S. HRG. 109–286, PT. 6 

Senate Hearings 

Before the Committee on Appropriations 

Departments of Labor, 

Health and Human Services, 

Education, and Related 

Agencies Appropriations 

Fiscal Year 2007 

109th CONGRESS, SECOND SESSION 

H.R. 5647/S. 3807 

PART 6 

DEPARTMENT OF EDUCATION 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

NONDEPARTMENTAL WITNESSES 
Labor-HHS-Education Appropriations, 2007 (H.R. 5647/S. 3807)—Part 6 
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WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

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27–036 PDF 2007

S. HRG. 109–286, PT. 6 

DEPARTMENTS OF LABOR, HEALTH AND HUMAN 

SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2007 

HEARINGS 

BEFORE A

SUBCOMMITTEE OF THE 

COMMITTEE ON APPROPRIATIONS 

UNITED STATES SENATE 

ONE HUNDRED NINTH CONGRESS 

SECOND SESSION 

ON

H.R. 5647/S. 3807 

AN ACT MAKING APPROPRIATIONS FOR THE DEPARTMENTS OF LABOR, 

HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED 

AGENCIES FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2007, AND 

FOR OTHER PURPOSES 

PART 6 

Department of Education 

Department of Health and Human Services 

Nondepartmental Witnesses 

Printed for the use of the Committee on Appropriations 

Available via the World Wide Web: http://www.gpoaccess.gov/congress/index.html 
(II) 

COMMITTEE ON APPROPRIATIONS 

THAD COCHRAN, Mississippi, Chairman 

TED STEVENS, Alaska 

ARLEN SPECTER, Pennsylvania 

PETE V. DOMENICI, New Mexico 

CHRISTOPHER S. BOND, Missouri 

MITCH MCCONNELL, Kentucky 

CONRAD BURNS, Montana 

RICHARD C. SHELBY, Alabama 

JUDD GREGG, New Hampshire 

ROBERT F. BENNETT, Utah 

LARRY CRAIG, Idaho 

KAY BAILEY HUTCHISON, Texas 

MIKE DEWINE, Ohio 

SAM BROWNBACK, Kansas 

WAYNE ALLARD, Colorado 

ROBERT C. BYRD, West Virginia 

DANIEL K. INOUYE, Hawaii 

PATRICK J. LEAHY, Vermont 

TOM HARKIN, Iowa 

BARBARA A. MIKULSKI, Maryland 

HARRY REID, Nevada 

HERB KOHL, Wisconsin 

PATTY MURRAY, Washington 

BYRON L. DORGAN, North Dakota 

DIANNE FEINSTEIN, California 

RICHARD J. DURBIN, Illinois 

TIM JOHNSON, South Dakota 

MARY L. LANDRIEU, Louisiana 

J. KEITH KENNEDY, Staff Director 

TERRENCE E. SAUVAIN, Minority Staff Director 

SUBCOMMITTEE ON DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, 

EDUCATION, AND RELATED AGENCIES

ARLEN SPECTER, Pennsylvania, Chairman 

THAD COCHRAN, Mississippi 

JUDD GREGG, New Hampshire 

LARRY CRAIG, Idaho 

KAY BAILEY HUTCHISON, Texas 

TED STEVENS, Alaska 

MIKE DEWINE, Ohio 

RICHARD C. SHELBY, Alabama 

TOM HARKIN, Iowa 

DANIEL K. INOUYE, Hawaii 

HARRY REID, Nevada 

HERB KOHL, Wisconsin 

PATTY MURRAY, Washington 

MARY L. LANDRIEU, Louisiana 

RICHARD J. DURBIN, Illinois 

ROBERT C. BYRD, West Virginia (Ex officio) 

Professional Staff 

BETTILOU TAYLOR

JIM SOURWINE

MARK LAISCH

SUDIP SHRIKANT PARIKH

CANDICE NGO

LISA BERNHARDT

ELLEN MURRAY (Minority) 

ERIK FATEMI (Minority) 

ADRIENNE HALLETT (Minority) 
(III) 

C O N T E N T S 

WEDNESDAY, MARCH 1, 2006 

Page 

Department of Education: Office of the Secretary ................................................ 1 

WEDNESDAY, MAY 3, 2006 

Department of Health and Human Services: Office of the Secretary ................. 61 

FRIDAY, MAY 19, 2006 

Department of Health and Human Services: National Institutes of Health ...... 105 

NONDEPARTMENTAL WITNESSES

Department of Labor ............................................................................................... 301 

Department of Health and Human Services ......................................................... 315 

National Institutes of Health .................................................................................. 384 

Department of Education ........................................................................................ 538 

Related Agencies ...................................................................................................... 575 

(1) 

DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 

FISCAL YEAR 2007 

WEDNESDAY, MARCH 1, 2006 

U.S. SENATE, 

SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS, 

Washington, DC. 

The subcommittee met at 10:45 a.m., in room SD–124, Dirksen 

Senate Office Building, Hon. Arlen Specter (chairman) presiding. 

Present: Senators Specter, Craig, Harkin, Kohl, Murray, and 

Landrieu. 

DEPARTMENT OF EDUCATION 

OFFICE OF THE SECRETARY

STATEMENT OF HON. MARGARET SPELLINGS, SECRETARY 

ACCOMPANIED BY: THOMAS SKELLY, DIRECTOR, BUDGET SERVICE 

OPENING STATEMENT OF SENATOR ARLEN SPECTER

Senator SPECTER. Good morning Ladies, and Gentlemen, the subcommittee on Labor, Health and Human Services, and Education 

will now proceed with our hearing on the budget from the Department of Education. I regret our delayed start, but we just finished 

a vote on the PATRIOT Act, and Senator Harkin was on the floor 

and should be here I think, shortly. Scheduling has been complicated because of this vote. As you know we had moved the time 

from 9:30 to 11:00 and then back to 10:30 and we don’t like to keep 

people waiting, especially the Secretary of Education. But we welcome you here, Madam Secretary. 

You were confirmed on January 20, 2005. You have extensive experience working for the President when he had been a Governor; 

you were Assistant to the Secretary for Domestic Policy. You were 

Senior Advisor to then Governor Bush with responsibilities for developing and implementing the Governor’s education policy. You 

are a graduate of the University of Houston, with a bachelor’s degree in political science and journalism. 

PREPARED STATEMENT

Madam Secretary, I shall be relatively brief because of our time 

here, our late start. Without objection, my written statement will 

be included in the record. As you and I have talked briefly earlier 
2 

this week, I’m concerned about the overall budget. We had a budget for this subcommittee, which has in addition to the Department 

of Education, Health and Human Services and Labor, which fell 

about $8 billion short when you figure the cuts and take into account, inflation. I know that it is difficult as a loyal member of the 

administration when you have the policies working up through the 

Office of Management and Budget. But as I said to you in our telephone conversation, and as I’ve said repeatedly, I think there’s a 

real need for someone in your position to be a tough advocate for 

your Department. Education is simply under funded. When I took 

a look at the President’s budget, we’re always asked for comment 

and I wanted to be definitive and brief and chose the word scandalous which I think it is. I know the President, the administration 

have tremendous problems in many, many areas but when you 

have so much money for the National Institutes for Health, and the 

Centers for Disease Control and Prevention, and Worker Safety, 

and Mine Safety, and important education programs, it’s simply insufficient to have continual cuts on discretionary programs. We’re 

regrettably moving to a system where there will be no discretionary 

funding at all. We’ll all be out of jobs. The Appropriations Committee, which used to be—was once a powerful committee. 

[The statement follows:] 

PREPARED STATEMENT OF SENATOR ARLEN SPECTER

This morning, the Subcommittee on Labor, Health and Human Services, and Education will discuss the President’s $54.410 billion 2007 budget request for the Department of Education. We are delighted to have before us the distinguished Secretary of Education, the Honorable Margaret Spellings, our Nation’s 8th Secretary 

of Education. 

Madam Secretary, your impressive biography clearly illustrates your abilities and 

potential for leading this important Department. Being a mother of two school-age 

daughters gives you important insights into your other job as Secretary of Education. 

This subcommittee is pleased to see several shared priorities funded in the fiscal 

year 2007 budget including the $200 million request for school improvement grants, 

$380 million for the American Competitiveness Initiative, and additional funding for 

foreign language instruction and the Advanced Placement Program. 

However, I am concerned that the budget is $2.1 billion below the fiscal year 2006 

level and that there are 42 program eliminations. For example, $303 million currently available for Gear-Up, which provides for the transition from seventh grade 

to college; $1.2 billion for State grants for vocational and technical education programs; and $23 million for correctional education programs all are proposed for 

elimination. The Pell Grant maximum award is frozen at $4,050 for the fifth year 

in a row. 

I know, Madam Secretary, that you can appreciate the difficult tradeoffs that this 

subcommittee will need to negotiate in the coming months as we balance the competing pressures of biomedical research, worker protection programs and continued 

investment in our Nation’s youth. Madam Secretary, I look forward to working with 

you to craft an appropriations bill that maintains our commitment to fiscal restraint 

while preserving funding for high priority programs. 

Senator SPECTER. Senator Landrieu, would you care to be acting 

ranking and make an opening statement? 

STATEMENT OF SENATOR MARY L. LANDRIEU

Senator LANDRIEU. Thank you, Mr. Chairman. 

Senator SPECTER. Or not be acting, just make an opening statement. 
3 

DEPARTMENT LAUDED FOR HURRICANE RESPONSE

Senator LANDRIEU. It’s hard shoes to fill, but I will make an 

opening statement. Just very briefly because I appreciate that we 

want to hear our witness. But I wanted, Mr. Chairman, to be here 

this morning to give compliments to this Department—being mindful of what you said and agreeing with the level of funding which 

I’ll get back to in a minute. Which I fully agree is scandalous. But 

Madam Secretary, your Department has been really a model of 

partnership for the State of Louisiana through the most difficult 

time that our State has experienced. I spoke to the Secretary, Mr. 

Chairman, privately before to let her know that if every Department of the Federal Government had worked this honestly, this reliably, with us we would not be experiencing the problems that 

we’re experiencing now. In all of the calls, and I had thousands of 

calls about Katrina and Rita and the devastation that occurred, not 

one call did my office receive from any school or university in the 

country or from any parent saying they couldn’t find a place for 

their child, or their young person to go to school. Number one, because the word went out across the country, please take the 

330,000 children that showed up for school on Friday; the hurricane hit on Sunday, and they had no school to go to on Monday. 

Mr. Chairman, it’s a credit to the education establishment in this 

country that almost to my knowledge, every high school student, 

every elementary school student, and every college student that 

wanted to, found a place to continue their education of the last 6 

months, and Madam Secretary, I think you deserve a lot of credit 

for that. 

Second, the quickness in which we were able in a bipartisan way, 

we were able to implement with the chairman’s help and assistance 

the special funding for getting our schools back up and started also 

is a great model. Having said that, we still have many problems 

as you know. We’re hoping the new school system that emerges in 

New Orleans can be a model for the Nation as it emerges as a network of public charter schools and we’re going to need your ongoing 

help and commitment to that end. 

We do have problems with FEMA in terms of reimbursing and 

not reimbursing for school construction, we’ve lost over 100 school 

buildings, Mr. Chairman, which is a great strain on any system, to 

have to try to build the physical plants as well as the internal operations. But I did want to start with that and then finally say, having said that, the overall budget for the Nation is just not sufficient 

to meet the new standards and challenges that we have set for our 

schools as we struggle to provide excellence, opportunity, no guarantee Madam Secretary, but an opportunity. 

TITLE I FUNDING

Title I funding, is the only Title that helps poor and lower middle-income children get the resources they need; to have the kinds 

of schools they need to be excellent. With that funding decreasing 

I don’t know how our poor counties and middle-income counties 

that are struggling can meet the targets of No Child Left Behind, 

which means closing that achievement gap. So that’s what I’m 
4 

going to focus on in the committee and, Mr. Chairman, I thank you 

very much. 

Senator SPECTER. Well thank you very much, Senator Landrieu. 

Well welcome again, Madam Secretary, the floor is yours, and we 

look forward to your testimony. 

SUMMARY STATEMENT OF HON. MARGARET SPELLINGS

Secretary SPELLINGS. Thank you very much, Mr. Chairman. It 

does seem like all roads lead to you today, and so I’m at your service, and thank you for all your work that you’re doing, not only in 

this arena, but in many others. 

EDUCATION FUNDS DISBURSED FOR HURRICANE RECOVERY

Senator Landrieu, thank you for your very generous comments. 

I appreciate the opportunity to be here and your support. Let me 

begin first, by thanking all of you for your work on behalf of the 

victims of hurricanes Rita and Katrina. As Senator Landrieu has 

talked about, we’ve worked a lot on that. After you passed the Hurricane Education Recovery Act in December, we sent immediately 

$250 million to Louisiana, Mississippi, Texas, and Alabama to help 

re-open schools in the region. That was in addition to $20 million 

that we sent to help open, or re-open, charter schools for affected 

students in Louisiana, and more than $200 million that we sent to 

help college students in the region. We’ll be sending another $500 

million in aid to these States in the coming days, and we’ve been 

consulting with experts at the Federal, State, and local levels, reviewing records from tax data, property loss data, and insurance 

claims, to make sure that this money is allocated fairly. 

We’ll also be providing $645 million to reimburse districts all 

over the country for the cost of educating displaced students, as 

they’ve done so welcomingly, and so well. We’ve been working with 

States to help accelerate this process and to identify the number 

of displaced students so we can begin sending this money to 

schools. 

FISCAL YEAR 2007 EDUCATION BUDGET REQUEST

But today I’m here to talk about the President’s budget, and it’s 

more important than ever that we spend taxpayer dollars wisely 

and well. Since taking office in 2001, the President has worked 

with you to increase funding for education by about 30 percent. The 

new budget increases education spending in key areas, but, as 

you’ve observed, not across the board. I know together we have a 

very tough job ahead. The programs you make funding decisions 

for are discretionary and you don’t have much room to maneuver. 

It’s only getting harder to fund priorities and reduce the deficit, because of the rising cost of entitlement spending. 

AMERICAN COMPETITIVENESS INITIATIVE

At the same time, as policymakers we must focus on results. 

We’ve looked at data to see what policies are working for students, 

and where we can save taxpayers money or work more efficiently 

and effectively by eliminating and consolidating less effective programs. Raising student achievement is always our watch word. The 
5 

President’s new American Competitiveness Initiative would devote 

$380 million to strengthen K–12 math and science education. Overall the Department of Education will increase funding for its programs in these critical fields by 51 percent. The President has 

asked me to form a national math panel of experts to help us bring 

together the best research on proven strategies for teaching math; 

just as we’ve done in reading. His budget includes $250 million for 

a new program called Math Now, that will help elementary and 

middle school students develop the academic foundation to eventually take higher-level classes in high school, such as Advanced 

Placement courses. The trouble today is that more than a third of 

our high schools offer no AP classes and that needs to change, especially when we know that students are going to need these skills 

in a world where 90 percent of the fastest growing jobs require 

postsecondary education. 

The President has also called for $122 million to prepare an additional 70,000 teachers to lead Advanced Placement and International Baccalaureate classes in math, science, and critical foreign 

languages. The budget includes $25 million to help recruit 30,000 

math and science professionals to become adjunct high school 

teachers in these critical areas. 

I know there are concerns about resources, but in reality we have 

resources available around these priorities. Currently 13 different 

government agencies spend about $2.8 billion on 207 different programs for math and science. The problem is that these programs 

are in their own silos with little or no coordination with No Child 

Left Behind and its goals for raising student achievement. It’s a 

1,000 flowers blooming and maybe even a few weeds throughout 

the Government. 

We should align these efforts with the principles of No Child Left 

Behind by continuing to hold schools accountable for getting students to grade-level proficiency by 2014, and by giving local policymakers and educators resources, authority, and the research base 

to do what’s best. 

SCHOOL IMPROVEMENT AND HIGH SCHOOL REFORM

Thanks to No Child Left Behind, we’ve reached a point where we 

have the data to see what’s working in our schools and what needs 

to work better. We’re proposing a new $200 million School Improvement program to help States use what we’ve learned to turn 

around schools in need of improvement. Now we must build on the 

foundations of the NCLB law, which is working in grades three 

through eight, to extend the benefits of assessment and accountability for results into our high schools, with the President’s $1.5 

billion high school reform proposal. There’s a wide and growing 

consensus that we have a problem in our high schools and we must 

work together to address these issues. A high school diploma must 

be a record of achievement and not just a certificate of attendance. 

If we raise the bar, our students will rise to the challenge just as 

they always have, but we must give them the skills to compete. 
6 

PREPARED STATEMENT

Thank you. I’d be glad to answer any questions. With me today 

is Tom Skelly, our Budget Director, who tells me he’s been doing 

this since 1976. So he knows what he’s doing by now. 

[The statement follows:] 

PREPARED STATEMENT OF HON. MARGARET SPELLINGS

Mr. Chairman and Members of the Committee. Thank you for this opportunity to 

testify on behalf of the President’s 2007 budget for education. I know you have received our Congressional justifications and other background materials laying out 

the details of our request, so I will concentrate on a few key highlights. 

President Bush is requesting $54.4 billion in discretionary appropriations for the 

Department of Education in fiscal year 2007. We are proposing significant increases 

in key areas, as well as substantial savings from reductions in lower priorities. The 

result would be a discretionary total that is up more than $12 billion, or 29 percent, 

since fiscal year 2001. 

We know the 2007 budget process will involve difficult trade-offs among existing 

programs, just as was the case with the 2006 appropriations bill. In 2006, we saw 

that this Subcommittee was willing to balance funding for priority programs with 

reductions and eliminations in other activities, and we hope you will take the same 

approach in 2007. 

For example, our budget would save $3.5 billion by eliminating funding for 42 programs. These reductions and terminations reflect the Administration’s longstanding 

goal of providing local control, streamlining government to avoid unnecessary duplication, and targeting taxpayer dollars to those programs with the greatest promise 

of improving student outcomes. Let me add that we very much appreciate the efforts 

of this Subcommittee last year in eliminating five Department programs, and making significant reductions in several others, in order to better target existing resources. We look forward to working with you on this goal again this year. 

A BROAD EMPHASIS ON COMPETITIVENESS

President Bush has made ensuring American competitiveness in the global economy a strong priority in his overall 2007 budget, primarily through his American 

Competitiveness Initiative. Several of the increases in the Department’s request are 

part of that Initiative, and I’ll say more about them in a minute, but I think most 

of you would agree that we need to address the competitiveness issue in America’s 

schools now, this year. This is why most of our major increases for 2007—not just 

those included in the President’s Initiative—are aimed at keeping our students, and 

our workforce, competitive for the 21st century. 

In that context, a key proposal for 2007 is a renewed request for High School Reform, a $1.5 billion initiative to support a wide range of locally determined reforms 

aimed at ensuring that every student not only graduates from high school, but graduates with the skills to succeed in either college or the workforce. The High School 

Reform proposal also would require States to assess students, in reading or language arts and math, at two additional grades in high school. NCLB currently requires assessments in these subjects for just one high school grade. We believe the 

additional assessments are needed to increase accountability and give parents and 

teachers the information they need to keep all students on track toward graduation. 

And more generally, these assessments will help researchers and policymakers understand more about what works and what doesn’t work in our high schools, a key 

goal when about 1 million high school students a year drop out, at great cost to our 

economy and society. Too many students drop out, and too many of them are minorities. 

We also are seeking $100 million for the Striving Readers program, which is applying the lessons of the successful Reading First model, which translates research 

into practice to improve reading instruction for young children, at the secondary 

school level. The $70 million increase for this program would expand support for the 

development and implementation of research-based methods for improving the skills 

of teenage students who are reading below grade level, and who otherwise might 

end up dropping out of school. It’s hard to compete with anyone if you don’t finish 

high school. 
7 

MATH AND SCIENCE

A critical new focus for 2007 is on improving student achievement in math and 

science from the early grades through high school, and the President is seeking 

$380 million in new funding to support this goal through his American Competitiveness Initiative (ACI). That total includes $250 million for two proposed programs 

we call Math Now, one focused on developing and implementing proven instructional practices for students in grades K–6, and one to support research-based interventions for middle school students. Both initiatives would be guided by the recommendations of a National Mathematics Panel that I will appoint soon, and that 

will be charged with identifying essential math content and sound instructional 

principles, just as the National Reading Panel did for reading instruction. 

Another key ACI request is a $90 million increase for the Advanced Placement 

program, to expand incentives for training teachers and encouraging students, particularly in high-poverty schools, to take high-level Advanced Placement and International Baccalaureate courses in math, science, and critical foreign languages. We 

also are proposing a new requirement for State or private-sector matching funds to 

expand the reach of the AP program, so that we can train an estimated 70,000 

teachers over the next five years. Over the long term, this proposal would increase 

the number of students taking AP-IB exams in math, science, and critical foreign 

languages from 380,000 today to 1.5 million in 2012, and triple the number of students passing these tests to 700,000 by 2012. 

I believe that increasing the number of American students studying and gaining 

fluency in critical foreign languages is essential not only for our national security, 

as suggested by the President’s National Security Language Initiative, but also to 

maintain our economic competitiveness. That’s why I’m very pleased that our request includes $35 million in new funds for a package of proposals that would encourage more students to master a critical foreign language. The largest proposal 

is $24 million for Advancing America Through Foreign Language Partnerships, a 

new program that would link postsecondary institutions with school districts to support language learning from kindergarten through high school, as well as advanced 

language study at the postsecondary level. 

BUILDING STATE CAPACITY FOR SCHOOL IMPROVEMENT

We continue to make good progress in implementing No Child Left Behind, with 

scores on State assessments up significantly across the country, and the National 

Assessment of Educational Progress showing real improvements in closing achievement gaps, especially in the early grades addressed by key NCLB programs like 

Title I and Reading First. Our 2007 request would help maintain that positive momentum, while providing a new push in the area of school improvement. Our budget 

would provide $12.7 billion for Title I Grants to Local Educational Agencies, which 

is the foundation of NCLB, while funding a $200 million School Improvement 

Grants program. This initiative would help States to establish and expand the statewide systems of improvement and support that are essential to the long-term success of NCLB. If we’re going to reach the 100-percent proficiency goal by 2013–14, 

we need to make continuous improvement our watchword, and our request would 

help States do just that. 

Our request also would support additional options for students enrolled in schools 

that have been identified for restructuring—these are chronically low-performing 

schools that have not made adequate yearly progress under NCLB for at least 5 

years. The $100 million America’s Opportunity Scholarships for Kids program would 

permit the parents of such students to transfer their children to a private school 

or to obtain intensive tutoring or other supplemental services, including after-school 

and summer-school instruction. The President believes that for accountability to be 

meaningful, there must be real consequences for schools and real options for students and parents. 

OTHER PROGRAMS

The 2007 budget would provide a $100 million increase for the reauthorized Special Education Grants to States program, for a total increase of $4.3 billion, or 69 

percent, over the past five years. We also would maintain a $4,050 Pell Grant maximum award with a $12.7 billion request for that program, while continuing to support the new Academic Competitiveness Grants and National SMART Grants program. I want to thank the Members of this Subcommittee, along with your colleagues in the House, for supporting these critical new grant programs. In particular, SMART Grants complement the President’s American Competitiveness Initiative by awarding up to $4,000 annually to third- and fourth-year postsecondary 
8 

students majoring in physical, life, or computer sciences, mathematics, technology, 

engineering, or a critical foreign language. 

CONCLUSION

These highlights of our 2007 request show that within the very tight constraints 

required by the need to reduce the Federal budget deficit in a time of war, we are 

proposing a strong education budget, one that will maintain and even accelerate 

progress under No Child Left Behind, while making key new investments in critical 

areas designed to ensure our future competitiveness in the 21st century global economy. 

I will be happy to answer any questions you may have. 

FISCAL YEAR 2007 EDUCATION BUDGET PRIORITIES

Senator SPECTER. Thank you very much, Madam Secretary. I 

begin with the questions which I posed in the letter which I sent 

to you, last month. I focus at the outset on the proposed budget for 

the Department of Education, being $2.1 billion below last year. 

The Department has highlighted rising test scores, a narrowing of 

the achievement gaps since the passage of No Child Left Behind, 

and the increase in Federal funding that has accomplished those 

results. What are the prospects for continued progress with the 

budget cuts which are in your proposal? 

Secretary SPELLINGS. Well Senator, I think there are a couple of 

answers to that. One is that the priorities of No Child Left Behind 

are indeed funded in the President’s budget—the emphasis on 

reading, the emphasis on teacher development, the emphasis on 

Title I. Then there are the additional resources that we are requesting for school improvement—the $200 million that we need as 

the No Child Left Behind law matures—as well as the investment 

in competitiveness, and in high schools, and in math and science. 

So I think that where we have resources we’ve focused them on the 

goals of No Child Left Behind. Second, I would say that a lot of the 

infrastructure that was needed to be put in place to do No Child 

Left Behind, such as assessments, and reading curriculum reform 

and those sorts of things, has been done, and now we’re turning 

our attention to the maturing of No Child Left Behind and these 

other priorities. 

Senator SPECTER. The difficulty, Madam Secretary, is that there 

are cuts in a lot of programs which impact the students whom 

you’re trying to deal with in No Child Left Behind. You’re robbing 

Peter to pay Paul, really. When you have a net decrease of $2.1 billion and you have the inflation factor as well, it just seems to me 

that it’s impossible to make it up with the shuffling that you’re 

suggesting. 

PUBLIC SCHOOL CHOICE AND SUPPLEMENTAL SERVICES

What is the situation with the repeated public comments about 

the difficulty of moving students from one school which is not satisfactory to other schools? We see constant complaints that the recipient school districts are unable to accommodate the students, 

that that has not really been a practical or realistic program? 

Secretary SPELLINGS. Let me make a couple of comments about 

that, Senator. First, I’ve observed that also. We have about a 10 

percent take-up, if you will: 2 million students are eligible for supplemental services, and about 200,000 students are seeking those 

options. So we must do a better job of making sure those options 
9 

for parents are real. But one of the things I think I’ve learned, and 

we’re piloting strategies in various places around the country, is, 

does it make more sense—and we ought to get some data about 

this—to allow students to get extra intervention and supplemental 

services before the public school choice options are used. So we’re 

testing that theory in Chicago, Los Angeles, New York, and some 

districts in Virginia will also test that out. Does it make more 

sense, before we ship them off to other schools, to get them additional remediation. That’s why the President’s call for an additional 

$100 million for either choice, or ramped up supplemental services, 

makes a lot of sense. 

Senator SPECTER. But you still are letting them choose to go to 

another district, aren’t you? 

Secretary SPELLINGS. The public school choice options, yes, are 

still in place. But what I’m saying is, perhaps parents would be 

equally satisfied or more satisfied to receive supplemental services 

first. 

Senator SPECTER. Well, are you saying that in all situations 

where children want to move from an inferior school to a better 

school that there are remedial programs to discourage their moving? 

Secretary SPELLINGS. Well, I’m saying that perhaps in the meantime, as we address these choice issues, that getting remediation 

in a particular skill or subject, quickly and readily available, convenient—— 

Senator SPECTER. Well, are you talking about something which 

is realistic, so that we have inferior schools in those situations, all 

of those situations, or almost all of those situations, or most of 

those situations, you have remedial programs to discourage going 

to another school? 

Secretary SPELLINGS. Well, I think it’s a range of fallibility if you 

will. I mean, some of these schools are chronically low performing 

and that’s why we need to spend $200 million to make sure that 

real school restructuring takes place. 

EFFECTIVENESS OF SUPPLEMENTAL SERVICES

Senator SPECTER. Madam Secretary, my time is almost up and 

I’m going to observe the time. But the question really is, is that a 

palliative and a fig leaf, or does it really work? 

Secretary SPELLINGS. I think supplemental services can work 

very well educationally for kids. 

Senator SPECTER. Can. But do they, are they? Are there sufficient supplemental services to pick up on this very critical program 

problem? 

Secretary SPELLINGS. In some places there are, and in some 

places there are not, Senator. Clearly, I agree. 

Senator SPECTER. Well, that’s not satisfactory. My red light went 

on, so I’m going to yield at this point to distinguished ranking 

member Senator Harkin. 

Senator HARKIN. Thank you very much Mr. Chairman, I apologize for being late, I’ll just forgo my opening statement and ask 

that it be made a part of the record, if that’s okay. 

Senator SPECTER. Without objection, it will be made part of the 

record. 
10 

[The statement follows:] 

PREPARED STATEMENT OF SENATOR TOM HARKIN

Good morning, Madam Secretary. I don’t get to see you that often in person, so 

I want to take this opportunity to commend you for the steps you’ve taken to make 

the No Child Left Behind Act more flexible. There’s still room for improvement, but 

you’re responding to the concerns that many people have with this law, and you deserve credit for that. 

Today, however, our focus is on the President’s proposed budget for education. 

And I must speak frankly: I don’t see how anyone in this administration can defend 

it. 

This budget would cut federal education spending by $2.1 billion. That’s the largest cut, in dollars, in the 26-year history of the Education Department. And it comes 

on the heels of a $600 million cut in fiscal year 2006—the first cut in a decade. 

It looks to me as if this administration has basically given up on the three programs that matter most to the Nation’s students—Title I, IDEA, and Pell. 

Title I is the cornerstone program for the No Child Left Behind Act. It’s the program that targets aid to the students who are most at risk of failing. That’s why 

NCLB calls for a $2.2 billion increase for Title I this year. But how much more does 

the President ask for? Zero. It’s flat funded. 

This administration has also given up on funding for students with disabilities. 

In fact, it’s moving in the wrong direction. In fiscal year 2005, the federal government provided 19 percent of the average per-pupil expenditure toward the costs of 

special education. This year, fiscal year 2006, it went down to 18 percent. Next year, 

under this budget, it would go down again, to 17 percent. As the federal share goes 

down, states and local districts have to pick up more of the tab. And we all know 

what that means—higher property taxes. 

This administration has also given up on student aid. Under this budget, the maximum Pell Grant award would be frozen at $4,050, the same level as four years 

ago. I wonder if there are any colleges in America that charge the same amount 

for tuition that they did four years ago. I doubt it. It gets tougher and tougher all 

the time for low- and middle-income families to afford college, but this administration doesn’t seem to care. 

It’s as if the President said, ‘‘Well, I spent a little money on education during the 

first couple years of my administration. So much for that. I’m done.’’ 

So if there’s nothing in this budget for Title I, Pell, and IDEA, what is there? Unfortunately, a lot of the ‘‘same old, same old.’’ 

Once again, the President proposes a high school reform initiative. But as far as 

I’m concerned, it’s dead on arrival. The President asked for it last year, Congress 

rejected it, and the same thing will happen again this year, as long as it’s contingent on eliminating the Perkins vocational ed program. 

And speaking of eliminations, the budget zeroes out 42 programs in all. Forty-one 

of them are programs you tried, unsuccessfully, to eliminate in the past. Congress 

restored the funding for them last year, and I can tell you right now, we’ll restore 

funding for almost all of them again this year. 

Like I said, more of the ‘‘same old, same old.’’ 

There are really only two new initiatives in this budget of any significance: the 

Math Now programs, which cost a total of $250 million, and the Title I School Improvement Grants, which are budgeted for $200 million. 

I happen to like both of these ideas. In fact, I was the first Member of Congress 

to include funding for School Improvement Grants in an appropriations bill. In fiscal 

year 2003, when I was chairman of this subcommittee, I included $100 million for 

this program in the Senate Labor-HHS bill. It didn’t end up getting funded, but I’d 

like to see it happen. 

But where will the money come from to fund these new initiatives? I guarantee 

you: We’re going to restore the TRIO programs that this budget would eliminate. 

There’s enormous bipartisan support for TRIO. So that’s $456 million that we’ve got 

to find from somewhere. We’re going to restore GEAR-UP, at $303 million. We’re 

going to restore the Robert C. Byrd Scholarships, at $41 million. We’re going to restore the counseling programs, at $35 million. I created that program, so I can assure you that Congress will save it. 

I could go on and on, program after program. But here’s the bottom line: Unless 

the President helps up find more money overall for education, his new initiatives 

are simply not going to get funded, at least not anywhere close to the levels he 

wants. 

I’ve served on this subcommittee as ranking member or chairman since 1989, so 

I know what I’m talking about. If you want us to fund these presidential initiatives, 
11 

you’re going to have to work with us to get our congressional priorities funded as 

well. 

Again, Madam Secretary, I want to welcome you to the subcommittee. I look 

orward to hearing your testimony. 

NO CHILD LEFT BEHIND FLEXIBILITY PROVISIONS

Senator HARKIN. Madam Secretary, welcome. First a compliment 

before I get into the other stuff, if you don’t mind; I don’t see you 

that often, I just want to take the opportunity to commend you for 

the steps that you’ve taken to make the No Child Left Behind Act 

more flexible. That has always been a sore point, and I appreciate 

that. There’s I think, still some room for improvement. But I think 

you were responding to the concerns that many people have with 

this law, and I think you deserve credit for that—to get that flexibility in there. But that’s aside from today. 

FISCAL YEAR 2007 EDUCATION DEPARTMENT BUDGET REQUEST

We’re talking about the budget. I guess my first question was, 

the budget that you’ve sent up for our subcommittee on education, 

would you Madam Secretary, like to see it passed exactly as you 

sent it up? 

Secretary SPELLINGS. Well, Senator, as you know, we propose 

and you dispose. It’s a process between the two of us, we seldom 

end up—you know, you all seldom enact exactly what the President 

sends up. I mean obviously—— 

Senator HARKIN. I’m just asking you. Do you back it? Do you 

back it as you sent it up? 

Secretary SPELLINGS. Certainly. I support the President’s budget. 

Senator HARKIN. Does your boss the President back it as it was 

sent up. 

Secretary SPELLINGS. Yes, he does. 

Senator HARKIN. So he wants it enacted just like that? 

Secretary SPELLINGS. Well, I think he believes that this is the 

smartest, best allocation of resources, given all the various priorities in the Government. 

PROPOSED EDUCATION BUDGET CUTS

Senator HARKIN. I just want to get that clear for the record. That 

this isn’t just some little game, that this is a budget that your boss 

the President of the United States, proposed to us, and this is how 

he’d like to see it enacted and so would you, Madam Secretary. 

Here is the biggest cut in Federal education spending, $2.1 billion 

in the 26 year history of the Education Department. Do you disagree with that? 

Secretary SPELLINGS. Well, Senator—— 

Senator HARKIN. Is that figure correct, or not? 

Secretary SPELLINGS. I can’t remember the exact figure, the 

$2.1—— 

Senator HARKIN. That’s what I have; I just want to make sure 

we’re on the same page. 

Mr. SKELLY. It’s the biggest since 1988. So not 26 years. 

Senator HARKIN. So what year was the bigger cut? 

Mr. SKELLY. 1988. 

Senator HARKIN. 1988 was a bigger cut? 
12 

Mr. SKELLY. In dollars and in percentage. 

Senator HARKIN. In dollars and in percentage, in 1988. 

Mr. SKELLY. Yes sir. 

Senator HARKIN. Okay, so I was off a few years. Then we had 

a $600 million cut in fiscal year 2006. Right? 

Mr. SKELLY. That’s right, Senator. 

[CLERK’S NOTE.—Senator Harkin was correct. The proposed cut 

of $2.1 billion would be the largest reduction in the 26-year history 

of the Education Department. The cut in 1988 was larger as a percentage of the total budget, but not in dollars.] 

TITLE I GRANTS TO LEAS

Senator HARKIN. Okay. I just want to make sure we’re on the 

same page. Now let’s turn to Title I, cornerstone program of the No 

Child Left Behind Act. Madam Secretary, I read your testimony, 

you said it was the cornerstone. 

Secretary SPELLINGS. I do. 

Senator HARKIN. No Child Left Behind calls for a $2.2 billion increase for Title I this year, how much did the President ask for? 

Zero. Flat funded. 

Secretary SPELLINGS. As well—— 

Senator HARKIN. That’s quite a cornerstone. 

Secretary SPELLINGS. As well as some additional resources that 

attach to No Child Left Behind, like $200 million for school improvement. 

Senator HARKIN. But Title I is the cornerstone, you say that. 

When it’s flat funded and when No Child Left Behind Act calls for 

a $2.21 billion increase for Title I this year, something’s wrong 

with the cornerstone. 

SPECIAL EDUCATION

Special education, Republicans and Democrats for years have 

been saying we’ve got to get it to the 40 percent level, you know 

what I’m talking about. 

Secretary SPELLINGS. Right, I do. 

Senator HARKIN. We’ve talked about it; we’ve had votes on it, 

Senate Resolutions that are 100 to nothing, or 99 to 1 or something 

like that, about doing this. Well, we’ve been inching up the last few 

years, under the leadership of Senator Specter. We’ve been getting 

it up; we’ve gone up to 19 percent. An all time high. Last year we 

went back to 18, under this budget we go back to 17 percent. 

I don’t know how you can see this as any kind of progress at all 

on how the administration can support this. 

PELL GRANTS

Student aid Pell Grants are now frozen at $4,050, the same as 

4 years ago. Can you name me one college in the United States 

where the tuition is the same this year as it was 4 years ago? 

There isn’t such a place. Yet the Pell Grant’s frozen at that. These 

are for the poorest of kids. I mean you know what you have to do 

to qualify for a Pell Grant? 

Secretary SPELLINGS. I do. 
13 

Senator HARKIN. You just about have to have nothing to qualify 

for a Pell Grant. But yet, the President talks about his competitiveness initiative. Sounds great, we all believe in that, but is it just 

competitiveness just for the kids of wealthy families, or families 

who can get loans and stuff like that; how about competitiveness 

for the kids that qualify for Pell Grants. What about them? What 

about their competitiveness? Where do they fit into this picture? 

Well—I just don’t see how you can support that. I’m not saying it’s 

all bad. There are some things that you got in there that are good. 

Some of the math and science stuff is okay. That’s fine. Little bits 

and pieces here and there. But in total, I just can’t imagine your 

support for that. I see my time is up now, and I didn’t really get 

a question in, but I wanted to make sure that we were talking 

about apples and apples, and not oranges and apples and that kind 

of stuff, and maybe on the second round I can have a question 

about that. Thank you very much. 

Senator SPECTER. Thank you, Senator Harkin. Senator Landrieu. 

EDUCATION RESPONSE FOR HURRICANE RECOVERY

Senator LANDRIEU. As the ranking member is here—before you 

came in Senator, I was complimentary of the Department, of the 

great work that they have done for the Hurricane Katrina and Rita 

victims, and said what a reliable partner they’ve been. I want to 

thank you also, Senator Harkin, because without you and Senator 

Specter our education aid bill would not have passed the way it 

did, and I want to say how much we appreciate that. 

FISCAL YEAR 2007 BUDGET REQUEST

Having said that, I want to agree with what both the chairman 

and ranking member said; not only do I think this budget is scandalous in terms of short changing our goals, Madam Secretary, for 

No Child Left Behind, but it’s disheartening and wholly inadequate. Disheartening for the army of people out there trying to 

close these achievement gaps, making the changes, pushing themselves to achieve excellence, only to find their budget is being cut. 

While Title I is flat funded dollar for dollar for last year, because 

it does not have an inflation factor and it’s not taking into consideration the extra efforts being made to move these poor and low-income, and moderate-income children up, it really is short changing 

their ability. 

Last night I got to attend a function in Washington, the Youth 

National Guard Youth Challenge Program, that tries to focus on 

reaching the 33 million Americans between the ages of 16 and 24 

that do not have a high school diploma—33 million Americans between the ages of 16 and 24. Those numbers don’t just pop, they 

are created by budgets like this that do not provide the support of 

children in those early grades so that they could get a diploma of 

achievement—they can read, and calculate at grade level. 

I know that as the Department’s Secretary you’re responsible for 

carrying out the President’s budget. But I want to say as a Senator 

who is given choices between extending dividend tax cuts, reducing 

capital gains taxes, this is what is paying for those tax cuts. The 

short changing in education for children in Louisiana, Mississippi, 

the Gulf Coast, Arizona, in Pennsylvania, in Wisconsin, and in 
14 

places in Iowa, and all places are paying for those tax cuts. I think 

it’s too heavy of a price. I just want to go on record. It’s too heavy 

of a price to pay. We end up paying for it, in you know, criminal 

justice systems. We end up paying it in mental health services. The 

taxpayer’s don’t get a break. The taxpayers just pick it up in a 

more painful, more expensive way. I don’t know when we’re going 

to learn that investment in early childhood education is giving children a fighting chance. There’s no guarantee of success, but I want 

to say for the record and my time, and I’d like to ask you this question because only our Federal portion represents about 8 to 10 percent of the total. The States are picking up about 70 percent, is 

that correct Madam Secretary of Education, expenses at the State 

level? 

Secretary SPELLINGS. It varies around the country. 

EQUITABLE DISTRIBUTION OF EDUCATION RESOURCES

Senator LANDRIEU. What is the Department doing to try to 

equalize or make more equitable the funding in the country, from 

our wealthier counties, to our poor counties? If you could just focus 

a minute of your answer. I know we haven’t directed you as such. 

Title I attempts to try to equal—it’s Congress’ best attempt to try 

to give poor and middle income children the same resources available. But is this Department at all focused on that resource gap? 

There’s an achievement gap, but there’s a resource gap. Do you 

know what it is, can you just tell us, and give us a minute of what 

you’re doing to try to close that gap? 

DISTRIBUTION OF HIGHLY QUALIFIED PERSONNEL

Secretary SPELLINGS. Well, that’s a great question and I think it 

manifests itself in a lot of ways. Highly qualified teachers: one of 

the dirty little secrets in education is that our most qualified people 

are in our least challenging environments and vice versa, and so 

as we implement No Child Left Behind we ought to look at how 

States and school districts allocate highly qualified personnel. The 

President’s budget proposal on Advanced Placement (AP)—I talked 

about the 40 percent of the high schools that offer no AP at all. I 

use the example in my speeches that in Fairfax County, Virginia, 

you can find schools with 20 plus AP classes, whereas in the District of Columbia, Ballou High School has just 3 or 4. Those are exactly the kinds of things that we need to address as part of either 

implementing No Child Left Behind or the resources that the President has asked for. 

No Child Left Behind—whether it’s for special education students or limited English speakers—has focused educators on bottom line results for all kids and resources. Obviously, our Federal 

commitment has always been to our Nation’s neediest students, 

and that’s why we invest so much money in IDEA and Title I, to 

help level out those educational opportunities around the country. 

With respect to Title I, obviously the formula reflects the numbers 

of poor kids as they migrate around our country. 
15 

PER PUPIL EXPENDITURES ACROSS THE NATION

Senator LANDRIEU. Just to conclude though, Mr. Chairman, we 

focus on the neediest. But I can say from—there are a lot of middle-income families now that would classify themselves as middleincome that are stretched and need help and as we continue to cut 

these programs back, we’re touching the bottom 5 or 7 percent, 

when we should be trying to help the bottom 40 or 50 percent. 

Tom, I would like you just to submit for the record, the difference 

in resources from the poorest counties, to the wealthiest counties 

to give us an update for the record of this committee. I understand 

in some places it’s like $3,000 or $4,000 a child, and then in some 

counties we’re spending $12,000–$14,000 a child. I know that we 

don’t direct that funding, but we can you know recognize that while 

there’s an achievement gap, there’s a resource gap that this committee has an obligation to fix, or try to fix. Thank you. 

[The information follows:] 

EDUCATION FUNDING IN HIGH-POVERTY AND LOW-POVERTY DISTRICTS

Average expenditures per student vary across local educational agencies (LEAs) 

from about $3,300 to over $20,000 per student, according to the 2003 Public Elementary-Secondary Education Finance Data compiled by the Census Bureau. Most of 

the largest and smallest figures are for very small school districts with limited enrollment. For example, of the 10 LEAs with expenditures per student between 

$3,000 and $4,000, only 1 had an enrollment of over 100 students. They are mostly 

small, rural school districts, including 5 in Nebraska and 3 in Montana. However, 

even excluding the very small and rural school outliers, there is a significant difference in the per-student averages among the poorest and wealthiest LEAs (with 

‘‘poor’’ and ‘‘wealthy’’ defined on the basis of the percentage of school-aged children 

living in poverty). The 100 LEAs with the lowest poverty rates and enrollment of 

at least 1,000 had average expenditures of $9,585 per student, while the 100 LEAs 

with the highest poverty rates and enrollment of at least 1,000 had average expenditures of $7,897 per student. 

Among the poorest LEAs, defined as those with poverty above 40 percent, there 

are many sizable school districts with average expenditures well below the national 

average of about $8,100. For example, Roosevelt Elementary School District in Arizona, with a poverty rate over 45 percent and enrollment of 11,000, had an average 

expenditure per student of $5,900. Laredo Independent School District in Texas (45 

percent poverty; enrollment of 24,000) had an average expenditure per student of 

$6,900. Greenville Public School District in Mississippi (42 percent poverty; enrollment of 7,400) had an average expenditure per student of $5,900. But there are also 

many poor districts with larger than average expenditures per student. These include Muskegon Heights School District in Michigan (44 percent poverty; $10,300 

per student), Todd County, South Dakota (40 percent poverty; $11,500 per student) 

and Rochester City School District in New York (40 percent poverty; $12,711 per 

student). 

The same can be said for the wealthier school districts. There are examples of 

high per-student expenditures, such as Fairfax County, Virginia (6 percent poverty; 

$9,500 per student), Montgomery County, Maryland (7 percent poverty; $10,580 per 

student), and Cherry Hill, New Jersey (3 percent poverty; $11,300 per student) as 

well as examples of low per-student expenditures, such as Clay County, Florida (9 

percent poverty; $5,600 per student), Scottsdale School District, Arizona (7 percent 

poverty; $5,600 per student), and Alpine School District in Utah (9 percent poverty; 

$4,400 per student). 

While the spread is significant between the poorest and wealthiest districts, there 

is a more noticeable pattern among States. The 142 LEAs with an average expenditure per-student below $5,000 are in only 17 States, with the majority in Arizona, 

Oklahoma, Utah, Montana, and Nebraska. At the other end of the spectrum, half 

of the 200 LEAs with the highest average expenditure per student are in three 

States: California, New York, and New Jersey. 
16 

VOCATIONAL EDUCATION FUNDS

Senator SPECTER. Thank you, Senator Landrieu. Senator Kohl. 

Senator KOHL. Thank you very much Mr. Chairman. 

Secretary Spellings; you’ll recall that we spoke at last year’s 

hearing about Perkins Vocational Education program. Perkins is 

very important to every State, but particularly my State. Wisconsin 

received almost $25 million in Perkins funds last year, and over 

23,000 students benefit in my State from Perkins services. The 

vast majority of Perkins recipients in Wisconsin have gone on to 

graduate and obtain high skill, high wage jobs. Last year the President proposed to eliminate Perkins funding but the Congress refused to go along, as you know. The Senate voted to reauthorize 

Perkins by a vote of 99 to nothing. We also worked to restore most 

of the funding cut by the President. One would think that these actions would have sent a very strong message to the President, and 

Senators in both parties feel strongly about Perkins. Yet once 

again, as you know, the President’s proposed elimination of this 

vital program in 2007. Would you explain how he apparently is so 

out of touch with we here who live and work with the problem everyday in our States? Not just to reduce Perkins, which is unacceptable, but to eliminate Perkins, which seems to me to be incomprehensible. 

INVESTMENT IN SECONDARY EDUCATION

Secretary SPELLINGS. Senator, yes I will. The President believes 

that we ought to gather up the resources that we spend in vocational education, TRIO, and GEAR UP and a number of our secondary school investments and create a high school reform program; a $1.5 billion high school initiative for States to use as they 

see fit, around graduation rates and enhanced achievement for all 

high school students, including additional accountability and the 

like. When and where vocational education programs, GEAR UP, 

TRIO, any of those programs work well, then States can and 

should—and I’m confident will—continue to invest in those. But I 

think we also have to look at our results of secondary education, 

and that is about half of the African American and Hispanic kids 

who start high school do not complete high school. When these resources and these programs are targeted to them I think we have 

to ask ourselves, are they working as well as they can be in the 

aggregate. 

Senator KOHL. Well, I don’t think you’ve really answered the 

question, he still proposes eliminating Perkins and aggregating it 

all really in the final analysis results in cuts. But it’s just done in 

a way that we don’t really see how these cuts occur, but that’s I 

believe pretty clear to most of us who look at this closely that aggregating really involves cutting. Madam Secretary, I supported 

the No Child Left Behind because it guaranteed flexibility and accountability would come with more Federal funding to make it 

work. Instead, funding levels have fallen billions of dollars short of 

what was authorized and these cuts as you know cause real hardships. Schools are being forced to cut staff and important programs 

like summer school, class size reductions, arts, physical education, 

and languages. Last year almost 11,000 schools failed to make ade-
17 

quately yearly progress under No Child Left Behind thus facing 

Federal sanctions. These schools will face even greater challenges 

as testing and teacher quality requirements go into full effect. 

So isn’t it time to provide the funding that was promised so that 

we can give schools and students a real chance to succeed which 

was the premise behind No Child Left Behind, that there would be 

funding which is by all accounts not what was promised. Where do 

we go from here? 

ALLOCATION OF BUDGET RESOURCES

Secretary SPELLINGS. I think what you’ll find in the President’s 

budget, and it is a tough budget no doubt about it, is that the resources are allocated around the core principles of No Child Left 

Behind, such as our sustained investments in Title I, in reading, 

in teacher quality, and the accountability features and achievement. That those are our most—that’s our most urgent calling, and 

our highest priority for resources. 

PELL GRANTS

Senator KOHL. Madam Secretary, the President’s budget proposal 

also targets student aid programs for harmful cuts including a $4.6 

billion reduction in funding for Pell Grants. The maximum Pell 

Grant award is again frozen at $4,050 for the fifth year in a row, 

despite rising tuition costs. These may just seem like numbers but 

they also have a real impact on students who are struggling to go 

to college. The University of Wisconsin in Madison alone dispersed 

$9.2 million in Pell Grants to 3,751 low-income students last year. 

In 1975 the Pell Grant recovered 80 percent of the costs of a 4-year 

public education in college and today that number is down to about 

40 percent. So my question is, how can this administration claim 

to want to make higher education a reality for low-income students 

while at the same time cut the very programs that would help 

them achieve that goal. 

Secretary SPELLINGS. Well, let me respond in a couple of ways. 

One, while as you said the Pell Grant itself is still $4,050, the actual grant has not been cut. There will be about 59,000 more students who will be taking advantage of Pell Grants. In addition to 

that, as part of the reconciliation that you all passed, there are additional resources for students who are studying in the critical 

areas of science, technology, engineering and math. Starting with 

about an additional $750 for year one of their studies, going up to 

$4,000 by the fourth year if they pursue those particular fields. As 

you know, the Congress finally has eliminated the Pell shortfall 

that has vexed us for so long, which is most of that $4 billion that 

you spoke of, but I think what we know is that the community colleges, in particular, continue to be able to offer a full and complete 

education at the Pell Grant level. So it’s a matter of students frequently starting there at community college as opposed to a State 

university. But the Pell Grant does remain stable at $4,050. 

PREPARED STATEMENT

Senator KOHL. Thank you, and before I turn it back to the chairman, my time has expired. When you keep a program like Pell 
18 

Grants at the same level for 5 years, you are reducing its value, 

obviously. When I pointed out that the Pell Grant covered in 1975, 

80 percent of your public education and today it’s 40 percent, that 

describes the erosion of keeping the number at a constant level. 

Thank you so much, and thank you Mr. Chairman. 

[The statement follows:] 

PREPARED STATEMENT OF SENATOR HERB KOHL

Thank you, Mr. Chairman. Secretary Spellings, I join my colleagues in welcoming 

you here today. You face a significant and challenging task in managing the Department of Education and I hope that we can work together to improve access to education for all Americans. 

I appreciate the difficult task you face in funding the many education priorities 

of our country. That job is more challenging, in our view, because this Administration has chosen budget and tax policies that have led to rising deficits and diminishing resources available for essential education programs. 

This budget is abysmal for the education community. It proposes the largest cut 

to federal education funding in the 26-year history of the Department. Students, 

educators, parents, and administrators all lose out under this budget. Funding for 

No Child Left Behind and Special Education, the main federal funding streams for 

our local school districts, are a far cry from their authorized levels. More specifically, funding for No Child Left Behind is $12.3 billion dollars below the authorization level, and IDEA is $6.3 billion short in 2007. In addition, over forty programs 

are slated for elimination, including funding for Career and Technical Education, 

Safe and Drug Free Schools, and TRIO programs. 

The President’s budget should reflect our nation’s priorities—but these are just 

a few examples of this budget being out of step with our values. I will continue to 

work with my colleagues to improve upon this budget. Madame Secretary, I hope 

that you will work with us to better meet our nation’s education needs. 

Senator SPECTER. Thank you Senator Kohl, Senator Craig. 

AMERICAN COMPETITIVENESS INITIATIVE

Senator CRAIG. Mr. Chairman, thank you very much. Madam 

Secretary, I’m pleased you’re with us this morning. First and foremost, I want to commend you and the President for including the 

American Competitiveness Initiative in his State of the Union. I 

thought that was critically important, and I’m looking forward to 

working with the Department of Education and in this instance the 

Department of Energy will have a fair chunk of that, and my colleagues in the implementation of many of those proposals. I think 

it’s important. I think we can convince the American people it’s important, that we remain competitive and that we design a system 

that allows us to do that. When we were holding hearings on that 

recently in the Energy committee I was likening it to our reaction 

to Sputnik. The Defense Education Act of the 1960s that followed 

and the tremendous—and the fallout, the positive fallout of that 

down through the decades, as we trained a generation of mathematicians, and scientists, all because we found ourselves not competitive in the real world in a cold war environment and out of that 

space initiative and everything else. Of course because the—what 

I believe is a national crisis we’re in today as it relates to energy, 

we take that a lot easier because the lights are still on, and even 

though gas is more expensive at the pump, it’s still there and we’re 

adjusting accordingly even though it’s costing us, you know, lots of 

jobs out there in the industrial sector today, and all that. The new 

world that we compete in is going to be ever demanding. 

We all know those stories, they are real and I’m glad to see the 

President out on the edge of that, pushing it. That’s extremely im-
19 

portant for us. In the context of doing that although, I think we 

have to shape budgets that begin to fit that and move us in those 

directions, and they are bits and pieces of all that we’re talking 

about in order to meet the challenges laid out by the President in 

the Competitiveness Initiative. I believe that bringing professionals 

into the classrooms will be tremendous assets to our students. Yet 

the system is so rigid to allowing that to happen today that it almost, at the very beginning unless we break down some of those 

barriers towards the very initiative that’s underway. What programs have been or are being implemented to ensure that professionals interested in teaching have the training they require, and 

do you believe the President’s budget provides adequate funding to 

bring these professionals ultimately into the classroom to work 

alongside the educator in inspiring these young people into these 

different areas that are within the Competitiveness Initiative? 

ADJUNCT TEACHERS PROGRAM

Secretary SPELLINGS. Thank you for that question. The Presi- dent’s budget calls for $25 million to start to seed some of this kind 

of activity, which we call Adjunct Teachers. We use this all the 

time in higher education, especially in community colleges, and it’s 

very effective. Typically, people who are engaged in their own profession teach part time in higher education. Many of these students 

now, high school students, enjoy dual enrollment programs between community colleges and high schools, and they are already 

being served by the kind of professionals that you talk about. IBM 

has committed 1,200 engineers and other highly skilled professionals to make transitions into the teaching profession, so I do 

think there’s an appetite and a willingness out there and a need— 

a dramatic need—for those sorts of competencies. We have some 

models to build on through Troops-to-Teachers, Teach for America, 

and some other programs that have taken mid-career professionals 

and helped them become effective teachers. But I think the notion 

is, let’s be able to get some of our expertise and resources from the 

broad community around some of these 185 day, 10-month contract 

sort of structures, that we’re so used to dealing with in education. 

INNOVATIVE HIGH SCHOOL RESTRUCTURING IN IDAHO

Senator CRAIG. I had the privilege, Mr. Chairman, of walking 

through a new high school in Idaho during this last recess. The 

largest building in our State from the standpoint of an educational 

institution, 2,200 students. I thought, oh my goodness, how can 

they possibly handle 2,200; surely they must be lost in the system, 

because I was thinking of the old models. But I walked into a 

school with academies, and the allowance to actually begin shaping 

from your freshman year on, some core competencies that move you 

then into community colleges, or into University settings. In the 

junior senior year, that nexus with the community college that you 

had—I spent a couple of hours there, spoke with the senior class, 

and walked out with a total different opinion. Or a sense of understanding as to these new structures, and in this particular school 

district which is the fastest growing in our State, they’re building 

a new high school about every 2 years now, they’re moving to this 

concept. They feel they can go to larger schools but they allow the 
20 

student to actually identify with a much smaller unit within the 

school. It’s impressive. It’s happening at other places in the county. 

Idaho is not alone in it certainly, and it makes some very real 

sense, tied to this competitive initiative, and being able to move 

young people out earlier. Those who chose to, to get into that higher learning, frankly, can break through the rigidity of the current 

system that says, no, no this is the way we’ve always done it, we 

control it, so this is the way you’re going to do it. If it isn’t providing us with that level of training and talent, then we’ve got to 

break through it, and if you can’t live within it, you get outside of 

it, I guess, and that’s starting to happen in parts of Idaho where 

we have community college settings in which they can cooperate. 

That’s a pretty exciting concept. But in doing so—and then 

transitioning them forward, there was concern about the Pell 

Grants and other tools to make sure that those students can carry 

on, and I’m looking at this budget concerned about obviously areas 

like the Federal Direct Student Loans and the Federal Family Education Loans, and all of those kind of things. Those tools are going 

to be in part a necessary component of any kind of competitiveness 

initiative to move these young people forward. 

Secretary SPELLINGS. I agree with that. 

Senator CRAIG. Thank you. 

Secretary SPELLINGS. Absolutely, Senator. I think I’d love to visit 

that school, I mean these are places as you said—— 

Senator CRAIG. You want to visit it? 

Secretary SPELLINGS. I would like to. 

Senator CRAIG. Fine, you’ll get an invitation today. 

Secretary SPELLINGS. Good. 

Senator CRAIG. We’d love to have you out. 

ADJUNCT TEACHERS

Secretary SPELLINGS. Establishing the nexus between higher 

education and high school, that can be more efficient and more effective as we get these professionals who are working in the field, 

and who have this expertise, because we’re frankly going to be very 

challenged to do it other ways. 

Senator CRAIG. Well, it’s an exciting model, and as I say, there 

are many large schools across the country that are recognizing that 

high schools of 2,000, if not restructured, lose children. 

Secretary SPELLINGS. Exactly. 

Senator SPECTER. Thank you very much, Senator Craig. Senator 

Murray. 

SCHOOLS-WITHIN-SCHOOLS

Senator MURRAY. Well, thank you very much Mr. Chairman, and 

Senator Craig, I’m delighted to hear that you went to that school. 

The Gates Foundation has been focusing on schools-within-schools, 

with some real successful programs. 

Senator CRAIG. If you’ll let me interrupt. I’m not absolutely sure, 

but it’s very possible they’re participating in this one. Yes. 
21 

ACADEMIC COMPETITIVENESS AND NATIONAL SMART GRANTS

Senator MURRAY. Yeah. I agree with the focus on high schools. 

I think it’s absolutely critical that we as a Nation really find out 

why we’re losing kids at such dramatic rates. Those kinds of programs really make a difference. But let me, Madam Secretary, talk 

with you a minute about some of the academic competitive grants 

in the national science and mathematics act says to retain talent, 

the SMART grants. To receive those American competitive grants, 

students have to have completed what is called the rigorous secondary school program of study. Now I agree, as I said that we 

have to do everything we can to prepare students for the global 

economy they’re going to be in. Whether—but I think a student’s 

luck in where they attend high school, whether it’s Senator Craig’s 

or another one, shouldn’t determine whether or not the Federal 

Government helps them attend college. CBO estimated that only 

9.9 percent of the Pell eligible students are going to be able to take 

advantage of those academic competitiveness and SMART grants in 

2007. Now the maximum Pell Grant has not increased for 4 years 

despite as we all know tuition rising at our Nation’s public colleges 

by over 7 percent last year. So if the $850 billion that those grants 

cost in 2007 were spent on Pell Grants, students would actually receive an additional $200 in aid that would have made a tremendous difference. I would like to find out from you, how you anticipate judging what constitutes a rigorous secondary school curriculum? 

RIGOROUS HIGH SCHOOL CURRICULUM

Secretary SPELLINGS. That’s a great question and we’re struggling with that at the Department now. About a week ago, we had 

folks in from the Gates Foundation, from the National Governors 

Association, and from the Council of Chief State School Officers to 

look at and talk about what’s the most appropriate way to do that 

while being very respectful of our prohibition at the Department of 

Education for prescribing curriculum. I certainly don’t want to sit 

up here and look at high school course syllabi and so forth. So 

we’re working on that right now. I mean, I think we know things 

that are widely accepted, like Advanced Placement, International 

Baccalaureate, and the State Scholar’s program—that 14 States 

have already bought into place, i.e. their determination of a collegeready curriculum. For State Scholars this is 4 years of English, 3 

years of math and science, and 2 years of foreign language. We’ll 

be announcing another 8 to 12 States that will be joining the State 

Scholars program soon. So States have come to terms largely, or 

are beginning to, with what they believe to be college-ready, so 

that, I hope, will be informative as we look at the Academic Competitiveness Grants. 

Senator MURRAY. Well, I appreciate the goal, but here we are in 

2007 where less than 10 percent of the students are going to be eligible for these grants, and in tight budget times it seems to me 

that using those dollars to help all kids get $200 in aid, not just 

those who are lucky enough to attend a high school that works out 

to have a ‘‘rigorous schedule.’’ I just think it’s something we have 

to manage. So I’m very concerned about a large amount of money 
22 

funneling to a few kids who happen to be in the right high school, 

with the right curriculum, versus us being able to help all students 

with an additional $200 with the same pot of money. So it’s just 

a budget issue in my mind. Obviously you’ve got a program you 

love, and you want to go down that road. But in tight budget times 

we have to say, are we going to help all kids out there, or just the 

ones who are lucky enough to have that somehow undefined yet 

rigorous curriculum. 

Secretary SPELLINGS. Well, it’s also obviously our responsibility 

to make sure that we have a college-ready curriculum, and this is 

why we need more Advanced Placement in more places, and so 

forth, making such a curriculum available to all kids everywhere. 

Senator MURRAY. Well, I think it’s good to provide incentives to 

high schools to move towards a rigorous curriculum, I’m with you 

on that. But I don’t want to see us use the kids as a tool. Because 

in the end they are the ones who are not going to be able to go 

to college based on where they went to school. I think it’s so important that we provide that opportunity, but it’s a philosophical debate. 

HEA TITLE IX

I have limited time. I wanted to ask you about Title IX. On 

March 17, the Department released a new guidance on the interest 

prong of the three-part test which schools are using to show their 

compliance with Title IX. As you are aware, I have some really 

grave concerns about this new guidance, because I believe it sets 

a new low bar for compliance with the Federal Civil Rights Law. 

Schools would now be allowed to use an email survey to show their 

compliance with Title IX. The school would only have to send that 

survey to women. So, a lack of response at our universities where 

kids already have a lot to do, and may just say to heck with that, 

seems to me a very poor way to be determining compliance with 

Title IX. Now I know that it’s used—surveys are used as part of 

compliance, but it’s the sole means to making sure whether a 

school complies or not, to me seems really wrong headed. 

Now as you know there’s a lot of concern over this new guidance, 

and there’s a bipartisan group of Senators on the subcommittee 

who have asked for a report on the guidance and the use of surveys 

and I wanted to find out from you this morning what the status 

is of that? 

Secretary SPELLINGS. We’ll be completing that next month. I believe you all gave us a deadline for March sort of timeframe there. 

We will be completing it then. I do want to note that we’ve not had 

any complaints about the survey aspect yet, and frankly as you 

know it is a legitimate prong to ascertain interest. This is prong 

three. 

Senator MURRAY. But the sole prong is a problem. 

Secretary SPELLINGS. We have about 116 schools around the 

country that do that now. But your report is due March 17, and 

we intend to meet that deadline. 

Senator MURRAY. Okay, well there’s a lot of confusion on behalf 

of schools about the guidance. I want to know what your department is doing regarding technical assistance to schools on the guidance of that? 
23 

Secretary SPELLINGS. You have recently confirmed Stephanie 

Monroe as AS for OCR. I’ve had a vacancy in that job for a long 

time, and we are providing technical guidance around that issue. 

I’m a mother of two daughters, I’m very committed to their opportunities as well, and so—— 

PREPARED STATEMENT

Senator MURRAY. Well, we all are. But if we base compliance on 

an e-mail survey to women in college expecting that their response 

back as students is going to decide whether or not a school is compliant, I think that is just not a very smart way to go. I’m going 

to continue to work with other likeminded Senators to make sure 

we don’t somehow use that information to take away the ability of 

many young women in this country to be able to access sports in 

colleges. 

[The statement follows:] 

PREPARED STATEMENT OF SENATOR PATTY MURRAY

Secretary Spellings, thank you for coming today to talk with us about the President’s fiscal year 2007 budget request for the Department of Education. I want to 

take this opportunity to say that I have always believed that the federal budget is 

more than just a compilation of numbers. Rather, it is a collective statement of the 

values and priorities of our nation. Looking at the figures included in the President’s fiscal year 2007 budget request for the Department of Education—which is 

the largest cut in federal education funding in 26 years—I have to say that I question the value that the President is placing on educating our nation’s youth this 

year. 

As a country, we are required to articulate and defend our values and priorities, 

particularly as we undergo the annual budget process. While I share the President’s 

stated commitment to preparing our nation and workforce for the competition of the 

21st century, I am disheartened to see that his rhetoric about the importance of 

leaving no child behind is not matched by the budget numbers this administration 

put forward in its fiscal year 2007 request. 

I want to remind my colleagues that what we do in the next few weeks will affect 

us—and the American people—for a long time. The budget decisions we make now 

will either empower us—or tie our hands—when we turn to determining funding 

levels in this appropriations committee later this year. That is why I must say I 

strenuously object to the request put forward by the President. 

While it’s true that the President’s budget includes increased dollars for math and 

science education, these funds come at the expense of cuts or elimination to other 

important programs. I view new initiatives in math and science as complements to, 

but in no way substitutions for, the other federal education investments we have 

made over the past 40 years. While science and math competence are undoubtedly 

a critical piece of what our students need to compete globally, it cannot come at the 

expense of helping disadvantaged students succeed academically, investing in our 

high schools, and ensuring our college students have the financial means to attend 

postsecondary education. 

I am particularly disheartened that the administration continues to fall behind in 

meeting its commitments under the No Child Left Behind Act. The President’s fiscal 

year 2007 request does not include any increases in NCLB’s cornerstone program, 

Title I. The administration’s decision to recommend level funding—at a time when 

requirements and accountability provisions for our schools continue to grow—essentially asks our schools to do more with less resources. This inconsistent messaging 

is disingenuous and unfair. What’s worse, our students, parents, teachers and 

schools suffer as a result. 

I also want to express my concern about the High School Reform package the 

President is promoting. As you know, I have been an advocate for focusing federal 

education resources to our nation’s high schools. That is why last year I introduced 

my Pathways for All Students to Succeed (PASS) Act, to provide targeted resources 

to our nation’s high schools. The PASS Act would help America’s teenagers graduate 

from high school, go on to college, and enter the working world with the skills they 

need to succeed. 
24 

While I appreciate the President’s interest in high school reform, the reality is 

that he elected to pay for these reforms by cutting important programs. The $1.475 

billion he is proposing for his high school package doesn’t come close to replacing 

the money we currently spend on the 42 programs, including vocational and technical education, GEAR UP and TRIO, proposed for elimination. At a time when 

3,000 students drop out of high school each and every school day and when half of 

our nation’s African American and Latino students do not complete high school, we 

need to be doing more, not less, to make our high schools places where all students 

can learn. 

In addition to stemming the tide of high school dropouts, we must assist students 

in the transition from high school to college by providing financial resources to facilitate access to higher education. Yet recently the federal government cut $12.7 

billion from student loans that help low- and middle-income families pay for college. 

This decision, during a year in which tuition and fees increased by 7.1 percent for 

four-year public universities and 5.9 percent for private universities, does not reflect 

our national priorities. In the same vein, the value the President purports to place 

on higher education is not reflected in his budget, which level-funds the Pell Grant 

program for the fourth year in a row. 

As we work together in the next few weeks to prepare the budget resolution, I 

will do my best to ensure that the values and priorities of our nation and my state 

of Washington are reflected in the numbers to which we will hold ourselves. As a 

policymaker and parent, I know that American competitiveness demands a more 

comprehensive approach to education. We must match our rhetoric with the necessary resources to support all of our students, at all grade levels, in all subject 

areas. Our children—and our country—deserve nothing less. 

Thank you. 

PROPOSED GEAR UP PROGRAM ELIMINATION

Senator SPECTER. Thank you, Senator Murray. Madam Secretary, what participation did you have in the elimination of the 

program known as ‘‘GEAR UP’’ that’s been in existence for about 

7 years? On the ratings by OMB, they say ‘‘GEAR UP’’ is based on 

successful models for increasing the college enrollment rate of atrisk students. Initial program results suggest that grantees have 

been more successful in increasing the percentage of students taking a more challenging course load, better preparing these students 

for future college enrollment. 

It was an idea advocated by Congressman Chaka Fattah, who 

has had a lot of experience in government in Philadelphia, where 

there are tough schools with a lot of dropouts and a lot of students 

with problems. It has been a program which has been funded principally out of the Senate that I have spoken about repeatedly. Let 

me ask you a two-part question. What do you think the chances are 

that ‘‘GEAR UP’’ is going to be dropped by the Congress? Second, 

what did you have to do with dropping it, if anything? 

Secretary SPELLINGS. Well, Senator, first let me say that you 

know ‘‘GEAR UP’’ was invented in Houston, Texas, I mean when 

President Bush was Governor, we were strong supporters of it. 

Senator SPECTER. Does President Bush know that? 

Secretary SPELLINGS. Yes. President Bush, then Governor Bush. 

Senator SPECTER. Does President Bush know it’s being dropped? 

Secretary SPELLINGS. I presume he does. 

Senator SPECTER. I’m going to tell him. 

Secretary SPELLINGS. I presume he does. 

Senator SPECTER. Have you told him? 

Secretary SPELLINGS. Yes, sir. But let me tell you what his—— 

Senator SPECTER. No, no. Have you—well you can tell me, but 

first tell me, have you told him? 
25 

Secretary SPELLINGS. Have I told him specifically ‘‘GEAR UP’’ is 

not in the budget? 

Senator SPECTER. Yes, ma’am, specifically. Have you told him 

that ‘‘GEAR UP’’ has been dropped? 

Secretary SPELLINGS. I don’t believe that I have told him that 

specifically. 

Senator SPECTER. Do you know if anybody has told him that specifically? 

Secretary SPELLINGS. I do not. 

Senator SPECTER. Get the President on the phone. 

Secretary SPELLINGS. I certainly will tell him. 

START OF GEAR UP PROGRAM

Senator SPECTER. He calls me with some frequency when he 

wants Supreme Court Justices confirmed. Next time he calls, I’m 

going to parry him with this question about ‘‘GEAR UP’’; I didn’t 

know it was started in Houston. 

Secretary SPELLINGS. By Jim Ketelsen. The former CEO of Tenneco. 

Senator SPECTER. The first question I’m going to ask him is, Mr. 

President, do you know ‘‘GEAR UP’’ was started in Houston? Second question I’m going to ask him is, do you know that ‘‘GEAR UP’’ 

has been dropped? The third question is, do you know the Secretary of Education didn’t personally tell you that it was being 

dropped? 

Secretary SPELLINGS. You can tell him that. 

Senator SPECTER. Okay. It’s your turn. 

HIGH SCHOOL REFORM INITIATIVE

Secretary SPELLINGS. But let me say this, the President’s philosophy here around this high school reform issue is that you need a 

block grant kind of program. That we ought to gather secondary 

school resources into a $1.5 billion title that we’re saying would get 

results. That we shouldn’t sit up here and say, here’s how you 

should get results. Now I fully believe that in Houston, Texas, in 

Philadelphia, and places where these programs are working well, 

and effectively, they will continue to do those. I can’t say that 

that’s necessarily true in the aggregate. Where they’re going to be 

effective they’ll be maintained. I’m confident of that. The President’s philosophy—— 

Senator SPECTER. How will they be maintained without funding? 

Secretary SPELLINGS. They will be paid for then out of the high 

school initiative. 

Senator SPECTER. So you rob Peter to pay Paul, which is what 

I said on my last round of questions, I’ll probably say it in my 

fourth round, too. 

Secretary SPELLINGS. I mean, I guess you could look at it that 

way. We’re gathering resources out of silos, out of specific prescribed programs. 

Senator SPECTER. So you think really, you ought to keep ‘‘GEAR 

UP’’ but under another name? 

Secretary SPELLINGS. No. I’m saying that States and local school 

districts ought to have the opportunity to design and choose pro-
26 

grams as they see fit, including GEAR UP, Vocational Education, 

or others. 

Senator SPECTER. But, when it’s been a successful Federal program, and has all the backing from the Members of the House and 

Senate, why submit a budget which cuts it? 

Secretary SPELLINGS. Well, I think the President believes that 

successful programs will be invested in with Federal dollars and 

maintained and enhanced at the State and local level. 

Senator SPECTER. Federal programs will be invested with Federal dollars and maintained, and enhanced at the State and local 

level? 

Secretary SPELLINGS. That where—in Philadelphia where this is 

working well, they will use their high school resources to invest in 

‘‘GEAR UP’’ and they’ll probably use State and local—— 

Senator SPECTER. What resources? They’re strapped to the edge 

now. 

Secretary SPELLINGS. Under the high school reform block grant, if you will, the $1.5 billion in Federal funds that would be invested 

in high school reform, this program would absolutely be an allowable purpose. 

FISCAL YEAR 2006 FUNDING LEVEL OF PROPOSED TERMINATIONS

Senator SPECTER. Well, since that will happen I can rest easy 

seeing it cut, I guess. Except that I won’t. Senator Harkin, why 

don’t you do that on your time. Harkin wisely points out. What was 

it you wisely pointed out? 

Senator HARKIN. That their reform package is $1.5 billion, but 

the total amount that gets cut out of all these other programs is 

$2.1 billion. 

Senator SPECTER. How about that, Madam Secretary? 

Secretary SPELLINGS. Well, I think it’s more like the $1.5 billion 

that we have gathered up. I don’t know what all the elements are 

that are in the $2 billion estimate that you have, Senator Harkin, 

but it depends on what’s on the list, I guess, is the short answer. 

Senator SPECTER. Madam Secretary, you can see the smooth coordination. I frequently use the expression that when we change 

chairman and ranking member that it’s a seamless passage of the 

gavel, which I now undertake to do, so that he can follow up on 

his Charlie McCarthy, Edgar Bergen question that I asked on his 

behalf. Senator Harkin. 

Senator HARKIN. Wait a minute. Which one am I? 

Senator SPECTER. You’re Edgar Bergen, I can tell you that. 

Senator HARKIN. Okay, well, to follow up on this. 

Senator SPECTER. Secretary Spellings is too young to really know 

who either is. 

Secretary SPELLINGS. I was just going to say you’re dating yourselves. But I wasn’t going to say anything. 

Senator HARKIN. But to follow up on it, Madam Secretary. I understand the High School Initiative program is at $1.475 billion. 

But there are 40 some programs that were eliminated. All the 

TRIO programs, Talent Search, Upward Bound, Smaller Learning 

Communities, that’s $2.1 billion. So you’ve taken away $2.1 billion 

that goes out to these high schools, and saying now, here’s $1.5 billion. 
27 

HIGH SCHOOL REFORM INITIATIVE

Secretary SPELLINGS. Here’s the difference. Part of the Perkins 

Vocational Education Program goes into community colleges and is 

in the postsecondary education environment, if you will, and so the 

high school reform proposal at $1.5 billion reflects the investments 

that are currently going to K–12 schools. The difference, the additional funds, can be found in community colleges, which is obviously higher education. 

Senator HARKIN. Oh, so you’re saying that Talent Search, Upward Bound and all those programs are now shifted somehow to 

community colleges? 

Secretary SPELLINGS. No, sir. I’m saying that the Perkins Voc Ed 

Program, some of those resources end up in community colleges, 

some end up in high schools. Trio, GEAR UP, those sorts of programs that are high school programs, would, could be funded from 

the $1.5 billion high school side of it. 

Senator HARKIN. Okay. I understand what you’re saying now. 

Please understand what I’m saying, that you add up all those cuts 

in those programs, it’s $2.1 billion. You replace that with $1.475 

billion for your high school initiative. So when you say that schools, 

well, if they want to continue the successful programs, they could. 

Well, I guess what I would ask you to submit to this committee is 

which of these, is it 42 programs, 40 some, I forget what it was, 

that you’re asking to be eliminated—I mean, which of those are you 

saying are not successful? 

Secretary SPELLINGS. Well—— 

Senator HARKIN. Which of them are not successful? Please. 

Secretary SPELLINGS. We have a PART process that rates the 

programs. I certainly could give that PART list for the 42 programs 

and will. The difference I want to say on the $2 billion worth is 

that, in the Perkins Program, part of those resources go to community colleges, so the high school initiative at $1.5 billion is, it reflects the resources that are spent in K–12 schools. 

[The information follows:] 

OMB PART RATINGS FOR PROGRAMS PROPOSED FOR TERMINATION IN THE FISCAL

YEAR 2007 BUDGET REQUEST

OMB developed the Program Assessment Rating Tool (PART) in order to assess 

and improve program performance so that the Federal Government can achieve better results. Ratings are based on questions in four critical areas—purpose and design, strategic planning, management, and results and accountability. The answers 

to questions in each of the four areas result in numeric scores, which are combined 

to achieve an overall qualitative rating that ranges from Effective, to Moderately Effective, to Adequate, to Ineffective. Programs for which we have insufficient evidence from either performance data or rigorous program evaluations cannot be assessed and receive a PART rating of Results Not Demonstrated. PART assessments 

help our Department and OMB improve the performance of Federal programs by 

identifying flaws in program design, management, or implementation that undermine effectiveness. PART assessments also help inform funding decisions, but a program’s PART rating would not dictate budget policy. For example, the Administration might not request funding for a program for which there is not a clear Federal 

role or which is duplicative of other programs, even if it is rated Effective or Moderately Effective. 

The following chart shows whether programs proposed for termination in the fiscal year 2007 budget request have been assessed using the PART, and if assessed, 

the year of the assessment and the rating the program received. 
28 

OMB PART FINDINGS FOR EDUCATION DEPARTMENT DISCRETIONARY PROGRAMS PROPOSED FOR 

TERMINATION IN FISCAL YEAR 2007 

Program Year assessed Rating 1

TRIO Talent Search ................................................................................ 2003/2005 ....... Moderately Effective 

Comprehensive School Reform .............................................................. 2002 ................ Adequate 

GEAR UP ................................................................................................ 2003 ................ Adequate 

Projects with Industry ........................................................................... 2004 ................ Adequate 

Even Start .............................................................................................. 2002 ................ Ineffective 

Safe and Drug-Free Schools State Grants ........................................... 2002 ................ Ineffective 

TRIO Upward Bound .............................................................................. 2002 ................ Ineffective 

Vocational Education State Grants ....................................................... 2002 ................ Ineffective 

B.J. Stupak Olympic Scholarships ........................................................ 2004 ................ Results Not Demonstrated 

Byrd Honors Scholarships ..................................................................... 2004 ................ Results Not Demonstrated 

Educational Technology State Grants ................................................... 2005 ................ Results Not Demonstrated 

Leveraging Educational Assistance Partnership .................................. 2004 ................ Results Not Demonstrated 

National Writing Project ........................................................................ 2004 ................ Results Not Demonstrated 

Parental Information and Resource Centers ........................................ 2004 ................ Results Not Demonstrated 

Smaller Learning Communities ............................................................. 2005 ................ Results Not Demonstrated 

Teacher Quality Enhancement ............................................................... 2003 ................ Results Not Demonstrated 

Tech-Prep State Grants ......................................................................... 2002 ................ Results Not Demonstrated 

Academies for American History and Civics ........................................ ...................... Not Assessed 

Arts in Education .................................................................................. ...................... Not Assessed 

Civic Education ..................................................................................... .................... Not Assessed 

Close Up Fellowships ............................................................................ .................... Not Assessed 

Demonstration Projects for Students with Disabilities ........................ .................... Not Assessed 

Elementary School Counseling .............................................................. .................... Not Assessed 

Excellence in Economic Education ........................................................ .................... Not Assessed 

Exchanges with Historic Whaling and Trading Partners ...................... ...................... Not Assessed 

Federal Perkins Loans Cancellations .................................................... .................... Not Assessed 

Foundations for Learning ...................................................................... .................... Not Assessed 

Javits Gifted and Talented .................................................................... .................... Not Assessed 

Mental Health Integration in Schools ................................................... .................... Not Assessed 

Ready to Teach ...................................................................................... .................... Not Assessed 

Safe Drug-Free Schools Alcohol Abuse Reduction ................................ .................... Not Assessed 

School Dropout Prevention .................................................................... .................... Not Assessed 

School Leadership ................................................................................. .................... Not Assessed 

Star Schools .......................................................................................... .................... Not Assessed 

State Grants for Incarcerated Youth Offenders .................................... .................... Not Assessed 

Thurgood Marshall Legal Educational Opportunity Program ................ .................... Not Assessed 

Underground Railroad Program ............................................................. .................... Not Assessed 

Vocational Education National Programs ............................................. ...................... Not Assessed 

VR Migrant and Seasonal Farmworkers ............................................... ...................... Not Assessed 

VR Recreational Programs .................................................................... ...................... Not Assessed 

VR Supported Employment State Grants .............................................. ...................... Not Assessed 

Women’s Educational Equity ................................................................. ...................... Not Assessed 

1 Reflects the most recent rating for programs that were reassessed. 

NOTE: A total of 74 ED programs have been assessed since 2002 using the Program Assessment Rating Tool (PART); additional programs will be rated in the future. 

Senator HARKIN. So in your opinion the $2.1 billion and $1.5 billion that’s just money that normally goes to community colleges, is 

that right? 

Secretary SPELLINGS. Yes, sir. 

Senator HARKIN. Well, I’ll have to take a look at that. I’m not 

certain about that one but give me some documents on that and 

I’ll—— 

Secretary SPELLINGS. I’ll definitely do that. 

Senator HARKIN. Let me ask you, but one thing I did want to 

cover is this what’s happening with special education. I said earlier 

it goes from 19 percent to 18 percent, now down to 17 percent and, 

right, but here’s the real problem, as bad as that is, there’s another 

hit coming to these schools outside your jurisdiction but you should 

be cognizant of it, Medicaid pays for the cost of coverage services 
29 

for eligible children with disabilities. School districts can be reimbursed by Medicaid for transportation costs they incur in providing 

services if this works. The administration wants to prohibit schools 

from getting reimbursed for transportation and in fiscal year 2007 

schools are expected to receive $615 million from Medicaid for that 

purpose. If this change goes through then they’re going to have to 

pay the $615 million in transportation costs themselves. So while 

you might say that there’s been a slight increase in IDEA funding 

from $10.583 to $10.683, a $100 million increase, still not keeping 

up with inflation or anything, there’s going to be another cut from 

Medicaid reimbursement for these kids. Where are these schools 

going to get that $615 million, $650 million, $615 million, can’t 

read it, $615 million for transportation? Did I make myself clear? 

Secretary SPELLINGS. You did. Senator, as you know, those are 

reimbursements through HHS and I’m sure you’ll discuss that with 

Secretary Leavitt. My understanding is, those are places where 

they found a lot of fraud and abuse with respect to those reimbursements and, you know, with respect to IDEA funding overall 

we’ve had a 68.5 percent increase in funding since 2001 and, you 

know, we continue investments on the education side for special 

education. With respect to the transportation funding, my understanding is that it’s been a place where there’s been some fraud 

and abuse and that that needs to be curtailed. 

Senator HARKIN. I’m all for cutting fraud and abuse but when 

you disallow the whole thing, I mean, you’re saying that every dollar’s being abused. I mean, you’re not saying it—— 

Secretary SPELLING. I’m just not very familiar with the particulars, since we don’t run that program. 

Senator HARKIN. You’re not saying that but OMB or the administration’s saying that and since there’s a close correlation here between the two, between you and HHS on this, I mean, somehow 

we’ve got to bring that together because if we cut the $615 million 

COLA, that’s going to be a big hit. 

ESEA TITLE I PROPOSED FUNDING DECREASE

Title I, let me just say one thing about Title I. Right now 29 

States will get less Title I funds under the budget, than they did 

last year. My State, Iowa, was one of 15 States that will get less 

Title I funding than they did 3 years ago in fiscal year 2004. On 

the district level it’s even bleaker. This fiscal year was the third 

year in a row that most districts got less Title I funding than they 

did the year before. Fiscal year 2007 will be the fourth straight 

year. In my State, two-thirds of Iowa districts got less Title I funding this year than they did 3 years ago. So how can you say you’re 

giving schools enough money for No Child Left Behind when our 

budget once again cuts Title I funds the most to the districts? 

Secretary SPELLING. Well, as you know, under Title I the distribution formulas follow the kids and the poorest kids as they 

move around and as those populations shift. There are also obviously States who are getting additional Title I resources owing to 

the distributional mechanics of Title I funds following those poorest, neediest kids. 
30 

SCHOOLS CATEGORIZED AS NEEDING IMPROVEMENT

Senator HARKIN. I’m told there are about 11,000 schools in this 

country that have been designated in need of improvement, is that 

about right? 

Secretary SPELLINGS. That’s sounds about right—— 

Senator HARKIN. 11,000. 

Secretary SPELLINGS [continuing]. That sometimes gets characterized as failing schools. I think, you know, we all know that there 

are schools that need improvement when half the minority kids 

aren’t getting out of high school. We have work to do with special 

ed students and limited English speakers and so on and so forth, 

so, it doesn’t surprise me that 11,000 schools need improvement. 

ESEA TITLE I FUNDING

Senator HARKIN. Yeah, but again how are we going to help these 

schools when we’re cutting Title I funding? I mean, you say it follows the kids around and I know poverty’s gone up in some areas 

but I can tell you we still have, I suppose, kids in Iowa and rural 

areas and places like that that are getting cut out, because it’s almost like you’re assuming there’s a static level of poor kids just 

goes to this level and they shift around but it always stays static, 

I mean the total number stays static. That’s not true. I don’t think 

there’s any figures that show that. The number of poor kids in this 

country has gone up. 

Secretary SPELLINGS. Right. That’s why we supported increases 

in Title I for the poor through the course of the present administration. 

Senator HARKIN. Well, we’re getting less Title I money. 

Secretary SPELLINGS. I’m talking about in the entirety of the 

President’s term, Title I funding is up about 45 percent. 

Senator HARKIN. Oh, I see. So it went up a couple of years in a 

row. Now we can sit back and we don’t have to increase it any 

more. 

Secretary SPELLINGS. Well, I’m not suggesting that we can sit 

back by any stretch but—— 

Senator HARKIN. We hear that when we double the funding for 

NIH and we got it up there, now we say, well they did that, now 

we don’t have to worry any more and we just sit back. I think what 

we were doing in the first couple of years is trying to play catchup ball in funding these kids in Title I. That doesn’t mean it’s remained static and I just think the program funds Title I. 

Secretary SPELLINGS. Well, we’ve also called for $200 million for 

School Improvement. You talked about the 11,000 schools. 

Senator HARKIN. I know about the $200 million. I just divide 

that out to 11,000, it’s about $20,000 per district. 

Secretary SPELLINGS. Well, I think we can learn from each other. 

I think States will be doing more systematic and systemic work at 

a State level that will leverage some of those resources. 

Senator HARKIN. Our time is up. Madam Secretary, you said 

quite frankly in your opening statement that the Federal Government’s role is providing help to States for under-privileged, poor 

kids and kids with disabilities. Well, this is it, right here, and I 
31 

think we’re shirking our responsibility in that area to provide that 

kind of help to the States. Thank you. 

HIGH SCHOOL DROPOUTS—THE SILENT EPIDEMIC

Senator SPECTER. Thank you, Senator Harkin. One final inquiry 

and, Madam Secretary, we’re having votes about to begin, force 

back votes on the PATRIOT Act. The publication of The Silent Epidemic is out on dropouts—I see you nodding in the affirmative— 

thanks to the Gates Foundation on funding it, and it shows that 

about 3.5 million young people between the ages of 16 and 25 have 

dropped out of high school, were not in school in the year 2003, the 

most recent year in which such an estimate is available. What in 

the budget is being directed to that major problem? 

ADDRESSING THE HIGH SCHOOL DROPOUT PROBLEM

Secretary SPELLINGS. Well, Senator, a few things. One, as that 

study observes, and I’m meeting with one of those authors of the 

report this afternoon, I think, of the things we know is that kids 

drop out because they don’t have the necessary reading and deciphering skills, particularly reading skills, to do high-school-level 

work. That’s why we support the Striving Readers Initiative for a 

$100 million, so we can take some of our reading research and extend it in the middle schools and get these kids caught up so that 

they can do more rigorous work. The other thing, as the report observes, and I think it speaks to boredom and a lack of rigor sometimes in high school, is that many of the students that drop out, 

you know, are passing. They are kids that are effective in attending 

school and they’re just completely disengaged and tend not to find 

it very satisfying. So I think if we expand Advanced Placement, if 

we expand dual enrollment, and provide some of these things that 

are more engaging and more interesting and more rigorous, and 

more relevant to kids—I think those are some things we can do to 

guard against dropouts. 

Senator SPECTER. What do you think the prospects are of ameliorating that problem? 

Secretary SPELLINGS. Well, I think it’s, you know, obviously 

going to be a journey. I don’t think this is something that happens 

overnight. I think we need to know more. This is why the President 

has called for enhanced accountability in high schools. We don’t 

know very specifically as policy-makers what is it about high school 

that’s working and not working and for whom. Is it reading? Is it 

rigor? Is it, you know, disengagement? Is it a lack of vocational—— 

Senator SPECTER. How do you propose to find out? 

Secretary SPELLINGS. Well, what the President has called for is 

additional accountability, more measurement in high school. We 

only test in one grade in high school. Typically States have elected 

to do that in the 10th or the 11th grade. So after 8th grade we lack 

information about what the state of high schools really is and an 

ability to parse that down for a policy tool. 

Senator SPECTER. Where the President has called for it, what has 

the response been? 

Secretary SPELLINGS. Many States have put high school assessments in place. I would say half or so have a full complement of 

assessment through high school. That’s the Governor’s—— 
32 

DEPARTMENT’S COMMENTS ON THE SILENT EPIDEMIC

Senator SPECTER. Madam Secretary, we’re going to have to recess here in a moment but what I would ask you to do is to give 

us your evaluation, your Department’s evaluation of this report on 

dropouts and what is currently being done and what you think 

ought to be done. That’s a gigantic problem which we really ought 

to address. 

Secretary SPELLINGS. I agree. 

[The information follows:] 

SCHOOL DROPOUTS

′′The Silent Epidemic: Perspectives of High School Dropouts,’’ a March 2006 report 

by Civic Enterprises in association with Peter D. Hart Research Associates for the 

Bill and Melinda Gates Foundation, is based on a series of focus group interviews 

conducted with young people aged 16–25 who identified themselves as high school 

dropouts from public schools in large cities, suburbs, and small towns. As the report 

notes, the study’s purpose was to approach the dropout problem from the perspectives of the former students themselves, to better understand the lives and circumstances of students who drop out of high school and to help ground the research 

in the stories and their reflections. 

Though the study is primarily anecdotal and was not designed to be nationally 

representative, its findings are consistent with the Administration’s emphasis on the 

need for high school reform in the 2006 and 2007 President’s Budget proposals, as 

well as the effort to bring more rigor to the high school curriculum through such 

initiatives as the expansion of support for Advanced Placement courses. 

For example, fully one-third of those surveyed said that they dropped out of high 

school because they were ‘‘failing in school,’’ and 45 percent said they lacked academic preparation for the challenges of high school. In response, The Silent Epidemic recommended the development of ‘‘early warning systems’’ to help identify 

students at risk of failing in school, the provision of intensive assistance to struggling students, and research on what works in high school. The Administration’s 

$1.5 billion High School Reform initiative, first proposed in the President’s 2006 

Budget, would address each of these recommendations. Grantees would use test 

scores of incoming high school students to identify those most at risk of not meeting 

State standards and potentially dropping out, develop individualized performance 

plans to meet student needs, and support research on specific interventions and 

strategies for improving student achievement in high school. 

The 2007 request also includes two other proposals specifically targeted to the 

needs of students like those discussed in The Silent Epidemic. First, a $70 million 

increase for the Striving Readers program would significantly expand the development and implementation of research-based interventions to improve the skills of 

teenage students who are reading significantly below grade level. And a new, $125 

million Math Now for Middle School Students initiative would support researchbased math interventions in middle schools. 

In addition, the proposed $90 million increase to expand the availability of Advanced Placement and International Baccalaureate programs in schools with large 

populations of low-income students would help ensure that such students are able 

to prepare for and successfully complete challenging, college-level curricula. 

Finally, the Department already has played a key leadership role in working with 

the National Governors Association (NGA) to reach a common definition for calculating high school graduation rates. In particular, the National Governors Association also agreed on the use, while States ramp up their own capacity for a longterm solution, of an Average Freshman Graduation Rate, an interim calculation developed by the Department to provide comparable State-level graduation data. 

The Department believes that momentum is building for a serious, nationwide effort to improve the performance of our high schools. President Bush has provided 

strong leadership in this area for the past two years, and The Silent Epidemic 

should contribute to that momentum and help persuade Congress that the time for 

action is now. 

STATEMENT OF SENATOR THAD COCHRAN

Senator SPECTER. We have received the prepared statement of 

Senator Thad Cochran which will be placed in the record. 
33 

[The statement follows:] 

PREPARED STATEMENT OF SENATOR THAD COCHRAN

Mr. Chairman, I welcome Secretary Spellings to the subcommittee and look forward to her testimony about the fiscal year 2007 Budget proposal for the Department of Education. 

I first want to thank the Secretary for her extraordinary efforts and those of her 

staff following Hurricane Katrina. The first questions our school superintendents in 

Mississippi had as they began recovering were about being able to comply with the 

No Child Left Behind standards and regulations. The Secretary showed understanding and compassion for the difficulties faced by these administrators who still 

are simply trying to get schools back in operation and students back in their classrooms. Her actions to waive and provide flexibility under these trying circumstances 

are greatly appreciated. Her visits to Southaven, Pass Christian, and Jackson and 

those of the Assistant Secretary for Elementary and Secondary Education, Henry 

Johnson to Biloxi and others to my State have been well received and again, appreciated. An especially helpful gesture to my staff was detailing Beverly Ward, a Department employee here in Washington, to my Mississippi Gulf Coast office. She is 

still there, and has helped to provide coordination, communication, and a sense of 

comfort to those in both K–12 and higher education. Thank you very much for that 

assistance, Madam Secretary. While the overall budget for the Department of Education is $2.2 billion less than 

last year, I am happy to see the budget proposal includes continuation and even 

some increases in important programs such as, Title I grants to schools for disadvantaged students this is especially important in my State; an increase of $100 

million for Special Education grants; continuation of Ready to Learn Television; and 

a $2 million increase in the Foreign Language Assistance Program grants to schools. 

The budget is challenging again this year, and the President has proposed a number of reductions and eliminations that include programs that have proven to be 

popular and successful, so we will work to find a consensus agreement on what and 

at what amounts programs should be funded. I note for example, the National Writing Project, Arts Education, Gifted Education, and Civic Education are among the 

proposed program eliminations. I’ll be working with you, Mr. Chairman, in an effort 

to ensure those programs are continued. 

We will discuss the details of these programs over the next few months. As always, we begin the process of the appropriations cycle with a number of competing 

interests: those from the administration, members of this Committee, other Senators, and the members of the House. We will work to accommodate as many of 

those priorities as possible, and come to decisions as a committee that will reflect 

what we ascertain as the best course of action. 

ADDITIONAL COMMITTEE QUESTIONS

Senator SPECTER. There will be some additional questions which 

will be submitted for your response in the record. 

[The following questions were not asked at the hearing, but were 

submitted to the Department for response subsequent to the hearing:] 

QUESTIONS SUBMITTED BY SENATOR ARLEN SPECTER

AMERICAN COMPETITIVENESS INITIATIVE

Question. The budget proposes to strengthen math and science achievement of K– 12 students through a new $380 million American Competitiveness Initiative. I am 

a co-sponsor of S. 2198, which addresses many of the same issues identified in this 

Initiative. My concern is that this worthwhile Initiative is funded through reductions in programs that many members of Congress support. Can you explain how 

this budget will accommodate both this new initiative and the other priority programs of various members of Congress? 

Answer. We very much appreciate the strong support that you and other Members 

of the Senate have shown for our efforts to improve math and science education, 

as shown by the very similar goals of S. 2198 and the ACI. As for your concerns 

about funding the ACI proposals, I would point out that at seven-tenths of 1 percent 

of our discretionary budget, the $380 million request for the ACI represents a modest, targeted approach to improving math and science education. The Congress 

should be able to finance this initiative by reducing funding for less needed or less 
34 

effective programs. I understand very well that trade-offs will be required by the 

Congress to fund the ACI, because we made those very same trade-offs in preparing 

our 2007 request. At the same time, we know that in negotiating the 2006 appropriations bill, your Subcommittee demonstrated a willingness to balance funding for 

priority programs with reductions and eliminations in other activities. We hope to 

work with you to achieve that same kind of funding discipline for 2007, and our request includes many examples of programs that could be reduced or eliminated to 

pay for new initiatives like the ACI. 

FEDERAL PERKINS LOANS

Question. Your budget includes $664 million in spending that is offset by the recall of the Federal contribution to the Perkins Loan program. During last year’s session, the House and Senate Authorizing Committees agreed to extend the Perkins 

Loan program, not phase it out, as your budget assumes. Can you tell me how my 

subcommittee should make-up for the fact that this $664 million offset is not a viable mechanism for additional spending proposed in your budget request? 

Answer. The administration continues to believe needy students would be better 

served by redirecting Perkins Loan funds to more broadly available student aid programs, such as the Pell Grant, Federal Family Education Loan (FFEL), and Direct 

Loan programs. With the number of Perkins Loan institutions declining from 3,338 

in academic year 1983–84 to 1,796 in 2003–04 and with only 3 percent of students 

enrolled in postsecondary education receiving Perkins Loans each year, the Administration believes the Federal share of funds held by this small group of institutions 

would be more effective if used in a way that serves all eligible students regardless 

of institution. 

USE OF TITLE I SCHOOL IMPROVEMENT FUNDS FOR COMPREHENSIVE SCHOOL REFORM

Question. In the last two Department of Education Appropriations Acts, the conferees have included language in the statement of the managers which encourages 

the Secretary to notify States of a priority that they should place on the awarding 

of funds from the 4 percent school improvement. Can you explain what actions your 

Department has taken to comply with this language? 

Answer. On March 9, 2005, the Department sent an e-mail to Title I State directors to notify them of the provision in the fiscal year 2005 appropriations report language and to inform them of the conditions that must be met for a State educational 

agency to use Title I school improvement funds for comprehensive school reform 

(CSR) projects. A Department official also discussed the directive at the Title I State 

directors’ meeting last year. 

In addition, the Department has hosted three regional meetings of State Title I 

directors and State CSR directors to talk about capturing the lessons learned from 

CSR, building bridges between Title I and CSR, and leveraging statewide systems 

of support to disseminate information learned through CSR. 

The Department will hold a meeting this spring focused on building State capacity 

to improve schools using CSR and Title I to institutionalize what has been learned 

about working with high-performing, high-poverty schools. At the meeting Department staff will discuss the fiscal year 2006 report language about using Title I 

school improvement funds to support CSR projects. 

COMPREHENSIVE SCHOOL REFORM AS SCHOOL IMPROVEMENT STRATEGY

Question. Given that one rationale for the elimination of the Comprehensive 

School Reform program was that States could use funds under their 4 percent set 

asides for the same activities, do you have any evidence that States have made or 

will make subgrants that support comprehensive school reform activities in school 

districts, and if not, why not? 

Answer. We do not yet have any evidence, either from evaluation data or other 

reports, that States or school districts are using comprehensive school reform as 

part of their school improvement strategy. In part, this may reflect the progressive 

nature of the No Child Left Behind Act’s (NCLB) school improvement requirements, 

which gradually move from school improvement plans in the first 2 years to replacement of curricula or staff under corrective action to alternative governance during 

restructuring. Comprehensive school reform generally represents the kind of thoroughgoing, fundamental change called for under corrective action and restructuring 

and, thus, may be adopted more frequently as increasing numbers of schools are 

subjected to these more stringent improvement measures. 

Also, while the school improvement requirements in NCLB are fairly prescriptive, 

they do not specifically mention comprehensive school reform as an improvement 

strategy. States and districts naturally look to the statute for guidance as to what 
35 

they must do to support schools in the various stages of improvement, and will tend 

to adopt the specific remedies found there. 

Finally, comprehensive school reform is intensive and time-consuming and requires considerable technical assistance from States and school districts that have 

been focused in recent years on overall implementation of NCLB. As States establish and strengthen their statewide systems of support for LEA and school improvement, they are likely to gain greater capacity to support activities like comprehensive school reform. The President’s School Improvement Grants proposal would support this kind of evolution in State-level improvement capabilities. 

TITLE I SCHOOL IMPROVEMENT SET-ASIDE

Question. In the fiscal year 2007 budget request, you have proposed overriding a 

provision in the No Child Left Behind Act to allow States to reduce the grants to 

local educational agencies below the amount they received in the 2006–2007 school 

year to generate sufficient funds under the 4 percent school improvement provision 

of the law. Could a State reduce the Title I grant funds of a school district identified 

for improvement and subgrant those funds to another district? 

Answer. Yes, that would be possible, but any such reduction would be very small. 

Under the Administration’s proposal, all districts would contribute proportionately 

to the pool of funds available to support State and local school improvement, not 

just those districts receiving increased allocations under the Title I formulas. States 

would then subgrant 95 percent of those funds to school districts with schools identified for improvement, with priority on those districts with the greatest need for such 

funds and the strongest commitment to using them to raise the performance of the 

lowest-achieving schools. By the way, the hold-harmless also leads States to reduce 

allocations to districts identified for improvement and redirect funds to other districts; it simply does so by disproportionately taking funds from districts that otherwise qualify for more Title I funds. 

LIMITATION ON REDUCTION OF TITLE I GRANTS FOR SCHOOL IMPROVEMENT PURPOSES

Question. Would this proposal establish any limit to the amount by which a State 

could reduce a school district’s Title I grant? 

Answer. Yes, unlike current law, our proposal actually would limit any reduction 

for school improvement purposes to 4 percent. Under current law, districts that receive increased Title I funding often see their allocations reduced by more than 4 

percent to make up for those districts protected by the hold-harmless. 

Question. If not, why do you believe that is unnecessary? 

Answer. As I said, our proposal actually would restore a meaningful limit to the 

State reservation for school improvement. 

TITLE I SCHOOL IMPROVEMENT FUNDING GENERATED BY 4 PERCENT SET-ASIDE

Question. With more than 9,000 schools identified for improvement in the 2004– 

2005 school year, effective interventions that reduce this number and lead to improved student outcomes would help States and local school districts meet the goals 

of No Child Left Behind. How much funding has been generated and allocated 

under the 4 percent set-aside for each of the past 3 fiscal years? 

Answer. We do not have actual data on the amounts reserved and allocated by 

the States during this period. We estimate that States reserved and allocated for 

school improvement purposes approximately $484 million in fiscal year 2004 and 

$500 million in fiscal year 2005, and will reserve and allocate roughly $499 million 

in fiscal year 2006. 

Question. Is there any information about the reach of this funding and the number of schools identified for improvement, or on watch lists, that have not been assisted? 

Answer. Earlier this year, the Department published a report, ‘‘Title I Accountability and School Improvement from 2001 to 2004,’’ which found that about 90 percent of school districts with schools identified for improvement reported that they 

provided at least some kinds of the assistance required by NCLB. At the same time, 

more than half of ‘‘continuously identified schools’’ (those identified for improvement 

throughout the period studied) reported that they did not receive more intensive assistance, such as assistance from a school support team or a school-based staff developer. The Department study also found, however, that State practices for allocating school improvement funds varied widely, partly because the study began 

prior to the implementation of No Child Left Behind, which brought significant 

changes to school improvement funding that were not fully implemented when the 

study was completed. 
36 

The recently released report, ‘‘National Assessment of Title I: Interim Report,’’ 

found that less than three-quarters of districts with identified schools reported having the staff, expertise, time, or money to improve the performance of those schools. 

Question. Is there any information on how the 4 percent set-aside for school improvement funds have been used to remove schools from school improvement lists? 

Answer. We currently do not have data directly linking school improvement funding with success in exiting improvement status. 

TITLE I SCHOOL IMPROVEMENT MONITORING

Question. Has the Department done any monitoring of the types of activities funded with the 4 percent school improvement set-aside established under the No Child 

Left Behind Act? 

Answer. Yes. The monitoring indicators used by ED’s Title I monitoring team include a focus on whether SEAs have (1) reserved and allocated Title I Part A funds 

for school improvement activities, and (2) created and sustained a statewide system 

of support that provides technical assistance to schools identified for improvement. 

The SEA must provide documentation that it has established effective school support teams with members who are knowledgeable about scientifically based research 

and practices related to school improvement. Likewise, the SEA must provide documentation that the teams provide support to schools on such topics as the design 

and operation of the instructional program and strategies for improving student performance. Monitors also seek evidence that SEAs are ensuring that LEAs carry out 

their own school improvement activities. 

Another area reviewed is how the SEA distributes the 4 percent school improvement funds. Of the amount it reserves, the SEA must allocate not less than 95 percent directly to LEAs that operate schools identified for improvement to support improvement activities. In most cases, States are using these funds to provide special 

grants to support improvement in those schools. In a few instances, States, with the 

approval of the LEAs, directly provide improvement activities or arrange to provide 

them through regional educational centers. 

At the local level, ED’s Title I monitors review how LEAs and schools are using 

the funds for improvement activities. This information is gleaned through interviews with LEA and school staffs. 

Question. In particular, has the Department monitored the use of funds for implementing required 2-year improvement plans incorporating strategies based on scientifically based research and addressing the specific issues that led to schools being 

identified for improvement? 

Answer. Yes. The monitoring indicators used by ED’s Title I monitoring team seek 

information and evidence that the SEA has assisted LEAs in developing or identifying effective curricula aligned with State academic achievement standards and 

disseminated the curricula to each LEA and school within the State. Additionally, 

monitors review and discuss school improvement plans with LEA and school staffs 

to discern how these plans address the 10 required components under NCLB, including how the improvement plans incorporate strategies that are research based 

and strategies that address the specific issues that led to the school being identified 

for improvement. 

SCHOOL IMPROVEMENT GRANTS PROGRAM AND EFFECTIVE SCHOOL IMPROVEMENT

ACTIVITIES

Question. What are your plans for using any knowledge generated through research on effective school improvement activities; and how will the fiscal year 2007 

budget request support this goal? 

Answer. The new $200 million request for School Improvement Grants recognizes 

the critical need for State leadership and support in LEA and school improvement. 

While States currently reserve 4 percent of Title I, Part A allocations for school improvement activities—an amount totaling more than $500 million annually, they 

must subgrant 95 percent of these funds to LEAs, leaving just $25 million available 

for State-level school improvement activities. The request would provide substantial 

new support for State-led LEA and school improvement efforts and would help build 

State capacity to carry out statutory improvement responsibilities. 

One research based approach that the Department is considering for the proposed 

School Improvement Grants program is requiring each State to use diagnostic assessments in schools that repeatedly fail to make adequate yearly progress. Such 

tests would help LEAs and schools clearly identify student strengths and weaknesses in a particular subject and develop appropriate instruction. 
37 

SUPPLEMENTAL EDUCATIONAL SERVICES

Question. Budget documents supporting the budget request note that ‘‘While 

many students attending schools identified for restructuring receive SES, the services tend to be of limited duration.’’ How does the amount of funding generated from 

the appropriations for Title I Grants to LEAs under the 20 percent SES/choice requirement relate to this finding? 

Answer. The statement in the budget request simply reflects the reality that the 

duration and intensity of current supplemental educational services (SES) are limited by the statutory cap on per-pupil payments, with the current cap averaging 

about $1,500 nationally. There are other factors that affect the duration of services, 

such as the structure of SES programs and the actual costs charged by various providers, but the general point is that the America’s Opportunity Scholarships for 

Kids proposal would roughly double the funding available for SES, from $1,500 to 

$3,000 and, therefore, greatly increase the intensity and duration of available services. 

Question. If limited funding is not the reason for such limited intensity, what are 

the primary causes of it? 

Answer. The premise of our budget request was to enable parents to purchase 

more extensive services with greater resources, and that students in schools identified for restructuring are likely to be those students who would most benefit from 

more extensive services than are available under current law. 

Question. What is the impact of this finding of limited intensity on the effectiveness of the SES activity? 

Answer. The SES program is still in its early years and we do not yet have meaningful impact data. 

Question. How is the Department monitoring the requirement in NCLB that requires low-achieving students to receive priority for services under choice and supplemental services options? 

Answer. ED’s Title I monitors review documentation to show that the SEA has 

developed and disseminated guidance to LEAs outlining requirements for implementing public school choice and supplemental education services and that this 

guidance includes the requirement that low-achieving students receive priority for 

these services. At the LEA level, ED’s Title I monitors review parent notification 

letters, guidance documents, LEA contracts with SES providers, and other documentation to determine if the LEA has complied with the required priority for providing the choice and SES options. 

SUPPLEMENTAL EDUCATIONAL SERVICES PILOT PROGRAM

Question. You announced a number of pilots last year giving a select number of 

districts in need of improvement the flexibility to serve as supplemental educational 

service (SES) providers in exchange for greater student participation and achievement data. All of your other pilots invited interested States to ‘‘apply’’ before being 

offered this sort of flexibility. Can you explain how you selected the handful of districts that are in the SES pilot and why you circumvented States altogether and 

negotiated with districts directly? 

Answer. For each of the pilots that we started last year (allowing Chicago and 

Boston to be providers although they are districts in need of improvement and allowing four districts in Virginia to reverse the order of choice and SES), the Department discussed and sought approval from each of the States before the pilots began. 

In the case of the Virginia pilots, we negotiated directly with the State throughout 

the entire process. For Chicago and Boston, we sought and received approval from 

their respective States for participation in the pilot. As for selection of these particular districts for the pilots, in the case of Chicago and Boston we worked with 

the Council of the Great City Schools to help us identify districts that were willing 

and able to participate in the pilot. Virginia had been in communication with the 

Department about ways to strengthen SES in the State, and came to the Department with a formal request to reverse the order of choice and SES. It was the first 

State to do so, and we granted this flexibility on a trial basis. 

SELECTION OF DISTRICTS FOR SES PILOT PROGRAM

Question. Why was Chicago selected as opposed to districts such as Pittsburgh or 

Philadelphia, for instance? 

Answer. As I mentioned, the Department worked with the Council of the Great 

City Schools to identify districts that had the ability to provide high-quality SES 

services and would meet the terms of the pilots. Pittsburgh and Philadelphia were 

not identified at the time as districts meeting these conditions. 
38 

STUDENT PARTICIPATION AND ACHIEVEMENT UNDER THE SES PILOT PROGRAM

Question. How many additional students are benefiting from each of the 3 pilots, 

which waive your regulation around prohibiting districts in need of improvement 

from serving as an SES provider? 

Answer. Chicago and Boston are the two districts participating in this pilot. New 

York City was invited to participate but declined for this year. In Chicago, approximately 55,000 students are participating in SES through Chicago’s program and private providers’ programs; this compares to about 40,000 last year. In Boston, about 

3,700 are participating, compared to about 2,000 last year. 

Question. When will we be able to see the data on the benefits of SES on student 

achievement from these pilots? 

Answer. We anticipate that this summer, after the spring State assessment results are in, we should be able to collect data on student achievement. 

Question. How are you assuring high-quality tutoring programs in SES? 

Answer. As a condition of participation in these pilots, each district had to meet 

a set of guiding principles that the Department identified as key elements of high 

quality SES programs. These included communicating to parents about SES through 

multiple venues and in languages that parents could understand, holding extended 

windows for enrollment, and allowing providers to serve students at school facilities 

for a reasonable fee. 

EXPANSION OF THE SES PILOT PROGRAM

Question. Do you plan to expand this pilot to additional districts in the next school 

year? 

Answer. We have monitored each of the pilot districts and collected data on their 

implementation this year. We are now in the process of reviewing these data and 

making determinations as to whether the Chicago, Boston, and Virginia pilots will 

continue, and whether additional sites will be added. 

Question. If you do plan to expand the pilot program, what will be the selection 

process and how many do you anticipate selecting? 

Answer. In the near future, we will be making determinations as to whether these 

pilots continue and the criteria we will use to select sites for participation. 

Question. Do you plan to put any additional requirements on school districts serving as SES providers and, if so, what changes might there be next year? 

Answer. We are considering whether to add any additional criteria to sites that 

participate in the pilots next year. We are using the information we have gained 

from this year’s pilot sites to consider ways to strengthen the agreements with districts and help ensure that more students are receiving quality SES services. 

AMERICA’S OPPORTUNITY SCHOLARSHIPS FOR KIDS

Question. The Department’s budget includes $100 million for a proposed voucher 

program that could be used by students in schools identified for restructuring so 

that they can transfer to a private school or receive intensive tutoring services. Why 

does the budget request $100 million for vouchers for an estimated 2 percent of Title 

I schools and request no increase in the amount of funds available for the Title I 

grant program, the cornerstone of Federal assistance for helping disadvantaged students? 

Answer. Congress has invested nearly $200 billion in Title I Grants to LEAs over 

the past 40 years, including $12.7 billion in the current fiscal year. While we agree 

that Title I is the cornerstone of our efforts to improve the quality of elementary 

and secondary education, particularly for low-income and minority students in highpoverty schools, the size of the program limits the impact of additional funding 

available under current budget constraints. For example, the $100 million proposed 

by President Bush for the America’s Opportunity Scholarships for Kids program represents less than one-tenth of one percent of the funding provided for Title I Grants 

to LEAs, and would have little or no impact when spread across 14,000 school districts. However, this amount is sufficient to permit a meaningful demonstration of 

the potential for expanded choice and tutoring options to improve the achievement 

of students attending chronically low-performing schools. Moreover, these funds 

would be targeted to the same students who are the focus of the Title I program 

and, in the case of students who select the tutoring option, would help improve the 

performance of Title I schools undergoing restructuring. 

Also, the President is requesting first-time funding for School Improvement 

Grants, which would provide an additional $200 million for State-led efforts to turn 

around low-performing school districts and schools. These funds would directly benefit participating Title I districts and schools that have been identified for improve-
39 

ment. For this reason, it is not entirely accurate to say that the President’s 2007 

budget includes no increase in the amount of funds available for Title I. 

MEASURING PERFORMANCE OF THE IMPACT AID PROGRAM

Question. The Administration has been undertaking an examination of how to 

measure performance under the Impact Aid program and has identified a model for 

estimating unmet need of eligible school districts. Please provide information on the 

findings of unmet need for various types of Impact Aid districts. 

Answer. In 2005, the Department created a simplified model to analyze the effectiveness of the Impact Aid formulas and, more specifically, address the question of 

whether or not funds are adequately compensating for a Federal presence and the 

associated tax burden. The Department sent a review and analysis of the model to 

the House and Senate Committees on Appropriations in January 2006. 

The report applied the simplified model to calculate the gap between available 

revenues to the LEA and the amount needed to fund schools at the State average 

per-pupil expenditure for Florida, Alabama, and Wyoming, three States for which 

adequate data were available. Comparing this gap to the actual payments made to 

Impact Aid districts revealed that there was very little correlation between the computation of local need from the simplified model and actual payments. 

The model incorporates tax data into the analysis and, while it brings us closer 

to being able to compute valid economic analyses of the program, because of data 

limitations the model has not yielded the desired results. In order to answer these 

questions properly, more sophisticated analysis with better data will likely be needed. 

IMPROVING TEACHER QUALITY PROGRAMS

Question. In November 2005, the Government Accountability Office released report GAO–06–25, which relates to State implementation of teacher qualification requirements of the No Child Left Behind Act. This report noted that some teachers 

who provide instruction in more than one core academic subject-such as special education teachers and those in rural schools-and secondary math and science teachers 

might not meet the teacher qualification requirement by the current deadline. What 

activities are funded currently and proposed in the fiscal year 2007 budget to help 

States and districts ensure that all students are taught by a highly qualified teacher? 

Answer. In 2007, the administration is requesting funds for several programs that 

focus on improving teacher quality to help ensure that all teachers are highly qualified. These include: Improving Teacher Quality State Grants ($2.9 billion), Title I 

Grants to Local Educational Agencies ($624 million—the estimated professional development portion), Mathematics and Science Partnerships ($182.2 million), Transition to Teaching ($44.5 million), Teaching of American History ($50 million), Troopsto-Teachers ($14.6 million), and Advanced Placement ($122.2 million). 

HIGHLY QUALIFIED TEACHERS

Question. What specific steps will be taken to ensure that the disparity between 

the proportion of highly qualified teachers in lower income school districts and higher income schools is eliminated? 

Answer. The Elementary and Secondary Education Act (ESEA), as amended by 

the No Child Left Behind Act, establishes the important goal that all students be 

taught by a ‘‘highly qualified teacher’’ (HQT) who holds at least a bachelor’s degree, 

has obtained full State certification, and has demonstrated knowledge in the core 

academic subjects he or she teaches. Further, the ESEA requires States and LEAs 

to include, in their annual report cards, information on the percentage of classes not 

taught by highly qualified teachers, disaggregated by high- and low-poverty schools. 

In addition, the Individuals with Disabilities Education Improvement Act of 2004 

reinforced the NCLB goal by aligning the requirements for special education teachers with the NCLB requirements. 

The Department has been requiring States to submit data as part of their Consolidated State Performance Reports on the percentage of core academic classes 

taught by highly qualified teachers in high- and low-poverty schools, as well as the 

reasons why, for classes taught by teachers who are not highly qualified, the teacher 

is not highly qualified. In addition, States must have an equity plan in place to ensure that poor or minority children are not taught by inexperienced, unqualified, or 

out-of-field teachers at higher rates than are other children. The Department will 

be looking at States’ progress in both of these areas this spring and summer. Although States and school districts are making significant progress in meeting the 

HQT requirement, there is still a lot of work to do to ensure that each State can 
40 

meet the goal that every child is taught by a highly qualified teacher by the end 

of the 2005–2006 school year. 

Meeting the NCLB Highly Qualified Teacher Requirement 

In the Department’s ongoing visits and communications with State and local officials, we are often asked what will happen if, despite their best efforts, districts cannot hire a highly qualified teacher for every class in a core academic subject by the 

end of the 2005–2006 school year. Personnel decisions are made at the State and 

local levels, and the law relies on education leaders in the States to make the best 

educational decisions for improving student achievement. Last fall, I sent a letter 

to the chief State school officers to assure them that States that did not quite reach 

the 100 percent goal by the end of the 2005–2006 school year would not lose Federal 

funds if they were implementing the law and making a good-faith effort to reach 

the HQT goal in NCLB as soon as possible. 

The letter also stated that the Department will determine whether or not a State 

is implementing the law and making a good-faith effort to reach the HQT goal by 

examining four elements of implementation of the HQT requirements: (1) the State’s 

definition of a ‘‘highly qualified teacher,’’ (2) how the State reports to parents and 

the public on classes taught by highly qualified teachers, (3) the completeness and 

accuracy of HQT data reported to the Department, and (4) the steps the State has 

taken to ensure that experienced and qualified teachers are equitably distributed 

among classrooms with poor and minority children and those with their peers. In 

addition, the Department will look at States’ efforts to recruit, retain, and improve 

the quality of the teaching force. If States meet the law’s requirements and the Department’s expectations in these areas but fall short of having highly qualified 

teachers in every classroom, they will have the opportunity to negotiate and implement a revised plan for meeting the HQT goal by the end of the 2006–2007 school 

year. However, for States that either are not in compliance with the statutory HQT 

requirements or are not making a good-faith effort to meet the goal of having all 

teachers highly qualified, the Department reserves the right to take appropriate action, such as the withholding of funds. 

Departmental Review of States’ Efforts to Meet the NCLB Highly Qualified Teacher 

Requirements 

In March 2006, I sent a follow-up letter to the chief State school officers with 

timelines and additional information about the Department’s review of States’ efforts to meet the HQT requirement. By the middle of May, the Department will assess States’ Consolidated State Performance Report data for the 2004–2005 school 

year, HQT data for previous years, and supporting information that we have obtained through State monitoring visits and the review of publicly available records. 

The Department will then make determinations about whether the State is on track 

to meet the highly qualified teacher requirement. 

Using the protocol ‘‘Assessing State Progress in Meeting the Highly Qualified 

Teacher Goal,’’ the Department will determine whether each State’s 2004–2005 data 

indicate that the State has a reasonable expectation of meeting the 100 percent 

HQT goal by the end of the 2005–06 school year and is faithfully implementing the 

law. If this is the case, the State may not be required to submit a revised plan, 

though it certainly may. 

It is likely, however, that the Department will request most States to submit a 

revised plan detailing the new steps they will take to reach the 100 percent HQT 

goal by the end of the 2006–2007 school year. As part of the plan, each State will 

explain how and when the SEA will complete the High Objective Uniform State 

Standard of Evaluation (HOUSSE) process for those teachers not new to the profession who were hired prior to the end of the 2005–2006 school year, and how the 

SEA will limit the use of HOUSSE procedures for teachers hired after the end of 

the 2005–2006 school year to those secondary school teachers teaching multiple subjects in eligible rural schools (who, if highly qualified in at least one subject at the 

time of hire, may use HOUSSE to demonstrate competence in additional subjects 

within 3 years), and those special education teachers teaching multiple subjects 

(who, if they are new to the profession and highly qualified in language arts, mathematics, or science at the time of hire, may use HOUSSE to demonstrate competence 

in additional subjects within 2 years). Peers and teacher-quality experts will review 

the State’s revised plan and evaluate how effectively the plan addresses the State’s 

challenges in reaching the 100 percent HQT goal. 

Corrective Steps for Districts not Meeting Highly Qualified Teacher Requirements 

Finally, if the Department determines that a State has not fulfilled its obligations 

under the statute and is not on track to have all teachers highly qualified by the 
41 

end of the 2005–2006 school year, the Department will take corrective actions in addition to requiring the State to submit a revised plan. 

By the middle of May, the Department will notify States, in writing, of the results 

of the assessment of their HQT progress and will request the States, as appropriate, 

to submit revised plans. States will have until July 7 to submit their revised plans 

to the Department, and the Department then will determine whether a revised 

State plan is sufficient to attain the HQT goal in 2006–2007 and beyond. In August, 

the Department will begin a new cycle of State monitoring visits to ensure that 

States are implementing their revised plans. 

INFORMATION DISSEMINATION ON HIGHLY QUALIFIED TEACHER REQUIREMENTS

Question. The report also identified some information dissemination challenges. 

What actions has the Department taken or planned for making helpful information 

available? 

Answer. The GAO report recommended that the Department ‘‘explore ways to 

make the Web-based information on teacher qualification requirements more accessible to users of its Web site. Specifically, the Secretary may want to more prominently display the link to state teacher initiatives, as well as consider enhancing 

the capability of the search function.’’ 

As noted in the GAO report, the Department agrees with the recommendation and 

has been working to improve the Department’s website so that it is more user 

friendly for teachers and officials who are trying to find information about the highly qualified teacher requirements. For example, the website now directs students, 

teachers, parents, and administrators to specific pages for materials of interest to 

them. The teacher page has a section that describes State and local initiatives to 

improve teacher quality, and both the teacher and administrator web pages have 

direct links to information about the highly qualified teacher provisions. 

STATES’ REPORTING OF HIGHLY QUALIFIED TEACHER DATA

Question. The Congressional Justification states, ‘‘The Department is not entirely 

confident that all States are reporting accurately on the highly qualified status of 

their teachers, particularly special education teachers.’’ This statement is consistent 

with the Government Accountability Office’s recent report regarding teacher quality 

issues. What actions are you taking to specifically address this issue and what plans 

do you have for future actions? 

Answer. Under the Improving Teacher Quality State Grants section of the congressional justification, we did report that the Department is not entirely confident 

that all States are reporting accurately on the highly qualified status of their teachers, particularly special education teachers. To address this concern, the Department has been working closely with States, especially through monitoring visits, to 

help them improve the quality of the data that they report. As of late March 2006, 

the Department has monitored all but three States concerning their highly qualified 

teacher status and will monitor the remaining States this spring. 

We will also be looking very carefully at States’ efforts to report accurately HQT 

data this spring and summer when we review their progress in meeting the requirement that all teachers of core academic subjects be highly qualified by the end of 

the 2005–2006 school year. After that review, we will likely require many States to 

submit revised State plans, and we may take corrective actions against any States 

that are not making a good-faith effort to improve their data collection and reporting. The Department also plans to begin a new round of State monitoring visits late 

this summer. 

Question. How does your budget support your current and planned actions? 

Answer. The Department is planning to use Salaries and Expenses funds to review States’ HQT data and their efforts towards meeting the goal of having all 

teachers of core academic subjects highly qualified. 

ENFORCEMENT OF HIGHLY QUALIFIED TEACHERS REQUIREMENT

Question. In your October 21, 2005 policy letter regarding the ‘‘highly qualified 

teacher’’ issue, you assured States they would not lose Federal funds if they failed 

to meet the 100 percent requirement and were making a good faith effort to implement the law. One of the ways you will make such a determination is by evaluating 

whether States take action to ensure that inexperienced, unqualified, or out-of-field 

teachers do not teach poor or minority children at higher rates than other children. 

How are highly qualified teachers distributed currently between low-income and 

high-income school districts? 

Answer. States are reporting steady improvement towards meeting the goal of 

having all teachers of core academic subjects highly qualified by the end of the 
42 

2005–2006 school year. Data for the 2005–2006 school year will be reported in 2007. 

For 2003–2004, the data indicate that 81 percent of core academic classes in highpoverty schools were taught by highly qualified teachers, an increase of 7 percentage points over the baseline of 74 in 2003. 2004 data for the percentage of core academic classes taught by highly qualified teachers in low-poverty, elementary, and 

secondary schools was 89 percent, 89 percent, and 84 percent, respectively. 

ENSURING HIGHLY QUALIFIED TEACHERS FOR STUDENTS OF ALL SOCIOECONOMIC

STATUS

Question. What steps is the Department taking to ensure socioeconomic status 

does not determine whether a student has access to a qualified teacher or not? 

Answer. For the Improving Teacher Quality State Grants program, the Department requires States to report on teachers’ highly qualified status at the classroom 

level. For example, in the 2003–2004 school year, 81 percent of core academic classes in high-poverty schools were taught by highly qualified teachers. We believe that, 

by requiring States to report on all classrooms, we are sending the message that 

we expect all core academic teachers to be highly qualified, whether they are teaching in a high- or low-poverty school, or whether at the elementary- or secondaryschool levels. 

As mentioned earlier, the Department will closely evaluate States’ progress in 

meeting the HQT requirement this spring and summer as part of our determination 

of whether they are making a good-faith effort to meet the 100 percent objective. 

This will include a review of their Title I equity plans, which are meant to ensure 

that poor or minority children are not taught by inexperienced, unqualified, or outof-field teachers at higher rates than are other children. 

FEDERAL EFFORTS TO ADDRESS INEQUITABLE DISTRIBUTION OF HIGHLY QUALIFIED AND

UNQUALIFIED TEACHERS

Question. How have States used Federal funds to address this issue? 

Answer. The Department sponsored a 2-day meeting for State coordinators in 

March 2006 that focused on the inequitable distribution of teachers who are unqualified, inexperienced, or out-of-field. Working with experts and researchers from 

the National Comprehensive Center for Teacher Quality (at Learning Point, Inc.), 

the Educational Testing Service, and the Council of Chief State School Officers, the 

Department provided the State coordinators with a series of written tools they can 

use to examine the inequity issue and begin to prepare State plans to address the 

issue. The Department also provided all of the States with a protocol that will be 

used to examine whether revised State plans, which must be provided to the Department this summer, will satisfactorily address this issue. 

For most States, this is the first time they will be preparing formal, written equity plans. In previous years, States had difficulty determining if there was an equity distribution problem, so they were unsure how to best address concerns about 

the unequal distribution of highly qualified teachers. The availability of valid data 

about the distribution of highly qualified teachers is now helping States to think 

about the problem and develop equity plans. 

Although States are just now developing their equity plans, many States already 

have incentive programs and strategies to encourage teachers to take on more challenging assignments. The Department is highlighting some of these strategies at the 

following weblink: http://www.teacherquality.us/Public/PublicHome.asp. 

TEACHER QUALITY ENHANCEMENT PROGRAM AND TEACHER RECRUITMENT AND

RETENTION

Question. In recent years, Congress has tried to affect teacher recruitment and retention through a number of legislative efforts, including scholarships for those who 

commit to teaching in certain geographic or content areas, loan forgiveness programs, and other efforts. In addition, there are new requirements that districts and 

States are trying ardently to meet as required by No Child Left Behind’s ‘‘highly 

qualified teacher’’ provisions. Why is the Department acknowledging the crucial role 

teachers play in maintaining the country’s competitiveness, while at the same time 

it is proposing elimination of the Higher Education Act’s Teacher Quality Enhancement program? Can you explain these seemingly conflicting efforts? 

Answer. We do not believe that there is any conflict in the Department’s efforts 

to improve teacher recruitment and retention and the Department’s proposal to terminate duplicative programs, such as the Teacher Quality Enhancement program. 

The Department continues to recognize that the quality of the teacher is one of the 

most critical components in how well students achieve and that improving efforts 

to recruit and retain top quality teachers, especially in geographic and academic 
43 

areas of high need, is critical to improving the overall quality of the Nation’s teachers. The Department’s proposal to terminate the Teacher Quality Enhancement program is based, in part, on the fact that State and local entities may already use 

funds they receive under a number of other Department programs to carry out the 

activities supported through the Teacher Quality Enhancement program. Both the 

Improving Teacher Quality State Grants program and the Transition to Teaching 

program include provisions designed to improve teacher recruitment and retention, 

including all of the activities that are allowable under the Teacher Quality Enhancement program. The Department’s proposal to eliminate funding for the Teacher 

Quality Enhancement program would reduce unnecessary duplication, improve programmatic efficiency, and simplify the grant process for potential recipients. 

DATA MANAGEMENT INITIATIVE

Question. The Government Accountability Office report (GAO), GAO–06–06, released in October 2005, included an assessment of the Department’s efforts to identify performance-related data items that could be collected and reported by States 

that would promote the evaluation of the effectiveness of Federal programs. This report identified several challenges with respect to the participation of and perceived 

benefit for States and quality and consistency of data collected through the system. 

What is the Department’s plan for addressing the challenges identified in the GAO 

report and how much funding is being allocated in fiscal year 2006 and requested 

in fiscal year 2007 for this initiative? 

Answer. The GAO report recommended that the Department develop a strategy 

to help States improve their ability to provide quality data. As described in the Corrective Action Plan we submitted to the GAO in response to their report, we have 

taken several steps to improve the quality of the data the Department collects. By 

the end of this fiscal year, we will have awarded nearly $50 million in grants to 

States under the Statewide Data Systems program to develop and implement statewide longitudinal data systems. The President’s 2007 budget requests a $30 million 

increase for this program. 

The National Center for Education Statistics is working with the staff of the Department’s central database, the Education Data Exchange Network (EDEN), to 

provide technical support and oversight for our grantees. The Department provides 

additional technical assistance to States through the Data Quality and Standards 

Contract with the Council of Chief State School Officers. The Department is also 

a contributing partner in the Data Quality Campaign, a partnership of more than 

10 national organizations that helps States implement high-quality statewide information management systems. Finally, the Department has established a Partner 

Support Center that provides expert technical assistance to States on data submission processes and quality issues related to EDEN. 

The Department is conducting a rigorous assessment of the quality of our data 

collection and reporting. As part of this process, the Department recently announced 

the launch of EDFacts, a new reporting and analysis tool for data collected and compiled through sources such as EDEN. In 2006, $5.705 million is being allocated for 

enhancements to the EDFacts and EDEN systems, and $6.244 million is requested 

for 2007. 

Question. Specifically, how will these funds be utilized? 

Answer. These funds will be used to support the operation of the Partner Support 

Center, development of new enhancements for the EDEN and EDFacts systems (including this year’s successful online collection of the Consolidated State Performance 

Report), maintenance of these systems, and development of new reports and tools 

that enhance program offices’ efficient use of collected K–12 performance data. 

FOREIGN LANGUAGE ASSISTANCE PROGRAM

Question. The budget proposes a $2 million increase for the Foreign Language Assistance program. Budget documents supporting this request state that beginning 

with the 2006 competition, the Department will focus this program on providing incentives for States and districts to provide instruction in critical needs language, especially those programs using technology. Please explain how the 2006 competition 

will be structured to address the issues raised in the fiscal year 2006 Senate Committee Report and the Statement of the Managers accompanying the fiscal year 

2006 Conference Report. Specifically, what type of priority are you proposing for the 

2006 competition, and what is the complete list of foreign languages that will be 

eligible for such a priority? 

Answer. The Department is committed to ensuring that all school districts that 

demonstrate the capacity to successfully implement a program receive consideration 

for competitive grant funds. In response to the concerns raised both in the Senate 
44 

Committee Report and the Statement of Managers that the poorest districts may 

be shut out of Foreign Language Assistance grants due to their inability provide the 

required 50 percent match, the Department has taken active steps to increase 

awareness of waiver availability for eligible grant applicants. The application package for grants includes detailed information about what resources may contribute 

to a grantee’s matching requirement, and the Department considers waivers for any 

district that can demonstrate financial hardship. The program office also has expanded its outreach efforts to include details about the waiver process and eligibility 

on the Department’s web page, at professional workshops, and in fact sheets about 

the program. The combination of improved grant application materials and increased public awareness about waivers will help ensure that disadvantaged districts are not precluded from participating in the program. 

Foreign Language Assistance Program—Critical Need Languages Priorty 

In addition to giving increased attention to grantees that may be eligible for waivers, the Department established a priority relating to critical need languages for the 

2006 grant competition. In conjunction with the President’s National Security Language Initiative, the Department will give preference to grant applicants that demonstrate the ability to build programs and courses in languages that have significant political or economic importance. The specific languages that have been identified as critical are Arabic, Chinese, Korean, Japanese, Russian, and the languages 

in the Indic, Iranian, and Turkic language families. 

ARTS EDUCATION

Question. The No Child Left Behind Act recognizes the arts as a core academic 

subject and studies show that the arts are proven to help close the achievement gap 

and improve essential academic skills. You have stated previously that a ‘‘wellrounded curriculum that includes the arts and music contributes to higher academic 

achievement.’’ If arts have been proven to be essential to the learning process, why 

has the President proposed the elimination of arts education in the fiscal year 2007 

budget? 

Answer. Our request to zero-fund Arts in Education reflects the Administration’s 

policy of increasing resources for high-priority programs by eliminating categorical 

programs that have narrow or limited effect. These categorical programs siphon off 

Federal resources that could be used by State and local educational agencies to improve the academic performance of all students. 

Districts desiring to implement arts education activities may use funds provided 

under other Federal programs. The Elementary and Secondary Education Act also 

provides LEAs with flexibility to consolidate certain Federal funds to carry out activities, including arts education programs, that best meet the needs of their district. For example, under the State and Local Transferability Act, most LEAs may 

transfer up to 50 percent of their formula allocations under various State formula 

grant programs to their allocations under: (1) any of the other authorized programs; 

or (2) Part A of Title I. Activities to support arts education are an allowable use 

of funds under the State Grants for Innovative Programs authority. Therefore, an 

LEA that wants to implement an arts education program may transfer funds from 

its allocations received under the authorized programs to its State Grants for Innovative Programs allocation, without having to go through a separate grant application process. 

In addition, under the Improving Teacher Quality State Grants program, local 

educational agencies can use their funds to implement professional development activities that improve the knowledge of teachers and principals in core academic subjects, including the arts. The flexibility that is available under these Federal programs provides additional justification for the Administration’s policy of eliminating 

discrete categorical grant programs such as Arts in Education. 

Question. As a ‘‘core academic subject,’’ the arts should be included in all research 

and data collection. The No Child Left Behind Act and current Department of Education policy make it clear that decisions regarding education are made on the basis 

of research. The FRSS report, ‘‘Arts in Education in Public Elementary and Secondary Schools,’’ is the only research report produced by the Department on the status of how arts education is delivered in America’s public schools. The last report 

was for data collected in the 1999–2000 school year and the fiscal year 2006 statement of the managers urges IES to repeat this comprehensive data collection and 

report. When is the Department planning on another round of data collection for 

an updated report, which will help study and improve access to the arts as a core 

academic subject? 

Answer. We agree that having periodic information about arts education is important. The next National Assessment of Educational Progress (NAEP) arts assess-
45 

ment is scheduled for 2008. It will be an 8th-grade assessment that will include 

components for music, theater, and the visual arts, as was the case with the last 

arts assessment in 1997. Work on the 2008 assessment began last year with item 

development, and we will conduct a field test this year. 

The Department has not budgeted for an arts education survey in the National 

Center for Education Statistics (NCES) Fast Response Survey program for fiscal 

year 2007. The expense of replicating a survey involving multiple samples of teachers in the visual arts, music, and dramatic arts is too great, given competing demands for funds and the costs of the ongoing data collection programs of NCES. The 

National Endowment for the Arts requested the earlier 1999–2000 arts education 

survey and paid for it in part. 

READY TO TEACH PROGRAM AND MATH AND SCIENCE EDUCATION

Question. Madam Secretary, the fiscal year 2007 budget allocates $380 million for 

new or increased funding for math and science programs aimed at giving students 

the skills they need to become competitive workers in the global economy of the 21st 

century. Specifically, part of this funding is targeted to address the critical shortage 

of qualified teachers for math and science education, particularly in high-concentration areas for low-income students. 

The Ready To Teach program funds the development of digital educational content and online professional development in partnerships with the public television 

community. Congress has invested in this program over several years to ensure that 

it is easily accessible, flexible and tailored to local, State, and national standards. 

The most recent grant competition recognized the continued success of PBS 

TeacherLine service, and technology-based programs that offer a cost-effective complement to off-campus training. In a difficult budget environment, the Department 

should work to utilize the assets of programs such as Ready to Teach in its effort 

to strengthen math and science education, especially in the area of teacher training. 

How will the Department utilize this investment in advancing math and science 

education? 

Answer. The Department has no plans to utilize the Ready to Teach program to 

advance math and science education. There is limited information on the effectiveness of professional development activities supported through this small technology 

program. It’s also not at all clear that nonprofit telecommunications entities, like 

Ready to Teach program grantees, are very well equipped to address the critical 

training and professional development and training needs of current and future 

math and science teachers. 

In past years, Ready to Teach has played a very limited role in helping schools 

and districts address professional development needs, and next to no role in actually 

providing teacher training. In light of recent research findings on the critical influence of highly qualified teachers on student learning, and the seriousness of the ongoing teacher shortage crisis, the Administration believes that funds should not be 

provided for small categorical programs like this one that have limited impact and 

that siphon off Federal resources that could be used by States and districts to pursue more important goals. 

READY TO LEARN PROGRAM

Question. Madam Secretary, last year the Department restructured the Ready to 

Learn educational television program to focus solely on programming that teaches 

literacy, and eliminated much of the widespread community outreach portion of the 

program. We all agree that literacy proficiency is central to fulfilling the goals of 

No Child Left Behind, and we applaud the Administration’s including funds for 

Ready to Learn in the Administration’s budget request. However, the elimination 

of the outreach activities concerns many of us here in Congress. How does the Department plan to build upon the successes of the local outreach activities by public 

television stations across the country? 

Answer. Over the current 5-year budget period, the Department intends to dedicate approximately $20 million to support on-going Ready to Learn (RTL) community outreach activities. While it’s true that the Department restructured the Ready 

to Learn educational television competition, it’s not true that ‘‘much of the widespread community outreach portion of the program’’ was eliminated. In fiscal year 

2005, the Department made three new awards under the Ready to Learn program, 

including one 5-year outreach award to the Corporation for Public Broadcasting 

(CPB). Under this outreach award, CPB will continue to work strategically with 

public television stations across the country to support a variety of local outreach 

activities. 
46 

WORKSHOP APPROACH TO OUTREACH AND IMPACT ON STUDENT LEARNING OUTCOMES

Question. A recent evaluation of ‘‘the workshop approach’’ to outreach supported 

by previous RTL grantees (entitled ‘‘Using Television as a Teaching Tool: The Impacts of Ready to Learn Workshops on Parents, Educators, and the Children in 

Their Care’’) suggests that RTL has yet to achieve intended results in key areas of 

outreach implementation. Although a link between RTL workshops and adults’ selfreported behaviors at 3 and 6 months after the workshops was established, the effect sizes were small and the impacts on adult behaviors did not translate into impacts on children. This study concluded that the workshop approach to outreach had 

no measurable effects on student learning outcomes and only moderate impacts on 

parent/caregiver behaviors. As the study pointed out, enhancing children’s school 

readiness to the point of significant, measurable improvement usually requires large 

investments in child-focused interventions over extended periods of time. Thus, it’s 

not surprising that the workshops, which necessarily cannot be implemented at the 

level of intensity usually associated with most interventions that improve studentlearning outcomes, showed no measurable effects on student behaviors and learning 

outcomes. Based on the findings of this rigorous 5-year evaluation, we believe that 

RTL outreach activities can be targeted far more effectively, to the end of ensuring 

that all children read on grade level by the third grade. 

Because outreach is such a critical component of the RTL program, under the new 

outreach award CPB plans to use the latest evidence from social marketing research 

to target their efforts more effectively. CPB will continue to rely heavily on community partnerships, and will strategically partner with public broadcasting stations 

as local community hubs. However, unlike in past outreach work, CPB will partner 

with PBS to promote public awareness of RTL at the national and local levels 

through press and media outlets such as newspapers, television, and radio, emphasizing those most likely to reach the target audience of low-income parents and caregivers. 

More specifically, isn’t there a way to combine the educational television programming on PBS funded by Ready to Learn, with local workshops for parents and 

teachers and other outreach activities by local public stations, such as free book distribution. 

Answer. As indicated in our response to the previous question, a recent evaluation 

of ‘‘the workshop approach’’ to outreach supported by previous RTL grantees (entitled ‘‘Using Television as a Teaching Tool: The Impacts of Ready to Learn Workshops on Parents, Educators, and the Children in Their Care’’) suggests that RTL 

has yet to achieve intended results in key areas of outreach implementation. Based 

on this evaluation, we believe that RTL outreach activities can be targeted far more 

effectively, to the end of ensuring that all children read on grade level by the third 

grade. 

Under the new outreach award, CPB plans to change its outreach strategy by 

using the latest evidence from social marketing research to inform its work. CPB 

will continue to rely heavily on community partnerships, and will strategically partner with public broadcasting stations as local community hubs. However, unlike in 

past outreach work, CPB will partner with PBS to promote public awareness of RTL 

at the national and local levels through press and media outlets such as newspapers, television, and radio, emphasizing those most likely to reach the target audience of low-income parents and caregivers. 

READY TO LEARN CONTINUATION PROJECTS

Question. Additionally, given the President’s emerging initiative in math and 

science education, would you support a proposal to expand the focus of Ready to 

Learn to include, in addition to literacy, math and science education programming? 

Answer. All of the Ready To Learn funds requested for fiscal year 2007 are needed to cover the continuation costs of current grantees, which were awarded 5-year 

grants in 2005. Both programming awards must focus on utilizing the principles of 

scientifically based reading research to improve literacy outcomes for young children, consistent with the priority established for last year’s competition and the cooperative agreements. By 2010, however, when the awards under this program will 

be re-competed, it is possible that the research base on how children acquire math 

and science knowledge will be sufficiently well-developed to support the development of new children’s educational programming in these areas. 
47 

MATH AND SCIENCE EDUCATION—MATH NOW PROGRAM AND MATH AND SCIENCE

PARTNERSHIPS

Question. The fiscal year 2007 budget proposes to establish Math Now for Elementary and Secondary School programs, which are intended to improve math instruction for elementary and middle school students. What is the potential overlap between the proposed math programs and the existing Math and Science Partnerships 

program? 

Answer. The administration believes that Mathematics and Science Partnerships, 

a formula-grant program that promotes strong teaching skills for elementary and 

secondary school teachers, is important for ensuring that all States have high-quality mathematics and science professional development programs that focus on implementing scientifically based research and technology into the curriculum. 

The Math Now programs, which will implement proven practices in mathematics 

instruction, including those recommended by the National Mathematics Panel, will 

go one step further by helping to ensure that American students are prepared to 

take and pass algebra courses in middle school, which will encourage them to take 

and pass higher-level mathematics and science courses in high school. They will 

focus more precisely than does Mathematics and Science Partnerships on the need 

to ensure that elementary-school students receive what the best research indicates 

is the most effective math instruction and for middle-school students who are struggling in math to receive the interventions they need. 

MATHEMATICS AND SCIENCE PARTNERSHIPS AND MATH NOW PROGRAM ACTIVITIES

Question. The States have some flexibility on how they target those funds through 

their sub-granting process. Is there any information about the extent to which 

States have targeted funding to the same issues proposed to be addressed by these 

new programs? 

Answer. The Department began collecting data from States and partnerships this 

year that will describe how Mathematics and Science Partnerships (MSP) subgrantees are implementing the program. These data will include information about 

the kinds of activities MSP subgrantees are conducting with program funds, and the 

information should be available this summer. 

Although we do not have a better sense of the activities MSP grantees are conducting, it is possible that there may be some overlap between the MSP and Math 

Now programs. However, we expect that it will be minimal. For example, the MSP 

program focuses on providing professional development for mathematics and science 

teachers, while the Math Now programs would have several allowable uses of funds, 

including professional development, but focusing more on improving elementaryschool math instruction and helping middle-school students who are significantly 

below grade level in math. The Math Now grantees would also implement instructional principles and promising practices developed by the National Mathematics 

Panel, which is not a requirement of MSP subgrantees. 

NATIONAL MATHEMATICS PANEL

Question. The fiscal year 2007 President’s budget proposes to establish a National 

Mathematics Panel to identify approaches and interventions that meet either the 

scientifically based research standard, as defined in the No Child Left Behind Act, 

or ‘‘promising practices.’’ How will the selections for the National Mathematics 

Panel be made, so that individuals with diverse backgrounds are represented on the 

panel? 

Answer. In order to ensure a diverse pool of expertise, the Secretary will appoint 

no more than 20 members from the public and private sectors, as well as no more 

than 10 members from the Department of Education and other Federal agencies to 

the National Mathematics Panel. Panel members may include researchers who 

study mathematics, professors of mathematics and mathematics education, professors of psychology and/or cognitive development, practicing teachers, principals, 

State or local education officials, parents, business leaders, foundation representatives, members of education associations, and other individuals selected on the basis 

of their expertise and experiences as appropriate. 

Question. How will ‘‘promising practices’’ be defined for purposes of identifying approaches and interventions? 

Answer. Once it has been convened, members of the National Mathematics Panel 

will meet and determine the appropriate definitions and methodology for their review and synthesis of the evidence base on mathematics education. One of their 

charges will be to recommend, based on the best available scientific evidence, instructional practices, programs, and materials that are effective for improving math-
48 

ematics learning. Since the scientific evidence base in mathematics education is inadequate in many areas, we anticipate that the Panel will also provide guidance 

that will help States and districts determine which approaches and interventions 

have some evidence-even through it does not yet meet the standards for scientifically based research-that indicate that the interventions will improve student outcomes. 

MATHEMATICS AND SCIENCE EDUCATION

Question. The President’s Academic Competitiveness Initiative (ACI) clearly emphasizes the need for improved science, technology, engineering and mathematics 

(STEM) education. The Department of Education’s 2007 budget request makes substantial improved mathematics education via the Math Now program, but does not 

make a comparable investment in science education. What is the Department’s plan 

for investing in science education? 

Answer. Both mathematics and science are important subjects for our students to 

learn well if we are to remain competitive in the global economy. Because we need 

to set priorities within our budget, we are focusing on mathematics first through 

the Math Now programs. Mathematics is a ‘‘gateway’’ course for upper-level mathematics and science learning, so we believe that it is crucial for students to first have 

a firm foundation in mathematics. In addition, because Title I mathematics assessments are already in place (while the science assessments will not come on line 

until 2007–2008), we have an immediate source of information for measuring the 

effectiveness of new strategies in teaching mathematics, but not in science. 

Science Education Support 

Finally, the budget request includes either increases or level funding for a number 

of programs that focus on science, including Mathematics and Science Partnerships 

and Graduate Assistance in Areas of National Need. The new Advanced Placement 

and Adjunct Teacher Corps proposals would target science, in addition to mathematics and critical foreign languages. Other Department programs that allow grantees to focus on science include Transition to Teaching, Troop-to-Teachers, and Improving Teacher Quality State Grants. 

INVESTMENTS IN ADVANCED PLACEMENT

Question. The fiscal year 2007 budget proposes to expand the reach of the Advanced Placement program by requiring grantees to offer incentives for teachers to 

become qualified to teach Advanced Placement and International Baccalaureate Organization classes in mathematics, science, and foreign languages and to teachers 

whose students pass tests in those subjects. The budget also proposes to require 

grantees to secure public and private matching funds to leverage the Federal investment. How much money does the Department expect the private sector to contribute 

toward the matching requirement for the Advanced Placement (AP) program? 

Answer. The Department expects the private sector to invest roughly $114 million 

in the AP program, which matches the Department’s funding request for AP Incentive Grants. Based on conversations with potential donors, who are very excited 

about this initiative, we believe this assumption is realistic. 

Question. What is the basis for that projection? 

Answer. Conversations between Department officials and representatives of private companies indicate that very substantial non-governmental support will be 

forthcoming. Senior officials are encouraging supporters of the proposal to publicize 

their commitment, and we hope to provide more information in the coming weeks. 

Question. Please provide the same information for State contributions. 

Answer. The Department is aware that many States are already committed to investing in the AP program, and believe that States will contribute their support and 

resources to increasing low-income students’ access to challenging coursework. Our 

expectation is that State and local funds will amount to approximately $114 million, 

resulting in roughly a one-third/one-third/one-third split in Federal, State and local, 

and private-sector contributions. 

Question. Also, does the Department plan to institute a maintenance-of-effort requirement for States; why or why not? 

Answer. No, because the statute already includes a ‘‘supplement, not supplant’’ 

provision, which will prevent the Federal funds from merely supplanting existing 

State and local efforts. 
49 

ADVANCED PLACEMENT INCENTIVE PROGRAM

Question. How will the Department ensure that the proposed incentive for teachers whose students pass AP/IB tests will not lead to the unintended consequence 

of discouraging students from taking these tests? 

Answer. Providing a bonus to teachers for each student who passes an AP test 

should be an incentive for teachers to get more students to take and pass AP exams. 

According to ‘‘Do What Works: How Proven Practices Can Improve America’s High 

Schools,’’ written by Tom Luce, now our Assistant Secretary for Planning, Evaluation, and Policy Development, and Lee Thompson, the AP incentive program increased the number of students taking AP courses and passing AP exams in Texas. 

The Department’s proposal would extend the opportunities granted to students in 

Texas to young people across America. 

FEDERAL STUDENT AID

Question. Budget documents supporting the recall of the Federal portion of repayments made under the Federal Perkins Loans program indicate that, ‘‘the Administration believes the Federal share of funds held by this small group of institutions 

might more effectively help students if used in a way that serves all eligible students regardless of institution.’’ In addition to the $664 million proposed recall of 

Perkins proceeds, the proposed budget includes a reduction of $436 million in funding from the Student Financial Assistance account. How does the proposed budget 

more effectively serve all eligible students by recalling $664 million from the Perkins loans program and reducing the Student Financial Assistance account by $436 

million? 

Answer. It is important to look at the Federal investment in student aid from a 

broad perspective. Overall, the President’s Budget would build on student benefits 

included in the Higher Education Reconciliation Act (HERA) to provide a record $82 

billion in new student grant and loan assistance in fiscal year 2007. The HERA created Academic Competitiveness Grants, a new need-based program supported with 

mandatory funding that will award annual grants of up to $1,300 to high-achieving 

first- and second-year students who have completed a rigorous high school curriculum or up to $4,000 for third- and fourth-year students majoring in mathematics, science, technology, engineering, or critical foreign languages. In 2007, the 

program would provide $850 million in grants to 600,000 low-income postsecondary 

students. Over 2006–2010, grant awards would total more than $4.5 billion. 

In addition, the HERA makes student loans more affordable by phasing out student origination fees and fixing student interest rates at 6.8 percent, reducing the 

maximum rate from the previous 8.25 percent. (If calculated today, the current variable rate formula—which will continue to apply for loans originated prior to July 

1, 2006—would be 7.11 percent; if recent trends continue through June, the actual 

rate may be even higher.) The HERA also expands loan limits for first- and secondyear students and graduate students and permanently expands loan forgiveness 

from $5,000 to $17,500 for math, science and special education teacher serving lowincome communities. 

Within the Student Financial Assistance account itself, most of the $436 million 

reduction you mention reflects the effect of the new scoring rule for the Pell Grant 

program, which reduces the need for current year budget authority by allowing the 

use of excess funds from the previous fiscal year. The balance of the reduction reflects revised, lower estimates of fiscal year 2007 Pell Grant program costs and the 

elimination of two redundant, ineffective, or unnecessary programs: Federal Perkins 

Loans and Leveraging Education Assistance Partnerships. 

COMMISSION ON THE FUTURE OF HIGHER EDUCATION

Question. Specifically, how will low- and middle-income students achieve the same 

access to postsecondary education as high-income students have, which is an objective of the Department of Education? 

Answer. In today’s highly competitive global economy it is vital that no American 

student be denied access to effective postsecondary education due to high costs. Accordingly, in September 2005 the Secretary’s Commission on the Future of Higher 

Education was created to examine how we as a Nation can keep higher education 

affordable and accessible. The Commission, made up of experienced leaders from 

education, business, and government, is holding a series of meetings around the 

country and gathering data from respected experts on higher education. A final report with the commission’s findings is expected by August. 
50 

FUNDING FOR HIGHER EDUCATION

Question. In ‘‘Cracks in the Education Pipeline: A Business Leader’s Guide to 

Higher Education Reform,’’ it is stated that low-income families, those with incomes 

in the bottom 40 percent of the earnings distribution, spend one-third of their income to send a child to community college and 43 percent to enroll in a public 4- 

year school. Further, the document states that, ‘‘Student aid has the greatest impact 

when targeted on low-income students who otherwise would not enroll in college.’’ 

What is proposed in this budget to help such families finance their goals for postsecondary education? 

Answer. The President’s 2007 Budget for student aid builds on a number of significant accomplishments in 2006 to provide a record $82 billion in assistance to 

more than 10 million students and parents. Adopting a proposal from the 2006 

President’s Budget, Congress appropriated $4.3 billion in mandatory funding in 

2006 to eliminate a long-standing funding shortfall in the Pell Grant program, putting this vital program—the foundation of Federal need-based aid—on a firm financial footing after years of growing fiscal instability. Congress also adopted new budget rules proposed by the President to prevent shortfalls from occurring in the future. 

In addition, the Higher Education Reconciliation Act, signed by the President in 

February, would further help the neediest students by phasing out origination fees 

for Stafford Loans and providing over $4.5 billion over 5 years in new need-based 

Academic Competitiveness and SMART Grants. 

ADVANCING AMERICA THROUGH FOREIGN LANGUAGE PARTNERSHIPS

Question. The fiscal year 2007 budget proposes a new program, through appropriations language, to establish partnerships between institutions of higher education and school districts that support programs of study in grades K–16 in critical 

need languages. Specifically, how will this proposed program complement existing 

Department programs, such as those authorized and funded under title VI of the 

Higher Education Act and the Fulbright-Hays Act? 

Answer. The Advancing America Through Foreign Language Partnerships program is intended to complement, not duplicate, existing Department programs that 

provide support for foreign language and areas studies education. Distinctive elements of the Advancing America Through Foreign Language Partnerships program, 

compared to the Title VI of the Higher Education Act and those authorized by the 

Mutual Educational and Cultural Exchange Act (Fulbright-Hays), include partnerships between institutions of higher education and school districts; the degree of 

focus on ‘‘critical need languages’’ such as Arabic, Chinese, Russian, Hindi, Farsi, 

and others; and unique language programs of study that enable successful students 

to advance from early learning in elementary school through advanced proficiency 

levels in high school to superior levels in college. The Title VI and Fulbright-Hays 

programs support 14 distinct yet interrelated programs designed to strengthen the 

capability and performance of American education in foreign languages and in area 

and international studies in a number of world regions. These programs do not establish articulated programs of study in grades K–16 in critical need foreign languages. 

In addition, the objectives of this proposed program that relate to establishing 

fully articulated K–16 programs that produce college students who achieve a superior level of proficiency cannot be accomplished through grants to local and State 

educational agencies under the Department’s Foreign Language Assistance program 

(FLAP). FLAP is focused on improving the quality of foreign language instruction 

in elementary and secondary schools. Institutions of higher education are not eligible to apply for funding under the FLAP program. Moreover, FLAP is not an appropriate vehicle for establishing the kind of partnerships needed between school districts and institutions of higher education to ensure an articulated curriculum and 

consistent goals and continual progress toward the required outcomes at all educational levels, including the postsecondary level. 

The Advancing America Through Foreign Language Partnerships program fits 

within the Department’s mission and complements Title VI and other Department 

activities relating to the teaching and learning of foreign languages. 

ADVANCING AMERICA THROUGH FOREIGN LANGUAGE PARTNERSHIPS AND DOD NATIONAL

FLAGSHIP LANGUAGE INITIATIVE

Question. How will this new program complement related programs administered 

by other Federal agencies? 

Answer. The Advancing America Through Foreign Language Partnerships program would operate following the model created under the National Flagship Lan-
51 

guage Initiative at the Department of Defense. The Administration seeks to expand 

on DOD’s pilot K–16 Mandarin Chinese program by awarding an additional 24 

grants to institutions of higher education for partnerships with school districts for 

programs of language study in a variety of languages critical to national security 

such as Arabic, Chinese, Russian, Hindi, Farsi, and others. The Administration is 

proposing that ED (and not DOD) undertake the expansion of this program because 

the goals of the program fit within the Department’s mission and the program complements other ED activities relating to the teaching and learning of foreign languages. 

REQUIREMENTS OF ADVANCING AMERICA THROUGH FOREIGN LANGUAGE PARTNERSHIPS

GRANTEES

Question. Supporting budget documents note that applicants would have to demonstrate the long-term success of their project, as well as commit to a significant 

amount of cost sharing. Would you please provide more information about each of 

these proposed requirements? 

Answer. To address the need for skilled professionals with superior competency 

in foreign languages critical to U.S. national security, such as Arabic, Chinese, Russian, Hindi, Farsi, and others, participants in the Advancing America Through Foreign Language Partnerships program would be expected to make significant commitments. We would expect that institutions of higher education applying for grants 

would be able to identify each local educational agency partner and describe each 

partner’s responsibilities (including how they would be involved in planning and implementing program curriculum, what resources they would provide, and how they 

would ensure continuity of student progress from elementary school to the postsecondary level). Participating institutions of higher education would be expected to 

work with partner school districts to develop and implement an articulated curriculum with consistent pedagogical philosophy and goals throughout all educational 

levels of the program. To ensure long-term success of the project, we would expect 

applicants to be able to describe in their applications how they would support and 

continue the program after the grant has expired, including how they would seek 

support from other sources, such as State and local government, foundations, and 

the private sector. We would also expect grantees to provide a non-Federal contribution, in cash or in kind, that would help carry out the activities supported by the 

grant. 

STATEWIDE DATA SYSTEMS PROGRAM

Question. The fiscal year 2007 budget requests $54.6 million for the Statewide 

Data Systems program, an increase of $30 million over the fiscal year 2006 amount. 

Budget documents supporting this request indicate that 14 States are receiving 

funds from this program, although all States need assistance to develop or refine 

and fully implement systems that allow them to track the progress of individual students statewide. Budget documents also state that the requested increase for fiscal 

year 2007 would focus on the issue accelerating the capacity of high schools to report and use accurate high school graduation and dropout data. How are States utilizing funds from fiscal year 2005 and fiscal year 2006? 

Answer. The Statewide Longitudinal Data Systems (SLDS) grant program is supporting State educational agencies in designing, developing, implementing, and 

using longitudinal individual student data and linking the student data to other 

contextual and management data, such as program, staffing, facilities, financial, 

early childhood, or post-secondary data. The resulting data systems will allow States 

to evaluate learning of all students and track the effectiveness of schools, programs, 

or interventions. Under the grant program, States are required to provide data and 

meaningful analyses back to local stakeholders, including teachers, principals, and 

districts. States are also required to develop ongoing evaluation procedures to ensure that the data collected are: (1) of high quality, (2) responsive to local information needs, and (3) useful for improving instruction and student learning. 

States receiving SLDS grant money are required to incorporate data from kindergarten to 12th grade in their data systems. Most have also proposed to incorporate 

preschool and even birth-to-preschool data. Similarly, most grantees propose to incorporate postsecondary data in their systems, spanning prekindergarten–16 and 

even prekindergarten–20. Some States will also link their data to those from noneducation agencies, such health or labor. These longitudinal student data, especially 

with links to rich contextual data, will for the first time allow States and districts 

to reliably link student outcomes to different variables, including curricula, educational environment, funding, socioeconomic background, and other factors that affect student learning. 
52 

STATEWIDE LONGITUDINAL DATA SYSTEMS

Question. How does this proposed priority fit with the basic needs of States for 

developing longitudinal data systems? 

Answer. Statewide longitudinal data systems (SLDS) grants enable States to have 

more informative and reliable data on what is happening and what works in high 

schools, including the ability to evaluate and track how students’ pre-high school experience affects how well they do in high school. These funds also enable States to 

understand how what happens in high school affects students’ success in postsecondary education and/or employment. Grant funds support data system development and enhancements that enable States to conduct a wide range of rigorous longitudinal analyses, including computations of a standard four-year adjusted cohort 

graduation rate, as adopted by the National Governors Association (NGA). Most of 

the first cohort of grantee States have not collected and compiled these data before. 

Some States in the first cohort of grants can currently compute the NGA graduation 

rate, but these States still depend upon their grant funding to ensure the quality 

of their data collection. 

The requested increase in funding for this program will enable more States that 

do not currently have this capacity to collect data necessary for the computation of 

accurate high school graduation and dropout rates necessary data on high school. 

For States that already collect these data, the requested funding will enable them 

to connect all relevant data in one longitudinal data system with better and more 

efficient verification of data over time and across different educational and other 

data systems. In these States, the SLDS grant will result in better data faster. 

NATIONAL ASSESSMENT OF EDUCATIONAL PROGRESS

Question. The budget requests an additional $4 million to allow the Department 

to begin work on essential activities for implementing in 2009 State-level assessments at the 12th grade level. What activities will be funded by this requested increase? 

Answer. The funds requested for fiscal year 2007 would be used to conduct validation studies to ensure that the assessment has predictive validity and is an appropriate measure of readiness for work, postsecondary education, or military service. 

The funds would also be used for the development and pilot testing of new mathematics and reading frameworks. 

12TH GRADE NAEP INITIATIVE—READING AND MATH ASSESSMENTS

Question. What is the total cost of the 12th grade NAEP initiative, and what is 

the range of options being considered for implementing this new policy? 

Answer. Assuming that State participation is mandatory, the estimated total cost 

of the 12th grade State-level assessments in Reading and Math for 2009 would be 

$45 million above the current NAEP appropriation. 

The following chart presents estimated costs for an assessment in the 50 States, 

the District of Columbia, and Puerto Rico; as well as for a non-mandated assessment, with 45 States volunteering to participate; and for a pilot State assessment, 

with 10 States selected to participate. Once the development and phase-in of the 

12th grade State-level assessments are complete, we estimate that the annual cost, 

beginning in 2010, of conducting State-level assessments in Reading and Mathematics would be $22.5 million for the mandatory scenario and $20.5 million for the 

voluntary scenario. 

[Estimated cost, in millions of dollars] 

Year 

12th Grade State-Level Reading and Math Assessments 

Mandatory 

(52 jurisdictions) 

Voluntary 

(45 jurisdictions) 

Pilot (10 jurisdictions) 

2007 ........................................................... 4.0 4.0 4.0 

2008 ........................................................... 18.5 18.5 4.0 

2009 ........................................................... 22.5 18.5 3.6 

Total .............................................. 45.0 41.0 11.6 

OFFICE OF COMMUNICATIONS AND OUTREACH

Question. Budget documents supporting your fiscal year 2007 budget request indicate that staffing for communications and outreach will change from 14 FTE in 2005 

to 140 in fiscal year 2006. Will you explain the need for 140 FTE’s in this office, 
53 

instead of utilizing these staff in grants monitoring and other program administration capacities? 

Answer. Staffing for communications and outreach did not increase from 14 to 

140. The reason there appears to be an increase is that we took staff from other 

areas and consolidated them under a new centralized communications office. In an 

effort to better coordinate the communication functions of the Department to ensure 

clear, consistent communications, a new Office of Communications and Outreach 

(OCO) was created. It now includes the former Office of Public Affairs (OPA), most 

of the functions of the former Office of Intergovernmental and Interagency Affairs 

(OIIA) and the function of internal communications. The new Office of Communications and Outreach encompasses speechwriting, public affairs, web site, publications, event services, external affairs and the Secretary’s 10 regional offices. The Office of Communications and Outreach is responsible for creating and distributing appropriate education materials to inform the work and decision-making of educators, 

policymakers, government officials, parents and students. 

DEPARTMENT EXPENDITURES FOR PUBLIC RELATIONS AND OUTREACH

Question. How much did your Department spend on public relations and outreach 

in fiscal year 2005? 

Answer. In fiscal year 2005, the Department spent $1,132,246 on public relations 

and outreach, in procurement of items and services such as speeches and editing 

for senior staff, logistical outreach event support, webcasting, and the monthly 

‘‘Education News Parents Can Use’’ satellite broadcasts. 

Question. How much do you plan to spend in fiscal year 2006 and fiscal year 2007, 

and what are the primary outcomes intended to be achieved by these expenditures? 

Answer. The Department plans on spending $1,025,000 in fiscal year 2006 and 

$1,100,000 in fiscal year 2007 on public relations and outreach events which are designed to inform members of the public about No Child Left Behind and other Department programs, the monthly ‘‘Education News Parents Can Use’’ satellite 

broadcast, and technical support for webcasting. 

Each ‘‘Education News Parents Can Us’’ broadcast explains U.S. Department of 

Education programs to parents using practical, plain-language discussions of topics 

such as ensuring safe and drug free schools, teaching reading, serving students with 

disabilities, and using new education technology. Each broadcast offers this information in a format that features short segments, including one-on-one interviews, 

‘‘how-to’’ demonstrations, and brief conversations with parents, educators, education 

experts, and community, business and religious leaders. 

Technical and production support is needed for the creation of high quality, live, 

or previously videotaped multi-media programs that can be broadcast over the Internet. These productions are for the purpose of raising the general public’s awareness 

of and encouraging participation in programs associated with ED’s education reform 

initiatives. 

QUESTIONS SUBMITTED BY SENATOR DANIEL K. INOUYE

NATIVE HAWAIIAN EDUCATION

Question. First and foremost, I’d like to express my sincere appreciation for the 

continued funding of Native Hawaiian Education. This funding facilitated uninterrupted curricula development, teacher training and recruitment programs as well as 

scholarship offerings. Programs such as these allowed many young Hawaiians’ the 

opportunity to fully realize their dreams. Through continued support of Native Hawaiian Vocational Education, countless individuals can now successfully enter, compete and advance in the ever-changing and competitive technological workplace. 

I would also like to extend my personal thanks to your Department administrators who have traveled to Hawaii to meet our local program coordinators and provide technical assistance to our remote communities. No doubt, your staff has seen 

first hand the tremendous impact and success these funded programs have had on 

the people of Hawaii. 

Madam Secretary, what are the indicators or measures your Department uses to 

manage existing competitive grantees under the Native Hawaiian Education Act? 

Answer. The Department has established three performance measures for the Native Hawaiian Education program authorized under Title VII of the ESEA. The 

measures are: 

—The percentage of teachers involved with professional development activities 

that address the unique educational needs of program participants. 
54 

—The percentage of Native Hawaiian children participating in early education 

programs who improve on measures of school readiness and literacy. 

—The percentage of students participating in the program who meet or exceed 

proficiency standards in mathematics, science, or reading. 

The Department collects data on these measures through the annual performance 

reports submitted by grantees. 

Question. Please also describe the process by which these indicators were selected. 

Answer. The development of the performance indicators for the Native Hawaiian 

Education program was based on an analysis of the program’s purpose, priorities 

and authorized activities, and how those align with the overall priorities and purpose of the No Child Left Behind Act. As the program authorizes a wide number 

of project activities, we also had to narrow somewhat the areas for performance 

measurement for the program, in order to minimize the burden of data collection 

and reporting. Since we were unable to arrive at one performance indicator that 

would be appropriate for all projects possible or allowed under the program, we conducted an analysis of grantee activities and goals. The analysis showed that most 

grantees are implementing projects around a small number of areas (early childhood, teacher professional development, and math and science education) and, thus, 

we developed indicators to track program performance in those areas. 

WOMEN IN TECHNOLOGY

Question. The Women in Technology (WIT) program originated in Maui 5 years 

ago as a workforce development project initially funded through a grant from the 

U.S. Department of Labor. A core mission component of the program was to partner 

with educators and industry to create a pipeline from education to employment in 

science, technology, engineering and math. This concept was first introduced in our 

local middle and high schools, to increase the confidence and interest of under represented populations in math and science studies and expose them to educational 

and professional opportunities in high-tech professions. This was accomplished at no 

cost to the students. 

Elementary school is a critical time to begin outreach efforts to attract students 

into the science, technology, engineering and math pipeline. National research indicates that gender identities and stereotyping about career roles are set by age 

seven. One of the goals of Women in Technology includes training elementary school 

teachers in ‘‘inquiry-based learning’’ methods. In this method, teachers learn how 

to harness the natural inquisitive nature of their students and nurture it into scientific questions/hypothesis and self-directed activities to prove/disprove the students’ questions. The inquiry-based activities are integrated into the teaching curriculum and align with grade level and standards. This method of teaching is well 

suited to children of both genders and stimulates all styles of learning. A pilot program, recently launched in Maui, included a professional development workshop for 

one dozen elementary teachers. 

Madam Secretary, Women In Technology is a critically important program to securing a more prosperous future for many young Hawaiians. So strong is my belief 

in the value of this program, that in years past, I sought funding for it via my earmarks. As such are no longer available, will the Department of Education provide 

funds for the expansion of science, technology, engineering and math ‘‘inquiry-based 

learning’’ curriculum and training to all elementary school teachers throughout the 

State of Hawaii? 

Answer. The agency operating the Women in Technology (WIT) program may pursue discretionary funding opportunities under a number of Department of Education 

programs that support activities such as the ones you describe. WIT may apply, for 

example, for funding under the Native Hawaiian Education program, which supports innovative projects to provide supplemental services that address the educational needs of Native Hawaiian children and adults. Authorized activities under 

that program include development and implementation of professional development 

programs to prepare teachers to address the unique needs of Native Hawaiian students. 

WIT may also be eligible for funding under the Mathematics and Science Partnerships program. Funds for the program are distributed to States based on a formula, 

and each State then administers a grant competition for the funds. The program 

supports State and local efforts to improve students’ academic achievement in mathematics and science by promoting strong teaching skills for elementary and secondary school teachers, including integrating teaching methods based on scientifically based research and technology into the curriculum. Grantees may also use 

program funds to develop more rigorous mathematics and science curricula that are 

aligned with challenging State and local content standards; establish distance learn-
55 

ing programs for mathematics and science teachers; and recruit individuals with 

mathematics, science, and engineering majors into the teaching profession through 

the use of signing and performance incentives, stipends, and scholarships. Professional development can include summer workshops, or institutes and programs, that 

bring mathematics and science teachers into contact with working scientists, mathematicians, and engineers in order to expand teachers’ subject-matter knowledge. 

WIT administrators should contact the Hawaii Department of Education for information on applying for this program. 

QUESTIONS SUBMITTED BY SENATOR HERB KOHL

SPECIAL EDUCATION FULL FUNDING

Question. Many of us here have worked hard every year to increase funding for 

Special Education. Year after year, school districts in Wisconsin tell me that this 

is one of their top concerns. But this year’s budget is especially worrisome. It proposes to cut the Federal share of IDEA costs from 18 percent to 17 percent—that 

is less than half of the 40 percent ‘‘full funding’’ level that Congress committed to 

paying when IDEA was first adopted 31 years ago. This deliberate step backward 

begs the question: does this Administration plan to ever fully fund IDEA? 

Answer. Under the President’s leadership, funding for the Grants to States program has increased by 67 percent since 2001. The President’s 2007 request for the 

Special Education—Grants to States program of $10.7 billion, which includes an increase of $100 million, would provide about 17 percent of the national average per 

pupil expenditure (APPE) for 6.9 million children with disabilities receiving special 

education, compared to about 14 percent of the APPE in 2001. No Administration 

has come close to requesting 40 percent of APPE, but this Administration has proposed record-high increases in funding for the program and has achieved recordhigh levels of the Federal contribution. 

EARLY CHILDHOOD EDUCATION FUNDING

Question. While I support the President’s proposals to increase resources to support math and science education at the high school level, I am concerned about the 

decrease in funding for programs that support early childhood education. Research 

shows that 80 percent of brain development takes place during the first 3 years of 

a child’s life. In light of this research, please explain the Administration’s rationale 

for funneling resources away from programs that support our youngest learners— 

like the Foundations for Learning and Even Start programs—and putting those 

funds into our high school age programs. 

Answer. The Department remains dedicated to the goal of promoting cognitive development for all children, and the President’s budget request reflects a strong commitment to programs that have a proven record of success in serving our Nation’s 

youngest citizens. Neither Even Start nor Foundations for Learning has a track 

record of demonstrated effectiveness. While some local Even Start programs are successful at supporting the development of children’s early academic skills, the program’s overall reliance on the family literacy model has not been shown to be effective. In addition, the Foundations for Learning program is duplicative of other programs that serve very young children and its size precludes any large impact on 

the populations to which it is targeted. Other programs, such as Early Reading First 

and the Early Childhood Educator Professional Development program, focus on 

proven methods of addressing the cognitive development and school readiness needs 

of young children 

PERKINS LOANS AND OTHER STUDENT AID PROGRAMS

Question. Not only does this budget cut Pell Grants, but it also calls for the elimination of the Federal Perkins loan program. This academic year, the University of 

Madison-Wisconsin served 5,202 students with $13.2 million in Federal Perkins 

Loans. These loans helped students cover the gap between other financial aid and 

the actual cost of attendance. They are also a good option for low-income students 

because they are not dependent on credit history. Secretary Spellings, if Congress 

were to agree to the President’s recommendation and eliminate Perkins loans, what 

do you suggest these students do to pay for higher education? 

Answer. First, to clarify, the President’s Budget does not cut Pell Grants; current 

estimates indicate every eligible student would receive his or her full award under 

our proposal. The reduction in budget authority compared with fiscal year 2006 reflects the new scoring rule under which an estimated $273 million in unused funds 
56 

from fiscal year 2006 can be used to reduce the need for new appropriations, as well 

as a slight reduction in the estimated cost of the Pell Grant program. 

More broadly, even with the Perkins Loan proposal, student aid would increase under the President’s Budget by more than $4.6 billion in fiscal year 2007 over the 

previous year, including $790 million in new need-based Academic Competitiveness 

and SMART Grants. In addition, student loans under the Federal Family Education 

Loan and Direct Loan programs will be a better bargain for borrowers due to lower 

interest rates and reduced origination fees. 

ELEMENTARY AND SECONDARY SCHOOL COUNSELING PROGRAM

Question. School counselors play a vital role in the lives of American youths by 

providing guidance on issues both academic and personal. During times of war and 

the ongoing fear of terrorism, the need for effective school counseling is clearer than 

ever. In addition, counselors continue to guide students in career, academic and social development. That’s why I am very concerned that the President’s budget again 

eliminates funding for the School Counseling Program. In Wisconsin, each public 

school counselor oversees 461 students—a caseload that already leaves many students underserved. 

School counselors play an important role in helping students meet the goals of No 

Child Left Behind. Why would the Administration cut a program that is helping to 

make its signature education policy work? 

Answer. The budget request to eliminate funding for the Elementary and Secondary School Counseling program is part of an overall budget strategy to discontinue programs that duplicate other programs that may be carried out with flexible State formula grant funds, or that involve activities that are better or more appropriately supported through State, local, or private resources. Specifically, the 

2007 budget proposes termination of 42 programs in order to free up almost $3.5 

billion (based on 2006 levels) for reallocation to higher-priority activities within the 

Department. These higher-priority activities include the Administration’s $1.5 billion High School Reform Initiative. Under this Initiative, local educational agencies 

will be able to include student counseling services as part of the comprehensive 

strategies they adopt to raise high school achievement and eliminate gaps in 

achievement among subgroups of students. 

In addition, if school districts choose to do so, they may support counseling programs with the funds they receive under the State Grants for Innovative Programs 

authority, which allows them to implement programs that best meet their needs. 

Furthermore, the Elementary and Secondary Education Act (ESEA) provides school 

districts with additional flexibility to meet their own priorities by consolidating a 

sizable portion of their Federal funds from their allocations under certain State formula grant programs and using those funds under any other of these authorized 

programs. A school district that seeks to implement a school counseling program in 

some or all of its schools may use funds from those programs to do so. 

QUESTIONS SUBMITTED BY SENATOR PATTY MURRAY

ACADEMIC COMPETITIVENESS/SMART GRANTS

Question. The fiscal year 2006 Budget Reconciliation bill created Academic Competitiveness grants and the National Science and Mathematics Access to Retain Talent (SMART) grants. To receive the Academic Competitiveness grants, students 

must have completed a rigorous secondary-school program of study. While I agree 

that we need to be doing all we can prepare students for a job in a global economy, 

a student’s luck in where they attend high school shouldn’t determine whether or 

not the Federal Government helps them attend college. The Congressional Budget 

Office has estimated that only 9.9 percent of Pell eligible students will be able to 

take advantage of the Academic Competitiveness and SMART grants in 2007. 

The maximum Pell grant has not increased for years despite tuition rising at our 

Nation’s public colleges rising by over 7 percent last year. If the $850 million that 

these grants cost in fiscal year 2007 were spent on Pell grants, students would receive an additional $200 in aid. 

How do you anticipate judging what constitutes a rigorous secondary-school curriculum? 

Answer. The Department of Education is working with all States to help them 

identify high school programs of study they can submit to the Secretary of Education for recognition as rigorous secondary programs of study. In addition, there 

will be alternative eligibility provisions for students from States that have not yet 

submitted designated programs to the Secretary. These State-identified, eligible rig-
57 

orous secondary school programs or acceptable alternatives will soon be posted on 

a Department web site. 

Question. Particularly in such tight budget times, shouldn’t we be spending our 

resources on helping all students attend college regardless of their circumstance, not 

benefiting the few who are lucky enough to attend the ‘‘right’’ high school? 

Answer. Taken together, the Federal student aid programs under the President’s fiscal year 2007 budget request would provide over $82 billion to students and families, much of it focused on the neediest Americans. Within this larger investment, 

we believe it is appropriate to target a portion of need-based aid—Academic Competitiveness/SMART Grant recipients must be eligible for a Pell Grant—to encourage the type of rigorous high school study and challenging college coursework that 

is linked to success both for individuals and, ultimately, for our Nation. 

TITLE IX REPORT

Question. On March 17, 2005, the Department of Education released new guidance on the interest prong of the three-part test which schools use to show compliance with Title IX in athletics. As you are aware, I have grave concerns about the 

new guidance because I believe it sets a new low bar for compliance with a Federal 

civil rights law. Schools would now be allowed to use an email survey to show compliance with Title IX. Further, the school would only have to send that survey to 

women and a lack of response could be determined as lack of interest in sports. Surveys have been used in the past to show compliance with Title IX, but not as a sole 

means and other factors such as emerging sports had to be taken into consideration. 

Because of concern over this new guidance, a bipartisan group of Senators on this 

subcommittee asked for a report on the guidance and use of surveys due March 17. 

What is the status of the requested report? 

Answer. The report in response to guidance and the use of surveys for Title IX 

was submitted to the Committee on March 17, 2006. 

TITLE IX TECHNICAL ASSISTANCE

Question. Clearly, there is a lot of confusion on behalf of schools about this new 

guidance. What is the Department doing regarding technical assistance on the guidance? 

Answer. The Office for Civil Rights (OCR) regularly provides technical assistance 

on a variety of issues to interested parties, including elementary and secondary 

schools and colleges and universities. Assistance is an important method to help 

educational institutions achieve voluntary compliance with the civil rights laws and 

assist in preventing civil rights violations by educating schools about their responsibilities. OCR provides guidance through a variety of methods, including responses 

to thousands of requests for individualized technical assistance, via phone, email, 

or mail, each year from individuals, recipients, and groups representing recipients 

and beneficiaries. Our technical assistance also includes on-site consultations, conferences, training, community outreach, publishing and disseminating materials, 

through the Department’s website and direct mailings, and issuing guidance. 

With respect to Title IX of the Education Amendments of 1972 (Title IX), the Department issued the Additional Clarification of Intercollegiate Athletics Policy (Additional Clarification) to clarify one method schools may choose to use to assess athletic interests and to provide a practical tool they may choose to use to conduct that 

assessment. 

To further assist schools, OCR has been and continues to actively seek out opportunities to provide technical assistance on a continuous basis. In the year since the 

Additional Clarification was issued, OCR has provided technical assistance on the 

Additional Clarification to more than a thousand coaches, athletic directors, Title IX 

coordinators and legal advisors, in addition to regularly providing individualized 

technical assistance. These presentations have included secondary schools, 2- and 4- 

year colleges and universities, and conferences sponsored by umbrella organizations 

responsible for developing and implementing the governing rules and procedures for 

national and regional athletics at the secondary, junior college, and 4-year college 

levels. We will continue to proactively seek out opportunities to educate recipients, 

educational and athletic organizations, administrators, parents and students regarding nondiscriminatory implementation of Title IX and the Additional Clarification. 

AMERICA’S OPPORTUNITY SCHOLARSHIPS FOR KIDS

Question. The President’s budget again proposes school vouchers through the 

America’s Opportunity Scholarships for Kids program. The President’s education 

budget also eliminates 42 programs. We often hear that the programs are proposed 

for elimination because they are ineffective. However, there is no evidence that pri-
58 

vate school vouchers do anything to improve achievement for any students. Further, 

we still have yet to see any real evaluation of achievement under the D.C. voucher 

program. In such a tight budget, how does the Administration justify spending $100 million 

on a program that has yet to be found effective? 

Answer. To offer the opportunity of a high-quality education to more students who 

attend schools in restructuring around the country, the Department proposes the 

creation of a national school choice program that gives parents the choice to send 

their children to any public or private schools that they believe would better serve 

their student’s needs. Though it is too early to know the potential effects on academic achievement of the D.C. School Choice Incentive Program, we do know that 

the program has generated significant support among parents of students in lowperforming schools in Washington, DC. The America’s Opportunity Scholarships 

program would extend that option to parents whose children attend low-performing 

schools across the Nation. In addition, several research studies, such as ‘‘Private 

School Vouchers and Student Achievement: An Evaluation of the Milwaukee Parental Choice Program’’ by Cecilia Rouse, and Jay Greene’s ‘‘The Effect of School 

Choice: an Evaluation of the Charlotte Children’s Scholarship Fund,’’ suggest that 

participation in the private school choice programs leads to improvements in student achievement. 

IMPACT OF MEDICAID CHANGE ON CHILDREN WITH DISABILITIES

Question. The Department of Health and Human Services reflects a change in 

how Medicaid is dealt with at schools. While I understand this change is proposed 

in the HHS budget and not the Department of Education, the impact will be felt 

by students and schools. The HHS budget says that certain costs associated with 

services provided to special education students who are also on Medicaid will no 

longer be reimbursed to the schools through Medicaid. The estimated savings to 

HHS is over $600 million for fiscal year 2007 and the 10-year savings is over $9 

billion. The President’s budget proposes only a $100 million increase to IDEA. While 

we will certainly fight for increasing funding for IDEA and other education programs, given these tight budget times, I have a feeling IDEA won’t receive $9 billion 

in the next 10 years. 

I am concerned that students will feel the impact of this change. The Federal Government has yet to live up to the promise of funding 40 percent of the cost of educating a special education student and schools will not be able to absorb the costs 

associated with this change. Students will be told to get such services outside of 

school hours. 

How do you propose ensuring that students get all the necessary service they receive now if this change happens at HHS? 

Answer. The President’s 2007 Budget includes a proposal that would prohibit Federal Medicaid reimbursement for Medicaid administrative activities performed in 

schools. It additionally provides that Federal Medicaid funds will no longer be available to pay for transportation required to be provided to children with disabilities 

by the Individuals with Disabilities Education Act. HHS has had long-standing concerns about improper billing by school districts for administrative costs and transportation services. Both the HHS Inspector General and the Government Accountability Office have identified these categories of expenses as susceptible to fraud and 

abuse. Schools would continue to be reimbursed for direct Medicaid services identified in an Individualized Education Program (IEP) or Individualized Family Service 

Plan (IFSP) and provided to Medicaid-eligible children, such as physical therapy, 

that are important to meeting the needs of Medicaid-eligible students with disabilities. 

A shift in funding responsibility for administrative and transportation costs associated with Medicaid eligible children with disabilities should not affect services for 

these children. State and local governments are responsible for ensuring that needed services are provided for all children with disabilities, regardless of whether they 

are Medicaid eligible. The change in policy would treat Medicaid eligible children 

with disabilities the same as other children with disabilities with regard to administrative and transportation costs. The Department of Education and HHS intend to 

work together to ensure that implementation of this change in policy is done in an 

orderly and sensible fashion. 

21ST CENTURY COMMUNITY LEARNING CENTERS

Question. The President’s budget would freeze funding for the 21st Century Community Learning Centers Program for the fifth year in a row. Furthermore, NCLB’s 

fiscal year 2007 authorization level for the program is $2.5 billion. This is a program 
59 

that enjoys extraordinary public and bipartisan congressional support. All of us hear 

from constituents who want and need more funding to develop more afterschool programs in their communities. These programs help working families, provide vital 

additional academic support to students and provide safe, supervised environments 

for kids afterschool—priorities that appear to match many of the President’s major 

goals. 

With such diverse, bipartisan support, why has the Department continued to pro- pose only $981 million for the program? That gap leaves the States, communities, 

families and students—as many as 1.4 million children—behind and more than 25 

States unable to offer new grant opportunities in fiscal year 2005. 

Answer. The program does, indeed, enjoy bipartisan support in Congress, and we 

do receive many letters from Members asking us to increase funding. However, in 

a tight budget environment, we need to target the limited available funding on programs that show evidence of success or that have a strong potential to fill major 

unmet needs. The results of the only national evaluation of 21st Century Community Learning Centers were not very positive and did not present a case for increasing the funding. However, the Department’s Institute of Education Sciences has 

launched a study of specific math and reading interventions that will determine 

after-school programs’ potential impact on academic achievement. We will review 

the results of that study, and also the program performance results that States submit, in determining whether to request increases in future years. 

CIVIC EDUCATION

Question. As you know, we face a crisis today with young people who are disenchanted with politics; they are apathetic and cynical about Government and its 

institutions. I was disappointed to discover the elimination of the Education for Democracy Act in the President’s budget request. This program funds domestic civic 

and international civic and economic education programs. The Civic Education program is successful in helping American students understand and appreciate fundamental values and principles of our Government. 

Can you comment on why a program that is consistent with the Administration’s 

desire for American students to have a basic understanding and appreciation of the 

workings of our Nation’s Government and politics along with its values and principles was eliminated in the President’s budget? 

Answer. The Administration agrees that there is a critical need for education programs that effectively promote basic understanding and appreciation of the workings of our Nation’s Government and politics, along with it values and principles. 

However, we question the efficacy and wisdom of statutorily mandating that 100 

percent of funds available for domestic civic education activities must go to a single 

organization, particularly when so little is known about the efficacy of civic education interventions developed and supported by this organization. The Administration believes that a more effective approach to addressing the issue is to invest in 

programs that make competitive awards to local schools districts and other eligible 

entities to help create safe learning environments where students understand, care 

about, and act on core ethical and citizenship values, such as Character Education 

(which would receive $24.2 million under the President’s request) and Safe Schools/ 

Healthy Students (which would receive $79.2 million under the President’s request). 

While the Civic Education program, as currently authorized, supports some 

worthwhile activities, there are no reliable measures of overall effectiveness of interventions supported using program funds. Studies and evaluations conducted by the 

Center for Civic Education provide limited information on program performance, but 

none are sufficiently rigorous to yield reliable information on the overall effectiveness or impact(s) of the various interventions supported through this program. 

The administration does not believe additional funding is necessary for the implementation of activities currently supported by the Center for Civic Education—an 

established non-profit organization with a broad network of program participants, 

alumni, volunteers, and financial supporters at the local, State, and national levels. 

The Center also has a long history of success raising additional support through 

such vehicles as selling program-related curricular materials, training and workshops, partnering with non-profit groups on core activities, lobbying, and seeking 

support from foundations. 

SUBCOMMITTEE RECESS

Senator SPECTER. Thank you very much. The subcommittee will 

stand in recess to reconvene at 10 a.m., Wednesday, May 3, in 

room SD–226. At that time we will hear testimony from the Honor-
60 

able Michael Leavitt, Secretary, Department of Health and Human 

Services. 

[Whereupon, at 12 noon, Wednesday, March 1, the subcommittee 

was recessed, to reconvene at 10 a.m., Wednesday, May 3.] 
(61) 

DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 

FISCAL YEAR 2007 

WEDNESDAY, MAY 3, 2006 

U.S. SENATE, 

SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS, 

Washington, DC. 

The subcommittee met at 10:15 a.m., in room SD–226, Dirksen 

Senate Office Building, Hon. Arlen Specter (chairman) presiding. 

Present: Senators Specter, Craig, Harkin, Kohl, Murray, and 

Durbin. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

OFFICE OF THE SECRETARY

STATEMENT OF HON. MICHAEL O. LEAVITT, SECRETARY 

OPENING STATEMENT OF SENATOR ARLEN SPECTER

Senator SPECTER. Good morning, ladies and gentlemen. The 

hearing for the Appropriations Subcommittee on Labor, Health and 

Human Services, Education, and Related Agencies will now proceed. I regret a little late start here, but we have been conferring 

with the distinguished Secretary of Health and Human Services, 

and we wanted to get some background information before coming 

into the public hearing. This is a very important hearing because 

it involves the budget for the Department of Health and Human 

Services, and health is our number one capital asset. Without 

health, none of us can function. 

I could give an extensive testimonial to that over the past year, 

but I’ll save that for another day and instead focus on the proposals for Federal expenditures. I say at the outset, as I have said 

privately to the Secretary, that I am very disturbed at the reduction in funds for his Department. There is a $1.6 billion reduction 

in funding for the Department of Health and Human Services, and 

that follows a pattern of reductions for—the other departments 

which are within the purview of this subcommittee. There have 

been reductions of some $2.2 billion for the Department of Education, reductions for the Department of Labor so that effectively, 

from the year—fiscal year 2005 until the present time, we have a 

reduction of $15.7 billion, and that means that there are vital programs for health, vital programs for human services which are in-
62 

adequately funded to start with and are now really effectively 

starved. 

The National Institutes of Health (NIH), which is the crown 

jewel of the Federal Government, is level funded, and that means 

taking into account inflation, there will be fewer grants made, and 

there have been enormous advances made by NIH. The leadership’s 

been provided really from this subcommittee long before you became Secretary, Mr. Secretary. When we took the NIH budget from 

$12 to $29 billion, there have been remarkable advances in the research on Alzheimer’s and Parkinson’s and heart disease and cancer, but not enough. 

As we speak, a very distinguished Federal jurist who has been 

named the 101st Senator as suffering from prostate cancer, and I 

lost my Chief of Staff, Carey Lackman, a beautiful young woman 

of 48 recently from breast cancer. In 1970, President Nixon declared war on cancer. If we had devoted the resources to the war 

on cancer which we devote toward other wars, we would have conquered cancer. In the past year, I have made the Kleenex industry 

wealthy, Mr. Secretary. This is a lingering aspect of chemotherapy 

treatment, and that brings me back to personalizing it just for a 

paragraph or two, but had the war on cancer been fought vigorously, I wouldn’t have gotten Hodgkin’s, I believe. The chances are 

good I wouldn’t have. Well, that’s the backdrop of these hearings 

and my views. 

As I told you privately a few moments ago and I think it’s worth 

repeating publicly, the President called in a number of committee 

chairmen last week for our views on what ought to be done, and 

when I had the opportunity to talk to the President, and I have 

had the opportunity to get to know President Bush rather well, he 

was in Pennsylvania 44 times in 2004 when he ran for reelection 

and I was up too, and I was with him on most of those occasions, 

and I have a very high regard for the President and the job he is 

doing notwithstanding the poll figures. Up close, he is very much 

engaged, very much on top of the job. The persona that comes 

through the news media is very very different. But at any rate, he 

is prepared to hear candid views even if they don’t agree with his, 

and I told him about the $15.7 billion reduction in spending and 

told him what was happening in the National Institutes of Health. 

I know that you are not the President, and as you reminded me, 

you are not even the Director of the Office of Management and 

Budget (OMB), but you are the Secretary of Health and Human 

Services. What I am calling upon all of the candid officers where 

I have a chairmanship and can make a constructive suggestion is 

to carry this fight to the Director of OMB and carry this fight to 

the President, and no department is more important than yours. To 

have level funding for NIH and to have cuts in the Centers for Disease Control and Prevention (CDC) with all the work CDC has to 

undertake is just unacceptable. 

Well, I appreciate your being here, Mr. Secretary, and I genuinely appreciate the job you are doing—leaving the Governorship of 

Utah, coming to Washington, tackling really big issues, and this 

matter of pandemic flu is of gigantic importance. Senator Harkin 

has been the leader, and I have worked with him as his partner, 

and we have moved ahead against some problems to produce $6.6 
63 

billion in funding. The potential for the pandemic flu if it strikes 

could be calamitous. When it has struck this country and the world 

in the past, millions of people have died. That’s a real danger, and 

I am pleased to see what you are doing and what you plan to do 

even with major announcements to come tomorrow. Senator Murray has a time conflict, and I will yield to her at this time. 

STATEMENT OF SENATOR PATTY MURRAY

Senator MURRAY. Well, thank you very much, Mr. Chairman. I 

am managing the floor for the Democrats in the supplemental and 

need to get back to the floor, and I appreciate the chairman yielding. I would second his statement and thank him for being the 

champion of NIH research, but also education and healthcare and 

all of the things that fall under the purview of this budget that you 

are presenting on behalf of the administration and echo his comments that investments in these diseases, investments in our future are absolutely critical to our Nation and the strength of our 

Nation in the future. I want to thank the chairman for his tremendous work on behalf of this and echo his sentiments that I am 

deeply concerned about the cuts that are coming. I can’t stay for 

the questioning. I did want to submit some for the record and tell 

you personally that I have been out in the state talking to many 

seniors about the new Medicare Part D prescription drug benefit. 

MEDICARE PART D DEADLINE EXTENSION

Although I voted against it, I want it to work. I want our seniors 

to be able to sign up for this and make it work. I am very concerned about what I am hearing from seniors as this May 15 deadline looms from seniors who can’t get access or think they have 

signed up for something find out several weeks later they haven’t. 

Many seniors are holding back signing up for it because they are 

worried about whether or not it’s going to cover their drugs. I 

mean, you have heard all of it as well, and I hope that we can be 

thoughtful in our approach, and I would encourage you to look at 

extending the deadline—at least for those whose benefits don’t 

begin until January of next year at the very minimum so that we 

don’t cause a lot of seniors harm in the process. What I see is people signing up for these plans out of fear rather than out of knowledge. I think in the long run, we will all be hurt if that occurs, and 

I wanted to encourage you to work with us and continue to work 

with us. I know you are hearing some of the same things we are 

and really would like to see this—and to talk with you about that, 

but I specifically wanted to ask because we are now seeing seniors 

who signed up January 1 fall into the donut hole. 

There is tremendous concern about those seniors who had pharmacy assistance plans who had drugs before who signed up for a 

drug are now falling into that donut hole. Are they considered uninsured, or are they considered insured for the purposes of being 

covered under the pharmacy assistance plans—and would like to 

get you or your staff to work with us as we try to help those seniors through that challenge right now. But Mr. Chairman, I will 

submit questions for the record, but I would like you and all of us 

to seriously look at this May 15 deadline and try and accommodate 

many of these seniors who are really having challenges who I think 
64 

we don’t want to lose in this process, and we want to make sure 

that we have given them a benefit and not given them some dire 

circumstances. So I appreciate the opportunity to throw that out 

there and look forward to working with you, Mr. Secretary. 

Senator SPECTER. Thank you, Senator Murray. Before yielding to 

Senator Craig, let me call upon our current distinguished ranking 

member for an opening statement. Before you walked in, Senator 

Harkin, I was praising you behind your back for your leadership— 

the number one leader on the funding for pandemic flu, and I said 

I was your partner, and the floor is yours. 

STATEMENT OF SENATOR TOM HARKIN

Senator HARKIN. Well, that’s kind of you, Mr. Chairman, but I 

just follow your lead—that’s all. If some of the reflective glory 

comes up, I am—that’s all right, that’s fine with me. Mr. Chairman, first of all, I want to thank you for your great leadership in 

so many areas—of course in this area of health. There is no stronger champion for the National Institutes of Health than the Senator 

from Pennsylvania. 

I have been by his side in—well, it’s now going on about 16 years 

now. If it weren’t for Senator Specter’s great leadership, we would 

never have doubled the funding for NIH that we did in the late 

1990s and put it up where it is. Now, of course, we have some problems now in making sure we continue that funding, and of course 

that’s one of the problems that I have with the President’s budget, 

and I am sure the chairman does also. 

Welcome the Secretary, and then we’ll just get to some questions 

in at that time. 

Senator SPECTER. Okay. Thank you very much, Senator Harkin. 

Senator Craig? 

STATEMENT OF SENATOR LARRY CRAIG

Senator CRAIG. Well, Mr. Chairman, I want to welcome the Secretary, and I must say that these two gentlemen struggle mightily 

with a very tough budget that Congress and this Senate have always supported, but your environment and our environment is one 

that we are being increasingly squeezed out of discretionary monies 

by mandatory spending. Someday, we’ll get brave enough to take 

it on in a responsible way. But until that time, the struggle of the 

chairman and the ranking member and this member will continue 

to go on because there has to be a sense of fiscal responsibility. I 

just came from the floor suggesting that the supplemental that we 

have got out there deserved to be vetoed by a President who had 

sent a message because it was about $10 billion out of line, and 

that’s because we can’t quit spending around here without a collective pressure being brought upon us. At the same time, there are 

priorities of spending that we get squeezed away from. I will say, 

Mr. Secretary, when I was home in the last recess, the good news— 

even though the Senator from Washington expresses continued 

concern about prescription drugs—is that you are having a phenomenal success, and I hope you will speak about it today. To 

stand up and bring on line a massive new program that this one 

is and to already be able to register the kinds of successes—someone said to me well, gee, it must have been pushed off the front 
65 

page by the price of oil. I said no, it was pushed off the front page 

because there was less criticism today and more praise as the results come in. I hope you will share those with us. Deadlines are 

important to cause people to react and to analyze and to decide on 

decisions that are necessary for them to make in a confused world. 

I will lastly say a couple of weeks ago, I am walking through the 

security line at the Boise Airport, and the fellow checking my ID 

said Senator, there are too many decisions, too many choices in 

prescription drugs, and I said well, then you would have preferred 

that we would have mandated a single program for you? Oh no, not 

at all. 

Then I said you need to get with it. He said I am and laughed. 

I said you saving money? He said, a lot of money, but it was a 

tough choice. He said I really had to force myself to do a little 

studying. Thank you. I yield the floor. 

Senator SPECTER. Thank you very much, Senator Craig. Senator 

Durbin, would you care to make an opening statement? 

STATEMENT OF SENATOR RICHARD DURBIN

MEDICARE PART D FORMULARY PRICES

Senator DURBIN. Mr. Chairman, thank you very much. I would 

just say briefly thank you, Mr. Secretary, for being here. I think 

you have an awesome responsibility and some very important programs that are under your control and leadership. I would say on 

Medicare Part D that I will not quarrel with the premise that offering senior citizens coverage for prescription drugs is a good thing. 

It keeps them healthy and independent, strong, and out of hospitals and nursing homes longer. That’s what they need. I do believe, though, that in my State there are still over 300,000 people 

who haven’t made that choice. I don’t know if that number has 

come down significantly in the last few days, but they only have 

2 weeks left before they face a penalty for not making a choice. It 

is also a fact that those who have made a choice in terms of their 

prescription drug plan are going to be somewhat surprised to learn 

that the prices are not locked in. The prices of the drugs—in fact, 

the formulary—the available drugs that you can purchase under a 

plan can change on a daily basis, which leads to some uncertainty 

about their future. Many of us felt that it would have been a better 

approach to allow Medicare to offer one universal plan which consumers could choose if they like, allow Medicare to bargain for deep 

discounts in drugs and to offer them nationwide. Then if private insurers wanted to compete, they would be allowed to. That position 

did not prevail. So, in Illinois, it meant some 45 different choices 

for prescription drug plans, and some seniors struggled with them. 

Many pharmacists continue to struggle with them as of today. 

NIH BUDGET CUTS

I would also want to echo what I know was said earlier by Senator Harkin. The pride that we have taken in Congress in the fact 

that the research money for the National Institutes of Health was 

doubled over a period of time. A former congressman from my 

State, John Porter, was the chairman of the Appropriations subcommittee that led that effort. He couldn’t have made it without 
66 

the cooperation and enthusiastic help from the Senate side, and I 

think that Senators Specter and Harkin are justifiably proud of 

that as well. But I am troubled that we have seen that growth in 

NIH research stall in last year’s budget and this year’s budget continues. It’s hard for me to believe that we are now at full capacity 

in terms of research for new drugs in America. I do believe that 

we need to expand the horizons, expand the opportunities to find 

cures for diseases, and this budget does not reflect that, and I hope 

that you will address that issue. 

MEDICAL PROFESSIONAL AVAILABILITY

One other issue that troubles me is the availability of medical 

professionals. With an aging American population, with increased 

demands for medical help for all of us, we want to make certain 

that when we push the button in our room, a nurse will show up, 

that a good doctor will be there to tend to our needs, and I am worried that we are not keeping up with that demand for our society. 

Sadly, one of the ways that we supplement our need for medical 

professionals is to go overseas, and I have done it myself—to go to 

other countries that will send us these medical professionals. In 

most cases, these countries cannot afford to give up their own, but 

they do because of the lure of living in the United States and the 

attractive salaries that might be available for these medical professionals. The only morally responsible thing that we can do is to increase the number of medical professionals in America. When it 

came to the Nurse Reinvestment Act, which Senator Mikulski and 

others pushed forward, we have not adequately funded it, and I 

think we are going to pay a price for it in terms of medical professionals and this continuing brain drain on the poorest countries in 

the world that are sending us their medical professionals they desperately need. 

As tough as it may be to practice medicine in the inner city of 

Chicago, it could not compare to practicing it in the Congo where 

there is one doctor for every 160,000 people, one surgeon for every 

3 million. That is an impossible situation, and we make it worse 

because we bring those medical professionals to the United 

States—many times at the expense of these countries. The responsible thing for us to do is to develop our own medical professionals 

to meet the needs in the future. I hope that you will be able to tell 

us that your budget addresses that. I look forward to your testimony, and thank you for joining us today. 

Senator SPECTER. Well, thank you, Senator Durbin. Well, we welcome you here, Secretary Leavitt, notwithstanding the opening 

statements of the Senators. You come to this position with a very 

distinguished record in public service—elected three times as Governor of the State of Utah, having served as Administrator for the 

Environmental Protection Agency and having taken over this very 

important job at the very beginning of the President’s second term 

in late January 2005. We give you the floor, Mr. Secretary. Take 

as long as you like. Do not run the clock on the Secretary. 

SUMMARY STATEMENT OF HON. MICHAEL O. LEAVITT

Secretary LEAVITT. Thank you, Senator. I will submit a formal 

statement for the record. 
67 

Senator SPECTER. Your statement will be made a part of the 

record and any other prepared statement. 

FISCAL YEAR 2007 HHS BUDGET

Secretary LEAVITT. You acknowledged in a very kind way my 

service—previously as Governor. I will tell you that I value every 

day I had that opportunity. However, I will also confess to you that 

earlier this week, I spoke with my colleagues at HHS and told 

them that I am among the few people I suspect in the world who 

can honestly say I can think of nothing that I would rather do in 

my life right now than exactly what I am doing. The issues here 

are demanding, but they are extraordinarily important to the people of this country and, may I say, the world. I say that with a 

sense of gratitude and humility with being in a position to have 

some impact on delivering on the most noble of aspirations that our 

country has—our desire to see cancer cured, to see other diseases 

cured as well, to find ways in which we can prepare ourselves for 

a pandemic influenza and to do the other things that are currently 

my responsibility. I just want you to know that these are difficult 

issues, but I am grateful for the opportunity to serve the American 

people. The budget that I’ll reflect today is a big budget. It’s $700 

billion. $75.5 billion of that we refer to as discretionary. Senator 

Craig referenced the fact that that number is being squeezed by 

the fact that the rest of the budget continues to grow at an alarming rate. I have a new grandson. He is now 8 months old. When 

he turns 35, Medicare alone—one of the programs that I am responsible to manage—will be 8 percent of our gross domestic product. By the time he retires at age 65, it will be 11 percent. I think 

everyone in this room knows that any nation that has one program 

that pays for the healthcare of those who have concluded their careers will likely not be on the economic leader board. I am deeply 

concerned about that as others are. It is having the impact of constraining our discretionary budgets. The budget I am here today to 

discuss is a deficit reduction budget. It is $1.5 billion less than the 

budget that I was here a year ago to discuss. You mentioned my 

11 years as Governor. During that period of time, I was responsible 

as the chief executive of my State to balance that budget, and I 

know that any time you are doing a deficit reduction budget, you 

are dealing with programs that have been on the budget for a very 

good reason and you are having to basically offset good programs 

against good programs. There are no easy choices here. There will 

be disagreement on what the priorities should be. I acknowledge 

that, and my purpose today is only to tell you the basis on which 

I made decisions given the need for this deficit reduction budget. 

You will find new initiatives here, things that I believe are extraordinarily important and that are important to the President, things 

that you have talked about. 

One of the things I am concerned about is our investments. At 

NIH, for example, we are seeking level funding at NIH, but there 

are new initiatives at HHS—for example, what we call critical 

path. Despite the fact that we have doubled the NIH budget, the 

number of molecules that we are able to actually take into the marketplace has been cut almost in half during that period of time. 

What that tells me is that we have to change the regulatory proc-
68 

ess and find new tools. So, one of the new initiatives we call critical 

path is essentially 76 science projects, if you will, to find new ways 

of measuring the efficacy and the safety of drugs that will allow us 

to dramatically improve that rather dismal statistic. You will see 

some Presidential initiatives here that will be familiar to you, such 

as a continued expansion of the community health centers. You will 

also see bioterrorism emphasized and pandemic influenza preparedness. I hope we’ll have a chance to talk at some length about 

our preparation. It is a very important matter, and we are giving 

it the highest level of priority at HHS. I have laid out the discretionary budget and asked those who helped me prepare it to use 

a set of principles—some things you will see follow through this entire budget. Some of those would be a pause in construction of new 

buildings, for example. Another thing you will see is that there are 

programs whose purposes have been addressed in other areas. I 

have discovered, like in many departments of the Federal Government, there are silos. There are places that deal in one silo with 

a problem and places that deal with it in another, and I have done 

my best to try to bring them together, and what that has allowed 

me to do is to find a way to be more efficient. You will see some 

programs with carryover funds where I have taken those funds and 

put them into some other purpose. 

PREPARED STATEMENT

Those are the means by which I have done it. I laid out a group 

of principles. I have tried to target as opposed to looking at general 

problems. I have tried to work at prevention as opposed to just ongoing funding of dilemmas. I have tried to look for places where 

there was new innovation. We’ll get a chance to talk about all of 

them. I won’t take more time. I am anxious to get directly to your 

questions, but I do want to tell you how appreciative I am of the 

chance to serve the American people and to be here today to work 

with you to accomplish that same purpose. 

[The statement follows:] 

PREPARED STATEMENT OF HON. MICHAEL O. LEAVITT

Good morning, Mr. Chairman, Senator Harkin, and Members of the Committee. 

I am honored to be here today to present to you the President’s fiscal year 2007 

Budget for the Department of Health and Human Services (HHS). 

Over the past 5 years, the Department of Health and Human Services has worked 

to make America healthier and safer. Today, we look forward to building on that 

record of achievement. For that is what budgets are—investments in the future. The 

President and I are setting out a hopeful agenda for the upcoming fiscal year, one 

that strengthens America against potential threats, heeds the call of compassion, 

follows wise fiscal stewardship and advances our Nation’s health. 

In his January 31 State of the Union Address, the President stressed that keeping 

America competitive requires us to be good stewards of tax dollars. I believe that 

the President’s fiscal year 2007 Budget takes important strides forward on national 

priorities while keeping us on track to cut the deficit in half by 2009. It protects 

the health of Americans against the threats of both bioterrorism and a possible influenza pandemic; provides care for those most in need; protects life, family and 

human dignity; enhances the long-term health of our citizens; and improves the 

human condition around the world. I would like to quickly highlight some key points 

of this budget. 

We are proposing new initiatives, such as expanded Health Information Technology and domestic HIV/AIDS testing and treatment that hold the promise for improving health care for all Americans. We are continuing funding for Presidential 

initiatives, including Health Centers, Access to Recovery, bioterrorism and pandemic 
69 

influenza; and we are also maintaining effective programs such as the Indian 

Health Service, Head Start, and the National Institutes of Health. 

We are a Nation at war. That must not be forgotten. We have seen the harm that 

can be caused by a single anthrax-laced letter and we must be ready to respond to 

a similar emergency—or something even worse. To this end, the President’s Budget 

calls for a four percent increase in bioterrorism spending in fiscal year 2007. That 

will bring the total budget up to $4.4 billion, an increase of $178 million over last 

year’s level. 

This increase will enable us to accomplish a number of important tasks. We will 

improve our medical surge capacity; increase the medicines and supplies in the 

Strategic National Stockpile; support a mass casualty care initiative; and promote 

the advanced development of biodefense countermeasures to a stage of development 

so they can be considered for procurement under Project BioShield. 

We must also continue to prepare against a possible pandemic influenza outbreak. 

We appreciate your support of $2.3 billion for the second year of the President’s 

Pandemic Influenza plan in the fiscal year 2006 Emergency Supplemental Appropriations Act for Defense, the Global War on Terror, and Hurricane Recovery. It is 

vital that this funding be allocated in the most effective manner possible to achieve 

our preparedness goals, including providing pandemic influenza vaccine to every 

man, woman and child within six months of detection of sustained human-to-human 

transmission of a bird flu virus; ensuring access to enough antiviral treatment 

courses sufficient for 25 percent of the U.S. population; and enhancing Federal, 

state and local as well as international public health infrastructure and preparedness. We also want to work with you to ensure that this funding is appropriated 

prior to October 1, 2006. 

The President’s fiscal year 2007 budget also provides more than $350 million for 

important ongoing pandemic influenza activities such as safeguarding the Nation’s 

food supply (FDA), global disease surveillance (CDC), and accelerating the development of vaccines, drugs and diagnostics (NIH). 

The budget includes a new initiative of $188 million to fight HIV/AIDS. These 

funds support the objective of testing for three million additional Americans for 

HIV/AIDS and providing treatment for those people who are on state waiting lists 

for AIDS medicine. This initiative will enhance ongoing efforts through HHS that 

total $16.7 billion for HIV/AIDS research, prevention, and treatment this year. 

The budget maintains the NIH, and includes important increases for important 

crosscutting initiatives that will move us forward in our battle to treat and prevent 

disease—$49 million for the Genes, Environment and Health Initiative and $113 

million for the Director’s Roadmap. In addition, it contains an additional $10 million 

for the Food and Drug Administration to lead the way forward in the area of personalized medicine and improved drug safety. 

One of the most important themes in our budget is that it increases funding for 

initiatives that are designed to enhance the health of Americans for a long time to 

come. For instance, the President’s Budget calls for an increase of nearly $60 million 

in the Health Information Technology Initiative. Among other things, these funds 

support the development of electronic health records (to help meet President Bush’s 

goal for most Americans to have interoperable electronic health records by 2014); 

consumer empowerment; chronic care management; and Biosurveillance. 

The Budget also includes several initiatives to protect life, family and human dignity. These include, for example, $100 million in competitive matching grants to 

States for family formation and healthy marriage activities in TANF. The President’s budget also promotes independence and choice for individuals through vouchers that increase access to substance abuse treatment. 

In the area of entitlement programs, I want to begin by congratulating you and 

other Members of Congress for having successfully enacted many needed reforms by 

passing the Deficit Reduction Act (DRA). DRA supports our commitment to sustainable growth rates in our important Medicare and Medicaid programs. It also 

strengthens the Child Support Enforcement program. The Deficit Reduction Act also 

achieves the notable accomplishment of reauthorizing Temporary Assistance for 

Needy Families (TANF), which has operated under a series of short-term extensions 

since the program expired in September 2002. 

Medicaid has a compassionate goal to which we are committed. Part of our obligation to the beneficiaries of this program is ensuring it remains available well into 

the future to provide the high-quality care they deserve. With its action on many 

of our proposals from last year in the Deficit Reduction Act, the Congress has made 

Medicaid a more sustainable program while improving care for beneficiaries. The 

President’s Budget proposals build on the DRA and include a modest number of legislative proposals, which improve care and will save $1.5 billion over 5 years in 
70 

Medicaid and S–CHIP and several administrative proposals saving $12.2 billion 

over 5 years. 

This Administration has also pursued a steady course toward Medicare modernization. In just the past 3 years, we have brought Medicare into the 21st century 

by adding a prescription drug benefit and offering beneficiaries more health plan 

choices. 

Medicare’s new prescription drug benefit represents the most significant improvement to senior health care benefits in 40 years. CMS has already exceeded the enrollment target with more than 30 million beneficiaries with drug coverage as of 

April 18, 2006. In addition, almost 6 million Medicare beneficiaries get drug coverage from other sources such as the Department of Veterans Affairs. This brings 

the total to approximately 35.8 million Medicare beneficiaries who are now receiving 

prescription drug coverage. In most cases, their coverage is either completely new 

or much better and much more secure than it was before. 

Savings from the prescription drug benefit have been greater than expected. CMS’ Office of the Actuary initially estimated beneficiary premiums averaging $37 per 

month. Today, however, the average monthly premium is $25 a month. And in some 

parts of the country, beneficiaries are seeing premiums of less than $2 per month. 

In 2006, the Federal government is projected to spend about 20 percent less per person than first estimated, and over the next 5 years, payments are projected to be 

more than ten percent lower than first estimated. So taxpayers will see significant 

savings and State contributions will be about 25 percent lower over the next decade 

for beneficiaries who are in both Medicaid and Medicare. All these savings result 

from the lower expected costs per beneficiary. 

Our work to modernize Medicare is not done. Rapid growth in Medicare spending 

over the long-term will place a substantial burden on future budgets and the economy. The President’s fiscal year 2007 Budget includes a package of proposals that 

will save $36 billion over 5 years and continue Medicare’s steady course toward financial security, higher quality, and greater efficiency. 

The bulk of these Medicare savings will come from proposals to adjust yearly payment updates for providers in an effort to recognize and encourage greater productivity. These proposals are consistent with the most recent recommendations of the 

Medicare Payment Advisory Commission. To ensure more appropriate Medicare 

payments, the Budget proposes changes to wheelchair and oxygen reimbursement, 

phase-out of bad debt payments, enhancing Medicare Secondary Payer provisions, 

and expanding competitive bidding to laboratory services. Building on initial steps 

in the Medicare Modernization Act, the Budget proposes to broaden the application 

of reduced premium subsidies for higher income beneficiaries. Finally, the President’s Budget proposes to strengthen the Medicare Modernization Act provision that 

requires Trustees to issue a warning if the share of Medicare funded by general revenue exceeds 45 percent. The Budget would add a failsafe mechanism to protect 

Medicare’s finances in the event that action is not taken to address the Trustees’ 

warning. If legislation to address the Trustees’ warning is not enacted, the Budget 

proposes to require automatic across-the-board cuts in Medicare payments. The Administration’s proposal would ensure that action is taken to improve Medicare’s sustainability. 

President Bush proposes total outlays of nearly $700 billion for Health and 

Human Services. That is an increase of more than $58 billion from 2006, or more 

than 9.1 percent. 

While overall spending will increase, HHS will also make its contribution to keeping America competitive. To meet the President’s goal of cutting the deficit in half 

by 2009, we are decreasing HHS discretionary spending. Our non-emergency request for discretionary budget authority for programs under the jurisdiction of this 

Subcommittee totals $61.1 billion, a decrease of $1.6 billion below fiscal year 2006. 

The $2.3 billion for the cost of the next phase of the President’s plan to prepare 

against an influenza pandemic that I discussed earlier is in addition to this amount. 

I recognize that every program is important to someone. But we had to make hard 

choices about well-intentioned programs. I understand that reasonable people can 

come to different conclusions about which programs are essential and which ones 

are not. That has been true with every budget I’ve ever been involved with. It remains true today. There is a tendency to assume that any reduction reflects a lack 

of caring. But cutting a program does not imply an absence of compassion. When 

there are fewer resources available, someone has to decide that it is better to do 

one thing rather than another, or to put more resources toward one goal instead 

of another. 

Government is very good at working toward some goals, but it is less efficient at 

pursuing others. Our budget reflects the areas that have the highest pay-off potential. 
71 

To meet our goals, we have reduced or eliminated funding for programs whose 

purposes are duplicative of those addressed in other agencies. One example of this 

is Rural Health where we have proposed to reduce this program in the Health Resources and Services Administration. The Medicare Modernization Act contained 

several provisions to support rural health, including increased spending in rural 

America by $25 billion over 10 years. For example, it increases Medicare Critical 

Access Hospitals (CAH) payments to 101 percent of costs and broadens eligibility 

criteria for CAHs. Moreover, recognizing that Congress adopted many of our saving 

proposals last year, we are continuing to make performance-based reductions. 

Our programs can work even more effectively than they do today. We expect to 

be held accountable for spending the taxpayers’ money more efficiently and effectively every year. To assist you, the Administration launched ExpectMore.gov, a 

website that provides candid information about programs that are successful and 

programs that fall short, and in both situations, what they are doing to improve 

their performance next year. I encourage the Members of this Committee and those 

interested in our programs to visit ExpectMore.gov, see how we are doing, and hold 

us accountable for improving. 

President Bush and I believe that America’s best days are still before her. We are 

confident that we can continue to help Americans become healthier and more hopeful, live longer and better lives. Our fiscal year 2007 budget is forward-looking and 

reflects that hopeful outlook. 

Thank you for the opportunity to testify. I will be happy to answer your questions. 

HISTORICAL PANDEMICS

Senator SPECTER. Thank you very much, Mr. Secretary. We’ll 

now go to the questioning by the Senators with 5-minute rounds. 

In the second round, Mr. Secretary, I intend to go into the budget 

cuts on the Centers for Disease Control and the National Institutes 

of Health and others which, as I have outlined earlier, I think totally unacceptable, but let me begin with the issue of the threat of 

the pandemic flu. There is a draft report, which has appeared publicly, where you are stockpiling 75 million doses of antiviral drugs 

and 20 million doses of vaccines. There are projections that there 

could be as much as 40 percent of the workforce absent. There are 

guidelines to keep people from congregating together. There is even 

a note about local police departments and National Guard would 

have the primary responsibility for keeping order, but the military 

would be available to assist. This sounds like a very, very stark situation. We know that when such disasters have occurred in the 

past, there have been millions who have been killed. One of the 

really important matters to be covered is to acquaint the public 

with what the problems are—that it may be difficult or dangerous 

to go to the grocery store, that it is important to have a supply of 

water, that there ought to be provisions made for a worst-case scenario. There have been articles, but they are buried in the newspapers, and I do not think that there is a real public understanding 

of the seriousness of this program. Now, what you are saying here 

today is going to be carried in the news media, and this hearing 

is being covered live on C–SPAN, so it is reaching people as we 

speak. Stark as it is, I think we ought to be very candid, very 

frank—brutally frank with the potential nature of the problem. 

Now, Mr. Secretary, what is the worst-case scenario? If it’s as bad 

as it can be, how bad would that be? 

Secretary LEAVITT. Mr. Chairman, pandemics happen. They have 

happened through all-time. You can date back to ancient Athens— 

25 percent of that city was wiped out because of disease. You can 

roll forward, and virtually every century, you will see two or three 
72 

pandemics. In the 14th century—Black Death, perhaps the best 

known, killed 25 million people across Europe. 

Senator SPECTER. How many people died in the pandemic in the 

United States not long into the 20th century? 

Secretary LEAVITT. Your point is a very good one. We have had 

10 pandemics in the last 300 years. We have had three pandemics 

in the last 100 years. In 1968 and 1957—a lot of people got sick. 

Not many people died. In 1918, however, many people got sick and 

regrettably, millions died. If we were to have a pandemic of equal 

proportion to that which occurred in 1918, roughly 90 million people in the United States would become ill. About half of those—45 

million would become sick enough that they would require some 

form of serious medical attention, and about 2 million people, regrettably, would die. 

Senator SPECTER. Well, those are pretty stark figures—90 million, about one-third—almost one-third of the population, and you 

say millions would die. What basic precautions should people take? 

PANDEMIC INFLUENZA PREPAREDNESS

Secretary LEAVITT. Well, for that reason, the President has asked 

that we mobilize the country. I have committed that we would hold 

pandemic summits in all 50 States. So far, we have had 46 of them. 

We are mobilizing State and local governments. We are also working to develop a global monitoring system. 

Senator SPECTER. What should individual citizens do? Should individual citizens stock up on water? Should individual citizens 

stock up on food? 

Secretary LEAVITT. Mr. Chairman, the preparation for a pandemic is essentially the same preparation that needs to occur in 

any disaster. It’s a good idea to have some nonperishable food 

stored at your home. That would be true for a hurricane or a tornado. It would be a good idea for a bioterrorism event or a nuclear 

event. It would be true as well for a pandemic. It’s a good idea to 

have a first aid kit and to have prescription drugs stocked up in 

a way that if you were to need your supply and couldn’t get to the 

drug store that you would have it. It’s a good idea to have thought 

through how you would deal with your children—if you had to alternate going to work with your spouse or if they both needed to 

stay home and you had to have some kind of caregiving process. 

It’s a good idea to take the same precautions as in any other emergency situation. 

Senator SPECTER. The red light went on in the middle of your answer, and I intend to observe the red light meticulously because I 

ask all the members of the panel to do the same, and now I yield 

to Senator Harkin. 

PANDEMIC INFLUENZA VACCINE STOCKPILE

Senator HARKIN. Thank you very much, Mr. Chairman. Again, 

welcome Mr. Secretary. Again, I just want to point out that this 

committee—the Senate went on record 73 to 27 on an amendment 

offered by Senator Specter on the budget to increase our budget allocation by $7 billion for health and education programs, much of 

which would go to this Department to make up for a lot of the cuts 

that we see in this budget. Of course, we don’t have a budget yet. 
73 

The House can’t seem to pass one. So, I don’t know what’s going 

to happen on that later on down the pipe, but I am hopeful that 

that $7 billion that Senator Specter and 72 other Senators voted 

to support stays in there. If that’s the case, then we can make up 

for some of the cuts that are in your budget that I think are just 

devastating—the cuts to Social Services Block Grants by $500 million, eliminating the Community Services Block Grant programs, 

the cuts—as you said, the level funding for NIH, which translates 

into cuts for some of NIH and for the Centers for Disease Control, 

the cuts on rural health programs, poison control centers, health 

professions trainings programs—all of these things all got cuts—all 

got cuts. Quite frankly, with the needs that we have out there, 

these cuts cannot stand, and that’s why I am hopeful that we can 

get that $7 billion. Now, I want to follow up a little bit on the 

Avian Flu. I want to see if we can clarify the issue of stockpiling 

of antivirals. The World Health Organization recommended that 

countries stockpile sufficient antivirals to treat 25 percent of their 

populations. In your written statement, you concur with that goal. 

That would equate to about 80 million Americans. I understand 

that your Department has ordered or has on hand enough 

antivirals to treat about 26 million individuals, so that leaves 

about 50 million—60 million short. I understand that you anticipate States will order 30 million courses of antivirals. The Government will subsidize that at 25 percent of the cost. States have been 

asked to place their orders with you by July—by this July. The 

final course of treatment will be ordered using pending funds— 

2007—next year funds. Well now, again, I laid that groundwork to 

say that—are there any States that have indicated that they will 

not be able to order these medications because they have a lack of 

funds or a lack of legislative authority to do so? 

Secretary LEAVITT. No State has made that statement to us at 

this point. 

Senator HARKIN. Okay. What is your plan if States don’t order 

these treatments by July? 

Secretary LEAVITT. We intend to acquire 50 million courses of 

antivirals. 

Senator HARKIN. You mean 50 million over the 20 you have? 

Secretary LEAVITT. Let me reconcile the entire amount and then 

give you the timeframes. We will have by the end of 2006 the 26 

million that you have spoken of. We will have by 2008, 50 million 

that will have been purchased by Federal money and that will be 

available for distribution. 

Senator HARKIN. Okay. 

PANDEMIC INFLUENZA VACCINE DISTRIBUTION

Secretary LEAVITT. We will make a distribution of that 50 million 

among the States on essentially a proportionate basis. So they will 

have that available to them in its entirety by the end of 2007. Each 

of the States then has an opportunity to supplement that—their 

proportionate share of that 50 million, and we will subsidize it by 

25 percent up to their proportionate share of the remaining 31 million. We anticipated originally that we would ask States to make 

that decision by July. Since that information was provided to you, 

we have made a decision that we will allow them to buy off of our 
74 

order and at the same time, deal directly with the manufacturer 

so that they could be more efficient rather than go through us. 

Senator HARKIN. My time is running out. Mr. Secretary, in the 

case of a pandemic, State, and local health departments will have 

to distribute the vaccines. Are you encouraging States to organize 

mass vaccination exercises during this next flu season to get ready 

for that? 

Secretary LEAVITT. We are. 

Senator HARKIN. If so, will you allow the States to use a portion 

of the $350 million that we allocated for that to purchase annual 

flu vaccine? 

Secretary LEAVITT. Actually, we would prefer that they utilize 

the $350 million to build up the public health infrastructure and 

to reach deep into the community to be able to do the kinds of 

things that Senator Specter was talking about. 

Senator HARKIN. But isn’t one way to do that is to purchase annual flu vaccine and put in place an infrastructure—— 

Secretary LEAVITT. Oh. 

Senator HARKIN [continuing]. To distribute it? That’s what I am 

saying. 

That’s what I am talking about. 

Secretary LEAVITT. I misunderstood your question. 

Senator HARKIN. Yeah. 

Secretary LEAVITT. At this point, we have not begun to distribute 

the stockpile of vaccine that we have. It is relatively small, but we 

will not release it until such time as we have seen person-to-person 

transmission. 

Senator HARKIN. No, now we’re—my time is running out, and 

that’s not what I am talking about. What I am talking about is the 

annual flu vaccine. 

Secretary LEAVITT. Oh. 

Senator HARKIN. Is we put $350 million for—to build up State 

and local structures in case of a pandemic. One of the ways to test 

that to see if it works, to do it is to buy the annual flu vaccine and 

say okay, we are going to set up processes and methodologies to get 

that annual flu vaccine out. 

Secretary LEAVITT. Third time is the charm, Senator. You got it. 

Senator HARKIN. Okay. 

Secretary LEAVITT. I think you finally reached me. 

Senator HARKIN. So, my question—would they be allowed to use 

some of that $350 million to purchase the annual flu vaccine to test 

modalities out there to—how to get it out? 

Secretary LEAVITT. I hadn’t thought of that. 

Senator HARKIN. Oh. 

Secretary LEAVITT. It’s a really interesting idea—— 

Senator HARKIN. Okay. 

Secretary LEAVITT [continuing]. I’d be happy to give it some 

thought and respond back to you. 

Senator HARKIN. I appreciate that. Thanks, Mr. Secretary. All 

right. 

[The information follows:] 
75 

PANDEMIC INFLUENZA INFRASTRUCTURE

A major component of the $350 million allocated to States for pandemic influenza 

planning is for States to exercise their plans. States are permitted to use Public 

Health Emergency Preparedness cooperative agreement funds to purchase vaccine 

in limited quantities for the purpose of conducting drills and exercises. At this time, 

they are not permitted to purchase annual vaccine with the emergency supplemental funding for pandemic influenza preparedness. However, they may use some 

of these emergency supplemental funds during the influenza season as an opportunity to exercise mass vaccination plans. 

Senator SPECTER. Thank you, Senator Harkin. Senator Craig? 

COMMUNITY HEALTH CENTERS

Senator CRAIG. Thank you very much, Mr. Chairman. Mr. Secretary, during the Easter recess when I was back in Idaho, I visited 

a community health center, and I do that on a regular basis to see 

how it’s working, who they are serving, how they are serving, and 

it is really one of those kind of unsung success stories out there 

that some of us fail to recognize. Obviously, this present—President 

hasn’t failed to recognize that to lower income Americans, one way 

to serve them is making sure the door is open, and community 

health centers do that very well. This particular community health 

center in Nampa, Idaho told me that in the year, they had served 

over 25,000 people, and the place was full, the parking lot was full, 

and the doctors and nurses there were very pleased with the work 

they were doing. Should this committee be concerned that expansion of new facilities coupled with a reduction in funds for training 

personnel to work in those facilities will slow the service—access 

to service in communities that need these facilities or worse—exacerbate shortages in medical personnel across the country? 

Secretary LEAVITT. Mr. Senator, as I indicated earlier, this is one 

of the President’s high priorities, and this budget includes funds to 

continue forward in his goal of providing 1,200 new or expanded 

community health center sites. This includes enough for 300, 80 of 

which will be in the highest poverty counties. This is a passion for 

the President and for me, and we are working with every asset we 

have to continue moving it forward. 

Senator CRAIG. Okay. So as I said, funds as it relates to the 

training of personnel, we don’t—you don’t see that as a problem in 

relation to standing these up and facilitating them for service? 

Secretary LEAVITT. As I speak with those who run and operate 

these in the same way that you have, there are always needs there. 

Senator CRAIG. Yeah. 

Secretary LEAVITT. I would not want to say that we will have 

quenched that, but we do recognize that training is a component 

of it and want to meet those needs. 

WELLNESS AND DISEASE PREVENTION

Senator CRAIG. Okay. Mr. Secretary, myself and other Senators 

consistently over time have introduced legislation to authorize 

Medicare to cover medical nutritional therapy services for some 

beneficiaries. However, there is generally a cost associated with 

any legislation, and that usually gives us problems in this area. I 

am one who believes that good health oftentimes brings down costs 

as it relates to healthcare and that we ought to be increasing advocates of that instead of repairs of broken bodies, if you will, after 
76 

the fact. Can you give me your general views based on your experience in implementing programs designed for health and wellness 

as opposed to programs designed to intervene or respond to long 

after diseases and ailments have onset? 

Secretary LEAVITT. I believe, Senator, it should become our entire 

focus. When I say entire focus—until we begin to view wellness 

with the same passion we do treatment, not only will we not see 

improvement in our health, we will not see improvement in our fiscal health. I believe that is one of the reasons—in fact, one of the 

primary reasons, why the new Part D prescription drug benefit is 

such a historic point in time. For the first time, we have begun to 

provide for seniors the prescription drugs they need to stay healthy 

as opposed to simply treating them after they are sick. Over and 

over again, as I have traveled the country meeting with seniors, I 

have heard stories of people who have had heart operations, ulcer 

operations, and osteoporosis treatments that could have been prevented with a small amount of prescription drugs at the onset as 

opposed to the treatment at the end. 

MEDICARE PART D ENROLLMENT

Senator CRAIG. Well, my time is up, but you segued nicely from 

my request for a response as it relates to medical nutritional therapy and to prescription drugs. Could you for a moment give us 

some of the current figures as to where we are with participation 

as to where we thought we would be and some of the savings that 

are now already appearing on the scene? 

Secretary LEAVITT. We anticipated that in the first year, we 

would see 28 to 30 million people enroll. We have now exceeded 30 

million. We anticipate between now and the 15 of May that we will 

have—I don’t know exactly of course, but another couple million. 

If you assume that that’s 32 million, there are 42 million in total 

who are eligible. There are 6 million who are getting coverage from 

either a private employer or some other source. If you add that 6 

to the 32, you get 38. That would mean we have a shot at being 

able to have enrolled 90 percent of every senior who is eligible for 

this benefit during the first year. That is a remarkable achievement in my mind, and it’s a tribute not just to the Centers for 

Medicare and Medicaid Services (CMS), but to the thousands of 

pharmacists, the thousands of volunteers, the tens of thousands of 

people all over this country who have been involved in reaching out 

to seniors in their homes, in their places of worship, in their senior 

centers. The other good news is the cost is coming down. The program is getting better everyday. The cost is coming down, and we 

are getting people enrolled. 

Senator CRAIG. Thank you. It is a success story. We appreciate 

it. 

Senator SPECTER. Thank you very much, Senator Craig. Under 

the early bird rule, we turn to Senator Durbin. 

MEDICARE PART D ENROLLMENT DEADLINE

Senator DURBIN. So, Mr. Secretary, there is more to the story, 

and here is the rest of the story. The Bush administration says 

that 35.8 million Medicare beneficiaries will have drug coverage as 

of mid-April. The truth is 75 percent of those people—more than 
77 

26 million—already had prescription drug coverage before January 

1 of this year through their employer, the VA or Medicaid. So there 

were 16 million Medicare beneficiaries who previously did not have 

drug coverage. Only half or about 9 million have signed up for the 

benefit. Millions need more time. In my State of Illinois, 606,000 

people have not signed up for Part D, and the clock is ticking. It’s 

less than 2 weeks away. Forty-five different plan choices, people— 

some of whom are flat on their back in nursing homes and in no 

position to make these choices—I think we have to acknowledge 

the obvious. Come May 15, the law will impose a penalty on a lot 

of people who did their best and just couldn’t get this done, and I 

want to ask you point-blank do you think we ought to extend the 

signup deadline beyond May 15? Number two—should you allow 

senior citizens a do-over if they picked a bad plan that dropped the 

formulary, increased the cost? Do you think that that will be a reasonable way to deal with clearly a challenge that has not been met? 

Secretary LEAVITT. Senator, millions of people—tens of millions 

of people—have prescription drug coverage who did not have it before. That is a great step forward, something I believe you would 

concur with. Let me again say that I believe that when May 15 

comes, we will have reached roughly 90 percent of those who are 

eligible. Of the remaining 10 percent, about half of them will be a 

population that, granted, is very difficult to reach. 

Senator DURBIN. But—— 

Secretary LEAVITT. We have had that problem—I want to answer 

your question. About half of them are in a low-income status, and 

we have granted them the ability if they qualify for the extra 

help—the people that you are most concerned about—we will not 

require that they wait until the next enrollment period. They will 

have no penalty, and they will have no wait. 

Senator DURBIN. So increasing monthly premiums of 1 percent 

for every month past the deadline—are you going to waive that? 

Secretary LEAVITT. If you are in fact a low-income eligible person, you will not have a penalty, and you will not be required to 

wait until the next enrollment period. 

Senator DURBIN. Will the administration support extending the 

deadline beyond May 15? 

Secretary LEAVITT. We believe that a deadline is necessary and 

that it is working. The Government actuary told us if we did not 

have a deadline, we would have substantially fewer people. We believe that the plan requires the time to mature. We think that 

the—that half of the people who are—who have yet to enroll will 

be eligible to enroll during that period once they have qualified for 

extra help. 

Senator DURBIN. I think that we are missing the point here. Of 

the universe of people who did not have prescription drug coverage 

on January 1, some 25—let me get the figure correct here—25 percent of the Medicare beneficiaries, about 15 percent of that number 

will have signed up by May 15, and 10 percent will have not. So 

60 percent of our goal will have been reached, but 40 percent not. 

You are shaking your head, but those are the numbers, and we get 

the report from your agency county by county. 606,000 people in 

my State, and we have done our best. What I say to you is I hope 

that you will understand their predicament, that the administra-
78 

tion will relent and give these seniors a second chance to sign up 

without penalty. Second, if they have made a bad choice, I hope 

you will give them a chance to have a do-over, a makeover, support 

legislation that we have introduced. They can pick a plan that really is better for them. If I might ask one other question—I’m going 

to run out of time. I am worried about whether or not we are doing 

what we need to do for our children on our watch. I go to schools 

across my State, and I ask a simple question—how many here have 

someone in your family with asthma? You will see more than half 

the hands go up. You can tell by looking at the children we are 

dealing with obesity. We know that one out of every 160 children 

in America have autism at this point. How can we deal with these 

issues when we are facing a budget that is going to make such significant cuts in the Centers for Disease Control and Prevention, in 

the National Institutes of Health and that eliminates the NIH National Children’s Study? How can we find out what’s happening out 

there and really protect our children against what appears to be an 

onset of some terrible health challenges? 

MEDICARE PART D PLAN CHOICE

Secretary LEAVITT. Senator, we do have an epidemic of obesity, 

particularly among our young people, and the Centers for Disease 

Control and Prevention does have a role as would many other 

agencies at HHS, and we are prepared to join with you in every 

way we can to assure that that occurs. It is a very serious problem. 

I would like to just mention one other thing on the choice of plans. 

A statistic I learned that I think you will find interesting—we did 

develop a standard plan that was recommended by the Congress. 

Only 10 percent of the more than 30 million people now have chosen that plan, which tells me that it was very important to people 

that they have a choice and that they are able to choose a plan that 

fits their situation. I know from signing a lot of people up that if 

they had just had to deal with the standard plan, no matter what 

it was, it would not have served them well. The plan will be simplified in the next version in the same way that the market has 

allowed for it to become better. We are all going to get better at 

this as time goes on. In 1965, Medicare became law. It got better 

in 1966. It got better in 1967. The plans are now maturing. The 

pharmacies are learning how to use the system. The consumers are 

now better informed. We are getting better at what we do. This is 

a very important milestone—undoubtedly the most important thing 

that’s happened in healthcare in the last 40 years. 

Senator DURBIN. Thank you. 

Senator SPECTER. Thank you, Senator Durbin. Senator Kohl? 

FDA GENERIC DRUG APPLICATIONS

Senator KOHL. Thank you, Mr. Chairman. Mr. Secretary, the 

FDA currently has a backlog of more than 800 generic drug applications, which is an all-time high, and FDA officials expect a record 

number of generic applications this year and an even larger backlog. The Congressional Budget Office estimates the use of generics 

provides a savings of $8 to $10 billion to consumers every year, and 

that doesn’t include the billions of dollars more of savings to hospitals, Medicare, and Medicaid. I believe it’s now more important 
79 

than ever that we speed less expensive generic drugs to market, 

and I would think that you agree. So do you support an increase 

in the FDA budget to help reduce this backlog, and how much do 

you believe the FDA needs to efficiently reduce the backlog and 

pass along the savings to our people and also to the Federal Government? 

Secretary LEAVITT. Senator Kohl, I concur with you that there is 

a need to speed generic drugs to market. It is a good thing for consumers. It’s a good thing for healthcare. We are taking steps to do 

just that—not only to speed them, but to prioritize them. The budget that I have proposed is the budget we have proposed. We think 

we can accomplish that within the budget that we have suggested. 

Senator KOHL. So you are not proposing any increase in the 

budget to help reduce this backlog? 

Secretary LEAVITT. We are putting substantial focus on it, however, I will tell you, at FDA. 

Senator KOHL. I’d like to hope that’s going to happen, that in fact 

we will get the kinds of numbers—increases that we need, that I 

think you believe we need, and you are saying that it’s going to 

happen? 

Secretary LEAVITT. Let me suggest one piece of information that 

might at least give you some insight into this. Of the 800 applications, some of them are essentially for the same chemical or same 

molecule. So, we have begun to focus on those on in which there 

is not one generic or two generics. In other words, we want to get 

new generics into the market as opposed to a repeat of existing 

molecules that have been made available in some generic form. 

Now, we think we can do this better, and I think we have to. 

ADMINISTRATION ON AGING (AOA) BUDGET CUTS

Senator KOHL. Mr. Secretary, some of the most painful cuts in 

the budget are programs under the Administration on Aging, which 

takes a $28 million hit in programs like Meals On Wheels and family caregiver support services. That means that—well, in my State, 

Wisconsin senior population continues to grow from 705,000 senior 

citizens in 2000 all the way up to 1.2 million senior citizens estimated for 2025. The budget does not account for the growth and 

the need for services. In addition, this budget proposes to eliminate 

Alzheimer’s demonstration grants. In Wisconsin, the Alzheimer’s 

Association is in its first year of a 3-year grant where they are 

working in Jefferson County on a program to open a dementia care 

clinic at a hospital in Fort Atkinson in Jefferson County. It is the 

first of its kind and the only one in the area, and they would lose 

their funding after this year should this budget prevail. So how do 

you explain your plan to cut these vital programs while at the 

same time our aging population is growing? 

Secretary LEAVITT. Senator, you have listed a number of different 

areas, so let me do my best to respond to them and to give you a 

sense of what was going on in here when I made these decisions. 

I asked my budget team to essentially use a series of principles. 

One of them I asked them is to look for one-time funds. So part 

of that may be one-time funds where the project was completed and 

hence wasn’t repeated. Another principle was looking for programs 

where purposes were involved in a number of different places at 
80 

HHS. So, it’s possible that some of those were there. There were 

also some funds that were carried over from existing programs that 

I didn’t repeat. Now, I can’t respond directly. If you’d like me to 

get to you specifically with those, I’d be happy to respond, but my 

guess is that we’ll find that those principles are the ones that were 

involved in helping to make the decisions we did. 

Senator KOHL. I would like some more information on those particular programs. 

Secretary LEAVITT. We’ll be happy to respond to that. 

[The information follows:] 

ALZHEIMER’S DEMONSTRATION GRANTS

For 14 years under the Alzheimer’s Disease Demonstration Grant to States Program (ADDGS), demonstrations in almost every State have highlighted successful, 

effective approaches for serving people with Alzheimer’s. Similar to Preventive 

Health Services, it is time to put these models and the lessons that have been 

learned to work by moving them in AoA’s core services programs—especially the National Family Caregiver Support Progam—as a number of States have already done. 

The fiscal year 2007 President’s budget includes the elimination of ADDGS. This 

reflects that demonstration projects for individual with Alzheimer’s and their caregivers are ready to be incorporated into the core activities of the National Aging 

Services Network. 

RURAL HEALTHCARE

Senator KOHL. There are a number of programs in your Department aimed at bolstering rural health. Wisconsin, one of the biggest beneficiaries in the country, received over $600,000 from the 

Rural Hospital Flexibility Grant Program just last year. This funding is used at over 60 rural hospitals that serve anywhere from 

10,000 to 12,000 patients every year. The President’s budget proposes to eliminate the Rural Hospital Flexibility Grant Program, 

the rural and community access to emergency devices and area 

health education centers. So how are rural communities expected 

to meet their unique healthcare challenges when these very important resources are being severely diminished? 

Secretary LEAVITT. I, like you, come from a State where rural 

medicine is a very important part of the social fabric of our State, 

and so I have become quite sensitive to this. We have adopted a 

slightly different strategy and that is to try to bolster the reimbursement rates for providers in those areas. I have also begun to 

look for places, frankly, where I wasn’t able to justify or I wasn’t 

able to see a result. We have invested about $25 billion through 

higher reimbursements in rural areas, and that’s the way we are 

intending for many of those funds to be replaced. 

Senator KOHL. Thank you, Mr. Chairman. 

CDC BUDGET CUTS

Senator SPECTER. Thank you very much, Senator Kohl. On round 

two, we begin now with Mr. Secretary. With respect to the budget 

cuts, the Centers for Disease Control and Prevention has been cut 

by $67 million this year. They have enormous responsibilities in 

many many areas which I shall not enumerate, and now we are 

looking to give them even greater responsibilities if there should be 

a pandemic flu. Dr. Julie Gerberding, a very distinguished Director 

of CDC, has sat at your side testifying, preparing on this item. The 

physical plant of CDC was a shambles when I visited it several 
81 

years ago. Prize-winning scientists were sitting in hallways, toxic 

materials were not under lock and key, and we have carved out 

funds within our existing budget to fund almost a billion and a half 

dollars. Immediately, Senator Harkin and I found $137 million. 

Now, the budget has been cut from $159 million to $30 million— 

a $129 million cut. I have been lobbied very heavily by people in 

the Atlanta community to find the funds, but I can’t find money 

out of thin air. How can CDC be realistically cut and their physical 

plant not improved given the increased responsibilities that you as 

Secretary are calling on them to perform? 

Secretary LEAVITT. Senator, may I acknowledge that the work 

that this committee has done to be supportive of CDC is not just 

noticeable, but revered, and I also acknowledge that the budget 

that we are presenting to you is reduced by $179 million. Within 

that total reduction, the buildings and facilities as far as new construction does make up $129 million of that. We have felt in a 

budget with a reduction or a deficit that we have made substantial 

progress in this area. 

Senator SPECTER. Should we stop the rebuilding? 

Secretary LEAVITT. Well, we believe that we are capable of pausing on what will be a long-term strategy to continue to improve the 

facilities. We have made substantial progress. They are remarkable 

facilities, and I want to express my enthusiasm for how much the 

campus has been improved, and I want to acknowledge as well the 

role of you and Senator Harkin in accomplishing that. 

Senator SPECTER. Let me ask you to submit the balance of your 

answer in writing so I can go onto NIH. 

[The information follows:] 

CDC PHYSICAL PLANT

CDC has made remarkable progress on its Master Plan with $1.2 billion invested 

to date to upgrade their facilities. Since 2000, CDC has initiated or completed the 

construction of more than 2.7 million gross square feet (gsf) of laboratory and facility space. For fiscal year 2007, we have included $30 million for repairs and improvements of CDC facilities. 

Consistent across HHS, our request focuses on finishing projects that are near 

completion and maintaining existing facilities. No funds are requested to initiate 

new construction. 

NIH RESEARCH GRANTS

Senator SPECTER. NIH tells us that there are going to be more 

than 800 applications—no, 656 fewer applications, fewer ideas submitted. I am worried that there may be some for breast cancer in 

that group or prostate cancer or Hodgkin’s. How can the crown 

jewel of the Federal Government—perhaps the only jewel of the 

Federal Government be cut in funds? 

Secretary LEAVITT. Senator, I want to tell you again I agree with 

you that funding new research ideas is a vital, important priority 

and that the fiscal year 2007 budget finances 275 more new grants. 

Now, one of the things you will see is that the actual number 

doesn’t reflect it because a lot of expiring noncompeting grants diminish the number. When we implemented the effort that you instigated in this committee to double the amount of funding, there 

was a huge amount of new grants. So, what we are in is the first 
82 

year where there are not as many non-competing continuation 

grants. 

Senator SPECTER. Well, there will be a lot of grant applications 

denied and a lot of existing grant applications denied. I get lots of 

letters, and one illustrates it from Pittsburgh—what am I going to 

do, Senator Specter, on the tremendous progress I am making if 

they are going to cut off the funding and the grant’s going to be 

withdrawn? Really, Mr. Secretary, this—these are not issues that 

can be handled within the purview of the funds which you are allocated. We are going to have to have a fundamental reassessment 

as to priorities. 

My red light just went on, but you—the red light doesn’t apply 

to you, Mr. Secretary, just to my questions. 

Secretary LEAVITT. I’d like to acknowledge that we are working 

to find opportunities for new investigators and for new innovations, 

and one of the things we are doing, frankly, is reevaluating the 

grants. After they have been concluded, then people must recompete. In some cases, there are research projects that simply don’t 

stack up to the opportunities because we have essentially been able 

to get the value from them that the peer review process believes 

would be to our advantage. So, we have begun to redeploy that into 

new grants. So, the actual number of new projects is higher than 

it appears because of the decline in the number of noncompeting 

grants. The red light’s on, and I am sensitive to it. 

Senator SPECTER. Well, I turn now to the second round for Senator Harkin, and I am anxious to see if he follows his customary 

pattern of having really tough questions in the second round. 

Secretary LEAVITT. I am going to watch that too. 

NIH FUNDING LEVELS

Senator HARKIN. You’re putting me on the spot here. Just to follow up on the distinguished chairman’s line of questioning on 

NIH—when we worked hard in a bipartisan fashion with so many 

others to double the funding for NIH, it was not meant to just double it and then reach a plateau and plateau off. We did this because for years, it had been underfunded, and we wanted to get it 

back up to where it had been maybe 25 years ago and continue the 

funding up. It was not meant to get it up and say oh, now we can 

level off. That’s what I see happening, and we are falling into the 

same pattern that we did 30 years ago when NIH all of a sudden 

had—it was getting out maybe 4 or 5 peer-reviewed grants per 

every 10 that came in—30 percent—40 percent—50 percent. Now, 

we are getting down to 10 percent again. So it’s like we’re 

plateauing off again. So we are going to do this, and 10 years from 

now when we are probably gone, somebody will be kind of like well, 

we’re going to have to double the funding again—not a good way 

to run things. So, I kind of plead with you use your counsels within 

the executive branch to tell them this is just not—this is not good. 

We—and I think that’s why we had so much support for the 

amendment that Senator Specter offered on the $7 billion. A lot of 

it had to do with we are not going to let NIH fall into that same 

rut again. Well, that’s a statement, and that’s not a question—darn 

it. Well, I had another statement too. 
83 

PANDEMIC INFLUENZA VACCINE

I won’t get into that, but on the flu vaccine, I do want to follow 

up a little bit on that. I have legislation in that would provide for 

a free flu shot for everyone every year—free flu—the Federal Government just provides a free flu shot. Now, why is that? Well, I am 

thinking about the vaccines and the—we have to get the infrastructure up for the pandemic flu that may—a lot of signs say is coming. 

As you point out, we have pandemics every so often. The infrastructure is not there to deliver it. So, if you had a free flu shot 

for everyone every year, not only do you save 35,000 lives a year 

perhaps or at least a good portion of those, you save a lot of hospitalizations, you save a lot of money if everyone got a free flu shot 

every year. Plus you get the States in to think about how you get 

it out there. You know, how do we start inoculating people in WalMarts and sporting centers, high schools, maybe even churches— 

after church or synagogue, they could get inoculated. In other 

words, to set up a system so that if a pandemic hits—bang, you 

have got it there and you can get it out. So I hope that you will 

take a look at that and see if there is any merit to getting a free 

flu shot for everyone out there, and I don’t know if you want to respond to that or not. 

Secretary LEAVITT. I’d love to respond just briefly. I believe one 

of the side benefits of our pandemic preparedness is the ability to 

take the annual flu vaccine dilemma off the table forever. 

Senator HARKIN. Yeah. 

Secretary LEAVITT. We will have to have new capacity developed 

and have it operating continually to keep our capacity warm—— 

Senator HARKIN. That’s right. 

Secretary LEAVITT [continuing]. The best thing to develop—— 

Senator HARKIN. That’s right. 

Secretary LEAVITT [continuing]. Would be new annual flu vaccine. 

Senator HARKIN. That’s right. 

Secretary LEAVITT. So, I fully believe that we will see substantial 

increases in the availability of annual flu vaccine. How we distribute it, what the cost is and so forth will be a matter of policy, 

but we do need to increase it. 

DISEASE PREVENTION

Senator HARKIN. Well, I appreciate that. I will continue to push 

that idea that we ought to just provide a free flu shot. It’s about— 

I estimated about—well, if you figure the flu shot’s about $10 for 

200 million people, that’s about $2 billion a year, but then the lives 

you save, the decrease in hospitalizations—maybe won’t cost that 

much, so you get a win on the other side. Let me follow up on Senator Craig’s comments. I told him when he walked out I was going 

to follow up on that, and I think I heard you say this was—your 

primary concern is to get prevention out there. When you mentioned the Medicare, that 8 percent GDP now going to 11 percent, 

the answer is not just to provide more drugs for the elderly Part 

D, and I don’t mean to get into that contest there, but the answer 

is just to start getting prevention earlier in life to our kids as they 

go through life. Now, you know I have been very concerned about 
84 

child obesity, diet-related chronic diseases, and one of the areas I 

am particularly interested in is the junk food marketing that targets kids—its impact. Last December, the IOM report, ‘‘Food Marketing to Children: Threat or Opportunity?’’ was released in December. It outlined a series of policy recommendations for government, the food and beverage industry, schools, parents—designed 

to limit junk food marketing and instead to utilize the power of 

marketing to promote healthier diets. What’s that got to do with 

you? Well, the final recommendation of IOM was for the Secretary 

of Health and Human Services to designate a responsible agency 

to formally monitor and report regularly on the progress of all of 

the recommendations in the report. On March 3 of this year, 14 

Members of the Senate wrote to you urging you to implement this 

final recommendation so that Congress can monitor the progress 

made or not made toward the goal to see whether we need to do 

something in that regard. Now again, I am not—don’t want to put 

you on the spot. We have not heard back from you, but that was 

only March—that was March 3. But again, Mr. Secretary, does 

HHS have any plans to take the action recommended by the Institute of Medicine to appoint a monitoring body on food marketing 

to children? If you don’t have that answer, just—— 

Secretary LEAVITT. I think I best respond to you—— 

Senator HARKIN. Respond to me. 

Secretary LEAVITT [continuing]. In writing. I have read about 

your concern about this, and I have begun to make inquiries as to 

what the current status is. 

[The information follows:] 

INSTITUTE OF MEDICINE POLICY RECOMMENDATIONS

Obesity prevention is one of my top priorities. I have asked Assistant Secretary 

for Health, Dr. John Q. Agwunobi, to work with all of the HHS agencies and offices 

to explore this issue in depth, and consider appropriate actions consistent with existing authorities and available resources. 

In addition, last year HHS and the Federal Trade Commission (FTC) sponsored 

a joint workshop on the effects of food marketing on children. On May 2, HHS and 

the Federal Trade Commission released a report titled ‘‘Perspectives on Marketing, 

Self-Regulation and Childhood Obesity’’ that recognizes that advertising and marketing can play a positive role in encouraging sound nutrition and physical activity. 

The report includes a series of recommendations for food companies and the entertainment industry to assist Americans in identifying more nutritious, lower-calorie 

foods; increase efforts to educate parents and children about nutrition and fitness; 

and to bolster the self-regulatory strategies that are currently employed to monitor 

the marketing of food and beverages to youth. In addition, the Council of Better 

Business Bureaus and the National Advertising Review Council recently announced 

the formation of a working group effort to review and propose changes to the Children’s Advertising Review Unit and its self-regulatory guidelines. 

Secretary LEAVITT. Senator, could I just make one other quick 

statement on a previous matter? 

Senator HARKIN. Sure. 

NIH RESEARCH

Secretary LEAVITT. I’d just like to acknowledge that—the commitment that I feel to maintain the momentum of the research we 

have going at NIH. I’ll probably be the only one who will say this 

is a good performance, but I have worked hard in a deficit reduction budget to make sure that we kept it at least flat. That is 

maybe good news only to me, but I wanted to tell you I have 
85 

worked hard on it and will continue to. I also believe that what Dr. 

Zerhouni is doing with respect to trans-institute projects with his 

Roadmap is a very important part of the future. I would like to see 

a greater percentage of the $30 billion that we spend there every 

year for research on inter-institute projects on basic science where 

all of the Institutes will benefit. I think that’s a more efficient way 

than simply allocating to whatever disease or body part institute 

it is to have their own project, and I would like at some point to 

work with this committee to create a means by which that could 

be accelerated. We need more cross-institute work. We need to 

have less siloed research, multidisciplined research is clearly where 

we will find success in the future. 

Senator HARKIN. I appreciate that. That’s good. 

COMPASSION CAPITAL FUND

Senator SPECTER. Thank you very much, Senator Harkin. Just 

one final question before we conclude the hearing—Mr. Secretary, 

I note that you and First Lady Laura Bush were in Pittsburgh to 

talk about the progress on the initiative in relating to gang control, 

a Capital Fund—Compassion Capital Fund program—antigang efforts through a community and faith-based organization back on 

March 7, 2005, and I would be interested to know what your thinking is on any progress there. The problem of gang warfare and 

shootings is epidemic and endemic. Just this morning, two teenagers were shot straight across from a high school in Philadelphia. 

The shootings are virtually a daily occurrence. Recently, there was 

a gunfight. Last week, two men were sentenced to life imprisonment for a massive gunfight outside an elementary school in February 2004 which killed a 10-year-old. Are the funds made available through this new program that you and First Lady Laura 

Bush announced having any significant impact? 

Secretary LEAVITT. We are nearing the point in our process of soliciting proposals. We have an obligation to come up and review it 

with the committee, and we intend to do that. I think at that point, 

we’ll be in a position to evaluate together the kinds of things those 

funds are being used for. We are quite optimistic about it and hopeful that we can continue the momentum of the program. 

Senator SPECTER. Well, the announcement was sometime ago— 

March 7, 2005. Have any grants been made under the program in 

the intervening 15 months? 

Secretary LEAVITT. We have not yet received proposals. We have 

an obligation to come to the committee to review them with you before we do that, and we will do so. 

Senator SPECTER. Well, we have put up a fair amount of money 

last year, and you are asking for $35 million more this year in a 

budget where there are cuts on some very vital programs, so we 

don’t want to keep those funds held in abeyance. If they can be directed effectively to juvenile gang problems, we want to do that. 

Secretary LEAVITT. Thank you. 

Senator SPECTER. But if the money is not going to be awarded 

so that we can see some positive results from those funds, we want 

to use them elsewhere. Mr. Secretary, thank you. 

Senator Harkin? 
86 

AGING SERVICES PROGRAMS

Senator HARKIN. There was one thing I just—thank you, Mr. 

Chairman—that I wanted to bring up before you left, Mr. Secretary. When we first met when you came into my office when your 

appointment was scheduled, one of the things I remember we 

talked about was Systems Change Grants. Shortly after the 

Olmstead decision by the Supreme Court, Senator Specter and I 

started working to provide funds to help States get deinstitutionalized or to prevent institutionalization, but get people to deinstitutionalize. The Olmstead decision said you know, we had to provide 

the least restrictive environment. So we started this program called 

Real Systems Change Grants, and we started putting money in it 

to implement these programs. I believe, from all that I have known 

about it, it has been a success year after year. But every year, we 

have to fight to put the money into it. Again this year, the budget 

eliminates funding for the grants again—once again, so we fight 

again to put it in. Now, I now read that you have a new program 

in the area—in the administration on aging called Choices for Independence. Your budget’s notes say, ‘‘It seeks to reduce the current 

systemic bias in favor of institutional care.’’ Well, that’s what we 

were doing under Systems Change Grants. So again, what’s the difference? Is this new program meant to replace it, to supplement it? 

I don’t understand, and what’s the difference between the two programs? Why would you eliminate the Systemic Change programs 

that we have been funding and now come up with this new program? 

Secretary LEAVITT. Our purpose is to continue a portion of it in 

the Administration on Aging. We do believe, as you have stated, 

the need for us to deinstitutionalize and to have people served in 

the communities and homes, and that’s the purpose. Perhaps we 

could provide you with more detail. 

Senator HARKIN. Well, provide me with more details because it’s 

not just aging. I mean, these are people with—a lot of the time 

physical disabilities, sometimes with mental disabilities, sometimes 

with both, but which has been proven that in many cases can live 

in a community setting. But a lot of times, it takes an initial expenditure made to get that done. After they get out, they’re fine. 

As you know, there is a bias in Medicaid. Medicaid will pay for 

someone to be in an institution, but that institution wants to live 

in a community, they don’t get that Medicaid support. 

Secretary LEAVITT. Something we’d like to change. 

Senator HARKIN. Well, I would like to change that too. That’s 

why we had this program. So I wish you would really look at that. 

We are mandated—Supreme Court mandated. We got to—they 

have got to deinstitutionalize. So, we need to change that bias in 

Medicaid, and I hope we can work with you to do that also to provide that, but I would like to know why this is different. You put 

it in aging, but it doesn’t just cover aging, it covers everybody else. 

If you don’t have it now—— 

Secretary LEAVITT. I have asked my staff to respond as quickly 

as possible. 

Senator HARKIN. I’d appreciate that. Thank you very much, Mr. 

Secretary. 
87 

Secretary LEAVITT. Thank you. 

[The information follows:] 

AGING SERVICES PROGRAMS

Thank you for this opportunity to clarify my remarks at the recent hearing. The 

Choices for Independence program ‘‘complements’’ the Real Choice Systems Change 

initiative. This is a very important distinction. Allow me to explain further how the 

two initiatives fit together. Since fiscal year fiscal year 2001, Congress has appropriated over $245 million for 

the Real Choice Systems Change (RCSC) Grants for Community Living. In implementing the RCSC program, the Centers for Medicare & Medicaid Services (CMS) 

has awarded over 297 grants to all 50 States, the District of Columbia (DC), and 

two territories. In fiscal year 2006, Congress appropriated an additional $25 million 

to fund a new round of RCSC grants. States and other eligible organizations, in 

partnership with their disability and aging communities, have the opportunity 

through RCSC to submit proposals to design and construct systems infrastructure 

that will result in effective and enduring improvements in community long-term 

support systems. These system changes are designed to enable children and adults 

of any age who have a disability or long-term illness to: 

—Live in the most integrated community setting appropriate to their individual 

support requirements and preferences; 

—Exercise meaningful choices about their living environment, the providers of 

services they receive, the types of supports they use, and the manner by which 

services are provided; and 

—Obtain quality services in a manner as consistent as possible with their community living preferences and priorities. 

As one component of their RCSC efforts, beginning in fiscal year 2003, CMS 

began partnering with the Administration on Aging (AoA) to fund States to develop 

Aging and Disability Resource Centers (ADRC) to streamline access to long-term 

supports for people with disabilities of all ages. Simplified access to services, as represented through the ADRC initiative, is a key element of a State’s overall systems 

change efforts. AoA resources for the ADRC initiative have come from the Older 

Americans Act Title IV Discretionary funding. 

Choices for Independence builds on the Older American’s Act unique mission, to 

help our Nation prepare for the aging of the baby boom generation. Like the Real 

Choice grants, Choices addresses issues facing Americans who need comprehensive 

home and community-based systems of long-term care to delay or avoid nursing 

home placement. Choices for Independence, like RCSC, is designed to promote home 

and community-based care. Choices will focus mainly on linking Older Americans 

with available services, improving consumer-directed care, promoting evidence-based 

disease prevention, and targeting individuals not yet eligible for Medicaid to help 

prevent them from spending down to eligibility. In this way, Choices will complement the work that Real Choice grants have so effectively begun to improve longterm care (LTC) service delivery systems at the State level. In fiscal year 2007, as 

CMS works to implement the Deficit Reduction Act of 2005 (DRA), they will continue working with States to reform their LTC delivery systems by building on the 

successful aspects of Real Choice Systems Change grants. 

The fiscal year 2007 budget for AoA essentially folds ADRCs into the Choices for 

Independence initiative. The fiscal year 2007 budget includes $28 million for 

Choices for Independence, including an estimated $12.5 million for ADRCs; at the 

same time, CMS is requesting no new funding for Real Choice Systems Change 

grants. After 5 years, these grants have made great strides in helping States make 

improvements to their home- and community-based health care delivery service systems. The initiative provided useful lessons that led to the development and implementation of the Money Follows the Person demonstration (focus is consumer-directed care) as well as the State plan options for home- and community-based services in the Deficit Reduction Act (DRA). While Choices for Independence does not 

currently assume funding from other agencies, AoA will continue to work closely on 

this initiative with CMS and the other HHS agencies that have been involved in 

the activities that led to its development. 

Senator SPECTER. Thank you very much, Secretary Leavitt. 

Thank you for what you are doing on the pandemic problem, and 

I urge you to do more on acquainting America with the nature of 

the worst-case scenario—how serious it could be and what people 

ought to be doing individually—and your efforts to stir up activity 
88 

by state and local agencies to deal with the problem. I would appreciate your assistance, your thought on what we can do about these 

budget shortfalls and about what can be done on advocacy within 

the administration, within the Office of Management and Budget 

which has the final word here and really with the President himself. I think that there is not a recognition as to what this means 

on a lot of very difficult very important agencies like the Centers 

for Disease Control and Prevention. These cuts on so many of the 

health agencies are just unacceptable. We can’t solve that this 

morning, and you can’t solve it, and there may be—have to be some 

action on Congress somewhere to find something that can give so 

these cuts are not implemented. Thank you. 

ADDITIONAL COMMITTEE QUESTIONS

Senator SPECTER. There will be some additional questions which 

will be submitted for your response in the record. 

[The following questions were not asked at the hearing, but were 

submitted to the Department for response subsequent to the hearing:] 

QUESTIONS SUBMITTED BY SENATOR ARLEN SPECTER

HEALTH PROFESSIONALS TRAINING

Question. Mr. Secretary, I am disappointed that the budget proposal again eliminates funding for health professions training at HRSA, particularly those programs 

focused on diversity. Why does the administration continue to neglect these programs which play such a vital role in the education of young minority students in 

the health professions? What do we need to do to get the administration to match 

the support for these programs that exists in the Congress? 

Answer. The administration prioritizes the distribution of health professionals by 

maintaining funding for the Nation Health Services Corps, which places physicians 

in underserved areas, at $126 million. There is no longer a supply problem for physicians. Improving access to health care takes a commitment to improve the distribution of health care providers so that they are serving in areas where there are 

unmet or under-met healthcare needs. Programs that place people in the communities that need them is the best investment. In fiscal year 2005, only 16 percent 

of health professionals supported by the Health Professions program entered practice in underserved areas. 

MEDICARE ELECTRONIC PAYMENTS

Question. The President’s budget includes a proposal to save $133 million in Medicare by requiring all providers to accept electronic payments, submit electronic 

claims, and accept more electronic remittance advices. These savings are dependent 

upon virtually all providers doing this by October 1, 2006. While I laud the goal of 

increasing Medicare electronic transactions, I question how realistic this is given 

that the majority of providers in our Nation are in small practices or are solo practitioners. Many of these providers may not have computers in their office or may be 

reluctant to give up paper. If the savings are not realized, Medicare claims processing contractor budgets will be shortchanged in fiscal year 2007. Given that CMS 

recently instructed its claims processing contractors to institute a hiring freeze on 

both new and replacement hires, which I understand could last through the remainder of this year, and possibly into 2007 in order to address current budget shortfalls, 

I am concerned with any proposal which could put their funding situation in further 

jeopardy. How does CMS intend to implement this proposal and achieve the estimated Medicare savings? What will the Agency do if the goal is not realized and 

the savings are not achieved? 

Answer. Senator, I appreciate your interest in our administrative processes. This 

proposal to save $133 million is part of an overall effort to modernize Medicare operations and administer this program more efficiently. We are working as expeditiously as possible to implement the proposal in 2006. It builds on laws that have 

already been in effect for several years including the Debt Collection Improvement 

Act (Public Law 104–134) which requires the government to issue payments elec-
89 

tronically, and the Administrative Simplification Compliance Act or ASCA (Public 

Law 107–105) which requires most providers to submit Medicare claims electronically. 

CMS acknowledges that certain providers are exempt from the requirement to 

submit electronic claims and will continue to allow these providers to submit paper 

claims. However, CMS has asked the Medicare contractors to review providers submitting paper claims to see if they are actually entitled to the ASCA exemption. We 

expect that these reviews will contribute to the savings that CMS expects to realize 

next year. In addition, CMS has been taking a broad look at the full range of 

claims-related activities to see which could be streamlined or consolidated. For example, the Medicare contractors currently send beneficiaries a monthly Medicare 

Summary Notice (MSN) listing services provided. A few of these MSNs include a 

check to the beneficiary but most do not involve payment. CMS believes it could 

save between $15 and $30 million by sending these ‘‘no pay’’ MSNs quarterly, or 

maybe semi-annually, instead of monthly. Another potential area for saving resources without placing additional burdens on providers or the Medicare contractors 

is to require those providers who already bill electronically to receive other claimsrelated Medicare information and outputs electronically as well. CMS believes that 

it may be able to save $10 million from this initiative. While there are substantial 

amounts at stake, CMS is confident that it can become more efficient without jeopardizing the Medicare contractors’ operations or burdening the providers. 

MEDICARE INTEGRITY PROGRAM

Question. CMS partners with private entities to administer the Medicare fee-forservice program. In addition to paying Medicare claims, handling appeals and answering beneficiary and provider inquiries, these contractors are the first line of defense against Medicare fraud and abuse. Unfortunately, the Medicare Integrity Program (MIP)—which is the portion of the budget that funds these critical anti-fraud 

activities—has been capped by statute since fiscal year 2003. I am pleased the 

President’s fiscal year 2007 proposal supports an increase for Medicare Part A and 

B Program Integrity efforts. However, I am concerned with funding for these activities this year. While I understanding there are no new dollars right now, I believe 

it is important to find ways for these contractors to operate more efficiently and effectively. One way to do this is for CMS to give these contractors greater flexibility 

to manage their MIP budgets. Currently, the Agency does not allow its contractors 

to transfer funds among MIP program lines if the total funds to be transferred exceed 5 percent of the total funding. In these cases, the contractors must request approval from CMS, which can take months and exacerbate funding problems. This 

Committee included report language in our fiscal year 2006 spending bill urging 

CMS to give its contractors this much needed budget flexibility. While CMS has 

granted its contractors flexibility to manage their program management budgets, 

they have not done so for MIP. Given the tight budgets contractors are currently 

facing with MIP dollars, will you consider giving these contractors greater flexibility 

so they can best manage their budgets to match programmatic needs? 

Answer. Although you are correct that the Health Insurance Portability and Accountability Act of 1996 (HIP AA) capped MIP funding at fiscal year 2003 levels, 

Congress provided an additional $100 million in 1-year mandatory funding for fiscal 

year 2006 in the Deficit Reduction Act of 2005 (DRA) for the new Parts C and D 

workloads. As you stated, the fiscal year 2007 President’s budget includes a proposal 

to increase MIP funding over the fiscal year 2003 capped level by $85,634,000 in 

discretionary funding. 

CMS requires all five major MIP functions (Medical Review, Benefit Integrity, 

Provider Education & Training, Provider Audit, and Medicare Secondary Payer) in 

order to have a robust arsenal in the fight against fraud, waste, and abuse. As you 

have noted, CMS is limited in its ability to shift MIP funds since we must ensure 

that a multi-faceted approach is maintained. In the last couple of years, CMS has 

increased this flexibility somewhat for the MIP contractors. For example, workload 

levels in Medical Review and Local Provider Education & Training (LPET) are scalable to a certain extent. During the budget formulation process, contractors determine the type and level of effort they will be able to provide given the available resources. As problem areas/issues surrounding their respective providers change, the 

contractors can revise their Medical Review and LPET strategies and shift the funding between the two functions as necessary. 

As a matter of routine, CMS expects the contractors to keep the agency informed 

of their changing resource requirements before they are in a deficit situation. CMS 

is then able to work with the contractors to identify workloads that can be altered 
90 

or areas with surplus funding that can be shifted while still achieving CMS’ goals 

and objectives. In limited cases, CMS is even able to provide additional funding. 

OFFICE OF MINORITY HEALTH

Question. Mr. Secretary, I am concerned that the budget proposal reduces funding for the Office of Minority Health by $10 million. In the face of a widening health 

status gap, how does the administration justify significantly reducing the budget of 

an office who’s mission is to lead the Department in the elimination of health disparities. 

Also, in the fiscal year 2006 bill, the legislation calls for a renewed focus on 

OMH’s support for historically black medical schools. Can you tell me the status of 

this effort? 

Answer. The Office of Minority Health (OMH), part of the Office of Public Health 

and Science (OPHS) in the Office of the Secretary, advises both the Secretary and 

OPHS on public health program activities affecting racial and ethnic minority populations. The fiscal year 2006 appropriation for OMH included a one-time congressional earmark in the amount of $10 million, which was not continued in the fiscal 

year 2007 President’s budget. 

OMH recognizes the important role that historically black medical schools play in 

increasing minority representation in the healthcare workforce, and in providing 

needed services to minority communities. Therefore, OMH encourages minority 

serving institutions of higher education (including historically black medical schools) 

to apply for grant programs supported by the Department of Health and Human 

Services (HHS). In fiscal year 2006, OMH has received proposals from three historically black medical schools; these proposals are currently under review for funding 

consideration. In addition to its own support, OMH is also working with other HHS 

Operating Divisions to enhance Departmental opportunities to support these institutions. 

NIH SLEEP DISORDERS CONFERENCE REPORT

Question. Mr. Secretary, during the National Institutes of Health’s Frontiers of 

Knowledge in Sleep and Sleep Disorders conference in March 2004, Surgeon General 

Carmona gave remarks on the profound impact that chronic sleep loss and untreated sleep disorders have on all Americans and that dissemination of the existing 

body of medical knowledge regarding sleep and sleep disorders is critically important. What are the prospects for development of a Surgeon General’s Report on 

Sleep and Sleep Disorders? 

Answer. The Office of the Surgeon General (OSG) is studying this topic as a potential subject for a Surgeon General’s Workshop or Surgeon General’s Conference. 

In addition to the comments he made at the March 2004 NIH conference on Sleep 

and Sleep Disorders, Surgeon General Carmona also provided information regarding 

healthy sleep habits in a December 29, 2005, press release, ‘‘Tips for Parents of 

Teenagers,’’ as part of The Year of the Healthy Child. In March 2006, OSG staff 

attended a scientific workshop on ‘‘Sleep Loss and Obesity: Interacting Epidemics’’ 

to gather more information and identify leaders in this field. In addition, OSG staff 

members have met with medical intern and resident advocates to discuss their prolonged work hours, and the potential impact on patient safety brought about by 

sleep loss in this population. 

UNDERAGE DRINKING PREVENTION

Question. In February, the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD), led by SAMHSA, released ‘‘A Comprehensive 

Plan for Preventing and Reducing Underage Drinking.’’ The plan sets three performance targets for 2009: reducing the prevalence of past month alcohol use by those 

aged 12–20 by 10 percent; reducing the prevalence of those aged 12–20 reporting 

binge alcohol use in the past 30 days by 10 percent; and increasing the average age 

of first use from 15.6 to 16.5. These are modest goals, and they expire in just 3 

years. It is well recognized, however, that reducing underage drinking will take a 

concerted effort over many years—certainly more than 3—and no one should be satisfied with 10 percent reductions. Why didn’t ICCPUD set more ambitious, longerterm targets? Would you consider doing so in your next annual report? 

Answer. The targets set forth in the Comprehensive Plan for Preventing and Reducing Underage Drinking are ambitious, yet achievable, particularly considering 

underage drinking rates have remained essentially unchanged for over a decade. 

The targets in the plan, which are to be measured over the 5 year period from 2004 

to 2009, represent an ambitious first step in addressing what has been a serious 

and persistent problem in our country. It is relevant to note that Mothers Against 
91 

Drunk. Driving (MADD) has recently adopted targets that are in the same range, 

including a 3-year goal of reducing the proportion of 16 to 20 year olds who drink 

alcohol and/or engage in high risk drinking by 5 percent by 2008. 

While the Interagency Coordinating Committee on the Prevention of Underage 

Drinking (ICCPUD) and SAMHSA believe that the current 5-year performance targets set forth in the plan are ambitious, these targets will be revisited during the 

development of the next annual report. 

Question. One of the expected benefits of forming the ICCPUD was that it would 

result in fewer duplicative efforts in the area of underage drinking. The idea was 

that as the many Federal agencies with a stake in this problem learned about each 

other’s efforts, they would discover where their efforts overlap and, as a result, 

eliminate redundancies. Has this occurred? Can you provide concrete examples in 

which agencies have streamlined their anti-drinking activities? 

Answer. Since the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD) was created in 2004, the member agencies have worked 

together to conduct an inventory of Federal underage drinking programs, develop 

the Comprehensive Plan for Preventing and Reducing Underage Drinking and annual report, support a national meeting of the States, support town hall meetings 

across the country, and create a government-wide website. Through these activities, 

the member agencies have gained a greater understanding of the science related to 

underage drinking, as brought to the group by the National Institute on Alcohol 

Abuse and Alcoholism (NIAAA), and have enhanced their understanding of each 

other’s activities. 

The ICCPUD agencies are using this .knowledge to support each other’s activities, 

as exemplified by the recent town hall meetings funded by SAMHSA. These meetings were used to distribute research developed by NIAAA, and were strongly supported by a number of key ICCPUD partners, including the Office of Juvenile Justice and Delinquency Prevention (OJJDP), the Office of Safe and Drug Free Schools 

(OSDFS), and the National Highway Traffic Safety Administration (NHTSA). Several of these agencies encouraged their regional and State counterparts to support 

and participate in the Town Hall meetings. NHTSA used the meetings broadly to 

encourage the use of the HBO documentary, SMASHED: Toxic Tales of Teens and 

Alcohol and its accompanying educational package to facilitate and stimulate dialogue about future evidence-based underage drinking prevention action in local communities. 

The Centers for Disease Control and Prevention (CDC) and SAMHSA Center for 

Substance Abuse Prevention (CSAP) were both considering alcohol epidemiological 

activities in the States. As a result of work with ICCPUD, each agency became 

aware of the others’ plans and avoided duplication of effort. CDC contributed to the 

development of the request for proposals issued by CSAP. This collaboration ensured that the CSAP funded program will be consistent with CDC’s efforts. 

Question. It is my understanding that the Surgeon General intends to issue a 

first-ever ‘‘Call to Action’’ on underage drinking prevention sometime this spring. 

What is the status of the ‘‘Call to Action’’ and its expected release date? 

Answer. A Call to Action working group has developed a draft Call to Action, 

which will be reviewed by the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD) member agencies in addition to the Department of Health and Human Services. The Surgeon General is committed to releasing the Call to Action at the earliest possible time. 

PANDEMIC INFLUENZA PREPAREDNESS

Question. Congress has appropriated $350 million for assistance to the States and 

localities for pandemic preparedness. The goal of that program is to assure that all 

localities meet a minimal level of preparedness. Is the Department planning to create a single, core set of performance standards that all jurisdictions must strive to 

achieve with these funds? 

Answer. As part of the Public Health Emergency Preparedness Cooperative Agreement, CDC in conjunction with State and local public health agencies and laboratories, national partner organizations, and Federal agencies, developed performance 

measures for overall public health preparedness. These measures are for all-hazards, including pandemic influenza. 

Question. As part of the initial ($100 million) funding that the Department is allocating to localities for preparedness, grantees are expected to perform some kind of 

preparedness exercise. Will the Department be reviewing the after action reports 

from these exercises? And if so, what resources (financial and personnel) has the 

Department set aside to provide technical assistance to the States to help them 

mitigate the deficiencies found in these exercises? 
92 

Answer. All States submitted draft pandemic influenza preparedness and re- sponse plans to CDC in July 2005. As part of the $100 million emergency supplemental funding, the Department, primarily through CDC project officers and Subject Matter Experts, will assist in developing, conducting, and evaluating various aspects of the pandemic influenza plans through the use of exercises. As part of the 

award of the remaining $250 million in pandemic influenza supplemental funding, 

States will receive funds to ‘‘fill gaps’’ identified during the initial round of support. 

‘‘Gaps’’ will be identified through two processes: first, by analyzing a comprehensive 

assessment conducted by local health departments measuring the many components 

of comprehensive influenza preparedness, and second, by analyzing results of exercises. Ongoing technical assistance will by provided by CDC. 

Question. How much of the $350 million has been released to the States and localities? By when does the Department expect these jurisdictions to have spent the 

funds? When will the remaining $250 million be made available to the States and 

localities? Is there an expectation that the total $350 million must be obligated or 

expended by the end of fiscal year 2006? If so, is this a realistic expectation? Answer. States were awarded $100 million on March 7, 2006 to conduct planning 

for pandemic influenza preparedness. Eighty percent of those funds were restricted 

pending receipt of their supplemental applications. The applications have been received and evaluated and CDC is in the process of releasing many of the restrictions. We anticipate releasing most of the remaining restrictions by May 17, 2006. 

The remaining $250 million will be awarded later this summer. CDC does not anticipate that all funds will be expended by the end of the budget period. Recipients 

of funding may request for consideration that carryover funds to be awarded the 

next budget year. 

Question. Given that one of the most critical aspects of preparedness will be the 

ability of local jurisdictions to rapidly distribute a pandemic vaccine, will the Department encourage States to organize mass vaccination exercises during the next 

flu season to test their distribution plans? If so, will the Department allow the 

States to use a portion of the $350 million to purchase annual flu vaccine? 

Answer. States are permitted to use Public Health Emergency Preparedness cooperative agreement funds to purchase vaccine in limited quantities for conducting 

drills and exercises. They are not permitted to purchase vaccine with the emergency 

supplemental funding for pandemic influenza preparedness. However, they may use 

some of these emergency supplemental funds during the influenza season as an opportunity to exercise mass vaccination plans. 

PANDEMIC INFLUENZA VACCINE

Question. The U.S. Government will be contributing to the expanded production 

capacity of several manufacturing companies, who will use that capacity to produce 

and market seasonal flu vaccine in the absence of a pandemic. Given this unprecedented public investment in private corporations, is the Department taking steps to 

assure that the price charged public programs (e.g., Medicaid, Medicare) for seasonal flu vaccine is reflective of this investment? 

Answer. Our goal is to be able to produce enough vaccine for every American 

within 6 months of a pandemic outbreak. To accomplish this goal, we have focused 

our efforts on developing a cell-based vaccine for influenza. Without this investment 

in new technologies, we will not be able to produce enough vaccine in the event of 

a pandemic. Another key element of our plan is to ensure that manufacturers expand capacity in the United States. It is our hope that these manufacturers will 

produce seasonal influenza vaccine in the absence of a pandemic, allowing us to provide coverage to more Americans. 

PANDEMIC INFLUENZA SURGE CAPACITY

Question. Which HHS agency is in charge of assuring States and localities create 

the surge capacity for treating people who become ill during a pandemic? 

Answer. The Office of Public Health and Emergency Preparedness (OPHEP) is the 

lead office in HHS for ensuring that States and localities create the surge capacity 

for treating people who become ill during a pandemic. OPHEP works closely with 

both HRSA and CDC to ensure that funding through the State and local cooperative 

agreements enhance surge capacity and pandemic influenza preparedness. 

Question. Is the Department providing specific guidance and performance measures with respect to creating surge capacity? Has the Department estimated the cost 

of creating a minimum level of surge capacity? 

Answer. An influenza pandemic in a large number of communities simultaneously 

would make the need for expanded medical surge capacity critical. The 2005 cooperative agreement guidance for the Health Resources and Services Administration 
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(HRSA) National Bioterrorism Hospital Preparedness Program provided performance benchmarks on surge capacity, including influenza. Specifically, grantees are 

required to establish systems that, at a minimum, can provide triage treatment and 

initial stabilization, above the current daily staffed bed capacity, for the following 

classes of adult and pediatric patients requiring hospitalization within 3 hours in 

the wake of a terrorism incident or other public health emergency—500 cases per 

million population for patients with symptoms of acute infectious disease—especially 

smallpox, anthrax, plague, tularemia, and influenza. 

In addition, the National Strategy for Pandemic Influenza Implementation Plan 

released on May 3, 2006, includes guidance to Federal departments and agencies, 

State and local government, the private sector, and the public about how to prepare 

for a pandemic. With respect to surge capacity, the plan includes a number of actions (with performance measures) on which HHS will collaborate with our partners 

at the Federal, State, local, and tribal levels and in the private sector. These include 

developing protocols for changing clinical care algorithms in settings of severe medical surge (action 6.3.4.1), strategies for and protocols for expanding hospital and 

home health care delivery capacity (action 6.3.4.2), policies and protocols for emergency reimbursement or enrollment in Medicaid and State Children’s Health Insurance Program that are appropriate for a pandemic (action 6.3.4.3), and ensuring 

that Federal medical assets are prepared to deploy to augment State and local capacity (actions 6.3.4.3 to 6.3.4.7). The Department is currently preparing the plan 

to implement these actions within the timelines specified in the National Strategy 

for Pandemic Influenza Implementation Plan. 

PANDEMIC INFLUENZA PREPAREDNESS PLAN IMPLEMENTION

Question. While significant funds are being invested in preparedness, when a pandemic hits the costs for Federal, State, and local governments will be significantly 

higher. Has the Department made an estimate of what the cost would be to implement its pandemic preparedness plans? For example, is there an estimate for what 

the actual pandemic flu vaccine will cost once it is available? Has the Department 

asked States and localities to estimate the costs of responding to the pandemic, as 

opposed to planning for one? 

Answer. It will be difficult to estimate with certainty the costs of implementing 

our pandemic influenza plans because each State and local preparedness plan is 

unique and because we do not know if we will be responding to a mild or severe 

pandemic. We are currently focusing our efforts on preparing for a pandemic to mitigate costs during an outbreak by ensuring enough vaccine for every American six 

months after human-to-human transmission, enough antivirals for 25 percent of the 

population, and. a stockpile of 20 million courses of pre-pandemic vaccine: We are 

also enhancing domestic and international surveillance to quickly detect a pandemic 

to slow its spread. We are working closely with States and local communities as 

they plan for a pandemic and to exercise those plans. 

UNINSURED ACCESS TO PANDEMIC INFLUENZA TREATMENT

Question. Hospitals and other health care providers will bear the brunt of costs 

associated with a pandemic. During a pandemic we need to make sure that those 

who are uninsured are not deterred from seeking necessary care as early as possible. At the same time we don’t want hospitals to have even higher levels of uncompensated care that could threaten their long-term financial viability. Has the Department considered what policies and funding might be needed to address this 

problem? 

Answer. As described in the National Strategy for Pandemic Influenza Implementation Plan, HHS will work with State Medicaid and SCHIP programs to ensure 

that Federal standards and requirements for reimbursement or enrollment are applied with the flexibilities appropriate to a pandemic, consistent with applicable law. 

In addition, we are also examining the recommendations of Federal Response to 

Hurricane Katrina: Lessons Learned report to determine what policies might be 

needed to respond to public health emergencies, including a pandemic. 

PANDEMIC INFLUENZA RESPIRATOR MASKS

Question. Last week the Institute of Medicine issued a report saying the respirator masks and surgical masks should not be re-used. The report also suggested 

that, as part of a larger strategy of infection control, N–95 respirator masks would 

offer some protection of health care workers. The WHO recommends use of these 

masks in a health care setting. How many N–95 masks does the United States now 

have stockpiled? How many N–95 masks are on order for the stockpile? Does the 

Department have an estimate of how many masks would be needed in the 
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healthcare system during a pandemic, when manufacturing and distribution of such 

masks may be hard to accomplish? 

Answer. The Strategic National Stockpile has approximately 9.1 million N–95 

masks on hand and 98.4 million N–95 masks on order. The Centers for Disease Control and Prevention estimates that up to 1.5 billion surgical masks and over 90 million N–95 respirators would be needed for the healthcare sector in the event of a 

severe pandemic. HHS purchased 150 million surgical masks and N–95 respirators 

in fiscal year 2006. The Federal Government, States, and the private sector share 

responsibility in ensuring an adequate level of preparedness. States have access to 

funding from Health Resources and Services Administration’s (HRSA) National Bioterrorism Hospital Preparedness Program to address these surge capacity needs. 

MEDICARE INTEGRITY PROGRAM

Question. The Congress has provided significant funding, both mandatory and discretionary, to help CMS combat the unacceptably high payment error rate in the 

Medicare and Medicaid programs—literally hundreds of millions of dollars even 

after you have made some progress in reducing the error rate. Reportedly, over 90 

percent of the Medicare Integrity Program funds, $720 million per year have been 

diverted to fiscal intermediaries and carriers doing routine claims processing, leaving about $50 million per year for the targeted error rate reduction contracts. What 

is the rationale for this diversion of resources from fraud and abuse activities? 

Answer. MIP funds are not used by fiscal intermediaries and carriers in the performance of routine claims processing. Separate funding under the Program Management account is set aside for that purpose. These contractors, however, have historically been the first line of defense in the fight against fraud and abuse. Under 

the MIP, they have conducted medical review, fraud review, cost report audit, provider education and other activities identified in the statute. All of these activities 

are intended to insure that payments are made properly and that inappropriate 

payments are recovered. Under the medical review/local provider education program, FIs and Carriers are evaluated on their ability to reduce the improper error 

rate. 

Additionally, a significant portion of the $720 million in MIP funding is used by 

a host of specialty contractors, most notably the Program Safeguard Contractors, 

whose sole focus is fraud and abuse activities. 

MEDICARE IMPROPER PAYMENTS

Question. The Congress just appropriated $100 million this year for fraud and 

abuse activities in the new Part D prescription drug program. What are the Department’s plans for using this money to address payment errors in the Part D program? When do you intend to commit funds this fiscal year? 

Answer. The $100 million appropriated in the Deficit Reduction Act (DRA) will 

be used for many different purposes to maintain the integrity of the prescription 

drug benefit and fight against fraud and abuse from all sources. CMS is in the process of committing the funds provided in the DRA and plans on using all of the funds 

by the end of the fiscal year. 

CMS has developed a comprehensive plan for a Part D oversight program building 

off the approach that has worked successfully for Part A and Part B. CMS has established this plan in an effort to ensure that the funding provided in the DRA will 

help to combat fraud, waste, and abuse associated with the new prescription drug 

benefit. We have included strong safeguards in areas where we identified 

vulnerabilities, including eligibility, the bidding process, beneficiary plan, and retail 

pharmacy fraud, incentives to reduce cost and cost sharing, formulary development 

(kickbacks), and misuse of Part D beneficiary lists. This program will ensure that 

Part D contractors and other program stakeholders meet all applicable statutory, 

regulatory and program requirements. 

CMS is expanding its efforts in fighting fraud and abuse in Medicare by using 

State of the art systems designed to prevent problems and maintain integrity for 

the new Medicare prescription benefit. A portion of the funding appropriated in the 

DRA will be used to develop and/or maintain the following program integrity systems: 

—Risk Adjustment System (RAS).—The system intended to vary the Federal share 

of premiums based on factors that are beyond the control of the drug plan; 

—Medicare Advantage Prescription Drug (MARx) System.—A stand alone system 

that will include the processing of all enrollment/disenrollment transactions associated with the Part D Program; 
95 

—The Drug Data Processing System (DDPS).—The system that collects, maintains, and processes information on all Medicare covered and non-covered drug 

events for Medicare beneficiaries participating in Part D; and 

—The Medicare Beneficiary Database (MBD).—The database that houses Medicare beneficiary enrollment information. 

CMS has contracted with program integrity contractors, known as Medicare Drug 

Integrity Contractors (MEDICs), to assist the Agency in overseeing the Medicare 

Part D program. Part of the $100 million will be used to establish and support three 

MEDICs in the regions, in addition to the Eligibility and Enrollment MEDIC that 

began on November 15, 2005. The MEDIC contractors will: 

—Analyze data to find trends that may indicate fraud or abuse; 

—Begin to investigate potential fraudulent activities surrounding enrollment, the 

determination of eligibility, or the delivery of prescription drugs; 

—Investigate unusual activities that could be considered fraudulent as reported 

by CMS, contractors, or beneficiaries; 

—Conduct fraud complaint investigations; and 

—Develop and refer cases to the appropriate law enforcement agency as needed. 

In addition, CMS will support compliance activities to combat fraud, waste, and 

abuse in association with the drug benefit. These efforts will include the following 

strategies: (1) Part D compliance monitoring; (2) accreditation organization validation studies for Medicare Advantage plans; (3) Part D auditing; (4) other compliance 

and monitoring strategies; and (5) compliance and oversight training for Medicare 

Advantage plans. 

CMS continues to work to ensure the integrity and validity of the data for the 

prescription drug benefit. The funding provided in the DRA will be used to monitor 

and evaluate prescription drug plans and Medicare Advantage plans to maintain 

data integrity. CMS’ monitoring activities will include reviewing the plans’ pricing 

and formulary to ensure that they follow the guidelines that have been established. 

In addition, CMS will review the data by performing payment validation of the 

plans. 

CMS will also use part of the $100 million to comply with the improper Payments 

Information Act of 2002 (IPIA). CMS is building on its current program integrity 

efforts by implementing new steps to analyze program data to detect improper payments and potential areas of fraud and abuse in the Medicare and Medicaid programs more quickly and accurately. CMS is using these analyses to more effectively 

educate providers and beneficiaries about ways to prevent and minimize waste, 

fraud, and abuse. CMS’ program integrity efforts are being expanded beyond feefor-service Medicare to encompass oversight of Part D prescription drug benefit and 

the new Medicare Advantage plans. 

The last activity that will be supported by the funding provided in the DRA are 

audits. These audits will include financial audits of at least one-third of all Part D 

organizations’ financial records including bids, data relating to Medicare utilization 

and allowable costs as mandated in the MMA. In addition, CMS will use the funding to audit one-third of the Medicare Advantage plans for adjusted community 

rates and perform various cost plan audits. 

Question. The fiscal year 2006 Senate bill and conference report encouraged CMS 

to move forward on a $3 million demonstration of the use of data fusion technology 

to detect payment error and fraud and abuse in the Medicare program. We understand that the agency is moving forward with a data fusion and analysis project to 

identify improper payments to providers from Medicare using data sources outside 

of current fraud recovery efforts. What can you do to get this program moving forward more quickly? 

Answer. CMS will be competing contracts among the MEDICs to support and develop the Integrated Data Repository and an overall data infrastructure to support 

CMS fraud, waste and abuse efforts. This effort requires significant resources and 

will be funded with the $3 million referenced in the Senate and conference reports 

and through the 1 year MIP funding provided in the DRA. We anticipate that this 

effort will integrate Medicare fee-for-service data, prescription drug data, and Medicaid data into one central repository. 

CMS—STATUS OF QUALITY DEMONSTRATION PROJECT

Question. Mr. Secretary, last year alone there were over 1.3 million new cases of 

cancer diagnosed in America—I can’t think of a single family who hasn’t had a 

friend or family member affected by this terrible disease. The status quo is simply 

not acceptable. The last 2 years your department has taken targeted regulatory action to prevent any access disruption through a demonstration project to support the 

development of quality-based payment policy. I strongly urge you to continue this 
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important program and begin to move towards a permanent funding solution that 

will preserve patient access to community cancer care. Do you have any updates for 

the committee as to the status of the quality demonstration project? 

Answer. CMS is very focused on creating a payment system that offers better support for the delivery of high-quality, low-cost care as well as improving the benefits 

available to America’s seniors to prevent disease complications and live longer 

healthier lives. CMS has worked closely with the AMA, AQA, and MedP AC among 

others to develop consistent and effective ways to measure the quality of care. 

We believe the oncology community is pleased with the improvements made in 

this year’s oncology demonstration project. This project will enable us to capture 

more specific information about cancer patients including their treatments and 

whether current cancer care represents best practices and is provided in accordance 

with accepted practice guidelines. 

After reviewing this year’s data, we will be able to make decisions about the continuation of the demonstration project and what additional improvements or modifications are necessary for 2007. 

CMS—ADEQUATE PROVIDER REIMBURSEMENT

Question. Mr. Secretary, when it enacted MMA, Congress established ASP as the 

reimbursement metric for prescription drugs covered under Part B of Medicare. My 

concern is that CMS has continued to resist using its administrative discretion to 

correct an ASP calculation problem that thwarts the clear legislative intent underlying the shift to ASP-based reimbursement. I am referring to CMS’s insistence that 

it cannot exclude the prompt pay discounts that manufacturers give wholesalers 

from the calculation of ASP because the term ‘‘prompt pay discounts’’ appears in the 

list of price concessions that the statute says are to be netted out when ASP is calculated. 

Wholesaler prompt pay discounts reward the timely completion of the wholesaler’s 

product purchase from the manufacturer, constitute an integral part of the revenues 

received by wholesalers for their services, and, in my experience, are not passed on 

to the wholesalers’ customers. By insisting that wholesaler prompt pay discounts be 

netted out of ASP, CMS has undermined Congress’ intent that payment at ASP∂6 

percent should cover physicians’ drug acquisition costs, allow for a reasonable level 

of pricing variability in the nationwide drug market, and provide compensation for 

drug-related costs that are not separately reimbursed. In essence, by requiring the 

inclusion of wholesaler prompt pay discounts in the ASP calculation, CMS has converted physician payments for Part B drugs from the congressionally mandated 

level of ASP∂6 percent to the lesser amount of ASP∂4 percent. 

Based on the statute and congressional language offered at the time of its adoption, what is CMS’ interpretation of congressional intent with regard to adequate 

provider reimbursement for drug reimbursement, and the application of the prompt 

pay discount to that reimbursement for oncology services? 

Answer. The Congress defined the ASP to be an average measure of sale prices 

across a broad range of classes of trade and, therefore, established that payments 

to providers represent average drug acquisition costs and not the actual cost experienced by a particular provider or specific class of trade. Further, in establishing that 

the payment rates are 106 percent of the ASP, Congress established a corridor 

above the average acquisition cost to address variations in actual costs. 

CMS interprets section 1847A(c)(3) to require manufacturers to deduct prompt 

pay discounts given on sales included in the ASP calculation from the ASP numerator (ASP=sales in dollars/units sold). The language in section 1847A(c)(3) is plain, 

‘‘In calculating the manufacturer’s average sales price under this subsection, such 

price shall include volume discounts, prompt pay discounts, cash discounts, free 

goods that are contingent on any purchase requirement, chargebacks, and rebates 

(other than rebates under section 1927). For years after 2004, the Secretary may 

include in such price other price concessions, which may be based on recommendations of the Inspector General that would result in a reduction of the cost to the 

purchaser.’’ 

In the preamble to the CY 2006 Physician Fee Schedule final rule (70 FR 70224), 

we stated that we lack the statutory authority to permit manufacturers to exclude 

prompt pay discounts from the calculation of the ASP. We continue to believe the 

use of ‘‘shall’’ and the limitations on the discretion to include other price concessions 

in the statutory language do not provide administrative discretion to exclude a 

statutorily named price concession from the ASP calculation. 
97 

CMS—PROMPT PAY DISCOUNT

Question. What evidence is available to CMS that the prompt pay discount is 

being passed along to the provider of oncology services? If the prompt pay discount 

is not being passed along to providers, how does CMS achieve the congressional intent to rationalize provider payments with actual costs? 

Answer. CMS does not have evidence that prompt pay discounts are or are not 

being passed along to the providers of oncology services. CMS achieves the congressional intent by implementing the ASP methodology cited in section 1847A(c)(3). 

CMS—REGULATORY AUTHORITY FOR REIMBURSEMENT

Question. Congress believes that CMS clearly has the administrative authority to 

put forward a regulation on provider reimbursement to resolve this issue. Does CMS 

share this view or is additional legislation necessary? 

Answer. CMS does not believe it has the regulatory authority to exclude prompt 

pay discounts from the ASP calculation. The ASP statutory language is plain and 

provides limitations on modifying price concessions. We believe the section 

l847A(c)(3) authority to adjust the price concessions is limited to those price concessions that would ultimately lower the ASP, whereas removing prompt pay discounts 

from the ASP calculation would increase Medicare expenditures. 

QUESTIONS SUBMITTED BY SENATOR TOM HARKIN

MEDICARE FRAUD

Question. Mr. Secretary, as you know, I have a long record of fighting fraud, 

waste, and abuse in the Medicare and Medicaid programs. I know that CMS has 

addressed the issue of fraud in payments to suppliers for power wheelchairs. However, there is still concerns among legitimate suppliers that CMS is not doing 

enough to root out suppliers that are not legitimate. 

I understand that CMS is developing tougher quality and accreditation standards 

for suppliers. When will these standards be released? And what is CMS doing to 

make sure that they only issue supplier numbers to legitimate providers? Are CMS’s 

efforts to root out fraud and abuse in this area being hampered by a lack of resources? 

Answer. CMS plans on issuing new draft quality standards for suppliers on its 

website this summer. CMS will then solicit accrediting organizations to review suppliers and assure that they meet the new quality standards. We anticipate that accreditation activities will start before the end of calendar year 2006. Currently, to 

ensure that only qualified suppliers are issued supplier numbers, we perform site 

visits prior to enrollment and re-enrollment (which is required every 3 years). We 

also perform additional reviews of potentially questionable suppliers. These reviews 

focus on questionable suppliers located in geographic areas where there is a high 

concentration of fraud and suppliers who have questionable patterns of billing and/ 

or high claims error rates. 

CMS—POWER WHEELCHAIRS

Question. On April 6 of this year, CMS published a new final rule that requires 

that power wheelchairs suppliers review a beneficiary’s medical records and determine if a physician’s prescription is supported by medical evidence before a power 

mobility device will be prescribed. What documentation are suppliers required to 

verify before filling a prescription for a power mobility device? Will CMS issue guidance for suppliers on documentation requirements—including the level of specificity 

of the documentation—in order to clarify any ambiguities regarding filling a legitimate prescription? 

Answer. CMS would like to note that during the comment period of the interim 

rule, some suppliers noted that they were already experiencing a significant improvement in the timeliness, completeness and substantive content of medical 

record documentation submitted by physicians since the interim rule became effective. Along with the positive feedback from suppliers, CMS has not received any significant concerns from physician groups or other treating practitioners on this topic. 

In fact, one professional organization representing over 94,000 physicians and medical students expressed support for the elimination of the certificates of medical necessity (CMNs) for power mobility devices (PMDs). 

As you are aware, the CMN for PMDs was eliminated. The CMN was originally 

designed to improve claims submission by allowing electronic transmission of certain data. Unfortunately, some in the industry saw the CMN as a substitute for evi-
98 

dence of a physician’s independent comprehensive examination and analysis of 

whether a PMD was medically necessary. Despite CMS’ and its contractors’ statements to the contrary, these suppliers treated the CMN as the ultimate instrument 

in determining coverage. Some suppliers went so far as to hire physicians to fraudulently complete CMNs. Furthermore, our analysis of claims has found that in approximately 45 percent of cases, statements claimed in the CMNs were not supported by the source information in the patient’s medical chart. 

Instead of a CMN, the Durable Medical Equipment Regional Carriers (DMERCs) 

will rely on the patient’s medical chart to determine medical necessity. We are concerned that a one-page scripted form would not protect the Medicare program or its 

beneficiaries in the same way that source information culled directly from a patient’s medical record would. The CMN did not help physicians or treating practitioners better document their patients’ clinical needs for a PMD, it did not ensure 

that beneficiaries always received appropriate equipment, and it did not serve as 

an effective deterrent to fraud and abuse. We believe the beneficiary’s physician or 

treating practitioner is in the best position to evaluate and document the beneficiary’s clinical condition and PMD medical needs, and good medical practice requires that this evaluation be adequately documented. Thus, to minimize the documentation requirements for providers while assuring that documentation is adequate, physicians and treating practitioners will now prepare written prescriptions 

(as required by MMA section 302 and the final rule) and submit copies of relevant 

existing documentation from the beneficiary’s medical record, rather than having to 

transcribe medical record information onto a separate form such as a CMN. 

The rule describes the information that must be included in the written prescription: beneficiary’s name, date of the face-to-face examination, diagnoses and condition that the PMD is expected to modify, a description of the item being prescribed, 

the length of need, the prescribing physician’s signature and date of signature. This 

model provides structure while maintaining appropriate flexibility for the prescribing physician or treating practitioner. Only about 10 percent of physicians and 

treating practitioners prescribe a PMD for a Medicare beneficiary in any given year, 

and the majority of those physicians and treating practitioners only prescribe one 

or two PMDs a year. Given the myriad of forms, brochures, requisitions and similar 

items in a typical physician’s office, a requirement to have a specific prescription 

form handy in the event that it might be needed would impose an unnecessary burden on the physician and other treating practitioners when that form would only 

be needed once or twice a year for most prescribers, and never actually needed for 

the vast majority. 

Finally, the physician or treating practitioner must sign the prescription for the 

PMD and is, therefore, accountable for documentation of the medical need for the 

device. We believe that this required signature and source documents in the patient’s chart effectively document the physician’s attestation that the medical need 

for the device is legitimate. 

CMS and the DMERCs have provided extensive educational outreach to both suppliers and the medical community pertaining to the documentation requirements for 

PMDs. Examples of formal communication include CMS program instructions, 

Medlearn Matter articles, and DMERC supplier articles explaining the new responsibilities of suppliers. In addition, medical review activities vary depending on the 

situation under review. CMS cannot develop an all inclusive list of documents or 

information that Medicare contractors may request during audits. When requesting 

additional documentation, the DMERCs write to suppliers and ask for the specific 

documentation or information needed for a review. CMS has defined the circumstances under which contractors request additional information in the Program 

Integrity Manual. Local Coverage Determinations are issued by our contractors to 

describe in more detail the conditions under which Medicare payment is made. This 

additional documentation is only collected during the course of medical review audits and does not need to be collected for all claims. 

MEDICAID/SPECIAL EDUCATION BENEFITS

Question. This question concerns Medicaid and special education. I asked Education Secretary Spellings about it at our hearing with her in March, but she said 

I needed to ask you, so I’d like to do that now. 

Under current law, Medicaid pays for the cost of covered services for eligible children with disabilities. School districts can also be reimbursed by Medicaid for the 

transportation and administrative costs they incur in providing these services. But 

now the administration wants to prohibit schools from getting reimbursed for those 

costs. In fiscal year 2007, schools are expected to receive $615 million from Medicaid 

for transportation and administrative costs. If this change goes through, they’ll have 
99 

to pay the $615 million themselves, and many will have great difficulty doing so. 

I’m concerned about this, because if schools can’t pay the transportation costs to 

children with disabilities, the children won’t end up getting the services. 

Does CMS plan to implement this cut? If so, where do you recommend that 

schools find the money to make up the difference?’’ 

Answer. Appropriate Medicaid services will continue to be reimbursed as allowed 

under current law. However, claiming for certain Medicaid services in school settings has proven to be prone to abuse and overpayments. Schools provide a wide 

range of medical services to students, which mayor may not be reimbursable under 

the Medicaid program. Problem areas include but are not limited to school bus 

transportation and administrative claiming, as well as direct medical services. The 

fiscal year 2007 budget proposes administrative actions to phase out Medicaid reimbursement for some services, including school bus transportation and administrative 

claiming related to Medicaid services provided in schools. 

According to section 1903(a)(7) of the Social Security Act (the Act), for the costs 

of any activities to be allowable and reimbursable under Medicaid, these activities 

must be ‘‘found necessary by the Secretary for the proper and efficient administration of the plan’’ (referring to the Medicaid State Plan). Additional authority derives 

from section 1902(a)(17) of the Act, which requires that States take into consideration available resources. Through the authority of these statutes, the administration proposes to prohibit Federal reimbursement for transportation provided by or 

through schools to providers. 

HHS has had long-standing concerns about improper billing by school districts for 

administrative costs and transportation services. Both the Department’s Inspector 

General and the General Accountability Office (GAO) have identified these categories of expenses as susceptible to fraud and abuse. GAO found weak and inconsistent controls over the review and approval of claims for school-based administrative activities that create an environment in which inappropriate claims generated 

excessive Medicaid reimbursements. Audit findings from States where the OIG conducted administrative claiming audits have shown egregious violations. Proper and 

accurate claiming for administrative services has not been carried out in compliance 

with applicable Medicaid regulations. Overall, the leading conclusions from these 

audits are that most States use an improper allocation methodology and insufficient 

attention is paid to the details of the claiming process. 

The fiscal year 2007 President’s budget includes a regulatory proposal that would 

prohibit Federal Medicaid reimbursement for Medicaid administrative activities performed in schools. It additionally proposes that Federal Medicaid funds will no 

longer be available to pay for the transportation to and from school related to medical services provided through an Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP). 

Schools would continue to be reimbursed for direct Medicaid services identified in 

an IEP or IFSP provided to Medicaid eligible children, such as physical therapy and 

occupational therapy that are important to meet the needs of Medicaid-eligible students with disabilities, as long as the providers meet Medicaid provider qualifications. CMS estimates that these proposals will save $0.6 billion in fiscal year 2007 

and $3.6 over 5 years. 

SPECIAL EXPOSURE COHORTS

Question. The Labor HHS Appropriations Act of 2006 (Public Law 109–149) requires NIOSH to prepare a report within 180 days of enactment evaluating whether 

there are additional radiosensitive cancers not already on the list of 22 cancers eligible for compensation under the Special Exposure Cohort provision of EEOICPA and 

RECA that should be eligible for compensation. Will NIOSH deliver this report to 

Congress on schedule? 

Will NIOSH solicit comments from experts in radiation epidemiology before submitting this report? 

Answer. NIOSH is currently working on finalizing this report and is seeking comments from a set of experts with diverse expertise and perspective, including experts in radiation epidemiology. The report will be peer-reviewed prior to submission. We are working as quickly as possible to obtain comments/edits from the outside reviewers to expedite the process. 

Question. The Office of Management and Budget recently issued a ‘‘Passback’’ 

memo to the Department of Labor, which called for options to ‘‘contain the growth 

in benefits’’ from new Special Exposure Cohorts under the Energy Employee Compensation law. To accomplish this, the memo outlines options including administration clearance of all Special Exposure Cohorts before a decision is made by you as 

Secretary of Health and Human Services. Has your Department formulated a legal 
100 

and policy response to the OMB memo and if so, could you please share that response with the Committee? 

Answer. The National Institute for Occupational Safety and Health (NIOSH) is 

responsible for receiving and scientifically evaluating petitions from classes of workers seeking inclusion in EEOICP A’s Special Exposure Cohort. NIOSH carries out 

this responsibility under regulations promulgated in May 2004, and amended in December 2005, to make the rule consistent with the amendments to EEOICPA contained in the Ronald W. Reagan National Defense Authorization Act for fiscal year 

2005. In fulfilling this duty, NIOSH evaluates the feasibility of scientifically estimating radiation dose for workers in the class that is petitioning for inclusion in 

the SEC. If a dose estimate is not feasible, NIOSH evaluates whether or not the 

health of the workers in the proposed SEC class was potentially endangered by their 

radiation exposure. 

NIOSH presents its scientific and technical evaluation findings and recommendations to the Presidentially appointed Advisory Board on Radiation and Worker 

Health (the Board), a chartered Federal Advisory Committee. The Board considers 

the NIOSH evaluation and then makes a recommendation to me to either add or 

not add the class of workers to the SEC. My decision about whether or not to add 

the class members to the SEC is based on the following: the requirements of the 

law and the above-mentioned regulations, the NIOSH findings and its recommendation to the Board, and the recommendation of the Board. 

QUESTIONS SUBMITTED BY SENATOR DANIEL K. INOUYE

HEALTH CENTERS PROGRAM

Question. I would like to express my sincere appreciation to Dr. Elizabeth Duke 

for her continued support and interest in the extension of health care service delivery networks to the underserved residents in some of the most geographically isolated communities in Hawaii. In particular, I am pleased with consideration to the 

future establishment of a health center on Lana’i. Through the establishment of 

these health centers, significant improvements have been noted in access, quality, 

and continuity of care. All of which are integral to the early detection, diagnosis and 

intervention in a myriad of potentially debilitating diseases. 

Answer. Thank you for your support of our work in the Health Centers program. 

This program is integral to our mission to enhance the health and well-being of 

Americans by providing for effective health and human services 

EMERGENCY MEDICAL SERVICES FOR CHILDREN

Question. As expressed last year, I am very concerned that once again the Emergency Medical Services for Children (EMSC) program has not been included in your 

budget. It can not be stressed often enough that the emergency care and resuscitation of children is uniquely different from adult resuscitation. One size does not fit 

all in the emergency care of children. There is great disparity in the quality and 

availability of emergency services for children across this country. While other programs are directed at ensuring the adequacy of adult emergency care services, this 

is the only program specifically directed at saving the lives of children. How does 

the Department plan to ensure that America’s children receive the emergency care 

they deserve with no targeted funding? 

Answer. States, through the Maternal and Child Health Block Grant program, 

can continue to fund these specialized services. 

BACCALAUREATE TO DOCTORAL PROGRAMS

Question. A long-standing supporter of the National Institute for Nursing Research, I am pleased that the administration has continued funding of this program. 

However, what impact will the $1 million reduction have on the National Institute 

of Nursing Research’s development of initiative that supports fast-track baccalaureate-to-doctoral programs? These programs were proposed to help increase the 

number of nursing faculty and in turn decrease the number of qualified nursing 

school candidates who were turned away in prior years. 

Answer. The overall reduction of $792,000 in the fiscal year 2007 budget request 

of $136.6 million for the National Institute of Nursing Research (NINR) will have 

no impact on its programs that fast-track baccalaureate-to-doctoral nurses to increase the number of nursing investigators. These programs are supported within 

the Research Training mechanism in NINR, and the fiscal year 2007 President’s 

budget maintains the current level of support of this activity. NINR remains committed to developing the next generation of nurse scientists. NINR encourages and 
101 

supports strategies to change the career trajectory of nurse scientists. The Institute 

emphasizes early entry into research careers, including fast-track baccalaureate-todoctoral programs, and supports pre-doctoral and postdoctoral nurses who are the 

future researchers and nursing faculty. 

QUESTIONS SUBMITTED BY SENATOR HERB KOHL

GENERIC DRUGS/FDA

Question. The FDA currently has a backlog of more than 800 generic drug applications—an all-time high—and FDA officials expect a record number of generic applications this year and an even larger backlog. The congressional Budget Office estimates the use of generics provides a savings of $8 to $10 billion to consumers every 

year, and that doesn’t include the billions of dollars of savings to hospitals, Medicaid 

and Medicare. It is now more important than ever that we speed less expensive generic drugs to market. 

Secretary Leavitt, do you support an increase in the FDA budget to help reduce 

the backlog? How much do you believe the FDA needs to efficiently reduce the backlog and pass along the savings to Americans and the Federal Government? 

Answer. First, let me state that I understand that Congress and the public are 

concerned about the high cost of prescription drug products. I believe that generic 

drugs play a very important role in granting access to products that will benefit the 

health of consumers and the government. Prompt approval of generic drug product 

applications, also known as abbreviated new drug applications, or ANDAs, is imperative to making generic products available to American consumers at the earliest 

possible date. This has been a high priority for FDA as it has been for me during 

my time here at HHS. I believe that the process improvements that FDA is currently implementing along with the investments we continue to make in generic 

drugs offer the best promise for reducing ANDA review time. 

FDA has made significant investments to improve the generic drug review process 

with the funds appropriated by Congress. In fiscal year 2007, FDA plans to spend 

$64.6 million relating to generic drugs, including $29 million in the Office of Generic 

Drugs, or OGD. This level represents an increase of more than 66 percent from the 

comparable fiscal year 2001 amount, which has resulted in a lower median review 

of 2 months. 

FDA has made significant process improvements to increase the efficiency of the 

ANDA review process. In fiscal year 2005, OGD focused on streamlining efforts and 

took steps to decrease the likelihood that applications will face multiple review cycles. OGD instituted additional enhancements to the review process such as early 

review of the drug master file as innovator patent and exclusivity periods come to 

an end, cluster reviews of multiple applications, and the early review of drug dissolution data. 

In fiscal year 2006, FDA is building on these process improvements. FDA began 

a major initiative to implement Question-based Review for assessment of chemistry, 

manufacturing, and controls data in ANDAs. This mechanism of assessment is consistent with the International Conference on Harmonization Common Technical 

Document and will enhance the quality of evaluation, accelerate the approval of generic drug applications, and reduce the need for supplemental applications for manufacturing changes. 

FDA’s OGD will continue to institute efficiencies in the review process to facilitate 

the review and approval of ANDAs in fiscal year 2007 and beyond. FDA will also 

continue to work closely with generic manufacturers and the generic drug trade association to educate the industry on how to submit applications that can be reviewed more efficiently and that take advantage of electronic efficiencies that speed 

application review. FDA will also work with new foreign firms entering the generic 

drug industry. It will take time for these new firms to understand the requirements 

for generic drug product applications. However, in the long-term, these efforts will 

shorten overall approval time and increase the number of ANDAs approved during 

the first cycle of review. 

With the process improvements stated above and the investments we continue to 

make in generic drugs, FDA will continue to reduce ANDA review time and deliver 

safe and effective generic drug products to the American public. 

PROGRAMS SERVING OLDER AMERICANS

Question. Some of the most painful cuts in this budget are programs under the 

administration on Aging, which takes a $28 million hit in programs like Meals on 

Wheels and Family Caregiver Support Services. That means that while Wisconsin’s 
102 

senior population continues to grow—from 705,000 senior citizens in 2000 to 

730,000 seniors this year and 1.2 million seniors by 2025—this budget does not account for the growth in the need for services. 

In addition, this budget proposes to eliminate Alzheimer Demonstration grants. 

The Wisconsin Alzheimer Association is in its first year of a 3-year grant, where 

they are working with Jefferson County to open a dementia care clinic at a hospital 

in Fort Atkinson. It is the first of its kind and the only one in the area. They would 

lose their funding after this year should this budget prevail. 

How do you explain the administration’s plan to cut these vital programs when 

our aging population is growing? 

Answer. The fiscal year 2007 President’s budget includes the elimination of the 

Alzheimer’s Disease Demonstration Grant to States Program (ADDGS), Preventive 

Health Services program, and small cuts to other AoA programs including a reduction of $906,000 to Home-Delivered Nutrition Services and $1,980,000 to Family 

Caregiver Support Services. These reductions reflect an effort to reduce the deficit 

while focusing on programs that provide needed services most efficiently. 

For 14 years under ADDGS, demonstrations in almost every State have highlighted successful, effective approaches for serving people with Alzheimer’s. Now, it 

is time to put these models and the lessons that have been learned to work by moving them into AoA’s core services programs—especially the National Family Caregiver Support Program—as a number of States have already done. 

Preventive Health Services is a limited, formula-grant funding stream intended 

to foster the provision of health promotion/disease prevention services in the context 

of the core community-based long-term care services of the National Aging Services 

Network. AoA’s proposal under the Choices for Independence initiative supports the 

same type of evidence-based health promotion and disease prevention. 

The Home-Delivered Nutrition Services and Caregiver Support Services programs 

have demonstrated efficiencies in leveraging Federal dollars. In addition, demonstrations such as Choices for Independence are aimed at increasing even further 

the efficiency of these programs. While reductions in Nutrition and Caregiver services reflect an effort to reduce the deficit, they also reflect an effort to target reductions in programs that have the greatest potential to maintain service delivery with 

fewer dollars. 

RURAL HEALTH

Question. Secretary Leavitt, there are a number of programs within your Department aimed at bolstering rural health. Wisconsin, one of the biggest beneficiaries 

in the country, received over $600,000 from the Rural Hospital Flexibility Grant 

program last year. This funding is used at over 60 rural hospitals that serve anywhere from 10,000 to 20,000 patients per year. The President’s budget proposes to 

eliminate the Rural Hospital Flexibility Grant program, the Rural and Community 

Access to Emergency Devices, and Area Health Education Centers. 

How are rural communities expected to meet their unique health care challenges 

when their resources are being slashed? 

Answer. The Medicare Prescription Drug, Improvement and Modernization Act 

(MMA) will increase Medicare spending in rural America by $25 billion over the 10 

years following MMA enactment, substantially increasing funding for hospitals and 

other rural health providers. This Act serves as a catalyst in rural communities by 

increasing payments to hospitals, health professionals and other services. In addition, the budget includes an additional $181 million to provide added direct health 

services to underserved communities through 302 new and expanded health center 

sites—about half of which are likely to be in rural areas. 

MEDICARE DRUG BENEFIT ENROLLMENT DEADLINE

Question. Less than 2 weeks remain for most Medicare beneficiaries to sign up 

for prescription-drug coverage without penalty. Yet last week a Kaiser Family Foundation poll found that only 55 percent of seniors realize the deadline is May 15, and 

only 53 percent know enrolling after the deadline will cost 1 percent more per 

month. Earlier this year, the Senate voted to give you authority to extend the enrollment deadline, but the House has not yet acted. Do you support Congress passing legislation to extend the deadline? 

Answer. We are focused on enrolling people now, while the resources are in place 

to help beneficiaries get the savings and security of prescription drug coverage. According to the Office of the Actuary at CMS, keeping the current May 15th deadline 

encourages beneficiaries to take action and enroll. The actuaries believe that extending the deadline would likely decrease overall enrollment in 2006 as pressure 

on beneficiaries to enroll would be diminished. However, in light of the cost effects 
103 

on our vulnerable populations, we have recently waived late-enrollment penalties for 

beneficiaries approved for low-income subsides if they enroll in a drug plan by the 

end of 2006. 

Proposals to extend the enrollment deadline beyond May 15 include no funding 

for Medicare to maintain the high level of enrollment support that is available right 

now. Beneficiaries should be encouraged to take advantage of outreach resources 

like the 1–800 MEDICARE telephone line. There are short waiting times now and 

individual, one-on-one counseling is available to help people select a coverage plan. 

Tens of thousands of beneficiaries are currently enrolling every day, and there is 

still time to enroll in a plan. 

NATIONAL INSTITUTES OF HEALTH FUNDING

Question. The President’s American Competitiveness Initiative states that sustained scientific advancement is the key to maintaining our competitive edge—and 

I agree with that. The President’s fiscal year 2007 budget proposal commits $5.9 billion to research and education in basic science, that is the physical sciences—and 

I agree with that as well. What I don’t understand is why the President would, in 

the same budget proposal, flat fund the National Institutes of Health and its research into health sciences and biotechnology. Other industrialized countries are 

making investments to make sure they get a piece of the growing biotech and health 

care sectors of the world economy—why aren’t we? 

Answer. In fiscal year 2003, President Bush fulfilled his commitment to complete 

the historic doubling of the NIH budget, which grew from $13.6 billion in fiscal year 

1998 to $27.2 billion in fiscal year 2003. During this 5-year period, NIH was able 

to fund nearly 11,600 more research grants than it did before the doubling began, 

representing research ideas that are leading to vaccines, cures, treatments, and 

other fundamental scientific breakthroughs helping to open up even more new opportunities for improving human health. 

With the fiscal year 2007 budget request of $28.6 billion, the NIH budget will 

have grown by ∂$8.1 billion, or ∂40 percent, during this administration. While the 

fiscal year 2007 request for NIH is a straight-line from the fiscal year 2006 level, 

NIH plans to continue to make strategic investments in trans-NIH initiatives and 

priorities within its available funds. These include increased support for new investigators, new research project grants, and the NIH Roadmap for Medical Research, 

a new initiative on Genes, Health and the Environment, and expansion of the Clinical and Translational Science Award program launched in fiscal year 2006. The 

NIH budget also includes increased investments in national priorities related to developing biodefense countermeasures and pandemic influenza diagnostics, vaccines, 

and therapeutics. These initiatives will preserve our investment in biomedical research and support medical advancements that will make healthcare more predictive, personalized, and preemptive and thus, improve the length and quality of 

human life. 

NIH welcomes the proposed increase in funding for the physical sciences. Biomedical research is becoming increasingly multi-disciplinary, requiring both science 

and mathematics to conduct projects in emerging areas of great scientific promise, 

such as bioinformatics, computational biology, nanotechnology, tissue engineering, 

and biomedical diagnostic imaging, to name just a few. 

SUBCOMMITTEE RECESS

Senator SPECTER. Thank you all very much. The subcommittee 

will stand in recess to reconvene at 8:30 a.m., Friday, May 19, in 

room SD–192. At that time we will hear testimony from the Hon. 

Elias A. Zerhouni, M.D., Director, Department of Health and 

Human Services. 

[Whereupon, at 11:30 a.m., Wednesday, May 3, the subcommittee 

was recessed, to reconvene at 8:30 a.m., Friday, May 19.] 

(105) 

DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 

FISCAL YEAR 2007 

FRIDAY, MAY 19, 2006 

U.S. SENATE, 

SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS, 

Washington, DC. 

The subcommittee met, at 8:31 a.m., in room SD–192, Dirksen 

Senate Office Building, Hon. Arlen Specter (chairman) presiding. 

Present: Senators Specter, Shelby, and Harkin. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

NATIONAL INSTITUTES OF HEALTH

STATEMENT OF ELIAS A. ZERHOUNI, M.D., DIRECTOR 

ACCOMPANIED BY: 

JOHN E. NIEDERHUBER, M.D., ACTING DIRECTOR, NATIONAL CANCER INSTITUTE 

FRANCIS S. COLLINS, M.D., DIRECTOR, NATIONAL HUMAN GENOME 

RESEARCH INSTITUTE 

ANTHONY S. FAUCI, M.D., DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES 

ELIZABETH G. NABEL, M.D., DIRECTOR, NATIONAL HEART, LUNG, 

AND BLOOD INSTITUTE 

OPENING STATEMENT OF SENATOR ARLEN SPECTER

Senator SPECTER. Good morning, ladies and gentlemen. The Appropriations Subcommittee on Labor, Health, Human Services, 

Education, and Related Agencies will proceed with this hearing on 

the National Institutes of Health, and the funding for these institutes. We have a rather unusual hearing this morning because we 

have asked representatives of groups advocating research on the 

major illnesses—heart, cancer, Alzheimer’s, Parkinson’s—some 20 

in total, to underscore the difficulties facing medical research in 

the United States today. 

As it is well known, this subcommittee, Senator Harkin and I, 

have taken the lead on NIH funding, which has grown from $12 

billion to $29 billion over the past 10 years. Now we have seen the 

increases which we had structured by, candidly, robbing Peter to 

pay Paul. We have a very complex budget on this subcommittee 

which has to fund not only health but education, labor, worker 

safety, Head Start, the bulk of the social programs. 
106 

Those programs have been cut in the last 2 fiscal years, taking into account actual cuts and inflation, cut by some $15.7 billion. 

The NIH, which I frequently say is the crown jewel of the Federal 

Government, if not the only jewel of the Federal Government, has 

been cut 10.4 percent in the last 2 years. We find that in fiscal year 

2006 there was an actual cut of almost $66 million. 

The funding for fiscal year 2007 is level by the administration. 

That means with the inflationary increase there is a decrease in 

the actual dollars which are available. That is just unacceptable in 

a country with an $11 trillion gross national product and a Federal 

budget of $2.8 trillion. 

The advances that have been made by medical science are really 

remarkable, but it takes funding to accomplish that. Something 

personal to me is the lack of adequate funding for the National 

Cancer Institute. In 1970 President Nixon declared war on cancer 

and if that war had been pursued with the same intensity as our 

other wars cancer would have been cured long ago. 

My chief of staff, Carey Lackman, a beautiful young woman of 

48, died of cancer, breast cancer, recently. My son’s partner’s wife, 

a beautiful young woman, died of breast cancer. One of my best 

friends, Judge Edward Becker, one of the most distinguished jurists in America, is suffering great anguish and great pain as we 

speak from prostate cancer. I had a bout with Hodgkin’s last year 

myself and if you see me dabbing my eyes that is one of the remnants of chemotherapy. Had the Nixon war on cancer been pursued, I think I would not have gotten Hodgkin’s and Carey 

Lackman would not have died, Paula Klein would not have died, 

Ed Becker would not be in the dire straits he is today. 

It is just unconscionable that we are not doing more. That is tied 

to stem cell research. Again, Senator Harkin and I have taken the 

lead there with our legislation which would enable, authorize, take 

the bar away from the Federal Government supporting embryonic 

stem cell research. We had a meeting yesterday with Senator Frist, 

the Majority Leader. I believe we are going to have a vote very 

soon on our issue. It is doubtful that we have 67 to override a presidential veto and we are talking about organizing a march on The 

Mall. We would like to put 1 million people on The Mall in September, enough people on The Mall to be heard in the living quarters of the White House just a few blocks away, because the estimate of 110 million people being affected directly or indirectly by 

these ailments is enough to produce two-thirds to override a presidential veto if in fact the President carries out his statement that 

he will veto the bill. 

Well, we have a very long hearing today. We moved the hearing 

from 9:30 to 9:00 and then we moved it from 9:00 to 8:30 because 

Senator Harkin has commitments in Iowa. I am a little more flexible. I only have to travel to Pennsylvania. But we have a hearing 

this afternoon in Philadelphia on campus safety. It is a very, very 

busy Congress and I think you have seen that from the activities 

on the confirmation of the Supreme Court justices and the immigration bill, the Patriot Act, and so many other things we are 

doing. 

But I do not believe there is any subject as important as this one. 

You keep hearing ‘‘nothing more important.’’ Well, we may be tied 
107 

for first place. I do not think that it is true that there is no subject 

more important than this one. I do not think there is any subject 

as important as this one. This is number one. Without health there 

is nothing. 

Senator Harkin. 

STATEMENT OF SENATOR TOM HARKIN

Senator HARKIN. Mr. Chairman, thank you very much for your 

very eloquent opening statement. I would ask that all my statement be made a part of the record. I will just comment on it here. 

First, let me thank you, Mr. Chairman, for your courageous leadership in this area of always fighting for the funding we need for 

NIH. You led the way on building the funding over those years. I 

was happy to backstop you and support you in that. It was a very 

courageous effort that you led on that. 

I thank you also for your courage in speaking out on the budget 

earlier this year and your continuing to speak out against the 

budget as it affects NIH. 

Let me also thank you for your own personal courage in battling 

Hodgkin’s lymphoma last year and the example that you set in 

coming to work every day and holding the hearings in the Judiciary Committee and the Supreme Court nominees and taking it to 

the floor even while you were undergoing some pretty severe chemotherapy. So it was a great example, I think, of personal courage 

and we thank you for that. 

I would just remind everyone of what Senator Hatfield said. 

When Senator Hatfield left the Senate, he gave his final speech on 

the Senate floor. I will never forget. I was over there to listen to 

it. He said at the time, he said: It is not that the Russians are coming. He said: It is the viruses are coming, the viruses are coming. 

How prophetic, how prophetic. 

We did not work hard to double the funding of NIH to then have 

it plateau off for another 20 years. The idea was to get it back up 

where it had been in the 70s, where we had some 40-some percent 

of our peer reviewed grants approved and funded. That had fallen 

down and now I think it is down to about—I do not have it in front 

of me. I think it is down to about 19 percent right now, the lowest 

ever, the lowest ever. 

The problem—not only is it a problem this year in terms of the 

budget—yes, it is 19 percent right now. About one out of every five 

is accepted for funding. I think that is having a ripple effect on researchers, it is having an effect on young people who are thinking 

about research as a lifetime avocation. 

But the problem is also looking ahead. As bad as this year’s 

budget is, next year’s could be worse. According to OMB projections, the administration will cut NIH by $800 million in 2008 and 

make more cuts in 2009 and fiscal year 2010. 

Something has got to be done about this. Again, Senator Specter, 

you have been tremendously courageous in speaking out and trying 

to get a better deal for us on the budget. But we need to hear from 

you at NIH, but we also need to hear from the groups that are coming later, to tell the human side and give the human face as to 

what is happening to so many people in our society. 
108 

PREPARED STATEMENT

I have a friend of mine who at this very moment is in the final 

stages of ALS disease. It is one of the worst things you can imagine. Yet we dither around and we cannot get stem cell research 

going in this country? 

Well, again, Mr. Chairman, thank you. It has been an honor to 

work with you. 

[The statement follows:] 

PREPARED STATEMENT OF SENATOR TOM HARKIN

Thank you, Mr. Chairman. You’ve led the way on NIH funding, and it’s been a 

real honor working with you on this issue. 

Good morning, Dr. Zerhouni, and welcome. We’re glad to have you back with us 

today. 

We need a strong NIH now more than ever, for so many reasons. First, our security as a Nation depends on it. We often think about security only in military terms. 

But in today’s world, we need to be just as worried about the threats we face from 

a bioterrorism attack or pandemic flu. NIH research is critically important for protecting us in both of those areas. 

We also need NIH to help us through our health care crisis. Consider just one 

disease—Alzheimer’s. It’s been estimated that delaying the onset of Alzheimer’s by 

just 5 years could save $50 billion a year in medical costs. That would go a long 

way to solving our Medicare problems all by itself. 

We need NIH now, because we’re on the cusp of so many exciting breakthroughs. 

Researchers are learning how to match drugs to individual patients, based on their 

genetic code. They’re learning more about stem cell research. They’re making discoveries about the interplay between our genes and the environment. 

What a shame, then, to get a budget like the one the President has sent us. 

His budget would level-fund NIH, one year after the first cut to this agency since 

1970. Eighteen of the 19 institutes would get less funding than they did last year. 

The number of research project grants would drop by about 640. And the success 

rate for grant applications would remain at a record low of just 19 percent. 

We’re at a point now where only 1 out of every 5 grant applications is accepted 

for funding. I’m sure there are a lot of young researchers out there who are wondering, ‘‘Why bother applying to NIH? Why bother going into research at all?’’ 

Senator Specter and I didn’t work so hard to double NIH funding just so we could 

watch the President cut it to the bone from then on out. But that seems to be the 

President’s plan. As bad as this year’s budget is, next year’s will probably be even 

worse. According to OMB projections, the Administration will cut NIH by $800 million in fiscal year 2008, and make more cuts in fiscal year 2009 and fiscal year 2010. 

We’re going to hear firsthand what the President’s budget will mean for many diseases from our second group of speakers. I want to thank the representatives of the 

20 advocacy groups that are with us today for taking the time to be here. 

Mr. Chairman, I look forward to the testimony. 

Senator SPECTER. Thank you very much, Senator Harkin. Thank 

you for your leadership on these issues and the partnership which 

I think has been very productive for our country. 

Senator Shelby. 

STATEMENT OF SENATOR RICHARD C. SHELBY

Senator SHELBY. Thank you, Mr. Chairman. Mr. Chairman, I ask 

that my written statement be made part of the record and I will 

be brief. 

This is a very important hearing and I am here this morning to 

help you. I think the President, George W. Bush, is going to have 

to speak out on this issue, that is properly funding NIH medical 

research. We are falling behind and we cannot, because we have 

led the world. We continue to lead the world, although we are 

struggling as far as finances are concerned. 
109 

Mr. Chairman, you and Senator Harkin, who are the leaders of 

this committee, I can tell you I am going to do everything I can. 

We are challenged in the research everywhere in biomedical, but 

in autoimmune areas there is a lot of hope there. I am particularly 

interested in the lupus area. We are challenged there. I am going 

to do everything I can as a member of the Appropriations Committee to help fund, properly fund, medical research through NIH. 

You have made a difference and you will make a tremendous difference in the future. 

PREPARED STATEMENT

But, as Senators Specter and Harkin both know, it is not going 

to be easy, but we cannot go backward. We cannot cede this to anybody else in the world. We are the leaders. We have got to stay 

there. 

Thank you, Mr. Chairman. 

[The statement follows:] 

PREPARED STATEMENT OF SENATOR RICHARD C. SHELBY

Mr. Chairman, thank you for holding this important hearing today. I want to 

thank all of you for taking the time to be here today. It is vitally important for me 

to hear directly from you on what your agency’s needs are, and the challenges you 

might face in the coming months. We as a Nation are facing a integral moment in 

funding critical research. Finding viable treatments and possible cures for many of 

our common afflictions is our most important goal, but I think early detection of disease is fundamentally important to containing costs in the long-term. 

As we begin to move forward in the appropriations process it is of the utmost importance that we ensure adequate funding for these indispensable research institutions. Millions of Americans rely on the life saving work they perform and it is imperative that we as appropriators fully support them. 

Federal funding for medical research is critical and while we have worked diligently to increase funding, more is left to do. 

I am hopeful that this hearing today will provide a forum to discuss the issues 

that must be addressed by researchers. 

Thank you for your time and I look forward to your testimony. 

Senator SPECTER. Thank you very much, Senator Shelby. 

We now welcome Dr. Elias Zerhouni, the Director of the National 

Institutes of Health. He had an illustrious career before coming to 

be the 15 Director of NIH. He had been executive vice dean at 

Johns Hopkins University School of Medicine, chair of the Department of Radiology and Radiological Science. He received his medical degree from the University of Algiers School of Medicine and 

completed his residency in diagnostic radiology at Johns Hopkins. 

Thank you for your leadership in this very vital area, Dr. 

Zerhouni, and we look forward to your testimony. 

SUMMARY STATEMENT OF DR. ELIAS A. ZERHOUNI

Dr. ZERHOUNI. Thank you, Mr. Chairman. Thank you, Senator 

Harkin, Senator Shelby. I submitted a written testimony. What I 

would like to do really is just summarize the salient points of the 

testimony, to allow as much time as possible for questions. 

Senator SPECTER. Thank you, Dr. Zerhouni. 

Dr. ZERHOUNI. What I would like to do is really direct your attention to the screens. 
110 

RETURN ON INVESTMENT ON NIH FUNDING

What I would like to address are the fundamental questions that 

I think all of us would like to have an answer to, to be able to set 

policy for the future. First and foremost, what is the return on the 

American people’s investment at the National Institutes of Health? 

Second, what has this NIH budget doubling delivered for the American people? Third, what is our future strategy? Where is NIH 

heading? When you talk about medical research it is important to 

understand that it is not a 100-meter dash, it is a marathon, and 

we have to sustain the effort over time. 

First, let me just remind everyone that biomedical research has 

delivered enormous returns to the American people. I am just going 

to give two examples here. Many more are in the testimony. In coronary heart disease, if you look at the progress over the past 30 

years, there has been a 63 percent decrease in mortality. Over a 

million early deaths are averted every year because of the research 

of the past 30 years. Economists tell us that this is worth $2.6 trillion in economic return because a cohort of individuals who would 

have died in their 50s now do not and then can produce economic 

return. We have enormously exciting, effective strategies for not 

only curing, but preventing and ultimately eliminating coronary 

heart disease. 

Now, you may ask yourself, what was the investment that the 

American people, that each one of us made to achieve that? Well, 

over the past 30 years each one of us has spent about $3.70 per 

year for medical research related to coronary heart disease. If you 

look at the total cumulative total over 30 years for heart research, 

it is $110 per person. I submit to you that medical research has 

delivered, for an investment that I think is extremely effective in 

its return. 

Cancer is another example. If you look at cancer—and you mentioned the war on cancer, Senator—for the first time in recorded 

history, this year we have a lower number of deaths from cancer 

in the United States, despite an increasing population and an increasing average age of the population. We have 10 million survivors. This is due to the advent of early screening, early detection, 

new therapies. 

What has this cost us? $8.60 per person per year over the past 

30 years. The total investment for each one of us is $260 over 30 

years. I do not think there is an investment that I can describe 

that any agency can be as proud of as the National Institutes of 

Health is of its effectiveness. We have delivered not only better 

cures, but also a healthier life for Americans, who live now longer 

and healthier lives, with a disability rate that has dropped by 30 

percent over the past 22 years because of improvements in bone 

health, in heart health, and many other advances. 

Since 1982 the disability rates have dropped by 30 percent and 

in the past 30 years American life expectancy has increased by over 

6 years, from a total investment cumulative over 30 years, of about 

$1,300 per American. 

This is not just what we have done in the past. We continue to 

deliver. If you look at just the advances of the past year—I am just 

going to take a few examples. If you look at the impact of the 
111 

human genome and genomics, we identified over 20 genes just in 

the past 12 months that relate to prostate cancer and the causes 

of prostate cancer, in mental health about obsessive compulsive disorder, and one of the most exciting ones is in vision disease, where 

we have found genes that may explain over 70 percent of cases of 

what we call age-related macular degeneration, the fastest rising 

cause of blindness in American seniors. 

Vaccines: We have the first global candidate vaccine on HIV/ 

AIDS, that Dr. Fauci and his team developed. Yesterday the FDA 

approved the first preemptive cancer vaccine against cervical cancer. We have expanded the Avian Flu trials. We have one vaccine 

in trial and a second one in development. This would not have been 

possible without the support of Congress and your support here on 

this committee. 

But we realize that biomedical research must continue to deliver 

and we have a challenge in front of us. We all know that the rising 

cost of health care and the burden of disease is going to be a challenge for all of us. We see the curve. We see that it is not sustainable. Society spends about $7,100 per American per year on health 

care costs. The total NIH spending, $95 per American per year, has 

to do something, must do something, to change that picture. 

This is the vision of NIH. Our vision, all of us as scientists at 

NIH, is to use our investment and deliver a complete transformation of medicine, because if we keep practicing medicine the 

way we know it today, 25 years from now it just will not be sustainable. So discoveries and new ways of not only curing disease, 

but preventing disease, preempting disease altogether, is the key. 

We will do this through what we call the four P’s of medicine. 

It will be more predictive because of our understanding of molecular events. It will be more personalized because we know that 

every one of us reacts differently to different diseases. It will have 

to be increasingly preemptive because this is where it is the least 

costly. But we cannot do this without the participation of everyone, 

and this is why we say the fourth P is, in the context of chronic 

diseases like diabetes or obesity, it will require us to include the 

patients as partners in this new medicine. 

PREPARED STATEMENTS

So my message is very simple. We have delivered, we continue 

to deliver, and we will deliver, and the return on investment is in 

my view one of the most remarkable returns that anyone can describe, and we will continue to do so. I am happy to take any questions. 

[The statements follow:] 

PREPARED STATEMENT OF DR. ELIAS A. ZERHOUNI

Mr. Chairman and distinguished members of the subcommittee, it is an honor and 

a privilege to appear before you today to present the National Institutes of Health 

(NIH) budget request for fiscal year 2007 and discuss the priorities of NIH for this 

year and beyond. 

BUDGET REQUEST

The request for NIH is $28.4 billion in fiscal year 2007, the same as the fiscal 

year 2006 level for the Agency. The budget request will support the research programs managed by NIH’s Institutes and Centers. At this budget level, NIH will in-
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crease the biodefense research program by $110 million for Advanced Development. 

Support for the Pandemic Influenza Preparedness Plan will increase by $17 million. 

We have also chosen to carefully invest in several trans-NIH strategic initiatives. 

The NIH Roadmap, an incubator for new ideas and initiatives that will accelerate 

the pace of discovery, increases by $113 million. We allocated $40 million to the Institutes and Centers to launch the Genes, Environment and Health Initiative to accelerate discovery of the major genetic and environmental factors for diseases that 

have a substantial public health impact. We have also directed $15 million to the 

new ‘‘Pathway to Independence’’ program to increase our support of new investigators. 

I will focus my testimony on the return of the investment in NIH for the American people. In particular, I will discuss how discoveries fueled by this investment 

are transforming the practice of medicine. We can now clearly envision an era when 

the treatment paradigm of medicine will increasingly become more predictive, personalized and preemptive. We will strike disease before it strikes us with the hope 

of greatly reducing overall costs to society. We expect to move away from the costly 

and predominantly curative model of today, which requires us to wait for the disease to occur before intervening. I will share with you the strategic vision of NIH 

and discuss the many management innovations we have implemented to ensure optimal stewardship of taxpayers’ resources. 

SELECTED ACCOMPLISHMENTS OF NIH AND THEIR IMPACT ON HEALTH

The achievements of NIH and our private sector partners in medical research are 

difficult to overstate. According to the latest report on the Nation’s health from the 

Centers for Disease Control and Prevention (CDC), life expectancy continues to rise, 

now at an unprecedented 78 years for the total U.S. population. Since 1950, the ageadjusted death rate for the total population declined by a remarkable 43 percent. 

Life expectancy has increased by one year in every five for the past 30 years. Americans are not only living longer, they are healthier. For instance, the disability rate 

of American seniors dropped by almost 30 percent in the past 20 years, owing to 

a range of scientific advances. 

The following are samples of the many advances driven by the investment in NIH. 

ADVANCES IN CARDIOVASCULAR DISEASE AND STROKE

Thirty years ago, it was common for a man or woman to suddenly die of a heart 

attack or stroke between the ages of 50 and 60. Had this trend continued unabated, 

today more than 1.6 million lives would have been lost per year. Fortunately, today 

the toll is much less. The death rates from cardiovascular disease have declined by 

63 percent and by 70 percent for stroke. Were it not for the ground-breaking research on the causes and treatment of heart disease, supported in large part by 

NIH, including recent developments such as drug coated stents, safe levels of blood 

pressure and cholesterol lowering therapies, heart attacks would still account for 1.2 

to 1.3 million deaths per year instead of the actual 515,000 deaths experienced 

today. The estimated total cumulative investment in cardiovascular research at the 

NIH per American over the past 30 years, including the doubling period, is about 

$110, or about $4 for each American per year over the entire period. 

ADVANCES IN CANCER

The mortality rates of cancer, the second leading cause of death in the United 

States, have been falling for several years, and this year, for the first time in history, the absolute number of cancer deaths in the United States has decreased. 

More effective therapies have led to improved outcomes for more than 10 million 

American cancer survivors. With the increase in budgets between 1999 and 2003, 

the National Cancer Institute has stimulated a paradigm shift in cancer therapy. 

We are seeing the emergence of targeted therapies, with the unprecedented ability 

to use specific molecular targeting to treat tumors with novel agents. We can also 

detect and treat cancer at earlier stages. The National Cancer Institute’s (NCI) 

Early Detection Research Network (EDRN), launched in 1999, has identified a number of biomarkers that allow for the earlier detection of breast, prostate, colon, lung 

and other cancers. This year, NCI, in collaboration with the Human Genome Research Institute, has launched a cancer genome pilot project to help further our understanding of the basic biology of cancer and identify additional treatment targets. 

The estimated total cumulative investment at the NCI per American over the past 

30 years, including the doubling period, is about $258, or about $9 per American 

per year over the entire period. 
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ADVANCES IN HIV/AIDS

Without the development and testing of antiretroviral drugs, there would be no 

hope for patients with HIV/AIDS. The development of Highly Active Antiretroviral 

Therapies primarily resulted from the work of a large cadre of NIH-supported scientists and their counterparts in the pharmaceutical industry. Their discoveries 

about the cellular mechanisms of the disease have transformed AIDS into a manageable disease, preventing hundreds of thousands of hospitalizations and early 

deaths. To date, 21 antiretroviral drugs and 4 combination formulations have been 

approved by the FDA. Many more less toxic AIDS drugs are currently in development. Today, fewer than 50 HIV-infected babies are born each year in the United 

States, sparing 16,000 to 20,000 children from AIDS through the use of 

antiretroviral drugs to prevent mother-to-child transmission. Mother-to-child transmission rates in developing countries have declined by 40 percent with the use of 

drug therapy. With the introduction of these new drugs, economists estimate the aggregate potential value of improved survival has been nearly $400 billion for those 

infected through 2000. They estimate the aggregate potential value for all past and 

future cohorts of individuals infected with HIV is almost $1.4 trillion. 

With the additional resources provided during the doubling of the NIH budget, 

we launched the Vaccine Production Program (VPP) Laboratory to efficiently translate candidate research vaccines, including HIV vaccines, into useable products. 

Since its inception in 2001, this program has overseen the manufacture of over 29 

bulk pharmaceutical compounds formulated into 14 different vaccine products for 

HIV, as well as West Nile, SARS and Ebola Virus, and expanded our network of 

clinical trial sites across the globe. This program is enabling NIH to serve the needs 

of the American people in an age of global risks of infectious diseases. 

ADVANCES AGAINST THE THREAT OF PANDEMIC INFLUENZA

Thanks to fundamental advances in viral genomics and genetic engineering, NIH 

has been able to help in the development of countermeasures against both seasonal 

and pandemic influenza viruses. We now have a vaccine against the H5N1 virus 

and will develop a second one in conjunction with CDC. Without such a vaccine, and 

others under development and testing, we would be completely defenseless against 

the potential pandemic that threatens the entire world. We are investing in research and development to hasten the production process by converting from eggbased to cell culture-based vaccines. We are developing novel vaccine approaches 

using a variety of molecular biological techniques, and we launched discovery efforts 

for new anti-viral compounds against pandemic flu. We initiated a project to identify 

the genomes of thousands of human and avian influenza viruses, and, to date, 831 

influenza genome sequences from human isolates have been deposited in NIH’s 

GenBank, allowing researchers across the world to better understand influenza viruses and develop countermeasures. 

DEVELOPMENT OF BIODEFENSE RESEARCH

Since 2001, NIH has directed more than $10 billion toward protecting the American public from bioterrorism. The 2001 intentional release of anthrax underscored 

the reality of a bioterrorism threat posed by other Category A agents such as smallpox, plague, tularemia, hemorrhagic fevers, and botulinum toxin. NIH responded 

swiftly. Promising vaccine candidates for Ebola and smallpox are currently in clinical trials. Identification of the three-dimensional structure of the anthrax toxin 

complex is fueling the search for compounds that block the toxin’s effects, and the 

discovery of the key mechanism of Ebola virus cell entry prompted experiments 

demonstrating that Ebola infection could be blocked in laboratory tests. We continue 

to build a national biodefense research infrastructure that will position the Nation 

to respond even more quickly and precisely to bioterrorism. 

ADVANCES IN DIABETES AND RELATED ILLNESSES

Nearly 21 million Americans have diabetes, a disease that can cause damage to 

multiple organs and lead to death. Without NIH research, the improvements of the 

past two decades in the therapies for diabetes would not have occurred. Through 

large prospective trials, made possible by the doubling of our budget, we have assessed the relative value of drug based approaches versus weight loss and physical 

activity, and showed it is possible to reduce the risk of type 2 diabetes by 58 percent 

with lifestyle modifications alone. 

Diabetes can also result in vision loss. Four million American adults suffer from 

diabetic retinopathy, the outcome of damage to the tiny blood vessels in the lightsensitive retina lining the inside of the eye. Nearly a million have the advanced vi-
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sion-threatening stage of the disease. The National Eye Institute completed a series 

of landmark clinical trials to develop novel treatments for diabetic retinopathy. 

Without these new treatments, 450,000 patients who have advanced disease today 

would otherwise likely be blind in 5 years. As a consequence, of those currently at 

risk, only 27,000 would progress to legal blindness, and only 9,000 would become 

blind today. In addition to reduced suffering and disability, the economic savings 

from these treatments will reach as much as $1.6 billion per year. 

As another example of payoff from recent NIH research, end-stage renal disease 

(ESRD)—kidney failure requiring dialysis or transplantation, a complication of diabetes and high blood pressure—results in direct federal expenditures of approximately $20 billion per year. Through the 1980s and 1990s, the incidence of ESRD 

nearly doubled each decade, but in the last five years overall rates have stabilized— 

and even declined in certain population groups. This improvement has been driven 

by monitoring for proteins in urine to prevent kidney disease or detect it in its early 

stages. Compared with earlier projections, the savings in federal health care expenditures are approximately $1 billion dollars per year. 

Without the investment in medical research, people with diabetes would be living 

shorter, less productive, and less hopeful lives. 

ADVANCES IN IMAGE-GUIDED MICROSURGERY

Increases in the NIH budget allowed new investments in the use of imaging technologies like CAT scanning, MRI or ultrasonography for the development of new 

microsurgical techniques. These minimally invasive therapies are changing the fate 

of many patients, including patients with Parkinson’s disease, through deep brain 

stimulation. These new techniques are also promising to revolutionize the treatment 

of epilepsy, a disease that affects over 2.7 million Americans. As we move forward 

with such research, we expect that surgery will become less invasive, more precise 

and less dangerous, with far less operative complications. 

ADVANCES IN HEALTH INFORMATION FOR SCIENTISTS AND THE PUBLIC

The National Library of Medicine of the NIH provides the American public with 

high quality, reliable information. The NIH web sites (www.nih.gov) are now recognized by independent organizations as the most successful health related web sites, 

with over 2 million queries per day. Millions of patients and their families regularly 

consult NIH web sites for up to date information in English and Spanish, a capability made entirely possible by the doubling of the NIH budget. The web-based 

ClinicalTrials.gov represents a landmark effort to provide information to patients 

and physicians across the country on NIH-funded clinical trials. 

NIH also leads the research field in developing information technology for biomedical research. No biomedical scientist develops a project without first consulting 

the suite of powerful informational research tools available through the NIH National Library of Medicine’s PubMed, a growing digital archive of peer-reviewed research articles and scientific databases. 

NEW RESEARCH TOOLS

NIH researchers have pioneered powerful new research tools and methods such 

as high throughput DNA sequencing, protein identification with mass spectrometry, 

gene expression arrays, the determination of thousands of new protein structures, 

and imaging technologies which were simply unavailable before the doubling of the 

NIH budget. A great illustration of the impact of these advances has been the identification of the cause of the SARS virus in less than a month and the current tracking of pandemic flu viruses. These tools have greatly accelerated the research process itself, spurred progress and spawned new discoveries in all areas of biomedical 

research. Perhaps nowhere else have these technological advances in imaging and 

genotyping elicited more excitement than in the field of mental and behavioral 

health, elucidating genes linked to schizophrenia, depression, bipolar disorder and 

anxiety. These discoveries are allowing for the first time direct visualization of brain 

structure and function to study the brain circuitry involved in thinking and a range 

of behaviors. 

NEW DIAGNOSTIC AND THERAPEUTIC TECHNOLOGIES

Some of NIH’s successes can be measured in new medical technologies. Advances 

in research are driving an increase in the number of technologies being licensed to 

companies for commercialization. In fiscal year 2004, there were thousands of active 

licenses between federally funded research institutions and companies worldwide. 

Out of these technologies, several thousand companies are making many new prod-
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ucts that have an immeasurable impact on public health. Today, from NIH funded 

research, more than 300 new drug products and vaccines targeting more than 200 

diseases—including various cancers, Alzheimer’s disease, heart disease, diabetes, 

multiple sclerosis, AIDS and arthritis—are in clinical trials. These outcomes are accomplished through the on-going network of successful collaborations with our colleagues in private industry. 

CHANGING LANDSCAPE OF DISEASE

Disease and injury are constant threats to humankind and are never static. New 

diseases can emerge at any time, such as HIV/AIDS, SARS, Pandemic Flu, obesity 

or many other conditions. Bioterrorism did not figure significantly in the NIH agenda in 2001, but is now a top priority of the agency. Twenty years ago the impact 

of Alzheimer’s disease was not fully appreciated, nor were its causes known. 

As the result of our success in preventing and treating acute and short term conditions such as heart attacks, stroke, cancer and many infectious diseases, we are 

living longer. Our increasingly older population faces the new challenge of multiple 

chronic conditions which now consume about 75 percent of healthcare expenditures. 

This shifting burden of health care from acute to chronic diseases is perhaps the 

greatest challenge we face. 

Health care costs in the United States have risen to more than $2 trillion. The 

amount spent on health care per person has doubled, from $3,461 in 1993 to $7,110 

today. The causes of health care inflation are varied and complex, requiring different, nation-wide solutions. 

We are in a race against the overwhelming human and economic consequences of 

disease. We can win this race, but only if we use research discoveries to transform 

medicine as we know it. Thanks to recent research advances, we can foresee a future of more effective medical treatment that might be less expensive than current 

practices. 

STRATEGIC VISION FOR NIH: FROM CURATIVE TO PREEMPTIVE CARE

We are in an era of great scientific opportunity. Advances in our understanding 

of basic human biology allowed NIH to sequence the human genome by 2003, two 

years ahead of schedule, and to complete the Haplotype Map, showing the variation 

between individual humans, in October 2005, also ahead of plans. One of the greatest scientific achievements in history, the genome blueprint, along with work in systems biology and proteomics, are driving a revolutionary period in the life sciences. 

We are on the brink of transforming medical treatment in the 21st Century. Our 

hope is to usher in an era where medicine will be predictive, personalized and preemptive. 

Toward this goal, NIH is strategically investing in research to further our understanding of the fundamental causes of diseases at their earliest molecular stages so 

that we can reliably predict how and when a disease will develop and in whom. Because we now know that individuals respond differently to environmental changes 

according to their genetic endowment and their own behavioral responses, we can 

envision the ability to precisely target treatment on a personalized basis. Ultimately, this individualized approach, completely different than how we treat patients today, will allow us to preempt disease before it occurs. 

Consider, for instance, how better predictive and personalized treatments could 

improve the safety and effectiveness of drugs. As we know, drugs do not fall into 

the ‘‘one size fits all’’ category. The same drug can help one patient and harm another. Recent research shows that we will be increasingly able to know which patients will benefit from treatment and which patients might be harmed. This field 

of study is known as pharmacogenetics. Using the latest genomic data, enabled by 

the doubling of the NIH budget, the NIH established a Pharmacogenetic Research 

Network which is studying the interactions of drugs and molecules as well as the 

biological processes that eliminate compounds from the body. In the first five years 

of this program, the researchers in this network made numerous discoveries. 

For example, they learned that 10 percent of the North American population exhibits a genetic variation that puts them at high risk for life-threatening reactions 

to irinotecan, a cancer drug. We now know that patients with this variation should 

be given lower than prescribed doses of this successful drug, thus potentially saving 

their lives. 

NIH researchers also discovered variations in a gene involved in the body’s response to more than half of all medications. Understanding these differences could 

explain critical individual as well as racial and ethnic differences in drug responses. 

Other genetic variations discovered by the NIH network will have an impact on 
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asthma treatment, the risk of sudden death from irregular heartbeats and the proper use of blood thinning medications to avoid deadly bleeding complications. 

In another example of emerging personalized medicine, cancer researchers have 

developed a test that helps determine the risk of recurrence for women who were 

treated for early stage, estrogen-dependent breast cancer. This information can help 

a woman and her doctor decide whether she should receive chemotherapy in addition to standard hormonal therapy. This test has the potential to change medical 

practice by sparing tens of thousands of women each year the unnecessary and 

harmful side effects associated with chemotherapy at large potential cost savings. 

RAPID ADVANCES IN THE GENOMIC ERA

Because of a hundred fold reduction in the cost of genomic technology, we can now 

study, at affordable costs, the differences between patients who have a disease and 

their normal counterparts. Recently, this revolutionary approach led to the discovery 

of two previously unsuspected factors that can identify who is at risk and how to 

protect patients from age-related macular degeneration, an increasing cause of 

blindness in our aging population, with over 7 million Americans at risk. Last 

month, a key transcription factor that may be responsible for a large percentage of 

cases of diabetes was discovered. 

These breakthroughs form the basis of our budget request for the Genes and Environment Initiative, supported by Secretary of Health and Human Services Michael 

Leavitt, because it will give us the unprecedented ability to discover, over the next 

three years, the potential causes of the 10 most common diseases afflicting the U.S. 

population. With this funding, if approved, we will also launch a technology development effort for enabling scientists to measure many types of environmental exposures at the individual level. Taken together, these efforts will lead to better understanding of the environmental and genetic factors in the development of many diseases. 

Imagine a world where we will be able to tell each patient whether they need to 

take action to preempt altogether the development of costly and painful diseases. 

Imagine telling them that they do not need to take expensive medications for life 

because they are not at risk of disease. A more predictive, personalized and preemptive form of medicine is no longer just a dream, but a vision to strive for as rapidly 

as we can. 

MANAGEMENT INNOVATIONS

NIH has an enormous and growing scope of mission. We conduct or support research on over 6,600 diseases and conditions, from the most common to the rarest. 

In 2005, more than 43,000 research grant applications went through our rigorous 

two-tiered review process, with about 22 percent of applications ultimately receiving 

funding. 

More than 80 percent of the NIH budget supports extramural research at 3,100 

institutions around the world, employing about 200,000 scientists and other research personnel. Another 10 percent of the budget goes into the NIH intramural 

program, consisting of approximately 6,000 scientists, where work is focused on public health priorities and cutting edge research. The hub of the intramural program, 

the NIH Clinical Center on the Bethesda campus, is the world’s largest dedicated 

clinical research complex. 

NIH is spending $95 per American this year on medical research, and we need 

to make every dollar count. With the growth and increasing complexity of the agency, NIH has aggressively moved to transform its management strategies and decision-making processes. To streamline, harmonize and better coordinate decisions 

that affect the entire agency, in 2003, I established the NIH Steering Committee, 

composed of nine Institute Directors who serve on a rotating basis. Six working 

groups support the Steering Committee. This new governance structure has enabled 

greater coordination and harmonization between the 27 Institutes and Centers at 

NIH. 

NIH has addressed the need for more robust means to oversee the vast NIH research portfolio, and plan and launch trans-NIH initiatives. While the NIH successfully developed important trans-NIH initiatives such as the Roadmap for Medical 

Research, the Strategic Plan for Obesity Research, and the Neuroscience Blueprint, 

the agency is now implementing even more rigorous and transparent processes and 

developing cutting-edge tools to analyze, assess and manage the array of research 

it supports. This will provide better information to support planning and prioritysetting in areas of shared Institute and Center interests. To reinforce these accomplishments, NIH is establishing a new office within the Office of the Director—the 

Office of Portfolio Analysis and Strategic Initiatives (OPASI). 
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Review of our programs by the Office of Management and Budget under the congressionally mandated Government Performance and Results Act (GPRA) provides 

evidence that our programs are effective. We have been rated in the top 15 percent 

of federal organizations. 

NIH’s effective performance is reflected in recent scores as measured by the OMB 

Program Assessment Rating Tool (PART). In the fiscal year 2007 PART, the Buildings and Facilities Program and the Intramural Research Program both received the 

highest possible rating of effective, with scores of 96 percent and 90 percent, respectively. On the fiscal year 2006 PART, the NIH Extramural Research Program 

achieved a similarly high 89 percent. These high scores demonstrate exemplary 

management and substantial progress toward meeting NIH performance measures. 

To date, approximately 90 percent of NIH’s budget has been PARTed and rated effective. 

TRANSLATING DISCOVERIES INTO BETTER MEDICAL TREATMENT

Rapidly translating our discoveries from the bench to the bedside is a top priority 

of the NIH. The opportunities have never been greater to use modern research 

methodologies such as genomics, proteomics, metabolomics, high sensitivity biochemical methods and other novel strategies to bring new insights to the study of 

human populations and more rapidly achieve the goal of making medicine predictive, personalized and preemptive. 

To accelerate progress, NIH recently introduced the institutional Clinical and 

Translational Science Award (CTSA). The CTSA program will stimulate institutions 

across the country in transforming Clinical and Translational Science in the U.S.A. 

to (1) captivate, advance, and nurture a cadre of well-trained multi- and inter-disciplinary investigators and research teams; (2) create an incubator for innovative research tools and information technologies; (3) synergize multi- and inter-disciplinary 

clinical and translational research; and (4) accelerate the application of new knowledge and techniques to clinical practice at the front lines of patient care. 

TRAINING A NEW GENERATION OF SCIENTISTS

New visions require new talent. In times of constrained budgets the most important action NIH needs to take is to preserve the ability of young scientists with 

fresh ideas to enter the competitive world of NIH funding. To that effect, NIH has 

launched the new ‘‘Pathway to Independence’’ program which will support, for each 

of the next five years, 150 to 200 recently trained scientists conducting independent, 

innovative research. 

IN SUMMARY

Our Nation’s investment in biomedical research has dramatically improved health 

outcomes. The return on the investment of the American people at NIH is nothing 

short of spectacular. Thanks to the support of Congress, we are able, through our 

science, to respond in record time to emerging threats such as SARS, Pandemic Flu 

and biodefense needs. We have learned how to decrease the incidence of many diseases and other disabilities for old and young Americans. The estimated total cumulative investment at the NIH per American over the past 30 years including the 

doubling period is about $1,334 or about $44 per American per year over the entire 

period. In return, Americans have gained over six years of life expectancy and are 

aging healthier than ever before. 

The President and Congress have wisely invested in biomedical research. We are 

acutely aware that NIH research is often the only hope for millions of people afflicted by disease. In the battle for health, NIH also believes that it needs to accelerate the pace of progress, as it is only through a fundamental transformation of 

medicine that solutions to the rising burden of healthcare will be found. 

I will be happy to answer any questions you may have. 
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PREPARED STATEMENT OF DR. JOHN E. NIEDERHUBER

Mr. Chairman and Members of the Committee: I am please to present the fiscal 

year 2007 President’s budget request for the National Cancer Institute (NCI). The 

fiscal year fiscal year 2007 budget includes $4,753,609,000, a decrease of 

$39,747,000 below the fiscal year 2006 enacted level of $4,793,356,000 comparable 

for transfers proposed in the President’s request. 

OUR GOAL REMAINS THE SAME

Four years ago, we put the NCI on a trajectory towards the Challenge Goal of 

eliminating suffering and death due to cancer as early as the year 2015. Since that 

time, we have vigorously and aggressively managed NCI’s portfolio of investments 

in cancer research across that entire continuum of the process of cancer, whether 

we’ve been focusing on understanding genetic mutations that were responsible for 

susceptibility to cancer or focusing on issues that have to do with survivorship and 

living with, rather than dying from, cancer. 

NCI has been a major leader in the molecular metamorphosis of biomedical medicine that has benefited all fields of medical research. Without the Nation’s support 

of NCI’s pioneering role in funding research—including basic science, clinical trials, 

and translational investigations—into the molecular and genetic processes that underlie all disease and the training of new cancer researchers, it is unlikely that the 

advances we are seeing today in many health areas—from AIDS to macular degeneration—would have occurred at the pace they have. These leadership efforts must 

be sustained going forward. 

The Nation’s past commitment to cancer research has proven its worth: mortality 

rates have declined for all cancers combined while incidence rates have stabilized 

or increased slightly, detection and treatments have improved, new therapeutic options offer startling promise. Today there are nearly 10 million cancer survivors in 

the United States compared to approximately 3 million cancer survivors in 1971 

when the National Cancer Act was established. Also, in 1971 fewer than half of 

those found to have cancer lived 5 years beyond their diagnosis; today the 5 year 

survival rate is 64 percent for adults and 79 percent for children aged 14 or younger. The latter figure is truly remarkable given how few children survived even a 

couple of years after being diagnosed in the early 1970s. NCI’s continued commitment is manifested today in far-reaching programs that have advanced our basic 

understanding of the genetic changes responsible for this dreaded disease. The Nation’s investment and the actions of Congress are directly responsible for the devel-
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opment of a nation-wide network of 61 NCI-designated cancer centers and a highly 

successful Community Clinical Oncology Program (CCOP), founded in 1983. 

Through the network of 64 CCOP grantees, community investigators participate actively in NCI-sponsored cancer prevention, control, and treatment clinical trials. 

These programs place cutting-edge research directly in communities and put access 

to cancer clinical trials into the hands of local physicians. Because of their participation in NCI trials, community clinicians more readily adopt new regimens, ensuring 

that these advances are rapidly made part of the standard of care. 

Recently, NCI’s leadership team has initiated a series of site visits to innovative 

community-based cancer centers as potential models for a new NCI initiative, the 

Community Cancer Centers Program (CCCP). The CCCP would help foster replication of successful community models across the country, set the standards for multispecialty state-of-the-art care, provide access to early phase clinical trials, and ultimately improve cancer care and outcomes. This program is especially designed to 

bring academic standards of care and clinical trials directly to the segments of our 

population who either through age or resources cannot leave their community. 

A RECORD OF REAL SUCCESS

The past year in cancer research shows a record of substantial and heartening 

achievement. We are expanding our foundation of knowledge and the technical tools 

with which rapid advances can be made in understanding the mechanisms of cancer. We are exponentially increasing the opportunities to manage this lethal disease. 

Building on NCI-funded research, large-scale clinical trials in 2005 yielded results 

that will have profound effects in preventing and treating many cancers. 

For example, three different clinical trials showed that adding trastuzumab 

(Herceptin®) to standard adjuvant chemotherapy significantly reduced the risk of 

recurrence in women with the early-stage breast cancer, HER–2/neu positive, which 

has an over expression of protein in the gene. Approximately 50,000 women in the 

United States are diagnosed with HER–2/neu positive breast cancer each year, representing about 20 percent of invasive breast cancers. 

Equally stunning results were seen in the trial of a vaccine that protects against 

two strains of human papillomavirus (HPV) that cause over 70 percent of cervical 

cancers, a disease that kills more than 200,000 women each year, including many 

in developing countries. Study results concluded that women who received the vaccine during a 2-year study were protected against precancerous lesions caused by 

HPV. NCI made the initial discoveries linking HPV to cervical cancer, which led to 

creation and testing of HPV vaccines that are based on technology also developed 

at the Institute. It is an outstanding exemplar in this era of molecular medicine of 

how NCI’s knowledge about the etiology of the disease enabled creation of a vaccine 

against a specific cancer. 

In January, an NCI-sponsored trial reported that women who received chemotherapy directly in their abdomens as part of treatment for advanced ovarian cancer 

lived more than a year longer than women who received the same chemotherapy 

intravenously. The findings confirm and expand recent research showing that 

intraperitoneal (IP) chemotherapy, which delivers drugs directly to the abdominal 

cavity through a catheter, can significantly increase survival for some women with 

the disease. As the results were made public, NCI issued a rare clinical announcement to raise awareness about IP chemotherapy for ovarian cancer among physicians and patients. The NCI announcement—the first since 1999—was warranted 

because IP chemotherapy is widely regarded as an old technology and previous 

trials have generated little interest among physicians. Ovarian cancer causes the 

most deaths of any gynecological cancer in the United States and frequently goes 

undetected until tumors spread beyond the ovaries. 

Another notable advance came last September with the announcement of results 

from the NCI-sponsored Digital Mammographic Imaging Screening Trial (DMIST). 

The study found that digital mammography is more accurate than film mammography for women with dense breasts, as well as for several other groups of women, 

including women under 50 and pre- and perimenopausal women. Overall, DMIST 

offers a model case study of how NCI can be an agent of change, pursuing new approaches to research, partnering with the private and public sectors, and fueling the 

development of technologies to achieve an important advance. It is particularly noteworthy that NCI and the American College of Radiology Imaging Network (ACRIN) 

secured the involvement in DMIST of four companies that developed and manufactured digital mammography machines for our use in clinical trials: Fischer Medical, 

Fuji Medical, General Electric Medical Systems, and Hologic. 

Finally, NCI has made strides to address the widespread disparities in cancer 

screening, treatment, and care for disadvantaged, mostly minority populations. One 
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approach to closing this access gap is NCI’s Patient Navigator Research Program, 

which relies on personal guides to shepherd disadvantaged cancer patients into 

standard care. NCI supports a number of Patient Navigator Program pilot projects 

in minority communities and about $24 million in grants will be awarded over the 

next 5 years as part of the program. 

ADVANCED TECHNOLOGIES ACCELERATE PROGRESS

The technology revolution is speeding up and enabling the discovery process. 

Nanotechnology has emerged as a key strategy for imaging molecular features of 

cancer and will ultimately lead to personalized medicine. NCI’s investment in 

nanotechnology is a powerful example of leveraging resources from the private sector through our Centers of Cancer Nanotechnology Excellence. 

Of equal significance, in December 2005 NCI and the National Human Genome 

Research Institute (NHGRI) launched The Cancer Genome Atlas (TCGA) Pilot 

Project, a comprehensive effort to accelerate understanding of the molecular basis 

of cancer and which evolved from the Human Genome Project (HGP). The TCGA 

Pilot Project will develop and test the science and technology needed to systematically identify the genetic changes in a small number of cancers. 

Additionally, NCI’s cancer Biomedical Informatics Grid (caBIGTM) is creating a 

unifying technology platform or ‘‘world-wide web’’ for cancer research. caBIGTM is 

well on the way to its goal to create a network of interconnected data, applications, 

individuals, and institutions that will redefine how cancer research is conducted and 

care is provided. This initiative has also whetted considerable commercial interest. 

INTERAGENCY COLLABORATIONS

Addressing the cancer problem requires that NCI work across institutional and 

sector boundaries, share knowledge, and bring together the diverse members of the 

Department of Health and Human Services (DHHS) family of agencies, as well as 

other federal offices, that can help develop systems-based solutions to the cancer 

problem. 

The NCI and FDA Interagency Oncology Task Force (IOTF) continues to remove 

bottlenecks in the process of developing and approving safe, more effective cancer 

interventions. During 2005, IOTF helped foster the creation of two important initiatives: the Exploratory Investigational New Drug (IND) process to streamline the 

early clinical development of new drugs and biologics; and the NCI Regulatory Affairs Liaison position to help NCI-funded researchers navigate through FDA’s IND 

application process. Both will help eliminate obstacles to the rapid development of 

promising new anticancer agents. 

DHHS Secretary Mike Leavitt announced last month the Oncology Biomarker 

Qualification Initiative (OBQI)—an unprecedented interagency agreement among 

NCI, FDA, and the Centers for Medicare and Medicaid Services (CMS) to collaborate on improving the development of cancer therapies and the outcomes for cancer 

patients through biomarker development and evaluation. 

CONCLUSION

We must do more to continue the acceleration of discovery, development, and delivery of the interventions that will hasten the transformation of our traditional 

view of cancer as a death sentence into a disease that we can prevent, eliminate, 

or control. This will be the legacy we leave our children. 

While progress is evident, there is much that remains to be accomplished. We are 

committed to face the challenge of making difficult choices between those programs 

that we will continue to grow and nurture and those that have already advanced 

our knowledge. The decisions will be science driven. This is an unprecedented era 

of discovery. The opportunities to apply powerful new technologies to advance our 

knowledge and the opportunities to change the course of cancer have never been 

greater. 

PREPARED STATEMENT OF DR. FRANCIS S. COLLINS

Mr. Chairman and Members of the Committee: I am pleased to present the fiscal 

year 2007 President’s budget request for the National Human Genome Research Institute (NHGRI). The fiscal year 2007 budget includes $482,942,000, a decrease of 

$3,107,000 from the fiscal year 2006 enacted level of $486,049,000 comparable for 

transfers proposed in the President’s request. 

On October 26, 2005, an international consortium of dedicated scientists from six 

countries, led by the NHGRI, published a new map of the human genome called 
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‘‘HapMap’’ that may prove even more powerful than the human genome sequence 

because of its medical applications. 

The Human Genome Project (HGP) spelled out the letters of the 99.9 percent of 

the DNA code that we all share. The haplotype map, or HapMap for short, provides 

detailed knowledge of the 0.1 percent that represents variation in the genome. The 

HapMap reveals the way in which this genetic variation is organized into chromosomal neighborhoods and provides a powerful tool to uncover those spelling differences in the human instruction book that predispose some people to diabetes, Alzheimer’s disease, heart disease, or cancer. As with the HGP, all of the data has been 

placed in the public domain. 

Since early deliberations about the HGP 20 years ago, scientists and physicians 

have dreamed of the day when we would be able to apply the tools of genomics to 

the diagnosis, treatment, and prevention of those common diseases that fill up our 

hospitals and clinics, causing untold suffering, misery, and premature death. The 

completion of the HapMap brings us a major step closer to the realization of that 

dream. 

The HapMap project could not have succeeded without the support of multiple 

NIH institutes, the U.S. Congress, and the dedication of more than 2,000 scientists 

across the world who delivered on every promise of the project. In fact, in its brief 

three-year life, this project produced a map three times more detailed than originally thought possible. The NHGRI and other NIH institutes can now move quickly 

to build on this success to discover the genetic and environmental factors that cause 

disease, and to utilize this information to develop better means of individualized 

prevention and treatment. 

ONGOING NHGRI INITIATIVES

Use of Comparative Genomics to Understand the Human Genome 

The NHGRI continues to support the sequencing of the genomes of non-human 

species such as the chimpanzee, dog, and mouse because of what they tell us about 

the human genome. The first comprehensive comparison of the genetic blueprints 

of humans and chimpanzees, published in Nature to wide acclaim in September 

2005, shows our closest living non-human relatives share identity with 96 percent 

of the human DNA sequence. The sequence of the dog genome was published in December 2005, revealing many interesting details about the remarkable diversity of 

man’s best friend, and greatly empowering the ability to track down the genes involved in many chronic illnesses (like cancer) where dogs are excellent models for 

human disease. 

Sequencing technology advances, on the way to the $1,000 genome 

DNA sequencing enables a detailed description of the order of the chemical building blocks, or bases, in a given stretch of DNA, and is a powerful engine for biomedical research. Though DNA sequencing costs have dropped by three orders of 

magnitude since the start of the HGP, sequencing an individual’s complete genome 

for medical purposes is still prohibitively expensive. Two bold new advances in sequencing technology recently developed by NHGRI-funded researchers promise to 

greatly reduce this cost. Ultimately, the NHGRI’s vision is to cut the cost of wholegenome sequencing to $1,000 or less. If achieved, this would enable the sequencing 

of individual genomes as part of routine medical care, providing health care professionals with a more accurate means to predict disease, personalize treatment, and 

preempt the occurrence of illness. 

Knockout Mouse Project 

The technology to ‘‘knockout’’ or inactivate genes in mouse embryonic stem cells 

has led to many insights into human biology and disease. However, information 

about knockout mice have only been published and made available to the research 

community for about 10 percent of the estimated 20,000 mouse genes. Recognizing 

the wealth of information that mouse knockouts can provide, the NHGRI coordinated an international meeting in 2003 to discuss the feasibility of a comprehensive 

project. These discussions have now resulted in a trans-NIH, coordinated, five-year 

cooperative research plan that will produce knockout mice for every mouse gene and 

make these mice available as a community resource. 

Chemical Genomics—Roadmap—Molecular Libraries and PubChem 

The NHGRI has taken a lead role in developing a trans-NIH chemical genomics 

initiative. This is part of the NIH Roadmap, and now offers public-sector researchers access to high throughput screening of libraries of small organic compounds that 

can be used as chemical probes to study the functions of genes, cells, and biochemical pathways. This powerful technology provides novel approaches to explore 
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the functions of major components of the cells in health and disease. All the data 

generated for this project is stored in the new PubChem database at the National 

Library of Medicine. 

Bench-to-Bedside in Intramural Research—The Example of Progeria 

As just one example of the focus of the NHGRI intramural program on 

translational research, rapid advances have recently been achieved in the study of 

progeria, a rare genetic disease of childhood characterized by dramatic acceleration 

of aging. In 2003, NHGRI researchers discovered that progeria is caused by a single 

letter misspelling in a gene known as lamin A. The lamin A protein undergoes a 

particular modification known as farnesylation. That same modification activates 

the protein product of the famous ras oncogene; ten years of hard work has made 

available a class of cancer drugs that blocks this step. Remarkably, cell culture and 

mouse model experiments suggest these drugs may also have benefits for children 

with progeria. Serious consideration of a clinical trial is now underway, just three 

years after gene discovery. 

The Surgeon General’s Family History Initiative 

Family medical history is a source of genetic information that can help more accurately determine an individual’s risk for specific diseases. However, to date, this resource has been underutilized in health. To address this, Surgeon General Richard 

Carmona established the U.S. Surgeon General’s Family History Initiative, a collaborative effort between a number of Department of Health and Human Services 

agencies, with leadership from NHGRI. The second annual National Family History 

Day was celebrated on Thanksgiving Day 2005, when a new and improved version 

of the software tool called ‘‘My Family Health Portrait’’ was released to help individuals compile their own family history information. This initiative should have an 

impact on patient-healthcare provider interaction, facilitating the development of 

more accurate family history information for patient medical records, and leading 

to more personalized and effective disease prevention and treatment strategies. 

NEW NHGRI INITIATIVES

The Genes and Environment Initiative (GEI) and the Genetic Association Information Network (GAIN). 

Just this February, the Department of Health and Human Services announced 

the creation of two related groundbreaking initiatives in which NHGRI will play a 

leading role, to speed up research on the causes of common diseases such as asthma, 

arthritis, the common cancers, diabetes, and Alzheimer’s disease. 

The Genes and Environment Initiative (GEI) is a trans-NIH research effort to 

combine comprehensive genetic analysis and environmental technology development 

to understand the causes of common diseases. NIH will invest $68 million in GEI 

in fiscal year 2007. Using the newly derived HapMap, GEI will search for the specific DNA variations that are associated with an increased risk of common illnesses. 

For the more than a dozen disorders chosen for investigation under GEI, NIH will 

study roughly 1,000 cases and 1,000 controls will be studied. Finding the variants 

that predispose a person to common disease is one of the highest priorities of current biomedical research, as this will enable developing personalized medicine and 

identifying new drug targets. 

To ensure that GEI takes advantage of the wide breadth of expertise that is available on DNA variations for common disorders, NIH has begun partnering under the 

Genetic Association Information Network with the Foundation for the NIH, Pfizer, 

and Affymetrix to begin research on seven diseases during this fiscal year. 

But genes alone do not tell the whole story. Recent increases in chronic diseases 

like diabetes, childhood asthma, obesity or autism cannot be due to major shifts in 

the human gene pool as those changes take much more time to occur. They must 

be due to changes in the environment, including diet and physical activity, which 

may produce disease in genetically predisposed persons. Therefore, GEI will also invest in innovative new technologies/sensors to measure environmental toxins, dietary intake and physical activity, and using new tools of genomics, proteomics, and 

understanding metabolism rates to determine an individual’s biological response to 

those influences. 

The Cancer Genome Atlas (TCGA) 

In December, the National Cancer Institute (NCI) and the National Human Genome Research Institute (NHGRI) jointly launched a very important new effort to 

accelerate our understanding of the molecular basis of cancer through the application of genome analysis technologies, including large-scale genome sequencing. 

Thanks to the tools and technologies developed by the Human Genome Project and 
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recent advances in using genetic information to improve cancer diagnosis and treatment, it is now possible to envision a comprehensive effort to map the changes in 

the human genetic blueprint associated with all known forms of cancer. The overall 

effort, called The Cancer Genome Atlas, will begin in 2006 with a three year, pilot 

project totaling $100 million to determine the feasibility of a full-scale effort to explore the universe of genomic changes involved in all types of human cancer. This 

atlas of genomic changes will provide: (1) new insights into the biological basis of 

cancer which in turn will lead to new tests to detect cancer in its early, most treatable stages; (2) new ways to predict which cancers will respond to which treatments; 

(3) new therapies to target cancer at its most vulnerable points; and (4) ultimately, 

new strategies to prevent cancer altogether. 

OTHER AREAS OF INTEREST

Education of Health Care Professionals 

To enable the translation of basic genetic discoveries into health care practice, the 

NHGRI has developed numerous educational programs to prepare health care professionals for this revolution. Specifically, the NHGRI continues to play a lead role 

in the National Coalition for Health Professional Education in Genetics (NCHPEG), 

which is leading a national effort to achieve genetic literacy amongst health professionals. NHGRI also worked closely with the American Academy of Family Physicians, who featured genomic medicine as their educational focus for 2005. 

Minority Outreach Activities 

The NHGRI has been at the forefront of ensuring that minority scientists and students are equipped to meet the new challenges of genome research for the 21st century. The institute has sponsored new initiatives to reach out to diverse populations 

including research, education, and outreach collaborations on the role of genetic factors in health disparities. In conjunction with the National Council of La Raza, 

NHGRI has developed a community-based model education program for provision of 

genetics information to underserved Latino communities. NHGRI is also working 

with Alaska Native communities and the University of Washington to expand community-based education programs in Alaska Native communities. 

Genetic Nondiscrimination 

The NHGRI remains very concerned about the impact of potential genetic discrimination on research and clinical practice. Through many surveys and research 

projects funded by the Ethical, Legal, and Social Implication (ELSI) program of the 

Institute, it is clear many Americans remain concerned about the possible misuse 

of their genetic information by insurers or employers. In February 2005, the Senate 

unanimously passed the Genetic Information Nondiscrimination Act of 2005 (S. 

306), which would address these concerns; the companion bill H.R. 1227 is now 

pending in the House. The Bush Administration has issued a Statement of Administrative Policy in support of the legislation. This issue remains a high priority for 

the Institute. 

PREPARED STATEMENT OF DR. ANTHONY S. FAUCI

Mr. Chairman and Members of the Committee: I am pleased to present the President’s budget request for the National Institute of Allergy and Infectious Diseases 

(NIAID) of the National Institutes of Health (NIH). The fiscal year 2007 budget of 

$4,395,496,000 includes an increase of $12,195,000 over the fiscal year 2006 appropriated level of $4,383,301,000, comparable for transfers proposed in the President’s 

request. 

The mission of NIAID is to conduct and support research to understand, treat, 

and prevent infectious and immune-related diseases. Infectious diseases include 

well-known killers such as HIV/AIDS, malaria, and tuberculosis; emerging or reemerging threats such as influenza; and ‘‘deliberately emerging’’ threats from potential agents of bioterrorism. Immune-related disorders include autoimmune diseases 

such as type 1 diabetes and rheumatoid arthritis as well as asthma, allergies, and 

problems associated with transplanted tissues and organs. 

NIAID has a two-fold mandate. First, NIAID must plan and execute a comprehensive and long-term basic and clinical research program on well-recognized endemic 

infectious and immune-mediated diseases. Second, and in this case it is unique 

among the NIH Institutes, it must respond quickly with targeted research to meet 

new and unexpected infectious disease threats as they arise, often in the form of 

public health emergencies. Part of the expansion of the NIAID research portfolio in 

recent years has been driven by unprecedented scientific opportunities in the core 
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NIAID scientific disciplines of microbiology and immunology. Advances in these key 

fields have led to a better understanding of the human immune system and the 

mechanisms of infectious and immune-mediated diseases. But the scope of NIAID 

programs also has grown because of a growing realization that biomedical research 

is a key component of a successful response to new challenges posed by emerging 

and re-emerging infectious diseases such as pandemic influenza and HIV/AIDS, the 

threat of bioterrorism, and the increase in asthma prevalence among children. 

EMERGING AND RE-EMERGING INFECTIOUS DISEASES

Despite advances in medicine and public health such as antibiotics, vaccines, and 

improved sanitation, the World Health Organization (WHO) estimates that infectious diseases still account for approximately 26 percent of all deaths worldwide, including about two-thirds of all deaths among children younger than five years of 

age. Moreover, the pathogens we face are not static, but change dramatically over 

time as new microbes emerge and familiar ones re-emerge with new properties or 

in unusual settings. 

Influenza is perhaps the most pertinent example of a re-emerging disease. Influenza viruses continually accumulate small changes such that a new vaccine must 

be made for each influenza season. When a totally new influenza virus against 

which the global population has no natural immunity emerges, a worldwide pandemic can result if the new viruses are able to transmit efficiently between people. 

Three such pandemics occurred in the 20th century, in 1918, 1957, and 1968. The 

pandemics of 1957 and 1968 were severe infectious disease events that killed approximately two million and 700,000 people worldwide, respectively. The 1918–1919 

pandemic, however, was catastrophic. Public health experts estimate that the 1918 

pandemic killed more than 500,000 people in the United States and more than 50 

million people worldwide. 

The highly pathogenic H5N1 avian influenza virus currently found in domestic 

and migratory birds in Asia, Africa, the Middle East, and Europe is of great concern. 

Although H5N1 is primarily an animal pathogen, it nonetheless has infected more 

than 170 people; more than half of all confirmed H5N1 patients have died. At this 

time, the virus is not able to spread efficiently from animals to humans and is extremely inefficient in spreading from person to person, but the feared human influenza pandemic could become a reality if the H5N1 virus mutates further or mixes 

its genes with human influenza viruses, remains highly virulent, and acquires the 

capability to spread efficiently from person to person. 

It is imperative that we prepare for the possibility that a new influenza virus will 

emerge to cause a 1918-like pandemic among human beings. It is important to note, 

however, that our ability to cope with a pandemic—with a sufficient supply of effective vaccines and antiviral drugs, effective infection control, and clear public communication—will to a large extent depend on how well we cope with seasonal influenza. 

It is clear that we have not yet optimized our preparedness and responsiveness to 

this recurring disease, which, according to estimates of the Centers for Disease Control and Prevention (CDC), kills an average of about 36,000 people in the United 

States each year. The serious vaccine shortage that occurred in the 2004/05 influenza season underscored the difficulties we face in annually renewing the influenza 

vaccine supply, and highlights the pressing need to move toward adoption of newer 

vaccine manufacturing techniques and other strategies that can improve the surge 

capacity, flexibility and speed with which vaccines are made. 

NIAID supports numerous research projects that lay the foundation for improved 

influenza vaccine manufacturing methods, new categories of vaccines that work 

against multiple influenza strains, as well as the next generation of anti-influenza 

drugs. Some of these are basic research projects intended to increase our understanding of how animal and human influenza viruses replicate, interact with their 

hosts, stimulate immune responses, and evolve into new strains. Other projects are 

more targeted, such as a program to screen compounds for antiviral activity against 

influenza viruses. One particularly important effort is to develop a vaccine that 

raises immunity to parts of the influenza virus that do not vary from season to season. Not only would such a vaccine provide continued protection over multiple influenza seasons, it might also offer considerable protection against a newly-emerged 

pandemic influenza virus and thereby substantially improve our preparedness for 

pandemic threats. 

The Department of Health and Human Services (DHHS) Pandemic Influenza Response and Preparedness Plan designates NIAID as the lead agency for research 

and development efforts related to pandemic influenza. In this capacity, NIAID has 

developed and is clinically evaluating several candidate H5N1 vaccines, including 

inactivated and live-attenuated vaccines, as well as other strategies such as recom-
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binant subunit and DNA vaccines. The potential benefits of NIAID research to the 

American public have been clear and immediate. The pre-pandemic H5N1 vaccine 

that is currently being stockpiled by DHHS was shown in clinical trials by NIAID 

to be safe and capable of inducing an immune response that would be predictive of 

being protective against the H5N1 virus. The dose of vaccine required for this protection, however, is high; and current NIAID studies are aimed at enhancing the 

response to lower doses of the H5N1 vaccine, particularly with the use of adjuvants, 

which are compounds that have been shown to enhance the immune response to 

vaccines. NIAID also conducts surveillance for the molecular evolution of influenza 

viruses among animals and humans in Asia and elsewhere, and tracks changes in 

the virus that might allow it to be transmitted more easily among people. The Institute also is evaluating new antiviral drugs against H5N1 influenza as well as combinations and varied doses of existing drugs. In addition, NIAID is working to establish a clinical trials network in Southeast Asia to conduct research on emerging infectious diseases, with an initial emphasis on influenza. 

Influenza is by no means the only emerging and re-emerging infectious disease 

threat that the world faces. For example, malaria is a substantial and growing problem compounded by the emergence of drug-resistant malaria parasites and insecticide-resistant mosquito vectors. NIAID supports a large malaria research portfolio; 

one recent study identified a specific parasite gene that is essential for full maturation of the parasites in mice. Disrupting this gene not only prevented the onset of 

disease in mice, but injection of the modified parasites stimulated an immune response that protected them from subsequent infection with unmodified, fully-virulent malaria parasites. This indicated that genetically attenuated parasites might 

be useful as a malaria vaccine in the future. 

Tuberculosis (TB) is an example of a microbial disease that has reemerged in recent years. Infection with Mycobacterium tuberculosis is estimated to be prevalent 

in one-third of the world’s population and is especially common among persons infected with HIV. NIAID supports a large portfolio of research to develop new drugs, 

vaccines, and diagnostics for TB and to evaluate improved treatment and preventive 

regimens. Recently, two novel, engineered TB vaccines developed with NIAID support entered Phase I clinical trials in the United States. These promising candidates 

are the first new TB vaccines to be tested in people in more than 60 years. In addition, the Global Alliance for TB Drug Development and NIAID have collaborated to 

develop a promising new TB drug candidate, which is now being tested in clinical 

trials. NIAID also has made substantial research progress on West Nile Virus, 

multi-drug resistant tuberculosis (MDR–TB), SARS, and other new or re-emerging 

infections. 

HIV/AIDS RESEARCH

HIV/AIDS was first recognized as an emerging disease only 25 years ago. Today 

it is a global catastrophe. According to the Joint United Nations Program on HIV/ 

AIDS (UNAIDS), approximately 40 million people worldwide are living with HIV/ 

AIDS, and their number is increasing by more than 5 million people every year— 

about 14,000 each day. In the United States, more than one million people are living 

with HIV/AIDS, and approximately 40,000 new infections occur annually. Worldwide, more than 25 million people with HIV have died since the pandemic began, 

including more than 520,000 in the United States. In 2004, there were 3 million 

deaths worldwide due to HIV/AIDS. These statistics are grim reminders of the physical and emotional devastation to individuals, families, and communities coping with 

HIV/AIDS, and of the terrible impact of HIV/AIDS on regional and global security 

and the global economy. 

Development of a vaccine that protects against HIV/AIDS is one of the highest 

priorities of the NIAID. The scientific challenges that must be overcome, however, 

are extraordinary. Because the immune system, with rare exceptions, has not been 

shown to contain HIV on its own, an HIV vaccine will have to elicit an even stronger immune response than elicited by natural HIV infection if it is to prevent infection. To help meet these challenges, NIAID established the Center for HIV/AIDS 

Vaccine Immunology (CHAVI) in June 2005. CHAVI’s mission is to tackle the fundamental immunological obstacles in HIV vaccine research and to design, develop, and 

test novel HIV vaccine candidates. The establishment of CHAVI complements 

NIAID’s continued support of other innovative research projects conducted through 

a highly cooperative and collaborative global research and development program. 

Among many HIV vaccine research efforts, NIAID scientists have developed a 

two-part vaccination strategy, consisting of an initial (prime) vaccination followed by 

a later (boost) vaccination. The priming dose is a ‘‘naked’’ DNA vaccine, and the 

boost is a recombinant adenovirus vaccine, which is based on a highly attenuated 
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version of a common cold virus. Both components contain genes from three different 

subtypes of HIV that together cause about 85 percent of all HIV infections around 

the world. An initial Phase I clinical trial showed that the pair of vaccines was welltolerated and induced substantial immune responses. Building on these promising 

findings, NIAID recently launched a second phase of testing of this ‘‘prime-boost’’ 

strategy. This project is a collaboration between three international clinical trial 

networks—NIAID’s HIV Vaccine Trials Network, the non-profit International AIDS 

Vaccine Initiative, and the U.S. Military HIV Research Program—and expands the 

safety and immunogenicity testing of the prime-boost strategy in the Americas, 

South Africa, and Eastern Africa. Also underway and slated to complete enrollment 

this year is the evaluation of a candidate adenoviral vaccine administered without 

a DNA vaccine to determine whether it may be useful alone in preventing HIV infection or disease. 

The use of potent combinations of anti-HIV drugs, many of which were developed 

with NIAID support, has dramatically reduced the numbers of AIDS deaths in industrialized countries. Most recently these drugs have had a major impact on several developing countries in sub-Saharan Africa, the Caribbean, South America and 

Asia, as drugs have become available to them. Indeed, these drug regimens have 

transformed the complexion of HIV/AIDS throughout the world, saving the lives of 

millions of people. These results are some of the most cogent examples of the practical benefits of NIH-supported research. But we cannot be complacent in our success. Anti-HIV drug regimens often cause serious side effects and frequently lose 

their effectiveness due to the emergence of resistant forms of HIV within a patient. 

Clinical research is moving new classes of AIDS drugs closer to market and defining 

how to optimally use currently licensed medications. Basic HIV research continues 

to uncover additional viral and cellular targets for therapy. For example, several potential drug targets have been identified by determining the mechanisms that HIV 

uses to gain entry into host cells. These include fusion inhibitors, the first of which 

was recently approved by the Food and Drug Administration (FDA). In addition, 

several inhibitors of the HIV enzyme that allows the virus to enter and integrate 

into an infected cell’s genes have shown great promise in clinical trials. 

BIODEFENSE RESEARCH

The potential use of biological agents in a terrorist attack is a serious threat to 

the citizens of our nation and the world. Research to mitigate this threat is a key 

focus of NIAID. The NIAID Strategic Plan for Biodefense Research, developed shortly after the terrorist attacks of 2001, outlines three essential pillars of the NIAID 

biodefense research program: infrastructure needed to safely conduct research on 

dangerous pathogens; basic research on microbes and host immune defenses that 

serves as the foundation for applied research; and targeted, milestone-driven development of medical countermeasures to create the vaccines, therapeutics and 

diagnostics that we would need in the event of a bioterror attack. Implementation 

of this plan enhances not only our preparedness for bioterrorism, but also for naturally occurring endemic and emerging infectious diseases. In addition, NIAID was 

recently given the role of coordinating and facilitating NIH research into countermeasures to mitigate harm to civilians from chemical and radiological/nuclear weapons. Other NIH Institutes and Centers will also contribute substantially to these efforts. The NIH Strategic Plan and Research Agenda for Medical Countermeasures 

against Radiological and Nuclear Threats was released in June 2005, and the NIH 

Strategic Plan and Research Agenda for Medical Countermeasures against Chemical 

Threats is scheduled to be released in mid-2006. 

Perhaps the most tangible signs of NIAID’s biodefense research progress are the 

biocontainment research facilities now under construction, which will be capable of 

safely containing dangerous pathogens, enabling scientists to study such agents. For 

example, through its extramural program, NIAID is supporting the construction of 

two National Biocontainment Laboratories—capable of safely containing the most 

deadly pathogens—as well as thirteen Regional Biocontainment Laboratories nationwide. In addition, three intramural biocontainment labs—on the NIH campus, on 

the National Interagency Biodefense Campus at Fort Detrick in Fredrick, MD, and 

at the NIAID Rocky Mountain Laboratories in Hamilton, MT—are either complete 

or under construction. NIAID also has established a nationwide network of Regional 

Centers of Excellence (RCEs) for Biodefense and Emerging Infectious Diseases Research; two new RCE awards were announced on June 1, 2005, bringing the total 

number of RCEs nationwide to ten. 

The investment in biodefense research has already yielded substantial dividends, 

some of which are of immediate benefit while others provide considerable promise 

for the future. Our basic research and clinical trials have already greatly increased 
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our ability to respond to the threats of smallpox, anthrax, and Ebola with new and 

improved vaccines. For example, in November 2004, DHHS awarded a contract for 

the acquisition of 75 million doses of a new anthrax vaccine to be held in the Strategic National Stockpile. NIAID’s support of the development of this vaccine was instrumental in making this initiative possible. In addition, NIAID-supported scientists recently discovered that a poxvirus infection may be halted by a cancer drug 

aimed not at the virus, but at the host cellular machinery that the virus needs to 

spread from cell to cell. Although much work remains, this research provides a lead 

to not only a new therapeutic approach to poxviruses such as smallpox, but also a 

means of circumventing antiviral drug resistance for other viruses. In another example of critical new discoveries, NIAID-supported scientists demonstrated that 

host cell proteins called cathepsins play an essential role in the Ebola virus’ ability 

to enter and infect cells, and that inhibitors of cathepsin activity block viral entry 

and reduce the production of infectious Ebola viruses. This suggests that drugs that 

inhibit the activity of cathepsins might be useful as anti-Ebola therapies. 

NIAID’s implementation of its Strategic Plan for Biodefense Research has been 

aided by the enactment of the Project BioShield Act of 2004. Project BioShield provides NIH additional flexibility in awarding contracts, cooperative agreements, and 

grants for research and development of critical medical countermeasures. The BioShield Act also provides NIH with streamlined personnel authority, which has allowed NIAID to hire highly-qualified individuals to fill key positions related to product development. Lastly, Project BioShield provides NIAID with additional authority 

for the construction of research facilities, which NIAID used to award grants in fiscal year 2005 for the construction of four Regional Biocontainment Laboratories. 

RESEARCH ON IMMUNE-MEDIATED DISEASES

Autoimmune diseases, allergic diseases, asthma and other immunologic diseases 

are significant causes of chronic disease and disability in the United States and 

throughout the world. Autoimmune diseases affect 5 to 8 percent of the U.S. population; asthma and allergic diseases together are the sixth leading cause of chronic 

disease and disability in this country; and asthma is the leading cause of hospitalizations and school absences among children. A promising strategy to treat and 

prevent immune-mediated diseases is known as immune tolerance. Immune tolerance therapies are designed to preprogram immune cells in a highly specific fashion 

to eliminate injurious immune responses, such as those seen in autoimmune diseases, while preserving protective responses needed to fight infection. The NIAID 

has established a comprehensive program in immune tolerance research, including 

basic research, preclinical testing of promising strategies in nonhuman primates, 

and clinical evaluation through the Immune Tolerance Network (ITN), a consortium 

of more than 80 investigators in the United States, Canada, Western Europe, and 

Australia. Currently, NIAID is supporting more than 40 clinical trials of immune 

tolerance strategies to treat autoimmune diseases, allergic diseases, and transplant 

rejection. 

NIAID-supported research in immune-mediated diseases has led to significant advances in our understanding of how to manage these diseases. For example, NIAIDsupported scientists recently identified novel ways to non-invasively assess the risk 

of kidney graft rejection by using immunologic and genetic biomarkers present in 

urine. If validated in larger studies, these biomarkers would allow physicians a noninvasive way to monitor transplant recipients for organ rejection, and intervene before organ injury, a significant advance in the clinical management of transplant patients. 

NIAID also remains committed to improving the health of children with asthma, 

particularly those who live in our Nation’s inner cities. For example, NIAID-supported researchers recently published the results of a study on the effect of homebased interventions that reduce exposure to common allergens such as cockroaches, 

house dust mites, and tobacco smoke. The study found that the interventions resulted in 20 percent fewer days with asthma symptoms and 14 percent fewer unscheduled clinic visits through the intervention year. We anticipate that our extensive research portfolio will continue to illuminate the causes of asthma and other 

immune-mediated conditions, and lead to new interventions to reduce the burden 

of these serious diseases. 

CONCLUSION

The research conducted at NIAID and at NIAID-sponsored laboratories encompasses a broad array of basic, applied and clinical studies. This research has resulted in tangible benefits to the American public and to individuals throughout the 

world. By supporting talented researchers and emphasizing a balance of basic stud-
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1Data in this statement regarding mortality and life expectancy are from U.S. Vital Statistics. 

ies and targeted research, we hope to continue to develop innovative technologies 

and treatments to combat a wide range of important diseases that afflict humanity. 

PREPARED STATEMENT OF DR. ELIZABETH G. NABEL

Mr. Chairman and Members of the Committee: I am pleased to present the fiscal 

year 2007 President’s Budget request for the National Heart, Lung, and Blood Institute (NHLBI). The fiscal year 2007 budget includes $2,901,012,000, a decrease of 

$20,745,000 over the fiscal year 2006 enacted level of $2,921,757,000. 

The NHLBI was established as the National Heart Institute in 1948 with a mandate ‘‘to improve the health of the people of the United States’’ through research 

on diseases of the heart and circulation. And that is exactly what we have done. 

I believe it is no exaggeration to claim that, over the past decades, biomedical research has made more progress in cardiovascular disease than in any other major 

chronic health problem. The impact on death rates alone constitutes a monumental 

validation of this country’s public investment in the NIH and the NHLBI. 

The United States experienced an epidemic of coronary heart disease (CHD) during the twentieth century and, had the trend continued unabated, more than 1.6 

million lives would be lost to CHD this year. In actuality, the toll will be less than 

500,000 deaths, reflecting a 63 percent decline in age-adjusted mortality since 

1950.1 Mortality from stroke, the third most common cause of death in the United 

States, declined 70 percent over that time. The effect on longevity has been remarkable—looking just at recent data, we can see that between 1970 and 2000 the life 

expectancy of the average American increased by 6 years, and nearly 4 years of that 

gain was due to reductions in deaths from cardiovascular disease. 

Much of the reduction in death rates has come from improved treatments for 

CHD. Not so long ago, atherosclerosis followed an inexorable course and, once an 

artery became occluded, blood flow could not be restored. Increasingly sophisticated 

technological developments in revascularization—coronary artery bypass surgery 

(1968), balloon angioplasty (1977), stents (1994), and now ‘‘drug-eluting’’ stents— 

coupled with vastly improved diagnostic procedures and new medications, have literally given many patients a new lease on life. NHLBI-supported basic and applied 

research studies, as well as carefully designed clinical trials, have enabled scientists 

to develop these interventions, to assess their utility and safety, and to determine 

the characteristics of patients most likely to benefit from them. Millions of Americans suffer from cardiovascular disease, and this research has contributed enormously to our ability to help them live longer and healthier lives. 

We are equally pleased to reflect on improvements that have occurred in our ability to treat acute heart attacks. In past generations, doctors could only stand by 

while a heart attack ran its course and they had little to offer the patient but bed 

rest and a prognosis of rapid death or severely restricted life as a ‘‘cardiac cripple.’’ 

All that changed in the 1980s when scientists determined that most heart attacks 

occur because of a blood clot in an artery that feeds the heart. The development of 

thrombolytic—‘‘clot-busting’’—therapy followed. NHLBI-sponsored clinical trials of 

thrombolysis demonstrated that the procedure could limit the area of damaged 

heart muscle and decrease mortality. This was revolutionary, and it rapidly influenced how heart attack is treated. 

The greatest benefit of thrombolysis, however, accrues in the initial minutes and 

hours after onset of the attack and, unfortunately, many patients do not reach the 

emergency room in time. In the 1990s the NHLBI initiated a successful trial of community-based interventions to reduce delays in seeking and receiving treatment for 

heart attack symptoms. The knowledge gained was used to develop Act in Time to 

Heart Attack Signs, a far-reaching public education campaign launched by the 

NHLBI during the NIH budget doubling. Also during the doubling, the Institute 

began a pilot program at Suburban Hospital to test a new approach to diagnosing 

heart attack patients who may be candidates for thrombolytic therapy. For many 

patients arriving at the emergency room with chest pain, diagnosis requires measurement of enzymes that appear in the bloodstream only hours after the heart attack has occurred—too late for effective thrombolysis. The experimental program is 

having great success in using MRI (magnetic resonance imaging) technology to provide a diagnosis in about 35 minutes, and we believe it may form the basis for a 

better approach to delivering prompt therapy to patients who are likely to benefit 

from it. In light of recent evidence that thrombolytic therapy may benefit patients 

who experience a clot-based stroke, we have also teamed up with the National Insti-
134 

tute of Neurological Disorders and Stroke to use MRI in evaluating patients who 

come to the emergency room with stroke symptoms. 

Let me mention some special efforts to improve treatment of coronary heart disease in a highly vulnerable population—patients with obesity and type II diabetes. 

Although there is near-universal optimism that a cure for diabetes will ultimately 

be found, in the meantime the majority of patients are suffering and dying from cardiovascular disease. We are working to identify approaches to prevent and treat 

these complications, and I am happy to note that the budget doubling enabled us 

to move forward with full funding of two major new clinical trials in this area. The 

ACCORD trial is testing the extent to which control of blood pressure, cholesterol, 

and glucose levels to thresholds beyond those that are currently recommended will 

reduce the occurrence of cardiovascular problems. The BARI–2D trial, focused on diabetic patients who already have coronary heart disease, is weighing the merits of 

revascularization versus medical treatment and, in addition, studying two different 

approaches to controlling blood sugar. These trials are effortful and expensive because they involve multiple complex issues in diabetes management. However, they 

address a critical public health need, given the escalating prevalence of obesity and 

diabetes in the United States, and many among us are likely to benefit from their 

findings. 

Much as we celebrate these advances in treatment, let me assure you that we 

have never lost sight of our ultimate objective—prevention. Indeed, we have had 

considerable success in identifying risk factors such as high blood pressure and cholesterol, developing and evaluating methods to control them, and translating the research findings into messages for health-care professionals, patients, and the general public. During the budget doubling, we launched The Heart Truth, an education campaign to raise awareness that heart disease is the leading cause of death 

in American women and call women to take action to reduce their risk of developing 

heart disease. Already we have evidence that the campaign’s message, ‘‘Heart disease doesn’t care what you wear—it’s the #1 killer of women,’’ has raised awareness 

throughout the nation. Last June we launched We Can! (Ways to Enhance Children’s Activity and Nutrition), a national education program to help children 8–13 

years of age stay at a healthy weight. We Can! offers parents and families tips and 

activities to encourage healthy eating, increase physical activity, and reduce sedentary or screen time. It also provides resources to help community groups and 

health professionals work toward these goals. 

Much of what we know about factors that put people at risk of developing cardiovascular diseases has come from the multigenerational Framingham Heart Study, 

begun in 1948. I am delighted to announce that the NHLBI, in conjunction with 

Boston University, recently unveiled a plan to take this study to the next level. Our 

new Framingham Genetic Research Study will entail up to 500,000 analyses of the 

DNA of 9,000 study participants. By identifying genetic variations that relate 

strongly to participant characteristics (e.g., blood pressure and cholesterol levels, 

overweight and obesity) and to outcomes (e.g., stroke, congestive heart failure, diabetes), we hope to refine our understanding of individual risk and identify carefully 

focused new strategies for treatment and prevention. We at the NHLBI share Dr. 

Zerhouni’s vision of an approach to medical care that is predictive, personalized, and 

preemptive and we believe this new endeavor constitutes a major step toward realizing that goal. 

PEDIATRIC HEART AND LUNG DISORDERS

Tremendous progress has been made in treating congenital cardiovascular malformations, the most common type of birth defect in the United States. Many of us 

remember when these conditions constituted a death sentence, but today we have 

an array of surgical and medical treatments, as well as reliable and effective methods for providing monitoring and support. As a result, more than 90 percent of these 

babies live to celebrate a first birthday. Indeed, the prognosis has improved so much 

that there are now more adults than children living with congenital heart defects, 

according to data from the Adult Congenital Heart Association. Nonetheless, congenital heart disease is still a major contributor to infant mortality and many challenges remain. Thanks to the budget doubling, we have been able to expand significantly our efforts in this area by funding two additional Specialized Centers of Research in Pediatric Cardiovascular Disease, establishing a clinical research network 

to enable rapid evaluation of new treatment approaches, and soliciting research proposals to develop devices for infants and children who experience cardiopulmonary 

failure and circulatory collapse. 

As recently as 35 years ago, many premature infants died within hours of birth 

from neonatal respiratory distress syndrome (RDS), a condition caused by lack of 
135 

a substance called surfactant that keeps the lung’s air sacs open for breathing. The 

NHLBI’s long-term investment in basic, applied, and clinical research has nearly 

relegated neonatal RDS to history. With development of special ventilation techniques to sustain babies until their lungs matured, introduction of a prenatal test 

for lung maturity, and demonstration that antenatal corticosteroid treatment could 

accelerate lung maturation, U.S. deaths from this disorder fell 60 percent between 

1970 and 1984—from 10,000 to 4,000 per year. Then, in the 1980s, NHLBI-supported studies of surfactant structure, function, and regulation and efforts to identify the genes for surfactant proteins culminated in development of surfactant replacement products for testing in clinical trials. Since 1990, when two surfactant 

treatments were approved for widespread clinical use, neonatal RDS mortality has 

fallen more than 75 percent, to about 1,000 deaths per year. 

ASTHMA

For centuries, asthma was viewed a bronchial spasm problem and treated—with 

limited success—as such. Our intensive research effort in recent years led to the realization that asthma is a manifestation of chronic inflammation and immune dysfunction. This insight revolutionized treatment, the mainstay of which now is antiinflammatory medications to treat the underlying disease, with bronchodilators used 

chiefly for quick relief of symptoms. The NHLBI has also been a pioneer in development of self-management strategies and their application, especially for inner-city 

minority children; evidence indicates favorable effects on emergency room visits and 

school absences in this vulnerable population. Results of all these efforts are rapidly 

incorporated into national guidelines that set the standard for modern asthma management. Clinical research networks have proven invaluable for rapidly assessing 

new treatment strategies, and during the budget doubling we were able to renew 

our highly productive adult Asthma Clinical Research Network and initiate the 

Childhood Asthma Research and Education Network, which addresses pediatric 

asthma. We also began a program focused on severe asthma. These efforts are enabling us to make good on our promise to patients, ‘‘Your asthma can be controlled— 

expect nothing less.’’ And we are now talking with increasing confidence about curing asthma, going beyond the initial promise of asthma control. 

SICKLE CELL DISEASE

As recently as 1970, the average patient with sickle cell disease died in childhood. 

Today, life expectancy is about 45 years. NHLBI research has led to a standard of 

care that begins with screening of newborns, provides prophylaxis for potentially lethal childhood infections, and offers transfusion therapy to prevent stroke in highrisk children. A clinical trial demonstrated the value of the drug hydroxyurea in 

preventing painful crises, acute chest syndrome (a life-threatening respiratory complication), and need for transfusions in adult patients. With the budget doubling, we 

have been able to undertake a hydroxyurea trial in children, and also to assess the 

value of stem cell transplantation as a possible cure. Our hope and expectation is 

that further gains in longevity and quality of life will be achieved. 

I would be pleased to respond to any questions that the Committee may have. 

PREPARED STATEMENT OF DR. DUANE ALEXANDER, DIRECTOR, NATIONAL INSTITUTE

OF CHILD HEALTH AND HUMAN DEVELOPMENT

Mr. Chairman and Members of the Committee: I am pleased to present the fiscal 

year 2007 President’s budget request for the National Institute of Child Health and 

Human Development (NICHD). The fiscal year 2007 budget includes $1,257,418,000, 

a decrease of $7,351,000 over the fiscal year 2006 enacted level of $1,264,769,000 

comparable for transfers proposed in the President’s request. 

The mission of the NICHD is vital to the NIH goal of ensuring the overall health 

and well-being of the American people. Our research focuses on both child health 

and human development. Increasingly, researchers are confirming that lifelong 

health and well-being are strongly influenced by events occurring early in life. 

Understanding human development evolves from understanding normal growth 

and change processes before birth through adulthood. It begins at the most basic 

molecular and cellular levels and encompasses cognitive, behavioral, physical and 

social development. By understanding what goes ‘‘right,’’ NICHD research provides 

clues as to what may go ‘‘wrong,’’ laying the critical scientific foundation not only 

for understanding many disease processes, but also for preventing them altogether. 
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FETAL DEVELOPMENT: JUMP START ON LIFE

We now know that both undernourished and obese mothers have children with 

increased risk of chronic disease later in life. This is a problem world wide and it 

is an increasing problem in the United States. 

To understand and reverse the epidemic of type 2 diabetes among young people, 

we need to look beyond their diet. The health and nutrition of the mother during 

fetal development influences not only how children function but also the later development of diabetes, high blood pressure, heart disease and other conditions. To better understand fetal origins of adult disease, researchers recently discovered links 

between birth weight and stress hormone (cortisol) levels in boys and girls who were 

small at birth, but healthy term babies. Cortisol helps to regulate blood pressure, 

energy production, and response to stress. The researchers found that the lower 

birth weight boys had higher levels of cortisol under stressful conditions compared 

to the higher birth weight boys. They found that the lower birth weight girls had 

higher cortisol levels at the beginning of the day. This discovery demonstrates how 

low birth weight can have lasting, yet different, effects on stress hormone levels in 

girls and boys. These alterations in cortisol may predispose children to obesity, hypertension, and glucose intolerance later in life. 

PREDICTING PREECLAMPSIA

Preeclampsia is a sudden, dangerously high increase in high blood pressure that 

threatens the health of a pregnant woman and her fetus. Preeclampsia strikes without warning and can result in maternal seizures and even death. The researchers 

studying this condition found that women who, in mid-pregnancy, have a lower level 

of a substance known as placental growth factor were more likely to develop 

preeclampsia. This advance may lead to a screening test for preeclampsia and a 

treatment to help women avoid the condition. 

OBSTETRIC PHARMACOLOGY—TREATMENT FOR PREGNANT WOMEN

Most drugs used to treat pregnant women are prescribed without full knowledge 

about safety and efficacy. In many cases, no data exists to predict how the drug’s 

dynamics may interfere with a woman’s pregnancy. To fill this knowledge gap, the 

NICHD has established the Obstetric-Fetal Pharmacology Research Units (OFPRU) 

Network to develop improved safety and efficacy drug information for pregnant 

women. One drug currently being studied is used to control gestational diabetes. 

Gestational diabetes affects up to 15 percent of all pregnancies according to the 

March of Dimes. The condition results from a sudden inability of the body to remove 

sugar from the blood. Untreated, gestational diabetes results in large, stocky babies 

who may cease breathing unexpectedly, have difficulty feeding, and must eat frequently to avoid seizures. Children of mothers with gestational diabetes are also 

likely to become obese during childhood and adulthood. 

For many years, physicians treated gestational diabetes with injections of insulin. 

Recently, however, physicians began treating pregnant women with glyburide, 

which stimulates the pancreas to gradually release small quantities of insulin. 

Many patients preferred the convenience of taking a pill to giving themselves an injection. Although many pregnant women have taken glyburide, no studies have ever 

tested the drug’s effectiveness in treating gestational diabetes. A new study is examining the use of glyburide in pregnancy, to determine if the current dosing schedule 

is the most effective means to treat the disorder. 

PREMATURE BIRTH RESEARCH

Reducing preterm birth (PTB) is a major public health priority and a major research priority for this Institute. One out of eight infants in the United States is 

born preterm. This amounts to about 476,000 infants a year. The March of Dimes 

estimates that babies born too soon or too small cost the U.S. health system $18.1 

billion a year. Preterm infants face a number of serious health problems and lifethreatening conditions. PTB accounts for nearly half of the neurological problems 

among newborns who are at risk of having learning disabilities and mental retardation. When preterm infants reach adulthood, they also face much higher risks of cardiovascular disease and diabetes. 

The NIH investment in preterm birth research is paying dividends. For the first 

time, we now have a method to reduce the risk of PTB for some women. One of our 

studies found that weekly injections of a synthetic form of progesterone reduces the 

chances of preterm delivery in women who had already given birth prematurely. For 

the first time, this research gives doctors an intervention that has been shown to 

be both safe and effective in reducing the risks of preterm birth. This discovery also 
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illustrates how quickly research can be turned into practice. Shortly after this research was published, The American College of Obstetricians and Gynecologists recommended that all of their members use progesterone to prevent PTB for women 

with previous PTB. Another study found that pregnant women who have a condition 

known as bacterial vaginosis have a greater likelihood of delivering prematurely. 

For many years, these women have been treated with antibiotics. Contrary to existing clinical thinking, treating the infection with an antibiotic during pregnancy did 

not reduce the incidence of preterm birth. Still another NICHD study found that 

women with a condition known as trichomoniasis are also at increased risk for 

preterm delivery. The study found that giving antibiotics does not reduce the risk 

of preterm birth associated with infection; moreover, this treatment actually increased the preterm birth rate. 

The new knowledge gained from each of these three studies was created by one 

of the multidisciplinary clinical research networks supported by the NICHD. With 

these networks in place, NICHD scientists working with researchers around the 

country can answer important scientific questions quickly, and work through professional organizations to help clinicians translate the new knowledge into practice. 

The NICHD recently established the Genomics and Proteomics Network for Premature Birth Research. This new network will focus on the hereditary information 

in DNA and the structure and function of proteins to understand the underlying 

processes that lead to preterm birth. 

GENES MAY HOLD THE KEY TO TREATING UTERINE FIBROIDS

Each year, more than 200,000 women in the United States undergo a 

hysterectomy to treat the chronic pain and abnormal bleeding caused by fibroids. 

Scientists are exploring alternative ways to treat fibroids without surgery. Previously, these researchers identified a molecule called transforming growth factor 

beta (TGF–β) that helps to regulate several processes including the growth of uterine fibroids. Using a powerful new technology, the researchers identified the different genes influenced by the growth factor in both normal and fibroid cells. The 

researchers then tested a gene therapy that appeared to block production and action 

of TGF–β. This insight may lead to novel, non-surgical therapeutic approaches, not 

only to prevent uterine fibroid growth, but also to treat other reproductive conditions. 

BUFFERGEL SHOWN TO BE SAFE CONTRACEPTIVE

Researchers have made a major step forward in developing contraceptives that 

protect women against HIV. One product, BufferGel, can be used with a diaphragm, 

much like a conventional spermicide. The results of a recent study demonstrate that 

BufferGel is as effective at preventing pregnancy as is currently available 

spermicides. A study is now in progress to determine if BufferGel can reduce transmission of the AIDS virus. 

GENE PROGRAMS EARLY DEVELOPMENT AND NEURAL MIGRATION

NICHD researchers made a significant advance in understanding dyslexia. In an 

article that Science Magazine called one of the 10 major breakthroughs in 2005, the 

researchers linked the developmental gene DCDC2 to dyslexia. This gene functions 

to control nerve cell migration in early brain development. This work suggests that 

genetic miscues alter brain biology in the womb in a way that predisposes people 

to problems later in life. 

FUTURE RESEARCH: NEWBORN SCREENING

The NICHD Newborn Screening Initiative is moving forward in its effort to develop and employ the latest technology for improving the availability, accessibility, 

and quality of genetic and other diagnostic laboratory testing for rare diseases and 

conditions affecting newborns. Ultimately, this research could help identify at-risk 

infants as early as possible and provide the data needed to develop therapies for 

many of these conditions. As a cornerstone activity, the NICHD funded a major 

grant for developing and refining a newborn screening test for spinal muscular atrophy (SMA), a common fatal neuromuscular disease in children. The NICHD will 

soon be funding additional grants to increase understanding of conditions such as 

SMA or other genetic conditions. 

MATHEMATICS AND SCIENCE COGNITION AND LEARNING

The NICHD is enhancing its program to better understand the underlying developmental processes that allow children to learn math and science. One goal is to 
138 

help researchers understand the developmental and cognitive processes needed to 

help children transition successfully from arithmetic to algebraic reasoning, a fundamental skill needed to allow children to advance their understanding of mathematical concepts. In turn, mastering math-related concepts such as recognizing patterns, representing relationships, and making generalizations is key to learning and 

understanding science. These critical program activities fill a major research need 

to clarify the cognitive factors needed for scientific thinking and learning. 

COMMUNITY-BASED REHABILITATION INTERVENTION

The aging of the baby-boom generation and expected pressures on the U.S. health 

care system make research into effective therapies in community settings a high priority. Clinical trials of rehabilitation therapies have demonstrated the efficacy of 

novel interventions in preventing or significantly lessening disabling conditions associated with stroke, traumatic brain injury, and other disorders and conditions. Little is known, however, about whether and how well such therapies will work in lesscontrolled community practice settings. Scientists do not know whether—or how— 

efficacious rehabilitative therapies and even clinical trial design may need to be 

modified for community settings. To address these critical questions, the NICHD 

will solicit applications for clinical trials by scientists partnering with persons with 

disabilities, practitioners, and others in the community. 

Mr. Chairman and members of the Committee, the support you have shown for 

medical research has allowed scientists in research centers around the country to 

make discoveries that advance the health of women, children and families. I will 

be pleased to answer any questions. 

PREPARED STATEMENT OF DR. BARBARA M. ALVING, ACTING DIRECTOR, NATIONAL

CENTER FOR RESEARCH RESOURCES

Mr. Chairman and Members of the Committee: It is a privilege to present to you, 

for the first time, as the Acting Director of the National Center for Research Resources (NCRR), the President’s budget request for NCRR for fiscal year 2007, a 

sum of $1,098,242,000, including support for AIDS research, which reflects a net decrease of $859,000 over the comparable fiscal year 2006 appropriation. 

By developing and funding essential research resources, NCRR connects scientists 

with one another, as well as with patients and communities across the nation. These 

connections bring together innovative research teams and the power of shared resources, multiplying the opportunities to improve human health. 

These connections can be seen in the new institutional Clinical and Translational 

Science Awards program, launched in fiscal year 2006, which enables researchers 

to train and collaborate in new ways to move findings in the laboratory more quickly to patients. NCRR also is bringing patients, advocacy groups, and researchers together to fight rare diseases—a unique opportunity to combine patient information 

and support with research knowledge. Other programs are helping investigators to 

create technologies that will make research information more accessible and precise 

through various software tools and Internet connections. 

In addition, NCRR-supported technologies help researchers—located in isolated 

regions—share information that benefits underserved populations across the country. And at NCRR-supported primate research centers, investigators come together 

to study AIDS vaccines, Parkinson’s, Alzheimer’s, and many other diseases. Perhaps 

our most wide-ranging connections are made through science education—programs 

that reach young and old—on a diverse range of health-related issues. 

These are just a few of the programs that comprise NCRR’s portfolio, but they 

illustrate how we are investing research dollars in order to bring the power of 

shared resources to communities and researchers across the nation and ultimately 

improve the health of Americans. I would now like to provide you with additional 

details about each of these exciting programs. 

INTEGRATING CLINICAL AND TRANSLATIONAL SCIENCE

Recognizing that a well-integrated collaborative effort is needed to transform basic 

discoveries into improved medical care, NCRR has launched an important new initiative—the Clinical and Translational Science Awards (CTSAs)—on behalf of the 

NIH Roadmap for Medical Research. The CTSA Program was initiated to break existing barriers between basic and clinical sciences and, above all, to get people to 

work together to speed the delivery of improved health care to the public. Developed 

with extensive input from the scientific community, the CTSAs will help research 

institutions nationwide create an academic home for clinical and translational re-
139 

search, essentially generating what NIH Director Dr. Elias Zerhouni calls the ‘‘glue’’ 

that fills the gaps among scientists in multiple disciplines and thus forms a bridge 

between basic and clinical research. 

In ongoing dialogues with the scientific community, researchers also have told us 

that the CTSA initiative will allow them to strengthen the career development pipeline for clinical and translational researchers. At the same time, it will build partnerships with communities that will ensure that diverse populations, and clinical 

practitioners serving those populations, play an integral part in addressing the 

unique health challenges that they face. With the community’s participation, the 

CTSAs will help to deliver improved medical care that meets the needs of these diverse patients and their communities. 

CREATING PARTNERSHIPS: RARE DISEASES NETWORK

Another NCRR initiative—the Rare Diseases Clinical Research Network—illustrates the importance of bringing patients and researchers together. Headed by 

NCRR in partnership with the NIH Office of Rare Diseases, the network is truly 

a trans-NIH activity, with funding coming from five additional NIH institutes. The 

need for such a network is best appreciated when one considers the emotional toll 

a family faces when they find out that their child has a rare disease and the desperation they face when they search for medical resources. For example, Trish Hertzog, a mother from Philadelphia who agreed that we could tell her story to help 

others, can vividly recall the day her son Mathew was born more than a decade ago. 

Unbeknownst to anyone, including his doctors, this seemingly healthy newborn 

lacked a critical gene that helps to remove toxic substances from the body. Within 

two days of his birth, Mathew fell into a coma, as lethal levels of ammonia built 

up in his brain, and died within hours. 

Mathew Hertzog had inherited a rare condition known as a urea cycle disorder, 

which affects only about 1 in 30,000 children. Collectively, rare diseases affect about 

25 million Americans, according to the National Organization for Rare Diseases. Research on rare diseases is especially challenging since few patients with the same 

condition can be recruited from any one clinical site. 

To improve outcomes and outreach, the Rare Diseases Clinical Research Network 

unites the efforts of researchers from multiple institutions and their patients nationwide. The Network’s web site has become a source of information for the public, 

physicians, patients, and investigators about rare diseases. The site also contains 

a unique web-based contact registry for patients who wish to learn about clinical 

studies. With this Network now available, parents like Trish can obtain information 

about rare diseases and learn about participating in one of the initial clinical trials. 

WIDENING THE NET: UNDER-REPRESENTED POPULATIONS AND AREAS

NCRR is using the latest advances in technology to promote greater inclusion of 

under-represented minority and rural populations in research by boosting capacity 

in institutions and regions of the country that lack high-capacity, broad-bandwidth 

Internet connections. Some states—including Montana, Wyoming, Alaska, Idaho, 

Nevada, and Hawaii—lack access to advanced Internet applications, such as virtual 

laboratories, digital libraries, distance education, as well as advanced networking 

capabilities. This lack of resources hinders the ability of the institutions in these 

states to conduct collaborative, data-intensive biomedical studies. In the first phase 

of a national effort called IDeANet, NCRR is enhancing high-speed network 

connectivity in these five rural Western states and Hawaii, which will bring these 

areas on par with connectivity in the other parts of the country. 

This effort is part of the Institutional Development Award (IDeA) Program, which 

broadens the geographical distribution of NIH funding for biomedical research. Ultimately, IDeANet will expand to include NCRR’s Research Centers in Minority Institutions Program, which enhances the research capacity and infrastructure at minority colleges and universities that offer doctorates in health sciences. 

SPURRING ADVANCES THROUGH DATA SHARING

Through the Biomedical Informatics Research Network (BIRN), NCRR supports 

the integration of data, expertise, and unique technologies to spur scientific advances that would be difficult or impossible in the context of individual laboratories. 

To illustrate this point, five volunteer research participants traveled across the 

country to nine different sites to have their brains imaged via magnetic resonance 

imaging (MRI). The data that was collected contributed to a first-of-its-kind 

neuroimaging dataset that will enhance large-scale, multisite imaging studies for 

years to come. Scientists found that brain images from a single individual appeared 

surprisingly different when collected at different MRI centers—such variance would 
140 

greatly hamper multi-site imaging studies. Through BIRN, scientists have recently 

developed software tools to standardize data and reduce this type of inter-site variability in brain scans. This collaboration is just one example of how BIRN contributes 

to solving complex health-related problems. While initial efforts are focusing on 

neuroimaging data, the tools and technologies developed by BIRN ultimately may 

be applied to other disciplines. 

PROVIDING CRITICAL LINKS: NONHUMAN PRIMATE RESEARCH

Studies of nonhuman primates are indispensable to translational research, providing a critical link between small laboratory animals and human subjects. Many 

of today’s life-saving interventions—including polio vaccines, AIDS-fighting drugs, 

and heart surgery techniques—depended on preliminary evaluation in nonhuman 

primates like the rhesus macaque. To support such studies, NCRR funds eight highly specialized research facilities known as the National Primate Research Centers, 

which bring together researchers with a variety of expertise, thereby contributing 

to studies of major human health issues, including cancer and neurodegenerative 

disorders. 

Because the nation currently lacks a sufficient number of clinically trained primate veterinarians, NCRR plans to support an initiative to attract and train graduate-level veterinarians in the procedures for conducting primate research. A welltrained veterinary research corps will enhance the country’s capacity to respond to 

the emergence and spread of potentially deadly human diseases, such as severe 

acute respiratory syndrome (SARS), influenza, and hepatitis. 

PROMOTING SCIENCE AND HEALTH LITERACY

By supporting collaborations among educators, researchers, community groups, 

museums, and other organizations, NCRR’s Science Education Partnership Award 

program increases the public’s understanding of medical research and delivers information about healthy living and career opportunities in science to children and the 

general public. For instance, a novel project at the University of Maryland is infusing physical education classes in grades 3–5 with science-enriched curriculum to enhance children’s knowledge of the heart and other muscles and the importance of 

physical fitness. Another project, a partnership involving the University of Hawaii 

and culturally diverse local communities, is designed to enhance biomedical education and mentoring for children and their teachers on isolated Hawaiian islands. 

By providing students with opportunities to participate in hands-on, inquiry-based 

research projects, NCRR hopes to demystify science and make it more accessible to 

individuals throughout the nation. 

CONCLUSION

The future of medical care will depend on our commitment to bring together scientists with diverse expertise and to support research institutions with varying 

strengths and research capacities. At the same time, we must ensure the participation of researchers and patients who are from ethnically and geographically diverse 

communities and share the importance of medical research with educators and students. Our goal in the coming year is to enhance these collaborations, partnerships, 

and networks in order to bring the power of shared resources to researchers across 

the nation and maximize our research investments. 

PREPARED STATEMENT OF DR. JEREMY BERG, DIRECTOR, NATIONAL INSTITUTE OF

GENERAL MEDICAL SCIENCES

Mr. Chairman and Members of the Committee: I am pleased to present the fiscal 

year 2007 President’s budget request for the National Institute of General Medical 

Sciences (NIGMS). The fiscal year 2007 budget includes $1,923,481,000, a decrease 

of $12,137,000 from the fiscal year 2006 enacted level of $1,935,618,000 comparable 

for transfers proposed in the President’s request. 

NIGMS supports a broad spectrum of research central to the National Institutes 

of Health’s mission of improving the nation’s health. Over the years, this 

foundational work has led to important breakthroughs and treatments. Biophysical 

studies sparked the development of life-saving drugs for AIDS. Inventive burn and 

trauma research yielded the first artificial skin to treat severely burned patients. 

Most recently, research in pharmacogenetics led the Food and Drug Administration 

(FDA) to change the label of irinotecan, a drug approved in 1996 for colorectal, lung, 

and other cancers. The label now indicates that people with a certain genetic vari-
141 

ation are at a greater risk for life-threatening reactions to the drug and encourages 

doctors to use a lower starting dose for those patients. 

In other areas, such as chemistry, groundbreaking basic research helped support 

drug development by the pharmaceutical industry. NIGMS’ investment in this area 

was recognized with the 2005 Nobel Prize in chemistry, bringing the number of laureates whose research we have funded to 57. Long-time grantees Robert H. Grubbs, 

Ph.D., of the California Institute of Technology and Richard R. Schrock, Ph.D., of 

the Massachusetts Institute of Technology were honored for developing a revolutionary way of synthesizing new molecules. Their discoveries transformed a seemingly esoteric process into a practical tool that is now routinely used in the pharmaceutical industry and in other areas of the economy, including the plastics industry. 

STRENGTHENING THE PIPELINE

In addition to providing stable research support to these chemists, NIGMS provided funds to support their transition from trainees to independent researchers. 

The Institute has a number of structured programs that offer thousands of trainees 

access to state-of-the-art resources, rigorous curricula, and high-quality ethics training. Each year, many scientists receiving NIGMS support launch independent careers and join the ranks of top-notch researchers in a wide range of scientific disciplines. 

Many creative contributions like the few I have highlighted above are the work 

of individual bright minds. However, as biomedical research converges and scientific 

fields meld together in new ways, researchers working in different areas need to 

combine their talent and expertise. Recognizing the dual need for teamwork and individual intellectual contribution, NIGMS has invested its resources wisely. In addition to funding a substantial number of individual investigators, we have broadened 

our investment by funding large, multidisciplinary scientific teams. These programs 

have served a truly catalytic role in tackling issues of great importance to public 

health, and I would like to describe some of their recent advances. 

DAWN OF PERSONALIZED MEDICINE

The NIGMS-led Pharmacogenetics Research Network (PGRN), a trans-NIH 

project consisting of 12 scientific teams, has just completed its first 5 years of work 

with an impressive track record. For example, the treatment of childhood leukemia 

is improving due to the discovery that variations in two genes can predict which 

patients with the most common form of the disease have a higher risk of relapse. 

On the horizon is safer dosing of the widely used blood-thinning medicine 

Coumadin® (also known as warfarin) due to the discovery that normal variation in 

two genes can put some patients at risk for excessive bleeding or for heart attacks 

and strokes. PGRN researchers have also made important strides in unraveling disparities in response to treatments for asthma, a disease that affects roughly 20 million Americans, according to the American Lung Association. Recent findings show 

that variation in just a few genes affects responses to two mainstay asthma therapies, inhaled steroids and beta-agonists. Genetic tests to detect these variations may 

be available within a year. 

Other payoffs from NIGMS investments in pharmacogenetics extend beyond implications for individual drug dosing. PGRN research has unexpectedly uncovered 

knowledge that can predict disease risk in subsets of patients, including those taking tamoxifen for breast cancer and beta-blockers for heart disease. Finally, NIGMSsponsored research in pharmacogenetics is having an impact on policy. PGRN studies have played a role in the FDA’s recent decision to develop new guidelines for 

personalized medicines. For example, an FDA program that allows manufacturers 

to submit pharmacogenetic data for review has seen a jump from six submissions 

to 25 in the space of 1 year. 

TEAMING SCIENCE FOR PUBLIC HEALTH GAINS

NIGMS’ innovative ‘‘glue grant’’ program is a novel approach that brings together 

scientists from different disciplines to attack problems beyond the scope of an individual investigator but crucial to the future of the public health enterprise. One example of a recent glue grant advance is the discovery that genes can help explain 

why patients can have dramatically different reactions to traumatic injury. The 

NIGMS-funded Inflammation and the Host Response to Injury research group, 

which performed this study, will also release this year a set of standard operating 

procedures for the care of critically injured patients. This work, while still in the 

early stages, is moving ahead rapidly and will likely improve standards for treatment across the nation as well as facilitate the conduct of high-quality research in 

this important field. 
142 

Many areas of basic biomedical research require an incubation period before results emerge and new knowledge is translated into the clinic. Both 

pharmacogenetics and much of the complex biology being investigated with glue 

grants are good examples, and the recent achievements I’ve described offer evidence 

that the wait has been worth it. However, in other circumstances NIGMS has invested basic research expertise in areas quite ripe for practical development. A case 

in point is the Models of Infectious Disease Agent Study (MIDAS), not yet 2 years 

old, which has already made an important mark on the public health policy landscape. Several key papers have emerged from this highly interdisciplinary effort, 

and the program continues to be fluid, evolving to match public health needs. The 

MIDAS network is focusing on modeling the spread of influenza, and its models are 

providing key inputs to policy makers and health officials engaged in preparing for 

possible influenza pandemics. 

VALUE OF A SYSTEMS APPROACH

The ready application of MIDAS research to current flu preparedness efforts is 

apparent, but I’d like to point out that this research is a shining example of what 

may seem a more esoteric concept: systems biology. In fact, systems biology is a 

powerful and promising approach for investigating how to control the progression 

of diseases worldwide. 

Systems biology addresses how the parts of a complex network work together to 

produce the behavior of the overall system. The threads of systems biology are apparent in pharmacogenetics, which goes beyond the consideration of a drug and its 

target to examine other molecules that affect drug action and determine how apparently subtle variations in these molecules can affect drug efficacy and safety. In infectious disease modeling, the properties of an infectious agent are superimposed on 

the structure of society, from transportation networks to human behavior. Systems 

biological approaches require interdisciplinary teams of scientists working together 

toward a common goal that is often closer to practical applications than are the 

powerful, ‘‘one component at a time’’ approaches that have driven biomedical research so successfully over the past decades. 

POWER OF THE MIND

Let me finish by returning to the contributions of individual minds. I’ll highlight 

two relatively young scientists who have been recognized by the NIH Director’s Pioneer Award program for their exceptional potential to make major breakthroughs. 

The first is Sunney Xie, Ph.D., of Harvard University. He is a pioneer in the development of methods that can see single biological molecules in action. Most biomedical experiments examine millions or more molecules, revealing the average behavior of all of them. While this information can be highly useful, many details are 

lost. Dr. Xie’s methods, developed through an inspired application of techniques 

from physics and chemistry, look at the behavior of one molecule at a time. This 

is like being able to hear one conversation clearly rather than hearing the din of 

a room full of people all talking at once. As these methods mature, they have the 

potential to transform our understanding of how gene expression is controlled in 

normal and diseased cells. 

The second NIH Director’s Pioneer Award winner I will mention is neurobiologist 

Erich Jarvis, Ph.D., of Duke University. Dr. Jarvis, an African American who grew 

up amid poverty, drugs, and violence in Harlem, seeks to unravel the mysteries of 

vocal learning. He is investigating this question using songbirds as a model system, 

and he has already made important strides in unlocking some of the complexity of 

one of biology’s unexplored frontiers: the brain. Although his research falls outside 

the realm of the NIGMS mission and Dr. Jarvis is not currently an Institute grantee, I tell you his story for a different, very important reason. He is a terrific example 

of what we stand to lose if we do not continue to invest in the creative individual 

sparks of young scientists in our diverse society. At least part of Dr. Jarvis’s rise 

to success can be attributed to chances he got in school. He participated in the 

NIGMS Minority Biomedical Research Support and Minority Access to Research Careers programs as an undergraduate at the City University of New York, Hunter 

College, where he received a bachelor’s degree in biology and mathematics. He later 

earned a Ph.D. in molecular neurobiology and animal behavior from the Rockefeller 

University and today works at the forefront of an exciting discipline at the intersection of biomedical and behavioral research. 

The creative energies of potential biomedical researchers—not just those in fields 

traditionally related to biomedicine but also those in associated fields in the physical, mathematical, behavioral, and social sciences—will drive advances leading to 

improvements in human health for many years to come. Nurturing a diverse sci-
143 

entific workforce will enhance the vitality of our nation and improve the health of 

our children and their children. 

Thank you, Mr. Chairman. I would be pleased to answer any questions that the 

Committee may have. 

PREPARED STATEMENT OF DR. PATRICIA A. GRADY, DIRECTOR, NATIONAL INSTITUTE

OF NURSING RESEARCH

Mr. Chairman and Members of the Committee: I appreciate the opportunity to 

present the fiscal year 2007 President’s budget request for the National Institute 

of Nursing Research (NINR). The fiscal year 2007 budget includes $136,550,000, a 

decrease of $792,000 over the fiscal year 2006 enacted level of $137,342,000 comparable for transfers proposed in the President’s request. 

I am pleased to describe some of the exciting research of the National Institute 

of Nursing Research (NINR). NINR is charged with supporting research that establishes the scientific basis of quality patient care regardless of disease or health status. We fund research that affects individuals across the lifespan and all health care 

settings, especially the underserved. 

NINR is currently celebrating the 20th anniversary of its establishment at NIH. 

We have used this occasion not only to take stock of our accomplishments, but more 

importantly, to look toward the future role of NINR’s research in today’s increasingly complex health care environment. We are faced with an aging population at 

a time when our Nation is experiencing a shortage of nurses. We are also in an era 

of new technologies, which demands that nurses be technologically-savvy and able 

to adapt these new methods to a variety of patient populations and settings. This 

dynamic health care environment provides many opportunities for nursing research 

to address a variety of challenges and improve health care for all patients. 

Let me give you a few examples of how our research has improved lives and the 

promise it holds for the future. 

HEALTHY MOTHERS AND HEALTHY CHILDREN

Sleep and Healthy Pregnancies.—Women often complain of fatigue and difficulty 

sleeping during pregnancy, especially as they approach delivery. Researchers studied women who slept less than 6 hours per night or who experienced frequent sleep 

disturbances during their pregnancy. These women had significantly longer labors 

and were 3–4 times more likely to have a cesarean delivery than women who slept 

7–8 hours a night with fewer disruptions. These results highlight the importance 

of adequate sleep during pregnancy, and suggest a need for care providers to stress 

better sleeping habits to their pregnant patients. 

Children and Health Disparities.—In fiscal year 2007, NINR will solicit new intervention research proposals aimed at reducing health disparities among children. 

NINR is committed to reducing disparities in health care, but current research in 

this area often targets adults. Children who live in poverty have little access to 

health care, and these children are disproportionately from minority populations. 

NINR’s effort to reduce disparities in child health will target such areas as: developing culturally-sensitive interventions to promote physical activity and healthy 

diets in children, reducing health risk factors in children that lead to poor health 

outcomes, and studying how gender and immigrant status affect child health and 

access to health care. 

STAYING HEALTHY THROUGHOUT ADULTHOOD

Culturally-sensitive Diet Intervention.—Diabetes is prevalent among rural AfricanAmericans, and compliance with dietary self-management guidelines is often poor. 

In one study, NINR researchers tested a dietary intervention for diabetic AfricanAmericans living in rural South Carolina. Through culturally-tailored classes that 

taught healthy food choices and low-fat cooking techniques, participants successfully 

lowered their body weight and fat intake. Other community-based interventions that 

include culturally-relevant components show similar successes. These types of programs may be important tools in promoting health and reducing health disparities. 

Heart Disease in Women.—Heart disease, the number one cause of death in the 

United States, is sometimes more difficult to diagnose in women than in men, because women can exhibit different symptoms of heart disease than men. Better 

ways of detecting heart disease are therefore needed. NINR investigators are currently developing and testing a new screening tool that could predict whether or not 

certain women are at risk for serious heart disease. The test takes into account the 
144 

1Langa KM, Chernew ME, Kabeto MU, Herzon AR, Ofstedal MB, Willis RJ, Wallace RB, 

Mucha LM, Straus WL, Fendrick AM, National Estimates of the Quantity and Cost of Informal 

Caregiving for the Elderly with Dementia. J Gen Intern Med 16: 770–778, 2001. 

different symptoms that women with heart disease experience, and it factors in the 

diverse symptoms experienced by women of different races. 

UNDERSTANDING AGING AND CARING FOR THE ELDERLY

Improving Self-management for the Elderly.—The aging American population has 

tremendous implications for our health care system. Better tools are needed to prevent and treat the health problems experienced by the elderly in a cost-effective 

manner. Improving self-management strategies is one way to decrease hospital and 

long-term care costs. Health professionals have developed telehealth programs that 

allow elderly patients to monitor and manage their symptoms at home by communicating with their providers over the phone or the internet. However, the effectiveness of telehealth interventions has not been well-studied. NINR investigators are 

currently testing a self-management telehealth intervention for patients with heart 

failure. The investigators will study questions such as: Is the intervention more effective than traditional methods of treatment? Are elderly patients willing to use 

the new technology? Do these techniques save money? Findings from these studies 

may help providers better use technology in self-management. This could ultimately 

lead to a higher quality of life for patients, and lower health care costs for consumers. Caregivers and Depression.—An aging population also means that an increasing 

number of spouses and children will be caring for their infirm partners or parents. 

In addition to significant economic and societal costs,1 caregiving may also have serious negative health impacts. Caregiving can often be a stressful and time-consuming experience for those who take on the responsibility. NINR has funded a 

wide range of studies to analyze the burdens experienced by caregivers and develop 

methods to alleviate these burdens. One group of NINR researchers surveyed over 

2,000 female caregivers of elderly veterans with dementia and found that over onethird of the caregivers exhibited symptoms of depression. However, less than one 

in five of those with depression were using antidepressants; Caucasians were twice 

as likely as African-Americans to be taking such medications. These results suggest 

that caregivers should be routinely screened for depression and that better efforts 

may be needed to educate informal caregivers about the potential benefits of 

antidepressant therapy. 

PATIENTS AND FAMILIES AT THE END OF LIFE

The final stage of life is a challenging time for everyone involved, from the patient, to attending physicians and nurses, and to bereaved family and friends. NINR 

is the lead NIH institute for end-of-life research. We are charged with finding ways 

to improve end-of-life care for all involved and ensure that patients experience death 

with as much dignity and comfort as possible. We fund research on such topics as: 

better management of symptoms prior to death; improving communication between 

doctors, patients, and family members; and examining factors that influence endof-life decision-making. NINR researchers continue to make important findings in 

these areas. 

Communicating with Families at the End of Life.—One study found that physicians in intensive care units often fail in communicating with family members when 

discussing the withholding or withdrawal of care from a dying patient. Problems included failures to listen to the concerns or address the emotions of the family members. Physicians also failed to properly explain the uses and purpose of palliative 

care or the ethical basis for deciding to remove life-prolonging therapies. A better 

awareness of these gaps can help physicians and nurses improve their communication skills for talking to families in difficult times. 

NURSING SHORTAGES AND TRAINING NURSE RESEARCHERS

The current aging of our population comes at a time when the supply of nurses 

in the United States cannot meet the demand. In addition, new advances in medical 

technology require a more technologically-savvy nursing workforce. There was a 

shortage of approximately 168,000 registered nurses in the United States in 2003, 

and this shortage is expected to top 1 million by 2020. The field of nursing research 

is experiencing the effects of this shortage. Fewer nurses mean fewer nurse researchers, and that means fewer nursing faculty. 

NINR continues to fund innovative initiatives to train new nurse researchers. Our 

Nursing Partnership Centers to Reduce Health Disparities partner research-inten-
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1Goldman DP et al. Consequences of Health Trends and Medical Innovations for the Future 

Elderly. Health Affairs online special issue ‘‘Health and Spending of the Future Elderly.’’ R5– 

R17, 2005. 

sive universities with minority-serving institutions to increase the number of researchers from underserved populations. We also continue to collaborate with universities on training students in fast-track baccalaureate-to-doctoral programs to 

speed the process of developing new nurse scientists and faculty. 

NINR AND THE NIH ROADMAP

NINR has incorporated two key themes of the NIH Roadmap into its research 

agenda: Interdisciplinary Research Teams of the Future and Re-engineering the 

Clinical Research Enterprise. Historically, NINR has maintained a focus on interdisciplinary research, but increased collaborations made possible by the Roadmap 

have fully introduced nursing science to the rest of the scientific community. They 

have also enabled nurse scientists to expand the breadth of their own work. Because 

of the strongly clinical emphasis of the NINR research portfolio, the Roadmap’s clinical research initiatives are ideally suited to NINR. We will actively pursue Roadmap initiatives that seek to develop new technologies to measure patient symptoms 

and quality of life, and others that strive to develop skilled clinical investigators 

with strong multidisciplinary backgrounds. 

CONCLUSION

In conclusion, NINR continues to discover effective approaches to meeting the 

challenges of today’s dynamic health care environment, while looking ahead to meet 

the health care needs of tomorrow. We will strive to improve the quality of care and 

quality of life for all individuals, especially the underserved, regardless of age or disease. We will also train the next generation of leaders in nursing research. The past 

twenty years have demonstrated the power of nursing research. The future holds 

endless opportunities. 

Thank you, Mr. Chairman. I will be happy to answer any questions that the Committee might have. 

PREPARED STATEMENT OF DR. RICHARD J. HODES, DIRECTOR, NATIONAL INSTITUTE

ON AGING

Mr. Chairman and Members of the Committee: The NIA is requesting an fiscal 

year 2007 budget of $1,039,828,000, a decrease of $6,803,000, or .6 percent below 

the fiscal year 2006 enacted level. 

Thank you for this opportunity to participate in today’s hearing. I am Dr. Richard 

Hodes, Director of the National Institute on Aging, and I am pleased to be here 

today to tell you about our progress making and communicating scientific discoveries that will improve the health and well-being of older Americans. 

There are today approximately 35 million Americans ages 65 and over, according 

to the U.S. Bureau of the Census, and this number is expected to rise dramatically 

in the coming decades as members of the Baby Boom generation reach retirement 

age. These older Americans are more likely than at any other time in history to 

enjoy good health and an active lifestyle: Data from the National Long Term Care 

Survey (NLTCS) indicate that the rate of disability among older Americans dramatically declined from the 1980s through the mid 1990s, even among the ‘‘oldest old,’’ 

people age 85 and older. At the same time, however, the downward trend in disability among the elderly may be in danger of reversal. Data from the National 

Health Interview Survey show that, over the same period, the disability rate actually rose significantly for people ages 18–59, with the growing prevalence of obesity 

an important factor in this trend. Now, in fact, some demographers are forecasting 

a complete leveling-off of the disability decline in the coming decade.1

The mission of the National Institute on Aging (NIA) is to improve the health and 

well-being of older Americans through research. In support of its mission, the Institute conducts and supports an extensive program of research on all aspects of aging, 

from the basic cellular and molecular changes that occur as we age, to the prevention and treatment of common age-related conditions, to the behavioral and social 

aspects of growing older, including the demographic and economic implications of an 

aging society. In addition, the NIA is the lead Federal agency for research related 

to the all-important effort to prevent and treat Alzheimer’s disease (AD). Finally, 

our education and outreach programs provide vital information to older people 
146 

2Data from the Alzheimer’s Association. See also Ernst, RL; Hay, JW. ‘‘The U.S. Economic 

and Social Costs of Alzheimer’s Disease Revisited.’’ American Journal of Public Health 1994; 

84(8): 1261—1264. This study cites figures based on 1991 data, which were updated in the journal’s press release to 1994 figures. 3 Hebert, LE et al. ‘‘Alzheimer Disease in the U.S. Population: Prevalence Estimates Using 

the 2000 Census.’’ Archives of Neurology August 2003; 60 (8): 1119–1122. 

across the Nation on a wide variety of topics, including living with chronic conditions, maintaining optimal health, and caregiving. 

ALZHEIMER’S DISEASE AND THE NEUROSCIENCE OF AGING

Alzheimer’s disease is a devastating condition with a profound impact on individuals, families, the health care system, and society as a whole. Approximately 4.5 

million Americans are currently battling AD, with annual costs for the disease estimated to exceed $100 billion.2 Moreover, the rapid aging of the American population 

threatens to increase this burden significantly in the coming decades: By 2050, the 

number of Americans with AD could rise to some 13.2 million, an almost three-fold 

increase.3

Dr. Zerhouni has told this Committee about the NIH’s new paradigm for biomedical research that is ‘‘predictive, personalized, and preemptive.’’ This vision 

greatly informs the NIA’s comprehensive program of Alzheimer’s disease research. 

NIA-supported investigators conduct research on topics across the spectrum of ADrelated inquiry, from basic brain biology to clinical trials of potential interventions. 

Through these studies, we are uncovering new predictors of individual risk for AD, 

and using this information, along with a greater understanding of specific pathways 

mediating disease processes, we are developing new approaches to prevention and 

treatment. 

Risk Factors and Early Diagnosis.—Population studies suggest that conditions affecting the circulatory system may be associated with higher risk for dementia, or 

that the presence of vascular disease may influence the progression of AD. One recent report indicated that AD dementia may be exacerbated by other cerebrovascular problems such as small strokes, while another linked untreated high blood 

pressure in mid-life with increased risk of dementia in later life. The possible association of diabetes, insulin resistance, and AD is garnering increased attention as 

well; recent findings from at least four long-term studies link diabetes with decline 

in cognitive function. The NIA recently funded two clinical trials to examine directly 

whether diabetes-related interventions might be effective in preventing or delaying 

cognitive decline or development of Alzheimer’s disease. 

Research suggests that the earliest AD pathology begins to develop in the brain 

long before clinical symptoms yield a diagnosis; the ability to make an accurate 

early diagnosis of AD would be highly beneficial. Improvements in brain imaging, 

coupled with the development of more sensitive cognitive tests, are enabling us to 

diagnose AD in the research setting with greater precision than ever before. Imaging techniques may become important for a number of other reasons, particularly 

in helping investigators understand events unfolding in specific regions of the brain 

in the very early stages of Alzheimer’s disease and in assessing the effectiveness of 

potential therapeutic strategies. To speed both the development of imaging techniques and the discovery of biological markers to detect Alzheimer’s disease, the National Institute on Aging and other Federal partners, in conjunction with nine pharmaceutical/biotech companies, the Institute for the Study of Aging, and the Alzheimer’s Association, announced the Alzheimer’s Disease Neuroimaging Initiative in 

October 2004. The study will test whether serial MRI, PET, or other biological 

markers can be used in conjunction with clinical and neuropsychological assessment 

to measure earlier and with greater sensitivity the development and progression of 

mild cognitive impairment (MCI) and early Alzheimer’s disease. This major publicprivate partnership could help researchers and clinicians develop new treatments 

and monitor their effectiveness as well as lessen the time and cost of clinical trials. 

The study, which is taking place at approximately 50 sites across the United States 

and Canada, began recruitment in late 2005; approximately 800 people ages 55 to 

90 will participate over the five years of the study. 

Prevention and Treatment.—Results of a growing number of studies are suggesting that diet and exercise may have significant benefits on not only physical but 

also cognitive health. For example, in one recent study, researchers related fruit and 

vegetable consumption among 13,388 older women over a 10–16 year period to subsequent cognitive performance and found that women consuming the most green 

leafy vegetables experienced slower decline than women consuming the least 

amount. Long-term epidemiologic studies now also suggest that exercise may have 

a specific influence on aspects of cognitive decline, and researchers are hoping that 
147 

4Lakdawalla, DN et al. The Health and Cost Consequences of Obesity Among the Future Elderly. Health Affairs on line special issue ‘‘Health and Spending of the Future Elderly.’’ R30– 

41. 

clinical trials will be able to directly test the therapeutic value of exercise and diet 

for improved cognitive performance and, eventually, for reduced risk of AD. Small 

clinical trials currently are ongoing to test the effects of exercise on cognitive decline, both in older adults with normal cognition and in persons with mild cognitive 

impairment with memory decline; a larger trial that would include a cognitive component is in the planning stages. In addition, the planned Lifestyle Interventions 

and Independence for Elders (LIFE) study, which has been designed to determine 

whether physical exercise is effective for preventing major mobility disability or 

death, will include a cognitive component. Clinical trials are also ongoing to test the 

effects of a variety of dietary supplements, including antioxidants and alpha-lipoic 

acid, on cognition. 

Investigators are also searching for drugs that will be effective in stopping the 

progression of AD or, ultimately, preventing the disease altogether. Recently, investigators announced the discovery of the first agent shown to delay the clinical diagnosis of Alzheimer’s in people with amnestic mild cognitive impairment, an MCI 

subtype strongly correlated with the later development of AD. The investigators 

found that individuals who took the drug donepezil (Aricept®) were at reduced risk 

of progressing to a diagnosis of Alzheimer’s disease during the first year of the trial, 

but by the end of the three-year study there was no benefit from the drug. Although 

donepezil’s effects were limited, the results are nonetheless encouraging. And although too little is known about donepezil’s long-term effects to support a recommendation for its routine use to forestall the diagnosis of AD in people with mild 

cognitive impairment, these findings do suggest that chemoprevention of AD is possible and support our hope that future clinical studies will lead to more significant 

progress. 

OTHER AGING-RELATED RESEARCH

Diseases of aging continue to affect many older men and women, seriously compromising their quality of life. Diseases and conditions currently under study at the 

NIA include: 

Obesity.—Overweight and obesity are widespread in the United States and are associated with an array of health problems, including heart disease, stroke, osteoarthritis, adult-onset diabetes, certain types of cancer and physical disability. NIH 

has assigned a high priority to research on obesity. 

These activities range from basic research on the genetic and biological mechanisms of overweight and obesity to human intervention studies. For example, recent 

studies of C. elegans, tiny worms frequently used for genetic studies, are providing 

important insights about fat regulation and storage that may that may be applicable 

in humans. NIA-supported researchers used RNA interference (RNAi), a technique 

in which genes are inactivated one at a time to determine their function, to screen 

the worm’s genome and found some 417 genes involved with fat regulation and storage. Many of the genes they found have human counterparts, a number of which 

had not been previously implicated in the regulation of fat storage. The genes identified in C. elegans may ultimately suggest new targets for treating human obesity 

and its associated diseases. 

Research has also shown that many of the disabling conditions affecting older people could be diminished through regular exercise and that fitness affects mortality 

risk regardless of an individual’s body fat. One study, which followed men 30–83 

years of age for an average of eight years, found that within each category of body 

fatness, ‘‘fit’’ men—as measured by exercise testing—were at a lower risk of death. 

In addition, among fit men, obesity was not significantly related to risk of death. 

In another study, low fitness increased mortality risk in men approximately fivefold 

for cardiovascular disease and threefold for all-cause mortality. Low fitness was associated with higher mortality in all weight groups. 

At a 2004 NIA and Centers for Medicare and Medicaid Services (CMS) sponsored 

workshop, researchers used published findings and trends to postulate that if the 

United States were able to prevent obesity until a person reaches 65 years of age 

by adjusting the body mass index for all cohorts entering Medicare, we could realize 

a significant decline in the percent with heart disease and diabetes, a significant 

increase in the percent without disability, and a cost savings to Medicare on the 

order of $10 billion annually over the subsequent 30 years.4
148 

5Data from the National Heart, Lung, and Blood Institute. 

Heart disease.—Each year over 1 million Americans undergo angioplasty,5 Aa procedure in which a long, thin tube attached to a tiny balloon is used to access and 

widen a blood vessel at the site of narrowing or blockage. However, a significant 

number of these individuals go on to experience restenosis, or gradual narrowing of 

the artery at the site of the blockage; this condition is aggravated by the implanting 

of stents (tiny metal scaffolds placed inside the artery to hold it open). Restenosis 

usually occurs within six months of angioplasty and results from the migration of 

cells from the middle of the arterial wall into the inner layer of the artery, where 

they multiply and block normal blood flow. Recognizing that cell division is crucial 

to the development of restenosis, NIA scientists tested the anticancer drug 

paclitaxel (Taxol®), which arrests cell division, as a means of preventing the tissue 

growth that leads to vessel narrowing, and found that stents coated with paclitaxel 

can delay restenosis both safely and effectively. The investigators obtained a patent 

for these paclitaxel-coated stents, and a cooperative research and development 

agreement was established with private industry partners to begin clinical testing. 

Today, paclitaxel is one of only two drugs that, when applied to stents, have been 

shown to safely reduce the incidence of restenosis in humans. FDA approval of 

paclitaxel-coated stents was granted in March 2004, and currently over 70 percent 

of the drug-eluting stents used worldwide are paclitaxel-coated. Approximately 1.8 

million patients worldwide have received paclitaxel-coated stents to date. 

Diabetes.—NIH investigators searching for potential treatments for type 2 diabetes conducted a study of the compound exendin-4, an analog of a hormone that is 

naturally released after eating and that can lower blood sugar in people with diabetes. The investigators found that exendin-4 is safe and effective, and in April 2004, 

the Food and Drug Administration approved exenatide (ByettaTM), a synthetic derivation of exendin-4, for the treatment of type 2 diabetes. 

HEALTH COMMUNICATIONS AND PROMOTION

The NIHSeniorHealth website continues to be a major initiative that enables the 

growing number of ‘‘wired seniors’’ to find credible aging-related health information 

in an online format that is compatible with their cognitive and visual needs, as evidenced by NIH-supported research. Conceived by NIA and jointly developed with 

the National Library of Medicine (NLM), the website now includes 26 health topics 

developed by eleven NIH Institutes. Each month, 52,000 unique visitors browse over 

a half a million pages. NIHSeniorHealth serves as a model for web designers seeking to make sites accessible to older adults. To increase the number of older adults 

skilled in searching for health information online, NIA has developed and is evaluating a senior-friendly Internet training curriculum geared around 

NIHSeniorHealth and NLM’s MedlinePlus web site for those who train older individuals to use computers. 

Changes in public health policy may necessitate the development of new communications strategies and techniques targeted at older Americans, as was demonstrated with the passage of Medicare Part D, the ‘‘prescription drug benefit’’ for 

U.S. seniors. NIA-supported researchers are currently using established datasets to 

rapidly collect information and analyze patterns of use under Medicare Part D; their 

findings have been communicated to the CMS on an ongoing basis and will inform 

the creation of new strategies for tailored communications that will assist older 

Americans in understanding and maximizing use of this important new program. 

Thank you for the opportunity to testify before this Subcommittee. I would be 

happy to answer any questions you may have. 

PREPARED STATEMENT OF DR. SHARON HRYNKOW, ACTING DIRECTOR, FOGARTY

INTERNATIONAL CENTER

Mr. Chairman and Members of the Committee: I am pleased to present the fiscal 

year 2007 President’s Budget for the Fogarty International Center (FIC). The fiscal 

year 2007 budget includes $66,681,000, which reflects an increase of $303,000 over 

the fiscal year 2006 enacted level of $66,378,000 comparable for transfers proposed 

in the President’s request. 

Forty-seven years ago, Congressman John E. Fogarty noted, ‘‘Time and time 

again, it has been demonstrated that the goal of better health has the capacity to 

demolish geographic and political boundaries and to enter the hearts and minds of 

men, women, and children in the four corners of the earth. It is an issue which 

serves as a forceful reminder of the oneness, the essential brotherhood of man.’’ 

Congressman Fogarty, the visionary namesake of the National Institutes of Health’s 
149 

(NIH’s) John E. Fogarty International Center for Advanced Study in the Health 

Sciences (Fogarty), recognized that when it comes to disease, we are truly one world. 

His words and those of his Congressional colleagues implored us to work for ‘‘a 

healthy America, in a healthier world.’’ 

Today, Fogarty works to meet this goal in two ways: by supporting the whole of 

the NIH mission via international partnerships, and through the support of global 

health research and training programs aimed at improving the health of citizens in 

the United States and around the globe. As a nation, our interest in global health 

stems not only from humanitarian concerns, but also from an enlightened self-interest. Such interests involve protecting our nation from imported diseases, and political and economic considerations—healthy, stable countries make strong allies and 

trading partners. In addition, through partnerships with scientists from around the 

world, we are able to identify new strategies and new understandings of disease 

processes, including HIV/AIDS, tuberculosis, and chronic diseases such as heart disease, that affect us all. I welcome this opportunity to relate Fogarty’s progress over 

the past year and proposed plans for fiscal year 2007. While Fogarty’s programs 

span over 20 topical areas, I will focus on three exemplars in this summary. 

BATTLE AGAINST HIV/AIDS

Fogarty continues to place a high priority on combating HIV/AIDS the deadliest 

pandemic of modern times. According to UNAIDS, an estimated 4.9 million people 

worldwide became newly infected with HIV in 2004—the highest number of new 

cases reported in any single year since the beginning of the pandemic. As the 

United States works to combat the spread of AIDS domestically and globally, 

trained scientists in countries hard-hit by AIDS are crucial allies in our fight. In 

the 18-year history of Fogarty’s flagship AIDS program, the AIDS International Research and Training Program (AITRP), Fogarty has helped train 2,000 health scientists, including Ph.D. and Masters level researchers from developing countries 

working on AIDS. More than 50,000 have received short-course training in their 

home countries through this program. These scientists represent a substantial increase in the global capacity to fight AIDS and provide a wealth of allies in our 

international struggle. 

Haiti has the largest number of people living with AIDS in the Caribbean. For 

almost two decades, Fogarty has invested in research and public health infrastructure to combat the HIV/AIDS crisis there. Haiti has now begun to ‘‘turn the corner 

on AIDS,’’ according to Dr. Jean Pape, Haiti’s leading AIDS researcher and longstanding Fogarty collaborator. As a result of Fogarty’s work and that of partner 

agencies, HIV seroprevalence at a key sentinel site in Haiti dropped from 6.3 percent in 1993 to 2.9 percent in 2003. 

Due to this strong research base, Dr. Pape’s institution received a grant from the 

President’s Emergency Plan for AIDS Relief (PEPFAR), allowing 2,000 patients to 

receive antiretroviral therapy. An analysis of the first 1,000 patients at the one-year 

follow-up indicates outcomes comparable to those achieved in the United States in 

terms of survival; other indicators show reduced amounts of HIV in the blood of 

AIDS patients, as well as increased amounts of cells that are critical to staving off 

the impacts of HIV. None of this would have been possible without the vision and 

foresight of Fogarty, working hand in glove with NIH partners, including the National Institute of Allergy and Infectious Diseases. 

In fiscal year 2007, Fogarty plans to expand both major AIDS programs in its 

portfolio. The AITRP expansion would involve new U.S. universities, including minority institutions, important partners as we work to address global health challenges and the range of U.S. challenges on AIDS. In addition, Fogarty’s new training program in clinical, operational and health services research would be expanded 

to build much needed expertise in monitoring and evaluating AIDS programs 

abroad. 

ADDRESSING THE THREAT OF EMERGING AND RE-EMERGING INFECTIOUS DISEASES: 

PREDICTION AND PREEMPTION

Little is known about the ecological factors that lead to the emergence or re-emergence of infectious diseases, including potentially pandemic diseases such as avian 

flu. We do know that most new diseases come from animals, both wild and domesticated. But beyond that we have little ability to predict the emergence of new diseases, or how new or existing diseases spread among animals, and from animals to 

humans. To better understand the relationships between ecological factors that 

drive emergence and transmission of infectious agents, and to develop predictive 

models that would suggest practical modes to interrupt disease spread, Fogarty led 

the development of a unique interagency program on the Ecology of Infectious Dis-
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eases (EID). The EID program fills a critical gap in our national effort to protect 

the health of the public—both in the United States and globally—against the threat 

of epidemic and emerging infectious diseases. The program links microbiologists, 

veterinarians, physicians, ecologists, geospatial scientists, and mathematical modelers together into transdisciplinary teams to create new knowledge and new methods to predict and prevent the spread of infectious disease. In its first years of operation, the EID program has already linked experts from 23 countries and has supported publication of over 200 scientific articles on dozens of human and wildlife diseases, including schistosomiasis, Hanta virus, cholera, and severe acute respiratory 

syndrome (SARS). 

SARS was first reported in southern China in the winter of 2002–2003, and within a few months it had spread to over two dozen countries. Within a month of its 

discovery, SARS was recognized as a viral respiratory illness caused by a newly 

identified coronavirus (CoV), yet the origin of the virus and how it was initially 

transmitted to humans remained a mystery. Preliminary evidence suggested that 

the palm civet (a raccoon-like mammal common in live animal markets in southern 

China) might have spread the virus to humans. However, the occurrence of related 

viruses in bats led some to think these animals may have been involved. A team 

of Fogarty-funded researchers from the United States, China, and Australia collected and analyzed specimens from nine species of bats in their native habitats in 

southern China. The team studied the presence of antibodies to the SARS virus and 

performed genome sequencing of viral isolates from positive tissues, comparing 

these genome sequences to that of the SARS virus. Study results indicate that bats 

are the natural reservoir of the SARS virus, suggesting that palm civets played an 

intermediary role in human infections. These findings have major implications for 

development of public health strategies to combat the spread of SARS. In fiscal year 

2007, FIC expects to expand the EID program in terms of the number of projects 

supported and their scope, simultaneously increasing the focus on supporting translation of research findings and predictions into action. 

As we consider the daunting challenge of pandemic avian influenza, programs 

such as the EID can provide a critical component in our ability to predict and prevent emergence and transmission of this and other disease threats. The United 

States and its global partners will be better poised to make effective interventions 

to prevent the spread of avian flu through understanding of migration patterns of 

reservoir bird species, the interactions between humans, domestic animals and 

birds, and the pathogen dynamics in and among these hosts. We cannot predict the 

spread of this disease, in its current zoonotic form, using mathematical or statistical 

models if we do not support the fieldwork necessary to sample wild and domesticated birds (work done by ornithologists, veterinarians, and ecologists). The field 

data are useful only for post field analysis if we integrate them into predictive models. The interagency EID program is unique in its integration of these methods into 

interdisciplinary teams to understand the biology and predict disease emergence 

and transmission. 

GLOBAL BURDEN OF TRAUMA AND INJURY

According to the World Health Organization (WHO), the numbers and the global 

burden due to trauma and injury are on the rise: more than 1.2 million people are 

killed in traffic accidents annually, and up to 50 million more are injured or disabled. If current trends continue, the number of people killed and injured on the 

world’s roads will rise by more than 60 percent between 2000 and 2020. Almost 90 

percent of deaths due to injuries take place in poorer countries—this is true for all 

forms of such trauma including road accidents, war, homicides, and suicides. And, 

according to the Association for Safe International Road Travel, road traffic accidents are the second leading cause of death for Americans abroad. 

To address this growing challenge, Fogarty, working closely with the Centers for 

Disease Control and Prevention, WHO, the Pan American Health Organization, and 

eight other NIH institutes, initiated a research training program to build the capacity of developing country investigators and institutions to conduct human trauma 

and injury research. The International Collaborative Trauma and Injury Research 

Training (ICTIRT) program involves collaborators from United States and developing country institutions to train the next generation in basic and applied science, 

the epidemiology of risk factors, acute care and survival, rehabilitation, and the 

long-term mental health consequences of trauma and injury, including civil strife. 

Benefits of this program will accrue not only to developing countries but, as lowcost and effective strategies are identified, to communities around the world. This 

program was initiated with awards in fiscal year 2005 and fiscal year 2006. We anticipate new awards in fiscal year 2006 and fiscal year 2007. 
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CONCLUSION

The programs and international initiatives of the Fogarty International Center 

are a living testament to the vision of Congressman John E. Fogarty. As we consider 

the daunting global challenges of AIDS, avian influenza and chronic problems, including obesity and mental health disorders, we understand the interconnectedness 

of the United States and the global community. These challenges require us to move 

forward with efficiency and diplomacy, for the benefit of the American people and 

the global community. 

PREPARED STATEMENT OF DR. THOMAS R. INSEL, DIRECTOR, NATIONAL INSTITUTE OF

MENTAL HEALTH

Mr. Chairman and members of the Committee: I am pleased to present the fiscal 

year 2007 President’s budget request for the National Institute of Mental Health 

(NIMH). The fiscal year 2007 budget includes $1,394,806,000, which reflects a decrease of $8,709,000 under the 2006 enacted level of $1,403,515,000 comparable for 

transfers proposed in the President’s request. In my statement, I will call to your 

attention our Nation’s most prevalent mental and behavioral disorders and include 

a brief review of our research activities and accomplishments. 

BURDEN AND COST OF MENTAL ILLNESS

Mental disorders are common, chronic, and disabling. They cause more disability 

than any other class of communicable medical illness in American adults under age 

45, according to the World Health Organization’s Global Burden of Disease report. 

The National Comorbidity Survey Replication (NCS–R), funded by NIMH and released in May 2005, documents the prevalence and severity of specific mental disorders in the United States. The study shows that half of all lifetime cases of mental 

illness begin by age 14, making these the chronic diseases of the young. About 6 

percent of the U.S. population is afflicted with a severely disabling mental disorder 

in a given year. Most troubling, this landmark study has demonstrated that despite 

effective treatments, there are long delays—sometimes decades—between first onset 

of symptoms and when people seek and receive treatment. 

The cost in human suffering from these mental diseases is compounded further 

by their economic burden. According to the President’s New Freedom Commission 

on Mental Health (2003), individuals with serious mental illnesses represent the 

single largest diagnostic group (35 percent) on the Supplemental Security Income 

(SSI) rolls. Medicaid is the largest single payer of mental health services, with more 

than 50 percent of all mental health expenditures paid for by the public sector (including Medicaid, Medicare, state and local governments. 

The good news is that there now are some extraordinary new tools and technologies, such as neuroimaging and genomics, with which to address these urgent 

public health needs. Our major challenge is to integrate and translate basic research 

discoveries and technological advances into practical strategies that can help all 

communities, including children, the socioeconomically disadvantaged, and others 

facing barriers to mental health care. 

ENVISIONING PERSONALIZED CARE

Research efforts stemming from former President George Bush’s proclamation of 

the 1990s as the Decade of the Brain established that mental disorders (autism, bipolar, depression, schizophrenia, and others) are brain disorders. The current decade is one in which many major candidate molecules, cells, and circuits for normal 

and abnormal brain function are being identified for the first time. Through these 

discoveries research will definitively identify the specific brain pathways that underlie each of the major mental disorders. By identifying the features of the brain that 

go awry in mental illnesses, we will have clear new targets to test how biological, 

behavioral, and environmental factors affect illness and to develop more effective 

interventions with the ultimate vision of delivering personalized care through preemptive treatments and strategic preventions. 

Currently, there are effective treatments for many mental disorders such as depression and anxiety disorders. Studies show that even from a business standpoint, 

treating these disorders is highly cost-effective; national business groups are encouraging employers to support such treatments in order to reduce healthcare costs 

while also improving productivity and reducing absenteeism. 

Not all treatments work for everyone, however, and clearly there remains room 

for improvement in both diagnosis and treatment. In mental disorders, just as in 

the rest of medicine, diagnosis should rely on detection of biomarkers of the specific 
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disease, and treatments should be based on medication and/or behavioral interventions targeting specific brain regions and processes. For a person with mental illness, one can imagine that a future clinician would use a cognitive task together 

with neuroimaging and genetics to diagnose and select a specific treatment, just as 

a contemporary cardiologist uses a stress test and echocardiogram to diagnose 

ischemic heart disease and select the proper intervention. 

It is critical to realize that this vision does not mean designing exotic technologies 

for a few privileged patients. The ultimate goal is personalized or individualized 

care for a broad spectrum of people with mental disorders. Now, specific treatments 

for any given patient are largely developed through trial and error. As researchers 

learn more about the brain pathophysiology of mental disorders and related behavioral and environmental factors, treatments will become more specific. Early detection of mental illnesses will require a thorough understanding of the range of risks 

that affect brain processes, which in turn is based on a comprehensive understanding of genetics and experience. 

PRACTICAL CLINICAL TRIALS

As noted above, we have treatments that are helpful for nearly all of the mental 

disorders. But these treatments are not optimal; recovery is often slow, incomplete, 

and compromised by adverse effects. Since we do not know who will respond completely and who will develop adverse effects, each clinician depends on trial and 

error with each patient. The Institute has developed practical clinical trials in more 

than 10,000 patients to help clinicians individualize treatments. Practical clinical 

trials, or ‘‘effectiveness studies,’’ are designed to examine changes in symptoms and 

functioning, changes which are vital to determining whether a treatment improves 

quality of life, caregiving burden, or health service use. The designs of practical clinical trials help increase relevancy to real-world clinical practice to help clinicians answer the question: what is the best treatment for my patient? Each of the following 

NIMH-funded practical clinical trials provides results from the largest and longest 

studies of their kind. 

In the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Study, 

1,432 schizophrenia patients from 56 sites, including private practices, community 

health care centers, and state facilities, were randomly assigned to treatment with 

one of five medications for 18 months. In the first phase of analysis the study found 

that newer, ‘‘atypical’’ antipsychotics are not much more effective than older, conventional antipsychotics; however all the medications studied have unique side effect profiles, some of which include significant weight gain and metabolic side effects, thus increasing risk for diseases such as diabetes. Later phases of this study 

will examine crucial issues including effects of switching from one treatment to another, use of health services, and cost-effectiveness. 

Another example is the Treatment for Adolescents with Depression Study (TADS), 

which compared short- and longer-term effectiveness of medication and psychotherapy for depression in 439 adolescents. TADS was designed to test best-practice 

care for depression and was carried out by 13 academic and community clinics 

across the country. Researchers found that fluoxetine (a selective serotonin reuptake 

inhibitor) in combination with cognitive behavioral therapy was more effective 

against adolescent depression than either one alone. In addition, clinically significant suicidal thinking was greatly reduced in all four treatment groups, with those 

receiving medication combined with cognitive therapy showing the greatest reduction. This is an especially important finding, considering recent concerns that the 

use of antidepressant medications themselves may induce suicidal behavior in 

youths. This study shows that treatment leads to a significant improvement of depression overall. It is vital that all patients being treated for depression be closely 

monitored. 

The Sequenced Treatment Alternatives to Relieve Depression Trial (STAR–D) examines 4,041 adults with major depression, particularly those who previously 

showed poor outcomes to treatment, to see if switching medications or augmenting 

the initial drug be more likely to achieve a remission. The study, conducted at 41 

sites coordinated by 14 regional centers, will also answer how the side effects of the 

various medications compare and how psychotherapy compares with medication for 

treatment-resistant depression. 

In the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP– 

BD) trial, 4,360 participants with bipolar disorder from 20 private, state, and community practice sites underwent various treatment pathways to find the most effective long-term and acute treatments and ways to prevent relapse. In the first phase, 

slightly more than half of the first group of 1,469 participants (58 percent) achieved 

recovery. In addition, almost half of the recovery group had a recurrence during the 
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follow-up period, and the majority (70 percent) of recurrences was characterized by 

a return to a depressive state. In the following phases of the trial, not yet published, 

various treatments will be tried such as mood-stabilizing medications, 

antidepressants, atypical antipsychotics, and various ‘‘talk’’ therapies, to see which 

is best for acute treatment, long-term treatment, and prevention of relapse. 

NIMH INITATIVES FOR FISCAL YEAR 2007

To further advance the vision of personalized mental health care, NIMH will pursue two collaborative initiatives in fiscal year 2007. The first is the Autism Phenome 

Project, in collaboration with the NIH Autism Coordinating Committee, the Centers 

for Disease Control and Prevention, and the Department of Energy. Just as the 

Human Genome Project identified the sequence and organization of human DNA, 

the phenome project seeks to identify the various clinical characteristics 

(phenotypes) and subtypes of autism and autism spectrum disorders. Identifying 

specific phenotypic subtypes will aid research on genetic and other potential causes 

and suggest more specific approaches to treatment. 

The second collaborative initiative is with the Department of Defense (DOD) and 

the Department of Veterans Affairs (VA) to study the mental health needs of active 

duty, National Guard, and Reserve personnel including their transition to VA health 

services. In particular, representative groups of men and women will be studied over 

time to assess post-deployment adjustment difficulties (including post-traumatic 

mood and anxiety disorders, and substance use and abuse disorders), the development and effectiveness of early detection and intervention methods, and the possibility of decreasing the risk of developing chronic conditions, disability, and death 

in those with adjustment difficulties. 

These initiatives, in conjunction with the exciting research already underway, will 

enable NIMH to make significant gains in the upcoming years. We intend to realize 

our vision of translating basic research and technologies to improved diagnosis, 

treatment, and preventive strategies that will allow development of personalized 

mental health care for the millions of Americans affected by mental illnesses. 

PREPARED STATEMENT OF DR. STEPHEN I. KATZ, DIRECTOR, NATIONAL INSTITUTE OF

ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

Mr. Chairman and Members of the Committee: I am pleased to present the fiscal 

year 2007 President’s budget request for the National Institute of Arthritis and 

Musculoskeletal and Skin Diseases (NIAMS). The fiscal year 2007 budget includes 

$504,533,000, a decrease of $3,399,000 below the fiscal year 2006 enacted level of 

$507,932,000. 

The NIAMS was created by an Act of Congress nearly 20 years ago, and since 

its inception, the Institute has contributed to significant research progress in areas 

of public health importance across diseases that are common, costly, and have a 

major impact on quality of life, disability, and mortality. Research milestones in the 

history of the Institute include the development of life-saving treatments for kidney 

failure in patients with lupus, and ground-breaking work to uncover the genetic 

bases of periodic fever syndromes that affect both children and adults, among many 

others. 

Most recently, investments that NIAMS made as a result of the NIH budget doubling are bringing results that will directly benefit patients. These include support 

for large-scale clinical trials in areas of high public health impact, such as 

osteoporosis and back pain; efforts in biomarkers research and epidemiology studies 

for common conditions such as osteoarthritis, as well as uncommon, but often devastating, disorders such as scleroderma; and new initiatives in translational research for diseases such as muscular dystrophy. Looking to the future, NIAMS will 

continue its commitment to fund outstanding science across a broad spectrum to enable us to better understand, treat, and, ultimately, prevent diseases of the bones, 

joints, muscles, and skin. 

PREVENTIVE MEDICINE

The NIAMS has made significant investments in studies to identify risk factors 

and biomarkers of disease, in an effort to facilitate the early identification of signs 

and symptoms, and to develop interventions that are more effective. This is particularly important from a public health perspective for common conditions such as 

osteoporosis and osteoarthritis that already afflict tens of millions of Americans, and 

will affect even more as the U.S. population ages in the coming decades. 
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In the area of osteoporosis, the NIAMS, along with the National Institute on 

Aging, has provided steady support for the Study of Osteoporotic Fractures (SOF), 

a multi-site clinical investigation to determine the risk factors for osteoporotic fractures in older women. Begun in 1986, SOF scientists recruited 9,704 white women 

aged 65 and older from 4 metropolitan areas for this study. In 1997, an additional 

662 African American women who are now seen with the original cohort were enrolled. Major contributions from this long-term study include the findings that bone 

mineral density (BMD) of the hip is the best predictor of all types of fractures, and 

that weight loss and parental history of hip fractures are among the most important 

risk factors for this condition. SOF investigators have also learned that the relationship of BMD and fracture risk is similar in white and African American women, but 

that at every level of BMD, fracture rates are 30 to 40 percent lower in African 

American women. These insights are providing clinicians with important information about which women are at most risk for this debilitating disease, so that prevention strategies may be used more effectively. Similar epidemiological studies 

have now been launched to learn about risk factors for osteoporosis in men. 

With respect to osteoarthritis, the NIAMS partnered with the National Institute 

on Aging, several other NIH components, and four pharmaceutical companies in establishing the Osteoarthritis Initiative, a public-private partnership aimed at developing clinical research resources that support the discovery and evaluation of biomarkers and surrogate endpoints for osteoarthritis clinical trials. For the first time, 

a public-private partnership is bringing together new resources and commitments 

to help find biological markers for the onset and progression of osteoarthritis. Recruitment of participants is actively underway, and by the end of fiscal year 2005, 

more than 3,800 participants have been recruited. One year follow-up measurements have been carried out on over 1,000 participants, and will continue for the 

next 4 years. All data and images collected will be available to researchers worldwide to help quicken the pace of scientific studies and biomarker identification. This 

consortium serves as a model for future endeavors that link the public and private 

sectors. 

COMPLEX GENETICS

The NIAMS is taking full advantage of the explosion of information related to genetics, genomics, and proteomics to pursue the causes of complex diseases, and how 

best to treat them. This includes recent work which identified a genetic variation 

that doubles the risk of developing rheumatoid arthritis. Scientists have long suspected that autoimmune diseases such as rheumatoid arthritis result from a combination of genetic and environmental factors. Now, a NIAMS-funded research team 

has identified a specific genetic variation, called a single nucleotide polymorphism 

or SNP, that increases rheumatoid arthritis risk twofold. The SNP is located within 

a gene that codes for a particular enzyme that is known to be involved in controlling 

the activation of white blood cells, called T cells, that play an important role in the 

body’s immune system. Under normal conditions, the enzyme works as a negative 

regulator: it inactivates a specific signaling molecule which, in turn, interrupts the 

communications and keeps immune cells from becoming overactive. However, in 

cases where the SNP is present in one or both copies of a person’s genes for this 

enzyme, the team found that the negative regulation by the enzyme appears to be 

inefficient, allowing T cells and other immune cells to respond too vigorously, causing increased inflammation and tissue damage. The implications of this finding go 

beyond a better understanding of rheumatoid arthritis risk. It may also help explain 

why different autoimmune diseases tend to run in families, since this gene variant 

is also found in diabetes and lupus. 

In other efforts, researchers have recently made breakthroughs in understanding 

the genetics underlying psoriasis, a chronic skin disease characterized by scaling 

and inflammation. This disorder occurs when skin cells rapidly pass from their origin below the surface of the skin and pile up on the surface before they have a 

chance to mature. Usually this movement (also called turnover) takes about a 

month, but in psoriasis it may occur in only a few days. Recent studies funded by 

the NIAMS are helping scientists and doctors to understand the disease process at 

the molecular level, and what role genes play in predisposing people toward psoriasis. In one such project, researchers investigated the role of both genes and the environment in psoriasis, psoriatic arthritis, and atopic dermatitis, another inflammatory skin condition. The researchers found similarities in genetic susceptibility 

for psoriasis and atopic dermatitis. As for psoriatic arthritis—a condition in which 

inflamed joints produce symptoms of arthritis for patients who have or will develop 

psoriasis—they found that the presence of modifier genes can indicate which people 

with psoriasis are also at risk for psoriatic arthritis. 
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TRANSLATIONAL RESEARCH

A key ingredient in research success is translation: work to bring insights from 

the laboratory bench to the patient bedside, and back again, with the ultimate goal 

of improving patient care and public health. In this vein, NIAMS has recently 

launched a new program to bring together basic and clinical scientists in a targeted 

and organized way. The Centers of Research Translation (CORT) program emphasizes the translation of results from basic to clinical studies, as well as translating 

findings from clinical research to enhance and focus the approaches used in basic 

studies—all with the goal of improving public health. 

This commitment to translational research is bringing results in many areas, including the field of muscular dystrophy research. NIAMS supports two of the six 

Senator Paul D. Wellstone Muscular Dystrophy Cooperative Research Centers: the 

first, at the University of Pittsburgh, focuses on gene and stem cell therapies to 

treat muscle disease; and the second, located at the University of Pennsylvania, is 

examining strategies to inhibit muscle degeneration and promote muscle growth. 

These centers promote side-by-side basic, translational, and clinical research; provide resources that can be used by the national muscular dystrophy and neuromuscular communities; and provide training and advice about muscle diseases for 

researchers and clinicians. 

The Institute has also launched new initiatives to encourage translational research in all forms of muscular dystrophy, and to stimulate career development opportunities for muscle disease researchers. These efforts are designed to facilitate 

the development of new and more effective treatments for muscular dystrophy, and 

to increase the number and quality of investigators in basic, translational, and clinical research focused on this disease. 

REGENERATIVE MEDICINE

Regenerative medicine—a multidisciplinary field that involves the life, physical, 

and engineering sciences—is an emerging area of research that cuts across several 

NIAMS programs. For example, important advances have been made recently in the 

development of promising new polymers for cartilage repair. Cartilage is a tissue 

that lacks capacity for self-repair. However, multidisciplinary studies by biologists, 

engineers, physicians, and other are providing new strategies for treating degenerative cartilage that may result in treatments for articular cartilage lesions. Researchers funded by the NIAMS have developed a class of injectable materials based on 

a biodegradable polymer, OPF (oligo-polyethylene glycol fumarate), for cartilage tissue engineering. Short-term studies in experimental animals demonstrated excellent 

tissue filling and integration resulting from implantation of these materials into cartilage defects. The polymers were also designed to deliver bioactive molecules (such 

as growth factors) as well as cells (such as chondrocytes or progenitor cells) to cartilage lesions to enhance tissue repair. Early results show that chondrocytes remain 

viable, proliferate, and synthesize cartilage matrix components in these polymer 

gels. Taken together, these results indicate that OPF gels are promising materials 

for cell delivery in cartilage repair strategies. 

CONCLUSION

The scientific advances and innovative initiatives highlighted above paint a picture of research progress that has benefited millions of American children and 

adults. In the coming fiscal years, NIAMS will focus on strategic collaborations by 

building partnerships to pursue shared goals across public, academic, and private 

research entities. A primary example of such a coordinated effort is the Collaborative Initiative on Bone Strength. NIAMS—in conjunction with other NIH components, the Food and Drug Administration, and industry partners—is exploring a potential public-private collaboration on bone strength. The main goals of such an initiative would be to provide data supporting the use of new bone strength markers 

as surrogate endpoints for fractures in clinical trials, and to find measurements that 

predict risk of fracture more accurately than does bone density. This would facilitate 

the continued development and approval of new treatment alternatives to prevent 

fractures through the support of clinical trials that are smaller, shorter, and less 

expensive than current studies. 

Finally, NIAMS is placing a high priority on strengthening the pipeline of welltrained investigators across the Institute’s areas of research interest. This commitment includes funding for the new NIH award program, ‘‘Pathway to Independence,’’ to support young investigators, as well as an enhanced emphasis on basic, 

translational, and clinical training at the major research centers supported by 

NIAMS. All of these activities are driven by our dedication to fulfill the mandate 
156 

that Congress gave the Institute when it created NIAMS; namely, to reduce the burden of illness and to enrich the quality of life for all Americans affected by diseases 

within our mission. 

PREPARED STATEMENT OF RAYNARD KINGTON, DEPUTY DIRECTOR, OFFICE OF THE

DIRECTOR

Mr. Chairman, Members of the Committee: I am pleased to present the fiscal year 

2007 President’s budget request for the Office of the Director (OD). The fiscal year 

2007 budget includes, $667,825,000, an increase of $140,259,000 over the fiscal year 

2006 appropriation of $527,566,000 comparable for transfers proposed in the President’s request. The OD provides leadership, coordination, and guidance in the formulation of policy and procedures related to biomedical research and research training programs. The OD also is responsible for a number of special programs and for 

management of centralized support services to the operations of the entire NIH. 

The OD guides and supports research by setting priorities; allocating funding 

among these priorities; developing policies based on scientific opportunities and ethical and legal considerations; maintaining peer review processes; providing oversight 

of grant and contract award functions and of intramural research; communicating 

health information to the public; facilitating the transfer of technology to the private 

sector; and providing fundamental management and administrative services such as 

budget and financial accounting, and personnel, property, and procurement management, administration of equal employment practices, and plant management services, including the implementation of environmental and public safety regulation. 

The principal OD offices providing these activities include the Office of Extramural 

Research (OER), the Office of Intramural Research (OIR), and the Offices of: Science 

Policy; Communications and Public Liaison; Legislative Policy and Analysis; Equal 

Opportunity; Budget; and Management. This request contains funds to support the 

functions of these offices. In addition, the OD also maintains several trans-NIH offices and programs to foster and encourage research on specific, important health 

needs. I will now discuss the budget request for the OD in greater detail. 

NIH ROADMAP FOR MEDICAL RESEARCH

Responding to 21st Century biomedical challenges, the NIH Roadmap for Medical 

Research serves as a test bed for trans-NIH programs designed to accelerate the 

pace and translation of biomedical discovery. Derived from stakeholder input, Roadmap initiatives are bearing fruit with infrastructure, tools and training programs 

that serve and intersect the needs of NIH research disciplines and missions. Several 

large initiatives follow a ‘‘hub-and-spoke’’ model that connects projects and research 

centers to one another and to the research community at large. For example, the 

National Centers of Biomedical Computing have created a networking ‘hub’ to cooperatively develop a number of computing resources that are being followed quickly 

by investigator-initiated projects (spokes) that will use and assess these resources. 

Recognizing that gaps in scientific knowledge can be filled in many types of ways, 

the Roadmap invests in people with innovative, high-risk ideas and in programs and 

training to foster the development of new research teams and disciplines. Re-engineering of clinical research is also underway with efforts to harmonize research policies, develop tools to examine patient-reported outcomes, integrate clinical research 

networks, and accelerate multidisciplinary and translational research training. The 

NIH Roadmap for Medical Research is lowering barriers to biomedical research and 

harnessing the collective knowledge from multiple disciplines to make the next great 

leap forward in biomedical discovery. The fiscal year 2007 budget request for NIH 

Roadmap for Medical Research is $110,700,000, an increase of $28,530,000 over the 

fiscal year 2006 level. 

OFFICE OF AIDS RESEARCH

The Office of AIDS Research (OAR) plays a unique role at NIH, establishing a 

roadmap for the AIDS research program. OAR coordinates the scientific, budgetary, 

legislative, and policy elements of the NIH AIDS research program. Our response 

to the AIDS epidemic requires a unique and complex multi-institute, multi-disciplinary, global research program. Perhaps no other disease so thoroughly transcends 

every area of clinical medicine and basic scientific investigation, crossing the boundaries of the NIH Institutes and Centers. This diverse research portfolio demands an 

unprecedented level of scientific coordination and management of research funds to 

identify the highest priority areas of scientific opportunity, enhance collaboration, 

minimize duplication, and ensure that precious research dollars are invested effec-
157 

tively and efficiently, allowing NIH to pursue a united research front against the 

global AIDS epidemic. OAR oversees the development of the annual comprehensive 

trans-NIH AIDS-related research plan and budget, based on scientific consensus 

about the most compelling scientific priorities and opportunities that will lead to 

better therapies and prevention strategies for HIV disease. The Plan serves as the 

framework for developing the annual trans-AIDS research budget; for determining 

the use of AIDS-designated dollars; and for tracking and monitoring those expenditures. OAR also identifies and facilitates multi-institute participation in priority 

areas of research and facilitates NIH involvement in international AIDS research 

activities. The fiscal year 2007 budget request for OAR is $59,290,000, which is a 

decrease if $1,000,000 below the fiscal year 2006 level. 

OFFICE OF RESEARCH ON WOMEN’S HEALTH

The Office of Research on Women’s Health (ORWH), the focal point for women’s 

health research for the Office of the Director, strengthens, enhances and supports 

research related to diseases, disorders, and conditions that affect women, and sex/ 

gender studies on differences/similarities between men and women; ensures that 

women are appropriately represented in biomedical and biobehavioral research studies supported by the NIH to facilitate analyses by sex/gender; and develops opportunities for the advancement of women in biomedical careers and investigators in 

women’s health research. ORWH is developing a novel initiative, entitled Advancing 

Novel Science in Women’s Health Research (ANSWHR), with the NIH ICs to support innovative research in women’s health and sex/gender issues. ORWH will continue funding for new or continuing programs through new RFAs for its highly successful interdisciplinary programs: Specialized Centers on Research (SCORs) Affecting Women’s Health and Building Interdisciplinary Research Careers in Women’s 

Health (BIRCWH). Reissuance of these interdisciplinary programs will insure the 

continuation of advances in sex and gender factors in women’s health research and 

the mentored development of junior faculty by bridging advanced training with research independence resulting in more clinical researchers performing in women’s 

health research. The fiscal year 2007 budget request is $$40,949,000, which is the 

same as the fiscal year 2006 level. 

OFFICE OF BEHAVIORAL AND SOCIAL SCIENCES RESEARCH

The NIH’s long history of funding behavioral and social sciences research has contributed significantly to our understanding, treatment, and prevention of disease 

and to the promotion of health and well-being. To further NIH’s ability to capitalize 

on such opportunities, Congress established the Office of Behavioral and Social 

Sciences Research (OBSSR) to provide leadership in developing research programs 

that are likely to improve our understanding of processes underlying health and disease and to provide directions for intervention. OBSSR works to ensure that behavioral and social sciences research is integrated into the greater NIH health research 

enterprise. 

As Secretary Leavitt’s announcement of the Genes, Environment and Health Initiative (GEHI) made clear, very little is known about how various characteristics of 

the environment interact with genetics to influence susceptibility to illness. The 

GEI’s focus is interactions among genetics, environmental toxins and individual behaviors (dietary intake and physical activity) that influence the risk of developing 

a number of common diseases. Based on recommendations from an OBSSR-supported Institute of Medicine study examining the state of the science on gene-social 

environment interactions, OBSSR is collaborating with ICs to develop research initiatives at the interface of social and genetic factors and health. Moreover, the office 

is initiating training institutes in genetics for behavioral and social scientists to provide them with the expertise they need to function in interdisciplinary research 

teams working in this area. 

Another area of trans-NIH emphasis has been effective design, communication 

and implementation of health and clinical information to ensure optimal outcomes 

across groups of diverse stakeholders. OBSSR’s participation in the ‘‘Dissemination 

and Implementation Research in Health’’ program will help identify and overcome 

many barriers to the widespread adoption of evidence-based social and behavioral 

interventions to treat and prevent illness. The promise of these efforts lies in their 

potential to improve treatment and prevention of illness, the use of these tools to 

address disparities in health outcomes, and the possibility of demonstrating opportunities for more cost-effective health policy and practice. 

To continue such groundbreaking work in the behavioral and social sciences, the 

fiscal year 2007 budget request for OBSSR is $26,121,000, the same amount as the 

fiscal year 2006 level. 
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OFFICE OF DISEASE PREVENTION

The primary mission of the Office of Disease Prevention (ODP) is to stimulate disease prevention research across the NIH and to coordinate and collaborate on related activities with other federal agencies as well as the private sector. There are 

several other offices within the ODP organizational structure. 

The Office of Medical Applications of Research (OMAR) has as its mission to work 

with NIH Institutes, Centers, and Offices to assess, translate and disseminate the 

results of biomedical research that can be used in the delivery of important health 

interventions to the public. The ODP has two additional specific programs/offices 

that place emphasis on particular aspects of the prevention and treatment of disease 

the Office of Dietary Supplements (ODS) and the Office of Rare Diseases (ORD). 

In fiscal year 2007, the ODS requests a budget of $26,807,000, the same amount 

as the fiscal year 2006 level. ODS promotes the scientific study of the use of dietary 

supplements by supporting investigator-initiated research, and stimulating research 

through the conduct of conferences and presentations at national and international 

meetings. Other current ODS efforts include: 

—Sponsorship of systematic reviews on the efficacy and safety of dietary supplements in reducing the risk of chronic diseases such as cancer and heart disease. 

—Collaborations for the development, validation, and dissemination of analytical 

methods and reference materials for dietary supplements. 

—Support for and development of databases of dietary supplement information including: 

—National Health and Nutrition Examination Survey (NHANES); 

—Collaboration with USDA to develop an analytically-based database of dietary 

supplement ingredients; 

—Plan to develop a dietary supplement label database; 

—International Bibliographic Information on Dietary Supplements (IBIDS); 

—CARDS, a database of federally funded research on dietary supplements. 

—Collaboration with other federal agencies to develop a coordinated approach to 

assessment of the health effects of bioactive factors in food and dietary supplements. 

—Publishing Fact Sheets on dietary supplements for consumers. 

Another component of ODP, the ORD, was formally established through the Rare 

Diseases Act of 2002, Public Law 107–280. The budget request for fiscal year 2007 

for ORD is $15,548,000, the same amount as the fiscal year 2006 level. The following are highlights of ORD activities: (1) An Extramural Rare Diseases Clinical 

Research Network that involves 10 consortia with 70 sites, and 30 patient support 

organizations for almost 50 rare diseases. Twenty-two clinical protocols have been 

approved and another 25 will be developed during 2006. (2) ORD provides support 

for 20 Bench-to-Bedside research projects in the NIH Intramural Research Program 

and supports collaborative research efforts with the National Human Genome Research Institute. (3) ORD also co-funds with the NIH institutes and centers approximately 80 to 100 scientific conferences per year to identify scientific opportunities 

or stimulate research where it is lagging or lacking. (4) To assist the rare diseases 

research community and patients with rare diseases, ORD initiated a pilot program 

to develop genetic tests from gene discoveries in the research laboratories to the 

clinic. (5) ORD is developing a Web-based database of rare diseases bio-specimen repositories in the United States to facilitate access to human biomaterials for research. 

OFFICE OF SCIENCE EDUCATION

The Office of Science Education (OSE), within the Office of Science Policy, develops science education programs to enhance efforts to attract young people to biomedical and behavioral science careers and to improve science literacy in both 

adults and children. The OSE creates programs to improve science education in 

schools (the NIH Curriculum Supplement Series); creates programs that stimulate 

interest in health and medical science careers (LifeWorks Web site); creates programs to advance public understanding of medical science, research, and careers; 

and advises NIH leadership about science education issues. Programs target diverse 

populations including under-served communities, women, and minorities, with a 

special emphasis on the teachers of students from Kindergarten through grade 12. 

The OSE Web site is a central source of information about available education resources and programs, http://science.education.nih.gov. The fiscal year 2007 budget 

request for OSE is $3,839,000, the same as the fiscal year 2006 level. 
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LOAN REPAYMENT AND SCHOLARSHIP PROGRAM

The NIH, through the Office of Loan Repayment and Scholarship (OLRS), administers the Loan Repayment and Undergraduate Scholarship Programs. The NIH 

Loan Repayment Programs (LRPs) seek to recruit and retain highly qualified physicians, dentists, and other health professionals with doctoral-level degrees to biomedical and behavioral research careers by countering the growing economic disincentives to embark on such careers, using as an incentive the repayment of educational loans. There are loan repayment programs designed to attract individuals 

to clinical research, pediatric research, health disparities research, and contraception and infertility research, and to attract individuals from disadvantaged backgrounds into clinical research. The AIDS, intramural Clinical, and General Research 

Loan Repayment Programs are designed to attract investigators and physicians to 

the NIH’s intramural research and research training programs. The NIH Undergraduate Scholarship Program (UGSP) is a scholarship program designed to support 

and enhance the training of undergraduate students from disadvantaged backgrounds in biomedical research careers and employment at the NIH. For fiscal year 

2006, the UGSP plans to award scholarships and provide funding for summer internship service pay-back for twenty (20) individuals and provide funding for twenty-one (21) individuals performing one-year service payback at a cost of $768,000. 

In fiscal year 2006, the Loan Repayment Program for Research Generally (GR–LRP) 

plans to award contracts to fifty-one (51) individuals entering into initial three-years 

contracts, and forty (40) contracts to individuals entering into one-year renewal contracts at a cost of $5,286,000. Lastly, the NIH Clinical Research Loan Repayment 

Program for Inidividuals from Disadvantaged Backgrounds (CR–LRP) plans to 

award contracts to two (2) individuals entering into initial two-year contracts, and 

ten (10) contracts to individuals entering into one-year renewal contracts at a cost 

of $483,000 in fiscal year 2006. The fiscal year 2007 budget request for OLRS is 

$7,141,000, the same as the fiscal year 2006 level. 

OFFICE OF PORTFOLIO ANALYSIS AND STRATEGIC INITIATIVES

In fiscal year 2005, the NIH established a new office within the Office of the Director, the Office of Portfolio Analysis and Strategic Initiatives (OPASI). The OPASI 

is made up of three divisions, focused on (1) resource development and analysis (including the development and deployment of knowledge management; (2) strategic 

coordination; and (3) evaluation and systematic assessments. Collectively, these 

three divisions identify and integrate information to support the planning and implementation of trans-NIH initiatives that address exceptional scientific opportunities and emerging public health needs. More specifically, OPASI is facilitating a 

‘‘functional integration’’ of strategic planning and evaluation activities across the 

agency. The fiscal year 2007 budget request for OPASI is $3,000,000, an increase 

of $1,020,000 over the fiscal year 2006 level. 

When fully staffed by fiscal year 2008, OPASI will have approximately 72 FTEs. 

Thirteen existing FTEs transferred to OPASI in fiscal year 2006, and approximately 

16 FTEs will be recruited during fiscal year 2006. The NIH is in the process of recruiting for a Director, OPASI and expects to fill this position in 2006. Funding for 

fiscal year 2007 will cover additional recruitments and Office operations in an 

amount consistent with OPASI’s structure and responsibilities. In addition to salaries to support the FTEs, funding will be used to pay for contractual services, supplies, equipment, office rent and other services. 

Through these efforts, the NIH Director and the IC Directors will have access to 

more consistent information to improve coordination and facilitate collaboration 

across the agency, and to inform priority setting and budget decisions. The governance process for OPASI will likely be carried out by a new working group of the 

NIH Steering Committee, as described above. The group will be charged with monitoring the overall effectiveness of the office, advising on policy and planning issues, 

and forecasting the need for changes in OPASI’s activities, among other areas. 

Thank you, Mr. Chairman for giving me the opportunity to present this statement; I will be pleased to answer questions that the Committee may have. 

PREPARED STATEMENT OF DR. STORY C. LANDIS, DIRECTOR, NATIONAL INSTITUTE OF

NEUROLOGICAL DISORDERS AND STROKE

Mr. Chairman and Members of the Committee, I am Story Landis, Director of the 

National Institute of Neurological Disorders and Stroke (NINDS). I am pleased to 

present the fiscal year 2007 President’s budget request for NINDS. 
160 

The mission of the NINDS is to reduce the burden of neurological disorders by 

developing ways to prevent or to treat these diseases. Epilepsy, autism, cerebral 

palsy, muscular dystrophy, spinal muscular atrophy (SMA), and hundreds of other 

disorders are first evident in infancy or childhood. Multiple sclerosis, spinal cord injury, migraine, and traumatic brain injury are among the many nervous system diseases that are prevalent in young adults. Stroke, dementias, chronic pain, and Parkinson’s disease will increase, if unchecked, with the aging of our population. The 

impact of neurological disorders on people, on their families, and on our economy 

is immense. 

CLINICAL RESEARCH

The NINDS currently supports more than 1,000 clinical research projects, of 

which more than 125 are clinical trials of interventions to prevent or treat disease. 

Ongoing clinical trials are testing drugs, natural biological molecules, surgery, deep 

brain stimulation, hypothermia, radiation, immunotherapy, and behavioral therapies for disorders including amyotrophic lateral sclerosis (ALS), brain tumor, cerebral palsy, epilepsy, headache, Huntington’s disease, multiple sclerosis, muscular 

dystrophy, myasthenia gravis, pain, Parkinson’s disease, spinal muscular atrophy, 

stroke, Tourette syndrome, and traumatic brain injury. 

Last year an NINDS clinical trial showed that aspirin prevents stroke effectively 

for the many people with partially blocked arteries in the brain who have had a previous stroke or TIA (mini stroke). Aspirin works as well as warfarin, a drug that 

requires monthly monitoring and carries the risk of major hemorrhage and heart 

attack. This trial is another step in a long march of advances that guide physicians 

in preventing stroke in particular risk groups. The U.S. Centers for Disease Control 

and Prevention estimated that the death rate from stroke declined by 18.5 percent 

for the U.S. population from 1993 to 2003, and progress is continuing with results 

like these. 

Each year also brings results from several NINDS preliminary clinical trials. Current drugs for Parkinson’s disease ultimately fail because they do not halt the progressive death of brain cells that causes this disease. The Neuroprotection Exploratory Trials in Parkinson’s Disease (NET–PD) is a network of 50 clinical centers 

throughout the United States that efficiently tests drugs to slow the underlying disease. NET–PD has completed phase II trials of four drugs that had been rigorously 

selected for testing from candidates suggested by scientists around the world, and 

just published the results of the first two. NET-PD will move quickly to a large, definitive clinical trial to test the safety and effectiveness of at least one of these drugs 

in preventing Parkinson’s disease. 

In addition to clinical trials, other types of clinical studies lead to new treatment 

or prevention strategies. An epidemiological study this year found that men who exercised vigorously as young adults had a 50 percent lower risk of developing Parkinson’s disease in later life than men who had low levels of physical activity. Other 

studies determined how to predict which patients with glioblastoma, a common and 

deadly brain tumor, will respond to a new class of anti-cancer drugs, and discovered 

why infant seizures do not respond to drugs that are effective in adults and what 

other drugs might work better. 

The NINDS Clinical Research Collaboration (CRC), now under development, will 

extend the reach of clinical research into more communities across the United 

States. The CRC engages community practice and academic neurologists to speed 

clinical studies; minimize costs; make clinical trials more accessible to diverse participants; facilitate trials of rare diseases; and improve transfer of research results 

to clinical practice in the community. Complementing the CRC, the NINDS is building a network to develop emergency treatments for neurological disorders. Stroke, 

seizures, traumatic brain and spinal cord injury, and other neurological disorders 

account for perhaps 5 to 10 percent of all medical emergencies. This program brings 

together specialists in emergency medicine, neurological disease and clinical trials. 

GENES AND NEUROLOGICAL DISORDERS

In December, the journal Science chose the discovery of a gene defect that can 

cause Tourette syndrome as one of the 10 most important scientific advances of the 

year. Since the NIH budget doubling began, scientists have identified more than 100 

genes associated with neurological diseases including ALS, ataxias, Batten disease, 

dyslexia, dystonia, epilepsy, muscular dystrophies, Parkinson’s disease, peripheral 

nerve diseases, and spinal muscular atrophies. 

Gene discoveries often have a rapid impact on patients and families. They yield 

definitive DNA diagnostic tests that are faster, cheaper, and more accurate, and 

allow genetic counseling and attention to special risks of people with particular in-
161 

herited disorders. For example, patients with ataxia used to undergo MRI brain 

scans, withdrawal of spinal fluid for analysis, tests for amino acids and organic 

acids, lipoprotein electrophoresis, urine heavy metal screens, thyroid function tests, 

and sometimes painful nerve or muscle biopsies to get a diagnosis, costing thousands of dollars over several months. Today, a commercially available DNA test can 

often give a definitive diagnosis of a genetic neurological disorder within a week for 

a few hundred dollars. 

Gene findings also jumpstart therapy development. Over the last year, studies of 

therapies in animal models, another benefit from gene discoveries, have shown 

promise for neurofibromatosis, muscular dystrophy, Fragile X syndrome, Huntington’s disease, hereditary ataxias, and several other disorders. Therapies are already 

moving from animal models into NIH or private sector clinical trials, including 

ceftriaxone for ALS, anti-oxidants for ataxia-telangiectasia, myostain inhibitors and 

gentamicin for muscular dystrophy, and coenzyme Q10 for Huntington’s disease. 

The pace is remarkable after decades without progress for many of these diseases. 

Knowing where and when genes are active is key to understanding the nervous 

system in health and disease. Most genes are active at some time and place in the 

brain, yet only a small fraction of these have been well characterized, so the NINDS 

initiated the GENSAT (Gene Expression Nervous System Atlas) to map gene activity in the brain across development. GENSAT also generates valuable research tools 

including strains of mice in which a visible marker is turned on where and when 

the gene of interest is active. Using these mice, scientists this year found new insights into Parkinson’s disease that could not have been revealed without this resource. The studies showed that one of two previously undistinguishable types of 

nerve cells is selectively affected in Parkinson’s disease, helped explain why brain 

movement control circuits malfunction, revealed the molecular mechanism that kills 

those cells, and identified a potential new target for drugs to slow Parkinson’s disease. 

TRANSLATIONAL RESEARCH

With the budget increases, the NINDS implemented major programs to move insights from basic research to practical therapies ready for testing in clinical trials, 

that is, translational research. The Cooperative Program for Translational Research 

supports research teams in academia and small companies. These milestone-driven, 

investigator-initiated projects are developing drug, stem cell, or gene therapies for 

Batten disease, Parkinson’s disease, Huntington’s disease, tuberous sclerosis, 

Duchenne muscular dystrophy, traumatic brain injury, and stroke, among other disorders. 

In another translational effort, the NINDS developed the SMA Project as a model 

program to expedite therapy development. The contract-based project is making encouraging progress towards its ambitious goal—having a drug for SMA ready for 

clinical trials by the end of 2007. A steering committee, with drug development expertise from industry, the FDA, academia, and the NIH, first developed a detailed 

drug development plan. To carry out the plan, the project then created a virtual 

drug development company with the tools and facilities for identifying ‘‘lead compounds,’’ chemically modifying leads into potentially improved compounds, testing 

drug candidates in cell and animal models, and coordinating the overall drug development scheme. More than 300 compounds have been prepared and are in testing. 

In 2007, the NINDS will address a major barrier in the development of drugs for 

other neurological diseases by extending the contract-based medicinal chemistry resource from the SMA Project. Medicinal chemists modify weakly active compounds 

so that drug development teams can test the new drugs for improved safety and effectiveness. 

NIH basic science stimulates therapy development in the private sector, as well 

as by the NIH. In the past year, private sector clinical studies of clotting Factors 

VII and VIIa have shown promise for serious and hard to treat strokes caused by 

bleeding in the brain. NIH research motivated those studies by showing that these 

strokes are followed by continued expansion of blood filled pockets in the brain, 

called hematomas, which contribute profoundly to disability and death. Private sector clinical trials in gene and cell therapies for Parkinson’s disease begun this year 

also build upon NINDS research. 

Longstanding NINDS targeted therapy development programs also catalyze private sector efforts. For three decades, the Anticonvulsant Screening Program (ASP) 

has fostered industry development of drugs for epilepsy, including six drugs in widespread use and several more now in clinical testing. Drugs that emerged from the 

ASP testing program are also among the most effective treatments for chronic pain. 

NINDS initiatives begun last year and to begin in 2007 focus on animal models for 
162 

testing drugs that block the development of epilepsy, work for treatment resistant 

epilepsy, and meet the special needs of pediatric and geriatric populations. 

COLLABORATIVE RESEARCH

The NINDS strongly encourages cooperative efforts among scientists and physicians from diverse disciplines, and works closely with other parts of the NIH, other 

government agencies, and non-governmental organizations, as well as with companies. As may be evident from the discussions of the Clinical Research Consortium, 

NET–PD, GENSAT, the Cooperative Program in Translational Research, and the 

SMA Project, most NINDS programs, whether focused on a particular disease or a 

scientific problem, emphasize collaboration. Other examples include research centers 

on muscular dystrophy, Parkinson’s, autism, spinal cord injury, stroke and heath 

disparities, and resources including the Human Genetics Repository and the 

Microarray Consortium. 

The NIH Neurosciences Blueprint, begun in 2005, presents a framework to enhance cooperation across the NIH institutes that share an interest in diseases of the 

nervous system. Blueprint initiatives have focused on neuroscience tools, training in 

the neurobiology of disease for basic scientists, genome analysis, neuroimaging, genetic mouse models, core research facilities, and clinical assessment tools. In 2007, 

the Blueprint will focus on neurodegeneration, which contributes to many diseases. 

Among government agencies, the NINDS is working closely with the U.S. Army 

Medical Research Institute of Chemical Defense (USAMRICD) because many potential chemical terrorist agents affect the nervous system. Cooperative projects with 

the Veterans Administration include a major clinical trial of deep brain stimulation 

for Parkinson’s disease. The NINDS also meets regularly with the FDA on stem 

cells and other biological therapies and works with the National Science Foundation 

on common interests including computational neuroscience and informatics. 

More than 300 non-governmental organizations (NGOs) focus on diseases within 

the mission of the NINDS. The World Parkinson Conference, held for the first time 

this February, and a major conference on epilepsy planned for March 2007 are two 

of many recent examples of cooperative efforts between NGOs and the NINDS. In 

June 2005, the Institute brought together 75 representatives of NGOs at the NIH 

for a day of presentations, informal interaction, and group discussions. Based on the 

strong positive feedback from participants, the NINDS will hold similar meetings 

in the future to explore how we can work together in the future. 

Thank you, Mr. Chairman. I would be pleased answer questions from the Committee. 

PREPARED STATEMENT OF DR. TING-KAI LI, DIRECTOR, NATIONAL INSTITUTE ON

ALCOHOL ABUSE AND ALCOHOLISM

Mr. Chairman and members of the Committee: I am pleased to present the fiscal 

year 2007 President’s budget request for the National Institute on Alcohol Abuse 

and Alcoholism (NIAAA). The fiscal year 2007 budget includes $433,318,000, which 

reflects a decrease of $2,612,000 over the fiscal year 2006 enacted level of 

$435,930,000 comparable for transfers proposed in the President’s request. 

Alcohol consumption kills or disables thousands of Americans each year. The Centers for Disease Control and Prevention (CDC) reported in 2005 that, in the mid1990s, alcohol use and abuse were among the top ten causes of death and disability 

in the United States. CDC also ranked excessive alcohol consumption as the third 

leading preventable cause of death in 2001. Motor vehicle crashes are among the 

most visible consequences of alcohol use; CDC estimates that in 2003, 40 percent 

of traffic deaths were alcohol-related. However, death and disability also result from 

alcohol-related diseases, such as liver cirrhosis, heart disease, stroke, dementia, and 

certain cancers. 

Despite these consequences, the majority of people who drink are able to do so 

without harm to themselves or others. One of the fundamental goals of alcohol research is to determine why some individuals cannot limit their drinking. Research 

has shown clearly that half of the risk for developing alcohol use disorders is a function of genes, while the other half can be traced to factors in the environment, such 

as family, friends, and culture. The measure of risk is not an either/or situation; 

genes and environmental factors interact and influence one another, even at the molecular level. 

Investigating the interplay of genes and environment is an important focus across 

the NIH, with implications for many of the most widespread, life-threatening, and 

costly health conditions affecting Americans. One of the exciting areas of research 

I would like to describe today has to do with how new tools we are developing to 
163 

investigate this interaction between genes and environment can contribute to an understanding of alcohol dependence. 

As a starting point, we have already identified several genes that can raise or 

lower the risk of developing alcohol dependence. Variants in two families of genes 

that are involved directly in alcohol metabolism, for example, can lower risk. These 

genes encode enzymes that break down alcohol. Some people inherit enzyme 

variants that will result, if a person drinks, in especially high levels of a toxic byproduct of alcohol metabolism. These individuals feel sick when they drink; as a result, they are at lower risk of developing alcohol use disorders. 

Other genes that play a role in alcoholism risk encode the communication circuitry of brain messenger molecules, the receptors of neurotransmitters, a number 

of which have been linked to alcoholism and psychiatric disorders that co-occur frequently with alcoholism. Research suggests, for example, that genes for 

neurotransmitters involved in depression and anxiety are also, in some groups, related to alcoholism risk. Among the neurotransmitter systems for which research 

has reported a relationship between genes and alcoholism risk: GABA, a 

neurotransmitter that slows the pace of brain signaling and is known to be involved 

in the alcohol response; NPY, a brain protein involved in stress responses and memory; serotonin, a neurotransmitter involved in the regulation of mood; and brain 

opioids, which play a role in the sensation of pleasure. 

Variants in these neurotransmitter genes influence alcoholism risk by shaping 

how the brain responds to alcohol, regulating how pleasant the experience is, or how 

sedating. An important new direction of research has to do with investigating how 

the opposite can occur: alcohol can make lasting changes in genes in ways that can 

have profound effects on health. 

Epigenetics refers to heritable and long-term changes in gene function that occur 

without a change in DNA sequence. Such changes could be caused, for example, by 

elements in the environment, such as alcohol, changing how genes are translated 

into proteins, in other words, how the genes are expressed. Epigenetics can help us 

understand how alcohol has lasting effects on health. 

One of the ways alcohol and its metabolites can change gene expression is by 

modifying histones—proteins that intertwine with DNA. Stable modification of DNA 

can also occur. Both of these reactions can activate or silence the expression of 

genes. Alcohol through its metabolism contributes to or alters the level of at least 

two specific metabolites that are required for these chemical modifications. 

Epigenetic modifications may be transmitted as the cell divides. Thus, these modifications may persist throughout the lifespan. Epigenetic changes also have the potential to be passed on to the next generation, producing abnormalities in offspring. 

This research, at the forefront of progress in genetics and molecular biology, gives 

us an opportunity to understand the complex mechanisms by which an external environmental factor like alcohol interacts with biology. It promises to help explain 

why repeated exposure to alcohol can change permanently how a person responds 

thereafter to the substance, setting the stage for dependence. It can help explain 

why drinking during pregnancy can cause irreversible damage to the brain of a 

fetus. And it may help explain what underlies alcohol’s destructive effects on such 

organs as the liver, pancreas, and brain, as well as its role in cancers associated 

with heavy alcohol exposure. 

Epigenetics research may also provide a means for investigating the long-term effects of alcohol consumption on adolescents. Alcohol is the drug most commonly used 

by youth. Adolescents who drink tend to do so intensively; according to 2005 data 

from the Monitoring the Future study, 11 percent of 8th graders, 21 percent of 10th 

graders, and 28 percent of 12th graders report drinking 5 or more drinks in a row 

in the past two weeks. This ‘‘binge’’ drinking is a particularly hazardous pattern of 

drinking at any age. But during adolescence, when the brain is still undergoing developmental change, binge drinking may have particular dangers. 

Preliminary studies suggest that alcohol has the potential to disturb normal brain 

development in adolescence and young adulthood. NIAAA research has established 

that youth who begin to drink in their early teens are at greater risk later of developing alcohol dependence. This increased risk can be explained only partly by inherited biological risk factors, suggesting that early drinking itself causes changes that 

manifest themselves in future behavior. Data from NIAAA’s National Epidemiologic 

Survey on Alcohol and Related Conditions has shown that most cases of alcoholism 

are established by age 25. This suggests that alcoholism, rather than being a disease of middle age, is a developmental disorder that has its roots in youth. 

An important NIAAA initiative is aimed at investigating the effects of alcohol, including epigenetic effects, on developing brain structures and systems that regulate 

behavior. It will address the mechanisms that underlie alcohol-related changes during brain development, the dosage and drinking patterns that result in changes, and 
164 

the factors that promote or protect against these changes. An important aim of this 

research is to determine whether and how alterations in brain function influence 

lifetime risk for alcohol use disorders, particularly in vulnerable individuals. 

Improving our fundamental understanding of how the environment interacts with 

genes has many potential benefits. For example, knowledge of the genes that are 

related to risk for alcohol problems—and how variants of these genes might be 

manifest in physical or behavioral traits—can be used to assist in the identification 

of individuals at risk or, in other words, predict who is vulnerable. Understanding 

how alcohol interacts with genes will help define how an individual makes the transition from casual drinking to dependence; and how long term heavy drinking 

causes disease. 

Our growing body of knowledge about genes and the cellular processes they encode is providing targets for medications development. Genetics research is helping 

to show why no one medication will work in every person. The ultimate goal will 

be to personalize treatment—similar to the approach in diseases like hypertension 

or depression—by choosing from an array of medications the agent that is most effective for a given individual. 

Finally, among its most important potential benefits, the investigation of genes 

and environment will give us a clear picture of the impact of alcohol on the longterm health and behavior of adolescents. Understanding the mechanisms behind 

these persistent effects will make even more compelling the imperative to identify 

effective ways of preventing adolescents from consuming alcohol, not only to safeguard their health and well-being in youth, but to preempt the development of alcohol use problems in adulthood. 

Thank you Mr. Chairman. I would be pleased to answer any questions that the 

Committee may have. 

PREPARED STATEMENT OF DR. DONALD A.B. LINDBERG, DIRECTOR, NATIONAL

LIBRARY OF MEDICINE

Mr. Chairman and Members of the Committee: I am pleased to present the President’s budget request for the National Library of Medicine (NLM) for fiscal year 

2007, a sum of $313,269,000, which is $1,641,623 less than the comparable fiscal 

year 2006 appropriation. 

Only a few years ago we frequently described the role of the National Library of 

Medicine almost entirely in the context of the medical literature—NLM collected 

and organized the books and journals that were then used in the process of making 

new discoveries that would be reported in yet more books and journals. That paradigm, although accurate as far as it goes, is no longer sufficient to describe the Library’s role. Today, the NLM is at the hub of an interconnected world of an amazing 

amount of information, ranging from the published literature, to molecular sequence 

and genomic data, to descriptions of clinical trials, to still and moving medical images, to maps of chemical spills and other information used for emergency preparedness, and to authoritative research-based information prepared especially for the 

general public—for patients and their families and caregivers. 

The range of persons and institutions with which the Library interacts is staggering. A National Network of Libraries of Medicine, with more than five thousand 

members, extends the reach of NLM’s services. Many medical organizations, publishers, academic institutions, government agencies, and libraries make data available to the world through the National Library of Medicine. The NLM, with a staff 

of experienced medical librarians, scientists, and health professionals, creates databases and other Web resources to ensure that high quality information is available 

to all, easily and without restriction. The bottom line of all this is that the Library 

operates the most-consulted scientific medical Web site in the world: two million 

people come to the Library’s Web site—to learn about diseases, search the literature, connect with other information providers, and to download terabytes of 

data—every day. 

As a key member of the NIH research team, the Library works closely with scientists on the Bethesda campus and around the country. A prime example of this 

is the work of NLM’s National Center for Biotechnology Information (NCBI) and the 

panoply of databases with genomic information contributed by NIH and NIH-supported scientists. This collaboration extends around the world, with partners at institutions in other nations contributing sequence and other data to the NCBI’s databases. Another example of extensive collaboration is that several thousand public 

and private organizations have agreements with NLM to use the Visible Human 

Project datasets of anatomical information to create techniques and software used 

in teaching and research. 
165 

But the Library is also a bricks and mortar facility on the campus of the National 

Institutes of Health. NLM has two reading rooms that are open to the public—one 

that serves the Library’s remarkable collection of historical materials and a main 

reading room. An exhibition, ‘‘Visible Proofs: Forensic Views of the Body,’’ has just 

been opened in the Library’s public area and will be visited by many thousands, including students from grade school up. Previous exhibitions are now touring the 

country, extending greatly the work of our history of medicine curators. 

A basic function of the National Library of Medicine is to serve as a ‘‘court of last 

resort’’ for seekers of medical information. With the world’s largest collection—eight 

million items—the NLM is relied on by institutions and individuals around the 

globe. 

INFORMATION SERVICES FOR THE PUBLIC

The Library’s main portal for consumer health information is MedlinePlus, available in both English and Spanish. Much of this material is based on research done 

or sponsored by the NIH Institutes. MedlinePlus has more than 700 ‘‘health topics,’’ 

containing, for example, overview information, pertinent clinical trials, alternative 

medicine, prevention, management, therapies, current research, and the latest news 

from the print media. In addition to the health topics, there are medical dictionaries, a medical encyclopedia, directories of hospitals and providers, and interactive 

‘‘tutorials’’ with images and sound. The newest addition to MedlinePlus is a series 

of surgical videos that show actual operations of common surgical procedures. Another new aspect of MedlinePlus is ‘‘Go Local,’’ that is, a service to link users from 

the MedlinePlus health topics to the health and social services in their community 

that are related to that topic. 

There are other popular NLM Web sites for the public. ClinicalTrials.gov was created to give everyone easy access to information about human research studies. The 

site contains information on more than 25,000 federally and privately supported 

trials. It includes summaries of the purpose of each study, the recruiting status, criteria for patient participation, location(s) of the trial and specific contact information. NIHSeniorHealth.gov is maintained by the Library in collaboration with the 

National Institute on Aging and other NIH Institutes. At present there are 22 topics 

of interest to seniors, including, for example, Alzheimer’s Disease, balance problems, 

macular degeneration, shingles, and stroke. NIHSeniorHealth.gov contains information in a format that is especially usable by seniors, with, for example, large type, 

and it also has a ‘‘talking’’ function that allows users to listen as the text is read 

to them. 

NLM’s Genetics Home Reference provides consumer-friendly summaries of genetic 

conditions and related genes and chromosomes. This information resource bridges 

consumer health information and scientific bioinformatics data, and it links to many 

existing resources, both at NLM and at other reliable sites. The Household Products 

Database provides easy-to-understand data in consumer-friendly language on the 

potential health effects of more than 2,000 ingredients contained in more than 6,000 

common household products. The Household Products Database has proved to be 

popular with the media, and there have been a number of newspaper and magazine 

articles about it. Another consumer health site is the colorful Tox Town, which looks 

at an ordinary town and points out many harmful substances and environmental 

hazards that might exist there. Users can click on a town location, like a school, 

office, factory, or park and find information about the toxic chemicals that may be 

encountered there. Other versions are available for a big city, a farm, and the U.S.- 

Mexico border area. There is also a new special section with information on toxic 

chemicals and disaster health concerns in the wake of Hurricane Katrina and Hurricane Rita. 

INFORMATION SERVICES FOR THE SCIENTIFIC COMMUNITY

The most frequently consulted online medical resource in the world is PubMed/ 

Medline, an easily searchable database of more than 15 million references and abstracts for medical journal articles from the 1950s to the present. Usage of PubMed/ 

Medline by the scientific and lay communities has grown considerably since it became free on the Web in 1997, to over two million searches per day. PubMed also 

links to the sites of participating publishers so that users can retrieve full-text articles from 5,000 journals. Where links to electronic full text are not available, the 

user may use PubMed to place an online order for an article directly from a library 

in the National Network of Libraries of Medicine. 

PubMedCentral (PMC) is a Web-based repository of biomedical journal literature 

providing free and unrestricted access to the full-text of articles. This repository is 

based on a natural integration with the existing PubMed/Medline biomedical lit-
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erature database of references and abstracts. Currently, PMC contains nearly 

600,000 full-text articles. Recent additions have come from newly published material 

as well as from digitizing back issues that previously were only available in printed 

form. NIH’s Public Access policy encourages scientists whose work is funded by the 

NIH to submit their manuscripts to PubMed Central. NLM’s National Center for 

Biotechnology Information designed and implemented the NIH Manuscript Submission system, a quick and easy-to-use system for scientists to submit their manuscripts. Creating such digital archives as PubMedCentral to ensure that the world’s 

biomedical literature is properly recorded and available for future generations, is an 

important NLM responsibility. 

Another heavily used scientific resource is a database of all publicly available 

DNA sequences, called GenBank. The NCBI, which maintains GenBank, has also 

created integrated retrieval tools that allow seamless searching of the sequence data 

and provide links to related sequences, bibliographic citations, and other resources. 

Such features allow GenBank to serve as a critical research tool in the analysis and 

discovery of gene function as well as discoveries that lead to identification and cures 

for a number of diseases. One recent example of the use of NCBI sequence databases was to identify the first polio case in the United States since 1999. The state 

health laboratory in Minnesota had isolated an unknown virus from a hospitalized 

child from an Amish community. The laboratory staff went to the Web, searched 

against the 55 million DNA sequences at NCBI, and found a match to the polio 

virus used in the Sabin oral vaccine. ‘‘Bingo,’’ said the laboratory’s director, ‘‘It was 

a 98 percent match. We knew we had nailed it.’’ 

A critical need in biomedical research, as identified in the NIH Roadmap Initiative, is a repository for what are called ‘‘small molecules’’ that are crucial in drug 

development. Small molecules are responsible for the most basic chemical processes 

that are essential for life and they often play an essential role in the attack of a 

pathogen, or in the cell’s response to the attack. The new PubChem database, developed by the NCBI, links the small molecules to their biological functions and to the 

macromolecules with which they interact. At present, PubChem includes over 7.5 

million records for small molecules with over 5 million molecular structures. These 

data have been contributed by public, academic, and commercial resources. 

The NCBI is also doing important work on other issues of current public concern. 

One of these is to provide an Influenza Virus Resource that links researchers working on vaccines to genomic data about the influenza virus. As the data accumulate 

and the analyses progress, the discoveries made will ultimately lead to better prediction of large-scale outbreaks, more effective vaccine design, and the saving of 

many human lives. Another area of NCBI work of topical interest is their development, in the aftermath of 9/11, of sophisticated software called OSIRIS. The software is now being tested within five collaborating forensic DNA laboratories to assist in the analysis and validation of forensic data and help identify victims from 

the Gulf Coast states in the aftermath of Katrina. 

A recently announced series of initiatives by several NIH Institutes directed at 

understanding the genetic factors underlying human disease will require the NCBI 

to play a key role. Several large-scale, long-term studies, such as the Framingham 

Heart Study, will be adding genetic information from participants to the clinical 

data already collected. NCBI has been selected by the Institutes to build the databases that will incorporate the clinical and genetic data, link them to the molecular 

and bibliographic resources at the NCBI and, for the first time, make these data 

available to the scientific and clinical research community. 

NLM remains the principal source of support nationally for research training in 

the field of biomedical informatics. This support is especially important as rapidly 

moving technology in health care and biomedical research requires investigators 

who understand biomedicine as well as fundamental problems of knowledge representation, decision support, and human-computer interface. Five-year institutional 

training grants from NLM support some 300 pre-doctoral, post-doctoral, and shortterm trainees across the country. 

OTHER AREAS OF INTEREST

The Library has an important role in developing standards for Electronic Health 

Records. As part of its Unified Medical Language System (UMLS) project, NLM creates vocabulary databases and software tools to assist informatics researchers and 

system developers in automated interpretation and integration of medical knowledge and health data. Chief among the UMLS resources is the Metathesaurus, 

which links and provides 4.7 million concept names for 1.2 million concepts from 

114 vocabularies in a single database format. The UMLS serves as a common distribution vehicle for standard code sets and vocabularies needed for administrative 
167 

transactions and electronic health records, as well as a resource for advanced natural language processing, automated indexing, and enhanced information retrieval. 

Building on its two decades of UMLS experience, the Library also serves as an HHS 

coordinating center for standard clinical vocabularies, such as the SNOMED CT 

clinical terminology. The Library works closely with the Office of the National Coordinator for Health Information Technology and other organizations to align health 

data standards into an effective interlocking set and to promote more rapid adoption 

of standards-based electronic health records to facilitate patient care, public health 

surveillance, and clinical research. 

Twenty years ago the National Library of Medicine published a long range plan 

that has proved to be of enormous benefit to the institution. Out of it grew such 

initiatives as the Visible Human Project, the National Center for Biotechnology Information, and the recommendation that the Library engage in an outreach campaign to reach minority and other underserved health professionals. The Library is 

now engaged in a similar planning exercise for the next decade. Leaders from across 

the spectrum of health and medicine are meeting at the Library to consider four 

major themes relating to resources and infrastructure, outreach to the underserved, 

support for clinical and public health systems, and support for genomics. The plan, 

which will be issued by the NLM Board of Regents and published later in 2006, will 

point the Library in the direction in which it can make its maximum contribution 

to society. 

PREPARED STATEMENT OF JUANITA M. MILDENBERG, ACTING DIRECTOR, OFFICE OF

RESEARCH FACILITIES DEVELOPMENT AND OPERATIONS

Mr. Chairman and Members of the Committee: I am pleased to present the President’s budget request for the Buildings and Facilities (B&F) Program for fiscal year 

2007, a sum of $81,081,000. 

ROLE IN THE RESEARCH MISSION

State-of-the-art facilities for scientific research and research support facilities are 

a vital part of the research enterprise. The National Institutes of Health’s (NIH) 

Buildings and Facilities (B&F) program designs, constructs, repairs and improves 

the agency’s portfolio of laboratory, clinical, animal, administrative and support facilities at its six installations in four states. These facilities house researchers from 

the NIH Institutes’ and Centers’ (ICs) intramural basic, translational, and clinical 

research programs; science administrators who oversee NIH’s grants; the NIH leadership, and various programs that support agency operations. The fiscal year 2007 

B&F budget request focuses on the need for responsible utilization and stewardship 

of NIH’s past and recent investments in the ‘‘bricks and mortar’’ of the research enterprise. In order to stay abreast of the changing needs of the NIH programs, it is 

imperative that we provide reliable, safe and secure research support facilities that 

are appropriately equipped, operated and maintained. 

The B&F budget request is the product of a comprehensive, corporate capital facilities planning process. This process begins with extensive consultation across the 

research community and the NIH’s professional facilities staff. It works through the 

Facilities Working Group, an advisory committee to the NIH Steering Committee, 

and the HHS Capital Investment Review Board. Through this process, the program 

demand for more effective and efficient facilities designed to support current and 

emerging investigative techniques, technologies, and tools is integrated with, and 

balanced against, the need to repair, renovate, and improve the existing building 

stock to keep it in service and to optimize its utility. 

The fiscal year 2007 request provides the necessary funding support for the ongoing safety, renovation and repair, and related projects that are vital to proper stewardship of the entire portfolio. 

The fiscal year 2007 B&F budget request is organized among three broad Program 

Activities: Essential Safety and Regulatory Compliance, Repairs and Improvements 

and Construction. The fiscal year 2007 request provides funds for specific projects 

in each of the program areas. The projects and programs enumerated are the end 

result of the aforementioned NIH facilities planning process and are the NIH’s capital facility priorities for fiscal year 2007. 

FISCAL YEAR 2007 BUDGET SUMMARY

The fiscal year 2007 budget request for Buildings and Facilities is $81.1 million. 

The B&F request contains a total of $14.5 million for Essential Safety and Regulatory Compliance programs composed of $2 million for the phased removal of asbes-
168 

tos from NIH buildings; $5 million for the continuing upgrade of fire and life safety 

deficiencies of NIH buildings; $1.5 million to systematically remove existing barriers 

to persons with disabilities from the interior of NIH buildings; $1 million to allow 

for environmental remediation activities at NIH sites; and $5 million for the continued support of the rehabilitation of animal research facilities. In addition, the fiscal 

year 2007 request includes $65.9 million in Repairs and Improvements for the continuing program of repairs, improvements, and maintenance that is the vital means 

of maintaining the complex research facilities infrastructure of the NIH; and 

$700,000 in Construction for pre-project planning including concept development 

studies and analyses of NIH-wide facility projects proposed in the facilities plan. 

My colleagues and I will be happy to respond to any questions you may have. 

PREPARED STATEMENT OF DR. RODERIC I. PETTIGREW, DIRECTOR, NATIONAL

INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

Mr. Chairman and Members of the Committee: I am pleased to present the fiscal 

year 2007 President’s budget request for the National Institute of Biomedical Imaging and Bioengineering (NIBIB). The fiscal year 2007 budget includes $294,850,000; 

a decrease of $1,960,000 over the fiscal year 2006 enacted level of $296,810,000 comparable for transfers proposed in the President’s request. 

BRIDGING THE PHYSICAL AND LIFE SCIENCES

The mission of the NIBIB is to improve human health by leading the development 

and accelerating the application of biomedical technologies. The Institute is committed to integrating the engineering and physical sciences with the life sciences to 

advance basic research and medical care. To demonstrate our commitment, the 

NIBIB gives special consideration for funding to research grant applications that 

bridge and integrate the life and physical sciences. 

TRANSLATING TECHNOLOGY INTO CLINICAL PRACTICE

Ultimately, the NIBIB seeks to translate research findings made in the laboratory 

into solutions that advance human health by reducing disease burden and improving quality of life. One highly successful example of a research and commercialization effort supported in part by the NIBIB is an automated, digital-imaging device 

called the ‘‘array microscope.’’ The system utilizes an array of 100 miniaturized objectives to produce a single, seamless sweep of a microscope slide of a histopathology 

sample. The result is a microscopic-level resolution, multi-colored digitized image of 

the pathology sample. The most immediate impact of this technology is expected to 

be in medical pathology. These ‘‘virtual slides’’ can be easily stored in a patient’s 

record and can also be viewed over the Internet, providing immediate on-line access 

to expert second opinions. 

The recently released ‘‘Quantum Project’’ initiative is another example of how the 

NIBIB strives to support a more integrated and focused research agenda using multidisciplinary approaches to develop innovative and marketable technologies. The 

goal of this unique program is to make a ‘‘quantum’’ advance in healthcare by funding research on a specific project or projects that will translate into new technologies 

and modalities for the treatment, prevention and cure of disease or resolve a major 

health care problem within a reasonable time frame. In these ‘‘bench to bedside’’ 

partnerships, a team of interdisciplinary scientists will conduct collaborative research that will result in a prototype product that can be translated into clinical 

practice. 

TECHNOLOGIES TO IMPROVE HEALTH CARE DELIVERY

With the advent of miniaturized devices and wireless communication, the way in 

which doctors care for patients has changed dramatically. Empowering clinicians to 

make decisions at the bedside, or the ‘‘point-of-care,’’ has the potential to significantly impact health care delivery and help address the challenges of health disparities. The success of such a shift relies on the development of portable diagnostic and 

monitoring devices for near-patient testing. The NIBIB has contributed to advances 

in this area by funding the development of sensor and microsystem technologies for 

point-of-care testing. These instruments combine multiple analytical functions into 

self-contained, portable devices that can be used by non-specialists to detect and diagnose disease, and can enable the selection and monitoring of optimal therapies. 

These advances limit the reliance on submission of samples to centralized laboratories and will make results more readily available within minutes as opposed to 

several hours or days, enabling clinicians to make decisions regarding treatment 
169 

when these decisions can have the greatest impact. An example under development 

at the NIBIB is a handheld system for the rapid detection and identification of bacteria which cause urinary tract infections. The research team anticipates this test 

could become available in the next two to three years. To further capitalize on these 

advances, the NIBIB is planning an initiative to support research on critical areas 

for the development of other hand-held, diagnostic devices. These systems could reduce the cost of health care, much as integrated electronics have reduced the cost 

of computing, and greatly simplify and improve patient delivery of care. 

NEXT GENERATION MINIMALLY-INVASIVE TECHNOLOGIES

Advances in imaging technologies have spurred new minimally-invasive procedures to accurately identify the site of disease and injury, provide tissue for a definitive diagnosis, administer treatment with minimal trauma, and monitor treatment 

responses. Image-guided interventions are not only more efficient in terms of time 

and cost, but their less invasive nature may result in fewer complications and less 

damage to tissue. For example, NIBIB investigators are developing new magnetic 

resonance imaging (MRI) techniques to detect and treat organ rejection noninvasively. The current standard for diagnosing and staging rejection is the biopsy, 

which is invasive, painful, and prone to sampling errors that can yield false negative 

results. The development of a non-invasive imaging-based method that can replace 

the biopsy is highly desirable. 

Over the next year, the NIBIB intends to expand its image-guided interventions 

program by supporting research on the development of technologies that allow the 

surgeon to visualize the patient seamlessly, in three-dimensional preoperative images; track intraoperative changes with real-time imaging; and restore a normal 

sense of touch through robotic tools with sensors for touch feedback, or haptics. This 

research may lead to new minimally-invasive surgical procedures with fewer complications, shorter hospital stays, and reduced costs. To plan for future initiatives 

in this area, the NIBIB recently organized an interagency retreat to identify high 

priority challenges that can serve as short- and long-term goals. Eight Federal agencies and nine NIH Institutes and Centers (ICs) participated in this retreat. 

SMEDICAL ROBOTIC

First generation surgical robots are already being installed in a number of operating rooms around the country. Although these robots can’t perform surgery on 

their own, they are certainly lending a mechanical hand. Robots are being used in 

medicine because they allow for unprecedented control and precision of surgical instruments and reduce trauma to the patient, dramatically improving surgical outcomes and lowering health care costs. Robots are also being used in rehabilitation 

as they provide considerable opportunities to improve the quality of life for physically disabled people. For example, one of the most common stroke disabilities is 

a paralyzed arm. The NIBIB and the National Institute of Child Health and Human 

Development are jointly funding the development of two robotic devices that could 

accelerate rehabilitation of patients with paralyzed arms and reduce the cost of 

physical therapy. These devices can also treat people who have experienced catastrophic events, such as war injuries resulting in limb loss. Testing with stroke patients is expected to begin this year using one device. 

Traumatic injury or neurological diseases can also significantly alter or impair the 

lifestyle of an individual. To help patients lead more productive lives, NIBIB scientists are developing a non-invasive brain-computer interface to provide both communication and control functions. By recording brain waves from the scalp and then 

decoding them, this system allows people to move a cursor to spell words, and even 

to control a robotic arm. Initial efforts to test this new technology in the field are 

underway. 

NANOTECHNOLOGY FOR DISEASE DETECTION AND DRUG DELIVERY

Detection of dormant metastatic tumor cells is a critical but elusive goal in cancer 

treatment. To find these cells, NIBIB researchers are developing non-invasive optical imaging techniques that are less costly and more accessible than MRI-based 

techniques and are free of the side effects associated with radioactive imaging 

agents. Microscopic or nanoscale ‘‘bubbles,’’ called polymerosomes, containing embedded fluorescent materials are the key to this new approach. These labeled bubbles are injected directly into a tumor and then imaged. Also in development are 

polymersomes that would deliver chemotherapy agents directly to a tumor. The surface of the bubble can carry a molecule that would bind to tumor cells, and its membrane would also hold fluorescent molecules for detection by optical imaging, with 

the chemotherapy ‘‘payload’ carried in the interior. One investigator has developed 
170 

a special device which improves drug release by ultrasonic fragmentation of the bubble. 

ENHANCED SUPPORT FOR NEW INVESTIGATORS

New investigators are the innovators of the future—they bring fresh ideas and 

technologies to existing biomedical research programs, and they pioneer new areas 

of investigation. Entry of new investigators into the ranks of independent, NIBIBfunded research is essential to the health of the biomedical imaging and bioengineering research enterprise. The NIBIB is specifically targeting new investigators for special funding consideration. This proved to be quite successful in the first 

year of this policy, and a continuation of this program is planned. 

TRAINING FOR THE FUTURE

An important goal of the NIBIB is to train a new generation of researchers 

equipped to meet the modern needs of interdisciplinary and transdisciplinary research. Researchers trained in biomedical imaging and bioengineering must be able 

to demonstrate technical competency in multiple fields as well as the ability to think 

independently, communicate ideas effectively, work in teams, and contribute to a 

strong vision that transcends a narrow discipline. To this end, the NIBIB will work 

with the community to develop new programs that cross-train research scientists in 

the biological and quantitative sciences. For example, the NIBIB’s Research Supplements to Promote Clinical Resident Research Experiences program has been very 

successful. This novel training mechanism is designed to serve as a ‘‘first step’’ in 

attracting outstanding clinicians into research careers related to the mission of the 

NIBIB by providing a one to two-year research opportunity during residency training. 

The NIBIB has also developed several public and private collaborations to catalyze research at this interface. For example, the NIBIB and the Howard Hughes 

Medical Institute partnered in a novel public-private partnership to stimulate the 

development of new interdisciplinary graduate training programs that integrate the 

physical, quantitative, and engineering sciences with the life sciences. This program 

will train a new generation of researchers, equipped to meet the challenges of the 

21st Century. 

NIH ROADMAP FOR BIOMEDICAL RESEARCH

An overarching goal of the NIH Roadmap is to facilitate the development of broadbased innovative, novel and multidisciplinary science and technology that has the 

potential to further advances in health care. This goal is well aligned with the 

NIBIB mission and is actively supported on a number of fronts. For example, over 

the last year NIBIB has been the lead Institute in a Roadmap initiative entitled 

‘‘Innovation in Molecular Imaging Probes.’’ Molecular imaging approaches can be 

used to study cellular events and biochemical abnormalities. The major roadblocks 

to in vivo clinical applications of molecular imaging are the poor sensitivity and potential toxicity of the current probes. This initiative supports research programs 

that will circumvent these roadblocks. 

NIH BLUEPRINT

The Neuroscience Blueprint is a framework designed to enhance cooperative activities among the NIH ICs that support research on the nervous system. During 

the last year, NIBIB contributed to the development of a number of initiatives, leading or participating in three project teams. These initiatives aim to support research 

and development of imaging technology for high resolution imaging of neural activity that is reflected in electrophysiological signals; and to develop a framework to 

address the critical need for neuroimaging data and software tools sharing and integration. The NIBIB also participated in the development of neuroscience training 

initiatives. 

PREPARED STATEMENT OF DR. GRIFFIN P. RODGERS, ACTING DIRECTOR, NATIONAL

INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

Mr. Chairman and Members of the Committee: I am pleased to present the fiscal 

year 2007 President’s budget request for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) a sum of $1,844,298,000, which includes 

$150,000,000 for the Special Appropriation for Research on Type 1 Diabetes through 

Sec. 330B of the Public Health Service Act. The NIDDK transfers some of these 

funds to other institutes of the NIH and to the Centers for Disease Control and Pre-
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1 National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics fact sheet: general information and national estimates on diabetes in the United States, 

2005. Bethesda, MD: U.S. Department of Health and Human Services, National Institute of 

Health, 2005 2The National Kidney Foundation http://www.kidney.org/kidneyDisease/. Accessed February 

14, 2006. 3 Hogan P, et al, Diabetes Care 26:917–932, 2003. 

vention (CDC). Adjusted for mandatory funds, this is an decrease of $10,627,000 

from the fiscal year 2006 enacted level of $1,854,925,000 comparable for transfers 

proposed in the President’s request. 

The NIDDK supports research to combat a wide range of chronic health problems, 

including diabetes and other endocrine and metabolic diseases; diseases of the digestive system, kidneys, urinary tract; and blood; nutritional disorders; and obesity. 

Through vigorous research, initiated both by investigators and by the Institute, the 

NIDDK will continue to elucidate the fundamental biology underlying health and 

disease. We are pursuing new strategies for disease diagnosis, treatment, and ultimately, prevention and cure. 

PREEMPTING CHRONIC DISEASES AND THEIR COMPLICATIONS

Chronic diseases pose some of the greatest health challenges to the Nation today. 

These diseases and their symptoms range in severity, but are often debilitating and 

sometimes fatal. Some impair fundamental body processes, such as metabolism, 

while others target the kidneys, liver, and other vital organs and systems. Though 

their causes and ultimate effects on health may differ, chronic diseases share the 

grim features of constant affliction and impaired quality-of-life. The burden of 

chronic diseases within NIDDK’s research purview is immense. Recent estimates 

using national health survey data reveal that diabetes (type 1 and type 2) affects 

nearly 21 million Americans.1 About 20 million Americans have chronically impaired kidney function, which places them at increased risk for irreversible kidney 

failure (end stage renal disease) and death.2 Digestive diseases, such as irritable 

bowel syndrome (IBS), inflammatory bowel disease (IBD), and liver and biliary diseases, wreak havoc with people’s lives. ‘‘Benign’’ diseases of the bladder and lower 

urinary tract, including urinary incontinence and prostate diseases, can be devastating. These chronic diseases also exact a heavy economic toll. For example, the 

healthcare and indirect costs of diabetes and its complications totaled $132 billion 

in 2002.3 The painful, debilitating symptoms of IBS and the bladder disease interstitial cystitis (IC) result in loss of work and increased medical costs. Costs of chronic 

diseases that strike the digestive system, kidneys, and bladder run into the tens of 

billions of dollars. 

The tremendous human and monetary costs of chronic disease are matched only 

by the extraordinary interventions often needed just to preserve life. Organ transplantation and kidney dialysis are but two examples. Although these are extreme 

measures for the sickest patients, they represent some of the victories achieved by 

biomedical research in reducing morbidity and mortality from advanced chronic disease. Our goal is to improve these treatments, while we simultaneously seek prevention strategies. For example, whole liver transplantation from deceased donors is a 

successful treatment for liver failure, but is limited by a shortage of donor organs. 

A new NIDDK clinical network (A2ALL) is maximizing this treatment option in 

adults by assessing the safety and outcomes, for both patients and donors, of new 

procedures that use partial liver transplants from living donors—thereby increasing 

the potential donor pool. Similarly, we are addressing the diminished quality-of-life 

and low five-year survival rates under current dialysis treatment, which is typically 

administered three times weekly. A new clinical trial will evaluate the effectiveness 

of daily dialysis. 

IMPORTANCE OF EARLY INTERVENTION

For persons already suffering from chronic disease, improved treatments will have 

great benefits. However, it is imperative that researchers find ways to intervene at 

the earliest possible stage of a disease. The goals for such research are to: (1) identify and use biological information, such as ‘‘biomarkers,’’ that can predict an individual’s susceptibility to disease, disease progression, or disease complications— 

thereby enabling more tailored use of interventions; (2) find the most effective interventions to preempt the onset or course of disease; and (3) ensure that these predictive tools and interventions can be precisely targeted for the benefit of patients. 

New advances in science, technology, and public health research are making these 

goals realizable, with the prospect of significant improvements in public health. Ex-
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4Flegal KM et al, JAMA 2002;288:1723–1727. 

amples of potential research payoffs include hepatitis C and diabetes complications. 

In the United States, hepatitis C infection affects an estimated 4 million people and 

is the leading cause of both liver cancer and liver failure due to end-stage cirrhosis. 

Patients who do not respond to standard medical therapy with interferon and 

ribavirin are at high risk of developing these severe health problems. Ideally, physicians should be able to predict likely ‘‘non-responders’’ to current therapy and those 

at risk for disease progression, and then tailor interventions to them. While this is 

not yet possible, ongoing studies will help to move the field forward, including a 

major clinical trial (HALT–C) aimed at preventing end-stage cirrhosis and lowering 

risk of liver cancer in ‘‘non-responders’’ with advanced disease. 

Likewise, physicians would welcome new, precise methods for tailoring interventions to individuals with diabetes so as to reduce complications in those at greatest 

risk, while also lessening treatment burden. Landmark clinical trials have demonstrated that tight control of blood sugar levels in type 1 diabetes patients significantly reduces their overall risk of eye, kidney, nerve, and cardiovascular disease. 

Unfortunately, current therapies to achieve tight control also increase the risk of potentially life-threatening bouts of low blood sugar. If a simple method existed to 

identify patients who could tolerate ‘‘looser’’ control of blood sugar levels without an 

increased risk of complications, then therapy could be tailored accordingly. Pinpointing the underlying causes of diabetes complications will pave the way to such 

targeted interventions. 

Developing a more personalized approach to medical therapy requires a robust 

toolkit forged from research advances. Therefore, the NIDDK is continuing with new 

initiatives to accelerate translation of fundamental research into clinically useful applications. For example, we want to be able to stop early scarring of the liver and 

kidney—known as fibrosis—before it ignites a series of events leading to irreversible 

organ failure. The NIDDK is fostering new, non-invasive imaging methods to reveal 

fibrosis. Such techniques will enable physicians to diagnose, monitor and treat liver 

and kidney disease more effectively. For diseases within the NIDDK mission, we are 

also committed to the discovery of biomarkers—factors, such as molecules, that can 

be measured and used to monitor a patient’s disease or response to therapy. A new 

translational initiative encourages research to develop and validate these biomarkers for clinical use. 

Critically important for predicting and preempting chronic diseases—such as polycystic kidney disease (PKD), focal segmental glomerulosclerosis (FSGS), kidney 

stones, IC, IBD, IBS, non-alcoholic steatohepatitis (NASH), and hepatitis B and C— 

is a thorough understanding of their natural history. For example, discovery of PKD 

genes has led to insights into the molecular defect underlying most cases of this disease. Promising new medical therapies are being explored to prevent or reduce cyst 

formation, and new trials (HALT–PKD) will now test approaches for preventing progressive kidney damage. In the kidney disease FSGS, we do yet know all the causative factors, but a better understanding of FSGS progression has enabled the 

NIDDK to undertake a trial of therapies to prevent or delay kidney failure in patients. A new international patient registry should increase our understanding of inherited causes of calcium oxalate kidney stones. The cause(s) of the bladder disease 

IC remains unknown, but studies of a promising biomarker from urine may lead to 

improved diagnosis and treatment for patients, as well as to new therapeutic options. 

Our efforts in digestive diseases will be guided by a long-range strategic research 

plan to be developed by a new National Commission, as well as by a recently completed Liver Disease Action Plan. We are already making progress on several fronts. 

In IBD, studies of a recently identified Crohn’s disease susceptibility gene are pointing the way to new therapeutic options. Researchers are exploring the multiple 

physical and cognitive factors that appear to play a role in IBS. A new clinical research network is studying the biological basis of progression from a less serious 

form of non-alcoholic fatty liver disease to the fatty liver, liver inflammation and 

scarring of NASH, and will test strategies to prevent disease progression in both 

adults and children. Studies of the hepatitis B virus continue in order to optimize 

treatment options. A new system to replicate (‘‘grow’’) hepatitis C virus in the laboratory will significantly enhance research to test potential therapeutic targets and 

open the door to vaccine development—complementing ongoing trials such as 

HALT–C. 

Strikingly, research has revealed that obesity, with its comorbidities, is at the 

nexus of many chronic diseases. The high prevalence of obesity in the U.S. population, with nearly 31 percent of adults affected,4 bears directly on the millions affected with chronic diseases. Obese individuals are at increased risk of type 2 diabe-
173 

tes, and obesity is linked to increased risk of NASH, as well as of ESRD via type 

2 diabetes and high blood pressure. However, not all overweight and obese individuals will develop obesity-associated diseases. Age, gender, race, ethnicity, socio-economic status, and individual genetics are among the many factors that may influence risk. Through initiatives developed by the NIH Obesity Task Force and 

through NIDDK-led efforts, we are encouraging research studies to promote prevention and to identify which subsets of obese individuals are at risk for developing 

particular comorbidities, and, in turn, to tailor interventions accordingly. 

Recent data offer promise that we may be able to stem the tide of obesity-related 

health problems. For example, analyses by the United States Renal Data System 

(USRDS) indicate that overall incidence rates of ESRD have stabilized in the United 

States, following a 20 year period of annual increases. This finding suggests that 

there has been a successful translation into medical practice of research-based 

knowledge important to preventing ESRD—the use of medications (ACE inhibitors) 

and the benefits of controlling blood sugar and blood pressure levels. Unfortunately, 

this positive result has not yet been seen across the entire U.S. population, in that 

ESRD continues to affect minority groups disproportionately. The National Kidney 

Disease Education Program (NKDEP) has a major campaign aimed at reducing the 

burden of kidney disease in African Americans, for whom the risk factors of high 

blood pressure, diabetes, and a family history are dangerous red flags. Through its 

working groups, the program is also promoting the standardized, routine reporting 

of serum creatinine—an indicator of kidney function. Use of this simple approach 

can facilitate early detection and treatment of impending or active chronic kidney 

disease in patients. Along the same lines, the National Diabetes Education Program 

(NDEP) has translated into a multi-faceted campaign for multiple audiences the impressive results of the Diabetes Prevention Program (DPP) clinical trial. This trial 

demonstrated that lifestyle changes—relatively moderate weight loss and increased 

physical activity—can reduce the risk of type 2 diabetes by 58 percent in persons 

at risk for the disease. 

Such hopeful results spur our efforts to further reduce the health burden of these 

chronic conditions through interventions to prevent obesity as early as possible. Prevention research needs to address the alarming rise in rates of pediatric overweight 

and obesity nationwide over the past three decades. A recent study indicates that 

approximately two million American adolescents have a prediabetic condition (IFG) 

strongly linked to obesity and overweight. Children and adolescents are being increasingly diagnosed with type 2 diabetes, NASH, and other obesity-associated conditions once found mainly in adults. To address key points of vulnerability early in 

life, the NIDDK is spearheading several initiatives, such as defining mechanisms by 

which maternal obesity and diabetes during pregnancy affect the future risk of obesity and other chronic diseases in offspring. Another initiative is focused on finding 

ways to prevent or manage weight gain in children. Moreover, the new ‘‘HEALTHY’’ 

trial will investigate whether a concerted, integrated program in middle schools will 

help reduce the prevalence of obesity-related harbingers of type 2 diabetes by improving cafeteria lunches, vending machine offerings, and physical education and 

promoting behavioral change. The tremendous success of the intensive lifestyle 

intervention for adults in the Diabetes Prevention Program provides hope that the 

HEALTHY trial may do the same for children. 

The Nation’s investment in NIH-funded research offers enormous benefits, particularly the opportunity to preempt disease and reduce its lifelong costs, both 

human and economic. To this end, the NIDDK is harnessing new technologies, 

maximizing research investments, and capitalizing on new opportunities to achieve 

early, effective intervention for the many chronic diseases within its mission. Thank 

you, Mr. Chairman. I would be pleased to answer any questions that the Committee 

may have. 

PREPARED STATEMENT OF DR. JOHN RUFFIN, DIRECTOR, NATIONAL CENTER ON

MINORITY HEALTH AND HEALTH DISPARITIES

Mr. Chairman and Members of the Committee: I am pleased to present the President’s budget request for the National Center on Minority Health and Health Disparities (NCMHD) for fiscal year 2007, a sum of $194,299,000, which represents a 

decrease of $1,106,000 over the comparable fiscal year 2006 appropriation. 

The overall health of the general American population has improved; yet as a Nation we continue to be challenged by disparities in health among racial and ethnic 

minority and other health disparity populations. There continues to be a disproportionate burden of illness, disability and premature death resulting from diseases 
174 

and health conditions such as cancer, cardiovascular disease, HIV/AIDS, stroke, obesity, mental illness and diabetes, in these communities. 

The cause of health disparities is multi-factorial in nature. The complexity of 

health disparities merits a strategic, innovative, and multi-faceted attack. Genes, biology, culture, race environment, socioeconomics, and health behaviors all contribute 

to this complex public health crisis. Biomedical research is essential in transforming 

the health of this Nation. In order to have the greatest impact on improving the 

health of America’s underserved populations, at NIH, we believe a new biomedical 

research paradigm is needed—one that is predictive, personalized and preemptive. 

We need a well-coordinated, interdisciplinary effort involving traditional as well as 

non-traditional partners to get to the crux of the health disparities crisis. 

The National Center on Minority Health and Health Disparities was established 

in 2000 to lead the Federal effort in health disparities research, research capacity 

building, and outreach. The NCMHD has always recognized the significance of partnerships in resolving health disparities. Our programs embody a strategy that emphasizes our efforts to build a biomedical research enterprise that is diverse, predictive, personalized, and preemptive. 

The NCMHD is committed to training a diverse biomedical research workforce to 

examine issues relevant to the disparities in health of America’s rapidly increasing 

racial and ethnic minority populations. More than 600 promising research scientists 

across the country have received NCMHD loan repayment awards to conduct health 

disparities research and clinical research. Institutional capacity building has been 

an important area of focus. Through our endowments and research infrastructure 

program, we have funded almost 40 academic institutions—ore than half being minority-serving institutions. The funding is helping to equip the institutions, their 

faculty and students to engage in avant-garde biomedical research and training. Another integral element of our strategy is community participation. Our aim is to empower the community to address its own health problems. Our communities should 

include individuals other than patients, who must be actively engaged in research 

intervention and ultimately the translation and dissemination of research results 

into practical community tools. 

Advancements in science and technology offer hope for the future. The NCMHD 

has supplied more than 100 individuals, institutions, and small businesses with resources to conduct research to help answer some of the perplexing issues in health 

disparities. NCMHD is one of the few NIH Institutes or Centers (IC) that focuses 

on populations and not specific diseases or health conditions. Consequently, we have 

had the unique opportunity of partnering with all of the ICs over the past five years 

in our quest to eliminate health disparities. Our partnerships and our programs 

have allowed us to support research into many of the diseases and health conditions 

affecting racial/ethnic minority and other health disparity populations. It is through 

these programs and partnerships, that the NCMHD has been able to have far reaching effect in improving the health of the Nation’s health disparity populations. We 

have made progress, but there is much more to be achieved. 

HEALTH DISPARITIES RESEARCH AGENDA

A national health disparities research agenda is fundamental in eliminating 

health disparities. Healthy People 2010, the prevention strategy for the Nation, 

identified a number of health objectives to be achieved over a 10-year period. The 

elimination of health disparities among different segments of the population in the 

United States is one of the goals. We have five years left as a Nation to demonstrate 

how far we have come in attaining that goal. The NIH through the leadership of 

the NCMHD has been a principal player in advancing the goals of Healthy People 

2010. The NCMHD coordinates the development of the evolving NIH health disparities research agenda—the NIH Health Disparities Strategic Plan. The Plan represents the trans-NIH health disparities vision and strategy. Through the Strategic 

Plan, the NIH can aggressively address health disparities by fostering pioneering 

partnerships and initiatives. The NCMHD, through the Institute of Medicine (IOM), 

initiated the five-year evaluation of the NIH Health Disparities Strategic Plan. The 

NCMHD, in collaboration with NIH leadership and the Secretary of Health and 

Human Services will address the recommendations of the IOM report in implementing and reshaping the NIH health disparities research agenda. 

NCMHD HEALTH DISPARITIES EFFORTS

At the NCMHD, we are working to build an inclusive, collaborative, and adaptive 

biomedical and behavioral research enterprise to identify innovative diagnostics, 

treatments, and preventive strategies that will eliminate health disparities. 

NMCHD activities have been numerous and far-reaching. The newest NCMHD ini-
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tiative is the Community-Based Participatory Research (CBPR) Program, which 

supports 25 institutions nationwide. The CBPR exemplifies a predictive, personalized and preemptive approach to eliminating health disparities. It is a three-part 

program that engages the community in all phases of the research process and is 

directed to a specific disease/health condition in a particular minority population. 

It starts with a three-year planning grant, followed by a five-year grant to conduct 

intervention research, and concludes with a three-year grant to disseminate the research information. The CBPR is a novel approach for the biomedical research enterprise, and we anticipate its potential in addressing health disparities through 

projects such as: Project GRACE: A Participatory Approach to Address Health Disparities in HIV/AIDS among African American Population; Partnership to Overcome 

Obesity in Hawaii; Project AsPIRE (Asian American Partnership in Research); The 

Healing of the Canoe (is aimed at planning, implementing and evaluating a community-based and culturally competent intervention to reduce health disparities and 

promote health in the Suquamish Tribe reservation community); and Partnership 

for a Hispanic Diabetes Prevention Program in Washington. 

The Centers of Excellence Program, ‘‘Project EXPORT’’ has been key in leading 

our effort in supporting the advancement of medical research and the transformation of the health care system. The program is creating new partnerships to 

enable institutions at all levels of capability to maximize their health disparities research, research training and community outreach efforts. The 73 Project EXPORT 

grantees have had a tremendous influence on creating more than 100 unique partnerships focused on health disparities. We have created an array of partnerships 

with entities such as hospitals; tribal groups; health plans; health centers; community and faith-based organizations; civic and non-profit health organizations; and 

local, city, and state governments. Biomedical research is important in understanding the underlying causes of health disparities, and how to prevent, diagnose 

and treat disease and disability. The research conducted by our Centers of Excellence will help to increase that understanding through projects such as: Perceived 

Discrimination in Healthcare among American Indian/Alaska Natives; Religious 

Outlook on Organ and Tissue Sharing; Inflammation and Asthma; Impact of Coronary Heart Disease Risk Perception on Health Behaviors and Physical Activity Assessment in Multi-Ethnic Women. 

The NCMHD Loan Repayment Programs support the goals of the new NIH Pathway to Independence Program by increasing the number of qualified health care 

professionals who conduct health disparities and clinical research. The programs 

promote a diverse and strong scientific workforce. Since its establishment, the Loan 

Repayment Program has made more than 600 new awards to researchers in research disciplines such as epidemiology, pharmacology, linguistics, etiology, health 

policy, and behavioral science. The program is fulfilling its Congressional intent 

with the majority of award recipients being from a health disparity population. The 

NCMHD is training research scientists and health professionals not only to deal 

with health disparities on the domestic level, but also globally. Through the Minority Health and Health Disparities International Research Training Program 

(MHIRT), 24 academic institutions have developed international training opportunities in health disparities research for faculty and students. MHIRT participants will 

be exposed to research areas including cancer epidemiology, reproductive biology, 

parasitology, and ethnopharmacology in countries such as Ethiopia, Ghana, Jamaica, Dominican Republic, Australia, and Spain. 

The NCMHD commitment to enhancing research capacity at academic institutions 

is best demonstrated through its Research Endowment Program and its Research 

Infrastructure in Minority Institutions (RIMI) Program. The RIMI program is building research capacity in 21 predominantly minority-serving academic institutions. 

The NCMHD provides endowment grants to eligible institutions to build minority 

health and other health disparities research and training capacity. The Endowment 

program has funded 16 institutions to strengthen teaching programs in the biomedical and behavioral sciences; establish endowed chairs and programs; obtain 

state-of-the-art equipment for instruction and research; and enhance the recruitment and retention of student and faculty from health disparity populations. 

RESEARCH COLLABORATIONS

The health disparities phenomenon is almost incomprehensible until it is humanized. Hurricane Katrina demonstrated the underlying national health crisis that 

continues to plague America’s racial and ethnic minority and low-socio economic 

communities. In some cases, evacuees received medical treatment for the first time 

for chronic and life-threatening diseases, such as hypertension, cardiovascular diseases, diabetes, and mental health disorders. 
176 

Community involvement and partnerships are critical to redress the devastation 

experienced by individuals caught in the path of Hurricane Katrina. The NCMHD 

is collaborating with the HHS Office of Minority Health on a HHS $12 million initiative to bring desperately needed health care services, information, and hope to 

racial and ethnic minority populations in the Gulf Coast region. The NCMHD provided $5.2 million in funding to support that initiative. Our Centers of Excellence 

have also been mobilized to participate in the initiative to create a Regional Coordinating Center to build a research infrastructure for on-going efforts to eliminate 

health disparities in the hurricane-ravaged communities. Such an infrastructure 

would integrate research-based academic facilities, public health, primary care, and 

specialty care officials to engage in innovative approaches to relief activities, including developing and testing culturally relevant telemedicine response to mental 

health needs, and other acute and chronic diseases; instituting electronic health 

records for individuals in the region through partnerships with academic experts in 

practice-based research; and establishing effective community-based screening and 

surveillance systems to monitor health needs of individuals evacuated from hurricane-ravaged communities, as well as those returning to communities as they are 

re-built, with a special focus on exacerbations of existing health disparities. 

The NCMHD Visiting Faculty Program is a new program that is assisting researchers displaced by the hurricane. The program will help to bring displaced scientists who were employed at institutions in the Gulf Coast states to the NIH, so 

that they can continue their research efforts. 

CONCLUSION

During its initial five years the NCMHD has strived to be inclusive, creative, and 

adaptable to changing circumstances. The programs highlighted are but some examples of what is being done to eliminate health disparities. We need to build on these 

successes and further our activities. Toward this end, the NCMHD will sustain and 

expand its primary strategies. Research capacity building will continue to extend beyond academia to involve community and faith-based organizations, individuals, and 

businesses at the local and grassroots level. Training and the diversification of the 

health, scientific, and technological workforce will remain key areas of focus in developing innovative projects. Prevention, treatment, cultural competency, and 

healthcare delivery for urban and rural communities will continue to be approached 

aggressively. 

Through our vision of the future embodied in the NIH Health Disparities Strategic Plan, the NCMHD renews its commitment to build a solid and diverse national 

biomedical research enterprise of individuals and institutions dedicated to eliminating health disparities. With our NIH Institute and Center collaborations and our 

partnerships with scientific institutions and community-based organizations across 

the Nation, the NCMHD will advance scientific discovery to ensure the health of 

all Americans. All citizens should have an equal opportunity to live long, healthy 

and productive lives. 

PREPARED STATEMENT OF DR. DAVID A. SCHWARTZ, DIRECTOR, NATIONAL INSTITUTE

OF ENVIRONMENTAL HEALTH SCIENCES

Mr. Chairman and Members of the Committee: I am pleased to present the President’s budget for the National Institute of Environmental Health Sciences (NIEHS) 

for fiscal year 2007, a sum of $637,323,000 which reflects a decrease of $3,809,000 

from the fiscal year 2006 appropriation. 

INTRODUCTION

As the Director of NIEHS, I am grateful for this opportunity to present our vision 

for the Institute and environmental health sciences. Our vision at NIEHS is to prevent disease and improve human health by using environmental sciences to understand human biology and human disease. Environmental agents contribute to many 

conditions of public importance, including cancer, neurodevelopmental disorders, 

autoimmune diseases, and chronic lung disease. While many of our investigators are 

focused on understanding the causes of disease, we are also involved in studies of 

susceptibility, basic mechanisms of disease, and identifying novel approaches to 

intervention and disease prevention. 

Recent NIEHS-supported research illustrates the range of our Institute’s science. 

In studying asthma, NIEHS scientists examined the mechanisms controlling the 

body’s own system for achieving balance between airway constriction and airway relaxation. They discovered a natural bronchodilator, deficient in asthmatics, that re-
177 

laxes the airway; absence of this enzyme in mice increases the development of allergen-induced asthma. In other work, investigators studied the role of supplements 

in preventing birth defects. While folate has been shown to prevent spina bifida, a 

defect in the spinal column, epidemiologists have now discovered that women who 

take folate supplements during pregnancy are at reduced risk of giving birth to a 

child with cleft lip and palate birth defects. Finally, NIEHS-supported studies have 

shown that short-term exposure to ozone can increase mortality rates. These studies 

demonstrated that a 10-part per billion (ppb) increase in the previous week’s ozone 

was associated with a significant increase in cardiovascular and respiratory mortality. 

CURRENT CHALLENGES

Today, we find ourselves at a critical junction where new tools and opportunities 

for substantial scientific achievement intersect with our growing understanding of 

cellular and molecular mechanisms by which environmental exposures exert their 

effects. Our challenge is to take advantage of these advances and to forge new frontiers to improve our nation’s health. To help ensure that the best opportunities are 

identified and funded, we have made several programmatic and scientific changes 

at the Institute since last April. Importantly, these changes are consistent with our 

strategic plan that we initiated ten months ago and have involved the efforts of 

many talented individuals across the country. Concurrently, we are engaged in developing critical partnerships to address areas of public health concern that involve 

the missions of multiple organizations. 

INTEGRATIVE RESEARCH ON HUMAN DISEASE

Environmental health science is not limited to an organ system, disease or population, but spans the full spectrum of human health and disease. The interdisciplinary nature of our work requires the right mix of specialists. As NIEHS increases 

its focus on common human diseases, interdisciplinary teams of scientists will be 

needed to integrate clinical, epidemiological, and toxicological research with basic 

mechanistic studies. To optimize the creation of these interdisciplinary research 

teams, I have begun a number of programmatic changes. I have created an Office 

of Translational Biomedicine that will re-focus the NIEHS intramural and extramural programs so that our basic research discoveries can be rapidly applied to improvements in human health. In our division of extramural research, I have initiated a new program, DISCOVER (Disease Investigation for Specialized Clinically 

Oriented Ventures in Environmental Research), that brings together extramural scientists with expertise in basic, clinical, and population-based research to focus on 

a disease related to environmental exposures. Among intramural investigators, I 

have developed a new program, the Director’s Challenge, that also supports multidisciplinary research teams to attack basic problems, like inflammation and 

oxidative stress, that can be induced by environmental exposures and can influence 

the development of many different diseases. I am re-engineering our Environmental 

Health Science Research Centers so that they include a clinical component in their 

research, thus enhancing the disease focus and relevance of these centers. I have 

also directed funds to build a new clinical research unit on campus so that our intramural research program can be integrated into human biology and human disease. 

RECRUIT AND TRAIN THE NEXT GENERATION

A more integrative approach to understanding complex human diseases will require innovative scientists with the type of training that can take advantage of new 

technologies and research opportunities. NIEHS has initiated a number of changes 

that address our future workforce needs. We have re-engineered our existing training programs so that we can better identify and encourage promising students at 

all levels to pursue careers in environmental health research. The existing T32 

training grants program will be broadened to include other training opportunities 

in interdisciplinary research and genetics and genomics. We will also train physician-scientists by expanding our MD, PhD training program and by supporting 

young investigators in their transition to early faculty positions (developed a K12 

training program. We have also instituted the Outstanding New Environmental Scientist, or ONES, award to help young, talented investigators make the transition 

from mentored to independent research. These grants will assist young scientists in 

launching innovative research programs focusing on problems of environmental exposures and human biology, human pathophysiology, and human disease by providing support for both the research and the start-up costs that are needed to establish a laboratory. 
178 

EXPAND COMMUNITY-LINKED RESEARCH

The likelihood of exposure to environmental agents increases in economically disadvantaged communities and is associated with an excess disease burden in these 

communities. The NIEHS traditionally supports research relevant to understanding 

those health disparities and community concerns. We will continue to support research, both domestically and globally, that can offer insights into how to reduce 

exposures and disease in these settings. We will also be involved in developing quick 

responses to emerging environmental health issues, such as arose in the aftermath 

of Hurricane Katrina, when NIEHS launched a website that used a Global Information System to assess environmental hazards caused by the storm, as well as coordinated a local team of physicians and support staff to deliver medical care. Beginning 

in fiscal year 2006, NIEHS is planning to support a research program to investigate 

the health consequences of Hurricane Katrina. This project will examine the role of 

genes, the environment, and gene-environment interaction in the exacerbation of 

airway disease from exposure to mold and microbial toxins in New Orleans following 

Hurricane Katrina. 

RE-EVALUATE PROGRAMMATIC INVESTMENTS

We have decided that investigator-initiated research needs to be prioritized at 

NIEHS and are rigorously re-evaluating other existing programs and approaches to 

determine if we need to re-conceptualize or eliminate some of these efforts. We have 

developed two new programs aimed at using environmental agents to understand 

basic mechanisms in human biology. One is the Epigenetics Initiative which explores intrauterine environmental and nutritional factors that can alter gene expression and generate developmental abnormalities or functional changes. The other is 

the Comparative Biology of Environmental Disease which uses novel ‘‘-omics’’ technologies and comparative biology approaches to study environmentally-relevant disease pathways. These studies will help us understand why people exposed to the 

same environmental stressors respond differently. Finally, we have reorganized the 

National Center for Toxicogenomics to insure a more timely and relevant product. 

In order to achieve these new programs and priorities, I have decided that the Comparative Mouse Genomics Centers Consortium has fulfilled its mission of infrastructure development and will not be re-competed. 

GENE, ENVIRONMENT AND HEALTH INITIATIVE—A NOVEL PARTNERSHIP

Currently, we have inadequate techniques to precisely measure environmental exposures. This situation is in marked contrast to the robust tools that have been recently developed for the fields of genetics and genomics. To be able to assess the 

role that environmental exposures and genetic variation play in the risk of developing disease, we simply need more robust tools to measure the environmental exposures and the biological responses to these agents. While these tools are absolutely 

vital in moving the field of environmental health sciences forward, these tools will 

be invaluable to investigators in all areas of biomedical research. To further this 

goal, the NIH, with the support of the Secretary, has developed the Gene, Environment and Health Initiative. Our goal in this initiative is to develop tools to precisely 

measure individual biological responses to changes in our environment, diet, and activity level so that we can understand the relationship between various environmental exposures and human health and disease. 

NIEHS STRATEGIC PLAN—A NEW OUTLOOK

The NIEHS recently embarked on a strategic planning exercise, the final version 

of which can be viewed on our website and will soon be distributed in hardcopy. 

This document represents the efforts of many scientists and advocacy groups. I have 

been gratified by the intense interest and involvement from citizens and scientists 

throughout the country. This document is truly a national plan that represents our 

collective wisdom of where environmental health sciences needs to go in order to 

reap full benefit of our investments and opportunities. Many of the suggestions have 

already been incorporated into our new programs and we will continue to design 

programs that are responsive to this plan. 

SUMMARY

The opportunities within environmental health sciences are greater than they 

have ever been. With our recent nationally supported strategic plan and the exciting 

partnerships that we are developing, it is my belief that environmental health 

sciences will continue to strengthen. With an improved relevance to major public 

health concerns, better technology for teasing out important environmental contrib-
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1 Comparison of preschool vision screening tests as administered by licensed eye are professionals in the Vision in Preschoolers Study. Ophthalmology 111(4):637–50, 2004. 

utors to disease, an integrated approach to research, and a re-energized workforce, 

I expect the NIEHS to provide many of the important scientific advances of the future. Ultimately, this knowledge will be used to reduce the burden of many important diseases both in this country and abroad. I would be happy to answer any questions you might have. 

PREPARED STATEMENT OF DR. PAUL A. SIEVING, DIRECTOR, NATIONAL EYE INSTITUTE

Mr. Chairman and Members of the Committee: I am pleased to present the fiscal 

year 2007 President’s budget request for the National Eye Institute (NEI). The fiscal 

year 2007 budget includes $661,358,000, which reflects a decrease of $5,398,000 

under the fiscal year 2006 enacted level of $666,756,000 comparable for transfers 

proposed in the President’s request. 

As the Director of the NEI it is my privilege to report on the progress laboratory 

and clinical scientists are making in combating blindness and visual impairment 

and about the unique opportunities that exist in the field of vision research. 

RETINAL DISEASES

Retinal diseases are a diverse set of sight-threatening conditions that include agerelated macular degeneration (AMD), diabetic retinopathy, retinopathy of prematurity, retinitis pigmentosa, Usher’s syndrome, ocular albinism, retinal detachment, uveitis (inflammation) and cancer (choroidal melanoma and retinoblastoma). 

Of these diseases, AMD is the most frequent cause of vision loss and legal blindness in older-age Americans, making it a research priority for the NEI. AMD causes 

degeneration of the macula, the central part of the retina that gives us fine, sharp 

visual detail. AMD is thought to result from the confluence of genetic predisposition 

and chronic exposure to environmental risk factors. 

On the genetic side of the equation, identifying subtle alterations in a gene or 

genes in AMD and other late onset diseases has been complicated by the fact that 

traditional genetic research strategies and tools are either inadequate or too cumbersome in their application. The development of more sophisticated genetic tools 

has enabled scientists to scan the entire human genome more quickly and efficiently. Using data from the Human Genome Project and the International HapMap 

Project, four different NEI supported laboratories identified a common variation in 

a gene called complement factor H (CFH) that accounts for an estimated 50 percent 

of the risk of developing AMD. 

The CFH protein regulates an inflammatory response that is typically triggered 

by infectious microbes. Alterations in the CFH gene are postulated to poorly regulate this response, leading to chronic, localized inflammation and ensuing damage 

to cells in the center of the retina, the macula, and its neighboring tissues. Inflammation is thought to play a role in many other common diseases such as Alzheimer’s 

disease, Parkinson’s disease, multiple sclerosis, kidney disease, stroke, and atherosclerosis. Although the cells, tissues, and molecular events in these diseases are diverse, they may share some common disease mechanisms that present an opportunity to cross pollinate findings from diverse research areas. 

The discovery of the CFH gene will allow researchers to create animal models and 

evaluate therapies that control chronic inflammation. The CFH gene also illustrates 

the potential of a new paradigm for medicine in the 21st century. This new paradigm holds that the practice of medicine should be preemptive, personal and predictive. The CFH gene presents the possibility to one day identify at-risk patients 

and intervene well before pathology is clinically detectable. 

STRABISMUS, AMBLYOPIA AND VISUAL PROCESSING

Developmental disorders such as strabismus (misalignment of the eyes) and amblyopia (commonly known as ‘‘lazy eye’’) are among the most common eye conditions 

that affect the vision of children. It is estimated that 20 percent of preschool children ages 3–4 have these and other treatable eye conditions.1

In an effort to identify children with treatable eye conditions, many states are developing guidelines for preschool screening programs. However, none of the commonly used vision tests have been evaluated in a research-based environment to establish their effectiveness. To address this issue, the NEI supported a large, multicenter study called the Vision in Preschoolers (VIP) Study to determine which tests 

and test conditions can effectively identify preschoolers in need of a comprehensive 
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2The Eye Diseases Prevalence Research Group: Prevalence of open-angle glaucoma among 

adults in the United States. Arch Ophthalmol 122:532–538, 2004. 3The Eye Diseases Prevalence Research Group: The prevalence of refractive errors among 

adults in the United States, Western Europe, and Australia. Arch Ophthalmol. 122:495–505, 

2004. 

eye exam. Previously VIP Study researchers found that in the hands of licensed eye 

care professionals, the best performing tests were able to detect 90 percent of children with the most severe visual impairments. This year, VIP Study investigators 

found that specially trained nurses and lay people can achieve results that are comparable to screenings performed by licensed eye care professionals. Given that most 

eye screening programs rely on lay people and nurses, this finding validates the effectiveness of this approach. 

GLAUCOMA AND OPTIC NEUROPATHIES

Glaucoma is a group of eye disorders that causes optic nerve damage that can 

lead to severe visual impairment or blindness. Elevated intraocular pressure (IOP) 

is frequently, but not always, associated with glaucoma. Glaucoma is a major public 

health problem and published studies find that the disease is three times higher in 

African Americans than in non-Hispanic whites.2

The defining event that leads to vision loss in all forms of glaucoma is the degeneration of retinal ganglion cells (RGC) in the back of the eye. These cells relay visual information to the brain through the optic nerve and their loss effectively severs 

the neural network that allows us to process visual information. However, little is 

known about the molecular events that result in RGC degeneration. Using high dose 

radiation and bone marrow rescue to explore inflammatory responses in an animal 

model of glaucoma, researchers unexpectedly discovered that this procedure prevents the loss of RGCs. The neuroprotection offered by this procedure was complete, 

highly reproducible, and lasting. Normally, by 12–14 months, these glaucoma susceptible mice have complete RGC loss. At 14 months, treated mice had no detectable 

signs of disease. Although the mechanism that offers neuroprotection is not yet 

known, researchers speculate that it is due to radiation, because the transferred 

bone marrow was genetically identical to the original bone marrow the mice were 

born with. This highly novel treatment protocol offers a tool to understand 

neurodegeneration and, with refinement, could have important implications for the 

treatment and prevention of neurodegenerative diseases. 

CORNEAL DISEASES

The cornea is the transparent tissue at the front of the eye. Corneal disease and 

injuries are the leading cause of visits to eye care professionals, and are some of 

the most painful ocular disorders. In addition, approximately 25 percent of Americans have a refractive error known as myopia or nearsightedness that requires correction to achieve sharp vision; many others are far-sighted or have astigmatism.3

Inflammation is a common immune response to injury and infection in the body. 

In the cornea, however, inflammation can cause extreme discomfort and result in 

vision loss. Nonetheless, the cornea retains a remarkable capacity for wound repair 

while actively suppressing an inflammatory response. Scientists have recently discovered that two lipids, lipoxin A4 (LXA4) and docosahexaenoic acid-derived 

neuroprotectin D1 (NPD1), are formed in the cornea and act as anti-inflammatory 

agents during corneal infection and wound healing. Topical treatment with LXA4

and NPD1 in mice with corneal injuries increased the rate of tissue repair and inhibited inflammation without impairing the recruitment of key immune leukocytes, 

which are normally associated with inflammation, into the wounded tissue. Moreover, a transgenic mouse that lacks these lipids exhibited delayed wound healing 

and attenuated leukocyte recruitment. The identification of these anti-inflammatory 

lipids in the cornea and their enhancement of wound healing by topical application 

suggest their use as therapeutic agents to overcome aberrant and damaging inflammatory responses in the eye. 

CATARACT

Cataract, an opacity of the lens of the eye, interferes with vision and is the leading cause of blindness in developing countries. In the United States, cataract is also 

a major public health problem. The enormous economic burden of cataract will worsen significantly in coming decades as the American population ages. 

The lens is a dense, compact structure containing two cell types: metabolically active epithelial cells and quiescent fiber cells. Throughout the life-time of an individual, the lens carries out a process of continued growth with epithelial cells divid-
181 

ing and differentiating into fiber cells. During this process, the emerging fiber cells 

become denuded of organelles such as the nucleus and mitochondria. This process 

in part helps the lens achieve the high transparency needed for clear vision. Scientists have previously found that the lens uses proteins involved in a biological 

process called programmed cell death or apoptosis to rid lens fiber cells of their 

organelles. This past year, vision researchers have discovered the biologic process 

that regulates apoptosis such that it allows for the elimination of organelles without 

resulting in cell death. 

The process is termed Apoptosis-related Bcl-2 and Caspase-dependent (ABC) differentiation. In this process, a number of proteins that normally lead to cell death 

such as caspases—proteins that break-down internal cellular structures—are expressed to denude organelles. The caspase proteins are balanced by the simultaneous induction of pro-survival molecules such as bcl-2, a protein that binds to cell 

death proteins and inhibits further damage or death to fiber cells. The discovery of 

ABC differentiation in the lens will allow researchers to better understand lens cell 

renewal and determine whether faulty mechanisms in this process might lead to 

cataract formation. 

NIH ROADMAP

A goal of the NIH Roadmap Nanomedicine Initiative is to characterize quantitatively the molecular scale components or nanomachinery of cells and to precisely 

control and manipulate these molecules and supramolecular assemblies in living 

cells to improve human health. The NEI has a leadership role in implementing the 

NIH Roadmap Nanomedicine Initiative. Under this initiative, a Request for Applications (RFA) was prepared to award Nanomedicine Center Concept Development 

Awards. These concept development awards were created to allow applicants time 

and resources to develop the concept for a Nanomedicine Center that would address 

various issues in nanomedicine including, biomolecular dynamics, intracellular 

transport, and protein-protein interactions. Understanding these fundamental biologic processes at the nanoscale level will allow scientists to engineer molecular 

structures, assemblies, and organelles for treating diseased or damaged cells and 

tissues. Of the applications, four Nanomedicine Centers were awarded in fiscal year 

2005. The Centers will be dedicated to understanding the nanobiology that underlies 

protein folding machinery; ion channels and ion transport proteins; synthetic signaling and motility systems; and mechanical biology. The NIH expects to fund additional Nanomedicine Centers in fiscal year 2006. The Nanomedicine Initiative will 

also benefit eye research in a more direct way. Current NEI grantees are exploring 

the use of nanotechnology to assist in corneal wound healing and drug delivery to 

the retina. Increased support of nanomedicine through the NIH Roadmap will undoubtedly speed progress in these areas. 

NIH NEUROSCIENCE BLUEPRINT

The NIH Neuroscience Blueprint is a collaborative effort among 15 NIH institutes 

and centers to accelerate the pace of discovery and understanding in neurosciences 

research. In an effort to better understand all elements of the nervous system, the 

Blueprint will focus on the development of tools and resources that will facilitate 

research on the processes of development, neurodegeneration, and plasticity that underlie the health and disorders of the nervous system. One of the approaches to develop these tools and resources is a cellular level approach to discovering the key 

molecules involved in nervous system function. There is still a need to identify the 

location, the developmental timing, and the cellular function of most of the genes 

and proteins expressed in the brain. Mapping of the neurogenome is being conducted by creating and analyzing transgenic mice to map gene expression and activity to different cell types and regions of the mouse central nervous system. The NEI 

component of this effort will be to ensure that the genes involved in neurons of the 

complete visual system are included in the neurogenome map. 

Mr. Chairman, this concludes my prepared statement. I would be pleased to respond to any questions you or other members of the committee may have. 

PREPARED STATEMENT OF DR. STEPHEN E. STRAUS, DIRECTOR, NATIONAL CENTER

FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE

Mr. Chairman and Members of the Committee: I am pleased to present the President’s fiscal year 2007 budget request for the National Center For Complementary 

And Alternative Medicine (NCCAM). The fiscal year 2007 budget includes 
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$120,554,000, a decrease of $911,000 over the comparable fiscal year 2006 appropriation of $121,465,000. 

NCCAM has made significant progress in discovering the potential of complementary and alternative medicine (CAM) to prevent and treat disease. During NCCAM’s 

first 7 years, the Center has formed a research enterprise that addresses the challenges of conducting CAM research as well as training investigators, conducting outreach, and facilitating the integration of proven CAM therapies into the health care 

that Americans receive. 

SETTING THE COURSE

Through national surveys, we know that two-thirds of Americans are using some 

form of CAM each year. We are gaining understanding of which Americans use the 

various CAM modalities and for which health purposes. These patterns of CAM use 

will inform NCCAM’s research priority setting in fiscal year 2007, along with guidance from two key documents: 

—The NCCAM Strategic Plan for 2005–2009 (developed with input from the public and scientific and medical communities nationwide); and 

—The Institute of Medicine’s 2005 report, ‘‘Complementary and Alternative Medicine in the United States.’’ 

In fiscal year 2007, NCCAM will again collaborate with the Centers for Disease 

Control and Prevention to support the National Health Interview Survey to capture 

changes in trends of the American public’s use of CAM. 

FURTHERING THE RESEARCH MISSION

Seven years of NCCAM investments in CAM research translate to the support of 

more than 1,200 projects (in research, training, and career development) at over 260 

U.S. institutions. There has been a 20-fold increase in the number of CAM papers 

published in leading scientific journals by NCCAM grantees. In fiscal year 2007, 

building upon this strong foundation, NCCAM plans to further enhance CAM research in the following areas. 

A Flourishing Centers Program 

NCCAM has expanded and refined its approach to research centers. As a result, 

the Center now has a diverse cadre of multidisciplinary research centers at conventional and CAM institutions nationwide. 

—Centers of Excellence for Research on CAM.—Six centers with outstanding research records direct teams of CAM and conventional investigators to explore, 

using cutting-edge technologies, how CAM therapies may work. 

—Developmental Centers for Research on CAM.—Scientists and practitioners at 18 

CAM and conventional institutions have forged research partnerships. In fiscal 

year 2007 there will be new Phase I developmental centers for CAM institutions 

just launching programs of research, and Phase II developmental centers for 

CAM institutions prepared to undertake more sophisticated research studies. 

—International Centers for Research on CAM.—Two centers support U.S. investigators who collaborate with experts in the traditional medical systems of their 

own countries, building research expertise and capacity abroad and providing 

foreign researchers with valuable experience in navigating the NIH grants system. 

—Botanical Research Centers.—Seven dietary supplement research centers focusing on studies of botanical products are funded by NCCAM and the NIH Office 

of Dietary Supplements. Research conducted by these centers will advance the 

scientific base of knowledge about the safety, effectiveness, and mechanisms of 

action of botanicals. 

Studies of Herbals and Other Dietary Supplements 

Herbals and other dietary supplements are widely used by the American public 

and they are a research priority for NCCAM. Studying botanicals, however, has presented special research challenges related to product characterization, standardization, and dosage. With the advice of experts in herbal medicine and leaders of the 

dietary supplement industry, NCCAM is improving product consistency for research 

studies and thus increasing the probability that the studies NCCAM funds will yield 

accurate findings. 

In this regard, the Center has developed research-quality cranberry products to 

use in studies of urinary tract infections and standardized an extract of milk thistle 

(silymarin), for study in patients with chronic viral hepatitis and non-alcohol-related 

steatohepatitis, a collaborative project with the National Institute of Diabetes and 

Digestive and Kidney Diseases. 
183 

NCCAM has worked with several NIH partners to design, conduct, and fund large 

clinical trials of dietary supplements. The largest of these was reported in February 

2006 in the New England Journal of Medicine: a 4-year study (co-funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases) of glucosamine 

and chondroitin sulfate, two dietary supplements widely used by people with knee 

osteoarthritis. In this study, the two supplements combined did not provide statistically significant pain relief for all the participants, compared to placebo. However, 

a small subset of participants with moderate-to-severe pain had significant pain relief. An ancillary study is continuing to determine whether the combination of these 

supplements can prevent or delay further joint deterioration, a common long-term 

outcome for people with osteoarthritis. 

A Broad Research Portfolio 

There are hundreds of different practices, products, and approaches that comprise 

CAM. Thus, the research that NCCAM funds is wide-ranging. Areas that NCCAM 

will emphasize further in fiscal year 2007 include: 

—Manual therapies.—The mechanisms of action underlying the effects of manipulative and body-based therapies such as chiropractic and massage are little understood. Therefore, NCCAM is launching an initiative in fiscal year 2007 on 

the biology of manual therapies to better understand the effects of these techniques on the body. 

—Mind-body medicine.—One recent NCCAM-funded study found that tai chi combined with standard medical care benefits patients with chronic heart failure. 

Studies of meditation and mindfulness-based stress reduction in various health 

conditions are under way. NCCAM is also redirecting the focus of its intramural 

research program to emphasize studies of mind-body medicine. 

—Echinacea.—Research on echinacea is being done both because of the public 

health burden of the common cold and the public’s widespread use of this natural product. A study of a single dosage of Echinacea purpurea to treat viral 

colds in healthy children was recently completed by an NCCAM grantee. A larger study is being undertaken in which a range of doses of this popular herb will 

be assessed for its ability to prevent colds in children. 

—Immune responses.—Many CAM interventions are believed to affect the immune 

system, either by enhancing its ability to thwart infection or by suppressing an 

overactive response, as occurs in autoimmune diseases. NCCAM is exploring the 

immune effects and basic mechanisms of action of various CAM modalities such 

as traditional Chinese herbal mixtures, ginseng, green tea, and Ginkgo biloba. 

EXPANDING TRAINING AND CAREER DEVELOPMENT

There can be no significant CAM research progress without a sufficient cadre of 

investigators who are both skilled in rigorous research and knowledgeable about 

CAM practices. NCCAM has increased the number, quality, and diversity of the 

CAM research community using a variety of approaches and grant mechanisms. In 

fiscal year 2007, NCCAM will offer three new training opportunities: supplements 

to existing research grants, in order to attract more CAM practitioners into research 

endeavors; the CAM Practitioner Research Career Development Award, for CAM 

practitioners interested in research; and the NCCAM Career Transition Award, to 

help outstanding postdoctoral research fellows in their transition to an independent 

career in CAM research. 

DISSEMINATING INFORMATION

From the outset, NCCAM has made it a priority to help practitioners, patients, 

and the public make informed decisions about CAM. The Center conducts outreach 

to public and professional audiences through a variety of channels: information 

clearinghouse, website, quarterly newsletter, conferences, Distinguished Lecture Series, and online continuing education. With the National Library of Medicine, the 

Center publishes CAM on PubMed, an online database of more than 400,000 research papers on CAM. 

FACILITATING INTEGRATION

NCCAM is committed to facilitating the integration of safe and effective CAM 

therapies into conventional medicine. One example of this effort is within the NIH 

itself. The Center is establishing a new Integrative Medicine Consult Service at the 

NIH Clinical Center, to provide integrative medical consultations and enrich patient 

care. In addition, NCCAM continues to provide CAM curriculum development grants 

to conventional medical, dental, and nursing schools. 
184 

COLLABORATING ACROSS NIH

NCCAM continues its collaborations with other NIH Institutes and Centers, as a 

contributing member of the biomedical research community. For example, NCCAM 

is a partner in several of the NIH Roadmap for Medical Research initiatives, including the Exploratory Centers for Interdisciplinary Research. Also, by participating in 

efforts like the NIH Neuroscience Blueprint, the NIH Pain Consortium, and the 

Trans-NIH Obesity Initiative, NCCAM can accelerate efforts to unlock the potential 

of CAM therapies through these multidisciplinary research initiatives. 

LOOKING TOWARD THE FUTURE

Mindful of the lessons learned in our first 7 years as an NIH Center, and with 

growing understanding of the scientific opportunities and public health priorities to 

be addressed with CAM approaches, NCCAM will continue to explore options to sustain and improve the health and well-being of the American people. 

Thank you, Mr. Chairman. I would be pleased to answer any questions that the 

Committee may have. 

PREPARED STATEMENT OF DR. LAWRENCE A. TABAK, DIRECTOR, NATIONAL INSTITUTE

OF DENTAL AND CRANIOFACIAL RESEARCH

Mr. Chairman and Members of the Committee: I am pleased to present the President’s budget request for the National Institute of Dental and Craniofacial Research 

(NIDCR) for fiscal year 2007. The fiscal year 2007 budget includes $386,095,000, a 

decrease of $3,241,000 from the fiscal year 2006 level of $389,336,000, comparable 

for transfers proposed in the President’s Request. 

STRENGTHENING THE EVIDENCE BASE IN DENTAL CARE

Health care decisions should be guided by the preponderance of clinical research 

data, or evidence, whenever possible. This approach is known as ‘‘evidence-based 

medicine’’, a concept that has evolved into a driving force in healthcare. 

Recognizing the concept’s value, dentistry also has embraced an evidence-based 

approach. Yet, having sufficient clinical data from which to build that base can be 

challenging. For some oral health problems, evidence-based approaches are possible; 

for many others, knowledge gaps must be filled before an evidence-based approach 

can take root. As the nation’s leading supporter of oral, dental, and craniofacial research, the NIDCR is uniquely positioned to fill those gaps while continuing its efforts in the laboratory to develop new and even more effective ways to prevent, diagnose, and treat dental diseases. I would like to highlight over the next few minutes 

how the NIDCR is sowing the clinical seeds of progress to advance evidence-based 

dentistry in America and, above all, improve the nation’s oral health. 

PRACTICE-BASED RESEARCH NETWORKS

Healthcare providers sometimes comment that too often they are not included as 

participants in research, noting that their clinical experience and insight are significant assets to understand and address patients’ most pressing health concerns. I believe that there is much to be gained from engaging clinical practitioners in research. That is why the NIDCR recently established three regional practice-based 

research networks (PBRNs) to investigate everyday issues in oral healthcare. 

Each PBRN involves 100 or more oral health practitioners who will propose and 

conduct studies of common dental procedures across a range of patient and clinical 

conditions. For example, some of the early investigations will gather data on methods dentists use to restore teeth with deep decay, and to assess caries risk. Each 

network will conduct 15 to 20 clinical studies over the next seven years. The PBRNs 

also will collect information to generate data on disease, treatment trends, and the 

prevalence of less common oral conditions. 

While the PBRNs aim high, their success will be rooted in their focus on realworld clinical issues and their ability to generate information that will be of immediate value to practitioners and patients alike. The studies will involve topics and 

procedures that clinicians themselves identify as relevant and in need of systematic 

research to help guide clinical decisions. I believe the PBRNs have the potential to 

generate a body of high quality clinical research data in a relatively short period 

of time. Most importantly, their research will substantially enhance the base of evidence clinicians can use to inform treatment decisions, translate newer information 

into daily practice, and directly affect and improve routine dental care. 
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1Martin JA, Hamilton BE, et al. Births: Final data for 2003. National vital statistics reports; 

vol. 54 no 2. Hyattsville, MD: National Center for Health Statistics. 2005. 2Offenbacher S, Katz V, et al. Periodontal infection as a possible risk factor for preterm low 

birth weight. J Periodontol, vol. 67(10) p. 1103–13. 

GREATER EMPHASIS ON LARGE CLINICAL STUDIES

The nation’s progress against heart disease, cancer, and infectious diseases has 

been accelerated by large clinical studies yielding results that can be generalized 

and can clarify the interplay of many variables. In dentistry, clinical research traditionally has involved smaller studies with fewer participants. The NIDCR is changing this trend by supporting larger clinical studies whose outcomes have the potential to fundamentally change dental practice and improve public health. I would like 

to tell you about some examples. 

PERIODONTAL DISEASE AND PRETERM BIRTH

In the United States, about one in eight babies is born prematurely.1 Preterm babies can be so small and underdeveloped that they must remain hospitalized for 

months and, if they survive, spend years battling chronic health problems. This 

heartbreaking situation has spurred scientists to identify risk factors associated 

with premature births. Risk factors such as smoking, hypertension, and diabetes 

allow doctors to identify women who are more likely to deliver prematurely and to 

tailor their prenatal care. However, identification of risk factors is a work in 

progress. One in four of preterm births (more than 125,000 per year) occurs without 

any known explanation.2 Scientists have assembled an intriguing body of preliminary evidence to suggest that women who have severe gum, or periodontal, disease 

during pregnancy are at increased risk of preterm delivery. This raises the question: 

Does treatment for periodontal disease during pregnancy help women reach full 

term and give birth to healthy babies? 

The NIDCR is supporting the first large, controlled Phase III clinical trials to answer this important public health question. Two studies involve over 2,600 women 

of various racial, ethnic, and economic backgrounds. The first, called the Obstetrics 

and Periodontal Therapy (OPT) trial, will soon report its findings, providing for the 

first time the clinical data needed to offer sound scientific advice on this issue. The 

results of the second study, called the Maternal Oral Therapy to Reduce Obstetric 

Risk (MOTOR) trial, should be forthcoming next year. 

BETTER PAIN TREATMENTS FOR JAW CONDITION

Temporomandibular joint and muscle disorder (TMJMD) is an umbrella term for 

conditions affecting the area in and around the temporomandibular joint, or TMJ. 

The TMJs connect the jaw to the skull. Common symptoms of TMJMD include persistent pain in the jaw muscles, restricted jaw movement, and jaw locking. 

Although TMJ disorders vary in their duration and severity, for some people the 

pain becomes severe and permanent. NIDCR recently launched a large, seven-year 

clinical study to accelerate research on better pain-control treatments for TMJMDs. 

The study, called Orofacial Pain: Prospective Evaluation and Risk Assessment 

(OPPERA) will collect data on 3,200 healthy volunteers for three to five years to 

see how many develop TMJMD, opening a largely unexplored window from which 

to observe the early stages of the disorder. With this unique vantage point, they can 

gather data on key genetic, physiologic, and psychological variables involved in 

TMJMD pain, ultimately weaving the information into more effective treatments. 

Only a decade ago, a large study tracking the development of TMJMD over time 

would have been scientifically problematic, because little was known about the basic 

mechanisms of human pain. However, because progress in the basic sciences has fed 

the knowledge pipeline, pain researchers have now better defined the molecular circuitry involved in pain transmission, thereby providing the conceptual framework 

for this important clinical study. 

MOLECULAR MEDICINE AND ORAL CANCER

In the fight against cancer, future weapons of choice likely will fall within the 

therapeutic category of molecular medicine. The concept builds on world-wide efforts 

to design cancer treatments targeting the precise molecules that drive the tumor 

process, leaving normal cells unscathed. As envisioned, molecular medicine will increase the benefits of treatment and limit greatly the unwanted side effects that 

now afflict cancer patients. For the vision to become reality, scientists first must 

learn to correctly identify distinctive features of the genetic and/or protein profiles 

of developing tumors. Much progress has been made in the laboratory, but the 
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promise of molecular diagnostics remains largely unready for translation to patient 

care. 

An NIDCR-supported project that has successfully taken that critical step is a 

partnership between scientists, dental educators, and a community clinic in British 

Columbia. The partners have integrated molecular techniques with existing screening tools by combining certain molecular discoveries with clinical use of toluidine 

blue, a chemical dye used to determine whether or not to biopsy an abnormal 

growth. The technique hinges on laboratory work that showed an association in 

early oral lesions between toluidine blue retention and the presence of cells with distinct, cancer-predisposing chromosomal abnormalities. The program already has 

identified several people requiring treatment for oral cancer and pre-cancerous lesions. 

DRY MOUTH AND RADIATION THERAPY

Persistent dry mouth often occurs in head and neck cancer patients because radiation from the therapy damages the salivary glands. This irreversible, chronic dryness makes normal chewing and swallowing difficult, and leads to a range of painful 

oral diseases. Recently, NIDCR scientists teamed with researchers at the National 

Cancer Institute to develop an important new lead in protecting the salivary glands 

during radiation therapy to the head and neck. Their work involves a synthetic 

chemical called Tempol, which possesses a unique ability to protect cells against radiation. In mice, administration of Tempol 10 minutes prior to radiation therapy to 

the head and neck provided significant protection to the salivary glands. Critically, 

Tempol did not protect tumors from radiation, and thus did not diminish the beneficial effects of the radiation therapy. Future clinical trials in people are likely. 

REDUCING DISPARITIES IN THE NATION’S ORAL HEALTH

Although the Nation’s oral health has improved greatly over the past several decades, this progress has not been equally shared by millions of low income and underserved Americans. To help reverse this trend, the NIDCR supports five Centers 

for Research to Reduce Oral Health Disparities. The centers are designed to explore, 

understand, and improve the oral health of those who reside in underserved communities. The researchers seek creative but practical approaches that are inexpensive, 

can be easily applied, and are exportable to other underserved communities. 

This year, the Disparities Centers reported several noteworthy findings. For example, after a two-year clinical study, San Francisco researchers found that infants 

and small children who receive at least one fluoride varnish treatment per year can 

cut their dental caries rate in half. Fluoride varnish is a concentrated fluoride in 

a resin or synthetic base that is applied directly onto the teeth. The treatment is 

inexpensive and is more easily used with very small children than other preventive 

measures, such as dental sealants and mouth rinses. 

Meanwhile, the Disparities Center at the University of Washington is evaluating 

the oral health benefits of gum and candy sweetened with xylitol rather than cariespromoting sugars. Xylitol, a natural substance found in certain fruits, has been 

shown to fight tooth decay. The team is refining the optimal dose to satisfy taste 

and fight decay. Xylitol use exemplifies an easily adopted, self-administered, scientifically validated approach that may be useful in underserved populations. 

IMPROVING THE NATION’S ORAL HEALTH

As these highlights demonstrate, the NIDCR has made a strong commitment to 

expand clinical research and to build the evidence base that will inform better clinical practice. At the same time, progress in basic science continues to provide new 

and exciting leads that can translate into large clinical trials, yielding results with 

the potential to transform dentistry and public health. Above all, the NIDCR seeks 

to find practical solutions to intractable problems and, in so doing, improve the Nation’s oral health. 

PREPARED STATEMENT OF DR. NORA VOLKOW, DIRECTOR, NATIONAL INSTITUTE ON

DRUG ABUSE

Mr. Chairman and Members of the Committee: I am pleased to present the fiscal 

year 2007 President’s budget request for the National Institute on Drug Abuse 

(NIDA). The fiscal year 2007 budget estimate is $994,829,000, a decrease of 

$5,200,000 from the fiscal year 2006 enacted level of $1,000,029,000, comparable for 

transfers proposed in the President’s request. 
187 

INTRODUCTION

The National Institute on Drug Abuse, within the National Institutes of Health 

(NIH), is once again pleased to report continuing declines in overall drug use among 

our Nation’s youth. NIDA has focused much of its research on the vulnerable adolescent period of development, since this is when drug abuse typically takes hold and 

can bend a young life toward long-term drug abuse problems or addiction. Research 

findings elucidating the mechanisms of action and destructive consequences of drugs 

of abuse on the brain and body appear to be getting through to this population. For 

example, the 2005 Monitoring the Future (MTF) Survey of 8th, 10th, and 12th graders shows a dramatic 19 percent reduction in use since 2001. However, areas of significant concern remain, including the alarmingly high rates of non-medical use of 

painkillers among 12th graders, the high rates of stimulant abuse among 12th graders, and the spread of methamphetamine abuse to new geographic areas of the 

country. 

Therefore, while we can acknowledge and appreciate the positive effects of evidence-based prevention and treatment efforts, we also recognize the need to keep 

pace with emergent problems. To this end, ongoing support of leading edge research 

by NIDA scientists continues to enhance innovative prevention and treatment interventions, while collaborations with other Institutes and public and private partners 

make optimal use of our research infrastructure. 

PRESCRIPTION DRUG ABUSE—THE PROBLEM WITH PAINKILLERS

According to the 2004 National Survey on Drug Use and Health, nearly threefourths of the estimated 6 million people aged 12 and older who reported non-medical use of prescription psychoactive drugs said they abuse pain relievers in particular, with young adults (18–25) showing the greatest increases in lifetime use 

from 2002–2004. Even younger populations are involved, revealed by findings from 

NIDA’s 2005 MTF Survey. 

NIDA is tackling this growing problem from multiple angles, seeking to understand the factors that have brought us to this point so that we may reverse negative 

trends and stop new ones from emerging. Underlying factors include the fact that 

opioids are now among the most commonly prescribed medications, that society is 

more accepting of using medications to treat all kinds of health problems, and that 

the Internet provides greater access to prescription drugs. 

In response to these concerns, NIDA’s new initiative on prescription opioids and 

treatment of pain is soliciting a broad range of preclinical and clinical studies from 

across the sciences. We will examine the basic mechanisms involved in pain and 

how their interaction with prescription painkillers influences addiction potential— 

for example, whether opiates are equally addictive to an individual in pain versus 

one who is not in pain. Research on the basic interactions between pain and opioid 

systems is needed to inform physicians about associated abuse risks and to guide 

their prescribing practices. 

Other strategies for reducing prescription painkiller abuse include developing alternative pain medications and promoting better delivery systems for painkillers to 

minimize abuse potential. Recent studies have identified a subset of cannabinoid receptors (i.e., CB2 receptors) as promising new targets for treating chronic pain from 

nervous system injury. In addition, because of their lack of activity in brain reward 

centers and diminished abuse liability, novel CB2-based medications present an attractive alternative for treating chronic pain. Buprenorphine/naloxone, a recently 

approved medication for the treatment of opioid addiction, represents another approach. Acting on the same brain receptors as drugs like heroin and morphine, 

buprenorphine does not produce the same high, physical dependence, harsh withdrawal symptoms, or dangerous side effects. Further, its unique formulation with 

naloxone, an opioid antagonist, produces severe withdrawal symptoms in addicts 

who inject it to get high, thereby lessening the likelihood of diversion while maintaining desired therapeutic properties. NIDA is planning a multiple trial study to 

evaluate the effectiveness of buprenorphine in the treatment of the pain patient who 

is addicted to his/her pain medication and to help develop guidelines on how to treat 

these types of patients. 

GENES, ENVIRONMENT, AND BEHAVIOR

A person’s individual genome, or genetic makeup, plays an important role in determining his or her vulnerability to or protection against addiction. Studies of heredity have shown that about 40–60 percent of predisposition to substance abuse 

can be attributed to genetics, with environment impacting how those genes function 

or are expressed. Addiction is a quintessential gene-x-environment interaction dis-
188 

ease: that is, a person must be exposed to drugs (environment) to become addicted, 

yet exposure alone is not determinative—genes interact with this environment to 

create a vulnerability to addiction. Growing knowledge about the dynamic interactions of genes with the environment confirm addiction as a complex and chronic 

disease of the brain with many contributors to its expression in individuals. 

NIDA is studying these interactions to see what they reveal about vulnerability 

to addiction and to other adverse effects of abused drugs. For example, one recent 

study found that carriers of a common variant of the COMT gene were more likely 

to exhibit psychotic symptoms and to develop schizophreniform disorder if they used 

marijuana. 

Thus, people with particular genes may suffer more harmful effects from drugs 

of abuse. 

To expedite the translation of findings that could help identify the location of 

genes that confer vulnerability or protection, NIDA is supporting innovative research to help design, develop, and market technology to conduct rapid behavioral 

throughput screens for identifying genetic vulnerability using animal models of drug 

abuse and addiction. This information could then become part of a database of candidate genes for drug abuse, for eventual mapping and for targeted therapeutic application. Advances in genetics research in addiction are already suggesting ways 

to tailor our interventions to have the greatest impact. For example, a recent study 

showed that distinct alleles of the dopamine receptor gene led to different outcomes 

according to the type of smoking cessation therapy used—bupropion or nicotine replacement therapy. Such findings provide a glimpse of a future in which a patient’s 

genetic background will be a major factor in selecting the most appropriate therapeutic course of action. 

Other NIDA studies are also helping to unravel the ways in which environmental 

factors, such as stress, induce brain changes that interact with drugs of abuse and 

alter behavior. It is well known that stress is a major cause of relapse to drug abuse 

in recovering addicts and can prompt the release of a neurochemical, corticotrophin 

releasing factor (CRF). Recent research showed that in cocaine-exposed animals, 

stress-induced CRF triggered drug-seeking behavior, even as long as 3 weeks after 

exposure. This research highlights the concept of persistent brain changes leaving 

individuals vulnerable to certain relapse triggers like stress. Moreover, stress may 

be common to a variety of conditions, including depression, anxiety, and some forms 

of overeating and obesity. By revealing the precise brain mechanisms involved in 

stress, our research can lead to treatments that for these conditions. 

We are also learning how environmental factors not only alter the expression but 

the structure of genes involved in brain function, which then influences an individual’s behavior. Known as ‘‘epigenetics,’’ this field gives researchers an opportunity 

to investigate gene-environment interactions, including the deleterious changes to 

brain circuits resulting from drug abuse. Understanding how drugs of abuse effect 

epigenetic changes may help in developing interventions to counter or prevent such 

changes. A recent study of demonstrated that cocaine caused significant structural 

changes to the DNA in regions containing genes implicated in shaping the brain’s 

response to drugs of abuse; furthermore, in animals genetically engineered to minimize those changes, the rewarding effects of cocaine were dramatically reduced. 

These results show how gene-environment interactions can change the brain and 

drive behaviors associated with drug addiction. NIDA is supporting innovative research to help design, develop, and market technology to conduct rapid behavioral 

throughput screens for identifying gene/environment interactions. 

SOCIAL NEUROSCIENCE

NIDA is targeting the influence of social factors both in individual and group decision-making. This focus is critical not just to understanding drugs of abuse but 

other health behaviors as well. For instance, a social neurobiological perspective is 

being applied in NIDA studies investigating the mechanisms underlying adolescents’ 

increased sensitivity to social influences (i.e., peers) and decreased sensitivity to 

negative consequences of their behavior that together make them particularly vulnerable to drug abuse. 

A recent NIDA request for research in the emerging field of social neuroscience 

is soliciting studies from basic to clinical science as we work to examine how 

neurobiology and the social environment interact in abuse and addiction processes 

(e.g., initiation, maintenance, relapse, and treatment). We now have the tools to see 

how genetics, epigenetics, and brain chemistry can change social behavior and how 

the social interactions of an individual can change his or her brain. For example, 

studies of early maternal behavior in animals demonstrated that offspring receiving 

low levels of care during their first week of life developed an over-responsive stress 
189 

system that lasted a lifetime. In this case, genes responsible for regulating stress 

responses were ‘‘silenced’’ by environmental manipulation. Some of these changes 

can be reversed in adulthood by targeted intervention, making this research area 

ripe for developing approaches to counteract the effects of adverse environmental 

impacts, which in the case of stress are known to increase the risks for substance 

abuse. 

We are also committed to efforts to better characterize ‘‘phenotypes’’ of social environments and to understand their interaction with other vulnerabilities, such as genetics. One approach could include strategies such as mapping community risk factors for drug use (e.g., parental practices, family structure, school systems, socio-economic status, neighborhood characteristics, and drug availability) and to use that 

knowledge to inform us about mediators of the social stressors that elevate risk for 

drug abuse. A better understanding of this relationship is relevant both for the 

treatment of drug addiction and for psychotherapeutic interventions for mental illnesses, which also involve social aspects of human behavior. 

DRUG ADDICTION TREATMENT WORKS

NIDA’s research findings have demonstrated that drug addiction treatment 

works. Moreover, comprehensive treatments (i.e., those that include a combination 

of available medications, behavioral treatments, and job training and referral services) tailored to the needs of the individual patient have the highest success rates. 

We continue to work with the private sector to develop medications to use with behavioral therapies to treat drug addiction, and are pursuing collaborations with 

pharmaceutical companies to move novel and promising compounds forward to clinical evaluation. In addition, NIDA’s initiative focusing on pilot clinical trials of new 

addiction medications will invigorate the field by helping investigators generate sufficient safety and efficacy data to support full-scale clinical trials and expedite the 

possible progression of novel medications to real-world use. 

Over the past year, we have made great progress in identifying potential medications for treating drug addiction, including addiction to stimulants such as cocaine 

and methamphetamine. Several promising compounds have been identified in animal studies, and initial clinical efficacy for drug abuse has been demonstrated for 

medications marketed for other uses: disulfiram, prescribed for alcoholism; 

modafinil, for treatment of narcolepsy; and gamma-vinyl GABA (not marketed in 

the United States) and topiramate, both used to treat seizure disorders. Progress 

is also being made in the area of vaccine development for cocaine and nicotine addiction, and Rimonabant, a cannabinoid receptor blocker is a promising candidate for 

treating marijuana addiction. Close to being approved for marketing by the pharmaceutical industry as a weight loss aid, Rimonabant may also have the potential to 

prevent relapse to cocaine, heroin, and methamphetamine abuse, and nicotine addiction. Marinol, another cannabinoid receptor agonist, may also show promise as a 

treatment for marijuana withdrawal symptoms. 

Interventions are also needed to treat comorbid mental disorders and addiction. 

For example, given that an estimated 15–30 percent of patients with substance 

abuse problems also suffer from comorbid ADHD, as found in research studies, 

NIDA has launched a large clinical study in our Clinical Trials Network (CTN) to 

test whether treatment of ADHD with methylphenidate, in parallel with treatment 

for substance abuse, will improve outcomes in those who suffer from both conditions. 

We are also developing drug abuse treatments for use in the criminal justice system. Our research findings show that drug treatment works even for people who 

enter it under legal mandate, with outcomes as favorable as for those who enter 

treatment voluntarily. To illustrate, in a Delaware Work Release study sponsored 

by NIDA, those who participated in prison-based treatment followed by aftercare 

were seven times more likely to be free of drugs after 3 years than those who received no treatment. Moreover, nearly 70 percent of those in the comprehensive 

drug treatment group remained arrest-free after 3 years—compared to only 30 percent in the no-treatment group. We are helping to integrate drug treatment into the 

criminal justice system and improve outcomes for offenders through our comprehensive Criminal Justice Drug Abuse Treatment Studies (CJ–DATS) initiative, undertaken in collaboration with Federal, state, and local criminal justice partners. 

NIDA research has demonstrated the value of drug addiction treatment programs 

in helping patients recover from the complex disease of addiction. Faith-based and 

community-centered programs are often part of long-term recovery, yet their effectiveness and role in delivering treatment needs to be studied more extensively. 

NIDA is conducting research to examine this role. 
190 

HIV/AIDS AND MINORITY DISPARITIES

The latest data from the Centers for Disease Control and Prevention (CDC) suggest that the HIV/AIDS epidemic is evolving, with drug abuse still a major vector 

in its spread. Progress in treating injection drug abuse has helped to decrease HIV 

transmission among this highly vulnerable population, influenced by a multipronged approach including community-based outreach to reduce risky behaviors 

and development of medications such as methadone and buprenorphine to treat injecting drug users. But while this approach has helped reduce U.S. cases from this 

route of transmission, other countries, such as Russia and Southeast Asia, continue 

to report that injection drug abuse accounts for a large proportion of their HIV/AIDS 

cases. Thus NIDA is supporting international studies to promote HIV prevention 

practices and use of medications to treat drug addiction. Depot-Naltrexone is one 

such possibility, since it is a long-acting opioid antagonist medication expected to 

soon receive approval for treatment of alcohol addiction. Because efforts to decrease 

drug abuse also modify the behaviors that can lead to HIV transmission, we believe 

strongly that drug abuse treatment is HIV prevention. 

Early detection of HIV helps prevent HIV transmission and increase health and 

longevity. NIDA-supported research indicates that routine HIV screening, even 

among populations with prevalence rates as low as 1 percent, is as cost effective as 

screening for other conditions such as breast cancer and high blood pressure. These 

findings have important public health implications, but require efforts to increase 

HIV screening acceptability (similar to mammography) in order to be effective. 

We are also deeply concerned about the disproportionate impact of HIV/AIDS on 

African Americans. For while they represent just 13 percent of the U.S. population, 

African Americans account for 42 percent of AIDS cases diagnosed since the start 

of the epidemic, according to CDC. In fact, data from the CDC’s National Vital Statistics Report published in 2003 show that HIV/AIDS is the leading cause of death 

among all African Americans 25–44 years old, ahead of heart disease, accidents, 

cancer, and homicide. 

To address these disparities, NIDA is encouraging research on the nexus of drug 

abuse and HIV/AIDS among African Americans to understand the risk factors and 

the pathways between them and to develop culturally sensitive prevention and 

treatment programs for drug abuse and HIV/AIDS. We are committed to making 

sure this research is translated in a meaningful way. 

FROM BENCH TO BEDSIDE TO COMMUNITY

NIDA is proud of our myriad efforts to translate the results of our basic and clinical research on the brain and body effects, getting new treatments into the hands 

of providers who will use them, disseminating prevention messages to people who 

will hear them, and raising the awareness of people who can help change the course 

of drug abuse treatment in this country. Our audiences are many and include physicians, teens, teachers, judges, parents, and others. 

Through our physician outreach initiative, we are funding efforts to develop strategies for primary care physicians to better identify and serve drug abusing patients 

through use of science-based screening and brief interventions. We are also supporting development of a pilot judicial training curriculum in Cook County, Illinois, 

to help criminal court judges understand the neurobiology of addiction and the effectiveness of treatment. The goal of this program is to better inform judicial decisionmaking with regard to substance-abusing offenders. These efforts will be applied to 

the Federal court system as well. We also support grants to evaluate results from 

drug courts to achieve optimal dissemination and improve outcomes, and we will 

soon publish a book of treatment principles for application with individuals involved 

in the criminal justice system. 

Our education portfolio continues to grow and includes a wealth of materials, such 

as our NIDA Goes Back to School Initiative, a science education campaign to provide middle school students with information about how drugs work in the brain. 

An interactive website complements this effort, allowing students and teachers to 

easily obtain additional information about drugs of abuse. To help young people understand the risks of drug abuse leading to HIV infection, NIDA and our partnering 

organizations—including the American Academy of Child and Adolescent Psychiatry, the AIDS Alliance for Children, Youth, and Families, and the United Negro 

College Fund Special Programs Corporation—recently launched a multimedia educational campaign, including a public service announcement and website, to help 

young people ‘‘learn the link’’ between drug abuse and HIV infection. We are translating these materials into Spanish and making them culturally relevant for different populations. 
191 

We are also collaborating with our sister agency, the Substance Abuse and Mental 

Health Services Administration (SAMHSA) and with the National Institute of Mental Health on a new initiative to enhance the capacity of community-based providers 

of drug abuse treatment services. We continue to work with SAMHSA, supporting 

the development and dissemination of research-based products through their Addiction Technology Transfer Centers across the country, applying findings from our 

Clinical Trials Network and other research. And because addictive, psychiatric, and 

neurological disorders emerge from common neural substrates, a tremendous 

amount of inter-Institute collaboration has taken place—an approach we will continue to emphasize, given its ability to produce sharable findings and cost efficiencies. 

CONCLUSION

Our investment in basic and clinical research has changed the way people view 

drug abuse and addiction in this country. We now know how drugs work in the 

brain, their health consequences, how to treat people already addicted, and what 

constitutes effective prevention strategies. As science advances, NIDA’s comprehensive research portfolio is strategically positioned to capitalize on new opportunities. 

We continue to make great strides in translating and disseminating the products 

of our research, so they can be used in real communities by people who need them, 

providing front-line clinicians around the country with the tools needed to reduce 

drug abuse and addiction in our Nation. To make the most of scarce resources, we 

depend on a rigorous planning and priority-setting process that not only supports 

our strong commitment to reducing drug abuse and HIV transmission in this country, but extends to other health fields represented by NIH. Sustaining the momentum of our efforts will lead to even more discoveries that will improve the health 

and safety of all Americans. 

Thank you, Mr. Chairman. I will be pleased to answer any questions the Committee may have. 

IMPACT OF BUDGET CUTS

Senator SPECTER. We will now proceed with questioning by the 

Senators, 5 minutes each. 

Dr. Zerhouni, you say you will continue to deliver. How is that 

possible when you have had more than a 10 percent decrease, considering inflation, which amounts to about $3 billion? The comments that I hear relate to there being a panic, panic among the 

applicants for NIH research. How can you continue to deliver with 

that kind of a budget? 

Dr. ZERHOUNI. It is very important to realize that medical research cannot be funded through ups and down. We have to sustain the investment over time, and it is clear that medical research 

requires support for scientists. What is happening right now is that 

through the doubling we have generated a new generation of scientists. We have over a 50 percent increase in the number of scientists. 

Senator SPECTER. What is the consequence of the cut? 

Dr. ZERHOUNI. The consequence of the cut is very simple. If you 

keep investing below and lose purchasing power, the most important impact on research is loss of scientists. This is what we have 

seen in the past and this is what may happen again if we do not 

sustain our investment in medical research. 

PREPAREDNESS FOR PANDEMIC INFLUENZA

Senator SPECTER. Dr. Fauci, there is a great concern, as we all 

know, about pandemic influenza. This subcommittee has held a series of hearings on the subject. How are we doing? What are the 

prospects for being prepared if that wave should strike us in the 

United States? 
192 

Dr. FAUCI. From the standpoint of the scientific preparation for 

developing vaccines and drugs, from the last time I testified before 

you, Mr. Chairman, which was just a couple of months ago, we 

have made even more progress. We have, as you know, as Dr. 

Zerhouni alluded to, we have a vaccine that is currently in clinical 

trial in different age groups and demographic groups. We have 

tested it and published the results in healthy young adults. We 

have tested it in the elderly and in children. As I mentioned to you 

at the last hearing, the vaccine appears to be very well tolerated 

and induces an immune response that would be predictive of being 

protective. 

There is a big problem with it, though. The problem relates to 

the fact that the dose that is required to induce the level of immunity that you would predict would be protective is prohibitively 

high, which is leading us to the studies that are ongoing now, 

namely the use of what we call adjuvants, or compounds which expand the capability of the immune system to respond. Those studies are ongoing right now. 

FUNDING FOR PANDEMIC INFLUENZA

Senator SPECTER. Is the funding adequate? 

Dr. FAUCI. We could do more with more funding, there is no 

doubt about that. I would be—— 

Senator SPECTER. How much do you need? 

Dr. FAUCI. It is difficult to put a number on it, except to say 

that—— 

Senator SPECTER. Well, if you cannot put a number on it, we cannot. 

Dr. FAUCI. Well, we need—for example, if I could bring one component up that I think would be of interest to this committee, is 

that we are currently pursuing rather aggressively the concept of 

what we call a universal influenza vaccine, namely a vaccine that 

cross-reacts from season to season and would also be protective 

against the pandemic flu. 

Senator SPECTER. Dr. Fauci, I am reluctant to cut off a witness 

with your distinctive record. Give us in writing what funding you 

need. 

Dr. FAUCI. Okay, I could do that for you. 

[The information follows:] 

FUNDING FOR PANDEMIC INFLUENZA

The National Institute of Allergy and Infectious Diseases (NIAID) supports a robust and diverse portfolio of research on influenza, including pandemic influenza. 

Many opportunities to accelerate the research and development of medical countermeasures against influenza as well as to advance our understanding of influenza 

viruses could be pursued in fiscal year 2007 and fiscal year 2008 should additional 

funds become available. In its professional judgment that is outside the context of 

other competing priorities, NIAID estimates that it could obligate an additional 

$212 million in influenza research in fiscal year 2007 above the budget request and 

an additional $458 million in fiscal year 2008. 

NIAID could use such funds to accelerate research and development of antiviral 

drugs, vaccines, adjuvants, and diagnostics for influenza. For example, NIAID could 

accelerate the development and clinical testing of promising universal vaccine candidates, which could offer protection against multiple influenza virus strains, and 

the development of new and improved vaccine strategies for influenza such as recombinant subunit vaccines and gene-based vaccines that may allow for more rapid 

production of a vaccine against a pandemic strain of influenza, should one emerge. 
193 

These additional funds also could facilitate the expansion of critical research resources, such as animal models and clinical trials infrastructure that are essential 

for the development of medical countermeasures against influenza. 

Underpinning efforts to develop medical interventions against pandemic influenza 

is research into the basic biology and disease-causing mechanisms of influenza viruses. With additional funding, NIAID could expand basic research in the areas of 

influenza virology, pathogenesis, epidemiology, immunology, genomics, proteomics, 

and systems biology as well as to expand international animal surveillance activities. This research is crucial to the development of antiviral drugs, vaccines, and 

diagnostics for influenza. 

CANCER GENOME ATLAS

Senator SPECTER. Let me turn now to Dr. Niederhuber with respect to the cancer-genomics initiative. Can that be implemented 

with the current funding? What do we need to successfully prosecute the war against cancer? 

Dr. NIEDERHUBER. Well, Senator Specter, thank you. We are very 

committed, the National Cancer Institute, with our partner, the 

National Human Genome Research Institute, to initiate a pilot 

project on the Cancer Genome Atlas. Each Institute has committed 

$50 million from our existing resources to do that. This will be a 

pilot project which is helping us understand the technology needs, 

the technology advancements, and our ability to do this project. 

Senator SPECTER. Dr. Niederhuber, would you supplement your 

testimony today with a memorandum as to what you need as to 

that program and as to the war on cancer overall? 

Dr. NIEDERHUBER. Absolutely, sir. 

Senator SPECTER. Give us a winning strategy for that war? 

Dr. NIEDERHUBER. Absolutely. 

[The information follows:] 

CANCER GENOME ATLAS

The Cancer Genome Atlas program is the product of several years of investment 

by the NCI in the Cancer Genome Anatomy Project (C–GAP) and other large scale 

genomics programs, some of which were performed in collaboration with the 

NHGRI. These efforts culminated in 2003 with a report from the NCI’s National 

Cancer Advisory Board (NCAB) which recommended that the two Institutes undertake a pilot program to determine the feasibility of systematically developing an 

‘‘atlas’’ of all genetic alterations involved in cancer. 

Active planning for The Cancer Genome Atlas, or TCGA, began in the latter half 

of 2002 as a consequence of progress and convergence of science and advanced technologies in three distinct areas. First, the completion of the sequencing of the 

human genome provided for the first time in history a benchmark to begin to understand the effect of genetic changes on the etiology and progression of diseases such 

as cancer. Second, our years of investment in understanding cancer at the molecular 

level resulted in the discovery of some very important genetic changes in cancer 

cells that led to the development of targeted drugs such as Gleevec and Herceptin. 

Based on an understanding of the specific genetic alterations driving specific tumors, these targeted drugs allowed oncologists for the first time to target specific 

genetic alterations in patients with chronic myelogenous leukemia (CML) and breast 

cancer, respectively. Finally, the pace of technology development in analyzing all aspects of genes and their products is accelerating—setting the stage for large scale 

interrogation of the genome to understand the role of genetic mutation in diseases 

such as cancer. Interestingly, one of the major requirements for this project is the 

development of an unprecedented data management system and ultimately an accompanying database; NCI’s investment in the Cancer Bioinformatics Grid (caBIG) 

over the past several years provides the advanced technology platform needed to 

meet this need. 

Cancer is a disease of changes in genes that occur over an individual’s lifetime. 

Three kinds of genetic alterations contribute to cancer—those that occur in the DNA 

of egg or sperm and are passed from a parent to offspring (germline mutations), 
194 

those that occur as a result of exposure to the environment (somatic mutations) and 

changes in DNA that lead to changes in genes that control proteins involved in transcription and translation. Additionally, changes in gene function can occur without 

a change in the sequence of DNA (epigenetic changes). TCGA will finally facilitate 

an in-depth understanding of how these types of genetic changes differ in terms of 

their role in an individual’s inherited risk vs. those changes that arise from environmental exposure. It is the latter category of mutations that will allow scientists to 

obtain a clear picture of the impact of these somatic mutations on the major pathways that appear to drive many of the major hallmarks of cancer cells. Overall, the 

TCGA pilot project, much like the Human Genome Project, has the potential to create an unparalleled knowledge base, drive a new era of discovery by scientists from 

all fields of biomedical research and ultimately provide a new paradigm for the prevention, detection and treatment of chronic diseases such a cancer. 

The NCI and NHGRI believe strongly that TCGA is one of the most important 

projects undertaken in medicine to date. It leverages all that has gone before and 

for the first time will allow scientists to apply our understanding of the human genome sequence to cancer—a disease that will strike over 1.4 million Americans this 

year and kill over 560,000 at a cost of well over $190 billion. We are committed to 

getting this project underway within current budget constraints. The NCI has identified funds for redeployment from other projects, and the NHGRI will dedicate a 

large portion of its sequencing capacity to performing this first-ever large scale effort in medical sequencing. 

The information generated by the TCGA pilot project will provide the necessary 

scientific data by which the Institutes and the scientific community can evaluate the 

preliminary outcomes of the research. 

The convergence of our understanding of cancer at the molecular level, advanced 

genome analysis technologies, especially bioinformatics, and experience gained in 

the Human Genome Project, allow us to now undertake TCGA, a project that promises to contribute significantly to the development of 21st century medicine. Both 

the NCI and the NHGRI are committed to leveraging these strengths to ensure that 

we move forward toward our goal of personalized medicine for cancer and all diseases. 

A WINNING STRATEGY AGAINST CANCER

NCI has developed a Strategic Plan to reduce and eliminate the suffering and 

death due to cancer with the help of the scientific community. The Plan sets forth 

a framework within which NCI can use its funding, infrastructure, tools, and intellectual resources to lead and work with others. We set forth eight strategic objectives in the Plan and these will be instrumental in guiding our operational level 

plans and serve as an organizer for measuring and reporting progress. A complete 

description of the Strategic Plan can be found on NCI’s web site at http:// 

www.cancer.gov/aboutnci/2015. 

There are two basic tactics—preempting cancer and ensuring the best outcomes 

for all—embodied in the Plan’s objectives. 

To preempt cancer at every opportunity, there are four strategic objectives: 

—Understand the causes and mechanisms of cancer; 

—Accelerate progress in cancer prevention; 

—Improve early detection and diagnosis; and 

—Develop effective and efficient treatments. 

To ensure the best outcomes for all, there are four strategic objectives: 

—Understand the factors that influence cancer outcomes; 

—Improve the quality of cancer care; 

—Improve the quality of life for cancer patients, survivors, and their families; and 

—Overcome cancer health disparities. 

To achieve these objectives requires numerous funding vehicles and support mechanisms throughout the cancer research community. The steps we could take in order 

to accelerate progress to eliminate the suffering and death due to cancer include: 

—Rapid development of an integrated technology initiative; 

—Deployment of a modern integrated clinical trials infrastructure; 

—Expansion and integration of the Cancer Centers program; and 

—Mechanisms and Flexibilities—streamlined procurement and review processes 

to acquire materials and services and coordination of licensing and patenting 

activities. 

An integrated advanced technology initiative for cancer could provide a linkage 

between the National Cancer Program and R&D initiatives being developed in selected national laboratories and advanced technology facilities located in more than 

40 states and regions. Connected in real-time through a common bioinformatics 
195 

grid, forming a ‘‘network of networks’’ of science, technology, and treatment, such 

an initiative could serve to accelerate the emerging discipline of molecular oncology. 

This would create a pipeline of new personalized cancer diagnostics and therapeutics from bench concept to bedside and community delivery. In the next few 

years, such an initiative could: 

—Accelerate the implementation of a nationwide high-end information technology 

grid for bioinformatics that could be uniquely adapted for real-time data sharing. NCI’s pilot version, called caBIG, is slated for full-scale implementation 

this year and, during the pilot phase, was implemented among 50 Cancer Centers, FDA, and other organizations. 

—Develop a comprehensive biomarker discovery and validation program. 

—Foster the application of emerging technologies, such as nanotechnology, and integrate molecular agents with advanced imaging devices. 

—Accelerate a nationwide real-time medical information electronic system for research and medical data sharing using technologies and devices currently employed by the banking industry and large-scale commercial enterprises. 

—Enhance the discovery and validation of new targets of genes and proteins critical to cancer development. 

NCI could deploy a more modern and integrated infrastructure for cancer clinical 

trials. This clinical research infrastructure could: 

—Strengthen collaborations with industry, FDA, Centers for Medicare and Medicaid Services, and other public, private, academic, and patient advocacy organizations to oversee the conduct of cancer clinical trials. 

—Develop new infrastructure and procedures to standardize, coordinate, and 

track clinical trials development and accrual across all NCI-supported clinical 

trials. 

—Increase utilization of imaging tools in screening and therapy trials, evaluate 

new imaging probes and methodologies, enable access to the imaging data from 

trials in an electronic format, and facilitate evaluation of image-guided interventions. 

—Expand access and improve the timeliness for completion of the highest priority 

clinical studies. 

—Foster the development of a cadre of established clinical investigators who could 

work between bench and bedside. 

—Pilot new approaches and develop prototypes for clinical trials networks that 

could improve the efficiency, coordination, and integration of our national efforts. 

—Develop a common clinical trials informatics platform that could be made available to the full range of investigators working within the cancer clinical trials 

system. 

NCI plans to accelerate the expansion and integration of the NCI-designated Cancer Centers program, including the addition of 14 new Cancer Centers, increasing 

the number of centers to 75. The Cancer Centers program could: 

—Implement progressive bioinformatics and communication systems to achieve 

horizontal integration. 

—Fund additive programs in collaborative, multidisciplinary research, and require 

integration and sharing of results. 

—Broaden the geographic impact of the centers, networks, and consortia and 

vertically integrate them with community and regional health care delivery systems. 

—Improve the access of minority and underserved populations to state-of-the-art 

research and resources. 

—Create and strengthen partnerships with government agencies and community 

organizations. 

—Broadly provide expertise and other resources to caregivers, patients and families, and appropriate health agencies. 

In addition to appropriations, flexible legislative authorities related to exemptions 

from specific parts of current procurement, grant review and processing, and licensing and patenting rules could also help accelerate progress. A streamlined procurement process could facilitate the acquisition of materials and services to support the 

R&D activities. Technology development could also be enhanced by sufficient flexibility and integration to enable interactions among a wide array of laboratories and 

other entities. Expedited review procedures and workflow processing could help to 

award funds in sequence as needed. Coordination of the licensing and patenting activities among grantees, contractors, and the intramural program could also be useful for many of the multicomponent technology platforms that could be created 

through an advanced technology effort. 
196 

WOMEN’S HEART DISEASE

Senator SPECTER. Let me turn now to Dr. Nabel. What have the 

results been with the Women’s Health Study? With respect to heart 

disease, we know that women are affected differently. I want the 

record to note that my question ends with no red light, but you can 

proceed. 

Dr. NABEL. Thank you, Mr. Chairman. 

The women’s health initiative was an important study conducted 

over 15 years with 161,000 women in this country ages 50 to 79 

participating. We gathered important information about heart disease, the number one killer of women in this country. 

From other studies, we realize that heart disease often manifests 

itself in women differently than men. We have come to recognize 

what those symptoms are. We have come to recognize that some of 

the diagnostic tests have to be different and we have come to recognize that some of the treatments have to be specifically focused towards women. 

These studies have given us a tremendous amount of information. We now have engaged in a very large public awareness education campaign and we are in the midst of helping women to understand what their risks are for heart disease and how to seek 

help when they need it. 

Senator SPECTER. Thank you. 

Senator Harkin. 

NATIONAL CHILDREN’S STUDY

Senator HARKIN. Thank you, Mr. Chairman. 

Dr. Zerhouni, of all the proposed cuts in the budget there is one 

that I think may be discouraging than all the rest, and that is the 

planned elimination of the National Children’s Study. We passed 

this legislation back in 2000. It was going to be the largest longterm study of children’s health ever conducted in the United 

States. It was going to involve 100,000 children from before birth 

to adulthood. The idea was to better understand the link between 

the environments where the children are raised and their physical 

and emotional health and development. 

We have already spent about $50 million planning the study, 4 

to 5 years of planning on it. Now I understand that the study is 

going to stop. Why is that? 

Dr. ZERHOUNI. Well, the study has had a pilot phase to evaluate 

feasibility. The issue really is, you are talking about a very long 

study with a large budgetary impact, and at the end it was just a 

matter of budgetary priorities which led to the decision of not completing the pilots at this time, but to look at other times when the 

budgets will be easier. 

Senator HARKIN. I understand that the budgetary impact was 

$70 million. Is that correct or not? 

Dr. ZERHOUNI. If you look at—the $70 million is not just a 1-year 

expenditure. In fact, you have to continue that expenditure. If you 

committed to that expenditure, Senator, then you have committed 

to the $3.2 billion or thereabouts total over the total study. Why? 

Because once you launch the study you have to continue recruitment of the 100,000 children, the parents, and so on. 
197 

So if you look on the screen that tries to describe the evolution, 

it is $69 million in 2007, $111 million in 2008, $192 million, $194 

million, and so on. So this is what led to the budgetary conclusion 

for these tight fiscal times. Committing to 2007 meant not just 

2007, but a whole series of budgetary commitments, and in the context of projections it was very hard to see how it would fit in. 

WOMEN’S HEALTH INITIATIVE

Senator HARKIN. Well, as you know, it was supposed to start by 

the end of this fiscal year. 

Dr. Nabel, how long was the women’s health initiative study? 

Dr. NABEL. 15 years, Mr. Senator. 

Senator HARKIN. 15 years. 

Dr. NABEL. Yes. 

Senator HARKIN. Obviously, we got a lot of good information out 

of it. 

Dr. NABEL. We sure did. 

Senator HARKIN. What did that cost, do you know? 

Dr. NABEL. In total, about $710 million. 

Senator HARKIN. For the 15 years. How many women did it 

cover? 

Dr. NABEL. 161,000 women. 

Senator HARKIN. This is 100,000 children and it was supposed to 

be how many years study? About 20—— 

Dr. ZERHOUNI. 21 plus 4, so about 25 years, and about $3.2 billion is the number I remember, but upwards of that. 

Senator HARKIN. Well, it seems to me from the women’s health 

initiative we learned the benefits of long-term studies, long-term 

longitudinal studies. It seems to me with everything that is impacting on obesity, to diabetes to mental health, kids and how they 

grow up, there is just a lot of things that need to be taken into account. If you do these studies, then you would be able to factor 

some of these things in after a longer period of time. 

I just find this very disturbing that we are cutting this program. 

I am hopeful that we can put this back in the budget. Maybe this 

is another result of the President’s budget. I do not know. Is that 

what it is? I am just asking it rhetorically. I do not expect an answer, but I am just asking this rhetorically. If that is what it is, 

then we have got to find the money to put back in there. 

This did not just come up. This is something that we had talked 

about for a long time with your predecessor and others, about getting this very long-term study done. We just assumed, at least I did 

anyway, that it was on track and that we were going to do it, and 

all of a sudden this year it pops up and it is going to be eliminated. 

EPA was coming in on the study, I think, also CDC was also going 

to partner in the study, if I am not mistaken. 

Dr. ZERHOUNI. No, you are not mistaken, Senator. It was a transgovernmental study. It was not just an NIH study. It really involved 14 different departments. Environmental health was important, genetic health was important. Education was involved as 

well. So 14 Federal agencies were involved. 

Senator HARKIN. Well, I am just wondering what kind of a priority would this be in the scheme of things. Is this just something 
198 

that we can just drop out the bottom, or is this really an important 

study to be done? Is it important or not? 

Dr. ZERHOUNI. So the issue is really an issue of prioritization, 

and you have a pilot phase study so we can evaluate whether or 

not to go forward. But you mentioned yourself the critical factor of 

sustaining success rates, and so in the context of those decisions 

you can see where, in a constant sum budget, studies like this will 

have a large impact on success rates across the board. Therefore, 

when you look at the investments that medical schools and others 

have made over the doubling period, what we are seeing is a large 

increase in demand for grants at the time when the supply for 

grants is sort of flattening. 

So the real tension right now is, how do you sustain a vibrant 

research enterprise across the board and at the same time look at 

issues like this one, which is a very valid issue to look at? That is 

what the tension is and that is where the budgetary decisions came 

up. 

Senator HARKIN. Thank you, Dr. Zerhouni. 

Thank you, Mr. Chairman. 

Senator SPECTER. Thank you very much, Senator Harkin. 

Senator Shelby. 

AUTOIMMUNE DISEASES

Senator SHELBY. Thank you, Mr. Chairman. 

I want to, doctor, focus on the area of autoimmune, specifically 

lupus. It is estimated that 1.5 million Americans suffer from lupus. 

Ninety percent of those being diagnosed are women. This is a terribly painful disease, as you well know. It has been about 40 years, 

it is my understanding, since a new drug has been developed and 

approved for treatment of lupus. Is there any hope in sight for new 

treatment, because this is in the area, as I understand it, of autoimmune, in which you do a lot of research? 

So how do we—first, what do you see down the road there? 

Dr. ZERHOUNI. This is an excellent, excellent question, in a field 

of research, autoimmune disease, that affects 5 to 8 percent of 

Americans. It is not just lupus, Senator. 

Senator SHELBY. It is all autoimmune, is it not? 

Dr. ZERHOUNI. Right, it is all autoimmune. It is a whole category 

of diseases that we are now beginning to understand. Breakthroughs over the past year indicate that we may have actually developed technologies where we could develop—we could detect 

years before the disease really starts the markers of the disease 

and maybe intervene earlier. 

What I would like to do is ask my colleague Dr. Fauci, who is 

the Director of the National Institute of Allergy and Infectious Diseases, who has a lot of knowledge in autoimmune diseases, to perhaps address some of that. 

Senator SHELBY. That would be good. Thank you, doctor. 

Dr. FAUCI. Thank you, Dr. Zerhouni. 

Senator Shelby, there are some very promising areas in the 

whole arena of autoimmune diseases. There is still a long way to 

go, but, very briefly, as Dr. Zerhouni mentioned in his opening 

statement, it falls within that area of predictive and ultimately preemptive and preventive, in the sense that we now are developing 
199 

rapidly, not only with lupus, much more sensitive diagnostic tests 

that can give you a feel for the ultimate evolution of an autoimmune disease. 

One among many therapeutic modalities that I would just submit 

for your consideration that we are very excited about is the whole 

area of what is called immune tolerance. Immune tolerance means 

that you manipulate the immune system to get it to not respond 

to a particular antigen. In other words, you tolerize it to it. 

This has been something that has been very exciting in animal 

studies. Now, with a network involving multiple institutes within 

the NIH, the immune tolerance network, we have been able to 

tolerize the body against rejecting transplanted organs. We found 

very rapidly that that can be applied to diseases of autoimmunity. 

PREDNISONE

Senator SHELBY. Is that what Prednisone does? 

Dr. FAUCI. Well, Prednisone is a drug that dampens globally the 

immune system. But we are talking about when we talk about tolerance, specifically training the body either not to reject an organ 

that is transplanted or not to respond to tissues that are self tissues. Patients should not respond to self antigens, but for reasons 

that relate to genetic, environmental, and other factors, they inappropriately react against their own tissues. 

So now we try to tolerize them and dampen the immune response only specifically for the particular tissue that they are attacking, not general immunosuppression, because one of the real 

problems with treating any autoimmune disease, if you induce a 

global immunosuppression you have a lot of complications that relate to immunosuppressive therapy, much the way cancer patients 

have complications related to chemotherapy. 

LUPUS

Senator SHELBY. What could you say to the 1.5 million or more 

lupus sufferers out there right now in the pipeline? 

Dr. ZERHOUNI. Well, if I may, Dr. Fauci, I would like to show you 

the evolution of our investments in lupus research. 

What I want to tell you is that there is really hope because, one, 

we have made advances in genomics that allow us to now identify 

some genetic factors in patients with lupus. Two, we really understand the immune response very specifically and we believe that 

the T-cells that respond in lupus may be a target for treatments. 

We also have research that suggests that perhaps a viral connection exists as well. 

So over the past 2 years, 3 years, there has been a multiplication 

of new ideas thanks to the doubling and many people looking at it. 

What we intend to do is sustain it. We have ideas of how to in fact 

focus on autoimmune diseases across NIH and do the basic research across all institutes that will serve every one of these diseases. 

So, Senator, it is a difficult disease. It is not an easy disease. If 

you have known anyone with lupus—— 

Senator SHELBY. My wife. 

Dr. ZERHOUNI. I am sorry, Senator. I did not know about that. 

It is something that we really care about. 
200 

Senator SHELBY. Thank you very much. 

Mr. Chairman, thank you. 

PROGRAM FUNDING

Senator SPECTER. Thank you, Senator Shelby. 

Obviously, we would like to have a lot more time to go into greater detail on many subjects. But what we would appreciate your 

doing is giving us a supplemental memorandum as to what the 

cuts will mean for your ongoing programs. I would like to share 

that with all of our colleagues in the House. Second, what it would 

take to adequately fund the issues you are working on and what 

you could accomplish with the figure you put on as being adequate. 

Dr. Zerhouni, your statistics are very impressive and the showing 

of a trillion dollars in savings compared to a modest investment, 

that is the kind of things Congress needs to hear. That is the kind 

of things which impresses the Congress. 

[The information follows:] 

PROGRAM FUNDING

Within the context of a deficit-reduction budget, the President’s Budget request 

had to weigh many competing priorities, and still proposed to hold spending for NIH 

at a straightlined level for fiscal year 2007. In fiscal year 2006, NIH reduced all 

noncompeting Research Project Grant (RPG) awards by ¥2.35 percent, and the average cost of competing RPGs was held at the fiscal year 2005 level. The fiscal year 

2007 President’s Budget Request provides no inflationary increases for noncompeting continuation awards and holds the average cost of competing RPGs to the 

fiscal year 2006 level, which could lead to an erosion of the research buying power 

of NIH research projects. Within its available funds, however, NIH is supporting the 

highest priority research activities, including making strategic investments in biodefense, the NIH Roadmap, a new program for new investigators, and the Clinical 

and Translational Sciences Award program. 

If additional funds were available above these priorities, such as an increase for 

fiscal year 2007 above the Biomedical Research and Development Price Index inflator of 3.8 percent, NIH would be able restore the buying power of its research program, and fund additional projects, from basic, translational, and clinical research 

to therapeutic development and advanced technologies. All of these activities could 

serve to advance our understanding of the mechanisms underlying human health 

and disease and contribute to improving human health. Examples of projects that 

were not funded in the President’s Budget Request, but could be undertaken are as 

follows: 

Large-scale Genome Study for Serious Mental Disorders.—This study could speed 

development of new effective treatments for the 13 million Americans suffering from 

seriously debilitating mental disorders that prevent people from participating in 

daily life at home, work, or social settings for over 80 days per year and results in 

early death or suicide for 30,000 individuals each year. 

Schizophrenia Treatment Research.—This proposed study could build on recent 

advances in schizophrenia treatment to determine whether an early intervention of 

aggressive pharmacotherapy, combined with focused rehabilitative efforts, can prevent long-term disability and suffering of schizophrenia, devastating mental illness 

affecting 2.4 million adult Americans. 

Protocols for Treating Autism Spectrum Disorders Early.—These studies could bolster efforts to determine the most effective treatment regimens to improve outcomes 

for children and families struggling with the life-long disability and pain of autism 

spectrum disorders. 

The Atherosclerosis Prevention Trial.—Although drugs to lower low-density 

lipoprotein (LDL) cholesterol levels are known to reduce the risk of major adverse 

cardiovascular events, it is not yet known whether additional benefits can be realized by lowering LDL cholesterol beyond current treatment guidelines. A multi-center, randomized clinical trial could determine whether aggressive lowering of lowdensity lipoprotein cholesterol beyond current treatment guidelines further reduces 

major adverse cardiovascular events. 

Program to Reduce Cardiovascular Disease Risk in Young Adults by Preventing 

Weight Gain.—Studies could develop and evaluate promising intervention ap-
201 

proaches for preventing weight gain in young adults, which is a major risk factor 

for cardiovascular disease (CVD) and associated CVD risk factors including elevated 

cholesterol, high blood pressure, and diabetes. 

Systolic Blood Pressure Intervention Trial.—Although drug treatment to lower 

blood pressure, both systolic and diastolic, is known to reduce CVD mortality, it is 

not yet known whether additional benefits can be realized by lowering systolic pressures beyond current treatment guidelines. A multi-center trial could determine 

whether treating systolic blood pressure to a lower goal than currently recommended further reduces cardiovascular disease mortality and morbidity, particularly for those aged 50 years and older in whom systolic blood pressure is more 

strongly associated with CVD risk than diastolic blood pressure. 

PREPAREDNESS FOR PANDEMIC INFLUENZA

Senator SPECTER. Dr. Fauci, if you would supplement what you 

have testified to on pandemic flu. There is enormous concern in 

this country today and we would like to know to what extent are 

we prepared. Being prepared is a tough subject to answer, but to 

what extent are we prepared. When you say that more funding 

would be of material assistance, I think there is something that we 

are prepared to fund. 

Senator Harkin took the lead and put a figure of $7 billion. We 

came close to $6 billion, and contracts have been let for five big 

companies for a billion dollars. It is scary. It could be devastating. 

So let us know, and this subcommittee is prepared to take the lead 

again. 

[The information follows:] 

PREPAREDNESS FOR PANDEMIC INFLUENZA

The Department has made great strides to improve the Nation’s preparedness for 

a pandemic influenza outbreak. For example, HHS has stockpiled roughly 8 million 

doses of vaccine against one H5N1 virus strain. Given, a two-dose vaccination schedule, this would allow vaccination of 4 million people. The Department also recently 

invested more than $1 billion in the development of cell-based vaccine technology; 

shifting from the current egg-based technology is critical to quickly producing vast 

quantities of vaccine should a pandemic develop. Our goal is to build the capacity 

to vaccinate all 300 million Americans within 6 months of a pandemic outbreak. The 

Strategic National Stockpile now contains sufficient antivirals to treat nearly 7 million people, and with another 19 million courses on order, it should contain 26 million courses by the end of 2006. HHS is also enabling States and other entities to 

purchase up to 31 million antiviral treatment courses off of the Federal contract. 

Our goal is to have enough antivirals on hand for 25 percent of the population, or 

approximately 75 million individuals. In addition, we have purchased 150 million 

N95 respirators, surgical masks and other personal protective equipment. Planning 

summits have been held in all but two States, and almost every State has either 

a draft or final pandemic flu plan in place. As Secretary Leavitt has stated, ‘‘Preparation is a continuum. Every day we prepare brings us closer to being ready. We 

are better prepared than we were yesterday. And we must be better prepared tomorrow than we are today.’’ 

The National Institute of Allergy and Infectious Diseases (NIAID) is a major component of these preparation efforts. For example, NIAID has made progress in the 

development of an H5N1 influenza vaccine. NIAID-supported researchers at St. 

Jude Children’s Research Hospital obtained a clinical isolate of a highly virulent 

H5N1 influenza virus in Vietnam in early 2004, and used a technique called reverse 

genetics to create a non-virulent vaccine reference strain from this isolate. NIAID 

then contracted with sanofi pasteur and Chiron Corporation (now Novartis) to manufacture pilot lots of the inactivated virus vaccine for use in clinical trials. The 

sanofi pasteur vaccine has been tested in healthy adults and is currently in clinical 

testing in healthy elderly people and children. The Chiron vaccine is currently in 

clinical testing in healthy adults. 

Results from the trial of the sanofi pasteur vaccine in healthy adults provide both 

good and sobering news. The good news is that the vaccine is well-tolerated, and 

induces an immune response that augurs well for protecting people against the 

H5N1 virus. The sobering news is that larger doses of the H5N1 vaccine than typi-
202 

cally used for yearly influenza vaccine are needed to elicit immune responses in the 

majority of people that would be predictive of protection. However, preliminary results from a Phase I clinical trial of an H9N2 influenza vaccine candidate made by 

Chiron suggest that addition of an adjuvant—a vaccine component that increases 

the immune response—may help to reduce the required dose. Clinical trials of H5N1 

candidates using adjuvants and other strategies to improve immune responses at 

lower doses of vaccine are ongoing or imminent. 

In addition, NIAID intramural researchers are working with colleagues from 

MedImmune, Inc. under a Cooperative Research and Development Agreement 

(CRADA) to produce and test multiple vaccine candidates for potential pandemic influenza strains, including H5N1 strains. The researchers have developed three liveattenuated H5N1 vaccine candidates, designed for nasal spray delivery, that have 

been shown to be protective in mice. The CRADA capitalizes on the long history of 

NIAID research and development of respiratory virus vaccines, including fundamental research that was key to the development of FluMist®, the licensed nasal 

spray influenza vaccine manufactured by MedImmune. The researchers have produced a clinical lot of a candidate H5N1 vaccine based on a strain isolated in Vietnam in 2004, and clinical trial of this vaccine is expected to begin later this year. 

NIAID also supports a number of basic and applied research projects that could 

lead to significant advances in the development and production of vaccines against 

potential pandemic strains of avian influenza. This includes investigation of cell culture-based vaccine production as an alternative to chicken egg-based vaccine production—as noted above, an endeavor to which the Department of Health and Human 

Services recently committed $1 billion that was awarded to several pharmaceutical 

companies. In addition, NIAID conducts and supports research into new vaccine 

platforms, including recombinant subunit vaccines, in which cultured cells are induced to make various influenza virus proteins that are then purified and used in 

a vaccine; gene-based vaccines, in which influenza genetic sequences are injected directly into a person to stimulate an immune response; and vector approaches that 

insert the genes of influenza virus into another non-virulent virus (the vector) and 

inject the vector vaccine as a carrier to present the influenza proteins to the vaccine 

recipient. For example, a gene-based influenza vaccine developed by researchers at 

the NIAID Vaccine Research Center is expected to enter Phase I clinical trials later 

in 2006. 

In addition to efforts to develop vaccines against potential pandemic influenza 

strains, NIAID is supporting basic and applied research to develop improved 

antiviral drugs against influenza. These efforts include a screening program for new 

drugs, as well as targeted drug development and clinical trials. NIAID-supported researchers are conducting studies of varying doses and combinations of existing 

antiviral medications, developing and testing long-acting next-generation antivirals, 

and evaluating novel drug targets for potential prevention and treatment of influenza using in vitro and animal models. 

Because a pandemic influenza virus could emerge anywhere in the world, NIAID 

helps to conduct global surveillance and molecular analysis of circulating influenza 

viruses. For example, NIAID funds a long-standing program to detect the emergence 

of influenza viruses with pandemic potential, in which researchers in Hong Kong 

and at St. Jude Children’s Research Hospital collect and analyze influenza viruses 

from wild birds and other animals in Asia and North America and generate candidate vaccines against them. 

NIAID is also supporting a collaborative effort to release full genomic sequence 

information for several thousand influenza viruses to the public domain. More than 

1,000 influenza viruses have been sequenced. Readily available sequence data will 

allow researchers to further study how influenza viruses evolve, spread, and cause 

disease, which may ultimately lead to improved methods of treatment and prevention; identify specific characteristics of previous pandemic strains, which may help 

focus preparedness efforts; and identify genes that are highly conserved among various strains, and therefore act as possible targets for broadly protective therapeutics 

or vaccines. 

Lastly, NIAID is collaborating with Oxford University, the Wellcome Trust and 

the World Health Organization to establish a small network of clinical sites in 

Southeast Asia to conduct clinical research on avian influenza and other emerging 

infectious diseases. A key purpose of the effort is to build an independent clinical 

research capacity in these countries. Five sites in Vietnam, four sites in Thailand 

and two in Jakarta will be established. 

Senator SPECTER. I had thought it would be helpful if you stayed 

to hear the other testimony, but now that we have given you this 
203 

homework your time is too valuable. So we will stay and forge on 

alone. 

Thank you very much for coming in. Thank you for what you are 

doing for America and the world. 

Senator SHELBY. Mr. Chairman, can I just take 1 second? 

Senator SPECTER. Certainly. 

Senator SHELBY. I just want to commend you for bringing all 

these people together. This is a blue ribbon panel if I have ever 

seen one and I have seen a lot of panels in the Congress, as you 

have. We appreciate what NIH has done and we will be ashamed 

of ourselves if we do not properly fund you for the benefit of the 

American people. 

Senator SPECTER. That is high praise coming from Senator Shelby because he usually deals with bankers. 

Senator SPECTER. Senator Harkin. 

MULTI-BUG APPROACH ON VACCINES

Senator HARKIN. Mr. Chairman, I want to thank the panel and 

all the people from NIH for coming down here today. 

Dr. Fauci, in your supplement that the chairman spoke to you 

about, I wanted to delve a little bit into the multi-bug approach on 

vaccines that I understand you are working on, rather than just 

the one bug, one vaccine approach. So I would like to know a little 

bit more about that and where that stands. 

Dr. Collins, in regards to—there is some interesting work going 

on in terms of the relating of genes and environment. I know you 

are doing some stuff on that and I would also like to be kind of 

brought up to speed on that, too, if you could submit that. 

Thank you. 

[The information follows:] 

MULTI-BUG APPROACH ON VACCINES

The National Institute of Allergy and Infectious Diseases (NIAID) is supporting 

research and development of alternate approaches to dealing with the threat of 

emerging and re-emerging infectious diseases such as influenza. 

For example, NIAID is pursuing the development of a ‘‘universal vaccine’’ that 

protects against multiple virus strains such as those resulting from antigenic drift 

associated with seasonal influenza and antigenic shift associated with pandemic influenza. As influenza viruses circulate, the genes that determine the structure of 

their surface proteins undergo small changes. Sometimes the change in the genes 

results in a slight change in the antigenic properties of the protein, a process commonly referred to as ‘‘antigenic drift’’. Antigenic drift is the basis for the changes 

in seasonal influenza observed during most years, and is the reason that we must 

update influenza vaccines annually. Influenza viruses also can change more dramatically. For example, viruses sometimes emerge that can jump species from natural reservoirs, such as wild ducks, to infect domestic poultry, farm animals, or humans. When an influenza virus jumps species from an animal, such as a chicken, 

to infect a human, the result is usually a ‘‘dead-end’’ infection that cannot readily 

spread further in the human population. However, mutations in the virus could develop that allow human-to-human transmission. Furthermore, if an avian influenza 

virus and another human influenza virus were to simultaneously co-infect a person 

or animal, the two viruses might swap genes, possibly resulting in a virus that is 

readily transmissible between humans, and against which the population would 

have no natural immunity. These types of significant changes in influenza viruses 

are referred to as ‘‘antigenic shift.’’ When an ‘‘antigenic shift’’ occurs, a global influenza pandemic can result. Historically, pandemic influenza is a proven threat. In 

the 20th century, influenza pandemics occurred in 1918, 1957, and 1968. 

The NIAID is supporting a number of research projects to develop a vaccine that 

induces a potent immune response to the common elements of the influenza virus 
204 

that undergo very few changes from season to season and from strain to strain. Although this is a difficult task, such a ‘‘universal’’ influenza vaccine would not only 

provide continued protection over multiple seasons, it might also offer protection 

against a newly emerged pandemic influenza virus and thus substantially reduce 

the susceptibility of the population to infection by any influenza virus—making the 

country far less vulnerable to influenza viruses emerging from avian and other animal sources. 

One relatively stable element of the influenza virus is a protein called M2. The 

external portion of the M2 protein is very similar in influenza viruses from year to 

year and from strain to strain. A ‘‘universal’’ influenza vaccine targeting the M2 protein, or other conserved elements, could be protective against a range of influenza 

strains. NIAID-supported researchers have demonstrated that vaccines made with 

bioengineered versions of M2 can protect mice from lethal influenza virus. The scientists now are testing cross-reactivity between different species and strains of influenza, examining how long the immunity provided by these vaccines lasts, and 

evaluating whether the influenza viruses can evade these vaccines by developing 

mutations in their M2 proteins. 

In addition, researchers at the NIAID Vaccine Research Center (VRC) are developing and testing gene-based influenza vaccines that will protect against multiple 

strains of influenza. As a first step, initial candidate vaccines, each containing the 

gene encoding the hemagglutinin (H) surface protein of an influenza virus isolated 

from a recent human outbreak of influenza (H1N1, H3N2 or H5N1), have already 

shown promise in animal studies. VRC researchers plan to develop additional genebased vaccines for all common variants of hemagglutinin, as well as other influenza 

viral proteins, such as nucleoprotein and the M2 protein. In future, the VRC will 

incorporate both conserved and variable genes from multiple influenza strains into 

DNA and adenovirus vectors that can readily be produced by existing manufacturing processes. 

A second approach, while not technically a vaccine, is an immune enhancer which 

specifically targets a component of the immune system and enhances one’s ability 

to respond to a broad range of microbial threats. Studies of the human innate immune system, which is comprised of ‘‘first responder’’ cells and other defenses that 

provide a first line of defense against a wide variety of pathogens, have been moving 

forward rapidly. These advances suggest it may be possible to develop a relatively 

small set of fast-acting, broad-spectrum countermeasures that can boost innate immune responses to many pathogens or toxins, including influenza. The capability to 

boost the innate immune system also could lead to the development of more powerful vaccine additives, called adjuvants, that can increase vaccine potency. The concept of immune enhancers has been demonstrated in early stage clinical studies, but 

requires further research and development to be applied to pandemic influenza vaccination. 

GENES, ENVIRONMENT, AND HEALTH INITIATIVE

On February 8, 2006, HHS Secretary Leavitt announced that the President’s 

budget proposal for fiscal year 2007 included $68 million for the Genes, Environment and Health Initiative (GEI), a research effort by the National Institutes of 

Health (NIH) to combine a type of genetic analysis and environmental technology 

development to understand the causes of common diseases such as asthma, arthritis, many types of cancer, diabetes, and Alzheimer’s disease. This represents a $40 

million increase above the $28 million already planned for such efforts by the NIH 

for fiscal year 2007. 

If approved by Congress, $26 million of the requested $40 million increase in 

funding would go to genetic analysis and $14 million to the development of new 

tools to measure environmental exposures that affect health. The discoveries made 

through these efforts can potentially lead to profound advances in disease prevention and treatment. By seizing the historic opportunity provided by the Human Genome Project and the International HapMap Project, this initiative would speed the 

discovery of genetic risk factors for common diseases. But, as it has been said, genetics loads the gun; environment pulls the trigger. GEI will also provide markedly 

improved ways to measure and analyze the environmental contribution to disease, 

so that we can understand the complex interplay among genes and environment 

that is responsible for all human health and disease. 

The NIH has recently formed a Coordinating Committee of representatives from 

13 Institutes and Centers that would develop the content, priorities, and implementation of the initiative, should it be approved by the Congress. Similar to the management of NIH Roadmap initiatives, specific functions of the Coordinating Committee include: (a) identification of research priorities and opportunities relevant to 
205 

the program, (b) guidance and support of the development and implementation of 

specific research initiatives related to the program, (c) evaluation of proposals for 

specific activities to be conducted under the auspices of the program, and (d) facilitation of appropriate NIH-wide communication of program goals, initiatives, and findings. Two subcommittees have been formed, one to focus on the genetics component 

of GEI and the other to focus on its environmental component. These subcommittees 

will do the necessary planning for the proposed program during the current year 

and will be prepared to help administer the initiative, provided fiscal year 2007 

funds are made available. Attached is a breakdown of the proposed budget for the 

initiative. Since the initiative is so early in its planning stages, the number of 

grants that would be awarded eventually is not known at this time. 

Through initiatives such as GEI, we stand on the threshold of creating a future 

that would revolutionize the practice of medicine by allowing us to predict disease, 

identify environmental triggers, develop more precise therapies and, ultimately, prevent the development of disease in the first place. 

Senator SPECTER. Thank you all very much. 

We turn now to our next panel: Dr. Knapp, Dr. Auerbach, Dr. 

Chao, Dr. Comstock, Dr. Emerson, Ms. Eng, and Dr. Fox. 

We have taken the unusual step of inviting 20 witnesses to this 

hearing to give us a bird’s eye view or a thumbnail sketch, to mix 

metaphors, as to what is happening in specific lines of medical research. We have allocated as much time as we can, consistent with 

the schedule. It is not enough. 

Dr. Knapp represents the entire group on medical research and 

there has been an allocation of 3 minutes for him and an allocation 

for every other witness, regrettably, of only a minute and a half. 

But that is the best we can do, and you have submitted written 

statements, all of which will be made a part of the record, and that 

will give us an opportunity to have some insights on your views 

and what is happening in your specific fields. 

We are going to just indicate the group you are associated with, 

as opposed to going over your curriculum vitae’s, which are all 

very, very impressive. Dr. Knapp, we start with you, representing 

the Ad Hoc Group for Medical Research. 

STATEMENT OF RICHARD M. KNAPP, M.D., CHAIR, AD HOC GROUP FOR 

MEDICAL RESEARCH 

Dr. KNAPP. Good morning. My name is Dick Knapp and I chair 

the Ad Hoc Group for Medical Research. 

Mr. Chairman, all Americans owe you and Senator Harkin an 

enormous debt of gratitude for your unwavering commitment to 

medical research and your continued leadership in the support of 

the NIH, and we applaud your efforts to add funds to the 2007 

budget to permit a $2 billion increase in NIH funding. 

The President’s budget claims to freeze NIH at the 2006 level, 

but for almost all NIH institutes and centers this budget represents a cut, not a freeze. This budget proposal represents the 

fourth consecutive year that NIH funding has failed to keep pace 

with inflation. In inflation-adjusted dollars, as you pointed out, Mr. 

Chairman, this budget represents a loss of almost 11 percent of 

purchasing power since 2003. 

Mr. Chairman, we are well on our way to undoubling the NIH 

budget that you and your colleagues fought so hard to achieve. As 

you heard from Dr. Zerhouni, NIH-funded research is driving the 

transformation of the practice of medicine. At a time of unparalleled scientific opportunities and unprecedented health challenges, 

NIH should be positioned to support more research, not less. Yet, 
206 

under this President’s budget NIH would fund 10 percent fewer 

competing research project grants in 2007 than 4 years ago. 

Because new investigators are essential to NIH’s future, as Dr. 

Zerhouni pointed out, NIH-sponsored training should be supported 

as a top priority. However, due to fiscal constraints, the NIH has 

been unable to meet the stipend recommendations it made in 2001, 

and the President’s budget proposes no stipend increases in 2007. 

The flattening of the NIH budget also undermines the Nation’s 

biomedical research infrastructure. Mr. Chairman, and you Senator 

Harkin have emphasized the need for increased support for the 

renovation and construction of extramural research facilities and 

the acquisition of state of the art laboratory instrumentation. Yet 

this budget again fails to request funds for the NIH extramural facilities program and the budget proposes to cut funding for shared 

instrumentation grants by nearly 8 percent below the level of 2005. 

This morning’s witnesses will describe how NIH research has 

safeguarded and improved the lives of all Americans while at the 

same time serving as a catalyst for new products and technologies, 

creating skilled jobs and contributing to the Nation’s economic 

growth. 

PREPARED STATEMENT

We share your concern that the continued flattening of the NIH 

budget threatens further progress in all of these areas. Thank you 

for the chance to be here. 

[The statement follows:] 

PREPARED STATEMENT OF RICHARD M. KNAPP

Mr. Chairman and members of the subcommittee, my name is Dick Knapp, and 

I chair the Ad Hoc Group for Medical Research Funding, a coalition of more than 

300 patient and voluntary health groups, medical and scientific societies, academic 

and research organizations, and industry. The Ad Hoc Group is pleased to have the 

opportunity to provide an overview of the President’s fiscal year 2007 budget for the 

National Institutes of Health (NIH). 

Mr. Chairman, the members of the Ad Hoc Group, and indeed, all Americans, owe 

you and Senator Harkin an enormous debt of gratitude for your unwavering commitment to medical research and your continued leadership in support for the NIH. 

We share your belief that much of what has been accomplished in the past half century to help save lives and improve the health of all Americans can be attributed, 

directly or indirectly, to the NIH. And we applaud your efforts to add funds to the 

fiscal year 2007 budget resolution to permit a $2 billion increase in the NIH budget. 

In January, the Ad Hoc Group joined four other major medical research advocacy 

groups in calling for the NIH budget to be increased by a minimum of $1.4 billion 

(5 percent) in fiscal year 2007. 

The President’s budget for fiscal year 2007 proposes $28.35 billion in budget authority through this subcommittee for the NIH, which is an increase of less than 

$1 million over the current year’s level. Much has been made of this proposal for 

flat funding. But for most areas of research, this budget represents a cut, not a 

freeze. Under the President’s proposal, the fiscal year 2007 budgets for almost all 

NIH institutes and centers would be reduced below the fiscal year 2006 levels. 

In addition, it is important to recognize that this year’s budget is not a one-year 

aberration. The President’s overall request is $64.5 million less than what NIH received in fiscal year 2005, and the proposed budgets for most institutes and centers 

are between 1 and 1.5 percent lower than two years ago. If adopted, the President’s 

budget would represent the fourth consecutive year that NIH funding has failed to 

keep pace with inflation as measured by the Biomedical Research and Development 

Price Index. In fact, in terms of inflation-adjusted dollars, the President’s budget 

represents a loss of 11 percent of purchasing power since 2003, as shown in the attached graph. Mr. Chairman, we are well on our way to ‘‘undoubling’’ the NIH budget that you and your colleagues fought so hard to achieve. 
207 

It is the cumulative effect of this multi-year ‘‘flattening’’ of the NIH budget that 

is cause for concern. The flattening has had and would continue to have a severe 

impact across the pillars of NIH: basic research, translational and clinical research, 

research training, and the research infrastructure. 

NIH-funded researchers have blazed new trails for medical research. Basic research forms the knowledge foundation needed to achieve continued scientific advancement. And as you have heard from Dr. Zerhouni, the discoveries resulting 

from the investment in NIH-funded research are driving the transformation of the 

practice of medicine through the development of novel and personalized therapies, 

cures, and prevention strategies. 

According to the Congressional Justification accompanying the President’s budget, 

in fiscal year 2007 NIH will be able to support 37,671 total research project grants 

(RPGs). This is 1,570 fewer RPGs than NIH funded in fiscal year 2004. What is 

more critical is the reduction in the number of new and competing RPGs. Under 

the President’s budget, NIH will be able to award 9,337 competing RPGs in fiscal 

year 2007, a decrease of 1,074 compared to fiscal year 2003. This is 10 percent reduction in just four years. At a time of unparalleled scientific opportunities and unprecedented health challenges, NIH should be positioned to support more research, 

not less. 

In addition, a key function of NIH is to support training awards to encourage new 

investigators into basic and clinical medical research careers. Because an influx of 

new investigators is essential to NIH’s future, NIH-sponsored training opportunities 

should be supported as a top priority, with realistic funding levels for stipends, tuition, and benefits. Under the President’s budget, the NIH will be able to support 

17,499 full-time training positions (FTTPs) in the Ruth L. Kirschstein National Research Service Award (NRSA) program. This is a reduction of 139 since fiscal year 

2005. Furthermore, in 2001 the NIH recommended increased stipend support for 

NRSA recipients; however, the agency has been unable to meet these objectives due 

to fiscal constraints. For example, stipends for pre-doctoral students and post-doctoral fellows have fallen significantly short of NIH’s targets, and the President’s 

budget provides no increases for stipends above the fiscal year 2006 levels. How are 

we to continue to attract the best and brightest students with stipends that are unduly low in view of the high level of education and professional skills involved in 

biomedical research? 

The flattening of the NIH budget also undermines the nation’s biomedical research infrastructure. NIH extramural research infrastructure grants are essential 

if research institutions are to update or replace aging research laboratories. Senator 

Harkin recognized the critical importance of the research infrastructure to the continued leadership of the United States in medical research when he championed the 

Twenty-First Century Research Laboratories Act, which was enacted in 2000. This 

legislation emphasized the need for increased support for the renovation and construction of extramural research facilities and the acquisition of state-of-the-art laboratory instrumentation. Yet once again, the President’s budget fails to request 

funds for the peer-reviewed, competitively awarded, extramural research facilities 

grant program administered through NIH’s National Center for Research Resources. 

Federal funding also is critical to equip core facilities at biomedical research institutions with state-of-the-art technologies. NIH administers two competitive grant 

programs that award funds to institutions to purchase present and emerging technologies: the Shared Instrumentation Grant Program for groups of NIH-supported 

investigators to obtain commercially-available equipment that costs more than 

$100,000; and the High-End Instrumentation Grant Program to acquire more expensive equipment, such as structural and functional imaging systems, electron microscopes, and supercomputers. These grants maximize the utility of federal research 

funds by allowing a number of scientists with similar instrumentation needs to 

share such equipment, and promote interactions among scientists, frequently across 

scientific disciplines, thereby catalyzing mutually rewarding new research collaborations. Yet, the President’s budget proposes to reduce funding for these programs to 

$64.4 million, which is 7.7 percent below the fiscal year 2005 level. 

This morning’s witnesses will give specific examples of how the research supported and conducted by NIH has had a profound and far-reaching impact on society 

in many important ways, serving as a catalyst for new products and technologies, 

creating skilled jobs, contributing to the nation’s economic growth, and most importantly, safeguarding and improving the lives of all our citizens. Mr. Chairman, we 

share you concern that the continued flattening of the NIH budget as proposed by 

the President threatens further progress in all of these areas. 
208 

Senator SPECTER. Thank you, Dr. Knapp. 

Dr. Judith Auerbach, representing the Foundation for AIDS Research. 

STATEMENT OF JUDITH AUERBACH, Ph.D., VICE PRESIDENT, PUBLIC 

POLICY AND PROGRAM DEVELOPMENT, AMFAR, THE FOUNDATION FOR AIDS RESEARCH 

Dr. AUERBACH. Good morning, Mr. Chairman, and thank you 

very much. I am Judy Auerbach from amFAR and I will speak very 

quickly since we have only 90 seconds. 

There are now more than 1 million HIV-infected people in the 

United States and the rates of HIV infection have risen dramatically among vulnerable populations, including racial and ethnic minority women and men. To make headway in the fight against 

AIDS, we need a strong Federal commitment to research leading 

to more effective treatment and prevention methods. 

During the doubling of NIH’s budget, the Agency was able to expand the knowledge base in basic research focusing on human immunology, macromolecular biology, structural biology, and behavioral research. This led to a dramatic increase in the number of 

vaccine and therapeutic candidates in the pipeline and to the implementation of crucial HIV prevention trials in populations most 

at risk of infection. 

But much of this progress is in jeopardy with current and proposed cuts. Factoring in the recent recalculation, AIDS research at 

NIH was cut by about 2.4 percent between 2005 and 2006 and will 

be cut another 6 percent under the President’s 2007 request. This 

has grave consequences for grants overall, for expanded trials of 

promising prevention technologies and therap eutics, and for new 

and seasoned investigators. 
209 

The number of R01’s in AIDS research decreased by 5 percent in 

both numbers and dollars from 2005 to 2006 and would decrease 

even further in 2007. Under current budget constraints, it is anticipated that the AIDS clinical trials networks will be allocated only 

about 54 percent of what it is estimated they will need over the 

next 7 years. This means important effectiveness trials of new prevention technologies and new therapeutics will not be launched. 

Research institutes are losing potential new investigators and more 

experienced ones are demoralized, knowing that the majority of 

submissions are triaged and unscored and that funding is not likely 

until resubmission, even if then. 

So altogether this means that important AIDS research will not 

be undertaken and people at risk for or living with HIV and AIDS 

will not have access to lifesaving interventions. 

My time is over, so I will stop there. Thank you. 

Senator SPECTER. Thank you, Dr. Auerbach. 

Dr. Moses Chao, Christopher Reeve Foundation. 

STATEMENT OF MOSES CHAO, M.D., CHRISTOPHER REEVE FOUNDATION 

Dr. CHAO. Thank you, Mr. Chairman. 

In the past 10 years we have witnessed a remarkable turnaround 

in neuroscience research. It used to be dogma that the adult spinal 

cord could not regenerate or recover from serious injury. But now 

through basic research we know of specific genes, proteins, and 

cells that can stimulate the repair of the spinal cord, and we are 

now ready to convert these findings into new therapies. 

But the United States is falling behind because of the decrease 

in NIH funding. The decrease has affected many scientists, including my own lab, because the level of funding has actually dropped 

to 10 percent. What that means is 1 out of 10 grants is being funded and that has produced some drastic consequences, because 

many innovative applications and promising experiments are not 

supported or carried out. 

More distressingly, there is a huge negative impact on the recruitment of our next generation of young scientists because of this 

discouraging situation. So we believe that this is the time to invest 

in basic research to advance the progress that we have made in 

this area. Christopher Reeve often argued that what we learn 

about spinal cord regeneration has direct implications to many diseases, including glaucoma, Alzheimer’s disease, and Parkinson’s 

disease. Therefore, to put the brakes on funding basic research will 

interfere with new scientific discoveries that will be aimed at improving the health of all Americans. 

Thank you. 

Senator SPECTER. Thank you, Dr. Chao. 

Ms. Amy Comstock, Parkinson’s Action Network. 

STATEMENT OF AMY L. COMSTOCK, CHIEF EXECUTIVE OFFICER, PARKINSON’S ACTION NETWORK 

Ms. COMSTOCK. Good morning. Thank you, Chairman Specter 

and Senators Harkin and Shelby. I am Amy Comstock, the Chief 

Executive Officer of the Parkinson’s Action Network, and I am here 

on behalf of Parkinson’s patients, their families, and all of the national Parkinson’s organizations. 
210 

Parkinson’s disease is now listed among the 15 leading causes of 

death in this country. Yet there is still no cure and no known treatments that even slow the progression of the disease. In fact, since 

the introduction of dopaminergic treatments nearly 50 years ago, 

our community is still struggling with mere variations of that 

treatment for this progressive disease. 

Even with the introduction of deep brain stimulation for Parkinson’s disease, we are still only responding to the symptoms of the 

disease and not doing that very well sometimes, and certainly not 

for a long duration. 

So I am here this morning, quite frankly, to use the word that 

we are terrified of flat funding at NIH. Not only will flat funding 

eat into all forms of research currently under way at NIH, but we 

are particularly fearful that it will have a disproportionate impact 

on clinical and translational research, which is exactly the kind of 

research that we need the most. 

Clinical research is very expensive to conduct, but it is what we 

have to have in order for treatments to make it through the drug 

development pipeline and become available to patients. For example, there is a handful of drugs slated for clinical trials right now 

at NIH that in fact may be what we need so badly. They may be 

compounds that can slow the progression of the disease. 

PREPARED STATEMENT

We have to have these trials, but we cannot have them without 

funding. With flat funding, even if those trials are conducted—we 

have to do the math—other research would be cut at NIH. Therefore, we strongly support a minimum of 5 percent increase for NIH. 

Thank you. 

[The statement follows:] 

PREPARED STATEMENT OF AMY L. COMSTOCK

Thank you Chairman Specter, Ranking Member Harkin, and distinguished members of the Subcommittee for convening this hearing on NIH appropriations. I am 

the Chief Executive Officer of the Parkinson’s Action Network (PAN). PAN represents the Parkinson’s community, including the more than one million Americans 

currently fighting Parkinson’s disease (PD), and their families, and the national 

Parkinson’s organizations, such as The Michael J. Fox Foundation for Parkinson’s 

Research, Parkinson’s Disease Foundation, National Parkinson Foundation, Parkinson Alliance, and American Parkinson Disease Association. 

As I am sure you all you know, PAN was instrumental in helping garner Congressional support for this Subcommittee’s doubling of the NIH budget over five years 

during the late 1990’s and early in this decade. We continue to work in conjunction 

with so many to prevent the proposed freeze in funding for NIH. Flat-funding 

would, in effect, constitute a significant cut, as the Biomedical Research and Development Price Index (BRDPI) is estimated to have increased by 5.5 percent for fiscal 

year 2005, and will likely increase by 4.1 percent for fiscal year 2006, and 3.8 percent in fiscal year 2007. Accordingly, in order to not lose ground in ongoing research, we support the medical research advocacy community’s recommendation for 

a 5 percent increase above the fiscal year 2006 funding level for the National Institutes of Health. 

We cannot turn our backs on our most promising research, which may happen if 

this funding is not provided. The Parkinson’s community is particularly concerned 

with several clinical trials that may be eliminated without sufficient funding and 

direction. 

These clinical trials are a part of a study going on at NIH right now that embody 

the kind of translational research most promising to the Parkinson’s community and 

is desperately needed. NET–PD (Neuroprotection Exploratory Trials in Parkinson’s 

Disease) is a trial to study compounds that may slow the progression of Parkinson’s 
211 

disease. Research into treatments that might slow progression is particularly important as current treatments for PD alleviate some symptoms but do not slow progression of the disease. Despite the potential value, this program may be halted or cut 

back if NIH does not receive adequate funding. Yet, NET–PD is exactly the kind 

of translational research that we strongly support NIH aggressively pursuing. 

We believe that there is hope for today’s Parkinson’s disease patients and their 

families. There are emerging therapies that should be pursued—even therapies that 

could potentially reverse the progression of the disease. These are the neuro-restorative therapies, such as neural growth factors, gene therapies, and tissue transplants 

including stem cells, which ultimately may restore function in patients suffering 

from Parkinson’s disease as well as other neurodegenerative disorders. However, if 

this important research is not aggressively pursued it may take many more years 

than necessary to determine if this hopeful research may become much-needed 

therapies for today and tomorrow’s Parkinson’s patients. 

On behalf of the Parkinson’s community, I thank you for your continued interest 

in Parkinson’s disease issues and your support for better treatments and a cure for 

Parkinson’s. I would be happy to answer any questions you may have. 

Senator SPECTER. Thank you, Ms. Comstock. 

We turn now to Dr. Steven Emerson on the cancer issue. Give 

my regards and thanks to Dr. John Glick, my oncologist. 

STATEMENT OF STEPHEN EMERSON, M.D., ASSOCIATE DIRECTOR FOR 

CLINICAL RESEARCH, ABRAMSON CANCER CENTER, UNIVERSITY 

OF PENNSYLVANIA HOSPITAL 

Dr. EMERSON. Good morning, Chairman Specter, Senators Harkin and Shelby. My name is Steve Emerson. I am the associate director for clinical research at the Abramson Cancer Center at 

Penn. Our outgoing director, Dr. Glick, sends his regards. He is no 

stranger to this committee. 

First off, I want to thank you all for your continued support for 

the health and welfare of this country by means of health care research over the past several years. Without your support, we could 

not have done what we have done. In the area of cancer where I 

work, I have seen in the 25 years I have been working a change 

where 25 years ago a cancer diagnosis was uniformly and relatively 

quickly fatal, to now where over half the patients who walk in my 

office know that they will live at least 5 years, if not be cured of 

their cancer. 

But still we are only partway there and at this point cancer is 

still the largest cause of death in all Americans under the age of 

85. It is still a huge killer. We have a long way to go. 

Now, you have heard a lot about the issues with the doubling of 

the budget and yet where we are with the flat budgets going forward. I want to concentrate on just one part of that. One of my 

roles at Penn is head of training and the mentoring of the next 

generation of investigators. What you see with the budget being 

flat is actually a reduction in all new R01’s being funded to this 

year the eleventh percentile, next year much lower. This is onethird the level of funding in terms of numbers of grants and 

chances of getting funded that it was even 3 years ago, and that 

is going to get worse next year. 

Worse than that, the money per grant is being cut 30 percent off 

even the best grants. So the funds going in for new research have 

plummeted. That is the source of the panic you are talking about. 

So for new investigators that we have all invested in, the outlook 

for them for careers, for taking care of all of us and for finding new 

cures, it is hard to convince them what the future is. If we do not 

correct this, all of the goodwill and investment we have made in 
212 

the infrastructure with the road map, all the collaborative work, all 

the genomics and cancer that we have put this investment into will 

go to waste because we will not have a next generation of scientists 

to take advantage of it. 

PREPARED STATEMENT

So thank you all again in the past and in the future for your efforts on preserving the NIH budget and its mission. Thanks again. 

[The statement follows:] 

PREPARED STATEMENT OF DR. STEPHEN EMERSON

Good Morning, Chairman Specter, Senator Harkin, and Members of the Subcommittee. I am Stephen Emerson, Associate Director for Clinical Research at the 

University of Pennsylvania’s Abramson Cancer Center, one of NIH’s original comprehensive cancer centers funded by the National Cancer Institute three decades 

ago. Our outgoing Director, Dr. John Glick, no stranger to this Subcommittee, extends his regards and regrets his schedule did not permit him to appear this morning. 

Thank you for the opportunity to speak with you today about efforts by scientists 

and clinicians in the ongoing fight against cancer, a disease that is the leading 

cause of death for Americans 85 years of age and younger. In the United States last 

year, 1 of every 4 deaths was from cancer. This illness claimed the lives of about 

563,700 Americans, with approximately 1.4 million new cancer cases diagnosed. 

These staggering figures should not, however, diminish the hope that exists for 

all those who fall victim to this disease from the dramatic progress we have made 

in this fight. When the Abramson Center opened its doors three decades ago, a cancer diagnosis was a near certain, imminent death sentence. But through the efforts 

of millions of people, and as a direct result of the steadfast support of this Subcommittee in robust funding for cancer research over the years, today about 60 percent of cancer patients can expect to live more than five years after diagnosis. Working with our colleagues in partnership with organizations like the American Cancer 

Society and the Friends of Cancer Research, there is an aggressive, day-to-day battle to reverse the devastating effect that cancer has on the lives of so many individuals and families—through research, prevention efforts and treatment. 

That effort, however, is under assault, and at great risk, if the President’s fiscal 

year 2007 budget for the National Institutes of Health, and its proposed allocation 

for the National Cancer Institute, is not reversed. In the Bush 2007 budget proposal, the NCI is slated to receive $4.75 billion—a cut of nearly $40 million, or almost 1 percent, below NCI’s fiscal year 2006 level. That is a reduction of $70 million 

cut from the fiscal year 2005 level and approximately $186 million less than what 

the Congressional Budget Office estimates is necessary to maintain current projects, 

infrastructure and spending adjusted for inflation and other factors. 

Within the proposed levels for the NCI, virtually every major activity, other than 

activities for the NIH Roadmap initiative, would be reduced. Cancer research activities would be cut $50 million below the 2006 level, which itself was slightly reduced 

from the level allocated for 2005. Cancer biology research would be cut nearly $41 

million and research into the causes of cancer would be reduced more than $6 million. Overall support for the cancer centers would be reduced by more than $2 million, capping a two-year period of real decline in the NIH investment for its cancer 

centers. Even cancer control and prevention, one of the single most important areas 

in our efforts to combat this disease, is scheduled to be hit with a nearly $2.5 million reduction, reductions that amount to a cumulative decline of nearly $17 million 

over two years. 

These proposed reductions, which I know you oppose Mr. Chairman, completely 

contradict the Administration’s stated goal of ending suffering and death from cancer by 2015. They fly in the face of the spiraling cost of cancer treatment, pegged 

at more than $72 billion annually in the United States, nearly five percent of all 

health care expenditures. And they send the wrong message to the nation at a time 

when the economic burden, excluding the costs for treatment, from cancer morbidity 

and premature mortality is a staggering $120 billion annually. 

For the community of scientists and clinicians who have dedicated their lives to 

the prevention, diagnosis and treatment of cancer, and who are the members of the 

team working in every state in our nation to meet that 2015 goal, these proposed 

cuts are both alarming and highly discouraging. If enacted, these funding levels 

would drop success rates for scientists proposing research project grants to the NCI 
213 

to just 16 percent—that is a 1 in 6 chance of obtaining funding. Such a level would 

mean a drop in the NCI grant success rate of more than 50 percent since 1998, and 

a drop of 43 percent since 2002. For NCI’s R01 grants, the bread and butter mechanism for most NIH funded scientists, the payline for last year is even worse—just 

11 percent. Reductions in 2007 would only erode that level further. 

While older, more established research scientists will likely find a way to hold on 

to most of their core funds, the effect on young investigators—the seed corn of our 

future in this battle—is nothing short of devastating. The NIH New Investigators 

Committee presented data last December that showed the average age of a typical 

new NIH R01 awardee with an M.D. degree had reached 44. At the same time, the 

percentage of new investigators in competing R01 Awards across NIH continues to 

decline to just 20 percent. For the NCI, the first-time investigator success rate for 

all grant mechanism is worse—just 11 percent. For R01’s, the success rate is again 

just 17 percent. The message these proposed cuts send is that for promising young 

biomedical professionals, a career focused on tackling cancer—whether in the fundamental study of genomics, proteomics, and biomarkers, or the more applied disciplines directed at generating new diagnostic or treatment regimes and devices— 

is not worth pursuing. The President’s budget runs the risk of beginning the effective elimination of a whole generation of cancer scientists—at the very time when 

we are turning the corner on the fight against this disease. 

Those of us who have spent our lives focused on ending the scourge of this disease 

know that this Subcommittee—more so than any other in the U.S. Congress—led 

the fight for funds to double the NIH budget. And there has been tremendous 

progress against cancer as the number of people who died from cancer between 2002 

and 2003 decreased for the first time, the year corresponding to the last of the large 

NIH budget increases. The Director of the NCI, in his testimony to this Committee 

last month, outlined a number of significant scientific breakthroughs in the treatment and diagnosis of breast, ovarian and cervical cancers in just the last year. 

These continue the remarkable success we have had in fighting the number two 

cause of death in the United States. 

The proposed 2007 budget cuts would help to unravel the progress this Subcommittee fought so hard to achieve in the doubling of NIH from 1998–2003. We 

urge you to redouble your efforts to stop them, and provide a modest increase—perhaps an additional $300 million for the NCI in the coming year—to help offset declines enacted in 2006 and provide for most increases to sustain the pool of young 

scientists whose careers will hopefully be marked by the end of cancer as a scourge 

on so much of our nation and our world. 

Thank you for the chance to present my views to the Subcommittee. We would 

be happy to prepare responses to any questions you might have for the record. 

Senator SPECTER. Thank you, Dr. Emerson. 

Ms. Lauren A. Eng, Spinal Muscular Atrophy Foundation. 

STATEMENT OF LAUREN A. ENG, PRESIDENT, SPINAL MUSCULAR ATROPHY FOUNDATION 

Ms. ENG. My daughter is one of the 33,000 American children 

suffering from spinal muscular atrophy, the most common genetic 

killer of young children. One missing gene causes nerves and muscles to wither away and most children die by the age of 2. But 

there are many terrible diseases. What makes SMA remarkable is 

the imminence of treatment. SMA represents both the problem and 

the opportunity of drug development for orphan diseases. Half of 

Americans with illness suffer from rare diseases and for the vast 

majority of rare diseases, especially pediatric ones, money and scientific advances are wasted because discoveries do not move from 

the bench to the bedside. 

Because of scientific breakthroughs, NINDS chose SMA from its 

600 diseases for a groundbreaking drug discovery program. The 

SMA project is a shining example that NIH can develop treatments 

and invest in further and basic science that is ripe and pays off. 

With less than $5 million a year, a group of potential drugs have 

already been identified. NIH has been a catalyst of advancing re-
214 

search and drug companies are interested. It achieved in 3 years 

what might have otherwise taken 10. 

PREPARED STATEMENT

But running an astonishing race is useless if you stop short of 

the finish line. Under the proposed budget, continuation of the program is at risk. There is funding to pursue one drug, but scientists 

believe at least three should be advanced, each costing $15 million 

to bring to trials. If NIH cannot fund this next step, it will have 

catastrophic effect. Academic and industry research will stop. We 

will have wasted the enormous investments and progress made in 

biomedical research, and for my child all of this is the difference 

between life and death. 

[The statement follows:] 

PREPARED STATEMENT OF LOREN A. ENG

I am Loren Eng, president of the Spinal Muscular Atrophy (SMA) Foundation and 

am here on behalf of the SMA Coalition. Most importantly, I am the mother of Arya 

Singh, who is one of the 30,000 children in America dying from Spinal Muscular 

Atrophy. 

As you may know, SMA is a terrible disease. It is the most common genetic killer 

of babies and young children in America, and it is untreatable and fatal. It is often 

described as a genetic version of polio, or the children’s equivalent of ALS. In children with SMA, one missing gene, and one missing protein causes motor neurons 

to die. Muscles weaken and wither away, leaving the bright minds of its young victims trapped by their failing bodies. Most children with SMA die within the first 

few years of life. Some are ‘‘lucky’’ and live longer, but face extreme disability and 

suffering. 

But there are many terrible diseases. What makes SMA remarkable is the ability 

to truly make a difference with a modest amount of money and smart strategy. 

SMA is a poster child for both the problem and the opportunity of drug development for rare pediatric diseases. 

For large diseases, the historical focus on basic science works well—large drug 

companies take that basic science and translate it into treatments that save lives. 

However, half of Americans with illness have smaller diseases, and for them the 

system has not worked. Breakthroughs are often achieved in basic science, but there 

are no large drug companies waiting to turn those breakthroughs into treatments. 

For a handful of smaller diseases, drug companies will only get involved at later 

stages where perceived risk is lower. But for most small diseases, the basic science 

is wasted because of the challenges of advances research from the bench to the bedside. This is especially true for rare pediatric diseases. Money is spent, but children 

still die. 

In the past decade, scientists studying SMA have achieved incredible breakthroughs, creating a unique opportunity to develop treatments. To its credit, NINDS 

has recognized the opportunity and taken steps to advance basic science with a revolutionary translational research effort. 

Just three years ago, the NINDS designated SMA, from among 600 diseases, as 

the best candidate for a model new program to translate basic science into actual 

drugs and treatments. The SMA Project combined academic and industry expertise, 

and was a focused and strategic effort to translate remarkable science into real solutions. 

In just three years, and for less than $5 million per year, the SMA Project has 

brought us within reach of an effective treatment. Investigators have identified a 

group of potential drugs that may slow the progression of the disease. Despite a 

miniscule budget for the project, NINDS has made incredible strides in harnessing 

the community’s efforts toward a near term treatment. 

Unfortunately, running a brilliant race is useless if you stop before the finish line, 

and that is what we fear is at risk of happening. 

I am not an expert in the federal budget but I do know that: 

—this model SMA program would never have been initiated under this budget, 

—the existing funding of just $5 million a year is at risk, and 

—the very success of the program is at risk. 
215 

The next phase of the project is pre-IND studies but there is only enough funding 

to study JUST one compound. Project scientists say we need at least two to three, 

and each costs $2 million. For clinical trials we will need $10 to $15 million each. 

The leadership of the NIH has been a catalyst of incredible progress—it expects 

to advance research to a point when they can be ‘‘handed off’’ to drug companies 

to fully develop. For a fraction of the vast amounts spent on caring for SMA victims, 

we could develop treatments that would save them. With a modest amount of money 

and continued focus, we can save lives, and money. 

If NIH can not provide for these critical next steps, it will have a domino effect 

elsewhere: 

—Young investigators will not focus on SMA, 

—Existing non-government research will stall, 

—Industry will surely not engage, and 

—Other diseases like ALS and DMD will not reap the benefits of SMA research. 

The SMA Project has been a revolutionary effort and a shining example of how 

NIH cannot only fund basic research but actually DEVELOP TREATMENTS for 

deadly diseases. 

Through a solution driven approach, the NIH has achieved in 3 years what might 

have taken a decade. ‘‘Smart investment’’ could pay off in treatments that save 

lives. This is an incredible example of finding solutions, not just spending money. 

Of course, in this case, a ‘‘solution’’ means treatment that could save the lives and 

reduce the suffering of 30,000 children. 

We urge you not to stop short now when we are so close. Reducing funding for 

NIH, and for projects like the SMA Project will have devastating consequences—we 

will waste the enormous amounts of money that have been spent and progress that 

has been made. For our daughter, it could mean the difference between life and 

death. 

Senator SPECTER. Thank you, Ms. Eng. 

We turn now to Dr. Philip Fox, American Association for Dental 

Research. 

STATEMENT OF DR. PHILIP C. FOX, DIRECTOR OF CLINICAL RESEARCH, DEPARTMENT OF ORAL MEDICINE, CAROLINAS MEDICAL CENTER ON BEHALF OF THE AMERICAN ASSOCIATION FOR 

DENTAL RESEARCH 

Dr. FOX. Thank you, Mr. Chairman. I am Dr. Phil Fox and I am 

really representing the dental research community. 

I would like to highlight this morning some advances in salivary 

diagnostics, an area you have not heard much about. Diagnosis of 

most health conditions requires a blood or a urine sample and that 

may be invasive or painful to obtain. But now, after many years 

of research, saliva is poised to be used as a noninvasive diagnostic 

fluid for a number of oral and systemic conditions. 

Dental researchers have been able to amplify molecular signals 

that are present in saliva, heralding the advent of new tests that 

allow for earlier diagnosis than is currently possible. Saliva is already being used routinely for rapid noninvasive HIV diagnosis and 

saliva-based tests will soon be available to detect oral cancer. Further, saliva has the potential to detect exposure to chemical and biological weapons and is being looked at in autoimmune diseases as 

well. 

Now, most of this research is funded by the National Institute 

of Dental and Craniofacial Research, the NIDCR. However, as you 

have heard, the investment that is made in the NIH doubling is 

now at risk. I think that we have the research equivalent now of 

being all dressed up and nowhere to go. 

As a result of your past investment, there are many unprecedented opportunities in dental research. But the austere budget of 

the last 4 years has resulted in a steady decrease in new research 

grants and many young investigators who are leaving the field. 
216 

Imagine a future in which a saliva sample is used for quick, 

painless and less expensive diagnostic tests and to monitor many 

systemic health conditions and exposure to chemical and biological 

weapons. Early diagnosis could save thousands of lives. We need 

you to sustain your commitment to NIH and to dental research in 

order to realize these unprecedented scientific opportunities. 

Thank you for your interest and support. 

Senator SPECTER. Thank you very much, Dr. Fox. 

Unless there is some question from the panel, we will turn now 

to our next group of experts. 

Thank you all very, very much. 

Dr. KNAPP. Thank you. 

Dr. EMERSON. Thank you. 

Senator SPECTER. We now call on Ms. Patricia Furlong, Dr. Sam 

Gandy, Ms. Ann Gibbons, Dr. Robert Goldstein, Dr. Lawrence 

Holzman, and Dr. Steven Houser. 

Thank you all very much for joining us. As is the situation with 

all of the witnesses, your full statements will be made a part of the 

record. We turn first to Ms. Patricia Furlong, who represents the 

Project on Muscular Dystrophy. Ms. Furlong. 

STATEMENT OF PATRICIA FURLONG, CO-FOUNDER AND CHIEF EXECUTIVE OFFICER, PARENT PROJECT MUSCULAR DYSTROPHY 

Ms. FURLONG. Thank you very much, Senator Specter, Senator 

Harkin, and Senator Shelby. I so appreciate this opportunity to 

talk about NIH funding. 

I thought I would start by giving you three examples. In 1999 

a scientist from the University of Pennsylvania with NIH support 

looked at aminoglycosides to suppress premature stop codons. Premature stop codons in a genetic sentence could be interpreted as 

a period in the middle of a genetic sentence, creating the loss of 

a significant protein. These aminoglycosides are found to suppress 

a premature stop. 

This particular scientist went to industry and, again with his 

own NIH support, began high throughput screens. Today we have 

a drug in trial called PTC–124. This drug has implications for all 

genetic diseases in terms of a subset of the population with premature stops. It is currently in trial and demonstrating pharmacological activity in cystic fibrosis and in Duchenne muscular dystrophy we do not have the data. But this drug has sweeping potential results across the rare genetic disease community. 

In 2000 a scientist from Johns Hopkins University looked at 

muscle regulators and found that inhibiting myostatin would improve the bulk of the muscle and potentially the strength. This 

drug is currently in trial in muscular dystrophies FSH, Becker, and 

myotonic. 

In the year 2001, the Bowman-Burke inhibitor compound was 

looked at. It is a protease inhibitor that can slow or halt muscle 

degeneration in muscular dystrophy. It had been in trial in the National Cancer Institute and was halted, not because of any risk to 

the patient, but primarily due to lack of material. This drug is now 

going into trial through NIH funding in muscular dystrophy in 

January. 
217 

PREPARED STATEMENT

It is these cures, potential treatments for all of us, that make 

such a difference in our lives. We ask you to commit to NIH funding to supply that NIH, that research enterprise, with the funding 

it needs to help all of us, to give us time with the people we love, 

and to help not only the American people but people across the 

world. 

Thank you. 

[The statement follows:] 

PREPARED STATEMENT OF PAT FURLONG

Good morning/afternoon Mr. Chairman and Members of the Committee, and 

thank you for this opportunity to testify on the NIH budget. 

My name is Pat Furlong, Co-Founder and CEO of Parent Project Muscular Dystrophy and the mother of two sons who battled Duchenne Muscular Dystrophy. 

Thanks to the significant amount of basic research funded by NIH in recent years, 

we are making encouraging progress in our quest to develop effective treatments for 

this always-fatal disease. Right now, we are in a Phase II clinical trial on a promising drug for a subset of patients with Duchenne muscular dystrophy, and potentially a subset of patients with many other genetic conditions. 

It’s basic NIH-funded research that served as a foundation and provided the spark 

for this drug, and many other promising therapies that are in the works. Without 

adequate NIH funding to support basic research, the medical research tower will 

rise much lower before eventually buckling due to the tremendous strain placed on 

too few resources. 

We are particularly concerned about the negative impact the budget crunch will 

have on young investigators seeking to enter the field of Duchenne MD research. 

The budget limitations we have seen over the past few years have made it tremendously more difficult for young, first-time investigators with meritorious submissions to secure an R01 grant. 

I urge your panel and the entire Senate to continue to lead the way in restoring 

critically needed dollars to support basic NIH research. 

Senator SPECTER. Thank you very much, Ms. Furlong. 

We now turn to Dr. Sam Gandy, representing the Alzheimer’s 

Association. 

STATEMENT OF SAM GANDY, M.D., Ph.D., CHAIR, MEDICAL AND SCIENTIFIC ADVISORY COUNCIL, ALZHEIMER’S ASSOCIATION 

Dr. GANDY. Mr. Chairman, members of the subcommittee: As a 

direct result of this subcommittee’s leadership and foresight, scientists supported by the NIH have made enormous strides towards 

understanding Alzheimer’s, a disease that affects 4.5 million Americans today and will affect as many as 16 million in a few decades. 

For the first time in the history of medicine, we have Alzheimer’s 

genes in hand and we can now contemplate rational therapy for 

Alzheimer’s. With adequate resources, scientists will be able to develop medications that modify Alzheimer’s pathology in as few as 

3 years. Achieving that goal will relieve a major bottleneck and attract every major pharmaceutical company to begin bringing new 

drugs into human clinical trials. 

The current trajectory of NIH cuts threatens to arrest progress 

and devastate the upcoming generation of scientists. Current 

grants are now routinely cut by 18 percent. In my institution this 

is already causing layoffs and I see my students turning away from 

research careers. Budget cuts also mean that some of the most 

promising drug targets will go unstudied. An important new molecule was discovered just last month. Where will we find the resources to study its potential therapeutic value? 
218 

PREPARED STATEMENT

The inescapable conclusion is that Federal budget cuts are killing more than programs. These cuts are killing the minds of millions of Americans. The threat of Alzheimer’s is staggering in its 

scope. I urge you and your colleagues to act now to reverse the disastrous path upon which we find ourselves. 

Thank you very much for providing me with this opportunity to 

testify. 

[The statement follows:] 

PREPARED STATEMENT OF SAM GANDY

Mr. Chairman and members of the Subcommittee, I appreciate the opportunity to 

be here to discuss Alzheimer’s disease, a disease that, as we speak today, is robbing 

4.5 million Americans of their abilities to form memories and thoughts. The disease 

will ultimately take the life of every one of these 4.5 million. Within a few decades, 

as many as 16 million Americans will have Alzheimer’s, all of whom will eventually 

succumb to the disease, unless we all, together, take up the fight toward a cure or 

means of prevention. 

As a direct result of the leadership and foresight of this Subcommittee, the National Institutes of Health have played essential roles in developing and maintaining a cadre of American scientists such as myself who have made enormous strides 

toward understanding Alzheimer’s and, for the first time in the history of medicine, 

contemplating rational interventions aimed at the underlying disease process We 

now know that Alzheimer’s is a disease and not an inevitable consequence of aging. 

We have identified several key genetic mistakes that are so malignant that one single mistake in the DNA is sufficient to cause the complete picture of Alzheimer’s. 

These DNA mistakes have been both necessary and sufficient to supply us with essential information that has eluded scientists for the century since Alois Alzheimer 

presented his landmark paper in Munich in 1906. For the first time in the history 

of medicine, we are now able mimic the earliest steps in the disease using chemicals, cells, or, most valuably, the lowly laboratory mouse. Human Alzheimer genes 

have enabled us not only to create in the laboratory a living brain with Alzheimer’s, 

but, astoundingly, we are also now able to cure experimental Alzheimer’s in the laboratory. These experimental therapies are now entering human trials so that we 

might translate these experimental cures into practical medicines for humans. 

To date, four drugs have been approved for treating the symptoms of Alzheimer’s, 

but these drugs only help a few patients, and even then, only modestly and temporarily. Current Alzheimer drugs leave the basic underlying disease untouched and 

the natural progression from amnesia to death proceeds along the standard, predictable, inevitable, and cruel path that we know all too well. Yet, from the laboratory, 

for the first time, scientists and physicians see genuine, tangible, quantifiable hope. 

Most experts agree that with adequate resources, scientists will be able to develop 

medications that will modify Alzheimer’s pathology within the next three years. If 

the prevailing wisdom about the root cause of the disease is validated, a major bottleneck will be relieved, and every major pharmaceutical company will begin bringing new drugs into human clinical trials. 

But that can only happen if you and your colleagues sustain the Alzheimer research enterprise. Alzheimer’s drug development will certainly be stymied if Congress adopts the President’s proposal, where for the fourth consecutive year the NIH 

budget fails to even keep pace with inflation. 

The NIH doubling process is directly responsible for the progress of Alzheimer’s 

research as a field of study: the field has moved from a backwater of obscurity into 

perhaps the single most visible, most competitive, and most exciting research field 

in experimental neurology. Within three years after this Subcommittee first appropriated funds for Alzheimer’s, the number of scientists drawn into this field of study 

increased three-fold. But because of budget cuts over the past three years we are 

already seeing talented scientists turning to other fields. 

The current trajectory of cuts threatens to devastate the upcoming generation of 

scientists. NIH funding of the scientists who populate the faculties of our universities is not simply used to buy test tubes and chemicals: those funds directly pay 

the salaries of scientists on these faculties. Draconian cuts will render these scientists and professors unemployable. And with the loss of this talent, we are postponing the day that we can eradicate this deadly disease. 
219 

But perhaps most importantly, persistent budget cuts are shutting out opportunities to find ways to cure or prevent Alzheimer’s disease. In 1998, NIH was funding 

30 percent of top-rated grant applications. Today, the percentage of Alzheimer 

projects that actually receive funding is down to 18 percent. Some institutes are 

struggling to maintain 10 percent funding. This means that most scientific opportunities are being left on the table. It also means that some of the most promising 

clinical trials—the tools we need to translate basic research findings into effective 

clinical treatments—will be delayed or scrapped altogether. The inescapable conclusion, for me, at least, is that federal budget cuts are killing more than programs; 

they are killing the minds of millions of Americans. 

Mr. Chairman and Senator Harkin, I am certain that you both realize that we 

cannot be a strong nation unless we are a healthy nation. In fiscal year 2007, spending on all Medicare beneficiaries benefits will total $449.2 billion. Unless we find 

a way to prevent or cure Alzheimer’s disease, in less than 25 years, the care of 

Medicare beneficiaries that is attributed to Alzheimer’s alone will cost over $400 billion, roughly equivalent to today’s entire Medicare budget. The threat is so enormous that the temptation is to just give in to nihilism and cynicism. I urge you and 

your colleagues to join us in resisting this temptation and act now to reverse the 

disastrous path upon which we find ourselves. 

Thank you for the opportunity to testify. 

Senator SPECTER. Thank you. Thank you, Dr. Gandy. 

Our next witness is Ms. Ann Gibbons, representing Autism 

Speaks. 

STATEMENT OF ANN GIBBONS, MEMBER, BOARD OF DIRECTORS, AUTISM SPEAKS 

Ms. GIBBONS. I am the mother of a 17-year-old boy with autism 

and I am a member of the board of directors of Autism Speaks, and 

I am here to speak for those who cannot. 

Autism is our Nation’s fastest growing developmental disorder, 

affecting 1 in 166 children, up more than tenfold from a decade ago 

and costing our Nation approximately $35 billion annually. Autism 

has no known cause, no known cure, and few effective treatments. 

The incidence of autism has increased at epidemic proportions, but 

NIH funding for autism research has been frozen over the past 2 

years and will remain so in the President’s 2007 budget. 

Specifically, the first lost opportunity is developing new treatment standards for autism. This would support research on new or 

existing early interventions to establish common methods of 

verifiably effective treatment. Early intervention provides children 

with the best possible opportunity to develop in the most normal 

way possible, but not with the President’s budget, where this critical research will not be funded. 

Another lost opportunity is defining the core features of autism, 

when it begins, its long-term course, and subtypes of the disorder 

that may exist on the autism spectrum. Understanding the common features of autism will lead to identification of its causes, both 

genetic and environmental, and identify better treatments or even 

prevention of the disease. The President’s proposed budget will not 

fund this research. 

PREPARED STATEMENT

The incidence of autism will continue to grow, but funding for 

autism research will not. With the President’s budget, opportunities will be lost, but the pain and suffering of autistic children and 

their families will continue to grow, as will the cost to society. 

I just want to thank you all for what you are doing for biomedical research. 
220 

[The statement follows:] 

PREPARED STATEMENT OF ANN GIBBONS

Mr. Chairman, I am Ann Gibbons, a resident of Bethesda, Maryland, a member 

of the Board of Autism Speaks, and the mother of a 17-year-old son with autism. 

Autism Speaks was launched to help find a cure for autism by raising the funds 

to facilitate and quicken the pace of research, to raise public awareness of autism, 

and to give hope to all those who suffer from this disorder. Autism Speaks’ goal is 

to give a voice to an entire community, to every family dealing with the hardships 

of autism. With its mergers with the National Alliance for Autism Research and the 

Autism Coalition for Research and Education, Autism Speaks now represents our 

nation’s largest autism advocacy organization. 

In both of my roles, in my public capacity as an Autism Speaks board member 

and in my private role as a mother of an autistic child, I commend you, Mr. Chairman, for your leadership in promoting funding for biomedical research and support 

you in your efforts to secure increased funding for the National Institutes of Health 

this year. 

Funding for understanding the causes of and finding treatments for autism is 

sorely needed. Autism is our nation’s fastest-growing developmental disorder, now 

affecting 1 in 166 children in the United States, up more than tenfold from just a 

decade ago. A Harvard School of Public Health professor, in a recent book, estimates 

that it can cost $3.2 million to care for an autistic person over the course of his or 

her lifetime, and by conservative estimates autism costs our society $35 billion annually in direct and indirect costs. 

Autism has no known cause, no known cure, and few effective treatments. And 

while NIH funding for autism may have tripled in the past decade to $100 million, 

that amount pales in comparison to the money spent for research on other diseases 

and disorders that affect fewer individuals. 

Autism research is poised at a turning point. While diagnoses are skyrocketing 

at epidemic rates, many areas of autism research stand on the verge of important 

findings. If adequately funded, this research could yield real progress on the diagnosis, treatment and cure for this disorder. The President’s proposed freeze on NIH 

funding falls short on all counts, and would seriously impede the progress and 

promise of autism research. 

One turning point is the development of new treatment standards for autism spectrum disorder. This program would support research on new or existing interventions with the goals of establishing common methods of treatment and measurements of treatment efficacy. This study could hasten the ability to use existing 

treatments early to improve outcomes for children and families struggling with the 

disability of autism spectrum disorders. When autistic children do receive evidencebased early intervention service between ages 3 and 5, from 20 to 50 percent of 

them are able to go onto mainstream kindergarten. Early intervention is critical in 

order to provide children with autism the optimum opportunity to develop in the 

most normal way possible. 

Unfortunately, Mr. Chairman, the President’s proposed budget for fiscal year 2007 

will freeze funding for autism, and research leading to advances in autism intervention will not be possible. 

Another turning point is the need to define core features of autism, including 

when it begins, its long-term course, and subtypes of the disorder that may exist 

on what is known as the autism spectrum. 

Defining the features of autism could lead toward the long-term goal of finding 

genetic and non-genetic causes of autism and offering the possibility of providing 

better treatments or even prevention of the disease. It’s also urgent that we better 

understand the genetic associations with autism so that research into the interaction of genes with the environment can be understood. 

With the budget proposed by President, this research will not be funded, and 

these advances cannot be made. 

With the President’s budget, progress in understanding brain development and 

autism, one of the most devastating disorders affecting hundreds of thousands of 

children, will be slowed or halted. Scientists will be unable to realize the full potential of the latest scientific techniques, in neuroimaging and genetics technology. 

Mr. Chairman, autism, which the Centers for Disease Control and Prevention estimates now affects 300,000 American children between ages 4 and 17, will continue 

to grow, with 3 children now being diagnosed ever hour. The pain and suffering of 

autistic children and their families will continue, as will the costs to society. But 

research on this devastating disorder will be stymied, progress on potential treat-
221 

ments and cures will be stymied as a result of the President proposed freeze on 

spending for biomedical research and on research on autism. 

Moreover, we will lose the opportunity to save an entire generation of children 

from this devastating disorder, which can lock people in their own worlds, unable 

to communicate with, and sometimes unable to experience the affection of those who 

love them. 

Mr. Chairman, thank you for giving me the opportunity to speak for those with 

autism and their families. 

Senator SPECTER. Thank you. Thank you very much, Ms. Gibbons. 

Our next witness is Dr. Robert Goldstein, representing the Juvenile Diabetes Research Foundation. 

STATEMENT OF ROBERT GOLDSTEIN, M.D., Ph.D., CHIEF SCIENTIFIC 

OFFICER, JUVENILE DIABETES RESEARCH FOUNDATION 

Dr. GOLDSTEIN. Thank you, Senators Specter, Harkin, and Shelby for this opportunity to testify. I am Robert Goldstein, the chief 

scientific officer for the Juvenile Diabetes Research Foundation. 

Without an increase in Federal funding for diabetes research, 

there will be a disproportionate impact on clinical translation research. Islet cell transplantation, a procedure that has been successfully done experimentally in nearly 600 diabetes patients, will 

delay the—the NIH-sponsored clinical trials to expand this proven 

treatment out into the community will be seriously delayed. 

In the area of hypoglycemia, dangerously low blood sugar can 

lead to convulsions, coma, or even death. The Diabetes Research 

and Children’s Network’s efforts to assess new glucose monitoring 

technology will impact on the management of type 1 diabetes in 

children. 

Diabetic retinopathy. Anti-angiogenesis drugs that can reverse 

diabetic retinopathy have been discovered, but clinical trials to extend and expand these findings to test new classes of drugs would 

be delayed or halted. 

Treatment of new onset of type 1 diabetes. Clinical trials using 

monoclonal antibodies have shown that insulin-secreting cells can 

be protected for up to 2 years. Support studies to determine how 

to prolong this effect, whether treatment prior to the onset can prevent diabetes, and whether these therapies can be given years after 

onset would be delayed or curtailed. Since type 1 diabetes is an 

autoimmune disease, this will impact understanding of other autoimmune diseases. 

PREPARED STATEMENT

Causes of type 1 diabetes. NIH-supported efforts to identify the 

genes responsible for susceptibility will be curtailed and delay our 

ability to effectively prevent disease in at-risk populations. 

Thank you for the opportunity to testify. 

[The statement follows:] 

PREPARED STATEMENT OF ROBERT GOLDSTEIN

Chairman Specter, Ranking Member Harkin and Members of the Subcommittee, 

thank you for the opportunity to testify before you today regarding the many opportunities that will be lost without an increase in federal funding for diabetes research 

at the National Institutes of Health. I am Robert Goldstein, the Chief Scientific Officer for the Juvenile Diabetes Research Foundation International. 

In the past 25 years, the number of people with diabetes has more than doubled, 

so that today approximately 20.8 million Americans have diabetes. Evidence sug-
222 

gests that 1 in 3 Americans born in 2000 will develop diabetes during his or her 

lifetime. Diabetes is the 6th leading cause of death in the United States. The disease cost this country $132 billion in 2002, which is almost 5 times NIH’s annual 

budget. Only research to better prevent, treat and cure diabetes will significantly 

impact these numbers. 

The Diabetes Research Working Group recommended $1.6 billion in fiscal year 

2004—the last year of their study—to take advantage of the many diabetes research 

opportunities. We have used appropriations to build critical momentum for accelerating the delivery of therapies to people with diabetes. There have been major advances (see attached) and more importantly programs have been put in place that 

will insure continued advances. Yet funding today is $600 million short of this recommendation. Absent an increase in federal funding, this momentum will be lost 

and progress and solutions will be delayed. Specifically, the following areas of diabetes research will be seriously impacted: 

Islet Cell Transplantation.—Nearly 600 diabetes patients worldwide have now received islet transplants, and enough patients have been transplanted that long-term 

benefits can be documented. Islet cell transplants have resulted in significant benefits to people with very complicated forms of type 1 diabetes: for instance, at least 

half of the transplant recipients exhibit stabilization or reversal of their diabetic eye 

and nerve diseases. Overall, islet transplant patients report a significant improvement in their quality of life. However, challenges remain, and we need additional 

funding for NIH programs and NIH/CMS sponsored clinical trials to test new protocols and fully understand how to maximize this proven treatment so it is an appropriate therapy for all who suffer from type 1 diabetes. 

Hypoglycemia.—Hypoglycemia—episodes of dangerously low blood sugar—is the 

most feared acute complication of diabetes and can lead to shaking, convulsions, 

coma, or even death in extreme cases. Young diabetic children who may not be able 

to recognize or communicate the signs of impending hypoglycemia are especially vulnerable. Technologies coming onto the market in the near term have the ability to 

warn patients of hypoglycemia, and it is critical that the technology is suitable for 

use in children. The NIH has established the Diabetes Research in Children Network (DirecNet) to provide independent assessments of glucose monitoring technology and its impact on the management of type 1 diabetes in children, and this 

important work would be delayed without additional funds. 

Diabetic Retinopathy.—Diabetes is the leading cause of new blindness in working 

age adults; more than 8.5 million people in the United States have diabetic retinopathy or eye disease. Significant progress being made on the causes and pathogenesis 

of diabetic retinopathy is generating renewed hope for the prevention or reversal of 

eye disease. For the very first time anti-angiogenesis drugs that can actually reverse 

diabetic retinopathy, as opposed to simply halting further progression by means of 

laser treatment, have been discovered. The NIH-supported Diabetes Retinopathy 

Clinical Research Network (DRCR.Net) includes more than 150 collaborating physicians across the United States, and provides an organized platform for rapidly 

translating new therapeutic ideas from the research community into clinical testing 

in human patients. Clinical trials to test the pipeline of potential new drugs would 

be delayed, curtailed or halted without continued funding. 

Treatment of New Onset Type 1 diabetes.—By the time type 1 diabetes is diagnosed, patients have already suffered a devastating autoimmune attack that has destroyed most of the insulin-producing beta cells of the pancreas. Research has shown 

that a patient’s level of residual beta cell activity correlates with the ability to more 

easily maintain glucose levels close to normal and reduces the amount of insulin 

that must be injected. A prime research goal is to develop new therapies that will 

help newly diagnosed type 1 diabetes patients preserve remaining beta cells and 

possibly even dampen the immune system enough to allow the pancreas to regenerate new beta cells. Researchers have identified a drug that can effectively alter 

the clinical course of the disease. A short 1–2 week course of treatment with an 

antibody—named anti-CD3—helps patients maintain or increase their ability to 

produce insulin naturally for up to 18 months after diagnosis compared to a placebo. 

This treatment demonstrates the proof of principle that the clinical source of an established autoimmune disease can be significantly altered. This work could not have 

been done without the major advances in clinical trial platforms from several NIH 

sponsored programs, including: 

—Immune Tolerance Network, whose goals are to develop new therapies to treat/ 

prevent autoimmune disease and to prevent or treat graft rejection in transplantation by inducing immune tolerance. Among the diseases under investigation by this collaborative effort include type 1 diabetes and islet transplantation; and 
223 

—TRIAL NET which also supports studies aimed at both preventing further destruction of insulin secreting cells in new onset type 1 diabetes, as well as developing the means to prevent disease. 

More extensive studies to determine how long this effect can be maintained, and 

whether the addition of specific antigen therapy or other drugs can prolong this effect, will not occur without continued support. Similarly, large studies to determine 

whether early treatment prior to disease onset can prevent diabetes or whether 

these therapies can be given years after disease should be supported. 

Genetics and Environmental Causes of Type 1 Diabetes.—The best way to attack 

type 1 diabetes is to stop it before it ever starts, but this requires sophisticated 

knowledge of the underlying causes of disease. Ground breaking NIH efforts 

(T1DGC, TEDDY, TRIGR) to identify the genes responsible for susceptibility to type 

1 diabetes coupled with the identification of environmental triggers (viruses, toxins, 

dietary factors) will be curtailed or abandoned without continued funding, and delay 

our ability to effectively prevent disease in at-risk populations. 

Diabetes research has demonstrated a strong return on the federal investment. 

Continued strong federal commitment is needed. 

Thank you again for the opportunity to appear before you today. I am happy to 

answer any questions you may have. 

NIH AND DIABETES RESEARCH—A STRONG RETURN ON FEDERAL INVESTMENT

Diabetes affects more than 20 million adults and children in the United States, 

up to 7 percent of the population. In 2001, approximately $3.8 billion was spent on 

inpatient care for diabetes; two-thirds of those costs could have been saved with appropriate primary care for complications. A 2002 study estimated that diabetes— 

both type 1 and type 2—caused the U.S. economy $132 billion in direct medical costs 

and indirect costs such as disability, work loss, and premature mortality. The disease accounts for more than 30 percent of Medicare expenditures. Total diabetes 

costs are predicted to climb to as much as $192 billion per year by 2020. 

Beyond the economic impact is the personal toll that diabetes exacts. Individuals 

with diabetes have twice the prevalence of disability as persons without diabetes. 

In 2002, more than 176,000 cases of permanent disability were attributed to diabetes at an estimated cost of $7.5 billion. That same year diabetes accounted for 88 

million disability days. Persons with diabetes are at greater risk for stroke, heart 

attack, blindness, kidney failure, limb amputation, nerve damage, severe dental disease, and complications of pregnancy. Type 1 diabetes can reduce a person’s expected lifespan by as much as 15 years. 

The Diabetes Control and Complications Trial (DCCT), a clinical trial of 1,441 

people with type 1 diabetes, demonstrated that tight control of blood glucose 

through intensive insulin therapy could significantly reduce or delay many diabetic 

complications. This landmark finding spurred a shift in the daily management of 

type 1 diabetes and energized research in the field. In 1996, at the conclusion of 

the DCCT, it was estimated that implementation of intensive insulin management 

in the entire U.S. diabetic population would save 920,000 years of sight, 691,000 

years free from end stage kidney disease, 678,000 years free from amputation, and 

611,000 years of life. 

Since the discovery of insulin more than 80 years ago, biomedical research has 

continued to improve the health and lives of diabetes patients. The research listed 

below demonstrates that the field of juvenile diabetes research is making advances 

worthy of a continued strong federal investment. 

—Advances in Islet Cell Transplantation.—Since 1999, almost 600 diabetes patients worldwide have received islet transplants, and enough patients have been 

transplanted that long-term benefits are beginning to emerge. This procedure 

involves isolating the insulin-producing cells, called islet cells, from a donor 

pancreas, and injecting them into an adult who has juvenile diabetes. Islet cell 

transplants have resulted in significant benefits to people with very complicated 

forms of type 1 diabetes: for example, at least half of patients exhibit stabilization or reversal of their diabetic eye and nerve diseases. Overall, islet transplant patients report a significant improvement in their quality of life. Unfortunately this procedure cannot be used in children because the medications that 

need to be taken to prevent the body from rejecting these donated cells can have 

many side effects. Researchers are working to improve this procedure and to develop new techniques so that one day the procedure can be suitable for children 

with juvenile diabetes. 

—Treatment in new Onset Type 1 Diabetes.—Researchers have identified a drug, 

a monoclonal antibody, that can effectively alter the clinical course of type 1 diabetes: a short 1–2 week course of treatment with the antibody—named anti- 
224 

CD3—helps patients maintain or increase their ability to produce insulin naturally for up to 18 months after diagnosis compared to a placebo. Treated patients required reduced insulin dosage, and better hemoglobin A1c levels. A 

larger phase II trial of this procedure is underway. These findings are significant because residual beta cell activity correlates with the ability to more easily 

maintain glucose levels close to normal, and to prevent the development of the 

devastating complications of diabetes. Anti-CD3 is at the leading edge of a robust pipeline of potential therapies for reversing new onset type 1 diabetes. The 

Type 1 Diabetes TrialNet was established in 2001 to ‘‘fast track’’ potential diabetes therapies into clinical trials. —Advances in Preventing Hypoglycemia.—Significant advances in glucose monitoring technology help patients to determine whether their blood sugars are falling (signaling the need to eat to avoid hypoglycemia) or rising (indicating the 

need for an insulin dose). Researchers have evidence that patients who use continuous glucose monitoring systems spend more time in the normal glucose 

range; a critical finding because short term variability in glucose levels may be 

as important as overall, long-term glucose control in predicting the risk of complications. In 2005, an NIH-funded study validated that newer-generation home 

blood glucose meters demonstrated a high degree of accuracy over a broad range 

of glucose concentrations in children with type 1 diabetes. The study was conducted by Diabetes Research in Children Network (DirecNet), a network of clinical centers that provides an independent assessment of glucose monitoring 

technology and its impact on the management of type 1 diabetes in children. 

DirecNet is now testing the new continuous glucose monitors, which will be the 

next wave in diabetes care and represent an essential step toward an artificial 

pancreas. —Reversing of Diabetic Retinopathy.—Diabetes is the leading cause of new blindness in working age adults. Laser treatment can reduce the risk of severe vision 

loss by 20 to 50 percent and saves up to $1.6 billion per year by preventing or 

treating diabetic eye disease. New research has discovered anti-angiogenesis 

drugs that can actually reverse diabetic retinopathy, as opposed to simply halting further progression by means of laser treatment. These and other new classes of drugs make up a pipeline that must be tested in clinical trials. —Preventing Cardiovascular Disease.—Adults with diabetes are two to four times 

more likely to have a stroke or to die from heart disease than adults without 

diabetes. Indeed, heart disease or stroke is the leading cause of death among 

patients with diabetes, accounting for 65 percent of deaths in this population. 

Blood pressure control reduces the risk of heart attack and stroke by 33 to 50 

percent and the risk of other complications by as much as 33 percent. Nevertheless, additional research is necessary to understand the factors that contribute 

to increased cardiovascular risk. New findings to design new diagnostic tools 

that predict or detect the early onset of cardiovascular disease, develop new 

drugs or devices to reverse cardiovascular damage due to diabetes, and clinically test new therapies in large, randomized trials. 

—Slowing Onset and Progression of Kidney Disease.—Diabetes is the leading 

cause of kidney failure in the United States, accounting for 44 percent of new 

cases in 2002. Based on NIH-funded research, scientists have made great 

progress in developing methods that slow the onset and progression of kidney 

disease in people with diabetes. Drugs used to lower blood pressure 

(antihypertensive drugs) can slow the progression of kidney disease significantly. Two types of drugs, angiotensin-converting enzyme (ACE) inhibitors and 

angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease. Drugs that lower blood pressure, including ACE inhibitors or angiotensin receptor blockers (ARBs), decrease the onset of kidney 

disease by 30 to 70 percent. 

—Gaining an Understanding of Kidney Disease Susceptibility.—Some diabetic patients seem to be particularly susceptible to developing diabetic nephropathy, 

while others show no signs of kidney damage even after many years of living 

with diabetes. Researchers are actively investigating the genetic factors that influence an individual’s susceptibility or resistance to diabetic nephropathy. The 

Genetics of Kidneys in Diabetes (GoKinD) Study has gathered more than 2,600 

participants for the study of the genetic risk factors for type 1 diabetes and diabetic kidney disease. This sample and data collection will provide a resource to 

facilitate investigator-driven research into the genetic basis of diabetic kidney 

disease. Furthermore, GoKinD participants form the core of a population registry that could be recruited for future clinical trials. 

—Reducing Incidence of Diabetic Neuropathy.—Two-thirds of all diabetes patients 

suffer from some degree of nerve damage affecting organs throughout the body. 
225 

This condition—known as diabetic neuropathy—results in loss of sensation, 

weakness, or pain in hands or feet, carpal tunnel syndrome, pain in the eyes 

or face, pain in the chest or abdomen, profuse sweating, loss of balance or coordination, slowed digestion of food or related gastrointestinal problems, urinary 

incontinence, erectile dysfunction, and a variety of other nerve problems. The 

inability to feel pain coupled with impaired wound healing often leads to nonhealing foot ulcers and, ultimately, amputation of some part of the foot or leg. 

For this reason, diabetic neuropathy is the most common cause of non-traumatic 

lower limb amputation. Comprehensive foot care programs to detect and treat 

skin ulcers before they progress can reduce the rate of amputation by 45 to 85 

percent. —Understanding Susceptibility to Disease.—The Type 1 Diabetes Genetics Consortium (T1DGC) will identify the genes responsible for susceptibility to type 1 diabetes, leading to a better understanding of pathways to disease. Researchers recently confirmed the discovery of a new gene that contributes to susceptibility 

to disease. The pathway controlled by this gene implicates it in other autoimmune diseases, not just type 1 diabetes, underlining that common pathways 

may be involved in the development of autoimmunity. This understanding may 

lead to better diagnosis and new therapies to stop diabetes before it ever starts. —Identifying Environmental Causes of Type 1.—The Triggers and Environmental 

Determinants of Diabetes in Youth (TEDDY) study has screened more than 

6,000 newborns to identify the environmental causes of type 1 diabetes in genetically susceptible individuals. Once completed, the TEDDY study will have 

amassed the largest data set and samples on newborns at risk autoimmunity 

and type 1 diabetes anywhere in the world. —Investigating Vaccine to Prevent Type 1.—Recent studies in animal models have 

raised the possibility that a ‘‘vaccine’’ may be able to prevent type 1 diabetes. —Monitoring Progression of Type 1 Onset.—Researchers have developed a means 

to non-invasively monitor the start and progression of insulitis, the inflammation of insulin producing cells, in mice, which may allow researchers to prediction whether and when individual people will develop type 1 diabetes in the 

future. —Regenerating of Insulin Producing Cells.—Replacement of the lost beta cells 

through either transplantation of islets from an external source or regeneration 

of islets within a patient’s own pancreas is required to restore physiological control of glucose and cure type 1 diabetes. Development of regenerative treatments to restore beta cells without transplantation will require researchers to 

understand how beta cells are normally formed in the adult pancreas, and then 

use that information to identify molecular targets for drugs that can induce that 

process in diabetic patients. Researchers supported by the NIH Beta Cell Biology Consortium are now uncovering multiple pathways by which new beta cells 

are formed in the body. The work should help clarify how pancreatic beta cells 

develop, and it could potentially lead to successful treatments for both type 1 

and type 2 diabetes. 

—Identifying Animal Models for Complication Studies.—The Animal Models of Diabetic Complications Consortium (AMDCC) has identified more than 70 animal 

models for the study of diabetic complications, including a number of promising 

models for type 1 diabetic cardiomyopathy, nephropathy and neuropathy. 

Senator SPECTER. Thank you, Dr. Goldstein. 

We now turn to Dr. Lawrence Holzman, representing the 

NephCure Foundation. 

STATEMENT OF LAWRENCE B. HOLZMAN, M.D., CHAIRMAN, SCIENTIFIC ADVISORY BOARD, NEPHCURE FOUNDATION 

Dr. HOLZMAN. Mr. Chairman and members of the subcommittee: 

Despite advances in dialysis and kidney transplantation, kidney 

failure remains a devastating diagnosis, carrying a survival prognosis similar to patients diagnosed with cancer and assuring a lifetime of severe medical complications. 

NIH-sponsored investigators have been really remarkably successful in advancing our understanding of kidney disease, with the 

goal of preserving and preventing kidney functional loss. For example, a recent revolution in our knowledge of the biology of the kidney filter has allowed the identification of several inherited dis-
226 

eases and promises to provide tools that will better allow us to diagnose and treat kidney failure in general. 

However, cutting the NIH budget for kidney disease research or 

even failing to keep up with inflationary costs threatens present research momentum. As an investigator and as a member of an NIH 

peer review committee that evaluates scientific proposals, I can assure you that the effects of a restricted NIH budget are already 

being felt. Threatened by a pay line at which only 12 percent of 

grant applications are funded, investigators are reluctant to take 

risks necessary to dramatically advance the field. Delays in funding outstanding proposals retard progress and result in loss of 

uniquely trained research personnel. 

PREPARED STATEMENT

Finally, despite NIH set-asides designed to protect junior investigators, our next generation of talented young people observe the 

anxiety created by funding uncertainty, make rational economic decisions, and turn away from a career in biomedical science. 

Therefore, we ask you to provide an increase of 5 percent in fiscal year 2007 to the NIDDK and to the NIH budget overall. 

Thank you for your attention. 

[The statement follows:] 

PREPARED STATEMENT OF LAWRENCE HOLZMAN

Mr. Chairman, and members of the Subcommittee, thank you for giving me this 

opportunity to come before you today. I am Dr. Lawrence Holzman, Associate Professor of Internal Medicine and Director of the NIH-sponsored Nephrology Training 

Program at the University of Michigan Medical School. I also serve as Chairman 

of the Scientific Advisory Board of the NephCure Foundation (NCF), a non-profit organization dedicated to fighting idiopathic nephrotic syndrome and focal segmental 

glomerulosclerosis (FSGS). 

Fifteen million Americans have significantly impaired kidney function and are at 

risk of loosing their kidney function entirely. Another 400,000 have already lost 

their kidney function. Despite NIH-sponsored advances in dialysis and kidney transplantation, kidney failure—due to common diseases such as diabetic kidney disease 

or hypertension, or due to relatively rare diseases such as focal segmental 

glomerulosclerosis—remains a devastating diagnosis. Kidney failure carries a shortened survival similar to that of many cancers and assures a lifetime of severe medical complications. The American people spend nearly $20 billion per year to provide 

medical care for these individuals alone. Undeniably, there remains a critical need 

to prevent patients from losing kidney function. 

Recognizing this need, NIH-sponsored investigators have made great strides in 

the basic science and clinical science of kidney disease, progress that has begun to 

slow the incidence of kidney failure. For example, during the past decade, a revolution in our understanding of the biology of the kidney filter sparked by initial successes in molecular genetics has allowed the identification of several inherited diseases of the kidney filter and promises to provide tools that will much better guide 

diagnosis and treatment of the patients who are likely to lose their kidneys. Dramatic advances in our understanding of the biology of cystic diseases of the kidney 

such as polycystic kidney disease has led to promising clinical trials of medications 

that might slow or prevent these diseases. For those patients that have already lost 

their native kidneys to disease, NIH-sponsored research has improved our understanding of the immune system, providing hope for kidney transplant patients who 

suffer the dangerous side effects of present day anti-rejection medications and who 

suffer from the knowledge that the average kidney transplant lasts only 11 years. 

Moreover, dialysis patients have improved quality of life because NIH sponsored 

clinical research has taught nephrologists how to better care for their patients. 

Cutting the NIH-budget for kidney disease research, or even failing to keep up 

with the inflation in costs for doing this research, immediately threatens the research momentum that was attained by doubling the NIH budget. As an independent investigator, and as member of an NIH peer review committee that evalu-
227 

ates independent-investigator initiated scientific proposals, I can assure you that the 

affects of a restricted NIH budget are already being felt in a real but difficult to 

quantify fashion. Threatened by a ‘‘pay line’’ at which only 12–14 percent of grant 

applications are funded (rather than 24 percent just three years ago), investigators 

have become reluctant to take risks that must be taken in their research that would 

dramatically advance a field. Delays in funding outstanding proposals (because they 

must be recycled through the application process several times before they are funded) retard progress and result in the loss of talented and uniquely trained research 

personnel that cannot be readily replaced. Finally, despite NIH set asides designed 

to protect junior investigators, our next generation of talented young people observe 

the anxiety created by funding uncertainty, make rationale economic decisions, and 

turn away from a career in biomedical science, leaving the future of this science in 

jeopardy. 

NIH sponsored biomedical research is an American treasure that reaps multifold 

benefits; it is a treasure that must be nurtured and protected. Therefore, we ask 

you to provide an increase of 5 percent in fiscal year 2007 for the National Institute 

of Diabetes, Digestive, and Kidney Diseases (NIDDK), and the NIH overall. 

Thank you. 

Senator SPECTER. Thank you, Dr. Holzman. 

Our final witness on the panel is Dr. Steven Houser, representing the American Heart Association. 

STATEMENT OF STEVEN R. HOUSER, Ph.D., DIRECTOR, CARDIOVASCULAR RESEARCH CENTER, TEMPLE UNIVERSITY SCHOOL 

OF MEDICINE ON BEHALF OF THE AMERICAN HEART ASSOCIATION 

Dr. HOUSER. Thank you, Senator Specter and Senators Harkin 

and Shelby. I am an American Heart Association volunteer for the 

last 30 years. My day job is at a cardiovascular research group at 

Temple University School of Medicine in North Philadelphia. My 

NIH-funded research focuses on how we can fix broken hearts so 

that people can live healthier, happier lives. 

Thanks to your investments, I believe we are on the threshold of 

making wonderful discoveries that can be translated into novel 

therapies. My lab group works on a very simple concept. We have 

found that in every one of your hearts there are stem cells that are 

making new myocites and blood vessels all the time. I believe that 

we have the opportunity to figure out ways to take these cells from 

each of your hearts, expand them, prime them to repair your heart, 

and save them in case you ever need them if your heart becomes 

damaged. 

PREPARED STATEMENT

Unfortunately, the NIH cuts are limiting my ability and the ability of my collaborators in Pennsylvania, Iowa, which I just visited 

last week, and Alabama, where I will visit in about a month, to 

pursue these ideas. It is forcing me to cut my staff, train fewer people, lay off local workers. I think this has impact not just on 

science and medicine, but on the economies of the communities and 

the States that we are charged to serve. 

So thank you so much for all your hard work with respect to 

these issues, and I would be happy to answer any questions. 

[The statement follows:] 
228 

PREPARED STATEMENT OF STEVEN R. HOUSER

SUMMARY OF RECOMMENDATIONS 

Agency Amount 

National Institutes of Health ......................................................................................................................... $29,800,000,000 

National Institutes of Health Heart Research ...................................................................................... 2,200,000,000 

National Institutes of Health Stroke Research ..................................................................................... 357,000,000 

National Heart, Lung, and Blood Institute .................................................................................. 3,100,000,000 

National Institute of Neurological Disorders and Stroke ............................................................. 1,600,000,000 

Agency for Healthcare Research and Quality ................................................................................................ 440,000,000 

Centers for Disease Control and Prevention (plus funding for pandemic influenza preparedness) ........... 8,500,000,000 

Heart Disease and Stroke Prevention Program .................................................................................... 55,000,000 

Health Resources and Services Administration: Rural and Community Access to Emergency Devices Program .......................................................................................................................................................... 8,900,000 

Department of Education: Carol M. White Physical Education Program ...................................................... 100,000,000 

An estimated 71 million American adults suffer from heart disease, stroke, and 

other forms of cardiovascular disease. Nearly 2,500 Americans die of cardiovascular 

disease each day—an average of one death every 35 seconds. Heart disease and 

stroke remain the first and third leading causes of death, respectively, for both men 

and women in the United States today and more than half of men and nearly 40 

percent of women will develop cardiovascular disease during their lifetime. As the 

baby boom generation ages, the prevalence of cardiovascular disease will increase 

dramatically, because although this disease can strike at any stage of life—the likelihood increases with age. Deaths from heart disease alone are projected to increase 

by about 130 percent between 2000 and 2050, according to one report. 

Cardiovascular disease also costs Americans an estimated $403 billion in medical 

expenses and lost productivity in 2006—more than any other disease and more than 

the projected budget deficit for that year. As the population ages, the combination 

of demographics and high costs will result in a cardiovascular disease crisis with 

staggering implications for health care costs and quality of care. 

Although progress has been made in the treatment of cardiovascular disease, 

there is no cure. In fact, studies suggest that increased rates of diabetes, obesity 

and other risk factors may reverse four decades of declining mortality. The most 

prudent way to address this looming crisis is to simultaneously invest in prevention 

and in the development of more cost-effective treatments. Regretfully, the funding 

levels proposed by the President undermine efforts in both of these areas. 

When adjusted for biomedical research inflation, the proposed NIH budget for cardiovascular disease research is estimated to be 15 percent lower in 2007 than in fiscal year 2003. Funding levels proposed in the budget for the CDC’s Heart Disease 

and Stroke Prevention Program remain flat at a time when only 14 states receive 

the resources necessary to implement prevention programs and strategies. In addition, the Rural and Community Access to Emergency Devices Program, administered by the Health Resources and Services Administration, is terminated in the 

President’s budget. This program provides grants to rural areas and communities 

to purchase and place AEDs in schools, churches, fire stations, and other locations 

to save the lives of cardiac arrest victims. 

Now is the wrong time to reduce our nation’s investment in programs that prevent and treat America’s leading and most costly cause of death. Solving a problem 

of this magnitude will require a significant public investment in these fiscally challenging times, but if we fail to take aggressive and deliberate action now—we will 

pay a terrible cost later—both in terms of health care expenditures and human 

lives. The following recommendations from the American Heart Association address 

this problem in a comprehensive but fiscally responsible manner. 

INCREASE FUNDING FOR THE NATIONAL INSTITUTES OF HEALTH (NIH)

NIH-sponsored research has revolutionized patient care and holds the key to an 

eventual cure for all forms of cardiovascular disease. Research funded by the NIH 

also fuels innovation that generates economic growth and preserves our nation’s role 

as a world leader in the biomedical and biotechnology industries. For fiscal year 

2006, NIH funding was cut below the previous year’s level for the first time in 35 

years. The President preserved this cut in his fiscal year 2007 budget and reduced 

NIH further over the next five years by nearly 20 percent. This five year cut reduces 

NIH resources in inflation adjusted terms by more than one-third from its peak in 

fiscal year 2003—the end of the historical five-year doubling of the NIH budget. 
229 

Recommendation.—The AHA joins the research and patient advocacy community 

in recommending an fiscal year 2007 appropriation of $29.8 billion for the NIH. This 

level, which represents a 5 percent increase over 2006, covers the increased costs 

of biomedical research inflation and provides additional resources to investigate 

emerging research opportunities. 

INCREASE FUNDING FOR NIH HEART AND STROKE RESEARCH

From 1993–2003, death rates from cardiovascular diseases have fallen by 22 percent, death rates from coronary heart disease have declined by 30 percent, and 

death rates from stroke have fallen by 19 percent. NIH sponsored heart and stroke 

research has improved health outcomes and in some cases, lowered health care 

costs. Examples of recent NIH-supported research follow. 

Aspirin Prevents Another Type of Stroke.—Aspirin is as effective as, and safer 

than, the blood thinning drug warfarin in preventing intracranial arterial stenosis— 

which accounts for roughly 10 percent of all strokes. Aspirin is a low cost therapy 

that does not require the intricate and costly monitoring like the drug warfarin. Researchers estimate that use of aspirin rather than warfarin could cut health care 

costs by $20 million each year. 

Blood Test to Screen for Stroke Wins FDA Approval.—A blood test to screen for 

heart disease gained approval to predict stroke risk. The test scans the blood for 

levels of the enzyme lipoprotein-associated phospholipase A2, which are higher in 

potential stroke victims. 

Diuretics Again Initial Therapy for High Blood Pressure.—Continuing analyses of 

the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial 

(ALLHAT) for diabetics, blacks and non-blacks with high blood pressure confirms, 

the initial conclusion that diuretics should be the initial high blood pressure treatment instead of newer, more costly drugs. 

Antibiotics do not Prevent Second Cardiovascular Events.—Results of clinical 

trials have shown that antibiotics are ineffective in preventing second events like 

heart attack, unstable chest pain and stroke in patients with existing heart disease. 

This finding was unanticipated. 

Slightly Elevated Blood Pressure Triples Heart Attack Risk.—Examining data 

from the Framingham Heart Study, researchers found that the 59 million Americans with prehypertension, blood pressures ranging from 120–139 over 80–89 mm 

Hg, are three times more likely to suffer a heart attack and nearly twice as likely 

to experience heart disease than those with normal blood pressure. Scientists estimate that aggressive treatment would prevent 47 percent of heart attacks. 

Although cardiovascular disease is the leading cause of death in the United 

States, the NIH heart and stroke research budget remains disproportionately underfunded compared to the burden of these diseases on society. Cardiovascular disease 

meets NIH’s priority setting criteria (public health needs, scientific quality of research, scientific progress potential, portfolio diversification and adequate infrastructure support), yet only 7 percent of the NIH budget is invested in heart research and a mere 1 percent is dedicated to stroke. Adjusted for medical research 

inflation, resources for cardiovascular research will decline 15 percent since fiscal 

year 2003 if the President’s budget is enacted. These declining resources are insufficient to support and expand current activities and to invest in promising initiatives 

to aggressively advance the battle against heart disease and stroke. Additional 

funds would be used in the following areas: 

Atherosclerosis Prevention Trial Network.—Atherosclerosis is a major risk factor 

for heart disease and stroke. With increased funding, the National Heart, Lung, and 

Blood Institute (NHLBI) could initiate a clinical trial to determine whether reducing 

low-density lipoprotein cholesterol, so-called ‘‘bad’’ cholesterol, to a level lower than 

currently recommended, reduces major cardiovascular disease events in healthy patients at high risk of heart disease and or stroke. 

Systolic Blood Pressure Intervention Trial.—High blood pressure is a major risk 

factor for heart disease, heart failure and stroke. More funding would allow the 

NHLBI to conduct a multicenter clinical trial to determine whether reducing systolic 

blood pressure to a lower level than currently recommended could prevent heart attacks and strokes. 

Preventing Weight Gain in Young Adults.—Young adults are at a high risk for 

weight gain. With more resources, NHLBI could develop and test innovative practical, cost-effective ways to prevent weight gain in young adults to prevent cardiovascular disease. 

Stroke is the No. 3 killer of Americans and a major cause of permanent disability. 

In addition to the elderly, stroke also strikes newborns, children and young adults. 

An estimated 700,000 Americans will suffer a stroke this year, and nearly 158,000 
230 

will die. Many of America’s 5.5 million stroke survivors face debilitating physical 

and mental impairment, emotional distress and huge medical costs; about 1 in 4 

survivors are permanently disabled. 

As a result of fiscal year 2001 Congressional report language, the National Institute of Neurological Disorders and Stroke (NINDS) convened a Stroke Progress Review Group. A report from this group provides a long-range stroke strategic plan 

for stroke research that includes 5 research priorities and 7 resource priorities. Multiple scientific programs initiated since the report have made impressive progress; 

however, additional funding is needed to implement the plan. The fiscal year 2007 

estimate for NINDS stroke research falls 50 percent short of the target for implementation of that year of the plan. Additional funds would be used to conduct stroke 

research in the following areas: 

Stroke Translational Research.—Translational studies are vital to providing cutting-edge stroke treatment and prevention. Due to budget shortfalls, the NINDS has 

been forced to compress its Specialized Programs of Translational Research in Acute 

Stroke (SPOTRIAS) from the planned 10 extramural centers to the five currently 

funded. SPOTRIAS researchers facilitate translation of basic research into patient 

care and evaluate and treat victims rapidly after the onset of stroke symptoms. 

Neurological Emergencies Treatment Trials Network.—Limited resources will also 

force the NINDS to scale back its Neurological Emergencies Treatment Trials Network. This initiative is designed to develop a clinical research network of emergency 

medicine physicians, neurologists and neurosurgeons to develop more and improved 

treatments for acute neurological emergencies, such as stroke, through clinical 

trials. 

Stroke Education.—As a member of the Brain Attack Coalition—a group of organizations devoted to fighting stroke—the AHA works with the NINDS to increase 

public awareness of stroke symptoms and the need to call 9–1–1. Together, we initiated a public education campaign, Know Stroke: Know the Signs, Act in Time, and 

we are striving to develop systems to make tPA available to appropriate patients. 

In partnership with the CDC, the NINDS extended this campaign to launch a grassroots program called Know Stroke in the Community to enlist the aid of ‘‘Stroke 

Champions’’ who educate communities about stroke signs and symptoms. When 

these measures are implemented, stroke treatment will shift from supportive care 

to early brain-saving intervention. Additional funds are needed to educate the public 

and health providers about stroke. 

Recommendation.—The AHA recommends an fiscal year 2007 appropriation of 

$2.2 billion for NIH heart research. We advocate for an appropriation of $3.068 billion for the NHLBI. And, we recommend $357 million for NIH stroke research. We 

advocate for an appropriation of $1.612 billion for the NINDS. These appropriations 

represent a 5 percent increase over fiscal year 2006—commensurate with the Association’s overall recommended funding increase for the NIH. 

INCREASE FUNDING AT THE CENTERS FOR DISEASE CONTROL (CDC)

Basic research must be translated into easy-to-understand guidance so that people 

can apply it to their daily lives. Prevention is the best way to protect Americans’ 

health and ease the financial burden of disease. Although the clinical literature indicates that increased and improved cardiovascular disease interventions can be highly successful, investigators have concluded that well-established strategies for combating cardiovascular disease are often not being implemented. Recent studies suggest that not smoking, maintaining a healthy weight, and avoiding diabetes, high 

blood pressure and high cholesterol, may add 10 years to life. 

The AHA commends Congress for supporting CDC’s new Division for Heart Disease and Stroke Prevention, which provides funding to 33 states to create programs 

to educate and prevent first and second instances of heart disease and stroke. These 

state-tailored programs facilitate collaboration among public and private sector partners to help individuals control high blood pressure, lower elevated cholesterol, 

learn heart disease and stroke signs and symptoms, call 9–1–1, improve emergency 

response and quality of care, and eliminate treatment disparities. Many of these 

programs have been successful in reducing risk factors—like high blood pressure. 

In fiscal year 2006, only 14 states received funding to implement these prevention 

programs. The remaining 19 states received funds for planning; which is now largely complete. Because cardiovascular disease remains the No. 1 killer in every state, 

each state needs basic implementation money for this program. However, current 

funding levels will not allow for the expansion of this program. 

Recommendation.—For fiscal year 2007, the AHA recommends an appropriation 

of $8.5 billion plus funding for pandemic influenza preparedness for the CDC, including a 10 percent increase over current funding to return chronic disease preven-
231 

tion to the same level as fiscal year 2002. Within that total, we recommend $55 million to expand the Heart Disease and Stroke Prevention Program. This funding level 

would allow the CDC to add up to 4 states to the program, allowing them to conduct 

a state-tailored plan, and elevate 4 more states from planning to program implementation, maintain the Paul Coverdell National Acute Stroke Registry, and start 

the development of a state-based cardiac arrest registry. 

RESTORE FUNDING FOR THE RURAL AND COMMUNITY ACCESS TO EMERGENCY DEVICES

PROGRAM

The Rural and Community Access to Emergency Devices Program provides grants 

to states to train lay rescuers and first responders to use AEDs and buy and place 

them where cardiac arrests are likely to occur. During the first year of the program, 

6,400 AEDs were purchased and 38,800 individuals were trained. AEDs have been 

placed in schools, faith-based and recreation facilities, nursing homes, and other locations in communities across our nation. 

About 94 percent of cardiac arrest victims die outside of a hospital. Immediate 

CPR and early defibrillation using an automated external defibrillator (AED) can 

more than double a victim’s chance of survival. Small, easy-to-use AEDs can shock 

the heart back into normal rhythm. Placing AEDs in more public settings could save 

thousands of lives each year. Communities with comprehensive AED programs that 

include training of anticipated rescuers have achieved survival rates of 40 percent 

or higher. 

The Rural and Community Access to Emergency Devices Program is terminated 

in the President’s fiscal year 2007 budget. The budget justification asserts that 

much of the demand for AEDs has been met, although between fiscal year 2002 and 

fiscal year 2004 less than half of the grant dollars requested by states for this lifesaving program were actually awarded. 

Recommendation.—For fiscal year 2007, the AHA recommends that the Subcommittee allocate $8.927 million for HRSA’s Rural and Community Access to 

Emergency Devices Program to restore funding to its fiscal year 2005 level. 

INCREASE FUNDING FOR THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ)

The AHRQ is a critical partner with the public and private health care sectors. 

This agency helps develop evidence-based information needed by consumers, providers, health plans and policymakers to improve health care decision making. 

Through its Effective Health Care Program, AHRQ supports research focusing on 

outcomes, comparative clinical effectiveness, and appropriateness of pharmaceuticals, devices and healthcare services for a number of conditions, including 

ischemic heart disease, stroke, and high blood pressure. The new research and comparative effectiveness reviews conducted and funded under this program will help 

address issues raised in the Institute of Medicine’s (IOM) report: Crossing the Quality Chasm. 

The AHRQ’s initiative on health information technology (HIT) is a key element 

to the nation’s strategy to bring health care into the 21st century. This initiative 

includes more than $166 million in grants, and through these and other projects, 

AHRQ and its partners will help to identify challenges to HIT adoption and use, 

solutions and best practices, and tools that will help hospitals and clinicians successfully incorporate new HIT. To facilitate this effort, the AHRQ’s National Resource Center for HIT provides the health care community with technical assistance 

and consulting services to HIT projects, and particularly focus on addressing challenges to HIT implementation in rural and small community settings. 

Recommendation.—The AHA joins with the Friends of AHRQ in advocating for an 

appropriation of $440 million for the AHRQ to advance health care quality, cut medical errors and expand the availability of health outcomes information. 

INCREASE FUNDING FOR THE CAROL M. WHITE PHYSICAL EDUCATION PROGRAM (PEP)

Physical inactivity is a key risk factor for heart disease and stroke, but Youth 

Risk Behavior Surveillance data indicates that almost half of 12–21 year olds do not 

participate in any vigorous physical activity on a regular basis. Despite recent studies by Action for Healthy Kids and the Robert Wood Johnson Foundation showing 

that almost 80 percent of parents support daily physical education (PE) in schools 

to help combat physical inactivity and teach life long skills, only 6–8 percent of 

schools nationally offer daily PE. One of the primary barriers to providing PE is 

adequate financial resources for equipment, program development, and staff training. The Carol M. White Physical Education Program helps schools overcome this 

barrier by providing money for school-based physical education activities that teach 
232 

life-long physical activity habits. PEP is the only federal program that directly supports PE in schools. 

Recommendation.—For fiscal year 2007, the AHA recommends an appropriation 

of $100 million for the Carol M. White Physical Education Program. This level of 

funding will allow the Department of Education to expand the program to more districts while maintaining funding for the duration of previously awarded grants. 

Although heart disease, stroke, and other cardiovascular disease are largely preventable, these diseases continue to exact a deadly toll on our nation. As baby 

boomers age, our nation faces an expanding cardiovascular disease crisis unless significant steps are taken. We urge the subcommittee to consider these recommendations for the fiscal year 2007 budget. Adequate funding of research, treatment and 

prevention programs will save lives and reduce rising health care costs. 

Senator SPECTER. Thank you very much, Dr. Houser. 

Senator Harkin, do you have any comment or question? 

Senator HARKIN. Just one. I have a lot of questions for the panel, 

but just one that I just want to ask Dr. Goldstein. Give us just a 

few seconds on your view on the potential of stem cell, embryonic 

stem cell research to benefit juvenile diabetes, type 1 diabetes? 

Dr. GOLDSTEIN. We are extremely bullish, Senator Harkin, on 

the potential to create insulin-secreting cells that are fully functional and respond to glucose. Work has already carried the human 

embryonic stem cell work to the point of producing endoderm, 

which is the tissue that then can create the pancreas. Investigators 

in animal studies can instruct endoderm to make pancreas. If we 

can make pancreas, that will give us the precursor cells for beta 

cells and insulin-secreting cells. 

So we are extremely, extremely optimistic and wish the work 

could go forward with full speed. 

Senator HARKIN. Thank you. 

Senator SPECTER. Senator Shelby, any comment or question? 

Senator SHELBY. Yes. 

Is anyone on the panel dealing in the autoimmune area, especially dealing with lupus or lupus-related? Dr. Holzman, do you 

want to comment on where we are going? You heard the first panel 

earlier. 

Dr. HOLZMAN. Actually, in this regard I am more the clinician 

dealing with patients on the front lines. 

Senator SHELBY. That is very important, the clinical work. 

Dr. HOLZMAN. I am a nephrologist, a person who deals with kidney disease, and see many of the most complicated patients with 

lupus and kidney disease. I can tell you first that these are patients who suffer dramatically, that their lives are spent worrying 

about not only dealing with the current flare, the current problem, 

but the probability that the disease will recur. 

I should say that, thanks to big investments by the NIH in clinical trials, there actually have been some new drugs, drugs that 

have actually been around for a while but now are proven safer 

and actually as effective as earlier, more dangerous drugs, such as 

cyclophosphamide. We are now using microphenalate moftil as a 

first-line drug for kidney lupus and with I think fairly good success. 

Senator SHELBY. So you see a lot of hope there? 

Dr. HOLZMAN. I see a lot of hope there. I think that we need to 

further invest using the latest technology and translational studies 

in this area. 

Senator SHELBY. Thank you. 
233 

Thank you, Mr. Chairman. 

Senator SPECTER. Thank you, Senator Shelby. 

Thank you very much, ladies and gentlemen. 

Senator SHELBY. I think Dr. Goldstein was going to say something. 

Dr. GOLDSTEIN. Real quickly, Senator Shelby. I would just like 

to repeat something that Dr. Fauci said: the support of the Immune Tolerance Network, which is a clinical trial translation platform for autoimmune diseases, including lupus, type 1 diabetes, 

and others. We learn from each other, from the science. Choking 

that funding off is going to eliminate the possibility to do those cutting edge clinical trials. 

Senator SHELBY. Thank you. 

Thank you. 

Senator SPECTER. Thank you very much, ladies and gentlemen. 

We very much appreciate your coming in. 

We now turn to panel three: Dr. Daniel Koo, Dr. Phil Landrigan, 

Mr. Emeran Mayer, Dr. Peter McDonnell, Ms. Sandra Raymond, 

Mr. Herman Taylor, Ms. Suzanne Vogel-Scibilia. 

Our first witness is Dr. Daniel Koo, represent the Deaf and Hard 

of Hearing Alliance, and Dr. Koo is accompanied by an interpreter. 

Dr. Koo, we begin with you. 

STATEMENT OF DANIEL KOO, M.D., ON BEHALF OF THE DEAF AND 

HARD OF HEARING ALLIANCE 

Dr. KOO [speaks through a sign language interpreter]. Mr. Chairman, members of the Subcommittee of Senate Appropriations: On 

behalf of the member organizations of the Deaf and Hard of Hearing Alliance—— 

Senator HARKIN. Excuse me. Could you speak into that just a little bit louder. I am having a hard time. 

Senator SPECTER. Senator Thurmond always would say: Bring 

the machine a little closer. 

Dr. KOO. Mr. Chairman and members of the Senate Appropriations Subcommittee: On behalf of the member organizations of the 

Deaf and Hard of Hearing Alliance, a coalition of professional and 

consumer organizations serving and representing people who are 

deaf and hard of hearing, it is my pleasure to be here with you this 

morning to discuss the President’s budget request for NIH’s National Institute on Deafness and Other Communication Disorders. 

My name is Dr. Koo. I am a postdoctoral fellow at Georgetown 

University conducting neuroimaging studies on language and literacy, supported by NIDCD. 

Fiscal year 2007’s budget request for NIDCD is $1.9 million less 

compared to the fiscal year 2006 appropriation. The DHHA strongly urges Congress not to impose further cuts in NIH or NIDCD research funding and that Congress and the administration work together to ensure appropriate funding that does not compromise 

current and future research efforts. The DHHA applauds current 

research being conducted related to people who are deaf and hard 

of hearing, specifically the strategies to protect hearing, diagnose 

and prevent hearing loss, and explore genetic modifiers. 

However, we urge the NIDCD to continue to pursue and support 

studies that delve into the acquisition and learning of oral and-or 
234 

visual languages, the various communication modes and educational settings. 

Cutting the funding most assuredly will prevent the expansion of 

research in this critical area of need. Funding support for NIDCD 

to date has allowed many scientists, like myself, to make significant advances in hearing research as well as related sensory and 

cognitive areas. With congressional support, the NIDCD can continue its important research that aids in preventing hearing loss as 

well as assisting those who are deaf or hard of hearing. 

PREPARED STATEMENT

With hearing loss expected to reach 40 million Americans within 

the next generation, scientific work taking place at NIH and 

NIDCD is too critical to the human condition to take a step backward at this time. 

Thank you. 

[The statement follows:] 

PREPARED STATEMENT OF DANIEL KOO

On behalf of the member organizations of the Deaf and Hard of Hearing Alliance, 

a coalition of professional and consumer organizations serving and representing people who are deaf or hard of hearing, it is my pleasure to be here with you this morning to discuss the President’s budget request for the National Institutes of Health, 

specifically the National Institute on Deafness and Other Communication Disorders 

(NIDCD). 

My name is Daniel Koo. I am a post-doctoral fellow at Georgetown University conducting neuron-imaging studies on language and literacy supported by NIDCD. 

The fiscal year 2007 budget request for NIDCD is $391,556,000, a decrease of 

$1,902,000 compared to the fiscal year 2006 Appropriation. The DHHA strongly 

urges Congress not to impose further cuts in NIH or NIDCD research funding, and 

we ask that Congress and the Administration work together to ensure appropriate 

funding to ensure that current and future research efforts are not compromised. 

With hearing loss expected to affect 40 million within one generation, there has 

never been a time when research has been needed so much. 

The DHHA applauds the current research being conducted related to people who 

are deaf or hard of hearing, specifically the strategies to protect hearing, diagnose 

and prevent hearing loss, and explore genetic modifiers. However, we urge NIDCD 

to continue to pursue and support studies that delve into the acquisition and learning of oral and/or visual languages the necessary precursor to a variety of communication modes and settings. Cutting the funding will most assuredly prevent the 

expansion of research in this critical area of need. 

Funding support for NIDCD to date has allowed many scientists like myself to 

make significant advances in hearing research, as well as related sensory and cognitive areas that impact the human condition. With Congressional support the 

NIDCD can continue its important research that aids in preventing hearing loss as 

well as assisting those who are deaf or hard of hearing. The work taking place at 

NIH and NIDCD is too critical to the human condition to take a step backward at 

this time. 

Members of the Deaf and Hard of Hearing Alliance include: Alexander Graham 

Bell, Association for the Deaf & Hard of Hearing, American Academy of Audiology, 

American Academy of Otolaryngology-Head and Neck Surgery, American SpeechLanguage-Hearing Association, Conference of Educational Administrators of Schools 

& Programs for the Deaf, Council of American Instructors of the Deaf, Cued Language Network of America, Deafness Research Foundation, Hearing Loss Association of America, Media Access Group at WGBH, National Association of the Deaf, 

National Cued Speech Association, Registry of Interpreters for the Deaf, Testing, 

Evaluation, and Certification Unit, and Telecommunications for the Deaf, Inc. 

Senator SPECTER. Thank you very much, Dr. Koo. 

We now turn to Dr. Philip Landrigan, representing the Campaign for American Children’s Health. Dr. Landrigan. 
235 

STATEMENT OF PHILIP J. LANDRIGAN, M.D., MSc, FAAP, PRESIDENT, 

CAMPAIGN FOR AMERICAN CHILDREN’S HEALTH 

Dr. LANDRIGAN. Good morning, Senator Specter, Senator Harkin, 

Senator Shelby. I’m Philip Landrigan, pediatrician at Mount Sinai 

Medical School in New York City, and I thank you for inviting me 

here this morning to come to speak in support of the National Children’s Study. 

I’d like first of all to thank all of you for the great support that 

you’ve given the National Children’s Study over the past 6 years 

since its inception in 2000, and thanks most particularly for the 

discussion that you had in support of the study just a few minutes 

ago this morning. 

The reason that this Nation needs the National Children’s Study 

is that the children’s study will give us information on the preventable environmental causes of the major diseases that afflict American children today—asthma, which has more than doubled; childhood brain cancer has gone up 40 percent; autism, you heard a few 

minutes ago has gone up remarkably; other learning disabilities. 

It’s been said that the study is expensive and it is. But the diseases, the chronic diseases that the study will address, cost this 

Nation more than $600 billion a year. The very same logic that Dr. 

Zerhouni invoked this morning when he spoke of the great declines 

that have been achieved in heart disease because of the Framingham study, the women’s health initiative, that same logic applies to the National Children’s Study, and it’s ironic that I chose 

to include the same image in my testimony as he used in his screen 

presentation this morning. 

PREPARED STATEMENT

If we fail to fund the National Children’s Study it will be a major 

opportunity lost. The National Children’s Study is our generation’s 

best hope, indeed probably our only hope, to get on top of the 

chronic diseases in America’s children. 

I thank you. 

[The statement follows:] 

PREPARED STATEMENT OF PHILIP J. LANDRIGAN

Good morning, Mr. Chairman and Members of the Subcommittee. I am Dr. Philip 

J. Landrigan. I am a pediatrician, Professor and Chairman of Community & Preventive Medicine, and Professor of Pediatrics at the Mount Sinai School of Medicine. 

I am Principal Investigator for the Queens, New York Vanguard Center of the National Children’s Study. I am also President of the Campaign for American Children’s Health, a not-for-profit organization committed to preserving the health of 

America’s children by sustaining the National Children’s Study. 

Why Do We Need the National Children’s Study? The United States needs the 

National Children’s Study because we desperately need the information the Study 

will provide on preventable causes of the major diseases that confront America’s 

children today. Information from the National Children’s Study will provide a blueprint for prevention. The diseases of greatest current concern in American children 

are: 

—Asthma, which has more than doubled in frequency since 1980 and become 

theleading cause of pediatric hospitalization and school absenteeism; 

—Birth defects, which are now the leading cause of infant death. Certain 

birthdefects, such as hypospadias, have doubled in frequency; 

—Neurodevelopmental disorders—autism, dyslexia, mental retardation, and attention deficit/hyperactivity disorder (ADHD). These conditions affect 5–10 percent of the 4 million babies born each year in the United States. Reported rates 

ofautism are increasing especially sharply—more than 20 percent per year; 
236 

—Leukemia and brain cancer in children and testicular cancer in adolescents. Incidence rates of these malignancies have increased since the 1970s, despite declining rates of mortality. Testicular cancer has risen by 55 percent, and 

primarybrain cancer by 40 percent. Cancer is now the second leading cause of 

death in American children, surpassed only by traumatic injuries; 

—Preterm birth, which has increased in incidence by 27 percent since 1981; 

—Obesity and its consequence, type 2 diabetes. Obesity has trebled in 

prevalencein the United States. Obesity has become common in even the youngest of our children, and for example, 41 percent of 5-year-olds entering kindergarten in the five boroughs of New York City in 2005 were overweight or frankly obese. The future toll of disease and premature death in these youngsters— 

from diabetes, heart disease, stroke and probably cancer—will be fearsome. 

We have a responsibility to safeguard our children. They are the most vulnerable 

among us, our most precious resource, and the hope for our future. But these rapidly rising rates of chronic disease threaten the health of our children and the future security of our nation. 

Indeed, concern is strong among the pediatric community that these rapidly rising 

rates of disease may create a situation unprecedented in the 200 years of our nation’s history, in which our current generation of children may be the first American 

children ever not to enjoy a longer life span than the generation before them. In 

other words, if we do not support the necessary research—especially the National 

Children’s Study—and if we fail to take needed preventive action, we are actually 

at risk of losing hard-won ground in children’s health. 

What is the National Children’s Study?—The National Children’s Study is a prospective multi-year epidemiological study that will follow 100,000 American children, a nationally representative sample of all children born in the United States, 

from conception to age 21. The study will assess and evaluate the environmental 

exposures these children experience in the womb, in their homes, in their schools 

and in their communities. It will seek associations between environmental exposures and disease in children. The diseases of interest include all those listed above. 

The principal goal of the Study is to identify the preventable environmental causes 

of pediatric disease and to translate those findings into preventive action and improved health care. 

The National Children’s Study was mandated by Congress through the Children’s 

Health Act of 2000. The lead federal agency principally responsible for the Study 

is the National Institute of Child Health and Human Development. Other participating agencies include the National Institute of Environmental Health Sciences, 

the Environmental Protection Agency, and the Centers for Disease Control and Prevention. 

By working with pregnant women and couples, the Study will gather an unprecedented volume of high-quality data on how environmental factors acting either 

alone, or in combination with genetic factors, affect the health of infants and children. Examining a wide range of environmental factors—from air, water, and dust 

to what children eat and how often they see a doctor—the Study will help develop 

prevention strategies and cures for a wide range of childhood diseases. By collecting 

data nationwide the study can test theories and generate hypotheses that will inform biomedical research and he care of young patients for years to come. Simply 

put, this seminal effort will provide the foundation for children’s healthcare in the 

21st Century. 

The Unique Strengths of the National Children’s Study.—Six aspects of the architecture of the National Children’s Study make it a uniquely powerful tool for protecting the health of America’s children: 

1. The National Children’s Study is prospective in its Design.—The great strength 

of the prospective study design is that it permits unbiased assessment of children’s 

exposures in real time as they actually occur, months or years before the onset of 

disease or dysfunction. Most previous studies have been forced to rely on inherently 

inaccurate retrospective reconstructions of past exposures in children who were already affected with disease. The prospective design obviates the need for recall. It 

is especially crucial for studies that require assessments of fetal and infant exposures, because these early exposures are typically very transitory and will be missed 

unless they are captured as they occur. 

2. The National Children’s Study Will Employ the Very Latest Tools of Molecular 

Epidemiology.—Molecular epidemiology is a cutting-edge approach to population 

studies that incorporates highly specific biological markers of exposure, of individual 

susceptibility and of the precursor states of disease. Especially when it is embedded 

in a prospective study, molecular epidemiology is an extremely powerful instrument 

for assessing interactions between exposures and disease at the level of the individual child. 
237 

3. The National Children’s Study Will Incorporate State-of-the-Art Analyses of 

Gene-Environment Interactions.—Recognition is now widespread that gene-environment interactions are powerful determinants of disease in children. These interactions between the human genome and the environment start early in life, affect 

the health of our children, and set the stage for adult disorders. The heroic work 

of decoding the human genome has shown that only about 10–20 percent of disease 

in children is purely the result of genetic inheritance. The rest is the consequence 

of interplay between environmental exposures and genetically determined variations 

in individual susceptibility. Moreover, genetic inheritance by itself cannot account 

for the sharp recent increases that we have seen in incidence of pediatric disease. 

4. The National Children’s Study Will Examine a Nationally Representative Sample of American Children.—Because the 100,000 children to be enrolled in the Study 

will be statistically representative of all babies born in the United States during the 

five years of recruitment, findings from the Study can be directly extrapolated to 

the entire American population. We will not need to contend with enrollment that 

is skewed by geography, by socioeconomic status, by the occurrence of disease or by 

other factors that could blunt our ability to assess the links between environment 

and disease. 

5. Environmental Analyses in the National Children’s Study will be conducted at 

the Centers for Disease Control and Prevention.—The CDC laboratories in Atlanta 

are the premier laboratories in this nation and the world for environmental analysis. Because the testing will be done at CDC it will be the best available, and the 

results will be unimpeachable. 

6. Samples Collected in the National Children’s Study Will be Stored Securely and 

Will be Available for Analysis in the Future.—New tests and new hypotheses will 

undoubtedly arise in the years ahead. Previously unsuspected connections will be 

discovered between the environment, the human genome and disease in children. 

The stored specimens so painstakingly collected in the National Children’s Study 

will be available for these future analyses. 

The Current State of the National Children’s Study.—Congress has already laid 

a firm foundation for the National Children’s Study. Between 2000 and 2005, the 

Congress invested more than $55 million to design the study and begin building the 

nationwide network necessary for its implementation. 

Seven Vanguard Centers and a Coordinating Center were designated in 2005 at 

sites across the nation—in Pennsylvania, New York, North Carolina, Wisconsin, 

Minnesota, South Dakota, Utah and California—to test the necessary research 

guidelines—with plans to expand the program to 38 states and 105 communities nationwide. 

The tough job of designing and organizing is nearly complete. Funding for the 

Study this year will permit researchers to begin achieving the results that will 

make fundamental improvements in the health of America’s children. 

To abandon the Study at this point would mean forgoing all of that dedication, 

all of that incredible effort, and all of the logistical preparation. 

The Study Will More Than Pay for Itself.—The National Children’s Study will 

yield benefits that far outweigh its cost. It will be an extraordinarily worthwhile investment for our nation, and it can be justified even in a time of fiscal stress such 

as we face today. 

Six of the diseases that are the focus of the Study (obesity, injury, asthma, diabetes, autism and schizophrenia) cost America $642 billion each year. If the Study 

were to produce even a 1 percent reduction in the cost of these diseases, it would 

save $6.4 billion annually, 50 times the average yearly costs of the Study itself. 

But in actuality, the benefits of the National Children’s study will likely be far 

greater than a mere 1 percent reduction in the incidence of disease in children. The 

Framingham Heart Study, upon which the National Children’s Study is modeled, 

is the prototype for longitudinal medical studies and the benefits that it has yielded 

have been enormous. 

The Framingham Study was launched in 1948, at a time when rates of heart disease and stroke in American men were skyrocketing, and the causes of those increases were poorly understood. The Framingham Study used path-breaking methods to identify risk factors for heart disease. It identified cigarette smoking, hypertension, diabetes, elevated cholesterol and elevated triglyceride levels as powerful 

risk factors for cardiovascular disease. These findings contributed powerfully to the 

42 percent reduction in mortality rates from cardiovascular disease that we have 

achieved in this country over the past 5 decades (see Figure, next page). 

The data from Framingham have saved millions of lives—and billions of dollars 

in health care costs. The National Children’s Study, which will focus on multiple 

childhood disorders, could be even more valuable. 
238 

The National Children’s Study will Yield Benefits in the Near-Term Future.—We 

do not need to wait 21 years for benefits to materialize from the National Children’s 

Study. Valuable information will become available in a few years’ time, as soon as 

the first babies in the Study are born. 

Consider, for example, data on premature births. The rate of U.S. premature 

births in 2003 was 12.3 percent, far higher than the 7 percent rate in most western 

European countries. Hospital costs associated with a premature birth average 

$79,000, over 50 times more than the average $1,500 cost for a term birth. Just a 

5 percent reduction in rates of prematurity would cut hospital costs by $1.6 billion 

annually. Within just two years, that savings would match the full cost of the Study. 

The Study Enjoys Broad Support.—The Study enjoys a broad group of supporters, 

including The American Academy of Pediatrics; Easter Seals; the March of Dimes; 

the National Hispanic Medical Association; the National Association of County and 

City Health Officials; the National Rural Health Association; the Association of 

Women’s Health, Obstetric and Neonatal Nurses; United Cerebral Palsy; the Spina 

Bifida Association of America; and the United States Conference of Catholic 

Bishops, just to name a few. This broad and diverse group recognizes the overwhelming benefits this Study will produce for America’s children. 

Congress Should Fully Fund the National Children’s Study.—Congress first authorized the National Children’s Study in 2000, and has appropriated $55 million 

since then to design the Study, complete preparatory research, and designate the 

seven Vanguard sites that will conduct preliminary testing. 

This has been a wise investment that should not be abandoned just as the Study 

is about to bear fruit. Unfortunately, the Administration has not provided continued 

funding in the fiscal year 2007 budget, a decision which threatens to squander the 

investment already made and to throw away the multi-generational benefits the 

Study will yield. 

Funding for the Study this year requires a commitment of $69 million. These 

funds will be used to begin enrolling children in the study. They will enable the NIH 

to continue establishing the 105 study sites around the country. We urge Congress 

to fully fund the National Children’s Study. It is an investment in our children— 

and in America’s future. 

The National Children’s Study will give our nation the ability to understand the 

causes of chronic disease that cause so much suffering and death in our children. 

It will give us the information that we need on the environmental risk factors and 

the gene-environment interactions that are responsible for rising rates of morbidity 
239 

and mortality. It will provide a blueprint for the prevention of disease and for the 

enhancement of the health in America’s children today and in the future. It will be 

our legacy to the generations yet unborn. 

Thank you. I shall be pleased to answer your questions. 

Senator SPECTER. Thank you very much, Dr. Landrigan. 

We now turn to Dr. Emeran Mayer, representing the Digestive 

Disease National Coalition. Dr. Mayer. 

STATEMENT OF EMERAN A. MAYER, M.D., ON BEHALF OF THE DIGESTIVE DISEASE NATIONAL COALITION 

Dr. MAYER. Thank you, Senators Specter, Harkin, and Shelby, 

for this opportunity. I’m here on behalf of the Digestive Disease 

National Coalition, representing the International Foundation for 

Functional Gastrointestinal Disorders. I’m a gastroenterologist and 

director of an NIH-funded research center at UCLA dedicated to 

the study of functional gastrointestinal disorders. 

These disorders, specifically irritable bowel syndrome, or IBS, 

are the most common GI disorders in society. They’re characterized 

by chronic abdominal pain and discomfort and affect women 

disproportionally. IBS’s health care costs are $2 billion annually 

and exceed $20 billion when indirect costs are included. Yet the 

cause of this disorder remains incompletely understood. 

During the past 10 years, NIDDK has helped advance biomedical 

research in the field, bringing us within reach for the first time of 

several IBS treatments with great potential. The NIDDK is embarking on a strategic planning process for digestive diseases in 

which IBS will be a critical component. This is essential to advance 

our understanding, improve treatments, and recruit new investigators for the disease. 

The President’s proposed cuts to NIH will have a detrimental impact on research advancements in digestive diseases and specifically in IBS. Such cuts would slow our understanding of 

pathophysiological mechanisms and effective treatments, slow or 

eliminate pivotal clinical trials, and prevent the pharmaceutical industry to develop new treatments, and most importantly reduce the 

number of established investigators and send a shock wave to 

young investigators considering entering into this field. 

PREPARED STATEMENT

It is therefore essential to continue our investment into these 

programs that hold such promise at this point. I urge you therefore 

to prevent the proposed NIH budget cuts and to prevent the likely 

unraveling of all the progress that has been made during the past 

decade. 

Thank you for the opportunity to testify. 

[The statement follows:] 

PREPARED STATEMENT OF EMERAN A. MAYER

Chairman Specter and members of the Subcommittee, thank you for the opportunity to present testimony before you today on the effect that the President’s fiscal 

year 2007 budget for the National Institutes of Health (NIH) will have on functional 

gastrointestinal and motility disorders research. My name is Dr. Emeran A. Mayer 

and I am here today representing the International Foundation for Functional Gastrointestinal Disorders’ (IFFGD) Board of Directors and the IFFGD Advisory Board 

on behalf of the Digestive Disease National Coalition (DDNC). I am the Director of 

the UCLA Center for Neurovisceral Sciences & Women’s Health (CNS), a 
240 

translational research program recently funded by the NIH that is currently viewed 

as the leading integrated research program in the world in the area of functional 

digestive disorders. 

Functional gastrointestinal disorders, specifically irritable bowel syndrome or IBS, 

and motility disorders are the most common gastrointestinal disorders experienced 

in society and are present in about 25 percent of the U.S. population. The impact 

on the healthcare system and society in general is substantial. These disorders comprise about 40 percent of gastrointestinal problems for which patients seek health 

care and the frequency of work absenteeism as a result of these disorders is second 

only to the common cold. IBS health care costs to society are $2 billion annually 

and exceed $19 billion when indirect factors such as loss of work and productivity 

are considered. Although the cause of IBS is incompletely understood, we do know 

that this disorder needs a multidisciplinary approach in research and often treatment, in order to help the millions of patients suffering across the country. 

New knowledge on the mechanisms of these disorders, in particular in terms of 

dysregulation of the elaborate interactions between the nervous system and the digestive system, has resulted in neurophysiological and neuropharmacological investigations which have the potential to produce new pharmaceutical agents as well as 

disease management programs for treatment of these disorders. 

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 

has been supporting research into the basic and translational mechanisms of functional GI disorders including IBS, in terms of individual research grants (R–01), career development grants to young investigators (K awards), and major support of 

two research centers, including our own at UCLA. These efforts during the past 10 

years have been essential in advancing biomedical research in the field and, for the 

first time, bringing us within reach of several novel pharmacological treatments 

with great potential for IBS. The NIDDK is in the process of embarking on a strategic planning process for digestive diseases, and IBS will be a critical component 

of this plan. Strategic planning is essential to advancing our understanding of this 

disease, determining improved treatment options for IBS sufferers, and assisting in 

the recruitment of new investigators to conduct IBS research. 

Cutting the budget for the NIH, as is proposed in the President’s fiscal year 2007 

budget, will have a detrimental impact on the research advancements in this important disease area that have been accomplished during the past several years. Specifically, such cuts would have an immediate impact in the following areas: 

—It will slow the elucidation of pathophysiological mechanisms and identification 

of novel targets, which will have a ripple effect on drug development by the 

pharmaceutical industry. There will be no new drug development without NIH 

funded basic and translational research. 

—It will slow or eliminate the execution of pivotal clinical trials of novel treatments for IBS. 

—Most importantly, it will slow strategic planning and reduce the number of 

young investigators dedicated to the field by starting an exodus of such individuals into jobs in the pharmaceutical industry and private practice. Such a reduction in the research base will take years to undo. 

Biomedical research, sponsored by the NIH, has advanced our understanding of 

countless diseases and disorders. It is important to continue our investment in these 

vital programs that hold such promise for our nation’s future. Therefore, we ask you 

to provide an increase of 5 percent in fiscal year 2007 for the National Institute of 

Diabetes and Digestive and Kidney Diseases and for the NIH overall. 

Senator SPECTER. Thank you, Dr. Mayer. 

Our next witness is Dr. Peter McDonnell, representing the National Alliance for Eye and Vision Research. Dr. McDonnell. 

STATEMENT OF PETER McDONNELL, M.D., ON BEHALF OF THE NATIONAL ALLIANCE FOR EYE AND VISION RESEARCH 

Dr. MCDONNELL. Thank you, Chairman Specter, Senator Harkin, 

Senator Shelby. 

The President’s proposed fiscal year 2007 budget would cut National Eye Institute funding by 0.8 percent, or $5.3 million. This 

will have a significant detrimental impact on the entire NEI research portfolio, especially research programs into age-related 

macular degeneration, AMD. As Dr. Zerhouni mentioned this 
241 

morning, this is the leading cause of blindness now in the United 

States. It robs our seniors of their independence. 

I offer three examples. The NEI has identified variants of a gene 

associated with the body’s inflammatory response responsible for 

50 percent of the risk of developing AMD. Without adequate funding, NEI will not be able to develop diagnostics for early detection 

of at-risk individuals and conduct clinical studies with promising 

therapies, as well as study the impact of the inflammatory response and other degenerative eye diseases. 

The NEI has demonstrated that dietary zinc and anti-oxidant vitamins actually reduce vision loss in individuals at risk of developing AMD. Without adequate funding, NEI will not be able to proceed with follow-up clinical studies to identify additional dietary 

supplements used singly or in combination to demonstrate even 

greater protective effects against progression to advanced disease. 

NEI’s research has resulted in the first generation of FDA-approved drugs to treat abnormal blood vessel growth in the wet form 

of AMD, halting further vision loss. NEI’s ability to conduct clinical 

studies of these therapies in patients with macular edema associated with diabetes and diabetic retinopathy would also be jeopardized. 

Thank you, Mr. Chairman, and we appreciate the subcommittee’s 

efforts to increase NIH and NEI funding in the fiscal year 2007 

budget. 

Senator SPECTER. Thank you very much, Dr. McDonnell. 

We now turn to Ms. Sandra Raymond, representing the Lupus 

Foundation of America. 

STATEMENT OF SANDRA RAYMOND, ON BEHALF OF THE LUPUS FOUNDATION OF AMERICA 

Ms. RAYMOND. Good morning, Mr. Chairman, Senator Harkin, 

Senator Shelby. 

Lupus is the prototypical autoimmune disease, so an investment 

in lupus research may in fact produce answers to many other autoimmune diseases affecting more than 23 million Americans. In recent years, NIH has had funded studies that give us great hope 

that we are on the brink of major breakthroughs in lupus research. 

For example, one study, an adult stem cell transplantation study, 

is carried out on only the most severely ill of lupus patients, for 

whom all other treatments have failed. Fifty percent of these patients having the procedure had disease-free survival for 5 years. 

In another NIH-funded study, researchers identified a gene that 

plays a role in one of the immune system pathways meant to fight 

infection. In people with lupus, this pathway turns on, but never 

turns off. 

Mr. Chairman, should NIH appropriations be curtailed there 

may not be a future generation of scientists to do lupus research. 

Already the hint that funding may be reduced has caused leaders 

in our field to consider better funded areas. Cuts in NIH funding 

could bring to a standstill support of clinical trials and large observational studies in lupus and could limit research on those at highest risk for lupus, women of color. 
242 

PREPARED STATEMENT

NIH-funded research currently in progress will lead to new and 

improved treatments for lupus. There has not been a new FDA-approved drug for lupus in almost 40 years and the drugs that our 

patients are currently taking are very harsh chemotherapies, 

chemotherapies in lupus as well as in cancer. 

Thank you. 

[The statement follows:] 

PREPARED STATEMENT OF THE LUPUS FOUNDATION OF AMERICA, INC. 

I am Dr. Michael Madaio, Chief of Nephrology, Professor of Medicine, Temple 

University School of Medicine and a lupus researcher. The Lupus Foundation of 

America, Inc. (LFA) appreciates the opportunity to submit written comments for the 

record regarding funding for lupus related programs for fiscal year 2007. The LFA 

is the nation’s leading non-profit voluntary health organization dedicated to improving the diagnosis and treatment of lupus, supporting individuals and families affected by the disease, increasing awareness of lupus among health professionals and 

the public, and finding the causes and cure. As you may know, lupus is a debilitating, chronic autoimmune disease that causes inflammation and tissue damage to 

virtually any organ system; it can cause significant disability or even death. Lupus 

is the prototypical autoimmune disease; therefore, finding answers to questions 

about lupus may also provide understanding about other autoimmune diseases that 

affect 22 million Americans. The leaders and members of the LFA and the 1.5 to 

2 million people suffering from lupus respectfully request for fiscal year 2007 $29.7 

billion for the National Institutes of Health (NIH) to support lupus research. Specifically, we urge Congress to direct NIH to support and bolster lupus research across 

all relevant institutes, centers, and offices. 

I have been funded for lupus research for over 20 years. I am proud to be affiliated with the Lupus Foundation of America as a member of the Medical Scientific 

Advisory Board and Chairman of the Medical Advisory Board for the Southeastern 

Pennsylvania Chapter of the LFA. While I am a nephrologist, since my research and 

clinical practice is focused on lupus, I really work day-to-day within the realms of 

nephrology and rheumatology as well as other medical specialties and subspecialty 

areas. I understand the importance of biomedical research funding and the impact 

that federal research funding has had, does have, and can have on the lives of the 

1.5 million people living with lupus and the 22 million Americans with other autoimmune diseases. 

After a tragic 40 year dearth of new treatments to manage this often debilitating 

and devastating disease, the good news is that we finally are on the brink of major 

breakthroughs, thanks to research sponsored by the National Institutes of Health. 

Exciting research and strides in treatments for people with lupus are on the horizon 

and a sustained investment now in lupus research will speed the day to better treatments and a cure. One exciting study, adult stem cell transplantation, was carried 

out on only the most severely ill of lupus patients for whom all other treatments 

have failed. Fifty percent of the patients having the procedure had disease free survival at 5 years. In another NIH funded study researchers identified a gene that 

plays a role in one of the immune system pathways meant to fight infection. In people with lupus this pathway turns on and never turns off. These findings and others 

will lead to effective ways of treating lupus and other autoimmune diseases affecting 

23 million Americans. 

Specifically, I am conducting extensive research on lupus nephritis, which is kidney involvement in lupus disease. My field is advancing rapidly, due in large part 

to factors directly dependent on NIH funding: 

—the burgeoning growth in the number of new animal models, including a wealth 

of informative transgenic and gene-targeted mutants; 

—increased access to improved powerful technologies such as gene and protein arrays, now available at many institutions and to many investigators through 

NIH core facilities; 

—new technologies that permit successful query of the very small amounts of 

human tissue typically available from patients and, collaboration across disciplines and across institutions to bring crucial expertise together; 

—new insights into underlying biology and pathophysiology in immunity and 

lupus are constantly emerging; 

—technologies to identify biomarkers are improved and accessible; and 
243 

—new approaches to therapy are being explored. 

These endeavors are bearing fruit but they are highly dependent on NIH funding. 

If funding for the NIH is cut or level funded, it could cripple or paralyze current 

lupus research efforts. 

As lupus is a systemic disease that can affect any organ or tissue elucidating 

pathogenesis (or cause) and treatments of lupus will have direct impact on many 

other autoimmune diseases (e.g. results and treatments translating to other diseases). Providing adequate resources to support lupus research will help the nation 

turn the corner on finding better treatments or a cure for lupus while also supporting breakthroughs and progress for other disease states. It is important to note 

that the corollary is true: cuts in lupus research funding also will have an adverse 

effect on progress for lupus and for progress in related diseases. Cuts in NIH funding could bring to a standstill support of clinical trials and large observational studies, and could curtail research on those at highest risk for lupus, women of color; 

it also could negatively impact pediatric research at a time when researchers have 

just begun to undertake studies in important new areas. Furthermore, insufficient 

federal funding also could slow much-needed genetic research when we are just discovering the critical components that may contribute to lupus and its effects. Therefore, it is critical that biomedical researchers be provided the necessary resources 

to continue seeking answers to the questions that will lead to better lupus treatments. Increased research funding will help deliver much-needed breakthroughs 

from the laboratory to patients in need. 

The National Institute of Arthritis and Musculoskeletal and Skin Diseases 

(NIAMS), the institute most involved in lupus research, is one of the smallest institutes at NIH. In the past 2 years there has been a decrease in research funding 

for NIAMS overall, with a 10 percent decrease in new research grants. Currently, 

only 12–15 percent of the grant applications submitted to NIAMS receives funding. 

Further cuts will cause this rate to drop precipitously to below 10 percent next year. 

Just 2 or 3 years ago, funding levels were at 25–30 percent. Cuts in research funding, coupled with the rate of biomedical research inflation (3–4 percent per year), 

further erode NIAMS’ ability to fund lupus research grant applications at the rate 

necessary to begin making real progress. As such, an increase above the rate of biomedical research inflation is necessary to allow NIH to sustain and build on its research progress resulting from the recent budget doubling while avoiding the severe 

disruption to that progress that would result from a lesser increase or cut. 

Furthermore, in the proposed budget for NIAMS for 2007 there will be a loss of 

10 training grants; each grant funds training for four physicians, mostly 

rheumatologists. Young and senior investigators alike are moving into other fields 

because of the lost of funding. Exacerbating the situation, medical schools are struggling financially due to public funding cuts thus eliminating any safety net for researchers that may have previously existed. As a result, young investigators are not 

attracted to lupus research which means there will be not be a future generation 

of lupus scientists and clinicians to do research. Moreover, after having attracted 

scientists to translational immunology in the last 5 to 10 years, when funding was 

increasing, there is now a possibility we could lose both the current and next generation of young investigators. Increased funding is necessary to support an adequate number of training grants. Without research and training funds lupus researchers might be forced to become private practice physicians instead, leading to 

an imbalance in the health care system: sufficient numbers of physicians to treat 

lupus patients, but no new treatments with which to care for them, and no researchers to develop the cures of tomorrow. 

We recognize and appreciate that Congress and the nation face unprecedented fiscal challenges; however, we cannot afford to lose ground in biomedical research at 

such a promising time. The LFA looks forward to working with the subcommittee 

and others in Congress to reduce and prevent the suffering caused by lupus. We 

stand ready to serve as a resource for any information you may need in this regard 

and thank you for this opportunity to submit written testimony for the record concerning fiscal year 2007 lupus related funding. 

Senator SPECTER. Thank you very much, Ms. Raymond. 

Our next witness is Dr. Herman Taylor, representing the Jackson Heart Study. Dr. Taylor. 

STATEMENT OF HERMAN A. TAYLOR, JR., M.D., ON BEHALF OF THE 

JACKSON HEART STUDY 

Dr. TAYLOR. Thank you, Mr. Chairman, and good morning, Senator Harkin, Senator Shelby. I am Herman Taylor, professor and 
244 

cardiologist at the University of Mississippi Medical Center and 

also with appointments at Jackson State and Talugu College. 

I am proud this morning to come to you on behalf of the largest 

study of cardiovascular disease ever undertaken in the African 

American population. It is called the Jackson Heart Study. The 

NHLBI and the National Center for Minority Health and Health 

Disparities are the NIH entities that fund this groundbreaking 

work. We are not only doing research, but we are actively involved 

in training young people to be scientific leaders for tomorrow. 

We are accomplishing much, but our challenges are huge. A well 

documented and widening gap has opened up between blacks and 

other citizens of this country with respect to cardiovascular health. 

While most Americans have enjoyed a 40-year decline in death 

rates from cardiovascular disease, there has been virtually no 

change in the death rate from cardiovascular disease for African 

Americans in the State of Mississippi and certain other urban 

areas in other parts of the country share these equally dismal statistics. 

So while the Jackson Heart Study is a very heartening and wonderful undertaking, if the intent is to approach these disparities 

what we have done thus far can be compared to throwing a 10-foot 

rope to a man at the bottom of a 40-foot well. It is a great idea, 

it is a good intention, but it comes up short. 

PREPARED STATEMENT

If we consider the question of health disparities an important national priority, you have to ask yourself what if we were equal. Dr. 

David Satcher asked that question in a recent publication and he 

concluded, looking at CDC statistics, that last year 80,000 African 

Americans died unnecessary deaths compared to their white counterparts. In our State 1,200, our small southern State, 1,200 African Americans died unnecessarily. 

To reverse this trend, we must support research and extend the 

work of the Jackson Heart Study. Thank you. 

[The statement follows:] 

PREPARED STATEMENT OF HERMAN A. TAYLOR, JR. 

I am proud to come to you today on behalf of the largest and most comprehensive 

study of CVD in the African American community ever conducted—the JHS. 

Through the generous support of 2 NIH components—NHLBI and the NCMHD— 

this ambitious and multifaceted project is emerging as a leading study on CV disease among African Americans. Besides its establishing a growing database of detailed health information and test results ranging from advanced images of the 

heart to genetics to measures of stress and psychological parameters, the JHS is 

also an incubator for the scientific leaders of tomorrow through our education and 

training programs that involve minority students in didactic classroom sessions and 

practical research experiences. And while we search for answers and train future 

leaders, we also are taking action NOW—to serve the community with important 

health information from our study as well as others. 

We are relatively new, born during the period of NIH budget doubling, and already we have accomplished much within the Jackson community and beyond. However, despite the promise of the JHS and our optimism over its impact, I come to 

you with a deep concern, summarized in the arresting quotes below. 

‘‘It has been discovered that the health of [blacks] in [parts of] Mississippi is deteriorating while the health standards for the nation are improving... .’’—The Wall 

Street Journal 
245 

‘‘Cardiovascular deaths in MS seem to be rising while they have fallen for the 

past 30 years for the rest of the country.’’—Circulation (the official organ of the 

American Heart Association) 

These 2 quotes are distressing, whether you are African American or not, whether 

you are Mississippian or not. However, the magnitude of the problem they summarize becomes clearer when you consider that the two statements were made 32 

years—a full generation—apart. The notion that in the richest country in the history of man, one location or group within its borders can be so singularly and peculiarly burdened from a largely preventable disease is barely credible. But it is true, 

and it has the status quo for around forty years. 

So while the JHS represents an inspired, timely effort of the NHLBI and the 

NCMHD, to freeze research efforts at the current levels of funding would be like 

throwing a 10 foot rope to a man at the bottom of a 40 foot hole. We come up short, 

and despite the right idea and a noble attempt, the problem of disparate CV health 

remains unsolved. To extend the reach of the JHS to its full potential, our Study 

and other complementary studies—and the investigators driving them—must thrive, 

and have support for their approaches and new ideas. 

The JHS contributes to extending the research lifeline in several important ways. 

First there is the core JHS Study itself. Classically designed in the pattern of the 

world famous Framingham Study, it offers a chance to Study a wide list of possible 

causes for poorer cardiovascular health among African Americans, to inform precise 

interventions that will reduce disparities. Funded through 2013 by NHLBI and 

NCMHD, it is a landmark undertaking. The JHS also is innovative in its list of 

partnering institutions. Besides the guidance and support of the NHLBI and the 

NCMHD, 3 local Jackson Institutions of higher learning take active part in making 

the JHS work—Jackson State University, University of Mississippi Medical Center, 

and Tougaloo College all have unique and vital roles in the Study. Comprising a 

team of 2 Historically Black institutions and a third predominantly minority-serving 

institution, this combination has been ground-braking and synergistic in the service 

of this population-based study of an African American population. Training of promising young talent from the affected population and participation of HBCU’s in epidemiological research at the highest level is bearing fruit for the Nation in terms 

of a rising cadre of leaders in the relevant fields. 

However, the potential impact of the JHS is bigger than even this important core 

Study will provide. This is because not only is the JHS a Study in its own right, 

it is a platform for critical spin-off studies. These ‘‘Ancillary Studies’’ require secondary funding that is NOT a part of the JHS contract funding. A flat or declining 

NIH budget threatens these important studies, where much of the truly innovative 

work on health disparities could occur. For instance, nearly all of the genetics studies of heart disease in the JHS require this ancillary funding. The genetics of CVD 

may be the key in the lock of our understanding of much of the current epidemic. 

Implications of these studies may be huge for not only African Americans, but all 

people threatened by the nation’s number one killer. Flat budget lines severely limit 

the opportunities for such important studies. This is especially devastating to new 

investigators, those who apply for the career development (K) awards that NHLBI 

has been so committed to funding. These young people are the cadre of scientists 

in whom we are investing our future hopes of American world leadership in health 

research, and the ultimate resolution of health disparities. 

The future of innovative science from the JHS is therefore tied in important ways 

to Ancillary studies (R01’s) and career development (K) awards for new investigators. Holding the line on the NIH budget is to worsen a palpable threat scientists 

now feel—that of being squeezed out of a zero-sum game where more and more scientists are fighting each other and the rising cost of research in order to launch and 

sustain promising careers. This is especially devastating to new investigators, in 

whom we are investing our future hopes of American world leadership in health research. 

Therefore, the JHS at this point in its evolution can be thought of as a major platform for scientific discovery—an incredible growing database that is a national resource. If the growing brain trust of scientists—in Jackson as well as Boston, Bethesda, Minneapolis, Baltimore, New York, Chicago and elsewhere—who are showing active interest, receive funding for meritorious ideas, the JHS stands to produce 

important breakthroughs in our understanding of the CVD patterns seen in AA and 

others. However, if flat pay lines prevent the funding of new ideas for using this 

unparalleled resource, the trajectory of discovery will be blunted, the pace of advance slowed, and important scientific opportunity, squandered. And the wisdom 

shown by NCMHD and NHLBI in building this platform for discovery will be in 

many ways betrayed. 
246 

We cannot afford to squander any opportunities to improve health overall and 

eliminate health disparities. I witness the impact of failed promises everyday. 

Among my patients, I see the end result of our incomplete understanding of heart 

disease: in young mothers whose hearts fail after childbirth for no good reason— 

though we have a name for it—peripartum cardiomyopathy—we don’t understand 

it, and we don’t understand why it afflicts Blacks more than other Americans. I see 

it in fathers with no known risk factors, but develop coronary disease anyway. I see 

it in people suffering from morbid obesity who not only are at increased risk for disease, but because of their size, therapeutic and diagnostic interventions themselves 

are technically much more difficult. Standard operations are often riskier, and sometimes impossible to perform. With 1,200 unnecessary deaths from CVD among AA 

in our small Southern state alone, deferring the dream of health equality only adds 

to our regional tragedy of health disparities. With 80,000 unnecessary deaths nationally among African Americans in 2004 (most from CVD) research retrenchment 

in the form of flat lining or cutting the research budget only defers finding answers 

that were needed yesterday for our Nation’s health. An act of national compassion 

and strong resolve is necessary. I pray that this Congress and President will engage 

this great threat to the dream of a healthy, vigorous nation. It is in our compelling 

national interest to do so. 

Thank you, Mr. Chairman. I would be pleased to answer any questions that the 

Committee may have. 

Senator SPECTER. Thank you very much, Dr. Taylor. 

Our final witness is Dr. Suzanne Vogel-Scibilia, representing the 

National Alliance for Mental Illness. 

STATEMENT OF SUZANNE VOGEL-SCIBILIA, M.D., PRESIDENT, NATIONAL ALLIANCE ON MENTAL ILLNESS 

Dr. VOGEL-SCIBILIA. Greetings from Beaver County, Pennsylvania, Senator Specter. 

I’m a volunteer with—— 

Senator SPECTER. Whereabouts? Where? 

Dr. VOGEL-SCIBILIA. Beaver. 

Senator SPECTER. Thank you. 

Dr. VOGEL-SCIBILIA. I’m a volunteer at NAMI and the president 

of the National Alliance on Mental Illness, and I have been a practicing psychiatrist and a family member of persons with mental illness as well as a consumer with bipolar disorder myself. I have had 

periods of severe illness, but I have had a good recovery. 

Unfortunately, though, many people in our country have not yet 

achieved recovery. If Congress cuts funding at the NIMH as the 

President has suggested, we will have to continue to have millions 

of people in this country with chronic disability and a $40 billion 

loss in economic productivity each year alone for schizophrenia, not 

to mention other illnesses. 

Because of the past doubling of the research budget, NIMH has 

brought forth vitally important real world trials to impact the 

treatment of all persons with schizophrenia, bipolar disorder, and 

depression. Unfortunately, though, the future gains in medication 

and treatment options for this vital research will not be realized 

unless further medical support is given to these important studies. 

We will be unable to fund the United States whole genome studies 

for serious mental illness, which could transform the understanding of causes and risk factors for these devastating illnesses 

and open up new avenues of effective treatment. 

Last, we will be unable to advance schizophrenia and bipolar research progress. One example is in the understanding if early 

intervention and medication therapy and rehabilitation will prevent disability and morbidity for persons with new onset schizo-
247 

phrenia. We will also be unable to address and prevent the epidemic of suicide in this country, including a substantial number of 

our young people who die or are disabled before their life has truly 

started, and the elderly who are cheated from their retirement 

years. 

For myself, my children, and the people who belong to over 1,100 

affiliates of NAMI in the United States of America, we humbly 

thank you for all your reform to express our concerns and hope 

that research dollars will be provided to help those of us who suffer. 

Thank you very much. 

Senator SPECTER. Thank you very much, Dr. Vogel-Scibilia. 

One question, Dr. Taylor. When you say ‘‘unnecessary deaths,’’ 

how would you define that? 

Dr. TAYLOR. Yes. The term, sir, refers to deaths that you would 

not expect, given statistical projections, given the current level of 

care and our understanding of risk factors for cardiovascular disease. So these are people who—a certain number of people are expected to die, of course, from certain diseases, like heart disease, 

every year. Well, these are people who you would not expect to 

have died. Dr. Satcher and others have termed these ‘‘unnecessary 

deaths.’’ 

Senator SPECTER. You are saying in effect that that is higher for 

blacks, African Americans, than others? 

Dr. TAYLOR. Senator, it is substantially higher. Again, the national prediction is that 80,000 of these deaths occur from a variety 

of causes and the lion’s share of those deaths are due to cardiovascular causes. 

Senator SPECTER. What is the reason for the higher incidence of 

deaths among blacks? 

Dr. TAYLOR. Well, this is the principal focus of the Jackson Heart 

Study and studies like it, to figure that out. Clearly there are higher levels of risk factors, such as obesity, hypertension, diabetes. But 

one must ask the question, why are those risk factors higher? We 

cannot simply say, well, there is more hypertension, therefore we 

expect more deaths. The question is why is there more hypertension and related problems? 

Also, access to care clearly is a major part of this. But historically, African Americans as a group have been understudied with 

regards to what are the true determinants of poor health. Studies 

like the Jackson Heart Study and studies related to it I think will 

help unravel these questions and give us detail that we might not 

even suspect at this point. The Jackson Heart Study, for instance, 

includes studies into genetic underpinnings of various illnesses. 

But on the opposite end perhaps of the spectrum, we look very 

carefully at psychological determinants of ill health, at social and 

behavioral parameters that may also impact how well people do in 

terms of their overall health. 

Senator SPECTER. Senator Shelby. 

Senator SHELBY. Thank you, Mr. Chairman. 

Ms. Raymond, what funding do we really need to sustain research into lupus at NIH in your judgment? 
248 

Ms. RAYMOND. Well, presently the amount of funding now allo- cated is around $66 million. In order to really sustain and break 

through, I think we need $200 million. 

Senator SHELBY. That is a lot of money. 

Ms. RAYMOND. A lot of money. 

Senator SHELBY. But a lot of promise, too. 

Ms. RAYMOND. I think so. We have many deaths due to lupus. 

Senator SHELBY. Absolutely. 

Ms. RAYMOND. It is a fatal disease. It is prototypical because it 

affects any organ system, any tissue system in the body. 

Senator SHELBY. 90 percent of them are women, are they not? 

Ms. RAYMOND. 90 percent are women and a majority are women 

of color, African American, Hispanic, Asian, and Native Americans. 

Senator SHELBY. Dr. McDonnell, macular degeneration. What is 

the real promise once you are diagnosed in that area? 

Dr. MCDONNELL. Well, Senator, this is now with the tidal wave 

of aging Americans, this has taken over from diabetes as the major 

cause of Americans to go blind. It is a progressive disease involving—it is almost our Alzheimer’s or Parkinson’s—a neurodegenerative condition of the cells of the retina, of the back of the 

eye. The eye is part of the brain, and this progression occurs. 

Now we believe we have some dietary supplements that may 

slow the progression. 

Senator SHELBY. What are these? 

Dr. MCDONNELL. Anti-oxidant vitamins and zinc have been 

shown, thanks to an NEI-funded study, to delay the progression to 

severe forms of the macular degeneration. Now, we have some 

treatments that can treat severe forms with blood vessels that are 

causing leakage and bleeding and scarring in the back of the retina. We also hope to be able to begin and expand upon studies of 

regenerative medicine using stem cells, such as would be done in 

other fields, to restore the cells that are lost or damaged from this 

disease. 

Senator SHELBY. So there is great promise everywhere in biomedical research. It has just got to be properly funded. Is that the 

bottom line? 

Dr. MCDONNELL. I agree with that. As you heard, lupus also 

damages the eye. The eye is part of the brain. Fortunately, not all 

patients are afflicted in the eye, but we have patients go blind and 

we need the same treatments that would improve the kidney damage and brain damage of lupus also for our eye patients. 

Senator SHELBY. Thank you. 

Mr. Chairman, thank you. 

Senator SPECTER. Thank you, Senator Shelby. 

Senator Harkin. 

Senator HARKIN. Thank you, Mr. Chairman. 

Dr. Landrigan, thank you for bringing up the children’s study. 

That is why I brought it up earlier. You talked about the benefits 

to children, but would it not also benefit adults also? I mean, obviously obese children have later complications as they grow older. 

Many of the things that happen to you in childhood you carry with 

you, especially mental health. If you have mental health problems 

early in life and they are not attended to, it can manifest itself 

later on. 
249 

So I just wanted to draw you out a little bit on that in terms of 

the benefits of the children’s study, not just to kids, but I think 

across the spectrum. 

Dr. LANDRIGAN. Yes, Mr. Harkin, that is absolutely true. There 

is an expanding body of research, called the early origins of adult 

disease hypothesis. For example, slow fetal growth of the baby still 

in the mother’s womb is associated in young adult life with an increased risk of diabetes, hypertension, and heart disease. There are 

some intriguing clues, more from animal studies than human at 

the moment, that early exposures to toxic chemicals may cause 

brain damage that does not become manifest in childhood, but 

shows up four, five, six decades later in the form of dementia or 

Parkinson’s disease. 

So I think it is both to protect America’s kids as well as future 

generations of adults that we are seeking the full funding for the 

study to be restored in fiscal year 2007, which would be $69 million, and also assurances that the study will continue to be funded 

in the years ahead. It will not succeed unless the funding for it is 

sustained. 

Senator HARKIN. Thank you very much. 

Mr. Chairman, I do not have any further questions. I would just 

again for the record state, Mr. Chairman, that you and I and others on this committee had planned for this children’s study. It was 

passed in 2000. A lot of planning went into this and forethought 

went into it to set up this long-term study, and I just cannot believe that we are just going to just stop it at this point in time. 

So we have just got to do everything we can to mandate, if we 

have to, mandate—I do not know if there is anyone here from 

OMB, but mandate—that this funding go forward this next year. 

Thank you very much. 

Senator SPECTER. Thank you. Thank you, Senator Harkin. 

I thank all of you. We are fighting. We put up a Specter-Harkin amendment and added $7 billion to the budget in the Senate. Unfortunately, that has not been accomplished in the House. We have 

added from that $7 billion $2 billion for the National Institutes of 

Health. 

But this is a battle that really has to be engaged in by 110 million Americans who are suffering directly or indirectly from the 

kinds of illness which we have heard about here today. 

We thank you for coming in. This has been an impressive hearing because it puts a face on these ailments. They are sort of abstractions. They are not abstractions if your wife is suffering from 

them or a close relative or a close friend or you are suffering from 

them. They are not abstractions at all. But there has to be a very 

intense advocacy effort. We call it lobbying around here. It is really 

advocacy. Your organizations are very, very important in this advocacy effort. We thank you for what you are doing. But you have to 

contact your counterparts everywhere. 

The amendment which Senator Harkin and I sponsored won 73 

to 27, but there were 27 Senators who voted no and you ought to 

identify them and you ought to march on them in their cities, in 

their States, seriously, very, very seriously. It is a little hard, with 

all that Senator Harkin and I have to do—he has got to bounce out 

of here and go to Iowa for a meeting later today and I have got 
250 

to conduct a hearing on campus violence in Philadelphia at 2 

o’clock. I have not been in my office all week. I have been on the 

floor managing the immigration bill. Before that I was fully occupied with the Supreme Court nominations. 

But your groups are advocates and I would like to see that million person march. But it has got to be done. We are a democracy 

and people in Washington pay attention to people in their home 

States. If I get seven letters, I have got 12 million constituents, I 

think it is significant. You have really got to be more politically active, not Democrat or Republican active, but active for these issues, 

active for NIH, active for stem cells. 

I am convinced there are cures for all of these ailments and we 

have the resources to do it. It is a question of how many doctors 

and hospitals and research scientists and dedicated people you 

have. It is not a matter of how many dollars you have. It is a matter of what your resources are. The money flow comes out of Washington to a large extent, also out of your State capitals. 

ADDITIONAL COMMITTEE QUESTIONS

There will be some additional questions which will be submitted 

for your response in the record. 

[The following questions were not asked at the hearing, but were 

submitted to the Department for response subsequent to the hearing:] 

QUESTIONS SUBMITTED BY SENATOR ARLEN SPECTER

LIVER DISEASE RESEARCH BRANCH

Question. Dr. Zerhouni, 3 years ago, the NIDDK established a Liver Diseases Research Branch within its Division of Digestive Diseases and Nutrition. Please explain the benefits of having a Research Branch dedicated to a specific area of research and describe how this Liver Disease Research Branch has succeeded in its 

mission. 

Answer. Research on diseases of the liver is a trans-NIH effort involving 19 institutes, centers, and offices. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has lead responsibility for liver disease research at the NIH. 

Within the NIDDK, liver disease research is under the purview of the Division of 

Digestive Diseases and Nutrition. The Federal liver disease research effort has benefited greatly from the establishment in 2003 of an organizational entity within the 

NIDDK—the Liver Disease Research Branch—dedicated exclusively to this very important area. This new Branch was formed to focus and coordinate research efforts 

on critical areas relevant to liver and biliary disease, such as hepatitis and liver 

transplantation. 

Following a national search, Jay H. Hoofnagle, M.D., an internationally recognized authority in liver disease research, was appointed as Chief of this Branch. The 

NIDDK recruited an additional scientific Program Director with expertise in liver 

diseases to further support the efforts of the Branch. The Branch also includes scientific experts in the areas of viral hepatitis, clinical trials, epidemiology and data 

systems, genetics and genomics, and research training and career development. 

The Liver Disease Research Branch has accelerated research on liver disease supported by the NIDDK and has helped to coordinate and stimulate liver-related research efforts across the NIH and within other Federal agencies, such as the Centers for Disease Control and Prevention, the Department of Defense, the Bureau of 

Prisons, the Food and Drug Administration, and the Department of Veterans Affairs. An initial important task set for the Branch was to prepare the trans-NIH 

Action Plan for Liver Disease Research. The Plan provides an overview of the current burden of liver disease in the United States, the current level of NIH research 

funding in liver disease, and recent research advances. Importantly, the Plan also 

summarizes challenges to advancing liver disease research and delineates the major 

goals for future research. Specific goals for the next 10 years are defined for each 

of 16 topic areas in liver disease research. 
251 

One mission of the Branch is to oversee the conduct of the Plan, which includes 

annual Progress Reviews to aid in its implementation through an ongoing assessment of progress and the need for further efforts to promote liver and biliary disease 

research. The Progress Review for 2005, the first year following release of the Action 

Plan, is available at: http://www.niddk.nih.gov/fund/divisions/ddn/ldrb/ 

Progresslreviews.htm. The Branch also develops and coordinates future NIH efforts in liver disease research aimed at reaching the goals defined in the Plan. 

Thus, the Branch is succeeding in its mission to plan and direct the NIH program 

of liver research, as evidenced by an impressive array of initiatives that include 

major clinical trials and special program announcements in the areas of proteomics 

of the liver, biomarkers for liver disease, non-invasive tests for diagnosis and staging of liver disease, and ancillary studies linked to specific clinical trials, databases 

and cohort studies on liver disease (http://www.niddk.nih.gov/fund/program/DDNlist.htm#Liverprograms). 

UROLOGY RESEARCH STRATEGIC PLANNING

Question. Our conference report last year ‘‘urged the NIDDK to continue to support and develop the ‘Urologic Diseases in America’ report and to include urological 

complications as well as diabetes and obesity research initiatives.’’ This language 

was included in response to concern that the NIH-wide Obesity Strategic Plan did 

not address urological issues such as, stress urinary incontinence or erectile dysfunction (ED), two conditions highly associated with obesity. These conditions severely affect quality of life and result in high medical costs. How do you ensure that 

all disciplines are represented in strategic planning? 

Answer. The NIH acts to ensure that its strategic planning efforts for research 

are comprehensive, inclusive, and evidence-based. Currently, strategic planning is 

conducted by the individual Institutes, Centers, and Offices of the NIH, as well as 

through trans-NIH and interagency mechanisms, as appropriate. The NIH Office of 

Portfolio Analysis and Strategic Initiatives, which I established recently, will have 

an instrumental role in facilitating both individual and trans-NIH strategic planning efforts through its planned activities. 

To ensure effective planning processes, the NIH seeks input from a wide array 

of stakeholders, including scientific experts, representatives from professional organizations, and patient advocates. For example, most strategic planning for urologic 

diseases research is conducted by the National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK). In two major planning efforts, the NIDDK assembled large, multidisciplinary groups of scientists and medical professionals prominent in their fields and active in patient and professional societies related to bladder 

disease in 2002, and in pediatric urology in 2006. These groups were thus able to 

bring multiple perspectives to bear when reviewing progress in bladder disease and 

pediatric urology research, and to provide broad-based assessments of research 

needs and recommendations for future action, including recommendations regarding 

the impact of obesity and diabetes on certain urologic diseases. As a result, these 

groups’ 2002 and 2006 reports have served as a model for NIH planning for urologic 

diseases research and for trans-NIH collaborations in this area. Moreover, the 

NIDDK has continued to gather multidisciplinary expert groups to assist in more 

focused areas of research planning, such as prostate disease, and urologic diseases 

in women. All of these efforts are bolstered by the Urologic Diseases in America report, which has provided significant information related to major urologic diseases. 

The NIDDK is strongly committed to maintaining this program, and a research solicitation is being developed for the next phase of Urologic Diseases in America that 

will include assessment of the impact of diabetes and obesity on urologic diseases. 

Additional, ongoing assessments of research progress in urologic diseases through 

advisory group meetings, scientific conferences, and stakeholder input allow flexibility, capitalization on new research advances, and the opportunity to strategically 

address research gaps and barriers that may emerge or become evident over time. 

The Strategic Plan for NIH Obesity Research, developed by the NIH Obesity Research Task Force, similarly drew upon a broad base of scientific expertise within 

and external to NIH. The plan focuses, in part, on goals and strategies to break the 

link between obesity and its associated health conditions. Recommendations from 

this and other plans and from ongoing strategic planning efforts are reflected in 

NIH action. For example, the NIDDK has funded the Program to Reduce Incontinence by Diet and Exercise (PRIDE) study, which is examining the impact of weight 

loss on urinary incontinence in overweight and obese women. The benefits of considering multiple disciplines in research planning can be seen in research results. For 

example, the NIH-funded Diabetes Prevention Program recently found that weight 

loss improves bladder control in women with prediabetes. This new knowledge, that 
252 

an intervention proven to reduce risk of type 2 diabetes can also reduce episodes 

of urinary incontinence, has the potential to improve health and quality of life for 

the large number of older American women who have both prediabetes and bladder 

control problems. The NIH has also been supporting a similar study in patients with 

type 1 diabetes who are participating in the Epidemiology of Diabetes Interventions 

and Complications study, to determine whether intensive control of blood sugar levels—an intervention proven to reduce risk of developing eye, kidney, nerve, and cardiovascular complications of diabetes—also reduces risk of urologic complications. 

OPASI TRANS-NIH FUNDING PROGRAM

Question. Dr. Zerhouni, you have initiated a new trans-NIH funding program, 

which requires each Institute and Center to contribute a fixed portion of their appropriations for cross-cutting research initiatives. Can this program move forward 

as planned in an environment of no real increases in NIH funding? 

Answer. The Administration has focused resources on our highest priority: protecting the citizens and our homeland. This underscores the importance of being as 

strategic as possible with NIH dollars to catalyze high-impact research. The time 

is right for NIH to take a more coordinated approach to the development and funding of trans-agency initiatives by asking each IC to pool a very small proportion of 

their appropriation in a Common Fund for shared needs. This is true not only because of the difficult budgets, but also because many of the most exciting scientific 

opportunities and pressing public health challenges we now face cut across the mission areas of multiple institutes and centers. Thus, the creation of this new transNIH funding stream will actually enable the NIH to be more proactive in addressing 

emerging scientific needs and opportunities; to fund high-risk, high-impact science; 

and to incubate and launch pilot efforts that have transforming potential for all of 

science. 

THE HEART TRUTH ROAD SHOW

Question. As a member of the Congressional Heart and Stroke Coalition, I am 

concerned that heart disease remains the leading cause of death of women in the 

United States, but many women do not realize this fact. I know that for the past 

several years, the NIH has been working with the fashion industry in your Heart 

Truth Campaign to increase women’s knowledge about their No. 1 killer and that 

the Heart Truth Road Show stopped in Pittsburgh recently. Please explain to the 

Committee about the progress of this initiative? 

Answer. The National Heart, Lung, and Blood Institute’s (NHLBI) The Heart 

Truth campaign continues to flourish, extending the reach of the campaign in a variety of ways. 

—As the campaign ambassador, First Lady Laura Bush is leading the federal effort to give women a personal and urgent wake-up call about their risk of heart 

disease, participating in more than a dozen Heart Truth events around the nation over the past 3 years. 

—Corporate partners, including General Mills, Minute Maid, and DermaDoctor, 

have featured the campaign’s Red Dress (emblematic of the message ‘‘Heart disease doesn’t care what you wear; it’s the killer of women’’) on more than 60 million product packages. Johnson & Johnson, L’eggs hosiery, Benecol, Starkist 

Tuna, and Celestial Seasonings have promoted The Heart Truth campaign and 

Red Dress logo in newspaper advertising inserts, resulting in a combined circulation of 370 million. 

—The Red Dress Collection 2006 Fashion Show took place on the third annual 

National Wear Red Day—Friday, February 3, 2006. People throughout the 

country participated in the day’s celebration to increase awareness of women’s 

heart disease. 

—The Heart Truth Road Show visited shopping malls in Pittsburgh, Memphis, 

and Washington, DC, in the spring of 2006 to raise awareness about women and 

heart disease by helping participants learn about risk factors; providing free 

health screenings including blood pressure, body mass index, total blood cholesterol, and blood glucose; and disseminating educational materials. 

—The campaign launched ‘‘Know The Heart Truth’’ in April 2006, an initiative 

that is recruiting and training health advocates and educators in local communities to increase awareness about women and heart disease. The Heart Truth 

has also formed partnerships with leading organizations representing women of 

color to engage in national and local activities, including a faith-based initiative, 

to help women reduce their risk for heart disease. 

The impact of The Heart Truth campaign is already becoming apparent. Awareness of heart disease as the leading cause of death among American women in-
253 

creased from 34 percent in 2000 to 46 percent in 2003 to 55 percent in 2005. A 2005 

survey commissioned by WomenHeart found that 60 percent of U.S. women agreed 

that the Red Dress makes them want to learn more about heart disease. Twentyfive percent of women recalled the Red Dress as the national symbol for women and 

heart disease awareness and 45 percent agreed that it would prompt them to talk 

to their doctor and/or get a check-up. A Lifetime Television Women’s Pulse Poll released in February 2006 showed that women are increasingly aware of the dangers 

of heart disease. Thirty-nine percent of survey participants recognized the Red 

Dress as the national symbol for women and heart disease awareness, up from 25 

percent in 2005. 

STROKE

Question. Following up on language from last year’s congressional report, please 

provide this Committee with highlights of implementation progress on the Stroke 

Progress Review Group report. 

Answer. In 2001, the NINDS convened the first meeting of the Stroke Progress 

Review Group (SPRG) to identify and prioritize scientific opportunities and needs 

in stroke research. One hundred forty prominent scientists, clinicians, patient advocates, and industry representatives participated and developed a set of scientific and 

resource recommendations that the NINDS assembled in a Report of the SPRG in 

2002. In 2003, the chairs of the SPRG meeting reprioritized their recommendations 

and identified a subset of high priorities for stroke research in an Implementation 

Report. Many of the following research activities address the scientific research and 

resource priorities identified by the SPRG in its 2002 Report and 2004 Implementation Report. 

The NINDS is funding a wide range of studies on the basic biology of stroke, including the role of the blood-brain barrier (BBB; the cellular barrier that controls 

the exchange of substances between the blood and the nervous system) and the neurovascular unit (NVU; the functional ‘‘unit’’ comprised by brain blood vessels, glial 

support cells, and neurons). Understanding the function of the NVU and the BBB 

in stroke is critical to developing strategies for treating and preventing stroke and 

related conditions such as vascular cognitive impairment (VCI). NINDS is supporting a variety of stroke-related studies focused on the roles of the NVU and the 

BBB under two recent Program Announcements with set-aside funding. To more 

fully understand the biological basis of VCI, the Institute held a workshop in June 

2006 to discuss the cell biology of VCI and develop recommendations to accelerate 

research in this area. 

To facilitate the translation of basic research findings into the clinical setting, 

NINDS is planning to expand its Specialized Programs of Translational Research 

in Acute Stroke to include seven programs across the country participating in clinical trials, training of research fellows, and translational research on stroke. In addition, NINDS released two new grant solicitations to address barriers to 

translational research in stroke. 

The NINDS also continues to fund many clinical trials involving potential interventions and preventive strategies for stroke. To improve outcomes for stroke patients in emergency-room settings, the NINDS is developing a Neurological Emergencies Treatment Trials (NETT) Network of emergency medicine physicians, neurologists, and neurosurgeons, and plans to fund the clinical coordinating center component of the NETT in fiscal year 2006. The Institute is also supporting research 

on the causes of stroke among high risk groups, improved methods for diagnosing 

stroke, and a range of educational outreach programs to increase awareness of 

stroke risk factors and symptoms. 

In September 2006, the NINDS will sponsor another meeting of the SPRG to assess research progress in stroke, evaluate current priorities, and identify new opportunities for advancing stroke research. Prior to the meeting, 16 working groups will 

assess progress and develop recommendations for future priorities on topics ranging 

from genetics of stroke to recovery and rehabilitation. NINDS solicited information 

from the stroke research community on research progress and remaining needs and 

research gaps, and will provide this feedback to the SPRG participants prior to their 

deliberations. Following the September meeting, the SPRG will produce a midcourse implementation report that reflects the current status of stroke research and 

identifies new priorities. 

CLINICAL AND TRANSLATIONAL SCIENCE AWARDS

Question. You have announced that by the year 2010, the GCRC program will 

have been phased out and the funding transferred to a new program. How are you 

going to assure that the CTSAs maintain or enhance services currently provided by 
254 

the GCRCs including specialty nursing care, patient facilities, laboratory testing, 

and specialized monitoring and diagnostic capabilities? 

Answer. Applicants for the Clinical and Translational Science Awards (CTSAs) 

are asked to propose a center, department, or institute for clinical research that will 

transform the clinical and translational research environment at their institution. 

Up to $6 million additional funds may be requested in addition to certain National 

Center for Research Resources (NCRR) and NIH Roadmap awards held by the institution at the time of application. These additional funds may be used to transform 

the local, regional, and national environment for clinical and translational science, 

thereby increasing the efficiency and speed of clinical and translational research. By 

introducing CTSAs as an increase in support, NIH is allowing applicants to retain 

such services as are currently provided by the General Clinical Research Centers 

(GCRCs) that they deem needed for their clinical research, such as inpatient and 

outpatient facilities, laboratory testing, and specialized monitoring and diagnostic 

capabilities. 

Question. You have announced that by the year 2010, the GCRC program will 

have been phased out and the funding transferred to a new program. How will you 

monitor the impact on the vitally important clinical research support currently provided to patients and investigators through the GCRCs? 

Answer. NIH staff review GCRC Annual Reports, communicate frequently with 

grantees, and attend annual meetings with Center grantees in Washington, DC. 

Clinical and Translational Science Awards likewise will submit Annual Reports and 

will establish Steering Committees on which NIH will be represented. These various 

tools and forums provide opportunities to assess the impact of the Clinical and 

Translational Science Awards and General Clinical Research Centers and will assure NIH of the requisite monitoring for impact on clinical research support. 

Question. You have announced that by the year 2010, the GCRC program will 

have been phased out and the funding transferred to a new program. Will institutions that lose their existing GCRC funding and do not receive CTSA awards be able 

to support patient-oriented research facilities and services? 

Answer. The 60 CTSAs that NIH plans to award could support over 90 percent 

of the institutions that currently have GCRCs. Researchers that perform patient oriented research at institutions that do not receive CTSAs may apply for investigatorinitiated NIH research supported by a variety of NIH grant mechanisms including 

Research Project and Research Program Projects and Centers grants. Additional 

sources of research support for investigators may come from Research Foundations, 

partnerships with industrial sponsors and institutional funds. 

Question. You have announced that by the year 2010, the GCRC program will 

have been phased out and the funding transferred to a new program. Will researchers in these institutions have to cancel planned patient-oriented research projects 

because of inadequate facilities? Certainly, the NIH budget is too constrained to provide this support through other competitive mechanisms. 

Answer. Researchers in the institutions that do not receive Clinical and 

Translational Science Awards may apply for investigator initiated NIH research 

supported by numerous NIH grant mechanisms including Research Project and Research Program Projects and Centers grants. Research Foundations, partnerships 

with industrial sponsors, and institutional funds may also provide additional 

sources of research support for investigators. 

Question. The K12 training mechanism is required for the CTSA award. Why isn’t 

the GCRC M01 mechanism required? The RFA appears to marginalize the GCRCs 

and their functions, and I am concerned about that. Why not require the M01 mechanism in the CTSA award RFA in 2007? 

Answer. Applicants for a CTSA are required to include a Mentored Clinical Research Scholar Award (K12) component in their proposal so as to promote clinical 

and translational research as a distinct discipline. There is no requirement for applicants to be K12 awardees for them to apply for a CTSA. NCRR has not made 

an M01 award an eligibility requirement for a CTSA application in the expectation 

that certain new affiliations amongst institutions that do not currently hold an M01 

award would be strong enough to compete successfully. CTSAs will support the discipline of clinical and translational science and the needs of its researchers, so applicants are encouraged to look beyond the constraints of M01 awards and to propose 

novel concepts, methodologies, and approaches that could be integrated into a comprehensive, effective, and efficient researcher-, trainee-, and participant-centered 

clinical research program. 

Question. Could NIH maintain a GCRC or mini-GCRC program for institutions 

that have had strong GCRCs, historically, but do not receive CTSA awards. 

Answer. NCRR has received wide support for the new CTSA program, so we believe that the purposes of clinical research will best be served by a smooth and unin-
255 

terrupted transition. Several new consortia are expected to apply for CTSAs and 

clinical research at those sites that compete well in the peer review process should 

not be delayed by prolongation of the GCRC program. Retaining the GCRC program 

would limit the funding available for the CTSA program and NIH believes that this 

would be detrimental to the needs and interests of the majority of clinical investigators. 

Question. Have you considered the possibility of a ‘‘pause’’ after the second year 

of implementation to evaluate the effectiveness and impact of the new CTSA program before proceeding with additional awards? 

Answer. The combination of Annual Reports with Clinical and Translational 

Science Award Steering Committees will assure NIH of the requisite evaluation opportunities during their implementation. In the event that changes are required to 

optimize the award functionality, they can be made without the delays that would 

be incurred through a ‘‘pause’’ in making awards. 

Question. Do you have a fall-back plan if the budget is not sufficient to accommodate the implementation of the CTSA program as you envision it? 

Answer. Transformation of Clinical Research infrastructure programs from 

GCRCs to CTSAs will be funded principally by NCRR appropriated funds, with additional funds from the NIH Roadmap for Medical Research. The project period for 

CTSA grants is 5 years, and NIH is planning for an additional 5-year competitive 

renewal of these awards. The fiscal year 2006 funding level for the combined CTSA/ 

GCRC program is $322,740,000 and their estimated fiscal year 2007 funding level 

is $361,200,000. NIH plans to award four to seven CTSAs in fiscal year 2006, to 

increase the number of awards annually, and to have 60 CTSAs in place by 2012. 

While changes in Congressional Appropriations would affect both the GCRC and 

CTSA programs in parallel, the transformation of the GCRC program to CTSAs is 

occurring in response to user demand. 

POLYCYSTIC KIDNEY DISEASE

Question. The Food and Drug Administration has granted ‘‘Fast Track’’ designation for Tolvaptan, a promising drug therapy designed to retard disease progression 

in polycystic kidney disease (PKD) and thus prevent kidney failure. What does the 

NIH plan to do to make the most of this discovery and foster the development of 

further PKD therapies? 

Answer. The NIH is committed to research that will pursue opportunities to combat polycystic kidney disease (PKD)—a serious, burdensome, and costly disease. 

Within the NIH, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) supports a diverse portfolio of basic and clinical research into the 

underlying biology of and possible therapies for PKD. The Interdisciplinary Centers 

for Polycystic Kidney Disease Research are important components of this research 

portfolio. The NIDDK recently renewed funding for four Centers for five additional 

years. Three of the Centers focus on the more common autosomal dominant PKD 

(ADPKD), and will explore extensively the basic and clinical functional changes seen 

in ADPKD. The fourth is a Research and Translational Core that focuses on 

autosomal recessive PKD (ARPKD) and will make available to investigators in the 

field a broad range of model research systems and reagents for the study of ARPKD. 

The Institute also has two other major research projects related to PKD—the 

HALT–PKD trial network, and the Consortium for Radiologic Imaging Studies of 

PKD (CRISP) cohort study. CRISP was established to develop innovative and standardized imaging techniques and analyses that would allow clinicians to reliably follow disease progression of ADPKD. This four-year study followed 240 PKD patients 

with annual glomerular filtration rate evaluation (a measure of kidney function), 

and magnetic resonance imaging to assess changes in kidney volume over time. The 

first phase of CRISP was recently completed, and the primary study results were 

published in the New England Journal of Medicine in May 2006 (NEJM 354: 2122– 

2130, 2006). Although the preliminary findings show promise for use of imaging 

methods and structural endpoints for tracking progression of ADPKD, the NIDDK 

has extended the CRISP cohort study for another five years, in order to collect additional structure and function data on enrolled subjects. Additional data from CRISP 

II will enable investigators to assess how reliably structural changes can predict 

functional kidney changes over time in ADPKD. The CRISP II investigators are currently developing the protocol for the next phase of the study. 

The Polycystic Kidney Disease Clinical Trials Network, co-funded by the PKD 

Foundation, is conducting two phase III-type studies in the HALT–PKD trial—one 

in patients with early kidney disease and another in patients with more advanced 

disease. HALT–PKD is testing whether blockade of the renin-aldosteroneangiotensin system, with angiotensin-converting enzyme inhibitor monotherapy or 
256 

combination angiotensin-converting enzyme inhibitor and angiotensin receptor 

blocker, will slow the progression of ADPKD. A partnership was also negotiated 

with industry to provide medications for testing in these studies. The HALT–PKD 

trial in subjects with early kidney disease is novel in that it is implementing the 

CRISP imaging methods in order to determine how reliable the methods are for 

interventional studies in ADPKD. The ability to reliably implement imaging methods for trials of ADPKD will have a significant impact on planning future interventional studies of new therapeutics in this disease. The HALT–PKD studies began 

enrolling patients in January 2006, and will be the largest interventional trial ever 

conducted in ADPKD. 

NATIONAL PRIMATE RESEARCH CENTER

Question. The fiscal year 2006 Labor-HHS-Education Appropriations bill provided 

the NIH Office of AIDS Research with up to $4 million to spend for construction 

or renovation necessary to expand a breeding colony for non-human primates for 

AIDS research, which is intended to be collaborative effort amongst the National 

Primate Research Centers. What progress has been made on that effort, and what 

is the expected completion date? 

Answer. Although the fiscal year 2006 bill allows the Office of AIDS Research 

(OAR) to utilize funds for construction for the national breeding resource facility, 

funds will not be used for that purpose in fiscal year 2006. In late fiscal year 2005, 

the Tulane National Primate Research Center successfully competed for the first 

phase of a national breeding resource facility project. However, construction capability in this region has been limited in the aftermath of Hurricane Katrina. Thus 

the second phase of this project has not proceeded as scheduled. Consequently, OAR 

cannot use this provision of the fiscal year 2006 appropriations bill this year. Instead, OAR provided funds to NCRR to support AIDS-related research infrastructure needs and increased operating expenses, such as unanticipated high energy 

costs, at the National Primate Research Centers (NPRCs). A timeline for completing 

the national breeding resource facility project is being reassessed. 

QUESTIONS SUBMITTED BY SENATOR TOM HARKIN

COLLABORATION AMONG INSTITUTES

Question. Dr. Zerhouni, one of the most common complaints I hear from advocacy 

groups is that they can’t get multiple NIH institutes and centers (ICs) to work together on common goals. Consider diseases like scleroderma, neurofibromatosis or 

epilepsy, all of which fall under the jurisdictions of more than one IC. In each case, 

one IC might be designated as taking the lead on the disease, but other ICs also 

share the responsibility for conducting research on it. Too often, unfortunately, patients complain that the ICs don’t collaborate. Sometimes the patients themselves 

practically have to drag a researcher from one institute into a meeting with a researcher from another institute, just to get them to talk. 

I know you’re well aware of this problem. It’s an issue that the National Academies addressed in its report on NIH’s structure in 2003. What are you doing to 

improve the situation? 

Answer. In 2002, I began a process called the Roadmap for Medical Research that 

was designed to identify major opportunities and gaps in biomedical research that 

no single institute at NIH could tackle alone to make the biggest impact on the 

progress of medical research. A primary accomplishment of the Roadmap was internal ‘‘functional integration’’ of the 27 institutes and centers (IC) to plan, implement 

and fund initiatives that go beyond the mission of any one IC. These accomplishments led to creation of the Office of Portfolio Analysis and Strategic Initiatives 

(OPASI) which has begun to institutionalize these processes. The establishment of 

OPASI represents a major organizational change at NIH aimed primarily at addressing challenges in the coordination of biomedical research of benefit to every IC. 

Using a combination of approaches such as agency-encompassing portfolio analysis 

and establishment of a common fund for shared needs, OPASI will synergize diverse 

components of the NIH toward the attainment of common goals more efficiently. 

Continuing the tradition of the NIH Roadmap, this office will also support well-developed initiatives that address areas of science which do not clearly fall within the 

mission of any one IC or program office. This makes OPASI a natural space for NIH 

ICs to work together on broad-reaching opportunities which will impact multiple aspects of public health and disease intervention. 
257 

CONFLICTS OF INTEREST

Question. Last August, NIH announced the final ethics rules on conflicts of interest. What impact are they having on employee retention and recruitment, and on 

interactions between NIH scientists and outside associations, such as trade groups 

and scientific associations? 

Answer. Regarding Employee retention and recruitment. In the preamble to the 

final rule (published in August 2005), we stated that we would review the rule to 

‘‘evaluate continued adequacy and effectiveness in relation to current agency responsibilities.’’ We are particularly interested in learning about any effects that the prohibited holding and outside activities provisions of the rule have had on hiring and 

retention. We are currently in the process of conducting a survey of current NIH 

employees, collecting their feedback related to the new regulations. In separate surveys in the coming months, we intend to ask former employees (those who left the 

NIH after January 1, 2005) and potential employees their opinions as well. 

Interactions between NIH scientists and outside associations, such as trade 

groups and scientific associations. The regulations do not affect official duty interactions that scientists may have with trade groups or scientific associations. 

PANDEMIC FLU

Question. We are all concerned about how long it would take between the time 

that we detected a pandemic flu virus in the United States and when we could create a vaccine for it. Right now, if a pandemic were to occur, I understand that it 

would take almost six months to produce a vaccine, using our current egg-based 

methods. 

HHS recently invested $1 billion in the development of new cell-based technologies to produce a pandemic vaccine. We’re all looking forward to the results. But 

even if successful, a cell-based vaccine would not be immediately available at the 

time of a pandemic. 

The current methods of vaccine development are commonly referred to as the ‘‘one 

drug, one bug’’ philosophy—develop a vaccine for each flu strain or strains. But that 

means that you have to identify the ‘‘bug’’ or flu strain before you can begin to manufacture a vaccine. However, I have heard that there is work being done to develop 

a vaccine that would address all strains of the flu—a ‘‘one drug, many bugs’’ plan. 

Is NIH supporting this type of research? Does it have promise? 

Answer. The National Institute of Allergy and Infectious Diseases (NIAID) is supporting research and development of alternate approaches to dealing with the threat 

of emerging and re-emerging infectious diseases such as influenza. 

For example, NIAID is pursuing the development of a ‘‘universal vaccine’’ that 

protects against multiple virus strains such as those resulting from antigenic drift 

associated with seasonal influenza and antigenic shift associated with pandemic influenza. As influenza viruses circulate, the genes that determine the structure of 

their surface proteins undergo small changes. Sometimes the change in the genes 

results in a slight change in the antigenic properties of the protein, a process commonly referred to as ‘‘antigenic drift.’’ Antigenic drift is the basis for the changes 

in seasonal influenza observed during most years, and is the reason that we must 

update influenza vaccines annually. Influenza viruses also can change more dramatically. For example, viruses sometimes emerge that can jump species from natural reservoirs, such as wild ducks, to infect domestic poultry, farm animals, or humans. When an influenza virus jumps species from an animal, such as a chicken, 

to infect a human, the result is usually a ‘‘dead-end’’ infection that cannot readily 

spread further in the human population. However, mutations in the virus could develop that allow human-to-human transmission. Furthermore, if an avian influenza 

virus and another human influenza virus were to simultaneously co-infect a person 

or animal, the two viruses might swap genes, possibly resulting in a virus that is 

readily transmissible between humans, and against which the population would 

have no natural immunity. These types of significant changes in influenza viruses 

are referred to as ‘‘antigenic shift.’’ When an ‘‘antigenic shift’’ occurs, a global influenza pandemic can result. Historically, pandemic influenza is a proven threat. In 

the 20th century, influenza pandemics occurred in 1918, 1957, and 1968. 

The NIAID is supporting a number of research projects to develop a vaccine that 

induces a potent immune response to the common elements of the influenza virus 

that undergo very few changes from season to season and from strain to strain. Although this is a difficult task, such a ‘‘universal’’ influenza vaccine would not only 

provide continued protection over multiple seasons, it might also offer protection 

against a newly emerged pandemic influenza virus and thus substantially reduce 

the susceptibility of the population to infection by any influenza virus—making the 
258 

country far less vulnerable to influenza viruses emerging from avian and other animal sources. 

One relatively stable element of the influenza virus is a protein called M2. The 

external portion of the M2 protein is very similar in influenza viruses from year to 

year and from strain to strain. A ‘‘universal’’ influenza vaccine targeting the M2 protein, or other conserved elements, could be protective against a range of influenza 

strains. NIAID-supported researchers have demonstrated that vaccines made with 

bioengineered versions of M2 can protect mice from lethal influenza virus. The scientists now are testing cross-reactivity between different species and strains of influenza, examining how long the immunity provided by these vaccines lasts, and 

evaluating whether the influenza viruses can evade these vaccines by developing 

mutations in their M2 proteins. 

In addition, researchers at the NIAID Vaccine Research Center (VRC) are developing and testing gene-based influenza vaccines that will protect against multiple 

strains of influenza. As a first step, initial candidate vaccines, each containing the 

gene encoding the hemagglutinin (H) surface protein of an influenza virus isolated 

from a recent human outbreak of influenza (H1N1, H3N2 or H5N 1), have already 

shown promise in animal studies. VRC researchers plan to develop additional genebased vaccines for all common variants of hemagglutinin, as well as other influenza 

viral proteins, such as nucleoprotein and the M2 protein. In the future, the VRC 

will incorporate both conserved and variable genes from multiple influenza strains 

into DNA and adenovirus vectors that can readily be produced by existing manufacturing processes. 

A second approach, while not technically a vaccine, is an immune enhancer which 

specifically targets a component of the immune system and enhances one’s ability 

to respond to a broad range of microbial threats. Studies of the human innate immune system, which is comprised of ‘‘first responder’’ cells and other defenses that 

provide a first line of defense against a wide variety of pathogens, have been moving 

forward rapidly. These advances suggest it may be possible to develop a relatively 

small set of fast-acting, broad-spectrum countermeasures that can boost innate immune responses to many pathogens or toxins, including influenza. The capability to 

boost the innate immune system also could lead to the development of more powerful vaccine additives, called adjuvants, that can increase vaccine potency. The concept of immune enhancers has been demonstrated in early. stage clinical studies, 

but requires further research and development to be applied to pandemic influenza 

vaccination. 

QUESTIONS SUBMITTED BY SENATOR DANIEL K. INOUYE

TRADITIONAL HEALING PRACTICES

Question. Last year, at my request, Dr. Donald Lindberg, Director of the National 

Library of Medicine, visited one of our Native Hawaiian Healing programs at Papa 

Ola Lokahi for the purpose of conducting ‘‘listening circles’’ to discuss the needs for 

preservation and documentation of traditional cultural healing practices. I am very 

interested in a report of his findings from this visit. I am most appreciative of the 

National Library of Medicine’s continued interest and support of Native Hawaiian 

issues. 

Answer. Early this year NLM convened a working group to examine both the feasibility of an exhibition on Native health and healing, and NLM’s role in collecting 

and preserving information about traditional medicine. As a result of this working 

group, NLM has reviewed its collection to develop policies, as well as examined its 

collection in these areas. Subsequently, the Library has made an effort to collect 

modern publications such as all the items in the Bishop Museum’s (Honolulu, HI) 

current catalog as well as their out of print materials. 

In addition to purchasing standard published materials, NLM is also obtaining 

input from Native American (including Native Hawaiian) healers, leaders, educators, and others, on appropriate collection and preservation policies. Over the past 

year, since the series of Listening Circles the NLM participated in with different 

Native Peoples, NLM staff have met with many such individuals to gain insight into 

the issues of collecting and preserving information about traditional healing practices. For example, in February, NLM staff met with librarians and curators from 

the Bishop Museum, Hawaiian Historical Society, The Hawaiian Mission Children’s 

Society Library, and the University of Hawaii to gather information to planning a 

larger follow-up meeting. 

This meeting, to include NLM staff, occurred in July 2006, and a report of findings from this visit will be prepared. 
259 

DEVELOPING NURSE RESEARCHERS

Question. A long-standing supporter of the National Institute for Nursing Research, I am pleased with the extensive array of research initiatives that have been 

undertaken by the Institute. I am particularly pleased with those endeavors that 

are directed at developing the pool of nurse researchers who also become nurse faculty. Another important initiative is training support for fast-track baccalaureate to 

doctoral program participants. I welcome news of the Institute’s progress in facilitating research projects in rural areas that serve minority students via community 

colleges. 

Answer. NINR considers the development of nurse researchers and nurse faculty 

to be a fundamental component of its research mission. Indeed, developing nurse investigators will be an overarching goal in the Institute’s new strategic plan for 

2006–2010. 

Approximately 7 percent of NINR’s budget supports the Institute’s Centers programs, which are used to develop the nursing research infrastructure and train new 

investigators. In addition to our ten Core and nine Exploratory Centers, we have 

co-sponsored a joint initiative with the National Center on Minority Health and 

Health Disparities that supports partnerships between established, research-intensive institutions and growing, minority-serving institutions. These Nursing Partnership Centers on Reducing Health Disparities, involving 17 schools of nursing, will 

increase health disparities research and broaden the diversity of the nurse scientist 

pool. Several of these Centers are located in rural areas or serve rural and other 

underserved populations. These Centers represent a major investment aimed at expanding the cadre of nurse scientists involved in health disparities research. 

BACCALAUREATE TO DOCTORAL PROGRAMS

Question. A long-standing supporter of the National Institute for Nursing Research, I am pleased that the Administration has continued funding of this program. 

However, what impact will the $1 million reduction have on the National Institute 

of Nursing Research’s development of initiative that supports fast-track baccalaureate-to-doctoral programs? These programs were proposed to help increase the 

number of nursing faculty and in turn decrease the number of qualified nursing 

school candidates who were turned away in prior years. 

Answer. The overall reduction of $792,000 in the fiscal year 2007 budget request 

of $136.6 million for the National Institute of Nursing Research (NINR) will have 

no impact on its programs that fast-track baccalaureate-to-doctoral nurses to increase the number of nursing investigators. These programs are supported within 

the Research Training mechanism in NINR, and the fiscal year 2007 President’s 

Budget maintains the current level of support of this activity. NINR remains committed to developing the next generation of nurse scientists. NINR encourages and 

supports strategies to change the career trajectory of nurse scientists. The Institute 

emphasizes early entry into research careers, including fast-track baccalaureate-todoctoral programs, and supports pre-doctoral and postdoctoral nurses who are the 

future researchers and nursing faculty. 

CANCER CENTERS

Question. The National Cancer Institute has had great success and demonstrated 

value in its system of cancer centers across the country. When awarding core grants 

for cancer research, is attention paid to geographic and ethnic diversity to ensure 

that results will capture the often significant differences in outcomes among various 

ethnic groups and lifestyles? 

Answer. The NCI-designated Cancer Centers are vital parts of a national strategy 

to reduce the suffering and death due to cancer. The NCI Cancer Centers Program 

provides critical infrastructure for academic and research institutions throughout 

the United States that provide broad based, coordinated, interdisciplinary programs 

in cancer research. These institutions are characterized by scientific excellence and 

a capacity to integrate various research approaches focused on the problem of cancer. Generally, in order to become an NCI-designated Cancer Center, an institution 

must have a large cancer-relevant grant funding base; substantial institutional commitment in the form of space, resources, and authorities provided to the Center Director; a synergistic organization of transdisciplinary research across all scientific 

areas of the institution; and, specifically for comprehensive centers, community outreach, education, and training activities. 

While the NCI designation is based solely on an evaluation of the science, Centers 

deliver medical advances to patients and their families; provide state-of-the-art care 

and access to clinical trials; serve as the major training ground for new clinicians 
260 

and researchers; and have the strong links with national, state, and local agencies 

and advocacy groups needed to address cancer issues most relevant to their communities. 

Examples of strategies focused on the geographic reach of Cancer Center services 

include: 

—Minority Institution/Cancer Center Partnership Programs (MI/CCP).—The MI/ 

CCP, which partner Minority-Serving Institutions (MSIs) with existing NCI-designated Cancer Centers, was established in 2000 to take maximum advantage 

of their respective expertise and experience. The program is designed to foster 

development of independent cancer research programs and minority career scientists in MSIs and to improve minority-focused outreach and training efforts 

in NCI-designated Cancer Centers. Participation in this program better positions MSIs to compete for independent NCI designation and/or to form equal 

and permanent research alliances with existing NCI-designated Cancer Centers. 

These partnerships are expected to enable the NCI-designated Cancer Centers 

to realize substantial progress in their efforts to implement effective research, 

outreach, and education programs that truly benefit minority populations. 

—Affiliations and Consortia.—Realizing that many institutions serving minorities 

may not have the research capability or the desire to apply for NCI designation 

independently, NCI revised the Cancer Center guidelines to encourage the development of affiliations and consortia. We specifically encourage consideration 

of partnerships that address cancer in minority and other underserved populations. 

—Emphasized Integration.—Through NCI’s ‘‘Discovery, Development, Delivery’’ 

continuum, we expect the continued development of links between existing Cancer Centers, their affiliates and partners in research; as well as state, municipal, and community-based private organizations. NCI is actively seeking mechanisms to foster both vertical integration (i.e., from the Cancer Centers through 

the community layers they serve) and horizontal integration (i.e., across Cancer 

Centers and a nationwide network of public and private partners) of the benefits of cancer research. This integration provides a more unified approach to reducing cancer and cancer risk, and more uniform delivery of the benefits of cancer research into all communities. 

NCI recognizes that the Cancer Research Center of Hawaii is unique in the community it serves. NCI program staff regularly consults with existing NCI-designated 

centers on approaches for enhancing representation of underserved populations, and 

provides support and direction to Center and institutional leadership on how to 

maintain NCI designation; the latter activities are viewed as particularly critical for 

Centers with. significant minority and other undeserved populations. 

NCI continues to pay close attention to the Cancer Centers geographic placement. 

The latest planning grants for NCI Cancer Research Centers (an initial step to gaining designation) have gone to areas without an NCI-designated Center (University 

of Louisville, University of Oklahoma, Emory University, Medical University of 

South Carolina, and Howard University). The University of New Mexico, a former 

planning grant recipient, received Cancer Center designation last year. NCI also 

continues to advise emerging centers in a number of other underrepresented areas 

around the country on an informal basis. 

Additionally, the Cancer Centers themselves are increasingly establishing their 

own networks with community hospitals and private oncology practices and extending the benefits of care and clinical trials further into communities not previously 

reached. 

CONSULTATION PROTOCOL

Question. I am pleased that the National Library of Medicine and the National 

Cancer Institute have made substantial efforts to incorporate, within their program 

areas, resources to address Native Hawaiian health issues and concerns. The Secretary’s latest directive on consultation directs the Intra-Department Council on Native American Affairs to incorporate Native Hawaiian health needs and concerns 

within the consultation framework for agencies within the Department of Health 

and Human Services similar to that afforded American Indians and Alaska Natives. 

Would the National Institutes of Health be willing to engage in discussions with 

Papa Ola Lokahi (Native Hawaiian Health Board) on how best the lessons learned 

working with the National Library of Medicine and the National Cancer Institute 

can be incorporated within all the Institutes of the National Institutes of Health to 

develop an agency-wide consultation protocol for the National Institutes of Health 

and Native Hawaiians similar to that afforded to American Indians and Alaska Natives? 
261 

Answer. The NCMHD has established a trans-NIH Committee to work on the 

NIH implementation of the Department of Health and Human Services’ tribal consultation policy. As the committee prepares the NIH-wide tribal consultation protocol, it will look at various best practice models among the Institutes and Centers, 

including the National Library of Medicine and National Cancer Institute’s models 

for lessons learned that could be incorporated into the protocol and be beneficial to 

Papa Ola Lokahi and other Native Hawaiians. The NIH recognizes the importance 

of listening, dialoguing, and developing relationships prior to developing programs 

and services, and would be willing to hear the suggestions of Papa Ola Lokahi. 

QUESTIONS SUBMITTED BY SENATOR HARRY REID

CHRONIC FATIGUE SYNDROME (CFS)

Question. How many Chronic Fatigue Syndrome (CFS) specific grant applications 

were received, reviewed and funded for fiscal year 2004 and fiscal year 2005? 

Answer. In fiscal year 2004, 17 CFS-specific grant applications (R01) were received and reviewed; 2 were awarded. One P50, a specialized center, was received 

and awarded. One R13, a conference grant, was received and awarded. In fiscal year 

2005, eight CFS-specific grant applications (R01) were received and reviewed; one 

was awarded. One K12, Physician Scientist Award, was received but not awarded. 

Question. Please provide a detailed list of the studies, institutions, lead researchers and individual grant amounts for all CFS studies funded in fiscal year 2004 and 

fiscal year 2005. 

Answer. The information requested is included in the following tables compiled 

by the OD Budget Office. 
262 

NATIONAL INSTITUTES FOR HEALTH—FUNDING FOR CHRONIC FATIGUE SYNDROME FISCAL YEAR 2004 

[Whole dollars] 

IC Project number Principal investigator Institution State Project title Amount 

NHLBI ................................... 5 RO1 HL045462 ......... COLLINS, TUCKER O .................. CHILDREN’S HOSPITAL (BOSTON) .... MA ... TRANSCRIPTIONAL REGULATION OF E-SELECTIN ................... $177,750 NHLBI ................................... 5 R01 HL054926 .......... ISCHIROPOUL OS, HARRY .......... CHILDREN’S HOSPITAL OF PHILADELPHIA. PA ... REACTIVE SPECIES IN VASCULAR DISEASE-INJURY MECHA- NISMS. 170,000 NHLBI ................................... 5 R01 HL055591 .......... LOMASNEY, JON W .................... NORTHWESTERN UNIVERSITY .......... IL ..... MOLECULAR BASIS FOR PROTEIN-PHOSPHOLIPID INTERACTION. 148,500 NHLBI ................................... 5 R01 HL056850 .......... CLEMMONS, DAVID R ................ UNIVERSITY OF NORTH CAROLINA 

CHAPEL HILL.

NC ... MECHANISMS BY WHICH IGF-I STIMULATES SMOOTH MUSCLE CELLS. 203,694 

NHLBI ................................... 5 R01 HL059459 .......... FREEMAN, ROY .......................... BETH ISRAEL DEACONESS MEDICAL 

CENTER.

MA ... ORTHOSTATIC INTOLERANCE IN CFS ...................................... 392,186 

NHLBI ................................... 2 R01 HL061388 .......... CRANDALL, CRAIG G ................. UNIVERSITY OF TEXAS SW MED 

CTR/DALLAS.

TX .... HEAT STRESS AND CIRCULATORY CONTROL .......................... 61,066 

NHLBI ................................... 5 R01 HL066007 .......... STEWART, JULIAN M .................. NEW YORK MEDICAL COLLEGE ........ NY ... CIRCULATORY DYSFUNCTION IN CHRONIC FATIGUE SYNDROME. 252,000 NHLBI ................................... 5 R0l HL067422 ........... CRANDALL, CRAIG G ................. UNIVERSITY OF TEXAS SW MED 

CTR/DALLAS.

TX .... SKIN COOLING TO IMPROVE ORTHOSTATIC TOLERANCE ........ 131,500 

NHLBI ................................... 5 RO1 HL070215 ......... CALDWELL, ROBERT W .............. MEDICAL COLLEGE OF GEORGIA ..... GA ... ENDOTHELIAL CELL DYSFUNCTION IN OXIDATIVE STRESS 

MODELS.

125,562 

TOTAL, NHLBI .......... ...................................... ................................................... .......................................................... ......... ................................................................................................ 1,662,258 

NINDS ................................... 1R13NSO47105–01 ...... HORTOBAGYI, TIBOR .................. EAST CAROLINA UNIVERSITY ........... SC ... INTERNATIONAL SYMPOSIUM ON MOTOR CONTROL USING 

TMS.

2,250 

NINDS ................................... 5Z01NS002979–06 ...... GOLDSTEIN, DAVID .................... NINDS .............................................. MD .. CLINICAL NEUROCARDIOLOGY: CATECHOLAMINE SYSTEMS IN 

STRESS AND DISEASE.

531,506 

TOTAL, NINDS ......... ...................................... ................................................... .......................................................... ......... ................................................................................................ 533,756 

NIAID .................................... 1 R01 AI05601401A1 ... SULLIVAN, PATRICK F ................ UNIVERSITY OF NORTH CAROLINA 

CHAPEL HILL.

NC ... MICROARRAYS & PROTEOMICS IN MZ TWINS DISCORDANT 

FOR CFS.

255,301 

NIAID .................................... 5 RO1 AI042403–07 .... BARANIUK, JAMES N .................. GEORGETOWN UNIVERSITY .............. DC ... MECHANISMS OF RHINITIS IN CFS ......................................... 232,800 NIAID .................................... 5 R01 AI049720–05 .... JASON, LEONARD ....................... DE PAUL UNIVERSITY ...................... IL ..... ACTIVITY INTERVENTION FOR CHRONIC FATIGUE SYNDROME. 266,169 NIAID .................................... 5 R01 AI051270–03 .... TAM, PATRICIA E ....................... UNIVERSITY OF MINNESOTA TWIN 

CITIES.

MN .. VIRAL DSRNA AS A MEDIATOR OF CHRONIC MUSCLE DISEASES. 334,125 
263 

NIAID .................................... 2 RO1 AI054478–02 .... NATELSON, BENJAMIN H ............ UNIV OF MED/DENT NJ NEWARK ..... NJ .... SLEEP AND CYTOKINES IN CHRONIC FATIGUE SYNDROME .... 334,904 

TOTAL, NIAID ........... ...................................... ................................................... .......................................................... ......... ................................................................................................ 1,423,299 

NICHD ................................... R01HD043301–02 ........ TAYLOR,RENE E R ..................... UNIVERSITY OF ILLINOIS AT CHICAGO. IL ..... CHRONIC FATIGUE SYNDROME IN ADOLESCENTS .................. 267,009 

TOTAL, NICHD ......... ...................................... ................................................... .......................................................... ......... ................................................................................................ 267,009 

NIAMS ................................... 5–R01–AR–47678–03 BUCHWALD DEDRA S ................ UNIVERSITY OF WASHINGTON .......... WA ... ARE FIBROMYALGIA AND CHIARI I MALFORMATION RELATED?. 146,712 

TOTAL, NIAMS ......... ...................................... ................................................... .......................................................... ......... ................................................................................................ 146,712 

NIMH .................................... 5K23MH001961–04 ...... FRIEDBERG, FRED ..................... STATE UNIVERSITY NEW YORK 

STONY BROOK.

NY ... PSYCHIATRIC COMORBIDITY IN CHRONIC FATIGUE SYNDROME. 148,923 

TOTAL, NIMH ........... ...................................... ................................................... .......................................................... ......... ................................................................................................ 148,923 

NINR ..................................... R01–AI049720–05 ....... LEONARD, JASON ....................... DE PAUL UNIVERSITY ...................... IL ..... ACTIVITY INTERVENTION FOR CHRONIC FATIGUE SYNDROME. 100,000 

TOTAL, NINR ........... ...................................... ................................................... .......................................................... ......... ................................................................................................ 100,000 

NCRR .................................... 2M01RR000037–44 ..... SMITH, MARK ............................. UNIVERSITY OF WASHINGTON .......... WA ... THE EFFECT OF PARENTAL CHRONIC FATIGUE SYNDROME 

ON OFFSPRING.

29,494 

NCRR .................................... 3P41RR002305–20S1 .. MCCULLY, KEVIN ....................... UNIVERSITY OF PENNSYLVANIA ....... PA ... CHRONIC FATIGUE SYNDROME ............................................... 5,742 NCRR .................................... 5M01RR000039–44 ..... PAPANICOLA OU, DIMITRIS A .... EMORY UNIVERSITY ......................... GA ... EFFECTS OF CORTICOTROPIN-RELEASING HORMONE INFUSION IN NORMAL FEMALES. 179,251 NCRR .................................... 5M01RR000042–44 ..... WILLIAMS, DAVID A ................... UNIVERSITY OF MICHIGAN AT ANN 

ARBOR.

MI .... SUBJECT REGISTRY: INTERDISCIPLINARY STUDIES OF 

CHRONIC MULTI-SYMPTOM ILLNESSES.

9,149 

NCRR .................................... 5M01RR000046–44 ..... LIGHT, KATHLEEN C ................... UNIVERSITY OF NORTH CAROLINA 

CHAPEL HILL.

NC ... FACTORS IN ARTHRITIS, CFS, FIBROMYALGIA & 

TEMPOROMANDIBULA R DISORDERS.

74,144 

NCRR .................................... 5M01RR000052–43 ..... ROWE, PETER C ........................ JOHNS HOPKINS UNIVERSITY ........... MD .. DISORDERED RESPONSES TO ORTHOSTATIC STRESS 

IN . . . GULF WAR SYNDROME SYMPTOMS.

7,991 

NCRR .................................... 5M01RR000052–43 ..... SCHWARTZ, CINDY .................... JOHNS HOPKINS UNIVERSITY ........... MD .. MOVEMENT RESTRICTION AND FATIGUE IN CANCER SURVIVORS. 157 NCRR .................................... 5M01RR002635–20 ..... ADLER, GAIL .............................. BRIGHAM AND WOMEN’S HOSPITAL. MA ... IMMUNONEUROENDOC RINE RESPONSE TO TETANUS TOXOID. 4,821 
264 

NATIONAL INSTITUTES FOR HEALTH—FUNDING FOR CHRONIC FATIGUE SYNDROME FISCAL YEAR 2004—Continued 

[Whole dollars] 

IC Project number Principal investigator Institution State Project title Amount 

NCRR .................................... 5MO1RR010710–07 ..... FRIEDBERG, FREDRICK .............. STATE UNIVERSITY NEW YORK 

STONY BROOK.

NY ... PSYCHIATRIC COMORBIDITY IN CHRONIC FATIGUE SYNDROME. 159,869 

NCRR .................................... 5M01RRO10710–07 ..... FRIEDBERG, FREDRICK .............. STATE UNIVERSITY NEW YORK 

STONY BROOK.

NY ... WHY DO PEOPLE DROP OUT OF SUPPORT GROUPS FOR 

CHRONIC FATIGUE SYNDROME?.

6,401 

NCRR .................................... 5M01RR016587–03 ..... HURWITZ, BARRY ...................... UNIVERSITY OF MIAMI-MEDICAL ...... FL .... RBC MASS/AUTONOMIC NERVOUS SYSTEM/INTEGRITY/SY 

NCOPE IN CHRONIC FATIGUE SYNDROME.

142,237 

NCRR .................................... 5P20RR011145–10 ...... FRIEDMAN, THEODORE C .......... CHARLES R. DREW UNIVERSITY OF 

MED & SCI.

CA ... USE OF VIAGRA TO ALTER SYMPTOMS IN PTS WITH CFS ...... 118,851 

NCRR .................................... 5P41RR008119–12 ...... TARASOV, SERGEY G ................. UNIVERSITY OF MARYLAND BALT 

PROF SCHOOL.

MD .. SPECT & DNA BINDING OF NAPHTYLIMIDO 

IMIDAZOACRIDONE WMC79 & RELATED COMPOUND.

43,966 

NCRR .................................... 5P51RR000168–43 ...... MADRAS, BERTHA K .................. HARVARD UNIVERSITY (MEDICAL 

SCHOOL).

MA ... MOLECULAR TARGETS OF THE ANTI-NARCOLEPTIC DRUG 

MODAFINIL.

14,843 

NCRR .................................... 5R13RR017508–03 ...... LAKOWICZ, JOSEPH R ................ UNIVERSITY OF MARYLAND BALT 

PROF SCHOOL.

MD .. CFS COURSE ON FLUORESCENCE SPECTROSCOPY: MICROSCOPY, DATA ANALYSIS, FLUOROMETRY. 4,084 

TOTAL, NCRR .......... ...................................... ................................................... .......................................................... ......... ................................................................................................ 801,000 

OD ........................................ 1R01HD43301–02 ........ TAYLOR, RENEE ......................... UNIVERSITY OF ILLINOIS, CHICAGO. IL ..... CFS ......................................................................................... 400,000 

TOTAL, OD ............... ...................................... ................................................... .......................................................... ......... ................................................................................................ 400,000 GRAND TOTAL ......... ...................................... ................................................... .......................................................... ......... ................................................................................................ 5,482,957 

NATIONAL INSTITUTES FOR HEALTH—FUNDING FOR CHRONIC FATIGUE SYNDROME FISCAL YEAR 2005 

[Whole dollars] 

IC Project number Principal investigator Institution State Project title Amount 

NHLBI ................................... 5 R01 HL045462 ................ COLLINS, TUCKER O ........... CHILDREN’S HOSPITAL BOSTON ...... MA ... TRANSCRIPTIONAL REGULATION OF E-SELECTIN ................... $177,750 NHLBI ................................... 5 R01 HL054926 ................ ISCHIROPOUL OS, HARRY ... CHILDREN’S HOSPITAL OF PHILADELPHIA. PA ... REACTIVE SPECIES IN VASCULAR DISEASE-INJURY MECHA- NISMS. 170,000 
265 

NHLBI ................................... 5 R01 HL055591 ................ LOMASNEY, JON W .............. NORTHWESTERN UNIVERSITY .......... IL ..... MOLECULAR BASIS FOR PROTEIN-PHOSPHOLIPID INTERACTION. 148,500 NHLBI ................................... 5 R01 HL056850 ................ CLEMMONS, DAVID R .......... UNIVERSITY OF NORTH CAROLINA 

CHAPEL.

NC ... MECHANISMS BY WHICH IGF-I STIMULATES SMOOTH MUSCLE CELLS. 209,541 

NHLBI ................................... 5 R01 HL059459 ................ FREEMAN, ROY ................... BETH ISRAEL DEACONESS MEDICAL. MA ... ORTHOSTATIC INTOLERANCE IN CFS ...................................... 403,952 NHLBI ................................... 5 RO1 HL061388 ................ CRANDALL, CRAIG G ........... UNIVERSITY OF TEXAS SW MED ...... TX .... HEAT STRESS AND CIRCULATORY CONTROL .......................... 47,164 NHLBI ................................... 5 R01 HL067422 ................ CRANDALL, CRAIG G ........... UNIVERSITY OF TEXAS SW MED ...... TX .... SKIN COOLING TO IMPROVE ORTHOSTATIC TOLERANCE ........ 131,500 NHLBI ................................... 5 R01 HL070215 ................ CALDWELL, ROBERT W ....... MEDICAL COLLEGE OF GEORGIA 

(MCG).

GA ... ENDOTHELIAL CELL DYSFUNCTION IN OXIDATIVE STRESS 

MODELS.

125,562 

TOTAL, NHLBI .......... ............................................. ............................................. .......................................................... ......... ................................................................................................ 1,413,969 

NINDS ................................... 5Z01NS002979–07 ............. DAVID, GOLDSTEIN .............. NINDS INTRAMURAL RESEARCH 

PROGRAM.

MD .. CLINICAL NEUROCARDIOLOGY: CATECHOLAMINE SYSTEMS IN 

STRESS AND DISEASE.

559,424 

NINDS ................................... 9L30NS054198–02 ............. FRANTOM, CATHERINE G .... LOAN REPAYMENT ........................... ......... NEURO-REHAB MEASUREMENT .............................................. 3,058 

TOTAL, NINDS ......... ............................................. ............................................. .......................................................... ......... ................................................................................................ 562,482 

NIAID .................................... 5 R0l AI051270–04 ............ TAM, PATRICIA E ................. UNIVERSITY OF MINNESOTA TWIN 

CITIES.

MN .. VIRAL DSRNA AS A MEDIATOR OF CHRONIC MUSCLE DISEASES. 349,860 

NIAID .................................... 5 R01 AI054478–03 ........... NATELSON, BENJAMIN H ..... UNIV OF MED/DENT OF NJ-NJ MEDICAL SCHOOL. NJ .... SLEEP AND CYTOKINES IN CHRONIC FATIGUE SYNDROME .... 673,289 NIAID .................................... 1 R01 A1055735–01A2 ...... JASON, LEONARD A ............. DE PAUL UNIVERSITY ...................... IL ..... RISK FACTRORS ASSOCIATED WITH CFS AND CF PROGNOSIS. 541,703 NIAID .................................... 5 R01 AI056014–02 ........... SULLIVAN, PATRICK F ......... UNIVERSITY OF NORTH CAROLINA 

CHAPEL HILL.

NC ... MICROARRAYS & PROTEOMICS IN MZ TWINS DISCORDANT 

FOR CFS.

518,667 

TOTAL, NIAID ........... ............................................. ............................................. .......................................................... ......... ................................................................................................ 2,083,519 

NICHD ................................... R01HD043301–03 .............. TAYLOR, RENE E R ............. UNIVERSITY OF ILLINOIS AT CHICAGO. IL ..... CHRONIC FATIGUE SYNDROME IN ADOLESCENTS .................. 268,159 

TOTAL, NICHD ......... ............................................. ............................................. .......................................................... ......... ................................................................................................ 268,159 

NIAMS ................................... 5–RO1–AR–47678–04 ........ BUCHWALD DEDRA S .......... UNIVERSITY OF WASHINGTON .......... WA ... ARE FIBROMYALGIA AND CHIARI I MALFORMATION RELATED?. 127,983 

TOTAL, NIAMS ......... ............................................. ............................................. .......................................................... ......... ................................................................................................ 127,983 
266 

NATIONAL INSTITUTES FOR HEALTH—FUNDING FOR CHRONIC FATIGUE SYNDROME FISCAL YEAR 2005—Continued 

[Whole dollars] 

IC Project number Principal investigator Institution State Project title Amount 

NIMH .................................... 5K23MH001961–05 ............ FRIEDBERG, FRED ............... STATE UNIVERSITY NEW YORK 

STONY BROOK.

NY ... PSYCHIATRIC COMORBIDITY IN CHRONIC FATIGUE SYNDROME. 157,316 

TOTAL, NIMH ........... ............................................. ............................................. .......................................................... ......... ................................................................................................ 157,316 

NCRR .................................... 1M01RR020359–01 ............ BARANIUK, JAMES N ........... CHILDREN’S RESEARCH INSTITUTE. DC ... RHINITIS IN CHRONIC FATIGUE SYNDROME (CFS) ................. 3,236 NCRR .................................... 2M01RR000052–44 ............ SCHWARTZ, CINDY .............. JOHNS HOPKINS UNIVERSITY ........... MD .. MOVEMENT RESTRICTION AND FATIGUE IN CANCER SURVIVORS. 1,246 NCRR .................................... 2P20RR011145–11 ............. FRIEDMAN, THEODORE C .... CHARLES R. DREW UNIVERSITY OF 

MED & SCI.

CA ... USE OF VIAGRA TO ALTER SYMPTOMS IN PTS WITH CFS ...... 19,782 

NCRR .................................... 2P41RR002305–21A1 ......... MCCULLY, KEVIN ................. UNIVERSITY OF PENNSYLVANIA ....... PA ... CHRONIC FATIGUE SYNDROME ............................................... 16,453 NCRR .................................... 5M01RR000037–45 ............ SMITH, MARK ...................... UNIVERSITY OF WASHINGTON .......... WA ... THE EFFECT OF PARENTAL CHRONIC FATIGUE SYNDROME 

ON OFFSPRING.

6,418 

NCRR .................................... 5M01RR000042–45 ............ WILLIAMS, DAVID A ............. UNIVERSITY OF MICHIGAN AT ANN 

ARBOR.

MI .... SUBJECT REGISTRY: INTERDISCIPLINARY STUDIES OF 

CHRONIC MULTI-SYMPTOM ILLNESSES.

77,197 

NCRR .................................... 5M01RR000046–45 ............ LIGHT, KATHLEEN C ............ UNIVERSITY OF NORTH CAROLINA 

CHAPEL HILL.

NC ... FACTORS IN ARTHRITIS, CFS, FIBROMYALGIA & 

TEMPOROMANDIBUL AR DISORDERS.

17,907 

NCRR .................................... 5M01RR000048–44 ............ TAYLOR, RENEE .................. NORTHWESTERN UNIVERSITY .......... IL ..... A PROSPECTIVE STUDY OF CHRONIC FATIGUE SYNDROME IN 

ADOLESCENTS.

26,247 

NCRR .................................... 5MO1RR000071–42 ............ MATHEW, SANJAY ................ MOUNT SINAI SCHOOL OF MEDICINE

OF NYU.

NY ... MRS NEUROMETABOLITE S IN CHRONIC FATIGUE SYNDROME, GENERALIZED ANXIETY DISORDER. 10,871 

NCRR .................................... 5MO1RRO10710–08 ........... FRIEDBERG, FREDRICK ....... STATE UNIVERSITY NEW YORK 

STONY BROOK.

NY ... PSYCHIATRIC COMORBIDITY IN CHRONIC FATIGUE SYNDROME. 48,251 

NCRR .................................... 5MO1RRO10710–08 ........... FRIEDBERG, FREDRICK ....... STATE UNIVERSITY NEW YORK 

STONY BROOK.

NY ... WHY DO PEOPLE DROP OUT OF SUPPORT GROUPS FOR 

CHRONIC FATIGUE SYNDROME?.

42,683 

NCRR .................................... 5M01RR016587–04 ............ HURWITZ, BARRY ................ UNIVERSITY OF MIAMI-MEDICAL ...... FL .... RBC MASS/AUTONOMIC NERVOUS SYSTEM/INTEGRITY/SYNCOPE IN CHRONIC FATIGUE SYNDROME. 28,827 NCRR .................................... 5P41RR008119–13 ............. NOWACZYK, KAZIMIERZ ...... UNIVERSITY OF MARYLAND BALT 

PROF SCHOOL.

MD .. CFS COMPUTERS .................................................................... 20,687 

NCRR .................................... 5P51 RR000168–44 ........... MADRAS, BERTHA K ............ HARVARD UNIVERSITY (MEDICAL 

SCHOOL).

MA ... MOLECULAR TARGETS OF THE ANTI-NARCOLEPTIC DRUG 

MODAFINIL.

120,481 
267 

NCRR .................................... 5R13RR017508–04 ............ LAKOWICZ, JOSEPH R ......... UNIVERSITY OF MARYLAND BALT 

PROF SCHOOL.

MD .. CFS COURSE ON FLUORESCENCE SPECTROSCOPY: MICROSCOPY, DATA ANALYSIS, FLUOROMETRY. 4,207 

TOTAL, NCRR .......... ............................................. ............................................. .......................................................... ......... ................................................................................................ 444,493 

OD ........................................ 1R01HD43301–03 .............. TAYLOR, RENEE .................. UNIVERSITY OF ILLINOIS AT CHICAGO. IL ..... CFS ......................................................................................... 300,000 OD ........................................ 1R01AI055735–01A2 .......... JASON, LEONARD ................ DE PAUL UNIVERSITY ...................... IL ..... CFS ......................................................................................... 100,000 

TOTAL, OD ............... ............................................. ............................................. .......................................................... ......... ................................................................................................ 400,000 TOTAL, NIH .............. ............................................. ............................................. .......................................................... ......... ................................................................................................ 5,457,921 
268 

Question. NIH is expected to announce later this month the awards made in response to the 7/14/05 RFA for CFS. Will the studies funded under this RFA yield 

a true increase in the level of NIH research funding for CFS? 

Answer. Yes. The 7 new grants funded will infuse an additional several million 

dollars into the bottom line for CFS funding that has remained relatively constant 

in the $5.5–$6 million range over the past years. A projected $2 million is derived 

from the redirected funds of the ORWH budget to fund and co-fund studies through 

the ICs. The remainder will be provided by the NIAAA, NIAMS, NIEHS, and 

NINDS. Additionally, individual letters sent from the Tans-NIH Working Group for 

Research on Chronic Fatigue Syndrome encouraged the unsuccessful applicants to 

revise and submit their proposals under the standing CFS Program Announcement. 

Many have been in touch for advice and plan to resubmit. The announcement resulted in increased interest from many researchers who had not previously conducted research on CFS. They are now aware that NIH interest in CFS is broad 

based and that many disciplines can contribute. It is expected that this RFA, information on the new website, and contacts established with members of the CFSWG 

will lead to. a further increase in investigator initiated submissions. 

Question. You have been a strong advocate for more centralized power and discretion within the NIH Office of the Director for the Roadmap Initiative to identify 

major opportunities and gaps in research that no single institute at NIH can tackle 

alone but that the agency as a whole must address. CFS is a complex illness that 

affects the brain and multiple body systems and thus is an example of a condition 

that must be addressed by multiple institutes. The CDC is expected to announce 

that CFS affects more than four million adults in the United States. In 1999, responsibility for CFS was moved to the Office of the Director. What progress in NIH’s 

approach to the study of CFS has been made since this move? 

Answer. Tremendous progress has been and will continue to be made in pursuing 

and further stimulating CFS research. This is accomplished through a trans-NIH 

Working Group for Research on CFS (CFSWG) that is chaired by the Office of Research on Women’s Health (ORWH) in the Office of the Director and includes members from 13 different ICs. The CFSWG was established in April 2001 to develop 

an action plan to enhance the status of CFS research at the NIH and among the 

external scientific community. The Working Group first issued a program announcement based on recommendations from the Chronic Fatigue Syndrome, State of the 

Science Conference held in October 2000 that encouraged innovative and interdisciplinary CFS research. The CFSWG updated and reissued this announcement in 

2005 based on the results of a second NIH-sponsored scientific workshop. This workshop, Neuro-Immune Mechanisms and Chronic Fatigue Syndrome: Will understanding central-mechanisms enhance the search for the causes, consequences and 

treatment of CFS?, was held in June 2003. Its proceedings were published in 2004 

(NIH Publication No. 04–5497) and disseminated widely among the scientific community. The first issue of the new ORWH Science Series for the Public, informational fact sheets, is also derived from these proceedings. Also based on these proceedings, the ORWH and the CFSWG developed a request for applications (RFA) to 

explicate how the brain, as the mediator of the various body systems involved, fits 

into the schema for understanding CFS (RFA OD–06–002). This RFA specifically solicited proposals from multidisciplinary teams of scientists to develop an interdisciplinary approach to the mechanisms involved in CFS in men and women across 

the life span. Twenty-nine applications were received and are in process. All documents mentioned above as well as complete information about the NIH CFS program are available at http://orwh.od.nih.gov/cfs.html. All of the above demonstrate 

concerted trans-NIH efforts coordinated by an OD program office that is the focal 

point for research on women’s health, ORWH, to engage the scientific community 

in addressing the many aspects of and increasing knowledge of CFS. 

Question. Has the move to the Office of the Director led to any real progress in 

multidisciplinary research? If so, what specifics can you point to? 

Answer. Yes. Collaborative achievements that include the development of an action plan to enhance the status of CFS research at the NIH and the products of 

this plan, such as trans-NIH Program Announcements, Requests for Applications, 

Scientific Workshops would not have been possible without the formation of a transNIH CFSWG chaired by the ORWH in the Office of the Director. The ORWH has 

had a long and successful track record for developing and leading interdisciplinary 

research and training initiatives on women’s health and sex and gender factors in 

human health through its Coordinating Committee for Research on Women’s Health 

(CCRWH), which brings together representatives from every institute and center to 

facilitate collaborative efforts. Similarly, the CFSWG, supported and led by the 

ORWH, is composed of representatives from 13 NIH institutes and centers with an 

interest in facilitating collaborative efforts to invigorate CFS research at the NIH. 
269 

Question. How does the current status of CFS research within the NIH serve as 

a model for progress, based on more centralized authority within the Office of the 

Director or as a model for multidisciplinary approaches and the Roadmap. 

Answer. NIH has made steady progress towards an interdisciplinary approach to 

CFS through the efforts and function of an OD program office that was established 

to serve as the NIH focal point for the OD on women’s health research. Therefore, 

the OD, through ORWH, was able to bring together diverse institutes to collaborate 

effectively in a trans-NIH initiative to enhance research on CFS. The ORWH also 

contributed staff and budget to these expanded research activities. This ORWH effort for CFS serves as an example of how an office within the OD can facilitate 

trans-NIH scientific initiatives that manifest real progress in research. 

QUESTIONS SUBMITTED BY SENATOR HERB KOHL

ALZHEIMER’S DISEASE

Question. In April, the National Center for Health Statistics reported that the life 

expectancy of Americans has risen to 78 years—the highest it has ever been. However, they also reported that the death rate from Alzheimer’s disease is increasing 

among the top 10 causes of death in the United States. In light of the fact that the 

Baby Boom generation is entering the age of highest risk for Alzheimer’s, shouldn’t 

NIH be increasing, rather than reducing, its investment in Alzheimer’s research? 

Answer. It should be noted that our fiscal year 2007 funding level for Alzheimer’s 

disease is an estimate and reflects a reduction that is comparable to the reductions 

in the total budgets of the NIH ICs supporting research in this important area. At 

this time, it is not possible to be precise as to where available funding will be allocated. Funding decisions will be based on public health need, scientific and technological opportunity, and the peer review of research applications. 

As the Senator points out, with current trends, Alzheimer’s disease will become 

an increasingly critical public health concern over the coming decades. To reverse 

this trend, it is critical that we explore all promising avenues of discovery and promote the translation of research results into interventions for the successful prevention, detection, diagnosis, and treatment of Alzheimer’s disease. Alzheimer’s disease 

research continues to be a high priority for NIH, and scientific opportunities in this 

area will be actively pursued within available resources. 

EPILEPSY

Question. As you know, for years I have pushed NIH to work harder to develop 

better treatments and a cure for epilepsy. I have supported efforts by the National 

Institute of Neurological Disorders and Stroke to fund epilepsy research. However, 

many experts think we need a broader approach, with greater collaboration between 

NINDS and the National Institute on Mental Health, the National Institute on 

Child Health and Human Development, and other Institutes. What are you doing 

to guarantee that multi-Institute studies on epilepsy are developed and funded in 

the coming year? 

Answer. As the lead NIH Institute for epilepsy research, the National Institute 

of Neurological Disorders and Stroke (NINDS) coordinates epilepsy research efforts 

through the InterAgency Epilepsy Working Group. The Epilepsy Working Group is 

composed of scientific program staff from the NINDS, eight other Institutes, including the National Institute of Mental Health (NIMH) the National Institute of Child 

Health and Human Development (NICHD), and staff members from the Centers for 

Disease Control and Prevention. The Working Group facilitates coordination and 

collaboration among NIH Institutes. For example, NINDS and NIMH Epilepsy 

Working Group members collaborated with the American Epilepsy Society to sponsor an international workshop in May 2005 on treatment of nonepileptic seizures 

(NES), a neuropsychiatric seizure disorder. As a result of this meeting, the NIMH 

and the NINDS issued a request for applications on ‘‘Collaborative Research on 

Mental and Neurological Disorders.’’ 

This initiative focused on co-morbidities between mental health and neurological 

disorders, including epilepsy. 

The NINDS and the NICHD have a long history of collaboration on epilepsy research. The NICHD funds the Mental Retardation Research Centers Program, a 

network of regional centers developed for research on mental retardation and related aspects of human development, including epilepsy. Many of the Centers also 

provide infrastructure for NINDS-supported epilepsy research projects. Both Institutes fully expect this successful collaboration to continue in the future. 
270 

The NIMH, NICHD, and NINDS also collaborate in funding the Autism Research 

Network (ARN). The ARN is made up of eight collaborative research centers that 

focus on the causes, diagnosis, early detection, prevention, and treatment of autism. 

One of the network studies, ‘‘A Longitudinal Assessment of Behavior Problems, Puberty, and Epilepsy’’ is designed to investigate which children with autism develop 

seizures and whether there are changes in behavior that either precede or follow 

the development of seizures. 

Question. As you know, NINDS held a successful epilepsy conference in 2000, 

where research benchmarks were developed and used to create a research agenda 

in epilepsy. It’s my understanding that NINDS is planning a follow-up conference 

on Curing Epilepsy in March 2007. Will you ensure that representatives from other 

Institutes participate in the 2007 conference? What steps will you take after the 

conference to ensure that collaborative research is pursued in order to have the 

greatest impact for epilepsy patients? 

Answer. The NINDS has invited all the organizations represented on the InterAgency Epilepsy Working Group (IAEWG) to participate in planning and co-sponsoring the Curing Epilepsy 2007 conference. Co-morbidities, such as cognitive and 

psychological issues in children and adults with epilepsy, will be one of the major 

themes of the conference. Epilepsy co-morbidities often include behavioral problems, 

learning and memory difficulties, and depression. The NINDS expects that the conference will draw attention to the importance of these issues and will stimulate 

interdisciplinary investigation into the causes, treatment and prevention of epilepsy 

and its co-morbidities. The IAEWG will also consider the potential for collaborative 

activities in response to any recommendations that result from the Curing Epilepsy 

2007 conference. 

AGE-RELATED MACULAR DEGENERATION

Question. You have publicly cited as an NIH ‘‘breakthrough’’ the discovery of a 

gene strongly associated with age-related macular degeneration (AMD). As you 

know, AMD is the leading cause of blindness in the United States, especially among 

our seniors, robbing them of their independence and quality of life. What does this 

finding mean for new treatments to stop or reverse this blinding eye disease? How 

will the National Eye Institute follow up on this exciting breakthrough when the 

President’s budget proposes to cut NEI funding? 

Answer. National Eye Institute-sponsored investigators have made considerable 

progress since the recent discovery of the complement factor H (CFH) gene in agerelated macular degeneration (AMD). NEI intramural researchers are initiating a 

phase I clinical trial to evaluate anti-inflammatory agents that may inhibit damaging immune responses potentially resulting from alterations in the CFH gene. 

NEI extramural and NIH intramural scientists discovered that alterations in a second gene in the inflammatory pathway, complement factor B, are also associated 

with AMD. Variations in these two genes can predict the clinical outcome in 74 percent of individuals with AMD. In addition, the NEI launched a new research initiative to further investigate the role of inflammation in AMD and other common eye 

diseases such as diabetic retinopathy and uveitis. 

IRRITABLE BOWEL SYNDROME

Question. For the last several years, the Appropriations Committee has asked the 

National Institute of Diabetes and Digestive and Kidney Diseases to develop a strategic plan for research into Irritable Bowel Syndrome. NIDDK has explained that 

the Institute [is] creating an overall digestive disease action plan and that IBS will 

be a significant part of it. Can you update us on NIDDK’s progress on the digestive 

disease plan and explain how much attention IBS will receive? 

Answer. The NIH established a National Commission on Digestive Diseases in 

August 2005, based on the shared interest of the NIH and the Congress in advancing research on digestive diseases. One of the Commission’s primary purposes is to 

develop a Long-Range Research Plan for Digestive Diseases, which will include 

plans for stimulating research on functional gastrointestinal (GI) and motility disorders such as irritable bowel syndrome (IBS). Within the NIH, the NIDDK has lead 

responsibility for digestive diseases research and supports a research portfolio in 

IBS and other types of functional GI and motility disorders. The NIDDK is providing leadership and support for this federally chartered Commission. 

As NIH Director, I appointed members of the Commission after a broad call for 

nominees with diverse scientific, professional, and personal experiences related to 

digestive diseases from within the academic and medical research and practice communities, patient and patient advocacy community, and the NIH and other Federal 

health agencies. The perspective of individuals with personal or professional interest 
271 

in IBS and other types of functional GI and motility disorders is represented within 

the Commission. 

Commission members recently convened for their first meeting on June 12, 2006, 

and are currently finalizing topics for chapters of the Research Plan, one of which 

is expected to focus on IBS and related GI motility disorders research. The ultimate 

goal of the Commission’s Research Plan is to improve the nation’s health through 

advancing research on digestive diseases, such as IBS. The Research Plan will include: (1) information on the burden of disease on individuals and society; (2) examples of research advances that are generating new knowledge vital to understanding, treatment, and prevention; and (3) compelling opportunities for future 

NIH-funded research, which offer promise for reducing the burden of disease. This 

Research Plan will recommend promising research directions relevant to IBS and 

other types of functional GI and motility disorders, which will help guide the 

NIDDK, the NIH, and the investigative and lay community in the pursuit of the 

most productive research avenues. 

The Commission will rely on broad stakeholder input from members of the digestive diseases community to inform the Research Plan throughout its development. 

For example, Commission members are currently establishing Working Groups composed of individuals with expertise related to specific areas of digestive diseases research, who will provide input necessary for crafting a well-informed Research Plan. 

One of these Working Groups is expected to focus on functional GI and motility disorders, such as IBS, in addition to potential overlapping and synergistic efforts in 

this area on the part of other Working Groups. Other opportunities for broad stakeholder input into the Commission’s activities will include public Commission meetings and an open comment period for public input on the draft Research Plan. Additional information on the Commission’s ongoing activities can be found on its 

website at: http://NCDD.niddk.nih.gov. 

CONCLUSION OF HEARINGS

Senator SPECTER. So thank you for what you are doing. We appreciate your thanks to us, and we are going to do more and we 

ask you to do more. That concludes our hearings. 

[Whereupon, at 10:14 a.m., Friday, May 19, the hearings were 

concluded, and the subcommittee was recessed, to reconvene subject to the call of the Chair.] 

(273) 

DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 

FISCAL YEAR 2007 

U.S. SENATE, 

SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS, 

Washington, DC. 

DEPARTMENT OF LABOR 

OFFICE OF THE SECRETARY

[The following questions were submitted to be answered for the record:] 
274 

QUESTIONS SUBMITTED BY SENATOR ARLEN SPECTER

MINE SAFETY

Question. Congress has now passed bi-partisan mine safety legislation that contained many of the provisions in a bill I introduced on February 16, 2006. Congress 

has also passed a pending supplemental appropriations bill containing $35,600,000 

to augment inspections of coal mines and to expand research to develop mine safety 

technology. How do you intend to implement these authorization and appropriation 

measures? What additional appropriations are necessary to fully implement the new 

authorization? 

During the hearing this Subcommittee held on January 23, 2006, on the Sago 

Mine disaster, I questioned the policy of the requiring mine representatives to be 

present during accident investigation interviews with miners. Although the legislation I introduced would prohibit this practice, it was not included in the consensus 

bill reported last week. Do you support such a provision? 

Answer. $25.6 million of the $35.6 million contained in the supplemental appropriation was appropriated to MSHA. The supplemental appropriation contains a 

provision requiring MSHA to submit a spending plan for these funds to the appropriations committees by July 15, 2006, and MSHA will comply with this provision. 

The remaining $10 million in supplemental funding was appropriated to NIOSH for 

expansion of research and mine safety technology, therefore NIOSH is the appropriate entity to answer questions regarding their plans for the use of those funds. 

With regard to additional appropriations necessary to fully implement the MINER 

Act, the MINER Act contains authorization for new grant programs but no funding 

for these programs has been appropriated. Many of the new MINER Act provisions 

do not require any additional funding. For example, the increase of the maximum 

civil penalty for flagrant violations and the implementation of minimum penalties 

for unwarrantable citations and orders, as well as the provision requiring every 

mine to have an Emergency Response Plan do not require any increases in funding. 

With regard to MSHA accident investigations, the Mine Act gives MSHA discretion to determine who may be present during accident investigation interviews with 

miners and other persons who may have relevant information. As you are aware, 

MSHA’s longstanding past practice regarding interviews has generally included participation by the mine operator and the representative of miners. However, we have 

come to the conclusion that this process should be changed to conform to the process 

used by virtually all other law enforcement investigative agencies. We believe that 

witness interviews should be conducted with only federal, and where applicable, 

state authorities. Of course, witnesses would continue to have the option of having 

a personal representative of their choosing present during the interview. We believe 

that the time proven technique of interviewing witnesses separately and without additional persons present is the best method of eliciting useful information without 

fear of intimidation, and minimizes the ability of witnesses to modify their testimony in light of the knowledge gained from other witnesses. In fact, recent experience has demonstrated that the presence of third-parties could compromise the investigation, make witnesses less likely to cooperate, and result in premature release 

of information before all witness interviews are complete. Thus, we agree that participation in interviews by non-government personnel should be limited to a personal representative of the witness. Of course, MSHA will continue its practice of 

releasing all witness transcripts, except those requested under the Mine Act to be 

confidential, once the investigation has reached a stage where release would not impede or interfere with the investigation. 

JOB CORPS FUNDING

Question. It has been more than 45 calendar days of continuous session of the 

Congress since the President proposed rescinding $75 million of Job Corps construction and renovation funds. Have these funds now been released as required by the 

Congressional Budget and Impoundment Control Act? 

Answer. The $75 million in Construction, Rehabilitation, and Acquisition funds 

were not withheld from obligation, as noted in our May 30, 2006 letter to GAO on 

this matter, and remain available for obligation by the Office of Job Corps. 

Question. Your budget proposed to cut $62,578,000 from the Job Corps budget for 

program year 2007, which would result in 3,614 fewer students enrolled than in 

2005. This would reduce funding, on inflation-adjusted basis, 8.5 percent below the 

level in 2005. How far below capacity would this put the 122 existing Job Corps centers? 
275 

Answer. With the requested 2007 operating budget of $1,401,602,000, Job Corps 

will be able to maintain 42,863 year-around training slots, which represents 95.5 

percent of the peak level that could be accommodated by our physical infrastructure. 

REINTEGRATION OF YOUTHFUL OFFENDERS

Question. Your budget once again zeroes out the program I was instrumental in 

creating, for training and employing of youthful offenders. Even after last November’s conference agreement restored $49 million for this program, the Administration immediately offered it up as an offset to help pay for December’s Katrina supplement. Do you think this was an appropriate way to respond? 

Answer. The impacts of the Katrina and Rita hurricanes were unprecedented and 

the Administration carefully prioritized the use of available resources across government to fund relief and recovery efforts. The Youth Offender appropriation was only 

one of many offsets the Administration presented to Congress, and this is consistent 

with the Administration’s proposal in the fiscal year 2007 and previous budgets to 

replace the Responsible Reintegration of Young Offenders program with the Prisoner Reentry Initiative, thereby increasing the program’s overall scope and reach. 

ELIMINATION OF MIGRANT JOB TRAINING

Question. Both the House and the Senate appropriations committees have repeatedly rejected your proposal to eliminate the Migrant and Seasonal Farmworkers 

Program under the Workforce Investment Act. I think it’s fair to say that Congress 

recognizes that it is unrealistic to expect states and localities to be responsible for 

a unique and difficult-to-serve migratory population that, from their point of view, 

is ‘‘here today and gone tomorrow.’’ It is also unfair to shift this burden to states 

when you are proposing to reduce the already limited job training resources that 

states have to serve their eligible local residents. If Congress understands this, why 

doesn’t the Department? 

Answer. The Administration’s fiscal year 2007 Budget proposal seeks to tap the 

workforce investment system’s potential to serve more migrant and seasonal farmworkers by providing job training services to them through the One-Stop Career 

Center system, and turning to other, appropriate agencies to provide supportive 

services, housing, and other related assistance. Currently, the section 167 program 

provides employment and training services to only 10,000 of an estimated two million farmworkers, which demonstrates the need for a wider system approach. 

The Administration believes that providing services to farmworkers through the 

One-Stop system will increase the number served and have a positive employment 

and earnings impact on those who receive services. 

IMPACT OF JOB TRAINING CUTS

Question. Your budget is based on the assumed enactment of a new Workforce Investment Act reauthorization proposal calling for Career Advancement Accounts, to 

be run through a consolidated workforce system, cutting nearly $700 million. Until 

the authorization legislation is changed, this Committee acts on the basis of extending current law. In the absence of law change, what impact will your budget proposals have on existing programs for youth, adults, dislocated workers, and the Employment Service? For example, the Pennsylvania Association of Workforce Investment Boards estimates the President’s Budget would result in a 17 percent cut from 

current levels for the youth, adult and dislocated worker block grants. Do I have 

your assurance that you will not proceed administratively to implement proposals 

such as consolidated Career Accounts without Congressional approval? 

Answer. The President’s Budget request does assume enactment of the Career Advancement Account (CAA) proposal, which would reduce overhead and administrative costs and focus more funding on training, thereby tripling the number of individuals receiving job training through the workforce investment system. 

In the absence of any legislation passed by Congress, states will continue to operate Workforce Investment Act programs and the Employment Service as currently 

authorized. The appropriation level provided by Congress is a separate issue from 

job training reform. We feel that CAAs are a more effective approach than the current workforce investment system, regardless of the funding level provided by Congress. 

Several states and local areas have expressed interest in piloting CAAs. We will 

work with these areas to develop a limited pilot that can be carried out under current law. However, statutory changes are necessary to achieve all of the reforms envisioned under the CAA proposal. 
276 

WORKFORCE TRAINING CUTS

Question. Your budget for workforce programs contains cuts of $506 million for state grant programs, while increasing funding under national control by $107 million. How does this square with your legislative proposal to shift greater control of 

resources to the States? 

Answer. The President’s fiscal year 2007 Budget proposes a minimal increase for 

programs under ‘‘national control.’’ The only activity that falls under this category 

that is proposed for additional funding is Unemployment Insurance National Activities, whereby an increase of $600,000 is requested to pay for activity related to processing separation documents and unemployment claims of former military service 

personnel. 

Furthermore, the fiscal year 2007 Budget request proposes initiatives that give 

greater control of funding to states and local areas. The Career Advancement Account proposal promotes state and local flexibility by streamlining and strengthening the One-Stop Career Center system and removing or simplifying statutory requirements that create rigidity and hinder flexibility in providing education and 

training opportunities to American workers. Also, the Administration included a 

streamlined program structure in its Older Americans Act reauthorization proposal, 

which would give states greater control over the Senior Community Service Employment Program (SCSEP) funds. 

ASBESTOS EXPOSURE

Question. Madame Secretary, the fiscal year 2006 appropriation contained $2 million for the Employment Standards Administration to facilitate the expeditious 

startup of a system to resolve the claims of injury caused by asbestos exposure. How 

are these funds being used to shorten the lead-time for implementation of pending 

asbestos legislation? 

Answer. If the Asbestos legislation is enacted as currently written, the Department of Labor will be expected to manage a new and very substantial national benefits program involving the disbursement of billions of dollars in compensation to 

hundreds of thousands of individual asbestos claimants. The proposed time frame 

for implementing this legislation is extremely short, requiring immediate preparatory work and the up-front expenditure of resources to ensure that payments 

can begin being made to compensable claimants as quickly as possible. 

Given the status of the pending legislation, the $2 million is being used to analyze 

the proposed legislation and plan how to implement it in the event that it is passed. 

In the next phase, funding will be used for initial program start-up expenses in the 

areas of program design, acquisition of specialized expertise, technology, and infrastructure. 

OSHA PENALTIES FOR ASBESTOS VIOLATIONS

Question. I have introduced legislation (S. 668) to subject employers who willfully 

violate OSHA asbestos standards to fines at levels set by the Uniform Criminal 

Code as well as imprisonment of up to five years, or both. Currently OSHA provides 

for criminal penalties only in those cases where a willful violation of standards results in the death of a worker within six months after the violation is discovered. 

Do you agree that stronger enforcement action is needed against parties that violate 

OSHA asbestos enforcement rules? 

Answer. Currently, the OSH Act provides for criminal fines and imprisonment of 

up to six (6) months against an employer only where the employer’s willful violation 

of a standard caused the death of an employee. In addition, criminal penalties exist 

against employers who make false statements to OSHA investigators or who unlawfully interfere with OSHA investigations. S. 668 provides that any willful violation 

of a standard issued under OSH Act section 6 with respect to control of occupational 

exposure to asbestos is punishable by fines under section 3571 of Title 18, United 

States Code, and imprisonment in the case of a first offense, of up to five years. 

While we agree that occupational exposure to asbestos is a very serious health issue, 

we believe the current OSH Act and penalty structure provide the means and flexibility to address instances where penalties are warranted. 

IMMIGRATION BILL

Question. The Senate passed immigration legislation, S. 2611, contains a provision 

requiring the Secretary of Labor to certify that no United States workers are available for a specified position before employers can hire an alien for the job. Do you 

support this provision, and does your Department have sufficient resources to administer it? 
277 

Answer. The Department supports the need to enact comprehensive immigration 

reform that creates a guest worker program and enhances the security of our borders. In his various speeches on immigration reform, the President has repeatedly 

noted that foreign workers should be allowed to take only those jobs that no U.S. 

worker is willing or available to perform. To implement this important program design feature, the Department will need to either establish a labor market test for 

domestic worker interest or create a mechanism whereby employers can attest that 

they have tested the labor market and been unable to find a U.S. worker to fill the 

job. If an attestation system is created, the Department would randomly audit employer attestations to ensure program integrity. We agree that the S. 2611 provision 

is consistent with the President’s position and we support it accordingly. The administration will work with Congress as immigration legislation moves forward to ensure that the need for resources is addressed. 

Question. Your Department has the responsibility to prevent employer exploitation of undocumented workers, by enforcing minimum wage and overtime laws. 

To what extent is this effort discouraging illegal immigration? 

Answer. The strong enforcement of basic labor standards for all employees weakens the incentive to hire undocumented workers. Although it is difficult to quantify 

the extent to which labor standards enforcement deters or dissuades employers from 

hiring undocumented workers, most studies on the impact of illegal immigration acknowledge the importance of such enforcement as a key component in an overall 

strategy for addressing the problem. 

Question. What actions do Labor Department inspectors take when they come 

across evidence that a business unlawfully employs illegal immigrants? 

Answer. When the Wage and Hour Division (WHD) performs an investigation a 

complaint-based investigation, it does not seek evidence of the complainant’s immigration status. WHD instituted this policy to avoid discouraging complaints from 

undocumented workers who might otherwise be reluctant to complain to WHD because of their immigration status. 

However, WHD investigators do perform directed investigations (non-complaint 

cases) to determine employers’ compliance with their employment eligibility 

verification obligations (Forms I–9). In cases where it appears that violations have 

been committed, WHD refers the matter to DHS pursuant to a Memorandum of Understanding. 

MEDICAL LEAVE PROGRAM

Question. At your last appearance before this Committee on March 15, 2005 you 

stated no final decision has been made with respect to revising regulations implementing the Family and Medical leave Act. What progress has been made addressing concerns of workers and employers that have resulted in so many lawsuits on 

the interpretation of when employers are eligible for leave under the law? 

Answer. The Department continues to review the issues raised by the Supreme 

Court’s decision in Ragsdale v. Wolverine World Wide, Inc., as well as other court 

decisions, and the possibility of revisions to the FMLA regulations remains an item 

on the Department’s regulatory agenda. No final decisions have yet been reached 

as to what, if any, changes might actually be proposed. If changes are proposed, the 

public will be provided ample opportunity to comment through the formal notice and 

comment rulemaking process. 

RE-ALLOCATION OF UNSPENT FUNDS

Question. Your budget proposed bill language that would take money away from 

states that have more than 30 percent unspent job training funds, yet you do not 

propose applying this principle to Dislocated Worker national reserve funds, which 

currently have unspent funds exceeding 50 percent. What is your justification for 

this? 

Answer. The Department always obligates all National Reserve monies to states 

during the program year for which such money was appropriated. Any unspent 

funds are unspent at the state and local level, not at the national level. This indicates that even more funds are available for expenditure by states and grantees. 

RAPID RESPONSE FUNDS

Question. Currently, states use rapid response funds to provide immediate service 

to workers affected by a mass layoff, often before the workers are even laid off. 

Under your legislative proposal, states will need to apply to the Employment and 

Training Administration for rapid response funds as events occur. What are the reasons for keeping these funds at the national level, and having states apply for them 

each time they are faced with mass layoffs? 
278 

Answer. The Department does not contemplate that a state would have to apply 

for funds each time there is a mass layoff or to only sporadically fund a state rapid 

response coordinator. Early intervention to provide information and assistance to 

workers to decrease the amount of time between actual layoff and re-employment 

is a key principle of the dislocated worker program. Rapid response is a key element 

of this early intervention strategy. 

States could demonstrate need and apply for rapid response funds at the beginning of the program year or throughout the program year. We will not propose that 

a state be required to submit an application for funding each time a dislocation 

event occurs. 

In spite of all the good work that has been done over the past fifteen years with 

dislocated worker rapid response funds, the Department has found that most company executives do not know about the type and quality of assistance available to 

them and their employees when closures or layoffs are contemplated. They have also 

reported that where they have layoffs in several states simultaneously, the levels 

and quality of assistance varies dramatically. ETA, in collaboration with state and 

local partners, has undertaken several initiatives in the auto, textile and defense 

industries recently to try to integrate services and develop more consistency. We believe a nationally-coordinated approach to delivering rapid response assistance by 

states can help bring the services to more workers and employers. 

The proposed mechanism will assist both the Department and the states to better 

manage scarce taxpayer resources by directing the bulk of the funds to the areas 

of need. For example, not all states experience major layoffs every year. Analyses 

of dislocated worker program expenditures reported by states have shown that the 

funds reserved for rapid response are consistently under-expended. In the aggregate, 

the rapid response carry-in funds from program year 2003 to 2004, and from 2004 

to 2005, was $136.7 million and $166 million, respectively. Through March 31, 2006, 

states reported accrued expenditures of just over $176 million of a total available 

of more than $342.5 million, or 51.4 percent of the total funds available. States are 

not required to retain the up to 25 percent authorized to be reserved for rapid response activities. They may include a portion of the funds in the amount allocated 

to local workforce investment boards for core, intensive and training services for dislocated workers, or they may award additional funds from the reserved amount to 

local areas that experience disasters, mass layoffs, plant closings or other events 

that precipitate substantial increases (defined by the state) in the number of unemployed workers. 

COMMENTS ON CECIL ROBERTS TESTIMONY

Question. Mr. Cecil Roberts, President of the United Mine Workers of America, 

testified to this Committee that the penalties assessed by the Labor Department are 

designed to insure that mining remains profitable, even if the conditions are so hazardous the mine should be shut down. Do you believe that keeping a mine operating 

is more important than the safety of the miners? 

Answer. No, we do not believe that keeping a mine operating is more important 

than the safety of the miners who work in that mine. The Mine Act states in its 

opening section that ‘‘the first priority of all in the coal or other mining industry 

must be the health and safety of its most precious resource—the miner.’’ That is 

the premise on which the Mine Act is based and the reason for the existence of 

MSHA. The Mine Act contains provisions to withdraw miners until the hazard or 

violation is abated when there is an imminent danger to the health and safety of 

miners or an unwarrantable failure of an operator to comply with a mandatory 

health and safety standard. MSHA uses its withdrawal authority vigorously and appropriately. 

Under the Mine Act, MSHA has the authority to propose penalties for violations 

of the Act. MSHA does so in accordance with the six statutory criteria enacted by 

Congress in the Mine Act, including consideration of the effect of the proposed penalty on the operator’s ability to stay in business. Consistent with the Administration’s last three budget requests, Congress included a provision in the MINER Act 

to increase the maximum civil penalty for flagrant violations of the Mine Act to 

$220,000. Minimum penalties were also included for unwarrantable failure violations. The Department has announced that MSHA will be revising its regulations 

and proposing a new penalty formula to raise penalties for mine safety and health 

violations across the board. These higher penalties should provide a greater incentive to mine operators to comply with MSHA’s safety standards. 
279 

OLDER WORKER EMPLOYMENT PROGRAM

Question. The Department has launched another national grant competition process for the Senior Community Service Employment Program despite not having the 

essential performance data that will not be available for new performance goals 

until September 2006. Since the current law directs that re-competition be conducted for non-performance by a grantee, on what basis do you deem this new round 

of competition to have sound data for assessing current or future grantee performance or capacity? 

Answer. The Department has been collecting performance data since the inception 

of the program, and has been collecting additional data on the new common performance measures since July 2004. 

Furthermore, according to the Title V of the Older Americans Act, competition is 

not limited to when grantees fail performance measures. Section 514(a) limits the 

award of SCSEP grants to no more than three years, thus requiring a selection of 

grantees within three years of the first competition. The issue of whether the Department can compete the SCSEP grants has also been addressed by the courts. The 

U.S. District Court of the District of Columbia held recently in Experience Works 

v. Chao, 267 F.Supp. 2d 93 (D.D.C. June 17, 2003), ‘‘[t]he use of competitive procedures is a time-honored method for obtaining the most highly qualified awardees 

of government funds, for allowing new and innovative ideas and organizations to receive those funds, and for assuring public confidence in the integrity of the process 

to distribute government funds.’’ 

Finally, the current Solicitation for Grant Applications (SGA) clearly identifies the 

criteria against which applicants are assessed. All applicants will be rated using a 

ranking criterion based on points. This SGA requires that responses be thoughtful 

and reflect a strategic vision. 

The SGA evaluation criteria are as follows: 

1. Design and Governance—15 points 

2. Program and Grant Management Systems—10 points 

3. Financial Management System—10 points 

4. Program Service Delivery—40 points 

5. Performance Accountability—25 points 

Question. When the program was competed in 2003, this whole competition process—application, grading and transition—took almost 6 months—including over 6 

weeks for transitioning the participants affected. This time the new competition 

rules are much more complex, yet the whole process has been shortened to 4 

months, leaving barely 3 weeks for transition of these vulnerable participants—why 

the rush to get this done this way this year? 

Answer. This year’s competition is not rushed. Applicants were given nearly the 

same amount of time this year as in the 2003 competition to respond to the Solicitation for Grant Applications (SGA). In 2003, grantees were given 90 days to respond 

to the SGA, a time period which included Christmas. This year, the competition was 

announced in the Federal Register on March 2, and grantees were given until May 

26 to respond, or 85 days. 

Further, once grants are awarded, grantees have 2 months in which to transition 

participants among grantees, a longer transition period than in 2003. As specified 

in the SGA, the transition period follows a 1-month extension of current grants and 

will take place August 1-September 30, 2006. This means that the period from publication of the SGA (March 2) until the transition period ends (September 30) is approximately 7 months, 1 month longer than the 2003 competition. 

Question. The cost of transitioning thousands of participants nationwide among 

old and new sponsors will be significant. Subsequent to publication of the SGA in 

the Federal Register, the DOL website was amended to say, ‘‘Transition cost should 

be submitted as an integral part of the budget and reflected on the other’ cost category with a narrative explanation. Can you assure the Committee that services to 

enrollees will not be diminished as a result of incurred transitions costs? 

Answer. All current grantees were required to build transition costs into their 

budgets in the 2003 competition, and all applicants under the 2006 competition have 

also budgeted for transition costs. Further, the Department is prepared to assist 

grantees with additional costs associated with the transition, as it did following the 

transition after the 2003 competition. Program Year 2004 recaptured funds are 

available for this purpose. 

At the time of the 2003 competition, many participants and grantees were concerned about the transition effects upon participants. The Department can say with 

authority that every single participant was transitioned successfully. Competition 

does not need to cause any disruption among services participants receive. 
280 

DOL has identified specific responsibilities for itself, national grantees and state 

grantees to ensure a smooth transition. DOL will provide orientation to all national 

grantees to provide information on program administration and management. DOL 

will begin regular conference calls between federal and regional DOL staff and national grantees to quickly address any transition issues. DOL will also provide assistance through a national call center, and provide on-site technical assistance as 

needed. 

Question. Your budget proposes to save $44 million in the Community Service 

Employment for Older American program through ‘‘efficiencies related to program 

streamlining.’’ What exactly is being proposed to save this amount? 

Answer. The Administration proposes that reauthorization of the Title V SCSEP 

program be based on five key reform principles: (1) helping meet employers’ demands for skilled workers by attracting more older workers into the labor force, encouraging others to remain in the workforce, and by offering opportunities for older 

workers to update their skills; (2) making the One-Stop Career Center system effective for older individuals seeking to work or upgrade their skills, including better 

integrating services for older workers and assisting more older workers, regardless 

of income, to gain skills that are in demand; (3) tailoring services to meet the needs 

of individual older workers by providing a range of training experiences, including 

community service employment, on-the-job training and classroom training, depending on the individual’s background and experience; (4) targeting SCSEP resources 

to those older workers most in need (primarily low-income older workers who lack 

the basic skills for private sector employment), while ensuring that others receive 

services through the One-Stop Career Center system; and (5) streamlining the program to make it easier to administer in order to improve program performance, 

serve more participants, and receive a return on investment for the federal taxpayers’ dollar. 

In fiscal year 2007, savings from streamlining administration and other reforms 

will amount to an estimated $44 million in the first year of implementation. Specifically, we expect that savings will be achieved from the following reforms: 

—Revamping the SCSEP program structure so that states conduct a competition 

every three years to run the program in the state, which will simplify administration, eliminate duplication, and create a more comprehensive program. 

—Eliminating fringe benefits for program participants (except accident insurance 

or benefits that may be required by law) to reinforce the training aspect of the 

program. 

—Allowing SCSEP funding to be used for training (as opposed to wages) and allowing more flexible training options in addition to community service work experience. 

In addition to savings from reforms through reauthorization, savings will also be 

realized through the current grant competition. The current Solicitation for Grant 

Applications encourages a regional service delivery architecture that will reduce redundancy and fragmentation of service delivery areas by requiring that applicants 

apply to serve an entire county instead of a portion, and generally requiring that 

applicants apply to serve contiguous counties if multiple counties are served. 

It is important to note that the fiscal year 2007 request will continue to support 

92,300 low-income elderly individuals, the same level as fiscal year 2006. 

ADMINISTRATION AND MANAGEMENT

Question. Provide appropriations and full time equivalent staff for each of fiscal 

years 2003 through 2005 enacted, fiscal 2006 comparable, and fiscal 2007 budget 

request, for each of the components of the Administration and Management activity 

within the Departmental Management account, including: Department Budget Center; Center for Program Planning and Results; Human Resources Center; Information Technology Center; Civil Rights Center; Office of Security and Emergency Management and Business Operation Center. Provide the source, by Department of 

Labor agency and activity, of the FTE and funding for Working Capital Fund Programs, comparing fiscal year 2006 comparable with the fiscal year 2007 request. 

Answer. The information for Administration and Management follows: 
281 

ADMINISTRATION AND MANAGEMENT BUDGET ACTIVITY DEPARTMENTAL MANAGEMENT SALARIES AND EXPENSES 

[Amount in thousands] 

Agency 

Fiscal year 2003 

enacted 

Fiscal year 2004 

enacted 

Fiscal year 2005 

enacted 

Fiscal year 2006 

comparable 

Fiscal year 2007 

request 

AMT FTE AMT FTE AMT FTE AMT FTE AMT FTE 

Center for Program Planning and Results ................................................................... $6,352 4 $6,076 9 $5,537 8 $5,438 8 $5,562 8 Human Resources Center ............................................................................................. 3,650 23 3,473 23 3,502 24 3,445 24 3,573 24 Information Technology Center ..................................................................................... 12,414 60 12,954 56 11,624 50 9,346 37 9,755 37 Business Operation Center ........................................................................................... 2,652 16 2,026 14 1,959 11 1,778 11 1,825 11 Office of Security and Emergency Mgmt.1 ................................................................... ................ ................ ................ ................ 6,944 ................ 6,875 ................ 1,893 ................Department Budget Center 2 ........................................................................................ ................ ................ 1,776 15 2,362 19 2,056 18 2,116 18 Library ........................................................................................................................... 714 2 719 2 754 1 754 1 782 1 Federal Executive Board ............................................................................................... 170 2 173 2 176 2 206 2 210 2 Assistant Secretary for Administration and Management ........................................... 4,239 5 5,956 5 6,500 10 7,590 10 7,923 10 Civil Rights Center 3 ..................................................................................................... 5,930 48 6,144 48 6,237 46 6,451 46 6,735 46 

1 Represents funding for Frances Perkins Building security enhancements. The fiscal year 2007 Request includes a comparative transfer of $5 million from this budget activity to the Working Capital Fund for upgrading security and continuity of operations capabilities for the Department. 2 Department Budget Center was transferred to Administration and Management budget activity from the Chief Financial Officer budget activity in fiscal year 2004. 3 CRC is funded from the Civil Rights Activity, rather than the Administration and Management Activity. 
282 

The information for Working Capital Fund follows: 

DOL AGENCY WORKING CAPITAL FUND ASSESSMENTS 

[In thousands of dollars] 

Fiscal year 

2006 estimate 2007 request 

ETA .................................................................................................................................................. 14,987 17,942 

ETA/TES ........................................................................................................................................... 9,326 9,922 

ESA .................................................................................................................................................. 37,620 44,021 

OSHA ................................................................................................................................................ 22,851 25,235 

EBSA ................................................................................................................................................ 10,054 11,463 

BLS .................................................................................................................................................. 16,009 19,353 

OIG ................................................................................................................................................... 4,097 4,685 

OSEC ................................................................................................................................................ 14,458 16,730 

VETS ................................................................................................................................................ 2,832 3,207 

SOL .................................................................................................................................................. 6,396 6,646 

ILAB ................................................................................................................................................. 1,984 2,228 

MSHA ............................................................................................................................................... 11,237 13,564 

ODEP ................................................................................................................................................ 1,250 1,305 

FPB repairs ..................................................................................................................................... 915 833 

Total ................................................................................................................................... 154,016 177,134 

PROGRAM DIRECTION

Question. Provide appropriations and full time equivalent staffing for each of fiscal years 2003 through 2005 enacted, fiscal 2006 comparable, and fiscal 2007 budget 

request, for each of the following components of the Program Direction and Support 

activity within the Departmental Management account: Office of the Secretary; Office of the Deputy Secretary; Office of Public Affairs; Office of the Assistant Secretary for Policy; Office of Congressional and Intergovernmental Affairs; Office of 

Small Business Programs; Office of Public Liaison; Office of the 21st Century Workforce; and the Center for Faith-Based and Community Initiatives. 

Answer. The information for Program Direction follows: 
283 

PROGRAM DIRECTION AND SUPPORT 

[Amount in thousands] 

PDS components 

Fiscal year 2003 

enacted 

Fiscal year 2004 

enacted 

Fiscal year 2005 

enacted 

Fiscal year 2006 1

comparable 

Fiscal year 2007 

request 

AMT FTE AMT FTE AMT FTE AMT FTE AMT FTE 

Office of the Secretary ................................................................................................. $3,669 17 $3,015 12 $4,639 21 $4,859 17 $5,068 20 Office of the Deputy Secretary ..................................................................................... 1,173 8 1,270 8 1,260 9 1,234 8 1,293 9 Office of Small Business Programs ............................................................................. 1,021 9 1,097 9 1,289 8 1,344 7 1,659 8 Office of Public Liaison ................................................................................................ 840 8 895 7 949 6 1,004 6 1,072 6 Office of Congressional and Intergovernmental Affairs .............................................. 4,232 32 4,456 32 4,420 27 4,651 24 5,258 27 Office of Public Affairs ................................................................................................. 4,003 26 5,861 35 3,612 28 3,772 26 4,812 28 Office of the Assistant Secretary for Policy 2 ............................................................... 10,423 53 8,975 46 8,903 40 7,222 35 8,741 40 Office of the 21st Century Workforce ........................................................................... 1,019 8 1,049 8 1,041 6 1,040 6 1,092 6 Center for Faith-Based & Community Initiatives ........................................................ ................ ................ 593 5 605 6 633 6 800 6 

1 $28.5 million was appropriated in ETA Program Administration for Job Corps program salaries and expenses. These funds have been allotted to the Office of the Secretary to be used for the Job Corps program in accordance with Section 

102 of Public Law 109–149. 

2 Includes ASP drug-free workplace funds. 
284 

BUILT-IN AND PROGRAM CHANGES

Question. Provide a table for each discretionary appropriation account, identifying 

by line-item, the built-in changes from the fiscal year 2006 adjusted level, and each 

program increase, to arrive at the fiscal year 2007 budget request level. 

Answer. The attached table reflects built-in increases and decreases, program increases and decreases, and finance changes, affecting each discretionary appropriation account from the fiscal year 2006 adjusted level to the fiscal year 2007 budget 

request level. 
285 

DEPARTMENT OF LABOR 

[In thousands of dollars] 

Discretionary Appropriation Account 

Fiscal year 

2006 adjusted 

level 

Built-In Program 

Transfer Finance changes 

Fiscal year 

2007 budget 

request current Law Increases Decreases Increases Decreases 

EMPLOYMENT & TRAINING ADMIN: 

TRAINING AND EMPLOYMENT SERVICES: 

Adult Employment and Training Activities ........................................................................... 857,079 ................ .................... ................ ¥145,079 ................ ................ 712,000 Dislocated Worker Employment and Training Activities ....................................................... 1,337,553 ................ .................... ................ ¥222,971 ................ ................ 1,114,582 Youth Activities ..................................................................................................................... 940,500 ................ .................... ................ ¥100,000 ................ ................ 840,500 

Job Corps: 

Operations ............................................................................................................................. 1,450,400 1,282 .................... ................ ¥50,080 ................ ................ 1,401,602 Construction and Renovation ............................................................................................... 106,920 ................ .................... ................ ¥6,920 ................ ................ 100,000 

Subtotal—Job Corps ........................................................................................................ 1,557,320 1,282 .................... ................ ¥57,000 ................ ................ 1,501,602 

Responsible Reintegration for Young Offenders ........................................................................... 49,104 ................ .................... ................ ¥49,104 ................ ................ ....................Prisoner Re-entry ........................................................................................................................... 19,642 ................ .................... ................ .................... ................ ................ 19,642 Native Americans ........................................................................................................................... 53,696 ................ .................... ................ ¥2,238 ................ ................ 51,458 Migrants and Seasonal Farmworkers ............................................................................................ 79,252 ................ .................... ................ ¥79,252 ................ ................ ....................National Programs: 

Pilots, Demonstrations and Research .................................................................................. 29,700 ................ .................... ................ ¥12,000 ................ ................ 17,700 Evaluation ............................................................................................................................. 7,857 ................ .................... ................ ¥2,936 ................ ................ 4,921 Denali Commission ............................................................................................................... 6,875 ................ .................... ................ ¥6,875 ................ ................ ....................Other ..................................................................................................................................... 1,980 ................ .................... ................ ¥1,980 ................ ................ ....................Community College Initiative ................................................................................................ .................... ................ .................... 150,000 .................... ................ ................ 150,000 

Subtotal—National Programs .......................................................................................... 46,412 ................ .................... 150,000 ¥23,791 ................ ................ 172,621 

Job Corps Construction Balances Cancellation ............................................................................. .................... ................ .................... ................ ¥75,000 ................ ................ ¥75,000 

Total—Training and Employment Services .............................................................................. 4,940,558 1,282 .................... 150,000 ¥754,435 ................ ................ 4,337,405 

COMMUNITY SERVICE EMPLOYMENT .............................................................................................. 432,311 ................ .................... ................ .................... ................ ................ 432,311 
286 

DEPARTMENT OF LABOR—Continued 

[In thousands of dollars] 

Discretionary Appropriation Account 

Fiscal year 

2006 adjusted 

level 

Built-In Program 

Transfer Finance changes 

Fiscal year 

2007 budget 

request current Law Increases Decreases Increases Decreases 

STATE UI & ES OPERATIONS: 

Unemployment Compensation (Trust Funds): State Operations ................................................................................................................... 2,497,770 101,905 .................... 40,000 .................... ................ ................ 2,639,675 

AWIU ............................................................................................................................. 41,580 ................ ¥41,580 ................ .................... ................ ................ ....................National Activities ........................................................................................................ 9,900 ................ .................... 600 .................... ................ ................ 10,500 

Subtotal—Unemp Comp. ........................................................................................ 2,549,250 101,905 ¥41,580 40,600 .................... ................ ................ 2,650,175 

Employment Service: 

Grants to States: 

Federal funds ...................................................................................................... 22,883 ................ .................... ................ ¥867 ................ ................ 22,016 Trust funds ......................................................................................................... 693,000 ................ .................... ................ ¥26,247 ................ ................ 666,753 

National Activities (Trust Funds) ................................................................................. 33,428 ................ .................... ................ ¥510 ................ ................ 32,918 

Subtotal—Employment Service ............................................................................... 749,311 ................ .................... ................ ¥27,624 ................ ................ 721,687 

One Stop Career Centers /ALMIS ................................................................................. 81,662 ................ .................... ................ ¥17,807 ................ ................ 63,855 Work Incentives Grants ................................................................................................ 19,514 ................ .................... ................ ¥19,514 ................ ................ ....................

Total—State UI & ES Operations ........................................................................... 3,399,737 101,905 ¥41,580 40,600 ¥64,945 ................ ................ 3,435,717 

Program Administration: 

Adult Services ....................................................................................................................... 43,360 1,716 .................... ................ .................... ................ ¥288 44,788 

Trust Funds .................................................................................................................. 7,846 ................ .................... ................ .................... ................ 288 8,134 

Youth Services ...................................................................................................................... 38,565 1,410 .................... ................ .................... ................ ................ 39,975 Workforce Security ................................................................................................................. 6,225 2,616 .................... ................ .................... ................ ¥2,415 6,426 

Trust Funds .................................................................................................................. 72,113 ................ .................... 6,000 .................... ................ 4,688 82,801 

Apprenticeship Training, Employer and Labor Services ....................................................... 21,538 800 .................... ................ .................... ................ ¥923 21,415 Executive Direction ................................................................................................................ 6,956 320 .................... ................ .................... ................ ¥1,120 6,156 

Trust Funds .................................................................................................................. 2,090 ................ .................... ................ .................... ................ ¥231 1,859 
287 

Total—Program Administration .............................................................................. 198,693 6,862 .................... 6,000 .................... ................ ¥1 211,554 Total—ETA .............................................................................................................. 8,971,299 110,049 ¥41,580 196,600 ¥819,380 ................ ¥1 8,416,987 

EMPLOYEE BENEFITS SECURITY ADMINISTRATION: 

Enforcement & Participant Assisstance ........................................................................................ 111,604 3,794 ¥98 5,000 .................... ................ ................ 120,300 Policy & Compliance Assistance ................................................................................................... 17,358 642 .................... ................ .................... ................ ................ 18,000 Executive Leadership, Program Oversight & Administration ........................................................ 5,044 229 .................... ................ .................... ................ ................ 5,273 

Total—EBSA .............................................................................................................................. 134,006 4,665 ¥98 5,000 .................... ................ ................ 143,573 

EMPLOYMENT STANDARDS ADMIN.: 

Enforcement of Wage & Hour Standards ...................................................................................... 166,408 5,170 .................... 6,000 .................... ................ ................ 177,578 Office of Labor Management Standards ....................................................................................... 45,912 1,974 .................... 4,520 .................... ................ ................ 52,406 Federal Contractor EEO Standards ................................................................................................ 81,645 3,012 .................... ................ ¥1,000 ................ ................ 83,657 Federal Programs for Workers’ Comp. ........................................................................................... 99,593 4,581 .................... ................ .................... ................ ................ 104,174 Trust Funds .................................................................................................................................... 2,034 42 .................... ................ .................... ................ ................ 2,076 Program Direction & Support ........................................................................................................ 17,253 550 400 ¥677 .................... ................ ................ 17,526 

Total—ESA ................................................................................................................................ 412,845 15,329 .................... 10,920 ¥1,677 ................ ................ 437,417 

OCCUPATIONAL SAFETY & HEALTH: 

Safety & Health Standards ............................................................................................................ 16,462 430 .................... ................ .................... ................ ................ 16,892 Federal Enforcement ...................................................................................................................... 173,430 6,503 .................... ................ .................... ................ ................ 179,933 State Programs .............................................................................................................................. 91,093 ................ .................... ................ .................... ................ ................ 91,093 Technical Support .......................................................................................................................... 21,435 957 .................... ................ .................... ................ ................ 22,392 Compliance Assistance: 

Compliance Assistance—Federal ......................................................................................... 72,545 1,396 .................... 2,616 .................... ................ ................ 76,557 Compliance Assistance—State ............................................................................................ 53,357 ................ .................... ................ .................... ................ ................ 53,357 Training grants ..................................................................................................................... 10,116 ................ .................... ................ ¥10,116 ................ ................ ....................

Subtotal—Compliance Assistance ................................................................................... 136,018 1,396 .................... 2,616 ¥10,116 ................ ................ 129,914 

Safety and Health Statistics ......................................................................................................... 24,253 521 .................... 7,500 .................... ................ ................ 32,274 Executive Direction ......................................................................................................................... 10,591 578 .................... ................ .................... ................ ................ 11,169 

Total—OSHA .............................................................................................................................. 473,282 10,385 .................... 10,116 ¥10,116 ................ ................ 483,667 

MINE SAFETY & HEALTH ADMIN: 

Coal ................................................................................................................................................ 117,463 2,932 .................... ................ .................... ................ ................ 120,395 
288 

DEPARTMENT OF LABOR—Continued 

[In thousands of dollars] 

Discretionary Appropriation Account 

Fiscal year 

2006 adjusted 

level 

Built-In Program 

Transfer Finance changes 

Fiscal year 

2007 budget 

request current Law Increases Decreases Increases Decreases 

Metal/Nonmetal .............................................................................................................................. 68,227 1,879 .................... ................ .................... ................ ................ 70,106 Standards Development ................................................................................................................. 2,485 173 .................... ................ .................... ................ ................ 2,658 Assessments .................................................................................................................................. 5,405 161 .................... ................ .................... ................ ................ 5,566 Educational Policy and Development ............................................................................................ 31,749 1,177 .................... ................ .................... ................ ................ 32,926 Technical Support .......................................................................................................................... 25,609 804 .................... 1,000 .................... ................ ................ 27,413 Program Eval & Info Resources .................................................................................................... 15,532 203 .................... ................ .................... ................ 1 5,735 Program Administration ................................................................................................................. 11,938 1,099 .................... ................ .................... ................ ................ 13,037 

Total—MSHA ............................................................................................................................. 278,408 8,428 .................... 1,000 .................... ................ ................ 287,836 

BUREAU OF LABOR STATISTICS: 

Employment & Unemployment Statistics ...................................................................................... 165,683 5,373 .................... ................ .................... ................ ................ 171,056 Labor Market Information (Trust Funds) ....................................................................................... 77,066 1,960 .................... ................ .................... ................ ................ 7,026 Prices and Cost of Living .............................................................................................................. 173,515 5,566 .................... 8,000 .................... ................ ................ 187,081 Compensation and Working Conditions ......................................................................................... 81,052 2,808 .................... ................ .................... ................ ................ 83,860 Productivity and Technology .......................................................................................................... 10,777 341 .................... ................ .................... ................ ................ 11,118 Executive Direction & Staff Services ............................................................................................. 30,235 912 .................... ................ .................... ................ ................ 31,147 

Total—BLS ................................................................................................................................ 538,328 16,960 .................... 8,000 .................... ................ ................ 563,288 

DEPARTMENTAL MANAGEMENT: 

Program Direction and Support ..................................................................................................... 25,759 1,320 ¥152 2,868 .................... ................ ................ 29,795 Departmental IT Cross Cut ............................................................................................................ 29,462 ................ .................... ................ ¥57 ................ ................ 29,405 Departmental Management Cross Cut .......................................................................................... 1,683 ................ .................... ................ ¥575 ................ ................ 1,108 Legal Services ................................................................................................................................ 80,416 3,246 .................... 1,204 .................... ................ ................ 84,866 Trust Funds .................................................................................................................................... 308 14 .................... ................ .................... ................ ................ 322 International Labor Affairs ............................................................................................................ 72,567 651 ¥26 ................ ¥60,829 ................ ................ 12,363 Administration & Management ...................................................................................................... 30,613 1,237 ¥4 ................ ¥100 ................ ................ 31,746 FPB Security Enhancements .......................................................................................................... 1,875 18 .................... ................ .................... ................ ................ 1,893 Adjudication ................................................................................................................................... 27,243 1,700 ¥12 ................ .................... ................ ................ 28,931 Women’s Bureau ............................................................................................................................ 9,763 456 ¥71 ................ ¥800 ................ ................ 9,348 Civil Rights Activities .................................................................................................................... 6,451 284 .................... ................ .................... ................ ................ 6,735 
289 

Chief Financial Officer ................................................................................................................... 5,340 239 .................... ................ .................... ................ ................ 5,579 

Total—DM S&E ......................................................................................................................... 291,480 9,165 ¥265 4,072 ¥62,361 ................ ................ 242,091 

OFFICE OF DISABILITY EMPLOYMENT POLICY ......................................................................................... 27,695 558 .................... ¥7,934 .................... ................ ................ 20,319 VETERANS EMPLOYMENT AND TRAINING: 

State Administration Grants .......................................................................................................... 160,791 427 .................... ................ .................... ................ ................ 161,218 Federal Administration ................................................................................................................... 30,211 2,206 .................... ................ .................... ................ ................ 32,417 Nat’l Veterans Training Institute (NVTI) ........................................................................................ 1,964 5 .................... ................ .................... ................ ................ 1,969 Homeless Veterans Program .......................................................................................................... 21,780 58 .................... ................ .................... ................ ................ 21,838 Veterans Workforce Investment Program ....................................................................................... 7,425 20 .................... ................ .................... ................ ................ 7,445 

Total—VETS .............................................................................................................................. 222,171 2,716 .................... ................ .................... ................ ................ 224,887 

OFFICE OF INSPECTOR GENERAL: 

Program Activities .......................................................................................................................... 65,744 2,329 .................... ................ .................... ................ ................ 68,073 Trust Funds .................................................................................................................................... 5,552 136 .................... ................ .................... ................ ................ 5,688 

Total—OIG ................................................................................................................................. 71,296 2,465 .................... ................ .................... ................ ................ 73,761 

Working Capital Fund ............................................................................................................................. 6,168 16 .................... 13,954 ¥6,184 ................ ................ 13,954 

Total—DM ................................................................................................................................. 618,810 14,920 ¥265 10,092 ¥68,545 ................ ................ 575,012 Total—Department of Labor ..................................................................................................... 11,426,978 180,736 ¥41,943 241,728 ¥899,718 ................ ¥1 10,907,780 
290 

WOMEN IN APPRENTICESHIP

Question. The conference agreement on the fiscal year 2006 Labor Department ap- propriations legislation specified $982,000 for carrying out Public Law 102–530, the 

Women in Apprenticeship and Non-Traditional Occupations Act. 

What action is being taken to issue grants to community based organizations to 

encourage employment of women in apprenticeable occupations and nontraditional 

occupations? 

Answer. The Employment and Training Administration and the Women’s Bureau 

have worked collaboratively to develop a Solicitation for Grant Applications (SGA). 

The SGA is currently going through Departmental clearance and we expect a notice 

announcing the SGA to be published in the Federal Register in August 2006. 

APPALACHIAN COUNCIL/WORKING FOR AMERICA INSTITUTE

Question. This subcommittee held a hearing on July 22, 2004, on the funding of 

the Appalachian Council and Working for America Institute. Despite that hearing, 

the Labor Department did not renew the contracts for these organizations, forcing 

Congress to earmark $2.2 million and $1.5 million, respectively, for their continued 

operation. I understand that funding has now run out, and I urge you to renew the 

contracts. Will you take another look at the organizations, and see what can be done 

to provide renewed funding? Answer. On February 1, 2005, the Department of Labor executed a $1,500,000 

grant to the Working for America Institute (WAI). This grant will remain active 

until February 3, 2007. The Department of Labor continues to work closely with 

WAI to support the deliverables of their grant, including developing resources to 

support a well-skilled advanced manufacturing workforce. 

Job Corps funded the Appalachian Council for $2.2 million in February, 2005 and 

then renewed the funding in the amount of $2.2 million in April, 2006. That funding 

is through March 31, 2007. An evaluation will be done to determine if additional 

funding will be provided based upon performance and funding availability. 

JOB TRAINING STAFF

Question. Your budget request for federal administration of Employment and 

Training Administration programs provided for 1,158 direct full-time equivalent 

staff, compared to the current level of 1,194 staff. 

Why are you requesting only a reduction of 14 federal staff when you are proposing to consolidate several job training programs into a single block grant to 

states? 

Answer. The Employment and Training Administration (ETA) fiscal year 2006 

FTE level supported by appropriated funds is 1,180 (with an additional 16 FTE supported by fees and reimbursements). The ETA fiscal year 2007 Legislative Proposal 

FTE level (excluding FTE supported by fees and reimbursements) is 1,158. Compared with fiscal year 2006 staffing, ETA’s fiscal year 2007 Legislative Proposal represents a net reduction of 22 FTE—an addition of 7 FTE within Youth Services to 

support the proposed transfer of Youthbuild from the Department of Housing and 

Urban Development to ETA, and a reduction of 29 FTE in Workforce Security in 

anticipation of the enactment of a Foreign Labor Certification Permanent Program 

fee. 

ETA does not anticipate that the implementation of the Career Advancement Accounts (CAA) will have an immediate impact on ETA staffing levels. Assuming the 

passage of authorizing legislation in fiscal year 2007, a significant amount of effort 

by ETA staff will be required to transition from the current Workforce Investment 

Act (WIA) structure to a new CAA structure. Moreover, during the transition and 

until it is complete, the same or a similar level of effort that is currently provided 

will be necessary to continue national and regional Federal oversight required to administer WIA. The time necessary to implement the transition to a new CAA structure will also provide ample time for an orderly transition to an FTE level appropriate for the level of Federal oversight required to administer CAAs. 

SAFE PLACES IN MINES

Question. The Commonwealth of Pennsylvania has begun an analysis of locating 

safe places in the mines for workers to seek refuge in case escape routes are 

blocked. These safe places could be permanent or portable. Do you intend to conduct 

a similar analysis nationwide? 

Answer. Section 13 of the MINER Act requires NIOSH to study various refuge 

alternatives in an underground coal mine environment and issue a report not later 

than 18 months after enactment of the Act. Not later than 180 days after the receipt 
291 

of this report, the Secretary of Labor is required to provide a response to the two 

authorizing committees describing what actions, if any, the Secretary intends to 

take based on the report. The Department will comply with this statutory requirement. 

COMPETITIVENESS AGENDA

Question. You propose cutting $653 million from workforce investment programs and another $27 million from the Employment Service, despite the fact that funding 

for workforce programs is $1 billion below the funding level than when the President took over and there are one million more unemployed workers than there were 

in 2001. Isn’t that approach inconsistent with a competitiveness agenda that is supposedly going to help America, and its workers, compete in the global economy? 

Answer. Although the President’s fiscal year 2007 Budget request for the Employment and Training Administration is below the fiscal year 2006 appropriation, it is 

a responsible budget that reflects the competitive demands for very limited resources for domestic programs and the need to eliminate waste and redundancy. 

The proposed reforms align with the competitiveness agenda by reforming the workforce investment system so that many more workers are trained, equipping them 

with the skills necessary to succeed in the 21st Century. 

The public workforce investment system could be structured to better meet the 

training challenges presented by the increased need for skills and competencies by 

workers. There exists a lack of integration, which causes too much money to be 

spent on competing bureaucracies, overhead costs, and unnecessary infrastructure, 

and not enough on meaningful skills training that leads to job growth and economic 

prosperity. 

Career Advancement Accounts, relative to the existing workforce investment system, will be more effective and flexible in meeting the demands of the global economy and in addressing the nation’s workforce challenges. Career Advancement Accounts would mean a streamlined workforce investment system that gets more 

training dollars in the hands of workers and reduces costs by eliminating duplication across employment and training programs and lowering overhead costs. The 

greater efficiency from this redesign of the system will result in cost savings that 

account for much of the reduction in ETA’s budget. More than triple the number 

of workers currently being trained would be trained under this proposal. 

VOUCHER PROPOSAL

Question. You have proposed a new WIA reauthorization proposal calling for Career Advancement Accounts, i.e. vouchers, to be run through a consolidated workforce system overseen by the Governor, allowing him or her to choose to eliminate 

the local workforce system and the One Stop network. This is the third different 

reauthorization proposal you have made to the Congress, your previously two attempts to create a block grant for the Governor have been resoundingly rejected in 

both the House and Senate, which have consistently protected the local workforce 

delivery system as essential to helping our workers receiving training for jobs in the 

local economy. Knowing that this approach has been rejected twice before, isn’t your 

budget proposal jut a smokescreen to provide a rationale for deep budget cuts to the 

workforce system? 

Answer. No. Under the Administration’s proposal for Career Advancement Accounts, states can maintain One-Stop Career Centers to provide employment services to job seekers and employers, as well as access to Career Advancement Accounts, at these sites. Career Advancement Accounts are a more efficient and effective way to deliver job training that will result in more workers getting the skills 

they need with less overhead costs. We believe that with the constraints on discretionary spending and the promise of more than tripling the number of workers 

trained with this innovative new approach, Congress will take this proposal seriously. This proposal is consistent with the ‘‘innovation’’ agenda that has bi-partisan 

support in Congress. 

Workforce Investment Act (WIA) reauthorization has been pending in Congress 

for three years. No proposals have been either formally accepted or rejected. H.R. 

27, which was passed by the House on March 2, 2005, does consolidate the WIA 

Adult, WIA Dislocated Worker, and Employment Service funding streams, indicating interest on the part of Congress in streamlining programs as the Administration proposed. 

RATIONAL FOR WORKFORCE TRAINING

Question. You claim that only 200,000 are trained annually by the workforce system; however your data provides the smallest data pool possible to make your claim, 
292 

as it only measures participants leaving training during a fiscal year. GAO estimates that over double this number, 416,000 receive training annually. Your own 

data provided in the Budget Justifications shows that over 15 million participants 

receive an array of training, intensive, or basic employment assistance annually 

through the workforce system. Isn’t your budget request another example of using 

selective data to block grant and cut program funding? 

Answer. The important point is that 200,000 people complete and exit training per year with a $4 billion investment, meaning that too much money is being spent 

on low-cost services with little value to the customer. ETA uses actual data collected 

from the states in referencing number of people trained. The GAO study indicates 

that 40 percent of funds are used for training adults and dislocated workers, whereas ETA estimates this figure at 26 percent. This discrepancy occurs due to two primary differences in the measurements: (1) ETA is measuring exiters, or those that 

have actually completed training, while GAO is measuring training costs of all participants receiving training (meaning that people are ‘‘double counted’’ because their 

training may have occurred over two program years); and (2) ETA includes expenditures, while GAO includes both expenditures and obligations—obligations which 

may not result in someone actually being trained. The estimates by ETA and GAO 

are different because they look at distinctly different sets of cost estimates and individuals included in the count. 

The question also refers to the number of individuals served by the workforce investment system. The large majority of these participants are receiving only basic 

employment services, including self-services. The Career Advancement Accounts 

proposal would increase the number of individuals trained through the workforce investment system, while still providing basic employment services to job seekers. 

ELIMINATION OF MIGRANT PROGRAMS

Question. For the third year in a row, you have proposed eliminating the Migrant 

and Seasonal Farmworker program authorized under WIA. You first proposed to 

work with states and local areas to ensure that migrant and seasonal farmworkers 

could access services through One-Stop Career Centers; despite the fact that your 

Department’s data show that the program met its performance goals. Now you propose to give governors the flexibility to design how individuals will access information and Career Advancement Accounts or vouchers. How does the Administration 

propose to ensure that these individuals—some of America’s neediest adults and 

their families—will be able to successfully navigate among service delivery systems 

that will differ from state to state and secure the job training and employment services that they need? 

Answer. The Administration’s fiscal year 2007 Budget proposal seeks to tap the 

workforce investment system’s potential to serve more migrant and seasonal farmworkers by providing job training services to them through the One-Stop Career 

Center system, and turning to other, appropriate agencies to provide supportive 

services, housing, and other related assistance. Currently, the section 167 program 

provides employment and training services to only 10,000 of an estimated 2 million 

farmworkers, which demonstrates the need for a wider system approach. 

The Administration believes that providing services to farmworkers through the 

One-Stop system will increase the number served and have a positive employment 

and earnings impact on those who receive services. 

The Administration’s fiscal year 2007 budget proposal seeks to take advantage of 

the One-Stop system’s potential to better serve more migrant and seasonal farmworkers by helping them access the full array of employment and training services 

available from the seventeen federal programs delivered through the One-Stop system. While the proposal is to increase the amount of funding spent on training utilizing Career Advancement Accounts as the vehicle, the proposal also includes continued funding for core service delivery, including career guidance and job referrals, 

to any job seeker. Career Advancement Accounts can be used for a combination of 

remedial training leading to a diploma or GED in addition to post secondary education. We believe this combination of career guidance and training in the context 

of the One-Stop delivery system that connects workers to a wide array of services, 

including supportive services, can result in increased services to farmworkers and 

more positive employment and earnings impact on those farmworkers who receive 

services. 

EMPLOYMENT SERVICE CUTS

Question. You propose to cut the Employment Service by about $27 million in fiscal year 2007 over and above a $96 million reduction in fiscal year 2006. You would 

give states the flexibility to determine how to provide basic employment services to 
293 

1Osterman, Paul. ‘‘Employment and Training Policies: New Directions for Less Skilled 

Adults.’’ Paper prepared for the Urban Institute. October 2005. p.16. 

America’s workers and at the same time, absorb other costs that you propose to divest from the federal level—in labor market information products and services and 

dedicated professionals to help the disabled obtain employment. Past shortfalls in 

federal support have forced states to close local offices. With these deep cuts, states 

will be forced to shut down many more One Stop Career Centers that help match 

job seekers and employers seeking workers. How do you expect governors to be able 

to help an expected 14 million workers who need jobs and the thousands of employers looking for workers? 

Answer. The Department proposes to consolidate the Workforce Investment Act 

(WIA) programs for adults, dislocated workers, and youth, and the Wagner-Peyser 

funding stream into a single flexible grant that enables governors to utilize these 

resources strategically to both drive their economies and provide maximum training 

and employment opportunities for their citizens. 

The public workforce investment system, as currently constituted, is ill-equipped 

to meet the workforce challenges presented by the increased need for advanced 

skills and competencies in the 21st century economy. As one researcher has noted, 

‘‘As it now stands, employment services (and by extension the One-Stop system) is 

very far from being an effective labor exchange capable of assisting people surmount 

the challenges of today’s job market.1 This is due, in part, to the lack of integration, 

which causes too much money to be spent on competing bureaucracies, overhead 

costs, and unnecessary infrastructure, and not enough on meaningful skills training 

that leads to job growth and economic prosperity. For example, while the Employment Service is intended to be the cornerstone of the One-Stop system under WIA, 

many states continue to have a separate network of Employment Service offices that 

offer the same ‘‘core services’’ that are available under WIA through One-Stop Career Centers. 

Furthermore, large amounts of state unexpended carryover funds still remain. In 

fiscal year 2004, unexpended funds from the WIA Adult, Dislocated Worker, and 

Youth programs totaled almost $1.2 billion and a similar amount is projected for 

fiscal year 2005, which ends on June 30, 2006. Therefore, it is the Administration’s 

position that through more efficient administration, integration of existing funding, 

and the effective use of currently available resources, states will not face the need 

to reduce services to the citizens generally or to populations with barriers to employment. 

NATIONAL RESERVE FUND

Question. Your proposal indicates that the Department would retain at the national level a portion of funds for a National Reserve Fund for unexpected emergencies before allocating funds for Career Advancement Accounts. What is the Department’s estimate for this fund? And how would we distinguish the uses of these 

funds from the pilot, demonstration, and research account? 

Answer. Under the Career Advancement Account (CAA) proposal, the Department 

proposes to set aside funds for a National Reserve in a manner similar to the current Dislocated Worker National Reserve structure. The Department would reserve 

7.5 percent of the appropriation provided by Congress for Career Advancement Accounts for the National Reserve. The Secretary would have the discretion to use this 

funding to quickly address unanticipated events, such as natural disasters, mass 

layoffs and plant closings, and the impacts of foreign trade. The National Reserve 

would also be used to provide technical assistance and for demonstration activities. 

The proposed use of Career Advancement Account National Reserve funds for 

demonstrations in addition to those carried out under pilots, demonstration and research budget authority is no different than the current structure. Under WIA section 171(d), up to ten percent of the National Reserve is used for dislocated worker 

projects. These demonstrations are in addition to the pilots, demonstrations and research authorized under WIA section 171(b). As it does now, the Department will 

maintain rigorous financial controls that track fund sources for all programs and activities. 

RAPID RESPONSE SERVICES

Question. Your consolidation proposal eliminates state resources set aside specifically for states to respond rapidly with information and services to workers who 

have received word of pending layoffs. You would require states to apply for funds 

from the National Reserve Account to provide such services. What justification do 

you provide states about requiring them to go through extra steps to provide rapid 
294 

response services and gaining their confidence that the Department can respond to 

such requests in a timely manner? 

Answer. The Department does not contemplate that a state would have to apply 

for funds each time there is a mass layoff or to only sporadically fund a state rapid 

response coordinator. Early intervention to provide information and assistance to 

workers to decrease the amount of time between actual layoff and re-employment 

is a key principle of the dislocated worker program. Rapid response is a key element 

of this early intervention strategy. 

States could demonstrate need and apply for rapid response funds at the beginning of the program year or throughout the program year. We will not propose that 

a state be required to submit an application for funding each time a dislocation 

event occurs. 

In spite of all the good work that has been done over the past fifteen years with 

dislocated worker rapid response funds, the Department has found that most company executives do not know about the type and quality of assistance available to 

them and their employees when closures or layoffs are contemplated. They have also 

reported that where they have layoffs in several states simultaneously, the levels 

and quality of assistance varies dramatically. ETA, in collaboration with state and 

local partners, has undertaken several initiatives in the auto, textile and defense 

industries recently to try to integrate services and develop more consistency. We believe a nationally-coordinated approach to delivering rapid response assistance by 

states can help bring the services to more workers and employers. 

The proposed mechanism will assist both the Department and the states to better 

manage scarce taxpayer resources by directing the bulk of the funds to the areas 

of need. For example, not all states experience major layoffs every year. Analyses 

of dislocated worker program expenditures reported by states have shown that the 

funds reserved for rapid response are consistently under-expended. In the aggregate, 

the rapid response carry-in funds from program year 2003 to 2004, and from 2004 

to 2005, was $136.7 million and $166 million, respectively. Through March 31, 2006, 

states reported accrued expenditures of just over $176 million of a total available 

of more than $342.5 million, or 51.4 percent of the total funds available. States are 

not required to retain the up to 25 percent authorized to be reserved for rapid response activities. They may include a portion of the funds in the amount allocated 

to local workforce investment boards for core, intensive and training services for dislocated workers, or they may award additional funds from the reserved amount to 

local areas that experience disasters, mass layoffs, plant closings or other events 

that precipitate substantial increases (defined by the state) in the number of unemployed workers. 

ADULT TRAINING FUNDS

Question. We need to upgrade the skills of our current workforce, including the 

low skilled on a broad base to increase economic growth and incomes. Recent data 

released from the National Assessment of Adult Literacy indicates that 14 percent 

of American adults had less than basic literacy skills—meaning they had a hard 

time locating easily identifiable information on commonplace material or following 

written instructions in simple documents. Your proposal would reduce adult training funds and turn the funds that are left into Career Advancement Accounts. It 

appears that low skilled adults who would compete with other workers for these 

vouchers may require combinations of assessment, career planning and developmental education services prior to being able to benefit from technical training. How 

will these individuals really fare under a system of capped vouchers and high pressure sales from many training providers? 

Answer. We agree there is a need to upgrade the skills of our current workforce, 

including those with low skills and literacy. State and local workforce systems set 

service priorities, and this will continue to be the case under the CAA proposal. 

These priorities will differ across the country, since demographics, labor markets 

and regional economies differ. By combining funding streams, our proposal will 

allow a more flexible response to these differences. Our proposal will triple the number of workers who currently are being trained by the workforce investment system. 

Assessment, career planning and developmental education services will continue 

to be accessed through One-Stop Career Centers, provided either through Workforce 

Investment Act funding or One-Stop partner programs. States will be responsible 

for determining eligible training providers within the state, as well as determining 

policies that govern those providers, such as policies to prevent false advertising and 

other abuses. 
295 

ECONOMIC GROWTH EFFORTS

Question. Your consolidation proposal, combined with sizable cuts and program 

eliminations, ironically puts states in the position of not being able to jump start 

or continue to nurture regional economic growth planning and collaboration activities that integrates economic development, workforce development and education 

systems. These activities are similar to those you are promoting through your new 

WIRED initiative. What do you say to states that want to move forward with such 

integrated economic growth efforts if they don’t qualify for funds under federal 

rules? 

Answer. The proposals for consolidation of workforce programs are intended to 

provide maximum flexibility for states and regional economies to implement the 

type of workforce investment services that are needed in that specific region. We 

believe that our traditional thinking about how individual programs are funded is 

contributing to the persistent problem of siloed program services, with excessive 

funds being spent on overhead and bureaucracy, rather than addressing the workforce needs of a regional economy. If regional economic needs are to be effectively 

and comprehensively addressed, it will take many sources of funding, including 

funding from economic development agencies and educational institutions, and coordination across these funding streams. Therefore, the approach of making Federal 

funding for workforce services more flexible will contribute to integrated economic 

development efforts and the maximum leveraging of resources. Finally, the transformation of a regional economy is not dependent on Federal demonstration funding. 

What drives transformation is the collaborative leadership and strategic planning 

of economic development, research and development, capitalization, entrepreneurship and workforce development visionaries. 

ELIMINATION OF YOUTH TRAINING GRANTS

Question. Your proposal to redesign the workforce delivery system eliminates WIA 

training grants for disadvantaged youth that are aimed at improving their education, employment, and earnings prospects. It is difficult to reconcile your proposed 

request when the President and you as well have focused on the need to raise the 

skills of young people in order to maintain our competitive edge in this new global 

economy. And from research—much funded by your Department, we know that an 

array of services is necessary to help disadvantaged youth complete their education, 

mature into solid citizens, and make the successful transition to work. By making 

these young people compete with adults for Career Advancement Accounts, aren’t 

you really limiting their changes for future success? 

Answer. We agree that there should be an emphasis on raising the skills of young 

people in order to maintain our competitive edge in the global economy. Career Advancement Accounts will be available to out-of-school youth. Furthermore, states 

and localities will still be able to provide career counseling and other services to 

these out-of-school youth, and workforce information will be available to assist them 

in choosing careers in high growth industries and in determining appropriate training for those careers. 

Targeted programs and set-asides have led to multiple program silos, excessive 

overhead and bureaucracy, lack of coordination and integration, and only a modest 

number of people trained for the size of the workforce system investment. States 

and local areas will still be able to serve targeted groups, such as out-of-school 

youth, but will have more flexibility in using resources and not be subject to the 

often conflicting requirements of multiple programs or funding streams. Furthermore, consolidating funding streams will enable states and localities to better focus 

on the needs of their distinct populations, since labor force demographics and labor 

markets vary considerably across the country. The substantial number of requests 

for waivers to allow transfer of funds between programs indicates the need for more 

flexibility in this area than the current legislation allows. 

CAREER ADVANCEMENT ACCOUNTS

Question. A recent ETR article on the fiscal year 2007 budget request noted ‘‘ETA 

officials said their legislative analysts believe this program—the consolidated Career 

Accounts proposal—can be implemented under current authorizing statues, but 

would be easier for states to embrace with program consolidation that would occur 

under the WIA reauthorization package put forward by House Republicans, HR 27.’’ 

It’s my understanding that HR 27 has passed the House and is awaiting conference 

with the Senate. Please explain how, if the House already has a bill that is not consistent with your Career Advancement Accounts proposal, how you plan to accomplish this. 
296 

Answer. As you indicate, the House has passed H.R. 27 and the Senate recently 

passed its version of Workforce Investment Act reauthorization legislation. H.R. 27 

would implement many key components of the President’s job training reform proposal, such as merging funding streams. We believe CAAs can be built upon this 

piece of legislation. 

ELIMINATION OF JOB BANK PROGRAM

Question. The elimination of America’s Job Bank is particularly troubling. It is 

the backbone for more than 20 state job banks as well as the electronic version of 

a national employment service. Thousands of job seekers get their work through 

AJB and thousands of employers use it. By your own Department’s last count, over 

138 million job searches were conducted on AJB for the year ending June 3, 2005 

and over 9 million resume searches were conducted by employers during the same 

period. There were about 7.8 million job postings originated on AJB during that 

year, over 700,000 new resumes posted, and 55,000 new employer registrations. All 

of these activity counts are increases over the prior year. How can the United States 

have a modern public employment service without an electronic exchange? 

Answer. The Department of Labor considered numerous factors in coming to the 

decision to phase out America’s Job Bank (AJB), which included looking at the larger environment in which AJB is operating and weighing the costs associated with 

running the system. Since the launch of AJB, the number of private sector Internetbased job banks (Career Builder, Monster, Yahoo! Hot Jobs, etc.) has proliferated, 

calling into question the need for a Federal government-sponsored national job 

bank. These private-sector electronic labor exchange systems are continuously improving and most, if not all, of these sites offer free services to job seekers. Current 

trends in the industry seem to indicate that some level of free service will also be 

offered to businesses/employers in the future and many employers who currently 

use AJB are already using these other job banks simultaneously to advertise their 

openings. 

In addition, it has been increasingly difficult, if not impossible, to keep America’s 

Job Bank updated as technology has advanced. Also, as Internet technology and 

technical resources have become widespread and the costs associated with them 

have declined, state and local areas that previously relied on AJB for their Internet 

self-service labor exchange presence have built and operate job banks of their own 

that are not based on AJB and promote them to their job seeker and business customers rather than AJB. 

AJB is not the backbone for 20 state job banks, nor is there any evidence of widespread job gains as a result of using AJB. In fact, AJB is not used in most OneStop Career Centers across the country. 

PROPOSED WORKFORCE LEGISLATION

Question. The Administration plans to introduce legislation to reform the workforce investment system and create the Career Advancement Accounts (CAAs). If 

this legislation is not passed before fiscal year 2007, what would be the impact on 

services of the proposed 15 percent funding reduction for workforce development 

programs? 

Answer. The President’s Budget request assumes enactment of the Career Advancement Account (CAA) proposal, which would reduce overhead and administrative costs and focus more funding on training, thereby tripling the number of individuals receiving job training through the workforce investment system. In the absence of CAA legislation passed by Congress, the workforce investment system will 

continue to have siloed funding streams that result in duplicative costs. 

While states will be able to continue operating Workforce Investment Act programs and the Employment Service at the lower funding levels proposed by the Administration, these reduced levels, without the accompanying reforms, may result 

in decreases in the number of participants served through these programs, compared to the President’s proposal. 

Question. States could administer the CAAs through ‘‘community career centers’’ 

at community colleges, public libraries, senior centers, and other locations, as well 

as through existing one-stop centers. Could this approach lead to the creation of a 

parallel system of job search and career assessment services, that duplicates what 

is already available through the one-stop centers? Could it lead to confusion among 

potential customers of the system, about where to go to access services? 

Answer. Under our proposal, states can maintain One-Stop Career Centers to provide employment services to job seekers and employers, as well as access to Career 

Advancement Accounts. States and localities would have the option of making em-
297 

ployment services and access to Career Advancement Accounts available at additional sites in the community. 

Question. Will the existing state and local workforce boards have any role in administering the new program, or will they be disbanded? Similarly, will the programs that are currently mandatory partners in the one-stop system have any role 

in administering the CAAs? 

Answer. State and local Workforce Investment Boards will continue to exist and 

retain roles and functions similar to what they have under the current Workforce 

Investment Act. Similarly, the required partners will continue to participate in the 

One-Stop service delivery system, and have a role in setting local policy and providing oversight for the service delivery system. The specific role of the partner programs in administering Career Advancement Accounts (CAA) would be worked out 

under policies set by the state in setting up the CAA system. 

Question. How will the Labor Department calculate the amount of funds each 

state will receive for CAAs? Will there be a formula? 

Answer. There will be a formula for allotting Career Advancement Account funds 

to states, similar to the formulas that have been used to allot funds to states under 

current law. The specific formula proposal has not been finalized, but the final formula would be worked out between the Administration and Congress. 

Question. The CAA proposal assumes that individuals need minimal assessment 

and case management services to make good decisions about whether and how to 

use training funds. However, in implementing reform of the Trade Adjustment Assistance (TAA) program, you have emphasized the need to co-enroll TAA participants in WIA for case management, so that their training needs can be properly 

assessed. What is the basis for your decision to provide training funds with minimal 

case management funds, in the CAA proposal? 

Answer. The Department’s ongoing evaluation of the Individual Training Account 

activity under the Workforce Investment Act shows that when an individual is provided more choice in training and counseling services, the individual is more likely 

to use an ITA for training and to enter training more quickly. Further, the individual’s training selection tends to be similar to training programs selected by similar 

individuals who are required to receive counseling services and approval. 

We believe that up-front assessment (as contrasted with ongoing and costly case 

management) is what workers need, including those served under the TAA program. 

Assessments can be provided under the CAA proposal if needed, with over $700 million set aside for such services to complement training (22 percent of the total consolidated resources per state, roughly equivalent to the current Wagner-Peyser 

amount for core services). The purpose of such assessments is to properly gauge 

marketable skills and assist workers to reenter employment or identify training to 

fill gaps in marketable skills. Our demonstrations show that with this ‘‘informed 

choice’’ more people can receive actual training for jobs in the local labor market. 

Question. The new system would be designed based on lessons from the implementation of the Individual Training Account and Personal Reemployment Account 

(PRA) programs. What lessons specifically have been drawn from the implementation of those programs? What evaluations exist to support giving more control over 

training funds to individuals? 

Answer. CAAs provide individuals with increased customer choice and flexibility 

for selecting training and other services that are appropriate for them and are based 

in part on lessons learned from Individual Training Account (ITA) and Personal Reemployment Account (PRA) demonstrations. 

The ongoing evaluation of the ITA Experiment explored the use of increasing customer choice in the delivery of ITAs. Initial analysis from eight local boards participating in the experiment showed that when an individual was provided more customer choice in training and counseling services, the individual was more likely to 

accept an ITA for training, the individual’s training selection tended to be similar 

to training programs selected by individuals required to receive counseling services 

and approval of programs, and the individual was more likely to enter training 

quickly. The final report, to be completed later this year, will provide a more indepth analysis of the impacts of the three different ITA service approaches. 

The goals of PRAs are to provide individuals who are identified as most likely to 

exhaust Unemployment Compensation with a quicker return to work, direct access 

to training, greater customer choice and control, and better economic outcomes. Initial observations from the PRA Demonstration show that participating states were 

able to implement the PRAs generally as planned, with the first accounts offered 

in March 2005. The evaluation of the PRA Demonstration is underway. An interim 

report, to be completed this year, will provide a more in-depth understanding of the 

implementation process. In the meantime, reports from states on best practices 
298 

show that account mechanisms can be implemented, appropriate oversight can be 

maintained, and individual choice can provide greater access to needed services. 

Question. The CAA proposal includes performance measures that are similar to 

those now used to assess the adult and dislocated worker programs. However, with 

CAA funds going directly to individuals, who would be held accountable for performance outcomes—states or the local community career centers? Does it make sense 

to apply performance measures designed for adults (that focus on employment outcomes) to CAAs that are also used by youth? Currently, youth performance measures also consider educational goals. 

Answer. States will continue to negotiate performance targets and report to the 

Department of Labor on three primary outcome measures: (1) entered employment, 

(2) retention in employment, and (3) earnings. In addition, attainment of a degree 

or certificate, entry into training and education, and literacy and numeracy gains 

would be tracked as intermediate outcomes. 

RAPID RESPONSE FUNDS

Question. Currently, states use rapid response funds to provide immediate service 

to workers affected by a mass layoff, often before the workers are even laid off. 

Under your legislative proposal, states will need to apply to The Employment and 

Training Administration for rapid response funds as events occur. What are the reasons for keeping these funds at the national level, and having states apply for them 

each time they are faced with a mass layoff? What effect will this approach have 

on states’ ability to provide immediate rapid response services for mass layoffs? 

Answer. The Department does not contemplate that a state would have to apply 

for funds each time there is a mass layoff or to only sporadically fund a state rapid 

response coordinator. Early intervention to provide information and assistance to 

workers to decrease the amount of time between actual layoff and re-employment 

is a key principle of the dislocated worker program. Rapid response is a key element 

of this early intervention strategy. 

States could demonstrate need and apply for rapid response funds at the beginning of the program year or through the program year. We will not propose that 

a state be required to submit an application for funding each time a dislocation 

event occurs. 

In spite of all the good work that has been done over the past fifteen years with 

dislocated worker rapid response funds, the Department has found that most company executives do not know about the type and quality of assistance available to 

them and their employees when closures or layoffs are contemplated. They have also 

reported that where they have layoffs in several states simultaneously, the levels 

and quality of assistance varies dramatically. ETA, in collaboration with state and 

local partners, has undertaken several initiatives in the auto, textile and defense 

industries recently to try to integrate services and develop more consistency. We believe a national approach to delivering rapid response assistance by states can help 

bring the services to more workers and employers. 

The proposed mechanism will assist both the Department and the states to better 

manage scarce taxpayer resources by directing the bulk of the funds to the areas 

of need. For example, not all states experience major layoffs every year. Analyses 

of dislocated worker program expenditures reported by states have shown that the 

funds reserved for rapid response are consistently under-expended. In the aggregate, 

the rapid response carry-in funds from program year 2003 to 2004, and from 2004 

to 2005, was $136.7 million and $166 million, respectively. Through March 31, 2006, 

states reported accrued expenditures of just over $176 million of a total available 

of more than $342.5 million, or 51.4 percent of the total funds available. States are 

not required to retain the up to 25 percent authorized to be reserved for rapid response activities. They may include a portion of the funds in the amount allocated 

to local workforce investment boards for core, intensive and training services for dislocated workers, or they may award additional funds from the reserved amount to 

local areas that experience disasters, mass layoffs, plant closings or other events 

that precipitate substantial increases (defined by the state) in the number of unemployed workers. 

FOREIGN LABOR CERTIFICATION

Question. There is an inherent unfairness to having some employers’ applications 

from six years ago pending at the BEC and having new applications adjudicated in 

two months. These inordinate delays have caused and are causing serious prejudice 

to employers and employees alike. With this as background, please address the following issues: 
299 

Answer. The Department published a final regulation implementing a new re-engineered Permanent Labor Certification Program effective March 28, 2005. This regulation created a new faster and more efficient method for employers to have their 

applications processed. The regulation applies to all applications filed after its effective date. However, for applications previously filed up until March 27, 2005, those 

applications must be processed under the previous regulation. The process prescribed by the previous regulation takes considerably more time than the new one, 

despite efficiency measures we have introduced, e.g., technology, to streamline it as 

much as possible. 

Question. Congress has expressed a clear intention in the Child Status Protection 

Act to prevent government delays from separating families by having children turn 

21 during the permanent residence processing. At the time Congress passed the 

CSPA, the existing scope of the DOL backlog was unanticipated. In light of the clear 

Congressional intention, why has the Department of Labor refused to expedite longpending backlogged applications based upon a showing that the impact of the delay 

will forever prevent a child from becoming a permanent resident with his or her 

parents? 

Answer. We understand the Child Status Protection Act applies only to cases 

pending before the Department of Homeland Security. The Department of Labor 

strongly supports efforts to keep families together. The Department has determined 

this goal can best be accomplished by minimizing the amount of time it takes to 

process foreign labor certification applications. For this reason, the Department has 

consistently applied a first in/first out (FIFO) policy to cases in the Program Electronic Review Management (PERM) program. The FIFO policy prevents the need to 

make subjective decisions regarding which, if any, cases merit special consideration 

for expedition, thereby conserving resources and substantially reducing the amount 

of time that is required to process applications. It is ETA’s longstanding policy to 

also process cases in the permanent labor certification program backlog on a ‘‘FirstIn/First-Out’’ basis within that system’s various processing categories; for example 

Reduction in Recruitment (RIR) cases are in a separate processing queue from cases 

being handled through the traditional recruitment process (TR), but cases in each 

queue are processed on a ‘‘First-In/First-Out’’ basis. It has been ETA’s established 

policy never to expedite cases bases on the specific circumstances of individual employers or aliens. 

Question. In addition to children aging out, other significant detriments to employers and employees exist in specific cases. Examples include inability to promote 

employees, loss of tuition benefits, inability to travel, inability for spouses to work, 

etc. Given that the delays are through no fault of the employer or the employee, 

why has the Department of Labor failed to establish a system for expediting worthy 

cases? 

Answer. The Department’s policy of not expediting cases saves an enormous 

amount of limited resources since we do not have to evaluate the merits of each request to expedite across what potentially could be tens of thousands of cases. Furthermore, we believe some of the concerns you note arise from visa restrictions over 

which the Departments of State and Homeland Security have jurisdiction and not 

from any DOL permanent labor certification rules or requirements. 

The most equitable response to this complicated issue is to require strict adherence to our first-in/first-out policy under which all applicants are treated consistently. For every case considered for expedited consideration, an older case would be 

further delayed. Unlike the Department of Homeland Security, the Department of 

Labor does not have the legislative authority for a fee structure which allows for 

‘‘premium processing.’’ 

Currently, employers do not pay a fee to DOL for the processing of permanent 

foreign labor certification applications. Employers benefit significantly from the admission of foreign workers, and the efficient review of applications they receive 

under the new, streamlined process. The backlog system is not fully automated and 

therefore continues to function through a FIFO process. The Administration has included a proposal in the fiscal year 2007 budget to create a fee structure for the 

Permanent Labor Certification Program. We anticipate revenue from such fees 

would permit the assignment of additional staff, such that there should be no backlogs in the new PERM system. 

Question. Why has the Department of Labor made it so difficult and risky for employers to convert cases from the BEC to PERM? Seemingly, DOL has created the 

most restrictive rules possible to discourage these conversions, resulting in an unexpectedly low number of conversions and an unexpectedly high number of cases remaining at the BECs? Will DOL amend its rules to encourage conversions? Examples of improvements include eliminating the risk of the loss of priority date if a 

case is not eventually adjudicated to be ‘‘identical’’; eliminating the risk of loss of 
300 

the ability to obtain seventh year H–1B extension if the case is not considered to 

be ‘‘identical’’; removing the ‘‘identical’’ standard entirely; changing present procedures which involve audits of most or all of the conversion cases; eliminating the 

very extensive delays in adjudicating PERM conversion cases; and allowing cases at 

the BEC to remain pending until the approval of the PERM case (especially since 

a mere typographical error could result in a PERM case being denied). 

Answer. The Department is in the process of reviewing the rate at which cases 

have been converting from the old pre-PERM certification system to PERM. Employers currently have the option of re-filing the case if it meets the requirements of 

the PERM regulation. Those who wish to have the benefit of the new efficient processing system must meet the regulatory requirements of that rule. The Department 

does not have the resources to process identical cases under two different regulations implementing the permanent labor certification program, i.e., pre-PERM and 

post-PERM. Removing the ‘‘identical’’ standard under the PERM regulation would 

require a new rulemaking process and has the potential for trading backlogs between the Backlog Elimination Centers and the Department’s National Processing 

Centers. We do not feel that this would be in the interests of employers or foreign 

workers. The new PERM system is much more efficient than the old system, but 

converting all old cases into new PERM cases would result in backlogs in PERM. 

Question. What is the plan for dealing with applications for which no 45 day letter 

was received by June 30? Will provisions be made for reconstructing lost files? 

When will employers be notified of these procedures? 

Answer. The BECs have taken extensive steps to ensure that all applications 

identified for transfer to the BECs have been shipped and received at their designated destination. However, because there may be some applications that for various reasons were never identified by the state agencies or ETA Regional Offices for 

shipment to the BECs, we are developing a process by which to handle those cases. 

Within the past two weeks, the Department posted a detailed set of Frequently 

Asked Questions (FAQs) on the foreign labor certification website which addresses 

procedures related to the 45-day letters http://www.ows.doleta.gov/foreign/ 

#whatsnew. 

Due to the high demand for information and time and resource constraints, we 

believe that posting the information on our website is the best way for the entire 

public to have access to the information at the same time. These FAQs will provide 

procedures for employers in the event they have had a case closed through the nonreceipt of a 45-day letter. Additional FAQs to cover these situations may be posted 

if appropriate at a later date. 

Question. What are the realistic expectations for adjudicating all BEC cases by 

September 30, 2007? How are these expectations impacted by losses of the top level 

people at the BEC in Pennsylvania? How has DOL factored into these expectations 

the lack of incentive for BEC employees to complete the cases on a timely basis 

since doing so will result in loss of their positions as of September 30, 2007? 

Answer. The Department has plans underway to fill all vacancies, both Federal 

and contractor staff, at the Philadelphia Backlog Elimination Center. Since establishing the two (2) backlog centers in July 2004, we have logged in all 360,000∂ 

cases transferred to the backlog centers from the states, sent 45-day letters to all 

employers, and cleared over (157,473) cases from the centers. We intend to have all 

backlog cases under processing by September 30, 2007. 
(301) 

DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 

FISCAL YEAR 2007 

U.S. SENATE, 

SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS, 

Washington, DC. 

NONDEPARTMENTAL WITNESSES 

[CLERK’S NOTE.—The subcommittee was unable to hold hearings 

on nondepartmental witnesses. The statements and letters of those 

submitting written testimony are as follows:] 

DEPARTMENT OF LABOR 

PREPARED STATEMENT OF THE NATIONAL ASSOCIATION OF WORKFORCE BOARDS

Chairman Specter, Ranking Member Harkin, and distinguished Members of the 

subcommittee, my name is Stephanie Powers, Chief Executive Officer of the National Association of Workforce Boards (NAWB). I am submitting this testimony on 

behalf of Leonard Wilson, Chairman of the Board of Directors of NAWB, and the 

Nation’s workforce investment boards regarding fiscal year 2007 funding for programs authorized under the Workforce Investment Act (WIA). We appreciate this 

opportunity. 

Workforce Investment Boards (WIBs).—The Nation’s 589 local, and 52 State workforce boards provide strategic guidance and leadership for the design and implementation of the Nation’s workforce investment system, which includes 2,000 comprehensive One-Stop Career Centers. The boards have approximately 13,000 private 

sector members who volunteer their time to insure that the workforce investment 

programs are connected with community economic development priorities and employers’ needs. 

The Workforce Challenge in the United States.—More than at any time in our history, the American workplace demands a competitive and responsive workforce. The 

complex interplay of technology and globalization, coupled with profound demographic changes, have set in motion a set of difficult challenges to our economic 

prosperity. Business, political leaders, and policy experts often disagree as to the 

proper mix of monetary, trade, taxation, and regulatory policy to ensure prosperity 

in the years ahead. Nonetheless, virtually all the experts, public and private, agree 

that a key ingredient to our economic success lies in the capacity of the American 

workforce to offer knowledge, skills and innovation to the economy. Yet, the administration continues to propose potentially devastating reductions in funding, and policy changes for the Nation’s workforce investment system that, if adopted, would 

virtually eliminate our workforce preparation infrastructure, and decimate United 

States efforts to maintain a skilled workforce. 

As your Committee examines the President’s fiscal year 2007 budget proposal, 

and deliberates over workforce investment and employment services funding, the 

National Association of Workforce Boards respectfully asks that you: (1) Weigh the 

potentially devastating impact of the administration’s budget and policy recommendations for WIA and the Wagner-Peyser Act; (2) Decide instead to enhance 

and build on strengths of locally-based, private sector-led Workforce Investment system and its successes; and (3) Invest, not disinvest in the Nation’s workforce devel-
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opment system, funding programs authorized under WIA and the Wagner-Peyser 

Act at not less than the fiscal year 2005 funding levels. 

In 2006, we know that it is crucial for our workers to be ready, willing, and able 

to respond to the pace of America’s changing workplace needs. On the demand side, 

employers must be ready to invest in the capacity of all workers, not just those already skilled and educated. Collectively, our Nation must commit resources at all 

levels, to raise the performance of students and workers at the bottom, while improving the performance of those in the middle and top. We must ensure that all 

low wage and structurally unemployed workers have the opportunity to gain new 

high-value skills, maintaining important transitional income support and health insurance while upgrading skills and changing careers. Our public policy investments 

need to embrace the realities of a 21st Century workplace and develop a system that 

will help our employers and workers compete successfully. Success for the future 

will depend not just on educating all Americans to much higher standards, but also 

to different standards. 

We believe that the complexity of what we are facing requires our Nation to maintain a strong Federal commitment to coherent and consistent public investment policies that address the needs of workers and employers alike. There will be a price 

to broad prosperity if we ignore the sum of these growing realities: —Broad Lack of Workforce Proficiency in Technology.—The Global Affairs Director 

of the Microsoft Corporation, Pamela Passman, in a recent speech at NAWB’s 

annual conference, expressed her company’s concerns about the ‘‘readiness of 

the American workforce to embrace technology as an essential tool of the knowledge economy.’’ She stressed that there is no concern with countries embracing 

technology, innovating, and investing in education and skills training, as long 

as America is doing the same. But she warned about the lack of proficiency of 

adults to search, comprehend, and use information (13 percent) and to perform 

computational tasks, despite the Nation’s focus on improving math and science 

skills (13 percent). These deficiencies, if not quickly addressed, will hamper 

growth and innovation expansion for ‘‘employers who are demanding more skills 

that revolve around knowledge creation, collaboration and communication, and 

analysis.’’ —A Growing Talent Shortage.—The well-regarded staffing company manpower asserts, in a recently released white paper entitled Confronting the Talent 

Crunch: What’s Next States, ‘‘There already is a talent shortage in many areas 

of the global labor force, a situation that will grow more widespread across more 

jobs over the next 10 years—and could threaten the engines of world economic 

growth and prosperity.’’ The Bureau of Labor Statistics predicts a shortfall of 

10 million workers in the United States by 2010, which may exert additional 

strain on the talent pool availability. —Demographic Reality #1: Aging Workforce.—The first of the baby boomers has 

turned 60 this year. Older workers will be leaving the workforce much faster 

than new workers are entering, and as they leave the workforce they will take 

with them an incredible wealth of education, talent, skills, experience, and traditional work ethic. For example, more than 50 percent of the current science 

and engineering workforce in the United States is approaching retirement. 

Given this, should we be concerned that China graduates four times as many 

engineers as the United States? Or that out of the 1.1 million high school seniors who took a college entrance exam, just under 6 percent indicated plans to 

pursue a degree in engineering—nearly a 33 percent decrease in interest from 

the previous decade (Passman, 2/27/06). 

—Demographic Reality #2.—Immigrants and Untapped Pools of Potential Workers. The future workforce will be far from homogeneous. The predicted growth 

in the American labor force will come largely from immigrants who are less 

likely to quickly replace the level of skills that will be departing with the 

boomers’ exodus. If these trends continue, and they are predicted to do so, increasing workforce remedial interventions will be needed to deal with English 

language deficiencies and to boost basic education proficiencies. Employers will 

also need to be better prepared to provide various accommodations for both an 

aging workforce and people with disabilities who are likely to enter the workforce in greater numbers as technology and civil rights protections enable higher rates of their participation. The continued growth of working women will require more flexible working schedules and family leave policies as their child 

care and elder care responsibilities require them to balance work and family 

commitments. 

So the question looms, how can workers be assisted in navigating and managing 

their work lives in this complex global economy? Will companies be competitive 

without access to a higher-skilled workforce? And importantly, how should public 
303 

policy respond to the realities of the societal changes and the vagaries of the global 

economy? The President acknowledged in his State of the Union message the increasing concern about national competitive challenges, but we regret that his budget proposal for workforce investment does not support his agenda in this area; in 

fact, it misses the mark. It is baffling why the administration would propose such 

deep cuts in the Nation’s workforce investment programs in the face of mounting 

evidence, and their call for attention to American competitiveness. We should increase, not decrease these investments. 

The WIA system currently provides a wide range of vital services to over 16 million U.S. jobseekers and employers through its One-Stop delivery system, including 

labor market information, job search assistance, guidance and counseling services 

to help workers find the right jobs, and employers find the right employees. The system provides essential rapid response and transition assistance to dislocated workers; support services for individuals pursuing first time employment; and assistance 

for low-wage workers in search of career growth opportunities leading to self-sufficiency. It is designed to help jobseekers access the education and training they need 

to succeed in the new knowledge economy; to meet the skill needs of employers. 

According to the U.S. GAO, the WIA system spent over 40 percent of its funding 

in fiscal year 2003 on training for jobseekers in the United States, and this estimate 

did not take into account funds used to pay for computer lab workshops in software 

applications, basic keyboarding, computer skills training, and even certain adult 

basic education classes offered through the One-Stop delivery system. Nor did it 

take into account training arranged by the One-stops but not paid for with WIA 

funds. 

As your Committee deliberates on funding for the U.S. workforce investment system, and considers the President’s 2007 budget proposal, we respectfully ask that 

you: 

(1) Enhance and Build on Workforce Investment Boards’ Successes 

The United States’ Council on Competitiveness and the experts who participated 

in its National Innovation Initiative identified innovation as the single most important factor in determining America’s success through the 21st Century. They identified the key ingredients for innovation as talent, investment, and infrastructure, 

and urged the knitting together of these strands to foster new innovation ‘‘hot spots’’ 

in regions across the United States than can sustain jobs and wage growth. It is 

crucial to find ways bring businesses, workers, researchers, economic developers, entrepreneurs, educational and training institutions, and governments together, at the 

regional level, to identify and develop their strengths and capacity for innovation. 

In fact, the Workforce Investment Act is predicated on such a collaborative model. 

Many Workforce Boards across the country are already performing this convening/ 

brokering role that is essential to regional economic prosperity. To eliminate funding 

for this work as proposed in the administration’s fiscal year 2007 budget, would be 

to put a stop to what hundreds of local workforce investment boards from around 

the country have already begun—the building of collaborative regional, knowledgebased economies. Let me share some examples with you. 

—The Finger Lakes Workforce Investment Board.—In New York identified and developed career maps for photonics and biotechnology as potential growth sectors 

for a region in transition. The WIB with K–12 schools, the business community, 

community colleges and the Syracuse University School of Education identified 

the foundational skill standards for these industries and recommended steps for 

secondary schools to realign curricula in science, math and technology, as well 

as ways to build awareness of the career opportunities and pathways existing 

in these sectors. 

—The South Florida Workforce Investment Board.—That serves the Miami metro 

area served 7,648 employers and placed 69,634 clients in jobs this past year. 

They calculate the return on investment to the community of $11.01 for every 

dollar of workforce funds invested. In an area of historically high unemployment, these results are the fruit of the partnerships that the WIB has fostered 

with economic development agencies, business and the community’s public 

agencies. 

—The Brevard Workforce Development Board.has created an extensive menu of 

business services and targeted those growth industries such as healthcare, manufacturing, and Aerospace that are growing jobs in their community, which is 

one of the hottest job growth areas in the country. Their ability to continue this 

work would be diminished, if not eliminated, if the proposed budget cuts and 

Career Advancement Account proposals are enacted. 

—The Northwest Wisconsin Workforce Investment Board.—Developed the ‘‘Talent 

Profiling System’’ (TPS), a soft skills matching tool, to respond to the over-
304 

whelming requests of employers to find people that fit their jobs. Since its implementation, TPS has achieved results ranging from having the highest employer penetration rate in the State’s 11 Workforce Development Areas to a decrease of $916.88 to $420.24 in cost-per-placement and realized $4.22 Return On 

Investment (ROI) for each tax dollar invested. —The North Central Texas Workforce Development Board.—Serves a fourteen 

county region with 1.6 million people that surrounds the Dallas/Fort Worth 

area. This board supports small businesses by serving as the HR department 

for small companies. In this vital role they provide personalized attention for 

recruiting and placement; applicant screening; and on-site assistance with interviewing. Services to small business such as these, the engine of economic 

growth, will be severely limited by 15 percent ∂ reductions in funding and the 

Career Advancement Account proposal. —The Greater Peninsula Workforce Development Consortium.—In Newport News, 

Virginia created The Manufacturing Pipeline Partnership for their local manufacturers. Participating manufacturers have been able to significantly improve 

their hiring practices through this collaborative effort. Northrop Grumman 

Newport News was able to hire 922 workers in skilled trades’ positions, Siemens VDO Automotive, hired 100 plus workers for crucial positions in their advanced technology production areas. The WIB and the partnership it convened 

is directly contributing to the long term economic vitality of the region. This 

would not have been possible without the WIB’s convening role, and WIBs 

would effectively be eliminated by the administration’s budget cuts. 

(2) Weigh the Potential Impact of Cuts on the Workforce Investment System and its 

Customers 

The administration’s fiscal year 2007 budget proposes a new 15 percent cut in 

funding for WIA and Wagner-Peyser. These reductions would be applied to a workforce investment system that has already sustained funding reductions over the 

years, and is stretched very thin. Simply put, our system cannot sustain any further 

cuts without having to close numerous One-Stop Centers throughout the country, 

and cut back on services provided to those in need (eg, dislocated workers, the structurally unemployed, low wage workers in search of self-sufficiency, at-risk youth, 

and employers). 

These negative consequences of funding reductions do not even take into account 

the potential devastation that would be caused by the administration’s policy recommendations contained in the fiscal year 2007 budget. In her testimony before 

your Committee, Secretary of Labor Elaine Chao indicated that the One-Stop delivery system would be preserved under the administration’s fiscal year 2007 proposal. 

She stated this despite the fact that 75 percent of the funding for States under their 

consolidated proposal, would be required to be spent on Career Advancement Accounts—leaving less funding for all other system functions and services, than now 

provided for the Wagner-Peyser program alone. 

The real impact of the administration’s proposal (in total) would be the elimination of most of the local Workforce Investment Boards around the country, and 

the closure of most of the One-Stop Centers. With only 22 percent of WIA and Wagner-Peyser funding, States would be forced to provide all remaining services other 

than training. Funds to engage the private sector, both through the boards and 

through business services would be immediately impacted. The loss of the private 

sector engagement and focus would be diametrically opposed to the original Congressional intent of WIA and to calls from the country’s leaders on U.S. competitiveness. Discussions with our colleagues around the country indicate that the impact 

on the workforce system infrastructure would be dramatic and would effectively dismantle much of the strategic partnership work, employer outreach, and physical 

One-Stop infrastructure that the WIBs have spent the last 5 years crafting. Innovative programs developed in partnership with employers and economic development, 

such as incumbent worker, industry sector, career ladder, and layoff aversion programs would be abruptly halted. And tragically, the private-sector leadership of the 

workforce boards, that has taken us so long to build, would be dismantled and swept 

under the rug. We believe this leadership and participation should be cultivated, not 

marginalized, particularly at a time when business leadership and employer engagement in the system is growing. It would be hard to find many other Federal programs where the business community has such a direct role in determining how 

Federal tax dollars are used in local communities. 

When WIA was enacted in 1998, it was clear that Congress intended a significantly enhanced role for business vested in the Workforce Investment Boards. As 

WIA has matured these past 5 years, we believe that this strategic oversight has 

turned out to be a highly desirable value proposition and we urge Congress to con-
305 

tinue a strong endorsement of the approach by maintaining and increasing WIA 

funding that insures the private sector’s engagement in the public workforce system. 

(3) Invest, Not Disinvest 

We applaud the efforts of the subcommittee to provide funding for WIA at levels 

as close to constant as possible in these increasingly difficult budgetary times. 

NAWB knows that there are many pressures on the Federal budget and many legitimate requests for funding. However, we submit the competitive posture of the 

Nation needs to be placed at the top of the priority list, and urge you to fund WIA 

and Wagner-Peyser at the fiscal year 2005 levels. 

While the Department of Labor may claim there is excess unspent money in the 

WIA system to justify their recommended budget cuts, they, in fact, are not presenting the facts accurately. The GAO’s 2002 study clearly disputed this claim. And 

since the original claims of slow expenditures and excessive carryover were made, 

the WIA system has significantly diminished system carryover to less than 30 percent of its accrued expenditures—the standard proposed by the administration for 

WIA reauthorization, and included in both the House and Senate WIA reauthorization bills. 

In summary, when WIA was enacted, it was intended to ensure that all Americans have access to the information, job search assistance, and training they need 

to qualify for good jobs, and to successfully manage their careers in the new economy of the 21st Century—we urge you not to turn your backs on America’s workforce investments.... they are about our future prosperity, and ultimately our national security in the purest sense. 

Thank you for your support in the past, and for this opportunity to submit testimony. 

PREPARED STATEMENT OF THE NATIONAL JOB CORPS ASSOCIATION

JOB CORPS WORTHY INVESTMENT TO AMERICA’S YOUTH

Six Million Youth Eligible to Participate 

On behalf of the National Job Corps Association (NJCA), we want to thank the 

Labor, Health and Human Services and Education Appropriations Subcommittee for 

its unwavering dedication to Job Corps and the vulnerable disadvantaged young 

Americans it serves. We appreciate the Committee’s strong support of Job Corps in 

fiscal year 2006. Not only did the Committee provide a funding increase, but it established Job Corps as an office reporting directly to the U.S. Secretary of Labor. 

With strong bipartisan support, Congress acknowledged Job Corps’ 40-year track 

record of success by eliminating layers of bureaucracy and ensuring departmentwide attention on America’s most disadvantaged youth. 

Job Corps is a voluntary program that serves more than 60,000 young Americans 

each year, which is only about 1 percent of the nearly 6 million disadvantaged youth 

that are eligible for Job Corps’ services. Over the last four decades, Job Corps has 

built its reputation as the Nation’s largest and most successful residential educational and vocational training program for economically disadvantaged youth, 

ages 16 through 24. With millions of youth eligible and in need of Job Corps services, it is only with your help that Job Corps can remain a beacon of hope for many 

young Americans and an excellent example of our government’s role in ensuring 

every American has a chance to succeed in the 21 century economy. Tony Pusateri, 

a Senior Vice President of Equity Residential in Plano, Texas and member of the 

National Apartment Association Education Institute observed: ‘‘I’ve been around 

Washington and seen a lot of government programs that I didn’t support, but Job 

Corps is one program . that I am proud my tax dollars go to.’’ 

Unfortunately, the administration’s fiscal year 2007 budget request cuts Job 

Corps by $72 million from the fiscal year 2006 enacted level. We are deeply concerned that such a funding cut would force a drastic reduction in the number of 

youth Job Corps will be able to serve. While we encourage spending restraint by 

the U.S. Government, we also believe it is imperative to provide adequate funding 

to support the young Americans who are our Nation’s future. 

JOB CORPS OPERATIONS FUNDING

Administration’s Fiscal Year 2007 Budget Proposal 

The administration’s proposal recommends funding Job Corps’ operations account 

at $1.401 billion, a decrease of $64 million compared to the fiscal year 2006 appropriated levels. This level of funding amounts to a 7.8 percent decrease in Job Corps’ 

real-dollar funding from fiscal year 2006. 
306 

If the operations account were to be cut by $64 million, more than 3,000 economically disadvantaged young Americans would be turned away from Job Corps. These 

vulnerable youth, though they have the desire, would not be able to enter Job Corps 

to complete their high school education and place themselves on a career path. As 

one of the few national job training programs that has shown consistent positive results, Job Corps has the ability to preserve economic prosperity by equipping thousands of high school dropouts, foster care youth, and other vulnerable youth with 

job skills to enter gainful employment and become responsible, productive citizens. 

This cut would limit the opportunities of vulnerable youth who are seeking a way 

to put themselves back on track for success. 

NJCA Fiscal Year 2007 Request 

The NJCA requests a total of $1.53 billion for Job Corps’ fiscal year 2007 operations account to support at least 44,000 training slots and keep all Job Corps centers at full capacity. This amount is based on the Office of Management and Budget’s (OMB) projected 3.3 percent rate of inflation between fiscal year 2006 and fiscal 

year 2007 as well as additional appropriations to support efforts to improve educational programs on Job Corps centers. The increase would (1) allow the 122 Job 

Corps centers across the country to operate at full capacity to ensure the programs 

serves as many eligible youth as possible; and (2) support the U.S. Department of 

Labor’s efforts to ensure the program has the necessary resources to hire capable 

teachers and ensure the quality of its educational courses. 

JOB CORPS CONSTRUCTION, REHABILITATION AND ACQUISITION (CRA) FUNDS

Administration’s Fiscal Year 2007 Budget Proposal 

The administration’s budget proposal recommends funding Job Corps’ CRA ac- count at $100 million, an $8 million reduction from fiscal year 2006. 

As you know, Job Corps gives young people the opportunity to focus and learn 

in a safe, stable, and supportive environment. However, the average building on a 

Job Corps center is 47 years-old—20 years older than the construction industry’s 

recommended lifespan. While the program is committed to addressing the backlog 

of repairs by developing a 10-year capital improvement plan to construct and repair 

facilities based on priority, it needs more funding resources. 

NJCA Fiscal Year 2007 Request 

With respect to Job Corps’ capital account, the NJCA requests $130 million in fiscal year 2007. These funds will be used to: repair dorms, classrooms, and other student facilities on existing Job Corps centers; replace deteriorated structures, especially those that threaten the safety and health or violate minimum building codes, 

including mechanical systems; continue to address the $700∂ million backlog of 

construction and/or repair needs; and provide third year funding for incremental Job 

Corps expansion. 

CONCLUSION

As Job Corps looks to the future to train the next generation of youth, we hope 

you agree that it remains a Federal program worthy of America’s attention and support. Seventy-four percent of Job Corps enrollees are high school dropouts. The typical Job Corps student reads slightly less than the 8th grade level. Most youth who 

attend Job Corps have never held a full-time job. Thirty-two percent come from families on public assistance. However, through targeted self paced learning and dedicated counselors and teachers, these youth graduate from Job Corps with well-documented improvements in their education and skill levels and more than 90 percent 

transition into employment, higher education or the military. Job Corps provides 

thousands of youth a second chance to achieve the American dream. 

The NJCA looks forward to working with the members of this Committee to ensure that thousands of disadvantaged young Americans will continue having the opportunity to lift themselves up through Job Corps. We have been encouraged by the 

Committee’s support that have expanded and strengthened Job Corps over the years 

and hope that we will enjoy that support and confidence in fiscal year 2007 and into 

the future. 

PREPARED STATEMENT OF THE NATIONAL YOUTH EMPLOYMENT COALITION

The National Youth Employment Coalition (NYEC) is a network of over 270 youth 

employment, education, and workforce development organizations dedicated to promoting policies and initiatives that help young people succeed in becoming lifelong 

learners, productive workers and self-sufficient citizens. NYEC works to improve the 
307 

effectiveness of youth-serving organizations by informing and tracking policy; setting and promoting quality standards; promoting professional development; and 

building organizational capacity. We thank you for your previous support of programs that provide meaningful job training and youth development opportunities for 

young people and for the opportunity to submit this testimony. 

Youth development/employment programs must be adequately funded because our 

youth are facing a crisis that has profound implications for their lives, their futures, 

and our society at large. There are 2.4 million low-income 16 to 24 year olds who 

left school without a diploma or received a diploma but are unemployed. 

Youth development/unemployment programs must be funded at a level commensurate with the need to develop a globally competitive and highly skilled workforce 

for the jobs of tomorrow and today. Youth face a crisis that has profound implications for the lives, their futures, and society at large. According to a report by Public/Private Ventures, ‘‘nationwide, 15 million people between the ages of 16 and 24 

are not prepared for high-wage employment. Inadequate education or training is a 

major reason.’’ A report by the National Association of Manufacturers identified 

three simultaneous phenomena that together are transforming the American economy and its labor force: global pressures, relentless advances in technology, and demographic shifts that will result in ‘‘a projected need for 10 million new skilled 

workers by 2020.’’ 

In the face of persistent youth unemployment and changes in the labor market 

which require more knowledge and skills, the administration’s proposed 2007 budget for WIA and Employment Services programs, is a matter of serious concern. It 

calls for a 15 percent reduction in these important programs and perpetuates the 

downward trend that would leave employment and training programs $1 billion 

below funding levels of 5 years ago. 

Unless Congress rejects these proposals, many thousands of youth will continue 

to lack the opportunities and supports necessary to succeed in the 21st century 

workplace. NYEC urges you to increase investment in programs under the Workforce Investment Act (WIA) and to restore funds for Perkins Act programs, TRIO, 

and Gear-Up, and the Reintegration for Young Offenders Program. 

These programs are needed because unemployment among youth is unacceptably 

high. While adult unemployment averaged 5 percent in the last quarter of 2005, the 

unemployment rate among youth 16–19 was 16.1 percent; more than three times 

as high. A recent study from Northeastern University’s Center for Labor Market 

Studies found that between 2000 and 2004, the number of employed teens declined 

by nearly 1.3 million. 

Since fiscal year 2002, our Nation has been in the process of disinvesting in youth 

employment and development programs. If this current round of cuts is implemented, investment in the WIA youth programs will have dropped by more than 38 

percent from $1.4 billion in fiscal year 2002 to $841 million in fiscal year 2007. This 

when according to the National Center on Education and the Economy we need ‘‘to 

invest in training on a scale that supports the well-being of the Nation’s economy 

and so that it is not just a privilege for the lucky few.’’ 

The administration’s disinvestment runs counter to its own philosophy of investing in programs that work and divesting from programs that do not work. These 

programs work. According to the U.S. Department of Labor’s fiscal year 2005 Performance and Accountability Report, in Program Year 2004 (July 2004-June 2005), 

WIA programs exceeded the Department’s target for Diploma Attainment among 

youth 14–18 (65 percent v. 53 percent), entry to employment for youth 19–21 (72 

percent v. 68 percent), and employment retention for youth 19–21 (82 percent v. 79 

percent). 

The only measure in which programs failed to meet or surpass the Department’s 

target was in cost per participant. According to the Report (page 65), ‘‘Average cost 

per participant was slightly higher than expected—$2,822 vs. a target of $2,663. 

However, consistent with ETA’s vision for youth services, the program has served 

a higher proportion of out-of-school youth. Out-of-school youth are a more expensive 

population to serve, with a cost of $3,724 per participant, therefore the overall cost 

per participant increased over prior years. At the time the cost per participant target was estimated, DOL did not anticipate the full extent of increased expenditures 

on out-of-school youth.’’ The Report also notes that ‘‘Results for PY 2004 continue 

an upward trend that began with WIA implementation in 1998. All three outcome 

indicators have increased from PY 2003 and exceeded performance targets. Most important is the continued increase in high school diploma attainment, given the 

strong statistical correlation between educational attainment and success in the 

labor market.’’ 
308 

It should be noted that even at $2,822 per participant, the cost is below the $3,000 assumed in the administration’s proposed Career Advancement Accounts 

(CAA). 

Further, a recent study of comprehensive youth workforce development programs 

in 36 communities carried out by the Center for Law and Social Policy confirms that 

Federal investment makes a difference. It found that that between 2000 and 2005 

these programs successfully connected out-of-work youth to approximately 18, 456 

long term unsubsidized work opportunities; 23,652 internship opportunities; 28,302 

short-term unsubsidized jobs; and 23,478 training opportunities. The program 

reached 42 percent of the eligible target population and 62 percent of the eligible 

out-of-school population. 

According to a 2004 report prepared by Northeastern University’s Center for 

Labor Market Studies, there are 5.4 million 16 to 24-year-olds who left school without a diploma or received a diploma but are unemployed. About 44 percent of them 

are low-income. With more than 540,000 students dropping out of high school each 

year the implications of this phenomenon are staggering: 

—The earnings gap widens with years of schooling and formal training. In 2003, earnings of male dropouts fell to $21,447; high school graduates earned an average of $32,266; and college graduates earned about $63,000 or triple that of 

dropouts. As a result, dropouts pay less taxes, are more likely to rely on public 

assistance, and to be part of the criminal justice system. —One expert estimates that the United States would save $41.8 billion in health 

care costs if 2004’s 600,000 dropouts were to advance an additional year in educational attainment. 

—Approximately 16 percent of all young men, ages 18–24, without a high school 

degree or GED are either incarcerated or on parole at any one point in time. 

—Three quarters of State prison inmates are high school dropouts, as are 59 percent of inmates in the Federal system. 

—Increasing the high school completion rate by 1 percent for all men aged 20– 60 would save the United States $1.4 billion a year in reduced costs from crime. 

—The situation is even more dire in minority communities where as few as 20 

percent of black teens are employed at any time, unemployment among young 

black men aged 16–24 not enrolled in school is about 50 percent, and approximately one-third of all young black men are involved with the criminal justice 

system at any given time. 

According to a paper by written by Professor Michael Wald and Tia Martinez for 

the Hewlett Foundation, ‘‘over the past 25 years the situation for youth who fall off 

the ladder as they move to adulthood has gotten considerably worse.’’ Nevertheless, 

inflation-adjusted spending for programs that target at-risk youth dropped by 63 

percent from 1985 to 2003. 

Youth workforce development programs provide a wide range of services to improve educational achievement, prevent youth from dropping out of high school, and 

reengage youth who are out of school and out of work. NYEC believes that we must 

reverse the trend of disinvesting in youth employment and development and fund 

the WIA youth formula at $1 billion. While we support new programs that help 

youth prepare for jobs and careers and prevent them from leaving school, funding 

for untested initiatives like the CAA’s should not come at the expense of successful 

programs that are already stretched to the breaking point. 

The administration’s fiscal year 2007 budget also proposes to eliminate the Reintegration of Young Offenders Program. According to the Bureau of Justice Statistics, approximately 120,000 youth under the age of 18 are currently incarcerated in 

juvenile detention centers, State prisons, and local jails. Most will be released in the 

next few years. 

A 1998 study by Vanderbilt Professor Mark Cohen, estimated that each teen prevented from adopting a life of crime could save the Nation between $1.7 and $2.3 

million. A report prepared in 2002 for the California State Senate Joint Committee 

on Prison and Construction Operations stated, ‘‘Given the staggering cost of failure, 

it is hard to imagine any justifiable argument against providing education and services to this population.’’ 

Finally, the cost per participant pales in comparison with the cost of alternatives 

like incarceration. According to the Justice Policy Institute, for example, ‘‘incarceration, particularly for juveniles, is an expensive proposition. Each year, capital costs 

to build new facilities run in the range of $100,000 per cell and operating costs typically exceed $60,000 per cell.’’ The return on investment in the Young Offenders 

program will be returned many times over. 

While NYEC recognizes the administration’s continuing commitment to helping 

prisoners successfully return to society, we are concerned that unless funds are specifically targeted to serving youth, the needs of adults will most often take prece-
309 

dence. At a minimum, funds currently targeted at court-involved youth under the 

Reintegration for Young Offenders Program should be restored to fiscal year 2003 

levels ($54 million). 

We support the goals of the President’s ‘‘American Competitiveness Initiative’’ and 

his charge that ‘‘We must continue to lead the world in human talent and creativity. 

Our greatest advantage... has always been our educated, hardworking, ambitious people—and we’re going to keep that edge.’’ Realizing that goal, however, requires investment in all our citizens. 

NYEC has many concerns about the CAA’s. We are particularly concerned that 

the limit of $3,000 a year for up to 2 years will function as a cap that will prevent 

workers from receiving the best and most appropriate training. A June 2005 GAO 

Report on the Workforce Investment Act (GAO–05–650) revealed that only 8 percent 

Workforce Investment Boards cap their Individual Training Accounts at $3,000. 

Fully 63 percent impose caps of $5,000 or more and 35 percent have caps of $7,000 

and up. Fifteen percent have no caps. While this could achieve DOL’s goal of increasing the number of people trained, it would call the quality of much of that 

training into question. 

Without Federal investment in effective programs such as those supported by 

WIA youth formula funds, the Responsible Reintegration of Young Offenders program, and the education programs that provide meaningful pathways from high 

school to higher education, millions of young people will not make the successful 

transition into productive employment. 

We thank the Committee for its commitment to these important programs that 

prepare our youth to compete in the global marketplace of the 21st century. We look 

forward to working with you to strengthen our Nation’s youth employment and 

youth development systems. 

PREPARED STATEMENT OF THE OREGON HUMAN DEVELOPMENT CORPORATION

Honorable Chairman, Senator Arlen Specter, and Honorable Committee Members: 

I want to thank you for the opportunity to share information about the Workforce 

Investment Act, Section 167 (WIA 167) National Farmworker Jobs Program. 

My name is Ronald Hauge and I am the Executive Director of Oregon Human Development Corporation (OHDC), a not-for-profit organization that has provided education, training, and workforce development services for Oregon’s migrant and seasonal farmworkers for more than 27 years. Throughout this period Congress has 

supported focused workforce development services for migrant and seasonal farmworkers within the CETA, JTPA, and WIA Federal workforce initiatives. The underlying reason for this support has been the recognition that migrant and seasonal 

farmworkers have different characteristics and needs than conventional job seekers 

who use the Nation’s workforce system, and that based on these differences specialized workforce services are necessary to effectively serve this population. 

The Department of Labor’s own performance reports that show the WIA 167 National Farmworker Jobs Program consistently among the higher performing workforce programs, yet the administration has tried to eliminate the WIA 167 for the 

last several years. It is only by congressional action that the WIA 167 program continues to exist. Each year this Committee has demonstrated its wisdom and priorities by supporting appropriations to preserve these effective workforce services. Accordingly, I want to thank the Honorable Chairman and Committee Members for 

your instrumental role in saving the program and maintaining these valuable investments for our Nation’s agricultural workforce. 

At this time I would like to point out a few features of the WIA 167 program that 

illustrate its importance. 

PROGRAM PERFORMANCE

According the Department of Labor’s performance reports the WIA 167 program 

has achieved entered employment rates above 80 percent, job retention rates of 75 

percent, and earnings gains above $4,000. This is unquestionably strong performance given that migrant and seasonal farmworkers are among the most difficult to 

serve job seekers in the workforce system, and that the program operates largely 

in rural areas with limited labor markets. 

INTEGRATION OF THE WIA 167 PROGRAM INTO THE ONE STOP WORKFORCE SYSTEM

The WIA 167 programs in each State are integrated into the One Stop workforce 

system on a location-by-location basis. In Oregon, for example, OHDC has six service delivery offices and each of the offices is integrated into the local One Stop sys-
310 

1 EDITORS NOTE.—Not real names. 

tem by virtue of co-location or other planned systemic integration. OHDC WIA 167 

staff are members of local Workforce Investment Boards in each service area. 

In Oregon, this integration is acknowledged at the State level and is well documented in the State of Oregon’s Two-Year Plan for Title I of the Workforce Investment Act and the Wagner-Peyser Act. The plan states that ‘‘strategies in Oregon 

to promote equal and effective access and service delivery and to promote enhancement and integration of services to MSFWs (migrant and seasonal farm workers) 

include Oregon Human Development WIA 167 staff have workspace in WorkSource 

Oregon centers and access rights to the MSFW customer base in each workforce 

area they serve. With this, they are able to identify from a broader base of MSFW 

customers those particularly interested in the intensive and training services they 

can offer and where other staff are able to understand more thoroughly the value 

added services offered by the WIA 167 for enhanced referral of their customers; they 

are seen as a critical component to delivering workforce services to MSFWs.’’ (emphasis added) 

FEW ALTERNATIVE OPTIONS FOR FARMWORKERS

The mainstream One Stop workforce system is geared primarily toward meeting 

the ‘‘demand’’ needs of high growth/high demand industries—as part of larger economic development strategies. This leaves lower skilled, hard working farmworkers 

with few or no options to improve their skills and secure stable employment in the 

primary labor market. Accordingly, the WIA 167 program becomes the only viable 

workforce development option for most farmworkers, a place with culturally sensitive, bilingual staff who are experienced in serving farmworkers and who understand the needs of local employers. It is clear that without the WIA 167 program 

few farmworkers would receive any developmental benefit from the Nation’s workforce system. 

RURAL COMMUNITY ASSET

The WIA 167 program is a real asset to rural communities. The program adds 

tangible service capacity and diversity to smaller rural One Stop workforce systems. 

The program can provide agricultural upgrade training to help agricultural employers enhance worker productivity and stability, thus extending the workforce development system’s benefit into the agricultural industry. Also, the program can serve 

as a foundation to attract other services for farmworkers such as housing, literacy 

and language training, disaster services, and a variety of emergency services that 

help stabilize the agricultural labor force in local communities. 

As you can see, the WIA 167 National Farmworker Jobs Program is an effective, 

valuable, coordinated resource that not only benefits farmworkers, but also 

strengthens the Nation’s One Stop workforce system and rural communities. 

Before closing I would like to share, in the words of OHDC workforce coordinators, the experience of two farmworkers who were assisted in Oregon Human Development Corporation’s WIA 167 program. 

Jesus Ortiz 1

Worked with Glen Walters Nursery for a number of years but had been unable 

to advance because he did not have any formal education on how to supervise a 

crew. Most of his knowledge came from first hand experience in the general operation of his department and observing other supervisors. In November 2004 OHDC 

enrolled Jesus in the WIA 167 National Farmworker Jobs Program. OHDC met 

with the employer and arranged to provide supervisory skills upgrade training to 

develop the supervisory skills of Jesus, with the understanding that Jesus would be 

promoted into a supervisory position following the training. Because Jesus had limited English language skills, OHDC provided the training in Spanish. Jesus completed the training, which was defined as ‘‘a success’’ by the employer, who promoted Jesus into a supervisory position. Jesus also received a wage increase that 

took his earnings from $7.45 per hour to $11.00 per hour. Now, Jesus not only has 

the knowledge foundation that makes him a more effective leader and supervisor, 

but he also has a better income that will dramatically improve his family’s well 

being. It is important to note that this success story would not have been possible 

if OHDC’s WIA 167 program had not been available to provide the training in Spanish—something not available from any other partner in the local One Stop workforce system. 
311 

1 EDITORS NOTE.—Not real names. 

Antonio Sanchez 1

Enrolled in the WIA 167 program in October 2005 at OHDC’s Woodburn office. 

Antonio is a married father of three children. Antonio had worked primarily in agricultural work since he was 18 years old. He was employed with a dairy since 2003, 

living in employer owned housing. At the dairy Antonio worked long hours and 

weekends (65–75 hours per week) earning a salary of $2,000 per month with no 

health or vacation benefits. Antonio was eager to start attending training classes 

available through the WIA 167 program—his primary goal was to obtain a Commercial Drivers License (CDL) and to secure a commercial driving job. Antonio completed job readiness, customer service, computer, CPR, and CDL trainings within 

a 6 month period, even though English was not his primary language. He was an 

active participant with a strong desire to learn as much as he could so he could secure employment that would offer him and his family health insurance benefits, a 

regular work schedule, and a good living wage so his family could purchase their 

own home. Upon obtaining his CDL, OHDC referred Antonio to a job interview with 

Sysco Food Service. According to the Sysco supervisor, Antonio made a great impression during his interview and was offered an entry level position starting at 

$12.13 an hour—and he will be given the opportunity to transition to a Truck Driver position earning more than $16.00 per hour. The position provides vacation and 

excellent health benefits, retirement and life insurance. The family is now in the 

process of purchasing a home of their own. 

These two examples illustrate how the WIA 167 program works for both farmworkers and employers. 

In closing, I want to thank you again for your ongoing concern for the Nation’s 

agricultural workforce. Although there are many priorities the Committee must 

evaluate, this is not the time for the Nation to turn its back on our hard working 

farmworkers who produce and harvest much of the Nation’s food and other agricultural products—and who contribute so much for our collective benefit. Therefore, I 

strongly urge the Committee to maintain or increase the appropriation for the WIA 

167 National Farmworker Jobs Program in the 2007 budget. 

PREPARED STATEMENT OF THE ASSOCIATION OF FARMWORKER OPPORTUNITY

PROGRAMS

Good morning Chairman Specter and members of the subcommittee. My name is 

David Strauss and I represent the 48 nonprofit and public agencies that provide job 

training and related services to our Nation’s migrant and seasonal farmworkers. 

They perform these tasks with grants from the United States Department of Labor 

pursuant to Section 167 of the Workforce Investment Act. As you know, the administration has tried to eliminate this program for the last 5 years. You and the members of your subcommittee have led the way in maintaining it each year, and we 

thank you for your leadership. 

About 2.5 million people labor in the fields and farms of America, from Hawaii 

to Florida and Puerto Rico, from Maine to California. Estimates are that 85 percent 

of the fruits and vegetables we eat are hand harvested by farmworkers. The pay 

is extremely low: most farmworkers earn less than $12,000 per year. Few farmworkers receive the job-related benefits, such as health insurance and sick pay, 

which we all take for granted. In most States, agricultural workers are not even eligible for unemployment compensation. They live a tough life. Many workers travel 

hundreds, sometimes thousands of miles in search of work. They get paid only when 

they perform the work: if the weather is bad or the crop is not as plentiful as the 

farmer had hoped, they simply do not receive wages. They typically cannot afford 

decent housing. Their children have to struggle mightily to even complete their public school education. The dropout rate for farmworker youth, especially those who 

migrate with their parents, is enormous. 

For over 33 years the Federal Government has made and kept a commitment to 

these hardworking people. Special Federal programs were created to recognize the 

reality that farmworkers often cross State lines to work and live. Thus, we have migrant head start, migrant health, migrant education, and the job training effort 

called the National Farmworker Jobs Program. These all are federally funded and 

have guidelines that acknowledge that Governors should not be placed in a position 

of deciding whether or not agricultural workers qualify for these services under 

State residency or other localized requirements. 
312 

Today, I want to explain the way some of our program operators and staff members helped farmworkers and other rural poor people during the aftermath of the 

hurricanes of 2005. 

When the winds and rains of Hurricanes Katrina and Rita ravaged the gulf States 

many impoverished groups suffered. Among the hardest hit were the area’s migrant 

and seasonal farmworkers. Thousands lost their jobs and many saw their homes 

damaged or destroyed. With incomes typically far below the poverty line, most farmworkers have no safety cushion when disaster strikes. To make matters worse, language barriers and cultural isolation often prevent them from accessing emergency 

services delivered by mainstream providers. 

It is hard to picture the severe hardships created by the hurricanes. Potable water 

could not be obtained, food and fuel were unavailable, and electricity and telephone 

services interrupted. These deprivations continued for weeks. For many, the migrant and seasonal farmworker job-training agencies provided the only relief. 

It must be noted that the four agencies mentioned below can only use Federal migrant and seasonal farmworker job training and assistance funds for eligible farmworkers and their dependents. The head of household must demonstrate eligibility, 

which includes proof of work authorization or citizenship and evidence of a recent 

history of performing farmwork. For those ineligible for Federal services, the agencies found other resources. The § 167 WIA agencies in the four States are funded 

solely through the DOL job training grants for farmworkers. Without Congress’s 

2005 appropriation for migrant and seasonal farmworker job training, those agencies’ doors would have been closed and none of the assistance described below would 

have happened. 

Here is a summary of the § 167 agencies’ relief activities: 

LOUISIANA

Motivation, Education and Training, Inc. of Louisiana (MET) is the 167 agency 

in that State. MET was on the ground in the Hammond, LA area a few days after 

the storm hit. That area had no electric power, or telephone service, gasoline, or 

clean water. MET set up an intake center in a trailer, powered by a generator. Staff 

provided emergency services to people who could not be reached by FEMA. Red 

Cross trucks brought water and ice. MET provided vouchers for food, clothing, rent 

and other items to over 300 families (made up of over 1,200 people) who otherwise 

might have starved or been rendered homeless. While much of the community infrastructure, was poorly supplied, the local Wal-Mart was well prepared for the needs 

of people affected by the storm, and MET worked out arrangements for the vouchers 

to be used there. The average voucher was about $370 per family. They continue 

to serve eligible families months after the storm. These vouchers are funded through 

the § 167 program. 

Ineligible families are referred to the Quad Area Community Action Agency, 

which issues commodities and other goods. 

MISSISSIPPI

The Mississippi Delta Council for Farmworker Opportunities (MDC) was one of 

the few statewide nonprofit organizations to have a nearly intact network following 

the hurricane. Headquartered in Clarksdale, MDC gave out vouchers and other help 

to hundreds of seasonal as well as migrant farmworkers. Vouchers were issued to 

330 eligible farmworkers and families, and commodities and other supplies were 

given to 331 other people. Vouchers were provided through § 167 WIA program 

funds. 

The commodity donations were made possible through the efforts of the § 167 WIA 

agency in Tucson, Arizona: Portable Practical Educational Programs (PPEP). PPEP 

gathered its own resources, those from the League of United Latin American Citizens, and from World Care. PPEP led two caravans consisting of a total of 14 trucks 

loaded with relief supplies making the 1,200-mile journey from Tucson to Clarksdale. MDC located a warehouse in Clarksdale, and the supplies continue to be distributed from there to farmworkers and other rural poor families throughout affected counties and in places where evacuees from the Gulf Coast and the New Orleans area are sited. MDC is also shipping supplies to their colleagues at Telamon 

Alabama for use in the Mobile area. As in Louisiana, the people they are serving 

are mostly outside any area of help provided by FEMA or the Red Cross. 

MDC is currently assessing farmworker needs in the counties of Scott, Simpson, 

Smith, Forrest, Greene, and George. There appears to be a tremendous need for 

housing for farmworkers whose homes were devastated by the storms. 
313 

ALABAMA

Telamon Alabama is the § 167 WIA agency in that State. It has provided direct 

voucher services to at least 25 farmworker families dislocated by the storm, primarily in Baldwin County. They have assisted about 200 others. Very little presence 

of FEMA or the Red Cross is reported for the farmworker areas of that county. A 

particular problem is that the fishing industry on the coast was devastated. Shrimp 

harvesting businesses operated by Vietnamese immigrants and others were virtually 

wiped out by the storm. Telamon is limited by the amount of help it can provide 

in two ways: its § 167 WIA grant is about half that of Mississippi and considerably 

less than Louisiana’s. In addition, there are large numbers of undocumented farmworkers, and there are few resources for referral for them. Telamon is providing as 

many persons as they can with commodities that have been shipped in from Arizona. 

FLORIDA

The counties in which farmworkers were most affected were not declared disaster 

areas. That restricted FEMA’s involvement. The Florida Department of Education’s 

Adult Migrant Programs (FDOE) operates the farmworker job-training program in 

Florida. FDOE funds a number of sites with § 167 WIA subgrants. Those sites have 

assisted over 400 farmworkers and their families, primarily obtaining resources 

from the United Way agencies that use Community Services Block Grant funds. A 

number of private funds were set up in the aftermath of the 2004 hurricanes, and 

these funds were used to alleviate suffering from these storms. The 400 farmworkers they have already assisted were working in nurseries that were wiped out 

by the storm. However, the avocado orchards that were to be harvested were severely damaged, and the planting season that farmworkers rely upon in late fall 

were delayed because of the wet conditions. 

SUMMARY

In Alabama, Louisiana, and Mississippi, the agencies that operate the programs 

funded under § 167 of the WIA served as primary relief sources for migrant and seasonal farmworkers and their families in the wake of Hurricanes Katrina and Rita. 

At least 1,800 farmworkers and family members have received emergency services 

to date, either in the form of vouchers or relief supplies. Hundreds of other people 

in those States and in Florida were referred to agencies funded to help storm victims. There are medium- and long-term problems that farmworkers will experience 

that are not yet fully known. Much farm labor housing in Mississippi and Alabama 

has been destroyed, and future prospects for employment in agriculture are unclear. 

It is crucial that these four organizations were in place when the rural poor of 

the affected areas needed them. Had the funding for these organizations ceased in 

2005 as the Department of Labor recommended, thousands of hard-working, lowpaid farmworkers and their families would face life-threatening deprivations. And 

the growers and farmers that rely on them would be facing a much more uncertain 

future as they try to rebuild their agricultural enterprises. Fortunately, despite 

DOL’s attempts to eliminate this program since 2002, Members of Congress have 

had the foresight to sustain the migrant and seasonal job-training program. 

Without these grants, who would be there to serve the working poor in rural Louisiana, Mississippi, Alabama, and Florida during this terrible time? 

PREPARED STATEMENT OF THE CENTRAL VALLEY OPPORTUNITY CENTER

Chairman Specter, and other members of the subcommittee, my name is Ernie 

Flores and I am the executive director of Central Valley Opportunity Center 

(CVOC). CVOC is the DOL WIA Title I Section 167 grantee, and also a Community 

Action Agency, in Madera, Merced and Stanislaus counties in the central San Joaquin Valley of California. At this time I submit my testimony for your consideration 

and in support of continued funding for the WIA 167 program, operated as the National Farmworker Jobs Program (NFJP) in the DOL. As you are aware, for the past 

5 years, the President’s budget, and the DOL, have proposed to eliminate the funding for NFJP. If this were to happen, it would effectively end vital employment and 

training services, job stabilization services, and various educational services that 

migrant and seasonal farm workers require to either continue working in agriculture, or to transition into year round employment outside of agriculture. It 

should also be mentioned that the funding for the entire NFJP program is approximately $80 million. Unfortunately, this amount of funding only allows us to serve 

3–5 percent of the eligible farmworkers in need of our services. 
314 

Although the U.S. DOL has testified that farm workers could be served through 

the local One-Stop Centers, all partners in the One Stop system, including the One 

Stop operators and the 167 grantee One Stop partners, are in agreement that the 

One Stop system is not prepared to served farmworkers. The majority of farm workers have limited English proficiency, possess very little formal education and generally have very few marketable job skills. The only jobs program that is prepared 

to help farm workers overcome those types of barriers, and become or continue to 

be gainfully employed, is the WIA 167 NFJP. 

The U.S. DOL has also testified before Congress that the NFJP is ineffective and 

duplicates the work of other job training programs. As to effectiveness, the DOL’s 

own internal performance reports document that the NFJP has attained the highest 

performance ratings, for all WIA employment programs in the areas of entered employment, wage gains, and retention in employment, during the past 4 quarters. As 

for duplication, the NFJP generally serves over 95 percent of all migrant and seasonal Farmworkers that are enrolled in any WIA programs during any 12 month 

program period. Any Farmworkers that are enrolled in other WIA programs are 

most likely co-enrolled into a NFJP WIA 167 program also. 

For the past 27 years CVOC has provided various employment, training and social service programs to migrant and seasonal farm workers and other low income 

persons in our three county service area in Central California. As is the case with 

all NFJP grantees, our field offices are easily accessible to Farmworkers since they 

are located in their communities. CVOC offers the following services under the 

NFJP grant: 

EMPLOYMENT AND TRAINING

—Outreach, assessment and enrollment 

—Case management/vocational guidance 

—Vocational training 

—Welding 

—Auto Mechanics 

—Cooking/Food preparation 

—General/Advance Business Occupations 

—Cashiering/Merchandising 

—Commercial Drivers License 

—English As a Second Language classes 

—General Equivalency Diploma classes 

—Supportive Services (child care, gas, food, housing) 

—Job Readiness Training 

—On the Job Training 

—Direct Job Placement 

—Indirect Job Placement 

—Active follow-up services 

—Retraining services 

In addition to these services, CVOC has leveraged resources with the help of the 

NFJP grant in order to provide farm workers with services such as energy payment 

assistance, emergency housing, food vouchers, medical & dental services and various 

other social services. 

In should be understood that there are no other programs in the WIA system that 

are prepared to meet the employment and training needs of migrant and seasonal 

farmworkers except for programs like CVOC, and the other grantees of the WIA 

NFJP. If these programs cease to operate as a nationally administered program, and 

funding is seriously cut or eliminated, there will literally be no employment and 

training services for migrant and seasonal farm workers. 

I sincerely implore you to continue the funding for the WIA 167 NFJP so that 

together we can continue to do for the least of our brothers. So that farmworkers 

can also reap the harvest of the American dream. 

At this time I would like to share some of our ‘‘success stories.’’ The stories clearly 

show how the lives of farmworkers, or their dependents, are forever changed for the 

better when they receive services from the National Farmworkers Jobs Programs 

grantees. 

Thank You. 

Isaura Gonzalez 

Before coming to CVOC, Isaura Gonzalez was a seasonal cannery worker at Michael Angelo Gourmet, where she was making $9.50/hr. This wage was not too bad 

considering she dropped out of school in the seventh grade. However, this was a 

temporary job and offered no benefits. Isaura came to CVOC with a dream. She 

wanted to obtain her General Education Diploma (GED) and find a year-round job 
315 

with fringe benefits. Six months later, all her dreams became true! Isaura successfully completed the CVOC 22-week General Business Occupations course a month 

early and obtained her GED with an amazing score of 2,910. This score is the highest ever in CVOC’s history! She is now working for Hilmar Cheese Company as a 

Data Entry/Machine Operator Manager making $14.95/hr. She has fringe benefits 

and a year-round job. Recently, during her first quarter follow-up she said she was 

expecting a raise soon. 

Juan Hernandez 

He had just graduated from high school when he came to CVOC to register for 

the welding program in October of 2004. He was 18 years old, the dependent of a 

farm worker. He was very eager to learn welding because his uncle is a welder so 

he wanted to follow his uncle’s footsteps. While he was in training, he was very 

punctual and the instructor was very happy to see how well he did and how eager 

he was to learn. After completing training, the Job Developer placed him as a welder at Gladden Equipment Erectors. His starting pay was $10.50 per hour and soon 

after, he began to travel to different States to work for the company. He sometimes 

spends a month traveling with the company. Today, he still works for the same company and earns $14.00 per hour. 

Hugo Sanchez 

Hugo had not graduated from high school when he came to CVOC to register for 

the Cashiering Program in March 2004. He was hoping to obtain his GED, enroll 

in ESL classes, and obtain a Vocational Training Certificate. While he was attending classroom training, he found the cashiering class was too easy for him so he decided to transfer to General Business Occupations (GBO) training. While in training, he obtained his GED, improved his English skills, and completed GBO training. 

After completing training, he started working as a temporary data entry teller at 

E & J Gallo Winery in August of 2004 earning $11.14 per hour. Since this job was 

temporary, he found another job. In November 2004, he started working at Foster 

Farms Dairy where he started earning $12.83 per hour. He continues to work for 

them and now earns $16.97 per hour. In May 2006 he will be making $18.90 per 

hour as the CAT supervisor 

Julian Diaz 

Before Julian Diaz came to CVOC, he was working as a farm worker and at WalMart. Julian was living with his parents in Modesto Housing Authority’s Public 

Housing. He wanted to become a welder and he discovered that CVOC offered this 

training. He saw the CVOC ad in the Modesto Bee and he decided to call. Julian 

began his 22-week training in welding in September of 2005. He completed his 

training on February 24, 2006. Even though he finished all his exams in January, 

Julian decided to stay until February to gain more skills. He was a great student 

and attended class every day. His instructor was very pleased with his hard work. 

The instructor even helped him find work. Julian is now working as a welder at West-Mark in Atwater making $11.00 per 

hour. He will soon be receiving health benefits and 401k. Julian has achieved all 

the goals he hoped to achieve and is very happy that he chose CVOC for his training. Julian even went as far as calling the welding instructor in tears on his first 

day of work to express his gratitude for the training, job skills, tools, and the opportunity that was given to him. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

PREPARED STATEMENT OF THE AIDS INSTITUTE

The AIDS Institute, a national public policy research, advocacy, and education organization, is pleased to submit written comments to you in support of a number 

of critical HIV/AIDS and Hepatitis programs as part of the fiscal year 2007 Labor, 

Health, and Education and Related Services appropriation measure. We thank you 

for your consistent support of these programs over the years, and trust you will do 

your best to adequately fund them in the future in order to provide for, and protect 

the health of, many Americans. 

HIV/AIDS

HIV/AIDS remains one of the world’s worst health pandemics in the history of civilization. Worldwide, some 40 million people are infected with this incurable infectious disease, and 14,000 new infections occur each passing day. Tragically, AIDS 

has already claimed the lives of 25 million people. Here in the United States, ac-
316 

cording to the CDC, 944,305 people have been diagnosed with AIDS, and over 

529,000 people have died through 2004. It is estimated there are more than 40,000 

new infections in the United States each year. At the end of 2003, an estimated 

1,039,000 to 1,185,000 persons in the United States were living with HIV/AIDS. 

Persons of minority races and ethnicities are disproportionately affected by HIV/ 

AIDS. In 2003, African Americans, who make up approximately 12 percent of the 

U.S. population, accounted for half of the HIV/AIDS cases diagnosed. HIV/AIDS also 

disproportionately affects the poor, and about 70 percent of those infected rely on 

public health care financing. 

The U.S. Government has played a leading role in fighting the AIDS epidemic, 

both at home and abroad. The vast majority of the discretionary programs supporting HIV/AIDS efforts domestically and a portion of our Nation’s contribution to 

the global AIDS effort are funded through your subcommittee. The AIDS Institute, 

working in coalition with other AIDS organizations, have developed realistic and 

practical funding request numbers for each of these domestic and global AIDS programs. The AIDS Institute asks that you do your best to adequately fund these programs at the requested level. 

We are keenly aware of the current budget constraints and competing interests 

for limited Federal dollars. Unfortunately, despite the growing need, almost all domestic HIV/AIDS programs in recent years have experienced funding decreases. 

This year, the President has proposed three new domestic HIV/AIDS initiatives 

by providing $70 million for getting prescription drugs to those who need them; $90 

million for testing those who do not yet know their status; and $25 million to help 

raise the awareness of those who do not know they should be tested. The AIDS Institute applauds these initiatives and encourages the subcommittee to fund these increases. 

RYAN WHITE CARE ACT 

[In millions of dollars] 

Fiscal year Amount 

2005 ......................................................................................................................................................................... 2,048 

2006 ......................................................................................................................................................................... 2,038 

2007 President’s request ......................................................................................................................................... 2,133 

2007 community request ......................................................................................................................................... 2,631 

The centerpiece of the Federal Government’s response to caring and treating lowincome individuals with HIV/AIDS are those programs funded under the Ryan 

White CARE Act. CARE Act programs currently reach over 571,000 low-income, uninsured, and underinsured people each year, most of who are from a racial or ethnic 

minority group. The majority of CARE Act funds support primary medical care and 

essential support services. 

Providing care and treatment for those who have HIV/AIDS is not only the compassionate thing to do, but it is cost-effective in the long run, and serves as a tool 

in prevention of HIV/AIDS. 

In recent years, with the exception of minor increases for the AIDS Drug Assistance Program (ADAP), CARE Act funding has decreased. Because of across the 

board recessions, flat funding has actually resulted in budget cuts for the past several years. We urge you to provide these vitally important programs with the community requested level of funding. Consider the following: 

(1) The caseload is increasing. People are living longer with HIV/AIDS due to lifesaving medications; there are 40,000 new infections each year; and the Federal Government has initiated increased testing programs to identify positive people-all of 

which will necessitate the need for more medical services and medications. 

(2) There is a greater financial burden on CARE Act programs. The price of 

healthcare, including medications, is increasing; non-profit organizations are struggling; Medicaid benefits are being scaled-back at the State level and significant 

Medicaid reductions recently passed the Congress. 

(3) Level or decreased funding for the CARE Act is impacting State and local governments grant awards. Because of reduced funding levels, 34 out of the 51 largest 

cities affected by HIV/AIDS experienced cuts to their Title I awards this year. This 

is after 18 cities experienced cuts last year. Additionally, 41 States and territories 

received less money last year in their Title II base awards. 

(4) ADAP funding shortfalls are causing States to place clients on waiting lists, 

limiting drug formularies, and increasing eligibility requirements. In February 2006, 

nine States reported having waiting lists, totaling 791 people. Several ADAPs re-
317 

ported other cost containment measures, including formulary reductions (4), eligibility restrictions (2) and limiting annual client expenditures (2). Due to the small 

increase the ADAP program was given last year, additional severe restrictions are 

anticipated in many additional States across the country. 

(5) Two recent reports conclude there are a staggering number of people in the 

United States who are not receiving life-saving AIDS medications. The Institute of 

Medicine report ‘‘Public Financing and Delivery of HIV/AIDS Care, Securing the 

Legacy of Ryan White’’ concluded that 233,069 people in the United States who 

know their HIV status do not have continuous access to Highly Active Antiretroviral 

Therapy (HAART). A study by the CDC titled, ‘‘Estimated number of HIV-infected 

persons eligible for and receiving antiretroviral therapy, 2003—United States’’, 

reached similar conclusions. According to CDC’s estimates, 212,000, or 44 percent 

of eligible people living with HIV/AIDS, aged 15–49 in the United States, are not 

receiving antiretroviral therapy. The report concludes, ‘‘there is a substantial unmet 

health care need for antiretroviral therapy among HIV-infected persons in care.’’ 

This is a travesty in our own country. As we seek to provide lifesaving medications to those abroad, we must ensure we are providing medications to our own here 

in the United States. 

Fiscal Year 2007 Administration Initiative.—The AIDS Institute is in strong support of President Bush’s proposed increase of $70 million for ‘‘States in need to 

bridge the existing gaps in coverage for Americans waiting for life-saving medications. These funds would help the States end current waiting lists and help support 

care for additional patients.’’ Since ADAP only received a funding increase of $2 million in fiscal year 2006 and the need number for fiscal year 2007 is $197 million, 

the $70 million increase, while certainly not enough, is a welcome increase. We urge 

the Committee to approve this long overdue increase. 

Additionally, President Bush proposed an increase of additional $25 million Title 

III Ryan White CARE Act funding ‘‘to significantly strengthen outreach by local 

community and faith-based organizations in hardest hit areas. These grants would 

help raise awareness, increase early detection, combat stigma, and facilitate access 

to treatment, especially for African-American, Hispanic, Native American, and other 

minority community groups whose need is often greatest.’’ This additional funding 

is also extremely worthy of funding, and the administration should be commended 

for its proposal. 

The AIDS Institute supports continued and increased funding for the Minority 

HIV/AIDS Initiative (MHAI). MHAI funds services nationwide that address the disproportionate impact that HIV has on communities of color. 

CENTERS FOR DISEASE CONTROL AND PREVENTION—HIV PREVENTION AND SURVEILLANCE 

[In millions of dollars] 

Fiscal year Amount 

2005 ......................................................................................................................................................................... 662 

2006 ......................................................................................................................................................................... 651 

2007 President’s request ......................................................................................................................................... 740 

2007 community request ......................................................................................................................................... 1,049 

While the number of new HIV infections in the United States has greatly decreased since the 1980’s, there are still an estimated 40,000 new infections each 

year. Since AIDS is a preventable disease, these are 40,000 new infections annually 

that could have been prevented. Leading the Federal Government’s campaign in 

AIDS prevention is the CDC. As with other domestic AIDS programs, funding is severely lagging, and the CDC is being asked to do more with fewer and fewer dollars. 

In fact, CDC’s AIDS funding has declined in the last 4 years in a row. It is not surprising given the budget decreases, the administration’s goal of reducing the infection rate in half by 2005 did not occur. 

Fiscal Year 2007 Administration Initiative.—The AIDS Institute is in strong support of President Bush’s proposed increase of $90 million ‘‘to the purchase and distribution of rapid HIV test kits, facilitating the testing of more than 3 million additional Americans. Test kits would be distributed in areas of the country with the 

highest rates of newly discovered HIV cases, and the highest suspected rates of undetected cases.’’ A large portion of the funds would be used for the testing of prisoners and intravenous drug users, two groups with extremely high levels of infections. Knowledge of one’s HIV status, particularly for high risk individuals, is an 

effective prevention tool. Approximately one quarter of the over 1 million people living with HIV in the United States (252,000 to 312,000 persons) are unaware of their 
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HIV status. This initiative, if funded by the Congress, should help prevent future 

infections and bring additional people into lifesaving treatment and care. The AIDS 

Institute urges the Committee to fund this extremely worthy program. 

While The AIDS Institute supports increased testing programs, we do not support 

funding those efforts at the expense of prevention intervention programs. Funding 

for these programs are already under funded. 

We are pleased to hear that the new leadership of CDC’s HIV prevention programs has pledged to make the CDC budget more transparent, and will better detail 

where the funds are being spent, and on what populations and programs. For far 

too long, this information has not been made available. 

Efforts to improve prevention methods and weed out non-effective programs 

should be a constant undertaking and be guided by science and fact based decisionmaking. It is for these reasons that The AIDS Institute opposes funding of abstinence-only until marriage programs, for which the President requested a $27 million increase. While we support abstinence-based prevention programs as part of a 

comprehensive prevention message, there is no scientific proof that abstinence-only 

programs work. On the contrary, they reject proven prevention tools, such as 

condoms, and fail to address the needs of homosexuals, who can not marry, and who 

remain greatly impacted by HIV/AIDS. Given that approximately one-half of all new 

infections in the United States are among those under the age of 25, it is essential 

that our youth be given the proper tools to prevent HIV infection. 

NATIONAL INSTITUTES OF HEALTH-AIDS RESEARCH 

[In million of dollars] 

Fiscal year Amount 

2005 ......................................................................................................................................................................... 2,921 

2006 ......................................................................................................................................................................... 2,903 

2007 President’s request ......................................................................................................................................... 2,888 

2007 community request ......................................................................................................................................... 3,000 

Through the NIH, research is conducted to: understand the AIDS virus and its 

complicated mutations; discover new drug treatments; develop a vaccine and other 

prevention programs such as microbicides; and ultimately, a cure. Much of this work 

at the NIH is done in cooperation with private funding and ingenuity. The critically 

important work performed by the NIH not only benefits those in the United States, 

but the entire world. 

This research has already helped in the development of many highly effective new 

drug treatments, prolonging the lives of millions of people. Undoubtedly, the commitment of the Congress and the administration to double NIH funding over the 

past 5 years has led to great advances. As neither a cure nor a vaccine exists, and 

patients continue to build resistance to existing medications, additional research in 

cooperation with private interests must continue. We are disappointed the President’s budget is proposing a decrease of $15 million in AIDS research for fiscal year 

2007. We ask the Committee to fund NIH, including critical AIDS research, at the 

community requested level of $30 billion. 

Substance Abuse and Mental Health Services Administration 

It is widely known that many persons infected with HIV also experience drug 

abuse and/or mental health problems, and require the programs funded by 

SAMHSA. Given the growing need for services, we are disappointed that overall 

funding requested for SAMHSA is down by $71 million, and the Center for Substance Abuse Treatment is being cut by $24 million, the Center for Substance Abuse 

Prevention is cut by $12 million, and the Center for Mental Health Services is cut 

by $35 million. We ask the Committee to reject these cuts, and adequately fund 

these programs. 

VIRAL HEPATITIS

Viral Hepatitis, whether A, B, or C, are infectious diseases that also deserve special attention by the Federal Government and the subcommittee. According to the 

CDC, there are an estimated 1.25 million Americans chronically infected with Hepatitis B, and 73,000 new infections each year. Although there is no cure, a vaccine 

has been available since 1982, and there are a few treatment options available. An 

estimated 3.9 million (1.8 percent) Americans have been infected with Hepatitis C, 

of whom 2.7 million are chronically infected. Currently, there is no vaccine or cure, 
319 

and very few treatment options available. It is believed that one-third of those infected with HIV are co-infected with Hepatitis C. 

Given these numbers, we are disappointed that the administration is proposing 

to cut the 317 Immunization Grant Program funds that serve as the major source 

in the public sector for at-risk adult immunizations. Instead of facing cuts, since the 

vaccines are relatively inexpensive, this cost-effective program should be significantly enhanced in order to protect people from Hepatitis A and B. We recommend 

funding the 317 Program at $800 million for fiscal year 2007 in order to fully realize 

the public health benefits of immunization. 

The administration is also calling for decreased funding for Viral Hepatitis at the 

CDC. The program is currently funded at a level less than it was in fiscal year 2003, 

and falls way short of the $50 million that is needed. These funds are needed to 

establish a program to lower the incidence of Hepatitis C through education, outreach, and surveillance, and to support such initiatives as the CDC National Hepatitis C Prevention Strategy and the 2002 NIH Consensus Statement on the Management of Hepatitis C and accompanying recommendations. 

The AIDS Institute asks that you give great weight to our testimony and remember it as you deliberate over the fiscal year 2007 appropriation bill. Should you have 

any questions or comments, feel free to contact Carl Schmid, Director of Federal Affairs, The AIDS Institute (202) 462–3042 or cschmid@theaidsinstitute.org. Thank 

you very much. 

PREPARED STATEMENT OF THE AMERICAN ACADEMY OF FAMILY PHYSICIANS

The 94,000-member American Academy of Family Physicians submits this statement for the record to the Senate Appropriations Subcommittee on Labor/Health 

and Human Services, Education and Related Agencies. Our statement is made in 

support of the Section 747 Primary Care Medicine and Dentistry Cluster. The Academy also supports the Agency for Healthcare Research and Quality (AHRQ) and 

rural health programs. 

BRIEF BACKGROUND: TRAINING FAMILY PHYSICIANS

Section 747 within the Public Health Service Act is the only Federal program that 

funds training for family physicians. The law requires the program to meet two 

goals: (1) increase the number of primary care physicians (family physicians, general internists and general pediatricians) and (2) boost the number of people to provide care to the underserved. Regarding family medicine specifically, Section 747 offers competitive grants for training programs in medical school and in residency 

programs. 

The fiscal year 2006 spending bill provided $41 million to Section 747, a figure 

that was a significant cut from the $88.8 million the cluster received in fiscal year 

2005. And, unfortunately, the President’s fiscal year 2007 budget proposed zero dollars for the program. We urge Congress to fund Section 747 at fiscal year 2005 levels ($88.8 million). 

WHO ARE FAMILY PHYSICIANS?

Family physicians are the specialists trained to provide comprehensive, coordinated and continuing care to patients of both genders and all ages and ethnicities, 

regardless of medical condition. These residency-trained, primary care physicians 

treat babies with ear infections, adolescents who are obese, adults with depression 

and seniors with multiple, chronic illnesses. And because they focus on prevention, 

primary care, and integrating care for their patients, they are able to treat illnesses 

early and cost-effectively. In addition, when necessary, family physicians help patients navigate our complex health system and find the right subspecialists. Finally, 

family physicians are distributed throughout the country in approximately the same 

proportion as the population: about one-quarter of all Americans live in rural areas 

and about 25 percent of family physicians practice there, as well. 

COMMUNITY HEALTH CENTERS: UNDERSTAFFED WITH SHORTAGES OF FAMILY

PHYSICIANS

Over the last few years, the administration has made increasing the number of 

Community Health Centers (CHCs) a priority within its health care budget. Specifically, the President’s fiscal year 2007 blueprint recommends an increase of $181 million for CHCs, which would increase funding to nearly $2 billion. These dollars 

would complete the administration’s goal to create 1,200 health center sites around 

the Nation. While a laudable objective, this funding does not take into account staff-
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ing issues at these centers; the CHC dollars go primarily to so-called ‘‘bricks and 

mortar,’’ i.e., construction of the health care clinics. 

The additional funding recommended in the President’s budget to build Community Health Centers, and the zero dollars proposed to train family physicians under 

Section 747, are a serious disconnect: primary care physicians make up nearly 90 

percent of doctors working in CHCs—and most are family physicians. In short, without more family physicians, no one will be available to staff these new centers. 

This point was brought home in a March 1, 2006 article in the Journal of the 

American Medical Association (JAMA). The authors found that in 2004, CHCs were 

understaffed and could not fill all clinical positions (Rosenblatt, et al.). Rural health 

centers had more openings that took longer to fill than those in urban areas. More 

alarmingly, over 13 percent of family physician positions at CHCs were vacant. 

As the only Federal program that trains family physicians, funding for Section 

747 is critical. Without Section 747 to train family physicians, CHCs staffing problems will get worse. 

SECTION 747 PRODUCES DOCTORS WHO WORK IN CHCS AND SERVE IN THE NHSC

A second study buttresses the importance of family physicians to CHCs and to the 

National Health Service Corps, which is another administration priority. An unpublished 2006 study from the University of California, San Francisco and the Robert 

Graham Center for Policy Studies in Family Medicine and Primary Care shows that 

medical schools that receive Section 747 dollars produce physicians who work in 

CHCs and serve in the National Health Service Corps compared to schools without 

this funding. 

The finding is particularly true for family physicians. Specifically, according to the 

study, nearly 4,000 family physicians and general practitioners were exposed to 

Title VII funding during medical school and subsequently chose to work in a CHC. 

Without this exposure, at least 750 fewer family physicians would have been working in a CHC in 2003. Coupled with the JAMA article, which shows that there are 

600 vacancies for family physicians, without Section 747 funding, there would be 

twice as many vacancies in health centers. 

LOWER HEALTH CARE COSTS AND IMPROVED QUALITY

Section 747 plays a role in lowering our Nation’s health care costs and increasing 

the quality of U.S. health care. For example, an article in Health Affairs (April 

2004) demonstrated that States that spent more on Medicare had lower quality of 

care. While seemingly counterintuitive, the authors found two reasons for this result. 

The first reason was that expensive health care did not improve patient satisfaction or outcomes. The second reason was that the makeup of the health care workforce made a difference: more primary care doctors in a State meant higher quality 

care and lower cost. In contrast, more specialists and fewer generalists led to lower 

quality and higher costs. And, just a small increase in the number of primary care 

doctors in a State was associated with a large boost in that State’s quality ranking. 

The first reason was that expensive health care did not improve patient satisfaction or outcomes. The second reason was that the makeup of the health care workforce made a difference: more primary care doctors in a State meant higher quality 

care and lower cost. In contrast, more specialists and fewer generalists led to lower 

quality and higher costs. And, just a small increase in the number of primary care 

doctors in a State was associated with a large boost in that State’s quality ranking. 

An article in a March 2005 edition of Health Affairs, ‘‘The Effects of Specialist 

Supply on Populations’ Health: Assessing the Evidence’’ went even further. This 

piece stated that there was a ‘‘negative relationship between the supply of primary 

care physicians and death from stroke, infant mortality and low-birthweight, and 

all-cause mortality.’’ The article went on to say that just one more primary care physician per 10,000 people was associated with a decrease of 34.6 deaths per 100,000 

people. 

The article also cited breast cancer research for the State of Florida, which indicated that ‘‘each tenth-percentile increase in primary care physician supply is associated with a statistically significant 4 percent increase in odds of early-stage breast 

cancer.’’ Statistics were similar for other types of cancers: there was a relationship 

between early identification of cancer and the supply of primary care physicians. 

Numerous other research was highlighted in the Health Affairs article that indicated a higher ratio of primary care physicians to populations led to better health 

outcomes. These data support the need for additional funding for Section 747, the 

only Federal program that produces primary care physicians. 
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THE OVERSPECIALIZED U.S. PHYSICIAN WORKFORCE: A WORLD ANOMALY

Unlike all other developed countries, the United States does not have a primary 

care-based health care system. While other developed countries have about equal 

numbers of primary care physicians and subspecialists, in the United States, less 

than one-third of the physician workforce is primary care. 

More disturbingly, compared to developed countries, the United States spends the 

most per capita on healthcare—but has some of the worst healthcare outcomes. 

More than 20 years of evidence have shown that a health system based on primary 

care produces greater health and economic benefits. Boosting support for Section 

747, which funds training for family physicians and for other primary care disciplines, could improve the health of patients in the United States. 

AGENCY FOR HEALTHCARE, RESEARCH AND QUALITY

The Academy recommends $440 million for the Agency for Healthcare, Research 

and Quality (AHRQ). A major purpose of AHRQ is to conduct primary care and 

health services research geared to physician practices, health plans and policymakers. What this means is that the agency translates research findings from basic 

science entities like the National Institutes of Health (NIH) into information that 

doctors can use every day in their practices. Another key function of the agency is 

to support research on the conditions that affect most Americans. 

More recently, AHRQ has become the lead Federal agency for research on comparative clinical effectiveness; information technology; and patient safety. For example, the Medicare Modernization Act asked AHRQ to study the ‘‘clinical effectiveness 

and appropriateness of specified health services and treatments,’’ and to use this information to improve the quality and effectiveness of the costly Medicare, Medicaid 

and SCHIP programs. In fiscal year 2006, $15 million was appropriated by Congress 

for this purpose. This type of study on ‘‘what works’’ in clinical therapies is crucial 

in an era of skyrocketing health care costs and limited Federal dollars. 

Historically, however, AHRQ has been the lead agency to translate research into 

information for physicians and patients. Over the years, Congress has provided billions of dollars to the National Institutes of Health, which has resulted in important 

insights in preventing and curing major diseases. However, AHRQ’s role has been 

to take this basic science and produce understandable, practical materials for the 

entire healthcare system. In short, AHRQ is the link between research and the patient care that Americans receive. 

In addition, AHRQ has long-supported research on conditions that affect most 

people. Most Americans get their medical care in doctors’ offices and clinics. However, most medical research comes from the study of extremely ill patients in hospitals. AHRQ studies and supports research on the types of illness that trouble most 

people. In brief, AHRQ looks at the problems that bring people to their doctors 

every day—not the problems that send them to the hospital. 

RURAL HEALTH PROGRAMS

Continued funding for rural programs is vital to provide adequate health care 

services to America’s rural citizens. We support the Federal Office of Rural Health 

Policy; Area Health Education Centers; the Community and Migrant Health Center 

Program; and the NHSC. State rural health offices, funded through the National 

Health Services Corps budget, help States implement these programs so that rural 

residents benefit as much as urban patients. 

CONCLUSION

The Academy urges Congress to fund Section 747 at fiscal year 2005 levels ($88.8 

million). We believe that the two recent studies showing that Community Health 

Centers not only rely heavily on family physicians, but cannot fill all of their positions, and the data indicating the crucial role that primary care training plays in 

whether physicians practice in CHCs or serve in the NHSC, make an irrefutable 

case for funding Section 747. In addition, however, family physicians are critical to 

the health and well-being of everyone in the country. Finally, all of these studies, 

authored by different researchers, are consistent: Section 747 works. 

The AAFP also urges Congress to fund the Agency for Healthcare Research and 

Quality at $440 million; and support rural health programs. We thank you in advance for making these investments in America’s healthcare system. 
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PREPARED STATEMENT OF THE AMERICAN ACADEMY OF PEDIATRICS

There can be no denying that there have been numerous and significant successes 

in improving the health and well-being of America’s children and adolescents, from 

even just decades ago. Infant and child mortality rates have been radically lowered. 

The number of 2-year-olds who have received the recommended series of immunizations is at an all-time high, while vaccine-preventable diseases such as measles, pertussis, and diphtheria have decreased by over 98 percent Teen pregnancy rates have 

declined by 27 percent over the last decade. Still, despite these successes, far too 

many children in America continue to suffer from disease, injury, abuse, racial and 

ethnic health disparities, or lack of access to quality care. And more than 9 million 

children and adolescents through age 18 remain uninsured. Clearly there remains 

much work to do. 

As clinicians we not only diagnose and treat our patients, we must also promote 

strong preventive interventions to improve the overall health and well-being of all 

infants, children, adolescents and young adults. Likewise, as policy-makers, you 

have an integral role to play in improving the health of the next generation through 

adequate and sustained funding of vital Federal programs. 

The AAP, SAM and APA have identified three key priorities within this Committee’s jurisdiction that are at the heart of improving the health and well-being of 

America’s children and adolescents: access to health care, quality of health care, and 

immunizations. 

ACCESS

We believe that all children and adolescents should have full access to comprehensive, age-appropriate, quality health care. From the ability to receive primary care 

from a pediatrician trained in the unique needs of children and adolescents, to timely access, to pediatric medical subspecialists and pediatric surgical specialists, 

America’s children and adolescents deserve access to quality pediatric care in a medical home. Given the recent cuts to the Medicaid program and fiscal belt-tightening 

in the States, discretionary programs now more than ever provide a vital health 

care safety net for America’s most vulnerable children and adolescents. 

Maternal and Child Health Block Grant.—The Maternal and Child Health (MCH) 

Block Grant Program at the Health Resources and Services Administration (HRSA) 

is the only Federal program exclusively dedicated to improving the health of all 

mothers and children. Nationwide, the MCH Block Grant Program provides preventive and primary care services to over 32 million women, infants, children, adolescents and children with special health care needs. In addition, the MCH Block 

Grant Program supports community programs around the country in their efforts 

to reduce infant mortality, prevent injury and violence, expand access to oral health 

care, and address racial and ethnic health disparities. Moreover, the MCH Block 

Grant Program includes efforts dedicated to addressing interdisciplinary training, 

services and research for adolescents’ physical and mental health care needs, and 

supports programs for vulnerable adolescent populations, including health care initiatives for incarcerated and minority adolescents, and violence and suicide prevention. It also plays an important role in the implementation of the State Children’s 

Health Insurance Program (SCHIP), which is critically important at a time when 

States are struggling with ongoing deficits and shifting costs. One of the many successful MCH Block Grant programs is the Healthy Tomorrows Partnership for Children Program, a public/private collaboration between the MCH Bureau and the 

American Academy of Pediatrics. Established in 1989, Healthy Tomorrows has supported over 140 family-centered, community-based initiatives in 44 States, including 

Ohio, Wisconsin, Texas, California, Kentucky, Rhode Island, and Maryland. These 

initiatives have addressed issues such as access to oral and mental health care, abstinence, injury prevention, and enhanced clinical services for chronic conditions 

such as asthma. To continue to foster these and other community-based solutions 

for local health problems, in fiscal year 2007 we strongly support an increase in 

funding for the MCH Block Grant Program to $724 million. 

Family Planning Services.—The family planning program, Title X of the Public 

Health Services Act, ensures that all teens have confidential access to valuable family planning resources. For every dollar spent on family planning through Title X, 

$3 is saved in pregnancy-related and newborn care costs to Medicaid. Title X— 

which does not provide funding for abortion services—provides critically needed preventive care services like pap tests, breast exams, and STI tests to millions of adolescents and women. But funding for Title X continues to fall well below the need. 

Over 9 million cases of STIs (almost half the total number) are in 15- to 24-yearolds, and over 30 percent of women will become pregnant at least once before age 

20. Teen pregnancy rates continue to vary over racial and ethnic groups, and nearly 
323 

half (48 percent) of all teens say that they want more information from—and increased access to—sexual health care services. Responsible sexual decision-making, 

beginning with abstinence, is the surest way to protect against sexually transmitted 

infections and pregnancy. However, for adolescent patients who are already sexually 

active, confidential contraceptive services, screening and prevention strategies 

should be available. We therefore support a funding level in fiscal year 2007 of $375 

million for Title X of the Public Health Service Act. 

Mental Health.—It is estimated that over 13 million children and adolescents 

have a mental health problem such as depression, ADHD, or an eating disorder, and 

for as many as 6 million this problem may be significant enough to disturb school 

attendance, interrupt social interactions, and disrupt family life. Despite these statistics, the National Institute of Mental Health (NIMH) estimates that 75–80 percent of these children fail to receive mental health specialty services, due to stigma 

and the lack of affordability of care and availability of specialists. Grants through 

the Children’s Mental Health Services program have been instrumental in achieving 

decreased utilization of inpatient services, improvement in school attendance and 

lower law enforcement contact for children and adolescents. We recommend that 

$109.7 million be allocated in fiscal year 2007 for the Mental Health Services for 

Children program to continue these improvements for children and adolescents with 

mental health problems. 

Child Abuse and Neglect.—Health care providers play a crucial role in the prevention, identification, and treatment of child abuse and neglect. In spite of this fact, 

few Federal resources are dedicated to bringing the medical profession into full partnership with law enforcement, the judiciary, and social workers. We urge the subcommittee to provide an increase of $10 million in fiscal year 2007 for the Center 

for Disease Control and Prevention’s National Center for Injury Prevention and 

Control to establish a network of consortia to link and leverage health care professionals and resources to address—and ultimately prevent—child abuse and neglect. 

Health Professions Education and Training.—Critical to building a pediatric 

workforce to care for tomorrow’s children and adolescents are the Training Grants 

in Primary Care Medicine and Dentistry, found in Title VII of the Public Health 

Service Act. These grants are the only Federal support targeted to the training of 

primary care professionals. They provide funding for innovative pediatric residency 

training, faculty development and post-doctoral programs throughout the country. 

For example, the Montefiore Medical Center in the South Bronx of New York City 

has used Title VII funds to support its Residency Training Program in Social Pediatrics (RPSP). Initiated in response to local needs to prepare physicians for the delivery of care to underserved populations and to practice specifically at Community 

Health Centers in the inner-city setting, RPSP simultaneously trains physicians in 

neighborhood health centers and in an academic hospital. Since its inception, RPSP 

has graduated over one hundred pediatricians, a large number of whom are women 

and minority physicians. Additionally, 79 percent of all RPSP graduates report that 

they currently practice in community-oriented primary care settings serving predominately poor and minority inner-city populations. Another 10 percent of RPSP 

graduates report that they are involved in professional activities such as health administration and policy, including directing patient care in community health centers. 

Through the continuing efforts of this subcommittee, Title VII has provided a vital 

source of funding for critically important programs that educate and train tomorrow’s generalist pediatricians in a variety of settings to be culturally competent and 

to meet the special health care needs of their communities. We recommend fiscal 

year 2007 funding of at least $40 million for General Internal Medicine/General Pediatrics. We also join with the Health Professions and Nursing Education Coalition 

in supporting an appropriation of at least $550 million in total funding for Titles 

VII and VIII. We applaud the administration’s support for the National Health 

Service Corps and Community Health Centers, key components with Title VII to ensuring an adequate distribution of health care providers across the country; but we 

emphasize the need for continued support of the training and education opportunities through Title VII for health care professionals who provide care for our Nation’s 

communities. 

Independent Children’s Teaching Hospitals.—Equally important to the future of 

pediatric education and research is the dilemma faced by independent children’s 

teaching hospitals. In addition to providing critical care to the Nation’s children, 

independent children’s hospitals play a significant role in training tomorrow’s pediatricians and pediatric subspecialists. Children’s hospitals train 30 percent of all pediatricians, half of all pediatric subspecialists, and the majority of pediatric researchers. However, children’s hospitals qualify for very limited Medicare support, 

the primary source of funding for graduate medical education in other inpatient en-
324 

vironments. As a bipartisan Congress has recognized in the last several years, equitable funding for Children’s Hospitals Graduate Medical Education (CHGME) is 

needed to continue the education and research programs in these child- and adolescent-centered settings. Since 2000, CHGME hospitals accounted for nearly 87 percent of the growth in pediatric subspecialty training programs and 68 percent of the 

growth in pediatric subspecialty fellows trained. We are extremely disappointed in 

the 67 percent reduction in funding for this vital program proposed by the administration, and join with the National Association of Children’s Hospitals to restore 

funding of $303 million for the CHGME program in fiscal year 2007. The support 

for independent children’s hospitals should not come, however, at the expense of valuable Title VII and VIII programs, including grant support for primary care training. 

QUALITY

Access to health care is only the first step in protecting the health of all children 

and adolescents. We must ensure that the care provided is of the highest quality. 

Robust Federal support for the wide array of quality improvement initiatives, including research, is needed if this goal is to be achieved. 

Emergency Services for Children.—One program that assists local communities in 

providing quality care to children in distress is the Emergency Medical Services for 

Children (EMSC) grant program. There are approximately 30 million child and adolescent visits to the Nation’s emergency departments every year. Children under the 

age of 3 years account for most of these visits. Up to 20 percent of children needing 

emergency care have underlying medical conditions such as asthma, diabetes, sicklecell disease, low birthweight, and bronchopulmonary dysplasia. A CDC report issued 

in February of 2006 reaffirmed that more hospitals must be properly equipped and 

clinicians must be educated and trained to manage these special health care needs 

in emergency situations. In addition, emergency systems must be equipped with the 

resources needed to care for this especially vulnerable population. In order to assist 

local communities in providing the best emergency care to children, we once again 

reject the administration’s proposed elimination of the EMSC program and strongly 

urge that the EMSC program be maintained and adequately funded at $25 million 

in fiscal year 2007. 

Agency for Healthcare Research and Quality.—Quality of care rests on quality research—for new detection methods, new treatments, new technology and new applications of science. As the lead Federal agency on quality of care research, the Agency for Healthcare Research and Quality (AHRQ) provides the scientific basis to improve the quality of care, supports emerging critical issues in health care delivery 

and addresses the particular needs of priority populations, such as children. Substantial gaps still remain in what we know about health care needs for children and 

adolescents and how we can best address those needs. Children are often excluded 

from research that could address these issues. The AAP and endorsing organizations 

strongly support AHRQ’s objective to encourage researchers to include children and 

adolescents as part of their research populations. We also support increasing 

AHRQ’s efforts to build pediatric health services research capacity through career 

and faculty development awards and strong practice-based research networks. Additionally, AHRQ is focusing on initiatives in community and rural hospitals to reduce 

medical errors and to improve patient safety through innovative use of information 

technology—an initiative that we hope would include children’s hospitals as well. 

Through its research and quality agenda, AHRQ continues to provide policymakers, 

health care providers, and patients with critical information needed to improve 

health care; therefore, we join with the Friends of AHRQ to recommend funding of 

$440 million for AHRQ in fiscal year 2007. 

National Institutes of Health.—Since its inception, the National Institutes of 

Health (NIH) has been an integral part of the public health continuum. NIH serves 

as a vital component in improving the Nation’s health through research, both on 

and off the NIH campus, and in the training of researchers, including pediatric investigators. Over the years, NIH has made dramatic strides that directly impact the 

quality of life for infants, children and adolescents through biomedical and behavioral research. For example, NIH research has led to successfully decreasing infant 

death rates by over 70 percent, increasing the survival rates from respiratory distress syndrome, and dramatically reducing the transmission of HIV from infected 

mother to fetus and infant from 25 percent to just 1.5 percent. NIH is engaged in 

a comprehensive research initiative to address and explain the reasons for a major 

public health dilemma—the increasing number of obese and overweight children 

and adults in this country. Today U.S. teenagers are more overweight than young 

people in many other developed countries. And the Newborn Screening Initiative is 
325 

moving forward to improve availability, accessibility, and quality of genetic tests for 

rare conditions that can be uncovered in newborns. The pediatric community applauds the prior commitment of Congress to maintain adequate funding for the 

NIH. We remain concerned, however, that the cumulative effect of several years of 

flat funding will stall or even set back the gains that were made under the years 

of the NIH’s budget doubling. We urge you to sustain the momentum of scientific 

discovery. We support the recommendation of the Ad Hoc Group for Medical Research for a funding level in fiscal year 2007 of $29.75 billion. In addition, to ensure 

ongoing and adequate child and adolescent focused research, such as the National 

Children’s Study (NCS) led by the National Institute for Child Health and Human 

Development (NICHD), we join with the Friends of NICHD Coalition in requesting 

$1.35 billion in fiscal year 2007. Moreover we recommend that the NCS be adequately funded in fiscal year 2007 at $69 million to begin the implementation phase 

of this important study. We are greatly disappointed by and reject the administration’s proposal to phase out the NCS in 2007. This large longitudinal study, authorized in the Children’s Health Act of 2000, will provide critical research and information on major causes of childhood illnesses such as premature birth, asthma, obesity, 

preventable injury, autism, development delay, mental illness, and learning disorders. 

We commend this committee’s ongoing efforts to make pediatric research a priority at the highest level of the NIH. We urge continued Federal support of NIH 

efforts to increase pediatric biomedical and behavioral research, including such 

proven programs as targeted training and education opportunities and loan repayment. We recommend continued interest in and support for the Pediatric Research 

Initiative in the Office of the NIH Director and sufficient funding to continue the 

pediatric training grant and pediatric loan repayment programs both enacted in the 

Children’s Health Act of 2000. This would ensure that we have adequately trained 

pediatric researchers in multiple disciplines that will not come at the expense of 

other important programs. 

Finally, as clinicians, we know first-hand the considerable benefits for children 

and society in securing properly studied and dosed medications. The benefits of pediatric drug testing are undisputed. Proper pediatric safety and dosing information 

reduces medical errors and adverse events, ultimately improving children’s health 

and reducing health care costs. In a very conservative estimate, the FDA projects 

savings from pediatric testing of over $228 million a year in reduced hospitalization 

expenses for just five diseases affecting children. But until now there has been little 

incentive for drug companies to study off-patent drugs—older drugs that are critically needed therapies for children. The Research Fund for the Study of Drugs, created as part of the Best Pharmaceuticals for Children Act of 2002, provides support 

for these critical pediatric testing needs, but unfortunately is currently funded at 

an amount sufficient to test only a fraction of the NIH and FDA-designated ‘‘priority’’ drugs. Therefore, we urge the subcommittee to provide the NIH with sufficient funding to fund the study of generic (off-patent) and selected on-patent drugs 

for pediatric use. 

We believe that these requests represent the best and most reliable estimates of 

the level of funding needed to sustain the high standard of scientific achievement 

embodied by the NIH. However, we encourage Congress to explore all possible options to identify additional sources of funding needed to support these increases if 

we are to reach these funding goals while not weakening any other valuable component of the Public Health Service. 

IMMUNIZATION

Immunization remains one of the greatest public health achievements of the last 

century, saving literally millions of lives. Thanks to the widespread use of vaccines, 

millions of children have avoided serious and often fatal diseases that previously 

devastated lives. Before immunization, polio paralyzed 10,000–25,000 children and 

adults, rubella (German measles) caused birth defects and mental retardation in as 

many as 20,000 newborns, and measles infected millions of children, killing 400– 

500 and leaving thousands with serious brain damage each year. Immunizations 

have reduced by more than 95 percent the cases of vaccine-preventable infectious 

diseases in this country. And some, like rubella, are virtually eliminated from North 

America, thanks to successful immunization programs. 

Pediatricians, working alongside public health professionals and other partners, 

have brought the United States its highest immunization coverage levels in history—over 92 percent of children received all vaccinations by school age in 2004– 

2005. We attribute this, in part, to the Vaccines for Children (VFC) Program, and 

encourage Congress to maintain its commitment to ensuring the program’s viability. 
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The VFC program combines the efforts of public health and private pediatricians 

and other health care professionals to accomplish and sustain vaccine coverage goals 

for both today’s and tomorrow’s vaccines. It removes vaccine cost as a barrier to immunization for some and reinforces the concept of vaccine delivery in a ‘‘medical 

home.’’ However, we are concerned that the administration’s fiscal year 2007 budget 

once again has proposed to reduce funding for the Section 317 program by transferring funds from that program to expand VFC. This is shortsighted. Additional section 317 funding is necessary to provide the pneumococcal conjugate vaccine (PCV– 

7), a vaccine that prevents an infection of the brain covering, blood infections and 

approximately 7 million ear infections a year, to those remaining States that currently do not provide it. Increased Section 317 funding also is needed to purchase 

the influenza vaccine—now recommended for children between the ages of 6 months 

and 5 years of age. This age cohort is increasingly susceptible to serious infection 

and the risk of hospitalization. And an increase in funding is needed to purchase 

the recently recommended rotavirus vaccine, tetanus-diptheria-pertussis (Tdap) vaccine for adolescents and the meningococcal conjugate vaccine (MCV). Meningococcal 

disease is a serious illness, caused by bacteria, with 10–15 percent of cases fatal and 

another 10–15 percent of cases resulting in permanent hearing loss, mental retardation, or loss of limbs. 

The public health infrastructure that now supports our national immunization efforts must not be jeopardized with insufficient funding. One of the conclusions of 

the 2000 Institute of Medicine report, Calling the Shots, was that unstable funding 

for State immunization programs threatens coverage levels for specific populations 

and age groups and vaccine safety. This continues to be true today. A strong and 

sufficient infrastructure is essential. For example, adolescents continue to be adversely affected by vaccine-preventable diseases (e.g., chicken pox, hepatitis B, measles and rubella). Comprehensive adolescent immunization activities at the national, 

State and local levels are needed to achieve national disease elimination goals. 

States and communities continue to be financially strapped and therefore, many 

continue to divert funds and health professionals from routine immunization clinics 

in order to accommodate anti-bioterrorism initiatives or now pandemic influenza. 

Moreover, continued investment in the CDC’s immunization activities must be made 

to avoid the reoccurrence of childhood vaccine shortages by providing and adequately funding a national 6 month stockpile for all routine childhood vaccines— 

stockpiles of sufficient size to insure that significant and unexpected interruptions 

in manufacturing do not result in shortages for children. 

While the ultimate goal of immunizations clearly is eradication of disease, the immediate goal must be prevention of disease in individuals or groups. To this end, 

we strongly believe that CDC’s efforts must be sustained. In fiscal year 2007, we 

recommend an overall increase in funding above fiscal year 2006 of $282 million to 

ensure that the CDC’s National Immunization Program has the funding necessary 

to accommodate vaccine price increases, new disease preventable vaccines coming on 

the market, global immunization initiatives—including funds for polio eradication 

and the elimination of measles and rubella—and to continue to implement the recommendations developed by the IOM. 

CONCLUSION

We appreciate the opportunity to provide our recommendations for the coming fiscal year. As this subcommittee is once again faced with difficult choices and multiple priorities we know that as in the past years, you will not forget America’s children and adolescents. 

Other recommendations for fiscal year 2007: 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Agency Amount 

Centers for Disease Control and Prevention (total) ........................................................................................ $8,500,000,000 

Polio Eradication ..................................................................................................................................... 101,254,000 

Birth Defects, Disability and Health ....................................................................................................... 135,000,000 

Newborn Hearing Screening Technical Assistance ................................................................................. 9,000,000 

National Violent Death Reporting System .............................................................................................. 10,000,000 

Folic Acid Education Campaign .............................................................................................................. 4,000,000 

Health Resources and Services Administration (total) ................................................................................... 7,500,000,000 

Newborn Hearing Screening Grants to States ........................................................................................ 10,000,000 

Consolidated Community Health Centers ............................................................................................... 2,038,000,000 

Substance Abuse and Mental Health Services Administration (total) ............................................................ 3,531,000,000 

Indian Health Service (total) ........................................................................................................................... 3,361,000,000 
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DEPARTMENT OF HEALTH AND HUMAN SERVICES—Continued 

Agency Amount 

Food and Drug Administration (total) ............................................................................................................. 1,566,000,000 

PREPARED STATEMENT OF THE AMERICAN ASSOCIATION OF COLLEGES OF NURSING

The American Association of Colleges of Nursing (AACN) respectfully submits this 

statement highlighting funding priorities for nursing education and research programs in fiscal year 2007. AACN represents over 590 senior colleges and universities with baccalaureate and graduate nursing programs that include over 210,000 

students and 11,000 faculty members. These institutions are responsible for educating almost half of our Nation’s registered nurses (RNs) and all of the nurse faculty and researchers. Nursing represents the largest health profession, with approximately 2.9 million dedicated, trusted professionals delivering primary, acute, 

and chronic care to millions of Americans. 

THE NATIONWIDE NURSING SHORTAGE

Our country continues to be challenged by a shortage of registered nurses that 

was first noted in 1998. This shortage is showing no signs of diminishing and demographics reveal that, unlike shortages in the past, it will affect health care delivery 

for the foreseeable future. In 2005, the American College of Healthcare Executives 

reported that 85 percent of hospitals experienced a nursing shortage. The U.S. Bureau of Labor Statistics (BLS) has projected that our country will require an additional 1.2 million new and replacement registered nurses by 2014. Nursing has been 

identified by BLS as the fastest growing professional occupation in the country. 

However, according to the Health Resources and Services Administration (HRSA), 

the supply of RNs will drop 29 percent below demand by 2020 unless deliberate action is taken to increase the number of nurses graduating each year and entering 

the workforce. Nursing vacancies exist throughout all health care sectors, including 

long-term care, home care, and public health. Among the Nation’s 5,000 community 

health centers, the vacancy rate for RNs is 10 percent and 9 percent for nurse practitioners. Even the Department of Veterans Affairs, the largest sole employer of RNs 

in the United States, has a 10 percent RN vacancy rate. 

Research clearly documents that patient safety is compromised without a sufficient number of RNs. In 2002, the Joint Commission on Accreditation of Healthcare 

Organizations (JCAHO) noted that the nursing shortage contributed to nearly a 

quarter of all unexpected incidents that adversely affect hospitalized patients. Since 

RNs comprise the largest component of a hospital workforce, shortages result in 

emergency room overcrowding and diversions, increased wait time for or cancellation of surgeries, discontinued patient care programs or reduced service hours, and 

delayed discharges. 

The nursing shortage also threatens homeland security and disaster preparedness 

efforts. The Government Accountability Office reported that local and State health 

officials cited the nursing shortage as an impediment to their preparedness efforts 

in 2003. 

These alarming facts are coupled with little change in contributing factors, such 

as the aging of America’s population, the aging nurse workforce, high rates of RN 

retirement, and the increasing demand for high acuity health care services by 

chronically ill, medically complex patients. To ensure that every patient receives the 

safest, highest quality health care, Federal support must continue to play an integral role in our Nation’s efforts to address the nursing shortage. 

CURRENT STRATEGY: NURSING WORKFORCE DEVELOPMENT PROGRAMS

Acknowledging the severity of the Nation’s nursing shortage, Congress passed The 

Nurse Reinvestment Act of 2002. This legislation created new programs and expanded existing Nursing Workforce Development authorities. Administered by 

HRSA under Title VIII of the Public Health Service Act, these programs focus on 

the supply and distribution of RNs across the country. Programs support individual 

students in their nursing studies through loans, scholarships, and loan repayment 

programs. Title VIII programs stimulate innovation in nursing practice and bolster 

nursing education throughout the continuum, from entry-level preparation through 

graduate study. They are the largest source of Federal funding for nursing education assisting students, schools of nursing, and health systems in their efforts to 
328 

educate, recruit, and retain RNs. In fiscal year 2005, these programs helped to educate 52,759 student nurses through individual and programmatic support. 

Funding for these authorities is insufficient to address the severity of the nursing 

shortage. Currently, Nursing Workforce Development Programs receive $149.68 million, down from $150.67 million in fiscal year 2005. During the nursing shortage in 

1974, Congress appropriated $153 million for nursing education programs. Translated into today’s dollars, that appropriation would total $615 million, more than 

four times the current level. However, it will take billions of dollars to resolve today’s nursing shortage. 

AACN respectfully requests $175 million for Title VIII Nursing Workforce Development in fiscal year 2007, an additional $25.32 million over fiscal year 2006. New 

monies would expand nursing education, recruitment, and retention efforts to help 

resolve the nursing shortage. 

Colleges of Nursing Respond 

The approximately 1,500 schools of nursing nationwide have been working diligently to expand enrollments. AACN’s 2005–2006 annual survey of 567 schools entitled, Enrollments and Graduations in Baccalaureate and Graduate Programs in 

Nursing, reveals that enrollments increased by 9.7 percent in entry-level baccalaureate nursing programs. This makes the fifth consecutive year of enrollment increases that can be attributed to a combination of Federal support through Nursing 

Workforce Development Programs, private sector marketing efforts, public-private 

partnerships providing additional resources to expand capacity of nursing programs, 

and State legislation targeting funds towards nursing scholarships and loan repayment. 

While impressive, these increases still cannot meet the demand. In the November 

2003 issue of Health Affairs, Dr. Peter Buerhaus reported that nursing school enrollments would have to increase by at least 40 percent annually just to replace 

those nurses who retire. Despite intensive efforts nationwide, AACN found that enrollments increased by a total of 57.2 percent, over the last 5 years in entry-level 

baccalaureate programs. Moreover, only 8.1 percent of RNs are under the age of 30, 

according to the 2004 National Sample Survey of Registered Nurses. 

Despite increasing enrollments and the escalating demand for RNs, U.S. schools 

of nursing still are forced to turn away eligible students. At least 41,683 qualified 

applications were turned away despite the increase in enrollments. This is a 27 percent increase from the over 32,797 denied admission in 2004, according to AACN 

data. Reasons cited for this denial are insufficient numbers of faculty, clinical sites, 

classroom space, clinical preceptors, and budget constraints. Over 73 percent of the 

schools surveyed cited the faculty shortage as the primary barrier to increasing enrollments. Some of these qualified students are placed on waiting lists for 2 years 

or more, but many good students are lost to the nursing profession. 

Bottleneck: The Nurse Faculty Shortage 

AACN believes that the most effective strategy to resolve the nursing shortage is 

addressing the underlying faculty shortage. HRSA reported in 2004 that just 13 percent of the RN workforce holds either a master’s or doctoral degree, credentials required to teach. In 2003, there were 10,500 full-time masters and doctorally prepared faculty in baccalaureate and graduate nursing programs. Projections through 

2012 show that the faculty pool will shrink by at least 2,000 as compared to 2003, 

even after accounting for retirements, resignations, and additional entrants. Note 

that these figures do not take into account the need for faculty in new or expanded 

programs, but only represent present staffing requirements. If the faculty vacancy 

rate holds steady, the deficit of nurse faculty is expected to swell to over 2,600 unfilled positions in 2012. 

This situation will only worsen with time. The number of productive years for 

nurse educators will decrease as faculty age continues to climb, averaging 52 years 

in 2004. As such, significant numbers of faculty are expected to retire in the coming 

years, but there are not enough candidates in the pipeline to take their places. An 

average of 410 individuals are awarded doctoral degrees in nursing each year, but 

almost a quarter (23 percent) take jobs outside of academic nursing. In 2005, AACN 

found a faculty vacancy rate of 8.5 percent, which translates into an average of approximately 2 faculty vacancies per school of nursing. Of those vacancies, over half, 

(52.6 percent) required a doctoral degree. Higher compensation in clinical and private sector settings lures current and potential nurse educators away from the 

classroom. For example, the average salary of a nurse practitioner in an emergency 

department was $84,835, according to the 2005 National Salary Survey of Nurse 

Practitioners. However, the average salary for a nurse practitioner in academia was 
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only $66,925, 26.8 percent less. Without sufficient nurse faculty, schools of nursing 

cannot expand enrollments. 

Reversing the Trend: Nurse Faculty Loan Program (Sec. 846A).—This trend can 

be reversed with additional appropriations for the Nurse Faculty Loan Program. Designed to increase the number of nurse faculty, schools of nursing receive grants to 

create a loan fund. To be eligible for these loans, students must pursue full-time 

study for a masters or doctoral degree. In exchange for teaching at a school of nursing, loan recipients will have up to 85 percent of their educational loans cancelled 

over a 4-year period. A student may receive a maximum loan award of $30,000 per 

academic year for tuition, books, fees, laboratory expenses, and other reasonable. 

educational costs. In fiscal year 2005, 66 new grants were made to schools of nursing, and 26 grants were continued, totaling 92. These funds will support an estimated 475 future nurse faculty members. In fiscal year 2006, $4.77 million was appropriated. However, if the current funding was doubled to almost $10 million, 

based on fiscal year 2005 projections, colleges of nursing could educate over 900 future faculty. Further, with an average faculty to student ratio of 1:10, those 900 faculty could teach an additional 9,000 nurses each year. 

Advanced Education Nursing Program (Sec. 811).—These grants support the majority of schools of nursing preparing graduate-level nurses, some of whom become 

faculty. Receiving $57.06 million in fiscal year 2006, this grant program helps 

schools of nursing, academic health centers, and other nonprofit entities improve the 

education and practice of nurse practitioners, nurse-midwives, nurse anesthetists, 

nurse educators, nurse administrators, public health nurses, and clinical nurse specialists. Out of the 88 applications reviewed for this program in fiscal year 2005, 

43 new grants were awarded, and 114 were continued. In addition, 422 schools of 

nursing received traineeship grants, which in turn directly supported 9,000 individual student nurses. 

The health system’s increasing demand for primary care, increased utilization of 

case-management—particularly for chronic illnesses, prevention and cost-efficiency, 

and a shortage of physicians are driving the Nation’s need for nurse practitioners, 

certified nurse-midwives, and other RNs with graduate education and advanced 

clinical skills, known as advanced practice registered nurses (APRNs). Mounting 

studies demonstrate the quality and cost effectiveness of APRN care. This is especially important for the 78 million aging Baby Boomers, whose demand for health 

care services will skyrocket in the near future. The rate of physician office visits 

by Medicare beneficiaries jumped 20.5 percent from 1992 to 2001, according to the 

Federal report Older Americans 2004: Key Indicators of Well-Being. 

Workforce Diversity Program (Sec. 821).—These grants prepare disadvantaged students to become nurses. As the United States becomes ever more heterogeneous, it 

is imperative that the composition of our nursing workforce mirrors this shift. According to the U.S. Census Bureau, roughly 30 percent of the population was reported as a racial or ethnic minority in 2000, but by 2050 that percentage will jump 

to over 52 percent. This program awards grants to schools of nursing and other entities seeking to increase access to nursing education for disadvantaged students, including those racial and ethnic minorities under-represented among RNs. Scholarships or stipends, pre-entry preparation, and retention activities are provided to enable students to complete their nursing education. In fiscal year 2005, 171 applications were reviewed, from those 11 new grants were awarded and 48 previously 

awarded grants were continued. These program funds assisted at least 6,344 students. Workforce Diversity received $16.11 million in fiscal year 2006. 

At Risk: Nursing Student Loan Program (Sec. 835).—This revolving loan fund was 

established in 1964 to specifically target nursing workforce shortages. The Nursing 

Student Loan (NSL) program provides participating undergraduate or graduate 

nursing students with a maximum of $13,000 in loans at 5 percent interest. Schools 

of nursing participating in the NSL select recipients and determine the level of assistance provided, with a preference for those with financial need. New loans are 

made as existing loans are repaid. This program has not received additional appropriations since 1983. However, in fiscal year 2005, the NSL provided financial assistance to 17,240 nursing students. In fiscal year 2005, Sec. 222 of the Consolidated 

Appropriations Act of 2005 (Public Law 108–447) included language which stated: 

‘‘The unobligated balance of the Nursing Student Loan program authorized by section 835 of the Public Health Services Act is rescinded.’’ As a result, the NSL gave 

back $6.1 million to the U.S. Treasury in July 2005. In previous years, those funds 

were redistributed among participating institutions, increasing the amount of possible loans. A similar provision, in the fiscal year 2006 appropriations law will force 

the NSL to return even more funds to the Treasury that instead could have assisted 

nursing students in completing their education. 
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NATIONAL INSTITUTE OF NURSING RESEARCH

One of the 27 Institutes and Centers at the National Institutes, of Health (NIH), 

the efforts of the National Institute of Nursing Research (NINR) improve patient 

care and foster advances in nursing and other health professions’ practice. These 

practices must be must constantly updated and validated based on rigorous, peerreviewed research. The outcomes-based findings derived from NINR research are 

important to the future of the health care system and its ability to deliver safe, costeffective, and high quality care. Through grants, research training, and interdisciplinary collaborations, NINR addresses care management of patients during illness 

and recovery, reduction of risks for disease and disability, promotion of healthy lifestyles, enhancement of quality of life in those with chronic illness, and care for individuals at the end of life. To advance this research, AACN requests a funding level 

of $150 million in fiscal year 2007, an additional $12.66 million over the $137.34 

million NINR received in fiscal year 2006. 

NINR Addresses the Need for Translational and Clinical Research 

NINR emphasizes translational research, the means by which basic findings relating to behavior, molecules, and genes are tested in the clinical setting and translated into innovative medical practices and improvements in public health. Under 

the framework of the Roadmap Initiative, NINR and nurse researchers are addressing the development of new interdisciplinary research teams and enhanced clinical 

research to move the overall NIH portfolio of social, behavioral, and medical research forward in this coordinated and cohesive effort. 

NINR Addresses the Shortage of Nurse Researchers and Faculty 

NINR allocates 8 percent of its budget, a high proportion when compared to other 

NIH institutes, to research training to help develop the pool of nurse researchers. 

In fiscal year 2005, NINR training dollars supported 80 individual researchers and 

provided 155 institutional awards, which in turn supported a number of nurse researchers at each site. Since nurse researchers often serve as faculty members for 

colleges of nursing, they are actively educating our next generation of RNs. 

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

While NIH supports biomedical research that improves health care by focusing on 

the cause, cure, and prevention of disease, the Agency for Healthcare Research and 

Quality (AHRQ) supports health systems research, collecting evidence-based information on health care outcomes. AHRQ research findings are used by patients, clinicians, health system decision makers, and public policymakers to guide health care 

delivery systems and patient care. The research supported by AHRQ not only improves the quality of health care services, but also helps people make more informed 

decisions about their health care. AACN joins the Friends of AHRQ in recommending a funding level of $440 million for fiscal year 2007, an additional $121.3 

million over the fiscal year 2006 level of $318.7 million. 

Health Systems Research at AHRQ Addresses Nurses’ Role in Patient Safety 

AHRQ research has demonstrated that inefficient work processes, overwhelming 

workloads, extended work hours, and poor workplace designs create obstacles to providing patients safe, cost-effective, and high quality health care. The New England 

Journal of Medicine published a study of over 6 million patients in May 2002, that 

found hospitalized patients had better outcomes when the majority of their nursing 

care was provided by RNs. Decreased hours of RN care, stemming from the nursing 

shortage, correlated with longer hospital stays, increased incidence of urinary tract 

infections and gastrointestinal bleeding, as well as higher rates of pneumonia, 

shock, and cardiac arrest. When patients received additional hours of RN care, the 

death rates dropped for pneumonia, shock or cardiac arrest, upper gastrointestinal 

bleeding, sepsis, and deep venous thrombosis. 

CONCLUSION

AACN acknowledges the fiscal challenges that the subcommittee and the entire 

Congress must work within. However, the health needs of our Nation must be addressed by a dedicated, long-term vision for educating the new nursing workforce. 

Today, nurses must evaluate research that promotes evidence-based practice and 

utilize technical innovations in providing safe, high quality patient care. Research 

shows that patient care suffers and mortality rates increase in facilities without sufficient numbers of RNs. Without highly educated nurses, who will care for us when 

we must enter into our increasingly complex health care system? 
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PREPARED STATEMENT OF THE AMERICAN ASSOCIATION OF COLLEGES OF

OSTEOPATHIC MEDICINE

On behalf of the American Association of Colleges of Osteopathic Medicine 

(AACOM) which represents the administrations, faculties and students of all twenty 

colleges of osteopathic medicine in the United States, I am pleased to present our 

views on the fiscal year 2007 appropriations for health professions education programs under Title VII of the Public Health Service Act. 

First, we must express our profound concern at the devastating cuts proposed by 

the administration for Title VII programs in its fiscal year 2007 budget. The Bureau 

of Health Professions received $342 million in cuts in the President’s fiscal year 

2007 proposal which is fully 46 prepared of its entire budget. While we support the 

$181 million increase in the President’s budget for Community Health Centers, the 

large funding decreases to the Title VII programs raises the question of whether 

there will be a sufficient number of health care providers to staff these clinics. The 

fiscal year 2007 cuts are in addition to the 12 programs that were eliminated in the 

fiscal year 2006 appropriations bills, as well as other programs that received significant decreases in both years. Congress must not allow these draconian slashes to 

cripple the programs that assist health professions schools in training the workforce 

needed to care for our citizens in the 21st century. 

A study that recently appeared in the Journal of the American Medical Association recommends increased Titles VII and VIII support to alleviate provider shortages at Community Health Centers [Shortages of Medical Personnel at Community 

Health Centers: Implications for Planned Expansion, Roger A. Rosenblatt, C. Holly. 

A. Andrilla, Thomas Curtin; L. Gary Hart, Journal of the American Medical Association, JAMA 2006;295:1042–1049]. The study found that Titles VII and VIII programs help ameliorate these shortages and maldistribution by training providers 

who are more likely to practice in rural and underserved communities. 

Health professions education programs under Title VII and nursing education programs under Title VIII are essential components of America’s health care safety net. 

An adequate diverse, well-distributed and culturally competent health workforce is 

indispensable to our national readiness efforts. Colleges of osteopathic medicine 

have a long tradition of training primary care physicians who practice in rural and 

urban underserved areas. 

The health professions education programs under Title VII and the nursing education programs under Title VIII of the Public Health Service Act have been valuable in our efforts to continue to ensure this commitment. In Public Law 105–392, 

the Health Professions Education Partnership Act of 1998, forty-four different Federal health professions training programs were consolidated into seven clusters. 

These clusters provide support for training of primary care and dental providers; the 

establishment and operation of interdisciplinary community-based training activities; health professions workforce analysis; public health workforce development; 

nursing education; and student financial assistance. These programs are designed 

to meet the health care delivery needs of over 2,800 Health Professions Shortage 

Areas in the country. Many rural and disadvantaged populations depend on the 

health professionals trained by these programs at their only source of health care. 

For example, without the practicing family physicians who are currently in place, 

an additional 1,332 of the United States’ 1,082 urban and rural counties would qualify for designation as primary care Health Professions Shortage Areas. 

Title VII programs have had a significant impact in reducing the Nation’s Health 

Professions Shortage Areas. Indeed, a 1999 study estimated that if funding for Title 

VII programs were doubled the effect would be to eliminate the Nation’s Health Professions Shortage Areas in as little as 6 years. [Politzer, RM, Hardwick, KC, Cultice, 

JM, Bazell, C. ‘‘Eliminating Primary Care Health Professions Shortage Areas: The 

Impact of Title VII Generalist Physician Education,’’ The Journal of Rural Health, 

1999: 15(1): 11–19]. 

A study by the Robert Graham Center showed that receipt of Title VII family 

medicine grants by medical schools produced more family physicians and more primary care doctors serving rural areas and health professions shortage areas. Over 

69 percent of Title VII funded internal medicine graduates practice primary care 

after graduation. This rate is nearly twice that of programs not receiving Title VII 

funding. 

Among the programs within these clusters that have been especially important to 

enhancing osteopathic medical schools’ ability to train the highest quality physicians 

are: General Internal Medicine Residencies; General Pediatric Residencies; Family 

Medicine Training; Preventive Medicine Residencies; Area Health Education Centers (AHECs); Health Education and Training Centers (HETCs); Health Careers Opportunities Programs (HCOP); and Centers of Excellence (COE) programs. 
332 

In addition, three Title VII programs offer interdisciplinary training for all health 

professions. The Geriatric Education Centers (GEC) program provides grants to support collaborative arrangements involving several health professions schools and 

health facilities that provide training in the diagnosis, treatment and prevention of 

disease and other health concerns of the elderly. The Geriatric Training program for 

physicians, dentists, and mental health professionals (GT) provides for these professionals who plan to become faculty members. The Geriatric Academic Career 

Awards (GACA) support the career development of geriatricians in junior faculty positions who are committed to an academic career of teaching clinical geriatrics in 

medical schools. 

Accordingly, Mr. Chairman and Members of the subcommittee, AACOM recommends that the fiscal year 2007 funding levels for Titles VII Health Professions 

Education and VIII Nursing Education be $299,552,000. You will note that this is 

the same level as the Congress approved for fiscal year 2005. 

AACOM also strongly urges continuation of funding for the Council on Graduate 

Medical Education (COGME). Since its inception, COGME’s diverse membership has 

given the health policy community an opportunity to discuss national workforce 

issues. The fifteen formal reports and multiple ancillary materials provided by 

COGME have offered important findings and observations in the rapidly changing 

health care environment and have argued for a system of graduate medical education that develops a physician workforce to meet the healthcare needs of the 

American people. 

Some of the more significant recommendations include: 

—Community-based education with an emphasis on primary care; 

—Continued progress toward a more representative participation of minorities in 

medicine; 

—The development and maintenance of a workforce planning infrastructure to improve the understanding of supply, need and demand forces; 

—The development of Federal-State partnerships to further workforce planning; 

and 

—Encouragement and support for medical education and health care delivery programs that increase the flow of physicians to rural areas, with an emphasis on 

the smaller, more remote communities. 

In summary, Mr. Chairman and Members of the subcommittee, health profession 

education programs under Title VII are an essential part of the healthcare safety 

net for all Americans. We respectfully urge you to restore funding for these programs at the fiscal year 2005 level. Please contact me or Michael J. Dyer, AACOM’s 

Vice President for Government Relations at (301) 968–4152 if you have any questions. 

PREPARED STATEMENT OF THE AMERICAN NURSES ASSOCIATION

The American Nurses Association (ANA) appreciates this opportunity to comment 

on fiscal year 2007 appropriations for nursing education, workforce development, 

and research programs. Founded in 1896, ANA is the only full-service national association representing registered nurses (RNs). Through our 54 constituent member 

associations, ANA represents RNs across the Nation in all practice settings. 

The ANA gratefully acknowledges this subcommittee’s history of support for nursing education and research. We appreciate your continued recognition of the important role nurses play in the delivery of quality health care services. This testimony 

will give you an update on the status of the nursing shortage, its impact on the Nation, and the outlook for the future. 

THE NURSING SHORTAGE TODAY

The nursing shortage is far from solved. Here are a few quick facts: 

—According to American Hospital Association’s 2005 Workforce Survey, 109,000 

nurses are needed immediately to fill vacancies at our Nation’s hospitals. In addition, 40 percent of the hospitals surveyed reported that RN recruitment was 

more difficult in 2004 than in 2003. 

—The Bureau of Labor Statistics reported in February of this year that registered 

nursing will have remarkable job growth in the time period spanning 2004– 

2014. During this time decade, the health care system will require more than 

1.2 million new nurses. 

—The report issued by the Division of Nursing at the Health Resources and Services Administration in 2002 projects that, absent aggressive intervention, the 

supply of nurses in America will fall 29 percent below requirements by the year 

2020. 
333 

This growing nursing shortage is having a detrimental impact on the entire 

health care system. Numerous studies have shown that nursing shortages contribute to medical errors, poor patient outcomes, and increased mortality rates. A 

study published in the January/February 2006 issue of Health Affairs showed that 

hospitals could avoid 6,700 deaths per year by increasing the amount of RN care 

provided to their patients. This study, ‘‘Nurse Staffing in Hospitals: Is There a Business Case for Quality?’’ by Jack Needleman, Peter Buerhaus, Maureen Stewart, 

Katya Zelevinsky and Soeren Mattke, also revealed that hospitals could avoid 4 million hours worth of inpatient care by avoiding the complications associated with a 

shortage of RN care. 

This study built upon research published in the New England Journal of Medicine 

in May 2002. The 2002 research was based on a review of more than 6 million patients. It found that increased hours of RN care were associated with fewer ‘‘failureto-rescue’’ deaths in hospitalized patients resulting from pneumonia, shock or cardiac arrest, upper gastrointestinal bleeding, sepsis and deep venous thrombosis. 

Research published in the October 23, 2002 Journal of the American Medical Association also demonstrated that more nurses at the bedside could save thousands 

of patient lives each year. In reviewing more than 232,000 surgical patients at 168 

hospitals, researchers from the University of Pennsylvania concluded that a patient’s overall risk of death rose roughly 7 percent for each additional patient above 

four added to a nurse’s workload. 

A Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) 

study published in 2002 shows that the shortage of nurses contributes to nearly a 

quarter of all unexpected incidents that kill or injure hospitalized patients. 

THE IMPACT ON PREPAREDNESS AND MILITARY HEALTH CARE

This growing nursing shortage has effects well beyond traditional domestic health 

care. RNs are integral to everything from pandemic flu management, to terrorism 

preparedness, to veterans’ health delivery, to disaster response. In the event of a 

terrorist attack or pandemic flu outbreak, nurses will be needed to evaluate patients, administer vaccines and medications, perform disease surveillance, and to 

train non-licensed staff. The GAO has repeatedly reported that the nursing shortage 

is complicating efforts at the State and local level to implement pandemic flu and 

bioterrorism preparedness efforts (see: GAO: 03–654T, 03–769T, 04–458T, 05–760T, 

05–863T). For instance, in May 2003, the GAO testified, ‘‘Five of the [seven] States 

we visited reported shortages of hospital medical staff, including nurses and physicians, necessary to increase response capacity in an emergency.’’ (GAO–03–769T). 

The nursing shortage is also stressing military health care delivery. The Army, 

Navy, and Air Force are offering new lucrative RN recruitment packages that include large sign-on bonuses, generous scholarships, and loan forgiveness packages. 

Yet, neither the Army nor the Air Force has met their active service nurse recruitment goals since the 1990s. On May 10, 2005, Army leaders warned the Senate Appropriations Committee that they were experiencing a 30 percent shortage of certified registered nurse anesthetists. In 2004, the Navy Nurse Corps recruitment fell 

32 percent below target. Because the military holds the vast majority of its health 

care assets in the reserves, the reserve activation has been particularly hard on 

nursing. This ongoing nurse shortage is creating real concerns about the ability to 

deliver needed health care to today’s military. 

NURSING WORKFORCE DEVELOPMENT PROGRAMS

Federal support for the Nursing Workforce Development Programs contained in 

Title VIII of the Public Health Service Act is unduplicated and essential. The 107th 

Congress recognized the detrimental impact of the developing nursing shortage and 

passed the Nurse Reinvestment Act (Public Law 107–205). This law improved the 

programs of Title VIII to meet the unique characteristics of today’s shortage. This 

achievement holds the promise of recruiting new nurses into the profession, promoting career advancement within nursing and improving patient care delivery. 

This promise will not be met, however, without a significant investment. 

In fiscal year 2005, this subcommittee allocated $151 million in funding for Title 

VIII which supported 52,795 individual grants. In fiscal year 2006, you allocated 

$150 million for Title VIII. While ANA applauds your ongoing recognition for these 

nursing workforce development programs, we also recognize that these funding levels fail to meet the challenges of the growing nursing shortage. For instance, in fiscal year 2005, 4,465 RNs applied for the Nurse Education Loan Repayment Program 

(described fully below). Due to lack of funding, a mere 803 (18 percent) were approved. 
334 

ANA strongly urges you to increase funding for Title VIII programs by at least $25 million to a total of $175 million in fiscal year 2007. This funding amount has 

been supported by a bipartisan group of 54 Senators in a Dear Colleague sent to 

this subcommittee. The nursing shortage and its impact on the health care of the 

Nation demand this continued investment. 

In 1974, this subcommittee invested $153.6 million Title VIII. Inflated to today’s dollars, this appropriation would equal $622.5 million, more than four times the current appropriation. Certainly, today’s shortage is more dire and systemic than that 

of the 1970’s; it deserves an equivalent response. 

Title VIII includes the following program areas: 

Nursing Education Loan Repayment Program & Scholarships.—This line item is 

comprised of the Nurse Education Loan Repayment Program (NELRP) and the 

Nursing Scholarship Program (NSP), the Secretary of HHS has the authority to allocate funds between the two areas. In fiscal year 2006, the Nurse Education Loan 

Repayment Program and Scholarships received $31 million. 

The NELRP repays up to 85 percent of a RN’s student loans in return for fulltime practice in a facility with a critical nursing shortage. The NELRP nurse is required to work for at least 2 years in a designated facility during which time the 

NELRP repays 60 percent of the RN’s student loan balance. If the nurse applies and 

is accepted for a third year, an additional 25 percent of the loan is repaid. 

The NELRP boasts a proven track record of delivering nurses to facilities hardest 

hit by the nursing shortage. HRSA has given NELRP funding preference to RNs 

who work in disproportionate share hospitals, skilled nursing facilities, federallydesignated health centers, and departments of public health. However, lack of funding has hindered the full implementation of this program. As stated above, in fiscal 

year 2005, 82 percent of the nurses willing to immediately begin practicing in facilities hardest hit by the shortage were turned away from this program due to lack 

of funding. 

The NSP offers funds to nursing students who, upon graduation, agree to work 

for at least 2 years in a health care facility with a critical shortage of nurses. Preference is given to students with the greatest financial need. Like the loan repayment program, the NSP has been stunted by a lack of funding. In fiscal year 2005, 

HRSA received 6,563 applications for the nursing scholarship. Due to lack of funding, a mere 217 scholarships were awarded. Therefore, 97 percent of nursing students willing to work in facilities with a critical shortage were denied access to this 

program. 

Nurse Faculty Loan Program.—This program establishes a loan repayment fund 

within schools of nursing to increase the number of qualified nurse faculty. Nurses 

may use these funds to pursue a master’s or doctoral degree. They must agree to 

teach at a school of nursing in exchange for cancellation of up to 85 percent of their 

educational loans, plus interest, over a 4-year period. Loans can cover the costs of 

tuition, fees, books, laboratory expenses, and other reasonable education expenses. 

In fiscal year 2006, this program received $4.8 million. 

This program is vital given the critical shortage of nursing faculty. America’s 

schools of nursing cannot increase their capacity without an influx of new teaching 

staff. Last year, schools of nursing were forced to turn away tens of thousands of 

qualified applicants due largely to the lack of faculty. In fiscal year 2005, HRSA 

awarded 66 nurse faculty loan repayments. 

Nurse Education, Practice, and Retention Grants.—This section is comprised of 

many programs designed to support entry-level nursing education and to enhance 

nursing practice. In fiscal year 2005, this line item supported 10,490 nursing students. All together, the Nurse Education, Practice, and Retention Grants received 

$37.3 million in fiscal year 2006. 

The education grants are designed to expand enrollments in baccalaureate nursing programs; develop internship and residency programs to enhance mentoring and 

specialty training, and; provide new technologies in education including distance 

learning. 

Practice grants currently support 18 Nurse Managed Clinics that provide primary 

health care in medically underserved communities; provide nursing students the 

skills necessary to practice in existing and emerging health systems, and; develop 

cultural competencies. 

Retention grant areas include career ladders and improved patient care delivery 

systems. The career ladders program supports education programs that assist individuals in obtaining the educational foundation required to enter the profession, and 

to promote career advancement within nursing. Enhancing patient care delivery system grants are designed to improve the nursing work environment. These grants 

help facilities to enhance collaboration and communication among nurses and other 

health care professionals, and to promote nurse involvement in the organizational 
335 

and clinical decision-making processes of a health care facility. These best practices 

for nurse administration have been identified by the American Nurse Credentialing 

Center’s Magnet Recognition Program ®. These practices have been shown to double 

nurse retention rates, increase nurse satisfaction, and improve patient care. 

Nursing Workforce Diversity.—This program provides funds to enhance diversity 

in nursing education and practice. It supports projects to increase nursing education 

opportunities for individuals from disadvantaged backgrounds—including racial and 

ethnic minorities, as well as individuals who are economically disadvantaged. In fiscal year 2006, these programs received $16 million. 

Racial and ethnic minorities currently comprise more than 25 percent of the Nation’s population and will comprise nearly 40 percent by the year 2020. However, 

only 10.6 percent of the RNs in the United States are self-identified as one or more 

of the racial and ethnic minority groups. Increasing cultural and ethnic diversity in 

nursing helps to address the prevention, treatment, and rehabilitation needs of an 

increasingly diverse population. For fiscal year 2005, HRSA received 191 submissions for nursing workforce diversity grants. HRSA was able to fund 97 (50 percent 

of applications). 

Advanced Nurse Education.—Advanced practice registered nurses (APRNs) are 

nurses who have attained advanced expertise in the clinical management of health 

conditions. Typically, an APRN holds a master’s degree with advanced didactic and 

clinical preparation beyond that of the RN. Most have practice experience as RNs 

prior to entering graduate school. Practice areas include, but are not limited to: anesthesiology, family medicine, gerontology, pediatrics, psychiatry, midwifery, 

neonatology, and women’s & adult health. Title VIII grants have supported the development of virtually all initial State and regional outreach models using distance 

learning methodologies to provide advanced study opportunities for nurses in rural 

and remote areas. In fiscal year 2006, these programs received $57 million. 

These grants also provide traineeships for masters and doctoral students. Title 

VIII funds more than 60 percent of U.S. nurse practitioner education programs and 

assists 83 percent of nurse midwifery programs. Over 45 percent of the nurse anesthesia graduates supported by this program go on to practice in medically underserved communities. Many provide care to minority or disadvantaged patients. In 

fiscal year 2005, HRSA funded 81 advanced education nursing grants (89 percent 

of applications), 347 advanced education nursing traineeships (every application), 

and 75 nurse anesthetist traineeships (every application). 

Comprehensive Geriatric Education Grants.—This authority awards grants to 

train and educate nurses in providing health care to the elderly. Funds are used 

to train individuals who provide direct care for the elderly, to develop and disseminate geriatric nursing curriculum, to train faculty members in geriatrics, and to provide continuing education to nurses who provide geriatric care. In fiscal year 2006, 

these grants received $3.4 million. 

The growing number of elderly Americans and the impending health care needs 

of the baby boom generation make this program critically important. In fiscal year 

2005, HRSA received 43 applications for comprehensive geriatric education grants. 

HRSA continued 17 previously awarded grants and awarded 11 new ones (65 percent of applications). 

NATIONAL INSTITUTE OF NURSING RESEARCH (NINR)

ANA also urges the subcommittee to increase funding for the NINR, one of the 

institutes at the National Institutes of Health (NIH). This research is integral to 

improving the effectiveness of nursing care. Advances in nursing care arising from 

behavioral and biomedical research have shown excellent progress in reducing 

health care costs. Research programs supported by NINR address a number of critical public health and patient care questions. The research is driven by real and immediate problems currently facing patients and their families. 

Recent studies have illuminated the impact of placing a patient in long term care 

on the patient’s family caregiver, the impact of maternal obesity prior to pregnancy 

on childhood weight problems, the difference in heart attack symptoms in women 

versus men, the most effective means to prevent infectious diseases in inner city 

households, and the incidence and risk factors for uterine rupture in pregnancies 

following cesarean section. NINR is leading the NIH research on end-of-life and palliative care. NINR is also the lowest funded institute at NIH. In fiscal year 2006, 

NINR received $137.3 million. ANA recommends $150 million in fiscal year 2007 

NINR funding. 
336 

CONCLUSION

While ANA appreciates the continued support of this subcommittee, we are concerned that Title VIII funding levels have not been sufficient to address the growing 

nursing shortage. The nursing shortage will continue to worsen if significant investments are not made. Recent efforts have shown that aggressive and innovative recruitment efforts can help avert the impending nursing shortage—if they are adequately funded. 

ANA asks you to meet today’s shortage with a relatively modest investment of $175 million in Title VIII programs. Additionally, an investment of $150 million in 

the NINR will help assure that these nurses are equipped with the information 

needed to provide the best care possible. 

PREPARED STATEMENT OF AMERICANS FOR NURSING SHORTAGE RELIEF

The undersigned organizations of the ANSR (Americans for Nursing Shortage Relief) Alliance greatly appreciate the opportunity to submit written testimony regarding fiscal year 2007 appropriations for Title VIII—Nursing Workforce Development 

Programs. The ANSR Alliance is comprised of fifty-one national nursing organizations that united in 2001 to identify and promote creative strategies for addressing 

the nursing and nurse faculty shortages, including passage of the Nurse Reinvestment Act of 2002—an important first step in increasing the number of qualified 

nurses in America. 

ANSR stands ready to work with policymakers to advance programs and policies 

that will sustain and strengthen our Nation’s nursing workforce. To ensure that our 

Nation has a sufficient and adequately prepared nursing workforce to provide quality care to every American well into the 21st century, ANSR advocates for the following: —At least $175 million in funding for Nursing Workforce Development Programs 

under Title VIII of the Public Health Service Act at the Health Resources and 

Services Administration (HRSA) in fiscal year 2007. 

THE NURSING SHORTAGE

Nurses play a critical role in this Nation’s health care system. With an estimated 

2.9 million licensed registered and advanced practice registered nurses (RNs and 

APRNs), nurses represent the largest occupational group of health care workers and 

provide patient care in virtually all locations in which health care is delivered. This 

coupled by their scope of practice areas make the nursing shortage an even more 

interesting challenge. Some facts to consider: 

—The nursing workforce is aging. In 1980, 26 percent of RNs were under the age 

of 30. Today, approximately 8 percent of RNs are under the age of 30 with the 

average nurse 46.8 years of age; 

—Approximately half of the RN workforce is expected to reach retirement age 

within the next 10 to 15 years. The average age of new RN graduates is almost 

30 years. 

—The Bureau of Labor Statistics report (December, 2005) projected that registered nursing would create the second largest number of new jobs among all 

occupations within 9 years. In addition, employment of registered nurses is expected to grow much faster than average for all occupations through 2014. It 

is anticipated that approximately 703,000 additional jobs, for a total of 

3,096,000, will be available for RNs by this date. 

—The national nursing shortage also is affecting our Nation’s 7.6 million veterans 

who receive care through the 1,300 Veterans Administration (VA) health care 

facilities; 

—Nearly 1,800 faculty members leave their positions every year due to factors of 

retirement or higher wages earned as a staff nurse. Fewer than 400 faculty candidates receive their doctoral degrees each year; and, 

—The number of full-time nurse faculty required to ‘‘fill the nursing gap’’ is approximately 40,000. Currently, the National League for Nursing estimates that 

there fewer than 10,000 full-time faculty members in the system. 

THE NURSING SUPPLY IMPACTS AMERICA’S EMERGENCY PREPAREDNESS

Nurses play a critical role as front-line, first-responders. When word of the devastation caused by Hurricanes Katrina and Rita spread, nurses across the country immediately volunteered in American Red Cross shelters, medical clinics, and hospitals throughout that area. Nurse midwives delivered babies in airplane hangars, 

and nurses trained in geriatric care assisted in caring for those evacuated from the 
337 

comforts of their homes, assisted living facilities or nursing homes. Nurse practitioners diligently staffed temporary and permanent health care clinics to provide 

needed primary care to hurricane victims. In addition, many nurses realized their 

role in the comfort and support they offered as they listened to survivors recount 

their stories of pain and tragedy. 

These stories seem particularly relevant in demonstrating the contributions that 

nurses provide during tragedies, and should illustrate the need to ensure an adequate supply of all types of nurses in all parts of the country. Unless steps are taken 

now, the Nation’s ability to respond to disasters will be further hindered by the 

growing nursing shortage. An investment in the nursing workforce is a step in the 

right direction to bolster our public health infrastructure and increase our Nation’s 

health care readiness and emergency response capabilities. 

THE DESPERATE NEED FOR NURSE FACULTY

After years of declining interest, the nursing profession is seeing the opposite 

occur. Many Americans have come to find nursing an attractive career because of 

job security, salary levels, and the opportunity to help others. However, the common 

theme among prospective nursing students is that due to a lack of a sufficient number of faculty they can face waiting periods of up to 3 years before matriculating. 

When all nursing programs are considered, the number of qualified applications 

turned away during the 2004–2005 academic year was estimated to be more than 

147,000 by the National League for Nursing. Without sufficient support for current 

nurse faculty and adequate incentives to encourage more nurses to become faculty, 

nursing schools will fail to have the teaching infrastructure necessary to educate 

and train the next generation of nurses that the Nation so desperately needs. 

THE FUNDING REALITY

Enacted in 2002, the Nurse Reinvestment Act included new and expanded initiatives, including loan forgiveness, scholarships, career ladder opportunities, and public service announcements to advance nursing as a career. Despite the enactment 

of this critical measure, HRSA fails to have the resources necessary to meet the current and growing demands for our Nation’s nursing workforce. For example, in fiscal 

year 2003, HRSA received 8,321 applications for the Nurse Education Loan Repayment Program but only had the funds to award 7 percent (602) of all applications. 

Also in fiscal year 2003, HRSA received 4,512 applications for the Nursing Scholarship Program but only had funding to support a mere 2 percent (94) of all applications. 

The ANSR Alliance strongly urges this subcommittee to provide a minimum of $17,505 million in fiscal year 2007 to fund Title VIII—Nursing Workforce Development Programs. This level of investment will help leverage the HRSA resources to 

fund a higher rate of Nurse Education Loan Repayment and Nursing Scholarship 

applications, as well as implement other essential endeavors to sustain and boost 

our Nation’s nursing workforce. 

SUMMARY

Programmatic area Final fiscal year 2006 

President’s budget 

fiscal year 2007 ANSR’s request 

Title VIII: Nurse Workforce Development Programs at HRSA .. $149,000,000 $150,000,000 $175,000,000 

ANSR ALLIANCE ORGANIZATIONS

Academy of Medical-Surgical Nurses; American Academy of Ambulatory Care 

Nursing; American Academy of Nurse Practitioners; American Association of Critical-Care Nurses; American Association of Nurse Anesthetists; American Association 

of Occupational Health Nurses, Inc.; American College of Nurse-Midwives; American 

Organization of Nurse Executives; American Society for Pain Management Nursing; 

American Society of PeriAnesthesia Nurses; American Society of Plastic Surgical 

Nurses; Association of periOperative Registered Nurses; Association of Rehabilitation Nurses; Association of State and Territorial Directors of Nursing; Association 

of Women’s Health, Obstetric and Neonatal Nurses; Dermatology Nurses’ Association; Developmental Disabilities Nurses Association; Emergency Nurses Association; 

Infusion Nurses Society; National Association of Clinical Nurse Specialists; National 

Association of Nurse Massage Therapists; National Association of Orthopaedic 

Nurses; National Association of Pediatric Nurse Practitioners; National Association 

of School Nurses; National Black Nurses Association; National Conference of Gerontological Nurse Practitioners; National Council of State Boards of Nursing; National 
338 

League for Nursing; National Student Nurses’ Association; National Nursing Centers Consortium; National Organization of Nurse Practitioner Faculties; Nurses Organization of Veterans Affairs; Oncology Nursing Society; Society for Urologic 

Nurses and Associates; Society of Trauma Nurses; and Wound Ostomy Continence 

Nurses Society. 

PREPARED STATEMENT OF THE AMERICAN PUBLIC POWER ASSOCIATION

The American Public Power Association (APPA) is the national service organization representing the interests of over 2,000 municipal and other State and locally 

owned utilities throughout the United States (all but Hawaii). Collectively, public 

power utilities deliver electricity to one of every seven electricity consumers (approximately 43 million people), serving some of the Nation’s largest cities. However, 

the vast majority of APPA’s members serve communities with populations of 10,000 

people or less. 

We appreciate the opportunity to submit this statement supporting funding for 

the Low-Income Home Energy Production Assistance Program (LIHEAP). 

APPA has consistently supported an increase in the authorization level for 

LIHEAP and supports the full authorization level of $5.1 billion for fiscal year 2007 

as enacted in the Energy Policy Act of 2005. 

APPA is proud of the commitment that its members have made to their low-income customers. Many public power systems have low-income energy assistance programs based on community resources and needs. Our members realize the importance of having in place a well-designed low-income customer assistance program 

combined with energy efficiency and weatherization programs in order to help consumers minimize their energy bills and lower their requirements for assistance. 

While highly successful, these local initiatives must be coupled with a strong 

LIHEAP program to meet the growing needs of low-income customers. In the last 

several years, volatile home-heating oil and natural gas prices, severe winters, high 

utility bills as a result of dysfunctional wholesale electricity markets and the effects 

of the economic downturn have all contributed to an increased reliance on LIHEAP 

funds. 

Also when considering LIHEAP appropriations this year, we encourage the subcommittee to provide advanced funding for the program so that shortfalls do not 

occur in the winter months during the transition from one fiscal year to another. 

LIHEAP is one of the outstanding examples of a State-operated program with minimal requirements imposed by the Federal Government. Advanced funding for 

LIHEAP is critical to enabling States to optimally administer the program. 

Thank you again for this opportunity to relay our support for increased LIHEAP 

funding for fiscal year 2007. We look forward to a favorable outcome. 

PREPARED STATEMENT OF THE ASSOCIATION OF MATERNAL AND CHILD HEALTH

PROGRAMS

The Association of Maternal and Child Health Programs (AMCHP) is a national, 

non-profit organization representing leaders of State public health programs for maternal and child health, including children with special health care needs, in all 50 

States, the District of Columbia, and eight additional jurisdictions. Our members 

administer Title V Maternal and Child Health Services Block Grant funds to improve the health of mothers and children. We strongly urge you to restore funding 

for the MCH Block Grant to the fiscal year 2005 level of $724 million. 

First authorized in 1935, the MCH Block Grant provides for a wide range of 

health services and fosters prevention of disease and disabling conditions for over 

32 million women and children across the country. Funds from the MCH Block 

Grant enable States to provide women with prenatal and postnatal care, screen 

newborns for genetic and hereditary conditions; support childhood immunizations; 

reduce infant mortality and developmentally handicapping conditions; and prevent 

childhood accidents and injuries. Block grant funding enables State agencies to tailor vital programs for women, children and families to the needs of each community, 

while ensuring that the programs meet national goals. 

Since the program’s inception, it has evolved into a powerful Federal-State partnership. Each year, $600 million Federal are matched by over $5 billion in State 

funds for maternal and child health programs. These funds have enabled States to 

reach more than 80 percent of infants, 50 percent of pregnant women and 20 percent of children in the United States. Since 2000, the number of women and children served has increased by almost 5 million, an increase of 18 percent. 
339 

In fiscal year 2006, $693 million was appropriated for the MCH Block Grant, $31 

million below the fiscal year 2005 comparable appropriation. This loss of funds, as 

the number of women and children needing services continues to increase, will impact the ability of States to address areas of critical need. While President Bush recommended level funding for the MCH program in his budget request, he also recommended that Federal support for the Traumatic Brain Injury program, Universal 

Newborn Hearing Screening, Emergency Medical Services for Children and the Sickle Cell Anemia Demonstration Project be eliminated. If this recommendation were 

enacted without a commensurate increase in the block grant, States would be forced 

to shift MCH Block Grant funds away from other pressing health priorities to meet 

those addressed by these programs. We recommend that funding for these four valuable programs be restored, in addition to the restoration of the MCH Block Grant 

funding to the fiscal year 2005 level. 

The flexibility of the block grant has allowed States to respond to emerging health 

issues that affect women and children, such as the rising infant mortality rates, particularly among minority populations, and the availability of newborn screening for 

a newly expanded range of diseases and disorders. Reducing the infant mortality 

rate is a goal of the MCH Block Grant program, which will be difficult to achieve 

if funding continues to erode. State maternal and child health programs coordinate 

newborn screening and follow-up services, activities to ensure that every infant born 

in this country receives screening tests that detect disorders that could result in 

death or permanent disabilities. The money spent on these screening programs 

saves lives, and preserves State and Federal Government dollars that would otherwise be spent on expensive, lifelong treatment and rehabilitative services for infants 

whose genetic disorders go undetected. Level funding of the MCH Block Grant will 

not allow States to meet the increasing demand for newborn screening services. 

Last year’s budget cut has already had a real impact on State programs, threatening the quality and quantity of care these programs provide. The MCH Block 

Grant can not continue to do more with less. Consider the following descriptions of 

the impact these cuts are having at the State level: 

—In Iowa, the impact of the MCH Block Grant cut means that the State will not 

have the resources to address emerging public health issues, such as planning 

for a potential bird flu pandemic. It will, instead, be necessary to direct Title 

V resources toward continuing existing programs. Infant mental health, smoking cessation during pregnancy and obesity prevention programs will all be 

short-changed as a consequence. 

—Funding has been pulled from a large Healthy Communities Access Program 

project in Washoe County, Nevada because of this year’s cuts just as it was 

making great inroads in systems development for access to care for low-income 

families in that county. Nevada has a community-based prenatal program that 

reached 600 participants in its first year. Demand for services has tripled this 

year. Further cuts to the MCH Block Grant would necessitate cutting this program, so fewer pregnant women would be served. The MCH program has had 

to drop all its contracts with community coalitions to promote access to care, 

which has hampered the success of these activities. 

—Alabama lost $409,339 in block grant funding in fiscal year 2006. The Alabama 

MCH program has reduced staffing by attrition at both the central office and 

county office levels. Nursing and nursing assistants, administrative support, 

and epidemiology services and medical equipment and supplies have been affected. 

—In Washington State, reductions in the MCH Block grant, impact women and 

children by minimizing or eliminating local community activities. Many activities will either be eliminated or drastically scaled back, including early childhood programs, adolescent health care, mental health services, the Healthy 

Youth Survey, newborn hearing screening, and services for children with special 

health care needs. Multiple Federal cuts mean than many of the MCH partners 

will also be reducing efforts. With this reduction, Washington State will be moving back in time, not even maintaining the status quo. 

—In Michigan, cut backs in medical care and treatment for children with special 

health care needs will be necessary as a result of the $656,000 reduction in its 

allocation. 

The dramatic effects are not unique to Iowa, Nevada, Alabama, Washington State 

or Michigan, but affect all States and jurisdictions. 

AMCHP recognizes the fiscal restraints facing this subcommittee. Nevertheless, 

we can not stress enough what a dire situation MCH Block Grant cuts are creating, 

especially given the cuts in the Medicaid program and the fact that other safety net 

programs also face reductions. Title V programs play a valuable, complementary 

role to the SCHIP and Medicaid programs. As more women and children are forced 
340 

out of the Medicaid program, they will turn to MCH programs to ensure that their 

health care needs are met. With increased demand for MCH Block Grant services, 

States will be forced to limit already stretched services to vulnerable populations. 

Our children are the future. Their needs should not be short-changed by budget 

limitations, but addressed effectively with adequate funding. The MCH Block Grant 

has a proven track record of effectiveness and supports health services for over 32 

million Americans. We strongly urge you to restore funding for the MCH Block 

Grant to the fiscal year 2005 level of $724 million. 

PREPARED STATEMENT OF THE CENTERS FOR DISEASE CONTROL AND PREVENTION

COALITION

The CDC Coalition is a nonpartisan coalition of more than 100 groups committed 

to strengthening our Nation’s prevention programs. Our mission is to ensure that 

health promotion and disease prevention are given top priority in Federal funding, 

to support a funding level for the Centers for Disease Control and Prevention (CDC) 

that enables it to carry out its prevention mission, and to assure an adequate translation of new research into effective State and local programs. Coalition member 

groups represent millions of public health workers, researchers, educators, and citizens served by CDC programs. We are grateful to be able to present our views to 

the subcommittee. 

The CDC Coalition continues to believe that Congress should support CDC as an 

agency—not just the individual programs that it funds. In the best judgment of the 

CDC Coalition—given the challenges and burdens of chronic disease, a potential influenza pandemic, terrorism, disaster preparedness, new and re-emerging infectious 

diseases and our many unmet public health needs and missed prevention opportunities—we believe the agency will require funding of at least $8.5 billion, plus sufficient funding to prepare the Nation against a potential influenza pandemic. This request reflects the support CDC will need to fulfill its core missions for fiscal year 

2007, as well as funding for the Agency for Toxic Substances and Disease Registry 

and the Vaccines for Children program. 

The CDC Coalition appreciates the subcommittee’s work over the years, including 

your recognition of the need to fund chronic disease prevention, infectious disease 

prevention and treatment, and environmental health programs at CDC. By translating research findings into effective intervention efforts, CDC has been a key 

source of funding for many of our State and local programs that aim to improve the 

health of communities. Perhaps more importantly, Federal funding through CDC 

provides the foundation for our State and local public health departments, supporting a trained workforce, laboratory capacity and public health education communications systems. 

CDC also serves as the command center for our Nation’s public health defense 

system against emerging and reemerging infectious diseases. With the potential 

onset of a worldwide influenza pandemic, in addition to the many other natural and 

man-made threats that exist in the modern world, the CDC has become the Nation’s—and the world’s—expert resource and response center, coordinating communications and action and serving as the laboratory reference center. States and communities rely on CDC for accurate information and direction in a crisis or outbreak. 

Unfortunately, Congress cut overall CDC funding in fiscal year 2006 for the first 

time in 25 years. And in fiscal year 2007, the President has proposed cutting CDC 

funding even more—more than 2 percent overall, and more than 4.5 percent to 

CDC’s core programs. We are moving in the wrong direction, especially in these 

challenging times when public health is being asked to do more, not less. In light 

of the current workload placed on the public health service—in addition to the 

threat of emerging diseases such as the avian flu—it simply does not make any 

sense to cut the budget for CDC at a time when the threats to public health are 

so great. Funding public health outbreak by outbreak is not an effective way to ensure either preparedness or accountability. Until we are committed to a strong public health system, every crisis will force trade offs. 

CDC serves as the lead agency for bioterrorism preparedness and must receive 

sustained support for its preparedness programs in order for our Nation to meet future challenges. In the best judgment of CDC Coalition members, given the challenges of terrorism and disaster preparedness, and our many unmet public health 

needs and missed prevention opportunities, we support the proposed increase for 

anti-terrorism activities at CDC, including the increases for the Strategic National 

Stockpile and the new Botulinum Toxin Research funding. However, we strongly 

caution that the President’s proposed level-funding of the State and local capacity 

grants continues to reflect a $95 million cut from fiscal year 2005 levels. We encour-
341 

age the subcommittee to restore these cuts to ensure that our States and local communities can be prepared in the event of an act of terrorism. 

Heart disease remains the Nation’s number one killer. In 2003, 684,462 people 

died of heart disease (51 percent of them women), accounting for 28 percent of all 

U.S. deaths. Stroke is the third leading cause of death after heart disease and cancer, and is a leading cause of serious, long-term disability. In 2003, stroke killed 

157,800 people (61percent of them women), accounting for about 1 of every 15 

deaths. In 1998, the U.S. Congress provided funding for CDC to initiate a national, 

State-based heart disease and stroke prevention program with funding for eight 

States. Currently, 32 States and the District of Columbia are funded, 19 as capacity 

building programs and 14 as basic implementation programs. The CDC Coalition 

recommends $55 million for the Heart Disease and Stroke Prevention Program. 

The CDC funds proven programs addressing cancer prevention, early detection, 

and care. Cancer is the second most common cause of death in the United States. 

In 2006, about 1.4 million new cases of cancer will be diagnosed, and about 564,830 

Americans—more than 1,500 people a day—are expected to die of the disease. The 

financial cost of cancer is also significant. According to the National Institutes of 

Health, in 2005, the overall cost for cancer in the United States was nearly $210 

billion: $74 billion for direct medical costs, $17.5 billion for lost worker productivity 

due to illness, and $118.4 billion for lost worker productivity due to premature 

death. 

Among the ways the CDC is fighting cancer, it funds the National Breast and 

Cervical Cancer Early Detection Program that helps low-income, uninsured and 

medically underserved women gain access to lifesaving breast and cervical cancer 

screenings and provides a gateway to treatment upon diagnosis. CDC also funds 

grants to States to develop Comprehensive Cancer Control (CCC) plans, bringing together a broad partnership of public and private stakeholders to jointly set priorities 

and implement specific cancer prevention and control activities customized to address each State’s particular needs. CDC also funds programs to raise awareness 

about colorectal, prostate, lung, ovarian and skin cancers, and the National Program 

of Cancer Registries, a critical registry for tracking cancer trends in all 50 States. 

The CDC coalition recommends $427.5 million for the Cancer Prevention and Control activities of the CDC. 

Although more than 18 million Americans have diabetes, 5.2 million cases are 

undiagnosed. From 1980—2002, the number of people with diabetes in the United 

States more than doubled, from 5.8 million to 13.3 million. Each year, 12,000— 

24,000 people with diabetes become blind, more than 42,800 develop kidney failure, 

and about 82,000 have leg, foot, or toe amputations. Preventive care such as routine 

eye and foot examinations, self-monitoring of blood glucose, and glycemic control 

could reduce these numbers. Without additional funds, most States will not be able 

to create programs based on these new data. States also will continue to need CDC 

funding for diabetes control programs that seek to reduce the complications associated with diabetes. 

Over the last 25 years, obesity rates have doubled among adults and children, and 

tripled in teens. Obesity, diet and inactivity are cross-cutting risk factors that contribute significantly to heart disease, cancer, stroke and diabetes. The CDC funds 

programs to encourage the consumption of fruits and vegetables, to get sufficient exercise, and to develop other habits of healthy nutrition and activity. The CDC Coalition recommends $70 million for CDC’s Division of Nutrition and Physical Activity. 

Arthritis and chronic joint symptoms affect nearly 66 million Americans and they 

are the Nation’s leading cause of disability. Early diagnosis and appropriate management of the disease can prevent much of the pain and disability associated it. 

The CDC Coalition recommends $14.4 million for the arthritis programs of the CDC. 

More than 400,000 people die prematurely every year due to tobacco use. The 

CDC’s tobacco control efforts seek to prevent tobacco addition in the first place, as 

well as help those who want to quit. The CDC Coalition recommends $145 million 

for the CDC’s tobacco control programs. 

Each day more than 4,000 young people try their first cigarette. At the same time, 

daily participation in high school physical education classes dropped from 42 percent 

in 1991 to 32 percent in 2001. Almost 80 percent of young people do not eat the 

recommended number of servings of fruits and vegetables, while nearly 30 percent 

of young people are overweight or at risk of becoming overweight. And every year, 

almost 800,000 adolescents become pregnant and about 3 million become infected 

with a sexually transmitted disease. School health programs are one of the most efficient means of correcting these problems, shaping our Nation’s future health, education, and social well-being. The CDC Coalition requests $34 million for CDC’s Division of Adolescent and School Health (DASH) Coordinated School Health Program 

and $41.8 million for DASH’s HIV prevention education programs. 
342 

Public health programs delivered at the State and local level should be flexible 

to respond to State and local needs. Within an otherwise-categorical funding construct, the Preventive Health and Health Services Block Grant is the only source 

of flexible dollars for States and localities to address their unique public health 

needs. The track record of positive public health outcomes from Prevention Block 

Grant programs is strong, yet so many requests go unfunded. However, the President’s budget proposes the elimination of the Preventive Health and Health Services 

Block Grant—again. We appreciate the work of the subcommittee to at least partially restore the fiscal year 2006 elimination of the Block Grant. Nevertheless, the 

$20 million cut to the Block Grant in fiscal year 2006 reduces the States’ ability 

to tailor Federal public health dollars to their specific needs. As States use their 

Prevention Block Grant dollars to address high priority needs such as emerging and 

chronic diseases, child safety seat programs, suicide prevention, smoke detector distribution and fire safety programs, adult immunization, oral health, worksite 

wellness, infectious disease outbreaks, food safety, emergency medical services, safe 

drinking water, and surveillance needs—we can scarcely understand why the Prevention Block Grant should be eliminated. We encourage the subcommittee to restore the cuts and fund the Prevention Block Grant at $132 million. 

Much of CDC’s work in chronic disease prevention and health promotion is guided 

by its prevention research activities. Prevention research considers the factors associated with illness, disability, and injury, such as lifestyles or exposure to environmental toxins, and the best ways to address these factors and thereby promote 

health. By answering these questions, prevention research links biomedical research, which focuses on human physiology and disease treatment, to policies and 

public health interventions that promote wellness and reduce the need for treatment. 

CDC provides national leadership in helping control the HIV epidemic by working 

with community, State, national, and international partners in surveillance, research, prevention and evaluation activities. The CDC estimates that up to 

1,185,000 Americans are living with HIV, one-quarter of whom are unaware of their 

infection. Also, the number of people living with HIV is increasing, as new drug 

therapies are keeping HIV-infected persons healthy longer and dramatically reducing the death rate. Prevention of HIV transmission is our best defense against the 

AIDS epidemic that has already killed over 500,000 U.S. citizens and is devastating 

the populations of nations around the globe, and CDC’s HIV prevention efforts must 

be expanded. The CDC Coalition recommends that a total of $1.05 billion be appropriated to the Division of HIV Prevention. 

The United States has the highest sexually transmitted diseases (STD) rates in 

the industrialized world. More than 18 million people contract STDs each year. In 

1 year, our Nation spends over $8.4 billion to treat the symptoms and consequences 

of STDs. Elimination of STDs, especially syphilis, is now within our grasp. These 

welcome opportunities, if adequately funded now, will save millions in annual 

health care costs in the future. Untreated STDs contribute to infant mortality, infertility, and cervical cancer. State and local STD control programs depend heavily on 

CDC funding for their operational support. 

CDC conducts the National Health and Nutrition Examination Survey 

(NHANES), the only national source of objective health data to provide accurate estimates of diagnosed and undiagnosed medical conditions in the population. 

NHANES is a unique collaboration between CDC, the National Institutes of Health 

(NIH), and others to obtain data for biomedical research, public health, tracking of 

health indicators, and policy development. Through physical examinations, clinical 

and laboratory tests, and interviews, NHANES assesses the health status of adults 

and children in the United States. Mobile exam centers travel throughout the country to collect data on chronic conditions, nutritional status, medical risk factors (e.g., 

high cholesterol level, obesity, high blood pressure), dental health, vision, illicit drug 

use, blood lead levels, food safety, and other factors that are not possible to assess 

by use of interviews alone. Findings from this survey are essential for determining 

rates of major diseases and health conditions and developing public health policies 

and prevention interventions. 

We must address the growing disparity in the health of racial and ethnic minorities. CDC’s REACH 2010 Demonstration Program, Racial and Ethnic Approaches to 

Community Health (REACH), helps States address these serious disparities in infant mortality, breast and cervical cancer, cardiovascular disease, diabetes, HIV/ 

AIDS and immunizations. We encourage the subcommittee to provide adequate 

funds for CDC’s REACH program. 

The CDC Coalition is requesting an appropriation of $49.75 million for Steps to 

a HealthierUS (STEPS) program. Additional resources will allow for the creation of 

programs in more States. Furthermore, while the President’s budget request in-
343 

cludes $1.5 million to support the YMCA Pioneering Healthier Communities initiative, $3 million is needed to continue to expand this important effort. This would 

enable additional communities to participate in this initiative, to allow on-going 

training for communities and to support a Center for Community Health Advancement at the CDC to assist the YMCA and other communities undertaking healthy 

lifestyle initiatives to prevent and control obesity and chronic disease. 

CDC oversees immunization programs for children, adolescents and adults, and 

is a global partner in the ongoing effort to eradicate polio worldwide. The value of 

adult immunization programs to improve length and quality of life, and to save 

health care costs, is realized through a number of CDC programs, but there is much 

work to be done and a need for sound funding to achieve our goals. Influenza vaccination levels remain low for adults. Levels are substantially lower for pneumococcal vaccination and significant racial and ethnic disparities in vaccination levels 

persist among the elderly. Childhood immunization programs at CDC also need a 

funding boost, to ensure sufficient purchase and delivery of the varicella and pneumococcal vaccines. In addition, developing functional immunization registries in all 

States will be less costly in the long run than maintaining the incomplete systems 

currently in place. The CDC Coalition requests $802.4 million for the National Immunization Program at CDC. 

Injuries are the leading cause of death in the United States for people ages 1– 

34. Of all injuries, those to the brain are most likely to result in death or permanent 

disability. Each year more than 50,000 people die as a result of a brain injury and 

as many as 90,000 others are left with a long-term disability. A traumatic brain injury (TBI) is defined as a blow or jolt to the head or a penetrating head injury that 

disrupts the function of the brain. The Traumatic Brain Injury Act is the Nation’s 

only law that was specifically designed to respond to this public health crisis. The 

Institute of Medicine reported this month that this law has been effective in addressing a wide variety of gaps in service system development. The CDC Coalition 

requests that the subcommittee restore $30 million in appropriations for TBI programs at CDC and at HRSA, which President Bush zeroed out. The monies would 

be allocated as follows: CDC—$9 million; HRSA State Grant Program—$15 million; 

and HRSA Protection and Advocacy program—$6 million. 

Injury at work remains a leading cause of death and disability among U.S. workers. During the period from 1980 through 1995, at least 93,338 workers in the 

United States died as a result of injuries suffered on the job, for an average of about 

16 deaths per day. The Bureau of Labor Statistics (BLS) at the Department of Labor 

has identified 5,915 workplace deaths from acute traumatic injury in 2000. BLS also 

estimates that 5.7 million injuries to workers occurred in 1997 alone; while NIOSH 

estimates that about 3.6 million occupational injuries were serious enough to be 

treated in hospital emergency rooms in 1998. The injury prevention and workforce 

protection initiatives of NIOSH need continued support. 

Of the 4 million babies born each year in the United States, 3 percent are born 

with one or more birth defects. Birth defects are the leading cause of infant mortality, accounting for more than 20 percent of all infant deaths. Children with birth 

defects who survive often experience lifelong physical and mental disabilities. An estimated 54 million people in the United States currently live with a disability, and 

17 percent of children under the age of 18 have a developmental disability. Direct 

and indirect costs associated with disability exceed $300 billion. 

Created by the Children’s Health Act of 2000 (Public Law 106–310), the National 

Center on Birth Defects and Developmental Disabilities (NCBDDD) at CDC conducts programs to protect and improve the health of children and adults by preventing birth defects and developmental disabilities; promoting optimal child development and health and wellness among children and adults with disabilities. We 

encourage the subcommittee to provide at least $135 million in fiscal year 2007 

funding for the NCBDDD. This would be a modest increase of $10 million and would 

further surveillance, research and prevention activities related to birth defects and 

developmental disabilities and improve the lives of those living with disabilities. 

We also encourage the subcommittee to provide $10 million for CDC’s Environmental Public Health Services Branch to revitalize environmental public health 

services at the national, State, and local level. As with the public health workforce, 

the environmental health workforce is declining. Furthermore, the agencies that 

carry out these services are fragmented and their resources are stretched. These 

services are the backbone of public health and are essential to protecting and ensuring the health and well being of the American public from threats associated with 

West Nile virus, terrorism, E. coli and lead in drinking water. 

We appreciate the subcommittee’s hard work in advocating for CDC programs in 

a climate of competing priorities. We encourage you to consider our request for $8.5 
344 

billion, plus sufficient funding to prepare for a possible influenza pandemic, for CDC 

in fiscal year 2007. 

PREPARED STATEMENT OF THE COLLEGE OF NEW ROCHELLE, NY 

Mr. Chairman and Members of the subcommittee, on behalf of The College of New 

Rochelle (CNR), and the thousands of New York City metropolitan area residents 

impacted by our programs each year, I am grateful for the opportunity to submit 

testimony to your committee regarding our Center for Wellness project. 

THE NATIONAL HEALTH CARE CRISIS: A NEED FOR THE PROJECT

Government sources report that one of the most important issues currently facing 

American society is the health care crisis. Among the reasons cited are the escalating costs of health care, an increasing lack of access to health insurance among 

the poor and middle class, an aging population and a growing national shortage of 

qualified nurses and other health care providers. 

Recent data shows the following: 

—Out of some 40 million Americans who are informal care givers, an estimated 

72 percent are women; 

—Women represent 71 percent of Americans age 85∂, the fastest growing segment of the population; 

—Almost two-thirds of Americans are overweight or obese; 

—One in three Americans born in the year 2000 will develop Type 2 diabetes; 

—Surveys indicate that 28 percent of high school girls think they are overweight; 

60 percent report trying to lose weight; 8 percent suffer from anorexia or 

bulimia; 

—More than half of all Americans get too little physical activity; 

—Some 45 million Americans have no health insurance; and 

—Over 1 million new and replacement nurses will be needed nationwide by 2020. 

One significant health care issue is the individual’s lack of attention to participation in self-care. Government experts emphasize the importance of widespread public awareness of basic health habits and preventative care, as well as support for 

those seeking preventative assistance in making better health and lifestyle choices. 

In order to keep the crisis from increasing, the U.S. Department of Health and 

Human Services, through the Office of Disease Prevention and Health Promotion, 

has launched a national initiative, Healthy People 2010. Through its School of Nursing, and programs such as Healthy Campus 2010, CNR has been participating actively in HHS initiatives for many years, developing local health education programs which benefit students and New York City metropolitan area residents, and 

which help address national goals. 

The Office of Disease Prevention and Health Promotion has identified ten major 

public health issues based on their causal relationship to serious or chronic illnesses. These are: insufficient physical activity, overweight and obesity, decreasing 

environmental quality, tobacco use, substance abuse, irresponsible sexual behavior, 

mental health disorders, injury and violence, immunization deficiencies, and lack of 

access to health care. People of all socio-economic backgrounds are susceptible; however, the risk factors are even greater among the poor, the elderly and the uninsured. 

Moreover, recent studies reveal that those most at risk for developing chronic and 

life-threatening conditions are African Americans, Hispanics, and Asians—populations largely represented in the New York metropolitan area where CNR has six 

campus locations serving 7,000 students and many local residents. 

THE NATIONAL NURSING SHORTAGE: CNR’S SCHOOL OF NURSING

Compounding the health care crisis is the critical and unprecedented nationwide 

shortage of nurses—one that is uniquely different from previous shortages. Among 

the causes cited for this growing problem are an aging nursing workforce, increased 

job opportunities for women in other fields, and fundamental changes in how and 

in what setting patients are treated. A compelling statistic is the average age of 

nurses which is now over 45. A significant percentage of nurses currently employed 

will most likely retire just as the baby boom generation reaches Medicare age. 

According to a recent Federal survey an estimated 1 million new and replacement 

nurses will be needed nationwide by 2020. Government leaders are stressing the urgency of embarking on a national agenda to encourage more students to choose 

nursing as a career. Among their recommendations are the creation of incentives to 
345 

recruit new candidates to the profession, and the broad-scale development of creative approaches for the continuing preparation and retention of skilled nurses. 

CNR’s School of Nursing (SON), founded in 1976, belongs to the National League 

for Nursing and is accredited by the Commission on Collegiate Nursing Education. 

The School is ideally poised to assume a leadership role in enacting the national 

recommendations cited above. In recent years, the School has been especially successful in recruiting students (including many from disadvantaged backgrounds) 

and in fostering a lifelong commitment to nursing careers. Enrollment in SON has 

increased by 25 percent over the past 2 years. At present, there are 669 students 

enrolled in SON: 580 in the baccalaureate program and 89 in the masters program. 

SON programs are addressing the shortage by creating initial student access to the 

nursing profession and also by providing a career ladder for nurses seeking to advance their careers. Five separate programs are offered: 

—Undergraduate program leading to a Bachelor of Science Degree in Nursing 

(BSN); 

—Programs of study for registered nurses seeking either a BSN or a Master of 

Science Degree; 

—BSN program for those holding degrees in other fields; 

—Graduate program with several tracks leading to an MS Degree in Nursing; and 

—Several post-Master certificate programs. 

A pivotal function of CNR’s multi-faceted Center for Wellness project includes the 

building of a new state-of-the-art facility on the College’s New Rochelle campus, providing space for nursing and health education classes and events. This will heighten 

the visibility of nurses as educators as a crucial part of the nursing profession 

throughout the New York City area and beyond. The new facility and its related 

health and wellness education programs also hold much promise for drawing a 

greater number of students to SON as well as providing expanded access and opportunity for nurses seeking to acquire additional professional skills and/or further 

their careers. 

THE CENTER FOR WELLNESS AT THE COLLEGE OF NEW ROCHELLE

The proposed Center for Wellness will be a state-of-the-art multi-purpose facility 

at the College’s main campus and will house Nursing programs, Physical Education, 

Health Education and Health Services programs. The faculty will create a comprehensive center for the development and delivery of a broad range of integrated 

health and wellness education programs. The program will include a variety of 

health and educational activities in an intergenerational fashion to involve students, 

employees, and members of the surrounding community. Health seminars will cover 

a wide variety of issues including parenting and women’s issues, smoking, diabetes, 

heart disease, nutrition and weight issues, sex education and assault issues, drug 

abuse prevention and treatment, and wellness education. The School of Nursing will 

offer courses and workshops in wellness and disease prevention, not only through 

the curriculum in the School of Nursing, but also to the students, staff and faculty 

in Westchester and at the branch campuses. The integrated wellness program will 

be supplemented with fitness and education programs targeted to specific populations such as the New Rochelle School District, the Senior Center of New Rochelle 

and the United Hebrew Home. 

The programs at the Center for Wellness will provide access to timely information 

and help foster lifelong healthy lifestyle choices among students, faculty and staff 

at the main campus and throughout the five metropolitan New York communities 

where CNR has city campus locations. At these city campuses, CNR will give busy 

low-income adult students access to wellness promotion, health maintenance and fitness programs on campus. For example, the College is working with the New York 

City health education program ‘‘Take Care New York’’ to educate all of our students 

on the necessity of a healthy lifestyle. CNR will also use distance learning technology so that faculty and staff at its campuses can share their own expertise, as 

well as that of national experts, with CNR students and community members. 

The College of New Rochelle recognizes that preventative health care is vital to 

our Nation’s future. This Center will position CNR as a model institution for the 

development and delivery of innovative health and wellness education. CNR believes 

that this holistic approach to wellness will serve as motivation for more students 

to enter the field of nursing and thus begin to alleviate the nursing shortage. The 

programs, adaptable to the needs of many different communities and populations, 

will be able to be replicated at other institutions regionally and nationally. 

The total cost to establish the Center for Wellness is estimated at $25 million. 

Through the support of the subcommittee, The College of New Rochelle received 

funding through the Labor, HHS and Education Appropriations Bill in the amount 
346 

of $200,000 in 2005. CNR has utilized this funding for the development of wellness 

education programs that have benefited CNR students, middle school students, and 

senior citizens from the area surrounding the New Rochelle Campus. In fiscal year 

2007, The College hopes that the subcommittee can fund our request of $2.7 million 

to construct and equip the Center. 

PREPARED STATEMENT OF THE DIABETES CARE COALITION

Mr. Chairman and members of the Committee, thank you for the invitation today 

to discuss how government, private industry and non-governmental agencies can 

form innovative partnerships to address the epidemic of uncontrolled diabetes in 

America. This raging epidemic is simply too great a challenge for any but a collective effort. 

I know this subcommittee has little ability to change the fiscal reality that you 

must produce an appropriations bill that, for a second consecutive year, must reduce 

spending under your jurisdiction by multiple billions of dollars. This fiscal reality 

does not change the fact that one out of every three people with diabetes will suffer 

a heart attack by age 40, every day 144 Americans with diabetes will go blind, every 

hour three people with diabetes will undergo an amputation, and every minute 20 

people with diabetes undergo kidney dialysis. The sad fact is most of these and 

other complications of diabetes are preventable through known interventions. But, 

not everyone living with diabetes is aware of some of the simple things they can 

do to monitor their disease and prevent some of these terrible consequences. 

My entire career has been dedicated to improving the care of people with diabetes, 

through research into the causes of diabetes complications, and how to improve diabetes care. I have been President of the American Diabetes Association, a member 

of the Coalition I represent today, and the founding Chairman of the private-public 

partnership of the National Diabetes Education Program (NDEP), which was funded 

by the National Institutes of Health and the Centers for Disease Control and Prevention (CDC) to improve the care of Americans with diabetes. I am also the Medical Advisor to the Diabetes Care Coalition (DCC) on whose behalf I am speaking 

today. 

As Dr. Gerberding told the House of Representatives Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies 

in March 2006, ‘‘where we invest, we can make a difference’’. I am here today to 

tell you that the DCC is committing significant private sector resources to mount 

a critical public awareness campaign aimed at improving the health of individuals 

with diabetes. We are initiating discussions with experts at the CDC, and are excited about the potential opportunity to develop an innovative partnership with this 

world-renown agency to leverage scarce Federal resources, and combine our efforts 

with theirs, to immediately begin to reduce the burden of this rapidly growing disease. 

In this difficult fiscal environment where we are seeing the CDC budget cut this 

year by hundreds of millions of dollars, and the President’s proposal to cut it again 

by almost $200 million next year, we believe it is imperative to encourage creative 

solutions to reach the millions of Americans living with diabetes with information 

that can ultimately prevent heart attacks, strokes, blindness, amputations, and 

other complications of this disease. The DCC represents what is truly a creative solution to combat the problem of uncontrolled diabetes. 

The DCC was born out of a recognition by its various participants that Americans 

with diabetes lack a basic understanding of how best to control their disease to reduce their risk of complications like heart attacks and strokes. The DCC’s pilot 

‘‘Know Your A1C’’ campaign represents a novel approach to empower people with 

diabetes to take personal responsibility by working with their diabetes healthcare 

team to manage the disease. 

Personally, I am concerned that the Federal Government’s commitment to battling the epidemic of uncontrolled diabetes is under-funded and potentially losing 

ground. Since 2003, the CDC estimates that the prevalence of diabetes in America 

increased 14 percent. Over 20.8 million adult Americans live with diabetes today 

compared to 18.2 million in 2003. While I recognize the limitations on the Federal 

budget and the tough choices that have to be made in this Committee every day, 

now is not the time to approve declining budgets for our Federal programs that aim 

to prevent and manage diabetes. 

I do not want to overwhelm you with facts and figures, but it is clear from even 

a brief review that diabetes is about to overwhelm America’s medical system. By 

providing you with perspective related to the reach of diabetes, I trust you will appreciate the need to invest in battling uncontrolled diabetes before its impact dev-
347 

astates our health system. The place our Nation needs to make this investment is 

here in your appropriations bill, in the CDC. 

Diabetes strikes across age groups, economic status, and ethnicity. Projections for 

the future are even more ominous. The Yale Schools of Public Health and Medicine 

project the population of Americans living with diabetes will increase two and a half 

times by 2025. Supporting this projection, the CDC estimates that 33 percent of all 

children and nearly one half of minority children born in the year 2000 will develop 

diabetes by 2050. 

The economic cost of diabetes is enormous. In 2002, the total economic impact of diabetes was $132 billion. Put another way, 1 out of every 10 health care dollars 

spent in the United States is spent on diabetes care and its complications. CMS estimates that 32 percent of the Medicare budget goes towards caring for Americans 

with diabetes—an amazing one-third of the entire Medicare program that is struggling with long-term solvency issues far more critical and a near-term fiscal crisis 

than Social Security solvency. 

The human costs of uncontrolled diabetes are more shocking: 

—2 out of 3 people with diabetes in America will die of a heart attack or stroke. 

—Diabetes is the leading cause of blindness, causing 12,000 to 24,000 new cases 

each year. 

—Diabetes is the leading cause of kidney failure, accounting for 43 percent of new 

cases in 2002. 

—More than 60 percent of non-traumatic lower-limb amputations occur in people 

with diabetes. 

Unfortunately, most diabetes patients are not controlling the risk factors that can 

keep them healthy. A1C is a compelling example of this trend. A1C is the single 

most important measure of glucose control over time and a proven risk factor for 

all major diabetes complications. A1C is a test that shows glucose control over the 

previous 3 months; sort of a diabetes batting average except that lower is better. 

Diabetes patients should know their A1C number and work to keep it in check— 

similar to blood pressure or cholesterol levels. The test is paid for by managed care, 

Medicare, and most private insurance plans; there are few financial barriers to 

being in the know. 

However, a recent study by the New York State Department of Health found that 

89 percent of patients with diabetes did not know their A1C. Worse, even among 

those who knew their A1C, 80 percent had A1C’s above the value deemed acceptable 

by all diabetes organizations. Nationally, the CDC estimates that 65 percent of all 

diabetes patients are out of control, defined by the CDC as ‘‘an A1C level above 7.’’ 

I urge this Committee to consider, based on the dire state of diabetes in America, 

whether we can or should continue to overlook the basic diabetes care needs of 

Americans. The answer to me seems obvious; we must embark on an aggressive 

campaign to encourage Americans to manage diabetes to control its staggering 

human and financial costs that encompass all sectors of the American community. 

The DCC works to bridge the diabetes management knowledge gap by educating 

diabetes patients and their healthcare teams on ways to battle uncontrolled diabetes 

primarily through A1C awareness and management. Through public education in its 

initial test markets, the DCC aims to help diabetes patients take control of their 

disease and live longer, healthier lives—without the specter of heart attack, stroke, 

amputation, or kidney failure. 

The American Diabetes Association and the Juvenile Diabetes Research Foundation International are jointly leading the DCC’s ‘‘Know Your A1C’’ campaign to battle uncontrolled diabetes in America. Providing financial support to this novel nonbranded, public-private partnership are six of the world’s leading pharmaceutical 

and medical device companies: Abbott Diabetes Care Inc., Becton, Dickinson and 

Company, LifeScan, Inc., Novo Nordisk Inc., Roche Diagnostics Corporation, and 

sanofi-aventis U.S. Inc. 

The ‘‘Know Your A1C’’ campaign is different from other public service campaigns. 

It encourages Americans and their families to control diabetes by focusing primarily 

on the message that patients need to know and to manage their A1C. Prior to 

launching its campaign, the DCC conducted research to determine the most effective 

way to encourage patients to manage diabetes and the findings supported a sole 

focus on A1C control. 

The campaign utilizes television, radio and print placements to reach families affected by diabetes in the pilot markets. While these placements consist of paid advertising today, beginning in late 2006, most of the effort will rely on public service 

announcements generated under an agreement with the Ad Council. 

The effort is enhanced by the sales teams of the corporate supporters who distribute unbranded educational materials into medical offices, clinical laboratories, 

pharmacies, diabetes educators’ offices and any other location likely to be frequented 
348 

by a person with diabetes in the pilot markets. The campaign also provides an order 

fulfillment system via 800 number allowing people to request basic materials associated with the campaign, a website and direct mail to healthcare professionals to ensure campaign materials have the broadest reach possible in the test markets. 

In 2006, the DCC will expand upon its 2005 ‘‘Know Your A1C’’ pilot program in 

Atlanta and Tampa. This year, the campaign will reach the television and radio 

markets of Atlanta, GA, Lexington, KY, Little Rock, AR and Memphis, TN. 

The DCC is expanding its focused campaign simply because it is proven to work. 

Consider some of these compelling highlights of the campaign’s achievements in 

2005 in Atlanta and Tampa. 

—An improvement in the number of patients with diabetes who report obtaining 

an A1C test in the past 3 months from a low of 25 percent prior to campaign 

launch to an average of 52 percent during the campaign. 

—An increase in patient with diabetes understanding of A1C awareness from a 

low of 38 percent among people with diabetes prior to the launch of the campaign to an average of 54 percent by the end of the campaign; and 

—An increase in patient with diabetes understanding of what the A1C test measures from a low of 17 percent prior to the campaign to an average of 41 percent 

during the campaign. 

Based upon these results, the Ad Council will join the DCC to refine the ‘‘Know 

Your A1C’’ campaign and transform it from a regional effort into a national public 

service campaign. This campaign is expected to launch in late 2006. Plus, the campaign hopes to reach English and Spanish speaking populations. I hope you share 

in my enthusiasm for this program as it could potentially transform America’s ambivalence towards the uncontrolled diabetes epidemic into a national call to action. 

We would like to build on the current NIH and CDC patient awareness campaigns 

and will soon talk to CDC about the best ways to work with it to improve patient 

awareness of A1C levels. This may include CDC support for needed patient and 

healthcare provider components that inform Americans with diabetes how they can 

and should manage the disease not presently part of the campaign. Components the 

DCC would like to incorporate in the campaign include more aggressive healthcare 

provider education tools, documents informing families how to help manage a family 

member’s diabetes, information detailing steps patients can take for A1C control, 

components that speak more directly to multi-cultural audiences and a more robust 

order fulfillment program. 

While the Diabetes Care Coalition will provide an expanded national ‘‘Know Your 

A1C’’ campaign in late 2006 and the personnel necessary to distribute the materials 

associated with the campaign, a partnership with the Federal Government will enable us to expand and enhance our campaign. A public-private partnership will give 

us the expertise and funding needed to take the battle to all Americans and their 

healthcare teams to eliminate uncontrolled diabetes. This makes economic and humanitarian sense. 

Today, the DCC joins the American Diabetes Association in requesting an increase in the CDC diabetes prevention and control program by $20.8 million in fiscal year 2007. Given the scope and reach of diabetes, we believe this is a modest 

request even in this budget climate. 

We also encourage this Committee to urge the CDC to dedicate new and existing 

resources for its diabetes control program to battling uncontrolled diabetes. To best 

serve the American people, CDC must equally address both aspects of controlling 

this disease—primary prevention activities to stop new cases of diabetes, as well as 

secondary prevention activities to improve the health of the 20.8 million people living with diabetes. 

Members of the Committee, the time to battle the epidemic of uncontrolled diabetes is now. If we miss this opportunity, America will lose substantial ground and 

run the risk of never getting the diabetes epidemic under control. 

Unfortunately, the 20.8 million Americans living with diabetes today represent 

‘‘the low water mark’’ in the reach and scope of the disease. It is time to realize 

that diabetes is here to stay in America and to act in a way that accepts this truth. 

Please help empower Americans living with diabetes, and the growing numbers who 

will live with it tomorrow, to ‘‘Know Your A1C’’ by providing the CDC with the resources needed to battle the epidemic of uncontrolled diabetes. 

Thank you for your time and consideration. 
349 

PREPARED STATEMENT OF THE INTERTRIBAL BISON COOPERATIVE

INTRODUCTION AND BACKGROUND

My name is Ervin Carlson, a Tribal Council member of the Blackfeet Tribe of 

Montana and President of the InterTribal Bison Cooperative. Please accept my sincere appreciation for this opportunity to submit testimony to the honorable members 

of the Appropriations Sub-Committee on Labor, Health and Human Services and 

Education. The InterTribal Bison Cooperative (ITBC) is a Native American nonprofit organization, headquartered in Rapid City, South Dakota, comprised of 57 

federally recognized Indian Tribes located within 19 States across the United States. 

Buffalo thrived in abundance on the plains of the United States for many centuries before they were hunted to near extinction in the 1800s. During this period 

of history, buffalo were critical to survival of the American Indian. Buffalo provided 

food, shelter, clothing and essential tools for Indian people and insured continuance 

of their subsistence way of life. Naturally, Indian people developed a strong spiritual 

and cultural respect for buffalo that has not diminished with the passage of time. 

Numerous tribes that were committed to preserving the sacred relationship between Indian people and buffalo established the ITBC as an effort to restore buffalo 

to Indian lands. ITBC focused upon raising buffalo on Indian Reservation lands that 

did not sustain other economic or agricultural projects. Significant portions of Indian Reservations consist of poor quality lands for farming or raising livestock. 

However, these wholly unproductive Reservation lands were and still are suitable 

for buffalo. ITBC began actively restoring buffalo to Indian lands after receiving 

funding in 1992 as an initiative of the Bush administration. 

Upon the successful restoration of buffalo to Indian lands, opportunities arose for 

Tribes to utilize buffalo for tribal economic development efforts. ITBC is now focused 

on efforts to assure that tribal buffalo projects are economically sustainable. Federal 

appropriations have allowed ITBC to successfully restore buffalo the tribal lands, 

thereby preserving the sacred relationship between Indian people and buffalo. The 

respect that Indian tribes have maintained for buffalo has fostered a serious commitment by ITBC member Tribes for successful buffalo herd development. The successful promotion of buffalo as a healthy food source will allow Tribes to utilize a 

culturally relevant resource as a means to achieve self-sufficiency. 

FUNDING REQUEST FOR PREVENTATIVE HEALTH CARE INITIATIVE

The InterTribal Bison Cooperative respectfully requests an appropriation for fiscal 

year 2007 in the amount of $2,000,000 in the form of an earmark to the Department 

of Health and Human Service Department’s budget. ITBC intends to utilize the 

funds to conduct a national demonstration project focused on the delivery of bison 

meat to Native Americans suffering from diet related diseases. 

The Native American population currently suffers from the highest rates of Type 

2 diabetes. The Indian population further suffers from high rates of cardio vascular 

disease and various other diet related diseases. Studies indicate that Type 2 diabetes commonly emerges when a population undergoes radical diet changes. Native 

Americans have been forced to abandon traditional diets rich in wild game, buffalo 

and plants and now have diets similar in composition to average American diets. 

More studies are needed on the traditional diets of Native Americans versus their 

modern day diets in relation to diabetes rates. However, based upon the current 

data available, it is safe to assume that disease rates of Native Americans are directly impacted by a genetic inability to effectively metabolize modern foods. More 

specifically, it is well accepted that the changing diet of Indians is a major factor 

in the diabetes epidemic in Indian Country. 

Approximately 65–70 percent of Indians living on Indian Reservations receive 

foods provided by the USDA Food Distribution Program on Indian Reservation 

(FDPIR) or from the USDA Food Stamp Program. The FDPIR food package is composed of approximately 58 percent carbohydrates, 14 percent proteins and 28 percent fats. Studies have shown that the FDPIR food package has not been compatible 

with the genetic compositions of Native Americans and has been a major factor in 

the high incidence of diet-related disease among Native Americans. Indians utilizing 

Food Stamps generally select a grain based diet and poorer quality protein sources 

such as high fat meats based upon economic reasons and the unavailability of higher quality protein food sources. 

Buffalo meat is low in fat and cholesterol and is compatible to the genetics of Indian people. ITBC intends to develop a health care initiative that would educate Indian Reservation families of the benefits of incorporating buffalo meat into their 

diets. In conjunction with educating Reservation families on the benefits of buffalo 

meat, ITBC intends to develop methods to make buffalo meat accessible for Indian 
350 

families and to promote incorporation of buffalo into their diets. ITBC intends to coordinate with Reservation health care providers in nutritional studies of Reservation 

populations that incorporate buffalo meat into diet packages. 

ITBC believes that incorporating buffalo meat will positively impact the diets of 

Indian people living on Reservations. A healthy diet for Indian people that results 

in a lower incidence of diabetes and other diet related illnesses will reduce Indian 

Reservation health care costs and result in a savings for taxpayers. 

FUNDING REQUEST FOR ITBC TRAINING AND LABOR PROGRAM

The InterTribal Bison Cooperative respectfully requests an appropriation for fiscal 

year 2007 in the amount of $500,000. This amount is $400,000 above the fiscal year 

2006 appropriation for ITBC and is critical to maintain last years funding level and 

to develop ITBC’s training and labor program. 

In fiscal year 2005, the ITBC and its member Tribes were funded at $100,000, 

a decrease of $200,000 from the previous year. ITBC is now requesting $500,000 for 

fiscal year 2007 for job training as part of ITBC’s labor initiative. To insure the success of ITBC’ s buffalo restoration efforts to Indian lands, training for the various 

jobs related to the buffalo projects is essential. Most member Tribes of ITBC have 

reservation unemployment rates of 72 percent. Jobs opportunities on most Indian 

Reservations are limited, low-paying, and often seasonal and temporary. The jobs 

created by buffalo restoration to Indian lands will positively impact Tribal unemployment rates and the overall Reservation poverty levels. Raising buffalo as an economic development effort requires skilled labor in permanent employment. ITBC 

has developed a job training program incorporating on-the-job training and work experience for youth that specifically addresses the unique needs of managing and 

maintaining buffalo. ITBC’s training program further focuses on strengthening the 

economic development opportunities of buffalo restoration with training specific to 

meat processing, veterinary science, wildlife and biological services, infrastructure 

development, business and management training, and the overall development of a 

skilled workforce. 

Sufficient funding for job training is critical to the success of the buffalo restoration projects. The increase in funding will ensure that ITBC can provide job training, job growth training to ITBC member tribes. Without funding at the requested 

level, the buffalo restoration projects have less assurance of success. 

ITB GOALS AND INITIATIVES

In addition to developing a preventative health care initiative, ITBC intends to 

continue with buffalo restoration efforts and the Tribal buffalo marketing initiative. 

In 1991, seven Indian Tribes had small buffalo herds, with a combined total of 

1,500 animals. The herds were not utilized for economic development but were often 

maintained as wildlife only. During ITBC’s relatively short 10-year tenure, it has 

been highly successful at developing existing buffalo herds and restoring buffalo to 

Indian lands that had no buffalo prior to 1991. Today, through the efforts of ITBC, 

over 35 Indian Tribes are engaged in raising over 15,000 buffalo. All buffalo operations are owned and managed by Tribes and many programs are close to achieving 

self-sufficiency and profit generation. ITBC’s technical assistance is critical to ensure that the current Tribal buffalo projects gain self-sufficiency and become profitgenerating. Further, ITBC’s assistance is critical to those Tribes seeking to start a 

buffalo restoration effort. 

Through the efforts of ITBC, a new industry has developed on Indian reservations 

utilizing a culturally relevant resource. Hundreds of new jobs directly and indirectly 

revolving around the buffalo industry have been created. Tribal economies have benefited from the thousands of dollars generated and circulated on Indian Reservations. 

CONCLUSION

ITBC has proven highly successful since its establishment to restore buffalo to Indian Reservation lands to revive and protect the sacred relationship between buffalo 

and Indian Tribes. Further, ITBC has successfully promoted the utilization of a culturally significant resource for viable economic development. 

ITBC has assisted Tribes with the creation of new jobs, on-the-job training and 

job growth in the buffalo industry resulting in the generation of new money for tribal economies. ITBC is also actively developing strategies for marketing Tribally 

owned buffalo. Finally, and most critically for Tribal populations, ITBC is developing a preventive health care initiative to utilize buffalo meat as a healthy addition 

to Tribal family diets to reduce the incidence of diet-related illnesses. 
351 

ITBC strongly urges you to support its request for a $2,000,000 earmark to the 

Department of Health and Human Service Department’s budget to develop the critically needed preventative health care initiative utilizing Tribally produced buffalo. 

PREPARED STATEMENT OF THE JOHN B. AMOS CANCER CENTER

Mr. Chairman and members of the subcommittee, I appreciate the opportunity to 

submit testimony to the hearing record regarding the John B. Amos Cancer Center 

(JBACC) in Columbus, Georgia. JBACC is a comprehensive community cancer center designed to address the continuum of the disease from prevention and early detection through treatment, survivorship and palliation. 

Accredited by the Commission on Cancer, American College of Surgeons, JBACC’s 

mission is to provide exceptional quality-driven care. Accordingly, we have opened 

a (49,620 sq. ft.) hospital-based cancer center located on its own campus and surrounded by meditation gardens. This unique facility is designed to address cancer 

along a disease management approach allowing patients, families, and the community at large to enter our services at any point in the disease process whether it 

is for education, diagnosis, treatment, or psychosocial support. Our outreach programs are a significant component of our action plan to improve the health of the 

region, as well. Further development of these programs is the reason I address you 

today. 

As you are aware, the John B. Amos Cancer Center received fiscal year 2005 

Labor, HHS, and Education Appropriations. I would like to thank the subcommittee 

for this support and elaborate on the success of our programs thus far. 

Leveraging community and government support, we have developed extensive 

Breast and Cervical Cancer Screening Programs that allow us to reach many underserved areas of the 14 county region encompassing our service area. Community 

Health Advisors (CHAs) trained and educated by JBACC in collaboration with the 

West Georgia Cancer Coalition to address cancer education, prevention, and diagnostic care, assist in the facilitation of community screenings to maximize the effect 

of the screening events. These CHAs are native to the communities they serve and 

therefore possess intuitive knowledge necessary for conducting successful community screenings such as appropriate venues and marketing techniques for the respective population. Other factors, such as matching a bilingual CHA with Hispanic 

communities to increase accessibility and comfort levels are also considered. 

Screenings are conducted on a weekly basis in communities throughout the region. Rural communities are specifically targeted as screening sites at least once a 

month. A culturally diverse multidisciplinary team extends a comprehensive approach to providing care and access to services at these events. This is a level of 

service previously unattainable in some areas. The team includes a bilingual physician, a nurse practitioner, a nurse, a case manager, and clerical personnel. Additionally, volunteers are often available to set up educational materials. The CHAs often 

attend the events as well and may sometimes act as liaisons between patients and 

the JBACC staff. 

By the point at which many patients walk into the Amos Cancer Center facility, 

the disease has advanced to a stage at which treatment and cure is exceedingly difficult. Therefore, the primary goal of community screenings is to promote and make 

available early detection and treatment options. To this end, initial on-site exams 

are performed free of charge, regardless of ability to pay, to increase service accessibility. Abnormal exams are referred to care coordinators for referral for additional 

screenings or diagnostic testing, as applicable. Dependent upon the patient’s schedule, this can usually be achieved with the same week as the initial screening. A surgical consult is provided 2 to 4 days after testing, if necessary. If further investigation is warranted, coordinators access the system to see that the patient’s needs, including financial and psychological are met. The target timeline objective is two 

weeks from exam to diagnosis and treatment. Identification of cervical abnormalities 

is slightly more involved and requires a timeline of approximately 3.5 to 4 weeks. 

The outreach program is not limited to screenings. Educational programs and cancer prevention programs are provided to organizations throughout the region. These 

include breast health lectures provided to churches, sororities, and healthcare 

groups, and providing educational materials and interactive displays for cancerthemed events on local college campuses. These events reinforce the importance of 

early detection. 

We have developed a successful early detection outreach program. The requested 

funding of $2 million in fiscal year 2007 would allow us to expand the program to 

be even more effective within the fourteen county region in which 511,736 citizens 

reside. Expansion efforts would allow us to reach traditionally underserved popu-
352 

lations by scheduling screenings in communities not yet familiar with our programs. 

This includes rural and urban areas in both Georgia and Alabama, some of which 

lie in the socio-economically deprived ‘‘Black Belt’’. 

In addition to the community screenings, funding would provide for the development of two permanent weekly cancer screening clinics. These clinics would allow 

citizens the peace of mind of the availability of set screening opportunities, rather 

than waiting for a local opportunity to occur. 

Funding from JBACC’s fiscal year 2005 Labor, HHS, Education Appropriation 

was limited to breast and cervical cancer screening. However, we have identified a 

need and an opportunity within the community to focus on men’s health issues as 

well, through prostate screenings. The requested funding would allow for the expansion of our outreach program to include this component. Incorporation of prostate 

screenings into our existing program could occur seamlessly. This would allow us 

to expand our focus to include a population previously not served in this capacity. 

Excluding skin cancers, prostate cancer is the most common cancer in American 

men. While the statistics regarding prostate cancer are staggering, early detection 

and more effective treatment methods have led to lower death rates in recent years. 

This further underscores the need for prostate screening programs in underserved 

areas to improve the health status of the region. 

The requested funding would also provide for colorectal screenings. This year, 

nearly 150,000 men and women will be diagnosed with colorectal cancer while approximately 56,000 will die from it. Once again, however, early detection and treatment are essential to increased survival rates. However, studies indicate that many 

people are often uncomfortable talking about the disease. They are also misguided 

on their risk factors and chance of getting the disease. Overcoming these obstacles 

to diagnosis and treatment can be achieved through community educational and 

screening opportunities. 

Mr. Chairman, John B. Amos Cancer Center is committed to improving the health 

of the region by addressing and embracing the Healthy People 2010 focus areas of 

overall cancer deaths. Recognizing that to reach our goals we must design programs 

that engage the region in our early detection and screening programs, we have 

taken great strides to do so. We believe in the documented success of our outreach 

programs and hope that the subcommittee will provide $2 million toward program 

expansion. Through the expansion, we will reach underserved populations and reduce cancer mortality and morbidity, thereby improving the health of the region in 

accordance with the goals of the Department of Health and Human Services as well 

as this subcommittee. 

PREPARED STATEMENT OF MATRIA HEALTHCARE

SUMMARY OF FISCAL YEAR 2007 RECOMMENDATIONS

—Provide full funding in fiscal year 2007 for the Health and Human Services 

(HHS) Health Information Technology Initiative, including funding for the Office of the National Coordinator for Health Information Technology (ONCHIT) 

and the Agency for Healthcare Research and Quality (AHRQ). 

—Provide a 5 percent increase for fiscal year 2007 to the National Institutes of 

Health (NIH) budget. Within NIH, provide an increase of 5 percent to the National Library of Medicine (NLM). 

—Urge the National Coordinator for the Office of the National Coordinator for 

Health Information Technology (ONCHIT), the National Library of Medicine 

(NLM) at the National Institutes of Health (NIH), the Agency for Healthcare 

Research and Quality (AHRQ), and the Centers for Medicare and Medicaid 

Services (CMS) to conduct outreach activities to all public and private sector organizations which have demonstrated capabilities in health information technology, particularly to those who have demonstrated capabilities in disease 

management technology as it relates to saving health care dollars, and improving care for chronically ill individuals and the workforce. 

Chairman Specter and members of the subcommittee, thank you for the opportunity to present this written statement regarding the importance of health information technology, specifically as it relates to disease management technology, saving health care dollars, and improving care for chronically ill individuals and the 

workforce. 

Matria Healthcare is a national leader in disease management. Our disease management programs have been adopted by leading corporations, health plans, and 

State governments as a proven solution for reducing costs and improving health and 

productivity. Because 15 percent of the population typically drives 85 percent of 
353 

healthcare costs, Matria believes the strongest, most effective healthcare solutions 

start with a strong disease management program to begin curbing costs immediately. 

The disease management component of Matria’s health enhancement offering provides management programs for the Nation’s most costly chronic diseases, episodic 

conditions, and issues affecting the psychosocial well-being of patients and has produced outcomes like no other provider. Matria’s industry-leading TRAX technology 

platform represents the state-of-the-art in healthcare data warehousing and protocol-driven healthcare delivery. This platform is driving the clinical and financial 

outcome success of Matria in over one hundred Fortune 1000, health plan, and State 

government programs. Matria’s technology platform is being utilized by members of 

the National Coordinator for Health Information Technology’s Interoperability Consortium to successfully improve clinical outcomes and reduce healthcare expenditures amongst its employees. 

In April 2004, President Bush revealed his vision for the future of healthcare in 

the United States. The President’s plan involves a health care system that puts the 

needs of the patient first, is more efficient, and is cost-effective. At this time, he established, within the Office of the Secretary of Health and Human Services, an Office of the National Coordinator for Health Information Technology (ONCHIT). 

Among other things, this office is meant to ensure that appropriate information is 

available to guide medical decisions, improve healthcare quality, reduce healthcare 

costs resulting from inefficiency, medical errors, inappropriate care, and incomplete 

information, promote a more efficient marketplace, greater competition, and increase in choice, and improve the coordination of care and information among hospitals, laboratories, physician offices, and other ambulatory care providers. 

Matria’s health enhancement offerings are consistent with these goals of the 

President and the ONCHIT. In the transition towards a health care system where 

informed consumers will own their personal health records, health savings accounts, 

and health insurance, it is important for the Federal Government to partner with 

public and private sector organizations which have demonstrated capabilities in this 

arena. 

Health information technology will improve the practice of medicine and make it 

more efficient. The rapid implementation of secure and interoperable electronic 

health records will, for example, significantly improve the safety, quality, and costeffectiveness of health care. To implement this vision, Matria urges the subcommittee to support the President’s budget request of $116 million for the 

ONCHIT to provide strategic direction for development of a national interoperable 

health care system. Matria also encourages the subcommittee to support the $50 

million Health Information Technology Initiative through the Agency for Healthcare 

Research and Quality (AHRQ) to accelerate the development, adoption, and diffusion of interoperable information technology in a range of health care settings. Additionally, Matria urges the subcommittee to provide a 5 percent increase for fiscal 

year 2007 to the National Institutes of Health (NIH) budget, and within NIH, provide a proportional increase of 5 percent to the National Library of Medicine (NLM). 

Finally, Matria encourages the subcommittee to urge the National Coordinator for 

the ONCHIT, NLM, AHRQ, and the Centers for Medicare and Medicaid Services 

(CMS) to conduct outreach activities to all public and private sector organizations 

which have demonstrated capabilities in health information technology, particularly 

to those who have demonstrated capabilities in disease management technology as 

it relates to saving health care dollars, and improving care for chronically ill individuals and the workforce. 

By working together, the goal of creating an efficient national healthcare system 

will be realized. Thank you for allowing me to submit this testimony to you today. 

PREPARED STATEMENT OF THE NATIONAL ALLIANCE TO END HOMELESSNESS

The National Alliance to End Homelessness (the Alliance) is a nonpartisan, nonprofit organization that has several thousand partner agencies and organizations 

across the country. These partners are local faith-based and community-based nonprofit organizations and public sector agencies that provide homeless people with 

shelter, transitional and permanent housing, and services such as substance abuse 

treatment, job training, and health and mental health care. In addition, we have 

supported over 220 State and local entities as they create 10 year plans to end 

homelessness. The Alliance represents a united effort to address the root causes of 

homelessness and challenge society’s acceptance of homelessness as an inevitable 

by-product of American life. 
354 

Overview.—Adequate social services program funding is essential to ending homelessness. Housing must be coupled with appropriate services such as health care, 

employment preparation, mental health and substance abuse treatment, child care, 

and youth directed programs to be effective. These programs were put to the test 

as social service agencies assisted Katrina evacuees. The Social Services Block 

Grant, the Community Services Block Grant, Projects for Assistance in Transition 

from Homelessness, Education for Homeless Children and Youth funded school liaisons and Health Care for the Homeless clinics among others were essential as the 

gulf coast residents overcame their housing crisis. These lessons illustrate how 

HHS, Labor, and Education programs can help those homeless due to other crises 

such as job loss or catastrophic illness. 

GOALS

1. Moving Forward to End Homelessness.—By implementing 10 year plans to end 

homelessness, communities across America are ending homelessness. Communities 

are using Federal, State, and local funds to help homeless persons, some of whom 

have been homeless for years, maintain housing. It is important that this progress 

not be undermined. To this end, the Alliance recommends the following: 

A. Allocate $55 million for services in permanent supportive housing within 

SAMHSA’s Center for Mental Health Services. 

B. Reject cuts to the Grants for the Benefit of Homeless Individuals/Treatment for Homeless Individuals (GBHI) and insure that additional local programs can access these funds. 

C. Increase funding to Projects for Assistance in Transition from Homelessness (PATH) to $65 million. 

D. Increase the Runaway and Homeless Youth Act Programs to $140 million 

and reject detrimental policy recommendations. 

E. Fund Education for Homeless Children and Youth services at its full authorized level of $70 million. 

F. Increase funding for the Homeless Veterans Reintegration Program to $50 

million. 

2. Connecting Homeless Families, Individuals, and Youth to Mainstream Services.—The estimated 3.5 million people who are homeless throughout a year depend 

on mainstream programs such as the ones below to live day to day and once housed, 

remain housed. These programs help address the complex situations persons experiencing homelessness are trying to overcome. The Alliance recommends the following 

to meet this goal: 

A. Fund the Social Services Block Grant at $1.7 billion, the same funding 

level as fiscal year 2006. 

B. Reject elimination of the Community Services Block Grant. 

C. Appropriate $171 million for the Health Care for the Homeless programs 

within the Health Resource Services Administration’s Consolidated Health Centers program. 

D. Appropriate $60 million in education and training vouchers for youth 

exiting foster care under the Safe and Stable Families Program. 

Goal #1—Moving Forward to End Homelessness 

Support Services for Permanent Supportive Housing Projects 

The Alliance recommends allocating $55 million for services in permanent supportive housing within SAMHSA’s Center for Mental Health Services. The administration has set a goal of ending chronic homelessness by 2012. We know this goal 

is attainable based on evidence based practices. For example, through the collaborative initiative grants program, HHS, the Department of Veterans Affairs, and 

HUD have funded programs and seen results. These eleven grants have ended 

homelessness for 550 people who cumulatively had over 5,000 years of homelessness. Unfortunately, funding for these grants will end in 2006. The President has 

proposed an increase of $209 million for the McKinney/Vento homelessness programs as part of the proposed fiscal year 2007 HUD budget to primarily pay for 

housing for those who are chronically homeless. No such investment has been included for HHS. 

Treatment for Homeless Individuals 

The Alliance recommends that Congress fully reject cuts in Grants for the Benefit 

of Homeless Individuals (GBHI) funding and work to strengthen the program for additional grantees. Maintaining programs such as GBHI is essential to achieving the 

President’s goal of ending chronic homelessness by 2012. Mainstream health, welfare, addiction, and mental health programs often do not adequately serve homeless 
355 

people. In 2003, the U.S. Department of Health and Human Services studied mainstream programs and their ability to serve chronically homeless populations. The report, entitled Ending Chronic Homelessness: Strategies for Action, explained that no 

mainstream program is comprehensive enough to adequately serve chronically 

homeless people. Thus, HHS included in the recommendations that future program 

budgets should focus on funding programs directed for chronic homelessness. 

There are a variety of reasons mainstream programs fail to adequately service 

people who are chronically homeless. Many programs simply lack the ability to fund 

or coordinate the full range of health, housing, and support services required to adequately help homeless people. Grants through the Treatment for Homeless Individuals/Grants for the Benefit of Homeless Individuals (GBHI) program help homeless 

service providers assemble services that meet the complex needs of their clients and 

maintain their housing. 

Projects for Transition Assistance from Homelessness (PATH) 

The Alliance recommends that Congress increase PATH funding to $65 million. 

The PATH program provides homeless people with serious mental illnesses access 

to mental health services. PATH focuses on outreach to eligible consumers, followed 

by help in ensuring that those consumers are connected with mainstream services. 

Under the PATH formula grant, approximately 30 States share in the program’s annual appropriations increases. The remaining States and territories receive the minimum grant of $300,000 for States and $50,000 for territories. These amounts have 

not been raised since the program was authorized in 1991. To account for inflation, 

the minimum allocation should be raised to $600,000 for States and $100,000 for 

territories. Amending the minimum allocation requires a legislative change. If the 

authorizing committees do not have sufficient time to address this issue, we hope 

that appropriators will explore ways to make the amendment through appropriations bill language. 

Runaway and Homeless Youth Programs 

The Alliance recommends funding the Runaway and Homeless Youth Act (RHYA) programs at $140 million. RHYA programs support cost-effective, community and 

faith-based organizations that protect youth from the harms of life on the streets. 

The problems of homeless and runaway youth are addressed by the Administration 

for Children and Families within HHS, which operates coordinated competitive 

grant programs like RHYA. The RHYA programs can either reunify youth safely 

with family or find alternative living arrangements. RHYA programs end homelessness by: engaging youth living on the street with Street Outreach Programs, quickly 

providing emergency shelter and family crisis counseling through the Basic Centers, 

or providing supportive housing that helps young people develop lifelong independent living skills through Transitional Living Programs. 

Education for Homeless Children and Youth 

The Alliance recommends funding Education for Homeless Children and Youth 

(EHCY) at its full authorized level of $70 million. The most important potential 

source of stability for these children is school. The mission of the Education for 

Homeless Children and Youth program is to ensure that homeless children can continue to attend school and thrive. A struggle for homeless service providers who 

serve families with children is to maintain the children’s stability during a time 

when their lives are turned upside down. Even if new housing can be found in a 

short time, the lasting effects of a spell of homelessness can be devastating. 

The Education for Homeless Children and Youth program, within the Department 

of Education’s Office of Elementary and Secondary Education, removes obstacles to 

enrollment and retention by establishing liaisons between schools and shelters and 

providing funding for transportation, tutoring, school supplies, and the coordination 

of statewide efforts to remove barriers. 

Homeless Veterans Reintegration Program (HVRP) 

The Alliance recommends that Congress increase HVRP funding to $50 million. 

HVRP, within the Department of Labor’s Veterans Employment and Training 

Service (VETS), provides competitive grants to community-based, faith-based, and 

public organizations to offer outreach, job placement, and supportive services to 

homeless veterans. HVRP is the primary employment services program accessible 

by homeless veterans and the only targeted employment program for any homeless 

subpopulation. The Department of Labor estimates that 8,750 homeless veterans 

will be served through HVRP at the fiscal year 2006 appropriation level of $22 million. This figure represents just 2 percent of the overall homeless veteran population, which the Department of Veterans Affairs estimates numbers more than 

400,000 over the course of a year. An appropriation at the authorized level of $50 
356 

1Section 202 is dedicated to housing from elderly and disabled individuals and families. 

2 U.S. Department of Health and Human Services, Administration of Children and Families. 

The Community Services Block Grant Fiscal Year 2004 Statistical Report. Prepared by the National Association for State Community Services Programs. 3 Harris, Shirley N, Carol T. Mowbray and Andrea Solarz. Physical Health, Mental Health and 

Substance Abuse Problems of Shelter Users. Health and Social Work, Vol. 19, 1994. 

million would enable HVRP grantees to reach approximately 19,866 homeless veterans. 

Goal #2—Connecting Homeless Families, Individuals and Youth to Mainstream 

Services 

Social Services Block Grant (SSBG) 

The Alliance recommends that Congress fully restore SSBG funding to its fiscal year 2006 level of $1.7 billion. Cuts to programs like the SSBG will create additional 

barriers for communities trying to achieve the President’s goal of ending chronic 

homelessness by 2012. SSBG funds are essential for programs dedicated to ending 

homelessness. In particular, youth housing programs and permanent supportive 

housing providers often receive State, county, and local funds which originate from 

the SSBG. As the U.S. Department of Housing and Urban Development has focused 

its funding on housing, programs that provide both housing and social services have 

struggled to fund the service component of their programs. This gap is often closed 

using Federal programs such as SSBG. 

Community Services Block Grant (CSBG) 

The Alliance recommends that Congress fully restore CSBG funding to its fiscal year 2006 level of $630 million. Eliminating funding for the CSBG will destabilize 

the progress communities have made toward ending homelessness by not only ending services directly provided by CSBG funds but limiting a community’s ability to 

access other Federal dollars such as those provided by HUD. This runs contrary to 

the President’s stated goal of ending chronic homelessness by 2012. Community Action Agencies (CAAs) are directly involved in housing and homelessness services. In 

several communities, CAAs lead the Continuum of Care (CoC). CoCs coordinate 

local homeless service providers and the community’s McKinney-Vento Homeless 

Assistance Grant application process with the Department of Housing and Urban 

Development. 

In the fiscal year 2004 Community Services Block Grant Information Systems report published by the U.S. Department of Health and Human Services, CAAs reported administering $207.4 million in Section 8 vouchers, $30 million in Section 

202 services 1 and $271.1 million in other Department of Housing and Urban Development (HUD) programs which includes homeless program funding.2

Health Care for the Homeless (HCH) 

The Alliance recommends $171 million, the amount recommended by the Presi- dent, for HCH (8.7 percent of the $1.963 billion requested for the Consolidated 

Health Centers account). Persons living on the streets suffer from health problems 

resulting from or exacerbated by the conditions of being homeless, such as hypothermia, frostbite, and heatstroke. In addition, they often have infections of the respiratory and gastrointestinal systems, tuberculosis, vascular diseases such as leg ulcers, and hypertension.3 Health care for the homeless programs are vital to prevent 

these conditions from becoming fatal. Congress allocates 8.7 percent of the Consolidated Health Centers account for Health Care for the Homeless (HCH) projects. The 

HCH program has achieved significant success since its inception in 1987, but the 

health care needs Americans experiencing homelessness each year far exceed the 

service capacity of Health Care for the Homeless grantees. The President’s fiscal 

year 2007 budget would create 15 to 20 new projects, serving an additional 25,000 

to 30,000 people experiencing homelessness. 

Foster Youth Education and Training Vouchers 

The Alliance recommends that Congress appropriate $60 million in education and 

training vouchers for youth exiting foster care under the Safe and Stable Families 

Program. The Education and Training Voucher Program offers funds to foster youth 

and former foster youth to enable them to attend colleges, universities and vocational training institutions. Students may receive up to $5,000 a year for college or 

vocational training education. The funds may be used for tuition, books, housing, 

or other qualified living expenses. Given the large number of people experiencing 

homelessness who have a foster care history, it is important to provide assistance 

such as these education and training vouchers to stabilize youth, prevent economic 

crisis, and prevent possible homelessness. 
357 

CONCLUSION

Homelessness is not inevitable. As communities implement plans to end homelessness, they are struggling to find funding for the services homeless and formerly 

homeless clients need to maintain housing. The Federal investments in mental 

health services, substance abuse treatment, employment training, youth housing, 

and case management discussed above will help communities create stable housing 

programs and change social systems which will end homelessness for millions of 

Americans. 

PREPARED STATEMENT OF THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH

CENTERS

On behalf of more than 1,000 health center grantees across the country serving 

more than 15 million patients, the National Association of Community Health Centers (NACHC) is pleased to submit this statement for the record, and thank the subcommittee for its continued support and investment in the Health Centers program. 

ABOUT HEALTH CENTERS

Over more than 40 years, the Health Centers program has grown from a small 

demonstration project providing desperately needed primary care services in underserved communities to one of the fundamental elements of our Nation’s health care 

safety net. Funding was approved in 1965 for the first two neighborhood health center demonstration projects, one in Boston, Massachusetts, and the other in Mound 

Bayou, Mississippi. 

Today, America’s health centers are helping communities meet escalating health 

needs and address costly and devastating health problems, from prenatal and infant 

health development to chronic illness (like diabetes and asthma), to mental health, 

substance addiction, domestic violence and HIV/AIDS. Health centers are the family 

doctor for 1 in 8 uninsured individuals, and 1 in every 5 low-income children. Health 

centers serve as the primary health care safety net for many communities across 

the country and the Federal grant program enables more low-income and uninsured 

patients to receive care each year. 

Every Federally Qualified Health Center (FQHC) is governed by a community 

board with a patient majority—a true patient democracy. Health centers are required to be located in a federally designated Medically Underserved Area (or 

MUA), and must provide a package of comprehensive primary care services to anyone who comes in the door, regardless of their ability to pay. At the typical health 

center, roughly one-quarter of the operating revenues are from the Federal grant; 

and just over 40 percent are from reimbursement through Federal insurance programs, principally Medicare and Medicaid. The balance of the revenues are from 

State and community partnerships, privately insured individuals, and patients ability to pay. 

The Health Centers program is administered by the Bureau of Primary Health 

Care (BPHC) at the Health Resources and Services Administration (HRSA), within 

the U.S. Department of Health and Human Services (HHS). 

FUNDING BACKGROUND

The subcommittee has approved substantial funding increases for the Consolidated Health Centers program over the past several years resulting in a broad expansion effort to serve many of those that remain underserved in our country. Most 

recently, the increase in funding approved for fiscal year 2006 will help more than 

600,000 additional Americans gain access to effective, affordable primary and preventive care services offered by our Nation’s Health Centers. 

Since 2001, the subcommittee has increased funding for Health Centers in order 

to stabilize existing centers and meet the goals of the President’s initiative—1,200 

new or expanded centers and an additional 6.1 million patients served by 2006. To 

date, the expansion has brought high-quality services to an additional 4 million 

Americans and has produced new or expanded facilities in over 800 communities nationwide. Even with the increases provided over the past several years, hundreds 

of communities submitted applications that received high ratings but could not be 

funded, due to lack of funds. There is clearly a tremendous need and a tremendous 

desire to expand health center services to new communities. 

The health centers program has succeeded in expanding access to primary and 

preventive care services in underserved communities across the country. The Office 

of Management and Budget rated the Health Centers program as one of the top 10 

Federal programs, and the best competitive grant program within all of HHS. With 
358 

additional resources, health centers stand ready to provide low-cost, highly effective 

care to millions more uninsured and underserved individuals and families. 

FISCAL YEAR 2007

In his fiscal year 2007 budget proposal, President Bush requested an increase for the Health Centers program of $181 million, for a total funding level of $1.963 billion in fiscal year 2007. NACHC strongly supports the President’s requested increase for the program, which will continue the historic expansion of the Health 

Centers program into hundreds of additional communities nationwide. 

In 2005, President Bush called for ‘‘a community health center in every poor county’’ in America. NACHC strongly supports this goal and urges Congress to provide 

funds to begin this critical expansion effort. NACHC was encouraged that the administration did not recommend waiving the statutorily designated proportionality 

requirements for Migrant, Public Housing and Homeless Health Centers in order to 

implement this second expansion initiative. 

In addition to the expansion efforts, it is critical that Federal funding for health 

centers keep pace with the growing cost of delivering care. NACHC requests that 

the subcommittee designate $50 million of any increase in funding to be used to 

make base grant adjustments for existing centers, allowing an average increase of 

2.8 percent in current health center grants, equal to the Medicare Economic Index. 

Under the subcommittee’s leadership, Congress has provided base grant adjustments for existing centers in 5 out of the 7 previous fiscal years. A recent study 

by NACHC found that in the 2 years that these adjustments were not included in 

the Health Centers appropriation, the number of patient visits per grantee actually 

decreased. 

NACHC appreciates the subcommittee’s leadership in stabilizing the Federal Tort 

Claims Act (FTCA) judgment fund for health centers in past years. For fiscal year 

2007, the President has requested that $44,500,000 be appropriated for this purpose. This is the same funding level as last year, and NACHC expects it will be sufficient to cover FTCA claims in 2007. 

In 1997, Congress authorized and began funding the HRSA Loan Guarantee Program (LGP) for the construction, renovation, and modernization of health centers. 

Demand for this guarantee program has accelerated significantly in the last year. 

NACHC expects that at the current rate of usage, the remaining $5 million in credit 

subsidy will be entirely used during fiscal year 2006. In response that the success 

of this program, NACHC is requesting an additional $5 million be provided until 

expended for additional loan guarantees. The LGP has proven to be a vital resource 

for health centers across the country as they seek financing to fund the facilities 

necessary to accommodate the growth in patient visits resulting from recent expansion efforts. 

Finally, Health Centers support funding for other Federal programs that are integral to the continued expansion and strength of community health centers. These 

include: 

—$150 million for the National Health Service Corps, which is the largest source 

of health professionals for health centers; 

—$250 million for Title III of the Ryan White CARE Act, which provides grants 

to health centers and other safety net providers for outpatient early intervention services; 

—$550 million for Title VII and Title VIII Health Professions programs, particularly Area Health Education Centers, which bring together academic and community partners to improve the supply and distribution of health professionals 

in underserved communities. 

—$170 million for health information technology (HIT) resources through various 

programs at the Department of Health and Human Services. Health centers 

must have adequate resources through HHS to facilitate the utilization of electronic health records and other important HIT tools to promote health disparities reduction. 

CONCLUSION

America’s health centers are grateful to the subcommittee for its ongoing efforts 

to support and stabilize the Health Centers program and to expand health centers’ 

reach into more than 5,000 communities nationwide. As a result of those efforts, 

more than 15 million people have access to the affordable, effective primary care 

services that our Nation’s health centers provide. 

We respectfully ask that the subcommittee continue that investment, as the work 

of caring for our uninsured and medically underserved is far from complete. Some 

36 million Americans are still without regular access to medical services. America’s 
359 

health centers look forward to meeting that need and rising to the challenge of providing a health care system that works for all Americans. We look forward to working with you over the coming year to move toward that goal. 

If you need any additional information or have any questions related to health 

centers or NACHC, please do not hesitate to contact me or John Sawyer, Assistant 

Director of Federal Affairs, at (202) 331–4603, or via email at jsawyer@nachc.com. 

PREPARED STATEMENT OF THE NATIONAL ASSOCIATION FOR STATE COMMUNITY

SERVICES PROGRAMS

The National Association for State Community Services Programs (NASCSP) 

thanks this committee for its continued support of the Community Services Block 

Grant (CSBG), and seeks an appropriation of $650 million for the State grant portion of the CSBG, the same as its fiscal year 2004 appropriation. We are requesting 

that the CSBG funding be restored to the fiscal year 2004 level this year in order 

for the CSBG Network to continue addressing the long-term needs of those families 

affected by Hurricanes Katrina and Rita, those families transitioning from welfare 

to work, and to assist low-income workers in remaining at work through supportive 

services such as transportation and child care. It is essential that the CSBG funding 

be restored in full for fiscal year 2007. The across the board cuts the CSBG has experienced the past several years have decreased the ability of the CSBG Network 

to provide essential services to low-income Americans. 

In addition, NASCSP urges this Committee to eliminate all authorization language regarding the management of the CSBG from the fiscal year 2007 appropriation bill. In fiscal year 2006, the appropriations bill included authorization language 

regarding the use of the block grant at the State level. Specifically, the fiscal year 

2006 appropriations report included the following authorization language which conflicted with ‘‘SEC. 675C. USES OF FUNDS (A)(3) of the Public Law 105–285: The 

Community Opportunities, Accountability, and Training and Educational Services 

Act of 1998 (the CSBG authorization law): ‘‘That to the extent Community Services 

Block Grant funds are distributed as grant funds by a State to an eligible entity 

as provided under the Act, and have not been expended by such entity, they shall 

remain with such entity for carryover into the next fiscal year for expenditure by 

such entity consistent with program purposes.’’ 

The 1998 CSBG Authorization allows CSBG eligible entities to carry over up to 

20 percent of funds but requires the State to recapture or redistribute any funds 

that exceed 20 percent. According to the 1998 CSBG Authorization, once these funds 

are recaptured the State is to redistribute the excess funds to other low-income communities in dire need of additional funds. When language such as the above is 

placed in the Appropriations document, it overrides the Authorization language. The 

inclusion of such language in the appropriations report caused a hardship on States 

as they managed the block grant. Passing national legislation which contradicts the 

authorization language regarding the distribution of funds preempts the prerogative 

of States. NASCSP urges the committee to discourage the incorporation of authorization language in the appropriations act. 

NASCSP is the national association that represents State administrators of the 

Community Services Block Grant (CSBG), and State directors of the Department of 

Energy’s Low-Income Weatherization Assistance Program. 

BACKGROUND

The States believe the Community Services Block Grant (CSBG) is a unique block 

grant that has successfully devolved decision making to the local level. Federally 

funded with oversight at the State level, the CSBG has maintained a local network 

of nearly 1,100 agencies which coordinate nearly $9.7 billion in Federal, State, local, 

and private resources each year. Operating in 99 percent of counties in the Nation 

and serving nearly 15.2 million low-income persons, local agencies, known as Community Action Agencies (CAAs), provide services based on the characteristics of poverty in their communities. For one town, this might mean providing job placement 

and retention services; for another, developing affordable housing; in rural areas it 

might mean providing access to health services or developing a rural transportation 

system. 

Since its inception, the CSBG has shown how partnerships between States and 

local agencies benefit citizens in each State. We believe it should be looked to as 

a model of how the Federal Government can best promote self-sufficiency for lowincome persons in a flexible, decentralized, non-bureaucratic and accountable way. 

Long before the creation of the Temporary Assistance for Needy Families (TANF) 

block grant, the CSBG was setting the standard for private-public partnerships that 
360 

work to the betterment of local communities and low-income residents. Family oriented, while promoting economic development and individual self-sufficiency, the 

CSBG relies on an existing and experienced community-based service delivery system of CAAs and other non-profit organizations to produce results for its clients. 

MAJOR CHARACTERISTICS OF THE COMMUNITY SERVICES NETWORK

Emergency Response.—CAAs are utilized by Federal and State emergency personnel as a frontline resource to deal with emergency situations such as floods, hurricanes and economic downturns. They are also relied on by citizens in their community to deal with individual family hardships, such as house fires or other emergencies. 

In fact, during and after Hurricane Katrina and Rita the State CSBG offices and 

local CAAs quickly mobilized to provide immediate and long-term assistance to over 

355,000 evacuees. This immediate assistance included, but was not limited to, transportation, food, medical check-ups, housing, utility deposits, job placement, and 

clothing. State CSBG offices and CAAs across the country coordinated their relief 

efforts with other agencies providing disaster relief assistance such as FEMA, Red 

Cross, and other faith-based and community-based organizations. 

State CSBG offices through their local network of CAAs continue to provide the 

long-term assistance evacuees will need as they relocate and re-establish themselves 

through self-sufficiency and family development programs. These programs offer 

comprehensive approaches to selecting and offering supportive services that promote, empower and nurture the individuals and families seeking economic self-sufficiency. At a minimum, these approaches include: 

—A comprehensive assessment of the issues facing the family or family members 

and of the resources the family brings to address these issues; 

—A written plan for becoming more financially independent and self-supporting; 

—A comprehensive mix of services that are selected to help the participant implement the plan; 

—Professional staff members who are flexible and can establish trusting, longterm relationships with program participants; and 

—A formal methodology used to track and evaluate progress as well as to adjust 

the plan as needed. 

Additional information on the CSBG Network’s Hurricane Katrina relief efforts 

may be found in the attached issue brief. 

Accountable.—The Federal Office of Community Services, State CSBG offices and 

CAAs have worked closely to develop a results-oriented management and accountability (ROMA) system. Through this system, individual agencies determine local 

priorities within six common national goals for CSBG and report on the outcomes 

that they achieved in their communities. 

Leveraging Capacity.—For every CSBG dollar they receive, CAAs leverage $4.87 

in non-federal resources (State, local, and private) to coordinate efforts that improve 

the self-sufficiency of low-income persons and lead to the development of thriving 

communities. 

Volunteer Mobilization.—CAAs mobilize volunteers in large numbers. In fiscal 

year 2004, the most recent year for which data are available, the CAAs elicited more 

than 44 million hours of volunteer efforts, the equivalent of almost 21,182 full-time 

employees. Using just the minimum wage, these volunteer hours are valued at nearly $227 million. 

Locally Directed.—Tri-partite boards of directors guide CAAs. These boards consist of one-third elected officials, one-third low-income persons and one-third representatives from the private sector. The boards are responsible for establishing policy and approving business plans of the local agencies. Since these boards represent 

a cross-section of the local community, they guarantee that CAAs will be responsive 

to the needs of their community. 

Adaptability.—CAAs provide a flexible local presence that governors have mobilized to deal with emerging poverty issues. 

The statutory goal of the CSBG is to ameliorate the effects of poverty while at 

the same time working within the community to eliminate the causes of poverty. 

The primary goal of every CAA is self-sufficiency for its clients. Helping families become self-sufficient is a long-term process that requires multiple resources. This is 

why the partnership of Federal, State, local, and private enterprise has been so vital 

to the successes of the CAAs. 

WHO DOES THE CSBG SERVE?

National data compiled by NASCSP show that the CSBG serves a broad segment 

of low-income persons, particularly those who are not being reached by other pro-
361 

grams and are not being served by welfare programs. Based on the most recently 

reported data, from fiscal year 2004: 

—More than 2.7 million customer families have incomes at or below the poverty 

level; 1.1 million customer families have incomes at or below 50 percent of the 

poverty guidelines. In 2004, the poverty level for a family of three was $15,670. 

—58 percent of adults have a high school diploma or equivalency certificate. 

—44 percent of all customer families are ‘‘working poor’’ and have wages or unemployment benefits as income. 

—23 percent depend on pensions and Social Security and are therefore poor, 

former workers. 

—Almost 430,000 families are TANF participants, 22 percent of the average 

monthly TANF caseload. 

—Nearly 60 percent of families assisted have children under 18 years of age. 

WHAT DO LOCAL CSBG AGENCIES DO?

Since Community Action Agencies operate in rural areas as well as in urban 

areas, it is difficult to describe a typical Community Action Agency. However, one 

thing that is common to all is the goal of self-sufficiency for all of their clients. 

Reaching this goal may mean providing day care for a struggling single mother as 

she completes her General Equivalency Diploma (GED) certificate, moves through 

a community college course and finally is on her own supporting her family without 

Federal assistance. It may mean assisting a recovering substance abuser as he seeks 

employment. Many of the Community Action Agencies’ clients are persons who are 

experiencing a one-time emergency. Others have lives of chaos brought about by 

many overlapping forces—a divorce, sudden death of a wage earner, illness, lack of 

a high school education, closing of a local factory or the loss of family farms. 

CAAs provide access to a variety of opportunities for their clients. Although they 

are not identical, most will provide some if not all of the services listed below: 

—a variety of crisis and emergency safety net services; 

—employment and training programs; 

—transportation and child care for low-income workers; 

—individual development accounts; 

—micro business development help for low-income entrepreneurs; 

—local community and economic development projects; 

—housing and weatherization services; 

—Head Start; 

—energy assistance programs; 

—nutrition programs; 

—family development programs; and 

—senior services. 

CSBG funds many of these services directly. Even more importantly, CSBG is the 

core funding which holds together a local delivery system able to respond effectively 

and efficiently, without a lot of red tape, to the needs of individual low-income 

households as well as to broader community needs. Without the CSBG, local agencies would not have the capacity to work in their communities developing local funding, private donations and volunteer services and running programs of far greater 

size and value than the actual CSBG dollars they receive. 

CAAs manage a host of other Federal, State and local programs which makes it 

possible to provide a one-stop location for persons whose problems are usually multifaceted. Over half (52 percent) of the CAAs manage the Head Start program in their 

community. Using their unique position in the community, CAAs recruit additional 

volunteers, bring in local school department personnel, tap into religious groups for 

additional help, coordinate child care and bring needed health care services to Head 

Start centers. In many States they also manage the Low Income Home Energy Assistance Program (LIHEAP), raising additional funds from utilities for this vital program. CAAs may also administer the Weatherization Assistance Program and are 

able to mobilize funds for additional work on residences not directly related to energy savings that, for example, may keep a low-income elderly couple in their home. 

CAAs also coordinate the Weatherization Assistance Program with the Community 

Development Block Grant program to stretch Federal dollars and provide a greater 

return for tax dollars invested. They also administer the Women, Infants and Children (WIC) nutrition program as well as job training programs, substance abuse 

programs, transportation programs, domestic violence and homeless shelters, as well 

as food pantries. 
362 

1The National Consumer Law Center (NCLC) is a nonprofit organization that represents the 

interests of low-income consumers on a broad range of issues, including access to adequate and 

affordable supplies of utility service for home heating and cooling. This testimony was prepared 

by Olivia Wein, staff attorney in NCLC’s Washington, DC office. 2The Appalachian People’s Action Coalition (Ohio); Texas Legal Services Center; Action, Inc. 

(Gloucester, MA); Action for Boston Community Development, Inc. 3 42 U.S.C. § 8621 et seq. 4 National Energy Assistance Directors Association, National Energy Assistance Survey (April 

2004) (NEADA survey) available at www.neada.org. 

EXAMPLES OF CSBG AT WORK

Since 1994, CSBG has implemented Results-Oriented Management and Accountability practices whereby the effectiveness of programs is captured through the use 

of goals and outcomes measures. Below you will find the network’s first nationally 

aggregated outcomes achieved by individuals, families and communities as a result 

of their participation in innovative CSBG programs during fiscal year 2004: 

—103,057 participants gained employment with the help of community action (49 

States reporting); 

—13,313 participants obtained ‘‘living wage’’ employment with benefits (35 States 

reporting); 

—88,187 low-income participants obtained safe and affordable housing in support 

of employment stability (43 States reporting); 

—510,322 low-income households achieved an increase in non-employment financial assets, including tax credits, child support payments, and utility savings, 

as a result of community action ($133.5 million in aggregated savings); 

—5,645 families achieved home ownership as a result of community action assistance (41 States reporting); 

—56,283 low-income people obtained pre-employment skills and received training 

program certificates or diplomas (47 States reporting); 

—30,776 low-income people completed Adult Basic Education or GED coursework 

and received certificates or diplomas (40 States reporting); 

—9,647 low-income people completed post-secondary education and obtained a certificate or diploma (41 States reporting); and 

—2,284,577 new community opportunities and resources were created for low-income families as a result of community action work or advocacy, including ‘‘living wage’’ jobs, affordable and expanded public and private transportation, medical care, child care and development, new community centers, youth programs, 

increased business opportunity, food, and retail shopping in low-income neighborhoods (46 States reporting). 

All the above considered, NASCSP urges this committee to fund the CSBG grant 

to the States at $650 million. 

PREPARED STATEMENT OF THE NATIONAL CONSUMER LAW CENTER

The National Consumer Law Center (NCLC),1 on behalf of our low-income clients,2 respectfully submits this testimony regarding the appropriation of funds for 

the Low Income Home Energy Assistance Program (LIHEAP) 3 for fiscal year 2007. 

NCLC and our clients are strong supporters of LIHEAP, the primary safety net between low-income consumers and the disconnection of vital utility service. The high 

energy prices that squeeze the budgets of low-income households to the breaking 

point show no sign of abating. The recent National Energy Assistance Directors’ Association (NEADA) national study on LIHEAP recipients documents the tremendous 

value of LIHEAP to low-income families as well as the severe sacrifices made by 

the poor to pay their home energy bills.4 Low-income families and fixed-income elderly clients continue to fall further behind as energy prices have reached a new, 

higher baseline. LIHEAP is essential for their safety and well being. We thank the 

subcommittee for its strong support of the LIHEAP program in the fiscal year 2006 

appropriations process and, in light of the forecasted continued high energy prices, 

urge the subcommittee to consider fully appropriating LIHEAP at $5.1 billion in 

regular LIHEAP funds for fiscal year 2007, the amount authorized under the Energy Policy Act of 2005, with advance appropriations of the same amount for fiscal 

year 2008. 

Home Energy Prices Are At An All-Time High.—Residential energy prices were expected to continue to rise this year, but the disruption in the Gulf fuel refineries 

by the hurricanes sent them skyrocketing. Consequently, paying home energy bills 

has been all the more difficult for fixed income seniors and low-income households 

and has made LIHEAP all the more important for these vulnerable families. The 
363 

5 Center on Budget and Policy Priorities. ‘‘Steep Spike in Energy Costs Increases Low-Income 

Households’ Need For Help Paying Heating Bills This Winter’’ (Oct. 6, 2005). 6Statement of Guy Caruso, Administrator for the Energy Information Administration, U.S. 

Department of Energy before the Committee on Energy and Natural Resources, United States 

Senate. Full Committee Hearing—Winter Fuels Outlook (Oct. 18, 2005). 7Meg Power, PhD. Economic Opportunity Studies. ‘‘Energy Bills of Low-Income Consumers 

in Fiscal Year 2005, The Resources Available to Help Them Pay, and the Impact on Their 

Household Budgets’’ (Nov. 23, 2004). 8 CDC, ‘‘Extreme Heat: A Prevention Guide to Promote Your Personal Health and Safety’’ 

available at www.bt.cdc.gov/disasters/extremeheat/heatlguide.asp. 9 Id. 

10 National Energy Assistance Directors, ‘‘Est. Total Households Receiving LIHEAP Heating 

Assistance by State—Projected Applications for Fiscal Year 2006’’ (2/13/06). 

Center on Budget and Policy Priorities has acknowledged that this year marks the 

‘‘largest 1-year jump in home heating prices in three decades.’’ 5 According to Guy 

Caruso, Administrator of the Energy Information Administration at the U.S. Department of Energy, ‘‘several factors are driving up winter prices and expenditures: 

first, international factors such as low spare crude oil capacity and political tensions 

contribute to uncertainty and low supply growth for crude oil and high crude prices; 

second, recent hurricanes and associated disruptions exacerbate already tight markets in oil, petroleum products, and natural gas; and, finally, winter weather affects 

consumption and consequently household expenditures.’’ 6 The summer heat is also 

dangerous, especially for the elderly, the very young and those with chronic diseases. Unfortunately, the vast majority of newer electric generation plants rely on 

natural gas, thus tying electricity prices to the volatile natural gas prices. Taking 

all of these factors into account, it is obvious how critical LIHEAP’s heating and 

cooling assistance is to the livelihood of so many families. The mounting increases 

in essential residential energy prices as illustrated in the chart below are putting 

more and more families’ health and safety at risk. 

More Households Than Ever Cannot Keep Up With Costs Of Home Energy.—Although the costs of home energy have been a burden to most Americans, those with 

low incomes have been hurt the most. The salary for low-income Americans has 

stayed relatively flat while the cost of living has gone up, resulting in even more 

challenging struggles just to make ends meet for many families. According to Dr. 

Meg Power of Economic Opportunity Studies, families below 150 percent of the Federal poverty guideline spend on average about $1,470 on energy costs, about 19 percent of their total yearly income. In 2005, however, low income families were expected to pay more than $1,650.7 Those prices will only go up for 2006. Having their 

heat switched off is a real possibility for numerous low-income households, and although there are winter utility shut-off moratoria in place for many States, not 

every home is protected against energy shut-offs in the middle of winter. As we approach the lifting of winter shut-off moratoria, we expect to see a wave of disconnections as households are unable to afford the cost of the energy bills. In the summer, 

the inability to keep the home cool can be lethal, especially to seniors. According 

to the CDC, in 2001 300 deaths were caused by excessive heat exposure and seniors 

and young children are particularly vulnerable to heat stress.8 The CDC also notes 

that air-conditioning is the number one protective factor against heat-related illness 

and death.9

Iowa.—Despite milder winter temperatures this winter, the sharp rise in natural 

gas prices has set back a record number of low-income households in Iowa. The 

number of low-income households with past due energy accounts as of January 2006 

is 14.7 percent higher than the same time last year and 162 percent higher than 

the number in January 1999. The total amount of arrearages of LIHEAP households 

has also grown sharply due to the increase in prices. By January 2006, the total 

amount of LIHEAP household arrearages had increased 32 percent from the same 

period in 2005 and 169 percent compared to the same period in 1999. The total 

number of LIHEAP households increased 8 percent from this same period last 

year.10

Ohio.—In Ohio, the number of households entering into the State’s low-income energy affordability program, the Percentage of Income Payment Program (PIPP), increased 23 percent from January 2005 to January 2006. The increase is even more 

dramatic at 84 percent, when comparing PIPP enrollment from January 2002 to 

January 2006. The total dollar arrearage amounts for PIPP customers also increased 27 percent from January 2005 to January 2006. Likewise, the total PIPP 

arrearages have increased dramatically, 84 percent, from January 2002 to January 

2006. Ohio’s LIHEAP program expects to provide heating assistance to almost 5 percent more households in fiscal year 2006 than in fiscal year 2005 (and almost 30 
364 

11 Based on date from the National Energy Assistance Directors, ‘‘Est. Total Households Receiving LIHEAP Heating Assistance by State—Projected Applications for Fiscal Year 2006 (2/ 

13/06)’’ and ‘‘Estimated Total Households Receiving LIHEAP Heating Assistance by State 

Actuals in 2002, 2003; Projected in 2004.’’ Available at www.neada.org. 12http://www.puc.state.pa.us/general/presslreleases/presslreleases.aspx?ShowPR=1435. 13http://www.puc.state.pa.us/general/pdf/TerminationslTablelJan-Dec04-05.pdf 14http://www.neada.org/news/news060213lliheap06projections.pdf 15 NEADA Survey, Table 47. 16http://www.neada.org/news/news060213lliheap06projections.pdf. 17 U.S. Department of Energy: A Consumer’s Guide to Energy Efficiency and Renewable Energy. http://www.eere.energy.gov/consumer/yourlhome/spacelheatinglcooling/index.cfm/ 

mytopic=12600. 18 NEADA Survey, Table 39. To pay their energy bills, 22 percent of LIHEAP recipients went 

without food, 38 percent went without medical or dental care, 30 percent did not fill or took 

less than the full dose of a prescribed medicine. 

percent more households when compared to Ohio households that received heating 

assistance in fiscal year 2002).11

Pennsylvania.—Utilities in Pennsylvania that are regulated by the Pennsylvania 

Public Utility Commission (PA PUC) have established universal service programs 

that assist utility customers in paying bills and reducing energy usage. Even with 

these programs, electric and natural gas utility customers find it difficult to keep 

pace with their energy burdens. The PA PUC estimates that approximately 21,000 

households entered the current heating season without heat-related utility service— 

this number includes about 4,000 households who are heating with potentially unsafe heating sources such as kerosene space heaters. This is an increase of 68 percent when compared to the average number entering the heating season without 

heat for the years 2000–2003. An additional 17,500 residences where service was 

previously terminated are now vacant.12 In 2005, the number of terminations increased 52 percent compared with terminations in 2004.13 As of January 2006, 17.48 

percent of residential electric customers and 18.19 percent of natural gas customers 

are overdue on their energy bills. As of February 2006, Pennsylvania projected serving 354,065 LIHEAP applicants in fiscal year 2005, an 8.2 percent increase over the 

prior year.14

LIHEAP Helps These Vulnerable Households.—Growing utility arrearages for lowincome households will only place these fragile households on a downward spiral towards disconnections. Adequate LIHEAP assistance can help families facing terminations, but, even more importantly, adequate LIHEAP appropriations can help 

struggling families maintain vital energy services and protect the health and safety 

of vulnerable seniors, families with young children or disabled family members. The 

recent NEADA national energy assistance survey found that 48 percent of LIHEAP 

recipients would have had their electricity or home heating fuel discontinued if 

LIHEAP had not been available.15

The Need For LIHEAP Is Greater Than Ever.—The continued sharp rise in residential energy prices is expected for the near future. The data from Iowa, Ohio and 

Pennsylvania, which are amongst the few States that collect residential utility customer payment data, show that even in a milder than normal winter, the prices 

have risen to such a degree that an increasing number of low-income households 

is falling behind. This year’s dramatic rise in residential energy prices has yielded 

the greatest number of LIHEAP applications in 12 years.16 Last year, the number 

of eligible recipients for LIHEAP climbed to 32 million; however, only around 5 million were able to benefit from it. 

The Consequences Of Unaffordable Energy Bills Are Dire.—When people are unable to afford paying their home energy bills, many dangerous and unhealthy actions are often taken. Common practices include resorting to alternative heating 

sources, such as space heaters, ovens and burners, all of which are huge fire hazards; numerous deaths due to fires started by space heaters have already occurred 

this year and are a recurring problem every year. According to the U.S. Consumer 

Product Safety Commission, about 25,000 fires in homes are caused by space heaters and 300 people are killed because of them every year in the United States.17

Other dangerous practices include illegal gas hookups that create dangerous gas 

leaks, keeping the thermostat at unhealthy and sometimes hypothermic temperatures (and hyperthermic temperatures in the summer). Those who cannot afford 

their winter heating bill often face dire choices such as sacrificing food, medical care 

or prescription medicine.18 In the summer, the inability to afford cooling bills can 

result in heat-related deaths and illness. The loss of essential utility services can 

be devastating, especially for poor families that can find themselves facing the pros-
365 

19From 2000 to 2003, approximately 50 percent-68 percent of heat-related deaths were 60 

years old or older. Office of Climate, Water and Weather Services, Heat Related Fatalities by 

Age and Gender, reports for 2000—2003. 20 In 1998 there were over 49,000 heating-equipment related home fires resulting in 388 

deaths and 1,445 injuries and $515 million in property damage. National Fire Protection Association Fact Sheets on Home Heating, in United States Home Heating Fire Patterns and 

Trends, John H. Hall, Jr., NFPA, June 2001. 21 Robert B. Swift, Rising Costs for Home Heating Fuel Could Spawn More Problems, Sunbury 

(PA) Item, Jan. 29, 2000. 22Pediatric Academic Societies, Publication #921, Platform Presentation, Epidemiology Session, May 6, 2003, Seattle, WA: Children’s Sentinel Nutrition Assessment Program: Heat or Eat: 

Low Income Home Energy Assistance Program and Nutritional Risk Among Children < 3. 23 U.S. Department of Health and Human Services, Administration for Children and Families, 

Office of Community Services, Division of Family Assistance, LIHEAP Home Energy Notebook 

for Fiscal Year 2001 (February 2003), Table A–2b, p. 49. 

pects of hypothermia in the winter, hyperthermia in the summer,19 eviction, property damage from frozen pipes, the use of dangerous alternative sources of heat,20

and the potential threat of the intervention of child welfare agencies.21 Studies have 

also demonstrated the clear links between homelessness and utility disconnections, 

as well as the connections between unaffordable utility service and the disruption 

to families and children’s education. LIHEAP works to bring fuel costs within a 

manageable range for low-income households. There are other societal benefits to 

a strong LIHEAP. A recent study documents an association between receipt of 

LIHEAP assistance and a reduced incidence of undernutrition in young children.22

People are putting themselves at risk when they do not have sufficient funds to 

pay their home energy bills, but LIHEAP can and does come to their aid and does 

greatly alleviate some of the hardship caused by high energy bills. With the assistance of LIHEAP, households will not have to make such unconscionable, dangerous 

sacrifices. 

The Need for Advance Appropriations is Critical.—The timing of the release of the 

LIHEAP block grant to the States is critical for the effective and efficient operation 

of the State programs. The normal appropriations process leaves very little time between enactment of the Labor-HHS-Education spending bill and the start of most 

States’ heating programs. An advance appropriation is essential for States to determine income guidelines and benefit levels well ahead of time and for properly planning the components of their program year (e.g., amounts set aside for heating, cooling and emergency assistance, weatherization, self sufficiency and leveraging activities). Without advance appropriations, delayed passage of the spending bill can force 

States to open their winter heating program without knowledge of their final grant 

amount. Advance appropriations shield States from disruption of the start-up of 

their winter heating programs if there is a delay in the passage of the Labor-HHSEducation spending bill. 

LIHEAP Works.—LIHEAP is a targeted block grant that assists vulnerable lowincome households with the costs of home energy. According to the U.S. Department 

of Health and Human Services, one-third of households receiving LIHEAP heating 

and cooling assistance had an elderly member; over 30 percent of households receiving heating and cooling assistance had a member with a disability; and almost one 

third of households receiving heating assistance and around a fifth of households 

receiving cooling assistance had young children. In fiscal year 2001, LIHEAP recipient households had a mean individual energy burden almost five times the energy 

burden for non-low income households.23 A While there are broad Federal guidelines 

for LIHEAP, States have the flexibility to tailor their programs to best meet their 

needs. Administrative costs are minimal—capped at 10 percent. This ensures that 

the vast majority of LIHEAP dollars are directed to energy assistance for low-income families. 

The National Association of Regulatory Utility Commissioners (NARUC), the National Energy Assistance Directors Association and the National Fuel Funds Network also support fully funding the regular block grant LIHEAP program at $5.1 

billion. 

Conclusion.—In light of the continued projected increase in residential energy 

costs and LIHEAP’s continued demonstrated success in helping low-income families 

maintain access to vital energy service, we urge the subcommittee to appropriate 

$5.1 billion for the regular LIHEAP program in fiscal year 2007 as well as advance 

appropriations for fiscal year 2008 of $5.1 billion for the regular program. Thank 

you for consideration of our testimony. 
366 

PREPARED STATEMENT OF THE NATIONAL KIDNEY FOUNDATION

The National Kidney Foundation (NKF), a voluntary health organization whose 

membership includes patients and families; organ transplant recipients; families 

who have donated the organs of loved ones for transplantation and living organ donors; and health care professionals, is pleased to submit public witness testimony 

for the written record in support of fiscal year 2007 Appropriations. 

We are very appreciative of the $1,800,000 in funding that Congress provided in 

fiscal year 2006 to establish a Chronic Kidney Disease (CKD) program within the 

Centers for Disease Control and Prevention (CDC). As the subcommittee drafts the 

fiscal year 2007 Labor, Health and Human Services, and Education Appropriations 

Bill, we respectfully request your continued support for funding to expand these activities, as outlined below. Unfortunately, the administration did not request continued funding for this program in its 2007 Budget Request. 

IMPACT OF CHRONIC KIDNEY DISEASE

The implications of kidney disease for the public are considerable, yet the average 

American is relatively unaware of its consequences. Twenty million Americans have 

CKD, and another 20 million are at risk of developing the disease, but most people 

with kidney disease do not know they have it and will not be diagnosed until it has 

threatened their health and even their lives. Individuals with diabetes or hypertension are especially vulnerable. 

Kidney disease is the 9th leading cause of death in the United States, and death 

by cardiovascular disease is 10 to 30 times higher in kidney dialysis patients than 

in the general population. Kidney disease is associated with 25 percent of the Medicare budget and 7 percent of the Medicare population has a diagnosis of kidney disease. Further, the number of individuals with end stage renal disease (ESRD), irreversible kidney failure requiring either dialysis or a transplant to remain alive, is 

expected to increase from 382,000 patients in 2000 to 712,000 by 2015. Effective 

treatments are available to reduce morbidity and mortality resulting from kidney 

disease and its complications and to retard progression to kidney failure. However, 

CKD is not being detected sufficiently early to initiate treatment regimens and reduce death and disability. NKF believes a public health approach would contribute 

toward early detection and treatment, thereby reducing hardship and saving money 

and lives. 

2006 CDC ACTIVITIES

NKF is working closely with CDC to implement this program and we are very 

pleased with the progress to date. CDC intends to use the current-year appropriation to identify and coordinate sources for CKD data; propose solutions to fill data 

deficiencies; undertake a surveillance system feasibility study; fund pilot projects in 

selected States; and, organize an expert consensus conference to lay the groundwork 

for a Public Health Kidney Disease Strategic Plan. Earlier this year, CDC requested 

proposals to support the development of a comprehensive CKD surveillance system. 

The agency expects to award two grants in 2006 designed to identify sources of CKD 

data, as well as gaps and deficiencies in existing data. The program will also propose solutions to remedy deficiencies, including the execution of a feasibility study 

and pilot test for a surveillance system. Additional activities in 2006 will include 

studies of the economic benefit of CKD intervention. 

FISCAL YEAR 2007 REQUEST

A restoration of funding to the 2006 level would enable CDC to continue planning 

for capacity and infrastructure for a kidney disease epidemiology, research and 

health outcomes program and to institute a CKD surveillance system. We are hopeful for a funding increase over fiscal year 2006, which would enable the agency to 

expand the number and scope of grants to support State-based community demonstration projects for CKD detection and treatment, a core component of this CKD 

initiative. We envision this would include tracking the progression of CKD in patients who have been diagnosed, as well as identify the onset of kidney disease 

among individuals who are members of high risk groups. 

We thank you for your past support of this initiative and respectfully request your 

continued support, to enable CDC and the public health community to move forward 

to address the growing concern of Chronic Kidney Disease. 
367 

PREPARED STATEMENT OF THE NATIONAL LEAGUE FOR NURSING

The National League for Nursing (NLN)—representing more than 1,100 nursing 

schools and health care agencies, some 17,000 individual members comprised of 

nurses, educators, administrators, public members, and 18 constituent leagues—appreciates the subcommittee’s past support for nursing education and your continued 

recognition of the important role nurses play in the delivery of health care services. 

We, however, are concerned. Unless additional resources are expended, the advancements made by Congress to help alleviate the nursing shortage will be impeded owing to the currently proposed fiscal year 2007 appropriations level. The 

NLN advocates your continued support for Title VIII—Nursing Workforce Development Programs (Public Health Services Act), housed in the Health Resources and 

Services Administration (HRSA) with the congressionally prescribed mission of ensuring a sufficient supply of nurses. We urge you to fund the Title VIII programs 

at a minimum level of $175 million for fiscal year 2007. Placing this minimal funding request in perspective, note that during the last serious nursing shortage in 

1974, Congress appropriated $153 million for nurse education programs. In today’s 

dollars that appropriation would equate to approximately $592 million, nearly four 

times the amount the Federal Government is spending on nurse education now. 

Today’s nursing shortage is very real and very different from any experienced in 

the past. The existing shortage is evidenced by an aging workforce and too few people entering the profession. A critical factor exacerbating the national nurse-workforce deficiency is the declining number of qualified nurses available to teach future 

generations of registered nurses. The NLN’s Faculty Survey conducted in 2002 concludes that not enough qualified nurse educators exist to teach the number of 

nurses necessary to ameliorate the nursing shortage. 

The NLN Survey found three trends influencing the future of nursing education 

over the next decade: 

The aging of the nurse faculty population 

An average of 1.3 full-time faculty members per program left their positions in 

nursing education in 2002. About half the survey respondents had at least one unfilled budgeted full-time faculty position and some had as many as 15 such positions. 36.5 percent of faculty who left their positions in the preceding year did so 

because of retirement; 8.6 percent of faculty were 61 years of age or older; and 75 

percent of the current faculty population is expected to retire by 2019. 

Approximately 1,800 full-time faculty members leave their positions each year. 

About 10,000 master’s level nurses graduate per year, 15 percent of whom would 

have to enter teaching in order to maintain today’s production level for generating 

the Nation’s nurse workforce. Since this is highly unlikely, the gap between unfilled 

positions and the candidate pool is widening significantly. 

The increasing number of part-time faculty 

The number of part-time faculty has increased notably since 1996—nearly 17 percent in baccalaureate programs and 14 percent in associate degree programs. Parttime faculty now provides approximately 23 percent of the estimated number of faculty FTEs. 

Part-time employees often are not an integral part of the design, implementation, 

and evaluation of the overall nursing education program. Many may hold other positions that often limit their availability to students. Further, many part-time faculty 

have not been prepared for the faculty role. 

The large number of nursing faculty who are not prepared at the doctoral level 

Approximately half the full-time faculties in baccalaureate and higher-degree programs hold a doctoral degree. In associate degree programs, doctorally-prepared faculty account for only 6.6 percent of the total faculty and the number is slightly more 

than 5 percent in diploma programs. Only 350 to 400 nursing students receive doctoral degrees each year and the pool of doctorally-prepared candidates for full-time 

nursing professorships is very limited. 

Educators without doctoral degrees may lack credibility within a university setting and have limited opportunities to assume leadership positions. Institutions 

with low numbers of doctorally-prepared educators may be less likely to obtain 

funds to support research or educational innovations. As important as educational 

incentives are for future practicing nurses, the scholarships for doctoral students 

who will instruct the next generation of nurses are even more critical. 

Since less than an adequate number of nurse educators currently teach in the 

education pipeline, the situation appears to be growing acute and is not expected 

to improve in the near future absent adequate intervention. In a survey of the 

2004–2005 academic year conducted by the NLN, an estimated 147,000 qualified ap-
368 

plications were turned away from nursing programs at all degree levels owing in 

large part to the lack of faculty necessary to teach this number of additional students. This number represents a 17.6 percent increase from the 2003–2004 academic 

year. With an increasing application pool, a key priority in tackling the nurse shortage has to be scaling up the capacity to accept qualified applicants. Today’s undersized supply of appropriately prepared nurses and nurse faculty does not bode well 

for meeting the needs of a diverse, aging population. 

Congress made an important step in passing the Nurse Reinvestment Act in 2002. 

The new monies used to fund loans and scholarships are appreciated. Yet, it has 

become abundantly clear that significantly more funding is required to even minimally meet the HRSA charge to support nursing students and schools of nursing 

so as to meet the existing and rising national needs for nurses. In fiscal year 2005, 

HRSA was forced to turn away 82 percent of the applicants for the Nurse Education 

Loan Repayment Program and more than 98 percent of the applicants for the Nursing Scholarship Program due to lack of adequate funding. 

Please do not allow the Nation to lose ground in the effort to remedy the nursing 

shortage. Fund Title VIII—Nursing Workforce Development Programs at a level 

commensurate with the severity of the health care crisis facing the Nation today. 

Your support will help ensure that nurses exist in the future who are prepared and 

qualified to take care of you, your family, and all those in this country who will need 

our care. 

PREPARED STATEMENT OF THE ONCOLOGY NURSING SOCIETY

The Oncology Nursing Society (ONS) appreciates the opportunity to submit written comments for the record regarding fiscal year 2007 funding for cancer and nursing related programs. ONS, the largest professional oncology group in the United 

States composed of more than 33,000 nurses and other health professionals, exists 

to promote excellence in oncology nursing and the provision of quality care to those 

individuals affected by cancer. As part of its mission, the Society honors and maintains nursing’s historical and essential commitment to advocacy for the public good. 

This year more than 1.4 million Americans will be diagnosed with cancer and 

more than 565,000 will lose their battle with this terrible disease. Despite these 

grim statistics, significant gains in the War Against Cancer have been made 

through our Nation’s investment in cancer research and its application. Research 

holds the key to improved cancer prevention, early detection, diagnosis, and treatment, but such breakthroughs are meaningless unless we can deliver them to all 

Americans in need. Recent studies have reported 126,000 registered nurse vacancies 

in hospitals and 13,900 registered nurse vacancies in nursing homes. Moreover, a 

recent survey of ONS members found that the nursing shortage is having an adverse impact in oncology physician offices and hospital outpatient departments. 

Some respondents indicated that when a nurse leaves their practice that they are 

unable to hire a replacement due to the shortage—leaving them short-staffed and 

posing scheduling challenges for the practice and the patients. These vacancies in 

all care settings create significant barriers to ensuring access to quality care. 

To ensure that all people with cancer have access to the comprehensive, quality 

care they need and deserve, ONS advocates on-going and significant Federal funding for cancer research and application, as well as funding for programs that help 

ensure an adequate oncology nursing workforce to care for people with cancer. The 

Society stands ready to work with policymakers at the local, State, and Federal levels to advance policies and programs that will reduce and prevent suffering from 

cancer and sustain and strengthen the Nation’s nursing workforce. 

SECURING AND MAINTAINING AN ADEQUATE ONCOLOGY NURSING WORKFORCE

Oncology nurses are on the front lines in the provision of quality cancer care for 

individuals with cancer—administering chemotherapy, managing patient therapies 

and side-effects, working with insurance companies to ensure that patients receive 

the appropriate treatment, providing counseling to patients and family members, 

and engaging in myriad other activities on behalf of people with cancer and their 

families. Cancer is a complex, multifaceted chronic disease, and people with cancer 

require specialty-nursing interventions at every step of the cancer experience. People with cancer are best served by nurses specialized in oncology care, who are certified in that specialty. Overall, age is the number one risk factor for developing 

cancer. Approximately 77 percent of all cancers are diagnosed at age 55 and older. 

Currently, Medicare beneficiaries account for more than 50 percent of all cancer diagnoses and 64 percent of cancer deaths. Over the next 10 to 15 years the number 

of Medicare beneficiaries with cancer is estimated to double while, according to U.S. 
369 

Department of Labor estimates, more than 1.1 million registered nursing vacancies 

will need to be filled by 2012 to meet growing patient demand and replace retiring 

nurses. As the overall number of nurses will drop precipitously in the coming years, we 

likely will experience a commensurate decrease in number of nurses trained in the 

specialty of oncology. With an increasing number of people with cancer needing high 

quality health care, coupled with an inadequate nursing workforce, our Nation could 

quickly face a cancer care crisis of serious proportion with limited access to quality 

cancer care, particularly in traditionally underserved areas. A study in the New 

England Journal of Medicine found that nursing shortages in hospitals are associated with a higher risk of complications—such as urinary tract infections and pneumonia, longer hospital stays, and even patient death. Without an adequate supply 

of nurses, there will not be enough qualified oncology nurses to provide the quality 

cancer care to a growing population of people in need and patient health and wellbeing could suffer. 

Further, of additional concern is that our Nation also will face a shortage of 

nurses available and able to conduct cancer research and clinical trials. With a 

shortage of cancer research nurses, progress against cancer will take longer because 

of scarce human resources coupled with the reality that some practices and cancer 

centers resources could be funneled away from cancer research to pay for the hiring 

and retention of oncology nurses to provide direct patient care. Without a sufficient 

supply of trained, educated, and experienced oncology nurses, our Nation may falter 

in its delivery and application of the benefits from our Federal investment in research. 

ONS has joined with others in the nursing community in advocating $175 million 

as the fiscal year 2007 funding level necessary to support implementation of the 

Nurse Reinvestment Act and the range of nursing workforce programs housed at the 

U.S. Health Resources and Services Administration (HRSA). Enacted in 2002, the 

Nurse Reinvestment Act included new and expanded initiatives, including loan forgiveness, scholarships, career ladder opportunities, and public service announcements to advance nursing as a career. Despite the enactment of this critical measure, HRSA fails to have the resources necessary to meet the current and growing 

demands for our Nation’s nursing workforce. For example, in fiscal year 2005, 

HRSA was forced to turn away 82 percent of the applicants for the Nurse Education 

Loan Repayment Program and over 98 percent of the applicants for the Nursing 

Scholarship Program due to lack of adequate funding. 

While a number of years ago one of the biggest factors associated with the shortage was a lack of interested and qualified applicants, due to the efforts of the nursing community and other interested stakeholders, the number of applicants is growing. As such, now one of the greatest factors contributing to the shortage is that 

nursing programs are turning away qualified applicants to entry-level baccalaureate 

programs due to a shortage of nursing faculty. According to the American Association of Colleges of Nursing (AACN), at least 32,617 of such qualified applicants were 

turned away in 2004 alone. Many of these qualified students are being placed on 

waiting lists that may be as long as 2 years or more. The National League for Nursing (NLN) released a preliminary report in December 2005 that showed that due 

to faculty shortages, in total schools of nursing were forced to reject more that 

147,000 qualified applications for 2005, an 18 percent increase over 2004 figures. 

The number of full-time nursing faculty required to ‘‘fill the nursing gap’’ is approximately 40,000 and currently there are less than 20,000 full-time nursing faculty in 

the system. The nurse faculty shortage is only expected to worsen with time as faculty age continues to climb, averaging 52 years in 2004. Significant numbers of faculty are expected to retire in the coming years with insufficient numbers of candidates in the pipeline to take their places. If funded sufficiently, the components 

and programs of the Nurse Reinvestment Act will help address the multiple factors 

contributing to the nursing shortage. 

ONS strongly urges Congress to provide HRSA with a minimum of $175 million 

in fiscal year 2007 to ensure that the agency has the resources necessary to fund 

a higher rate of nursing scholarships and loan repayment applications and support 

other essential endeavors to sustain and boost our Nation’s nursing workforce. 

Nurses—along with patients, family members, hospitals, and others—have joined together in calling upon Congress to provide this essential level of funding. One Voice 

Against Cancer (OVAC), a collaboration of more than 45 national nonprofit organizations representing millions of Americans, also advocates $175 million for the 

Nurse Reinvestment Act in fiscal year 2007. ONS and its allies have serious concerns that without full funding, the Nurse Reinvestment Act will prove an empty 

promise and the current and expected nursing shortage will worsen, and people will 

not have access to the quality care they need and deserve. 
370 

BOOST OUR NATION’S INVESTMENT IN CANCER PREVENTION, EARLY DETECTION, AND

AWARENESS

Approximately two-thirds of cancer cases are preventable through lifestyle and behavioral factors and improved practice of cancer screening. Although the potential 

for reducing the human, economic, and social costs of cancer by focusing on prevention and early detection efforts remains great, our Nation does not invest sufficiently in these strategies. While as a Nation we spend almost a trillion dollars a 

year on our health care system, we only allocate approximately 1 percent of that 

amount for population-based prevention efforts. By 2020, cancer and other chronic 

disease expenditures will reach $1 trillion or 80 percent of health care costs. The 

Nation must make significant and unprecedented Federal investments today to address the burden of cancer and other chronic diseases, and to reduce the demand 

on the healthcare system and diminish suffering in our Nation both for today and 

tomorrow. 

As the Nation’s leading prevention agency, the Centers for Disease Control and 

Prevention (CDC) plays an important role in translating and delivering at the community level what is learned from research. Therefore, ONS joins with our partners 

in the cancer community—including OVAC—in calling on Congress to provide additional resources for the CDC to support and expand much-needed and proven effective cancer prevention, early detection, and risk reduction efforts. Specifically, ONS 

advocates the appropriation of $427.5 million in fiscal year 2007 for the CDC’s comprehensive cancer, ovarian cancer, breast and cervical cancer early detection, cancer 

registries, prostate cancer, colorectal cancer, and skin cancer programs. ONS also 

urges a funding increase for the CDC’s physical activity, nutrition, and tobacco-control programs to help reduce risk factors for developing cancer and other chronic diseases. ONS advocates the following fiscal year 2007 funding levels: 

—$250 million for the National Breast and Cervical Cancer Early Detection Program; 

—$65 million for the National Cancer Registries Program; 

—$25 million for the Colorectal Cancer Prevention and Control Initiative; 

—$50 million for the Comprehensive Cancer Control Initiative; 

—$20 million for the Prostate Cancer Control Initiative; 

—$5 million for the National Skin Cancer Prevention Education Program; 

—$7.5 million for the Ovarian Cancer Control Initiative; 

—$5 million for the Geraldine Ferraro Blood Cancer Program; 

—$145 million for the National Tobacco Control Program; and 

—$70 million for the Nutrition, Physical Activity, and Obesity Program. 

SUSTAIN AND SEIZE CANCER RESEARCH OPPORTUNITIES

Our Nation has benefited immensely from past Federal investment in biomedical 

research at the National Institutes of Health (NIH). ONS has joined with the broader health community in advocating $29.7 billion for NIH in fiscal year 2007. This 

will allow NIH to sustain and build on its research progress resulting from the recent doubling of its budget while avoiding the severe disruption to that progress 

that would result from a minimal increase. Cancer research is producing extraordinary breakthroughs—leading to new therapies that translate into longer survival 

and improved quality of life for cancer patients. We have seen extraordinary advances in cancer research resulting from our national investment that have produced effective prevention, early detection and treatment methods for many cancers. 

To that end, ONS calls upon Congress to allocate $5.034 billion to the National Cancer Institute (NCI) in fiscal year 2007 to continue our battle against cancer. 

The National Institute of Nursing Research (NINR) supports basic and clinical research to establish a scientific basis for the care of individuals across the life span— 

from management of patients during illness and recovery to the reduction of risks 

for disease and disability and the promotion of healthy lifestyles. These efforts are 

crucial in translating scientific advances into cost-effective health care that does not 

compromise quality of care for patients. Additionally, NINR fosters collaborations 

with many other disciplines in areas of mutual interest such as long-term care for 

older people, the special needs of women across the life span, bioethical issues associated with genetic testing and counseling, and the impact of environmental influences on risk factors for chronic illnesses such as cancer. ONS joins with the nursing community in advocating an allocation of $150 million for NINR in fiscal year 

2007. 
371 

CONCLUSION

ONS stands ready to work with policymakers to advance policies and support programs that will reduce and prevent suffering from cancer and sustain and strengthen our Nation’s nursing workforce. Moreover, ONS maintains a strong commitment 

to working with Members of Congress, other nursing societies, patient organizations, and other stakeholders to ensure that the oncology nurses of today continue 

to practice tomorrow and that we recruit and retain new oncology nurses to meet 

the unfortunate growing demand that we will face in the coming years. Thank you 

for this opportunity to discuss the fiscal year 2007 funding levels necessary to ensure that our Nation has a sufficient nursing workforce to care for the patients of 

today and tomorrow and that our Nation continues to make gains in our fight 

against cancer. 

PREPARED STATEMENT OF THE PANCREATIC CANCER ACTION NETWORK

On behalf of The Pancreatic Cancer Action Network (PanCAN), I thank you for 

this opportunity to present written testimony to the Labor, Health and Human 

Services, and Education subcommittee of the House Appropriations Committee. 

PanCAN was founded in 1999 to focus national attention on the need to find the 

cure for pancreatic cancer. We provide public and professional education that embraces the urgent need for more research, effective treatments, prevention programs, and early detection methods. PanCAN is the first and only national patient 

based advocacy organization specifically focused on pancreatic cancer. We now have 

a full time staff of 30 individuals, and 90 ‘‘Team Hope’’ affiliates in communities 

across the country, comprised of thousands of volunteers who seek to increase 

awareness about this disease, raise funds, and voice their concern that there is a 

desperate need to find a cure for pancreatic cancer. 

BACKGROUND ON PANCREATIC CANCER

Every 17 minutes, someone in the United States dies form pancreatic cancer. It 

is the 4th leading cause of cancer death in the Untied States. The facts on pancreatic cancer are striking: 

—Over 33,730 Americans will be diagnosed with pancreatic cancer in 2006, and 

32,300 will die from this disease. 

—The 99 percent mortality rate is the highest of any cancer. 

—There are no early detection methods. 

—The average life expectancy after diagnosis with metastatic disease is just 3 to 

6 months. 

Yet, despite these statistics, pancreatic cancer receives the least amount of research funding from the Federal Government of all major cancers. Federal funding 

for pancreatic cancer research totaled roughly $66 million in fiscal year 2005, a 

mere 1 percent of the National Cancer Institute’s (NCI’s) $4.825 billion research 

budget. While good progress is being made in early detection, research and treatment programs for some cancers, this is clearly not the case for pancreatic cancer. 

Pancreatic cancer is the deadliest cancer for one reason: limited Federal funding 

opportunities discourage researchers from pursuing pancreatic cancer as a focus. 

There are less than 15 fully-funded researchers nationwide who are specifically 

dedicated to this disease. The combination of few dollars and few researchers means 

there has been very little scientific progress. 

PanCAN has outlined opportunities below for the Federal Government to take 

specific actions to facilitate progress in combating this disease. 

Provide Adequate Funding Increases for Cancer Research, Prevention, and Treatment 

Programs 

Pancreatic cancer is the country’s fourth leading cause of cancer death, killing 

over 33,730 people annually, yet it remains severely under-funded when comparing 

NCI funding levels for the top five cancers based on mortality. The NCI spent a reported $66 million on pancreatic cancer research in fiscal year 2005, yet the other 

four top cancers (in mortality) are funded at levels at least four times this amount. 

Further, the discrepancy in funding has existed for many years, only compounding 

this inconsistency. 

PanCAN supports the highest possible funding increase that Congress can provide 

for the National Institute of Health (NIH) and the NCI in fiscal year 2007. With 

additional funding for both the NIH and the NCI, new research grants can be 

awarded to fulfill the research goals identified by the NCI as essential to combating 

this disease. PanCAN is a member of the ‘‘One Voice Against Cancer’’ (OVAC) coali-
372 

tion which is comprised of more than 50 cancer advocacy organizations that have 

come together to support our common goal: increased Federal funding for cancer research, prevention and training programs that are funded through the NIH, NCI 

and Centers for Disease Control and Prevention (CDC). 

PanCAN wholeheartedly endorses OVAC’s proposed fiscal year 2007 funding requests that seek a 5 percent increase for both the NIH and NCI. We urge you to 

provide a minimum of $29.7 billion for the NIH in fiscal year 2007. Separate testimony submitted to the Committee by OVAC reiterates the need for additional Federal funding for biomedical research: ‘‘The tremendous investment our Nation has 

made in the NIH has reaped remarkable returns and set the table for a period of 

unparalleled innovation in the fight against cancer and other diseases. For fiscal 

year 2007, OVAC joins with the broader public health community and urges Congress to provide $29.7 billion for the NIH. This is the minimal level of funding that 

will allow the NIH to maintain the current pace of discovery and innovation.’’ 

PanCAN also supports the NCI Director’s Professional Judgment Budget, which 

calls for a total of $5.9 billion for the NCI in fiscal year 2007. Those within the 

agency and very knowledgeable of the research being conducted by the NCI have 

developed this plan and accompanying budget that seeks to investigate the most 

promising research available to the community at this time. We urge the Committee 

to do all that it can to support investments in biomedical research that will save 

lives. At a minimum, we urge the Committee to support a funding increase of 5 percent above last year’s level for the NCI, which would bring the agency’s fiscal year 

2007 funding level to $5.034 billion. This funding level would provide an additional 

$240 million to at least keep the existing level of research at the NCI moving forward at a stable pace and thus protect the current number of investigator grant 

awards from significant cuts. 

Ensure that Pancreatic Cancer Research is Not Compromised as the NCI Shifts its 

Focus from Disease Specific Research to More Global Science Initiatives 

Last year, PanCAN requested that the Committee oversee implementation of the 

short, medium, and long-term strategies as identified in the Pancreatic Cancer 

Progress Review (PRG). The PRG has been in place since September 2002 and yet, 

4 years later, few of these strategies have been implemented. For this reason, 

PanCAN urges the Committee to require the NCI to implement, in fiscal year 2007, 

all of the outstanding strategies as identified in the NCI implementation plan for 

pancreatic cancer PRG recommendations. 

Through conversations and meetings with NCI leadership, we’ve learned about 

the shift in the NCI’s focus on research. Disease specific science is being shelved 

in favor of sexier initiatives in the areas of nanotechnology, genomics, and the development of a biospecimen repository. 

As the NCI moves its scientific agenda forward in these three areas, PanCAN is 

concerned that critical resources will be taken away from the significant investments that have been made in research related to early detection, diagnosis and 

treatment protocols for specific cancers. Other cancers have achieved significant declines in their respective mortality rates after early detection protocols have been 

developed. Since there is no such tool for diagnosing pancreatic cancer early in its 

development, the mortality rates remain high, and tens of thousands of patients are 

lost each year. As the advocacy community for pancreatic cancer patients, we feel 

that the NCI cannot justify any reductions in funding for pancreatic cancer research 

until significant reductions are achieved in the mortality rate for this cancer. 

PanCAN urges the Committee to obtain assurance from the NCI that the cornerstone research of the agency will not be diminished as these new scientific initiatives are pursued. Further, PanCAN urges the Committee to direct the NCI to develop a written report that specifically details how these three major scientific initiatives will specifically advance pancreatic cancer research and submit this report 

to the Committee by April 1, 2007. 

Support Selected Opportunities for Advancement of Pancreatic Cancer Research to 

Capitalize on the Initial Investment of Disease Specific Research 

Identify genetic factors, environmental factors, and gene-environment interactions 

that contribute to pancreatic cancer development. 

Achieve a more complete understanding of the biology of the normal pancreas and 

the development of pancreatic adenocarcinoma and use this knowledge to improve 

prevention, early detection, and treatment interventions. 

Develop nationwide tissue and data repositories, molecular profiling resources, 

and bioinformatics tools for pancreatic cancer research. Use these resources to develop prevention and early detection interventions that are based on molecular features of pancreatic cancer. 
373 

1White House Office of Technology Assessment. Researching health risks. Washington, DC: 

EOP (1993). 2 NIEHS Fact Sheet: The National Toxicology Program. Research Triangle Park, NC: NIEHS 

(1996). 

Establish models for the study of environmental factors, gene-environment interactions, chemoprevention, chemotherapy, radiation therapy, vaccines, and imaging 

to improve understanding of pancreatic cancer risk, prevention, diagnosis, and treatment. 

Identify and develop surveillance and diagnosis methods for early detection of 

pancreatic cancer and its precursors. 

Develop and establish sustained, expanded training and career development efforts in pancreatic cancer research and care to build a comprehensive, multidisciplinary research community focused on this disease. 

Mr. Chairman, the scientific community—through research—is making great 

progress in combating cancer. More people are surviving cancer today than any 

other time in history. Unfortunately, these achievements are not extended to the 

vast majority of pancreatic cancer patients. We urge you to provide America’s worldrenowned research enterprise with the funding levels necessary for investigators to 

continue to work their magic and develop screening protocols, effective treatments 

and therapies that will one day lead to the eradiation of all cancers—including pancreatic. To quote Congressman Clay Shaw (R-FL), a cancer patient, ‘‘When you approach the finish line, you don’t walk... you run!’’ If the United States truly 

seeks to move forward with its ambitious goal to stop pain and death from cancer 

by 2015, it is imperative that Federal research programs be adequately funded to 

achieve this goal. On behalf of the 33,730 patients diagnosed with pancreatic cancer 

in 2006, I urge you to support increased funding for cancer research, treatment and 

prevention programs in your fiscal year 2007 bill. 

PREPARED STATEMENT OF PEOPLE FOR THE ETHICAL TREATMENT OF ANIMALS

People for the Ethical Treatment of Animals (PETA) represents more than 1.3 

million Americans who support the Federal Government’s ongoing commitment to 

develop scientifically valid safety tests to protect human health and the environment from chemical hazards while reducing, and ultimately replacing, the use of 

animals. Thank you for the opportunity to present testimony relevant to the fiscal 

year 2007 budget request for the National Institute of Environmental Health 

Sciences in relation to the National Toxicology Program (NTP). 

HISTORY OF THE NTP

The NTP was established in 1978 to provide information about potentially toxic 

chemicals and to coordinate toxicity testing programs within the Federal Government, strengthen the science of toxicology, and develop and validate improved testing methods. Three agencies form the core of the NTP: the National Institute of Environmental Health Sciences of the National Institutes of Health (NIEHS/NIH), the 

National Institute of Occupational Safety and Health of the Centers for Disease 

Control and Prevention (NIOSH/CDC), and the National Center for Toxicological Research of the Food and Drug Administration (NCTR/FDA). The NTP’s activities are 

funded through the NIEHS at an annual level of approximately $500 to $600 million.1

NTP RODENT CANCER TESTING PROGRAM

During the 1960s and 70s, as vast numbers of new chemicals were being produced 

and used in agriculture, manufacturing, food preparation, and virtually every other 

aspect of modern life, the public became increasingly concerned that these chemicals 

were finding their way into the environment and food supply. Since much of the 

public anxiety regarding chemicals related to their potential to cause cancer, the 

Federal Government instituted a program to assess the cancer-causing potential of 

chemicals using rats and mice—on the assumption that rodent carcinogens could 

also present a cancer risk to humans. This rodent cancer-testing program began 

under the auspices of the National Cancer Institute, but has been managed by the 

NTP since its inception in 1968. 

A conventional NTP rodent cancer study takes approximately 5 years to design, 

conduct and interpret, consuming at least 860 animals and up to $4 million per 

chemical tested.2The study exposes three groups of animals to three different doses 
374 

3 502 lifetime cancer studies in rats and mice × $2–4 million/study = $1–2 billion. 4 NIEHS News Release: NTP completes 500th two-year rodent study and report; series is the 

gold standard of animal toxicology. 25 Jan 2001. <http://www.niehs.nih.gov/oc/news/ 

ntp500.htm>. 5 Contrera JF, Jacobs AC, DeGeorge JJ. Carcinogenicity testing and the evaluation of regulatory requirements for pharmaceuticals. Regulatory Toxicology and Pharmacology 25, 130–145 

(1997). 7 Brinkley J. Many say lab-animal tests fail to measure human risk. The New York Times 

1993 Mar 23;Sect A:1. 8Shane BS. Human reproductive hazards. Environmental Science and Technology 30, 1193 

(1989). 6Schwetz B, Gaylor D. New directions for predicting carcinogenesis. Molecular Carcinogenesis 

20, 2 75–279 (1997). 9PETA’s full report is available upon request or may be downloaded from http:// 

www.stopanimaltests.com/u-ntp.asp. 

of a test chemical, while a fourth group (known as the ‘‘control’’ group) receives no 

chemical exposure. The chemically exposed animals receive daily doses of a test substance for their entire 18- to 24-month life span. If these animals develop more tumors than the non-chemically exposed controls, this is taken as evidence that a 

chemical causes cancer. To date, the NTP has tested hundreds of substances in rodent cancer studies—including pharmaceuticals, pesticides, plastics, industrial 

chemicals, and even plant extracts—at a projected cost of more than 1 billion U.S. 

taxpayer dollars.3

A HISTORY OF CONTROVERSY

The NTP recently celebrated the publication of its 500th rodent cancer study as 

‘‘the gold standard in animal toxicology.’’ 4 However, in contrast to the fanfare with 

which this announcement was made, the history of NTP rodent cancer studies is one 

of controversy spanning several decades, with top Federal officials admitting: 

‘‘The current 2-year rodent carcinogenicity study was never validated and there 

is little evidence supporting the repeatability and reproducibility of the current rodent carcinogenicity study.’’ 5

—Drs. Joseph Contrera, Abigail Jacobs, and Joseph DeGeorge 

Food and Drug Administration, Center for Drug Evaluation and Research 

‘‘We have been concerned about the predictivity of 2-[year] [rodent cancer studies] 

for the past 10 [years], as our experience and knowledge have expanded.’’ 6

—Drs. Bernard Schwetz and David Gaylor 

Food and Drug Administration, Office of the Director/National Center for Toxicological Research 

‘‘The problem is we don’t know what the findings really mean.’’ 7

—Dr. Robert Maronpot, chief, Laboratory of Experimental Pathology, 

National Institute of Environmental Health Sciences (NIEHS) 

‘‘Even if a chemical is found to be nontoxic in animal studies, the safety of the 

chemical cannot be assured.’’ 8

—Dr. Barbara Shane, NTP executive secretary 

‘‘I have to say we don’t serve the American people very well right now.’’ 6

—Dr. Kenneth Olden, director, NTP & NIEHS (1991–2005) 

PETA’S ANALYSIS

PETA recently conducted an in-depth analysis of all 502 federally funded and conducted lifetime rodent cancer studies published on the NTP website as of January 

2006.9 On the basis of this analysis, together with more than 25 years of published 

scientific literature on this subject, we have determined that: 

—The great majority of the U.S. Government’s more than $1 billion investment 

in the NTP rodent cancer-testing program has produced little or no actual benefit, having been used to underwrite studies that: 

—Have been judged by the NTP itself to be ‘‘inadequate’’ or to produce ‘‘equivocal’’ (ambiguous) results, which are of no use to health authorities ($121 million). 

—Have produced such dubious and conflicting results that more than 75 percent of tested chemicals remain either unclassified as to their cancer risk to 

humans, or are lumped into such meaningless categories as ‘‘possible’’ human 

carcinogens or ‘‘unclassifiable’’ as to human cancer risk—designations that do 

nothing to enhance public health or worker protection ($460–720 million). 

—Have been shown by other scientists to produce consistent and reproducible 

results only 57 percent of the time when the same chemicals are tested more 
375 

10Laskin S, Sellakumar AR. Models in chemical respiratory carcinogenesis. In: Karbe E, Park 

JF, eds. Experimental lung cancer: carcinogenesis and bioassays. New York: Springer-Verlag 

(1974). 11 Rodelsperger K, Woitowitz H–J. Airborne fiber concentrations and lung burden compared 

to the tumor response in rats and humans exposed to asbestos. Annals of Occupational Hygiene 

39, 715–725 (1995). 12DeLore P, Borgomono C. Acute leukemia following benzene poisoning. Journal de 

MAE1decin de Lyon 9, 227–236 (1928). 13De Marini DM and others. Benchmarks: alternative methods in toxicology. MA Mehlman, 

ed. Princeton, NJ: Princeton Scientific Publishing (1989). 14 NIEHS Fact Sheet: The Report on Carcinogens—9th edition. 15 May 2000. <http:// 

www.niehs.nih.gov/oc/news/9thROC.htm>. 15Ward EM, Schulte PA, Bayard S, et al. Priorities for development of research methods in 

occupational cancer. Environmental Health Perspectives 111, 1–12 (2003). 16Toxicology in the 21st Century: The Role of the National Toxicology Program. 24 Feb 2004. 

<http://ntp-server.niehs.nih.gov/index.cfm?objectid=EE4AED80-F1F6-975E7317D7CB17625A15>. 

than once using the same method—a result that could be achieved by simply 

tossing a coin. 

—Critical public health and worker protection measures related to cigarette 

smoke, asbestos, benzene, and other cancer-causing substances were delayed for 

many years because of misplaced trust in animal tests, which for years could 

not replicate cancerous effects that had already been documented in people.10

11 12 13 If standard animal tests failed to readily identify these well-known 

human carcinogens, how many other dangerous chemicals are Americans being 

exposed to today as a result of misleading animal data? 

—Conversely, substances such as saccharin and ethyl acrylate (used in the manufacturing of latex paints and textiles) have been branded as ‘‘probable’’ human 

carcinogens and stigmatized on the basis of animal data later dismissed as irrelevant or otherwise inapplicable to humans.14 False alarms such as these can 

cost society billions in terms of loss of viable products in commerce, decreased 

international competitiveness, job loss, litigation, and unnecessary public anxiety. 

—Lifetime cancer studies in rats and mice are so costly and inefficient that the 

NTP has only been able to conduct an average of 12 such studies per year over 

the past several decades. At this rate, it would take the NTP more than 32,000 

years, 68 million animals, and $160 billion to test the more than 80,000 environmental chemicals whose cancer-causing potential has not yet been specifically assessed.15

These findings call into question the wisdom of continued Federal appropriations 

to the NTP rodent cancer-testing program. Taxpayer dollars would be better spent 

developing more reliable, relevant, and cost-effective methods for assessing chemical 

safety. 

NTP VISION AND ROADMAP FOR THE 21ST CENTURY

The NTP itself appears to recognize the limitations of relying upon decades old 

and never validated toxicity studies. In 2003, the NTP articulated its ‘‘vision’’ to 

move toxicology from an observational to a predictive science with markedly reduced 

reliance on animal testing.16 Among the methods that the NTP has identified for 

further development are ‘‘high throughput’’ screens, which combine robotics and in 

vitro (cell-based) toxicology to create a system capable of rapidly and inexpensively 

screening tens of thousands of substances per year at multiple concentrations relevant to real-world human exposure levels. PETA believes that a ‘‘battery’’ of several in vitro tests—based on human tissues and mechanisms of cancer induction 

that are relevant to people (e.g., genetic damage, cell transformation, depression of 

the immune system, hormone imbalance, etc.) represents the most credible and viable approach to accurately identifying chemicals that pose a cancer risk to humans. 

REQUEST FOR APPROPRIATIONS

In order to more rapidly and effectively screen chemicals to detect those that 

present a cancer risk to humans, we respectfully urge the subcommittee to support 

increasing appropriations from within the existing NIEHS budget for the development and validation of efficient and economical non-animal test methods under the 

NTP’s ‘‘21st Century Vision’’ program.16 Given the dubious value of the NTP rodent 

cancer-testing program, we respectfully recommend that funding of this program be 

discontinued and redirected instead to the NTP Vision program. 
376 

1 National Research Council (1997) Chimpanzees in research: strategies for their ethical care, 

management and use. National Academies Press: Washington, D.C. 2 Report of the Chimpanzee Management Plan Working Group to the National Advisory Research Resources Council; May 18, 2005. 3http://www.ncrr.nih.gov/compmed/cmlchimp.asp. 4 Ibid. 

5 National Research Council (1997) Chimpanzees in research: strategies for their ethical care, 

management and use. National Academies Press: Washington, D.C. 6http://www.ncrr.nih.gov/compmed/cmlchimp.asp 7Muchmore, E., (2001) Chimpanzee models for human disease and immunobiology, 

Immunological Reviews, 183, 86–93. 8 Reynolds, V., (1995) Moral issues in relation to chimpanzee field studies and experiments, 

Alternatives to Laboratory Animals, 23, 621–625. 9Source: http://dcis.hhs.gov/nih/nihldailylactivelweb.html (See contract No. 272022754). 

REQUEST FOR COMMITTEE REPORT LANGUAGE

We also respectfully request that the subcommittee consider the following report 

language for the Senate Labor, Health and Human Services, Education and Related 

Agencies Appropriations bill: 

‘‘Not later than March 30, 2007, the Director of the NTP/NIEHS shall provide 

Congress with a report detailing the number of rodent lifetime cancer studies funded to date by the NTP/NCI which (i) produced results deemed to be equivocal and/ 

or inadequate for classification as to human cancer risk, or (ii) have failed to provide 

a clear answer as to whether the substance tested presents a cancer risk to humans. 

The Director’s report should detail the costs associated with such studies, and explain the NTP’s continued reliance on rodent lifetime cancer studies in light of criticisms from senior Federal officials regarding their dubious validity and utility.’’ 

Thank you for the opportunity to submit this request on behalf of our more than 

1.3 million members and supporters. 

PREPARED STATEMENT OF PROJECT R&R 

Project R&R: Release and Restitution for Chimpanzees in U.S. Laboratories, 

whose advisory board of chimpanzee experts includes 12 organizations with a combined membership of 500,000, respectfully submits testimony on our funding priority. 

We request that Federal funding for breeding chimpanzees for research, or for 

projects that require breeding, be terminated. We do so for the following reasons: 

—A ‘‘surplus’’ of chimpanzees has resulted from over-breeding in the 1980s for 

HIV/AIDS research and later findings that they are a poor HIV/AIDS model.1

—There are enough chimpanzees to address existing federally funded research.2

—As a result of the ‘‘surplus,’’ the government funds a national sanctuary system.3

—The current population costs about $11 million Federal per year. 

—Breeding more chimpanzees increases taxpayers’ financial burden. 

—Expansion of the population compounds existing concerns about their quality of 

care. 

—While there is a breeding moratorium, NIH still funds research projects requiring breeding.4

—The public is concerned about the use of chimpanzees in research. 

Background.—Of an estimated 1,300 chimpanzees in laboratories in the United 

States today, approximately 850 are federally owned or supported. In the mid-1990s, 

the National Research Council (NRC) made recommendations to address the ‘‘surplus’’ that included a moratorium on breeding federally-owned or supported chimpanzees for at least 5 years 5 (implemented in 1995). The National Advisory Research Resources Council, which advises NCRR on funding activities, policies, and 

program, met on 09/15/05 and recommended that NCRR extend the moratorium to 

12/07. The recommendation was accepted 6—reasons included the high costs associated with care and the fact that chimpanzees are a poor model for human HIV research.7 8

Circumventing the moratorium.—Despite the moratorium, NIH funds research 

projects requiring breeding. For example, the National Institute of Allergy and Infectious Diseases (NIAID) maintains a contract with the New Iberia Research Center (NIRC) to provide 10 to 12 infants annually for research. The 10 year contract 

entitled ‘‘Leasing of chimpanzees for the conduct of research’ was allotted over $22 

million ($3.9 million has been spent since 2002).9
377 

10http://nirc.louisiana.edu/divisions/nihgrants.html 11Dyke, B., Williams-Blangero, S. et al, 1995 ‘‘Future costs of chimpanzees in U.S. research 

institutions,’’ ILAR Journal V37(4) http://dels.nas.edu/ilarl/ilarjournal/37l4/37lFuture.shtml 12 Institute for Laboratory Animal Research, website at http://dels.nas.edu/ilarln/ilarhome/ 

about.shtml 13The Chimpanzee Sequencing and Analysis Consortium/Mikkelsen, TS, et al.,(1 September 

2005) Initial sequence of the chimpanzee genome and comparison with the human genome, Nature 437, 69–87. 

NIRC has also received $5.47 million from 09/00 to 08/05 for a grant from NCRR 

to maintain 138 chimpanzees for breeding. NIH/NCRR spends more than $1 million 

annually to maintain the NIRC breeding colony.10 These grants result in $9 million 

going to breeding-related activities at NIRC alone since 2000. 

Such expenditures circumvent the intent of the breeding moratorium, compelling 

the need to prevent the growing financial burden of increasing numbers of chimpanzees, particularly since, by the government’s own admission, a ‘‘surplus’’ already 

exists. 

Costs for Chimpanzee Maintenance.—The cost of care for chimpanzees is a major 

concern, particularly with NIH’s tightening budget. In 1995, the Institute for Laboratory Animal Research (ILAR) published a study that projected the future costs 

of maintaining chimpanzees in U.S. research.11 ILAR, a division of the National 

Academies of Science, functions as ‘‘an advisor to the Federal Government, the biomedical research community, and the public.’’ 12

The ILAR study examined the per diem costs of the existing population of chimpanzees at six facilities. Taking into account a variety of factors such as longevity, 

distribution of sex, and complexity of care, it projected costs of maintaining the 

present colony over the next 60 years. To account for inflation, an annual 4 percent 

increase was incorporated, corresponding approximately to the Biomedical Research 

and Development Price Index. 

The results of the study indicated that the lifetime cost of maintaining chimpanzees over the next 60 years—the approximate lifespan of chimpanzees in captivity—will exceed $3.14 billion. The 1995 projection, however, was based on a population of 1,447 chimpanzees. The present population of federally owned or supported 

chimpanzees in 2006, due to implementation of the partial breeding moratorium in 

1995 and the close of the Coulston Foundation in 2002, stands closer to 850. This 

represents approximately 59 percent of the 1,447 number used in ILAR’s projection. 

Thus we can estimate the cost of the existing colony to be $1.85 billion. 

The ILAR projection also concluded that the current 2006 annual costs would be 

approximately $18.8 million. Adjusting this number by 59 percent results in $11 

million spent in 2006 alone to maintain chimpanzees for research. 

It is important to note that $11 million represents only a partial estimate of the 

entire Federal expenditure for chimpanzee research. The total population of U.S. 

chimpanzees available for research is estimated at 1,300. Approximately 500 of 

these chimpanzees are privately owned. Privately owned chimpanzees are also partially funded by Federal research dollars. Therefore, the 2006 estimate of annual expenditure actually exceeds $11 million by an undetermined amount. 

Delivery of care.—USDA inspection reports indicate that facilities housing chimpanzees for research are not adequately meeting basic housing needs. Inspection reports for the NIRC 2004 showed some chimpanzees being housed in less than the 

minimal space requirements. The facility was given one year to correct the non-compliance, which needed to be further extended as construction of new housing facilities was still not completed. NIRC was also cited 7 times during its 12/04 inspection 

for improperly sanitizing cages and living quarters, as well as for failing to provide 

adequate environment enhancement. 

Inspection reports filed on the Southwest Foundation for Biomedical Research and 

the Yerkes Primate Facility, both National Primate Research Centers, also demonstrate multiple non-compliant items for failing to keep chimpanzee areas in wellmaintained condition, and failing to maintain safe facilities free of dangers due to 

disrepair. 

A poor model.—It is widely agreed within the scientific community that chimpanzees are a poor model for HIV. Years of research demonstrated that HIV-infected chimpanzees do not develop AIDS. Similarly, while chimpanzees are used in 

current hepatitis C research, they do not model the course of the human disease. 

The decoding of the chimpanzee genome pointed out similarities as well as differences between humans and chimpanzees. Some of those greatest differences relate to the immune system.13 Such differences question the validity of using chimpanzees in infectious disease research, further arguing the need to curb populations 

and costs. 
378 

14 U.S. Public Opinion of Chimpanzee Research, Support for a Ban, and Related Issues, Prepared for the New England Anti-Vivisection Society, by the Humane Research Council, 2005. 15Public Opinion Poll, Prepared for the Chimpanzee Collaboratory, by Zogby International, 

2001. 

Ethical concerns.—The U.S. public is concerned about the use of chimpanzees in 

research because of their intellectual, emotional and social similarities to humans. 

A 2005 poll conducted by the Humane Research Council revealed that 4 out of 5 

(83 percent) of the U.S. public recognize chimpanzees as highly intelligent, social individuals who have an extensive capacity to communicate. A full 71 percent of 

Americans support the release of chimpanzees if they have been used in research 

for more than 10 years.14 A 2001 poll conducted by Zogby International showed that 

90 percent of Americans believe it is unacceptable to confine chimpanzees in government-approved cages.15

Conclusion.—We respectfully request that the following language appear in the 

House Labor, Health and Human Services, Education and Related Agencies Appropriations Subcommittee Report for Fiscal Year 2007: 

‘‘None of these funds shall be used for the breeding of chimpanzees or research 

projects that require the breeding of chimpanzees.’’ 

We hope the committee will accommodate this modest request that will save the 

government substantial money, benefit chimpanzees, and allay some concerns of the 

public at large. Thank you for your consideration. 

LETTER FROM SENATOR PAT ROBERTS, ET AL. 

WASHINGTON, DC, April 5, 2006. 

Hon. ARLEN SPECTER, Chair, 

Hon. TOM HARKIN, Ranking Member, 

Subcommittee on Labor, HHS, and Education, Senate Committee on Appropriations, 

Washington, DC 

DEAR CHAIRMAN SPECTER AND RANKING MEMBER HARKIN: As you begin your work 

on the fiscal year 2007 Labor, Health and Human Services, and Education Appropriations bill, we urge you to provide the same level of funding for Title VII health 

professional as was appropriated in fiscal year 2005 ($299,552,000). These programs 

provide direct financial support for health care workforce development and education. In addition, they are the only Federal programs designed to train providers 

in interdisciplinary setting to respond to the needs of special and underserved populations. They also work to increase minority representation in the health care workforce. 

The fiscal year 2006 Labor, Health and Human Services, Education Appropriations bill dramatically reduced funding for Title VII health professions programs, resulting in a 51 percent overall cut below fiscal year 2005. At a time of serious health 

professions shortages, this reduction has already had devastating effects on the 

country’s neediest communities. By restoring funding to these programs to fiscal 

year 2005 levels, you will enable them to continue to improve the distribution, quality, and diversity of the health professions workforce. 

We respectfully urge you to restore funding to the Title VII programs in the fiscal 

year 2007 Labor, Health and Human Services, and Education appropriations bill. 

We greatly appreciate your consideration of the request. 

Sincerely, 

Senators Pat Roberts, Jack Reed, Elizabeth Dole, Daniel K. Akaka, Susan 

M. Collins, Lamar Alexander, Richard Durbin, Sam Brownback, 

Blanche L. Lincoln, Richard G. Lugar, James M. Jeffords, Paul S. 

Sarbanes, Norm Coleman, Charles E. Schumer, Byron L. Dorgan, 

Frank R. Lautenberg, Dianne Feinstein, Mark L. Pryor, Hillary 

Rodham Clinton, Evan Bayh, Christopher J. Dodd, Patrick J. Leahy, 

John F. Kerry, Tim Johnson, Debbie Stabenow, Jon Kyl, Ken 

Salazar, Bill Nelson, Benjamin E. Nelson, Edward M. Kennedy, Robert Menendez, Barbara A. Mikulski, Russell D. Feingold, George V. 

Voinovich, Mary L. Lanorieu, Maria Cantwell, Barack Obama, Joseph I. Lieberman, Jeff Bingaman, Harry Reid, John D. Rockefeller, 

IV, Conrad Burns, Barbara Boxer, Mark Dayton, Lincoln Chafee, 

Patty Murray, Christopher S. Bond, Carl Levin, Mike DeWine, Chuck 

Hagel, John Warner, Lindsey Graham, Richard M. Burr, James M. 

Talent, Jeff Sessions, and Ron Wyden. 
379 

PREPARED STATEMENT OF THE SPINA BIFIDA ASSOCIATION

On behalf of the more than 70,000 individuals and their families who are affected 

by Spina Bifida, the Spina Bifida Association (SBA) appreciates the opportunity to 

submit written testimony for the record regarding fiscal year 2007 funding for the 

National Spina Bifida Program and other related Spina Bifida initiatives. SBA is 

the national voluntary health agency working on behalf of people with Spina Bifida 

and their families through education, advocacy, research and service. The Association was founded in 1973 to address the needs of the Spina Bifida community and 

today serves as the representative of 56 chapters serving more than 125 communities nationwide. SBA stands ready to work with Members of Congress and other 

stakeholders to ensure our Nation takes all the steps necessary to reduce and prevent suffering from Spina Bifida. 

BACKGROUND ON SPINA BIFIDA

Spina Bifida, a neural tube defect (NTD), occurs when the spinal cord fails to 

close properly during the early stages of pregnancy, typically within the first few 

weeks of pregnancy and most often before the mother knows that she is pregnant. 

Over the course of the pregnancy—as the fetus grows—the spinal cord is exposed 

to the amniotic fluid which increasingly becomes toxic. It is believed that the exposure of the spinal cord to the toxic amniotic fluid erodes the spine and results in 

Spina Bifida. There are varying forms of Spina Bifida occurring from mild—with little or no noticeable disability—to severe—with limited movement and function. In 

addition, within each different form of Spina Bifida the effects can vary widely. Unfortunately, the most severe form of Spina Bifida occurs in 96 percent of children 

born with this birth defect. 

The result of this neural tube defect is that most children with it suffer from a 

host of physical, psychological, and educational challenges—including paralysis, developmental delay, numerous surgeries, and living with a shunt in their skulls 

which seeks to ameliorate their condition by helping to relieve cranial pressure associated with spinal fluid that does not flow properly. As we have testified previously, 

the good news is that after decades of poor prognoses and short life expectancy, children with Spina Bifida are now living long enough to become adults with Spina 

Bifida. These gains in longevity principally are due to breakthroughs in research, 

combined with improvements generally in health care and treatment. However, with 

this extended life expectancy, our Nation and people with Spina Bifida now face new 

challenges—education, job training, independent living, health care for secondary 

conditions, aging concerns, among others. Despite these gains, individuals and families affected by Spina Bifida face many challenges—physical, emotional, and financial. Fortunately, with the advent of the National Spina Bifida Program 4 years ago, 

individuals and families affected by Spina Bifida now have a national resource to 

provide them with the support, information, and assistance they need and deserve. 

While the consumption of 400 micrograms of folic acid daily prior to becoming 

pregnant and throughout the first trimester of pregnancy, can help reduce the incidence of Spina Bifida by up to 75 percent, cases of Spina Bifida still occur and our 

Nation still must take steps to ensure that the tens of thousands of individuals living with Spina Bifida can live full, healthy, and productive lives. To ensure the 

highest quality-of-life possible, prevention interventions and treatment therapies 

must be identified, developed, and delivered to those in need. 

COST OF SPINA BIFIDA

It is important to note that the lifetime costs associated with a typical case of 

Spina Bifida—including medical care, special education, therapy services, and loss 

of earnings—are as much as $1 million. The total societal cost of Spina Bifida is 

estimated to exceed $750 million per year, with just the Social Security Administration payments to individuals with Spina Bifida exceeding $82 million per year. 

Moreover, tens of millions of dollars are spent on medical care paid for by the Medicaid and Medicare Programs. Our Nation must do more to help reduce the emotional, financial, and physical toll of Spina Bifida on the individuals and families 

affected. Efforts to reduce and prevent suffering from Spina Bifida help to save 

money and save lives. 

IMPROVING QUALITY-OF-LIFE THROUGH THE NATIONAL SPINA BIFIDA PROGRAM

SBA has worked with Members of Congress to ensure that our Nation is taking 

all the steps possible to prevent Spina Bifida and diminish suffering for those currently living with this condition. With appropriate, affordable, and high-quality 

medical, physical, and emotional care, most people born with Spina Bifida likely will 
380 

have a normal or near normal life expectancy. Ensuring access to these services is 

essential to improving the quality-of-life for those born with this birth defect. 

The National Spina Bifida Program at the National Center for Birth Defects and 

Developmental Disabilities (NCBDDD) at the Centers for Disease Control and Prevention (CDC) works on two critical levels—to reduce and prevent Spina Bifida incidence and morbidity and to improve quality-of-life for those living with Spina Bifida. 

The program seeks to ensure that what is known by scientists is practiced and experienced by the 70,000 individuals and families affected by Spina Bifida. Moreover, 

the National Spina Bifida Program works to improve the outlook for a life challenged by this complicated birth defect—principally identifying valuable therapies 

from in-utero throughout the lifespan and making them available and accessible to 

those in need. 

The National Spina Bifida Program serves as a national center for information 

and support to help ensure that individuals, families, and other caregivers, such as 

health professionals, have the most up-to-date information about effective interventions for the myriad primary and secondary conditions associated with Spina Bifida. 

Among many other activities, the program helps individuals with Spina Bifida and 

their families learn how to treat and prevent secondary health problems, such as 

bladder and bowel control difficulties, learning disabilities, depression, latex allergy, 

obesity, skin breakdown and social and sexual issues. Children with Spina Bifida 

often have learning disabilities and may have difficulty with paying attention, expressing or understanding language, and grasping reading and math. All of these 

problems can be treated or prevented, but only if those affected by Spina Bifida— 

and their caregivers—are properly educated and taught what they need to know to 

maintain the highest level of health and well-being possible. The National Spina 

Bifida Program’s secondary prevention activities represent a tangible quality-of-life 

difference to the 70,000 individuals living with Spina Bifida with the goal being living well with Spina Bifida. 

In fiscal year 2006, Congress folded funding for a study on folic acid (also known 

as the ‘‘China Study’’) into the National Spina Bifida Program and provided $5.1 

million in fiscal year 2006 (a final allocation of $5 million after the one percent 

across-the-board cut) for this new joint program. SBA appreciates Congressional interest and intent in ensuring that the CDC’s folic acid and Spina Bifida activities 

are coordinated. SBA maintains a strong interest in working with NCBDDD and 

Members of the subcommittee to ensure that this new joint program fulfills Congressional intent and that the quality-of-life components of the National Spina 

Bifida Program receive adequate funding to support ongoing and expanded endeavors. 

SBA advocates that the National Spina Bifida Program receive $6 million in fiscal 

year 2007 and that that sum be used to expand and continue to promote qualityof-life programs that support people with Spina Bifida so they can live fulfilling and 

productive lives. In its first 3 years, this program already has made a difference for 

our community and with additional resources it can expand its reach and provide 

additional assistance and hope to those with an affected loved one. Increasing funding for the National Spina Bifida Program will help ensure that our Nation continues to mount a comprehensive effort to prevent and reduce suffering from Spina 

Bifida. 

PREVENTING SPINA BIFIDA

While the exact cause of Spina Bifida is unknown, over the last decade, medical 

research has confirmed a link between a woman’s folate level before pregnancy and 

the occurrence of Spina Bifida. Sixty million women are at-risk of having a child 

born with Spina Bifida and each year approximately 3,000 pregnancies in this country are affected by Spina Bifida, resulting in 1,500 births. As mentioned above, the 

consumption of 400 micrograms of folic acid daily prior to becoming pregnant and 

throughout the first trimester of pregnancy can help reduce incidence of Spina 

Bifida up to 75 percent. There are few public health challenges that our Nation can 

tackle and conquer by three-fourths in such a straightforward fashion. However, we 

must still be concerned with addressing the 25 percent of Spina Bifida cases that 

cannot be prevented by folic acid consumption, as well as ensuring that all women 

of childbearing age—particularly those most at-risk for a Spina Bifida pregnancy— 

consume adequate amounts of folic acid. 

The good news is that progress has been made in convincing women of the importance of folic acid consumption and the need to maintain diet rich in folic acid. Since 

1968, the CDC has led the Nation in monitoring birth defects and developmental 

disabilities, linking these health outcomes with maternal and/or environmental factors that increase risk, and identifying effective means of reducing such risks. 
381 

Former CDC Director Jeff Koplan has stated that the agency’s folic acid prevention 

campaign has reduced neural tube defect births by 20 percent. This public health 

success should be celebrated, but it is only half of the equation as approximately 

3,000 pregnancies still are affected by this devastating birth defect. The Nation’s 

public education campaign around folic acid consumption must be enhanced and 

broadened to reach segments of the population that have yet to heed this call—such 

an investment will help ensure that as many cases of Spina Bifida can be prevented 

as possible. 

SBA works collaboratively with CDC and the March of Dimes to increase awareness of the benefits of folic acid, particular for those at elevated risk of having a 

baby with neural tube defects (those who have Spina Bifida themselves or those who 

have already conceived a baby with Spina Bifida). With additional funding in fiscal 

year 2007 these activities could be expanded to reach the broader population in need 

of these public health education, health promotion, and disease prevention messages. SBA advocates that Congress provide additional funding to CDC to allow for 

a particular public health education and awareness focus on at-risk populations (e.g. 

Hispanic-Latino communities) and health professionals who can help disseminate 

information about the importance of folic acid consumption among women of childbearing age. In addition to a $6 million fiscal year 2007 allocation for the National Spina Bifida Program, SBA supports a fiscal year 2007 allocation of $135 million for the 

NCBDDD so the agency can enhance its programs and initiatives to prevent birth 

defects and developmental disabilities and promote health and wellness among people with disabilities. 

IMPROVING HEALTH CARE FOR INDIVIDUALS WITH SPINA BIFIDA

The mission of the Agency for Healthcare Research and Quality (AHRQ) is to improve the outcomes and quality of health care; reduce its costs; improve patient safety; decrease medical errors; and broaden access to essential health services. The 

work conducted by the agency is vital to the evaluation of new treatments in order 

to ensure that individuals and their families living with Spina Bifida continue to 

receive the high quality health care that they need and deserve—SBA recommends 

that AHRQ receive $443 million in fiscal year 2007 so that it can continue to conduct follow-up efforts to evaluate Spina Bifida treatments, promulgate associated 

standards of care, and further the provision of evidence-based care stemming from 

the outcomes of the 2003 Spina Bifida Research Conference. 

SUSTAIN AND SEIZE SPINA BIFIDA RESEARCH OPPORTUNITIES

SBA seeks to support individuals and families affected by Spina Bifida, maximize 

the prevention of Spina Bifida, and ensure that all babies born with Spina Bifida 

have the greatest chance of survival and the highest quality-of-life—through the 

lifespan. When families recently diagnosed with a Spina Bifida pregnancy contact 

SBA, the organization puts them in touch with another family who has a child with 

the condition so they can learn of the joys and challenges of having a child with 

the birth defect. Unfortunately, traditionally when families have faced a Spina 

Bifida diagnosis they have had two difficult options. The first is to continue the 

pregnancy with the expectation of multiple surgeries for the child after birth, uncertain life expectancy, and many physical and developmental challenges and complications. The second, unfortunately, is to terminate the pregnancy. Fortunately, now 

there may be an important and effective third option. 

Since the late 1990s, doctors at three U.S. hospitals—Children’s Hospital of Philadelphia, Vanderbilt University Medical Center in Nashville, and the University of 

California at San Francisco—have been operating before birth on fetuses diagnosed 

with Spina Bifida. In 2004, the University of North Carolina became the fourth hospital in the Nation to perform the in-utero operations. By closing the spinal lesion 

early in pregnancy, physicians believe they can minimize the damage created by 

fluid leaking from the spine, as well as limit by the harm done due to the spinal 

cord’s contact with the amniotic fluid. Surgeons have found that closing the hole in 

the spine in this fashion before birth may correct breathing problems in 15 percent 

of the children receiving the procedure and may reduce the need for a shunt to 

drain fluid from the brain by between 33 percent and 50 percent. 

To determine whether or not this new procedure is safer and more effective than 

the traditional post-birth surgery to address the condition, the National Institute of 

Child Health and Human Development (NICHD) is conducting a large study involving the Children’s Hospital of Philadelphia, Vanderbilt University Medical Center, 

and the University of California at San Francisco. While these three institutions 

have undertaken preliminary studies of the in-utero surgery technique, the overall 
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and long-term effectiveness of this approach as compared to traditional therapy remains unknown. Given the potential for this surgery to ameliorate many of the conditions associated with Spina Bifida, we must do a better job of studying and evaluating this procedure, educating health care providers about this surgery as a potential option, and making information about it available to more families facing a 

Spina Bifida pregnancy. 

Additionally, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is scheduled to host an interagency meeting in spring 2006 on 

urological complications. We are also excited to report that the National Institute 

of Neurological Disorders and Stroke (NINDS) has formed a trans-agency Spina 

Bifida Working Group. SBA looks forward to working with both agencies on these 

and other important Spina Bifida related initiatives. 

Our Nation has benefited immensely from our past Federal investment in biomedical research at the National Institutes of Health (NIH). SBA joins with the rest 

of the public health community in advocating that NIH receive $29.7 billion in fiscal 

year 2007. This funding will support applied and basic biomedical, psychosocial, 

educational, and rehabilitative research to improve the understanding of the etiology, prevention, cure and treatment of Spina Bifida and its related conditions. In 

addition, SBA urges the NIH to explore the following as they relate to individuals 

with Spina Bifida: assistive technology, in utero surgery, cost of care, women’s and 

men’s health, tethered spinal cord, hydrocephalus, latex allergies, and other related 

factors. 

CONCLUSION

SBA stands ready to work with policymakers to advance policies that will reduce 

and prevent suffering from Spina Bifida. Again, we thank you for the opportunity 

to present our views on funding for programs that will improve the quality-of-life 

for the 70,000 Americans and their families living with Spina Bifida and stand 

ready to answer any questions you may have. 

PREPARED STATEMENT OF THE TUOMEY HEALTHCARE SYSTEM

Mr. Chairman, and Members of the subcommittee, thank you for the opportunity 

to submit testimony regarding the need for a Bedside Medication Verification System and subsequently a Computerized Practitioner Order Entry and Clinical Decision Support System at Tuomey Healthcare System. 

For more than 90 years, Tuomey’s growth and advancement have been guided by 

professionals who care deeply about the Sumter community and the individual 

healthcare needs of every person in it. From the small 20-bed Sumter Hospital born 

out of Timothy Tuomey’s gift in 1913 to a healthcare system of more than 1,600 employees and 266 beds, Tuomey’s history has been one of compassion and resolve. It 

is propelled by a long-term vision for healthcare that’s second to none and is enhanced by a deeply philanthropic mission. 

Since 2000, Tuomey has provided tens of millions of dollars in community services. And each year, we absorb almost $20 million in indigent care. Our employee 

base is tremendously dedicated to Sumter’s health as well, as evidenced by their gift 

of close to $1 million since 2000. Through all of this, Tuomey is committed to Sumter, and it shows in everything we do. In the last year, Tuomey has ranked in the 

97th and 98th percentiles nationally in the Press Ganey customer satisfaction scores 

in the inpatient and ambulatory surgery center categories. 

The demand for Tuomey services will be further increased with the upcoming addition of approximately 850 service men and women to Shaw Air Force Base and 

the closing of the base’s inpatient hospital. This equates to an approximate 3,000 

person increase in total population to the Sumter community. To handle Tuomey’s 

additional patient volume and to continue providing the quality care for which we 

are known, it is imperative we increase our inpatient capacity. Likewise, we must 

expand our women’s and obstetrics service areas and our Emergency Department 

to meet the growing needs of this community. It is an expensive proposition, but 

one to which we are committed. It’s the next step in our path to safeguarding this 

community’s health. 

Plans are currently underway for the construction of a new 24-bed women’s complex called The Tuomey Women’s Center, expansion and enhancement of our nurseries, the addition of 22 general medical inpatient rooms, and the expansion of the 

Emergency Department. The total combined cost of these expansions and enhancements is $31.5 million. 

High quality care and patient safety are the core elements of everything we do 

at Tuomey, utilizing technology where appropriate and cost effective. We have been 
383 

a Meditech Information Systems customer since 1988, with virtually every department in our facility computerized, to include nursing documentation, radiology results, laboratory results and all financials. In July 2005, we went live with the 

McKesson Electronic Medical Record, which allows physicians to access patient information from anywhere with an internet connection, enhancing the timely delivery 

and continuity of care. However, even with the benefits gained from our technology, 

we still deal with the challenges of caring for sicker patients in a shorter period of 

time with limited financial resources and shortages of skilled labor. Like many other 

hospitals, a completely safe and accurate medication management process remains 

one of our most difficult challenges. In addition, the medication management process is one of the areas where technology can offer the greatest number of improvements in terms of patient safety and quality of care. 

In its 1999 report, ‘‘To Err is Human: Building a Safer Health System,’’ The Institute of Medicine (IOM) estimated that 44,000 to 98,000 patients die each year from 

medical errors, of which the largest portion, up to one-third, has been linked to 

medication errors or adverse drug events (ADEs). A medication error can lead to increased charges and longer patient stays while adverse drug events can lead to patient injury and death. While there is a difference between medication errors and 

adverse drug events, Tuomey’s goal is to avoid both and to consistently offer the 

highest quality care in the safest patient care environment possible. 

Medication administration safety is dependent on five basic safety checks: the correct patient, the correct drug, the correct dose, the correct route of administration 

and the correct time of administration. Any deviation from these five standards of 

medication administration practice can lead to medication errors and Adverse Drug 

Events. Given that there are now more than 17,000 brand and generic names for 

pharmaceuticals in North America and nurses are caring for sicker patients on 

shorter hospital stays, the implementation of automated systems to safeguard 

against human errors in all aspects of the medication administration process has 

reached a state of critical need at Tuomey. 

Currently, Tuomey is using an antiquated, yet not uncommon, system of medication ordering in which providers handwrite orders that are sent via pneumatic tube 

to a pharmacy location. The pharmacy staff deciphers the handwritten orders to the 

best of their human ability and sends the medications to the nursing staff that then 

rely on handwritten orders and the five rights of medication administration. In addition, the pharmacy charges the patient’s account for the medications at the point 

the medications are dispensed from the pharmacy. The pharmacy is then responsible for crediting the patient’s account if the medications are never taken. 

The failure rate for this type of system is staggering throughout the healthcare 

community. Physicians, pharmacists, nurses and support staff work long hours with 

fluctuating levels of stress. Experts have estimated that at least 38 percent of all 

medication errors take place at the bedside using manual handwritten systems like 

the one currently in use at Tuomey. There are simply too many distractions and 

too many chances for something to go wrong when completely relying on protocols 

and procedures to assure safe and accurate medication administration. It is important to note, though, that Tuomey has never been complacent with a system that 

puts any patient at risk. Tuomey has remained vigilant to the risks associated with 

its current medication administration process and has made many improvements 

and changes to the manual system to promote patient safety and accuracy. 

Unfortunately, for many years, there has not been a feasible alternative to the 

manual system. Technology and system availability have only recently reached a 

State worth investigating for true process improvement. Tuomey has investigated 

the currently available technologies and has identified viable solutions to improve 

the medication administration process. Bedside Medication Administration systems 

using barcode verification (BMV) and Computerized Physician Order Entry with 

Clinical Decision Support (CPOE/CDSS) have been identified as two systems that 

can greatly minimize the chance of errors and promote the highest quality care in 

the medication administration process. 

Bedside Medication Administration using barcode identification systems have consistently been shown to improve patient safety and patient billing in hospital sites 

throughout the country. The basic process for bar code medication administration 

systems begins with an initial positive identification of a patient by the nursing 

staff. After the initial identification, the patient is given a wristband with an identifying bar code. From that point forward, the patient will be identified via a scan 

of the wristband’s bar code. Before administering any medication or performing a 

treatment, the patient must be identified to the system via the scan. By first correctly identifying the patient to the system, the nurse then allows the system to 

double check the other four rights before the actual administration. 
384 

If a medication order has expired or been changed, the nurse is immediately alerted to avoid a possible medication error or Adverse Drug Event. The basic setup for 

the bar code medication administration system involves a laptop computer with a 

scanner linked to a hospital wireless network that runs the medication verification 

and patient billing systems. Accurate identification and correct order association assure patient safety and patient billing is accurately updated at the point of administration. 

Computerized Practitioner Order Entry (CPOE) and Clinical Decision Support 

System (CDSS) implementation at Tuomey will virtually eliminate the chance of 

error in the deciphering of handwritten orders and eliminate any need for transcription all together since providers will be entering all medication and treatment 

orders directly into the information system with alerts and warnings regarding allergies, duplications and dangerous interactions readily available. If the orders are 

accurately entered and double checked for safety, then the bedside point of administration system will accurately ensure the correctly entered orders are carried out 

safely and accurately as intended by the ordering clinicians. Nurses will ensure that 

all five standards of medication administration are correct and accurate using 

barcodes identifying both the medication and the patient. 

While Bedside Medication Verification and Computerized Practitioner Order 

Entry/Clinical Decision Support Systems are highly interdependent, staging of the 

implementations are vital to success. CPOE/CDSS cannot receive real-time feedback 

regarding medication administration without a Bedside Medication Verification system implemented and functioning. Likewise, Computerized Practitioner Order Entry 

(CPOE) and Clinical Decision Support System (CDSS) maturity lags behind Bedside 

Medication Verification due to the level of sophistication and logic design required. 

Any implementation strategy for Bedside Medication Verification and CPOE/CDSS 

at Tuomey Healthcare System must include plans to implement Bedside Medication 

Verification before moving to the other systems. 

In fiscal year 2007, we hope that the subcommittee will support our request for 

funding of $1.5 million in order to implement a Bedside Medication Verification system that will be Phase I of this entire project. It is our belief that we will be highly 

successful in this project and could serve as a resource and site for other health care 

organizations to learn from in enhancing the safety of all patients. 

As healthcare continues to evolve, so does Tuomey Healthcare System. We’re here 

to anticipate the needs of the communities we serve, responding with proactive 

healthcare initiatives, such as the systems noted above. Our stable but consistent 

growth positions Tuomey as one of South Carolina’s largest healthcare systems. 

Tuomey is committed to Sumter, and it shows in everything we do. 

NATIONAL INSTITUTES OF HEALTH 

PREPARED STATEMENT OF THE AMERICAN ASSOCIATION FOR CANCER RESEARCH

(AACR) 

The number of cancer deaths is falling and the number of cancer survivors is increasing each year. This remarkable progress has occurred because of the advances 

in cancer research, discovery, detection, prevention, and treatment made possible, 

in part, by a strong and steady level of funding and commitment by the Federal 

Government. 

The National Cancer Program supports an incredible array of cancer research programs that shows great promise for benefit to patients with cancer. To sustain the 

research momentum that has been so carefully built up over the past decade—and 

to continue to give hope to those with cancer—the Congress must provide sufficient 

resources to preserve the scientific infrastructure and foster new discoveries. 

The American Association for Cancer Research (AACR) stands ready to contribute 

its share to accelerate our progress against this devastating disease. The AACR 

joins with other leaders in the cancer community to call upon the Congress to take 

the following actions to enable these invaluable programs to continue their contributions to improving the lives of patients with cancer and other life-threatening diseases: 

(1) Provide a 5 percent increase in funding for the National Institutes of Health 

to $29.75 billion for fiscal year 2007; and 

(2) Provide a 5 percent increase in funding for the National Cancer Institute to 

$5.03 billion for fiscal year 2007. 

Early this year, it was reported that the number of cancer deaths every year in 

the United States fell for the first time in more than 70 years. Coupled with the 

fact that observed cancer death rates from all cancers combined dropped 1.1 percent 
385 

each year from 1993 to 2002, these persistent declines in cancer mortality rates are 

evidence of the success of the National Cancer Program and its research, prevention, and treatment advances. 

Among these advances are a series of new targeted cancer therapies that have 

evolved from a process of rational drug design based upon our expanded understanding of the genetic basis of disease. For example, Herceptin became the first 

targeted therapy for breast cancer in 1997—it is an injectable antibody that targets 

and blocks the function of HER2 protein when it is overproduced in the body, which 

leads to cancer. In 2001, Gleevec became the first approved kinase inhibitor for cancer, shutting down the BCR–ABL kinase that causes chronic myeloid leukemia. 

These discoveries have led to a half-dozen other more recent drug approvals that 

are based upon these and other novel mechanisms of action. 

Exciting, life-saving scientific progress such as this will only continue if it is nurtured and sustained by an adequate level of Federal research investment. The 

American Association for Cancer Research (AACR) calls upon the President and the 

United States Congress to make the commitment to sustain this research momentum by increasing the appropriations for the National Institutes of Health (NIH) to 

$29.75 billion and the National Cancer Institute (NCI) to $5.03 billion for fiscal year 

2007. Without such a commitment, promising research will be abandoned, new 

treatments may never come to fruition, and patients with cancer will lose the hope 

of enjoying a life beyond cancer. 

The AACR stands ready to contribute its share to accelerate our progress against 

this devastating disease. As AACR approaches its Centennial Year in 2007, with 

more than 24,000 members, it is well positioned to foster and facilitate the scientific 

developments that will underpin our forward movement in basic, translational, and 

clinical cancer research. Through its five prestigious scientific journals—including 

Cancer Research, the most frequently cited cancer journal in the world—AACR rapidly disseminates cutting-edge, peer-reviewed findings throughout the medical research community. AACR’s Annual Meeting attracts more than 16,000 scientists 

worldwide to cross-disciplinary sessions led by the world’s leading experts. The 

AACR has been at the forefront of the art of anticancer drug development and the 

science of cancer prevention, and originated the annual International Conference on 

Cancer Prevention Research. Through these high quality scientific meetings, along 

with prestigious awards and research training programs and grants, the AACR utilizes a multilayered approach to stimulate and foster the best science that will lead 

to the conquest of cancer. 

No single sector or entity alone can successfully tackle the complex set of diseases 

known as cancer. Academic scientists and clinicians have a large role to play in discovery and the translation of discoveries into standard clinical care. Biotechnology 

and pharmaceutical companies, with their vast research and development and manufacturing and distribution capabilities, are also essential for the smooth, efficient, 

and effective delivery of cancer medicines to hospitals and patients. Barriers or 

roadblocks in any aspect of the research, discovery, development, or delivery path 

will have an adverse impact on achieving the goal of conquering cancer and saving 

lives. 

Central to this multisector effort is the National Cancer Program and the fundamental and foundational work of the National Cancer Institute. For 35 years, because of the National Cancer Act, the NCI has spearheaded the research efforts that 

have led to the declining mortality rates we are experiencing today. The strategies 

underlying the National Cancer Program have been developed by the NCI in close 

collaboration with the cancer community. Each year the Director of the NCI engages 

in an open and transparent priority-setting process to develop a plan and budget 

proposal for the following year. It is reviewed by the cancer community and published each fall as The Nation’s Investment in Cancer Research: A Plan and Budget 

Proposal. It is the definitive guide to how the NCI is using its funds and how it 

plans to spend additional funds should they become available. 

The scope and breadth of the activities in which the National Cancer Institute is 

engaged are truly remarkable. As the leader of the Nation’s grand plan to attack 

cancer, the NCI must be provided with the resources necessary to carry out its mission on many different fronts and in many different ways. The five-year doubling 

of the budget of the NIH enabled the National Cancer Institute to begin to expand 

its activities into promising new areas that had been beyond its reach. However, 

since the completion of the budget doubling in 2003, negligible NCI budget increases 

(in the .5 to 2.6 percent range) and an actual hard budget cut in fiscal year 2006, 

have forced retrenchment and curtailing of some research. 

Our Nation’s current investment in the National Cancer Institute supports a 

broad range of scientific research, infrastructure, communications structure, and 

technological advances. The AACR strongly supports continued and increased in-
386 

vestments in these key areas as the surest way to guarantee progress against cancer. In particular, the AACR urges that the NCI maintain its focus on: 

—Research to understand the causes and mechanisms of cancer, including continued studies into the genetic, environmental, and lifestyle factors that contribute 

to cancer causation. This research includes population studies that identify cancer risks, studies of normal as well as abnormal biological functioning, and research on cellular and molecular mechanisms of cancer initiation, progression, 

and metastasis. 

—Research on new approaches to prevent or delay the onset of cancer, including 

nutrition, vaccination, and chemoprevention. This research should continue its 

emphasis on behavioral factors that affect cancer risk—poor diet, lack of physical activity, sun exposure, and tobacco use—and strategies to change these behaviors. 

—Research to improve early detection and diagnosis of cancer through the discovery and development of biomarkers and imaging techniques. This research 

includes using proteomic technologies to develop biomarker panels and anatomical and molecular imaging techniques to detect tumors and identify metastasis, 

as well as studying how patients accept and comply with cancer screening 

methods. 

—Research to discover, develop, and evaluate therapeutics for destroying or controlling cancer cells and metastasis. These include localized therapies—such as 

surgery or radiotherapy; systemic therapies—such as chemotherapy or vaccines; 

molecularly targeted therapies (such as Herceptin and Gleevec) directed at specific tumors or tissues; and combinations which are often more effective than 

either therapy alone. 

—Research to improve the quality of cancer care and the quality of life of cancer 

patients, including the development of ways to measure quality, the impact of 

aging on quality of care, health and lifestyle issues of cancer survivors, and the 

development and application of interventions to overcome cancer health disparities. 

The National Cancer Institute carries out this vast research portfolio through a 

wide variety of different vehicles and mechanisms in its research infrastructure. The 

AACR strongly favors continued and increased support for these areas to optimize 

the return on research dollars. In particular, the AACR recommends that the National Cancer Institute continue to utilize the following successful multisector approaches to implementing the National Cancer Program: 

—Extramural program supports independent scientists conducting research in 

universities, teaching hospitals, and other organizations outside the NIH. The 

largest portion of NCI research funds is devoted to this program. It supports 

a balanced portfolio of more than 7,000 research and training awards, as well 

as grants, cooperative agreements, and contracts with individual investigators, 

professional societies, and research institutions. Peer-reviewed research under 

this program includes genetic, epidemiological, behavioral, social, applied, and 

surveillance research, basic prevention science, cancer biomarkers, 

chemopreventive agent development, community oncology and prevention trials, 

early detection, nutrition science, organ system research, cancer diagnostics, imaging, drug development, and biometrics, among others. 

Thousands of AACR member scientists participate in and depend upon support 

from the extramural program to advance their research goals. Investigator-initiated 

scientific research is the engine driving new discoveries and advances in cancer research and it must remain at the forefront of efforts to conquer this disease. Funding for this aspect of the National Cancer Program must be maintained at a sufficiently high level to promote and advance research progress. 

—Training and Career Development to increase the number of scientists who specialize in the basic or clinical biomedical fields is a critical NCI function. Such 

investments foster the development of interdisciplinary teams and ensure a 

growing core of well trained investigators to focus on cancer. 

—Partnerships, including with other agencies, pharmaceutical companies, academia, and a wide variety of other organizations, are essential to leverage the 

limited resources of the NCI. Interagency agreements with the Food and Drug 

Administration and the Centers for Medicare and Medicaid Services have been 

highly successful in expediting new drug development and coverage for new 

treatments. The Academic Public Private Partnership Program (AP4) supports 

a new way of accelerating drug discovery and development through multiple 

partnerships. 

—Additional important means used by the National Cancer Institute to advance 

its cancer research agenda include Cancer Centers and Centers of Research Excellence at major academic and research institutions across the country; Net-
387 

works and Consortia, such as the Early Detection Research Network; NCI-Supported Clinical Trials that involve more than 12,000 investigators; Cancer Surveillance through the voluminous data collected by the NCI Surveillance, Epidemiology, and End Results (SEER) program; Technology Development, including 

the cancer Biomedical Informatics Grid (caBIG) platform for sharing research 

data; and Communication, Education, and Dissemination of research progress 

directly to and for the benefit of the public and public health professionals. 

Through this wide array of effective mechanisms, the National Cancer Institute 

seeks to implement the ambitious research goals of the National Cancer Program. 

Each facet of the strategy is important and generates synergies with other facets 

to accomplish more than the apparent sum of the parts. Cuts to cancer research 

funding jeopardize multiple facets of the strategy and have a direct adverse impact 

on patients by delaying or halting development of promising treatments. 

To sustain the research momentum that has been so painstakingly built up over 

the past decade, the Congress must provide sufficient resources to preserve the current infrastructure and prevent its diminishment through inflation or other means. 

The American Association for Cancer Research and the cancer community, recognizing the many competing demands on the Federal budget, believe that, at a minimum, a 5 percent increase for the NIH and the NCI, to $29.75 billion and $5.03 

billion respectively, will enable these valuable programs to continue in a strong, if 

not robust, way. 

To make a quantum push forward with our efforts against cancer, the Director 

of the National Cancer Institute has identified, with significant communitywide 

input, at least five additional areas and opportunities that the NCI is poised to exploit if the resources become available. By investing in these new strategic initiatives (at an additional cost of less than $800 million) the Congress will clearly demonstrate its strong commitment to making the conquest of cancer a national priority 

and a goal that is within our reach. Several of these areas for strategic new investments to accelerate our progress against cancer include: 

—Expand the Number of Cancer Centers to improve access for underserved populations and extend their outreach and collaboration capabilities. 

—Reengineer Cancer Clinical Trials through implementation of the recommendations of the Clinical Trials Working Group. 

—Link Science and Technology using a variety of new mechanisms and resources. 

—Integrate Cancer Science and encourage interdisciplinary team science across 

the biomedical research community. 

This Nation has the most sophisticated and highly developed biomedical research 

infrastructure in the world in the National Institutes of Health. A significant portion of that research investment is directed squarely at the cancer problem. Incredible progress has been made in understanding this disease and in devising cuttingedge approaches to preventing, controlling, and eliminating it. The pace of this research must be maintained to continue our record of advances that is leading to decreased mortality and improved patient care and outcomes. 

The American Association for Cancer Research respectfully requests the Congress 

to support, at a minimum, a 5 percent funding increase for the National Institutes 

of Health (to $29.75 billion) and the National Cancer Institute (to $5.03 billion) to 

preserve the ability of these successful institutions to continue their groundbreaking 

work toward the conquest of cancer for the benefit of all of our citizens. 

PREPARED STATEMENT OF THE AMERICAN ASSOCIATION FOR GERIATRIC PSYCHIATRY

The American Association for Geriatric Psychiatry (AAGP) appreciates this opportunity to present its recommendations on issues related to fiscal year 2007 appropriations for mental health research and services. AAGP is a professional membership organization dedicated to promoting the mental health and well being of older 

Americans and improving the care of those with late-life mental disorders. AAGP’s 

membership consists of approximately 2,000 geriatric psychiatrists as well as other 

health professionals who focus on the mental health problems faced by senior citizens. 

AAGP appreciates the work this subcommittee has done in recent years in support of funding for research and services in the area of mental health and aging 

through the National Institutes of Health (NIH) and the Substance Abuse and Mental Health Services Administration (SAMHSA). Although we generally agree with 

others in the mental health community about the importance of sustained and adequate Federal funding for mental health research and treatment, AAGP brings a 

unique perspective to these issues because of the elderly patient population served 

by our members. 
388 

AAGP recognizes the Federal budget constraints that the subcommittee must consider in making allocations. At the same time, it is important to note that research 

dollars and better trained professionals can help avert a crisis in the delivery of 

mental health care to the elderly in future generations when more efficient and effective therapies are identified through research. In fact, the New England Journal 

of Medicine has just published an important study, funded by NIMH, that suggests 

we can significantly decrease relapse rates in depression—which lead to more physician visits and hospitalizations—by continuing these patients for longer periods on 

antidepressant medication. In addition, studies of the IMPACT model for treating 

late-life depression suggest that effective treatment of depression in primary care 

reduces the cost of general health care in those settings. 

Even as we note the important research being doing in the field, there are serious 

concerns, shared by AAGP and researchers, clinicians, and consumers that there exists a critical disparity between appropriations for research, training, and health 

services and the projected mental health needs of older Americans. This disparity 

is evident in the convergence of several key factors: 

—demographic projections inform us that, with the aging of the U.S. population, 

there will be an unprecedented increase in the burden of mental illness among 

aging persons, especially among the baby boom generation; 

—this growth in the proportion of older adults and the prevalence of mental illness is expected to have a major direct and indirect impact on general health 

service use and costs; 

—despite the fact that effective treatment exists, the current mental health needs 

of many older adults remain unmet; 

—the number of physicians being trained in geriatric mental health research and 

clinical care is insufficient to meet current needs, and this workforce shortfall 

is projected to become a crisis as the U.S. population ages over the next decade; 

—a major gap exists between research, mental health care policy, and service delivery; and 

—as funding for Federal health research has slowed across disciplines, the allocation of funds for research that focuses specifically on aging and mental health 

is disproportionately low, and woefully inadequate to deal with the impending 

crisis of mental health in older Americans. 

In this context, it is important to note actions relating to late life mental health 

addressed by the White House Conference on Aging, which was convened by President Bush in December 2005. Recognizing the current health and mental health 

needs of older Americans and the challenges awaiting as the Baby Boom generation 

ages, delegates placed mental health and geriatric health professional training 

issues at the forefront by voting them among their top 10 resolutions. 

DEMOGRAPHIC PROJECTIONS AND THE MENTAL DISORDERS OF AGING

With the baby boom generation nearing retirement, the number of older Americans with mental disorders is certain to increase in the future. By the year 2010, 

there will be approximately 40 million people in the United States over the age of 

65. Over 20 percent of those people will experience mental health problems. A national crisis in geriatric mental health care is emerging and has received recent attention in the medical literature. Action must be taken now to avert serious problems in the near future. While many different types of mental and behavioral disorders can occur late in life, they are not an inevitable part of the aging process, 

and continued research holds the promise of improving the mental health and quality of life for older Americans. 

The current number of health care practitioners, including physicians, who have 

training in geriatrics is inadequate. As the population ages, the number of older 

Americans experiencing mental problems will almost certainly increase. Since geriatric specialists are already in short supply, these demographic trends portend an 

intensifying shortage in the future. There must be a substantial public and private 

sector investment in geriatric education and training, with attention given to the 

importance of geriatric mental health needs. We will never have, nor will we need, 

a geriatric specialist for every older adult. However, without mainstreaming geriatrics into every aspect of medical school education and residency training, broadbased competence in geriatrics will never be achieved. There must be adequate 

funding to provide incentives to increase the number of academic geriatricians to 

train health professionals from a variety of disciplines, including geriatric medicine 

and geriatric psychiatry. This year’s loss of all funding for geriatric health professions programs under Title VII of the Public Health Service Act is a stunning blow 

to this critical need, and AAGP urges the subcommittee to restore these programs. 
389 

Current and projected economic costs of mental disorders alone are staggering. It 

is estimated that total costs associated with the care of patients with Alzheimer’s 

disease is over $100 billion per year in the United States. Psychiatric symptoms (including depression, agitation, and psychotic symptoms) affect 30 to 40 percent of 

people with Alzheimer’s and are associated with increased hospitalization, nursing 

home placement, and family burden. These psychiatric symptoms, associated with 

Alzheimer’s disease, can increase the cost of treating these patients by more than 

20 percent. Although NIA has supported extensive research on the cause and treatment of Alzheimer’s, treatment of these behavioral and psychiatric symptoms has 

been neglected and should be supported through NIMH. 

Depression is another example of a common problem among older persons. Of the 

approximately 32 million Americans who have attained age 65, about 5 million suffer from depression, resulting in increased disability, general health care utilization, 

and increased risk of suicide. Depression is associated with poorer health outcomes 

and higher health care costs. Co-morbid depression with other medical conditions 

affects a greater use and cost of medications as well as increased use of health services (e.g., medical outpatient visits, emergency visits, and hospitalizations). For example, individuals with depression are admitted to the emergency room for hypertension, arthritis, and ulcers at nearly twice the rate of those without depression. 

Those individuals with depression are more likely to be hospitalized for hypertension, arthritis, and ulcers than those without depression. And, those with depression experience almost twice the number of medical visits for hypertension, arthritis 

and ulcers than those without depression. Finally, the cost of prescriptions and 

number of prescriptions for hypertension, arthritis, and ulcers were more than twice 

than those without depression. 

Older adults have the highest rate of suicide rate compared to any other age 

group. Comprising only 13 percent of the U.S. population, individuals age 65 and 

older account for 19 percent of all suicides. The suicide rate for those 85 and older 

is twice the national average. More than half of older persons who commit suicide 

visited their primary care physician in the prior month—a truly stunning statistic. 

NATIONAL INSTITUTE OF MENTAL HEALTH

In his fiscal year 2007 budget, the President proposed a decrease in funding for 

the National Institutes of Health (NIH), for the first time in 30 years. This decline 

in funding is likely to have a devastating impact on the ability of NIH to sustain 

the ongoing, multi-year research grants that have been initiated in recent years. 

AAGP would like to call to the subcommittee’s attention the fact that, even in the 

years in which funding was increased for NIH and NIMH, these increases did not 

always translate into comparable increases in funding that specifically address problems of older adults. Data supplied to AAGP by NIMH indicates that while extramural research grants by NIMH increased 59 percent during the five-year period 

from fiscal year 1995 through fiscal year 2000 (from $485,140,000 in fiscal year 1995 

to $771,765,000 in fiscal year 2000), NIMH grants for aging research increased at 

less than half that rate: only 27.2 percent during the same period (from $46,989,000 

to $59,771,000). Furthermore, despite the fact that over the past 5 years, Congress, 

through committee report language, has specifically urged NIMH to increase research grant funding devoted to older adults, this has not occurred. 

AAGP is pleased that NIMH has recently renewed its emphasis on mental disorders among the elderly, and commends the recent creation of a new Aging Treatment and Prevention Intervention Research Branch at NIMH. AAGP would like the 

scope of this Branch increased into a comprehensive aging Branch that is responsible for all facets of clinical research, including translational, interventions, and 

disease-based psychopathology. The Branch should also be given adequate resources 

to fulfill its primary mission within NIMH. 

In addition to supporting research activities at NIMH, AAGP supports increased 

funding for research related to geriatric mental health at the other institutes of NIH 

that address issues relevant to mental health and aging, including the National Institute of Aging (NIA), the National Institute on Alcohol Abuse and Alcoholism 

(NIAAA), the National Institute on Drug Abuse (NIDA), and the National Institute 

of Neurological Disorders and Stroke. 

CENTER FOR MENTAL HEALTH SERVICES

It is also critical that there be adequate funding for the mental health initiatives 

under the jurisdiction of the Center for Mental Health Services (CMHS) within 

SAMHSA. While research is of critical importance to a better future, the patients 

of today must also receive appropriate treatment for their mental health problems. 

SAMHSA provides funding to State and local mental health departments, which in 
390 

turn provide community-based mental health services to Americans of all ages, 

without regard to the ability to pay. AAGP was pleased that the final budgets for 

the last 5 years have included $5 million for evidence-based mental health outreach 

and treatment to the elderly. AAGP worked with members of this subcommittee and 

its House counterpart on this initiative, which is a very important program for addressing the mental health needs of the Nation’s senior citizens. Increasing this 

mental health outreach and treatment program must be a top priority, as it is the 

only Federally funded services program dedicated specifically to the mental health 

care of older adults. 

The greatest challenge for the future of mental health care for older Americans 

is to bridge the gap between scientific knowledge and clinical practice in the community, and to translate research into patient care. Adequate funding for this geriatric 

mental health services initiative is essential to disseminate and implement evidence-based practices in routine clinical settings across the States. Consequently, 

we would urge that the $5 million for mental health outreach and treatment for the 

elderly included in the CMHS budget for fiscal year 2005 be increased to $20 million 

for fiscal year 2006. Of that $20 million appropriation, AAGP believes that $10 million should be allocated to a National Evidence-Based Practices Program, which will 

disseminate and implement evidence-based mental health practices for older persons in usual care settings in the community. This program will provide the foundation for a longer-term national effort that will have a direct effect on the well-being 

and mental health of older Americans. 

The Community Mental Health Services Block Grant Program requires States 

and territories to include an annual plan for providing comprehensive community 

mental health services to adults with a serious mental illness and children with a 

serious emotional disturbance. Experience has demonstrated that States do not 

make adequate provisions for older adults. AAGP recommends that SAMHSA require these plans to include specific provisions for mental health services for older 

adults. 

HEALTH RESOURCES AND SERVICES ADMINISTRATION

Despite growing evidence of the need for more geriatric specialists to care for the 

nation’s elderly population, a critical shortage persists. For fiscal year 2006, the 

Congress inexplicably eliminated all funding for the geriatric health professions program under Title VII of the Public Health Service Act. The loss of these programs 

could have a disastrous impact on physician workforce development over the next 

decade, with dangerous consequences for the growing population of older adults who 

will not have access to appropriate specialized care. The geriatric health professions 

program supports three important initiatives. The Geriatric Faculty Fellowship 

trains faculty in geriatric medicine, dentistry, and psychiatry. The Geriatric Academic Career Award program encourages newly trained geriatric specialists to move 

into academic medicine. The Geriatric Education Center (GEC) program provides 

grants to support collaborative arrangements that provide training in the diagnosis, 

treatment, and prevention of disease. In fiscal year 2005, these programs were funded at $31.5 million, but, while they were funded in the Senate Appropriations bill 

for fiscal year 2006, the final legislation followed the House version, which eliminated funding for them. AAGP urges the subcommittee to restore funding to this 

program at fiscal year 2005 levels. 

The loss of these programs, just as the massive Baby Boomer generation are entering late life, will have a devastating effect on the Nation’s ability to provide the 

kind of health care that will allow these seniors to be independent and productive 

as they age. 

CONCLUSION

Based on AAGP’s assessment of the current need and future challenges of late life 

mental disorders, we submit the following fiscal year 2007 funding recommendations: 

1. The current rate of funding for aging grants at NIMH and CMHS is inadequate 

and should be increased to at least three times their current funding levels. In addition, the substantial projected increase in mental disorders in our aging population 

should be reflected in the budget process in terms of dollar amount of grants and 

absolute number of new grants. 

2. To help the country’s elderly access necessary mental health care, previous 

years’ funding of $5 million for evidence-based mental health outreach and treatment for the elderly within CMHS must be increased to $20 million. 

3. Funding for the geriatric health professions program under Title VII of the 

Public Health Service Act should be restored to fiscal year 2005 levels. 
391 

1 National Institutes of Health Fiscal Year 2007 Performance Budget Overview, pp.1–2. Many 

AAI members are medical school professors and researchers who receive grants from NIH, and 

in particular from the National Institute of Allergy and Infectious Diseases (NIAID) and the National Cancer Institute (NCI) (as well as other NIH Institutes and Centers), to support their 

research endeavors. 2 Immunologists depend heavily on the use of animal models in their research. Without animal 

experimentation, theories about immune system function and treatments that might cure or prevent disease would have to be tested first on human subjects, something our society—and our 

scientists—would never countenance. Despite the clear necessity for animal research, we are experiencing both increasing regulatory burden in animal experimentation (eroding the return on 

NIH’s investment), and threats from people and organizations that oppose such research. The 

legal and illegal methods used by some groups to further an animal-rights/anti-medical research 

agenda are diverting precious resources from our work, threatening the personal safety and security of scientists, and delaying the progress of important research now underway. 

4. Both NIMH and CMHS must support adequate infrastructure and funding 

within both NIMH and CMHS to develop initiatives in aging research, to monitor 

the number and quality of applicants for aging research grants, to promote funding 

of meritorious projects, and to manage those grant portfolios. 

5. The scope of the recently formed Aging Treatment and Prevention Intervention 

Research Branch at NIMH should be increased to include all relevant clinical research, including translational, interventions, and disease-based psychopathology, 

and must receive NIMH’s full support so it may fulfill its primary mission. 

AAGP looks forward to working with the members of this subcommittee and others in Congress to establish geriatric mental health research and services as a priority at appropriate agencies within the Department of Health and Human Services. 

PREPARED STATEMENT OF THE AMERICAN ASSOCIATION OF IMMUNOLOGISTS

The American Association of Immunologists (‘‘AAI’’) is pleased to have this opportunity to submit its views on fiscal year 2007 funding for the National Institutes 

of Health (NIH). AAI would like to thank the members of the subcommittee for their 

strong support for biomedical research, and in particular, express our great appreciation to the chairman, Senator Specter, and Ranking Member, Senator Harkin, for 

their extraordinary leadership and dedication to advancing biomedical research. 

The AAI is a not-for profit professional society representing more than 6,500 research scientists and physicians who are the world’s leading experts on the immune 

system. While our members work in academia, government, and industry, most are 

among the more than 200,000 research personnel affiliated with more than 3,000 

institutions who depend on NIH funding to support their work.1 With approximately 

84 percent of NIH funds awarded to these individuals and institutions, NIH’s funding level has a huge impact both on the advancement of biomedical research and 

on the local, State, and national economies. 

THE IMPORTANCE OF IMMUNOLOGY

Immunological research is crucial in a world increasingly at risk from infectious 

agents and chronic diseases.2 Basic research on the immune system provides a foundation for the development of diagnostics, vaccines, and therapeutics. Current efforts are focused on preventing and treating diseases caused by natural infectious 

agents, including influenza and avian flu, SARS, West Nile Virus, tuberculosis, and 

AIDS, as well as those that may be modified for use as agents of bioterrorism, including plague, smallpox, and anthrax. In addition, basic immunological research 

continues to be crucial in the development of increasingly effective approaches for 

treating chronic diseases, including cancer, autoimmune diseases, inflammatory disorders, and immunodeficiencies. 

The immune system works by recognizing and attacking ‘‘foreign invaders’’ (i.e., 

bacteria and viruses) inside the body. It also plays an important role in controlling 

the growth of tumor cells. The immune system can protect its host (human or animal) from illness or disease either entirely—by attacking and destroying the virus, 

bacterium, or tumor cell—or partially, resulting in a less serious illness. But even 

a healthy immune system cannot completely protect us from all threats that might 

cause disease. Moreover, the immune system also has a ‘‘dark side’’: it can lead to 

the rejection of transplanted organs or bone marrow and—if it is working improperly—can allow the body to attack itself instead of an invader, resulting in an ‘‘autoimmune’’ disease (e.g., Type 1 diabetes, multiple sclerosis, rheumatoid arthritis). 

Recent advances in immunology have allowed for revolutionary treatments. For 

example, therapeutic substances called ‘‘biologics’’ have provided new, effective 

treatments for painful, debilitating and life-threatening diseases such as rheumatoid 
392 

3 NIH funding increases/decreases since the doubling period ended [fiscal year 2004 (3.03 percent), fiscal year 2005 (2.18 percent) and fiscal year 2006 (¥.12 percent)] have all been below 

the Biomedical Research and Development Price Index (‘‘BRDPI’’), a U.S. Department of Commerce (‘‘DOC’’) estimate of the cost of inflation for biomedical research. The BRDPI was developed by the DOC’s Bureau of Economic Analysis under an agreement with NIH and is updated 

annually. It indicates how much the NIH budget must increase to maintain purchasing power. 

Projections for future years are prepared by the NIH Office of Science Policy. 4 AAI analyzed paylines of key NIH Institutes from fiscal year 2000-fiscal year 2002; see 

www.nih.gov. 

arthritis, inflammatory diseases, and cancer. Biologics that use modified human 

antibodies and cell receptors specifically target the substance (TNF) that causes 

joint destruction in rheumatoid arthritis, and the painful symptoms of psoriasis, and 

ankylosing spondylitis. An engineered antibody (herceptin) is being used to control 

the reoccurrence of breast cancer; resulting in a two-fold reduction in reoccurrence. 

Another monoclonal antibody and human protein—CTLA4Ig—has been dramatically 

effective in clinical trials treating prostate cancer and melanoma as well as showing 

promise as a treatment for lupus, arthritis, multiple sclerosis, and organ transplant 

rejection. 

Immunologists have also focused on improved approaches to vaccine development, 

including a vaccine for Hemophilius influenza type b. This vaccine has reduced the 

incidence of pediatric meningitis in the United States from approximately 20,000 to 

200 cases per year. Our understanding of what makes an efficacious vaccine will 

be critical as we face future pandemics, be they natural, like avian flu, or altered 

pathogens that could be used for bioterrorism, like missilized anthrax. 

None of these advances could have been made without substantial public investment in basic immunological research. But even as we make huge strides, new 

threats emerge: immunologists are working feverishly to defend against bird flu and 

potential bioterrorism pathogens. 

THE NIH BUDGET: TROUBLE IN THE POST-DOUBLING YEARS

AAI is very grateful to this subcommittee and the Congress for doubling the NIH 

budget from fiscal year 1998 to fiscal year 2003. This ‘‘doubling’’ represented an unprecedented commitment by the Federal Government to preventing, treating, and 

curing disease, and has allowed scientists to begin new, cutting edge research made 

possible by recent advances in sequencing the genomes of humans, model organisms, and microbial pathogens that cause human and animal diseases. 

But scientific research takes time, and the doubling of the NIH budget will have 

been for naught if we are unable to complete ongoing studies or retain trained personnel. Indeed, the doubling has already been eroded. Since 2003, the annual increases in the NIH budget have not kept pace with biomedical research inflation.3

Moreover, the President’s fiscal year 2007 ‘‘flat’’ budget would result in an effective 

decrease in the NIH budget, only the second time in 36 years that the NIH budget 

has been reduced. This would have a devastating effect: 

1. Key NIH Institutes could be forced to drop paylines even lower than the current, far too low 10–14 percent (significantly below the approximately 22 percent 

funded during the doubling); 4

2. There would be no inflationary increases for direct, recurring costs in non-competing Research Project Grants (RPGs), undermining NIH’s fiscal year 2007 goal to 

‘‘preserve to the greatest extent possible the ability of scientists to obtain individual 

support for their research ideas.’’ National Institutes of Health Summary of the Fiscal Year 2007 President’s Budget February 6, 2006, p.3; 

3. It would have rapid, adverse repercussions on the future of the research enterprise. Our brightest young people will be deterred from pursuing biomedical research careers if their chances of receiving an NIH grant become even lower. If we 

cannot attract and retain the best young minds, the United States will lose its preeminence in science and technology to nations—including India, Singapore, China, 

and Korea—that are investing aggressively to compete. 

4. It would not permit increases in already inadequate stipends to pre- and postdoctoral fellows, and will undermine efforts to attract excellent scientists to NIH 

and to academia. 

PANDEMIC INFLUENZA/INFLUENZA

Influenza leads to more than 200,000 hospitalizations and about 36,000 deaths 

nationwide in an average year. Pandemic influenza could cause millions of deaths 

and hospitalizations. Despite these very real threats, the President’s fiscal year 

2007 NIH Budget includes an increase of only $17 million to support specific re-
393 

search initiatives focused on pandemic influenza, bringing total NIH spending on influenza to approximately $199 million (about $35 million over fiscal year 2006). The vast majority of funds (more than $3 billion) appropriated to date under the 

Department of Health and Human Services Pandemic Influenza Preparedness Plan 

have been devoted to other pandemic influenza related activities (including production/procurement of vaccines/antivirals). While these public health efforts are extremely important, it is essential to realize that any existing pathogen that could 

cause influenza or pandemic influenza (e.g., bird flu) can mutate, rendering existing 

countermeasures ineffective. Since new influenza strains can quickly emerge, research to identify new pathogens, understand the immune response, and develop 

tools for protecting against the pathogen should never take a back seat to other pandemic influenza-related activities. The need for this research supports AAI’s request 

for an increased budget for NIH. 

BIODEFENSE RESEARCH

AAI supports the President’s request for $1.891 billion for biodefense research, an 

increase of 6.2 percent over fiscal year 2006. NIH’s fiscal year 2007 biodefense research priorities include continuing work on developing vaccines and treatments for 

anthrax, smallpox, plague, tularemia, hemorrhagic fevers, and botulinum toxin. NIH plans to direct $160 million to an Advanced Development Fund (‘‘ADF’’) 

within the Office of the NIH Director to ‘‘support efforts to work with academia and 

industry to develop candidate countermeasures from the point of Investigation New 

Drug Application (INDA) to the level that these candidate countermeasures could 

be eligible for acquisition by Project Bioshield.’’ AAI urges that the NIH Director 

work closely with the NIAID Director to ensure that the ADF focuses on NIH’s traditional expertise in basic and translational research and not on activities relevant 

to commercial development or the manufacturing of a product. NIH also plans to spend $25 million to construct additional high containment laboratories at biosafety level (BSL) 3 and to renovate existing labs to meet current 

BSL–3 standards. (BSL–3 labs are necessary for the safe conduct of research on 

dangerous and infectious pathogens.) AAI recommends that these funds be used 

first for the renovation of existing labs; the construction of new labs may not be necessary with the limited research funding that may be available this year. 

ADMINISTRATIVE ISSUES

1. Office of Portfolio Analysis and Strategic Initiatives 

AAI supports the newly formed Office of Portfolio Analysis and Strategic Initiatives (OPASI) as a way of better managing and analyzing NIH’s portfolio. While we 

understand the need for a ‘‘Common Fund’’ to support OPASI, we believe that, in 

this difficult fiscal climate, such a fund should be limited and should grow no faster 

than the overall NIH budget. 

2. Research, Management and Support (RM&S) 

The President’s fiscal year 2007 budget proposal for Research, Management and 

Services (RM&S), which supports the management, monitoring, and oversight of intramural and extramural research activities (including NIH’s highly regarded peer 

review process), includes an increase of $14 million, or 1.3 percent. AAI supports 

an appropriate increase in the RM&S budget to ensure that it is sufficient (1) to 

enable NIH to supervise a portfolio of increasing size and complexity and (2) to ensure that NIH funds are well and properly spent. 

3. Outsourcing 

AAI continues to be concerned about the ‘‘outsourcing’’ of NIH jobs. While certain 

NIH jobs may be appropriate for such an approach, it should not be applied to program administration staff, many of whom are highly experienced and have historical 

knowledge and understanding of NIH programs and policies. Such outsourcing 

would result in the loss of a dedicated and capable workforce and reduce efficiency 

in the long run. 

AAI’S RECOMMENDED BUDGET INCREASE FOR FISCAL YEAR 2007: 5 PERCENT (1.2

PERCENT ABOVE PROJECTED INFLATION)

AAI strongly believes that we must increase the NIH budget now in order to capitalize on important advances that have resulted from the doubling. We urge this 

subcommittee to increase the NIH budget by 5 percent ($1.4 billion) in fiscal year 

2007, for a total budget of $29.75 billion. This increase, which is only 1.2 percent 

above the projected rate of biomedical research inflation, would enable researchers 

to capitalize on important advances that have resulted from the doubling, leading 
394 

to increased translational and clinical applications. It would also assist efforts to attract and retain bright young American scientists to research careers. 

THE EFFECTIVE USE OF NIH FUNDS

While AAI advocates a 5 percent increase in NIH funding, we agree that NIH 

should use its existing funds as effectively as possible. To that end, we recommend 

the following: 

(1) The ‘‘NIH Roadmap for Biomedical Research’’ (‘‘NIH Roadmap’’) 

AAI notes that the President’s fiscal year 2007 budget request for the NIH Road- map has grown to $443 million, an increase of $113 million over fiscal year 2006. 

While AAI supports this effort to fund multidisciplinary, interdisciplinary research 

and agrees that such research is an important part of biomedical research in the 

21st century, we recommend that funds allocated to the NIH Roadmap not grow 

faster than the overall NIH budget and that all Roadmap funds, including the Director’s Pioneer Awards, be awarded through a rigorous peer review process. 

(2) NIH ‘‘Enhanced Access to Scientific Publications’’ Policy 

AAI recommends that NIH partner with not-for-profit scientific publishers to provide enhanced public access to NIH-funded research results, rather than continuing 

an expensive effort to publish manuscripts itself. In this era of limited funds, NIH 

should work with these willing partners to ensure that its budget is used to support 

and advance research and not to duplicate services already provided by the private 

sector. AAI urges the subcommittee to support efforts underway between NIH and 

the not-for-profit scientific publishing community to develop a policy that will enhance public access while addressing the concerns of publishers. 

(3) Peer review and the independence of science 

Millions of lives—as well as the prudent use of taxpayer dollars—depend on government officials receiving—and taking—the very best and most independent scientific advice available. We urge this subcommittee to provide oversight which ensures that funds expended enhance the ability of scientists to provide independent 

scientific advice (particularly on government scientific advisory panels) and preserve 

independent peer review (including ensuring the review of scientific research results 

by peers through robust, independent scientific journals). 

CONCLUSION

AAI greatly appreciates this opportunity to testify and thanks the members of this 

subcommittee for your strong support for biomedical research, the NIH, and the scientists who devote their lives to preventing, treating, and curing disease. We look 

forward to working with you and hope that you will contact me or AAI if you have 

any questions or if we can be of assistance. 

PREPARED STATEMENT OF THE AMERICAN ASSOCIATION OF NURSE ANESTHETISTS

FISCAL YEAR 2007 APPROPRIATIONS REQUEST SUMMARY 

Fiscal year 2006 actual Fiscal year 2007 

budget 

AANA fiscal year 2007 

request 

HHS/HRSA/BHPr Title VIII Advanced Education Nursing, 

Nurse Anesthetist Education Reserve.

Awaiting grant allocations.

$3.5 million fiscal 

year 2005.

Grant allocations 

not specified.

$4 million for nurse 

anesthesia education 

$65 million for advanced education 

nursing 

Title VIII HRSA BHPr Nursing Education Programs .......... $151,191,000 $150,000,000 $175,000,000 

The AANA is the professional association for more than 34,000 Certified Registered Nurse Anesthetists (CRNAs) and student nurse anesthetists representing 

over 90 percent of the nurse anesthetists in the United States. Today, CRNAs are 

directly involved in approximately 65 percent of all anesthetics given to patients 

each year in the United States. CRNA services include administering the anesthetic, 

monitoring the patient’s vital signs, staying with the patient throughout the surgery, as well as providing acute and chronic pain management services. CRNAs provide anesthesia for a wide variety of surgical cases and are the sole anesthesia providers in almost 70 percent of rural hospitals, affording these medical facilities ob-
395 

stetrical, surgical, and trauma stabilization, and pain management capabilities. 

CRNAs work in every setting in which anesthesia is delivered including hospital 

surgical suites and obstetrical delivery rooms, ambulatory surgical centers (ASCs), 

pain management units and the offices of dentists, podiatrists and plastic surgeons. 

Nurse anesthetists are experienced and highly trained anesthesia professionals 

whose record of patient safety in the field of anesthesia was bolstered by the Institute of Medicine report that found in 2000, that anesthesia is 50 times safer than 

20 years previous. (Kohn L., Corrigan J., Donaldson M., ed. To Err is Human. Institute of Medicine, National Academy Press, Washington DC, 2000.) Nurse anesthetists continue to set for themselves the most rigorous continuing education and 

re-certification requirements in the field of anesthesia. Relative anesthesia patient 

safety outcomes are comparable among nurse anesthetists and anesthesiologists, 

with Pine having recently concluded, ‘‘the type of anesthesia provider does not affect 

inpatient surgical mortality.’’ (Pine, Michael MD et al. Surgical mortality and type 

of anesthesia provider. Journal of American Association of Nurse Anesthetists. Vol. 

71, No. 2, p. 109–116. April 2003.) In addition, a recent AANA workforce study’s 

data showed that CRNAs and anesthesiologists are substitutes in the production of 

surgeries. Through continual improvements in research, education, and practice, 

nurse anesthetists are vigilant in their efforts to ensure patient safety. 

CRNAs provide the lion’s share of the anesthesia care required by our U.S. Armed 

Forces through active duty and the reserves, from here at home to the leading edge 

of the field of battle. In May 2003, at the beginning of ‘‘Operation Iraqi Freedom’’ 

364 CRNAs were deployed to the Middle East to ensure military medical readiness 

capabilities. For decades, CRNAs have staffed ships, remote U.S. military bases, and 

forward surgical teams without physician anesthesiologist support. 

IMPORTANCE OF TITLE VIII NURSE ANESTHESIA EDUCATION FUNDING

The nurse anesthesia profession’s chief request of the subcommittee is for $4 million to be reserved for nurse anesthesia education and $65 million for advanced education nursing from the Title VIII program. This sustained funding is justified by 

two facts. First, there is a 12 percent vacancy rate of nurse anesthetists in the 

United States impacting people’s healthcare. And second, the Title VIII program, 

which has been strongly supported by members of this subcommittee in the past, 

is an effective means to help address the nurse anesthesia workforce demand. This 

demand for CRNAs is something that the nurse anesthesia profession addresses 

every day with success, and with the critical assistance of Federal funding through 

HHS’ Title VIII appropriation. 

The increase in funding for advanced education nursing from $58 million to $65 

million is necessary to meet the continuing demand for nursing faculty and other 

advanced education nursing services throughout the United States. Only a limited 

number of new programs and traineeships can be funded each year at the current 

funding levels. The program provides for competitive grants and contracts to meet 

the costs of projects that support the enhancement of advanced nursing education 

and practice and traineeships for individuals in advanced nursing education programs. This funding is critical to the efforts to meet the nursing workforce needs 

of Americans who need healthcare. 

In 2003, the AANA conducted a nurse anesthesia workforce study that concluded 

a 12 percent vacancy rate in hospitals for CRNAs, and a lower vacancy rate in ambulatory surgical centers. The supply has increased in recent years, stimulated by 

increases in the number of CRNAs trained. However, these increases had not been 

enough to offset the number of retiring CRNAs. This trend, established in 2003, requires a continuous growth in the number of nurse anesthesia graduates to fill the 

vacancy rate. This is compounded by the rising number of Medicare-eligible Americans, from about 34 million today to more than 40 million in 2010, who will require 

the care that CRNAs provide. 

The problem is not that our 99 accredited programs of nurse anesthesia are failing to attract qualified applicants; it is that the programs are full. Each CRNA program continues to turn away qualified applicants—bachelor’s educated registered 

nurses who had spent at least 1 year serving in an acute care environment. These 

CRNA schools are located all across the country including the following: 

State 

Number of accredited 

nurse anesthesia 

programs 

PA ................................................................................................................................................................... 12 

FL .................................................................................................................................................................... 6 

OH ................................................................................................................................................................... 5 
396 

State 

Number of accredited 

nurse anesthesia 

programs 

TX ................................................................................................................................................................... 5 

IL .................................................................................................................................................................... 4 

NY ................................................................................................................................................................... 4 

CA ................................................................................................................................................................... 3 

CT ................................................................................................................................................................... 3 

MD .................................................................................................................................................................. 3 

RI .................................................................................................................................................................... 2 

WI ................................................................................................................................................................... 1 

Recognizing the importance of nurse anesthetists to quality healthcare, the AANA 

has been working with the 99 accredited programs of nurse anesthesia to increase 

the number of qualified graduates. In addition, the AANA has worked with nursing 

and allied health deans to develop new CRNA programs. 

The Council on Certification of Nurse Anesthetists (CCNA) reports that in 1999, 

our schools produced 948 new graduates. In 2005, that number had increased to 

1,790, an 89 percent increase in just 5 years. This growth is expected to continue. 

The CCNA projects CRNA programs to produce over 1,900 graduates in 2006. 

To truly meet the nurse anesthesia workforce challenge, the capacity and number 

of CRNA schools must continue to expand. With the help of competitively awarded 

grants supported by Title VIII funding, the nurse anesthesia profession is making 

significant progress, expanding both the number of clinical practice sites and the 

number of graduates. 

The AANA is pleased to report that this progress is extremely cost-effective from 

the standpoint of Federal funding. Anesthesia can be provided by nurse anesthetists, physician anesthesiologists, or by CRNAs and anesthesiologists working together. As mentioned earlier, it has been confirmed, ‘‘the type of anesthesia provider 

does not affect inpatient surgical mortality.’’ Yet, for what it costs to train just one 

anesthesiologist, several CRNAs may be educated to provide the same service with 

the same optimum level of safety. This represents a significant educational cost/benefit for supporting CRNA educational programs with Federal dollars vs. supporting 

other models of anesthesia education. 

To further demonstrate the effectiveness of the $3 million Title VIII investment 

in nurse anesthesia education, the AANA surveyed its CRNA program directors in 

2003 to gauge the impact of the Title VIII funding. Of the eleven schools that had 

reported receiving competitive Title VIII Nurse Education and Practice Grants funding from 1998 to 2003, the programs indicated an average increase of at least 15 

CRNAs graduated per year. They also reported on average more than doubling their 

number of graduates, who provide care to patients during and following their education. Moreover, they reported producing additional CRNAs that went to serve in 

rural or medically underserved areas. Under both of these circumstances, an increased number of student nurse anesthetists and CRNAs are providing healthcare 

to the people of medically underserved America. 

We believe it is important for the subcommittee to allocate $4 million for nurse 

anesthesia education for several reasons. First, as this testimony has documented, 

the funding is cost-effective and well needed. Second, the Title VIII authorization 

previously providing such a reserve expired in September 2002. Third, this particular funding is important because nurse anesthesia for rural and medically underserved America is not affected by increases in the budget for the National Health 

Service Corps and community health centers, since those initiatives are for delivering primary and not surgical healthcare. Lastly, this funding meets an overall objective to increase access to quality healthcare in medically underserved America. 

TITLE VIII FUNDING FOR STRENGTHENING THE NURSING WORKFORCE

The AANA joins a growing coalition of nursing organizations and others in support of the subcommittee providing a total of $175 million in fiscal year 2007 for 

nursing shortage relief through Title VIII. This amount is approximately $25 million 

over the fiscal year 2005 level and over the President’s fiscal year 2007 budget. 

Every district in America is familiar with the importance of nursing. The AANA 

is appreciative of the leadership of the subcommittee and the congressional support 

for the $5 million increase over the President’s request in fiscal year 2005 for nurse 

education funding. 

America spends more than $2 trillion on healthcare this year, paid by private and 

public sources. About $298 billion accounted for Medicare outlays in 2005. Medicare 

directs about $8.7 billion of that to fund direct and indirect GME, with some 99 per-
397 

cent of that funding helping to educate physicians and allied health professionals, 

and about 1 percent to help educate nurses. For every present and future healthcare 

patient, Congress must put some focus on nurses and nurse anesthesia care. 

To ensure that America has access to nurse anesthesia care when needed, a sustained investment from Congress is necessary especially for the provision of services 

in rural and medically underserved America. Quality anesthesia care provided by 

CRNAs saves lives, promotes quality of life, and makes fiscal sense. This Federal 

support for nurse education will improve patient access to quality services and 

strengthen the Nation’s healthcare delivery system. 

Thank you. 

PREPARED STATEMENT OF THE AMERICAN COLLEGE OF CARDIOLOGY

The American College of Cardiology appreciates the opportunity to provide the 

subcommittee with recommendations for fiscal year 2007 funding for life-saving cardiovascular research and education. 

The ACC is a 33,000 member non-profit professional medical society and teaching 

institution whose purpose is to foster optimal cardiovascular care and disease prevention through professional education, promotion of research, and leadership in the 

development of standards and formulation of health care policy. 

Heart disease is the leading cause of death for both women and men in the United 

States, killing more than 900,000 Americans each year. More than 70 million Americans live with some form of heart disease. The economic impact of cardiovascular 

disease on the U.S. health care system continues to grow as the population ages. 

In 2005, heart disease and stroke were projected to cost the Nation $393 billion, including health care services, medications, and lost productivity. 

As the premier cardiovascular society, the ACC supports a strong Federal investment in research and public education that addresses the prevention, detection and 

treatment of cardiovascular disease. Current Federal research is providing breakthrough advances that fundamentally change our understanding of cardiovascular 

disease, leading to more effective treatments, decreased costs and increased quality 

of life for patients. 

For instance, a study published in the February 2006 issue of the Journal of the 

American College of Cardiology yielded important findings for women with coronary 

heart disease. Part of the National Heart, Lung, and Blood Institute (NHLBI)’s 

Women’s Ischemia Syndrome Evaluation (WISE) study, researchers found that 

women with a condition called coronary microvascular syndrome often go 

undiagnosed for heart disease because dysfunction occurs in very small arteries of 

the heart and does not show up when physicians use standard tests. As a result 

of the missed diagnosis, women are not treated for angina and high cholesterol and 

remain at high risk for a heart attack. National Institutes of Health (NIH) studies 

like WISE are helping to unravel the mystery of cardiovascular disease in women 

and hold immediate implications for the treatment of women at risk for heart disease. 

The ACC is extremely concerned that the administration’s budget request proposes no increase in funding for the NIH and cuts funding for many critical health 

programs. If instituted, the administration’s budget would force the research community to scale back and even halt valuable initiatives. The ACC is encouraged that 

the Senate recently approved an amendment to its budget resolution that provides 

an extra $7 billion for key health and education programs. 

FUNDING RECOMMENDATIONS

The ACC urges Congress to support the following fiscal year 2007 funding recommendations. 

National Institutes of Health: $29.849 billion.—Research conducted through the 

NIH has resulted in better diagnosis and treatment of cardiovascular disease, improving the quality of life for those living with the disease and lowering the number 

of deaths attributed to it. 

National Heart Lung and Blood Institute: $3.068 billion.—The NIH is doing critical research into the causes, treatment and prevention of cardiovascular disease 

through the NHLBI. 

Agency for Healthcare Research and Quality: $440 million.—The Agency for 

Healthcare Research and Quality (AHRQ)’s health services research complements 

the research of the NIH by helping cardiologists make choices about what treatments work best, for whom and when. 

CDC State Heart Disease and Stroke Prevention Program: $55 million.—The Centers for Disease Control and Prevention (CDC) State Heart Disease and Stroke Pre-
398 

vention program’s public education efforts is making strides in the prevention and 

early intervention of cardiovascular disease. 

HRSA Rural and Community AED Program: $9 million.—The Health Resources 

and Services Administration (HRSA) Rural and Community Access to Emergency 

Defibrillation program is saving lives by placing external defibrillators in public facilities. 

SUMMARY

The ACC appreciates the subcommittee’s past support for these important programs. The ACC urges Congress to provide a strong fiscal year 2007 investment in 

the cardiovascular research and education programs described above to continue the 

great strides being made in fighting cardiovascular disease. Should you have any 

questions, please contact Jennifer Brunelle at jbrunell@acc.org or (301) 581–3477. 

PREPARED STATEMENT OF THE AMERICAN COLLEGE OF OBSTETRICIANS AND

GYNECOLOGISTS

The American College of Obstetricians and Gynecologists (ACOG), representing 

49,000 physicians and partners in women’s health care, is pleased to offer this statement to the House Committee on Appropriations, Subcommittee on Labor, Health 

and Human Services, and Education. We thank Chairman Regula, Ranking Member 

Obey, and the entire subcommittee for their leadership to continually address maternal and child health care services. 

The Nation has made important strides to improve women and children’s health 

over the past several years, and ACOG is grateful to this Committee for its commitment to research. We look forward to working with the Members of this Committee 

to ensure that vital research continues to eliminate disease and to ensure valuable 

new treatment discoveries are implemented. The National Institutes of Health 

(NIH) has examined and determined many disease pathways, while the Health Resources and Services Administration (HRSA) and the Centers for Disease Control 

and Prevention (CDC) have been successful in translating research findings into valuable public health policy solutions. This dedicated commitment to elevate, promote 

and implement medical research faces an uncertain future at a time when scientists 

are on the cusp of new cures. 

It is essential that the Committee provide strong support for current studies, and 

for future advances, as well. We urge the Committee to support a an fiscal year 

2007 appropriation of $29.75 billion for the NIH, and $1.328 billion for the National 

Institute of Child Health and Human Development (NICHD), both a 5 percent increase over fiscal year 2006 levels. We also continue to support efforts to secure adequate funds for important public health programs at HRSA ($7.5 billion) and the 

CDC ($8.5 billion plus funding for pandemic influenza preparedness).Continued appropriations to these agencies will ensure ongoing and new research initiatives continue to yield positive results for women and children’s health. 

NATIONAL INSTITUTES OF HEALTH—RESEARCH LEADING THE WAY

Research at the NICHD 

The NICHD conducts research that holds great promise to improve maternal and 

fetal health and safety. With the support of Congress, the Institute has initiated research addressing the causes of cerebral palsy, gestational diabetes and pre-term 

birth. However, much more needs to be done to reduce the rates of maternal mortality and morbidity in the United States. More research is needed on such pregnancy-related issues as the impact of chronic conditions during pregnancy, racial 

and ethnic disparities in maternal mortality and morbidity, and drug safety with 

respect to pregnancy. 

A commitment to research in maternal health sheds light on a breadth of issues 

that save women’s lives. Important research examining the following issues must 

continue: 

Reducing High Risk Pregnancies 

NICHD’s Maternal Fetal Medicine Unit Network, working at 14 sites across the 

United States (University of Alabama, University of Texas-Houston, University of 

Texas-Southwestern, Wake Forest University, University of North Carolina, Brown 

University-Women and Infant’s Hospital, Columbia University, Drexel University, 

University of Pittsburgh-Magee Women’s Hospital, University of Utah, Northwestern University, Wayne State University, Case Western University, and Ohio 

State University), will help reduce the risks of cerebral palsy, caesarean deliveries, 
399 

and gestational diabetes. This Network discovered that progesterone reduces 

preterm birth by one-third. 

Reducing the Risk of Perinatal HIV Transmission 

In the last 10 years, NICHD research has helped decrease the rate of perinatal 

HIV transmission from 27 percent to 1.2 percent. This advancement signals the 

near end to mother-to-child transmission of this deadly disease. 

Reducing the Effects of Pelvic Floor Disorders 

The Institute has made recent advancements in the area of pelvic floor disorders. 

The NICHD is investigating whether women that have undergone cesarean sections 

have fewer incidences of pelvic floor disorder than women who have delivered 

vaginally. 

Reducing the Prevalence of Premature Births 

NICHD is helping our Nation understand how adverse conditions and health disparities increase the risks of premature birth in high-risk racial groups. 

Drug Safety During Pregnancy 

The NICHD recently created the Obstetric and Pediatric Pharmacology Branch to 

measure drug metabolism during pregnancy. 

The Challenge of the Future: Attracting New Researchers 

Despite the NICHD’s critical advancements, reduced funding has made it difficult 

for this research to continue, largely due to the lack of new investigators. Congressional programs such as the loan repayment program, the NIH Mentored Research 

Scientist Development Program for reproductive health, and a small grant program, 

all attract new researchers, but low pay lines make it difficult for the NICHD to 

maintain them. Due to the structure of the peer review system, previous grant recipients have an advantage because their grants require fewer funds. This makes 

it more difficult for new investigators to get into the system, jeopardizing the future 

of women’s health research. We urge the Committee to significantly increase funding at the NICHD to maintain a high level of research innovation and excellence, 

in turn reducing the incidence of maternal morbidity and mortality and discovering 

cures for other chronic conditions. 

HRSA AND CDC: TURNING RESEARCH INTO PUBLIC HEALTH SOLUTIONS

It is essential that we rapidly transform women’s health research findings into 

public health solutions. HRSA and the CDC have created women and children’s 

health outreach programs based on research conducted on infant mortality, birth defects, gynecological cancers, and a variety of other health issues. 

For example, research shows tobacco abuse and health disparities are risk factors 

for infant mortality. Healthy Start offers programs for States, which fund provider 

and community education programs that improve maternal health through tobacco 

cessation programs, and finds ways to decrease the infant mortality rate by investigating cultural and institutional health disparities. Research also shows that early 

screening and detection of certain strands of the human papilloma virus (HPV) may 

progress into cervical cancer. By screening thousands of low-income women who 

would not otherwise receive access to care; this CDC program has saved hundreds 

of lives. 

National Fetal Infant Mortality Review 

The Fetal and Infant Mortality Review (FIMR) is a cooperative Federal agreement 

between ACOG and the Maternal Child Health Bureau at HRSA. FIMR uses the 

expertise of ob-gyns and local health departments to find solutions to problems related to infant mortality. In light of the increase in the infant mortality rate for 

2002, the FIMR program is vital to develop community-specific, culturally appropriate interventions. Today 220∂ local programs in 42 States are implementing 

FIMR and finding it is a powerful tool to bring communities together to address the 

underlying problems that negatively affect the infant mortality rate. 

In order to meet the demand of the increasing number of FIMR programs, NFIMR 

must be able to continue its activities at an adequate funding level. A rigorous national evaluation of FIMR conducted by Johns Hopkins University has concluded 

that the FIMR methodology is an effective perinatal initiative. Based on that new 

research, FIMR can now be called an evidence based MCH intervention. All Healthy 

Start programs and every locality with disparities in infant outcomes should be actively encouraged to implement this FIMR process. We urge this Committee to recognize the many positive contributions of the FIMR program and ensure it remains 

a fully funded program within HRSA. 
400 

Provider’s Partnership 

Through May 2003, HRSA funded the Provider’s Partnership, a cooperative agreement between the Federal Maternal and Child Health Bureau and ACOG. This 

Partnership includes a series of State-level projects initiated to address key women’s 

health issues, while simultaneously building partnerships between ACOG Members 

and public health leadership. 

The Partnership works specifically with psychosocial issues that greatly impact 

the health and well-being of women. The morbidity and mortality attributed to 

issues such as a woman’s depression, tobacco use, substance abuse and domestic violence are becoming increasingly apparent as they weigh on both the woman and her 

entire family. Without treatment, these psychosocial issues place a heavy financial 

burden on State and Federal resources. Obstetrician-gynecologists play a critical 

role in addressing these problems within their current practice; however because of 

the complexity and the importance of promptly linking at-risk women with appropriate services, responsibility for full psychosocial assessment and treatment cannot 

fall solely on obstetrician-gynecologists. Partnerships between women’s health care 

physicians and State and community programs are needed that allow for integration 

of medical care with psychosocial services. Partnerships increase coordination thereby minimizing demands on both the behavioral health care system and individual 

providers. Provider’s Partnership enables stakeholders to improve prevention interventions, so that later complications can be avoided. 

There are currently 30 State-level Partnership teams focused on depression in 

women, tobacco use, perinatal HIV transmission and oral health. These teams have 

been successful at surveying obstetric providers on their screening; counseling and 

referral practices for perinatal depression and tobacco use, the results of which have 

been the basis for the development of statewide legislative and practice policy guidelines; establishing pilot screening and intervention initiatives for depression in 

women; and instituting provider training and technical assistance for depression 

and tobacco use screening and intervention. Despite their successes, these teams 

still struggle for funds to offset administrative and program costs. Representatives 

from additional States have expressed an interest in developing an ACOG Provider’s 

Partnership; however, any new efforts are being postponed until additional funding 

can be identified. We urge the committee to restore funding for the Partnership to 

fiscal year 2003 levels. 

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) 

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) 

administered by the CDC is an indispensable health program in helping underserved women gain access to screening programs for early detection of breast and 

cervical cancers. The NBCCEDP has served over 2.5 million women and provided 

5.8 million screening examinations. Early detection and treatment of breast and cervical cancers greatly increase a woman’s odds of conquering these diseases. The 

President’s fiscal year 2007 Budget recommends decreasing funding by $1.4 million, 

preventing access to these services for an estimated 4,000 women per year. We 

strongly urge the Committee to continue saving women’s lives and prevent cuts to 

this vital program. 

National Center on Birth Defects and Developmental Disabilities (NCBDDD) 

Birth defects affect about one in every 33 babies born in the United States each 

year. Babies born with birth defects have a greater chance of illness and long term 

disability than babies without birth defects. According to the CDC, a great opportunity for further improvement lies in prevention strategies that, if implemented 

prior to conception, would result in additional improvement of pregnancy outcomes. 

A cooperative agreement between the NCBDDD and ACOG has resulted in increased provider knowledge of genetic screening and diagnostic tests, technical guidance on routine preconception care and prenatal genetic screening, and improved access to care for women with disabilities. 

Again, we would like to thank the Committee for its continued support in addressing the multiple factors that affect maternal and child health. We strongly urge this 

subcommittee to support increased funding for the NICHD, and renewed appropriations for the maternal child health programs at the CDC and HRSA. By continuing 

to translate research done at the NICHD into positive outreach programs such as 

the Provider’s Partnership and the NBCCEDP, we can further improve our Nation’s 

overall health. 
401 

PREPARED STATEMENT OF THE AMERICAN DIABETES ASSOCIATION

Thank you for the opportunity to submit testimony on the importance of Federal 

funding for diabetes programs at the Centers for Disease Control and Prevention 

(CDC) and diabetes research at the National Institutes of Health (NIH). 

As the Nation’s leading nonprofit health organization providing diabetes research, 

information and advocacy, the American Diabetes Association feels strongly that 

Federal funding for diabetes prevention and research efforts is critical not only for 

the 20.8 million Americans who currently have diabetes, but also for the more than 

40 million who have a condition known as ‘‘pre-diabetes.’’ 

Diabetes is a serious disease, and is a contributing and underlying cause of many 

of the diseases on which the Federal Government spends the most health care dollars. In addition to the $132 billion in 2002 dollars in direct and indirect costs spent 

solely on diabetes each year, diabetes is a significant cause of heart disease (which 

costs our Nation $258.5 billion each year), a significant cause of stroke ($57.9 billion 

each year), and the leading cause of kidney disease ($40.3 billion). Diabetes is also 

the leading cause of adult-onset blindness and lower limb amputations. 

Approximately 48,000 people suffering from diabetes live in each congressional 

district and the number of people living with diabetes in this country is growing at 

a shocking rate. In the last 2 years alone, diabetes prevalence in the United States 

has increased by 14 percent. The number of Americans with diabetes is now growing at a rate of 8 percent per year and is the single most prevalent chronic illness 

among children. Because of the systemic havoc that diabetes wreaks throughout the 

body, it is no surprise that the life expectancy of a person with the disease averages 

10–15 years less than that of the general population. 

As the statistics listed above illustrate, we are facing an epidemic of diabetes in 

this country, which if left unchecked could have significant implications for many 

future generations. A recent study of the diabetes epidemic in New York City warns 

that diabetes-caused heart attacks threatens to reverse the tremendous gains made 

in preventing deaths from heart disease. One of the authors of the study termed 

it ‘‘a public health catastrophe.’’ We know, for example, that in every 24 hour period, 

there will be 4,100 people diagnosed with diabetes, 230 amputations in people with 

diabetes, 120 people who enter end-stage kidney disease programs and 55 people 

who go blind. All told, there will be nearly 225,000 deaths from diabetes each year. 

That is the ultimate cost of underfunding research and prevention programs. 

While science continues to work towards finding a cure, we must first adequately 

fund the diabetes prevention and outreach work being done at the Centers for Disease Control and Prevention. Therefore, we are requesting: 

—At least a 10 percent increase over fiscal year 2006 levels for the CDC’s Center 

on Chronic Disease Prevention and Health, including an additional $20.8 million increase for the CDC’s Division of Diabetes Translation (DDT), only $1 for 

each American suffering from diabetes; and 

—Restoration of the Preventive Health & Health Services Block Grant. 

The CDC’s Division of Diabetes Translation is critical to our national efforts to 

prevent and manage diabetes because they translate the research that has already 

been done to real programs at the community level. Currently, for every $1 that diabetes costs this country, the Federal Government invests less than $.01 to help 

Americans prevent and manage this deadly disease. This dynamic must be changed. 

While the Association strongly believes that significant funding is needed to fully 

fund programs in all 50 States, our request of $20.8 million will allow these critical 

programs to expand to an additional 10 States. 

In 2005 DDT provided support for more than 50 State- and territorial-based Diabetes Prevention and Control Programs (DPCPs) to increase outreach and education, and reduce the complications associated with diabetes. However, funding 

constraints required DDT to provide severely limited support to 22 States, 8 territories, and D.C. This level of funding, referred to as ‘‘capacity building,’’ allows a 

State to do surveillance, but is not enough for the State to do much—or anything— 

in the way of intervention. 

DDT was able to provide the higher level of support, ‘‘basic implementation,’’ to 

the other 28 States. At the basic implementation level, States are able to devise and 

execute community-level programs. With an additional $20.8 million over fiscal year 

2006 funding levels, an additional 10 States could start to receive the substantial 

benefits of basic implementation programs. 

The basic implementation programs undoubtedly make a major impact on local 

communities. For example, the West Virginia DPCP has developed a model education training program in state-of-the-art diabetes care, and has established a 

work-site health promotion program for State employees. At the same time, by collaborating with the West Virginia Association of Diabetes Educators, the State has 
402 

almost doubled the number of certified diabetes educators, and plans to expand that 

success to underserved rural areas through satellite training programs. Our goal is 

to make this a reality for the rest of the country, so that communities have the ability to invest in their future by investing in diabetes prevention and education. 

Without fully-funded diabetes programs and projects in all parts of the country, 

it will be exceedingly difficult—if not impossible—to control the escalating costs associated with diabetic complications and to stem the epidemic rise in diabetes rates. 

State DPCPs, when provided with enough funding, are proven programs that have 

been extremely successful in helping Americans prevent and manage their diabetes. 

In the Division of Diabetes Translation Program Review fiscal year 2004, the CDC 

stated, ‘‘The Basic Implementation DPCPs serve as the backbone for our growing 

primary prevention efforts. These State programs are the key elements to our success in meeting the challenges of controlling and preventing diabetes.’’ For example, 

the Texas DPCP contracts with local health departments, community health centers, and local non-profits to serve counties throughout the State. These programs 

have demonstrated success in promoting physical activity, weight and blood pressure control, and smoking cessation for those with diabetes. One of their programs, 

Coordinated Approach to Child Health (CATCH), is an elementary school program 

to increase activity levels, improve diets and reduce children’s risk for obesity, a 

leading factor in the development of diabetes in children. Americans in every State 

should have access to such quality programs. Unfortunately, the Division’s fiscal 

year 2006 budget of just over $63 million, and the President’s request for a cut in 

fiscal year 2007 to $62.42 million, will prevent more counties and States from implementing programs such as the one described above. 

In addition to DPCP, the CDC’s Division of Diabetes Translation also conducts 

other activities to help people currently living with diabetes. To put research into 

action, CDC works with NIH to jointly sponsor the National Diabetes Education 

Program (NDEP), which seeks to improve the treatment and outcomes of people 

with diabetes, promote early detection, and prevent the onset of diabetes. The CDC 

is also currently working to develop a National Public Health Vision Loss Prevention Program that will investigate the economic burden and strengthen the surveillance and research of this all-to-common complication of diabetes. In addition, CDC 

funds work at the National Diabetes Laboratory to support scientific studies that 

will improve the lives of people with diabetes. In fiscal year 2005, the Division of 

Diabetes Translation alone published 53 manuscripts on the care, prevention, and 

science of diabetes, including 17 abstracts. 

The Association appreciates the increased attention by Congress to diabetes research at the National Institutes of Health (NIH) in recent years. While there is 

not yet a cure for diabetes, researchers at NIH are working on a variety of projects 

that represent hope for the millions of individuals with Type 1 and Type 2 diabetes. 

The Association strongly encourages you to provide at least a 5 percent increase to 

the NIH to fulfill this promise. Unfortunately, while the death rate due to diabetes 

has increased by more than 40 percent in recent years, diabetes research funding 

has not kept pace. Indeed, from 1987–2001, appropriated diabetes funding as a 

share of the overall NIH budget has dropped by more than 20 percent (from 3.9 percent to 2.9 percent). While Congress had initially begun to address this discrepancy, 

the fiscal year 2006 budget reduced funding at the National Institutes of Diabetes, 

Digestive and Kidney Diseases (NIDDK) by $9 million. This is unconscionable when 

diabetes deaths continue to increase at such a rate. The Association believes that 

NIH research and CDC translational programs go hand in hand in the effort to combat the diabetes epidemic. 

The Association is also supportive of restoration of the CDC’s Preventive Health 

& Health Services Block Grant (PBG). The PBG, which allows States to develop innovative health programs at the community level, received $99 million in fiscal year 

2006, but is currently slated for no funding for fiscal year 2007. These programs 

have been very successful. In the State of Louisiana, the grants are used to train 

school based health personnel on the diagnosis and management of type 2 diabetes, 

and also to screen adolescents at significant risk for type 2 diabetes. There are 53 

school based health centers in Louisiana that are directly assisted by this program. 

As the State continues to rebuild following Hurricane Katrina, it would be tragic 

to remove this small but critical piece of health infrastructure funding. 

The Association, and the millions of individuals with diabetes we represent, firmly 

believes that we could rapidly move toward curing, preventing, and managing this 

disease by increasing funding for diabetes programs and research both at CDC and 

NIH. Your leadership is essential to accomplishing this goal. As you are considering 

fiscal year 2007 funding, we ask you to remember that chronic diseases, including 

diabetes, account for nearly 70 percent of all health care costs as well as 70 percent 

of all deaths annually. Unfortunately, less than $1.25 per person is directed toward 
403 

public health interventions focused on preventing the debilitating effects associated 

with chronic diseases, demonstrating that Federal investment in chronic disease 

prevention remains grossly inadequate. We cannot ignore those Americans who are 

currently living with diabetes and other diseases. 

In closing, the American Diabetes Association strongly urges the subcommittee 

and Congress to provide a 10 percent increase for the CDC’s Center on Chronic Disease Prevention and Health, including a $20.8 million increase for the CDC’s Division of Diabetes Translation, and to restore the Preventive Health & Health Services Block Grant. Providing this funding would be an important step towards empowering States to fight diabetes at the community level. Additionally, we urge the 

subcommittee to increase NIH funding by 5 percent to allow for an increased commitment to diabetes research. 

On behalf of the 20.8 million Americans with diabetes—a disease that crosses 

gender, race, ethnicity and political party; a disease that is among the most costly, 

debilitating, deadly and prevalent in our Nation; and a disease that is exploding 

throughout our Nation—thank you for the opportunity to submit this testimony. The 

American Diabetes Association is prepared to answer any questions you might have 

on these important issues. 

PREPARED STATEMENT OF THE AMERICAN FOUNDATION FOR THE BLIND

Mr. Chairman and members of the subcommittee, my name is Paul Schroeder and 

I am the Vice President for Programs and Policy at the American Foundation for 

the Blind. Thank you for giving the American Foundation for the Blind (AFB) the 

opportunity to submit testimony to the subcommittee as you begin to consider funding priorities for fiscal year 2007. The AFB is a national non-profit organization 

with a commitment to enhancing and promoting the health, education, employment, 

and overall quality of life for people with vision loss. 

For nearly a century AFB has been expanding possibilities for people with vision 

loss by setting trends and devising innovative programs. For example, AFB works 

with the corporate sector to get the latest technologies that promote equal access 

into the hands of people who have vision loss. AFB also promotes the development 

and dissemination of new ideas and resources for service professionals, and AFB assists consumers with vision loss to maintain independent and healthy lives by providing them and their families with information about services and advice on purchasing decisions. In these and many other ways AFB continues to respond to the 

current needs of the vision loss community. 

The AFB, with headquarters in New York City, and a Public Policy Center in 

Washington, DC, also operates the National Center on Vision Loss in Dallas, TX, 

to help ensure that Americans with vision loss have information and access to all 

technologies needed to maintain their independence. This innovative resource center 

offers information, education, technology, and training—all under one roof and 

through the Internet—to create accessible living and work environments for people 

who are visually impaired. The AFB has launched a $2.4 million campaign—Project 

Independence—to expand and enhance the Dallas center and ensure it has national 

reach through web-based and other information dissemination programs. Also this 

year, the AFB has enhanced its efforts to promote health maintenance and prevention of secondary health conditions among those with vision loss. The testimony that 

follows will speak in more detail to this issue. 

RECOGNIZING THE LEADERSHIP OF THE SUBCOMMITTEE IN SUPPORT OF AMERICANS

WITH DISABILITIES

According to the Institute of Medicine’s 1991 report Disability in America: Toward 

a National Agenda for Prevention, ‘‘disability is an issue that affects every individual, community, neighborhood and family in the United States.’’ This statement 

remains equally true today. An estimated 54 million people in the United States 

currently live with a disability, including severe vision loss. There are approximately 10 million Americans that are blind or have vision impairment, 6.5 million 

of whom are elderly. With the continued aging of the population, the number of elderly Americans affected by vision loss will only increase. 

Mr. Chairman, AFB commends the subcommittee’s leadership and commitment to 

programs of interest and benefit to citizens with disabilities. Within the jurisdiction 

of the Labor, Health and Human Services, and Education Subcommittee are the 

vast majority of the Federal programs that support services to people with disabilities. The main focus of our testimony, however, is to highlight for the subcommittee 

the critically important work of the CDC’s National Center on Birth Defects and Developmental Disabilities. 
404 

THE CDC’S NATIONAL CENTER ON BIRTH DEFECTS AND DEVELOPMENTAL DISABILITIES

Mr. Chairman, on behalf of the American Foundation for the Blind, I would like 

to commend the leadership of the CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD) for their hard work and dedication to their mission to promote the health and wellness of children and adults living with disabilities. We are particularly pleased and supportive of the Center’s new focused initiatives to address the secondary health effects of people with vision loss and other disabilities. 

It has been widely documented that individuals with disabilities experience negative health, social, emotional, family, and community outcomes at higher rates than 

others. Sadly, 20.1 percent of people with disabilities lack health insurance, as compared to 17.8 percent of the general population. Moreover, secondary conditions such 

as heart disease, diabetes and stroke, all of which are modifiable and preventable, 

are also particularly acute among Americans with vision loss. For example, elderly 

Americans with vision loss have higher rates of depression, hypertension, heart disease, stroke, and physical injuries than people without these sensory impairments. 

Unique to individuals with vision loss is the risk of prescription errors stemming 

from inaccessible print labeling and/or instructions about safe administration of the 

drugs. 

These disparities in health have multiple consequences including the decreased 

ability to perform valued activities, participate in social roles including employment, 

and ever-escalating costs associated with deteriorating health conditions. 

Many Americans with vision impairment, however, could substantially improve 

their every day lives and prevent the onset of secondary conditions with appropriate 

health interventions and information. To ensure that this help is available, additional research to strengthen the evidence base for effective public health interventions needs to be conducted. In addition, substantially enhanced dissemination programs of these interventions through a website and other means accessible to people 

with vision loss is a vital component of such a program. Such a dedicated program 

would be of significant benefit to those facing vision loss and their families. The initiation of such a program at the National Center on Birth Defects and Developmental Disabilities would reduce health disparities and push forward the public 

health frontier in assisting people with blindness and vision loss. 

RECOMMENDATIONS

Mr. Chairman, the administration’s request for the National Center on Birth De- fects and Developmental Disabilities is $110,481,000, a decrease of $14.28 million 

below fiscal year 2006 levels. If enacted, this would be the second year in a row that 

the incredibly important programs funded in this national Center received cuts. 

AFB strongly encourages the subcommittee to reverse these reductions and to specifically add $950,000 for a dedicated program to ameliorate and prevent secondary 

health conditions that affect individuals with vision loss. AFB would also encourage 

the subcommittee to support an expansion of the proposed Center on Vision Loss 

in Dallas, Texas. 

SUMMARY AND CONCLUSIONS

Mr. Chairman, again we wish to thank the subcommittee for its past leadership 

and commitment to disability issues. With your leadership much additional progress 

can be made to improve the lives and health of Americans with vision loss. 

Thank you for this opportunity to testify. 

PREPARED STATEMENT OF THE AMERICAN PHYSIOLOGICAL SOCIETY

The American Physiological Society (APS) thanks the subcommittee for its sustained support for the National Institutes of Health (NIH). The doubling of the 

agency budget that took place between fiscal years 1996 and 2002 allowed the NIH 

to expand its efforts to address old and new challenges in biomedical science. Our 

Nation’s investment in basic, translational, and clinical research plays an important 

role in the continued health and prosperity of our people. Increases in NIH funding 

have allowed researchers to explore scientific opportunities on an unprecedented 

scale. However, to build on existing knowledge and explore new areas, NIH must 

be able to provide research support for innovative ideas. In fiscal year 2006 the NIH 

budget was cut for the first time since 1970, and the administration’s fiscal year 

2007 budget proposal would keep the agency at the same level. Taking inflation into 

account, the President’s budget plan represents another budget cut that will reduce 

the number of research grants funded. As funding falters, the best and brightest 
405 

1S. L. Farmen et al., Am J Physiol Lung Cell Mol Physiol 289, L1123–30 (Dec. 2005). 

minds will turn away from careers in medical science. If NIH cannot fund new 

ideas, this will not only hamper efforts to find cures, it will also discourage up and 

coming researchers who could become the next generation of basic and clinical scientists. The APS urges you to make every effort to provide the NIH with a 5 percent 

funding increase so we can take advantage of more scientific opportunities that will 

lead to ways to alleviate the suffering and burdens of disease and strengthen the 

Nation’s scientific workforce to face future challenges. 

The APS is a professional society dedicated to fostering research and education 

as well as the dissemination of scientific knowledge concerning how the organs and 

systems of the body work. The Society was founded in 1887 and now has more than 

10,000 member physiologists across the United States. The APS offers these comments on the budget recognizing both the enormous financial challenges facing our 

Nation and the enormous opportunities before us to make progress against disease. 

NIH’s task is both to cure specific diseases and to look broadly at scientific opportunities that may help us expand our understanding of biological problems that affect health. Basic research contributes to a body of knowledge whose importance will 

only be determined over time. Physiology, which is the study of biological function, 

provides the foundation for much of the translational research that turns discoveries 

into therapies and prevention strategies. 

One example of this is the lung disease cystic fibrosis. Over the last 20 years, the 

scientific community has made great leaps in understanding the role that genes 

play in the development of various diseases. The CFTR gene responsible for cystic 

fibrosis was identified in 1989. Since then, researchers have worked to gain a better 

understanding of what happens in the disease at the molecular level with the hope 

of developing a gene therapy that would prolong and improve patients’ lives. One 

critical question was how much of the normal gene is necessary to improve lung 

function. In late 2005, NIH supported researchers at the University of Iowa published the results of experiments in which they delivered healthy copies of the CFTR 

gene to cultured lung cells taken from cystic fibrosis patients.1 They were then able 

to measure whether function improved with increasing amounts of gene product. 

Unexpectedly, delivery of low levels of the CFTR gene was more effective than very 

high doses. This type of experiment provides the foundation for designing safe and 

effective clinical treatments. 

In addition to supporting research, the NIH must also address workforce issues 

to be sure our Nation’s researchers are ready to meet the challenges they will face 

in the future. Last year the NIH announced a new program to encourage clinical 

and translational research at universities. The new Clinical and Translational Service Awards (CTSAs) will provide a total of $30 million in fiscal year 2006 to develop 

new research and training programs at academic institutions around the country. 

This will allow researchers to capitalize on knowledge generated from basic research 

through the development of clinical applications and treatments. 

The NIH plays many critical roles in advancing biomedical research. It provides 

opportunities for individual researchers at universities and medical schools throughout the country to compete for research funds based upon the scientific merit of 

their ideas. NIH also carries out other functions including: 

—Sponsoring research training opportunities for young scientists and physicians; 

—Funding major collaborative initiatives that bring together multiple institutions 

with diverse resources; 

—Providing the public with up-to-date information about the latest research on 

various diseases and health conditions through individual institutes and online 

resources such as ‘‘MedLine Plus’’ and ClinicalTrials.gov; 

—Supporting unique science education programs, particularly for underserved minority students; and 

—Funding innovative research through the NIH Roadmap initiative. 

These activities are critical to moving science forward, and they are unique to the 

NIH. Another example is the newly developed Genes and Environment Initiative 

(GEI). The GEI is a multi-institute effort to identify genetic and environmental risk 

factors that contribute to common diseases such as asthma, diabetes, heart disease, 

cancer and Alzheimer’s disease. The planned research will build on the Human Genome Project and take advantage of new technologies developed in the pursuit of 

basic research. With its wide range of expertise, the NIH is uniquely suited to undertake broad projects such as this. 

The examples listed above represent a select few examples from the NIH’s extensive and outstanding portfolio. The APS joins the Federation of American Societies 

for Experimental Biology (FASEB) and the Ad Hoc Group for Medical Research 

Funding in urging that NIH be provided with a 5 percent funding increase in fiscal 
406 

year 2007 to permit the agency to maintain its current wide-ranging and important 

research efforts. This forward-looking approach to our Nation’s biomedical research 

efforts is much to be preferred over the administration’s proposal to fund the agency 

at last year’s level, which would force the NIH to contract its research portfolio, 

thus leaving many important projects unfunded. 

PREPARED STATEMENT OF THE COALITION OF NORTHEASTERN GOVERNORS

The Coalition of Northeastern Governors (CONEG) is pleased to provide this testimony for the record to the Senate Subcommittee on Labor, Health and Human Services, Education, and Related Agencies regarding fiscal year 2007 appropriations for 

the Low Income Home Energy Assistance Program (LIHEAP). The Governors appreciate the subcommittee’s consistent support for the LIHEAP program. We also welcome the additional fiscal year 2006 funds recently provided by the Congress, even 

as we recognize the difficult challenges facing the subcommittee in this time of severe fiscal constraints. However, in light of sharply higher home energy prices, we 

request the subcommittee to provide the full authorized amount of $5.1 billion in 

regular fiscal year 2007 LIHEAP funding—to restore the purchasing power of the 

LIHEAP program. In addition, we request that the subcommittee provide contingency funds to address energy emergency situations. 

The continuing trend in rising prices for natural gas and home heating fuels is 

creating a growing home energy crisis for low-income citizens across the Nation. 

Low-income households, whose percentage of income spent on energy may be four 

times that of average households, can amass significant home energy debt that 

makes it difficult to purchase heating fuels or pay outstanding utility bills. High levels of accumulated arrearages owed by low-income households raise the prospect of 

hundreds of thousands of households cut off from utility service this spring. 

Particularly in the Northeast, which is heavily dependent on deliverable home 

heating fuels such as home heating oil, kerosene, and propane, price volatility has 

an especially perverse impact. These low-income households, without the disposable 

income to purchase fuels off-season, typically enter the market when both the demand for and price of fuels are high. Without access to LIHEAP assistance during 

the heating season, they may not be able to obtain any fuel at all, due to the collecton-delivery business policy commonly used by fuel dealers. If LIHEAP benefit levels 

are too low, these households may not be able to afford the cost of the required minimum delivery. 

LIHEAP is a vital tool in making home energy more affordable for almost 5 million of the Nation’s very low-income households faced with high energy burden—the 

elderly and disabled on fixed incomes and families with young children. Over the 

past 5 years, as the average price of home heating oil and natural gas more than 

doubled, the purchasing power of the LIHEAP grant has plummeted—undercutting 

the ability of the program to serve adequately these vulnerable households. States 

across the country in recent years have seen significant increases in their regular 

LIHEAP caseloads, as well as in requests for emergency crisis from those households in imminent danger of a utility or fuel service cut-off. The number of requests 

for LIHEAP assistance has reached its highest level in more than a decade. In response to the continually rising home energy costs and the growing crisis in this 

recent heating season, States across the country have stepped in to provide more 

than $450 million for low-income energy programs. In addition to regulatory actions, 

such as extending shut-off moratoria periods and limiting deposit and reconnection 

fees, many State public utility commissions have provided more than $100 million 

in assistance from funding sources such as public benefit funds or universal service 

funds. 

The LIHEAP program delivers maximum program dollars to households in need— 

the consequence of its administrative costs being among the lowest of human service 

programs. In the Northeast, States have incorporated various administrative strategies designed to minimize the amount of program funds used to operate the program. Innovative administrative strategies include the use of uniform application 

forms to determine program eligibility, establishment of a one-stop shopping approach for the delivery of LIHEAP and related programs, sharing administrative 

costs with other programs, and the use of mail recertification. 

The recent action by Congress to increase LIHEAP funding in fiscal year 2006 is 

a welcome and important step to begin restoring some of the lost LIHEAP purchasing power. However, the prospect of continued high and potentially volatile 

prices for home energy means that the projected need continues to outweigh available Federal and State funding. Even with these additional Federal and State 

funds, the value of the LIHEAP grant has been significantly reduced, defraying only 
407 

a modest amount of a low-income household’s total heating bill; and it reaches only 

a small percentage of the households that need assistance. 

Increased Federal funding is vital for LIHEAP to assist the Nation’s vulnerable, 

low-income households faced with unaffordable home energy bills. An increase in 

the regular LIHEAP appropriation to the full authorized level of $5.1 billion for fiscal year 2007 in addition to contingency funds, will enable our States to help mitigate the potential life-threatening emergencies and economic hardship that confront 

the Nation’s most vulnerable citizens. With these additional funds, States can provide assistance to more households in need, offer benefit levels that can make a 

meaningful reduction in their home energy burden, lessen the need for emergency 

crisis, plan and operate a more efficient program, and again make optimal use of 

leveraging and other cost-effective programs. 

We thank the subcommittee for this opportunity to share the views of the Coalition of Northeastern Governors, and we stand ready to provide you with any additional information on the importance of the Low Income Home Energy Assistance 

Program to the Northeast. 

PREPARED STATEMENT OF THE AMERICAN LUNG ASSOCIATION

SUMMARY: FUNDING RECOMMENDATIONS 

[In millions of dollars] 

Agency Amount 

National Institutes of Health ................................................................................................................................... 30,205 

National Heart, Lung, and Blood Institute ..................................................................................................... 3,099 

National Cancer Institute ................................................................................................................................ 5,030 

National Institute of Allergy and Infectious Disease ..................................................................................... 4,682 

National Institute of Environmental Health Sciences .................................................................................... 680 

National Institute of Nursing Research .......................................................................................................... 146 

Fogarty International Center ........................................................................................................................... 70 

Centers for Disease Control and Prevention ........................................................................................................... 8,500 

National Institute for Occupational Safety and Health .................................................................................. 285 

Office on Smoking and Health ....................................................................................................................... 145 

Environmental Health: Asthma Activities ....................................................................................................... 70 

Tuberculosis Control Programs ....................................................................................................................... 252 

Influenza Pandemic .................................................................................................................................................. 2,652 

The American Lung Association is pleased to present our recommendations for 

programs in the Labor Health and Human Services and Education Appropriations 

Subcommittee purview. These appropriations will make a difference in the lives of 

millions of Americans who suffer from lung disease. 

The American Lung Association is one of the oldest voluntary health organizations in the United States, with a National Office and constituent associations 

around the country. Founded in 1904 to fight tuberculosis, the American Lung Association today fights lung disease in all its forms, with special emphasis on funding 

research for cures, promoting cleaner air and helping prevent kids from smoking. 

The Lung Association is funded by contributions from the public, along with gifts 

and grants from corporations, foundations and government agencies, and achieves 

its many successes through the work of thousands of committed volunteers and 

staff. 

THE TOLL OF LUNG DISEASE

Each year, an estimated 349,000 Americans die of lung disease. Lung disease is 

America’s number three killer, responsible for one in every seven deaths. More than 

35 million Americans suffer from a chronic lung disease. Each year lung disease 

costs the economy an estimated $157.8 billion. Lung diseases represent a spectrum 

of chronic and acute conditions that interfere with the lung’s ability to extract oxygen from the atmosphere, protect against environmental or biological challenges and 

regulate a number of metabolic processes. Lung diseases include: asthma, chronic 

obstructive pulmonary disease, lung cancer, tuberculosis, pneumonia, influenza, 

sleep disordered breathing, pediatric lung disorders, occupational lung disease and 

sarcoidosis. 
408 

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic Obstructive Pulmonary Disease, or COPD, is a growing health problem. 

Yet it remains relatively unknown to most Americans and much of the research 

community. COPD refers to a group of largely preventable diseases, including emphysema and chronic bronchitis, that generally gradually limit the flow of air in the 

body. COPD is the fourth leading cause of death in the United States and worldwide. 

In 2004, the annual cost to the Nation for COPD was $37.2 billion. This includes 

$20.9 billion in direct health care expenditures, $8.9 billion in indirect morbidity 

costs and $7.4 billion in indirect mortality costs. Medicare expenses for COPD beneficiaries were nearly 2.5 times that of the expenditures for all other patients. 

It has been estimated that 11.4 million patients have been diagnosed with some 

form of COPD and as many as 24 million adults may suffer from its consequences. 

In 2004, an estimated 9 million Americans were diagnosed with chronic bronchitis 

by a health professional. Further, an estimated 3.6 million Americans have been diagnosed with emphysema in their lifetime. In 2002, 120,555 people in the United 

States died of COPD. Women have exceeded men in the number of deaths attributable to COPD since 2000. Over the past 30 years, the death rate due to COPD 

has doubled while the death rates for heart disease, cancer and stroke have decreased by over 50 percent. 

Today, COPD is treatable but not curable. Fortunately, promising research is on 

the horizon for COPD patients. Research on the genetic susceptibility underlying 

COPD is making progress. Research is also showing promise for reversing the damage to lung tissue caused by COPD. 

Despite these promising research leads, the American Lung Association believes 

that research resources committed to COPD are not commensurate with the impact 

COPD has on the United States and the world. 

The American Lung Association strongly recommends that the NIH and other 

Federal research programs commit additional resources to COPD research programs. In addition, there is a need for improved surveillance data on the disease. 

The Lung Association supports the CDC in gathering more information about COPD 

as part of the National Health and Nutrition Examination Survey, the Behavioral 

Risk Factor Surveillance System and other health surveys. This information will 

help public health professionals and researchers understand the disease better and 

lead to possible control of the disease. 

TOBACCO USE

Tobacco use is the leading preventable cause of death in the United States, killing 

more than 438,000 people every year. Smoking is responsible for one in five U.S. 

deaths. The direct health care and lost productivity costs of tobacco-caused disease 

and disability are also staggering, an estimated $167 billion each year. Taxpayers 

pay billions of dollars each year to treat tobacco-caused disease through federally 

funded health programs including Medicare and Medicaid. 

The CDC’s Office on Smoking and Health provides significant technical assistance 

to States that are using tobacco settlement dollars to develop comprehensive and 

effective tobacco prevention programs, in addition to providing a small, yet essential, amount of Federal assistance directly to State tobacco control and prevention 

programs. States that currently fund comprehensive programs, as well as those 

seeking to develop programs, rely on CDC’s expertise. Funds for tobacco prevention 

at CDC also are used to maintain comprehensive information on smoking and 

health and to support ongoing research on tobacco-related issues. 

We believe Congress should fund the type of youth tobacco prevention programs 

that science tells us are essential to counter the impact of tobacco company marketing to our kids. The American Lung Association strongly supports a minimum 

level of $145 million in fiscal year 2007 funding for the CDC’s Office on Smoking 

and Health. 

ASTHMA

Asthma is a chronic lung disease in which the bronchial tubes become swollen and 

narrowed, preventing air from getting into or out of the lung. An estimated 30.2 million Americans have ever been diagnosed with asthma by a health professional. Approximately 20.5 million Americans currently have asthma, of which 11.7 million 

had an asthma attack in 2004. Asthma prevalence rates are 39 percent higher 

among African Americans than whites. Studies also suggest that Puerto Ricans 

have higher asthma prevalence rates and age-adjusted death rates than all other 

Hispanic subgroups. 
409 

Asthma is expensive. The growth in the prevalence of asthma will have a significant impact on our Nation’s health expenditures, especially Medicaid. Asthma incurs an estimated annual economic cost of $16.1 billion to our Nation. Asthma is 

the third leading cause of hospitalization among children under the age of 15. It is 

also the number one cause of school absences attributed to chronic conditions. The 

Federal response to asthma has three components: research, programs and planning. We are making progress on all three fronts but more must be done: 

Asthma Research 

Researchers are developing better ways to treat and manage chronic asthma. Two 

examples show why this should continue. Research supported by National Heart, 

Lung and Blood Institute (NHLBI) has shown that using corticosteroids to treat 

children with mild to moderate asthma is safe and effective, answering a parent’s 

question about whether these effective drugs would stunt the growth of children 

who used them. 

Genetic research is also providing insights into asthma. Researchers in the 

NHLBI-supported Asthma Clinical Research Network have discovered that a genetic 

variation determines how well asthma patients will respond to the most common 

asthma medication, inhaled beta-agonists. This discovery will help physicians better 

target the drugs they proscribe. 

Asthma Programs 

Last year, Congress provided approximately $31.9 million for the Centers for Disease Control and Prevention (CDC) to conduct asthma programs. The American 

Lung Association recommends that CDC be provided $70 million in fiscal year 2007 

to expand its asthma programs. This funding includes State asthma planning 

grants, which leverage small amounts of funding into more comprehensive State 

programs. 

Asthma Surveillance 

In addition to public education programs, the CDC has been piloting programs to 

determine how to establish a nationwide health-tracking system. The pilots have 

shown how to integrate different data to determine how pervasive asthma is in 

these communities. Congress needs to increase funding to create a nationwide 

health-tracking system, based on the localized pilots that are underway now. 

LUNG CANCER

An estimated 350,679 Americans are living with lung cancer. During 2005, an estimated 172,570 new cases of lung cancer will be diagnosed. This year 163,510 

Americans will die from lung cancer. Survival rates for lung cancer tend to be much 

lower than those of most other cancers. Men have higher rates of lung cancer than 

women. However, over the past 30 years, the lung cancer age-adjusted incidence 

rate has decreased 9 percent in males compared to an increase of 143 percent in 

females. Further, African Americans are more likely to develop and die from lung 

cancer than persons of any other racial group. 

Given the magnitude of lung cancer and the enormity of the death toll, the American Lung Association strongly recommends that the NIH and other Federal research programs commit additional resources to lung cancer research programs. We 

support increasing the National Cancer Institute budget to $5.003 billion. 

INFLUENZA

Influenza is a highly contagious viral infection and one of the most severe illnesses of the winter season. It is responsible for an average of 200,000 hospitalizations and 36,000 deaths each year. Further, the emerging threat of a pandemic influenza is looming. Public health experts warn that over half a million Americans 

could die and over 2.3 million could be hospitalized if a moderately severe strain 

of a pandemic flu virus hits the United States. To prepare for a potential pandemic, 

the American Lung Association supports funding the Federal Pandemic Influenza 

Plan at the recommended level of $2.652 billion. 

TUBERCULOSIS

Tuberculosis is an airborne infection caused by a bacterium, Mycobacterium tuberculosis (TB). TB primarily affects the lungs but can also affect other parts of the 

body, such as the brain, kidneys or spine. There are an estimated 10 million to 15 

million Americans who carry latent TB infection. Each has the potential to develop 

active TB in the future. About 10 percent of these individuals will develop active 
410 

TB disease at some point in their lives. In 2005, there were 14,093 cases of active 

TB reported in the United States. 

The American Lung Association has endorsed the Institute of Medicine (IOM) report, Ending Neglect: The Elimination of Tuberculosis in the United States, IOM report and its recommendations on how to eliminate TB in the United States. While 

declining overall TB rates are good news, the emergence and spread of multi-drug 

resistant TB pose a significant threat to the public health of our Nation. Continued 

support is needed if the United States is going to continue progress toward the 

elimination of TB. We estimate it will cost $528 million for the CDC Tuberculosis 

Elimination Program to implement the report recommendations. We request that 

Congress increase funding for tuberculosis programs to $252 million for fiscal year 

2007. 

The NIH also has a prominent role to play in the elimination of TB. Currently 

there is no highly effective vaccine to prevent TB transmission. However, the recent 

sequencing of the TB genome and other research advances has put the goal of an 

effective TB vaccine within reach. In addition, the American Lung Association encourages the subcommittee to fully fund the TB vaccine blueprint development effort 

at the National Institutes of Allergy and Infectious Disease (NIAID). 

Fogarty International Center TB Training Programs 

The Fogarty International Center (FIC) at NIH provides training grants to U.S. 

universities to teach AIDS treatment and research techniques to international physicians and researchers. Because of the link between AIDS and TB infection, FIC 

has created supplemental TB training grants for these institutions to train international health care professionals in the area of TB treatment and research. However, we believe TB training grants should not be offered exclusively to institutions 

that have received AIDS training grants. The TB grants program should be expanded and open to competition from all institutions. The American Lung Association recommends Congress provide $70 million for FIC to expand the TB training 

grant program from a supplemental grant to an open competition grant. 

ENVIRONMENTAL HEALTH

The National Institute of Environmental Health Sciences funds vital research on 

the impact of environmental influence on disease. The American Lung Association 

supports increasing the appropriation from this subcommittee to $680 million. 

RESEARCHING AND PREVENTING OCCUPATIONAL LUNG DISEASE

The American Lung Association recommends that the subcommittee provide $285 

million for the National Institute for Occupational Safety and Health (NIOSH) at 

the CDC. 

CONCLUSION

In conclusion, Mr. Chairman, lung disease is a continuing, growing problem in the 

United States. It is America’s number three killer, responsible for one in seven 

deaths. The lung disease death rate continues to climb. Mr. Chairman, the level of 

support this committee approves for lung disease programs should reflect the urgency illustrated by these numbers. 

PREPARED STATEMENT OF THE AMERICAN NEPHROLOGY NURSES’ ASSOCIATION

The American Nephrology Nurses’ Association (ANNA) appreciates the opportunity to submit written comments for the record regarding fiscal year 2007 funding 

to address the challenges that kidney disease and the nursing shortage are posing 

to the Nation. ANNA exists to advance nephrology nursing practice and positively 

influence outcomes for patients with kidney or other disease processes requiring replacement therapies through advocacy, scholarship, and excellence. ANNA consists 

of more than 12,000 registered nurses and other health care professionals with varying experience and expertise in such areas as hemodialysis, peritoneal dialysis, conservative management, continuous renal replacement therapies, chronic kidney disease, and renal transplantation. 

As part of our mission, we educate health professionals, the public, and policymakers to increase public awareness and understanding of the unique health care 

needs and challenges people with kidney disease face. Moreover, ANNA maintains 

a strong commitment to securing public policies and programs that help secure better treatments and care for individuals with kidney disease. ANNA specifically 

seeks to advance public and private efforts to improve treatment of kidney disease, 
411 

reduce and prevent the onset of end stage renal disease (ESRD), and ensure that 

all people with kidney disease have access to the medical care and treatment options they need to live the highest quality of life possible. 

To that end, ANNA respectfully requests that Congress reject the President’s proposed $11 million cut in funding for the National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK) and instead support increased funding for diabetes 

and kidney disease research to find better treatments, preventive interventions, and 

develop a cure. NIDDK conducts and supports research on most of the more serious 

diseases affecting public health. The Institute supports much of the clinical research 

on the diseases of internal medicine and related subspecialty fields, as well as many 

basic science disciplines. Additional fiscal year 2007 funding for NIDDK will help 

advance our Nation’s understanding of the risk factors associated with kidney disease, boost efforts to identify ways in which kidney disease can be reduced and prevented, and increase initiatives to improve care and treatment of individuals with 

chronic kidney disease as well as those with ESRD. 

The National Institute of Nursing Research (NINR) supports clinical and basic research to establish a scientific basis for the care of individuals across the life spanfrom management of patients during illness and recovery to the reduction of risks 

for disease and disability, the promotion of healthy lifestyles, promoting quality of 

life in those with chronic illness, and care for individuals at the end of life. NINR 

seeks to understand and ease the symptoms of acute and chronic illness, to prevent 

or delay the onset of disease or disability or slow its progression, to find effective 

approaches to achieving and sustaining good health, and to improve the clinical settings in which care is provided. Importantly, NINR research also focuses on the special needs of at-risk and under-served populations, with an emphasis on health disparities, such as those seen among the ESRD population. These efforts are crucial 

in the creation of scientific advances and their translation into cost-effective health 

care that does not compromise quality. ANNA is pleased to join with others in the 

nursing community in advocating a fiscal year 2007 allocation of $150 million for 

NINR. 

As you know, the Nation is facing a nursing shortage of unprecedented proportion. 

At the same time the nursing shortage is expected to worsen, the number of people 

with ESRD needing access to state-of-the-art treatment and care is estimated to increase significantly. More than 350,000 Americans have ESRD which gives the 

United States the highest incidence rate. As the population continues to grow and 

age and medical services advance, the need for nurses will continue to increase. A 

report issued by the U.S. Health Resources and Services Administration (HRSA), 

Projected Supply, Demand, and Shortages of Registered Nurses: 2000–2020, predicted that the nursing shortage is expected to grow to 29 percent by 2020, compared to a seven percent shortage in 2005. Nurses are crucial to the health of our 

Nation and those with ESRD. 

According to the U.S. Department of Health and Human Services (HHS), the 

nursing workforce programs housed at HRSA will support the recruitment, education, and retention of an estimated 36,750 nurses and nursing students and approximately 956 new loan repayments and scholarships among other activities. With 

additional funding in fiscal year 2007, the HRSA nursing workforce programs would 

have more sufficient resources to bolster the Nation’s nursing workforce at a rate 

necessary to help stem the nursing shortage tide. To address this current and growing challenge in the health care delivery system, ANNA urges Congress to support 

the nursing community’s request of $175 million for the HRSA nursing workforce 

programs. Moreover, please note that ANNA supports the written testimony submitted by the Americans for Nursing Shortage Relief (ANSR) Alliance and respectfully requests your full and fair consideration of the funding allocations and issues 

outlined by ANSR. 

Please know that we understand that Congress has limited resources to allocate. 

However, we are concerned that without adequate funding for research and the Nation’s nursing workforce, the Nation will falter in its efforts to diminish suffering 

from kidney disease and to provide quality nursing care to all in need. On behalf 

of ANNA’s Board of Directors and the hundreds of thousands of individuals with 

kidney disease to whom we provide care, thank you for this opportunity to submit 

written testimony regarding the fiscal year 2007 funding levels necessary to ensure 

that our Nation adequately supports kidney disease research and the Nation’s nursing workforce. Please feel free to contact us at any time; we are happy to be a resource to subcommittee members and your staff. 
412 

PREPARED STATEMENT OF THE AMERICAN PUBLIC HEALTH ASSOCIATION

The American Public Health Association (APHA) is the Nation’s oldest, largest 

and most diverse organization of public health professionals in the world, dedicated 

to protecting all Americans and their communities from preventable, serious health 

threats and assuring community-based health promotion and disease prevention activities and preventive health services are universally accessible in the United 

States. We are pleased to submit our views on Federal funding for public health activities in fiscal year 2007. 

RECOMMENDATIONS FOR FUNDING THE PUBLIC HEALTH SERVICE

The APHA’s budget recommendation for overall funding for the Public Health 

Service includes funding for the Centers for Disease Control and Prevention (CDC), 

the Health Resources and Services Administration (HRSA), the Substance Abuse 

and Mental Health Services Administration (SAMHSA), the Agency for Healthcare 

Research and Quality (AHRQ), and the National Institutes of Health (NIH), as well 

as agencies outside the subcommittee’s jurisdiction—the Food and Drug Administration (FDA) and the Indian Health Service (IHS). We encourage the subcommittee 

to restore $1 billion in funding cuts that occurred in fiscal year 2006, and reject the 

President’s proposal to cut an additional $600 million from the Public Health Service. 

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

The APHA believes that Congress should support CDC as an agency—not just the 

individual programs that it funds. We support a funding level for CDC that enables 

it to carry out its mission to protect and promote good health and to assure that 

research findings are translated into effective State and local programs. 

In the best professional judgment of the APHA, in conjunction with the CDC Coalition—given the challenges of terrorism and disaster preparedness, new and reemerging infectious diseases, the epidemic of obesity, particularly among children, 

and our many unmet public health needs and missed prevention opportunities—we 

believe the agency will require funding of at least $8.5 billion, plus sufficient funding to prepare the Nation against a potential influenza pandemic. This request reflects the support CDC will need to fulfill its core missions for fiscal year 2007, as 

well as funding for the Agency for Toxic Substances and Disease Registry and the 

Vaccines for Children program. 

The APHA appreciates the subcommittee’s work over the years, including your 

recognition of the need to fund chronic disease prevention, infectious disease prevention and treatment, and environmental health programs at CDC. By translating research findings into effective intervention efforts, CDC has been a key source of 

funding for many of our State and local programs that aim to improve the health 

of communities. Perhaps more importantly, Federal funding through CDC provides 

the foundation for our State and local public health departments, supporting a 

trained workforce, laboratory capacity and public health education communications 

systems. 

CDC also serves as the command center for our Nation’s public health defense 

system against emerging and reemerging infectious diseases. With the potential 

onset of an influenza pandemic, in addition to the many other natural and manmade threats that exist in the modern world, the CDC has become the Nation’s— 

and the world’s—expert resource and response center, coordinating communications 

and action and serving as the laboratory reference center. States and communities 

rely on CDC for accurate information and direction in a crisis or outbreak. 

Unfortunately, Congress cut overall CDC funding in fiscal year 2006 for the first 

time in 25 years. And in fiscal year 2007, the President has proposed cutting CDC 

funding even more—more than 2 percent overall, and more than 4.5 percent to 

CDC’s core programs. We are moving in the wrong direction, especially in these 

challenging times when public health is being asked to do more, not less. In light 

of the current workload placed on the public health service—in addition to the 

threat of emerging diseases such as the avian flu—it simply does not make any 

sense to cut the budget for CDC at a time when the threats to public health are 

so great. Funding public health outbreak by outbreak is not an effective way to ensure either preparedness or accountability. Until we are committed to a strong public health system, every crisis will force trade offs. 

CDC serves as the lead agency for bioterrorism preparedness and must receive 

sustained support for its preparedness programs in order for our Nation to meet future challenges. APHA supports the proposed increase for anti-terrorism activities 

at CDC, including the increases for the Strategic National Stockpile and the new 
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Botulinum Toxin Research funding. However, we strongly caution that the President’s proposed level-funding of the State and local capacity grants continues to reflect a $95 million cut from fiscal year 2005 levels. We encourage the subcommittee 

to restore these cuts to ensure that our States and local communities can be prepared in the event of an act of terrorism. 

Unfortunately, the President’s budget proposes the elimination of some very important CDC programs, like the Preventive Health and Health Services Block 

Grant. Within an otherwise-categorical funding construct, the Preventive Health 

and Health Services Block Grant is the only source of flexible dollars for States and 

localities to address their unique public health needs. The track record of positive 

public health outcomes from Prevention Block Grant programs is strong, yet so 

many requests go unfunded. However, the President’s budget proposes the elimination of the Preventive Health and Health Services Block Grant—again. We appreciate the work of the subcommittee to at least partially restore the fiscal year 2006 

elimination of the Block Grant. Nevertheless, the $20 million cut to the Block Grant 

in fiscal year 2006 reduces the States’ ability to tailor Federal public health dollars 

to their specific needs. As States use their Prevention Block Grant dollars to address 

high priority needs such as emerging and chronic diseases, child safety seat programs, suicide prevention, smoke detector distribution and fire safety programs, 

adult immunization, oral health, worksite wellness, infectious disease outbreaks, 

food safety, emergency medical services, safe drinking water, and surveillance 

needs—we can scarcely understand why the Prevention Block Grant should be 

eliminated. We encourage the subcommittee to restore the cuts and fund the Prevention Block Grant at $132 million. 

We also encourage the subcommittee to provide $10 million for CDC’s Environmental Public Health Services Branch to revitalize environmental public health 

services at the national, State, and local level. As with the public health workforce, 

the environmental health workforce is declining. Furthermore, the agencies that 

carry out these services are fragmented and their resources are stretched. These 

services are the backbone of public health and are essential to protecting and ensuring the health and well being of the American public from threats associated with 

West Nile virus, terrorism, E. coli and lead in drinking water. 

We appreciate the subcommittee’s hard work in advocating for CDC programs in 

a climate of competing priorities. 

HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)

HRSA programs are designed to give all Americans access to the best available 

health care services. Through its programs in thousands of communities across the 

country, HRSA provides a health safety net for medically underserved individuals 

and families, including more than 45 million Americans who lack health insurance; 

50 million Americans who live in neighborhoods where primary health care services 

are scarce; African American infants, whose infant mortality rate is more than double that of whites; and the estimated 1 to 1.2 million people living with HIV/AIDS. 

Programs to support the underserved place HRSA on the front lines in erasing our 

Nation’s racial/ethnic and rural/urban disparities in health status. HRSA funding 

goes where the need exists, in communities all over America. We support a growing 

trend in HRSA programs to increase flexibility of service delivery at the local level, 

necessary to tailor programs to the unique needs of America’s many varied communities. The agency’s overriding goal is to achieve 100 percent access to health care, 

with zero disparities. In the best professional judgment of the APHA, to respond to 

this challenge, the agency will require an overall funding level of at least $7.5 billion for fiscal year 2007. 

The APHA is gravely concerned about a number of programs that are slated for 

deep cuts or elimination under the administration’s budget proposal. Building on the 

HRSA programs that were cut or eliminated in the fiscal year 2006 appropriations 

bill, we strongly suggest that this trend is moving our Nation in the wrong direction. We urge the subcommittee to restore funding to HRSA programs that were cut 

last year, as well as ensure adequate funding for fiscal year 2007 by rejecting the 

proposed cuts contained in the President’s budget. 

We express our dismay at the eroding support from the subcommittee for some 

of HRSA’s programs over the last few years, including Health Professions programs, 

Area Health Education Centers, and the Maternal and Child Health block grant, 

among others. On top of the $250 million cut to the agency for fiscal year 2006, the 

President has proposed another $321 million overall cut from last year’s appropriated level. Under the President’s proposal, total cuts to HRSA since fiscal year 

2005 would reach more than $570 million, a devastating 8 percent cut in 2 years. 
414 

We urge the subcommittee to restore the fiscal year 2006 cuts, and reject the President’s proposed cuts for fiscal year 2007. 

One program that has received consistent support from the subcommittee is the 

community-based health centers and National Health Service Corps-supported clinics, which form the backbone of the Nation’s health safety net. More than 4,000 of 

these sites across the Nation provide needed primary and preventive care to 15 million poor and near-poor Americans. HRSA primary care centers include community 

health centers, migrant health centers, health care for the homeless programs, public housing primary care programs and school-based health centers. Health centers 

provide access to high-quality, family-oriented, culturally and linguistically competent primary care and preventive services, including mental and behavioral 

health, dental and support services. Nearly three-fourths of health center patients 

are uninsured or on Medicaid, two-thirds are people of color, and more than 90 percent live below 200 percent of the poverty level. Additional primary care is provided 

by 2,700 clinicians in the National Health Service Corps. Corps members work in 

communities with a shortage of health professionals in exchange for scholarships 

and loan repayments. The APHA is pleased that the President has requested a significant increase for Community Health Centers for a total of $1.918 billion. 

Nevertheless, in the context of corresponding cuts to the Health Professions programs, we are left with some doubt about who, exactly, is going to staff all these 

new Community Health Centers. We are once again very concerned that the HRSA 

health professions programs under Title VII and VIII of the Public Health Service 

Act have landed on the chopping block. Today our Nation faces a widening gap between challenges to improve the health of Americans and the capacity of the public 

health workforce to meet those challenges. An adequate, diverse, well-distributed 

and culturally competent health workforce is indispensable to our national readiness 

efforts and to address critical health care needs. These programs help meet the 

health care delivery needs of the areas in this country with severe health professions shortages, at times serving as the only source of health care in many rural 

and disadvantaged communities. Therefore, the elimination of most funding for the 

Title VII health professions training programs and flat funding for Title VIII nurse 

training will only make certain that the needs of these medically underserved populations will not be met. 

Furthermore, we believe the elimination of the Healthy Community Access Program, universal newborn hearing screening programs, and the Emergency Medical 

Services for Children Program, will further undermine the availability of basic 

health services for some that are most in need—especially children. The Healthy 

Community Access Program is an example in which communities build partnerships 

among health care providers to deliver a broader range of health services to their 

neediest residents. This program of coordinated service delivery is innovative, not 

duplicative of other available programs, and therefore its elimination is of grave 

concern. Also, the proposed zero funding of universal newborn hearing screening 

programs in the administration’s budget will likely cause many hearing impairments in infants to go undetected, which can negatively impact speech and language 

acquisition, academic achievement, and social and emotional development. The proposed elimination of the Emergency Medical Services for Children Program will likely halt the improvements made in recent years to pediatric emergency care, which 

will disproportionately affect children who are eligible for Medicaid and SCHIP, but 

not enrolled due to State enrollment limits and budgetary pressures, and therefore 

frequently use emergency health services. 

The Maternal and Child Health (MCH) Block Grant is operating for a second year 

with less funds than in fiscal year 2005, yet with greater needs among more pregnant women, infants, and children, particularly those with special health care 

needs. Furthermore, if programs like the Traumatic Brain Injury program, Universal Newborn Hearing Screening, and Emergency Medical Services for Children 

program are eliminated, those costs will be borne by the MCH Block Grant. 

We are pleased with the increases proposed by the President for programs under 

the Ryan White CARE Act, administered by HRSA’s HIV/AIDS Bureau. The CARE 

Act programs are an important safety net, providing an estimated 571,000 people 

access to services and treatments each year. At a time when HIV/AIDS is the sixth 

leading cause of death for people who are 25 to 44 years old in the United States, 

and the number of new domestic HIV/AIDS cases is increasing, we support increased funding for Ryan White Act programs. 

Through its many programs and initiatives, HRSA helps countless individuals live 

healthier, more productive lives. As leaders of our Nation, this subcommittee decides what direction we will go in terms of delivering health care to those who need 

it most. The APHA believes that with adequate resources, HRSA is well positioned 

to meet these challenges as it continues to provide needed health care to the Na-
415 

tion’s most vulnerable citizens. We encourage the subcommittee to restore the funds 

to these important public health programs and reject the proposed cuts in the President’s budget. 

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ)

We request a funding level of $440 million for the AHRQ for fiscal year 2007, an increase of $121 million over the enacted fiscal year 2006 level. This level of funding 

is needed for the agency to fully carry out its congressional mandate to improve 

health care quality, including eliminating racial and ethnic disparities in health, reducing medical errors, and improving access and quality of care for children and 

persons with disabilities. The cuts proposed in the administration budget will severely hamper these efforts. 

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)

The APHA supports a funding level of $3.466 billion for SAMHSA for fiscal year 2007, an increase of $107 million over the enacted fiscal year 2006 level. This funding level would provide support for substance abuse prevention and treatment programs, as well as continued efforts to address emerging substance abuse problems 

in adolescents, the nexus of substance abuse and mental health, and other serious 

threats to the mental health of Americans. 

NATIONAL INSTITUTES OF HEALTH (NIH)

The APHA supports a funding level of $29.75 billion for the NIH for fiscal year 2007, an increase of $1.1 billion over the enacted fiscal year 2006 level. The translation of fundamental research conducted at NIH provides the basis for community 

based public health programs that help to prevent and treat disease. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

The budget of the Office of Minority Health faced several years of decreasing budgets prior to last year. In fiscal year 2006, OMH received $56 million; and the 

proposed budget in fiscal year 2007 is $46 million. APHA is concerned that at a time 

when we have increasing evidence of disparities in health care delivery, access and 

health outcomes, the budget of OMH is getting cut. We support maintaining OMH 

funding at the fiscal year 2006 level. 

CONCLUSION

In closing, we emphasize that the public health system requires financial investments at every stage. Successes in biomedical research must be translated into tangible prevention opportunities, screening programs, lifestyle and behavior changes, 

and other interventions that are effective and available for everyone. While we have 

said this before, in the post-September 11th era, we need to apply this to our spending growth in terrorism and influenza preparedness as well. We must think in a 

broad and balanced way, leveraging homeland security programs and funding whenever possible to provide public health benefits as a matter of routine, rather than 

emergency. 

We thank the subcommittee for the opportunity to present our views on the fiscal 

year 2007 appropriations for public health service programs. 

PREPARED STATEMENT OF THE AMERICAN SOCIETY FOR CLINICAL PATHOLOGY

DEMAND FOR QUALIFIED LABORATORY PERSONNEL OUTSTRIPS SUPPLY

On behalf of the American Society for Clinical Pathology (ASCP), a non-profit organization representing 140,000 pathologists, medical technologists, cytotechnologists and other medical laboratory professionals, we are submitting this written 

testimony regarding the Title VII Allied Health Professions program that is administered by the Health Resources and Services Administration (HRSA). 

Last year, funding for the Title VII Allied Health Professions program was cut 

by 68 percent. Funding for these programs, which provide seed money for the establishment and expansion of medical laboratory education training programs, was reduced from $300 million in fiscal 2005 to $94 million for the 2006 fiscal year. Funding for the allied health and other disciplines program was reduced from $11.8 million to $4 million. Congress eliminated funding for the allied health special project 

grants that fund medical laboratory education programs under the Title VII of the 

Public Health Service Act. These programs represent a small portion of the funding 

provided by the Labor, Health and Humans Services, and Education Appropriations 
416 

bill, but their importance to developing the next cadre of laboratory professionals 

can not be overstated. 

Because few patients have direct contact with the people who work in our Nation’s medical laboratories, the important role these health care practitioners play 

in patient care often goes unnoticed. Not only is laboratory testing key to diagnosing 

patient health, but laboratories also help identify appropriate patient treatments. In 

fact, the results of diagnostic laboratory testing impact over 70 percent of all 

healthcare treatment decisions. So, ensuring that our Nation’s laboratories possess 

the laboratory professionals needed to accurately process laboratory testing demands is critical to patient health. 

Unfortunately, the United States continues to face a severe shortage of qualified 

laboratory personnel. The U.S. Department of Labor projects that approximately 

15,000 medical laboratory professionals will be needed each year through 2014. Unfortunately, fewer than 5,000 individuals are graduating each year from accredited 

or approved educational training programs. 

Hardest hit by the shortage are rural areas and areas served by smaller hospitals. 

These areas are finding it increasingly difficult to recruit and retain qualified laboratory personnel. According to data gathered by the American Society for Clinical 

Pathology, half of all medical laboratories are reporting substantial difficulties hiring new testing personnel. It can often take a laboratory 6 to 12 months to hire an 

employee. 

Another cause for concern is the average age of the laboratory workforce, which 

has been increasing steadily over the past few years, reflecting the fact that the 

pace with which younger, newly trained laboratorians have entered the laboratory 

workforce has not kept pace with retirements. At 43.7, the average age of medical 

technologists is essentially the same as that of nurses (43.3). An aging workforce 

can be more vulnerable to the adverse health and safety risks associated with shift 

work. Moreover, as our Nation ages, estimates project that the demand for laboratory testing services may increase. 

Personnel turnover is also an increasing problem. With competition for laboratory 

personnel intensifying over the last year, turnover rates for some categories of laboratory personnel exceed 20 percent. Because of the difficulty in finding qualified 

staff, medical laboratories are increasingly turning to temporary staff (many of 

whom may already be working full- or part-time at another medical laboratory) to 

handle the patient testing workload. 

To make matters worse, our Nation’s capacity to train new laboratory personnel 

has declined substantially over the past 10 years. According to the National Accrediting Agency for Clinical Laboratory Sciences, school closings in the last 5 years 

have reduced the number of medical technologists and medical laboratory technicians being trained annually. The number of individuals graduating from these educational programs has declined approximately 35 percent over the last 10 years, 

from 6,783 graduates in 1994 to 4,390 in 2004. Over the last 10 years, the number 

of educational programs for laboratory professionals has declined more than 30 percent, from 637 programs in 1994 to 435 programs in 2004. For cytotechnologists, the 

number of educational programs has been reduced 25 percent over the last 10 years, 

from 65 programs in 1994 to 49 programs in 2004. Only 260 cytotechnologists graduate from these educational programs each year. Now with the devastating cuts to 

the Title VII programs, more programs may close. 

Besides reducing our ability to train new laboratorians quickly, these losses have 

an especially profound impact on rural areas, where prospective laboratory practitioners often seek training close to home. Wyoming, for example, has no accredited 

or approved medical laboratory educational programs. Not surprisingly, data provided by HRSA indicates Wyoming has one of the lowest concentrations of laboratory professionals per resident (66 per 100,000 residents) in the United States. 

ASCP believes that the Title VII Allied Health Education Programs have helped 

make a difference. For example, the University of Nebraska has for several years 

now offered a medical laboratory education program that has received funding 

under the allied health and other disciplines program. The University’s program includes an effective distance training program that has served other nearby States 

as well. HRSA data indicates Nebraska has more than 128 laboratory professionals 

per 100,000 residents—almost twice the number of Wyoming and one of the highest 

concentrations of laboratory personnel in the United States. Because of cuts to the 

Title VII programs, Federal funding for the University of Nebraska’s medical laboratory education program has been eliminated. 

Given that medical technologist and medical laboratory technician jobs have often 

been ranked among the best jobs by the Jobs Rated Almanac, we hope increasing 

funding for laboratory professionals education programs will help encourage more 

individuals to pursue rewarding careers in the medical laboratory. Your help in re-
417 

storing funding for these important educational programs will make our shared goal 

of reversing the laboratory personnel shortage much more obtainable. ASCP joins 

with our colleagues in the Health Professions and Nursing Education Coalition to 

request that Congress appropriate $550 million for the Title VII programs. 

PREPARED STATEMENT OF THE AMERICAN SOCIETY FOR MICROBIOLOGY

The American Society for Microbiology (ASM) is pleased to submit the following 

statement on the fiscal year 2007 appropriation for the National Institutes of Health 

(NIH). The ASM is the largest single life science Society with over 42,000 members 

who are involved in basic biomedical research, research and development activities, 

and diagnostic testing in university, industry, government and clinical laboratories. 

The ASM is deeply concerned that the President’s proposed fiscal year 2007 budget falls far short of adequately funding biomedical research supported by the NIH. 

Under the President’s fiscal year 2007 budget request, 18 of the 19 Institute budgets 

are reduced in real dollars. These proposed reductions come at a time when more, 

not less, research is needed to address pressing health problems. Funding for the 

NIH in recent years has fallen substantially in constant dollars, foreshadowing a 

troubling future for biomedical research and for progress against health challenges 

from emerging and entrenched infectious diseases and chronic diseases. The continued toll on human life from chronic diseases, new threats from pandemic diseases 

and the potential dangers from bioterrorism make the ASM firmly believe that now 

is not the time to perpetuate the decline in funding of the past three fiscal years 

for the NIH. Biomedical research supported by the NIH is critical to the discovery 

of new knowledge and understanding which underpins development of medical 

treatments and vaccines. As the U.S. population ages and as global stability is 

threatened by pandemics, basic research which can only be supported by the NIH 

is essential to the well being of the world. However, basic biomedical research and 

the recruitment and training of the next generation of researchers will be weakened 

if funding for the NIH stagnates and does not keep pace with inflation for a fourth 

year. 

The ASM commends Congress for the past decades of substantial and sustained 

funding for the NIH, an investment which is key to global health and benefits all 

Americans medically and economically. The ASM is pleased that the Senate recently 

has taken steps to increase the NIH budget for fiscal year 2007. The ASM urges 

Congress to continue to recognize the medical, economic, and strategic importance 

of adequately funding the NIH and recommends at least a 5 percent increase for 

the NIH in fiscal year 2007, an appropriation of $29.75 billion. This level of funding 

is the minimum amount necessary to sustain the current rate of research progress 

and offset biomedical research inflation. 

BIOMEDICAL RESEARCH BENEFITS PUBLIC HEALTH PREPAREDNESS AND THE ECONOMY

In the past year, there have been tragic reminders that being unprepared protects 

neither the public health nor the economic and strategic interests of the United 

States. Increased support for biomedical research is needed because new knowledge 

and technology are the pillars of preparedness against biological threats. Each day 

we face local, national, and global threats to health, safety, and well-being. To 

counter these threats, the NIH’s resources are focused on preserving and improving 

health in this country and elsewhere through innovative, cutting-edge research. Declining cancer, heart disease and stroke mortality, extended HIV/AIDS life 

expectancies, and massive genome databanks are evidence of the power of biomedical research. Research supported by the NIH is responding to the realities of 

21st century medicine, developing predictive and preemptive medical capabilities to 

overcome expected health resource shortages and unforeseen dangers like newly 

identified microbial pathogens. 

Research funded by the NIH also contributes to the Nation’s competitiveness and 

economic strength, which is clearly rooted in basic science that generates commercially viable products and technologies. Biomedical research advances scientific 

knowledge, expands the high-technology workforce of the Nation, and enhances innovation among the country’s private sector companies. Roughly 84 percent of the 

proposed fiscal year 2007 NIH budget will support the extramural science community through research grants and contracts. This funding will sustain work by more 

than 200,000 research personnel affiliated with approximately 3,000 hospitals, universities, private companies, and other research facilities. 
418 

INFECTIOUS DISEASE RESEARCH NEEDS INCREASED SUPPORT

Inadequate increases in funding for biomedical research weakens our national defenses against infectious diseases, which despite some medical victories persist as 

the second leading cause of death worldwide, accounting for 26 percent of all deaths. 

Infectious diseases particularly affect years of healthy life lost because they cause 

approximately two-thirds of deaths among children less than 5 years of age. Our 

ability to combat infectious diseases depends on basic research of how microbes 

spread, how they are harbored in the environment, and how they cause disease. The 

National Institute of Allergy and Infectious Diseases (NIAID) supports research that 

is essential to developing strategies to prevent, diagnose and treat infectious diseases here and abroad. NIAID funding supports both intramural and extramural researchers in academia and the private sector searching for new therapies, 

diagnostics, vaccines, and other technologies that improve health care for infectious 

diseases. This critical work also focuses on high-priority homeland security initiatives, includes influenza preparedness and counter-bioterrorism. Unfortunately, the 

proposed fiscal year 2007 budget leaves funding for the NIAID flat, about $4.4 billion or 0.3 percent over the fiscal year 2006 appropriation. With additional resources 

the NIAID could fund more promising initiatives and restore funding for research 

projects. 

THE THREAT OF PANDEMIC INFLUENZA

Biomedical research and preparedness save lives and, in the case of pandemic influenza, the number of lives saved could be significant. Anticipating dire possibilities if the H5N1 avian influenza virus mutates sufficiently to move easily from 

human to human, the Department of Health and Human Services (DHHS) and 

other Federal agencies recently introduced the National Strategy for Pandemic Influenza. The ASM commends this plan as a prudent response to what could become 

a lethal global event. Fearsome pandemics have ravaged human populations three 

times in the past century: the 1918–1919 Spanish influenza that took more than 40 

million lives worldwide, the 1957 Asian influenza, and the 1968 Hong Kong influenza. Those unusually virulent viral strains contained genetic material from avian 

influenza viruses like the current H5N1 virus. Confirmed reports of H5N1 related 

deaths in birds and mammals are coming from an expanding list of nations, where 

millions of domestic and wild fowl have died or been destroyed. In just the 4 months 

since the introduction of the National Strategy for Pandemic Influenza, H5N1 has 

spread to 37 nations. At present about 186 humans have contracted the disease, 

more than half of whom have died. Feared for their facile ability to infect and kill, 

influenza viruses are always with us. Every year, seasonal influenza causes 250,000 

to 500,000 deaths worldwide. In the United States, this highly communicable disease annually causes an average 36,000 deaths, more than 200,000 hospitalizations, 

and, when calculated with pneumonia, an estimated $37.5 billion in direct and indirect costs. Together influenza and pneumonia are the leading infectious cause of 

deaths in the United States, ranked seventh among all causes of death. The Centers 

for Disease Control and Prevention has estimated that if pandemic flu arrives in 

the United States, 90 million people will become ill and almost 2 million people 

could die. The global potential for profound loss, millions of human lives and billions 

in financial costs, clearly demands that our public health institutions be ready with 

the most effective preventive and therapeutic measures against influenza. 

The ASM strongly supports the critically important NIH influenza initiatives. Researchers sponsored by the NIAID are focusing on effective vaccines and antivirals 

as prioritized in the national strategic plan, which calls for pandemic vaccine within 

6 months of detection, as well as enough antiviral treatment. Scientists supported 

by the NIAID have completed a successful clinical trial of an experimental inactivated H5N1 influenza vaccine. Research efforts in the DHHS Plan also include the 

development of new vaccine delivery systems and higher capacity cell-based production methods. Recent advances supported by the NIAID include the institute’s Influenza Genome Project, collecting to date the full genomic sequences of more than 830 

influenza viral isolates from human patients and building a repository databank for 

use by other scientists. 

PROGRESS AGAINST INFECTIOUS DISEASES

There are numerous research programs at the NIH that battle a long and growing 

list of infectious diseases which deserve increased support. Biomedical research consistently yields new ways to treat or prevent diseases. The following are just a few 

examples of new science advances: 
419 

Scientists supported by the NIAID have collaborated to develop a tissue culture 

cell system in which the whole hepatitis C virus can be grown, which will allow researchers to better understand how Hepatitis C Virus (HCV) replicates and causes 

infection. HCV is a major cause of chronic liver disease with over 170 million infected people worldwide and can progress to cirrhosis of the liver, leading to liver 

cancer and failure. Two studies by the NIAID have shown that anti-cancer drugs 

show promise as potential antiviral drugs and merit further exploration. A vaccine 

to protect adults and adolescents against illness due to Bordetella pertussis infection, or whooping cough, has proved more than 90 percent effective in a large-scale 

clinical trial, which could help stem the increase in pertussis cases in the United 

States. The NIAID has supported a clinical trial of a vaccine against pneumococcal 

disease, which is a major cause of illness and death in children worldwide. 

Biomedical research must remain focused on major killers like HIV/AIDS, tuberculosis and malaria, which together are responsible for more than 5 million deaths 

each year. Despite extensive prevention programs, an estimated 14,000 people are 

newly infected with HIV daily. Twenty-five years after physicians first described 

AIDS as a new disease, more than 40 million people are living with HIV. The bacterium that causes TB currently infects about one-third of the world’s population. 

Multi-drug resistant (MDR) TB increased 13.3 percent in the United States from 

2003 to 2004, the largest single year increase in MDR TB since l993, presenting significant challenges to treatment and control of TB in the United States and abroad. 

Extensively drug-resistant (XDR) TB has increased in the industrialized nations 

from 3 percent of MDR TB cases in 2000 to 11 percent in 2004. Two new engineered 

TB vaccines developed with support of the NIAID have entered clinical trials and 

a number of TB drug candidates are ready for clinical testing. Scientists continue 

to pursue a wealth of genomic data to understand malaria pathogenesis and to uncover new molecular targets for both drugs and vaccines for malaria which has an 

incidence of 300 to 500 million cases a year. 

The NIAID funds extensive, multifaceted programs focused on these devastating 

diseases. In the past year, advances include: the new Center for HIV/AIDS Vaccine 

Immunology to address what is proving to be the very difficult task of finding HIV 

vaccines, with clinical sites in England, Africa, and three U.S. States; a clinical trial 

of two topical microbicides to assess effectiveness in stopping HIV transmission; and 

detection of a cellular protein that helps the tuberculosis microbe resist standard 

antimicrobials. 

EMERGING DISEASES AND BIODEFENSE RESEARCH

A world influenced by rapid transit and global markets challenges not just U.S. 

competitiveness, but also our public health networks and our national sense of security. We no longer can view far-flung disease outbreaks as remote or theoretical 

threats to our well-being. The administration has requested $1.9 billion in fiscal 

year 2007 funding for the NIH’s biodefense efforts in recognition that the ability to 

counter bioterrorism depends on progress in biomedical research and the support of 

scientific capacity to respond to new biological threats. In 2005, the NIAID awarded 

two additional grants to research consortia aimed at new vaccines, therapies, and 

diagnostics, completing a national network of 10 Regional Centers of Excellence for 

the NIAID Biodefense and Emerging Infectious Diseases Research program. Research targets include anthrax, plague, smallpox, West Nile fever, botulism, 

hantaviruses, viral hemorrhagic fevers and many other less-common diseases. The 

NIAID also began clinical trials of an experimental DNA vaccine against the West 

Nile virus, which first appeared in the United States in 1999; two NIAID-supported 

teams identified how Nipah and Hendra viruses attack human and animal cells, 

both emerging viruses that cause serious respiratory and neurological disease; and 

NIAID researchers and their university partners determined which host-cell enzymes Ebola viruses can hijack to infect humans. 

CONCLUSION

To sustain the pace of research discovery, we must continue to enhance the research capacity and productivity of the Nation’s biomedical research enterprise. We 

must be prepared for the predictable diseases and build sufficient research capacity 

to detect and respond quickly to unexpected health threats. The 2002–2003 outbreak of Severe Acute Respiratory Syndrome (SARS) is a prime example of this balance, a rapid international response occurred to the sudden reality of a novel pathogen, which spread to more than two dozen countries. Biomedical scientists drew 

upon vast reserves of earlier viral research and quickly developed three distinct 

SARS vaccines now being evaluated, with the first human clinical trial opening just 

21 months after SARS appeared as a new disease. Increased funding for biomedical 
420 

research will strengthen our public health preparedness, our technological competitive edge and our ability to improve the quality and length of life for people. We 

urge Congress to provide at least a 5 percent increase for the NIH budget for fiscal 

year 2007 to help accomplish these goals. 

PREPARED STATEMENT OF THE AMERICAN SOCIETY FOR MICROBIOLOGY

The American Society for Microbiology (ASM) is submitting the following statement in support of increased funding for the Centers for Disease Control and Prevention (CDC) in fiscal year 2007. The ASM is the largest single life science society 

with over 42,000 members who are involved in research and diagnostic testing in 

university, industry, government and clinical laboratories. 

The fiscal year 2007 budget request would reduce funding for the CDC for the second year in a row. Excluding one-time emergency funding items, CDC core programs would be cut over 4 percent below the fiscal year 2006 level of funding, which 

was 4 percent below the fiscal year 2005 budget. In view of the CDC’s critical role 

in protecting the health and safety of the public, the cumulative two year reduction 

of funding of over 8 percent is cause for serious concern. The ASM recommends that 

Congress provide $8.5 billion plus sufficient funding for pandemic influenza preparedness for the CDC in fiscal year 2007. This level of funding will sustain core 

programs crucial to improving public health in the United States and overseas. 

The CDC works with partners in the United States and across the globe to monitor health status and trends, detect and investigate health problems, conduct research to enhance prevention, develop and advocate sound health policies, and foster 

safe and healthy environments. CDC capabilities must expand, not contract, as increasing worldwide connectivity brings global health concerns to the United States. 

Among the CDC’s health protection goals are ‘‘people prepared for emerging health 

threats’’ and ‘‘healthy people in a healthy world.’’ Both will require continued, extensive efforts here and abroad and clearly need sustained funding to assure success. 

CDC PREPAREDNESS

CDC leadership in public health requires readiness to respond to unexpected 

health crises, above and beyond the Agency’s ability to guard day-to-day wellness 

of people. In fiscal year 2005, the CDC’s Epidemic Intelligence Service (EIS) officers 

responded to 66 health outbreaks, eight of them in other countries, and personnel 

from the CDC assigned to State or local health departments conducted 367 field investigations. After Hurricane Katrina struck the Gulf Coast, the CDC quickly provided information critical to preserving health and created the Katrina Information 

Network, later called the Emergency Response Information Network. Within two 

weeks, the CDC posted nearly 200 pertinent documents on its website (on infection 

control, first responder and volunteer safety, environmental issues and more). A 

commercial test kit for mold contamination, developed in 2003 by scientists of the 

CDC and a private biotech company, became a valuable assessment tool postKatrina. Calls to the agency for rapid response generally involve infectious diseases, 

which persist as a principal concern of the CDC. 

PANDEMIC INFLUENZA

Within the proposed fiscal year 2007 budget, pandemic influenza is a top-priority 

for funding for the CDC. The requested $188 million for pandemic preparedness 

would expand the CDC’s participation in the Federal interagency National Strategy 

for Pandemic Influenza, the Federal agency plan to prevent, detect, and treat outbreaks of influenza. Since mid-2005, a virulent avian influenza virus (strain H5N1) 

has been moving more rapidly from nation to nation, killing millions of wild and 

domestic birds and causing concern that viral mutations might cause human-tohuman transmission. Scientists recently found that the human virus strains responsible for three major pandemics in the 20th century contained genetic material derived from avian viruses. Thus far, human deaths from H5N1 have been relatively 

few, but those known to be infected suffer a high mortality rate. Globally, traditional seasonal influenza already kills 250,000 to 500,000 each year; pandemic influenza could kill many millions. Although the H5N1 virus has not reached the United 

States, many health officials consider future outbreaks in this country to be inevitable. If viral mutations provoke a human pandemic, 15–35 percent of the U.S. population could be affected, exacting a large number of influenza deaths and economic 

losses of $71.3–$166.5 billion, according to the CDC’s estimates. 

The proposed fiscal year 2007 funding for pandemic preparedness will continue 

fiscal year 2006 improvements in domestic disease surveillance, upgrades of quar-
421 

antine stations at major ports of entry, and support of global surveillance and detection activities in endemic, epidemic, and other high-risk countries. The proposed 

budget would fund new resources to increase stocks of diagnostic reagents; establish 

laboratory facilities with appropriate biocontainment capabilities; develop models 

and risk-assessment tools to predict disease spread; increase seasonal flu vaccine 

production; establish a viral-genome reference library; and create an electronic registry to more effectively track, distribute and administer vaccines to the public. The 

CDC would conduct studies that examine human infections of animal influenza A 

viruses; an additional $2.8 million would streamline outbreak response in countries 

identified as needing special assistance; and nearly $20 million would help States 

administer more seasonal influenza vaccines and thus stimulate greater vaccine production by manufacturers. 

In the past year, Federal support for the CDC’s influenza preparedness activities 

yielded promising testing and vaccine development innovations. Researchers developed a laboratory test to diagnose currently circulating A/H5 (Asian lineage) strains 

of influenza in patients, which was approved this February by the Food and Drug 

Administration. Using advanced molecular technology, the test gives preliminary results within four hours, compared to two to three days with previous testing. To 

more rapidly detect U.S. influenza outbreaks, the test is being distributed to laboratories within the national Laboratory Response Network (LRN), facilities in all 50 

States with special training in molecular testing, biosafety, and containment procedures. The CDC also shared the new testing technology with the World Health Organization (WHO); the CDC is one of four WHO Collaborating Centers worldwide 

providing technical and logistical expertise on pandemic influenza. Using new genetic sequence information, scientists from the CDC also collaborated last year with 

Federal and academic researchers to reconstruct the virus responsible for an estimated 20 to 50 million people during the 1918–19 pandemic. The virus particles are 

being stored at the CDC, for use in expedited vaccine and antiviral drug development. 

INFECTIOUS DISEASES

To protect public health, the CDC has a major responsibility for preventing and 

controlling infectious diseases, still a leading cause of death and disability in this 

country and worldwide. The ASM is particularly aware of the important role of the 

CDC in protecting against infectious diseases. The fiscal year 2007 budget request 

includes $245 million for infectious disease programs, from laboratory research and 

epidemic investigations to surveillance networks, public education programs and 

specialized training. Increased funding for infectious diseases is needed not only to 

maintain and expand funding for existing infectious disease problems, but also to 

respond to new infectious disease threats and emergencies. The CDC must be able 

and ready to respond to shifting challenges, as it has done in the past for emerging 

disease outbreaks. The public clearly expects and relies on the CDC for rapid response to disease threats and for accurate, science-based advice on health issues. 

After the agency consolidated all of its more than 40 health information hotlines 

and clearinghouses into one toll-free service last March, the consumer center handled nearly 500,000 calls during its first 9 months and continues to expand. 

Preventing and controlling serious infectious diseases in the United States depends on the CDC’s scientific expertise and education outreach tailored for specific 

diseases. An example is the CDC program to prevent HIV/AIDS, sexually transmitted diseases, and tuberculosis, an ongoing multi-faceted effort that is allotted 

$1.0 billion in the administration’s fiscal year 2007 request ($86 million more than 

fiscal year 2006). Tuberculosis continues to be a serious threat in the United States 

and worldwide, with a 13.3 percent increase in multi-drug resistant (MDR) TB in 

the United States from 2003 to 2004, the largest single year increase in MDR TB 

since 1993. An estimated 40,000 individuals newly acquire HIV in the United States 

each year and far more effort to prevent new infections is needed. The prevalence 

of anti-retroviral resistance to therapy at the time of HIV diagnosis is also increasing rapidly and will result in dramatically increased morbidity and health care costs 

if more effective efforts at prevention are not implemented. In contrast, new pediatric HIV infections are decreasing in number and routine prenatal HIV testing 

planned by the CDC for fiscal year 2007 should decrease pediatric cases even further. The CDC’s National Plan to Eliminate Syphilis, started in 1999, requires further support with syphilis rates among U.S. men unfortunately increasing in the 

United States. 

Preventive health in the United States met a major milestone last year, when 

government efforts finally eliminated rubella virus, the highly contagious agent of 

childhood measles. The ASM agrees with the CDC’s fiscal year 2007 budgetary em-
422 

phasis on vaccination, certainly one of the most efficient and effective methods to 

fight infectious diseases. The fiscal year 2007 $2.6 billion immunization program 

continues two established components to protect the Nation’s children, the Vaccines 

for Children program that provides vaccines free to children in financial need (40 

percent of all childhood vaccines purchased in the United States), and the Section 

317 program, supporting State-managed immunization programs. Researchers from 

the CDC recently used computer modeling to evaluate economic benefits from this 

country’s standard childhood immunization schedule, comprising seven vaccines for 

illnesses like diphtheria, mumps, and polio. They concluded that collectively the immunizations not only save thousands of lives each year, but also $10 billion in direct 

medical costs plus more than $40 billion in indirect costs. 

The CDC’s protection of American health and safety reaches beyond national borders, facing infections that can migrate from one afflicted population to the next 

through global travel and commerce. International collaboration against pandemic 

influenza is a large-scale example, but one among many such responses. Last year, 

experts from the CDC worked with officials from the WHO and the Angola government to control an outbreak of Marburg hemorrhagic fever in that African nation, 

posting traveler alerts on its website and providing on-site laboratory and field investigative services. 

The proposed fiscal year 2007 budget requests $381 million for the CDC’s global 

health activities, to improve detection and control of diseases such as HIV/AIDS, 

malaria, polio, and measles. In fiscal year 2005, the CDC program Preventing Mother-and-Child HIV Transmission collaborated with other nations to screen 2 million 

pregnant women in 15 countries, giving short-course antiretroviral prophylaxis to 

125,000 who tested HIV-positive. The fiscal year 2007 budget includes $122 million 

in direct AIDS-related funding for ongoing prevention, treatment, and surveillance 

in 25 countries. From 1988 to 2004, global polio incidence declined by more than 

99 percent, saving about 250,000 lives and avoiding 5 million cases of childhood paralysis. Global deaths due to measles fell by 48 percent between 1999 and 2004. 

The National Laboratory Training Network (NLTN) is a unique training system 

sponsored by the CDC and the Association of Public Health Laboratories. The 

NLTN is solely dedicated to ensuring quality laboratory practice for testing of public 

health significance through relevant and timely continuing education offered in a 

variety of educational venues at a reasonable cost, often at no charge. The NLTN 

Continuing Education programs offer laboratories critical insights into public health 

needs while also ensuring high quality, cost-effective, and clinically relevant direct 

patient testing needs are met. The ASM strongly supports the continuation of the 

NLTN programs though the CDC. 

BIOTERRORISM

The possibility of bioterrorism persists as a principal focus for the CDC, and the 

fiscal year 2007 budget requests $1.7 billion to support ongoing programs, the Strategic National Stockpile (SNS), surveillance and quarantine efforts, laboratory research on high-risk pathogens like anthrax, and assistance to State and local governments. Since its creation in 1999, the SNS has expanded its inventory of vaccines, drugs, and other countermeasures, preparing for health crises like influenza 

pandemics, natural catastrophes like Hurricane Katrina, and biological, chemical, 

radiological, or nuclear terrorist attacks. Supplies can be delivered anywhere in the 

United States within 12 hours of an event. The SNS fiscal year 2007 request of $593 

million increases the fiscal year 2006 appropriation by $70 million, nearly $50 million of which will finance portable hospital units under the Mass Casualty Initiative, 

for rapid deployment to expand local hospital capacity. The CDC’s fiscal year 2007 

bioterrorism strategy also includes funding to utilize a recent invention, a new mass 

spectrometry method from the CDC’s Environmental Health Laboratory for detecting botulinum toxin in people and the Nation’s milk supply within 15 seconds. The 

additional funds will improve the method to more rapidly detect anthrax lethal factor, ricin and other toxins that can be used as bioweapons, as well as fully exploit 

the method’s ‘‘fingerprinting’’ of suspect toxins to determine their source. 

The ASM asks Congress to recognize and support the CDC’s crucial activities by 

providing increased support for the CDC’s core programs and pandemic influenza 

preparedness. 
423 

PREPARED STATEMENT OF THE AMERICAN SOCIETY OF NEPHROLOGY

INTRODUCTION

The American Society of Nephrology (ASN) is pleased to submit this statement 

for the record to the Senate Appropriations Subcommittee on Labor, Health and 

Human Services, and Education in support of the ASN’s top funding and research 

priorities for fiscal year 2007. 

The ASN is a professional society of more than 10,000 researchers, physicians, 

and practitioners who are committed to the treatment, prevention, and cure of kidney disease. Specifically, the ASN is committed to enhance and assist the study and 

practice of nephrology, to provide a forum for the promulgation of research, and to 

meet the professional and continuing education needs of its members. 

The ASN statement focuses on those issues and programs that most immediately 

fall under the committee’s jurisdiction and assist our members to fulfill their missions. We want to express our strong support for advancing programs supported by 

the National Institutes of Health (NIH) and Agency for Healthcare Research and 

Quality (AHRQ). The ASN thanks the subcommittee for its commitment and steadfast support of these programs. 

THE FACE OF KIDNEY DISEASE

Kidney disease is a major health problem in the United States, and along with 

Alzheimer’s disease, the fastest growing cause of death in the United States. (CDC 

data). It is estimated that at least 15 million people have lost 50 percent of their 

kidney function without even knowing it and suffer from Chronic Kidney Disease 

(CKD). Another 20 million more Americans are at increased risk of developing kidney disease. Sub clinical kidney disease has emerged recently as a major risk factor 

for CVD. The culmination of unimpeded progression is end stage renal disease 

(ESRD), a condition in which patients have permanent kidney failure, affects almost 

400,000 Americans, and directly causes 50,000 deaths annually. In the past 10 

years, the number of patients in the United States with ESRD has almost doubled. 

Although the largest age group having ESRD ranges from 45–64 years old, rates 

increase steadily for those between the ages of 65–74 and are disproportionately 

high in African-Americans. African-Americans represent about 32.4 percent of all 

patients treated for kidney failure in the United States and the risk of ESRD for 

middle-age African-American males with high blood pressure is six times that of 

their Caucasian counterparts. 

ECONOMIC COSTS

Although no dollar amount can be affixed to human suffering or the loss of human 

life, economic data can help to identify and quantify the current and projected future financial costs associated with ESRD. The 2000 report of the United States 

Renal Data System indicates that the total Medicare ESRD program cost will more 

than double, surpassing $28 billion, by 2010, as the prevalence of kidney failure is 

projected to double. The annual average cost per ESRD patient is approximately 

$55,000. These escalating costs serve to magnify the need to investigate new, and 

better apply, recently proven strategies for preventing progressive kidney disease. 

In short, we can treat and maintain patients who have lost their kidney function 

but the critical need is to prevent the loss of kidney function and its complications 

in the first place. Meeting this vital goal can only be accomplished through more 

concerted research and education. 

MAJOR CAUSES OF END STAGE RENAL DISEASE

Diabetes, a disease that affects 17 million Americans, is the most common cause 

of ESRD in the United States. Nearly 34 percent of all Americans being treated for 

kidney failure have diabetes. Moreover, only 18 percent of people with diabetes survive 5 years after beginning treatment for kidney failure. With current projections 

that the epidemic of obesity-related diabetes mellitus will continue to soar, a dramatic increase in kidney disease is anticipated in the next 10 years. 

Hypertension, or high blood pressure, is the next leading cause of ESRD, accounting for 23.6 percent of ESRD patients. Similar to diabetes, higher rates of hypertension can be found among certain age and ethnic groups. For example, hypertension is common among African-Americans (35 percent). It is also a disease of the 

aged and accounts for 37 percent of new ESRD cases in those 65 years old and 

above. 

Despite recent progress and discoveries regarding the major causes of ESRD, it 

is among many areas of disease research that remain under-investigated. Research-
424 

ers agree that significant inroads in previously understudied sub-fields need to be 

made. Significant among them, more focus and direction need to be introduced into 

the general field of renal research and patient and physician education. These pressing factors provided the impetus for an informal dialogue on the resulting calls to 

action. 

LACK OF PUBLIC AWARENESS

A major problem with kidney disease is that it is largely a ‘‘Silent Disease’’. In 

fact, of the 15 million Americans who have lost at least half of their kidney function, 

the vast majority have no knowledge of their condition. While people with chronic 

kidney disease may not show any symptoms, this does not mean that they are not 

going to have long-term damage to their kidney function, requiring dialysis or a 

transplant. These people may also be especially vulnerable to cardiovascular disease. If these 15 million people were identified early, there are new therapies, particularly special blood pressure drugs known as ACE inhibitors, which could be prescribed with potentially significant benefits. In addition, vigorous treatment of hypertension and other complications that cause illnesses and loss of productivity 

could be administered to the patients. 

Given the cost to human life and to the Federal Government caused by ESRD specifically, as well as other forms of kidney disease, we urge this subcommittee to provide funding increases for kidney disease research. 

KIDNEY DISEASE RESEARCH

National Institutes of Health (NIH) 

The ASN applauds Congress and members of the subcommittee for leading the 

bipartisan effort to double our investment in promising biomedical research supported and conducted by the NIH. NIH has served as a vital component in improving the Nation’s health through research, both on and off the NIH campus, and in 

the training of research investigators, including nephrology researchers. Strides in 

biomedical discovery have had an impact on the quality of life for people with kidney disease. If we are to sustain this momentum and translate the promise of biomedical research into the reality of better health, this Nation must maintain its 

commitment to medical research. We support the recommendation of the Ad-Hoc 

Group for Medical Research Funding to add 5 percent in fiscal year 2007 to the NIH 

budget for a total of $29.750 billion. 

In fiscal year 2007, the NIH budget must grow by 3.5 percent, or nearly $1 billion, 

just to keep pace with inflation. Further, the NIH has ambitious plans for new initiatives to combat the health challenges of the future. To ensure that NIH’s momentum is not further eroded, and to continue the fight against the diseases and disabilities that affect millions of Americans, the ASN will work with the administration 

and the Congress to seek an NIH budget of at least $30 billion for fiscal year 2007. 

National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) 

Many recent advances have been made in our understanding into the causes and 

progression of renal failure, such as: how diabetes and hypertension affect the kidney and the mechanisms responsible for acute renal failure. 

Despite these advances, the number of people with renal failure and the numbers 

who die of renal failure continue to increase each year. Most alarming is the significant increase in diabetes, the most common cause of chronic kidney failure, and its 

relationship to kidney disease. The ASN believes the rising incidence and prevalence 

of diabetes-related kidney disease warrants additional recourses to improve our understanding of the relationship between kidney disease and diabetes. 

The NIDDK sponsors a number of activities that researchers hope will lead to improved detection, treatment and prevention of kidney disease and chronic kidney 

failure. To ensure ongoing kidney disease and kidney disease related research and 

important clinical trials infrastructure development we recommend a 5 percent increase for the NIDDK over fiscal year 2006 levels. 

ASN RESEARCH GOALS & RECOMMENDATIONS FOR KIDNEY DISEASE

In the fall of 2004, the ASN conducted a series of research retreats to develop priorities to combat the growing prevalence of kidney disease in the United States. The 

ASN joined experts, both within and outside the renal community, and identified 

five areas requiring attention: acute renal failure, diabetic nephropathy, hypertension, transplantation, and kidney-associated cardiovascular disease. 

The final research retreat report(s) highlighted priorities and contained three 

overriding recommendations. Theses include: 
425 

1. Development of Core Centers for kidney disease research 

Expansion of the kidney research infrastructure in the United States can be 

achieved by vigorous funding of a program of kidney research core centers. Specifically, we propose that the number of kidney centers be increased with the goal of 

providing core facilities to support collaborative research on a local, regional and national level. It should be emphasized that such a program of competitively reviewed 

kidney core centers would facilitate investigator-initiated research in both laboratory and patient-oriented investigation. This approach is highly compatible with the 

collaborative research enterprise conceived in the NIH Road Map Initiative. 

2. Support programs/research initiatives that impact the understanding of the relationship between renal and cardiovascular disease 

It is now well recognized that chronic kidney dysfunction is an important risk factor for the development of cardiovascular disease. It is recommended that the 

NIDDK and NHLBI work cooperatively to support both basic and clinical science 

projects that will shed light on the pathogenesis of this relationship and to support 

the exploration of interventions that can decrease cardiovascular events in patients 

with CKD. Thus, we specifically propose that NHLBI should support investigatorinitiated research grants in areas of kidney research with a direct relationship to 

cardiovascular disease. Similarly, NHLBI should work collaboratively with NIDDK 

to support the proposed program of kidney core research centers. 

3. Continued support and expansion of investigator initiated research projects 

In each of the five subjects there are areas of fundamental investigation that require the support of investigator initiated projects, if ultimately progress is to be 

made in the understanding of the basic mechanisms that underlie the diseases processes. It is recommended that there should be an expansion of support for research 

in the areas that lend themselves to this mechanism of funding, by encouraging applications with appropriate program announcements and requests for proposals. In 

addition to vigorous support for RO1 grants, continued funding of Concept Development and R21/R33 grants is essential to support development of investigator-initiated clinical studies in these areas of high priority. Such funding is critical to accelerate the transfer of new knowledge from the bench to the bedside. 

In summary, the ASN foresees the following important directions in the future of 

kidney disease research: 

—Continued research in acute renal failure, diabetic nephropathy, hypertension, 

transplantation, and kidney-associated cardiovascular disease; 

—The establishment of core centers for kidney disease research; 

—Persistent attention to the relationship between kidney disease and hypertension and collaboration between NIDDK and NHLBI; 

—Expansion of investigator initiated research projects. 

The ASN will strive to fulfill its mission statement and research recommendations 

(agenda). The ASN will remain active on Capitol Hill and assist members of Congress and the administration in their understanding of kidney disease and problems 

facing CKD and ESRD patients and the health care providers who serve them. 

Agency for Health Care Research and Quality (AHRQ) 

Complementing the medical research conducted at NIH, the AHRQ sponsors 

health services research designed to improve the quality of health care, decrease 

health care costs, and provide access to essential health care services by translating 

research into measurable improvements in the health care system. The AHRQ supports emerging critical issues in health care delivery and addresses the particular 

needs of priority populations, such as people with chronic diseases. The ASN firmly 

believes in the value of AHRQ’s research and quality agenda, which continues to 

provide health care providers, policymakers, and patients with critical information 

needed to improve health care and treatment of chronic conditions such as kidney 

disease. The ASN supports the Friends of AHRQ recommendation of $440 million 

for AHRQ in fiscal year 2007. 

CONCLUSION

Currently, there is no cure for kidney disease. The progression of chronic renal 

failure can be slowed, but never reversed. Meanwhile, millions of Americans face a 

gradual decline in their quality of life because of kidney disease. In many cases, abnormalities associated with early stage chronic renal failure remain undetected and 

are not diagnosed until the late stages. In sum, chronic renal failure requires our 

serious and immediate attention. 

As practicing nephrologists, ASN members know firsthand the devastating effects 

of renal disease. ASN respectfully requests the subcommittees’ continued support to 
426 

enable the nephrology community to continue with its efforts to find better ways to 

treat and prevent kidney disease. 

Thank you for your continued support for medical research and kidney disease research. To obtain further information about ASN, please go to http://www.asn-online.org or contact Paul Smedberg, ASN Director of Policy & Public Affairs at 202– 

416–0646. 

PREPARED STATEMENT OF THE ASSOCIATION OF ACADEMIC HEALTH CENTERS

The Association of Academic Health Centers (AAHC) is pleased to submit this 

statement for the record with its fiscal year 2007 appropriations recommendations 

for a number of essential programs that are critical to improving health and health 

care delivery in our Nation. 

The AAHC, the national organization representing almost 100 academic health 

centers, is dedicated to improving the Nation’s health care system by mobilizing and 

enhancing the strengths and resources of the academic health center enterprise in 

health professions education, patient care, and research. An academic health center 

consists of an allopathic or osteopathic medical school, one or more other health professions schools or programs, and one or more owned or affiliated teaching hospitals, 

health systems, or other organized health care services. Our member institutions 

have enormous impact on their regions, the Nation, and the global economy. 

THE RESEARCH ENTERPRISE

AAHC member institutions are the infrastructure of the Nation’s research enterprise. Academic health center researchers in both the basic and clinical sciences are 

pushing the bounds of science to advance progress in the diagnosis and treatment 

of myriad diseases and chronic illnesses. In addition, our institutions are engaged 

in a broad range of health services research contributing to improvements in the 

organization, financing, and delivery of health services. 

Our key partner in the nation’s research achievements is the National Institutes 

of Health (NIH), which throughout its history has provided the necessary funding 

for basic science research and a wide array of projects to test clinical applications. 

Maintaining NIH’s capabilities to carry out investigator-initiated research is absolutely critical to ensure that the Nation advances in health care, sustains the education and advancement of highly trained scientists, and builds the infrastructure 

for the conduct of research across the country. We believe that America’s preeminence in science and its leading position in our global economy are tied closely 

to the Nation’s investment in its research enterprise through the NIH. 

Over the past 3 years, increases in appropriations for the NIH have not kept pace 

with inflation. In fact, the administration’s current proposal to freeze the NIH budget at a level that is more than 11 percent below the 2003 funding level in constant 

dollars can only be viewed as threatening to the Nation. The practical effect of such 

funding is that NIH cannot sustain its ongoing efforts and at the same time support 

promising new research. The opportunity costs in terms of our capacity to reduce 

the burden of illness and improve patient outcomes are enormous. Disrupting ongoing research projects or failing to support promising new proposals is, in the long 

run, more costly than any short-term budget savings. The cost will be counted by 

the missed opportunities to mitigate or cure many conditions, reducing the quality 

of life for people throughout the world. 

We believe that the Congress must renew its commitment to the research enterprise, even in these times of budgetary restraint. Failure to do so means that with 

each passing year the NIH will support less internal and extramural research. We 

are very pleased that the Senate Budget Resolution for fiscal year 2007 provides for 

a $7 billion increase in overall discretionary dollars for health and education programs, including an assumption of at least $1 billion for the NIH. We are very 

grateful for the leadership of Senators Specter and Harkin who proposed an amendment to increase funding and argued persuasively for making this investment in the 

future of biomedical research. We strongly recommend that funding for the NIH in 

fiscal year 2007 be increased at least 5 percent or no less than the funding provided 

in fiscal year 2005 to prevent further erosion of its purchasing power. 

THE HEALTH PROFESSIONS WORKFORCE

The health workforce must be viewed as a cornerstone of our Nation’s well being. 

The health professions not only treat and care for patients but also represent an 

economic engine for the country. Unfortunately, the supply of health professionals 

is threatened. By most estimates, there are an insufficient number of health profes-
427 

sionals to meet current and future demands. It has been estimated that the Nation 

will need approximately 3.5 million health care workers in addition to the 2 million 

workers to replace those who leave the workforce. 

Further, the geographic maldistribution of health professionals—especially primary care physicians and other non-physician practitioners—leaves large numbers 

of Americans without access to care with as many as 50 million people living in 

communities officially designated as health professions shortage areas. Of particular 

concern are estimated shortages in dentistry, medicine, nursing, pharmacy, and an 

array of allied health professionals that will likely increase with an aging population 

and potentially less migration of health professionals throughout the world. 

The health and economic prosperity of the Nation depend on an effective and welltrained health workforce. Key to ensuring an adequate supply is investment in the 

educational programs and the students who are pursing careers in the health professions. Moreover, these educational programs need to increasingly attract students 

who will practice in underserved areas—both during their training and afterward. 

At the same time, continuing education and distance learning programs must be 

maintained to connect practitioners with advances in care and provide opportunities 

for consultation and referral. Strengthening the health care delivery system in underserved areas is key to our efforts to improve the health of the Nation and eliminate the disparities in health outcomes that result from inadequate access to care. 

The cornerstone of efforts to address the maldistribution of health professionals, 

to train a diverse health professions workforce, and to promote access for elderly 

and other vulnerable populations has been the programs authorized under Title VII 

of the Public Health Service Act. These programs include targeted scholarships for 

disadvantaged students; initiatives at the secondary school level to prepare students 

for college-level programs in the allied health professions; direct support for programs in pharmacy, dentistry, geriatrics, pediatrics, and other primary care disciplines; and Area Health Education Centers and Health Education and Training 

Centers. In addition, Title VIII funds for nursing have been especially important in 

helping to address widespread and persistent shortages and to develop programs for 

much needed advanced practice nurses, including the faculty to direct these programs. Support for health professions programs has been unstable and, in the case 

of Title VII, was cut more than half this year—from $252 million in fiscal year 2005 

to $99 million in fiscal year 2006. 

It is also important to note that cutting support for health professions education 

is likely to undermine current efforts to significantly expand community health centers. Staffing for these centers relies on primary care practitioners in the disciplines 

that are the focus of many of the programs in Titles VII and VIII. A recent study 

published in The Journal of the American Medical Association (March 1, 2006; Vol. 

295, No. 9) found that workforce shortages ‘‘may impede the expansion of the U.S. 

community health center safety net, particularly in rural areas.’’ The study also recommends that funding for Title VII be bolstered as this is ‘‘the only Federal program that exists to encourage the production of primary care clinicians likely to 

practice in underserved areas . . .’’ 

Reports from the member institutions of the AAHC confirm the adverse impact 

of further reductions in funding for Title VII. For example, at the University of Nebraska Medical Center, Title VII grants totaling $3.2 million were received in fiscal 

year 2005. These grants support the placement of behavioral health professionals 

in more than 140 rural and other underserved settings providing over 5,000 annual 

behavioral health visits. 

In addition, the Nebraska Geriatric Education Center, supported by a Title VII 

grant, plays a key role in training professionals to meet the needs of older patients 

while at the same time expanding access to care for this population. Finally, the 

School of Allied Health and the primary care medicine programs at the University 

of Nebraska Medical Center depend on Title VII grants to increase the diversity of 

their student population and to provide teaching opportunities in sites serving rural 

and other underserved communities. 

Without continuing support from Title VII grants, California health professions 

training programs could lose approximately $18 million annually. Statewide programs in California train physicians to work in underserved areas such as rural and 

inner city clinics, teach medical Spanish and cultural awareness skills to health professionals, and work with community health workers in low-income neighborhoods 

to teach self-help skills to patients with diabetes and asthma. 

In North Carolina more than $12.5 million in Title VII grants were distributed 

to the University of North Carolina at Chapel Hill, Duke University, and Wake Forest University. These funds are used to train primary care physicians, dentists, geriatric specialists, physician assistants, and others. These programs have helped to 

recruit a diverse cadre of students as well as support the work of Area Health Edu-
428 

cation Centers which are linked to the universities and provide essential access to 

care in underserved areas. 

These are just a few examples of the valuable work that results from the Federal 

funding of Title VII. The administration’s recommendations would virtually eliminate funding for these programs. 

Leaders of academic health centers nationwide confirm that these programs have 

made a difference in the nation’s health. The Nation’s return on its investment is 

clear. Title VII has succeeded in (1) supplying a workforce to serve populations in 

need, (2) enabling institutions and communities to recruit a diverse workforce, and 

(3) expanding access to care for many of the Nation’s most vulnerable individuals. We strongly recommend that funding for Titles VII and VIII total $550 million for fiscal year 2007. This would help to off-set the $155 million cut in place for this 

year and ensure that these critical programs can continue to address the urgent 

need to improve the health of our Nation. 

HOSPITAL PREPAREDNESS PROGRAM

The continuing threats from natural and/or terrorist events require our health 

system to be prepared to treat mass casualty events. Critical emergency care and 

inpatient surge capacity must be available across the country. Because of the financial condition of many public and non-profit hospitals, the cost of capital to undertake the necessary preparations for the treatment of large numbers of patients is 

beyond their reach. These funds make it possible for hospitals to build the infrastructure and surge capacity that is necessary to meet unknown, but potentially 

large, public health emergencies. 

We strongly support the administration’s budget request for $474 million for the 

hospital preparedness program to continue progress toward a more rapid and coherent response to these unpredictable circumstances. 

STATE HIGH-RISK INSURANCE POOLS

The number of uninsured in America continues to grow as employers curtail or 

drop group coverage and many workers are forced to forego coverage. The AAHC 

has been at the forefront of efforts to address the crisis of the Nation’s uninsured. 

This is an urgent problem and we are committed to supporting a range of approaches to make health coverage more accessible and affordable. 

One subset of the uninsured population involves individuals at risk for health 

care coverage because of one or more pre-existing health conditions. Some of these 

individuals have only been able to purchase coverage under the auspices of State 

high-risk health insurance pools because no other insurance product is available to 

them. State high-risk insurance pools are a vital pathway for those who have been 

excluded from the health insurance market because of their health status. 

Section 2745 of the Public Health Service Act authorizes a program of grants to 

the States for the establishment and operation of qualified high-risk health insurance pools. In the recently enacted Deficit Reduction Act, Congress extended this 

program and authorized $75 million for fiscal year 2007. Unfortunately, the President’s budget does not recommend any funding for this important program. We urge 

the subcommittee to fund this grant program at the fully authorized amount of $75 

million. 

We thank you for the opportunity to present our views and recommendations regarding funding for discretionary health programs in fiscal year 2007. Our member 

institutions are committed to improving the Nation’s health and well-being, and we 

look forward to working with Chairman Specter and all members of the subcommittee. We are pleased to be available to provide information and answer questions at any time. 

PREPARED STATEMENT OF THE ASSOCIATION OF AMERICAN CANCER INSTITUTES

The Association of American Cancer Institutes (AACI), representing 86 of the Nation’s premier academic and free-standing cancer centers, appreciates the opportunity to submit this statement for consideration as the Labor-Health and Human 

Services Appropriations Subcommittee plans the fiscal year 2007 appropriations for 

the National Institutes of Health (NIH) and the National Cancer Institute (NCI). 

AMERICA’S INVESTMENT IN CANCER RESEARCH

Thirty–five years ago, a diagnosis of cancer was largely a death sentence. Since 

then, our national investment in cancer research has reaped remarkable returns, including potential cancer vaccines, improved detection strategies, and targeted, less 
429 

1 United States. Department of Health and Human Services. The Nation’s Investment in Cancer Research. 2006. (http://plan.cancer.gov/pdf/ncil2007lplan.pdf) 2Statistics from the American Cancer Society. 

3 Estimates from the National Heart, Lung and Blood Institute. 

4 United States Senate. Joint Economic Committee, Office of the Chairman, Connie Mack. The 

Benefits of Medical Research and the Role of NIH. 2000. (http://jec.senate.gov) 5 Estimates from Lasker/Funding First. (www.fundingfirst.org) 

6 United States. Department of Commerce, Bureau of Economic Analysis. Regional Multipliers: 

A User Handbook for the Regional Input-Output Modeling System (RIMS II). 3rd ed. 1997. 7 United States. National Cancer Institute. Advancing Translational Cancer Research: A Vision of the Cancer Center and SPORE Programs of the Future. 2003. (http://deainfo.nci.nih.gov/ 

advisory/ncab/p30-p50/P30-P50final12feb03.pdf) 

difficult therapies. The last several years have been particularly exciting for science 

and specifically for cancer research. Advances such as the sequencing of the human 

genome and improved insights about the genetics of cancer have led to promising 

new approaches to the prevention and treatment of cancer. Today, many patients 

are benefiting from targeted drug therapies, like Gleevec, Tarceva and Avastin that 

are more specific, less toxic and more effective. It is the support of the Nation’s cancer research enterprise by the NCI, 80 percent 1 of whose funds are spent at academic research institutions across the country, that has led to these discoveries. 

The President’s 2007 budget proposal provides only level funding for the NIH and 

a $40 million cut for the NCI. This is of great concern to the Nation’s cancer centers, 

which play a critical role in the progress against cancer, and are major hubs of State 

of the art cancer research, drug development, treatment, prevention and control. A 

depleted budget for NCI directly impacts the pace of scientific discovery and may 

mean that new ideas to combat cancer will go unexplored, and the development of 

novel cancer therapies will be seriously compromised. Reduced funding will also discourage the next generation of cancer researchers leading some to choose other 

fields. We are at a time of unprecedented opportunity to make a dramatic assault 

on cancer, and the hard-won momentum that has been achieved in recent years 

must be sustained. Otherwise, America risks losing an entire generation of ideas 

that could produce possible cures for the diseases we know as cancer. 

CANCER RESEARCH: SAVING LIVES AND MONEY

At the Nation’s cancer institutes, we have demonstrated that cancer research 

saves lives. Cancer mortality rates decreased by 10 percent between 1991 and 2001, 

translating to as many as 321,000 lives saved 2 and in 2003, the number of cancer 

deaths dropped for the first time since the war on cancer began. The death rate for 

all cancers combined is dropping about 1.1 percent per year, while the rate of new 

cancers is holding steady.2 The five-year relative survival rate for all cancers diagnosed between 1995 and 2000 is 64 percent, an increase from just 50 percent in the 

mid-1970s. Thanks to prevention research and the development of early detection 

technologies and new treatments, today, nearly 10 million Americans are cancer 

survivors.2

The financial cost of cancer is rising, but research advances help to mitigate cancer’s annual price tag, which in 2005 was estimated at $210 billion, including $136 

billion in lost productivity and over $70 billion in direct medical costs.3 Tamoxifen, 

used to treat breast cancer, is saving $41,372 for each year of life gained in women 

35 to 49 years old; $68,349 for women 50 to 59 years old; and $74,981 for women 

60 to 69 years old.4 The drug Cisplatin has translated to an increase in the survival 

rate for testicular cancer patients. The drug cost an estimated $56 million to develop 

and has already produced an annual return of $166 million in treatment savings.5

That research saves money is evident. 

THE NATION’S CANCER CENTERS: ECONOMIC ENGINES IN THEIR COMMUNITIES

In addition to training the future workforce for cancer care and research, America’s cancer centers themselves have direct economic impact, both locally and nationally. It is estimated that every dollar spent on research funding and patient activities at cancer centers translates to $2.50 to $3 invested in the local economy.6 In 

addition, the amount of research support and operating budgets that are leveraged 

through NCI-designated cancer centers support grant (CCSG) funding alone is striking. The total amount of research support is more than ten times the amount generated by the CCSG grants themselves.7 By attracting patients from outside the 

community, constructing new laboratories and clinical facilities, recruiting new faculty and staff from outside the region who bring cutting-edge scientific, clinical and 

public health expertise to work in communities, and developing entrepreneurial op-
430 

portunities in the biotech and pharmaceutical industries, cancer research centers 

serve as an economic stimulus and generate commerce in their communities. 

UNITED STATES: GLOBAL LEADER IN CANCER RESEARCH

The United States is a world leader in the battle against cancer because of the 

Nation’s past investment in cancer research, but our competitive edge will quickly 

erode without continued commitment. Sustained inquiry and scientific advancement 

are critical to maintaining our competitive stature. Failure to appropriate new funds 

for biomedical innovation and discovery threatens America’s capacity to compete 

with emerging global economies and other countries are eager to take our place as 

the world’s leader in biomedical research. The United States must significantly enhance its research and technical capacity to maintain our preeminent position. 

CONCLUSION

In summary, cancer research saves lives, saves money, stimulates economic 

growth at home and enhances U.S. competitiveness abroad. Federal investment in 

cancer research must remain a national priority. America must commit to sustaining the pace of cancer-related science so that new discoveries are translated into 

clinical benefit for all. Congress has the opportunity now to take an important leadership role in assuring that the NIH budget is increased in fiscal year 2007. We 

urge your support to increase this critically important funding. 

PREPARED STATEMENT OF THE ASSOCIATION OF INDEPENDENT RESEARCH INSTITUTES

The Association of Independent Research Institutes (AIRI) respectfully submits 

this written statement for the record of the U.S. Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education. AIRI appreciates 

the commitment that the members of this Subcommittee have made to biomedical 

research through support for the National Institutes of Health (NIH). 

AIRI is a national organization of 86 independent, not-for-profit research institutes that perform basic and clinical research in the biological and behavioral 

sciences in 28 States. Our member institutes are private, stand-alone research centers that set their sights on the vast frontiers of medical science. AIRI institutes— 

many of which were originally established by generous philanthropists or from spinoffs of unique university research areas—tend to be relatively small in size, with 

budgets ranging from a few million to hundreds of millions of dollars. In addition, 

each AIRI institution is governed by its own independent Board of Directors, which 

allows our members to be structurally nimble and capable of adjusting their research programs to emerging areas of inquiry. While the primary function of AIRI 

institutes is research, most are also strongly involved in training the next generation of biomedical researchers. In a testament to the quality of research and innovative ideas that AIRI institutes bring to the national biomedical enterprise—our institutions consistently exceed the success rates of the overall NIH grantee pool, and 

receive about 11 percent of NIH’s peer reviewed, competitively awarded extramural 

grants. 

The doubling of the NIH budget allowed the biomedical research community to 

accelerate solutions to human disease and disability. We have blazed new trails for 

medical research, diving into the intricacies of how the human body musters its defenses, and how those responses can be evaluated, enhanced, and modified. In addition, it helped us to realize new scientific management strategies such as fostering 

interdisciplinary research and creating new robust teams of scientists that, before 

the doubling, did not have scientific common ground. These research teams navigate 

the fast progressing research environment where there is an increasing need to integrate and aggregate basic research, computational capabilities, and clinical evidence 

into new cures more quickly. Further, the doubling has helped us to redefine health 

and healthcare goals based on scientific discoveries that were out of reach prior to 

the doubling. We now talk about disease and health care in terms of predictive, preventative and pre-emptive tactics. 

With flexible structures that are friendly to change, AIRI institutes are able to 

move amongst the new science partnerships that will transform America’s health 

and health care in the 21st century. NIH has responded to the rapidly changing 

world by strategically framing the next generation of biomedical research through 

cross-cutting, interdisciplinary initiatives such as those supported in the NIH Roadmap, the NIH Neuroscience Blueprint, the new Clinical and Translational Science 

Award program and the new Genes, Environment and Health Initiative. AIRI institutes are innovators poised to foster partnerships that will nurture the collaborative 
431 

environment necessary to successfully and efficiently conduct research within these 

evolving NIH frameworks. 

AIRI endorses the fiscal year 2007 Ad Hoc Group for Medical Research proposal 

to increase the NIH budget by five percent over the fiscal year 2006 level. We recognize that the current budget environment puts pressure on Congress to face difficult 

funding trade-offs; however, as this subcommittee works to define priorities for the 

year and set goals for the future, AIRI asks that you maintain your long-term commitment of support for NIH and its mission. The President’s fiscal year 2007 budget 

would flat-fund NIH. The 5 percent increase for NIH supported by AIRI would not 

only allow the agency to sustain current programs but also invest in critical new 

initiatives. This would prevent NIH from falling behind the ‘‘Innovation Index’’—the 

rate of biomedical inflation as calculated in the Biomedical Research and Development Price Index (BRDPI) plus a modest investment in new initiatives. 

Using the fiscal year 2007 BRDPI projection as a base, NIH would require an increase of at least 3.8 percent over fiscal year 2006. AIRI strongly believes that an 

increase for NIH above BRDPI is justified by the health needs as well as current 

and burgeoning research capabilities of the Nation. An increase above BRDPI would 

allow new innovative ideas to be funded and would infuse existing programs to 

evolve as their research findings push them to higher levels of basic understanding, 

translation and clinical functionality. 

AIRI also hopes that the subcommittee will support programs and policies that 

foster a sustainable, biomedical research workforce. The biomedical research community is dependent upon a knowledgeable and skilled workforce to address current 

and future critical health research challenges. The cultivation and preservation of 

this workforce is dependent upon several factors, including the ability to: recruit scientists and students globally; train researchers both in basic and clinical biomedical 

research; focus on career development initiatives to recruit and retain researchers 

at critical stages; support new and young investigators; and maintain the NIH extramural investigator salary cap at Executive Level I. By again maintaining the 

NIH extramural investigator salary cap (the salary level that extramural researchers may apply toward their NIH grants) at Executive Level I in the fiscal year 2007 

Appropriations bill, Congress will ensure that extramural investigators’ salaries are 

competitive with the salary level for intramural researchers at NIH. As we work to 

enhance biomedical research capabilities, we should not impose barriers that would 

discourage talented people from committing to careers in research. 

In addition, AIRI urges Congress to support NIH-funded equipment and infrastructure programs. As the investment in medical research and the national biomedical research agenda have expanded, the need for acquisition and modernization 

of laboratory equipment and infrastructure has become critical. NIH equipment 

grants meet the specific infrastructure needs of research institutions to maximize 

productivity of their research grants. 

Medical research is a long-term process and, in order to meet the challenges of 

improving human health, we must not diminish our Federal commitment and investment. It is essential to sustain the momentum of NIH-funded research so that 

it continues to meet the goal of improving the health of all Americans. AIRI would 

like to thank the subcommittee for its important work to ensure the health of the 

Nation, and we appreciate this opportunity to present recommendations concerning 

the fiscal year 2007 Appropriations bill. 

PREPARED STATEMENT OF THE ASSOCIATION OF WOMEN’S HEALTH, OBSTETRIC AND

NEONATAL NURSES (AWHONN) 

The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) 

appreciates the opportunity to provide comment on the fiscal year 2007 appropriations for nursing education, research, and workforce development programs as well 

as programs designed to improve maternal and child health. AWHONN is a membership organization of 22,000 nurses, and it is our mission to promote the health 

and well-being of all women and newborns. AWHONN members are registered 

nurses, nurse practitioners, certified nurse-midwives, and clinical nurse specialists 

who work in hospitals, physicians’ offices, universities, and community clinics 

throughout the United States. 

HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)

AWHONN recommends a minimum of $7.5 billion in funding for HRSA 

AWHONN is deeply concerned by the President’s budget request of a $255 million 

cut in fiscal year 2007 to HRSA. Through its many programs and new initiatives, 

HRSA helps countless individuals live healthier, more productive lives. In this day 
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and age, rapid advances in research and technology promise unparalleled change in 

the Nation’s health care delivery system. HRSA could be well positioned to meet 

these new challenges as it continues to provide for the Nation’s most vulnerable citizens. In order to respond to these challenges, AWHONN asserts that HRSA will require an overall funding level of at least $7.5 billion for fiscal year 2007. 

TITLE VIII—NURSING WORKFORCE DEVELOPMENT PROGRAMS UNDER HRSA

AWHONN recommends a minimum of $175 million in funding for Title VIII 

Nursing workforce development programs are authorized under Title VIII of the 

Public Health Service Act. These programs are essential components of the American health care safety net, which brings critical services to our entire Nation. In 

addition, Title VIII programs are the only comprehensive Federal programs that 

provide annual funds for nursing education that help nursing schools and nursing 

students prepare to meet patient needs in a changing healthcare delivery system. 

These programs are also in institutions that train nurses for practice in medically 

underserved communities and Health Professional Shortage Areas. While the President’s budget recommends level funding of Title VIII at $150 million for fiscal year 

2007, AWHONN supports a minimum of $175 million in funding for Title VIII Nursing Workforce Development programs. 

In 2002, Congress enacted the Nurse Reinvestment Act that provides funding for 

new and expanded programs such as scholarship and repayment programs like the 

Nurse Education Loan Repayment Program (NELRP), career ladders, internships 

and residencies, retention programs, and faculty loans designed to encourage students to consider nursing, keep nurses in the field, and ensure that nurse educators 

are plentiful enough to educate future nurses that we desperately need. These new 

programs received an initial appropriation of $20 million in fiscal year 2003, which 

was in addition to $93 million in funding provided for existing Title VIII programming. Unfortunately, due to limited funding in the first 2 years of the new authorization, the loan and scholarship programs have not been as successful as they could 

be in providing support to students in nursing schools. For example, NELRP is a 

competitive program that repays 60 percent of the qualifying loan balance of registered nurses selected for funding in exchange for 2 years of service at a critical 

shortage facility. In fiscal year 2005, HRSA made a total of 599 awards of this nature with an obligation of $19 million. These loans are imperative for continuing to 

bring nurses into underserved communities in addition to bringing nurses through 

their education and training years. 

Nurses are essential health care providers, and the nursing community seeks the 

support of this subcommittee for bolstering existing nursing programs and creating 

new ones for recruiting students into the nursing profession. In addition, AWHONN 

seeks development of qualified faculty members for educating new nurses, and we 

need to create career opportunities for retaining nurses as faculty. The entire nursing workforce needs strengthening. As a result, it will take long-term planning and 

innovative initiatives at the local, State, and Federal level to assure an adequate 

supply of a qualified nurse workforce for the Nation. Federal investment in nursing 

education and retention programs is critical for meeting the health care needs of 

our Nation. 

Increased funding for Title VIII will make a positive impact on the nursing 

shortage 

Recent data from the Bureau of Health Professions, Division of Nursing’s National 

Sample Survey of Registered Nurses—February 2002, confirm that of the approximately 2.9 million registered nurses in the Nation only 82 percent of these nurses 

work full-time or part-time in nursing. A dominant factor in this shortage is the impending retirement of up to 40 percent of the workforce by 2010. This surge in retirement will occur at the same time as the surging baby boomer population retires, 

which will noticeably cause an increase in demand for health care services and the 

services of registered nurses. In addition, the U.S. Bureau of Labor and Statistics 

detailed in February 2004 that registered nurses will have the largest projected 10- 

year job growth in the United States, with about 1 million new job openings by 

2010. 

The shortage of registered nurses and the effect of this shortage on staffing levels, 

patient safety and quality care demands attention and a significant increase in 

funding to bolster and improve these programs. Nursing is the largest health profession, yet only one-fifth of one percent of Federal health funding is directed to nursing education. A significant increase in funding for these programs can help lay the 

groundwork for expanding the nursing workforce, through education and clinical 

training and retention programs. 
433 

Increased funding for Title VIII will help fill the nursing gap 

The nursing shortage is not confined solely to care providers, and this demand 

for providers is hindered by the growing shortage of nursing faculties. Nursing faculty continues to decrease in number. According to a 2005 survey on faculty vacancies from the American Association College of Nursing, the number of full-time 

nursing faculty required to ‘‘fill the nursing gap’’ is approximately 40,000. Currently, 

there are less than 20,000 full-time nursing faculty in the system. In 2004, nursing 

schools turned away more than 32,000 qualified applicants to entry-level baccalaureate and graduate nursing programs due to insufficient faculty, clinical sites, 

classroom space, clinical preceptors, and budget constraints, including almost 3,000 

students who could potentially fill faculty roles. When all nursing programs are considered, the number turned away during the 2003–2004 academic year grows to 

more than 125,000 qualified applicants. Without sufficient support for current nursing faculty and adequate incentives to encourage more nurses to become faculty, 

nursing schools will fail to have the teaching infrastructure necessary to educate 

and train our next generation of nurses that we so desperately need. 

While the capacity to implement faculty development is currently available 

through Section 811 and Section 831, adequate funding and direction is needed to 

ensure that these programs are fully operational. Options to provide support for fulltime doctoral study are essential to rapidly prepare the nurse educators of the future. AWHONN recommends that a portion of the funds be allocated for faculty development and mentoring. 

Increase funding for Title VIII will encourage advance practice nursing. 

AWHONN recognizes the importance of the investment in advanced practice nursing programs. As in other professions, the advanced degree has become a necessary 

achievement for career advancement, and registered nurses who pursue the MSN 

degree are part of the cadre of nurses who go on to become faculty. Our Nation 

needs more nurses with basic training to enter the field, but focusing only on these 

nurses addresses only half the problem. The nursing shortage encompasses nursing 

faculty; both advanced practice nursing and basic nursing must receive additional 

funding but not one at the expense of the other. 

TITLE V—MATERNAL AND CHILD HEALTH BUREAU (MCHB) UNDER HRSA

AWHONN recommends $850 million in funding for MCHB 

The Maternal and Child Health Bureau incorporates valuable programs like the 

Traumatic Brain Injury program, Universal Newborn Hearing Screening, Emergency Medical Services for Children and Healthy Start, which were zeroed out, and 

the Maternal and Child Health Block Grant (MCH) that was level funded. These 

programs provide comprehensive, preventive care for mothers and young children, 

as well as an array of coordinated services for children with special needs. In fact, 

MCH serves over 80 percent of all infants in the United States, half of all pregnant 

women, and 20 percent of all children. 

Restore Funding to the Universal Newborn Hearing Screening 

The Children’s Health Act of 2000 authorized funding for grants and programs 

to improve State-based newborn screening. Newborn screening is a public health activity used for early identification of infants affected by certain genetic, metabolic, 

hormonal or functional conditions for which there are effective treatment or intervention. Screening detects disorders in newborns that, left untreated, can cause 

death, disability, mental retardation and other serious illnesses. 

Screening programs coordinated through MCHB help to ensure that every baby 

born in the United States receives, at a minimum, a universal core group of screening tests regardless of the State in which he or she is born. However, the administration again proposes eliminating universal newborn screening programs. It goes 

without saying that more disorders will go unnoticed if the affected newborns are 

not screened. AWHONN encourages the subcommittee to restore funding to the fiscal year 2006 level plus inflation for the newborn hearing screening program. 

NATIONAL INSTITUTES OF HEALTH (NIH)

AWHONN recommends $29.75 billion in funding for the NIH 

Multiple institutes housed under the National Institutes of Health (NIH) serve 

valuable roles in helping promote the importance of nursing in the health care industry along with the health and well-being of women and newborns. While 

AWHONN applauds the doubling of NIH’s budget over the years, the President’s 

Budget signals a level funding of NIH programs for fiscal year 2007. By allowing 

level funding, America will most certainly loose its edge in biomedical research. 
434 

NATIONAL INSTITUTE OF NURSING RESEARCH (NINR) UNDER NIH

AWHONN recommends $160 million in funding for NINR 

The National Institute of Nursing Research (NINR) engages in significant research affecting areas such as health disparities among ethnic groups, training opportunities for management of patient care and recovery, and telehealth interventions in rural/underserved populations. This research allows nurses to continually 

refine their practice and provide quality patient care. 

For example, NINR research is invaluable in contributing to improved health outcomes for women. Recent public awareness campaigns target differences in the manifestation of cardiovascular disease between men and women. The differing symptoms are the source of many missed diagnostic opportunities among women suffering from the disease, which is the primary killer of American women. Because 

of the emphasis on biomedical research in this country, there are few sources of 

funds for high-quality behavioral research for nursing other than NINR. It is critical 

that we increase funding in this area in an effort to optimize patient outcomes and 

decrease the need for extended hospitalization. While the President’s budget recommended level funding for NINR at $137 million, AWHONN requests $160 million 

for fiscal year 2007. 

NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT (NICHD) UNDER NIH

AWHONN recommends $1.328 billion in funding for NICHD 

The National Institute of Child Health and Human Development (NICHD) seeks 

to ensure that every baby is born healthy, that women suffer no adverse consequences from pregnancy, and that all children have the opportunity for a healthy 

and productive life unhampered by disease or disability. For example, with increased funding, NICHD could expand its use of the NICHD Maternal-Fetal Medicine Network to study ways to reduce the incidence of low birth weight. Prematurity/low birth weight is the second leading cause of infant mortality in the 

United States and the leading cause of death among African American infants. 

AWHONN, like many organizations directly involved in programs to improve the 

health of women and newborns, looks to NICHD to provide national initiatives, such 

as the Maternal-Fetal Medicine Network that assists with the care of pregnant 

women and babies. 

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS) UNDER NIH

AWHONN recommends $680 million for NIEHS 

Research conducted by the National Institute of Environmental Health Sciences 

(NIEHS) plays a critical role in what we know about the relationship between environmental exposures and the onset of diseases. Through the research sponsored by 

this Institute, we know that Parkinson’s disease, breast cancer, birth defects, miscarriage, delayed or diminished cognitive function, infertility, asthma and many 

other diseases and ailments have confirmed environmental triggers. Our expanded 

knowledge, as a result, allows both policymakers and the general public to make 

important decisions about how to reduce toxin exposure and reduce the risk of disease and other negative health outcomes. 

INDIAN HEALTH SERVICE (IHS) UNDER THE DEPARTMENT OF HEALTH AND HUMANS

SERVICES (HHS)

AWHONN recommends $5.54 billion in funding for IHS 

The Indian Health Service (IHS) is the principal Federal health care provider and 

health advocate for the American Indian and Alaska Native populations. The President’s budget recognizes this importance by requesting an increase to the IHS budget of $124 million over the fiscal year 2006 level, bringing the total to $4 billion for 

fiscal year 2007. While AWHONN applauds this increase, we recommend further increased funding for IHS to fully achieve its goals. 

A recent study of Federal health care spending per capita found that the United 

States spends $3,803 per year per Federal prisoner, while spending about half that 

amount for a Native American: $1,914. Per capita health care spending for the U.S. 

general population is $5,065 per year. A significant increase in funding over fiscal 

year 2006 spending levels is necessary for the Federal government to fulfill its responsibility to Indian Country and achieve its stated goals. 

While the nursing shortage continues nationwide, IHS has been disproportionately affected by the lack of RNs. IHS nurses are older, with an average age of 48, 

and nearly 80 percent of RNs are over the age of 40. Further, the average vacancy 

rate for RNs is 14 percent. IHS administers three interrelated scholarship programs 
435 

designed to meet the health professional staffing needs of IHS and other health programs serving Indian people. These programs are severely under-funded. Targeted 

resources need to be invested in the IHS health professions programs in order to 

recruit and retain registered nurses in Indian Country. 

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) UNDER HHS

AWHONN recommends $8.65 billion in funding for CDC 

The President’s budget request funds the CDC at $8.2 billion for fiscal year 2007, 

a $179 million decrease over fiscal year 2006. It is critically important to increase 

funding for CDC. For example, CDC has been deeply involved in the prevention of 

birth defects through programs like the Folic Acid Education Campaign and the National Center on Birth Defects and Developmental Disabilities (NCBDDD) for over 

30 years. The public health impact of birth defects is tremendous. Of the four million babies born each year in the United States, approximately 120,000 are born 

with a serious birth defect. CDC funds several programs critical to reducing the 

number of children born with birth defects, including funding to States for birth defects tracking systems. Due to lack of funds, in fiscal year 2005 CDC was only able 

to fund 15 States, which were down from 28 States in fiscal year 2004. Additional 

funding for these grants is needed to fund all of the States seeking CDC assistance 

for these critical surveillance programs. 

Overall, AWHONN urges the Subcommittee to at a minimum restore all cuts to 

programs from fiscal year 2006 and adjust for inflation. Funding the aforementioned 

agencies and their programs at this minimum level will at least allow them to effectively operate and achieve their stated mission. AWHONN thanks you for your time, 

and we greatly appreciate this opportunity submit testimony on these critical areas 

of funding. 

PREPARED STATEMENT OF THE CHARLES R. DREW UNIVERSITY OF MEDICINE AND

SCIENCE

SUMMARY OF RECOMMENDATIONS FOR FISCAL YEAR 2007

—Provide a 5 percent increase for fiscal year 2007 to the National Institutes of 

Health (NIH) and a proportional increase of 5 percent to the individual institutes and centers, specifically, the National Cancer Institute (NCI), the National 

Center for Research Resources (NCRR), and the National Center on Minority 

Health and Health Disparities (NCMHD). 

—Continue to urge NCI to support the establishment of a collaborative minority 

health comprehensive research center at a historically minority institution in 

collaboration with the existing NCI Cancer Centers. Continue to urge NCRR 

and NCMHD to collaborate on the establishment of a minority health comprehensive research center. 

—Urge the Department of Health and Human Service, particularly the Office of 

Minority Health (OMH), to support a Health Professions Leadership Development and Support Program at Charles R. Drew University of Medicine and 

Science. 

Mr. Chairman and members of the subcommittee, thank you for the opportunity 

to present you with testimony. Charles R. Drew University of Medicine and Science 

is one of four predominantly minority medical schools in the country, and the only 

one located west of the Mississippi River. It is also one of the Hispanic serving institutions in California. 

Charles R. Drew University of Medicine and Science is located in the Watts-section of South Central Los Angeles, and has a mission of rendering quality medical 

education to underrepresented minority students, and, through its affiliation with 

the University of California Los Angeles (UCLA) at the co-located King-Drew Medical Center, Drew provides valuable health care services to the medically underserved community. Through innovative basic science, clinical, and health services 

research programs, Charles R. Drew University works to address the health and social issues that strike hardest and deepest among inner city and minority populations. 

The population of this medically underserved community is predominately African 

American and Hispanic. Many of these people would be without health care if not 

for the services provided by Charles R. Drew University of Medicine and Science. 

This record of service has led Charles R. Drew University (in partnership with 

UCLA School of Medicine) to be designated as a Health Resources and Services Administration Minority Center of Excellence. 
436 

RESEARCH: A RESPONSE TO HEALTH DISPARITIES

Racial and ethnic disparities in health outcomes for a multitude of major diseases 

in minority and underserved communities continue to plague this Nation that was 

built on a premise of equality. As articulated in the Institute of Medicine report entitled ‘‘Unequal Treatment: Confronting Racial and Ethnic Disparities in Health 

Care’’, this problem is not getting better on its own. For example, African American 

males develop cancer 15 percent more frequently than white males. Similarly, African American women are not as likely as white women to develop breast cancer, 

but are much more likely to die from the disease once it is detected. In fact, according to the American Cancer Society, those who are poor, lack health insurance, or 

otherwise have inadequate access to high-quality cancer care, typically experience 

high cancer incidence and mortality rates. Despite these devastating statistics, we 

still do not have the resources to try to combat cancer in our communities. 

In response to these findings and the high cancer rate in our own community, 

Charles R. Drew University of Medicine and Science has been working to build a 

Life Sciences Research Facility on its campus. The Center would specialize in providing not only medical treatment services for the community, but would also serve 

as a research facility, focusing on prevention and the development of new strategies 

in the fight against cancer. These strategies will be disseminated locally and nationally to communities at risk, as well as to others engaged in comprehensive cancer 

prevention programs. 

The Life Sciences Research Building will provide the additional laboratory and 

support space necessary for further progress and development of innovative research 

in the clinical, biological, and life sciences. The new, three story building will provide Drew with state-of-the-art, flexible, modern biomedical and bio-behavioral research space. The proposed structure will provide 40,000 gross square feet, which 

is a significant increase over existing facilities at the University. Current research 

activities will be enhanced by additional laboratory and support space. The facility 

will house the Life Sciences Institute, building upon Drew’s demonstrated strengths 

in clinical research, health services research, and basic science research. The Life 

Sciences Research Building will allow researchers in the College of Medicine and in 

the College of Allied Health to capitalize on the explosion of knowledge in genetics 

and biology, epidemiology, and health care delivery while exploring the interface between health, social, and economic infrastructure, cultural attitudes, and legislative 

policy. The Institute will play a unifying role for the life sciences across the University by bringing researchers from a wide array of disciplines together under one roof 

to collaborate in forward-looking research aimed at improving the health and quality of life of medically underserved and low-income communities. 

Mr. Chairman, the support that this subcommittee has given to the National Institutes of Health (NIH) and its various institutes and centers has and continues 

to be invaluable to our university and our community. The dream of a state-of-theart facility to aid in the fight against cancer and other diseases in our underserved 

community would be impossible without the resources of NIH. 

To help facilitate the establishment of the Life Sciences Research Building at 

Charles R. Drew University of Medicine and Science, the University is seeking support from the National Institutes of Health’s National Center for Research Resources (NCRR), the National Center for Minority Health and Health Disparities 

(NCMHD), and the National Cancer Institute (NCI). 

HEALTH PROFESSIONS LEADERSHIP DEVELOPMENT AND SUPPORT PROGRAM

A Health Professions Leadership Development & Support Program is designed to: 

(1) enhance faculty recruitment and retention support for academicians providing 

for the supervision, instruction, and guidance of resident physicians-in-training in 

underserved communities; and (2) provide financial stability for the Office of Graduate Medical Education (GME) to ensure the sustainability of this national priority 

area. 

This is a critical program for improving the minority pipeline as outlined in the 

recent report by a committee chaired by former Secretary of DHHS, Dr. Louis Sullivan titled ‘‘Missing Persons: Minorities in the Health Professions September 20, 

2004’’. This report highlights the critical role played by institutions such as Drew 

University as a major training site for minority health care professionals and biomedical scientists. Specifically, this program will help to support the Drew University Graduate Medical Education program. 

The Program will be used by the University to augment and/or recruit physician 

leaders in Family Medicine, Pediatrics, Psychiatry, Surgery, Internal Medicine, and 

Obstetrics/Gynecology in response to the need to develop external, non-County residency rotations. The Surgery residency program was not renewed as of 2005, how-
437 

ever, the University plans to reapply for a new program as part of its faculty recruitment plans. These actions coincide with the affiliated medical center’s anticipated efforts to secure institutional approval from the Centers for Medicare and 

Medicaid Services (CMS) as well as the Joint Commission on the Accreditation of 

Healthcare Organizations (JCAHO). 

CONCLUSION

Despite our knowledge about racial/ethnic, socio-cultural and gender-based disparities in health outcomes, the ‘‘gap’’ continues to widen in most instances. Not 

only are minority and underserved communities burdened by higher disease rates, 

they are less likely to have access to quality care upon diagnosis. As you are aware, 

in many minority and underserved communities preventive care and/or research is 

completely inaccessible either due to distance or lack of facilities and expertise. This 

is a critical loss of untapped potential in both physical and intellectual contributions 

to the entire society. 

Even though institutions like Charles R. Drew are ideally situated (by location, 

population, and institutional commitment) for the study of conditions in which 

health disparities have been well documented, research is limited by the paucity of 

appropriate research facilities. With your help, the Life Sciences Research Facility 

will facilitate translation of insights gained through research into greater understanding of disparities. 

We look forward to working with you to lessen the burden of health disparities 

and working with the Department of Health and Human Services to address the 

residency training program issues at Charles R. Drew University. 

Mr. Chairman, thank you for the opportunity to present testimony on behalf of 

Charles R. Drew University of Medicine and Science. 

PREPARED STATEMENT OF THE COOLEY’S ANEMIA FOUNDATION

SUBJECT

Mr. Somma’s testimony thanks the subcommittee for the past support it has 

shown to the Cooley’s Anemia Foundation and to the patients who are afflicted with 

this fatal genetic blood disease, also known as thalassemia. He urges the Committee 

to restore the funding cut in the President’s budget from the Thalassemia Blood 

Safety Surveillance program at CDC. He discusses the importance of funding NIH 

research into this disease, particularly through NHLBI and NIDDK. He challenges 

the subcommittee to challenge the NIH to find the cure for thalassemia and, with 

it, for other similar diseases through a strong commitment to gene therapy. He 

urges continued support for the Thalassemia Clinical Research Network. 

Mr. Chairman and Members of the Subcommittee: Thank you for the opportunity 

to present this testimony to the subcommittee today. My name is Frank Somma. 

I live in Holmdel, New Jersey and I am honored to serve as the National President 

of the Cooley’s Anemia Foundation. I speak to you in my capacity as a volunteer. 

As many members of this subcommittee know, Cooley’s anemia, or thalassemia, is 

a fatal genetic blood disease. 

I could bog you down in a detailed scientific explanation of what happens physiologically when the human body cannot produce red blood cells in adequate numbers 

and of adequate quality to sustain life. I am not going to do that. The important 

thing for members of this subcommittee to remember about Cooley’s anemia is that 

it is an incurable and fatal genetic blood disease. Period. 

I also understand that I can present you with five pages of single-spaced testimony. I am not going to do that either. Instead, I am respectfully going to address 

the following three issues in a clear and succinct manner. 

—The first is the immediate need to restore $2.0 million to the CDC to fund the 

thalassemia blood safety surveillance network. 

—The second issue is the equally critical need for this subcommittee to commit 

our government to the development of a focused gene therapy program that is 

designed to cure something. 

—The third issue is the urgent need to restore funding to NIH to assure the continuation of desperately needed research at NIDDK and for the Thalassemia 

Clinical Research Network at NHLBI. 

Blood Safety Surveillance 

Mr. Chairman, when a baby is diagnosed with Cooley’s anemia, or thalassemia 

major, the standard of treatment is to begin that child on blood transfusions. I want 

to be very clear here that the treatment is not to give the child a blood transfusion; 
438 

it is to begin a lifetime treatment regimen of such invasive and dangerous intervention. Our patients receive a blood transfusion every two weeks for the rest of their 

lives. 

Because Cooley’s anemia patients are transfused so regularly, they are the early 

warning system for problems in the blood supply. If there is an emerging infection 

or other problem with the blood supply, it is our patients that will get it first. 

Please understand that nearly every patient over the age of 18 today who has 

thalassemia major also has HIV or hepatitis C as a result of their transfusions— 

or did have it while they were still alive. 

Blood safety is a major national issue. Surgical and trauma patients often have 

no choice but to be transfused. And, it is done an emergency basis many times. 

Nothing is more important to the patient at the time of transfusion than that they 

can be confident that the blood being pumped into their veins is free from infectious 

agents. 

Utilizing the status of our patient population, the CDC has been monitoring the 

overall safety of the blood supply to this Nation and is prepared to issue an alert 

if a new virus or threat emerges. The blood safety surveillance program is currently 

operating very effectively through the Office of Hereditary Blood Diseases in the National Center for Birth Defects and Developmental Disability (NCBDDD) with about 

$2.0 million in funding. Inexplicably, the President’s budget eliminates the program, 

leaving the blood supply vulnerable to contamination by new viruses or mutated 

versions of old viruses, putting all Americans not just those with Cooley’s Anemia 

at risk. 

We are respectfully requesting that the subcommittee restore this funding to the 

$2.0 million level that currently exists in order to continue to protect Americans 

from unnecessary infections and diseases that may occur in the blood supply. 

Gene Therapy 

Mr. Chairman, it has been a long time coming, but we are here to bring you some 

very good news about gene therapy. After a lot of false starts, we can now see a 

pathway for scientists to follow to help turn the promise of gene therapy into cures 

for single gene disorders. The problem to this point has not been one of science; it 

has been one of expectations. As a society, we forgot that science requires trial and 

error and that experiments are just that—experiments. 

Today, gene therapy is advancing at a rapid pace in the rest of the world. Exciting 

work is being undertaken in Japan and China, in the UK and in France. Unfortunately, it is showing less progress the United States of America... and that is 

not right. We are the international leaders in scientific research and, in a field like 

this—fraught with financial, scientific and ethical minefields—it is essential that 

America be the world leaders. We set the highest ethical and moral standards on 

every one of these issues. We protect human subjects best. It is simply too important to leave it to anyone else. 

For persons with a single cell mutation disorder like thalassemia or sickle cell disease or severe combined immune deficiency (SCID), gene therapy holds out great 

promise for a cure. In fact, the CAF has recently launched the CURE Campaign: 

Citizens United for Research Excellence. The theme of the campaign is ‘‘It is Time 

to Cure Something.’’ We are now learning so much about how to deliver healthy 

genes to unhealthy cells that we cannot turn back—nor can we as a Nation afford 

to let our friends in Europe and Asia race ahead of us in the areas of biomedical 

research and gene therapy. 

We hope that this Congress—speaking through this subcommittee—will do what 

we have done and dare the NIH and its grantees to ‘‘cure something.’’ You are investing nearly $29 billion of taxpayer money in this agency that houses the ‘‘best 

and the brightest’’ and that funds ‘‘the best and the brightest.’’ We as Americans 

must never stop striving to reach previously unimaginable heights. If that means 

that we have to shake up the status quo and create a new funding mechanism, let’s 

do it. But let’s not continue to follow the slow going incremental’’ path of the past. 

We need to spend our tax dollars in a coordinated and focused manner that will 

maximize the chances that we will unlock the secrets of how to correct single gene 

defects. We are very close now, with an experiment currently being conducted—in 

France—that may be a breakthrough. It is time for the United States to step up 

and lead the world in this life-saving area of research. 

NIH and the Thalassemia Clinical Research Network 

Mr. Chairman, about 5 years ago, working closely with members of this subcommittee, the CAF convinced the NHLBI of the need to create a clinical research 

network that would allow the top researchers in the field to collaborate on desperately needed research projects using common protocols. Today, that network is 
439 

up and running and is the focal point for thalassemia research, most of which takes 

place in academic medical centers throughout the country. 

However, there is a cloud hanging over this, and all other, research at NIH. As 

the Biomedical Research and Development Price Index continues to escalate, the 

buying power of a flat-funded NIH continues to decrease. There would be nothing 

wrong with this if we had cured thalassemia, and hemophilia, and cystic fibrosis, 

and all other genetic and non-genetic diseases. But that is not the case. 

There is an enormous amount of work to be done. And there is no one else to do 

it but our National Institutes of Health, with the support of our Congress and President. 

I urge the subcommittee to settle for nothing less than a 5 percent increase in 

funding for NIH so that the critical life saving research that is occurring there can 

continue. Some of our fellow citizens don’t have another year to wait. 

CONCLUSION

As I indicated at the outset, Mr. Chairman, I am not interested in filling the air 

with words. Unfortunately, I don’t have the luxury of time to do that. The Cooley’s 

Anemia Foundation has three priorities this year: 

—Funding the blood safety surveillance program at CDC at $2.0 million; 

—An enhanced focus on gene therapy designed to cure something; and, 

—A five percent increase in NIH funding to continue current vital research programs. 

Mr. Chairman, every night when I watch my beautiful, smart, talented 21 year 

old daughter Alicia put a needle under her skin to infuse a drug for 8–10 hours to 

remove the excess iron in her system from her bi-weekly blood transfusions, I know 

we can do better. 

Please excuse my passion, but this is the United States of America. I know we 

can prevent this disease from happening in newborns. I know we can improve the 

lives of those who currently have it. And, most importantly, I am absolutely certain 

we can cure it once and for all. 

You don’t need five pages of testimony from me to do that. You just need to demand the very best from the very best—our scientists, our government, the patient 

advocacy community and ourselves. 

Thank you for your very kind attention and for all the support this committee has 

shown to our patients and their families over the years. 

PREPARED STATEMENT OF THE CROHN’S AND COLITIS FOUNDATION OF AMERICA

SUMMARY OF FISCAL YEAR 2007 RECOMMENDATIONS

(1) A 5 percent increase for the National Institute of Diabetes, and Digestive and 

Kidney Diseases, and the National Institute of Allergy and Infectious Diseases. 

(2) $700,000 for the National Inflammatory Bowel Disease Epidemiological Program at the Centers for Disease Control and Prevention. 

Mr. Chairman, thank you for the opportunity to submit testimony on behalf of the 

Crohn’s and Colitis Foundation of America (CCFA). We greatly appreciate your leadership and the opportunity to work with you to improve the quality of life for our 

patients and families. 

My name is Kenneth Edmonds and I serve on the National Board of Trustees for 

the CCFA, the Nation’s oldest and largest voluntary organization dedicated to finding a cure for and to seeking to prevent Crohn’s disease and ulcerative colitis. 

Through research, education and support, CCFA is committed to improving the 

quality of life of children and adults affected by these diseases, collectively known 

as inflammatory bowel disease (IBD). I am one of them. 

IBD is a chronic disorder that causes inflammation of the digestive tract. It affects 

approximately 1.4 million Americans, 30 percent of whom are diagnosed in their 

childhood. IBD can cause persistent diarrhea, severe abdominal pain, fever, and, at 

times, rectal bleeding. If complications develop, it also can lead to, among other conditions, anemia, liver disease and colorectal cancer. 

Indeed, inflammatory bowel disease can be painful and debilitating. And, its impact is perhaps most devastating for children and adolescents, whose diagnoses 

often make them stand out at a time when they most want to fit in. Their disease 

can make them not only feel different, but look different as some adolescents with 

IBD may have delays in physical growth and puberty, causing them to appear 

younger and smaller than their peers. But, at any age, being diagnosed with IBD 

can bring change and challenge. 
440 

The news of my diagnosis came not in one, sudden rush, but rather in a long, 

gradual backslide—and into a hospital bed. In retrospect, I exhibited typical signs 

of IBD as early as 1993 while a student in college. But, unfortunately, I responded 

to those signals like too many adolescents and young adults—I overlooked them. 

At the time, I experienced acute abdominal pain so sharp and sudden that I would 

double over. These cramps often came without warning, creating an intense urge to 

use the nearest bathroom. On these occasions and others, my stools had traces of 

blood. 

But, because I was young and active, I didn’t think that much about it. And, I 

certainly didn’t talk about it, to anyone. I chalked these brief episodes up to my regimen, rather than my abdomen. I figured that I just needed to add more greens to 

my diet and add more hours to my sleep. 

But, by 1996, after moving to Chicago, my symptoms had become too persistent, 

too serious and too severe to ignore. By the summer of that year, I had developed 

sores or ulcers on my tongue, making it difficult and painful to eat. I lost appetite 

and lost weight. 

In addition to the persistent diarrhea and acute cramps, I also had developed a 

tear (a fissure) in the lining of my anus, which caused excruciating pain and bleeding during bowel movements. I also suffered from severe exhaustion. 

As you can imagine, this was an agonizing predicament: I was losing weight, but 

could not eat. I was fatigued, but could not sleep. I had frequent, sudden bowel 

movements, but they caused sharp, piercing pain. Indeed, I had deteriorated dramatically; my condition relegating me to somewhere between bedridden and bathroom-bound. 

A misdiagnosis, three, long, withering weeks, and a plane ride later, I found myself in the Washington Hospital Center under the care of my uncle, a gastroenterologist here in the District. After a series of tests, x-rays and examinations, 

I was diagnosed with Crohn’s colitis and prescribed medications for my symptoms. 

Since my hospitalization 10 years ago, I am pleased to report that the disease has 

been in remission and I have enjoyed relatively good health. 

But, Mr. Chairman, IBD is a life-long disease. While there are drug therapies to 

treat symptoms, there is no medical cure. And, its cause is unknown. 

That’s why CCFA’s work has been so critical and groundbreaking. 

RECOMMENDATIONS FOR FISCAL YEAR 2007

(1) National Institutes of Health 

In fact, CCFA has developed incredibly successful research partnerships with the 

NIH, forging longstanding collaborations with the National Institute of Diabetes and 

Digestive and Kidney Diseases (NIDDK), which sponsors the majority of IBD research, and the National Institute of Allergy and Infectious Diseases (NIAID). CCFA 

provides crucial ‘‘seed-funding’’ to researchers, helping investigators gather preliminary findings, which in turn enables them to pursue advanced IBD research projects 

through the NIH. This approach led to the identification of the first gene associated 

with Crohn’s—a landmark breakthrough in understanding this disease. 

Mr. Chairman, CCFA’s scientific leaders, with significant involvement from 

NIDDK, have developed an ambitious research agenda, titled ‘‘Challenges in Inflammatory Bowel Disease’’ that outlines and seeks to address the many opportunities 

that currently exist. Fortunately, the field of IBD is widely viewed within the scientific community as one of tremendous potential. To help capitalize on these opportunities, CCFA recommends that the subcommittee provide a 5 percent increase in 

funding for NIDDK and NIAID in fiscal year 2007. Moreover, CCFA requests that 

the subcommittee encourage these two institutes to expand their IBD research portfolios at a similar rate. 

(2) Centers for Disease Control and Prevention 

IBD Epidemiology Program 

Mr. Chairman, CCFA estimates that 1.4 million people in the United States suffer 

from IBD, but there could be many more. We do not have an exact number due to 

these diseases’ complexity and the difficulty in identifying them. 

We are extremely grateful for your leadership in providing funding over the past 

2 years for an epidemiology program on IBD at the Centers for Disease Control and 

Prevention. This program is yielding valuable information about the prevalence of 

IBD in the United States and increasing our knowledge of the demographic characteristics of the IBD patient population. If we are able to generate an accurate analysis of the geographic makeup of the IBD patient population, it will provide us with 

invaluable clues about the potential causes of IBD. 
441 

Unfortunately Mr. Chairman, the President has eliminated funding for this important program in his fiscal year 2007 budget for the CDC. CCFA encourages the 

subcommittee to restore support for the IBD Epidemiology Program at last year’s 

level of $700,000. 

Once again Mr. Chairman, thank you for the opportunity to submit written testimony 

PREPARED STATEMENT OF THE DIGESTIVE DISEASE NATIONAL COALITION

SUMMARY OF FISCAL YEAR 2007 RECOMMENDATIONS

—Provide increased funding for the National Institutes of Health (NIH) at an increase of 5 percent over fiscal year 2006. Increase funding for the National Cancer Institute (NCI), the National Institute of Diabetes and Digestive and Kidney 

Diseases (NIDDK) and the National Institute of Allergy and Infectious Diseases 

(NIAID) by 5 percent. 

—Continue focus on digestive disease research and education at NIH, including 

the areas of Inflammatory Bowel Disease (IBD), Hepatitis and other liver diseases, Irritable Bowel Syndrome (IBS), Colorectal Cancer, Endoscopic Research, 

Pancreatic Cancer, Celiac Disease, and Hemochromatosis. 

—$30 million for the Centers for Disease Control and Prevention’s (CDC) Hepatitis Prevention and Control activities. 

—$25 million for the Center for Disease Control and Prevention’s (CDC) 

Colorectal Cancer Screening and Prevention Program. 

Chairman Specter, thank you for the opportunity to again submit testimony to the 

subcommittee. Founded in 1978, the Digestive Disease National Coalition (DDNC) 

is a voluntary health organization comprised of 23 professional societies and patient 

organizations concerned with the many diseases of the digestive tract. The Coalition 

has as its goal a desire to improve the health and the quality of life of the millions 

of Americans suffering from both acute and chronic digestive diseases. 

The DDNC promotes a strong Federal investment in digestive disease research, 

patient care, disease prevention, and public awareness. The DDNC is a broad coalition of groups representing disorders such as Inflammatory Bowel Disease (IBD), 

Hepatitis and other liver diseases, Irritable Bowel Syndrome (IBS), Pancreatic Cancer, Ulcers, Pediatric and Adult Gastroesophageal Reflux Disease, Colorectal Cancer, Celiac Disease, and Hemochromatosis. 

Mr. Chairman, the social and economic impact of digestive disease is enormous 

and difficult to grasp. Digestive disorders afflict approximately 65 million Americans. This results in 50 million visits to physicians, over 10 million hospitalizations, 

collectively 230 million days of restricted activity. The total cost associated with digestive diseases has been conservatively estimated at $60 billion a year. 

The DDNC would like to thank the subcommittee for its past support of digestive 

disease research and prevention programs at the National Institutes of Health 

(NIH) and the Centers for Disease Control and Prevention (CDC). With respect to 

the coming fiscal year, the DDNC is recommending an increase of 5 percent to $30.1 

billion for the National Institutes of Health (NIH) and all of its Institutes. 

Specifically the DDNC recommends 

—$5.35 billion for the National Cancer Institute (NCI). 

—$2 billion for the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK). 

—$4.89 billion for the National Institute of Allergy and Infectious Diseases 

(NIAID). 

We at the DDNC respectfully request that any increase for NIH does not come 

at the expense of other Public Health Service agencies. 

With the competing and the challenging budgetary constraints the subcommittee 

currently operates under, the DDNC would like to highlight the research being accomplished by NIDDK which warrants the increase for NIH. 

INFLAMMATORY BOWEL DISEASE

In the United States today about 1 million people suffer from Crohn’s disease and 

ulcerative colitis, collectively known as Inflammatory Bowel Disease (IBD). These 

are serious diseases that affect the gastrointestinal tract causing bleeding, diarrhea, 

abdominal pain, and fever. Complications arising from IBD can include anemia, ulcers of the skin, eye disease, colon cancer, liver disease, arthritis, and osteoporosis. 

Crohn’s disease and ulcerative colitis are not usually fatal but can be devastating. 
442 

The cause of IBD is still unknown, but research has led to great breakthroughs in 

therapy. 

In recent years researchers have made significant progress in the fight against 

IBD. In 1998, the FDA approved the first drug ever specifically to fight Crohn’s disease, a remarkable milestone. The DDNC encourages the subcommittee to continue 

its support of IBD research at NIDDK and NIAID at a level commensurate with 

the overall increase for each institute. The DDNC would like to applaud the NIDDK 

for its strong commitment to IBD research through the Inflammatory Bowel Disease 

Genetics Research Consortium. The DDNC urges the Consortium to continue its 

work in IBD research. Given the recent advancements in treatment for these diseases and the increased risk that IBD patients have for developing colorectal cancer, 

the DDNC strongly believes that generating improved epidemiological information 

on the IBD population is essential if we are to provide patients with the best possible care. Therefore the DDNC and its member organization the Crohn’s and Colitis 

Foundation of America encourage the CDC to initiate a nationwide IBD surveillance 

and epidemiological program in fiscal year 2007. 

HEPATITIS C: A LOOMING THREAT TO HEALTH

It is estimated that there are over 4 million Americans who have been infected 

with Hepatitis C of which over 2.7 million remain chronically infected. About 10,000 

die each year and the Centers for Disease Control and Prevention (CDC) estimates 

that the death rate will more than triple by 2010 unless there is additional research, education, and more effective treatments and public health interventions. 

Hepatitis C infection is the largest single cause for liver transplantation and one 

of the principal causes of liver cancer and cirrhosis. There is currently no vaccine 

for hepatitis C, and treatment has limited success, making the infection among the 

most costly diseases in terms of health care costs, lost wages, and reduced productivity. Patients who are older at the time of infection, those who continually ingest 

alcohol, and those co-infected with HIV demonstrate accelerated progression to more 

advanced liver disease. 

The DDNC applauds all the work NIH and CDC have accomplished over the past 

year in the areas of hepatitis and liver disease. The DDNC urges that funding be 

focused on expanding the capability of State health departments, particularly to enhance resources available to the hepatitis C State coordinators. The DDNC also 

urges that CDC increase the number of cooperative agreements with coalition partners to develop and distribute health education, communication, and training materials about prevention, diagnosis and medical management for hepatitis A, B, and 

C. 

The DDNC supports $30 million for the CDC’s Hepatitis Prevention and Control 

activities. The hepatitis division at CDC supports the hepatitis C prevention strategy and other cooperative nationwide activities aimed at prevention and awareness 

of hepatitis A, B, and C. The DDNC also urges the CDC’s leadership and support 

for the National Viral Hepatitis Roundtable to establish a comprehensive approach 

among all stakeholders for viral hepatitis prevention, education, strategic coordination, and advocacy. 

COLORECTAL CANCER PREVENTION

Colorectal cancer is the third most commonly diagnosed cancer for both men and 

woman in the United States and the second leading cause of cancer-related deaths. 

Colorectal cancer affects men and women equally. According to the American Cancer 

Society, this year alone about 135,400 individuals will be diagnosed with colorectal 

cancer, and of those diagnosed 56,700 patients will die. Although colorectal cancer 

is preventable and curable when polyps are detected early, a General Accounting 

Office report issued in March 2000 documented that less than 10 percent of Medicare beneficiaries have been screened for colorectal cancer. This report revealed a 

tremendous need to inform the public about the availability of screening and educate health care providers about colorectal cancer screening guidelines. In 2003, the 

New York City Department of Health has recommended colonoscopy for everyone 

over age 50 to prevent colorectal cancer. 

The DDNC recommends a funding level of $25 million for the CDC’s Colorectal 

Cancer Screening and Prevention Program. This important program supports enhanced colorectal screening and public awareness activities throughout the United 

States. The DDNC also supports the continued development of the CDC-supported 

National Colorectal Cancer Roundtable, which provides a forum among organizations concerned with colorectal cancer to develop and implement consistent prevention, screening, and awareness strategies. 
443 

PANCREATIC CANCER

In 2006, an estimated 33,730 people in the United States will be found to have 

pancreatic cancer and approximately 32,300 will die from the disease. Pancreatic 

cancer is the fifth leading cause of cancer death in men and women. Only 1 out of 

4 patients will live 1 year after the cancer is found and only 1 out of 25 will survive 

5 or more years. Although we do not know exactly what causes pancreatic cancer, 

several risk factors linked to the disease have been identified: 

(1) Age: Most people are over 60 years old when the cancer is found; 

(2) Sex: Men have pancreatic cancer more often than women; 

(3) Race: African Americans are more likely to develop pancreatic cancer than are 

white or Asian Americans; 

(4) Smoking; 

(5) Diet: Increased red meats and fats; and 

(6) Diabetes. 

The National Cancer Institute (NCI) has established a Pancreatic Cancer Progress 

Review Group charged with developing a detailed research agenda for the disease. 

The DDNC encourages the subcommittee to provide an increase for pancreatic cancer research at a level commensurate with the overall percentage increase for NCI 

and NIDDK. 

IRRITABLE BOWEL SYNDROME (IBS)

IBS is a disorder that affects an estimated 35 million Americans. The medical 

community has been slow in recognizing IBS as a legitimate disease and the burden 

of illness associated with it. Patients often see several doctors before they are given 

an accurate diagnosis. Once a diagnosis of IBS is made, medical treatment is limited 

because the medical community still does not understand the pathophysiology of the 

underlying conditions. 

Living with IBS is a challenge, patients face a life of learning to manage a chronic 

illness that is accompanied by pain and unrelenting gastrointestinal symptoms. Trying to learn how to manage the symptoms is not easy. There is a loss of spontaneity 

when symptoms may intrude at any time. IBS is an unpredictable disease. A patient 

can wake up in the morning feeling fine and within a short time encounter abdominal cramping to the point of being doubled over in pain and unable to function. 

The unpredictable bowel symptoms may make it next to impossible to leave your 

home. It is difficult to ease the pain that may repeatedly occur periodically throughout the day. A patient can become reluctant to eat for fear that just eating a meal 

will trigger symptoms all over again. IBS has a broad and significant impact on a 

person’s quality of life. It strikes individuals from all walks of life and results in 

a significant toll of human suffering and disability. 

While there is much we don’ understand about the causes and treatment of IBS, 

we do know that IBS is a chronic complex of systems affecting as many as one in 

five adults. In addition: 

(1) It is reported more by women than men; 

(2) It is the most common gastrointestinal diagnosis among gastroenterology practices in the United States; 

(3) It is a leading cause of worker absenteeism in the United States; and 

(4) It costs the U.S. Health Care System an estimated $8 billion annually. 

Mr. Chairman, much more can still be done to address the needs of the nearly 

35 million Americans suffering from irritable bowel syndrome and other functional 

gastrointestinal disorders. The DDNC recommends that NIDDK increase its research portfolio on Functional Gastrointestinal Disorders and Motility Disorders. 

GASTROPARESIS

Gastroparesis, or paralysis of the stomach, refers to a stomach that empties slowly. Gastroparesis is characterized by symptoms from the delayed emptying of food, 

namely: bloating, nausea, vomiting or feeling full after eating only a small amount 

of food. Gastroparesis can occur as a result of several conditions; it can occur in up 

to 30 percent to 50 percent of patients with diabetes mellitus. A person with diabetic 

gastroparesis may have episodes of high and low blood sugar levels due to the unpredictable emptying of food from the stomach, leading to diabetic complications. 

Other causes of gastroparesis include Parkinson’s disease and some medications, especially narcotic pain medications. In many patients a cause of the gastroparesis 

cannot be found and the disorder is termed idiopathic gastroparesis. Over the last 

several years, as more is being found out about gastroparesis, it has become clear 

this condition affects many people and the condition can cause a wide range of 

symptoms of differing severity. 
444 

CELIAC DISEASE

Celiac Disease is a life-long condition in which the body develops an allergy to 

gluten, a protein found in wheat, barley, and rye, which can result in damage to 

the small intestine. Celiac disease affects as many as 2 million Americans. Onset 

of the disease can occur at any age. The common symptoms of Celiac Disease include fatigue, anemia, chronic diarrhea or constipation, weight loss, and bone pain. 

The only treatment for celiac disease is strict adherence to a gluten-free diet. 

Undiagnosed and untreated celiac disease can lead to other disorders such as 

osteoporosis, infertility, neurological conditions, and in rare cases cancer. Persons 

with Celiac Disease often have other associated autoimmune disorders as well. 

DIGESTIVE DISEASE COMMISSION

In 1976, Congress enacted Public Law 94–562, which created a National Commission on Digestive Diseases. The Commission was charged with assessing the State 

of digestive diseases in the United States, identifying areas in which improvement 

in the management of digestive diseases can be accomplished and to create a longrange plan to recommend resources to effectively deal with such diseases. The Commission’s subsequent report in 1979 laid the groundwork for significant progress in 

the area of digestive disease research. After almost 25 years, however, the burden 

of digestive diseases among the U.S. population remains substantial. 

The DDNC recognizes the creation of the National Commission on Digestive Diseases, and looks forward to working with the National Commission to address the 

numerous digestive disorders that remain in today’s diverse population. 

CONCLUSION

The DDNC understands the challenging budgetary constraints and times we live 

in that this subcommittee is operating under, yet we hope you will carefully consider the tremendous benefits to be gained by supporting a strong research and education program at NIH and CDC. Millions of Americans are pinning their hopes for 

a better life, or even life itself, on digestive disease research conducted through the 

National Institutes of Health. 

Mr. Chairman, on behalf of the millions of digestive disease sufferers, we appreciate your consideration of the views of the Digestive Disease National Coalition. We 

look forward to working with you and your staff. 

DIGESTIVE DISEASE NATIONAL COALITION

The Digestive Disease National Coalition was founded 25 years ago. Since its inception, the goals of the coalition have remained the same: to work cooperatively 

to improve access to and the quality of digestive disease health care in order to promote the best possible medical outcome and quality of life for current and future 

patients with digestive diseases. 

PREPARED STATEMENT OF THE DORIS DAY ANIMAL LEAGUE

The Doris Day Animal League represents 350,000 members and supporters nationwide who support a strong commitment by the Federal Government to research, 

development, standardization, validation and acceptance of non-animal and other alternative test methods. We are also submitting our testimony on behalf of the Humane Society of the United States and The Procter & Gamble Company. Thank you 

for the opportunity to present testimony relevant for the fiscal year 2007 budget request for the National Institute of Environmental Health Sciences (NIEHS) for the 

fiscal year 2007 activities of the National Toxicology Program Center for the Evaluation of Alternative Toxicological Test Methods (NICEATM), the support center for 

the Interagency Coordinating Committee for the Validation of Alternative Test 

Methods (ICCVAM). 

In 2000, the passage of the ICCVAM Authorization Act into Public Law 106–545, 

created a new paradigm for the field of toxicology. It requires Federal regulatory 

agencies to ensure that new and revised animal and alternative test methods be scientifically validated prior to recommending or requiring use by industry. An internationally agreed upon definition of validation is supported by the 15 Federal regulatory and research agencies that compose the ICCVAM, including the EPA. The 

definition is: ‘‘the process by which the reliability and relevance of a procedure are 

established for a specific use.’’ 
445 

FUNCTION OF THE ICCVAM

The ICCVAM performs an invaluable function for regulatory agencies, industry, 

public health and animal protection organizations by assessing the validation of 

new, revised and alternative toxicological test methods that have interagency application. After appropriate independent peer review of the test method, the ICCVAM 

recommends the test to the Federal regulatory agencies that regulate the particular 

endpoint the test measures. In turn, the Federal agencies maintain their authority 

to incorporate the validated test methods as appropriate for the agencies’ regulatory 

mandates. This streamlined approach to assessment of validation of new, revised 

and alternative test methods has reduced the regulator burden of individual agencies, provided a ‘‘one-stop shop’’ for industry, animal protection, public health and 

environmental advocates for consideration of methods and set uniform criteria for 

what constitutes a validated test methods. In addition, from the perspective of animal protection advocates, ICCVAM can serve to appropriately assess test methods 

that can refine, reduce and replace the use of animals in toxicological testing. This 

function will provide credibility to the argument that scientifically validated alternative test methods, which refine, reduce or replace animals, should be expeditiously integrated into Federal toxicological regulations, requirements and recommendations. 

HISTORY OF THE ICCVAM

The ICCVAM is currently composed of representatives from the relevant Federal 

regulatory and research agencies. It was created from an initial mandate in the NIH 

Revitalization Act of 1993 for NIEHS to ‘‘(a) establish criteria for the validation and 

regulatory acceptance of alternative testing methods, and (b) recommend a process 

through which scientifically validated alternative methods can be accepted for regulatory use.’’ In 1994, NIEHS established the ad hoc ICCVAM to write a report that 

would recommend criteria and processes for validation and regulatory acceptance of 

toxicological testing methods that would be useful to Federal agencies and the scientific community. Through a series of public meetings, interested stakeholders and 

agency representatives from all 14 regulatory and research agencies, developed the 

NIH Publication No. 97–3981, ‘‘Validation and Regulatory Acceptance of Toxicological Test Methods.’’ This report, and subsequent revisions, has become the 

sound science guide for consideration of new, revised and alternative test methods 

by the Federal agencies and interested stakeholders. 

After publication of the report, the ad hoc ICCVAM moved to standing status 

under the NIEHS’ NICEATM. Representatives from Federal regulatory and research agencies and their programs have continued to meet, with advice from the 

NICEATM’s Advisory Committee and independent peer review committees, to assess the validation of new, revised and alternative toxicological methods. Since then, 

several methods have undergone rigorous assessment and are deemed scientifically 

valid and acceptable. In addition, the ICCVAM is working to streamline assessment 

of methods from the European Union (EU) that have already been validated for use 

within the EU. The open public comment process, input by interested stakeholders 

and the continued commitment by the Federal agencies has led to ICCVAM’s success. It has resulted in a more coordinated review process for rigorous scientific assessment of the validation of new, revised and alternative test methods. 

REQUEST FOR APPROPRIATIONS

On December 19, 2000, the ‘‘ICCVAM Authorization Act’’ which makes the entity 

a permanent standing committee, was signed into Public Law No. 106–545. For several years, the NIEHS has provided financial resources to the NICEATM for 

ICCVAM’s activities. In order to ensure that Federal regulatory agencies and their 

stakeholders benefit from the work of the ICCVAM, it is important for NIEHS to 

provide funding at an appropriate level. We respectfully request a fiscal year funding level of $4 million. 

REQUEST FOR COMMITTEE REPORT LANGUAGE

The NIEHS should support the NICEATM/ICCVAM in creating a five-year roadmap for assertively setting goals to prioritize ending the use of antiquated animal 

tests for specific endpoints. While the stream of methods forwarded to the ICCVAM 

for assessment has remained relatively steady, it is imperative that the ICCVAM 

take a more proactive role in isolating areas where new methods development is on 

the verge of replacing animal tests. These areas should form a collective call by the 

Federal agencies that compose ICCVAM to fund any necessary additional research, 

development, validation and validation assessment that is required to eliminate the 
446 

animal methods. We also strongly urge the NICEATM/ICCVAM to closely coordinate 

research, development and validation efforts with its European counterpart, the European Centre for the Validation of Alternative Methods (ECVAM) to ensure the 

best use of available funds and sound science. This coordination should also reflect 

a willingness by the Federal agencies comprising ICCVAM to more readily accept 

validated test methods proposed by the ECVAM to ensure industry has a uniform 

approach to worldwide chemical safety evaluation. 

We also respectfully request the subcommittee consider the following report language for the Senate Labor, Health and Human Services, Education and Related 

Agencies Appropriations bill: 

‘‘The Committee commends the National Interagency Center for the Evaluation of 

Alternative Methods/Interagency Coordinating Committee on the Validation of Alternative Methods (NICEATM/ICCVAM) for its leadership role in the assessment of 

new, revised and alternative scientifically validated methods for the Federal government. The Committee also commends the National Toxicology Program (NTP) for finalizing its ‘Roadmap to Achieve the NTP Vision, A Toxicology Program for the 21st 

Century’, which commits to ‘develop and validate improved testing methods and, 

where feasible, ensure that they reduce, refine or replace the use of animals’ as one 

of its top four goals. 

‘‘The Committee directs the NICEATM/ICCVAM, in partnership with the relevant 

Federal agency program offices and the NTP, to build on the NTP Roadmap to create a 5-year plan to research, develop, translate and validate new and revised nonanimal and other alternative assays for integration of relevant and reliable methods 

into the Federal agency testing programs. In this 5-year plan the Federal agency 

program offices shall be directed to identify areas of high priority for new and revised non-animal and alternative assays or batteries of those assays to create a path 

forward for the replacement, reduction and refinement of animal tests, when this 

is scientifically valid and appropriate. The Committee directs a transparent, public 

process for developing this plan and recommends the plan be presented to the Committee by November 15, 2007. Funding for developing the plan shall be from the 

NIEHS and the NTP, and shall not reduce the NICEATM/ICCVAM funding base.’’ 

PREPARED STATEMENT OF THE DYSTONIA MEDICAL RESEARCH FOUNDATION

SUMMARY OF FISCAL YEAR 2007 RECOMMENDATIONS

—Provide increased funding for the National Institute of Health at an increase 

of 5 percent over fiscal year 2006. Increase funding for the National Institute 

of Neurological Disorders and Stroke (NINDS), the National Institute of Deafness and other Communication Disorders (NIDCD), and the National Eye Institute (NEI) by 5 percent. 

—Fiscal Year 2007 Recommendations for NIH 

—NIH: $30 billion 

—NINDS: $1.61 billion 

—NEI: $700.4 million 

—NIDCD: $412.7 million 

—Continue to accelerate funding for intramural and extramural dystonia research 

at NINDS. 

—Continue to expand NIDCD’s intramural and extramural research on 

dysphonia. 

—Continue to expand NEI’s intramural and extramural research on dystonia. 

Chairman Specter, thank you for the opportunity to submit testimony to the subcommittee on behalf of the Dystonia Medical Research Foundation (DMRF). 

Dystonia has affected the lives of many Americans and we are thankful to be able 

to provide for you our recommendations for fiscal year 2007 Federal funding with 

regards to dystonia research. 

Dystonia is a neurological disorder characterized by powerful and painful involuntary muscle spasms that causes the body to twist, repetitive jerking movements, and 

sustained postural deformities. There are several different variations of dystonia, including: focal dystonias which affect specific parts of the body, such as the arms, 

legs, neck, jaw, eyes, vocal cords; and generalized dystonia, affecting many parts of 

the body at the same time. Some forms of dystonia are genetic and others are 

caused by injury or illness. Dystonia does not affect a person’s consciousness or intellect, but is a chronic and progressive movement disorder for which, at this time, 

there is no known cure. The Foundation estimates that some form of dystonia affects about 300,000 people in North America. 
447 

Even though there is no known cure for dystonia, there are treatments to lessen 

the severity of the symptoms of the disease such as oral medications, botulinum 

toxin injections, and in some cases surgery. Having increased access to these medical therapies is becoming an increasing larger issue for the community as a whole. 

In the past few decades, dystonia researchers have made several exciting scientific 

advancements and have been able to rapidly turn laboratory and clinical research 

into diagnostic examinations and treatment procedures, directly benefiting those affected. Genetics, in particular, is opening up a new understanding into the cause 

and pathophysiology of the disorder. Thus far, 13 dystonia related genes or gene loci 

have been identified. In 1997, the DYT1 gene for childhood early onset dystonia was 

identified, and we now have a genetic test available to confirm diagnosis of this particular type of dystonia. Most recently, in 2002, the gene for myoclonus dystonia was 

identified. However the community is still without a diagnostic test and misdiagnosis still occurs too frequently. 

Deep brain stimulation is a surgical procedure that was originally developed to 

treat Parkinson’s disease but is now being applied to severe cases of dystonia. Deep 

brain stimulation has drastically improved the lives of dozens of dystonia patients 

during the past few years. Individuals who were previously bedridden by muscle 

spasms and pain are able to walk without assistance, to speak clearly, to dress 

themselves, to get a driver’s license, to date, to travel, and to live the life of an ablebodied person. Deep brain stimulation is currently used primarily to treat severe 

cases of generalized dystonia but its promising role in treating focal dystonias is 

being explored. Surgical interventions are a crucial and active area of dystonia research. 

RESEARCH, AWARENESS, AND SUPPORT

Now is an exciting time to be involved in dystonia research and awareness. Researchers are becoming more interested in movement disorders and dystonia at the 

National Institutes of Health (NIH), and research is yielding promising clues for 

better understanding and management of this disorder. 

One way the Dystonia Medical Research Foundation has advocated for more research on dystonia, is by funding ‘‘seed’’ grants to researchers. Thus far the 

Dystonia Foundation has funded over 415 grants and fellowships totaling more than 

$21 million. Due to our advocacy there are a growing number of talented researchers dedicated to understanding the biochemistry of dystonia, genetic causes, new 

therapeutics and the necessity of an epidemiology study. 

Another primary goal of the Dystonia Foundation is education of both lay and 

medical audiences. The Foundation conducts regular medical workshops and patient 

symposiums to present, discuss, and disseminate comprehensive medical and research data on dystonia. In January 2001, NINDS co-sponsored a genetics and animal models meeting, designed to involve not only prominent researchers but inviting junior investigators to participate in the discussions. In September, 2005 NIH 

funded a workshop on ‘‘Rehabilitation in Dystonia’’ at which leading experts from 

neurosurgeons and neurologists to physical therapists, psychologists, and biomedial 

engineers argued for more aggressive research and the use of new concepts and 

tools in the treatment of dystonia and in 2006 NIH is funding a science workshop 

on the dystonia protein torsinA/Nuclear envelope. On June 6 & 7 a NINDS Research 

Agenda Workshop will take place. 

The Young Investigators Award Program and the Residency Program are in place 

to entice emerging medical professionals into the field of dystonia research and cultivate future dystonia experts. 

Since 1995, over 10,000 educational medical videos have been distributed to hospitals, medical and nursing schools, and at medical conventions. In addition to medical and coping publications, we have a children’s video to educate families and increase public awareness of this devastating disorder in younger populations. Media 

awareness is conducted throughout the year, and especially during Dystonia Awareness Week, observed nationwide from June 4 through 11. Local volunteers have 

been successful in securing news stories on dystonia in local venues as well as national media shows such as Good Morning America, The Oprah Winfrey Show, and 

Maury Povich. Through his friendship with the mother of a dystonia patient, screen 

star Kirk Cameron has taken an interest in promoting dystonia awareness, and the 

Dystonia Foundation is in the process of investigating the possibility of a public 

service announcement and several appearances at fundraising events. In the Fall 

of 2006 the new dystonia documentary entitled TWISTED will be premiered on 

PBS. 

The Dystonia Foundation has over 100 chapters, support groups, and area contacts across North America. In addition, there are chairpersons whose mission is to 
448 

promote awareness, children’s advocacy, development, extension, Internet resources, 

leadership, medical education, and symposiums. Furthermore, patient symposiums 

are held internationally and regionally to provide the latest medical and coping information to dystonia patients and others interested in the disorder. 

DYSTONIA AND THE NATIONAL INSTITUTES OF HEALTH

The Dystonia Medical Research Foundation recommends an increase to $31.6 billion or 5 percent for NIH overall, and a 5 percent increase for NINDS, and NIDCD. 

We at DMRF request that this increase for NIH does not come at the expense of 

other Public Health Service agencies. 

We also urge the subcommittee to recommend that NINDS provide the necessary 

funding for additional extramural research. There is also an imperative need for 

NINDS to increase its efforts to educate the public and medical community about 

dystonia through co-sponsorship of workshops and seminars. We also encourage the 

subcommittee to support NIDCD in its efforts to revamp its strategic planning process by implementing a Strategic Planning Group which will help NIDCD as they: 

consider applications for high program priority; develop program announcements 

and requests for applications; and develop new research areas in the Intramural Research Program. 

The National Institute of Neurological Disorders and Stroke (NINDS) awarded 

eleven grants for dystonia research in response to the Program Announcement, 

‘‘Studies into the Causes and Mechanisms of Dystonia’’ (August 2002). These awards 

covered a wide range of research areas, which included gene discovery, the genetics 

and genomics of dystonia, the development of animal models of primary and secondary dystonia, molecular and cellular studies inherited forms of dystonia, epidemiology studies, and brain imaging. In addition, the National Institute on Deafness 

and Other Communication Disorders (NIDCD) funded an eighth study on brainstem 

systems and their role in spasmodic dysphonia. 

DMRF also supports the many intramural researchers studying dystonia. Research includes: exploring improved clinical rating scales for dystonia, elevations of 

sensory motor training, utilizing Botox as a possible treatment for focal hand 

dystonia, characterization of abnormalities in sensory regions of the brain, treatments for spasmodic dysphonia, deep brain stimulation (the direct electrical stimulation of specific brain targets), non-invasive transcranial brain stimulation, anatomy imaging of the affect of dystonia on brain activity, and exploring the link between laryngitis and spasmodic dysphonia. The public awareness impact of pianist 

Leon Fleisher’s treatment through the NIH intramural research program has had 

a tremendously positive impact. 

NINDS continues to work with dystonia research and voluntary disease groups 

in the community. In June 2005, NINDS sponsored a workshop on spasmodic 

dysphonia, which was held at the NIH and was supported by the NINDS and the 

NIH Office of Rare Diseases. NIH staff are currently drafting a white paper on the 

results of the meeting and future research opportunities for improving the diagnosis, understanding the pathogenesis, developing new treatments, and preventing 

spasmodic dysphonia. Another NINDS laboratory is investigating several 

neurodegenerative disorders, including a form of hereditary dystonia known as the 

Mohr-Tranebjaerg deafness-dystonia syndrome. This form of dystonia is inherited 

through the X chromosome. The NINDS laboratory is investigating how abnormalities in a specific protein lead to the death of affected cells. 

Dystonia is the third most common movement disorder after Parkinson’s Disease 

and tremor, and effects many times more people than better known disorders such 

as Huntington’s Disease, muscular dystrophy and ALS or Lou Gehrig’s Disease. We 

ask that NINDS fund dystonia-specific extramural research at the same level that 

it supports research for other neurological movement disorders. 

CONCLUSION

The ultimate goal of the Dystonia Foundation is a cure for dystonia. Until that 

goal is realized, we are hungry for knowledge about the nature of dystonia and for 

more effective treatments with fewer side effects. We have amassed many exceptional and diligent researchers; who are committed to our goal, and our top priority 

is funding their very important research. But the Foundation cannot do it alone. We 

need Federal support through NIH to continue to fund quality scientific research 

and eliminate this debilitating disease. 

Combine the thwarting of scientific progress with the decreased access to therapies and all the progress of the last few years could be wiped away. We ask that 

you aggressively support medical research, specifically for movement disorders and 
449 

brain research. By doing so, you are doing a tremendous service for my family and 

myself and to the hundreds of thousands of people and families affected by dystonia. 

Thank you very much. 

PREPARED STATEMENT OF THE FSH SOCIETY

Chairman Specter, Senator Harkin and members of the subcommittee, I am Daniel Perez, President & CEO of the FSH Society. The FSH Society is a non-profit volunteer health agency organized by patients for patients with facioscapulohumeral 

muscular dystrophy (FSHD). Our purpose is to be a resource for individuals and 

families with FSH muscular dystrophy (FSHD), represent them and advocate on 

their behalf. On behalf of the FSH Society and its members, thank you for this opportunity to testify. 

FSHD is the third most prevalent form of muscle disease and the second most 

prevalent adult muscular dystrophy. It affects 1/20,000 people. For men, women, 

and children the major consequence of inheriting FSHD is a lifelong progressive and 

severe loss of all skeletal muscles. The FSH Society was created because of a need 

for a comprehensive resource for FSHD individuals and families. A world leader in 

combating muscular dystrophy it has provided well over a million dollars in seed 

grants to pioneering researchers worldwide and created an international collaborative network of patients and researchers. The Society relies entirely on private 

grants, donations and philanthropy. Since our establishment in 1991, our major 

focus has been to help facilitate Federal research agencies such as the National Institutes of Health (NIH) grow funding and programs for FSHD research. The Society 

has submitted 28 written and five oral testimonies to Senate and House Appropriations Subcommittees on Labor, Health, Human Services and Education on the need 

for more NIH funding on FSHD. 

The NIH often applauds the effort and dedication of the Society in expanding research efforts in FSHD and bringing additional attention to this dystrophy. We commend the Director of the NIH, Dr. Elias Zerhouni, for the significant efforts made 

by his agency in muscular dystrophy. Between 1987 and 2005, the overall NIH 

funding for dystrophy increased from $4.6 million to $39.3 million. Since 2000, the 

FSHD budget has increased from $400,000 to $2.1 million (fiscal year 2006 estimated). We applaud Dr. Stephen I. Katz, Director, National Institute of Arthritis 

and Musculoskeletal Disorders (NIAMS) and Chairman of the Muscular Dystrophy 

Coordinating Committee (MDCC), and John D. Porter, Program Director Muscular 

Dystrophy, National Institute of Neurological Disorders and Stroke (NINDS) and 

Executive Secretary MDCC, for their extraordinary comprehension, accuracy and for 

the speed in which the NIH Action Plan for Muscular Dystrophy was researched, 

compiled, written, and approved. The NIH is making significant investments to understand muscular dystrophy research needs and has made excellent choices in recruiting program staff with the ability to understand the extremely complex nature 

of muscular dystrophy. However, to this day, the NIH reports difficulty in growing 

and expanding its FSH muscular dystrophy research portfolio and in receiving sufficient numbers of investigator-submitted applications of high quality. 

THE MD–CARE ACT, PUBLIC LAW 107–84

Congress enacted The Muscular Dystrophy Community Assistance, Research and 

Education Amendments of 2001 (the MD–CARE Act, Public Law 107–84) that was 

signed into law on December 18, 2001. Both the Senate and House acted with force 

and clarity to mandate the NIH and other applicable Federal agencies, to immediately expand and intensify research on all forms of muscular dystrophy. The MD– 

CARE Act declared that: (1) the Director of the NIH work with the Directors of 

NIAMS, NINDS and NIH National Institute of Child Health and Human Development (NICHD) to expand and intensify research on all nine types of dystrophy described in the Act; (2) Centers of excellence for research should be established for 

all nine types of dystrophy; (3) a MDCC with two-thirds government and one-third 

public members be established to coordinate activities across NIH and other national research agencies on all forms of dystrophy; and; (4) the MDCC to submit a 

research action plan for conducting, and supporting research and education for all 

nine types of dystrophy. The MD–CARE Act also requires annual updates on research funding amounts by the Department of Health and Human Services (DHHS) 

for Duchenne, Myotonic, FSHD and other muscular dystrophies. 

In August 2004, the MDCC submitted an initial report for the NIH Muscular Dystrophy Research and Education Plan to Congress which was put through a more intensive planning process that involved external scientific experts in the field of mus-
450 

1 NIH Action Plan for the Muscular Dystrophies, Mechanisms Section, Research Objective 3: 

‘‘Define the molecular pathogenetic mechanisms that lead to facioscapulohumeral muscular dystrophy,’’ December 2005. 

‘‘Defining the molecular mechanisms by which a reduction in repeats at the D4Z4 translates 

into the multi-system symptoms seen in facioscapulohumeral muscular dystrophy has been difficult. Elucidation of the function of the allelic variants (A and B) at D4Z4 may help advance 

understanding of disease mechanisms. If perturbations of chromatin structure and/or 

derepression of gene expression ultimately figure into pathogenesis, there are some other diseases that could help inform researchers in this field. A potentially important avenue of research is the analysis of the chromatin structure at the D4Z4 locus, including methylation and/ 

or binding of specific repressors or activators. Such chromatin conformational changes have been 

suggested as a possible disease mechanism, presumably affecting the regulation of expression 

of other genes. Since the issue of altered regulation of genes in the vicinity of D4Z4 remains 

controversial, there is a need for careful studies using microarrays or other techniques, to determine if genes near the D4Z4 repeat units on chromosome 4q, or at more distant locations on 

this chromosome, are up-regulated or down-regulated in facioscapulohumeral muscular dystrophy. The expression and function of the D4Z4 gene, DUX4, should be analyzed. The association of 4qter with the nuclear lamina and the potential role of this association upon gene expression profiles should be explored. Genetic causes for facioscapulohumeral muscular dystrophy, 

other than the D4Z4 contraction (such as non-chromosome 4 linked cases), should be investigated in available patients.’’ 

cular dystrophy and muscle disease. This detailed version of the MDCC ‘‘Action Plan 

for the Muscular Dystrophies’’ was submitted to Congress in December 2005. 

FSHD is prominently and well represented in the five sections of the NIH ‘‘Action 

Plan for the Muscular Dystrophies.’’ Three key sections for FSHD research are: 

Mechanisms Section, Research Objective 3, ‘‘Define the molecular pathogenetic 

mechanisms that lead to facioscapulohumeral muscular dystrophy’’; Mechanisms 

Section, Research Objective 4, ‘‘Establish mouse (and cellular) models for 

facioscapulohumeral muscular dystrophy, specific to emerging candidate genes and/ 

or disease genomics, to understand the epigenetic mechanisms and for the development of novel intervention strategies’’; and, the Infrastructure Section, Research Objective 13, ‘‘Stimulate international collaborations and infrastructure sharing to ensure that opportunities are exploited and resources are used to maximum advantage, particularly in cases of novel opportunity or for the rare and/or understudied 

muscular dystrophies.’’ The full description and text of research objective three in 

the mechanisms section illustrates that the NIH fully comprehends what needs to 

be done to achieve progress in FSHD.1

It is absolutely clear that muscular dystrophy is a high priority for the NIH and 

it understands the research that needs be developed, funded and contracted. However, the dystrophies such as FSHD with complex etiology, low prevalence or that 

present unique scientific opportunity are getting far less funding than they deserve. 

FSHD is clearly deficient in projects and funding caused by it being a complicated 

disease with complex etiology that requires mastery to review grants or to undertake research. In the dystrophy area, the NIH believes that insight gained from 

studying a specific type of dystrophy will provide benefit for all of the muscular dystrophies. Sadly, that is not the case for FSHD. 

NIH EFFORTS ON FSH MUSCULAR DYSTROPHY (2000-PRESENT)

NIH has supported several initiatives in recent years in dystrophy research and 

training. In response to the fiscal year 2000 report language, the NINDS, NIAMS 

and the NIH Office of Rare Diseases (ORD) held a research symposium in May 

2000, in Bethesda, on the cause and treatment of FSH muscular dystrophy. The 

international team of researchers and NIH staff assembled research recommendations and directions that called for enhancing the understanding of the mechanism 

and molecular process associated with FSHD, strategies for exploring potential 

treatments and therapies, strategies to promote establishment of biomaterials registries and longitudinal and population based studies of FSHD, and a listing of required infrastructure and research resources. 

The findings of the conference on FSHD were used to create NIH solicitations. 

One request focused on exploratory and high risk research applications on FSH 

muscular dystrophy, and several other announcements were made for grant applications on therapeutic and pathogenic approaches for muscular dystrophy in which 

FSHD was mentioned. 

In September 2000, the NINDS and NIAMS issued a contract to establish and 

fund a National Registry for Myotonic and FSH Muscular Dystrophy based at the 

University of Rochester. Patients join the registry voluntarily by providing medical 

and family history data. The registry brings together FSHD patients and families 

seeking to participate in research with researchers seeking patients for research on 

the disorder. 
451 

Several program announcements were issued to promote large scale clinical and 

translational research in muscular dystrophy, as called for in the MD–CARE Act, 

called the Senator Paul D. Wellstone Muscular Dystrophy Research Centers. One 

of these centers, at the University of Rochester, focuses on myotonic and FSH muscular dystrophy. One-quarter of this Wellstone MD CRC center focuses on the molecular pathology of FSHD and serves as a resource for cell lines, tissue biopsies, 

antibodies and data about gene expression. This Wellstone MD CRC core at Rochester is the only funding specific for FSHD in the six Wellstone MD CRCs. 

The MD–CARE Act provides that the Wellstone MD CRC centers are not to replace funding and projects in existing basic research portfolios. In addition to building national infrastructure for dystrophy research, the NIH is expanding research 

resources for FSHD by funding several basic research grants related to understanding the mechanism and pathology of FSH muscular dystrophy. 

One of these grantees, Rossella Tupler, supported by the FSH Society, helped 

bring about a momentous breakthrough in FSHD research. The prestigious scientific 

journal Nature made an advance online publication of ‘‘Facioscapulohumeral muscular dystrophy in mice over-expressing FRG1’’, by Davide Gabellini and Rossella 

Tupler, et al., on December 11, 2005. The Nature paper is a breakthrough on multiple levels, it: (1) creates an animal model for FSHD; (2) points to a gene, called 

FRG1, that causes FSHD; (3) identifies other genetic processes impacted by FRG1 

over-expression involved in other major adult dystrophies; (4) shows that both the 

FRG1 gene and mis-expressed pre-mRNA intermediary products can be targeted 

and regulated by new and novel gene therapy techniques to correct expression levels; and (5) gives FSHD the hard target needed in order have better success in securing major funding from large agencies. They have demonstrated that 

transcriptional modulation of a gene from the region can produce an interesting, potentially relevant phenotype. This model can now be used to create conditional 

variants and ultimately move on to look for transcriptional suppressors of the phenotype. 

The NINDS, NIAMS and NICHD support career development and training 

awards for muscle biology and neuroscience through three program announcements 

for domestic and foreign investigators to help create a cadre of new scientists and 

researchers working on muscular dystrophy. The NINDS, NIAMS program officers 

in dystrophy are working diligently trying to help extramural researchers submit 

the highest quality applications. 

The NIH assisted Dr. Melanie Ehrlich of Tulane University, who was displaced 

by hurricane Katrina by offering a position in the NIAMS intramural research laboratory of Dr. Kuan Wang and granting supplemental relief funds to salvage her 

FSHD research. 

NIH MUSCULAR DYSTROPHY FUNDING

However, in the 6 years since the MD–CARE Act was signed the NIH [NIAMS, 

NINDS, NICHD, NHGRI] funding for FSHD remains very small. Since 2000, the 

overall NIH wide muscular dystrophy budget has increased from $12.6 million to 

$39.0 million in fiscal year 2007 estimated. Since 2000, the FSHD budget has increased from $400,000 to $2.1 million in fiscal year 2007 estimated. In the past 

year, at least five basic research grant applications (R01s) were submitted on FSHD 

and none were chosen for funding! Though the international field of FSHD researcher is small, the researchers are absolutely top-rate, world class and certainly 

competitive with other NIH grant applicants. Five applications represents about 25– 

30 percent of the entire field of FSHD researchers with the standing and experience 

to submit a basic research grant. A significant amount of FSHD researchers are 

submitting grant applications! 

NATIONAL INSTITUTES OF HEALTH (NIH) APPROPRIATIONS HISTORY 

[Dollars in millions] 

Fiscal year NIH overall MD research MD percent of 

NIH FSHD research FSHD percent of MD 

FSHD percent 

of NIH 

2000 ........................................... $17,821 $12.60 0.071 $0.40 3.18 0.0022 

2001 ........................................... 20,458 21.00 0.103 0.50 2.38 0.0024 

2002 ........................................... 23,296 27.60 0.118 1.30 4.71 0.0056 

2003 ........................................... 27,067 39.10 0.144 1.50 3.83 0.0055 

2004 ........................................... 27,887 38.70 0.139 2.20 5.67 0.0079 

2005 ........................................... 28,494 39.50 0.139 2.00 5.06 0.0070 

2006 ........................................... 28,428 39.3E 0.138 2.1E 5.31 0.0074 
452 

NATIONAL INSTITUTES OF HEALTH (NIH) APPROPRIATIONS HISTORY—Continued 

[Dollars in millions] 

Fiscal year NIH overall MD research MD percent of 

NIH FSHD research FSHD percent of MD 

FSHD percent 

of NIH 

2007E ......................................... 28,428 39.0E 0.137 2.1E 5.38 0.0074 

Source: NIH/OD Budget Office & NIH OCPL. 

NIAMS has one research contract for FSHD, the National Registry for Myotonic and FSH muscular dystrophy for $295,888 (fiscal year 2005). Its total muscular dystrophy portfolio for fiscal year 2005 was 57 projects, including two Wellstone MD 

CRC components for a total of $17,136,343. FSHD was only 1.7 percent of NIAMS 

fiscal year 2005 muscular dystrophy funding. 

NINDS reports three research grants, one intramural grant, one research con- tract, and one-quarter of a Wellstone CRC for FSHD for a total of $1,359,930 in fiscal year 2005. The total muscular dystrophy fiscal year 2005 portfolio reported for 

fiscal year 2005 was 33 projects, including two Wellstone CRCs for a total of 

$11,987,219. FSHD was only 11.4 percent of NINDS fiscal year 2005 muscular dystrophy funding. NICHD reports that approximately ten percent of its $4,762,321 fiscal year muscular dystrophy portfolio has some broad or general application to FSHD, but does 

not identify specific projects. The NICHD reports that $400,000 was spent on FSHD. 

The total muscular dystrophy fiscal year 2005 portfolio reported was 17 projects, including three Wellstone MD CRC components for a total of $4,762,321. FSHD was 

only 8.4 percent of NICHD fiscal year 2005 dystrophy funding. 

The NIAMS, NINDS, NICHD, and NHGRI—the four lead institutes on muscular 

dystrophy—reported a combined total of 108 projects on muscular dystrophy totaling 

$34,285,883 in fiscal year 2005. Of that total amount facioscapulohumeral muscular 

dystrophy (FSHD) received $1,440,555 in directly titled funds for three grants, one 

contract and one-quarter of a Wellstone MD CRC. 

The NIH now has six Wellstone MD CRCs, which are approximately equivalent 

to 27 basic research grants (R01). One-quarter of one Wellstone, or one R01 equivalent, has direct relevance to FSHD. Only 3.7 percent of the total Wellstone MD CRC 

expenditure is being spent on the second most prevalent adult muscular dystrophy 

or the third most prevalent form of muscular dystrophy affecting men, women and 

children. 

REQUEST

Mr. Chairman and Members of the Committee, we request an appropriation of 

$10 million–$12.5 million to accomplish the FSH muscular dystrophy research plan 

as outlined by the NIH and submitted to the Congress. As a start, simply examining 

the scope of the work outlined in the NIH Action Plan for Muscular Dystrophy 

‘‘Mechanisms Section, Research Objective 3: Define the molecular pathogenetic 

mechanisms that lead to FSH muscular dystrophy,’’ illustrates a requirement of at 

least 12 to 15 basic research grants (R01s) and/or high risk innovative research 

grants (R21s) that require $5 million–$6 million to adequately fund them. 

We also request that the umbrella area of muscular dystrophy receive an appropriation commensurate with similar disease areas, and we request equity by starting with a doubling of the current $39 million to $80 million to adequately fund the 

NIH research plan for dystrophy. NIH Disease Funding, Special Areas of Interest 

table shows that similar umbrella areas of health burden, scope, and impact such 

as Multiple Sclerosis ($109 million), Motor Neuron Disease ($57 million), Cystic Fibrosis ($89 million), Parkinson’s ($223 million), and Huntington’s ($48 million) receiving average funding levels of $105 million. Muscular dystrophy affects hundreds 

of thousands of individuals, including family and friends. 

We understand that the NIH overall budget went down in fiscal year 2006 to 

$28,428M from $28,494M and that Congress is strapped with other priorities. Chairman Specter, thank you for the constant and consistent support of biomedical research and for the NIH programs that offer hope for millions of sick and dying people. Mr. Chairman, members of the committee and members of Congress, the opportunities for FSHD research are greater than ever. The past year brought with it several major breakthroughs and discoveries and we are on the cusp of understanding 

FSHD and a never before seen class of disease. Now that we have a very refined 

plan of attack and research direction by the NIH, the need for funding is even greater. FSHD research needs to continue unabated and we remind you that there is no 

treatment or therapy for this devastating and crippling disease. 
453 

We ask the subcommittee to appropriate in fiscal year 2007 $12.5 million for FSH Muscular Dystrophy and $80 million for Muscular Dystrophy either as new money 

towards the overall NIH budget or as a requested allocation/re-allocation of resources internally within the NIH, to support the NIH stated plan of action to work 

on dystrophy. We thank the subcommittee for this opportunity to present our views. 

PREPARED STATEMENT OF THE FOSTER GRANDPARENT PROGRAM

Mr. Chairman and members of the subcommittee, thank you for the opportunity 

to submit this testimony in support of fiscal year 2007 funding for the Foster Grandparent Program (FGP), the oldest and largest of the three programs known collectively as the National Senior Volunteer Corps, which are authorized by Title II of 

the Domestic Volunteer Service Act (DVSA) of 1973, as amended and administered 

by the Corporation for National and Community Service (CNS). NAFGPD is a membership-supported professional organization whose roster includes the majority of 

more than 350 directors, who administer Foster Grandparent Programs nationwide, 

as well as local sponsoring agencies and others who value and support the work of 

FGP. 

Mr. Chairman, I would like to begin by thanking you and the distinguished members of the subcommittee for your steadfast support of the Foster Grandparent Program. No matter what the circumstances, this subcommittee has always been there 

to protect the integrity and mission of our programs. Our volunteers and the children they serve across the country are the beneficiaries of your commitment to FGP, 

and for that we thank you. I also want to acknowledge your outstanding staff for 

their tireless work and very difficult job they have to ‘‘make the numbers fit.’’—an 

increasingly difficult task in this budget environment. 

NAFGPD remains concerned that the Corporation’s fiscal year 2007 request does 

not provide any new funding where it is needed most—in the field. All of us recognize the spending constraints placed on the President and, most importantly on you 

and the Appropriations Committee. However, in a time of such scarce Federal resources, NAFGPD believes strongly that any new funding should flow to our programs in the field where it is most urgently needed, not CNCS headquarters. 

This fiscal year 2007 budget request follows fiscal year 2006 in which FGP experi- enced a nearly $500,000 funding cut. The last time FGPs in the field realized any 

increases at all to cover the increased costs of doing business—especially in the area 

of transportation costs—was in fiscal year 2005; that increase amounted to a very 

small .84 percent, when inflationary price increases have been averaging 2–3 percent every year. FGP programs continue to face considerable stress in covering the 

rising costs of administering programs and maintaining program quality. 

NAFGPD respectfully requests two things of the subcommittee: 

(1) To provide $115.929 million for the Foster Grandparent Program in fiscal year 

2007, an increase of $4.992 million over the fiscal year 2006 level. This critical funding will ensure the continued viability of the Foster Grandparent Program, and 

allow for important expansion of this unique program. Specifically, this proposal 

would fund a 3 percent cost of living increase for every Foster Grandparent Program 

and expansion grants to existing programs that would add 370 new low-income senior volunteers to serve children; 

(2) To maintain current appropriations statutory language that prohibits CNCS 

from using funds in the bill to pay non-taxable stipend to volunteers whose incomes 

exceed 125 percent of the national poverty level. In its budget narrative, CNCS has 

again requested that this language be eliminated because it stifles innovation. In 

fact, CNCS has the ability to test any innovations they wish through demonstration 

activities—they just cannot pay a non-taxable stipend to volunteers whose incomes 

exceed 125 percent of the national poverty level. Congress has repeatedly over the 

last six years disavowed this practice and re-affirmed that the non-taxable stipend 

must be reserved for low-income volunteers. We ask that you again protect the mission of the Foster Grandparent and Senior Companion Programs—to enable low-income older people—to serve their communities by maintaining this important statutory language. 

FGP: AN OVERVIEW

Established in 1965, the Foster Grandparent Program was the first federally 

funded, organized program to engage older volunteers in significant service to others. From the 20 original programs based totally in institutions for children with 

severe mental and physical disabilities, FGP now comprises nearly 350 programs in 

every State and the District of Columbia, Puerto Rico, and the Virgin Islands. These 

programs are now primarily in community-based child caring agencies or organiza-
454 

tions—where most special needs children can be found today—and are administered 

locally through a non-profit organization or agency and Advisory Council comprised 

of community citizens dedicated to FGP and its mission. FGP represents the best 

in the Federal partnership with local communities, with Federal dollars flowing directly to local sponsoring agencies, which in turn determine how the funds are used. 

Through this partnership and the flexibility of the program, FGP is able to meet 

the immediate needs of the local communities. This was demonstrated by Foster 

Grandparent Programs in communities that were impacted by the influx of Hurricane Katrina evacuees. Foster Grandparents rallied to provide services to children 

in shelters, child care centers, and schools. 

There are currently 38,700 Foster Grandparent volunteers who give over 36 million hours annually to more than 277,000 children. The Foster Grandparent Program is unique for several reasons. The program is one of only two volunteer programs in existence that enable seniors living on very limited incomes to serve their 

communities as volunteers by providing a small non-taxable stipend and other support which allow volunteers to serve at little or no cost to themselves. FGP volunteers provide intensive, consistent service—15 to 40 hours every week, usually four 

hours every day. FGP provides intensive pre-service orientation and at least 48 

hours of ongoing training every year to keep volunteers current and informed on 

how to work with children who have special needs. And our volunteers provide oneto-one service to their assigned children, exactly what is required to help prepare 

our Nation’s neediest children to become self-sufficient adults. 

FGP: THE VOLUNTEERS

The Foster Grandparent Program is a versatile, dynamic, and uniquely multi-purpose program. First, the program gives Americans 60 years of age or older who are 

living on incomes at or less than 125 percent of the poverty level the opportunity 

to serve 15 to 40 hours every week and use the talents, skills and wisdom they have 

accumulated over a lifetime to give back to the communities which nurtured them 

throughout their lives. Seniors in general are not valued or respected in today’s society, and low-income seniors are particularly devalued because of their economic status. They are rarely asked by their communities to contribute through volunteering, 

because they are not traditionally those who participate in community activities. 

FGP actively seeks out these low-income seniors. We dare to ask them to serve, 

to give something back. And we help them to develop the additional skills they may 

need to function effectively in settings unfamiliar to them, like public schools, hospitals, childcare centers, and juvenile detention facilities. We also provide them with 

ongoing training and support throughout their tenure as Foster Grandparents. 

Through their service, our older volunteers say they feel and stay healthier, that 

they feel needed and productive. Most importantly, they leave to the next generation 

a legacy of skills, perspective and knowledge that has been learned the hard way— 

through experience. 

Within budgetary constraints, FGP is engaging older people who are not usually 

asked to serve and those usually considered as needing services rather than being 

able to serve: 86 percent are 65 or older and 45 percent come from various ethnic 

groups. 

FGP: THE CHILDREN

Through our volunteers, the Foster Grandparent Program also provides personto-person service to children and youth under the age of 21 who have special or exceptional needs, many of whom face serious, often life-threatening challenges. With 

the changing dynamics in family life today, many children with disabilities and special needs lack a consistent, stable adult role model in their lives. The Foster Grandparent is very often the only person in a child’s life who is there every day, who 

accepts the child, encourages him no matter how many mistakes the child makes, 

and focuses on the child’s successes. 

Special needs of children served by Foster Grandparents include AIDS or addiction to crack or other drugs; abuse or neglect; physical, mental, or learning disabilities; speech, or other sensory disabilities; incarceration and terminal illness. Of the 

children served, 7 percent are abused or neglected, 26 percent have learning disabilities, and 11 percent have developmental delays. FGP focuses its resources in areas 

where they will have the most impact: early intervention services and literacy activities. Nationally, 85 percent of the children served by Foster Grandparents are 

under the age of 12, with 39 percent of these children age 5 or under. Foster Grandparents work intensively with these very young children to address their problems 

at as early an age as possible, before they enter school. Nearly one-half of FGP vol-
455 

unteers serve nearly 12 million hours annually addressing literacy and emergentliteracy problems with special needs children. 

Activities of the FGP volunteers with their assigned children include teaching parenting skills to teen parents; providing physical and emotional support to babies 

abandoned in hospitals; helping children with developmental, speech, or physical 

disabilities develop self-help skills; reinforcing reading and mathematics skills; and 

giving guidance and serving as mentors to incarcerated or other youth. 

FGP: THE VOLUNTEER SITES

The Foster Grandparent Program provides child-caring agencies and organizations offering services to special-needs children with a consistent, reliable, invaluable extra pair of hands 15 to 40 hours every week to assist in providing these services. Seventy-one percent of FGP volunteers serve in public and private schools as 

well as sites that provide early childhood pre-literacy services to very young children, including Head Start. 

FGP: COST-EFFECTIVE SERVICE

The Foster Grandparent Program serves local communities in a high quality, efficient and cost-effective manner, saving local communities money by helping our 

older volunteers stay independent and healthy and out of expensive in-home or institutional care. Using the Independent Sector’s 2003 valuation for one hour of volunteer service ($17.19/hour), the value of the service given by Foster Grandparents 

annually is over $618 million, and represents a 5-fold return on the Federal dollars 

invested in FGP. The annual Federal cost for one Foster Grandparent is $3,800— 

less than $4 per hour. 

The value local communities place on FGP and its multifaceted services is evidenced by the large amount of cash and in-kind donations contributed by communities to support FGP. For example, FGP’s fiscal year 2001 Federal allocation was 

matched with $40 million in non-Federal donations from States and local communities in which Foster Grandparents volunteer. This represents a non-Federal match 

of 42 percent, or $.42 for every $1 in Federal funds invested—well over the 10 percent local match required by law. 

NAFGPD’S FISCAL YEAR 2007 BUDGET REQUEST

Given the dramatically expanding number of low-income seniors eligible to serve 

and the staggering number of troubled and challenged children in America today, 

we respectfully request that the subcommittee provide $115.929 million for the Foster Grandparent Program in fiscal year 2007, an increase of $4.992 million over fiscal year 2006. This critical funding will ensure the continued viability of the Foster 

Grandparent program, and allow for an expansion of this important program. 

The requested increase would be allocated for the following purposes, in order of 

priority: 

1. in accordance with the Domestic Volunteer Service Act (DVSA), designate onethird of the increase over the fiscal year 2006 level to fund Program of National Significance (PNS) expansion grants to allow existing FGP programs to expand the 

number of volunteers serving in areas of critical need as identified by Congress in 

the DVSA. This expansion of FGP was overwhelmingly supported and endorsed by 

White House Conference in Aging delegates at the recent 2005 Conference convened 

by the President. 

2. use all remaining funds to award an administrative cost increase of at least 

3 percent to each existing Foster Grandparent Program in order to maintain quality, 

enable recruitment and sustain the work already being done by programs. 

This funding proposal will generate opportunities for approximately 370 new lowincome senior volunteers to contribute 390,000 hours of service annually to nearly 

2,000 additional children with special needs through PNS grants to existing FGPs. 

We request that no funds be provided for Senior Demonstration. Language in the 

Corporation for National and Community Service’s Budget Justification indicate 

that any demonstration funds awarded will again be used for programming that allows the payment of a stipend to individuals whose incomes exceed 125 percent of 

the national poverty level. In recognition of the fact that this practice has nothing 

to do with the true spirit of volunteerism, Congress has expressly prohibited this 

practice for the last 6 years in appropriations language; we request that this important language be maintained to protect the purpose of FGP and SCP: to enable lowincome elders to serve their communities. 

The message is clear: (1) the population of low-income seniors available to volunteer 15 to 40 hours every week is increasing; (2) communities need and want more 

Foster Grandparent volunteers and more Foster Grandparent Programs. The sub-
456 

committee’s continued investment in FGP now will pay off in savings realized later, 

as more seniors stay healthy and independent through volunteer service, as communities save tax dollars, and as children with special needs are helped to become contributing members of society. 

Mr. Chairman, in closing I would like to again thank you for the subcommittee’s 

support and leadership for FGP over the years. NAFGPD takes great comfort in 

knowing you and your colleagues in Congress appreciate what our low-income senior 

volunteers accomplish every day in communities across the country. 

PREPARED STATEMENT OF FRIENDS OF THE NATIONAL INSTITUTE ON AGING

Chairman Specter and members of the subcommittee, thank you for this opportunity to testify in support of increasing funding within the National Institutes of 

Health (NIH), and in particular within the National Institute on Aging (NIA). 

The Friends of the NIA is a relatively new coalition comprised of some 50 organizations from academia and the non-profit community. All of the groups comprising 

the Friends of the NIA conduct, fund or advocate for scientific efforts to improve 

the health and quality of life for Americans as they grow older. All of our groups 

support the continuation and expansion of biomedical, behavioral, and social science 

research within the NIA. The Friends of the NIA seeks to raise awareness about 

aging research and the important scientific progress supported and guided by the 

NIA. Our testimony not only addresses recent research advances funded by the NIA, 

but also points to missed opportunities if there is not growth in the NIA appropriation from Congress in fiscal year 2007. 

The NIA is dedicated to conducting biomedical, behavioral, and social science research in order to prevent disease and other problems of the aged, and to maintain 

the health and independence of older Americans. This research is all the more urgent because of the explosive growth of the older population in the United States. 

This year, the first wave of our largest generation—some 77 million members of the 

postwar Baby Boom generation—began turning aging 60. Currently there are some 

36 million Americans aged 65 and older. That population is expected to double in 

size within the next 25 years, at which time nearly 20 percent of the American population will be older than age 65 and eligible for old age assistance for health care 

under the Federal Medicare program (Federal Interagency Forum on Aging-Related 

Statistics 2004, Older Americans). Of particular interest is the dramatic growth that 

is anticipated among those most at risk for disease and disability, people age 85 and 

over whose numbers are expected to grow from 4.3 million in 2000 to at least 19.4 

million in 2050 (65∂ in the United States: 2005, U.S. Census, 2006). 

This growing population presents many social and economic challenges as increasing numbers of Americans reach retirement age. This rapidly expanding population, 

many of whom will have multiple medical needs, will require substantial changes 

in health care delivery. Aging itself is not the cause of disease, disability, and frailty, but these conditions are influenced by age-related changes, lifestyle choices and 

rising risk factors. We also know that outside influences, such as economic, physical, 

environmental, and caregiving stresses increase vulnerability to disease, especially 

amongst the elderly. NIA has a broad research portfolio and is the only Institute 

that studies the normal changes associated with aging as well as pathological conditions from an interdisciplinary perspective. Understanding when and how changes 

occur as we age provides important clues for developing interventions that will prevent and treat diseases, and improve quality of life. 

In addition to participating in NIH-wide initiatives, NIA has made and supported 

many significant contributions of its own to the biomedical and psycho-social understanding of the aging processes and, through ongoing clinical trials, to the testing 

of promising interventions for the detection, treatment and prevention of many agerelated conditions. 

The NIA is the lead Federal research agency for Alzheimer’s disease (AD). AD is 

the most common cause of dementia and a serious threat to the Nation’s health and 

economic well-being. Today, an estimated 4.5 million Americans, 1 in 10 persons 

over age 65 and nearly one-half of those over 85, suffer from this debilitating disease. That toll is projected to increase to 5.1 million people by 2010 and 16 million 

by 2050 (Hebert et al. 2003, Alzheimer’s Disease in the U.S. Population). Over the 

next decade, Medicare spending on beneficiaries with AD will more than triple to 

$189 billion. Our concern is that flattened budgets for the NIH institutes are threatening major AD research initiatives. One example is the Alzheimer’s Disease 

Neuroimaging Initiative (ADNI), launched in 2004 as a public/private partnership: 

the most comprehensive effort to date to identify neuroimaging strategies and biomarkers to identify the onset of mild cognitive impairment and early AD with great-
457 

er sensitivity. The project currently involves approximately 50 sites across the 

United States and Canada and holds the promise of early diagnosis and subsequent 

interventions that could postpone or more effectively treat AD. The Genetics Initiative is another multi-site collaboration that is collecting, sharing, and analyzing 

data to complete the picture of genetic risk factors for AD. These programs offer 

enormous potential to identify AD and intervene early, but lack of adequate funding 

will prevent or slow realization of the full potential of these programs. With aging 

baby boomers on the horizon, we cannot afford this delay. 

Great strides have been made in AD. Only a few years ago, this disease could not 

be positively confirmed until autopsy. Now we can diagnose the disease in life with 

a high degree of certainty; we understand some of the basic mechanisms of the disease; and five approved drugs for treating symptoms are now approved with many 

new compounds being tested in publicly and industry-supported clinical trials. 

This is a critical time for investment not retrenchment. Scientists are poised to 

find effective ways to prevent, delay onset, and even treat this disease. If the onset 

of AD could be delayed by just two years, the AD afflicted population would remain 

at current size, even with the expected increases in senior population; a five-year 

delay of onset would cut the projected AD population in half. 

Other promising NIA biomedical research efforts into prominent diseases include 

research programs to discover new Parkinson’s susceptibility genes; studies of agerelated bone loss and osteoporosis; development of programs to assess genetic and 

environmental factors in racial and ethnic health differences simultaneously; and 

bone marrow failure diseases, all of which occur in higher incidence in people over 

60. 

NIA’s behavioral and social science research programs have been instrumental in 

providing crucial economic and demographic population information. NIA’s Centers 

on the Demography of Aging, particularly their Health and Retirement Survey 

(HRS) and the National Long-Term Care Survey (NLTCS), provide critical data on 

the health and economic status of the older population. These data have been used 

by Congress to better understand the budgetary impact of population aging, as potential changes to public programs such as Social Security, Medicare, and Medicaid 

are deliberated. By using NLTCS data, investigators identified the declining rate of 

disability in older Americans first observed in the mid-1990s—a trend that has continued. This trend, if continued, could have momentous impact on reducing the need 

for costly long-term care. The Social Security Administration recognizes and cofunds the HRS as a ‘‘Research Partner’’ and posts the study on its home page to 

improve its availability to the public and to policymakers. In 2005, the Center for 

Medicare and Medicaid Services (CMS) funded a supplemental survey using the 

HRS to provide timely information on who is likely to enroll in the new Medicare 

Part D prescription drug program and how those decisions are related to knowledge 

of the program, drug use and costs. 

There is building evidence that continued engagement in productive activities has 

a positive impact on health and life satisfaction. The experience and expertise of the 

new 65∂ population offers great potential to help address workforce shortages as 

well as some of the critical social needs of our country. The NIA is working to build 

a research agenda that focuses on maximizing older workers’ safety, health, productivity and life satisfaction—knowledge that this will be critical to developing sound 

national policies. 

NIA provides critical support for the training of new investigators. The reduction 

in funded proposals as a result of limited NIA budget will impact the ability to recruit and sustain an appropriate pool of qualified researchers in gerontology and 

geriatrics. Numerous reports have cited the need for more geriatricians and geriatric-trained professionals for our aging society. By 2030, the United States will 

need up to 36,000 geriatricians and will fall far short of that figure by as many as 

25,000 unless effective steps are taken to train new providers (Medical Never-Never 

Land, Alliance for Aging Research, 2002). Further budget cuts will reduce funding 

available for training, and may force some leading researchers and practitioners to 

abandon gerontology as well as the mentoring of new professionals in the field. 

With bipartisan leadership in Congress, the NIH budget doubled between 1998 

and 2003 ($13.6 to $27.3 billion). However, since 2003, funding for the NIH in real 

dollars has been on a downward trajectory. Under the President’s proposed fiscal 

year 2007 budget, the NIA is slated to be decreased in real terms by $10 million. 

Further, in order to preserve clinical trials already underway, NIA will fund only 

18 percent of new grant proposals. This is down substantially from 28.5 percent in 

2003, and will not come close to supporting the more than 50 percent of submitted 

applications that the NIA has determined to be highly promising. At the same time 

that the acceptance rate of new proposals is down, the funding levels of new grants 

has also dropped from years past. Moreover, even those grantees receiving funding 
458 

face an average reduction from requested budgets by 18 percent across the board. 

(Fiscal Year 2007, National Institutes on Aging, Justification of Estimates for Appropriations Committees). Investigator-initiated research projects provide new 

breakthroughs in knowledge and treatment to benefit older Americans and their 

families. Declining budgets slow momentum and impact future research programs. 

For example, continued cuts will impact projects such as, the start up of new clinical 

trials in caloric restriction, testosterone supplementation in men, and lifestyle interventions and independence for elders, all of which have shown great potential for 

significant public health outcomes. 

The Friends of the National Institute on Aging recommend the following directives: 

(1) The time for research on aging is now if we are to achieve a healthier and 

more productive aging America. To further this goal, the Friends of the NIA endorse 

the recommendation issued by the Ad Hoc Group for Medical Research in calling 

for a 5 percent overall increase for the National Institutes of Health in fiscal year 

2007. 

(2) NIA needs additional resources to support individual investigator awards, to 

avoid an 18 percent cut in its existing grants, and to sustain training and research 

opportunities for new investigators. 

Mr. Chairman, the Friends of the NIA thanks you for this opportunity to outline 

the challenges threats and opportunities that lie ahead as you consider appropriate 

funding for the NIH and the National Institute on Aging. 

PREPARED STATEMENT OF FRIENDS OF NIDA COALITION

The Friends of the National Institute on Drug Abuse (FoN), a burgeoning coalition 

of scientific and professional societies, patient groups, and other organizations committed to preventing and treating substance use disorders as well as understanding 

the causes and public health consequences of addiction, is pleased to provide testimony in support of the NIDA’s extraordinary work. Pursuant to clause 2(g)4 of 

House Rule XI, the Coalition does not receive any Federal funds. 

Drug abuse is costly—to individuals and to our society as a whole. Smoking, alcohol abuse and illegal drugs cost this country more than $500 billion a year, with 

illicit drug use alone accounting for about $180 billion in health care, crime, productivity loss, incarceration, and drug enforcement. Beyond its monetary impact, drug 

and alcohol abuse tear at the very fabric of our society, often spreading infectious 

diseases and bringing about family disintegration, loss of employment, failure in 

school, domestic violence, child abuse, and other crimes. The good news is that 

treatment for drug abuse is effective and recovery from addiction is real for millions 

of Americans across the country. Preventing drug abuse and addiction and reducing 

these myriad adverse consequences in the ultimate aim of our Nation’s investment 

in drug abuse research. Over the past three decades, scientific advances resulting 

from research have revolutionized our understanding of and approach to drug abuse 

and addiction. 

NODA supports a comprehensive research portfolio that spans the continuum of 

basic neuroscience, behavior and genetics research through applied health services 

research and epidemiology. While supporting research on the positive effects of evidence-based prevention and treatment efforts, NIDA also recognizes the need to 

keep pace with emergent problems. Research shows encouraging trends that NIDA’s 

public education and awareness efforts are having an impact: For example, the 2005 

Monitoring the Future Survey of 8th, 10th, and 12th graders shows a dramatic 19 

percent reduction in use since 2001. However, areas of significant concern remain. 

Some of NIDA’s current research priorities include understanding more about methamphetamine and the brain, addressing the growing problem of prescription drug 

abuse, using drug abuse treatment to curtail the spread of HIV/AIDS, and encouraging collaborations that address comorbidity. 

Because of the critical importance of drug abuse research for the health and economy of our Nation, we write to you today to request your support for a 5 percent 

increase for NIDA in the fiscal 2007 Labor, Health and Human Services, Education 

and Related Agencies Appropriations bill. That would bring total funding for NIDA 

in fiscal 2007 to $1,050,030,450. Recognizing that so many health research issues 

are inter-related, we also support a 5 percent increase for the National Institutes 

of Health overall, which would bring its total to $30 billion for fiscal 2007, This 

work deserves continuing, strong support from Congress. Below is a short list of significant NIDA accomplishments, challenges, and successes. 

Adolescent Brain Development—How Understanding the Brain Can Impact Prevention Efforts.—NIDA maintains a vigorous developmental research portfolio fo-
459 

cused on adolescent populations. NIDA working collaboratively with other NIH Institutes has shown that the human brain does not fully develop until about age 25. 

This adds to the rationale for referring to addiction as a ‘‘developmental disease;’’ 

it often starts during the early developmental stages in adolescence and sometimes 

as early as childhood, a time when we know the brain is still developing. Having 

insight into how the human brain works, and understanding the biological 

underpinnings of risk taking among young people will help in developing more effective prevention programs. FoN believes NIDA should continue its emphasis on 

studying adolescent brain development to better understand how developmental 

processes and outcomes are affected by drug exposure, the environment and genetics. 

Medications Development.—NIDA has demonstrated leadership in the field of 

medications development by partnering with private industry to develop anti-addiction medications resulting in a new medication, buprenorphine, for opiate addiction. 

FoN recommends that NIDA continue its work with the private sector to develop 

much needed anti-addiction medications, for cocaine, methamphetamine, and marijuana dependence. 

Co-Occurring Disorders.—NIDA recognizes the need to to adequately address research questions related to co-occurring substance abuse and mental health problems. In particular, NIDA has developed robust collaborations with other agencies 

(such as NIAAA, NIMH and SAMHSA) to stimulate new research to develop effective strategies and to ensure the timely adoption and implementation of evidencebased practices for the prevention and treatment of co-occurring disorders. Through 

these initiatives, NIDA is supporting research to determine the most effective models of clinically appropriate treatment and how to bring them to communities with 

limited resources. FoN recognizes the imperative for continued funding of essential 

research into the nature of and improved treatment for these complex disorders and 

endorses these efforts. 

Drug Abuse and HIV/AIDS.—One of the most significant causes of HIV virus acquisition and transmission involves drug taking practices and related risk factors 

in different populations (e.g. criminal justice, pregnant women, minorities, and 

youth). Drug abuse prevention and treatment interventions have been shown to be 

effective in reducing HIV risk. FoN congratulates NIDA on its ‘‘Drug Abuse and 

HIV—Learn the Link’’ public awareness campaign, targeting young people, and believes NIDA should continue to support research that focuses on developing and 

testing drug-abuse related interventions designed to reduce the spread of HIV/AIDS. 

Emerging Drug Problems.—NIDA recognizes that drug use patterns are constantly changing and expends considerable effort to monitor drug use trends and to 

rapidly inform the public of emerging drug problems. FoN believes NIDA should 

continue supporting research that provides reliable data on emerging drug trends, 

particularly among youth and in major cities across the country and will continue 

its leadership role in alerting communities to new trends and creating awareness 

about these drugs. 

Reducing Prescription Drug Abuse.—NIDA research has documented continued increases in the numbers of people, especially young people, who use prescription 

drugs for non-medical purposes. Particular concern revolves around the inappropriate use of opiod analgesics—very powerful pain medications. FoN commends 

NIDA for its research focus in this area, and for the new Prescription Opioid Use 

and Abuse in the Treatment of Pain initiative. Research targeting a reduction in 

prescription drug abuse, particularly among our Nation’s youth, will continue to be 

a priority for NIDA. Finally, FoN endorses NIDA’s programmatic research designed 

to further the development of medications that are less likely to have abuse/addiction liability, and to develop prevention and treatment interventions for adolescents 

and adults who are abusing prescription drugs. 

Reducing Methamphetamine Abuse.—NIDA continues to recognize the epidemic 

abuse of methamphetamine across the United States. Methamphetamine abuse not 

only affects the users, but also the communities in which they live, especially due 

to the dangers associated with its production. FoN believes NIDA should continue 

to support research to address the broad medical consequences of methamphetamine 

abuse, and is encouraged by the evidence of treatment effectiveness in these populations. Topics of particular concern include: understanding the effects of prenatal 

exposure to methamphetamine, developing pharmacotherapies and behavioral therapies to treat methamphetamine addiction and information dissemination strategies 

to inform the public that treatment for methamphetamine addiction is effective. 

Reducing Inhalant Abuse.—FoN recognizes that inhalant use continues to be a 

significant problem among our youth. Inhalants pose a particularly significant problem since they are readily accessible, legal, and inexpensive. They also tend to be 

abused by younger teens and can be highly toxic and even lethal. FoN applauds 
460 

NIDA’s inhalant research portfolio and believes NIDA should continue its support 

of research on prevention and treatment of inhalant abuse, and to enhance public 

awareness on this issue. 

Long-Term Consequences of Marijuana Use.—NIDA research shows that marijuana can be detrimental to educational attainment, work performance, and cognitive function. However, more information is needed in order to assess the full impact of long-term marijuana use. Therefore, FoN recommends that NIDA continue 

to support efforts to assess the long-term consequences of marijuana use on cognitive abilities, achievement, and mental and physical health, as well as work with 

the private sector to develop medications focusing on marijuana addiction. 

Translating Research Into Practice.—FoN commends NIDA for its outreach and 

work with State substance abuse authorities to reduce the current 15- to 20-year 

lag between the discovery of an effective treatment intervention and its availability 

at the community level. In particular, FoN applauds NIDA for continuing its work 

with SAMHSA to strengthen State substance abuse agencies’ capacity to support 

and engage in research that will foster statewide adoption of meritorious sciencebased policies and practices. FoN encourages NIDA to continue collaborative work 

with State substance abuse agencies to ensure that research findings are relevant 

and adaptable by State substance abuse systems. NIDA is also to be congratulated 

for its broad and varied information dissemination programs as part of an effort to 

ensure drug abuse research is used in everyday practice. The Institute is focused 

on stimulating and supporting innovative research to determine the components 

necessary for adopting, adapting, delivering, and maintaining effective research-supported policies, programs, and practices. As evidence-based strategies are developed, 

FoN urges NIDA to support research to determine how these practices can be best 

implemented at the community level. 

Primary Care Settings and Youth.—NIDA recognizes that primary care settings, 

such as offices of pediatricians and general practitioners, are potential key points 

of access to prevent and treat problem drug use among young people; yet primary 

care and drug abuse services are commonly delivered through separate systems. 

FoN encourages NIDA to continue to support health services research on effective 

ways to educate primary care providers about drug abuse; develop brief behavioral 

interventions for preventing and treating drug use and related health problems, particularly among adolescents; and develop methods to integrate drug abuse screening, assessment, prevention and treatment into primary health care settings. 

Utilizing Knowledge of Genetics and New Technological Advances to Curtail Addiction.—NIDA recognizes that not everyone who takes drugs becomes addicted and 

that this is an important phenomenon worthy of further exploration. Research has 

shown that genetics plays a critical role in addiction, and that the interplay between 

genetics and environment is crucial. The science of genetics is at a crucial phase— 

technological advances are providing the tools to make significant breakthroughs in 

disease research. For example, FoN believes NIDA should take advantage of new 

high-resolution genetic technologies which may help to develop new tailored treatments for smoking. 

Reducing Health Disparities.—NIDA research demonstrates that the consequences 

of drug abuse disproportionately impacts minorities, especially African American 

populations. FoN believes that researchers should be encouraged to conduct more 

studies in this population and to target their studies in geographic areas where 

HIV/AIDS is high and or growing among African Americans, including in criminal 

justice settings. 

The Clinical Trials Network—Using Infrastructure to Improve Health.—FoN applauds the continued success of NIDA’s National Drug Abuse Treatment Clinical 

Trials Network (CTN), which was established in 1999 and has grown to include over 

17 research centers or nodes spread across the country. The CTN provides an infrastructure to test the effectiveness of new and improved interventions in real-life 

community settings with diverse populations, enabling an expansion of treatment 

options for providers and patients. FoN suggests NIDA continue to develop ways to 

use the CTN as a vehicle to address emerging public health needs. 

Behavioral Science.—NIDA has long demonstrated a strong commitment to supporting behavioral science research. FoN encourages NIDA to continue to determine 

the interplay of behavioral, biological, and social factors that affect development and 

the onset of diseases like drug addiction to understand common pathways that may 

underlie other compulsive behaviors such as gambling and eating disorders. 

Drug Treatment in Criminal Justice Settings.—NIDA is very concerned about the 

well-known connections between drug use and crime. Research continues to demonstrate that providing treatment to individuals involved in the criminal justice system decreases future drug use and criminal behavior, while improving social functioning. Blending the functions of criminal justice supervision and drug abuse treat-
461 

1 Heart Rhythm Foundation, Arrhythmia Key Facts, 2004 http:// 

www.heartrhythmfoundation.org/facts/arrhythmia.asp. 

ment and support services create an opportunity to have an optimal impact on behavior by addressing public health concerns while maintaining public safety. FoN 

strongly supports NIDA’s efforts in this area, particularly the Criminal Justice Drug 

Abuse Treatment Studies (CJ–DATS), a multi-site set of research studies designed 

to improve outcomes for offenders with substance use disorders by improving the 

integration of drug abuse treatment with other public health and public safety systems. 

Social Neuroscience.—Research-based knowledge about the dynamic interactions 

of genes with environment confirm addiction as a complex and chronic disease of 

the brain with many contributors to its expression in individuals. FoN applauds 

NIDA’s involvement in the recently released ‘‘social neuroscience’’ request for applications, and encourages the Institute to continue its focus on the interplay between 

genes, environment, and social factors and their relevance to drug abuse and addiction. 

Translational Research: Ensuring Research is Adaptable and Useable.—FoN commends NIDA for its broad and varied information dissemination programs. FoN also 

understands that the Institute is focused on stimulating and supporting innovative 

research to determine the components necessary for adopting, adapting, delivering, 

and maintaining effective research-supported policies, programs, and practices. As 

evidence-based strategies are developed, FoN urges NIDA to support research to determine how these practices can be best implemented at the State and community 

level. 

Blending Research and Practice.—FoN notes that it takes far too long for clinical 

research results to be implemented as part of routine patient care, and that this 

lag in diffusion of innovation is costly for society, devastating for individuals and 

families, and wasteful of knowledge and investments made to improve the health 

and quality of people’s lives. FoN applauds NIDA’s collaborative approach aimed at 

proactively involving all entities invested in changing the system and making it 

work better. NIDA is leading efforts to make the best substance abuse treatments 

available to those who need them, and this effort requires working with many different contributors to assimilate their feedback and create change at multiple levels. 

CONCLUSION

The Nation’s investment in scientific research has changed the way people view 

drug abuse and addiction in this country. We now know how drugs work in the 

brain, their health consequences, how to treat people already addicted, and what 

constitutes effective prevention strategies. FoN asks you to provide an appropriation 

of $1,050,030,450 for NIDA, so that it may continue to serve the public health of 

all Americans and capitalize on new opportunities as science advances. 

We understand that the fiscal year 2007 budget cycle will involve setting priorities and accepting compromise. However, in the current climate, we believe a focus 

on substance abuse and addiction, which according to the World Health Organization account for nearly 20 percent of disabilities among 15–44 year olds, deserve to 

be prioritized accordingly. We look forward to working with you to make this a reality. 

Thank you, Mr. Chairman, and the subcommittee, for your support for the National Institute on Drug Abuse. 

PREPARED STATEMENT OF THE HEART RHYTHM SOCIETY

The Heart Rhythm Society (HRS) thanks you and the Subcommittee on Labor, 

Health and Human Services and Education for your past and continued support of 

the National Institute of Health, and specifically the National Heart, Lung and 

Blood Institute (NHLBI). 

The Heart Rhythm Society, founded in 1979 to address the scarcity of information 

about the diagnosis and treatment of cardiac arrhythmias, is the international leader in science, education and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. The Heart 

Rhythm Society serves as an advocate for millions of American citizens from all 50 

States, since arrhythmias are the leading cause of heart-disease related deaths. 

Other, less lethal forms of arrhythmias are even more prevalent, account for 14 percent of all hospitalizations of Medicare beneficiaries.1 Our mission is to improve the 

care of patients by promoting research, education and optimal health care policies 
462 

2Murphy, KM and Topel, RH, The Value of Health and Longevity, National Bureau of Economic Research Working Paper Series, Working Paper 11405, June 2005. 3 American Stroke Association and American Heart Association, Heart Disease and Stroke 

Statisticsl2005 Update, 2005 http://www.americanheart.org/downloadable/heart/ 

1105390918119HDSStats2005Update.pdf. 

and standards. We are the preeminent professional group, representing more than 

4,200 specialists in cardiac pacing and electrophysiology. 

The Heart Rhythm Society recommends the subcommittee renew its commitment 

to supporting biomedical research in the United States and recommends Congress 

provide NIH with a 5 percent increase for fiscal year 2007. This translates into an 

appropriation of $29.849 billion for NIH, with $3.068 billion designated to the National Heart, Lung, and Blood Institute (NHLBI). This increase will enable NIH and 

NHLBI to sustain the level of research that leads to research breakthroughs and 

improved health outcomes. In particular, the Heart Rhythm Society recommends 

Congress support research into abnormal rhythms of the heart. 

HRS appreciates the actions of Congress to double the budget of the NIH in recent years. The doubling has directly promoted innovations that have improved 

treatments and cures for a myriad of medical problems facing our Nation. Medical 

research is a long-term process and in order to continue to meet the evolving challenges of improving human health we must not let our commitment wane. Furthermore, NIH research fuels innovation that generates economic growth and preserves 

our Nation’s role as a world leader in the biomedical and biotech industries. 

Healthier citizens are the key to robust economic growth and greater productivity. 

Economists estimate that improvements in health from 1970 to 2000 were worth 

$95 trillion. During the same time period, the United States invested $200 billion 

in the NIH. If only 10 percent of the overall health savings resulted from NIH-funded research, our investment in medical research has provided a 50-fold return to the 

economy.2

RESEARCH ACCOMPLISHMENTS

In the field of cardiac arrhythmias, NIH-funded research has advanced our ability 

to treat atrial fibrillation and thus prevent the devastating complications of stroke. 

Atrial fibrillation is found in about 2.2 million Americans and increases the risk for 

stroke about 5-fold. About 15–20 percent of strokes occur in people with atrial fibrillation. Stroke is a leading cause of serious, long-term disability in the United States 

and people who have strokes caused by AF have been reported as 2–3 times more 

likely to be bedridden compared to those who have strokes from other causes. Each 

year about 700,000 people experience a new or recurrent stroke and in 2002 stroke 

accounted for more than 1 of every 15 deaths in the United States. Ablation therapy 

however is providing a cure for individuals whose rapid heart rates had previously 

incapacitated them, giving them a new lease on life.3

Important advances have also been made in identifying patients with heart failure and those who have suffered a heart attack and are at risk for sudden death. 

The development, through initial NIH-sponsored research, and implantation of sophisticated internal cardioverter defibrillators (ICD’s) in such patients has saved the 

lives of hundreds of thousands and provides peace of mind for families everywhere, 

including that of Vice-President Cheney’s. A new generation of pacemakers and 

ICDs is restoring the beat of the heart as we grow older, permitting us to lead more 

normal and productive lives, reducing the burden on our families, communities and 

the healthcare system. Arrhythmias and sudden death affect all age groups and are 

not solely diseases of the elderly. 

Research advances in molecular genetics have provided us the root basis for lifethreatening abnormal rhythms of the heart associated with of wide range of inherited syndromes including long and short QT, Brugada syndromes, and hypertrophic 

cardiomyopathies. This knowledge has provided guidance to physicians for better detection and treatment of these sudden death syndromes reducing mortality and disability of infants, children and young adults. Individuals who survive an instance 

of sudden death often remain in vegetative states, resulting in a devastating burden 

on their families and an enormous economic burden on society. These advances have 

translated into sizeable savings to the health care system in the United States. Researchers are also developing a noninvasive imaging modality for cardiac arrhythmias. Despite the fact that more than 325,000 Americans die every year from heart 

rhythm disorders, a noninvasive imaging approach to diagnosis and guided therapy 

of arrhythmias, the equivalent of CT or MRI, has previously not been available. 

The NIH-funded Public Access Defibrillation (PAD) Trial was also able to determine that trained community volunteers increase survival for victims of cardiac arrest. It had already been known that defibrillation, utilizing an automated external 
463 

4 National Heart Lung and Blood Institute, NIH, Public Access Defibrillation by Trained Community Volunteers Increases Survival for Victims of Cardiac Arrest, November 2003 http:// 

www.nhlbi.nih.gov/new/press/03l11l11.htm. 5 Heart Rhythm Foundation, The Facts on Sudden Cardiac Arrest, 2004 http:// 

www.heartrhythmfoundation.org/itslaboutltime/pdf/providerlfactlsheet.pdf. 6 Heart Rhythm Society, Atrial Fibrillation & Flutter, 2005lttp://www.hrspatients.org/patients/heartldisorders/atriallfibrillation/default.asp. 7 American Stroke Association, Impact of Stroke, 2005 http://www.strokeassociation.org/presenter.jhtml?identifier=1033. 8Task Force on the Future of American Innovation, The Knowledge Economy: Is the United 

States Losing it’s Competitive Edge?, February 16, 2005. 

defibrillator (AED), by trained public safety and emergency medical services personnel is a highly effective live-saving treatment for cardiac arrest. A NIH-funded 

trial however was able to conclude that placing AED’s in public places and training 

lay persons to use them can prevent additional deaths and disabilities.4

Without NIH support, these life-saving findings may have taken a decade to unravel. The highly focused approach utilizing basic and clinical expertise, funded 

through Federal programs made these advances a reality in a much shorter timeperiod. 

BUDGET JUSTIFICATION

These impressive strides notwithstanding, cardiac arrhythmias continue to plague 

our society and take the lives of loved ones at all ages, nearly one every minute of 

every day, as well as straining an already burdened health system. Sudden Cardiac 

Arrest is a leading cause of death in the United States, claiming an estimated 

325,000 lives every year, or one life every two minutes.5 The burden of morbidity 

and mortality due to cardiac arrhythmias is predicted to grow dramatically as the 

baby boomers age. Atrial fibrillation strikes 3–5 percent of people over the age of 

65,6 presenting a skyrocketing economic burden to our society in the form of 

healthcare treatment and delivery. It is estimated in 2005 that the direct and indirect cost of stroke will be $56.8 billion.7 Cardiac diseases of all forms increase with 

advancing age, ultimately leading to the development of arrhythmias. NIH research 

provides the basis for the medical advances that hold the key to lowering health 

care costs. 

The above progress we have witnessed in recent years will provide treatments for 

this illness, only if the resources continue to be available to the academic scientific 

and medical community. However, the budgets appropriated by Congress to the NIH 

in the past three years were far below the level of scientific inflation. These vacillations in funding cycles threaten the continuity of the research and the momentum 

that has been gained over the years. While HRS recognizes that Congress must balance other priorities, sustaining multi-year growth for the biomedical research enterprise is critical. A central objective of the doubling of the NIH budget was to accelerate solutions to human disease and disability. NIH is now engaging in the next 

generation of biomedical research to translate basic research and clinical evidence 

into new cures. Our ability to bring together uniquely qualified and devoted investigators and collaborators both at the basic science level and in the clinical arena 

is a vital key to our to this success. Funding models however show that a threshold 

exists, below which NIH will not be able to maintain its current scope and number 

of grants, let alone expand its programs to address new concerns and emerging opportunities. Furthermore, the United States is in danger of losing its leadership role 

in science and technology. The United States faces growing competition from other 

nations, such as China and India, which are working to invest more of their GDP’s 

into building state-of-the-art research institutes and universities to foster innovation 

and compete directly for the world’s top students and researchers.8

It is for this reason that we are asking for your support to increase NIH appropriations by 5 percent for a fiscal year 2007 budget of $29.849 billion for NIH and 

$3.068 billion for NHLBI. The Heart Rhythm Society recommends Congress specifically acknowledge the need for cardiac arrhythmia research to prevent sudden cardiac arrest and other life threatening conditions such as sudden infant death syndrome, definitive therapeutic approaches for atrial fibrillation and the prevention of 

stroke, and other genetic arrhythmia conditions. Thank you very much for your consideration of our request. 

If you have any questions or need additional information, please contact Nevena 

Minor, Coordinator, Health Policy at the Heart Rhythm Society 

(amelnick@hrsonline.org or 202–464–3434). 

Thank you again for the opportunity to submit testimony. 
464 

PREPARED STATEMENT OF THE HEMOPHILIA FEDERATION OF AMERICA

SUMMARY OF FISCAL YEAR 2007 RECOMMENDATIONS

—Continued support for Hemophilia Treatment Centers through the Health Resources and Services Administration Maternal and Child Health Block Grant. 

—$10 million for hemophilia programs at the Centers for Disease Control and 

Prevention and expansion of the program to allow partnerships with additional 

patient-based organizations within the hemophilia community. 

—A 5 percent increase overall for the National Institutes of Health, including a 

5 percent increase for the National Heart, Lung, and Blood Institute, and the 

National Institute for Allergy and Infectious Diseases. 

INTRODUCTION

The Hemophilia Federation of America (HFA) is a national nonprofit organization 

that assists and advocates for the blood clotting disorders community. The vision of 

the HFA is that the blood clotting disorders community will face no barriers to 

choice of treatment and quality of life. 

The programming of HFA is designed to be of assistance to the consumer and 

their families and is structured to follow our mission and vision. We at HFA consider ourselves the ‘‘consumer organization.’’ That was the purpose of our organization when we were established a decade ago and it has remained constant in the 

structure and activities of the organization. The following is a summary of some of 

the programs that HFA offers to the hemophilia community: 

‘‘Helping Hands’’ 

Helping Hands is a program that offers financial assistance to patients and families in a crisis. The grant applicant requests funds for emergency assistance with 

various needs such as: rent, utilities, car repair, and quality of life issues. Over one 

half of the requests funded in recent years were first time applicants. The requests 

are comprised of referrals from member organizations and industry. 

‘‘Dads in Action’’ 

Dads in Action is a new program launched in the fall of 2003 that is designed 

to encourage dads to take a more active role in their children’s lives, to be more 

involved in the care of their child with hemophilia and to strengthen communication 

throughout the family. Participants return to their home chapters to start a ‘‘Dads 

in Action’’ program where they carry the lessons learned to fellow Dads at their 

local chapter. The program receives high reviews from participants and is an integral part of our vision for the community. 

The Annual HFA Symposium 

HFA’s annual Symposium is one of the brightest stars in our programmatic agenda. This event has grown from a small gathering of 100 people in 1996 to over 500 

in 2006. Are sole focus at this annual event is the consumer. Our patients view that 

annual symposium as a big family reunion where they learn how to cope with everyday situations. There are also free programs for teens and children. The goal of the 

Symposium is to address issues that impact the entire community. Presenters are 

experts in their field and share their expertise with the community. 

FISCAL YEAR 2007 APPROPRIATIONS RECOMMENDATIONS

Hemophilia Treatment Centers/Health Resources and Services Administration 

In 1974, Congress created a network of Hemophilia Treatment Centers (HTCs) 

throughout the United States. This treatment centers remain essential to ensuring 

that comprehensive and specialized care is available for persons with bleeding disorders. There are currently over 140 HTCs in the United States. These centers 

abide by Federal guidelines for the delivery of comprehensive hemophilia services 

as developed by the Health Resources and Services Administration and the Centers 

for Disease Control and Prevention. 

HTC’s provide family centered, state-of-the-art medical and psychosocial services, 

as well as education and research to persons with inherited bleeding disorders. The 

bleeding disorder community utilizes many services through the Hemophilia Treatment Centers. These services include diagnostic evaluations for hemophilia, von 

Willebrand disease and other bleeding disorders. They also include annual comprehensive evaluations, clinical trials on new blood clotting therapies, coordination 

with the individual’s primary care physician, emergency consultations, 

hematological management for surgeries, dental procedures and childbirth. HTC’s 

educate patients and family members on infusion training, encourage collaboration 
465 

with clinicians throughout the United States, participate in CDC research, and collaborate with the hemophilia community. 

At the Health Resources and Services Administration, funding is provided to 

HTC’s through the Maternal and Child Health Block Grant program. For fiscal year 

2007, HFA encourages the subcommittee to reject the president’s proposed $36 million cut to MCHBG, and restore funding to the fiscal year 2006 level of $816 million. 

Hemophilia Program at the Centers for Disease Control and Prevention 

Mr. Chairman, HFA strongly supports the expansion of hemophilia related programs within CDC’s National Center on Birth Defects and Developmental Disabilities’ Hereditary Blood Disorders program. In partnership with HRSA, this program 

provides vital support to Hemophilia Treatment Centers, particularly in the areas 

of research, education, disease management, blood safety and surveillance. For fiscal 

year 2007, HFA encourages the subcommittee to provide an increase of $3 million 

for hemophilia related activities at CDC. This proposed increase would bring the 

total level of CDC funding for the hemophilia treatment center network to $10 million. This increase is important given the fact the program has been level funded 

for over 10 years. 

HFA was very pleased that the fiscal year 2006 Senate Labor-HHS–Education 

committee report encouraged CDC to expand opportunities for additional patientbased organizations to participate in the agency’s hemophilia program. Under the 

current structure of the program, only one hemophilia organization is eligible to receive support for the purpose of providing much needed services to patients. In order 

to maximize the effectiveness of the CDC program, we believe that additional patient based organizations should be empowered to receive funding on an annual 

basis. As referenced earlier, HFA offers a wide variety of high quality, consumer focused, programs that no other organization provides. If the CDC program were 

opened-up to allow additional organizations to participate, we would be able to help 

a much larger number of patients and families throughout the country. We encourage the subcommittee to support our efforts in this regard in the fiscal year 2007 

bill. 

Research at the National Institutes of Health 

HFA applauds the National Heart, Lung and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Institute of 

Allergy and Infectious Diseases for their strong support of hemophilia related research. We are grateful to the subcommittee for recognizing the growing problem 

of bleeding disorders in women, which if untreated, can lead to serious medical conditions including anemia, unnecessary hysterectomies, and menstrual complications. 

Patients and families in the hemophilia community are placing their hopes for a 

better quality of life on treatment advances made through biomedical research. For 

fiscal year 2007, we encourage the subcommittee to provide a 5 percent increase 

overall for each institute and center at the NIH. 

Mr. Chairman, thank you for the opportunity to present the views of the Hemophilia Federation of America. 

PREPARED STATEMENT OF HEPATITIS FOUNDATION INTERNATIONAL

SUMMARY OF FISCAL YEAR 2007 RECOMMENDATIONS

—Continue the great strides in research at the National Institutes of Health 

(NIH) by providing a 5 percent budget increase for fiscal year 2007. Increase 

funding for the National Institute for Allergy and Infectious Diseases (NIAID), 

the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 

the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the National Institute on Drug Abuse (NIDA) by 5 percent. 

—Continued support for the hepatitis B vaccination program for adults at the 

Centers for Disease Control and Prevention (CDC) as well as CDC’s Prevention 

Research Centers by providing an 8 percent increase for CDC. 

—Support for the Substance Abuse and Mental Health Services Administration 

(SAMHSA) by providing an 8 percent increase in fiscal year 2007. 

—Urge CDC, NIAID, NIDDK, NIAAA, NIDA, and SAMHSA to work with voluntary health organizations to promote liver wellness, education, and prevention of both hepatitis and substance abuse. 

Mr. Chairman and members of the subcommittee, thank you for your continued 

leadership in promoting better research, prevention, education, and control of diseases affecting the health of our Nation. I am Thelma King Thiel, Chairman and 

Chief Executive Officer of the Hepatitis Foundation International (HFI). 
466 

Currently, five types of viral hepatitis have been identified, ranging from type A 

to type E. All of these viruses cause acute, or short-term, viral hepatitis. Hepatitis 

B, C, and D viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes lifelong. While treatment options are available for many patients, 

individuals with chronic viral hepatitis B and C represent a significant number of 

patients requiring a liver transplant. Current treatments have limited success and 

there is no vaccine available for hepatitis C, the most prevalent of these diseases. 

HEPATITIS A

The hepatitis A virus (HAV) is contracted through fecal/oral contact (i.e. fecal contamination of food, water, and diaper changing tables if not cleaned properly), and 

sexual contact. In addition, eating raw or partially cooked shellfish contaminated 

with HAV can spread the virus. Children with HAV usually have no symptoms; 

however, adults may become quite ill suddenly experiencing jaundice, fatigue, nausea, vomiting, abdominal pain, dark urine/light stool, and fever. There is no treatment for HAV; however, recovery occurs spontaneously over a 3 to 6 month period. 

About 1 in 1,000 with HAV suffer from a sudden and severe infection that may require a liver transplant. A highly effective vaccine can prevent HAV. This vaccination is recommended for all children and individuals who have chronic liver disease 

or clotting factor disorders, in addition to those who travel or work in developing 

countries. 

HEPATITIS B

Hepatitis B (HBV) claims an estimated 5,000 lives every year in the United 

States, even though therapies exist that slow the progression of liver damage. Vaccines are available to prevent hepatitis B. This disease is spread through contact 

with the blood and body fluids of an infected individual and from an HBV infected 

mother to child at birth. Unfortunately, due to both a lack in funding to vaccinate 

adults and the absence of an integrated preventive education strategy, transmission 

of hepatitis B continues to be problematic. Additionally, there are significant disparities in the occurrence of chronic HBV-infections. Asian Americans represent four 

percent of the population; however, they account for over half of the 1.3 million 

chronic hepatitis B cases in the United States. Current treatments do not cure hepatitis B, but appropriate treatment can help to reduce the progression to liver cancer 

and liver failure. Yet, many are not treated. Preventive education and universal vaccination are the best defenses against hepatitis B. 

HEPATITIS C

Infection rates for hepatitis C (HCV) are at epidemic proportions. Unfortunately, 

many individuals are not aware of their infection until many years after they are 

infected. This creates a vicious cycle, as individuals who are infected continue to 

spread the disease, unknowingly. The Center for Disease Control and Prevention estimates that there are over 4 million Americans who have been infected with hepatitis C, of which over 2.7 million remain chronically infected, with 8,000–10,000 

deaths each year. Additionally, the death rate is expected to triple by 2010 unless 

additional steps are taken to improve outreach and education on the prevention of 

hepatitis C and scientists identify more effective treatments and cures. As there is 

no vaccine for HCV, prevention education and treatment of those who are infected 

serve as the most effective approach in halting the spread of this disease. 

PREVENTION IS THE KEY

The absence of information about the liver and hepatitis in education programs 

over the years has been a major factor in the spread of viral hepatitis through unknowing participation in liver damaging activities. Adults and children need to understand the importance of the liver and how viruses and drugs can damage its ability to keep them alive and healthy. Many who are currently infected are unaware 

of the risks they are taking that expose them to viral infections and ultimate liver 

damage. 

Knowledge is the key to prevention. Preventive education is essential to motivate 

individuals to protect themselves and avoid behaviors that can cause life-threatening diseases. Primary prevention that encourages individuals to adopt healthful 

lifestyle behaviors must begin in elementary schools when children are receptive to 

learning about their bodies. Schools provide access to one-fifth of the American population. 

Individuals need to be motivated to assess their own risk behaviors, to seek testing, to accept vaccination, to avoid spreading their disease to others, and to under-
467 

stand the importance of participating in their own health care and disease management. The NIH needs to support education programs to train teachers and 

healthcare providers in effective communication techniques, and to evaluate the impact preventive education has on reducing the incidence of hepatitis and substance 

abuse. 

Therefore, HFI recommends that CDC, NIAID, NIDDK, NIAAA, NIDA, and 

SAMHSA be urged to work with voluntary health organizations to promote liver 

wellness, education, and prevention of viral hepatitis, sexually transmitted diseases 

and substance abuse. 

Only a major investment in immunization and preventive education will bring 

these diseases under control. All newborns, young children, young adults, and especially those who participate in high-risk behaviors must be a priority for immunization, outreach initiatives, and preventive education. We recommend that the following activities be undertaken to prevent the further spread of all types of hepatitis: 

—Provide effective preventive education in our elementary and secondary schools 

so children can avoid the serious health consequences of risky behaviors that 

can lead to viral hepatitis. 

—Train educators, health care professionals, and substance abuse counselors in 

effective communication and counseling techniques. 

—Promote public awareness campaigns to alert individuals to assess their own 

risk behaviors, motivate them to seek medical advice, encourage immunization 

against hepatitis A and B, and to stop the consumption of any alcohol if they 

have participated in risky behaviors that may have exposed them to hepatitis 

C. 

—Expand screening, referral services, medical management, counseling, and prevention education for individuals who have HCV, many of whom may be co-infected with HIV and Hepatitis C and/or Hepatitis B. 

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

HFI recommends an 8 percent increase in fiscal year 2007 for further implementation of CDC’s Hepatitis C Prevention Strategy. This increase will support and expand the development of State-based prevention programs by increasing the number 

of State health departments with CDC funded hepatitis coordinators. The Strategy 

will use the most cost-effective way to implement demonstration projects evaluating 

how to integrate hepatitis C and hepatitis B prevention efforts into existing public 

health programs. 

CDC’s Prevention Research Centers, an extramural research program, plays a 

critical role in reducing the human and economic costs of disease. Currently, CDC 

funds 26 prevention research centers at schools of public health and schools of medicine across the country. HFI encourages the subcommittee to increase core funding 

for these prevention centers, as it has been decreasing since this program was first 

funded in 1986. We recommend the subcommittee provide an 8 percent increase for 

the Prevention Research Centers program in fiscal year 2007. 

Also, HFI recommends that the CDC, particularly the Division of Adolescent and 

School Health (DASH), work with voluntary health organizations to promote liver 

wellness with increased attention toward childhood education and prevention. 

INVESTMENTS IN RESEARCH

Investment in the NIH has led to an explosion of knowledge that has advanced 

understanding of the biological basis of disease and development of strategies for 

disease prevention, diagnosis, treatment, and cures. Countless medical advances 

have directly benefited the lives of all Americans. NIH-supported scientists remain 

our best hope for sustaining momentum in pursuit of scientific opportunities and 

new health challenges. For example, research into why some HCV infected individuals resolve their infection spontaneously may prove to be life saving information 

for others currently infected. Other areas that need to be addressed are: 

—Reasons why African Americans do not respond as well as Caucasians and Hispanics to antiviral agents in the treatment of chronic hepatitis C. 

—Pediatric liver diseases, including viral hepatitis. 

—The outcomes and treatment of renal dialysis patients who are infected with 

HCV and HBV. 

—Co-infections of HIV/HCV and HIV/HBV positive patients. 

—Hemophilia patients who are co-infected with HIV/HCV and HIV/HBV. 

—The development of effective treatment programs to prevent recurrence of HCV 

infection following liver transplantation. 

—The development of effective vaccines to prevent HCV infection. 
468 

HFI supports a 5 percent increase for NIH in fiscal year 2007. HFI also recommends a comparable increase of 5 percent in hepatitis research funding at 

NIAID, NIDDK, NIAAA, and NIDA. 

HFI is dedicated to the eradication of viral hepatitis, which affects over 500 million people around the world. We seek to raise awareness of this enormous worldwide problem and to motivate people to support this important—and winnable—battle. Thank you for providing this opportunity to present testimony. 

PREPARED STATEMENT OF IN DEFENSE OF ANIMALS

Six years ago, In Defense of Animals (IDA) testified before Congress about the 

NIH’s egregious oversight failures and illegal funding of the New Mexico-based 

Coulston Foundation, at the time the world’s largest chimpanzee lab. IDA testified 

about Coulston’s abysmal animal care record and unprecedented violations, dating 

back to 1993, of Federal animal welfare laws. IDA recommended, among other 

things, a Congressional investigation. 

Within weeks of IDA’s March 2000 testimony, the NIH took ownership of 288 

chimpanzees from Coulston, citing concerns about the lab’s resources and ability to 

properly care for the animals, which IDA had raised in our testimony. The NIH left 

the chimpanzees in Coulston’s ‘‘care’’ and continued to illegally fund the lab despite 

its continued animal welfare violations. 

The NIH’s Coulston oversight debacle resulted in international media coverage, 

public outrage and intense Congressional scrutiny. As a result, the NIH was finally 

forced to end its illegal funding of Coulston in June 2001. The agency took over ownership of the lab where the 288 chimpanzees were housed, renamed it the 

‘‘Alamogordo Primate Facility’’ (APF), and awarded a ten-year, $42 million taxpayerfunded contract to Charles River Laboratories (CRL) to operate it. However, the 

APF was now NIH-owned and part of the agency’s Intramural Research Program; 

the contract between the NIH and CRL explicitly states that the NIH is responsible 

for ‘‘day-to-day management’’ of the lab, including its ‘‘associated animal activities.’’ 

Subsequently, the House Committee on Energy and Commerce conducted an investigation, and found that the NIH had indeed continued to fund Coulston despite 

its violation of Federal administrative laws. This prompted the Investigations subcommittee to question the NIH’s oversight and management of billions of dollars in 

taxpayer-funded grants; this subcommittee consequently launched a broad investigation of the NIH in March 2003. 

Amazingly, six years after IDA’s March 2000 testimony, the NIH oversight debacle that launched a prior Congressional investigation is actually worse, and cries out 

for Congressional action. That is because in September 2004, New Mexico District 

Attorney Scot Key filed multiple counts of criminal animal cruelty against CRL. 

After an independent investigation that lasted almost one year, the D.A. found that 

it was ‘‘standard practice’’ for CRL to have trained animal care staff leave at the 

end of the workday, and leave the ‘‘care’’ of critically ill or injured chimpanzees to 

once-per-hour monitoring by untrained security guards. This ‘‘standard practice’’— 

instituted in August 2002 as an apparent cost-saving measure—resulted in the suffering and deaths of two chimpanzees, Rex and Ashley, and the near-death of a 

third, Topsy. The D.A. charged CRL and APF Director Rick Lee with three counts 

of criminal cruelty alleging abandonment and failure to provide necessary sustenance. This understaffed small-town D.A. with a caseload of murders had stepped 

in to enforce the law and protect the chimpanzees from a multi-billion dollar public 

company and a $28 billion Federal agency. It should be noted that because the APF 

is now a Federal research lab, the USDA has no jurisdiction under the Animal Welfare Act. This was the first time in U.S. history that an entire lab had been charged 

with criminal animal cruelty. This case, the culmination of 10 years of NIH-funded 

abuse of these New Mexico chimpanzees, contains shocking facts that cry out for 

further Congressional action. 

Despite initial promises of cooperation, CRL instead hired a high-powered criminal law firm perhaps best known for obtaining an acquittal of a two-time husband 

killer after she had shot husband number two in New Mexico. CRL refused to cooperate with the D.A.’s criminal investigation. CRL refused to comply with the 

D.A.’s subpoena demanding records relating to the three chimpanzees. The D.A. 

then obtained a grand jury subpoena, but CRL still refused to supply the records 

to the D.A. The NIH did nothing to force CRL to cooperate. 

Tellingly, however, CRL did supply these records to an ad-hoc NIH consultant 

with no law enforcement authority. During only a portion of his one-day site visit, 

this veterinarian simply reviewed the records, without interviewing a single witness, and, predictably, found no problems. Neither the NIH nor CRL wanted an 
469 

independent, legitimate law enforcement officer, such as the D.A., to get within a 

mile of these records, and did everything possible to prevent his obtaining them. 

The NIH did not want any independent, legitimate investigation, since any problems found would be an indictment of the agency’s own management of the lab. The 

NIH’s responsibility for ‘‘oversight’’ at its own lab constitutes an unmitigated conflict 

of interest. Had the NIH found a chimpanzee shot in the head, the agency would 

no doubt have ruled it a suicide. 

Like CRL, the NIH has also refused to supply these records to the public, even 

after IDA filed a Federal FOIA lawsuit in September 2004. In its briefs, the NIH 

has actually claimed that it does not possess these clinical records—for NIH-owned 

chimpanzees at an NIH-owned facility that is part of the NIH’s Intramural Research Program. This laughable assertion is belied by the NIH’s own contract with 

CRL, which explicitly states that the NIH does indeed possess these records. 

CRL submitted only one of two reports generated by the one-day NIH site visit 

to the New Mexico court trying the criminal case—predictably, the one praising 

CRL’s veterinary care, which was based on only a review of records, not any witness 

interviews nor an actual investigation. However, the criminal charges had nothing 

to do with CRL’s veterinary care, but instead CRL’s alleged ‘‘standard practice’’ of 

abandoning critically ill or injured chimpanzees to once-per-hour monitoring by untrained security guards. The second report, written by the NIH Project Officer for 

the CRL contract and obtained by IDA through FOIA, clearly shows that the NIH 

was completely and totally unaware of the abandonment alleged by the D.A. 

During the time period covered by the multiple counts of criminal animal cruelty, the NIH actually awarded CRL bonuses totalling $175,000 paid for with taxpayer 

funds. CRL received the maximum bonuses; the major criterion for these bonuses 

was ‘‘no animal care deficiencies.’’ 

While the D.A.’s independent investigation—run by a 24-year police veteran—took 

almost a year and interviewed six witnesses, including eyewitnesses, the NIH interviewed no witnesses regarding Rex, Ashley and Topsy and allowed the so-called ‘‘investigation’’ to be conducted by CRL—another blatant conflict of interest. Because 

CRL refused to cooperate—despite its initial promises—the D.A. could only interview ex-CRL employees. But those ex-employees painted a devastating portrait of 

the alleged acts of cruelty and CRL’s operation of this NIH lab. 

Dr. Kelly Avila started work at the APF only 58 days after she graduated from 

veterinary school. She told the D.A.’s investigator that she had been promised training, but instead found herself the main clinician for over 250 chimpanzees. She confirmed that in August 2002, APF Director Rick Lee instituted the policy where security guards would take over for animal care at quitting time, 4:00 p.m. She repeatedly stated that Ashley, the first chimpanzee mentioned in the criminal charges, 

had shock. Avila had ‘‘serious problems’’ with APF practices, and discussed problems 

associated with having security/maintenance personnel perform animal care. She 

started a system of writing daily reports of what she found on exams and also which 

chimpanzees were sick and needed monitoring; apparently no such systemic surveillance existed before her arrival. Being fresh out of vet school, she also said she felt 

she had to defer to the more-experienced vets Lee and Langner. She stated that financial considerations played a role in the standard of care; if she wanted an animal care staffer to stay past quitting time she would have to go through Andrea 

Lee, the APF’s Program Administrator and wife of Director Rick Lee. That would 

have ‘‘meant that Dr. Lee’s wife would have gotten all over my case for overtime.’’ 

Avila said that it was ‘‘always a fight’’ with Andrea Lee—who had no veterinary 

training whatsoever—and that the ‘‘veterinary staff... either cowed down to this 

lady or you had to leave.’’ Avila also stated that Rick Lee, instead of training her 

as promised, ‘‘spent his time in the office doing director kind of activities,’’ and that 

she hardly ever saw him. Instead, she said her mentors included an online message 

board, the Veterinary Information Network (VIN). 

Dr. Avila posted dozens of messages to the VIN during her year working at the 

APF. Perhaps the most devastating was posted on September 16, 2002, only hours 

before Ashley died. Avila explains Ashley’s condition, that she was bleeding from a 

fight and suffered from a condition that makes blood clotting more difficult. After 

describing how she had treated Ashley to that point, she then asks the chilling, allrevealing question: ‘‘Does anyone have other ideas on how to treat?’’ Many of these 

messages demonstrate a facility in disarray, and a veterinarian fresh out of vet 

school who was trying to do the right thing but was clearly in over her head. Avila 

asked for advice on almost every conceivable subject relating to chimpanzee care: 

reference texts for chimpanzee nutrition (she noticed what she thought were signs 

of malnutrition); how to conduct biopsies and take bone marrow samples; how to 

treat hypertension; how to interpret ultrasounds and x-rays. She repeatedly stated 

that she conducted her own medical literature searches in attempts to find treat-
470 

ments. She tells of her APF colleagues’ ignorance of specific treatments and dangerous side effects of drugs. In a May 23, 2003 post, she states ‘‘I recently lost my 

fifth chimp,’’ then describes how a chimp died after a tooth extraction. Importantly, 

she states that this chimp had a history of suffering from grand mal seizures when 

given ketamine, which is one of the only two sedatives allowed at the APF (the 

other is pharmacologically similar to ketamine), and says that she had just been 

lucky prior to that because she had given him only very small doses as supplements. 

She states this is one of the reasons she is resigning. She tells VIN that respiratory 

diseases, measles and chicken pox have been passed to the chimps from human employees over the past year. She asks about vaccinations, questioning why the APF 

only vaccinates against tetanus, and is told that there is a standard series of vaccinations recommended for chimpanzees, which includes tetanus, measles, mumps 

and rubella. She describes her fight against a drug company trying to test a drug 

for hepatitis C on chimpanzees, since the side effects in humans are so severe and 

she is concerned that the chimpanzees would suffer, while relating that she 

‘‘dislike[s] the pressure greatly’’ that she is getting from the drug company to perform the study. For one chimpanzee, she is ‘‘at her wits end’’ in trying to find a 

treatment; one she had previously used ‘‘led to more edema so I won’t be doing that 

again. Oh well I guess I am learning here,’’ and then asks for suggestions on how 

to treat. She asks if anyone knows of a procedure for tapping the heart (fluid) of 

a chimpanzee, and asks ‘‘Do I proceed as I would with a dog?’’ In another revealing 

post, she asks if anyone has experience with using steroids as an appetite stimulant 

in chimpanzees, for a 40-year-old. Other vets chime in, saying that old age is not 

a disease, and that this and some of her other posts indicate that she is treating 

symptoms, not trying to get diagnosis so she can treat an underlying disease. Avila 

responds with a devastating indictment of the APF operation: ‘‘I am working at getting actual diagnosis before I continue treatments. There is great resistance to this 

as the old adage ‘if it ain’t broke don’t fix it’ applies here on a regular basis! However, it is against my nature to give up and allow people to act foolishly while I 

clean up the mess they leave behind so I will continue to try to find specific diagnosis and treat those whenever I can.’’ A similar post concerns a self-mutilating 

chimpanzee; Avila is concerned about the long-term effects of Prozac. Vets chime in 

again that she should try to determine the underlying cause of the self-mutilation; 

one vet relates that’s what she did, and was able to stop the mutilation and wean 

a baboon off of Prozac. Avila states that the APF behaviorist pretty much wants to 

keep the chimpanzee on Prozac forever, and agrees that she should try to find the 

underlying cause of the self-mutilation. 

Maintenance man Ernest Farwell went into great detail about the cases of Rex 

and Ashley to the D.A.’s investigator. He confirms Dr. Avila’s recollection that August 2002 is when CRL instituted the policy of having maintenance/security, such 

as Farwell, take over from animal care after quitting time. Like the other maintenance man interviewed, Benjamin Thompson, Farwell confirmed that he received no 

special training in chimpanzee care. He saw Rex unconscious, lying on his side with 

his mouth open, vomiting, and an animal care staffer suctioning out the vomit with 

an evacuation wand. He witnessed Dr. Avila say to the animal care staffer ‘‘We have 

to go, he won’t let us stay.’’ The animal care staffer then actually removed Rex’s 

life support, and he and Avila left while Rex was still unconscious and vomiting. 

Farwell later witnessed Rex on his side, but with the vomit coming out of his mouth 

(since no one was there to suction it out). Rex was found dead later that night; the 

pathology report showed vomit in his mouth and trachea. Farwell also witnessed 

Ashley; when he first saw her, he was shocked at the amount of blood in her cage, 

and she was still bleeding. He then witnessed her shake violently; this was the 

symptom of shock mentioned by Dr. Avila in her witness statement. Later he found 

her dead. Farwell also states that APF employees were threatened with polygraph 

tests when Rick Lee was trying to find out who gave information to the D.A. about 

the alleged cruelty, and were ordered not to speak with anyone, including the D.A., 

about the allegations. Such threats violate the 1988 Federal Employee Polygraph 

Protection Act. This climate of intimidation was also apparent when Farwell complained about having to give medicine to chimpanzees, protesting that he wasn’t 

qualified, explaining ‘‘If animal care found a problem with the boilers you wouldn’t 

expect them to fix it.’’ He was then written up and felt threatened, and signed an 

agreement that he would perform these duties (i.e., care of chimpanzees) and anything else CRL told him to, for apparent fear of losing his job. 

The APF had problems from day one; for the first 6 months, the facility did not 

have requirements for care as basic as euthanasia drugs. This resulted in chimpanzee suffering; CRL actually had to borrow euthanasia drugs from the Coulston 

Foundation, which was offsite, miles away, and almost bankrupt. Although the 

chimpanzees lacked for drugs, APF Program Administrator Andrea Lee—who made 
471 

decisions on animal care overtime—had plenty; in 2004, she was criminally charged 

with 15 counts of fraudulently obtaining a controlled substance (Vicodin). She had 

been illegally using the DEA licenses of two APF veterinarians—at a taxpayer-funded facility—and pled guilty to one count. APF veterinarian Cynthia Doane—not the 

NIH or CRL management—became suspicious and began to investigate. Further 

buttressing the existence of a climate of intimidation and fear at the APF, Doane 

wrote a letter to the New Mexico Board of Pharmacy in April 2004, stating her willingness to help in the investigation, but that ‘‘I emphasize, however, that I cannot 

trust anyone at my place of work at this time.’’ 

Instead of proclaiming its innocence by demanding its day in court, CRL, presumably with the NIH’s blessing, threw up one legal technicality after another in a prolonged effort to hide from the evidence accumulated by the D.A. and to prevent a 

jury, and the public, from ever seeing it argued in open court. CRL claimed that 

the State of New Mexico had no jurisdiction to prosecute its own animal cruelty 

statute because the APF was located on a Federal Air Force Base, despite the fact 

that the New Mexico legislature had specifically amended its cruelty statute in 2001 

because of the chimpanzee abuses at this very same facility. This amendment gave 

the D.A. the legal authority to prosecute CRL. The company claimed that because 

the New Mexico cruelty statute did not require qualified personnel, there was no 

abandonment because untrained security guards were in the vicinity of the critically 

ill or injured chimpanzees (once per hour). And in the most egregious of all the technicalities, CRL actually claimed that it was engaged in the practice of veterinary 

medicine in the cases of Rex, Ashley and Topsy, and because the cruelty statute exempts the practice of veterinary medicine, the case should be dismissed. In other 

words, according to CRL and the NIH, the deliberate policy of denying veterinary 

care constitutes the practice of veterinary care. Incredibly, the judge agreed with 

that technicality, and dismissed the case—a dismissal having nothing to do with the 

merits of the D.A.’s investigation or case. The D.A. appealed, and the case is currently being adjudicated at the New Mexico Court of Appeals, the State’s secondhighest court. 

RECOMMENDATIONS

IDA believes that given the NIH’s egregious record, Congress should both investigate and hold hearings, not only into the NIH/Coulston/Charles River debacle, but 

the larger oversight issues raised by the NIH’s actions. One would have thought 

that, given the years of Coulston Foundation administrative animal welfare violations, the NIH would have been that much more careful in choosing and overseeing 

a successor. Instead, the facility—now directly owned and managed by the NIH— 

descended into alleged criminal animal cruelty. Given the NIH’s ten-year record of 

funding abuse against these chimpanzees, we respectfully request that the NIH be 

barred from any responsibility whatsoever for them. These chimpanzees have endured enough; the survivors should be placed at a reputable private sanctuary for 

permanent retirement, with the remainder of the $42 million contract going to the 

sanctuary. This would be the morally and ethically correct course of action that is 

so greatly overdue for these long-suffering chimpanzees. 

PREPARED STATEMENT OF INDEPENDENCE TECHNOLOGY

Mr. Chairman and members of the subcommittee, my name is Gregg Howard and 

I am the Vice President for Sales and Reimbursement for Independence Technology, 

LLC, a Johnson & Johnson company. I appreciate the opportunity to provide comments in support of the many programs within the jurisdiction of the subcommittee 

that are important to citizens with disabilities. 

The Institute of Medicine report, ‘‘Disability in America: Toward a National Agenda,’’ began with the words ‘‘Disability is an issue that affects every individual, community, neighborhood, and family in the United States.’’ These words are as true 

today as when the IOM published its report. 

The demographic imperative resulting from the aging of the baby boom generation 

will soon substantially increase the proportion and numbers of Americans in the 

older age groups that are most at risk of physical and mental impairments, limitations, and disabilities. At the same time, certain trends in other age groups—for example, the increased rates of survival of extremely premature infants, increases in 

the prevalence of obesity in younger populations and a growing number of disabled 

Iraq era veterans—are putting more children and younger adults at risk of disabling 

conditions. Thus, the promotion of good health, independence, and social integration 

for people with disabilities and the prevention of disabling injuries, diseases, and 

disorders are more important objectives than ever. 
472 

Mr. Chairman, the Labor, Health and Human Services, and Education subcommittee funds the significant majority of Federal programs of interest and benefit 

to citizens with disabilities. These programs are in the Department of Labor, the 

Department of Health and Human Services, and the Department of Education. At 

the end of this statement, we list these many programs in tabular form and include 

a fiscal year 2007 funding recommendation for each of these programs. We join with 

the 100 plus organizations of Consortium for Citizens with Disabilities in making 

these recommendations and would urge the subcommittee’s efforts to address these 

funding needs. 

Mr. Chairman, also very importantly, the Social Security Administration, Medicare and Medicaid programs are of significant importance for citizens with disabilities. While these programs are mostly viewed as entitlements and therefore fall in 

the jurisdiction of the Senate Finance Committee and House Ways and Means Committee, your subcommittee appropriates administrative funds that permit the operations of these programs. On behalf of Independence Technology, LLC, I would like 

to highlight a matter currently under consideration by administrative personnel at 

Medicare that will have an important impact on the lives of many disabled Americans. 

Independence Technology, LLC, has invested over $100 million over the last decade to develop a revolutionary new mobility system that allows individuals with disabilities to achieve extensive function and the physical mobility necessary in order 

to live independently. This innovative technology is the first of its kind to largely 

eliminate barriers by climbing stairs, improving reach, transversing various surfaces, and balancing the seated user at standing eye level. For many this technology 

can take the place of more costly and/or drastic alternatives such as moving from 

one’s home, extensive home modifications, use of home health aides, and unnecessary institutionalization or bed confinement. 

While this new technology is clearly not appropriate for all individuals with mobility impairments, for the subset disabled of individuals for whom it is appropriate, 

it is a life changing device which improves health, functional status, independent 

living, and quality of life. In 2002 and 2003 the Veterans Health Administration 

evaluated these devices and made a determination as to which subset of disabled 

veterans could appropriately benefit from the device. Based on this review and policy determination, the Veterans Health Administration now prescribes and provides 

financial support for the procurement of these devices. 

Currently underway at CMS is a similar review process. On January 26, 2006 

CMS posted for public comment the application by Independence Technology, LLC, 

for the development of a National Coverage Determination for an interactive balancing mobility system such as the iBOT. A total of 151 comments were presented 

to CMS by patients, disability groups, health care providers, and others affected by 

disabilities. Letters were also sent in support of the application by 10 U.S. Senators 

and approximately 20 House Members. Overall, 97 percent of the comments provided to CMS on this matter were positive. 

The comment period for establishing a National Coverage Determination for 

‘‘interactive balancing mobility systems’’ closed on March 5, 2006. CMS now has up 

to 6 months to announce a decision on the question of proceeding to the development of a National Coverage Determination. It is our view that the establishment 

of coverage criteria for this new state-of-the-art interactive balancing mobility systems sends an important message that when research and development results in 

technological advancements improving the health, functional status, independent 

living, and quality of life, these advances will be made accessible to those who will 

benefit. 

Mr. Chairman, in summary we appreciate the leadership of you and your subcommittee in championing so many important programs of benefit to disabled Americans. While we recognize the limitations placed on the subcommittee by spending 

ceilings, we would urge your careful review and considerations of the funding recommendations found at the end of this statement. We would also request the subcommittee’s support and direct guidance to CMS to support reimbursement policies 

that will help bring new technological advances such as the iBOT to disabled Americans who stand to benefit from their use. 

Thank you for the opportunity to testify. 
473 

APPROPRIATIONS RECOMMENDATIONS FOR FISCAL YEAR 2007 

[In millions of dollars] 

Fiscal year 

2006 final 

Fiscal year 

2007 

President 

Fiscal year 

2007 CCD 

DEPARTMENT OF LABOR 

Workforce Investment Act (selected programs): 

Adult Employment ......................................................................................... 857.0 712.0 987.9 

Pilots, Demonstrations, Research ................................................................. 29.7 17.7 151.0 

Youth Activities ............................................................................................. 940.5 840.5 1,093.4 

Office of Disability Employment Policy .................................................................. 27.7 20.0 47.5 

Work Incentives Grants .......................................................................................... 19.5 .................... 20.7 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Health Services Resources Administration: 

Maternal & Child Health Block Grant .......................................................... 693.0 693.0 724.0 

Developmental Disabilities Act Programs: 

Basic State Grants—Councils on DD ................................................. 71.8 72.0 84.5 

Protection & Advocacy Systems—DD .................................................. 38.7 39.0 45.0 

University Centers for Excellence in DD .............................................. 33.2 33.0 37.0 

Projects of Nat’l Sig. & Family Support .............................................. 11.4 11.0 22.6 

TBI State Grants ........................................................................................... 9.0 .................... 15.0 

TBI Protection & Advocacy Grants ................................................................ 3.1 .................... 6.0 

Universal Newborn Hearing Screening ......................................................... 10.0 .................... 10.0 

Centers for Disease Control and Prevention: 

Birth Defects, Developmental Disabilities, & Health ................................... 124.7 110.5 137.6 

Chronic Disease Prevention .......................................................................... 836.6 818.7 417.4 

Environmental Health ................................................................................... 149.9 141.0 153.0 

Preventive Health Block Grant ...................................................................... 99.0 .................... 133.6 

Injury Prevention and Control ....................................................................... 139.0 138.2 142.8 

Epilepsy Program .......................................................................................... 7.7 .................... 8.0 

TBI Registries and Surveillance ................................................................... 5.3 5.3 9.0 

National Institutes of Health ................................................................................. 28,578.0 28,578.0 29,750.0 

Natl. Institute of Child Health and Hum. Dev. ............................................ 1,264.7 1,257.0 1,327.9 

Natl. Institute on Deafness & Other Communication Disorders .................. 393.0 392.0 412.7 

Natl. Inst. of Neurological Disorders & Stroke ............................................. 1,534.8 1,525.0 1,611.5 

Natl. Institute on Mental Health .................................................................. 1,403.8 1,395.0 1,474.0 

Natl. Institute on Drug Abuse ...................................................................... 1,000.0 995.0 1,050.0 

Natl. Institute on Alcohol Abuse ................................................................... 435.9 433.0 457.7 

Social Services Block Grant ................................................................................... 1,683.0 1,200.4 2,380.0 

Child Care & Development Block Grant ................................................................ 2,062.1 2,062.0 2,588.0 

Head Start .............................................................................................................. 6,876.0 6,786.0 7,300.0 

Child Abuse Prevention and Treatment Act .......................................................... 95.2 101.0 142.0 

Nat’l Family Caregiver Support Program ............................................................... 162.0 160.0 162.0 

Grants to States to Remove Barriers to Voting .................................................... 10.9 10.9 25.0 

Protection & Advocacy for Voting Access .............................................................. 4.9 4.8 10.0 

SAMHSA: 

Children’s Mental Health Services ............................................................... 104.1 104.1 109.7 

PATH Homeless Program ............................................................................... 54.3 54.3 57.1 

Protection & Advocacy for Indivs. with MI ................................................... 34.0 34.0 40.0 

Mental Health Block Grant ........................................................................... 428.5 428.5 451.2 

Projects of Regional and Nat’l Significance ................................................ 263.2 228.1 285.9 

DEPARTMENT OF EDUCATION 

Individuals with Disabilities Education Act: 

State and Local Grants Part B ..................................................................... 10,582.8 10,682.9 16,938.9 

Preschool Grants ........................................................................................... 380.8 380.8 841.0 

Early Intervention Part C .............................................................................. 436.4 436.4 680.0 

Part D National Programs: 

State Personnel Development .............................................................. 50.1 .................... 55.7 

Technical Assistance and Dissemination ............................................ 48.9 48.9 57.6 

Personnel Preparation .......................................................................... 89.7 89.7 108.7 

Parent Information Centers ................................................................. 25.7 25.7 28.6 

Technology and Media ......................................................................... 38.4 31.1 42.6 

Transition Initiative .............................................................................. .................... 2.0 5.5 

Research and Innovation (Inst. Ed. Sciences) ...................................................... 81.7 81.7 92.4 
474 

APPROPRIATIONS RECOMMENDATIONS FOR FISCAL YEAR 2007—Continued 

[In millions of dollars] 

Fiscal year 

2006 final 

Fiscal year 

2007 

President 

Fiscal year 

2007 CCD 

Rehabilitation Services Administration: 

Rehabilitation State Grant ............................................................................ 2,693.0 2,837.2 3,120.0 

Client Assistance Programs .......................................................................... 11.8 11.8 13.0 

Rehabilitation Training ................................................................................. 38.4 38.4 42.7 

Special Demonstrations ................................................................................ 6.5 6.5 28.1 

Recreation ..................................................................................................... 3.0 .................... 3.0 

Protection & Advocacy for Individual Rights ............................................... 16.5 16.5 22.0 

Projects with Industry ................................................................................... 20.0 .................... 50.0 

Supported Employment State Grant ............................................................. 29.7 .................... 50.0 

Migrant & Seasonal Farm workers ............................................................... 2.0 .................... 2.3 

Independent Living State Grant ................................................................... 22.6 22.6 25.0 

Centers for Independent Living .................................................................... 74.6 74.6 82.9 

Independent Living Serv. for Older Blind Ind. ............................................. 32.9 32.9 36.5 

State Assistive Technology Programs and TA .............................................. 22.4 22.4 29.0 

Protection & Advocacy for Assistive Tech. ................................................... 4.4 .................... 6.0 

National Institute for Disability & Rehabilitation Research ................................. 106.7 106.7 120.0 

Demonstration Projects-Disability (Higher Ed.) ..................................................... 6.9 .................... 10.0

National Council on Disability ............................................................................... 3.1 2.8 3.7 

Helen Keller National Center ................................................................................. 8.5 8.5 11.7 

American Printing House for the Blind ................................................................. 17.6 17.6 20.0 

PREPARED STATEMENT OF THE INTERNATIONAL FOUNDATION FOR FUNCTIONAL

GASTROINTESTINAL DISORDERS

SUMMARY OF FISCAL YEAR 2007 RECOMMENDATIONS

—Provide a 5 percent increase for fiscal year 2007 to the National Institutes of 

Health (NIH) budget. Within NIH, provide proportional increases of 5 percent 

to the various institutes and centers, specifically, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 

—Accelerate funding for extramural clinical and basic functional gastrointestinal 

disorders (FGID) and motility disorders research at NIDDK. 

—Continue to urge NIDDK to develop a strategic plan on irritable bowel syndrome (IBS) with the purpose of setting research goals, determining improved 

treatment options for IBS sufferers, and assisting in recruitment of new investigators to conduct IBS research. 

—Urge the National Institute of Child Health and Human Development (NICHD) 

and NIDDK to continue to support research into fecal and urinary incontinence, 

including the development of a standardization of scales to measure incontinence severity and quality of life and to develop strategies for primary prevention of fecal incontinence associated with childbirth. 

—Provide funding to NIDDK and the National Cancer Institute (NCI) for more 

research on the causes of esophageal cancer. 

Chairman Specter and members of the subcommittee, thank you for the opportunity to present this written statement regarding the importance of functional gastrointestinal and motility disorders research. IFFGD has been serving the digestive 

disease community for fifteen years. We work to broaden the understanding about 

functional gastrointestinal and motility disorders in adults and children. IFFGD 

speaks about and raises awareness on disorders and diseases that many people are 

uncomfortable and embarrassed to talk about. The prevalence of fecal incontinence 

and irritable bowel syndrome or IBS, as well as a host of other gastrointestinal disorders affecting both adults and children, is underestimated in the United States. 

These conditions are truly hidden in our society. Not only are they misunderstood, 

but also the burden of illness and human toll has not been fully recognized. 

Since its establishment, the IFFGD has been dedicated to increasing awareness 

of functional gastrointestinal and motility disorders, among the public, health professionals, and researchers. While maintaining a high level of public education efforts, the IFFGD has also become recognized for our professional symposia. We consistently bring together a unique group of international multidisciplinary investigators to communicate new knowledge in the field of gastroenterology. In the spring 
475 

of 2007, IFFGD will be hosting our Seventh International Symposium on Functional 

Gastrointestinal Disorders, bringing scientists, researchers, and clinicians from 

across the world together to discuss the current science and opportunities on IBS 

and other functional gastrointestinal and motility disorders. Also, in November of 

2002, we hosted a conference on fecal and urinary incontinence, the proceedings of 

which were published in Gastroenterology, the official journal of the American Gastroenterological Association (AGA). The IFFGD has also been working with the National Institute of Child Health and Human Development (NICHD), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the Office of 

Medical Applications of Research (OMAR) in the NIH Office of the Director on the 

State of the Science Conference on Fecal and Urinary Incontinence. 

The majority of the diseases and disorders we address have no cure. We have yet 

to completely understand the pathophysiology of the underlying conditions. Patients 

face a life of learning to manage chronic illness that is accompanied by pain and 

an unrelenting myriad of gastrointestinal symptoms. The costs associated with these 

diseases are enormous; estimates range from between $25–$30 billion annually. The 

human toll is not only on the individual but also on the family. Economic costs spill 

over into the workplace. In essence, these diseases reflect lost potential for the individual and society. The IFFGD is a resource and provides hope for hundreds of 

thousands of people as they try to regain as normal a life as possible. 

IRRITABLE BOWEL SYNDROME (IBS)

IBS strikes people from all walks of life affecting between 25 to 45 million Americans and results in significant human suffering and disability. This chronic disease 

is characterized by a group of symptoms, which include abdominal pain or discomfort associated with a change in bowel pattern, such as loose or more frequent bowel 

movements, diarrhea, and/or constipation. Although the cause of IBS is unknown, 

we do know that this disease needs a multidisciplinary approach in research and 

often treatment. 

IBS can be emotionally and physically debilitating. Because of persistent bowel 

irregularity, individuals who suffer from this disorder may distance themselves from 

social events, work, and even may fear leaving their home. 

In the House and Senate fiscal years 2004, 2005, and 2006 Labor, Health and 

Human Services, and Education Appropriations bills, Congress recommended that 

NIDDK develop an IBS strategic plan. The development of a strategic plan on IBS 

would greatly increase the institute’s progress toward the needed research on this 

functional gastrointestinal disorder, as well as serve to advance our understanding 

of this disease, determine improved treatment options for IBS sufferers, and assist 

in recruiting new investigators to conduct IBS research. NIDDK is formulating an 

action plan for digestive diseases through the National Commission on Digestive 

Diseases and has indicated that IBS will be included as a component of this overall 

plan. IBS must be given sufficient attention, however, in order to increase the FGID 

and motility disorders research portfolio at NIDDK. 

FECAL INCONTINENCE

At least 6.5 million Americans suffer from fecal incontinence. Incontinence is neither part of the aging process nor is it something that affects only the elderly. Incontinence crosses all age groups from children to older adults, but is more common 

among women and in the elderly of both sexes. Often it is a symptom associated 

with various neurological diseases and many cancer treatments. Yet, as a society, 

we rarely hear or talk about the bowel disorders associated with multiple sclerosis, 

diabetes, colon cancer, uterine cancer, and a host of other diseases. 

Damage to the anal sphincter muscles; damage to the nerves of the anal sphincter 

muscles or the rectum; loss of storage capacity in the rectum; diarrhea; or pelvic 

floor dysfunction can cause fecal incontinence. People who have fecal incontinence 

may feel ashamed, embarrassed, or humiliated. Some don’t want to leave the house 

out of fear they might have an accident in public. Most try to hide the problem as 

long as possible. They withdraw from friends and family, and often limit work or 

education efforts. Incontinence in the elderly burdens families and is a major reason 

for nursing home admissions, an already huge social and economic burden in our 

increasingly aging population. 

In November 2002, the IFFGD sponsored a consensus conference—‘‘Advancing the 

Treatment of Fecal and Urinary Incontinence Through Research: Trial Design, Outcome Measures, and Research Priorities.’’ Among other outcomes, the conference resulted in six key research recommendations: 
476 

1. More comprehensive identification of quality of life issues associated with fecal 

incontinence and improved assessment and communication of treatment outcomes 

related to quality of life. 

2. Standardization of scales to measure incontinence severity and quality of life. 

3. Assessment of the utility of diagnostic tests for affecting management strategies 

and treatment outcomes. 

4. Development of new drug compounds offering new treatment approaches to 

fecal incontinence. 

5. Development and testing of strategies for primary prevention of fecal incontinence associated with childbirth. 

6. Further understanding of the process of stigmatization as it applies to the experience of individuals with fecal incontinence. 

The IFFGD has been working with the NICHD, NIDDK, and OMAR on a State 

of the Science Conference on Fecal and Urinary Incontinence. The goal of this conference will be to assess the state of the science and outline future priorities for research on both fecal and urinary incontinence; including, the prevalence and incidence of fecal and urinary incontinence, risk factors and potential prevention, 

pathophysiology, economic and quality of life impact, current tools available to 

measure symptom severity and burden, and the effectiveness of both short and long 

term treatment. Once the conference is completed, the NIH must prioritize implementation of the recommendations of this important conference. 

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Gastroesophageal reflux disease, or GERD, is a common disorder affecting both 

adults and children, which results from the back-flow of acidic stomach contents 

into the esophagus. GERD is often accompanied by persistent symptoms, such as 

chronic heartburn and regurgitation of acid. But sometimes there are no apparent 

symptoms, and the presence of GERD is revealed when complications become evident. One uncommon complication is Barrett’s esophagus, a potentially pre-cancerous condition associated with esophageal cancer. Symptoms of GERD vary from 

person to person. The majority of people with GERD have mild symptoms, with no 

visible evidence of tissue damage and little risk of developing complications. There 

are several treatment options available for individuals suffering from GERD. 

Gastroesophageal reflux (GER) affects as many as one-third of all full term infants born in America each year. GER results from an immature upper gastrointestinal motor development. The prevalence of GER is increased in premature infants. Many infants require medical therapy in order for their symptoms to be controlled. Up to 25 percent of older children and adolescents will have GER or GERD 

due to lower esophageal sphincter dysfunction. In this population, the natural history of GER is similar to that of adult patients, in whom GER tends to be persistent 

and may require long-term treatment. 

GASTROPARESIS

Gastroparesis, or paralysis of the stomach, refers to a stomach that empties slowly. Gastroparesis is characterized by symptoms from the delayed emptying of food, 

namely: bloating, nausea, vomiting or feeling full after eating only a small amount 

of food. Gastroparesis can occur as a result of several conditions; it can occur in up 

to 30 percent to 50 percent of patients with diabetes mellitus. A person with diabetic 

gastroparesis may have episodes of high and low blood sugar levels due to the unpredictable emptying of food from the stomach, leading to diabetic complications. 

Other causes of gastroparesis include Parkinson’s disease and some medications, especially narcotic pain medications. In many patients a cause of the gastroparesis 

cannot be found and the disorder is termed idiopathic gastroparesis. Over the last 

several years, as more is being found out about gastroparesis, it has become clear 

this condition affects many people and the condition can cause a wide range of 

symptoms of differing severity. 

ESOPHAGEAL CANCER

Approximately 13,000 new cases of esophageal cancer are diagnosed every year 

in this country. Although the causes of this cancer are unknown, it is thought that 

this cancer may be more prevalent in individuals who develop Barrett’s esophagus. 

Diagnosis usually occurs when the disease is in an advanced stage; early screening 

tools are currently unavailable. 
477 

CHILDHOOD DEFECATION DISORDERS AND DISEASES

Chronic Intestinal Pseudo-Obstruction (CIP).—About 200 new cases of CIP are diagnosed in American Children each year. Often life threatening, the future for children severely affected with CIP is brightened by the evolving promise of cure with 

intestinal or multi-organ transplantation. 

Hirschsprung’s Disease.—A serious childhood and sometimes life-threatening condition that can cause constipation, occurs once in every 5,000 American children 

born each year. Approximately 20 percent of children with HD will continue to have 

complications following surgery. These complications include infection and/or fecal 

incontinence. 

Functional Constipation.—Millions of children (1 in every 10) each year will be 

diagnosed with functional constipation. In fact, it is the chief complaint of 3 percent 

of pediatric outpatient visits and 10–25 percent of pediatric gastroenterology visits. 

FUNCTIONAL GASTROINTESTINAL AND MOTILITY DISORDERS AND THE NATIONAL

INSTITUTES OF HEALTH

The International Foundation for Functional Gastrointestinal Disorders recommends an increase of 5 percent for NIH overall, and a 5 percent increase for 

NIDDK and NICHD. However, we request that this increase for NIH does not come 

at the expense of other Public Health Service agencies. 

We urge the subcommittee to provide the necessary funding for the expansion of 

the NIDDK’s research program on functional gastrointestinal disorders (FGID) and 

motility disorders. This increased funding will allow for the growth of new research 

on FGID and motility disorders at NIDDK, a strategic plan on IBS, and increased 

public and professional awareness of FGID and motility disorders. In addition, we 

urge the subcommittee to continue to support and provide adequate funding to the 

Office of Research on Women’s Health (ORWH) under the NIH Office of the Director, particularly for their Specialized Centers of Research on Sex and Gender Factors Affecting Women’s Health (SCORs) program and the Building Interdisciplinary 

Research Careers in Women’s Health (BIRCWH) program. The ORWH supports important research into IBS. 

A primary tenant of IFFGD’s mission is to ensure that clinical advancements concerning GI disorders result in improvements in the quality of life of those affected. 

By working together, this goal will be realized and the suffering and pain millions 

of people face daily will end. 

Thank you. 

PREPARED STATEMENT OF THE INDUSTRIAL MINERALS ASSOCIATION—NORTH AMERICA

It appears that the President’s 2007 Budget for the Centers for Disease Control 

(CDC) includes a proposed reduction from $255.2 million to $250.2 million in funding for the National Institute for Occupational Safety and Health (NIOSH). IMA– 

NA notes that the fiscal year 2007 estimate carries forward fiscal year 2006 Conference language to move management and administrative costs ($34.8 million) from 

Occupational Safety and Health to Business Services Support. However, please note 

that the portion of the NIOSH budget to cover CDC overhead apparently has increased from 4.3 percent of NIOSH’s budget in 2001 to nearing 14 percent in fiscal 

year 2007. This fee appears to be taking an increasingly larger share of NIOSH 

funds that otherwise would be dedicated to occupational safety and health research. 

IMA–NA encourages you to fund NIOSH as a stand-alone agency within the HHS 

organizational structure. 

IMA–NA also favors increasing the fiscal year 2007 budget to expand the NIOSH 

in-house mining research program. Recent mining fatalities in the underground 

coal-mining sector have highlighted the need for a forward-looking initiative to improve mine emergency communications and to develop reliable technologies for 

tracking the location of underground miners. While IMA–NA supports these research initiatives, there is concern that other critical mine safety and health-related 

research important to the industrial minerals sector could be affected adversely. 

IMA–NA encourages you to fund NIOSH mining-related occupational safety and 

health research programs above current funding levels to address such critical 

issues as cumulative musculoskeletal trauma, dust control, and noise-induced hearing loss. 

The Industrial Minerals Association—North America (IMA–NA) is a trade association organized to advance the interests of North American companies that mine or 

process industrial minerals. These minerals are used as feedstocks for the manufacturing and agricultural industries and are used to produce such essential products 
478 

are glass, paints and coatings, ceramics, detergents and fertilizers. The IMA–NA 

membership includes producers of ball clay, bentonite, borates, feldspar, industrial 

sand, mica, soda ash (trona), sodium silicate, talc and wollastonite. IMA–NA’s membership also includes many of the suppliers to the industrial minerals industry, including equipment manufacturers, railroads and trucking companies, and consultants. 

IMA–NA respectfully requests your support in opposing reductions in funding for 

occupational safety and health research, particularly as they affect mine safety and 

health. In the latter regard, we respectfully request additional funding above current levels. 

PREPARED STATEMENT OF THE HHT FOUNDATION INTERNATIONAL

Mr. Chairman and honorable members of the committee, thank you for the opportunity to present my family’s story in this testimony in support of the HHT Foundation’s legislative initiative. I would like express my appreciation to Congresswoman 

DeLauro for all of her assistance to make this testimony possible. 

My name is Jane Ribicoff Silk, I was fortunate to be the daughter of the former 

Senator Abraham & Mrs. Ruth Ribicoff, but I was unfortunate to have inherited Hereditary Hemorrhagic Telangiectasia (HHT). I am also the past president of the 

HHT Foundation, International. 

HHT is a hidden killer: 20 percent of people with HHT die early or are disabled 

due to lung or brain involvement. 

It is estimated that 70,000–100,000, or 1 in 3,000–5,000 Americans, are affected 

with Hereditary Hemorrhagic Telangiectasia (HHT). HHT is a genetic disorder, 

which affects blood vessels of the brain, spinal cord, lung, liver, gastrointestinal 

tract and most commonly, the nose. The affected blood vessels of the brain, spinal 

cord, and lung are prone to rupture and may result in stroke, hemorrhage or death. 

Bleeding from the nose and gastrointestinal tract can cause transfusion dependency 

and anemia, which can lead to heart failure. HHT can be treated successfully if correctly diagnosed. Children of an affected parent have a 50 percent chance of inheriting HHT. 

DISABILITY AND DEATH CAN BE PREVENTED WITH PROPER DIAGNOSIS, SCREENING AND

TREATMENT. 

Nine of 10 people with HHT are not yet diagnosed due to widespread lack of 

knowledge by medical professionals. 

HHT is a national health problem associated with high health care costs that has 

long been neglected. 

From the time I was a very young child, I experienced the trauma of my grandmother’s severe hemorrhages of the nose. The bleeding would not stop. The ambulance came. My grandmother went to the hospital where she received multiple 

transfusions of blood and came back home, her nose packed with gauze—and still 

bleeding. This was not an infrequent occurrence. In between her severe nosebleeds, 

there would be daily nosebleeds lasting for more than an hour. My grandmother 

died at the age of 67 from a transfusion tainted with hepatitis. The severity of my 

grandmother’s bleeding, and the number of transfusions she needed to keep her 

alive, can now be prevented with modern therapy. 

I realized at an early age that my mother, Ruth Ribicoff, also had a bleeding problem. She bled from her nose multiple times a week and every few months was hospitalized for transfusions due to blood loss. In her mid forties, it was discovered that 

she was also bleeding from her intestines. Additionally, she had HHT in her liver 

which caused her heart to pump harder and to enlarge. This eventually led to heart 

failure. She was often weak and never robustly energetic. Being the wife of a busy 

congressman, governor, cabinet member and senator put an additional social strain 

on my mother as she never knew at what inopportune moment she might get a bad 

nosebleed. Every purse she owned was stocked with a good supply of cotton. 

In 1972, my mother died at the age of 64 of complications of the liver, intestinal 

bleeding and nosebleeds that are treatable today. Even today, it is still not recognized that 9 out of 10 people with HHT are not diagnosed. 

My older brother, Peter, has carried the family burden of HHT almost his whole 

life and is the most impaired of all of us. His quality of life has been greatly diminished and he suffers every day. As a young boy he had occasional nosebleeds. When 

he was in his 20’s he started getting backaches. He went to several doctors who 

could not help him, including Dr. Janet Travell, President Kennedy’s personal back 

specialist. When he was in his 30’s he began to lose sensation in the tops of his legs. 

An astute physician took some x-rays and noticed some dark spots around his spine. 
479 

The only doctor in the world at that time, who used dye to see the blood vessels 

in the spinal cord, was in Paris. So, my brother took his young family and went 

to Paris. During his hospitalization, he was told to go home and have exploratory 

surgery on his spine as there were malformations there that were most likely life 

threatening. Indeed, they were life threatening. During a 9-hour surgery, it was discovered that his HHT had affected the arteries of his spinal cord. He had had multiple hemorrhages over the years, which had caused his mysterious backaches, and 

if he had waited much longer, a massive hemorrhage of the malformed blood vessels 

of the spinal cord would have occurred—which would have either paralyzed him or 

killed him. So with meticulous care, each tangled and malformed artery snaking 

through his whole spinal column was tied off. It was not known if he would ever 

walk again. With extensive rehabilitation he did walk. But the loss of sensation 

caused by nerve damage was never regained. This has led to a continuously deteriorating condition for my brother. With a loss of sensation in his legs, he has become 

stooped over, uses a cane for balance and walks with a limp. Also due to his nerve 

damage, he has multiple complications with his bladder. For years he has had daily 

nosebleeds. He is in a weakened state all the time and his life has been permanently affected. If recognized early, his spinal cord malformation could have been 

treated and much suffering prevented. 

Adding further insult to injury, my brother’s daughter, Judith, a successful young 

woman, has a liver abnormality associated with HHT. When it was first discovered, 

doctors thought it was a tumor and almost did a biopsy which could have led to 

her loss of life. The doctors had no awareness of HHT. Fortunately, because of our 

experience with the Yale University HHT Center of Excellence and Dr. Robert I. 

White, Jr., she was taken care of and is now leading a normal life. 

Last, but not least is myself. My nosebleeds started in adolescence and in my late 

teens and early 20’s I had nosebleeds that could last 2 hours—and with HHT—you 

never have advance warning about when they are coming! I have led a pretty normal life, but have never had a lot of stamina. 

When I was about 55, I went through a period of time of feeling completely exhausted. A check up at the doctor showed that my liver enzymes were unusually 

high. In the search for the cause, a CAT scan of my liver was done. What was discovered was something that the doctors in my community had never seen. They 

were ready to do a liver biopsy. I insisted that the lead doctor speak to the Yale 

HHT Center of Excellence. They explained that what they were looking at was not 

uncommon for people with HHT and should not be touched at that time. I am monitored regularly and as I get older, it is clear that of all of those in my family I 

am the most fortunate. 

I have a daughter with HHT and granddaughter with HHT who may one day 

have children with HHT. I ask for funding so that not only my family, but all future 

generations will not have to live with HHT themselves or watch a family member 

slowly deteriorate or die a sudden preventable death. 

HOW THE FEDERAL GOVERNMENT CAN HELP

Stroke, lung and brain hemorrhages can be prevented through early diagnosis, 

screening and treatment. Severe hemorrhages in the nose and gastrointestinal tract 

can be controlled through intervention and heart failure can be managed through 

proper diagnosis of HHT and treatments. Access to effective evidence-based interventions and treatment should be established through a joint legislative initiative 

between the 8 established National HHT Treatment Centers of Excellence and the 

National Center on Birth Defects and Disabilities Hereditary Blood Disorders Group 

with a legislative initiative of a $10 million set aside at the CDC through the HHS 

Appropriations bill in support of the 8 U.S. HHT Centers. These funds will be used 

to provide surveillance; create a multi-center clinical database to collect and analyze 

data; support epidemiological studies; document effectiveness or patient interventions, develop educational programs for health care programs and ultimately improve the quality of life for people living with HHT and future generations. 

An additional $0.75 million is requested for the establishment of an HHT National Resource Center through a partnership between the CDC and the national 

voluntary agency representing HHT Families. These funds would be used to provide 

family support, education targeted to families and medical professionals, annual patient conferences, national and international scientific meetings and an aggressive 

research program. The CDC is ready and willing to work in partnership with the 

HHT Foundation to accomplish this mission. 

Mr. Chairman, again, thank you for the opportunity to testify. On behalf of the 

HHT Foundation and all of its members I personally appeal to the committee for 

funding for the 8 HHT Centers of Excellence. We believe this will benefit those with 
480 

HHT and also reduce health care costs by the prevention of complications and the 

development of new therapies for this condition. 

PREPARED STATEMENT OF THE LUPUS FOUNDATION OF AMERICA, INC. 

As President and CEO of the Lupus Foundation of America, Inc. (LFA) I appreciate the opportunity to submit written comments for the record regarding funding 

for lupus related programs for fiscal year 2007. The LFA is the Nation’s leading 

non-profit voluntary health organization dedicated to improving the diagnosis and 

treatment of lupus, supporting individuals and families affected by the disease, increasing awareness of lupus among health professionals and the public, and finding 

the causes and cure. As you may know, lupus is a debilitating, chronic autoimmune 

disease that causes inflammation and tissue damage to virtually any organ system; 

it can cause significant disability or even death. Lupus is the prototypical autoimmune disease; therefore, finding answers to questions about lupus may also provide understanding about other autoimmune diseases that affect 22 million Americans. The leaders and members of the LFA and the 1.5 to 2 million people suffering 

from lupus respectfully request the following for fiscal year 2007 to reduce and treat 

suffering from lupus: 

—$29.7 billion for the National Institutes of Health (NIH) to support lupus research. Specifically, we urge Congress to direct NIH to support and bolster 

lupus research across all relevant institutes, centers, and offices. 

—$1 million in new funding for The Office of Women’s’ Health at the Department 

of Health and Human Services (HHS) to support a sustained national lupus 

education campaign. This campaign is directed towards the general public and 

healthcare professionals who diagnose and treat people with lupus, with emphasis on reaching those individuals at highest risk—women of color—a health disparity that remains unexplained. 

—$1.5 million for the National Lupus Patient Registry (NLPR) at the National 

Center for Chronic Disease Prevention and Health Promotion within the Center 

for Disease Control and Prevention (CDC) to sustain current epidemiological efforts, and expand the CDC’s work to include all forms of lupus and all affected 

populations, particularly African Americans, Hispanics, and Asian Americans 

who are disproportionately at-risk for—and have worse outcomes associated 

with—lupus. 

The purpose of the CDC lupus registry is to collect data and conduct lupus epidemiological studies to better understand and measure the burden of the illness, the 

social and economic impact of the disease, and stimulate additional private investment by industry in the development of new, safe and effective therapies for lupus. 

Existing epidemiological data on lupus is decades old and no longer reliable. Population-based epidemiological studies of lupus must be conducted at strategically-located sites throughout the Nation that will provide accurate data on all forms of 

lupus (i.e. systemic lupus, primary discoid lupus, drug-induced lupus, neonatal 

lupus, antiphospholipid antibodies) and the disparity among the various racial and 

ethnic populations. 

To ensure that we begin to comprehensively study and understand the dramatic 

health disparities associated with lupus, the NLPR and associated epidemiological 

studies must be expanded to include additional sites that constitute a mix of urban 

and rural areas and contain academic centers with a track record and some existing 

infrastructure for performing epidemiological studies. Thank you. 

I am Dr. Michael Madaio, Professor of Medicine at the University of Pennsylvania 

School of Medicine, and a lupus researcher. I have been funded for lupus research 

for over twenty years. I am proud to be affiliated with the Lupus Foundation of 

America as a member of the Medical Scientific Advisory Board and Chairman of the 

Medical Advisory Board for the Southeastern Pennsylvania Chapter of the LFA. 

While I am a nephrologist, since my research and clinical practice is focused on 

lupus, I really work day-to-day within the realms of nephrology and rheumatology 

as well as other medical specialties and subspecialty areas. I understand the importance of biomedical research funding and the impact that Federal research funding 

has had, does have, and can have on the lives of the 1.5 million people living with 

lupus and the 22 million Americans with other autoimmune diseases. 

After a tragic 40 year dearth of new treatments to manage this often debilitating 

and devastating disease, the good news is that we finally are on the brink of major 

breakthroughs, thanks to research sponsored by the National Institutes of Health. 

Exciting research and strides in treatments for people with lupus are on the horizon 

and a sustained investment now in lupus research will speed the day to better treatments and a cure. Specifically, I am conducting extensive research on lupus nephri-
481 

tis, which is kidney involvement in lupus disease. My field is advancing rapidly, due 

in large part to factors directly dependent on NIH funding: 

—the burgeoning growth in the number of new animal models, including a wealth 

of informative transgenic and gene-targeted mutants; 

—increased access to improved powerful technologies such as gene and protein arrays, now available at many institutions and to many investigators through 

NIH core facilities; 

—new technologies that permit successful query of the very small amounts of 

human tissue typically available from patients and, collaboration across disciplines and across institutions to bring crucial expertise together; 

—new insights into underlying biology and pathophysiology in immunity and 

lupus are constantly emerging; 

—technologies to identify biomarkers are improved and accessible; and 

—new approaches to therapy are being explored. 

These endeavors are bearing fruit but they are highly dependent on NIH funding. 

If funding for the NIH is cut or level funded, it could cripple or paralyze current 

lupus research efforts. 

As lupus is a systemic disease that can affect any organ or tissue elucidating 

pathogenesis (or cause) and treatments of lupus will have direct impact on many 

other autoimmune diseases (e.g. results and treatments translating to other diseases). Providing adequate resources to support lupus research will help the Nation 

turn the corner on finding better treatments or a cure for lupus while also supporting breakthroughs and progress for other disease states. It is important to note 

that the corollary is true: cuts in lupus research funding also will have an adverse 

effect on progress for lupus and for progress in related diseases. Cuts in NIH funding could bring to a standstill support of clinical trials and large observational studies, and could curtail research on those at highest risk for lupus, women of color; 

it also could negatively impact pediatric research at a time when researchers have 

just begun to undertake studies in important new areas. Furthermore, insufficient 

Federal funding also could slow much-needed genetic research when we are just discovering the critical components that may contribute to lupus and its effects. Therefore, it is critical that biomedical researchers be provided the necessary resources 

to continue seeking answers to the questions that will lead to better lupus treatments. Increased research funding will help deliver much-needed breakthroughs 

from the laboratory to patients in need. 

The National Institute of Arthritis and Musculoskeletal and Skin Diseases 

(NIAMS), the institute most involved in lupus research, is one of the smallest institutes at NIH. In the past two years there has been a decrease in research funding 

for NIAMS overall, with a ten percent decrease in new research grants. Currently, 

only 12–15 percent of the grant applications submitted to NIAMS receives funding. 

Further cuts will cause this rate to drop precipitously to below 10 percent next year. 

Just two or three years ago, funding levels were at 25–30 percent. Cuts in research 

funding, coupled with the rate of biomedical research inflation (3–4 percent per 

year), further erode NIAMS’ ability to fund lupus research grant applications at the 

rate necessary to begin making real progress. As such, an increase above the rate 

of biomedical research inflation is necessary to allow NIH to sustain and build on 

its research progress resulting from the recent budget doubling while avoiding the 

severe disruption to that progress that would result from a lesser increase or cut. 

Furthermore, in the proposed budget for NIAMS for 2007 there will be a loss of 

10 training grants; each grant funds training for four physicians, mostly 

rheumatologists. Young and senior investigators alike are moving into other fields 

because of the lost of funding. Exacerbating the situation, medical schools are struggling financially due to public funding cuts thus eliminating any safety net for researchers that may have previously existed. As a result, young investigators are not 

attracted to lupus research which means there will be not be a future generation 

of lupus scientists and clinicians to do research. Moreover, after having attracted 

scientists to translational immunology in the last five to ten years, when funding 

was increasing, there is now a possibility we could lose both the current and next 

generation of young investigators. Increased funding is necessary to support an adequate number of training grants. Without research and training funds lupus researchers might be forced to become private practice physicians instead, leading to 

an imbalance in the health care system: sufficient numbers of physicians to treat 

lupus patients, but no new treatments with which to care for them, and no researchers to develop the cures of tomorrow. 

We recognize and appreciate that Congress and the Nation face unprecedented fiscal challenges; however, we cannot afford to lose ground in biomedical research at 

such a promising time. The LFA looks forward to working with the subcommittee 

and others in Congress to reduce and prevent the suffering caused by lupus. We 
482 

stand ready to serve as a resource for any information you may need in this regard 

and thank you for this opportunity to submit written testimony for the record concerning fiscal year 2007 lupus related funding. 

PREPARED STATEMENT OF THE MARCH OF DIMES BIRTH DEFECTS FOUNDATION

The 3 million volunteers and 1,400 staff members of the March of Dimes appreciate the opportunity to submit the Foundation’s Federal funding recommendations 

for fiscal year 2007. The March of Dimes is a national voluntary health agency 

founded in 1938 by President Franklin D. Roosevelt to prevent polio. Today, the 

Foundation works to improve the health of mothers, infants and children by preventing birth defects, premature birth and infant mortality through research, community services, education, and advocacy. The March of Dimes is a unique partnership of scientists, clinicians, parents, members of the business community, and other 

volunteers affiliated with 52 chapters in every State, the District of Columbia, and 

Puerto Rico. 

The volunteers and staff of the March of Dimes are deeply concerned that the 

funding recommendations in the President’s Budget are not sufficient to meet the 

challenge of improving the health of women and children across the Nation. Continued under-funding of critical research and public health programs imperils the 

health of mothers and children today and in the future. In our judgment, the funding increases recommended below would lead to an immediate positive impact on 

reducing the incidence of preterm birth and birth defects, as well as making newborn screening for treatable metabolic and functional disorders more widely available. 

NATIONAL INSTITUTES OF HEALTH

The March of Dimes joins the larger research community in recommending a 5 

percent increase in funding for the National Institutes of Health (NIH), bringing 

total Federal support to just under $30 billion. The administration’s fiscal year 2007 

budget recommendation would necessitate absolute reductions in research investments as the levels of funding proposed are insufficient even to keep up with inflation and certainly will not sustain the necessary investment in medical research. 

National Institute of Child Health and Human Development 

The March of Dimes recommends a 5 percent increase for NICHD in fiscal year 

2007 and an increase of at least $100 million over the next five years to boost prematurity-related research. Additional resources are needed to support research on 

the causes of preterm labor and delivery and on strategies for improving the care 

and treatment of infants born prematurely or at low birth weight. In addition, funding should be provided to enable the Institute to work with the Office of the Director 

of NIH to create a comprehensive strategic plan for this research that includes coordination of strategies and studies across multiple Institutes. 

Since 1981, the preterm birth rate has increased 33 percent resulting in more 

than 500,000 premature births in 2004—that is 1 in 8 births. Preterm birth is the 

leading cause of death in the first month of life and, for those babies who do survive, 

one in 5 experiences multiple health problems including cerebral palsy, mental retardation, chronic lung disease, and vision and hearing loss. Preterm labor can happen to any pregnant woman, and the causes of nearly half of all premature births 

are unknown. This growing problem is a tragedy for families and expensive for the 

Nation. In 2003, the national hospital bill for the care of babies with a primary or 

secondary diagnosis of prematurity exceeded $18 billion, half of which was borne by 

Medicaid and other public programs and the remainder was charged to employers 

and families. Until we know how to prevent preterm labor, the worsening incidence 

of prematurity means that overall hospital charges will also spiral upward. 

In recent years, the NICHD has made a major commitment to increasing our understanding of the factors that result in premature birth and to developing strategies to prolong pregnancy. But additional work is needed and adequate funding is 

key. 

An area deserving more support is the collaborative Maternal-Fetal Medicine 

Units (MFMU) and Neonatal Research (NR) collaboratives. One clinical trial funded 

through the MFMU network reported a promising preventive intervention that relies on a derivative of the hormone progesterone. The incidence of preterm delivery 

was reduced by up to 30 percent in women who received weekly injections of the 

compound compared to the women who were given a placebo. The results of this 

intervention are impressive and additional funding is needed to support further clinical trials of this promising intervention. 
483 

Finally, the March of Dimes urges the subcommittee to include in its bill an increase of $57 million for the National Children’s Study (NCS). While the amount 

may seem substantial, it is dwarfed by the cost of treating the diseases and conditions the study is designed to address. If allowed to go forward, the NCS will generate groundbreaking research that greatly increases our knowledge of the role family genetics and the environment play in the health and development of children. 

Planning for this study has been completed; the Vanguard sites have been designated. The project is poised to start implementation which will yield critical information for research on preterm birth. The NCS will prove a rich and ongoing information resource for use by scientists and clinicians to develop treatments and preventive measures tailored for the pediatric population. Failure to provide the resources needed for this study would be extremely shortsighted. 

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

Safe Motherhood/Infant Health 

The National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health works to promote optimal reproductive and infant 

health. The March of Dimes recommends a $20 million increase in fiscal year 2007 

to support expansion of research to identify risk factors and to develop strategies 

for preventing preterm birth. This can be accomplished with increased funding for 

the two programs described below: 

1. The Pregnancy Risk Assessment Monitoring System (PRAMS) is a state-specific, population-based surveillance system designed to identify and monitor selected 

maternal behaviors and experiences before, during, and after pregnancy. Data collected through PRAMS is used to increase understanding of maternal behaviors and 

experiences and their relationship to adverse pregnancy outcomes, to improve maternal and child health programs, and to facilitate the dissemination of the latest 

research findings and clinical practice standards. The March of Dimes recommends 

an increase of $5 million to improve PRAMS so that CDC can develop national estimates on behavioral and demographic risk factors for preterm birth. 

2. Epidemiological research conducted at CDC is vital to the prevention of 

preterm labor and delivery. The March of Dimes recommends an increase of $15 

million for the expansion of basic etiologic research, research on women at risk for 

preterm delivery and the social and environmental factors contributing to higher 

rates of preterm delivery in African-American women. Increasing CDC’s research activities related to preterm birth will lead to improvements in screening and early 

detection and new interventions for women at risk for preterm labor. 

National Center on Birth Defects and Developmental Disabilities 

The March of Dimes recommends a minimum of $135 million in fiscal year 2007 

funding for the National Center on Birth Defects and Developmental Disabilities 

(NCBDDD). NCBDDD conducts programs to protect and improve the health of children by: (1) preventing birth defects and developmental disabilities; and (2) promoting optimal development and wellness among children with disabilities. Of particular interest to the March of Dimes is NCBDDD’s birth defects program that includes surveillance, research and prevention activities. For fiscal year 2007, the 

March of Dimes requests an increase of $6 million to support surveillance and research and an additional $2 million for folic acid education. These modest increases 

are vital to making progress in reducing the incidence of birth defects. 

In the United States, about 3 percent of all babies are born with a major birth 

defect. Birth defects are the leading cause of infant mortality accounting for more 

than 20 percent of all infant deaths every year. Children with birth defects who survive often experience long term physical and mental disabilities, and are at increased risk for developing other significant health problems. In fact, birth defects 

contribute substantially to the Nation’s health care costs. According to CDC, the 

lifetime cost of caring for infants born with one of the 18 most common birth defects 

exceeds $8 billion annually. 

NCBDDD provides funding to assist States with community-based birth defects 

tracking systems, programs to prevent birth defects and improve access to health 

services for children with birth defects. In 2006, CDC has been able to support only 

15 States in their efforts to improve surveillance programs, down from 28 States in 

fiscal year 2004. Additional resources are sorely needed to help States seeking assistance. 

The causes of nearly 70 percent of birth defects are unknown and it is therefore 

critical that the Committee increase funding for the National Birth Defects Prevention Study. This groundbreaking CDC initiative is being carried out by 9 regional 

Centers for Birth Defects Research and Prevention located in Arkansas, California, 
484 

Georgia, Iowa, Massachusetts, New York, North Carolina, Texas, and Utah. Each 

of these centers obtains data on infants with major birth defects through interviews 

with their mothers and biological samples that provide information about medical 

history, environmental exposures, and lifestyle before and during pregnancy. The 

study focuses on both genetic and environmental causes, including medication use 

during pregnancy, maternal diet and vitamin use. This study is an ongoing source 

of information for use in research on the causes of birth defects. With adequate 

funding this study has the potential to dramatically increase our understanding of 

the causes of birth defects and will provide information for developing effective preventive measures. 

NCBDDD is conducting a national public and health professions education campaign designed to increase the number of women taking folic acid. CDC estimates 

that up to 70 percent of neural tube defects (NTDs), serious birth defects of the 

brain and spinal cord including anencephaly and spina bifida could be prevented if 

all women of childbearing age consume 400 micrograms of folic acid daily, beginning 

before pregnancy. Since fortification of grain products with folic acid in 1996, the 

rate of NTDs in the United States has decreased by 26 percent, but more must be 

done to educate every woman of childbearing age and the health professionals who 

treat them about the importance of taking folic acid daily. 

Finally, the March of Dimes recommends that additional funds be provided to conduct surveillance and epidemiological research on cerebral palsy through the network already in place for autism (Centers of Excellence for Autism and Developmental Disabilities Research and Epidemiology). Cerebral palsy is one of the most 

common developmental disabilities and there is currently very limited surveillance 

and research being conducted. 

National Immunization Program 

If the Nation is to meet the Healthy People 2010 goals of vaccinating 90 percent 

of children and adults, CDC, States, and localities will need the resources required 

to reach those in need of immunizations. According to the CDC, nearly 25 percent 

of two-year-olds have not received all of the recommended vaccine doses. CDC’s National Immunization Program provides grants to 64 State, local, and territorial public health agencies to reduce the incidence of disability and death resulting from 12 

vaccine preventable diseases. The March of Dimes urges the subcommittee to continue its longstanding policy of ensuring that Federal vaccine programs are well 

funded. For fiscal year 2007, the March of Dimes recommends $802.4 million to ensure that the National Immunization Program has the resources it needs to account 

for vaccine price increases, introduction of new vaccines, and to implement recommendations by the Institute of Medicine. 

Polio Eradication 

The March of Dimes supports a funding level of $101.254 million for CDC’s fiscal 

year 2007 global polio eradication activities. Level with fiscal year 2006, this funding would allow CDC to continue its supplementary immunization activities in the 

remaining endemic and high-risk countries in Africa and Asia and to move quickly 

to interrupt polio transmission in these regions. The U.S. Government must maintain its commitment to the worldwide eradication initiative that promises to save 

lives and reduce unnecessary health-related costs globally. 

National Center for Health Statistics 

The National Center for Health Statistics (NCHS) provides data essential for both 

public and private research and programmatic initiatives. The National Vital Statistics System and the National Survey on Family Growth, for example, are major 

sources of information on the utilization of prenatal care and on birth outcomes, including preterm delivery, low birthweight and infant mortality. Increased funding 

would enable CDC to introduce web-based technology to facilitate more rapid and 

accurate compilation of data obtained from health professionals and facilities. This 

information is used to track trends in birth outcomes and to support State birth defects registries. Data from NCHS surveys are also used to identify emerging trends 

and to optimize use of existing program resources. 

HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)

Newborn Screening 

Newborn screening is a vital public health activity used to identify genetic, metabolic, hormonal and/or functional conditions in newborns that if left untreated can 

cause disability, mental retardation, and even death. Although nearly all babies 

born in the United States are screened for some genetic birth defects, the number 

of these tests varies from State to State. The March of Dimes recommends that 
485 

every baby born in the United States receive, at a minimum, screening for a core 

set of 28 metabolic disorders plus hearing deficiencies. 

In fiscal year 2005 and fiscal year 2006, Congress provided funding for implementation of Title XXVI of the Children’s Health Act of 2000; specifically, to fund the 

Regional Genetic Service and Newborn Screening Collaboratives that work to address the maldistribution of genetic services and resources and bring services closer 

to local communities. The March of Dimes supports an appropriation of $25 million 

to enable HRSA to improve the capacity of States to: (1) provide screening, counseling, testing, and special services for newborns and children at risk for heritable 

disorders; (2) educate health professionals and parents on the availability and importance of newborn screening; and (3) support States with technical assistance on 

the acquisition and use of new technologies and newborn screening services. 

Healthy Start 

The Healthy Start Initiative is a collection of community based projects focused 

on reducing infant mortality, low birthweight and racial disparities in perinatal outcomes. The March of Dimes strongly supports Healthy Start and urges continued 

funding for this important program to decrease this Nation’s tragically high rate of 

infant mortality. 

Maternal and Child Health Block Grant 

In recent years, Federal funding for Title V of the Social Security Act, the Maternal and Child Health (MCH) Block Grant, has not kept pace with increased demand 

for services. Although the MCH Block Grant provides assistance for a growing number of community-based programs (such as home visiting, respite care for children 

with special health care needs and ‘‘wrap around’’ services for pregnant women and 

children enrolled in Medicaid and SCHIP), the funding level was reduced by $24 

million in fiscal year 2006. In order for maternal and child health programs to 

shoulder responsibility for additional beneficiaries and services, funding must be increased. The March of Dimes recommends full funding of the MCH Block Grant at 

the authorized level of $850 million. 

Consolidated Health Centers 

Consolidated (Community) Health Centers are an important source of obstetric 

and pediatric care for more than 15 million individuals, approximately 40 percent 

of whom are uninsured. The Foundation recommends new funding sufficient to increase the number of centers and to improve the scope of perinatal services provided. Adding funds to this program would be consistent with the President’s fiveyear plan to create and expand health center sites in 1,200 communities and to increase the number of patients served annually to more than 16 million. 

Thank you for the opportunity to testify on the federally supported programs of 

highest priority to the March of Dimes. The Foundation’s volunteers and staff in 

every State, the District of Columbia, and Puerto Rico look forward to working with 

members of the subcommittee to improve the health of the Nation’s mothers, infants 

and children. 

PREPARED STATEMENT OF THE MEDICAL LIBRARY ASSOCIATION AND THE ASSOCIATION

OF ACADEMIC HEALTH SCIENCES LIBRARIES

Mr. Chairman, thank you for the opportunity to testify today on behalf of the 

Medical Library Association (MLA) and the Association of Academic Health Sciences 

Libraries (AAHSL) regarding the fiscal year 2007 budget for the National Library 

of Medicine (NLM). I am Marianne Comegys, Director of the Louisiana State University Health Sciences Center Library, Shreveport, Louisiana. 

MLA, a nonprofit educational organization established in 1898, comprises health 

sciences information professionals with more than 4,500 members worldwide. 

Through its programs and services, MLA provides lifelong educational opportunities, 

supports a knowledgebase of health information research, and works with a global 

network of partners to promote the importance of quality information for improved 

health to the health care community and the public. 

AAHSL is comprised of the directors of the libraries of 142 accredited United 

States and Canadian medical schools belonging to the Association of American Medical Colleges (AAMC). Together, MLA and AAHSL address health information issues 

and legislative matters of importance through a joint task force. 

Mr. Chairman, the National Library of Medicine (NLM), on the campus of the National Institutes of Health (NIH) in Bethesda, Maryland, is the world’s largest medical library. NLM collects material in all areas of biomedicine and health care, as 
486 

well as works on biomedical aspects of technology, the humanities, and the physical, 

life, and social sciences. 

With respect to the Library’s budget for the coming year, I would like to touch 

briefly on six issues: (1) the growing demand for NLM’s basic services; (2) NLM’s 

outreach and education services; (3) Emergency preparedness and response; (4) 

NLM’s health information technology activities; (5) NLM’s facility needs; and (6) 

NLM’s infrastructure that supports the NIH Public Access Policy. 

THE GROWING DEMAND FOR NLM’S BASIC SERVICES

Mr. Chairman, it is a tribute to NLM that the demand for its collections continues 

to steadily increase each year. These collections stand at 8.5 million items-books, 

journals, technical reports, manuscripts, microfilms, photographs, and images. 

Housed within the library is one of the world’s finest collections of old and rare medical works. NLM is a national resource for all U.S. health science libraries through 

the National Network of Libraries of Medicine. Increasingly, it is also becoming an 

international resource for world-wide research collaboration. 

Our Nation’s healthcare providers, researchers, and consumers all use the library’s collections, through the reading rooms or through interlibrary loan, and on 

the World Wide Web. Increasingly, NLM’s collection is also available in digital form. 

NLM is developing a strategy for selecting, organizing, and ensuring permanent access to digital information. By doing so they are ensuring their availability for future generations. This availability of health information remains the highest priority for the Library. 

Mr. Chairman, simply stated, NLM is a national treasure. I can tell you that 

without NLM our Nation’s medical libraries would be unable to provide the quality 

information services that our Nation’s healthcare providers, educators, researchers, 

and patients, have all come to expect. 

Recognizing the invaluable role that NLM plays in our healthcare delivery system, the Medical Library Association and the Association of Academic Health 

Sciences Libraries join with the Ad Hoc Group for Medical Research Funding in recommending a 5 percent increase for NLM and NIH overall in fiscal year 2007. 

OUTREACH AND EDUCATION

NLM’s outreach programs are of particular interest to both MLA and AAHSL. 

These activities, designed to educate medical librarians, healthcare professionals 

and the general public about NLM’s services, are an essential part of the Library’s 

mission. 

The Library has taken a leadership role in promoting educational outreach aimed 

at public libraries, secondary schools, senior centers, and other consumer-based settings. NLM’s emphasis on outreach to underserved populations assists the effort to 

reduce health disparities among large sections of the American public. 

NLM’s ‘‘Partners in Information Access’’ program is designed to improve the access of local public health officials to health information. The establishment of additional programs across the country will go a long way towards ensuring that 

healthcare workers across America are familiar with NLM and the National Network of Libraries of Medicine. My own facility, the LSU Health Sciences Center in 

Shreveport, Louisiana, participates in this program. Through it, we are able to train 

public health workers on how to access health information online. 

We ask the Committee to encourage NLM to coordinate its outreach activities 

with the medical library community. 

PubMed Central 

The medical library community also applauds NLM for its leadership in establishing PubMed Central, an online repository for life science articles. Introduced in 

2000, PubMed Central was created by NLM’s National Center for Biotechnology Information and evolved from an electronic archiving concept proposed by former NIH 

director Dr. Harold Varmus. The site houses 615,000 articles from 232 journals including the Proceedings of the National Academy of Sciences and Molecular Biology 

of the Cell. 

The medical library community believes that medical librarians should continue 

to play a key role in the further development of PubMed Central and we are pleased 

that medical librarians are members of the PubMed Central Advisory Committee. 

Because of the high level of expertise health information specialists have in the organization, collection, and dissemination of medical literature, we believe that our 

community can assist NLM with issues related to copyright, fair use, and information classification. We look forward to continuing our collaboration with the Library 

as this exciting project continues to evolve. 
487 

MEDLINEplus 

MEDLINEplus [http://www.nlm.nih.gov/medlineplus], a source of authoritative, 

full-text, health information resources from the NIH institutes and a variety of nonFederal sources, has grown tremendously in its coverage and its usage by the public. 

In January of 2006, MEDLINEplus had 8.6 million unique visitors research 67 million pages of health information (including information from over 1,250 organizations). MEDLINEplus’s features include illustrated interactive patient tutorials, a 

daily news feed from the public media on health-related topics, and the NIH 

SeniorHealth website [http://www.nihseniorhealth.gov], a collaborative project between NLM and the National Institute on Aging. 

‘‘Go Local’’ is another new and exciting feature of MEDLINEplus. Go Local enables local and State agencies and others to participate by creating sites that connect the MEDLINEplus information seeker to local hospitals, pharmacies, doctors, 

and other health services. These agencies use the infrastructure created by NLM 

that makes this possible. Using Go Local, a search by topic on MEDLINEplus will 

lead the consumer to local services connected to that topic. Currently, there are 

fourteen localities participating in the Go Local service, and many more will be 

added in the near future. Through this service, NLM and MEDLINE are becoming 

increasingly valuable tools, not just for medical librarians and other health professionals but also for the health consumer. 

Clinical Trials 

Mr. Chairman, I also want to address another frequently used service offered by 

NLM—its clinical trials database [http://www.clinicaltrials.gov]. This listing of more 

than 27,000 Federal and privately funded trials for serious or life-threatening diseases was launched in February 2000 and currently logs more than 8 million page 

views per month and 25,000 visitors daily. The clinical trials database is a free and 

invaluable resource to patients and families interested in participating in cutting 

edge treatments for serious illnesses. The medical library community congratulates 

NLM for its leadership in creating ClinicalTrials.gov and looks forward to assisting 

the Library in advancing this important initiative. 

EMERGENCY PREPAREDNESS AND RESPONSE

Since the late 1960s, NLM has been actively involved in disaster response and 

management. As a Louisiana resident, I am pleased to report about NLM’s relief 

work in response to Hurricane Katrina. NLM’s Specialized Information Services 

(SIS) Division compiled a Hurricane Katrina Web page on toxic chemical and environmental health information resources. The Web page provided links to information on chemicals that may have been released and on environmental concerns following the wind and flood damage. The page also linked to the Wireless Information 

System for Emergency Responders (WISER). WISER provides information on 400 of 

the most hazardous chemicals in NLM’s Hazardous Substances Databank. It can be 

downloaded to a Personal Digital Assistant (PDA) or field laptop, providing first responders with ready access to basic emergency haz-mat information. At the request 

of the Environmental Protection Agency, NLM provided 15 PDAs loaded with 

WISER for the EPA National Decontamination Team to take with them when they 

were deployed to New Orleans. In addition, NLM’s National Center for Biotechnology Information (NCBI) has provided assistance to the State of Louisiana in 

identifying Katrina victims with software tools that improve speed and accuracy of 

DNA identification. 

In addition to NLM’s efforts on the national level, the South Central Regional office of the NLM-supported National Network of Libraries of Medicine provided specific help to the libraries in its territory that were impacted by Katrina. When librarians were dispersed to remote sites, the Regional office purchased laptops and 

printers for them to use. Arrangements were also made for Katrina-area libraries 

to have free interlibrary loans. The South Central Regional office also created a 

blog, ‘‘Hurricane Katrina in the SCR,’’ for librarians to post information regarding 

colleagues and building conditions. During the first few weeks after Katrina, when 

we were unsure of where our friends had relocated and how to contract them, the 

blog was an invaluable resource for helping us to find them and for suggesting ways 

to assist them. 

Mr. Chairman, we applaud the success of NLM’s outreach initiatives, particularly 

those initiatives that reach out to medical libraries and healthcare consumers. We 

look forward to continuing our work with the Library in fiscal year 2007 on these 

important programs. 
488 

HEALTH INFORMATION TECHNOLOGY AND BIOINFORMATICS

Mr. Chairman, NLM played a major role in creating and nurturing the field of 

medical informatics. For nearly 35 years, the Library has supported informatics research and training and the application of advanced computing and communications 

to biomedical research and health care delivery. Many of today’s informatics leaders 

are graduates of NLM-funded informatics research programs at universities across 

the country. Many of the country’s exemplary electronic health record systems (e.g., 

in Indianapolis, Vanderbilt, and Pittsburgh) benefited from NLM grant support. The 

Library began supporting informatics research that addresses information management problems relevant to disaster management several years ago. It has also funded innovative telemedicine projects in various rural and urban medically underserved communities, as models for evaluating the impact of telemedicine on cost, 

quality, and care. A leader in supporting, licensing, developing, and disseminating 

standard clinical terminologies for free nationwide use, NLM works closely with the 

National Coordinator of Health Information technology to promote adoption of interoperable electronic records. Through its National Center for Biotechnology Information, NLM creates and provides access to GenBank, the genetic sequence repository, 

and a wide array of related scientific data and analysis tools. These publicly accessible resources are speeding the pace of scientific discovery around the world, including important insights into the evolution of the flu. Building on this success, 

NLM will develop databases to manage the vast amount of genetic, medical and environmental information that will emanate from new HHS and NIH efforts to analyze genetic variation in groups of patients with specific illnesses and to devise new 

ways of monitoring personal environmental exposures that interact with genetic 

variations and result in human diseases. 

We are pleased that NLM is supporting informatics research that addresses information management problems relevant to disaster management. Medical librarians 

and health information specialists have an important role to play in supporting 

these cutting edge technologies and in serving as important sources of health information for those displaced by disasters. We encourage Congress and NLM to continue their strong support of NLM’s medical informatics and genomic science initiatives, at a point when the linking of clinical and genetic data holds increasing promise for enhancing the diagnosis and treatment of disease. MLA and AAHSL also 

support Health Information Technology initiatives in the Office of the National Coordinator for Health Information Technology (ONCHIT) and the Agency for 

Healthcare Research and Quality (AHRQ) that build upon initiatives housed at 

NLM. 

NLM’S FACILITIES NEEDS

Mr. Chairman, over the past two decades NLM has assumed several new responsibilities, particularly in the areas of biotechnology, health services research, high 

performance computing, and consumer health. As a result, the Library has had tremendous growth in its basic functions related to the acquisition, organization, and 

preservation of an ever-expanding collection of biomedical literature. In order to 

complete these functions, NLM has had to expand its staff. NLM now houses 1,100 

staff in a facility built to accommodate only 650. This increase in the volume of biomedical information and in the number of personnel has led to a serious shortage 

of space at the Library. 

In order for NLM to continue its mission as the world’s premier biomedical library, a new facility is urgently needed. The NLM Board of Regents has assigned 

the highest priority to supporting the acquisition of a new facility. The medical library community is pleased that Congress appropriated the necessary architectural 

and engineering funds for the design of the facility expansion at NLM in 2003. The 

community is also pleased that the American Center for Cures Act, (S. 2104) introduced in the Senate by Senator Lieberman, asks Congress to make a special effort 

to fund the expansion of NLM’s facilities. 

We encourage the subcommittee to provide the resources necessary to construct 

a new facility and to support the Library’s health information programs. 

NIH PUBLIC ACCESS POLICY

MLA and AAHSL support the goals of the NIH public access policy to create a 

central archive of NIH-funded research publications to advance science and enable 

NIH to better manage its research portfolio, and to provide electronic access to the 

public to NIH-funded research publications. We are concerned, however, that the 

current rate of participation in the voluntary policy is low—less than 4 percent. Information provided by the NIH Public Access Working Group indicates that the sub-
489 

mission system is not difficult to use and that the majority of NIH-funded researchers appear to know about the policy. For these reasons, we concur with the conclusion of NLM’s Board of Regents, that the NIH Policy cannot achieve its stated goals 

unless deposit of manuscripts becomes mandatory. We also support the Board of Regents’ recommendation that NIH and NLM develop a careful plan for transitioning 

to a mandatory policy, and to provide clear guidance and a reasonable timetable to 

minimize burden on NIH-funded researchers and grantee institutions, and also to 

work with publishers to make it easy for them to submit articles on behalf of their 

NIH-supported authors. 

We encourage Congress to continue to ask for periodic evaluation of the plan as 

it is implemented in the coming months and years. 

Mr. Chairman, thank you again for the opportunity to present the views of the 

medical library community. 

PREPARED STATEMENT OF THE MENDED HEARTS, INC. 

The Mended Hearts, Inc. (MHI) is a national nonprofit organization that offers 

the gift of hope to heart patients, their families and caregivers for more than 50 

years. Mended Hearts has 21,000 members operating through 280 community-based 

chapters across the country, with two in Canada. Chapters partner with more than 

450 hospitals and cardiac care facilities in providing patient-to-patient support services. I have been appointed by the group as their legal representative—a volunteer 

position. I am a heart disease survivor. 

About 30 years ago, I was diagnosed with a rare heart disease. After having chest 

discomfort and trouble breathing for more than two years, I was diagnosed with hypertrophic cardiomyopathy (HCM), a disease in which the heart enlarges. The heart 

muscle gradually thickens so much that heart cannot pump blood out effectively. 

The new heart muscle replacing the old heart tissue does not grow in the normal 

parallel pattern. Instead, it grows in a helter-skelter pattern. Studies show that 36 

percent of young athletes who die suddenly have probable or definite hypertrophic 

cardiomyopathy, but it also affects men and women of all ages. HCM is one of the 

major causes of sudden death due to cardiac arrhythmias. There is no cure for 

HCM. However, medication may work, and there is surgery, which may alleviate 

the pain and discomfort, prolonging the patient’s life. If surgery does not work, the 

alternative is a heart transplant, but donor organs are scarce. The doctor who made 

my diagnosis was trained at the National Institutes of Health’s (NIH) National 

Heart, Lung, and Blood Institute (NHLBI). 

Initially, I received several medications, which enabled me to engage in most activities. However, some activities, such as walking up hills, caused shortness of 

breath and severe chest pains. But, generally I could function normally. After about 

10 years, the discomfort was increasing, and it became apparent that I was in serious trouble. I could not walk sixty feet without having to stop to catch my breath. 

Sometimes the pain was so severe that I would almost double over in the middle 

of the street. My wife told me later that my face would become gray. And the perspiration would pour off my body. The quality of my life had deteriorated so drastically 

that I knew I needed some treatment. 

In 1988, I went to Georgetown Hospital for an angiogram—the gold standard for 

diagnosing heart problems. After the test, the cardiologist told me that he had bad 

news and worse news. The bad news was that I had a 95 percent blockage in my 

left anterior descending heart artery at the location known as the ‘‘widow-makers 

spot.’’ The worse news was that I had a major chance of suffering a severe heart 

attack, with less than a 5 percent chance of survival because of the HCM. At this 

point, my wife was quietly crying and I was perspiring profusely. 

Because Georgetown Hospital did not have the expertise to operate on my condition, they called the NIH to see if they would accept me as a patient. I was sent 

home pending notice from NIH. I knew that I had run out of alternatives. No matter 

what the results, I needed treatment and I needed it immediately. 

Subsequently, the NIH accepted me. After entering the NHLBI on February 9, my 

surgery occurred on February 11, 1998. No matter how trite the expression, it is 

very true—the day after surgery was the first day of the rest of my life. The surgery, a left ventricular myotomy and myectomy, was considered drastic. I was later 

told that the mortality rate was as high as 10 percent. That surgery is still done 

in only a few hospitals. It is considered the gold standard for the treatment of HCM. 

This Murrow Procedure, in honor of the innovator, was developed and improved at 

the NIH. 

Currently, there is a new experimental protocol in which the same effect is now 

being attempted by using alcohol to deaden the excessive heart tissue, instead of 
490 

removing a piece of heart muscle from the heart’s main pumping chamber, as was 

done in my case. 

Now, I am on medication for the rest of my life. My condition is progressive. More 

than 10 years ago, I was fitted with a pacemaker to ensure that my heart beats 

at the correct rate. I am 100 percent dependent upon my pacemaker. Without the 

pacemaker, there are times when my normal heart beat is so slow that I could die. 

I am eternally grateful to the physicians funded by the NHLBI, particularly to 

Dr. Charles MacIntosh and his staff, for the gift of life. Because of this marvelous 

doctor and research, I have lived eighteen years free of pain. I have seen two children graduate from college, witnessed the birth of three grandchildren, and shared 

these years with a wonderful wife. And, I have been able to work at my profession— 

attorney at law. 

I have had the gift of life restored to me. To express my gratitude for that gift, 

under the aegis of the Mended Hearts, Inc., I visit patients recovering from heart 

episodes at two hospitals: Washington Hospital Center and Washington Adventist 

Hospital. Last year MHI visited more than 228,000 patients and their families in 

our mission of support. We have also made 6,700 visits over the telephone to give 

succor to these patients. 

If this tale of woe is not enough, about 3.5 years ago, I suddenly began to have 

mini-strokes. I experienced five episodes within 13 months. The last episode was 

just a year ago. Medication, including coumadin, now seems to have the incidents 

under control. Coumadin is a blood thinning drug that requires constant monitoring. 

At least once a month, I have to go to the hospital to get blood drawn from my arm 

to check the level of the drug. 

To advance the fight against heart disease and stroke, I respectfully ask for the 

fiscal year 2007 appropriations in the following amounts: 

—National Institutes of Health—$29.8 billion 

—National Heart, Lung, and Blood Institute—$3.1 billion 

—National Institute of Neurological Disorders and Stroke—$1.6 billion. 

My experience and my continued life is proof that the research supported by the 

NIH benefits not just the patients at the Clinical Center, but throughout the United 

States. The benefits go worldwide too. 

Cardiovascular diseases remain the major killer of men and women in the United 

States. Nearly 40 percent of people who die in the United States, die from cardiovascular diseases. From 1979 through 2003, cardiovascular operations and procedures increased 470 percent. 

PREPARED STATEMENT OF THE MONTGOMERY COUNTY (MARYLAND) STROKE

ASSOCIATION

My name is Susan Emery. I am the President of the Montgomery County Stroke 

Association and I am a stroke survivor. 

Our Association conducts education and supports activities for stroke survivors, 

their family members, and caregivers. We serve people in the Maryland suburbs of 

Washington, D.C., and are fortunate to be in the same county as the National Institutes of Health. We have benefited on many occasions by the participation of NIH 

staff members in our membership meetings. They have been generous in sharing 

information with us about their research on stroke prevention and treatment. 

On December 26, 1965, at the age of nine, I was playing a new game with my 

brother and a few friends at the kitchen table. That is the last thing that I remember. I was unconscious for the next two days. My mother first learned, incorrectly, 

that I had spinal meningitis. I was transferred to another hospital where my mother 

was told that I had little chance of survival. Yet, I am here, more than 40 years 

later, and I have survived a stroke. 

People seldom associate strokes with children. These strokes are rare, but they 

do happen. There are about three cases of stroke per year in every 100,000 children 

aged 14 and under. One of the difficulties in dealing with strokes in children is getting the right diagnosis quickly. There are often delays in diagnosis of childhood 

stroke. 

I spent two weeks in the hospital and the subsequent 4 months in intensive physical therapy. My 10th birthday was spent in the hospital, and I have a picture in 

my photo album of myself with my mother and a new friend. My right eye is turned 

down, my mouth is turned down, but I am still smiling. During the 4 months in 

therapy at Holy Cross in Detroit, I learned the basics: how to walk, how to talk, 

and how to move the fingers on my right hand. My mother followed the doctor’s instructions and sent me back to school very quickly, where classmates helped me 

button and unbutton my coat and carry my books, and teachers taped papers to the 
491 

desk so I could learn to write again. I survived that 4 months, and would never wish 

to repeat it. 

I have been in therapy six times in my life. I need to tell you about the one time 

that was the most important to my family. I was 26 years old and had just had 

my first child. I kept her safe, for I knew my limitations. I always used my left hand 

to support her. But when she was 6 months old, she got to be a little heavy, and 

twice, as I was putting her on the floor to change her diaper, my right hand slipped 

from under her buttocks. She fell only inches in both cases and did not even notice. 

But I noticed. I went in for 2 or 3 months of therapy close to Denver, Colorado, 

where I was living at the time. Here, for the first time, they helped my right hand 

and arm dexterity through occupational therapy. I also learned that I had aphasia— 

the inability to speak, write or understand spoken or written language because of 

brain injury—because I called things like fruit baskets ‘‘unicorns’’ instead of cornucopias. Instead of the word being the same, I picked a word that sounded the 

same. The therapists in Colorado worked with my mind and my body and I will forever be in their debt. 

Close to 15 years ago, I made a new life for myself in Maryland. Here, I have 

been an outpatient at the National Rehabilitation Hospital three times: once for my 

right foot, once for my Achilles tendon, and once for my right knee. I have seen numerous physiatrists, all of whom are excellent in their field. I have also seen my 

fair share of therapists. Since I have had therapy on and off for most of my life, 

I can honestly say that the first few times you go in to see a therapist, you will 

come out hurting more than when you went in. But in the long run, they help tremendously. 

On a work related note, I received a Bachelor of Science in 1978 from Michigan 

State University in Computer Science and worked for 12 years in the field. I started 

working in the telecommunications industry in 1990, and got a Master of Science 

from the University of Maryland, University College in Telecommunications Management. I now work for ITT Industries as a senior engineer on a contract supporting the Federal Aviation Administration’s leased telecommunications activities, 

and have worked with the FAA for more than 10 years. I have done more than survive. I have become a productive member of society. 

Stroke research has changed my life. Without the research carried out 40 to 50 

years ago, I would not have benefited from electric shock therapy that made me understand the muscles that move my fingers. Without research done 30 years ago, 

I may not have been able to understand how to exercise my hand for dexterity. 

Without research performed 10 years ago, the people around me would not understand that they need to get me to the hospital quickly if ever I have another stroke. 

Without current support, researchers may never understand how to stop strokes before they happen or how to make current stroke survivors live healthier lives. 

Stroke remains America’s No. 3 killer and a major cause of permanent disability. 

An estimated 5.5 million Americans live with the consequences of stroke and about 

1 in 4 is permanently disabled. Yet, stroke research continues to receive a mere 1 

percent of the National Institutes of Health budget. I strongly urge you to significantly increase funding for the National Institutes of Health-supported stroke research, particularly for National Institute of Neurological Disorders and Stroke-supported stroke research. NIH stroke research is essential to prevent strokes from 

happening to children and adults in the first place, and to advance recovery and 

rehabilitation of those who survive this potentially devastating illness. 

PREPARED STATEMENT OF THE NATIONAL ASSOCIATION OF CHILDREN’S HOSPITALS

The National Association of Children’s Hospitals (N.A.C.H.) is pleased to submit 

a statement for the record in support of the Children’s Hospitals’ Graduate Medical 

Education (CHGME) Program in the Health Resources and Services Administration. 

On behalf of the Nation’s 60 independent children’s teaching hospitals, N.A.C.H. 

very much appreciates Chairman Specter’s and the subcommittee’s early and continuing commitment over many years to provide full, equitable GME funding for 

these hospitals. CHGME seeks to give them a level of Federal support for their 

teaching comparable to what all other teaching hospitals receive from Medicare. 

N.A.C.H. also appreciates the subcommittee’s support for $300 million for fiscal 

year 2006. Ultimately this was reduced to $297 million, or less than level funding, 

due to a 1 percent across-the-board cut in discretionary spending. This marked the 

third consecutive year CHGME was reduced due to across-the-board cuts since Congress first agreed to appropriate $305 million for fiscal year 2004. 

CHGME has been a success. Thanks to the program, Federal GME support to 

children’s hospitals now approaches equity with Medicare GME support to adult 
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hospitals. CHGME has made it possible for children’s hospitals to strengthen their 

training of pediatric providers at a time of national shortages, without having to 

sacrifice clinical or research programs. It has enabled them to have strong financial 

positions, which are essential for their capital intensive missions. For fiscal year 2007, N.A.C.H. respectfully requests $330 million for CHGME 

funding. This amount would make up for erosion in funding over the last three 

years and address the cost of inflation, a critical factor in a program associated with 

both wage-related and medical teaching costs. Full funding would ensure the hospitals will have the resources necessary to train and educate the Nation’s pediatric 

workforce. Given the challenges the subcommittee faces, we hope, at a minimum, 

CHGME can be maintained at level funding and not lose further ground in fiscal 

year 2007. 

N.A.C.H. AND CHILDREN’S HOSPITALS

N.A.C.H. represents more than 130 children’s hospitals. They include independent 

acute care children’s hospitals, children’s hospitals within larger medical centers, 

and independent children’s specialty and rehabilitation hospitals. N.A.C.H. helps its 

members fulfill their missions of clinical care, education, research and advocacy for 

the health and well-being of all children. 

Children’s hospitals are regional and national centers of excellence for children 

with serious and complex conditions. They are centers of biomedical and health 

services research for children and serve as the major training centers for pediatric 

researchers, as well as a significant number of children’s doctors. They also are 

major safety net providers, serving a disproportionate share of children from lowincome families, and they are advocates for the public health of all children. 

Although they represent less than 5 percent of all hospitals in the United States, 

the three major types of children’s hospitals provide 41 percent of the inpatient care 

for all children, 42 percent of the inpatient care for children assisted by Medicaid, 

and the vast majority of hospital care for children with serious conditions such as 

cancer or heart defects. 

BACKGROUND: THE NEED FOR CHGME

While they account for less than 1 percent of all hospitals, independent children’s 

teaching hospitals train nearly 30 percent of all pediatricians, half of all pediatric 

specialists and the majority of pediatric researchers. These hospitals provide required pediatric rotations for many other residents and train more than 4,800 resident full time equivalents annually. Shortages of pediatric specialists across the Nation only heighten the importance of these hospitals. 

Prior to initial funding of the CHGME program for fiscal year 2000, the eligible 

hospitals faced enormous challenges in maintaining their training programs. The increasingly price competitive medical marketplace was resulting in more and more 

payers failing to cover the costs of care, including the costs associated with teaching. 

Because they see few—if any—Medicare patients, independent children’s hospitals 

were essentially left out of Medicare GME funding, which had become the one major 

source of GME financing for other teaching hospitals. Independent children’s hospitals received only 1/200th (or less than 0.5 percent) of the Federal GME support 

that all other teaching hospitals received under Medicare. This lack of GME financing, combined with financial challenges stemming from other missions, threatened 

the hospitals’ teaching programs, as well as other services. 

Safety Net Institutions.—Independent children’s hospitals are a significant part of 

the health care safety net for low-income children. This critical mission puts the 

hospitals at financial risk. In fiscal year 2005, children assisted by Medicaid were, 

on average, more than 50 percent of all discharges from independent acute care children’s hospitals. Yet, Medicaid, on average, paid only 79 percent of costs. Without 

disproportionate share hospital payments, Medicaid would cover, on average, only 

73 percent of costs. Medicaid payment shortfalls for outpatient and physician care 

are even greater. 

Independent children’s hospitals also are essential providers of care for seriously 

and chronically ill children. The hospitals devote more than 75 percent of their care 

to children with one or more chronic or congenital conditions. They provide the majority of inpatient care to children with many serious illnesses—from children with 

cancer or cerebral palsy, for example, to children needing heart surgery or organ 

transplants. In some regions, these children’s hospitals are the only source of pediatric specialty care. The services they must maintain to assure access to high quality, complex care for all children are often inadequately reimbursed. 

Many of the independent children’s hospitals also are a vital part of the emergency and critical care services in their regions. They are part of the emergency re-
493 

sponse system that must be in place for public health emergencies. Expenses associated with preparedness add to their continuing costs in meeting children’s needs. 

Mounting Financial Pressures.—The CHGME program, and its relatively quick 

progress to full funding in fiscal year 2002, came at a critical time. In 1997, when 

Congress first considered establishing CHGME, a growing number of independent 

children’s hospitals had financial losses; many more faced mounting financial pressures. More than 10 percent had negative total margins, more than 20 percent had 

negative operating margins and nearly 60 percent had negative patient care margins. Some of the Nation’s most prominent children’s hospitals were at financial 

risk. Thanks to CHGME, these hospitals have been able to maintain and strengthen 

their training programs. 

Pediatric Workforce Development.—The important role CHGME plays in the continual development of our Nation’s pediatric workforce is not lost on the larger pediatric community, including the American Academy of Pediatrics and Association of 

Medical School Pediatric Department Chairs. They support CHGME and recognize 

it is critical not only to the future of the individual hospitals but also to provision 

of children’s health care and advancements in pediatric medicine overall. 

CONGRESSIONAL RESPONSE

In the absence of movement to broader GME financing reform, Congress authorized the CHGME discretionary grant program in 1999 to address the existing inequity in GME financing for the independent children’s hospitals. The legislation 

was reauthorized in 2000, through fiscal year 2005, and provided $285 million for 

fiscal year 2001 and ‘‘such sums as necessary’’ in the years beyond. Congress passed 

the initial authorization as part of the ‘‘Healthcare Research and Quality Act of 

1999’’ and the reauthorization as part of the ‘‘Children’s Health Act of 2000.’’ 

With this subcommittee’s support, Congress appropriated initial funding for 

CHGME in fiscal year 2000, before the enactment of the program’s authorization. 

Following enactment, Congress moved substantially toward full funding for the program in fiscal year 2001 and completed that goal, providing $285 million in fiscal 

year 2002. Subsequently, Congress appropriated $290 million in fiscal year 2003, 

$303 million in fiscal year 2004, $301 million in fiscal year 2005, and $297 million 

in fiscal year 2006. (In the last three years, the funding levels are net of acrossthe-board cuts in discretionary funding.) 

Health Resources and Services Administration (HRSA).—CHGME funding is distributed through HRSA to 60 children’s hospitals according to a formula based on 

the number and type of full-time equivalent residents trained, in accordance with 

Medicare rules, as well as the complexity of care and intensity of teaching the hospitals provide. Consistent with the authorizing legislation, HRSA allocates the annual appropriation in biweekly periodic payments to eligible independent children’s 

hospitals. 

‘‘Adequate’’ Rating from Administration.—The Office of Management and Budget 

gave CHGME an ‘‘adequate’’ rating in 2003, using its Program Assessment Rating 

Tool (PART). The PART review found CHGME has a ‘‘clear purpose,’’ is ‘‘effectively 

targeted,’’ has specific ‘‘long-term performance measures’’ that focus on outcomes, 

and holds grantees ‘‘accountable for cost, schedule, and performance results.’’ 

CHGME SUCCESS

The annual CHGME appropriation represents an extraordinary achievement for 

the future of children’s health and the Nation’s independent children’s teaching hospitals: 

—Thanks to CHGME, the Federal Government has made substantial progress in 

providing more equitable Federal GME support to independent children’s hospitals. The hospitals now receive about 80 percent of the level of Federal GME 

support that Medicare provides to other teaching hospitals. This is still not true 

equity, but it is dramatic improvement from the 0.5 percent of 1998. 

—As a result of CHGME, children’s hospitals have been able to make a substantial improvement in their contribution to the Nation’s pediatric workforce, without having to sacrifice their clinical or research missions. From 2000 to 2004, 

without the CHGME hospitals being able to increase the numbers of general 

pediatric residents they trained, the Nation would have experienced a net decline in number of new pediatricians. During the same time, CHGME hospitals 

accounted for more than 80 percent of new pediatric subspecialty programs and 

more than 60 percent of the new pediatric subspecialists trained. 

—CHGME has allowed children’s hospitals to achieve strong financial positions. 

According to Moody’s, before 2000, children’s hospitals tended to have negative 
494 

to break-even financial margins. Since then, their margins have improved. 

CHGME is a major reason. 

FISCAL YEAR 2007 REQUEST

N.A.C.H. respectfully requests that the subcommittee provide equitable GME funding for independent children’s hospitals by providing $330 million in fiscal year 

2007. Such funding is particularly important for a program that has wage-related 

and medical teaching costs and has experienced three years of successive reductions 

due to across-the-board cuts. Given the challenges the subcommittee faces, we hope 

CHGME at least can be maintained at level funding and not lose further ground 

in fiscal year 2007. 

Adequate, equitable funding for CHGME is an ongoing need. Children’s hospitals 

continue to train new pediatric residents and researchers every year. Children’s hospitals have appreciated very much the support they have received, including the attainment of the program’s authorized full funding level in fiscal year 2002 and continuation of full funding with an inflation adjustment in fiscal year 2003 and fiscal 

year 2004. Congress can regain this progress by providing $330 million in fiscal year 

2007. 

Continuing equitable CHGME funding is more important than ever in light of 

budget shortfalls in many States and pressures for significant reductions in State 

Medicaid spending. Because children’s hospitals devote such a substantial portion 

of their care to children from low-income families, they are especially affected by 

cutbacks in State Medicaid programs. 

Support for a strong investment in GME at independent children’s teaching hospitals is also consistent with the repeated concern the subcommittee has expressed 

for the health and well-being of our Nation’s children, through education, health and 

social welfare programs. And it is consistent with the subcommittee’s repeated emphasis on the importance of enhanced investment in the National Institutes of 

Health (NIH) and in NIH support for pediatric research in particular, for which 

N.A.C.H. is grateful. 

CHGME funding is essential to the ability of the independent children’s hospitals 

to sustain their GME programs. At the same time, the program enables them to do 

so without sacrificing support for other critically important services that also rely 

on hospital subsidy, such as specialty and critical care services, child abuse prevention and treatment services, poison control centers, services to low-income children 

with inadequate or no coverage, mental health and dental services, and community 

advocacy, such as immunization and motor vehicle safety campaigns. 

CONCLUSION

In conclusion, CHGME is a success. The program is an invaluable investment in 

children’s health. The future of the pediatric workforce and children’s access to quality pediatric care, including specialty and critical care services, depend upon 

CHGME. N.A.C.H. and the independent children’s teaching hospitals are deeply 

grateful to the Chairman and subcommittee for your continuing leadership on behalf 

of children’s hospitals. 

PREPARED STATEMENT OF THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH

OFFICIALS

SUMMARY

The proposed cuts in the fiscal year 2007 budget for the Centers for Disease Control and Prevention (CDC) continue a pattern of reduced funding for public health 

that gravely worries the Nation’s local health departments. The National Association of County and City Health Officials (NACCHO) is particularly concerned about 

two funding streams that directly benefit local health departments, although the 

range of reductions in CDC’s budget threaten overall work in prevention that we 

fully support. 

Last year, funding for State and local bioterrorism and public health preparedness 

was cut by $95 million, more than 10 percent. NACCHO understands that this will 

result in a cut of about 12 percent in the cooperative agreement funding that goes 

directly to States and four large cities. The Preventive Health and Health Services 

block grant program, the other major source of CDC funding to local health departments, was cut by $19 million, which was 16 percent below the actual fiscal year 

2005 funding made available to grantees, and almost 25 percent below the fiscal 

year 2005 appropriated amount. The fiscal year 2007 budget freezes preparedness 

funds and eliminates the block grant. Taken together, these reductions will seri-
495 

ously compromise the ability of the Nation’s governmental public health system to 

fulfill its mission of protecting and promoting health. 

Local public health departments work every day on the front lines to combat 

threats to the health of their communities. They can ill afford substantial reductions 

in Federal support for their roles as first responders to bioterrorism and other public health emergencies. Moreover, local public health departments receive about 40 

percent of the Preventive Health and Health Services block grant (PHHS) funds. 

These enable them to carry out programs ranging from prevention of heart attack 

and stroke to combating West Nile virus. In States where local health departments 

rely exclusively on these funds to run prevention programs activities to reduce the 

burdens of preventable disease will cease. 

At a time when the Nation is engaged in urgent work to protect the homeland 

from terrorists and natural disasters, as well as to stop an epidemic of obesity, it 

is profoundly counterproductive and irrational to reduce support for local programs 

that are the first line of defense against the greatest threats to the health of communities. NACCHO urges Congress to continue funding these two CDC programs 

at levels no less than those in fiscal year 2005. Those levels are $927 million for 

State and local bioterrorism preparedness and $131 million for the Preventive 

Health and Health Services block grant. 

STRENGTHENING THE GOVERNMENTAL PUBLIC HEALTH SYSTEM TO IMPROVE HOMELAND

SECURITY REQUIRES SUSTAINED FUNDING

Congress recognized in 1997 an unmet need to strengthen the Nation’s capacity 

to respond to an act of bioterrorism and initiated funding for bioterrorism preparedness in fiscal year 1999. The initial funding of about $121 million (which included 

$51 million solely for stockpiling medications) assisted CDC and State and local 

health departments to begin examining what plans and resources were necessary. 

After 9/11 and the anthrax outbreaks in the fall of 2001, Congress increased bioterrorism funding markedly and included $940 million for building State and local capacities, of which about $870 million was actually made available to States and localities. The Department of Health and Human Services got these funds out to 

States and three large cities via cooperative agreements very promptly, far ahead 

of other homeland security funds for States and localities. 

Substantial bioterrorism preparedness funds for improving all aspects of preparedness have actually been in the hands of State health departments since August 2002. Local public health departments, many of which have been funded for 

less time, are justifiably proud of the progress they have made. 

Extensive response plans, developed in collaboration with local emergency management systems, have been made. Numerous ‘‘tabletop’’ and real field exercises 

have tested local capabilities. Mass vaccination clinics have taken place, some as 

part of a real response to flu vaccine shortages. Communications systems and equipment that enable rapid electronic information exchange among and by health departments to their communities are operational. Improved systems for disease detection are in place. 

Local health departments have engaged hospitals, physicians, and others in the 

private sector to develop further their roles in responding to a serious disease outbreak. Complex logistical arrangements needed to distribute medications or equipment from the Strategic National Stockpile to stricken populations have been developed. 

In some locations, genuine public health crises, such as flu vaccine shortages or 

an influx of evacuees from the Gulf Coast in the wake of Katrina, have demanded 

a response. In the act of responding, local health departments and their community 

partners continually identify new challenges and new ways to improve their ability 

to respond. Improving a locality’s ability to detect a disease outbreak promptly and 

to contain it swiftly is a continuous process of training, exercising, and improving 

plans based on these exercises. Interrupting that process through funding cuts 

would take the Nation’s public health preparedness backwards, not forward. New 

capacities that are now in place cannot be sustained without sustained funding. 

Congress appropriated supplemental funding of $350 million to assist States and 

localities in pandemic influenza preparedness. These funds are greatly appreciated, 

but they cannot fill the gaps left by other funding cuts. The narrow range of activities permitted by CDC’s grant guidance for the first $100 million now available to 

States adds to the tasks required of health departments, but the sums available are 

insufficient to enable hiring new personnel to carry them out. Moreover, the production and exercise of plans for any biological event, including pandemic influenza, is 

never a one-time activity. Meaningful progress requires a continuous process of 

training, exercising and improvement that involves not merely public health re-
496 

sponders, but all community partners that are part of any response, including law 

enforcement, emergency management, hospitals, schools, and a host of private sector partners. 

The Nation has a long way to go before every citizen enjoys the best possible protection by disease detection and response systems that work as quickly as humanly 

possible. Providing this protection is the job of the governmental public health system. No other entity can do it. NACCHO urges Congress to reverse the cuts in funds 

available to local public health departments, the Nation’s first responders to bioterrorism. 

THE PHHS BLOCK GRANT IS A LINCHPIN FOR PREVENTION

Local public health departments receive approximately 40 percent of the Preventive Health and Health Services block grants nationally. The proportion varies 

among States from less than 5 percent to almost 100 percent. The block grant funds 

fulfill three critical purposes. First, they enable States to address critical unmet 

public health needs. The coexistence of other Federal categorical public health funds 

does not mean that sufficient funds are available to address all public health needs. 

They are not. Improving chronic disease prevention through screening programs and 

programs that promote healthy nutrition and physical activity are prime examples 

of activities to which many jurisdictions devote PHHS funds. Forty percent of fiscal 

year 2004 block grant funds were spent on chronic disease prevention, including 

prevention of obesity, stroke, heart disease, cancer, diabetes, and dental caries. 

Second, PHHS funds provide some flexible funding to address unexpected problems or problems unique to a particular geographic area. West Nile virus, a fully 

preventable disease spread to humans by mosquitoes, is one good example. Third, 

PHHS fund provide leverage for more funds and in-kind resources from non-Federal 

sources. In one southern State, local health departments collectively used $2.77 million in block grant funds to establish new prevention programs and generate $5 million in additional resources for those programs. 

States are fully accountable to the Department of Health and Human Services for 

their expenditures of block grant funds and must report how much money they 

spend by specific program area. In those States where local health departments receive a significant amount of PHHS funds from the State, local prevention efforts 

will diminish. Local and State health departments are key leaders and providers of 

population-based prevention programs. They work to keep prevention in the public 

eye and build on programs that have been proven effective in reducing disease and 

preventing premature death. As health care costs escalate, reducing the Nation’s 

commitment to prevention by eliminating the PHHS block grant, weakening state 

and local public health departments, is unwise and uneconomic. 

The National Association of County and City Health Officials (NACCHO) is the 

organization representing the almost 3,000 local public health departments in the 

United States. 

PREPARED STATEMENT OF THE NATIONAL COALITION FOR OSTEOPOROSIS AND

RELATED BONE DISEASES

The National Coalition for Osteoporosis and Related Bone Diseases (Bone Coalition) is pleased to comment on the fiscal year 2007 budget for the National Institutes of Health (NIH) as it relates to bone research. The Federal investment made 

to date goes a long way towards improving the bone health of our citizens and we 

are appreciative of the Committee’s leadership over the years. We also congratulate 

the Committee for recognizing the complexities of the issues in the bone field and 

including language in the fiscal year 2006 committee report directing the NIH to 

establish a ‘‘Bone Health Research Blueprint.’’ 

The recent Surgeon General’s Report on bone health and osteoporosis illustrates 

the large burden that bone disease places on our Nation and its citizens. The Bone 

Coalition is committed to reducing the impact of bone diseases through expanded 

basic, clinical, epidemiological and behavioral research and through education leading to improvement in patient care. The Coalition participants are leading national 

bone disease organizations—the American Society for Bone and Mineral Research, 

the National Osteoporosis Foundation, the Osteogenesis Imperfecta Foundation, and 

the Paget Foundation for Paget’s Disease of Bone. 

Bone diseases such as osteoporosis, osteogenesis imperfecta, and Paget’s disease 

of bone pose a significant public health and economic challenge. 

—Osteoporosis.—Is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility 

to fractures of the hip, spine, and wrist. It remains widespread across all popu-
497 

lations. This is due to several factors, such as the aging of our population, the 

prevalence of secondary osteoporosis, and low bone mass that is common in immobilized patients and nursing home populations. Secondary osteoporosis, resulting from numerous chronic medical conditions and the long-term use of 

many medications, causes osteoporosis and related fractures in children, adolescents, and young adults. Over 10 million Americans have osteoporosis, the majority of whom (80 percent) are women, and 34 million more have low bone 

mass, placing them at increased risk for this disease. One out of every two 

women and one in four men over 50 will have an osteoporosis-related fracture 

in her/his lifetime. Osteoporosis is responsible for more than 1.5 million fractures annually, and mortality and morbidity following both spine and hip fractures is high when compared to unaffected peers. The estimated national direct 

expenditures for osteoporosis and related fractures total $18 billion (2002 dollars) each year. 

—Paget’s Disease of Bone.—The second most prevalent bone disease after 

osteoporosis—is a chronic skeletal disorder that may result in enlarged or deformed bones in one or more regions of the skeleton. Excessive bone breakdown 

and formation can result in bone that is dense, but fragile. Complications may 

include arthritis, fractures, bowing of limbs, neurological complications, and 

hearing loss if the disease affects the skull. Prevalence in the population ranges 

from 1.5 percent to 8 percent depending on the person’s age and geographical 

location. Paget’s disease primarily affects people over 50. 

—Osteogenesis Imperfecta (OI).—Causes brittle bones that break easily due to a 

problem with collagen production. For example, a cough or sneeze can break a 

rib, rolling over can break a leg. Besides fragile bones, people with OI may have 

hearing loss, brittle teeth, short stature, skeletal deformities, and respiratory 

difficulties. OI affects between 20,000 to 50,000 Americans. In severe cases fractures occur before and during birth. In some cases, an affected child can suffer 

repeated fractures before a diagnosis can be made. Undiagnosed OI may result 

in accusations of child abuse. 

—Cancer Metastasis to Bone.—A frequent complication of cancer is its spread to 

bone (bone metastasis) that occurs in up to 80 percent of patients with 

myeloma, 70 percent of patients with either breast or prostate cancer, and 15 

to 30 percent of patients with lung, colon, stomach, bladder, uterine, rectal, and 

renal cancer causing severe bone pain and pathologic fractures. Only 20 percent 

of breast cancer patients and 5 percent of lung cancer patients survive more 

than 5 years after discovery of bone metastasis. 

According to Dr. Zerhouni, ‘‘. . . we are facing great challenges in [the area of 

bone research]: an aging population at increasing risk for bone problems; the attendant costs of bone disease, both in human and financial terms; and the need for more 

physician-scientists to continue the important work of discovery, treatment, and prevention.’’ 

Bone diseases take many forms and cause complications such as fractures, chronic 

pain, hearing loss, brittle teeth, respiratory difficulties, bone metastasis from cancer, 

and neurological complications that reduce people’s quality of life and cost society 

billions of dollars. These challenges in bone research cut across numerous institutes/ 

centers at the National Institutes of Health. They traverse the focus of individual 

Institutes and require an interdisciplinary scientific approach. 

At the NIH, as part of the Roadmap Initiative, a series of awards have been established that will make it easier for scientists to conduct interdisciplinary research 

and an Office of Portfolio Analysis and Strategic Initiatives has been established to 

coordinate trans-NIH initiatives. The health problems in the bone field require new 

approaches. We believe these new efforts will remove obstacles to scientific progress 

and better coordinate the discoveries of tomorrow. 

NIH-supported research in bone health has led to important discoveries and has 

generated new treatments and pharmaceutical products. It must be recognized that 

new discoveries and breakthroughs could come from any areas of biomedical research and could result in new treatments and eventually a cure for bone diseases. 

—Research has taught us that those with low bone mass are at risk for 

osteoporosis. These individuals can then address their risk with exercise, diet, 

other behavioral and lifestyle changes, and medication. 

—Research has decreased fracture risk and extended the lifespan to normal for 

people with OI. 

—Research has identified drugs which improve the quality of life of people whose 

cancer has metastasized to bone. 

—Research has led us to develop simple, non-invasive and accurate tests that can 

determine bone mass and help predict fracture risk. 
498 

—Research has identified and demonstrated a variety of drugs that can reduce 

bone loss and fractures, and even build new bone. Thirty years ago, there was 

no treatment for osteoporosis. 

—Research has helped us to understand the need for weight-bearing exercise to 

build and maintain bone in order to reduce fracture risk. Falling can be reduced 

by strength-building exercise that increases balance and flexibility. 

But much remains to be done. A concentrated effort is required to address bone 

health. The Coalition is particularly interested in NIH support for the following in 

fiscal year 2007: 

—Research is needed into the pathophysiology of bone loss in varied populations 

and in targeted therapies to improve bone density and bone quality according 

to the etiology of osteoporosis. In addition research is needed to identify patients at risk for fracture who do not meet current criteria for osteoporosis, as 

well as to study the effects of available and developing osteoporosis treatments 

on the reduction of fracture risk in these patients. 

—NCI, NIAMS, NIA and NIDDK must support research to determine mechanisms and to identify, block and treat cancer metastasis to bone. Furthermore, 

NCI must expand research on osteosarcoma to improve survival and quality of 

life and to prevent metastatic osteosarcoma in children and teenagers who develop this cancer. 

—Although bone mineral density has been a useful predictor of susceptibility to 

fracture, other properties of the skeleton contribute to bone strength, including 

mechanical loading (exercise) and mechanisms of biomineralization. However, at 

this time little is understood as to how these properties assist in the maintenance of bone strength. Support of this research by NIA, NIAMS, NIBIB, 

NICHD, NIDDK, and NHLB will achieve identification of these parameters and 

lead to better prediction for prevention and treatment of bone diseases such as 

osteoporosis, osteogenesis imperfecta, bone loss due to kidney disease, and heart 

attacks due to hardening of the arteries. 

—Thousands of children and adolescents nationwide suffer from musculoskeletal 

disorders and malformations, many of which have devastating effects on mortality and disability. NIAMS and NICHD must support research focusing on 

mechanisms of preventing fractures and improving bone quality and correcting 

malformations, on innovations in surgical and non-surgical approaches to treatment, and on physical factors that affect growth. 

—Diseases such as osteogenesis imperfecta, fibrous dysplasia, osteopetrosis, and 

Paget’s disease are caused by poorly understood genetic mutations. In Paget’s 

disease, underlying genetic defects can also be exacerbated by environmental 

factors. NIAMS, NICHD, NIDCR, and NIDDK must support research on genetic 

defects that cause bone disease. 

—57.9 million Americans are injured annually, more than one-half incur injuries 

to the musculoskeletal system. In the United States, back pain is a major reason listed for lost time from work and sports injuries are increasing in ‘‘weekend 

warriors’’ of both sexes. NIAMS, NIA, and NCCAM must study ways to better 

understand the epidemiology of back pain, improve on existing diagnostic techniques for back pain, as well as to develop new ones. NIAMS, NIBIB, NIDDK 

and NIA must expand research to improve diagnostic and therapeutic approaches to significantly lower the impact of musculoskeletal traumas, and on 

research on accelerated fracture healing, the use of biochemical or physical bone 

stimulation, and bone substitutes such as hydroxyapatite and allogeneic tissues. 

To move this research forward, Congress must provide sufficient funding to the 

National Institutes of Health to sustain the robust research atmosphere in which 

to address the challenges in the bone field. The revolution in genetics/genomics that 

has provided new tools and databases and the powerful new imaging devices must 

not be hindered. Research must continue to be accelerated in order to improve the 

health of the Nation. 

RECOMMENDATIONS

The National Coalition for Osteoporosis and Related Bone Diseases supports a 5 

percent increase for the National Institutes of Health (above the fiscal year 2006 

funding level), as recommended by the Ad Hoc Group for Medical Research, along 

with the National Health Council, the Campaign for Medical Research and Research!America. 

The recent Surgeon General’s Report on bone health and osteoporosis illustrates 

the large burden that bone disease places on our Nation and its citizens. We support 

the establishment of a ‘‘Bone Health Research Blueprint’’ to address the need for 

interdisciplinary approaches to research and increased coordination of research ef-
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forts. We believe that more deliberately integrated activities in the areas of bone 

research at NIH and at extramural institutions will move our science more rapidly 

to discoveries that will preserve health and cure disease. 

Thank you for the opportunity to submit our statement regarding the fiscal year 

2007 budget for the National Institutes of Health. 

PREPARED STATEMENT OF THE NATIONAL COMMUNITY ACTION FOUNDATION

REQUESTING LEVEL FUNDING FOR THE FISCAL YEAR 2007 COMMUNITY SERVICES BLOCK

GRANT, LIHEAP, AND HEAD START PROGRAMS

I first want to convey the deep gratitude of every one of the Nation’s 1,100 Community Action Agencies to Chairman Specter and Senator Harkin for their leadership in amending the Budget Resolution to preserve critical domestic programs. 

We are requesting that the subcommittee go forward with the Chairman’s original 

intent of restoring all the programs that are reduced or eliminated by the President’s 2007 budget request. This remains the correct priority in light of the extreme 

and, in our opinion, destructive constraints placed on all domestic discretionary 

spending. Of course, this one-year policy is no substitute for a renaissance of investment in healthy children, in the workforce of tomorrow, in the health of the public, 

and in the science that will sharpen America’s competitive edge in 21st century 

trade. 

The following facts on the threat to Community Action’s top priority programs— 

CSBG, Head Start and LIHEAP—will indicate how important to Community Action 

are the strategic decisions facing the subcommittee. 

The Community Service Block Grant (CSBG) is the funding that underwrites the 

unique assignment of CAAs: their responsibility to convene local leadership to make 

a plan with the low-income community that implements a mix of strategies to bring 

in new investment and social resources. CAAs sustain their communities’ long-term 

commitment to expand access to new opportunities for their residents who need to 

become more productive and more self-sufficient. Fifty two Senators have written 

the subcommittee opposing the President’s request. 

If CSBG is reduced or eliminated, important community institutions will be lost. 

In Pennsylvania: 

—Mercer County’s Weed & Seed Community Revitalization effort, Micro-enterprise Development project that makes small business owners out of former lowincome workers and the Elm Street revitalization project will cease. 

—That CAA would also end its sponsorship of three HUD projects (22 units) 

which are home to special needs populations; those precious subsidized apartments will be rented out at ‘‘fair market value’’. 

—In Venango and Crawford Counties services in the areas of youth development, 

supportive housing services, and education would be eliminated. 

—The Pittsburgh and Philadelphia CAAs would close, their services absorbed into 

a variety of city government departments; 

—Outreach Centers across the State’s rural areas would be shuttered. 

In Iowa, eliminating CSBG means: 

—91 outreach centers will close; these are the local offices where programs operate, meet both those in need and offer the entire community space for groups 

working on local betterment. 

—The same will befall dozens of food pantries supported by CAA warehouses, 

storage and trucking in which Churches and other volunteers participate. 

—633 homeless children in the Hawkeye area will have no preventive screenings. 

—117 elderly individuals around Davenport will lose the chore assistance services 

that have allowed them to remain in their own homes. 

—In Des Moines the vast community gardens project will shut down and three 

thrift stores the low-income community depends on will close; 

—In Dubuque, the financial literacy education initiative will end. 

Even more ominous is the prospect that no future partnerships or new initiatives 

will be imagined and developed; in the past two years, CAAs across America have 

used their CSBG as the flexible ‘‘venture capital’’ that supports the efforts to develop partnerships, plan projects, and raise and package resources. Among the results that are permanently changing their communities are: numerous dental clinics, housing developments, job creation projects, energy services for all the community, and clean water supply facilities. CAAs have developed and improved communities with permanent investments such as these for four decades. Ending CSBG 

dams up the stream of emerging community infrastructure and services and cuts 
500 

the ties that keep public-private local partnerships that coordinate their resources 

to change local conditions. 

CAAs serve one-third of the Head Start and Early Head Start participants.—The 

requirements for program quality have increased as science’s knowledge of early 

childhood; the expectations for the depth and number of services and professional 

care are high. The staff cannot receive cost of living increases, much less the salaries their skills merit, without reductions in enrollment. The threat to children’s 

hard won gains grows with each reduction. CAAs will be forced to deny places to 

6,300 of the 19,000 qualified children that are anticipated to go unserved under a 

freeze in fiscal year 2007 Head Start funding. 

Finally, LIHEAP must be maintained at least at its current level.—This year the 

Congress, led by the Senate with many Members of this subcommittee in the vanguard, at last got LIHEAP right. 

The $3.1 billion the Chairman and Ranking Member supported for the fiscal year 

2006 program is desperately needed. We have surveyed our member agencies who, 

collectively, deliver more than a third of the LIHEAP program nationwide. They are 

confident that, in spite of the late start, all the new resources will be distributed 

either to consumers who where shut out of the first round of assistance or to participants whose initial benefits were too low to buy them more than a few short weeks 

worth of fuel. 

The ‘‘Sunbelt’’ programs that nearly doubled their initial grants when the supplemental funds were appropriated are making especially speedy and good use of the 

resources they have long needed. It is surprising, but true, that low-income consumers in Florida, the Gulf Coast States and the Southwest spend nearly as high 

a percentage of their income on energy bills as do Midwesterners. That is just one 

reason it is essential that most of 2007 LIHEAP funds be distributed according to 

the statutory formula, as is the case with the fiscal year 2006 funding. 

Further, the only good reason for a large contingency fund is to correct for the 

extreme effects of the formula factors that deny the cold States a fair share of appropriations above $2 billion. A presidential contingency reserve for crises should 

only be an amount sufficient to meet an unpredicted need—such as a major natural 

disaster—during the period of awaiting major supplemental emergency legislation. 

Winter and Summer do not qualify as unexpected events; neither do high prices. 

The level and timing of program funding cannot be abandoned to Presidential politics. 

The Department of Energy predicted on April 11 that 2007 home fuel prices will 

essentially remain at this year’s record levels.(EIA Short-term Energy Outlook) Last 

year, its April prediction for prices in normal 2005–06 winter weather turned out 

to be about 10 percent under the prices we faced in this unusually mild winter. Next 

winter, the energy markets will afford no relief for struggling LIHEAP-eligible customers. LIHEAP must, at least, be sustained. 

Community Action will be beside and behind this subcommittee’s fight for a fair 

budget for America’s priorities in every way possible in every part of this Nation. 

Thank you for considering these views and for your strategic and moral leadership. 

PREPARED STATEMENT OF THE NATIONAL AHEC ORGANIZATION

SUMMARY OF FISCAL YEAR 2007 RECOMMENDATIONS: 

1. Increase funding for the Health Professions and Nursing Education programs 

under Title VII and Title VIII of the Public Health Service Act to at least $550 million for fiscal year 2007. 

2. Restore funding for area Health Education Centers (AHECs) to the fiscal year 

2003 level of $33.141 million. 

3. Restore funding for the Health Education Training Centers to the fiscal year 

2003 level of $4.371 million. 

Mr. Chairman, and members of the subcommittee, I am pleased to present testimony on behalf of the National Area Health Education Centers Organization (NAO). 

NAO is the professional organization representing the Area Health Education Centers (AHECs) and the Health Education Training Centers (HETCs). 

I am Kathleen Vasquez, director of the Ohio Statewide AHEC program, director 

of the Medical University of Ohio’s AHEC program, and the co-chair of the National 

AHEC Organization (NAO)’s Public Policy Committee. 

AHECs develop and support the community based training of health professions 

students, particularly in underserved rural and urban areas. They also provide continuing education and other services that improve the quality of community-based 

health care. HETCs use the infrastructure of the AHECs to address the needs of 
501 

diverse populations with persistent and severe unmet health needs. In 5 border and 

6 non-border States, HETCs train and support Community Health Workers to provide health information and services in their communities. Last year alone HETCs 

provided the initial training and continuing education for over 5,000 Community 

Health Workers. 

Since 1980, the Ohio AHEC program has played a vital part in training the 

State’s healthcare workforce. Through a community-based education infrastructure, 

the delivery of direct patient care is expanded and a pipeline of professionals is 

maintained to provide future care. That pipeline of future professionals who will go 

on to practice in rural and underserved areas is maintained through collaborative 

partnerships with community health centers (CHCs) and the National Health Service Corps (NHSC). These partnerships allow the AHECs to help the Nation’s health 

professions workforce to address timely issues such as bioterrorism, flu prevention 

and the nursing shortage. 

COMMUNITY HEALTH CENTERS AND THE NATIONAL HEALTH SERVICE CORPS

Community Health Centers are dedicated to providing preventive and ambulatory 

health care to the most uninsured and underinsured populations by placing pointof-service facilities in these areas. A March 2006 study published in the Journal of 

the American Medical Association (JAMA) found that community health centers report high percentages of provider vacancies, including an insufficient supply of dentists, pharmacists, pediatricians, family physicians, and registered nurses. These 

shortages are especially pronounced in rural community health centers. Because 

Title VII programs (including AHECs and HETCs) have a successful record of training providers who work in underserved areas, the study recommends increased support for Title VII as the primary means of alleviating the health professions shortage in rural areas. The article serves as an important reminder that the success of 

CHCs is highly dependent upon a well-trained clinical staff to provide care. 

The Ohio AHEC program has worked closely with Community Health Centers to 

promote and support their complementary missions through the co-sponsorship of 

educational programs, the development of clinical training sites, and the recruitment of talented students. The Ohio AHEC program places students in rotations at 

Community Health Centers all over the State. For example, the Northeast Ohio 

AHEC places nursing, nutrition, and health education students in rotations at the 

Health and Dental Centers of Community Action Agency of Coloumbiana County. 

The Summit Portage AHEC places third year medical students in an ‘‘exploratory 

experience’’ elective with the Akron Community Health Resources. Other medical 

students are placed at the Ohio North East System, which has three Community 

Health Centers in Youngstown, Warren, and Alliance. The AHECs affiliated with 

the Medical University of Ohio place students at the expansion community health 

center in Lima as well as at the only designated migrant health center in Ohio, 

Community Health Services in rural Fremont. A network of over 500 physicians volunteer their time to teach the students at these Community Health Centers along 

with students placed in other underserved and rural areas of the State. 

Through another partnership with the Ohio Primary Care Association (OPCA), 

Ohio AHECs organized a statewide health literacy and diabetes conference, with accompanying health literacy train-the-trainer components. Through this type of 

train- the- trainer education, Ohio AHECs have maximized limited resources to 

build capacity to continue providing education beyond the initial offering. Many of 

the participants in this health literacy and diabetes conference worked at a Community Health Center. 

The leadership of the Community Health Centers and the AHECs in Ohio often 

work closely together. I, as the Director of the Ohio Statewide AHEC program, serve 

on the board of a Community Health Center. The Executive Director of that same 

Community Health Center serves on the board of the Sandusky AHEC. And the Executive Director of the Health and Dental Centers of Community Action Agency of 

Columbiana County is a member of the Eastern Ohio AHEC Board. These partnerships allow the AHEC program to help Community Health Centers in Ohio to recruit, train, and retain well-qualified health professionals who are passionate about 

serving in a rural or otherwise underserved area. 

AHECs also undertake a variety of programs related to the placement and support of National Health Service Corps (NHSC) scholars and loan repayment recipients. The Ohio AHEC is a contractor of the NHSC ‘‘SEARCH’’ program. The 

AHECs, in collaboration with the Ohio Academy of Family Practice and the Ohio 

Department of Health, annually recruit 70 students, develop training sites, monitor 

placements and advise on individual community projects. These students will gain 
502 

experience and exposure to practice in rural, underserved and especially community 

health center sites throughout the State. 

BIOTERRORISM AND FLU PREVENTION

Ohio AHECs provide nearly 400 continuing education programs, which are attended by 11,000 practicing professionals. These providers do not have to leave their 

communities or arrange coverage in order to attend these programs, because the 

programs are brought to them in their local communities. The topics of continuing 

education programs are determined by the needs of the practitioners in the community, so timely topics such as avian flu and bioterrorism have been recently provided. 

Ohio AHECs have stepped in to provide health professionals with the latest updates on surveillance, reporting, risk communication, treatment, and other responses to the threat of bioterrorism. In rural areas of the State, AHECs bring in 

downlinks and sponsor bioterrorism preparedness programs. Ohio AHECs have provided preparedness training for clinicians at the Community Health Centers, and 

also provided train- the- trainer education programs at 4 regional locations. In addition, some of our sister AHEC programs are already heavily involved in public education for flu prevention. 

NURSING SHORTAGE

Contrary to what may be commonly understood, persistent and severe shortages 

exist in a number of health professions. Chronic shortages exist for all health professions in many of our Nation’s underserved communities, and substantial shortages 

exist in all communities for some high-need professions such as nursing. 

Historically, the supply of and demand for health care professionals has waxed 

and waned in a manner that produced cycles of shortage and excess. However, it 

is reasonable to believe that the current shortages are of a different and more persistent nature. First, the breadth and depth of shortages are greater than at any 

time in the past. More disciplines are in short supply, more sites of care (hospitals, 

nursing homes, home care agencies, and clinics) are experiencing shortages, and the 

duration of vacancies is longer. Second, the demand for health care services is steadily and inexorably increasing due to the aging population and the advances in medical technology. Third, the health care provider population is aging itself. Fourth, 

the resources with which the health care industry might respond to shortages are 

inadequate. Due to the squeeze of managed care, provider institutions are unable 

to increase salaries, and due to cuts in government funding, educational institutions 

are unable to expand class sizes. Finally, the career opportunities available to 

women, who historically have dominated the nursing profession, have expanded 

greatly. 

Currently, AHECs and HETCs are working with schools of nursing, State nursing 

associations, Community Health Centers, and the National Health Service Corps, to 

increase the number of qualified applicants to nursing schools, increase minority enrollment in nursing schools, expand the number of community-based nursing training sites, and retrain nurses who wish to re-enter the profession. 

JUSTIFICATION FOR FUNDING RECOMMENDATIONS

Mr. Chairman, I respectfully ask the subcommittee to support our recommendations to increase funding for the health professions and nursing education programs 

under Title VII and Title VIII of the Public Health Act to at least $550 million for 

fiscal year 2007. Our recommendations are consistent with those of the Health Professions and Nursing Education Coalition (HPNEC). 56 of your colleagues (led by 

Senators Reed and Roberts), signed a letter to the subcommittee, stating that restoring funding to Title VII health professions programs is vital to reversing health professions shortages in the Nation’s neediest communities. 

Two of the Title VII programs, AHECs and HETCs, improve access to primary 

and preventive care through community partnerships, linking the resources of academic health centers with local communities. AHECs and HETCs have proven to 

be responsive and efficient models for addressing an ever-changing variety of community health issues, including bioterrorism, flu prevention, and the nursing shortage. In order to continue this potential, additional Federal investment is required. 

We request that in fiscal year 2007 you restore funding to the fiscal year 2003 levels 

of $33.141 million for AHECs, and $4.371 million for HETCs. 
503 

PREPARED STATEMENT OF THE NATIONAL COALITION FOR HEART AND STROKE

RESEARCH

My name is Jack Owen Wood. I solicit your support for more aggressive Federal 

funding for research into prevention and treatment of the sister diseases, stroke and 

heart disease. Strokes and heart attacks are occurring at an alarming rate. 

I am representing the National Coalition for Heart and Stroke Research. The coalition consists of 18 national organizations representing more than 5 million volunteers and members united in support for increased funding for heart and stroke research. Members of the Coalition include: American Academy of Neurology; American Academy of Physical Medicine and Rehabilitation; American Association of 

Neurological Surgeons; American College of Cardiology; American College of Chest 

Physicians; American Heart Association; American Neurological Association; American Stroke Association; American Vascular Association Foundation; Association of 

Black Cardiologists; Child Neurology Society; Children’s Cardiomyopathy Foundation, Inc.; Congress of Neurological Surgeons; Heart Rhythm Society; Mended 

Hearts, Inc.; National Stroke Association; Society of Interventional Radiology; and 

Society for Vascular Surgery. 

I will deal primarily with one man’s personal experience with stroke and its functional and financial costs—my own. I have only the use of my right arm. 

I was born in 1937, raised in Vicksburg, Mississippi, earned an engineering degree at Mississippi State University and currently reside in Port Orchard, Washington. I worked for the Boeing Company in Seattle, am a former Director of the 

Washington State Energy Office, served as Director of Cost and Revenue Analysis 

and as the Forecasting Manager for a major Northwest Area Natural Gas Utility 

until May 1, 1995. 

On May 1, 1995, at the age of 57, I was stricken and severely disabled by my 

stroke. Two years later I experienced a triple bypass heart operation. You might say 

I’ve ‘‘been there and done that’’ for both major cardiovascular diseases. So you see, 

I am an expert. 

Years ago I was offered an exciting and rewarding volunteer opportunity. I was 

asked to lead the ‘‘JACK WOOD STROKE VICTOR TOUR’’ for the American Heart 

Association. 

The JACK WOOD STROKE VICTOR TOUR was a 5-State lobbying tour. Through 

it I tried to meet personally with every Northwest Congressional representative on 

his or her home turf (in Alaska, Idaho, Montana, Oregon and Washington). In each 

meeting I was joined by local people, stroke survivors and their families and medical 

professionals. I told my story and asked them to join the Congressional Heart and 

Stroke Coalition and to support increased Federal funding for heart and stroke research. 

I am proud to say I traveled to 18 communities and met personally with 28 members of our delegation or their staff. 

One of the most powerful memories for me was the frequency in which Members 

of Congress or staff members related their personal experience with stroke. One 

member I spoke to lost both parents to stroke. I suspect many of you have stories 

too. 

I realize your interest is greater than the physical impact of my stroke. Your concern must include the financial impact, not only to me, but also on our country from 

increased health care costs and lost productivity and its many implications. 

I have confronted the difficult and painful task of calculating that cost to me. Besides being a man whose stroke took his ability to pick up and play with his grandchildren and his livelihood, I remain a statistician at heart. I could not resist calculating and telling that part of my story. But please remember my story is not dissimilar to that of many of the 5.5 million stroke survivors in the United States. 

Many of whom were stricken in their prime earning years. Who in a matter of moments, seemingly without warning, are transformed from a contributor and provider 

to a receiver and patient. 

Allow me to highlight three figures that I feel sum up my data and should be important to you. I estimate that my stroke at age 57: 

—Reduced my earnings before retirement age 65 by more than $600,000. 

—Subsequently, the cost to the Federal Government in lost income and other 

taxes, early Medicare payments and Social Security disability payments is more 

than $320,000. 

—My HMO spent approximately $150,000 to respond to and treat my stroke. 

—One man, over $1 million. 

About 700,000 Americans will suffer a stroke this year costing this Nation an estimated $58 billion in medical expenses and lost productivity. 
504 

Earlier I described a stroke as occurring seemingly without warning. All too often 

as in my case, people either don’t know or ignore the signs of a stroke, even one 

in progress. When my stroke hit I denied it. It took me two days after my stroke 

to acknowledge it and seek help. Because of research into new treatments, we now 

have tPA, a clot-busting drug, which if administered within 3 hours of the onset of 

stroke symptoms, can dramatically reduce the damage of clot-based strokes. Had I 

recognized and acknowledged my stroke, gone to a hospital with a neurologist on 

staff and had there been tPA, the impact of my stroke most certainly would have 

been lessened. 

What is even more painful to me is that my impending stroke could have been 

detected. Unfortunately, we need to create easier and less expensive diagnostic techniques so that effective diagnostics can be given routinely as part of regular health 

exams. And they must be covered through insurance. 

I am not asking for your sympathy. Instead, please think of me as two of the 

ghosts in the famous Dickens’ story. Please don’t misunderstand, I am not casting 

you as Scrooge. See me as both the ghosts of things past and things yet to be. I 

too am here to tell you, the future, which I represent, needs not be. It is largely 

up to you. 

I hope my story and estimate of the cost of my stroke convinces you that taking 

on stroke and heart disease through increased research, leading to better prevention, diagnosis and treatment is fiscally responsible. The human and financial costs 

are astronomical. 

Thank you for your past support of research. 

PREPARED STATEMENT OF THE NATIONAL MULTIPLE SCLEROSIS SOCIETY

Mr. Chairman and distinguished members of the subcommittee, we appreciate the 

opportunity to submit written testimony on behalf of the National Multiple Sclerosis 

Society. Multiple sclerosis (MS) is a chronic, unpredictable and often disabling disease of the central nervous system. Symptoms range from numbness in the limbs, 

to loss of vision, memory deficits, and in some instances partial or total paralysis. 

The progress, severity and specific symptoms of MS in any one person can vary and 

cannot yet be predicted, but advances in research and treatment are giving hope to 

those affected by the disease. 

Since its inception in 1946, the Society’s highest priority has been to end the devastating effects of MS by supporting research aimed at finding the cause of MS, providing better treatments, and ultimately discovering a cure. In 2006, the National 

MS Society will spend over $40 million on MS research supporting over 350 MS investigations. By the end of 2006, the Society cumulatively will have expended some 

$500 million since awarding its first three grants in 1947. This represents the largest privately funded program of basic, clinical, and applied research and training 

related to MS in the world. 

Any effort to conquer MS will require the collective efforts of many individuals 

as well as private and public organizations. The Federal Government is a critical 

partner in the fight against MS and must continue its vital role in furthering the 

scientific understanding of MS. To this end, the Society supports the following proposals related to Federal efforts: 

—There is a great need to determine how many Americans have MS. We therefore 

ask that the National Institutes of Health (NIH) collaborate with the Centers 

for Disease Control/Agency for Toxic Substances and Disease Registry (CDC/ 

ASTDR), the Society and other MS organizations to begin the task of establishing the incidence and prevalence of MS. 

—There is a great need to find treatments for the primary-progressive form of MS 

(PPMS). We therefore ask that NIH bring additional research focus to the primary-progressive form of MS. 

—There is a great need to develop laboratory tests to help physicians easily diagnose and monitor MS. We therefore ask that NIH expand its efforts to identify 

biomarkers for MS. 

—There is a great need provide effective rehabilitation services to Americans with 

MS. We therefore urge that the National Institute on Disability and Rehabilitation Research (NIDRR) in the Department of Education fund one additional 

Medical Rehabilitation Research and Training Center for MS and take steps to 

stimulate individual research projects in MS. 

—There is a great need to sustain the country’s research enterprise and to accelerate the discovery of life-changing treatments for MS. We therefore ask that 

Congress increase fiscal year 2007 NIH funding by 5 percent. 
505 

1 Based on a 1994 Duke University study, indexed for 2004 by the National MS Society, the 

average annual cost of MS is estimated at $57,500 per person due to lost wages, increased medical care and other expenses. Nationwide, there are an estimated 400,000 people with MS. 

The National MS Society has had a long and productive relationship with the 

NIH, particularly with National Institute of Neurological Disorders and Stroke 

(NINDS). Our founder, Sylvia Lawry, helped spearhead the legislation that established NINDS in 1950 and the Society has been pleased to work with the NINDS 

on many areas of mutual interest. Indeed, we extend our thanks to NINDS Director, 

Dr. Story Landis, and key members of her staff, for meeting the Society’s senior 

leadership to explore collaborative opportunities. We look forward to continued discussions with Dr. Landis and are eager to initiate similar discussions with the leadership of other NIH institutes. 

The Federal investment in the NIH and the NIDRR plays a major role in MS research. At the NIH, there are two other institutes that conduct or fund the majority 

of MS research: the NINDS, which funds 75 percent, and the National Institute of 

Allergy and Infectious Diseases (NIAID), which funds about 20 percent. The National Center for Medical Rehabilitation Research (NCMRR—a unit of the National 

Institute of Child Health and Human Development) also funds a small amount of 

MS research specifically targeting rehabilitation issues. In addition to the NIH, the 

NIDRR through the Department of Education invests in MS research. 

For fiscal year 2006 and fiscal year 2007, it is estimated that NIH expenditures 

on MS research will be approximately $109 and 108 million, respectively. For fiscal 

year 2006 and fiscal year 2007 NIDRR expenditures on MS research will be approximately $1.6 million per year out of a total budget of $107 million per year. 

—While this demonstrates one measure of the Federal investment in MS research, this amount pales in comparison with the annual direct and indirect disease cost—approximately $23 billion for all people with MS in the United 

States.1

INVESTING IN RESEARCH PRIORITIES RELEVANT TO MS

The National MS Society recognizes that new discoveries and breakthrough findings could come from almost any area of biomedical research and could apply to the 

primary concern of our members: finding a cure for MS. NIH plays THE major role 

in maintaining our country’s preeminence in the biotechnology industry and provides world-wide leadership in health research and discovery. We thus encourage 

Congress to focus on NIH as a whole, and on agencies of particular relevance to our 

concern, knowing that a well-funded Federal research enterprise will benefit all of 

us. 

Determining how many Americans are affected by MS.—An area in critical need 

of attention is determining the incidence, prevalence, and distribution of MS. The 

last national study of incidence and prevalence of MS in the United States took 

place more than 30 years ago. Since that time the population of the United States 

has changed dramatically in size, composition, and distribution. Moreover, numerous questions have arisen concerning possible ethnic, geographic, and local variations in the distribution of MS. Knowledge concerning these distributions and possible causal factors may provide important information concerning the nature of MS 

and its triggers. Rational policy formulation for MS health care requires up-to-date 

information concerning numbers and characteristics of persons with MS down to the 

State level. 

We are pleased to note that CDC/ASTDR has taken an important step in addressing this issue by convening a workshop to discuss a proposal for setting up national 

surveillance systems for MS and amyotrophic lateral sclerosis (ALS). The Society 

was pleased to participate in this meeting and looks forward to collaborating with 

CDC/ASTDR in planning of regional pilot studies of methods to establish incidence 

and prevalence of MS, and ultimately the design and deployment of a national or 

multi-regional surveillance system for MS. Establishment of such systems, however, 

is beyond the resources of the Society. We therefore urge NINDS and other appropriate NIH institutes to collaborate with the CDC/ATSDR and to allocate funds for 

the conduct of the critical pilot studies and to support a national effort to accurately 

measure incidence and prevalence of MS. 

Finding new treatments for primary-progressive MS.—Advances in immunology 

have provided clinicians with powerful tools to better understand the underlying 

causes of MS, leading to new therapeutic advances. Although there are FDA-approved treatments for relapsing MS, there are still no approved treatments for progressive MS. The primary-progressive form of MS (PPMS) is characterized from the 
506 

onset by the absence of acute attacks and instead involves a continuous and gradual 

clinical decline. 

Approximately 10 percent of individuals are diagnosed with PPMS from the onset. 

Clinically, this form of the disease is associated with a lack of response to any form 

of the approved MS therapies. This leads to the concept that PPMS may in fact be 

a very different disease as compared to relapsing-remitting MS. The Society identifies the study of primary-progressive MS as an area that merits greater attention 

by the research community in order to increase our understanding of PPMS and to 

have effective therapies for this progressive form of the disease. In the upcoming 

year, the Society encourages NIH to help the Society address this underserved area 

of MS research. 

Helping physicians with diagnosis and treatment.—The complexity of MS poses 

many challenges for both diagnosis and treatment of the disease. Biomarkers, substances that are detectible in blood or other body fluids by laboratory testing, are 

a promising tool for physicians since they could aid in diagnosis, treatment selection, and prediction of disease course. In addition, valid biomarkers will be very useful in evaluating the effectiveness of new drugs. 

The fundamental importance of biomarkers for MS has been recognized by the 

NIH Autoimmune Disease Coordinating Committee and NINDS, which sponsored a 

workshop on this topic in 2004. Moreover we are pleased to note that NINDS has 

provided $4 million for a major biomarker discovery effort as part of a large-scale 

clinical trial, CombiRx. The CombiRx trial is evaluating whether or not a combination of approved MS therapies is more effective in treating MS than individual 

therapies. We applaud NINDS for its efforts to-date and urge that NINDS and other 

NIH institutes work with the Society to expand their efforts to support research directed at the discovery and validation of biomarkers for MS. 

EXPANDING THE SCOPE OF FEDERAL SUPPORT FOR MS RESEARCH

In addition to efforts at the NIH, the Society is pleased to note that for more than 

20 years, NIDRR has funded a Medical Rehabilitation Research and Training Center (MRRTC) for MS. However, the institute’s overall investment in MS research remains limited, $1.6 million in fiscal year 2006 and fiscal year 2007. It is dismaying 

that the current NIDRR portfolio includes only 4 projects related to MS whereas spinal cord injury, with a prevalence less than that of MS, has 39 active projects in 

the NIDRR portfolio. 

Since the advent of FDA-approved MS disease-modifying treatments in 1993, persons with MS have had access to therapeutics which can slow the progression of disability. However, in order to maintain maximum levels of independence, persons 

with MS need rehabilitation to address residual deficits. Unfortunately, due to the 

limited support for MS rehabilitation research, we know relatively little about the 

efficacy of rehabilitative interventions in MS. We therefore urge the NIDRR to increase its support for MS rehabilitation research through the funding of at least one 

additional MRRTC along with initiatives to stimulate individual research projects. 

OVERALL NIH FUNDING INCREASE FOR FISCAL YEAR 2007

The Society is deeply concerned that NIH may face a fourth year of overall low 

funding increases. This low funding level endangers the potential breakthroughs 

and discoveries that motivated Congress to complete a five-year campaign to double 

NIH’s budget in 2003. In fact, the trend toward flat or slightly decreased NIH funding could put NIH on a trajectory to un-double its budget because the annual cost 

of inflation cannot be covered. 

Furthermore, we are gravely concerned that the current annual NIH investment 

in MS research of $110 million is projected to drop by $1 million in 2007 and another $1 million in 2008. This trend jeopardizes progress toward a cure and new 

treatments for MS. Indeed, we remind the committee that in the 1990’s, it was the 

NIH’s basic and clinical research that contributed greatly to the development of the 

first disease modifying drugs for MS. Now there are 6 such drugs approved for MS 

therapy, and the NIH is funding a major trial to test whether combining drugs can 

enhance their benefit. 

Moreover, NIH-funded research catalyzes industry efforts to develop drugs in 

many ways. Industry tells us that developing biomarkers that can measure the progression of MS could dramatically enhance their efforts to develop drugs. Over the 

last several years, advances in brain imaging for MS have taken a major step towards the goal of MS biomarkers. The NIH has a major effort underway to identify 

additional methods to measure the progression of MS, this is another step toward 

increased understanding of MS. Moreover, because of these advances in understanding of MS, biotech and pharmaceutical companies currently have more than 
507 

a dozen drugs for MS in various stages of clinical testing. Despite these significant 

efforts, the number of new drug applications to the Food and Drug Administration 

continues to decline. The Society fears that this negative trend will be accelerated 

by continued reductions in NIH-funded research. 

A lack of Federal funds for biomedical research and MS research, in particular, 

will also force junior and senior researchers to leave the scientific workforce, further 

slowing the pace of research. Such an outcome would mean that substantial investments biomedical research would have been squandered, and replenishing this 

workforce would take a generation. We therefore urge Congress to: 

—Appropriate a 5 percent fiscal year 2007 funding increase for NIH. 

—Balance the fiscal year 2007 NIH appropriation to allow growth across all NIH 

institutes and all areas of disease research. 

We ask the subcommittee to be mindful of the thousands of Americans, and particularly those with MS, who will be affected if the pace of research is slowed by 

reductions in NIH funding. While treatments are available for MS, these are expensive and only partially effective for some patients. Until a cure is found, people affected by MS want more effective and more economical treatments. 

The surest path to discovering treatments for MS, and for human diseases in general, is by sustaining the country’s investment in innovative biomedical research at 

universities and small businesses. Funding cuts threaten these efforts, and will invariably harm the country’s research infrastructure. Correcting such damage may 

take a generation, and Americans with MS cannot afford to wait that long. Moreover, the country cannot afford the economic consequences of delaying the discovery 

of treatments that could change the lives of those impacted by MS. 

We thank the subcommittee for this opportunity to comment and applaud your 

commitment to advancing the health and well-being of all Americans through investment in biomedical research. 

PREPARED STATEMENT OF THE NIH TASK FORCE OF THE BIOENGINEERING DIVISION

OF THE BASIC ENGINEERING GROUP OF THE COUNCIL ON ENGINEERING OF ASME 

The NIH Task Force of the Bioengineering Division of the Basic Engineering 

Group of the Council on Engineering of ASME, is pleased to provide comments on 

the bioengineering-related programs in the National Institutes of Health (NIH) fiscal year 2007 budget request. The ASME Bioengineering Division is focused on the 

application of mechanical engineering knowledge, skills and principles from conception to the design, development, analysis and operation of biomechanical systems. 

THE IMPORTANCE OF BIOENGINEERING

Bioengineering is an interdisciplinary field that applies physical, chemical and 

mathematical sciences and engineering principles to the study of biology, medicine, 

behavior, and health. It advances knowledge from the molecular to the organ systems level, and develops new and novel biologics, materials processes, implants, devices, and informatics approaches for the prevention, diagnosis, and treatment of 

disease, for patient rehabilitation, and for improving health. Bioengineers have employed mechanical engineering principles in the development of many life-saving 

technologies, such as the artificial heart, prosthetic joints and numerous rehabilitation technologies. 

BACKGROUND

NIH is the world’s largest and most eminent organization dedicated to improving 

health through medical science. During the last 50 years, NIH has played a preeminent role in the major breakthroughs that have increased average life expectancy by 15 to 20 years. 

NIH is comprised of different Institutes and Centers that support a wide spectrum of research activities including basic research, disease and treatments related 

studies, and epidemiological analyses. The missions of individual Institutes and 

Centers focus on a particular organ (e.g. heart, kidney, eye), on a given disease (e.g. 

cancer, infectious diseases, mental illness), on a stage of development (e.g. childhood, old age), or, may encompass crosscutting needs (e.g., sequencing of the human 

genome and the National Institute of Biomedical Imaging and Bioengineering 

(NIBIB). 

The total fiscal year 2007 NIH budget request is $28.6 billion, which represents 

approximately the same level as the fiscal year 2006 appropriation. Some $50 million of this increase is for radiological/nuclear countermeasures development. NIH 

R&D, 97 percent of the total NIH budget, would also remain flat at $27.8 billion 
508 

next year. The largest increases would go to the Office of Director and towards biodefense R&D. 

According to the President’s fiscal year 2007 budget request, ‘‘NIH’s highest priority is the funding of medical research through research project grants (RPGs). 

Support for RPGs allows NIH to sustain the scientific momentum of investigatorinitiated research while pursuing new research opportunities.’’ The administration 

estimates that the fiscal year 2007 budget would support an estimated 9,337 new 

research project grants (RPGs), an increase of about 275 new competing RPGs from 

fiscal year 2006. Nevertheless, NIH projects a decline in the total number of RPGs 

for the third year in a row, no inflation adjustment for most new or continuing 

grants, and a decline in the RPG success rate for the sixth year in a row down to 

19 percent. RPGs account for 52 percent of the 2007 NIH Budget Request. 

The largest percentage increase would go to the Office of the Director (OD; up 

25.1 percent) to boost OD funding for clinical research, high-risk basic research, and 

collaborative research in the NIH Roadmap for Biomedical Research. The Roadmap 

would receive $443 million in fiscal year 2006 (up 34 percent), with $332 million 

coming from institute budgets. Currently, the Roadmap Initiatives provides $80 million annually, or roughly 24 percent of the total roadmap budget, for bioengineeringrelated project. 

Other initiatives funded by the fiscal year 2007 budget request are 5 awards for 

the new K/R ‘‘Pathway to Independence’’ program and the Genes, Environmental, 

and Health Initiative (GEHI) that will study genetic factors associated with disease 

and accelerate technological development that can measure human responses to environmental influences on health. 

The President’s fiscal year 2007 budget requests $294.5 million for the NIBIB, a reduction of $1.96 million (0.7 percent) below the fiscal year 2006 enacted level. 

Most NIH institutes are also slated for reductions in funding in the President’s 

budget request. 

Below are some highlights from the fiscal year 2007 budget request for NIBIB. 

Further details can be found at http://www.nibib.nih.gov/ 

publicPage.cfm?pageID=263#FY2007. 

NIBIB Extramural Research would decline 1.3 percent, to $268 million. 

The number of research project applications to NIBIB continues to grow, with the 

number doubling from fiscal year 2003 to fiscal year 2004 and then increasing by 

20 percent from fiscal year 2004 to fiscal year 2005. The research budget, however, 

has remained flat. Consequently, the success rate for investigators applying for extramural research grants from the NIBIB is the second lowest among the NIH institutes and centers. It is estimated that the success rate for these applications was 

16.8 percent in fiscal year 2004, decreasing to approximately 15 percent in fiscal 

year 2005. The projected success rate for fiscal year 2006 is only between 10 and 

15 percent 

NIBIB Intramural Research would grow 6.3 percent, to $7.7 million. 

In September 2004, the NIBIB Special Advisory Panel for Intramural Programs 

met to develop recommendations for the National Advisory Council on Biomedical 

Imaging and Bioengineering concerning an intramural research program within the 

NIBIB. Intramural research accounts for approximately 10 percent of the total NIH 

budget. The NIBIB currently is at the low end in terms of funds it commits to intramural research among all of the NIH institutes, both in terms of dollars expended 

and percentage of its total budget. The Panel recommended that NIBIB not pursue 

the near-term expansion of its Intramural Research Program beyond the available 

funding in the current budget and the fiscal year 2005 President’s Budget proposal. 

The Panel further recommended that NIBIB use its limited intramural funds primarily to expand interdisciplinary training opportunities at the postdoctoral level. 

In addition to the already established training grants offered by the NIBIB, there 

is a new initiative co-sponsored by the NSF Engineering Directorate to offer summer institute training for undergraduate students. It is hoped that such programs 

can be offered regularly now and/or expanded. More information can be found at 

http://bbsi.eeicom.com/. 

The estimate for NIH-wide bioengineering research was $1.291 billion in fiscal 

year 2006, and $1.32 billion in fiscal year 2005. The proposed 2007 amount is $1.296 

billion, a 0.4 percent increase over 2006. These numbers reflect bioengineering funding by any of the 27 NIH institutes or Office of the Director. 

RECOMMENDATIONS

The Task Force is concerned that funding for bioengineering has continued to lag 

compared to many areas of NIH, and will continue to do so, especially now that the 
509 

doubling of the NIH budget is complete and the total funding for NIH remains flat. 

While a strong supporter of the NIBIB, the Task Force is also concerned that bioengineering continues to constitute less than half the budget for the NIBIB. There 

is a need for advanced engineering concepts to be applied to basic and translational 

biomedical problems for the potential of recent biological advances to be realized. 

The request for more bioengineering funding addresses a critical need for developing 

and applying more complex engineering principles to biomedical problems. In many 

cases, such engineered solutions to health care problems will result in a reduction 

in health care costs. Therefore, the Task Force strongly urges Congress to provide 

increased funding for bioengineering within the NIBIB and across NIH. The NIBIB 

requires exceptional consideration for funding increases in the coming years. It is 

notable that the success rate for funding applications to the NIBIB is currently between 10–15 percent, even lower than the declining average NIH-wide success rate 

of 19 percent. This is a direct manifestation of the continued growth of the field outpacing funding increases to the NIBIB. 

While the Task Force supports new Federal proposals that seek to double Federal 

research and development in the physical sciences over the next decade, the Task 

Force believes that strong Federal support for bioengineering and the life sciences 

is essential to the health and competitiveness of the Nation. Increased funding for 

the NIH has put the United States is a leading position in pharmaceuticals, bioengineering, and medical sciences. Long-term lack of funding for NIH programs 

would harm the tremendous gains the United States has made over the last decade. 

ASME International is a non-profit technical and educational organization with 

125,000 members worldwide. The Society’s members work in all sectors of the economy, including industry, academic, and government. This statement represents the 

views of the ASME NIH Task Force of the Bioengineering Division and is not necessarily a position of ASME as a whole. 

PREPARED STATEMENT OF THE NATIONAL PRIMATE RESEARCH CENTERS

The Directors of the National Primate Research Centers (NPRCs) respectfully 

submit this written testimony for the record of the U.S. Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education. The NPRCs appreciate the commitment that the members of this subcommittee have made to biomedical research through strong support for the National Institutes of Health 

(NIH). Given your leadership on this issue, the NPRCs urge Congress to direct resources to NIH to ensure that the Federal investment in vital biomedical research 

will not be compromised. 

The NPRCs are a national network of eight primate research centers supported 

by the NIH National Center for Research Resources (NCRR). The centers comprise 

the National Primate Research Program (NPRP), which was developed by Congress 

in 1960. The program seeks to address human health problems through scientific 

research using the animal models that most closely resemble humans in their genetics, physiology, and disease processes—primates. NPRCs support research that is 

sponsored by nearly every institute of NIH. For example, NPRCs conduct research 

to help understand and treat diseases such as heart disease, hypertension, cancer, 

diabetes, hepatitis, AIDS, kidney disease, Alzheimer’s disease, and Parkinson’s disease. They also conduct research on emerging infectious diseases and many aspects 

of biodefense. Each NPRC makes its facilities available to investigators from around 

the country. Our centers create collaborative research environments that allow scientists to combine their individual expertise beyond the scope of established disciplinary research projects. 

NPRCs endorse the fiscal year 2007 Ad Hoc Group for Medical Research proposal 

to increase the NIH budget by five percent over the fiscal year 2006 level. We recognize that the current budget environment puts pressure on Congress to face difficult 

funding trade-offs; however, as this subcommittee works to define priorities for the 

year and set goals for the future, we ask that you maintain your long-term commitment of support for NIH and its mission. The President’s fiscal year 2007 budget 

would flat-fund NIH. The five percent increase for NIH supported by NPRCs would 

not only allow the agency to sustain current programs but also invest in critical new 

initiatives. This would prevent NIH from falling behind the ‘‘Innovation Index’’—the 

rate of biomedical inflation as calculated in the Biomedical Research and Development Price Index (BRDPI) plus a modest investment in new initiatives. Using the 

fiscal year 2007 BRDPI projection as a base, NIH would require an increase of at 

least 3.8 percent over fiscal year 2006 to maintain current programs. However, we 

strongly believe that an increase for NIH above BRDPI is justified by the health 

needs as well as current and burgeoning research capabilities of the Nation. An in-
510 

crease above BRDPI would allow new innovative ideas to be funded and would infuse existing programs to evolve as their research findings push them to higher levels of basic understanding, translation and clinical functionality. 

As a result of years of expanded investment in biomedical research, the demand 

for the NPRCs’ resources has increased significantly. The ability of NIH-funded researchers to conduct future projects with primate models will depend on the enhancement of three key areas: (1) the nationwide availability of primates; (2) the 

quality and capacity of primate housing and breeding facilities, as well as the availability of related state-of-the-art diagnostic and clinical support equipment at 

NPRCs; and (3) the number of personnel trained in primate care and management 

at NPRCs. These areas can be enhanced by an NIH/NCRR commitment to increase 

the NPRCs P51 base grants (the mechanism that funds each NPRC). Biomedical researchers across the Nation are experiencing shortages in the availability of primates for essential research. Increases to the P51 base grants would allow NPRCs 

to: expand existing breeding colonies and develop bridging programs to use effectively the under-utilized species of primates in research; invest in repairs, renovation, and construction of research facilities, as well as the purchase of modern laboratory equipment; and ensure that adequate numbers of experts are trained in laboratory animal medicine and research, because NPRCs must maintain primate management teams comprised of behavioral specialists, veterinarians, and primate research experts to ensure excellent primate care, health, and research success. 

Increases from NIH/NCRR to the NPRCs P51 base grant are necessary to meet 

the needs discussed above and are critical to the ability of NPRCs to supply adequate primate resources for scientists across the Nation to carry out important research projects. As mentioned previously, these research projects span the disease 

foci at NIH institutes and centers, and also play important roles in the NIH Roadmap, the NCRR Strategic Plan, and grand challenges facing the scientific community. In the 1950’s, primate research produced the first vaccine for one of the world’s 

worst childhood killers, the Polio virus, reducing the number of cases in the United 

States from 58,000 to one or two per year. Primates have also served as the best 

model for various types of HIV research, and their availability for use has resulted 

in at least 14 licensed anti-viral drugs for treatment of HIV infection. Primate models will continue to be necessary to defend the world against possible future 

epidemics such as SARS, West Nile Virus, and avian flu. In addition to deadly viral 

epidemics, primate research has enabled the discovery of better treatments and 

therapies for diseases and occurrences such as stroke, cataracts, depression and 

other psychiatric illnesses. Significant advances in prenatal and postnatal care have 

also resulted from primate research. 

Further, not only do primates have the potential to provide answers for longstanding research questions, primate research provides an unparalleled opportunity 

to address more recently defined research priorities, such as those relating to 

genomics and bioterrorism. The specific availability of information in the primate 

genome, which is quite similar to the human genome, makes primates essential in 

studies that require an integrated understanding of a whole biological system. Recent reports suggest that extensive analysis of genome structure and function in 

nonhuman primates could make immediate and significant contributions to the 

overall mission of NIH by accelerating progress in understanding many human diseases. Also, primates serve as critical animal models in biodefense research projects 

for which, in some cases, it would be inappropriate to conduct early clinical trials 

in humans. Primates are recognized as vital research resources within Federal strategic plans regarding biodefense research, including: the National Institute of Allergy and Infectious Diseases (NIAID) Strategic Plan for Biodefense Research; the 

NIAID Research Agenda for Category A Agents; and the NIAID Research Agenda 

for Category B and C Priority Pathogens. Also, NPRCs are partners in NIAID-funded Regional Centers of Excellence for Biodefense and Emerging Infectious Diseases 

as well as with NIAID-funded National and Regional Biocontainment Laboratories. 

As NIH and the national biomedical research agenda evolve, NPRCs adjust to 

meet the resource needs of the research community but also to maintain research 

programs that are on the cutting-edge of science. The reservoirs of knowledge residing within the NPRCs create new opportunities for research partnerships with investigators at host academic institutions and in the biomedical research community 

at large. Never have the research questions been so profound, or the implications 

for human health so critical. NPRCs are poised to bridge the gap between knowledge already gleaned from simple cellular and animal models and knowledge that 

is needed to promote human health and cure human disease. Past accomplishments 

demonstrate, and current and future research directions will rely on, the roles of 

robust primate research programs in addressing critical research questions. The 
511 

breadth and success of primate research programs confirm the vital role that the 

eight NPRCs play in biomedical research nationwide. 

Thank you for the opportunity to submit this written testimony and for your attention to the critical need for primate research and enhancement of the NPRCs 

P51 base grant, as well as our recommendations concerning funding for NIH in the 

fiscal year 2007 Appropriations Bill. 

PREPARED STATEMENT OF THE NATIONAL PROSTATE CANCER COALITION

On behalf of the National Prostate Cancer Coalition, I appreciate the opportunity 

to submit written comments regarding funding to Prostate Cancer programs. I 

would also like to offer our best estimates on the resources necessary to continue 

to fight the war on prostate cancer in fiscal year 2007, most specifically funding for 

prostate cancer research, prevention, detection and treatment programs funded by 

the Labor, Health and Human Services and Education Appropriations Bill. 

HISTORY OF PROSTATE CANCER FUNDING

For the past ten years, the NPCC has worked to reduce the burden of prostate 

cancer through awareness, outreach, and advocacy. As you may know Prostate cancer is the most common cancer (next to skin cancer) and the second leading cause 

of cancer-related death in men in the United States. It is estimated this year over 

234,000 men will be diagnosed with prostate cancer, and more than 27,000 will die 

as a result of the disease. Of the 10 million Americans living with cancer today, two 

million of these have prostate cancer. 

This past decade has been an exciting and important one for prostate cancer research. Congress and the administration have taken notice of the impact prostate 

cancer has on our Nation. In 1998, Congress promised to double the budget of the 

NIH within 5 years, and triple the amount of Federal funding for prostate cancer 

research. By keeping that promise, prostate cancer research funding has increased 

and expanded to record levels. As a result, more men are screened and diagnosed 

with this disease and prostate cancer survivorship rates have increased. Also for the 

first time since 1930, the number of cancer deaths has decreased in 2003. These exciting results cannot continue without a stable and reasonable level of funding to 

the NIH. Unfortunately in fiscal year 2003, NIH funding did not keep up with the 

increase of inflation. Last year in fiscal year 2006 the NIH and prostate cancer research programs received a hard cut to programs at the Center for Disease Control 

and the National Cancer Institute. 

With less funding, researches cannot continue to discover ways to combat prostate 

cancer. New drugs and treatment options are harder to translate from the lab to 

the patients. We cannot fight the war on prostate cancer without the proper tools. 

The National Prostate Cancer Coalition understands the limited resources our Nation faces. However, when research continues to show the eradication of cancer is 

within research, we must continue to fund these programs which will save millions 

of lives, reduce untold suffering and save the Nation billions of dollars in healthcare 

costs. 

It is important to note that Americans spend over $4.6 billion per year for treatment of this disease (this does not include the burden of lost productivity and 

wages). Statistics show that as baby boomers continue to age, the number of Americans impacted by cancer will increase. These statistics show the far reaching effects 

prostate cancer can have, not only on individuals and their families, but the Nation’s economy as well. 

FUNDING REQUESTS

This year we have joined with the Cancer and Public Health Communities to urge 

this committee and Congress to provide $29.7 billion for the NIH, a $1.4 billion increase of fiscal year 2006. We request funding that will maintain current programs 

and progress at the NIH. We would also request that Congress appropriate $5.034 

billion for the National Cancer Institute, a $240 million increase over fiscal year 

2006. Again, this funding would only maintain the current discovery pace. Additionally we ask for Congress to appropriate $20 million (∂6.07 million) for the Prostate 

Cancer Control Initiatives at the Centers for Disease Control. With this program, 

the public receives information about prostate screening and early detection. With 

increased funding, this program can expand and improve outreach efforts. 

The NPCC urges these changes to the fiscal year 2007 Appropriations bill to ensure funding to cancer research and related programs are a top priority in fiscal 

year 2007 and in the future. We thank you for the opportunity to discuss the need 
512 

for these tools to fight the war on prostate cancer. Again, we need to continue to 

fund these programs to ensure that our Nation continues to make advances in cancer eradication. 

PREPARED STATEMENT OF THE NATIONAL SLEEP FOUNDATION

SUMMARY OF FISCAL YEAR 2007 RECOMMENDATIONS

—Provide a 5 percent increase for fiscal year 2007 to the National Institutes of 

Health (NIH) and a proportional increase of 5 percent to the individual institutes and centers, specifically, the National Heart, Lung, and Blood Institute 

(NHLBI). 

—Continue to urge the National Center on Sleep Disorders Research (NCSDR) of 

the NHLBI and the Centers for Disease Control and Prevention (CDC) to partner with voluntary health organizations, such as the National Sleep Foundation 

(NSF), to develop a collaborative sleep education and public awareness initiative 

based on the roundtable model that other public health-related agencies have 

used with success. In view of the success of the CDC with similar initiatives, 

encourage and support the CDC in taking a leadership role with the roundtable 

initiative. 

—Encourage the Director of the NIH and the Director of the National Heart, 

Lung, and Blood Institute to name a permanent Director to the National Center 

on Sleep Disorders Research. 

—Encourage CDC to increase support for initiatives connecting sleep to overall 

health and safety. Provide $6.321 billion for fiscal year 2007 to the CDC, the 

same amount Congress provided to the agency in fiscal year 2005. 

—Continue to urge the United States Surgeon General to develop and implement 

a report on sleep and sleep disorders in order to call attention to the importance 

of sleep and develop strategies to protect and advance the health and safety of 

the Nation. 

Mr. Chairman and members of the subcommittee, thank you for allowing me to 

submit testimony on behalf of the National Sleep Foundation (NSF). I am Dr. Barbara Phillips, Chairman of the NSF Board of Directors and professor at the University Of Kentucky College Of Health in the Department of Preventive Medicine. The 

NSF is an independent, non-profit organization that is dedicated to improving public 

health and safety by achieving understanding of sleep and sleep disorders, and by 

supporting sleep-related education, research, and advocacy. We work with sleep 

medicine and other health care professionals, researchers, patients and drowsy driving victims throughout the country as well as collaborate with many government 

and public and private organizations with the goal of preventing health and safety 

problems related to sleep deprivation and untreated sleep disorders. 

Sleep problems, whether in the form of medical disorders, or related to work 

schedules and a 24/7 lifestyle, are ubiquitous in our society. At least 50 million 

Americans suffer from sleep disorders and millions of others experience sleep problems related to other medical conditions; yet more than 60 percent of adults have 

never been asked about the quality of their sleep by a physician, and fewer than 

20 percent have ever initiated such a discussion. Millions of individuals struggle to 

stay alert at school, on the job, and on the road. According to the National Highway 

Traffic Safety Administration’s 2002 National Survey of Distracted and Drowsy 

Driving Attitudes and Behaviors, an estimated 1.35 million drivers have been involved in a drowsy driving related crash in the past five years. A large number of 

academic studies have linked work accidents, absenteeism, and school performance 

to sleep deprivation and circadian effects. 

Sleep apnea, a sleep-related breathing disorder which affects at least 5 percent 

of adult Americans and is closely related to some of America’s most pressing health 

problems, such as obesity, hypertension, heart failure, and diabetes. Chronic insomnia, experienced by at least 10 percent of our population is a strong risk factor for 

depression and other widespread mental health conditions. The direct and indirect 

costs associated with sleep disorders and sleep deprivation total an estimated $100 

billion annually. 

Sleep science has clearly demonstrated the importance of sleep to health and wellbeing, yet research studies continue to show that millions of Americans are at risk 

for the serious health and safety consequences of untreated sleep disorders and inadequate sleep. Moreover their quality of life suffers and the personal and national 

economic impact is staggering. The severity of the public health burden represented 

by sleep issues are compellingly detailed in a groundbreaking new report, Sleep Dis-
513 

orders and Sleep Deprivation: An Unmet Public Health Problem by the Institute of 

Medicine. 

NSF believes that every American needs to understand that good health includes 

healthy sleep, just as it includes regular exercise and balanced nutrition. We must 

elevate sleep to the top of the national health agenda. We need your help to make 

this happen. 

Our biggest challenge is bridging the gap between the outstanding scientific advances we have seen in recent years and the level of knowledge about sleep held 

by health care practitioners, educators, employers, and the general public. Consequently, the NSF is spearheading two important initiatives to raise public and 

physician awareness of the importance of sleep to the health, safety and well-being 

of the Nation. 

First, because resources are limited and the challenges great, we think creative 

and new partnerships need to be developed to address sleep awareness. Therefore, 

the NSF has been working with the National Center on Sleep Disorders Research 

(NCSDR) and the Centers for Disease Control and Prevention (CDC), to develop an 

ongoing, inclusive mechanism for public and professional awareness on sleep, sleep 

disorders and the consequences of fatigue. Such collaboration between Federal agencies and voluntary health organizations would create an opportunity for dramatically improving public health and safety as well as the quality of life for millions, 

if not all, Americans. Since November of 2004, NIH, CDC, and NSF have been meeting with other interested and diverse voluntary and professional groups and Federal 

agencies to discuss the formation of a broad coalition dedicated to raising public 

awareness of sleep. This effort should continue to receive the support of Congress 

in order to encourage the participation of relevant Federal agencies. 

In relation to this effort, the National Center on Sleep Disorders Research within 

the National Heart, Lung and Blood Institute (NHLBI) currently has an acting director as the result of the recent promotion of Dr. Carl Hunt. NCSDR was created 

in 1993 by the National Institutes of Health Revitalization Act (Public Law 103– 

43) and has served an important role in furthering the scientific and public health 

knowledge related to sleep deprivation and sleep disorders. NSF requests that you 

encourage both Drs. Elias Zerhouni, the Director of NIH, and Elizabeth Nabel, the 

Director of the NHLBI to name a permanent director to this vitally important Center as soon as possible, so that the mission of the NCSDR is not significantly impacted. Additionally, given the significant and unique mission of the Center, NIH 

should consider the following characteristics for the NCSDR director position: history of collaborative efforts among sleep investigators and educators; recognition and 

stature in the field of sleep medicine; and familiarity with the research needs and 

gaps in the field of sleep medicine. 

Secondly, at the National Institutes of Health’s Frontiers of Knowledge in Sleep 

and Sleep Disorders conference, the U.S. Surgeon General acknowledged widespread 

illiteracy in our country regarding sleep loss and untreated sleep disorders. He emphasized that sleep problems are easily related to the three top areas of the national 

health agenda: prevention, preparedness, and health disparities. Prevention of some 

of our Nation’s most pressing health problems would be fostered by attending to 

sleep disorders. Sleep deprivation is a major barrier to maximizing preparedness 

and response in times of crisis. Finally, like many health concerns, access to knowledge and medical care for sleep problems is less accessible to some of our citizens. 

Conferences and workshops held by the Surgeon General involve educating the 

public, advocating for effective disease prevention and health promotion programs 

and activities, and providing a highly recognized symbol of national commitment to 

protecting and improving the public’s health. The NSF believes it is time that the 

Federal Government helps promote sleep as a public health concern through the development of a Surgeon General’s Report on Sleep and Sleep Disorders in order to 

call attention to the importance of sleep and develop strategies to protect and advance the health and safety of the Nation. Therefore, the NSF is advocating for the 

development and dissemination of a Surgeon General’s Report on Sleep and Sleep 

Disorders. 

The new report by the Institute of Medicine includes important recommendations 

that support the sprit of these efforts and other specific actions to be taken by the 

CDC, NIH and other Federal agencies and private foundations to increase surveillance of and education on sleep health and sleep disorders. CDC, NIH and the Surgeon General must partner with voluntary health organizations and increase support for initiatives that help ensure the health and safety of all Americans. 

Thank you again for the opportunity to present you with this testimony. 
514 

PREPARED STATEMENT OF THE NEPHCURE FOUNDATION

SUMMARY OF RECOMMENDATIONS FOR FISCAL YEAR 2007

(1) A 5 percent increase for the National Institutes of Health (NIH) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 

(2) Continue to expand the NIH’S Nephrotic Syndrome (NS) and Focal Segmental 

Glomerularsclerosis (FSGS) research portfolios by aggressively supporting NIDDK 

grant proposals in this area and by encouraging the National Center for Minority 

Health and Health Disparities (NCMHD) to initiate studies into the incidence and 

cause of NS and FSGS in minority populations. 

Mr. Chairman and members of the subcommittee, I am pleased to present testimony on behalf of the NephCure Foundation (NCF), a non-profit organization driven 

by a panel of respected medical experts and a dedicated band of patients and families working together towards a common goal-to save kidneys and to save lives. NCF 

is the only non-profit organization exclusively devoted to fighting idiopathic nephrotic syndrome (NS) and focal segmental glomerulosclerosis (FSGS). Now in its sixth 

year, the NephCure Foundation continues to work tirelessly to support glomerular 

disease research. 

FSGS: One Family’s Story 

My son, Bradly Grizzard, was diagnosed with focal segmental glomerulosclerosis 

(FSGS) in 2002. In May of 2005, I donated one of my kidneys to him. 

FSGS is one of a cluster of glomerular diseases that attack the one million tiny 

filtering units (nephrons) contained in each human kidney. Glomerular disease attacks the portion of the nephron called the glomerulus, scarring and often destroying these filters. Scientists do not know why glomerular injury occurs, and there is 

no known cure for these diseases. 

FSGS patients, upon diagnosis, often take a downward plunge at a rapid rate and 

it is extremely difficult to make a comeback. My son was a star football player at 

his high school and was being recruited by college football coaches before FSGS attacked his body. When his kidneys failed, he was forced to give up football, and he 

had to try and juggle college classes along with several hours of dialysis a day. We 

were lucky that my kidney was a match for him, but even so the first few hospitals 

that we approached refused to perform the transplant. We were eventually able to 

find a doctor and a hospital that was willing to perform the operation, and the 

transplanted kidney is now working well. But Bradly must remain on costly 

immunosuppressant drugs for the rest of his life. These drugs cause many unpleasant side effects and medical complications. 

My son’s story is not unique. There are thousands of other people in this country 

who have had their lives disrupted due to the sudden onset of FSGS or NS. And 

although kidney transplants have been very successful for thousands of patients, 

many patients end up rejecting the transplanted kidney. Other times, the disease 

comes back and attacks the transplanted kidney. In either case, the patient must 

then again rely on daily dialysis as a means of survival. There are thousands of 

young people who are in a race against time, hoping for a treatment that will save 

their lives. The NephCure Foundation today raises its voice to speak for them all, 

asking you to take specific actions that will aid our quest to find the cause and cure 

of FSGS and NS. 

First and foremost, we join the Ad Hoc Group for Medical Research Funding in 

asking for a 5 percent increase for the National Institutes of Health (NIH) and the 

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 

More Research is Needed 

We are no closer to finding the cause or the cure of FSGS. Scientists tell us that 

much more research needs to be done on the basic science behind the disease. 

We are thankful that the NIDDK continues to work with the NephCure Foundation on the FSGS clinical trial. Currently 150–175 patients nationwide are enrolled 

in the trial. Recently, the steering committee charged with providing programmatic 

direction to the trial decided on several changes which would accelerate progress. 

NCF is also working with the NIDDK to cosponsor ancillary basic biological material studies of the enrolled patients. 

The NephCure Foundation is also grateful to the NIDDK for issuing two program 

announcements (PAs) that serve to initiate grant proposals on glomerular disease. 

The first program announcement, issued in December of 2005, includes glomerular 

disease as one of several kidney or urologic diseases for which the PA will fund 

grant proposals. The second PA, issued in March of 2006, is glomerular-disease specific. Both of these announcements will utilize the R21 mechanism to award researchers $275,000 over two years. 
515 

We ask the Committee to encourage the NIDDK to help find the cause and the 

cure for glomerular disease by continuing its support for the FSGS clinical trial and 

the ancillary basic biological material studies. We also ask the NIDDK to continue 

to add glomerular disease to program announcements. 

Too Little Education About a Growing Problem 

When glomerular disease strikes, it results in a loss of protein from the urine and 

edema. The edema often manifests itself as puffy eyelids, a symptom that many parents and physicians mistake as allergies. With experts projecting a substantial increase in the number of cases of glomerular disease in the coming years, there is 

a clear need to educate pediatricians and family physicians about glomerular disease and its symptoms. 

The NephCure Foundation has numerous education programs underway. A national FSGS conference will be held in Philadelphia from June 3rd–4th, 2006. This 

conference will aim to provide attendees with the most up to date information on 

this disease. Through speakers, information sessions, and informal conversations 

with other patient families, attendees will realize they are not alone and will be further energized for the effort to find a cause and a cure for FSGS. 

Also, this summer, the NIDDK will sponsor a working group scientific conference. 

This working group will advise NIDDK on animal models, reagents, and other resources for the study of glomerular disease. 

We also applaud the work of the NIDDK in establishing the National Kidney Disease Education Program (NKDEP), and we seek your support in urging the NIDDK 

to make sure that glomerular disease remains a focus of the NKDEP. 

We ask the Committee to encourage the NIDDK to have glomerular disease receive high visibility in its education and outreach efforts, and to continue these efforts in conjunction with the NephCure Foundation’s work. These efforts should be 

targeted towards both physicians and patients. 

Glomerular Disease Strikes Minority Populations 

Nephrologists tell us that glomerular disease strikes a disproportionate number 

of African-Americans. No one knows why this is, but some studies have suggested 

that a genetic sensitivity to sodium may be partly responsible. DNA studies of African Americans who suffer from FSGS may lead to insights that would benefit the 

thousands of African Americans who suffer from kidney disease. 

As an African-American female and the mother of a son with FSGS, I ask that 

the NIH pay special attention to why this disease affects my race to such a large 

degree. The NephCure Foundation wishes to work with the NIDDK and the National Center for Minority Health and Health Disparities (NCMHD) to encourage 

the creation of programs to study the high incidence of glomerular disease within 

the African-American population. 

There is also evidence to suggest that the incidence of glomerular disease is higher among Hispanic-Americans than in the general population. An article in the February 2006 edition of the NIDDK publication Recent Advances and Emerging Opportunities, discussed the case of Frankie Cervantes, a six year old boy of Mexican 

and Panamanian descent. Frankie has FSGS, and like Bradly, received a transplanted kidney from his mother. We applaud the NIDDK for highlighting FSGS in 

their publication, and for translating the article about Frankie into both English 

and Spanish. Only through similar culturally appropriate efforts can African American and Hispanic families learn more about glomerular disease. 

We ask the Committee to join with us in urging the NIDDK and the National 

Center for Minority Health and Health Disparities (NCMHD) to collaborate on research that studies the incidence and cause of this disease among minority populations. We also ask that the NIDDK and the NCMHD undertake culturally appropriate efforts aimed at educating minority populations about glomerular disease. 

PREPARED STATEMENT OF ONE VOICE AGAINST CANCER

One Voice Against Cancer (OVAC) appreciates the opportunity to submit written 

comments for the record regarding funding for cancer programs for research, prevention, detection, and treatment as well as programs that educate and train nurses 

in fiscal year 2007 at the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration (HRSA). OVAC is a collaboration of more than 40 major national organizations representing millions of Americans affected by cancer, unified to urge Congress and the White House to increase cancer-related appropriations. OVAC stands 

ready to work with policymakers at the Federal, State, and local levels to ensure 
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that these important cancer and nursing initiatives at NIH, CDC, and HRSA receive 

adequate funding in fiscal year 2007. 

Our Nation’s prior investments in cancer research-related programs have saved 

thousands of lives and accelerated our progress toward the Administration’s goal of 

eliminating death and suffering due to cancer by the year 2015. However, the challenge remains—cancer will strike one of every two men and one of every three 

women in the United States. This year alone, more than 1.4 million men and women 

in this country will receive the devastating news that they have cancer; yet, more 

than 10 million cancer survivors can attest to the fact that we are making real 

progress against this disease. 

The Congress took a bold step forward in 1998 when it promised to double the 

budget of the National Institutes of Health (NIH) within five years. By keeping that 

promise, Congress opened the floodgates to countless new opportunities and advances in cancer research and programs. Thanks to the advances spawned by that 

infusion of support for biomedical research, cancer survivorship rates have steadily 

increased each year. For the first time since 1930, the number of cancer deaths in 

the United States decreased in 2003. Congress must maintain that promise with a 

stable and reasonable level of funding increases to sustain the momentum of this 

exciting research. Since fiscal year 2003, NIH funding levels have fallen far short 

of keeping pace with inflation alone, and fiscal year 2006 resulted in a hard cut to 

both NIH and National Cancer Institute funding levels. 

Less funding translates immediately into fewer discoveries, fewer new drugs in 

development, and fewer new treatments reaching patients. We cannot reach the 

2015 goal without the continued support of the Congress. We appreciate that our 

Nation faces many challenges and Congress has limited resources to allocate. However, the conquest of cancer and elimination of health disparities is truly within our 

grasp. Making cancer a national priority will save millions of lives, reduce untold 

suffering, and save the Nation billions of dollars in healthcare costs now and for the 

foreseeable future. The investment is surely worth it. 

SUSTAIN AND SEIZE CANCER RESEARCH OPPORTUNITIES

The tremendous investment our Nation has made in the National Institutes of 

Health (NIH) has reaped remarkable returns and set the table for a period of unparalleled innovation in the fight against cancer and other diseases. For fiscal year 

2007, OVAC joins with the broader public health community and urges Congress 

to provide $29.7 billion for the NIH, a $1.4 billion increase over fiscal year 2006. 

This is the minimal level of funding that will allow the NIH to maintain the current 

pace of discovery and innovation. 

OVAC recognizes the fiscal challenges facing policymakers, but does not believe 

that those challenges require us to weaken our national commitment to conquering 

cancer. While the long-term goal of providing adequate funding to explore the most 

promising opportunities must remain paramount, for fiscal year 2007, OVAC urges 

Congress to provide the National Cancer Institute (NCI) with at least $5.034 billion, 

a $240 million increase over fiscal year 2006. This level of funding is the bare minimum required to protect our cancer research enterprise and maintain the current 

pace of discovery. 

While a minimal increase of $240 million will maintain current programs, it is 

not sufficient to allow us to move forward with advances that we know are possible. 

For fiscal year 2007, OVAC would recommend an increase closer to that of the professional judgment budget prepared by the NCI Director. This budget, which calls 

for $5.9 billion for fiscal year 2007, represents our national battle plan against cancer, outlining the critical core research that is currently underway and the most 

promising and extraordinary research opportunities. These exceptional research opportunities include expansion of the NCI-designated cancer centers program from 60 

to 75 centers; implementation of the plan to reengineer cancer clinical trials for 

greater standardization, speed, and efficiency; construction of linkages between 

science and the new technologies of advanced imaging, proteomics, and computational modeling; expansion of the use of medical informatics and bioinformatics to 

cancer-specific applications; and development of an integrative site-based approach 

to cancer research through interdisciplinary team science and collaboration. The 

professional judgment budget is developed through an open and public process; it 

reflects the best thinking of cancer researchers, patients, clinicians, and other constituency groups and is focused on the Institute’s goal of eliminating suffering and 

death from cancer by the year 2015. 

The National Center on Minority Health and Health Disparities (NCMHD) was 

created by Congress to help address the undue burden of chronic and acute disease, 

morbidity and mortality, and lower survival rates borne by racial and ethnic minor-
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ity groups, rural populations and other medically underserved populations. OVAC 

urges the Congress to provide the NCMHD with $200 million for fiscal year 2007 

to advance its critical work coordinating and advancing health disparities research 

across the NIH. OVAC seeks to ensure that NCMHD has the resources to develop 

and enhance initiatives aimed at reducing and ultimately eliminating disparities in 

many chronic diseases, including cancer. Having worked with Congress to establish 

the NCMHD, the members of OVAC are committed to seeing it fulfill its mission 

and achieve its goals and objectives. 

BOOST OUR NATION’S INVESTMENT IN CANCER PREVENTION, EARLY DETECTION, AND

AWARENESS

The Centers for Disease Control and Prevention’s (CDC) State-based cancer programs provide vital resources for cancer monitoring and surveillance, breast and 

cervical cancer screening, State cancer control planning and implementation, and 

awareness initiatives targeting skin, prostate, colon, ovarian and blood cancers. For 

fiscal year 2007, OVAC requests the following funding levels for these proven programs: 

—National Comprehensive Cancer Control Program: $50 million (∂$33 million).— 

The Comprehensive Cancer Control program provides grants and technical assistance to help States develop and implement plans addressing the cancers 

most significantly affecting their communities through prevention, early detection and treatment. OVAC’s request will allow this program to help more States 

implement previously developed plans. 

—National Program of Cancer Registries: $65 million (∂$16.89 million).—The 

National Program of Cancer Registries facilitates State tracking of cancer 

trends and subsequent allocation of resources to address specific needs, while 

also identifying highly effective cancer control programs that can be emulated 

across the country. The registry provides critical data to ensure we remain on 

track in the fight against cancer. OVAC’s request will enable States to continue 

to collect and analyze high-quality data as well as evaluate existing cancer prevention efforts. 

—National Breast and Cervical Cancer Early Detection Program: $250 million 

(∂$47.57 million).—OVAC appreciates the Administration’s longstanding commitment to this important program that provides free breast and cervical 

screening tests to low income and uninsured women. Unfortunately, millions of 

eligible women lack access to these critical tests due to lack of funding. The 

CDC estimates that the program currently only reaches 20 percent of eligible 

women aged 50 to 64. OVAC’s funding request for fiscal year 2007 would allow 

at least an additional 130,000 women to be served by the program. 

—Colorectal Cancer Screening, Education & Outreach Initiative: $25 million 

(∂$10.51 million).—Strong scientific evidence has shown that regular screening 

and treatment is a cost-effective way to reduce colorectal cancer incidence and 

mortality. However, screening rates for CRC are currently lower than for other 

cancer screening services. The Colorectal Cancer Screening, Education & Outreach Initiative helps increase public awareness of colorectal cancer, educate 

health care providers about colorectal screening guidelines and assist State programs with colorectal cancer priorities. With additional resources this program 

will be able to expand its awareness initiatives and reduce the number of preventable colorectal cancer deaths. 

—National Skin Cancer Prevention Education Program: $5 million (∂$2.93 million).—Skin cancer is the most common form of cancer in the United States and 

is largely preventable. OVAC’s request will allow the program to educate the 

public about ways to protect themselves and reduce the risks of getting skin 

cancer. 

—Prostate Cancer Control Initiatives: $20 million (∂6.07 million).—This initiative 

provides the public, with special emphasis on men and their physicians, with 

information about prostate cancer screening and early detection. OVAC’s request will allow the program to expand and improve its outreach efforts. 

—Ovarian Cancer Control Initiatives: $7.5 million (∂$2.98 million).—The Ovarian Cancer Initiative partners with academic and medical institutions to spur 

discovery of techniques that will detect this cancer and develop more successful 

treatments. OVAC’s request will increase public and professional awareness of 

the symptoms and best treatments for ovarian cancer, restoring hope to the 

more than 20,000 women who will be diagnosed with this devastating illness 

this year. 

—Geraldine Ferraro Blood Cancer Program: $5 million (∂$0.46 million).—Authorized under the Hematological Cancer Research Investment and Education 
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Act of 2002, this program was created to provide public and patient education 

about blood cancers, including leukemia, lymphoma and myeloma. OVAC’s request will allow the program to continue to provide patients with educational, 

disease management and survivorship resources to enhance treatment and 

prognosis. 

SECURING AND MAINTAINING AN ADEQUATE ONCOLOGY NURSING WORKFORCE

OVAC joins with the nursing community in asking Congress to provide $175 million in fiscal year 2007 for the Nurse Reinvestment Act and the other nursing workforce programs at the Health Resources and Services Administration (HRSA). Over 

the next 15 years, the number of Medicare beneficiaries with cancer is expected to 

double, while more than 1.1 million nursing positions go unfilled. The critical role 

of nurses in our health care system cannot be overstated. Oncology nurses are on 

the front-lines of the provision of quality care for cancer patients and are vital to 

administering chemotherapy, managing patient treatments and side-effects and providing counseling to patients and family members. 

Without an adequate supply of nurses, there will not be enough qualified oncology 

nurses to provide quality, comprehensive cancer care to a growing patient population in need. Nurses are also vital to helping conduct cancer research through clinical trials, and a shortage will slow down the pace of medical research progress. 

These programs will help address the multiple factors contributing to the nationwide nursing shortage, including the decline in student enrollments, shortage of faculty and poor public perception of nursing as a viable and worthwhile profession. 

CONCLUSION

OVAC stands ready to work with policymakers to ensure that funding for cancer 

research and related programs is a top priority in fiscal year 2007 and beyond. We 

thank you for this opportunity to discuss the funding levels necessary to ensure that 

our Nation continues to make gains in our fight against cancer and has a sufficient 

nursing workforce to care for the patients with cancer of today and tomorrow. 

PREPARED STATEMENT OF THE OVARIAN CANCER NATIONAL ALLIANCE

On behalf of the Ovarian Cancer National Alliance (the Alliance), I thank the subcommittee for this opportunity to submit written testimony regarding the fiscal year 

2007 funding allocations for programs in the Labor-Health and Human Services and 

Education appropriations measure that the Alliance and ovarian cancer community 

believe are necessary to help reduce and prevent suffering from ovarian cancer. 

Since its inception nine years ago, the Alliance has worked to increase awareness 

of ovarian cancer and boost Federal resources to support scientific research into 

diagnostics and treatments for the disease. Among the most urgent challenges in 

the ovarian cancer field are late detection and poor survival of women. 

As a national umbrella organization with 50 regional, State, and local groups, the 

Alliance unites and reaches more than 800,000 grassroots activists, women’s health 

advocates, health care professionals and the public to bring national attention to 

ovarian cancer. As part of this effort, the Alliance advocates for a sustained Federal 

investment in ovarian cancer research, awareness, education and early detection. To 

that end, the Alliance respectfully requests that the subcommittee provide the following in fiscal year 2007 funding: 

—$7.5 million to the Centers for Disease Control and Prevention’s (CDC) Ovarian 

Cancer Control Initiative; 

—$29.7 billion to the National Institutes of Health (NIH); and 

—$5.034 billion to the National Cancer Institute (NCI). 

These three agencies are working relentlessly to achieve much-needed gains in 

ovarian cancer early detection, treatment and survivorship. Consistent investment 

in ovarian cancer research and public awareness campaigns at CDC, NIH and NCI 

is vital to our fight against this deadly disease. The Alliance believes all women 

should have the opportunity to survive ovarian cancer, but unfortunately, unless our 

Nation makes significant investment in ovarian cancer research and awareness efforts, thousands of women will continue to lose their lives every year. 

OVARIAN CANCER’S DEADLY STATISTICS

Today, it is both striking and disheartening to see that despite progress made in 

the scientific, medical and advocacy communities, ovarian cancer mortality rates 

have not significantly improved during the past decade. According to the American 

Cancer Society, in 2006 more than 20,000 American women will be diagnosed with 
519 

ovarian cancer and approximately 15,300 will lose their lives to this disease, making 

it the fifth leading cause of cancer death in women (behind lung, breast and 

colorectal cancers). Every woman is at risk for ovarian cancer and one in 58 will 

develop it in her lifetime. 

Behind the sobering statistics are the lost lives of our loved ones, colleagues and 

community members. The country recently lost a national treasure to the disease 

when Mrs. Coretta Scott King died from stage III ovarian cancer in January. Her 

disease was considered terminal after a late-stage diagnosis. Unfortunately, Mrs. 

King’s story is common for women in our community. When detected early, the fiveyear survival rate for women with ovarian cancer increases to more than 90 percent. 

However, a valid and reliable screening test—a critical tool for improving early diagnosis and survival rates—still does not exist for ovarian cancer. With no early detection test, more than 75 percent of women diagnosed with ovarian cancer are diagnosed in stage III or IV. At these stages prognosis is worst as the five-year survival 

rate drops below 30 percent. In simple terms, today, almost half (45 percent) of all 

women with ovarian cancer will die within five years of their diagnosis. 

Until a screening test is developed, public knowledge of the symptoms of ovarian 

cancer and comprehensive, effective treatment protocols are the keys to reduced 

mortality rates. The CDC Ovarian Cancer Control Initiative, NIH and NCI work together to support programs and research grants that seek to improve early detection 

and treatment and educate women and health care providers about ovarian cancer, 

thereby increasing awareness and ultimately saving lives. 

THE OVARIAN CANCER CONTROL INITIATIVE AT THE CENTERS FOR DISEASE CONTROL

AND PREVENTION

The CDC Ovarian Cancer Control Initiative plays an essential role in our Nation’s 

fight to eliminate suffering and death from ovarian cancer. Created by Congress in 

2000, the program coordinates and funds health activities aimed at identifying and 

filling any gaps in knowledge of ovarian cancer diagnosis and treatment. According 

to the program website, ‘‘CDC enhances the limited knowledge about ovarian cancer 

by initiating research projects with partners, colleagues and national organizations 

to help identify factors related to early disease detection and treatment and survivorship.’’ The CDC Ovarian Cancer Control Initiative actively partners with State 

cancer registries and cancer centers across the country. 

As the Nation’s leading public health agency, the CDC plays an important role 

in translating and delivering research discoveries at the community level, especially 

ensuring that those populations disproportionately affected by cancer receive the 

benefits of our Nation’s investment in medical research. With its extensive network 

of health professionals and cancer registries, the CDC is the optimal Federal agency 

for such work. 

EARLY DETECTION AND AWARENESS

Most women and many health professionals remain unaware of the signs and 

symptoms associated with ovarian cancer. Consequently, many women suffer with 

the disease for months, even years, prior to receiving an accurate—and often fatal— 

diagnosis. Since there is no effective screening tool for ovarian cancer, it is imperative that women and their health care providers be aware of the multiple ways that 

ovarian cancer can present in a woman through symptoms. The CDC Ovarian Cancer Control Initiative is unique among CDC cancer programs. With no screening 

tool, the goal of the Ovarian Cancer Control Initiative is to learn more about current 

practice and identify areas of knowledge and practice patterns that need improvement to reduce the overwhelming burden of ovarian cancer. 

STANDARDS OF CARE AND TREATMENT

The efforts of the CDC Ovarian Cancer Control Initiative also are targeted at improving prognosis for women currently living with and fighting the disease. Investigation into early symptoms, survival trends based on care provided, and research 

into general epidemiology will fill in information gaps to provide a stable body of 

knowledge which will guide future research. Most significantly, examination of survival trends based on care received contributes to the development of best practice 

guidelines for women with ovarian cancer. Currently, research funded by the Ovarian Cancer Control Initiative addresses four public health questions: 

—What factors influence risk perception and how does risk perception affect 

screening behaviors? 

—What are the primary diagnostic pathways in the diagnosis of ovarian cancer? 

—Are women receiving optimal surgical and chemotherapy treatments? 

—Are women receiving optimal end-of-life care? 
520 

Investigation into these questions will allow the CDC to maximize screening effectiveness by primary care physicians, improve early detection and diagnosis and provide physicians with ‘‘best practice’’ guidelines for women diagnosed with ovarian 

cancer. According to the CDC, $2.2 billion is spent on treatment for ovarian cancer 

each year. This figure could greatly be reduced with earlier diagnoses and more efficient practice guidelines. 

CDC OVARIAN CANCER CONTROL INITIATIVE-FUNDED GRANTS

Grants supported by the CDC Ovarian Cancer Control Initiative have covered a 

diverse array of activities over the past six years, all aimed at accomplishing the 

program’s mission of increasing awareness and improving treatment and survivorship of ovarian cancer. Current on-going ovarian cancer studies include the following: 

—The Division of Cancer Prevention and Control (DCPC) at the CDC is investigating the influence of perceived risk of ovarian cancer on screening behaviors. 

This information will be used to maximize screening effectiveness in average 

and high risk women. 

—Analysis of records of ovarian cancer patients and healthy women presenting 

symptoms similar to those associated with ovarian cancer to create more specific guidelines for symptom-recognition. 

—Investigation into the relationship between patient characteristics, provider 

characteristics, diagnostic procedures and referral patterns leading to a positive 

diagnosis to create best practice guidelines for primary care physicians. 

—Investigation into current surgical and chemotherapy practices for women diagnosed with ovarian cancer to develop best practice guidelines and to identify the 

demographics of women who typically receive poor treatment plans. 

—Research and development of end-of-life care guidelines to prevent undue suffering in women with ovarian cancer. 

BOOSTING THE CDC’S OVARIAN CANCER PREVENTION AND AWARENESS EFFORTS

In only six years of existence, the CDC Ovarian Cancer Control Initiative has 

made important contributions to better understanding and awareness of the disease. 

However, until the development of a valid and reliable screening test, more must 

be done to increase awareness and recognition of the symptoms of ovarian cancer. 

The full impact and benefits of CDC Ovarian Cancer Control Initiative efforts will 

not be fully realized unless the results are effectively translated into public health 

interventions. 

The CDC Ovarian Cancer Control Initiative must continue to build its research 

efforts, but needs enhanced funding to move research results out to health care providers and women. Most significantly, increased resources are needed for a national 

effort to educate primary care providers on the signs and symptoms of ovarian cancer. These physicians and nurses are the most likely group to encounter women presenting with ovarian cancer warning signs and symptoms that, if recognized early, 

could lead to a faster diagnosis and therefore an increased chance of survival. 

Additional funding in fiscal year 2007 will enable the CDC to expand the reach 

and scope of its current ovarian cancer initiatives to help advance our Nation’s efforts to reduce and prevent ovarian cancer morbidity and mortality. The allocation 

of $7.5 million in fiscal year 2007 will continue the excellent progress being made 

and would help expand the program’s efforts to include: 

—Development and implementation of two critical and complementary national 

campaigns about the signs and symptoms of ovarian cancer: 

—(A) A public education campaign with a focus on the signs and symptoms of 

ovarian cancer, the importance of regular monitoring for high risk populations 

and strategies for risk reduction. 

—(B) A targeted education and awareness campaign involving primary care 

physicians. 

—Examination of the epidemiology of ovarian cancer and development of appropriate strategies for addressing issues related to incidence and survival in minority populations. 

—Training of health care professionals in best practices for treating ovarian cancer, emphasizing referral to gynecologic oncologists for optimal survival outcomes. 

A SUSTAINED COMMITMENT TO FUND CANCER RESEARCH

Our Nation has reaped many benefits from past Federal investments in biomedical research at the NIH. The Alliance has joined with the broader health community in urging Congress to provide NIH $29.7 billion and NCI $5.034 billion in 
521 

fiscal year 2007 to allow these agencies to sustain their efforts while also having 

the resources to avoid the severe disruption to that progress that would result from 

a minimal funding increase. The requested increase in NCI allocations represents 

our national battle plan against cancer, focusing on critical ongoing research and 

promising research opportunities. 

When funding stagnates or does not keep pace with inflation, progress in critical 

research programs can be halted or slowed significantly. Inadequate funding for the 

NIH, NCI and the CDC can result in inadequate funding for the lesser-known or 

less popular—yet terribly devastating—diseases such as ovarian cancer. The requested funding levels would provide the minimum resources required to preserve 

our cancer research enterprise and maintain the current pace of discovery. 

SUMMARY AND CONCLUSION

The Alliance maintains a long-standing commitment to work with Congress, the 

Administration, and other policymakers and stakeholders to improve the survival 

rate from ovarian cancer through education, public policy, research and communication. Please know that we appreciate and understand that Congress has limited resources to allocate, but we believe the health and safety of American women are imperative to the strength of our Nation and should be a national priority. We are concerned that without increased funding to bolster and expand ovarian cancer education, awareness and research efforts, the Nation will continue to see growing 

numbers of women losing their battle with this terrible disease. 

On behalf of the entire ovarian cancer community—patients, family members, clinicians and researchers—we thank you for your leadership and support of Federal 

programs that seek to reduce and prevent suffering from ovarian cancer. Thank you 

in advance for your support of the funding allocations we have requested for the 

CDC Ovarian Cancer Control Initiative, NIH and NCI. Please know that we stand 

ready to serve as a resource for any information you may need. Thank you for the 

opportunity to submit testimony on fiscal year 2007 ovarian cancer funding. 

PREPARED STATEMENT OF THE POPULATION ASSOCIATION OF AMERICA/ASSOCIATION

OF POPULATION CENTERS

INTRODUCTION

Thank you, Mr. Chairman Specter, Mr. Ranking Member Harkin, and other distinguished members of the subcommittee, for this opportunity to express support for 

the National Institutes of Health (NIH) and the National Center for Health Statistics (NCHS)—two agencies important to our organizations. 

BACKGROUND ON THE PAA/APC AND DEMOGRAPHIC RESEARCH

The PAA is a scientific organization comprised of over 3,000 population research 

professionals, including demographers, sociologists, and economists. The APC is a 

similar organization comprised of over 30 universities and research groups that foster collaborative demographic research and data sharing, translate basic population 

research for policy makers, and provide educational and training opportunities in 

population studies. Over 30 population research centers are located throughout the 

country, including two in Ohio (Bowling Green State University and Ohio State University) and two in Pennsylvania (Pennsylvania State University and the University 

of Pennsylvania). 

Demography is the study of populations and how or why they change. Demographers, as well as other population researchers, collect and analyze data on trends 

in births, deaths, and disabilities as well as racial, ethnic, and socioeconomic 

changes in populations. Major policy issues population researchers are studying include the demographic causes and consequences of population aging, trends in fertility, marriage, and divorce and their effects on the health and well being of children, and immigration and migration and how changes in these patterns affect the 

ethnic and cultural diversity of our population and the Nation’s health and environment. 

The NIH mission is to support research that will improve the health of our population. The health of our population is fundamentally intertwined with the demography of our population. Recognizing the connection between health and demography, the NIH supports population research programs primarily through the National Institute on Aging (NIA) and the National Institute of Child Health and 

Human Development (NICHD). 
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1Federal Interagency Forum on Aging Related Statistics. Older Americans 2000: Key Indicators of Well-Being. 2000. 

NATIONAL INSTITUTE ON AGING

Over the next 25 years, the number of individuals age 65 and older will likely 

double, reaching 70.3 million and comprising a larger proportion of the entire population, rising from 13 percent today to 20 percent in 2030.1This substantial growth 

in the older population is driving policymakers to consider dramatic changes in Federal entitlement programs, such as Medicare and Social Security, and other budgetary changes that could affect programs serving the elderly. Further, the macroeconomic and global impact of population aging on competitiveness in the world 

economy is becoming a bigger issue. To inform this debate, policymakers need objective, reliable data about the antecedents and impact of changing social, demographic, economic, and health characteristics of the older population. The NIA Behavioral and Social Research (BSR) program is the primary source of Federal support for research on these topics. 

In addition to supporting an impressive research portfolio, that includes the prestigious Centers of Demography of Aging Program, the NIA BSR program also supports several large, accessible data surveys. Two such surveys, the National LongTerm Care Survey (NLTCS) and the Health and Retirement Study (HRS) have become seminal sources of information to assess the health and socioeconomic status 

of older people in the United States. By using NLTCS data, investigators identified 

the declining rate of disability in older Americans first observed in the mid-1990s— 

a trend that continued and even accelerated. This trend, if continued, could have 

momentous impact on reducing the need for costly long-term care. The HRS, which 

was launched in 1992 and has tracked 27,000 people, has provided data on a number of issues, including the role families play in the provision of resources to needy 

elderly and the economic and health consequences of a spouse’s death. The Social 

Security Administration recognizes and funds the HRS as one of its ‘‘Research Partners’’ and posts the study on its home page to improve its availability to the public 

and policymakers. In 2005, the Center for Medicare and Medicaid Services (CMS) 

funded a supplemental survey using the HRS to provide CMS with timely information on who is likely to enroll in the new Medicare Part D prescription drug program and how those decisions are related to knowledge of the program, drug costs, 

and use. 

With additional support in fiscal year 2007, the NIA BSR program could fully 

fund its existing centers and support its ongoing surveys. Additional support would 

allow NIA to expand the centers’ role in understanding the domestic macroeconomic 

as well as the global competitiveness impact of population aging. NIA could also use 

additional resources to support individual investigator awards by precluding an 18 

percent cut in its existing grants, improving its funding payline, which is now in 

the 10th percentile, and sustaining training and research opportunities for new investigators, which are being heavily cut back. 

NATIONAL INSTITUTE ON CHILD HEALTH AND HUMAN DEVELOPMENT

Since its establishment in 1968, the NICHD Center for Population Research has 

supported research on population processes and change. Today, this research is 

housed in the Center’s Demographic and Behavioral Sciences Branch (DBSB). The 

Branch encompasses research in four broad areas: family and fertility, mortality and 

health, migration and population distribution, and population composition. In addition to funding research projects in these areas, DBSB also supports a highly regarded population research infrastructure program and a number of large database 

studies, including the Fragile Families and Child Well Being Study and National 

Longitudinal Study of Adolescent Health. 

NICHD-funded demographic research has consistently provided critical scientific 

knowledge on issues of greatest consequence for American families: work-family conflicts, marriage and childbearing, childcare, and family and household behavior. 

However, in the realm of public health, demographic research is having an even 

larger impact, particularly on issues regarding adolescent and minority health. For 

example, in 2006, researchers with the National Longitudinal Study of Adolescent 

Health, reported findings illustrating that by the time they reach early adulthood 

(age 19–24), a large proportion of American youth have begun the poor practices 

contributing to three leading causes of preventable death in the United States: 

smoking, poor diet and physical inactivity, and alcohol abuse. This study is striking 

in that it found the health situation of young people—in terms of behavior, health 

conditions, and access to and use of care—deteriorates markedly between the teen 

and young adult years. The study reinforces the importance of educating young peo-
523 

ple about adopting healthy lifestyles after they leave high school and the parental 

home. 

Understanding the role of marriage and stable families in the health and development of children is another major focus of the NICHD DBSB. Consistently, research 

has shown children raised in stable family environments have positive health and 

development outcomes. Therefore, NICHD supports research to elucidate factors 

that contribute to family formation and strong partnerships. Recent findings have 

identified factors that can destabilize relationships between new parents. These factors include serious health or developmental problems of the parents’ child, lower 

earnings, less education, and a father who has other children with different mothers. Policymakers and community programs can use these findings to support unstable families and improve the health and well being of children. 

With additional support in fiscal year 2007, NICHD could restore full funding to 

its large-scale surveys, which serve as a resource for researchers nationwide. Furthermore, the Institute could apply additional resources toward improving its funding payline, which has gone from the 20th percentile range in 2003 to the 10th percentile in January 2006. Additional support could be used to preclude cuts of 17 percent to 22 percent in applications approved for funding and to support and stabilize 

essential training and career development programs to prepare the next generation 

of researchers. 

NATIONAL CENTER FOR HEALTH STATISTICS

Located within the Centers for Disease Control (CDC), the National Center for 

Health Statistics (NCHS) is the Nation’s principal health statistics agency, providing data on the health of the U.S. population and backing essential data collection activities. Most notably, NCHS funds and manages the National Vital Statistics 

System, which contracts with the States to collect birth and death certificate information. NCHS also funds a number of complex large surveys to help policy makers, 

public health officials, and researchers understand the population’s health, influences on health, and health outcomes. These surveys include the National Health 

and Nutrition Examination Survey, National Health Interview Survey, and National 

Survey of Family Growth. Together, NCHS programs provide credible data necessary to answer basic questions about the state of our Nation’s health. 

In fiscal year 2006, Congress provided NCHS with the same level of funding as 

in fiscal year 2005, and the Administration has recommended NCHS receive the 

same level in fiscal year 2007. For fiscal year 2007, the Friends of NCHS recommends the agency receive $139 million, a $30 million increase over the fiscal year 

2006 level. This funding is needed to, among other things, cover cost increases in 

basic survey operations, improve data timeliness and access to data, and expand 

and improve data collection to capture much needed information on issues such as 

health disparities, assisted living, and community health centers. 

RECOMMENDATIONS

At a time when our Nation is poised to reap the promise of the past investment 

made in the NIH, the agency is facing the prospect receiving flat funding in fiscal 

year 2007. When inflation is factored in, the NIH could actually be facing being 

funded for the fourth year in a row below the rate of biomedical research inflation. 

PAA and APC join other organizations in expressing our concern about the precarious NIH funding trajectory. Already, NIH has seen a 15 percent reduction in new 

grants between fiscal year 2003 and fiscal year 2006. For population research, increased support is needed to ensure the best research projects, including new and 

innovative projects, are being awarded, surveys and databases are supported, and 

training programs are stabilized. With respect to NCHS, funding is needed to sustain and update its major operations. 

The PAA and APC join the Ad Hoc Group for Medical Research in supporting an 

fiscal year 2007 appropriation of $29.75 billion, a 5 percent increase over the fiscal 

year 2006 appropriation, for the NIH. In addition, the Friends of NCHS, support 

a fiscal year 2007 appropriation of $139 million, a 30 percent increase over the fiscal 

year 2006 appropriation, for the NCHS. Finally, PAA and APC urge the subcommittee to include language in the fiscal year 2007 bill, allowing continuation of 

the National Children’s Study at the NICHD. 

Thank you for considering our requests and for supporting Federal programs that 

benefit the field of demographic research. 
524 

PREPARED STATEMENT OF THE PULMONARY HYPERTENSION ASSOCIATION

SUMMARY OF FISCAL YEAR 2007 RECOMMENDATIONS

—$250,000 within the Centers for Disease Control and Prevention for a pulmonary hypertension awareness and education program. 

—A 5 percent increase for the National Heart, Lung and Blood Institute and the 

establishment of ‘‘Specialized Centers of Clinically Orientated Research’’ on Pulmonary Hypertension at the Institute. 

—$25 million for the Health Resources and Services Administration’s ‘‘Gift of 

Life’’ Donation Initiative. 

Mr. Chairman, thank you for the opportunity to submit testimony on behalf of the 

Pulmonary Hypertension Association. 

I am honored today to represent the hundreds of thousands of Americans who are 

fighting a courageous battle against this devastating disease. Pulmonary hypertension is a serious and often fatal condition where the blood pressure in the lungs 

rises to dangerously high levels. In PH patients, the walls of the arteries that take 

blood from the right side of the heart to the lungs thicken and constrict. As a result, 

the right side of the heart has to pump harder to move blood into the lungs, causing 

it to enlarge and ultimately fail. 

PH can occur without a known cause or be secondary to other conditions such as; 

collagen vascular diseases (i.e., scleroderma and lupus), blood clots, HIV, sickle cell, 

and liver disease. PH does not discriminate based on race, gender or age. Patients 

develop symptoms that include shortness of breath, fatigue, chest pain, dizziness, 

and fainting. Unfortunately, these symptoms are frequently misdiagnosed, leaving 

patients with the false impression that they have a minor pulmonary or cardiovascular condition. By the time many patients receive an accurate diagnosis, the 

disease has progress to a late stage, making it impossible to receive a necessary 

heart or lung transplant. 

While new treatments are available, unfortunately, PH is frequently misdiagnosed 

and often progresses to late stages by the time it is detected. Although PH is chronic 

and incurable with a poor survival rate, the new treatments becoming available are 

providing a significantly improved quality of life for patients. Recent data indicates 

that the length of survival is continuing to improve, with some patients able to manage the disorder for 20 years or longer. 

Fifteen years ago, when three patients who were searching to end their own isolation founded the Pulmonary Hypertension Association, there were less than 200 diagnosed cases of this disease. It was virtually unknown among the general population and not well known in the medical community. They soon realized that this 

was unacceptable, and formally established PHA, which is headquartered in Silver 

Spring, Maryland. 

Today, PHA includes: 

—Over 6,000 patients, family members, and medical professionals. 

—An international network of over 120 support groups. 

—An active and growing patient telephone helpline. 

—A new and fast-growing research fund. (A cooperative agreement has been 

signed with the National Heart, Lung, and Blood Institute to jointly create and 

fund five, five-year, mentored clinical research grants and PHA has awarded 

eleven Young Researcher Grants.) 

—Numerous electronic and print publications, including the first medical journal 

devoted to pulmonary hypertension—published quarterly and distributed to all 

cardiologists, pulmonologists and rheumatologists in the United States. 

Mr. Chairman, at the age of 5, my wife and I noticed that our daughter, Emily, 

could not keep up with the other kids in the neighborhood. She seemed to lack the 

energy and strength to run and play. This condition seemed to worsen to the point 

to where she would have to stop and rest after coming down the steps in the morning. We noticed that when she was sitting on the bottom step in the morning, her 

lips appeared to have a bluish color. 

After pressing for an answer to these problems for several months, Emily was finally diagnosed with pulmonary hypertension and the doctors gave a probable remaining lifespan of three years. That unforgettable day was 8 years ago and, as you 

can see, Emily is still here today. She is here because of continued advances in the 

treatment of pulmonary hypertension and by the grace of God. There is however, 

NO cure for pulmonary hypertension. Thanks to congressional action, Emily’s 

chances of a full life have greatly increased. We need, however, additional support 

for research and related activities to continue to develop treatments that will extend 

the published NIH life expectancy beyond the 2.8 years after diagnosis. 
525 

FISCAL YEAR 2007 APPROPRIATIONS RECOMMENDATIONS

(A) National Heart, Lung and Blood Institute 

Mr. Chairman, PHA commends the National Heart, Lung and Blood Institute 

(NHLBI) for its strong support of PH research. According to leading researchers in 

the field, we are on the verge of significant breakthroughs in our understanding of 

the disease and the development of new and advanced treatments. Ten years ago, 

a diagnosis of PH was essentially a death sentence, with only one approved treatment for the disease. Thanks to advancements made through the public and private 

sector, patients today are living longer and better lives with a choice of five FDA 

approved therapies. Recognizing we have made tremendous progress, we are also 

mindful that we are a long way from where we want to be, and that is; (1) the management of pulmonary hypertension as a treatable chronic disease, and (2) A CURE. 

Mr. Chairman, it is our understanding that NHLBI is poised to establish ‘‘Specialized Centers of Clinically Orientated Research’’ in pulmonary hypertension later 

this year. We are very excited about the promise these Centers hold for the future 

development of new treatments and we encourage the subcommittee to support this 

worthy investment. In addition, we applaud NHLBI and the NIH Office of Rare Diseases for their plans to co-sponsor a two-day scientific conference on pulmonary hypertension this Fall. This important event will bring together leading PH researchers from the United States and abroad to discuss the state of the science in pulmonary hypertension and future research directions. 

In order to facilitate the establishment of the Specialized Centers of Clinically 

Orientated Research and maintain promising research currently underway on PH, 

the Pulmonary Hypertension Association encourages the subcommittee to provide 

NHLBI with a 5 percent increase in funding in fiscal year 2007. 

(B) Centers for Disease Control and Prevention 

PHA applauds the subcommittee for its leadership over the years in encouraging 

the Centers for Disease Control and Prevention to initiate a Pulmonary Hypertension Education and Awareness Program. We know for a fact that Americans are 

dying due to a lack of awareness of PH, and a lack of understanding about the many 

new treatment options. This unfortunate reality is particularly true among minority 

and underserved populations. However Mr. Chairman, you don’t have to rely solely 

on our word regarding the need for additional education and awareness activities. 

On November 11, 2005 the CDC released a long awaited Morbidity and Mortality 

Report on pulmonary hypertension. In that report, the CDC states: 

(1) ‘‘More research is needed concerning the cause, prevention, and treatment of 

pulmonary hypertension. Public health initiatives should include increasing physician awareness that early detection is needed to initiate prompt, effective disease 

management. Additional epidemiologic initiatives also are needed to ascertain prevalence and incidence of various pulmonary hypertension disease entities.’’ (Page 1, 

MMWR Surveillance Summary—Vol. 54 No. SS–5) 

(2) ‘‘Prevention efforts, including broad based public health efforts to increase 

awareness of pulmonary hypertension and to foster appropriate diagnostic evaluation and timely treatment from health care providers, should be considered. The 

science base for the etiology, pathogenesis, and complications of pulmonary hypertension disease entities must be further investigated to improve prevention, treatment, and case management. Additional epidemiologic activities also are needed to 

ascertain the prevalence and incidence of various disease entities.’’ (Page 7, MMWR 

Surveillance Summary—Vol. 54 No. SS–5) 

Mr. Chairman, we are grateful to CDC for their recent support of a DVD highlighting the proper diagnosis of PH. However, despite repeated encouragement from 

the subcommittee over the past 5 years, CDC has not taken any steps to establish 

an education and awareness program on PH. Therefore, we respectfully request that 

you provide $250,000 in fiscal year 2007 for the establishment of a PH awareness 

initiative through the Pulmonary Hypertension Association. 

(C)‘‘Gift of Life’’ Donation Initiative at HRSA 

Mr. Chairman, PHA applauds the success of the Health Resources and Services 

Administration’s ‘‘Gift of Life’’ Donation Initiative. This important program is working to increase organ donation rates across the country. Unfortunately, the only 

‘‘treatment’’ option available to many late-state PH patients is a lung or heart and 

lung transplantation. This grim reality is why PHA established ‘‘Bonnie’s Gift 

Project.’’ ‘‘Bonnie’s Gift’’ was started in memory of Bonnie Dukart, one of PHA’s 

most active and respected leaders. Bonnie was a PH patient herself. She battled 

with PH for almost 20 years until her death in 2001 following a double lung transplant. Prior to her death, Bonnie expressed an interest in the development of a pro-
526 

gram within PHA related to transplant information and awareness. PHA will use 

‘‘Bonnie’s Gift’’ as a way to disseminate information about PH, transplantation and 

the importance of organ donation to our community and organ donation cards. 

PHA has had a very successful partnership with HRSA’s ‘‘Gift of Life’’ Donation 

Program in recent years. Collectively, we have worked to increase organ donation 

rates and raise awareness about the need for PH patients to ‘‘early list’’ on transplantation waiting lists. For fiscal year 2007, PHA recommends an appropriation of 

$25 million (an increase of $2 million) for this important program. 

Mr. Chairman, once again thank you for the opportunity to present the views of 

the Pulmonary Hypertension Association. We look forward to continuing to work 

with you and the subcommittee to improve the lives of pulmonary hypertension patients. 

PREPARED STATEMENT OF THE SOCIETY FOR INVESTIGATIVE DERMATOLOGY

SUMMARY OF THE SOCIETY FOR INVESTIGATIVE DERMATOLOGY’S FISCAL YEAR 2007

RECOMMENDATIONS

(1) A 5 percent increase for all of the National Institutes of Health (NIH) and for 

the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). 

(2) Establishment of a skin disease clinical trials network that will collect baseline 

data for specific orphan diseases and facilitate the exchange of scientific data across 

disciplines and institutes. 

(3) Encourage NIAMS to develop collaborative funding mechanisms with other 

NIH institutes and private foundations that leverage skin biology studies as a developmental model that will serve for the advancement of research across a multitude 

of diseases and specialties. 

(4) Encourage NIAMS to sponsor studies that capture general and skin disease 

specific measures in order to generate incidence, prevalence and quality of life data 

attributable to skin diseases. 

(5) Increase the number of training awards through the NIH designed to facilitate 

the entry of more individuals into careers in skin disease research. 

BACKGROUND

The Society for Investigative Dermatology (SID) was founded in 1938. Its 2,000 

members represent over 40 countries worldwide, including scientists and physician 

researchers working in universities, hospitals and industry. 

Our members are dedicated to the advancement and promotion of the sciences relevant to skin health and disease through education, advocacy, and the scholarly exchange of scientific information along with our colleagues from the American Academy of Dermatology. 

This collective commitment to research is evidenced in the scientific journal published by the SID, the Journal of Investigative Dermatology. The Journal is a catalyst for the exchange of scientific information pertaining to the 3,000 skin diseases 

that afflict nearly 80 million Americans annually. 

The purpose in presenting testimony is to increase awareness of the need for more 

skin research, based on the burden attributable to skin disease. It will also highlight 

some of the advancements that past support has enabled. 

We join with the Ad Hoc Group for Medical Research Funding in asking for a 5 

percent increase to the National Institutes of Health (NIH) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). 

BURDEN OF SKIN DISEASE

Prior bill report language directed NIAMS to ‘‘consider supporting the development of new tools to measure the burden of skin diseases, and the training of researchers in this important area’’. There only a handful of researchers working on 

NIH-sponsored research that will provide such measures. 

Skin disease impacts our citizens more than previously estimated. A recent report 

released by the Society for Investigative Dermatology and the American Academy 

of Dermatology, ‘‘The Burden of Skin Disease’’, compiled data from only 21 of the 

known 3,000 skin diseases and disorders. The estimated economic costs to society 

each year from those 21 diseases totaled nearly $39 billion. 

The true impact extends far beyond mere economics. These patients encounter 

discomfort and pain, physical disfigurement, disability, dependency and death. Skin 

conditions affect an individual’s ability to interact with others and compromise the 

self-confidence of those inflicted. 
527 

One of the most striking findings in the study was the lack of general and skindisease specific measures that are needed to generate data surrounding the incidence, prevalence, economic burden, quality of life, disability and handicaps attributable to these diseases. 

We ask the Committee to devote the resources needed to develop components of 

national health surveys that capture dermatological data above and beyond skin 

cancer incidence and prevalence. 

RESEARCH ADVANCES

Skin is the body’s largest organ and serves as the primary barrier to external 

pathogens and toxins. Researchers at the NIH campus and institutions around the 

country are working diligently to define how the skin functions to protect us, how 

this fails in disease, and how compromised functions in disease can be restored. 

Cell biology allows scientists to understand the life cycle of skin and hair-producing cells and identify the causes of disease, leading to better treatments and preventative measures. Advances in wound healing and skin ulcers are helping the 

growing aging population, those with diabetes, burn victims and our veteran population. Lasers continue to provide less invasive options for patients requiring surgery. 

Fundamental discoveries resulting from skin biology and translational research 

have yielded advances that are broadly applicable to human development and disease. Continued investment is required to fully capitalize on these ground-breaking 

advances. 

Important new research findings include the following: 

—The genes responsible for skin cancer and inherited skin disorders have been 

identified, making targeted therapy possible. 

—The molecular mechanisms of auto-immune and inflammatory skin diseases are 

better understood, allowing for the use of focused, selective immunosuppressive 

therapy with greater safety and efficacy. 

—Oral medications to treat and prevent viral and fungal diseases have become 

available. 

—Lasers have made possible the removal of disfiguring skin malformations. 

—Modern phototherapy and photochemotherapy allow for more effective treatment of inflammatory skin disease, lymphoma, depigmenting disorders and 

auto-immune diseases. 

—Retinoids and sunscreens have reduced the risk of skin cancer in the elderly, 

in transplant patients, and in other populations. 

—Painless transdermal drug delivery has become available. 

Recent developments in the areas of clinical epidemiology, biostatistics, economics, 

and the quantitative social sciences have begun to provide objective evaluation 

measures, although additional and improved measures are still desperately needed. 

These measures will help to identify effective interventions and allow us to better 

quantify contributions to the quality of life and health of Americans. 

A significant portion of skin disease is chronic, resulting from aging, genetics and 

environmental and occupational exposure. 

We ask the NIH to work to identify additional biomarkers in order to better understand skin disease pathways and interaction with other diseases and environmental factors. 

TRANSLATING DISCOVERY TO TREATMENTS FOR AMERICANS

The goal of skin disease research is to improve the quality of life for the one in 

three Americans that suffer from skin disease. That goal is embedded in the collective missions of the SID and the intramural and extramural scientists funded 

through the skin portfolios of many of the 27 Institutes and Centers of the NIH. 

Medical research organizations such as the SID are the direct recipients of the 

awards made possible through the rigorous peer-reviewed grant system in place at 

the NIH. The ultimate beneficiaries are the nearly 80 million Americans that stand 

to benefit from the discoveries resulting from research grants. 

Inadequate levels of Federal funding have forced Institute administrators to reduce certain types of the available funding mechanisms currently in place at the 

NIH, to decrease success rates, to increase administrative cost reductions, to consider decreasing the number of awards, and to cut award levels in existing programs. 

Unfortunately, this reality impairs the ability of hypothesis-driven research, the 

source of countless discoveries, to drive the research system. Adequate funding levels will allow the peer-review system to work at full potential, leading to findings 

that translate into better care for those suffering from debilitating diseases. Without 
528 

sufficient funding provided specifically for skin research, nearly one third of the Nation would be denied any hope for a better quality of life. 

We are grateful for the past support that has been given to the NIH and ask you 

to look for innovative ways to avoid flat or decreased funding levels to these Institutes that are charged with improving the health of Americans. 

PREPARED STATEMENT OF THE SOCIETY FOR MATERNAL-FETAL MEDICINE

The Society for Maternal-Fetal Medicine appreciates the opportunity to comment 

on the fiscal year 2007 budget for the National Institutes of Health. We are especially grateful for the Committee’s support of the National Institute of Child Health 

and Human Development over the past years and urge your continued commitment 

to the critical medical research conducted and supported by the National Institutes 

of Health. 

Established in 1977, the Society for Maternal-Fetal Medicine (SMFM) is a not-forprofit organization of over 2,000 members that are dedicated to improving perinatal 

care through research and education. Maternal-fetal medicine doctors have advanced knowledge of the obstetrical, medical, genetic and surgical complications of 

pregnancy and their effects on both the mother and fetus. The many advances in 

research have allowed the maternal-fetal medicine physician to provide the direct 

care needed to treat the special problems that high risk mothers and fetuses face. 

The SMFM applauds the National Institute of Child Health and Human Development (NICHD) for its efforts to pursue research to understand, prevent and treat 

the abnormal events that can occur during pregnancy. For example: 

Preterm birth.—Remains a leading cause of death, illness, and disability among 

infants during their first year of life. It poses great risks to both the infant and 

mother. Infants born too early are at higher risk than full-term babies for medical 

and developmental complications. The earlier the birth, the more risk of complications. In addition even without any neonatal conditions, these infants face serious 

adult complications including heart disease and diabetes resulting from their intrauterine environment and low birthweight. 

NICHD-supported research has improved the outlook for preterm infants and 

families. The Maternal-Fetal Medicine Units (MFMU) Network established in 1986, 

to address issues pertaining to preterm births and low birth weight deliveries, has 

made steady and impressive strides in these areas. 

Researchers recently found that: 

—A substance in the urine of pregnant women can be measured to predict the 

later development of preeclampsia—a life-threatening complication of pregnancy. 

—Weekly injections of 17-hydroxyprogesterone can reduce preterm birth by more 

than one third among women who are at increased risk of preterm delivery. 

However, despite these efforts, the rate of preterm births continues to rise. SMFM 

therefore urges full support of the MFMU Network so that it can continue to address these issues. 

In addition, full funding of the new Genomic and Proteomic Network will hasten 

a better understanding of the pathophysiology of premature birth and discover novel 

diagnostic biomarkers. Studies to be undertaken by this network will ultimately aid 

in formulating more effective interventional strategies to prevent premature birth. 

Stillbirth.—Is a major public health issue with morbidity equal to that of all infant deaths. Despite this significant and persistent burden of stillbirths, they have 

remained largely unstudied and, for at least half of all stillbirths, the cause is undetermined. The NICHD cooperative network has initiated a pilot study with the full 

study planned to start this year. The information that will be obtained will aid in 

future research to improve preventive and therapeutic interventions and to understand the pathologic mechanisms leading to fetal death. Increased knowledge regarding the causes of stillbirths will benefit families who have experienced a loss, 

pregnant women, and their physicians, and may lead to the development and evaluation of improved clinical and preventive interventions. Full funding of this study 

is urgently needed. 

Near-Term Births.—The preterm birth rate is now over 12 percent of all live 

births, and of these 75 percent are near term births. Near-term birth occurs after 

35–37 weeks of gestation. It is estimated that this group encompasses 40 percent 

of Neonatal ICU admissions. These infants are at risk for sepsis; pneumonia; feeding difficulties; white matter damage; seizures; apnea; and remain at risk for higher 

morbidities in early infancy. This group of infants has not been well studied and 

may account for a portion of the increase in adverse long-term outcomes such as 
529 

autism, attention deficit disorders, and neurodevelopmental disorders. Additional 

funding will allow NICHD to facilitate the critical need for research in this area. 

In addition to the need for funding for research, the state of funding for physician 

scientists and researchers has become a major problem and is in dire need of a fix. 

Over the last decade, NICHD has responded to the scientific community’s need 

for enhanced training programs to provide a solid framework for the development 

of physician scientists and researchers. The expansion of research training programs 

has included a substantial investment in the ‘‘T’’ (Training Programs) and ‘‘F’’ (Fellowship Programs) line and the expansion of the ‘‘K’’ (Research Career Awards) line. 

After completion of these programs it is anticipated that investigators will be competitive for research awards. However, given the substantial reduction in the 

payline, the new investigator’s ability to be successful is severely restricted. It is imperative that NICHD identify and provide an opportunity for funding to investigators that NIH has already invested in through completion of training programs and 

who have demonstrated a commitment to a research career. It is of major concern 

to the scientific community that a cadre of scientists may be lost due to the stringent funding payline. 

RECOMMENDATIONS

—The Society for Maternal-Fetal Medicine supports a 5 percent increase in fiscal 

year 2007 for the National Institutes of Health (above the fiscal year 2006 funding level) as recommended by the Ad Hoc Group for Medical Research, along 

with the National Health Council, the Campaign for Medical Research and Research!America. 

—SMFM supports a 5 percent increase for the National Institute of Child Health 

and Human Development and urge full funding support for: 

—the Maternal Fetal Medicine Unit Network 

—the Genomic and Proteomic Network 

—Research in the area of near-term births 

—The stillbirth collaborative research network (SCRN) 

—Physician scientists and researchers 

Again, thank you for allowing SMFM the opportunity to express its concerns regarding the need for sustained funding in fiscal year 2007 for the critical research 

programs supported by the National Institute of Child Health and Human Development and the National Institutes of Health overall. 

PREPARED STATEMENT OF THE SOCIETY OF NUCLEAR MEDICINE

The Society of Nuclear Medicine (SNM) appreciates the opportunity to submit 

written testimony for the record regarding Federal funding for biomedical research 

in fiscal year 2007. SNM is an international, scientific, professional organization 

with more than 16,000 members dedicated to promoting the science, technology, and 

practical application of nuclear medicine. Over the last 50 years, since biomedical 

imaging first began, the nuclear medicine community has had a positive working 

relationship with the National Institutes of Health (NIH). The research and development supported by NIH have made ground-breaking discoveries in the field of nuclear medicine. Similarly, NIH has benefited from the nuclear medicine research 

conducted through Federal funding of the Medical Applications and Measurement 

Science Program at the Department of Energy (DOE). Unfortunately, that $37 million in funding was eliminated in the fiscal year 2006 Energy and Water Appropriations bill. Therefore, the Society requests and strongly recommends that the Labor, 

Health and Human Services, and Education (LHHS) Appropriations Subcommittee 

work with the Energy and Water Development Appropriations Subcommittee to ensure that dedicated funding for nuclear medicine research is fully restored in fiscal 

year 2007. 

WHAT IS NUCLEAR MEDICINE?

Nuclear medicine is an established specialty that performs noninvasive molecular 

imaging procedures to diagnose and treat diseases and determine the effectiveness 

of therapeutic treatments, whether surgical, chemical, or radiation. It contributes 

extensively to the treatments and diagnoses of patients with cancers of the brain, 

breast, blood, bone, bone marrow, liver, lungs, pancreas, thyroid, ovaries, and prostate. Molecular imaging continues to provide critical information to help doctors, 

technicians, and other health care personnel manage abnormalities of the heart, 

brain, and kidneys. In fact, recent advances in the detection and diagnosis of Alzheimer’s disease can be attributed to nuclear medicine imaging procedures, specifi-
530 

cally positron emission tomography (PET) scans. These advances—which were made 

possible by research performed by nuclear medicine professionals—helped lead the 

Centers for Medicare and Medicaid Services (CMS) to extend Medicare coverage to 

include PET scans for some beneficiaries who suffer from Alzheimer’s and other dementia-related diseases. 

The effect nuclear medicine has on the lives of men, women, and children suffering from cancer, heart, and brain diseases is far-reaching. Annually, more than 

20 million men, women, and children require noninvasive molecular/nuclear medical 

procedures. These safe, cost-effective procedures include PET scans to diagnose and 

monitor treatments in cancer, cardiac stress tests that analyze heart function, bone 

scans for orthopedic injuries, and lung scans for blood clots. In addition, patients 

undergo procedures to diagnose liver and gall bladder functional abnormalities and 

to diagnose and treat hyperthyroidism and thyroid cancer. 

IMPACT OF THE LOSS OF FEDERAL FUNDING FOR NUCLEAR MEDICINE RESEARCH ON NIH

In fiscal year 2006, the government abandoned its fifty-year commitment to supporting nuclear medicine research by eliminating funding for the Medical Applications and Measurement Science Program at the DOE and making no accommodation to transition nuclear medicine programs to another government agency. Over 

the years, the DOE Medical Applications and Measurement Science Program has 

generated advances in the field of molecular/nuclear medicine. For example, DOE 

funding provided the resources necessary for molecular/nuclear medicine professionals to develop PET scanners to diagnose and monitor the treatment of cancer. 

PET scans offer significant advantages over CT and MRI scans in diagnosing disease and are more effective in identifying whether cancer is present, if it has 

spread, if it is responding to treatment, and if a person is cancer free after treatment. In fact, the DOE has stated that this program supports ‘‘research in universities and in the National Laboratories, and occupies a critical and unique niche in 

the field of radiopharmaceutical research. The NIH relies on our basic research to 

enable them to initiate clinical trials.’’ 

The advances in molecular/nuclear medicine made possible by Federal funding of 

nuclear medicine research at the DOE include: 

—Modeling Radiation Damage to the Lung: Treatment of thyroid disease and 

lymphomas using radioisotopes can cause disabling lung disease. Investigators 

at Johns Hopkins University have developed a Monte Carlo model that can be 

used to determine the probability of lung toxicity and be incorporated into a 

therapeutic regimen. This model will optimize the dose of radioactivity delivered 

to cancer cells and avoid untoward effects on the lung. 

—New Radiopharmaceuticals with Important Clinical Applications: The DOE 

radiopharmaceutical science program has developed a number of innovative 

radiotracers at the University of California at Irvine for the early diagnosis of 

neuro-psychiatric illnesses, including Alzheimer’s disease, schizophrenia, depression, and anxiety disorders. 

—Imaging Gene Expression in Cancer Cells: Images of tumors in whole animals 

that detect the expression of three cancer genes were accomplished for the first 

time by investigators at Thomas Jefferson University and the University of 

Massachusetts Medical Center. This advanced imaging technology will lead to 

the detection of cancer in humans using cancer cell genetic profiling. 

—Rapid Preparation of Radiopharmaceuticals for Clinical Use: The DOE-sponsored program at the University of Tennessee has developed a new method for 

preparing radiopharmaceuticals by placing a boron-based salt at the position 

that will be occupied by the radiohalogen. The method has been used to prepare 

a variety of cancer-imaging agents. 

—Smaller, More Versatile PET Scanners: Brookhaven National Laboratory (BNL) 

has completed a prototype mobile PET scanner, which will record images in the 

awake animal. The mobile PET will be able to acquire positron-generated images in the absence of anesthesia-induced coma and correct for motion of the 

animal. The long-term goal is to develop PET instrumentation able to diagnose 

neuro-psychiatric disorders in children. 

—Highest Resolution PET Scanner Developed: Scientists at the Lawrence Berkeley National Laboratory (LBNL) have developed the world’s most sensitive PET 

scanner. The instrument is 10-times more sensitive than a conventional PET 

scanner and became operational in 2005. 

With restored Federal funding, essential molecular/nuclear medicine research will 

continue at universities, research institutions, national laboratories, and small businesses. Moreover, research with radiochemistry, genomic sciences, and structural biology will be able to usher in a new era of mapping the human brain and using 
531 

specific radiotracers and instruments to more precisely diagnose neuro-psychiatric 

illnesses and cancer. 

The future of life-saving therapies and cutting-edge research in molecular/nuclear 

medicine and imaging depends on the restoration of Federal funding for nuclear 

medicine research. 

SUSTAIN AND SEIZE RESEARCH OPPORTUNITIES

For decades, Americans and people from across the world have benefited from the 

strong Federal investment in nuclear medicine and biomedical research at NIH. 

SNM hopes that the LHHS subcommittee will continue that trend and fund NIH 

and the National Institute of Biomedical Imaging and Bioengineering (NIBIB) and 

the National Cancer Institute (NCI) at sufficient levels in fiscal year 2007. 

SNM is proud to join its colleagues in the public health community in recommending that NIH receive $29.7 billion in fiscal year 2007 funding—the same level 

of funding that is included in the Senate-passed budget resolution. This funding 

level would permit NIH to sustain and build upon its current research activities, 

which are a byproduct of the recent NIH budget-doubling effort. Even a minimal 

decrease or slowed momentum in increased funding for NIH could cause severe disruption in the Institutes’ research activities and capabilities. 

Research in biomedical imaging and bioengineering is progressing rapidly, and recent technological advances have revolutionized the diagnosis and treatment of disease. In 2000, NIBIB was created to specifically focus on biomedical imaging and 

bioengineering. It has made great strides in helping the health care community and 

patients recognize and understand different diseases and disorders. Pancreatic 

transplantation, brain scans, and improvement in epilepsy surgeries are just a few 

examples of how NIBIB research is helping to diagnose and treat patients. In order 

for NIBIB to continue its important work, SNM requests that Congress provide it 

with $388 million in Federal funding for fiscal year 2007. This funding level would 

allow NIBIB to further its research, development, and application of emerging and 

cutting-edge biomedical technologies to facilitate improved disease detection, management, and prevention. 

In addition, SNM advocates that NCI receive $5.034 billion in fiscal year 2007. 

The American Cancer Society predicts that more than 1.4 million Americans will 

be diagnosed with cancer in 2005. Significant gains have been made in the war on 

cancer, and there have been successful breakthroughs in diagnosing and treating 

this terrible disease. Currently, PET scans are available to detect more than a dozen 

types of cancer. Cancer research is leading to new therapies that translate into 

longer survival and improved quality of life for cancer patients. Extraordinary advances in cancer research have resulted because of the strong commitment by the 

Federal, State, and local governments in combating cancer. 

CONCLUSION

As outlined above, SNM has a strong interest in making sure that biomedical research in the United States is sufficiently funded. Also, since NIH relied on the pool 

of research conducted by the DOE’s Medical Applications and Measurement Science 

Program, SNM would like to stress the impact that the loss of Federal funding for 

nuclear medicine research will have on NIH. In order to ensure that the positive 

effects and results of research and development are not seriously compromised, 

SNM advocates the allocation of $29.7 billion for NIH, including $388 million for 

NIBIB and $5.034 billion for NCI, and requests that the LHHS Appropriations subcommittee work with the Energy and Water Development Appropriations Subcommittee to ensure that Federal funding for nuclear medicine research is fully restored. 

SNM stands ready to work with policymakers on both sides of the aisle to advance 

biomedical research and innovation to help reduce and prevent suffering from disease for all Americans. Again, on behalf of the members of SNM, I thank you for 

the opportunity to submit testimony regarding the need for increased Federal funding for biomedical research. 

PREPARED STATEMENT OF THE SOCIETY FOR WOMEN’S HEALTH RESEARCH AND

WOMEN’S HEALTH RESEARCH COALITION

On the behalf of the Society for Women’s Health Research and the Women’s 

Health Research Coalition, we are pleased to submit the following testimony in support of biomedical research, and more specifically women’s health research. 
532 

The Society for Women’s Health Research is the only national non-profit women’s 

health organization whose mission is to improve the health of women through research, education, and advocacy. Founded in 1990, the Society brought to national 

attention the need for the appropriate inclusion of women in major medical research 

studies and the need for more information about conditions affecting women disproportionately, predominately, or differently than men. In 1999, the Women’s 

Health Research Coalition was created by the Society as a grassroots advocacy effort 

consisting of scientists, researchers, and clinicians from across the country that are 

concerned and committed to improving women’s health research. 

The Society and Coalition are committed to advancing the health of women 

through the discovery of new and useful scientific knowledge. We believe that sustained funding for biomedical and women’s health research programs conducted and 

supported across the Federal agencies is necessary if we are to accommodate the 

health needs of the population and advance the Nation’s research capability. 

NATIONAL INSTITUTES OF HEALTH

From decoding the human genome to elucidating the scientific components of 

human physiology, behavior, and disease, scientists are unearthing exciting new discoveries which have the potential to make our lives and the lives of our families 

longer and healthier. The National Institutes of Health (NIH) has made this all possible by conducting and supporting our Nation’s biomedical research. World-class researchers, scientists, and programs at NIH are dedicated to understanding how the 

human body works and to gain insight into countless diseases and disorders. Congressional investment and support for NIH has made the United States the world 

leader in medical research and has had a direct and significant impact on women’s 

health research and the careers of women scientists in the last decade. 

Great strides and advancements have been made since the doubling of the NIH 

budget from $13.7 billion in 1998 to $27 billion in 2003. However, we are concerned 

that the momentum driving new research will erode under the current budgetary 

constraints. Medical research needs to be considered an essential investment—an 

investment in thousands of newly trained and aspiring scientists; an investment to 

remain competitive in the global marketplace; and an investment in our Nation’s 

health. In fact, a recent national poll indicated that a 58 percent of Americans believe that a strong investment in research and science is critical not only for our 

global scientific leadership but for the health of our economy and citizens. Furthermore, 94 percent consider accelerating medical research an important national priority—comparable to homeland security. 

The administration’s fiscal year 2007 budget request of $28.6 billion for NIH is 

unraveling the successes from the doubling of NIH’s budget. The proposed budget 

would freeze NIH funding at the fiscal year 2006 appropriated level of $28.57 billion 

and cut most individual Institute budgets from 0.5 to 0.8 percent. The proposed decrease does not keep pace with the inflation rate. The annual change in the Biomedical Research and Development Price Index (BRDPI) will increase to 4.1 percent 

in fiscal year 2006 and 3.8 percent in fiscal year 2007 and fiscal year 2008. BRDPI 

indicates how much the NIH budget would need to change to maintain purchasing 

power to compensate for the average increase in prices and to maintain research 

activity at the previous year’s level. 

A flat-funded budget will have a negative impact on the number of grants NIH 

will be able to fund. NIH predicts total the total number of grants funded will decrease by 656. The number of new grants funded by NIH has already dropped by 

nearly fifteen percent from 10,393 in fiscal year 2003 to an estimated 9,062 for fiscal 

year 2006. The shrinking pool of available grants will have a significant impact on 

scientists as they depend upon NIH support to help cover their salaries and laboratory expenses. If one fails to obtain a grant they will be less likely to achieve tenure 

and new, less established researchers will be forced to consider other careers, resulting in a loss of the critical workforce needed to sustain America’s cutting edge in 

biomedical research. 

In order to continue the momentum of scientific advancement and expedite the 

translation of research from the laboratory to the patient, the Society calls for a five 

percent increase for the NIH fiscal year 2007. In addition, we request that you 

strongly encourage the NIH to assure that women’s health research receives resources sufficient to meet the health needs of all women. 

Scientists have long known of the anatomical differences between men and 

women, but only within the past decade have they begun to uncover significant biological and physiological differences. Sex-based biology, the study of biological and 

physiological differences between men and women, has revolutionized the way that 

the scientific community views the sexes. 
533 

Sex differences play an important role in disease susceptibility, prevalence, time 

of onset and severity and are evident in cancer, obesity, coronary heart disease, 

autoimmune, mental health disorders, and other illnesses. This research needs to 

be supported and encouraged. Congress recognizes this importance and should support NIH at an appropriate level of funding and direct NIH to continue expanding 

research into sex-based biology. 

Sex differences research in heart disease has long been neglected. Heart disease 

is the number one killer of women in United States, killing 493,623 women. Information gaps related to the development, diagnosis, and treatment of heart disease 

among women are enormous, in part because women continue to be underrepresented in heart-related research studies. As a result, women face misdiagnosis, delayed diagnosis, under-treatment and mistreatment of their heart problems. In fiscal 

year 2005 the Centers for Medicare and Medicaid Services highest expenditure in 

women’s health 2005 was cardiovascular/pulmonary services. Despite large expenditures to treat heart disease, little funding is targeted at research that could lead 

to more effective prevention, diagnosis, and treatment. In order to address the discrepancies, the Society in conjunction with WomenHeart: the National Coalition for 

Women with Heart Disease compiled a list of ten questions that must be answered 

if women are to receive optimal cardiovascular care and treatment. The 10 unanswered research questions are: 

1. Why do women receive significantly fewer referrals for advanced diagnostic 

testing and treatments for heart disease than men, and how can the referral rate 

for women be increased? 

2. What are the best tools and methods for assessing women’s risk of heart disease? 

3. What are the best strategies for preventing heart disease in women? 

4. What treatments for heart disease work best for women? 

5. What are the most effective methods and treatments for diastolic heart failure, 

which is the most common form of congestive heart failure in women? 

6. How can the heart disease diagnosis and care disparities between white women 

and women of color be eliminated? 

7. What are the biological differences between men and women in the location, 

type, and heart disease risk level associated with fat deposits, and what determines 

these differences? 

8. How do sex differences in the regulation of heart rhythm affect risk of heart 

disease and response to treatment? 

9. What is the role of inflammation in heart disease in women? 

10. Why are women ages 50 and younger more likely to die following a heart attack than men of the same age? 

We strongly believe and encourage that these questions serve as a guide for NIH 

and other health related agencies while developing research portfolios. 

OFFICE OF RESEARCH ON WOMEN’S HEALTH

The NIH Office of Research on Women’s Health (ORWH) has a fundamental role 

in coordinating women’s health research at NIH, advising the NIH Director on matters relating to research on women’s health; strengthening and enhancing research 

related to diseases, disorders, and conditions that affect women; working to ensure 

that women are appropriately represented in research studies supported by NIH; 

and developing opportunities for and support of recruitment, retention, re-entry and 

advancement of women in biomedical careers. ORWH strives to address sex and 

gender perspectives of women’s health and women’s health research, as well as differences among special populations of women across the entire life span, from birth 

through adolescence, reproductive years, menopausal years and elderly years. 

Two highly successful programs supported by ORWH that are critical to furthering the advancement of women’s health research are Building Interdisciplinary 

Research Careers in Women’s Health (BIRCWH) and Specialized Centers of Research on Sex and Gender Factors Affecting Women’s Health (SCOR). These programs benefit both women’s and men’s health through sex and gender research, 

interdisciplinary scientific collaboration, and provide tremendously important support for young investigators in a mentored environment. 

The BIRCWH program is an innovative, trans-NIH career development program 

that provides protected research time for junior faculty by pairing them with senior 

investigators in an interdisciplinary mentored environment. What makes BIRCWH 

so unique is that it bridges advanced training with research independence across 

scientific disciplines. It is expected that each scholar’s BIRCWH experience will culminate in becoming an established independent researcher in women’s health. Since 

2000, 197 scholars have been trained in the twenty-four centers recording over 634 
534 

publications and 526 abstracts. The scholars have secured forty NIH grants and seventy awards from industry and institutional sources. 

The SCOR program, administered by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, was developed by ORWH in 2001. SCOR’s are designed to increase the transfer of basic research findings into clinical practice by 

housing laboratory and clinical studies under one roof. The program was designed 

to complement other federally supported programs addressing women’s health 

issues such as BIRCWH. The eleven SCOR programs are conducting interdisciplinary research focused on major medical problems affecting women and comparing 

gender difference to health and disease. Each SCOR works hard to transfer their 

basic research findings into the clinical practice setting. 

Despite the advancement of women’s health research and its innovative programs, we were disappointed to see ORWH receive a $250,000 cut in fiscal year 2006 from 

the Office of the Director. Congress must direct NIH to continue its support of 

ORWH and its programs. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

The Department of Health and Human Services (HHS) has several offices that enhance the focus of the government on women’s health research. Agencies with offices, advisors or coordinators for women’s health or women’s health research are 

the Department of HHS, the Food and Drug Administration, the Centers for Disease 

Control and Prevention, the Agency for Healthcare Quality and Research, the Indian Health Service, the Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration, and the Centers for Medicare and Medicaid Services. These agencies need to be funded at levels adequate 

for them to perform their assigned missions. We ask that the Committee Report 

clarify that Congress supports these offices and would like to see them continued 

and strengthened in the coming fiscal year. 

The focus on women’s health within HHS has been critical to the advances made 

in women’s health in getting the appropriate message out to patients and providers. 

Scientists have only just scratched the surface of understanding female biology, with 

new information forthcoming as a result of the recent sequencing of the human X 

chromosome. Now is the time to press ahead with this vital research to make discoveries and educate women about their health and clarify the misinformation they 

have been given for years and these offices are critical to the success of this effort. 

There are many important programs that we could identify from these women’s 

health offices but we would like to specifically mention two in particular. 

HHS OFFICE OF WOMEN’S HEALTH

The HHS Office of Women’s Health (OWH) is the government’s champion and 

focal point for women’s health issues. It works to redress inequities in research, 

health care services, and education that have historically placed the health of 

women at risk. The OWH coordinates women’s health efforts in HHS to eliminate 

disparities in health status and supports culturally sensitive educational programs 

that encourage women to take personal responsibility for their own health and 

wellness. An extraordinary program initiated by the OWH is the National Centers 

of Excellence in Women’s Health (CoEs). 

Developed in 1996, the CoEs offer a new model for university-based women’s 

health care. Selected on a competitive basis, the current twenty CoEs throughout 

the country seek to improve the health of all women across the lifespan through the 

integration of comprehensive clinical health care, research, medical training, community outreach and public education, and medical school faculty leadership development. The CoEs are able to reach a more diverse population of women, including 

more women of color and women beyond their reproductive years. However, CoEs 

are vulnerable to pressures of obtaining adequate funding and having to compete 

for scarce resources. A CoE designation by the OWH is critical not only to patients 

and surrounding communities but also to establishing foundation and other non-government funding. 

In fiscal year 2006 OWH received a decrease in its budget and the proposed fiscal 

year 2007 would flat fund the office. We urge Congress to provide an increase of 

$1.5 million for the HHS OWH to allow it to continue to sustain and expand the 

National Centers of Excellence in Women’s Health. 

AGENCY FOR HEALTHCARE AND RESEARCH QUALITY

The Agency for Healthcare Research and Quality (AHRQ) is the lead Public 

Health Service agency focused on health care quality, including coordination of all 

Federal quality improvement efforts and health services research. AHRQ’s work 
535 

serves as a catalyst for change by promoting the results of research findings and 

incorporating those findings into improvements in the delivery and financing of 

health care. This important information provided by AHRQ is brought to the attention of policymakers, health care providers, and consumers who can make a difference in the quality of health care women receive. 

AHRQ has a valuable role in improving health care for women. Through AHRQ’s 

research projects and findings, lives have been saved and underserved populations 

have been treated. For example, women treated in emergency rooms are less likely 

to receive life-saving medication for a heart attack. AHRQ funded the development 

of two software tools, now standard features on hospital electrocardiograph machines that have improved diagnostic accuracy and dramatically increased the timely use of ‘‘clot-dissolving’’ medications in women having heart attacks. 

While AHRQ has made great strides in women’s health research, the Administration’s budget for fiscal year 2007 could threaten life-saving research. If a budget request of $319 million were enacted, AHRQ would be flat funded for the third year 

in a row at fiscal year 2005 levels. Flat funding prior to application of taps by Congress seriously jeopardizes the research and quality improvement programs that 

Congress demands or mandates from AHRQ. 

We encourage Congress to fund AHRQ at $443 million for fiscal year 2007. This 

will ensure that adequate resources are available for high priority research, including women’s health care, gender-based analyses, Medicare, and health disparities. 

In conclusion, Mr. Chairman, we thank you and this Committee for its strong 

record of support for medical and health services research and its unwavering commitment to the health of the Nation through its support of peer-reviewed research. 

We look forward to continuing to work with you to build a healthier future for all 

Americans. 

PREPARED STATEMENT OF THE HUMANE SOCIETY OF THE UNITED STATES

On behalf of The Humane Society of the United States (HSUS) and our more than 

9.5 million supporters nationwide, we appreciate the opportunity to provide testimony on our top funding priorities for the Labor, Health and Human Services, Education and Related Agencies Subcommittee in fiscal year 2007. 

ALTERNATIVES TO ANIMAL TESTING

The ICCVAM Authorization Act (Public Law 106–545) requires Federal regulatory 

agencies to ensure that new and revised animal and alternative test methods be scientifically validated prior to recommending or requiring use by industry. The internationally agreed upon definition of validation, supported by the 15 Federal regulatory and research agencies that compose the ICCVAM, is: ‘‘the process by which 

the reliability and relevance of a procedure are established for a specific use.’’ 

Function of the ICCVAM 

The ICCVAM performs an invaluable function by assessing the validation of new, 

revised and alternative toxicological test methods that have interagency application. 

After appropriate independent peer review, the ICCVAM recommends the test to the 

Federal regulatory agencies that regulate the particular endpoint test measures. In 

turn, the Federal agencies maintain their authority to incorporate the validated test 

methods as appropriate for the agencies’ regulatory mandates. This streamlined approach of assessing the validation of test methods has reduced the regulatory burden of individual agencies; provided a ‘‘one-stop shop’’ for stakeholders for consideration of methods; and set uniform criteria for what constitutes a validated test 

method. The ICCVAM can also serve to appropriately assess test methods that can 

refine, reduce and replace the use of animals in toxicological testing. 

The ICCVAM’s representatives have rigorously assessed several test methods that 

are now deemed scientifically valid and acceptable. In addition, the ICCVAM is 

working to streamline assessment of methods from the European Union (EU) that 

have already been validated for use within the EU. 

Request for Appropriations 

Since passage of the ‘‘ICCVAM Authorization Act’’ in 2000, which makes the entity a permanent standing committee, NIEHS has provided between $1 and $2.6 million per fiscal year to NICEATM for ICCVAM’s activities. In order to ensure that 

Federal regulatory agencies and their stakeholders benefit from the work of the 

ICCVAM, NIEHS funding is important. We respectfully request $4 million for this 

purpose in fiscal year 2007. 
536 

1 NRC (National Research Council) (1997) Chimpanzees in research: strategies for their ethical care, management and use. National Academies Press: Washington, D.C. 

Request for Committee Report Language 

The NIEHS should support the NICEATM/ICCVAM in creating a five-year roadmap for assertively setting goals to prioritize ending the use of antiquated animal 

tests for specific endpoints. It is also imperative that the ICCVAM take a more 

proactive role in isolating areas where new methods development is on the verge 

of replacing animal tests. These areas should form a collective call by the Federal 

agencies that compose the ICCVAM to fund any necessary additional effort that is 

required to eliminate the animal methods. We also strongly urge the NICEATM/ 

ICCVAM to closely coordinate efforts with its European counterpart, the European 

Centre for the Validation of Alternative Methods (ECVAM), to ensure the best use 

of available funds and sound science and to ensure industry has a uniform approach 

to worldwide chemical safety evaluation. 

We also respectfully request that the Committee consider including the following 

report language: ‘‘The Committee commends the National Interagency Center for 

the Evaluation of Alternative Methods/Interagency Coordinating Committee on the 

Validation of Alternative Methods (NICEATM/ICCVAM) for its leadership role in 

the assessment of new, revised and alternative scientifically validated methods for 

the Federal Government. The Committee also commends the National Toxicology 

Program (NTP) for finalizing its ‘‘Roadmap to Achieve the NTP Vision, A Toxicology 

Program for the 21st Century,’’ which commits to ‘‘develop and validate improved 

testing methods and, where feasible, ensure that they reduce, refine or replace the 

use of animals’’ as one of its top four goals. 

The Committee directs the NICEATM/ICCVAM, in partnership with the relevant 

Federal agency program offices and the NTP, to build on the NTP Roadmap to create a five-year plan to research, develop, translate and validate new and revised 

non-animal and other alternative assays for integration of relevant and reliable 

methods into the Federal agency testing programs. In this 5-year plan the Federal 

agency program offices shall be directed to identify areas of high priority for new 

and revised non-animal and alternative assays or batteries of those assays to create 

a path forward for the replacement, reduction and refinement of animal tests, when 

this is scientifically valid and appropriate. The Committee directs a transparent, 

public process for developing this plan and recommends the plan be presented to 

the Committee by November 15, 2007. Funding for developing the plan shall be 

from the NIEHS and the NTP, and shall not reduce the NICEATM/ICCVAM funding base.’’ 

BREEDING OF CHIMPANZEES FOR RESEARCH

The HSUS requests that no Federal funding be appropriated for breeding of chimpanzees for research, or for research that requires breeding of chimpanzees, for the 

following reasons: 

—The United States currently has a surplus of chimpanzees available for use in 

research due to overzealous breeding for HIV research and subsequent findings 

that they are a poor HIV model.1

—The cost of maintaining chimpanzees in laboratories is exorbitant, totaling between and $9.3 million each year for the current population of 850 federally 

owned or supported chimpanzees ($15–30 per day per chimpanzee;1 $500,000 

per chimpanzee’s 50-year lifetime). 

—The National Center for Research Resources has a publicly-declared moratorium on breeding chimpanzees. 

—Use of chimpanzees in research raises strong public concerns. 

Background and history 

Beginning in 1995, the National Research Council (NRC) confirmed a chimpanzee 

surplus and recommended a moratorium on breeding of federally owned or supported chimpanzees,1 who now number approximately 850 of the 1,300 total chimpanzees available for research in the United States. According to a National Research Resources Advisory Council September 15, 2005 meeting, the National Center for Research Resources (NCRR) of NIH extended the moratorium until December 

2007 because of high costs of chimpanzee care, lack of existing colony information, 

and failure of chimpanzees as an HIV model. There are, however, cases in which 

the moratorium is not being obeyed, prompting the need for Congressional action. 
537 

2The Chimpanzee Sequencing and Analysis Consortium/Mikkelsen, TS, et al.,(1 September 

2005) Initial sequence of the chimpanzee genome and comparison with the human genome, Nature 437, 69–87. 3 NIH extramural funding accounts for approximately 90 percent of the NIH budget, or $25.5 

billion. Of this, approximately 40 percent is devoted to some aspect of animal research—totaling 

approximately $10.2 billion. Intramural research also accounts for some animal research, but 

the exact figure is unknown. 

Deviations from the moratorium 

Despite the NCRR breeding moratorium, which prohibits breeding of federally 

owned or supported chimpanzee or NIH funding of projects that require chimpanzee 

breeding (NCRR written communication, February 28, 2006), chimpanzee breeding 

is still being funded by NIH. For example, the National Institute of Allergy and Infectious Diseases maintains a contract with New Iberia Research Center in Louisiana to provide 10 to 12 infant chimpanzees annually for research projects. The 

10-year contract entitled ‘‘Leasing of chimpanzees for the conduct of research’’ has 

been allotted over $22 million, with $3.9 million awarded since its inception in September 2002. 

Chimpanzees have often been a poor model for human health research 

The scientific community recognizes that chimpanzees are poor models for HIV 

because chimpanzees do not develop AIDS. Similarly, though chimpanzees do not 

model the course of the human Hepatitis C virus, they continue to be widely used 

for this research. According to the chimpanzee genome, some of the greatest differences between chimpanzees and humans relate to the immune system,2 calling 

into question the validity of infectious disease research using chimpanzees. 

Ethical and public concerns about chimpanzee research 

Chimpanzee research raises serious ethical issues, particularly because of their 

extremely close similarities to humans in terms of intelligence and emotions. Americans are clearly concerned about these issues: 90 percent believe it is unacceptable 

to confine chimpanzees individually in government-approved cages, and 54 percent 

believe that it is unacceptable for chimpanzees to ‘‘undergo research which causes 

them to suffer for human benefit’’ (conducted by Zogby International for Chimpanzee Collaboratory, 2001). 

We respectfully request the following committee report language: 

‘‘The Committee directs that no funds provided in this Act be used to support the 

breeding of chimpanzees for research or to support research that requires breeding 

of chimpanzees.’’ 

PAIN AND DISTRESS RESEARCH

It is estimated that at least $10.2 billion per year of the current National Institutes of Health budget is devoted to some aspect of animal research.3 At this time, 

no funding is set aside specifically for determination of ways to reduce the amount 

of pain and distress in animal research. Knowledge regarding recognition, assessment, and alleviation of animal pain and distress is critical for both the quality of 

scientific research and animal welfare. 

NIH may receive $28.6 billion in fiscal year 2007 if Congress fulfills the Presi- dent’s budget request. Out of this funding, we seek $2.5 million (0.009 percent) for 

research and development focused on recognizing, assessing, and alleviating animal 

pain and distress in research. This is not a request for basic research on pain pathways or for application to the study of human pain, for example, but for the benefit 

of animals used in painful and distressful research. In addition to our request for $2.5 million for this purpose, we also urge the Committee to specify in report language that this research should be conducted in conjunction with, or ‘‘piggy-backed’’ onto, ongoing research that already causes pain and 

distress. Infliction of pain and distress on additional animals is unnecessary, given 

the volume of existing research that is believed to involve moderate to significant 

pain and/or distress (we estimate a minimum of 20–25 percent of all animal research). Furthermore, it is expected that the amount of research that involves animal pain and distress will increase as animal use in biodefense research increases, 

as one example. 

NIH has a statutory mandate to conduct or support research into alternative 

methods that produce less pain and distress in animals; this was specified in the 

NIH Revitalization Act of 1993 regarding a plan for the use of animals in research. 

Earmarked funding will assist NIH in meeting this mandate. Additionally, researchers themselves often comment publicly about the urgent need for funding in order 

to properly understand and mitigate pain and distress in research animals and to 
538 

1This appropriation was reduced by a 1 percent across-the-board rescission to $35.3 million. 

follow Animal Welfare Act and Public Health Service policy requirements to minimize pain and distress. 

It is well known that uncontrolled, undetected, and unalleviated pain and distress 

has adverse effects on animal welfare, which leads to adverse effects on the quality 

of science. Ultimately, the lack of information on pain and distress leads to misinterpretation of research results that could result in harmful effects in human beings 

when animal research results are applied to human clinical trials. 

Numerous surveys indicate that concern about animal pain and distress strongly 

influences public opinion about animal research in general. For example, 75 percent 

of the American public opposes research that causes severe animal pain and/or distress, even when the goal of the research is to benefit human health (survey conducted by an independent polling firm for The HSUS, 2001). 

Our Nation takes pride in leading the world in biomedical research, yet we lag 

behind many other countries in our efforts to minimize pain and distress in animal 

subjects. We urge the Committee to make this small investment of $2.5 million to 

promote animal welfare and enhance the integrity of scientific research. We also respectfully request this accompanying committee report language: 

‘‘The Committee provides $2.5 million to support research and development focused on improving methods for recognizing, assessing, and alleviating pain and distress in research animals. No pain and distress should be inflicted solely for the 

purpose of this initiative, since the investigations can and should be conducted in 

conjunction with ongoing research that is believed to involve pain and distress 

under Government Principle IV of Public Health Service Policy, which assumes that 

procedures that cause pain and distress in humans may cause pain and distress in 

animals.’’ 

Thank you for the opportunity to submit these requests on behalf of The Humane 

Society of the United States. 

DEPARTMENT OF EDUCATION 

PREPARED STATEMENT OF AMERICANS FOR THE ARTS

REQUEST

Americans for the Arts is pleased to submit testimony supporting fiscal year 2007 

appropriations of $53 million for the Arts in Education program of the U.S. Department of Education (USDE). We call on the Senate Labor/HHS/ED Appropriations 

subcommittee to reject the severe cuts to the Corporation for Public Broadcasting 

and instead provide $430 million in fiscal year 2009. However, we support the President’s request of $41.39 million for the Office of Museum Services within the Institute of Museum & Library Services (IMLS), also funded through this subcommittee. 

Americans for the Arts is one of the leading national nonprofit organizations for 

advancing the arts and arts education in America. With a 45-year record of objective 

arts industry research, we are dedicated to representing and serving local communities and creating opportunities for every American to participate in and appreciate 

all forms of the arts. 

ARTS EDUCATION

Our belief in the importance of practical research causes us to take special pleasure in supporting USDE’s Arts in Education program, which is generating impressive evidence on the best ways to improve overall academic achievement by integrating the arts into the school curriculum. 

As members of the subcommittee know, the Elementary and Secondary Education 

Act [20 USC 7271] provides that funding up to $15 million be directed to the John 

F. Kennedy Center for the Performing Arts and VSAarts. Prior to fiscal year 2001, 

funding never exceeded that level. Since fiscal year 2001, however, Congress has appropriated funding sufficient to support a broader array of arts education programs—for fiscal year 2006, Congress appropriated $35.6 million.1 In addition to the 

Kennedy Center and VSAarts, USDE now supports grant competitions to further develop established arts education models and support professional development for 

arts educators in four arts disciplines. 
539 

2http://www.aep-arts.org/CLhome.html. 

3http://www.nga.org/Files/pdf/050102ARTSED.pdf. 

4http://www.nasaa-arts.org/publications/artsandchildren.shtml. 

5 ‘‘Worried About India’s and China’s Booms? So Are They,’’ Thomas Friedman, New York 

Times, March 24, 2006. 

Three Reasons to Increase Arts Education Funding 

Arts education works for children.—The most important reason to support arts 

education is simply stated: arts education works for children. Research increasingly 

confirms the beneficial effects of arts education in several areas, including but not 

limited to academic achievement. We refer the subcommittee to the research compendium Critical Links: Learning in the Arts and Student Academic and Social Development, released by the Arts Education Partnership in 2002, which includes 62 

separate studies pointing to ‘‘critical links’’ between arts education and reading, 

writing, mathematics, cognitive skills, motivation, social behavior, and the school 

environment. The studies indicate that arts education is especially useful for students who are economically disadvantaged and/or in need of remedial instruction.2

Arts education provides training for a competitive workforce.—According to the 

2002 National Governors Association publication The Impact of Arts Education on 

Workforce Preparation, ‘‘School districts are finding that the arts develop many 

skills applicable to the ‘real world’ environment. In a study of 91 school districts 

across the Nation, evaluators found that the arts contribute significantly to the creation of the flexible and adaptable workers that businesses demand to compete in 

today’s economy.’’ 3

In addition, with more than 548,000 arts-centric businesses employing nearly 

three million people, arts education becomes a critical tool in fueling the creative 

industries of the future with arts-trained workers. Arts education is critical to the 

sustainability of an industry that comprises more than 4 percent of all U.S. businesses. We know from published research studies on the benefits of arts education 

that early learning in the arts nurtures the types of skills and brain development 

that are important for individuals working in the new economy of ideas. 

In his State of the Union address this January, President Bush said ‘‘We must 

continue to lead the world in human talent and creativity.’’ The arts are core to the 

development of creativity in our children. The arts develop skills and talents that 

foster imagination, critical thought, and teamwork: skills that are transferable to 

the workplace. 

In the documentary ‘‘The Arts and Children: A Success Story,’’ Dr. Sol Snyder— 

2003 recipient of the National Medal of Science and Distinguished Service Professor 

of Neuroscience, Pharmacology and Psychiatry at the Johns Hopkins University— 

said: 

‘‘In the arts, one trains one’s senses to perceive and integrate what’s going on either in the visual environment, auditory involvement, or even in the senses of smell, 

taste, and touch. The arts are very good for building those talents, those abilities. 

Sensory perception becomes quite important in mathematics, science, business. 

‘‘From my own background as a physician and research scientist, I have noticed 

that the most talented, the most productive people in the field are those who actually have a background in the arts because simple narrow scientific training is not 

enough to make major discoveries. The greatest scientists actually are artists in a 

sense. They are creative; they put together disparate things.’’ 4

A similar theme on the essential integration of the arts and innovation was mentioned in a recent New York Times column by Thomas Friedman when he wrote, 

‘‘Innovation is often a synthesis of art and science, and the best innovators often 

combine the two.’’ He went on to write that America’s growing emphasis on math 

and reading must maintain a balance with creative learning in the arts to optimize 

human talent.5

There is solid research measuring how the arts are integrated into the classroom 

and how they boost achievement in math and science. Students who took four years 

of arts coursework outperformed those of their peers who had one half-year or less 

of arts coursework by 38 points on the math portion of the SAT. Students who include art in their studies are four times more likely to be recognized for academic 

achievement and four times more likely to participate in a math and science fair. 

For example, the ‘‘Math in a Basket’’ program in the Long Beach, CA, school district—funded through a U.S. Department of Education Arts in Education Model Development & Dissemination grant—teaches students how to plan, design, and make 

baskets from scratch. Students become familiar with art concepts, measurement, algebraic formulas, and geometric concepts as they work with their baskets to find 

the surface area, perimeter, and volume of each basket. Participants in the ‘‘Math 
540 

6http://www.dramaticresults.org/results.php. 

7http://www.nasbe.org/ResearchlProjects/LostlCurriculum.html. 8http://www.ecs.org/html/Document.asp?chouseid=5058. 

9http://www.cep-dc.org/nclb/Year4/Press/. 

in a Basket’’ program score an average of 20 points higher than the control group 

on State math tests.6

Model programs are a wise investment.—Despite increases in overall Federal 

spending for K–12 education, evidence is beginning to accumulate that schools are 

neglecting those areas of the curriculum that are not subject to the mandatory testing requirements of No Child Left Behind (NCLB). The National Association of 

State Boards of Education (NASBE) identified the threat in its 2003 report ‘‘The 

Lost Curriculum.’’ 7 In 2004, the Council for Basic Education released a survey of 

school principals in four States; one quarter of them reported that they have decreased instructional time in the arts.8 This finding was confirmed just last month 

in the Center for Education Policy’s (CEP) report ‘‘From the Capital to the Classroom: Year 4 of the No Child Left Behind Act,’’ when it found that almost a quarter 

of school districts surveyed reported that time in science, art, and music had been 

reduced due to an increased emphasis on reading and math.9 The CEP report recommends that USDE should promote ‘‘effective practices being used by school districts to enhance instruction in tested subjects without cutting time for other important subjects.’’ The USDE arts education program is a wise investment in developing and disseminating these effective practices. 

USDE Needs to Maintain Research Efforts in Arts Education 

Meaningful research from USDE is needed to further determine the status of 

dance, music, theater, and visual arts education. The Fast Response Survey System 

(FRSS) report ‘‘Arts Education in Public Elementary and Secondary Schools’’ is the 

only research produced by USDE on the delivery of arts education and the last 

FRSS reported data collected in the 1999–2000 school year. The next round of data 

collection for an updated report is long overdue. We urge the subcommittee to direct 

USDE to execute the FRSS study as intended. Similarly, the National Assessment 

of Education Progress (NAEP)—the national arts ‘‘report card’’ last performed in 

1997—is scheduled to be administered in 2008, and must stay on track. The next 

NAEP will provide critical information about the arts skills and knowledge of our 

Nation’s students. Both of these quantitative studies are essential to studying and 

improving access to the arts as a core academic subject. 

The Model Development & Dissemination program and the Professional Development program in the Arts in Education initiative at USDE receive targeted funding 

and are tested and measured in a limited number of implementation projects, and 

finally disseminated field-wide. This is a highly appropriate use of Federal dollars. 

Through this program, USDE promotes educational excellence, demonstrating how 

small projects can be brought to scale across entire school districts. Increased funding means more help for State and local departments of education to develop models 

that will work in highly disparate school districts across the Nation. We urge the 

Senate Subcommittee on Labor, Health and Human Services, and Education to recommend $53 million in funding for USDE’s Arts in Education programs, with the 

bulk of the increase to be allocated to the Arts in Education Model Development and 

Dissemination Program and the Professional Development Program. 

CORPORATION FOR PUBLIC BROADCASTING

We urge the subcommittee to reject the Administration’s proposed funding cuts 

to the Corporation for Public Broadcasting (CPB) in the fiscal year 2007 LaborHHS–Education appropriations bill. Any reduction in CPB’s budget will drastically 

reduce the access that many Americans have to public broadcasting, and thus to 

high-quality arts and cultural programming. 

CPB supports public television through its partner, the Public Broadcasting Service (PBS). A trusted community resource, PBS brings quality programs and education services to nearly 100 million people each week. With community-based arts 

programming and nationally televised shows, PBS is often the only source of arts 

programming in many rural parts of the country. 

Public television airs arts programming that is not available on commercial television. For example, the Legends of Jazz television series on PBS marks the first 

time in 40 years that jazz has been the focus of a national network weekly series. 

Hosted by noted jazz pianist and radio personality Ramsey Lewis, the 13 weekly, 

30-minute episodes debuted in June 2005 on PBS stations nationwide. 

Budget cuts will weaken National Public Radio (NPR) stations and thus the availability of high-quality arts programming. Budget cuts will impact public radio 
541 

broadcasting, as CPB funding represents an average of 13 percent of the budget for 

individual member stations of NPR. If NPR loses CPB support, many stations will 

have to make severe cuts to their programming and local services. This will especially impact rural areas and stations serving minority populations, as these stations heavily rely on Federal funding for their operating budgets. While local and 

State arts agencies also support these stations, they could not make up for a loss 

of Federal funding on this scale. 

We join a broad coalition of public broadcasting supporters with this request for 

funding: 

CPB General Appropriations—$430 million for fiscal year 2009 

CPB Digital Funding—$40 million for fiscal year 2007 

CPB Interconnection—$36 million for fiscal year 2007 

Ready to Learn—$32 million for fiscal year 2007 

Ready to Teach—$15 million for fiscal year 2007 

INSTITUTE FOR MUSEUM & LIBRARY SERVICES

We urge the subcommittee to support no less than the President’s proposed increase to $41.39 million for the Office of Museum Services within IMLS in the fiscal 

year 2007 Labor-HHS–Education appropriations bill. 

IMLS encourages excellence and leverages State, local, and private funds. National competition is a catalyst for excellence and improves museum service nationwide. Federal leadership helps disseminate models and puts a spotlight on the remarkable resources that museums bring to education and to communities across the 

United States. In addition, peer-reviewed IMLS grants assure State, local, and private funders that a museum has met high national standards and is worthy of their 

additional support. 

IMLS reinforces the role of museums in lifelong learning. Funding supports 

projects that address a full range of learning opportunities in museums, including 

developing exhibitions, working with schools to develop curriculum and programs, 

creating family and adult programs, and developing internet content. American museums provide over 18 million instructional hours to K–12 schoolchildren. Seventyone percent work with school curriculum specialists to tailor programs to support 

local and State curriculum standards, according to the 2003 edition of the IMLS’s 

report ‘‘True Needs, True Partners.’’ 

CONCLUSION

As the research cited above demonstrates, Federal funds boost the quality and 

quantity of support for arts education as well as the knowledge that can be gained 

and disseminated across the education establishment. Increased funding means 

more help for State departments of education, educators in schools, and local education agencies. Most importantly, it means a better education and more career opportunities for our children. 

Americans for the Arts is the leading nonprofit organization for advancing the 

arts in America. With offices in Washington, DC, and New York City, it has a record 

of more than 45 years of service. Americans for the Arts is dedicated to representing 

and serving local communities and creating opportunities for every American to participate in and appreciate all forms of the arts. Additional information is available 

at www.AmericansForTheArts.org. 

PREPARED STATEMENT OF THE AMERICAN GEOLOGICAL INSTITUTE

Thank you for this opportunity to provide the American Geological Institute’s perspective on fiscal year 2007 appropriations for the Department of Education. The 

President’s fiscal year 2007 request for the Department of Education places an emphasis on increasing U.S. competitiveness through math, science, and foreign language programs in keeping with the Administration’s American Competitiveness 

Initiative announced in the President’s State of the Union address. While $380 million is devoted to new funds for projects based on this initiative, these new funds 

would be offset by significant cuts to other programs within the Department of Education. The Department of Education budget would be reduced by $3.2 billion for 

a total requested budget of $54.4 billion. AGI strongly supports the President’s initiative and in particular funding for improved science literacy for teachers and students, however, we do encourage the subcommittee to retain and provide support 

for other proven and effective programs. 

The National Math and Science Partnership (MSP) program as part of No Child 

Left Behind effectively strengthens K–12 science and math education. The Presi-
542 

dent’s request includes $182 million for the MSP program within the Department 

of Education, which is the same level of funding appropriated in fiscal year 2006. 

AGI supports this stable funding and encourages appropriate emphasis on science 

education. Science often includes mathematical exercises applied to real-world problems, giving students a comprehensive and interesting learning experience. 

The President’s request for fiscal year 2007 focuses much new spending on math 

education and less on science education. Funding proposals based on the initiative 

include $125 million for Math Now for elementary school students and $125 million 

for Math Now for middle school students, plus an additional $10 million to create 

a National Math Panel to review and develop math curricula. While a solid math 

education is important, additional funding should also be devoted to science education, which complements and expands upon a mathematical foundation to understanding and exploring how physical, chemical and biological processes work. 

It is essential that highly qualified science teachers develop the energetic, eager 

and curious next generation of scientists and engineers. Skilled geoscientists and 

geoengineers, in particular, are needed to find, develop and maintain our energy, 

agricultural, water and air resources, to understand and mitigate natural hazards 

and to ensure an educated public with a general understanding of the Earth environment to enhance our public and private quality of life. 

AGI is a nonprofit federation of 44 geoscientific and professional societies representing more than 100,000 geologists, geophysicists, and other Earth scientists. 

Founded in 1948, AGI provides information services to geoscientists, serves as a 

voice for shared interests in our profession, plays a major role in strengthening geoscience education, and strives to increase public awareness of the vital role the geosciences play in society’s use of resources and interaction with the environment. 

In 1999, the Third International Math and Science Study found that the longer 

U.S. students are in school, the farther they fall behind in math and science proficiency in international comparisons. That prompted President Bush to propose the 

National Math and Science Partnership (MSP) program as part of No Child Left Behind. The goal of the partnership program is to strengthen K–12 science and math 

education by promoting a vision of education as a continuum that begins with the 

youngest learners and progresses through adulthood with teacher training. Among 

its activities, the program supports partnerships that unite K–12 schools, institutions of higher education and private industry. 

Congress took the President’s suggestion and authorized an MSP program at the 

National Science Foundation (NSF) and another partnership program at the Department of Education in 2002. These acts of Congress fund two different types of partnerships to achieve the overall goal of highly qualified math and science teachers 

ensuring that all students have the basic knowledge to compete in the ever changing and competitive job market. The funds allocated for the NSF’s MSPs go to the 

highest quality proposals chosen through a competitive peer-reviewed grant program. The program focuses on modeling, testing and identification of effective mathscience activities. The funds allocated for the Department of Education MSPs go directly to the States as formula grants, providing funds to all States to replicate and 

then implement the best of the NSF partnerships throughout the country. Once 

States receive the money, they make competitive grants to local partnerships. 

The $120 million in funds for Secondary Education Mathematics Initiative is part 

of the overall High School Initiative, which will expand the application of No Child 

Left Behind principles to improve high school education and raise achievement, particularly the achievement of students most at risk of failure. This new initiative 

combines a number of categorical programs in order to give States and districts 

more flexibility and contains stronger accountability mechanisms. 

AGI believes the two MSPs are the most effective approach to rapidly improving 

the abilities of all students to enhance their future prospects regardless of their ultimate career goals. The two programs, designed and authorized by Congress, are 

complementary. AGI supports funding at NSF for competitive grants for teaching 

tools and teacher training and funding at the Department of Education for formula 

grants for implementation of these tools in K–12 education. The peer-review process 

in the NSF program should be safeguarded as should the formula grants for all 

States as administered by the Department of Education. Moreover, the program 

within the Department of Education should not suffer a net reduction in funding 

in order to support a new initiative for mathematics. These funds should serve the 

Math and Science Partnership with no earmarks or set-asides. 

Thank you for the opportunity to present this testimony to the subcommittee. If 

you would like any additional information, please contact me at 703–379–2480, ext. 

228 voice, 703–379–7563 fax, rowan@agiweb.org, or 4220 King Street, Alexandria 

VA 22302–1502. 
543 

PREPARED STATEMENT OF THE ASSOCIATION OF MINORITY HEALTH PROFESSIONS

SCHOOLS

SUMMARY OF FISCAL YEAR 2007 RECOMMENDATIONS

—(1) $550 Million for HRSA’s Health Professions Training Programs, Including: 

—$34 million for Minority Centers of Excellence. 

—$36 million for the Health Careers Opportunity Program. 

—$47 million for Scholarships for Disadvantaged Students. 

—(2) $83 million for HRSA’S Healthy Communities Access Program. 

—(3) 5 percent increase overall for the National Institutes of Health, including 

$250 million for the National Center on Minority Health and Health Disparities. 

—(4) $119 million for the National Center for Research Resources Extramural Facilities Construction Program. 

—(5) $65 million for the Department of Education’s Strengthening Historically 

Black Graduate Institutions Program. 

—(6) $65 million for the HHS Office of Minority Health, including support for a 

new health disparities initiative. 

Mr. Chairman, thank you for the opportunity to present the views of the Association of Minority Health Professions Schools (AMHPS). I am Dr. Wayne Harris, Dean 

of the College of Pharmacy at the Xavier University of Louisiana. 

AMHPS is comprised of the Nation’s twelve historically black medical, dental, 

pharmacy, and veterinary schools. Combined, our institutions have graduated 50 

percent of African-American physicians and dentists, 60 percent of all the Nation’s 

African-American pharmacists, and 75 percent of the African-American veterinarians. 

Mr. Chairman, historically black health professions institutions are addressing a 

pressing national need in carrying out their mission of training minorities in the 

health professions. While African-Americans represent approximately 15 percent of 

the U.S. population, only 2–3 percent of the Nation’s health professions workforce 

is African-American. Studies have demonstrated that when African Americans and 

other minorities are trained in minority institutions, they are much more likely to: 

(1) serve in medically underserved areas, (2) care for minorities, and (3) accept patients who are Medicaid dependent or otherwise poor. 

This is important Mr. Chairman because the gap in health status between our 

Nation’s minority and majority populations continues to widen due in part to the 

lack of access to quality health care services in minority communities. As a result, 

we believe it is imperative that the Federal commitment to training African Americans and other minorities in the health professions remains strong. 

In spite of our proven success in training health professionals, and the important 

contribution these professionals make, our institutions continue to face a financial 

struggle inherent to our mission. The financial challenges facing the majority of our 

students affect our institutions in numerous ways. For example, we are unable to 

depend on tuition as a means by which to respond to any discontinuation of Federal 

support. Moreover, the patient populations served by the AMHPS institutions are 

overwhelmingly poor. As a result, our institutions cannot rely on patient care income at a time when the average medical school gets 40–60 percent of its operating 

revenue from health care services. 

Mr. Chairman, before I go into a discussion of our Association’s fiscal year 2007 

recommendations, I would like to share Xavier’s experience with Hurricane Katrina 

and update you on our recovery efforts. Xavier is located in New Orleans and the 

entire campus was flooded with 3–6 feet of water. Each building on campus had significant damage on the first floor and the campus was shut down until January 9, 

2006. The University developed an ambitious plan to repair damage and resume operations on January 17, 2006 using a revised academic calendar to complete the entire academic year in August 2006. I am happy to report that the University resumed classes on January 17 as planned. Overall University enrollment dropped, 

however, from approximately 4,000 students in August 2005 to approximately 3,000 

students post-Katrina. The College of Pharmacy enrollment was less severely affected with enrollment dropping from 619 to 600. 

Significant challenges still remain, including cash flow problems as we deal with 

recovery costs in the range of $30 million for construction and equipment and disruption of operations of key health care institutions in New Orleans. These institutions are vital to the clinical education program of the College of Pharmacy and to 

our continued recovery. It is absolutely essential to the University that health care 

delivery services are restored as quickly as possible. 
544 

The University recognized the need to resume our academic programs as quickly 

as possible in order to continue to produce African American health professionals 

and contribute to rebuilding the City of New Orleans. By working with other Colleges of Pharmacy across the country, we were able to allow senior pharmacy students to continue their clinical education while under evacuation and we are pleased 

to report that pharmacy students will graduate on May 20, 2006. Our rebuilding 

effort is well underway but disruption of Federal support for important programs 

such as HRSA’S Center of Excellence would severely hinder this rebuilding effort. 

FISCAL YEAR 2007 RECOMMENDATIONS FOR FEDERAL PROGRAMS OF INTEREST TO AMHPS

Health Resources and Services Administration 

Health Professions Training 

Mr. Chairman, we are disappointed that the President’s budget all but eliminates 

funding again this year for health professions training programs focused on diversity in the workforce. The health professions training programs administered by the 

Health Resources and Services Administration are the only Federal initiatives designed to address the longstanding under-representation of minority individuals in 

health careers. HRSA’s Minority Centers of Excellence, Health Careers Opportunity 

Program, and Scholarships for Disadvantaged Students, support health professions 

institutions with a historic mission and commitment to increasing the number of minorities in the health professions. For fiscal year 2007, AMHPS joins with the 

Health Professions Nursing and Education Coalition in recommending an overall 

funding level of $550 million for health professions training. 

For the health professions programs specifically focused on enhancing minority 

representation in the health care workforce, AMHPS recommendations are as follows: 

Minority Centers of Excellence 

The purpose of the Minority Centers of Excellence program (COE) is to assist 

schools that train minority health professionals by supporting programs of excellence in health professions education at those institutions. The COE program focuses on improving student recruitment and performance; improving curricula and 

cultural competence of graduates; facilitating faculty/student research on minority 

health issues; and training students to provide health services to minority individuals by providing clinical teaching at community-based health facilities. For fiscal 

year 2007, AMHPS recommends a funding level of $34 million for Minority Centers 

of Excellence (an increase of $22 million over fiscal year 2006). 

Health Careers Opportunity Program 

Grants made to health professions schools and educational entities under the 

Health Careers Opportunity Program (HCOP) enhance the ability of individuals 

from disadvantaged backgrounds to improve their competitiveness to enter and 

graduate from health professions schools. HCOP funds activities that are designed 

to develop a more competitive applicant pool through partnerships with institutions 

of higher education, school districts, and other community based entities. HCOP 

also provides for mentoring, counseling. primary care exposure activities and information regarding careers in a primary care discipline. Sources of financial aid are 

provided to students as well as assistance in entering into the health professions 

school. 

For fiscal year 2007, AMHPS recommends a funding level of $36 million for the Health Careers and Opportunities Program (an increase of $32 million over fiscal 

year 2006). 

Scholarships for Disadvantaged Students 

The Scholarships for Disadvantaged Students program was established to make 

scholarship funds available to eligible students from disadvantaged backgrounds 

who are enrolled (or accepted for enrollment) as full-time students. To be eligible 

for funding, a school must have in place a program to recruit and retain students 

from disadvantaged backgrounds (including racial and ethnic minorities) and demonstrate that the program has achieved success based on the number or percentage 

of disadvantaged students who graduate from the school. For fiscal year 2007, 

AMHPS recommends a funding level of $47 million for the Scholarships for Disadvantaged Students program (an increase of $47 million over fiscal year 2007). 

Healthy Communities Access Program 

Mr. Chairman, Congress passed legislation in 2003 to reauthorize the Community 

Health Centers program. Included in this important measure was a provision which 

established a demonstration authority within the Healthy Community Access Pro-
545 

gram to foster greater collaboration between historically black health professions 

and federally qualified CHC’s. Specifically, this provision: 

(1) Establishes a demonstration program for the development of research infrastructure at historically black health professions schools affiliated with federally 

qualified Community Health Centers. 

(2) Establishes joint and collaborative programs of medical research and data collection between historically black health professions schools and federally qualified 

Community Health Centers with the goal of improving the health status of medically underserved populations. 

(3) Supports the cost of patient care, data collection, and academic training resulting from these partnerships. 

Mr. Chairman, several of our member institutions received funding in fiscal year 

2005 under this promising new demonstration authority. Unfortunately, the H–CAP 

program was eliminated in the fiscal year 2006 Labor-HHS bill, and the President’s 

budget for fiscal year 2007 does not provide any funding for the coming year. 

AMHPS encourages the subcommittee to restore support for this important program 

in fiscal year 2007 at the fiscal year 2005 level of $83 million. 

National Institutes of Health 

The National Center on Minority Health and Health Disparities 

Established in 2000 by the Minority Health and Health Disparities Research and 

Education Act (Public Law 106–525), the National Center on Minority Health and 

Health Disparities at NIH is charged with addressing the longstanding health status gap between minority and majority populations. The National Center has the 

authority to: 

—Directly support biomedical research, training, and information dissemination 

focused on eliminating health status disparities. 

—Serve in a leadership capacity in developing a comprehensive plan for minority 

health research at NIH. 

—Participate as an equal when NIH institute and center directors meet to determine research policy. 

—Support the enhancement of biomedical research capacity at minority health 

professions institutions through a ‘‘Research Endowment’’ program. 

—Support the development of health professions institutions with a history and 

mission of serving minority and medically underserved communities through a 

‘‘Centers of Excellence’’ program. 

For fiscal year 2006, AMHPS recommends a funding level of $250 million for the 

National Center. This is an increase of $54 million. This new funding will enable 

the Center to support all of its new programs and begin to meet the challenge of 

eliminating health status disparities within minority and medically underserved 

communities 

Extramural Facilities Construction 

Mr. Chairman, if we are to take full advantage of the historic funding increases 

for biomedical research that Congress has provided to NIH over the past decade, 

it is critical that our Nation’s research infrastructure remain strong. The current 

authorization level for the Extramural Facility Construction program at the National Center for Research Resources is $250 million. The law also includes a 25 

percent set-aside for ‘‘Institutions of Emerging Excellence’’ (many of which are minority institutions) for funding up to $50 million. Finally, the law allows the NCRR 

Director to waive the matching requirement for institutions participating in the program. We strongly support all of these provisions of the authorizing legislation. 

Unfortunately, funding for NCRR’s Extramural Facility Construction program 

was completely eliminated in the fiscal year 2006 Labor-HHS bill. For fiscal year 

2007, AMHPS encourages the subcommittee to restore funding for this program to 

its fiscal year 2004 level of $119 million, or at a minimum, provide funding equal 

to the fiscal year 2005 appropriation of $40 million. 

Research Centers in Minority Institutions 

The Research Centers at Minority Institutions program (RCMI) at the National 

Center for Research Resources has a long and distinguished record of helping our 

institutions develop the research infrastructure necessary to be leaders in the area 

of health disparities research. Although NIH has received unprecedented budget increases in recent years, funding for the RCMI program has not increased by the 

same rate. Therefore, AMHPS recommends that funding for this important program 

grow at the same rate as NIH overall in fiscal year 2007. 
546 

Strengthening Historically Black Graduate Institutions—Department of Education 

The Department of Education’s Strengthening Historically Black Graduate Institutions program (Title III, Part B, Section 326) is extremely important to AMHPS 

institutions. The funding from this program is used to enhance educational capabilities, establish and strengthen program development offices, initiate endowment 

campaigns, and support numerous other institutional development activities. For 

fiscal year 2007, AMHPS recommends an appropriation of $65 million (an increase 

of $7 million over fiscal year 2006) to continue the vital support that this program 

provides to historically black graduate institutions. 

HHS Office of Minority Health 

The HHS Office of Minority Health (OMH) has the potential to play a critical role 

in addressing health status disparities throughout the country. Unfortunately, the 

office does not currently have the authority or resources necessary to support activities that will truly make a difference in closing the health gap between minority 

and majority populations. For fiscal year 2007, AMHPS recommends a funding level 

of $65 million for the Office, with $10 million designated for the following programs 

focused on medically underserved communities and capacity building for the training of minorities in health professions: 

(1) OMH sponsored programs to assist medically underserved communities with 

the greatest need in solving health disparities and attracting and retaining health 

professionals; 

(2) Assistance to minority institutions in acquiring real property to expand their 

campuses to increase the capacity to train minorities for medical careers; 

(3) Support of conferences for high school and undergraduate students to pursue 

health professions careers; and 

(4) Support for cooperative agreements with minority institutions for the purpose 

of strengthening their capacity to train more minorities in the health professions. 

Once again, thank you for the opportunity to present the views of the Association 

of Minority Health Professions Schools. We look forward to working with you in support of these important programs. 

PREPARED STATEMENT OF THE CENTER FOR EDUCATION

EXECUTIVE SUMMARY

The Department of Education’s (ED) justification for eliminating funding for the 

Education for Democracy Act is essentially the same as it was for fiscal year 2006. 

It also includes the same omissions and errors, as noted in the following response. 

The Center for Civic Education (Center) and others supported under the Act believe the three major findings of the ED report are not adequately supported by the 

facts. Brief responses to the three findings are presented here. More detailed responses follow. 

1. ‘‘Limited impact.’’ The first paragraph of the ED justification for eliminating 

the Civic Education program states that it is ‘‘eliminating small categorical programs that have limited impact. . . .’’ The statement appears to be contradicted in 

the next paragraph which recognizes the extent of the Center’s programs: ‘‘Districts 

in nearly every State and major urban area participate in We the People program 

activities.’’ 

The Center’s programs provide sound, sustained, and effective instruction in the 

fundamental values and principles of constitutional democracy annually to approximately 3 million domestic students and 2 million students in other nations at a cost 

of approximately $5–6 per student. Research and evaluation have demonstrated the 

significant impact of these programs that provide a cost-effective means of reaching 

a significant number of students. Since its inception, the Center’s We the People 

program alone has reached more than 28 million students in the United States. 

2. ‘‘Little or no reliable evidence of effectiveness.’’ The ED justification fails to cite 

or recognize the extensive research and evaluation of Center programs as well as 

other significant evidence of program effectiveness, none of which is matched by any 

other program in the field. 

3. ‘‘Additional funding is not necessary for the successful operation of this program.’’ To anyone aware of the history of support for civic education, and the policies, priorities, and practices of private sector funding, it is clear that support for 

national and international programs in civic education of the magnitude of those implemented by the Center is simply not available from sources other than the Federal 

Government. Federal funding is essential for the continuation of this program. 

The following information provides a more detailed response to the ED report. 
547 

INTRODUCTION

The Department of Education’s (ED) justification for eliminating funding for the 

Education for Democracy Act is essentially the same as it was for fiscal year 2006. 

It also includes the same omissions and errors as will be noted in the following response. 

ED’s justification is composed of three major parts: that the Civic Education programs supported under the act (1) have ‘‘limited impact,’’ (2) have ‘‘little or no reliable evidence of effectiveness,’’ and that (3) ‘‘additional funding is not necessary for 

the successful operation of this program.’’ The Center for Civic Education (Center) 

and others supported under the Act believe these findings are not adequately supported by the facts. The Center’s responses follow. 

1. Response: The Civic Education program has ‘‘limited impact’’ 

The first paragraph of the ED justification for eliminating the Civic Education 

program states that ED is ‘‘eliminating small categorical programs that have limited 

impact. . . .’’ In the next paragraph it states that ‘‘The Center . . . is an established non-profit organization with a broad network of program participants, alumni, volunteers, and financial supporters at the local, state, and national levels. Districts in nearly every State and major urban area participate in We the People program activities.’’ It is difficult to square the first statement with the second, because 

for a relatively small amount of Federal funds, the Center’s domestic and international programs have a significant impact on the education of students at the precollegiate level as well as their teachers in the United States and abroad. The following information supports this premise. 

The fiscal year 2006 appropriation for the Education for Democracy Act is $29.1 

million. In round figures, the allocation of these funds is as follows: 

—Center for Civic Education (directed funding) 

—Domestic programs = $17 million 

—International programs = $4.5 million 

—National Council for Economic Education (directed funding) 

—International program = $4.5 million 

—Competitive international exchange program = $3.1 million 

—Note: The Center currently has a $1 million grant under this program for Latin 

America and a $1 million grant for Africa 

Impact of the Center’s Domestic Programs 

Approximately 70 percent of the Center’s $17 million for domestic programs is allocated to public- and private-sector institutions or organizations at State and local 

levels in the form of sub-awards, free curricular materials, and subsidized teacher 

training programs. These funds are managed by approximately 120 coordinators located in public or private sector agencies or organizations at State levels. They are 

assisted by approximately 630 congressional district coordinators, many of whom 

are affiliated with school districts. These coordinators, essentially volunteers, receive a modest stipend to cover operating costs. These coordinators in turn coordinate thousands of additional volunteers who serve as judges, academic coaches, timers, facilitators, and in other roles required by the size and scope of this endeavor. 

The value of this volunteer network greatly amplifies the value of the Federal investment and the reach of the program and exemplifies American civic virtue in action. The remaining 30 percent of the funds pays for technical assistance to this network and the administrative operating costs of the Center. 

The domestic network of coordinators oversees the implementation of three major 

curricular programs that reach approximately 3 million students annually at a cost 

of approximately $5.67 per student. For this sum, each student receives the use of 

a free textbook and an estimated 10 to 40 or more hours of instruction in the fundamental values and principles of American constitutional democracy and how to participate competently and responsibly in political life. As noted below, ample research 

testifies to the positive outcomes of these programs. 

The Department of Education’s rationale for cutting the Civic Education program 

claims that its ‘‘contribution to the Department’s mission is marginal.’’ This statement does not seem to be in line with the policy of President Bush, who stressed 

the importance of civic education in the 2002 introduction to his initiative in History, Civics, and Service, in which he stated that: 

‘‘American children are not born knowing what they should cherish—are not born 

knowing why they should cherish American values. A love of democratic principles 

must be taught. At this very moment, Americans are fighting in foreign lands for 

principles defined at our founding, and every American—particularly every American child—should fully understand these principles.’’ 
548 

The question might be asked: What other programs in civic education does ED 

support, if any, that accomplish the mission set forth in President Bush’s speech 

and which, if any, have the impact on students per Federal dollar that result from 

programs supported under the Education for Democracy Act? It should be noted 

that the Federal funding for this program is matched by cost sharing at State and 

local levels estimated at from $5–$8 in value for every Federal dollar spent. 

The need for improvement in the civic education of our Nation’s students has been 

demonstrated repeatedly by research findings over the past several decades. This 

need was clearly illustrated in a recent survey in which only 28 percent of Americans could list two or more First Amendment freedoms, while more than 50 percent 

could name at least two cartoon characters from ‘‘The Simpsons’’ (McCormick Tribune Freedom Museum Poll, March 1, 2006). The programs supported by Congress 

under the Education for Democracy Act are a proven cost-effective means of remedying this shortcoming in the education of our Nation’s youth. 

Impact of the Center’s International Programs 

As with its domestic programs, approximately 70 percent or more of the Center’s 

international funding is allocated to public- and private-sector institutions or organizations at State and local levels in the United States and similar organizations in 

approximately 70 emerging and advanced democracies throughout the world. This 

support is provided in the form of sub-awards, free curricular materials, and subsidized teacher training programs. These funds are managed by public- and privatesector organizations in 28 States and similar organizations in the participating 

countries. The remaining 30 percent of the funds pay for technical assistance to this 

network and the administrative operating costs of the Center. 

The international network of coordinators oversees the implementation of curricular programs focused on education for democracy. It is difficult in many cases 

to get accurate figures on participation in these programs from the participating 

countries. We believe that 2 million students per year is a modest estimate. The students in these countries are being provided instruction in the fundamental values 

and principles of constitutional democracy and how to participate competently and 

responsibly in political life. As noted below, ample research testifies to the positive 

outcomes of these programs. 

The $4.5 million in baseline funding for this program from ED is augmented by 

approximately $8 million more in grants from ED, the Department of State, USAID, 

and other domestic sources. The program has also precipitated funding from other 

sources of approximately $15 million to augment its impact. These sources include 

the European Union, the Russian Ministry of Education, the InterAmerican Development Bank, the World Bank, the Mexican Institute for Federal Elections, and 

other public- and private-sector sources in other countries. This additional support 

could not have been generated without the funding from ED that has served as 

‘‘seed’’ money for the establishment of successful education for democracy programs 

in other nations. 

The impact and success of these programs is supported by research findings and 

numerous reports from U.S. Embassies and AID missions, which have assisted the 

Center in their establishment. In many cases, the successful impact of pilot programs supported by ED funds has prompted these entities to add their own funds 

to augment the programs. A notable example of such an occurrence was the Center’s 

ED-supported Jordanian pilot program in democracy education, which has received 

approval for nationwide implementation by the Ministry of Education. The success 

of this program led the State Department to provide an additional $3.2 million to 

implement democracy education programs in ten Arab nations in North Africa and 

the Middle East. In turn, the success of that program led the State Department to 

request that the Center submit a proposal for three years of funding for the region 

at $3–4 million per year. None of this would have been possible without the sustained funding from ED that enables the Center to initiate and maintain education 

for democracy programs in spite of the changing priorities of other sources of funding. It is important to note that the State Department funding does not eliminate 

the need for the baseline ED funding for the international civic education program 

and that with continued ED funding, similar advances might be made in other parts 

of the world. 

It is clear that these programs are a significant and cost-effective contribution to 

the administration’s effort to further the worldwide growth of democracy, which is 

why President Bush has met with the Center’s Russian partner, and Secretary of 

State Condolleeza Rice has met with the Center’s partner in Pakistan. It is also 

clear that the international civic education for democracy movement, central to the 

administration’s foreign policy, is at risk without significant continuing funding. Although a fledgling nongovernmental membership organization—Civitas Inter-
549 

national—was founded by the United States Information Agency in 1995 to assist 

efforts in this field, the organization was never able to raise sustaining funds from 

other organizations or individuals that would permit it to function independently. 

Instead, the organization asked the Center to assist it by folding its meetings and 

functions into the Center’s civic education network. 

Note: In addition to those students reached by the Center’s international programs, the economics program funded under this Act and implemented by the National Council for Economic Education reaches an estimated 2.4 million students annually. The goal of this effective program is to help students understand the principles and institutions of market economies and their relationship to democracy. 

Summary 

Contrary to the Department of Education’s assertion in its justification for eliminating funding for the Education for Democracy Act, the Center’s programs have a 

significant impact on the civic education of pre-collegiate students and their teachers in the United States and abroad. 

The Center’s programs are proven, cost effective, and reach millions of students 

throughout the world. Approximately 3 million students in the United States benefit 

from the Center’s curricular programs at a cost of approximately $5.67 per student. 

The Center’s programs directly contribute to the mission of the Department of Education by accomplishing the mission set forth in President Bush’s initiative in History, Civics, and Service. 

Approximately 2 million students per year outside of the United States are provided by the Center and its network of coordinators with instruction in the fundamental values and principles of constitutional democracy and learn how to participate competently and responsibly in political life. Funding provided by the Department of Education is essential for the establishment of successful education for democracy programs in other nations. The spectacular success of Center initiatives in 

Jordan and other Arab nations demonstrates the Center’s cost-effective contribution 

to the Bush administration’s effort to advance the worldwide growth of democracy. 

2. Response: There is ‘‘little or no reliable evidence of [the] effectiveness’’ of the Center’s programs 

The Department’s document claims that studies of the programs of the Center are 

not sufficiently rigorous to yield reliable results about their overall effectiveness. To 

that end, a single study conducted by the Center on students participating in the 

national finals of the Center’s annual We the People competition was cited. The 

study employs nationally normed items from the National Assessment of Educational Progress (NAEP), the National Election Studies, and the College Freshman 

surveys. The positive results of this study were challenged by ED because the students were a select sample—even though that fact had always been clearly identified and understood as such, and the Department accepted it as a valid performance 

indicator. Indeed, the study in question is performed annually in partial fulfillment 

of requirements placed on the Center by the Department of Education. 

Since its inception in 1965 at the University of California at Los Angeles, the Center has conducted numerous studies on the effectiveness of its curricular programs 

and contracted with third parties that have also conducted such studies. (Most of 

these studies are not referred to in the ED report.) Indeed, the We the People programs have been more thoroughly researched than any other programs in the field. 

Each of the recent studies cited below falls within the recommendations of the 

What Works Clearinghouse at the Institute of Educational Sciences (IES) of the Department of Education. IES encourages the methodological rigor of studies that include experimental or high-quality quasi-experimental design and cites them as the 

best determinants for measuring curricular effectiveness. 

Study: MPR Associates, Inc.— A high-quality quasi-experimental study of the We 

the People: The Citizen and the Constitution program conducted in 2003 by MPR 

Associates, Inc., in collaboration with noted research scholars Dr. Richard Niemi, 

University of Rochester, and Dr. Elizabeth Theiss-Morse, University of NebraskaLincoln, found statistically significant differences between We the People and nonWe the People students. Specifically, We the People students enrolled in AP classes 

performed, on average, 30 percent better on the knowledge survey than students enrolled in non-We the People AP classes. We the People students in regular classrooms also significantly outperformed their non-We the People counterparts. 

The study also found that We the People students were more likely than their 

peers to show greater growth in their sense of political efficacy, sense of citizen responsibility, appreciation of obligations of citizenship, and a greater sense of political and community responsibility than the control group. The results of these studies show the degree to which the Center’s programs meet President Bush’s request 
550 

1 Bush, George W. (2002). ‘‘President Introduces History and Civic Education Initiatives.’’ Remarks of the president on the Teaching History and Civic Education Initiative, September 17. 

www.whitehouse.gov. 

for civic education initiatives that ‘‘improve students’ knowledge of American history, increase civic involvement, and deepen their love for our great country.’’ (Bush 

2002, 1) 1 It should be noted that the Center was unable to obtain funding for a proposal submitted to the Department of Education in 2005 for a study employing random assignment of students to the curriculum. The Center is still seeking funds to 

use the instruments it has developed to conduct a longitudinal study over seven 

years. 

Study: University of Texas.—Dr. Kenneth Tolo, University of Texas at Austin, 

found that the Center’s We the People: Project Citizen program had positive effects 

on student attitudes and skills, including students’ attitudes about their own effectiveness and their engagement in their communities. The program also enhanced 

student communication and research skills. 

The study also details seven key areas of Project Citizen implementation—State 

administration, the recruitment of and outreach to teachers and school administrators, teacher training, teacher and class use, Project Citizen competitions, benefits 

to students, and financial and political support—and offers recommendations for 

maximizing implementation efforts in each of these areas. These recommendations 

have been invaluable to improving the implementation strategies of Project Citizen 

in the United States and abroad. 

Study: RMC Research.—In 2004–2005, RMC Research used qualitative and quantitative measures in a quasi-experimental study of students taking part in the 

Project Citizen program in Oklahoma, Michigan, Colorado, the Czech Republic, and 

Slovakia. The study found that students in grades 6–12 increased their global 

knowledge of democracy. The study found significant gains in students’ knowledge 

of public policy, support for freedom of belief, the right of citizens to question government messages, and the right to join organizations. Students’ civic skills improved as well. Based upon these results, RMC is improving item reliability and will 

conduct a second study in 2006. 

Study: Indiana University at Bloomington.—A high-quality quasi-experimental 

study of students in Indiana, Latvia, and Lithuania by Thomas S. Vontz, Kim K. 

Metcalf, and John J. Patrick, Indiana University at Bloomington, found that We the 

People: Project Citizen develops students’ civic knowledge, skills, and dispositions 

positively and significantly, irrespective of nationality. The full report has been published in a volume titled Project Citizen and the Civic Development of Adolescent 

Students in Indiana, Latvia, and Lithuania. 

Study: Center for Civic Education, Bosnia and Herzegovina.—A high-quality 

quasi-experimental study of students in Bosnia and Herzegovina in 2000 by Dr. Suzanne Soule, Center for Civic Education, found that Project Citizen students showed 

greater confidence in their knowledge of local government, were more skilled at explaining problems; showed greater analytical abilities in using facts and reason to 

analyze other people’s positions on problems, had more positive attitudes with regard to their own power in the community and internal efficacy, and showed a 

greater propensity to hold public officials accountable. In 2002, First Lady Laura 

Bush praised the program in remarks to the Organization for Economic Cooperation 

and Development: 

‘‘The United States is also a partner in the Balkans, working with the International Community and Civitas in Bosnia and Herzegovina to develop a course in 

democracy and human rights. This course is taught in (primary) schools throughout 

the region, including Brcko, and it has been translated for all three ethnic groups. 

The course is part of a larger effort called ‘Project Citizen.’ Through ‘Project Citizen’ 

programs, children learn to identify and solve problems in their own communities, 

from supplying clean water to improving dangerous traffic crossings. Citizenship— 

a sense of belonging and responsibility—strengthens societies.’’ 

Study: Center for Civic Education, Indonesia.—A high-quality quasi-experimental 

study of students in Indonesia in 2002 by Dr. Suzanne Soule found Project Citizen 

participants’ political participation increased as a result of their involvement with 

the program. In contrast to the control group, they participated more in the political 

process, conducted more research by contacting experts to obtain information on 

issues they cared about, and participated in protests at higher rates. They also paid 

more attention to public affairs in the media. The dispositions of students who participated more fully in the program—by selecting their problems, presenting their 

proposals, and engaging in other programmatic activities—changed more. They became more interested in politics and public affairs. Their confidence in their ability 
551 

2 Brilliant, F. (2000). Civic Education Assessment—Stage II. Civic Education Programming 

Since 1990—A Case Study Based Analysis. Report for the U.S. Agency for International Development. 

to participate, along with their sense of political efficacy, increased. Further, highinvolvement participants increased their expectations of the proper responsiveness 

of government, an important component of accountability. 

Study: WestEd.—The Center is currently working with WestEd, a leading surveydesign firm, to devise knowledge and attitude tests for We the People: Project Citizen domestic and international use. The standardized test will be refined and used 

within and outside the United States with various quasi-experimental and experimental studies to ensure a maximum scale of comparability. The knowledge tests 

have been piloted in Nigeria and South Africa and are to be utilized in an experimental study in Colombia and Mexico in 2006. 

State Department Report.—In a report released by the State Department’s Bureau 

of Western Hemisphere Affairs, the Center’s ED-supported Civitas Latin America 

program is presented as a model for developing Cuban democracy (see Chapters 2 

and 3). The report cites success in training teachers and effectiveness of programs 

as important for encouraging democratic thought and practice. 

USAID Report.—The State Department report is in accord with an independent 

assessment of civic education programs funded by USAID from 1990 to 2000, which 

found that ‘‘We the People: Project Citizen has many of the characteristics of the 

most effective civic education programs. It is highly participatory, it relates to issues 

that affect the participants in their daily lives, it produces tangible as well as intangible results, and it is firmly rooted in the community in which it takes place.’’ (Brilliant, 2000, 38).2

Other Evidence of the Effectiveness of the Center’s Programs 

In addition to previous references to visits with program participants by President 

Bush, Mrs. Bush, and Secretary Rice, the obvious effectiveness of the Center’s programs has been recognized at other times at the highest levels of government in the 

United States and other nations. For example: 

—In 1996, the Supreme Court hosted the newly elected U.S. Senate in the Great 

Hall of the Court. The event was attended by seven Justices and more than 

ninety senators. The major attraction of the evening was a well-received demonstration of the We the People competitive hearing by students from the State 

of Oregon. 

—In 1998, students from the We the People program were honored by the Department of Education when Secretary Riley announced the release of the findings 

of the NAEP study of student knowledge of civics and government. 

—In 2000, We the People students were invited to testify in Congress on the subject of school violence. Members of the committee before which the students testified said that they were better prepared than many of the expert witnesses 

who had testified earlier. 

—In 2004, the Bush administration hosted a White House Conference on History, 

Civics, and Service. The only civics program featured was the We the People 

program. Students from Arizona demonstrated their outstanding knowledge of 

the U.S. Constitution and Bill of Rights before a panel composed of a noted 

scholar and two Federal judges. One of the Federal judges commented that the 

students had a firmer grasp of constitutional principles than most attorneys 

who appear in her court. 

—In 2005, the Department of Education invited teachers of the We the People 

program to speak to a Constitution Day assembly at the Department, at which 

they were extremely well received. 

—Other nations: The following are a few of the many incidences where other nations have recognized the quality and effectiveness of the Center’s programs: 

—The Russian Ministry of Education has approved the use of the Center’s We the 

People and Project Citizen texts in all Russian schools. 

—The Mexican Institute for Federal Elections has translated and adapted the 

Project Citizen text and is implementing it in classrooms in all States of Mexico. 

—The Center has helped the U.S. Embassy in Bosnia and Herzegovina develop 

a K–12 civic education program that is being implemented in all schools in that 

country. 

—The Jordanian Ministry of Education has approved the implementation of 

Project Citizen in all schools in Jordan. 

—The Kurdish Regional Authority in Iraq has translated and adapted the Center’s Foundations of Democracy program and implemented it with more that 

400,000 students in their region. 
552 

—The U.S. Embassy in Baghdad recently supported the training of teacher trainers in the Center’s curricular materials and intends to support their implementation throughout the country. 

—The textbook division of the Chinese Ministry of Education has translated and 

adapted material from the Center’s texts to be used in schools throughout 

China. The division has also signed a memorandum of understanding with the 

Center to work together to develop more curricular materials. 

Summary.—The following generalizations can be made from internal and external 

research and evaluation studies conducted during the past seventeen years. Students who participate in the Center’s curricular programs show the following results. In comparison with their peers and some adults, students in Center programs: 

—demonstrate a greater understanding of and commitment to fundamental values 

and principles of constitutional democracy, such as individual rights, the common good, the rule of law, and civic responsibility. They are also less cynical, 

more politically engaged, more politically tolerant, and think that they can and 

do make a difference in the political life of their communities and nations; 

—demonstrate a greater understanding of politics and government at local, intermediate, and national levels and a deeper knowledge of how to participate effectively in the political process; 

—possess better research, analytic, and communication skills. This includes an increased capacity to evaluate, take, and defend positions on public issues; 

—demonstrate a greater capacity to work with others to effectively monitor and 

influence the decisions of their government; 

—pay more attention to politics and the media, discuss politics more often, volunteer to work for candidates, register to vote, and vote at significantly higher 

rates than their peers. Students also take active roles in the enactment of policies to improve the life of their communities and nations. 

Please see the attached bibliography for a list of studies conducted on Center programs. 

3. Response: ‘‘Additional funding is not necessary for the successful operation of this 

program’’ 

The Department’s justification claims that ‘‘additional funding is not necessary for 

the continuation of this program.’’ Further, the Department asserts that: 

‘‘[the] Center also has a long history of success raising additional funding support 

through such vehicles as selling program-related curricular materials, trainings, and 

workshops, partnering with non-profit groups on core activities, lobbying, and seeking support from foundations. For example, the Center has received financial support from such organizations as the Pew Charitable Trusts, the National Endowment for the Humanities, the Joyce Mertz-Gilmore Foundation, the Lincoln and 

Therese Filene Foundation, Inc., and an increasing number of State and local entities. Also with a national board that includes . . . noted scholars (etc.), the Center 

will have many opportunities to generate additional support for core program activities.’’ 

The statements in this section of the report do not reflect a sound knowledge of 

the history, policies, and practices of public- and private-sector support for civic education programs in the United States over the past fifty years, nor a firm grounding 

in the facts regarding past and present funding of the Center or the probability of 

obtaining the level of support necessary from sources other than the Federal Government. To anyone aware of the history of support for civic education, it is clear 

that support for national and international programs in civic education of the magnitude of those implemented by the Center and described above is simply not available from sources other than the Federal Government. Federal funding is essential 

for the continuation of this program. 

The Center has always sought and sometimes received support from other 

sources. In reference to the sources the ED report notes above, the Center did receive $1 million from the Pew Charitable Trusts in 1988 to develop and promote 

the implementation of CIVITAS: A Framework for Civic Education. In 1991, the 

Pew Charitable Trusts provided a grant of $400,000 to match funds the Center received from the Department of Education to develop the National Standards for 

Civics and Government. For several years the Joyce Mertz Gilmore Foundation 

awarded the Center $20,000 to partially offset the costs of an annual bilateral conference on civic education the Center conducted with the Federal Center for Political 

Education of Germany. For the past three years the Lincoln and Therese Filene 

Foundation has provided about $100,000 annually to support a summer institute for 

teachers. A similar level of support has, in some years, been provided for the same 

purpose by the National Endowment for the Humanities. The Center receives 
553 

$250,000 each year from the California State Department of Education to augment 

its Federal funding for the implementation of Project Citizen in California. Despite 

its efforts, the Center has never been able to secure sustained funding in more substantial amounts from such sources for its major programs. 

The ED report claims that the Center receives income from ‘‘such vehicles as selling program-related curricular materials, trainings, and workshops.’’ Support from 

ED enables the Center to provide approximately 450,000 free textbooks to schools 

each year. The Center grosses approximately $1 million each year from the sale of 

these texts, with the majority of these funds paying for printing, handling, and 

other overhead costs connected to the materials. The remainder of these funds is 

used to support and augment the programs supported with Federal funds. The Center does not receive funds for ‘‘trainings and workshops’’ which are, in fact, provided 

free to thousands of teachers each year under its federally supported programs. 

Summary.—Although the expansion of the Center’s efforts has at times been assisted through supplemental funding provided by States and foundations, the core 

of its efforts depends on the Federal dollars that the administration seeks to eliminate. Without these crucial funds, much of the Center’s national and international 

networks and their many volunteers and programs in education for democracy will 

simply cease to exist. The Center seeks to continue to develop relationships with 

other agencies, nonprofit organizations, and funding sources to expand its operations and ultimately to institutionalize its efforts. However, if successful, the administration’s attempt to discontinue funding would undermine the very possibility 

of institutionalizing the foremost civic education for democracy programs in the 

world by prematurely cutting the lifeline of the Center’s networks and programs. 

4. Chronological List of Research and Evaluation Studies Conducted by Internal and 

External Evaluators on Center Domestic and International Programs 

1. A Programmatic Evaluation of Civitas: An International Civic Education Exchange Program 2004–2005 (2006). Gary Marx, Center for Public Outreach. A report 

to the Center for Civic Education. 

2. We the People: The Citizen and the Constitution: 2005 National Finalists’ 

Knowledge of and Support for American Democratic Institutions and Processes 

(2006). Sharareh Frouzesh Bennett and Dr. Suzanne Soule, Center for Civic Education. 

3. Evaluation of We the People: Project Citizen Summer Institutes: How the Teachers Translated the Experience into Classroom Instruction (2006). Jennifer Nairne, 

Center for Civic Education. 

4. Political Education Beyond National Borders: Teaching Democracy Abroad to 

Promote More Peaceful International Relations (2005). Dr. Alden Craddock, Bowling 

Green State University. Paper presented at the 2005 German-American Conference—Responsible Citizenship, Education, and the Constitution. 

5. Project Citizen: Evaluation Report (2005). RMC Research Corporation. 

6. An Analysis of the Depiction of Democratic Participation in American Civics 

Textbooks (2005). Sharareh Frouzesh Bennett, Center for Civic Education. Paper 

presented at the 2005 German-American Conference—Responsible Citizenship, Education, and the Constitution. 

7. Changes in the Political Landscape and Their Implications for Civic Education 

(2005). Dr. Margaret Branson, Center for Civic Education. Paper presented at the 

2005 German-American Conference—Responsible Citizenship, Education, and the 

Constitution. 

8. Differences in Gender and Civic Education in Ukraine (2005). Dr. Alden 

Craddock, Bowling Green State University. Paper presented at the European Consortium of Political Research General Conference. 

9. Advancing Peace and Stability through Active Citizenship: The Role of Civic 

Education (2005). Dr. Margaret Branson, Center for Civic Education. Speech delivered at the Ninth Annual World Congress on Civic Education. 

10. Voting and Political Participation of We the People: The Citizen and the Constitution Alumni in the 2004 Presidential Election (2005). Dr. Suzanne Soule, Center 

for Civic Education. 

11. Monitoring the Effectiveness of Youth Participation in Project Citizen: A 

Civitas-Russia Evaluation Project: Summary of Preliminary Findings (2005). Dr. 

Charles White, Boston University. 

12. Civitas Latin America: A Civic Education Exchange Program Annual Evaluation Report, Year 2 (2005). West Ed. A report to the Center for Civic Education. 

13. A Programmatic Evaluation of Civitas: An International Civic Education Program 2003–2004 (2005). Gary Marx, Center for Public Outreach. A report to the 

Center for Civic Education. 
554 

14. We the People: The Citizen and the Constitution Summer Institutes: How the 

Teachers Translated the Experience into Classroom Instruction (2005). Jennifer 

Nairne, Center for Civic Education. 

15. American Identity, Citizenship, and Multiculturalism (2005). Dr. Diana Owen, 

Georgetown University. Paper presented at the 2005 German-American Conference—Responsible Citizenship, Education, and the Constitution. 

16. Knowledge of and Support for American Democratic Institutions and Processes 

by Participating Students in the National Finals 2005 (2005). (Reports available 

from previous years 1999–2004). Dr. Suzanne Soule and Sharareh Frouzesh Bennett, Center for Civic Education. 

17. An Independent Evaluation of Civic Education Programs in Jordan, Egypt, 

and West Bank 2002–2003 (2004). Glaser Consulting Group. 

18. A Rising Tide in Indonesia: Attempting to Create a Cohort Committed to Democracy through Education (2004). Dr. Suzanne Soule, Center for Civic Education. 

19. We the People Curriculum: Results of a Pilot Test (2004). Dr. Ardice Hartry 

and Kristie Porter, MPR Associates, Inc. 

20. Civitas Latin America: A Civic Education Exchange Program Annual Evaluation Report, Year 1 (2004). WestEd. 

21. Evaluation Report on 2003 We the People: Project Citizen Summer Institutes 

(2004). Sharareh Frouzesh Bennett, Center for Civic Education. 

22. Foundations of Democracy Program and Prevention of Aggressive Behavior of 

Children in Preschool Educational Institutions (2003). Ivan Glasovac, Croatian evaluator. 

23. Learning to Live Together: An Evaluation of Civic-Link (2003). Work Research 

Co-operative, independent evaluator. 

24. Creating a Cohort Committed to Democracy? Civic Education in Bosnia and 

Herzegovina (2002). Dr. Suzanne Soule, Center for Civic Education. 

25. Voting and Political Participation of the We the People: The Citizen and the 

Constitution Alumni in the 2000 Presidential Election (2001). Dr. Suzanne Soule, 

Center for Civic Education. 

26. Programmatic Evaluation of Civitas: An International Civic Education Exchange Program 2000–2001 (2001). Gary Marx, Independent Evaluator. 

27. Civic Education Assessment—Stage II. Civic Education Programming Since 

1990—A Case Study Based Analysis (2000). Dr. Franca Brilliant. Report for the U.S. 

Agency for International Development. 

28. Project Citizen and the Civic Development of Adolescent Students in Indiana, 

Latvia, and Lithuania (2000). Drs. Thomas Vontz, Kay Metcalf, and John Patrick, 

Indiana University. 

29. Prevention of School Violence through Civic Educational Curricula: Year One 

of a National Demonstration Program (2000). Dr. Kenneth Tolo, LBJ School of Public Affairs, University of Texas at Austin. 

30. Beyond Communism and War: The Effect of Civic Education on the Democratic 

Attitudes and Behavior of Bosnian Youth (2000). Dr. Suzanne Soule, Center for 

Civic Education. 

31. Programmatic Evaluation of Civitas: An International Civic Education Exchange Program 1999–2000 (2000). Eva Stahl, independent evaluator. 

32. An Assessment of We the People... Project Citizen: Promoting Citizenship 

in Classrooms and Communities (1998). Dr. Kenneth Tolo, LBJ School of Public Affairs, University of Texas at Austin. 

33. Bell Gardens Study on Fifth and Sixth Grade Participants in Center and Constitutional Rights Foundation Curricula (1997). University of California, Los Angeles. 

34. Program Effectiveness Panel Validation of We the People (1995). United States 

Department of Education National Diffusion Network. 

35. Civic Education and Political Attitudes: Examining the Effects on Political Tolerance of the We the People Curriculum (1994). Dr. Richard Brody, Stanford University. 

36. Testing for Learning: How New Approaches to Evaluation Can Improve American Schools (1992). Dr. Ruth Mitchell. 

37. An Evaluation of the Instructional Impact of the Elementary and Middle 

School Curricular Materials Developed for the National Bicentennial Competition on 

the Constitution and Bill of Rights (1991). Educational Testing Service. 

38. A Comparison of the Impact of the We the People. . . Curricular Materials on 

High School Students Compared to University Students (1991). Educational Testing 

Service. 

39. An Evaluation of the Instructional Effects of the Nationals Bicentennial Competition on the Constitution and Bill of Rights (1988). Educational Testing Service. 
555 

PREPARED STATEMENT OF THE COLLEGE BOARD

ANCHORING MATHEMATICS AND SCIENCE EDUCATION REFORM IN AN EXPANDED

ADVANCED PLACEMENT PROGRAM

Introduction 

The College Board is a national not-for-profit association of more than 5,000 member schools, colleges and universities, with a challenging mission: To connect students to college success and opportunity. One of the College Board’s most ambitious 

and important teaching and learning programs is the Advanced Placement Program 

(AP). As a set of 38 college-level courses taught in high school, AP has become the 

most influential general education program in the country, and it represents the 

highest standard of academic excellence in our Nation’s schools. The AP Program 

is a collaborative effort between motivated students, dedicated teachers, expert college professors, and committed high schools, colleges, and universities. Ninety percent of the colleges and universities in the United States, as well as colleges and 

universities in 30 other countries, have an AP policy granting incoming students 

credit, placement or both on the basis of their AP Exam grades. Many of these institutions grant up to a full year of college credit (sophomore standing) to students who 

earn a sufficient number of qualifying AP grades. Since its inception in 1955, the 

AP Program has allowed millions of students to take college-level courses and 

exams, and to earn college credit or placement while still in high school. President Bush’s request for $90 million in new funding to train 70,000 new AP 

math, science, and world language teachers over the next five years will dramatically improve the quality of instruction in these areas. The ultimate outcome will 

include a substantial increase in the number of high school graduates who enter college with the desire and ability to succeed in science, technology, engineering, and 

mathematics (STEM) fields and compete in a global marketplace. Moreover, increased support for an expanded AP Program in these content areas will contribute 

to raising standards and achievement in all of our Nation’s high schools. The AP 

Program benefits both the students who take AP courses and those who do not take 

AP by promoting higher standards and better teaching in all classes. As such, a significant investment in the expansion of AP math, science, and world language programs will have a profound effect on the overall quality of education in our Nation’s 

schools. 

AP is a 50-year-old, time-tested program with an existing infrastructure of tens 

of thousands of teachers and a network of hundreds of training sites across the 

country. Funds invested in this program will not need to be dedicated to creating 

a new system for teacher professional development, course development, or the administration and scoring of assessments. That system already exists as a result of 

our efforts over the past 50 years, and as a result of the involvement of thousands 

of schools, colleges and universities in the operation of the AP Program. Thus, new 

Federal dollars invested in AP can go directly into teacher training and student 

preparation and support. 

The table on page four of this statement provides a summary of the total dollars 

that each State would receive through this initiative, and provides one model for 

the use of those funds that illustrates how many students and teachers could be 

served if the full $90 million request were supported. 

THE AP PROGRAM

The principles and values of the AP Program can be stated quite simply: 

—AP supports academic excellence. AP represents a commitment to high standards, hard work, and enriched academic experiences for students, teachers, and 

schools. 

—AP is about equity. The AP Program should be open to all students, and we 

believe that every student should have access to AP courses and should be given 

the support he or she needs to succeed in these challenging courses. 

—AP can drive school-wide academic reform. Schools that use AP as an anchor 

for setting high standards and raising expectations for all students see significant returns not just in terms of AP participation but in terms of increasing 

the overall quality and intensity of their academic programs. 

Across the Nation, every State, and most school districts are exploring ways to 

raise standards and ensure that all students take challenging courses that prepare 

them for success in college and work. AP is recognized as a powerful tool for increasing academic rigor, improving teacher quality, and creating a culture of excellence 

in high schools. Students who take AP courses assume the intellectual responsibility 

of thinking for themselves, and they learn how to engage the world critically and 

analytically—both inside and outside of the classroom. This is an invaluable experi-
556 

1 Committee on Science, Engineering and Public Policy. Rising Above the Gathering Storm: 

Energizing and Employing America for a Brighter Economic Future. National Academies Press, 

2006. This report notes that America appears to be on a ‘‘losing path’’ today with regard to our 

future competitiveness and standard of living. 

ence for students as they prepare for college or work upon graduation from high 

school. Moreover, schools in which AP is widely offered—and accessible to all students—experience the diffusion of higher standards throughout the entire school 

curriculum. 

AP MATHEMATICS AND SCIENCE COURSES

Increasing rigorous math and science education in the United States will significantly boost our high school graduates’ math and science proficiency—and also increase the number of students who enter college ready to succeed in science, technology, engineering, and mathematics (STEM) careers. And we urgently need to create those opportunities for our students. Today, only 32 percent of American undergraduates are earning degrees in science and engineering, compared to 66 percent 

of undergraduates in Japan, 59 percent in China, and 36 percent in Germany. In 

2004, China graduated 600,000 engineers, India graduated 350,000, and the United 

States graduated 70,000.1

The AP Program is an important tool in this Nation’s efforts to increase its economic competitiveness. AP math and science students are much more likely than 

other students to major in STEM disciplines than students whose first exposure to 

college-level math and science courses is in college. For example: 

—Sixteen percent of students who take AP Chemistry go on to major in chemistry 

in college. By way of contrast, only 3–4 percent of students who take general 

chemistry instead of AP chemistry major in that field in college. 

—More than 25 percent of students who take AP Calculus go on to major in a 

STEM field in college, and 40 percent of students who take AP Physics major 

in physics in college. 

Furthermore, research indicates that AP math and science courses prepare American students to achieve a level of proficiency that exceeds that of students from all 

other nations. For example, in the most recent TIMSS assessments, U.S. Calculus 

students ranked number 15 (out of 16 countries) in the international advanced 

mathematics assessment. But AP Calculus students who scored a 3 or better on the 

AP Calculus Exam ranked first in the world. Even AP Calculus students who scored 

a 1 or 2 on the AP Calculus Exam—below ‘‘passing’’—were ranked second in the 

world. AP Physics students, as compared to other U.S. physics students and physics 

students internationally, were also at the top of the ranking. 

Most significantly, there are many, many more U.S. students who can succeed in 

AP math and science courses—if they are simply given the chance. This year in the 

United States, we anticipate that more than 100,000 students will earn a grade of 

3 or above on the AP Calculus Exam—the grade typically required for college credit. 

But in a national analysis of the math proficiency of students enrolled in U.S. high 

schools during the 2005–2006 academic year, we can identify, by name and school, 

an additional 500,000 students who have the same academic background and likelihood of success in AP Calculus as the 100,000 students who currently are fortunate 

enough to have an AP Calculus course available. If we look at Biology, we see an 

even larger gap; we expect that about 74,000 students will earn exam grades of 3 

or higher on the AP Biology Exam this year, whereas we know that at least 640,000 

additional U.S. students have the academic skills that would enable them to succeed 

in AP Biology if they only had a course available to them and the encouragement 

to take on this challenge. There are literally hundreds of thousands of high school 

students in the United States who are prepared and ready to succeed in rigorous 

high school courses such as AP Calculus, AP Biology, AP Physics, and AP Chemistry. In many cases, the only thing preventing them from learning at this higher 

level is the lack of an AP teacher in their school or the lack of adequate encouragement and support to take the AP course. 

The College Board believes AP has tremendous potential to drive reform in a powerful way in all of our Nation’s schools. No single program can have as strong an 

impact on overall student and teacher quality as AP. AP is not for the elite, it is 

for the prepared. The Committee’s support for expanded AP math, science, and 

world language courses and exams will prepare many more students for the opportunity to compete in a global environment and succeed in STEM fields in college 

and work. We respectfully urge that you fully fund the Administration’s request for 

AP expansion. 
557 

State 

Potential New 

2007 AP funding 

Under President’s 

Proposal 

Total number 

of middle and 

high school 

teachers provided with 

Pre-AP or AP 

training 

Number of 

students benefiting from 

teachers receiving Pre-AP 

training (20 

students per 

5 sections) 

Number of 

students benefiting from 

teachers receiving AP 

training (25 

students per 

AP teacher) 

Alabama .................................................................................... $1,600,989 750 60,037 3,752 

Alaska ....................................................................................... 453,123 212 16,992 1,062 

Arizona ...................................................................................... 2,074,097 972 77,779 4,861 

Arkansas ................................................................................... 1,016,284 476 3,8111 2,382 

California .................................................................................. 12,527,993 5,872 469,800 29,362 

Colorado .................................................................................... 933,670 438 35,013 2,188 

Connecticut ............................................................................... 542,351 254 20,338 1,271 

Delaware ................................................................................... 453,123 212 ,16992 1,062 

District of Columbia ................................................................. 453,123 212 16,992 1,062 

Florida ....................................................................................... 4,948,272 2,320 185,560 11,598 

Georgia ...................................................................................... 2,823,013 1,323 105,863 6,616 

Hawaii ....................................................................................... 453,123 212 16,992 1,062 

Idaho ......................................................................................... 453,123 212 16,992 1,062 

Illinois ....................................................................................... 3,228,779 1,513 121,079 7,567 

Indiana ...................................................................................... 1,254,941 588 47,060 2941 

Iowa .......................................................................................... 482,954 226 18,111 1,132 

Kansas ...................................................................................... 537,051 252 20,139 1,259 

Kentucky .................................................................................... 1,335,985 626 50,099 3,131 

Louisiana .................................................................................. 2,012,675 943 75,475 4,717 

Maine ........................................................................................ 453,123 212 16,992 1,062 

Maryland ................................................................................... 978,436 459 36,691 2,293 

Massachusetts .......................................................................... 1,093,966 513 41,024 2,564 

Michigan ................................................................................... 2,431,666 1,140 91,187 5,699 

Minnesota ................................................................................. 746,455 350 27,992 1,750 

Mississippi ................................................................................ 1,349,629 633 50,611 3,163 

Missouri .................................................................................... 1,418,338 665 53,188 3,324 

Montana .................................................................................... 453,123 212 16,992 1,062 

Nebraska ................................................................................... 453,123 212 16,992 1,062 

Nevada ...................................................................................... 575,422 270 21,578 1,349 

New Hampshire ......................................................................... 453,123 212 16,992 1,062 

New Jersey ................................................................................ 1,500,749 703 56,278 3,517 

New Mexico ............................................................................... 827,151 388 31,018 1,939 

New York ................................................................................... 6,191,847 2,902 232,194 14,512 

North Carolina .......................................................................... 2,401,977 1,126 90,074 5,630 

North Dakota ............................................................................. 453,123 212 16,992 1,062 

Ohio ........................................................................................... 2,504,484 1,174 93,918 5,870 

Oklahoma .................................................................................. 1,132,521 531 42,470 2,654 

Oregon ....................................................................................... 902,459 423 33,842 2,115 

Pennsylvania ............................................................................. 2,659,829 1,247 99,744 6,234 

Rhode Island ............................................................................. 453,123 212 16,992 1,062 

South Carolina .......................................................................... 1,338,960 628 50,211 3,138 

South Dakota ............................................................................ 453,123 212 16,992 1062 

Tennessee ................................................................................. 1,661,104 779 62,291 3,893 

Texas ......................................................................................... 8,742,609 4,098 327,848 20,490 

Utah .......................................................................................... 479,572 225 17,984 1,124 

Vermont ..................................................................................... 453,123 212 16,992 1,062 

Virginia ..................................................................................... 1,443,618 677 54,136 3,383 

Washington ............................................................................... 1,340,908 629 50,284 3,143 

West Virginia ............................................................................ 615,683 289 23,088 1,443 

Wisconsin .................................................................................. 934,028 438 35,026 2,189 

Wyoming .................................................................................... 453,123 212 16,992 1,062 

American Samoa ....................................................................... 453,123 212 16,992 1,062 

Guam ........................................................................................ 453,123 212 16,992 1,062 

Northern Mariana Islands ......................................................... 453,123 212 16,992 1,062 

Puerto Rico ............................................................................... 3,877,930 1,818 145,422 9,089 

Virgin Islands ........................................................................... 453,123 212 16,992 1,062 

Freely Associated States ........................................................... ........................ .................... .................... ....................

Indian set-aside ....................................................................... ........................ .................... .................... ....................

Other (non-State allocations) ................................................... 455,400 213 1,7078 1,067 

Total ............................................................................ 91,080,000 42,694 3,415,500 213,469 
558 

PREPARED STATEMENT OF THE COUNCIL OF STATE ADMINISTRATORS OF VOCATIONAL

REHABILITATION (CSAVR) 

This testimony is submitted on behalf of the Council of State Administrators of 

Vocational Rehabilitation (CSAVR). The CSAVR is composed of the chief administrators of the State Vocational Rehabilitation (VR) Agencies serving individuals with 

physical and/or mental disabilities in the United States, the District of Columbia 

and the Territories. These agencies constitute the State partners in the State-Federal Program of Rehabilitation Services provided under Title 1 the Rehabilitation 

Act of 1973, as amended. State VR agencies provide individualized services and supports to eligible individuals with significant disabilities that are required for them 

to go to work. These services may include, but are not limited to, counseling and 

guidance, job training, higher education, physical and mental restoration services, 

and assistive technology. Nearly 1 million individuals with disabilities are served 

annually. In fiscal year 2005, these agencies placed 206,695 individuals with disabilities into competitive employment. 

The CSAVR, founded in 1940 to furnish input into the State-Federal Rehabilitation Program, provides a forum for State administrators to study, deliberate, and 

act upon matters affecting the rehabilitation and employment of individuals with 

disabilities. The Council serves as a resource for the formulation and expression of 

the collective points of view of State rehabilitation agencies on all issues affecting 

the provision of quality employment and rehabilitation services to persons with significant disabilities. 

CSAVR’S RECOMMENDATION FOR THE FISCAL YEAR 2007 APPROPRIATION FOR THE PUBLIC

VOCATIONAL REHABILITATION PROGRAM

For fiscal year 2007, CSAVR recommends an increase in the Vocational Rehabilitation (VR) appropriation of $258 million above the President’s budget request for 

fiscal year 2007. The President’s budget proposes a 4.3 percent increase in funding 

for the Public VR program, which is the mandated CPI increase, called for in law. 

However, the President’s budget request also eliminates funding for several smaller 

programs, Supported Employment (SE), Projects with Industry (PWI), and Migrant 

and Seasonal Farm Workers (MSFW), with a total loss of funding of 51.7 million. 

With the majority of State VR Agencies operating under an Order of Selection, a 

system of prioritization whereby individuals with the most significant disabilities 

are served first, it is unlikely that the State VR Agencies would be able to continue 

to provide services, under Title 1 of the Rehabilitation Act, to all of the individuals 

previously served under the programs that lost their funding. 

In addition to the proposed elimination of the SE, PWI, MSFW, and Recreation 

programs, which CSAVR does not support, HR 27, the House bill to reauthorize the 

Workforce Investment Act (WIA), and S 1021, the Senate bill to reauthorize the 

WIA, expands the requirements for VR to provide transition services to students 

with disabilities. Based on the significant internal and external challenges facing 

the Public VR Program, (i.e., staffing shortages, State budget shortfalls, increased 

numbers of consumers seeking services, and increased service costs and expectations, the CSAVR believes that an increased appropriation of 258 million above the 

President’s budget request for VR, for fiscal year 2007, is an appropriate recommendation. 

The CSAVR is requesting a $206 million increase specifically for the purposes of 

implementing the new transition requirements in the Rehabilitation Act. The most 

recent data on transition students, published in 2003 in the Individuals with Disabilities Education Act (IDEA) 25 Annual Report to Congress, indicates that there 

were 2,791,886 students between the ages of 12–17 and 283,265 between the ages 

of 18–21. A small sample survey of State VR Agencies revealed that the average 

annual cost to serve a transition student is $2062.00. The CSAVR will have the capacity to serve 100,000 new transition students in fiscal year 2007, with a funding 

increase of $206 million. 

In addition, CSAVR is requesting that you restore the $51.7 million to the MSFW, 

the SE and the PWI programs, whose budgets were eliminated in the President’s 

budget request for fiscal year 2007. 

These three programs are vital to VR consumers and desperately needed to assure 

that vital support services, necessary for successful employment of certain populations, are maintained. 

THE PUBLIC VOCATIONAL REHABILITATION PROGRAM

The Public VR Program is one of the most cost-effective programs ever created 

by Congress. It enables hundreds of thousands of individuals with disabilities to go 
559 

to work each year and become tax-paying citizens. In fiscal year 2005, the VR Program assisted 984,315 individuals with disabilities who wanted to work, by providing them with the job skills, training and support services they needed to become 

employed. Of those served, 206,695 entered into competitive employment. Funding 

for the VR Program requires a State match of 21.3 percent, and creates a StateFederal partnership that has worked effectively for more than 86 years, and has assisted approximately 16 million individuals with disabilities to engage in employment and become tax-paying citizens. 

The Rehabilitation Act mandates that the annual Federal appropriation for the 

VR Program grow at a rate at least equal to the change in the Consumer Price 

Index (CPI) over the previous fiscal year. While the mandate was intended to create 

a floor for the VR appropriation, Congress has not appropriated funds above the 

mandated CPI increase since 1999. This is particularly problematic because the formula used to distribute these funds, which is based on a State’s per capita income 

and population, results in significant variations in the increases in individual 

State’s allotments. When the increase is limited to the CPI increase and the formula 

is applied, not all States receive increases that are equal to the annual rate of inflation. In fiscal year 2006, 30 States did not receive the required CPI increase in their 

State allotment. 

CHALLENGES FACING THE PUBLIC VR PROGRAM

Over the last several years, the Public VR Program has faced a number of external challenges that have been compounded by the minimal increases in Federal 

funding. 

SPECIAL EDUCATION

Between 1990 and 2004, the Federal appropriation for special education increased 

by approximately 333 percent. During the same time period, the Federal appropriation for the Public VR Program increased by only 22 percent. As a result of these 

very significant increases in special education funding, an ever-increasing number 

of special education students are exiting the education system and seeking adult 

services, including Vocational Rehabilitation, in order to participate in post secondary education, job training, and/or to go to work. 

IMPACT OF THE WORKFORCE INVESTMENT ACT OF 1998 (WIA)

The Public VR Program is a mandatory partner in the WIA and, as such, is required to contribute significant resources to support the infrastructure and other 

costs associated with the operation of the One-Stop Centers. While VR’s involvement 

in State Workforce Investment Systems is critically important, WIA has placed yet 

another financial burden on an already strained program, further reducing the percentage of VR funds that are available to provide services and supports to eligible 

individuals with disabilities. In addition, the House bill to reauthorize the WIA, 

H.R. 27, proposes to take significant resources from the Public VR Program far beyond the resources contributed to the One-Stop Centers under current law. The Senate bill, S. 1021, also requires resources from VR to fund the infrastructure costs 

and other common costs associated with the operation of One-Stop Centers; however, the CSAVR is very grateful for the graduated CAP on infrastructure funding 

for VR in S. 1021. 

—A 2002 Longitudinal Study of the Public VR Program provided evidenced based 

research that the VR Program is effective in putting people with disabilities to 

work in good jobs with opportunities for advancement. 

—A fiscal year 2006 Program Assessment Rating Tool (PART) Review, conducted 

by the Office of Management and Budget (OMB) to rate program performance, 

rated the VR Program favorably, and in general, successful in meeting its program goal. 

—A report by the Social Security Administration, released annually, provides detailed information on the funds disbursed to State VR Agencies, based on their 

successfully serving beneficiaries on Social Security Disability Insurance (SSDI) 

and Supplemental Security Income (SSI). In fiscal year 2004 SSA projected a 

470.3 million savings to the Trust Fund by the VR Program, and established 

that every $1.00 that SSA spends on VR results in a $6.00 savings. 

In this era of significant Federal and State budget deficits, and an increase in the 

unemployment rate for individuals with disabilities, we urge you to consider an increase in funding for the Public VR Program, through which you can be assured to 

have positive outcomes, based on the three factors mentioned above. 

Our Nation’s ability to be competitive in a global economy depends on the quality 

of our workforce. According to information provided by the Department of Labor, 
560 

Employment & Training Administration, during the fiscal year 2006 Budget Briefing, the American workforce will be vastly different than it is today, as the 21st century unfolds. The fastest growing jobs of the future will need to be filled by ‘‘knowledge workers,’’ who have specialized skills and training. Ninety percent of the fastest growing jobs in the United States (U.S.) require some level of post-secondary 

education and training. Yet, the U.S. Census Bureau reports that in the United 

States, just 28 percent of those 25 and older in 2004 had a bachelor’s degree. Integrating all available workers into the workforce, including workers with significant 

disabilities, will be required for employers to meet the demands of the 21st century 

economy. Significant numbers of large and small employers have acknowledged that 

hiring individuals with disabilities makes good business sense. It provides them 

with dependable workers and access to a market of individuals with spending 

power, which has historically been untapped. These same employers also have longstanding, positive relationships with VR, to whom they look to provide them with 

qualified workers with disabilities. Integrating all available workers into the workforce, including workers with disabilities, will require significant resources. 

Recently, the CSAVR developed a National VR/Business Network for the purposes 

of increasing significantly, the number and quality of employment opportunities for 

VR’s consumer. This National Network, spearheaded by CSAVR’s Director of Business Relations, has already expanded the number of employment opportunities 

available to VR’s consumers in a significant number of States, and is continuing to 

grow. VR’s positive relationships with employers, who rely heavily on the Public VR 

Program to meet their hiring needs, further emphasizes and documents the need for 

additional resources for VR. 

The Public VR Program, 86 years of history, 16 million individuals served, and 

a demonstrated return on investment. With additional resources, the Public VR Program can do more of what it does best—provide the resources for individuals with 

disabilities to go to work and live the American Dream. 

The CSAVR thanks the Chairman and Members of the Senate Appropriations 

subcommittee for the opportunity to submit written testimony on behalf of the Public VR Program. 

PREPARED STATEMENT OF GALLAUDET UNIVERSITY

Mr. Chairman and members of the committee: I would like to express my appreciation to you and to Congress for the generous support that we received in fiscal 

year 2006 to continue maintaining and enhancing academic programs and salaries 

at Gallaudet University. I am especially grateful that Congress continues to support 

us during these challenging times, and I am testifying in support of our appropriation request for fiscal year 2007. As I prepare to retire as President at the end of 

this calendar year, I would particularly like to express my appreciation for the support that Congress has provided to Gallaudet during the 18 years of my administration and of majority control of the Board of Trustees by deaf individuals. One of my 

proudest accomplishments is the increase in the percentages of our employees who 

are deaf or members of minority groups. These percentages now stand at 41 percent 

and 38 percent respectively. 

Consistent with our legal purpose, as stated in the Education of the Deaf Act 

(EDA), we have greatly expanded programs at the doctoral level. When I became 

President, we had only one doctoral level program in administration and supervision—we now have additional doctoral programs in audiology, clinical psychology, 

education, and linguistics. At the undergraduate level we have focused on programs, 

such as tutoring and first year seminars, designed for long term enhancement of our 

persistence and graduation rates, and we have initiated a much needed bachelor’s 

level interpreter training program. At the Clerc Center, following guidance from 

Congress during the 1992 reauthorization of the EDA, we have refocused our demonstration and outreach activities at the pre-college level on high priority student 

populations throughout the United States. 

During my presidency, Gallaudet responded to the Government Performance and 

Results Act (GPRA). In 2005, we had 31 ambitious goals published under GPRA, 

with 17 of those fully accomplished in that year. These goals reflect the wide array 

of programs and services that Gallaudet provides as required by legislative mandate 

and performance expectations as agreed to with the U.S. Department of Education. 

During 2005, Office of Management and Budget (OMB) conducted a Program Assessment Rating Tool (PART) of Gallaudet, and, based on a limited and narrow set 

of GPRA indicators, it gave Gallaudet an ‘‘ineffective’’ rating. I protested the rating 

in part because of the assessment’s limited scope and also because we were not involved in the assessment. I am pleased to inform you that OMB has agreed to con-
561 

duct a reassessment of Gallaudet this year, and I will insist on a broader set of indicators that truly represent Gallaudet’s complex mission. 

When I became President in 1988, every building on the Kendall Green campus 

had been constructed with virtually 100 percent Federal funding. Since I became 

President, every major construction or renovation project we have undertaken has 

been supported either by cost-sharing with the Federal Government or by private 

fundraising alone. For example, the buildings constructed here most recently, the 

Kellogg Conference Hotel at Gallaudet University and the Student Academic Center, were constructed without any additional Federal appropriations. We are currently well on the way to raising the funds needed for a facility to house our language and communication programs, including a $5 million leadership gift from the 

Sorenson family of Utah. 

When I became President, the Gallaudet endowment was valued at $10 million. 

Partly with the assistance of the Federal Endowment Program created by the 1986 

passage of the Education of the Deaf Act, our endowment now stands at $165 million and generates more than $4 million in annual income to support programs and 

scholarships. 

When I became President in 1988, total staffing at Gallaudet stood at about 1,450 

employees. Following a comprehensive staffing reduction program, it now stands at 

just over 1,100, a reduction of more than 20 percent. This reduction provided much 

needed budget flexibility during a time when Congress was seeking to reduce the 

Federal budget deficit. During my tenure, we have also decreased the proportion of 

our operating budget that is supported by Federal appropriations by about 10 percentage points. This reduction was made possible in part by a long term plan to increase tuition charges to Gallaudet students, following an agreement between the 

University and the Department of Education. For many years, we increased tuition 

at 7 percent annually, more than twice the rate of inflation. Following expressions 

of concern by members of Congress and by a consulting group we retained to study 

our tuition policy, we reduced these increases to 3 percent annually starting in fiscal 

year 2006. I believe that we have been very responsible in our requests for Federal 

support and that we have done everything we could to seek additional sources of 

funding during a time when Congress has faced funding limitations. 

Because of Congress’s ongoing support of Gallaudet in fiscal year 2006, we have 

been able to maintain a competitive pay structure for our employees while retaining 

the flexibility to meet the needs of a changing student body. Given the unique student population we serve and the communication skills our employees are expected 

to possess, retaining skilled employees is critical to our mission. Gallaudet employees received general pay increases of 2 percent in fiscal year 2003, 3 percent in fiscal 

year 2004, 2 percent in fiscal year 2005, and 2 percent again in fiscal year 2006, 

increases that are below what Federal employees in the region received during the 

same timeframe, but in line with increases in the Consumer Price Index (CPI). During the most recent 12 month period, the CPI–U increased by 4 percent. It will be 

important for Gallaudet to ensure that our employees receive at least a 3 percent 

general pay increase in fiscal year 2007, commensurate with current increases in 

inflation. We are also requesting support for inflationary increases in non-salary 

areas, especially in the cost of utilities and benefits. In this regard, I need to point 

out that our benefits charges during the past several years have increased by more 

than 2 percent of base salaries, and we have had to fund those increases as part 

of our total payroll package. 

The administration budget for fiscal year 2007 includes $106.998 million for Gallaudet, the same as our current fiscal year 2006 appropriation. I have carefully analyzed our fiscal year 2006 funding needs and have determined that in order to 

award a 3 percent salary increase to our faculty and staff, and to meet other inflation-driven increases, we need an increase of about $5 million, 4.7 percent above our 

current appropriation. All of our planning is now guided by a comprehensive strategic plan driven by eight goals, arrived at in consultations involving our Board, and 

our faculty and staff, relating to student academic achievement within the liberal 

arts tradition, excellence in research and other programs, diversity among students 

and employees, leadership in the deaf community, and maintenance of a strong resource base. 

FUNDING REQUEST FOR FISCAL YEAR 2007

In our budget request to the Department of Education for fiscal year 2007, we addressed the need for inflationary increases as well as support for program development. Given the funding issues currently facing Congress, I am requesting support 

at this time for only our most pressing inflationary needs. Funding our need to 

cover inflationary costs will provide us some budget stability, but we will continue 
562 

to face the need for development and enhancement of our programs. Our strategy 

will be to seek alternative sources of funding for some of these program priorities 

and to defer others. We will continue to seek support for program growth from both 

Federal and private sources in the future. 

Salaries.—I am requesting support for a 3 percent increase in salaries, approximately $2.6 million. 

Benefits.—I am requesting support for increases in benefits costs that have created the need for increasing charges to our operating units by 2 percent of base salaries, approximately $1.4 million. 

Utilities.—The total cost for utilities at Gallaudet rose by $1.8 million, or 50 percent, between fiscal year 2002 and 2005, and I expect these costs to continue rising 

steeply in fiscal year 2006. I am seeking $1 million to partially offset these increases. 

My total request for fiscal year 2007 is, thus, $112 million. 

In summary, I appreciate the challenges that Congress faces in making appropriations decisions for fiscal year 2007, but I believe experience has shown that Gallaudet provides an outstanding return on Federal dollars that are invested here, in 

terms of the educated and productive deaf community that the Nation enjoys as a 

result. 

PREPARED STATEMENT OF THE HEALTH PROFESSIONS AND NURSING EDUCATION

COALITION

The members of the Health Professions and Nursing Education Coalition 

(HPNEC) are pleased to submit this statement for the record in support of the 

health professions education programs authorized under Titles VII and VIII of the 

Public Health Service Act. 

HPNEC is an informal alliance of over 50 organizations representing a variety of 

schools, programs, health professionals, and others dedicated to ensuring that Title 

VII and VIII programs continue to help educate the Nation’s health care and public 

health personnel. HPNEC members are thankful for the support the subcommittee 

has provided to the programs, which are essential to building a well-educated, diverse health care workforce. 

The Title VII and VIII health professions and nursing programs are essential 

components of Americans’ health care safety net, bringing health care services to 

our underserved communities. These programs support the training and education 

of health care providers with the aim of enhancing the supply, diversity, and distribution of the workforce, filling the gaps in the health professions’ supply not met 

by traditional market forces. The Title VII and VIII health professions programs are 

the only Federal programs designed to train providers in interdisciplinary settings 

to meet the needs of special and underserved populations, as well as increase minority representation in the health care workforce. 

The final fiscal year 2006 Labor-HHS-Education Appropriations bill cut Title VII 

& VIII programs by 34.5 percent, including a 51.5 percent cut to Title VII programs. 

Moreover, the President’s fiscal year 2007 budget proposes an additional 93.1 percent cut to Title VII and a 45.8 percent cut overall to both Title VII and VIII. 

HPNEC members recommend that the Title VII and VIII programs receive an appropriation of at least $550 million for fiscal year 2007. This recommendation would 

ensure the programs have sufficient funds to continue fulfilling their mission of educating and training a health care workforce that meets the public’s health care 

needs, restoring some of the unprecedented cuts imposed on the programs in fiscal 

year 2006. 

As described in an April 5 letter to the subcommittee, led by Senators Pat Roberts 

and Jack Reed, and signed by 56 of your colleagues (letter attached), restoring funding to Title VII health professions programs is vital to reversing health professions 

shortages in the Nation’s neediest communities. An April 3 letter led by Senators 

Susan Collins and Barbara Mikulski was signed by 54 Senators in support of adequate funding for Title VIII nursing programs as well (letter attached). 

The enacted and proposed cuts to the programs will: 

Exacerbate existing provider shortages in rural, medically underserved, and federally 

designated health professions shortage areas 

—With Title VII funding, the Department of Family Medicine at Pennsylvania 

State University increased the number of students entering primary care to 50 

percent of all graduates. Through rural rotations and required primary care 

clerkships, Penn State placed 30 percent of graduates into medically underserved areas over the last three years. With cutbacks in Title VII funding, they 
563 

will lose their ability to continue producing physicians for underserved and 

rural areas. 

—According to the University of Nebraska Medical Center, eliminating Title VII 

funding will cut off access to psychologists for many families in rural areas. 

Over the last four years, the Munroe Meyer Institute Department of Psychology 

has served children and families from over 140 Nebraska cities and towns 

(3,500 patients each year), and has placed Pediatric Psychologists in five rural 

primary care practices. The rural programs will be in severe financial crisis as 

a result of cuts, which would further reduce Nebraska’s already severely limited 

mental health services to its rural citizens. 

Impede recruitment of underrepresented minorities and students of disadvantaged 

backgrounds into the health professions and intensify health disparities among 

minority and underserved citizens 

—The Saint Louis University School of Medicine operates a Health Careers Opportunity Program (HCOP). The negative impact of the elimination of Federal 

funding on the development of pipeline programming will be significant, as over 

2,300 K–12 students annually participate in one or more pipeline programs. A 

correlative impact will be in the area of minority/disadvantaged recruitment, as 

pipeline programs heighten awareness of opportunities for medical and premedical training (i.e., research opportunities) at Saint Louis University. Elimination of Federal dollars will severely limit the ability of Saint Louis University 

to continue to impact young people at an early age to begin thinking about medicine. A reduction in minority enrollment is certain to occur at a time when enrollment diversity is having critical implications on institutional and faculty development, as well as on cultural competency initiatives. 

—The University of Illinois’ College of Medicine has received Federal funding for 

its HCOP program for over 25 years and has graduated over 1400 health professionals. With a loss of funds, the school expects that the breadth of its recruitment activities will be curtailed, resulting in fewer contacts with underrepresented students, truncating the opportunities for exposing students to medicine as a career choice, to financial aid information, to curriculum preparedness, 

etc. These programmatic impacts will shape the medical profession as a whole, 

as there will be fewer underrepresented minorities who are recruited, retained, 

and who graduate to become physicians; fewer underrepresented minorities who 

are able to assist in bridging the dearth of medical care in underserved areas; 

fewer underrepresented minorities who are able to continue eliminating health 

disparities and contributing to health policy; and fewer underrepresented minorities who are culturally competent to appropriately provide health care services to the Nation’s historically underserved populations. 

Negatively impact vulnerable populations such as the elderly 

—Over four years, the South Carolina Geriatric Education Center (GEC) has 

trained over 6,000 physicians. The enacted cuts to Title VII programs eliminate 

funding for geriatrics programs, including those at the University of South 

Carolina School of Medicine and the Medical University of South Carolina. As 

one of the top five States in rate of growth for older individuals, the direct impact on educating physicians and other health professionals on the special needs 

of aging adults will reverberate throughout South Carolina. On a national scale, 

the cuts will affect 50 GECs throughout the country which train over 50,000 

health care professionals representing 35 disciplines annually. These centers log 

8.6 million patient encounters each year, and over two-thirds of GECs serve 

rural areas and underserved populations. The effect of this lost funding is devastating to both academic institutions and older individuals who will not receive 

care from health professionals equipped to address their unique needs. 

Undermine efforts to encourage health professions students to enter primary care 

—The University of California, San Diego School of Medicine reports that 71 percent of UCSD Hispanic Center of Excellence (HCOE) alumni completed or are 

completing primary care residencies, compared to only 57 percent of the UCSD 

alumni, graduating in 2002–2004, who have completed or are completing primary care residencies. 

A November 2002 report by the Advisory Committee on Training in Primary Care 

Medicine and Dentistry emphasizes the essential role of the Title VII programs in 

enhancing public health training for the primary care health workforce. In its recommendations, the committee notes that in 1998, 42 to 56 percent of graduates from 

the Title VII-supported primary care programs entered practice in underserved 

areas, compared to a mean of 10 percent of health professions graduates overall. 

Data from 1998 also indicate that 35 to 50 percent of graduates of these programs 
564 

represented minority or disadvantaged groups, compared to 10 percent minority representation overall. 

Community health centers (CHCs) also benefit from Title VII and VIII programs. 

A March 2006 study published in the Journal of the American Medical Association 

found that community health centers report high percentages of provider vacancies, 

including an insufficient supply of dentists, pharmacists, pediatricians, family physicians, and registered nurses; these shortages are especially pronounced among 

CHCs in rural areas. Because Title VII programs have a successful record of training providers who serve underserved areas, the study recommends increased support for the programs as its primary means of alleviating the shortages. Further, 

the publication serves as an important reminder that the success of CHCs is highly 

dependent upon a well-trained clinical staff to provide care. 

During their 40-year existence, the Title VII and VIII programs have created a 

network of initiatives across the country that supports the training of many disciplines of health providers. These are the only Federal programs designed to create 

infrastructures at our schools and in our communities that facilitate customized 

training designed to bring the latest emerging national priorities to the populations 

at large and meet the health care needs of special, underserved populations. 

HPNEC members urge the subcommittee to consider the vital need for these 

health professions education programs as demonstrated by the passage of the 

Health Professions Education Partnerships Act of 1998 (Public Law 105–392), which 

reauthorized these programs. The reauthorization provided additional flexibility in 

the administration of these programs and consolidated them into seven general categories: Minority and Disadvantaged Health Professions Training; Primary Care 

Training; Interdisciplinary, Community-Based Linkages; Health Professions Workforce and Analysis; Public Health Workforce Development; Nursing Workforce Development; and Student Financial Assistance. 

—The purpose of the Minority and Disadvantaged Health Professionals Training 

programs is to improve health care access in underserved areas and the representation of minority and disadvantaged health care providers in the health 

professions. Minority Centers of Excellence support programs that seek to increase the number of minority health professionals through increased research 

on minority health issues, establishment of an educational pipeline, and the 

provision of clinical opportunities in community-based health facilities. The 

Health Career Opportunity Program seeks to improve the development of a 

competitive applicant pool through partnerships with local educational and community organizations. The Faculty Loan Repayment and Faculty Fellowship 

programs provide incentives for schools to recruit underrepresented minority 

faculty. The Scholarships for Disadvantaged Students (SDS) make funds available to eligible students from disadvantaged backgrounds who are enrolled as 

full-time health professions students. Nursing students receive 16 percent of the 

funds appropriated for SDS. 

—The Primary Care Training category, including General Pediatrics, General Internal Medicine, Family Medicine, General Dentistry, Pediatric Dentistry, and 

Physician Assistants, provides for the education and training of primary care 

physicians, dentists, and physician assistants to improve access and quality of 

health care in underserved areas. As noted in the November 2002 Advisory 

Committee report, two-thirds of all Americans interact with a primary care provider every year, and approximately one-half of primary care providers trained 

through these programs go on to work in underserved areas, compared to 10 

percent of those not trained through these programs. The General Pediatrics 

and General Internal Medicine programs provide critical funding for primary 

care training in community-based settings and have been successful in directing 

more primary care physicians to work in underserved areas. They support a 

range of initiatives, including medical student training, residency training, faculty development and the development of academic administrative units. Title 

VII is the only Federal program that provides funding for family medicine residency training, academic departments, predoctoral programs, and faculty development. The General Dentistry and Pediatric Dentistry programs provide 

grants to dental schools and hospitals to create or expand primary care dental 

residency training programs. Recognizing that all primary care is not only provided by physicians, the primary care cluster also provides grants for physician 

assistant programs to encourage and prepare students for primary care practice 

in rural and urban Health Professional Shortage Areas. Additionally, these programs enhance the efforts of osteopathic medical schools to continue to emphasize primary care medicine, health promotion, and disease prevention, and the 

practice of ambulatory medicine in community-based settings. 
565 

—Because much of the Nation’s health care is delivered in areas far removed from 

health professions schools, the Interdisciplinary, Community-Based Linkages 

cluster provides support for community-based training of various health professionals. These programs are designed to provide greater flexibility in training 

and to encourage collaboration between two or more disciplines. These training 

programs also serve to encourage health professionals to return to such settings 

after completing their training. The Area Health Education Centers (AHECs) 

provide clinical training opportunities to health professions and nursing students in rural and other underserved communities by extending the resources 

of academic health centers to these areas. AHECs, which have substantial State 

and local matching funds, form networks of health-related institutions to provide education services to students, faculty and practitioners. Health Education 

and Training Centers (HETCs) were created to improve the supply of health 

professionals along the U.S.-Mexico border. They incorporate a strong emphasis 

on wellness through public health education activities for disadvantaged populations. Given America’s burgeoning aging population, there is a need for specialized training in the diagnosis, treatment, and prevention of disease and 

other health concerns of the elderly. Geriatric Health Professions programs support geriatric faculty fellowships, the Geriatric Academic Career Award, and 

Geriatric Education Centers, which are all designed to bolster the number and 

quality of health care providers caring for our older generations. The Quentin 

N. Burdick Program for Rural Health Interdisciplinary Training places an emphasis on long-term collaboration between academic institutions, rural health 

care agencies and providers to improve the recruitment and retention of health 

professionals in rural areas. The Allied Health Project Grants program represents the only Federal effort aimed at supporting new and innovative education programs designed to reduce shortages of allied health professionals and 

create opportunities in medically underserved and minority areas. Health professions schools use the funding to help establish or expand allied health training programs. The need to address the critical shortage of certain allied health 

professionals has been repeatedly acknowledged. For example, this shortage has 

received special attention given past bioterrorism events and efforts to prepare 

for possible future attacks. The allied health project grants funding enables the 

training of much needed allied health professionals, including those experiencing significant shortages. The Graduate Psychology Education Program provides grants to American Psychological Association accredited doctoral, internship and postdoctoral programs in support of interdisciplinary training of psychology students with other health professionals for the provision of mental and 

behavioral health services to underserved populations (i.e., older adults, children, chronically ill, and victims of abuse and trauma, including returning military personnel and their families), especially in rural and urban communities. 

Since its inception in 2002, the GPE Program has supported 52 grants in 27 

States. 

—The Health Professions Workforce and Analysis program provides grants to institutions to collect and analyze data on the health professions workforce to advise future decision-making on the direction of health professions and nursing 

programs. The Health Professions Research and Health Professions Data programs have developed a number of valuable, policy-relevant studies on the distribution and training of health professionals, including the soon-to-be-released 

Eighth National Sample Survey of Registered Nurses (NSSRN), the Nation’s 

most extensive and comprehensive source of statistics on registered nurses. 

—The Public Health Workforce Development programs are designed to increase 

the number of individuals trained in public health, to identify the causes of 

health problems, and respond to such issues as managed care, new disease 

strains, food supply, and bioterrorism. The Public Health Traineeships and Public Health Training Centers seek to alleviate the critical shortage of public 

health professionals by providing up-to-date training for current and future 

public health workers, particularly in underserved areas. Preventive Medicine 

Residencies, which receive minimal funding through Medicare GME, provide 

training in the only medical specialty that teaches both clinical and population 

medicine to improve community health. Dental Public Health Residency programs are vital to the Nation’s dental public health infrastructure. The Health 

Administration Traineeships and Special Projects grants are the only Federal 

funding provided to train the managers of our health care system, with a special emphasis on those who serve in underserved areas. 

—The Nursing Workforce Development programs provide training for entry-level 

and advanced degree nurses to improve the access to, and quality of, health 

care in underserved areas. Health care entities across the Nation are experi-
566 

encing a crisis in nurse staffing, caused in part by an aging workforce, an insufficient number of young people entering the profession, and a shortage of nurse 

faculty. At the same time, the need for nursing services is expected to increase 

significantly over the next 20 years, with the demand for licensed, registered 

nurses growing by over 29 percent within the next nine years alone. Congress 

responded to this dire national need by passing the Nurse Reinvestment Act 

(Public Law 107–205) which aims to attract more people into the nursing profession, increase the capacity for nurse education, and encourage practicing 

nurses to remain in the profession. The Advanced Education Nursing program 

awards grants to train a variety of advanced practice nurses, including nurse 

practitioners, certified nurse-midwives, nurse anesthetists, public health nurses, 

and nurse administrators. Workforce Diversity grants support opportunities for 

nursing education for disadvantaged students through scholarships, stipends, 

and retention activities. Nurse Education, Practice, and Retention grants are 

awarded to help schools of nursing, academic health centers, nurse managed 

health centers, State, and local governments, and other health care facilities to 

develop programs that provide nursing education, promote best practices, and 

enhance nurse retention. The Loan Repayment and Scholarship Program repays 

up to 85 percent of nursing student loans and offers individuals who are enrolled or accepted for enrollment as a full-time or part-time nursing student the 

opportunity to apply for scholarship funds. In return these students are required to work for at least two years of practice in a designated nursing shortage area. The Comprehensive Geriatric Education grants assist in training individuals to provide geriatric care for the elderly. The Nurse Faculty Loan program provides a student loan fund administered by schools of nursing to increase the number of qualified nurse faculty. The Title VIII nursing programs 

also support the National Advisory Council on Nurse Education and Practice, 

which is charged with advising the Secretary of Health and Human Services 

and Congress on nursing workforce, education, and practice improvement 

issues. 

—The loan programs in the Student Financial Assistance support needy and disadvantaged medical and nursing school students in covering the costs of their 

education. The Nursing Student Loan (NSL) program provides loans to undergraduate and graduate nursing students with a preference for those with the 

greatest financial need. The Primary Care Loan (PCL) program provides loans 

covering the cost of attendance in return for dedicated service in primary care. 

The Health Professional Student Loan (HPSL) program provides loans covering 

the cost of attendance for financially needy health professions students based 

on institutional determination. The NSL, PCL, and HPSL programs are funded 

out of each institution’s revolving fund and do not receive Federal appropriations. The Loans for Disadvantaged Students (LDS) program provides grants to 

health professions institutions to make loans to health professions students 

from disadvantaged backgrounds. 

HPNEC members respectfully urge support for funding of at least $550 million 

for the Title VII and VIII programs, an investment essential not only to the development and training of tomorrow’s health care professions but also to our Nation’s efforts to provide needed health care services to underserved and minority communities. We greatly appreciate the support of the subcommittee and look forward to 

working with members of Congress to achieve these goals in fiscal year 2007 and 

into the future. 

PREPARED STATEMENT OF THE INSTITUTE FOR STUDENT ACHIEVEMENT

Mr. Chairman and Members of the subcommittee, thank you for the opportunity 

to submit testimony to the hearing record regarding the Institute for Student 

Achievement (ISA), a national not for profit educational organization. 

INTRODUCTION TO THE INSTITUTE FOR STUDENT ACHIEVEMENT

The Institute for Student Achievement’s mission is ‘‘to improve the quality of education for youth at risk so that they can succeed in our society.’’ ISA has had a solid 

15 year history of promoting high achievement for underserved students, first 

through its legacy direct service programs, COMET (for middle school) and STAR 

(for high school), and now through its school reform model. ISA launched its high 

school reform model in September 2001, with four pilot sites, three in New York 

City and one in Fairfax County, Virginia. As you know, funds to expand the work 

of ISA have been included in recent appropriations cycles, and we appreciate the 

support of the subcommittee. As a result we have created 31 small schools and 
567 

learning communities serving over 8,000 students in New York State, Virginia (in 

partnership with Fairfax County Schools), Atlanta, Georgia and Union City, New 

Jersey. 

ISA partners with school districts to create new small schools or to transform 

large existing high schools into clusters of autonomous small schools or semi-autonomous small learning communities. The ISA high school reform model targets underserved, underperforming young people, including students from low-income families, 

students of color, recent immigrants and English Language Learners. ISA helps 

schools to develop small learning communities with the seven school design principles that have succeeded in preparing all high school students, including those 

who are disadvantaged and underperforming, to achieve, graduate, and go on to college. 

Briefly described, the 7 ISA Principles are: 

A College Preparatory Instructional Program promoting rigorous intellectual development, strong literacy and numeracy skills, critical thinking, habits of mind and 

work, and practical knowledge of the college application process. 

A Dedicated Team of Teachers and a Counselor who collaborate to ensure that 

students develop and achieve academically and socially. 

Continuous Professional Development that strengthens the capacities of teachers, 

counselors and school leaders to effectively provide a college preparatory program 

through rich professional growth experiences; regularly scheduled team meetings; 

classroom interventions for teachers; and customized professional development on 

topics ranging from inquiry in science to conflict resolution. 

Distributed Counseling TM an approach in which faculty get to know all students 

well, as both learners and people, and integrate counseling into the education program so that students graduate ready for college. The counselor provides ongoing 

guidance to the teacher/advisors and direct services to students and their families. 

An Extended School Day and School Year provide extra time for students to develop skills, complete assignments, engage in test preparation, participate in community service projects and internships, and have opportunities for talent development and enrichment. 

Parent Involvement is integrated into school operations. The school program is designed to allow—and encourage—parents to be full partners in realizing educational 

excellence for their children. 

Continuous Organizational Improvement focuses on optimizing student learning. 

ISA and its higher education partner, the National Center for Restructuring Education, Schools and Teaching (NCREST) of Teacher’s College, Columbia University, 

work with the small schools and small learning communities to assess and evaluate 

in order to inform instruction and enhance program development. 

In each ISA small learning community or small school, a team of at least four 

core subject teachers and a guidance counselor is dedicated to a group of 100–125 

students, staying with the students over multiple years. Each ISA small school or 

small learning community selects an ISA coach, who is experienced in the development of small or restructuring schools, brings substantive knowledge of one or more 

core content areas, and has considerable background in working closely with teachers in reflecting on and improving their practice. The ISA coach works with the 

school over a four-year period at the school site, supporting school administrators 

and dedicated teacher/counselor teams as they implement the seven ISA principles 

to meet the needs of their school community. 

The ISA coach works with individual teachers to strengthen their pedagogical 

skills and facilitates curriculum development and implementation. He or she helps 

the teacher/counselor teams to create a personalized, supportive environment that 

optimizes student learning. The team is further assisted with the implementation 

of ISA’s Distributed Counseling TM model and their efforts to increase the level of 

parent involvement are informed by ISA best practices. ISA also helps schools to 

develop extended day programming that reinforces school day learning and offers 

young people opportunities to prepare for college and career. 

THE CONCEPTUAL AGE

Our mission today is even more important than it was when ISA was founded because of the dramatic transformation of our economy and the nature of work. The 

fact is, we are charged with preparing our children to succeed in a world that in 

many ways bears little relation to the world we entered when we left school—or 

even the world we woke up in yesterday. In a microscopic measure of human time, 

we have moved through the Agricultural Age, to the Industrial Age, to the Information Age, and now to another era altogether. Author Daniel Pink calls this new era 
568 

the Conceptual Age. It requires us to be not only knowledgeable and competent, but 

creative and inquisitive as well. 

Studies have shown that many of our high schools, even those that boast of high 

graduation and college-attendance rates, rarely demand that students use information, skills, and technologies to construct new knowledge and to solve complex problems, integrate concepts and ideas across disciplines, communicate effectively orally 

and in writing, and work in diverse groups. Yet this is precisely the kind of learning 

students need for a Conceptual Age. Students themselves tell us that they want to 

be held to high standards but that they find their high schools boring, 

unchallenging, and disconnected from their lives. 

THE GLOBAL CHALLENGE

Microsoft Chairman Bill Gates recently told the Nation’s governors that American 

high school education is ‘‘obsolete.’’ He said, ‘‘When I compare our high schools to 

what I see when I’m traveling abroad, I am terrified for our workforce of tomorrow. . . . In 2001, India graduated almost a million more students from college 

than the United States did. China graduates twice as many students with bachelor’s 

degrees as the United States and [has] six times as many graduates majoring in 

engineering. . . . America is falling behind.’’ 

Gates was describing a global economy in which the chance to move up into a better economic life is slipping overseas, along with jobs that can be performed anywhere—manufacturing in China, technology support in India, online order fulfillment across borders. The Internet brings Bhutan and Bangalore just as close to our 

offices and living rooms as Boise. Our children’s competitors are not the other 

schools in the district or the State or even the Nation. They are the technologically 

literate young people in Taiwan, India, Korea, and other developing nations. For today’s American students, learning and retraining will be a lifelong experience. 

To be ‘‘competitive’’ now, U.S. students must develop sophisticated critical thinking and analytical skills to manage the conceptual nature of the work they will do. 

They will need to be able to recognize patterns, create narrative, and imagine solutions to problems we have yet to discover. They will have to see the big picture and 

ask the big questions. How many high schools do you know that are nurturing 

minds like that? 

The 12th-grade data from the Third International Mathematics and Science Study 

showed that of the 20 countries participating, only two—Cyprus and South Africa— 

scored lower than the United States. American students enrolled in the most advanced courses in math and science performed at low levels compared to students 

in other countries. 

LEAVING SOME STUDENTS BEHIND

Two serious gaps hold back most of our students and risk the prosperous future 

of the entire country. The gap we hear least about is the one between a rigorous, 

intellectually challenging curriculum and the rote instructional program that is 

commonplace in far too many classrooms. The gap we hear much more about is the 

one in student achievement that is exposed when data is disaggregated by race, ethnicity, and family income. Our challenge is to ensure that both gaps are closed and 

that all children—not just some of them—receive a high-quality education that will 

prepare them well for the world in which they will live and work. 

There are tremendous gaps in achievement among racial and ethnic groups within 

our own country. We are systematically leaving behind large numbers of our poor 

and minority students. On the 2005 National Assessment of Educational Progress, 

39 percent of white eighth-graders scored at or above proficient on the math exam, 

while only 9 percent of African-American and 13 percent of Hispanics achieved at 

that level. 

A U.S. Department of Education study shows that the average 12th-grade African-American student is reading and doing math at around the level of the average 

eighth-grade white or Asian student. Hispanic students are about as far behind. On 

the 2004 SAT, black students, on the average, scored 104 points lower on the math 

test and 98 points lower on the verbal test than white students. Between 25 to 30 

percent of America’s teenagers fail to graduate from high school with a regular diploma. That figure climbs to more than 50 percent for black male and Hispanic students. 

Clearly, this is not the path to global competitiveness. The quality and the inequality of education in this country should be at the top of the agenda for every 

meeting of the school board and superintendent. An uneven playing field is 

everybody’s turf—and it needs tending. 
569 

THE INSTITUTE FOR STUDENT ACHIEVEMENT IS SUCCEEDING

At a time when the vast majority of jobs require a college degree or some type 

of postsecondary degree, most low-achieving students are relegated to classrooms 

where remediation and instruction in low-level skills are the norm. But poor performance and a shortage of vision are not inevitable characteristics of our educational system. ISA is addressing this challenge. 

Typically ISA schools have attendance rates of over 90 percent average daily attendance. Over 95 percent of graduates from ISA schools and learning communities 

have gone on to college. The small size, 400 students grades 9–12, results in a high 

level of personalization, individual student attention, extensive, professional development, a challenging curriculum, and family and community involvement. Our research has shown that ISA small schools and learning communities have higher 

graduation rates, very low dropout rates, outstanding student attendance, increased 

teacher satisfaction and are more cost effective than large high schools. 

In fiscal year 2007, ISA has requested Federal funding to help us continue our 

work in developing rigorous college preparatory high schools in the States of Georgia, Virginia, New Jersey and New York. Beyond that, our goal, with your help, is 

to expand the number of ISA schools to over 100 throughout the Nation, over the 

next three years. When we have met that challenge we will have demonstrated that 

there are model public high schools that are successfully educating all students in 

high need communities to be conceptual thinkers and ready for the challenges we 

are confronting in today’s global economy. We hope that the subcommittee can be 

supportive of our efforts and our request for funding. 

PREPARED STATEMENT OF THE NATIONAL WRITING PROJECT

I am Richard Sterling, Executive Director of the National Writing Project (NWP). 

NWP is authorized under Title II, Subchapter C, Subpart 2 of the Elementary and 

Secondary Education Act of 1965. It has been authorized as part of ESEA since 

1991. 

I appreciate the opportunity to present this testimony requesting continued support for the National Writing Project. As you know, the Department of Education’s 

(ED) fiscal year 2007 budget request to Congress did not include funding for this 

program. 

NWP is a national organization, a network of local writing project sites, working 

with teachers of all subject areas and at all grade levels to improve the teaching 

of writing in the Nation’s schools. Today there are 195 university-based writing 

project sites in all 50 States, the District of Columbia, Puerto Rico, and the U.S. 

Virgin Islands. NWP sites promote core principles of effective instruction while they 

respond to the needs of local schools and communities. The fiscal year 2006 appropriation for the NWP is $21.5 million. Another $22 million in local support is leveraged by writing project sites across the country. 

By statute, the purposes of the NWP are to (1) ‘‘support and promote the expansion of the NWP network so that teachers in every region of the United States have 

access to an NWP program,’’ (2) ‘‘ensure the consistent high quality of sites through 

ongoing review, evaluation, and technical assistance,’’ and (3) ‘‘support and promote 

the establishment of programs to disseminate effective practices and research findings about the teaching of writing.’’ 

The Department of Education’s justification for elimination of the NWP states 

that the ED is ‘‘eliminating small categorical programs that have limited impact and 

for which there is little or no evidence of effectiveness.’’ In addition, the ED States 

that, ‘‘These small categorical programs siphon off Federal resources that could be 

used by State and local agencies to improve the performance of all students.’’ In relation to the NWP network these findings are not adequately supported by the facts. 

The NWP’s response follows: 

RESPONSE TO THE STATEMENT: THE NWP HAS ‘‘LIMITED IMPACT’’ 

It is difficult to understand the basis for the finding that the NWP has ‘‘limited 

impact.’’ The impact of a funded project is determined by the scale of services provided and the value of those services to districts, schools, teachers, and students. 

In terms of the scale of its services, the NWP is by far the largest provider of professional development in writing in the country. 

Data gathered by an independent evaluator, Inverness Research Associates (IRA), 

show the scale of NWP as it affects students. Approximately 1.95 million students 

are taught every year by teachers who received professional development services 

from writing project sites. In addition, NWP programs also directly serve 45,000 stu-
570 

dents through school-year and summer youth writing programs each year. (Data 

available from IRA, www.inverness-research.org.) 

Data also demonstrate the scale of NWP’s reach to teachers across the country. 

The NWP network provides 19 hours of professional development to 1 out of every 

8 secondary language arts teachers and 1 out of every 35 elementary school teachers 

every year. 

In 2004–2005 alone, more than 3,000 teachers attended intensive NWP summer 

institutes. These summer institute participants directly teach more than 60,000 students during the school year. (Their students are representative of the student population: 42 percent students of color, 13 percent English language learners, 46 percent in Title I programs.) These 2004–2005 teacher-participants join the more than 

12,000 writing project teacher-leaders from past summer institutes who are serving 

their home communities. Together, these teachers conducted 7,288 professional development programs for more than 141,000 educators in 2004–2005. 

The network of 195 local sites is a unique national asset now providing geographical access to teachers in two-thirds of the counties in the Nation. In 2004– 

2005, 1,657 districts (1 out of ten in the Nation) and 2,907 schools (1 out of every 

30 schools) chose to invest their professional development dollars with NWP local 

sites. Local writing project sites have formed ongoing partnerships with 371 districts 

and schools. 

Thus, not only is the scale of work of the NWP network of national significance, 

there is strong evidence that the services offered are highly valued by States, local 

districts, schools, and teachers. 

Expanding the NWP 

Since 2000, the NWP network has added 60 new writing project sites in 30 states. 

Each year between 6 and 10 new sites are established in areas of the country that 

previously had not been served. This addresses the statutory requirement to expand 

the NWP network ‘‘so that teachers in every region of the United States have access 

to an NWP program.’’ In addition to adding new sites, NWP has developed local satellite programs so that existing sites can provide services to teachers and schools 

at a distance from the host university. NWP receives an average of 12 requests for 

new sites and satellites each year from universities eager to bring the writing 

project to their local communities. 

Assuring program quality 

In order to ensure the quality of local sites, NWP has conducted an annual site 

performance review since 1994. As part of the process, each local writing project site 

completes an extensive performance survey of its programs as well as of its teacher 

and administrator participants. The statistical data from these surveys are independently analyzed and reported by IRA on an annual basis. Every site must reapply for funding each year, and the analysis of these data, along with the site application, are used in the site performance review. During this annual review process, some sites are identified as in need of technical assistance from the NWP. If 

the sites are unable to resolve their issues after this technical support, they are no 

longer eligible for Federal funding. Over the last 10 years, 51 site grants were not 

renewed; however, 8 of these sites were re-funded after a transition period that resolved their issues. 

While each local NWP site receives a small amount of core funding from the Federal grant, the vast majority of the work done by each local NWP site is supported 

by States, counties, local school districts, and individual teachers. States, districts, 

and schools must make careful decisions about how they spend their resources for 

professional development—the fact that they continue to invest in the work of the 

NWP over many years is strong evidence of both the value and the effectiveness of 

NWP services. 

RESPONSE TO THE STATEMENT: THERE IS ‘‘LITTLE OR NO EVIDENCE OF EFFECTIVENESS’’ 

OF THE NWP

The Program Assessment Rating Tool (PART) review concluded that ‘‘there is insufficient evidence on the overall effectiveness of NWP interventions.’’ This assertion 

is based on incomplete information about a range of studies conducted on the effectiveness of NWP programs. In particular, the NWP PART section 2.1 provides incomplete information concerning long-term performance measures that NWP has 

employed to ‘‘focus on outcomes and meaningfully reflect the purpose of the program.’’ 

In fact, since its inception in 1974 as a single writing project site located at the 

University of California, Berkeley, NWP has supported its sites in conducting numerous studies on the effectiveness of their professional development programs and 
571 

contracted with third parties that have also conducted such studies. (Only two of 

these studies are referred to in the ED report.) Multiple research studies have 

shown that NWP programs significantly increase the instructional knowledge of 

teachers to teach writing. High quality quasi-experimental studies confirm significant gains for students of teachers who have participated in writing project programs. The NWP’s website (www.writingproject.org) contains information on these 

and other recent studies. 

The PART assessment is based on incomplete information about the establishment of long-term measures to ensure that NWP sites disseminate effective practices in NWP teacher training programs. Beginning in 1999, following the establishment of GPRA performance indicators by ED, NWP contracted with IRA to collect 

and analyze additional data on teacher satisfaction with the summer training they 

received and to assess their implementation of effective instructional strategies in 

the teaching of writing in the year following the training. Targets were established 

by ED for this indicator in 1999. 

NWP has exceeded the target established for every year of the evaluation to date, 

with an average of 96 percent of elementary and secondary teachers reporting that 

they gained effective teaching strategies and up-to-date research that they can apply 

to their teaching. The independent evaluation also showed that instructional strategies that NWP participants learn in the institutes and use in their classrooms correlate positively with greater student achievement in writing on the NAEP Writing 

Assessment. This study is performed annually in partial fulfillment of requirements 

placed on the NWP by ED. To date, more than 15,000 teachers have been surveyed, 

with consistent results across all six years of the evaluation. (These annual reports 

are available at www.inverness-research.org, including The National Writing Project 

Client Satisfaction and Program Impact: Results from a Satisfaction Survey and 

Follow-up Survey of Participants at 2004 Invitational Institutes, December 2005.) 

The NWP PART assessment was also conducted before the conclusion of five rigorous quasi-experimental design studies that measured the extent to which students 

of teachers who received training by an NWP site improved their writing skills. Student learning in writing project teachers’ classrooms was studied relative to student 

learning in comparable non-writing project teachers’ classrooms. A team of external 

evaluators reviewed all of the research proposals and also designed and oversaw the 

independent national scoring of student writing. These five quasi-experimental studies have been completed and the results have been submitted to ED as well as posted on the NWP website. 

Central to each of the five studies conducted in 2004–2005 was the writing project 

site’s commitment to understand what difference writing project professional development makes for participating teachers’ practices and, in turn, what difference 

those changes in instructional practices make for student learning. Each study employed direct assessments of student writing, and each included carefully matched 

comparison classes and/or students. In an independent national scoring of student 

writing, NWP students’ improvement outpaced that of students in carefully constructed comparison groups. 

Every comparison across all five studies shows positive effects of NWP programming. Student results were strong and favorable in those aspects of writing that the 

NWP is best known for, such as organization and the development of ideas. Students in writing project classrooms made greater gains than their peers in the area 

of conventions as well, suggesting that even these basic skills benefit from the NWP 

approach to teaching writing. These quasi-experimental studies uniformly indicate 

positive effects for the students of teachers who participated in writing project programs. 

These studies conform to the advice regarding rigor in quasi-experimental designs 

as offered by the Institute of Educational Sciences (IES) of ED. 

RESPONSE TO THE STATEMENT: ‘‘SMALL CATEGORICAL PROGRAMS SIPHON OFF FEDERAL

RESOURCES THAT COULD BE USED BY STATE AND LOCAL AGENCIES TO IMPROVE THE

PERFORMANCE OF ALL STUDENTS’’ 

Rather than ‘‘siphon off’’ resources, the Federal investment in the NWP helps to 

augment and amplify local expenditures in the improvement of writing. All NWP 

sites match their Federal base grant with State, local, and private funding at a ratio 

of at least 1:1. The Federal investment provides core funding for the NWP and enables local sites to leverage additional funds from a variety of sources, including 

host universities, surrounding school districts, private corporations, and other entities. The quantity and quality of local professional development depends on the 

modest Federal investment that has so clearly demonstrated its power to attract 

and focus local resources. Without these crucial Federal funds, the core writing 
572 

project work that develops teacher expertise and leadership and supports the dissemination of research and effective practices will simply cease to exist. 

An independent analysis by IRA of cost-efficiency over the past five years highlights the cost effectiveness of the Federal investment in the NWP. Local sites have 

leveraged an average of $3.65 for every Federal dollar they received from the NWP. 

The need for strong literacy skills for our Nation’s students is a central tenet of 

all current school reform efforts. The NWP is a very good example of a Federal-local 

partnership that addresses this core need. The Federal funds: (1) enable local sites 

to maintain a minimal but critically important effective group of teacher-leaders, (2) 

develop ongoing working relationships between universities and school districts, (3) 

respond to local needs, and (4) provide support to all local sites so that they can 

continue to improve and expand their programs. In summary, the NWP provides 

high quality, large scale, and cost-effective support to teachers and students to improve writing and learning in the Nation’s schools. 

PREPARED STATEMENT OF THE STATE EDUCATIONAL TECHNOLOGY DIRECTORS

ASSOCIATION

NCLB TITLE II, PART D—ENHANCING EDUCATION THROUGH TECHNOLOGY (EETT)

Members of the State Educational Technology Directors Association (SETDA) include the State directors of technology from the SEAs in all 50 States, D.C., and 

American Samoa. I am pleased to submit this information and data which demonstrates how EETT is being utilized in over 80 percent of school districts across 

this country. EETT supports all areas of NCLB, including: 

—Closing the Achievement Gap 

—Recruiting and Retaining Highly Qualified Teachers 

—Improving Data Systems to Meet AYP 

EETT is also a key foundation to address the critical STEM and Competitiveness 

issues and initiatives. EETT has already begun to address these needs and will continue to do so through programs with data to support their effectiveness, including: 

—Improving math and science achievement 

—Ensuring highly qualified teachers in math and science 

—Ensuring students and teachers have skills to ensure that they are prepared for 

the global workforce 

This testimony includes the following: 

1. Key Examples that illustrate the key role EETT plays in helping schools, districts, and States to meet NCLB goals, but also demonstrate the focus on math, 

science, and improving students’ abilities to compete in a global workforce. 

2. Overview of National Trends Report on Round 3 of EETT Funding data and 

results; the entire report on how EETT funds were used in all 50 States and D.C. 

can be accessed at http://www.setda.org/content.cfm?sectionID=185. 

1. KEY EXAMPLES

Improvements in Math and Science Achievement 

Iowa’s Success With Algebra.—In Columbus Community School District, with 70 

percent high poverty and 65 percent Hispanic populations, the 8th grade in the 

2001–02 school year scored only 51 percent of the students as proficient on the ITBS 

Math Assessment. Cognitive Tutor Algebra I implementation began in 2002 with 

the instructor rating a very high level of implementation by the CEO of the program. Columbus Students improved proficiency by 11 percent from Grade 8 to 

Grade 9. They continued to improve and were 74 percent proficient as 11th graders. 

Louisiana’s Online Algebra I Course.—Algebra I is often a predictor for success 

in high school and beyond. Louisiana implemented an online Algebra I course to 

provide additional opportunities for student achievement. Preliminary evaluations 

indicate that students in the online course, with similar pre-test scores are showing 

more significant achievement gains compared to the control group as indicated 

below: 

Group 

Pre-test 

(fall) 

mean 

Post-test 

(spring) 

mean 

Algebra I Online Students .............................................................................................................. 13.3 17.2 

Control Students ............................................................................................................................. 13.4 15.6 
573 

Michigan’s Freedom to Learn Project.—This one-to-one initiative, which includes 

each student having a computer and professional development for teachers, showed 

significant impact with 7th-grade reading scores jumping from 29 percent to 41 percent and 8th-grade math scores increasing from 31 percent to 63 percent. 

Closing the Achievement Gap 

Missouri’s eMINTS,—The eMINTS National Center provides tools to teachers in 

grades 3–5 to integrate multimedia into lessons. Three years of data analysis have 

demonstrated the highly positive effect of the program on student achievement. Performance in the fourth grade in the fiscal year 2002 cohort was essentially equalized 

between African-American and white students. Indeed, African-American students 

in eMINTS classrooms had a slightly higher average score in social studies for fiscal 

year 2002 than white students not enrolled in those classrooms; and in mathematics, the average performance between these two groups was almost identical. 

West Virginia’s Basic Skills Computer Education Program.—Researcher Dale 

Mann (ASBO, 2003) cited a direct correlation between pupil performance and technology in instruction through West Virginia’s Basic Skills/Computer Education program. The study found that while per capita income had not changed between 1991 

and 1998, the infusion of technology was the single factor that accounted for the 

State moving from 33rd among the States for student achievement to 11th. In a 

similar study, Mann found that the cost of advancing students one unit in reading 

by decreasing the class size cost $636 and using technology to achieve the same result cost $86 (Mann, 2003). Technology provides a key opportunity to increase student achievement. 

Providing Opportunities to Rural and Small School Districts Through Distance 

Education.—The U.S. Department of Education and NCES’ recent Distance Education Courses for Public Elementary and Secondary School Students: 2002–2003 

(2005) documents the fact that smaller and rural schools use distance education opportunities more often, with a strong emphasis on foreign language courses. Additionally, 50 percent of districts that provide distance learning opportunities had students enrolled in Advanced Placement (AP) Courses. The recent NGA Summit on 

High School reform indicated the importance of students’ access and participation 

in AP Courses. At least 80 percent of districts noted that distance education allowed 

them to increase the course offerings for their students. EETT provides a significant 

funding for these opportunities. 

Recruiting and Retaining Highly Qualified Teachers 

North Carolina’s IMPACT Model Schools Grant.—This EETT grant program provides personnel, connectivity, hardware, software, and professional development to 

improve student achievement. A collaborative model, it focuses on using technology 

as a tool to encourage authentic, project-based learning incorporating 21st Century 

Learning Skills into all curriculum areas. In a time where more than one-half of 

all teachers leave the teaching field within the first three years, teachers who are 

scheduled to retire often choose to stay in these IMPACT schools, others request 

transfers into them, and new teachers clamor to be hired. ‘‘These teachers like the 

way technology is changing the way they teach, and the enthusiasm with which 

their students approach learning,’’ says Frances Bryant Bradburn, Director of Instructional Technology for the North Carolina Department of Public Instruction. Additionally, the initial results from this quasi-experimental design evaluation demonstrate that: 

—In first year, students in IMPACT schools had stronger growth than comparison 

school students, and for particular subgroups there was substantially stronger 

growth varying from small differences to about half a grade level of extra 

growth, depending on the outcome and grade level. 

—IMPACT students often started lower than their comparison school counterparts, but caught up within one school year. 

—In general, the most challenged IMPACT students showed the most growth in 

achievement. 

Maryland Increasing Teacher Retention.—Nationally, 50 percent of teachers leave 

the field within the first three years of their careers. To provide additional support 

for new teachers, Prince George’s County has utilized Intel’s Teach to the Future 

to provide extensive technology integration training for teachers and opportunity for 

graduate credit. Associated with Towson University, the first cohort of 125 beginning teachers are demonstrating a very high rate of retention: 94 percent. 

Improving Data Systems to Meet AYP 

Vermont Education Data Warehouse.—EETT funds in Vermont are being utilized 

directly for the implementation of data systems to support NCLB Accountability requirements through the Vermont Data Consortium that is creating a statewide 
574 

‘‘Education Data Warehouse.’’ The State grants provided through EETT funds support LEAs or schools in the development of local data systems to improve student 

achievement, support for teachers in analyzing data, improvement in evidence-based 

policy, and data standards to address local interoperability. 

Philadelphia’s Instructional Management System (IMS).—A comprehensive reform 

effort that includes new resources, a standardized curriculum, after school programs, and professional development, IMS provides teachers and administrators 

with immediate data on student learning aligned to State and District standards. 

A benchmark assessment, given every five weeks, allows teachers to differentiate instruction, provide immediate remediation, and identify those students who need additional assistance. In 2003, before these technology tools were provided to teachers, 

only 9 of the 40 initial participating schools had met AYP; and 15 were identified 

for Corrective Action. At the end of the 2004 school year, 25 schools met their AYP 

targets, and only 10 remained in Corrective Action II. 

2. OVERVIEW OF NATIONAL TRENDS REPORT ON EETT

Key Findings 

1. Promising Interim Results at 3-Year Mark Warrant Continued Investment 

2. States Have Set the Bar High for Professional Development 

3. States Are Making Progress with Evaluation and Impact Research 

4. States Are Leveraging Resources through Collaborations and Partnerships 

Over 40 percent of States required LEAs that received NCLB II D competitive 

grant funds to focus on reading or mathematics. States are not only building the 

conditions essential to effective technology use, but they are also seeing results as 

measured in increased student learning. 

Nearly 25 percent of States are funding or commissioning research studies on the 

impact of educational technology on learning in schools. Over 88 percent of States 

are collecting data annually from either districts, schools, or both. States are increasingly triangulating data sources (e.g., district surveys, school surveys, teacher 

surveys, student surveys, and site visitations). 

43 percent of the States went beyond the Title II D’s 25 percent minimum funding 

requirement to focus additional resources toward professional development. Thus, 

over $159 million of grant funds was dedicated to professional development during 

Round 3 of the NCLB II D program. 

Key Facts 

1. Within the 50 States and the District of Columbia, 14,291 districts were eligible 

for Title II D funds, representing 89.3 percent of LEAs. Collectively, the survey respondents administered $635,027,468 in NCLB Title II D funding for Round 3, fiscal 

year 2004. 

2. Most States are encouraging school districts and schools to integrate technology 

systematically and 23.5 percent actually require that technology planning and 

school improvement be conducted within the same process. 

3. Funds are administered through both formula grants and competitive grants. 

Approximately 48 percent of the formula grants are under $5,000. That means that 

less than 4 percent of the funds require almost 50 percent of the administrative support for formula grants. 

4. The following States report that NCLB II D is the only source of funding in 

their State for educational technology: Arizona, California, Delaware, Illinois, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Hampshire, Oklahoma, 

Vermont, Washington, and Wisconsin. 

5. On the other hand, many States, including Virginia, Pennsylvania, Florida and 

Alabama, are leveraging EETT to secure significant State investments in education 

technology through on-line assessment, high school reform, one to one initiatives 

and on-line learning initiatives. 

Full copies of the National Trends Report are available for download from the 

State Educational Technology Directors Association (SETDA) Website, 

www.setda.org. SETDA is the principal association representing the State directors 

for educational technology. SETDA?s membership includes all 50 States, the District 

of Columbia, and American Samoa. 

Thank you for your consideration of this data. Please contact me at 

mwolf@setda.org or 410-647-6965 with any questions. 
575 

RELATED AGENCIES 

PREPARED STATEMENT OF THE NATIONAL FEDERATION OF COMMUNITY BROADCASTERS

Thank you for the opportunity to submit testimony to this subcommittee regarding the appropriation for the Corporation for Public Broadcasting (CPB). As the 

President and CEO of the National Federation of Community Broadcasters, I speak 

on behalf of 250 community radio stations and related organizations across the 

country. Nearly half our members are rural stations and half are minority controlled 

stations. In addition, our members include many of the new Low Power FM stations 

that are putting new local voices on the airwaves. NFCB is the sole national organization representing this group of stations which provide service in the smallest communities of this country as well as the largest metropolitan areas. 

In summary, the points we wish to make to this subcommittee are that NFCB: 

—Requests $430 million in funding for CPB for fiscal year 2009, a $30 million increase over the fiscal year 2008 advance appropriation; 

—Requests $40 million in fiscal year 2007 for conversion of public radio and television to digital broadcasting. Also supports funding for the Public TV interconnection system; 

—Requests that advance funding for CPB is maintained to preserve journalistic 

integrity and facilitate planning and local fundraising by public broadcasters; 

—Reject the Administration’s proposal to rescind $103 million of already-appropriated fiscal year 2007 and 2008 CPB funds; 

—Supports CPB activities in facilitating programming and services to Native 

American, African American and Latino radio stations; 

—Supports CPB’s efforts to help public radio stations utilize new distribution 

technologies and requests that the subcommittee ensure that these technologies 

are available to all public radio services and not just the ones with the greatest 

resources. 

Community Radio fully supports $430 million in Federal funding for the Corporation for Public Broadcasting in fiscal year 2009. Federal support distributed through 

CPB is an essential resource for rural stations and for those stations serving minority communities. These stations provide critical, life-saving information to their listeners and are often in communities with very small populations and limited economic bases, thus the community is unable to financially support the station without Federal funds. 

In larger towns and cities, sustaining grants from CPB enable Community Radio 

stations to provide a reliable source of noncommercial programming about the communities themselves. Local programming is an increasingly rare commodity in a Nation that is dominated by national program services and concentrated ownership of 

the media. 

For the past 30 years, CPB appropriations have been enacted two years in advance. This insulation has allowed pubic broadcasting to grow into a respected, independent, national resource that leverages its Federal support with significant local 

funds. Knowing what funding will be available in advance has allowed local stations 

to plan for programming and community service and to explore additional non-governmental support to augment the Federal funds. Most importantly, the insulation 

that advance funding provides ‘‘go[es] a long way toward eliminating both the risk 

of and the appearance of undue interference with and control of public broadcasting.’’ (House Report 94–245.) 

For the last few years, CPB has increased support to rural stations and committed resources to help public radio take advantage of new technologies such as 

the Internet, satellite radio and digital broadcasting. We commend these activities 

which we feel provide better service to the American people but want to be sure that 

the smaller stations with more limited resources are not left out of this technological 

transition. A step in this direction is the $3 million Internet Service Grant Fund 

that will help rural and minority stations serve their listeners and communities better through a website. We ask that the subcommittee include language in the appropriation that will ensure that funds are available to help the entire public radio system utilize the new technologies, particularly rural and minority stations. 

NFCB commends CPB for the leadership it has shown in supporting and fostering 

the programming services to Latino stations and to Native American stations. For 

example, Sate ́lite Radio Bilingu ̈ e provides 24 hours of programming to stations 

across the United States and Puerto Rico addressing issues in Spanish of particular 

interest to the Latino population. At the same time, American Indian Radio on Satellite (AIROS) is distributing programming for the Native American stations, arguably the fastest growing group of stations. There are now over 33 stations controlled 

by and serving Native Americans. 
576 

Last year CPB funded the establishment of the Center for Native American Public 

Radio (CNAPR). Based on a comprehensive assessment of the Native American 

Radio System, CNAPR will develop new funding sources for Native stations and programming; provide direct services to the Native Radio System; encourage collaborations; and represent the Native Radio System. These stations are critical in serving 

local isolated communities (all but one are on Indian Reservations) and in preserving cultures that are in danger of being lost. CPB’s assessment recognized that 

‘‘. . . Native Radio faces enormous challenges and operates in very difficult environments.’’ CPB funding is critical to these rural, minority stations. CPB’s funding of 

the Intertribal Native Radio Summit in 2001 helped to pull these isolated stations 

together into a system of stations that can support each other. The CPB assessment 

goes on to say: ‘‘Nevertheless, the Native Radio system is relatively new, fragile and 

still needs help building its capacity at this time in its development.’’ The Center 

for Native American Public Radio promises to leverage additional, new funding to 

ensure that these stations can continue to provide essential services to their communities. 

CPB also funded a Summit for Latino Public Radio which took place in September 

2002 in Rohnert Park, California, home of the first Latino Public Radio station. 

These Summits have expanded the circle of support for Native and Latino Public 

Radio and identified projects that will improve efficiency among the stations 

through collaborations and explore new ways of reaching the target audiences. 

CPB plays a very important role for the public and Community Radio system. 

They are the convener of discussions on critical issues facing us as a system. They 

support research so that we have a better understanding of how we are serving listeners. And they provide funding to programming, new ventures, expansion to new 

listeners, and projects that improve the efficiency of the system. This is particularly 

important at a time when there are so many changes in the radio and media environment with new distribution technologies and media consolidation. An example of 

this support is the grant that NFCB received to update and publish our Public 

Radio Legal Handbook online. This provides easy-to-read information to stations 

about complying with governmental regulations so that stations can function legally 

and use their precious resources for programming instead of legal fees. Finally, Community Radio supports $40 million in fiscal year 2007 for conversion 

to digital broadcasting by public radio and television. It is critical that this digital 

funding be in addition to the on-going operational support that CPB provides. The 

President’s proposal that digital money should be taken from the fiscal year 2007 

CPB appropriation would effectively cut stations’ grants by over 20 percent. This 

would have a devastating impact as stations trying to recover from hard economic 

times. And it would come at a time when the local voices of community and public 

radio are especially important to notify and support people during emergency situations and to help communities deal with the loss of loved ones—things that commercial radio is no longer able to do because of media consolidation. 

While public television’s digital conversion needs are mandated by the FCC, public radio is converting to digital to provide more public service and to keep up with 

what commercial radio is doing. The Federal Communications Commission has approved a standard for digital radio transmission. CPB has provided funding for 461 

transmitters to convert to digital, is supporting additional research on AM radio 

conversion, and is working with radio transmitter and receiver manufacturers to 

build in the capacity to provide a second channel of programming. Most exciting to 

public and community radio is the encouraging results of tests that National Public 

Radio has conducted, with funding from CPB, that indicate that stations can broadcast at least two high-quality signals, even while they continue to provide the analog signal. The development of second audio channels will potentially double the 

public service that public radio can provide, particularly in service to unserved and 

underserved communities. This initial funding still leaves nearly 400 radio transmitters that will ultimately need to convert to digital or be left behind. 

Federal funds distributed by the CPB should be available to all public radio stations eligible for Federal equipment support through the Public Telecommunications 

Facilities Program (PTFP) of the National Telecommunications and Information 

Agency of the Department of Commerce. In previous years, Federal support for public radio has been distributed through the PTFP grant program. The PTFP criteria 

for funding are exacting, but allow for wider participation among public stations. 

Stations eligible for PTFP funding and not for CPB funding include small-budget, 

rural and minority controlled stations and the new Low Power FM service. 

We appreciate Congress’ direction to CPB that it utilize its digital conversion fund 

for both radio and television and ask that you ensure that the funds are used for 

both media. Congress stated, with regard to fiscal year 2000 digital conversion 

funds: 
577 

‘‘The required (digital) conversion will impose enormous costs on both individual 

stations and the public broadcasting system as a whole. Because television and 

radio infrastructures are closely linked, the conversion of television to digital will 

create immediate costs not only for television, but also for public radio stations (emphasis added). Therefore, the Committee has included $15,000,000 to assist radio 

stations and television stations in the conversion to digitalization . . .’’ (S. Rpt. 

105–300)’’ 

Community Radio also supports funding for the public television interconnection 

system. Interconnection is vital to the delivery of the high quality programming that 

public broadcasting provides to the American people. 

This is a period of tremendous change. Digital is transforming the way we do 

things; new distribution avenues like digital satellite broadcasting and the Internet 

are changing how we define the business we are in; the concentration of ownership 

in commercial radio makes public radio in general, and Community Radio in particular, more important as a local voice than we have ever been. New Low Power 

FM stations are providing new local voices in their communities. Community radio 

is providing essential local emergency information, programming about the local impact of the major global events taking place, culturally appropriate information and 

entertainment in the language of the native culture, as well as helping to preserve 

cultures that are dying out. During the natural disasters of this last year, radio 

proved once again to be the most dependable, available medium to get emergency 

information to the public. 

During these challenging times, the role of CPB as a convener of the system becomes even more important. The funding that it provides will allow the smaller stations to participate along with the larger stations which have more resources, as we 

move into a new era of communications. 

Thank you for your consideration of our testimony. 

PREPARED STATEMENT OF THE NATIONAL MINORITY CONSORTIA

The National Minority Consortia (NMC) submits this statement on the fiscal year 

2009 appropriation for the Corporation for Public Broadcasting (CPB). The NMC is 

a coalition of five national organizations dedicated to bringing a significant amount 

of programming from our communities into the mainstream of public broadcasting 

and to other media. The role we fulfill in this regard is crucial to public 

broadcasting’s mission. We are unique as organizations and as a coalition of organizations in the services we provide to our communities and to public broadcasting. 

In summary, we ask the Committee to: 

—Direct CPB to increase its efforts for diverse programming with commensurate 

increases for minority programming and the National Minority Consortia 

—Direct CPB to continue its support for the Native radio system 

—Recommend at least $430 million for CPB core funding for fiscal year 2009, a 

$30 million increase over fiscal year 2008 and the amount being requested by 

CPB 

—Reject the Administration’s proposal to end advance funding for CPB 

—Reject the Administration’s proposal to rescind $103 million of already-appropriated fiscal years 2007 and 2008 CPB funds 

REPORT LANGUAGE

We ask for Committee report language, as a follow-up to report language from 

last year, which recognizes the contribution of the NMC and directs that the CPB 

partnership with us be expanded. The report from last year stated: 

‘‘The Committee recognizes the importance of the partnership CPB has with the 

National Minority Public Broadcasting Consortia, which helps develop, acquire, and 

distribute public television programming to serve the needs of African American, 

Asian American, Latino, Native American, Pacific Islander, and many other viewers. 

As many communities in the Nation welcome increased numbers of citizens of diverse ethnic backgrounds, the local public television stations should strive to meet 

these viewers’ needs. With an increased focus on programming to meet local community needs, the Committee encourages CPB to support and expand this critical partnership.’’ (S. Rpt. 109–103, p. 298) 

We request that the above language be modified to direct CPB to increase its support of the NMC and that it also include a reference to radio. 
578 

FISCAL YEAR 2009 APPROPRIATION

We support a fiscal year 2009 Federal appropriation for CPB of at least $430 million. This would be a reasonable, albeit modest, contribution toward our national 

treasure of public broadcasting. The quality gap between network television and 

public television has never been wider, and it continues to grow with each new ‘‘reality’’ show. 

Public broadcasting, including PBS, NPR, and Native Radio is particularly important for our Nation’s growing minority and ethnic communities. While there is a 

niche in the commercial broadcast and cable world for quality programming about 

our communities and our concerns, it is in the public broadcasting industry where 

minority communities and producers are more able to bring quality programming 

for national audiences. Additionally, public television and radio is universally available. 

ADVANCE FUNDING

We strongly oppose the Administration’s proposal that the advance funding for 

CPB be eliminated, a proposal that would stop CPB funding for two years. We appreciate that Congress has rejected this proposal each of the last five years. Reasons 

to continue advance funding for CPB include: 

—The development of production of programming for public broadcasting usually 

takes several years and substantial lead time is necessary for planning productions. 

—Public broadcasting programs are supported by multiple funding sources, and 

two years advance knowledge of the amount of Federal funding allows CPB to 

more effectively leverage its Federal funds to bring in other sources of revenue. 

—The NMC administers a significant amount of CPB programming monies, and 

elimination of advance funding would negatively affect our organizations’ planning, fundraising and producing work for public television and radio. 

RESCISSION OF FISCAL YEAR 2007 AND 2008 FUNDS

We are extremely concerned about the Administration’s proposal to rescind $103 

million of already appropriated fiscal year 2007 and 2008 CPB funds ($53.5 million 

of fiscal year 2007 and $50 million of fiscal year 2008 funds). Such a rescission/diversion of funds would wreck havoc on our organizations and the independent producers that we help support as well as many radio and television stations. 

NATIVE RADIO

Native American Public Telecommunications—one of the five National Minority 

Consortia organizations—works with both the radio and television sides of public 

broadcasting. NAPT operates American Indian Radio on Satellite (AIROS) which 

distributes programming to Native-owned and other radio stations. Koahnic Broadcasting Corporation, headquartered in Alaska, also produces and distributes Native 

American programming. 

Native-owned radio is the fastest growing area of community radio. There are currently 33 Native-owned stations, all but one of which is located in Indian country. 

We greatly appreciate CPB’s central role in the establishment late last year of the 

Center for Native American Public Radio (CNAPR), an organization that will provide technical and other services to Native radio stations. CNAPR’s mission also includes developing new sources of revenue for the Indian radio system and being an 

advocate for Native radio. CPB is providing $1.5 million over a three-year period 

for CNAPR. 

We ask that this Committee urge CPB to continue its support for Native radio. 

ABOUT THE NATIONAL MINORITY CONSORTIA

With primary funding from the Corporation for Public Broadcasting, the NMC 

serves as an important component of American public television. By training and 

mentoring the next generation of minority producers and program managers we are 

able to ensure the future strength of public television and radio television programming from our communities. Individually, each Consortia organization is engaged in 

cultivating ongoing relationships with the independent producer community by providing technical assistance, program funding, programming support and distribution. Often the funding we provide is the initial seed money for a project, thus allowing it to develop. We also provide numerous hours of programming to individual 

public television and radio stations, programming that is beyond the production 

reach of most local stations. 
579 

While the Consortia organizations work on projects specific to their communities, 

the five organizations also work collaboratively. One example is our joint effort on 

the public television four-part series, Matters of Race that aired in the Fall of 2003. 

That series explored the complexity of our rapidly changing multiracial, multicultural society in America. The project resulted in more than television programming. 

The project was designed so that modules could be pulled out for classroom use. It 

was also formatted for radio broadcast and for the internet, and included extended 

interviews. This project provided a great opportunity for extensive and diverse community outreach and collaboration throughout its development, distribution, and 

use. We also worked with American Public Television on 6 one-hour programs (named 

Colorvision) featuring the work of Native American, Asian American, Pacific Islander, Latino and African American filmmakers and television producers. It is now 

in national distribution for all public television stations. 

Below is information about our individual organizations. 

Center for Asian American Media 

The Center’s mission is to present stories that convey the richness and diversity 

of the Asian American experience to the broadest possible audience. Over our 25- 

year history we have provided funding for more than 200 projects, many of which 

have gone on to win Academy, Emmy and Sundance awards, examples of which are 

Daughter from Danang, Of Civil Wrongs and Rights; The Fred Korematsu Story; 

and Maya Lin: A Strong Clear Vision. The Center reaches large audiences through 

the annual International Asian American Film Festival and distributes Asian Pacific American media to schools, colleges, and universities. 

Latino Public Broadcasting 

LPB supports the development, production, acquisition and distribution of noncommercial educational and cultural television, representative of Latino people. The 

resulting programs, disseminated to public television and other public telecommunications entities, provide a voice to the diverse Latino community throughout the 

United States. Productions that have received LPB support include Mirror Dance; 

Visiones: Latino Art and Culture; Life and Time of Frida Kahlo; The Blue Diner; 

Farmingville; and The New Americans. 

National Black Programming Consortium 

The mission of NBPC, founded in 1979, is to preserve and promote complex and 

dynamic stories of the African Diaspora through program development, outreach 

and audience development, and professional development. NPBC has provided hundreds of hours of programming to the national PBS schedule; provided seed money 

to hundreds of projects by African American and other producers, and served as a 

window for emerging producers to break into the national; public broadcasting system. Currently under production is a film on issues surrounding Hurricane Katrina. 

During Black History Month in 2005, over 30 hours of programming were fed to stations. Examples of NBPC-supported programs are Two Towns of Jasper; The Murder of Emmett Till; A Doula Story; and Daughters of the Dust. 

Native American Public Telecommunications 

NAPT, founded in 1977, utilizes various media—public television, public radio, 

and the internet—to bring awareness of Indian and Alaska Native issues to the Nation. We market and distribute up to 10 hours per year on public television stations 

nationwide and fund 5 to 10 new Native productions annually. NAPT operates 

American Indian Radio on Satellite (AIROS) which distributes programming to the 

33 Native-owned radio stations and other radio stations. Among the programming 

we offer is a national daily radio talk show, Native America Calling, on Native subjects, and we also cover live major Indian events. Between 2002 and 2005, NAPT 

delivered or supported the delivery of 24 hours of programming to public television. 

We also funded 30 projects, represented by 54 producers. NAPT projects garnered 

3 national awards and 15 film festival awards during this time period. 

Pacific Islanders in Communications 

PIC delivers programs and training that bring new voice and visibility to Pacific 

Islands. A recent program which we helped bring into being is the award-wining 

Whale Rider, a story about a young Maori girl who confronts years of tribal tradition to fulfill her destiny as the leader of her people. When this program was aired 

on PBS, 107 million households watched the film. In partnership with the Girl 

Scouts, we held free screenings of the film and developed a website about the Maori 

people. PIC offers a wide range of development opportunities for Pacific Island producers through travel grants, seminars and media training. 
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CPB Funds for the National Minority Consortia 

The National Minority Consortia currently receives funds from two portions of the 

CPB budget, organization support funds from the Systems Support and programming funds from the Television Programming sections. CPB financial support is critical to the work of our organizations. We believe that we make a major contribution 

to public broadcasting with a very modest amount of funding, but there is so much 

more that should be done. 

The organizational support funds we receive from CPB are used not only for operations requirements but for also for a broad array of programming support activities 

and for outreach to our communities. We received $1.8 million in fiscal year 2006 

CPB funds for organizational support ($370,000 for each organization). This represents 0.45 percent of the fiscal year 2006 CPB appropriation. We have received 

only very small increases in operations support funds in the past several years. 

The programming funds we receive from CPB are re-granted to producers, used 

for purchase of broadcast rights and other related programming activities. Each organization solicits applications from our communities for these programming funds. 

We received $3.1 million in fiscal year 2006 CPB funds for programming ($636,363 

for each organization). This represents 0.78 percent of the fiscal year 2006 CPB appropriation. Our CPB programming funds have remained virtually flat over the past 

nine years, despite increases in CPB appropriations. 

Thank you for your consideration of our recommendations. We see new opportunities to increase diversity in programming, production, audience, and employment in 

the new media environment, and we thank Congress for support of our work on behalf of our communities. 

PREPARED STATEMENT OF THE RAILROAD RETIREMENT BOARD

Mr. Chairman and Members of the Committee: We are pleased to present the following information to support the Railroad Retirement Board’s (RRB) fiscal year 

2007 budget request. 

The RRB administers comprehensive retirement/survivor and unemployment/sickness insurance benefit programs for railroad workers and their families under the 

Railroad Retirement and Railroad Unemployment Insurance Acts. The RRB also has 

administrative responsibilities under the Social Security Act for certain benefit payments and Medicare coverage for railroad workers. During fiscal year 2005, the RRB 

paid nearly $9.2 billion in retirement/survivor benefits to about 634,000 beneficiaries, and $72.9 million in unemployment/sickness insurance benefits to about 

29,000 claimants. 

We are requesting $103,517,570 for agency operations in fiscal year 2007, which 

is the same as the amount included in the President’s proposed budget. We are also 

requesting a legislative change to permit the RRB to continue using the services of 

the Department of the Treasury for disbursement of retirement and survivor benefits. In addition, we are requesting that the appropriations language for the Dual 

Benefits Payments Account be revised to make it clear that a rescission does not 

preclude the availability of the 2 percent supplemental funding in that appropriation. 

AGENCY ADMINISTRATION

The President’s proposed budget would provide $2 million more than the RRB’s 

appropriation for fiscal year 2006. The increase is intended to provide for information technology improvements, which are needed to maintain the agency’s service 

delivery systems. We estimate that under current legislation, the President’s proposed budget would provide sufficient funding for a staffing level of 895 FTE’s, 

which is 53 FTE’s less than we expect to use in fiscal year 2006. In order to reach 

this level, we would need to conduct a reduction-in-force (RIF) of about 31 employees at an estimated cost of $394,000. However, the RIF could be avoided if the RRB 

is not required to contract for the services of a nongovernmental disbursement agent 

in fiscal year 2007, as discussed in the following section. Administrative funding requested for fiscal year 2007 includes a total of $2.7 mil- lion for information technology investments, of which $1,557,000 would be used for 

a project begun in fiscal year 2005, to transition our mainframe non-relational database management system to a current technology relational database management 

system, DB2. The project, which directly correlates with our Enterprise Architecture 

Strategic Plan, will reduce the RRB’s dependency on declining technologies, with 

their attendant risk of failure, and enable the agency to move ahead with further 

improvements to the benefit payment systems. In fiscal year 2007, we plan to use 

contractual support to optimize the performance of our databases and further reduce 
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data redundancy in order to ensure acceptable response times and system availability. 

We are also moving forward to streamline the RRB’s field service operations. In 

fiscal year 2005, we approved a high-level plan to restructure the field service into 

a hub and satellite configuration that will enhance the agency’s ability to distribute 

work more efficiently among offices. In fiscal year 2006, we hired a consultant to 

assist in developing a 5-year plan that will include consolidation, co-location, and/ 

or the establishment of virtual offices in the field service. The plan is to identify 

out-year savings while maintaining good customer service. 

NONGOVERNMENTAL DISBURSEMENT AGENT

Section 107(e) of the Railroad Retirement and Survivors’ Improvement Act of 2001 

(Public Law 107–90) provides for contracting with a nongovernmental agent for the 

disbursement of railroad retirement benefits. However, initial market research has 

indicated that the cost of doing so would be about three times the cost of having 

similar services provided by the Department of the Treasury. In addition, our Inspector General has questioned whether certain services provided by the Department of the Treasury, such as reclamations, would be provided as effectively by a 

nongovernmental disbursement agent. 

We have concluded that outsourcing this function would be inconsistent with the 

President’s policy of outsourcing only where the government would reduce costs. For 

fiscal years 2005 and 2006, the Congress added language to our appropriations bill 

prohibiting this transfer: Section 516 of Public Law 109–149, the Departments of 

Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2006 provides that none of the funds appropriated under the Act are 

to be used to contract with a nongovernmental disbursement agent. The RRB also 

submitted separate legislation to the Congress on May 5, 2005, to address this issue. 

Our estimates indicate that the cost of contracting with a nongovernmental dis- bursement agent would be about $3 million for the first year and $2.3 million in 

subsequent years. By comparison, the annual cost of having these services provided 

by the Department of the Treasury is about $800,000. Enactment of legislation to 

remove this requirement would provide sufficient savings in fiscal year 2007 to enable the RRB to cover essential operating costs at the proposed budget level. 

VESTED DUAL BENEFITS PAYMENTS APPROPRIATION

The President’s proposed budget includes $88 million to fund the continuing phase-out of vested dual benefits, plus a 2 percent contingency reserve, $1,760,000, 

which ‘‘shall be available proportional to the amount by which the product of recipients and the average benefit received exceeds $88,000,000.’’ The requested funding level of $88 million reflects the RRB Chief Actuary’s current estimate of the amount needed to pay full benefits in fiscal year 2007. However, the estimate does not provide for the effect of a possible rescission, which could 

significantly reduce the total amount provided in the budget year. Because the Dual 

Benefits Payments Account is classified as discretionary rather than mandatory, appropriations to the account have been reduced in recent years by across-the-board 

rescissions enacted as part of the annual appropriations process. The reductions 

have created a risk that vested dual benefits payments would need to be reduced 

due to insufficient funding in the account. 

The Railroad Retirement Act provides that vested dual benefits payments in a fiscal year may not exceed the amount appropriated for that year. If the amount appropriated is not sufficient to fund full payments, individual vested dual benefits 

must be reduced on a pro rata basis. However, the current appropriations language 

is unclear as to whether the 2 percent contingency reserve would be available to 

cover a shortfall due to a rescission. We request that the appropriations language 

be revised to clarify that the contingency reserve may be used if needed to prevent 

a reduction of current-year benefits for any reason. 

In addition to the requests noted above, the President’s proposed budget includes 

$150,000 for interest related to uncashed railroad retirement checks. 

FINANCIAL STATUS OF THE TRUST FUNDS

Railroad Retirement Accounts.—The RRB continues to coordinate its activities 

with the National Railroad Retirement Investment Trust (NRRIT), which was established by the Railroad Retirement and Survivors’ Improvement Act of 2001 to manage and invest railroad retirement assets. Through fiscal year 2005, the RRB transferred a total of $21.276 billion to the NRRIT for this purpose. During the same period, the NRRIT transferred $2.673 billion to the Railroad Retirement Account for 

payment of retirement and survivor benefits. As of September 30, 2005, the market 
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value of NRRIT-managed railroad retirement assets was approximately $27.7 billion. 

In June 2005, we released the annual report on the railroad retirement system 

required by Section 22 of the Railroad Retirement Act of 1974, and Section 502 of 

the Railroad Retirement Solvency Act of 1983. The report, which reflects changes 

in benefit and financing provisions under the Railroad Retirement and Survivors’ 

Improvement Act of 2001, addresses the 25-year period 2005–2029 and contains 

generally favorable information concerning railroad retirement financing. The report 

includes projections of the status of the retirement trust funds under three employment assumptions. These indicate no cash flow problems throughout the projection 

period. The findings represent an improvement over last year’s report and reflect 

continued favorable employment experience in the railroad industry. 

Railroad Unemployment Insurance Account—The equity balance of the Railroad 

Unemployment Insurance Account at the end of fiscal year 2005 was $94.2 million, 

an increase of $14.3 million from the previous year. The RRB’s latest annual report 

on the financial status of the railroad unemployment insurance system was issued 

in June 2005. The report indicated that even as maximum daily benefit rates rise 

39 percent (from $56 to $78) from 2004 to 2015, experience-based contribution rates 

maintain solvency, with the exception of small, short-term cash flow problems in 

2007 and 2008. Projections show quick repayment of the loans, even under our most 

pessimistic assumption. The average employer contribution rate remains well below 

the maximum throughout the projection period, but a 1.5 percent surcharge is now 

in effect and is expected for calendar year 2007. We did not recommend any financing changes based on this report. 

In conclusion, we want to stress the RRB’s continuing commitment to improving 

our operations and providing quality service to our beneficiaries. Thank you for your 

consideration of our budget request. We will be happy to provide further information 

in response to any questions you may have. 

PREPARED STATEMENT OF THE RAILROAD RETIREMENT BOARD

Mr. Chairman and members of the subcommittee: My name is Martin J. Dickman, 

Inspector General of the Railroad Retirement Board (RRB). I would like to thank 

you, Mr. Chairman, and the members of the committee for your continued support 

for the Office of Inspector General. I wish to describe our fiscal year 2007 appropriations request and our planned activities. 

The Office of Inspector General requests funding of $7,606,000 to ensure the continuation of its independent oversight of the RRB. The agency is responsible for 

managing benefit programs which paid $9.2 billion in retirement and survivor benefits to approximately 634,000 beneficiaries in fiscal year 2005 and an additional $73 

million in net railroad unemployment and sickness insurance benefits to 29,000 

claimants. The RRB also administers Medicare Part B, the physician services aspect 

of the Medicare program, for qualified railroad retirement beneficiaries. Through 

this program, approximately $870 million in annual Medicare benefits are paid to 

approximately 535,000 beneficiaries. 

In fiscal year 2007, the Office of Inspector General will continue to concentrate 

its efforts on the performance of reviews of significant policy issues and program 

operational areas. We will coordinate our efforts with agency management to identify and eliminate operational weaknesses. We will also continue our investigation 

of allegations of fraud, waste and abuse, and refer cases for prosecution and monetary recovery action. 

We also request the removal of the prohibition on the use of appropriated funds 

for any audit, investigation or review of the Railroad Medicare program. The RRB 

manages a nationwide contract for processing Medicare Part B claims for railroad 

beneficiaries. The agency is responsible for the enrollment of beneficiaries, premium 

collection, answering beneficiary inquiries and conducting the annual Carrier Performance Evaluation for the Medicare carrier. 

The prohibition does not permit this office to fulfill its statutory oversight responsibilities for a major agency program. Removal of the prohibition would benefit both 

the Railroad Retirement Board and its constituents, and would be consistent with 

the priorities established by the Administration and the Congress to reduce fraud 

in one of the largest Federal programs. 

We also request oversight authority to conduct audits and investigations of the 

National Railroad Retirement Investment Trust (NRRIT), the body responsible for 

the investment of approximately $29 billion in trust funds used to support Railroad 

Retirement Act benefit programs. This office would ensure sufficient reporting 

mechanisms are in place and that the NRRIT members are fulfilling their fiduciary 
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responsibilities. We have repeatedly expressed concerns about RRB management’s 

passive relationship with the NRRIT, and identified the issue as a serious challenge 

for the RRB. 

We are currently required to reimburse the agency for office space, equipment, 

communications, office supplies, maintenance and other administrative services. We 

are the only Federal OIG that cannot negotiate a service level agreement with its 

parent agency, and, therefore, request that the current appropriation language be 

amended accordingly. 

OFFICE OF AUDIT

Auditors will perform the audit of the RRB’s 2006 financial statements and preliminary work for the 2007 financial statements to ensure the issuance of reliable 

financial information. The OIG will obtain contractor actuarial services to audit the 

statement of social insurance. 

Audit staff will work with agency management to ensure detailed and verifiable 

financial information is available from the National Railroad Retirement Investment 

Trust (NRRIT). As discussed above, we believe RRB management should take a 

more active interest in NRRIT activities. 

Auditors will conduct the annual evaluation of the RRB’s information systems security to meet the requirements of the Federal Information Security Management 

Act of 2002. They will also monitor the agency’s information systems operations to 

determine if the agency is meeting the goals established in its Strategic Information 

Resources Management Plan and to ensure the agency is in compliance with the 

provisions of the Information Technology Management Reform Act. 

Auditors will continue to monitor agency actions to address security deficiencies 

and complete corrective actions. They will ensure that network and system security 

safeguards are in place to protect the confidentiality of sensitive financial and personal information. Auditors will also perform assessments of the agency’s e-government initiatives to identify and eliminate system vulnerabilities, and to ensure compliance with the E–Government Act of 2002. We will continue our monitoring efforts 

of the RRB’s document imaging activities and the expansion of paperless processing 

to ensure the integrity of records. 

Auditors will continue to review RRB benefit processes and procedures to identify 

ways to reduce administrative and adjudicative errors. They will offer recommendations to strengthen the agency’s debt collection program to reduce the outstanding 

receivables. 

OFFICE OF INVESTIGATIONS

The Office of Investigations (OI) identifies, investigates and presents cases for 

prosecution, throughout the United States, concerning fraud in RRB benefit programs. In fiscal year 2007, OI will continue to focus its resources on the investigation of cases with the highest fraud losses. OI currently has approximately 500 active investigations involving fraudulent benefit payments and fraudulent reporting 

with fraud losses of approximately $11.8 million. These cases involve all RRB programs that provide sickness and unemployment insurance benefits to injured or unemployed workers, retirement benefits, and disability benefits for workers who are 

disabled. 

We will coordinate our efforts with agency program managers to address weaknesses in agency programs that allow fraudulent activity to occur, and will recommend changes to ensure program integrity. 

We will concentrate resources on cases with the highest fraud losses, those related 

to the RRB’s retirement and disability programs. OI will dedicate considerable time 

to the investigation of nationwide schemes to defraud the RRB disability program. 

Disability cases currently constitute about 44 percent of our investigative caseload. 

These cases involve more complicated schemes and result in the recovery of substantial funds for the agency’s trust funds. 

In fiscal year 2007, we will continue to use the Department of Justice Affirmative 

Civil Enforcement (ACE) program for those cases which do not meet the criminal 

guidelines of U.S. Attorneys. Through this program, we are able to obtain civil 

judgements and recover trust fund monies for the RRB. 

SUMMARY

In fiscal year 2007, the Office of Inspector General will continue to focus resources 

on the reviewing RRB program operations and ensuring the integrity of agency trust 

funds. We will also continue to aggressively pursue individuals who engage in activities to fraudulently obtain RRB funds. 
584 

PREPARED STATEMENT OF THE NATURE CONSERVANCY

Mr. Chairman and members of the subcommittee, I appreciate this opportunity 

to present The Nature Conservancy’s recommendations for fiscal year 2007 appropriations. The Nature Conservancy is an international, nonprofit organization dedicated to the conservation of biological diversity. Our mission is to preserve the 

plants, animals and natural communities that represent the diversity of life on 

Earth by protecting the lands and waters they need to survive. Our on-the-ground 

conservation work is carried out in all 50 States and in 27 foreign countries and 

is supported by approximately one million individual members. We have helped conserve nearly 15 million acres of land in the United States and Canada and more 

than 102 million acres with local partner organizations globally. 

The Conservancy owns and manages approximately 1,400 preserves throughout 

the United States—the largest private system of nature sanctuaries in the world. 

We recognize, however, that our mission cannot be achieved by core protected areas 

alone. Therefore, our projects increasingly seek to accommodate compatible human 

uses, and especially in the developing world, to address sustained human well-being. 

The focus of my testimony is on the Americorps National Civilian Conservation 

Corps (NCCC) program, which has made a tremendous contribution, as well as provided cost savings, to conservation and public recreation in the United States. The 

President’s fiscal year 2007 Budget proposes to cut funding for the program from 

$26.7 million to $4.9 million, with the intention of eliminating the program completely. The Nature Conservancy urges the Committee to retain funding for the 

NCCC program at its current levels. 

NCCC has been known in recent months for the critical support its participants 

provided to disaster relief efforts after Hurricane Katrina. We applaud those efforts. 

We also want to highlight the important conservation work that NCCC participants 

have engaged in over the past years. Many Federal, State, and local government 

agencies, as well as non-profit conservation organizations, use the NCCC program 

to implement Federal programs and to achieve significant public benefits at low 

cost. At the Conservancy, we have employed NCCC participants to do the following: 

—Provide outdoor recreational opportunities and health benefits for Americans 

across the country; 

—Use prescribed fire to reduce hazards to communities and restore ecosystems; 

—Control invasive species; and 

—Train the next generation of natural resource managers. 

The program has saved our organization millions of dollars in recent years, and 

has provided work that would otherwise take years to accomplish, or simply would 

not get done at all. Below are some examples of specific results that NCCC has 

achieved. 

PROVIDING AMERICANS WITH RECREATIONAL OPPORTUNITIES AND HEALTH BENEFITS

As the country’s appetite for outdoor recreation grows—and issues like childhood 

obesity demonstrate the importance of increased outdoor activity—there is a growing need to provide safe, beautiful places for Americans to use and experience. The 

Nature Conservancy and our partners help provide these opportunities through a 

system of preserves and parks. Our efforts are significantly augmented by NCCC 

participants. The NCCC has built and maintained trails and boardwalks, restored 

campsites, repaired interpretive signs, provided wildlife protection, planted trees 

and developed archaeological dig sites. These activities provide the public with 

greater access to the outdoors, at low cost, and enhance the outdoors experience. 

USING PRESCRIBED FIRE TO REDUCE HAZARDS AND RESTORE ECOSYSTEMS

As reflected in recent legislative actions, including passage of the Healthy Forests 

Restoration Act of 2004, reduction of hazardous fuels on the Nation’s forested lands 

is one of the country’s greatest land management challenges. President Bush has 

emphasized the need to reduce fire hazards to communities, and restore ecosystems, 

through prescribed burning and other management techniques. Each year, the U.S. 

Forest Service and the Department of the Interior set acreage goals for burning and 

related treatments. The Nature Conservancy provides training and personnel to assist in meeting these goals. 

In recent years, NCCC participants have comprised a new cadre of fire managers, 

bringing skills and knowledge to individual projects, and assisting government agencies and non-profit land managers alike. The Nature Conservancy has used NCCC 

participants in at least eleven States to assist in burning tens of thousands of acres 

at a cost savings of several hundred thousand dollars. We also work with NCCC to 
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burn on military bases, U.S. Forest Service lands, State parks and natural areas, 

and other public lands. 

On some projects, fire management results in restoration efforts that ease the 

burden on private landowners and Federal land managers in complying with the 

Endangered Species Act. For example, in Virginia, NCCC-assisted burns have restored habitat and supported the recovery of an endangered species, the redcockaded woodpecker. Finally, NCCC participants assist land managers and public 

agencies in measuring performance and evaluating the success of fuels treatment 

efforts. 

REDUCING THE THREAT OF INVASIVE SPECIES

Invasive species—primarily weeds and insects—are one of the principal threats to 

our natural resources across the United States; they have damaged many natural 

landscapes as well as reduced the value of working lands. NCCC participants have 

assisted in abating impacts of invasive species at many locations. Their activities 

have included controlling invasive plants that are destroying valuable salt marshes 

and fens in New York; restoring natural tallgrass prairie by removing invasive trees 

in Minnesota; and preserving riparian and old growth forest habitat in Oregon. 

Along with actual removal of invasive species, NCCC participants have worked to 

educate the public on threats of invasive species and measures to control them. 

BUILDING A NEW GENERATION OF NATURAL RESOURCE MANAGERS

As the country’s population grows and threats to the environment increase, we 

face constant challenges to the conservation of our natural heritage. We will not be 

able to meet those challenges unless we encourage young people to pursue conservation careers and we provide them with the necessary training. The NCCC program 

has succeeded in doing this. Our experience is that NCCC participants are organized, well-trained and enthusiastic, and that they care deeply about conservation— 

in part because they understand the benefits to communities and to people that conservation provides. 

In particular, because of the job training focus of NCCC, its participants make up 

a substantial portion of the country’s future fire managers—a group of professionals 

we cannot afford to lose, given the hazards that wildfire poses to our communities. 

A significant portion of the Federal fire workforce will retire in the next five years, 

and the NCCC program plays a critical role in replenishing that workforce. 

NCCC makes an important contribution to Americans’ access to and enjoyment 

of the outdoors, as well as to conservation of our natural heritage. We urge the 

Committee to provide funding at current services levels for this important program. 

Thank you again for the opportunity to testify. If you have questions, please contact Louise Milkman at 703–247–3675. 

PREPARED STATEMENT OF THE VOICES FOR NATIONAL SERVICE

Mr. Chairman and members of the subcommittee: We are writing as members of 

Voices for National Service to urge you to reject funding cuts to AmeriCorps, Learn 

and Serve America, and the National Civilian Community Corps (NCCC) included 

in the Administration’s fiscal year 2007 budget. 

Voices for National Service is a coalition of more than 160 community-based organizations, faith-based groups, governor-appointed State commissions, private sector 

partners, institutions of higher education, and others dedicated to expanding opportunities for Americans to serve community and country. 

Our message to the Labor-HHS Subcommittee is quite simple: AmeriCorps, Learn 

and Serve America, and the NCCC are cost-effective programs that meet critical 

community needs, and funding for these programs should be sustained and increased. While we recognize the fiscal constraints that lawmakers must operate 

under, now is not the time to cut funding for national service. We urge you to fund 

these programs at their fiscal year 2004 enacted levels: 

—$441 million for AmeriCorps; 

—$43 million for Learn and Serve America; and 

—$26 million for the NCCC. 

We would like to note the following areas of concern and consideration as they 

relate to the appropriation for these programs: 

—We are concerned that the Administration’s budget proposes to cut funding for 

the NCCC to $5 million in fiscal year 2007, and to eliminate the program by 

2008. As numerous first-hand accounts by Gulf Coast residents, newspaper stories and op-eds have attested in the past weeks, the NCCC responded to the 
586 

crisis in the Gulf Coast heroically, deploying 1,600 members to the region who 

have provided critically needed services and support. This is not the time to 

eliminate a program with a proven track record in strengthening America’s disaster preparedness and relief capacity. 

—While we are eager for NCCC’s funding to be reinstated, we hope that you will 

not preserve this program at the expense of other critical programs like 

AmeriCorps State and National and Learn and Serve America. Like the NCCC, 

these programs have had a profound impact in the Gulf Coast and in the communities they serve. Americans want to serve. We should be expanding their 

opportunities, not eliminating them. 

—We are concerned that despite strong bipartisan support, the proposed budget 

would result in a 17 percent reduction in AmeriCorps State and National funding since fiscal year 2004. AmeriCorps is a critically needed program that provides opportunities for 70,000 Americans to serve each year, and its funding 

should be sustained or increased, not cut. 

—We are concerned that the proposed funding cut to Learn and Serve America 

would have serious negative consequences for both the 1.5 million students who 

participate in this program and the communities they serve. Compared to its 

fiscal year 2004 funding level of $43 million, the proposed cut to $34.2 million 

would mean: 

—300,000 fewer students serving their communities through Learn and Serve 

America; 

—A loss of $34 million in leveraged private and community resources; and 

—A decline of 7.3 million service hours to communities. 

We are concerned that the Corporation for National and Community Service’s 

plan to continue to recruit 75,000 AmeriCorps members in spite of the program’s 

proposed cuts will be detrimental to programs running full-time, stipended corps. 

The proposed cuts include a $300 reduction in the average Federal contribution per 

full-time corps member. AmeriCorps programs have been required to absorb an increasing percentage of their program operating costs. As fixed and mandated costs 

grow, annual reductions in operating support are destabilizing the AmeriCorps field. 

Efforts to do more with less threaten AmeriCorps’ historic mix of full-time and parttime, stipended and non-stipended corps. 

ABOUT AMERICORPS, LEARN AND SERVE AMERICA, AND THE NCCC

AmeriCorps State and National is a network of local, State, and national service 

programs that connect at least 70,000 Americans each year in intensive service to 

meet our country’s needs in education, public safety, health, and the environment. 

Learn and Serve America provides State formula and competitive grants to support service-learning in K–12 schools, colleges and universities, and non-profit organizations. Service-learning integrates community service with academic study to enrich learning, teach civic responsibility, and strengthen communities. At an average 

cost of only $28 per participant, Learn and Serve America leverages private and 

community resources to yield $4 in services to the community for each $1 invested 

by the government. The program also fosters collaboration between educational institutions and civic, faith-based, and community groups to engage youth in meaningful service to address local needs, help young people answer President Bush’s Call 

to Service, and assist in meeting the Corporation’s strategic goal of having quality 

service-learning in half of all K–12 schools by 2010. 

The AmeriCorps NCCC is a full-time residential program for men and women 

ages 18–24 that strengthens communities while developing leaders through direct, 

team-based national and community service. The NCCC is a trained force that can 

be immediately deployed. Four trained NCCC teams were pulled from other assignments and sent to support shelters in Mississippi and Alabama one day after Hurricane Katrina hit. 

THE ROLE OF NATIONAL SERVICE IN MEETING CRITICAL NEEDS IN THE GULF COAST

The Administration’s budget provides the NCCC with a modest $5 million appropriation to graduate its final class of corps members and permanently close the program’s five regional campuses. The budget also proposes to cut funding for 

AmeriCorps State and National, reducing funding levels by 17 percent since fiscal 

year 2004. And yet as we write, thousands of AmeriCorps and NCCC members are 

on the front lines in the Nation’s response to the greatest natural disaster in U.S. 

history, serving our Nation in the Gulf Coast. 

To date, more than 13,000 national service members have contributed to hurricane relief efforts in the Gulf and around the country. NCCC members were among 

the first on the scene, and to date, 1,600 NCCC members have served on more than 
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100 separate disaster service projects in the Gulf Coast region, providing humanitarian aid and physical service, as well as managing the thousands of outside volunteers who want to help. This program embodies the important role that citizens 

must play in partnering with government to respond to community crises and national disasters. 

According to Malcolm Jones, City Attorney of Pass Christian, Mississippi who 

worked closely with a team of NCCC members to provide services to town residents, 

‘‘Our town, on the Gulf Coast of Mississippi, 7,000 people, we got the hardest part 

of [the storm]. When I came back after evacuating for Katrina. . . . I found out that 

AmeriCorps [is] a very powerful, powerful thing. [W]hen we lost hope, [AmeriCorps] 

came.’’ 

Because of AmeriCorps, young people from around the country are putting their 

talents to work in the Gulf Coast region by doing everything from clearing debris 

and repairing roofs in Mississippi, to preventing further damage to historic buildings in New Orleans, to managing a supply warehouse in Louisiana, and serving 

displaced residents aboard ships in Alabama. We would like to share a few of their 

stories with you as examples of the critical services that AmeriCorps and NCCC 

members are providing: 

Kenye Quiroga was sent to Louisiana one week after joining AmeriCorps. He 

writes that, ‘‘While in D’Iberville we stayed on pallets in an old community center 

with only half a roof. The living definitely wasn’t easy, but I had the opportunity 

to get to know some great people. By the end of our mission in D’Iberville, my team 

had assessed every household in the town and brought food, water, and medication 

to families who needed emergency supplies.’’ 

According to Kimberly Walker of Jackson, Mississippi, ‘‘In the aftermath of the 

Hurricane, Mississippi Primary Health Care Association served as one of the many 

distribution points to assist Hurricane victims with basic supplies. Our 

team . . . carried supplies to a larger designated distribution site and was able to 

meet and talk first hand to some of the victims. . . . We assisted in directing them 

to other services available to them.’’ 

Carrie Ann Smith from the West Seneca, New York AmeriCorps program was deployed to Slidell, Louisiana. She writes, ‘‘I felt like I was entering a war zone. I felt 

the pain and frustration that still loomed in the air, but most of all I felt the need 

to help, to serve, and to make a difference. That’s what AmeriCorps does and I am 

proud to be a member of such a noble and upstanding organization. But even more 

so, I am proud to be an American who was given the opportunity to help my fellow 

Americans in a time of tragedy and such utter devastation. I would not have had 

that opportunity if not for AmeriCorps.’’ 

These young people, and thousands like them, served and continue to serve with 

great distinction, bringing hope and relief to fellow citizens, and learning the value 

of civic engagement and giving to communities in need. The national service response, however, has not been limited to the on-the-ground effort in the Gulf. In 

communities across the country, national service programs are joining with local, 

State and Federal agencies and nonprofit organizations to provide long-term relief 

to those uprooted and displaced by the storms. For example, tens of thousands of 

students supported by Learn and Serve America are collecting school supplies, raising funds and preparing disaster relief kits. 

NATIONAL SERVICE ACCOMPLISHMENTS ACROSS AMERICA

In addition to responding to needs in the Gulf Coast region, AmeriCorps members 

are also serving in thousands of communities across the United States. Every day, 

70,000 AmeriCorps members add value to school curricula by tutoring and mentoring, operating after-school programs, expanding the reach of community health 

centers, teaching in underserved public and parochial schools, and improving our 

environment. 

Below are just a few examples of the many community needs that AmeriCorps 

members met in 2004–2005: 

—In Florida, members recruited 2,000 community volunteers to provide education 

services, maintained and expanded 200 acres of habitat for threatened and endangered species, and built 40 homes for low-income families. 

—In Kentucky, members educated more than 1,000 at-risk elderly about home 

safety and conducted 265 Home Safety Assessments for seniors. 

—In Maryland, members removed 453 tons of trash, improving the quality of 

storm water run-off into the Chesapeake Bay and 1,900 homeless families received food, clothing, or furniture. 

—In Mississippi, members conducted life skills trainings with 715 people with disabilities, helped train mentally and developmentally disabled adults for employ-
588 

ment, and mentored 1,100 low income and underachieving middle school students. 

—In New York, members transported 1,000 children to medical appointments, delivered meals and snacks to about 58,000 children and seniors, and provided literacy activities to almost 17,000 children. 

—In Ohio, members trained more than 9,000 youth in conflict resolution, built repaired, or rehabilitated 364 housing units, and provided educational support 

services to 1,500 students during the summer months. 

—In Pennsylvania, members tutored almost 14,600 elementary and high school 

students and more than 6,800 citizens received either needs assessment or support in the areas of domestic violence, foster care, mental health, and housing 

for homeless veterans. 

IMPACT OF NATIONAL SERVICE PROGRAMS

In the last decade, more than 500,000 young Americans dedicated themselves to 

either full or part-time service through AmeriCorps to improve their communities 

and their country. Through dedicated service to our Nation, AmeriCorps members 

have earned Education Awards worth more than $1.5 billion that have helped them 

afford higher education or career training. 

Evaluations prove that AmeriCorps works. Recent studies by the Center for Leadership and Public Service at Harvard University and Bridgestar indicate that the 

United States is facing a significant leadership gap in the next decade. Given the 

need for an emerging group of young leaders to fill leadership positions in the social, 

private, and public sectors, the results of AmeriCorps programs in terms of building 

civic skills and a commitment to public service are striking. To cite but a few examples of some of the positive results of recent program evaluations: 

—A rigorous multi-site control group evaluation by Abt Associates and Brandeis 

University reported significant employment and earnings gains by young people 

who join service or conservation corps. 

—A study of Teach for America (TFA) by Mathematica Research Group found that 

‘‘it supplies low-income schools with academically talented teachers who contribute to the academic achievement of their students. TFA 

teachers... produce higher student test scores than the other teachers in 

their schools.’’ 

—An evaluation of City Year alumni by Policy Studies Associates showed that 

more than three-quarters of alumni reported an increased commitment to public 

responsibility and greater knowledge and skills that improved their ability to 

address and solve community problems. 

Learn and Serve America has tremendous impact and support. According to a 

2004 study by RMC Research, ‘‘Service-learning, when implemented with high quality, yields statistically significant impacts on students’ academic achievement, civic 

engagement, acquisition of leadership skills, and personal/social development.’’ Evaluations also indicate that the program correlates with a reduction in the number 

of behavioral problems, and reduced sexual activity and pregnancy among students. 

THE FISCAL YEAR 2007 REQUEST

We understand the funding constraints of the current appropriations process, and 

appreciate your leadership in seeking to provide support to the many programs that 

are meeting community needs across the Nation in a challenging fiscal environment. 

Given the track record of AmeriCorps, Learn and Serve America, and the NCCC 

in serving children, families, and communities and in responding effectively and efficiently to the recent disasters in the Gulf Coast region, we urge you to reject the 

funding cuts to these programs in the administration’s fiscal year 2007 budget request and to fund these programs at their fiscal year 2004 levels. These programs 

have proven to be worthy of your investment. 
(i) 

LIST OF WITNESSES, COMMUNICATIONS, AND 

PREPARED STATEMENTS 

Page 

Alexander, Dr. Duane, Director, National Institute of Child Health and 

Human Development, National Institutes of Health, Department of Health 

and Human Services, prepared statement ......................................................... 135 

Alving, Dr. Barbara M., Acting Director, National Center for Research Resources, National Institutes of Health, Department of Health and Human 

Services, prepared statement .............................................................................. 138 

American: 

Academy of: 

Family Physicians, prepared statement .................................................. 319 

Pediatrics, prepared statement ................................................................ 322 

Association: 

For: 

Cancer Research (AACR), prepared statement ................................ 384 

Geriatric Psychiatry, prepared statement ........................................ 387 

Of: 

Colleges of: 

Nursing, prepared statement ..................................................... 327 

Osteopathic Medicine, prepared statement .............................. 331 

Immunologists, prepared statement ................................................. 391 

Nurse Anesthetists, prepared statement ......................................... 394 

College of Obstetricians and Gynecologists, prepared statement ................. 398 

Diabetes Association, prepared statement ..................................................... 401 

Foundation for the Blind, prepared statement .............................................. 403 

Geological Institute, prepared statement ....................................................... 541 

Lung Association, prepared statement ........................................................... 407 

Nephrology Nurses’ Association, prepared statement ................................... 410 

Nurses Association, prepared statement ........................................................ 332 

Physiological Society, prepared statement ..................................................... 404 

Public: 

Health Association, prepared statement ................................................. 412 

Power Association, prepared statement .................................................. 338 

Society: 

For: 

Clinical Pathology, prepared statement ........................................... 415 

Microbiology, prepared statements .............................................. 417, 429 

Of Nephrology, prepared statement ......................................................... 423 

Americans: 

For: 

Nursing Shortage Relief, prepared statement ........................................ 336 

The Arts, prepared statement .................................................................. 538 

Association of: 

Academic Health Centers, prepared statement ............................................. 426 

American Cancer Institutes, prepared statement .......................................... 428 

Farmworker Opportunity Programs, prepared statement ............................ 311 

Independent Research Institutes, prepared statement ................................. 430 

Maternal and Child Health Programs, prepared statement ......................... 338 

Minority Health Professions Schools, prepared statement ........................... 543 

Women’s Health, Obstetric and Neonatal Nurses (AWHONN), prepared 

statement ....................................................................................................... 431 

Auerbach, Judith, Ph.D., vice president, Public Policy and Program Development, Amfar, the Foundation for Aids Research ............................................... 208 
Page

ii 

Berg, Dr. Jeremy, Director, National Institute of General Medical Sciences, 

National Institutes of Health, Department of Health and Human Services, 

prepared statement .............................................................................................. 140 

Centers for Disease Control and Prevention Coalition, prepared statement ..... 340 

Central Valley Opportunity Center, prepared statement .................................... 313 

Chao, Moses, M.D., Christopher Reeve Foundation ............................................. 209 

Charles R. Drew University of Medicine and Science, prepared statement ....... 435 

Coalition of Northeastern Governors, prepared statement .................................. 406 

Cochran, Senator Thad, U.S. Senator from Mississippi: 

Prepared statement .......................................................................................... 33 

Statement .......................................................................................................... 32 

College Board, prepared statement ........................................................................ 555 

College of New Rochelle, NY, prepared statement ............................................... 344 

Collins, Francis S., M.D., Director, National Human Genome Research Institute, National Institutes of Health, Department of Health and Human 

Services ................................................................................................................. 105 

Prepared statement .......................................................................................... 125 

Comstock, Amy L., chief executive officer, Parkinson’s Action Network ............ 209 

Prepared statement .......................................................................................... 210 

Cooley’s Anemia Foundation, prepared statement ............................................... 437 

Council of State Administrators of Vocational Rehabilitation (CSAVR), prepared statement ................................................................................................... 558 

Craig, Senator Larry, U.S. Senator from Idaho .................................................... 64 

Crohn’s and Colitis Foundation of America, prepared statement ....................... 439 

Diabetes Care Coalition, prepared statement ....................................................... 346 

Digestive Disease National Coalition, prepared statement .................................. 441 

Doris Day Animal League, prepared statement .................................................... 444 

Durbin, Senator Richard, U.S. Senator from Illinois ............................................ 65 

Dystonia Medical Research Foundation, prepared statement ............................. 446 

Emerson, Stephen, M.D., associate director for clinical research, Abramson 

Cancer Center, University of Pennsylvania Hospital ....................................... 211 

Prepared statement .......................................................................................... 212 

Eng, Lauren A., president, Spinal Muscular Atrophy Foundation ...................... 213 

Prepared statement .......................................................................................... 214 

Fauci, Anthony S., M.D., Director, National Institute of Allergy and Infectious 

Diseases, National Institutes of Health, Department of Health and Human 

Services ................................................................................................................. 105 

Prepared statement .......................................................................................... 128 

Foster Grandparent Program, prepared statement .............................................. 453 

Fox, Dr. Philip C., director of clinical research, Department of Oral Medicine, 

Carolinas Medical Center on behalf of the American Association for Dental 

Research ................................................................................................................ 215 

Friends of: 

NIDA Coalition, prepared statement .............................................................. 458 

The National Institute on Aging, prepared statement .................................. 456 

FSH Society, prepared statement ........................................................................... 449 

Furlong, Patricia, co-founder and chief executive officer, Parent Project Muscular Dystrophy .................................................................................................... 216 

Prepared statement .......................................................................................... 217 

Gallaudet University, prepared statement ............................................................ 560 

Gandy, Sam, M.D., Ph.D., Chair, Medical and Scientific Advisory Council, 

Alzheimer’s Association ....................................................................................... 217 

Prepared statement .......................................................................................... 218 

Gibbons, Ann, member, board of directors, Autism Speaks ................................. 219 

Prepared statement .......................................................................................... 220 

Goldstein, Robert, M.D., Ph.D., chief scientific officer, Juvenile Diabetes Research Foundation ................................................................................................ 221 

Prepared statement .......................................................................................... 221 

Grady, Dr. Patricia A., Director, National Institute of Nursing Research, 

National Institutes of Health, Department of Health and Human Services, 

prepared statement .............................................................................................. 143 

Harkin, Senator Tom, U.S. Senator from Iowa: 

Prepared statements...................................................................................... 10, 108 
Page

iii 

Questions submitted by ................................................................................. 97, 256 

Statements...................................................................................................... 64, 107 

Health Professions and Nursing Education Coalition, prepared statement ....... 562 

Heart Rhythm Society, prepared statement .......................................................... 461 

Hemophilia Federation of America, prepared statement ..................................... 464 

Hepatitis Foundation International, prepared statement .................................... 465 

HHT Foundation International, prepared statement ........................................... 478 

Hodes, Dr. Richard J., Director, National Institute on Aging, National Institutes of Health, Department of Health and Human Services, prepared 

statement .............................................................................................................. 145 

Holzman, Lawrence B., M.D., chairman, scientific advisory board, Nephcure 

Foundation ............................................................................................................ 225 

Prepared statement .......................................................................................... 226 

Houser, Steven R., Ph.D., director, cardiovascular research center, Temple 

University School of Medicine on behalf of the American Heart Association ........................................................................................................................ 227 

Prepared statement of ...................................................................................... 228 

Hrynkow, Dr. Sharon, Acting Director, Fogarty International Center, National Institutes of Health, Department of Health and Human Services, 

prepared statement .............................................................................................. 148 

In Defense of Animals, prepared statement .......................................................... 468 

Independence Technology, prepared statement .................................................... 471 

Industrial Minerals Association—North America, prepared statement .............. 477 

Inouye, Senator Daniel K., U.S. Senator from Hawaii, questions submitted 

by................................................................................................................ 53, 100, 258 

Insel, Dr. Thomas R., Director, National Institute of Mental Health, National 

Institutes of Health, Department of Health and Human Services, prepared 

statement .............................................................................................................. 151 

Institute for Student Achievement, prepared statement ...................................... 566 

International Foundation for Functional Gastrointestinal Disorders, prepared 

statement .............................................................................................................. 474 

InterTribal Bison Cooperative, prepared statement ............................................. 349 

John B. Amos Cancer Center, prepared statement .............................................. 351 

Katz, Dr. Stephen I., Director, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of 

Health and Human Services, prepared statement ............................................ 153 

Kington, Raynard, Deputy Director, Office of the Director, National Institutes 

of Health, Department of Health and Human Services, prepared statement ...................................................................................................................... 156 

Knapp, Richard M., M.D., Chair, Ad Hoc Group for Medical Research .............. 205 

Prepared statement .......................................................................................... 206 

Kohl, Senator Herb, U.S. Senator from Wisconsin: 

Prepared statement .......................................................................................... 18 

Questions submitted by ........................................................................ 55, 101, 269 

Koo, Daniel, M.D., on behalf of the Deaf and Hard of Hearing Alliance ............ 233 

Prepared statement .......................................................................................... 234 

Landis, Dr. Story C., Director, National Institute of Neurological Disorders 

and Stroke, National Institutes of Health, Department of Health and 

Human Services, prepared statement ................................................................ 159 

Landrieu, Senator Mary L., U.S. Senator from Louisiana ................................... 2 

Prepared statement .......................................................................................... 235 

Landrigan, Philip J., M.D., MSC, FAAP, president, Campaign for American 

Children’s Health ................................................................................................. 235 

Leavitt, Hon. Michael O., Secretary, Office of the Secretary, Department 

of Health and Human Services ........................................................................... 61 

Prepared statement .......................................................................................... 68 

Summary statement ......................................................................................... 66 

Li, Dr. Ting-Kai, Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Department of Health and Human 

Services, prepared statement .............................................................................. 162 

Lindberg, Dr. Donald A.B., Director, National Library of Medicine, National 

Institutes of Health, Department of Health and Human Services, prepared 

statement .............................................................................................................. 164 

Lupus Foundation of America, Inc., prepared statements............................... 242, 480 
Page

iv 

March of Dimes Birth Defects Foundation, prepared statement ......................... 482 

Matria Healthcare, prepared statement ................................................................ 352 

Mayer, Emeran, A.M.D., on behalf of the Digestive Disease National Coalition ........................................................................................................................ 239 

Prepared statement .......................................................................................... 239 

McDonnell, Peter, M.D., on behalf of the National Alliance for Eye and 

Vision Research .................................................................................................... 240 

Medical Library Association and the Association of Academic Health Sciences 

Libraries, prepared statement ............................................................................ 485 

Mildenberg, Juanita M., Acting Director, Office of Research Facilities Development and Operations, National Institutes of Health, Department of 

Health and Human Services, prepared statement ............................................ 167 

Montgomery County (Maryland) Stroke Association, prepared statement ......... 490 

Murray, Senator Patty, U.S. Senator from Washington: 

Prepared statement .......................................................................................... 23 

Questions submitted by ................................................................................... 56 

Statement .......................................................................................................... 63 

Nabel, Elizabeth G., M.D., Director, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human 

Services ................................................................................................................. 105 

Prepared statement .......................................................................................... 133 

National: 

AHEC Organization, prepared statement ...................................................... 500 

Alliance to End Homelessness, prepared statement ...................................... 353 

Association: 

For State Community Services Programs, prepared statement ............ 359 

Of: 

Children’s Hospitals, prepared statement ........................................ 491 

Community Health Centers, prepared statement ........................... 357 

County and City Health Officials, prepared statement .................. 494 

Workforce Boards, prepared statement ............................................ 301 

Coalition for: 

Heart and Stroke Research, prepared statement ................................... 503 

Osteoporosis and Related Bone Diseases, prepared statement ............. 496 

Community Action Foundation, prepared statement .................................... 499 

Consumer Law Center, prepared statement .................................................. 362 

Federation of Community Broadcasters, prepared statement ...................... 575 

Job Corps Association, prepared statement ................................................... 305 

Kidney Foundation, prepared statement ........................................................ 366 

League for Nursing, prepared statement ....................................................... 367 

Minority Consortia, prepared statement ........................................................ 577 

Multiple Sclerosis Society, prepared statement ............................................. 504 

Primate Research Centers, prepared statement ............................................ 509 

Prostate Cancer Coalition, prepared statement ............................................. 511 

Sleep Foundation, prepared statement ........................................................... 512 

Writing Project, prepared statement .............................................................. 569 

Youth Employment Coalition, prepared statement ....................................... 306 

NephCure Foundation, prepared statement .......................................................... 514 

Niederhuber, John E., M.D., Acting Director, National Cancer Institute, National Institutes of Health, Department of Health and Human Services ....... 105 

Prepared statement .......................................................................................... 123 

NIH Task Force of the Bioengineering Division of the Basic Engineering 

Group of the Council on Engineering of ASME, prepared statement .............. 507 

Oncology Nursing Society, prepared statement .................................................... 368 

One Voice Against Cancer, prepared statement ................................................... 515 

Oregon Human Development Corporation, prepared statement ......................... 309 

Ovarian Cancer National Alliance, prepared statement ...................................... 518 

Pancreatic Cancer Action Network, prepared statement ..................................... 371 

People for the Ethical Treatment of Animals, prepared statement .................... 373 

Pettigrew, Dr. Roderic I., Director, National Institute of Biomedical Imaging 

and Bioengineering, National Institutes of Health, Department of Health 

and Human Services, prepared statement ......................................................... 168 

Population Association of America/Association of Population Centers, prepared statement ................................................................................................... 521 

Project R&R, prepared statement .......................................................................... 376 
Page

v 

Pulmonary Hypertension Association, prepared statement ................................. 524 

Railroad Retirement Board, prepared statements............................................ 580, 582 

Raymond, Sandra, on behalf of the Lupus Foundation of America ..................... 241 

Reid, Senator Harry, U.S. Senator from Nevada, questions submitted by ......... 261 

Roberts, Senator Pat, et al., letter from ................................................................ 378 

Rodgers, Dr. Griffin P., Acting Director, National Institute of Diabetes and 

Digestive and Kidney Diseases, National Institutes of Health, Department 

of Health and Human Services, prepared statement ........................................ 170 

Ruffin, Dr. John, Director, National Center on Minority Health and Health 

Disparities, National Institutes of Health, Department of Health and 

Human Services, prepared statement ................................................................ 173 

Schwartz, Dr. David A., Director, National Institute of Environmental Health 

Sciences, National Institutes of Health, Department of Health and Human 

Services, prepared statement .............................................................................. 176 

Shelby, Senator Richard C., U.S. Senator from Alabama: 

Prepared statement .......................................................................................... 109 

Statement .......................................................................................................... 108 

Sieving, Dr. Paul A., Director, National Eye Institute, National Institutes 

of Health, Department of Health and Human Services, prepared statement ...................................................................................................................... 179 

Skelly, Thomas, Director, Budget Service, Office of the Secretary, Department 

of Education .......................................................................................................... 1 

Society: 

For: 

Investigative Dermatology, prepared statement ..................................... 526 

Maternal-Fetal Medicine, prepared statement ....................................... 528 

Women’s Health Research and Women’s Health Research Coalition, 

prepared statement ............................................................................... 531 

Of Nuclear Medicine, prepared statement ..................................................... 529 

Specter, Senator Arlen, U.S. Senator from Pennsylvania: 

Opening statements .................................................................................. 1, 61, 105 

Prepared statement .......................................................................................... 2 

Questions submitted by ................................................................. 33, 88, 250, 274 

Spellings, Hon. Margaret, Secretary, Office of the Secretary, Department 

of Education .......................................................................................................... 1 

Prepared statement .......................................................................................... 6 

Summary statement ......................................................................................... 4 

Spina Bifida Association, prepared statement ...................................................... 379 

State Educational Technology Directors Association, prepared statement ........ 572 

Straus, Dr. Stephen E., Director, National Center for Complementary and 

Alternative Medicine, National Institutes of Health, Department of Health 

and Human Services, prepared statement ......................................................... 181 

Tabak, Dr. Lawrence A., Director, National Institute of Dental and 

Craniofacial Research, National Institutes of Health, Department of Health 

and Human Services, prepared statement ......................................................... 184 

Taylor, Herman A., Jr., M.D., on behalf of the Jackson Heart Study ................. 243 

Prepared statement .......................................................................................... 244 

The: 

Humane Society of the United States, prepared statement ......................... 535 

Mended Hearts, Inc., prepared statement ...................................................... 489 

Nature Conservancy, prepared statement ...................................................... 584 

Tuomey Healthcare System, prepared statement ................................................. 382 

Vogel-Scibilia, Suzanne, M.D., president, National Alliance on Mental Illness ........................................................................................................................ 246 

Voices for National Service, prepared statement .................................................. 585 

Volkow, Dr. Nora, Director, National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, prepared 

statement .............................................................................................................. 186 

Zerhouni, Elias A., M.D., Director, National Institutes of Health, Department 

of Health and Human Services ........................................................................... 105 

Prepared statement .......................................................................................... 111 

Summary statement ......................................................................................... 109 

(vii) 

SUBJECT INDEX 

DEPARTMENT OF EDUCATION 

OFFICE OF THE SECRETARY

Page 

A Broad Emphasis on Competitiveness ................................................................. 6 

Academic Competitiveness: 

And National Smart Grants ............................................................................ 21 

Smart Grants .................................................................................................... 56 

Additional Committee Questions ............................................................................ 33 

Addressing the High School Dropout Problem ...................................................... 31 

Adjunct Teachers ..................................................................................................... 20 

Program ............................................................................................................. 19 

Advanced Placement Incentive Program ............................................................... 49 

Advancing America Through Foreign Language Partnerships ............................ 50 

And DOD National Flagship Language Initiative ......................................... 50 

Allocation of Budget Resources .............................................................................. 17 

America’s Opportunity Scholarships for Kids....................................................... 38, 57 

American Competitiveness Initiative ............................................................... 4, 18, 33 

Arts Education ......................................................................................................... 44 

Building State Capacity for School Improvement ................................................. 7 

Civic Education ........................................................................................................ 59 

Commission on the Future of Higher Education .................................................. 49 

Comprehensive School Reform as School Improvement Strategy ....................... 34 

Data Management Initiative .................................................................................. 43 

Department: 

Expenditures for Public Relations and Outreach .......................................... 53 

Lauded for Hurricane Response ...................................................................... 3 

Department’s Comments on the Silent Epidemic ................................................. 32 

Distribution of Highly Qualified Personnel ........................................................... 14 

Early Childhood Education Funding ...................................................................... 55 

Education: 

Funding in High-Poverty and Low-Poverty Districts .................................... 15 

Funds Disbursed for Hurricane Recovery ...................................................... 4 

Response for Hurricane Recovery ................................................................... 13 

Effectiveness of Supplemental Services ................................................................. 9 

Elementary and Secondary School Counseling Program ..................................... 56 

Enforcement of Highly Qualified Teachers Requirement ..................................... 41 

Ensuring Highly Qualified Teachers for Students of all Socioeconomic Status .......................................................................................................................... 42 

Equitable Distribution of Education Resources .................................................... 14 

ESEA Title I: 

Funding ............................................................................................................. 30 

Proposed Funding Decrease ............................................................................. 29 

Expansion of the SES Pilot Program ..................................................................... 38 

Federal: 

Efforts to Address Inequitable Distribution of Highly Qualified and Unqualified Teachers ......................................................................................... 42 

Perkins Loans ................................................................................................... 34 

Student aid ........................................................................................................ 49 

Fiscal Year: 

2006 Funding Level of Proposed Terminations .............................................. 26 

2007: 

Budget: 

Request ............................................................................................... 4, 13 
Page

viii 

Fiscal Year—Continued 

2007—Continued 

Budget—Continued 

Request—Continued 

Priorities ...................................................................................... 8 

Education Department Budget Request .................................................. 11 

Foreign Language Assistance Program ................................................................. 43 

Funding for Higher Education ................................................................................ 50 

HEA Title IX ............................................................................................................ 22 

High School: 

Dropouts—the Silent Epidemic ....................................................................... 31 

Reform Initiative.............................................................................................. 25, 27 

Highly Qualified Teachers ...................................................................................... 39 

Impact of Medicaid Change on Children With Disabilities .................................. 58 

Improving Teacher Quality Programs ................................................................... 39 

Information Dissemination on Highly Qualified Teacher Requirements ............ 41 

Innovative High School Restructuring in Idaho .................................................... 19 

Investment in: 

Advanced Placement ........................................................................................ 48 

Secondary Education ........................................................................................ 16 

Limitation on Reduction of Title I Grants for School Improvement Purposes ... 35 

Math and Science .................................................................................................... 7 

Education .......................................................................................................... 48 

Math now Program and Math and Science Partnerships ...................... 47 

Partnerships and Math now Program Activities ........................................... 47 

Measuring Performance of the Impact Aid Program ............................................ 39 

National: 

Assessment of Educational Progress ............................................................... 52 

Mathematics Panel ........................................................................................... 47 

Native Hawaiian Education .................................................................................... 53 

No Child Left Behind Flexibility Provisions ......................................................... 11 

Office of Communications and Outreach ............................................................... 52 

OMB PART Ratings for Programs Proposed for Termination in the Fiscal 

Year 2007 Budget Request .................................................................................. 27 

Other Programs ....................................................................................................... 7 

Pell Grants............................................................................................................... 12, 17

Per Pupil Expenditures Across the Nation ............................................................ 15 

Perkins Loans and Other Student Aid Programs ................................................. 55 

Proposed: 

Education Budget Cuts .................................................................................... 11 

GEAR UP Program Elimination ..................................................................... 24 

Public School Choice and Supplemental Services ................................................. 8 

Ready to: 

Learn: 

Continuation Projects ................................................................................ 46 

Program ...................................................................................................... 45 

Teach Program and Math and Science Education ......................................... 45 

Requirements of Advancing America Through Foreign Language Partnerships 

Grantees ................................................................................................................ 51 

Rigorous High School Curriculum .......................................................................... 21 

School: 

Dropouts ............................................................................................................ 32 

Improvement: 

And High School Reform .......................................................................... 5 

Grants Program and Effective School Improvement Activities ............. 36 

Categorized as Needing Improvement ............................................................ 30 

Within-Schools .................................................................................................. 20 

Selection of Districts for SES Pilot Program ......................................................... 37 

Special Education .................................................................................................... 12 

Funding ............................................................................................................. 55 

Start of GEAR UP Program .................................................................................... 25 

States’ Reporting of Highly Qualified Teacher Data ............................................ 41 

Statewide: 

Data Systems Program .................................................................................... 51 

Longitudinal Data Systems ............................................................................. 52 

Student Participation and Achievement Under the SES Pilot Program ............ 38 

Supplemental Educational Services ....................................................................... 37 

Pilot Program .................................................................................................... 37 
Page

ix 

Teacher Quality Enhancement Program and Teacher Recruitment and Retention ........................................................................................................................ 42

Title I: 

Funding ............................................................................................................. 3 

Grants to LEAS ................................................................................................ 12 

Improvement Funding Generated by 4 Percent Set-Aside ............................ 35 

School Improvement: 

Monitoring .................................................................................................. 36 

Set-Aside .................................................................................................... 35 

Title IX: 

Report ................................................................................................................ 57 

Technical Assistance ........................................................................................ 57 

12th Grade NAEP Initiative—Reading and Math Assessments .......................... 52 

21st Century Community Learning Centers ......................................................... 58 

Use of Title I School Improvement Funds for Comprehensive School Reform ... 34 

Vocational Education Funds ................................................................................... 16 

Women in Technology .............................................................................................. 54 

Workshop Approach to Outreach and Impact on Student Learning Outcomes ..................................................................................................................... 46 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

NATIONAL INSTITUTES OF HEALTH

A: 

Record of Real Success ..................................................................................... 124 

Winning Strategy Against Cancer .................................................................. 194 

Additional Committee Questions ............................................................................ 250 

Addressing the Threat of Emerging and Re-Emerging Infectious Diseases: 

Prediction and Preemption .................................................................................. 149 

Advanced Technologies Accelerate Progress ......................................................... 125 

Advances: 

Against the Threat of Pandemic Influenza .................................................... 113 

In: 

Cancer ........................................................................................................ 112 

Cardiovascular Disease and Stroke ......................................................... 112 

Diabetes and Related Illnesses ................................................................ 113 

Health Information for Scientists and the Public ................................... 114 

HIV/AIDS ................................................................................................... 113 

Image-Guided Microsurgery ..................................................................... 114 

Age-related Macular Degeneration ........................................................................ 270 

Alzheimer’s Disease ................................................................................................. 269 

And the Neuroscience of Aging ....................................................................... 146 

Asthma ..................................................................................................................... 135

Autoimmune Diseases ............................................................................................. 198 

Baccalaureate to Doctoral Programs ...................................................................... 259 

Battle Against HIV/AIDS ........................................................................................ 149 

Better Pain Treatments for Jaw Condition ........................................................... 185 

Biodefense Research ................................................................................................ 131 

Bridging the Physical and Life Sciences ................................................................ 168 

Budget Request ........................................................................................................ 111 

Buffergel Shown to be Safe Contraceptive ............................................................ 137 

Burden and Cost of Mental Illness ........................................................................ 151 

Cancer: 

Centers .............................................................................................................. 259 

Genome Atlas .................................................................................................... 193 

Cataract .................................................................................................................... 180 

Changing Landscape of Disease ............................................................................. 115 

Chronic Fatigue Syndrome (CFS) .......................................................................... 261 

Clinical: 

And Translational Science Awards ................................................................. 253 

Research ............................................................................................................ 160 

Collaborating: 

Across NIH ........................................................................................................ 184 

Among Institutes .............................................................................................. 256 

Collaborative Research ............................................................................................ 162 

Community-based Rehabilitation Intervention ..................................................... 138 

Complex Genetics .................................................................................................... 154 
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Conflicts of Interest ................................................................................................. 257 

Consultation Protocol .............................................................................................. 260 

Corneal Diseases ...................................................................................................... 180 

Creating Partnerships: Rare Diseases Network ................................................... 139 

Current Challenges ................................................................................................. 177 

Dawn of Personalized Medicine .............................................................................. 141 

Developing Nurse Researchers ............................................................................... 259 

Development of Biodefense Research ..................................................................... 113 

Disseminating Information ..................................................................................... 183 

Drug Addiction Treatment Works .......................................................................... 189 

Dry Mouth and Radiation Therapy ........................................................................ 186 

Emerging and Re-Emerging Infectious Diseases .................................................. 129 

Enhanced Support for New Investigators .............................................................. 170 

Envisioning Personalized Care ............................................................................... 151 

Epilepsy .................................................................................................................... 269 

Expand Community-Linked Research ................................................................... 178 

Expanding Training and Career Development ..................................................... 183 

Facilitating Integration ........................................................................................... 183 

Fetal Development: Jump Start on Life ................................................................ 136 

Fiscal Year 2007 Budget Summary ........................................................................ 167 

From Bench to Bedside to Community .................................................................. 190 

Funding for Pandemic Influenza ............................................................................ 192 

Furthering the Research Mission ........................................................................... 182 

Future Research: Newborn Screening ................................................................... 137 

Gene: 

Environment and Health Initiative—a Novel Partnership ........................... 178 

Programs Early Development and Neural Migration .................................... 137 

Genes: 

And Neurological Disorders ............................................................................. 160 

May Hold the Key to Treating Uterine Fibroids ........................................... 137 

Environment, and: 

Behavior ..................................................................................................... 187 

Health Initiative ........................................................................................ 204 

Glaucoma and Optic Neuropathies ........................................................................ 180 

Global Burden of Trauma and Injury .................................................................... 150 

Greater Emphasis on Large Clinical Studies ........................................................ 185 

Health: 

Communications and Promotion ..................................................................... 148 

Disparities Research Agenda ........................................................................... 174 

Healthy Mothers and Healthy Children ................................................................ 143 

HIV/AIDS: 

And Minority Disparities ................................................................................. 190 

Research ............................................................................................................ 130 

Heart Truth Road Show .......................................................................................... 252 

Impact of Budget Cuts ............................................................................................ 191 

Importance of Early Intervention ........................................................................... 171 

Improving the Nation’s Oral Health ...................................................................... 186 

Increase Funding: 

At the Centers for Disease Control (CDC) ..................................................... 230 

For: 

NIH Heart and Stroke Research .............................................................. 229 

The: 

Agency for Healthcare Research and Quality (AHRQ) ................... 231 

Carol M. White Physical Education Program (PEP) ....................... 231 

National Institutes of Health (NIH) ................................................. 228 

Information Services for the: 

Public ................................................................................................................. 165 

Scientific Community ....................................................................................... 165 

Integrating Clinical and Translational Science .................................................... 138 

Integrative Research on Human Disease .............................................................. 177 

Interagency Collaborations ..................................................................................... 125 

Irritable Bowel Syndrome ....................................................................................... 270 

Liver Disease Research Branch .............................................................................. 250 

Loan Repayment and Scholarship Program .......................................................... 159 

Looking Toward the Future .................................................................................... 184 

Lupus ........................................................................................................................ 199 

Management Innovations ........................................................................................ 116 

Mathematics and Science Cognition and Learning .............................................. 137 
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Molecular Medicine and Oral Cancer .................................................................... 185 

Multi-bug Approach on Vaccines ............................................................................ 203 

Nanotechnology for Disease Detection and Drug Delivery .................................. 169 

National: 

Children’s Study ............................................................................................... 196 

Primate Research Center ................................................................................. 256 

NCMHD Health Disparities Efforts ....................................................................... 174 

New: 

Diagnostic and Therapeutic Technologies ...................................................... 114 

NHGRI Initiatives ............................................................................................ 127 

Research Tools .................................................................................................. 114 

Next Generation Minimally-Invasive Technologies .............................................. 169 

NIEHS Strategic Plan—A New Outlook ................................................................ 178 

NIH: 

And Diabetes Research—A Strong Return on Federal Investment ............. 223 

Blueprint ........................................................................................................... 170 

Neuroscience Blueprint .................................................................................... 181 

Roadmap ............................................................................................................ 181 

For: 

Biomedical Research .......................................................................... 170 

Medical Research ............................................................................... 156 

NIMH Initatives for Fiscal Year 2007 ................................................................... 153 

NINR and the NIH Roadmap ................................................................................. 145 

Nursing Shortages and Training Nurse Researchers ........................................... 144 

Obstetric Pharmacology—Treatment for Pregnant Women ................................. 136 

Office of: 

AIDS Research .................................................................................................. 156 

Behavioral and Social Sciences Research ....................................................... 157 

Disease Prevention ........................................................................................... 158 

Portfolio Analysis and Strategic Initiatives ................................................... 159 

Research on Women’s Health .......................................................................... 157 

Science Education ............................................................................................. 158 

Ongoing NHGRI Initiatives .................................................................................... 126 

Opasi Trans-NIH Funding Program ...................................................................... 252 

Other: 

Aging-related Research .................................................................................... 147 

Areas of Interest........................................................................................... 128, 166 

Our Goal Remains the Same .................................................................................. 123 

Pandemic Flu ........................................................................................................... 257 

Patients and Families at the End of Life .............................................................. 144 

Pediatric Heart and Lung Disorders ...................................................................... 134 

Periodontal Disease and Preterm Birth ................................................................. 185 

Polycystic Kidney Disease ....................................................................................... 255 

Power of the Mind ................................................................................................... 142 

Practical Clinical Trials .......................................................................................... 152 

Practice-based Research Networks ......................................................................... 184 

Predicting Preeclampsia .......................................................................................... 136 

Prednisone ................................................................................................................ 199 

Preempting Chronic Diseases and Their Complications ...................................... 171 

Premature Birth Research ...................................................................................... 136 

Preparedness for Pandemic Influenza ............................................................... 191, 201 

Prescription Drug Abuse—the Problem With Painkillers .................................... 187 

Preventive Medicine ................................................................................................ 153 

Program Funding ..................................................................................................... 200 

Promoting Science and Health Literacy ................................................................ 140 

Providing Critical Links: Nonhuman Primate Research ...................................... 140 

Rapid Advances in the Genomic Era ..................................................................... 116 

Re-evaluate Programmatic Investments ................................................................ 178 

Recruit and Train the Next Generation ................................................................ 177 

Reducing Disparities in the Nation’s Oral Health ................................................ 186 

Regenerative Medicine ............................................................................................ 155 

Research Collaborations .......................................................................................... 175 

Research on Immune-Mediated Diseases .............................................................. 132 

Restore Funding for the Rural and Community Access to Emergency Devices 

Program ................................................................................................................ 231 

Retinal Diseases ....................................................................................................... 179 

Return on Investment on NIH Funding ................................................................ 110 

Role in the Research Mission ................................................................................. 167 
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Selected Accomplishments of NIH and Their Impact on Health ......................... 112 

Setting the Course ................................................................................................... 182 

Sickle Cell Disease ................................................................................................... 135 

SMedical Robotic ...................................................................................................... 169 

Social Neuroscience ................................................................................................. 188 

Spurring Advances Through Data Sharing ........................................................... 139 

Staying Healthy Throughout Adulthood ................................................................ 143 

Strabismus, Amblyopia and Visual Processing ..................................................... 179 

Strategic Vision for NIH: From Curative to Preemptive Care ............................ 115 

Strengthening the: 

Evidence Base in Dental Care ......................................................................... 184 

Pipeline .............................................................................................................. 141 

Stroke ........................................................................................................................ 253 

Teaming Science for Public Health Gains ............................................................. 141 

Technologies to Improve Health Care Delivery .................................................... 168 

Traditional Healing Practices ................................................................................. 258 

Training: 

A New Generation of Scientists ...................................................................... 117 

For the Future .................................................................................................. 170 

Translating: 

Discoveries Into Better Medical Treatment ................................................... 117 

Technology Into Clinical Practice .................................................................... 168 

Translational Research ....................................................................................... 155, 161 

Understanding Aging and Caring for the Elderly ................................................ 144 

Urology Research Strategic Planning .................................................................... 251 

Value of a Systems Approach ................................................................................. 142 

Widening the Net: Under-represented Populations and Areas ............................ 139 

Women’s: 

Health Initiative ............................................................................................... 197 

Heart Disease ................................................................................................... 196 

OFFICE OF THE SECRETARY

Additional Committee Questions ............................................................................ 88 

Administration on Aging (AoA) Budget Cuts ........................................................ 79 

Aging Services Programs ........................................................................................ 86, 87 

Alzheimer’s Demonstration Grants ........................................................................ 80 

Baccalaureate to Doctoral Programs ...................................................................... 100 

CDC: 

Budget Cuts ...................................................................................................... 80 

Physical Plant ................................................................................................... 81 

CMS: 

Adequate Provider Reimbursement ................................................................ 96 

Power Wheelchairs ........................................................................................... 97 

Prompt Pay Discount ....................................................................................... 97 

Regulatory Authority for Reimbursement ...................................................... 97 

Status of Quality Demonstration Project ....................................................... 95 

Community Health Centers .................................................................................... 75 

Compassion Capital Fund ....................................................................................... 85 

Disease Prevention .................................................................................................. 83 

Emergency Medical Services for Children ............................................................. 100 

FDA Generic Drug Applications ............................................................................. 78 

Fiscal Year 2007 HHS Budget ................................................................................ 67 

Generic Drugs/FDA ................................................................................................. 101 

Health: 

Centers Program ............................................................................................... 100 

Professionals Training ..................................................................................... 88 

Historical Pandemics ............................................................................................... 71 

Institute of Medicine Policy Recommendations ..................................................... 84 

Medicaid/Special Education Benefits ..................................................................... 98 

Medical Professional Availability ........................................................................... 66 

Medicare: 

Drug Benefit Enrollment Deadline ................................................................. 102 

Electronic Payments ......................................................................................... 88 

Fraud ................................................................................................................. 97 

Improper Payments .......................................................................................... 94 

Integrity Program ............................................................................................ 89, 94 

Part D: 

Deadline Extension ................................................................................... 63 
Page

xiii 

Medicare—Continued 

Part D—Continued 

Enrollment ................................................................................................. 76 

Deadline .............................................................................................. 76 

Formulary Prices ....................................................................................... 65 

Plan Choice ................................................................................................ 78 

National Institutes of Health: 

Budget Cuts ...................................................................................................... 65 

Funding ............................................................................................................. 103 

Levels ......................................................................................................... 82 

Research ............................................................................................................ 84 

Grants ........................................................................................................ 81 

Sleep Disorders Conference Report ................................................................. 90 

Office of Minority Health ........................................................................................ 90 

Pandemic Influenza: 

Infrastructure ................................................................................................... 75 

Preparedness .................................................................................................... 72, 91 

Plan Implemention .................................................................................... 93 

Respirator Masks .............................................................................................. 93 

Surge Capacity .................................................................................................. 92 

Vaccine .............................................................................................................. 83, 92 

Distribution ................................................................................................ 73 

Stockpile ..................................................................................................... 72 

Programs Serving Older Americans ....................................................................... 101 

Rural Health ............................................................................................................ 102 

Rural Healthcare ..................................................................................................... 80 

Special Exposure Cohorts ....................................................................................... 99 

Underage Drinking Prevention .............................................................................. 90 

Uninsured Access to Pandemic Influenza Treatment ........................................... 93 

Wellness and Disease Prevention ........................................................................... 75 

DEPARTMENT OF LABOR 

OFFICE OF THE SECRETARY

Administration and Management .......................................................................... 280 

Adult Training Funds .............................................................................................. 294 

Appalachian Council/Working for America Institute ............................................ 290 

Asbestos Exposure ................................................................................................... 276 

Built-in and Program Changes ............................................................................... 284 

Career Advancement Accounts ............................................................................... 295 

Comments on Cecil Roberts Testimony ................................................................. 278 

Competitiveness Agenda ......................................................................................... 291 

Economic Growth Efforts ........................................................................................ 295 

Elimination of: 

Job Bank Program ............................................................................................ 296 

Migrant: 

Job Training ............................................................................................... 275 

Programs .................................................................................................... 292 

Youth Training Grants ..................................................................................... 295 

Employment Service Cuts ....................................................................................... 292 

Foreign Labor Certification ..................................................................................... 298 

Immigration Bill ...................................................................................................... 276 

Impact of Job Training Cuts ................................................................................... 275 

Job: 

Corps Funding .................................................................................................. 274 

Training Staff ................................................................................................... 290 

Medical Leave Program ........................................................................................... 277 

Mine Safety .............................................................................................................. 274 

National Reserve Fund ........................................................................................... 293 

Older Worker Employment Program ..................................................................... 279 

OSHA Penalties for Asbestos Violations ................................................................ 276 

Program Direction ................................................................................................... 282 

Proposed Workforce Legislation ............................................................................. 296 

Rapid Response: 

Funds ............................................................................................................ 277, 298 

Services .............................................................................................................. 293 

Rational for Workforce Training ............................................................................ 291 
Page

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Re-allocation of Unspent Funds ............................................................................. 277 

Reintegration of Youthful Offenders ...................................................................... 275 

Safe Places in Mines ................................................................................................ 290 

Voucher Proposal ..................................................................................................... 291 

Women in Apprenticeship ....................................................................................... 290 

Workforce Training Cuts ......................................................................................... 276 

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