What a difference a year makes. Last spring, while official Washington was reeling from the changes in Congress, the entire federal budget was on the potential chopping block, including the National Institutes of Health (NIH)-normally a perennial favorite of Congress-which was facing a 5- to to-percent cut. The good news is: NIH ended up getting a sizeable increase (5.7 percent) and has emerged as one of the more protected federal agencies.
APS was part of the effort that encouraged Congress to preserve NIH’s budget last year, through direct advocacy and through leadership in several Washington-based health research coalitions. NIH includes a large amount of behavioral and social science research, with many of the national institutes funding sizeable portfolios in these areas.
Now, the preliminary stages of the budget process for FY97 are underway. What we are seeing is considerably different this year, and we have already gotten assurances from key congressional leaders that the events of the past year will not be repeated.
One of the biggest reversals from last year occurred during a hearing before the House appropriations subcommittee that oversees the National Institute of Mental Health (NIMH). The budget battles in Congress last year were the backdrop for an attack on NIMH in which more than 30 of its grants, many behavioral, were singled out as examples of wasteful government spending. Leading the attack was Rep. Ernest Jim Istook (R-OK), a member of the appropriations subcomntittee. Istook, was supported by a coalition of scientologists and other groups portraying themselves as taxpayer watchdogs. Their tactics included misleading press releases and other statements that grossly distorted the research.
NIMH responded with a compelling defense of the grants. The issue was elevated to national importance when Istook’s claims were investigated by Primetime Live co-anchor Sam Donaldson. The story featured interviews with several of the scientists whose grants were targeted, with Istook, and with Rex Cowdry, then acting director of NIMH. Donaldson said he started out thinking he had found the “mother-lode” of government waste, but became convinced of the value of the research. The positive television story and NIMH’s strong defense of the grants combined to derail the attack.
Now, a year later, the issue boiled down to one small but telling scene when APS Executive Director Alan Kraut delivered our testimony on the NIH budget before the same subcomntittee where the attacks had originated. He discussed the importance of behavioral science in public health and requested stronger NIH support of training for the field.
The chair of the subcommittee, Rep. John Edward Porter (RIL), responded very favorably, underscoring the importance of linking health and behavior, and urging APS and others to continue to “get the message out.”
Porter also made a surprisingly strong statement against What he caned the “mindless attacks” on NIMH from last year. His comments were a clear signal that similar attacks would not fare well in the subcommittee this year.
Porter was sintilarly encouraging when APS Director of Government Relations Susan Persons testified on the budget for the National Institute of Child Health and Human Development (NICHD). Persons, who chairs the Friends of NICHD coalition, presented a consensus of more than 100 groups regarding the NICHD budget and asked the subcommittee to support research in child health and development. In response, Porter said he would do his best to fulfill the coalition’s funding request, and that efforts should be directed toward the House Budget Committee and its chair, Rep. John Kasich (R-OH).
Another encouraging sign was that congressional members of the subcommittee raised questions with NIH Director Harold Vannus and several Institute directors during NIH budget hearings about what NIH is doing in behavioral research. Topics discussed included training young behavioral science investigators, fetal alcohol syndrome, the status of behavioral science at NIMH, and child abuse.
The main points of the APS and Friends Coalition testimony are presented below.
• NIH and Training. APS recommended a 6.5-percent increase for NIH in FY97, an amount that was agreed on as “reasonable” in the current fiscal climate by two major Washington coalitions that advocate for the NIH- the Coalition for Health Funding (CHF) and the Ad Hoc Group for Medical Research Funding. APS is well-represented in the leadership of both groups, with Kraut serving as president of the CHF and on the executive committee of the Ad Hoc Group.
APS also asked Congress to strengthen training in behavioral sciences at NIH through two specific actions: Encourage NIH to increase the number of National Research Service Awards (NRSA) in behavioral sciences, as recommended by the National Academy of Science; and encourage wider use of the B/ST ART (Behavioral Science Track Award for Rapid Transition) program among institutes that fund large amounts of behavioral science.
B/START is a program of small grants aimed at newer investigators. It originated at NIMH in 1994, and is designed to attract new investigators to the field and to sustain them while they collect pilot data and gain experience in the NIH grant review process. Other institutes have developed or are considering developing B/START programs (see below). “Ten years from now, NIH will be pointing with pride to the discoveries of former B/START’ers who have gone on to be full NIH grantees,” Kraut told the subcommittee.
Several other behavioral science projects at various NIH institutes were highlighted in APS’s and Friends’ testimony to the House of Representatives. A selection of these are summarized below.
• B/START and More at NIDA As reported in the in the March 1996 Observer, the National Institute on Drug Abuse (NIDA) has launched its own B/START program to encourage new researchers in the areas of cognition, social and personality development, motivation, and the mechanisms of craving involved in drug abuse and addiction.
Other NIDA activities include a behavioral therapies development program that applies to the assessment of such therapies the same controlled evaluation process used in evaluating new medications.
• Patient/Treatment Matching in Alcoholism. The National Institute on Alcohol Abuse and Alcoholism is sponsoring behavioral research on ways to match patients to the most appropriate intervention. ProjectMATCH, a large, randomized, multisite, clinical trial involving more than 1,700 patients, is the largest and most complex trial of patient-treatment matching and treatment effectiveness ever taken.
• Cognitive Changes in Aging. The National Institute on Aging supports a number of behavioral and social science projects on problems of perception, memory, and mobility associated with aging. Such research is looking at how problems develop, how cognitive impairment can be an early warning of Alzheimer’s disease, and whether exercise can improve cognitive functioning in older individuals.
• Child Development. NICHD leads the federal government’s research efforts in child development. A recent ground-breaking, 10-site study of child care, which involved over 1,300 children, has found that placing children in the care of someone other than their mothers does not, by itself, damage the emotional attachment between mother and child. Unlike previous studies, this one is taking into consideration family and individual characteristics in combination with day care.
Other important behavioral research described in the testimony of the Friends of NICHD, includes efforts to combat Sudden Infant Death Syndrome (SIDS). NICHD’s research has shown a clear link between infant sleep position and SIDS. NICHD has launched a major public education campaign called “Back to Sleep” to change the behavior of parents by encouraging them to put their babies to sleep on their sides or back, a behavioral intervention that has been shown to be the first effective way to prevent SIDS. More than 6,000 babies die every year of SIDS, and now for the first time, that number is diminishing.
NICHD is also supporting studies on adolescent pregnancy that have been instrumental in examining the factors leading to adolescent sexual activity, pregnancy, and parenting. Additionally, the Institute is conducting studies to improve our understanding of the consequences of these behaviors by teenagers.
Because minority youth so often face unique risks as they grow to adulthood, NICHD is committed to finding behavioral interventions that will decrease the generally higher levels of violence, disease, and sexual activity. NlCHD will identify, implement, and evaluate these interventions.
• Traumatic Head Injury. Traumatic head injury in children is a major public health problem. Most research in this area has focused on children with severe brain injury, whose problems are persistent and often evolve over time. However, the majority of cases are considered “mild.” The National Institute of Neurological Disorders and Stroke is sponsoring research that will enable more precise detection of cognitive impairments and other abnormalities in brain functioning that may be associated with such injuries.
• Solutions to Heart Disease. The National Heart, Lung, and Blood Institute launched a $30 million, 6- to 7-year multicenter study of interventions that provide social support and treat depression in coronary heart patients. The study is investigating whether reducing depression and isolation can prolong patients’ survival and decrease other cardiac problems. It is part of a more general effort to devise alternatives to “high tech” solutions to heart disease.