[Congressional Record (Bound Edition), Volume 145 (1999), Part 7]
[Extensions of Remarks]
[Pages 9836-9837]
[From the U.S. Government Publishing Office, www.gpo.gov]


[[Page 9836]]

            CONGRESSIONAL RECORD 

                United States
                 of America



May 17, 1999





                          EXTENSIONS OF REMARKS

             SUPPORT THE CLINICAL RESEARCH ENHANCEMENT ACT

                                 ______
                                 

                        HON. JAMES C. GREENWOOD

                            of pennsylvania

                    in the house of representatives

                          Monday, May 17, 1999

  Mr. GREENWOOD. Mr. Speaker, today I rise to introduce the Clinical 
Research Enhancement Act, which has been endorsed by more than 80 
associations and universities. The bill begins to address the 
disincentives that are steering young physicians away from research 
careers. The legislation improves our commitment to clinical research 
by: improving the peer review process for clinical research grants; 
establishing new training awards that focus on clinical investigators; 
establishing support for structured academic training in clinical 
investigation; and expanding the existing intramural loan repayment 
program so it will be available to clinical investigators in academic 
medical centers around the country.
  Clinical research at NIH has dropped from 3% of NIH's budget to 1% 
over the past 30 years. Combine this decrease in applied research with 
the diminished capacity of some managed care organizations to subsidize 
clinical investigation, and it is easy to see why translating 
laboratory breakthroughs to the bedside are in jeopardy. Because 
clinical research is the pathway that links basic science to human 
health, we may endanger the hard fought increases in the NIH budget by 
failing to arm our scientists with practical applications.
  Twenty years ago, Dr. James Wyngaarden, a former director of the NIH, 
brought the scientific community's attention to the issue when he 
described the clinical investigator as an endangered species. In 1994, 
the Institute of Medicine of the National Academy of Sciences 
reiterated this problem and offered solutions for the declining numbers 
of American physicians pursuing research careers. And again in January, 
significant data have come to light that documents this dramatic drop 
in physician scientists.
  At the National Institutes of Health, the number of MD postdoctoral 
trainees has dropped by 51% between 1992 and 1996. In addition, the NIH 
has seen a \1/3\ drop in the number of first time MD applications for 
grant support in just three short years between 1994 and 1997. This 
historical and continuing decrease in the number of physicians pursuing 
careers in applied biomedical research must be reversed.
  I am including in the Record letters of support from the American 
Federation for Medical Research and the American Medical Association. 
In addition, I have included a list of supporters. My hope is this 
important legislation is considered and passed by this Congress. I 
encourage my colleagues to support it.

                                           American Federation for


                                             Medical Research,

                                     Washington, DC, May 12, 1999.
     Hon. James Greenwood,
     House of Representatives, Washington, DC.
       Dear Congressman Greenwood: I write to express the strong 
     support of the American Federation for Medical Research for 
     the legislation you will introduce to enhance clinical 
     research programs at the National Institutes of Health. The 
     AFMR is a national organization of 5,000 physical scientists 
     engaged in basic, clinical and health services research. Most 
     of our members receive NIH support for their basic research 
     but are finding it increasingly difficult to obtain funding 
     for translational or clinical research studies through which 
     basic science discoveries are translated to the care of 
     patients.
       In the past, academic medical centers provided 
     institutional support for this research through revenues 
     generated by patient care activities. However, as the health 
     care marketplace has become increasingly competitive, 
     academic centers have all but eliminated internal subsidies 
     for clinical research or the training of clinical 
     investigators. In fact, the Association of American Medical 
     Colleges has estimated that these institutions have lost 
     approximately $800 million in annual ``purchasing power'' for 
     research and research training within their institutions.
       This loss of support for clinical investigation has had a 
     large effect on young investigators and medical students 
     considering a research career. The number of medical school 
     graduates indicating an interest in a research career has 
     fallen steadily in the 1990's according to the American 
     Medical Association. The number of first time physician 
     applicants to the NIH for research support has fallen by 
     thirty percent between 1994 and 1997. The Clinical Research 
     Enhancement Act would seem to be an extremely modest 
     investment in a much-needed program to reinvigorate our 
     nation's clinical research capabilities.
       There is a strong consensus among the 80 scientific and 
     consumer organizations that have endorsed this legislation 
     that Congress must stop the deterioration of the U.S. 
     clinical research capacity. In addition, we must assure that 
     the American people and the American economy benefit from the 
     translation of basic science breakthroughs to improved 
     clinical care and new medical products. The American 
     Federation for Medical Research is pleased to have the 
     opportunity to express its strong support for this important 
     piece of legislation.
           Sincerely,
                                                     William Lowe,
                                                        President.

                               __________
                               

                                 American Medical Association,

                                         Chicago, IL, May 3, 1999.
     Hon. James Greenwood,
     Rayburn House Office Building, House of Representatives, 
         Washington, DC.
       Dear Congressman Greenwood: The American Medical 
     Association (AMA) is pleased to support the Clinical Research 
     Enhancement Act of 1999.
       At a time when we are on the verge of achieving exciting 
     breakthroughs involving many fatal and debilitating diseases, 
     it is important that research programs and accompanying 
     funding keep pace to achieve this goal. A 1997 Institute of 
     Medicine report emphasized the immediate need for additional 
     clinical research support noting an insufficient number of 
     persons involved in clinical research; lack of infrastructure 
     to adequately select and support the best clinical research; 
     and declining overall fiscal investment in biomedical 
     research.
       Your legislation would lend strong support by strengthening 
     and improving the peer review process for clinical research 
     grants; establishing innovative awards that would be reviewed 
     by scientists with extensive backgrounds in clinical 
     research; strengthening the general clinical research 
     centers; providing support for scientists seeking advanced 
     degrees in clinical investigation; and expanding the existing 
     loan repayment program available to clinical scientists.
       The AMA has been a solid advocate of strong clinical 
     research programs. We ardently believe that fundamental and 
     applied clinical research is essential to constructing the 
     knowledge base for the practice of modern medicine and is the 
     essential link connecting advances in basic science knowledge 
     to advances in the diagnosis and treatment of human disease.
       We commend you for your leadership on this issue and look 
     forward to working with you to achieve passage of this much 
     needed legislation.
           Respectfully,
                                       E. Ratcliffe Anderson, Jr.,
                                         Executive Vice President.

                               __________
                               

            Supporters for Clinical Research Enhancement Act

       Alliance for Aging Research; Alzheimer's Association; 
     Ambulatory Pediatric Association; American Academy of Child 
     and Adolescent Psychiatry; American Academy of Dermatology; 
     American Academy of Neurology; American Academy of Optometry; 
     American Academy of Ophthalmology; American Academy of 
     Otolaryngology-Head and Neck Surgery; American Academy of 
     Pediatrics; American Academy of Physical Medicine and 
     Rehabilitation; American Association for Cancer Research; 
     American Association for the Surgery of Trauma; American 
     Association of Anatomists; American Association of Colleges 
     of Nursing, American Association of Neurological Surgeons; 
     American Cancer Society; American Celiac Society--Dietary 
     Support Coalition; American College of Chest Physicians; 
     American College of Clinical Pharmacology; and
       American College of Medical Genetics; American College of 
     Neuropsychopharmacology; American College of Preventive 
     Medicine; American Diabetes Association; American Federation 
     for Medical Research; American Gastroenterological 
     Association; American Geriatrics Society; American Heart 
     Association; American Kidney Fund; American Liver Foundation; 
     American Lung Association; American Medical Association; 
     American Neurological Association; American Optometric 
     Association; American Pediatric Society; American Psychiatric 
     Association; American Skin Association;

[[Page 9837]]

     American Society for Bone and Mineral Research; American 
     Society for Clinical Nutrition; American Society for Clinical 
     Pharmacology and Therapeutics; American Society for 
     Reproductive Medicine; and
       American Society of Addiction Medicine; American Society of 
     Adults with Pseudo-Obstruction, Inc.; American Society of 
     Clinical Nutrition; American Society of Hematology; American 
     Society of Nephrology; American Thoracic Society; American 
     Urological Association; Americans for Medical Progress; 
     Arthritis Foundation; Association for Medical School 
     Pharmacology; Association for Research in Vision and 
     Ophthalmology; Association of Academic Health Centers; 
     Association of Academic Physiatrists; Association of American 
     Cancer Institutes; Association of American Medical Colleges; 
     Association of American Veterinary Medical Colleges; 
     Association of Behavioral Sciences and Medical Education; 
     Association of Departments of Family Medicine; Association of 
     Medical and Graduate Departments of Biochemistry; Association 
     of Medical School Pediatric Department Chairmen; Association 
     of Pathology Chairs; Association of Professors of Dematology; 
     Association of Professors of Medicine; and
       Association of Program Directors in Internal Medicine; 
     Association of Schools and Colleges of Optometry; Association 
     of Schools of Public Health; Association of Subspecialty 
     Professors; Association of Teachers of Preventive Medicine; 
     Association of University Radiologists; American 
     Urogynecologic Society; Center for Ulcer Research and 
     Education Foundation; Citizens for Public Action; Cooley's 
     Anemia Foundation; Crohn's and Colitis Foundation of America; 
     Cystic Fibrosis Foundation; Dean Thiel Foundation; Digestive 
     Disease National Coalition; East Carolina University School 
     of Medicine; Ehlers-Danlos National Foundation; Emory 
     University School of Medicine; The Endocrine Society; 
     Epilepsy Foundation of America; Foundation for Ichthyosis and 
     Related Skin Types; Gay Men's Health Crisis; General Clinical 
     Research Center Program Directors' Association; Gluten 
     Intolerance Group; and
       Hemochromatosis Research Foundation; Hepatitis Foundation 
     International; Inova Institute of Research and Education; 
     Institute for Asthma and Allergy; International Foundation 
     for Functional Gastrointestinal Disorders; Jeffrey Modell 
     Foundation; Joint Council of Allergy, Asthma and Immunology; 
     Juvenile Diabetes Foundation International; Lawson Wilkins 
     Pediatric Endocrine Society; Lupus Foundation of America, 
     Inc; Medical Dermatology Society; Mount Sinai Medical Center; 
     National Caucus of Basic Biomedical Science Chairs; National 
     Committee to Preserve Social Security and Medicare; National 
     Health Council; National Hemophilia Foundation; National 
     Marfan Foundation; National Multiple Sclerosis Society; 
     National Organization for Rare Disorders; National 
     Osteoporosis Foundation; National Perinatal Association; 
     National Tuberous Sclerosis Association; National Vitiligo 
     Foundation, Inc.; National Vulvodynia Association; and
       North American Society of Pacing and Electrophysiology; 
     Oley Foundation for Home Parenteral and Enteral Nutrition; 
     The Orton Dyslexia Society; Osteogenesis Imperfecta 
     Foundation; Parkinson's Action Network; PXE International; 
     RESOLVE; Schepens Eye Research Institute; Scleroderma 
     Research Foundation; Society for Academic Emergency Medicine; 
     Society for the Advancement of Women's Health Research; 
     Society for Inherited Metabolic Disorders; Society for 
     Investigative Dermatology; Society for Pediatric Research; 
     Society of Gastroenterology Nurses and Associates, Inc.; 
     Society of Gynecologic Oncologists; Society of Medical 
     College Directors of Continuing Medical Education; Society of 
     University Urologists; St. Jude Children's Research Hospital; 
     Tourette Syndrome Association, Inc.; United Ostomy 
     Association; United Scleroderma Foundation; University of 
     Rochester School of Medicine and Dentistry; Wound, Ostomy and 
     Continence Nurses Society; and Yale University School of 
     Medicine.

     

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