[Senate Hearing 109-]
[From the U.S. Government Publishing Office]
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\
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\1\ Editors Note.--Not real names.
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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 [email protected]. 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\
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\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.
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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.
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\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.
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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 [email protected].
______
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.
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\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.
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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.
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\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).
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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\
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\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.
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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\
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\10\ National Energy Assistance Directors, ``Est. Total Households
Receiving LIHEAP Heating Assistance by State--Projected Applications
for Fiscal Year 2006'' (2/13/06).
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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\
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\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\
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\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\
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\15\ NEADA Survey, Table 47.
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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\
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\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\
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\1\ White House Office of Technology Assessment. Researching health
risks. Washington, DC: EOP (1993).
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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\
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\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.
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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:
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\4\ NIEHS News Release: NTP completes 500th two-year rodent study
and report; series is the gold standard of animal toxicology. 25 Jan
2001. .
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``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\
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\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).
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--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\
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\7\ Brinkley J. Many say lab-animal tests fail to measure human
risk. The New York Times 1993 Mar 23;Sect A:1.
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--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\
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\8\ Shane BS. Human reproductive hazards. Environmental Science and
Technology 30, 1193 (1989).
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--Dr. Barbara Shane, NTP executive secretary
``I have to say we don't serve the American people very well right
now.'' \6\
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\6\ Schwetz B, Gaylor D. New directions for predicting
carcinogenesis. Molecular Carcinogenesis 20, 2 75-279 (1997).
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--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:
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\9\ PETA's full report is available upon request or may be
downloaded from http://www.stopanimaltests.com/u-ntp.asp.
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--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?
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\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).
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--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.
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\14\ NIEHS Fact Sheet: The Report on Carcinogens--9th edition. 15
May 2000. .
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--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\
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\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).
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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.
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\16\ Toxicology in the 21st Century: The Role of the National
Toxicology Program. 24 Feb 2004. .
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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\
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\1\ National Research Council (1997) Chimpanzees in research:
strategies for their ethical care, management and use. National
Academies Press: Washington, D.C.
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--There are enough chimpanzees to address existing federally funded
research.\2\
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\2\ Report of the Chimpanzee Management Plan Working Group to the
National Advisory Research Resources Council; May 18, 2005.
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--As a result of the ``surplus,'' the government funds a national
sanctuary system.\3\
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\3\ http://www.ncrr.nih.gov/compmed/cm_chimp.asp.
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--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\
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\4\ Ibid.
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--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\
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\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.
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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).
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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
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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\
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\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
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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\
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\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 [email protected] 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.
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\1\ S. L. Farmen et al., Am J Physiol Lung Cell Mol Physiol 289,
L1123-30 (Dec. 2005).
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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.
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\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)
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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\
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\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.
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\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)
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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.
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\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)
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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.
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\1\ Heart Rhythm Foundation, Arrhythmia Key Facts, 2004 http://
www.heartrhythmfoundation.org/facts/arrhythmia.asp.
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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\
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\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.
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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\
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\3\ American Stroke Association and American Heart Association,
Heart Disease and Stroke Statistics_2005 Update, 2005 http://
www.americanheart.org/downloadable/heart/
1105390918119HDSStats2005Update.pdf.
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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\
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\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.
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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.
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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\
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\8\ Task Force on the Future of American Innovation, The Knowledge
Economy: Is the United States Losing it's Competitive Edge?, February
16, 2005.
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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 ([email protected] 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\
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\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.
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\1\ Federal Interagency Forum on Aging Related Statistics. Older
Americans 2000: Key Indicators of Well-Being. 2000.
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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.
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\1\ NRC (National Research Council) (1997) Chimpanzees in research:
strategies for their ethical care, management and use. National
Academies Press: Washington, D.C.
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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.
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\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.
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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.
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\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.
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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.
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\1\ This appropriation was reduced by a 1 percent across-the-board
rescission to $35.3 million.
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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\
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\2\ http://www.aep-arts.org/CLhome.html.
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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\
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\3\ http://www.nga.org/Files/pdf/050102ARTSED.pdf.
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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\
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\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\
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\5\ ``Worried About India's and China's Booms? So Are They,''
Thomas Friedman, New York Times, March 24, 2006.
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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\
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\6\ http://www.dramaticresults.org/results.php.
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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.
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\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/.
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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,
[email protected], 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.
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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
[email protected] 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.