DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
Witness appearing before the
Senate Subcommittee on Labor-HHS-Education Appropriations
Griffin P. Rodgers, M.D., M.A.C.P., Director
National Institute of Diabetes and Digestive and Kidney Diseases
May 21 2009
Mr. Chairman and Members of the Committee:
I am pleased to present the President’s Fiscal Year 2010 Budget request for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH). The FY 2010 budget includes $1,781,494,000, which is $20,156,000 more than the FY 2009 appropriation of $1,761,338,000. Complementing these funds is an additional $150,000,000 also available in FY 2010 from the special statutory Type 1 Diabetes Research Program for NIDDK.
Our Institute supports research on a wide range of common, chronic, costly, and consequential health problems that affect millions of Americans. These include diabetes and other endocrine and metabolic diseases; digestive and liver diseases; kidney and urologic diseases; blood diseases; obesity; and nutrition research. Additionally, consistent with the President’s commitment to increase funding for cancer research, and with the HHS-wide initiatives on autism, NIDDK will support research relevant to these diseases.
GENETIC FACTORS IN COMPLEX DISEASES
Many complex diseases within the NIDDK mission result from interactions amongst multiple genetic and environmental factors. Building upon the wealth of genetic information from the Human Genome Project, basic research on genetic contributors to these diseases lays the foundation for translation of knowledge into clinical settings, where it can be used to better predict and preempt disease development, as well as provide more personalized medical care.
For example, the NIDDK supported recent research uncovering six new genetic variants involved in type 2 diabetes. Combined with previous genetic findings, this new knowledge can help to determine who is at risk for this disease and how it might best be treated and prevented. NIDDK research has also recently shown how a genetic variant associated with type 1 diabetes works to alter immune function, enhancing understanding of this disease and highlighting potential targets for therapy. NIDDK also contributed to international research efforts yielding an explosion of new genes or gene regions associated with the inflammatory bowel disease known as Crohn’s disease. The total number of known susceptibility genes currently stands at more than 30, each of which promises fresh insights into this disease and its management. Genetic analyses have also identified contributors to other diseases within the NIDDK mission, including nonalcoholic fatty liver disease, liver cancer, and diabetes-related kidney disease. Some of this research addresses populations disproportionately affected by certain diseases. For example, genetic variants were identified that account for much of the burden of non-diabetic kidney disease in African Americans. These studies may lead to future screening strategies and more personalized therapies.
The NIDDK also participates in trans-NIH efforts exploring how genetic factors impact disease. Data from an NIDDK-sponsored study of the genetics of diabetic kidney disease are being analyzed by the Gene Association Information Network to inform disease prevention, diagnosis, and treatment. The NIDDK leads two projects within the Genes, Environment, and Health Initiative, which studies effects of genetic variants on disease risk in response to environmental exposures. The NIH Roadmap Epigenomics Program is researching how epigenetics—or biochemical changes to DNA—can control genes during different stages of development, such as fetal epigenetic responses in the intrauterine environment and the risk of diabetes after birth.
CLINICAL AND POPULATION-BASED RESEARCH
Clinical and population-based research generates important information not only for developing more effective therapies, but also for identifying strategies to preempt disease development—both essential for the future of medical care. NIDDK-sponsored research informs screening efforts to detect early signs of susceptibility and prevent full-blown disease. For example, recent studies have proven the potential of intensive early colonoscopy screening for precancerous polyps in African Americans to reduce their disproportionate colon cancer burden.
NIDDK-sponsored efforts are also testing interventions to address type 2 diabetes related to overweight in both adults and children. Researchers are studying obese adults with type 2 diabetes to observe the effects of lifestyle changes to lower risk of diabetes complications. Similarly, in children, a study is determining if healthier food choices in schools, increased physical activity, and improved awareness of healthy behaviors can reduce weight and lower risk factors for type 2 diabetes—a disease that was once seen only in adults, but has been increasing in American youth.
Obesity continues to be one of our nation’s most pressing health problems. The NIDDK supports a multi-pronged obesity research effort that includes studies of molecular and environmental contributors to feeding behavior and metabolism, processes such as inflammation in metabolic tissues, bariatric surgery and other potential treatments for obesity, and lifestyle interventions to prevent or reverse obesity. For example, a recent study showed that modest reductions in time spent by children watching TV or using the computer have beneficial effects on their weight.
Clinical research is also yielding new insights into the development and management of kidney, urologic, and liver diseases. Recent clinical studies showed the limited effectiveness of drugs to enable vascular access during hemodialysis for kidney failure and for treating chronic kidney disease due to high blood pressure in African American patients. A multi-center network is investigating causes of the two most common urologic pelvic pain disorders—interstitial cystitis/painful bladder syndrome and chronic prostatitis/chronic pelvic pain syndrome—which may yield new targets for managing these diseases. A new clinical research network conducting translational research on chronic hepatitis B is focused on understanding disease processes and applying this knowledge to more effective treatment and control strategies.
ENHANCING FUTURE HEALTH RESEARCH
The biomedical research enterprise will depend heavily on the next generation of investigators, innovative ideas of individual scientists, and the synergy of public-private partnerships. The NIDDK, along with the wider NIH, will continue its commitment to helping new investigators realize their potential through such efforts as special funding consideration, small grant and career awards, and mentoring workshops. The Institute also remains firmly committed to supporting investigator-initiated research. Public-private partnerships through such entities as the Foundation for the NIH will continue to expand the reach of NIDDK research.
Strategic planning, analyses of disease burden, and research coordination are tools utilized by the NIDDK to advance research. Recently, the National Commission on Digestive Diseases—for which NIDDK provided leadership and support—released its long-range research plan, identifying challenges and opportunities for digestive diseases research. A separate report on the burden of digestive diseases in the U.S. was prepared by the NIDDK to inform this research plan. The “NIDDK Prostate Research Strategic Plan,” released in 2008, provides recommendations for future research efforts targeting the causes, prevention, and treatment of benign prostate disease.
NIH recently initiated an effort to update its 2004 “Strategic Plan for NIH Obesity Research” in order to review research progress and identify new opportunities. This strategic planning effort is overseen by the NIH Obesity Research Task Force, which I co-chair together with Dr. Elizabeth Nabel, Director of the National Heart, Lung, and Blood Institute.
Coordination to enhance research efforts across the NIH and with research partners in other Federal agencies is also achieved through the work of coordinating committees. The Diabetes Mellitus Interagency Coordinating Committee (DMICC) coordinates diabetes activities across the Federal government and fosters opportunities for agency collaboration. In its coordinating role, the DMICC encourages Federal research collaborations, minimizes overlap of agency research efforts, and enhances public awareness of diabetes research and health information provided by Federal agencies. The DMICC is the focal point for diabetes research planning efforts.
PROMOTING HEALTH AWARENESS
In addition to supporting health research, the NIDDK remains committed to ensuring that knowledge gained from research is used to promote health awareness. Relevant activities include the National Diabetes Education Program, National Kidney Disease Education Program, Weight-control Information Network, Celiac Disease Awareness Campaign, and programs to promote prevention of obesity and overweight.
Recently, the NIDDK expanded its health information materials with a new Awareness and Prevention series of fact sheets. These publications are designed to raise awareness of diseases such as diabetes, digestive diseases, and kidney and urologic diseases among people not yet diagnosed with these illnesses. Materials produced by the NIDDK are often translated into multiple languages. For example, the Institute is currently developing Asian language materials on hepatitis B to reach people whose origins place them at higher risk—a priority highlighted at the NIH Consensus Development Conference on Management of Hepatitis B in October 2008.
Another resource for promoting health awareness in affected groups is a set of teaching tools for school-based diabetes education in American Indians, who have the highest rates of diabetes in the U.S. Through educating American Indian youth about diabetes prevention, these tools aim to reduce the incidence of type 2 diabetes in these young people and their families, as well as encourage entry into health-related careers.
A key goal of the NIDDK is to maximize the return on research investments to derive the greatest health and economic benefits. Embedded in the population-based projects I mentioned is a consideration of their cost-effectiveness. As areas of research converge around common disease mechanisms—such as microbial influences on health—and research tools—like genetics-based technologies—opportunities exist to leverage resources and foster collaborations. Past investments in sample repositories and databases can be extended in ancillary and follow-up studies. In these ways, the intrinsic economic benefit of NIDDK-sponsored research can be fully realized.
In closing, I thank the Chairman and members of the Committee for this opportunity to highlight some of the NIDDK’s research and outreach efforts to improve our nation’s health. I would be pleased to answer any questions you may have.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
National Institute of Diabetes and Digestive and Kidney Diseases
Griffin P. Rodgers, M.D., M.A.C.P.
Dr. Rodgers is the Director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health, a position he has held since April 1, 2007, after holding the post of Acting Director for one year. As Director, Dr. Rodgers oversees a national research program in diabetes, endocrinology, and metabolic diseases; digestive diseases and nutrition; obesity; and kidney, urologic, and hematologic diseases, the goal of which is to improve the health and quality of life for all Americans. Prior to leading the Institute, Dr. Rodgers served as its Deputy Director from 2001. An active researcher, Dr. Rodgers also is Chief of the Molecular and Clinical Hematology Branch of the NHLBI’s Intramural Research Program.
A native of New Orleans, Dr. Rodgers received his undergraduate, graduate, and medical degrees from Brown University in Providence, Rhode Island. He was an intern, resident and chief resident in internal medicine at Barnes Hospital and the Washington University School of Medicine in St. Louis, Missouri. His fellowship training in hematology was in a joint program of the National Institutes of Health, The George Washington University, and the Washington Veterans Administration Medical Center. Dr. Rodgers has also recently received a Master of Business Administration degree with a concentration in the Business of Medicine from The Johns Hopkins University in Baltimore, Maryland.
Dr. Rodgers has engaged in groundbreaking basic and clinical research focused on developing new therapeutic approaches to hematopoietic diseases, such as thalassemia and sickle cell disease. He is widely recognized for his contributions to the development of the first effective—and now Food and Drug Administration-approved—therapy for sickle cell anemia.
Dr. Rodgers has been honored for his research with numerous awards including the Public Health Service Physician-Researcher of the Year Award. He has delivered several named lectures nationally and internationally, and published over 150 original research articles, numerous reviews, book chapters, books and monographs. He is a member of the editorial board of several scientific journals, and has held leadership positions in major professional medical societies.