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Home > About NIH > Director |
Opening Statement on the FY 2003 President's Budget Request |
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Department of Health and Human Services Opening Statement of the Director on the FY 2003
President's Budget Request Dr. Ruth Kirschstein, Acting Director Mr. Chairman and Members of the Committee: I am Ruth Kirschstein, the Acting Director of the National Institutes of Health. I am honored to appear before the Subcommittee, representing my colleagues, the Directors of the 27 Institutes and Centers, each of whom has presented a written statement related to the President's budget proposal for FY 2003. I shall present an overview of the total Administration budget for the NIH for FY 2003. The Congress, the Administration, and the American public have been committed to doubling the funding of the NIH by FY 2003. Although scientific accomplishments often take years to produce new treatments or diagnostic tools, the confluence of generous Budgets and extraordinary scientific opportunity has already begun to yield amazing results. The current budget proposal of $27.3 billion, an increase of 15.7 percent over FY 2002, completes the original commitment, enables the NIH to continue to take advantage of the broader and deeper opportunities now at hand to understand diseases and improve health, and opens the way for future progress in medical research. Opportunities truly are at hand. Some are general, benefitting research in many areas, and others are specific, dealing with particular diseases and disorders. Among the general opportunities, the complete draft of the DNA sequence of the human genome is the best known of the new tools, helping scientists in many disciplines to understand how the human body works and what causes disease. But there are several other areas of investigation that are changing the way biomedical research is done. These include proteomics — the computer-aided analysis of the patterns present in large sets of proteins (the products of our genes) with the goal of understanding their function; combinatorial chemistry — a new way to generate large libraries of molecules that can be screened for use as drugs; and new, advanced imaging techniques that enable scientists to see within the human body and within its cells as various functions are carried out. There are, as well, new and expanded opportunities in therapeutics and prevention that we will be undertaking. These efforts do not eclipse research into specific diseases and disorders, but enable us to acquire new knowledge to more fully understand — and ultimately to control or defeat — cancer, Parkinson's disease, diabetes, Alzheimer's disease, asthma, and many other diseases, and prepare for incidents of bioterrorism. The President's budget for FY 2003 provides the NIH and its Institutes and Centers with funding to deliver results on these promises, some of which I will now describe. Cancer Research Last month, for example, scientists from the National Cancer Institute (NCI) and the Food and Drug Administration (FDA) reported using proteins found in blood serum to detect cancer of the ovary, even at early stages. This new diagnostic method, built on the concept of proteomics, has great promise. Usually patients with ovarian cancer are diagnosed at a late stage and have only a 20 percent chance, or even less, of survival after five years. Preliminary studies of this new test are able to identify correctly, in a small number of patients, all of those with ovarian cancer who were at stage I of the disease. Not only is this test simple and accurate, requiring only a blood sample, but the approach has exciting potential for diagnosing many other cancers, as well as other diseases. Last May, as discussed at last year's hearings, another new concept — the design of drugs based on understanding the molecular anatomy of tumor cells — produced Gleevec, which is taken as a pill to treat a chronic type of leukemia that usually strikes middle-aged or older people. While studies continue with Gleevec in patients with this type of leukemia, it is also being tested for those with other cancers, including those that attack the brain and nervous system, the soft-tissues such as muscle, and the gastrointestinal tract. An intensive effort is now underway to identify other cancer-causing proteins in other tumors so that drugs can be specifically designed to block their action. With the increases requested for FY 2003, the NIH will provide support to answer critical questions about controlling, preventing and screening for cancer. For example, the NIH will conduct the largest prevention study ever to determine if vitamin E and selenium can protect against prostate cancer. The study will include 32,400 men recruited through more than 400 sites in the United States, Puerto Rico, and Canada and is expected to take 12 years to complete. The NIH will also launch the first multicenter study to compare digital mammography to standard mammography for the detection of breast cancer. Digital mammographic technology provides images at higher resolution than standard mammography, and investigators want to determine if it can detect breast cancer more accurately. These are just a few examples of compelling new avenues for cancer research. While increases for the National Cancer Institute constitute over 80 percent of the proposed increase for cancer research, many other NIH Institutes and Centers will also contribute to the emphasis placed on cancer. For example, the National Center for Complementary and Alternative Medicine will study the integration of complementary and alternative therapies into more conventional treatments for cancer, the National Institute of Neurological Disorders and Stroke will emphasize sophisticated ways to improve the treatment of brain tumors, and the National Institute on Deafness and Other Communication Disorders will continue its research on new therapies to treat patients with head and neck cancers, while preserving their ability to speak. Bioterrorism Research The threat of bioterrorism became a reality for the United States with the intentional delivery of anthrax spores through the mail, demonstrating our vulnerability and giving impetus to research to protect the public health. A number of government agencies have specific roles to play in protecting the public from bioterrorism; the role of the NIH is to conduct research to learn more about the viruses and bacteria that can be used in bioterrorism and about how the body responds to such assaults, and to develop counter-measures, such as diagnostic tests, vaccines, and treatments. The FY 2003 budget request for bioterrorism-related research is $1.75 billion, an increase of $1.47 billion over FY 2002. Most of these funds will go to the National Institute of Allergy and Infectious Diseases (NIAID), which already has a remarkable track record for success in this area of science. For example, in November 2001, scientists funded by the NIAID reported a new understanding about the toxins released by the anthrax bacterium, providing leads for potential new therapies. The NIAID is now completing a study aimed at learning whether use of the current smallpox vaccine, if diluted to stretch the existing supply, could still convey protection; results are scheduled to be reported soon. Meanwhile, the NIAID continues to work on a new, safer smallpox vaccine as well as a new vaccine to protect against anthrax. In addition, members of the NIAID intramural research program have demonstrated the efficacy of an Ebola vaccine in a monkey model. This vaccine will soon enter early safety trials in humans. And as we all remember, Mr. Chairman, when HIV/AIDS was first recognized as an epidemic some 20 years ago, the NIAID took the lead at the NIH in swiftly mobilizing key stakeholders, planning research, providing resources, and translating basic findings into clinical practice. The NIAID has already convened a Blue Ribbon Panel of experts to review a strategic plan prepared by NIAID to guide the effort against bioterrorism. Some elements of the plan include establishing Extramural Centers of Excellence for Bioterrorism and Emerging Infections around the country so that scientists can have the tools and the secure facilities they need to conduct their work; continuing the study of the genetics of microbes that might be used in bioterrorism; launching challenge grants to industry and academic centers to attract their long-term interest; and supporting clinical trials of next-generation vaccines and therapeutic agents. The Nation's research enterprise is alert to this urgent need and eager to expand its efforts. Translating Research into Practice Clinical research, or studies involving patients and healthy volunteers, is the crucial step for translating basic science into better health for everyone. Our new age of medical research — capitalizing on the Human Genome Project, the new field of proteomics, and advanced imaging technology — is providing unprecedented opportunities to design new ways to prevent, diagnose, and treat many diseases and conditions. But we will not realize the promise of new knowledge and new techniques without clinical research — and well-trained clinical researchers — to bring findings from the laboratory to the patient. Our clinical trials have become wider-ranging, more representative of the population, and larger — and they must become even more so in the future. In FY 2003, the NIH will place additional emphasis on clinical research. For example, the National Institute on Aging (NIA) is accelerating research to slow the progress of Alzheimer's disease, to delay its onset, and to prevent the disease entirely. Already scientists have identified new targets to block directly the effects of the disease in the brain and are developing imaging and other tests to diagnose people in the early stages of the disease. Major prevention trials are under way using vitamin E and the drug Aricept, as well as folate, anti-inflammatory drugs, and estrogen. The NIA is also funding a five-year initiative to speed the development of immune-based approaches and other novel strategies for preventing Alzheimer's disease. Another example: The National Institute of Neurological Disorders and Stroke (NINDS) will support a network of acute stroke centers across the United States, each capable of treating patients rapidly and serving as a clinical laboratory for scientific studies related to acute stroke, including tests of new drugs. The first effective treatment for acute ischemic stroke, the drug TPA, is only partly effective and cannot be used for all types of strokes. The NINDS has demonstrated the potential of others drugs for stroke in laboratory studies, and translating those findings into practical treatments would be enhanced by state-of-the-art centers for stroke. The potential of such clinical studies to improve the Nation's health has made even more urgent our need to recruit and retain highly qualified health professionals as clinical investigators. The NIH plans to expand its current Extramural Loan Repayment Program for Clinical Researchers, which provides for repaying the educational loans of qualified health professionals who agree to conduct clinical research. The FY 2003 President's budget request doubles this program by providing $28 million over the FY 2002 estimate. Research on Disease Prevention Research to prevent disease has been a major aspect of the NIH's mission, and we plan to launch a number of prevention initiatives in FY 2003, while continuing others started earlier. Although considered a traditional approach, vaccines are effective forms of prevention, and today's vaccine research takes advantage of the most up-to-date knowledge and technology. NIH scientists and NIH-supported scientists are producing and testing vaccines aimed at preventing otitis media (which causes ear infection and sometimes hearing loss in children), Ebola (an often fatal disease caused by a virus found in parts of Africa), dengue fever (a viral disease spread by mosquitoes), HIV/AIDS, Leishmania (a devastating disease spread by sandflies in the subtropics), and malaria. Just last month, scientists at the National Institute of Child Health and Human Development announced the development of the first vaccine against Staphylococcus aureus (often called "staph"), a major cause of infection and death in hospital patients. Also last month, scientists supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) reported the results of the Diabetes Prevention Program. The research conveys a powerful message of hope to individuals at risk for type 2 diabetes, a life-threatening disease that has been increasing in this country parallel to the increase in obesity. The study showed that millions of overweight Americans at high risk for type 2 diabetes can delay and possibly prevent the disease with improved diet and moderate exercise. The same study found that the oral diabetes drug metformin also reduces the risk of type 2 diabetes, but not as effectively as lifestyle changes. We know that lifestyle patterns contribute greatly to the risk of developing type 2 diabetes. Thus, the great challenge now is to identify those at risk for type 2 diabetes and encourage them to act on the findings of the study. We are prepared to do that since our legislative authority and the traditional mission at the NIH has always included both disseminating the results of research and communicating general health information directly to health care professionals, patients, and the public. In cooperation with the Centers for Disease Control and Prevention (CDC), the NIH has already launched the National Diabetes Education Program to increase public awareness of diabetes, its risk factors, and strategies for preventing diabetes and its complications. Other Features of the Budget Request Mr. Chairman, this is only a brief summary of our emphasis areas now and in FY 2003. Our research portfolio is so broad, deep, and complex that, even in many more pages, I would still not be able to give a complete picture. Yet I am confident that the FY 2003 budget request enables the NIH to sustain momentum of research already in progress, to open the way to new research opportunities in the coming fiscal year and in years to come, and to augment both our research infrastructure and our human capital. In FY 2003 the President's budget request would fund a total of 9,854 new, competing research grants, or a total of 38,038 awards, the highest annual total ever. Intramural research increases by 15 percent over the FY 2002 estimate, with most Institutes and Centers increasing by 9 percent, while the NIAID and the NCI increase by 52 percent and 11 percent respectively, as a result of the large increases in bioterrorism and cancer research. The Research Management and Support (RMS) funds are vital, if the NIH is to manage its programs and resources efficiently and effectively. The RMS funds are used by the NIH to sustain, guide, and monitor extramural and intramural research activities. This funding increases by 17 percent in total in FY 2003. All Institutes and Centers except the NIAID and the NCI increase by 9 percent over the FY 2002 estimate. The NCI and, in particular, the NIAID are requesting increased resources in RMS funding to effectively manage their large program increases. Mr. Chairman, this concludes my opening statement. I would be glad to respond to any questions. Related Document: NIH Statements for House and Senate Appropriations Subcommittees, FY 2003 (Institute and Center Requests) |
| This page was last reviewed on January 24, 2003 . |
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