Budget Request
FY 2016

Statement for the Record
Senate Subcommittee on Labor-HHS-Education Appropriations

June 15, 2015

Stephen I. Katz, M.D., Ph.D., Director
National Institute of Arthritis and Musculoskeletal and Skin Diseases


Mr. Chairman and Members of the Committee: I am pleased to present the Presidentís fiscal year (FY) 2016 budget request for the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health (NIH). The FY 2016 budget request for NIAMS is $533,232,000, which is $11,704,000 more than the FY 2015 level.

As the primary Federal agency for supporting medical research on diseases of the bones, joints, muscles, and skin, NIAMS touches the lives of nearly every American. Arthritis limits the activities of more than 22.7 million adults in the United States each year (National Health Interview Survey, 2010-2012); medical care and lost wages attributable to musculoskeletal conditions cost Americans $950 billion annually (Agency for Healthcare Research and Quality Medical Expenditures Panel Survey, 1996-2006); and skin conditions such as eczema and psoriasis affect more than 12 percent of people worldwide (Global Burden of Disease Study, 2010). NIAMS is working to enhance health, lengthen life, and reduce illness and disability by supporting research that will impact clinical practice; training future bone, joint, muscle, and skin scientists; and disseminating research findings and related health information to all Americans.

UNRAVELING LIFEíS MYSTERIES THROUGH BASIC RESEARCH

NIAMS funding supports thousands of scientists around the Nation who are uncovering the basic biologic processes of bone, joint, muscle, and skin health and disease. A recent study demonstrated that dietary changes, as well as antibiotic use, can prevent an autoinflammatory bone disease in a susceptible animal model. These findings build on knowledge and tools developed through the NIHís Human Microbiome Project and add to a growing body of evidence that diet can influence disease by affecting bacteria within the intestinal tract. Other exciting discoveries are coming from investigators who are converting skin cells into stem cells that can be used to correct genetic diseases such as epidermolysis bullosa. Two research teams, each using their own techniques, have converted cells from epidermolysis bullosa patients into disease-free sheets of skin cells that form normal tissue when grafted onto mice.

In FY 2014, NIAMS, the National Institute of Allergy and Infectious Diseases (NIAID), and the Foundation for the NIH partnered with pharmaceutical companies and patient advocacy and professional societies to launch the Accelerating Medicines Partnership in Rheumatoid Arthritis and Lupus (AMP RA/Lupus) Network. Identification of shared and disease-specific pathways through this Network is expected to reveal targets for drug development at an overall lower cost, and in less time, than can be accomplished through a less coordinated approach.

TRANSLATING DISCOVERY INTO HEALTH

NIAMS is committed to improving the health of patients with rheumatic, musculoskeletal, and skin diseases by supporting investigator-initiated clinical trials. One such study, the Spine Patient Outcomes Research Trial for low back pain, is developing information and resources that health care providers can use when reviewing treatment options with patients who have one of the three most common causes of severe low back pain. Another NIAMS-funded clinical trial, conducted through the Multicenter Orthopaedic Outcomes Network, is providing data that doctors can refer to as they discuss different surgical approaches, the likelihood that additional surgeries will be needed, and the appropriateness of injury prevention programs for a given patient.

Other investigators are mining electronic health records to compare patient responses to treatments. When researchers used this approach to compare two drugs that can prevent life-threatening blood clots after total joint replacement, they found that low-molecular-weight heparin increased the risk for bleeding and superficial infections, while patients who received warfarin experienced fewer postoperative infections.

HARNESSING DATA AND TECHNOLOGY TO IMPROVE HEALTH

The dissemination of information about research progress is essential for translating discoveries into better health. NIAMS recently expanded its social media presence to strengthen connections with patients and the general public, including multicultural communities. Efforts to reach multicultural communities include a bilingual Twitter chat that NIAMS hosted in recognition of Hispanic Heritage Month. NIAMS also regularly posts in Spanish on Twitter and features Spanish language resources on Facebook and Google Plus.

Since 2002, NIAMS has led a study of nearly 5,000 people who have or are at high risk of developing knee osteoarthritis (OA). This public-private partnership, known as the Osteoarthritis Initiative (OAI), provides data, images, and biologic specimens to researchers who are interested in developing and validating disease markers that could be incorporated into clinical studies of OA. More than 3,400 scientists from 90 countries have registered to use OAI resources. Over 200 papers have been published; many more are expected as investigators continue searching for structural and biochemical changes that are linked to OA development and progression.

NIAMS also plays a leading role in the NIH Patient Reported Outcomes Measurement Information System (PROMIS) Initiative, which is developing and distributing electronic tools for measuring patientsí overall health and function. New activities include expanding PROMIS to collect more information about chronic conditions affecting children (e.g., juvenile arthritis, asthma, and childhood obesity).

LOOKING TO THE FUTURE

Other plans for FY 2016 and beyond include launching an initiative called Supplements to Advance Research (STAR) from Projects to Programs. Part of the Instituteís efforts to foster a talented biomedical workforce, STAR targets scientists who are at an early stage of their independent careers. Eligible researchers are invited to compete for STAR funding to expand their single NIAMS-funded projects into broad programs that they can sustain over the next decades.

NIAMS continues to implement recommendations from a formal evaluation of its Centers Program. In FY 2016, NIAMS will fund a new set of resource-based centers that provide infrastructure, shared facilities, and services to scientists who are answering research questions related to the NIAMS mission. Additionally, NIAMS is reexamining how it supports core resources to facilitate investigator-initiated clinical studies. Input collected through a request for information and other sources will ensure that NIAMS-funded resources continue to support scientifically rigorous clinical research, promote creativity and discovery, and foster training of clinical and epidemiological researchers.