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Testimony

Statement for the Record
Submitted by
Friends of VA Medical Care and Health Research
to the
Senate Appropriations Subcommittee on Veterans Affairs, Housing and Urban Development, and Independent Agencies
on the
FY 2003 Budget of the Department of Veterans Affairs

March 22, 2002

The Friends of VA Medical Care and Health Research (FOVA), a coalition of 78 medical research, specialty, physician, academic, patient advocacy and industry organizations committed to quality care for veterans, is pleased to provide recommendations regarding FY 2003 funding for the Department of Veterans Affairs (VA) medical and prosthetics research program. FOVA strongly encourages the Senate Subcommittee on Veterans, Housing and Urban Development to support VA research by recommending an FY 2003 appropriation of at least $460 million.

FOVA's FY 2003 recommendations build on the $20 million increase provided for the current year. The Administration's FY 2003 budget request for a $38 million (10%) increase in research program dollars is notable for being the first time in many years that an administration has proposed funding sufficient to maintain VA's current level of effort in advancing treatments for conditions particularly prevalent in the veteran population including prostate cancer, diabetes, heart diseases, Parkinson's disease, mental illnesses, spinal cord injury and aging related conditions. We applaud the Administration and Department of Veterans Affairs Secretary Anthony J. Principi for recognizing the invaluable contribution VA research makes to delivering high quality care for veterans and toward improving the health of veterans and the nation.

Please note that the Administration's budget request for a $38 million increase for VA research includes a shift from OPM to VA of $15 million in accrued government health and retirement benefit funds. Consequently, the Administration's budget proposes a $23 million (6%) increase in research program funds plus $15 million in federal employee benefit expenses previously paid by an OPM account, for a total increase of $38 million (10%) over current year funding of $371 million. FOVA strongly recommends that the entire $38 million increase be allocated to VA research's programmatic needs and that accrued benefits continue to be paid out of the OPM trust fund.

However, even a $38 million increase would not allow VA to address all of the opportunities it has to improve care for veterans, nor to meet the new challenges presented by the tragedies of September 11 and subsequent events. FOVA strongly encourages the Committee on Veterans Affairs to recommend an FY 2003 appropriation of at least $460 million for the VA medical and prosthetics research program. This represents growth in program dollars of $90 million (74%).

Four core needs justify the FOVA recommendation of $460 million:

1. Investments in investigator-initiated research projects at the VA have led to an explosion of knowledge that promises to advance our knowledge of disease and unlock new strategies for prevention, treatment and cures. Attachment 1 is a list of just a few of VA's recent achievements and initiatives. However, many health challenges still confront the veteran community. Additional funding is needed to take advantage of the burgeoning scientific opportunities and to improve quality of life for our nation's veterans as well as the general public. FOVA urges the Committee to support additional funding for the following research priority areas identified by the VA for FY 2003:

• Quality of Care: Additional funding for the Quality Enhancement Research Initiative (QUERI) program would be used to fund centers in prostate cancer and dementia/Alzheimer's.

• Special Populations: VA would expand research in quality of care, community access and restoration of function to achieve greater understanding of existing racial, ethnic and gender disparities in health care.

• Diseases of the Brain: Additional studies are needed on the impact of different classes of psychiatric drugs on cognitive and behavioral function.

• Treatment Strategies in Chronic Progressive Multiple Sclerosis: Recent studies have shown that immunotherapy of acute MS can reduce disability. More studies are needed to determine the optimal therapy for patients.

• Micro Technology: In the area of low vision, work in retinal prostheses is an emerging science and may restore sight lost as a result of a variety of disorders including age-related macular degeneration and retinal pigmentosa.

• Patient Outcomes in Rehabilitative Care: Specific areas of emphasis include long-term care strategies to enhance patients' independence and activities of daily life, consequences of community reintegration and the impact of assistive technology on quality and functionality of life.

• Chronic Disease Management: VA is proposing two major initiatives in comparing clinical efficacy of 1) vascular surgery conducted on and off cardiopulmonary bypass machines, and 2) open versus endovascular surgery for abdominal aortic aneurysms.

2. The complexity of research combined with biomedical research inflation has increased the costs of research. The average cost of each VA research project is now $150,000, a 9% increase in just two years. As a result, VA requires an increase of at least $15 million just to maintain a stable number of programs.

3. In response to the events of September 11, VA seeks to establish a research portfolio to address the threats of bio-terrorism. This objective is consistent with VA's statutory obligation to provide medical back-up services in times of national emergencies. VA has an established history of research accomplishments in the areas of infectious diseases and immunology, including vaccine development. The laboratories of VA research scientists are disseminated nationwide, and are affiliated with top-flight universities. VA research provides a unique national resource that can be readily adapted and quickly mobilized in response to diverse biological threats.

To meet this emerging challenge, consistent with H.R. 3253, the National Medical Emergency Medical Preparedness Act of 2001, FOVA strongly supports VA's proposal to establish four new centers of research excellence focusing on fundamental issues critical for responding to chemical, biological and radiological threats to public safety. The targeted research portfolio would include pathogen detection, disease diagnosis and treatment, protection, and vaccine development. The mission of these centers would also encompass the evaluation and management of illnesses consequent to military service, especially in our current conflict.

4. VA's career development programs are a national resource for training the next generation of clinician scientists, those doctors who treat patients and address questions that have a direct impact on patient care. Additional funding is needed to expand this program in order to address the growing national shortage of clinician-investigators.

Separate from its recommendations for the VA research appropriation, FOVA strongly encourages the Committee to address the increasingly urgent need for improvements in VA's research facilities.

In 1997, NIH conducted site visits of six VA research facilities and concluded that, "VA has had increasing difficulty in providing sufficient resources via its congressional appropriation to satisfactorily fund the infrastructure necessary to support research at the VAMCs." It is FOVA's understanding that VA has made no significant, centrally administered investment in its existing research facilities since this finding. Ventilation, electrical supply and plumbing appear frequently on lists of needed upgrades along with space reconfiguration. Substandard facilities make VA a less attractive partner in research collaborations with affiliated universities; reduce VA's ability to leverage the R&D appropriation with other federal and private sector funding; and make it difficult to attract cutting edge researchers, both clinician investigators and laboratory scientists, to careers in VA. Facility R&D Committees regularly disapprove projects for funding consideration because the facility does not have the necessary infrastructure and has little prospect of acquiring it.

Under the current system, research must compete with other medical facility and clinical needs for basic infrastructure and physical plant support. Unfortunately, the minor construction appropriation is chronically inadequate to meet facility needs for clinical improvements much less research upgrades, and year after year the list of urgently needed research repairs and upgrades grows longer. VA has identified 18 sites in urgent need of minor construction funding to upgrade their research facilities. These sites plus the many facilities with smaller, but no less important needs, provide more than sufficient justification for an appropriation of $45 million specifically for research facility improvements.

FOVA recommends that a new funding mechanism, such as a minor construction appropriation specifically for research facilities, be developed to provide a permanent, steady stream of resources dedicated to upgrading and renovating existing research facilities. State-of-the-art research requires state-of-the-art facilities.

FOVA thanks the Committee for consideration of its views. For questions or additional information, please contact any member of the FOVA executive committee listed on this letterhead. Thank you for your consideration.

Organizations that have endorsed FOVA's FY 2003 recommendations:

Administrators of Internal Medicine
Alliance for Aging Research
Alzheimer's Association
American Academy of Child and Adolescent Psychiatry
American Academy of Neurology
American Academy of Opthalmology
American Academy of Orthopaedic Surgeons
American Association of Colleges of Osteopathic Medicine
American Association of Colleges of Pharmacy
American Association of Neurological Surgeons
American Association of Spinal Cord Injury Nurses
American Association of Spinal Cord Injury Psychologists and Social Workers
American College of Clinical Pharmacology
American College of Physicians-American Society of Internal Medicine
American College of Rheumatology
American Dental Education Association
American Federation for Medical Research
American Gastroenterological Association
American Geriatrics Society
American Gold Star Mothers of America
American Heart Association
American Lung Association
American Military Retirees Association
American Optometric Association
American Osteopathic Association
American Paraplegia Society
American Physiological Society
American Psychiatric Association
American Psychological Association
American Society for Pharmacology and Experimental Therapeutics
American Society of Hematology
American Society of Nephrology
American Thoracic Society
American War Mothers
Association for Assessment and Accreditation of Laboratory Animal Care International
Association for Research in Vision and Ophthalmology
Association of Academic Health Centers
Association of American Medical Colleges
Association of Pathology Chairs
Association of Professors of Medicine
Association of Program Directors in Internal Medicine
Association of Schools and Colleges of Optometry
Association of Subspecialty Professors
Association of VA Chiefs of Medicine
Blinded Veterans Association
Blue Star Mothers of America
Clerkship Directors in Internal Medicine
Coalition for American Trauma Care
Coalition for Heath Services Research
Congress of Neurological Surgeons
Digestive Disease National Coalition
Gerontological Society of America
Independence Technology, Inc.
Johnson & Johnson
Juvenile Diabetes Research Foundation International
Legion of Valor
Medicine-Pediatrics Program Directors Association
National Alliance for the Mentally Ill
National Association for Biomedical Research
National Association for the Advancement of Orthotics and Prosthetics
National Association for Uniformed Services
National Association of State Universities and Land Grant Colleges
National Association of VA Dermatologists
National Association of VA Physicians and Dentists
National Association of Veterans' Research and Education Foundations
National Mental Health Association
National Multiple Sclerosis Society
National Organization of Rare Disorders
Nurses Organization of Veterans Affairs
Paralyzed Veterans of America
Partnership Foundation for Optometric Education
Research Society on Alcoholism
Research!America
Society for Investigative Dermatology
Society for Neuroscience
Society of General Internal Medicine
Veterans Affairs Physician Assistant Association
Veterans of the Vietnam War

Attachment 1

VA Research - Recent Achievements and Initiatives

Promise for TB Vaccine
Researchers at the Portland VA have found a unique mechanism by which human T cells recognize cells infected with Mycobacterium tuberculosis, the bacteria that cause TB. They have found that the molecule HLA-E can present TB antigens to cytotoxic T cells. A further understanding of this mechanism may facilitate the development of an improved TB vaccine. Worldwide, over 2 million people die each year from TB. Advancement towards an effective TB vaccine has significant potential to improve both national and global health.

New Centers to Study Parkinson's Disease
VA created six new centers specializing in research, education and clinical care for Parkinson's disease. The centers-in Houston, Philadelphia, Portland (Ore.), Richmond (Va.), San Francisco and West Los Angeles-will conduct research covering basic biomedicine, clinical trials, rehabilitation, and health services. In addition, each center will take part in a major VA clinical trial to assess the effectiveness of surgical implantation of deep brain stimulators to reduce symptoms. (Feb. 2001)

Key to Wasting Syndrome Discovered
Researchers at the San Diego VA Medical Center have unraveled the biological chain of events that causes wasting syndrome in mice, and identified the same process in liver and tissue from cancer patients. Wasting syndrome or cachexia, affects about half of all cancer and HIV/AIDS patients, as well as those with bacterial and parasitic diseases, rheumatoid arthritis, and chronic diseases of the bowel, liver, lungs and heart. By noting the similarities between animal and human models, researchers hope to expedite the development of treatments to help patients. (Dec. 2001)

VA Evaluating Robotic Walker for Vision-Impaired
VA researchers in Pittsburgh and Atlanta are testing a new high-tech walking frame designed to promote mobility and independence for the vision-impaired frail elderly. Using laser range finders, sonar sensors, steering motors and a motion controller, the Personal Adaptive Mobility Aid (PAM-AID) seeks to build the functionality of a guide dog into a robust walking frame. (Oct. 2001)

VA Establishes New HIV Research Center
VA is the nation's largest single provider of health care to HIV-infected persons. A new Center of HIV Research Resources at the Palo Alto VA Health Care System seeks to improve health care for veterans by assessing research and clinical trials throughout VA and other agencies and determining their potential for further research and clinical application. (Oct. 2001)

Rehab Researchers Collaborate in Artificial Retina Trials
VA researchers from the Rehabilitation Research and Development Service have recently collaborated with colleagues at the Louisiana State University Medical Center on studies to implant silicon-chip retinas in the eyes of patients blinded by retinal disease. About the size of a pinhead, the artificial silicon retinas are completely self-contained and require no wires or batteries. They contain 3,500 microscopic solar cells that generate electrical current in response to light. The implants stimulate healthy retinal cells underneath the retina in a pattern that resembles the light images focused on the chips. These images are then transmitted to the brain via the optic nerve. The implants are designed to treat retinitis pigmentosa and macular degeneration. (Sept. 2001)

New Blood Test Speeds Diagnosis of Heart Attacks
Researchers at the San Diego VA Medical Center have developed a simple, inexpensive blood test to increase the speed at which heart attacks are diagnosed in hospital emergency rooms. The new blood tests can rule out a heart attack with 100% accuracy within 90 minutes by looking for three cardiac enzymes released by distressed heart tissue during an attack. Ruling out a heart attack by traditional methods usually takes 6 to 24 hours. As a result, critical care admissions dropped 40% and overall hospital admissions dropped 20%. (Sept. 2001)

Chronic Lymphocytic Leukemia May Be Underestimated
VA researchers at the Central Arkansas Veterans Healthcare System have found that the true incidence of Chronic Lymphocytic Leukemia (CLL) is substantially higher than estimated from the tumor registry database. Researchers credited the VA's Computerized Patient Record System (CPRS) as making the study possible by allowing researchers to review data from a large patient population without handling paper records. Revision in the data may show CLL to be the most common lymphoid malignancy in the United States. (Sept. 2001)

Friendly Virus May Slow Replication of HIV
VA researchers at the University of Iowa have shown that a form of the hepatitis virus called GPV-C may prolong the life of patients with HIV by preventing the HIV from replicating. GPV-C does not appear to cause any symptoms and may provide future therapy options for HIV. Specifically, the VA team showed that infecting human blood cells with GPV-C in the laboratory slowed the rate at which HIV multiplies. (Sept. 2001)

Higher Estrogen Doses May Enhance Memory for Alzheimer's Patients
VA researchers have found that higher doses of estrogen may enhance memory and attention for post-menopausal women with Alzheimer's Disease. Building on previous research showing the positive effects of estrogen administered by a skin patch, the researchers showed that a short-term administration of a higher dose of estrogen was found to significantly improve verbal and visual memory as well as attention in post-menopausal women. Although estrogen therapy does not show improved brain function for patients with mild to moderate Alzheimer's, it may slow the progression or prevent the disease. (Aug. 2001)

Diet and Exercise Reduce Risk and Delay Onset of Type 2 Diabetes
As part of the Diabetes Prevention Program (DPP), researchers at the VA Puget Sound Health Care System and the University of Washington have collaborated in a major clinical trial that showed at least 10 million Americans can reduce their risk of contracting Type 2 diabetes with a regimen of diet and exercise. Funded by a wide group of federal agencies, private associations, pharmaceutical companies and product manufacturers, the DPP was ended a year early because the data had clearly answered the major research questions. (Aug. 2001)

VA Researcher Identifies Breast Cancer Gene
A VA researcher at the San Francisco VA Medical Center and the University of California at San Francisco led a study that showed that women who have a specific sequence of a transforming growth-factor gene have a 60% lower risk of developing breast cancer. (June 2001)

Increased "Good" Cholesterol Reduces Rate of Strokes
A VA Cooperative Study at 20 VA Medical Centers has found that treatment aimed at raising levels of high-density lipoproteins (HDL), commonly called "good" cholesterol, substantially reduces the incidence of strokes in some patients. Patients who received the drug Gemfibrozil had a 31% lower incidence of stroke. The result is part of a larger study aimed at showing that higher HDL levels reduce the risk of major cardiovascular events. (June 2001)

Brain Development Continues into Late-40's
An inter-agency study led by a VA researcher at the Central Arkansas Veterans Healthcare System has shown that the brain continues to develop in late 40-year olds. This view contradicts the current view that brain maturation ends before age 20 and may shed light on brain ailments such as Alzheimer's Disease, schizophrenia and drug addiction. Using magnetic resonance imaging (MRI) to measure brain development, the study showed that so-called white matter - where memory, higher reasoning, and impulse functions take place - continues to develop until the age of 48, on average. (May 2001)

Reduced Opiate Treatment May Increase Efficacy of Chronic Pain Treatment
Researchers at the Tampa VA Medical Center have found that patients taking opiates for chronic pain conditions reported no greater pain intensity than those not taking the drugs. Those receiving opiate treatment did report increased impairment. The program gradually phased out opiate use and those who remained off the drugs reported less pain and increased functionality and reduced depression. (May 2001)

New Technique to Evaluate Corneal Tissue for Implants
Researchers at the Central Arkansas Veterans Healthcare System and the Jones Eye Institute at the University of Arkansas for Medical Sciences have developed a new technique to evaluate the surface of a cornea to determine suitability for transplantation. The new technique allows for evaluation of the entire surface of the cornea; current inspection is done visually or by methods that detect only large lesions. (May 2001)

Old Drug Resists Pull of Cocaine
Researchers at the Philadelphia VA Medical Center and the University of Pennsylvania report that Propranolol, a drug currently used to treat high blood pressure, helps addicts remain in treatment when the withdrawal effects of cocaine are especially high and treatment dropout rates are otherwise high. The research suggests that the drug reduces withdrawal symptoms by lowering the anxiety causing effects of adrenaline. (April 2001)

New Method to Treat Osteoporosis, Grow Bone Tissue
By using a synthetic form of estrogen that promotes bone growth without affecting the reproductive system, researchers at the Central Arkansas Veterans Healthcare System and the University of Arkansas for Medical Sciences may have discovered a new way to treat osteoporosis. Existing estrogen replacement therapy for osteoporosis is associated with several side effects including uterine cancer. This conceptual breakthrough could lead to a new generation of drugs and hormone therapies. (March 2001)

Natural Recovery from Spinal Cord Injury Shown in Rats
Researchers at the San Diego VA Medical Center have found that rats with spinal cord injuries develop some spontaneous re-growth of nerves leading to increased motor function. In rats where 97% of the spinal cord connections are severed, rats were able to regain function within four weeks of surgery. Further research in continuing to determine how this process of "sprouting" can be enhanced. (March 2001)

Flu Vaccines Could Save the Nation $1.3 Billion Annually
Routine influenza vaccinations of all working adults could save the nation as much as $1.3 billion each year according to a study led by researchers at the Minneapolis VA Medical Center and the University of Minnesota Medical School. By examining both the direct and indirect costs associated with influenza, researchers estimated that health care costs could be reduced by an average of $13.66 per person vaccinated. (March 2001)

Implanted Electrodes Help Stroke Patients Walk
Using a technique known as Functional Neuromuscular Stimulation (FNS), VA scientists implanted electrodes in the leg muscles of stroke patients and used sophisticated software to electrically stimulate the muscles over a six-month course of treatment. The patients experienced significant improvements in gait and other abilities, with no adverse effects. The research was described in the Journal of Rehabilitation Research and Development and other journals. (Feb. 2001)

©2005 Friends of VA Medical Care and Health Research