Advocacy Archive
Testimony of ALAN G. KRAUT APS Executive Director
National Institutes of Health, FY 2000 Appropriations
Subcommittee on Labor, Health and Human Services, and Education,
Committee on Appropriations
U.S. HOUSE OF REPRESENTATIVES
The Honorable John E. Porter, Chair
April 21, 1999
Mr. Chairman, Members of the Committee: Thank you for allowing me to testify today on the FY 2000 appropriations for the National Institutes of Health (NIH). I am Alan Kraut, the Executive Director of the 15,000-member American Psychological Society. Our members are researchers and academic leaders in scientific psychology at colleges and universities throughout the Nation. These are the scientists who investigate the connections between the brain and behavior; who delve into the basic processes of cognition and memory in people of all ages; who study the interactions of the mind and body to improve health; who research how children grow and learn; who produce the behavioral science knowledge that helps to manage debilitating chronic conditions such as diabetes and arthritis as well as depression and other mental disorders; and who conduct research on the behavioral aspects of smoking and drug and alcohol abuse in order to find ways that people can escape addiction. The behavioral research enterprise spans from theoretical to applied, from basic to clinical, and it extends to almost every institute at NIH.
Mr. Chairman, first let me thank you for all your support and for the support of the subcommittee in the enormous role you played in increasing the NIH budget. We are here to do what we can to encourage a similar increase this year. As a member of the Ad Hoc Group for Medical Research Funding, APS recommends a 15 percent increase for NIH in FY 2000. We recognize the difficulty this presents in the context of the budget caps on spending. However, the expansion is needed to ensure NIH's fulfillment of its public health mission.
My testimony today focuses on behavioral and social science research at NIH. I am an unabashed advocate for NIH, as more than ten years' worth of my testimony before this Committee indicates. However, I must point out that for many of the Nation's most pressing public health concerns, major advances will not be achieved without changes in NIH's general approach to health and behavior and to behavioral science.
Over the past decade, this Committee, along with your colleagues in the Senate, repeatedly urged NIH to increase its funding for behavioral and social science research. Why? It's because the evidence grows year after year that the biggest health risk in our nation is unhealthy behavior. Surgeons General have weighed in on this, as have the National Academy of Sciences, others in Congress, several Secretaries of HHS, and even some smaller parts of NIH itself. They all say the same thing: The leading causes of death and premature mortality in this country -- more than 50% of them -- are due to behavior. Think of just some of our national public health problems: smoking, drinking, drug abuse, violence, suicide, teen pregnancy, obesity. All begin with behaviors, but they end with devastating physical, psychological, social and economic consequences: lung and heart disease, neurological disorders, catastrophic injury, sexually-transmitted diseases, and developmental disorders, to name a few. Now, think back to the hearings with NIH witnesses earlier this year, and try to recall anything about behavioral research initiatives. You won't be able to. Behavior is not what you hear about when you talk to most institute directors, and it's not what you read about when you find a list of NIH priorities.
Why the gap between NIH priorities and behavioral aspects of health? One reason is that NIH leadership sees biology as its core, and sees behavior as too far afield from that. But this distinction between biology and behavior is an artificial one. The behavioral side of an individual is inexorably linked to the biological side. Still, most molecular or biological scientists I know don't view it that way. I have often heard outright astonishment from my biological colleagues after they sit through a talk on something like the impact of learning on brain structure, or the way genes work to allow a child to live within his or her environment, or some new finding about the biological basis of emotion, or information about electrical brain activity associated with changes in thinking. It opens up new worlds to them, and they are worlds of human functioning that NIH should be promoting.
A second problem NIH has with behavior stems from the NIH tradition of starting from a disease. When you look at what determines health, you can't help but notice behavior. Smoking, drinking, taking drugs -- all begin as behaviors. But 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. And too often the approach is "Okay, it's time for you to quit." And that is easier said than done.
Substance abuse, AIDS, teen pregnancy, violence and the rest are major public health problems. No one is untouched by them. But how much NIH research is being done on the fundamental processes of thinking, motivation, on social development, attitude change, and community or family support underlying these behaviors? What cognitive, emotional and psychological mechanisms are involved when teens ignore the risks associated with substance abuse or unprotected sex? What are the individual and environmental origins of violence? And what are the protective factors that keep so many kids from engaging in these risky behaviors?
The point is, behavior is as threatening to health and well-being as any genetic or biological condition. Certain NIH institutes, such as those for Mental Health, Drug Abuse, Alcoholism, and Aging, recognize this and have been key in promoting the study of behavior at NIH. Yet most NIH officials talk as if they sponsor only biological research. They don't. 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 there isn't enough, and it isn't recognized as a core element in NIH's mission. Just look at the lack of support for behavioral infrastructure needs such as training and instrumentation, the continued reduction in intramural laboratory activities in behavioral science research, and the absence of behavioral scientists at the table when decisions about priorities and resource allocations are being made. I want to close this portion of my testimony by reiterating my strong support for NIH and to underscore to the Committee that my remarks are made in the spirit of wanting to make a great institution even better. I ask the Committee to give its fullest consideration to these concerns and to help make behavioral research more of a priority at NIH.
Almost all of the National institutes support at least a little behavioral science research (one notable exception, NIGMS, is addressed below). While it is not possible to describe the activities of all of the Institutes within the time available, the remainder of my statement will highlight several initiatives of which we would ask the Committee to take particular note.
Training: National Research Service Awards
In its most recent report (1994) on National Research Service Awards, the National Academy of Sciences (NAS) recommended to generally increase NIH stipends and to additionally increase the number of awards for research training in nursing, oral health, health services research, and behavioral science be increased. As NIH indicated in a report to you last year, only the stipend increase was implemented. I see this as a primary example of NIH's resistance to behavioral and other less traditional NIH research fields. Training support is essential in all areas of science in order to ensure a future generation of investigators. Yet, 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 NAS recommendations.
Office of Behavioral and Social Sciences Research
Congress mandated the creation of the OBSSR in 1993. It too two full years for NIH to establish the office. But since then, OBSSR has demonstrated exceptional leadership by developing ground-breaking behavioral science initiatives involving joint efforts by NIH institutes. In FY 99, OBSSR is coordinating a $10 million NIH-wide project on the interactions of the mind and body to determine health. This project has had the strong backing of Congress. We believe it 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 similar 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.
In addition, last year Congress expressed concern that OBSSR's budget is "extremely limited." We share that concern, and we urge this Committee to support an increase in OBSSR's administrative budget so that the Office can pursue the kinds of initiatives outlined above.
National Institute of Mental Health
NIMH is one of the largest funders of behavioral research at NIH. In recent years, NIMH has been making great efforts to strengthen and expand behavioral science programs, through reorganization and through initiatives that promote new directions. One example is the National Advisory Mental Health Council's project to improve connections between basic behavioral research and clinical and applied issues. The Advisory Council will be developing recommendations for specific research and training priorities. We ask the Committee to continue to encourage NIMH's support of both basic behavioral research and of initiatives that connect basic and applied research in behavior.
Most recently, NIMH has begun an initiative to increase research that combines public health and behavioral research, in part by increasing connections between academic departments of psychology and schools of public health. We ask the Committee to encourage this initiativeas an effective means of increasing the visibility of mental health issues in public health, and the central role of behavior in the origins of and the solutions to problems of public health.
National Institute on Drug Abuse
Under the leadership of psychologist Alan Leshner, NIDA has made dramatic progress in addressing the nation's drug abuse and dependence problems. In FY 99, NIDA launched a national Clinical Trials Network to test drug treatment strategies in "real life" settings. Interventions that have been effective under controlled research conditions will be applied on a wide-scale with a variety of patients in many geographical settings. This network is based on new partnerships among NIDA, treatment researchers, and community-based treatment providers. Initially, most of the interventions being tested are based on behavioral treatments, since those have been found to be most effective. As effective pharmacological interventions are developed, these will be incorporated into the clinical trials network. Given the enormous promise of this initiative to improve the nation's drug treatment programs and reduce the public health problems associated with drug abuse and addiction, we ask the Committee to fully fund NIDA's Clinical Trials Network in FY 2000.
National Institute on Alcohol Abuse and Alcoholism
NIAAA is expanding its behavioral science portfolio to include basic research of the underlying psychological and cognitive processes involved in alcohol related behaviors. In addition, there are new initiatives in the social psychology of group identification; in behavioral genetics to understand the biological and environmental factors in vulnerability to alcoholism; in the psychophysiology of alcoholism; and in the effects of long-term alcohol abuse on memory.
As part of its expansion, and with Congress' encouragement, NIAAA has 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 B/START program. B/START has been used successfully by other Institutes, and we ask the Committee to encourage all NIH institutes make similar use of the B/START mechanism to ensure a supply of behavioral science researchers in areas related to their missions.
I would also like to mention that NIAAA's Advisory Council has established a Subcommittee on College Drinking to examine problems of alcohol abuse, particularly "binge" drinking and drinking with the intent to get drunk, which continue to pose significant problems for college communities. The Subcommittee will identify the context and consequences of college drinking and provide recommendations on the prevention and treatment of the problem. This initiative targets young people at a time when life-long behavioral patterns of alcohol abuse may be established. We ask the Committee to support NIAAA's College Drinking Initiative.
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 behavioral science research or training, even though there is a range of basic behavioral research and training that NIGMS could be supporting in such areas as the fundamental relationships between the brain and behavior; auditory and visual perception; social processes, basic cognitive processes such as motivation, learning, and information processing; the development of research techniques, methodologies, and analyses; the behavioral underpinnings of chronic pain; and the connections between mental processes and health. We believe NIGMS should develop a basic behavioral science research program in consultation with the behavioral science research community and other national institutes and offices. We ask the Committee to encourage development of a plan for basic behavioral science research at NIGMS.
National Institute on Aging
Cognitive functioning is one of the most important aspects of health status in the elderly. A study underway at the Institute of Medicine is examining current knowledge in the area of cognition and aging in order to identify future directions for behavioral, cognitive, and neuroscience research in this area. We ask the Committee to encourage the use of the IOM's recommendations as a guide for expanding NIA's portfolio in this critical area of research.
National Institute on Diabetes and Digestive and Kidney Diseases
Congress recently 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 is undertaking a number of initiatives to increase understanding of the behavioral and cognitive aspects of the child development. These focus on behavioral development; cognitive research on how children learn; developmental aspects of emotions and self-regulation; and the role of parents in determining children's cognitive, social, and risk-taking behaviors. In addition, NICHD now promotes small grants to attract new investigators to child development research. However, it appears that more senior investigators are applying for this mechanism, which is attracting established investigators to the field, but does not address the need to support young investigators who will be the future workforce in this area. The B/START mechanism I described earlier would be especially appropriate in this instance. We ask the Committee to encourage NICHD's use of B/START small grant awards, as used by NIMH, NIDA, NIAAA, and other institutes, to encourage interest among young investigators more directly.
This concludes my statement. Thank you for the opportunity to appear before you. I would be pleased to answer questions or provide additional information.