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
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
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
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
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
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
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.).