Advocacy Archive
Testimony on the
FY 2003 Budget of the National Institutes of Health
Before the Subcommittee on Labor, Health, and Human Services, and Education
Committee on Appropriations
U.S. House of Representatives
The Honorable Ralph Regula, Chair
April 30, 2002
1:00 pm
- As a member of the Ad Hoc Group for Medical Research Funding, APS recommended $27.3 billion for NIH in FY 2003 as the 5th installment of the 5-year doubling plan.
- APS requested Committee support for increased behavioral and social science research and training at NIH in order to: better meet the Nation's health needs, many of which are behavioral in nature; realize the exciting scientific opportunities in behavioral and social science research, and; accommodate the changing nature of science, in which new fields and new frontiers of inquiry are rapidly emerging. Specifically, we asked that the subcommittee help make behavioral research more of a priority at NIH, both by providing maximum funding for those institutes 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.
- Committee support is requested for specific behavioral science activities at a number of individual institutes. This testimony provides examples to illustrate the exciting and important behavioral and social science work being supported at NIH.
Mr. Chairman, Members of the Committee: On behalf of our members, I want to thank the 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 $27.3 billion for NIH in FY 2003 as the 5th and final installment of the 5-year doubling plan. The rationale for these aggressive increases remains as compelling today as it was in FY 1999, the year that you and your colleagues in the Senate embarked on this path. NIH has experienced a period of unparalleled growth in the past 5 years, and the progress achieved as a result of research funded by NIH will lead us into a new era of discovery and innovation.
Within the NIH budget, my testimony today focuses on the behavioral and social science research activities of NIH.
OVERVIEW: BASIC AND APPLIED PSYCHOLOGICAL RESEARCH RELATED TO HEALTH
The effects of behavior on health are indisputable. Many leading health conditions -- heart disease, lung disease, diabetes, developmental disabilities, brain injury, AIDS, and so many more -- are behavioral in origin. Consider, for example, the devastating health consequences of smoking, drinking, taking drugs, engaging in risky sexual behaviors. Even conditions which may be biological in origin often are behavioral in their manifestation. I'm speaking, for example, of such things as cognitive impairment due to brain injury, mental illness, or dementia. None of these conditions can be fully understood without an awareness of the behavioral and psychological factors involved in causing, treating and preventing them. Understanding behavior is as important as mapping a gene or diagnosing a biological disorder.
APS members include thousands of scientists who, with NIH support, conduct basic research related to physical and mental health at our Nation's leading universities and colleges. Virtually every institute at NIH supports some amount of psychological science. Examples include: The connections between the brain and behavior; research into how children grow and develop; management of debilitating chronic conditions such as diabetes and arthritis as well as mental disorders; and the behavioral aspects of smoking and drug and alcohol abuse, so that science may find ways for people to escape addiction. These are some of the most promising research frontiers today, and our field is poised to make significant strides in a number of scientific areas that a few years ago did not even exist.
The basic psychological research conducted by APS members and others in the field has implications for a wide range of applications at NIH, including developing more effective interventions to prevent such diseases as diabetes, cancer, heart disease, and addiction, even developing more effective hearing aids and speech recognition machines. All of these areas of research are bound together by a simple concept: that understanding the human mind, brain, and behavior is central to maximizing human potential. That places these pursuits squarely at the forefront of the most pressing health issues facing this Congress, this Administration, and this Nation. We ask that you continue to help make behavioral research more of a priority at NIH, both by providing maximum funding for those institutes 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.
BEHAVIORAL SCIENCE RESEARCH TRAINING: A GUARANTEED INVESTMENT
The outcomes of science are unpredictable. Yet there is one aspect of science where the time and money invested is guaranteed to pay off: the training of our future scientists. 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. This is a serious issue in behavioral science at NIH, where the demand for behavioral science investigators at NCI, NIMH, and other institutes outpaces the current supply of behavioral science researchers. In order to meet the future needs of research in health and behavior, NIH must have a comprehensive training strategy in place today, one that focuses on training young investigators in the core disciplines of behavioral and social science research as well as in multidisciplinary perspectives. 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.
I would now like to turn my attention to the behavioral science research that is taking place at the individual institutes.
NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH)
Strengthening Clinical Science. Under the leadership of Acting Director Richard Nakamura, NIMH is working with the Academy of Psychological Clinical Science to explore the development of training models for clinical science in psychology. The goal is to establish training for clinical scientists who will go on to create new ways to diagnose, measure and treat mental disorders, and new ways to evaluate how those treatments translate from the lab to the real world. We ask the Committee to support the efforts of NIMH as the institutes takes this very complex first step in the on-going fight against mental illness.
Translational Research in Behavioral Science. NIMH has demonstrated enormous leadership in promoting translational research in behavioral science, aimed at bringing knowledge from the laboratory into clinical research and application. The goal is to develop more effective, theory-based interventions and service-delivery models for mental disorders through increased applications of the garnered data. In simplest terms, this is the result Congress was looking for when it chose to double the NIH budget: the results of research being used to treat patients with complex disorders in an effective and efficient manner. This initiative will develop research centers that support the transition of basic behavioral science research to patient-oriented studies regarding new interventions and delivery of services for patients with mental disorders.
Basic Behavioral Research at NIMH. NIMH is to be commended for promoting the transfer of knowledge into application. At the same time, basic behavioral research at NIMH must continue to receive the same strong support it traditionally receives there. This is crucial, as 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 respective missions, 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)
Behavioral research plays an important role in NIDA's search for solutions to the complex social and public health problems posed by drug abuse and addiction. NIDA supports basic research on such topics as craving, motivation, and decision-making to determine how behavioral and cognitive factors underlie and can lead to drug addiction. Recognizing that for some individuals the initial voluntary behavior to use a drug is more likely to lead to the disease state of addiction, NIDA has a comprehensive behavioral research portfolio that serves as the foundation for all of its prevention and treatment efforts.
NIDA's National Prevention Research Initiative. NIDA's new Prevention Research Initiative integrates basic science with prevention research. NIDA-supported investigators will draw on basic behavioral, cognitive, developmental, social and neurobiological research to inform the development of innovative and novel prevention interventions. NIDA will focus on preventing the initiation of drug abuse by better understanding basic cognitive processes, such as the decision to use a drug. This basic research component is just one of three components (along with establishment of transdisciplinary prevention centers and community multi-site prevention trials) that NIDA will use to enhance national prevention efforts. Understanding behavior will not only aid in the development of prevention strategies, it will also aid in the development of new therapies for those addicted to drugs. We ask this Committee to increase NIDA's budget in proportion to the overall increase at NIH in order to reduce the health, social and economic burden resulting from drug abuse and addiction in this Nation.
NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM (NIAAA)
NIAAA has broadened its behavioral science portfolio in order 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 group peer pressure and group norms concerning drinking influence drinking. The Institute also convened a group of experts in cognitive research to explore the effects of alcohol abuse on memory, decision-making, cognitive development to begin looking at issues of cognitive rehabilitation.
Combining Behavioral Science with Pharmacology. With research suggesting a genetic component to alcoholism and alcohol abuse and physiological dependency as a key factor in alcohol intake, the lines are becoming less and less clear between what is considered behavioral and what is considered biological research. An excellent example of how behavioral science research can mesh with pharmacological research is NIAAA's project, Combining Medications and Behavioral Interventions (COMBINE). Over the next two years, at eleven treatment research centers across the United States, alcohol-dependent research participants will receive one of two medications (naltrexone and acamprosate), and one of two behavioral therapies (moderate-intensity and minimal-intensity). Some individuals will receive only the moderate-intensity behavioral therapy. The goal is to develop the most effective therapies that combine both pharmacology and behavior.
College Drinking. In early April, 2002, NIAAA launched its College Drinking Initiative, highlighted by its just-released flagship report, "A Call to Action: Changing the Culture of Drinking at U.S. Colleges." The report is the result of several years of collaborative work by distinguished alcohol researchers, senior higher education officials, and students as members of NIAAA's Task Force on College Drinking. The release of this study on April 9, 2002 received significant nation-wide media attention on 3 major networks. Led by APS member Dr. Mark Goldman of the University of South Florida, and Reverend Edward Malloy of the University of Notre Dame, the task force's goals are to advise NIAAA and other policy makers on future research that can improve campus prevention and treatment programs, and to provide college presidents, policy makers, and researchers with information on the effectiveness of current interventions. The research strongly supports the use of comprehensive, integrated programs with multiple complementary components that target individuals, including at-risk or alcohol-dependent drinkers, the student population as a whole, and the college and the surrounding community. This is an excellent example of how behavioral science can be a pillar of public health. We ask this Committee to increase NIAAA's budget in FY 2003 in proportion to the overall increase at NIH 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 diseases or disorders. That legislative mandate also extends to behavioral science research:
The general purpose of the National Institute of General Medical Sciences is the conduct and support of research, training, and, as appropriate, health information dissemination, and other programs with respect to general or basic medical sciences and related natural or behavioral sciences [emphasis added] which have significance for two or more other national research institutes or are outside the general area of responsibility of any other national research institute. (TITLE 42, CHAPTER 6A, SUBCHAPTER III, Part C, subpart 11, Sec. 285k)
Despite this legislative mandate, NIGMS does not now support behavioral science research or training. This is an enormous oversight, given the wide range of fundamental behavioral topics with relevance to a variety of diseases and health conditions.
Congress addressed this issue for the past three years in the reports on the FY 2000, FY 2001, and FY 2002 appropriations for NIH. Specifically, Congress said: "The Committee is concerned that NIGMS does not support behavioral science research training. As the only Institute mandated to support research not targeted to specific diseases or disorders, there is a range of basic behavioral research and training that NIGMS could be supporting. The Committee urges NIGMS, in consultation with the Office of Behavioral and Social Sciences, to develop a plan for pursuing the most promising research topics in this area." NIGMS has not responded to your requests. Once again, we ask the Committee to direct NIGMS to develop a plan for establishing a basic behavioral science research program at NIGMS.
NATIONAL CANCER INSTITUTE (NCI)
Having already established itself as a leader among NIH Institutes in many fields of research, NCI has made enormous advances in the behavioral sciences.
NCI's Behavioral Research Program. NCI's comprehensive behavioral science research program 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. NCI's Behavioral Research Program applies conceptual and methodological innovations from psychological science to cancer-related issues. Focusing on transdisciplinary and collaborative research, NCI's Behavioral Program has expanded to five branches, including a basic biobehavioral research branch, a health communication and informatics research branch, and the tobacco control research branch. The transdisciplinary research conducted by NCI is an example of the new path for science, as disciplines are only made stronger when complimented by others. With every new discovery that arises, we see more and more that no branch of science is complete if it stands alone. The great Chinese philosopher Sun Tzu once said, "The musical notes are just five in number, but their combination gives rise to so numerous melodies that one cannot hear them all." The same philosophy must be applied to scientific research; psychology, biology, physics, genetics, technology all are intertwined, and when used together they form a foundation for advancement that is endless. We ask Congress to support NCI's behavioral science research and training initiatives and to encourage other institutes to use these programs as models.
Health Communications. 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. Researchers are exploring innovative strategies for communicating cancer information to diverse populations, looking at various communication approaches such as message tailoring and framing with application in multiple communication channels. 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 healthy behaviors.
It's not possible to highlight all of the worthy behavioral science research programs at NIH. In addition to those I've discussed here, many other institutes play a key role in the NIH behavioral science research enterprise. These include the National Institute on Aging, the National Heart Lung and Blood Institute, the National Institute of Child Health and Human Development, the National Institute of Neurological Disorders and Stroke, and within the NIH Director's office, the Office of Behavioral and Social Sciences Research. Behavioral science is a central part of the mission of each of these, and each deserves the Committee's support.
This concludes my testimony. Again, thank you for the opportunity to discuss the NIH and specifically, the importance of behavioral science research in addressing the Nation's public health concerns. I would be pleased to answer any questions or provide additional information.