DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
Dr. Duane Alexander
Director, National Institute of Child Health and Human Development
Fiscal Year 2000 President's Budget Request
for the National Institute of Child Health and Human Development
Mr. Chairman and Members of the Committee:
I am pleased to present the FY 2000 President’s budget request for the National Institute of Child Health and Human Development (NICHD) of $694.1 million, an increase of $16.2 million or 2.4 percent over the comparable FY 1999 appropriation. Including the estimated allocation for AIDS, the total support proposed for NICHD is $771.7, million an increase of $18.1 million over the comparable FY 1999 appropriation. Funds for NICHD efforts in AIDS research are included within the Office of AIDS Research budget request.
The activities of the NICHD are covered within the NIH-wide Annual Performance Plan required under the Government Performance and Results Act (GPRA). The FY 2000performance goals and measures for NIH are detailed in this performance plan and are linked to both the budget and the HHS GPRA Strategic Plan which was transmitted to Congress on September 30, 1997. NIH’s performance targets in the Plan are partially a function of resource levels requested in the President’s Budget and could change based upon final Congressional Appropriations action. NIH looks forward to Congress’ feedback on the usefulness of its Performance Plan, as well as to working with Congress on achieving the NIH goals laid out in this Plan.
The National Institute of Child Health and Human Development seeks to assure that every individual is born healthy, is born wanted, and has the opportunity to fulfill his or her potential for a healthy and productive life unhampered by disease or disability. In pursuit of this mission, the NICHD conducts and supports laboratory, clinical, and epidemiological research on the reproductive, neurobiologic, developmental, and behavioral processes that determine and maintain the health of children, adults, families, and populations.
The beginning of the 21st century is an occasion to measure our accomplishments and look forward to promising opportunities. We can look back with a sense of pride on our research achievements that allow us to leave behind many disease and disability burdens that have affected the lives of children and adults throughout most of the 20th century. For example:
- Infant mortality has been reduced by 70 percent since the NICHD was established 35 years ago, largely due to NICHD research that has led to new ways to treat and prevent respiratory distress syndrome, manage premature infants, and prevent Sudden Infant Death Syndrome or SIDS.
- Infertility that left millions of couples unable to have children of their own during much of the last century is no longer a hopeless sentence, thanks to NICHD research that provides couples with a wide range of techniques to diagnose the causes of infertility, and numerous options to help them have their own children.
- A number of causes of mental retardation including Hemophilus influenzae type b (Hib) meningitis, phenylketonuria (PKU), congenital hypothyroidism, jaundice, measles, and rubella have become relics of the last century due to research discoveries that prevent or correct these conditions. (See attached chart.)
- The social isolation and mistreatment of persons with mental retardation and physical disabilities has been greatly diminished by NICHD research. Through improved ways to teach, manage behavior, increase mobility, and remove barriers, changing attitudes have enabled people with disabilities to actively participate in our communities, including attending our schools and contributing to the workforce.
- Many more children born to women infected with HIV will now enter the 21st century free of this virus as a result of research that has reduced the rate of virus transmission from mother to infant from 25 percent to 2 percent.
NEW RESEARCH CHALLENGES
As we leave behind some of the most feared disorders of the 20th century, many others remain unsolved, and some new conditions threaten our people.
At least 30 percent or 15 million of our nation’s children fail to develop adequate reading skills for functioning in a literate society. Our poor and minority children are at the greatest risk. NICHD scientists have developed successful, research-based interventions that appear to markedly reduce the rate of reading failure. Scientists supported by the NICHD are applying and testing these methods in many locations, including nine public schools in Washington, D.C. After only one year, data indicate that reading failures have been significantly reduced at all participating schools.
While the rate of SIDS deaths has been cut nearly in half during the four years of the NICHD Back to Sleep campaign, the rate has not declined equally in all segments of society. African American and Native American babies are still more likely to die from SIDS. To address SIDS in minority and high risk communities, the NICHD has enlisted Surgeon General Dr. David Satcher and others to help reach these populations. We have also initiated a major outreach to child care centers, urging caretakers to place babies on their backs to sleep to help reduce the risk of SIDS.
Last year the NICHD, in collaboration with other NIH components, established the Women’s Reproductive Health Research Career Development Centers. These 12 innovative programs will support the development of obstetrician-gynecologists to do basic, translational, and clinical research relevant to women’s health, and to transfer clinical innovations to their colleagues in the profession. We will support an additional eight research centers with funds provided in FY 1999.
With the increased funding in FY 1999, the NICHD has also expanded its Pediatric Pharmacology Research Unit Network from 7 to 13 sites. These sites will play an increasingly important role in the health of children by quickly and safely obtaining the clinical data required for approved pediatric use of drugs. The Network also will be conducting research on genetic differences in drug metabolism in children as a way to make drugs safer for them.
As we approach the 21st Century, NICHD research has sparked important discoveries that hold the promise of healthier lives for children as well as adults.
In a new study, NICHD scientists found that pregnant women infected with HIV can reduce the risk of transmitting the virus to their infants by 50 percent if they deliver by elective cesarean section before labor and rupture of their membranes. This finding contributes to the growing body of knowledge on preventing HIV transmission from mother to child.
Another important discovery may give women a new way to control their fertility without unwanted, harmful side effects. In a study using mice and rats, NICHD-supported scientists used inhibitors of enzymes in cells surrounding an egg in the ovary to prevent the egg from maturing, without disturbing other events in the female cycle. Because the eggs could not mature, they could not be fertilized. Future work will attempt to translate this advance into a product that will give women new opportunities to have children when they are wanted.
When women do give birth, new NICHD research has provided evidence that women who receive epidural anesthesia during labor and delivery do not have an increased rate of cesarean deliveries. This evidence allows women to choose epidural anesthesia for delivery without fear that it may increase their chance of cesarean section.
In the important area of medical rehabilitation research, NICHD-supported scientists have developed an improved prosthetic device that can restore hand function to both child and adult amputees. This prototype hand works by sensing the user’s muscular contractions and moving the mechanical fingers in response. Early testing shows that the device is sensitive enough to permit limited piano playing.
One of the more exciting research discoveries involved new cloning techniques. In the first accomplishment of its kind, scientists have demonstrated that cloning mammals from adult cells could be accomplished repeatedly in mice. This extraordinary advance will enable researchers to answer many basic questions about how cells are programmed during normal and abnormal development. These newest cloning techniques can have a variety of applications. They can improve the breeds of livestock, eventually help derive therapeutic products, and may also help preserve rare and endangered species.
NEW INITIATIVES FOR FY 2000
The beginning of a new century is also a time to look forward to new scientific frontiers. Urinary incontinence affects millions of adults and nearly twice as many women as men. Through original work under a Small Business Innovation Research (SBIR) grant, investigators have developed a new approach to correct "stress incontinence." This condition often occurs in women due to a weakening of the muscles during pregnancy or childbirth, or after a woman enters menopause. A recent discovery holds tremendous promise for restoring independence and improving the quality of life for millions of women. Using DNA technology, scientists injected special polymers around the urethra and effectively strengthened the damaged muscles found in patients with stress incontinence. Building on this advance, the NICHD, in collaboration with other Institutes, is supporting research to address a series of conditions termed pelvic floor disorders. Incontinence and pelvic organ prolapse are the most common conditions. The major factor for the development of these disorders in women is vaginal delivery. Our research will lead to a better understanding of the effects of vaginal delivery and the specific aspects of the labor and delivery process that adversely affect the pelvic floor.
Birth defects remain the leading cause of infant mortality in this country. Tremendous knowledge gaps exist in understanding birth defects and how to prevent them. To bridge these gaps, the NICHD is significantly expanding its birth defects research. We will capitalize on the revolutionary discoveries of the Human Genome Project and extraordinary advances in molecular and developmental biology. Researchers will identify target genes, environmental factors, genetic susceptibilities, and interactions between a gene and its environment. This information should provide the basis for diagnosing, treating, and preventing a wide range of birth defects.
Every year, thousands of children from homes where Spanish is the primary language spoken enter school and struggle to read in English. We do not have sound experimental evidence from the classroom indicating the most effective way to teach English reading skills to Spanish-speaking children. For instance, we do not know if these children should first be taught to read in Spanish, and then in English, nor do we know the best time to make the transition from one language to another. Building upon NICHD’s successful research-based program to teach reading skills to English-speaking children, we will work with the U.S. Department of Education on a similar research program to determine the most successful ways to help Spanish-speaking children learn to read English.
Recently, the NICHD sponsored a consensus development conference on the rehabilitation of persons with traumatic brain injury (TBI). Long-term behavioral consequences remain a serious problem after TBI, and deficits in cognition, memory, and attention often result. Rehabilitation to help these individuals return to work, school, and society is costly, complicated, and often of limited success. Based on conference recommendations, a new NICHD initiative will support research applying brain imaging techniques to correlate injury with outcomes of neuropsychological testing and various rehabilitation approaches. The goal of this research will be to develop new drug or behavioral strategies to help rehabilitate persons with TBI. Plans are also under way for a TBI clinical trials network to develop and conduct multi-center studies of therapeutic techniques and procedures, as well as devices and drugs that improve the health-related function of persons with TBI.
The research supported by NICHD addresses some of the most important health and development problems facing our children and families. I would be pleased to answer any questions that the Committee may have about the programs and plans of the NICHD.