APA Warns of Consequences of Underfunding Research

Government-sponsored research that found substantial improvement among 85 percent of patients with depression who are treated with a combination of medication and behavioral therapy has provided much-needed guidance to clinicians. But that kind of research is imperiled by insufficient funding.

That was the message APA took to Capitol Hill in March as Congress began to budget for the coming fiscal year.

James H. Scully Jr., M.D., APA medical director, testified before the House Appropriations Labor, Health and Human Services, and Education Subcommittee on March 27 that a 6.7 percent increase is needed in the $28.9 billion proposed budget for the National Institutes of Health (NIH), which is the federal government's primary health research engine.

“We desperately need to increase our research capacity for understanding the long-term needs of those with traumatic brain injury,” Scully said, about a condition that is increasingly common among injured veterans of the Iraq and Afghanistan conflicts but inadequately understood.

He noted that research has indicated that people with traumatic brain injury (TBI) face early-onset dementia, which has huge implications for Veterans Affairs nursing-home capacity and Medicaid-funded nursing homes. Research is needed to uncover interventions that may prevent the onset of TBI-induced dementia.

A better understanding of the short-term and long-term treatment needs of soldiers with TBI could also aid in the care of civilians with similar brain injuries, such as car-crash victims.

Additional research is also needed on posttraumatic stress disorder (PTSD) and on substance use disorders that stem from people self-medicating to cope with the PTSD symptoms. The Department of Defense estimates that PTSD affects 13 percent of returning troops, and that percentage is expected to increase substantially in future years as the effects of combat trauma are“ re-activated” by future traumatic events, Scully noted.

After a query by Rep. Mike Honda (D-Calif.) about whether researchers have investigated PTSD effects among refugees and whether those finding were made available, Scully said pilot studies have found many immigrants were exposed to traumatic events just getting to this country. Further funding is needed to identify the extent of PTSD in immigrant groups and the best way to identify and treat them.

One effective way to increase detection and treatment among immigrant groups, Scully said, is to recruit and educate members of the community in psychiatry and mental health work. Although APA fellowships fund psychiatric education for minority students and cultural training for psychiatrists working among minority groups, Scully said, further support is needed for federal training programs.

Scully urged the subcommittee to restore funding for the Minority Fellowship Program administered by the Center for Mental Health Services. The program, which aims to eliminate ethnic and racial disparities in access to and quality of mental health and substance abuse care, is marked for elimination under President Bush's proposed Fiscal 2008 budget.

The push by APA and other medical organizations and patient groups for increased research funding is driven by stagnation in the NIH budget after Congress voted to double it between Fiscal 1998 and 2003. The NIH budget has had modest increases since then, but they resulted in an inflation-adjusted 13 percent drop in its purchasing power since 2005, said research advocates.

Advocates of increased federal research support pushed to change the House budget blueprint (HCONRES 99), which set spending parameters for the 2008 budget, to include increased NIH funding. The House was expected to approve a budget outline during April.

Rep. David Obey (D-Wis.), chair of the subcommittee, said that health advocates at the hearing need to tell their constituents that NIH spending increases are not possible unless Bush-supported tax cuts are rolled back and massive war spending in Iraq is ended.

The push for a boost in NIH funding was more successful in the Senate budget bill (SCONRES 21), where Sens. Tom Harkin (D-Iowa) and Arlen Specter (R-Pa.) added $2.2 billion annually for four years for NIH and the Centers for Disease Control and Prevention. Specter recently referred to the $2.2 billion as “Confederate money” until appropriators approve the department-specific funding bills later in the year. The two chambers will need to reconcile the budget blueprint bills, which serve as guides to Congress's intent on the next budget and do not need presidential approval at this stage.

Federal health officials testifying the same week before the Senate Appropriations subcommittee dealing with health issues echoed Scully's warning that the mental health needs of returning veterans require research on the best ways to identify and “preempt” conditions, such as PTSD.

Thomas Insel, M.D., director of the National Institute of Mental Health, told the subcommittee that 170,000, or 13 percent, of combat veterans from Iraq and Afghanistan now suffer from PTSD, but that percentage will likely jump to at least the Vietnam-era level of 30 percent in the coming years.

“Our biggest hope is that we can use the science we have to develop better treatments than we now have,” he said.

Insel said federally supported researchers will focus much effort on“ predicting and preempting” conditions such as PTSD and autism. Future research also will be better coordinated through the recently formed Blueprint for Neuroscience Research, which pools the research tools, resources, and training of the 15 NIH institutes invested in this research area.

In addition, further research is needed to develop fast-acting, targeted treatments for eating disorders, Insel said. Federal research support also is needed to understand the physiological changes causing and underlying mental disorders.

Mental health and addiction research advocates generally received broad support during their congressional testimony, but final funding increases are expected to be small, due to the government's tight fiscal environment.

“We will provide the resources you need to the maximum of our capabilities, which is more limited than it used to be,” Harkin said, referring to stricter adherence to spending limits Congress has pledged to follow this year.

Other members of Congress who also participated in Advocacy Day events were Rep. John Sullivan (R-Okla.), Rep. Steve Buyer (R-Ind.), Rep. Jim Gerlach (R-Pa.), Rep. Phil English (R-Pa.), Rep. John Tanner (D-Tenn.), Rep. Bob Etheridge (D-N.C.), Rep. Jim McDermott (D-Wash.), Rep. Eliott Engel (D-N.Y.), Rep. Joe Wilson (R-S.C.), and Rep. Tim Murphy (R-Pa.).

The House budget resolution is posted at<http://thomas.loc.gov/cgi-bin/bdquery/z?d110:h.con.res.00099:..>. The Senate version is posted at<http://thomas.loc.gov/cgi-bin/bdquery/z?d110:s.con.res.00021:>.▪