DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
Fiscal Year 2013 Budget Request
Statement for the Record
House Subcommittee on Labor-HHS-Education Appropriations
Alan E. Guttmacher, M.D., Director
Eunice Kennedy Shriver National Institute of Child Health and Human Development
Mr. Chairman and Members of the Committee, I am pleased to present the FY 2013 President’s Budget Request for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of $1,320,600,000. This reflects an increase of $775,000 above the comparable FY 2012 level of $1,319,825,000.
50 Years of Contributions to Health
This year marks the 50th anniversary of the founding of the NICHD. Thanks to continuing Congressional support and the unwavering dedication of our scientists and stakeholders, NICHD research has changed the lives of women, children, families, and those individuals with disabilities worldwide. Since the NICHD was established in the early 1960s, research supported by the Institute contributed to a 50 percent drop in sudden infant death syndrome (SIDS), and a 70 percent drop in respiratory distress syndrome, both leading causes of the nation’s infant mortality rate. Transmission of HIV from infected mother to fetus dropped from 25 percent to less than one percent in the past 15 years. Discovery of an early biological marker of pregnancy led to the development of what is now the standard pregnancy test. The incidence of Haemophilus influenzae type b (Hib) meningitis, once the leading cause of acquired intellectual disability, has dropped more than 90 percent with the development of the Hib vaccine by NICHD scientists. Beyond these past contributions to public health, our anniversary presents a unique opportunity to catalyze scientific advances.
New Advances Continue the Momentum
The NICHD’s basic research, conducted on the NIH campus and supported at academic institutions nationwide, adds to scientific knowledge and enables clinical researchers to develop and test new treatments. For example, in Type 1 diabetes, the immune system destroys the body’s insulin-producing cells that help control blood glucose levels. Infertility researchers funded by the NICHD found a way to convert endometrial stem cells into insulin-producing cells and transplant them into mice to control diabetes. These findings suggest that ultimately, a woman’s own, readily available, endometrial stem cells could be used to develop insulin-producing islet cells, minimizing the chance of rejection posed by using tissues or cells from another person.
Research shows promise for developing new treatments for uterine fibroids. These non-cancerous tumors, three to four times more common in African American than white women, are often associated with chronic pain, infertility, and preterm labor. Currently, few treatment options exist except surgical removal of the uterus (hysterectomy). A recent NICHD-sponsored analysis concluded that the economic costs of the poor health outcomes, treatment, and management of fibroids in the U.S. may reach $34 billion annually. Other NICHD-supported researchers found that treatment with vitamin D reduced the size of uterine fibroids in laboratory rats predisposed to developing the tumors, suggesting that differential rates of Vitamin D deficiency could help explain the health disparities in fibroid formation. Another approach, using a drug to shrink the tumors, has shown promise in preliminary clinical studies.
New technologies and tools are allowing the research community to move science along faster than ever. For example, a NICHD-supported physiatrist is combining bioengineering with a technique called “targeted muscle reinnervation,” using nerves that remain after amputation to control assistive devices; this has enabled researchers to link an individual’s brain impulses to a computer in a prosthesis that directs motors to move the limb. The NICHD small business innovation research (SBIR) program has supported development of emerging technologies to address mounting concerns about the effects of concussions. Scientists have created a device mounted inside a football helmet to measure the impact of a collision. This new tool has already helped to quantify the impact of concussions for college football players, determine how head injuries may differ for football players at different positions, and can be used to design more protective helmets.
Scientists at the NIH’s Autism Centers of Excellence are taking advantage of new insights into brain structure and function in their Infant Brain Imaging Study. Using a special imaging technique, they tracked the brain development of infants and toddlers who have an older sibling with an autism spectrum disorder (ASD), and thus, are at increased risk of developing ASD themselves. The researchers found distinctly different patterns of brain development in the younger siblings who were later diagnosed with ASD compared to those who weren’t. These findings represent the earliest age (six to 24 months) at which such biomarkers for ASD have been identified.
It is especially gratifying when scientific advances like these are put into practice. Last year, I reported on a major new study supported by the NICHD demonstrating that fetal surgery to correct myelomeningocele (spina bifida) greatly reduced the risk of death and doubled the chances of children being able to walk, compared to the standard practice of postnatal surgery. Over the past year, the NICHD has convened a series of meetings with numerous leading professional societies to ensure sufficient and consistent training and guidelines for performing this highly complex procedure as it becomes available in various sites around the country.
In late 2011, an NICHD-supported analysis of over five million medical records showed that pregnant women assaulted by an intimate partner are at increased risk of giving birth to infants at lower birth weights. Babies born at low birth weights are at higher risk for SIDS, heart and breathing problems, and learning disabilities. The American College of Obstetricians and Gynecologists used this information in developing physician training materials for screening patients for intimate partner violence.
Since 2002, the NICHD has led the NIH’s implementation of the Best Pharmaceuticals for Children Act, supporting pharmacokinetic research and new clinical trials on drugs not previously tested for pediatric use. Due in large part to the NICHD’s Pediatric Trials Network, data on pediatric safety, dosing, and efficacy for several common drugs were sent to the Food and Drug Administration this year so that the drugs’ labels can be changed, and the children potentially benefiting from these therapeutics can be treated appropriately.
Looking Ahead: Scientific Visioning
As exciting as these advances are, we know that the promise of improving the nation’s health depends on enlightened management of the research enterprise. The NICHD has just concluded a “visioning” process to help us focus over the next ten years on the best ways to achieve scientific goals, enhance prevention, and continue to improve the nation’s health. After in-depth consultation with over 700 experts from around the country, white papers covering nine major areas of our science were made available online (http:// www.nichd.nih.gov/vision), and a scientific commentary summarizing NICHD’s overall vision will appear in a major medical journal later this year. Now the NICHD looks to the future, where we will work with our research partners to detail how genes, the environment, and behaviors interact, starting before birth, to affect health outcomes. We plan to determine all the causes of preterm birth, devise new treatments to maximize gynecologic health, and improve the health and functioning of individuals with intellectual, developmental, or physical differences. Collaborative efforts to strengthen transdisciplinary research and enhance the ways that we conduct science will be essential to this future.
Whether they work at the NIH or receive grants at academic institutions across the country, NICHD-supported scientists are an invaluable national resource. In the past year alone, two long-time NICHD grantees were among only seven researchers named by President Obama as recipients of the National Medal of Science. And, to honor her work encouraging young women from the inner city to engage in scientific research careers, a third NICHD grantee was recently awarded the Presidential Award for Excellence in Science, Mathematics, and Engineering Mentoring. It is with the help of exceptional individuals such as these, and your support, that we will embark on the next fifty years of the NICHD’s “Research for a Lifetime.”