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Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations for Fiscal Year 2012

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Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations for Fiscal Year 2012 DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2012 WEDNESDAY, MAY 11, 2011 U.S. SENATE, SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS, Washington, DC. The subcommittee met at 9:59 a.m., in room SD–124, Dirksen Senate Office Building, Hon. Tom Harkin (chairman) presiding. Present: Senators Harkin, Reed, Mikulski, Brown, Shelby, Kirk and Moran. DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL INSTITUTES OF HEALTH STATEMENT OF DR. FRANCIS S. COLLINS, DIRECTOR ACCOMPANIED BY: HAROLD VARMUS, M.D., DIRECTOR, NATIONAL CANCER INSTITUTE ANTHONY S. FAUCI, M.D., DIRECTOR, NATIONAL INSTITUTE OF AL- LERGY AND INFECTIOUS DISEASES SUSAN B. SHURIN, M.D., ACTING DIRECTOR, NATIONAL HEART, LUNG, AND BLOOD INSTITUTE DR. GRIFFIN RODGERS, DIRECTOR, NATIONAL INSTITUTE OF DIA- BETES, DIGESTIVE AND KIDNEY DISEASES OPENING STATEMENT OF SENATOR TOM HARKIN Senator HARKIN. The Senate Subcommittee on Labor, Health and Human Services, and Education will now come to order. First of all, Dr. Collins, welcome back to the subcommittee. We welcome also Dr. Harold Varmus, Director of the National Cancer Institute; Dr. Tony Fauci, Director of the National Institute of Al- lergy and Infectious Diseases; Dr. Griffin Rodgers, Director of the National Institute of Diabetes, Digestive and Kidney Diseases; and Dr. Susan Shurin, Director of the National Heart, Lung, and Blood Institute. This subcommittee holds an appropriations hearing on the NIH budget every year, and every year I am both inspired by the dedi- cation of the scientists who testify before us and proud that their accomplishments have made America the world leader in bio- medical research. But in recent years, our Nation’s status in that regard has been threatened. While China and Singapore make (1) 2 massive investments in research, here in the United States we’re pulling back. The fiscal year 2011 appropriations bill that Congress passed last month cut NIH funding by $322 million below the fiscal year 2010 level. When you consider how much funding was needed to keep up with inflation, the cut was more like $1.3 billion, taking inflation into account. We should be thankful that the result wasn’t significantly worse. H.R. 1, the spending bill passed by the House majority, would have cut NIH funding by $1.6 billion or $2.6 billion if you counted infla- tion. Fortunately, the Senate rejected that plan. But even the compromise bill that was ultimately signed in law will result in a success rate for NIH research grants, I’m told, of just 17 or 18 percent, meaning just one out of every six peer-re- viewed application will be approved. And, again, I am informed that that is the lowest success rate on record for NIH. What a dismal downturn from what Senator Specter and I, and others did back in the late 1900s and early 2000 when we doubled the funding of NIH and we got the success rate up, I think—if I’m not mistaken. You correct me, Dr. Collins—up in the 20–30 percent range, somewhere in there. And we thought we were on a path to continue that kind of a success rate. Now, it’s down lowest on record. And there is cause to fear even bigger cuts next year. The budget plan approved by the House last month would cut health funding by 9 percent in fiscal year 2012. If that plan were approved, severe reductions to NIH research would be unavoidable. That doesn’t make sense. Let’s set aside for a moment any thoughts about the moral value of trying to improve people’s health, and just look at the issue from a purely economic stand- point. NIH research is one of the best investments this country can make. A study released yesterday by United for Medical Research con- cluded that in fiscal year 2010, NIH funding supported almost 500,000 jobs across country. And I always have to remind people that only a small percentage of that goes to NIH in Bethesda, Maryland. I want Senator Mikulski to know that. Most is awarded to researchers at academic institutions all over the United States. Another study by Battelle examined the specific impact of the Human Genome Project, which was overseen, again, by Dr. Collins and completed in 2003. The Federal Government spent a total of $3.8 billion on this historic initiative. A lot of money, but the re- turn on the investment is staggering. According to the Battelle study that $3.8 billion translated into an economic output of $796 billion between 1988 and 2010. And, of course, we’ll be seeing bene- fits from the Human Genome Project for many more decades to come. In fact, when I was reading all of your testimonies last night, what struck me in each one of them there were references made back to genomic research in every single case of the institutes who are represented here. So the lesson is clear. Biomedical research is one of the engines that drive our economy. If we want our economy to grow, both im- mediately and in the long term, that engine needs fuel. Drastically cutting NIH, as the House budget would force us to do, would be 3 a classic case of penny wise and pound foolish thinking. That, again, is just on the economic side. On the human side, though, the great advances that have been made in cancer research and what we have done to lessen the threat of cancer—young kids now with leukemia are being cured at an almost 100 percent rate. Maybe that’s not quite right, but pretty darn close, things that were unheard of just a few years ago. The advances that we’re making in infectious diseases, unheard of 20 years ago when I first came on this subcommittee. Well, that’s been 25 years ago, but great advances have been made. Just stark. So, from the human standpoint, in helping people have better lives and overcoming some of the dreaded diseases that have plagued mankind for so long, on both fronts, biomedical research is the place to go and we ought not to be penny wise and pound foolish on that. And so now I’ll recognize my ranking member, Senator Shelby, for an opening statement. STATEMENT OF SENATOR RICHARD C. SHELBY Senator SHELBY. Thank you, Mr. Chairman. I appreciate you holding this hearing today to discuss the vital mission carried out by the National Institutes of Health. We live in a world where there are thousands of debilitating and life-threatening diseases, all that could use additional funding for research and clinical trials. I support Federal investment in basic biomedical research and development. Research carried out by the NIH and its network of 325,000 researchers at 3,000 institutions across the country serves the Nation with the goal of improving human health. As research becomes more expensive and private capital dries up, I believe it’s critical to ensure support for translational research; that is, re- search that moves a potential therapy from development to the market. The NIH has developed an interesting proposal with the estab- lishment of the National Center for Advancing Translational Sciences, NCATS. NCATS is intended to fill the gap between ad- vances in scientific understanding of disease and the process to turn new scientific insights into products. I believe the need for an entity to straddle the world’s research and industry is clear. In the private market, pharmaceutical companies will abandon drug development projects that are not initially successful, become too complex or do not provide a lucrative path forward. For example, since 1949, there have only been two major drug discoveries in mental health—lithium and Thorazine. Sixty years later, researchers still do not know why these drugs actually work. Hundreds of genes have been shown to play roles in mental illness, too many for focused efforts by drug developers. Therefore, many drug manufacturers have dropped out of the mental-health field. In particular, pharmaceuticals for rare and ne- glected disease are often ignored because private companies avoid this small market with little profit appeal leaving patients with no treatment options. Even promising new drugs discovered through basic research often struggle during the translational stage of the process because 4 it’s expensive, time consuming and prone to failure. These barriers inhibit both the scientists dedicated to improving health and the patients who ultimately need improved cures and care. The question remains, however, as to whether NCATS is the right approach to solving the issue. Will NCATS be the right mech- anism for taking valuable discoveries that the taxpayer has funded and giving it a greater opportunity to make it in the marketplace? As we review this proposal, we need to consider the fact that NIH is not a drug developer or an expert in the therapeutics world. Dr. Collins, I would like to continue to work with you to make a thoughtful, informed decision regarding the NCATS. Unfortu- nately, the fiscal year 2012 budget request, I believe, does not pro- vide adequate details on the reorganization. It is May 11 and we’ve not received a budget amendment or spe- cific structural details of an NCATS, a program NIH wants to im- plement by October 1. How can the subcommittee be expected to support a program that does not yet exist in budget documents? I understand that the transition from basic research to clinical application requires interdisciplinary and multidisciplinary exper- tise. Research that aims to transform science is inherently difficult. If it were easy, the need for transformation would not exist.
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