and adaptable by State substance abuse
    systems. NIDA is also to be congratulated for its broad and varied
    information dissemination programs as part of an effort to ensure drug
    abuse research is used in everyday practice. The Institute is focused
    on stimulating and supporting innovative research to determine the
    components necessary for adopting, adapting, delivering, and
    maintaining effective research-supported policies, programs, and
    practices. As evidence-based strategies are developed, FoN urges NIDA
    to support research to determine how these practices can be best
    implemented at the community level.
        Primary Care Settings and Youth.--NIDA recognizes that primary care
    settings, such as offices of pediatricians and general practitioners,
    are potential key points of access to prevent and treat problem drug
    use among young people; yet primary care and drug abuse services are
    commonly delivered through separate systems. FoN encourages NIDA to
    continue to support health services research on effective ways to
    educate primary care providers about drug abuse; develop brief
    behavioral interventions for preventing and treating drug use and
    related health problems, particularly among adolescents; and develop
    methods to integrate drug abuse screening, assessment, prevention and
    treatment into primary health care settings.
        Utilizing Knowledge of Genetics and New Technological Advances to
    Curtail Addiction.--NIDA recognizes that not everyone who takes drugs
    becomes addicted and that this is an important phenomenon worthy of
    further exploration. Research has shown that genetics plays a critical
    role in addiction, and that the interplay between genetics and
    environment is crucial. The science of genetics is at a crucial phase--
    technological advances are providing the tools to make significant
    breakthroughs in disease research. For example, FoN believes NIDA
    should take advantage of new high-resolution genetic technologies which
    may help to develop new tailored treatments for smoking.
        Reducing Health Disparities.--NIDA research demonstrates that the
    consequences of drug abuse disproportionately impacts minorities,
    especially African American populations. FoN believes that researchers
    should be encouraged to conduct more studies in this population and to
    target their studies in geographic areas where HIV/AIDS is high and or
    growing among African Americans, including in criminal justice
    settings.
        The Clinical Trials Network--Using Infrastructure to Improve
    Health.--FoN applauds the continued success of NIDA's National Drug
    Abuse Treatment Clinical Trials Network (CTN), which was established in
    1999 and has grown to include over 17 research centers or nodes spread
    across the country. The CTN provides an infrastructure to test the
    effectiveness of new and improved interventions in real-life community
    settings with diverse populations, enabling an expansion of treatment
    options for providers and patients. FoN suggests NIDA continue to
    develop ways to use the CTN as a vehicle to address emerging public
    health needs.
        Behavioral Science.--NIDA has long demonstrated a strong commitment
    to supporting behavioral science research. FoN encourages NIDA to
    continue to determine the interplay of behavioral, biological, and
    social factors that affect development and the onset of diseases like
    drug addiction to understand common pathways that may underlie other
    compulsive behaviors such as gambling and eating disorders.
        Drug Treatment in Criminal Justice Settings.--NIDA is very
    concerned about the well-known connections between drug use and crime.
    Research continues to demonstrate that providing treatment to
    individuals involved in the criminal justice system decreases future
    drug use and criminal behavior, while improving social functioning.
    Blending the functions of criminal justice supervision and drug abuse
    treatment and support services create an opportunity to have an optimal
    impact on behavior by addressing public health concerns while
    maintaining public safety. FoN strongly supports NIDA's efforts in this
    area, particularly the Criminal Justice Drug Abuse Treatment Studies
    (CJ-DATS), a multi-site set of research studies designed to improve
    outcomes for offenders with substance use disorders by improving the
    integration of drug abuse treatment with other public health and public
    safety systems.
        Social Neuroscience.--Research-based knowledge about the dynamic
    interactions of genes with environment confirm addiction as a complex
    and chronic disease of the brain with many contributors to its
    expression in individuals. FoN applauds NIDA's involvement in the
    recently released ``social neuroscience'' request for applications, and
    encourages the Institute to continue its focus on the interplay between
    genes, environment, and social factors and their relevance to drug
    abuse and addiction.
        Translational Research: Ensuring Research is Adaptable and
    Useable.--FoN commends NIDA for its broad and varied information
    dissemination programs. FoN also understands that the Institute is
    focused on stimulating and supporting innovative research to determine
    the components necessary for adopting, adapting, delivering, and
    maintaining effective research-supported policies, programs, and
    practices. As evidence-based strategies are developed, FoN urges NIDA
    to support research to determine how these practices can be best
    implemented at the State and community level.
        Blending Research and Practice.--FoN notes that it takes far too
    long for clinical research results to be implemented as part of routine
    patient care, and that this lag in diffusion of innovation is costly
    for society, devastating for individuals and families, and wasteful of
    knowledge and investments made to improve the health and quality of
    people's lives. FoN applauds NIDA's collaborative approach aimed at
    proactively involving all entities invested in changing the system and
    making it work better. NIDA is leading efforts to make the best
    substance abuse treatments available to those who need them, and this
    effort requires working with many different contributors to assimilate
    their feedback and create change at multiple levels.
                                   conclusion
        The Nation's investment in scientific research has changed the way
    people view drug abuse and addiction in this country. We now know how
    drugs work in the brain, their health consequences, how to treat people
    already addicted, and what constitutes effective prevention strategies.
    FoN asks you to provide an appropriation of $1,050,030,450 for NIDA, so
    that it may continue to serve the public health of all Americans and
    capitalize on new opportunities as science advances.
        We understand that the fiscal year 2007 budget cycle will involve
    setting priorities and accepting compromise. However, in the current
    climate, we believe a focus on substance abuse and addiction, which
    according to the World Health Organization account for nearly 20
    percent of disabilities among 15-44 year olds, deserve to be
    prioritized accordingly. We look forward to working with you to make
    this a reality.
        Thank you, Mr. Chairman, and the subcommittee, for your support for
    the National Institute on Drug Abuse.
                                     ______

                 Prepared Statement of the Heart Rhythm Society
        The Heart Rhythm Society (HRS) thanks you and the Subcommittee on
    Labor, Health and Human Services and Education for your past and
    continued support of the National Institute of Health, and specifically
    the National Heart, Lung and Blood Institute (NHLBI).
        The Heart Rhythm Society, founded in 1979 to address the scarcity
    of information about the diagnosis and treatment of cardiac
    arrhythmias, is the international leader in science, education and
    advocacy for cardiac arrhythmia professionals and patients, and the
    primary information resource on heart rhythm disorders. The Heart
    Rhythm Society serves as an advocate for millions of American citizens
    from all 50 States, since arrhythmias are the leading cause of heart-
    disease related deaths. Other, less lethal forms of arrhythmias are
    even more prevalent, account for 14 percent of all hospitalizations of
    Medicare beneficiaries.\1\ Our mission is to improve the care of
    patients by promoting research, education and optimal health care
    policies and standards. We are the preeminent professional group,
    representing more than 4,200 specialists in cardiac pacing and
    electrophysiology.
    ---------------------------------------------------------------------------
        \1\ Heart Rhythm Foundation, Arrhythmia Key Facts, 2004 http://
    www.heartrhythmfoundation.org/facts/arrhythmia.asp.
    ---------------------------------------------------------------------------
        The Heart Rhythm Society recommends the subcommittee renew its
    commitment to supporting biomedical research in the United States and
    recommends Congress provide NIH with a 5 percent increase for fiscal
    year 2007. This translates into an appropriation of $29.849 billion for
    NIH, with $3.068 billion designated to the National Heart, Lung, and
    Blood Institute (NHLBI). This increase will enable NIH and NHLBI to
    sustain the level of research that leads to research breakthroughs and
    improved health outcomes. In particular, the Heart Rhythm Society
    recommends Congress support research into abnormal rhythms of the
    heart.
        HRS appreciates the actions of Congress to double the budget of the
    NIH in recent years. The doubling has directly promoted innovations
    that have improved treatments and cures for a myriad of medical
    problems facing our Nation. Medical research is a long-term process and
    in order to continue to meet the evolving challenges of improving human
    health we must not let our commitment wane. Furthermore, NIH research
    fuels innovation that generates economic growth and preserves our
    Nation's role as a world leader in the biomedical and biotech
    industries. Healthier citizens are the key to robust economic growth
    and greater productivity. Economists estimate that improvements in
    health from 1970 to 2000 were worth $95 trillion. During the same time
    period, the United States invested $200 billion in the NIH. If only 10
    percent of the overall health savings resulted from NIH-funded
    research, our investment in medical research has provided a 50-fold
    return to the economy.\2\
    ---------------------------------------------------------------------------
        \2\ Murphy, KM and Topel, RH, The Value of Health and Longevity,
    National Bureau of Economic Research Working Paper Series, Working
    Paper 11405, June 2005.
    ---------------------------------------------------------------------------
                            research accomplishments
        In the field of cardiac arrhythmias, NIH-funded research has
    advanced our ability to treat atrial fibrillation and thus prevent the
    devastating complications of stroke. Atrial fibrillation is found in
    about 2.2 million Americans and increases the risk for stroke about 5-
    fold. About 15-20 percent of strokes occur in people with atrial
    fibrillation. Stroke is a leading cause of serious, long-term
    disability in the United States and people who have strokes caused by
    AF have been reported as 2-3 times more likely to be bedridden compared
    to those who have strokes from other causes. Each year about 700,000
    people experience a new or recurrent stroke and in 2002 stroke
    accounted for more than 1 of every 15 deaths in the United States.
    Ablation therapy however is providing a cure for individuals whose
    rapid heart rates had previously incapacitated them, giving them a new
    lease on life.\3\
    ---------------------------------------------------------------------------
        \3\ American Stroke Association and American Heart Association,
    Heart Disease and Stroke Statistics_2005 Update, 2005 http://
    www.americanheart.org/downloadable/heart/
    1105390918119HDSStats2005Update.pdf.
    ---------------------------------------------------------------------------
        Important advances have also been made in identifying patients with
    heart failure and those who have suffered a heart attack and are at
    risk for sudden death. The development, through initial NIH-sponsored
    research, and implantation of sophisticated internal cardioverter
    defibrillators (ICD's) in such patients has saved the lives of hundreds
    of thousands and provides peace of mind for families everywhere,
    including that of Vice-President Cheney's. A new generation of
    pacemakers and ICDs is restoring the beat of the heart as we grow
    older, permitting us to lead more normal and productive lives, reducing
    the burden on our families, communities and the healthcare system.
    Arrhythmias and sudden death affect all age groups and are not solely
    diseases of the elderly.
        Research advances in molecular genetics have provided us the root
    basis for life-threatening abnormal rhythms of the heart associated
    with of wide range of inherited syndromes including long and short QT,
    Brugada syndromes, and hypertrophic cardiomyopathies. This knowledge
    has provided guidance to physicians for better detection and treatment
    of these sudden death syndromes reducing mortality and disability of
    infants, children and young adults. Individuals who survive an instance
    of sudden death often remain in vegetative states, resulting in a
    devastating burden on their families and an enormous economic burden on
    society. These advances have translated into sizeable savings to the
    health care system in the United States. Researchers are also
    developing a noninvasive imaging modality for cardiac arrhythmias.
    Despite the fact that more than 325,000 Americans die every year from
    heart rhythm disorders, a noninvasive imaging approach to diagnosis and
    guided therapy of arrhythmias, the equivalent of CT or MRI, has
    previously not been available.
        The NIH-funded Public Access Defibrillation (PAD) Trial was also
    able to determine that trained community volunteers increase survival
    for victims of cardiac arrest. It had already been known that
    defibrillation, utilizing an automated external defibrillator (AED), by
    trained public safety and emergency medical services personnel is a
    highly effective live-saving treatment for cardiac arrest. A NIH-funded
    trial however was able to conclude that placing AED's in public places
    and training lay persons to use them can prevent additional deaths and
    disabilities.\4\
    ---------------------------------------------------------------------------
        \4\ National Heart Lung and Blood Institute, NIH, Public Access
    Defibrillation by Trained Community Volunteers Increases Survival for
    Victims of Cardiac Arrest, November 2003 http://www.nhlbi.nih.gov/new/
    press/03_11_11.htm.
    ---------------------------------------------------------------------------
        Without NIH support, these life-saving findings may have taken a
    decade to unravel. The highly focused approach utilizing basic and
    clinical expertise, funded through Federal programs made these advances
    a reality in a much shorter time-period.
                              budget justification
        These impressive strides notwithstanding, cardiac arrhythmias
    continue to plague our society and take the lives of loved ones at all
    ages, nearly one every minute of every day, as well as straining an
    already burdened health system. Sudden Cardiac Arrest is a leading
    cause of death in the United States, claiming an estimated 325,000
    lives every year, or one life every two minutes.\5\ The burden of
    morbidity and mortality due to cardiac arrhythmias is predicted to grow
    dramatically as the baby boomers age. Atrial fibrillation strikes 3-5
    percent of people over the age of 65,\6\ presenting a skyrocketing
    economic burden to our society in the form of healthcare treatment and
    delivery. It is estimated in 2005 that the direct and indirect cost of
    stroke will be $56.8 billion.\7\ Cardiac diseases of all forms increase
    with advancing age, ultimately leading to the development of
    arrhythmias. NIH research provides the basis for the medical advances
    that hold the key to lowering health care costs.
    ---------------------------------------------------------------------------
        \5\ Heart Rhythm Foundation, The Facts on Sudden Cardiac Arrest,
    2004 http://www.heartrhythmfoundation.org/its_about_time/pdf/
    provider_fact_sheet.pdf.
        \6\ Heart Rhythm Society, Atrial Fibrillation & Flutter, 2005_ttp:/
    /www.hrspatients.org/patients/heart_disorders/atrial_fibrillation/
    default.asp.
        \7\ American Stroke Association, Impact of Stroke, 2005 http://
    www.strokeassociation.org/presenter.jhtml?identifier=1033.
    ---------------------------------------------------------------------------
        The above progress we have witnessed in recent years will provide
    treatments for this illness, only if the resources continue to be
    available to the academic scientific and medical community. However,
    the budgets appropriated by Congress to the NIH in the past three years
    were far below the level of scientific inflation. These vacillations in
    funding cycles threaten the continuity of the research and the momentum
    that has been gained over the years. While HRS recognizes that Congress
    must balance other priorities, sustaining multi-year growth for the
    biomedical research enterprise is critical. A central objective of the
    doubling of the NIH budget was to accelerate solutions to human disease
    and disability. NIH is now engaging in the next generation of
    biomedical research to translate basic research and clinical evidence
    into new cures. Our ability to bring together uniquely qualified and
    devoted investigators and collaborators both at the basic science level
    and in the clinical arena is a vital key to our to this success.
    Funding models however show that a threshold exists, below which NIH
    will not be able to maintain its current scope and number of grants,
    let alone expand its programs to address new concerns and emerging
    opportunities. Furthermore, the United States is in danger of losing
    its leadership role in science and technology. The United States faces
    growing competition from other nations, such as China and India, which
    are working to invest more of their GDP's into building state-of-the-
    art research institutes and universities to foster innovation and
    compete directly for the world's top students and researchers.\8\
    ---------------------------------------------------------------------------
        \8\ Task Force on the Future of American Innovation, The Knowledge
    Economy: Is the United States Losing it's Competitive Edge?, February
    16, 2005.
    ---------------------------------------------------------------------------
        It is for this reason that we are asking for your support to
    increase NIH appropriations by 5 percent for a fiscal year 2007 budget
    of $29.849 billion for NIH and $3.068 billion for NHLBI. The Heart
    Rhythm Society recommends Congress specifically acknowledge the need
    for cardiac arrhythmia research to prevent sudden cardiac arrest and
    other life threatening conditions such as sudden infant death syndrome,
    definitive therapeutic approaches for atrial fibrillation and the
    prevention of stroke, and other genetic arrhythmia conditions. Thank
    you very much for your consideration of our request.
        If you have any questions or need additional information, please
    contact Nevena Minor, Coordinator, Health Policy at the Heart Rhythm
    Society (amelnick@hrsonline.org or 202-464-3434).
        Thank you again for the opportunity to submit testimony.
                                     ______

           Prepared Statement of the Hemophilia Federation of America
                  summary of fiscal year 2007 recommendations
      --Continued support for Hemophilia Treatment Centers through the
            Health Resources and Services Administration Maternal and Child
            Health Block Grant.
      --$10 million for hemophilia programs at the Centers for Disease
            Control and Prevention and expansion of the program to allow
            partnerships with additional patient-based organizations within
            the hemophilia community.
      --A 5 percent increase overall for the National Institutes of Health,
            including a 5 percent increase for the National Heart, Lung,
            and Blood Institute, and the National Institute for Allergy and
            Infectious Diseases.
                                  introduction
        The Hemophilia Federation of America (HFA) is a national nonprofit
    organization that assists and advocates for the blood clotting
    disorders community. The vision of the HFA is that the blood clotting
    disorders community will face no barriers to choice of treatment and
    quality of life.
        The programming of HFA is designed to be of assistance to the
    consumer and their families and is structured to follow our mission and
    vision. We at HFA consider ourselves the ``consumer organization.''
    That was the purpose of our organization when we were established a
    decade ago and it has remained constant in the structure and activities
    of the organization. The following is a summary of some of the programs
    that HFA offers to the hemophilia community:
    ``Helping Hands''
        Helping Hands is a program that offers financial assistance to
    patients and families in a crisis. The grant applicant requests funds
    for emergency assistance with various needs such as: rent, utilities,
    car repair, and quality of life issues. Over one half of the requests
    funded in recent years were first time applicants. The requests are
    comprised of referrals from member organizations and industry.
    ``Dads in Action''
        Dads in Action is a new program launched in the fall of 2003 that
    is designed to encourage dads to take a more active role in their
    children's lives, to be more involved in the care of their child with
    hemophilia and to strengthen communication throughout the family.
    Participants return to their home chapters to start a ``Dads in
    Action'' program where they carry the lessons learned to fellow Dads at
    their local chapter. The program receives high reviews from
    participants and is an integral part of our vision for the community.
    The Annual HFA Symposium
        HFA's annual Symposium is one of the brightest stars in our
    programmatic agenda. This event has grown from a small gathering of 100
    people in 1996 to over 500 in 2006. Are sole focus at this annual event
    is the consumer. Our patients view that annual symposium as a big
    family reunion where they learn how to cope with everyday situations.
    There are also free programs for teens and children. The goal of the
    Symposium is to address issues that impact the entire community.
    Presenters are experts in their field and share their expertise with
    the community.
                fiscal year 2007 appropriations recommendations
    Hemophilia Treatment Centers/Health Resources and Services
            Administration
        In 1974, Congress created a network of Hemophilia Treatment Centers
    (HTCs) throughout the United States. This treatment centers remain
    essential to ensuring that comprehensive and specialized care is
    available for persons with bleeding disorders. There are currently over
    140 HTCs in the United States. These centers abide by Federal
    guidelines for the delivery of comprehensive hemophilia services as
    developed by the Health Resources and Services Administration and the
    Centers for Disease Control and Prevention.
        HTC's provide family centered, state-of-the-art medical and
    psychosocial services, as well as education and research to persons
    with inherited bleeding disorders. The bleeding disorder community
    utilizes many services through the Hemophilia Treatment Centers. These
    services include diagnostic evaluations for hemophilia, von Willebrand
    disease and other bleeding disorders. They also include annual
    comprehensive evaluations, clinical trials on new blood clotting
    therapies, coordination with the individual's primary care physician,
    emergency consultations, hematological management for surgeries, dental
    procedures and childbirth. HTC's educate patients and family members on
    infusion training, encourage collaboration with clinicians throughout
    the United States, participate in CDC research, and collaborate with
    the hemophilia community.
        At the Health Resources and Services Administration, funding is
    provided to HTC's through the Maternal and Child Health Block Grant
    program. For fiscal year 2007, HFA encourages the subcommittee to
    reject the president's proposed $36 million cut to MCHBG, and restore
    funding to the fiscal year 2006 level of $816 million.
    Hemophilia Program at the Centers for Disease Control and Prevention
        Mr. Chairman, HFA strongly supports the expansion of hemophilia
    related programs within CDC's National Center on Birth Defects and
    Developmental Disabilities' Hereditary Blood Disorders program. In
    partnership with HRSA, this program provides vital support to
    Hemophilia Treatment Centers, particularly in the areas of research,
    education, disease management, blood safety and surveillance. For
    fiscal year 2007, HFA encourages the subcommittee to provide an
    increase of $3 million for hemophilia related activities at CDC. This
    proposed increase would bring the total level of CDC funding for the
    hemophilia treatment center network to $10 million. This increase is
    important given the fact the program has been level funded for over 10
    years.
        HFA was very pleased that the fiscal year 2006 Senate Labor-HHS-
    Education committee report encouraged CDC to expand opportunities for
    additional patient-based organizations to participate in the agency's
    hemophilia program. Under the current structure of the program, only
    one hemophilia organization is eligible to receive support for the
    purpose of providing much needed services to patients. In order to
    maximize the effectiveness of the CDC program, we believe that
    additional patient based organizations should be empowered to receive
    funding on an annual basis. As referenced earlier, HFA offers a wide
    variety of high quality, consumer focused, programs that no other
    organization provides. If the CDC program were opened-up to allow
    additional organizations to participate, we would be able to help a
    much larger number of patients and families throughout the country. We
    encourage the subcommittee to support our efforts in this regard in the
    fiscal year 2007 bill.
    Research at the National Institutes of Health
        HFA applauds the National Heart, Lung and Blood Institute, the
    National Institute of Diabetes and Digestive and Kidney Diseases, and
    the National Institute of Allergy and Infectious Diseases for their
    strong support of hemophilia related research. We are grateful to the
    subcommittee for recognizing the growing problem of bleeding disorders
    in women, which if untreated, can lead to serious medical conditions
    including anemia, unnecessary hysterectomies, and menstrual
    complications.
        Patients and families in the hemophilia community are placing their
    hopes for a better quality of life on treatment advances made through
    biomedical research. For fiscal year 2007, we encourage the
    subcommittee to provide a 5 percent increase overall for each institute
    and center at the NIH.
        Mr. Chairman, thank you for the opportunity to present the views of
    the Hemophilia Federation of America.
                                     ______

            Prepared Statement of Hepatitis Foundation International
                  summary of fiscal year 2007 recommendations
      --Continue the great strides in research at the National Institutes
            of Health (NIH) by providing a 5 percent budget increase for
            fiscal year 2007. Increase funding for the National Institute
            for Allergy and Infectious Diseases (NIAID), the National
            Institute of Diabetes and Digestive and Kidney Diseases
            (NIDDK), the National Institute on Alcohol Abuse and Alcoholism
            (NIAAA), and the National Institute on Drug Abuse (NIDA) by 5
            percent.
      --Continued support for the hepatitis B vaccination program for
            adults at the Centers for Disease Control and Prevention (CDC)
            as well as CDC's Prevention Research Centers by providing an 8
            percent increase for CDC.
      --Support for the Substance Abuse and Mental Health Services
            Administration (SAMHSA) by providing an 8 percent increase in
            fiscal year 2007.
      --Urge CDC, NIAID, NIDDK, NIAAA, NIDA, and SAMHSA to work with
            voluntary health organizations to promote liver wellness,
            education, and prevention of both hepatitis and substance
            abuse.
        Mr. Chairman and members of the subcommittee, thank you for your
    continued leadership in promoting better research, prevention,
    education, and control of diseases affecting the health of our Nation.
    I am Thelma King Thiel, Chairman and Chief Executive Officer of the
    Hepatitis Foundation International (HFI).
        Currently, five types of viral hepatitis have been identified,
    ranging from type A to type E. All of these viruses cause acute, or
    short-term, viral hepatitis. Hepatitis B, C, and D viruses can also
    cause chronic hepatitis, in which the infection is prolonged, sometimes
    lifelong. While treatment options are available for many patients,
    individuals with chronic viral hepatitis B and C represent a
    significant number of patients requiring a liver transplant. Current
    treatments have limited success and there is no vaccine available for
    hepatitis C, the most prevalent of these diseases.
                                  hepatitis a
        The hepatitis A virus (HAV) is contracted through fecal/oral
    contact (i.e. fecal contamination of food, water, and diaper changing
    tables if not cleaned properly), and sexual contact. In addition,
    eating raw or partially cooked shellfish contaminated with HAV can
    spread the virus. Children with HAV usually have no symptoms; however,
    adults may become quite ill suddenly experiencing jaundice, fatigue,
    nausea, vomiting, abdominal pain, dark urine/light stool, and fever.
    There is no treatment for HAV; however, recovery occurs spontaneously
    over a 3 to 6 month period. About 1 in 1,000 with HAV suffer from a
    sudden and severe infection that may require a liver transplant. A
    highly effective vaccine can prevent HAV. This vaccination is
    recommended for all children and individuals who have chronic liver
    disease or clotting factor disorders, in addition to those who travel
    or work in developing countries.
                                  hepatitis b
        Hepatitis B (HBV) claims an estimated 5,000 lives every year in the
    United States, even though therapies exist that slow the progression of
    liver damage. Vaccines are available to prevent hepatitis B. This
    disease is spread through contact with the blood and body fluids of an
    infected individual and from an HBV infected mother to child at birth.
    Unfortunately, due to both a lack in funding to vaccinate adults and
    the absence of an integrated preventive education strategy,
    transmission of hepatitis B continues to be problematic. Additionally,
    there are significant disparities in the occurrence of chronic HBV-
    infections. Asian Americans represent four percent of the population;
    however, they account for over half of the 1.3 million chronic
    hepatitis B cases in the United States. Current treatments do not cure
    hepatitis B, but appropriate treatment can help to reduce the
    progression to liver cancer and liver failure. Yet, many are not
    treated. Preventive education and universal vaccination are the best
    defenses against hepatitis B.
                                  hepatitis c
        Infection rates for hepatitis C (HCV) are at epidemic proportions.
    Unfortunately, many individuals are not aware of their infection until
    many years after they are infected. This creates a vicious cycle, as
    individuals who are infected continue to spread the disease,
    unknowingly. The Center for Disease Control and Prevention estimates
    that there are over 4 million Americans who have been infected with
    hepatitis C, of which over 2.7 million remain chronically infected,
    with 8,000-10,000 deaths each year. Additionally, the death rate is
    expected to triple by 2010 unless additional steps are taken to improve
    outreach and education on the prevention of hepatitis C and scientists
    identify more effective treatments and cures. As there is no vaccine
    for HCV, prevention education and treatment of those who are infected
    serve as the most effective approach in halting the spread of this
    disease.
                             prevention is the key
        The absence of information about the liver and hepatitis in
    education programs over the years has been a major factor in the spread
    of viral hepatitis through unknowing participation in liver damaging
    activities. Adults and children need to understand the importance of
    the liver and how viruses and drugs can damage its ability to keep them
    alive and healthy. Many who are currently infected are unaware of the
    risks they are taking that expose them to viral infections and ultimate
    liver damage.
        Knowledge is the key to prevention. Preventive education is
    essential to motivate individuals to protect themselves and avoid
    behaviors that can cause life-threatening diseases. Primary prevention
    that encourages individuals to adopt healthful lifestyle behaviors must
    begin in elementary schools when children are receptive to learning
    about their bodies. Schools provide access to one-fifth of the American
    population.
        Individuals need to be motivated to assess their own risk
    behaviors, to seek testing, to accept vaccination, to avoid spreading
    their disease to others, and to understand the importance of
    participating in their own health care and disease management. The NIH
    needs to support education programs to train teachers and healthcare
    providers in effective communication techniques, and to evaluate the
    impact preventive education has on reducing the incidence of hepatitis
    and substance abuse.
        Therefore, HFI recommends that CDC, NIAID, NIDDK, NIAAA, NIDA, and
    SAMHSA be urged to work with voluntary health organizations to promote
    liver wellness, education, and prevention of viral hepatitis, sexually
    transmitted diseases and substance abuse.
        Only a major investment in immunization and preventive education
    will bring these diseases under control. All newborns, young children,
    young adults, and especially those who participate in high-risk
    behaviors must be a priority for immunization, outreach initiatives,
    and preventive education. We recommend that the following activities be
    undertaken to prevent the further spread of all types of hepatitis:
      --Provide effective preventive education in our elementary and
            secondary schools so children can avoid the serious health
            consequences of risky behaviors that can lead to viral
            hepatitis.
      --Train educators, health care professionals, and substance abuse
            counselors in effective communication and counseling
            techniques.
      --Promote public awareness campaigns to alert individuals to assess
            their own risk behaviors, motivate them to seek medical advice,
            encourage immunization against hepatitis A and B, and to stop
            the consumption of any alcohol if they have participated in
            risky behaviors that may have exposed them to hepatitis C.
      --Expand screening, referral services, medical management,
            counseling, and prevention education for individuals who have
            HCV, many of whom may be co-infected with HIV and Hepatitis C
            and/or Hepatitis B.
                centers for disease control and prevention (cdc)
        HFI recommends an 8 percent increase in fiscal year 2007 for
    further implementation of CDC's Hepatitis C Prevention Strategy. This
    increase will support and expand the development of State-based
    prevention programs by increasing the number of State health
    departments with CDC funded hepatitis coordinators. The Strategy will
    use the most cost-effective way to implement demonstration projects
    evaluating how to integrate hepatitis C and hepatitis B prevention
    efforts into existing public health programs.
        CDC's Prevention Research Centers, an extramural research program,
    plays a critical role in reducing the human and economic costs of
    disease. Currently, CDC funds 26 prevention research centers at schools
    of public health and schools of medicine across the country. HFI
    encourages the subcommittee to increase core funding for these
    prevention centers, as it has been decreasing since this program was
    first funded in 1986. We recommend the subcommittee provide an 8
    percent increase for the Prevention Research Centers program in fiscal
    year 2007.
        Also, HFI recommends that the CDC, particularly the Division of
    Adolescent and School Health (DASH), work with voluntary health
    organizations to promote liver wellness with increased attention toward
    childhood education and prevention.
                            investments in research
        Investment in the NIH has led to an explosion of knowledge that has
    advanced understanding of the biological basis of disease and
    development of strategies for disease prevention, diagnosis, treatment,
    and cures. Countless medical advances have directly benefited the lives
    of all Americans. NIH-supported scientists remain our best hope for
    sustaining momentum in pursuit of scientific opportunities and new
    health challenges. For example, research into why some HCV infected
    individuals resolve their infection spontaneously may prove to be life
    saving information for others currently infected. Other areas that need
    to be addressed are:
      --Reasons why African Americans do not respond as well as Caucasians
            and Hispanics to antiviral agents in the treatment of chronic
            hepatitis C.
      --Pediatric liver diseases, including viral hepatitis.
      --The outcomes and treatment of renal dialysis patients who are
            infected with HCV and HBV.
      --Co-infections of HIV/HCV and HIV/HBV positive patients.
      --Hemophilia patients who are co-infected with HIV/HCV and HIV/HBV.
      --The development of effective treatment programs to prevent
            recurrence of HCV infection following liver transplantation.
      --The development of effective vaccines to prevent HCV infection.
        HFI supports a 5 percent increase for NIH in fiscal year 2007. HFI
    also recommends a comparable increase of 5 percent in hepatitis
    research funding at NIAID, NIDDK, NIAAA, and NIDA.
        HFI is dedicated to the eradication of viral hepatitis, which
    affects over 500 million people around the world. We seek to raise
    awareness of this enormous worldwide problem and to motivate people to
    support this important--and winnable--battle. Thank you for providing
    this opportunity to present testimony.
                                     ______

                  Prepared Statement of In Defense of Animals
        Six years ago, In Defense of Animals (IDA) testified before
    Congress about the NIH's egregious oversight failures and illegal
    funding of the New Mexico-based Coulston Foundation, at the time the
    world's largest chimpanzee lab. IDA testified about Coulston's abysmal
    animal care record and unprecedented violations, dating back to 1993,
    of Federal animal welfare laws. IDA recommended, among other things, a
    Congressional investigation.
        Within weeks of IDA's March 2000 testimony, the NIH took ownership
    of 288 chimpanzees from Coulston, citing concerns about the lab's
    resources and ability to properly care for the animals, which IDA had
    raised in our testimony. The NIH left the chimpanzees in Coulston's
    ``care'' and continued to illegally fund the lab despite its continued
    animal welfare violations.
        The NIH's Coulston oversight debacle resulted in international
    media coverage, public outrage and intense Congressional scrutiny. As a
    result, the NIH was finally forced to end its illegal funding of
    Coulston in June 2001. The agency took over ownership of the lab where
    the 288 chimpanzees were housed, renamed it the ``Alamogordo Primate
    Facility'' (APF), and awarded a ten-year, $42 million taxpayer-funded
    contract to Charles River Laboratories (CRL) to operate it. However,
    the APF was now NIH-owned and part of the agency's Intramural Research
    Program; the contract between the NIH and CRL explicitly states that
    the NIH is responsible for ``day-to-day management'' of the lab,
    including its ``associated animal activities.''
        Subsequently, the House Committee on Energy and Commerce conducted
    an investigation, and found that the NIH had indeed continued to fund
    Coulston despite its violation of Federal administrative laws. This
    prompted the Investigations subcommittee to question the NIH's
    oversight and management of billions of dollars in taxpayer-funded
    grants; this subcommittee consequently launched a broad investigation
    of the NIH in March 2003.
        Amazingly, six years after IDA's March 2000 testimony, the NIH
    oversight debacle that launched a prior Congressional investigation is
    actually worse, and cries out for Congressional action. That is because
    in September 2004, New Mexico District Attorney Scot Key filed multiple
    counts of criminal animal cruelty against CRL. After an independent
    investigation that lasted almost one year, the D.A. found that it was
    ``standard practice'' for CRL to have trained animal care staff leave
    at the end of the workday, and leave the ``care'' of critically ill or
    injured chimpanzees to once-per-hour monitoring by untrained security
    guards. This ``standard practice''--instituted in August 2002 as an
    apparent cost-saving measure--resulted in the suffering and deaths of
    two chimpanzees, Rex and Ashley, and the near-death of a third, Topsy.
    The D.A. charged CRL and APF Director Rick Lee with three counts of
    criminal cruelty alleging abandonment and failure to provide necessary
    sustenance. This understaffed small-town D.A. with a caseload of
    murders had stepped in to enforce the law and protect the chimpanzees
    from a multi-billion dollar public company and a $28 billion Federal
    agency. It should be noted that because the APF is now a Federal
    research lab, the USDA has no jurisdiction under the Animal Welfare
    Act. This was the first time in U.S. history that an entire lab had
    been charged with criminal animal cruelty. This case, the culmination
    of 10 years of NIH-funded abuse of these New Mexico chimpanzees,
    contains shocking facts that cry out for further Congressional action.
        Despite initial promises of cooperation, CRL instead hired a high-
    powered criminal law firm perhaps best known for obtaining an acquittal
    of a two-time husband killer after she had shot husband number two in
    New Mexico. CRL refused to cooperate with the D.A.'s criminal
    investigation. CRL refused to comply with the D.A.'s subpoena demanding
    records relating to the three chimpanzees. The D.A. then obtained a
    grand jury subpoena, but CRL still refused to supply the records to the
    D.A. The NIH did nothing to force CRL to cooperate.
        Tellingly, however, CRL did supply these records to an ad-hoc NIH
    consultant with no law enforcement authority. During only a portion of
    his one-day site visit, this veterinarian simply reviewed the records,
    without interviewing a single witness, and, predictably, found no
    problems. Neither the NIH nor CRL wanted an independent, legitimate law
    enforcement officer, such as the D.A., to get within a mile of these
    records, and did everything possible to prevent his obtaining them. The
    NIH did not want any independent, legitimate investigation, since any
    problems found would be an indictment of the agency's own management of
    the lab. The NIH's responsibility for ``oversight'' at its own lab
    constitutes an unmitigated conflict of interest. Had the NIH found a
    chimpanzee shot in the head, the agency would no doubt have ruled it a
    suicide.
        Like CRL, the NIH has also refused to supply these records to the
    public, even after IDA filed a Federal FOIA lawsuit in September 2004.
    In its briefs, the NIH has actually claimed that it does not possess
    these clinical records--for NIH-owned chimpanzees at an NIH-owned
    facility that is part of the NIH's Intramural Research Program. This
    laughable assertion is belied by the NIH's own contract with CRL, which
    explicitly states that the NIH does indeed possess these records.
        CRL submitted only one of two reports generated by the one-day NIH
    site visit to the New Mexico court trying the criminal case--
    predictably, the one praising CRL's veterinary care, which was based on
    only a review of records, not any witness interviews nor an actual
    investigation. However, the criminal charges had nothing to do with
    CRL's veterinary care, but instead CRL's alleged ``standard practice''
    of abandoning critically ill or injured chimpanzees to once-per-hour
    monitoring by untrained security guards. The second report, written by
    the NIH Project Officer for the CRL contract and obtained by IDA
    through FOIA, clearly shows that the NIH was completely and totally
    unaware of the abandonment alleged by the D.A.
        During the time period covered by the multiple counts of criminal
    animal cruelty, the NIH actually awarded CRL bonuses totalling $175,000
    paid for with taxpayer funds. CRL received the maximum bonuses; the
    major criterion for these bonuses was ``no animal care deficiencies.''
        While the D.A.'s independent investigation--run by a 24-year police
    veteran--took almost a year and interviewed six witnesses, including
    eyewitnesses, the NIH interviewed no witnesses regarding Rex, Ashley
    and Topsy and allowed the so-called ``investigation'' to be conducted
    by CRL--another blatant conflict of interest. Because CRL refused to
    cooperate--despite its initial promises--the D.A. could only interview
    ex-CRL employees. But those ex-employees painted a devastating portrait
    of the alleged acts of cruelty and CRL's operation of this NIH lab.
        Dr. Kelly Avila started work at the APF only 58 days after she
    graduated from veterinary school. She told the D.A.'s investigator that
    she had been promised training, but instead found herself the main
    clinician for over 250 chimpanzees. She confirmed that in August 2002,
    APF Director Rick Lee instituted the policy where security guards would
    take over for animal care at quitting time, 4:00 p.m. She repeatedly
    stated that Ashley, the first chimpanzee mentioned in the criminal
    charges, had shock. Avila had ``serious problems'' with APF practices,
    and discussed problems associated with having security/maintenance
    personnel perform animal care. She started a system of writing daily
    reports of what she found on exams and also which chimpanzees were sick
    and needed monitoring; apparently no such systemic surveillance existed
    before her arrival. Being fresh out of vet school, she also said she
    felt she had to defer to the more-experienced vets Lee and Langner. She
    stated that financial considerations played a role in the standard of
    care; if she wanted an animal care staffer to stay past quitting time
    she would have to go through Andrea Lee, the APF's Program
    Administrator and wife of Director Rick Lee. That would have ``meant
    that Dr. Lee's wife would have gotten all over my case for overtime.''
    Avila said that it was ``always a fight'' with Andrea Lee--who had no
    veterinary training whatsoever--and that the ``veterinary staff . . .
    either cowed down to this lady or you had to leave.'' Avila also stated
    that Rick Lee, instead of training her as promised, ``spent his time in
    the office doing director kind of activities,'' and that she hardly
    ever saw him. Instead, she said her mentors included an online message
    board, the Veterinary Information Network (VIN).
        Dr. Avila posted dozens of messages to the VIN during her year
    working at the APF. Perhaps the most devastating was posted on
    September 16, 2002, only hours before Ashley died. Avila explains
    Ashley's condition, that she was bleeding from a fight and suffered
    from a condition that makes blood clotting more difficult. After
    describing how she had treated Ashley to that point, she then asks the
    chilling, all-revealing question: ``Does anyone have other ideas on how
    to treat?'' Many of these messages demonstrate a facility in disarray,
    and a veterinarian fresh out of vet school who was trying to do the
    right thing but was clearly in over her head. Avila asked for advice on
    almost every conceivable subject relating to chimpanzee care: reference
    texts for chimpanzee nutrition (she noticed what she thought were signs
    of malnutrition); how to conduct biopsies and take bone marrow samples;
    how to treat hypertension; how to interpret ultrasounds and x-rays. She
    repeatedly stated that she conducted her own medical literature
    searches in attempts to find treatments. She tells of her APF
    colleagues' ignorance of specific treatments and dangerous side effects
    of drugs. In a May 23, 2003 post, she states ``I recently lost my fifth
    chimp,'' then describes how a chimp died after a tooth extraction.
    Importantly, she states that this chimp had a history of suffering from
    grand mal seizures when given ketamine, which is one of the only two
    sedatives allowed at the APF (the other is pharmacologically similar to
    ketamine), and says that she had just been lucky prior to that because
    she had given him only very small doses as supplements. She states this
    is one of the reasons she is resigning. She tells VIN that respiratory
    diseases, measles and chicken pox have been passed to the chimps from
    human employees over the past year. She asks about vaccinations,
    questioning why the APF only vaccinates against tetanus, and is told
    that there is a standard series of vaccinations recommended for
    chimpanzees, which includes tetanus, measles, mumps and rubella. She
    describes her fight against a drug company trying to test a drug for
    hepatitis C on chimpanzees, since the side effects in humans are so
    severe and she is concerned that the chimpanzees would suffer, while
    relating that she ``dislike[s] the pressure greatly'' that she is
    getting from the drug company to perform the study. For one chimpanzee,
    she is ``at her wits end'' in trying to find a treatment; one she had
    previously used ``led to more edema so I won't be doing that again. Oh
    well I guess I am learning here,'' and then asks for suggestions on how
    to treat. She asks if anyone knows of a procedure for tapping the heart
    (fluid) of a chimpanzee, and asks ``Do I proceed as I would with a
    dog?'' In another revealing post, she asks if anyone has experience
    with using steroids as an appetite stimulant in chimpanzees, for a 40-
    year-old. Other vets chime in, saying that old age is not a disease,
    and that this and some of her other posts indicate that she is treating
    symptoms, not trying to get diagnosis so she can treat an underlying
    disease. Avila responds with a devastating indictment of the APF
    operation: ``I am working at getting actual diagnosis before I continue
    treatments. There is great resistance to this as the old adage `if it
    ain't broke don't fix it' applies here on a regular basis! However, it
    is against my nature to give up and allow people to act foolishly while
    I clean up the mess they leave behind so I will continue to try to find
    specific diagnosis and treat those whenever I can.'' A similar post
    concerns a self-mutilating chimpanzee; Avila is concerned about the
    long-term effects of Prozac. Vets chime in again that she should try to
    determine the underlying cause of the self-mutilation; one vet relates
    that's what she did, and was able to stop the mutilation and wean a
    baboon off of Prozac. Avila states that the APF behaviorist pretty much
    wants to keep the chimpanzee on Prozac forever, and agrees that she
    should try to find the underlying cause of the self-mutilation.
        Maintenance man Ernest Farwell went into great detail about the
    cases of Rex and Ashley to the D.A.'s investigator. He confirms Dr.
    Avila's recollection that August 2002 is when CRL instituted the policy
    of having maintenance/security, such as Farwell, take over from animal
    care after quitting time. Like the other maintenance man interviewed,
    Benjamin Thompson, Farwell confirmed that he received no special
    training in chimpanzee care. He saw Rex unconscious, lying on his side
    with his mouth open, vomiting, and an animal care staffer suctioning
    out the vomit with an evacuation wand. He witnessed Dr. Avila say to
    the animal care staffer ``We have to go, he won't let us stay.'' The
    animal care staffer then actually removed Rex's life support, and he
    and Avila left while Rex was still unconscious and vomiting. Farwell
    later witnessed Rex on his side, but with the vomit coming out of his
    mouth (since no one was there to suction it out). Rex was found dead
    later that night; the pathology report showed vomit in his mouth and
    trachea. Farwell also witnessed Ashley; when he first saw her, he was
    shocked at the amount of blood in her cage, and she was still bleeding.
    He then witnessed her shake violently; this was the symptom of shock
    mentioned by Dr. Avila in her witness statement. Later he found her
    dead. Farwell also states that APF employees were threatened with
    polygraph tests when Rick Lee was trying to find out who gave
    information to the D.A. about the alleged cruelty, and were ordered not
    to speak with anyone, including the D.A., about the allegations. Such
    threats violate the 1988 Federal Employee Polygraph Protection Act.
    This climate of intimidation was also apparent when Farwell complained
    about having to give medicine to chimpanzees, protesting that he wasn't
    qualified, explaining ``If animal care found a problem with the boilers
    you wouldn't expect them to fix it.'' He was then written up and felt
    threatened, and signed an agreement that he would perform these duties
    (i.e., care of chimpanzees) and anything else CRL told him to, for
    apparent fear of losing his job.
        The APF had problems from day one; for the first 6 months, the
    facility did not have requirements for care as basic as euthanasia
    drugs. This resulted in chimpanzee suffering; CRL actually had to
    borrow euthanasia drugs from the Coulston Foundation, which was
    offsite, miles away, and almost bankrupt. Although the chimpanzees
    lacked for drugs, APF Program Administrator Andrea Lee--who made
    decisions on animal care overtime--had plenty; in 2004, she was
    criminally charged with 15 counts of fraudulently obtaining a
    controlled substance (Vicodin). She had been illegally using the DEA
    licenses of two APF veterinarians--at a taxpayer-funded facility--and
    pled guilty to one count. APF veterinarian Cynthia Doane--not the NIH
    or CRL management--became suspicious and began to investigate. Further
    buttressing the existence of a climate of intimidation and fear at the
    APF, Doane wrote a letter to the New Mexico Board of Pharmacy in April
    2004, stating her willingness to help in the investigation, but that
    ``I emphasize, however, that I cannot trust anyone at my place of work
    at this time.''
        Instead of proclaiming its innocence by demanding its day in court,
    CRL, presumably with the NIH's blessing, threw up one legal
    technicality after another in a prolonged effort to hide from the
    evidence accumulated by the D.A. and to prevent a jury, and the public,
    from ever seeing it argued in open court. CRL claimed that the State of
    New Mexico had no jurisdiction to prosecute its own animal cruelty
    statute because the APF was located on a Federal Air Force Base,
    despite the fact that the New Mexico legislature had specifically
    amended its cruelty statute in 2001 because of the chimpanzee abuses at
    this very same facility. This amendment gave the D.A. the legal
    authority to prosecute CRL. The company claimed that because the New
    Mexico cruelty statute did not require qualified personnel, there was
    no abandonment because untrained security guards were in the vicinity
    of the critically ill or injured chimpanzees (once per hour). And in
    the most egregious of all the technicalities, CRL actually claimed that
    it was engaged in the practice of veterinary medicine in the cases of
    Rex, Ashley and Topsy, and because the cruelty statute exempts the
    practice of veterinary medicine, the case should be dismissed. In other
    words, according to CRL and the NIH, the deliberate policy of denying
    veterinary care constitutes the practice of veterinary care.
    Incredibly, the judge agreed with that technicality, and dismissed the
    case--a dismissal having nothing to do with the merits of the D.A.'s
    investigation or case. The D.A. appealed, and the case is currently
    being adjudicated at the New Mexico Court of Appeals, the State's
    second-highest court.
                                recommendations
        IDA believes that given the NIH's egregious record, Congress should
    both investigate and hold hearings, not only into the NIH/Coulston/
    Charles River debacle, but the larger oversight issues raised by the
    NIH's actions. One would have thought that, given the years of Coulston
    Foundation administrative animal welfare violations, the NIH would have
    been that much more careful in choosing and overseeing a successor.
    Instead, the facility--now directly owned and managed by the NIH--
    descended into alleged criminal animal cruelty. Given the NIH's ten-
    year record of funding abuse against these chimpanzees, we respectfully
    request that the NIH be barred from any responsibility whatsoever for
    them. These chimpanzees have endured enough; the survivors should be
    placed at a reputable private sanctuary for permanent retirement, with
    the remainder of the $42 million contract going to the sanctuary. This
    would be the morally and ethically correct course of action that is so
    greatly overdue for these long-suffering chimpanzees.
                                     ______

                 Prepared Statement of Independence Technology
        Mr. Chairman and members of the subcommittee, my name is Gregg
    Howard and I am the Vice President for Sales and Reimbursement for
    Independence Technology, LLC, a Johnson & Johnson company. I appreciate
    the opportunity to provide comments in support of the many programs
    within the jurisdiction of the subcommittee that are important to
    citizens with disabilities.
        The Institute of Medicine report, ``Disability in America: Toward a
    National Agenda,'' began with the words ``Disability is an issue that
    affects every individual, community, neighborhood, and family in the
    United States.'' These words are as true today as when the IOM
    published its report.
        The demographic imperative resulting from the aging of the baby
    boom generation will soon substantially increase the proportion and
    numbers of Americans in the older age groups that are most at risk of
    physical and mental impairments, limitations, and disabilities. At the
    same time, certain trends in other age groups--for example, the
    increased rates of survival of extremely premature infants, increases
    in the prevalence of obesity in younger populations and a growing
    number of disabled Iraq era veterans--are putting more children and
    younger adults at risk of disabling conditions. Thus, the promotion of
    good health, independence, and social integration for people with
    disabilities and the prevention of disabling injuries, diseases, and
    disorders are more important objectives than ever.
        Mr. Chairman, the Labor, Health and Human Services, and Education
    subcommittee funds the significant majority of Federal programs of
    interest and benefit to citizens with disabilities. These programs are
    in the Department of Labor, the Department of Health and Human
    Services, and the Department of Education. At the end of this
    statement, we list these many programs in tabular form and include a
    fiscal year 2007 funding recommendation for each of these programs. We
    join with the 100 plus organizations of Consortium for Citizens with
    Disabilities in making these recommendations and would urge the
    subcommittee's efforts to address these funding needs.
        Mr. Chairman, also very importantly, the Social Security
    Administration, Medicare and Medicaid programs are of significant
    importance for citizens with disabilities. While these programs are
    mostly viewed as entitlements and therefore fall in the jurisdiction of
    the Senate Finance Committee and House Ways and Means Committee, your
    subcommittee appropriates administrative funds that permit the
    operations of these programs. On behalf of Independence Technology,
    LLC, I would like to highlight a matter currently under consideration
    by administrative personnel at Medicare that will have an important
    impact on the lives of many disabled Americans.
        Independence Technology, LLC, has invested over $100 million over
    the last decade to develop a revolutionary new mobility system that
    allows individuals with disabilities to achieve extensive function and
    the physical mobility necessary in order to live independently. This
    innovative technology is the first of its kind to largely eliminate
    barriers by climbing stairs, improving reach, transversing various
    surfaces, and balancing the seated user at standing eye level. For many
    this technology can take the place of more costly and/or drastic
    alternatives such as moving from one's home, extensive home
    modifications, use of home health aides, and unnecessary
    institutionalization or bed confinement.
         While this new technology is clearly not appropriate for all
    individuals with mobility impairments, for the subset disabled of
    individuals for whom it is appropriate, it is a life changing device
    which improves health, functional status, independent living, and
    quality of life. In 2002 and 2003 the Veterans Health Administration
    evaluated these devices and made a determination as to which subset of
    disabled veterans could appropriately benefit from the device. Based on
    this review and policy determination, the Veterans Health
    Administration now prescribes and provides financial support for the
    procurement of these devices.
        Currently underway at CMS is a similar review process. On January
    26, 2006 CMS posted for public comment the application by Independence
    Technology, LLC, for the development of a National Coverage
    Determination for an interactive balancing mobility system such as the
    iBOT. A total of 151 comments were presented to CMS by patients,
    disability groups, health care providers, and others affected by
    disabilities. Letters were also sent in support of the application by
    10 U.S. Senators and approximately 20 House Members. Overall, 97
    percent of the comments provided to CMS on this matter were positive.
        The comment period for establishing a National Coverage
    Determination for ``interactive balancing mobility systems'' closed on
    March 5, 2006. CMS now has up to 6 months to announce a decision on the
    question of proceeding to the development of a National Coverage
    Determination. It is our view that the establishment of coverage
    criteria for this new state-of-the-art interactive balancing mobility
    systems sends an important message that when research and development
    results in technological advancements improving the health, functional
    status, independent living, and quality of life, these advances will be
    made accessible to those who will benefit.
        Mr. Chairman, in summary we appreciate the leadership of you and
    your subcommittee in championing so many important programs of benefit
    to disabled Americans. While we recognize the limitations placed on the
    subcommittee by spending ceilings, we would urge your careful review
    and considerations of the funding recommendations found at the end of
    this statement. We would also request the subcommittee's support and
    direct guidance to CMS to support reimbursement policies that will help
    bring new technological advances such as the iBOT to disabled Americans
    who stand to benefit from their use.
        Thank you for the opportunity to testify.

               APPROPRIATIONS RECOMMENDATIONS FOR FISCAL YEAR 2007
                            [In millions of dollars]
    ------------------------------------------------------------------------
                                                    Fiscal year
                                       Fiscal year      2007     Fiscal year
                                        2006 final   President     2007 CCD
    ------------------------------------------------------------------------
           DEPARTMENT OF LABOR

    Workforce Investment Act
     (selected programs):
        Adult Employment.............        857.0        712.0        987.9
        Pilots, Demonstrations,               29.7         17.7        151.0
         Research....................
        Youth Activities.............        940.5        840.5      1,093.4
    Office of Disability Employment           27.7         20.0         47.5
     Policy..........................
    Work Incentives Grants...........         19.5  ...........         20.7

      DEPARTMENT OF HEALTH AND HUMAN
                 SERVICES

    Health Services Resources
     Administration:
        Maternal & Child Health Block        693.0        693.0        724.0
         Grant.......................
        Developmental Disabilities
         Act Programs:
            Basic State Grants--              71.8         72.0         84.5
             Councils on DD..........
            Protection & Advocacy             38.7         39.0         45.0
             Systems--DD.............
            University Centers for            33.2         33.0         37.0
             Excellence in DD........
            Projects of Nat'l Sig. &          11.4         11.0         22.6
             Family Support..........
        TBI State Grants.............          9.0  ...........         15.0
        TBI Protection & Advocacy              3.1  ...........          6.0
         Grants......................
        Universal Newborn Hearing             10.0  ...........         10.0
         Screening...................
    Centers for Disease Control and
     Prevention:
        Birth Defects, Developmental         124.7        110.5        137.6
         Disabilities, & Health......
        Chronic Disease Prevention...        836.6        818.7        417.4
        Environmental Health.........        149.9        141.0        153.0
        Preventive Health Block Grant         99.0  ...........        133.6
        Injury Prevention and Control        139.0        138.2        142.8
        Epilepsy Program.............          7.7  ...........          8.0
        TBI Registries and                     5.3          5.3          9.0
         Surveillance................
    National Institutes of Health....     28,578.0     28,578.0     29,750.0
        Natl. Institute of Child           1,264.7      1,257.0      1,327.9
         Health and Hum. Dev.........
        Natl. Institute on Deafness &        393.0        392.0        412.7
         Other Communication
         Disorders...................
        Natl. Inst. of Neurological        1,534.8      1,525.0      1,611.5
         Disorders & Stroke..........
        Natl. Institute on Mental          1,403.8      1,395.0      1,474.0
         Health......................
        Natl. Institute on Drug Abuse      1,000.0        995.0      1,050.0
        Natl. Institute on Alcohol           435.9        433.0        457.7
         Abuse.......................
    Social Services Block Grant......      1,683.0      1,200.4      2,380.0
    Child Care & Development Block         2,062.1      2,062.0      2,588.0
     Grant...........................
    Head Start.......................      6,876.0      6,786.0      7,300.0
    Child Abuse Prevention and                95.2        101.0        142.0
     Treatment Act...................
    Nat'l Family Caregiver Support           162.0        160.0        162.0
     Program.........................
    Grants to States to Remove                10.9         10.9         25.0
     Barriers to Voting..............
    Protection & Advocacy for Voting           4.9          4.8         10.0
     Access..........................
    SAMHSA:
        Children's Mental Health             104.1        104.1        109.7
         Services....................
        PATH Homeless Program........         54.3         54.3         57.1
        Protection & Advocacy for             34.0         34.0         40.0
         Indivs. with MI.............
        Mental Health Block Grant....        428.5        428.5        451.2
        Projects of Regional and             263.2        228.1        285.9
         Nat'l Significance..........

         DEPARTMENT OF EDUCATION

    Individuals with Disabilities
     Education Act:
        State and Local Grants Part B     10,582.8     10,682.9     16,938.9
        Preschool Grants.............        380.8        380.8        841.0
        Early Intervention Part C....        436.4        436.4        680.0
        Part D National Programs:
            State Personnel                   50.1  ...........         55.7
             Development.............
            Technical Assistance and          48.9         48.9         57.6
             Dissemination...........
            Personnel Preparation....         89.7         89.7        108.7
            Parent Information                25.7         25.7         28.6
             Centers.................
            Technology and Media.....         38.4         31.1         42.6
            Transition Initiative....  ...........          2.0          5.5
    Research and Innovation (Inst.            81.7         81.7         92.4
     Ed. Sciences)...................
    Rehabilitation Services
     Administration:
        Rehabilitation State Grant...      2,693.0      2,837.2      3,120.0
        Client Assistance Programs...         11.8         11.8         13.0
        Rehabilitation Training......         38.4         38.4         42.7
        Special Demonstrations.......          6.5          6.5         28.1
        Recreation...................          3.0  ...........          3.0
        Protection & Advocacy for             16.5         16.5         22.0
         Individual Rights...........
        Projects with Industry.......         20.0  ...........         50.0
        Supported Employment State            29.7  ...........         50.0
         Grant.......................
        Migrant & Seasonal Farm                2.0  ...........          2.3
         workers.....................
        Independent Living State              22.6         22.6         25.0
         Grant.......................
        Centers for Independent               74.6         74.6         82.9
         Living......................
        Independent Living Serv. for          32.9         32.9         36.5
         Older Blind Ind.............
        State Assistive Technology            22.4         22.4         29.0
         Programs and TA.............
        Protection & Advocacy for              4.4  ...........          6.0
         Assistive Tech..............
    National Institute for Disability        106.7        106.7        120.0
     & Rehabilitation Research.......
    Demonstration Projects-Disability          6.9  ...........         10.0
     (Higher Ed.)....................
    National Council on Disability...          3.1          2.8          3.7
    Helen Keller National Center.....          8.5          8.5         11.7
    American Printing House for the           17.6         17.6         20.0
     Blind...........................
    ------------------------------------------------------------------------

                                     ______

       Prepared Statement of the International Foundation for Functional
                           Gastrointestinal Disorders
                  summary of fiscal year 2007 recommendations
      --Provide a 5 percent increase for fiscal year 2007 to the National
            Institutes of Health (NIH) budget. Within NIH, provide
            proportional increases of 5 percent to the various institutes
            and centers, specifically, the National Institute of Diabetes
            and Digestive and Kidney Diseases (NIDDK).
      --Accelerate funding for extramural clinical and basic functional
            gastrointestinal disorders (FGID) and motility disorders
            research at NIDDK.
      --Continue to urge NIDDK to develop a strategic plan on irritable
            bowel syndrome (IBS) with the purpose of setting research
            goals, determining improved treatment options for IBS
            sufferers, and assisting in recruitment of new investigators to
            conduct IBS research.
      --Urge the National Institute of Child Health and Human Development
            (NICHD) and NIDDK to continue to support research into fecal
            and urinary incontinence, including the development of a
            standardization of scales to measure incontinence severity and
            quality of life and to develop strategies for primary
            prevention of fecal incontinence associated with childbirth.
      --Provide funding to NIDDK and the National Cancer Institute (NCI)
            for more research on the causes of esophageal cancer.
        Chairman Specter and members of the subcommittee, thank you for the
    opportunity to present this written statement regarding the importance
    of functional gastrointestinal and motility disorders research. IFFGD
    has been serving the digestive disease community for fifteen years. We
    work to broaden the understanding about functional gastrointestinal and
    motility disorders in adults and children. IFFGD speaks about and
    raises awareness on disorders and diseases that many people are
    uncomfortable and embarrassed to talk about. The prevalence of fecal
    incontinence and irritable bowel syndrome or IBS, as well as a host of
    other gastrointestinal disorders affecting both adults and children, is
    underestimated in the United States. These conditions are truly hidden
    in our society. Not only are they misunderstood, but also the burden of
    illness and human toll has not been fully recognized.
        Since its establishment, the IFFGD has been dedicated to increasing
    awareness of functional gastrointestinal and motility disorders, among
    the public, health professionals, and researchers. While maintaining a
    high level of public education efforts, the IFFGD has also become
    recognized for our professional symposia. We consistently bring
    together a unique group of international multidisciplinary
    investigators to communicate new knowledge in the field of
    gastroenterology. In the spring of 2007, IFFGD will be hosting our
    Seventh International Symposium on Functional Gastrointestinal
    Disorders, bringing scientists, researchers, and clinicians from across
    the world together to discuss the current science and opportunities on
    IBS and other functional gastrointestinal and motility disorders. Also,
    in November of 2002, we hosted a conference on fecal and urinary
    incontinence, the proceedings of which were published in
    Gastroenterology, the official journal of the American
    Gastroenterological Association (AGA). The IFFGD has also been working
    with the National Institute of Child Health and Human Development
    (NICHD), the National Institute of Diabetes and Digestive and Kidney
    Diseases (NIDDK), and the Office of Medical Applications of Research
    (OMAR) in the NIH Office of the Director on the State of the Science
    Conference on Fecal and Urinary Incontinence.
        The majority of the diseases and disorders we address have no cure.
    We have yet to completely understand the pathophysiology of the
    underlying conditions. Patients face a life of learning to manage
    chronic illness that is accompanied by pain and an unrelenting myriad
    of gastrointestinal symptoms. The costs associated with these diseases
    are enormous; estimates range from between $25-$30 billion annually.
    The human toll is not only on the individual but also on the family.
    Economic costs spill over into the workplace. In essence, these
    diseases reflect lost potential for the individual and society. The
    IFFGD is a resource and provides hope for hundreds of thousands of
    people as they try to regain as normal a life as possible.
                         irritable bowel syndrome (ibs)
        IBS strikes people from all walks of life affecting between 25 to
    45 million Americans and results in significant human suffering and
    disability. This chronic disease is characterized by a group of
    symptoms, which include abdominal pain or discomfort associated with a
    change in bowel pattern, such as loose or more frequent bowel
    movements, diarrhea, and/or constipation. Although the cause of IBS is
    unknown, we do know that this disease needs a multidisciplinary
    approach in research and often treatment.
        IBS can be emotionally and physically debilitating. Because of
    persistent bowel irregularity, individuals who suffer from this
    disorder may distance themselves from social events, work, and even may
    fear leaving their home.
        In the House and Senate fiscal years 2004, 2005, and 2006 Labor,
    Health and Human Services, and Education Appropriations bills, Congress
    recommended that NIDDK develop an IBS strategic plan. The development
    of a strategic plan on IBS would greatly increase the institute's
    progress toward the needed research on this functional gastrointestinal
    disorder, as well as serve to advance our understanding of this
    disease, determine improved treatment options for IBS sufferers, and
    assist in recruiting new investigators to conduct IBS research. NIDDK
    is formulating an action plan for digestive diseases through the
    National Commission on Digestive Diseases and has indicated that IBS
    will be included as a component of this overall plan. IBS must be given
    sufficient attention, however, in order to increase the FGID and
    motility disorders research portfolio at NIDDK.
                               fecal incontinence
        At least 6.5 million Americans suffer from fecal incontinence.
    Incontinence is neither part of the aging process nor is it something
    that affects only the elderly. Incontinence crosses all age groups from
    children to older adults, but is more common among women and in the
    elderly of both sexes. Often it is a symptom associated with various
    neurological diseases and many cancer treatments. Yet, as a society, we
    rarely hear or talk about the bowel disorders associated with multiple
    sclerosis, diabetes, colon cancer, uterine cancer, and a host of other
    diseases.
        Damage to the anal sphincter muscles; damage to the nerves of the
    anal sphincter muscles or the rectum; loss of storage capacity in the
    rectum; diarrhea; or pelvic floor dysfunction can cause fecal
    incontinence. People who have fecal incontinence may feel ashamed,
    embarrassed, or humiliated. Some don't want to leave the house out of
    fear they might have an accident in public. Most try to hide the
    problem as long as possible. They withdraw from friends and family, and
    often limit work or education efforts. Incontinence in the elderly
    burdens families and is a major reason for nursing home admissions, an
    already huge social and economic burden in our increasingly aging
    population.
        In November 2002, the IFFGD sponsored a consensus conference--
    ``Advancing the Treatment of Fecal and Urinary Incontinence Through
    Research: Trial Design, Outcome Measures, and Research Priorities.''
    Among other outcomes, the conference resulted in six key research
    recommendations:
        1. More comprehensive identification of quality of life issues
    associated with fecal incontinence and improved assessment and
    communication of treatment outcomes related to quality of life.
        2. Standardization of scales to measure incontinence severity and
    quality of life.
        3. Assessment of the utility of diagnostic tests for affecting
    management strategies and treatment outcomes.
        4. Development of new drug compounds offering new treatment
    approaches to fecal incontinence.
        5. Development and testing of strategies for primary prevention of
    fecal incontinence associated with childbirth.
        6. Further understanding of the process of stigmatization as it
    applies to the experience of individuals with fecal incontinence.
        The IFFGD has been working with the NICHD, NIDDK, and OMAR on a
    State of the Science Conference on Fecal and Urinary Incontinence. The
    goal of this conference will be to assess the state of the science and
    outline future priorities for research on both fecal and urinary
    incontinence; including, the prevalence and incidence of fecal and
    urinary incontinence, risk factors and potential prevention,
    pathophysiology, economic and quality of life impact, current tools
    available to measure symptom severity and burden, and the effectiveness
    of both short and long term treatment. Once the conference is
    completed, the NIH must prioritize implementation of the
    recommendations of this important conference.
                     gastroesophageal reflux disease (gerd)
        Gastroesophageal reflux disease, or GERD, is a common disorder
    affecting both adults and children, which results from the back-flow of
    acidic stomach contents into the esophagus. GERD is often accompanied
    by persistent symptoms, such as chronic heartburn and regurgitation of
    acid. But sometimes there are no apparent symptoms, and the presence of
    GERD is revealed when complications become evident. One uncommon
    complication is Barrett's esophagus, a potentially pre-cancerous
    condition associated with esophageal cancer. Symptoms of GERD vary from
    person to person. The majority of people with GERD have mild symptoms,
    with no visible evidence of tissue damage and little risk of developing
    complications. There are several treatment options available for
    individuals suffering from GERD.
        Gastroesophageal reflux (GER) affects as many as one-third of all
    full term infants born in America each year. GER results from an
    immature upper gastrointestinal motor development. The prevalence of
    GER is increased in premature infants. Many infants require medical
    therapy in order for their symptoms to be controlled. Up to 25 percent
    of older children and adolescents will have GER or GERD due to lower
    esophageal sphincter dysfunction. In this population, the natural
    history of GER is similar to that of adult patients, in whom GER tends
    to be persistent and may require long-term treatment.
                                 gastroparesis
        Gastroparesis, or paralysis of the stomach, refers to a stomach
    that empties slowly. Gastroparesis is characterized by symptoms from
    the delayed emptying of food, namely: bloating, nausea, vomiting or
    feeling full after eating only a small amount of food. Gastroparesis
    can occur as a result of several conditions; it can occur in up to 30
    percent to 50 percent of patients with diabetes mellitus. A person with
    diabetic gastroparesis may have episodes of high and low blood sugar
    levels due to the unpredictable emptying of food from the stomach,
    leading to diabetic complications. Other causes of gastroparesis
    include Parkinson's disease and some medications, especially narcotic
    pain medications. In many patients a cause of the gastroparesis cannot
    be found and the disorder is termed idiopathic gastroparesis. Over the
    last several years, as more is being found out about gastroparesis, it
    has become clear this condition affects many people and the condition
    can cause a wide range of symptoms of differing severity.
                               esophageal cancer
        Approximately 13,000 new cases of esophageal cancer are diagnosed
    every year in this country. Although the causes of this cancer are
    unknown, it is thought that this cancer may be more prevalent in
    individuals who develop Barrett's esophagus. Diagnosis usually occurs
    when the disease is in an advanced stage; early screening tools are
    currently unavailable.
                  childhood defecation disorders and diseases
        Chronic Intestinal Pseudo-Obstruction (CIP).--About 200 new cases
    of CIP are diagnosed in American Children each year. Often life
    threatening, the future for children severely affected with CIP is
    brightened by the evolving promise of cure with intestinal or multi-
    organ transplantation.
        Hirschsprung's Disease.--A serious childhood and sometimes life-
    threatening condition that can cause constipation, occurs once in every
    5,000 American children born each year. Approximately 20 percent of
    children with HD will continue to have complications following surgery.
    These complications include infection and/or fecal incontinence.
        Functional Constipation.--Millions of children (1 in every 10) each
    year will be diagnosed with functional constipation. In fact, it is the
    chief complaint of 3 percent of pediatric outpatient visits and 10-25
    percent of pediatric gastroenterology visits.
      functional gastrointestinal and motility disorders and the national
                              institutes of health
        The International Foundation for Functional Gastrointestinal
    Disorders recommends an increase of 5 percent for NIH overall, and a 5
    percent increase for NIDDK and NICHD. However, we request that this
    increase for NIH does not come at the expense of other Public Health
    Service agencies.
        We urge the subcommittee to provide the necessary funding for the
    expansion of the NIDDK's research program on functional
    gastrointestinal disorders (FGID) and motility disorders. This
    increased funding will allow for the growth of new research on FGID and
    motility disorders at NIDDK, a strategic plan on IBS, and increased
    public and professional awareness of FGID and motility disorders. In
    addition, we urge the subcommittee to continue to support and provide
    adequate funding to the Office of Research on Women's Health (ORWH)
    under the NIH Office of the Director, particularly for their
    Specialized Centers of Research on Sex and Gender Factors Affecting
    Women's Health (SCORs) program and the Building Interdisciplinary
    Research Careers in Women's Health (BIRCWH) program. The ORWH supports
    important research into IBS.
        A primary tenant of IFFGD's mission is to ensure that clinical
    advancements concerning GI disorders result in improvements in the
    quality of life of those affected. By working together, this goal will
    be realized and the suffering and pain millions of people face daily
    will end.
        Thank you.
                                     ______

       Prepared Statement of the Industrial Minerals Association--North
                                    America
        It appears that the President's 2007 Budget for the Centers for
    Disease Control (CDC) includes a proposed reduction from $255.2 million
    to $250.2 million in funding for the National Institute for
    Occupational Safety and Health (NIOSH). IMA-NA notes that the fiscal
    year 2007 estimate carries forward fiscal year 2006 Conference language
    to move management and administrative costs ($34.8 million) from
    Occupational Safety and Health to Business Services Support. However,
    please note that the portion of the NIOSH budget to cover CDC overhead
    apparently has increased from 4.3 percent of NIOSH's budget in 2001 to
    nearing 14 percent in fiscal year 2007. This fee appears to be taking
    an increasingly larger share of NIOSH funds that otherwise would be
    dedicated to occupational safety and health research. IMA-NA encourages
    you to fund NIOSH as a stand-alone agency within the HHS organizational
    structure.
        IMA-NA also favors increasing the fiscal year 2007 budget to expand
    the NIOSH in-house mining research program. Recent mining fatalities in
    the underground coal-mining sector have highlighted the need for a
    forward-looking initiative to improve mine emergency communications and
    to develop reliable technologies for tracking the location of
    underground miners. While IMA-NA supports these research initiatives,
    there is concern that other critical mine safety and health-related
    research important to the industrial minerals sector could be affected
    adversely. IMA-NA encourages you to fund NIOSH mining-related
    occupational safety and health research programs above current funding
    levels to address such critical issues as cumulative musculoskeletal
    trauma, dust control, and noise-induced hearing loss.
        The Industrial Minerals Association--North America (IMA-NA) is a
    trade association organized to advance the interests of North American
    companies that mine or process industrial minerals. These minerals are
    used as feedstocks for the manufacturing and agricultural industries
    and are used to produce such essential products are glass, paints and
    coatings, ceramics, detergents and fertilizers. The IMA-NA membership
    includes producers of ball clay, bentonite, borates, feldspar,
    industrial sand, mica, soda ash (trona), sodium silicate, talc and
    wollastonite. IMA-NA's membership also includes many of the suppliers
    to the industrial minerals industry, including equipment manufacturers,
    railroads and trucking companies, and consultants.
        IMA-NA respectfully requests your support in opposing reductions in
    funding for occupational safety and health research, particularly as
    they affect mine safety and health. In the latter regard, we
    respectfully request additional funding above current levels.
                                     ______

             Prepared Statement of the HHT Foundation International
        Mr. Chairman and honorable members of the committee, thank you for
    the opportunity to present my family's story in this testimony in
    support of the HHT Foundation's legislative initiative. I would like
    express my appreciation to Congresswoman DeLauro for all of her
    assistance to make this testimony possible.
        My name is Jane Ribicoff Silk, I was fortunate to be the daughter
    of the former Senator Abraham & Mrs. Ruth Ribicoff, but I was
    unfortunate to have inherited Hereditary Hemorrhagic Telangiectasia
    (HHT). I am also the past president of the HHT Foundation,
    International.
        HHT is a hidden killer: 20 percent of people with HHT die early or
    are disabled due to lung or brain involvement.
        It is estimated that 70,000-100,000, or 1 in 3,000-5,000 Americans,
    are affected with Hereditary Hemorrhagic Telangiectasia (HHT). HHT is a
    genetic disorder, which affects blood vessels of the brain, spinal
    cord, lung, liver, gastrointestinal tract and most commonly, the nose.
    The affected blood vessels of the brain, spinal cord, and lung are
    prone to rupture and may result in stroke, hemorrhage or death.
    Bleeding from the nose and gastrointestinal tract can cause transfusion
    dependency and anemia, which can lead to heart failure. HHT can be
    treated successfully if correctly diagnosed. Children of an affected
    parent have a 50 percent chance of inheriting HHT.
    disability and death can be prevented with proper diagnosis, screening
                                 and treatment.
        Nine of 10 people with HHT are not yet diagnosed due to widespread
    lack of knowledge by medical professionals.
        HHT is a national health problem associated with high health care
    costs that has long been neglected.
        From the time I was a very young child, I experienced the trauma of
    my grandmother's severe hemorrhages of the nose. The bleeding would not
    stop. The ambulance came. My grandmother went to the hospital where she
    received multiple transfusions of blood and came back home, her nose
    packed with gauze--and still bleeding. This was not an infrequent
    occurrence. In between her severe nosebleeds, there would be daily
    nosebleeds lasting for more than an hour. My grandmother died at the
    age of 67 from a transfusion tainted with hepatitis. The severity of my
    grandmother's bleeding, and the number of transfusions she needed to
    keep her alive, can now be prevented with modern therapy.
        I realized at an early age that my mother, Ruth Ribicoff, also had
    a bleeding problem. She bled from her nose multiple times a week and
    every few months was hospitalized for transfusions due to blood loss.
    In her mid forties, it was discovered that she was also bleeding from
    her intestines. Additionally, she had HHT in her liver which caused her
    heart to pump harder and to enlarge. This eventually led to heart
    failure. She was often weak and never robustly energetic. Being the
    wife of a busy congressman, governor, cabinet member and senator put an
    additional social strain on my mother as she never knew at what
    inopportune moment she might get a bad nosebleed. Every purse she owned
    was stocked with a good supply of cotton.
        In 1972, my mother died at the age of 64 of complications of the
    liver, intestinal bleeding and nosebleeds that are treatable today.
    Even today, it is still not recognized that 9 out of 10 people with HHT
    are not diagnosed.
        My older brother, Peter, has carried the family burden of HHT
    almost his whole life and is the most impaired of all of us. His
    quality of life has been greatly diminished and he suffers every day.
    As a young boy he had occasional nosebleeds. When he was in his 20's he
    started getting backaches. He went to several doctors who could not
    help him, including Dr. Janet Travell, President Kennedy's personal
    back specialist. When he was in his 30's he began to lose sensation in
    the tops of his legs. An astute physician took some x-rays and noticed
    some dark spots around his spine. The only doctor in the world at that
    time, who used dye to see the blood vessels in the spinal cord, was in
    Paris. So, my brother took his young family and went to Paris. During
    his hospitalization, he was told to go home and have exploratory
    surgery on his spine as there were malformations there that were most
    likely life threatening. Indeed, they were life threatening. During a
    9-hour surgery, it was discovered that his HHT had affected the
    arteries of his spinal cord. He had had multiple hemorrhages over the
    years, which had caused his mysterious backaches, and if he had waited
    much longer, a massive hemorrhage of the malformed blood vessels of the
    spinal cord would have occurred--which would have either paralyzed him
    or killed him. So with meticulous care, each tangled and malformed
    artery snaking through his whole spinal column was tied off. It was not
    known if he would ever walk again. With extensive rehabilitation he did
    walk. But the loss of sensation caused by nerve damage was never
    regained. This has led to a continuously deteriorating condition for my
    brother. With a loss of sensation in his legs, he has become stooped
    over, uses a cane for balance and walks with a limp. Also due to his
    nerve damage, he has multiple complications with his bladder. For years
    he has had daily nosebleeds. He is in a weakened state all the time and
    his life has been permanently affected. If recognized early, his spinal
    cord malformation could have been treated and much suffering prevented.
        Adding further insult to injury, my brother's daughter, Judith, a
    successful young woman, has a liver abnormality associated with HHT.
    When it was first discovered, doctors thought it was a tumor and almost
    did a biopsy which could have led to her loss of life. The doctors had
    no awareness of HHT. Fortunately, because of our experience with the
    Yale University HHT Center of Excellence and Dr. Robert I. White, Jr.,
    she was taken care of and is now leading a normal life.
        Last, but not least is myself. My nosebleeds started in adolescence
    and in my late teens and early 20's I had nosebleeds that could last 2
    hours--and with HHT--you never have advance warning about when they are
    coming! I have led a pretty normal life, but have never had a lot of
    stamina.
        When I was about 55, I went through a period of time of feeling
    completely exhausted. A check up at the doctor showed that my liver
    enzymes were unusually high. In the search for the cause, a CAT scan of
    my liver was done. What was discovered was something that the doctors
    in my community had never seen. They were ready to do a liver biopsy. I
    insisted that the lead doctor speak to the Yale HHT Center of
    Excellence. They explained that what they were looking at was not
    uncommon for people with HHT and should not be touched at that time. I
    am monitored regularly and as I get older, it is clear that of all of
    those in my family I am the most fortunate.
        I have a daughter with HHT and granddaughter with HHT who may one
    day have children with HHT. I ask for funding so that not only my
    family, but all future generations will not have to live with HHT
    themselves or watch a family member slowly deteriorate or die a sudden
    preventable death.
                      how the federal government can help
        Stroke, lung and brain hemorrhages can be prevented through early
    diagnosis, screening and treatment. Severe hemorrhages in the nose and
    gastrointestinal tract can be controlled through intervention and heart
    failure can be managed through proper diagnosis of HHT and treatments.
    Access to effective evidence-based interventions and treatment should
    be established through a joint legislative initiative between the 8
    established National HHT Treatment Centers of Excellence and the
    National Center on Birth Defects and Disabilities Hereditary Blood
    Disorders Group with a legislative initiative of a $10 million set
    aside at the CDC through the HHS Appropriations bill in support of the
    8 U.S. HHT Centers. These funds will be used to provide surveillance;
    create a multi-center clinical database to collect and analyze data;
    support epidemiological studies; document effectiveness or patient
    interventions, develop educational programs for health care programs
    and ultimately improve the quality of life for people living with HHT
    and future generations.
        An additional $0.75 million is requested for the establishment of
    an HHT National Resource Center through a partnership between the CDC
    and the national voluntary agency representing HHT Families. These
    funds would be used to provide family support, education targeted to
    families and medical professionals, annual patient conferences,
    national and international scientific meetings and an aggressive
    research program. The CDC is ready and willing to work in partnership
    with the HHT Foundation to accomplish this mission.
        Mr. Chairman, again, thank you for the opportunity to testify. On
    behalf of the HHT Foundation and all of its members I personally appeal
    to the committee for funding for the 8 HHT Centers of Excellence. We
    believe this will benefit those with HHT and also reduce health care
    costs by the prevention of complications and the development of new
    therapies for this condition.
                                     ______

          Prepared Statement of the Lupus Foundation of America, Inc.
        As President and CEO of the Lupus Foundation of America, Inc. (LFA)
    I appreciate the opportunity to submit written comments for the record
    regarding funding for lupus related programs for fiscal year 2007. The
    LFA is the Nation's leading non-profit voluntary health organization
    dedicated to improving the diagnosis and treatment of lupus, supporting
    individuals and families affected by the disease, increasing awareness
    of lupus among health professionals and the public, and finding the
    causes and cure. As you may know, lupus is a debilitating, chronic
    autoimmune disease that causes inflammation and tissue damage to
    virtually any organ system; it can cause significant disability or even
    death. Lupus is the prototypical autoimmune disease; therefore, finding
    answers to questions about lupus may also provide understanding about
    other autoimmune diseases that affect 22 million Americans. The leaders
    and members of the LFA and the 1.5 to 2 million people suffering from
    lupus respectfully request the following for fiscal year 2007 to reduce
    and treat suffering from lupus:
      --$29.7 billion for the National Institutes of Health (NIH) to
            support lupus research. Specifically, we urge Congress to
            direct NIH to support and bolster lupus research across all
            relevant institutes, centers, and offices.
      --$1 million in new funding for The Office of Women's' Health at the
            Department of Health and Human Services (HHS) to support a
            sustained national lupus education campaign. This campaign is
            directed towards the general public and healthcare
            professionals who diagnose and treat people with lupus, with
            emphasis on reaching those individuals at highest risk--women
            of color--a health disparity that remains unexplained.
      --$1.5 million for the National Lupus Patient Registry (NLPR) at the
            National Center for Chronic Disease Prevention and Health
            Promotion within the Center for Disease Control and Prevention
            (CDC) to sustain current epidemiological efforts, and expand
            the CDC's work to include all forms of lupus and all affected
            populations, particularly African Americans, Hispanics, and
            Asian Americans who are disproportionately at-risk for--and
            have worse outcomes associated with--lupus.
        The purpose of the CDC lupus registry is to collect data and
    conduct lupus epidemiological studies to better understand and measure
    the burden of the illness, the social and economic impact of the
    disease, and stimulate additional private investment by industry in the
    development of new, safe and effective therapies for lupus. Existing
    epidemiological data on lupus is decades old and no longer reliable.
    Population-based epidemiological studies of lupus must be conducted at
    strategically-located sites throughout the Nation that will provide
    accurate data on all forms of lupus (i.e. systemic lupus, primary
    discoid lupus, drug-induced lupus, neonatal lupus, antiphospholipid
    antibodies) and the disparity among the various racial and ethnic
    populations.
        To ensure that we begin to comprehensively study and understand the
    dramatic health disparities associated with lupus, the NLPR and
    associated epidemiological studies must be expanded to include
    additional sites that constitute a mix of urban and rural areas and
    contain academic centers with a track record and some existing
    infrastructure for performing epidemiological studies. Thank you.
        I am Dr. Michael Madaio, Professor of Medicine at the University of
    Pennsylvania School of Medicine, and a lupus researcher. I have been
    funded for lupus research for over twenty years. I am proud to be
    affiliated with the Lupus Foundation of America as a member of the
    Medical Scientific Advisory Board and Chairman of the Medical Advisory
    Board for the Southeastern Pennsylvania Chapter of the LFA. While I am
    a nephrologist, since my research and clinical practice is focused on
    lupus, I really work day-to-day within the realms of nephrology and
    rheumatology as well as other medical specialties and subspecialty
    areas. I understand the importance of biomedical research funding and
    the impact that Federal research funding has had, does have, and can
    have on the lives of the 1.5 million people living with lupus and the
    22 million Americans with other autoimmune diseases.
        After a tragic 40 year dearth of new treatments to manage this
    often debilitating and devastating disease, the good news is that we
    finally are on the brink of major breakthroughs, thanks to research
    sponsored by the National Institutes of Health. Exciting research and
    strides in treatments for people with lupus are on the horizon and a
    sustained investment now in lupus research will speed the day to better
    treatments and a cure. Specifically, I am conducting extensive research
    on lupus nephritis, which is kidney involvement in lupus disease. My
    field is advancing rapidly, due in large part to factors directly
    dependent on NIH funding:
      --the burgeoning growth in the number of new animal models, including
            a wealth of informative transgenic and gene-targeted mutants;
      --increased access to improved powerful technologies such as gene and
            protein arrays, now available at many institutions and to many
            investigators through NIH core facilities;
      --new technologies that permit successful query of the very small
            amounts of human tissue typically available from patients and,
            collaboration across disciplines and across institutions to
            bring crucial expertise together;
      --new insights into underlying biology and pathophysiology in
            immunity and lupus are constantly emerging;
      --technologies to identify biomarkers are improved and accessible;
            and
      --new approaches to therapy are being explored.
        These endeavors are bearing fruit but they are highly dependent on
    NIH funding.
        If funding for the NIH is cut or level funded, it could cripple or
    paralyze current lupus research efforts.
        As lupus is a systemic disease that can affect any organ or tissue
    elucidating pathogenesis (or cause) and treatments of lupus will have
    direct impact on many other autoimmune diseases (e.g. results and
    treatments translating to other diseases). Providing adequate resources
    to support lupus research will help the Nation turn the corner on
    finding better treatments or a cure for lupus while also supporting
    breakthroughs and progress for other disease states. It is important to
    note that the corollary is true: cuts in lupus research funding also
    will have an adverse effect on progress for lupus and for progress in
    related diseases. Cuts in NIH funding could bring to a standstill
    support of clinical trials and large observational studies, and could
    curtail research on those at highest risk for lupus, women of color; it
    also could negatively impact pediatric research at a time when
    researchers have just begun to undertake studies in important new
    areas. Furthermore, insufficient Federal funding also could slow much-
    needed genetic research when we are just discovering the critical
    components that may contribute to lupus and its effects. Therefore, it
    is critical that biomedical researchers be provided the necessary
    resources to continue seeking answers to the questions that will lead
    to better lupus treatments. Increased research funding will help
    deliver much-needed breakthroughs from the laboratory to patients in
    need.
        The National Institute of Arthritis and Musculoskeletal and Skin
    Diseases (NIAMS), the institute most involved in lupus research, is one
    of the smallest institutes at NIH. In the past two years there has been
    a decrease in research funding for NIAMS overall, with a ten percent
    decrease in new research grants. Currently, only 12-15 percent of the
    grant applications submitted to NIAMS receives funding. Further cuts
    will cause this rate to drop precipitously to below 10 percent next
    year. Just two or three years ago, funding levels were at 25-30
    percent. Cuts in research funding, coupled with the rate of biomedical
    research inflation (3-4 percent per year), further erode NIAMS' ability
    to fund lupus research grant applications at the rate necessary to
    begin making real progress. As such, an increase above the rate of
    biomedical research inflation is necessary to allow NIH to sustain and
    build on its research progress resulting from the recent budget
    doubling while avoiding the severe disruption to that progress that
    would result from a lesser increase or cut.
        Furthermore, in the proposed budget for NIAMS for 2007 there will
    be a loss of 10 training grants; each grant funds training for four
    physicians, mostly rheumatologists. Young and senior investigators
    alike are moving into other fields because of the lost of funding.
    Exacerbating the situation, medical schools are struggling financially
    due to public funding cuts thus eliminating any safety net for
    researchers that may have previously existed. As a result, young
    investigators are not attracted to lupus research which means there
    will be not be a future generation of lupus scientists and clinicians
    to do research. Moreover, after having attracted scientists to
    translational immunology in the last five to ten years, when funding
    was increasing, there is now a possibility we could lose both the
    current and next generation of young investigators. Increased funding
    is necessary to support an adequate number of training grants. Without
    research and training funds lupus researchers might be forced to become
    private practice physicians instead, leading to an imbalance in the
    health care system: sufficient numbers of physicians to treat lupus
    patients, but no new treatments with which to care for them, and no
    researchers to develop the cures of tomorrow.
        We recognize and appreciate that Congress and the Nation face
    unprecedented fiscal challenges; however, we cannot afford to lose
    ground in biomedical research at such a promising time. The LFA looks
    forward to working with the subcommittee and others in Congress to
    reduce and prevent the suffering caused by lupus. We stand ready to
    serve as a resource for any information you may need in this regard and
    thank you for this opportunity to submit written testimony for the
    record concerning fiscal year 2007 lupus related funding.
                                     ______

       Prepared Statement of the March of Dimes Birth Defects Foundation
        The 3 million volunteers and 1,400 staff members of the March of
    Dimes appreciate the opportunity to submit the Foundation's Federal
    funding recommendations for fiscal year 2007. The March of Dimes is a
    national voluntary health agency founded in 1938 by President Franklin
    D. Roosevelt to prevent polio. Today, the Foundation works to improve
    the health of mothers, infants and children by preventing birth
    defects, premature birth and infant mortality through research,
    community services, education, and advocacy. The March of Dimes is a
    unique partnership of scientists, clinicians, parents, members of the
    business community, and other volunteers affiliated with 52 chapters in
    every State, the District of Columbia, and Puerto Rico.
        The volunteers and staff of the March of Dimes are deeply concerned
    that the funding recommendations in the President's Budget are not
    sufficient to meet the challenge of improving the health of women and
    children across the Nation. Continued under-funding of critical
    research and public health programs imperils the health of mothers and
    children today and in the future. In our judgment, the funding
    increases recommended below would lead to an immediate positive impact
    on reducing the incidence of preterm birth and birth defects, as well
    as making newborn screening for treatable metabolic and functional
    disorders more widely available.
                         national institutes of health
        The March of Dimes joins the larger research community in
    recommending a 5 percent increase in funding for the National
    Institutes of Health (NIH), bringing total Federal support to just
    under $30 billion. The administration's fiscal year 2007 budget
    recommendation would necessitate absolute reductions in research
    investments as the levels of funding proposed are insufficient even to
    keep up with inflation and certainly will not sustain the necessary
    investment in medical research.
    National Institute of Child Health and Human Development
        The March of Dimes recommends a 5 percent increase for NICHD in
    fiscal year 2007 and an increase of at least $100 million over the next
    five years to boost prematurity-related research. Additional resources
    are needed to support research on the causes of preterm labor and
    delivery and on strategies for improving the care and treatment of
    infants born prematurely or at low birth weight. In addition, funding
    should be provided to enable the Institute to work with the Office of
    the Director of NIH to create a comprehensive strategic plan for this
    research that includes coordination of strategies and studies across
    multiple Institutes.
        Since 1981, the preterm birth rate has increased 33 percent
    resulting in more than 500,000 premature births in 2004--that is 1 in 8
    births. Preterm birth is the leading cause of death in the first month
    of life and, for those babies who do survive, one in 5 experiences
    multiple health problems including cerebral palsy, mental retardation,
    chronic lung disease, and vision and hearing loss. Preterm labor can
    happen to any pregnant woman, and the causes of nearly half of all
    premature births are unknown. This growing problem is a tragedy for
    families and expensive for the Nation. In 2003, the national hospital
    bill for the care of babies with a primary or secondary diagnosis of
    prematurity exceeded $18 billion, half of which was borne by Medicaid
    and other public programs and the remainder was charged to employers
    and families. Until we know how to prevent preterm labor, the worsening
    incidence of prematurity means that overall hospital charges will also
    spiral upward.
        In recent years, the NICHD has made a major commitment to
    increasing our understanding of the factors that result in premature
    birth and to developing strategies to prolong pregnancy. But additional
    work is needed and adequate funding is key.
        An area deserving more support is the collaborative Maternal-Fetal
    Medicine Units (MFMU) and Neonatal Research (NR) collaboratives. One
    clinical trial funded through the MFMU network reported a promising
    preventive intervention that relies on a derivative of the hormone
    progesterone. The incidence of preterm delivery was reduced by up to 30
    percent in women who received weekly injections of the compound
    compared to the women who were given a placebo. The results of this
    intervention are impressive and additional funding is needed to support
    further clinical trials of this promising intervention.
        Finally, the March of Dimes urges the subcommittee to include in
    its bill an increase of $57 million for the National Children's Study
    (NCS). While the amount may seem substantial, it is dwarfed by the cost
    of treating the diseases and conditions the study is designed to
    address. If allowed to go forward, the NCS will generate groundbreaking
    research that greatly increases our knowledge of the role family
    genetics and the environment play in the health and development of
    children. Planning for this study has been completed; the Vanguard
    sites have been designated. The project is poised to start
    implementation which will yield critical information for research on
    preterm birth. The NCS will prove a rich and ongoing information
    resource for use by scientists and clinicians to develop treatments and
    preventive measures tailored for the pediatric population. Failure to
    provide the resources needed for this study would be extremely
    shortsighted.
                centers for disease control and prevention (cdc)
    Safe Motherhood/Infant Health
        The National Center for Chronic Disease Prevention and Health
    Promotion, Division of Reproductive Health works to promote optimal
    reproductive and infant health. The March of Dimes recommends a $20
    million increase in fiscal year 2007 to support expansion of research
    to identify risk factors and to develop strategies for preventing
    preterm birth. This can be accomplished with increased funding for the
    two programs described below:
        1. The Pregnancy Risk Assessment Monitoring System (PRAMS) is a
    state-specific, population-based surveillance system designed to
    identify and monitor selected maternal behaviors and experiences
    before, during, and after pregnancy. Data collected through PRAMS is
    used to increase understanding of maternal behaviors and experiences
    and their relationship to adverse pregnancy outcomes, to improve
    maternal and child health programs, and to facilitate the dissemination
    of the latest research findings and clinical practice standards. The
    March of Dimes recommends an increase of $5 million to improve PRAMS so
    that CDC can develop national estimates on behavioral and demographic
    risk factors for preterm birth.
        2. Epidemiological research conducted at CDC is vital to the
    prevention of preterm labor and delivery. The March of Dimes recommends
    an increase of $15 million for the expansion of basic etiologic
    research, research on women at risk for preterm delivery and the social
    and environmental factors contributing to higher rates of preterm
    delivery in African-American women. Increasing CDC's research
    activities related to preterm birth will lead to improvements in
    screening and early detection and new interventions for women at risk
    for preterm labor.
    National Center on Birth Defects and Developmental Disabilities
        The March of Dimes recommends a minimum of $135 million in fiscal
    year 2007 funding for the National Center on Birth Defects and
    Developmental Disabilities (NCBDDD). NCBDDD conducts programs to
    protect and improve the health of children by: (1) preventing birth
    defects and developmental disabilities; and (2) promoting optimal
    development and wellness among children with disabilities. Of
    particular interest to the March of Dimes is NCBDDD's birth defects
    program that includes surveillance, research and prevention activities.
    For fiscal year 2007, the March of Dimes requests an increase of $6
    million to support surveillance and research and an additional $2
    million for folic acid education. These modest increases are vital to
    making progress in reducing the incidence of birth defects.
        In the United States, about 3 percent of all babies are born with a
    major birth defect. Birth defects are the leading cause of infant
    mortality accounting for more than 20 percent of all infant deaths
    every year. Children with birth defects who survive often experience
    long term physical and mental disabilities, and are at increased risk
    for developing other significant health problems. In fact, birth
    defects contribute substantially to the Nation's health care costs.
    According to CDC, the lifetime cost of caring for infants born with one
    of the 18 most common birth defects exceeds $8 billion annually.
        NCBDDD provides funding to assist States with community-based birth
    defects tracking systems, programs to prevent birth defects and improve
    access to health services for children with birth defects. In 2006, CDC
    has been able to support only 15 States in their efforts to improve
    surveillance programs, down from 28 States in fiscal year 2004.
    Additional resources are sorely needed to help States seeking
    assistance.
        The causes of nearly 70 percent of birth defects are unknown and it
    is therefore critical that the Committee increase funding for the
    National Birth Defects Prevention Study. This groundbreaking CDC
    initiative is being carried out by 9 regional Centers for Birth Defects
    Research and Prevention located in Arkansas, California, Georgia, Iowa,
    Massachusetts, New York, North Carolina, Texas, and Utah. Each of these
    centers obtains data on infants with major birth defects through
    interviews with their mothers and biological samples that provide
    information about medical history, environmental exposures, and
    lifestyle before and during pregnancy. The study focuses on both
    genetic and environmental causes, including medication use during
    pregnancy, maternal diet and vitamin use. This study is an ongoing
    source of information for use in research on the causes of birth
    defects. With adequate funding this study has the potential to
    dramatically increase our understanding of the causes of birth defects
    and will provide information for developing effective preventive
    measures.
        NCBDDD is conducting a national public and health professions
    education campaign designed to increase the number of women taking
    folic acid. CDC estimates that up to 70 percent of neural tube defects
    (NTDs), serious birth defects of the brain and spinal cord including
    anencephaly and spina bifida could be prevented if all women of
    childbearing age consume 400 micrograms of folic acid daily, beginning
    before pregnancy. Since fortification of grain products with folic acid
    in 1996, the rate of NTDs in the United States has decreased by 26
    percent, but more must be done to educate every woman of childbearing
    age and the health professionals who treat them about the importance of
    taking folic acid daily.
        Finally, the March of Dimes recommends that additional funds be
    provided to conduct surveillance and epidemiological research on
    cerebral palsy through the network already in place for autism (Centers
    of Excellence for Autism and Developmental Disabilities Research and
    Epidemiology). Cerebral palsy is one of the most common developmental
    disabilities and there is currently very limited surveillance and
    research being conducted.
    National Immunization Program
        If the Nation is to meet the Healthy People 2010 goals of
    vaccinating 90 percent of children and adults, CDC, States, and
    localities will need the resources required to reach those in need of
    immunizations. According to the CDC, nearly 25 percent of two-year-olds
    have not received all of the recommended vaccine doses. CDC's National
    Immunization Program provides grants to 64 State, local, and
    territorial public health agencies to reduce the incidence of
    disability and death resulting from 12 vaccine preventable diseases.
    The March of Dimes urges the subcommittee to continue its longstanding
    policy of ensuring that Federal vaccine programs are well funded. For
    fiscal year 2007, the March of Dimes recommends $802.4 million to
    ensure that the National Immunization Program has the resources it
    needs to account for vaccine price increases, introduction of new
    vaccines, and to implement recommendations by the Institute of
    Medicine.
    Polio Eradication
        The March of Dimes supports a funding level of $101.254 million for
    CDC's fiscal year 2007 global polio eradication activities. Level with
    fiscal year 2006, this funding would allow CDC to continue its
    supplementary immunization activities in the remaining endemic and
    high-risk countries in Africa and Asia and to move quickly to interrupt
    polio transmission in these regions. The U.S. Government must maintain
    its commitment to the worldwide eradication initiative that promises to
    save lives and reduce unnecessary health-related costs globally.
    National Center for Health Statistics
        The National Center for Health Statistics (NCHS) provides data
    essential for both public and private research and programmatic
    initiatives. The National Vital Statistics System and the National
    Survey on Family Growth, for example, are major sources of information
    on the utilization of prenatal care and on birth outcomes, including
    preterm delivery, low birthweight and infant mortality. Increased
    funding would enable CDC to introduce web-based technology to
    facilitate more rapid and accurate compilation of data obtained from
    health professionals and facilities. This information is used to track
    trends in birth outcomes and to support State birth defects registries.
    Data from NCHS surveys are also used to identify emerging trends and to
    optimize use of existing program resources.
              health resources and services administration (hrsa)
    Newborn Screening
        Newborn screening is a vital public health activity used to
    identify genetic, metabolic, hormonal and/or functional conditions in
    newborns that if left untreated can cause disability, mental
    retardation, and even death. Although nearly all babies born in the
    United States are screened for some genetic birth defects, the number
    of these tests varies from State to State. The March of Dimes
    recommends that every baby born in the United States receive, at a
    minimum, screening for a core set of 28 metabolic disorders plus
    hearing deficiencies.
        In fiscal year 2005 and fiscal year 2006, Congress provided funding
    for implementation of Title XXVI of the Children's Health Act of 2000;
    specifically, to fund the Regional Genetic Service and Newborn
    Screening Collaboratives that work to address the maldistribution of
    genetic services and resources and bring services closer to local
    communities. The March of Dimes supports an appropriation of $25
    million to enable HRSA to improve the capacity of States to: (1)
    provide screening, counseling, testing, and special services for
    newborns and children at risk for heritable disorders; (2) educate
    health professionals and parents on the availability and importance of
    newborn screening; and (3) support States with technical assistance on
    the acquisition and use of new technologies and newborn screening
    services.
    Healthy Start
        The Healthy Start Initiative is a collection of community based
    projects focused on reducing infant mortality, low birthweight and
    racial disparities in perinatal outcomes. The March of Dimes strongly
    supports Healthy Start and urges continued funding for this important
    program to decrease this Nation's tragically high rate of infant
    mortality.
    Maternal and Child Health Block Grant
        In recent years, Federal funding for Title V of the Social Security
    Act, the Maternal and Child Health (MCH) Block Grant, has not kept pace
    with increased demand for services. Although the MCH Block Grant
    provides assistance for a growing number of community-based programs
    (such as home visiting, respite care for children with special health
    care needs and ``wrap around'' services for pregnant women and children
    enrolled in Medicaid and SCHIP), the funding level was reduced by $24
    million in fiscal year 2006. In order for maternal and child health
    programs to shoulder responsibility for additional beneficiaries and
    services, funding must be increased. The March of Dimes recommends full
    funding of the MCH Block Grant at the authorized level of $850 million.
    Consolidated Health Centers
        Consolidated (Community) Health Centers are an important source of
    obstetric and pediatric care for more than 15 million individuals,
    approximately 40 percent of whom are uninsured. The Foundation
    recommends new funding sufficient to increase the number of centers and
    to improve the scope of perinatal services provided. Adding funds to
    this program would be consistent with the President's five-year plan to
    create and expand health center sites in 1,200 communities and to
    increase the number of patients served annually to more than 16
    million.
        Thank you for the opportunity to testify on the federally supported
    programs of highest priority to the March of Dimes. The Foundation's
    volunteers and staff in every State, the District of Columbia, and
    Puerto Rico look forward to working with members of the subcommittee to
    improve the health of the Nation's mothers, infants and children.
                                     ______

         Prepared Statement of the Medical Library Association and the
               Association of Academic Health Sciences Libraries
        Mr. Chairman, thank you for the opportunity to testify today on
    behalf of the Medical Library Association (MLA) and the Association of
    Academic Health Sciences Libraries (AAHSL) regarding the fiscal year
    2007 budget for the National Library of Medicine (NLM). I am Marianne
    Comegys, Director of the Louisiana State University Health Sciences
    Center Library, Shreveport, Louisiana.
        MLA, a nonprofit educational organization established in 1898,
    comprises health sciences information professionals with more than
    4,500 members worldwide. Through its programs and services, MLA
    provides lifelong educational opportunities, supports a knowledgebase
    of health information research, and works with a global network of
    partners to promote the importance of quality information for improved
    health to the health care community and the public.
        AAHSL is comprised of the directors of the libraries of 142
    accredited United States and Canadian medical schools belonging to the
    Association of American Medical Colleges (AAMC). Together, MLA and
    AAHSL address health information issues and legislative matters of
    importance through a joint task force.
        Mr. Chairman, the National Library of Medicine (NLM), on the campus
    of the National Institutes of Health (NIH) in Bethesda, Maryland, is
    the world's largest medical library. NLM collects material in all areas
    of biomedicine and health care, as well as works on biomedical aspects
    of technology, the humanities, and the physical, life, and social
    sciences.
        With respect to the Library's budget for the coming year, I would
    like to touch briefly on six issues: (1) the growing demand for NLM's
    basic services; (2) NLM's outreach and education services; (3)
    Emergency preparedness and response; (4) NLM's health information
    technology activities; (5) NLM's facility needs; and (6) NLM's
    infrastructure that supports the NIH Public Access Policy.
                  the growing demand for nlm's basic services
        Mr. Chairman, it is a tribute to NLM that the demand for its
    collections continues to steadily increase each year. These collections
    stand at 8.5 million items-books, journals, technical reports,
    manuscripts, microfilms, photographs, and images. Housed within the
    library is one of the world's finest collections of old and rare
    medical works. NLM is a national resource for all U.S. health science
    libraries through the National Network of Libraries of Medicine.
    Increasingly, it is also becoming an international resource for world-
    wide research collaboration.
        Our Nation's healthcare providers, researchers, and consumers all
    use the library's collections, through the reading rooms or through
    interlibrary loan, and on the World Wide Web. Increasingly, NLM's
    collection is also available in digital form. NLM is developing a
    strategy for selecting, organizing, and ensuring permanent access to
    digital information. By doing so they are ensuring their availability
    for future generations. This availability of health information remains
    the highest priority for the Library.
        Mr. Chairman, simply stated, NLM is a national treasure. I can tell
    you that without NLM our Nation's medical libraries would be unable to
    provide the quality information services that our Nation's healthcare
    providers, educators, researchers, and patients, have all come to
    expect.
        Recognizing the invaluable role that NLM plays in our healthcare
    delivery system, the Medical Library Association and the Association of
    Academic Health Sciences Libraries join with the Ad Hoc Group for
    Medical Research Funding in recommending a 5 percent increase for NLM
    and NIH overall in fiscal year 2007.
                             outreach and education
        NLM's outreach programs are of particular interest to both MLA and
    AAHSL. These activities, designed to educate medical librarians,
    healthcare professionals and the general public about NLM's services,
    are an essential part of the Library's mission.
        The Library has taken a leadership role in promoting educational
    outreach aimed at public libraries, secondary schools, senior centers,
    and other consumer-based settings. NLM's emphasis on outreach to
    underserved populations assists the effort to reduce health disparities
    among large sections of the American public.
        NLM's ``Partners in Information Access'' program is designed to
    improve the access of local public health officials to health
    information. The establishment of additional programs across the
    country will go a long way towards ensuring that healthcare workers
    across America are familiar with NLM and the National Network of
    Libraries of Medicine. My own facility, the LSU Health Sciences Center
    in Shreveport, Louisiana, participates in this program. Through it, we
    are able to train public health workers on how to access health
    information online.
        We ask the Committee to encourage NLM to coordinate its outreach
    activities with the medical library community.
    PubMed Central
        The medical library community also applauds NLM for its leadership
    in establishing PubMed Central, an online repository for life science
    articles. Introduced in 2000, PubMed Central was created by NLM's
    National Center for Biotechnology Information and evolved from an
    electronic archiving concept proposed by former NIH director Dr. Harold
    Varmus. The site houses 615,000 articles from 232 journals including
    the Proceedings of the National Academy of Sciences and Molecular
    Biology of the Cell.
        The medical library community believes that medical librarians
    should continue to play a key role in the further development of PubMed
    Central and we are pleased that medical librarians are members of the
    PubMed Central Advisory Committee. Because of the high level of
    expertise health information specialists have in the organization,
    collection, and dissemination of medical literature, we believe that
    our community can assist NLM with issues related to copyright, fair
    use, and information classification. We look forward to continuing our
    collaboration with the Library as this exciting project continues to
    evolve.
    MEDLINEplus
        MEDLINEplus [http://www.nlm.nih.gov/medlineplus], a source of
    authoritative, full-text, health information resources from the NIH
    institutes and a variety of non-Federal sources, has grown tremendously
    in its coverage and its usage by the public. In January of 2006,
    MEDLINEplus had 8.6 million unique visitors research 67 million pages
    of health information (including information from over 1,250
    organizations). MEDLINEplus's features include illustrated interactive
    patient tutorials, a daily news feed from the public media on health-
    related topics, and the NIH SeniorHealth website [http://
    www.nihseniorhealth.gov], a collaborative project between NLM and the
    National Institute on Aging.
        ``Go Local'' is another new and exciting feature of MEDLINEplus. Go
    Local enables local and State agencies and others to participate by
    creating sites that connect the MEDLINEplus information seeker to local
    hospitals, pharmacies, doctors, and other health services. These
    agencies use the infrastructure created by NLM that makes this
    possible. Using Go Local, a search by topic on MEDLINEplus will lead
    the consumer to local services connected to that topic. Currently,
    there are fourteen localities participating in the Go Local service,
    and many more will be added in the near future. Through this service,
    NLM and MEDLINE are becoming increasingly valuable tools, not just for
    medical librarians and other health professionals but also for the
    health consumer.
    Clinical Trials
        Mr. Chairman, I also want to address another frequently used
    service offered by NLM--its clinical trials database [http://
    www.clinicaltrials.gov]. This listing of more than 27,000 Federal and
    privately funded trials for serious or life-threatening diseases was
    launched in February 2000 and currently logs more than 8 million page
    views per month and 25,000 visitors daily. The clinical trials database
    is a free and invaluable resource to patients and families interested
    in participating in cutting edge treatments for serious illnesses. The
    medical library community congratulates NLM for its leadership in
    creating ClinicalTrials.gov and looks forward to assisting the Library
    in advancing this important initiative.
                      emergency preparedness and response
        Since the late 1960s, NLM has been actively involved in disaster
    response and management. As a Louisiana resident, I am pleased to
    report about NLM's relief work in response to Hurricane Katrina. NLM's
    Specialized Information Services (SIS) Division compiled a Hurricane
    Katrina Web page on toxic chemical and environmental health information
    resources. The Web page provided links to information on chemicals that
    may have been released and on environmental concerns following the wind
    and flood damage. The page also linked to the Wireless Information
    System for Emergency Responders (WISER). WISER provides information on
    400 of the most hazardous chemicals in NLM's Hazardous Substances
    Databank. It can be downloaded to a Personal Digital Assistant (PDA) or
    field laptop, providing first responders with ready access to basic
    emergency haz-mat information. At the request of the Environmental
    Protection Agency, NLM provided 15 PDAs loaded with WISER for the EPA
    National Decontamination Team to take with them when they were deployed
    to New Orleans. In addition, NLM's National Center for Biotechnology
    Information (NCBI) has provided assistance to the State of Louisiana in
    identifying Katrina victims with software tools that improve speed and
    accuracy of DNA identification.
        In addition to NLM's efforts on the national level, the South
    Central Regional office of the NLM-supported National Network of
    Libraries of Medicine provided specific help to the libraries in its
    territory that were impacted by Katrina. When librarians were dispersed
    to remote sites, the Regional office purchased laptops and printers for
    them to use. Arrangements were also made for Katrina-area libraries to
    have free interlibrary loans. The South Central Regional office also
    created a blog, ``Hurricane Katrina in the SCR,'' for librarians to
    post information regarding colleagues and building conditions. During
    the first few weeks after Katrina, when we were unsure of where our
    friends had relocated and how to contract them, the blog was an
    invaluable resource for helping us to find them and for suggesting ways
    to assist them.
        Mr. Chairman, we applaud the success of NLM's outreach initiatives,
    particularly those initiatives that reach out to medical libraries and
    healthcare consumers. We look forward to continuing our work with the
    Library in fiscal year 2007 on these important programs.
                health information technology and bioinformatics
        Mr. Chairman, NLM played a major role in creating and nurturing the
    field of medical informatics. For nearly 35 years, the Library has
    supported informatics research and training and the application of
    advanced computing and communications to biomedical research and health
    care delivery. Many of today's informatics leaders are graduates of
    NLM-funded informatics research programs at universities across the
    country. Many of the country's exemplary electronic health record
    systems (e.g., in Indianapolis, Vanderbilt, and Pittsburgh) benefited
    from NLM grant support. The Library began supporting informatics
    research that addresses information management problems relevant to
    disaster management several years ago. It has also funded innovative
    telemedicine projects in various rural and urban medically underserved
    communities, as models for evaluating the impact of telemedicine on
    cost, quality, and care. A leader in supporting, licensing, developing,
    and disseminating standard clinical terminologies for free nationwide
    use, NLM works closely with the National Coordinator of Health
    Information technology to promote adoption of interoperable electronic
    records. Through its National Center for Biotechnology Information, NLM
    creates and provides access to GenBank, the genetic sequence
    repository, and a wide array of related scientific data and analysis
    tools. These publicly accessible resources are speeding the pace of
    scientific discovery around the world, including important insights
    into the evolution of the flu. Building on this success, NLM will
    develop databases to manage the vast amount of genetic, medical and
    environmental information that will emanate from new HHS and NIH
    efforts to analyze genetic variation in groups of patients with
    specific illnesses and to devise new ways of monitoring personal
    environmental exposures that interact with genetic variations and
    result in human diseases.
        We are pleased that NLM is supporting informatics research that
    addresses information management problems relevant to disaster
    management. Medical librarians and health information specialists have
    an important role to play in supporting these cutting edge technologies
    and in serving as important sources of health information for those
    displaced by disasters. We encourage Congress and NLM to continue their
    strong support of NLM's medical informatics and genomic science
    initiatives, at a point when the linking of clinical and genetic data
    holds increasing promise for enhancing the diagnosis and treatment of
    disease. MLA and AAHSL also support Health Information Technology
    initiatives in the Office of the National Coordinator for Health
    Information Technology (ONCHIT) and the Agency for Healthcare Research
    and Quality (AHRQ) that build upon initiatives housed at NLM.
                             nlm's facilities needs
        Mr. Chairman, over the past two decades NLM has assumed several new
    responsibilities, particularly in the areas of biotechnology, health
    services research, high performance computing, and consumer health. As
    a result, the Library has had tremendous growth in its basic functions
    related to the acquisition, organization, and preservation of an ever-
    expanding collection of biomedical literature. In order to complete
    these functions, NLM has had to expand its staff. NLM now houses 1,100
    staff in a facility built to accommodate only 650. This increase in the
    volume of biomedical information and in the number of personnel has led
    to a serious shortage of space at the Library.
        In order for NLM to continue its mission as the world's premier
    biomedical library, a new facility is urgently needed. The NLM Board of
    Regents has assigned the highest priority to supporting the acquisition
    of a new facility. The medical library community is pleased that
    Congress appropriated the necessary architectural and engineering funds
    for the design of the facility expansion at NLM in 2003. The community
    is also pleased that the American Center for Cures Act, (S. 2104)
    introduced in the Senate by Senator Lieberman, asks Congress to make a
    special effort to fund the expansion of NLM's facilities.
        We encourage the subcommittee to provide the resources necessary to
    construct a new facility and to support the Library's health
    information programs.
                            nih public access policy
        MLA and AAHSL support the goals of the NIH public access policy to
    create a central archive of NIH-funded research publications to advance
    science and enable NIH to better manage its research portfolio, and to
    provide electronic access to the public to NIH-funded research
    publications. We are concerned, however, that the current rate of
    participation in the voluntary policy is low--less than 4 percent.
    Information provided by the NIH Public Access Working Group indicates
    that the submission system is not difficult to use and that the
    majority of NIH-funded researchers appear to know about the policy. For
    these reasons, we concur with the conclusion of NLM's Board of Regents,
    that the NIH Policy cannot achieve its stated goals unless deposit of
    manuscripts becomes mandatory. We also support the Board of Regents'
    recommendation that NIH and NLM develop a careful plan for
    transitioning to a mandatory policy, and to provide clear guidance and
    a reasonable timetable to minimize burden on NIH-funded researchers and
    grantee institutions, and also to work with publishers to make it easy
    for them to submit articles on behalf of their NIH-supported authors.
        We encourage Congress to continue to ask for periodic evaluation of
    the plan as it is implemented in the coming months and years.
        Mr. Chairman, thank you again for the opportunity to present the
    views of the medical library community.
                                     ______

                 Prepared Statement of The Mended Hearts, Inc.
        The Mended Hearts, Inc. (MHI) is a national nonprofit organization
    that offers the gift of hope to heart patients, their families and
    caregivers for more than 50 years. Mended Hearts has 21,000 members
    operating through 280 community-based chapters across the country, with
    two in Canada. Chapters partner with more than 450 hospitals and
    cardiac care facilities in providing patient-to-patient support
    services. I have been appointed by the group as their legal
    representative--a volunteer position. I am a heart disease survivor.
        About 30 years ago, I was diagnosed with a rare heart disease.
    After having chest discomfort and trouble breathing for more than two
    years, I was diagnosed with hypertrophic cardiomyopathy (HCM), a
    disease in which the heart enlarges. The heart muscle gradually
    thickens so much that heart cannot pump blood out effectively. The new
    heart muscle replacing the old heart tissue does not grow in the normal
    parallel pattern. Instead, it grows in a helter-skelter pattern.
    Studies show that 36 percent of young athletes who die suddenly have
    probable or definite hypertrophic cardiomyopathy, but it also affects
    men and women of all ages. HCM is one of the major causes of sudden
    death due to cardiac arrhythmias. There is no cure for HCM. However,
    medication may work, and there is surgery, which may alleviate the pain
    and discomfort, prolonging the patient's life. If surgery does not
    work, the alternative is a heart transplant, but donor organs are
    scarce. The doctor who made my diagnosis was trained at the National
    Institutes of Health's (NIH) National Heart, Lung, and Blood Institute
    (NHLBI).
        Initially, I received several medications, which enabled me to
    engage in most activities. However, some activities, such as walking up
    hills, caused shortness of breath and severe chest pains. But,
    generally I could function normally. After about 10 years, the
    discomfort was increasing, and it became apparent that I was in serious
    trouble. I could not walk sixty feet without having to stop to catch my
    breath. Sometimes the pain was so severe that I would almost double
    over in the middle of the street. My wife told me later that my face
    would become gray. And the perspiration would pour off my body. The
    quality of my life had deteriorated so drastically that I knew I needed
    some treatment.
        In 1988, I went to Georgetown Hospital for an angiogram--the gold
    standard for diagnosing heart problems. After the test, the
    cardiologist told me that he had bad news and worse news. The bad news
    was that I had a 95 percent blockage in my left anterior descending
    heart artery at the location known as the ``widow-makers spot.'' The
    worse news was that I had a major chance of suffering a severe heart
    attack, with less than a 5 percent chance of survival because of the
    HCM. At this point, my wife was quietly crying and I was perspiring
    profusely.
        Because Georgetown Hospital did not have the expertise to operate
    on my condition, they called the NIH to see if they would accept me as
    a patient. I was sent home pending notice from NIH. I knew that I had
    run out of alternatives. No matter what the results, I needed treatment
    and I needed it immediately.
        Subsequently, the NIH accepted me. After entering the NHLBI on
    February 9, my surgery occurred on February 11, 1998. No matter how
    trite the expression, it is very true--the day after surgery was the
    first day of the rest of my life. The surgery, a left ventricular
    myotomy and myectomy, was considered drastic. I was later told that the
    mortality rate was as high as 10 percent. That surgery is still done in
    only a few hospitals. It is considered the gold standard for the
    treatment of HCM. This Murrow Procedure, in honor of the innovator, was
    developed and improved at the NIH.
        Currently, there is a new experimental protocol in which the same
    effect is now being attempted by using alcohol to deaden the excessive
    heart tissue, instead of removing a piece of heart muscle from the
    heart's main pumping chamber, as was done in my case.
        Now, I am on medication for the rest of my life. My condition is
    progressive. More than 10 years ago, I was fitted with a pacemaker to
    ensure that my heart beats at the correct rate. I am 100 percent
    dependent upon my pacemaker. Without the pacemaker, there are times
    when my normal heart beat is so slow that I could die.
        I am eternally grateful to the physicians funded by the NHLBI,
    particularly to Dr. Charles MacIntosh and his staff, for the gift of
    life. Because of this marvelous doctor and research, I have lived
    eighteen years free of pain. I have seen two children graduate from
    college, witnessed the birth of three grandchildren, and shared these
    years with a wonderful wife. And, I have been able to work at my
    profession--attorney at law.
        I have had the gift of life restored to me. To express my gratitude
    for that gift, under the aegis of the Mended Hearts, Inc., I visit
    patients recovering from heart episodes at two hospitals: Washington
    Hospital Center and Washington Adventist Hospital. Last year MHI
    visited more than 228,000 patients and their families in our mission of
    support. We have also made 6,700 visits over the telephone to give
    succor to these patients.
        If this tale of woe is not enough, about 3.5 years ago, I suddenly
    began to have mini-strokes. I experienced five episodes within 13
    months. The last episode was just a year ago. Medication, including
    coumadin, now seems to have the incidents under control. Coumadin is a
    blood thinning drug that requires constant monitoring. At least once a
    month, I have to go to the hospital to get blood drawn from my arm to
    check the level of the drug.
        To advance the fight against heart disease and stroke, I
    respectfully ask for the fiscal year 2007 appropriations in the
    following amounts:
      --National Institutes of Health--$29.8 billion
      --National Heart, Lung, and Blood Institute--$3.1 billion
      --National Institute of Neurological Disorders and Stroke--$1.6
            billion.
        My experience and my continued life is proof that the research
    supported by the NIH benefits not just the patients at the Clinical
    Center, but throughout the United States. The benefits go worldwide
    too.
        Cardiovascular diseases remain the major killer of men and women in
    the United States. Nearly 40 percent of people who die in the United
    States, die from cardiovascular diseases. From 1979 through 2003,
    cardiovascular operations and procedures increased 470 percent.
                                     ______

         Prepared Statement of the Montgomery County (Maryland) Stroke
                                  Association
        My name is Susan Emery. I am the President of the Montgomery County
    Stroke Association and I am a stroke survivor.
        Our Association conducts education and supports activities for
    stroke survivors, their family members, and caregivers. We serve people
    in the Maryland suburbs of Washington, D.C., and are fortunate to be in
    the same county as the National Institutes of Health. We have benefited
    on many occasions by the participation of NIH staff members in our
    membership meetings. They have been generous in sharing information
    with us about their research on stroke prevention and treatment.
        On December 26, 1965, at the age of nine, I was playing a new game
    with my brother and a few friends at the kitchen table. That is the
    last thing that I remember. I was unconscious for the next two days. My
    mother first learned, incorrectly, that I had spinal meningitis. I was
    transferred to another hospital where my mother was told that I had
    little chance of survival. Yet, I am here, more than 40 years later,
    and I have survived a stroke.
        People seldom associate strokes with children. These strokes are
    rare, but they do happen. There are about three cases of stroke per
    year in every 100,000 children aged 14 and under. One of the
    difficulties in dealing with strokes in children is getting the right
    diagnosis quickly. There are often delays in diagnosis of childhood
    stroke.
        I spent two weeks in the hospital and the subsequent 4 months in
    intensive physical therapy. My 10th birthday was spent in the hospital,
    and I have a picture in my photo album of myself with my mother and a
    new friend. My right eye is turned down, my mouth is turned down, but I
    am still smiling. During the 4 months in therapy at Holy Cross in
    Detroit, I learned the basics: how to walk, how to talk, and how to
    move the fingers on my right hand. My mother followed the doctor's
    instructions and sent me back to school very quickly, where classmates
    helped me button and unbutton my coat and carry my books, and teachers
    taped papers to the desk so I could learn to write again. I survived
    that 4 months, and would never wish to repeat it.
        I have been in therapy six times in my life. I need to tell you
    about the one time that was the most important to my family. I was 26
    years old and had just had my first child. I kept her safe, for I knew
    my limitations. I always used my left hand to support her. But when she
    was 6 months old, she got to be a little heavy, and twice, as I was
    putting her on the floor to change her diaper, my right hand slipped
    from under her buttocks. She fell only inches in both cases and did not
    even notice. But I noticed. I went in for 2 or 3 months of therapy
    close to Denver, Colorado, where I was living at the time. Here, for
    the first time, they helped my right hand and arm dexterity through
    occupational therapy. I also learned that I had aphasia--the inability
    to speak, write or understand spoken or written language because of
    brain injury--because I called things like fruit baskets ``unicorns''
    instead of cornucopias. Instead of the word being the same, I picked a
    word that sounded the same. The therapists in Colorado worked with my
    mind and my body and I will forever be in their debt.
        Close to 15 years ago, I made a new life for myself in Maryland.
    Here, I have been an outpatient at the National Rehabilitation Hospital
    three times: once for my right foot, once for my Achilles tendon, and
    once for my right knee. I have seen numerous physiatrists, all of whom
    are excellent in their field. I have also seen my fair share of
    therapists. Since I have had therapy on and off for most of my life, I
    can honestly say that the first few times you go in to see a therapist,
    you will come out hurting more than when you went in. But in the long
    run, they help tremendously.
        On a work related note, I received a Bachelor of Science in 1978
    from Michigan State University in Computer Science and worked for 12
    years in the field. I started working in the telecommunications
    industry in 1990, and got a Master of Science from the University of
    Maryland, University College in Telecommunications Management. I now
    work for ITT Industries as a senior engineer on a contract supporting
    the Federal Aviation Administration's leased telecommunications
    activities, and have worked with the FAA for more than 10 years. I have
    done more than survive. I have become a productive member of society.
        Stroke research has changed my life. Without the research carried
    out 40 to 50 years ago, I would not have benefited from electric shock
    therapy that made me understand the muscles that move my fingers.
    Without research done 30 years ago, I may not have been able to
    understand how to exercise my hand for dexterity. Without research
    performed 10 years ago, the people around me would not understand that
    they need to get me to the hospital quickly if ever I have another
    stroke. Without current support, researchers may never understand how
    to stop strokes before they happen or how to make current stroke
    survivors live healthier lives.
        Stroke remains America's No. 3 killer and a major cause of
    permanent disability. An estimated 5.5 million Americans live with the
    consequences of stroke and about 1 in 4 is permanently disabled. Yet,
    stroke research continues to receive a mere 1 percent of the National
    Institutes of Health budget. I strongly urge you to significantly
    increase funding for the National Institutes of Health-supported stroke
    research, particularly for National Institute of Neurological Disorders
    and Stroke-supported stroke research. NIH stroke research is essential
    to prevent strokes from happening to children and adults in the first
    place, and to advance recovery and rehabilitation of those who survive
    this potentially devastating illness.
                                     ______

     Prepared Statement of the National Association of Children's Hospitals
        The National Association of Children's Hospitals (N.A.C.H.) is
    pleased to submit a statement for the record in support of the
    Children's Hospitals' Graduate Medical Education (CHGME) Program in the
    Health Resources and Services Administration. On behalf of the Nation's
    60 independent children's teaching hospitals, N.A.C.H. very much
    appreciates Chairman Specter's and the subcommittee's early and
    continuing commitment over many years to provide full, equitable GME
    funding for these hospitals. CHGME seeks to give them a level of
    Federal support for their teaching comparable to what all other
    teaching hospitals receive from Medicare.
        N.A.C.H. also appreciates the subcommittee's support for $300
    million for fiscal year 2006. Ultimately this was reduced to $297
    million, or less than level funding, due to a 1 percent across-the-
    board cut in discretionary spending. This marked the third consecutive
    year CHGME was reduced due to across-the-board cuts since Congress
    first agreed to appropriate $305 million for fiscal year 2004.
        CHGME has been a success. Thanks to the program, Federal GME
    support to children's hospitals now approaches equity with Medicare GME
    support to adult hospitals. CHGME has made it possible for children's
    hospitals to strengthen their training of pediatric providers at a time
    of national shortages, without having to sacrifice clinical or research
    programs. It has enabled them to have strong financial positions, which
    are essential for their capital intensive missions.
        For fiscal year 2007, N.A.C.H. respectfully requests $330 million
    for CHGME funding. This amount would make up for erosion in funding
    over the last three years and address the cost of inflation, a critical
    factor in a program associated with both wage-related and medical
    teaching costs. Full funding would ensure the hospitals will have the
    resources necessary to train and educate the Nation's pediatric
    workforce. Given the challenges the subcommittee faces, we hope, at a
    minimum, CHGME can be maintained at level funding and not lose further
    ground in fiscal year 2007.
                       n.a.c.h. and children's hospitals
        N.A.C.H. represents more than 130 children's hospitals. They
    include independent acute care children's hospitals, children's
    hospitals within larger medical centers, and independent children's
    specialty and rehabilitation hospitals. N.A.C.H. helps its members
    fulfill their missions of clinical care, education, research and
    advocacy for the health and well-being of all children.
        Children's hospitals are regional and national centers of
    excellence for children with serious and complex conditions. They are
    centers of biomedical and health services research for children and
    serve as the major training centers for pediatric researchers, as well
    as a significant number of children's doctors. They also are major
    safety net providers, serving a disproportionate share of children from
    low-income families, and they are advocates for the public health of
    all children.
        Although they represent less than 5 percent of all hospitals in the
    United States, the three major types of children's hospitals provide 41
    percent of the inpatient care for all children, 42 percent of the
    inpatient care for children assisted by Medicaid, and the vast majority
    of hospital care for children with serious conditions such as cancer or
    heart defects.
                         background: the need for chgme
        While they account for less than 1 percent of all hospitals,
    independent children's teaching hospitals train nearly 30 percent of
    all pediatricians, half of all pediatric specialists and the majority
    of pediatric researchers. These hospitals provide required pediatric
    rotations for many other residents and train more than 4,800 resident
    full time equivalents annually. Shortages of pediatric specialists
    across the Nation only heighten the importance of these hospitals.
        Prior to initial funding of the CHGME program for fiscal year 2000,
    the eligible hospitals faced enormous challenges in maintaining their
    training programs. The increasingly price competitive medical
    marketplace was resulting in more and more payers failing to cover the
    costs of care, including the costs associated with teaching.
        Because they see few--if any--Medicare patients, independent
    children's hospitals were essentially left out of Medicare GME funding,
    which had become the one major source of GME financing for other
    teaching hospitals. Independent children's hospitals received only 1/
    200th (or less than 0.5 percent) of the Federal GME support that all
    other teaching hospitals received under Medicare. This lack of GME
    financing, combined with financial challenges stemming from other
    missions, threatened the hospitals' teaching programs, as well as other
    services.
        Safety Net Institutions.--Independent children's hospitals are a
    significant part of the health care safety net for low-income children.
    This critical mission puts the hospitals at financial risk. In fiscal
    year 2005, children assisted by Medicaid were, on average, more than 50
    percent of all discharges from independent acute care children's
    hospitals. Yet, Medicaid, on average, paid only 79 percent of costs.
    Without disproportionate share hospital payments, Medicaid would cover,
    on average, only 73 percent of costs. Medicaid payment shortfalls for
    outpatient and physician care are even greater.
        Independent children's hospitals also are essential providers of
    care for seriously and chronically ill children. The hospitals devote
    more than 75 percent of their care to children with one or more chronic
    or congenital conditions. They provide the majority of inpatient care
    to children with many serious illnesses--from children with cancer or
    cerebral palsy, for example, to children needing heart surgery or organ
    transplants. In some regions, these children's hospitals are the only
    source of pediatric specialty care. The services they must maintain to
    assure access to high quality, complex care for all children are often
    inadequately reimbursed.
        Many of the independent children's hospitals also are a vital part
    of the emergency and critical care services in their regions. They are
    part of the emergency response system that must be in place for public
    health emergencies. Expenses associated with preparedness add to their
    continuing costs in meeting children's needs.
        Mounting Financial Pressures.--The CHGME program, and its
    relatively quick progress to full funding in fiscal year 2002, came at
    a critical time. In 1997, when Congress first considered establishing
    CHGME, a growing number of independent children's hospitals had
    financial losses; many more faced mounting financial pressures. More
    than 10 percent had negative total margins, more than 20 percent had
    negative operating margins and nearly 60 percent had negative patient
    care margins. Some of the Nation's most prominent children's hospitals
    were at financial risk. Thanks to CHGME, these hospitals have been able
    to maintain and strengthen their training programs.
        Pediatric Workforce Development.--The important role CHGME plays in
    the continual development of our Nation's pediatric workforce is not
    lost on the larger pediatric community, including the American Academy
    of Pediatrics and Association of Medical School Pediatric Department
    Chairs. They support CHGME and recognize it is critical not only to the
    future of the individual hospitals but also to provision of children's
    health care and advancements in pediatric medicine overall.
                             congressional response
        In the absence of movement to broader GME financing reform,
    Congress authorized the CHGME discretionary grant program in 1999 to
    address the existing inequity in GME financing for the independent
    children's hospitals. The legislation was reauthorized in 2000, through
    fiscal year 2005, and provided $285 million for fiscal year 2001 and
    ``such sums as necessary'' in the years beyond. Congress passed the
    initial authorization as part of the ``Healthcare Research and Quality
    Act of 1999'' and the reauthorization as part of the ``Children's
    Health Act of 2000.''
        With this subcommittee's support, Congress appropriated initial
    funding for CHGME in fiscal year 2000, before the enactment of the
    program's authorization. Following enactment, Congress moved
    substantially toward full funding for the program in fiscal year 2001
    and completed that goal, providing $285 million in fiscal year 2002.
    Subsequently, Congress appropriated $290 million in fiscal year 2003,
    $303 million in fiscal year 2004, $301 million in fiscal year 2005, and
    $297 million in fiscal year 2006. (In the last three years, the funding
    levels are net of across-the-board cuts in discretionary funding.)
        Health Resources and Services Administration (HRSA).--CHGME funding
    is distributed through HRSA to 60 children's hospitals according to a
    formula based on the number and type of full-time equivalent residents
    trained, in accordance with Medicare rules, as well as the complexity
    of care and intensity of teaching the hospitals provide. Consistent
    with the authorizing legislation, HRSA allocates the annual
    appropriation in biweekly periodic payments to eligible independent
    children's hospitals.
        ``Adequate'' Rating from Administration.--The Office of Management
    and Budget gave CHGME an ``adequate'' rating in 2003, using its Program
    Assessment Rating Tool (PART). The PART review found CHGME has a
    ``clear purpose,'' is ``effectively targeted,'' has specific ``long-
    term performance measures'' that focus on outcomes, and holds grantees
    ``accountable for cost, schedule, and performance results.''
                                 chgme success
        The annual CHGME appropriation represents an extraordinary
    achievement for the future of children's health and the Nation's
    independent children's teaching hospitals:
      --Thanks to CHGME, the Federal Government has made substantial
            progress in providing more equitable Federal GME support to
            independent children's hospitals. The hospitals now receive
            about 80 percent of the level of Federal GME support that
            Medicare provides to other teaching hospitals. This is still
            not true equity, but it is dramatic improvement from the 0.5
            percent of 1998.
      --As a result of CHGME, children's hospitals have been able to make a
            substantial improvement in their contribution to the Nation's
            pediatric workforce, without having to sacrifice their clinical
            or research missions. From 2000 to 2004, without the CHGME
            hospitals being able to increase the numbers of general
            pediatric residents they trained, the Nation would have
            experienced a net decline in number of new pediatricians.
            During the same time, CHGME hospitals accounted for more than
            80 percent of new pediatric subspecialty programs and more than
            60 percent of the new pediatric subspecialists trained.
      --CHGME has allowed children's hospitals to achieve strong financial
            positions. According to Moody's, before 2000, children's
            hospitals tended to have negative to break-even financial
            margins. Since then, their margins have improved. CHGME is a
            major reason.
                            fiscal year 2007 request
        N.A.C.H. respectfully requests that the subcommittee provide
    equitable GME funding for independent children's hospitals by providing
    $330 million in fiscal year 2007. Such funding is particularly
    important for a program that has wage-related and medical teaching
    costs and has experienced three years of successive reductions due to
    across-the-board cuts. Given the challenges the subcommittee faces, we
    hope CHGME at least can be maintained at level funding and not lose
    further ground in fiscal year 2007.
        Adequate, equitable funding for CHGME is an ongoing need.
    Children's hospitals continue to train new pediatric residents and
    researchers every year. Children's hospitals have appreciated very much
    the support they have received, including the attainment of the
    program's authorized full funding level in fiscal year 2002 and
    continuation of full funding with an inflation adjustment in fiscal
    year 2003 and fiscal year 2004. Congress can regain this progress by
    providing $330 million in fiscal year 2007.
        Continuing equitable CHGME funding is more important than ever in
    light of budget shortfalls in many States and pressures for significant
    reductions in State Medicaid spending. Because children's hospitals
    devote such a substantial portion of their care to children from low-
    income families, they are especially affected by cutbacks in State
    Medicaid programs.
        Support for a strong investment in GME at independent children's
    teaching hospitals is also consistent with the repeated concern the
    subcommittee has expressed for the health and well-being of our
    Nation's children, through education, health and social welfare
    programs. And it is consistent with the subcommittee's repeated
    emphasis on the importance of enhanced investment in the National
    Institutes of Health (NIH) and in NIH support for pediatric research in
    particular, for which N.A.C.H. is grateful.
        CHGME funding is essential to the ability of the independent
    children's hospitals to sustain their GME programs. At the same time,
    the program enables them to do so without sacrificing support for other
    critically important services that also rely on hospital subsidy, such
    as specialty and critical care services, child abuse prevention and
    treatment services, poison control centers, services to low-income
    children with inadequate or no coverage, mental health and dental
    services, and community advocacy, such as immunization and motor
    vehicle safety campaigns.
                                   conclusion
        In conclusion, CHGME is a success. The program is an invaluable
    investment in children's health. The future of the pediatric workforce
    and children's access to quality pediatric care, including specialty
    and critical care services, depend upon CHGME. N.A.C.H. and the
    independent children's teaching hospitals are deeply grateful to the
    Chairman and subcommittee for your continuing leadership on behalf of
    children's hospitals.
                                     ______

       Prepared Statement of the National Association of County and City
                                Health Officials
                                    summary
        The proposed cuts in the fiscal year 2007 budget for the Centers
    for Disease Control and Prevention (CDC) continue a pattern of reduced
    funding for public health that gravely worries the Nation's local
    health departments. The National Association of County and City Health
    Officials (NACCHO) is particularly concerned about two funding streams
    that directly benefit local health departments, although the range of
    reductions in CDC's budget threaten overall work in prevention that we
    fully support.
        Last year, funding for State and local bioterrorism and public
    health preparedness was cut by $95 million, more than 10 percent.
    NACCHO understands that this will result in a cut of about 12 percent
    in the cooperative agreement funding that goes directly to States and
    four large cities. The Preventive Health and Health Services block
    grant program, the other major source of CDC funding to local health
    departments, was cut by $19 million, which was 16 percent below the
    actual fiscal year 2005 funding made available to grantees, and almost
    25 percent below the fiscal year 2005 appropriated amount. The fiscal
    year 2007 budget freezes preparedness funds and eliminates the block
    grant. Taken together, these reductions will seriously compromise the
    ability of the Nation's governmental public health system to fulfill
    its mission of protecting and promoting health.
        Local public health departments work every day on the front lines
    to combat threats to the health of their communities. They can ill
    afford substantial reductions in Federal support for their roles as
    first responders to bioterrorism and other public health emergencies.
    Moreover, local public health departments receive about 40 percent of
    the Preventive Health and Health Services block grant (PHHS) funds.
    These enable them to carry out programs ranging from prevention of
    heart attack and stroke to combating West Nile virus. In States where
    local health departments rely exclusively on these funds to run
    prevention programs activities to reduce the burdens of preventable
    disease will cease.
        At a time when the Nation is engaged in urgent work to protect the
    homeland from terrorists and natural disasters, as well as to stop an
    epidemic of obesity, it is profoundly counterproductive and irrational
    to reduce support for local programs that are the first line of defense
    against the greatest threats to the health of communities. NACCHO urges
    Congress to continue funding these two CDC programs at levels no less
    than those in fiscal year 2005. Those levels are $927 million for State
    and local bioterrorism preparedness and $131 million for the Preventive
    Health and Health Services block grant.
    strengthening the governmental public health system to improve homeland
                      security requires sustained funding
        Congress recognized in 1997 an unmet need to strengthen the
    Nation's capacity to respond to an act of bioterrorism and initiated
    funding for bioterrorism preparedness in fiscal year 1999. The initial
    funding of about $121 million (which included $51 million solely for
    stockpiling medications) assisted CDC and State and local health
    departments to begin examining what plans and resources were necessary.
    After 9/11 and the anthrax outbreaks in the fall of 2001, Congress
    increased bioterrorism funding markedly and included $940 million for
    building State and local capacities, of which about $870 million was
    actually made available to States and localities. The Department of
    Health and Human Services got these funds out to States and three large
    cities via cooperative agreements very promptly, far ahead of other
    homeland security funds for States and localities.
        Substantial bioterrorism preparedness funds for improving all
    aspects of preparedness have actually been in the hands of State health
    departments since August 2002. Local public health departments, many of
    which have been funded for less time, are justifiably proud of the
    progress they have made.
        Extensive response plans, developed in collaboration with local
    emergency management systems, have been made. Numerous ``tabletop'' and
    real field exercises have tested local capabilities. Mass vaccination
    clinics have taken place, some as part of a real response to flu
    vaccine shortages. Communications systems and equipment that enable
    rapid electronic information exchange among and by health departments
    to their communities are operational. Improved systems for disease
    detection are in place.
        Local health departments have engaged hospitals, physicians, and
    others in the private sector to develop further their roles in
    responding to a serious disease outbreak. Complex logistical
    arrangements needed to distribute medications or equipment from the
    Strategic National Stockpile to stricken populations have been
    developed.
        In some locations, genuine public health crises, such as flu
    vaccine shortages or an influx of evacuees from the Gulf Coast in the
    wake of Katrina, have demanded a response. In the act of responding,
    local health departments and their community partners continually
    identify new challenges and new ways to improve their ability to
    respond. Improving a locality's ability to detect a disease outbreak
    promptly and to contain it swiftly is a continuous process of training,
    exercising, and improving plans based on these exercises. Interrupting
    that process through funding cuts would take the Nation's public health
    preparedness backwards, not forward. New capacities that are now in
    place cannot be sustained without sustained funding.
        Congress appropriated supplemental funding of $350 million to
    assist States and localities in pandemic influenza preparedness. These
    funds are greatly appreciated, but they cannot fill the gaps left by
    other funding cuts. The narrow range of activities permitted by CDC's
    grant guidance for the first $100 million now available to States adds
    to the tasks required of health departments, but the sums available are
    insufficient to enable hiring new personnel to carry them out.
    Moreover, the production and exercise of plans for any biological
    event, including pandemic influenza, is never a one-time activity.
    Meaningful progress requires a continuous process of training,
    exercising and improvement that involves not merely public health
    responders, but all community partners that are part of any response,
    including law enforcement, emergency management, hospitals, schools,
    and a host of private sector partners.
        The Nation has a long way to go before every citizen enjoys the
    best possible protection by disease detection and response systems that
    work as quickly as humanly possible. Providing this protection is the
    job of the governmental public health system. No other entity can do
    it. NACCHO urges Congress to reverse the cuts in funds available to
    local public health departments, the Nation's first responders to
    bioterrorism.
               the phhs block grant is a linchpin for prevention
        Local public health departments receive approximately 40 percent of
    the Preventive Health and Health Services block grants nationally. The
    proportion varies among States from less than 5 percent to almost 100
    percent. The block grant funds fulfill three critical purposes. First,
    they enable States to address critical unmet public health needs. The
    coexistence of other Federal categorical public health funds does not
    mean that sufficient funds are available to address all public health
    needs. They are not. Improving chronic disease prevention through
    screening programs and programs that promote healthy nutrition and
    physical activity are prime examples of activities to which many
    jurisdictions devote PHHS funds. Forty percent of fiscal year 2004
    block grant funds were spent on chronic disease prevention, including
    prevention of obesity, stroke, heart disease, cancer, diabetes, and
    dental caries.
        Second, PHHS funds provide some flexible funding to address
    unexpected problems or problems unique to a particular geographic area.
    West Nile virus, a fully preventable disease spread to humans by
    mosquitoes, is one good example. Third, PHHS fund provide leverage for
    more funds and in-kind resources from non-Federal sources. In one
    southern State, local health departments collectively used $2.77
    million in block grant funds to establish new prevention programs and
    generate $5 million in additional resources for those programs.
        States are fully accountable to the Department of Health and Human
    Services for their expenditures of block grant funds and must report
    how much money they spend by specific program area. In those States
    where local health departments receive a significant amount of PHHS
    funds from the State, local prevention efforts will diminish. Local and
    State health departments are key leaders and providers of population-
    based prevention programs. They work to keep prevention in the public
    eye and build on programs that have been proven effective in reducing
    disease and preventing premature death. As health care costs escalate,
    reducing the Nation's commitment to prevention by eliminating the PHHS
    block grant, weakening state and local public health departments, is
    unwise and uneconomic.
        The National Association of County and City Health Officials
    (NACCHO) is the organization representing the almost 3,000 local public
    health departments in the United States.
                                     ______

       Prepared Statement of the National Coalition for Osteoporosis and
                             Related Bone Diseases
        The National Coalition for Osteoporosis and Related Bone Diseases
    (Bone Coalition) is pleased to comment on the fiscal year 2007 budget
    for the National Institutes of Health (NIH) as it relates to bone
    research. The Federal investment made to date goes a long way towards
    improving the bone health of our citizens and we are appreciative of
    the Committee's leadership over the years. We also congratulate the
    Committee for recognizing the complexities of the issues in the bone
    field and including language in the fiscal year 2006 committee report
    directing the NIH to establish a ``Bone Health Research Blueprint.''
        The recent Surgeon General's Report on bone health and osteoporosis
    illustrates the large burden that bone disease places on our Nation and
    its citizens. The Bone Coalition is committed to reducing the impact of
    bone diseases through expanded basic, clinical, epidemiological and
    behavioral research and through education leading to improvement in
    patient care. The Coalition participants are leading national bone
    disease organizations--the American Society for Bone and Mineral
    Research, the National Osteoporosis Foundation, the Osteogenesis
    Imperfecta Foundation, and the Paget Foundation for Paget's Disease of
    Bone.
        Bone diseases such as osteoporosis, osteogenesis imperfecta, and
    Paget's disease of bone pose a significant public health and economic
    challenge.
      --Osteoporosis.--Is a disease characterized by low bone mass and
            structural deterioration of bone tissue, leading to bone
            fragility and an increased susceptibility to fractures of the
            hip, spine, and wrist. It remains widespread across all
            populations. This is due to several factors, such as the aging
            of our population, the prevalence of secondary osteoporosis,
            and low bone mass that is common in immobilized patients and
            nursing home populations. Secondary osteoporosis, resulting
            from numerous chronic medical conditions and the long-term use
            of many medications, causes osteoporosis and related fractures
            in children, adolescents, and young adults. Over 10 million
            Americans have osteoporosis, the majority of whom (80 percent)
            are women, and 34 million more have low bone mass, placing them
            at increased risk for this disease. One out of every two women
            and one in four men over 50 will have an osteoporosis-related
            fracture in her/his lifetime. Osteoporosis is responsible for
            more than 1.5 million fractures annually, and mortality and
            morbidity following both spine and hip fractures is high when
            compared to unaffected peers. The estimated national direct
            expenditures for osteoporosis and related fractures total $18
            billion (2002 dollars) each year.
      --Paget's Disease of Bone.--The second most prevalent bone disease
            after osteoporosis--is a chronic skeletal disorder that may
            result in enlarged or deformed bones in one or more regions of
            the skeleton. Excessive bone breakdown and formation can result
            in bone that is dense, but fragile. Complications may include
            arthritis, fractures, bowing of limbs, neurological
            complications, and hearing loss if the disease affects the
            skull. Prevalence in the population ranges from 1.5 percent to
            8 percent depending on the person's age and geographical
            location. Paget's disease primarily affects people over 50.
      --Osteogenesis Imperfecta (OI).--Causes brittle bones that break
            easily due to a problem with collagen production. For example,
            a cough or sneeze can break a rib, rolling over can break a
            leg. Besides fragile bones, people with OI may have hearing
            loss, brittle teeth, short stature, skeletal deformities, and
            respiratory difficulties. OI affects between 20,000 to 50,000
            Americans. In severe cases fractures occur before and during
            birth. In some cases, an affected child can suffer repeated
            fractures before a diagnosis can be made. Undiagnosed OI may
            result in accusations of child abuse.
      --Cancer Metastasis to Bone.--A frequent complication of cancer is
            its spread to bone (bone metastasis) that occurs in up to 80
            percent of patients with myeloma, 70 percent of patients with
            either breast or prostate cancer, and 15 to 30 percent of
            patients with lung, colon, stomach, bladder, uterine, rectal,
            and renal cancer causing severe bone pain and pathologic
            fractures. Only 20 percent of breast cancer patients and 5
            percent of lung cancer patients survive more than 5 years after
            discovery of bone metastasis.
        According to Dr. Zerhouni, ``. . . we are facing great challenges
    in [the area of bone research]: an aging population at increasing risk
    for bone problems; the attendant costs of bone disease, both in human
    and financial terms; and the need for more physician-scientists to
    continue the important work of discovery, treatment, and prevention.''
        Bone diseases take many forms and cause complications such as
    fractures, chronic pain, hearing loss, brittle teeth, respiratory
    difficulties, bone metastasis from cancer, and neurological
    complications that reduce people's quality of life and cost society
    billions of dollars. These challenges in bone research cut across
    numerous institutes/centers at the National Institutes of Health. They
    traverse the focus of individual Institutes and require an
    interdisciplinary scientific approach.
        At the NIH, as part of the Roadmap Initiative, a series of awards
    have been established that will make it easier for scientists to
    conduct interdisciplinary research and an Office of Portfolio Analysis
    and Strategic Initiatives has been established to coordinate trans-NIH
    initiatives. The health problems in the bone field require new
    approaches. We believe these new efforts will remove obstacles to
    scientific progress and better coordinate the discoveries of tomorrow.
        NIH-supported research in bone health has led to important
    discoveries and has generated new treatments and pharmaceutical
    products. It must be recognized that new discoveries and breakthroughs
    could come from any areas of biomedical research and could result in
    new treatments and eventually a cure for bone diseases.
      --Research has taught us that those with low bone mass are at risk
            for osteoporosis. These individuals can then address their risk
            with exercise, diet, other behavioral and lifestyle changes,
            and medication.
      --Research has decreased fracture risk and extended the lifespan to
            normal for people with OI.
      --Research has identified drugs which improve the quality of life of
            people whose cancer has metastasized to bone.
      --Research has led us to develop simple, non-invasive and accurate
            tests that can determine bone mass and help predict fracture
            risk.
      --Research has identified and demonstrated a variety of drugs that
            can reduce bone loss and fractures, and even build new bone.
            Thirty years ago, there was no treatment for osteoporosis.
      --Research has helped us to understand the need for weight-bearing
            exercise to build and maintain bone in order to reduce fracture
            risk. Falling can be reduced by strength-building exercise that
            increases balance and flexibility.
        But much remains to be done. A concentrated effort is required to
    address bone health. The Coalition is particularly interested in NIH
    support for the following in fiscal year 2007:
      --Research is needed into the pathophysiology of bone loss in varied
            populations and in targeted therapies to improve bone density
            and bone quality according to the etiology of osteoporosis. In
            addition research is needed to identify patients at risk for
            fracture who do not meet current criteria for osteoporosis, as
            well as to study the effects of available and developing
            osteoporosis treatments on the reduction of fracture risk in
            these patients.
      --NCI, NIAMS, NIA and NIDDK must support research to determine
            mechanisms and to identify, block and treat cancer metastasis
            to bone. Furthermore, NCI must expand research on osteosarcoma
            to improve survival and quality of life and to prevent
            metastatic osteosarcoma in children and teenagers who develop
            this cancer.
      --Although bone mineral density has been a useful predictor of
            susceptibility to fracture, other properties of the skeleton
            contribute to bone strength, including mechanical loading
            (exercise) and mechanisms of biomineralization. However, at
            this time little is understood as to how these properties
            assist in the maintenance of bone strength. Support of this
            research by NIA, NIAMS, NIBIB, NICHD, NIDDK, and NHLB will
            achieve identification of these parameters and lead to better
            prediction for prevention and treatment of bone diseases such
            as osteoporosis, osteogenesis imperfecta, bone loss due to
            kidney disease, and heart attacks due to hardening of the
            arteries.
      --Thousands of children and adolescents nationwide suffer from
            musculoskeletal disorders and malformations, many of which have
            devastating effects on mortality and disability. NIAMS and
            NICHD must support research focusing on mechanisms of
            preventing fractures and improving bone quality and correcting
            malformations, on innovations in surgical and non-surgical
            approaches to treatment, and on physical factors that affect
            growth.
      --Diseases such as osteogenesis imperfecta, fibrous dysplasia,
            osteopetrosis, and Paget's disease are caused by poorly
            understood genetic mutations. In Paget's disease, underlying
            genetic defects can also be exacerbated by environmental
            factors. NIAMS, NICHD, NIDCR, and NIDDK must support research
            on genetic defects that cause bone disease.
      --57.9 million Americans are injured annually, more than one-half
            incur injuries to the musculoskeletal system. In the United
            States, back pain is a major reason listed for lost time from
            work and sports injuries are increasing in ``weekend warriors''
            of both sexes. NIAMS, NIA, and NCCAM must study ways to better
            understand the epidemiology of back pain, improve on existing
            diagnostic techniques for back pain, as well as to develop new
            ones. NIAMS, NIBIB, NIDDK and NIA must expand research to
            improve diagnostic and therapeutic approaches to significantly
            lower the impact of musculoskeletal traumas, and on research on
            accelerated fracture healing, the use of biochemical or
            physical bone stimulation, and bone substitutes such as
            hydroxyapatite and allogeneic tissues.
        To move this research forward, Congress must provide sufficient
    funding to the National Institutes of Health to sustain the robust
    research atmosphere in which to address the challenges in the bone
    field. The revolution in genetics/genomics that has provided new tools
    and databases and the powerful new imaging devices must not be
    hindered. Research must continue to be accelerated in order to improve
    the health of the Nation.
                                recommendations
        The National Coalition for Osteoporosis and Related Bone Diseases
    supports a 5 percent increase for the National Institutes of Health
    (above the fiscal year 2006 funding level), as recommended by the Ad
    Hoc Group for Medical Research, along with the National Health Council,
    the Campaign for Medical Research and Research!America.
        The recent Surgeon General's Report on bone health and osteoporosis
    illustrates the large burden that bone disease places on our Nation and
    its citizens. We support the establishment of a ``Bone Health Research
    Blueprint'' to address the need for interdisciplinary approaches to
    research and increased coordination of research efforts. We believe
    that more deliberately integrated activities in the areas of bone
    research at NIH and at extramural institutions will move our science
    more rapidly to discoveries that will preserve health and cure disease.
        Thank you for the opportunity to submit our statement regarding the
    fiscal year 2007 budget for the National Institutes of Health.
                                     ______

         Prepared Statement of the National Community Action Foundation
     requesting level funding for the fiscal year 2007 community services
                  block grant, liheap, and head start programs
        I first want to convey the deep gratitude of every one of the
    Nation's 1,100 Community Action Agencies to Chairman Specter and
    Senator Harkin for their leadership in amending the Budget Resolution
    to preserve critical domestic programs.
        We are requesting that the subcommittee go forward with the
    Chairman's original intent of restoring all the programs that are
    reduced or eliminated by the President's 2007 budget request. This
    remains the correct priority in light of the extreme and, in our
    opinion, destructive constraints placed on all domestic discretionary
    spending. Of course, this one-year policy is no substitute for a
    renaissance of investment in healthy children, in the workforce of
    tomorrow, in the health of the public, and in the science that will
    sharpen America's competitive edge in 21st century trade.
        The following facts on the threat to Community Action's top
    priority programs--CSBG, Head Start and LIHEAP--will indicate how
    important to Community Action are the strategic decisions facing the
    subcommittee.
        The Community Service Block Grant (CSBG) is the funding that
    underwrites the unique assignment of CAAs: their responsibility to
    convene local leadership to make a plan with the low-income community
    that implements a mix of strategies to bring in new investment and
    social resources. CAAs sustain their communities' long-term commitment
    to expand access to new opportunities for their residents who need to
    become more productive and more self-sufficient. Fifty two Senators
    have written the subcommittee opposing the President's request.
        If CSBG is reduced or eliminated, important community institutions
    will be lost.
        In Pennsylvania:
      --Mercer County's Weed & Seed Community Revitalization effort, Micro-
            enterprise Development project that makes small business owners
            out of former low-income workers and the Elm Street
            revitalization project will cease.
      --That CAA would also end its sponsorship of three HUD projects (22
            units) which are home to special needs populations; those
            precious subsidized apartments will be rented out at ``fair
            market value''.
      --In Venango and Crawford Counties services in the areas of youth
            development, supportive housing services, and education would
            be eliminated.
      --The Pittsburgh and Philadelphia CAAs would close, their services
            absorbed into a variety of city government departments;
      --Outreach Centers across the State's rural areas would be shuttered.
        In Iowa, eliminating CSBG means:
      --91 outreach centers will close; these are the local offices where
            programs operate, meet both those in need and offer the entire
            community space for groups working on local betterment.
      --The same will befall dozens of food pantries supported by CAA
            warehouses, storage and trucking in which Churches and other
            volunteers participate.
      --633 homeless children in the Hawkeye area will have no preventive
            screenings.
      --117 elderly individuals around Davenport will lose the chore
            assistance services that have allowed them to remain in their
            own homes.
      --In Des Moines the vast community gardens project will shut down and
            three thrift stores the low-income community depends on will
            close;
      --In Dubuque, the financial literacy education initiative will end.
        Even more ominous is the prospect that no future partnerships or
    new initiatives will be imagined and developed; in the past two years,
    CAAs across America have used their CSBG as the flexible ``venture
    capital'' that supports the efforts to develop partnerships, plan
    projects, and raise and package resources. Among the results that are
    permanently changing their communities are: numerous dental clinics,
    housing developments, job creation projects, energy services for all
    the community, and clean water supply facilities. CAAs have developed
    and improved communities with permanent investments such as these for
    four decades. Ending CSBG dams up the stream of emerging community
    infrastructure and services and cuts the ties that keep public-private
    local partnerships that coordinate their resources to change local
    conditions.
        CAAs serve one-third of the Head Start and Early Head Start
    participants.--The requirements for program quality have increased as
    science's knowledge of early childhood; the expectations for the depth
    and number of services and professional care are high. The staff cannot
    receive cost of living increases, much less the salaries their skills
    merit, without reductions in enrollment. The threat to children's hard
    won gains grows with each reduction. CAAs will be forced to deny places
    to 6,300 of the 19,000 qualified children that are anticipated to go
    unserved under a freeze in fiscal year 2007 Head Start funding.
        Finally, LIHEAP must be maintained at least at its current level.--
    This year the Congress, led by the Senate with many Members of this
    subcommittee in the vanguard, at last got LIHEAP right.
        The $3.1 billion the Chairman and Ranking Member supported for the
    fiscal year 2006 program is desperately needed. We have surveyed our
    member agencies who, collectively, deliver more than a third of the
    LIHEAP program nationwide. They are confident that, in spite of the
    late start, all the new resources will be distributed either to
    consumers who where shut out of the first round of assistance or to
    participants whose initial benefits were too low to buy them more than
    a few short weeks worth of fuel.
        The ``Sunbelt'' programs that nearly doubled their initial grants
    when the supplemental funds were appropriated are making especially
    speedy and good use of the resources they have long needed. It is
    surprising, but true, that low-income consumers in Florida, the Gulf
    Coast States and the Southwest spend nearly as high a percentage of
    their income on energy bills as do Midwesterners. That is just one
    reason it is essential that most of 2007 LIHEAP funds be distributed
    according to the statutory formula, as is the case with the fiscal year
    2006 funding.
        Further, the only good reason for a large contingency fund is to
    correct for the extreme effects of the formula factors that deny the
    cold States a fair share of appropriations above $2 billion. A
    presidential contingency reserve for crises should only be an amount
    sufficient to meet an unpredicted need--such as a major natural
    disaster--during the period of awaiting major supplemental emergency
    legislation. Winter and Summer do not qualify as unexpected events;
    neither do high prices. The level and timing of program funding cannot
    be abandoned to Presidential politics.
        The Department of Energy predicted on April 11 that 2007 home fuel
    prices will essentially remain at this year's record levels.(EIA Short-
    term Energy Outlook) Last year, its April prediction for prices in
    normal 2005-06 winter weather turned out to be about 10 percent under
    the prices we faced in this unusually mild winter. Next winter, the
    energy markets will afford no relief for struggling LIHEAP-eligible
    customers. LIHEAP must, at least, be sustained.
        Community Action will be beside and behind this subcommittee's
    fight for a fair budget for America's priorities in every way possible
    in every part of this Nation. Thank you for considering these views and
    for your strategic and moral leadership.
                                     ______

              Prepared Statement of the National AHEC Organization
                  summary of fiscal year 2007 recommendations:
        1. Increase funding for the Health Professions and Nursing
    Education programs under Title VII and Title VIII of the Public Health
    Service Act to at least $550 million for fiscal year 2007.
        2. Restore funding for area Health Education Centers (AHECs) to the
    fiscal year 2003 level of $33.141 million.
        3. Restore funding for the Health Education Training Centers to the
    fiscal year 2003 level of $4.371 million.
        Mr. Chairman, and members of the subcommittee, I am pleased to
    present testimony on behalf of the National Area Health Education
    Centers Organization (NAO). NAO is the professional organization
    representing the Area Health Education Centers (AHECs) and the Health
    Education Training Centers (HETCs).
        I am Kathleen Vasquez, director of the Ohio Statewide AHEC program,
    director of the Medical University of Ohio's AHEC program, and the co-
    chair of the National AHEC Organization (NAO)'s Public Policy
    Committee.
        AHECs develop and support the community based training of health
    professions students, particularly in underserved rural and urban
    areas. They also provide continuing education and other services that
    improve the quality of community-based health care. HETCs use the
    infrastructure of the AHECs to address the needs of diverse populations
    with persistent and severe unmet health needs. In 5 border and 6 non-
    border States, HETCs train and support Community Health Workers to
    provide health information and services in their communities. Last year
    alone HETCs provided the initial training and continuing education for
    over 5,000 Community Health Workers.
        Since 1980, the Ohio AHEC program has played a vital part in
    training the State's healthcare workforce. Through a community-based
    education infrastructure, the delivery of direct patient care is
    expanded and a pipeline of professionals is maintained to provide
    future care. That pipeline of future professionals who will go on to
    practice in rural and underserved areas is maintained through
    collaborative partnerships with community health centers (CHCs) and the
    National Health Service Corps (NHSC). These partnerships allow the
    AHECs to help the Nation's health professions workforce to address
    timely issues such as bioterrorism, flu prevention and the nursing
    shortage.
         community health centers and the national health service corps
        Community Health Centers are dedicated to providing preventive and
    ambulatory health care to the most uninsured and underinsured
    populations by placing point-of-service facilities in these areas. A
    March 2006 study published in the Journal of the American Medical
    Association (JAMA) found that community health centers report high
    percentages of provider vacancies, including an insufficient supply of
    dentists, pharmacists, pediatricians, family physicians, and registered
    nurses. These shortages are especially pronounced in rural community
    health centers. Because Title VII programs (including AHECs and HETCs)
    have a successful record of training providers who work in underserved
    areas, the study recommends increased support for Title VII as the
    primary means of alleviating the health professions shortage in rural
    areas. The article serves as an important reminder that the success of
    CHCs is highly dependent upon a well-trained clinical staff to provide
    care.
        The Ohio AHEC program has worked closely with Community Health
    Centers to promote and support their complementary missions through the
    co-sponsorship of educational programs, the development of clinical
    training sites, and the recruitment of talented students. The Ohio AHEC
    program places students in rotations at Community Health Centers all
    over the State. For example, the Northeast Ohio AHEC places nursing,
    nutrition, and health education students in rotations at the Health and
    Dental Centers of Community Action Agency of Coloumbiana County. The
    Summit Portage AHEC places third year medical students in an
    ``exploratory experience'' elective with the Akron Community Health
    Resources. Other medical students are placed at the Ohio North East
    System, which has three Community Health Centers in Youngstown, Warren,
    and Alliance. The AHECs affiliated with the Medical University of Ohio
    place students at the expansion community health center in Lima as well
    as at the only designated migrant health center in Ohio, Community
    Health Services in rural Fremont. A network of over 500 physicians
    volunteer their time to teach the students at these Community Health
    Centers along with students placed in other underserved and rural areas
    of the State.
        Through another partnership with the Ohio Primary Care Association
    (OPCA), Ohio AHECs organized a statewide health literacy and diabetes
    conference, with accompanying health literacy train-the-trainer
    components. Through this type of train- the- trainer education, Ohio
    AHECs have maximized limited resources to build capacity to continue
    providing education beyond the initial offering. Many of the
    participants in this health literacy and diabetes conference worked at
    a Community Health Center.
        The leadership of the Community Health Centers and the AHECs in
    Ohio often work closely together. I, as the Director of the Ohio
    Statewide AHEC program, serve on the board of a Community Health
    Center. The Executive Director of that same Community Health Center
    serves on the board of the Sandusky AHEC. And the Executive Director of
    the Health and Dental Centers of Community Action Agency of Columbiana
    County is a member of the Eastern Ohio AHEC Board. These partnerships
    allow the AHEC program to help Community Health Centers in Ohio to
    recruit, train, and retain well-qualified health professionals who are
    passionate about serving in a rural or otherwise underserved area.
        AHECs also undertake a variety of programs related to the placement
    and support of National Health Service Corps (NHSC) scholars and loan
    repayment recipients. The Ohio AHEC is a contractor of the NHSC
    ``SEARCH'' program. The AHECs, in collaboration with the Ohio Academy
    of Family Practice and the Ohio Department of Health, annually recruit
    70 students, develop training sites, monitor placements and advise on
    individual community projects. These students will gain experience and
    exposure to practice in rural, underserved and especially community
    health center sites throughout the State.
                        bioterrorism and flu prevention
        Ohio AHECs provide nearly 400 continuing education programs, which
    are attended by 11,000 practicing professionals. These providers do not
    have to leave their communities or arrange coverage in order to attend
    these programs, because the programs are brought to them in their local
    communities. The topics of continuing education programs are determined
    by the needs of the practitioners in the community, so timely topics
    such as avian flu and bioterrorism have been recently provided.
        Ohio AHECs have stepped in to provide health professionals with the
    latest updates on surveillance, reporting, risk communication,
    treatment, and other responses to the threat of bioterrorism. In rural
    areas of the State, AHECs bring in downlinks and sponsor bioterrorism
    preparedness programs. Ohio AHECs have provided preparedness training
    for clinicians at the Community Health Centers, and also provided
    train- the- trainer education programs at 4 regional locations. In
    addition, some of our sister AHEC programs are already heavily involved
    in public education for flu prevention.
                                nursing shortage
        Contrary to what may be commonly understood, persistent and severe
    shortages exist in a number of health professions. Chronic shortages
    exist for all health professions in many of our Nation's underserved
    communities, and substantial shortages exist in all communities for
    some high-need professions such as nursing.
        Historically, the supply of and demand for health care
    professionals has waxed and waned in a manner that produced cycles of
    shortage and excess. However, it is reasonable to believe that the
    current shortages are of a different and more persistent nature. First,
    the breadth and depth of shortages are greater than at any time in the
    past. More disciplines are in short supply, more sites of care
    (hospitals, nursing homes, home care agencies, and clinics) are
    experiencing shortages, and the duration of vacancies is longer.
    Second, the demand for health care services is steadily and inexorably
    increasing due to the aging population and the advances in medical
    technology. Third, the health care provider population is aging itself.
    Fourth, the resources with which the health care industry might respond
    to shortages are inadequate. Due to the squeeze of managed care,
    provider institutions are unable to increase salaries, and due to cuts
    in government funding, educational institutions are unable to expand
    class sizes. Finally, the career opportunities available to women, who
    historically have dominated the nursing profession, have expanded
    greatly.
        Currently, AHECs and HETCs are working with schools of nursing,
    State nursing associations, Community Health Centers, and the National
    Health Service Corps, to increase the number of qualified applicants to
    nursing schools, increase minority enrollment in nursing schools,
    expand the number of community-based nursing training sites, and
    retrain nurses who wish to re-enter the profession.
                   justification for funding recommendations
        Mr. Chairman, I respectfully ask the subcommittee to support our
    recommendations to increase funding for the health professions and
    nursing education programs under Title VII and Title VIII of the Public
    Health Act to at least $550 million for fiscal year 2007. Our
    recommendations are consistent with those of the Health Professions and
    Nursing Education Coalition (HPNEC). 56 of your colleagues (led by
    Senators Reed and Roberts), signed a letter to the subcommittee,
    stating that restoring funding to Title VII health professions programs
    is vital to reversing health professions shortages in the Nation's
    neediest communities.
        Two of the Title VII programs, AHECs and HETCs, improve access to
    primary and preventive care through community partnerships, linking the
    resources of academic health centers with local communities. AHECs and
    HETCs have proven to be responsive and efficient models for addressing
    an ever-changing variety of community health issues, including
    bioterrorism, flu prevention, and the nursing shortage. In order to
    continue this potential, additional Federal investment is required. We
    request that in fiscal year 2007 you restore funding to the fiscal year
    2003 levels of $33.141 million for AHECs, and $4.371 million for HETCs.
                                     ______

       Prepared Statement of the National Coalition for Heart and Stroke
                                    Research
        My name is Jack Owen Wood. I solicit your support for more
    aggressive Federal funding for research into prevention and treatment
    of the sister diseases, stroke and heart disease. Strokes and heart
    attacks are occurring at an alarming rate.
        I am representing the National Coalition for Heart and Stroke
    Research. The coalition consists of 18 national organizations
    representing more than 5 million volunteers and members united in
    support for increased funding for heart and stroke research. Members of
    the Coalition include: American Academy of Neurology; American Academy
    of Physical Medicine and Rehabilitation; American Association of
    Neurological Surgeons; American College of Cardiology; American College
    of Chest Physicians; American Heart Association; American Neurological
    Association; American Stroke Association; American Vascular Association
    Foundation; Association of Black Cardiologists; Child Neurology
    Society; Children's Cardiomyopathy Foundation, Inc.; Congress of
    Neurological Surgeons; Heart Rhythm Society; Mended Hearts, Inc.;
    National Stroke Association; Society of Interventional Radiology; and
    Society for Vascular Surgery.
        I will deal primarily with one man's personal experience with
    stroke and its functional and financial costs--my own. I have only the
    use of my right arm.
        I was born in 1937, raised in Vicksburg, Mississippi, earned an
    engineering degree at Mississippi State University and currently reside
    in Port Orchard, Washington. I worked for the Boeing Company in
    Seattle, am a former Director of the Washington State Energy Office,
    served as Director of Cost and Revenue Analysis and as the Forecasting
    Manager for a major Northwest Area Natural Gas Utility until May 1,
    1995.
        On May 1, 1995, at the age of 57, I was stricken and severely
    disabled by my stroke. Two years later I experienced a triple bypass
    heart operation. You might say I've ``been there and done that'' for
    both major cardiovascular diseases. So you see, I am an expert.
        Years ago I was offered an exciting and rewarding volunteer
    opportunity. I was asked to lead the ``JACK WOOD STROKE VICTOR TOUR''
    for the American Heart Association.
        The JACK WOOD STROKE VICTOR TOUR was a 5-State lobbying tour.
    Through it I tried to meet personally with every Northwest
    Congressional representative on his or her home turf (in Alaska, Idaho,
    Montana, Oregon and Washington). In each meeting I was joined by local
    people, stroke survivors and their families and medical professionals.
    I told my story and asked them to join the Congressional Heart and
    Stroke Coalition and to support increased Federal funding for heart and
    stroke research.
        I am proud to say I traveled to 18 communities and met personally
    with 28 members of our delegation or their staff.
        One of the most powerful memories for me was the frequency in which
    Members of Congress or staff members related their personal experience
    with stroke. One member I spoke to lost both parents to stroke. I
    suspect many of you have stories too.
        I realize your interest is greater than the physical impact of my
    stroke. Your concern must include the financial impact, not only to me,
    but also on our country from increased health care costs and lost
    productivity and its many implications.
        I have confronted the difficult and painful task of calculating
    that cost to me. Besides being a man whose stroke took his ability to
    pick up and play with his grandchildren and his livelihood, I remain a
    statistician at heart. I could not resist calculating and telling that
    part of my story. But please remember my story is not dissimilar to
    that of many of the 5.5 million stroke survivors in the United States.
    Many of whom were stricken in their prime earning years. Who in a
    matter of moments, seemingly without warning, are transformed from a
    contributor and provider to a receiver and patient.
        Allow me to highlight three figures that I feel sum up my data and
    should be important to you. I estimate that my stroke at age 57:
      --Reduced my earnings before retirement age 65 by more than $600,000.
      --Subsequently, the cost to the Federal Government in lost income and
            other taxes, early Medicare payments and Social Security
            disability payments is more than $320,000.
      --My HMO spent approximately $150,000 to respond to and treat my
            stroke.
      --One man, over $1 million.
        About 700,000 Americans will suffer a stroke this year costing this
    Nation an estimated $58 billion in medical expenses and lost
    productivity.
        Earlier I described a stroke as occurring seemingly without
    warning. All too often as in my case, people either don't know or
    ignore the signs of a stroke, even one in progress. When my stroke hit
    I denied it. It took me two days after my stroke to acknowledge it and
    seek help. Because of research into new treatments, we now have tPA, a
    clot-busting drug, which if administered within 3 hours of the onset of
    stroke symptoms, can dramatically reduce the damage of clot-based
    strokes. Had I recognized and acknowledged my stroke, gone to a
    hospital with a neurologist on staff and had there been tPA, the impact
    of my stroke most certainly would have been lessened.
        What is even more painful to me is that my impending stroke could
    have been detected. Unfortunately, we need to create easier and less
    expensive diagnostic techniques so that effective diagnostics can be
    given routinely as part of regular health exams. And they must be
    covered through insurance.
        I am not asking for your sympathy. Instead, please think of me as
    two of the ghosts in the famous Dickens' story. Please don't
    misunderstand, I am not casting you as Scrooge. See me as both the
    ghosts of things past and things yet to be. I too am here to tell you,
    the future, which I represent, needs not be. It is largely up to you.
        I hope my story and estimate of the cost of my stroke convinces you
    that taking on stroke and heart disease through increased research,
    leading to better prevention, diagnosis and treatment is fiscally
    responsible. The human and financial costs are astronomical.
        Thank you for your past support of research.
                                     ______

         Prepared Statement of the National Multiple Sclerosis Society
        Mr. Chairman and distinguished members of the subcommittee, we
    appreciate the opportunity to submit written testimony on behalf of the
    National Multiple Sclerosis Society. Multiple sclerosis (MS) is a
    chronic, unpredictable and often disabling disease of the central
    nervous system. Symptoms range from numbness in the limbs, to loss of
    vision, memory deficits, and in some instances partial or total
    paralysis. The progress, severity and specific symptoms of MS in any
    one person can vary and cannot yet be predicted, but advances in
    research and treatment are giving hope to those affected by the
    disease.
        Since its inception in 1946, the Society's highest priority has
    been to end the devastating effects of MS by supporting research aimed
    at finding the cause of MS, providing better treatments, and ultimately
    discovering a cure. In 2006, the National MS Society will spend over
    $40 million on MS research supporting over 350 MS investigations. By
    the end of 2006, the Society cumulatively will have expended some $500
    million since awarding its first three grants in 1947. This represents
    the largest privately funded program of basic, clinical, and applied
    research and training related to MS in the world.
        Any effort to conquer MS will require the collective efforts of
    many individuals as well as private and public organizations. The
    Federal Government is a critical partner in the fight against MS and
    must continue its vital role in furthering the scientific understanding
    of MS. To this end, the Society supports the following proposals
    related to Federal efforts:
      --There is a great need to determine how many Americans have MS. We
            therefore ask that the National Institutes of Health (NIH)
            collaborate with the Centers for Disease Control/Agency for
            Toxic Substances and Disease Registry (CDC/ASTDR), the Society
            and other MS organizations to begin the task of establishing
            the incidence and prevalence of MS.
      --There is a great need to find treatments for the primary-
            progressive form of MS (PPMS). We therefore ask that NIH bring
            additional research focus to the primary-progressive form of
            MS.
      --There is a great need to develop laboratory tests to help
            physicians easily diagnose and monitor MS. We therefore ask
            that NIH expand its efforts to identify biomarkers for MS.
      --There is a great need provide effective rehabilitation services to
            Americans with MS. We therefore urge that the National
            Institute on Disability and Rehabilitation Research (NIDRR) in
            the Department of Education fund one additional Medical
            Rehabilitation Research and Training Center for MS and take
            steps to stimulate individual research projects in MS.
      --There is a great need to sustain the country's research enterprise
            and to accelerate the discovery of life-changing treatments for
            MS. We therefore ask that Congress increase fiscal year 2007
            NIH funding by 5 percent.
        The National MS Society has had a long and productive relationship
    with the NIH, particularly with National Institute of Neurological
    Disorders and Stroke (NINDS). Our founder, Sylvia Lawry, helped
    spearhead the legislation that established NINDS in 1950 and the
    Society has been pleased to work with the NINDS on many areas of mutual
    interest. Indeed, we extend our thanks to NINDS Director, Dr. Story
    Landis, and key members of her staff, for meeting the Society's senior
    leadership to explore collaborative opportunities. We look forward to
    continued discussions with Dr. Landis and are eager to initiate similar
    discussions with the leadership of other NIH institutes.
        The Federal investment in the NIH and the NIDRR plays a major role
    in MS research. At the NIH, there are two other institutes that conduct
    or fund the majority of MS research: the NINDS, which funds 75 percent,
    and the National Institute of Allergy and Infectious Diseases (NIAID),
    which funds about 20 percent. The National Center for Medical
    Rehabilitation Research (NCMRR--a unit of the National Institute of
    Child Health and Human Development) also funds a small amount of MS
    research specifically targeting rehabilitation issues. In addition to
    the NIH, the NIDRR through the Department of Education invests in MS
    research.
        For fiscal year 2006 and fiscal year 2007, it is estimated that NIH
    expenditures on MS research will be approximately $109 and 108 million,
    respectively. For fiscal year 2006 and fiscal year 2007 NIDRR
    expenditures on MS research will be approximately $1.6 million per year
    out of a total budget of $107 million per year.
      --While this demonstrates one measure of the Federal investment in MS
            research, this amount pales in comparison with the annual
            direct and indirect disease cost--approximately $23 billion for
            all people with MS in the United States.\1\
    ---------------------------------------------------------------------------
        \1\ Based on a 1994 Duke University study, indexed for 2004 by the
    National MS Society, the average annual cost of MS is estimated at
    $57,500 per person due to lost wages, increased medical care and other
    expenses. Nationwide, there are an estimated 400,000 people with MS.
    ---------------------------------------------------------------------------
                investing in research priorities relevant to ms
        The National MS Society recognizes that new discoveries and
    breakthrough findings could come from almost any area of biomedical
    research and could apply to the primary concern of our members: finding
    a cure for MS. NIH plays THE major role in maintaining our country's
    preeminence in the biotechnology industry and provides world-wide
    leadership in health research and discovery. We thus encourage Congress
    to focus on NIH as a whole, and on agencies of particular relevance to
    our concern, knowing that a well-funded Federal research enterprise
    will benefit all of us.
        Determining how many Americans are affected by MS.--An area in
    critical need of attention is determining the incidence, prevalence,
    and distribution of MS. The last national study of incidence and
    prevalence of MS in the United States took place more than 30 years
    ago. Since that time the population of the United States has changed
    dramatically in size, composition, and distribution. Moreover, numerous
    questions have arisen concerning possible ethnic, geographic, and local
    variations in the distribution of MS. Knowledge concerning these
    distributions and possible causal factors may provide important
    information concerning the nature of MS and its triggers. Rational
    policy formulation for MS health care requires up-to-date information
    concerning numbers and characteristics of persons with MS down to the
    State level.
        We are pleased to note that CDC/ASTDR has taken an important step
    in addressing this issue by convening a workshop to discuss a proposal
    for setting up national surveillance systems for MS and amyotrophic
    lateral sclerosis (ALS). The Society was pleased to participate in this
    meeting and looks forward to collaborating with CDC/ASTDR in planning
    of regional pilot studies of methods to establish incidence and
    prevalence of MS, and ultimately the design and deployment of a
    national or multi-regional surveillance system for MS. Establishment of
    such systems, however, is beyond the resources of the Society. We
    therefore urge NINDS and other appropriate NIH institutes to
    collaborate with the CDC/ATSDR and to allocate funds for the conduct of
    the critical pilot studies and to support a national effort to
    accurately measure incidence and prevalence of MS.
        Finding new treatments for primary-progressive MS.--Advances in
    immunology have provided clinicians with powerful tools to better
    understand the underlying causes of MS, leading to new therapeutic
    advances. Although there are FDA-approved treatments for relapsing MS,
    there are still no approved treatments for progressive MS. The primary-
    progressive form of MS (PPMS) is characterized from the onset by the
    absence of acute attacks and instead involves a continuous and gradual
    clinical decline.
        Approximately 10 percent of individuals are diagnosed with PPMS
    from the onset. Clinically, this form of the disease is associated with
    a lack of response to any form of the approved MS therapies. This leads
    to the concept that PPMS may in fact be a very different disease as
    compared to relapsing-remitting MS. The Society identifies the study of
    primary-progressive MS as an area that merits greater attention by the
    research community in order to increase our understanding of PPMS and
    to have effective therapies for this progressive form of the disease.
    In the upcoming year, the Society encourages NIH to help the Society
    address this underserved area of MS research.
        Helping physicians with diagnosis and treatment.--The complexity of
    MS poses many challenges for both diagnosis and treatment of the
    disease. Biomarkers, substances that are detectible in blood or other
    body fluids by laboratory testing, are a promising tool for physicians
    since they could aid in diagnosis, treatment selection, and prediction
    of disease course. In addition, valid biomarkers will be very useful in
    evaluating the effectiveness of new drugs.
        The fundamental importance of biomarkers for MS has been recognized
    by the NIH Autoimmune Disease Coordinating Committee and NINDS, which
    sponsored a workshop on this topic in 2004. Moreover we are pleased to
    note that NINDS has provided $4 million for a major biomarker discovery
    effort as part of a large-scale clinical trial, CombiRx. The CombiRx
    trial is evaluating whether or not a combination of approved MS
    therapies is more effective in treating MS than individual therapies.
    We applaud NINDS for its efforts to-date and urge that NINDS and other
    NIH institutes work with the Society to expand their efforts to support
    research directed at the discovery and validation of biomarkers for MS.
             expanding the scope of federal support for ms research
        In addition to efforts at the NIH, the Society is pleased to note
    that for more than 20 years, NIDRR has funded a Medical Rehabilitation
    Research and Training Center (MRRTC) for MS. However, the institute's
    overall investment in MS research remains limited, $1.6 million in
    fiscal year 2006 and fiscal year 2007. It is dismaying that the current
    NIDRR portfolio includes only 4 projects related to MS whereas spinal
    cord injury, with a prevalence less than that of MS, has 39 active
    projects in the NIDRR portfolio.
        Since the advent of FDA-approved MS disease-modifying treatments in
    1993, persons with MS have had access to therapeutics which can slow
    the progression of disability. However, in order to maintain maximum
    levels of independence, persons with MS need rehabilitation to address
    residual deficits. Unfortunately, due to the limited support for MS
    rehabilitation research, we know relatively little about the efficacy
    of rehabilitative interventions in MS. We therefore urge the NIDRR to
    increase its support for MS rehabilitation research through the funding
    of at least one additional MRRTC along with initiatives to stimulate
    individual research projects.
               overall nih funding increase for fiscal year 2007
        The Society is deeply concerned that NIH may face a fourth year of
    overall low funding increases. This low funding level endangers the
    potential breakthroughs and discoveries that motivated Congress to
    complete a five-year campaign to double NIH's budget in 2003. In fact,
    the trend toward flat or slightly decreased NIH funding could put NIH
    on a trajectory to un-double its budget because the annual cost of
    inflation cannot be covered.
        Furthermore, we are gravely concerned that the current annual NIH
    investment in MS research of $110 million is projected to drop by $1
    million in 2007 and another $1 million in 2008. This trend jeopardizes
    progress toward a cure and new treatments for MS. Indeed, we remind the
    committee that in the 1990's, it was the NIH's basic and clinical
    research that contributed greatly to the development of the first
    disease modifying drugs for MS. Now there are 6 such drugs approved for
    MS therapy, and the NIH is funding a major trial to test whether
    combining drugs can enhance their benefit.
        Moreover, NIH-funded research catalyzes industry efforts to develop
    drugs in many ways. Industry tells us that developing biomarkers that
    can measure the progression of MS could dramatically enhance their
    efforts to develop drugs. Over the last several years, advances in
    brain imaging for MS have taken a major step towards the goal of MS
    biomarkers. The NIH has a major effort underway to identify additional
    methods to measure the progression of MS, this is another step toward
    increased understanding of MS. Moreover, because of these advances in
    understanding of MS, biotech and pharmaceutical companies currently
    have more than a dozen drugs for MS in various stages of clinical
    testing. Despite these significant efforts, the number of new drug
    applications to the Food and Drug Administration continues to decline.
    The Society fears that this negative trend will be accelerated by
    continued reductions in NIH-funded research.
        A lack of Federal funds for biomedical research and MS research, in
    particular, will also force junior and senior researchers to leave the
    scientific workforce, further slowing the pace of research. Such an
    outcome would mean that substantial investments biomedical research
    would have been squandered, and replenishing this workforce would take
    a generation. We therefore urge Congress to:
      --Appropriate a 5 percent fiscal year 2007 funding increase for NIH.
      --Balance the fiscal year 2007 NIH appropriation to allow growth
            across all NIH institutes and all areas of disease research.
        We ask the subcommittee to be mindful of the thousands of
    Americans, and particularly those with MS, who will be affected if the
    pace of research is slowed by reductions in NIH funding. While
    treatments are available for MS, these are expensive and only partially
    effective for some patients. Until a cure is found, people affected by
    MS want more effective and more economical treatments.
        The surest path to discovering treatments for MS, and for human
    diseases in general, is by sustaining the country's investment in
    innovative biomedical research at universities and small businesses.
    Funding cuts threaten these efforts, and will invariably harm the
    country's research infrastructure. Correcting such damage may take a
    generation, and Americans with MS cannot afford to wait that long.
    Moreover, the country cannot afford the economic consequences of
    delaying the discovery of treatments that could change the lives of
    those impacted by MS.
        We thank the subcommittee for this opportunity to comment and
    applaud your commitment to advancing the health and well-being of all
    Americans through investment in biomedical research.
                                     ______

    Prepared Statement of the NIH Task Force of the Bioengineering Division
      of the Basic Engineering Group of the Council on Engineering of ASME
        The NIH Task Force of the Bioengineering Division of the Basic
    Engineering Group of the Council on Engineering of ASME, is pleased to
    provide comments on the bioengineering-related programs in the National
    Institutes of Health (NIH) fiscal year 2007 budget request. The ASME
    Bioengineering Division is focused on the application of mechanical
    engineering knowledge, skills and principles from conception to the
    design, development, analysis and operation of biomechanical systems.
                        the importance of bioengineering
        Bioengineering is an interdisciplinary field that applies physical,
    chemical and mathematical sciences and engineering principles to the
    study of biology, medicine, behavior, and health. It advances knowledge
    from the molecular to the organ systems level, and develops new and
    novel biologics, materials processes, implants, devices, and
    informatics approaches for the prevention, diagnosis, and treatment of
    disease, for patient rehabilitation, and for improving health.
    Bioengineers have employed mechanical engineering principles in the
    development of many life-saving technologies, such as the artificial
    heart, prosthetic joints and numerous rehabilitation technologies.
                                   background
        NIH is the world's largest and most eminent organization dedicated
    to improving health through medical science. During the last 50 years,
    NIH has played a preeminent role in the major breakthroughs that have
    increased average life expectancy by 15 to 20 years.
        NIH is comprised of different Institutes and Centers that support a
    wide spectrum of research activities including basic research, disease
    and treatments related studies, and epidemiological analyses. The
    missions of individual Institutes and Centers focus on a particular
    organ (e.g. heart, kidney, eye), on a given disease (e.g. cancer,
    infectious diseases, mental illness), on a stage of development (e.g.
    childhood, old age), or, may encompass crosscutting needs (e.g.,
    sequencing of the human genome and the National Institute of Biomedical
    Imaging and Bioengineering (NIBIB).
        The total fiscal year 2007 NIH budget request is $28.6 billion,
    which represents approximately the same level as the fiscal year 2006
    appropriation. Some $50 million of this increase is for radiological/
    nuclear countermeasures development. NIH R&D, 97 percent of the total
    NIH budget, would also remain flat at $27.8 billion next year. The
    largest increases would go to the Office of Director and towards
    biodefense R&D.
        According to the President's fiscal year 2007 budget request,
    ``NIH's highest priority is the funding of medical research through
    research project grants (RPGs). Support for RPGs allows NIH to sustain
    the scientific momentum of investigator-initiated research while
    pursuing new research opportunities.'' The administration estimates
    that the fiscal year 2007 budget would support an estimated 9,337 new
    research project grants (RPGs), an increase of about 275 new competing
    RPGs from fiscal year 2006. Nevertheless, NIH projects a decline in the
    total number of RPGs for the third year in a row, no inflation
    adjustment for most new or continuing grants, and a decline in the RPG
    success rate for the sixth year in a row down to 19 percent. RPGs
    account for 52 percent of the 2007 NIH Budget Request.
        The largest percentage increase would go to the Office of the
    Director (OD; up 25.1 percent) to boost OD funding for clinical
    research, high-risk basic research, and collaborative research in the
    NIH Roadmap for Biomedical Research. The Roadmap would receive $443
    million in fiscal year 2006 (up 34 percent), with $332 million coming
    from institute budgets. Currently, the Roadmap Initiatives provides $80
    million annually, or roughly 24 percent of the total roadmap budget,
    for bioengineering-related project.
        Other initiatives funded by the fiscal year 2007 budget request are
    5 awards for the new K/R ``Pathway to Independence'' program and the
    Genes, Environmental, and Health Initiative (GEHI) that will study
    genetic factors associated with disease and accelerate technological
    development that can measure human responses to environmental
    influences on health.
        The President's fiscal year 2007 budget requests $294.5 million for
    the NIBIB, a reduction of $1.96 million (0.7 percent) below the fiscal
    year 2006 enacted level. Most NIH institutes are also slated for
    reductions in funding in the President's budget request.
        Below are some highlights from the fiscal year 2007 budget request
    for NIBIB. Further details can be found at http://www.nibib.nih.gov/
    publicPage.cfm?pageID=263#FY2007.
    NIBIB Extramural Research would decline 1.3 percent, to $268 million.
        The number of research project applications to NIBIB continues to
    grow, with the number doubling from fiscal year 2003 to fiscal year
    2004 and then increasing by 20 percent from fiscal year 2004 to fiscal
    year 2005. The research budget, however, has remained flat.
    Consequently, the success rate for investigators applying for
    extramural research grants from the NIBIB is the second lowest among
    the NIH institutes and centers. It is estimated that the success rate
    for these applications was 16.8 percent in fiscal year 2004, decreasing
    to approximately 15 percent in fiscal year 2005. The projected success
    rate for fiscal year 2006 is only between 10 and 15 percent
    NIBIB Intramural Research would grow 6.3 percent, to $7.7 million.
        In September 2004, the NIBIB Special Advisory Panel for Intramural
    Programs met to develop recommendations for the National Advisory
    Council on Biomedical Imaging and Bioengineering concerning an
    intramural research program within the NIBIB. Intramural research
    accounts for approximately 10 percent of the total NIH budget. The
    NIBIB currently is at the low end in terms of funds it commits to
    intramural research among all of the NIH institutes, both in terms of
    dollars expended and percentage of its total budget. The Panel
    recommended that NIBIB not pursue the near-term expansion of its
    Intramural Research Program beyond the available funding in the current
    budget and the fiscal year 2005 President's Budget proposal. The Panel
    further recommended that NIBIB use its limited intramural funds
    primarily to expand interdisciplinary training opportunities at the
    postdoctoral level. In addition to the already established training
    grants offered by the NIBIB, there is a new initiative co-sponsored by
    the NSF Engineering Directorate to offer summer institute training for
    undergraduate students. It is hoped that such programs can be offered
    regularly now and/or expanded. More information can be found at http://
    bbsi.eeicom.com/.
        The estimate for NIH-wide bioengineering research was $1.291
    billion in fiscal year 2006, and $1.32 billion in fiscal year 2005. The
    proposed 2007 amount is $1.296 billion, a 0.4 percent increase over
    2006. These numbers reflect bioengineering funding by any of the 27 NIH
    institutes or Office of the Director.
                                recommendations
        The Task Force is concerned that funding for bioengineering has
    continued to lag compared to many areas of NIH, and will continue to do
    so, especially now that the doubling of the NIH budget is complete and
    the total funding for NIH remains flat. While a strong supporter of the
    NIBIB, the Task Force is also concerned that bioengineering continues
    to constitute less than half the budget for the NIBIB. There is a need
    for advanced engineering concepts to be applied to basic and
    translational biomedical problems for the potential of recent
    biological advances to be realized. The request for more bioengineering
    funding addresses a critical need for developing and applying more
    complex engineering principles to biomedical problems. In many cases,
    such engineered solutions to health care problems will result in a
    reduction in health care costs. Therefore, the Task Force strongly
    urges Congress to provide increased funding for bioengineering within
    the NIBIB and across NIH. The NIBIB requires exceptional consideration
    for funding increases in the coming years. It is notable that the
    success rate for funding applications to the NIBIB is currently between
    10-15 percent, even lower than the declining average NIH-wide success
    rate of 19 percent. This is a direct manifestation of the continued
    growth of the field outpacing funding increases to the NIBIB.
        While the Task Force supports new Federal proposals that seek to
    double Federal research and development in the physical sciences over
    the next decade, the Task Force believes that strong Federal support
    for bioengineering and the life sciences is essential to the health and
    competitiveness of the Nation. Increased funding for the NIH has put
    the United States is a leading position in pharmaceuticals,
    bioengineering, and medical sciences. Long-term lack of funding for NIH
    programs would harm the tremendous gains the United States has made
    over the last decade.
        ASME International is a non-profit technical and educational
    organization with 125,000 members worldwide. The Society's members work
    in all sectors of the economy, including industry, academic, and
    government. This statement represents the views of the ASME NIH Task
    Force of the Bioengineering Division and is not necessarily a position
    of ASME as a whole.
                                     ______

          Prepared Statement of the National Primate Research Centers
        The Directors of the National Primate Research Centers (NPRCs)
    respectfully submit this written testimony for the record of the U.S.
    Senate Appropriations Subcommittee on Labor, Health and Human Services,
    and Education. The NPRCs appreciate the commitment that the members of
    this subcommittee have made to biomedical research through strong
    support for the National Institutes of Health (NIH). Given your
    leadership on this issue, the NPRCs urge Congress to direct resources
    to NIH to ensure that the Federal investment in vital biomedical
    research will not be compromised.
        The NPRCs are a national network of eight primate research centers
    supported by the NIH National Center for Research Resources (NCRR). The
    centers comprise the National Primate Research Program (NPRP), which
    was developed by Congress in 1960. The program seeks to address human
    health problems through scientific research using the animal models
    that most closely resemble humans in their genetics, physiology, and
    disease processes--primates. NPRCs support research that is sponsored
    by nearly every institute of NIH. For example, NPRCs conduct research
    to help understand and treat diseases such as heart disease,
    hypertension, cancer, diabetes, hepatitis, AIDS, kidney disease,
    Alzheimer's disease, and Parkinson's disease. They also conduct
    research on emerging infectious diseases and many aspects of
    biodefense. Each NPRC makes its facilities available to investigators
    from around the country. Our centers create collaborative research
    environments that allow scientists to combine their individual
    expertise beyond the scope of established disciplinary research
    projects.
        NPRCs endorse the fiscal year 2007 Ad Hoc Group for Medical
    Research proposal to increase the NIH budget by five percent over the
    fiscal year 2006 level. We recognize that the current budget
    environment puts pressure on Congress to face difficult funding trade-
    offs; however, as this subcommittee works to define priorities for the
    year and set goals for the future, we ask that you maintain your long-
    term commitment of support for NIH and its mission. The President's
    fiscal year 2007 budget would flat-fund NIH. The five percent increase
    for NIH supported by NPRCs would not only allow the agency to sustain
    current programs but also invest in critical new initiatives. This
    would prevent NIH from falling behind the ``Innovation Index''--the
    rate of biomedical inflation as calculated in the Biomedical Research
    and Development Price Index (BRDPI) plus a modest investment in new
    initiatives. Using the fiscal year 2007 BRDPI projection as a base, NIH
    would require an increase of at least 3.8 percent over fiscal year 2006
    to maintain current programs. However, we strongly believe that an
    increase for NIH above BRDPI is justified by the health needs as well
    as current and burgeoning research capabilities of the Nation. An
    increase above BRDPI would allow new innovative ideas to be funded and
    would infuse existing programs to evolve as their research findings
    push them to higher levels of basic understanding, translation and
    clinical functionality.
        As a result of years of expanded investment in biomedical research,
    the demand for the NPRCs' resources has increased significantly. The
    ability of NIH-funded researchers to conduct future projects with
    primate models will depend on the enhancement of three key areas: (1)
    the nationwide availability of primates; (2) the quality and capacity
    of primate housing and breeding facilities, as well as the availability
    of related state-of-the-art diagnostic and clinical support equipment
    at NPRCs; and (3) the number of personnel trained in primate care and
    management at NPRCs. These areas can be enhanced by an NIH/NCRR
    commitment to increase the NPRCs P51 base grants (the mechanism that
    funds each NPRC). Biomedical researchers across the Nation are
    experiencing shortages in the availability of primates for essential
    research. Increases to the P51 base grants would allow NPRCs to: expand
    existing breeding colonies and develop bridging programs to use
    effectively the under-utilized species of primates in research; invest
    in repairs, renovation, and construction of research facilities, as
    well as the purchase of modern laboratory equipment; and ensure that
    adequate numbers of experts are trained in laboratory animal medicine
    and research, because NPRCs must maintain primate management teams
    comprised of behavioral specialists, veterinarians, and primate
    research experts to ensure excellent primate care, health, and research
    success.
        Increases from NIH/NCRR to the NPRCs P51 base grant are necessary
    to meet the needs discussed above and are critical to the ability of
    NPRCs to supply adequate primate resources for scientists across the
    Nation to carry out important research projects. As mentioned
    previously, these research projects span the disease foci at NIH
    institutes and centers, and also play important roles in the NIH
    Roadmap, the NCRR Strategic Plan, and grand challenges facing the
    scientific community. In the 1950's, primate research produced the
    first vaccine for one of the world's worst childhood killers, the Polio
    virus, reducing the number of cases in the United States from 58,000 to
    one or two per year. Primates have also served as the best model for
    various types of HIV research, and their availability for use has
    resulted in at least 14 licensed anti-viral drugs for treatment of HIV
    infection. Primate models will continue to be necessary to defend the
    world against possible future epidemics such as SARS, West Nile Virus,
    and avian flu. In addition to deadly viral epidemics, primate research
    has enabled the discovery of better treatments and therapies for
    diseases and occurrences such as stroke, cataracts, depression and
    other psychiatric illnesses. Significant advances in prenatal and
    postnatal care have also resulted from primate research.
        Further, not only do primates have the potential to provide answers
    for long-standing research questions, primate research provides an
    unparalleled opportunity to address more recently defined research
    priorities, such as those relating to genomics and bioterrorism. The
    specific availability of information in the primate genome, which is
    quite similar to the human genome, makes primates essential in studies
    that require an integrated understanding of a whole biological system.
    Recent reports suggest that extensive analysis of genome structure and
    function in nonhuman primates could make immediate and significant
    contributions to the overall mission of NIH by accelerating progress in
    understanding many human diseases. Also, primates serve as critical
    animal models in biodefense research projects for which, in some cases,
    it would be inappropriate to conduct early clinical trials in humans.
    Primates are recognized as vital research resources within Federal
    strategic plans regarding biodefense research, including: the National
    Institute of Allergy and Infectious Diseases (NIAID) Strategic Plan for
    Biodefense Research; the NIAID Research Agenda for Category A Agents;
    and the NIAID Research Agenda for Category B and C Priority Pathogens.
    Also, NPRCs are partners in NIAID-funded Regional Centers of Excellence
    for Biodefense and Emerging Infectious Diseases as well as with NIAID-
    funded National and Regional Biocontainment Laboratories.
        As NIH and the national biomedical research agenda evolve, NPRCs
    adjust to meet the resource needs of the research community but also to
    maintain research programs that are on the cutting-edge of science. The
    reservoirs of knowledge residing within the NPRCs create new
    opportunities for research partnerships with investigators at host
    academic institutions and in the biomedical research community at
    large. Never have the research questions been so profound, or the
    implications for human health so critical. NPRCs are poised to bridge
    the gap between knowledge already gleaned from simple cellular and
    animal models and knowledge that is needed to promote human health and
    cure human disease. Past accomplishments demonstrate, and current and
    future research directions will rely on, the roles of robust primate
    research programs in addressing critical research questions. The
    breadth and success of primate research programs confirm the vital role
    that the eight NPRCs play in biomedical research nationwide.
        Thank you for the opportunity to submit this written testimony and
    for your attention to the critical need for primate research and
    enhancement of the NPRCs P51 base grant, as well as our recommendations
    concerning funding for NIH in the fiscal year 2007 Appropriations Bill.
                                     ______

          Prepared Statement of the National Prostate Cancer Coalition
        On behalf of the National Prostate Cancer Coalition, I appreciate
    the opportunity to submit written comments regarding funding to
    Prostate Cancer programs. I would also like to offer our best estimates
    on the resources necessary to continue to fight the war on prostate
    cancer in fiscal year 2007, most specifically funding for prostate
    cancer research, prevention, detection and treatment programs funded by
    the Labor, Health and Human Services and Education Appropriations Bill.
                       history of prostate cancer funding
        For the past ten years, the NPCC has worked to reduce the burden of
    prostate cancer through awareness, outreach, and advocacy. As you may
    know Prostate cancer is the most common cancer (next to skin cancer)
    and the second leading cause of cancer-related death in men in the
    United States. It is estimated this year over 234,000 men will be
    diagnosed with prostate cancer, and more than 27,000 will die as a
    result of the disease. Of the 10 million Americans living with cancer
    today, two million of these have prostate cancer.
        This past decade has been an exciting and important one for
    prostate cancer research. Congress and the administration have taken
    notice of the impact prostate cancer has on our Nation. In 1998,
    Congress promised to double the budget of the NIH within 5 years, and
    triple the amount of Federal funding for prostate cancer research. By
    keeping that promise, prostate cancer research funding has increased
    and expanded to record levels. As a result, more men are screened and
    diagnosed with this disease and prostate cancer survivorship rates have
    increased. Also for the first time since 1930, the number of cancer
    deaths has decreased in 2003. These exciting results cannot continue
    without a stable and reasonable level of funding to the NIH.
    Unfortunately in fiscal year 2003, NIH funding did not keep up with the
    increase of inflation. Last year in fiscal year 2006 the NIH and
    prostate cancer research programs received a hard cut to programs at
    the Center for Disease Control and the National Cancer Institute.
        With less funding, researches cannot continue to discover ways to
    combat prostate cancer. New drugs and treatment options are harder to
    translate from the lab to the patients. We cannot fight the war on
    prostate cancer without the proper tools. The National Prostate Cancer
    Coalition understands the limited resources our Nation faces. However,
    when research continues to show the eradication of cancer is within
    research, we must continue to fund these programs which will save
    millions of lives, reduce untold suffering and save the Nation billions
    of dollars in healthcare costs.
        It is important to note that Americans spend over $4.6 billion per
    year for treatment of this disease (this does not include the burden of
    lost productivity and wages). Statistics show that as baby boomers
    continue to age, the number of Americans impacted by cancer will
    increase. These statistics show the far reaching effects prostate
    cancer can have, not only on individuals and their families, but the
    Nation's economy as well.
                                funding requests
        This year we have joined with the Cancer and Public Health
    Communities to urge this committee and Congress to provide $29.7
    billion for the NIH, a $1.4 billion increase of fiscal year 2006. We
    request funding that will maintain current programs and progress at the
    NIH. We would also request that Congress appropriate $5.034 billion for
    the National Cancer Institute, a $240 million increase over fiscal year
    2006. Again, this funding would only maintain the current discovery
    pace. Additionally we ask for Congress to appropriate $20 million
    (+6.07 million) for the Prostate Cancer Control Initiatives at the
    Centers for Disease Control. With this program, the public receives
    information about prostate screening and early detection. With
    increased funding, this program can expand and improve outreach
    efforts.
        The NPCC urges these changes to the fiscal year 2007 Appropriations
    bill to ensure funding to cancer research and related programs are a
    top priority in fiscal year 2007 and in the future. We thank you for
    the opportunity to discuss the need for these tools to fight the war on
    prostate cancer. Again, we need to continue to fund these programs to
    ensure that our Nation continues to make advances in cancer
    eradication.
                                     ______

              Prepared Statement of the National Sleep Foundation
                  summary of fiscal year 2007 recommendations
      --Provide a 5 percent increase for fiscal year 2007 to the National
            Institutes of Health (NIH) and a proportional increase of 5
            percent to the individual institutes and centers, specifically,
            the National Heart, Lung, and Blood Institute (NHLBI).
      --Continue to urge the National Center on Sleep Disorders Research
            (NCSDR) of the NHLBI and the Centers for Disease Control and
            Prevention (CDC) to partner with voluntary health
            organizations, such as the National Sleep Foundation (NSF), to
            develop a collaborative sleep education and public awareness
            initiative based on the roundtable model that other public
            health-related agencies have used with success. In view of the
            success of the CDC with similar initiatives, encourage and
            support the CDC in taking a leadership role with the roundtable
            initiative.
      --Encourage the Director of the NIH and the Director of the National
            Heart, Lung, and Blood Institute to name a permanent Director
            to the National Center on Sleep Disorders Research.
      --Encourage CDC to increase support for initiatives connecting sleep
            to overall health and safety. Provide $6.321 billion for fiscal
            year 2007 to the CDC, the same amount Congress provided to the
            agency in fiscal year 2005.
      --Continue to urge the United States Surgeon General to develop and
            implement a report on sleep and sleep disorders in order to
            call attention to the importance of sleep and develop
            strategies to protect and advance the health and safety of the
            Nation.
        Mr. Chairman and members of the subcommittee, thank you for
    allowing me to submit testimony on behalf of the National Sleep
    Foundation (NSF). I am Dr. Barbara Phillips, Chairman of the NSF Board
    of Directors and professor at the University Of Kentucky College Of
    Health in the Department of Preventive Medicine. The NSF is an
    independent, non-profit organization that is dedicated to improving
    public health and safety by achieving understanding of sleep and sleep
    disorders, and by supporting sleep-related education, research, and
    advocacy. We work with sleep medicine and other health care
    professionals, researchers, patients and drowsy driving victims
    throughout the country as well as collaborate with many government and
    public and private organizations with the goal of preventing health and
    safety problems related to sleep deprivation and untreated sleep
    disorders.
        Sleep problems, whether in the form of medical disorders, or
    related to work schedules and a 24/7 lifestyle, are ubiquitous in our
    society. At least 50 million Americans suffer from sleep disorders and
    millions of others experience sleep problems related to other medical
    conditions; yet more than 60 percent of adults have never been asked
    about the quality of their sleep by a physician, and fewer than 20
    percent have ever initiated such a discussion. Millions of individuals
    struggle to stay alert at school, on the job, and on the road.
    According to the National Highway Traffic Safety Administration's 2002
    National Survey of Distracted and Drowsy Driving Attitudes and
    Behaviors, an estimated 1.35 million drivers have been involved in a
    drowsy driving related crash in the past five years. A large number of
    academic studies have linked work accidents, absenteeism, and school
    performance to sleep deprivation and circadian effects.
        Sleep apnea, a sleep-related breathing disorder which affects at
    least 5 percent of adult Americans and is closely related to some of
    America's most pressing health problems, such as obesity, hypertension,
    heart failure, and diabetes. Chronic insomnia, experienced by at least
    10 percent of our population is a strong risk factor for depression and
    other widespread mental health conditions. The direct and indirect
    costs associated with sleep disorders and sleep deprivation total an
    estimated $100 billion annually.
        Sleep science has clearly demonstrated the importance of sleep to
    health and well-being, yet research studies continue to show that
    millions of Americans are at risk for the serious health and safety
    consequences of untreated sleep disorders and inadequate sleep.
    Moreover their quality of life suffers and the personal and national
    economic impact is staggering. The severity of the public health burden
    represented by sleep issues are compellingly detailed in a
    groundbreaking new report, Sleep Disorders and Sleep Deprivation: An
    Unmet Public Health Problem by the Institute of Medicine.
        NSF believes that every American needs to understand that good
    health includes healthy sleep, just as it includes regular exercise and
    balanced nutrition. We must elevate sleep to the top of the national
    health agenda. We need your help to make this happen.
        Our biggest challenge is bridging the gap between the outstanding
    scientific advances we have seen in recent years and the level of
    knowledge about sleep held by health care practitioners, educators,
    employers, and the general public. Consequently, the NSF is
    spearheading two important initiatives to raise public and physician
    awareness of the importance of sleep to the health, safety and well-
    being of the Nation.
        First, because resources are limited and the challenges great, we
    think creative and new partnerships need to be developed to address
    sleep awareness. Therefore, the NSF has been working with the National
    Center on Sleep Disorders Research (NCSDR) and the Centers for Disease
    Control and Prevention (CDC), to develop an ongoing, inclusive
    mechanism for public and professional awareness on sleep, sleep
    disorders and the consequences of fatigue. Such collaboration between
    Federal agencies and voluntary health organizations would create an
    opportunity for dramatically improving public health and safety as well
    as the quality of life for millions, if not all, Americans. Since
    November of 2004, NIH, CDC, and NSF have been meeting with other
    interested and diverse voluntary and professional groups and Federal
    agencies to discuss the formation of a broad coalition dedicated to
    raising public awareness of sleep. This effort should continue to
    receive the support of Congress in order to encourage the participation
    of relevant Federal agencies.
        In relation to this effort, the National Center on Sleep Disorders
    Research within the National Heart, Lung and Blood Institute (NHLBI)
    currently has an acting director as the result of the recent promotion
    of Dr. Carl Hunt. NCSDR was created in 1993 by the National Institutes
    of Health Revitalization Act (Public Law 103-43) and has served an
    important role in furthering the scientific and public health knowledge
    related to sleep deprivation and sleep disorders. NSF requests that you
    encourage both Drs. Elias Zerhouni, the Director of NIH, and Elizabeth
    Nabel, the Director of the NHLBI to name a permanent director to this
    vitally important Center as soon as possible, so that the mission of
    the NCSDR is not significantly impacted. Additionally, given the
    significant and unique mission of the Center, NIH should consider the
    following characteristics for the NCSDR director position: history of
    collaborative efforts among sleep investigators and educators;
    recognition and stature in the field of sleep medicine; and familiarity
    with the research needs and gaps in the field of sleep medicine.
        Secondly, at the National Institutes of Health's Frontiers of
    Knowledge in Sleep and Sleep Disorders conference, the U.S. Surgeon
    General acknowledged widespread illiteracy in our country regarding
    sleep loss and untreated sleep disorders. He emphasized that sleep
    problems are easily related to the three top areas of the national
    health agenda: prevention, preparedness, and health disparities.
    Prevention of some of our Nation's most pressing health problems would
    be fostered by attending to sleep disorders. Sleep deprivation is a
    major barrier to maximizing preparedness and response in times of
    crisis. Finally, like many health concerns, access to knowledge and
    medical care for sleep problems is less accessible to some of our
    citizens.
        Conferences and workshops held by the Surgeon General involve
    educating the public, advocating for effective disease prevention and
    health promotion programs and activities, and providing a highly
    recognized symbol of national commitment to protecting and improving
    the public's health. The NSF believes it is time that the Federal
    Government helps promote sleep as a public health concern through the
    development of a Surgeon General's Report on Sleep and Sleep Disorders
    in order to call attention to the importance of sleep and develop
    strategies to protect and advance the health and safety of the Nation.
    Therefore, the NSF is advocating for the development and dissemination
    of a Surgeon General's Report on Sleep and Sleep Disorders.
        The new report by the Institute of Medicine includes important
    recommendations that support the sprit of these efforts and other
    specific actions to be taken by the CDC, NIH and other Federal agencies
    and private foundations to increase surveillance of and education on
    sleep health and sleep disorders. CDC, NIH and the Surgeon General must
    partner with voluntary health organizations and increase support for
    initiatives that help ensure the health and safety of all Americans.
        Thank you again for the opportunity to present you with this
    testimony.
                                     ______

                 Prepared Statement of the NephCure Foundation
                summary of recommendations for fiscal year 2007
        (1) A 5 percent increase for the National Institutes of Health
    (NIH) and the National Institute of Diabetes and Digestive and Kidney
    Diseases (NIDDK).
        (2) Continue to expand the NIH'S Nephrotic Syndrome (NS) and Focal
    Segmental Glomerularsclerosis (FSGS) research portfolios by
    aggressively supporting NIDDK grant proposals in this area and by
    encouraging the National Center for Minority Health and Health
    Disparities (NCMHD) to initiate studies into the incidence and cause of
    NS and FSGS in minority populations.
        Mr. Chairman and members of the subcommittee, I am pleased to
    present testimony on behalf of the NephCure Foundation (NCF), a non-
    profit organization driven by a panel of respected medical experts and
    a dedicated band of patients and families working together towards a
    common goal-to save kidneys and to save lives. NCF is the only non-
    profit organization exclusively devoted to fighting idiopathic
    nephrotic syndrome (NS) and focal segmental glomerulosclerosis (FSGS).
    Now in its sixth year, the NephCure Foundation continues to work
    tirelessly to support glomerular disease research.
    FSGS: One Family's Story
        My son, Bradly Grizzard, was diagnosed with focal segmental
    glomerulosclerosis (FSGS) in 2002. In May of 2005, I donated one of my
    kidneys to him.
        FSGS is one of a cluster of glomerular diseases that attack the one
    million tiny filtering units (nephrons) contained in each human kidney.
    Glomerular disease attacks the portion of the nephron called the
    glomerulus, scarring and often destroying these filters. Scientists do
    not know why glomerular injury occurs, and there is no known cure for
    these diseases.
        FSGS patients, upon diagnosis, often take a downward plunge at a
    rapid rate and it is extremely difficult to make a comeback. My son was
    a star football player at his high school and was being recruited by
    college football coaches before FSGS attacked his body. When his
    kidneys failed, he was forced to give up football, and he had to try
    and juggle college classes along with several hours of dialysis a day.
    We were lucky that my kidney was a match for him, but even so the first
    few hospitals that we approached refused to perform the transplant. We
    were eventually able to find a doctor and a hospital that was willing
    to perform the operation, and the transplanted kidney is now working
    well. But Bradly must remain on costly immunosuppressant drugs for the
    rest of his life. These drugs cause many unpleasant side effects and
    medical complications.
        My son's story is not unique. There are thousands of other people
    in this country who have had their lives disrupted due to the sudden
    onset of FSGS or NS. And although kidney transplants have been very
    successful for thousands of patients, many patients end up rejecting
    the transplanted kidney. Other times, the disease comes back and
    attacks the transplanted kidney. In either case, the patient must then
    again rely on daily dialysis as a means of survival. There are
    thousands of young people who are in a race against time, hoping for a
    treatment that will save their lives. The NephCure Foundation today
    raises its voice to speak for them all, asking you to take specific
    actions that will aid our quest to find the cause and cure of FSGS and
    NS.
        First and foremost, we join the Ad Hoc Group for Medical Research
    Funding in asking for a 5 percent increase for the National Institutes
    of Health (NIH) and the National Institute of Diabetes and Digestive
    and Kidney Diseases (NIDDK).
    More Research is Needed
        We are no closer to finding the cause or the cure of FSGS.
    Scientists tell us that much more research needs to be done on the
    basic science behind the disease.
        We are thankful that the NIDDK continues to work with the NephCure
    Foundation on the FSGS clinical trial. Currently 150-175 patients
    nationwide are enrolled in the trial. Recently, the steering committee
    charged with providing programmatic direction to the trial decided on
    several changes which would accelerate progress. NCF is also working
    with the NIDDK to cosponsor ancillary basic biological material studies
    of the enrolled patients.
        The NephCure Foundation is also grateful to the NIDDK for issuing
    two program announcements (PAs) that serve to initiate grant proposals
    on glomerular disease. The first program announcement, issued in
    December of 2005, includes glomerular disease as one of several kidney
    or urologic diseases for which the PA will fund grant proposals. The
    second PA, issued in March of 2006, is glomerular-disease specific.
    Both of these announcements will utilize the R21 mechanism to award
    researchers $275,000 over two years.
        We ask the Committee to encourage the NIDDK to help find the cause
    and the cure for glomerular disease by continuing its support for the
    FSGS clinical trial and the ancillary basic biological material
    studies. We also ask the NIDDK to continue to add glomerular disease to
    program announcements.
    Too Little Education About a Growing Problem
        When glomerular disease strikes, it results in a loss of protein
    from the urine and edema. The edema often manifests itself as puffy
    eyelids, a symptom that many parents and physicians mistake as
    allergies. With experts projecting a substantial increase in the number
    of cases of glomerular disease in the coming years, there is a clear
    need to educate pediatricians and family physicians about glomerular
    disease and its symptoms.
        The NephCure Foundation has numerous education programs underway. A
    national FSGS conference will be held in Philadelphia from June 3rd-
    4th, 2006. This conference will aim to provide attendees with the most
    up to date information on this disease. Through speakers, information
    sessions, and informal conversations with other patient families,
    attendees will realize they are not alone and will be further energized
    for the effort to find a cause and a cure for FSGS.
        Also, this summer, the NIDDK will sponsor a working group
    scientific conference. This working group will advise NIDDK on animal
    models, reagents, and other resources for the study of glomerular
    disease.
        We also applaud the work of the NIDDK in establishing the National
    Kidney Disease Education Program (NKDEP), and we seek your support in
    urging the NIDDK to make sure that glomerular disease remains a focus
    of the NKDEP.
        We ask the Committee to encourage the NIDDK to have glomerular
    disease receive high visibility in its education and outreach efforts,
    and to continue these efforts in conjunction with the NephCure
    Foundation's work. These efforts should be targeted towards both
    physicians and patients.
    Glomerular Disease Strikes Minority Populations
        Nephrologists tell us that glomerular disease strikes a
    disproportionate number of African-Americans. No one knows why this is,
    but some studies have suggested that a genetic sensitivity to sodium
    may be partly responsible. DNA studies of African Americans who suffer
    from FSGS may lead to insights that would benefit the thousands of
    African Americans who suffer from kidney disease.
        As an African-American female and the mother of a son with FSGS, I
    ask that the NIH pay special attention to why this disease affects my
    race to such a large degree. The NephCure Foundation wishes to work
    with the NIDDK and the National Center for Minority Health and Health
    Disparities (NCMHD) to encourage the creation of programs to study the
    high incidence of glomerular disease within the African-American
    population.
        There is also evidence to suggest that the incidence of glomerular
    disease is higher among Hispanic-Americans than in the general
    population. An article in the February 2006 edition of the NIDDK
    publication Recent Advances and Emerging Opportunities, discussed the
    case of Frankie Cervantes, a six year old boy of Mexican and Panamanian
    descent. Frankie has FSGS, and like Bradly, received a transplanted
    kidney from his mother. We applaud the NIDDK for highlighting FSGS in
    their publication, and for translating the article about Frankie into
    both English and Spanish. Only through similar culturally appropriate
    efforts can African American and Hispanic families learn more about
    glomerular disease.
        We ask the Committee to join with us in urging the NIDDK and the
    National Center for Minority Health and Health Disparities (NCMHD) to
    collaborate on research that studies the incidence and cause of this
    disease among minority populations. We also ask that the NIDDK and the
    NCMHD undertake culturally appropriate efforts aimed at educating
    minority populations about glomerular disease.
                                     ______

                 Prepared Statement of One Voice Against Cancer
        One Voice Against Cancer (OVAC) appreciates the opportunity to
    submit written comments for the record regarding funding for cancer
    programs for research, prevention, detection, and treatment as well as
    programs that educate and train nurses in fiscal year 2007 at the
    National Institutes of Health (NIH), the Centers for Disease Control
    and Prevention (CDC), and the Health Resources and Services
    Administration (HRSA). OVAC is a collaboration of more than 40 major
    national organizations representing millions of Americans affected by
    cancer, unified to urge Congress and the White House to increase
    cancer-related appropriations. OVAC stands ready to work with
    policymakers at the Federal, State, and local levels to ensure that
    these important cancer and nursing initiatives at NIH, CDC, and HRSA
    receive adequate funding in fiscal year 2007.
        Our Nation's prior investments in cancer research-related programs
    have saved thousands of lives and accelerated our progress toward the
    Administration's goal of eliminating death and suffering due to cancer
    by the year 2015. However, the challenge remains--cancer will strike
    one of every two men and one of every three women in the United States.
    This year alone, more than 1.4 million men and women in this country
    will receive the devastating news that they have cancer; yet, more than
    10 million cancer survivors can attest to the fact that we are making
    real progress against this disease.
        The Congress took a bold step forward in 1998 when it promised to
    double the budget of the National Institutes of Health (NIH) within
    five years. By keeping that promise, Congress opened the floodgates to
    countless new opportunities and advances in cancer research and
    programs. Thanks to the advances spawned by that infusion of support
    for biomedical research, cancer survivorship rates have steadily
    increased each year. For the first time since 1930, the number of
    cancer deaths in the United States decreased in 2003. Congress must
    maintain that promise with a stable and reasonable level of funding
    increases to sustain the momentum of this exciting research. Since
    fiscal year 2003, NIH funding levels have fallen far short of keeping
    pace with inflation alone, and fiscal year 2006 resulted in a hard cut
    to both NIH and National Cancer Institute funding levels.
        Less funding translates immediately into fewer discoveries, fewer
    new drugs in development, and fewer new treatments reaching patients.
    We cannot reach the 2015 goal without the continued support of the
    Congress. We appreciate that our Nation faces many challenges and
    Congress has limited resources to allocate. However, the conquest of
    cancer and elimination of health disparities is truly within our grasp.
    Making cancer a national priority will save millions of lives, reduce
    untold suffering, and save the Nation billions of dollars in healthcare
    costs now and for the foreseeable future. The investment is surely
    worth it.
                sustain and seize cancer research opportunities
        The tremendous investment our Nation has made in the National
    Institutes of Health (NIH) has reaped remarkable returns and set the
    table for a period of unparalleled innovation in the fight against
    cancer and other diseases. For fiscal year 2007, OVAC joins with the
    broader public health community and urges Congress to provide $29.7
    billion for the NIH, a $1.4 billion increase over fiscal year 2006.
    This is the minimal level of funding that will allow the NIH to
    maintain the current pace of discovery and innovation.
        OVAC recognizes the fiscal challenges facing policymakers, but does
    not believe that those challenges require us to weaken our national
    commitment to conquering cancer. While the long-term goal of providing
    adequate funding to explore the most promising opportunities must
    remain paramount, for fiscal year 2007, OVAC urges Congress to provide
    the National Cancer Institute (NCI) with at least $5.034 billion, a
    $240 million increase over fiscal year 2006. This level of funding is
    the bare minimum required to protect our cancer research enterprise and
    maintain the current pace of discovery.
        While a minimal increase of $240 million will maintain current
    programs, it is not sufficient to allow us to move forward with
    advances that we know are possible. For fiscal year 2007, OVAC would
    recommend an increase closer to that of the professional judgment
    budget prepared by the NCI Director. This budget, which calls for $5.9
    billion for fiscal year 2007, represents our national battle plan
    against cancer, outlining the critical core research that is currently
    underway and the most promising and extraordinary research
    opportunities. These exceptional research opportunities include
    expansion of the NCI-designated cancer centers program from 60 to 75
    centers; implementation of the plan to reengineer cancer clinical
    trials for greater standardization, speed, and efficiency; construction
    of linkages between science and the new technologies of advanced
    imaging, proteomics, and computational modeling; expansion of the use
    of medical informatics and bioinformatics to cancer-specific
    applications; and development of an integrative site-based approach to
    cancer research through interdisciplinary team science and
    collaboration. The professional judgment budget is developed through an
    open and public process; it reflects the best thinking of cancer
    researchers, patients, clinicians, and other constituency groups and is
    focused on the Institute's goal of eliminating suffering and death from
    cancer by the year 2015.
        The National Center on Minority Health and Health Disparities
    (NCMHD) was created by Congress to help address the undue burden of
    chronic and acute disease, morbidity and mortality, and lower survival
    rates borne by racial and ethnic minority groups, rural populations and
    other medically underserved populations. OVAC urges the Congress to
    provide the NCMHD with $200 million for fiscal year 2007 to advance its
    critical work coordinating and advancing health disparities research
    across the NIH. OVAC seeks to ensure that NCMHD has the resources to
    develop and enhance initiatives aimed at reducing and ultimately
    eliminating disparities in many chronic diseases, including cancer.
    Having worked with Congress to establish the NCMHD, the members of OVAC
    are committed to seeing it fulfill its mission and achieve its goals
    and objectives.
     boost our nation's investment in cancer prevention, early detection,
                                 and awareness
        The Centers for Disease Control and Prevention's (CDC) State-based
    cancer programs provide vital resources for cancer monitoring and
    surveillance, breast and cervical cancer screening, State cancer
    control planning and implementation, and awareness initiatives
    targeting skin, prostate, colon, ovarian and blood cancers. For fiscal
    year 2007, OVAC requests the following funding levels for these proven
    programs:
      --National Comprehensive Cancer Control Program: $50 million (+$33
            million).--The Comprehensive Cancer Control program provides
            grants and technical assistance to help States develop and
            implement plans addressing the cancers most significantly
            affecting their communities through prevention, early detection
            and treatment. OVAC's request will allow this program to help
            more States implement previously developed plans.
      --National Program of Cancer Registries: $65 million (+$16.89
            million).--The National Program of Cancer Registries
            facilitates State tracking of cancer trends and subsequent
            allocation of resources to address specific needs, while also
            identifying highly effective cancer control programs that can
            be emulated across the country. The registry provides critical
            data to ensure we remain on track in the fight against cancer.
            OVAC's request will enable States to continue to collect and
            analyze high-quality data as well as evaluate existing cancer
            prevention efforts.
      --National Breast and Cervical Cancer Early Detection Program: $250
            million (+$47.57 million).--OVAC appreciates the
            Administration's longstanding commitment to this important
            program that provides free breast and cervical screening tests
            to low income and uninsured women. Unfortunately, millions of
            eligible women lack access to these critical tests due to lack
            of funding. The CDC estimates that the program currently only
            reaches 20 percent of eligible women aged 50 to 64. OVAC's
            funding request for fiscal year 2007 would allow at least an
            additional 130,000 women to be served by the program.
      --Colorectal Cancer Screening, Education & Outreach Initiative: $25
            million (+$10.51 million).--Strong scientific evidence has
            shown that regular screening and treatment is a cost-effective
            way to reduce colorectal cancer incidence and mortality.
            However, screening rates for CRC are currently lower than for
            other cancer screening services. The Colorectal Cancer
            Screening, Education & Outreach Initiative helps increase
            public awareness of colorectal cancer, educate health care
            providers about colorectal screening guidelines and assist
            State programs with colorectal cancer priorities. With
            additional resources this program will be able to expand its
            awareness initiatives and reduce the number of preventable
            colorectal cancer deaths.
      --National Skin Cancer Prevention Education Program: $5 million
            (+$2.93 million).--Skin cancer is the most common form of
            cancer in the United States and is largely preventable. OVAC's
            request will allow the program to educate the public about ways
            to protect themselves and reduce the risks of getting skin
            cancer.
      --Prostate Cancer Control Initiatives: $20 million (+6.07 million).--
            This initiative provides the public, with special emphasis on
            men and their physicians, with information about prostate
            cancer screening and early detection. OVAC's request will allow
            the program to expand and improve its outreach efforts.
      --Ovarian Cancer Control Initiatives: $7.5 million (+$2.98
            million).--The Ovarian Cancer Initiative partners with academic
            and medical institutions to spur discovery of techniques that
            will detect this cancer and develop more successful treatments.
            OVAC's request will increase public and professional awareness
            of the symptoms and best treatments for ovarian cancer,
            restoring hope to the more than 20,000 women who will be
            diagnosed with this devastating illness this year.
      --Geraldine Ferraro Blood Cancer Program: $5 million (+$0.46
            million).--Authorized under the Hematological Cancer Research
            Investment and Education Act of 2002, this program was created
            to provide public and patient education about blood cancers,
            including leukemia, lymphoma and myeloma. OVAC's request will
            allow the program to continue to provide patients with
            educational, disease management and survivorship resources to
            enhance treatment and prognosis.
        securing and maintaining an adequate oncology nursing workforce
        OVAC joins with the nursing community in asking Congress to provide
    $175 million in fiscal year 2007 for the Nurse Reinvestment Act and the
    other nursing workforce programs at the Health Resources and Services
    Administration (HRSA). Over the next 15 years, the number of Medicare
    beneficiaries with cancer is expected to double, while more than 1.1
    million nursing positions go unfilled. The critical role of nurses in
    our health care system cannot be overstated. Oncology nurses are on the
    front-lines of the provision of quality care for cancer patients and
    are vital to administering chemotherapy, managing patient treatments
    and side-effects and providing counseling to patients and family
    members.
        Without an adequate supply of nurses, there will not be enough
    qualified oncology nurses to provide quality, comprehensive cancer care
    to a growing patient population in need. Nurses are also vital to
    helping conduct cancer research through clinical trials, and a shortage
    will slow down the pace of medical research progress. These programs
    will help address the multiple factors contributing to the nationwide
    nursing shortage, including the decline in student enrollments,
    shortage of faculty and poor public perception of nursing as a viable
    and worthwhile profession.
                                   conclusion
        OVAC stands ready to work with policymakers to ensure that funding
    for cancer research and related programs is a top priority in fiscal
    year 2007 and beyond. We thank you for this opportunity to discuss the
    funding levels necessary to ensure that our Nation continues to make
    gains in our fight against cancer and has a sufficient nursing
    workforce to care for the patients with cancer of today and tomorrow.
                                     ______

           Prepared Statement of the Ovarian Cancer National Alliance
        On behalf of the Ovarian Cancer National Alliance (the Alliance), I
    thank the subcommittee for this opportunity to submit written testimony
    regarding the fiscal year 2007 funding allocations for programs in the
    Labor-Health and Human Services and Education appropriations measure
    that the Alliance and ovarian cancer community believe are necessary to
    help reduce and prevent suffering from ovarian cancer. Since its
    inception nine years ago, the Alliance has worked to increase awareness
    of ovarian cancer and boost Federal resources to support scientific
    research into diagnostics and treatments for the disease. Among the
    most urgent challenges in the ovarian cancer field are late detection
    and poor survival of women.
        As a national umbrella organization with 50 regional, State, and
    local groups, the Alliance unites and reaches more than 800,000
    grassroots activists, women's health advocates, health care
    professionals and the public to bring national attention to ovarian
    cancer. As part of this effort, the Alliance advocates for a sustained
    Federal investment in ovarian cancer research, awareness, education and
    early detection. To that end, the Alliance respectfully requests that
    the subcommittee provide the following in fiscal year 2007 funding:
      --$7.5 million to the Centers for Disease Control and Prevention's
            (CDC) Ovarian Cancer Control Initiative;
      --$29.7 billion to the National Institutes of Health (NIH); and
      --$5.034 billion to the National Cancer Institute (NCI).
        These three agencies are working relentlessly to achieve much-
    needed gains in ovarian cancer early detection, treatment and
    survivorship. Consistent investment in ovarian cancer research and
    public awareness campaigns at CDC, NIH and NCI is vital to our fight
    against this deadly disease. The Alliance believes all women should
    have the opportunity to survive ovarian cancer, but unfortunately,
    unless our Nation makes significant investment in ovarian cancer
    research and awareness efforts, thousands of women will continue to
    lose their lives every year.
                       ovarian cancer's deadly statistics
        Today, it is both striking and disheartening to see that despite
    progress made in the scientific, medical and advocacy communities,
    ovarian cancer mortality rates have not significantly improved during
    the past decade. According to the American Cancer Society, in 2006 more
    than 20,000 American women will be diagnosed with ovarian cancer and
    approximately 15,300 will lose their lives to this disease, making it
    the fifth leading cause of cancer death in women (behind lung, breast
    and colorectal cancers). Every woman is at risk for ovarian cancer and
    one in 58 will develop it in her lifetime.
        Behind the sobering statistics are the lost lives of our loved
    ones, colleagues and community members. The country recently lost a
    national treasure to the disease when Mrs. Coretta Scott King died from
    stage III ovarian cancer in January. Her disease was considered
    terminal after a late-stage diagnosis. Unfortunately, Mrs. King's story
    is common for women in our community. When detected early, the five-
    year survival rate for women with ovarian cancer increases to more than
    90 percent. However, a valid and reliable screening test--a critical
    tool for improving early diagnosis and survival rates--still does not
    exist for ovarian cancer. With no early detection test, more than 75
    percent of women diagnosed with ovarian cancer are diagnosed in stage
    III or IV. At these stages prognosis is worst as the five-year survival
    rate drops below 30 percent. In simple terms, today, almost half (45
    percent) of all women with ovarian cancer will die within five years of
    their diagnosis.
        Until a screening test is developed, public knowledge of the
    symptoms of ovarian cancer and comprehensive, effective treatment
    protocols are the keys to reduced mortality rates. The CDC Ovarian
    Cancer Control Initiative, NIH and NCI work together to support
    programs and research grants that seek to improve early detection and
    treatment and educate women and health care providers about ovarian
    cancer, thereby increasing awareness and ultimately saving lives.
       the ovarian cancer control initiative at the centers for disease
                             control and prevention
        The CDC Ovarian Cancer Control Initiative plays an essential role
    in our Nation's fight to eliminate suffering and death from ovarian
    cancer. Created by Congress in 2000, the program coordinates and funds
    health activities aimed at identifying and filling any gaps in
    knowledge of ovarian cancer diagnosis and treatment. According to the
    program website, ``CDC enhances the limited knowledge about ovarian
    cancer by initiating research projects with partners, colleagues and
    national organizations to help identify factors related to early
    disease detection and treatment and survivorship.'' The CDC Ovarian
    Cancer Control Initiative actively partners with State cancer
    registries and cancer centers across the country.
        As the Nation's leading public health agency, the CDC plays an
    important role in translating and delivering research discoveries at
    the community level, especially ensuring that those populations
    disproportionately affected by cancer receive the benefits of our
    Nation's investment in medical research. With its extensive network of
    health professionals and cancer registries, the CDC is the optimal
    Federal agency for such work.
                         early detection and awareness
        Most women and many health professionals remain unaware of the
    signs and symptoms associated with ovarian cancer. Consequently, many
    women suffer with the disease for months, even years, prior to
    receiving an accurate--and often fatal--diagnosis. Since there is no
    effective screening tool for ovarian cancer, it is imperative that
    women and their health care providers be aware of the multiple ways
    that ovarian cancer can present in a woman through symptoms. The CDC
    Ovarian Cancer Control Initiative is unique among CDC cancer programs.
    With no screening tool, the goal of the Ovarian Cancer Control
    Initiative is to learn more about current practice and identify areas
    of knowledge and practice patterns that need improvement to reduce the
    overwhelming burden of ovarian cancer.
                        standards of care and treatment
        The efforts of the CDC Ovarian Cancer Control Initiative also are
    targeted at improving prognosis for women currently living with and
    fighting the disease. Investigation into early symptoms, survival
    trends based on care provided, and research into general epidemiology
    will fill in information gaps to provide a stable body of knowledge
    which will guide future research. Most significantly, examination of
    survival trends based on care received contributes to the development
    of best practice guidelines for women with ovarian cancer. Currently,
    research funded by the Ovarian Cancer Control Initiative addresses four
    public health questions:
      --What factors influence risk perception and how does risk perception
            affect screening behaviors?
      --What are the primary diagnostic pathways in the diagnosis of
            ovarian cancer?
      --Are women receiving optimal surgical and chemotherapy treatments?
      --Are women receiving optimal end-of-life care?
        Investigation into these questions will allow the CDC to maximize
    screening effectiveness by primary care physicians, improve early
    detection and diagnosis and provide physicians with ``best practice''
    guidelines for women diagnosed with ovarian cancer. According to the
    CDC, $2.2 billion is spent on treatment for ovarian cancer each year.
    This figure could greatly be reduced with earlier diagnoses and more
    efficient practice guidelines.
              cdc ovarian cancer control initiative-funded grants
        Grants supported by the CDC Ovarian Cancer Control Initiative have
    covered a diverse array of activities over the past six years, all
    aimed at accomplishing the program's mission of increasing awareness
    and improving treatment and survivorship of ovarian cancer. Current on-
    going ovarian cancer studies include the following:
      --The Division of Cancer Prevention and Control (DCPC) at the CDC is
            investigating the influence of perceived risk of ovarian cancer
            on screening behaviors. This information will be used to
            maximize screening effectiveness in average and high risk
            women.
      --Analysis of records of ovarian cancer patients and healthy women
            presenting symptoms similar to those associated with ovarian
            cancer to create more specific guidelines for symptom-
            recognition.
      --Investigation into the relationship between patient
            characteristics, provider characteristics, diagnostic
            procedures and referral patterns leading to a positive
            diagnosis to create best practice guidelines for primary care
            physicians.
      --Investigation into current surgical and chemotherapy practices for
            women diagnosed with ovarian cancer to develop best practice
            guidelines and to identify the demographics of women who
            typically receive poor treatment plans.
      --Research and development of end-of-life care guidelines to prevent
            undue suffering in women with ovarian cancer.
       boosting the cdc's ovarian cancer prevention and awareness efforts
        In only six years of existence, the CDC Ovarian Cancer Control
    Initiative has made important contributions to better understanding and
    awareness of the disease. However, until the development of a valid and
    reliable screening test, more must be done to increase awareness and
    recognition of the symptoms of ovarian cancer. The full impact and
    benefits of CDC Ovarian Cancer Control Initiative efforts will not be
    fully realized unless the results are effectively translated into
    public health interventions.
        The CDC Ovarian Cancer Control Initiative must continue to build
    its research efforts, but needs enhanced funding to move research
    results out to health care providers and women. Most significantly,
    increased resources are needed for a national effort to educate primary
    care providers on the signs and symptoms of ovarian cancer. These
    physicians and nurses are the most likely group to encounter women
    presenting with ovarian cancer warning signs and symptoms that, if
    recognized early, could lead to a faster diagnosis and therefore an
    increased chance of survival.
        Additional funding in fiscal year 2007 will enable the CDC to
    expand the reach and scope of its current ovarian cancer initiatives to
    help advance our Nation's efforts to reduce and prevent ovarian cancer
    morbidity and mortality. The allocation of $7.5 million in fiscal year
    2007 will continue the excellent progress being made and would help
    expand the program's efforts to include:
      --Development and implementation of two critical and complementary
            national campaigns about the signs and symptoms of ovarian
            cancer:
        --(A) A public education campaign with a focus on the signs and
                symptoms of ovarian cancer, the importance of regular
                monitoring for high risk populations and strategies for
                risk reduction.
        --(B) A targeted education and awareness campaign involving primary
                care physicians.
      --Examination of the epidemiology of ovarian cancer and development
            of appropriate strategies for addressing issues related to
            incidence and survival in minority populations.
      --Training of health care professionals in best practices for
            treating ovarian cancer, emphasizing referral to gynecologic
            oncologists for optimal survival outcomes.
                 a sustained commitment to fund cancer research
        Our Nation has reaped many benefits from past Federal investments
    in biomedical research at the NIH. The Alliance has joined with the
    broader health community in urging Congress to provide NIH $29.7
    billion and NCI $5.034 billion in fiscal year 2007 to allow these
    agencies to sustain their efforts while also having the resources to
    avoid the severe disruption to that progress that would result from a
    minimal funding increase. The requested increase in NCI allocations
    represents our national battle plan against cancer, focusing on
    critical ongoing research and promising research opportunities.
        When funding stagnates or does not keep pace with inflation,
    progress in critical research programs can be halted or slowed
    significantly. Inadequate funding for the NIH, NCI and the CDC can
    result in inadequate funding for the lesser-known or less popular--yet
    terribly devastating--diseases such as ovarian cancer. The requested
    funding levels would provide the minimum resources required to preserve
    our cancer research enterprise and maintain the current pace of
    discovery.
                             summary and conclusion
        The Alliance maintains a long-standing commitment to work with
    Congress, the Administration, and other policymakers and stakeholders
    to improve the survival rate from ovarian cancer through education,
    public policy, research and communication. Please know that we
    appreciate and understand that Congress has limited resources to
    allocate, but we believe the health and safety of American women are
    imperative to the strength of our Nation and should be a national
    priority. We are concerned that without increased funding to bolster
    and expand ovarian cancer education, awareness and research efforts,
    the Nation will continue to see growing numbers of women losing their
    battle with this terrible disease.
        On behalf of the entire ovarian cancer community--patients, family
    members, clinicians and researchers--we thank you for your leadership
    and support of Federal programs that seek to reduce and prevent
    suffering from ovarian cancer. Thank you in advance for your support of
    the funding allocations we have requested for the CDC Ovarian Cancer
    Control Initiative, NIH and NCI. Please know that we stand ready to
    serve as a resource for any information you may need. Thank you for the
    opportunity to submit testimony on fiscal year 2007 ovarian cancer
    funding.
                                     ______

    Prepared Statement of the Population Association of America/Association
                             of Population Centers
                                  introduction
        Thank you, Mr. Chairman Specter, Mr. Ranking Member Harkin, and
    other distinguished members of the subcommittee, for this opportunity
    to express support for the National Institutes of Health (NIH) and the
    National Center for Health Statistics (NCHS)--two agencies important to
    our organizations.
               background on the paa/apc and demographic research
        The PAA is a scientific organization comprised of over 3,000
    population research professionals, including demographers,
    sociologists, and economists. The APC is a similar organization
    comprised of over 30 universities and research groups that foster
    collaborative demographic research and data sharing, translate basic
    population research for policy makers, and provide educational and
    training opportunities in population studies. Over 30 population
    research centers are located throughout the country, including two in
    Ohio (Bowling Green State University and Ohio State University) and two
    in Pennsylvania (Pennsylvania State University and the University of
    Pennsylvania).
        Demography is the study of populations and how or why they change.
    Demographers, as well as other population researchers, collect and
    analyze data on trends in births, deaths, and disabilities as well as
    racial, ethnic, and socioeconomic changes in populations. Major policy
    issues population researchers are studying include the demographic
    causes and consequences of population aging, trends in fertility,
    marriage, and divorce and their effects on the health and well being of
    children, and immigration and migration and how changes in these
    patterns affect the ethnic and cultural diversity of our population and
    the Nation's health and environment.
        The NIH mission is to support research that will improve the health
    of our population. The health of our population is fundamentally
    intertwined with the demography of our population. Recognizing the
    connection between health and demography, the NIH supports population
    research programs primarily through the National Institute on Aging
    (NIA) and the National Institute of Child Health and Human Development
    (NICHD).
                          national institute on aging
        Over the next 25 years, the number of individuals age 65 and older
    will likely double, reaching 70.3 million and comprising a larger
    proportion of the entire population, rising from 13 percent today to 20
    percent in 2030.\1\ This substantial growth in the older population is
    driving policymakers to consider dramatic changes in Federal
    entitlement programs, such as Medicare and Social Security, and other
    budgetary changes that could affect programs serving the elderly.
    Further, the macroeconomic and global impact of population aging on
    competitiveness in the world economy is becoming a bigger issue. To
    inform this debate, policymakers need objective, reliable data about
    the antecedents and impact of changing social, demographic, economic,
    and health characteristics of the older population. The NIA Behavioral
    and Social Research (BSR) program is the primary source of Federal
    support for research on these topics.
    ---------------------------------------------------------------------------
        \1\ Federal Interagency Forum on Aging Related Statistics. Older
    Americans 2000: Key Indicators of Well-Being. 2000.
    ---------------------------------------------------------------------------
        In addition to supporting an impressive research portfolio, that
    includes the prestigious Centers of Demography of Aging Program, the
    NIA BSR program also supports several large, accessible data surveys.
    Two such surveys, the National Long-Term Care Survey (NLTCS) and the
    Health and Retirement Study (HRS) have become seminal sources of
    information to assess the health and socioeconomic status of older
    people in the United States. By using NLTCS data, investigators
    identified the declining rate of disability in older Americans first
    observed in the mid-1990s--a trend that continued and even accelerated.
    This trend, if continued, could have momentous impact on reducing the
    need for costly long-term care. The HRS, which was launched in 1992 and
    has tracked 27,000 people, has provided data on a number of issues,
    including the role families play in the provision of resources to needy
    elderly and the economic and health consequences of a spouse's death.
    The Social Security Administration recognizes and funds the HRS as one
    of its ``Research Partners'' and posts the study on its home page to
    improve its availability to the public and policymakers. In 2005, the
    Center for Medicare and Medicaid Services (CMS) funded a supplemental
    survey using the HRS to provide CMS with timely information on who is
    likely to enroll in the new Medicare Part D prescription drug program
    and how those decisions are related to knowledge of the program, drug
    costs, and use.
        With additional support in fiscal year 2007, the NIA BSR program
    could fully fund its existing centers and support its ongoing surveys.
    Additional support would allow NIA to expand the centers' role in
    understanding the domestic macroeconomic as well as the global
    competitiveness impact of population aging. NIA could also use
    additional resources to support individual investigator awards by
    precluding an 18 percent cut in its existing grants, improving its
    funding payline, which is now in the 10th percentile, and sustaining
    training and research opportunities for new investigators, which are
    being heavily cut back.
            national institute on child health and human development
        Since its establishment in 1968, the NICHD Center for Population
    Research has supported research on population processes and change.
    Today, this research is housed in the Center's Demographic and
    Behavioral Sciences Branch (DBSB). The Branch encompasses research in
    four broad areas: family and fertility, mortality and health, migration
    and population distribution, and population composition. In addition to
    funding research projects in these areas, DBSB also supports a highly
    regarded population research infrastructure program and a number of
    large database studies, including the Fragile Families and Child Well
    Being Study and National Longitudinal Study of Adolescent Health.
        NICHD-funded demographic research has consistently provided
    critical scientific knowledge on issues of greatest consequence for
    American families: work-family conflicts, marriage and childbearing,
    childcare, and family and household behavior. However, in the realm of
    public health, demographic research is having an even larger impact,
    particularly on issues regarding adolescent and minority health. For
    example, in 2006, researchers with the National Longitudinal Study of
    Adolescent Health, reported findings illustrating that by the time they
    reach early adulthood (age 19-24), a large proportion of American youth
    have begun the poor practices contributing to three leading causes of
    preventable death in the United States: smoking, poor diet and physical
    inactivity, and alcohol abuse. This study is striking in that it found
    the health situation of young people--in terms of behavior, health
    conditions, and access to and use of care--deteriorates markedly
    between the teen and young adult years. The study reinforces the
    importance of educating young people about adopting healthy lifestyles
    after they leave high school and the parental home.
        Understanding the role of marriage and stable families in the
    health and development of children is another major focus of the NICHD
    DBSB. Consistently, research has shown children raised in stable family
    environments have positive health and development outcomes. Therefore,
    NICHD supports research to elucidate factors that contribute to family
    formation and strong partnerships. Recent findings have identified
    factors that can destabilize relationships between new parents. These
    factors include serious health or developmental problems of the
    parents' child, lower earnings, less education, and a father who has
    other children with different mothers. Policymakers and community
    programs can use these findings to support unstable families and
    improve the health and well being of children.
        With additional support in fiscal year 2007, NICHD could restore
    full funding to its large-scale surveys, which serve as a resource for
    researchers nationwide. Furthermore, the Institute could apply
    additional resources toward improving its funding payline, which has
    gone from the 20th percentile range in 2003 to the 10th percentile in
    January 2006. Additional support could be used to preclude cuts of 17
    percent to 22 percent in applications approved for funding and to
    support and stabilize essential training and career development
    programs to prepare the next generation of researchers.
                     national center for health statistics
        Located within the Centers for Disease Control (CDC), the National
    Center for Health Statistics (NCHS) is the Nation's principal health
    statistics agency, providing data on the health of the U.S. population
    and backing essential data collection activities. Most notably, NCHS
    funds and manages the National Vital Statistics System, which contracts
    with the States to collect birth and death certificate information.
    NCHS also funds a number of complex large surveys to help policy
    makers, public health officials, and researchers understand the
    population's health, influences on health, and health outcomes. These
    surveys include the National Health and Nutrition Examination Survey,
    National Health Interview Survey, and National Survey of Family Growth.
    Together, NCHS programs provide credible data necessary to answer basic
    questions about the state of our Nation's health.
        In fiscal year 2006, Congress provided NCHS with the same level of
    funding as in fiscal year 2005, and the Administration has recommended
    NCHS receive the same level in fiscal year 2007. For fiscal year 2007,
    the Friends of NCHS recommends the agency receive $139 million, a $30
    million increase over the fiscal year 2006 level. This funding is
    needed to, among other things, cover cost increases in basic survey
    operations, improve data timeliness and access to data, and expand and
    improve data collection to capture much needed information on issues
    such as health disparities, assisted living, and community health
    centers.
                                recommendations
        At a time when our Nation is poised to reap the promise of the past
    investment made in the NIH, the agency is facing the prospect receiving
    flat funding in fiscal year 2007. When inflation is factored in, the
    NIH could actually be facing being funded for the fourth year in a row
    below the rate of biomedical research inflation. PAA and APC join other
    organizations in expressing our concern about the precarious NIH
    funding trajectory. Already, NIH has seen a 15 percent reduction in new
    grants between fiscal year 2003 and fiscal year 2006. For population
    research, increased support is needed to ensure the best research
    projects, including new and innovative projects, are being awarded,
    surveys and databases are supported, and training programs are
    stabilized. With respect to NCHS, funding is needed to sustain and
    update its major operations.
        The PAA and APC join the Ad Hoc Group for Medical Research in
    supporting an fiscal year 2007 appropriation of $29.75 billion, a 5
    percent increase over the fiscal year 2006 appropriation, for the NIH.
    In addition, the Friends of NCHS, support a fiscal year 2007
    appropriation of $139 million, a 30 percent increase over the fiscal
    year 2006 appropriation, for the NCHS. Finally, PAA and APC urge the
    subcommittee to include language in the fiscal year 2007 bill, allowing
    continuation of the National Children's Study at the NICHD.
        Thank you for considering our requests and for supporting Federal
    programs that benefit the field of demographic research.
                                     ______

          Prepared Statement of the Pulmonary Hypertension Association
                  summary of fiscal year 2007 recommendations
      --$250,000 within the Centers for Disease Control and Prevention for
            a pulmonary hypertension awareness and education program.
      --A 5 percent increase for the National Heart, Lung and Blood
            Institute and the establishment of ``Specialized Centers of
            Clinically Orientated Research'' on Pulmonary Hypertension at
            the Institute.
      --$25 million for the Health Resources and Services Administration's
            ``Gift of Life'' Donation Initiative.
        Mr. Chairman, thank you for the opportunity to submit testimony on
    behalf of the Pulmonary Hypertension Association.
        I am honored today to represent the hundreds of thousands of
    Americans who are fighting a courageous battle against this devastating
    disease. Pulmonary hypertension is a serious and often fatal condition
    where the blood pressure in the lungs rises to dangerously high levels.
    In PH patients, the walls of the arteries that take blood from the
    right side of the heart to the lungs thicken and constrict. As a
    result, the right side of the heart has to pump harder to move blood
    into the lungs, causing it to enlarge and ultimately fail.
        PH can occur without a known cause or be secondary to other
    conditions such as; collagen vascular diseases (i.e., scleroderma and
    lupus), blood clots, HIV, sickle cell, and liver disease. PH does not
    discriminate based on race, gender or age. Patients develop symptoms
    that include shortness of breath, fatigue, chest pain, dizziness, and
    fainting. Unfortunately, these symptoms are frequently misdiagnosed,
    leaving patients with the false impression that they have a minor
    pulmonary or cardiovascular condition. By the time many patients
    receive an accurate diagnosis, the disease has progress to a late
    stage, making it impossible to receive a necessary heart or lung
    transplant.
        While new treatments are available, unfortunately, PH is frequently
    misdiagnosed and often progresses to late stages by the time it is
    detected. Although PH is chronic and incurable with a poor survival
    rate, the new treatments becoming available are providing a
    significantly improved quality of life for patients. Recent data
    indicates that the length of survival is continuing to improve, with
    some patients able to manage the disorder for 20 years or longer.
        Fifteen years ago, when three patients who were searching to end
    their own isolation founded the Pulmonary Hypertension Association,
    there were less than 200 diagnosed cases of this disease. It was
    virtually unknown among the general population and not well known in
    the medical community. They soon realized that this was unacceptable,
    and formally established PHA, which is headquartered in Silver Spring,
    Maryland.
        Today, PHA includes:
      --Over 6,000 patients, family members, and medical professionals.
      --An international network of over 120 support groups.
      --An active and growing patient telephone helpline.
      --A new and fast-growing research fund. (A cooperative agreement has
            been signed with the National Heart, Lung, and Blood Institute
            to jointly create and fund five, five-year, mentored clinical
            research grants and PHA has awarded eleven Young Researcher
            Grants.)
      --Numerous electronic and print publications, including the first
            medical journal devoted to pulmonary hypertension--published
            quarterly and distributed to all cardiologists, pulmonologists
            and rheumatologists in the United States.
        Mr. Chairman, at the age of 5, my wife and I noticed that our
    daughter, Emily, could not keep up with the other kids in the
    neighborhood. She seemed to lack the energy and strength to run and
    play. This condition seemed to worsen to the point to where she would
    have to stop and rest after coming down the steps in the morning. We
    noticed that when she was sitting on the bottom step in the morning,
    her lips appeared to have a bluish color.
        After pressing for an answer to these problems for several months,
    Emily was finally diagnosed with pulmonary hypertension and the doctors
    gave a probable remaining lifespan of three years. That unforgettable
    day was 8 years ago and, as you can see, Emily is still here today. She
    is here because of continued advances in the treatment of pulmonary
    hypertension and by the grace of God. There is however, NO cure for
    pulmonary hypertension. Thanks to congressional action, Emily's chances
    of a full life have greatly increased. We need, however, additional
    support for research and related activities to continue to develop
    treatments that will extend the published NIH life expectancy beyond
    the 2.8 years after diagnosis.
                fiscal year 2007 appropriations recommendations
    (A) National Heart, Lung and Blood Institute
        Mr. Chairman, PHA commends the National Heart, Lung and Blood
    Institute (NHLBI) for its strong support of PH research. According to
    leading researchers in the field, we are on the verge of significant
    breakthroughs in our understanding of the disease and the development
    of new and advanced treatments. Ten years ago, a diagnosis of PH was
    essentially a death sentence, with only one approved treatment for the
    disease. Thanks to advancements made through the public and private
    sector, patients today are living longer and better lives with a choice
    of five FDA approved therapies. Recognizing we have made tremendous
    progress, we are also mindful that we are a long way from where we want
    to be, and that is; (1) the management of pulmonary hypertension as a
    treatable chronic disease, and (2) A CURE.
        Mr. Chairman, it is our understanding that NHLBI is poised to
    establish ``Specialized Centers of Clinically Orientated Research'' in
    pulmonary hypertension later this year. We are very excited about the
    promise these Centers hold for the future development of new treatments
    and we encourage the subcommittee to support this worthy investment. In
    addition, we applaud NHLBI and the NIH Office of Rare Diseases for
    their plans to co-sponsor a two-day scientific conference on pulmonary
    hypertension this Fall. This important event will bring together
    leading PH researchers from the United States and abroad to discuss the
    state of the science in pulmonary hypertension and future research
    directions.
        In order to facilitate the establishment of the Specialized Centers
    of Clinically Orientated Research and maintain promising research
    currently underway on PH, the Pulmonary Hypertension Association
    encourages the subcommittee to provide NHLBI with a 5 percent increase
    in funding in fiscal year 2007.
    (B) Centers for Disease Control and Prevention
        PHA applauds the subcommittee for its leadership over the years in
    encouraging the Centers for Disease Control and Prevention to initiate
    a Pulmonary Hypertension Education and Awareness Program. We know for a
    fact that Americans are dying due to a lack of awareness of PH, and a
    lack of understanding about the many new treatment options. This
    unfortunate reality is particularly true among minority and underserved
    populations. However Mr. Chairman, you don't have to rely solely on our
    word regarding the need for additional education and awareness
    activities. On November 11, 2005 the CDC released a long awaited
    Morbidity and Mortality Report on pulmonary hypertension. In that
    report, the CDC states:
        (1) ``More research is needed concerning the cause, prevention, and
    treatment of pulmonary hypertension. Public health initiatives should
    include increasing physician awareness that early detection is needed
    to initiate prompt, effective disease management. Additional
    epidemiologic initiatives also are needed to ascertain prevalence and
    incidence of various pulmonary hypertension disease entities.'' (Page
    1, MMWR Surveillance Summary--Vol. 54 No. SS-5)
        (2) ``Prevention efforts, including broad based public health
    efforts to increase awareness of pulmonary hypertension and to foster
    appropriate diagnostic evaluation and timely treatment from health care
    providers, should be considered. The science base for the etiology,
    pathogenesis, and complications of pulmonary hypertension disease
    entities must be further investigated to improve prevention, treatment,
    and case management. Additional epidemiologic activities also are
    needed to ascertain the prevalence and incidence of various disease
    entities.'' (Page 7, MMWR Surveillance Summary--Vol. 54 No. SS-5)
        Mr. Chairman, we are grateful to CDC for their recent support of a
    DVD highlighting the proper diagnosis of PH. However, despite repeated
    encouragement from the subcommittee over the past 5 years, CDC has not
    taken any steps to establish an education and awareness program on PH.
    Therefore, we respectfully request that you provide $250,000 in fiscal
    year 2007 for the establishment of a PH awareness initiative through
    the Pulmonary Hypertension Association.
    (C)``Gift of Life'' Donation Initiative at HRSA
        Mr. Chairman, PHA applauds the success of the Health Resources and
    Services Administration's ``Gift of Life'' Donation Initiative. This
    important program is working to increase organ donation rates across
    the country. Unfortunately, the only ``treatment'' option available to
    many late-state PH patients is a lung or heart and lung
    transplantation. This grim reality is why PHA established ``Bonnie's
    Gift Project.'' ``Bonnie's Gift'' was started in memory of Bonnie
    Dukart, one of PHA's most active and respected leaders. Bonnie was a PH
    patient herself. She battled with PH for almost 20 years until her
    death in 2001 following a double lung transplant. Prior to her death,
    Bonnie expressed an interest in the development of a program within PHA
    related to transplant information and awareness. PHA will use
    ``Bonnie's Gift'' as a way to disseminate information about PH,
    transplantation and the importance of organ donation to our community
    and organ donation cards.
        PHA has had a very successful partnership with HRSA's ``Gift of
    Life'' Donation Program in recent years. Collectively, we have worked
    to increase organ donation rates and raise awareness about the need for
    PH patients to ``early list'' on transplantation waiting lists. For
    fiscal year 2007, PHA recommends an appropriation of $25 million (an
    increase of $2 million) for this important program.
        Mr. Chairman, once again thank you for the opportunity to present
    the views of the Pulmonary Hypertension Association. We look forward to
    continuing to work with you and the subcommittee to improve the lives
    of pulmonary hypertension patients.
                                     ______

        Prepared Statement of the Society for Investigative Dermatology
    summary of the society for investigative dermatology's fiscal year 2007
                                recommendations
        (1) A 5 percent increase for all of the National Institutes of
    Health (NIH) and for the National Institute of Arthritis and
    Musculoskeletal and Skin Diseases (NIAMS).
        (2) Establishment of a skin disease clinical trials network that
    will collect baseline data for specific orphan diseases and facilitate
    the exchange of scientific data across disciplines and institutes.
        (3) Encourage NIAMS to develop collaborative funding mechanisms
    with other NIH institutes and private foundations that leverage skin
    biology studies as a developmental model that will serve for the
    advancement of research across a multitude of diseases and specialties.
        (4) Encourage NIAMS to sponsor studies that capture general and
    skin disease specific measures in order to generate incidence,
    prevalence and quality of life data attributable to skin diseases.
        (5) Increase the number of training awards through the NIH designed
    to facilitate the entry of more individuals into careers in skin
    disease research.
                                   background
        The Society for Investigative Dermatology (SID) was founded in
    1938. Its 2,000 members represent over 40 countries worldwide,
    including scientists and physician researchers working in universities,
    hospitals and industry.
        Our members are dedicated to the advancement and promotion of the
    sciences relevant to skin health and disease through education,
    advocacy, and the scholarly exchange of scientific information along
    with our colleagues from the American Academy of Dermatology.
        This collective commitment to research is evidenced in the
    scientific journal published by the SID, the Journal of Investigative
    Dermatology. The Journal is a catalyst for the exchange of scientific
    information pertaining to the 3,000 skin diseases that afflict nearly
    80 million Americans annually.
        The purpose in presenting testimony is to increase awareness of the
    need for more skin research, based on the burden attributable to skin
    disease. It will also highlight some of the advancements that past
    support has enabled.
        We join with the Ad Hoc Group for Medical Research Funding in
    asking for a 5 percent increase to the National Institutes of Health
    (NIH) and the National Institute of Arthritis and Musculoskeletal and
    Skin Diseases (NIAMS).
                             burden of skin disease
        Prior bill report language directed NIAMS to ``consider supporting
    the development of new tools to measure the burden of skin diseases,
    and the training of researchers in this important area''. There only a
    handful of researchers working on NIH-sponsored research that will
    provide such measures.
        Skin disease impacts our citizens more than previously estimated. A
    recent report released by the Society for Investigative Dermatology and
    the American Academy of Dermatology, ``The Burden of Skin Disease'',
    compiled data from only 21 of the known 3,000 skin diseases and
    disorders. The estimated economic costs to society each year from those
    21 diseases totaled nearly $39 billion.
        The true impact extends far beyond mere economics. These patients
    encounter discomfort and pain, physical disfigurement, disability,
    dependency and death. Skin conditions affect an individual's ability to
    interact with others and compromise the self-confidence of those
    inflicted.
        One of the most striking findings in the study was the lack of
    general and skin-disease specific measures that are needed to generate
    data surrounding the incidence, prevalence, economic burden, quality of
    life, disability and handicaps attributable to these diseases.
        We ask the Committee to devote the resources needed to develop
    components of national health surveys that capture dermatological data
    above and beyond skin cancer incidence and prevalence.
                               research advances
        Skin is the body's largest organ and serves as the primary barrier
    to external pathogens and toxins. Researchers at the NIH campus and
    institutions around the country are working diligently to define how
    the skin functions to protect us, how this fails in disease, and how
    compromised functions in disease can be restored.
        Cell biology allows scientists to understand the life cycle of skin
    and hair-producing cells and identify the causes of disease, leading to
    better treatments and preventative measures. Advances in wound healing
    and skin ulcers are helping the growing aging population, those with
    diabetes, burn victims and our veteran population. Lasers continue to
    provide less invasive options for patients requiring surgery.
        Fundamental discoveries resulting from skin biology and
    translational research have yielded advances that are broadly
    applicable to human development and disease. Continued investment is
    required to fully capitalize on these ground-breaking advances.
        Important new research findings include the following:
      --The genes responsible for skin cancer and inherited skin disorders
            have been identified, making targeted therapy possible.
      --The molecular mechanisms of auto-immune and inflammatory skin
            diseases are better understood, allowing for the use of
            focused, selective immunosuppressive therapy with greater
            safety and efficacy.
      --Oral medications to treat and prevent viral and fungal diseases
            have become available.
      --Lasers have made possible the removal of disfiguring skin
            malformations.
      --Modern phototherapy and photochemotherapy allow for more effective
            treatment of inflammatory skin disease, lymphoma, depigmenting
            disorders and auto-immune diseases.
      --Retinoids and sunscreens have reduced the risk of skin cancer in
            the elderly, in transplant patients, and in other populations.
      --Painless transdermal drug delivery has become available.
        Recent developments in the areas of clinical epidemiology,
    biostatistics, economics, and the quantitative social sciences have
    begun to provide objective evaluation measures, although additional and
    improved measures are still desperately needed. These measures will
    help to identify effective interventions and allow us to better
    quantify contributions to the quality of life and health of Americans.
        A significant portion of skin disease is chronic, resulting from
    aging, genetics and environmental and occupational exposure.
        We ask the NIH to work to identify additional biomarkers in order
    to better understand skin disease pathways and interaction with other
    diseases and environmental factors.
               translating discovery to treatments for americans
        The goal of skin disease research is to improve the quality of life
    for the one in three Americans that suffer from skin disease. That goal
    is embedded in the collective missions of the SID and the intramural
    and extramural scientists funded through the skin portfolios of many of
    the 27 Institutes and Centers of the NIH.
        Medical research organizations such as the SID are the direct
    recipients of the awards made possible through the rigorous peer-
    reviewed grant system in place at the NIH. The ultimate beneficiaries
    are the nearly 80 million Americans that stand to benefit from the
    discoveries resulting from research grants.
        Inadequate levels of Federal funding have forced Institute
    administrators to reduce certain types of the available funding
    mechanisms currently in place at the NIH, to decrease success rates, to
    increase administrative cost reductions, to consider decreasing the
    number of awards, and to cut award levels in existing programs.
        Unfortunately, this reality impairs the ability of hypothesis-
    driven research, the source of countless discoveries, to drive the
    research system. Adequate funding levels will allow the peer-review
    system to work at full potential, leading to findings that translate
    into better care for those suffering from debilitating diseases.
    Without sufficient funding provided specifically for skin research,
    nearly one third of the Nation would be denied any hope for a better
    quality of life.
        We are grateful for the past support that has been given to the NIH
    and ask you to look for innovative ways to avoid flat or decreased
    funding levels to these Institutes that are charged with improving the
    health of Americans.
                                     ______

         Prepared Statement of the Society for Maternal-Fetal Medicine
        The Society for Maternal-Fetal Medicine appreciates the opportunity
    to comment on the fiscal year 2007 budget for the National Institutes
    of Health. We are especially grateful for the Committee's support of
    the National Institute of Child Health and Human Development over the
    past years and urge your continued commitment to the critical medical
    research conducted and supported by the National Institutes of Health.
        Established in 1977, the Society for Maternal-Fetal Medicine (SMFM)
    is a not-for-profit organization of over 2,000 members that are
    dedicated to improving perinatal care through research and education.
    Maternal-fetal medicine doctors have advanced knowledge of the
    obstetrical, medical, genetic and surgical complications of pregnancy
    and their effects on both the mother and fetus. The many advances in
    research have allowed the maternal-fetal medicine physician to provide
    the direct care needed to treat the special problems that high risk
    mothers and fetuses face.
        The SMFM applauds the National Institute of Child Health and Human
    Development (NICHD) for its efforts to pursue research to understand,
    prevent and treat the abnormal events that can occur during pregnancy.
    For example:
        Preterm birth.--Remains a leading cause of death, illness, and
    disability among infants during their first year of life. It poses
    great risks to both the infant and mother. Infants born too early are
    at higher risk than full-term babies for medical and developmental
    complications. The earlier the birth, the more risk of complications.
    In addition even without any neonatal conditions, these infants face
    serious adult complications including heart disease and diabetes
    resulting from their intrauterine environment and low birthweight.
        NICHD-supported research has improved the outlook for preterm
    infants and families. The Maternal-Fetal Medicine Units (MFMU) Network
    established in 1986, to address issues pertaining to preterm births and
    low birth weight deliveries, has made steady and impressive strides in
    these areas.
        Researchers recently found that:
      --A substance in the urine of pregnant women can be measured to
            predict the later development of preeclampsia--a life-
            threatening complication of pregnancy.
      --Weekly injections of 17-hydroxyprogesterone can reduce preterm
            birth by more than one third among women who are at increased
            risk of preterm delivery.
        However, despite these efforts, the rate of preterm births
    continues to rise. SMFM therefore urges full support of the MFMU
    Network so that it can continue to address these issues.
        In addition, full funding of the new Genomic and Proteomic Network
    will hasten a better understanding of the pathophysiology of premature
    birth and discover novel diagnostic biomarkers. Studies to be
    undertaken by this network will ultimately aid in formulating more
    effective interventional strategies to prevent premature birth.
        Stillbirth.--Is a major public health issue with morbidity equal to
    that of all infant deaths. Despite this significant and persistent
    burden of stillbirths, they have remained largely unstudied and, for at
    least half of all stillbirths, the cause is undetermined. The NICHD
    cooperative network has initiated a pilot study with the full study
    planned to start this year. The information that will be obtained will
    aid in future research to improve preventive and therapeutic
    interventions and to understand the pathologic mechanisms leading to
    fetal death. Increased knowledge regarding the causes of stillbirths
    will benefit families who have experienced a loss, pregnant women, and
    their physicians, and may lead to the development and evaluation of
    improved clinical and preventive interventions. Full funding of this
    study is urgently needed.
        Near-Term Births.--The preterm birth rate is now over 12 percent of
    all live births, and of these 75 percent are near term births. Near-
    term birth occurs after 35-37 weeks of gestation. It is estimated that
    this group encompasses 40 percent of Neonatal ICU admissions. These
    infants are at risk for sepsis; pneumonia; feeding difficulties; white
    matter damage; seizures; apnea; and remain at risk for higher
    morbidities in early infancy. This group of infants has not been well
    studied and may account for a portion of the increase in adverse long-
    term outcomes such as autism, attention deficit disorders, and
    neurodevelopmental disorders. Additional funding will allow NICHD to
    facilitate the critical need for research in this area.
        In addition to the need for funding for research, the state of
    funding for physician scientists and researchers has become a major
    problem and is in dire need of a fix.
        Over the last decade, NICHD has responded to the scientific
    community's need for enhanced training programs to provide a solid
    framework for the development of physician scientists and researchers.
    The expansion of research training programs has included a substantial
    investment in the ``T'' (Training Programs) and ``F'' (Fellowship
    Programs) line and the expansion of the ``K'' (Research Career Awards)
    line. After completion of these programs it is anticipated that
    investigators will be competitive for research awards. However, given
    the substantial reduction in the payline, the new investigator's
    ability to be successful is severely restricted. It is imperative that
    NICHD identify and provide an opportunity for funding to investigators
    that NIH has already invested in through completion of training
    programs and who have demonstrated a commitment to a research career.
    It is of major concern to the scientific community that a cadre of
    scientists may be lost due to the stringent funding payline.
                                recommendations
      --The Society for Maternal-Fetal Medicine supports a 5 percent
            increase in fiscal year 2007 for the National Institutes of
            Health (above the fiscal year 2006 funding level) as
            recommended by the Ad Hoc Group for Medical Research, along
            with the National Health Council, the Campaign for Medical
            Research and Research!America.
      --SMFM supports a 5 percent increase for the National Institute of
            Child Health and Human Development and urge full funding
            support for:
        --the Maternal Fetal Medicine Unit Network
        --the Genomic and Proteomic Network
        --Research in the area of near-term births
        --The stillbirth collaborative research network (SCRN)
        --Physician scientists and researchers
        Again, thank you for allowing SMFM the opportunity to express its
    concerns regarding the need for sustained funding in fiscal year 2007
    for the critical research programs supported by the National Institute
    of Child Health and Human Development and the National Institutes of
    Health overall.
                                     ______

             Prepared Statement of the Society of Nuclear Medicine
        The Society of Nuclear Medicine (SNM) appreciates the opportunity
    to submit written testimony for the record regarding Federal funding
    for biomedical research in fiscal year 2007. SNM is an international,
    scientific, professional organization with more than 16,000 members
    dedicated to promoting the science, technology, and practical
    application of nuclear medicine. Over the last 50 years, since
    biomedical imaging first began, the nuclear medicine community has had
    a positive working relationship with the National Institutes of Health
    (NIH). The research and development supported by NIH have made ground-
    breaking discoveries in the field of nuclear medicine. Similarly, NIH
    has benefited from the nuclear medicine research conducted through
    Federal funding of the Medical Applications and Measurement Science
    Program at the Department of Energy (DOE). Unfortunately, that $37
    million in funding was eliminated in the fiscal year 2006 Energy and
    Water Appropriations bill. Therefore, the Society requests and strongly
    recommends that the Labor, Health and Human Services, and Education
    (LHHS) Appropriations Subcommittee work with the Energy and Water
    Development Appropriations Subcommittee to ensure that dedicated
    funding for nuclear medicine research is fully restored in fiscal year
    2007.
                           what is nuclear medicine?
        Nuclear medicine is an established specialty that performs
    noninvasive molecular imaging procedures to diagnose and treat diseases
    and determine the effectiveness of therapeutic treatments, whether
    surgical, chemical, or radiation. It contributes extensively to the
    treatments and diagnoses of patients with cancers of the brain, breast,
    blood, bone, bone marrow, liver, lungs, pancreas, thyroid, ovaries, and
    prostate. Molecular imaging continues to provide critical information
    to help doctors, technicians, and other health care personnel manage
    abnormalities of the heart, brain, and kidneys. In fact, recent
    advances in the detection and diagnosis of Alzheimer's disease can be
    attributed to nuclear medicine imaging procedures, specifically
    positron emission tomography (PET) scans. These advances--which were
    made possible by research performed by nuclear medicine professionals--
    helped lead the Centers for Medicare and Medicaid Services (CMS) to
    extend Medicare coverage to include PET scans for some beneficiaries
    who suffer from Alzheimer's and other dementia-related diseases.
        The effect nuclear medicine has on the lives of men, women, and
    children suffering from cancer, heart, and brain diseases is far-
    reaching. Annually, more than 20 million men, women, and children
    require noninvasive molecular/nuclear medical procedures. These safe,
    cost-effective procedures include PET scans to diagnose and monitor
    treatments in cancer, cardiac stress tests that analyze heart function,
    bone scans for orthopedic injuries, and lung scans for blood clots. In
    addition, patients undergo procedures to diagnose liver and gall
    bladder functional abnormalities and to diagnose and treat
    hyperthyroidism and thyroid cancer.
    impact of the loss of federal funding for nuclear medicine research on
                                      nih
        In fiscal year 2006, the government abandoned its fifty-year
    commitment to supporting nuclear medicine research by eliminating
    funding for the Medical Applications and Measurement Science Program at
    the DOE and making no accommodation to transition nuclear medicine
    programs to another government agency. Over the years, the DOE Medical
    Applications and Measurement Science Program has generated advances in
    the field of molecular/nuclear medicine. For example, DOE funding
    provided the resources necessary for molecular/nuclear medicine
    professionals to develop PET scanners to diagnose and monitor the
    treatment of cancer. PET scans offer significant advantages over CT and
    MRI scans in diagnosing disease and are more effective in identifying
    whether cancer is present, if it has spread, if it is responding to
    treatment, and if a person is cancer free after treatment. In fact, the
    DOE has stated that this program supports ``research in universities
    and in the National Laboratories, and occupies a critical and unique
    niche in the field of radiopharmaceutical research. The NIH relies on
    our basic research to enable them to initiate clinical trials.''
        The advances in molecular/nuclear medicine made possible by Federal
    funding of nuclear medicine research at the DOE include:
      --Modeling Radiation Damage to the Lung: Treatment of thyroid disease
            and lymphomas using radioisotopes can cause disabling lung
            disease. Investigators at Johns Hopkins University have
            developed a Monte Carlo model that can be used to determine the
            probability of lung toxicity and be incorporated into a
            therapeutic regimen. This model will optimize the dose of
            radioactivity delivered to cancer cells and avoid untoward
            effects on the lung.
      --New Radiopharmaceuticals with Important Clinical Applications: The
            DOE radiopharmaceutical science program has developed a number
            of innovative radiotracers at the University of California at
            Irvine for the early diagnosis of neuro-psychiatric illnesses,
            including Alzheimer's disease, schizophrenia, depression, and
            anxiety disorders.
      --Imaging Gene Expression in Cancer Cells: Images of tumors in whole
            animals that detect the expression of three cancer genes were
            accomplished for the first time by investigators at Thomas
            Jefferson University and the University of Massachusetts
            Medical Center. This advanced imaging technology will lead to
            the detection of cancer in humans using cancer cell genetic
            profiling.
      --Rapid Preparation of Radiopharmaceuticals for Clinical Use: The
            DOE-sponsored program at the University of Tennessee has
            developed a new method for preparing radiopharmaceuticals by
            placing a boron-based salt at the position that will be
            occupied by the radiohalogen. The method has been used to
            prepare a variety of cancer-imaging agents.
      --Smaller, More Versatile PET Scanners: Brookhaven National
            Laboratory (BNL) has completed a prototype mobile PET scanner,
            which will record images in the awake animal. The mobile PET
            will be able to acquire positron-generated images in the
            absence of anesthesia-induced coma and correct for motion of
            the animal. The long-term goal is to develop PET
            instrumentation able to diagnose neuro-psychiatric disorders in
            children.
      --Highest Resolution PET Scanner Developed: Scientists at the
            Lawrence Berkeley National Laboratory (LBNL) have developed the
            world's most sensitive PET scanner. The instrument is 10-times
            more sensitive than a conventional PET scanner and became
            operational in 2005.
        With restored Federal funding, essential molecular/nuclear medicine
    research will continue at universities, research institutions, national
    laboratories, and small businesses. Moreover, research with
    radiochemistry, genomic sciences, and structural biology will be able
    to usher in a new era of mapping the human brain and using specific
    radiotracers and instruments to more precisely diagnose neuro-
    psychiatric illnesses and cancer.
        The future of life-saving therapies and cutting-edge research in
    molecular/nuclear medicine and imaging depends on the restoration of
    Federal funding for nuclear medicine research.
                    sustain and seize research opportunities
        For decades, Americans and people from across the world have
    benefited from the strong Federal investment in nuclear medicine and
    biomedical research at NIH. SNM hopes that the LHHS subcommittee will
    continue that trend and fund NIH and the National Institute of
    Biomedical Imaging and Bioengineering (NIBIB) and the National Cancer
    Institute (NCI) at sufficient levels in fiscal year 2007.
        SNM is proud to join its colleagues in the public health community
    in recommending that NIH receive $29.7 billion in fiscal year 2007
    funding--the same level of funding that is included in the Senate-
    passed budget resolution. This funding level would permit NIH to
    sustain and build upon its current research activities, which are a
    byproduct of the recent NIH budget-doubling effort. Even a minimal
    decrease or slowed momentum in increased funding for NIH could cause
    severe disruption in the Institutes' research activities and
    capabilities.
        Research in biomedical imaging and bioengineering is progressing
    rapidly, and recent technological advances have revolutionized the
    diagnosis and treatment of disease. In 2000, NIBIB was created to
    specifically focus on biomedical imaging and bioengineering. It has
    made great strides in helping the health care community and patients
    recognize and understand different diseases and disorders. Pancreatic
    transplantation, brain scans, and improvement in epilepsy surgeries are
    just a few examples of how NIBIB research is helping to diagnose and
    treat patients. In order for NIBIB to continue its important work, SNM
    requests that Congress provide it with $388 million in Federal funding
    for fiscal year 2007. This funding level would allow NIBIB to further
    its research, development, and application of emerging and cutting-edge
    biomedical technologies to facilitate improved disease detection,
    management, and prevention.
        In addition, SNM advocates that NCI receive $5.034 billion in
    fiscal year 2007. The American Cancer Society predicts that more than
    1.4 million Americans will be diagnosed with cancer in 2005.
    Significant gains have been made in the war on cancer, and there have
    been successful breakthroughs in diagnosing and treating this terrible
    disease. Currently, PET scans are available to detect more than a dozen
    types of cancer. Cancer research is leading to new therapies that
    translate into longer survival and improved quality of life for cancer
    patients. Extraordinary advances in cancer research have resulted
    because of the strong commitment by the Federal, State, and local
    governments in combating cancer.
                                   conclusion
        As outlined above, SNM has a strong interest in making sure that
    biomedical research in the United States is sufficiently funded. Also,
    since NIH relied on the pool of research conducted by the DOE's Medical
    Applications and Measurement Science Program, SNM would like to stress
    the impact that the loss of Federal funding for nuclear medicine
    research will have on NIH. In order to ensure that the positive effects
    and results of research and development are not seriously compromised,
    SNM advocates the allocation of $29.7 billion for NIH, including $388
    million for NIBIB and $5.034 billion for NCI, and requests that the
    LHHS Appropriations subcommittee work with the Energy and Water
    Development Appropriations Subcommittee to ensure that Federal funding
    for nuclear medicine research is fully restored.
        SNM stands ready to work with policymakers on both sides of the
    aisle to advance biomedical research and innovation to help reduce and
    prevent suffering from disease for all Americans. Again, on behalf of
    the members of SNM, I thank you for the opportunity to submit testimony
    regarding the need for increased Federal funding for biomedical
    research.
                                     ______

       Prepared Statement of the Society for Women's Health Research and
                       Women's Health Research Coalition
        On the behalf of the Society for Women's Health Research and the
    Women's Health Research Coalition, we are pleased to submit the
    following testimony in support of biomedical research, and more
    specifically women's health research.
        The Society for Women's Health Research is the only national non-
    profit women's health organization whose mission is to improve the
    health of women through research, education, and advocacy. Founded in
    1990, the Society brought to national attention the need for the
    appropriate inclusion of women in major medical research studies and
    the need for more information about conditions affecting women
    disproportionately, predominately, or differently than men. In 1999,
    the Women's Health Research Coalition was created by the Society as a
    grassroots advocacy effort consisting of scientists, researchers, and
    clinicians from across the country that are concerned and committed to
    improving women's health research.
        The Society and Coalition are committed to advancing the health of
    women through the discovery of new and useful scientific knowledge. We
    believe that sustained funding for biomedical and women's health
    research programs conducted and supported across the Federal agencies
    is necessary if we are to accommodate the health needs of the
    population and advance the Nation's research capability.
                         national institutes of health
        From decoding the human genome to elucidating the scientific
    components of human physiology, behavior, and disease, scientists are
    unearthing exciting new discoveries which have the potential to make
    our lives and the lives of our families longer and healthier. The
    National Institutes of Health (NIH) has made this all possible by
    conducting and supporting our Nation's biomedical research. World-class
    researchers, scientists, and programs at NIH are dedicated to
    understanding how the human body works and to gain insight into
    countless diseases and disorders. Congressional investment and support
    for NIH has made the United States the world leader in medical research
    and has had a direct and significant impact on women's health research
    and the careers of women scientists in the last decade.
        Great strides and advancements have been made since the doubling of
    the NIH budget from $13.7 billion in 1998 to $27 billion in 2003.
    However, we are concerned that the momentum driving new research will
    erode under the current budgetary constraints. Medical research needs
    to be considered an essential investment--an investment in thousands of
    newly trained and aspiring scientists; an investment to remain
    competitive in the global marketplace; and an investment in our
    Nation's health. In fact, a recent national poll indicated that a 58
    percent of Americans believe that a strong investment in research and
    science is critical not only for our global scientific leadership but
    for the health of our economy and citizens. Furthermore, 94 percent
    consider accelerating medical research an important national priority--
    comparable to homeland security.
        The administration's fiscal year 2007 budget request of $28.6
    billion for NIH is unraveling the successes from the doubling of NIH's
    budget. The proposed budget would freeze NIH funding at the fiscal year
    2006 appropriated level of $28.57 billion and cut most individual
    Institute budgets from 0.5 to 0.8 percent. The proposed decrease does
    not keep pace with the inflation rate. The annual change in the
    Biomedical Research and Development Price Index (BRDPI) will increase
    to 4.1 percent in fiscal year 2006 and 3.8 percent in fiscal year 2007
    and fiscal year 2008. BRDPI indicates how much the NIH budget would
    need to change to maintain purchasing power to compensate for the
    average increase in prices and to maintain research activity at the
    previous year's level.
        A flat-funded budget will have a negative impact on the number of
    grants NIH will be able to fund. NIH predicts total the total number of
    grants funded will decrease by 656. The number of new grants funded by
    NIH has already dropped by nearly fifteen percent from 10,393 in fiscal
    year 2003 to an estimated 9,062 for fiscal year 2006. The shrinking
    pool of available grants will have a significant impact on scientists
    as they depend upon NIH support to help cover their salaries and
    laboratory expenses. If one fails to obtain a grant they will be less
    likely to achieve tenure and new, less established researchers will be
    forced to consider other careers, resulting in a loss of the critical
    workforce needed to sustain America's cutting edge in biomedical
    research.
        In order to continue the momentum of scientific advancement and
    expedite the translation of research from the laboratory to the
    patient, the Society calls for a five percent increase for the NIH
    fiscal year 2007. In addition, we request that you strongly encourage
    the NIH to assure that women's health research receives resources
    sufficient to meet the health needs of all women.
        Scientists have long known of the anatomical differences between
    men and women, but only within the past decade have they begun to
    uncover significant biological and physiological differences. Sex-based
    biology, the study of biological and physiological differences between
    men and women, has revolutionized the way that the scientific community
    views the sexes.
        Sex differences play an important role in disease susceptibility,
    prevalence, time of onset and severity and are evident in cancer,
    obesity, coronary heart disease, autoimmune, mental health disorders,
    and other illnesses. This research needs to be supported and
    encouraged. Congress recognizes this importance and should support NIH
    at an appropriate level of funding and direct NIH to continue expanding
    research into sex-based biology.
        Sex differences research in heart disease has long been neglected.
    Heart disease is the number one killer of women in United States,
    killing 493,623 women. Information gaps related to the development,
    diagnosis, and treatment of heart disease among women are enormous, in
    part because women continue to be underrepresented in heart-related
    research studies. As a result, women face misdiagnosis, delayed
    diagnosis, under-treatment and mistreatment of their heart problems. In
    fiscal year 2005 the Centers for Medicare and Medicaid Services highest
    expenditure in women's health 2005 was cardiovascular/pulmonary
    services. Despite large expenditures to treat heart disease, little
    funding is targeted at research that could lead to more effective
    prevention, diagnosis, and treatment. In order to address the
    discrepancies, the Society in conjunction with WomenHeart: the National
    Coalition for Women with Heart Disease compiled a list of ten questions
    that must be answered if women are to receive optimal cardiovascular
    care and treatment. The 10 unanswered research questions are:
        1. Why do women receive significantly fewer referrals for advanced
    diagnostic testing and treatments for heart disease than men, and how
    can the referral rate for women be increased?
        2. What are the best tools and methods for assessing women's risk
    of heart disease?
        3. What are the best strategies for preventing heart disease in
    women?
        4. What treatments for heart disease work best for women?
        5. What are the most effective methods and treatments for diastolic
    heart failure, which is the most common form of congestive heart
    failure in women?
        6. How can the heart disease diagnosis and care disparities between
    white women and women of color be eliminated?
        7. What are the biological differences between men and women in the
    location, type, and heart disease risk level associated with fat
    deposits, and what determines these differences?
        8. How do sex differences in the regulation of heart rhythm affect
    risk of heart disease and response to treatment?
        9. What is the role of inflammation in heart disease in women?
        10. Why are women ages 50 and younger more likely to die following
    a heart attack than men of the same age?
        We strongly believe and encourage that these questions serve as a
    guide for NIH and other health related agencies while developing
    research portfolios.
                      office of research on women's health
        The NIH Office of Research on Women's Health (ORWH) has a
    fundamental role in coordinating women's health research at NIH,
    advising the NIH Director on matters relating to research on women's
    health; strengthening and enhancing research related to diseases,
    disorders, and conditions that affect women; working to ensure that
    women are appropriately represented in research studies supported by
    NIH; and developing opportunities for and support of recruitment,
    retention, re-entry and advancement of women in biomedical careers.
    ORWH strives to address sex and gender perspectives of women's health
    and women's health research, as well as differences among special
    populations of women across the entire life span, from birth through
    adolescence, reproductive years, menopausal years and elderly years.
        Two highly successful programs supported by ORWH that are critical
    to furthering the advancement of women's health research are Building
    Interdisciplinary Research Careers in Women's Health (BIRCWH) and
    Specialized Centers of Research on Sex and Gender Factors Affecting
    Women's Health (SCOR). These programs benefit both women's and men's
    health through sex and gender research, interdisciplinary scientific
    collaboration, and provide tremendously important support for young
    investigators in a mentored environment.
        The BIRCWH program is an innovative, trans-NIH career development
    program that provides protected research time for junior faculty by
    pairing them with senior investigators in an interdisciplinary mentored
    environment. What makes BIRCWH so unique is that it bridges advanced
    training with research independence across scientific disciplines. It
    is expected that each scholar's BIRCWH experience will culminate in
    becoming an established independent researcher in women's health. Since
    2000, 197 scholars have been trained in the twenty-four centers
    recording over 634 publications and 526 abstracts. The scholars have
    secured forty NIH grants and seventy awards from industry and
    institutional sources.
        The SCOR program, administered by the National Institute of
    Arthritis and Musculoskeletal and Skin Diseases, was developed by ORWH
    in 2001. SCOR's are designed to increase the transfer of basic research
    findings into clinical practice by housing laboratory and clinical
    studies under one roof. The program was designed to complement other
    federally supported programs addressing women's health issues such as
    BIRCWH. The eleven SCOR programs are conducting interdisciplinary
    research focused on major medical problems affecting women and
    comparing gender difference to health and disease. Each SCOR works hard
    to transfer their basic research findings into the clinical practice
    setting.
        Despite the advancement of women's health research and its
    innovative programs, we were disappointed to see ORWH receive a
    $250,000 cut in fiscal year 2006 from the Office of the Director.
    Congress must direct NIH to continue its support of ORWH and its
    programs.
                    department of health and human services
        The Department of Health and Human Services (HHS) has several
    offices that enhance the focus of the government on women's health
    research. Agencies with offices, advisors or coordinators for women's
    health or women's health research are the Department of HHS, the Food
    and Drug Administration, the Centers for Disease Control and
    Prevention, the Agency for Healthcare Quality and Research, the Indian
    Health Service, the Substance Abuse and Mental Health Services
    Administration, the Health Resources and Services Administration, and
    the Centers for Medicare and Medicaid Services. These agencies need to
    be funded at levels adequate for them to perform their assigned
    missions. We ask that the Committee Report clarify that Congress
    supports these offices and would like to see them continued and
    strengthened in the coming fiscal year.
        The focus on women's health within HHS has been critical to the
    advances made in women's health in getting the appropriate message out
    to patients and providers. Scientists have only just scratched the
    surface of understanding female biology, with new information
    forthcoming as a result of the recent sequencing of the human X
    chromosome. Now is the time to press ahead with this vital research to
    make discoveries and educate women about their health and clarify the
    misinformation they have been given for years and these offices are
    critical to the success of this effort. There are many important
    programs that we could identify from these women's health offices but
    we would like to specifically mention two in particular.
                          hhs office of women's health
        The HHS Office of Women's Health (OWH) is the government's champion
    and focal point for women's health issues. It works to redress
    inequities in research, health care services, and education that have
    historically placed the health of women at risk. The OWH coordinates
    women's health efforts in HHS to eliminate disparities in health status
    and supports culturally sensitive educational programs that encourage
    women to take personal responsibility for their own health and
    wellness. An extraordinary program initiated by the OWH is the National
    Centers of Excellence in Women's Health (CoEs).
        Developed in 1996, the CoEs offer a new model for university-based
    women's health care. Selected on a competitive basis, the current
    twenty CoEs throughout the country seek to improve the health of all
    women across the lifespan through the integration of comprehensive
    clinical health care, research, medical training, community outreach
    and public education, and medical school faculty leadership
    development. The CoEs are able to reach a more diverse population of
    women, including more women of color and women beyond their
    reproductive years. However, CoEs are vulnerable to pressures of
    obtaining adequate funding and having to compete for scarce resources.
    A CoE designation by the OWH is critical not only to patients and
    surrounding communities but also to establishing foundation and other
    non-government funding.
        In fiscal year 2006 OWH received a decrease in its budget and the
    proposed fiscal year 2007 would flat fund the office. We urge Congress
    to provide an increase of $1.5 million for the HHS OWH to allow it to
    continue to sustain and expand the National Centers of Excellence in
    Women's Health.
                   agency for healthcare and research quality
        The Agency for Healthcare Research and Quality (AHRQ) is the lead
    Public Health Service agency focused on health care quality, including
    coordination of all Federal quality improvement efforts and health
    services research. AHRQ's work serves as a catalyst for change by
    promoting the results of research findings and incorporating those
    findings into improvements in the delivery and financing of health
    care. This important information provided by AHRQ is brought to the
    attention of policymakers, health care providers, and consumers who can
    make a difference in the quality of health care women receive.
        AHRQ has a valuable role in improving health care for women.
    Through AHRQ's research projects and findings, lives have been saved
    and underserved populations have been treated. For example, women
    treated in emergency rooms are less likely to receive life-saving
    medication for a heart attack. AHRQ funded the development of two
    software tools, now standard features on hospital electrocardiograph
    machines that have improved diagnostic accuracy and dramatically
    increased the timely use of ``clot-dissolving'' medications in women
    having heart attacks.
        While AHRQ has made great strides in women's health research, the
    Administration's budget for fiscal year 2007 could threaten life-saving
    research. If a budget request of $319 million were enacted, AHRQ would
    be flat funded for the third year in a row at fiscal year 2005 levels.
    Flat funding prior to application of taps by Congress seriously
    jeopardizes the research and quality improvement programs that Congress
    demands or mandates from AHRQ.
        We encourage Congress to fund AHRQ at $443 million for fiscal year
    2007. This will ensure that adequate resources are available for high
    priority research, including women's health care, gender-based
    analyses, Medicare, and health disparities.
        In conclusion, Mr. Chairman, we thank you and this Committee for
    its strong record of support for medical and health services research
    and its unwavering commitment to the health of the Nation through its
    support of peer-reviewed research. We look forward to continuing to
    work with you to build a healthier future for all Americans.
                                     ______

         Prepared Statement of The Humane Society of the United States
        On behalf of The Humane Society of the United States (HSUS) and our
    more than 9.5 million supporters nationwide, we appreciate the
    opportunity to provide testimony on our top funding priorities for the
    Labor, Health and Human Services, Education and Related Agencies
    Subcommittee in fiscal year 2007.
                         alternatives to animal testing
        The ICCVAM Authorization Act (Public Law 106-545) requires Federal
    regulatory agencies to ensure that new and revised animal and
    alternative test methods be scientifically validated prior to
    recommending or requiring use by industry. The internationally agreed
    upon definition of validation, supported by the 15 Federal regulatory
    and research agencies that compose the ICCVAM, is: ``the process by
    which the reliability and relevance of a procedure are established for
    a specific use.''
    Function of the ICCVAM
        The ICCVAM performs an invaluable function by assessing the
    validation of new, revised and alternative toxicological test methods
    that have interagency application. After appropriate independent peer
    review, the ICCVAM recommends the test to the Federal regulatory
    agencies that regulate the particular endpoint test measures. In turn,
    the Federal agencies maintain their authority to incorporate the
    validated test methods as appropriate for the agencies' regulatory
    mandates. This streamlined approach of assessing the validation of test
    methods has reduced the regulatory burden of individual agencies;
    provided a ``one-stop shop'' for stakeholders for consideration of
    methods; and set uniform criteria for what constitutes a validated test
    method. The ICCVAM can also serve to appropriately assess test methods
    that can refine, reduce and replace the use of animals in toxicological
    testing.
        The ICCVAM's representatives have rigorously assessed several test
    methods that are now deemed scientifically valid and acceptable. In
    addition, the ICCVAM is working to streamline assessment of methods
    from the European Union (EU) that have already been validated for use
    within the EU.
    Request for Appropriations
        Since passage of the ``ICCVAM Authorization Act'' in 2000, which
    makes the entity a permanent standing committee, NIEHS has provided
    between $1 and $2.6 million per fiscal year to NICEATM for ICCVAM's
    activities. In order to ensure that Federal regulatory agencies and
    their stakeholders benefit from the work of the ICCVAM, NIEHS funding
    is important. We respectfully request $4 million for this purpose in
    fiscal year 2007.
    Request for Committee Report Language
        The NIEHS should support the NICEATM/ICCVAM in creating a five-year
    roadmap for assertively setting goals to prioritize ending the use of
    antiquated animal tests for specific endpoints. It is also imperative
    that the ICCVAM take a more proactive role in isolating areas where new
    methods development is on the verge of replacing animal tests. These
    areas should form a collective call by the Federal agencies that
    compose the ICCVAM to fund any necessary additional effort that is
    required to eliminate the animal methods. We also strongly urge the
    NICEATM/ICCVAM to closely coordinate efforts with its European
    counterpart, the European Centre for the Validation of Alternative
    Methods (ECVAM), to ensure the best use of available funds and sound
    science and to ensure industry has a uniform approach to worldwide
    chemical safety evaluation.
        We also respectfully request that the Committee consider including
    the following report language: ``The Committee commends the National
    Interagency Center for the Evaluation of Alternative Methods/
    Interagency Coordinating Committee on the Validation of Alternative
    Methods (NICEATM/ICCVAM) for its leadership role in the assessment of
    new, revised and alternative scientifically validated methods for the
    Federal Government. The Committee also commends the National Toxicology
    Program (NTP) for finalizing its ``Roadmap to Achieve the NTP Vision, A
    Toxicology Program for the 21st Century,'' which commits to ``develop
    and validate improved testing methods and, where feasible, ensure that
    they reduce, refine or replace the use of animals'' as one of its top
    four goals.
        The Committee directs the NICEATM/ICCVAM, in partnership with the
    relevant Federal agency program offices and the NTP, to build on the
    NTP Roadmap to create a five-year plan to research, develop, translate
    and validate new and revised non-animal and other alternative assays
    for integration of relevant and reliable methods into the Federal
    agency testing programs. In this 5-year plan the Federal agency program
    offices shall be directed to identify areas of high priority for new
    and revised non-animal and alternative assays or batteries of those
    assays to create a path forward for the replacement, reduction and
    refinement of animal tests, when this is scientifically valid and
    appropriate. The Committee directs a transparent, public process for
    developing this plan and recommends the plan be presented to the
    Committee by November 15, 2007. Funding for developing the plan shall
    be from the NIEHS and the NTP, and shall not reduce the NICEATM/ICCVAM
    funding base.''
                      breeding of chimpanzees for research
        The HSUS requests that no Federal funding be appropriated for
    breeding of chimpanzees for research, or for research that requires
    breeding of chimpanzees, for the following reasons:
      --The United States currently has a surplus of chimpanzees available
            for use in research due to overzealous breeding for HIV
            research and subsequent findings that they are a poor HIV
            model.\1\
      --The cost of maintaining chimpanzees in laboratories is exorbitant,
            totaling between and $9.3 million each year for the current
            population of 850 federally owned or supported chimpanzees
            ($15-30 per day per chimpanzee;\1\ $500,000 per chimpanzee's
            50-year lifetime).
      --The National Center for Research Resources has a publicly-declared
            moratorium on breeding chimpanzees.
      --Use of chimpanzees in research raises strong public concerns.
    Background and history
        Beginning in 1995, the National Research Council (NRC) confirmed a
    chimpanzee surplus and recommended a moratorium on breeding of
    federally owned or supported chimpanzees,\1\ who now number
    approximately 850 of the 1,300 total chimpanzees available for research
    in the United States. According to a National Research Resources
    Advisory Council September 15, 2005 meeting, the National Center for
    Research Resources (NCRR) of NIH extended the moratorium until December
    2007 because of high costs of chimpanzee care, lack of existing colony
    information, and failure of chimpanzees as an HIV model. There are,
    however, cases in which the moratorium is not being obeyed, prompting
    the need for Congressional action.
    ---------------------------------------------------------------------------
        \1\ NRC (National Research Council) (1997) Chimpanzees in research:
    strategies for their ethical care, management and use. National
    Academies Press: Washington, D.C.
    ---------------------------------------------------------------------------
    Deviations from the moratorium
        Despite the NCRR breeding moratorium, which prohibits breeding of
    federally owned or supported chimpanzee or NIH funding of projects that
    require chimpanzee breeding (NCRR written communication, February 28,
    2006), chimpanzee breeding is still being funded by NIH. For example,
    the National Institute of Allergy and Infectious Diseases maintains a
    contract with New Iberia Research Center in Louisiana to provide 10 to
    12 infant chimpanzees annually for research projects. The 10-year
    contract entitled ``Leasing of chimpanzees for the conduct of
    research'' has been allotted over $22 million, with $3.9 million
    awarded since its inception in September 2002.
    Chimpanzees have often been a poor model for human health research
        The scientific community recognizes that chimpanzees are poor
    models for HIV because chimpanzees do not develop AIDS. Similarly,
    though chimpanzees do not model the course of the human Hepatitis C
    virus, they continue to be widely used for this research. According to
    the chimpanzee genome, some of the greatest differences between
    chimpanzees and humans relate to the immune system,\2\ calling into
    question the validity of infectious disease research using chimpanzees.
    ---------------------------------------------------------------------------
        \2\ The Chimpanzee Sequencing and Analysis Consortium/Mikkelsen,
    TS, et al.,(1 September 2005) Initial sequence of the chimpanzee genome
    and comparison with the human genome, Nature 437, 69-87.
    ---------------------------------------------------------------------------
    Ethical and public concerns about chimpanzee research
        Chimpanzee research raises serious ethical issues, particularly
    because of their extremely close similarities to humans in terms of
    intelligence and emotions. Americans are clearly concerned about these
    issues: 90 percent believe it is unacceptable to confine chimpanzees
    individually in government-approved cages, and 54 percent believe that
    it is unacceptable for chimpanzees to ``undergo research which causes
    them to suffer for human benefit'' (conducted by Zogby International
    for Chimpanzee Collaboratory, 2001).
        We respectfully request the following committee report language:

        ``The Committee directs that no funds provided in this Act be used
    to support the breeding of chimpanzees for research or to support
    research that requires breeding of chimpanzees.''
                           pain and distress research
        It is estimated that at least $10.2 billion per year of the current
    National Institutes of Health budget is devoted to some aspect of
    animal research.\3\ At this time, no funding is set aside specifically
    for determination of ways to reduce the amount of pain and distress in
    animal research. Knowledge regarding recognition, assessment, and
    alleviation of animal pain and distress is critical for both the
    quality of scientific research and animal welfare.
    ---------------------------------------------------------------------------
        \3\ NIH extramural funding accounts for approximately 90 percent of
    the NIH budget, or $25.5 billion. Of this, approximately 40 percent is
    devoted to some aspect of animal research--totaling approximately $10.2
    billion. Intramural research also accounts for some animal research,
    but the exact figure is unknown.
    ---------------------------------------------------------------------------
        NIH may receive $28.6 billion in fiscal year 2007 if Congress
    fulfills the President's budget request. Out of this funding, we seek
    $2.5 million (0.009 percent) for research and development focused on
    recognizing, assessing, and alleviating animal pain and distress in
    research. This is not a request for basic research on pain pathways or
    for application to the study of human pain, for example, but for the
    benefit of animals used in painful and distressful research.
        In addition to our request for $2.5 million for this purpose, we
    also urge the Committee to specify in report language that this
    research should be conducted in conjunction with, or ``piggy-backed''
    onto, ongoing research that already causes pain and distress.
    Infliction of pain and distress on additional animals is unnecessary,
    given the volume of existing research that is believed to involve
    moderate to significant pain and/or distress (we estimate a minimum of
    20-25 percent of all animal research). Furthermore, it is expected that
    the amount of research that involves animal pain and distress will
    increase as animal use in biodefense research increases, as one
    example.
        NIH has a statutory mandate to conduct or support research into
    alternative methods that produce less pain and distress in animals;
    this was specified in the NIH Revitalization Act of 1993 regarding a
    plan for the use of animals in research. Earmarked funding will assist
    NIH in meeting this mandate. Additionally, researchers themselves often
    comment publicly about the urgent need for funding in order to properly
    understand and mitigate pain and distress in research animals and to
    follow Animal Welfare Act and Public Health Service policy requirements
    to minimize pain and distress.
        It is well known that uncontrolled, undetected, and unalleviated
    pain and distress has adverse effects on animal welfare, which leads to
    adverse effects on the quality of science. Ultimately, the lack of
    information on pain and distress leads to misinterpretation of research
    results that could result in harmful effects in human beings when
    animal research results are applied to human clinical trials.
        Numerous surveys indicate that concern about animal pain and
    distress strongly influences public opinion about animal research in
    general. For example, 75 percent of the American public opposes
    research that causes severe animal pain and/or distress, even when the
    goal of the research is to benefit human health (survey conducted by an
    independent polling firm for The HSUS, 2001).
        Our Nation takes pride in leading the world in biomedical research,
    yet we lag behind many other countries in our efforts to minimize pain
    and distress in animal subjects. We urge the Committee to make this
    small investment of $2.5 million to promote animal welfare and enhance
    the integrity of scientific research. We also respectfully request this
    accompanying committee report language:

        ``The Committee provides $2.5 million to support research and
    development focused on improving methods for recognizing, assessing,
    and alleviating pain and distress in research animals. No pain and
    distress should be inflicted solely for the purpose of this initiative,
    since the investigations can and should be conducted in conjunction
    with ongoing research that is believed to involve pain and distress
    under Government Principle IV of Public Health Service Policy, which
    assumes that procedures that cause pain and distress in humans may
    cause pain and distress in animals.''

        Thank you for the opportunity to submit these requests on behalf of
    The Humane Society of the United States.
                                     ______

                            DEPARTMENT OF EDUCATION

                  Prepared Statement of Americans for the Arts
                                    request
        Americans for the Arts is pleased to submit testimony supporting
    fiscal year 2007 appropriations of $53 million for the Arts in
    Education program of the U.S. Department of Education (USDE). We call
    on the Senate Labor/HHS/ED Appropriations subcommittee to reject the
    severe cuts to the Corporation for Public Broadcasting and instead
    provide $430 million in fiscal year 2009. However, we support the
    President's request of $41.39 million for the Office of Museum Services
    within the Institute of Museum & Library Services (IMLS), also funded
    through this subcommittee.
        Americans for the Arts is one of the leading national nonprofit
    organizations for advancing the arts and arts education in America.
    With a 45-year record of objective arts industry research, we are
    dedicated to representing and serving local communities and creating
    opportunities for every American to participate in and appreciate all
    forms of the arts.
                                 arts education
        Our belief in the importance of practical research causes us to
    take special pleasure in supporting USDE's Arts in Education program,
    which is generating impressive evidence on the best ways to improve
    overall academic achievement by integrating the arts into the school
    curriculum.
        As members of the subcommittee know, the Elementary and Secondary
    Education Act [20 USC 7271] provides that funding up to $15 million be
    directed to the John F. Kennedy Center for the Performing Arts and
    VSAarts. Prior to fiscal year 2001, funding never exceeded that level.
    Since fiscal year 2001, however, Congress has appropriated funding
    sufficient to support a broader array of arts education programs--for
    fiscal year 2006, Congress appropriated $35.6 million.\1\ In addition
    to the Kennedy Center and VSAarts, USDE now supports grant competitions
    to further develop established arts education models and support
    professional development for arts educators in four arts disciplines.
    ---------------------------------------------------------------------------
        \1\ This appropriation was reduced by a 1 percent across-the-board
    rescission to $35.3 million.
    ---------------------------------------------------------------------------
    Three Reasons to Increase Arts Education Funding
        Arts education works for children.--The most important reason to
    support arts education is simply stated: arts education works for
    children. Research increasingly confirms the beneficial effects of arts
    education in several areas, including but not limited to academic
    achievement. We refer the subcommittee to the research compendium
    Critical Links: Learning in the Arts and Student Academic and Social
    Development, released by the Arts Education Partnership in 2002, which
    includes 62 separate studies pointing to ``critical links'' between
    arts education and reading, writing, mathematics, cognitive skills,
    motivation, social behavior, and the school environment. The studies
    indicate that arts education is especially useful for students who are
    economically disadvantaged and/or in need of remedial instruction.\2\
    ---------------------------------------------------------------------------
        \2\ http://www.aep-arts.org/CLhome.html.
    ---------------------------------------------------------------------------
        Arts education provides training for a competitive workforce.--
    According to the 2002 National Governors Association publication The
    Impact of Arts Education on Workforce Preparation, ``School districts
    are finding that the arts develop many skills applicable to the `real
    world' environment. In a study of 91 school districts across the
    Nation, evaluators found that the arts contribute significantly to the
    creation of the flexible and adaptable workers that businesses demand
    to compete in today's economy.'' \3\
    ---------------------------------------------------------------------------
        \3\ http://www.nga.org/Files/pdf/050102ARTSED.pdf.
    ---------------------------------------------------------------------------
        In addition, with more than 548,000 arts-centric businesses
    employing nearly three million people, arts education becomes a
    critical tool in fueling the creative industries of the future with
    arts-trained workers. Arts education is critical to the sustainability
    of an industry that comprises more than 4 percent of all U.S.
    businesses. We know from published research studies on the benefits of
    arts education that early learning in the arts nurtures the types of
    skills and brain development that are important for individuals working
    in the new economy of ideas.
        In his State of the Union address this January, President Bush said
    ``We must continue to lead the world in human talent and creativity.''
    The arts are core to the development of creativity in our children. The
    arts develop skills and talents that foster imagination, critical
    thought, and teamwork: skills that are transferable to the workplace.
        In the documentary ``The Arts and Children: A Success Story,'' Dr.
    Sol Snyder--2003 recipient of the National Medal of Science and
    Distinguished Service Professor of Neuroscience, Pharmacology and
    Psychiatry at the Johns Hopkins University--said:

        ``In the arts, one trains one's senses to perceive and integrate
    what's going on either in the visual environment, auditory involvement,
    or even in the senses of smell, taste, and touch. The arts are very
    good for building those talents, those abilities. Sensory perception
    becomes quite important in mathematics, science, business.
        ``From my own background as a physician and research scientist, I
    have noticed that the most talented, the most productive people in the
    field are those who actually have a background in the arts because
    simple narrow scientific training is not enough to make major
    discoveries. The greatest scientists actually are artists in a sense.
    They are creative; they put together disparate things.'' \4\
    ---------------------------------------------------------------------------
        \4\ http://www.nasaa-arts.org/publications/artsandchildren.shtml.

        A similar theme on the essential integration of the arts and
    innovation was mentioned in a recent New York Times column by Thomas
    Friedman when he wrote, ``Innovation is often a synthesis of art and
    science, and the best innovators often combine the two.'' He went on to
    write that America's growing emphasis on math and reading must maintain
    a balance with creative learning in the arts to optimize human
    talent.\5\
    ---------------------------------------------------------------------------
        \5\ ``Worried About India's and China's Booms? So Are They,''
    Thomas Friedman, New York Times, March 24, 2006.
    ---------------------------------------------------------------------------
        There is solid research measuring how the arts are integrated into
    the classroom and how they boost achievement in math and science.
    Students who took four years of arts coursework outperformed those of
    their peers who had one half-year or less of arts coursework by 38
    points on the math portion of the SAT. Students who include art in
    their studies are four times more likely to be recognized for academic
    achievement and four times more likely to participate in a math and
    science fair.
        For example, the ``Math in a Basket'' program in the Long Beach,
    CA, school district--funded through a U.S. Department of Education Arts
    in Education Model Development & Dissemination grant--teaches students
    how to plan, design, and make baskets from scratch. Students become
    familiar with art concepts, measurement, algebraic formulas, and
    geometric concepts as they work with their baskets to find the surface
    area, perimeter, and volume of each basket. Participants in the ``Math
    in a Basket'' program score an average of 20 points higher than the
    control group on State math tests.\6\
    ---------------------------------------------------------------------------
        \6\ http://www.dramaticresults.org/results.php.
    ---------------------------------------------------------------------------
        Model programs are a wise investment.--Despite increases in overall
    Federal spending for K-12 education, evidence is beginning to
    accumulate that schools are neglecting those areas of the curriculum
    that are not subject to the mandatory testing requirements of No Child
    Left Behind (NCLB). The National Association of State Boards of
    Education (NASBE) identified the threat in its 2003 report ``The Lost
    Curriculum.'' \7\ In 2004, the Council for Basic Education released a
    survey of school principals in four States; one quarter of them
    reported that they have decreased instructional time in the arts.\8\
    This finding was confirmed just last month in the Center for Education
    Policy's (CEP) report ``From the Capital to the Classroom: Year 4 of
    the No Child Left Behind Act,'' when it found that almost a quarter of
    school districts surveyed reported that time in science, art, and music
    had been reduced due to an increased emphasis on reading and math.\9\
    The CEP report recommends that USDE should promote ``effective
    practices being used by school districts to enhance instruction in
    tested subjects without cutting time for other important subjects.''
    The USDE arts education program is a wise investment in developing and
    disseminating these effective practices.
    ---------------------------------------------------------------------------
        \7\ http://www.nasbe.org/Research_Projects/Lost_Curriculum.html.
        \8\ http://www.ecs.org/html/Document.asp?chouseid=5058.
        \9\ http://www.cep-dc.org/nclb/Year4/Press/.
    ---------------------------------------------------------------------------
    USDE Needs to Maintain Research Efforts in Arts Education
        Meaningful research from USDE is needed to further determine the
    status of dance, music, theater, and visual arts education. The Fast
    Response Survey System (FRSS) report ``Arts Education in Public
    Elementary and Secondary Schools'' is the only research produced by
    USDE on the delivery of arts education and the last FRSS reported data
    collected in the 1999-2000 school year. The next round of data
    collection for an updated report is long overdue. We urge the
    subcommittee to direct USDE to execute the FRSS study as intended.
    Similarly, the National Assessment of Education Progress (NAEP)--the
    national arts ``report card'' last performed in 1997--is scheduled to
    be administered in 2008, and must stay on track. The next NAEP will
    provide critical information about the arts skills and knowledge of our
    Nation's students. Both of these quantitative studies are essential to
    studying and improving access to the arts as a core academic subject.
        The Model Development & Dissemination program and the Professional
    Development program in the Arts in Education initiative at USDE receive
    targeted funding and are tested and measured in a limited number of
    implementation projects, and finally disseminated field-wide. This is a
    highly appropriate use of Federal dollars. Through this program, USDE
    promotes educational excellence, demonstrating how small projects can
    be brought to scale across entire school districts. Increased funding
    means more help for State and local departments of education to develop
    models that will work in highly disparate school districts across the
    Nation. We urge the Senate Subcommittee on Labor, Health and Human
    Services, and Education to recommend $53 million in funding for USDE's
    Arts in Education programs, with the bulk of the increase to be
    allocated to the Arts in Education Model Development and Dissemination
    Program and the Professional Development Program.
                      corporation for public broadcasting
        We urge the subcommittee to reject the Administration's proposed
    funding cuts to the Corporation for Public Broadcasting (CPB) in the
    fiscal year 2007 Labor-HHS-Education appropriations bill. Any reduction
    in CPB's budget will drastically reduce the access that many Americans
    have to public broadcasting, and thus to high-quality arts and cultural
    programming.
        CPB supports public television through its partner, the Public
    Broadcasting Service (PBS). A trusted community resource, PBS brings
    quality programs and education services to nearly 100 million people
    each week. With community-based arts programming and nationally
    televised shows, PBS is often the only source of arts programming in
    many rural parts of the country.
        Public television airs arts programming that is not available on
    commercial television. For example, the Legends of Jazz television
    series on PBS marks the first time in 40 years that jazz has been the
    focus of a national network weekly series. Hosted by noted jazz pianist
    and radio personality Ramsey Lewis, the 13 weekly, 30-minute episodes
    debuted in June 2005 on PBS stations nationwide.
        Budget cuts will weaken National Public Radio (NPR) stations and
    thus the availability of high-quality arts programming. Budget cuts
    will impact public radio broadcasting, as CPB funding represents an
    average of 13 percent of the budget for individual member stations of
    NPR. If NPR loses CPB support, many stations will have to make severe
    cuts to their programming and local services. This will especially
    impact rural areas and stations serving minority populations, as these
    stations heavily rely on Federal funding for their operating budgets.
    While local and State arts agencies also support these stations, they
    could not make up for a loss of Federal funding on this scale.
        We join a broad coalition of public broadcasting supporters with
    this request for funding:
        CPB General Appropriations--$430 million for fiscal year 2009
        CPB Digital Funding--$40 million for fiscal year 2007
        CPB Interconnection--$36 million for fiscal year 2007
        Ready to Learn--$32 million for fiscal year 2007
        Ready to Teach--$15 million for fiscal year 2007
                    institute for museum & library services
        We urge the subcommittee to support no less than the President's
    proposed increase to $41.39 million for the Office of Museum Services
    within IMLS in the fiscal year 2007 Labor-HHS-Education appropriations
    bill.
        IMLS encourages excellence and leverages State, local, and private
    funds. National competition is a catalyst for excellence and improves
    museum service nationwide. Federal leadership helps disseminate models
    and puts a spotlight on the remarkable resources that museums bring to
    education and to communities across the United States. In addition,
    peer-reviewed IMLS grants assure State, local, and private funders that
    a museum has met high national standards and is worthy of their
    additional support.
        IMLS reinforces the role of museums in lifelong learning. Funding
    supports projects that address a full range of learning opportunities
    in museums, including developing exhibitions, working with schools to
    develop curriculum and programs, creating family and adult programs,
    and developing internet content. American museums provide over 18
    million instructional hours to K-12 schoolchildren. Seventy-one percent
    work with school curriculum specialists to tailor programs to support
    local and State curriculum standards, according to the 2003 edition of
    the IMLS's report ``True Needs, True Partners.''
                                   conclusion
        As the research cited above demonstrates, Federal funds boost the
    quality and quantity of support for arts education as well as the
    knowledge that can be gained and disseminated across the education
    establishment. Increased funding means more help for State departments
    of education, educators in schools, and local education agencies. Most
    importantly, it means a better education and more career opportunities
    for our children.
        Americans for the Arts is the leading nonprofit organization for
    advancing the arts in America. With offices in Washington, DC, and New
    York City, it has a record of more than 45 years of service. Americans
    for the Arts is dedicated to representing and serving local communities
    and creating opportunities for every American to participate in and
    appreciate all forms of the arts. Additional information is available
    at www.AmericansForTheArts.org.
                                     ______

            Prepared Statement of the American Geological Institute
        Thank you for this opportunity to provide the American Geological
    Institute's perspective on fiscal year 2007 appropriations for the
    Department of Education. The President's fiscal year 2007 request for
    the Department of Education places an emphasis on increasing U.S.
    competitiveness through math, science, and foreign language programs in
    keeping with the Administration's American Competitiveness Initiative
    announced in the President's State of the Union address. While $380
    million is devoted to new funds for projects based on this initiative,
    these new funds would be offset by significant cuts to other programs
    within the Department of Education. The Department of Education budget
    would be reduced by $3.2 billion for a total requested budget of $54.4
    billion. AGI strongly supports the President's initiative and in
    particular funding for improved science literacy for teachers and
    students, however, we do encourage the subcommittee to retain and
    provide support for other proven and effective programs.
        The National Math and Science Partnership (MSP) program as part of
    No Child Left Behind effectively strengthens K-12 science and math
    education. The President's request includes $182 million for the MSP
    program within the Department of Education, which is the same level of
    funding appropriated in fiscal year 2006. AGI supports this stable
    funding and encourages appropriate emphasis on science education.
    Science often includes mathematical exercises applied to real-world
    problems, giving students a comprehensive and interesting learning
    experience.
        The President's request for fiscal year 2007 focuses much new
    spending on math education and less on science education. Funding
    proposals based on the initiative include $125 million for Math Now for
    elementary school students and $125 million for Math Now for middle
    school students, plus an additional $10 million to create a National
    Math Panel to review and develop math curricula. While a solid math
    education is important, additional funding should also be devoted to
    science education, which complements and expands upon a mathematical
    foundation to understanding and exploring how physical, chemical and
    biological processes work.
        It is essential that highly qualified science teachers develop the
    energetic, eager and curious next generation of scientists and
    engineers. Skilled geoscientists and geoengineers, in particular, are
    needed to find, develop and maintain our energy, agricultural, water
    and air resources, to understand and mitigate natural hazards and to
    ensure an educated public with a general understanding of the Earth
    environment to enhance our public and private quality of life.
        AGI is a nonprofit federation of 44 geoscientific and professional
    societies representing more than 100,000 geologists, geophysicists, and
    other Earth scientists. Founded in 1948, AGI provides information
    services to geoscientists, serves as a voice for shared interests in
    our profession, plays a major role in strengthening geoscience
    education, and strives to increase public awareness of the vital role
    the geosciences play in society's use of resources and interaction with
    the environment.
        In 1999, the Third International Math and Science Study found that
    the longer U.S. students are in school, the farther they fall behind in
    math and science proficiency in international comparisons. That
    prompted President Bush to propose the National Math and Science
    Partnership (MSP) program as part of No Child Left Behind. The goal of
    the partnership program is to strengthen K-12 science and math
    education by promoting a vision of education as a continuum that begins
    with the youngest learners and progresses through adulthood with
    teacher training. Among its activities, the program supports
    partnerships that unite K-12 schools, institutions of higher education
    and private industry.
        Congress took the President's suggestion and authorized an MSP
    program at the National Science Foundation (NSF) and another
    partnership program at the Department of Education in 2002. These acts
    of Congress fund two different types of partnerships to achieve the
    overall goal of highly qualified math and science teachers ensuring
    that all students have the basic knowledge to compete in the ever
    changing and competitive job market. The funds allocated for the NSF's
    MSPs go to the highest quality proposals chosen through a competitive
    peer-reviewed grant program. The program focuses on modeling, testing
    and identification of effective math-science activities. The funds
    allocated for the Department of Education MSPs go directly to the
    States as formula grants, providing funds to all States to replicate
    and then implement the best of the NSF partnerships throughout the
    country. Once States receive the money, they make competitive grants to
    local partnerships.
        The $120 million in funds for Secondary Education Mathematics
    Initiative is part of the overall High School Initiative, which will
    expand the application of No Child Left Behind principles to improve
    high school education and raise achievement, particularly the
    achievement of students most at risk of failure. This new initiative
    combines a number of categorical programs in order to give States and
    districts more flexibility and contains stronger accountability
    mechanisms.
        AGI believes the two MSPs are the most effective approach to
    rapidly improving the abilities of all students to enhance their future
    prospects regardless of their ultimate career goals. The two programs,
    designed and authorized by Congress, are complementary. AGI supports
    funding at NSF for competitive grants for teaching tools and teacher
    training and funding at the Department of Education for formula grants
    for implementation of these tools in K-12 education. The peer-review
    process in the NSF program should be safeguarded as should the formula
    grants for all States as administered by the Department of Education.
    Moreover, the program within the Department of Education should not
    suffer a net reduction in funding in order to support a new initiative
    for mathematics. These funds should serve the Math and Science
    Partnership with no earmarks or set-asides.
        Thank you for the opportunity to present this testimony to the
    subcommittee. If you would like any additional information, please
    contact me at 703-379-2480, ext. 228 voice, 703-379-7563 fax,
    rowan@agiweb.org, or 4220 King Street, Alexandria VA 22302-1502.
                                     ______

     Prepared Statement of the Association of Minority Health Professions
                                    Schools
                  summary of fiscal year 2007 recommendations
      --(1) $550 Million for HRSA's Health Professions Training Programs,
            Including:
        --$34 million for Minority Centers of Excellence.
        --$36 million for the Health Careers Opportunity Program.
        --$47 million for Scholarships for Disadvantaged Students.
      --(2) $83 million for HRSA'S Healthy Communities Access Program.
      --(3) 5 percent increase overall for the National Institutes of
            Health, including $250 million for the National Center on
            Minority Health and Health Disparities.
      --(4) $119 million for the National Center for Research Resources
            Extramural Facilities Construction Program.
      --(5) $65 million for the Department of Education's Strengthening
            Historically Black Graduate Institutions Program.
      --(6) $65 million for the HHS Office of Minority Health, including
            support for a new health disparities initiative.
        Mr. Chairman, thank you for the opportunity to present the views of
    the Association of Minority Health Professions Schools (AMHPS). I am
    Dr. Wayne Harris, Dean of the College of Pharmacy at the Xavier
    University of Louisiana.
        AMHPS is comprised of the Nation's twelve historically black
    medical, dental, pharmacy, and veterinary schools. Combined, our
    institutions have graduated 50 percent of African-American physicians
    and dentists, 60 percent of all the Nation's African-American
    pharmacists, and 75 percent of the African-American veterinarians.
        Mr. Chairman, historically black health professions institutions
    are addressing a pressing national need in carrying out their mission
    of training minorities in the health professions. While African-
    Americans represent approximately 15 percent of the U.S. population,
    only 2-3 percent of the Nation's health professions workforce is
    African-American. Studies have demonstrated that when African Americans
    and other minorities are trained in minority institutions, they are
    much more likely to: (1) serve in medically underserved areas, (2) care
    for minorities, and (3) accept patients who are Medicaid dependent or
    otherwise poor.
        This is important Mr. Chairman because the gap in health status
    between our Nation's minority and majority populations continues to
    widen due in part to the lack of access to quality health care services
    in minority communities. As a result, we believe it is imperative that
    the Federal commitment to training African Americans and other
    minorities in the health professions remains strong.
        In spite of our proven success in training health professionals,
    and the important contribution these professionals make, our
    institutions continue to face a financial struggle inherent to our
    mission. The financial challenges facing the majority of our students
    affect our institutions in numerous ways. For example, we are unable to
    depend on tuition as a means by which to respond to any discontinuation
    of Federal support. Moreover, the patient populations served by the
    AMHPS institutions are overwhelmingly poor. As a result, our
    institutions cannot rely on patient care income at a time when the
    average medical school gets 40-60 percent of its operating revenue from
    health care services.
        Mr. Chairman, before I go into a discussion of our Association's
    fiscal year 2007 recommendations, I would like to share Xavier's
    experience with Hurricane Katrina and update you on our recovery
    efforts. Xavier is located in New Orleans and the entire campus was
    flooded with 3-6 feet of water. Each building on campus had significant
    damage on the first floor and the campus was shut down until January 9,
    2006. The University developed an ambitious plan to repair damage and
    resume operations on January 17, 2006 using a revised academic calendar
    to complete the entire academic year in August 2006. I am happy to
    report that the University resumed classes on January 17 as planned.
    Overall University enrollment dropped, however, from approximately
    4,000 students in August 2005 to approximately 3,000 students post-
    Katrina. The College of Pharmacy enrollment was less severely affected
    with enrollment dropping from 619 to 600.
        Significant challenges still remain, including cash flow problems
    as we deal with recovery costs in the range of $30 million for
    construction and equipment and disruption of operations of key health
    care institutions in New Orleans. These institutions are vital to the
    clinical education program of the College of Pharmacy and to our
    continued recovery. It is absolutely essential to the University that
    health care delivery services are restored as quickly as possible.
        The University recognized the need to resume our academic programs
    as quickly as possible in order to continue to produce African American
    health professionals and contribute to rebuilding the City of New
    Orleans. By working with other Colleges of Pharmacy across the country,
    we were able to allow senior pharmacy students to continue their
    clinical education while under evacuation and we are pleased to report
    that pharmacy students will graduate on May 20, 2006. Our rebuilding
    effort is well underway but disruption of Federal support for important
    programs such as HRSA'S Center of Excellence would severely hinder this
    rebuilding effort.
     fiscal year 2007 recommendations for federal programs of interest to
                                     amhps
    Health Resources and Services Administration
                Health Professions Training
        Mr. Chairman, we are disappointed that the President's budget all
    but eliminates funding again this year for health professions training
    programs focused on diversity in the workforce. The health professions
    training programs administered by the Health Resources and Services
    Administration are the only Federal initiatives designed to address the
    longstanding under-representation of minority individuals in health
    careers. HRSA's Minority Centers of Excellence, Health Careers
    Opportunity Program, and Scholarships for Disadvantaged Students,
    support health professions institutions with a historic mission and
    commitment to increasing the number of minorities in the health
    professions. For fiscal year 2007, AMHPS joins with the Health
    Professions Nursing and Education Coalition in recommending an overall
    funding level of $550 million for health professions training.
        For the health professions programs specifically focused on
    enhancing minority representation in the health care workforce, AMHPS
    recommendations are as follows:
                Minority Centers of Excellence
        The purpose of the Minority Centers of Excellence program (COE) is
    to assist schools that train minority health professionals by
    supporting programs of excellence in health professions education at
    those institutions. The COE program focuses on improving student
    recruitment and performance; improving curricula and cultural
    competence of graduates; facilitating faculty/student research on
    minority health issues; and training students to provide health
    services to minority individuals by providing clinical teaching at
    community-based health facilities. For fiscal year 2007, AMHPS
    recommends a funding level of $34 million for Minority Centers of
    Excellence (an increase of $22 million over fiscal year 2006).
                Health Careers Opportunity Program
        Grants made to health professions schools and educational entities
    under the Health Careers Opportunity Program (HCOP) enhance the ability
    of individuals from disadvantaged backgrounds to improve their
    competitiveness to enter and graduate from health professions schools.
    HCOP funds activities that are designed to develop a more competitive
    applicant pool through partnerships with institutions of higher
    education, school districts, and other community based entities. HCOP
    also provides for mentoring, counseling. primary care exposure
    activities and information regarding careers in a primary care
    discipline. Sources of financial aid are provided to students as well
    as assistance in entering into the health professions school.
        For fiscal year 2007, AMHPS recommends a funding level of $36
    million for the Health Careers and Opportunities Program (an increase
    of $32 million over fiscal year 2006).
                Scholarships for Disadvantaged Students
        The Scholarships for Disadvantaged Students program was established
    to make scholarship funds available to eligible students from
    disadvantaged backgrounds who are enrolled (or accepted for enrollment)
    as full-time students. To be eligible for funding, a school must have
    in place a program to recruit and retain students from disadvantaged
    backgrounds (including racial and ethnic minorities) and demonstrate
    that the program has achieved success based on the number or percentage
    of disadvantaged students who graduate from the school. For fiscal year
    2007, AMHPS recommends a funding level of $47 million for the
    Scholarships for Disadvantaged Students program (an increase of $47
    million over fiscal year 2007).
    Healthy Communities Access Program
        Mr. Chairman, Congress passed legislation in 2003 to reauthorize
    the Community Health Centers program. Included in this important
    measure was a provision which established a demonstration authority
    within the Healthy Community Access Program to foster greater
    collaboration between historically black health professions and
    federally qualified CHC's. Specifically, this provision:
        (1) Establishes a demonstration program for the development of
    research infrastructure at historically black health professions
    schools affiliated with federally qualified Community Health Centers.
        (2) Establishes joint and collaborative programs of medical
    research and data collection between historically black health
    professions schools and federally qualified Community Health Centers
    with the goal of improving the health status of medically underserved
    populations.
        (3) Supports the cost of patient care, data collection, and
    academic training resulting from these partnerships.
        Mr. Chairman, several of our member institutions received funding
    in fiscal year 2005 under this promising new demonstration authority.
    Unfortunately, the H-CAP program was eliminated in the fiscal year 2006
    Labor-HHS bill, and the President's budget for fiscal year 2007 does
    not provide any funding for the coming year. AMHPS encourages the
    subcommittee to restore support for this important program in fiscal
    year 2007 at the fiscal year 2005 level of $83 million.
    National Institutes of Health
                The National Center on Minority Health and Health
                        Disparities
        Established in 2000 by the Minority Health and Health Disparities
    Research and Education Act (Public Law 106-525), the National Center on
    Minority Health and Health Disparities at NIH is charged with
    addressing the longstanding health status gap between minority and
    majority populations. The National Center has the authority to:
      --Directly support biomedical research, training, and information
            dissemination focused on eliminating health status disparities.
      --Serve in a leadership capacity in developing a comprehensive plan
            for minority health research at NIH.
      --Participate as an equal when NIH institute and center directors
            meet to determine research policy.
      --Support the enhancement of biomedical research capacity at minority
            health professions institutions through a ``Research
            Endowment'' program.
      --Support the development of health professions institutions with a
            history and mission of serving minority and medically
            underserved communities through a ``Centers of Excellence''
            program.
        For fiscal year 2006, AMHPS recommends a funding level of $250
    million for the National Center. This is an increase of $54 million.
    This new funding will enable the Center to support all of its new
    programs and begin to meet the challenge of eliminating health status
    disparities within minority and medically underserved communities
                Extramural Facilities Construction
        Mr. Chairman, if we are to take full advantage of the historic
    funding increases for biomedical research that Congress has provided to
    NIH over the past decade, it is critical that our Nation's research
    infrastructure remain strong. The current authorization level for the
    Extramural Facility Construction program at the National Center for
    Research Resources is $250 million. The law also includes a 25 percent
    set-aside for ``Institutions of Emerging Excellence'' (many of which
    are minority institutions) for funding up to $50 million. Finally, the
    law allows the NCRR Director to waive the matching requirement for
    institutions participating in the program. We strongly support all of
    these provisions of the authorizing legislation.
        Unfortunately, funding for NCRR's Extramural Facility Construction
    program was completely eliminated in the fiscal year 2006 Labor-HHS
    bill. For fiscal year 2007, AMHPS encourages the subcommittee to
    restore funding for this program to its fiscal year 2004 level of $119
    million, or at a minimum, provide funding equal to the fiscal year 2005
    appropriation of $40 million.
                Research Centers in Minority Institutions
        The Research Centers at Minority Institutions program (RCMI) at the
    National Center for Research Resources has a long and distinguished
    record of helping our institutions develop the research infrastructure
    necessary to be leaders in the area of health disparities research.
    Although NIH has received unprecedented budget increases in recent
    years, funding for the RCMI program has not increased by the same rate.
    Therefore, AMHPS recommends that funding for this important program
    grow at the same rate as NIH overall in fiscal year 2007.
    Strengthening Historically Black Graduate Institutions--Department of
            Education
        The Department of Education's Strengthening Historically Black
    Graduate Institutions program (Title III, Part B, Section 326) is
    extremely important to AMHPS institutions. The funding from this
    program is used to enhance educational capabilities, establish and
    strengthen program development offices, initiate endowment campaigns,
    and support numerous other institutional development activities. For
    fiscal year 2007, AMHPS recommends an appropriation of $65 million (an
    increase of $7 million over fiscal year 2006) to continue the vital
    support that this program provides to historically black graduate
    institutions.
    HHS Office of Minority Health
        The HHS Office of Minority Health (OMH) has the potential to play a
    critical role in addressing health status disparities throughout the
    country. Unfortunately, the office does not currently have the
    authority or resources necessary to support activities that will truly
    make a difference in closing the health gap between minority and
    majority populations. For fiscal year 2007, AMHPS recommends a funding
    level of $65 million for the Office, with $10 million designated for
    the following programs focused on medically underserved communities and
    capacity building for the training of minorities in health professions:
        (1) OMH sponsored programs to assist medically underserved
    communities with the greatest need in solving health disparities and
    attracting and retaining health professionals;
        (2) Assistance to minority institutions in acquiring real property
    to expand their campuses to increase the capacity to train minorities
    for medical careers;
        (3) Support of conferences for high school and undergraduate
    students to pursue health professions careers; and
        (4) Support for cooperative agreements with minority institutions
    for the purpose of strengthening their capacity to train more
    minorities in the health professions.
        Once again, thank you for the opportunity to present the views of
    the Association of Minority Health Professions Schools. We look forward
    to working with you in support of these important programs.
                                     ______

                 Prepared Statement of the Center for Education
                               executive summary
        The Department of Education's (ED) justification for eliminating
    funding for the Education for Democracy Act is essentially the same as
    it was for fiscal year 2006. It also includes the same omissions and
    errors, as noted in the following response.
        The Center for Civic Education (Center) and others supported under
    the Act believe the three major findings of the ED report are not
    adequately supported by the facts. Brief responses to the three
    findings are presented here. More detailed responses follow.
        1. ``Limited impact.'' The first paragraph of the ED justification
    for eliminating the Civic Education program states that it is
    ``eliminating small categorical programs that have limited impact. . .
    .'' The statement appears to be contradicted in the next paragraph
    which recognizes the extent of the Center's programs: ``Districts in
    nearly every State and major urban area participate in We the People
    program activities.''
        The Center's programs provide sound, sustained, and effective
    instruction in the fundamental values and principles of constitutional
    democracy annually to approximately 3 million domestic students and 2
    million students in other nations at a cost of approximately $5-6 per
    student. Research and evaluation have demonstrated the significant
    impact of these programs that provide a cost-effective means of
    reaching a significant number of students. Since its inception, the
    Center's We the People program alone has reached more than 28 million
    students in the United States.
        2. ``Little or no reliable evidence of effectiveness.'' The ED
    justification fails to cite or recognize the extensive research and
    evaluation of Center programs as well as other significant evidence of
    program effectiveness, none of which is matched by any other program in
    the field.
        3. ``Additional funding is not necessary for the successful
    operation of this program.'' To anyone aware of the history of support
    for civic education, and the policies, priorities, and practices of
    private sector funding, it is clear that support for national and
    international programs in civic education of the magnitude of those
    implemented by the Center is simply not available from sources other
    than the Federal Government. Federal funding is essential for the
    continuation of this program.
        The following information provides a more detailed response to the
    ED report.
                                  introduction
        The Department of Education's (ED) justification for eliminating
    funding for the Education for Democracy Act is essentially the same as
    it was for fiscal year 2006. It also includes the same omissions and
    errors as will be noted in the following response.
        ED's justification is composed of three major parts: that the Civic
    Education programs supported under the act (1) have ``limited impact,''
    (2) have ``little or no reliable evidence of effectiveness,'' and that
    (3) ``additional funding is not necessary for the successful operation
    of this program.'' The Center for Civic Education (Center) and others
    supported under the Act believe these findings are not adequately
    supported by the facts. The Center's responses follow.
    1. Response: The Civic Education program has ``limited impact''
        The first paragraph of the ED justification for eliminating the
    Civic Education program states that ED is ``eliminating small
    categorical programs that have limited impact. . . .'' In the next
    paragraph it states that ``The Center . . . is an established non-
    profit organization with a broad network of program participants,
    alumni, volunteers, and financial supporters at the local, state, and
    national levels. Districts in nearly every State and major urban area
    participate in We the People program activities.'' It is difficult to
    square the first statement with the second, because for a relatively
    small amount of Federal funds, the Center's domestic and international
    programs have a significant impact on the education of students at the
    pre-collegiate level as well as their teachers in the United States and
    abroad. The following information supports this premise.
        The fiscal year 2006 appropriation for the Education for Democracy
    Act is $29.1 million. In round figures, the allocation of these funds
    is as follows:
      --Center for Civic Education (directed funding)
      --Domestic programs = $17 million
      --International programs = $4.5 million
      --National Council for Economic Education (directed funding)
      --International program = $4.5 million
      --Competitive international exchange program = $3.1 million
      --Note: The Center currently has a $1 million grant under this
                program for Latin America and a $1 million grant for Africa
                Impact of the Center's Domestic Programs
        Approximately 70 percent of the Center's $17 million for domestic
    programs is allocated to public- and private-sector institutions or
    organizations at State and local levels in the form of sub-awards, free
    curricular materials, and subsidized teacher training programs. These
    funds are managed by approximately 120 coordinators located in public
    or private sector agencies or organizations at State levels. They are
    assisted by approximately 630 congressional district coordinators, many
    of whom are affiliated with school districts. These coordinators,
    essentially volunteers, receive a modest stipend to cover operating
    costs. These coordinators in turn coordinate thousands of additional
    volunteers who serve as judges, academic coaches, timers, facilitators,
    and in other roles required by the size and scope of this endeavor. The
    value of this volunteer network greatly amplifies the value of the
    Federal investment and the reach of the program and exemplifies
    American civic virtue in action. The remaining 30 percent of the funds
    pays for technical assistance to this network and the administrative
    operating costs of the Center.
        The domestic network of coordinators oversees the implementation of
    three major curricular programs that reach approximately 3 million
    students annually at a cost of approximately $5.67 per student. For
    this sum, each student receives the use of a free textbook and an
    estimated 10 to 40 or more hours of instruction in the fundamental
    values and principles of American constitutional democracy and how to
    participate competently and responsibly in political life. As noted
    below, ample research testifies to the positive outcomes of these
    programs.
        The Department of Education's rationale for cutting the Civic
    Education program claims that its ``contribution to the Department's
    mission is marginal.'' This statement does not seem to be in line with
    the policy of President Bush, who stressed the importance of civic
    education in the 2002 introduction to his initiative in History,
    Civics, and Service, in which he stated that:

        ``American children are not born knowing what they should cherish--
    are not born knowing why they should cherish American values. A love of
    democratic principles must be taught. At this very moment, Americans
    are fighting in foreign lands for principles defined at our founding,
    and every American--particularly every American child--should fully
    understand these principles.''

        The question might be asked: What other programs in civic education
    does ED support, if any, that accomplish the mission set forth in
    President Bush's speech and which, if any, have the impact on students
    per Federal dollar that result from programs supported under the
    Education for Democracy Act? It should be noted that the Federal
    funding for this program is matched by cost sharing at State and local
    levels estimated at from $5-$8 in value for every Federal dollar spent.
        The need for improvement in the civic education of our Nation's
    students has been demonstrated repeatedly by research findings over the
    past several decades. This need was clearly illustrated in a recent
    survey in which only 28 percent of Americans could list two or more
    First Amendment freedoms, while more than 50 percent could name at
    least two cartoon characters from ``The Simpsons'' (McCormick Tribune
    Freedom Museum Poll, March 1, 2006). The programs supported by Congress
    under the Education for Democracy Act are a proven cost-effective means
    of remedying this shortcoming in the education of our Nation's youth.
                Impact of the Center's International Programs
        As with its domestic programs, approximately 70 percent or more of
    the Center's international funding is allocated to public- and private-
    sector institutions or organizations at State and local levels in the
    United States and similar organizations in approximately 70 emerging
    and advanced democracies throughout the world. This support is provided
    in the form of sub-awards, free curricular materials, and subsidized
    teacher training programs. These funds are managed by public- and
    private-sector organizations in 28 States and similar organizations in
    the participating countries. The remaining 30 percent of the funds pay
    for technical assistance to this network and the administrative
    operating costs of the Center.
        The international network of coordinators oversees the
    implementation of curricular programs focused on education for
    democracy. It is difficult in many cases to get accurate figures on
    participation in these programs from the participating countries. We
    believe that 2 million students per year is a modest estimate. The
    students in these countries are being provided instruction in the
    fundamental values and principles of constitutional democracy and how
    to participate competently and responsibly in political life. As noted
    below, ample research testifies to the positive outcomes of these
    programs.
        The $4.5 million in baseline funding for this program from ED is
    augmented by approximately $8 million more in grants from ED, the
    Department of State, USAID, and other domestic sources. The program has
    also precipitated funding from other sources of approximately $15
    million to augment its impact. These sources include the European
    Union, the Russian Ministry of Education, the InterAmerican Development
    Bank, the World Bank, the Mexican Institute for Federal Elections, and
    other public- and private-sector sources in other countries. This
    additional support could not have been generated without the funding
    from ED that has served as ``seed'' money for the establishment of
    successful education for democracy programs in other nations.
        The impact and success of these programs is supported by research
    findings and numerous reports from U.S. Embassies and AID missions,
    which have assisted the Center in their establishment. In many cases,
    the successful impact of pilot programs supported by ED funds has
    prompted these entities to add their own funds to augment the programs.
    A notable example of such an occurrence was the Center's ED-supported
    Jordanian pilot program in democracy education, which has received
    approval for nationwide implementation by the Ministry of Education.
    The success of this program led the State Department to provide an
    additional $3.2 million to implement democracy education programs in
    ten Arab nations in North Africa and the Middle East. In turn, the
    success of that program led the State Department to request that the
    Center submit a proposal for three years of funding for the region at
    $3-4 million per year. None of this would have been possible without
    the sustained funding from ED that enables the Center to initiate and
    maintain education for democracy programs in spite of the changing
    priorities of other sources of funding. It is important to note that
    the State Department funding does not eliminate the need for the
    baseline ED funding for the international civic education program and
    that with continued ED funding, similar advances might be made in other
    parts of the world.
        It is clear that these programs are a significant and cost-
    effective contribution to the administration's effort to further the
    worldwide growth of democracy, which is why President Bush has met with
    the Center's Russian partner, and Secretary of State Condolleeza Rice
    has met with the Center's partner in Pakistan. It is also clear that
    the international civic education for democracy movement, central to
    the administration's foreign policy, is at risk without significant
    continuing funding. Although a fledgling nongovernmental membership
    organization--Civitas International--was founded by the United States
    Information Agency in 1995 to assist efforts in this field, the
    organization was never able to raise sustaining funds from other
    organizations or individuals that would permit it to function
    independently. Instead, the organization asked the Center to assist it
    by folding its meetings and functions into the Center's civic education
    network.
        Note: In addition to those students reached by the Center's
    international programs, the economics program funded under this Act and
    implemented by the National Council for Economic Education reaches an
    estimated 2.4 million students annually. The goal of this effective
    program is to help students understand the principles and institutions
    of market economies and their relationship to democracy.
                Summary
        Contrary to the Department of Education's assertion in its
    justification for eliminating funding for the Education for Democracy
    Act, the Center's programs have a significant impact on the civic
    education of pre-collegiate students and their teachers in the United
    States and abroad.
        The Center's programs are proven, cost effective, and reach
    millions of students throughout the world. Approximately 3 million
    students in the United States benefit from the Center's curricular
    programs at a cost of approximately $5.67 per student. The Center's
    programs directly contribute to the mission of the Department of
    Education by accomplishing the mission set forth in President Bush's
    initiative in History, Civics, and Service.
        Approximately 2 million students per year outside of the United
    States are provided by the Center and its network of coordinators with
    instruction in the fundamental values and principles of constitutional
    democracy and learn how to participate competently and responsibly in
    political life. Funding provided by the Department of Education is
    essential for the establishment of successful education for democracy
    programs in other nations. The spectacular success of Center
    initiatives in Jordan and other Arab nations demonstrates the Center's
    cost-effective contribution to the Bush administration's effort to
    advance the worldwide growth of democracy.
    2. Response: There is ``little or no reliable evidence of [the]
            effectiveness'' of the Center's programs
        The Department's document claims that studies of the programs of
    the Center are not sufficiently rigorous to yield reliable results
    about their overall effectiveness. To that end, a single study
    conducted by the Center on students participating in the national
    finals of the Center's annual We the People competition was cited. The
    study employs nationally normed items from the National Assessment of
    Educational Progress (NAEP), the National Election Studies, and the
    College Freshman surveys. The positive results of this study were
    challenged by ED because the students were a select sample--even though
    that fact had always been clearly identified and understood as such,
    and the Department accepted it as a valid performance indicator.
    Indeed, the study in question is performed annually in partial
    fulfillment of requirements placed on the Center by the Department of
    Education.
        Since its inception in 1965 at the University of California at Los
    Angeles, the Center has conducted numerous studies on the effectiveness
    of its curricular programs and contracted with third parties that have
    also conducted such studies. (Most of these studies are not referred to
    in the ED report.) Indeed, the We the People programs have been more
    thoroughly researched than any other programs in the field.
        Each of the recent studies cited below falls within the
    recommendations of the What Works Clearinghouse at the Institute of
    Educational Sciences (IES) of the Department of Education. IES
    encourages the methodological rigor of studies that include
    experimental or high-quality quasi-experimental design and cites them
    as the best determinants for measuring curricular effectiveness.
        Study: MPR Associates, Inc.-- A high-quality quasi-experimental
    study of the We the People: The Citizen and the Constitution program
    conducted in 2003 by MPR Associates, Inc., in collaboration with noted
    research scholars Dr. Richard Niemi, University of Rochester, and Dr.
    Elizabeth Theiss-Morse, University of Nebraska-Lincoln, found
    statistically significant differences between We the People and non-We
    the People students. Specifically, We the People students enrolled in
    AP classes performed, on average, 30 percent better on the knowledge
    survey than students enrolled in non-We the People AP classes. We the
    People students in regular classrooms also significantly outperformed
    their non-We the People counterparts.
        The study also found that We the People students were more likely
    than their peers to show greater growth in their sense of political
    efficacy, sense of citizen responsibility, appreciation of obligations
    of citizenship, and a greater sense of political and community
    responsibility than the control group. The results of these studies
    show the degree to which the Center's programs meet President Bush's
    request for civic education initiatives that ``improve students'
    knowledge of American history, increase civic involvement, and deepen
    their love for our great country.'' (Bush 2002, 1) \1\ It should be
    noted that the Center was unable to obtain funding for a proposal
    submitted to the Department of Education in 2005 for a study employing
    random assignment of students to the curriculum. The Center is still
    seeking funds to use the instruments it has developed to conduct a
    longitudinal study over seven years.
    ---------------------------------------------------------------------------
        \1\ Bush, George W. (2002). ``President Introduces History and
    Civic Education Initiatives.'' Remarks of the president on the Teaching
    History and Civic Education Initiative, September 17.
    www.whitehouse.gov.
    ---------------------------------------------------------------------------
        Study: University of Texas.--Dr. Kenneth Tolo, University of Texas
    at Austin, found that the Center's We the People: Project Citizen
    program had positive effects on student attitudes and skills, including
    students' attitudes about their own effectiveness and their engagement
    in their communities. The program also enhanced student communication
    and research skills.
        The study also details seven key areas of Project Citizen
    implementation--State administration, the recruitment of and outreach
    to teachers and school administrators, teacher training, teacher and
    class use, Project Citizen competitions, benefits to students, and
    financial and political support--and offers recommendations for
    maximizing implementation efforts in each of these areas. These
    recommendations have been invaluable to improving the implementation
    strategies of Project Citizen in the United States and abroad.
        Study: RMC Research.--In 2004-2005, RMC Research used qualitative
    and quantitative measures in a quasi-experimental study of students
    taking part in the Project Citizen program in Oklahoma, Michigan,
    Colorado, the Czech Republic, and Slovakia. The study found that
    students in grades 6-12 increased their global knowledge of democracy.
    The study found significant gains in students' knowledge of public
    policy, support for freedom of belief, the right of citizens to
    question government messages, and the right to join organizations.
    Students' civic skills improved as well. Based upon these results, RMC
    is improving item reliability and will conduct a second study in 2006.
        Study: Indiana University at Bloomington.--A high-quality quasi-
    experimental study of students in Indiana, Latvia, and Lithuania by
    Thomas S. Vontz, Kim K. Metcalf, and John J. Patrick, Indiana
    University at Bloomington, found that We the People: Project Citizen
    develops students' civic knowledge, skills, and dispositions positively
    and significantly, irrespective of nationality. The full report has
    been published in a volume titled Project Citizen and the Civic
    Development of Adolescent Students in Indiana, Latvia, and Lithuania.
        Study: Center for Civic Education, Bosnia and Herzegovina.--A high-
    quality quasi-experimental study of students in Bosnia and Herzegovina
    in 2000 by Dr. Suzanne Soule, Center for Civic Education, found that
    Project Citizen students showed greater confidence in their knowledge
    of local government, were more skilled at explaining problems; showed
    greater analytical abilities in using facts and reason to analyze other
    people's positions on problems, had more positive attitudes with regard
    to their own power in the community and internal efficacy, and showed a
    greater propensity to hold public officials accountable. In 2002, First
    Lady Laura Bush praised the program in remarks to the Organization for
    Economic Cooperation and Development:

        ``The United States is also a partner in the Balkans, working with
    the International Community and Civitas in Bosnia and Herzegovina to
    develop a course in democracy and human rights. This course is taught
    in (primary) schools throughout the region, including Brcko, and it has
    been translated for all three ethnic groups. The course is part of a
    larger effort called `Project Citizen.' Through `Project Citizen'
    programs, children learn to identify and solve problems in their own
    communities, from supplying clean water to improving dangerous traffic
    crossings. Citizenship--a sense of belonging and responsibility--
    strengthens societies.''

        Study: Center for Civic Education, Indonesia.--A high-quality
    quasi-experimental study of students in Indonesia in 2002 by Dr.
    Suzanne Soule found Project Citizen participants' political
    participation increased as a result of their involvement with the
    program. In contrast to the control group, they participated more in
    the political process, conducted more research by contacting experts to
    obtain information on issues they cared about, and participated in
    protests at higher rates. They also paid more attention to public
    affairs in the media. The dispositions of students who participated
    more fully in the program--by selecting their problems, presenting
    their proposals, and engaging in other programmatic activities--changed
    more. They became more interested in politics and public affairs. Their
    confidence in their ability to participate, along with their sense of
    political efficacy, increased. Further, high-involvement participants
    increased their expectations of the proper responsiveness of
    government, an important component of accountability.
        Study: WestEd.--The Center is currently working with WestEd, a
    leading survey-design firm, to devise knowledge and attitude tests for
    We the People: Project Citizen domestic and international use. The
    standardized test will be refined and used within and outside the
    United States with various quasi-experimental and experimental studies
    to ensure a maximum scale of comparability. The knowledge tests have
    been piloted in Nigeria and South Africa and are to be utilized in an
    experimental study in Colombia and Mexico in 2006.
        State Department Report.--In a report released by the State
    Department's Bureau of Western Hemisphere Affairs, the Center's ED-
    supported Civitas Latin America program is presented as a model for
    developing Cuban democracy (see Chapters 2 and 3). The report cites
    success in training teachers and effectiveness of programs as important
    for encouraging democratic thought and practice.
        USAID Report.--The State Department report is in accord with an
    independent assessment of civic education programs funded by USAID from
    1990 to 2000, which found that ``We the People: Project Citizen has
    many of the characteristics of the most effective civic education
    programs. It is highly participatory, it relates to issues that affect
    the participants in their daily lives, it produces tangible as well as
    intangible results, and it is firmly rooted in the community in which
    it takes place.'' (Brilliant, 2000, 38).\2\
    ---------------------------------------------------------------------------
        \2\ Brilliant, F. (2000). Civic Education Assessment--Stage II.
    Civic Education Programming Since 1990--A Case Study Based Analysis.
    Report for the U.S. Agency for International Development.
    ---------------------------------------------------------------------------
                Other Evidence of the Effectiveness of the Center's
                        Programs
        In addition to previous references to visits with program
    participants by President Bush, Mrs. Bush, and Secretary Rice, the
    obvious effectiveness of the Center's programs has been recognized at
    other times at the highest levels of government in the United States
    and other nations. For example:
      --In 1996, the Supreme Court hosted the newly elected U.S. Senate in
            the Great Hall of the Court. The event was attended by seven
            Justices and more than ninety senators. The major attraction of
            the evening was a well-received demonstration of the We the
            People competitive hearing by students from the State of
            Oregon.
      --In 1998, students from the We the People program were honored by
            the Department of Education when Secretary Riley announced the
            release of the findings of the NAEP study of student knowledge
            of civics and government.
      --In 2000, We the People students were invited to testify in Congress
            on the subject of school violence. Members of the committee
            before which the students testified said that they were better
            prepared than many of the expert witnesses who had testified
            earlier.
      --In 2004, the Bush administration hosted a White House Conference on
            History, Civics, and Service. The only civics program featured
            was the We the People program. Students from Arizona
            demonstrated their outstanding knowledge of the U.S.
            Constitution and Bill of Rights before a panel composed of a
            noted scholar and two Federal judges. One of the Federal judges
            commented that the students had a firmer grasp of
            constitutional principles than most attorneys who appear in her
            court.
      --In 2005, the Department of Education invited teachers of the We the
            People program to speak to a Constitution Day assembly at the
            Department, at which they were extremely well received.
      --Other nations: The following are a few of the many incidences where
            other nations have recognized the quality and effectiveness of
            the Center's programs:
      --The Russian Ministry of Education has approved the use of the
            Center's We the People and Project Citizen texts in all Russian
            schools.
      --The Mexican Institute for Federal Elections has translated and
            adapted the Project Citizen text and is implementing it in
            classrooms in all States of Mexico.
      --The Center has helped the U.S. Embassy in Bosnia and Herzegovina
            develop a K-12 civic education program that is being
            implemented in all schools in that country.
      --The Jordanian Ministry of Education has approved the implementation
            of Project Citizen in all schools in Jordan.
      --The Kurdish Regional Authority in Iraq has translated and adapted
            the Center's Foundations of Democracy program and implemented
            it with more that 400,000 students in their region.
      --The U.S. Embassy in Baghdad recently supported the training of
            teacher trainers in the Center's curricular materials and
            intends to support their implementation throughout the country.
      --The textbook division of the Chinese Ministry of Education has
            translated and adapted material from the Center's texts to be
            used in schools throughout China. The division has also signed
            a memorandum of understanding with the Center to work together
            to develop more curricular materials.
        Summary.--The following generalizations can be made from internal
    and external research and evaluation studies conducted during the past
    seventeen years. Students who participate in the Center's curricular
    programs show the following results. In comparison with their peers and
    some adults, students in Center programs:
      --demonstrate a greater understanding of and commitment to
            fundamental values and principles of constitutional democracy,
            such as individual rights, the common good, the rule of law,
            and civic responsibility. They are also less cynical, more
            politically engaged, more politically tolerant, and think that
            they can and do make a difference in the political life of
            their communities and nations;
      --demonstrate a greater understanding of politics and government at
            local, intermediate, and national levels and a deeper knowledge
            of how to participate effectively in the political process;
      --possess better research, analytic, and communication skills. This
            includes an increased capacity to evaluate, take, and defend
            positions on public issues;
      --demonstrate a greater capacity to work with others to effectively
            monitor and influence the decisions of their government;
      --pay more attention to politics and the media, discuss politics more
            often, volunteer to work for candidates, register to vote, and
            vote at significantly higher rates than their peers. Students
            also take active roles in the enactment of policies to improve
            the life of their communities and nations.
        Please see the attached bibliography for a list of studies
    conducted on Center programs.
    3. Response: ``Additional funding is not necessary for the successful
            operation of this program''
        The Department's justification claims that ``additional funding is
    not necessary for the continuation of this program.'' Further, the
    Department asserts that:

        ``[the] Center also has a long history of success raising
    additional funding support through such vehicles as selling program-
    related curricular materials, trainings, and workshops, partnering with
    non-profit groups on core activities, lobbying, and seeking support
    from foundations. For example, the Center has received financial
    support from such organizations as the Pew Charitable Trusts, the
    National Endowment for the Humanities, the Joyce Mertz-Gilmore
    Foundation, the Lincoln and Therese Filene Foundation, Inc., and an
    increasing number of State and local entities. Also with a national
    board that includes . . . noted scholars (etc.), the Center will have
    many opportunities to generate additional support for core program
    activities.''

        The statements in this section of the report do not reflect a sound
    knowledge of the history, policies, and practices of public- and
    private-sector support for civic education programs in the United
    States over the past fifty years, nor a firm grounding in the facts
    regarding past and present funding of the Center or the probability of
    obtaining the level of support necessary from sources other than the
    Federal Government. To anyone aware of the history of support for civic
    education, it is clear that support for national and international
    programs in civic education of the magnitude of those implemented by
    the Center and described above is simply not available from sources
    other than the Federal Government. Federal funding is essential for the
    continuation of this program.
        The Center has always sought and sometimes received support from
    other sources. In reference to the sources the ED report notes above,
    the Center did receive $1 million from the Pew Charitable Trusts in
    1988 to develop and promote the implementation of CIVITAS: A Framework
    for Civic Education. In 1991, the Pew Charitable Trusts provided a
    grant of $400,000 to match funds the Center received from the
    Department of Education to develop the National Standards for Civics
    and Government. For several years the Joyce Mertz Gilmore Foundation
    awarded the Center $20,000 to partially offset the costs of an annual
    bilateral conference on civic education the Center conducted with the
    Federal Center for Political Education of Germany. For the past three
    years the Lincoln and Therese Filene Foundation has provided about
    $100,000 annually to support a summer institute for teachers. A similar
    level of support has, in some years, been provided for the same purpose
    by the National Endowment for the Humanities. The Center receives
    $250,000 each year from the California State Department of Education to
    augment its Federal funding for the implementation of Project Citizen
    in California. Despite its efforts, the Center has never been able to
    secure sustained funding in more substantial amounts from such sources
    for its major programs.
        The ED report claims that the Center receives income from ``such
    vehicles as selling program-related curricular materials, trainings,
    and workshops.'' Support from ED enables the Center to provide
    approximately 450,000 free textbooks to schools each year. The Center
    grosses approximately $1 million each year from the sale of these
    texts, with the majority of these funds paying for printing, handling,
    and other overhead costs connected to the materials. The remainder of
    these funds is used to support and augment the programs supported with
    Federal funds. The Center does not receive funds for ``trainings and
    workshops'' which are, in fact, provided free to thousands of teachers
    each year under its federally supported programs.
        Summary.--Although the expansion of the Center's efforts has at
    times been assisted through supplemental funding provided by States and
    foundations, the core of its efforts depends on the Federal dollars
    that the administration seeks to eliminate. Without these crucial
    funds, much of the Center's national and international networks and
    their many volunteers and programs in education for democracy will
    simply cease to exist. The Center seeks to continue to develop
    relationships with other agencies, nonprofit organizations, and funding
    sources to expand its operations and ultimately to institutionalize its
    efforts. However, if successful, the administration's attempt to
    discontinue funding would undermine the very possibility of
    institutionalizing the foremost civic education for democracy programs
    in the world by prematurely cutting the lifeline of the Center's
    networks and programs.
    4. Chronological List of Research and Evaluation Studies Conducted by
            Internal and External Evaluators on Center Domestic and
            International Programs
        1. A Programmatic Evaluation of Civitas: An International Civic
    Education Exchange Program 2004-2005 (2006). Gary Marx, Center for
    Public Outreach. A report to the Center for Civic Education.
        2. We the People: The Citizen and the Constitution: 2005 National
    Finalists' Knowledge of and Support for American Democratic
    Institutions and Processes (2006). Sharareh Frouzesh Bennett and Dr.
    Suzanne Soule, Center for Civic Education.
        3. Evaluation of We the People: Project Citizen Summer Institutes:
    How the Teachers Translated the Experience into Classroom Instruction
    (2006). Jennifer Nairne, Center for Civic Education.
        4. Political Education Beyond National Borders: Teaching Democracy
    Abroad to Promote More Peaceful International Relations (2005). Dr.
    Alden Craddock, Bowling Green State University. Paper presented at the
    2005 German-American Conference--Responsible Citizenship, Education,
    and the Constitution.
        5. Project Citizen: Evaluation Report (2005). RMC Research
    Corporation.
        6. An Analysis of the Depiction of Democratic Participation in
    American Civics Textbooks (2005). Sharareh Frouzesh Bennett, Center for
    Civic Education. Paper presented at the 2005 German-American
    Conference--Responsible Citizenship, Education, and the Constitution.
        7. Changes in the Political Landscape and Their Implications for
    Civic Education (2005). Dr. Margaret Branson, Center for Civic
    Education. Paper presented at the 2005 German-American Conference--
    Responsible Citizenship, Education, and the Constitution.
        8. Differences in Gender and Civic Education in Ukraine (2005). Dr.
    Alden Craddock, Bowling Green State University. Paper presented at the
    European Consortium of Political Research General Conference.
        9. Advancing Peace and Stability through Active Citizenship: The
    Role of Civic Education (2005). Dr. Margaret Branson, Center for Civic
    Education. Speech delivered at the Ninth Annual World Congress on Civic
    Education.
        10. Voting and Political Participation of We the People: The
    Citizen and the Constitution Alumni in the 2004 Presidential Election
    (2005). Dr. Suzanne Soule, Center for Civic Education.
        11. Monitoring the Effectiveness of Youth Participation in Project
    Citizen: A Civitas-Russia Evaluation Project: Summary of Preliminary
    Findings (2005). Dr. Charles White, Boston University.
        12. Civitas Latin America: A Civic Education Exchange Program
    Annual Evaluation Report, Year 2 (2005). West Ed. A report to the
    Center for Civic Education.
        13. A Programmatic Evaluation of Civitas: An International Civic
    Education Program 2003-2004 (2005). Gary Marx, Center for Public
    Outreach. A report to the Center for Civic Education.
        14. We the People: The Citizen and the Constitution Summer
    Institutes: How the Teachers Translated the Experience into Classroom
    Instruction (2005). Jennifer Nairne, Center for Civic Education.
        15. American Identity, Citizenship, and Multiculturalism (2005).
    Dr. Diana Owen, Georgetown University. Paper presented at the 2005
    German-American Conference--Responsible Citizenship, Education, and the
    Constitution.
        16. Knowledge of and Support for American Democratic Institutions
    and Processes by Participating Students in the National Finals 2005
    (2005). (Reports available from previous years 1999-2004). Dr. Suzanne
    Soule and Sharareh Frouzesh Bennett, Center for Civic Education.
        17. An Independent Evaluation of Civic Education Programs in
    Jordan, Egypt, and West Bank 2002-2003 (2004). Glaser Consulting Group.
        18. A Rising Tide in Indonesia: Attempting to Create a Cohort
    Committed to Democracy through Education (2004). Dr. Suzanne Soule,
    Center for Civic Education.
        19. We the People Curriculum: Results of a Pilot Test (2004). Dr.
    Ardice Hartry and Kristie Porter, MPR Associates, Inc.
        20. Civitas Latin America: A Civic Education Exchange Program
    Annual Evaluation Report, Year 1 (2004). WestEd.
        21. Evaluation Report on 2003 We the People: Project Citizen Summer
    Institutes (2004). Sharareh Frouzesh Bennett, Center for Civic
    Education.
        22. Foundations of Democracy Program and Prevention of Aggressive
    Behavior of Children in Preschool Educational Institutions (2003). Ivan
    Glasovac, Croatian evaluator.
        23. Learning to Live Together: An Evaluation of Civic-Link (2003).
    Work Research Co-operative, independent evaluator.
        24. Creating a Cohort Committed to Democracy? Civic Education in
    Bosnia and Herzegovina (2002). Dr. Suzanne Soule, Center for Civic
    Education.
        25. Voting and Political Participation of the We the People: The
    Citizen and the Constitution Alumni in the 2000 Presidential Election
    (2001). Dr. Suzanne Soule, Center for Civic Education.
        26. Programmatic Evaluation of Civitas: An International Civic
    Education Exchange Program 2000-2001 (2001). Gary Marx, Independent
    Evaluator.
        27. Civic Education Assessment--Stage II. Civic Education
    Programming Since 1990--A Case Study Based Analysis (2000). Dr. Franca
    Brilliant. Report for the U.S. Agency for International Development.
        28. Project Citizen and the Civic Development of Adolescent
    Students in Indiana, Latvia, and Lithuania (2000). Drs. Thomas Vontz,
    Kay Metcalf, and John Patrick, Indiana University.
        29. Prevention of School Violence through Civic Educational
    Curricula: Year One of a National Demonstration Program (2000). Dr.
    Kenneth Tolo, LBJ School of Public Affairs, University of Texas at
    Austin.
        30. Beyond Communism and War: The Effect of Civic Education on the
    Democratic Attitudes and Behavior of Bosnian Youth (2000). Dr. Suzanne
    Soule, Center for Civic Education.
        31. Programmatic Evaluation of Civitas: An International Civic
    Education Exchange Program 1999-2000 (2000). Eva Stahl, independent
    evaluator.
        32. An Assessment of We the People . . . Project Citizen: Promoting
    Citizenship in Classrooms and Communities (1998). Dr. Kenneth Tolo, LBJ
    School of Public Affairs, University of Texas at Austin.
        33. Bell Gardens Study on Fifth and Sixth Grade Participants in
    Center and Constitutional Rights Foundation Curricula (1997).
    University of California, Los Angeles.
        34. Program Effectiveness Panel Validation of We the People (1995).
    United States Department of Education National Diffusion Network.
        35. Civic Education and Political Attitudes: Examining the Effects
    on Political Tolerance of the We the People Curriculum (1994). Dr.
    Richard Brody, Stanford University.
        36. Testing for Learning: How New Approaches to Evaluation Can
    Improve American Schools (1992). Dr. Ruth Mitchell.
        37. An Evaluation of the Instructional Impact of the Elementary and
    Middle School Curricular Materials Developed for the National
    Bicentennial Competition on the Constitution and Bill of Rights (1991).
    Educational Testing Service.
        38. A Comparison of the Impact of the We the People. . . Curricular
    Materials on High School Students Compared to University Students
    (1991). Educational Testing Service.
        39. An Evaluation of the Instructional Effects of the Nationals
    Bicentennial Competition on the Constitution and Bill of Rights (1988).
    Educational Testing Service.
                                     ______

                    Prepared Statement of the College Board
       anchoring mathematics and science education reform in an expanded
                           advanced placement program
    Introduction
        The College Board is a national not-for-profit association of more
    than 5,000 member schools, colleges and universities, with a
    challenging mission: To connect students to college success and
    opportunity. One of the College Board's most ambitious and important
    teaching and learning programs is the Advanced Placement Program (AP).
    As a set of 38 college-level courses taught in high school, AP has
    become the most influential general education program in the country,
    and it represents the highest standard of academic excellence in our
    Nation's schools. The AP Program is a collaborative effort between
    motivated students, dedicated teachers, expert college professors, and
    committed high schools, colleges, and universities. Ninety percent of
    the colleges and universities in the United States, as well as colleges
    and universities in 30 other countries, have an AP policy granting
    incoming students credit, placement or both on the basis of their AP
    Exam grades. Many of these institutions grant up to a full year of
    college credit (sophomore standing) to students who earn a sufficient
    number of qualifying AP grades. Since its inception in 1955, the AP
    Program has allowed millions of students to take college-level courses
    and exams, and to earn college credit or placement while still in high
    school.
        President Bush's request for $90 million in new funding to train
    70,000 new AP math, science, and world language teachers over the next
    five years will dramatically improve the quality of instruction in
    these areas. The ultimate outcome will include a substantial increase
    in the number of high school graduates who enter college with the
    desire and ability to succeed in science, technology, engineering, and
    mathematics (STEM) fields and compete in a global marketplace.
    Moreover, increased support for an expanded AP Program in these content
    areas will contribute to raising standards and achievement in all of
    our Nation's high schools. The AP Program benefits both the students
    who take AP courses and those who do not take AP by promoting higher
    standards and better teaching in all classes. As such, a significant
    investment in the expansion of AP math, science, and world language
    programs will have a profound effect on the overall quality of
    education in our Nation's schools.
        AP is a 50-year-old, time-tested program with an existing
    infrastructure of tens of thousands of teachers and a network of
    hundreds of training sites across the country. Funds invested in this
    program will not need to be dedicated to creating a new system for
    teacher professional development, course development, or the
    administration and scoring of assessments. That system already exists
    as a result of our efforts over the past 50 years, and as a result of
    the involvement of thousands of schools, colleges and universities in
    the operation of the AP Program. Thus, new Federal dollars invested in
    AP can go directly into teacher training and student preparation and
    support.
        The table on page four of this statement provides a summary of the
    total dollars that each State would receive through this initiative,
    and provides one model for the use of those funds that illustrates how
    many students and teachers could be served if the full $90 million
    request were supported.
                                 the ap program
        The principles and values of the AP Program can be stated quite
    simply:
      --AP supports academic excellence. AP represents a commitment to high
            standards, hard work, and enriched academic experiences for
            students, teachers, and schools.
      --AP is about equity. The AP Program should be open to all students,
            and we believe that every student should have access to AP
            courses and should be given the support he or she needs to
            succeed in these challenging courses.
      --AP can drive school-wide academic reform. Schools that use AP as an
            anchor for setting high standards and raising expectations for
            all students see significant returns not just in terms of AP
            participation but in terms of increasing the overall quality
            and intensity of their academic programs.
        Across the Nation, every State, and most school districts are
    exploring ways to raise standards and ensure that all students take
    challenging courses that prepare them for success in college and work.
    AP is recognized as a powerful tool for increasing academic rigor,
    improving teacher quality, and creating a culture of excellence in high
    schools. Students who take AP courses assume the intellectual
    responsibility of thinking for themselves, and they learn how to engage
    the world critically and analytically--both inside and outside of the
    classroom. This is an invaluable experience for students as they
    prepare for college or work upon graduation from high school. Moreover,
    schools in which AP is widely offered--and accessible to all students--
    experience the diffusion of higher standards throughout the entire
    school curriculum.
                       ap mathematics and science courses
        Increasing rigorous math and science education in the United States
    will significantly boost our high school graduates' math and science
    proficiency--and also increase the number of students who enter college
    ready to succeed in science, technology, engineering, and mathematics
    (STEM) careers. And we urgently need to create those opportunities for
    our students. Today, only 32 percent of American undergraduates are
    earning degrees in science and engineering, compared to 66 percent of
    undergraduates in Japan, 59 percent in China, and 36 percent in
    Germany. In 2004, China graduated 600,000 engineers, India graduated
    350,000, and the United States graduated 70,000.\1\
    ---------------------------------------------------------------------------
        \1\ Committee on Science, Engineering and Public Policy. Rising
    Above the Gathering Storm: Energizing and Employing America for a
    Brighter Economic Future. National Academies Press, 2006. This report
    notes that America appears to be on a ``losing path'' today with regard
    to our future competitiveness and standard of living.
    ---------------------------------------------------------------------------
        The AP Program is an important tool in this Nation's efforts to
    increase its economic competitiveness. AP math and science students are
    much more likely than other students to major in STEM disciplines than
    students whose first exposure to college-level math and science courses
    is in college. For example:
      --Sixteen percent of students who take AP Chemistry go on to major in
            chemistry in college. By way of contrast, only 3-4 percent of
            students who take general chemistry instead of AP chemistry
            major in that field in college.
      --More than 25 percent of students who take AP Calculus go on to
            major in a STEM field in college, and 40 percent of students
            who take AP Physics major in physics in college.
        Furthermore, research indicates that AP math and science courses
    prepare American students to achieve a level of proficiency that
    exceeds that of students from all other nations. For example, in the
    most recent TIMSS assessments, U.S. Calculus students ranked number 15
    (out of 16 countries) in the international advanced mathematics
    assessment. But AP Calculus students who scored a 3 or better on the AP
    Calculus Exam ranked first in the world. Even AP Calculus students who
    scored a 1 or 2 on the AP Calculus Exam--below ``passing''--were ranked
    second in the world. AP Physics students, as compared to other U.S.
    physics students and physics students internationally, were also at the
    top of the ranking.
        Most significantly, there are many, many more U.S. students who can
    succeed in AP math and science courses--if they are simply given the
    chance. This year in the United States, we anticipate that more than
    100,000 students will earn a grade of 3 or above on the AP Calculus
    Exam--the grade typically required for college credit. But in a
    national analysis of the math proficiency of students enrolled in U.S.
    high schools during the 2005-2006 academic year, we can identify, by
    name and school, an additional 500,000 students who have the same
    academic background and likelihood of success in AP Calculus as the
    100,000 students who currently are fortunate enough to have an AP
    Calculus course available. If we look at Biology, we see an even larger
    gap; we expect that about 74,000 students will earn exam grades of 3 or
    higher on the AP Biology Exam this year, whereas we know that at least
    640,000 additional U.S. students have the academic skills that would
    enable them to succeed in AP Biology if they only had a course
    available to them and the encouragement to take on this challenge.
    There are literally hundreds of thousands of high school students in
    the United States who are prepared and ready to succeed in rigorous
    high school courses such as AP Calculus, AP Biology, AP Physics, and AP
    Chemistry. In many cases, the only thing preventing them from learning
    at this higher level is the lack of an AP teacher in their school or
    the lack of adequate encouragement and support to take the AP course.
        The College Board believes AP has tremendous potential to drive
    reform in a powerful way in all of our Nation's schools. No single
    program can have as strong an impact on overall student and teacher
    quality as AP. AP is not for the elite, it is for the prepared. The
    Committee's support for expanded AP math, science, and world language
    courses and exams will prepare many more students for the opportunity
    to compete in a global environment and succeed in STEM fields in
    college and work. We respectfully urge that you fully fund the
    Administration's request for AP expansion.

    ----------------------------------------------------------------------------------------------------------------
                                                                                             Number of
                                                                                              students    Number of
                                                                                  Total      benefiting    students
                                                                                number of       from      benefiting
                                                                Potential New   middle and    teachers       from
                                                                   2007 AP     high school   receiving     teachers
                              State                             funding Under    teachers      Pre-AP     receiving
                                                                 President's     provided     training   AP training
                                                                  Proposal     with Pre-AP      (20          (25
                                                                                  or AP       students     students
                                                                                 training      per 5        per AP
                                                                                             sections)     teacher)
    ----------------------------------------------------------------------------------------------------------------
    Alabama..................................................      $1,600,989          750       60,037        3,752
    Alaska...................................................         453,123          212       16,992        1,062
    Arizona..................................................       2,074,097          972       77,779        4,861
    Arkansas.................................................       1,016,284          476       3,8111        2,382
    California...............................................      12,527,993        5,872      469,800       29,362
    Colorado.................................................         933,670          438       35,013        2,188
    Connecticut..............................................         542,351          254       20,338        1,271
    Delaware.................................................         453,123          212       ,16992        1,062
    District of Columbia.....................................         453,123          212       16,992        1,062
    Florida..................................................       4,948,272        2,320      185,560       11,598
    Georgia..................................................       2,823,013        1,323      105,863        6,616
    Hawaii...................................................         453,123          212       16,992        1,062
    Idaho....................................................         453,123          212       16,992        1,062
    Illinois.................................................       3,228,779        1,513      121,079        7,567
    Indiana..................................................       1,254,941          588       47,060         2941
    Iowa.....................................................         482,954          226       18,111        1,132
    Kansas...................................................         537,051          252       20,139        1,259
    Kentucky.................................................       1,335,985          626       50,099        3,131
    Louisiana................................................       2,012,675          943       75,475        4,717
    Maine....................................................         453,123          212       16,992        1,062
    Maryland.................................................         978,436          459       36,691        2,293
    Massachusetts............................................       1,093,966          513       41,024        2,564
    Michigan.................................................       2,431,666        1,140       91,187        5,699
    Minnesota................................................         746,455          350       27,992        1,750
    Mississippi..............................................       1,349,629          633       50,611        3,163
    Missouri.................................................       1,418,338          665       53,188        3,324
    Montana..................................................         453,123          212       16,992        1,062
    Nebraska.................................................         453,123          212       16,992        1,062
    Nevada...................................................         575,422          270       21,578        1,349
    New Hampshire............................................         453,123          212       16,992        1,062
    New Jersey...............................................       1,500,749          703       56,278        3,517
    New Mexico...............................................         827,151          388       31,018        1,939
    New York.................................................       6,191,847        2,902      232,194       14,512
    North Carolina...........................................       2,401,977        1,126       90,074        5,630
    North Dakota.............................................         453,123          212       16,992        1,062
    Ohio.....................................................       2,504,484        1,174       93,918        5,870
    Oklahoma.................................................       1,132,521          531       42,470        2,654
    Oregon...................................................         902,459          423       33,842        2,115
    Pennsylvania.............................................       2,659,829        1,247       99,744        6,234
    Rhode Island.............................................         453,123          212       16,992        1,062
    South Carolina...........................................       1,338,960          628       50,211        3,138
    South Dakota.............................................         453,123          212       16,992         1062
    Tennessee................................................       1,661,104          779       62,291        3,893
    Texas....................................................       8,742,609        4,098      327,848       20,490
    Utah.....................................................         479,572          225       17,984        1,124
    Vermont..................................................         453,123          212       16,992        1,062
    Virginia.................................................       1,443,618          677       54,136        3,383
    Washington...............................................       1,340,908          629       50,284        3,143
    West Virginia............................................         615,683          289       23,088        1,443
    Wisconsin................................................         934,028          438       35,026        2,189
    Wyoming..................................................         453,123          212       16,992        1,062
    American Samoa...........................................         453,123          212       16,992        1,062
    Guam.....................................................         453,123          212       16,992        1,062
    Northern Mariana Islands.................................         453,123          212       16,992        1,062
    Puerto Rico..............................................       3,877,930        1,818      145,422        9,089
    Virgin Islands...........................................         453,123          212       16,992        1,062
    Freely Associated States.................................  ..............  ...........  ...........  ...........
    Indian set-aside.........................................  ..............  ...........  ...........  ...........
    Other (non-State allocations)............................         455,400          213       1,7078        1,067
                                                              ------------------------------------------------------
          Total..............................................      91,080,000       42,694    3,415,500      213,469
    ----------------------------------------------------------------------------------------------------------------

                                     ______

    Prepared Statement of the Council of State Administrators of Vocational
                             Rehabilitation (CSAVR)
        This testimony is submitted on behalf of the Council of State
    Administrators of Vocational Rehabilitation (CSAVR). The CSAVR is
    composed of the chief administrators of the State Vocational
    Rehabilitation (VR) Agencies serving individuals with physical and/or
    mental disabilities in the United States, the District of Columbia and
    the Territories. These agencies constitute the State partners in the
    State-Federal Program of Rehabilitation Services provided under Title 1
    the Rehabilitation Act of 1973, as amended. State VR agencies provide
    individualized services and supports to eligible individuals with
    significant disabilities that are required for them to go to work.
    These services may include, but are not limited to, counseling and
    guidance, job training, higher education, physical and mental
    restoration services, and assistive technology. Nearly 1 million
    individuals with disabilities are served annually. In fiscal year 2005,
    these agencies placed 206,695 individuals with disabilities into
    competitive employment.
        The CSAVR, founded in 1940 to furnish input into the State-Federal
    Rehabilitation Program, provides a forum for State administrators to
    study, deliberate, and act upon matters affecting the rehabilitation
    and employment of individuals with disabilities. The Council serves as
    a resource for the formulation and expression of the collective points
    of view of State rehabilitation agencies on all issues affecting the
    provision of quality employment and rehabilitation services to persons
    with significant disabilities.
     csavr's recommendation for the fiscal year 2007 appropriation for the
                    public vocational rehabilitation program
        For fiscal year 2007, CSAVR recommends an increase in the
    Vocational Rehabilitation (VR) appropriation of $258 million above the
    President's budget request for fiscal year 2007. The President's budget
    proposes a 4.3 percent increase in funding for the Public VR program,
    which is the mandated CPI increase, called for in law. However, the
    President's budget request also eliminates funding for several smaller
    programs, Supported Employment (SE), Projects with Industry (PWI), and
    Migrant and Seasonal Farm Workers (MSFW), with a total loss of funding
    of 51.7 million. With the majority of State VR Agencies operating under
    an Order of Selection, a system of prioritization whereby individuals
    with the most significant disabilities are served first, it is unlikely
    that the State VR Agencies would be able to continue to provide
    services, under Title 1 of the Rehabilitation Act, to all of the
    individuals previously served under the programs that lost their
    funding.
        In addition to the proposed elimination of the SE, PWI, MSFW, and
    Recreation programs, which CSAVR does not support, HR 27, the House
    bill to reauthorize the Workforce Investment Act (WIA), and S 1021, the
    Senate bill to reauthorize the WIA, expands the requirements for VR to
    provide transition services to students with disabilities. Based on the
    significant internal and external challenges facing the Public VR
    Program, (i.e., staffing shortages, State budget shortfalls, increased
    numbers of consumers seeking services, and increased service costs and
    expectations, the CSAVR believes that an increased appropriation of 258
    million above the President's budget request for VR, for fiscal year
    2007, is an appropriate recommendation.
        The CSAVR is requesting a $206 million increase specifically for
    the purposes of implementing the new transition requirements in the
    Rehabilitation Act. The most recent data on transition students,
    published in 2003 in the Individuals with Disabilities Education Act
    (IDEA) 25 Annual Report to Congress, indicates that there were
    2,791,886 students between the ages of 12-17 and 283,265 between the
    ages of 18-21. A small sample survey of State VR Agencies revealed that
    the average annual cost to serve a transition student is $2062.00. The
    CSAVR will have the capacity to serve 100,000 new transition students
    in fiscal year 2007, with a funding increase of $206 million.
        In addition, CSAVR is requesting that you restore the $51.7 million
    to the MSFW, the SE and the PWI programs, whose budgets were eliminated
    in the President's budget request for fiscal year 2007.
        These three programs are vital to VR consumers and desperately
    needed to assure that vital support services, necessary for successful
    employment of certain populations, are maintained.
                  the public vocational rehabilitation program
        The Public VR Program is one of the most cost-effective programs
    ever created by Congress. It enables hundreds of thousands of
    individuals with disabilities to go to work each year and become tax-
    paying citizens. In fiscal year 2005, the VR Program assisted 984,315
    individuals with disabilities who wanted to work, by providing them
    with the job skills, training and support services they needed to
    become employed. Of those served, 206,695 entered into competitive
    employment. Funding for the VR Program requires a State match of 21.3
    percent, and creates a State-Federal partnership that has worked
    effectively for more than 86 years, and has assisted approximately 16
    million individuals with disabilities to engage in employment and
    become tax-paying citizens.
        The Rehabilitation Act mandates that the annual Federal
    appropriation for the VR Program grow at a rate at least equal to the
    change in the Consumer Price Index (CPI) over the previous fiscal year.
    While the mandate was intended to create a floor for the VR
    appropriation, Congress has not appropriated funds above the mandated
    CPI increase since 1999. This is particularly problematic because the
    formula used to distribute these funds, which is based on a State's per
    capita income and population, results in significant variations in the
    increases in individual State's allotments. When the increase is
    limited to the CPI increase and the formula is applied, not all States
    receive increases that are equal to the annual rate of inflation. In
    fiscal year 2006, 30 States did not receive the required CPI increase
    in their State allotment.
                    challenges facing the public vr program
        Over the last several years, the Public VR Program has faced a
    number of external challenges that have been compounded by the minimal
    increases in Federal funding.
                               special education
        Between 1990 and 2004, the Federal appropriation for special
    education increased by approximately 333 percent. During the same time
    period, the Federal appropriation for the Public VR Program increased
    by only 22 percent. As a result of these very significant increases in
    special education funding, an ever-increasing number of special
    education students are exiting the education system and seeking adult
    services, including Vocational Rehabilitation, in order to participate
    in post secondary education, job training, and/or to go to work.
              impact of the workforce investment act of 1998 (wia)
        The Public VR Program is a mandatory partner in the WIA and, as
    such, is required to contribute significant resources to support the
    infrastructure and other costs associated with the operation of the
    One-Stop Centers. While VR's involvement in State Workforce Investment
    Systems is critically important, WIA has placed yet another financial
    burden on an already strained program, further reducing the percentage
    of VR funds that are available to provide services and supports to
    eligible individuals with disabilities. In addition, the House bill to
    reauthorize the WIA, H.R. 27, proposes to take significant resources
    from the Public VR Program far beyond the resources contributed to the
    One-Stop Centers under current law. The Senate bill, S. 1021, also
    requires resources from VR to fund the infrastructure costs and other
    common costs associated with the operation of One-Stop Centers;
    however, the CSAVR is very grateful for the graduated CAP on
    infrastructure funding for VR in S. 1021.
      --A 2002 Longitudinal Study of the Public VR Program provided
            evidenced based research that the VR Program is effective in
            putting people with disabilities to work in good jobs with
            opportunities for advancement.
      --A fiscal year 2006 Program Assessment Rating Tool (PART) Review,
            conducted by the Office of Management and Budget (OMB) to rate
            program performance, rated the VR Program favorably, and in
            general, successful in meeting its program goal.
      --A report by the Social Security Administration, released annually,
            provides detailed information on the funds disbursed to State
            VR Agencies, based on their successfully serving beneficiaries
            on Social Security Disability Insurance (SSDI) and Supplemental
            Security Income (SSI). In fiscal year 2004 SSA projected a
            470.3 million savings to the Trust Fund by the VR Program, and
            established that every $1.00 that SSA spends on VR results in a
            $6.00 savings.
        In this era of significant Federal and State budget deficits, and
    an increase in the unemployment rate for individuals with disabilities,
    we urge you to consider an increase in funding for the Public VR
    Program, through which you can be assured to have positive outcomes,
    based on the three factors mentioned above.
        Our Nation's ability to be competitive in a global economy depends
    on the quality of our workforce. According to information provided by
    the Department of Labor, Employment & Training Administration, during
    the fiscal year 2006 Budget Briefing, the American workforce will be
    vastly different than it is today, as the 21st century unfolds. The
    fastest growing jobs of the future will need to be filled by
    ``knowledge workers,'' who have specialized skills and training. Ninety
    percent of the fastest growing jobs in the United States (U.S.) require
    some level of post-secondary education and training. Yet, the U.S.
    Census Bureau reports that in the United States, just 28 percent of
    those 25 and older in 2004 had a bachelor's degree. Integrating all
    available workers into the workforce, including workers with
    significant disabilities, will be required for employers to meet the
    demands of the 21st century economy. Significant numbers of large and
    small employers have acknowledged that hiring individuals with
    disabilities makes good business sense. It provides them with
    dependable workers and access to a market of individuals with spending
    power, which has historically been untapped. These same employers also
    have long-standing, positive relationships with VR, to whom they look
    to provide them with qualified workers with disabilities. Integrating
    all available workers into the workforce, including workers with
    disabilities, will require significant resources.
        Recently, the CSAVR developed a National VR/Business Network for
    the purposes of increasing significantly, the number and quality of
    employment opportunities for VR's consumer. This National Network,
    spearheaded by CSAVR's Director of Business Relations, has already
    expanded the number of employment opportunities available to VR's
    consumers in a significant number of States, and is continuing to grow.
    VR's positive relationships with employers, who rely heavily on the
    Public VR Program to meet their hiring needs, further emphasizes and
    documents the need for additional resources for VR.
        The Public VR Program, 86 years of history, 16 million individuals
    served, and a demonstrated return on investment. With additional
    resources, the Public VR Program can do more of what it does best--
    provide the resources for individuals with disabilities to go to work
    and live the American Dream.
        The CSAVR thanks the Chairman and Members of the Senate
    Appropriations subcommittee for the opportunity to submit written
    testimony on behalf of the Public VR Program.
                                     ______

                   Prepared Statement of Gallaudet University
        Mr. Chairman and members of the committee: I would like to express
    my appreciation to you and to Congress for the generous support that we
    received in fiscal year 2006 to continue maintaining and enhancing
    academic programs and salaries at Gallaudet University. I am especially
    grateful that Congress continues to support us during these challenging
    times, and I am testifying in support of our appropriation request for
    fiscal year 2007. As I prepare to retire as President at the end of
    this calendar year, I would particularly like to express my
    appreciation for the support that Congress has provided to Gallaudet
    during the 18 years of my administration and of majority control of the
    Board of Trustees by deaf individuals. One of my proudest
    accomplishments is the increase in the percentages of our employees who
    are deaf or members of minority groups. These percentages now stand at
    41 percent and 38 percent respectively.
        Consistent with our legal purpose, as stated in the Education of
    the Deaf Act (EDA), we have greatly expanded programs at the doctoral
    level. When I became President, we had only one doctoral level program
    in administration and supervision--we now have additional doctoral
    programs in audiology, clinical psychology, education, and linguistics.
    At the undergraduate level we have focused on programs, such as
    tutoring and first year seminars, designed for long term enhancement of
    our persistence and graduation rates, and we have initiated a much
    needed bachelor's level interpreter training program. At the Clerc
    Center, following guidance from Congress during the 1992
    reauthorization of the EDA, we have refocused our demonstration and
    outreach activities at the pre-college level on high priority student
    populations throughout the United States.
        During my presidency, Gallaudet responded to the Government
    Performance and Results Act (GPRA). In 2005, we had 31 ambitious goals
    published under GPRA, with 17 of those fully accomplished in that year.
    These goals reflect the wide array of programs and services that
    Gallaudet provides as required by legislative mandate and performance
    expectations as agreed to with the U.S. Department of Education. During
    2005, Office of Management and Budget (OMB) conducted a Program
    Assessment Rating Tool (PART) of Gallaudet, and, based on a limited and
    narrow set of GPRA indicators, it gave Gallaudet an ``ineffective''
    rating. I protested the rating in part because of the assessment's
    limited scope and also because we were not involved in the assessment.
    I am pleased to inform you that OMB has agreed to conduct a
    reassessment of Gallaudet this year, and I will insist on a broader set
    of indicators that truly represent Gallaudet's complex mission.
        When I became President in 1988, every building on the Kendall
    Green campus had been constructed with virtually 100 percent Federal
    funding. Since I became President, every major construction or
    renovation project we have undertaken has been supported either by
    cost-sharing with the Federal Government or by private fundraising
    alone. For example, the buildings constructed here most recently, the
    Kellogg Conference Hotel at Gallaudet University and the Student
    Academic Center, were constructed without any additional Federal
    appropriations. We are currently well on the way to raising the funds
    needed for a facility to house our language and communication programs,
    including a $5 million leadership gift from the Sorenson family of
    Utah.
        When I became President, the Gallaudet endowment was valued at $10
    million. Partly with the assistance of the Federal Endowment Program
    created by the 1986 passage of the Education of the Deaf Act, our
    endowment now stands at $165 million and generates more than $4 million
    in annual income to support programs and scholarships.
        When I became President in 1988, total staffing at Gallaudet stood
    at about 1,450 employees. Following a comprehensive staffing reduction
    program, it now stands at just over 1,100, a reduction of more than 20
    percent. This reduction provided much needed budget flexibility during
    a time when Congress was seeking to reduce the Federal budget deficit.
    During my tenure, we have also decreased the proportion of our
    operating budget that is supported by Federal appropriations by about
    10 percentage points. This reduction was made possible in part by a
    long term plan to increase tuition charges to Gallaudet students,
    following an agreement between the University and the Department of
    Education. For many years, we increased tuition at 7 percent annually,
    more than twice the rate of inflation. Following expressions of concern
    by members of Congress and by a consulting group we retained to study
    our tuition policy, we reduced these increases to 3 percent annually
    starting in fiscal year 2006. I believe that we have been very
    responsible in our requests for Federal support and that we have done
    everything we could to seek additional sources of funding during a time
    when Congress has faced funding limitations.
        Because of Congress's ongoing support of Gallaudet in fiscal year
    2006, we have been able to maintain a competitive pay structure for our
    employees while retaining the flexibility to meet the needs of a
    changing student body. Given the unique student population we serve and
    the communication skills our employees are expected to possess,
    retaining skilled employees is critical to our mission. Gallaudet
    employees received general pay increases of 2 percent in fiscal year
    2003, 3 percent in fiscal year 2004, 2 percent in fiscal year 2005, and
    2 percent again in fiscal year 2006, increases that are below what
    Federal employees in the region received during the same timeframe, but
    in line with increases in the Consumer Price Index (CPI). During the
    most recent 12 month period, the CPI-U increased by 4 percent. It will
    be important for Gallaudet to ensure that our employees receive at
    least a 3 percent general pay increase in fiscal year 2007,
    commensurate with current increases in inflation. We are also
    requesting support for inflationary increases in non-salary areas,
    especially in the cost of utilities and benefits. In this regard, I
    need to point out that our benefits charges during the past several
    years have increased by more than 2 percent of base salaries, and we
    have had to fund those increases as part of our total payroll package.
        The administration budget for fiscal year 2007 includes $106.998
    million for Gallaudet, the same as our current fiscal year 2006
    appropriation. I have carefully analyzed our fiscal year 2006 funding
    needs and have determined that in order to award a 3 percent salary
    increase to our faculty and staff, and to meet other inflation-driven
    increases, we need an increase of about $5 million, 4.7 percent above
    our current appropriation. All of our planning is now guided by a
    comprehensive strategic plan driven by eight goals, arrived at in
    consultations involving our Board, and our faculty and staff, relating
    to student academic achievement within the liberal arts tradition,
    excellence in research and other programs, diversity among students and
    employees, leadership in the deaf community, and maintenance of a
    strong resource base.
                      funding request for fiscal year 2007
        In our budget request to the Department of Education for fiscal
    year 2007, we addressed the need for inflationary increases as well as
    support for program development. Given the funding issues currently
    facing Congress, I am requesting support at this time for only our most
    pressing inflationary needs. Funding our need to cover inflationary
    costs will provide us some budget stability, but we will continue to
    face the need for development and enhancement of our programs. Our
    strategy will be to seek alternative sources of funding for some of
    these program priorities and to defer others. We will continue to seek
    support for program growth from both Federal and private sources in the
    future.
        Salaries.--I am requesting support for a 3 percent increase in
    salaries, approximately $2.6 million.
        Benefits.--I am requesting support for increases in benefits costs
    that have created the need for increasing charges to our operating
    units by 2 percent of base salaries, approximately $1.4 million.
        Utilities.--The total cost for utilities at Gallaudet rose by $1.8
    million, or 50 percent, between fiscal year 2002 and 2005, and I expect
    these costs to continue rising steeply in fiscal year 2006. I am
    seeking $1 million to partially offset these increases.
        My total request for fiscal year 2007 is, thus, $112 million.
        In summary, I appreciate the challenges that Congress faces in
    making appropriations decisions for fiscal year 2007, but I believe
    experience has shown that Gallaudet provides an outstanding return on
    Federal dollars that are invested here, in terms of the educated and
    productive deaf community that the Nation enjoys as a result.
                                     ______

      Prepared Statement of the Health Professions and Nursing Education
                                   Coalition
        The members of the Health Professions and Nursing Education
    Coalition (HPNEC) are pleased to submit this statement for the record
    in support of the health professions education programs authorized
    under Titles VII and VIII of the Public Health Service Act.
        HPNEC is an informal alliance of over 50 organizations representing
    a variety of schools, programs, health professionals, and others
    dedicated to ensuring that Title VII and VIII programs continue to help
    educate the Nation's health care and public health personnel. HPNEC
    members are thankful for the support the subcommittee has provided to
    the programs, which are essential to building a well-educated, diverse
    health care workforce.
        The Title VII and VIII health professions and nursing programs are
    essential components of Americans' health care safety net, bringing
    health care services to our underserved communities. These programs
    support the training and education of health care providers with the
    aim of enhancing the supply, diversity, and distribution of the
    workforce, filling the gaps in the health professions' supply not met
    by traditional market forces. The Title VII and VIII health professions
    programs are the only Federal programs designed to train providers in
    interdisciplinary settings to meet the needs of special and underserved
    populations, as well as increase minority representation in the health
    care workforce.
        The final fiscal year 2006 Labor-HHS-Education Appropriations bill
    cut Title VII & VIII programs by 34.5 percent, including a 51.5 percent
    cut to Title VII programs. Moreover, the President's fiscal year 2007
    budget proposes an additional 93.1 percent cut to Title VII and a 45.8
    percent cut overall to both Title VII and VIII.
        HPNEC members recommend that the Title VII and VIII programs
    receive an appropriation of at least $550 million for fiscal year 2007.
    This recommendation would ensure the programs have sufficient funds to
    continue fulfilling their mission of educating and training a health
    care workforce that meets the public's health care needs, restoring
    some of the unprecedented cuts imposed on the programs in fiscal year
    2006.
        As described in an April 5 letter to the subcommittee, led by
    Senators Pat Roberts and Jack Reed, and signed by 56 of your colleagues
    (letter attached), restoring funding to Title VII health professions
    programs is vital to reversing health professions shortages in the
    Nation's neediest communities. An April 3 letter led by Senators Susan
    Collins and Barbara Mikulski was signed by 54 Senators in support of
    adequate funding for Title VIII nursing programs as well (letter
    attached).
        The enacted and proposed cuts to the programs will:
    Exacerbate existing provider shortages in rural, medically underserved,
            and federally designated health professions shortage areas
      --With Title VII funding, the Department of Family Medicine at
            Pennsylvania State University increased the number of students
            entering primary care to 50 percent of all graduates. Through
            rural rotations and required primary care clerkships, Penn
            State placed 30 percent of graduates into medically underserved
            areas over the last three years. With cutbacks in Title VII
            funding, they will lose their ability to continue producing
            physicians for underserved and rural areas.
      --According to the University of Nebraska Medical Center, eliminating
            Title VII funding will cut off access to psychologists for many
            families in rural areas. Over the last four years, the Munroe
            Meyer Institute Department of Psychology has served children
            and families from over 140 Nebraska cities and towns (3,500
            patients each year), and has placed Pediatric Psychologists in
            five rural primary care practices. The rural programs will be
            in severe financial crisis as a result of cuts, which would
            further reduce Nebraska's already severely limited mental
            health services to its rural citizens.
    Impede recruitment of underrepresented minorities and students of
            disadvantaged backgrounds into the health professions and
            intensify health disparities among minority and underserved
            citizens
      --The Saint Louis University School of Medicine operates a Health
            Careers Opportunity Program (HCOP). The negative impact of the
            elimination of Federal funding on the development of pipeline
            programming will be significant, as over 2,300 K-12 students
            annually participate in one or more pipeline programs. A
            correlative impact will be in the area of minority/
            disadvantaged recruitment, as pipeline programs heighten
            awareness of opportunities for medical and pre-medical training
            (i.e., research opportunities) at Saint Louis University.
            Elimination of Federal dollars will severely limit the ability
            of Saint Louis University to continue to impact young people at
            an early age to begin thinking about medicine. A reduction in
            minority enrollment is certain to occur at a time when
            enrollment diversity is having critical implications on
            institutional and faculty development, as well as on cultural
            competency initiatives.
      --The University of Illinois' College of Medicine has received
            Federal funding for its HCOP program for over 25 years and has
            graduated over 1400 health professionals. With a loss of funds,
            the school expects that the breadth of its recruitment
            activities will be curtailed, resulting in fewer contacts with
            underrepresented students, truncating the opportunities for
            exposing students to medicine as a career choice, to financial
            aid information, to curriculum preparedness, etc. These
            programmatic impacts will shape the medical profession as a
            whole, as there will be fewer underrepresented minorities who
            are recruited, retained, and who graduate to become physicians;
            fewer underrepresented minorities who are able to assist in
            bridging the dearth of medical care in underserved areas; fewer
            underrepresented minorities who are able to continue
            eliminating health disparities and contributing to health
            policy; and fewer underrepresented minorities who are
            culturally competent to appropriately provide health care
            services to the Nation's historically underserved populations.
    Negatively impact vulnerable populations such as the elderly
      --Over four years, the South Carolina Geriatric Education Center
            (GEC) has trained over 6,000 physicians. The enacted cuts to
            Title VII programs eliminate funding for geriatrics programs,
            including those at the University of South Carolina School of
            Medicine and the Medical University of South Carolina. As one
            of the top five States in rate of growth for older individuals,
            the direct impact on educating physicians and other health
            professionals on the special needs of aging adults will
            reverberate throughout South Carolina. On a national scale, the
            cuts will affect 50 GECs throughout the country which train
            over 50,000 health care professionals representing 35
            disciplines annually. These centers log 8.6 million patient
            encounters each year, and over two-thirds of GECs serve rural
            areas and underserved populations. The effect of this lost
            funding is devastating to both academic institutions and older
            individuals who will not receive care from health professionals
            equipped to address their unique needs.
    Undermine efforts to encourage health professions students to enter
            primary care
      --The University of California, San Diego School of Medicine reports
            that 71 percent of UCSD Hispanic Center of Excellence (HCOE)
            alumni completed or are completing primary care residencies,
            compared to only 57 percent of the UCSD alumni, graduating in
            2002-2004, who have completed or are completing primary care
            residencies.
        A November 2002 report by the Advisory Committee on Training in
    Primary Care Medicine and Dentistry emphasizes the essential role of
    the Title VII programs in enhancing public health training for the
    primary care health workforce. In its recommendations, the committee
    notes that in 1998, 42 to 56 percent of graduates from the Title VII-
    supported primary care programs entered practice in underserved areas,
    compared to a mean of 10 percent of health professions graduates
    overall. Data from 1998 also indicate that 35 to 50 percent of
    graduates of these programs represented minority or disadvantaged
    groups, compared to 10 percent minority representation overall.
        Community health centers (CHCs) also benefit from Title VII and
    VIII programs. A March 2006 study published in the Journal of the
    American Medical Association found that community health centers report
    high percentages of provider vacancies, including an insufficient
    supply of dentists, pharmacists, pediatricians, family physicians, and
    registered nurses; these shortages are especially pronounced among CHCs
    in rural areas. Because Title VII programs have a successful record of
    training providers who serve underserved areas, the study recommends
    increased support for the programs as its primary means of alleviating
    the shortages. Further, the publication serves as an important reminder
    that the success of CHCs is highly dependent upon a well-trained
    clinical staff to provide care.
        During their 40-year existence, the Title VII and VIII programs
    have created a network of initiatives across the country that supports
    the training of many disciplines of health providers. These are the
    only Federal programs designed to create infrastructures at our schools
    and in our communities that facilitate customized training designed to
    bring the latest emerging national priorities to the populations at
    large and meet the health care needs of special, underserved
    populations.
        HPNEC members urge the subcommittee to consider the vital need for
    these health professions education programs as demonstrated by the
    passage of the Health Professions Education Partnerships Act of 1998
    (Public Law 105-392), which reauthorized these programs. The
    reauthorization provided additional flexibility in the administration
    of these programs and consolidated them into seven general categories:
    Minority and Disadvantaged Health Professions Training; Primary Care
    Training; Interdisciplinary, Community-Based Linkages; Health
    Professions Workforce and Analysis; Public Health Workforce
    Development; Nursing Workforce Development; and Student Financial
    Assistance.
      --The purpose of the Minority and Disadvantaged Health Professionals
            Training programs is to improve health care access in
            underserved areas and the representation of minority and
            disadvantaged health care providers in the health professions.
            Minority Centers of Excellence support programs that seek to
            increase the number of minority health professionals through
            increased research on minority health issues, establishment of
            an educational pipeline, and the provision of clinical
            opportunities in community-based health facilities. The Health
            Career Opportunity Program seeks to improve the development of
            a competitive applicant pool through partnerships with local
            educational and community organizations. The Faculty Loan
            Repayment and Faculty Fellowship programs provide incentives
            for schools to recruit underrepresented minority faculty. The
            Scholarships for Disadvantaged Students (SDS) make funds
            available to eligible students from disadvantaged backgrounds
            who are enrolled as full-time health professions students.
            Nursing students receive 16 percent of the funds appropriated
            for SDS.
      --The Primary Care Training category, including General Pediatrics,
            General Internal Medicine, Family Medicine, General Dentistry,
            Pediatric Dentistry, and Physician Assistants, provides for the
            education and training of primary care physicians, dentists,
            and physician assistants to improve access and quality of
            health care in underserved areas. As noted in the November 2002
            Advisory Committee report, two-thirds of all Americans interact
            with a primary care provider every year, and approximately one-
            half of primary care providers trained through these programs
            go on to work in underserved areas, compared to 10 percent of
            those not trained through these programs. The General
            Pediatrics and General Internal Medicine programs provide
            critical funding for primary care training in community-based
            settings and have been successful in directing more primary
            care physicians to work in underserved areas. They support a
            range of initiatives, including medical student training,
            residency training, faculty development and the development of
            academic administrative units. Title VII is the only Federal
            program that provides funding for family medicine residency
            training, academic departments, predoctoral programs, and
            faculty development. The General Dentistry and Pediatric
            Dentistry programs provide grants to dental schools and
            hospitals to create or expand primary care dental residency
            training programs. Recognizing that all primary care is not
            only provided by physicians, the primary care cluster also
            provides grants for physician assistant programs to encourage
            and prepare students for primary care practice in rural and
            urban Health Professional Shortage Areas. Additionally, these
            programs enhance the efforts of osteopathic medical schools to
            continue to emphasize primary care medicine, health promotion,
            and disease prevention, and the practice of ambulatory medicine
            in community-based settings.
      --Because much of the Nation's health care is delivered in areas far
            removed from health professions schools, the Interdisciplinary,
            Community-Based Linkages cluster provides support for
            community-based training of various health professionals. These
            programs are designed to provide greater flexibility in
            training and to encourage collaboration between two or more
            disciplines. These training programs also serve to encourage
            health professionals to return to such settings after
            completing their training. The Area Health Education Centers
            (AHECs) provide clinical training opportunities to health
            professions and nursing students in rural and other underserved
            communities by extending the resources of academic health
            centers to these areas. AHECs, which have substantial State and
            local matching funds, form networks of health-related
            institutions to provide education services to students, faculty
            and practitioners. Health Education and Training Centers
            (HETCs) were created to improve the supply of health
            professionals along the U.S.-Mexico border. They incorporate a
            strong emphasis on wellness through public health education
            activities for disadvantaged populations. Given America's
            burgeoning aging population, there is a need for specialized
            training in the diagnosis, treatment, and prevention of disease
            and other health concerns of the elderly. Geriatric Health
            Professions programs support geriatric faculty fellowships, the
            Geriatric Academic Career Award, and Geriatric Education
            Centers, which are all designed to bolster the number and
            quality of health care providers caring for our older
            generations. The Quentin N. Burdick Program for Rural Health
            Interdisciplinary Training places an emphasis on long-term
            collaboration between academic institutions, rural health care
            agencies and providers to improve the recruitment and retention
            of health professionals in rural areas. The Allied Health
            Project Grants program represents the only Federal effort aimed
            at supporting new and innovative education programs designed to
            reduce shortages of allied health professionals and create
            opportunities in medically underserved and minority areas.
            Health professions schools use the funding to help establish or
            expand allied health training programs. The need to address the
            critical shortage of certain allied health professionals has
            been repeatedly acknowledged. For example, this shortage has
            received special attention given past bioterrorism events and
            efforts to prepare for possible future attacks. The allied
            health project grants funding enables the training of much
            needed allied health professionals, including those
            experiencing significant shortages. The Graduate Psychology
            Education Program provides grants to American Psychological
            Association accredited doctoral, internship and postdoctoral
            programs in support of interdisciplinary training of psychology
            students with other health professionals for the provision of
            mental and behavioral health services to underserved
            populations (i.e., older adults, children, chronically ill, and
            victims of abuse and trauma, including returning military
            personnel and their families), especially in rural and urban
            communities. Since its inception in 2002, the GPE Program has
            supported 52 grants in 27 States.
      --The Health Professions Workforce and Analysis program provides
            grants to institutions to collect and analyze data on the
            health professions workforce to advise future decision-making
            on the direction of health professions and nursing programs.
            The Health Professions Research and Health Professions Data
            programs have developed a number of valuable, policy-relevant
            studies on the distribution and training of health
            professionals, including the soon-to-be-released Eighth
            National Sample Survey of Registered Nurses (NSSRN), the
            Nation's most extensive and comprehensive source of statistics
            on registered nurses.
      --The Public Health Workforce Development programs are designed to
            increase the number of individuals trained in public health, to
            identify the causes of health problems, and respond to such
            issues as managed care, new disease strains, food supply, and
            bioterrorism. The Public Health Traineeships and Public Health
            Training Centers seek to alleviate the critical shortage of
            public health professionals by providing up-to-date training
            for current and future public health workers, particularly in
            underserved areas. Preventive Medicine Residencies, which
            receive minimal funding through Medicare GME, provide training
            in the only medical specialty that teaches both clinical and
            population medicine to improve community health. Dental Public
            Health Residency programs are vital to the Nation's dental
            public health infrastructure. The Health Administration
            Traineeships and Special Projects grants are the only Federal
            funding provided to train the managers of our health care
            system, with a special emphasis on those who serve in
            underserved areas.
      --The Nursing Workforce Development programs provide training for
            entry-level and advanced degree nurses to improve the access
            to, and quality of, health care in underserved areas. Health
            care entities across the Nation are experiencing a crisis in
            nurse staffing, caused in part by an aging workforce, an
            insufficient number of young people entering the profession,
            and a shortage of nurse faculty. At the same time, the need for
            nursing services is expected to increase significantly over the
            next 20 years, with the demand for licensed, registered nurses
            growing by over 29 percent within the next nine years alone.
            Congress responded to this dire national need by passing the
            Nurse Reinvestment Act (Public Law 107-205) which aims to
            attract more people into the nursing profession, increase the
            capacity for nurse education, and encourage practicing nurses
            to remain in the profession. The Advanced Education Nursing
            program awards grants to train a variety of advanced practice
            nurses, including nurse practitioners, certified nurse-
            midwives, nurse anesthetists, public health nurses, and nurse
            administrators. Workforce Diversity grants support
            opportunities for nursing education for disadvantaged students
            through scholarships, stipends, and retention activities. Nurse
            Education, Practice, and Retention grants are awarded to help
            schools of nursing, academic health centers, nurse managed
            health centers, State, and local governments, and other health
            care facilities to develop programs that provide nursing
            education, promote best practices, and enhance nurse retention.
            The Loan Repayment and Scholarship Program repays up to 85
            percent of nursing student loans and offers individuals who are
            enrolled or accepted for enrollment as a full-time or part-time
            nursing student the opportunity to apply for scholarship funds.
            In return these students are required to work for at least two
            years of practice in a designated nursing shortage area. The
            Comprehensive Geriatric Education grants assist in training
            individuals to provide geriatric care for the elderly. The
            Nurse Faculty Loan program provides a student loan fund
            administered by schools of nursing to increase the number of
            qualified nurse faculty. The Title VIII nursing programs also
            support the National Advisory Council on Nurse Education and
            Practice, which is charged with advising the Secretary of
            Health and Human Services and Congress on nursing workforce,
            education, and practice improvement issues.
      --The loan programs in the Student Financial Assistance support needy
            and disadvantaged medical and nursing school students in
            covering the costs of their education. The Nursing Student Loan
            (NSL) program provides loans to undergraduate and graduate
            nursing students with a preference for those with the greatest
            financial need. The Primary Care Loan (PCL) program provides
            loans covering the cost of attendance in return for dedicated
            service in primary care. The Health Professional Student Loan
            (HPSL) program provides loans covering the cost of attendance
            for financially needy health professions students based on
            institutional determination. The NSL, PCL, and HPSL programs
            are funded out of each institution's revolving fund and do not
            receive Federal appropriations. The Loans for Disadvantaged
            Students (LDS) program provides grants to health professions
            institutions to make loans to health professions students from
            disadvantaged backgrounds.
        HPNEC members respectfully urge support for funding of at least
    $550 million for the Title VII and VIII programs, an investment
    essential not only to the development and training of tomorrow's health
    care professions but also to our Nation's efforts to provide needed
    health care services to underserved and minority communities. We
    greatly appreciate the support of the subcommittee and look forward to
    working with members of Congress to achieve these goals in fiscal year
    2007 and into the future.
                                     ______

          Prepared Statement of the Institute for Student Achievement
        Mr. Chairman and Members of the subcommittee, thank you for the
    opportunity to submit testimony to the hearing record regarding the
    Institute for Student Achievement (ISA), a national not for profit
    educational organization.
             introduction to the institute for student achievement
        The Institute for Student Achievement's mission is ``to improve the
    quality of education for youth at risk so that they can succeed in our
    society.'' ISA has had a solid 15 year history of promoting high
    achievement for underserved students, first through its legacy direct
    service programs, COMET (for middle school) and STAR (for high school),
    and now through its school reform model. ISA launched its high school
    reform model in September 2001, with four pilot sites, three in New
    York City and one in Fairfax County, Virginia. As you know, funds to
    expand the work of ISA have been included in recent appropriations
    cycles, and we appreciate the support of the subcommittee. As a result
    we have created 31 small schools and learning communities serving over
    8,000 students in New York State, Virginia (in partnership with Fairfax
    County Schools), Atlanta, Georgia and Union City, New Jersey.
        ISA partners with school districts to create new small schools or
    to transform large existing high schools into clusters of autonomous
    small schools or semi-autonomous small learning communities. The ISA
    high school reform model targets underserved, underperforming young
    people, including students from low-income families, students of color,
    recent immigrants and English Language Learners. ISA helps schools to
    develop small learning communities with the seven school design
    principles that have succeeded in preparing all high school students,
    including those who are disadvantaged and underperforming, to achieve,
    graduate, and go on to college.
        Briefly described, the 7 ISA Principles are:
        A College Preparatory Instructional Program promoting rigorous
    intellectual development, strong literacy and numeracy skills, critical
    thinking, habits of mind and work, and practical knowledge of the
    college application process.
        A Dedicated Team of Teachers and a Counselor who collaborate to
    ensure that students develop and achieve academically and socially.
        Continuous Professional Development that strengthens the capacities
    of teachers, counselors and school leaders to effectively provide a
    college preparatory program through rich professional growth
    experiences; regularly scheduled team meetings; classroom interventions
    for teachers; and customized professional development on topics ranging
    from inquiry in science to conflict resolution.
        Distributed Counseling TM an approach in which faculty
    get to know all students well, as both learners and people, and
    integrate counseling into the education program so that students
    graduate ready for college. The counselor provides ongoing guidance to
    the teacher/advisors and direct services to students and their
    families.
        An Extended School Day and School Year provide extra time for
    students to develop skills, complete assignments, engage in test
    preparation, participate in community service projects and internships,
    and have opportunities for talent development and enrichment.
        Parent Involvement is integrated into school operations. The school
    program is designed to allow--and encourage--parents to be full
    partners in realizing educational excellence for their children.
        Continuous Organizational Improvement focuses on optimizing student
    learning. ISA and its higher education partner, the National Center for
    Restructuring Education, Schools and Teaching (NCREST) of Teacher's
    College, Columbia University, work with the small schools and small
    learning communities to assess and evaluate in order to inform
    instruction and enhance program development.
        In each ISA small learning community or small school, a team of at
    least four core subject teachers and a guidance counselor is dedicated
    to a group of 100-125 students, staying with the students over multiple
    years. Each ISA small school or small learning community selects an ISA
    coach, who is experienced in the development of small or restructuring
    schools, brings substantive knowledge of one or more core content
    areas, and has considerable background in working closely with teachers
    in reflecting on and improving their practice. The ISA coach works with
    the school over a four-year period at the school site, supporting
    school administrators and dedicated teacher/counselor teams as they
    implement the seven ISA principles to meet the needs of their school
    community.
        The ISA coach works with individual teachers to strengthen their
    pedagogical skills and facilitates curriculum development and
    implementation. He or she helps the teacher/counselor teams to create a
    personalized, supportive environment that optimizes student learning.
    The team is further assisted with the implementation of ISA's
    Distributed Counseling TM model and their efforts to
    increase the level of parent involvement are informed by ISA best
    practices. ISA also helps schools to develop extended day programming
    that reinforces school day learning and offers young people
    opportunities to prepare for college and career.
                               the conceptual age
        Our mission today is even more important than it was when ISA was
    founded because of the dramatic transformation of our economy and the
    nature of work. The fact is, we are charged with preparing our children
    to succeed in a world that in many ways bears little relation to the
    world we entered when we left school--or even the world we woke up in
    yesterday. In a microscopic measure of human time, we have moved
    through the Agricultural Age, to the Industrial Age, to the Information
    Age, and now to another era altogether. Author Daniel Pink calls this
    new era the Conceptual Age. It requires us to be not only knowledgeable
    and competent, but creative and inquisitive as well.
        Studies have shown that many of our high schools, even those that
    boast of high graduation and college-attendance rates, rarely demand
    that students use information, skills, and technologies to construct
    new knowledge and to solve complex problems, integrate concepts and
    ideas across disciplines, communicate effectively orally and in
    writing, and work in diverse groups. Yet this is precisely the kind of
    learning students need for a Conceptual Age. Students themselves tell
    us that they want to be held to high standards but that they find their
    high schools boring, unchallenging, and disconnected from their lives.
                              the global challenge
        Microsoft Chairman Bill Gates recently told the Nation's governors
    that American high school education is ``obsolete.'' He said, ``When I
    compare our high schools to what I see when I'm traveling abroad, I am
    terrified for our workforce of tomorrow. . . . In 2001, India graduated
    almost a million more students from college than the United States did.
    China graduates twice as many students with bachelor's degrees as the
    United States and [has] six times as many graduates majoring in
    engineering. . . . America is falling behind.''
        Gates was describing a global economy in which the chance to move
    up into a better economic life is slipping overseas, along with jobs
    that can be performed anywhere--manufacturing in China, technology
    support in India, online order fulfillment across borders. The Internet
    brings Bhutan and Bangalore just as close to our offices and living
    rooms as Boise. Our children's competitors are not the other schools in
    the district or the State or even the Nation. They are the
    technologically literate young people in Taiwan, India, Korea, and
    other developing nations. For today's American students, learning and
    retraining will be a lifelong experience.
        To be ``competitive'' now, U.S. students must develop sophisticated
    critical thinking and analytical skills to manage the conceptual nature
    of the work they will do. They will need to be able to recognize
    patterns, create narrative, and imagine solutions to problems we have
    yet to discover. They will have to see the big picture and ask the big
    questions. How many high schools do you know that are nurturing minds
    like that?
        The 12th-grade data from the Third International Mathematics and
    Science Study showed that of the 20 countries participating, only two--
    Cyprus and South Africa--scored lower than the United States. American
    students enrolled in the most advanced courses in math and science
    performed at low levels compared to students in other countries.
                          leaving some students behind
        Two serious gaps hold back most of our students and risk the
    prosperous future of the entire country. The gap we hear least about is
    the one between a rigorous, intellectually challenging curriculum and
    the rote instructional program that is commonplace in far too many
    classrooms. The gap we hear much more about is the one in student
    achievement that is exposed when data is disaggregated by race,
    ethnicity, and family income. Our challenge is to ensure that both gaps
    are closed and that all children--not just some of them--receive a
    high-quality education that will prepare them well for the world in
    which they will live and work.
        There are tremendous gaps in achievement among racial and ethnic
    groups within our own country. We are systematically leaving behind
    large numbers of our poor and minority students. On the 2005 National
    Assessment of Educational Progress, 39 percent of white eighth-graders
    scored at or above proficient on the math exam, while only 9 percent of
    African-American and 13 percent of Hispanics achieved at that level.
        A U.S. Department of Education study shows that the average 12th-
    grade African-American student is reading and doing math at around the
    level of the average eighth-grade white or Asian student. Hispanic
    students are about as far behind. On the 2004 SAT, black students, on
    the average, scored 104 points lower on the math test and 98 points
    lower on the verbal test than white students. Between 25 to 30 percent
    of America's teenagers fail to graduate from high school with a regular
    diploma. That figure climbs to more than 50 percent for black male and
    Hispanic students.
        Clearly, this is not the path to global competitiveness. The
    quality and the inequality of education in this country should be at
    the top of the agenda for every meeting of the school board and
    superintendent. An uneven playing field is everybody's turf--and it
    needs tending.
              the institute for student achievement is succeeding
        At a time when the vast majority of jobs require a college degree
    or some type of postsecondary degree, most low-achieving students are
    relegated to classrooms where remediation and instruction in low-level
    skills are the norm. But poor performance and a shortage of vision are
    not inevitable characteristics of our educational system. ISA is
    addressing this challenge.
        Typically ISA schools have attendance rates of over 90 percent
    average daily attendance. Over 95 percent of graduates from ISA schools
    and learning communities have gone on to college. The small size, 400
    students grades 9-12, results in a high level of personalization,
    individual student attention, extensive, professional development, a
    challenging curriculum, and family and community involvement. Our
    research has shown that ISA small schools and learning communities have
    higher graduation rates, very low dropout rates, outstanding student
    attendance, increased teacher satisfaction and are more cost effective
    than large high schools.
        In fiscal year 2007, ISA has requested Federal funding to help us
    continue our work in developing rigorous college preparatory high
    schools in the States of Georgia, Virginia, New Jersey and New York.
    Beyond that, our goal, with your help, is to expand the number of ISA
    schools to over 100 throughout the Nation, over the next three years.
    When we have met that challenge we will have demonstrated that there
    are model public high schools that are successfully educating all
    students in high need communities to be conceptual thinkers and ready
    for the challenges we are confronting in today's global economy. We
    hope that the subcommittee can be supportive of our efforts and our
    request for funding.
                                     ______

               Prepared Statement of the National Writing Project
        I am Richard Sterling, Executive Director of the National Writing
    Project (NWP). NWP is authorized under Title II, Subchapter C, Subpart
    2 of the Elementary and Secondary Education Act of 1965. It has been
    authorized as part of ESEA since 1991.
        I appreciate the opportunity to present this testimony requesting
    continued support for the National Writing Project. As you know, the
    Department of Education's (ED) fiscal year 2007 budget request to
    Congress did not include funding for this program.
        NWP is a national organization, a network of local writing project
    sites, working with teachers of all subject areas and at all grade
    levels to improve the teaching of writing in the Nation's schools.
    Today there are 195 university-based writing project sites in all 50
    States, the District of Columbia, Puerto Rico, and the U.S. Virgin
    Islands. NWP sites promote core principles of effective instruction
    while they respond to the needs of local schools and communities. The
    fiscal year 2006 appropriation for the NWP is $21.5 million. Another
    $22 million in local support is leveraged by writing project sites
    across the country.
        By statute, the purposes of the NWP are to (1) ``support and
    promote the expansion of the NWP network so that teachers in every
    region of the United States have access to an NWP program,'' (2)
    ``ensure the consistent high quality of sites through ongoing review,
    evaluation, and technical assistance,'' and (3) ``support and promote
    the establishment of programs to disseminate effective practices and
    research findings about the teaching of writing.''
        The Department of Education's justification for elimination of the
    NWP states that the ED is ``eliminating small categorical programs that
    have limited impact and for which there is little or no evidence of
    effectiveness.'' In addition, the ED States that, ``These small
    categorical programs siphon off Federal resources that could be used by
    State and local agencies to improve the performance of all students.''
    In relation to the NWP network these findings are not adequately
    supported by the facts. The NWP's response follows:
           response to the statement: the nwp has ``limited impact''
        It is difficult to understand the basis for the finding that the
    NWP has ``limited impact.'' The impact of a funded project is
    determined by the scale of services provided and the value of those
    services to districts, schools, teachers, and students. In terms of the
    scale of its services, the NWP is by far the largest provider of
    professional development in writing in the country.
        Data gathered by an independent evaluator, Inverness Research
    Associates (IRA), show the scale of NWP as it affects students.
    Approximately 1.95 million students are taught every year by teachers
    who received professional development services from writing project
    sites. In addition, NWP programs also directly serve 45,000 students
    through school-year and summer youth writing programs each year. (Data
    available from IRA, www.inverness-research.org.)
        Data also demonstrate the scale of NWP's reach to teachers across
    the country. The NWP network provides 19 hours of professional
    development to 1 out of every 8 secondary language arts teachers and 1
    out of every 35 elementary school teachers every year.
        In 2004-2005 alone, more than 3,000 teachers attended intensive NWP
    summer institutes. These summer institute participants directly teach
    more than 60,000 students during the school year. (Their students are
    representative of the student population: 42 percent students of color,
    13 percent English language learners, 46 percent in Title I programs.)
    These 2004-2005 teacher-participants join the more than 12,000 writing
    project teacher-leaders from past summer institutes who are serving
    their home communities. Together, these teachers conducted 7,288
    professional development programs for more than 141,000 educators in
    2004-2005.
        The network of 195 local sites is a unique national asset now
    providing geographical access to teachers in two-thirds of the counties
    in the Nation. In 2004-2005, 1,657 districts (1 out of ten in the
    Nation) and 2,907 schools (1 out of every 30 schools) chose to invest
    their professional development dollars with NWP local sites. Local
    writing project sites have formed ongoing partnerships with 371
    districts and schools.
        Thus, not only is the scale of work of the NWP network of national
    significance, there is strong evidence that the services offered are
    highly valued by States, local districts, schools, and teachers.
    Expanding the NWP
        Since 2000, the NWP network has added 60 new writing project sites
    in 30 states. Each year between 6 and 10 new sites are established in
    areas of the country that previously had not been served. This
    addresses the statutory requirement to expand the NWP network ``so that
    teachers in every region of the United States have access to an NWP
    program.'' In addition to adding new sites, NWP has developed local
    satellite programs so that existing sites can provide services to
    teachers and schools at a distance from the host university. NWP
    receives an average of 12 requests for new sites and satellites each
    year from universities eager to bring the writing project to their
    local communities.
    Assuring program quality
        In order to ensure the quality of local sites, NWP has conducted an
    annual site performance review since 1994. As part of the process, each
    local writing project site completes an extensive performance survey of
    its programs as well as of its teacher and administrator participants.
    The statistical data from these surveys are independently analyzed and
    reported by IRA on an annual basis. Every site must reapply for funding
    each year, and the analysis of these data, along with the site
    application, are used in the site performance review. During this
    annual review process, some sites are identified as in need of
    technical assistance from the NWP. If the sites are unable to resolve
    their issues after this technical support, they are no longer eligible
    for Federal funding. Over the last 10 years, 51 site grants were not
    renewed; however, 8 of these sites were re-funded after a transition
    period that resolved their issues.
        While each local NWP site receives a small amount of core funding
    from the Federal grant, the vast majority of the work done by each
    local NWP site is supported by States, counties, local school
    districts, and individual teachers. States, districts, and schools must
    make careful decisions about how they spend their resources for
    professional development--the fact that they continue to invest in the
    work of the NWP over many years is strong evidence of both the value
    and the effectiveness of NWP services.
        response to the statement: there is ``little or no evidence of
                           effectiveness'' of the nwp
        The Program Assessment Rating Tool (PART) review concluded that
    ``there is insufficient evidence on the overall effectiveness of NWP
    interventions.'' This assertion is based on incomplete information
    about a range of studies conducted on the effectiveness of NWP
    programs. In particular, the NWP PART section 2.1 provides incomplete
    information concerning long-term performance measures that NWP has
    employed to ``focus on outcomes and meaningfully reflect the purpose of
    the program.''
        In fact, since its inception in 1974 as a single writing project
    site located at the University of California, Berkeley, NWP has
    supported its sites in conducting numerous studies on the effectiveness
    of their professional development programs and contracted with third
    parties that have also conducted such studies. (Only two of these
    studies are referred to in the ED report.) Multiple research studies
    have shown that NWP programs significantly increase the instructional
    knowledge of teachers to teach writing. High quality quasi-experimental
    studies confirm significant gains for students of teachers who have
    participated in writing project programs. The NWP's website
    (www.writingproject.org) contains information on these and other recent
    studies.
        The PART assessment is based on incomplete information about the
    establishment of long-term measures to ensure that NWP sites
    disseminate effective practices in NWP teacher training programs.
    Beginning in 1999, following the establishment of GPRA performance
    indicators by ED, NWP contracted with IRA to collect and analyze
    additional data on teacher satisfaction with the summer training they
    received and to assess their implementation of effective instructional
    strategies in the teaching of writing in the year following the
    training. Targets were established by ED for this indicator in 1999.
        NWP has exceeded the target established for every year of the
    evaluation to date, with an average of 96 percent of elementary and
    secondary teachers reporting that they gained effective teaching
    strategies and up-to-date research that they can apply to their
    teaching. The independent evaluation also showed that instructional
    strategies that NWP participants learn in the institutes and use in
    their classrooms correlate positively with greater student achievement
    in writing on the NAEP Writing Assessment. This study is performed
    annually in partial fulfillment of requirements placed on the NWP by
    ED. To date, more than 15,000 teachers have been surveyed, with
    consistent results across all six years of the evaluation. (These
    annual reports are available at www.inverness-research.org, including
    The National Writing Project Client Satisfaction and Program Impact:
    Results from a Satisfaction Survey and Follow-up Survey of Participants
    at 2004 Invitational Institutes, December 2005.)
        The NWP PART assessment was also conducted before the conclusion of
    five rigorous quasi-experimental design studies that measured the
    extent to which students of teachers who received training by an NWP
    site improved their writing skills. Student learning in writing project
    teachers' classrooms was studied relative to student learning in
    comparable non-writing project teachers' classrooms. A team of external
    evaluators reviewed all of the research proposals and also designed and
    oversaw the independent national scoring of student writing. These five
    quasi-experimental studies have been completed and the results have
    been submitted to ED as well as posted on the NWP website.
        Central to each of the five studies conducted in 2004-2005 was the
    writing project site's commitment to understand what difference writing
    project professional development makes for participating teachers'
    practices and, in turn, what difference those changes in instructional
    practices make for student learning. Each study employed direct
    assessments of student writing, and each included carefully matched
    comparison classes and/or students. In an independent national scoring
    of student writing, NWP students' improvement outpaced that of students
    in carefully constructed comparison groups.
        Every comparison across all five studies shows positive effects of
    NWP programming. Student results were strong and favorable in those
    aspects of writing that the NWP is best known for, such as organization
    and the development of ideas. Students in writing project classrooms
    made greater gains than their peers in the area of conventions as well,
    suggesting that even these basic skills benefit from the NWP approach
    to teaching writing. These quasi-experimental studies uniformly
    indicate positive effects for the students of teachers who participated
    in writing project programs.
        These studies conform to the advice regarding rigor in quasi-
    experimental designs as offered by the Institute of Educational
    Sciences (IES) of ED.
      response to the statement: ``small categorical programs siphon off
      federal resources that could be used by state and local agencies to
                   improve the performance of all students''
        Rather than ``siphon off'' resources, the Federal investment in the
    NWP helps to augment and amplify local expenditures in the improvement
    of writing. All NWP sites match their Federal base grant with State,
    local, and private funding at a ratio of at least 1:1. The Federal
    investment provides core funding for the NWP and enables local sites to
    leverage additional funds from a variety of sources, including host
    universities, surrounding school districts, private corporations, and
    other entities. The quantity and quality of local professional
    development depends on the modest Federal investment that has so
    clearly demonstrated its power to attract and focus local resources.
    Without these crucial Federal funds, the core writing project work that
    develops teacher expertise and leadership and supports the
    dissemination of research and effective practices will simply cease to
    exist.
        An independent analysis by IRA of cost-efficiency over the past
    five years highlights the cost effectiveness of the Federal investment
    in the NWP. Local sites have leveraged an average of $3.65 for every
    Federal dollar they received from the NWP.
        The need for strong literacy skills for our Nation's students is a
    central tenet of all current school reform efforts. The NWP is a very
    good example of a Federal-local partnership that addresses this core
    need. The Federal funds: (1) enable local sites to maintain a minimal
    but critically important effective group of teacher-leaders, (2)
    develop ongoing working relationships between universities and school
    districts, (3) respond to local needs, and (4) provide support to all
    local sites so that they can continue to improve and expand their
    programs. In summary, the NWP provides high quality, large scale, and
    cost-effective support to teachers and students to improve writing and
    learning in the Nation's schools.
                                     ______

       Prepared Statement of the State Educational Technology Directors
                                  Association
      nclb title ii, part d--enhancing education through technology (eett)
        Members of the State Educational Technology Directors Association
    (SETDA) include the State directors of technology from the SEAs in all
    50 States, D.C., and American Samoa. I am pleased to submit this
    information and data which demonstrates how EETT is being utilized in
    over 80 percent of school districts across this country. EETT supports
    all areas of NCLB, including:
      --Closing the Achievement Gap
      --Recruiting and Retaining Highly Qualified Teachers
      --Improving Data Systems to Meet AYP
        EETT is also a key foundation to address the critical STEM and
    Competitiveness issues and initiatives. EETT has already begun to
    address these needs and will continue to do so through programs with
    data to support their effectiveness, including:
      --Improving math and science achievement
      --Ensuring highly qualified teachers in math and science
      --Ensuring students and teachers have skills to ensure that they are
            prepared for the global workforce
        This testimony includes the following:
        1. Key Examples that illustrate the key role EETT plays in helping
    schools, districts, and States to meet NCLB goals, but also demonstrate
    the focus on math, science, and improving students' abilities to
    compete in a global workforce.
        2. Overview of National Trends Report on Round 3 of EETT Funding
    data and results; the entire report on how EETT funds were used in all
    50 States and D.C. can be accessed at http://www.setda.org/
    content.cfm?sectionID=185.
                                1. key examples
    Improvements in Math and Science Achievement
        Iowa's Success With Algebra.--In Columbus Community School
    District, with 70 percent high poverty and 65 percent Hispanic
    populations, the 8th grade in the 2001-02 school year scored only 51
    percent of the students as proficient on the ITBS Math Assessment.
    Cognitive Tutor Algebra I implementation began in 2002 with the
    instructor rating a very high level of implementation by the CEO of the
    program. Columbus Students improved proficiency by 11 percent from
    Grade 8 to Grade 9. They continued to improve and were 74 percent
    proficient as 11th graders.
        Louisiana's Online Algebra I Course.--Algebra I is often a
    predictor for success in high school and beyond. Louisiana implemented
    an online Algebra I course to provide additional opportunities for
    student achievement. Preliminary evaluations indicate that students in
    the online course, with similar pre-test scores are showing more
    significant achievement gains compared to the control group as
    indicated below:

    ------------------------------------------------------------------------
                                                      Pre-test    Post-test
                         Group                         (fall)      (spring)
                                                        mean         mean
    ------------------------------------------------------------------------
    Algebra I Online Students.....................         13.3         17.2
    Control Students..............................         13.4         15.6
    ------------------------------------------------------------------------

        Michigan's Freedom to Learn Project.--This one-to-one initiative,
    which includes each student having a computer and professional
    development for teachers, showed significant impact with 7th-grade
    reading scores jumping from 29 percent to 41 percent and 8th-grade math
    scores increasing from 31 percent to 63 percent.
    Closing the Achievement Gap
        Missouri's eMINTS,--The eMINTS National Center provides tools to
    teachers in grades 3-5 to integrate multimedia into lessons. Three
    years of data analysis have demonstrated the highly positive effect of
    the program on student achievement. Performance in the fourth grade in
    the fiscal year 2002 cohort was essentially equalized between African-
    American and white students. Indeed, African-American students in
    eMINTS classrooms had a slightly higher average score in social studies
    for fiscal year 2002 than white students not enrolled in those
    classrooms; and in mathematics, the average performance between these
    two groups was almost identical.
        West Virginia's Basic Skills Computer Education Program.--
    Researcher Dale Mann (ASBO, 2003) cited a direct correlation between
    pupil performance and technology in instruction through West Virginia's
    Basic Skills/Computer Education program. The study found that while per
    capita income had not changed between 1991 and 1998, the infusion of
    technology was the single factor that accounted for the State moving
    from 33rd among the States for student achievement to 11th. In a
    similar study, Mann found that the cost of advancing students one unit
    in reading by decreasing the class size cost $636 and using technology
    to achieve the same result cost $86 (Mann, 2003). Technology provides a
    key opportunity to increase student achievement.
        Providing Opportunities to Rural and Small School Districts Through
    Distance Education.--The U.S. Department of Education and NCES' recent
    Distance Education Courses for Public Elementary and Secondary School
    Students: 2002-2003 (2005) documents the fact that smaller and rural
    schools use distance education opportunities more often, with a strong
    emphasis on foreign language courses. Additionally, 50 percent of
    districts that provide distance learning opportunities had students
    enrolled in Advanced Placement (AP) Courses. The recent NGA Summit on
    High School reform indicated the importance of students' access and
    participation in AP Courses. At least 80 percent of districts noted
    that distance education allowed them to increase the course offerings
    for their students. EETT provides a significant funding for these
    opportunities.
    Recruiting and Retaining Highly Qualified Teachers
        North Carolina's IMPACT Model Schools Grant.--This EETT grant
    program provides personnel, connectivity, hardware, software, and
    professional development to improve student achievement. A
    collaborative model, it focuses on using technology as a tool to
    encourage authentic, project-based learning incorporating 21st Century
    Learning Skills into all curriculum areas. In a time where more than
    one-half of all teachers leave the teaching field within the first
    three years, teachers who are scheduled to retire often choose to stay
    in these IMPACT schools, others request transfers into them, and new
    teachers clamor to be hired. ``These teachers like the way technology
    is changing the way they teach, and the enthusiasm with which their
    students approach learning,'' says Frances Bryant Bradburn, Director of
    Instructional Technology for the North Carolina Department of Public
    Instruction. Additionally, the initial results from this quasi-
    experimental design evaluation demonstrate that:
      --In first year, students in IMPACT schools had stronger growth than
            comparison school students, and for particular subgroups there
            was substantially stronger growth varying from small
            differences to about half a grade level of extra growth,
            depending on the outcome and grade level.
      --IMPACT students often started lower than their comparison school
            counterparts, but caught up within one school year.
      --In general, the most challenged IMPACT students showed the most
            growth in achievement.
        Maryland Increasing Teacher Retention.--Nationally, 50 percent of
    teachers leave the field within the first three years of their careers.
    To provide additional support for new teachers, Prince George's County
    has utilized Intel's Teach to the Future to provide extensive
    technology integration training for teachers and opportunity for
    graduate credit. Associated with Towson University, the first cohort of
    125 beginning teachers are demonstrating a very high rate of retention:
    94 percent.
    Improving Data Systems to Meet AYP
        Vermont Education Data Warehouse.--EETT funds in Vermont are being
    utilized directly for the implementation of data systems to support
    NCLB Accountability requirements through the Vermont Data Consortium
    that is creating a statewide ``Education Data Warehouse.'' The State
    grants provided through EETT funds support LEAs or schools in the
    development of local data systems to improve student achievement,
    support for teachers in analyzing data, improvement in evidence-based
    policy, and data standards to address local interoperability.
        Philadelphia's Instructional Management System (IMS).--A
    comprehensive reform effort that includes new resources, a standardized
    curriculum, after school programs, and professional development, IMS
    provides teachers and administrators with immediate data on student
    learning aligned to State and District standards. A benchmark
    assessment, given every five weeks, allows teachers to differentiate
    instruction, provide immediate remediation, and identify those students
    who need additional assistance. In 2003, before these technology tools
    were provided to teachers, only 9 of the 40 initial participating
    schools had met AYP; and 15 were identified for Corrective Action. At
    the end of the 2004 school year, 25 schools met their AYP targets, and
    only 10 remained in Corrective Action II.
                 2. overview of national trends report on eett
    Key Findings
        1. Promising Interim Results at 3-Year Mark Warrant Continued
    Investment
        2. States Have Set the Bar High for Professional Development
        3. States Are Making Progress with Evaluation and Impact Research
        4. States Are Leveraging Resources through Collaborations and
    Partnerships
        Over 40 percent of States required LEAs that received NCLB II D
    competitive grant funds to focus on reading or mathematics. States are
    not only building the conditions essential to effective technology use,
    but they are also seeing results as measured in increased student
    learning.
        Nearly 25 percent of States are funding or commissioning research
    studies on the impact of educational technology on learning in schools.
    Over 88 percent of States are collecting data annually from either
    districts, schools, or both. States are increasingly triangulating data
    sources (e.g., district surveys, school surveys, teacher surveys,
    student surveys, and site visitations).
        43 percent of the States went beyond the Title II D's 25 percent
    minimum funding requirement to focus additional resources toward
    professional development. Thus, over $159 million of grant funds was
    dedicated to professional development during Round 3 of the NCLB II D
    program.
    Key Facts
        1. Within the 50 States and the District of Columbia, 14,291
    districts were eligible for Title II D funds, representing 89.3 percent
    of LEAs. Collectively, the survey respondents administered $635,027,468
    in NCLB Title II D funding for Round 3, fiscal year 2004.
        2. Most States are encouraging school districts and schools to
    integrate technology systematically and 23.5 percent actually require
    that technology planning and school improvement be conducted within the
    same process.
        3. Funds are administered through both formula grants and
    competitive grants. Approximately 48 percent of the formula grants are
    under $5,000. That means that less than 4 percent of the funds require
    almost 50 percent of the administrative support for formula grants.
        4. The following States report that NCLB II D is the only source of
    funding in their State for educational technology: Arizona, California,
    Delaware, Illinois, Louisiana, Maryland, Michigan, Minnesota, Missouri,
    New Hampshire, Oklahoma, Vermont, Washington, and Wisconsin.
        5. On the other hand, many States, including Virginia,
    Pennsylvania, Florida and Alabama, are leveraging EETT to secure
    significant State investments in education technology through on-line
    assessment, high school reform, one to one initiatives and on-line
    learning initiatives.
        Full copies of the National Trends Report are available for
    download from the State Educational Technology Directors Association
    (SETDA) Website, www.setda.org. SETDA is the principal association
    representing the State directors for educational technology. SETDA?s
    membership includes all 50 States, the District of Columbia, and
    American Samoa.
        Thank you for your consideration of this data. Please contact me at
    mwolf@setda.org or 410-647-6965 with any questions.
                                     ______

                                RELATED AGENCIES

    Prepared Statement of the National Federation of Community Broadcasters
        Thank you for the opportunity to submit testimony to this
    subcommittee regarding the appropriation for the Corporation for Public
    Broadcasting (CPB). As the President and CEO of the National Federation
    of Community Broadcasters, I speak on behalf of 250 community radio
    stations and related organizations across the country. Nearly half our
    members are rural stations and half are minority controlled stations.
    In addition, our members include many of the new Low Power FM stations
    that are putting new local voices on the airwaves. NFCB is the sole
    national organization representing this group of stations which provide
    service in the smallest communities of this country as well as the
    largest metropolitan areas.
        In summary, the points we wish to make to this subcommittee are
    that NFCB:
      --Requests $430 million in funding for CPB for fiscal year 2009, a
            $30 million increase over the fiscal year 2008 advance
            appropriation;
      --Requests $40 million in fiscal year 2007 for conversion of public
            radio and television to digital broadcasting. Also supports
            funding for the Public TV interconnection system;
      --Requests that advance funding for CPB is maintained to preserve
            journalistic integrity and facilitate planning and local
            fundraising by public broadcasters;
      --Reject the Administration's proposal to rescind $103 million of
            already-appropriated fiscal year 2007 and 2008 CPB funds;
      --Supports CPB activities in facilitating programming and services to
            Native American, African American and Latino radio stations;
      --Supports CPB's efforts to help public radio stations utilize new
            distribution technologies and requests that the subcommittee
            ensure that these technologies are available to all public
            radio services and not just the ones with the greatest
            resources.
        Community Radio fully supports $430 million in Federal funding for
    the Corporation for Public Broadcasting in fiscal year 2009. Federal
    support distributed through CPB is an essential resource for rural
    stations and for those stations serving minority communities. These
    stations provide critical, life-saving information to their listeners
    and are often in communities with very small populations and limited
    economic bases, thus the community is unable to financially support the
    station without Federal funds.
        In larger towns and cities, sustaining grants from CPB enable
    Community Radio stations to provide a reliable source of noncommercial
    programming about the communities themselves. Local programming is an
    increasingly rare commodity in a Nation that is dominated by national
    program services and concentrated ownership of the media.
        For the past 30 years, CPB appropriations have been enacted two
    years in advance. This insulation has allowed pubic broadcasting to
    grow into a respected, independent, national resource that leverages
    its Federal support with significant local funds. Knowing what funding
    will be available in advance has allowed local stations to plan for
    programming and community service and to explore additional non-
    governmental support to augment the Federal funds. Most importantly,
    the insulation that advance funding provides ``go[es] a long way toward
    eliminating both the risk of and the appearance of undue interference
    with and control of public broadcasting.'' (House Report 94-245.)
        For the last few years, CPB has increased support to rural stations
    and committed resources to help public radio take advantage of new
    technologies such as the Internet, satellite radio and digital
    broadcasting. We commend these activities which we feel provide better
    service to the American people but want to be sure that the smaller
    stations with more limited resources are not left out of this
    technological transition. A step in this direction is the $3 million
    Internet Service Grant Fund that will help rural and minority stations
    serve their listeners and communities better through a website. We ask
    that the subcommittee include language in the appropriation that will
    ensure that funds are available to help the entire public radio system
    utilize the new technologies, particularly rural and minority stations.
        NFCB commends CPB for the leadership it has shown in supporting and
    fostering the programming services to Latino stations and to Native
    American stations. For example, Satelite Radio Bilingue provides 24
    hours of programming to stations across the United States and Puerto
    Rico addressing issues in Spanish of particular interest to the Latino
    population. At the same time, American Indian Radio on Satellite
    (AIROS) is distributing programming for the Native American stations,
    arguably the fastest growing group of stations. There are now over 33
    stations controlled by and serving Native Americans.
        Last year CPB funded the establishment of the Center for Native
    American Public Radio (CNAPR). Based on a comprehensive assessment of
    the Native American Radio System, CNAPR will develop new funding
    sources for Native stations and programming; provide direct services to
    the Native Radio System; encourage collaborations; and represent the
    Native Radio System. These stations are critical in serving local
    isolated communities (all but one are on Indian Reservations) and in
    preserving cultures that are in danger of being lost. CPB's assessment
    recognized that ``. . . Native Radio faces enormous challenges and
    operates in very difficult environments.'' CPB funding is critical to
    these rural, minority stations. CPB's funding of the Intertribal Native
    Radio Summit in 2001 helped to pull these isolated stations together
    into a system of stations that can support each other. The CPB
    assessment goes on to say: ``Nevertheless, the Native Radio system is
    relatively new, fragile and still needs help building its capacity at
    this time in its development.'' The Center for Native American Public
    Radio promises to leverage additional, new funding to ensure that these
    stations can continue to provide essential services to their
    communities.
        CPB also funded a Summit for Latino Public Radio which took place
    in September 2002 in Rohnert Park, California, home of the first Latino
    Public Radio station. These Summits have expanded the circle of support
    for Native and Latino Public Radio and identified projects that will
    improve efficiency among the stations through collaborations and
    explore new ways of reaching the target audiences.
        CPB plays a very important role for the public and Community Radio
    system. They are the convener of discussions on critical issues facing
    us as a system. They support research so that we have a better
    understanding of how we are serving listeners. And they provide funding
    to programming, new ventures, expansion to new listeners, and projects
    that improve the efficiency of the system. This is particularly
    important at a time when there are so many changes in the radio and
    media environment with new distribution technologies and media
    consolidation. An example of this support is the grant that NFCB
    received to update and publish our Public Radio Legal Handbook online.
    This provides easy-to-read information to stations about complying with
    governmental regulations so that stations can function legally and use
    their precious resources for programming instead of legal fees.
        Finally, Community Radio supports $40 million in fiscal year 2007
    for conversion to digital broadcasting by public radio and television.
    It is critical that this digital funding be in addition to the on-going
    operational support that CPB provides. The President's proposal that
    digital money should be taken from the fiscal year 2007 CPB
    appropriation would effectively cut stations' grants by over 20
    percent. This would have a devastating impact as stations trying to
    recover from hard economic times. And it would come at a time when the
    local voices of community and public radio are especially important to
    notify and support people during emergency situations and to help
    communities deal with the loss of loved ones--things that commercial
    radio is no longer able to do because of media consolidation.
        While public television's digital conversion needs are mandated by
    the FCC, public radio is converting to digital to provide more public
    service and to keep up with what commercial radio is doing. The Federal
    Communications Commission has approved a standard for digital radio
    transmission. CPB has provided funding for 461 transmitters to convert
    to digital, is supporting additional research on AM radio conversion,
    and is working with radio transmitter and receiver manufacturers to
    build in the capacity to provide a second channel of programming. Most
    exciting to public and community radio is the encouraging results of
    tests that National Public Radio has conducted, with funding from CPB,
    that indicate that stations can broadcast at least two high-quality
    signals, even while they continue to provide the analog signal. The
    development of second audio channels will potentially double the public
    service that public radio can provide, particularly in service to
    unserved and underserved communities. This initial funding still leaves
    nearly 400 radio transmitters that will ultimately need to convert to
    digital or be left behind.
        Federal funds distributed by the CPB should be available to all
    public radio stations eligible for Federal equipment support through
    the Public Telecommunications Facilities Program (PTFP) of the National
    Telecommunications and Information Agency of the Department of
    Commerce. In previous years, Federal support for public radio has been
    distributed through the PTFP grant program. The PTFP criteria for
    funding are exacting, but allow for wider participation among public
    stations. Stations eligible for PTFP funding and not for CPB funding
    include small-budget, rural and minority controlled stations and the
    new Low Power FM service.
        We appreciate Congress' direction to CPB that it utilize its
    digital conversion fund for both radio and television and ask that you
    ensure that the funds are used for both media. Congress stated, with
    regard to fiscal year 2000 digital conversion funds:

        ``The required (digital) conversion will impose enormous costs on
    both individual stations and the public broadcasting system as a whole.
    Because television and radio infrastructures are closely linked, the
    conversion of television to digital will create immediate costs not
    only for television, but also for public radio stations (emphasis
    added). Therefore, the Committee has included $15,000,000 to assist
    radio stations and television stations in the conversion to
    digitalization . . .'' (S. Rpt. 105-300)''

        Community Radio also supports funding for the public television
    interconnection system. Interconnection is vital to the delivery of the
    high quality programming that public broadcasting provides to the
    American people.
        This is a period of tremendous change. Digital is transforming the
    way we do things; new distribution avenues like digital satellite
    broadcasting and the Internet are changing how we define the business
    we are in; the concentration of ownership in commercial radio makes
    public radio in general, and Community Radio in particular, more
    important as a local voice than we have ever been. New Low Power FM
    stations are providing new local voices in their communities. Community
    radio is providing essential local emergency information, programming
    about the local impact of the major global events taking place,
    culturally appropriate information and entertainment in the language of
    the native culture, as well as helping to preserve cultures that are
    dying out. During the natural disasters of this last year, radio proved
    once again to be the most dependable, available medium to get emergency
    information to the public.
        During these challenging times, the role of CPB as a convener of
    the system becomes even more important. The funding that it provides
    will allow the smaller stations to participate along with the larger
    stations which have more resources, as we move into a new era of
    communications.
        Thank you for your consideration of our testimony.
                                     ______

             Prepared Statement of the National Minority Consortia
        The National Minority Consortia (NMC) submits this statement on the
    fiscal year 2009 appropriation for the Corporation for Public
    Broadcasting (CPB). The NMC is a coalition of five national
    organizations dedicated to bringing a significant amount of programming
    from our communities into the mainstream of public broadcasting and to
    other media. The role we fulfill in this regard is crucial to public
    broadcasting's mission. We are unique as organizations and as a
    coalition of organizations in the services we provide to our
    communities and to public broadcasting. In summary, we ask the
    Committee to:
      --Direct CPB to increase its efforts for diverse programming with
            commensurate increases for minority programming and the
            National Minority Consortia
      --Direct CPB to continue its support for the Native radio system
      --Recommend at least $430 million for CPB core funding for fiscal
            year 2009, a $30 million increase over fiscal year 2008 and the
            amount being requested by CPB
      --Reject the Administration's proposal to end advance funding for CPB
      --Reject the Administration's proposal to rescind $103 million of
            already-appropriated fiscal years 2007 and 2008 CPB funds
                                report language
        We ask for Committee report language, as a follow-up to report
    language from last year, which recognizes the contribution of the NMC
    and directs that the CPB partnership with us be expanded. The report
    from last year stated:

        ``The Committee recognizes the importance of the partnership CPB
    has with the National Minority Public Broadcasting Consortia, which
    helps develop, acquire, and distribute public television programming to
    serve the needs of African American, Asian American, Latino, Native
    American, Pacific Islander, and many other viewers. As many communities
    in the Nation welcome increased numbers of citizens of diverse ethnic
    backgrounds, the local public television stations should strive to meet
    these viewers' needs. With an increased focus on programming to meet
    local community needs, the Committee encourages CPB to support and
    expand this critical partnership.'' (S. Rpt. 109-103, p. 298)

        We request that the above language be modified to direct CPB to
    increase its support of the NMC and that it also include a reference to
    radio.
                         fiscal year 2009 appropriation
        We support a fiscal year 2009 Federal appropriation for CPB of at
    least $430 million. This would be a reasonable, albeit modest,
    contribution toward our national treasure of public broadcasting. The
    quality gap between network television and public television has never
    been wider, and it continues to grow with each new ``reality'' show.
        Public broadcasting, including PBS, NPR, and Native Radio is
    particularly important for our Nation's growing minority and ethnic
    communities. While there is a niche in the commercial broadcast and
    cable world for quality programming about our communities and our
    concerns, it is in the public broadcasting industry where minority
    communities and producers are more able to bring quality programming
    for national audiences. Additionally, public television and radio is
    universally available.
                                advance funding
        We strongly oppose the Administration's proposal that the advance
    funding for CPB be eliminated, a proposal that would stop CPB funding
    for two years. We appreciate that Congress has rejected this proposal
    each of the last five years. Reasons to continue advance funding for
    CPB include:
      --The development of production of programming for public
            broadcasting usually takes several years and substantial lead
            time is necessary for planning productions.
      --Public broadcasting programs are supported by multiple funding
            sources, and two years advance knowledge of the amount of
            Federal funding allows CPB to more effectively leverage its
            Federal funds to bring in other sources of revenue.
      --The NMC administers a significant amount of CPB programming monies,
            and elimination of advance funding would negatively affect our
            organizations' planning, fundraising and producing work for
            public television and radio.
                 rescission of fiscal year 2007 and 2008 funds
        We are extremely concerned about the Administration's proposal to
    rescind $103 million of already appropriated fiscal year 2007 and 2008
    CPB funds ($53.5 million of fiscal year 2007 and $50 million of fiscal
    year 2008 funds). Such a rescission/diversion of funds would wreck
    havoc on our organizations and the independent producers that we help
    support as well as many radio and television stations.
                                  native radio
        Native American Public Telecommunications--one of the five National
    Minority Consortia organizations--works with both the radio and
    television sides of public broadcasting. NAPT operates American Indian
    Radio on Satellite (AIROS) which distributes programming to Native-
    owned and other radio stations. Koahnic Broadcasting Corporation,
    headquartered in Alaska, also produces and distributes Native American
    programming.
        Native-owned radio is the fastest growing area of community radio.
    There are currently 33 Native-owned stations, all but one of which is
    located in Indian country. We greatly appreciate CPB's central role in
    the establishment late last year of the Center for Native American
    Public Radio (CNAPR), an organization that will provide technical and
    other services to Native radio stations. CNAPR's mission also includes
    developing new sources of revenue for the Indian radio system and being
    an advocate for Native radio. CPB is providing $1.5 million over a
    three-year period for CNAPR.
        We ask that this Committee urge CPB to continue its support for
    Native radio.
                     about the national minority consortia
        With primary funding from the Corporation for Public Broadcasting,
    the NMC serves as an important component of American public television.
    By training and mentoring the next generation of minority producers and
    program managers we are able to ensure the future strength of public
    television and radio television programming from our communities.
    Individually, each Consortia organization is engaged in cultivating
    ongoing relationships with the independent producer community by
    providing technical assistance, program funding, programming support
    and distribution. Often the funding we provide is the initial seed
    money for a project, thus allowing it to develop. We also provide
    numerous hours of programming to individual public television and radio
    stations, programming that is beyond the production reach of most local
    stations.
        While the Consortia organizations work on projects specific to
    their communities, the five organizations also work collaboratively.
    One example is our joint effort on the public television four-part
    series, Matters of Race that aired in the Fall of 2003. That series
    explored the complexity of our rapidly changing multiracial,
    multicultural society in America. The project resulted in more than
    television programming. The project was designed so that modules could
    be pulled out for classroom use. It was also formatted for radio
    broadcast and for the internet, and included extended interviews. This
    project provided a great opportunity for extensive and diverse
    community outreach and collaboration throughout its development,
    distribution, and use.
        We also worked with American Public Television on 6 one-hour
    programs (named Colorvision) featuring the work of Native American,
    Asian American, Pacific Islander, Latino and African American
    filmmakers and television producers. It is now in national distribution
    for all public television stations.
        Below is information about our individual organizations.
    Center for Asian American Media
        The Center's mission is to present stories that convey the richness
    and diversity of the Asian American experience to the broadest possible
    audience. Over our 25-year history we have provided funding for more
    than 200 projects, many of which have gone on to win Academy, Emmy and
    Sundance awards, examples of which are Daughter from Danang, Of Civil
    Wrongs and Rights; The Fred Korematsu Story; and Maya Lin: A Strong
    Clear Vision. The Center reaches large audiences through the annual
    International Asian American Film Festival and distributes Asian
    Pacific American media to schools, colleges, and universities.
    Latino Public Broadcasting
        LPB supports the development, production, acquisition and
    distribution of non-commercial educational and cultural television,
    representative of Latino people. The resulting programs, disseminated
    to public television and other public telecommunications entities,
    provide a voice to the diverse Latino community throughout the United
    States. Productions that have received LPB support include Mirror
    Dance; Visiones: Latino Art and Culture; Life and Time of Frida Kahlo;
    The Blue Diner; Farmingville; and The New Americans.
    National Black Programming Consortium
        The mission of NBPC, founded in 1979, is to preserve and promote
    complex and dynamic stories of the African Diaspora through program
    development, outreach and audience development, and professional
    development. NPBC has provided hundreds of hours of programming to the
    national PBS schedule; provided seed money to hundreds of projects by
    African American and other producers, and served as a window for
    emerging producers to break into the national; public broadcasting
    system. Currently under production is a film on issues surrounding
    Hurricane Katrina. During Black History Month in 2005, over 30 hours of
    programming were fed to stations. Examples of NBPC-supported programs
    are Two Towns of Jasper; The Murder of Emmett Till; A Doula Story; and
    Daughters of the Dust.
    Native American Public Telecommunications
        NAPT, founded in 1977, utilizes various media--public television,
    public radio, and the internet--to bring awareness of Indian and Alaska
    Native issues to the Nation. We market and distribute up to 10 hours
    per year on public television stations nationwide and fund 5 to 10 new
    Native productions annually. NAPT operates American Indian Radio on
    Satellite (AIROS) which distributes programming to the 33 Native-owned
    radio stations and other radio stations. Among the programming we offer
    is a national daily radio talk show, Native America Calling, on Native
    subjects, and we also cover live major Indian events. Between 2002 and
    2005, NAPT delivered or supported the delivery of 24 hours of
    programming to public television. We also funded 30 projects,
    represented by 54 producers. NAPT projects garnered 3 national awards
    and 15 film festival awards during this time period.
    Pacific Islanders in Communications
        PIC delivers programs and training that bring new voice and
    visibility to Pacific Islands. A recent program which we helped bring
    into being is the award-wining Whale Rider, a story about a young Maori
    girl who confronts years of tribal tradition to fulfill her destiny as
    the leader of her people. When this program was aired on PBS, 107
    million households watched the film. In partnership with the Girl
    Scouts, we held free screenings of the film and developed a website
    about the Maori people. PIC offers a wide range of development
    opportunities for Pacific Island producers through travel grants,
    seminars and media training.
    CPB Funds for the National Minority Consortia
        The National Minority Consortia currently receives funds from two
    portions of the CPB budget, organization support funds from the Systems
    Support and programming funds from the Television Programming sections.
    CPB financial support is critical to the work of our organizations. We
    believe that we make a major contribution to public broadcasting with a
    very modest amount of funding, but there is so much more that should be
    done.
        The organizational support funds we receive from CPB are used not
    only for operations requirements but for also for a broad array of
    programming support activities and for outreach to our communities. We
    received $1.8 million in fiscal year 2006 CPB funds for organizational
    support ($370,000 for each organization). This represents 0.45 percent
    of the fiscal year 2006 CPB appropriation. We have received only very
    small increases in operations support funds in the past several years.
        The programming funds we receive from CPB are re-granted to
    producers, used for purchase of broadcast rights and other related
    programming activities. Each organization solicits applications from
    our communities for these programming funds. We received $3.1 million
    in fiscal year 2006 CPB funds for programming ($636,363 for each
    organization). This represents 0.78 percent of the fiscal year 2006 CPB
    appropriation. Our CPB programming funds have remained virtually flat
    over the past nine years, despite increases in CPB appropriations.
        Thank you for your consideration of our recommendations. We see new
    opportunities to increase diversity in programming, production,
    audience, and employment in the new media environment, and we thank
    Congress for support of our work on behalf of our communities.
                                     ______

              Prepared Statement of the Railroad Retirement Board
        Mr. Chairman and Members of the Committee: We are pleased to
    present the following information to support the Railroad Retirement
    Board's (RRB) fiscal year 2007 budget request.
        The RRB administers comprehensive retirement/survivor and
    unemployment/sickness insurance benefit programs for railroad workers
    and their families under the Railroad Retirement and Railroad
    Unemployment Insurance Acts. The RRB also has administrative
    responsibilities under the Social Security Act for certain benefit
    payments and Medicare coverage for railroad workers. During fiscal year
    2005, the RRB paid nearly $9.2 billion in retirement/survivor benefits
    to about 634,000 beneficiaries, and $72.9 million in unemployment/
    sickness insurance benefits to about 29,000 claimants.
        We are requesting $103,517,570 for agency operations in fiscal year
    2007, which is the same as the amount included in the President's
    proposed budget. We are also requesting a legislative change to permit
    the RRB to continue using the services of the Department of the
    Treasury for disbursement of retirement and survivor benefits. In
    addition, we are requesting that the appropriations language for the
    Dual Benefits Payments Account be revised to make it clear that a
    rescission does not preclude the availability of the 2 percent
    supplemental funding in that appropriation.
                             agency administration
        The President's proposed budget would provide $2 million more than
    the RRB's appropriation for fiscal year 2006. The increase is intended
    to provide for information technology improvements, which are needed to
    maintain the agency's service delivery systems. We estimate that under
    current legislation, the President's proposed budget would provide
    sufficient funding for a staffing level of 895 FTE's, which is 53 FTE's
    less than we expect to use in fiscal year 2006. In order to reach this
    level, we would need to conduct a reduction-in-force (RIF) of about 31
    employees at an estimated cost of $394,000. However, the RIF could be
    avoided if the RRB is not required to contract for the services of a
    nongovernmental disbursement agent in fiscal year 2007, as discussed in
    the following section.
        Administrative funding requested for fiscal year 2007 includes a
    total of $2.7 million for information technology investments, of which
    $1,557,000 would be used for a project begun in fiscal year 2005, to
    transition our mainframe non-relational database management system to a
    current technology relational database management system, DB2. The
    project, which directly correlates with our Enterprise Architecture
    Strategic Plan, will reduce the RRB's dependency on declining
    technologies, with their attendant risk of failure, and enable the
    agency to move ahead with further improvements to the benefit payment
    systems. In fiscal year 2007, we plan to use contractual support to
    optimize the performance of our databases and further reduce data
    redundancy in order to ensure acceptable response times and system
    availability.
        We are also moving forward to streamline the RRB's field service
    operations. In fiscal year 2005, we approved a high-level plan to
    restructure the field service into a hub and satellite configuration
    that will enhance the agency's ability to distribute work more
    efficiently among offices. In fiscal year 2006, we hired a consultant
    to assist in developing a 5-year plan that will include consolidation,
    co-location, and/or the establishment of virtual offices in the field
    service. The plan is to identify out-year savings while maintaining
    good customer service.
                       nongovernmental disbursement agent
        Section 107(e) of the Railroad Retirement and Survivors'
    Improvement Act of 2001 (Public Law 107-90) provides for contracting
    with a nongovernmental agent for the disbursement of railroad
    retirement benefits. However, initial market research has indicated
    that the cost of doing so would be about three times the cost of having
    similar services provided by the Department of the Treasury. In
    addition, our Inspector General has questioned whether certain services
    provided by the Department of the Treasury, such as reclamations, would
    be provided as effectively by a nongovernmental disbursement agent.
        We have concluded that outsourcing this function would be
    inconsistent with the President's policy of outsourcing only where the
    government would reduce costs. For fiscal years 2005 and 2006, the
    Congress added language to our appropriations bill prohibiting this
    transfer: Section 516 of Public Law 109-149, the Departments of Labor,
    Health and Human Services, and Education, and Related Agencies
    Appropriations Act, 2006 provides that none of the funds appropriated
    under the Act are to be used to contract with a nongovernmental
    disbursement agent. The RRB also submitted separate legislation to the
    Congress on May 5, 2005, to address this issue.
        Our estimates indicate that the cost of contracting with a
    nongovernmental disbursement agent would be about $3 million for the
    first year and $2.3 million in subsequent years. By comparison, the
    annual cost of having these services provided by the Department of the
    Treasury is about $800,000. Enactment of legislation to remove this
    requirement would provide sufficient savings in fiscal year 2007 to
    enable the RRB to cover essential operating costs at the proposed
    budget level.
                  vested dual benefits payments appropriation
        The President's proposed budget includes $88 million to fund the
    continuing phase-out of vested dual benefits, plus a 2 percent
    contingency reserve, $1,760,000, which ``shall be available
    proportional to the amount by which the product of recipients and the
    average benefit received exceeds $88,000,000.''
        The requested funding level of $88 million reflects the RRB Chief
    Actuary's current estimate of the amount needed to pay full benefits in
    fiscal year 2007. However, the estimate does not provide for the effect
    of a possible rescission, which could significantly reduce the total
    amount provided in the budget year. Because the Dual Benefits Payments
    Account is classified as discretionary rather than mandatory,
    appropriations to the account have been reduced in recent years by
    across-the-board rescissions enacted as part of the annual
    appropriations process. The reductions have created a risk that vested
    dual benefits payments would need to be reduced due to insufficient
    funding in the account.
        The Railroad Retirement Act provides that vested dual benefits
    payments in a fiscal year may not exceed the amount appropriated for
    that year. If the amount appropriated is not sufficient to fund full
    payments, individual vested dual benefits must be reduced on a pro rata
    basis. However, the current appropriations language is unclear as to
    whether the 2 percent contingency reserve would be available to cover a
    shortfall due to a rescission. We request that the appropriations
    language be revised to clarify that the contingency reserve may be used
    if needed to prevent a reduction of current-year benefits for any
    reason.
        In addition to the requests noted above, the President's proposed
    budget includes $150,000 for interest related to uncashed railroad
    retirement checks.
                      financial status of the trust funds
        Railroad Retirement Accounts.--The RRB continues to coordinate its
    activities with the National Railroad Retirement Investment Trust
    (NRRIT), which was established by the Railroad Retirement and
    Survivors' Improvement Act of 2001 to manage and invest railroad
    retirement assets. Through fiscal year 2005, the RRB transferred a
    total of $21.276 billion to the NRRIT for this purpose. During the same
    period, the NRRIT transferred $2.673 billion to the Railroad Retirement
    Account for payment of retirement and survivor benefits. As of
    September 30, 2005, the market value of NRRIT-managed railroad
    retirement assets was approximately $27.7 billion.
        In June 2005, we released the annual report on the railroad
    retirement system required by Section 22 of the Railroad Retirement Act
    of 1974, and Section 502 of the Railroad Retirement Solvency Act of
    1983. The report, which reflects changes in benefit and financing
    provisions under the Railroad Retirement and Survivors' Improvement Act
    of 2001, addresses the 25-year period 2005-2029 and contains generally
    favorable information concerning railroad retirement financing. The
    report includes projections of the status of the retirement trust funds
    under three employment assumptions. These indicate no cash flow
    problems throughout the projection period. The findings represent an
    improvement over last year's report and reflect continued favorable
    employment experience in the railroad industry.
        Railroad Unemployment Insurance Account--The equity balance of the
    Railroad Unemployment Insurance Account at the end of fiscal year 2005
    was $94.2 million, an increase of $14.3 million from the previous year.
    The RRB's latest annual report on the financial status of the railroad
    unemployment insurance system was issued in June 2005. The report
    indicated that even as maximum daily benefit rates rise 39 percent
    (from $56 to $78) from 2004 to 2015, experience-based contribution
    rates maintain solvency, with the exception of small, short-term cash
    flow problems in 2007 and 2008. Projections show quick repayment of the
    loans, even under our most pessimistic assumption. The average employer
    contribution rate remains well below the maximum throughout the
    projection period, but a 1.5 percent surcharge is now in effect and is
    expected for calendar year 2007. We did not recommend any financing
    changes based on this report.
        In conclusion, we want to stress the RRB's continuing commitment to
    improving our operations and providing quality service to our
    beneficiaries. Thank you for your consideration of our budget request.
    We will be happy to provide further information in response to any
    questions you may have.
                                     ______

              Prepared Statement of the Railroad Retirement Board
        Mr. Chairman and members of the subcommittee: My name is Martin J.
    Dickman, Inspector General of the Railroad Retirement Board (RRB). I
    would like to thank you, Mr. Chairman, and the members of the committee
    for your continued support for the Office of Inspector General. I wish
    to describe our fiscal year 2007 appropriations request and our planned
    activities.
        The Office of Inspector General requests funding of $7,606,000 to
    ensure the continuation of its independent oversight of the RRB. The
    agency is responsible for managing benefit programs which paid $9.2
    billion in retirement and survivor benefits to approximately 634,000
    beneficiaries in fiscal year 2005 and an additional $73 million in net
    railroad unemployment and sickness insurance benefits to 29,000
    claimants. The RRB also administers Medicare Part B, the physician
    services aspect of the Medicare program, for qualified railroad
    retirement beneficiaries. Through this program, approximately $870
    million in annual Medicare benefits are paid to approximately 535,000
    beneficiaries.
        In fiscal year 2007, the Office of Inspector General will continue
    to concentrate its efforts on the performance of reviews of significant
    policy issues and program operational areas. We will coordinate our
    efforts with agency management to identify and eliminate operational
    weaknesses. We will also continue our investigation of allegations of
    fraud, waste and abuse, and refer cases for prosecution and monetary
    recovery action.
        We also request the removal of the prohibition on the use of
    appropriated funds for any audit, investigation or review of the
    Railroad Medicare program. The RRB manages a nationwide contract for
    processing Medicare Part B claims for railroad beneficiaries. The
    agency is responsible for the enrollment of beneficiaries, premium
    collection, answering beneficiary inquiries and conducting the annual
    Carrier Performance Evaluation for the Medicare carrier.
        The prohibition does not permit this office to fulfill its
    statutory oversight responsibilities for a major agency program.
    Removal of the prohibition would benefit both the Railroad Retirement
    Board and its constituents, and would be consistent with the priorities
    established by the Administration and the Congress to reduce fraud in
    one of the largest Federal programs.
        We also request oversight authority to conduct audits and
    investigations of the National Railroad Retirement Investment Trust
    (NRRIT), the body responsible for the investment of approximately $29
    billion in trust funds used to support Railroad Retirement Act benefit
    programs. This office would ensure sufficient reporting mechanisms are
    in place and that the NRRIT members are fulfilling their fiduciary
    responsibilities. We have repeatedly expressed concerns about RRB
    management's passive relationship with the NRRIT, and identified the
    issue as a serious challenge for the RRB.
        We are currently required to reimburse the agency for office space,
    equipment, communications, office supplies, maintenance and other
    administrative services. We are the only Federal OIG that cannot
    negotiate a service level agreement with its parent agency, and,
    therefore, request that the current appropriation language be amended
    accordingly.
                                office of audit
        Auditors will perform the audit of the RRB's 2006 financial
    statements and preliminary work for the 2007 financial statements to
    ensure the issuance of reliable financial information. The OIG will
    obtain contractor actuarial services to audit the statement of social
    insurance.
        Audit staff will work with agency management to ensure detailed and
    verifiable financial information is available from the National
    Railroad Retirement Investment Trust (NRRIT). As discussed above, we
    believe RRB management should take a more active interest in NRRIT
    activities.
        Auditors will conduct the annual evaluation of the RRB's
    information systems security to meet the requirements of the Federal
    Information Security Management Act of 2002. They will also monitor the
    agency's information systems operations to determine if the agency is
    meeting the goals established in its Strategic Information Resources
    Management Plan and to ensure the agency is in compliance with the
    provisions of the Information Technology Management Reform Act.
        Auditors will continue to monitor agency actions to address
    security deficiencies and complete corrective actions. They will ensure
    that network and system security safeguards are in place to protect the
    confidentiality of sensitive financial and personal information.
    Auditors will also perform assessments of the agency's e-government
    initiatives to identify and eliminate system vulnerabilities, and to
    ensure compliance with the E-Government Act of 2002. We will continue
    our monitoring efforts of the RRB's document imaging activities and the
    expansion of paperless processing to ensure the integrity of records.
        Auditors will continue to review RRB benefit processes and
    procedures to identify ways to reduce administrative and adjudicative
    errors. They will offer recommendations to strengthen the agency's debt
    collection program to reduce the outstanding receivables.
                            office of investigations
        The Office of Investigations (OI) identifies, investigates and
    presents cases for prosecution, throughout the United States,
    concerning fraud in RRB benefit programs. In fiscal year 2007, OI will
    continue to focus its resources on the investigation of cases with the
    highest fraud losses. OI currently has approximately 500 active
    investigations involving fraudulent benefit payments and fraudulent
    reporting with fraud losses of approximately $11.8 million. These cases
    involve all RRB programs that provide sickness and unemployment
    insurance benefits to injured or unemployed workers, retirement
    benefits, and disability benefits for workers who are disabled.
        We will coordinate our efforts with agency program managers to
    address weaknesses in agency programs that allow fraudulent activity to
    occur, and will recommend changes to ensure program integrity.
        We will concentrate resources on cases with the highest fraud
    losses, those related to the RRB's retirement and disability programs.
    OI will dedicate considerable time to the investigation of nationwide
    schemes to defraud the RRB disability program. Disability cases
    currently constitute about 44 percent of our investigative caseload.
    These cases involve more complicated schemes and result in the recovery
    of substantial funds for the agency's trust funds.
        In fiscal year 2007, we will continue to use the Department of
    Justice Affirmative Civil Enforcement (ACE) program for those cases
    which do not meet the criminal guidelines of U.S. Attorneys. Through
    this program, we are able to obtain civil judgements and recover trust
    fund monies for the RRB.
                                    summary
        In fiscal year 2007, the Office of Inspector General will continue
    to focus resources on the reviewing RRB program operations and ensuring
    the integrity of agency trust funds. We will also continue to
    aggressively pursue individuals who engage in activities to
    fraudulently obtain RRB funds.
                                     ______

                  Prepared Statement of The Nature Conservancy
        Mr. Chairman and members of the subcommittee, I appreciate this
    opportunity to present The Nature Conservancy's recommendations for
    fiscal year 2007 appropriations. The Nature Conservancy is an
    international, nonprofit organization dedicated to the conservation of
    biological diversity. Our mission is to preserve the plants, animals
    and natural communities that represent the diversity of life on Earth
    by protecting the lands and waters they need to survive. Our on-the-
    ground conservation work is carried out in all 50 States and in 27
    foreign countries and is supported by approximately one million
    individual members. We have helped conserve nearly 15 million acres of
    land in the United States and Canada and more than 102 million acres
    with local partner organizations globally.
        The Conservancy owns and manages approximately 1,400 preserves
    throughout the United States--the largest private system of nature
    sanctuaries in the world. We recognize, however, that our mission
    cannot be achieved by core protected areas alone. Therefore, our
    projects increasingly seek to accommodate compatible human uses, and
    especially in the developing world, to address sustained human well-
    being.
        The focus of my testimony is on the Americorps National Civilian
    Conservation Corps (NCCC) program, which has made a tremendous
    contribution, as well as provided cost savings, to conservation and
    public recreation in the United States. The President's fiscal year
    2007 Budget proposes to cut funding for the program from $26.7 million
    to $4.9 million, with the intention of eliminating the program
    completely. The Nature Conservancy urges the Committee to retain
    funding for the NCCC program at its current levels.
        NCCC has been known in recent months for the critical support its
    participants provided to disaster relief efforts after Hurricane
    Katrina. We applaud those efforts. We also want to highlight the
    important conservation work that NCCC participants have engaged in over
    the past years. Many Federal, State, and local government agencies, as
    well as non-profit conservation organizations, use the NCCC program to
    implement Federal programs and to achieve significant public benefits
    at low cost. At the Conservancy, we have employed NCCC participants to
    do the following:
      --Provide outdoor recreational opportunities and health benefits for
            Americans across the country;
      --Use prescribed fire to reduce hazards to communities and restore
            ecosystems;
      --Control invasive species; and
      --Train the next generation of natural resource managers.
        The program has saved our organization millions of dollars in
    recent years, and has provided work that would otherwise take years to
    accomplish, or simply would not get done at all. Below are some
    examples of specific results that NCCC has achieved.
    providing americans with recreational opportunities and health benefits
        As the country's appetite for outdoor recreation grows--and issues
    like childhood obesity demonstrate the importance of increased outdoor
    activity--there is a growing need to provide safe, beautiful places for
    Americans to use and experience. The Nature Conservancy and our
    partners help provide these opportunities through a system of preserves
    and parks. Our efforts are significantly augmented by NCCC
    participants. The NCCC has built and maintained trails and boardwalks,
    restored campsites, repaired interpretive signs, provided wildlife
    protection, planted trees and developed archaeological dig sites. These
    activities provide the public with greater access to the outdoors, at
    low cost, and enhance the outdoors experience.
         using prescribed fire to reduce hazards and restore ecosystems
        As reflected in recent legislative actions, including passage of
    the Healthy Forests Restoration Act of 2004, reduction of hazardous
    fuels on the Nation's forested lands is one of the country's greatest
    land management challenges. President Bush has emphasized the need to
    reduce fire hazards to communities, and restore ecosystems, through
    prescribed burning and other management techniques. Each year, the U.S.
    Forest Service and the Department of the Interior set acreage goals for
    burning and related treatments. The Nature Conservancy provides
    training and personnel to assist in meeting these goals.
        In recent years, NCCC participants have comprised a new cadre of
    fire managers, bringing skills and knowledge to individual projects,
    and assisting government agencies and non-profit land managers alike.
    The Nature Conservancy has used NCCC participants in at least eleven
    States to assist in burning tens of thousands of acres at a cost
    savings of several hundred thousand dollars. We also work with NCCC to
    burn on military bases, U.S. Forest Service lands, State parks and
    natural areas, and other public lands.
        On some projects, fire management results in restoration efforts
    that ease the burden on private landowners and Federal land managers in
    complying with the Endangered Species Act. For example, in Virginia,
    NCCC-assisted burns have restored habitat and supported the recovery of
    an endangered species, the red-cockaded woodpecker. Finally, NCCC
    participants assist land managers and public agencies in measuring
    performance and evaluating the success of fuels treatment efforts.
                    reducing the threat of invasive species
        Invasive species--primarily weeds and insects--are one of the
    principal threats to our natural resources across the United States;
    they have damaged many natural landscapes as well as reduced the value
    of working lands. NCCC participants have assisted in abating impacts of
    invasive species at many locations. Their activities have included
    controlling invasive plants that are destroying valuable salt marshes
    and fens in New York; restoring natural tallgrass prairie by removing
    invasive trees in Minnesota; and preserving riparian and old growth
    forest habitat in Oregon.
        Along with actual removal of invasive species, NCCC participants
    have worked to educate the public on threats of invasive species and
    measures to control them.
             building a new generation of natural resource managers
        As the country's population grows and threats to the environment
    increase, we face constant challenges to the conservation of our
    natural heritage. We will not be able to meet those challenges unless
    we encourage young people to pursue conservation careers and we provide
    them with the necessary training. The NCCC program has succeeded in
    doing this. Our experience is that NCCC participants are organized,
    well-trained and enthusiastic, and that they care deeply about
    conservation--in part because they understand the benefits to
    communities and to people that conservation provides.
        In particular, because of the job training focus of NCCC, its
    participants make up a substantial portion of the country's future fire
    managers--a group of professionals we cannot afford to lose, given the
    hazards that wildfire poses to our communities. A significant portion
    of the Federal fire workforce will retire in the next five years, and
    the NCCC program plays a critical role in replenishing that workforce.
        NCCC makes an important contribution to Americans' access to and
    enjoyment of the outdoors, as well as to conservation of our natural
    heritage. We urge the Committee to provide funding at current services
    levels for this important program.
        Thank you again for the opportunity to testify. If you have
    questions, please contact Louise Milkman at 703-247-3675.
                                     ______

             Prepared Statement of the Voices for National Service
        Mr. Chairman and members of the subcommittee: We are writing as
    members of Voices for National Service to urge you to reject funding
    cuts to AmeriCorps, Learn and Serve America, and the National Civilian
    Community Corps (NCCC) included in the Administration's fiscal year
    2007 budget.
        Voices for National Service is a coalition of more than 160
    community-based organizations, faith-based groups, governor-appointed
    State commissions, private sector partners, institutions of higher
    education, and others dedicated to expanding opportunities for
    Americans to serve community and country.
        Our message to the Labor-HHS Subcommittee is quite simple:
    AmeriCorps, Learn and Serve America, and the NCCC are cost-effective
    programs that meet critical community needs, and funding for these
    programs should be sustained and increased. While we recognize the
    fiscal constraints that lawmakers must operate under, now is not the
    time to cut funding for national service. We urge you to fund these
    programs at their fiscal year 2004 enacted levels:
      --$441 million for AmeriCorps;
      --$43 million for Learn and Serve America; and
      --$26 million for the NCCC.
        We would like to note the following areas of concern and
    consideration as they relate to the appropriation for these programs:
      --We are concerned that the Administration's budget proposes to cut
            funding for the NCCC to $5 million in fiscal year 2007, and to
            eliminate the program by 2008. As numerous first-hand accounts
            by Gulf Coast residents, newspaper stories and op-eds have
            attested in the past weeks, the NCCC responded to the crisis in
            the Gulf Coast heroically, deploying 1,600 members to the
            region who have provided critically needed services and
            support. This is not the time to eliminate a program with a
            proven track record in strengthening America's disaster
            preparedness and relief capacity.
      --While we are eager for NCCC's funding to be reinstated, we hope
            that you will not preserve this program at the expense of other
            critical programs like AmeriCorps State and National and Learn
            and Serve America. Like the NCCC, these programs have had a
            profound impact in the Gulf Coast and in the communities they
            serve. Americans want to serve. We should be expanding their
            opportunities, not eliminating them.
      --We are concerned that despite strong bipartisan support, the
            proposed budget would result in a 17 percent reduction in
            AmeriCorps State and National funding since fiscal year 2004.
            AmeriCorps is a critically needed program that provides
            opportunities for 70,000 Americans to serve each year, and its
            funding should be sustained or increased, not cut.
      --We are concerned that the proposed funding cut to Learn and Serve
            America would have serious negative consequences for both the
            1.5 million students who participate in this program and the
            communities they serve. Compared to its fiscal year 2004
            funding level of $43 million, the proposed cut to $34.2 million
            would mean:
          --300,000 fewer students serving their communities through Learn
                and Serve America;
          --A loss of $34 million in leveraged private and community
                resources; and
          --A decline of 7.3 million service hours to communities.
        We are concerned that the Corporation for National and Community
    Service's plan to continue to recruit 75,000 AmeriCorps members in
    spite of the program's proposed cuts will be detrimental to programs
    running full-time, stipended corps. The proposed cuts include a $300
    reduction in the average Federal contribution per full-time corps
    member. AmeriCorps programs have been required to absorb an increasing
    percentage of their program operating costs. As fixed and mandated
    costs grow, annual reductions in operating support are destabilizing
    the AmeriCorps field. Efforts to do more with less threaten AmeriCorps'
    historic mix of full-time and part-time, stipended and non-stipended
    corps.
            about americorps, learn and serve america, and the nccc
        AmeriCorps State and National is a network of local, State, and
    national service programs that connect at least 70,000 Americans each
    year in intensive service to meet our country's needs in education,
    public safety, health, and the environment.
        Learn and Serve America provides State formula and competitive
    grants to support service-learning in K-12 schools, colleges and
    universities, and non-profit organizations. Service-learning integrates
    community service with academic study to enrich learning, teach civic
    responsibility, and strengthen communities. At an average cost of only
    $28 per participant, Learn and Serve America leverages private and
    community resources to yield $4 in services to the community for each
    $1 invested by the government. The program also fosters collaboration
    between educational institutions and civic, faith-based, and community
    groups to engage youth in meaningful service to address local needs,
    help young people answer President Bush's Call to Service, and assist
    in meeting the Corporation's strategic goal of having quality service-
    learning in half of all K-12 schools by 2010.
        The AmeriCorps NCCC is a full-time residential program for men and
    women ages 18-24 that strengthens communities while developing leaders
    through direct, team-based national and community service. The NCCC is
    a trained force that can be immediately deployed. Four trained NCCC
    teams were pulled from other assignments and sent to support shelters
    in Mississippi and Alabama one day after Hurricane Katrina hit.
      the role of national service in meeting critical needs in the gulf
                                     coast
        The Administration's budget provides the NCCC with a modest $5
    million appropriation to graduate its final class of corps members and
    permanently close the program's five regional campuses. The budget also
    proposes to cut funding for AmeriCorps State and National, reducing
    funding levels by 17 percent since fiscal year 2004. And yet as we
    write, thousands of AmeriCorps and NCCC members are on the front lines
    in the Nation's response to the greatest natural disaster in U.S.
    history, serving our Nation in the Gulf Coast.
        To date, more than 13,000 national service members have contributed
    to hurricane relief efforts in the Gulf and around the country. NCCC
    members were among the first on the scene, and to date, 1,600 NCCC
    members have served on more than 100 separate disaster service projects
    in the Gulf Coast region, providing humanitarian aid and physical
    service, as well as managing the thousands of outside volunteers who
    want to help. This program embodies the important role that citizens
    must play in partnering with government to respond to community crises
    and national disasters.
        According to Malcolm Jones, City Attorney of Pass Christian,
    Mississippi who worked closely with a team of NCCC members to provide
    services to town residents, ``Our town, on the Gulf Coast of
    Mississippi, 7,000 people, we got the hardest part of [the storm]. When
    I came back after evacuating for Katrina. . . . I found out that
    AmeriCorps [is] a very powerful, powerful thing. [W]hen we lost hope,
    [AmeriCorps] came.''
        Because of AmeriCorps, young people from around the country are
    putting their talents to work in the Gulf Coast region by doing
    everything from clearing debris and repairing roofs in Mississippi, to
    preventing further damage to historic buildings in New Orleans, to
    managing a supply warehouse in Louisiana, and serving displaced
    residents aboard ships in Alabama. We would like to share a few of
    their stories with you as examples of the critical services that
    AmeriCorps and NCCC members are providing:
        Kenye Quiroga was sent to Louisiana one week after joining
    AmeriCorps. He writes that, ``While in D'Iberville we stayed on pallets
    in an old community center with only half a roof. The living definitely
    wasn't easy, but I had the opportunity to get to know some great
    people. By the end of our mission in D'Iberville, my team had assessed
    every household in the town and brought food, water, and medication to
    families who needed emergency supplies.''
        According to Kimberly Walker of Jackson, Mississippi, ``In the
    aftermath of the Hurricane, Mississippi Primary Health Care Association
    served as one of the many distribution points to assist Hurricane
    victims with basic supplies. Our team . . . carried supplies to a
    larger designated distribution site and was able to meet and talk first
    hand to some of the victims. . . . We assisted in directing them to
    other services available to them.''
        Carrie Ann Smith from the West Seneca, New York AmeriCorps program
    was deployed to Slidell, Louisiana. She writes, ``I felt like I was
    entering a war zone. I felt the pain and frustration that still loomed
    in the air, but most of all I felt the need to help, to serve, and to
    make a difference. That's what AmeriCorps does and I am proud to be a
    member of such a noble and upstanding organization. But even more so, I
    am proud to be an American who was given the opportunity to help my
    fellow Americans in a time of tragedy and such utter devastation. I
    would not have had that opportunity if not for AmeriCorps.''
        These young people, and thousands like them, served and continue to
    serve with great distinction, bringing hope and relief to fellow
    citizens, and learning the value of civic engagement and giving to
    communities in need. The national service response, however, has not
    been limited to the on-the-ground effort in the Gulf. In communities
    across the country, national service programs are joining with local,
    State and Federal agencies and nonprofit organizations to provide long-
    term relief to those uprooted and displaced by the storms. For example,
    tens of thousands of students supported by Learn and Serve America are
    collecting school supplies, raising funds and preparing disaster relief
    kits.
                national service accomplishments across america
        In addition to responding to needs in the Gulf Coast region,
    AmeriCorps members are also serving in thousands of communities across
    the United States. Every day, 70,000 AmeriCorps members add value to
    school curricula by tutoring and mentoring, operating after-school
    programs, expanding the reach of community health centers, teaching in
    underserved public and parochial schools, and improving our
    environment.
        Below are just a few examples of the many community needs that
    AmeriCorps members met in 2004-2005:
      --In Florida, members recruited 2,000 community volunteers to provide
            education services, maintained and expanded 200 acres of
            habitat for threatened and endangered species, and built 40
            homes for low-income families.
      --In Kentucky, members educated more than 1,000 at-risk elderly about
            home safety and conducted 265 Home Safety Assessments for
            seniors.
      --In Maryland, members removed 453 tons of trash, improving the
            quality of storm water run-off into the Chesapeake Bay and
            1,900 homeless families received food, clothing, or furniture.
      --In Mississippi, members conducted life skills trainings with 715
            people with disabilities, helped train mentally and
            developmentally disabled adults for employment, and mentored
            1,100 low income and underachieving middle school students.
      --In New York, members transported 1,000 children to medical
            appointments, delivered meals and snacks to about 58,000
            children and seniors, and provided literacy activities to
            almost 17,000 children.
      --In Ohio, members trained more than 9,000 youth in conflict
            resolution, built repaired, or rehabilitated 364 housing units,
            and provided educational support services to 1,500 students
            during the summer months.
      --In Pennsylvania, members tutored almost 14,600 elementary and high
            school students and more than 6,800 citizens received either
            needs assessment or support in the areas of domestic violence,
            foster care, mental health, and housing for homeless veterans.
                      impact of national service programs
        In the last decade, more than 500,000 young Americans dedicated
    themselves to either full or part-time service through AmeriCorps to
    improve their communities and their country. Through dedicated service
    to our Nation, AmeriCorps members have earned Education Awards worth
    more than $1.5 billion that have helped them afford higher education or
    career training.
        Evaluations prove that AmeriCorps works. Recent studies by the
    Center for Leadership and Public Service at Harvard University and
    Bridgestar indicate that the United States is facing a significant
    leadership gap in the next decade. Given the need for an emerging group
    of young leaders to fill leadership positions in the social, private,
    and public sectors, the results of AmeriCorps programs in terms of
    building civic skills and a commitment to public service are striking.
    To cite but a few examples of some of the positive results of recent
    program evaluations:
      --A rigorous multi-site control group evaluation by Abt Associates
            and Brandeis University reported significant employment and
            earnings gains by young people who join service or conservation
            corps.
      --A study of Teach for America (TFA) by Mathematica Research Group
            found that ``it supplies low-income schools with academically
            talented teachers who contribute to the academic achievement of
            their students. TFA teachers . . . produce higher student test
            scores than the other teachers in their schools.''
      --An evaluation of City Year alumni by Policy Studies Associates
            showed that more than three-quarters of alumni reported an
            increased commitment to public responsibility and greater
            knowledge and skills that improved their ability to address and
            solve community problems.
        Learn and Serve America has tremendous impact and support.
    According to a 2004 study by RMC Research, ``Service-learning, when
    implemented with high quality, yields statistically significant impacts
    on students' academic achievement, civic engagement, acquisition of
    leadership skills, and personal/social development.'' Evaluations also
    indicate that the program correlates with a reduction in the number of
    behavioral problems, and reduced sexual activity and pregnancy among
    students.
                          the fiscal year 2007 request
        We understand the funding constraints of the current appropriations
    process, and appreciate your leadership in seeking to provide support
    to the many programs that are meeting community needs across the Nation
    in a challenging fiscal environment.
        Given the track record of AmeriCorps, Learn and Serve America, and
    the NCCC in serving children, families, and communities and in
    responding effectively and efficiently to the recent disasters in the
    Gulf Coast region, we urge you to reject the funding cuts to these
    programs in the administration's fiscal year 2007 budget request and to
    fund these programs at their fiscal year 2004 levels. These programs
    have proven to be worthy of your investment.

           LIST OF WITNESSES, COMMUNICATIONS, AND PREPARED STATEMENTS

                                  ----------
                                                                       Page

    Alexander, Dr. Duane, Director, National Institute of Child
      Health and Human Development, National Institutes of Health,
      Department of Health and Human Services, prepared statement....   135
    Alving, Dr. Barbara M., Acting Director, National Center for
      Research Resources, National Institutes of Health, Department
      of Health and Human Services, prepared statement...............   138
    American:
        Academy of:
            Family Physicians, prepared statement....................   319
            Pediatrics, prepared statement...........................   322
        Association:
            For:
                Cancer Research (AACR), prepared statement...........   384
                Geriatric Psychiatry, prepared statement.............   387
            Of:
                Colleges of:
                    Nursing, prepared statement......................   327
                    Osteopathic Medicine, prepared statement.........   331
                Immunologists, prepared statement....................   391
                Nurse Anesthetists, prepared statement...............   394
        College of Obstetricians and Gynecologists, prepared
          statement..................................................   398
        Diabetes Association, prepared statement.....................   401
        Foundation for the Blind, prepared statement.................   403
        Geological Institute, prepared statement.....................   541
        Lung Association, prepared statement.........................   407
        Nephrology Nurses' Association, prepared statement...........   410
        Nurses Association, prepared statement.......................   332
        Physiological Society, prepared statement....................   404
        Public:
            Health Association, prepared statement...................   412
            Power Association, prepared statement....................   338
        Society:
            For:
                Clinical Pathology, prepared statement...............   415
                Microbiology, prepared statements..................417, 429
            Of Nephrology, prepared statement........................   423
    Americans:
        For:
            Nursing Shortage Relief, prepared statement..............   336
            The Arts, prepared statement.............................   538
    Association of:
        Academic Health Centers, prepared statement..................   426
        American Cancer Institutes, prepared statement...............   428
        Farmworker Opportunity Programs, prepared statement..........   311
        Independent Research Institutes, prepared statement..........   430
        Maternal and Child Health Programs, prepared statement.......   338
        Minority Health Professions Schools, prepared statement......   543
        Women's Health, Obstetric and Neonatal Nurses (AWHONN),
          prepared statement.........................................   431
    Auerbach, Judith, Ph.D., vice president, Public Policy and
      Program Development, Amfar, the Foundation for Aids Research...   208

    Berg, Dr. Jeremy, Director, National Institute of General Medical
      Sciences, National Institutes of Health, Department of Health
      and Human Services, prepared statement.........................   140

    Centers for Disease Control and Prevention Coalition, prepared
      statement......................................................   340
    Central Valley Opportunity Center, prepared statement............   313
    Chao, Moses, M.D., Christopher Reeve Foundation..................   209
    Charles R. Drew University of Medicine and Science, prepared
      statement......................................................   435
    Coalition of Northeastern Governors, prepared statement..........   406
    Cochran, Senator Thad, U.S. Senator from Mississippi:
        Prepared statement...........................................    33
        Statement....................................................    32
    College Board, prepared statement................................   555
    College of New Rochelle, NY, prepared statement..................   344
    Collins, Francis S., M.D., Director, National Human Genome
      Research Institute, National Institutes of Health, Department
      of Health and Human Services...................................   105
        Prepared statement...........................................   125
    Comstock, Amy L., chief executive officer, Parkinson's Action
      Network........................................................   209
        Prepared statement...........................................   210
    Cooley's Anemia Foundation, prepared statement...................   437
    Council of State Administrators of Vocational Rehabilitation
      (CSAVR), prepared statement....................................   558
    Craig, Senator Larry, U.S. Senator from Idaho....................    64
    Crohn's and Colitis Foundation of America, prepared statement....   439

    Diabetes Care Coalition, prepared statement......................   346
    Digestive Disease National Coalition, prepared statement.........   441
    Doris Day Animal League, prepared statement......................   444
    Durbin, Senator Richard, U.S. Senator from Illinois..............    65
    Dystonia Medical Research Foundation, prepared statement.........   446

    Emerson, Stephen, M.D., associate director for clinical research,
      Abramson Cancer Center, University of Pennsylvania Hospital....   211
        Prepared statement...........................................   212
    Eng, Lauren A., president, Spinal Muscular Atrophy Foundation....   213
        Prepared statement...........................................   214

    Fauci, Anthony S., M.D., Director, National Institute of Allergy
      and Infectious Diseases, National Institutes of Health,
      Department of Health and Human Services........................   105
        Prepared statement...........................................   128
    Foster Grandparent Program, prepared statement...................   453
    Fox, Dr. Philip C., director of clinical research, Department of
      Oral Medicine, Carolinas Medical Center on behalf of the
      American Association for Dental Research.......................   215
    Friends of:
        NIDA Coalition, prepared statement...........................   458
        The National Institute on Aging, prepared statement..........   456
    FSH Society, prepared statement..................................   449
    Furlong, Patricia, co-founder and chief executive officer, Parent
      Project Muscular Dystrophy.....................................   216
        Prepared statement...........................................   217

    Gallaudet University, prepared statement.........................   560
    Gandy, Sam, M.D., Ph.D., Chair, Medical and Scientific Advisory
      Council, Alzheimer's Association...............................   217
        Prepared statement...........................................   218
    Gibbons, Ann, member, board of directors, Autism Speaks..........   219
        Prepared statement...........................................   220
    Goldstein, Robert, M.D., Ph.D., chief scientific officer,
      Juvenile Diabetes Research Foundation..........................   221
        Prepared statement...........................................   221
    Grady, Dr. Patricia A., Director, National Institute of Nursing
      Research, National Institutes of Health, Department of Health
      and Human Services, prepared statement.........................   143

    Harkin, Senator Tom, U.S. Senator from Iowa:
        Prepared statements.........................................10, 108
        Questions submitted by......................................97, 256
        Statements..................................................64, 107
    Health Professions and Nursing Education Coalition, prepared
      statement......................................................   562
    Heart Rhythm Society, prepared statement.........................   461
    Hemophilia Federation of America, prepared statement.............   464
    Hepatitis Foundation International, prepared statement...........   465
    HHT Foundation International, prepared statement.................   478
    Hodes, Dr. Richard J., Director, National Institute on Aging,
      National Institutes of Health, Department of Health and Human
      Services, prepared statement...................................   145
    Holzman, Lawrence B., M.D., chairman, scientific advisory board,
      Nephcure Foundation............................................   225
        Prepared statement...........................................   226
    Houser, Steven R., Ph.D., director, cardiovascular research
      center, Temple University School of Medicine on behalf of the
      American Heart Associa-
      tion...........................................................   227
        Prepared statement of........................................   228
    Hrynkow, Dr. Sharon, Acting Director, Fogarty International
      Center, National Institutes of Health, Department of Health and
      Human Services, prepared statement.............................   148

    In Defense of Animals, prepared statement........................   468
    Independence Technology, prepared statement......................   471
    Industrial Minerals Association--North America, prepared
      statement......................................................   477
    Inouye, Senator Daniel K., U.S. Senator from Hawaii, questions
      submitted by.............................................53, 100, 258
    Insel, Dr. Thomas R., Director, National Institute of Mental
      Health, National Institutes of Health, Department of Health and
      Human Services, prepared statement.............................   151
    Institute for Student Achievement, prepared statement............   566
    International Foundation for Functional Gastrointestinal
      Disorders, prepared statement..................................   474
    InterTribal Bison Cooperative, prepared statement................   349

    John B. Amos Cancer Center, prepared statement...................   351

    Katz, Dr. Stephen I., Director, National Institute of Arthritis
      and Musculoskeletal and Skin Diseases, National Institutes of
      Health, Department of Health and Human Services, prepared
      statement......................................................   153
    Kington, Raynard, Deputy Director, Office of the Director,
      National Institutes of Health, Department of Health and Human
      Services, prepared state-
      ment...........................................................   156
    Knapp, Richard M., M.D., Chair, Ad Hoc Group for Medical Research   205
        Prepared statement...........................................   206
    Kohl, Senator Herb, U.S. Senator from Wisconsin:
        Prepared statement...........................................    18
        Questions submitted by.................................55, 101, 269
    Koo, Daniel, M.D., on behalf of the Deaf and Hard of Hearing
      Alliance.......................................................   233
        Prepared statement...........................................   234

    Landis, Dr. Story C., Director, National Institute of
      Neurological Disorders and Stroke, National Institutes of
      Health, Department of Health and Human Services, prepared
      statement......................................................   159
    Landrieu, Senator Mary L., U.S. Senator from Louisiana...........     2
        Prepared statement...........................................   235
    Landrigan, Philip J., M.D., MSC, FAAP, president, Campaign for
      American Children's Health.....................................   235
    Leavitt, Hon. Michael O., Secretary, Office of the Secretary,
      Department of Health and Human Services........................    61
        Prepared statement...........................................    68
        Summary statement............................................    66
    Li, Dr. Ting-Kai, Director, National Institute on Alcohol Abuse
      and Alcoholism, National Institutes of Health, Department of
      Health and Human Services, prepared statement..................   162
    Lindberg, Dr. Donald A.B., Director, National Library of
      Medicine, National Institutes of Health, Department of Health
      and Human Services, prepared statement.........................   164
    Lupus Foundation of America, Inc., prepared statements.........242, 480

    March of Dimes Birth Defects Foundation, prepared statement......   482
    Matria Healthcare, prepared statement............................   352
    Mayer, Emeran, A.M.D., on behalf of the Digestive Disease
      National Coalition.............................................   239
        Prepared statement...........................................   239
    McDonnell, Peter, M.D., on behalf of the National Alliance for
      Eye and Vision Research........................................   240
    Medical Library Association and the Association of Academic
      Health Sciences Libraries, prepared statement..................   485
    Mildenberg, Juanita M., Acting Director, Office of Research
      Facilities Development and Operations, National Institutes of
      Health, Department of Health and Human Services, prepared
      statement......................................................   167
    Montgomery County (Maryland) Stroke Association, prepared
      statement......................................................   490
    Murray, Senator Patty, U.S. Senator from Washington:
        Prepared statement...........................................    23
        Questions submitted by.......................................    56
        Statement....................................................    63

    Nabel, Elizabeth G., M.D., Director, National Heart, Lung, and
      Blood Institute, National Institutes of Health, Department of
      Health and Human Services......................................   105
        Prepared statement...........................................   133
    National:
        AHEC Organization, prepared statement........................   500
        Alliance to End Homelessness, prepared statement.............   353
        Association:
            For State Community Services Programs, prepared statement   359
            Of:
                Children's Hospitals, prepared statement.............   491
                Community Health Centers, prepared statement.........   357
                County and City Health Officials, prepared statement.   494
                Workforce Boards, prepared statement.................   301
        Coalition for:
            Heart and Stroke Research, prepared statement............   503
            Osteoporosis and Related Bone Diseases, prepared
              statement..............................................   496
        Community Action Foundation, prepared statement..............   499
        Consumer Law Center, prepared statement......................   362
        Federation of Community Broadcasters, prepared statement.....   575
        Job Corps Association, prepared statement....................   305
        Kidney Foundation, prepared statement........................   366
        League for Nursing, prepared statement.......................   367
        Minority Consortia, prepared statement.......................   577
        Multiple Sclerosis Society, prepared statement...............   504
        Primate Research Centers, prepared statement.................   509
        Prostate Cancer Coalition, prepared statement................   511
        Sleep Foundation, prepared statement.........................   512
        Writing Project, prepared statement..........................   569
        Youth Employment Coalition, prepared statement...............   306
    NephCure Foundation, prepared statement..........................   514
    Niederhuber, John E., M.D., Acting Director, National Cancer
      Institute, National Institutes of Health, Department of Health
      and Human Services.............................................   105
        Prepared statement...........................................   123
    NIH Task Force of the Bioengineering Division of the Basic
      Engineering Group of the Council on Engineering of ASME,
      prepared statement.............................................   507

    Oncology Nursing Society, prepared statement.....................   368
    One Voice Against Cancer, prepared statement.....................   515
    Oregon Human Development Corporation, prepared statement.........   309
    Ovarian Cancer National Alliance, prepared statement.............   518

    Pancreatic Cancer Action Network, prepared statement.............   371
    People for the Ethical Treatment of Animals, prepared statement..   373
    Pettigrew, Dr. Roderic I., Director, National Institute of
      Biomedical Imaging and Bioengineering, National Institutes of
      Health, Department of Health and Human Services, prepared
      statement......................................................   168
    Population Association of America/Association of Population
      Centers, prepared statement....................................   521
    Project R&R, prepared statement..................................   376
    Pulmonary Hypertension Association, prepared statement...........   524

    Railroad Retirement Board, prepared statements.................580, 582
    Raymond, Sandra, on behalf of the Lupus Foundation of America....   241
    Reid, Senator Harry, U.S. Senator from Nevada, questions
      submitted by...................................................   261
    Roberts, Senator Pat, et al., letter from........................   378
    Rodgers, Dr. Griffin P., Acting Director, National Institute of
      Diabetes and Digestive and Kidney Diseases, National Institutes
      of Health, Department of Health and Human Services, prepared
      statement......................................................   170
    Ruffin, Dr. John, Director, National Center on Minority Health
      and Health Disparities, National Institutes of Health,
      Department of Health and Human Services, prepared statement....   173

    Schwartz, Dr. David A., Director, National Institute of
      Environmental Health Sciences, National Institutes of Health,
      Department of Health and Human Services, prepared statement....   176
    Shelby, Senator Richard C., U.S. Senator from Alabama:
        Prepared statement...........................................   109
        Statement....................................................   108
    Sieving, Dr. Paul A., Director, National Eye Institute, National
      Institutes of Health, Department of Health and Human Services,
      prepared state-
      ment...........................................................   179
    Skelly, Thomas, Director, Budget Service, Office of the
      Secretary, Department of Education.............................     1
    Society:
        For:
            Investigative Dermatology, prepared statement............   526
            Maternal-Fetal Medicine, prepared statement..............   528
            Women's Health Research and Women's Health Research
              Coalition, prepared statement..........................   531
        Of Nuclear Medicine, prepared statement......................   529
    Specter, Senator Arlen, U.S. Senator from Pennsylvania:
        Opening statements.......................................1, 61, 105
        Prepared statement...........................................     2
        Questions submitted by.............................33, 88, 250, 274
    Spellings, Hon. Margaret, Secretary, Office of the Secretary,
      Department of Education........................................     1
        Prepared statement...........................................     6
        Summary statement............................................     4
    Spina Bifida Association, prepared statement.....................   379
    State Educational Technology Directors Association, prepared
      statement......................................................   572
    Straus, Dr. Stephen E., Director, National Center for
      Complementary and Alternative Medicine, National Institutes of
      Health, Department of Health and Human Services, prepared
      statement......................................................   181

    Tabak, Dr. Lawrence A., Director, National Institute of Dental
      and Craniofacial Research, National Institutes of Health,
      Department of Health and Human Services, prepared statement....   184
    Taylor, Herman A., Jr., M.D., on behalf of the Jackson Heart
      Study..........................................................   243
        Prepared statement...........................................   244
    The:
        Humane Society of the United States, prepared statement......   535
        Mended Hearts, Inc., prepared statement......................   489
        Nature Conservancy, prepared statement.......................   584
    Tuomey Healthcare System, prepared statement.....................   382

    Vogel-Scibilia, Suzanne, M.D., president, National Alliance on
      Mental Ill-
      ness...........................................................   246
    Voices for National Service, prepared statement..................   585
    Volkow, Dr. Nora, Director, National Institute on Drug Abuse,
      National Institutes of Health, Department of Health and Human
      Services, prepared statement...................................   186

    Zerhouni, Elias A., M.D., Director, National Institutes of
      Health, Department of Health and Human Services................   105
        Prepared statement...........................................   111
        Summary statement............................................   109

                                 SUBJECT INDEX

                                  ----------

                            DEPARTMENT OF EDUCATION

                            Office of the Secretary

                                                                       Page

    A Broad Emphasis on Competitiveness..............................     6
    Academic Competitiveness:
        And National Smart Grants....................................    21
        Smart Grants.................................................    56
    Additional Committee Questions...................................    33
    Addressing the High School Dropout Problem.......................    31
    Adjunct Teachers.................................................    20
        Program......................................................    19
    Advanced Placement Incentive Program.............................    49
    Advancing America Through Foreign Language Partnerships..........    50
        And DOD National Flagship Language Initiative................    50
    Allocation of Budget Resources...................................    17
    America's Opportunity Scholarships for Kids......................38, 57
    American Competitiveness Initiative...........................4, 18, 33
    Arts Education...................................................    44
    Building State Capacity for School Improvement...................     7
    Civic Education..................................................    59
    Commission on the Future of Higher Education.....................    49
    Comprehensive School Reform as School Improvement Strategy.......    34
    Data Management Initiative.......................................    43
    Department:
        Expenditures for Public Relations and Outreach...............    53
        Lauded for Hurricane Response................................     3
    Department's Comments on the Silent Epidemic.....................    32
    Distribution of Highly Qualified Personnel.......................    14
    Early Childhood Education Funding................................    55
    Education:
        Funding in High-Poverty and Low-Poverty Districts............    15
        Funds Disbursed for Hurricane Recovery.......................     4
        Response for Hurricane Recovery..............................    13
    Effectiveness of Supplemental Services...........................     9
    Elementary and Secondary School Counseling Program...............    56
    Enforcement of Highly Qualified Teachers Requirement.............    41
    Ensuring Highly Qualified Teachers for Students of all
      Socioeconomic Sta-
      tus............................................................    42
    Equitable Distribution of Education Resources....................    14
    ESEA Title I:
        Funding......................................................    30
        Proposed Funding Decrease....................................    29
    Expansion of the SES Pilot Program...............................    38
    Federal:
        Efforts to Address Inequitable Distribution of Highly
          Qualified and Unqualified Teachers.........................    42
        Perkins Loans................................................    34
        Student aid..................................................    49
    Fiscal Year:
        2006 Funding Level of Proposed Terminations..................    26
        2007:
            Budget:
                Request.............................................. 4, 13
                    Priorities.......................................     8
            Education Department Budget Request......................    11
    Foreign Language Assistance Program..............................    43
    Funding for Higher Education.....................................    50
    HEA Title IX.....................................................    22
    High School:
        Dropouts--the Silent Epidemic................................    31
        Reform Initiative............................................25, 27
    Highly Qualified Teachers........................................    39
    Impact of Medicaid Change on Children With Disabilities..........    58
    Improving Teacher Quality Programs...............................    39
    Information Dissemination on Highly Qualified Teacher
      Requirements...................................................    41
    Innovative High School Restructuring in Idaho....................    19
    Investment in:
        Advanced Placement...........................................    48
        Secondary Education..........................................    16
    Limitation on Reduction of Title I Grants for School Improvement
      Purposes.......................................................    35
    Math and Science.................................................     7
        Education....................................................    48
            Math now Program and Math and Science Partnerships.......    47
        Partnerships and Math now Program Activities.................    47
    Measuring Performance of the Impact Aid Program..................    39
    National:
        Assessment of Educational Progress...........................    52
        Mathematics Panel............................................    47
    Native Hawaiian Education........................................    53
    No Child Left Behind Flexibility Provisions......................    11
    Office of Communications and Outreach............................    52
    OMB PART Ratings for Programs Proposed for Termination in the
      Fiscal Year 2007 Budget Request................................    27
    Other Programs...................................................     7
    Pell Grants......................................................12, 17
    Per Pupil Expenditures Across the Nation.........................    15
    Perkins Loans and Other Student Aid Programs.....................    55
    Proposed:
        Education Budget Cuts........................................    11
        GEAR UP Program Elimination..................................    24
    Public School Choice and Supplemental Services...................     8
    Ready to:
        Learn:
            Continuation Projects....................................    46
            Program..................................................    45
        Teach Program and Math and Science Education.................    45
    Requirements of Advancing America Through Foreign Language
      Partnerships Grantees..........................................    51
    Rigorous High School Curriculum..................................    21
    School:
        Dropouts.....................................................    32
        Improvement:
            And High School Reform...................................     5
            Grants Program and Effective School Improvement
              Activities.............................................    36
        Categorized as Needing Improvement...........................    30
        Within-Schools...............................................    20
    Selection of Districts for SES Pilot Program.....................    37
    Special Education................................................    12
        Funding......................................................    55
    Start of GEAR UP Program.........................................    25
    States' Reporting of Highly Qualified Teacher Data...............    41
    Statewide:
        Data Systems Program.........................................    51
        Longitudinal Data Systems....................................    52
    Student Participation and Achievement Under the SES Pilot Program    38
    Supplemental Educational Services................................    37
        Pilot Program................................................    37
    Teacher Quality Enhancement Program and Teacher Recruitment and
      Retention......................................................    42
    Title I:
        Funding......................................................     3
        Grants to LEAS...............................................    12
        Improvement Funding Generated by 4 Percent Set-Aside.........    35
        School Improvement:
            Monitoring...............................................    36
            Set-Aside................................................    35
    Title IX:
        Report.......................................................    57
        Technical Assistance.........................................    57
    12th Grade NAEP Initiative--Reading and Math Assessments.........    52
    21st Century Community Learning Centers..........................    58
    Use of Title I School Improvement Funds for Comprehensive School
      Reform.........................................................    34
    Vocational Education Funds.......................................    16
    Women in Technology..............................................    54
    Workshop Approach to Outreach and Impact on Student Learning Out-

      comes..........................................................    46

                    DEPARTMENT OF HEALTH AND HUMAN SERVICES

                         National Institutes of Health

    A:
        Record of Real Success.......................................   124
        Winning Strategy Against Cancer..............................   194
    Additional Committee Questions...................................   250
    Addressing the Threat of Emerging and Re-Emerging Infectious
      Diseases: Prediction and Preemption............................   149
    Advanced Technologies Accelerate Progress........................   125
    Advances:
        Against the Threat of Pandemic Influenza.....................   113
        In:
            Cancer...................................................   112
            Cardiovascular Disease and Stroke........................   112
            Diabetes and Related Illnesses...........................   113
            Health Information for Scientists and the Public.........   114
            HIV/AIDS.................................................   113
            Image-Guided Microsurgery................................   114
    Age-related Macular Degeneration.................................   270
    Alzheimer's Disease..............................................   269
        And the Neuroscience of Aging................................   146
    Asthma...........................................................   135
    Autoimmune Diseases..............................................   198
    Baccalaureate to Doctoral Programs...............................   259
    Battle Against HIV/AIDS..........................................   149
    Better Pain Treatments for Jaw Condition.........................   185
    Biodefense Research..............................................   131
    Bridging the Physical and Life Sciences..........................   168
    Budget Request...................................................   111
    Buffergel Shown to be Safe Contraceptive.........................   137
    Burden and Cost of Mental Illness................................   151
    Cancer:
        Centers......................................................   259
        Genome Atlas.................................................   193
    Cataract.........................................................   180
    Changing Landscape of Disease....................................   115
    Chronic Fatigue Syndrome (CFS)...................................   261
    Clinical:
        And Translational Science Awards.............................   253
        Research.....................................................   160
    Collaborating:
        Across NIH...................................................   184
        Among Institutes.............................................   256
    Collaborative Research...........................................   162
    Community-based Rehabilitation Intervention......................   138
    Complex Genetics.................................................   154
    Conflicts of Interest............................................   257
    Consultation Protocol............................................   260
    Corneal Diseases.................................................   180
    Creating Partnerships: Rare Diseases Network.....................   139
    Current Challenges...............................................   177
    Dawn of Personalized Medicine....................................   141
    Developing Nurse Researchers.....................................   259
    Development of Biodefense Research...............................   113
    Disseminating Information........................................   183
    Drug Addiction Treatment Works...................................   189
    Dry Mouth and Radiation Therapy..................................   186
    Emerging and Re-Emerging Infectious Diseases.....................   129
    Enhanced Support for New Investigators...........................   170
    Envisioning Personalized Care....................................   151
    Epilepsy.........................................................   269
    Expand Community-Linked Research.................................   178
    Expanding Training and Career Development........................   183
    Facilitating Integration.........................................   183
    Fetal Development: Jump Start on Life............................   136
    Fiscal Year 2007 Budget Summary..................................   167
    From Bench to Bedside to Community...............................   190
    Funding for Pandemic Influenza...................................   192
    Furthering the Research Mission..................................   182
    Future Research: Newborn Screening...............................   137
    Gene:
        Environment and Health Initiative--a Novel Partnership.......   178
        Programs Early Development and Neural Migration..............   137
    Genes:
        And Neurological Disorders...................................   160
        May Hold the Key to Treating Uterine Fibroids................   137
        Environment, and:
            Behavior.................................................   187
            Health Initiative........................................   204
    Glaucoma and Optic Neuropathies..................................   180
    Global Burden of Trauma and Injury...............................   150
    Greater Emphasis on Large Clinical Studies.......................   185
    Health:
        Communications and Promotion.................................   148
        Disparities Research Agenda..................................   174
    Healthy Mothers and Healthy Children.............................   143
    HIV/AIDS:
        And Minority Disparities.....................................   190
        Research.....................................................   130
    Heart Truth Road Show............................................   252
    Impact of Budget Cuts............................................   191
    Importance of Early Intervention.................................   171
    Improving the Nation's Oral Health...............................   186
    Increase Funding:
        At the Centers for Disease Control (CDC).....................   230
        For:
            NIH Heart and Stroke Research............................   229
            The:
                Agency for Healthcare Research and Quality (AHRQ)....   231
                Carol M. White Physical Education Program (PEP)......   231
                National Institutes of Health (NIH)..................   228
    Information Services for the:
        Public.......................................................   165
        Scientific Community.........................................   165
    Integrating Clinical and Translational Science...................   138
    Integrative Research on Human Disease............................   177
    Interagency Collaborations.......................................   125
    Irritable Bowel Syndrome.........................................   270
    Liver Disease Research Branch....................................   250
    Loan Repayment and Scholarship Program...........................   159
    Looking Toward the Future........................................   184
    Lupus............................................................   199
    Management Innovations...........................................   116
    Mathematics and Science Cognition and Learning...................   137
    Molecular Medicine and Oral Cancer...............................   185
    Multi-bug Approach on Vaccines...................................   203
    Nanotechnology for Disease Detection and Drug Delivery...........   169
    National:
        Children's Study.............................................   196
        Primate Research Center......................................   256
    NCMHD Health Disparities Efforts.................................   174
    New:
        Diagnostic and Therapeutic Technologies......................   114
        NHGRI Initiatives............................................   127
        Research Tools...............................................   114
    Next Generation Minimally-Invasive Technologies..................   169
    NIEHS Strategic Plan--A New Outlook..............................   178
    NIH:
        And Diabetes Research--A Strong Return on Federal Investment.   223
        Blueprint....................................................   170
        Neuroscience Blueprint.......................................   181
        Roadmap......................................................   181
            For:
                Biomedical Research..................................   170
                Medical Research.....................................   156
    NIMH Initatives for Fiscal Year 2007.............................   153
    NINR and the NIH Roadmap.........................................   145
    Nursing Shortages and Training Nurse Researchers.................   144
    Obstetric Pharmacology--Treatment for Pregnant Women.............   136
    Office of:
        AIDS Research................................................   156
        Behavioral and Social Sciences Research......................   157
        Disease Prevention...........................................   158
        Portfolio Analysis and Strategic Initiatives.................   159
        Research on Women's Health...................................   157
        Science Education............................................   158
    Ongoing NHGRI Initiatives........................................   126
    Opasi Trans-NIH Funding Program..................................   252
    Other:
        Aging-related Research.......................................   147
        Areas of Interest..........................................128, 166
    Our Goal Remains the Same........................................   123
    Pandemic Flu.....................................................   257
    Patients and Families at the End of Life.........................   144
    Pediatric Heart and Lung Disorders...............................   134
    Periodontal Disease and Preterm Birth............................   185
    Polycystic Kidney Disease........................................   255
    Power of the Mind................................................   142
    Practical Clinical Trials........................................   152
    Practice-based Research Networks.................................   184
    Predicting Preeclampsia..........................................   136
    Prednisone.......................................................   199
    Preempting Chronic Diseases and Their Complications..............   171
    Premature Birth Research.........................................   136
    Preparedness for Pandemic Influenza............................191, 201
    Prescription Drug Abuse--the Problem With Painkillers............   187
    Preventive Medicine..............................................   153
    Program Funding..................................................   200
    Promoting Science and Health Literacy............................   140
    Providing Critical Links: Nonhuman Primate Research..............   140
    Rapid Advances in the Genomic Era................................   116
    Re-evaluate Programmatic Investments.............................   178
    Recruit and Train the Next Generation............................   177
    Reducing Disparities in the Nation's Oral Health.................   186
    Regenerative Medicine............................................   155
    Research Collaborations..........................................   175
    Research on Immune-Mediated Diseases.............................   132
    Restore Funding for the Rural and Community Access to Emergency
      Devices Program................................................   231
    Retinal Diseases.................................................   179
    Return on Investment on NIH Funding..............................   110
    Role in the Research Mission.....................................   167
    Selected Accomplishments of NIH and Their Impact on Health.......   112
    Setting the Course...............................................   182
    Sickle Cell Disease..............................................   135
    SMedical Robotic.................................................   169
    Social Neuroscience..............................................   188
    Spurring Advances Through Data Sharing...........................   139
    Staying Healthy Throughout Adulthood.............................   143
    Strabismus, Amblyopia and Visual Processing......................   179
    Strategic Vision for NIH: From Curative to Preemptive Care.......   115
    Strengthening the:
        Evidence Base in Dental Care.................................   184
        Pipeline.....................................................   141
    Stroke...........................................................   253
    Teaming Science for Public Health Gains..........................   141
    Technologies to Improve Health Care Delivery.....................   168
    Traditional Healing Practices....................................   258
    Training:
        A New Generation of Scientists...............................   117
        For the Future...............................................   170
    Translating:
        Discoveries Into Better Medical Treatment....................   117
        Technology Into Clinical Practice............................   168
    Translational Research.........................................155, 161
    Understanding Aging and Caring for the Elderly...................   144
    Urology Research Strategic Planning..............................   251
    Value of a Systems Approach......................................   142
    Widening the Net: Under-represented Populations and Areas........   139
    Women's:
        Health Initiative............................................   197
        Heart Disease................................................   196

                            Office of the Secretary

    Additional Committee Questions...................................    88
    Administration on Aging (AoA) Budget Cuts........................    79
    Aging Services Programs..........................................86, 87
    Alzheimer's Demonstration Grants.................................    80
    Baccalaureate to Doctoral Programs...............................   100
    CDC:
        Budget Cuts..................................................    80
        Physical Plant...............................................    81
    CMS:
        Adequate Provider Reimbursement..............................    96
        Power Wheelchairs............................................    97
        Prompt Pay Discount..........................................    97
        Regulatory Authority for Reimbursement.......................    97
        Status of Quality Demonstration Project......................    95
    Community Health Centers.........................................    75
    Compassion Capital Fund..........................................    85
    Disease Prevention...............................................    83
    Emergency Medical Services for Children..........................   100
    FDA Generic Drug Applications....................................    78
    Fiscal Year 2007 HHS Budget......................................    67
    Generic Drugs/FDA................................................   101
    Health:
        Centers Program..............................................   100
        Professionals Training.......................................    88
    Historical Pandemics.............................................    71
    Institute of Medicine Policy Recommendations.....................    84
    Medicaid/Special Education Benefits..............................    98
    Medical Professional Availability................................    66
    Medicare:
        Drug Benefit Enrollment Deadline.............................   102
        Electronic Payments..........................................    88
        Fraud........................................................    97
        Improper Payments............................................    94
        Integrity Program............................................89, 94
        Part D:
            Deadline Extension.......................................    63
            Enrollment...............................................    76
                Deadline.............................................    76
            Formulary Prices.........................................    65
            Plan Choice..............................................    78
    National Institutes of Health:
        Budget Cuts..................................................    65
        Funding......................................................   103
            Levels...................................................    82
        Research.....................................................    84
            Grants...................................................    81
        Sleep Disorders Conference Report............................    90
    Office of Minority Health........................................    90
    Pandemic Influenza:
        Infrastructure...............................................    75
        Preparedness.................................................72, 91
            Plan Implemention........................................    93
        Respirator Masks.............................................    93
        Surge Capacity...............................................    92
        Vaccine......................................................83, 92
            Distribution.............................................    73
            Stockpile................................................    72
    Programs Serving Older Americans.................................   101
    Rural Health.....................................................   102
    Rural Healthcare.................................................    80
    Special Exposure Cohorts.........................................    99
    Underage Drinking Prevention.....................................    90
    Uninsured Access to Pandemic Influenza Treatment.................    93
    Wellness and Disease Prevention..................................    75

                              DEPARTMENT OF LABOR

                            Office of the Secretary

    Administration and Management....................................   280
    Adult Training Funds.............................................   294
    Appalachian Council/Working for America Institute................   290
    Asbestos Exposure................................................   276
    Built-in and Program Changes.....................................   284
    Career Advancement Accounts......................................   295
    Comments on Cecil Roberts Testimony..............................   278
    Competitiveness Agenda...........................................   291
    Economic Growth Efforts..........................................   295
    Elimination of:
        Job Bank Program.............................................   296
        Migrant:
            Job Training.............................................   275
            Programs.................................................   292
        Youth Training Grants........................................   295
    Employment Service Cuts..........................................   292
    Foreign Labor Certification......................................   298
    Immigration Bill.................................................   276
    Impact of Job Training Cuts......................................   275
    Job:
        Corps Funding................................................   274
        Training Staff...............................................   290
    Medical Leave Program............................................   277
    Mine Safety......................................................   274
    National Reserve Fund............................................   293
    Older Worker Employment Program..................................   279
    OSHA Penalties for Asbestos Violations...........................   276
    Program Direction................................................   282
    Proposed Workforce Legislation...................................   296
    Rapid Response:
        Funds......................................................277, 298
        Services.....................................................   293
    Rational for Workforce Training..................................   291
    Re-allocation of Unspent Funds...................................   277
    Reintegration of Youthful Offenders..............................   275
    Safe Places in Mines.............................................   290
    Voucher Proposal.................................................   291
    Women in Apprenticeship..........................................   290
    Workforce Training Cuts..........................................   276

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