Volumber 19, Number 6
Inside UPDATE...
The House Budget Committee marked up its version of the Fiscal Year (FY) 2001 budget resolution on March 15. In the course of the markup, the committee accepted an amendment sponsored by Representative Rush Holt (D-NJ) to add an additional $100 million for the National Science Foundation (NSF) budget. It also accepted a "Sense of the Congress" statement, sponsored by Representative Nick Smith (R-MI), praising NSF.
How this will play out down the road when the appropriators begin their actual allocations is still unclear. The budget resolution provides guidelines for the budget by function. Function 250 includes NSF, NASA, and the Department of Energy sciences. Function 550 is the health function and includes the National Institutes of Health (NIH). The appropriations subcommittees do not allocate by functions. For example, NSF and the National Aeronautics and Space Administration (NASA) are in the VA, HUD, Independent Agencies Subcommittee, while the Department of Energy science programs receive their spending allotments from the Energy and Water Appropriations Subcommittee.
For Function 250 the Committee provided a $500 million increase over the FY 2000 budget authority (how much an agency is authorized to spend, not necessarily all in one year) and an $800 million increase over FY 2000 (how much an agency is obligated to spend in that particular fiscal year). Again, whether this is enough to provide the full $675 million increase NSF seeks, will be determined by competing budget choices in other areas such as veterans' medical care, environmental, housing, and space programs.
The Committee assumed a $1 billion increase for NIH; the same as the president's request. At the same time, a member of the Labor, HHS, Education Appropriations Subcommittee predicted that NIH will receive in excess of $20 billion from the House in FY 2001, an increase of over $2 billion.
The Senate Budget Committee expects to mark up its version of the resolution on March 22nd and 23rd. Assuming floor enactment, and dissimilar versions, a House-Senate conference committee will need to reconcile the differences. The President does not sign or get a chance to veto the budget resolution. At that point the appropriations committees in the House and Senate will receive their 302A allocation, which provides the total dollars allocated for government programs. The committees then divide that total into the 302B allocations to the 13 subcommittees, which in turn determine the budgets for the agencies and programs under their jurisdiction.
At the moment the Republican leadership in Congress hopes to fast-track this process and would like to finish all the spending bills quickly so that the session can end relatively early and they can go home and campaign. However, a Democratic appropriations staffer suggests that this scenario is not likely, given that the budget resolution as it now stands and the president's budget request reflect too wide a gap in total overall discretionary spending and particularly on domestic discretionary spending. There is about a $30 billion gap in both. Since there is general agreement on the need to increase defense spending, the pressure on domestic discretionary spending is even greater.
The White House has made it clear that the budget resolution numbers are unacceptable, requiring too many cuts in domestic programs, especially when linked to tax cut proposals also in the resolution. The administration specifically mentions the president's initiatives in science and technology as endangered by the deficient spending numbers in the Congressional budget plan. It appears that we could be heading for another year of budget chaos that will likely end in early October with negotiations between a Congress desperate to leave town and a president once again holding most of the good cards.
In his first full-time week on the job, Norman Bradburn, the new Assistant Director for the National Science Foundation's (NSF) Social, Behavioral and Economic Sciences Directorate (SBE) came before the National Science Board (NSB) to present some preliminary thoughts on the exciting prospects for research in these sciences. The Board spent some time at its meeting on March 16 examining long- range planning aspects for the Foundation including "unmet opportunities" under which Bradburn's presentation fell.
Reflecting on his long career at the University of Chicago, the new Assistant Director told the NSB that he believed the best work in the SBE sciences was interdisciplinary and highly quantitative. He noted the uniqueness and duality of research, in what he called "the human sciences," in "that people are both the subject and object of inquiry." In suggesting how he viewed the future research agenda, Bradburn focused on "What Makes Us Human?" He responded that humans: have highly developed cognitive processes, learn and use language, experience a lengthy development period, and exhibit socio-economic organization and behavior. All of these are ripe for further research exploration, he claimed.
He told the Board that the SBE sciences have a "long history of conjecture," but a "short history of scientific research." Only since World War II have new techniques and tools allowed for significant scientific advances in these areas. He noted that the NSF's focus on supporting the development of advanced scientific tools will also allow the SBE sciences to prosper in the coming years. More powerful computers to conduct controlled experiments, functional MRI's to study brain processing, sequencing the genome to produce greater discoveries in human origins, and the increased capacity of electronic data storage and transmission to generate and analyze large data bases for research and teaching, are all improvements that will create opportunities for more important research in the SBE sciences.
With regard to the proposed new initiative for NSF's FY 2003 budget, Bradburn said he would create a "special strategic planning team" within SBE and coordinate efforts with the SBE Advisory Committee, other NSF directorates, and the broader SBE stakeholder community. He set as his goal doubling SBE's budget in 3 years.
NSF Director Rita Colwell continued to reiterate her commitment to enhance the SBE sciences at the Foundation. She noted her strong belief that research in these areas can contribute to helping with many of our national problems. The Director pointed to learning processes, and what she called the "cognitive/knowledge revolution," as areas in the SBE sciences that are of prime interest.
The Board also heard about strong support for enhancing research in the core disciplinary programs, attempts to increase the size and duration of grants, and the current initiatives in information technology, nanotechnology, biocomplexity in the environment, and the 21st Century workforce. All of the current initiatives are cross-disciplinary and cross-directorate, and all include a social and behavioral component.
Only a month into her tenure as Acting Assistant Attorney General for the Office of Justice Programs (OJP), Mary Lou Leary went before the House Appropriations Commerce, Justice, State, and Judiciary Subcommittee on March 15 to discuss the Administration's Fiscal Year (FY) 2001 budget request. Leary was met by an "absolutely puzzled" Representative Harold Rogers (R-KY), chairman of the Subcommittee. Rogers said he was "shocked" and "disappointed" with the request for the OJP, specifically noting his displeasure with the administration's decision to zero out funding for several block grant programs "in favor of several unauthorized initiatives."
As it did last year, the administration provided no funds for different block grant programs popular among most Republicans, as well as some Democrats: the Local Law Enforcement Block Grant Program (LLEBG) and the Juvenile Accountability Incentive Block Grant (JAIBG). As expected, this served as a point of contention. Rogers criticized the administration for taking the decisions about how to spend money away from the "locals and putting it in the hands of Washington bureaucrats." Locals, said Rogers, "know better than you" how to spend money to fight crime.
Leary noted that there were many competing priorities for limited funds, resulting in many tough decisions. Leary also pointed out that the administration decided to put its money toward innovative programs that determine what works and what does not work to prevent crime. She alluded to the seminal study conducted by the University of Maryland, Preventing Crime: What Works, What Doesn't, and What's Promising, that states increased funds need to be devoted to research new crime fighting approaches, demonstrations and evaluations of these approaches, and implementation of these prevention strategies in other sites.
Two such innovative programs included in the budget request are: the Strategic Approaches to Community Safety Initiative (SACSI) and the Community Mapping, Planning, and Analysis for Safety Strategies (COMPASS) program. SACSI is a comprehensive, information-driven crime-fighting initiative in which United States Attorneys work with local decision-makers and a researcher to identify, analyze, and respond to local crime problems. COMPASS is a data-driven crime fighting approach that combines information such as employment statistics, land-use data, hospital records, drug use, gun tracing, and arrest and victimization statistics into a centralized database. COMPASS incorporates Geographic Information Systems (GIS) which allow local officials to plot crime-related data against a map of a specified community or region to target crime fighting resources. Both programs, administered by the National Institute of Justice (NIJ) would receive $10 million in FY 2001.
Rogers also criticized the fact that a large portion (45 percent, according to Rogers) of the budget for the Office of Community Oriented Policing Services (COPS) is administered by the Office of Justice Programs. "Isn't this a charade?," asked Rogers. He suggested that the now-separate COPS office and OJP be merged. Director Thomas Frazier, on hand to defend the COPS budget request, noted that these funds administered by OJP are devoted to COPS-related initiatives. He further noted that the law enforcement community likes the Office's independence. Leary explained further that her agency and the COPS office already work collaboratively in many different areas. Rogers left the question on the table, and will likely revisit the issue in future hearings.
Conspicuously missing from Leary's testimony was any reference to the proposed research and evaluation set-aside for the NIJ. Specifically, the budget request calls for one percent of sums appropriated to the OJP be transferred to the NIJ to carry out research and evaluation — similar to the Public Health Service's (PHS) one percent set-aside for evaluation. Over the past several years, funding for social science research within the NIJ has been stagnant. The set-aside would significantly augment NIJ's ability to conduct and fund social science research. The budget request for the NIJ would provide a base of $49.4 million. If congressionally approved, NIJ's overall budget, including funds transfers, would reach $200 million in FY 2001.
In an effort to have its bill marked up and through the House by July, two months earlier than usual, the House Labor, Health and Human Services, and Education and Related Agencies Subcommittee, chaired by Representative John Porter (R-IL), started its hearing process in February.
Acting National Institutes of Health Director (NIH) Ruth Kirchstein, appearing before the Subcommittee regarding her agency's budget, promised to provide appropriators with an advance blueprint of how the NIH would utilize another 15 percent budget increase. Ranking Member David Obey (D-WI) requested that the information be provided in increments of $500 million. Porter, Obey, and the other Subcommittee members were very interested in the agency's ability to provide them with the information needed to convince their colleagues that NIH can spend the increases wisely. Kirchstein emphasized that opportunity has never been greater. There are many questions that we can answer, she said. The agency, she declared, will not spend its resources on bad science.
National Institute of Child Health and Human Development (NICHD). According to NICHD Director Duane Alexander, the Institute is exploring ways to improve reading skills in populations of culturally and linguistically diverse students. Alexander noted that data from the three year old Early Intervention Project are currently being collected and analyzed, but preliminary data show a pattern of remarkable improvements in reading ability. Reading scores in schools that have historically been at the 10th and 15th percentile have improved to better than the 50th percentile, said Alexander. Additionally, entire classes in intervention schools are now performing at the national average. The Institute and the Department of Education are jointly soliciting research proposals for systematically studying the most effective ways to teach reading English to children whose primary language is Spanish. Representative Anne Northup (R-KY) described the program as "phenomenal" and urged the Subcommittee to visit the schools and see the results for themselves.
Alexander highlighted the National Longitudinal Study of Adolescent Health (Add Health) which has "provided new insights into the ways that peers, families, schools, and neighborhoods can influence positive health outcomes, as well as negative outcomes, such as violent behavior, smoking, drinking, illegal drug use, and sexual behavior." The study, said Alexander, will help identify the major determinants of health and health behaviors during the transition from adolescence to early adulthood. Alexander noted that the data collected this year may be the most important part of Add Health Study because they follow up the study of the original cohort.
Alexander also noted that culturally sensitive materials and programs designed by and for African American communities are needed to combat the Sudden Infant Death Syndrome (SIDS) rate in these communities. The rate, said Alexander, remains more than double that of white infants. As a first step, the Institute is conducting research with African American caretakers (e.g., parents, grandparents, relatives, and child care workers) to identify effective ways to communicate the "back to sleep" message. NICHD's goal, he said, is to eliminate the racial disparity in SIDS within three years.
National Institute on Aging (NIA). Director Richard Hodes told Subcommittee members that studies have shown that the disability rates for people 65 and older have been falling at an accelerating pace since 1982. The benefits of this trend, he said, extend to both men and women and to minority groups. He emphasized "that more research is necessary to understand the causes and economic consequences of the decline in disability rates and to further accelerate these improvements."
Hodes noted that increasingly researchers are understanding the benefits of exercise, especially for older people, as a key to preventing or delaying the onset of disease and disability. There is also scientific evidence that suggests that exercise may be a factor related to increased life expectancy and the number of years people live free of disability, he said. He cited a clinical trial involving chronically ill older adults, aged 70 and older, where researchers reported that one year of increased physical activity, combined with chronic-illness self-management, resulted in fewer reported hospitalizations and total hospital stays.
Porter, noting that much of what we find out about disease and health relates to good diet and exercise, questioned whether we are doing enough in prevention to keep people healthy in the later years? "Clearly, we are not," answered Hodes. Trying to understand and sustain a change in lifestyle are not as easy as they appear, he said. Northup prodded Hodes to continue to encourage multidisciplinary efforts — including those that incorporate psychology and sociology.
National Institute on Mental Health (NIMH). Director Steven Hyman emphasized the importance of basic behavioral science. Basic behavioral science could bring treatment and people involved in public policy closer together, he said. Behavioral scientists could also serve to educate the public about the findings of research. Hyman also stressed the need for more minority researchers to enhance the inclusion of minorities in study populations.
Referring to the recent shooting of a six-year old by a classmate, Porter asked Hyman what is the connection between youth violence and mental disorders? Hyman said, to head off such violence, more needs to be done with families and family involvement regarding appropriate supervision. In his written testimony, Hyman noted "youth with conduct problems often exhibit inattention and impulsiveness, often coexisting with hyperactivity." Most youth violence occur between the hours of 3 p.m. and 10 p.m. Additional after-school programs are needed to keep youth active and out of trouble, Hyman further explained. Pushing them into delinquency programs and special needs schools just creates a "graduate school for delinquent youth."
National Cancer Institute (NCI). Director Richard Klausner noted that drops in mortality rates continue to be seen for lung, colorectal, breast, and prostate cancer. "Remarkably, the magnitude of these drops are such that, for the first time, between 1996 and 1997, the total number of cancer deaths did not rise, despite a growing and aging population." Klausner noted that for the second time in its history, the NCI released 25-year cancer mortality maps. He further noted that the maps do not tell the "causes of cancer or indeed whether a geographic pattern reveals either a localized environmental factor, a behavioral pattern, or a socio-economic pattern." Nevertheless, because they provide the starting point for addressing these issues, the maps are crucial resources, said Klausner.
He noted that one of the themes of NCI activities is to address gaps — gaps between what we need to know and our current state of knowledge, gaps between the burden of cancer across different segments of our population, and gaps between scientific discovery and medical breakthroughs. Klausner said that "one of the most important gaps is between evidence-based best practice and actual practice, which the Institute plans to address via a new initiative — the Quality Cancer Care Committee (QCCC). The QCCC will be a trans-agency initiative led by the NCI to develop a comprehensive research infrastructure to address the issues of quality cancer care across the cancer continuum from prevention to treatment to survivorship and end-of-life care. The research agenda will focus in four areas: 1) developing measures of cancer outcomes, 2) strengthening the meteorologic and empiric base for quality assessment, 3) strengthening the national clinical trials infrastructure, and 4) improving the quality of cancer communications.
Referencing the Institute of Medicine Study, the Unequal Burden of Cancer (See UPDATE, January 25, 1999, No. 2), Representative Jesse Jackson, Jr. (D-IL) pushed Klausner on what his Institute was doing to address the issues in the report, particularly that less than one percent of NCI's resources were granted to understanding the disparities in cancer research. Jackson stressed his interest in pursuing data that depict an absence of minority and women researchers in cancer research. He was not pleased with Klausner's response citing the creation of Special Population Networks for cancer control and research. Jackson declared that creating special centers is wrong, stressing that "set asides" are not what is required. Minorities need a seat at the power table.
Office of AIDS Research (OAR). Director Neal Nathanson, responding to the Subcommittee's support last year for research to address the international dimension of the AIDS epidemic, noted that "AIDS in Africa is killing ten times as many people as war, sabotaging economic development, leading to massive social breakdown, and creating a new generation of orphans." Quoting Ambassador Richard Holbrooke, Nathanson said that AIDS is "a direct, cancerous growth on the political, social, and economic security of Africa."
He emphasized that in the United States, while therapeutic interventions are delaying death, we have not slowed the epidemic. HIV infection rates are continuing to climb in women and minority populations, he said. Adding that drug resistant strains of HIV present a serious public health concern, Nathanson stressed that these "data forebode an epidemic of even greater magnitude ahead, and shapes" the OAR's most urgent research priorities. These priorities, he said, address two critical populations — those living in developing countries, and the minority populations of the U.S. He emphasized a two- pronged agenda: therapeutic research to treat those already infected, and prevention research to reduce HIV transmission. OAR's prevention agenda, he continued, includes non-vaccine strategies such as behavioral research.
Nathanson also informed the Subcommittee of OAR's establishment of an Ad Hoc Working Group on Minority Research to advise the Office on the scientific priorities in this research area, and of the addition of a new section on research targeting minorities in the OAR research plan. The Office, he said, is directing resources toward new interventions that address the co-occurrence of other STDs, hepatitis, drug abuse, and mental illness; and interventions that consider the role of culture, family, and other social factors in the transmission and prevention of these disorders in minority communities.
Fogarty International Center (FIC). Director Gerald Keusch explained to the Subcommittee that while one-fifth of the world's population enjoys an average life expectancy approaching 80 and live comparatively disability free, two-thirds of the world's population suffer overwhelmingly from the world's burden of illness and premature death. The toll in sickness and life-long disability, he continued, has even greater social, economic, and political consequences.
Keusch emphasized that research on conditions related to poverty in resource-poor nations have universal applications. The FIC's mandate is to serve as the NIH's international catalyst by enabling U.S. institutions to extend the geographic scope of research and training. Keusch emphasized that the FIC's priorities are in four foundation disciplines: 1) information science and technology, 2) epidemiological and clinical methodologies, 3) human genetics and genomics, and 4) ethical principles and practice in patient-oriented research. The Center, he said, will launch an effort directed at prevention and management of mental health disorders — an unseen epidemic in most developing countries. FIC will generate epidemiological data on the incidence of mental health disorders and risk factors, including sociocultural determinants of mental health in societies undergoing transition to industrialized economies.
Keusch, said Porter, is really changing the way FIC is operating. Responding to Porter's concern with how FIC deals with cultural differences, Keusch noted that it is important to understand particular cultures and not project cultural imperialism. Echoing NIA Director Richard Hodes, Keusch stressed that behavior change is very difficult. He further noted that the Center is collaborating with NIMH to better understand issues in changing behavior.
National Center for Complementary and Alternative Medicine. Director Stephen Strauss told the Subcommittee that "approximately 42 percent of U.S. healthcare consumers spent $27 billion on complementary and alternative medicine (CAM) therapies in 1997." Strauss emphasized that a number of practices, once considered unorthodox, have proven safe and effective and have assimilated seamlessly into current medical practice. He cited diet and exercise as examples of practices used to prevent and control diseases.
Strauss stressed that in order to best seize the opportunities, NCCAM's strategy must differ from that of the rest of NIH. NCCAM, he said, "must focus first on definitive clinical trials of widely utilized modalities that, from evidence-based reviews, appear to be the most promising." He noted that NCCAM is currently developing a strategic plan. Five strategic areas have been identified: investing in research, training CAM investigators, expanding outreach, facilitating integration, and practicing responsible stewardship.
John Eisenberg, director of the newly renamed and reauthorized AHRQ stressed that while the "reauthorization makes changes in how [the agency] focus [its] research agenda," it maintains the agency's core mission to ensure that the knowledge gained through health care research is translated into measurable improvements in the health care system. The fiscal year 2001 budget request of $250 million for AHRQ, said Eisenberg, will enable the agency to focus on three new priority areas: patient safety and medical errors, information technology, and worker health. Continuing priorities would also be supported, including: quality improvement, clinical preventive services, and building research capacity.
Kent McGuire, Assistant Secretary for the Office of Educational Research and Improvement (OERI), appeared before the House Labor, Health and Human Services, and Education Appropriations Subcommittee on March 15. In his brief opening statement, McGuire told the Subcommittee, chaired by retiring Representative John E. Porter (R-IL), that the OERI is now poised to make significant advances in schools through its accumulated pool of knowledge.
McGuire noted that the request for research, development, and dissemination activities ($198.6 million, a $30 million increase over the FY 2000 level) includes funds to continue support for high priority interagency research efforts, including the Interagency Education Research Initiative (IERI), a collaborative effort between OERI, the National Science Foundation (NSF), and the National Institute of Child Health and Human Development (NICHD). OERI would receive $20 million for its participation in the IERI, double OERI's FY 2000 level.
The President's budget request, said Porter, includes language that would create a new agency, the National Institute on Education Research (NIER), to replace OERI. He noted, however, that Congress has yet to see the administration's legislative proposal for the creation of NIER and asked when it would be transmitted to Congress. McGuire noted that the administration proposal had been sent to the Office of Management and Budget (OMB) in mid-August. Since then, he said, the administration has been consulting with the House Education and Workforce Committee. He was unsure, however, when the actual proposal would be introduced in Congress.
As she did in last year's appropriations hearing, Representative Anne Northup (R-KY) commended McGuire for the job that he has done since he took the reins at OERI. She was particularly supportive of the IERI. Northup voiced her concern, however, that there was a lack of material on how to apply research to actual classrooms. McGuire agreed that this was a challenge, and noted that OERI "must do a better job organizing the information that we already have" and getting this to the classroom.
Northup similarly voiced her concern that universities and colleges are not using research to teach teachers. McGuire noted that if we want to help teachers take advantage of what we know about how kids learn, we cannot continue to ignore teacher preparation. He said that we need to "identify the knowledge base and make recommendations about how to change teachers' colleges and universities."
Porter asked McGuire if the OERI used outcome-oriented standards to determine if research is actually making a difference in classrooms. McGuire noted that getting research to the classroom is not simply a linear process. Instead, it is very complex. He said that you just can't put a document on the Internet and expect it to make a difference. The OERI, stated McGuire, is about to assemble an "expert panel to look at the research we do and determine how effective it is."
On February 25, Acting NIH Director Ruth Kirchstein announced the appointment of Peter Kaufmann, as NIH's Acting Associate Director for Behavioral and Social Sciences Research and head of the Office of Behavioral and Social Sciences Research (OBSSR) effective April 1, 2000. Kaufmann will be working with current OBSSR Director Norman Anderson over the next few weeks to help ensure a smooth transition. Kaufmann has most recently been Group Leader of the Behavioral Medicine Research Group in National Heart, Lung and Blood Institute's (NHLBI) Division of Epidemiology and Clinical Applications. He began his career at NIH as a Health Scientist Administrator in the Behavioral Medicine Branch of NHLBl in 1983.