Advocacy Archive
Testimony of ALAN G. KRAUT APS Executive Director
FY 1999 Appropriations for the National Institutes of Health
Subcommittee on Labor, Health and Human Services, and Education of the
Committee on Appropriations
U.S. HOUSE OF REPRESENTATIVES
The Honorable John E. Porter, Chair
January 28, 1998
Mr. Chairman, Members of the Committee: Thank you for allowing me to testify on fiscal year (FY) 99 appropriations for the National Institutes of Health (NIH). I am Alan Kraut, Executive Director of the American Psychological Society (APS), the national organization devoted to the science of psychology. APS members include the most distinguished academic researchers and leaders in scientific psychology. Many receive NIH funding for research in such areas as brain and behavior, addiction, human development, aging, mental illness, violence, hearing, vision, and chronic pain, to name just a few relevant topics in our field.
On behalf of the 16,000 members of APS, let me begin by expressing sincere gratitude for your support of health research -- for the substantial increase you appropriated to NIH for the last few years, and also for your consistent and visible messages about the importance of research in public health. We applaud your efforts to devote additional resources to this essential public health enterprise. We look forward to working with you to double the NIH budget over five years. APS is part of the Ad Hoc Group for Medical Research Funding and we join the Ad Hoc Group in urging a 15 percent increase for NIH in FY 99 as a first step toward that goal.
But can NIH absorb this increase in so short a time? I can assure you that behavioral science research can. We are poised, both in terms of the role of behavior in causing serious health problems and in terms of the field's capacity, to proceed in a number of critical directions. Mr. Chairman, during your recent hearings on the health connections between the mind and body, you heard of the effects of behavior on health -- for example, how stress changes the immune system and how psychotherapy changes brain function. We were extremely encouraged when you talked about the importance of behavioral research for health, and especially your comments about ways to "open the door" to increase NIH's receptiveness to this work. We hope you will make this theme a standard part of your conversations with Institute Directors. A single question from you, such as "Can you tell me how you might encourage behavioral research in your Institute?" will go a long way toward broadening how NIH sees the science it supports.
My testimony today focuses on just that issue: increasing NIH's receptiveness to behavioral science research. As you already know, critical health concerns are reflected in such questions as: What goes on in the thinking of young people that leads them to start smoking, drinking, or taking drugs? What are the behavioral underpinnings of craving? When in our development do we acquire the behavioral patterns that may be with us for a lifetime? What are the connections between stress and health? What are the root causes of violence? What can we do to help memory as we age? And there are many others. But NIH's neglect of these kinds of questions continues despite a significant body of specific recommendations from Congress, from independent scientific agencies such as the National Academy of Sciences (NAS), and even from its own Institutes concerning new ways to develop behavioral approaches to health.
Training: National Research Service Awards
The clearest evidence of NIH's resistance to behavioral research is seen in the lack of response to Congressional and NAS recommendations on training young investigators in behavioral science. In a 1994 Congressionally-mandated report on the Nation's personnel needs in biomedical and behavioral sciences, NAS called for an increase in the size of stipends awarded under the National Research Service Awards (NRSAs) and for an increase in the number of behavioral science investigators, health services researchers and investigators in other areas, while holding the number of biomedical NRSA awards at the current level. The NAS set forth a specific number of NRSA awards needed in behavioral science and offered a compelling rationale for the increase. In 1995, this Committee began what turned into an annual ritual in which the Committee (and the Senate Committee as well) requested NIH to develop a plan and timetable for implementing the recommendations. NIH ignored both the NAS and Congress until a few months ago. In response to the FY 97 request from this Committee, NIH issued its response that the NAS recommendations will be selectively implemented. Specifically, NIH will increase the NRSA stipends, but not the number of awards in behavioral science or other areas.
It is ironic that even with the recent increases in NIH's annual budget and all the talk of doubling the NIH budget, NIH is citing budget concerns as the rationale for this selective implementation. They suggest that presumably neither the NAS nor this Committee "fully appreciated the costs" of increasing the number of behavioral trainees. And what is the cost? The behavioral science recommendation -- to add less than 400 trainees -- would add about $4 million over three years across all of NIH. Clearly, cost is not the concern here.
To build a stronger behavioral science research infrastructure that will improve NIH's ability to respond to the Nation's most urgent health problems, we ask the Committee to direct NIH to increase the number of National Research Service Awards for behavioral science investigators, as recommended by the National Academy of Sciences.
Training: B/START
Several Institutes on their own have recognized the need for more behavioral researchers. With encouragement from this Committee and from the Senate, they have developed Behavioral Science Track Awards for Rapid Transition (B/START), which are small grants to new Ph.D.'s in psychology or behavioral science. These are aimed at a critical juncture in a scientist's career -- a time when choices are made about what research to pursue, a time of intense competition for entry-level academic research positions, and a time to develop pilot data before submitting a regular (R01) grant proposal. It is also a time when many excellent scientists drop out because of a lack of support. These issues are addressed by B/START, which began at the National Institute of Mental Health and has spread to the National Institutes on Drug Abuse and on Aging. We commend NIMH, NIDA, and NIA for undertaking this approach to training behavioral investigators, and we ask this Committee to encourage the use of B/START mechanisms throughout NIH.
Office of Behavioral and Social Sciences Research (OBSSR)
Like clinical research, behavioral science should be supported in virtually every NIH Institute, Center and Division. We see the Office of Behavioral and Social Sciences Research, created by Congress in the office of the NIH Director, as taking the lead on the training objectives described above, and on ensuring that behavioral priorities are pursued aggressively throughout NIH -- there is a great deal of catching up to do. In its short existence under Director Norman Anderson, OBSSR has been an effective coordinating body on a number of cross-NIH initiatives and has increased the visibility of behavioral science at NIH. But OBSSR's budget is only $2.67 million, a minute amount compared to the budgets of parallel units within the NIH Director's office. Additional funding would give OBSSR the capacity to develop training initiatives, requests for applications in the most promising areas of behavioral science, and more effective responses to Congressional directives, recommendations from NAS and from individual Institutes, and advice from the field concerning future directions for research and training. We are in an era of exceptional promise in behavioral science, but we need a more encouraging federal environment to realize this potential. Increasing the budget of the OBSSR would be a significant step in creating that environment. We recommend an increase in the OBSSR budget to $20 million in FY 99.
In the rest of my testimony, I want to concentrate on examples of what is currently being done and what more could be done in behavioral science research at several individual Institutes.
National Institute of Mental Health (NIMH)
NIMH is the leading supporter of behavioral science research at NIH. Last year, I told you about the Institute's reorganization that increased the visibility of behavior in its structure. In addition, NIMH Director Steven Hyman pledged to strengthen connections between basic behavioral research and clinical applications, and in connections between the brain and behavior. But even our friends at NIMH resist some behavioral science priorities. For example, NIMH has yet to implement "Basic Behavioral Science Research for Mental Health," a 1994 plan by its own advisory council in the same mold as NIMH's plans for schizophrenia and neuroscience. This Committee circulated the NIMH report to Congress and has for several years urged NIMH to increase its emphasis on basic behavioral research by implementing the national plan. NIMH has not responded. Similarly, this Committee has expressed support over several years for the 1996 NIMH report "Reducing Mental Disorders: A Behavioral Science Research Plan for Psychopathology" which was compiled by outside experts with NIMH support. Again, the Institute has not responded. These plans document the contributions of behavioral research in mental health and mental illness, and they identify promising behavioral research opportunities. The plans on basic behavioral research and on psychopathology are resources that should be the basis for requests for applications, program announcements, training priorities, and other NIMH initiatives. We ask this Committee to encourage NIMH to report on how these two plans will lead to research and training in behavioral research related to mental health and illness.
National Institute on Drug Abuse (NIDA)
NIDA is a model of how we hope every National Institute would approach its behavioral science and public health responsibilities. Under psychologist Alan Leshner, NIDA has been strengthening its behavioral science portfolio in important directions, bringing to bear new perspectives on treating and preventing drug abuse and addiction. Drug addiction is a brain disease, but it doesn't start out that way. Why do young people initiate drug use? This question requires understanding the basic mechanisms of peer pressure, of how attitudes develop, and of the processes involved in cognition. Why do some go on to addiction, while others stop? This question requires identifying risk and protective factors in individuals, families, and communities. What is the effect of drugs on learning and behavior? This question involves connections between the brain and behavior, between thinking and acting.
Another question is: How do we treat addiction? NIDA's efforts in behavioral science are paying off here. We've known for some time that behavioral interventions are central to the treatment of addiction. They are the only available treatments for many drugs. Even where medications are available to treat addiction, the most effective courses of treatment have included behavioral interventions. Now, a NIDA-sponsored study shows that for cocaine, the effectiveness of newly developed medication is contingent on having a behavioral intervention first. In other words, medication doesn't work unless the person first has behavioral therapy. Given the central role of behavior in drug abuse and addiction, and given NIDA's aggressive pursuit of behavioral research, we strongly urge the Committee to do everything possible to ensure that NIDA receives the largest possible increase for FY 99.
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Similar gains are being made in behavioral research at NIAAA, where Director Enoch Gordis is expanding behavioral science. There are new initiatives in the social psychology of group identification; behavioral genetics to understand the biological and environmental factors in vulnerability to alcoholism; the psychophysiology of alcoholism; and basic behavioral research on craving and on the effects of alcohol abuse on memory and cognition. NIAAA also is moving forward on more applied research. The Institute published an impressive plan for its health services research, and is about to launch an initiative aimed at reducing drinking at college. We ask the Committee to support to NIAAA's aggressive pursuit of new behavioral science research and to ensure that NIAAA receives the largest possible increase for FY 99.
NIH Grant Review Reorganization
When NIMH, NIDA, and NIAAA were transferred to NIH by Congress, their peer review systems remained separate from NIH. The integration of those systems that is now underway has triggered a reorganization of the entire NIH peer review system. Here is an opportunity for NIH to strengthen its behavioral science infrastructure. Adding these three Institutes means there will be considerably more behavioral science research being reviewed in the NIH system. NIH must take deliberate and appropriate steps to ensure that the new system is equipped to handle these grants. These steps include having the appropriate balance of expertise on review committees -- putting the peer in peer review -- and establishing a scientifically appropriate referral process. Because of the enormous budgetary and public health implications of NIH grant review, we ask the Committee to monitor this peer review reorganization and request from NIH a report on its plans for ensuring the appropriate review of behavioral research grants.
National Institute on Aging
NIA supports much research on behavioral and social factors in aging. I want to focus on one area: cognitive psychology. With links ranging from neuroscience to social and developmental science, there may be no more exciting and productive area of aging research. Anyone over 40 has experienced normal memory glitches. "Where did I put those car keys?" "What is that person's name?" But when we start forgetting what the car keys are for, or can't recognize a loved one, those are signs of serious problems, possibly Alzheimer's or some other dementia. Early identification and treatment of these problems is likely to come from cognitive science, which is allowing us to look at the aging mind and better understand the effects of growing older on the ability to process information and to make decisions. NIA is exploring ways to expand its support of this promising frontier in research on aging and behavior. We ask the Committee to support NIA in its pursuit of new directions in cognitive psychology.
National Institute of Child Health and Human Development
Together with the community, NICHD has begun an effort to identify areas of behavioral research and training that are ripe for major breakthroughs as well as areas of research that require further nurturing. This effort included a conference entitled "Progress and Promise in the Behavioral Sciences," at which the leaders in the field recommended specific actions, among them: Increase pre- and post- doctoral research training and mentoring; support cross-disciplinary training mechanisms; support basic behavioral research on development to generate methodological and conceptual advances in research; and give priority to understanding the effects of poverty, different family structures, and technology on child physical and intellectual development.
NICHD has just reorganized its behavioral research programs into a new Child Development and Behavior Branch, headed by developmental neuropsychologist Reid Lyon. This Branch is well suited to respond to these recommendations. We are urging NICHD to aggressively pursue the recommendations of the "Progress and Promise" conference, and ask the Committee to request that NICHD develop a plan and a timetable for doing so.
National Institute of Nursing Research
NINR has been designated the lead Institute in a new NIH initiative that addresses end-of-life issues. This is one of the least researched phases of life. The NINR initiative includes improved treatment for pain, but also addresses diagnosis and treatment of behavioral symptoms such as cognitive problems, delirium, and depression. With its research in symptom management, decision making for patients, caregiving, and optimal environments for critically ill patients, NINR brings impressive experience to the lead role in end-of-life research. We ask that this Committee support NINR in this initiative.
Mr. Chairman, in my time today I am able to describe only a few of the contributions and importance of behavioral research in addressing the Nation's health concerns. Other Institutes with behavioral science portfolios include the National Heart, Lung, and Blood Institute, which supports investigations into the links between stress and heart disease; the National Institute of Neurological Disorders and Stroke, which supports research on brain and behavior; the National Cancer Institute, which has just formed a new prevention branch that should support increased of behavioral research; and the National Institute on Deafness and Communication Disorders, which supports psychologists' research in auditory perception and language development.
Despite all this activity, NIH still needs to recognize behavioral science as a core element in its dual missions in health research and public health. Priorities in research and training have been identified in numerous behavioral science areas but are not being pursued. This Committee has shown extraordinary largess in increasing the annual NIH budget and we are grateful for that support. Now, we ask you to ensure that the health of the Nation receives the full benefit of behavioral science research by encouraging NIH's leadership to take meaningful steps, such as those I have outlined above, to reverse the underfunding of behavioral science research.