Advocacy Archive

Testimony of ALAN G. KRAUT APS Executive Director
FY 2001 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

April 2000

Mr. Chairman, Members of the Committee: I am Alan Kraut, Executive Director of the American Psychological Society. Thank you for the opportunity to submit this statement. My testimony concerns FY 2001 appropriations at the National Institutes of Health (NIH), but I also will be discussing the Centers for Disease Control and Prevention (CDC).

The 15,000 people who belong to APS are scientists at our nation's leading universities and colleges. Many are conducting research supported by NIH. They range from principal investigators heading up research projects, to new investigators working on their first small grant award, to graduate students receiving training assistance, or to senior scientists with career development awards.

Mr. Chairman, on behalf of our members, I want to thank you for your leadership in increasing the NIH budget over your chairmanship. Your retirement will be a huge loss not only for your colleagues, but for the health research community whose work you have championed. We are pleased to join with you in supporting the doubling of the NIH budget over five years. As a member of the Ad Hoc Group for Medical Research Funding, APS recommends a 15 percent increase for NIH in FY 2001.

Virtually every institute at NIH supports psychological science. The behavioral research enterprise at NIH spans from theoretical to applied, from basic to clinical. Examples include investigations into: The connections between the brain and behavior; the basic processes of cognition and memory in people of all ages; the interactions of the mind and body to improve health; research into how children grow and learn; 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.

There is excellent behavioral science work being done at NIH, producing high quality knowledge and breakthroughs that should be a source of enormous pride for NIH. But behavioral research is not sufficiently recognized as a core element in NIH's mission. Behavior is as threatening to health and well-being 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. Too often in the NIH model, the initial behavior is ignored. It isn't until a person gets lung cancer, emphysema, heart disease, liver damage, brain damage, that the origins of the problem are addressed.

Increases in the NIH budget mean a new era in health research, and as advocates for NIH we are grateful for those increases. But I am convinced that without a significant shift in NIH's research priorities, the influx of money by itself will not bring about the kind of improvements in health that you and your colleagues in the Senate are intending to achieve. I ask the Committee to give its fullest consideration to these concerns and to help make behavioral research more of a priority at NIH.

In the remainder of my testimony, I will discuss some specific behavioral science research initiatives for NIH as a whole and at various institutes.

Training for Behavioral and Social Science Investigators
Training support is essential in all areas of science in order to ensure that we have the capacity to bring research possibilities to fruition and to ensure that we have a future generation of investigators working at the leading edge of science. But the training mechanisms NIH uses, particularly the National Research Service Awards (NRSA), do not cover a number of costs that are central to the training enterprise, such as even a portion salaries of training directors, faculty or administrative staff; nor do they cover such essential costs as payments for research participants. Among other things, this has a direct impact on our ability to conduct translational research, which is exactly the kind of research that is needed to move knowledge from the basic end of the research spectrum into clinical applications. These limitations prevent non-university research settings -- clinical service centers, health plan research centers from applying for training grants, and are even causing more traditional university-based departments to rethink their reasons for applying. This is not a problem just for behavioral and social science research; all areas of science are affected by this issue. In order to capitalize on the substantial body of fundamental knowledge that exists in behavioral science and other fields, NIH's training policies must be recast in ways that allow the true costs of training to be supported, and that allow training in the most appropriate settings.

Also in the area of training, it is with regret that I once again note to this Committee that NIH has continued to ignore both NAS and Congressional recommendations to increase its training support for behavioral science researchers. Given the importance of training to the vitality of behavioral science research, we ask for the Committee's support in encouraging NIH to develop a plan for complying with the most recent NAS recommendations regarding NRSAs.

Office of Behavioral and Social Sciences Research (OBSSR)
The OBSSR is coordinating an NIH-wide project on the interactions of the mind and body to determine health. This project, which has had the strong backing of Congress, is an exemplary model for joint projects among institutes that share responsibility for behavioral aspects of physical and mental health and disease. We ask the Committee to encourage OBSSR to support initiatives in areas where psychological, environmental, and biological conditions intersect to determine health status, such as in child development, aging, heart disease, and chronic diseases. One additional area for cross-institute coordination would be compliance with medical regimens.

Translational Research at the National Institute of Mental Health
NIMH is launching an exciting new initiative in translational research to close the gap between basic and clinical research in behavioral science. A panel of distinguished behavioral science researchers convened by the NIMH National Advisory Council has developed a blueprint to jump-start NIMH's translational research activities and bring the knowledge that has been generated in basic behavioral research into the clinical arena. As defined by the workgroup, translational research in the behavioral and social sciences "addresses how basic behavioral processes inform the diagnosis, prevention, treatment and delivery of services for mental illness, and conversely, how knowledge of mental illness increases our understanding of basic behavioral processes," examples of which include cognition, emotion, motivation, development, personality, and social interaction. The report is online at www.nimh.nih.gov/council/bswsummary.cfm .

Many of the workgroup's recommendations do not require large increases in funds, but rather, they outline changes in the way work is done. Recommended actions include adding supplements for translational research to existing grants, conducting workshops and conferences to encourage more interdisciplinary communication, developing model programs, training grants to create new investigators in translational research and career development awards to encourage more senior researchers to venture into this area. In developing their report, the workgroup -- chaired by former NSF Deputy Director Anne Petersen and co-chaired by Robert Levenson from UC-Berkeley -- consulted extensively with clinicians, advocates for the mentally ill, and other end-users of translational research, including insurers, service providers, and policymakers. The workgroup recommended that NIMH view these consumers as partners in setting its translational research agenda.

The behavioral science workgroup also recommended the establishment of translational research centers to support collaborations by behavioral and clinical investigators and provide access to clinical populations. These centers would provide a core presence for translational research at NIMH, and could serve as models for other institutes. Under the leadership of Director Steve Hyman, NIMH has begun to implement many of these recommendations across its extramural research divisions, and the Institute is taking a serious look at establishing translational research centers. We ask the Committee to encourage the behavioral science translational research initiative at NIMH, and to provide sufficient funding to support the establishment of behavioral science translational research centers.

NIMH Training
The behavioral science workgroup's report on translational research called for a dramatic increase in current funding levels for training. In fact, the workgroup said that "investing in the training of young scientists to conceptualize translational research and work in multidisciplinary teams is likely to have the greatest long-term return of any investment in this area." As I noted earlier, the existing training policies at NIH represent a barrier in two ways: one, training for behavioral science is not recognized as a priority, and two, NIH training support does not cover many activities that are essential for translational research. Because of the urgent need for translational research, NIMH cannot afford to wait while NIH reconsiders its training policies. Therefore, we ask this Committee to encourage NIMH to develop a plan for training of new investigators in behavioral science translational research.

One final note: The new initiative in translational research should not be at the expense of NIMH's basic behavioral research enterprise, which supports a great deal of fundamental work. For example, the Behavioral Science Research Branch in NIMH's Division of Neuroscience and Basic Behavioral Science is fostering basic developmental research that will integrate our knowledge of behavioral development with that of brain development, with the goal of identifying the reciprocal influences between the two. The branch also is developing a new area of interdisciplinary research at the juncture of social psychology and cognitive science to generate fundamental knowledge about the information processing mechanisms such as memory, perception and judgment, that enable individuals to function in a social world. This area of research is termed "social cognition." We ask this Committee to help ensure that funds continue to promote NIMH's basic behavioral science research enterprise.

National Institute on Drug Abuse
NIDA continues to make dramatic progress in addressing the nation's drug abuse and dependence problems. This progress has been accompanied by a broadening of NIDA's behavioral science portfolio. Under the leadership of psychologist Alan Leshner, NIDA has launched a national Clinical Trials Network (CTN) to test drug treatment strategies in "real life" settings. Interventions that have been effective under controlled research conditions are being applied on a wide-scale with a variety of patients in many geographical settings. Initially, most of the interventions being tested are based on behavioral treatments, since those have been found to be most 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. NIDA has awarded the first six CTN grants. When complete, the network will consist of 20 to 30 regional research treatment centers, each of which will be linked with 10 to 15 community-based programs that represent a variety of treatment settings and patient populations. 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 2001.

Related to this: We know that Congress is considering dramatic increases in funding for interdiction efforts aimed at reducing the supply of illegal drugs in this country. There should be a commensurate increase in funding for addiction research in order to develop effective prevention strategies, and to develop and test effective new treatment interventions. Congress is considering significant new funding for other anti-drug activities, including $1.7 billion in new drug interdiction funding for the Andean region nations of Colombia, Bolivia and Peru, either as part of an FY00 supplemental appropriations bill or as part of the FY01 appropriations process. The federal drug strategy should reflect an appropriate balance between supply-reduction activities like interdiction and demand-reduction activities such as NIDA's research on drug treatment.

Drug treatment has been demonstrated to be more cost-effective than supply-reduction efforts. The Rand Corporation, for example, has estimated that investing an additional $1 million in drug treatment programs would reduce fifteen times more crime than interdiction or longer sentences for drug offenders. NIDA research is crucial in improving the effectiveness of drug treatment and in the development of new treatment modalities. In addition to the Clinical Trials Network, NIDA's research on basic behavioral research helps treatment providers better understand and address the dynamics of addiction, including such phenomenon as peer pressure, craving and relapse. We ask this Committee to support an increase in NIDA's budget in order to establish a more balanced and effective drug control strategy for the nation.

Tobacco Research Centers
NIDA, the National Cancer Institute, and the Robert Wood Johnson Foundation are jointly funding transdisciplinary research centers on tobacco use, devoted to investigating new ways to combat tobacco use and nicotine addiction. The first awards were made in early FY 2000 to seven academic research institutions. NIDA and NCI will provide a total of $70 million over 5 years for the centers, with the Foundation providing an additional $14 million. Investigators will study the prevention of tobacco use, initiation of tobacco use, and addiction. This is an exemplary approach to investigating the behavioral underpinnings of a complex and widespread public health problem tobacco-related disease causes more than 450,000 deaths each year, including 170,000 cancer deaths. We ask the Committee to support the joint NIDA-NCI tobacco research centers program.

National Institute on Alcohol Abuse and Alcoholism
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 conversely, the impact of chronic alcohol abuse on those processes. As one example, NIAAA recently 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 the initiation and maintenance of drinking behaviors. Also, in 1998, with Congress' encouragement, NIAAA established a program of small grants for young investigators. The program, known as Behavioral Science Track Awards for Rapid Transition (B/START-NIAAA), is essential for ensuring the supply of scientists needed to examine the numerous behavioral factors that play a central role in alcohol abuse and alcoholism. We ask the Committee to continue to encourage NIAAA's behavioral science research activities and its B/START program.

NIAAA is also working with more than 25 governor's spouses to address the little-known but alarming facts surrounding alcohol consumption by younger children, ages 9 to 15. Earlier this year, the Governor's Spouse's Group launched "Leadership to Keep Children Alcohol Free," a multi-year, public-private partnership focused on preventing the use of alcohol by children, funded by the NIAAA and the Robert Wood Johnson Foundation. This is particularly important because science has shown that the earlier a child starts drinking, the more likely it is they will develop serious drinking problems. NIAAA also is continuing with efforts to reduce alcohol related problems on college campuses. We ask this Committee to encourage NIAAA's public outreach efforts aimed at reducing drinking among children and reducing alcohol-related problems on college campuses.

National Institute of General Medical Sciences
NIGMS is the only national institute specifically mandated to support research not targeted to specific diseases 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. Whether an oversight or a deliberate policy, the lack of behavioral science research at NIGMS represents is an enormous gap, given the basic behavioral research and training that NIGMS should be supporting. This Committee, as well as your Senate counterparts, addressed this issue last year in your appropriations reports on the FY 2000 budget 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." It appears that NIGMS has not responded to your request. 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 Institute on Aging
Within NIA's Behavioral and Social Research program, the Cognitive Functioning and Aging section supports research on how such processes as thinking and memory change with age, how these changes affect problem-solving and decision making, and how interventions can improve cognitive functioning. The National Academy of Sciences is planning to release a report soon that identifies future directions for behavioral, cognitive, and neuroscience research in these and related areas. Your colleagues in the Senate spoke about the value of this study in last year's appropriations report. We urge the Committee to encourage the use of NAS's recommendations as a guide for expanding NIA's portfolio in this critical area of research.

Beyond cognitive functioning in the elderly, the larger behavioral and social science research program at NIA also is undergoing an examination. The NIA leadership has been in touch with us and with others in the field for advice on how NIA should be attracting the best in our fields. We welcome this effort and we also ask the Committee to encourage NIA's behavioral science research portfolio.

National Institute on Diabetes and Digestive and Kidney Diseases
NIDDK's Behavioral Research Program encompasses individual, family, and community-based strategies aimed at preventing diabetes and its complications through lifestyle modifications, education and other behavioral interventions. Particular emphasis is placed on development of culturally-sensitive interventions to prevent or treat diabetes in diverse populations including African-Americans, Hispanic Americans and Native Americans. Specific areas of research include the link between behavior and physical health; and approaches to improving health-related behaviors and to enhancing diabetes self-management. Last year, Congress received the report of the Congressionally-mandated Diabetes Research Working Group. Among other things, the report recognized the role of behavioral research in preventing diabetes and in controlling various behavior-based aspects of this chronic disease, such as adherence to diabetes treatment and improving health-related behaviors to avoid or slow the deterioration in health that can result from diabetes. We ask the Committee to encourage NIDDK's implementation of the Diabetes Research Working Group's behavioral science recommendations.

National Institute on Child Health and Human Development
NICHD's Child Development and Behavior Branch supports research on the cognitive, social, and emotional development of children from newborns to adolescents. The factors studied include individual, social, and environmental influences on attention, memory, learning, family and peer relationships, personality, and self-esteem, to name a select few. The branch also supports studies of the causes and effects of child abuse and neglect. We are concerned that NICHD has received a below-average share of NIH's budget increases in the past few years; our fear is that this reflects a lack of confidence in the institute on the part of Congress and NIH's leadership. NICHD has an extremely important mission in behavioral and social science research relating to the health and development of children. We ask the Committee to monitor NICHD's efforts to strengthen its behavioral science research programs and provide the necessary resources to allow NICHD to fulfill its mission in these areas.

Centers for Disease Control and Prevention (CDC)

Violence Research
CDC supports research aimed at preventing and reducing behaviorally-based public health problems. No problem is of greater concern than violence, particularly its impact on young people. School shootings have tragically raised public awareness of this problem, but the effects of violence are even more widespread. In 1997, 6146 people between the ages of 15-24 were victims of homicide; homicide is second only to motor vehicle crashes as a leading cause of death in this age group. And for each death, there are at least 100 nonfatal injuries. CDC is advancing youth violence prevention through a pilot initiative in which family-based and school-based strategies are being tested in approximately 20 middle schools in various states. With additional funding, CDC would be able to conduct a full-scale version of this program at 48 schools, and would be able to bolster research to develop prevention strategies. Given the critical need to respond to problems of violence, we strongly encourage increased funding for CDC's youth violence prevention initiatives to allow for full funding.

This concludes my statement. I would be pleased to answer questions or provide additional information.