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S. Hrg. 103-264, Pt. 1 Senate Hearings Before the Committee on Appropriations Y 4, AP 6/2: S. HRG. 103-264/ PT.l Departments of Labor, Health and Hu... Departments of Labor, Human Health and Services, and and Related Education, Agencies Appropriations Fiscal Year 1994 103d CONGRESS, FIRST SESSION H.R. 2518 '" PART 1 (Pages 1-834) ^^Ql^'i#^W NONDEPARTMENTALWITNESSES S. Hrg. 103-264, Pt. 1 DEPARTMENTS OF HEALTH AND HUMAN LABOR, AND AND RELATED SERVICES, EDUCATION, AGENCIES APPROPRIATIONS FOR FISCAL YEAR 1994 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE ONE HUNDRED THIRD CONGRESS FIRST SESSION ON H.R. 2518 AN ACT MAKING APPROPRIATIONS FOR THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES, FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 1994, AND FOR OTHER PURPOSES Part 1 (Pages 1-834) Nondepartmental witnesses Printed for the use of the Committee on Appropriations U.S. GOVERNMENT PRINTING OFFICE 68-619cc WASHINGTON : 1993 ForsalebytheU.S.GovernmentPrintingOffice SuperintendentofDocuments,CongressionalSalesOffice,Washington,DC 20402 ISBN 0-16-041750-3 COMMITTEE ON APPROPRIATIONS ROBERT C. BYRD, West Virginia, Chairman DANIEL K. INOUYE, Hawaii MARK O. HATFIELD, Oregon ERNEST F. HOLLINGS, South Carolina TED STEVENS, Alaska J. BENNETT JOHNSTON, Louisiana THAD COCHRAN, Mississippi PATRICK J. LEAHY, Vermont ROBERT W. KASTEN, Jr., Wisconsin JIM SASSER, Tennessee ALFONSE M. D'AMATO, New York DENNIS DeCONCINI, Arizona ARLEN SPECTER, Pennsylvania DALE BUMPERS, Arkansas PETE V. DOMENICI, New Mexico FRANK R. LAUTENBERG, New Jersey DON NICKLES, Oklahoma TOM HARKIN, Iowa PHIL GRAMM, Texas BARBARA A. MIKULSKI, Maryland CHRISTOPHER S. BOND, Missouri HARRY REID, Nevada SLADE GORTON, Washington J. ROBERT KERREY, Nebraska MITCH McCONNELL, Kentucky HERB KOHL, Wisconsin CONNIE MACK, Florida PATTY MURRAY, Washington CONRAD BURNS, Montana DIANNE FEINSTEIN, California James H. English, StaffDirector Mary S. Dewald, ChiefClerk J. Keith Kennedy, Minority StaffDirector Subcommittee on Departments of Labor, Health and Human Services, and Education, and Related Agencies TOM HARKIN, Iowa, Chairman ROBERT C. BYRD, West Virginia ARLEN SPECTER, Pennsylvania ERNEST F. HOLLINGS, South Carolina MARK 0. HATFIELD, Oregon DANIEL K. INOUYE, Hawaii TED STEVENS, Alaska DALE BUMPERS, Arkansas THAD COCHRAN, Mississippi HARRY REID, Nevada SLADE GORTON, Washington HERB KOHL, Wisconsin CONNIE MACK, Florida PATTY MURRAY, Washington CHRISTOPHER S. BOND, Missouri Majority Professional Staff Ed Long, James J. Sourwine, Carol C. Mitchell, and Margaret Stuart Minority Professional Staff Bettilou Taylor and Craig A. Higgins Administrative Support Gladys Clearwaters and Susan A. McGovern (II) CONTENTS Monday, April 26, 1993 Page Nondepartmental witnesses 1 Wednesday, April 28, 1993 Nondepartmental witnesses 87 Friday, April 30, 1993 Nondepartmental witnesses 173 Monday, May 3, 1993 Nondepartmental witnesses 241 Wednesday, May 5, 1993 Nondepartmental witnesses 349 Friday, May 7, 1993 Nondepartmental witnesses 435 Material submitted subsequentto conclusion ofhearings 545 (ill) DEPARTMENTS OF LABOR, HEALTH AND HUMAN AND AND SERVICES, EDUCATION, RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 1994 MONDAY, APRIL 26, 1993 U.S. Senate, Subcommittee of the Committee on Appropriations, Washington, DC. The subcommittee met at 1:03 p.m., in room SD-192, Dirksen Senate Office Building, Hon. Patty Murray presiding. Present: Senators Murray and Gorton. NONDEPARTMENTAL WITNESSES OPENING STATEMENT OF SENATOR PATTY MURRAY Senator Murray. Good afternoon. Today, this subcommittee will begin its first day of testimony from approximately 150 congres- sional and public witnesses. We have scheduled six special sessions to hear this testimony. This year, the Committee had requests from 311 individuals and public organizations to testify before the subcommittee. Because of the limitations of time, we were able to schedule only 150 individuals and organizations who wrote to us. I regret that we cannot hear everyone, but the Committee has made it known to those who did not make the cutoff that we would be pleased to publish their statements in the hearing record. In order to keep on schedule, we will need to use the red light/ green light system, which will give each ofthe witnesses 3 minutes to summarize the key points of their statement. I would request that each witness please attempt to complete the statement when the 3 minute red light goes on. The red light will be preceded by a 2 minute yellow warning light. This will give us time to ask a few questions and it will also ensure that everyone gets a fair and equal chance to address this subcommittee. Today, we will hear testimony on a wide range of subjects, in- cluding programs for children, rural health, and the National Insti- tutes ofHealth. We will be hearing from a number ofimportant organizations representing those programs. I look forward to the ad- vice of each ofyou in making the many difficult decisions that face us during this year's appropriations cycle. As a brief introduction to some of the budgetary problems this subcommittee will be facing this year, let me go over some of the numbers. The President's budget released this month provides for (l) an $8.9 billion increase in investment and noninvestment programs in the labor, health and human services, and educations appropriations bill from the fiscal year 1993 level of $62.2 billion to $71.1 billion. By way of comparison, last year, this subcommittee's allocation over fiscal 1992 increased by only $1.7 billion. So if we fail to get the necessary allocation our chairman and the subcommittee members will be forced to make some very tough choices. I hope the testimony that will be presented to this subcommittee today and over the next 2 weeks will help us in making some of those decisions. STATEMENT OFDR. GAIL CASSELL, PRESIDENT-ELECT, AMERICAN SO- CDZTYFORMICROBIOLOGY Senator Murray. In the interest of time, I will be requesting that several witnesses come to the table at the same time. At this point, I ask that Gail Cassell, Gloria Reich, Jennifer Hutchinson, Peter Bellermann, Stephen Saunders, and Karen Mountain come to the table. We will begin with our first witness, Dr. Gail Cassell, president- elect ofthe American Society for Microbiology. Dr. Cassell. Senator Murray, first of all, I would like to thank you for the opportunity to testify this afternoon on behalf of the American Society for Microbiology. Our organization represents 39,000 members who are primarily involved in research related to microbiological infectious diseases and immunology. First of all also, I would like to thank you for the leadership that has been shown by this subcommittee in being an advocate for increased funding for the National Institutes of Health and to also state again that your continued leadership in this area will be absolutely essential ifthe United States is to maintain our competitiveness in biomedical research and biotechnology. Quite honestly, we find that the 1994 budget is a threat to our leadership position in biomedical research and biotechnology. We have submitted a written testimony and would appreciate it being accepted into the written record, and this afternoon I basically would like to just emphasize two points that we have made in our testimony. Our first and major concern is that for the first time in our memory the actual budgets for most of the NIH Institutes, in fact, have received decreased funding in this year's budget. We view this as a big threat to basic biomedical research. In fact, for the first time since 1992, there will be a decrease of 1,200 grants directly related to investigator-initiated research project grants. Basic research forms the foundation upon which biotechnology is based and also provides the groundwork for later clinical applica- tion. An example of that is that a number of years ago, up to 15 years ago, basic research on viral replication has given us the understanding of how viruses replicate. And it is that understanding now which forms the basis for gene therapy. You may have read in USA Today about the therapy trials that will be proceeding shortly in humans for cystic fibrosis. This is based on incorporation of the defective gene into a viral recom- binant vector that will be used for gene delivery. It was basic research that actually led to that technology. In fact, it was basic research that led to the emergence of biotechnology, and in fact, the National Institute of General Medical Science, as you may appreciate, is the Institute within NIH that funds most of basic research. In this year's budget there will be only a 0.1-percent increase in that Institute's budget. Our other major concern, other than the significant decrease for what we view as funding for basic biomedical research, is in the non-AIDS budgets within the National Institute of Allergy and In- fectious Diseases. At first glance, it looks like that this Institute which primarily funds most of the AIDS research, in fact, did fare very well with respect to overall funding. But once one subtracts the increases for AIDS research and that for earmarking, that institute for all non-AIDS research will receive an 8-percent decrease in research funding. This is important because there are a number ofnew and emerg- ing infectious diseases resulting from our problems in inner cities, the global economy where we have increased transportation of infectious agents into this country both by way of travelers as well as by way ofimported food. We view this as a major concern. PREPARED STATEMENT In summary, the fiscal year 1994 President's budget does not really reflect, we feel, a strong commitment to basic biomedical research and biotechnology for the reasons that I have mentioned. We feel that all of the NIH Institutes do need additional funding, additional resources, in order to survive and best accomplish its ob- jectives and mission. The ASM does support the ad hoc group's for biomedical research proposal for $11.6 billion for NIH. We thank you, again, for this opportunity and for your continued support. I would be happy to answer any questions that you might have. Senator Murray. Thank you, Dr. Cassell. [The statement follows:] Statementof Gail H. Cassell My name is Gail Cassell and I am President-Elect of the American Society for Microbiology (ASM). On behalfofthe ASM, I am pleased to present for your consideration our recommendations for the fiscal year 1994 appropriation for the National Institutes of Health (NIH). The ASM represents over 39,000 members in the microbiological sciences who are actively involved in such important areas as infec- tpiuobulsicanhedalitmhm.unWoelogwiicsahltdoiseexapsreess,smooluercualpaprrebciioaltoigoynafnodr ygeonuerticcos,ntbiinoutiencghnloelaodgeyrsahnidp to achieve more adequate funding for the important research programs ofthe Na- tional Institutes of Health. Your leadership is enormously important to the future ofbiomedical research and biotechnology in the U.S. We urgeyou to seriously recon- sidertheAdministration's fiscal year 1994 budgetrequest for the NIH. Biomedical research and biotechnology, which is a direct outgrowth of basic research, are areas in which the U.S. is and should remain a world leader. However, U.S. leadership in these two areas is threatened by the Administration's fiscal year 1994 funding request for the NIH. We understand the Administration must focus on deficit reduction but believe the NIH should be given special consideration because its programs are so vital to the future ofthis country. The proposed budget will have a significant damaging impact on the Nation's biomedical research efforts and it represents a shortsighted vision to achieve near-term savings. We are very disappointed that the Administration has for the first time in our memory proposed actual cuts in mostofthebudgets ofthe NIH institutes. Only two years ago the House and Senate Appropriations Committees directed NIH to formulate a "financial management plan' to bring stability to federal biomedical research funding. The plan was to fund 6,000 new and competing grants each year and maintain a stable pool of24,000 active grants without"downward ne- gotiations." Last year, Congress abandoned this plan and passed a 1993 budget for NIH which was about $200 million short of the amount needed to cover the cost ofbiomedical research inflation. The proposed budget increase for fiscal year 1994 will add to the dire situation for biomedical research because the proposed increase is only 3.2 percent, which is again below the biomedical inflation rate projected at 4.7 percent. Although the Administration's proposed budget earmarks funding for important areas sucn as AIDS, vaccines, tuberculosis and the genome project, basic biomedical research would be hurt most severely by the budget request. As you know, basic research cannot promise specific cures in a defined time, but without a continuous flow ofnew basic knowledge over the long-term, few treatments, cures or prevention ofdisease are possible. Gene therapy is the most promising approach to prevention ofmany inherited diseases. The most effective means ofgene delivery is use ofrecombinant viruses. Without our previous investment in research focused on basic viral replication, these life-saving therapies would not be available. The most effective approach to improving health lies in fostering the research that increases understandingofthe disease process. The U.S. must be at the frontier ofbasic research as well as applications oftech- nology to achieve economic progress. The nation's economy can benefit greatly from the results ofbasic research. Basic research supported by the NIH has led to U.S. preeminence in biotechnology, which is critical to industrial growth in the U.S. Bio- technology is making a growing contribution to our nation's economy. We are just on the threshold in biotechnology research and the largest portion ofthe recogmzed opportunities in biotechnology Tie ahead of us. With increased investment in basic research, opportunities in biotechnology can be pursued which can make significant reductions in health care costs through advances in early diagnosis and preventive craersee.arBcuhtacnodntitnruaiendinUg.S.prdoogmrianmasncfeunidnebdiobtyecthhneolNoIgyH.deWpeendasreo,nthmearienftoarie,nivnegrystrcoonn-g cerned that the institute devoted most exclusively to basic science, the National In- stitute of General Medical Sciences (NIGMS), is to receive only a 0.1 percent increase in the Administration's budget. The proposed budget for NIGMS is woefully inadequate and does not reflect a strong commitment to the future ofbiotechnology in the U.S. The NIGMS is a vitally important basic science institute which supports excellent research and training programs and also administers the Minority Access to Research Careers (MARC) program, as well as initiatives to improve the rep- resentation of minorities among Ph.D. recipients and their overall numerical rep- resentation in thebiomedical science workforce. Biomedical research and biotechnology are a real investment in the future and should be maintained as a high priority as this Administration tries to solve the nation's health, environmental and economic problems. Federal investment in NIH supported research has led to a scientific revolution, a golden age ofscientific opportunities to improve human health. However, scientific progress against disease will be limited by the Administration's proposed budget. Much promising research will go unfunded, which has the effect oi not only delaying new discoveries, but also dis- couraging students from pursuing careers in the biological sciences. Investigator-initiated research projects are the first step in any major scientific development that ultimately impacts on human health and public welfare. The strength of the U.S. biomedical research enterprise relies on investigator-initiated research grants, yet these grants will be underfunded, actually scaled back, in the Administration's budget request for NIH. The Administration's budget allows virtually no increase in the average cost ofgrants relative to fiscal year 1993. In fiscal 1994, the number of new and competing grants will decline to 5,594, a drastic reduction from the 6,795 new and competing grants funded in fiscal 1992. Ifthe Administration's budget is enacted, many of the NIH institutes will be able to support only one out of five grant applications in the coming year. This will have a devastating effect on the biomedical research enterprise and on our ability to tap the many scientific opportunities ready to be explored. Many well trained scientists are already beginning to drop out of the system due to lack of support. Entire laboratories are closing. Equipment is gaining dust due to lack ofresearch supplies and personnel. Thus we are not only losing "interest on our previous investments," but the system is rapidly headingtoward bankruptcy. This underinvestment in basic biomedical research now will limit future growth in applied areas, particularly biotechnology. The biotechnology industry is increas- ingly dependent on scientific personnel trained in universities in basic research areas. Sustained support for basic research also affects advances in biotechnology