Fiscal Year 2012 Budget Request by Dr. Richard J. Hodes, appearing before the Senate Subcommittee on Labor-HHS-Education Appropriations
Mr. Chairman and Members of the Committee:
I am pleased to present the President’s Fiscal Year 2012 Budget request for the National Institute on Aging (NIA) of the National Institutes of Health (NIH). The FY 2012 budget includes $1,129,987,000 which is $30,450,000 more than the comparable FY 2011 appropriation of $1,099,537,000.
The National Institute on Aging leads the national effort to understand aging and to identify and develop interventions that will help older adults enjoy robust health and independence, remain physically active, and continue to make positive contributions to their families and communities. We support a comprehensive portfolio of genetic, biological, clinical, behavioral, and social research related to the aging process, healthy aging, and diseases and conditions that often increase with age. We also carry out the crucial task of training the next generation of researchers who specialize in understanding and addressing the issues of aging and old age.
Approximately 39 million people age 65 and older live in the United States, and data from the Federal Interagency Forum on Aging-Related Statistics indicate that their numbers will double within 25 years. In less than 50 years, the number of “oldest old” – people ages 85 and older – may quadruple. As record numbers of Americans reach retirement age and beyond, profound changes will occur in our economic, health care, and social systems.
TRANSLATIONAL SCIENCES AND THERAPEUTICS DEVELOPMENT
NIA supports a comprehensive portfolio of research that builds upon basic discovery to develop new preventive, diagnostic, and therapeutic interventions for age-related diseases and conditions. For example, investigators with the Alzheimer’s Disease Neuroimaging Initiative (ADNI) have found that changes in the structure of the hippocampus, a brain area important to learning and memory, may reflect disease progression and effectiveness of potential treatments, and have established biomarker and imaging measures that may predict risk for cognitive decline and conversion to dementia. Clinical, imaging, and biological data from ADNI are available to qualified investigators around the world; over 1,700 researchers have signed up for access to the ADNI database, and global collaborations have resulted in over 170 published scientific papers since 2004.
NIA-supported research to identify Alzheimer’s disease (AD) biomarkers and gain a deeper understanding of the disease’s pathology and clinical course has made possible the first revision of the clinical diagnostic criteria for AD in 27 years through a joint effort of the NIA and the Alzheimer’s Association. Unlike the criteria that doctors and researchers have been using since 1984, the updated guidelines cover the full spectrum of the disease as it gradually changes over many years, from the earliest preclinical stages before symptoms are apparent through mild cognitive impairment (MCI) and advanced dementia. The new guidelines also address the use of imaging and biomarkers to determine whether changes in the brain and body fluids are due to AD.
Even under the new guidelines, however, diagnosis of AD remains complex. NIA intramural investigators are working toward development of an accurate, noninvasive, inexpensive blood test for AD. Last year, they found that the amount of a protein called clusterin in the blood of AD patients reflected the severity of disease, predicted the progression of memory impairment, and may predict brain amyloid burden long before the patient develops memory problems. These findings were recently replicated by independent researchers, and research is ongoing in this promising area.
A continuing translational research success story for NIH is the ongoing development of the compound exendin-4. NIA intramural investigators originally developed exendin-4 as a treatment for type 2 diabetes, but have since found that exendin-4 may act as a neuroprotective agent in animal models, and they are now conducting a phase II/III clinical trial of the compound in patients with MCI and early AD. NIA also supports over 40 drug discovery and development projects through our AD Translational and Drug Discovery Initiative, including a number of AD pilot clinical trials.
Other NIA-supported researchers are pursuing the development of interventions that will delay disease and dysfunction and even extend lifespan. Investigators with the innovative Interventions Testing Program found that the drug rapamycin, used to help prevent rejection of transplanted organs in humans, extended life span in middle-aged mice, and more recently demonstrated that the drug exerts beneficial effects early in life. Rapamycin inhibits the mTOR pathway, which helps regulate cell growth and proliferation. Building upon these findings, in 2010 NIA began soliciting research to identify and characterize molecular targets within the mTOR pathway with potential to impact health span and lifespan.
NIA also partners with other agencies and organizations on translational initiatives. For example, with the Administration on Aging, NIA has established an initiative to support development of evidence-based interventions, programs, policies, practices, and tools that can be used by community-based organizations to help elderly individuals remain healthy and independent in their own homes and communities. NIA is also joining “ambassadors” from organizations interested in the health and well-being of older people to promote Go4Life, our new exercise and physical activity website (www.nia.nih.gov/Go4Life.)
TECHNOLOGIES TO ACCELERATE DISCOVERY
New GWAS (genome-wide association study) technologies are transforming our understanding of the origins of disease and disability by facilitating rapid comparisons of the full genomes of thousands of individuals. This research may lead to the identification of novel disease pathways that can be targeted to develop new treatments. In the largest GWAS ever conducted in AD research, scientists with the AD Genetics Consortium found that a previously unconfirmed gene variant, BIN 1, affects development of late-onset AD and identified four additional genetic variants significant for the disease. The genes identified by this study may implicate pathways involved in inflammation and the movement of proteins and lipids both within and between cells as being important in the disease process. In a another large GWAS, NIA intramural researchers joined an international research consortium to confirm six previously identified genes for Parkinson’s disease and identify five new genes or loci (an area on the chromosome where a gene is thought to be located).
A new NIA-supported initiative is underway to develop technologies to better understand the life span and fate of cells in various tissues of aged mammals. In these studies, cells are permanently marked at a specific point in the organism’s life and those marked cells are followed to determine their fate and traits over time. These studies will provide important insights into aging at the cell and tissue levels.
USING SCIENCE TO INFORM HEALTH CARE REFORM
Research that will lead to the identification of more effective and less expensive clinical interventions is a high priority for NIA, particularly through a broad portfolio of comparative effectiveness research (CER). A major CER effort has been NIA’s administration, on behalf of the Agency for Health Care Research and Quality and the Office of the DHHS Secretary, of an initiative identifying ways that principles of behavioral economics could be used to encourage health care providers to incorporate findings from CER studies into their practices. Other ongoing CER studies include a randomized trial of behavioral economic interventions to reduce risk of cardiovascular disease; a study comparing various motivators to increase HIV screening; and a study comparing the effects of an intensive exercise program vs. stretching and range of motion exercises on ambulation in hip fracture patients.
Surprisingly little definitive evidence exists on the impact insuring the uninsured has on their health-related behaviors (including health care usage) and outcomes. However, NIA-supported investigators are currently taking advantage of a remarkable opportunity to develop such evidence. For a brief period in 2008, Oregon opened a waiting list for enrollment in its previously closed public health insurance program for certain low income adults, and then offered randomly-selected people the opportunity to enroll. By comparing individuals who obtained health insurance through this program with otherwise eligible individuals who were not selected in the “insurance lottery,” the investigators are assessing the impact of insurance on health care usage and health outcomes, including the differing impacts on different groups. Understanding the consequences of health insurance coverage will be central to evaluating proposals to expand or modify health insurance coverage in the U.S.
Recently, NIA-supported investigators studying older populations in the U.S., England, and 11 European countries found that retirement prior to age 65 was associated with a significant decline in cognitive performance. The investigators suggest that this may be in part because for many people retirement leads to a less stimulating daily environment, and the prospect of retirement reduces the incentive to engage in mentally stimulating activities on the job. It is possible (although not yet proven) that the recent trend of American workers delaying retirement may eventually lead to improved cognitive performance in this group.
NEW INVESTIGATORS, NEW IDEAS
As the American population grows older, the need for health care professionals who specialize in the unique needs of older individuals is becoming ever more urgent. To address this increase in demand effectively, we must foster the development of physician-scientists whose research will lead to improved care and more effective treatment options for older patients with complex medical conditions. Recently, NIA established the Grants for Early Medical/Surgical Subspecialists’ Transition to Aging Research (GEMSSTAR) program to support physicians who seek to become clinician-scientists in geriatric aspects of their subspecialty. We anticipate supporting 18 to 20 emerging physician-scientists in this program.
Once again, thank you. I welcome your questions.
Richard J. Hodes, M.D.
Director, National Institute on Aging
Richard J. Hodes, M.D., directs the research program of the National Institute on Aging (NIA) at the National Institutes of Health. A leading immunologist, Dr. Hodes was named Director of the NIA in 1993, to oversee studies of the basic, clinical, epidemiological and social aspects of aging.
Under Dr. Hodes’ stewardship, the NIA budget has surpassed $1 billion, reflecting increased public interest in aging as America and the world grow older. Dr. Hodes has devoted his tenure to the development of a strong, diverse, and balanced research program, focusing on the genetics and biology of aging, basic and clinical studies aimed at reducing disease and disability, including Alzheimer’s disease and age-related cognitive change, and investigation of the behavioral and social aspects of aging. Ultimately, these efforts have one goal -- improving the health and quality of life for older people and their families.
Dr. Hodes is a Diplomate of the American Board of Internal Medicine. In 1995, he was elected as a member of The Dana Alliance for Brain Initiatives; in 1997, he was elected as a Fellow of the American Association for the Advancement of Science; and in 1999, he was elected to membership in the Institute of Medicine of the National Academy of Sciences.
Dr. Hodes is a graduate of Yale University and received his M.D., from Harvard Medical School. He completed training in Internal Medicine at Massachusetts General Hospital and in Oncology at the National Cancer Institute. As an author of more than 250 research papers, he is an active scientist in and contributor to the field of immunology.