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Federal Document Clearing House
Congressional Testimony
March 14, 2000, Tuesday
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 3987 words
HEADLINE:
TESTIMONY March 14, 2000 ORA HIRSCH PESCOVITZ M.D.,PROFESSOR,DIRECTOR INDIANA
UNIVERSITY HOUSE APPROPRIATIONS LABOR, HEALTH AND HUMAN
SERVICES, AND EDUCATION LABOR HHS APPROPS
BODY:
ORA
HIRSCH PESCOVITZ, MD COMMITTEE ON APPROPRIATIONS SUBCOMMITTEE ON LABOR, HEALTH
AND HUMAN SERVICES, AND EDUCATION March 14,2000 WITNESS: Mr. Chairman, members
of the Subcommittee, I am Ora Hirsch Pescovitz, MD, Professor of Pediatrics,
Professor of Physiology and Biophysics and Director of Pediatric
Endocrinology/Diabetology at Indiana University. I am president- elect of the
Society for Pediatric Research and I also serve as a member of the Scientific
Advisory Committee of the Ad Hoc Group for Medical Research Funding. Today, I
present this testimony on behalf of the Public Policy Council (PPC), the public
affairs coordinating body for the three major pediatric academic research
societies, the Society for Pediatric Research, the American Pediatric Society
and the Association of Medical School Pediatric Department Chairs. Together,
these three organizations represent biomedical, clinical and health sciences
pediatric researchers in a variety of settings including medical schools,
children's hospitals and other research facilities. These pediatric researchers
have dual missions. First, they are the scientists - both laboratory and
clinical - who make critical discoveries that advance pediatric care to improve
the lives of America's children. Second, and equally as important, they serve as
the faculty and mentors to tomorrow's pediatricians and pediatric researchers so
that pediatric health care delivery and the education and training cycle can
continue. On behalf of the pediatric academic research community, my testimony
will address the following: the need for sustainable and appropriate funding for
biomedical, behavioral, clinical and health services research, including
pediatric research, the importance of equitable federal investment for the
training and education of the nation's future pediatricians and pediatric
scientists, particularly in independent children's teaching hospitals, and
highlight the importance of immunization research and delivery. PEDIATRIC
RESEARCH: Through federally funded advances in science, infants, children and
adolescents are leading healthier lives. The public's dollars are making a
difference on a daily basis. But this federal commitment must be sustained if we
are to ensure that each generation will be healthier than the last. Research
holds enormous promise for pediatric health as we begin this new century. Take
as an example the growing field of genetics and the potential implications for
children. As Francis Collins, MD, PhD, Director, National Human Genome Research
Institute, notes, we are now at the cusp of developing the periodic table for
biology. Since most diseases have a genetic component, the benefits from the
human genome revolution will be enormous, coupled with appropriate privacy
protections and patient and provider education. As you are aware, several months
ago, the first human chromosome, number 22, was decoded. Last year, a National
Institute of Child Health and Human Development (NICHD) supported researcher
discovered a gene that controls the development of the hippocampus, a part of
the brain crucial to learning and memory. Recently, another NICHD researcher
discovered the genetic basis for Retts disease, a neurological disorder that
primarily affects young girls and creates significant motor and mental
impairment in previously healthy- seeming young toddlers. As the genetic
revolution moves forward, opportunities for further investments in the building
blocks of scientific research will continue to blossom. Potentially even more
important, these scientific contributions directly improve pediatric health
outcomes. Last year, a study published in the New England Journal of Medicine
demonstrated that pregnant women infected with HIV can reduce the risk of
transmitting the virus to their infants by approximately 50 percent if they
deliver by elective cesarean section before they have gone into labor and their
membranes have ruptured. Combined with what was previously known about the use
of AZT or other antiretroviral drugs during pregnancy, transmission of HIV from
mother to child can be reduced to approximately 2 percent. Thanks to funding
from the National Institute for Child Health and Human Development (NICHD) and
the National Institute for Allergy and Infectious Disease (NIAID), we now know
how to reduce one of the most tragic routes of HIV infection - from mother to
newborn. There are still many pediatric diseases that are not preventable or for
which treatment may not exist, may only be palliative, or is simply inadequate.
Even relatively common pediatric diseases, such as cystic fibrosis and juvenile
onset diabetes - diseases that we do know a great deal about - do not have a
cure. Modem therapy for such diseases is cumbersome, costly and stressful for
children and their families. Whereas it is obvious that we want children to have
healthier childhoods, it may be less obvious that improvements in pediatric
medicine will have far-reaching implications on the societal and economic costs
of disease in adults. Many diseases usually associated with adulthood actually
have their origins in childhood. Thus, a strengthened investment in pediatric
research will benefit adults as well as children. An illustrative example is
childhood obesity that now affects as many as one in five children in the United
States. Obesity predisposes children to develop Type 11 diabetes, insulin
resistance and cardiovascular disease. African American, Latino, American and
Pima Indian children are at even greater risk for these disorders. With the
growing rate of obesity in children and adolescents, pediatric research is
needed to develop effective interventions to prevent morbidity both during
childhood and adulthood. If we could effectively reduce the rate of childhood
and adolescent obesity through prevention, healthier life styles, and/or
treatment, we could substantially reduce the financial burdens of other diseases
including coronary heart disease, diabetes and stroke. The combined costs of
cardiovascular, endocrine, nutritional and metabolic diseases are estimated to
be $232.1 billion annually, more then 12 times the size of the NIH budget.
Imagine the economic and societal savings that are possible if we invest in
preventing these diseases during childhood and adolescence! The pediatric
community applauds the ongoing commitment of Congress, through the leadership of
this Committee, to increase the funding for the National Institutes of Health.
We join with the Ad Hoc Group for Medical Research Funding in calling for a 15%
increase for the NIH's appropriation in FY 2001 as the third step towards
doubling the NIH budget by 2003. We also join with the Friends of the NICHD in
recommending $1.06 billion in funding for the NICHD in FY 2001. In particular,
this Committee has also helped make pediatric research a priority at the highest
level of the NIH through your continued support for the pediatric research
initiative. We recommend funding this initiative, currently in the office of the
NIH director, for at least $50 million in FY 2001. These funding recommendations
are grounded in the amount necessary to continue the advances that we have come
to expect and anticipate in pediatric research. Finally, we join with the
Association of American Medical Colleges and others in encouraging the future
"billionizing"of the Agency for Healthcare Research and Quality. To begin that
quest, we join the Friends of AHRQ to recommend $300 million for the Agency for
Healthcare Research and Quality in FY 2001, to ensure that basic and clinical
research is translated directly into improved quality of health care, including
pediatric care. PEDIATRIC EDUCATION: The opportunities for improving children's
health and health care are growing daily. However, without the appropriate
training, educational programs and mentorship for tomorrow's researchers and
clinicians, the advances of today may never be realized. At the National
Institutes of Health, MD/postdoctoral trainees decreased by 51 % in four years,
from 1992 to 1996, and the number of first time MD applications for grant
support fell by half from 1994 to 1997. A recent project spearheaded by the
Association of American Medical Colleges and the American Medical Association
found similar results. The pediatric academic research community encourages your
support for pediatric loan forgiveness programs to recruit and increase the
number of pediatric research scientists. We also urge expansion of and increased
funding for research training programs, such as at the NICHD, that will attract
and support pediatric research investigators, including minority group pediatric
research scientists, and provide opportunities for mentoring by experienced
clinical investigators. Without adequate pediatric research training avenues,
the field will wither. Equally important to the future of pediatric
education and research in this country is the plight of
graduate medical education programs in independent children's
teaching hospitals. As you are aware, independent children's teaching hospitals
represent less than I% of all hospitals in the country but play a critical role
in delivering health care services to children and in training future
pediatricians. Moreover, nearly 30% of the nation's pediatricians, nearly half
of the pediatric subspecialists and the majority of certain subspecialists, such
as pediatric emergency care physicians, are trained in these settings. With
missions dedicated to children's health including indigent care, and to
pediatric education and research, these hospitals are at a significant
disadvantage in the price- competitive health care market place. If these
independent children's hospitals do not survive, we fear potentially devastating
consequences for the future quality of children's health care. The pediatric
academic research community recognizes this committee's leadership and support
of graduate medical education funding for these essential
children's hospitals as evidenced by the FY 2000 start-up appropriations of $40
million, the first year the children's hospital GME program was authorized. We
strongly urge you to maintain and increase this commitment in FY 2001. According
to estimates of the Lewin Group, an independent health policy analysis firm, GME
support comparable to what other hospitals receive through Medicare would amount
to an appropriation of $285 million annually. This is the amount that Congress
authorized for GME support for children's hospitals in legislation enacted PL
106-129 last year. Until comprehensive GME financing reform occurs, we urge you
to build on last year's accomplishment and provide, at a minimum, $125 million
of funding for GME support for children's hospitals in FY 2001. Without this
support and federal funding, independent children's teaching hospitals may not
be able to continue their valuable contributions to pediatric research,
education and health care delivery. IMMUNIZATIONS - THE POWER OF SOUND PEDIATRIC
RESEARCH: The public health accomplishments of childhood immunizations serve as
an example of the enormous benefits that can come of sound pediatric biomedical
and clinical research and quality health care delivery. I would like to spend a
few moments on this issue. With a single intervention, we have reduced vaccine-
preventable infectious diseases by more than 95 to 99 percent (although many
causative agents still persist in epidemic or endemic burdens elsewhere in the
world). Smallpox has been eradicated. The incidence of measles has been reduced
from over 500,000 annual cases on average to only 89 cases in 1998. Haemophilus
influenzae type b Hib), the leading cause of childhood bacteria meningitis and
postnatal mental retardation, has fallen from an average annual incidence of
20,000 to 54 cases in 1998. Not only as a pediatrician, but also as a mother of
three healthy children, I am thankful that my children will never face many of
the diseases I saw earlier in my pediatric training. Through a national network
and partnership of clinicians, state health departments, community health
organizations, researchers, and state and federal policy makers, childhood
immunizations have become the most cost-effective and successful public health
achievement to date. This single intervention demonstrates the enormous return
possible on the federal investment in high quality biomedical and clinical
research. Without a continued federal commitment to research and delivery,
however, this national network may be at risk. As pediatric academicians and
researchers, we are closely monitoring several concerns recently raised
regarding the alleged linkages between the Hepatitis B, Hib, MMR and DTaP
vaccines and an increased incidence of several chronic diseases throughout the
country. Although it is understandable how a family can believe that a vaccine
caused the sudden, unexpected illness or death of a child, the preponderance of
the scientific research and evidence is to the contrary. Most recently, I am
disheartened to learn that the FDA's clinical trials for pneumoccocal vaccine
for infants and toddlers have been characterized unfairly as "Tuskegee- like"
for putting African American children at increased risk for the development of
diabetes. This is simply not true. In another instance an attempt was made to
link the MMR vaccine to diabetes. The research just does not support these
conclusions. Such allegations can both undermine the public's confidence and
have the potential to jeopardize the public health gains made by childhood
immunizations. Moreover, they illustrate the significant danger that can arise
when unfounded and scientifically questionable interpretations of research
capture the public's eye. Vaccine safety is an issue of significant importance
to me as a pediatrician and as a mother. I believe it can best be examined by
continuing to monitor existing vaccines, conducting new research in vaccine
development and furthering federal support of sound biomedical research, rather
than through the promotion of misinformation. There is more work to be done. As
the recently released Jordan Report 2000 highlights, the next frontier for
vaccines is clear: AIDS, malaria and tuberculosis. A child dies every thirty
seconds from malaria across the world. As childhood immunizations have
demonstrated to date, the best way to cope with disease is to prevent it from
occurring in the first place. We strongly urge you to provide appropriate
funding in FY 2001 of at least $615 million for the CDC's Childhood Immunization
program to continue to ensure that the safety and the national level of
vaccination remains as high as possible. Furthermore, we similarly urge you to
continue your strong commitment to vaccine research and development through
adequate funding for the NIH. CONCLUSION: As pediatricians and a researchers, we
know first hand that there are many important opportunities for additional
pediatric research which promise significant return on investment - not only
improved health for our children today but also economic productivity tomorrow -
as these children grow into adulthood. We support the increased investment in
research in general and the continued attention to the pediatric research
initiative in particular. Thank you for the opportunity to present this
testimony. In summary', the following list highlights programs, along with
funding recommendations, of importance to children. The Public Policy Council
joins with its many friends in other organizations and coalitions in presenting
these recommendations.
LOAD-DATE: March 17, 2000,
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