DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
Fiscal Year 2014 Budget Request
Statement for the Record
Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies
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 2014 President’s Budget Request for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of $1,339,360,000. This reflects an increase of $20,417,000 over the comparable FY 2013 level of $1,318,943,000.
This past year, the NICHD celebrated its 50th anniversary. Beyond celebrating past accomplishments, this milestone inspired the Institute, along with its many stakeholders, to identify compelling scientific opportunities for the next decade. The Institute’s future research must build upon its strong foundation of scientific advances, from better understanding of the basic mechanisms that transform cells into healthy and effectively functioning individuals, to clinical studies that improve the health and well-being of women, families, and individuals with disabilities.
Research in developmental biology increases knowledge about how individuals develop and the origins of various diseases and conditions. Recently, NICHD-funded scientists found that women with epilepsy who took the prescription drug topiramate during their first trimester to prevent seizures were at a slightly increased risk of having babies with cleft lip. Intramural scientists recently used next-generation gene sequencing techniques to discover in an animal model new brain regions, once thought to be inert, which appear to be active in the pineal gland, which controls the body’s 24-hour cycle and is integral to development. Advances in genetics and systems biology will shed new light on human development, and provide critical underpinnings for emerging fields such as regenerative medicine.
Developmental Origins of Health and Disease
Complex interactions among biological and external factors, starting before conception, can influence health across the life course, and even across generations. NICHD researchers discovered a genetic pathway common to the rapid growth of healthy fetuses and the uncontrolled cell division of cancer, shedding light on both normal development and the genetic bases of common cancers. Understanding the developmental origins of health and disease will benefit from interdisciplinary and global studies and, ultimately, can be applied to prevent, treat, or even reverse chronic conditions such as obesity, diabetes, and cognitive deterioration.
Pregnancy and Pregnancy Outcomes
Achieving a better understanding of pregnancy processes and fetal development can pave the way for predicting and preventing poor pregnancy outcomes as well as improving lifelong health for both women and infants. A new NICHD-funded study reported that pregnant women’s exposure to the flu was associated with a nearly four-fold increased risk that their children would develop bipolar disorder in adulthood. This information may encourage and increase the use of prevention strategies, such as the flu vaccine. Another study found that women who develop gestational diabetes during pregnancy can greatly decrease their risk of developing type 2 diabetes later in life by maintaining a healthy diet in the years following pregnancy. Targeted areas for future research include obtaining further understanding of how to promote healthy pregnancies and unraveling the complex causes of stillbirth and prematurity.
Reproductive health is an essential element of personal well-being across the lifespan, and necessary to ensuring the health of future generations. NICHD-supported research found that the hormone progestin, often given as a first step in infertility treatment for polycystic ovary syndrome, unexpectedly decreased the odds of conception and giving birth. Scientists advance our understanding of what works in clinical practice, while identifying potential new diagnostic and therapeutic targets for managing critical aspects of women’s and men’s reproductive health.
Behavior and Cognition
Human behaviors can promote positive health outcomes or increase the risk of adverse ones. NICHD-funded researchers found that when the mind is at rest, the electrical signals by which brain cells communicate appear to travel in reverse, wiping out unimportant information, while sensitizing cells for future learning. NICHD research found that children who failed to acquire a particular math skill, number system knowledge, in first grade scored well behind their peers by seventh grade, pointing the way for targeted intervention when it matters most. In another study, seven-month old babies who were later diagnosed with autism took slightly longer to shift their gaze than babies who developed normally, which may provide an early clue to differences in their brain structure. Future basic and translational research that combines neuropsychological, behavioral, and social science perspectives will increase knowledge about the mechanisms that underlie typical and atypical behavior and cognition.
Plasticity and Rehabilitation
Plasticity, adaptive or maladaptive change at the cellular, tissue, organ, or system levels, is at the core of human development and rehabilitation. NICHD researchers have identified proteins in an animal model that help fuse early-stage cells and eventually develop into muscle cells. This finding has implications for understanding how to repair and rehabilitate muscle tissue and how specialized cells (osteoclasts) repair and maintain bones. The ongoing challenge for scientists will be to generate additional knowledge about the mechanisms of plasticity, and translate this knowledge into interventions that can help individuals remodel, maintain, or enhance functioning.
Individuals, families, and communities are all critical units through which population-level factors interact with genetic and environmental variables, influencing individual health across the lifespan. A NICHD study demonstrated that the stresses of poverty were shown to lead to impaired learning ability in children. Another study, a landmark collaboration among NICHD, other NIH Institutes and Centers, federal agencies, and private foundations, demonstrated that providing specialized housing vouchers that enabled low-income women and children to move from impoverished neighborhoods to those with relatively few poor residents reduced extreme obesity and diabetes over time. Over the next decade, cutting edge data collection and analytic methods could assess biological, physical, and social processes in diverse families and communities to inform the development of effective population-based interventions to improve health and reduce health disparities.
Conduct of Science
In the coming years, biomedical and biobehavioral researchers will need to work as transdisciplinary teams, manage massive amounts of data, and acquire new and diverse skill sets. The very breadth of NICHD’s mission requires us to create and support such teams to translate and implement our research advances into actions that improve the health of women, families, and individuals with disabilities.