This morning the full Senate Appropriations Committee approved its fiscal year 2015 (FY15) Defense Appropriations bill. During the mark-up, many Senate appropriators across both aisles expressed support for medical research. This support is reflected in the bill which increases funding for the Department of Defense (DOD) core medical research program by $789 million, or 5%, over the FY14 funding level. Much of the increase is split between the Peer-Reviewed Medical Research Program and cancer research. The bill also includes language emphasizing collaboration between DOD and the National Institutes of Health (NIH) in research efforts. Before it becomes law, the bill must be passed by the full Senate and House of Representatives, and be signed by the President.
Of interest to the Sleep Research Society, the Senate FY15 Defense Appropriations bill includes:
Defense Health Program
- $247.5 million for the Peer-Reviewed Medical Research Program, an increase of $47.5 million over the FY14 funding level
Peer Reviewed Medical Research Program — The Committee recommends $247,500,000 for the Peer Reviewed Medical
Research Program. The Committee directs the Secretary of Defense, in conjunction with the Service Surgeons General, to
select medical research projects of clear scientific merit and direct relevance to military health. Research areas considered under this
funding are restricted to…chronic migraine and post-traumatic headache…gulf war illness…sleep disorders...The Committee
emphasizes that the additional funding provided under the Peer Reviewed Medical Research Program shall be devoted only to the
purposes listed above. The Committee remains supportive of the medical research being conducted by the Department that yields
medical breakthroughs for service members and often translates to the civilian population, as well. The Committee directs the Assistant
Secretary of Defense (Health Affairs) to provide a report to the congressional defense committees within 180 days of enactment of this
act on the breakdown of funding in the Congressionally Directed Medical Research program between basic and advanced research.
Sleep Disorder Research — The Committee recognizes that sleep disorders are increasingly prevalent among service members and
that such disruptions have been associated with diverse mental and physical disorders, including traumatic brain injury and
posttraumatic stress. The Committee applauds the Army for acknowledging the importance of sleep in achieving optimal physical,
mental, and emotional health and including sleep as a focus in the Performance Triad.
In support of this effort, the Committee urges the Department to support basic, translational, and clinical research on how the
disruption of normal sleep and circadian biological rhythms adversely affects the health, safety, performance, and productivity of our
military and civilian populations.
Collaboration on Medical Research — The Committee notes that the DOD coordinates with several other
Federal agencies, especially the National Institutes of Health [NIH], through its peer-review process for medical research. NIH currently
uses the Research Portfolio Online Reporting Tools [RePORTER] to consolidate reports, data, and analyses of NIH research activities,
including information on expenditures and the results of supported research. The Committee understands that DOD signed a
memorandum of agreement in February 2014, to initiate a pilot program to begin sharing DOD research data into RePORTER. The
Committee is supportive of this collaboration and directs the Assistant Secretary of Defense for Health Affairs to provide the Committee
a report on the status of this pilot program not later than 90 days after enactment of this act. The report should include a full description
of the pilot program, a timeline of its implementation, and any impediments for the Department in uploading all of its research
information into the database.
Additionally, DOD and NIH worked together to create the Federal Interagency Traumatic Brain Injury Research [FITBIR] system, a
centralized database for traumatic brain injury [TBI] research. FITBIR serves as a central repository for new data, links to current
databases, and allows valued comparison of results across studies. The Committee supports this type of collaboration and believes it
is a crucial step in addressing the critical gaps in knowledge regarding the diagnosis and treatment of TBI. The Committee encourages
continued collaboration between DOD and NIH in order to avoid duplication of effort and maximize Government investments in medical
In order to build on this collaboration, the Committee directs the Department to contract with the Institute of Medicine [IOM] to evaluate
the Congressionally Directed Medical Research Program [CDMRP] and provide a report to the congressional defense committees not
later than 12 months after enactment of this act The report should include an evaluation of the CDMRP two-tiered peer review process,
its coordination of research priorities with NIH, and recommendations for how the process can be improved. The Committee notes that
the peer review system used in the CDMRP is the recommendation of a 1993 IOM report and was modeled after the NIH system. The
inclusion of patient advocates in the CDMRP peer review has been a highly regarded addition to the process, and the Committee
believes that these voices provide a valuable contribution.
Investments in Medical Research — The Committee notes that Federal investment in medical research has generated medical
discoveries and scientific innovations that have led to longer lives, created new industries, and established the United States as a
leader in research and development. In order to maintain our Nation’s global leadership and facilitate future life-saving discoveries, the
Committee adds a total of $789,200,000 for medical research, a 5 percent increase over the Committee’s fiscal year 2014
Core Medical Research Funding — The Committee notes that the Department’s fiscal year 2015 budget for medical
research, excluding information technology, severely declined. Core research and development funding supports medical research in
medical training and health information sciences, military infectious diseases, military operational medicine, combat casualty care,
radiological health, and clinical and rehabilitation medicine. The Committee believes that this research yields important advances in
medical care for service members and their families, as well as the larger civilian population. Therefore, the Committee recommends
$162,200,000 to restore this unjustified funding reduction and allow the Department to continue funding its core research priorities.
Traumatic Brain Injury [TBI]/Psychological Health — The Committee recommends $60,000,000 above the fiscal year 2015 budget
request for continued research into treatment and prevention of traumatic brain injuries and improved psychological health. The
Committee directs the Assistant Secretary of Defense (Health Affairs) to submit a report to the congressional defense committees
within 180 days of enactment of this act on expenditure and obligation data of additional funding added by Congress for psychological
health and traumatic brain injury. This report should include information on agreements made with other government agencies.
Additionally, the Committee is aware of recent medical advances in drug development for neurodegenerative diseases and encourages
the Department to further its research into developing drugs that reverse, halt, or slow the neurodegenerative process associated with
traumatic brain injury.
Healthy Base Initiative — The Committee is encouraged by the Department’s development of the Healthy Base Initiative [HBI], which
holds the promise of substantially shifting behavior and practice to improve the wellness and resilience of the Nation’s military, their
families, and the communities that support them. The Committee is particularly supportive and encouraged that, to date, the program
has included bases representing each service, as well as the Guard and Reserve. The Committee encourages the Department to
commit internal structures and processes to ensure the program’s permanence.
The Committee recommends that the Department: (1) Issue necessary instructions or directions to ensure HBI’s sustainability,
including the training of DOD leadership at all levels about HBI; (2) expand HBI’s scope beyond tobacco use cessation and obesity to
better align with a broader whole systems approach, such as Total Force Fitness; (3) develop a multi-stakeholder working group,
including strong public-private partnerships that engage surrounding communities and leaders, to support the design and execution of
an expanded HBI; (4) identify and implement appropriate program metrics to measure impact on health as described in Total Force
Fitness; and (5) establish a single, fully accountable, vested DOD official in charge of HBI within the Office of Military Community and
Family Policy of the Under Secretary of Defense (Personnel & Readiness).
The Consolidated Appropriations Act, 2014 included $3,000,000 to expand HBI and the Committee looks forward to reviewing the
progress report on the status of the program due in July 2014. The Committee recommends $3,000,000 in Operation and Maintenance,
Defense Wide for the continuation and expansion of HBI.