APS Is in the (US) House

Testimony presented to NIH appropriations committee states APS priorities

Question: Which of the following statements is true?

(a) Many of the nation’s most pressing health and social problems are behavioral in nature.

(b) Psychologists are grantees at virtually everyone of the National Institutes of Health (NIH).

(c) NIH should support more behavioral science research and training than it already does.

Answer: All of the above. (But then you knew that.)

These were the basic messages from APS to Congress in the first round of public hearings on the FY98 budget for NIH. APS Executive Director Alan G. Kraut conveyed them in testimony to the committee in the House of Representatives that oversees the annual appropriations for NIH, which funds hundreds of millions of dollars in grants to psychologists.

“I’m here on behalf of scientists from the nation’s leading universities and scientific institutions [that] conduct research on the behavioral science aspects of physical and mental health,” Kraut told the legislators.

Noting that much of this research is supported by NIH, he went on to describe the variety of topics that scientific psychologists are investigating, including: the relationships between the brain and behavior; human development and aging; mental illness; drug and alcohol addiction; chronic pain; health in communities and families; cancer; disease prevention; heart disease; and AIDS.

Psychology’s Presence

Kraut also described the significant presence of psychologists at NIH. “You will find psychologists as principal investigators on grants from every … Institute. In fact, psychologists receive more grants than any other type of investigator from the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA),” he said.

But in a statement that many legislators might find surprising, Kraut pointed out that “psychologists also have a significant presence at other Institutes.”

For example, “In FY 1995, the National Institute on Aging (NIA) supported the grants of 160 psychologists, totaling $50 million,” he told the legislators. “Similarly, the National Institute on Neurological Disorders and Stroke supported 160 psychologists with $36 mi11ion in grants. And psychologists are also among the leading grantees from the National Institute on Child Health and Human Development, where 20 percent of NICHD’s budget supported more than 200 psychologists.”

APS joined the majority of others in the health research community in asking Congress to increase the NIH budget as a whole by 9 percent. This figure was developed by the Ad Hoc Group for Medical Research, a coalition of more than 200 organizations. Kraut serves on its Executive Committee. In addition , Kraut asked the legislators to support specific behavioral science initiatives at NIH that are either planned or just beginning. Some of these are discussed below.

Progress in Training

APS’s testimony highlighted two behavioral science training initiatives that enjoy some degree of congressional “ownership.” Over the past several years, APS has pressed Congress to support training for new behavioral science investigators. These efforts led to the establishment of the B/START (Behavioral Science Track Awards for Rapid Transition) mechanism of small grants that provide seed money for young investigators to pursue their research ideas. Today, B/START programs are in full swing at NIMH and NIDA, while a similar program is getting under way at NIA. Other institutes may soon follow suit.

APS also stirred congressional interest in the recommendations of the National Academy of Sciences (NAS), which, every few years reports on the nation’s research training needs. In its most recent report in 1994, NAS called for a large increase in the number of training grants, known as National Research Service Awards (NRSA), for behavioral science researchers while at the same time indicating that the NRSAs for biomedical researchers should be held at the current level.

Initially, it appeared that NIH was not planning to implement the NAS findings, which was taken as yet another sign of NIH’s resistance to increasing behavioral research. APS brought this to the attention of both the House of Representatives and Senate, which resulted in strong messages from both to NIH. This year, the NIH Office of Behavioral and Social Sciences Research (OBSSR) has launched a $700,000 initiative to fund NRSAs for behavioral researchers.

In his House testimony, Kraut characterized the progress in B/START and the NRSAs as “an encouraging initial NIH commitment to increasing the supply of behavioral researchers.” But, he added, “the future is far from certain. This Committee’s support is still essential to these programs, which will build the nation’s capacity to address some of the most profound issues facing us today.” His statement on training concluded by asking Congress to support expansions of B/START and NRSA training grants at NIH, adding that funds for these initiatives should not be allocated from existing behavioral research activities.

Mental Health Research

The fact that NIMH is the largest single supporter of psychology researchers at NIH means that the status of behavioral science research there is especially critical. Congressional interest in improving behavioral science at NIMH dates back to the late 1980s, when, at APS’s urging, the Senale sought to reverse NIMH’s narrowing of its mission away from behavioral science.

In the interim, many things have occurred. In addition to originating the B/START program, NIMH has established a program of behavioral science research centers, has reorganized in ways that increased the visibility of behavioral science, and is taking steps to ensure that as the NIMH peer review system is merged with the NIH system, there will be sufficient sensitivity to behavioral science grants.

NIMH also sponsored two behavioral science research plans that should be used to guide future research directions at the Institute. One, Reducing Mental Disorders: A Behavioral Science Research Plan for Psychopathology, was developed under the APS-initiated Human Capital Initiative, and is aimed at reducing depression, schizophrenia, and other severe disorders through increased research in psychopathology, combining the perspectives of a variety of traditional behavior-based research disciplines.

The other plan, Basic Behavioral Science Research for Mental Health: A National Investment, was developed by a blue-ribbon task force under the auspices of the NIMH Advisory Counci1. It outlines research priorities in a variety of areas, where fundamental knowledge on the behavioral aspects of mental disorders has the most potential to lead to effective treatment and prevention.

“While these plans represent important milestones in NIMH’s behavioral science program,” Kraut said in his testimony, “we are concerned that NIMH has not yet developed a timetable and plan for implementing the important recommendations presented in the plans, despite being [repeatedly] asked to do so by Congress.

“Given the importance of behavioral research in treating and preventing mental disorders,” Kraut asked the committee to direct NIMH to implement the plans as part of the continued strengthening of behavioral science at the institutes.

He also asked the House committee to support the creation of clinical research opportunities for basic behavioral science researchers at NIMH in order to “increase the links between basic and clinical behavioral science and bring behavioral research 10 bear on the full range of mental disorders.”

Drug Abuse Behaviors

The APS statement to Congress further highlighted behavioral research at NIDA, where the director is APS Member Alan Leshner. Under Leshner’s leadership, Kraut told the House committee. NIDA is expanding its portfolio “to investigate the many behavioral aspects of drug abuse and addiction.”

In addition to launching a B/START program, NIDA is encouraging behavioral researchers to look at the factors that place individual young people at risk for starting to take drugs, factors that lead some individuals to become heavy abusers or dependent on drugs, and factors that allow people to quit or reduce their drug abuse behaviors. ”The understanding of basic behavioral processes, from craving to peer pressure, is fundamental to curbing drug abuse and addiction,” Kraut told the legislators.

Behavioral research also is an important part of NIDA’s research on AIDS, said Kraut. “Intravenous drug use is a common mode of transmission of the AIDS virus,” he told the committee, “but behavioral research is showing that drug dependent individuals can change the behaviors that put them at risk for the virus.”

NIDA received special attention in this year’s budget proposal from the Clinton Administration, in the form of a $30-million (9 percent) increase to expand its role in combating the nation’s drug problems. No other entity at NIH was given this kind of increase.

In urging Congress “to support the proposed budget expansion for NIDA in whatever final NIH budget is agreed to,” Kraut told the legislators that “NIDA-sponsored investigations provide the basis for drug abuse treatment and prevention strategies for individuals, families, communities, and public health organizations,” but that “much remains to be done to realize the potential of this research.”

Alcohol and Behavior

NIAAA awards a significant number of grants to psychologists. Behavioral research supported by NIAAA includes basic behavioral research on brain damage in children exposed to alcohol in the womb, research on the effects of chronic alcohol abuse on an individual ‘s ability to learn and remember information (which has enormous implications for treatment effectiveness), research on effective behavioral therapies for alcoholism, and health services research.

APS has been stressing the need to expand the range of  behavioral science perspectives being pursued by NIAAA. “NIAAA’s solid behavioral science program, which includes behavioral genetics, decision-making, behavioral neuroscience, a broad array of topics within cognitive psychology and clinical psychology, has produced important findings,” Kraut said in his testimony. “However,” he continued, “there is a need for expansion in other areas, such as developmental psychology and social psychology, where research can provide critical information about the developmental and group processes that contribute to problem drinking.

“Research in these areas is increasingly focusing on the interplay between behavior and biology and between behavioral science and policy, making them even stronger candidates for NIAAA research,” Kraut pointed OUI. He asked Congress to encourage an expansion of NIAAA’ s behavioral science portfolio “as a means of bringing a broader array of perspectives to bear on the nation’s alcohol-related public health problems.” He also sought congressional support for the establishment of a B/START program at NIAAA, a move that the Institute is currently considering.

The House hearing was the first step in the legislative process that in the fall will produce a final budget for NIH and the rest of the federal budget. Watch future issues of the Observer for updates on the congressional response to the issues raised in APS testimony.

Observer Vol.10, No.3 May/June, 1997

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