Copyright 2000 eMediaMillWorks, Inc.
(f/k/a Federal
Document Clearing House, Inc.)
Federal Document Clearing House
Congressional Testimony
March 21, 2000, Tuesday
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 3107 words
HEADLINE:
TESTIMONY March 21, 2000 LINDA Y. BUCHWALD M.D. THE AMERICAN ACADEMY OF
NEUROLOGY HOUSE APPROPRIATIONS LABOR, HEALTH AND HUMAN
SERVICES, AND EDUCATION LABOR HHS APPROPS
BODY:
March 21, 2000 By: Linda Y. Buchwald, M.D. For: The American Academy of
Neurology The American Neurological Association The Child Neurology Society Mr.
Chairman: I wish to thank you and the Subcommittee for this opportunity to
testify on the budget for fiscal year 2001 and for your leadership as a
subcommittee on the NIH budget. I will emphasize in my testimony, our proposal
for the NIH budget for 2001. I am testifying on behalf of the American Academy
of Neurology (AAN), a medical specialty and scientific society of 16,000
physicians and neuroscientists, the American Neurological Association,
representing the academic community in neurology and the Child Neurology
Society, representing about 1200 child neurologists. My Curriculum Vitae is
attached. I am a practicing neurologist and currently serve as the chair of the
AAN Legislative Affairs Committee and am on the National Advisory Board of the
National MS Society. I specialize in treating Multiple Sclerosis and direct the
MS clinic at Mount Auburn Hospital in Cambridge. I currently hold faculty
appointments at both Harvard and Tufts University Medical Schools. For the past
two years, the Academy, the American Neurological Association and the Child
Neurology Society have been Dart of a coalition with consumer and patient groups
referred to as the Brain Advocacy Coalition (BAC), which I have chaired. Active
participants have included the Alzheimer's Disease Association, the American
Heart Association (Stroke Division), the ALS, the Brain Injury Association, the
Epilepsy Foundation of America, the National Multiple Sclerosis Society and the
Parkinsons Disease groups. The one priority, on which all groups in the BAC have
agreed over this two-year period, is the NIH budget. This fact only confirms the
data from public opinion surveys on the importance of medical research. There is
a clear consensus each year among all our groups supporting the importance of
expanding basic and clinical research at NIH in order to lengthen and improve
the lives of individuals suffering from neurological disorders. We thank the
Subcommittee for its efforts on this front in the past. We are coming to you
again for help. The President's budget for the fiscal year 2001 is far short of
what is needed for NIH. We urge you to continue the program begun in 1999 of
doubling the NIH and NINDS budgets over 5 years; this policy represents a 15%
increase for 2001. NIH AND NINDS INCREASES OF 15 % In support of our proposal
for a 15% increase for the NIH and NINDS in 2001, we have good news to report
about recent developments, and future plans, regarding research on the brain and
neurological conditions. First, we are very lucky to have great leadership of
the NINDS in the person of Dr. Fischbach. He has been thoroughly accessible to
the consumer, patient and scientific communities. He has established a strategic
plan for research in NINDS, which is a blend of both basic and clinical
research, emphasizing cross cutting, inter-institute initiatives. Of particular
note are the following achievements under Dr. Fischbach's leadership at NINDS: -
Application of deep brain stimulation technology in Parkinson's disease and
other neurological disorders; this is a major clinical research initiative. -
Research to guide improved treatment of brain aneurysms by identifying and
treating unruptured aneurysms. - New findings on the use of preventative
techniques to deal with stroke based on chemicals that enhance brain cell
tolerance after mild strokes, referred to as ischemic events. - Animal research
findings related to restoration of brain cell function in old age and preventing
or reducing memory loss. - Gene findings related to epilepsy, which may open the
door to new drug treatments. FUTURE PLANS OF NINDS Future initiatives being
planned, which would in our opinion require increases above the President's
budget, include expansion of efforts in the areas mentioned earlier as
achievements and the following: - Collaborative research with the National
Cancer Institute on research to deal with brain tumors. - A major initiative
referred to as the "Healthy Brain" - this initiative would include a
multi-institute longitudinal study similar to the Framingham study on heart
disease to determine risk factors of brain function degeneration and methods to
enhance brain function; this initiative also includes efforts to treat common
childhood conditions such as Retts Syndrome, autism and intractable epilepsy.
Regeneration and repair of the adult nervous system including the use of neural
prostheses and research on spinal regeneration. Research regarding the use of
neural stem cells to create stem cell therapies which may apply to many nervous
system disorders including Parkinson's disease and spinal cord injury. OTHER NIH
INITIATIVES I would like to identify three other specific NIH initiatives we
strongly support and urge the Committee to adopt. Neuroscience Center The NIH
budget proposal for fiscal year 2001 includes $73 million over two-years for
construction of a neuroscience center on the NIH campus. We strongly support
this proposal. The Center will bring together in one facility, with necessary
new lab space, both basic and clinical intramural scientists from the many
institutes involved in neuroscience in order to encourage their interaction and
the translation of basic research findings. The Center should stimulate further
interest in basic and clinical researchers to work in neuroscience. The Center
will bridge the artificial boundaries of NIH Institutes and agencies and
academic departments. It will emphasize important cross cutting themes such as
neurodegeneration, regeneration and repair of neurons, neurogenetics and pain
research. Clinical Research Initiatives - Loan Forgiveness Authority The NINDS
needs to be even more aggressive than it has been in, expanding clinical
research in neurology. Of particular importance to us is the NTH proposal in
this year's budget for the creation of a loan forgiveness fund to encourage
physician scientists to enter careers in clinical research. Under the proposal,
physician scientists engaged in clinical research, approved by NIH, would have
forgiven one year of principal and interest on medical school loans for each
year of clinical research they undertake. This is an initiative long sought by
the clinical research community. National Center for Medical Rehabilitation
Research (NCMRR) Finally, Mr. Chairman, we support a $1 0 million addition to
the President's budget request for the National Center for Medical
Rehabilitation Research (NCMRR) which is located in the National Institute for
Child Health and Human Development. The NCMRR works closely with NINDS and other
NIH agencies on research related to the rehabilitation needs of individuals with
physical disabilities. The NCMRR recently has had a new Director appointed, Dr.
Michael Weinrich, from Baltimore and the Baltimore VA associated with the
University of Maryland. Dr. Weinrich is a neurologist who is a medical
rehabilitation specialist. He is a leader in the Academy and we look forward to
his strong leadership of NCMRR. A $ 10 million addition to the President's
request for the NCMRR and the NICHD budget would support three specific
initiatives, which have been planned, or partly initiated, by the NCMRR: -
Clinical trials to test the efficacy of medical rehabilitation techniques
including new techniques for stroke rehabilitation and a clinical trial network
for brain injury research. - Cell plasticity and recovery from trauma including
tissue engineering for amputees and neuron growth related to stroke or spinal
cord injury. - Medical rehabilitation for victims of pediatric trauma who have
very special needs due to their lack of fall development at the time of injury.
GRADUATE MEDICAL ED UCA TION SUPPOR T FOR CHILDREN'S HOSPITALS The President's
budget proposes $80 million for fiscal year 2001 to support residency training
of physicians being trained in children's hospitals. This proposal implements a
new program enacted in November 1999 and funded by the Subcommittee and the
Congress at $40 million for 2000. Under current policy, graduate medical
education and residency training is financed by Medicare and funding is
proportional to the Medicare patients in a teaching hospital. Children's
hospitals have basically no Medicare patients but do training of residents in
pediatrics and subspecialties of pediatrics as well as related children's
specialties, such as child neurology. This new Children's Hospital program
provides support for the graduate medical education of these
various children's hospital training programs in order to compensate for the
fact that these hospitals get no Medicare medical education payments. Children's
hospitals provide for the first two years of training in child neurology, while
neurology departments in adult hospitals, together with children's hospitals,
provide the last three years of training. Medicare funds part of the last three
years only. Recently, Medicare was amended, with HCFA's support, to correct an
inequity in Medicare financing of child. Funding of this new program for
pediatric hospitals will assist in funding the first two years of child
neurology training. The Academy has supported a workforce study in neurology,
which established a major need for child neurologists. Other recent studies have
shown the need for more residents in pediatric subspecialties. We would urge the
Subcommittee to fully fund this program which is authorized at a total of $290
million. This amount is reasonably proportional to the number of residents in
general and specialty pediatrics and related children's programs, which utilize
pediatric hospitals for training. Medicare financing of graduate medical
education for all other specialties is about $7 billion. $290 million
is about 4% of that figure. At a minimum, we believe that $125 million is
necessary. Expansion of this program will greatly assist in efforts to increase
the numbers of child neurologists in order to expand access to care for children
with such complex conditions as epilepsy, other seizure disorders ' cerebral
palsy, brain injury, migraine headaches and severe learning disabilities.
Neither the individual testifying nor any of the organizations for which she is
testifying are recipients of any federal grants at this time or in the past
three (3) years.
LOAD-DATE: March 28, 2000, Tuesday
