Before the Subcommittee on Labor, Health, and Human Services, and Education
Committee on Appropriations
U.S. House of Representatives
The Honorable Ralph Regula, Chair
March 14, 2001
9:30 am
Organization: American Psychological Society
Witness: Alan G. Kraut, Ph.D., Executive Director
Mr. Chairman, Members of the Committee: On behalf of our members, I want to thank this committee for your leadership in the bipartisan effort to double the NIH budget. As a member of the Ad Hoc Group for Medical Research Funding, the American Psychological Society recommends $23.7 billion for NIH in FY 2002 as the 4th installment of the 5-year doubling plan. The rationale for these aggressive increases remains as compelling today as it was in FY 1999, the first year that you and your colleagues in the Senate embarked on this path. Our Nation's health needs, scientific opportunities, and the changing nature of health research all warrant this expansion. I will talk about these three areas in terms of the field that I represent, which is behavioral and social science research - specifically, psychological science research.
Health Needs. The effects of behavior on health have been widely documented. Behavior is as threatening as any genetic or biological condition. When you look at what determines health, you can't help but notice behavior. Smoking, drinking, taking drugs -- all begin as behaviors. And many other leading health concerns are behavioral in origin or in their manifestation: Heart disease, lung disease, diabetes, mental illness, developmental disabilities, brain injury, AIDS, and so many more cannot be fully understood without studying the behavioral and psychological factors involved in causing, treating and preventing them.
Scientific Opportunities. Many of the 15,000 people who belong to APS are scientists at our Nation's leading universities and colleges, conducting research and training supported by NIH. The behavioral research enterprise at NIH spans from theoretical to applied, from basic to clinical. Virtually every institute at NIH supports some amount of psychological science. Examples include investigations into: The connections between the brain and behavior; the basic processes of cognition and memory, social interaction in people of all ages; the interactions of such things as emotion, stress, and psychophysiology and their impact on health; research into how children grow and develop; management of debilitating chronic conditions such as diabetes and arthritis as well as depression and other mental disorders; and the behavioral aspects of smoking and drug and alcohol abuse, to find ways people can escape addiction. These topics represent some of the most exciting research frontiers today, and our field is poised to make significant strides in a number of scientific areas that a few years didn't even exist.
Changes in the Nature of Research. If we didn't know if before, the recent publicity surrounding the sequencing of the human genome has hit home the notion that we are in a new era of science. In the flurry of interviews and opinion pieces that followed the recent publication of human genome research articles, leaders of the human genome projects and other scientists have repeatedly stressed that genes alone cannot explain complex behavior or account for all risks for developing a particular physical or mental illness or for behavioral problems. They consistently caution against the notion that genes determine behavior. As noted by Robert Plomin, a distinguished APS Fellow and pioneer in the field of behavioral genetics, the influence of genes on behavior is "probabilistic, not deterministic."
The implications of mapping the human genome are enormous for psychological research. Psychologists and other behavioral scientists already are asking such questions as: How do the effects of specific genes unfold in behavioral development? How do they interact with experience and other environmental factors? In other words, now that we have genes, how do they work?
As just one example of what I mean, psychologists soon may be able to use genes to better target behavioral interventions to the people who need them most -- to tailor our interventions to those at highest genetic risk. For example, if we learn that certain genes put children at risk for behavioral disorders, say anorexia, depression, or even for diabetes, then those are the children for whom we need to develop specific prevention strategies. For diabetes, this may mean a much more aggressive approach to diet, weight control, and a program to maintain compliance with taking medication, an often-ignored but critically important and totally behavioral part of managing a disease. What this requires, however, it that at the same time we are trying to understand how genes influence behavior, we need to more systematically study the behavior itself and use that information to develop more targeted interventions.
The emergence of fields such as behavioral genetics draws from the progress made both in genetics and behavioral research, and illustrates the seamless connection between behavior and biology - a continuum we would like to see NIH promote more than it does now. Cognitive neuroscience, the combined approach of mapping the brain's psychological functioning onto it physical and biological functioning, is another such area. Unfortunately, NIH's research and training policies sometimes make it appear as if there is an artificial distinction between the behavior and biology. There is excellent behavioral science work at being done at NIH, producing quality knowledge and breakthroughs that should be a source of enormous pride for NIH. But too often in the NIH model, behavior is ignored, particularly basic behavioral research. It isn't until a person gets lung cancer, emphysema, heart disease, liver damage, brain damage, that behavior is thought of. As important as the molecular and cellular origins of these problems are, the behavioral origins are equally important. For example, how do the basics of learning, memory, perception, emotion, or even social development interact with the biology of learning, memory, perception, or even social development interact with the biology of various diseases? The answer is, there is a great deal of interaction among these factors. Almost none of the disorders NIH addresses can be fully understood without also understanding their behavioral dimensions.
Mr. Chairman, I ask you and the Committee to give your fullest consideration to these concerns as part of your deliberations on the FY 2002 budget for NIH. Specifically, we ask that you help make behavioral research more of a priority at NIH, both by providing maximum funding for those institutions where behavioral science is a core activity, and by encouraging NIH to advance a model of health that includes behavior in deciding its scientific priorities.
Training: A Return on the Investment - When discussing the budget for NIH and other federally-funded science agencies, we often talk in terms of investment - putting money into activities where the return will be realized somewhere down the road. In providing research grants, sometimes we don't know when or even whether there will be a significant payoff - we have an extensive review system that helps minimize the likelihood of a washout, but still, the outcomes of science are unpredictable.
One part of science where the investment is almost guaranteed to payoff is in the area of training. We know that if we provide support now for a young investigator, we will have a well-trained, highly-qualified scientist as a result. We also know that without training, we will not have an adequate pool of researchers to pick up where preceding generations leave off. Supply is a critical issue in behavioral science at NIH. Right now, NIH institutes are competing for a comparatively small pool of behavioral science researchers. In fact, we are seeing some institutes with new or expanding behavioral science programs enticing senior behavioral grantees from sister institutes, leaving the "old" institutes with critical gaps in their portfolios.
To address this problem, institutes need to "grow their own" -- the responsibility for training behavioral scientists should be shared across all the institutes because of the role of behavior in virtually all of the major health issues being addressed by NIH. Toward this end, several institutes have established B/START (Behavioral Science Track Awards for Rapid Transition) programs of small grants to encourage new behavioral science investigators. This has proved to be an effective mechanism and should be used across NIH.
But training shouldn't be just an issue of supply and demand. As I noted earlier, health needs should be the most important factor in determining our research and training priorities. In behavioral and social science research, training is essential not only to ensure future supply of scientists, but also to ensure that our Nation's best minds are working on the issues that are most directly linked to health.
Dozens of reports from the National Research Council and the Institute of Medicine have recommended increased training for health and behavior research. One such report, Bridging Disciplines in the Brain, Behavioral and Clinical Sciences, notes that "newly emerging health problems, as well as those that have plagued us over time, are proving to be suprisingly complex as scientists and health care providers begin to recognize the intricate interplay among environment, behavior and disease." The report adds that this is "driving disciplines toward each other" and that "the next generation of scientists must be prepared to integrate the advances of rapidly progressing disciplines." The report nicely complements the changes in the nature of research that I highlighted above.
Meeting the future needs of research in health and behavior means NIH must have a comprehensive training strategy today, a strategy that focuses on training young investigators in the core disciplines of behavioral and social science research as well as in the multidisciplinary perspectives alluded to in the NRC report and elsewhere. In addition to encouraging behavioral science training at individual institutes, NIH needs an overall plan that will minimize unnecessary duplication and will establish an appropriate behavioral science training enterprise that can serve the needs that exist throughout NIH's institutes and offices.
We ask the Committee to support the development, in consultation with the relevant scientific community, of a comprehensive training strategy for behavioral and social science research at NIH. This strategy should include all training mechanisms, and should be balanced between interdisciplinary research and traditional core disciplines in the behavioral sciences.
National Institute of Mental Health (NIMH) - Translational Research - In an effort to more closely link basic and clinical research in behavioral science, NIMH is implementing an institute-wide plan to expand its "translational research" activities that are intended to bring knowledge from the lab into practice, and for practice to influence what occurs in the laboratory. Responding to recommendations from a report conducted under the auspices of its national advisory council, NIMH, is stimulating new connections between basic and clinical research through such mechanisms as: Requests for Application (RFAs); providing greater access to clinical populations and collaborators; workshops connecting basic researchers with public health and clinical investigators; and new peer review procedures that draw on experts from both clinical and basic perspectives. NIMH is also considering support for translational research centers in behavioral science.
Basic Behavioral Research - We applaud NIMH for its efforts to promote transfer of knowledge into application. But basic behavioral research at NIMH must continue to receive the same strong support it traditionally receives there. This is important not only to ensure the foundation of basic knowledge in mental health, but also because NIMH is a de facto source of basic behavioral knowledge that is tapped by many other institutes. Until other institutes begin to support larger amounts of basic behavioral science research connected to their mission, it is essential that NIMH's programs of research into behavioral phenomena such as cognition, emotion, psychopathology, perception, development, and others continues to flourish.
We ask the Committee to encourage NIMH's continued efforts to strengthen the ties between basic and clinical behavioral research, and to encourage NIMH's basic behavioral science portfolio in order to ensure continued progress in our understanding of the causes, treatment, and prevention of mental illness and the promotion of mental health.
National Institute on Drug Abuse (NIDA) - NIDA's dramatic progress in addressing the Nation's drug problems (many of which are behavioral in nature) has been accompanied by a broadening of its behavioral science portfolio. Under the leadership of psychologist Alan I. Leshner, NIDA has launched a widescale Clinical Trials Network (CTN) to test drug treatment strategies that have proven effective under controlled research conditions. Most of the interventions currently being tested are based on behavioral treatments, since those have been found to be effective. The CTN was recommended by the 1998 Institute of Medicine report, Bridging the Gap Between Research and Practice, as the single mechanism most likely to improve drug abuse treatment in this country. Given the enormous promise of this initiative to improve the Nation's drug treatment programs and the urgency of the Nation's public health problems associated with drug abuse and addiction, we ask the Committee to increase funds for NIDA's Clinical Trials Network in FY 2002.
In addition to the Clinical Trials Network, NIDA's basic behavioral research helps treatment providers better understand and address the dynamics of addiction. NIDA is placing special emphasis on cognitive research because processes such as learning, memory, decision-making, and other cognitive factors play a central role in virtually every aspect of drug abuse and addiction, including vulnerability, craving, relapse, self-regulation, and treatment. The knowledge from NIDA's basic behavioral science research has enormous potential for reducing demand for drugs at the individual, family and community levels. We ask this Committee to increase NIDA's budget as part of an overall policy of creating a more balanced and effective drug control strategy for the Nation.
National Institute on Alcohol Abuse and Alcoholism (NIAAA) - College-age drinking and underage drinking are two behavioral topics of enormous concern to the Nation's universities, parents, and communities. A subcommittee of the NIAAA national advisory council is completing a report addressing various aspects of campus drinking. The report, being developed jointly by alcohol researchers and college presidents, describes the scope of the problem, examines the effectiveness of current interventions, and will recommend priorities for developing effective, science-based interventions to reduce college drinking.
NIAAA has made substantial efforts to broaden its behavioral science portfolio to understand the underlying psychological and cognitive processes that lead people to drink, and the impact of chronic alcohol abuse on those processes. As one example, NIAAA convened a workshop of national experts on social identification and alcohol research to examine ways that peer pressure in groups and group norms concerning drinking may influence drinking behaviors. More recently, the institute convened a group of experts in cognitive research to explore the effects of alcohol abuse on memory, decision-making, cognitive development, in order to begin looking at issues of cognitive rehabilitation.
Understanding the behavioral origins and manifestations of problem drinking and addiction is the key to addressing the Nation's epidemic of alcohol-related behavioral health problems, which range from brain disease to drunk driving. We ask Congress to increase NIAAA's budget in FY 2002 in order to reduce the Nation's alcohol-related health problems.
National Institute of General Medical Sciences (NIGMS) - NIGMS is the only national institute specifically mandated to support research not targeted to specific disease or disorders. NIGMS does not now support basic behavioral science research, despite the wide range of fundamental behavioral topics with relevance to a variety of diseases and health conditions. The lack of behavioral science research at NIGMS represents is an enormous gap, given the basic behavioral research and training the NIGMS should be supporting. Congress addressed this issue for the past two years in appropriations reports on the FY 2000 and FY 2001 budgets for NIH. Specifically, you said: "There is a range of basic behavioral research and training that the Institute could support, such as the fundamental relationships between the brain and behavior, basic cognitive processes such as motivation, learning and information processing, and the connections between mental processes and health. The Committee encourages NIGMS to support basic behavioral research and training, and to consult with the behavioral science research community and other Institutes to identify priority research and training areas." NIGMS has not responded to your requests. We continue to believe strongly that NIGMS should develop a basic behavioral science research program. Accordingly, we ask the Committee to direct NIGMS to develop a plan for basic behavioral science research at NIGMS.
National Cancer Institute (NCI) - NCI has expanded its commitment to behavioral research in a comprehensive program that ranges from basic behavioral science to research on the development, testing and dissemination of disease prevention and health promotion interventions in areas such as tobacco use, diet, and even sun protection. Recognizing the central role of effective communication in addressing issues of health and behavior, NCI has also undertaken a major effort to develop science-based communications strategies for disseminating information and persuasive messages about cancer prevention and treatment to the public. These messages draw from a foundation of basic behavioral and social science research into such issues as how people learn and remember health information, how they perceive health risks, and how they are persuaded to adopt health behaviors.
One of NCI's scientific priorities in FY 2002 is tobacco-related research. A significant portion of this initiative is to behavioral and social science research into such topics as identifying populations at risk for tobacco use, formulating effective prevention and quitting strategies, and capitalizing on legal, social and public policy developments on tobacco use and addiction.
Other basic behavioral research programs include research to develop theoretical models, identify underlying mechanisms of behavior change, and to develop and test science-based interventions. For example, NCI supports research that examines how stress and psychosocial influences on behavior, the central nervous system, the immune system, and CNS-immune system interactions affect the progression and remission of cancer. Other examples include research into the psychophysiological and genetic processes involved in health behaviors, and the psychosocial and behavioral consequences of cancer risk assessment, including the impact of genetic testing on the individual and the family.
NCI's behavioral research program also supports health promotion research, including behavioral science related to cancer prevention and program evaluation. We ask Congress to support NCI's expanded behavioral science research and training initiatives.
National Institute on Aging (NIA) - NIA is a major supporter of behavioral and social science research. NIA has reorganized its behavioral and social science programs in order to respond to - and create - new opportunities in the study of aging processes, how older people function in society, and how people change with aging. NIA also looks at the social institutions such as family and the health care system in terms of their impact on the health of older people. Areas of emphasis in NIA's behavioral and social science programs include health disparities, aging minds, health expectancy, health, work and retirement, behavior change, and the interplay among genetics, behavior, and social environment. NIA also supports a significant amount of research in cognitive functioning in its neuroscience and neuropsychology program, which looks at the effects of aging on memory and other brain-based behavioral functioning. We ask the Committee to support NIA's commitment to behavioral and social science research on aging.
National Institute on Child Health and Human Development - Child development involves some of the most complex and important questions facing behavioral and social science researchers. Understanding the interplay among behavior, social and physical environment, and biology is central to discovering ways to prevent behavior-based health problems ranging from fetal alcohol syndrome to teen pregnancy to violence. NICHD's Child Development and Behavior Branch supports research on the cognitive, social, and emotional development of children from newborns to adolescents. We are concerned that NICHD has received a below-average share of NIH's budget increases in the past few years; what this conveys, whether intended or not, is that children's issues have lower priority in health research. We hope you will send a strong counter-message this year, and allow NICHD to enhance its child development portfolio. We ask the Committee to allocate the necessary resources in FY 2002 to allow NICHD to fulfill its mission in these areas.
On a related topic, NICHD has been supporting the Study of Early Child Care and Youth Development, the most comprehensive study to date of child care experiences and characteristics and developmental outcomes. NICHD is now sharing the rich body of data from the study with other qualified researchers in order to allow an even greater number of researchers to explore issues around child care, including those that may affect child development. We ask the Committee to support this study and NICHD's data-sharing initiative.
NIH Office of Behavioral and Social Sciences Research (OBSSR) - We ask the Committee to welcome Raynard Kington as the new director of OBSSR, and to encourage him, as he contributes his expertise to NIH's "Health Disparities" initiative, to ensure that the full spectrum of behavioral and social science research be brought to bear on this important topic as well as on the other initiatives that are within OBSSR's purview.
Communication Disorders, Visual Perception, Diabetes, Brain and Behavior - Although space doesn't permit me to describe fully some of the other behavioral science activities across NIH, I want to note the impressive behavioral science working being done in such area as communication disorders, visual perception, diabetes, and brain research, all of which merits the encouragement and support of this Committee. We ask that in FY 2002, support be given to expanding the behavioral science research and training programs at institutes where this important work is being done.
This concludes my testimony - I would be pleased to provide additional information.