DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 1999

311 Pages·0.64 MB·English

by  Committee on Appropriations

[House Hearing, 105 Congress]
[From the U.S. Government Printing Office]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN
SERVICES, EDUCATION, AND RELATED AGENCIES
APPROPRIATIONS FOR 1999
========================================================================
HEARINGS
BEFORE A
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTH CONGRESS
SECOND SESSION
________
SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES,
EDUCATION, AND RELATED AGENCIES
JOHN EDWARD PORTER, Illinois, Chairman
C. W. BILL YOUNG, Florida DAVID R. OBEY, Wisconsin
HENRY BONILLA, Texas LOUIS STOKES, Ohio
ERNEST J. ISTOOK, Jr., Oklahoma STENY H. HOYER, Maryland
DAN MILLER, Florida NANCY PELOSI, California
JAY DICKEY, Arkansas NITA M. LOWEY, New York
ROGER F. WICKER, Mississippi ROSA L. DeLAURO, Connecticut
ANNE M. NORTHUP, Kentucky
NOTE: Under Committee Rules, Mr. Livingston, as Chairman of the Full
Committee, and Mr. Obey, as Ranking Minority Member of the Full
Committee, are authorized to sit as Members of all Subcommittees.
S. Anthony McCann, Robert L. Knisely, Carol Murphy, Michael K. Myers,
and Francine Salvador, Subcommittee Staff
________
PART 7B
(Pages 1-1371)
TESTIMONY OF MEMBERS OF CONGRESS AND OTHER
INTERESTED INDIVIDUALS AND ORGANIZATIONS
________
Printed for the use of the Committee on Appropriations
________
U.S. GOVERNMENT PRINTING OFFICE
48-709 O WASHINGTON : 1998
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For sale by the U.S. Government Printing Office
Superintendent of Documents, Congressional Sales Office,
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COMMITTEE ON APPROPRIATIONS
BOB LIVINGSTON, Louisiana, Chairman
JOSEPH M. McDADE, Pennsylvania DAVID R. OBEY, Wisconsin
C. W. BILL YOUNG, Florida SIDNEY R. YATES, Illinois
RALPH REGULA, Ohio LOUIS STOKES, Ohio
JERRY LEWIS, California JOHN P. MURTHA, Pennsylvania
JOHN EDWARD PORTER, Illinois NORMAN D. DICKS, Washington
HAROLD ROGERS, Kentucky MARTIN OLAV SABO, Minnesota
JOE SKEEN, New Mexico JULIAN C. DIXON, California
FRANK R. WOLF, Virginia VIC FAZIO, California
TOM DeLAY, Texas W. G. (BILL) HEFNER, North Carolina
JIM KOLBE, Arizona STENY H. HOYER, Maryland
RON PACKARD, California ALAN B. MOLLOHAN, West Virginia
SONNY CALLAHAN, Alabama MARCY KAPTUR, Ohio
JAMES T. WALSH, New York DAVID E. SKAGGS, Colorado
CHARLES H. TAYLOR, North Carolina NANCY PELOSI, California
DAVID L. HOBSON, Ohio PETER J. VISCLOSKY, Indiana
ERNEST J. ISTOOK, Jr., Oklahoma ESTEBAN EDWARD TORRES, California
HENRY BONILLA, Texas NITA M. LOWEY, New York
JOE KNOLLENBERG, Michigan JOSE E. SERRANO, New York
DAN MILLER, Florida ROSA L. DeLAURO, Connecticut
JAY DICKEY, Arkansas JAMES P. MORAN, Virginia
JACK KINGSTON, Georgia JOHN W. OLVER, Massachusetts
MIKE PARKER, Mississippi ED PASTOR, Arizona
RODNEY P. FRELINGHUYSEN, New Jersey CARRIE P. MEEK, Florida
ROGER F. WICKER, Mississippi DAVID E. PRICE, North Carolina
MICHAEL P. FORBES, New York CHET EDWARDS, Texas
GEORGE R. NETHERCUTT, Jr., Washington ROBERT E. (BUD) CRAMER, Jr., Alabama
MARK W. NEUMANN, Wisconsin
RANDY ``DUKE'' CUNNINGHAM, California
TODD TIAHRT, Kansas
ZACH WAMP, Tennessee
TOM LATHAM, Iowa
ANNE M. NORTHUP, Kentucky
ROBERT B. ADERHOLT, Alabama
James W. Dyer, Clerk and Staff Director
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
AGENCIES APPROPRIATIONS FOR 1999
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Wednesday, January 28, 1998.
TESTIMONY OF MEMBERS OF CONGRESS AND OTHER INTERESTED INDIVIDUALS AND
ORGANIZATIONS
WITNESS
JEROME PAULSON, M.D., AMERICAN ACADEMY OF PEDIATRICS
Mr. Porter. This hearing begins the subcommittee's work on
fiscal year 1999 funding for the departments and agencies
within our jurisdiction.
Today we begin by hearing from public witnesses. We will
then proceed to each of the departments and agencies, and then
finally to Members of Congress. We will also receive testimony
from the General Accounting Office. We have 29 days of hearings
scheduled, covering just over 3 months, and we expect to have
our final hearing right at the end of April.
Congress, as all of you know, is a busy place, and Members
have many conflicting hearings, meetings, and other official
responsibilities. However, let me assure you that while Members
may not be present, your testimony is reviewed by them and
their staffs and your views provide valuable information as we
review the President's budget requests.
In order to accommodate as many members of the public as
possible, we have scheduled over 20 witnesses for each session
and are still not able to hear from all who wanted to testify.
Overall, we will hear from over 200 witnesses in this segment
alone. As a result, I have to enforce the rule limiting
testimony to 5 minutes very strictly. My staff has acquired a
new countdown device that they are going to use, and I would
ask that, as you testify, you keep this limitation in mind in
consideration of other witnesses that must follow you.
I would also remind witnesses of two provisions of rules of
the House. In addition to their written statement,
nongovernmental witnesses must submit a curriculum vitae and a
statement of Federal grant or contract funds they or the entity
they represent have received.
If you have any questions concerning the applicability of
this provision or questions as to how to comply, please contact
this subcommittee staff.
We begin with Jerome Paulson, M.D., Associate Professor,
Division of Pediatrics, Department of Health Care Sciences,
George Washington University School of Medicine and Health
Sciences, representing the American Academy of Pediatrics.
Dr. Paulson, we welcome you this morning.
Dr. Paulson. Good morning, Mr. Porter. I am Jerome Paulson,
M.D., a member of the American Academy of Pediatrics. I am a
practicing pediatrician and an associate professor at George
Washington University. On behalf of the Academy and our
pediatric colleagues, I would like to thank the subcommittee
for the opportunity to present this statement, and I want to
thank you for putting children first on your agenda this
morning.
This year, as we celebrate the bicentennial of the U.S.
Public Health Service, we applaud how much has been
accomplished. We have conquered many diseases and disabling
conditions, especially for children; for example, smallpox, and
we are close to the eradication of polio.
To continue meeting the challenges ahead of new and
emerging infectious diseases, food safety concerns, and costly
chronic diseases, we must continue to invest in a continuum of
public health activities that includes the full spectrum of
biomedical, behavioral, and health services research, invests
in disease prevention and health promotion, targets health care
services for vulnerable populations, and educates a primary
care and public health work force.
As pediatricians, we are on the front line and we see
firsthand the impact of poverty and violence on the health of
our children and adolescents, and we know that the future of
our work force depends on the decisions we make today.
I will focus my oral remarks on a few observations from my
own practice and research. The pediatric community has strived
for decades to curb children and adolescents' access to and use
of tobacco. Each day 3,000 children nationally begin to use
tobacco. Of those people who will ever smoke, 90 percent begin
before age 19. Young smokers suffer from respiratory problems
and asthma, and among teens who are regular smokers, 1 in 3
will die from smoking.
As pediatricians, we counsel our patients about the
addictiveness of nicotine and its detrimental health effects.
In addition, we discuss with parents the impact of secondhand
smoke on their children. These facts alone confirm that tobacco
is truly a pediatric disease. As pediatricians, we strongly
recommend adequate support for a wide array of tobacco
prevention and cessation programs, including the CDC's office
on smoking and health. These programs have a proven record of
success in reducing smoking rates.
Let us not forget the environmental effects of tobacco
smoke. Asthma is the most common chronic disease of childhood
and is frequently exacerbated by tobacco. It is a disease that
is on the increase, and disproportionately affects African-
American and Latino children.
According to the CDC, asthma-related costs to the health
care system are continuing to grow because of increased
morbidity and mortality. The current CDC projections for the
year 2000 are $12.4 billion. Added to these health care costs
are days lost from school for children and days away from work
for their parents. However, with increased public health
education, cost-effective environmental interventions and
research, such as the NIH-, NIEHS- and NIAI-sponsored inner-
city asthma study, asthma-related illnesses and costs can be
dramatically reduced.
Injury is the leading cause of death and disability among
children and young adults 1 to 44 years of age. Every day 60
children die from injuries and countless others are injured and
disabled. Injury is costly on multiple levels: in theemotional
toll it takes on victims and their families; in direct medical
expenses, both acute and chronic; and in long-term economic costs due
to the years of potential life and productivity lost, especially with
respect to children.
In direct medical costs alone, injury costs the Federal
Government $12.6 billion annually, and an additional $18.4
billion each year in disability and death benefits. Therefore,
measures to prevent injury and reduce its severity are
extremely cost-effective. The National Center for Injury
Prevention and Control fulfills a unique function in this
undertaking.
The Center's work addresses many types of injuries, both
intentional, such as youth-perpetrated violence, and
unintentional. Additional resources would enable the Center to
continue its important leadership in the Safe America Program
through which the NCIPC has brought together diverse public and
private sector entities to develop and disseminate injury-
prevention information and interventions.
The initial focus of the effort is to reduce injury among
children and adolescents. Additional resources would also
enable the center to expand efforts to reduce physical and
sexual violence among children, produce a comprehensive youth
violence prevention program, and ensure that every U.S.
resident has access to the lifesaving and cost-effective
services of a poison control center through national and State-
specific toll-free numbers.
As scientists and investigators, pediatricians encourage
research decisions to continue to remain in the hands of
scientists at the CDC. But what happens to children or
adolescents when he or she is injured and requires emergency
services? As a participant in a project funded by the EMSC
program, I know how important those dollars are in enabling us
to develop the information that will improve the system of care
for children and save lives.
Thank you for this opportunity to provide you with our
recommendations for the coming fiscal year. We hope that we can
continue our dialogue with this committee following the release
of the President's fiscal year 1999 budget. There are many
important opportunities for pediatric behavioral and health
sciences research. We know that you will not forget America's
children.
Mr. Porter. Thank you. Thank you for your fine statement,
and thank you for being reasonably close to your time limit.
Mr. Paulson. You are welcome, sir.
[The prepared statement of Jerome Paulson, M.D., follows:]
[Pages 4 - 15--The official Committee record contains additional material here.]
Wednesday, January 28, 1998.
WITNESS
MIKE MILLER, M.D., FDA-NIH COUNCIL
Mr. Porter. Mike Miller, M.D., Director of Federal
Relations, Incorporated, testifying on behalf of the FDA
Research Council.
Dr. Miller. Thank you, Mr. Chairman.
On behalf of the FDA Research Council, I want to thank you
for the opportunity to submit testimony concerning the
importance of a sustainable, predictable funding base for the
NIH. Our comments in full will be included for the record.
We emphasize the importance of the NIH in improving the
quality of health care for all. In past years this committee
has been vitally important in addressing the funding needs of
the NIH and the Council, and the entire research community is
grateful for your support.
Based on the Council's assessment of challenges and
opportunities the FDA is presented within the next several
years, the Council supports doubling the NIH budget for the
next 5 years, starting with a 15 percent increase for fiscal
year 1999.
Why does the Council and NIAMS support such an increase for
the NIH's budget? The answer to this lies, I believe, in
understanding the goal of the entire process. It may seem
obvious, but the goal of the entire biomedical research
innovation and discovery process is to improve the quality of
people's lives. In our detailed budgetary discussions that we
had in Washington it is easy to forget that basic fact, but it
is also sometimes not easy to see that the ultimate goal is a
simple cure for a disease.
What everybody really wants is to be able to go to the
physician, take a pill, and be cured for whatever ails them.
Getting to that goal is not easy or simple. It takes a robust
biomedical research system. Worldwide the U.S. is the leader in
such a system, and the NIH is at its foundation.
What I would like to briefly discuss is the historical
context of our current biomedical research system, because by
understanding how we came to our current level of knowledge and
the treatments from that knowledge, we can better appreciate
the landscape ahead and better plan how we want to proceed in
the future.
Most people who support the NIH understand intuitively what
potentially lies ahead, but by understanding what seems
intuitive, it can help to clarify its importance and relevance
to our lives, our actions, and our future.
What has been the progress of medicine for the past 20, 50,
or 100 years? For example, 100 years ago, biomedical research
was largely a process of observation and classification.
Medical practice was largely based upon simple chemicals and
even herbal extracts which have been found by trial and error
over many years to have some beneficial effects.
In fact, in 1910, the AMA surveyed physicians and asked
them what they thought were the most important therapies
available to them. Number one on the list was ether, which
enabled anesthetized surgery. Number two was morphine, a
painkiller but certainly not curative. Number three was
digitalis for heart ailments. Number nine was alcohol. Number
10 was mercury.
The AMA did a similar survey in 1945 and found significant
advances. Number one was penicillin and the sulfa antibiotics,
ether had dropped to number four, and digitalis to number five.
Insulin had been discovered and was added to the list as number
eight, and number ten was vitamins.
The question is: What would such a list look like if
physicians were surveyed today. Insulin might still be on the
list because it is very important for people with diabetes, but
its form of purity has changed. Today human insulin is
available through the common DNA technology. Other innovative
medicines treat a variety of ailments which were not even
understood in 1945, such as cancers, autoimmune disorders,
AIDS, and neurological conditions. The list goes on.
One only needs to talk to friends or their children to find
out what kind of medicines are being taken that are available
today that were not available 5 or even 10 years ago. What has
changed in the past 20 to 50 years? Someoutstanding biomedical
breakthroughs have taken place to lead to these new medicines. Heart
disease, for example, is based on--new treatments for heart disease are
based on a better understanding of specific receptors or enzymes, how
they block or activate those enzymes or receptors. Each of these
advanced treatments is only possible once it is understood how the
receptor enzyme controls some aspect of health or disease. This is the
essential basic research which NIH supports. Without this knowledge,
new medicine would only be found through serendipity, not through
rational science.
I may have given the impression with my oversimplified
account simply that innovation proceeds in a linear, stepwise
fashion. It is actually sinuous and weblike, with many blind
paths and interlinking discoveries. With NIH in the lead
identifying promising paths, the other partners in the process
will be able to support the intellectual discoveries made
possible by NIH funding, and to work with NIH and academic
researchers to take these discoveries out of the test tube and
into a form where they can provide significant benefits to
millions of Americans.
To accomplish this, support for the NIH must be across its
range of programs, including those which provide means so
everyone in the community can take advantage of scientific
opportunities. One other exciting avenue which is just
beginning to be explored involves the race to develop and
validate diagnostic measures and tests to diagnose or to
determine the status of primary diseases before the symptoms
will develop. Such steps will attempt to prevent disease
progression in individuals and help researchers to determine
whether an experimental treatment is or is not effective, and
thus either make it more widely available, or attempt the
investigation in order to pursue other opportunities or paths.
These are some of the exciting opportunities and
challenges, Mr. Chairman. The Council appreciates your support
for the NIH, and urges you to consider our request for doubling
over 5 years and a 15 percent increase. We realize you have a
tough job and many priorities, but thank you for this
opportunity. We are willing to take any questions.
[The prepared statement of Mike Miller, M.D., follows:]
[Pages 18 - 27--The official Committee record contains additional material here.]
Mr. Porter. Dr. Miller, thank you, sir, for your excellent
statement. Let me say that the American people do intuitively
understand the importance of biomedical research, but all of
us, all of you, have to somehow get the message out as to what
progress has been made, why it is important to human beings. It
is not only important to improve lives, it saves health care
costs tremendously. It improves the quality of life in many
different ways.
Somehow we need to get that message out to every American
person, not just the Members of Congress but the whole
population at large. All of us have to put our shoulder to that
wheel if we are going to get the kinds of increases that we
think are necessary for NIH.
I would say one other thing. We can only work with what we
are given to work with. It is the budget process that allocates
the funds. If we sit and wait until the subcommittee marks up
its bill and says, oh, fine, you know, and we don't do anything
up to that point, we could well have lost the opportunity to
make the kinds of commitments to biomedical research that we
need to make.
So the fight is right now with the budget process, and
getting the kinds of allocations that allow us to make the
kinds of increases that both of us and everyone in this room, I
suspect, believe are our goal, and what we think will really
help advance the cause of biomedical science and improve the
lives of every person on the planet. Thank you, Dr. Miller.
Dr. Miller. Thank you. I couldn't agree with both your
points any more strongly. Thank you.
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Wednesday, January 28, 1998.
WITNESS
JOHN M. CRAWFORD, D.D.S., Ph.D., AMERICAN ASSOCIATION FOR DENTAL
RESEARCH
Mr. Porter. John M. Crawford, D.D.S., Ph.D., Professor of
Periodontics, the University of Illinois at Chicago, College of
Dentistry, representing the American Association for Dental
Research.
The Chair welcomes a fellow Chicagoan.
Dr. Crawford. Thank you very much. Thank you for this
opportunity to address the committee.
As you indicated, I am here to represent the American
Association for Dental Research and its 5,300 members. I would
like to discuss the 1999 budget allocation to the National
Institute for Dental Research and the Agency for Health Care
Policy and Research.
When you deal with the justification of allocations, you
have to look back and you have to look forward. You look back
to document the successful and the productive and wise use of
funds, and the consequent increase in the health of the
American people. I think that the NIDR has very good evidence
that it has done this in a very successful way. This evidence
we will present in our written testimony, and the Director of
NIDR will present more evidence for this in his oral testimony.
However, you have to look forward, and you have to present
evidence that there are problems yet to be solved. These
problems can be solved with the manpower and technology
available. It is this point I would like to discuss briefly
today.
I would like to present a scenario for oral health
management in the 21st century. I think this will focus on
identification of people at risk for oral disease, and there is
a lot of evidence that this is not distributed evenly through
the population of the U.S. There are people at risk and people
relatively immune.
We have already saliva-based tests to predict dental decay
activity, and there is interesting recent work which begins to
show us that we can predict the activity of gum disease as
well. Having identified people at risk, we will then be able to
offer them lifetime immunity from these diseases, and again,
the National Institute for Dental Research has supported
research which clearly shows the ability to produce a safe and
effective vaccine for dental caries, and there is interesting
work in the animal models for certain diseases, with mice and
monkeys, that shows we may be able to offer a safe and
effective vaccine for gum disease as well. So there is a
scenario for cost-effective health research focusing on at-risk
populations.
I would like to take a moment to describe the situation in
1997, using myself as an example. My dentist tells me to clean
my teeth 2 minutes with a toothbrush at night, and added to
that, 2 minutes with dental floss. That adds up to about 36\1/
2\ hours every year, and if I liveto the age of 76, my
actuarial limit, I will have spent 6 months cleaning my teeth. Life is
too short.
I would like to also indicate that if you are susceptible
to gum disease, you have a lifetime of struggle combatting this
disease, slowing it down, and trying to arrest it. This is a
chronic, disabling disease. The treatment is very
sophisticated, but it is also time-consuming, very costly, and
leads to lost productivity hours.
I would like to point out that teeth are the only organs
that we frequently discard before the end of our lives. And I
would like to point out that periodontal disease is a major
health problem in this country. Recent NIDR-sponsored research
has shown that 35.7 million Americans have at least mild bone
loss. But more surprisingly and more seriously, 13.1 million
Americans have moderate to severe bone loss. So this is a
public health problem of pandemic proportions.
I would like to envisage in the near future a longer,
healthier life, but at the end of that life, we will have our
healthy teeth in our mouths.
Mr. Chairman, the American Association for Dental Research
supports the ad hoc group's overall recommendation for NIH of
$15,695,000,000. More specifically, the American Association
for Dental Research supports the request for $240,822,000 for
the National Institute for Dental Research.
I would also like to take this opportunity to support the
work of the Agency for Health Policy and Research, because we
strongly feel that research into health care policy is
essential for the oral health of the American people.
I would be happy to attempt to answer any questions that
you may have.
[The prepared statement of John Crawford follows:]
[Pages 30 - 35--The official Committee record contains additional material here.]
Mr. Porter. Dr. Crawford, did you say 15.95 billion?
Dr. Crawford. The figure that I quoted was $15,695,000,000.
Mr. Porter. What does that represent?
Dr. Crawford. That represents a 15 percent increase, I
believe.
Mr. Porter. Whose figure is that?
Dr. Crawford. The ad hoc group's overall recommendation for
NIH.
Mr. Porter. I have already given my sermonette about how we
get there, but let's all work together to achieve that.
Dr. Crawford. Yes, indeed.
Mr. Porter. Thank you very much for your good testimony.
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Wednesday, January 28, 1998.
WITNESS
DAVID RECKER, M.D., AMERICAN COLLEGE OF RHEUMATOLOGY
Mr. Porter. David Recker, M.D., Member, ACR Government
Affairs Committee, representing the American College of
Rheumatology.
Dr. Recker. Good morning, Mr. Porter. I am David Recker,
M.D. I am a rheumatologist from Auburn, Pennsylvania, and I am
here today to testify for the American College of Rheumatology