to that report, enabling legislation has been drafted and adopted by Congress. These centers would be developed in the setting of currently well-established academic research and clinical programs on aging. A moderate amount of core support should be provided to these centers for continuity of key research personnel and ongoing efforts; however, such centers would be expected to compete for additional research funds on a continuing basis to ensure that their work remains current and is peer reviewed. The primary goal of these centers would be to produce substantial numbers of very well-trained, clinical-research-oriented investigators. To date, three centers have been funded. Ample expertise already exists at enough academic programs to warrant immediate funding of 10 additional centers, followed by funding of further centers over the next several years as the need is demonstrated.

Finally, it is abundantly clear that the facilities and infrastructure available in the United States to support the research enterprise are seriously deficient. Accordingly, the committee recommends additional support for infrastructure and for construction of new research space and renovation of outdated space.

CROSSCUTTING ISSUES

Clinical research in geriatrics and gerontology requires an approach that engages many disciplines. Insights from molecular and cell biology provide a basic biomedical foundation for much clinical investigation, including newer therapies for Alzheimer's disease and the diagnosis of age-associated cancers such as carcinoma of the colon. Behavioral and social research and the insights offered by studies in health care delivery make possible clinical programs to study the responses of older people to illness, and to find better ways of intervening to reduce disability and morbidity among the aged.

Of equal importance in clinical research are crosscutting issues that involve gender differences in response to illness or in the metabolic disposition of drugs as well as racial and ethnic variation in the way older individuals experience illness, both from a patient care perspective and from the vantage of exploring differences in physiological response to disease. An example of the influence of gender differences on outcome of disease is seen in the lower rates of morbidity and mortality in women who have hypertension than in men with hypertension. Racial differences also appear to influence prognosis in some diseases; higher death and complication rates occur in hypertensive black men than in white men.

Another critical crosscutting issue is that of ethics in clinical



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