# Presentation: 007663

## Prevention Research Today

**Elias A. Zerhouni, M.D.**
**Director, National Institutes of Health**
**Steps to a Healthier US: Putting Prevention First**
**Baltimore, MD – April 15, 2003**

**Prevention Research Today**

## Coronary Heart Disease

**Coronary Heart Disease**
**Age-Adjusted Death Rates: Actual and Expected**
**United States, 1950-2000**

- 500

- 400

- 300

- 200

- 100

- 0

- 1950

- 1955

- 1960

- 1965

- 1970

- 1975

- 1980

- 1985

- 1990

- 1995

- 2000

- Deaths per 100,000

- Year

**~ 514,000 Actual Deaths**
**	****in 2000**

**~ 1,329,000 Projected Deaths**
**	****      ****in 2000**

**815,000 Deaths **
**Prevented in 2000**

## Estimated U.S. Incidence of and Mortality from AIDS1981-2001

- Prevalence

- *Adjusted for reporting delays

- 81

- 83

- 85

- 87

- 89

- 91

- 93

- 95

- 97

- 99

- 82

- 84

- 86

- 88

- 90

- 92

- 94

- 96

- 98

- 00

- 01

**Year**

- Incidence

- Deaths

**Number of Cases/Deaths**
**(Thousands)**

**1993**

**Estimated U.S. Incidence of ****and Mortality from AIDS****1981-2001**

**More than 80 new drugs in development**
**Nearly 3X the number of vaccines in Phase I since 2001**

## New Challenges

- New threats
- Biodefense
- New health threats (West Nile, others)
- Emerging health Issues
- Obesity (4.6% to 15% of children and adolescents)
- Diabetes (incidence has doubled)
- Age-related diseases, for example,Alzheimer’s Disease, Macular Degeneration
- From acute to chronic diseases

## Obesity Trends* Among U.S. AdultsBRFSS, 2001

- Obesity Trends* Among U.S. AdultsBRFSS, 2001

- Source: Mokdad A H, et al.* J Am Med Assoc* 1999;282:16, 2001;286:10.

## Prevalence of Obesity among

**Children and Adolescents**
**Age 6-19 Years**

- 15

- 10

- 5

- 0

- 1963-1970

- 1971-1974

- 1976-1980

- 1988-1994

- 1999

- Percentage

**4.6**

**5.1**

**5.9**

**11.0**

**13.6**

## Prevalence of Diagnosed Diabetes 

**Prevalence of Diagnosed Diabetes **
**in the United States**
- Diagnosed (1960-1998) and Projected Diagnosed (2000-2050) Cases

- Data for 1960-1998 from the National Health Interview Survey, NCHS, CDC.
- Projected data for 2000-2050  from Boyle JP, et al, _Diabetes Care_ 24:1936-40, 2001.

**Year**

## Prevention Initiative

- President Bush’s FY 2004 budget plan calls for $100** **million additional to fund a new initiative to prevent diabetes, obesity and asthma through community initiatives:
- State programs to motivate and support responsible health choices that would reduce the burden of preventable disease
- Community initiatives to promote and enable healthful choices, especially those focused on youth and older Americans
- Health care and insurance systems that put prevention first and reduce people’s risk factors for chronic disease and reduce potential health care complications

## Need for new strategies

- Revolution in biomedical sciences
- New challenges and opportunities
- Accelerate pace of life science discoveries
- Post- genome implications
- More rapid translational processes
- Need for new approaches
- Orders of magnitude more effective than current approaches
- Molecular prevention and behavioral modification research

## New Discoveries in Obesity Research Using RNA interference (RNAi)

- 112 genes

- 305 genes

- Normal Worm

- Obese
- Worm

- Thin
- Worm

- Source: Ashrafi, K., Chang, F.Y., Watts, A.G., Kamath, R.S., Ahringer, J., and Ruvkun, G., "Genome-wide RNAi analysis of Caenorhabditis elegans fat regulatory genes,” Nature, Vol. 421, pp.  268-272.

## Disease Prevention and Health Promotion

- An integral part of the research mission
- One-fourth of the overall NIH budget
- Prevention Research Continuum – Reflects breadth of investigational areas
- Educate and train the next generation of prevention scientists
- Educate the public and health professionals

## Phases of the Prevention Research Continuum

**Phases of the Prevention Research Continuum**

**1**
**Hypothesis**
**Development**

**2**
**Methods**
**Development**

**3**
**Controlled**
**Intervention**
**Trials**

**4**
**Defined**
**Population**
**Studies**

**5**
**Implementation**
**Projects**

**Research Training**
**Public and Professional Education**

## Phase 1 - Hypothesis Development

**Phase 1 - Hypothesis Development**

**Framingham Heart Study; Honolulu Heart Study (NHLBI)**
**Study of Relationship Between Air Pollutants and School Absenteeism in Southern California (NIEHS)**
**Study of Women’s Health Across the Nation: SWAN (NIA)**
**Arthritis Among Latinos: A Study Based on National Data (NIAMS)**

**1**
**Hypothesis**
**Development**

**5**
**Implementation**
**Projects**

**4**
**Defined**
**Population**
**Studies**

**2**
**Methods**
**Development**

**3**
**Controlled**
**Intervention**
**Trials**

## Phase 2 - Methods Development

**Phase 2 - Methods Development**

**Early Detection Research Network to Develop Molecular Markers of Early Cancer (NCI)**
**Sacramento Neighborhood Alcohol Prevention Project (NIAAA)**
**Assessment Measures for Alzheimer’s Disease Primary Prevention Trials (NIA)**

**1**
**Hypothesis**
**Development**

**5**
**Implementation**
**Projects**

**4**
**Defined**
**Population**
**Studies**

**2**
**Methods**
**Development**

**3**
**Controlled**
**Intervention**
**Trials**

## Phase 3 - Controlled Intervention Trials

**Phase 3 - Controlled Intervention Trials**

**Dietary Approaches to Stop Hypertension: DASH and DASH-sodium (NHLBI)**
**Vitamin Intervention for Stroke Prevention Trial (NINDS)**
**Fall Prevention Program for High-Risk Elderly Women (NINR)**
**Selenium and Vitamin E Prostate Cancer Prevention Trial-SELECT (NCI)**

**1**
**Hypothesis**
**Development**

**5**
**Implementation**
**Projects**

**4**
**Defined**
**Population**
**Studies**

**2**
**Methods**
**Development**

**3**
**Controlled**
**Intervention**
**Trials**

## Phase 4 - Defined Population Studies

**Phase 4 - Defined Population Studies**

**Centers for Research to Reduce Oral Health Disparities (NIDCR)**
**Trial of Activity in Adolescent Girls: TAAG (NHLBI)**
**The Study of Tamoxifen and Raloxifene (STAR) to Prevent Breast Cancer in High-Risk Women (NCI)**
**The National Longitudinal Study of Adolescent Health: Add Health (NICHD, other Institutes)**

**1**
**Hypothesis**
**Development**

**5**
**Implementation**
**Projects**

**4**
**Defined**
**Population**
**Studies**

**2**
**Methods**
**Development**

**3**
**Controlled**
**Intervention**
**Trials**

## Phase 5 - Implementation Projects

**Phase 5 - Implementation Projects**

**Enhanced Dissemination and Utilization Centers: EDUCs (NHLBI)**
**State Models for Oral Cancer Prevention and Early Detection (NIDCR; NCI)**
**5-A-Day Campaign (NCI, CDC, ACS, Produce Industry, etc.)**
**Community Wide Program to Prevent Adolescent Alcohol Use (NIAAA)**
**Environmental Health Community Programs (27 Centers funded by NIEHS)**

**1**
**Hypothesis**
**Development**

**5**
**Implementation**
**Projects**

**4**
**Defined**
**Population**
**Studies**

**2**
**Methods**
**Development**

**3**
**Controlled**
**Intervention**
**Trials**

## NIH Roadmap Re-engineering the ClinicalResearch Enterprise“We need to more quickly translateour discoveries into practice.”

- Integrated Clinical Research Networks
- Clinical Research Informatics
- Training
- Public Trust
- Translational Research

**GOAL**
**A More Efficient National “Bench to Bedside”**
**Clinical Research System**

## National Clinical Research System

## Healthy People 2010

- Translation and application of research evidence that benefits the public health community
- Goals and objectives based on sound scientific research evidence
- Important DHHS instrument to guide planning and implementation of effective prevention strategies

## NIH

**Investing in People’s**
**Health**

**NIH**

## Our ultimate goal is to prevent disease and disability

- Research Is Key to Success

## Public and Professional Education

**Public and Professional Education**

**“****The National Diabetes Education Program (NIDDK and CDC)**
**National Asthma Education and Prevention Program (NHLBI)**
**Obesity Education Initiative (NHLBI)**
**PDQ Cancer Screening and Prevention Summaries, Trial Registry; Cancer Information Service (NCI)**

## NIH Roadmap Re-engineering the ClinicalResearch Enterprise“We need to more quickly translateour discoveries into practice.”

- Integrated Clinical Research Networks
- Clinical Research Informatics
- Training
- Public Trust
- Translational Research

**GOAL**
**A More Efficient National “Bench to Bedside”**
**Clinical Research System**