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|NIH director Dr. Elias Zerhouni (r)
responds to questions at a House appropriations subcommittee
hearing, with NICHD director
Dr. Duane Alexander (l) and
NIAID director Dr. Anthony Fauci.
NIH director Dr. Elias Zerhouni appeared Mar. 6 before the House appropriations subcommittee on Labor/HHS/Education to present NIH's FY 2008 budget request and to discuss priorities for this year and beyond. Flanked by 10 institute and center directors, he requested $28.9 billion, up $313 million from the FY 2007 request of $28.587 billion.
Subcommittee chair Rep. Dave Obey (D-WI) welcomed Zerhouni and his colleagues: "Let me say, doctor, that we want numbers put in context. What will this country look like in 10 years?"
"Major factors will force a transformation of medicine and health," Zerhouni replied, and laid out the megatrends. Due to advances over the past 30 years, Americans are now living longer and healthier, thanks in partto the total NIH investment of $44 per year for each American. Deaths from cancer, heart disease and stroke have decreased, while life expectancy has risen. Meanwhile, there are challenges in the shift from acute to chronic conditions; an aging population; health disparities; infectious diseases; obesity; and biodefense. As for expenditures, "in 10 years, these will double," Zerhouni predicted, projecting $4.1 trillion in health costs by 2017.
Then he made his case.
"The paradigm of the 21st century is to pre-empt disease," Zerhouni said. "That doesn't mean [disease] will only be solved by pills; it may require interventions in the behavioral or social science areas. Can we discover the fundamental drivers of the disease process 25 years before it hits the patient? Can we strike the disease before the disease strikes us? This is the paradigm shift and the focus of NIH research for the next 15, 20 years."
|At the hearing, Rep. Jesse Jackson, Jr. (l, D-IL) and subcommittee chair Rep. Dave Obey (D-WI) listen as NIH director Dr. Elias Zerhouni (at right) discusses his outlook for medical research.
||Shown in the photo with Zerhouni are (from l) Richard Turman, HHS deputy assistant secretary for budget; Alexander; and NHLBI director Dr. Elizabeth Nabel.
Zerhouni and the IC directors fielded questions reflecting national issues as well as constituent concerns. The President's NIH 2008 budget request, Obey cautioned, "doesn't adjust for inflation or real per capita needs." He and his colleagues were generally sympathetic to the NIH cause. Rep. Mike Honda (D-CA) quipped, "Dr. Zerhouni, I appreciate you bringing in this microchip [which tracks every gene in the human organism] - that's from San Jose." Honda's district includes Silicon Valley, the birthplace of IT innovation. Rep. Jerry Lewis (R-CA) recounted how his 4-year-old granddaughter had been brought from California to NIH for help: "I want you to know how grateful we are," he said, "and I think the country should be [grateful] for the work that you're about."
|Rep. Barbara Lee (D-CA) examines a microchip Zerhouni brought to Capitol Hill.
Testimony included these topics:
• Health disparities. Overall, American health has improved, but "it's unequal improvement," Zerhouni noted. Health disparities are among the top 6 priorities for NIH, with programs coordinated by NCMHD drawing 10 percent of the budget. NIH will provide Congress with a complete review of programs, both intramural and extramural, as well as a review of strategies for training to ensure diversity.
• Peer review. Responding to the charge that NIH grantees form an exclusive club, Zerhouni
explained that only 50 percent of first-time grants are renewed; after 5 years, only 25 percent are renewed: "The turnover is there. The peer review system is what you have to go through. It's like democracy - it's the worst system,
until you try the others."
• Vaccines. Current HIV/AIDS vaccines are now in trial, said NIAID director Dr. Anthony Fauci. Meanwhile, an RFP for developing a third-generation
anthrax vaccine has been rescinded because none of the proposals were "mature enough to go ahead," he said, "and when the field isn't mature, [we need] basic research."
• Heart disease. Recent declines in heart disease are attributable to lifestyle changes as well as drug therapies, Zerhouni said. NHLBI director Dr. Elizabeth Nabel described the largest longitudinal cohort study of Hispanic heart health in America, to extend over 6½ years and to straddle several ICs. She also reported that sleep disorders can affect the heart (as well as the lungs and neurological system).
• Global Fund for HIV/AIDS, Malaria and Tuberculosis. Zerhouni confirmed that NIH is the pass-through funding point for the U.S contribution to the Global Fund. Obey quipped that NIH acts as "the Bank of Bethesda" in this accounting process.
|Past chair of the subcommittee on Labor/HHS/Education Rep. Ralph Regula (R-OH) warmly greets Zerhouni after the hearing.
• Obesity. Rates of obesity among the young have increased at rates greater than expected, Zerhouni said, and NIEHS is looking at its relationship to environment. For example, if architects designed buildings whose first 3 floors had no elevators except for those in stringent need of them, "we could decrease obesity by 25 percent," Zerhouni said.
• Mental health. Zerhouni described depression as a growing concern, especially among people ages 24-44. NICHD director Dr. Duane Alexander described the problem of "the outdoor experience" now missing from many children's lives and how that lack may contribute to their rising rates of depression.
• Budget constraints. The U.S. is holding its own, said Zerhouni, “but when I project into the future, I am concerned. We are number one in research production, but there is increasing equilibration worldwide.” Furthermore, NIH is seeing a 44 percent drop in its foreign trainees “because there’s no money,” Nabel said. NCI director Dr. John Niederhuber added: “The impact on our clinical trials is dramatic. There will be 30 fewer phase III trials; 60 fewer phase II trials; and 3,000 fewer patients in clinical trials overall.” Alexander said there would be a trans-NIH plan to rebuild lost funding for Down syndrome, which concerns his institute as well as NIA.
• Child health. Newborn screening is high on the list of priorities, Alexander said. As for funding the National Children’s Study, Obey stated: “We’re going to put that money back next year.”
Slides of Zerhouni’s presentation are available at http://www.nih.gov/about/director/budgetrequest/
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