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ADDRESSING THE NATION'S CHANGING NEEDS FOR BIOMEDICAL AND BEHAVIORAL SCIENTISTS
high blood pressure and cholesterol, and such advances in diagnostics, treatment, and surgery as stress tests, “clotbuster” drugs, and balloon angioplasty. 6 Improvements in treatment now allow most survivors to return to normal activities within weeks of a heart attack.
Similarly, the anniversary of the National Institute of Dental and Craniofacial Research provided an opportunity to reflect on the enormous improvements in oral health over the last half century. At the outbreak of World War II, almost 10 percent of military-age American men were ineligible for the draft because they had less than six opposing teeth in each jaw. 7 Most people living in the U.S. at the time could expect to be toothless by the age of 45. 8 Today, the combination of fluoridated drinking water, dental sealants, and other improvements in prevention and treatment allow the majority of Americans to retain their teeth throughout their lives.
Beyond the latest improvements in medical care and health brought about by their research, investigators are also contributing to the nation's economy in new ways. The rise of cost-effectiveness studies (which may eventually help guide health care spending) 9,10 is one example; another, much further advanced, is evident in the field of biotechnology. After a period of steep growth—and occasional setbacks—in the 1980s, the biotechnology industry is now on firm footing and turning out new products at a rapid pace. Of the 65 drugs developed by biotechnology companies on the market in 1998, half had been introduced in the previous two years and the Food and Drug Administration is reviewing another 200. 11
ORIGINS OF THE NATIONAL RESEARCH SERVICE AWARD PROGRAM
Many roots of today's research training programs in the biomedical and behavioral sciences extend back to 1930 and the beginnings of the NIH. The enactment of the Ransdell Act that year established the NIH as the focus of the growing research activities of the Public Health Service and assigned the new agency a role in maintaining the research workforce. Recognizing that the agency would require a supply of trained personnel to fulfill its mission, legislators provided for the NIH to award fellowships to investigators interested in conducting research. 12
Before the decade was out, the first of NIH's “categorical” institutes had been founded, and the agency's duties had been expanded to include advanced clinical training as well. In establishing the National Cancer Institute in 1937, Congress charged it with providing “training and instruction in technical matters relating to the diagnosis and treatment of cancer,” 13 along with research training. As additional institutes were formed (the National Heart Institute and the National Institute for Dental Research in 1948, the National Institute of Mental Health in 1949, and the National Institute of Arthritis and Metabolic Diseases and the National Institute of Neurological Diseases and Blindness in 1950), their training responsibilities were based to a large degree on those established for the National Cancer Institute. 14 As a result, for much of its first two decades, NIH training support was divided between clinical and research training.
By the mid-1950s, NIH policymakers concluded that medical specialty training in most fields could be sustained without continuing NIH support, and the agency
National Institutes of Health. National Heart, Lung, and Blood Institute. Scientific Advances: Heart Attack and Counterattack. Bethesda, Md.: NIH, 1998.
Harris, Ruth Roy. Dental Science in a New Age: A History ofthe National Institute of Dental Research. Rockville, Md.: Montrose Press, 1989.
U.S. Congress. House. Committee on Appropriations. Subcommittee on Labor, Health and Human Services, and Education. Statement by Dr. Harold Slavkin on Fiscal Year 1999 President's Budget Request for the National Institute of Dental Research. 17 March 1998.
Berman, Stephen, Patricia J. Byrns, Jessica Bondy, Pamela J. Smith, and Dennis Lezotte. “Otitis Media-Related Antibiotic Prescribing Patterns, Outcomes, and Expenditures in a Pediatric Medicaid Population. ” Pediatrics 100, no. 4 (1997): 585-92.
Gleason, Patrick P., Wishwa N. Kapoor, Roslyn A. Stone, Judith R. Lave, D. Scott Obrosky, Richard Schulz, Daniel E. Singer, Christopher M. Coley, Thomas J. Marrie, and Michael J. Fine. “Medical Outcomes and Antimicrobial Costs with the Use of the American Thoracic Society Guidelines for Outpatients with Community-Acquired Pneumonia.” JAMA 278, no. 1 (1997): 32-39.
McDonald, Duff, Pablo Galarza, and Sarah Rose. “The Biotech Boom.” Money (September 1998): 83-98.
National Institutes of Health. Task Forces for the Review of NIH Biomedical Research. Review of the National Institutes ofHealth Biomedical Research Training Programs. Bethesda, Md.: NIH, 1989.
U.S. Congress. Senate. Committee on Labor and Public Welfare. National Research Service Award Act of 1974. 93rd Cong., 1st sess., 1973. S. Rept. 93-381.