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Patient Advocacy NAS Testimony John S. Zapp, DDS Members of the NAS Committee on the organizational structure of the NIH, my name is John Zapp and I am the President of the Friends of the National Institute of Dental and Craniofacial Research, FNIDCR. Thank you for the opportunity to express our support for an independent National Institute of Dental and Craniofacial Research. The mission of the National Institute of Dental and Craniofacial Research (NIDCR) is to promote the general health of the American people by improving their oral, dental and craniofacial health. Through the conduct and support of research and the training of researchers, the NIDCR aims to promote health, prevent diseases and conditions, and develop new diagnostics and therapeutics. NIDCR was created on June 24, 1948, the third Institute of the NIH, making it one of the oldest of the 27 Institutes and Centers. During World War II military leaders saw the devastating effects that oral infections had on our military preparedness. Nearly 10 percent of the Army recruits were rejected because of missing teeth. Realizing that a national epidemic was being overlooked, the federal government stepped in to rectify the problem; changing the way Americans thought and acted about oral health care. 50 years later, we are seeing the benefits of that investment. The Friends of the National Institute of Dental and Craniofacial Research is a non-profit organization that was established in 1998 on the 50th Anniversary of the Institute. The Friends is a broad-based coalition of individuals, institutions and corporations who understand the critical importance of dental, oral and craniofacial health to the well-being of society. Our mission is to support the Institute and help to promote oral health care and research. While the role of saliva, teeth, taste buds, and the tongue in maintaining health generally are understood, there are other tissues within the body whose role is being elucidated through oral health research. Studies at NIDCR are helping to uncover new pathologies and modes of therapy for such diseases as osteoarthritis, Paget's disease, osteoporosis, autoimmune diseases such as rheumatoid arthritis, Sjogren's syndrome and juvenile diabetes, oral and pharyngeal cancer, chronic pain and other neurological disorders, and a host of infectious diseases, including AIDS, candidiasis, herpes, hepatitis and human papillomavirus infections. As we are all well aware, Congress has been generous in its attempt to double the NIH budget over 5 years. Yes, the NIDCR has had its budget increased, but it still lags far behind and in fact is almost dead-last in terms of overall funding at the NIH. Frankly, it is not an Institute that receives a fair share of the NIH's budget. Since 1998, the NIDCR budget, as a percentage of the NIH budget, has consistently decreased. Projected figures for FY 2003 indicate that NIDCR will receive only 1.4 percent of the NIH's total allotment in the coming fiscal year, down from 1.57 percent in 1998. The oral health community has reason to fear this trend will continue, especially if NIDCR's autonomy is reduced or compromised in a streamlined NIH. If NIDCR were to be combined into a new, larger Institute, losing its individuality, then - and I think the dental and oral health community would agree with me - oral health research funding would be dramatically cut. In fact, some have suggested relocating NIDCR into a new Institute, called the National Institute for Internal Medicine Research. The likelihood that oral health research would become a priority in this Institute frankly is limited. On a positive note, these are extraordinary times for science and biomedical research. Advances in oral health research have made lasting impressions on the overall health of all Americans. Some have said that possibly the greatest advance to oral health care has been water fluoridation-making it one of the most effective, safe and ideal public health measures of the past 50 years, contributing significantly to a 20-year decline in dental decay and periodontal disease. We also, however, have learned to take better care of our teeth, in very great measure is because of the work of the Institute in advancing the need for better oral health care. The NIDCR's research continues to experience fundamental breakthroughs. As a result of information technologies, biotechnology and genetic advances, the Institute's potential has never been greater - nor has its level of support throughout the professional community and among the American public. By continuing to support strong investments in oral, dental and craniofacial research, we have the opportunity to:
Additionally, the Institute has plans to address research in the areas of:
These are important areas of research that only an institute like NIDCR can promote through R01s, T32s and T35s. Dental colleges and oral health programs look to the NIDCR for career paths of tomorrow's researchers and practitioners. On a whole different level, the Institute is the singular leader for collecting and disseminating oral health information. I have provided some history, facts and statistics. Now let me share with you the outcome of three families who were touched by the research of the NIDCR. Conditions affecting the craniofacial complex, particularly those affecting the dentition can be devastating. Cleft lip/palate, dentinogenesis imperfecta, amelogenesis imperfecta and ectodermal dysplasia are just a few of these disorders that affect hundreds of thousands of children and adults. In the case of ectodermal dysplasia, a broad group of genetic conditions, those affected often are missing most of their teeth. Traditionally, it was thought that children could not wear dentures until their teenage years. The resulting emotional trauma of growing up with no teeth was often far worse than the physical problems association with the disorder. However, in recent years important work at the NIDCR has changed all of that. Invaluable research has proven that dental implants are a safe and effective option for teens and that young children benefit greatly physically and emotionally from having dentures placed at an early age. In addition, the NIDCR has funded important genetic research, which now enables women to be tested to determine if they are at risk for passing on the gene for this life altering condition. One individual who participated in the implant clinical research program is now pursuing a career as a researcher and another will graduate from dental school in the spring. More recently, a new mother celebrated throughout her pregnancy and at the birth of her beautiful son because she knew she was not at risk for passing on the ED gene that affects her brother. The lives of all of these individuals have been greatly enhanced by the work of the NIDCR. I find it impossible to believe that craniofacial defects affecting the dentition would have received the efforts needed for improvement in lives anywhere other than the NIDCR. Finally, I would like to leave you with this. A recent survey completed by Research!America shows that there is overwhelming support for increased funding for dental and craniofacial research. The Friends of NIDCR know that if combined into a larger Institute that the NIH would still fund oral health research, but we feel that it would not meet the demand that most Americans expect. We firmly believe that a strong and independent NIDCR must remain a vibrant part of the NIH. As former Surgeon General David Satcher recognized, in his report that concentrated on oral health in America. And I quote: "it is important that we continue further research and build the science base on oral health concerns. Such research has been at the heart of scientific advances in oral health over the past several decades. Our continued investment in research is critical to obtain new knowledge about oral health needs if improvements are to be made." As a dentist, the former executive director of the American Dental Association, a health official in three previous administrations, and a vice president of the American Medical Association, I completely agree with Dr. Satcher's assessment. We can do more, we must do more. That begins with keeping the NIDCR a strong and independent Institute. Thank you for your time and I would be happy to answer any questions you have about our organization and its position on the NIH reorganization. |