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Government Affairs Committee
August, 1995

Senate Appropriations Action

Wednesday, August 23, 1995 9:13AM

A. OVERVIEW

Now that the House has completed its work and has proposed a 5.7%, or $642 million, increase for the NIH, our attention turns to the Senate. The Senate Labor, Health and Human Services, & Education (Labor/HHS) Appropriations Subcommittee will begin to markup its FY'96 Labor/HHS spending bill that includes funding for the NIH. The markup is scheduled for September 12-14. Following this, the full Appropriations Committee will vote on the spending bill, and than the entire Senate. After the Senate completes its work, the House and Senate bills must than be reconciled during the conference committee. Your response in the past has been critical to the success that we have achieved to date. To achieve a funding level in the Senate that is at least that of the House we need your support and that of your colleagues.

B. ACTION PLAN

Our message to Senators is to support the $642 million increase proposed by the House.

1. If your Senator (or if your institution is located in the state) of a Member of the Senate or House Appropriations Committee (see contact list below), write to the Senator to support funding for the NIH above the House figure. In your letter, note that as a member of the Appropriations Committee, he/she has significant influence in protecting the NIH and entire biomedical research enterprise. (Members of the Senate Labor/HHS Subcommittee that has direct funding jurisdiction over the NIH are in CAPS).

2. If your Senator does not sit on the Appropriations Committees listed below, you should also write to support the NIH. It is especially important that Members of Congress hear from scientists-constituents in States that have a smaller biomedical research enterprise. These Members of Congress may be indifferent to the NIH unless they hear directly from you.

3. All CLC members should continue writing letters and opinion pieces to support adequate funding for the NIH to editors of you local newspapers. Some members have already had success in Oregon, Texas, and Tennessee. If you wish to see published articles by scientists as a guide for your local efforts, please respond to this message (ask for the oped sample) and it will be e-mailed directly to you.

C. SENATE APPROPRIATIONS COMMITTEE CONTACT LIST

Phone and fax numbers are listed next to Members name. All area codes are 202. However, we urge you to mail your letters since fax numbers are often busy from high volume or disconnected. We ask that you do not e-mail letters to Members of Congress. Not many Members of Congress have valid e-mail addresses and there is no substitute for an original hard copy of a letter. Members of the Senate Labor/HHS Subcommittee are listed in uppercase.

The mailing address and salutation for the Senate is:

The Honorable______

United States Senate

Washington D.C. 20510

Dear Senator__:

Senate Appropriations Member Phone Fax

Robert Bennett (UT) 224-5444 224-6717

Christopher Bond (MO) 224-5721 224-8149

Dale Bumpers (AR) 224-4843 224-6435

Conrad Burns (MT) 224-2644 224-8594

Robert Byrd (WV) 224-3954 228-0002

Thad Cochran (MS) 224-5054 n/a

Pete Domenici (NM) 224-6621 224-7371

Slade Gorton (WA) 224-3441 224-9393

Phil Gramm (TX) 224-2934 228-2856

Judd Gregg (NH) 224-3324 224-4952

Tom Harkin (IA) 224-3254 224-9369

Mark Hatfield (OR) 224-3753 224-0276

Ernest Hollings (SC) 224-6121 224-4293

Daniel Inouye (HI) 224-3934 224-6747

Jim Jeffords (VT) 224-5141 n/a

J. Bennet Johnston (LA) 224-5824 224-2952

Robert Kerrey (NE) 224-6551 224-7645

Herbert Kohl (WI) 224-5653 n/a

Frank Lautenberg (NJ) 224-4744 224-9707

Patrick Leahy (VT) 224-4242 224-3595

Connie Mack (FL) n/a n/a

Mitch McConnell (KY) 224-2541 224-2499

Barbara Mikulski (MD) 224-4654 224-8858

Patty Murray (WA) 224-2621 224-02238

Harry Reid (NV) 224-3542 224-7327

Richard Shelby (AL) 224-5744 224-3416

Arlen Specter (PA) 224-4254 224-1893

Ted Stevens (AK) 224-3004 224-2354

D. FACTS SUPPORTING INVESTMENT IN THE NIH

The NIH is the world's leading biomedical research institution, supporting more than 35,000 scientists at more than 1,700 research universities and institutions in the United States. More than 80 percent of the NIH's FY 1995 budget of $11.3 billion will be spent on extramural research conducted at universities, research institutions and hospitals throughout the United States. NIH-supported researchers have made the U.S. the world leader in biomedical research, creating thousands of jobs and new business in the process. The NIH has played a critical role in facilitating innovations that have led to significant reductions in health care costs in many areas. In a 1994 report, the NIH estimated that approximately $4.3 billion invested in clinical and applied research supported by the NIH had the potential to realize annual savings of between $9.3 billion and $13.6 billion. This translates into a 200 to 300 percent annual return on the investment in research. Contingent on adequate federal support, America can expect continued advances that will change the face of tomorrow's health care.

I. Examples of Cost Savings From NIH-Supported Research

a. Researchers supported by the National Institute of Allergy and Infectious Diseases and the National Institute of Child Health and Human Development found that the drug AZT can reduce by two-thirds the rate of HIV transmission from mother to infant. The use of AZT in HIV-infected pregnant women could prevent the infection of 1,200 infants each year, with annual savings to the U.S. health care system of as much as $170 million.

b. Previously, 50 percent of people with diabetic retinopathy with high risk characteristics were blind within 5 years. Research supported by the National Eye Institute has demonstrated that laser treatments are up to 95 percent effective in preventing blindness. In addition, it is estimated that these treatments, which are currently used in only half of the patients with high risk characteristics, result in annual societal savings of between $1.2 billion and $1.6 billion. The costs of blindness include Social Security benefits, lost income tax revenues, and Medicare expenditures. NEI clinical research cost the American taxpayer $181 million between 1971 and 1992.

c. Research supported by the National Institute of Allergy and Infectious Diseases and the National Institute of Diabetes and Digestive and Kidney Diseases has led to the discovery of a connection between the presence of a specific bacterium -- Heliobacter pylori -- in the upper gastrointestinal tract and chronic gastritis and duodenal ulcer. This has led to the development of a revolutionary new treatment for peptic ulcers that eliminates the bacterium, cures individual lesions, and prevents their customary life-long recurrence, saving as much as $400 million a year in reduced treatment costs.

d. For an investment of $5.1 million, the National Institute of Allergy and Infectious Diseases developed an antiviral therapy using acyclovir to treat newborn infants suffering from neonatal herpes simplex. Research suggests that early diagnosis and treatment can reduce significantly the costs of premature mortality and severe neurological impairment, saving as much as $183 million a year for a one-year group of infected infants.

e. In a recent National Institute of Mental Health-funded study of severely ill patients with treatment-resistant schizophrenia who were maintained on Clozapine for over 2 years, total cost savings averaged $22,937 per patient. Applying these findings to the 75,000 schizophrenics who began taking clozapine between 1990 and 1994, it is conservatively estimated that $1.6 billion has been saved.

f. Through research supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, a drug therapy for kidney disease resulting from lupus has been found to save $93.1 million in health care costs in the United States each year. This drug regimen cost a total of only $9.8 million to develop.

g. National Cancer Institute research has led to new technologies to make affordable and effective bone marrow transplantation a treatment option for breast cancer. Five-year, disease-free survival rates increased from 30 percent to 72 percent in women with breast cancer in 10 or more lymph nodes, and from 1 percent to 15-20 percent in women with advanced breast cancer; improved outcomes for bone marrow transplantation by decreasing death rates (mortality) associated with the procedure from 21 to 25 percent to 2 to 3 percent; and decreased health care costs for bone marrow transplantation from $140,000 to $65,000 per transplant.

h. A clinical trial co-sponsored by the National Heart, Lung, and Blood Institute and the National Institute on Aging showed that an inexpensive, commonly-used antihypertensive drug reduced stroke and heart attack in victims of systolic hypertension (SH), a form of high blood pressure that afflicts about 3 million older Americans. Nationwide treatment of SH in the elderly could save at least $25 million a year in health care costs.

i. Research supported by the National Institute on Diabetes and Digestive and Kidney Diseases on the prevention of recurrent kidney stones has resulted in significant reductions in the cost of treatment. If it is assumed that drug therapies are adopted by 50 percent of eligible patients as opposed to surgical therapy, this research would result in estimated realizable one-year savings of approximately $300 million.

j. A multicenter clinical trial supported by the National Institute of Neurological Disorders and Stroke demonstrated that the risk of stroke could be reduced by 50 to 80 percent in individuals with atrial fibrillation, a condition characterized by an irregular heartbeat and associated with 70,000 strokes each year, by treating them with aspirin or an anticlotting drug called warfarin. Application of the findings of this study, which cost approximately $4.6 million, could prevent an estimated 20,000 to 30,000 strokes each year, with potential annual savings of $200 million.

II. NIH Research Is An Investment In Innovation

a. Basic Research

Improvements in public health depend on basic research to find answers to fundamental questions about disease processes. The development of an evolving, dynamic base of knowledge through a sustained investment in fundamental research is central to our ability to pursue an understanding of disease. Ultimate success in the war against disease will be impossible without the commitment of long-range funding in multiple areas of scientific investigation and a continuously renewed pool of talented scientists.

b. Biotechnology

Research funded by the NIH provided the tools that created the biotechnology revolution and established the United States as the international leader in the field. The NIH funds over 84 percent of this nation's spending in biotechnology research, an investment that continues to fuel and attract private capital to the biotechnology industry. Biotechnology is a major commercial enterprise that will play an increasingly prominent role in the U.S. economy by the end of the decade. World-wide sales of biotechnology-derived products have grown from zero in 1980 to $6 billion today, and are projected to be $50 billion by the year 2000. If the United States is to reap the benefits of advances in health care offered by biotechnology, support for basic research must increase.

III. NIH Research Is An Investment In Prevention

a. Improving Nutrition and Fitness

NIH research programs on nutrition and fitness are vital to learning how to sustain good health and prevent disease. This research has resulted in a greater understanding of the influence of diet and physical activity on specific diseases such as cancer, diabetes, osteoporosis, and heart disease. NIH research also is identifying and examining methods to maintain and increase involvement in physical activity, particularly among children and the elderly.

b. Linking Biology and Health

The environment, our genes, and age interact to determine our predisposition to good health or disease. Our advancing understanding of genetics, resulting from NIH-supported basic research, promises to revolutionize prevention. For example, an individual's genetic profile may reveal a predisposition to lung, breast, or prostate cancer, greatly improving the chances of diagnosing and treating these disorders earlier. The National Institute of General Medical Sciences and the National Center for Human Genome Research supports research focused on the identification and mapping of genes that cause common, complex genetic disorders, such as high blood pressure and certain cancers.

c. Fighting Infectious Diseases

The development and use of vaccines is one of the safest and most effective measures for preventing infectious diseases. NIH-supported basic research in virology, immunology, and molecular biology have led to exciting new developments. For an investment of $19.1 million, researchers supported by the National Institute of Allergy and Infectious Diseases developed a vaccine against Haemophilus influenza type B (Hib), which until recently was the leading cause of pediatric bacterial meningitis and acquired mental retardation in the United States. This vaccine saves over $435 million for each group of infants vaccinated in a one-year period. A $30 million investment in research led to the development of a vaccine to prevent some types of hepatitis, the ninth leading cause of death worldwide. It is believed that 300,000 Americans are infected each year, and an estimated one million in the United States are chronic carriers of the virus. Widespread use of two genetically engineered vaccines could result in savings of as much as $138 million each year.

d. Combatting Chronic Disease

The direct and indirect costs of chronic disease in the United States are staggering. It is estimated that the costs of heart attack, stroke, and cardiovascular disease exceed $137 billion annually. The costs for Alzheimer's disease approach $80 billion a year. Chronic conditions of mental illness, addictive disorders, and neurological diseases are responsible for over $300 billion in costs a year. Costs of arthritis and bone and muscle disorders (such as osteoporosis) are over $100 billion annually. A recently completed National Institute of Neurological Disorders and Stroke-supported clinical trial showed that surgery to remove fatty deposits from the carotid artery, one of the main arteries supplying blood to the brain, reduced the five-year risk of stroke by about half in patients with a 60 percent or more narrowing of this artery but no stroke-like symptoms. Stroke, the third leading cause of death in the United States, the major cause of permanent disability, and a major contributor to dementia in later life, cost this nation an estimated $25 billion in medical costs and lost productivity in 1995.

IV. NIH Is An Investment In Tomorrow's Health Care

a. The Hope of Gene Therapy

Investment in basic research in molecular biology, genetics, and virology during the past forty years has created the potential not only to identify the specific genetic defects that underlie many diseases but also to correct these deficiencies. With adequate federal support, we are within reach of major breakthroughs in understanding and treating chronic, debilitating diseases that affect millions of Americans including systemic lupus, rheumatoid arthritis, scleroderma, and other autoimmune rheumatic illnesses. NIH-supported research has led to major advances in our understanding of the genetic basis of neurodegenerative disorders of the brain, including Huntington's disease, amyotrophic lateral sclerosis (Lou Gehrig's disease) and the most common form of Alzheimer's disease have been identified.

b. Unlocking Cancer's Secrets

Advances in genetics has ushered in a new era in the prevention and treatment of some forms of cancer. Researchers have discovered the genes responsible for inherited breast cancer and an inherited form of colon cancer. In addition, recent research has shown that prostate cancer may be linked to a defect that hampers the body's defense against cancer-causing substances in the environment. Scientists found that a specific genetic defect blocks production of a protective enzyme, and they have been able to use drugs to make the problem gene work again under laboratory conditions. However, more research is needed to find out whether this can be done in people.

c. Understanding the Immune System and Combatting AIDS

Scientists have recently begun examining the use of an established cancer drug as a means to combat the AIDS virus, by undermining the processes that control its reproduction in the body. The findings that the drug hydroxyurea may block the replication of the human immunodeficiency virus (HIV) and that a protein from the virus controls the latent disease in the body following infection suggest that finding ways to control the disease without directly attacking it may be the optimal approach. Although only test-tube results are available now, scientists are optimistic about the indirect way of controlling the virus that attacks the body's immune system.

d. Enriching the Lives of the Elderly

NIH-funded researchers have identified a genetic marker for Alzheimer's disease that may lead to improved diagnosis and treatment. New genetic discoveries related to a protein known as apoE4 may lead to an effective inexpensive means of diagnosing Alzheimer's diseases.

Half of all Americans age 65 and older will suffer from some form of arthritis by the year 2000. In recent years, investigators have gained significant knowledge about how enzymes break down cartilage and bone in osteoarthritis, the most common form of the disease. Efforts to translate these basic research findings into clinical applications are now on the horizon.

As many as 3 million Americans suffer from congestive heart failure, the leading cause of hospitalization in Americans over age 65. An estimated 400,000 new cases of congestive heart failure occur each year. National Heart, Lung, and Blood Institute-supported researchers have discovered that an ACE inhibitor used in conjunction with standard therapy can treat symptoms, reduce hospitalization and death rates in people suffering from overt heart failure, and delay the onset of congestive heart failure in asymptomatic patients with poor ventricular function.

Parkinson's disease, which afflicts about 1 million Americans, is caused by the unexplained and gradual loss of brain cells that produce dopamine, a chemical in the nervous system (neurotransmitter) responsible for coordination of muscular activity. Recently, researchers have discovered a possible potent, specific nerve growth factor with promising potential as a treatment for Parkinson's disease. GDNF may be able to prevent or even reverse symptoms of the disease.

The National Institute of Neurological Disorders and Stroke supports research on stroke prevention, diagnosis, rehabilitation and treatment to protect nerve cells and limit brain damage following a stroke. Researchers are developing strategies to advance understanding of stroke through new genetic and novel immunologic technologies that will contribute to health care cost savings by allowing early diagnosis of stroke in patients at stroke risk and developing more effective treatment for stroke patients.

e. Enriching the Lives of Children

Recent advances in National Heart, Lung, and Blood Institute supported research have begun to clarify the genetic basis for many of the 35 types of congenital heart defects. NHLBI research aimed at identifying mechanisms by which nutrients affect genes necessary for normal heart development may lead to the recognition of new genes controlling heart maturation and ultimately to the prevention of congenital heart defects. NHLBI-funded centers of research in pediatric cardiovascular diseases are focusing on innovative multidisciplinary basic and clinical research on congenital and acquired cardiovascular diseases in children that could produce new prevention and treatment methods.

Juvenile diabetes (insulin-dependent) affects over 1 million Americans and primarily strikes children. Juvenile diabetes occurs when the body's immune system attacks itself and destroys insulin-producing cells in the pancreas. This autoimmune attack is triggered by a certain agent only in people with a specific genetic profile. Researchers have found evidence that the trigger may be the polio-related coxsackie virus. If this virus is show to be a primary cause of the disease, vaccines against it could prevent diabetes. In addition, recent advances in the identification of the genes associated with diabetes will allow more accurate assessments of people at risk of developing the disease.