[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]


                     ENHANCING PUBLIC HEALTH: LEGISLATION TO 
                            PROTECT CHILDREN AND FAMILIES

=======================================================================

                             HYBRID HEARING

                               BEFORE THE

                         SUBCOMMITTEE ON HEALTH

                                 OF THE

                    COMMITTEE ON ENERGY AND COMMERCE
                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION

                               __________

                            OCTOBER 20, 2021

                               __________

                           Serial No. 117-53
                           

[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]                           


     Published for the use of the Committee on Energy and Commerce

                   govinfo.gov/committee/house-energy
                        energycommerce.house.gov
                        
                               __________

                   U.S. GOVERNMENT PUBLISHING OFFICE                    
55-509 PDF                  WASHINGTON : 2024                    
          
-----------------------------------------------------------------------------------                         
                       
                    COMMITTEE ON ENERGY AND COMMERCE

                     FRANK PALLONE, Jr., New Jersey
                                 Chairman
BOBBY L. RUSH, Illinois              CATHY McMORRIS RODGERS, Washington
ANNA G. ESHOO, California              Ranking Member
DIANA DeGETTE, Colorado              FRED UPTON, Michigan
MIKE DOYLE, Pennsylvania             MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois             STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina    ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California          BRETT GUTHRIE, Kentucky
KATHY CASTOR, Florida                DAVID B. McKINLEY, West Virginia
JOHN P. SARBANES, Maryland           ADAM KINZINGER, Illinois
JERRY McNERNEY, California           H. MORGAN GRIFFITH, Virginia
PETER WELCH, Vermont                 GUS M. BILIRAKIS, Florida
PAUL TONKO, New York                 BILL JOHNSON, Ohio
YVETTE D. CLARKE, New York           BILLY LONG, Missouri
KURT SCHRADER, Oregon                LARRY BUCSHON, Indiana
TONY CARDENAS, California            MARKWAYNE MULLIN, Oklahoma
RAUL RUIZ, California                RICHARD HUDSON, North Carolina
SCOTT H. PETERS, California          TIM WALBERG, Michigan
DEBBIE DINGELL, Michigan             EARL L. ``BUDDY'' CARTER, Georgia
MARC A. VEASEY, Texas                JEFF DUNCAN, South Carolina
ANN M. KUSTER, New Hampshire         GARY J. PALMER, Alabama
ROBIN L. KELLY, Illinois, Vice       NEAL P. DUNN, Florida
    Chair                            JOHN R. CURTIS, Utah
NANETTE DIAZ BARRAGAN, California    DEBBBIE LESKO, Arizona
A. DONALD McEACHIN, Virginia         GREG PENCE, Indiana
LISA BLUNT ROCHESTER, Delaware       DAN CRENSHAW, Texas
DARREN SOTO, Florida                 JOHN JOYCE, Pennsylvania
TOM O'HALLERAN, Arizona              KELLY ARMSTRONG, North Dakota
KATHLEEN M. RICE, New York
ANGIE CRAIG, Minnesota
KIM SCHRIER, Washington
LORI TRAHAN, Massachusetts
LIZZIE FLETCHER, Texas
                                 ------                                

                           Professional Staff

                   TIFFANY GUARASCIO, Staff Director
                 WAVERLY GORDON, Deputy Staff Director
                  NATE HODSON, Minority Staff Director
                         Subcommittee on Health

                       ANNA G. ESHOO, California
                                Chairwoman
G. K. BUTTERFIELD, North Carolina    BRETT GUTHRIE, Kentucky
DORIS O. MATSUI, California            Ranking Member
KATHY CASTOR, Florida                FRED UPTON, Michigan
JOHN P. SARBANES, Maryland, Vice     MICHAEL C. BURGESS, Texas
    Chair                            H. MORGAN GRIFFITH, Virginia
PETER WELCH, Vermont                 GUS M. BILIRAKIS, Florida
KURT SCHRADER, Oregon                BILLY LONG, Missouri
TONY CARDENAS, California            LARRY BUCSHON, Indiana
RAUL RUIZ, California                MARKWAYNE MULLIN, Oklahoma
DEBBIE DINGELL, Michigan             RICHARD HUDSON, North Carolina
ANN M. KUSTER, New Hampshire         EARL L. ``BUDDY'' CARTER, Georgia
ROBIN L. KELLY, Illinois             NEAL P. DUNN, Florida
NANETTE DIAZ BARRAGAN, California    JOHN R. CURTIS, Utah
LISA BLUNT ROCHESTER, Delaware       DAN CRENSHAW, Texas
ANGIE CRAIG, Minnesota               JOHN JOYCE, Pennsylvania
KIM SCHRIER, Washington              CATHY McMORRIS RODGERS, Washington 
LORI TRAHAN, Massachusetts               (ex officio)
LIZZIE FLETCHER, Texas
FRANK PALLONE, Jr., New Jersey (ex 
    officio)
                            
                            C O N T E N T S

                              ----------                              
                                                                   Page
Hon. Anna G. Eshoo, a Representative in Congress from the State 
  of California, opening statement...............................     2
    Prepared statement...........................................     4
Hon. Brett Guthrie, a Representative in Congress from the 
  Commonwealth of Kentucky, opening statement....................     4
    Prepared statement...........................................     6
Hon. Frank Pallone, Jr., a Representative in Congress from the 
  State of New Jersey, opening statement.........................     7
    Prepared statement...........................................     8
Hon. Cathy McMorris Rodgers, a Representative in Congress from 
  the State of Washington, opening statement.....................     9
    Prepared statement...........................................    10

                               Witnesses

Hon. Richard M. Nolan, a Former Representative in Congress from 
  the State of Minnesota.........................................    13
    Prepared statement...........................................    16
Donald M. Lloyd-Jones, M.D., President, American Heart 
  Association....................................................    28
    Prepared statement...........................................    30
    Answers to submitted questions...............................   202
Stacey D. Stewart, President and Chief Executive Officer, March 
  of Dimes.......................................................    38
    Prepared statement...........................................    40
    Answers to submitted questions...............................   209
Jenny Radesky, M.D., Assistant Professor of Pediatrics, 
  University of Michigan Medical School..........................    54
    Prepared statement...........................................    57
    Answers to submitted questions...............................   214
Bruce L. Cassis, D.D.S., President, Academy of General Dentistry.    61
    Prepared statement...........................................    63
Raymond N. DuBois, M.D., Ph.D., Former President, American 
  Association for Cancer Research................................    68
    Prepared statement...........................................    70
    Answers to submitted questions...............................   219
Ellyn Miller, President and Founder, Smashing Walnuts Foundation.    73
    Prepared statement...........................................    75
    Answers to submitted questions...............................   224

                           Submitted Material

H.R. 623, the Gabriella Miller Kids First Research Act 2.0 \1\
H.R. 1193, the Cardiovascular Advances in Research and 
  Opportunities Legacy Act \1\
H.R. 1956, the Increasing Access to Quality Cardiac 
  Rehabilitation Care Act of 2021 \1\
H.R. 2161, the Children and Media Research Advancement Act \1\
H.R. 3749, the Katherine's Law for Lung Cancer Early Detection 
  and Survival Act of 2021 \1\
H.R. 4555, the Oral Health Literacy and Awareness Act of 2021 \1\
H.R. 4612, the Protecting Access to Lifesaving Screenings Act of 
  2021 \1\

----------

\1\ The legislation has been retained in committee files and is 
available at https://docs.house.gov/Committee/Calendar/
ByEvent.aspx?EventID=114134.
H.R. 5487, the Stillbirth Health Improvement and Education for 
  Autumn Act of 2021 \1\
H.R. 5551, the Improving the Health of Children Act \1\
H.R. 5552, the Lead Poisoning Prevention Act \1\
H.R. 5558, the Prostate Cancer Prevention Act \1\
H.R. 5561, the Early Hearing Detection and Intervention 
  Reauthorization Act \1\
Statement of the American Association of Nurse Practitioners, 
  October 20, 2021, submitted by Ms. Schrier.....................   150
Letter of October 19, 2021, from Tim Powderly, Senior Director, 
  Government Affairs, Americas, Apple, to Mr. Pallone and Ms. 
  Eshoo, submitted by Ms. Schrier................................   156
Letter of October 20, 2021, from Debbie Hatmaker, Chief Nursing 
  Officer and Executive Vice President, American Nurses 
  Association, to Mr. Pallone, et al., submitted by Ms. Schrier..   158
Letter of May 12, 2021, from WomenHeart, et al., to Hon. Andy 
  Barr, et al., submitted by Ms. Schrier.........................   160
Statement of U.S. Rep. Debbie Wasserman Schultz, October 20, 
  2021, submitted by Ms. Schrier.................................   162
Statement of U.S. Rep. Brendan F. Boyle, October 20, 2021, 
  submitted by Ms. Schrier.......................................   164
Letter of October 18, 2021, from Laurie Fenton Ambrose, 
  Cofounder, President, and Chief Executive Officer, GO2 
  Foundation for Lung Cancer, to Ms. Eshoo and Mr. Guthrie, 
  submitted by Ms. Schrier.......................................   166
Letter of October 19, 2021, from Celina Gorre, Chief Executive 
  Officer, WomenHeart, to Ms. Eshoo and Mr. Guthrie, submitted by 
  Ms. Schrier....................................................   168
Statement of U.S. Rep. Jennifer Wexton, October 20, 2021, 
  submitted by Ms. Schrier.......................................   169
Statement of U.S. Rep. Kathleen M. Rice, October 20, 2021, 
  submitted by Ms. Schrier.......................................   171
Letter of October 19, 2021, from Debbie Haine Vijayvergiya, The 2 
  Degrees Foundation, to Mr. Pallone, et al., submitted by Ms. 
  Schrier........................................................   172
Report of the Centers for Disease Control and Prevention, 
  ``Stillbirth in the United States,''submitted by Ms. Schrier...   177
Statement of U.S. Rep. Jamie Raskin, October 20, 2021, submitted 
  by Ms. Schrier.................................................   195
Letter of October 20, 2021, from Academy of General Dentistry, et 
  al., to Mr. Pallone, et al., submitted by Mr. Cardenas.........   197
Letter of October 19, 2021, from A. Lynn Williams, President, 
  American Speech-Language-Hearing Association, to Mr. Guthire 
  and Ms. Matsui, submitted by Mr. Guthrie.......................   199
Statement of U.S. Rep. Andy Barr, October 20, 2021, submitted by 
  Mr. Guthrie....................................................   200

----------

\1\ The legislation has been retained in committee files and is 
available at https://docs.house.gov/Committee/Calendar/
ByEvent.aspx?EventID=114134.

 
 ENHANCING PUBLIC HEALTH: LEGISLATION TO PROTECT CHILDREN AND FAMILIES

                              ----------                              


                      WEDNESDAY, OCTOBER 20, 2021

                  House of Representatives,
                            Subcommittee on Health,
                          Committee on Energy and Commerce,
                                                    Washington, DC.
    The subcommittee met, pursuant to call, at 10:30 a.m., in 
the John D. Dingell Room 2123, Rayburn House Office Building, 
and remotely via Cisco Webex online video conferencing, Hon. 
Anna Eshoo (chairwoman of the subcommittee) presiding.
    Members present: Representatives Eshoo, Butterfield, 
Matsui, Castor, Sarbanes, Welch, Schrader, Cardenas, Ruiz, 
Dingell, Kuster, Kelly, Barragan, Blunt Rochester, Craig, 
Schrier, Trahan, Fletcher, Pallone (ex officio), Guthrie 
(subcommittee ranking member), Upton, Burgess, Griffith, 
Bilirakis, Long, Bucshon, Mullin, Hudson, Carter, Dunn, Curtis, 
Joyce, and Rodgers (ex officio).
    Also present: Representative Walberg.
    Staff present: Shana Beavin, Professional Staff Member; 
Waverly Gordon, Deputy Staff Director and General Counsel; 
Tiffany Guarascio, Staff Director; Perry Hamilton, Clerk; 
Fabrizio Herrera, Staff Assistant; Stephen Holland, Health 
Counsel; Zach Kahan, Deputy Director, Outreach and Member 
Service; Mackenzie Kuhl, Digital Assistant; Aisling McDonough, 
Policy Coordinator; Meghan Mullon, Policy Analyst; Juan 
Negrete, Junior Professional Staff Member; Kaitlyn Peel, 
Digital Director; Caroline Rinker, Press Assistant; Tim 
Robinson, Chief Counsel; Chloe Rodriguez, Clerk; Andrew 
Souvall, Director of Communications, Outreach, and Member 
Services; Kimberlee Trzeciak, Chief Health Advisor; C.J. Young, 
Deputy Communications Director; Alec Aramanda, Minority 
Professional Staff Member, Health; Kate Arey, Minority Content 
Manager and Digital Assistant; Sarah Burke, Minority Deputy 
Staff Director; Seth Gold, Minority Professional Staff Member, 
Health; Grace Graham, Minority Chief Counsel, Health; Nate 
Hodson, Minority Staff Director; Emily King, Minority Member 
Services Director; Clare Paoletta, Minority Policy Analyst, 
Health; Kristin Seum, Minority Counsel, Health; Kristen 
Shatynski, Minority Professional Staff Member, Health; and 
Michael Taggart, Minority Policy Director.
    Ms. Eshoo. Good morning, everyone. The Subcommittee on 
Health will now come to order.
    Due to COVID-19, today's hearing is being held remotely as 
well as in person.
    For members and witnesses that are taking part in person, 
we are following the guidance of the CDC and the Office of the 
Attending Physician. So please wear a mask when you are not 
speaking.
    For Members and witnesses taking part remotely, microphones 
will be set on mute to eliminate background noise, and you will 
need to unmute your microphone when you wish to speak.
    Since Members are participating from different locations at 
today's hearing, recognition of Members for questions will be 
in order of subcommittee seniority.
    Documents for the record should be sent to Meghan Mullon at 
the email address we have provided your staffs, and all 
documents will be entered into the record at the conclusion of 
the hearing.
    The Chair now recognizes herself for 5 minutes for an 
opening statement.

 OPENING STATEMENT OF HON. ANNA G. ESHOO, A REPRESENTATIVE IN 
             CONGRESS FROM THE STATE OF CALIFORNIA

    Today our subcommittee examines 12 bipartisan bills.
    There is some noise in the background. Can you maybe 
refrain, or take your conversations out of the hearing room?
    Today our subcommittee examines 12 bipartisan bills to 
improve the healthcare of the American people. Six of the bills 
focus on children's health and well-being.
    Pediatric cancer is the number-one disease killer of 
children in America, but it is chronically underfunded by the 
public and private sectors. The Gabriella Miller Kids First 
Research Act 2.0 addresses this gap by redirecting hundreds of 
millions of dollars in penalties currently paid by 
pharmaceutical, cosmetic, supplement, and medical device 
companies into funding for a large-scale genetic and clinical 
database to help researchers find insights into childhood 
cancer. We are honored to hear testimony about this bill from 
Gabriella's mother, Ellyn Miller.
    Thank you, Ms. Miller, for joining us today, so close to 
the 8-year anniversary of Gabriella's death. And thank you for 
her beautiful portrait that you have at the table with you.
    Another children's health bill, the Children and Media 
Research Advancement Act, authorizes the NIH to lead research 
on the effects of technology and media on infants, children, 
and adolescents.
    We can't trust social media companies to do the right thing 
for our children. This bill provides funding for long-overdue 
independent research to keep media and tech companies from 
evading scrutiny about their impact on the development of 
children in our country.
    The other four children's health bills seek to prevent and 
reduce the impact of stillborn--of stillbirth, newborn hearing 
loss, lead poisoning, and birth defects or anomalies. We are 
fortunate to have Stacey Stewart of the March of Dimes as our 
expert witness for these bills. For over 80 years, the March of 
Dimes has been a trusted advocate for the health of all moms 
and children in our country.
    The next three bills focus on screening and prevention for 
lung, breast, and prostate cancer.
    First, Katherine's Law. It provides free coverage of lung 
cancer screening for individuals over the age of 40, even if 
they have no history of smoking.
    Nearly 25 percent of all cancer deaths in the United States 
are due to lung cancer, and a growing share of lung cancer 
cases are occurring in never-smokers. If lung cancer in never-
smokers were a separate category, it would be in the top 10 
cancers in our country for sickness and death. This tragedy hit 
home for one of our cherished colleagues, former Congressman 
Rick Nolan, who is with us today. He lost his precious 
daughter, Katherine, to lung cancer, even though she did not 
smoke.
    Thank you, Congressman Rick, for being here today. It is 
good to see you, and we look forward to hearing your all-
important testimony.
    The PALS Act allows for the early detection of breast 
cancer through free screenings for women over the age of 40, 
and the Prostate Cancer Prevention Act funds CDC programs to 
prevent and detect prostate cancer, the second most common 
cancer among men in our country.
    Finally, we are considering two bills to improve cardiac 
care and a bill to improve oral health literacy. The CAROL Act 
is named in honor of Carol Leavell Barr, the wife of 
Representative Andy Barr, who died last year of sudden cardiac 
arrest.
    The bill funds NIH grants to support research into valvular 
heart disease as well as increasing public education and 
awareness of valvular heart disease through the CDC. And the 
Increasing Access to Quality Cardiac Rehabilitation Care 
authorizes PAs, nurse practitioners, and clinical nurse 
specialists to supervise cardiac rehabilitation care so more 
Medicare patients can benefit from that care. Patients who 
receive cardiac rehab typically recover faster from heart 
attacks or surgery, and improve their quality of life.
    Through our efforts today, these 12 important, bipartisan 
health bills move closer from being words on a page to actually 
walking into the lives of our constituents to improve their 
health and well-being for decades to come.
    [The prepared statement of Ms. Eshoo follows:]

                Prepared Statement of Hon. Anna G. Eshoo

    Today, our Subcommittee examines 12 bipartisan bills to 
improve the health care of the American people.
    Six of the bills focus on children's health and wellbeing.
    Pediatric cancer is the number one disease killer of 
children in America, but it is chronically underfunded by the 
public and private sectors. The Gabriella Miller Kids First 
Research Act 2.0 addresses this gap by redirecting hundreds of 
millions of dollars in penalties currently paid by 
pharmaceutical, cosmetic, supplement, and medical device 
companies into funding for a large-scale genetic and clinical 
database to help researchers find insights into childhood 
cancer.
    We're honored to hear testimony about this bill from 
Gabriella's mother, Ellyn Miller. Thank you, Ms. Miller, for 
joining us today, so close to the 8-year anniversary of 
Gabriella's death. And thank you for her beautiful portrait you 
have at the table with you.
    Another children's health bill, the Children and Media 
Research Advancement Act authorizes the NIH to lead research on 
the effects of technology and media on infants, children, and 
adolescents. We can't trust social media companies to do the 
right thing for our children. This bill provides funding for 
long overdue, independent research to keep media and tech 
companies from evading scrutiny about their impact on the 
development of children.
    The other four children's health bills seek to prevent and 
reduce the impact of stillbirth, newborn hearing loss, lead 
poisoning, and birth defects or anomalies. We're fortunate to 
have Stacey Stewart of the March Dimes as our expert witness 
for these bills. For over 80 years, the March of Dimes has been 
a trusted advocate for the health of all moms and children in 
our country.
    The next three bills focus on screening and prevention for 
lung, breast, and prostate cancer.
    First, Katherine's Law provides free coverage of lung 
cancer screening for individuals over the age of 40, even if 
they have no history of smoking. Nearly 25% of all cancer 
deaths in the U.S. are due to lung cancer and a growing share 
of lung cancer cases are occurring in never-smokers. If lung 
cancer in never-smokers were a separate category, it'd be in 
the top 10 cancers in the U.S. for sickness and death. This 
tragedy hit home for one of our former colleagues, former 
Congressman Rick Nolan, who lost his daughter Katherine to lung 
cancer even though she did not smoke. Thank you, Congressman, 
for being here today. It's good to see you and we look forward 
to hearing your all-important testimony.
    The PALS Act allows for the early detection of breast 
cancer through free screenings for women over the age of 40 and 
the Prostate Cancer Prevention Act funds CDC programs to 
prevent and detect prostate cancer, the second most common 
cancer among men in our country.
    Finally, we're considering two bills to improve cardiac 
care and a bill to improve oral health literacy.
    The CAROL Act is named in honor of Carol Leavell Barr, the 
wife of Rep. Andy Barr, who died last year of sudden cardiac 
arrest. The bill funds NIH grants to support research into 
valvular heart disease, as well as increasing public education 
and awareness of valvular heart disease through the CDC.
    The Increasing Access to Quality Cardiac Rehabilitation 
Care authorizes PAs, nurse practitioners, and clinical nurse 
specialists to supervise cardiac rehabilitation care so more 
Medicare patients can benefit from that care. Patients who 
receive cardiac rehab typically recover faster from heart 
attacks or surgery and improve their quality of life.
    Through our efforts today, these 12 important, bipartisan 
health bills move closer from being words on a page to actually 
walking into the lives of our constituents to improve their 
health and wellbeing for decades to come.

    Ms. Eshoo. The Chair now is pleased to recognize the 
gentleman--and that he is--Mr. Guthrie, the ranking member of 
our subcommittee, for 5 minutes for his opening statement.

 OPENING STATEMENT OF HON. BRETT GUTHRIE, A REPRESENTATIVE IN 
           CONGRESS FROM THE COMMONWEALTH OF KENTUCKY

    Mr. Guthrie. Thank you, Madam Chair, for hosting this 
important meeting, and welcome to my friend from Minnesota--
have you here, and the rest of the panelists that are here with 
us today.
    Before us today are several public health bills pertaining 
to critical prevention and early detection efforts for children 
and families. But before I get into those bills, I would like 
to draw attention to the partisan health policies currently 
being drafted by Democrats behind closed doors here in 
Washington.
    My colleagues on the other side of the aisle are trying to 
pass a reckless tax-and-spending spree package that would get 
the Government more involved in Americans' lives, including 
their healthcare. The Democrats' bill would cost an estimated 
$4.3 trillion and, according to the Congressional Budget Office 
letter received yesterday, this bill would lead to 2.8 million 
Americans losing their employer-based health insurance.
    Further, this spending bill is a stepping stone for a 
Government-run, one-size-fits-all healthcare system that can 
lead to millions more losing their employer- or union-sponsored 
health insurance, along with their doctors.
    And I have been a long-time supporter of increasing 
healthcare access for patients and allowing patients to keep 
the doctor of their choice. I believe we need to modernize, 
personalize, and improve healthcare, not let the Government 
take it over. That would lead to worst-case, longer waits--
worse care, longer waits, and fewer choices.
    And further, I must bring up H.R. 3 that is in the spending 
bill that would stifle innovation for finding new cures and 
result in fewer new treatments. I strongly believe in investing 
in biomedical research to discover innovative solutions to 
prevent, detect, and treat disease. Innovation improves 
healthcare outcomes and saves lives. The drug pricing scheme 
would do the opposite and destroy innovation.
    But fortunately, today we are taking a step in the right 
direction by examining several important bipartisan public 
health initiatives. Since 2015 I have been proud to lead, along 
with my colleague Representative Doris Matsui, the Early 
Hearing Detection Intervention Reauthorization Act, or EHDI. 
This bipartisan bill would provide early diagnosis, 
intervention, and treatment of children with hearing loss.
    Nearly 3 out of every 1,000 children in the U.S. are born 
with a detectable level of hearing loss in one or both ears. 
Before the EHDI program began 2 decades ago, only 46\1/2\ 
percent of infants were screened for hearing loss. Thankfully, 
due to the success of the program, 98 percent of infants are 
now screened. However, followup treatments continue to be a 
concern, with only 67 percent of infants receiving early 
intervention treatment. It is essential that infants are 
screened early for hearing loss and receive necessary 
intervention services in a timely manner so families can get 
the appropriate care needed.
    Additionally, I am honored to cosponsor H.R. 1193, the 
Cardiovascular Advances in Research Opportunities Legacy Act, 
or CAROL Act. Despite having long been a supporter of 
legislation that promotes health research, these efforts became 
much more personal for Representative Andy Barr when he 
tragically lost his wife, who was 39, Carol, to sudden cardiac 
arrest in 2020, June of 2020. Inspired by her extraordinary 
life--and, those who knew her, she was extraordinary--he 
introduced H.R. 1193, the Cardiovascular Advances in Research 
and Opportunities Legacy, or the CAROL Act.
    The CAROL Act will address the gaps in understanding about 
valvular heart disease by authorizing a grant program 
administered by the National Heart, Lung, and Blood Institute 
to support research on valvular heart disease, including MVP. 
The bill has garnered the support of 167 bipartisan Members of 
Congress, including many on this committee. Companion 
legislation was introduced in the Senate by Minority Leader 
Mitch McConnell and Senator Kyrsten Sinema. The legislation 
would help other families avoid the tragedy that has so 
profoundly impacted Andy's family and so many others throughout 
the country.
    In closing, we do have bipartisan and successful public 
health programs that should continue. Before Congress 
authorizes new programs, we need to ensure that current 
programs are impactful, funds are spent appropriately, and 
reform or improvements to a program are evaluated. We have 
learned time and time again that throwing money at a problem is 
not an effective way to solve issues, or a good use of taxpayer 
dollars.
    I yield back.
    [The prepared statement of Mr. Guthrie follows:]

                Prepared Statement of Hon. Brett Guthrie

    Chair Eshoo, thank you for holding this important hearing.
    Before us today we have several public health bills 
pertaining to critical prevention and early detection efforts 
for children and families. Before I get into those bills, I 
would like to draw attention to the partisan health policies 
currently being drafted by Democrats behind closed doors in 
Washington.
    My colleagues on the other side of the aisle are trying to 
pass a reckless tax and spending spree package that would get 
the government more involved in Americans' lives, including in 
their health care. The Democrats' bill would cost an estimated 
$4.3 trillion and, according to a Congressional Budget Office 
letter received yesterday, this bill will lead to 2.8 million 
Americans losing their employer-based health insurance. 
Further, this spending bill is a stepping-stone for a 
Government-run, one-size-fits-all health care system that could 
lead to millions more losing their employer or union sponsored 
health insurance, along with their doctors.
    I have been a longtime supporter of increasing health care 
access for patients and allowing patients to keep the doctor of 
their choice. I believe we need to modernize, personalize, and 
improve health care--not let the government take it over. That 
would lead to worse care, longer waits, and fewer choices.
    Further, including H.R. 3 in the Democrats' reckless 
spending bill would stifle innovation for finding new cures and 
result in fewer new treatments. I strongly believe in investing 
in biomedical research to discover innovative solutions to 
prevent, detect, and treat disease. Innovation improves health 
outcomes and saves lives. The Democrats' drug pricing scheme 
would do the opposite and destroy innovation.
    Today we are taking a step in the right direction by 
examining several important bipartisan public health 
initiatives.
    Since 2015, I have been proud to lead along with my 
colleague, Representative Doris Matsui, the Early Hearing 
Detection and Intervention Reauthorization Act, or EHDI (ed-
ee). This bipartisan bill would provide early diagnosis, 
intervention, and treatment for children with hearing loss. 
Nearly 3 out of every 1,000 children in the U.S. are born with 
a detectable level of hearing loss in one or both ears. Before 
the EHDI program began two decades ago, only 46.5% of infants 
were screened for hearing loss. Thankfully, due to the success 
of the program, 98% of infants are now screened. However, 
follow up treatments continue to be a concern with only 67% of 
infants receiving early intervention treatment. It is essential 
that infants are screened early for hearing loss and receive 
necessary intervention services in a timely manner so families 
can get the appropriate care needed.
    Additionally, I am honored to cosponsor H.R. 1193, the 
Cardiovascular Advances in Research and Opportunities Legacy 
Act or CAROL Act.
    Despite having long been a supporter of legislation that 
promotes health research, these efforts became much more 
personal for Rep. Andy Barr when he tragically lost his wife 
Carol to sudden cardiac arrest in June 2020.
    Inspired her extraordinary life, he introduced H.R. 1193, 
the Cardiovascular Advances in Research and Opportunities 
Legacy Act (CAROL Act).
    The CAROL Act will address the gaps in understanding about 
valvular heart disease by authorizing a grant program, 
administered by the National Heart, Lung, and Blood Institute, 
to support research on valvular heart disease, including MVP.
    The bill has garnered the support of 167 bipartisan Members 
of Congress, including many on this Committee. Companion 
legislation was introduced in the Senate by Minority Leader 
Mitch McConnell and Senator Krysten Sinema.
    This legislation would help other families avoid the 
tragedy that has so profoundly impacted Andy's family and so 
many others throughout the country.
    In closing, we do have bipartisan and successful public 
health programs that should continue. Before Congress 
authorizes new programs, we need to ensure that current 
programs are impactful, funds are spent appropriately, and 
reform or improvements to a program are evaluated. We've 
learned time and time again that throwing money at a problem is 
not an effective way to solve issues or a good use of taxpayer 
dollars.
    I yield back.

    Ms. Eshoo. The gentleman yields back. The Chair is pleased 
to recognize the chairman of the full committee, Mr. Pallone, 
for his 5 minutes of opening statement.

OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE 
            IN CONGRESS FROM THE STATE OF NEW JERSEY

    Mr. Pallone. Thank you, Chairwoman Eshoo.
    Today the committee continues our important bipartisan work 
to protect children and families. The COVID-19 pandemic has 
tested every aspect of family health and demonstrated how 
critical physical and social environmental factors are to 
health outcomes.
    There are also significant concerns that many children and 
families have gone without routine care during the pandemic, 
and this is worrisome, because this care is critical to 
promoting public health and identifying health conditions 
early.
    Unfortunately, it will be some time before we realize the 
full impact of this lapse in care. Today we are considering 
legislation that will tackle these challenges in multiple ways.
    For example, the pandemic created obstacles to preventative 
care, including cancer screenings, which could have resulted in 
early forms of cancer going undetected. We will consider three 
bills that reauthorize or otherwise expand lifesaving screening 
services for lung, prostate, and breast cancer. And these are 
important bipartisan pieces of legislation that will help 
Americans access care and treatment when it is most effective.
    The pandemic has also undoubtedly delayed care for children 
and introduced new challenges in the absence of child care and 
in-person learning. Some studies suggest that nearly 30 percent 
of parents postponed or did not seek care for their children, 
due to concerns about exposure to COVID-19. The impacts have 
been greater on lower-income families, who have been more 
likely to delay care or just simply go without care. And since 
the pandemic has had a disparate impact on lower-income 
families, it is important that we act to reverse any harmful 
effect on the health and well-being of children.
    And today we are considering multiple bills that seek to 
expand pediatric research and healthcare services. We will 
discuss H.R. 2161, the Children and Media Research Advancement 
Act, which will reauthorize the National Institutes of Health 
to expand research into the cognitive, physical, and social-
emotional development effects of media on infants, children, 
and adolescents. This bill is particularly important right now, 
as the pandemic has resulted in children spending more time on 
electronics for learning and social engagement with friends.
    We will also consider H.R. 5487, the Stillbirth Health 
Improvement and Education for Autumn Act. This bill would 
provide resources to State and Federal health departments to 
improve data collection, and increase education about 
stillbirths, which tragically affect an estimated 24,000 
families nationwide each year.
    And these are just a few of the proposals that we will 
consider. And we have an excellent panel of witnesses ready to 
discuss the full slate of bills. We'll hear from medical 
experts in the fields of cancer, cardiology, and pediatrics. 
And we will also hear from two parents, who will share the 
stories of their two daughters, Katherine Bensen and Gabriella 
Miller, who both lost their lives too soon to cancer.
    I look forward to hearing from Ellyn Miller, who is also 
the president and founder of the Smashing Walnuts Foundation, 
about the Gabriella Miller Kids First Research Act.
    And I would also like to thank our former colleague, 
Representative Nolan, for coming to share his daughter 
Katherine's story and to discuss the Katherine's Law for Lung 
Cancer Early Detection and Survival Act.
    Finally, I am pleased we are able to work with Ranking 
Members Rodgers and Guthrie on this hearing and on this 
bipartisan slate of bills that will improve the health of 
children and families all across the Nation.
    And I look forward--I know we are having these legislative 
hearings, but we look forward to moving these bills soon. So 
thank you, and I yield back, Chairwoman.
    [The prepared statement of Mr. Pallone follows:]

             Prepared Statement of Hon. Frank Pallone, Jr.

    Today, the Committee continues our important, bipartisan 
work to protect children and families.
    The COVID-19 pandemic has tested every aspect of family 
health and demonstrated how critical physical and social 
environmental factors are to health outcomes. There are also 
significant concerns that many children and families have gone 
without routine care during the pandemic. This is worrisome 
because this care is critical to promoting public health and 
identifying health conditions early. Unfortunately, it will be 
some time before we realize the full impact of the lapse in 
care.
    Today, we are considering legislation that will tackle 
these challenges in multiple ways.
    For example, the pandemic created obstacles to preventative 
care, including cancer screenings, which could have resulted in 
early forms of cancer going undetected. We will consider three 
bills that reauthorize or otherwise expand life-saving 
screening services for lung, prostate, and breast cancer. These 
are important bipartisan pieces of legislation that will help 
Americans access care and treatment when it is most effective.
    The pandemic has also undoubtedly delayed care for children 
and introduced new challenges in the absence of childcare and 
in-person learning. Some studies suggest that nearly 30 percent 
of parents postponed or did not seek care for their children 
due to concerns about exposure to COVID-19. The impacts have 
been greater on lower income families who have been more likely 
to delay care or to simply go without care. Since the pandemic 
has had a disparate impact on lower income families, it is 
important that we act to reverse any harmful effect on the 
health and well-being of children.
    Today we are considering multiple bills that seek to expand 
pediatric research and health care services. We will discuss 
H.R. 2161, the Children and Media Research Advancement Act, 
which will authorize the National Institutes of Health to 
expand research into the cognitive, physical, and social-
emotional development effects of media on infants, children, 
and adolescents. This legislation is particularly important 
right now as the pandemic has resulted in children spending 
more time on electronics for learning and social engagement 
with friends.
    We will also consider H.R. 5487, the Stillbirth Health 
Improvement and Education for Autumn Act. This bill would 
provide resources to State and Federal health departments to 
improve data collection and increase education about 
stillbirths, which, tragically, affect an estimated 24,000 
families nationwide each year.
    These are just a few of the proposals we will consider, and 
we have an excellent panel of witnesses ready to discuss the 
full slate of bills. We will hear from medical experts in the 
fields of cancer, cardiology, and pediatrics.
    We will also hear from two parents who will share the 
stories of their two daughters, Katherine Bensen and Gabriella 
Miller, who both lost their lives too soon to cancer. I look 
forward to hearing from Ellyn Miller who is also the President 
and Founder of the Smashing Walnuts Foundation, about the 
``Gabriella Miller Kids First Research Act.'' And I would also 
like to thank our former colleague, Representative Nolan, for 
coming to share his daughter Katherine's story, and to discuss 
the ``Katherine's Law for Lung Cancer Early Detection and 
Survival Act.''
    Finally, I'm pleased we were able to work with Ranking 
Members Rodgers and Guthrie on this hearing and on this 
bipartisan slate of bills that will improve the health of 
children and families all across the Nation.
    I look forward to moving these bills forward soon. Thank 
you.

    Ms. Eshoo. The gentleman yields back. The Chair now is 
pleased to recognize Congresswoman Cathy McMorris Rodgers.
    Is she----
    Mr. Guthrie. She is virtual.
    Ms. Eshoo. She is virtual? Oh, OK, great.
    Congresswoman McMorris Rodgers is the ranking member of the 
full committee, and I am pleased to recognize her for her 5 
minutes for an opening statement.

      OPENING STATEMENT OF HON. CATHY McMORRIS RODGERS, A 
    REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON

    Mrs. Rodgers. Thank you, Madam Chair, Mr. Chairman, and to 
all our witnesses, thank you for being here this morning.
    Many of the solutions we are considering today renew key 
public health programs [audio malfunction] importance of 
renewing and updating expired authorizations that continue to 
be appropriated. So I am pleased that our Members are 
fulfilling the duties we have as an authorizing committee.
    Mr. Carter's Improving the Health of Child Act reauthorizes 
activities at the National Center on Birth Defects and 
Developmental Disabilities.
    Mr. Walberg's Lead Poisoning Prevention Act renews critical 
lead poisoning prevention and screening initiatives.
    Dr. Dunn's bill reauthorizes prostate cancer activities at 
the CDC.
    Other bills reauthorize programs that expire next year, 
like Mr. Guthrie's Early Hearing Detection and Intervention 
Reauthorization Act.
    We will also be considering bills that establish new public 
health programs, like Representatives Mullin and Herrera 
Beutler's SHINE for Autumn Act to mitigate the risk of 
stillbirths and help more moms and babies, and Mr. Barr's CAROL 
Act that will improve research and public health outreach 
related to heart disease.
    All of these solutions reflect the importance of the 
committee's authorizing responsibilities over key public health 
programs.
    It is important for Federal agencies to come before this 
committee to comment, discuss programs and other related health 
initiatives that--and that also should have happened today. In 
fact, except for a budget hearing with Secretary Becerra on the 
budget that was not released at the time, no administration 
official has come before the Health Subcommittee this Congress.
    We need to hear from the administration and public health 
officials. They have not been before this committee, even after 
making top-down decisions that impact every person in this 
country related to COVID-19 data, changing guidelines, schools, 
vaccine mandates, and booster shots. Unfortunately, it is 
undermining trust in public health and people's abilities to 
make the best decisions for themselves.
    We are also seeing a historic surge in opioid overdose 
deaths made worse by the economic shutdowns, lost jobs, 
isolation, fear, and despair. The majority's refusal to bring 
the administration before us to address these crises is a 
complete lack of our oversight and legislative 
responsibilities. We should be plowing the hard ground, 
listening, and working together to crush this pandemic and 
modernize healthcare.
    The bills we are considering touch on several important 
issues, but we also must recognize the central role our public 
health programs have played over the last year and a half, and 
the massive influx of funding that they have received as a part 
of the pandemic response. We should be addressing these public 
health agencies more holistically.
    Let's hear from States and the Substance Abuse and Mental 
Health Services Administration on how to save lives, combat the 
opioid epidemic, and improve the mental health of children who 
are in crisis.
    Let's permanently schedule fentanyl analogues in Schedule 
I. DEA is warning the American public on the increasing dangers 
of fake prescription pills containing fentanyl.
    Let's learn from the pandemic on how we safely speed up 
innovation, like we did to get safe and effective vaccines, and 
supply those--apply those lessons to discover new cures and 
treatments.
    Let's investigate how this pandemic even started, so it 
never happens again.
    This committee has a rich history of bipartisan work by 
listening and leading on solutions to solve our greatest 
challenges. Today is a step in that direction, but we have a 
lot more work to do to address the concerns that are on the 
hearts and minds of the American people.
    And this brings me to the tax-and-spending spree that 
Speaker Pelosi is rewriting right now behind closed doors. It 
will lead to fewer cures, lost coverage, and force the sick to 
beg the Government for lifesaving care. Just yesterday, CBO 
provided its analysis that shows the dangers of the 
majority's--to socialized medicine that is going to cost more 
than half a trillion dollars: 2.8 million people will lose 
their employer-sponsored healthcare. Just like 11 years ago, 
Speaker Pelosi plans to pass a massive bill that radically 
disrupts people's lives and livelihoods. And if you like your 
health insurance, you may not be able to keep it.
    I again urge this committee to get back to the people's 
work, not the Speaker's agenda, and take a step in the right 
direction today. I hope we can continue this encouraging trend 
by addressing the important major public health issues facing 
our Nation today.
    [The prepared statement of Mrs. Rodgers follows:]

           Prepared Statement of Hon. Cathy McMorris Rodgers

INTRO
    Many of the solutions we are considering today renew key 
public health programs.
    I have led for years on the importance of addressing 
expired authorizations that continue to be appropriated, so I'm 
pleased to see our Members fulfilling the duties we have as an 
authorizing committee.
    Mr. Carter's Improving the Health of Children Act 
reauthorizes activities at the National Center on Birth Defects 
and Developmental Disabilities.
    Mr. Walberg's Lead Poisoning Prevention Act renews critical 
lead poisoning prevention and screening initiatives.
    Dr. Dunn's bill reauthorizes prostate cancer activities at 
the CDC.
    Other bills reauthorize programs that expire next year, 
like Mr. Guthrie's Early Hearing Detection and Intervention 
Reauthorization Act.
    We will also be considering bills that establish new public 
health programs.
    Like Representative Mullin and Herrera Butler's SHINE for 
Autumn Act to mitigate the risk of stillbirths and help more 
moms and babies...
    .. and Mr. Barr's CAROL Act that will improve research and 
public health outreach related to heart disease.
PROCESS
    ALL of these solutions reflect the importance of the 
committee's authorizing responsibilities over key public health 
programs.
    It's important for Federal agencies to come before this 
committee to comment, discuss programs, and other related 
health initiatives, and that should have happened today.
    In fact, except for a budget hearing with Secretary Becerra 
on a budget that was not released at the time...
    .. no administration official has come up before the health 
subcommittee yet this Congress.
    We need to hear from the administration and public health 
officials.
    They have NOT been before this committee even after making 
top-down decisions that impact every person in this country 
related to COVID-19 data, changing guidelines, schools, vaccine 
mandates, and booster shots.
    It's undermining trust in public health...
    . and people's abilities to make the best decisions for 
themselves and their families.
    We are also seeing an historic surge in opioid overdose 
deaths... made worse by economic shutdowns, lost jobs, 
isolation, fear, and despair.
    The Majority's refusal to bring the administration before 
us to address real crises like these is an abdication of our 
oversight and legislative responsibilities.
PLOWING THE HARD GROUND
    We should be plowing the hard ground...listening and 
working together... to crush this pandemic and modernize health 
care.
    The bills we are considering touch on several important 
issues, but given the central role our public health programs 
have played over the last year and a half, and the massive 
influx of funding they have received as part of the pandemic 
response.
    . we should be addressing these public health agencies more 
holistically.
    Let's hear from States and Substance Abuse and Mental 
Health Services Administration on how to save lives, combat the 
opioid epidemic, and improve the mental health of children who 
are in crisis.
    Let's permanently schedule fentanyl analogs in Schedule I.
    DEA is warning the American public on the increasing 
dangers of fake prescription pills containing fentanyl.
    Let's learn from the pandemic how we can safely speed up 
innovation, like we did to get safe and effective vaccines and 
apply those lessons To discover new cures and treatments.
    Let's investigate how this pandemic even started so it 
never happens again.
    This Committee has a rich history of bipartisan work--by 
listening and then leading on solutions to solve our greatest 
challenges.
    Today is a small step in that direction...
    .. but we have a lot more work to do to address top 
concerns of the American people.
RECONCILIATION
    This brings me to the tax and spending spree that Speaker 
Pelosi is re-writing behind closed doors right now.
    It will lead to fewer cures, lost coverage, and force the 
sick to beg the government for lifesaving care.
    Just yesterday, CBO provided its analysis that shows the 
dangers of the Majority's lurch to socialized medicine that 
will cost more than a half trillion dollars.
    2.8 million people will lose their employer sponsored 
health plan.
    Just like 11 years ago, Speaker Pelosi plans to pass a 
massive bill that radically disrupts people's lives and 
livelihoods... and, if you like your health insurance, you may 
not be able to keep it.
CONCLUSION
    I again urge this Committee to get back to the People's 
work... not Pelosi's work....and we're taking a step in the 
right direction today.
    I hope we can continue this encouraging trend by addressing 
the important major public health issues facing our Nation 
today.
    Thank you, I yield back.

    Mrs. Rodgers. Thank you, I yield back.
    Ms. Eshoo. The gentlewoman yields back. I would just like 
to make a couple of comments. I always welcome constructive 
criticism, it is always welcome. We learn from each other.
    But the ranking member is not correct about testimony from 
administration officials. We have had the FDA, we have had the 
NIH. We--they were both in July. We have had the CDC, Dr. 
Collins, who testified on long COVID.
    And there is no bill that is being written behind closed 
doors. All of the Energy and Commerce Committee were involved 
in--what was it, 36, 38, 39--hours of markup of the Build 
Better--Build Back Better legislation. And the Energy and 
Commerce Committee, of course, had a significant role in that. 
So I just want to state that for the record, because those are 
the facts.
    I now would like to introduce our witnesses. We are so 
fortunate to have each one here today.
    First, our colleague, our former colleague, our--someone 
that will be a friend for life, Congressman Rick Nolan of 
Minnesota. He is the father of Katherine, and the namesake of 
Katherine's Law, which we are considering today.
    Dr. Donald Lloyd-Jones is the president of the American 
Heart Association.
    Welcome to you too.
    Ms. Stacey Stewart, the president and the CEO of the March 
of Dimes. When she came into the hearing room this morning I 
went over to welcome her and told her what I recall as a child, 
maybe 7 years old, 8 years old, my mother holding my hand and 
walking through the entire neighborhood, ringing doorbells in 
the early evening after supper for donations to the March of 
Dimes. So that is not only etched in my memory, but it is 
etched in my heart.
    Dr. Jenny Radesky is the assistant professor of pediatrics 
at the University of Michigan Medical School and a constituent 
of Congresswoman Debbie Dingell. And we will call on 
Congresswoman Dingell to introduce Dr. Radesky.
    Dr. Bruce Cassis is the president of the Academy of General 
Dentistry.
    Dr. Raymond DuBois is the former president of the American 
Association for Cancer Research.
    And Ms. Ellyn Miller is the president and founder of the 
Smashing Walnuts Foundation and the mother--most importantly, 
the mother of Gabriella Miller.
    So, Congressman Nolan, we will start with you. You have--
you are recognized for 5 minutes. And welcome again, and thank 
you for traveling across the country to be with us this 
morning.
    [Pause.]
    Ms. Eshoo. Is your microphone on, Rick?
    Mr. Nolan. There we go.
    Ms. Eshoo. There you go.
    Voice. Turn it towards you.
    Ms. Eshoo. And bring it towards you.
    Mr. Nolan. Thank you. It is such a joy----
    Ms. Eshoo. And you can take off your mask while you are 
testifying. And pull the mike up to you. There you go. See, 
just 2 years and----
    Mr. Nolan. Used to sitting on the other----
    Ms. Eshoo. There you go. Two years, and you are out of 
practice.
    Mr. Nolan [continuing]. Side of the table.
    [Laughter.]

 STATEMENT OF HON. RICHARD M. NOLAN, FORMER REPRESENTATIVE IN 
 CONGRESS FROM THE STATE OF MINNESOTA; DONALD M. LLOYD-JONES, 
M.D., PRESIDENT, AMERICAN HEART ASSOCIATION; STACEY D. STEWART, 
 PRESIDENT AND CHIEF EXECUTIVE OFFICER, MARCH OF DIMES; JENNY 
RADESKY, M.D., ASSISTANT PROFESSOR OF PEDIATRICS, UNIVERSITY OF 
 MICHIGAN MEDICAL SCHOOL; BRUCE L. CASSIS, D.D.S., PRESIDENT, 
 ACADEMY OF GENERAL DENTISTRY; RAYMOND N. DuBOIS, M.D., Ph.D., 
FORMER PRESIDENT, AMERICAN ASSOCIATION FOR CANCER RESEARCH; AND 
     ELLYN MILLER, PRESIDENT AND FOUNDER, SMASHING WALNUTS 
                           FOUNDATION

               STATEMENT OF HON. RICHARD M. NOLAN

    Mr. Nolan. It is such a joy to see so many old friends, and 
thank you for inviting me to be here today.
    As I was saying, Chairwoman Eshoo, Ranking Member Guthrie, 
chairman of the full committee Frank Pallone, and 
Representative McMorris Rodgers, and thank you all for being 
here.
    I am here as--not as a former Member. I am really here as a 
father and a public citizen and a nonlobbyist for anybody, I 
might add, and to give testimony and to thank all of you on 
this committee, your personal staff, your committee staffs, for 
their service, for conducting this hearing, for giving me an 
opportunity to testify on behalf of H.R. 3749, Katherine's Law, 
for the early detection and survival of lung cancer victims.
    It--a little history. It was in 1971 that President Richard 
Nixon declared war on cancer. And since that time every 
president, Democrat and Republican, has entered into that war 
and joined with the Congress of the United States and this 
committee in a very strong, resolute, nonpartisan manner to win 
this war against cancer, which kills so many people--lung 
cancer, in particular, which kills more people than virtually 
all the other cancers combined.
    Our daughter, Katherine, who was a nonsmoker, devoted her 
terminal cancer diagnosis as what she called her ticking time 
bomb. It was not a matter--question of whether, it was just a 
question of when. And she chose to devote the last years of her 
life to her four children, her husband, and then doing 
everything she could to spare people in the future from having 
to endure what she and so many others had to endure.
    And it was during that process where Katherine learned and 
informed her dad that breast cancer, prostate cancer, 
colorectal cancer benefited from public policies that provided 
routine, free cancer screening, which enabled early detection. 
Unfortunately, for lung cancer, the only people--and by the 
way, that was starting at age 40 for most of these other 
cancers. Unfortunately, for lung cancer, the only people who 
were entitled to that routine screening were 55 years of age, 
and they had to have smoked a package of cigarettes every day 
for 20 years. Or was it 30 years? Somebody can correct me on 
that. I forget at the moment. But people who were nonsmokers, 
many of whom are victims of lung cancer, were not entitled to 
any screening whatsoever.
    And she learned also--and informed me and others--that that 
was in part because of the stigmatization of lung cancer by 
virtue of smoking but also the fact that our lungs don't have 
any nerves, unlike the other parts of our body. So in the other 
cancers, in addition to early detection and screening, you 
might feel a lump, you might feel discomfort, you might feel 
pain. That doesn't happen with lung cancer. There are no 
nerves. You don't have any discomfort until it starts pressing 
against other organs.
    And without the benefit of early screening, you are not 
getting the same strong, positive results that the victims of 
other cancer have. Breast cancer, for example, prostate cancer, 
colorectal cancer. They, respectively, have survival rates 
after 5 years of 90 percent, breast--prostate cancer, 98 
percent; colorectal, 65 percent. Unfortunately, for lung cancer 
it is a little over 20 percent after 5 years because of that 
disparity, very unfair to the victims of cancers, whether they 
were smokers or nonsmokers.
    And during her journey, that is when we learned this. So 
she said to me, ``Dad, is there any reason why we can't draft a 
bill to provide that same kind of opportunity for free 
screening for victims of lung cancer? It kills more people than 
all the other cancers. Why not do that, give them an 
opportunity to survive with early detection?''
    So that is how the bill emerged. And I have told you what 
the survival rates are. This bill gives each and every one of 
us here a chance to advance that. And they said it has always 
been a strong, nonpartisan, bipartisan effort that has resulted 
in those wonderfully good statistics for so many of the other 
cancers, but not for the victims of lung cancer.
    In any event, Katherine said, ``Dad, if that bill could be 
passed, I would gladly, along with--endure all that I have had 
endured, along with so many others, gladly, including my 
fatality at the end, if I knew that it would spare so many 
other people the pain that we have had to endure.''
    So the bill was drafted, and Congressman Brendan Boyle 
agreed to sponsor it, and sponsor it in her name.
    And let me conclude with just a couple of things here. 
Several hours before Katherine died--we, of course, were with 
her, and she was very weak. And I said to her, ``Katherine, one 
of the great mysteries''--most will admit we don't know where 
we are going when this life of ours is over, but I said, 
``Wherever that is, I want to be there with you as soon as 
possible.''
    And with her weak but clear voice, she just raised her 
hand. She looked her dad in the eye and said, ``Dad, not until 
you get my bill passed.''
    So it is in that spirit that I am here today, and I can't 
thank--and each and every one of you.
    So let me close by saying what that immortal western cowboy 
hero of ours, John Wayne, who died of lung cancer, might have 
said--``God willing, the creek don't rise''--and the Congress 
enacts this important legislation, Katherine's Law will become 
the law of the land, and many tens if not hundreds of thousands 
of lives will be saved.
    Thank you.
    [The prepared statement of Mr. Nolan follows:]
    
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. Eshoo. Thank you, Congressman Nolan. Katherine's Law 
will become the law of the land. We are on our way. And your 
being here to help launch it, and the work that we are doing 
today is a--we have a clear path, and we are going to make sure 
what Katherine said before she left this world becomes reality. 
How is that? OK, thank you so much.
    Dr. Lloyd Jones, you are recognized for 5 minutes of 
testimony.
    Dr. Lloyd-Jones. Good morning. Thank you. Can you hear me?
    Ms. Eshoo. Good morning. Welcome.

            STATEMENT OF DONALD M. LLOYD-JONES, M.D.

    Dr. Lloyd-Jones. Thank you. Chairwoman Eshoo, Chair 
Pallone, Ranking Members Guthrie and McMorris Rodgers, and 
members of the Health Subcommittee. Thank you for the 
opportunity to testify today on behalf of the American Heart 
Association and its more than 40 million volunteers and 
supporters.
    My name is Dr. Donald Lloyd-Jones and, as president of the 
American Heart Association, I serve as its chief volunteer 
officer responsible for the oversight of all medical, 
scientific, public health, and public policy matters.
    I am also a cardiologist and a cardiovascular 
epidemiologist, and chair of the Department of Preventive 
Medicine, professor of preventive medicine, cardiology and 
pediatrics at Northwestern University's Feinberg School of 
Medicine in Chicago.
    I am pleased to testify today about the ways in which two 
bipartisan bills under your consideration would improve heart 
health for all. Specifically, I wish to address the Increasing 
Access to Quality Cardiac Rehabilitation Care Act of 2021, H.R. 
1956, and the Cardiovascular Advances in Research and 
Opportunities Legacy, or CAROL Act, H.R. 1193.
    My statement today is a summary of my more extensive 
remarks in support of these bills that have been submitted for 
the record.
    I would like to thank Representatives Lisa Blunt Rochester 
and Adrian Smith for championing the Increasing Access to 
Quality Cardiac Rehabilitation Care Act, which would 
significantly expand patient access to cardiac rehabilitation 
services.
    Cardiac rehabilitation, or cardiac rehab, for short, is a 
medically supervised program for patients who have experienced 
a serious cardiac event or surgery. It includes monitored 
exercise training, education about heart healthy lifestyles, 
and counseling to reduce stress. Participation in cardiac rehab 
has been shown to significantly reduce the risks of death and 
cardiovascular events as well as result in decreased hospital 
readmissions.
    As a practicing cardiologist, I am an avid user of cardiac 
rehab for all of my qualifying patients, and those who have 
participated routinely tell me that it teaches them about 
improving their heart health and what symptoms they need to pay 
attention to in the future and, crucially, that it restores 
their sense of well-being and their ability to trust their body 
as they return to normal life and activities.
    Despite these clear benefits of cardiac rehab, only one-
third of all eligible patients, and only a quarter of Medicare 
patients, will ever receive it. Barriers to participation 
include things like lack of referral, large disparities in 
referral patterns based on sex, race, ethnicity, socioeconomic 
position, and geography, and long wait times to enrollment.
    This act would improve health equity by facilitating the 
timely referral of patients and by enabling greater patient 
access in rural and underserved communities.
    It would also remove burdensome requirements for direct 
physician supervision at cardiac rehab facilities, where highly 
trained advanced-practice providers are already able to provide 
necessary safety oversight.
    These advances will allow cardiac rehab programs to operate 
in areas where physicians are scarce, improving patient access 
to these lifesaving programs.
    The American Heart Association is also pleased to support 
the CAROL Act.
    And first, I would like to express my deepest sympathy to 
Representative Andy Barr and his family for the tragic loss of 
his wife, Carol. We are deeply grateful to him for sponsoring 
this legislation to advance our understanding and awareness of 
heart valve diseases that kill approximately 25,000 Americans 
each year. With this bill we could help prevent more families 
from enduring a similar tragedy.
    The CAROL Act authorizes funding for the National Heart, 
Lung, and Blood Institute to gather information and fund 
lifesaving research on heart valve disease. This investment 
will help address gaps in our understanding, including what 
causes sudden cardiac death due to mitral valve prolapse, or 
MVP.
    MVP is a degenerative heart valve condition that is present 
in approximately 2 percent of individuals, many of whom are 
unaware that they have it, and that led to the untimely death 
of Carol Barr. MVP uncommonly becomes a serious condition. But 
when it does, it can cause heart failure, stroke, or abnormal 
heart rhythms that may become life threatening. Significant MVP 
poses a threefold elevated risk of sudden cardiac death 
compared to the general population.
    One of the most troubling aspects of MVP for me, as a 
clinician, is just how much we still don't know about its 
causes, factors that lead to progressive problems, when is the 
best time to intervene, and what increases risk for sudden 
cardiac death.
    The CAROL Act would authorize new workshops and research 
funded by the NIH, increase awareness through projects at the 
CDC, and invest in efforts to improve data collection about 
sudden cardiac arrest. Ultimately, it would increase screening, 
detection, and diagnosis of heart valve disease and help reduce 
the incidents of sudden cardiac death.
    So, in conclusion, the bills under consideration today will 
advance equity by improving access to care for cardiac rehab 
and will expand our understanding of treatment for heart valve 
diseases, including MVP.
    Thank you so much for the opportunity to offer my 
testimony, and I look forward to answering questions.
    [The prepared statement of Dr. Lloyd-Jones follows:]
    
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    Ms. Eshoo. Thank you, Dr. Lloyd-Jones, for your important 
and superb testimony. We appreciate you being with us.
    The Chair now recognizes Ms. Stewart for your 5 minutes of 
testimony. And welcome, again. It is great to see you.
    Ms. Stewart. Great to see you too.

                 STATEMENT OF STACEY D. STEWART

    Ms. Stewart. Thank you and good morning, Chairwoman Eshoo 
and Ranking Member Guthrie, and members of the Health 
Subcommittee. Thank you for the opportunity to testify today. I 
am Stacey Stewart, president and CEO of March of Dimes.
    The March of Dimes' work is now more important than ever. 
Our Nation is in the midst of a dire maternal and infant health 
crisis, which the pandemic has worsened. By improving the 
health of women before, during, and after pregnancy, we can 
improve outcomes for both mothers and for infants. But we have 
many public health challenges before us.
    The U.S. remains the most dangerous developed nation in the 
world in which to give birth. And it is even more dire for 
women and babies of color. Pre-term birth is the second leading 
cause of infant mortality, which has slowly declined over the 
past few years. Yet still, two babies die every single hour, 
and two women die from pregnancy complications every single 
day.
    This month, as we observe Pregnancy and Infant Loss 
Awareness Month, we know that one out of every four individuals 
and families' lives are affected by the death of their children 
during pregnancy, at birth, and in infancy.
    We must help these families by remembering their losses and 
working to better understand the causes of stillbirth, with the 
goal of lowering the stillbirth rate.
    We hope new efforts by the Biden administration and 
Congress will spur further action to address the maternal and 
infant health crisis that we face. However, we must continue to 
focus our attention on the other challenges facing us and 
utilize the tools we have to improve the health of children and 
families.
    To that end, March of Dimes supports the following 
legislation that is being considered by the subcommittee today.
    First, H.R. 5487, Stillbirth Health Improvement and 
Education for Autumn Act of 2021, or the SHINE for Autumn Act, 
would invest in research and data collection to better 
understand stillbirth in the U.S. This will allow us to better 
track and research stillbirths, find out who is impacted, and 
the role disparities have in negatively impacting infant and 
parental health.
    Second, H.R. 5551, the Improving the Health of Children 
Act, would reauthorize the National Center for Birth Defects 
and Developmental Disabilities. The Center's tracking and 
public health research systems help to identify causes of birth 
defects and find opportunities to prevent them. It also does 
critical work at researching developmental disabilities such as 
autism, addressing blood disorders that affect millions of 
people each year, and advancing healthcare for people with 
disabilities so they can stay well, active, and a part of the 
community.
    March of Dimes has partnered with the Center to support 
research and prevention, promote birth defects prevalence data 
from States on our Peristats website, and we have led efforts 
to help reduce health-related stigma through our Beyond Labels 
initiative.
    We are also a strong supporter of the Surveillance for 
Emerging Threats to Mothers and Babies Network--it is called 
SET-NET--which we must scale nationally to have a complete 
picture, through real-time clinical and survey data, of how 
COVID-19 impacted care for mothers and babies.
    Third, H.R. 5552, the Lead Poisoning Prevention Act, would 
provide critical resources for educational outreach for 
screenings and referrals, the CDC's Advisory Committee on 
Childhood Lead Poisoning Preventions, and help lead exposure 
before children are harmed. Children can be severely affected 
by lead's impact on brain and body development, with Black 
children nearly three times more likely than White children to 
have elevated blood lead levels. High levels of exposure before 
and during pregnancy can cause fertility problems, 
hypertension, delayed brain development, premature birth, low 
birth weight, and miscarriage.
    H.R. 5561, the Early Hearing Detection and Intervention 
Reauthorization Act. This act authorizes the early detection 
and intervention program for deaf and hard-of-hearing newborns 
and infants and young children. The program has dramatically 
increased the number of newborns screened annually, as we heard 
from Ranking Member Guthrie, from less than 10 percent to 
currently around 98 percent, which has significantly helped 
deaf and hard-of-hearing children begin learning speech and 
language in the first 6 months of life to develop better 
language skills.
    Chairwoman Eshoo and Ranking Member Guthrie, I want to say 
thank you for inviting me to be here. I was so moved by your 
story, Chairwoman, of your early involvement with March of 
Dimes. As I know, that has been the case for many of you. Thank 
you for attention--for your attention today, for focusing on 
some of the Nation's most critical public health challenges. We 
must continue to invest in programs in our toolbox, such as 
prevention and data collection and surveillance systems. Thank 
you so much.
    [The prepared statement of Ms. Stewart follows:]
    
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    Ms. Eshoo. Thank you, Ms. Stewart, and the entire team at 
the March of Dimes. It is an organization that is trusted and 
respected by the American people. Thank you for your 
leadership.
    Next we are going to have Dr. Radesky testify, and I am--we 
are going to call on our colleague, a distinguished member of 
our subcommittee, Mrs. Dingell, to introduce Dr. Radesky, who 
is--of course, hails from Michigan. And she can tell you the 
rest.
    So, Debbie, are you out there?
    Mrs. Dingell. Thank you. I am, Madam Chair. Can you hear 
me?
    Ms. Eshoo. OK, good to see you.
    Mrs. Dingell. Good to see you. And it is good to see all of 
our witnesses, who--two of whom I have worked with closely for 
many years, and to see our dear friend Rick.
    But I am really proud we have got a Go Blue presence in the 
House today.
    Dr. Jenny Radesky is a practicing developmental behavioral 
pediatrician and assistant professor of pediatrics at the 
University of Michigan Medical School. Her research focuses on 
the impact that digital media use and mobile technology has on 
children's health and behavior as well as on parent-child 
interaction. She is a practicing pediatrician who has focused 
on psychosocial determinants of childhood development, and she 
is the lead author of the 2016 American Academy of Pediatrics 
policy statement on digital media use in early childhood. Her 
research has been cited by many people: CBS, the New York 
Times, and other leading publications.
    We look forward to her testimony today on the CAMRA Act and 
her expertise as a researcher and clinician.
    Thank you very much, Madam Chair. I yield back, and I have 
to close again with ``Go Blue.''
    Dr. Radesky. Thank you so much, Representative Dingell. Can 
you hear me OK?
    So good morning, everyone.
    Ms. Eshoo. We can, and welcome.

                STATEMENT OF JENNY RADESKY, M.D.

    Dr. Radesky. Thank you. I am so happy to be here. I would 
like to thank Chairwoman Eshoo, Ranking Member Guthrie, and 
members of the Committee on Energy and Commerce, the 
Subcommittee on Health, for the invitation to speak today.
    I am a developmental behavioral pediatrician at U of M 
Medical School, where my NICHD-funded research focuses on 
media, parenting, and child socioemotional development.
    So my testimony today is in support of CAMRA, the Children 
and Media Research Advancement Act, and it represents my 
expertise as a pediatrician and researcher, not the views of 
the University of Michigan.
    So I first want to preface my remarks by emphasizing that 
caring about children's relationships with digital media is not 
an emotional issue. It is highly practical. It is good public 
health. Digital media are some of the most universal, 
ubiquitous exposures children experience on a daily basis, and 
they are often designed by adults untrained in the curious and 
expansive ways that children experience the world. 
Consequently, digital design often focuses on monetization or 
engagement metrics and may not consider unintended negative 
consequences on society--in particular, children.
    So parents have seen firsthand the way digital design can 
either support or frustrate their family's needs during the 
COVID-19 pandemic--for example, whether their child is learning 
new computer coding skills through a well-designed app or is 
distracted from remote learning by YouTube videos, whether 
their family feels connected through video chat or divided by 
extreme social media posts.
    And new digital products are being adopted at an 
increasingly rapid pace. For example, Pokemon Go reached 50 
million users in less than 3 weeks, and tech companies are 
investing millions of dollars in marketing and data analytics 
to engage child and teen users.
    Academic research on how these technologies impact our 
youth cannot keep up. We need the support of the NIH to carry 
out rigorous, independent research on children and media.
    In my expert opinion, there are several pressing gaps in 
scientific knowledge that would benefit from CAMRA's funding.
    First, we need more nuanced understanding of the day-to-day 
relationships between media and child well-being. Research 
studies on children and media have often relied on global 
ratings of how children use media, such as screen time, which 
is not detailed enough for the complex outcomes like mental 
health. We need study designs that follow children in their 
natural experiences, track their responses to the media they 
use, and the media messages they consume, so we can uncover 
sources of resilience and vulnerability.
    Second, new measurement tools are needed. My research lab 
has created innovative methods, with the support of NICHD, for 
studying media use, like harnessing data streams already 
collected by smartphones to see which apps children are using, 
and when. My work with Common Sense Media has generated new 
ways of collecting children's YouTube viewing histories to 
evaluate what types of content dominates this platform. Tech 
companies already collect troves of these types of data. 
However, researchers need more access so that we can truly 
characterize the positive and negative experiences that 
children have online.
    Third, we need to know more about children's differential 
susceptibility to media. Research usually examines children as 
homogeneous population, but we know that children have 
remarkable variability in their strengths, their challenges. 
Some children are more anxious, some are easygoing, while 
others are impulsive and reactive, and this likely determines 
which children will have problematic versus balanced 
relationships with media. CAMRA specifically calls for this 
type of research, focusing on individual differences and media 
use.
    Fourth, we need to understand more about the interplay 
between poverty, psychosocial stress, and media use. There are 
deep, socioeconomic inequities in our country, and this is 
rarely addressed head-on in media research. But as we saw 
during COVID-19, structural factors play a strong role in how 
much media children use, and their access to other 
opportunities.
    Finally, CAMRA is unique in that it envisions a sustained 
commitment to this field, which needs to keep up with the 
rapidly evolving technology around us. For example, we need to 
understand the impact of virtual reality or the algorithms that 
shape children's recommendation feeds, or other understudied 
areas like online gambling. Sustained CAMRA research dollars 
would also train a new generation of scientists to use cutting-
edge methods, and then translate their findings for parents and 
policymakers.
    This is a crucial moment for funding research in children 
and media. There is a growing consensus that it is time to 
shift the scientific framework away from only asking what 
children and parents can do better to also asking what 
technology companies can change, whether in their designs or 
their business models, to promote child well-being. This 
digital ecosystem is relatively young, so there is much that 
can be done, based in part on solid, independent evidence 
generated through NIH funding.
    So I am grateful for your time today, and I appreciate your 
consideration of the CAMRA bill.
    [The prepared statement of Dr. Radesky follows:]
   
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    Ms. Eshoo. Thank you very much, Dr. Radesky. We appreciate 
your testimony, and this is an area that really cries out for 
study. So your testimony is--and on this legislation, the 
legislation itself, I think, is really badly needed, and I am 
glad we are addressing it today.
    Next we recognize Dr. Cassis to testify for 5 minutes.
    We welcome you, and we thank you for being with us, and you 
are on.

              STATEMENT OF BRUCE L. CASSIS, D.D.S.

    Dr. Cassis. Thank you, Chairwoman Eshoo, Ranking Member 
Guthrie, Chairman Pallone and Ranking Member McMorris Rodgers, 
and members of the subcommittee. Thank you so much for----
    Ms. Eshoo. Can you speak up, Doctor?
    Dr. Cassis. I certainly can. Thank you so much----
    Ms. Eshoo. Wonderful.
    Dr. Cassis [continuing]. For the opportunity--is that 
better?
    Ms. Eshoo. It is much better, thank you.
    Dr. Cassis. OK. Thank you so much for this opportunity to 
speak with you today.
    My name is Dr. Bruce Cassis, and I am a general dentist 
from Fayetteville, West Virginia. I am also president of the 
Academy of General Dentistry, or AGD, which represents over 
40,000 general dentists across the country. We exist to serve 
the needs of our members through continuing education and 
advocacy, which in turn better serves the needs and interests 
of our patients.
    I am pleased to be here today to discuss legislation that 
would help improve the health of families and children, 
specifically H.R. 4555, the Oral Health Literacy and Awareness 
Act.
    Oral health literacy is the degree to which people have the 
capacity to obtain, process, and understand basic health 
information and services needed to make appropriate oral health 
decisions. As a dentist practicing in rural West Virginia for 
nearly 42 years, I have seen firsthand more times than I can 
count the effects of oral disease, especially on our most 
vulnerable population: our children.
    Many people are unaware that oral health is linked to 
overall health. Diseases related to oral health can cause so 
many negative things: pain, loss of school and work time, 
nutrition problems, emergency room visits, and even death. Oral 
disease does not stop at the mouth and teeth. Diabetes, low 
birth weight, even early onset Alzheimer's, and many more.
    Fortunately, most oral-health-related ailments can be 
prevented. Good oral health habits are especially important for 
expectant mothers, children, and young parents.
    Oral disease especially impacts children. Tooth decay is 
the most common chronic disease among school-aged youth. 
Roughly one in four U.S. adults has at least one untreated 
cavity. Most of oral health ailments can be avoided by 
increasing oral health literacy among all populations, with an 
emphasis on children, to ensure that they develop and maintain 
healthy habits into adulthood.
    Folks need to complete regular dental visits to stay on top 
of their oral health. Unfortunately, the majority of Americans 
are not using the oral healthcare system. According to the 
latest data from HHS, 46 percent of the population had a dental 
visit in 2018. This is only 1.7 percent higher than the 
percentage of the population who visited the dentist in 2003. 
The lack of progress on this front is startling and cannot 
continue.
    Notably, significant disparities continue to exist within 
our population when it comes to both oral healthcare 
utilization and status. While 52 percent of non-Hispanic White 
people were able to visit a dental provider in 2018, only 
around 34 percent of those who are Hispanic and non-Hispanic 
Black saw a dentist in the same year. According to the CDC, 
nearly twice as many non-Hispanic Black or Mexican American 
adults have untreated cavities, compared to other groups. 
Adults with less than a high school education are almost three 
times as likely to have untreated cavities as adults with at 
least some college education.
    These disparities highlight the need to focus on oral 
health literacy improvement within vulnerable populations. 
Fortunately, Representatives Cardenas and Bilirakis have 
introduced legislation, H.R. 4555, that would do just that.
    The Oral Health Literacy and Awareness Act would direct the 
HRSA to develop and test evidence-based oral health literacy 
strategies. These strategies aim to improve oral healthcare 
education, including education on preventing oral diseases such 
as early childhood and other caries, periodontal disease, and 
oral cancer. This multi-year initiative would focus 
specifically on children, pregnant women, parents, older 
adults, and people with disabilities, and, of course, racial 
and ethnic minorities.
    A strategy HRSA uses would need to communicate with these 
populations in a language that resonates with them. While we 
are all aware of the pressures and broad messaging on the 
importance of oral health, there has never been a serious 
effort at the Federal level to develop actual evidence to 
measure outcomes on oral health literacy messaging.
    I believe HRSA's work through this initiative to measure 
outcomes on the effectiveness of targeted oral health literacy 
strategies would be indispensable in advising----
    Ms. Eshoo. Dr. Cassis, you need to wrap up.
    Dr. Cassis. Yes, OK.
    I want to end today by stressing the importance of 
recognizing oral health literacy as an integral part of 
national health policy. And I do greatly appreciate the 
subcommittee's recognition that oral health literacy is a 
priority.
    Thank you.
    [The prepared statement of Dr. Cassis follows:]
    
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    Ms. Eshoo. Thank you, Dr. Cassis, for your important 
testimony.
    Dr. DuBois, we want to thank you for testifying today, and 
you now have 5 minutes to do so.
    Dr. DuBois. Can you hear me OK?
    Ms. Eshoo. Yes.
    Dr. DuBois. OK, great.

          STATEMENT OF RAYMOND N. DUBOIS, M.D., Ph.D.

    Dr. DuBois. Well, Chairman Eshoo and Chair Pallone, Ranking 
Members Guthrie and Rodgers, and members of the subcommittee, 
thank you for inviting me today. I am Ray DuBois, and I am the 
past president of the American Association for Cancer Research. 
I am editor-in-chief of the Cancer Prevention Research Journal 
and director of the Hollings Cancer Center here, in Charleston, 
South Carolina.
    I really commend you for this hearing, and holding it to 
discuss important prevention for public health, and I am very 
pleased you are including cancer screenings as a part of these 
discussions, and we have heard some very important testimony 
earlier.
    The data show that cancer screenings do save lives and 
improve outcomes, because cancers, or in some cases precancers, 
can be identified in an earlier stage, when physicians can 
treat it much more effectively. This often results in less 
invasive treatment, quicker recovery, and lower cost.
    Cancer organizations such as AACR publish research that 
informs the medical community about who, how, and to--how to 
most effectively screen for different types of cancer. We 
really want to avoid those false negatives and false positives, 
and really have the most sensitive and specific screening 
possible.
    The U.S. Preventive Services Task Force, or USPSTF, 
examines the evidence of lower--trying to lower cancer 
mortality, as well as risk cost and other complications. They 
grade guidelines based on an A or B, and the Affordable Care 
Act uses those tools, the A or B, so that those screenings can 
be covered by insurance without cost to the patient.
    As more research is generated, those guidelines can be 
updated. This year they did update the eligibility for lung 
cancer and colon cancer screenings. For lung, as you heard 
earlier, they did--they changed the lung cancer deaths by 24 
percent after 10 years by expanding screening to smokers as 
young as 50 who smoked a pack a day for 20 years. That doubled 
the number of individuals who could now be screened at no cost. 
Previously, only older Americans could be screened. These new 
guidelines are especially beneficial for women and African 
Americans, who tend to smoke fewer cigarettes.
    The task force also reduced the age recommendation for 
colonoscopies from 50 to 45 because of the increasing incidence 
of that disease in the younger population.
    I am of the belief that effective screening is extremely 
important. However, that does not mean that screening for all 
cancers without a scientific basis is in the public interest. 
Overscreening can be cost prohibitive, and sometimes with side 
effects. The task force has to balance this evidence with risk 
and benefits and be mindful that those recommendations are 
based on evolving science.
    Colon cancer screenings do not take into account the 
growing evidence that the younger, obese Americans are being 
diagnosed with colon cancer at a growing rate. For lung cancer, 
it is based on smoking history and age, but it does not take 
into account whether a person grew up in a home with smokers or 
may have substantial interactions with secondhand smoke or 
increased risk due to occupation and environmental factors.
    The recommendation to start mammograms for women at age 50 
will leave many younger women vulnerable to breast cancer that 
could spread before it could have been detected. In some cases 
I would encourage Congress to consider the individual, rather 
than the population as a whole, when designing these screening 
criteria. There are many other factors besides just age, 
including underserved populations, occupation, environmental 
exposures, and lifestyle factors.
    The simple age criteria contribute to inequities, 
especially in the underserved communities, who are 
underrepresented in screening trials and don't usually 
participate in those studies, and we want to ensure that all 
racial and ethnic groups and socioeconomic classes have the 
knowledge to make informed decisions.
    In South Carolina the incidence of breast cancer in Black 
women is lower than that in White women, but their death rate 
is much higher because many Black women have longer delays to 
get screened and treated, possibly due to their lack of 
access--of care, to health services.
    The mortality rate in prostate cancer for Black men is much 
worse than White men. While it could be genetic influences, it 
is most likely due to lack of access to specialty care.
    Screening and treatment outcome disparities are areas that 
the medical research community must improve on as we go 
forward. Many cancers we don't have effective screening 
mechanisms for at the current time.
    In addition to the advances in healthcare delivery, the 
congressional investment in basic and translational research is 
very important. Several academic institutions in the industry 
are making progress in cancer blood testing, which will bring 
new and innovative ways to screen for these cancers once they 
are validated and studied in large populations.
    Before I conclude, I want to importantly note that we are 
still not yet out of the pandemic, and we have lowered cancer--
screening for all cancers during this time. The NCI estimates 
that, due to COVID-19 and delaying cancer screenings, as many 
as 10,000 additional Americans could die of breast or colon 
cancer in the coming decade alone. As the scientific community 
works to improve cancer screening, it is imperative that we 
really improve our screening in the [audio malfunction].
    I want to thank you again for the opportunity to testify 
before you today.
    [The prepared statement of Dr. DuBois follows:]
    
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    Ms. Eshoo. Thank you very much, Dr. DuBois, for your 
important testimony. There was so much packed into it, with the 
statistics, and it is a reminder to all of us how important 
witnesses are, the expertise they bring to us and, obviously, 
shoring up the reasons why the legislation we are considering 
should become law for the people of our country. So thank you.
    Last, and certainly not least, is Ms. Ellyn Miller.
    Welcome again to you. Thank you for traveling and being 
with us in person today. You are now recognized for your 
testimony.

                   STATEMENT OF ELLYN MILLER

    Ms. Miller. Thank you. Chairwoman Eshoo, Ranking Member 
Guthrie, and distinguished members of this committee. My name 
is Ellyn Miller, and I would like to thank you for the 
opportunity to testify in support of this childhood cancer and 
disease legislation, the Gabriella Miller Kids First 2.0.
    My daughter was only 9 years old when she was diagnosed 
with a terminal-upon-diagnosis brain cancer called diffuse 
intrinsic pontine glioma. This is the same brain cancer that 
Neil Armstrong's daughter, Karen, died from in 1962. Sixty 
years later, and our children that are diagnosed with this 
cancer are still receiving the exact same treatment. But yet, 
in these 60 years, we have gotten men to the moon and safely 
back home, we have a rover on Mars, but we can't solve 
something that is a few inches under our skin?
    In the 1980s, AIDS was a death sentence. Today it is a 
chronic disease. A handful of years ago, Ebola was also a death 
sentence. Now it is curable. We, as a country, can claim these 
incredible accomplishments because we banded together to make 
them a national priority.
    In 6 days from now, on October 26, will mark 8 years since 
my daughter died. In those 8 years, daily incidences of 
childhood cancer diagnoses in the United States has risen from 
36 to 47. And every day, at least seven kids die from cancer. 
This means that, in those 8 years since my daughter died, over 
137,000 parents have heard the words ``Your child has cancer'' 
and more than 20,000 families have buried their child.
    We must make our children a national priority. And we have 
the vehicle to do that with the Kids First 2.0. The original 
Kids First was signed into law with strong bipartisan support 
in 2014. Many of those Members are in this room right now. And 
it is because of your support that over 60 grants have been 
awarded to institutes across the country to research childhood 
cancer and birth defects.
    The Kids First program has generated the largest molecular 
and clinical data sets, with approximately 50,000 genetic 
sequences that are publicly available to researchers across the 
country. Resources are brought together to develop new 
connectivity that allows for real-time data availability. All 
the while, this program is developing and implementing a 
transformative infrastructure that NIH has embraced and is 
using as a template across the institutes.
    The Kids First was selected to lead a development of new 
technologies that will empower the use of electronic health 
records. Its infrastructure is being used for a model for 
developing and piloting programs that focus on Down Syndrome, 
rare disease, the Childhood Cancer Data Initiative, and more.
    It was also chosen to lead the development of the pediatric 
COVID clinical trial via the NIH Caring for Children with COVID 
Initiative.
    The Kids First has opened the door in a transformative 
force within NIH and around the world, and it is just the 
beginning. I reached out to my congresswoman, Jennifer Wexton, 
with the need to continue the work of the Kids First. She 
suggested an innovative funding source that Congress has used 
in the past: the use of existing, nondesignated penalties 
against bad actors that knowingly violate the Foreign Corrupt 
Practices Act. The Kids First 2.0 proposes to use this untapped 
resource from pharmaceuticals, medical device manufacturers, 
cosmetics, and natural supplements to continue the battle 
against childhood cancer and disease. To date, 77 bipartisan 
Members agree, 22 of whom are members of the Energy and 
Commerce Committee.
    Two weeks before Gabriella died, she was interviewed and 
asked what message she had for our elected official about kids 
like her, and she responded, ``Stop talking, and start doing.'' 
Our political leaders have certainly done that, and today I am 
personally asking the committee to continue doing by proceeding 
through markup and moving this critical piece of legislation to 
the floor as quickly as possible.
    My daughter's name might be on this legislation, but, truth 
be told, it could be any number of the hundreds of thousands of 
children that are afflicted with cancer and disease across this 
country. And I bring with me today almost 1,000 families that 
have signed on because they wanted their children to be 
represented here today, and it could be one of them.
    I thank you for your time, and I look forward to your 
questions.
    [The prepared statement of Ms. Miller follows:]
   
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    Ms. Eshoo. Thank you so much, Ellyn. Your voice is an 
eloquent one, as a mother. And thank you for representing all 
the other families that have lost their child. There can't--it 
simply cannot be a greater grief than for a parent to bury 
their child. It is not the way it is supposed to be. But we can 
do something about it, and that is what we are here for today. 
Thank you.
    To our former colleague and friend Rick Nolan: Rick, you 
have really taught us all something. I never knew that lung 
cancer patients that never smoked got lung cancer. And I think 
that we have--you have been a great teacher in that. And is--
can you, just for a moment, tell us when--I am recognizing 
myself now for questions that--when was your daughter 
diagnosed, and how?
    Did she have any symptoms, or was it--yes, turn your mike 
on.
    Mr. Nolan. Thank you, that is a very good question. My 
aunt, Eleanor Nolan--the first female judge in the State of 
Minnesota, by the way, a real pioneer, was--a half-a-century 
ago was diagnosed with terminal lung cancer, and she died 6 
months later.
    Katherine was diagnosed a little over 6--just about 6 years 
ago. But because of the great progress that has been made by 
this committee and people in the past--by the way, I like to 
remind people that, in my grandfather's time, life expectancy 
in this country was 47.
    Ms. Eshoo. Right.
    Mr. Nolan. Forty-seven. Today, because of good public 
health----
    Ms. Eshoo. We would all be dead and gone, right.
    Mr. Nolan [continuing]. Policies, bipartisan policies, it 
is in the middle to upper 80s----
    Ms. Eshoo. So how did she find out that she had it?
    Mr. Nolan. Well----
    Ms. Eshoo. Did she not feel well?
    Mr. Nolan. Because, as I mentioned, the lungs don't have 
nerves, which is why early detection is so important. You don't 
find out----
    Ms. Eshoo. But how did she find out, Rick?
    Mr. Nolan. You don't----
    Ms. Eshoo. I have some other questions----
    Mr. Nolan. You are out of breath. You are out of breath.
    Ms. Eshoo. I see, OK, all right.
    Mr. Nolan. At which point it is too late. It is terminal. 
You didn't get those early indications. You didn't get the 
benefit of the early screening.
    Ms. Eshoo. OK, that is instructive.
    Mr. Nolan. And it is too late.
    Ms. Eshoo. That is instructive.
    Ellyn, to you, in the--the funds that come out of the 
penalties that are paid that that you referenced, what amounts 
are those, on average, annually, about? What--how much are we 
talking about?
    Ms. Miller. I would love to be able to say a number with 
that. The challenge that comes into play is that you need to 
have somebody who is violating law. They have to be----
    Ms. Eshoo. No, I was just curious if you know how much that 
is, approximately what goes into that fund.
    Ms. Miller. I would love to be able to answer that. I 
could----
    Ms. Eshoo. Maybe we will find out from the----
    Ms. Miller [continuing]. Get you information, and share 
that.
    Ms. Eshoo [continuing]. From the authors.
    Ms. Miller [continuing]. Share that with Aisling about 
those that are in the past. But moving forward, it is 
impossible to say that.
    Ms. Eshoo. I don't know, does the staff on either side of 
the aisle know if--it is hundreds of millions of dollars?
    Well then, that funding is going to be--those dollars are 
going to dance, I think, if it is hundreds of millions of 
dollars.
    To Dr. Radesky: Facebook research that was shared by the 
most recent whistleblower, Frances Haugen, demonstrated that 32 
percent of teen girls said that they felt bad about their 
bodies, and Instagram made them feel even worse. I think that 
this is astonishing. I mean, it just takes my breath away.
    What is the difference, in your view, between internal 
company research and the type of research that the CAMRA Act 
would enable?
    Dr. Radesky. There are several differences.
    First, with academic or independent research, we have to go 
through rigorous training in protecting vulnerable populations, 
the IOB, and ethical board approval. There is lots of 
transparency, and lots of accountability, in terms of reporting 
negative side effects or unintended events that might happen 
during our research.
    And the internal research for Facebook revealed some of 
those negative and likely unintended consequences of the design 
of Instagram, which is very focused on appearance, and filters 
and other ways of editing images. But they didn't have the 
accountability to either stop their research, change their 
intervention, their product, or to be accountable to the users 
who were involved.
    Ms. Eshoo. Have you ever been asked by a social media 
platform to provide any guidance to them?
    Dr. Radesky. I have communicated with several different 
teams. Facebook had reached out to me a few years ago. There 
has been an invitation to conferences, or more informal 
conversations with the child policy and safety teams at these 
companies. But I do not have a formal role with any of them.
    Ms. Eshoo. Thank you very much.
    The Chair now recognizes Mr. Guthrie, our ranking member of 
the subcommittee, for his 5 minutes of questions.
    Mr. Guthrie. Thanks, Madam Chair, and thanks for all of you 
being in this important meeting. And I am just going to say I 
am going to step out in a few minutes, not because I don't find 
this extremely important. I have a World War II vet and a 
couple of other veterans that are going to be arriving at the 
World War II Memorial, and I am going to see them, and I will 
come right back--I want to greet them--because this is very 
important to do.
    First, Rick, thanks for sharing your story. It is important 
as to how our loved ones live on when we share their stories 
and move forward.
    And also, Ms. Miller, I had a--back in the early 1970s, 
when I was probably 10 or 11, I had a friend of mine that had 
leukemia, Tam Hambach--that is how they live, by mentioning 
their names--and I always think she would be--could be alive 
today, if we knew what we were--if we moved forward with 
leukemia.
    And then I had a good friend of mine, Abby Cummings--her 
mom, B.J. Cummings, a friend of mine--was 11 in 2006, was 
diagnosed with bone cancer, I guess, and passed away a couple 
of years later. And it is just like, can we not fix that? It is 
the frustrating thing with so much, as you mentioned, going on.
    And I would tell you there is nothing more bipartisan in 
Washington. As you see, if you watch the new cable news, 
particularly, you think everybody is fighting over everything. 
But we are trying to figure out how to do more for NIH and 
cancer research, and just trying to find the right way to do 
that. And so I appreciate it.
    And Ms. Stewart, I enjoyed talking to you the other day. We 
are--Atlanta was the city we would go to when I was a kid, and 
we shared some experiences of growing up. My dad was the only 
one that--we never flew, we couldn't afford to fly, but he took 
us to the airport to watch planes take off and land. And I 
found out your father did, as well. So maybe we are not that 
unique.
    But I have a question on the early childhood hearing--I 
only have a couple of questions, and I have used some of my 
time, so I wish I could ask everybody a question--but I have 
been a long-term champion of the early childhood detection. 
And, as we saw, 98 percent of the kids now have early detection 
of everything. If we can catch it early, we can treat it, 
hopefully, and develop--children can develop further.
    But we are having 98 percent get screened, but only 67\1/2\ 
percent getting the care that they need for--as a result of 
this screening. And what--in your opinion, how can we reduce 
barriers to access?
    Ms. Stewart. Well, I think that your point is well taken, 
in that we have made a lot of progress with early 
identification. But the issue is to go further than that, to 
not only identify it early but to make sure the kids have the 
right access to the care, the referrals that they need, the 
services that they need.
    And we know that, for example, when kids are not able to 
identify hearing challenges early in life, it affects them, it 
affects them over the--over their lifetime. It affects their 
early progress with early education, and it affects their 
ability to succeed later in life. I think part of it is just 
making sure that both kids have access to the right referrals 
and the right services to follow up with and that their 
families have the right education and awareness to know how 
their children can be treated, as well.
    You know, parents have a big role to play in this, along 
with pediatricians, with early child care providers. We have to 
make sure that everyone is aware of hearing challenges, and 
making sure that those kids have the right access to early 
identification and then referral and services, as well. And 
that may need to continue over a lifetime, not just early in 
life.
    Of course, we know that the earlier that those problems can 
be identified, even within the first month or two of life, that 
can make a big difference.
    Mr. Guthrie. Right.
    Ms. Stewart. But we may need to provide services over a 
longer period of time, to the extent that children have 
continued challenges.
    Mr. Guthrie. Thank you for that, and thank you for the work 
the March of Dimes is doing for that. I think a lot of us know 
where we were when we got the phone call that my colleague Andy 
Barr's wife had passed away. Just tragic. And people get those 
phone calls all the--every day, all the time. And so the CAROL 
Act is before us.
    So, Dr. Lloyd-Jones, you discovered--you discussed in your 
testimony that some individuals are born with genetic risks for 
developing mitral valve prolapse, or MVP. The CAROL Act 
improves research that would help medical professionals detect 
the existence of this genetic risk and diagnose it early on. 
What are the main barriers hindering medical professionals from 
being able to improve detection methods?
    Dr. Lloyd-Jones. Well, thanks very much for your question, 
sir. You know, you are absolutely right. Mitral valve prolapse 
is one of the heart conditions that can run in families. There 
are other connective tissue diseases and other considerations 
that can lead to an increased propensity for mitral valve 
prolapse.
    But unfortunately, there is really no great way to diagnose 
this. Symptoms, as with lung cancer, only occur very late in 
the process, so we need people to have access to healthcare so 
we can listen to their chest with a stethoscope, which is 
probably the main way we start to become suspicious about 
mitral valve prolapse. But you can't diagnose this without 
echocardiography. And so that is really our main way.
    And once again, access to healthcare, and quality 
healthcare, are major issues for people in order to be able to 
be diagnosed and monitored over time, which is a crucial 
portion----
    Ms. Eshoo. Doctor, what did you say was needed to diagnose? 
I couldn't hear you. And I think it is important to know this.
    Dr. Lloyd-Jones. Yes, so the firm diagnosis of mitral valve 
prolapse requires echocardiography, or ultrasound of the heart.
    Mr. Guthrie. Echocardiogram.
    Ms. Eshoo. I see.
    Dr. Lloyd-Jones. Yes, in order to actually make the 
diagnosis. And it is the main way we monitor patients, as well, 
to see if that is progressing over time.
    Mr. Guthrie. Yes, I think Carol actually had been screened 
and was scheduled for one and, because it wasn't deemed a 
critical--as critical at the time, because of COVID, she 
couldn't get the service before she passed away from that, 
unfortunately.
    Dr. Lloyd-Jones. So sad.
    Mr. Guthrie. So I just want to--I know my time has expired, 
but I have a statement from Congressman Barr on his bill to 
introduce to the record, and then also an American Speech-
Language-Hearing Association statement, I think, that has been 
given to the staff. I would like to introduce those to the 
record.
    Ms. Eshoo. The gentleman yields back. The Chair now 
recognizes the chairman of the full committee, Mr. Pallone, for 
his 5 minutes of questions.
    Thank you, Mr. Guthrie.
    Mr. Pallone. Thank you, Madam Chair. I want to emphasize 
that prioritizing robust funding in these key children's 
prevention, research, and screening programs really is critical 
in protecting the most vulnerable from long-term poor health 
outcomes. But I think the levels at which we authorize these 
programs matter and speak to the success and confidence and 
work of these programs and their policies.
    So my questions are all of Ms. Stewart. I know the March of 
Dimes is at the front lines of supporting the EHDI program, and 
how these investments--you probably know well how these 
investments can help improve health outcomes.
    So my first question is, in your view, is the level of the 
authorization in the reauthorization of the EHDI program 
sufficient to support the program needs and service as many 
families as possible?
    And if not, what authorization level do you think is 
necessary to ensure sufficient support?
    Ms. Stewart. Thank you. I think, you know, I think the most 
important thing is making sure that we can reach as many kids 
as possible, and I think what we are asking for in terms of 
reauthorization is probably sufficient.
    I think the other thing, though, is--but, you know, the 
fact of the matter is we still have a number of kids who are 
still being impacted by this issue, and they are suffering for 
a long period of time.
    I think one of the most important things we can do is to 
make sure that the amount of funding over a long period of time 
is available. For example, if they are screening early on, 
making sure that those resources are available so that they do 
have the kind of support that they may need over a longer 
period of time.
    A lot of families also need more support, as well. So I 
think the reauthorization amount is probably sufficient, but I 
think we ought to continue to revisit to see what more--what 
may be needed, what more may be needed over time.
    Mr. Pallone. All right. And then I have the same question 
for the level of support for the National Center for Birth 
Defects and Developmental Disabilities.
    Do you think the proposed authorization that is included in 
that bill, H.R. 5487, is sufficient to support the program? 
Same question.
    Ms. Stewart. Well, I think, obviously, the National Center 
has done some great work in a number of areas around birth 
defects, looking at blood disorders. We have been working with 
the Center for a number of years on a number of these issues.
    I think one of the things that, you know, we have to better 
understand, for example, during COVID-19 is what is the effect 
that it is having on families and children today.
    So one of the things that we don't know right now is what 
more will we learn over time that we might need to invest more 
in later on. For example, what is the long-term effect of 
babies that may have been affected by COVID? What are the long-
term effects that children may be affected by that we still 
don't understand today?
    So I think we need to, again, look at refunding where we 
are today, but be prepared that we may need to put more money 
into this----
    Mr. Pallone. The----
    Ms. Stewart [continuing]. Going forward.
    Mr. Pallone. No, and I agree with you. But, I mean, as far 
as the bill, you are OK with it at this point.
    Ms. Stewart. We are.
    Mr. Pallone. You think it is adequate?
    Ms. Stewart. We are, for what is being requested, yes----
    Mr. Pallone. Because I wanted to ask you one more question 
about health inequities.
    You know, these health inequities were brought to light as 
a result of the pandemic, even more so. And many of those on 
the front lines of intervention and screening programs have 
been raising these issues for years. But do you see health 
inequities as a concern in early intervention and screening 
programs such as EHDI?
    And should this committee consider more detailed guidance 
encouraging the expansion of work in this program to address 
disparities in followup services among racial or ethnic 
minoritie, or other medically underserved populations? My last 
question.
    Ms. Stewart. So, Congressman, in just about every one of 
the issues that I have addressed today, starting from the 
broadest level of maternal and infant health all the way down 
to issues around lead poisoning, or around other issues 
generally around health inequity, this country faces those 
challenges across the board.
    There--it is very clear that we have underinvested, and we 
have not had the kind of policy environment that really 
supports making sure there is an equal playing field with 
respect to health equity.
    We know that Black women, for example, are three to four 
times more likely to die as a result of pregnancy and 
childbirth. Black women are 50 percent more likely to give 
birth to a baby preterm. Black women are far more likely to 
have a baby born in stillbirth. So the fact that we have all 
these statistics really suggests that we are underinvesting, to 
your point, in eliminating health inequity. But it is going to 
have to be a much more comprehensive approach.
    There is one big effort that we are supporting right now 
around Momnibus, for example, that is intended to address those 
issues. But even in the--some of the issues that we are dealing 
with today, it is an issue that we have to continue to focus 
on, because the health inequities are there and we have 
historically underinvested in all of these areas.
    Mr. Pallone. I appreciate that. And let me just say we are 
still pushing very hard for the----
    Ms. Stewart. Momnibus?
    The Chairman [continuing]. Momnibus----
    Ms. Stewart. Yes.
    Mr. Pallone. [continuing]. In the reconciliation.
    Ms. Stewart. I appreciate that, thank you.
    Mr. Pallone. Thank you.
    Thank you, Madam Chair.
    Ms. Eshoo. Certainly. And Mr. Chairman, can you give the--
our witnesses, especially the parents that are here, some 
indication when you think we can bring these bills to the full 
committee, and then to the floor?
    He is going to kill me for doing this.
    Mr. Pallone. Well, as you know----
    Ms. Eshoo. But I want you to leave----
    Mr. Pallone. As the chairwoman----
    Ms. Eshoo [continuing]. With a lot of hope in your hearts.
    Mr. Pallone. As the chairwoman knows, we wouldn't be having 
this legislative hearing today if we weren't trying to move 
these bills soon, believe me. So, I mean, the answer is yes, 
that we--I am not sure I know exactly what she asked me, but 
the answer is yes.
    Ms. Eshoo. Yes, you do.
    Mr. Pallone. We want a bill--we want to move these bills 
soon. Thank you.
    Ms. Eshoo. OK.
    Mr. Pallone. I just have to rush to another meeting. I 
apologize.
    Ms. Eshoo. Well, I just wanted to get you before you left. 
How's that? Thank you, Mr. Chairman.
    OK, now I am pleased to recognize the gentlewoman who is 
the ranking member of the full committee, Congresswoman Cathy 
McMorris Rodgers, for your 5 minutes of questions.
    Mrs. Rodgers. Thank you, Madam Chair. And to all our 
witnesses, I just want to thank you for joining us today. We 
have heard some really telling, powerful testimony.
    Mr. Nolan, on behalf of Katherine's Law, it is good to see 
you, and thank you for sharing her story again.
    And to Mrs. Miller, I remember when the Gabriella Miller 
Act was first passed, and just appreciate everyone for being 
here and advocating for so many others.
    And certainly, Carol Barr's death was so untimely and hit 
us all really hard, and I appreciate the work that is being 
done to help others that may face similar situations.
    I have been very clear about my concerns with Big Tech, and 
I am troubled by Big Tech censorship of conservatives, and 
anyone that seems to disagree with liberal ideology. I believe 
that free speech is fundamental to our great Nation. We need to 
cherish it, defend it, and not attack it.
    I am also very concerned about the harm that Big Tech is 
doing to our children. And we have seen it recently again with 
Instagram. But you know, they are not alone. The same applies 
to TikTok, YouTube, Snapchat, any platform that profits from, 
you know, keeping our children online as much as possible. And 
that is why the Energy and Commerce Republicans are committed 
to leading this fight against Big Tech.
    And, in fact, in July, every Republican on the--on this 
committee rolled out a bill as a part of a larger package to 
address censorship and provide protection for our kids.
    Dr. Radesky, I have been calling on Big Tech to be more 
transparent about the impact that their products are having on 
children's mental health. And studies have shown that even 
passively consuming content is harmful. And yet these companies 
continue to design their products to increase this passive 
consumption. I just wanted to start by asking you, what advice 
do you give to parents as they consider their children's own 
use of social media?
    Dr. Radesky. Yes, thanks for that question, and yes, I work 
a lot with the American Academy of Pediatrics on guidelines to 
help families adapt to this rapidly changing tech environment 
that is often hard to understand.
    So the guidance we give is to be as curious and open-minded 
as possible. Gather all the information you can, use resources 
like Common Sense Media, be extremely informed. Because right 
now, the tech environment still feels like a Wild West. It 
feels a little bit like a circus. They are trying to get lots 
of attention.
    There is a lot of good stuff out there, but in our research 
on YouTube we found that the videos with the highest views, the 
ones that are getting the most reach through algorithms, are 
the ones that are actually the most shallow or the most 
consumerist, or they have some pranking and other sort of role 
modeling that we don't necessarily want kids to be, you know, 
spending all their time with.
    So we encourage parents to watch along and help their 
children recognize when there is bad information or stereotypes 
or other sorts of messages that they don't agree with and to 
help their kids be savvy, critical consumers. How to find the 
right sort of channels to subscribe to, how to take breaks from 
social media so you can reflect and see how it makes you feel.
    Our emotional and social reactions to these social media 
platforms that are often constructed to really get a lot of our 
attention around social relationships, it can happen without us 
truly thinking about it. It is supposed to be frictionless so 
that we are not pausing and reflecting on why we have these 
relationships. So that is another thing, is I encourage parents 
to take breaks----
    Mrs. Rodgers. Thank you----
    Dr. Radesky [continuing]. Have experiments, open the 
conversation with their children to really help them guide 
through.
    Mrs. Rodgers. What--would you speak to how you believe 
COVID-19 pandemic distance learning and social isolation has 
also impacted kids' social media use and the increase of mental 
health issues?
    Dr. Radesky. Yes, this is such an important issue. And even 
yesterday the AAP, together with other organizations, released, 
you know, a state of emergency on child mental health. We have 
seen a large increase in emergency room visits for mental 
health issues in my own clinical practice. Children have really 
suffered. School is very stabilizing for children, and the 
experience of remote learning resulted in decreased motivation, 
decreased sense of connection, more mood symptoms, sleep 
disruption, defiant behavior, or withdrawn behavior. This has 
been shown in multiple studies.
    And in our own research at Michigan we have found that 
parents of elementary school kids said they started social 
media accounts for their children younger than they hoped to, 
just so they could keep in touch. So this is an extremely 
pressing issue, because children now have much more access to 
digital platforms that weren't necessarily designed with young 
minds in mind.
    And so what we have found is that, in some cases, digital 
connections such as video chatting has helped child mental 
health, whereas, more online gaming, lots of video viewing, 
less sleep isn't as supportive. And this is why both research 
and policy on this area right now is equally pressing.
    Mrs. Rodgers. Well, thank you for sharing your expert----
    Ms. Eshoo. Who is next?
    Mrs. Rodgers [continuing]. Mental health, the suicide 
crisis, and the rest.
    I yield back, Madam Chair.
    Dr. Radesky. Thank you.
    Ms. Eshoo. And thank you, Cathy. And we are all saying our 
prayers that your children are healthy and well very soon. We 
miss having you here in person but want you to know that we are 
all thinking about you.
    The Chair now recognizes the gentleman from North Carolina, 
Mr. Butterfield, for his 5 minutes of questions.
    Mr. Butterfield. Thank you, Madam Chair. Let me first say 
good afternoon to all of my colleagues.
    And thank you, Madam Chair, for convening this very 
important hearing, and thank you to the witnesses. I have 
listened to all of your powerful testimonies, and just thank 
you for coming forward today and giving us the benefit of this 
information. Let me address my comment and my question to Ms. 
Stewart.
    Ms. Stewart, in your opening remarks, you mentioned how 
critical SET-NET, the National Center for Birth Defects and 
Developmental Disabilities, is to protect vulnerable mothers 
and babies. Can you expand more on this program's importance, 
both the reauthorization of the Center as well as increased and 
sustained funding?
    Ms. Stewart. Thank you, Congressman. And I did mention 
about SET-NET, and I just want to say a couple more things 
about it.
    What SET-NET is is really an innovative data collection 
system that links maternal exposures during pregnancy to health 
outcomes for babies. What we found, especially during the Zika 
outbreak, is that SET-NET came in as a very useful system that 
allowed us to leverage existing data sources, enabling CDC and 
health departments to detect new and emerging health threats, 
to understand that health threat.
    We also know that in fiscal year 2021 SET-NET has provided 
support to 29 State, local, and Territorial health departments 
to monitor impact on pregnant individuals' and babies' exposure 
to Zika, to syphilis, to COVID-19.
    So what we know is that, when we have better data 
collection, we can monitor these kinds of outbreaks more 
successfully, and we can create the right interventions.
    The most important thing, though, is that SET-NET, in 
fiscal year 2021, was funded at $10 million. The House proposed 
increasing funding to--by another 5 million, but we still think 
that that is woefully inadequate to really get to the high-
quality data collection system that we need.
    We have actually recommended SET-NET be funded at $100 
million. And what we know is, especially as we are still 
dealing with the pandemic, the lack of data to really 
understand the impact and what is going on with pregnant women, 
with women and with children, is affecting our ability to serve 
them and keep them healthy. So we would ask for that to be 
certainly reconsidered, and that goes back to the early 
question, as well----
    Mr. Butterfield. Yes, let's drill down and--let's just 
drill down, if we can, on data collection. I believe that data 
collection is just critically important for making a positive 
impact on maternal and child health outcomes.
    You may know that, 2 weeks ago, the Communications and 
Technology Subcommittee held a hearing on my bill, which is 
referred to as H.R. 1218, the Data Mapping to Save Moms Act of 
2021. The bill would require the FCC to map areas of the 
country that have both high rates of negative maternal health 
outcomes and gaps in internet service.
    It would also require the GAO to issue a report on the 
effectiveness of Internet connectivity in reducing maternal 
morbidity rates.
    Can you now discuss how broadband and telehealth access 
will intersect with maternal and infant health?
    Ms. Stewart. Yes, and we are a proud supporter, the March 
of Dimes, of the Data Mapping to Save Lives Act.
    We also saw during the pandemic how many pregnant women, 
for example, went without prenatal care because they were too 
concerned about getting out to their healthcare provider to 
seek care.
    We also know, for example, in this country we have--half of 
all the counties in this country lack basic access to obstetric 
care. And so, if we don't have the ability for women to seek 
care through other means, especially through technology, 
through digital tools, we are still going to be leaving too 
many women without the care that they need, especially in rural 
areas.
    So this Data Mapping to Save Lives Act is really important 
to bridge the gap, to make sure we have technology available 
for women who may not be able to seek services close to where 
they live.
    And we would also want to make sure--and we support the 
provision that the GAO provide a report on the effectiveness of 
Internet connectivity in reducing maternal morbidity rates, as 
well. So thank you for your leadership on that.
    Mr. Butterfield. And thank you for including those comments 
in the record. That is very important, and we are going to act 
accordingly.
    Madam Chair, before yielding back, let me just ask that we 
consider additional legislative hearings. I encourage the 
subcommittee to take up the H.R.--the bill H.R. 2356, the 
Better Wound Care at Home Act, which I jointly introduced with 
Congressman Markwayne Mullin. This bipartisan bill will help 
patients with chronic wounds stay healthy in their homes and 
avoid future complications, particularly for patients of color 
who are at higher risk for infection, hospitalization, and limb 
loss.
    I thank the Chair for listening. I thank you for your 
consideration. Thank you for your friendship. And at this time, 
I yield back the balance of my time.
    Ms. Eshoo. You are such a gentleman, Mr. Butterfield, and a 
friend to all of us. Truth be told, I would have a hearing 
every single day of the week, I really would. So I think you 
need to nudge a little bit at the top of our committee. I 
certainly will. There are so many bills pending.
    This subcommittee is really the workhorse of Energy and 
Commerce, in terms of subcommittees. We have some 700 bills, 
over 700 bills that have been referred to us. But it doesn't 
mean that we have taken them up. So I am all for a crowded 
calendar. How is that?
    Mr. Butterfield. Let's do it, let's do it.
    Ms. Eshoo. And I would love to take your bill up.
    Mr. Butterfield. Thank you.
    Ms. Eshoo. So let's talk some more about it, talk to Mr. 
Pallone, and I would like more hearing dates for the rest of 
the fall, so that we can really move, put the pedal to the 
metal, and move a lot more legislation. A lot of good bills, a 
lot of good ideas, worthy ideas that are going to help people 
in our country.
    So thank you, Mr. Butterfield.
    Next, it is a pleasure to recognize the gentleman from 
Michigan--he is indeed that, a gentleman--and he is the former 
chairman of the Energy and Commerce Committee, Mr. Upton, for 
your 5 minutes of questions.
    Mr. Upton. Well, thank you, Madam Chair.
    And Ms. Miller, it is nice to see you again. As I recall, I 
managed the time on the House floor debate with you and your 
daughter and the gallery a number of years ago, and was glad to 
shepherd that bill through and get it signed into law. And I 
have asked to cosponsor the bill that you referenced today, 
H.R. 623.
    And Rick, as always, it is a pleasure to see you, even 
though you have a mask on. Mine was on a moment ago. But I am 
going to help you keep your promise. And I am going to 
cosponsor your bill, as well.
    Madam Chair, I want to thank you for holding this very 
important hearing on a good number of bipartisan public-health 
priorities. I want to really thank you also for looking at the 
Protecting Access to Lifesaving Screening, the PALS Act, which 
is going to help millions of women between the ages of 40 and 
49 keep access to breast cancer screening.
    I also want to highlight Representative Walberg and Tonko's 
Lead Poisoning Act, which I have cosponsored. We are certainly 
having a declared state of emergency in my district, in Benton 
Harbor, Michigan, due to the lead in the water, and this bill 
is going to help ensure that those situations don't happen in 
the future.
    And I know that there are several expiring authorizations 
from 21st Century Cures that we still need to look at that were 
not part of this hearing, going along with Mr. Butterfield's 
comments, especially with regards to mental health. So it is my 
hope that we can add that to the workload list for 
reauthorization soon.
    Two questions in my remaining time.
    Ms. Stewart, as I mentioned before, we are currently facing 
a crisis in my home district, Benton Harbor, related to lead in 
the water. And I was able to get $5.6 million in EPA funding 
last October for the city to replace lead service lines, and 
the State is providing additional resources that they have 
referenced in the--just in the last couple of weeks.
    What are some things that the Federal Government can do in 
addition to ensuring continued predictable support that H.R. 
5552 provides for lead poisoning prevention and screening to 
ensure that this doesn't happen in communities?
    How can agencies at the Federal, State, and local levels 
work better in order to prevent future crises, Ms. Stewart?
    Ms. Stewart. Thank you, Mr.--Congressman, and I acknowledge 
that we--you have, in Benton Harbor, been experiencing and seen 
it up close and personal, the devastation that has been created 
in Benton Harbor. I had a chance to visit Benton Harbor when I 
was a student at University of Michigan. Benton Harbor is a 
predominantly Black city, and we know that lead poisoning does 
impact disproportionately people of color, especially Black 
children and Black families. And what is going on in Benton 
Harbor is simply a disaster, and it is a manmade disaster.
    And so if we are prepared to deal with manmade disasters in 
other areas, we certainly should deal with it in this area, 
because lead poisoning has such a devastating effect on the 
health of families, on the health of children.
    One of the things that the Lead Poisoning Prevention Act 
does do is it reconstitutes this advisory committee at the CDC 
that, for years, supported CDC's Childhood Lead Poisoning 
Prevention Program. It would allow there to be expansion of 
resources for grants for support, for relief and recovery, 
especially in at-risk communities.
    We think that, for a lot of States that are struggling with 
some of these issues--and we think it goes beyond just Michigan 
and Benton Harbor--that States need more support, and financial 
support, in dealing with these kinds of crises. And it is not 
only in terms of prevention, but it is also in dealing with the 
effects of lead poisoning as they exist today. So there have to 
be more resources paid to the--attention to make sure that we 
can address those children, especially, that have been impacted 
by lead poisoning.
    But again, to your point, also preventing it and putting 
more resources into the issue in places like Benton Harbor and 
more.
    Mr. Upton. Yes, we had some promising news just yesterday. 
The Governor was there, the Lieutenant Governor was there last 
week, and they have announced that they are going to replace 
all of the lines, hopefully, within 18 months. And I know in 
the--what we call the BIF, the bipartisan infrastructure bill, 
that did pass the Senate 69 to 30 back in August, it includes 
15 billion for lead lines in that, as well.
    Dr. DuBois, can you speak to how the U.S. Preventive 
Services Task Force screening guidelines are tied to insurance 
coverage and copays?
    Isn't it true that any screening decisions--breast cancer, 
any other preventive screening decisions that don't receive 
that A or B grade is no longer guaranteed coverage with a 
copay?
    Dr. DuBois. Can you hear me?
    Mr. Upton. I can.
    Dr. DuBois. Yes, that is correct. The--if it is not an A or 
a B by the task force, then it is not automatically covered by 
insurance coverage.
    Although many societies and other bodies do recommend 
screening starting at age 40, and so there is a lot of that 
going on. I think this bill actually helps support funding for 
those services. Most people in the cancer field and other 
individuals in this area definitely feel that screening needs 
to begin at 40 for women for breast cancer.
    Mr. Upton. Thank you.
    I yield back. Thank you, Madam Chair.
    Ms. Eshoo. The gentleman yields back. I am pleased to 
recognize the gentlewoman from California, Ms. Matsui, for your 
5 minutes of questions.
    Ms. Matsui. Thank you very much, Madam Chair, for the 
recognition.
    And I want to thank all the witnesses for joining us today. 
Your--you have been absolutely outstanding, and I really 
especially want to say thank you to my former colleague Rick 
Nolan for sharing your story. It is--what a wonderful way to 
really honor Katherine in the sense that you are doing her 
work, as far as trying to ensure that no one else goes through 
what she has gone through. So thank you, Rick.
    I want to talk about the Early Hearing Detection and 
Intervention, the EHDI program, which has proven key to 
improving public health for children and families. Before the 
program began 2 decades ago, less than 10 percent of infants 
were screened for hearing loss. And today, thanks to a 
successful EHDI program, the screening rate is 98 percent.
    But I am really concerned that all infants with hearing 
loss are not receiving the necessary followup treatment they 
need in a timely manner. So further, too many of our children 
who have been identified as deaf or hard of hearing are still 
facing disparities in access to care.
    Early childhood is, as we know, a crucial period for 
language acquisition, and it is critical that we equip 
healthcare providers and parents with the knowledge and tools 
they need to make timely decisions about hearing services and 
supports for their children.
    Now, with these goals in mind, I recently joined Ranking 
Member Guthrie in introducing legislation that will reauthorize 
this program, and I am looking forward to our continued efforts 
here and have several questions about the status of the 
program.
    Ms. Stewart, it is important for the CDC to improve their 
hearing loss, surveillance, research, and connection followup 
services. Could you explain what role CDC plays in ensuring 
newborns screened through this program can access the followup 
services that they need?
    Ms. Stewart. Well----
    Ms. Matsui. Ms. Stewart?
    Ms. Stewart [continuing]. Thank you, Congresswoman. As we 
talked about, one of the things that is really important in all 
of this hearing is understanding the importance of early 
detection, of good data collection, and that extends to a lot 
of issues, including the issues around early hearing and 
detection.
    And we are doing a much better job, as we have talked 
about. When we look back, in 1999, according to NIH, when, 
prior to the establishment of this Federal universal newborn 
infant hearing screening program, we were only screening less 
than 10 percent of newborns. We are now screening 98 percent of 
newborns.
    But what we also know, according to the CDC, and in the 
school year--and this was just--these are older numbers, but 
from the school year of 1999 to 2000, the total cost of special 
education programs for children who were deaf or hard of 
hearing was about $652 million. That is about $11,000 per 
child. But the lifetime educational cost for a child who is 
deaf or hard of hearing is estimated at $115,000 per child. So 
the costs that go into monitoring kids early in life isn't just 
screening them in the first month of life, which is what the 
recommendation is, that babies should be screened at one month, 
it is also making sure that there is funding and we are 
tracking the progress of children over their lifetime 
education, for their lifetime educational needs.
    And we would hope that the CDC would play a vital role in 
making sure that we can track that, as long as--with what other 
lifelong health challenges, or----
    Ms. Matsui. And certainly, Ms.----
    Ms. Stewart [continuing]. Other issues that children may 
experience.
    Ms. Matsui. Ms. Stewart, would you agree that the increase 
in CDC funding in this bill is key to expanding these 
activities?
    Ms. Stewart. I would agree with that, for sure.
    Ms. Matsui. Thank you very much.
    I was deeply disturbed, as others, about the Facebook 
testimony by the whistleblower Frances Haugen and about young 
users, in particular, who--leading young users to anorexia 
content. I have long been concerned about the mental health 
impact of eating disorders on young people, especially young 
girls.
    In 2015, as the E&C lead of the Anna Westin Act, I was 
proud to support passage of this important legislation, which 
increased education and resources for those suffering with 
eating disorders. Now, while we made progress in ensuring 
access to treatment, we have to do more to protect our kids 
from being exposed to toxic content on social media.
    Dr. Radesky, thank you for your testimony. Would you agree 
that the connection between mental health, eating disorders, 
and algorithms that determine children's recommendation feeds 
is an issue area in urgent need of the funding and research 
provided by the CAMRA Act?
    Dr. Radesky. Yes, thank you for that question. One thing I 
really appreciate about the CAMRA Act is that it tries to 
understand individual children's vulnerabilities to what might 
make them profiled in a certain way, and therefore be fed 
content that is not in their best interest, how they might be 
profiled to send them advertising that is--you know, also could 
nudge their behavior, in one way or another, that is not in 
their best interest.
    Ms. Matsui. Right.
    Dr. Radesky. One thing about eating disorders, in 
particular, is that we do need more research that focus on 
specific diagnosis populations. Eating disorders, or autism 
spectrum disorder, or learning disabilities, ADHD, all of this 
would be much more robustly funded through the CAMRA Act.
    Ms. Matsui. OK. Well, thank you very much, Dr. Radesky.
    And I yield back.
    Ms. Eshoo. The gentlewoman yields back. It is a pleasure to 
recognize the gentleman from Virginia, my friend, Mr. Griffith, 
for your 5 minutes of questions.
    Mr. Griffith. Thank you very much, Madam Chair. I do 
appreciate it.
    I want to go a little off subject, because we have the 
stillbirth bill, which I think is a good bill. A lot of these 
bills are.
    But it came to my attention a couple of years ago, as often 
happens with us in our profession. I was at a county fair, and 
a lady brought a situation to me that I think we need to work 
on. It is not our committee, so we can't do anything about it, 
but it deals with stillbirth situations. And many States, 
including Virginia--in fact, there was a somewhat notorious 
prosecution of a lady who had a stillbirth, and Virginia law, 
because she just put the baby in the trash can, but it was 
clearly stillbirth, no misconduct on her part, other than that, 
and the State requires that you both fill out the proper forms, 
but that you also, once a baby gets to a certain age, we 
require a burial, or a proper disposal of the remains, which I 
think is appropriate.
    But we, as a Congress, have not done anything to give a tax 
credit. If the child is born alive and takes one breath, you 
get a tax deduction. You have all the same expenses. And in 
fact, what was brought to me at the county fair was a young 
lady who didn't know her baby had died and went in on the due 
date, only to discover that the baby had had died, and they had 
to put her through labor in order to take care of it. So she 
went through all the expenses, all the trauma of having a baby, 
knowing that the baby was dead, and yet no help from our 
Federal Government.
    So that is just an aside, and I apologize to our witnesses, 
but I think it is important.
    I am going to take another side and go to you, Congressman 
Nolan, and I want Dr. Lloyd-Jones to listen, as well.
    I am for the bill, so that is not the issue. But I am 
wondering, because I had a constituent who--his watch told him, 
``You are in AFib,'' and he went to have it checked out, they 
couldn't find it at first. He did a stress test, and sure 
enough, they found a heart valve problem. He had it fixed. It 
was no problem, as long as he got it fixed, and he is out there 
and doing fine today.
    I am wondering if, both in regard to lung cancer and you 
can't get your breath, is there some kind of--do we see any 
kind of future technology that would make it so that you can 
basically do something at home? Your watch isn't going to tell 
you you are having a breathing problem, I don't think. But I am 
just wondering if you know of any new technologies coming 
along.
    I am for the screenings. I think that makes sense. But I am 
just wondering if there is any other technologies that you are 
aware of that might--that you might be able to do something at 
home to get an earlier screening, as well.
    Mr. Nolan. Thank you, Congressman. That is a very good 
question.
    I think it is reasonable to understand why that early free 
screening wasn't initially given to the victims of lung cancer 
who were nonsmokers, of whom there are many, because all that 
was available was a chest X-ray, and that was not very good, 
and it caused too many false positives and false negatives, 
and--but over the years since that time, low-dose CT scans have 
been developed that are very, very good, and as good or equal 
to the screening techniques made available for other cancers.
    So I think it is the advance of technology that makes this 
legislation ready----
    Mr. Griffith. And that makes sense. And I will tell you, 
because of stuff I had going on as a kid, they spotted a little 
teeny spot on my lungs and popped me into one of those, and 
everything is fine, and it is not a problem, it is just old 
scarring. But that is what they were looking for.
    And--but you shouldn't have to have a spot caused by having 
bronchitis 100 times when you were a kid that gets you that 
screening, and I think that your legislation is----
    Mr. Nolan. Well, thank you.
    Mr. Griffith. It is right on. I appreciate----
    Mr. Nolan. And I might tell you, my daughter was very 
physically active and very conscious of her health, and she had 
started a new business and had kind of backed off a little bit 
on her daily exercise routines and figured that her lack of 
breath was because she hadn't been exercising as----
    Mr. Griffith. Right.
    Mr. Nolan [continuing]. As she should have. And so she 
doubled down on her exercise, and things didn't get better, 
they got worse. So she went to the doctor and was diagnosed, 
and by that time it was too late. It was terminal.
    Mr. Griffith. Yes.
    Mr. Nolan. But I might add to the committee--and thank you, 
because this committee has played such an important role in the 
advances in preventing and extending the lives of cancer 
victims.
    And you know, Katherine, my--I started to say my aunt 
Eleanor Nolan, who was dead in 6 months after----
    Mr. Griffith. Right.
    Mr. Nolan. Katherine lived another 6 years.
    Mr. Griffith. Yes.
    Mr. Nolan. And had a great time with her family and her 
husband and was able to devote much time to advocating for lung 
cancer victims, donated her body to the Mayo Clinic, and was 
very grateful for the men and women who have promoted good 
public policies. And she would be--I would be remiss if I 
didn't thank the committee for the work that has been done over 
the years.
    Mr. Griffith. Well, I thank you for that, and the 
chairwoman and I were talking about it earlier, in that so much 
of what we do here is not partisan, it is just trying to solve 
problems, and that is what this committee normally tries to do.
    My time is up. I did--I may ask a few questions after the 
fact of Dr. Lloyd-Jones. I will note, as the head of the Welsh 
Caucus, Dr. Jones, that--or Dr. Lloyd-Jones, that, as a fellow 
with the name of Morgan Griffith, it is mighty nice to have a--
somebody who has got at least some Welsh ancestry, because you 
wouldn't have names of Lloyd and Jones if you didn't have some 
Welsh ancestry. So I look forward to your answers to the 
written questions I will submit later.
    I yield back.
    Ms. Eshoo. Thank you, Congressman. The gentleman yields 
back, and he says that with enormous pride, and we are proud of 
you too.
    So the Chair now recognizes the gentleman from Maryland, 
Mr. Sarbanes, for your 5 minutes of questions.
    Mr. Sarbanes. Thanks very much, Madam Chair. I want to 
thank our panel for their testimony. I want to thank, in 
particular, our former colleague, Rick Nolan, for being here 
and delivering very difficult but powerful testimony.
    All the bills that we are hearing about today are very 
critical. I am going to focus on one that has already gotten a 
fair amount of attention that I, along with many of our 
colleagues, are cosponsors of, which is the CAMRA Act.
    We certainly know that the internet and the digital 
revolution have been vital tools. It created vital tools for 
innovation, creativity, economic growth, both for individuals 
and communities, obviously. But we also know that it has 
created a lot of new considerations around safety and health 
that we have to address.
    I am often discussing the use of media, particularly social 
media, in the context of protecting our democracy, and 
safeguarding our elections and things of that nature. But I am 
also super concerned about the effects social media is having 
on our children's well-being. And we know the topic is getting 
a lot of attention increasingly now, which is good, but it 
means we really have to wrestle with what are the solutions. 
What do we bring to bear, and make sure children are protected?
    Dr. Radesky, you have already talked at some length about 
all of this. I wonder if you could speak for a moment to 
whether there is a way--whether we should have the ambition, I 
guess, of trying to kind of flip the presumptions here that, 
when these tools are being developed inside of these large, 
digital ad companies or, frankly, inside any organization that 
is going to deploy them widely, whether they should, in a 
sense, have to first demonstrate the precautions they are 
taking to protect children before the tools are more widely 
deployed. Because, as you know, and I think you have testified, 
you know, there is a blind spot there. These get developed with 
adults in mind, and how to sort of cultivate the connection 
with adults.
    But the collateral damage on young people is huge. And I am 
sure you have been tracking with your own work, whether you are 
beginning to see any culture change inside some of these 
organizations, where they frontload their focus on what this 
can do when it gets in the hands of children, knowing that that 
is going to happen. And then, in a sense, back out the product 
line from there, instead of it being an afterthought.
    So if you could speak to that for a couple of minutes, I 
would be interested to hear, because I think that could guide 
the way we design legislation here on the Hill to try to 
protect young people in this digital age with all its benefits, 
but, as we know, with some severe drawbacks, as well.
    Dr. Radesky. Thank you. That is an excellent question. And 
I really like the emphasis on children not being an 
afterthought.
    Children have such different ways of interacting with 
digital spaces that it is normal that adult designers wouldn't 
recognize all those things. But we have lots of know-how from 
really good research on TV and video games about how children 
experience those platforms. What we need is more research to 
inform our advisement to tech companies about how a child at 
different developmental stages, from infancy to preschool, 
elementary school, teenage years, would interact with different 
types of algorithms that elevate different content that might 
take off different social engagement metrics like liking and 
sharing.
    And one thing that I have been impressed with, from a 
policy standpoint, is the UK and the EU have done a lot of 
movement in the past few years about a child-centered design 
code. And here in the U.S., I sit on a steering committee along 
with other folks like Center for Humane Technology, Common 
Sense Media, Fair Play, where we are trying to find the same 
sort of child-centered principles to put children's needs first 
before products are released.
    In the EU they do--they are recommending or debating a 
child impact assessment before tech is released, so that you 
can have child experts and technologists working together to 
say, ``Can we anticipate how this might be misused? Can we do 
some trial runs to see what are the metrics that show children 
are really benefiting from this?'' It is giving them new ideas, 
not sucking away their time.
    Mr. Sarbanes. Thanks. That is really helpful. That is 
exactly the answer I was looking for, and I like this concept 
of a child-centered design code, and sort of making sure, 
before the broader rollout happens, that that assessment is 
being done.
    And we can learn from what our peer nations are doing 
around the world, absolutely, in this space.
    Thank you very much, Madam Chair, I yield back.
    Ms. Eshoo. Thank you, Mr. Sarbanes. The Chair is now 
pleased to recognize the gentleman from Florida, Mr. Bilirakis, 
for your 5 minutes of questions.
    Mr. Bilirakis. Thank you, Madam Chair, I appreciate it very 
much. And I feel blessed to, of course, represent the 12th 
Congressional District in the State of Florida, but also to sit 
on this committee and make a real difference, because this is 
the best committee in Congress, without question. Thank you, 
Madam Chair.
    Ms. Eshoo. Thank you.
    Mr. Bilirakis. Again, I was particularly glad to see the 
bill I coled with my friend Representative Cardenas, the Oral 
Health Literacy and Awareness Act, including--included on 
today's docket. So thank you again for that, Madam Chair, and 
the ranking member, as well.
    This bipartisan bill would direct HRSA to develop and test 
oral health literacy strategies capable of reaching across 
vulnerable populations to provide oral disease prevention 
education through a 5-year oral health literacy campaign.
    Dr. Cassis, can you tell us why HRSA is best equipped to 
push out such a campaign, as opposed to an entity like the CDC?
    And can you explain why establishing evidence-based 
strategies, as outlined in this bill, are important to ensure 
the agency is reaching our communities effectively?
    Dr. Cassis. Certainly, I would be happy to respond to that. 
And forgive me, you know, I am from West Virginia, and we don't 
talk real fast here, unlike some of my distinguished colleagues 
on the committee and witnesses.
    But to be quite factual, HRSA is a much smaller 
organization than the CDC, and they definitely deal with a lot 
of facts, as opposed to how you guys operate, and knowing is it 
a good program or not. They can--with their small size, we can 
figure it out real fast, whether it is effective or not.
    And as far as funding for that, you know, it is really a 
small amount, but it is this--the catalyst that may help.
    Again, I have--I have practiced 42 years, and I have to 
speak so many different languages of understanding with all of 
my patients. So if there's better ways to get people into the 
office, then we need to--that common thread of what works for 
everybody.
    Mr. Bilirakis. Thank you, sir. My next question is for Ms. 
Miller.
    I want to thank you for testifying today and highlighting 
the importance of the Gabriella Miller Kids First Research Act 
2.0.
    I appreciate everything, and--which I am proud to be a 
cosponsor, the Republican lead. I am glad to see many other 
Members joining in support of this, of course, very important 
legislation named after your late daughter--may her memory be 
eternal--and remain hopeful we can continue to move this 
forward through the legislative process.
    We know that all pediatric cancers are considered rare but 
that is not a rare problem, as you know. And as cochair of the 
Rare Disease Caucus, we need to ensure we are directing much-
needed research funding and attention for these most vulnerable 
patients.
    Some have expressed concern that using civil fines to fund 
the Pediatric Research Initiative could result in varying 
levels of money each year. Can you elaborate why you believe 
using this particular mechanism can be helpful in properly 
funding these critical programs? Because, obviously, you have a 
lot of support for the program. If you could answer that, I 
think that would be very helpful.
    Ms. Miller. Well, first, let me thank you for being an 
original sponsor on this piece of legislation. I appreciate 
your leadership on this.
    As you stated, the funding for childhood cancer and 
childhood diseases desperately needing an infusion, the--
childhood cancer gets approximately 4 percent of the NCI 
budget. And what is so fantastic about this piece of 
legislation is the unique funding source does not require our 
elected officials to appropriate the other 96 percent--it could 
stay as is--it supplements what we already have.
    And what is also fantastic about it is that it will be a 
never-ending source until such time as we have no longer a need 
for that. And right now, there is such a desperate need.
    So this source of funding is unique and innovative and will 
truly move the bar forward. Thank you for asking.
    Mr. Bilirakis. Very good. Sounds great.
    I will yield back, Madam Chair. Thank you.
    Ms. Eshoo. I thank the gentleman. The Chair now is happy to 
recognize the gentleman from Vermont, Mr. Welch, for his 5 
minutes of questions.
    Mr. Welch. Thank you very much.
    Ms. Eshoo. There you are.
    Mr. Welch. It--you know, it is always good to see Mr. 
Nolan. I mean, most of the time.
    [Laughter.]
    Mr. Welch. And it is always good to see Ms. Miller--such 
fond memories of us working together with Eric Cantor to pass 
the first bill.
    But I do want to say sincerely to both of you, it is so 
refreshing in this world that is so filled with strife, and 
then oftentimes with personal pain and personal loss, to have 
before us two people who have turned that loss, that pain, into 
progress in benefit for other people. That is inspiring for all 
of us.
    So Rick, I want to thank you, and Gabriella, I want to 
thank you so much--on behalf of your daughter, Gabriella. And I 
see your husband is here too, and I have fond memories of the 
bill signing. We went down with Eric Cantor, and President 
Obama signed it. And even as that was being signed, you were 
advocating with President Obama for the next step. So thank you 
very much.
    Ms. Miller, Marilyn, I want to ask you about the funding 
source, because that was the whole issue here, and how is it 
that--just elaborate a little bit about what the insecurity is 
of the funding source and why it is--that we need to have this 
Gabriella Miller 2.0.
    Thanks, Marilyn. Go ahead.
    Ms. Miller. Again, as with Congressman Bilirakis, let me 
thank you for your support. And you are an original sponsor of 
the first piece of legislation. And when I approached you on 
this one, you just immediately said, ``Count me in.'' So thank 
you for that.
    The original piece of legislation was a designated funding 
amount. We knew that every year that we get it appropriated, it 
is $12.6 million. This new funding source, we don't have that. 
We need to wait, obviously, for a penalty to be----
    Mr. Welch. Right.
    Ms. Miller [continuing]. Found. But the--and Madam Chair 
asked earlier the amounts of the monies, and I wish that I 
could answer that with definite--you know, a definite answer, 
but we don't know how much they could be.
    Mr. Welch. OK.
    Ms. Miller. It could be, you know, $10 million----
    Ms. Eshoo. My staff tells me that the--excuse me, that the 
total amount of--in terms of penalties that came in that go 
into the general fund in 2019 was 335.8 million. So I am 
surprised some Member hasn't found that money before to use 
for----
    Ms. Miller. It is ours.
    Ms. Eshoo [continuing]. Filling the----
    Ms. Miller. It is ours.
    Ms. Eshoo. But it is a----
    Ms. Miller. The kids need it.
    Ms. Eshoo. It is a good sum of money.
    Ms. Miller. Yes.
    Mr. Welch. The bottom line here is it is----
    Ms. Miller. So----
    Mr. Welch. There has got to be some stability in the 
funding if we are going to do the research.
    Ms. Miller. So one thing that we truly like about this 
piece of legislation is that----
    Mr. Welch. Yes.
    Ms. Miller [continuing]. You know, we don't know that we 
will get a penalty every year. So there could be a year that 
there is no funding. And what we have done differently in this 
year is, once our bill was introduced in the 116th Congress, I 
reached out to Dr. Collins, the Director of NIH, and I asked 
him to help me with language, so that we could ensure that it 
is not a use-it-or-lose-it situation, as it was with the 
original.
    Mr. Welch. Right.
    Ms. Miller. And his staff helped, and we got that language 
put into our current legislation, where it will allow for it to 
roll over. So there----
    Mr. Welch. Well, thank you.
    Ms. Miller [continuing]. Will never be a year that will go 
by----
    Mr. Welch. Right.
    Ms. Miller [continuing]. That there won't be any monies 
that are allowed for----
    Mr. Welch. Thank you, very----
    Ms. Miller [continuing]. To research.
    Mr. Welch. Thank you very much.
    And I wanted to ask Congressman Nolan, if you were back 
here, what would you have Congress be doing to assist cancer 
patients from diagnosis--throughout diagnosis and treatment?
    Mr. Nolan. For lung cancer, I presume.
    Mr. Welch. Yes.
    Mr. Nolan. Yes.
    Mr. Welch. That is right.
    Mr. Nolan. Well, I would like to see it become a national 
priority, because it is a national emergency. Every day 361,000 
people die. It is like an Airbus going down every day, and 
every passenger being killed.
    And I think, you know, there is some very disparate 
treatment between lung cancer and many other cancers. Lung 
cancer kills more than almost all of them combined. It has been 
stigmatized, because of smoking.
    Mr. Welch. Right.
    Mr. Nolan. And while other cancers are given early 
detection, as a common procedure, lung cancer victims only get 
it if they are 55 years of age and smoked 20, 30 packs of--
cigarettes a day for 20 or 30 years.
    Mr. Welch. Right.
    Mr. Nolan. And it has become epidemic among young women 
between 20 and 30.
    And so, providing early screening----
    Mr. Welch. Right.
    Mr. Nolan [continuing]. As well as additional funding for 
research and prevention and those, I think, is the most 
important thing, I think, we can do. It will save tens if not 
hundreds of thousands of lives by providing that early 
screening and detection for lung cancer.
    Mr. Welch. Thank you very much, and thank you again, both, 
for your advocacy.
    Mr. Nolan. Thank you.
    Ms. Eshoo. The gentleman yields back. It is a pleasure to 
recognize Dr. Dunn of Florida for his 5 minutes of questions.
    Mr. Dunn. Thank you very much, Madam Chair and Ranking 
Member Guthrie, for hosting this hearing today to consider 
legislation related to public health.
    And the public health focus over the last 18 months has 
appropriately been on COVID-19, and we have experienced 
successes and failures with COVID-19 and should legislate 
accordingly.
    We also, however, now have to ensure that Americans are 
able to get back on track when it comes to maintaining their 
health and staying up to date with routine healthcare visits. I 
am very concerned that the data indicates nearly 10 million 
screenings for cancer were foregone during the public health 
emergency so far, which is why I introduced H.R. 5558, the 
Prostate Cancer Prevention Act.
    This bill will reauthorize the expired CDC Prostate Cancer 
Research Prevention Program, and I want to thank my colleague 
Mr. Bobby Rush, who is chair of the Energy Subcommittee, for 
cosponsoring this important bill.
    I witnessed firsthand immense progress in the field of 
cancer treatment throughout my medical career and continue to 
be amazed at how far we have come.
    I am concerned over the impact of COVID-19, what it has had 
on the diagnosis, treatment, and outcomes of cancer. An 
essential aspect of success in the field of cancer is, of 
course, early and accurate detection of disease.
    Dr. DuBois, I have a question for you. You spoke during 
your testimony about the importance of cancer screening. I 
appreciated your comments regarding evaluating the whole 
picture of an individual's risk when considering cancer 
screening, and I believe that a strong doctor-patient 
relationship leads to this type of thoughtful risk assessment. 
Doctors should be looking at far more than just age and race 
when making determinations about risk, and physicians should be 
examining the full spectrum of risk, including life 
circumstances and whatnot when making screening 
recommendations.
    We should be empowered to make the most appropriate care 
recommendations for each of our patients. So Dr. DuBois, could 
you elaborate on your concerns regarding the Preventive 
Services Task Force reform and how to ensure that the task 
force is not impeding appropriate patient care decisions?
    Dr. DuBois. Well, thank you for the question. I think the 
task force has a, you know, sometimes a difficult task. They 
really are focused on looking at the whole population----
    Ms. Eshoo. We need you to speak up.
    Dr. DuBois. OK.
    Ms. Eshoo. We need you to speak--get closer to your 
microphone. Maybe raise your voice a little bit. We don't want 
to miss what you are saying.
    Mr. Guthrie. Thank you.
    Ms. Eshoo. Sure.
    Dr. DuBois. OK, so can you hear me now?
    Ms. Eshoo. Yes, it is better.
    Dr. DuBois. OK, sorry about that.
    You know, the task force looks at the whole population, and 
they calculate their risk and benefits of that screening and 
who would benefit from it and who would be harmed by it. It is 
really made up of individuals who are mostly public health 
experts, or epidemiology experts, and people like that. And it 
is--you know, it is sort of a formula that--examined.
    I think you are right in the sense of there are many other 
exposures and issues related to the hereditary issues. There is 
environmental exposures, there is secondhand smoke exposures, 
and all of those aren't considered in the calculation. So it is 
always important for patients to speak with their primary 
doctor, let them know if----
    Mr. Dunn. So--we are--our time grows short, Doctor, so I am 
just going to jump in with another question to you, and I 
encourage you, as Chairwoman Eshoo did, to turn up your 
microphone a little bit, because we--you are soft.
    So throughout the COVID-19 pandemic, the CDC has repeatedly 
released inconsistent guidance surrounding masking, testing, 
immunity, you know, just simple knowledge about the classroom 
policies, et cetera. Do you think the inconsistent messaging 
from public health agencies in general, but specifically 
regarding COVID-19, harms our Federal public health efforts 
regarding cancer screenings and credibility, moving forward?
    Dr. DuBois. Can you hear me better now?
    Mr. Dunn. A little. Go ahead.
    Dr. DuBois. Sorry about that. I am not sure what has 
happened to my----
    Mr. Dunn. The clock is running. Go ahead and answer.
    Dr. DuBois. Well, you know, the CDC, it is a tough 
situation. We--there has been a rapid development of agents for 
treating COVID patients and diagnosing them. And we have 
learned a lot in a very short time. So it is--you know, it has 
been a very difficult issue for the whole medical field to deal 
with.
    In terms of, you know, for cancer patients, which is my 
main focus, we are trying to get everybody vaccinated. We are 
trying to make sure that they are as protected as possible 
because of they're immune compromised from their treatment and 
from their disease.
    Mr. Dunn. Thank you. So I would summarize it--I think that 
credibility in cancer treatment also suffers from credibility 
in general public health announcements. And I suspect that you 
would agree with that.
    With that, Madam Chair, thank you, and I yield back.
    Ms. Eshoo. Thank you, Dr. Dunn. The Chair is pleased to 
recognize the gentleman from California, a special friend to 
me, Mr. Cardenas, for your 5 minutes of questions.
    Mr. Cardenas. Thank you very much, Madam Chairwoman, and 
also Ranking Member Guthrie, for having this very, very 
important hearing.
    And I want to thank all of my colleagues for the diligent 
effort that we have had in this discussion today, and the work 
that we have done leading to this day, and the work that we 
have yet to do to complete--to do the work that is demanded of 
us. I say that respectfully, ``demanded of us.'' And I want to 
give a special thank you to somebody that I love very dearly, 
my former colleague, Congressman Rick Nolan.
    It is just so wonderful to see you. You are one of the 
kindest individuals to ever serve in this House. And I miss you 
very much, and we are going to do everything that we can to 
keep your promise to your daughter and to all the people who 
deserve the best of us. The best of us.
    And we must keep in mind that what we do on this 
legislation, these pieces of legislation, not only will honor 
those who have passed, but it will, more importantly, honor 
those that will live because we have given them the opportunity 
to have the respect and the dignity that they deserve so that 
if, in fact, cancer comes their way, that they will survive. 
Because we are and shall be the greatest nation in the world, 
not by our military might, but by the care that we give to 
every human being that deserves the best of us. The best of us.
    I would like to start by thanking my colleague, 
Representative Bilirakis--Republican, by the way, and I am a 
Democrat. And together we introduced the bill which is H.R. 
455, and that bill actually is included--and I want to thank 
the chairwoman and the ranking member for doing so--and it is 
the Oral Health Literacy Act.
    Yes, oral health, something that is very important, 
something that has already been explained today that most 
Americans don't have access to, or don't afford themselves the 
opportunity to get that dental checkup, to be preventative 
about saving--yes, in some cases, actually saving their life by 
making sure that they get preventative care.
    This bipartisan bill will allow U.S. Health Resources and 
Services Administration, otherwise known as HRSA, to carry out 
a public education campaign to increase oral health literacy 
and awareness.
    Chairwoman Eshoo, I would like to request that we enter 
into the record at the end of this committee hearing a letter 
of support for this bill, H.R. 455, Oral Health--by the oral 
health professionals and stakeholders.
    Ms. Eshoo. So ordered.
    Mr. Cardenas. Thank you, Madam Chair.
    I am grateful again for the inclusion of this bill in this 
important hearing, and I hope to see it advance for the sake of 
all of us in this great country.
    Dr. Cassis, thank you again for being here, and I would 
like to ask you a question. Is there--when it comes to people 
in America not having true access to oral healthcare, is it 
only people who, for example, are homeless, or are there--does 
this include people who are working perhaps one, two, three 
jobs? Are people who are hardworking Americans, are they not 
having access to oral health?
    Dr. Cassis. Thank you for the question, Representative 
Cardenas. This----it is across the board. It has nothing to do 
with, you know, where you might live. It is definitely across 
the board.
    We have to do a better job of communicating the necessary 
appointments to safeguard their lives. As you said, there are 
people that die from dental disease and complications every 
day.
    Mr. Cardenas. So, Dr. Cassis, again, could you please help 
emphasize that--we are talking about many of these individuals 
are hardworking, full-time workers, people who are working full 
time, and they and their family members are--don't have true 
access to oral healthcare. Is that the case in America today?
    Dr. Cassis. It is, you are exactly right. There are--you 
know, they have to ration dental care out, just like they have 
to ration food at times. And, you know, it is not a pretty 
scene, but it is across the board.
    Mr. Cardenas. Yes, thank you. I wanted to emphasize that 
because I think in these hearings, when we talk about helping 
those who are less fortunate, a lot of people think that we are 
not talking about you, hardworking Americans. We are definitely 
talking about you, people who are holding down a full-time job, 
single moms. We are talking about you. That is who we are 
fighting for.
    And I see that my time has expired. Thank you very much, 
Madam Chairwoman, I yield back.
    Dr. Cassis. Thank you.
    Ms. Eshoo. The gentleman yields back. It is a pleasure to 
recognize one of the outstanding doctors that is a member of 
our subcommittee.
    Dr. Bucshon of Indiana, you are recognized for 5 minutes. 
Good to see you----
    Mr. Bucshon. Thank you, Madam Chairwoman, and I am sorry 
for not being here for a good part of the hearing, but I have 
read your testimony, and----
    Ms. Eshoo. Oh, Dr. Bucshon, can I just interrupt for a 
moment?
    Mr. Bucshon. You can.
    Ms. Eshoo. I--and I am not going to--I am not taking your 
time away. I have been asked to remind Members and witnesses 
that are not in the hearing room to turn off your mikes, mute 
them, because there is background noise on the live stream. We 
are not picking it up here, but evidently others are. OK? Thank 
you very much.
    And Dr. Bucshon, you are recognized for 5 minutes.
    Mr. Bucshon. Thank you, Madam Chairwoman.
    Mr. DuBois--is it ``Doo-Bois'' or ``Doo-Bwah''? I want to 
thank you for focusing in on the importance of preventive 
health and routine screenings, especially for cancer. As a 
doctor myself, I believe Congress can do better in promoting 
preventative healthcare--health.
    I also agree we need to encourage Americans to screen early 
and screen often for preventable diseases, especially now that 
so many are behind in their screenings due to the public health 
emergency.
    A growing concern I have regarding routine screenings is 
our ability to maintain timely access to quality cancer care in 
all settings. While many facilities are already facing 
physician shortages across the country, many are also facing 
the reality of having to scale back staff or, even worse, close 
due to looming reimbursement cuts that are facing--they are 
facing at the start of next year.
    Coupling the fee schedule cuts with the proposed update to 
the clinical labor component, some providers I talk to are 
facing up to 20 percent in cuts. This is especially true for 
radiation oncology.
    Mr. DuBois, what are the real-world implications of 
proposed policies like these, and do you think such drastic 
reimbursement cuts would disrupt access to quality cancer care?
    Dr. DuBois. Can you hear me OK now?
    Mr. Bucshon. Yes.
    Dr. DuBois. OK, I had to switch my microphone. I am sorry 
about that earlier.
    Well, those cuts are having impacts, and I know exactly 
what you are talking about. My focus on my testimony today was 
really on cancer prevention, but those changes in 
reimbursements for the radiation oncology and other services, 
you know, will have an adverse impact. I don't know the total 
extent of that, but clearly, we need to keep an eye on that and 
make sure that, you know, we can continue to support those 
individuals who are providing that essential care.
    Mr. Bucshon. Thank you very much. And earlier this Congress 
I joined my friend and colleague Congressman Rush in 
introducing the PSA Screening for HIM Act. This bill waives 
deductibles, copayments, and coinsurance for prostate cancer 
screenings for African-American men and men who have a family 
history of prostate cancer, as both of these patient 
populations have a much higher risk of prostate cancer. By 
encouraging early and routine screening, doctors will be able 
to catch the disease in its early and treatable stage, saving 
countless lives.
    Congress, I think, has a bad habit of looking at healthcare 
policies in a 10-year budget window, ignoring potential savings 
that accrue past the 10-year mark. So frequently that blocks 
healthcare policy, because it costs money in the short run, but 
in the long run, I would argue, saves not only lives, but 
money.
    Although many preventive care policies seem to cost--again, 
cost them on the front end, I think it is prudent for us, for 
the reasons I have explained, to look at these policies as they 
affect the entire lifespan of individuals.
    Mr. DuBois, how do screenings for early detection and 
preventive health measures lead not only to lives saved but 
also lower costs to the overall healthcare system?
    And how can we do better, as a country, in promoting and 
encouraging preventive health?
    Dr. DuBois. Well, thank you for that great question. You 
know, I have devoted my entire sort of career to cancer 
prevention and early detection, and the data is coming out now. 
Some very good studies have been done in colon and breast and 
other cancers. Clearly, when we can detect it early in the 
precancerous stage, or early while it still hasn't 
metastasized, the outcome is just tremendous. There is a much 
more longer term of life. There is, you know, the--if it can be 
removed early by surgery, there is a cure, a chance for a cure. 
So early detection definitely pays off. The health economic 
studies have been done. And the overall long-term impact is 
tremendous.
    So I agree with your statement. I think we need to focus 
more on disease prevention. It is something that we do in 
cardiovascular disease and other diseases, and cancer is 
something we just can't ignore.
    Mr. Bucshon. Do you think there are things--I mean, 
obviously, paying for preventative or early detection, things 
like--that we have started to do a number of years ago--for 
example, breast cancer screening, and screening--colonoscopy, 
for example, I mean, are there things we can still do better?
    Is it primarily just reimbursement, or are there other 
things the Federal Government can do more to encourage people 
to take advantage of preventive evaluations?
    Dr. DuBois. Well, I mentioned this in my testimony. There's 
definitely some underserved rural communities who don't have 
good health coverage and don't have access to this type of 
screening, and the outcomes are much worse in those 
populations. It is very clear.
    One thing that we have been doing here is sending out 
screening mobile units to these areas so that we can include 
those populations in that type of early screening.
    There is some very exciting research that is supported by 
the NCI that has developed a blood test for pan cancer testing. 
Cancer cells are released into the bloodstream, and this test 
can detect when they are present, and what tissue they came 
from. It is too early to deploy this clinically, but once those 
tests are validated and sensitive and specific enough, it could 
really change the way we do our early screening for all cancer 
patients.
    Mr. Bucshon. Thank you, Madam Chairwoman. I yield back.
    Ms. Eshoo. The gentleman yields back. The Chair is pleased 
to recognize the gentlewoman from New Hampshire, Ms. Kuster, to 
be followed by the gentleman from Missouri, Mr. Long.
    Annie, you are on.
    Ms. Kuster. Thank you so much, Madam Chair. This is a very 
important discussion, and I want to thank the witnesses, 
especially my very, very dear friend and colleague, Rick Nolan, 
for joining us here today.
    While this committee has been keenly focused on the COVID-
19 pandemic, we must continue to support and invest in programs 
that protect our children and families. We have all heard the 
startling statistics of delays in routine healthcare during 
COVID, and there are simply too many Americans--including, I 
might add, my own brother--who recently postponed screenings 
and surgeries, only to later discover they may have much more 
serious healthcare conditions.
    We have also discussed in the Oversight and Investigation 
Subcommittee the enormous impact the pandemic is having on our 
children, and I recently raised the issue with--of adolescent 
mental health during a visit to Mountain Valley Treatment 
Center in my district in Plainfield, New Hampshire. It was 
incredible to hear directly from these teens about the mental 
health challenges that they are facing, and I am pleased that 
today's hearing includes the CAMRA Act, which would have the 
National Institutes of Health research the effects of 
technology and media on infants, children, and adolescent 
health and development.
    We need to better understand the effects of digital media 
on our children's well-being, and I am a proud cosponsor of 
this legislation as well as the CAROL Act, which would expand 
research on valvular heart disease and treatment. Many 
Americans, particularly women, suffer from valvular heart 
disease, and they do not know that they are at serious risk. So 
we need better public health outreach and data to address the 
gaps in understanding, especially for women, people of color, 
and those living in rural areas like my district.
    Dr. Jones, could you elaborate on how valvular heart 
disease and its related complications, despite requiring 
minimal intervention, can become fatal?
    Dr. Lloyd-Jones. Certainly. Thank you so much, 
Congresswoman.
    So we are talking today really about chronic valvular heart 
diseases, and they come in two subtypes. There is either 
narrowing or scarring of a valve we call stenosis, or there is 
leakiness of a valve we call regurgitation. But really, at the 
end of the day, both of these lead to a kind of a final common 
pathway, where the heart tends to enlarge, the pump weakens, 
and that leads to the development of heart failure symptoms: 
congestion, development of shortness of breath, retention, and 
fluid. And when severe enough, that leads to rhythm 
disturbances that can cause sudden cardiac death.
    So because of these processes, it is incredibly important, 
just as with cancer, that we catch these processes early, and 
that really requires routine screening--again with the 
stethoscope. But also, if there is any suspicion of a valvular 
heart problem, that we do echocardiography or ultrasound to be 
able to detect both the presence and the severity of valvular 
heart disease.
    Ms. Kuster. And what role do health disparities due to 
gender, race, or socioeconomic status play in increasing the 
risk for fatal heart valvular disease?
    Dr. Lloyd-Jones. Well, there are really no known major 
genetic or sociocultural differences that sort of lead to 
disparities. So I will come back to the issues of--really, of 
access to healthcare.
    It is really that access problem that means people are 
getting diagnosed only when they have symptoms, after the heart 
has been damaged too significantly to actually be able to 
reverse that damage and avoid some of the complications and, 
potentially, deaths that are related to it.
    So much of what drives those disparities is the underlying 
risk factors for heart disease: high blood pressure, diabetes, 
cholesterol problems, and smoking. So if we can address those 
things, those upstream determinants, it will also help with 
valvular heart disease, as well. But of course, there are major 
health disparities in all of those things, as well.
    Ms. Kuster. And is there a factor related to gender? I know 
that women seem to be particularly at risk.
    Dr. Lloyd-Jones. Yes, there are some issues with gender 
related to valvular heart disease and also in some of the 
consequences, like sudden cardiac death, where women may be 
more susceptible. So, you know, I think that encouraging women 
to get this as part of their routine screening, make sure that 
someone is paying attention to their heart and their heart 
valve, is incredibly important.
    We know that only recently fewer women now are dying of 
heart disease than men, but still far too many, and over 
400,000 women per year dying of heart disease. Much of that, 80 
to 90 percent, would be preventable with good, routine 
screening and care.
    Ms. Kuster. So I will just close by saying that is why it 
is so important for us to provide access to affordable 
healthcare to every American, including those in States like 
Florida and Texas, large States with large populations that did 
not increase their rolls under the Medicaid expansion. And that 
is why we want to include that in the Build Back Better.
    So I thank you, and I yield back.
    Ms. Eshoo. The gentlewoman--let's see. Oh, the Chair is 
pleased to recognize the very patient, wonderful Member from 
Missouri, Mr. Long, for your 5 minutes of questions.
    Mr. Long. Thank you, Madam Chair.
    And Rick, I would like to start with you. Are you familiar 
with Philip Francis Thomas?
    Mr. Nolan. With who?
    Mr. Long. Philip Francis Thomas.
    Mr. Nolan. No, I am not.
    Mr. Long. Philip Francis Thomas was a congressman in 
Washington, DC, and he had a small gap in his service of 34 
years, from 1841 to 1875, 34 years. So he is number one. Who 
would you think number two is that had a 32-year gap in their 
service in Congress?
    Mr. Nolan. Yes, mine was 32 years.
    Mr. Long. Huh?
    Mr. Nolan. Mine--my gap was----
    Mr. Long. Can you take your mask off, so I can see what you 
are saying?
    Mr. Nolan. I guess I am number two, huh?
    Mr. Long. Yes, but--yes, I just wanted to point that out to 
the folks that are seeing this, that you were in Congress and 
then had a little minor 32-year gap and came back to Congress 
the same year that I came in. And it is very good to see you 
again.
    Mr. Nolan. Oh, thank you. I enjoyed serving with you. It 
was great.
    Mr. Long. And this is a very important hearing that we are 
having here today.
    And particularly near and dear to my heart, our youngest 
daughter was diagnosed with Hodgkin's lymphoma 6\1/2\, 7 years 
ago, and we thought we were going to lose her, knew nothing 
about the disease, and I couldn't talk to anybody, I couldn't 
pick up the phone, I couldn't talk to friend or foe for a 
couple of weeks when she was first diagnosed. And I am proud to 
report that she is 6 years past her last chemo treatment, 
actually got married last October. And so this is--and then our 
older daughter is a pediatrician, so she deals with a lot of 
these situations, especially on the children and things.
    And I am also a member of the Black Maternal Mortality 
Caucus. We had one of the most heart-wrenching testimonies ever 
delivered in this hearing room a couple of years ago by a 
fellow that lost his wife during a pre-planned C-section. And 
they just--she was having issues, and they actually came in and 
told her that she was not a priority, and he was begging for 
her life for a 16-, 18-hour period, and she deceased with her 
second child, like I said, in a planned C-section. So I know 
what the mortality rate is like with Black women, and it is not 
acceptable, and I hope to be able to do something. And I have 
been on that caucus for a couple of years now.
    Dr. Lloyd-Jones, there is really an untold story about how 
COVID took a toll on people, and it is not always reflected in 
the numbers. COVID and shutdowns disrupted normal healthcare 
for months, and many people were simply not able to receive 
normal treatments. If it was a noncritical treatment or if it 
was a routine procedure, the hospitals were not allowed to do 
it. And sadly, that adversely affected Andy Barr's family, his 
wife, Carol, who we have been talking about here today.
    She--I was on the House floor one day, and Andy came up to 
me, and he had his cell phone out, and he said, ``Read this, 
Billy, read this,'' and it--he had just received the notes from 
his wife's doctor. He came home--37 years old, I believe she 
was 37, 39--and was deceased after he came home from a meeting. 
And two beautiful young daughters that Andy is raising now. But 
he said, ``Read this,'' and I read his cell phone, and it was 
the notes his doctor had written, and they said that ``echo 
after virus subsides.''
    Well, the virus didn't subside, and Carol subsided before--
so they couldn't do an echocardiogram because it was not 
considered a critical procedure that would have probably, most 
likely, have saved her life. And so I am a proud cosponsor of 
the CAROL Act introduced by Andy Barr, my buddy from Kentucky.
    And Dr. Lloyd-Jones, we still don't know a lot about heart 
valve disease causes and the factors that increase risk for 
sudden cardiac death. Obviously, that is the reason why this 
bill is so important. Can you talk about the workshop that this 
bill creates, what its goals are, and how the findings of the 
workshop are translated to results at the National Institute of 
Health and the National Heart, Lung, and Blood Institute?
    Dr. Lloyd-Jones. Thank you, Congressman, and thank you for 
sharing that story. I think it is tragic, and really important 
that we get our patients back into care as quickly as possible.
    So that NIH uses workshops as very important fact-finding 
opportunities. And I have been a member of a number of these 
for the NHLBI. But it is really an opportunity to bring 
together experts in the field, researchers, even industry and 
other public-private partners, to make sure we understand all 
aspects of a situation, and that then NHLBI can use--or NIH can 
use--that information to actually design calls for research and 
grant applications so that we are really targeting the most 
important aspects of whatever the disease of interest is.
    In this case, you are absolutely right. We need to know 
much more about the causes, the reasons for progression, and 
the link to sudden cardiac death related to valvular heart 
disease.
    Mr. Long. OK, thank you. And unfortunately, I am out of 
time with all my gift of gab beforehand.
    So Madam Chair, I yield back.
    Ms. Eshoo. And we enjoy all of it, Mr. Long. You add a 
great deal of interest to our committee. You really do.
    The Chair is pleased to recognize the gentlewoman from 
Illinois, Ms. Kelly, for her 5 minutes of questions.
    Ms. Kelly. Thank you, Chairwoman Eshoo and Ranking Member 
Guthrie, for holding this important hearing. Today we are 
focusing on legislation that impacts a wide range of diseases.
    While it is important to increase research funding for 
cancer and other diseases to identify new treatments, we also 
need to ensure that clinical trials are reflective of racial 
disparities and disease. According to the Prostate Cancer 
Foundation, Black men are 75 percent more likely to develop 
prostate cancer and more than twice as likely to die of it, 
compared to other racial groups. Yet, according to the NIH, the 
median percentage of Black participants in prostate cancer 
clinical trials funded in fiscal year 2018 was only 8 percent.
    Dr. DuBois, how can public research funders such as the NIH 
hold clinical trial sponsors accountable for increasing the 
diversity in clinical trials?
    Dr. DuBois. Thank you for that question. Can you hear me 
OK?
    Ms. Kelly. Yes.
    Dr. DuBois. Good. Well, this is a big problem. And one of 
the things the NIH has done through the NCI is to establish 
these community oncology outreach efforts, where we have 
community oncology groups that actually do participate in 
clinical trials.
    We have five of these sites in South Carolina, and that--if 
we have those trials available in the communities where most of 
these people live, there is a much higher likelihood that they 
are going to participate. And so we have been able to increase 
the percentage of minorities in many of the trials, and it is 
really in the outreach effort that we are doing in those local 
communities.
    I think we really need to--program, because we are also 
missing out on other community groups that--where patients just 
can't get to major urban areas where a lot of those trials are 
being held. And the--so I think more support for this program 
would be wonderful and improve participation from those groups.
    Ms. Kelly. Thank you. Would there be any benefit to 
empowering NIH with greater authority to work with clinical 
trial sponsors to establish clear, measurable diversity goals 
in the funding application?
    Dr. DuBois. I think that is a great idea. And, you know, 
they do look at that in some applications. It is not as--
probably as stringent as it should be. But I think that that is 
something that could be [audio malfunction].
    Ms. Kelly. Thank you. We do need to increase accountability 
to make sure that all clinical trials are--racial and ethnic 
disparities and diseases. This is why I am working on a 
clinical trial diversity bill with my E&C colleagues 
Representative Cardenas, Butterfield, and Clark. And we look 
forward to working with the committee to advance this important 
issue.
    Ms. Stewart, good to see you. In your statement you 
mentioned the importance of increasing access to prenatal and 
postpartum care. Can you speak to the role that extending 
Medicaid postpartum coverage to 1 year can play in reducing 
racial disparities in maternal health outcomes?
    Ms. Stewart. Good to see you, Congresswoman. Yes, we have 
been a big advocate of extending Medicaid postpartum at least 
12 months. It is--we have made some progress towards that, 
where it is now an option for some States to do that. But we 
feel it shouldn't be an option, it should be mandatory.
    And the reason for that is because, when you look at 
maternal deaths, between pregnancy at the time of childbirth 
and then after childbirth, about a third of all maternal deaths 
happen in that stage 1 week beyond when the baby is born out to 
1 year. And that is when women need care just as much as they 
do when they are pregnant, just as much as they do when they 
are delivering their baby.
    We know that a lot of women are suffering with mental 
health challenges. They may have extenuating health challenges 
that may have developed during pregnancy or at the time of 
childbirth, and they need to be seen by a care provider. And 
because Medicaid covers 40 percent of all the births in the 
country and because so many women of color are a part of that 
coverage, we know that it can go a long way to helping to 
eliminate and reduce the disparities that we see between Black 
maternal health, Brown maternal health, and other groups, as 
well.
    Ms. Kelly. Well, I would like to thank you and commend the 
March of Dimes for your work to address maternal mortality. And 
you know that I am out here fighting to do exactly what you 
said is needed. So thank you so much, and I yield back.
    Ms. Eshoo. The gentlewoman yields back. It is a pleasure to 
recognize the gentleman from Oklahoma, Mr. Mullin. And then, 
coming up, followed by Blunt Rochester from Delaware, followed 
by Mr. Carter from Georgia. I think that is the lineup. I know 
that we have votes scheduled, I think, at about 1:45. So let's 
see if we can make it before the votes are called, OK?
    So Mr. Mullin.
    Mr. Mullin. Thank you, Ms. Chairwoman, I appreciate it, and 
thank you for holding this hearing.
    Ms. Stewart, with the United States ranked 25th in the 
number of stillbirths per capita, why do you think these rates 
remain unchanged despite medical innovations?
    And what interventions do you think other countries have 
done that we aren't that has lowered their stillbirth rates?
    Ms. Stewart. Thank you, Congressman. I think it is a very 
good question.
    I mean, yes, we have seen stillborn rates where, today, 
24,000 babies by--die as a result of stillbirth. And that rate 
has--that number has not really improved. In fact, when you 
look at other countries, we are ranked 183rd out of 195 
countries, in terms of reduction of stillbirth rates over the 
last two decades. So we have a lot of work to do.
    When you look at other countries, they have implemented 
successfully--for example, in Australia--some impressive care 
bundles that look at issues around early detection of fetal 
growth restriction, smoking cessation--which we actually do 
focus on a lot in this country--decreased fetal movement, safe 
sleeping practices for moms, some side sleeping practices, 
making sure that babies are avoiding early C-sections so that 
they are not born early.
    You know, one of the things that we have to do is just have 
a more comprehensive approach to maternal care, and I think a 
lot of the gaps in our system of care, again, these maternal 
care deserts that I talked about, the lack of access to care, 
if you don't have insurance, or if you just don't even live 
near a care provider are all contributing to the high rates of 
stillbirth. And because we have not made comprehensive 
improvements in maternal care in this country is also why we 
have not seen much improvement in stillbirth. Even though we 
have seen increases in NICU care, where we have seen technology 
and medical care actually extend life, a baby's, in the NICU, 
we have not seen that same kind of advancement with stillbirth.
    Mr. Mullin. Thank you. How important is adequate data, 
then, to fight this, to fight against stillbirths?
    Ms. Stewart. Sorry, I just want to make sure--how important 
is adequate----
    Mr. Mullin. Yes, when you start looking at data, what is--
what do you feel about----
    Ms. Stewart. Yes.
    Mr. Mullin. I mean, there doesn't seem to be----
    Ms. Stewart. Yes.
    Mr. Mullin [continuing]. That good of information out there 
when we start talking about data. And so, when we are looking 
at fighting the stillbirth--I would almost say a pandemic, but 
it is not really, but, you know, the serious issues we are 
dealing with there, when we are looking at it, how important is 
that data?
    Ms. Stewart. So it is really important.
    One of the things that we know, when a stillbirth occurs, 
is that it may be noted on the death certificate, but that 
doesn't explain the full reason, or the----
    Mr. Mullin. Right.
    Ms. Stewart [continuing]. All of the underlying issues that 
may have led to the stillbirth.
    And in fact, some tests that would determine that actually 
are made available sometimes weeks after the death certificate 
is actually filed. And so we haven't been actually collecting 
all of the best data around stillbirth.
    And so what the SHINE for Autumn Act will hopefully do is 
to provide more resources so that we can do a much better job 
of research and data collection to understand, first, the 
underlying causes of stillbirth, which we need to do more of 
that around preterm birth and miscarriage and all of that, as 
well, but also better data collection around stillbirth so we 
can design better interventions.
    We saw this same kind of progress made that we made with 
maternal mortality when we--when Congress passed legislation 
that would allow for maternal mortality review committees. 
Collecting better data allowed us to identify better underlying 
causes of maternal death, leading to better interventions. The 
same needs to be true for stillbirth, as well, and that is what 
we hope the SHINE for Autumn Act will do.
    Mr. Mullin. Well, thank you. Thank you so much, because you 
answered all my other questions while you were answering that 
question, and I really appreciate it.
    In closing, I just want to second what Mr. Butterfield said 
earlier. He made a suggestion that we look at the Better Wound 
Care Act at home, and maybe look at doing an upcoming hearing 
on this. I, Madam Chair, I would like to say I would like to 
second that, because it is an important policy that is good for 
patients. And hopefully, I look forward to advancing this 
through our--through the committee.
    With that, I yield back.
    Ms. Eshoo. Thank you, Mr. Mullin. So noted. Thank you.
    The Chair now recognizes the gentleman from California, Dr. 
Ruiz, for his 5 minutes of questions.
    Mr. Ruiz. Thank you. Thank you very much. This is a very 
important hearing.
    The COVID-19 pandemic has illuminated health equity issues 
that we have long known to be the norm in the United States. 
One disease that continues to disproportionately impact 
minorities or--is cancer, with unacceptably high death rates 
and unequal late-stage diagnoses.
    New multicancer early detection tests and development have 
the potential to detect many cancers simultaneously, including 
cancers without screening tests today and those that 
disproportionately impact underserved populations.
    While access barriers to healthcare services including 
prevention have improved over time, there is still much work to 
do. Technologies like multicancer early detection tests could 
reduce late-stage diagnoses by catching cancers earlier and 
saving lives. That is why I have joined my colleague, 
Congresswoman Sewell, to introduce H.R. 1946, the Medicare 
Multi-Cancer Early Detection Screening Coverage Act, which 
would provide a possible future pathway for Medicare coverage 
of these lifesaving technologies.
    While this bill is not under consideration today, I urge 
the committee to consider advancing this bill, supported by a 
consensus of cancer care stakeholders and over 90 bipartisan 
Members.
    So now onto the legislation at hand. Oral health is 
physical health, but too often people neglect their oral 
health, whether that is because they don't have access to a 
provider or because they can't afford to see a dentist or 
because they don't realize how critical oral health is. That is 
why I really want to highlight the bill introduced by my 
colleagues Mr. Cardenas and Bilirakis, the Oral Health Literacy 
and Awareness Act of 2021, which will increase public education 
for oral health literacy and awareness.
    We know that there are oral health disparities by race and 
by income. According to the CDC, for children aged 12 to 19, 
nearly 70 percent of Mexican-American children have had 
cavities in their permanent teeth, compared with 54 percent of 
non-Hispanic White children. So for that same age group, 23 
percent of children from lower-income families have untreated 
cavities in their permanent teeth, twice that of children from 
higher-income households.
    So, Dr. Cassis, can you speak to some of the disparities 
that exist in oral health and how this bill might help address 
those disparities?
    Dr. Cassis. The bill helps in educating. We are so far 
behind in how we communicate with minorities and, really, 
everybody.
    I would like to point out that, prepandemic, the--dentistry 
was in a good place. You know, we have the best infection 
control ever, since the 1980s. And after our mandatory 
shutdown, we came back busier than ever, and it hasn't let up. 
And what I would like to tell the whole community is that we 
see more minorities or underprivileged patients now than we 
ever have. So some of that has come out that, you know, it is 
safe to go to the dentist. And I would tell you, absolutely, if 
you are following the OSHA guidelines, we are in a great 
position for that.
    However, the bill itself will go so far into getting more 
minorities into the dental offices around the country. It is 
something I would highly endorse, and would beg the committee 
to consider keeping that funding in place.
    Mr. Ruiz. In addition to that we need more dental offices 
in minority communities, or in the medically underserved areas 
of our country. There is--so, you know, it is--this is one 
piece of a larger puzzle, a very important piece.
    Dr. Cassis. Yes.
    Mr. Ruiz. If there is a cost-effective way of improving 
health, it is to increase health literacy. In this case, 
increasing oral health literacy is vital, and very important in 
people to understand not only just the importance but the 
practical way to care for their oral health and to really make 
that association that your oral health is--has a direct 
connection to your cardiac health. It has a direct connection 
to your other systems, organ systems. And so that is why it is 
so important to really put that in the forefront, as well.
    So with that, I yield back my time, and I thank you for 
your work and bringing attention to this.
    And again, I thank my colleagues Congressmen Cardenas and 
Bilirakis for putting this bill forward.
    Ms. Eshoo. The gentleman yields back. The Chair is pleased 
to recognize the gentleman from Georgia, Mr. Carter, for your 5 
minutes of questions.
    Mr. Carter. Thank you, and thank all of you for being here.
    Congressman, good to see you.
    I wanted to ask Dr. Radesky and Ms. Stewart--I will ask you 
separately. But first of all, let me say, as you all know, the 
National Center on Birth Defects and Developmental 
Disabilities, this Center works to detect, to prevent, and also 
to research birth defects and intellectual disabilities. And 
that is why I feel like it is crucial that we work and pass my 
legislation that we are discussing today, the Improving the 
Health of Children Act. This would reauthorize the Center for 
the first time since 2007, and I think it is extremely 
important that they would--that we do that.
    Ms. Stewart, I will ask you first, why is it so important 
to have early diagnosis for birth defects and intellectual 
disabilities?
    Ms. Stewart. Thank you, Congressman. Well, birth defects 
are common, and they are also costly, and it is critical that 
we provide early detection and early treatment for babies.
    We have been a strong advocate at March of Dimes for 
newborn screening for many, many years, and we have been 
working in partnership with the National Center on a lot of 
these issues around birth defects. There are close to 8 million 
babies worldwide that suffer from a serious birth defect, and 
more than 3 million of them die before the age of 5.
    So--and there are a range of different birth defects that 
babies are sometimes dealing with in newborn babies, and the 
screening has to happen very, very, very quickly, in many 
cases.
    Developmental disabilities, as you mentioned, around 
autism. The Center has done an amazing job to really advance 
the research around the causes of autism, as an example.
    Many families that suffer with blood disorders, especially, 
for example, in the African-American community around sickle 
cell, the Center has done an incredible job of advancing 
success there.
    And then it is not just babies with disabilities. When we 
identify those disabilities early in life, people are then 
dealing with those disabilities over a long period of time. And 
so the Center has also been there to make sure that healthcare 
and programs are available for people to sustain them, to keep 
them active in life, and providing the care that they need to 
have an improved quality of life over a long period of time.
    Mr. Carter. Right. So you would agree the Center does need 
to be reauthorized?
    Ms. Stewart. Oh, no question about it.
    Mr. Carter. OK. Dr. Radesky, let me ask you. The Center 
itself, do you feel like parents of newborns and--with 
disabilities have easy and readily accessible access to the 
resources of the Center?
    Dr. Radesky. You know, I am not sure I am qualified to 
answer that question. I can speak to my clinical experience 
with--families of children with developmental disabilities in 
general find it very challenging to access resources throughout 
the community, whether provided through private or public 
sources. I just think--I don't know specifically about the 
Center in question.
    Mr. Carter. But you are saying your experiences are that, 
in general, there is a problem with accessing any of the 
centers, or any of the available options for these parents?
    Dr. Radesky. It varies, depending on the family's health 
insurance and what is authorized in terms of treatments for 
things like autism or other developmental delays.
    Another factor is socioeconomic status or health literacy 
and other material hardships that impact a family's ability to, 
say, get transportation for early intervention for therapies.
    And also, just the fact that it is intimidating to 
coordinate and navigate all of these different therapies for 
your child, that I think some families feel very engaged and 
activated for, and other families find it confusing, 
overwhelming, and have a hard time engaging.
    Mr. Carter. Well, I appreciate your input on that, because 
I consider you to be boots on the ground, if you will.
    And Ms. Stewart, what can we do to improve this? What do 
you think the solution is, with the situation like she is 
describing?
    Ms. Stewart. Well, I think she is right in that every State 
it varies and every community varies, in terms of the access of 
actual resources on the ground. I think what she is referring 
to are followup with experts and with specialists and others 
who can help in addressing those developmental disabilities. So 
there is a range of care.
    What the Center really does is help to provide a lot of the 
surveillance and the data collection and the understanding of 
what kinds of birth defects and other kinds of health issues 
can be--that can be screened at the time of birth. But there 
has to be a better way of connecting that to the healthcare 
system and more resources, especially in low-resource 
communities, so that it can access the care that they need, 
whether that is at home or----
    Mr. Carter. So how do you do that? I mean, do you educate 
the caregivers? Do you educate the--not caregivers, but the 
healthcare professionals, the doctors and the nurses?
    Ms. Stewart. I think it is not only them, but you have to 
educate family members and you have to educate community 
members, school members. A lot of people don't know how to 
address these special needs, and without the level of awareness 
and the education that is needed--and, frankly, the funding 
that many families need if they don't have access to high-
quality healthcare--they need additional resources to access 
the care that they may be looking for.
    Mr. Carter. Great. My time has expired. Thank you all for 
being here today, and I yield back.
    Ms. Eshoo. The gentleman yields back.
    Now I need some assist from our staff, because we have a 
series of eight votes that are on the floor right now. Should 
we take a----
    Voice. So take Ms. Barragan and go into recess.
    Ms. Eshoo. OK, so the Chair is going to recognize the 
gentlewoman from California, Ms. Barragan, for her 5 minutes of 
questions. Then we will recess and, I think, have someone 
else--will someone--oh, we are going to have to recess because 
of eight votes on the floor, and there are still Members that 
are--that haven't had the----
    Voice. So we will take a 2-hour.
    Ms. Eshoo. We are going to take a 2-hour break. You 
probably--all the witnesses need a break. I am sorry that we 
have to do it this way, but it is a compliment to each one of 
you that we have had such wonderful participation of committee 
members today, and that is what we want.
    So let's hear from or recognize the gentlewoman from 
California, Ms. Barragan, for your 5 minutes of questions, and 
then we will recess.
    Ms. Barragan. Thank you, Chairwoman Eshoo, for holding this 
important hearing today on legislation that will advance 
scientific research, improve our public health system, and 
expand access to care for so many families across the Nation.
    Maternal mental health conditions are a significant barrier 
for the health and well-being of women. In my home State of 
California, one in five California women suffer from 
depression, anxiety, or both while pregnant or after giving 
birth. Despite this high prevalence, 75 percent of impacted 
mothers never receive treatment.
    In addition, Black mothers are twice--two times more 
likely, and Latina mothers are 1\1/2\ times more likely than 
White mothers to develop depression during and after pregnancy.
    Ms. Stewart, how should maternity care, mental healthcare, 
and pediatric health systems work together to ensure the health 
and well-being of both the mother and child?
    Ms. Stewart. Thank you, Congresswoman. And the fact that we 
pay so much attention to maternal healthcare from a physical 
point of view really doesn't give the most attention that we 
need to pay to maternal mental health, which are the issues 
that you are dealing--that you are addressing and you are 
raising, and we are grateful that you are, and your leadership 
on these issues.
    Maternal mental health challenges are some of the biggest 
challenges that many women face during pregnancy and after 
pregnancy. We know very, very much the issues of postpartum 
depression. A lot of people don't know--again, I think I 
mentioned earlier--that maternal mental health is often one of 
the leading causes of death for women between--after giving 
birth to their child.
    And we are grateful that there have been some expanded 
resources. For example, there is now a maternal mental health 
hotline that the March of Dimes advocated for. The grant was 
just awarded by HRSA. That is a huge step forward, but we need 
to do more.
    We have been strong--given a strong endorsement for the 
creation of a Federal task force on maternal mental health 
through the Triumph for New Moms Act of 2021.
    We also are very supportive in the Momnibus of the Moms 
Matter Act, which is currently being reviewed by this 
committee, and it would also invest critical resources in 
maternal mental health, as well.
    So one of the things that you mentioned is how stress and 
anxiety have an impact on maternal health outcomes and birth 
outcomes. That is especially true in communities of color that 
are dealing with the issues of stress and anxiety, often 
brought on by the racism and discrimination that they 
experience in their own lives, especially in the course of 
bringing a baby into the world. So the issue of focusing on 
maternal mental health is really critical, and we strongly 
support all the efforts to improve and create more resources to 
address the issue, especially for women of color.
    Ms. Barragan. Well, thank you, Ms. Stewart, for your 
important testimony on this subject, for mentioning my bill. 
Certainly, given the significant impact of our families, I hope 
that the committee will consider my bipartisan Triumph for New 
Moms Act and other maternal mental health bills in the near 
future.
    Ms. Stewart, this next question is also for you. Lead in 
older homes remains a persistent problem for families across 
South Los Angeles. Roughly 2,000 children are diagnosed with 
unsafe levels of lead in their blood each year in Los Angeles 
County alone, particularly for communities of color, where 
costs are a major barrier to access healthcare. Families are 
often unaware their homes could be a source of lead until the 
children are tested.
    Ms. Stewart, oftentimes Federal outreach and education 
programs use language that is overly technical, or does not 
resonate with the intended audience. Can you discuss why a 
Federal advisory committee on childhood lead poisoning should 
provide culturally and linguistically appropriate outreach to 
communities of color to reduce the risk of childhood lead 
poisoning?
    Ms. Stewart. Well, thank you, and I am aware of the recent 
issues in communities of color in Los Angeles with respect to--
especially in the southern part of the city, with respect to 
children being--testing positive for high blood levels. And it 
just reinforces the importance of passing the Lead Poisoning 
Prevention Act to invest more in resources and education 
outreach, referrals, and screenings for children that are 
testing positive for lead in their blood.
    It is also really important--and we have seen this in the 
pandemic--that the way in which we provide information to 
communities of color has to be culturally appropriate. It has 
to be done in conjunction with those communities, so that it 
addresses language barriers, it addresses other barriers, and 
it especially addresses the trust barriers that exist in 
communities of color, as well.
    So we would strongly recommend that all of the education 
outreach that happens be done in conjunction with those 
communities, so that communities can receive it, understand how 
to use that information, and appropriately address the needs 
that their children may be having, especially if they are 
affected by high blood levels of lead.
    Ms. Barragan. Thank you, Ms. Stewart----
    Ms. Eshoo. The gentlewoman's time has expired, and your 
comments about your legislation, so noted----
    Ms. Barragan. Thank you.
    Ms. Eshoo [continuing]. Congresswoman Barragan. I am going 
to stay, because Mr. Curtis has been here since the beginning 
of the hearing this morning, and I want to call on him for his 
5 minutes of questions, and then we will take a break.
    Mr. Curtis, thank you for your patience and being here for 
the entirety, and you are on.
    Mr. Curtis. Madam Chair, you are too gracious, and I will 
go quick, because we don't want you to miss the vote.
    Ms. Eshoo. No, that is--go ahead. We will make it.
    Mr. Curtis. And to our witnesses, we will all shorten our 
answers, if we can do this quickly.
    First of all, Madam Chair, thank you. It has been clear 
that this is an important hearing. I would just point out I do 
have a bill. It is the Fix Nondisclosure in Health Research Act 
that I hope we can include in future hearings. I would have 
loved it to be included in this.
    In short, it requires the NIH to report to Congress on 
funded research grantees that have ties to foreign governments.
    Ms. Stewart, maternal healthcare is important, and it is a 
priority for me, as for so many here, specifically helping moms 
who are also suffering from substance use disorder. And I heard 
you talk about a number of conditions, but if maybe we could 
just touch on that one just a minute, I authorized legislation 
that required the Centers for Disease Control and Prevention to 
study the causes of opioid substance use disorder in pregnant 
and postpartum women, and that was the Poppy Seed Act.
    Have we improved outcomes for those expecting mothers and 
postpartum moms dealing with substance abuse disorders?
    Ms. Stewart. Well, I think there is, you know--obviously, 
the opioid crisis has had a severe impact on maternal health 
outcomes, infant health outcomes. You know, we have seen a 
dramatic increase in the number of babies that are affected by 
Neonatal Abstinence Syndrome. It is really a huge issue that we 
are facing.
    We have been a strong supporter of making sure, one, that 
we don't penalize women who are suffering from substance use 
disorder, that we find them treatment if they are pregnant or 
if they are a new mom, and also making sure that we identify 
those babies who are suffering from NAS and really need 
additional treatment, as well.
    Mr. Curtis. You think the pandemic has hurt our efforts? 
And is there anything specifically you can think of that you 
would like Congress to do?
    Ms. Stewart. I think there is no question the pandemic has 
created even more of a stress on the system with respect to 
mental health overall, and that has shown up in the ways in 
which the opioid crisis, even though we aren't--we are not 
paying attention to it as much as we are the pandemic, it is 
still raging in this country, and it is affecting many, many 
families. It is affecting pregnant women.
    We strongly advocate to do more to make sure that women are 
able to get the treatment and the help they need as soon as 
they are able to, that they are able to stay in treatment, 
because it is going to protect their lives and their babies, as 
well.
    Mr. Curtis. Thank you very much. Quickly, Dr. Jones, I am 
curious if we should be looking at preventive measures in 
addition to the steps you outlined in your testimony to reduce 
chronic heart disease in the United States. For example, I 
introduced legislation that would make it easier for small 
group plans and individual marketplace plans to invest in 
social determinants of health services, including offering, for 
instance, gym memberships as a benefit.
    Could you quickly explain if this would be helpful in 
addressing some of these chronic conditions?
    Dr. Lloyd-Jones. Yes, absolutely. As you are implying, you 
know, cardiovascular disease remains our leading cause of death 
and disability, not only in this country but across the globe. 
And we know what causes 90 percent of heart disease and stroke, 
and that is the traditional risk factors of cholesterol, blood 
pressure, diabetes, smoking, overweight, and all the things 
that actually happen up upstream, those social determinants of 
health that are the causes of the causes.
    And so it is really critical that we apply all of our 
knowledge about improving social conditions, economic things, 
education, social and community context, and especially 
healthcare, so that people have access to all of the tools that 
we know can prevent cardiovascular diseases and stroke.
    So amen to what you said. We need to do a much, much better 
job focusing on prevention. And in fact, it touches on some of 
these other things. If we improve the cardiovascular health of 
our population, we see dramatically lower rates of cancer, we 
see much healthier mothers heading into pregnancy who don't 
deliver, unfortunately, either stillbirths or, you know, have 
adverse pregnancy outcomes or have children who start off on 
less healthy trajectories. So this is really the key to driving 
towards a healthier population. So very much support anything 
we can do in this regard.
    Mr. Curtis. Thank you. The Chair has slipped out. I would 
like to thank her, even though she is not here, for extending 
this for a few minutes, and I appreciate everybody's patience 
and quick answers. Madam, I yield my time.
    Ms. Schrier [presiding]. The gentleman yields. I will now 
recognize myself for 5 minutes.
    Thank you to all the witnesses who are here today for 
hanging in there, and I want to thank the chairwoman, who I am 
replacing for the moment, for this focus on children and 
families.
    There's two bills that I would like to speak on today, and 
the first is the Gabriella Miller Kids First Research Act 2.0.
    And Mr. and Mrs. Miller, I just want to thank you for being 
here today. Your experience with Gabriella is, sadly, one that 
far too many other heartbroken parents have also experienced, 
as you said in your testimony.
    And just yesterday I spoke with the mother of a little girl 
named Danica, who was diagnosed with a brain tumor at age 21 
months. And she died, sadly, last year, at just 5 years old. 
And her mom, as she told me her tragic story and the family's 
tragic story, I thought about so many children with cancer who 
I have taken care of over 20 years as a pediatrician, and it is 
because of them and Danica that I so strongly support this 
legislation that will increase funding for pediatric cancer and 
rare disease research.
    The other bill that I would like to talk about today is the 
CAMRA Act, and I really want to thank Dr. Radesky for being 
here virtually to talk about the importance of this research 
into the impacts that screens and screen time and social media 
have on our children.
    And so, Dr. Radesky, I first want to appreciate your 
highlighting that ``screen time'' is far too general a term, 
and that there is a difference between a FaceTime chat with 
Grandma and Grandpa and violent video games. And so I was 
wondering if you could first describe the family media plan 
that you created that helps pediatricians work with families to 
incorporate screen time in a healthy and balanced way.
    Dr. Radesky. Yes, I am happy to, thank you. So when our 
American Academy of Pediatrics guidelines came out in 2016, we 
wanted to have more practical ideas for families who were 
trying to navigate this Wild West of new technologies. And we 
thought that having really actionable ideas delivered through a 
kind of tailored, digital format through the Family Media Use 
Plan on the HealthyChildren.org website would just help this be 
delivered a little bit more easily to families.
    We also wanted to encourage conversations that really get 
to the heart of when is technology a problem, when is it 
interrupting our family connections and our meals, when is it 
actually fun to do together, and to tell us stories that make 
our lives more meaningful? When are we using it for our human 
needs?
    And so it represented that sort of balanced conversation, 
and we have found that, you know, tens--hundreds of thousands 
of families have used it, and we are actually updating it now, 
because the research is constantly changing, the platforms that 
families are using are constantly changing, and we want to 
continue to be a resource for families, you know, that is 
relevant on the ground, understanding the everyday tensions 
around this.
    Ms. Schrier. And I know I appreciate that, as a 
pediatrician: No devices in the bedroom, not at the kitchen 
table, et cetera. And I was wondering if you could give some 
quick answers, just a few words on each of these: Generally 
speaking, the effect on social media and video games on 
attention spans, specifically in school.
    Dr. Radesky. Yes, there have been a couple of longitudinal 
studies. These are important, because they look at how a child 
started off and how things change over time. And a few of the 
good ones have shown that the more frequent checking of social 
media, the more that children's everyday activities are 
fractured into different fragments by media use, that that does 
impact attention span, and that it is not only kids who have 
preexisting ADHD.
    Ms. Schrier. Thank you. And I will note, just in the 
interest of time, the effect of social media and video games on 
sleep, staying up too late, social interactions, the ability to 
communicate face to face, also between time spent on screens 
and myopia and obesity and learning.
    And I--yesterday I was speaking with one of your 
colleagues, Dr. Dimitri Christakis at Seattle Children's, and 
he noted that schools are spending a lot of money on buying 
devices, computers in the classroom, and that it is really not 
clear yet whether that is helpful or not.
    And so I would just like to round--to kind of wrap up by 
saying that we need to be really strategic about screen time 
and media and our children. And the fact of the matter is that 
you are researchers and you still don't have access to the data 
that Big Tech does. And that is why the CAMRA Act is so 
important, to make sure that the NIH gets this data to guide us 
as pediatricians, teachers, parents on our children's access 
and use of social media and screen time.
    Thank you, and I yield back. I would like to recognize----
    Voice. So we don't have any Members yet, so I would say 
that you can adjourn.
    Ms. Schrier. I will adjourn, and call the--I will recess 
this committee.
    [Recess.]
    Ms. Schrier. The hearing will resume. Dr. Joyce has just 
arrived.
    That is all right, we are happy to have you, Dr. Joyce, and 
thrilled to resume the hearing. You have 5 minutes.
    Mr. Joyce. First of all, I want to thank Dr. Schrier, my 
colleague and my friend, for bringing us all together today, 
because this is an important slate of bipartisan bills that we 
are considering.
    I would especially like to note that H.R. 1113, the CAROL 
Act, named for the late wife of my friend and my colleague, 
Andy Barr, and urge that it be marked up by this committee as 
soon as we are able to do so.
    Since March of last year, the COVID-19 pandemic has 
disrupted and upended lives in many ways that none of us could 
have ever imagined. Even with the staggering impact of this 
virus on public health, as a physician I remain gravely 
concerned about the secondary effects that we will ultimately 
and continue to see. As businesses and practices have shut 
down, routine cancer screenings, health checkups, immunizations 
were delayed and even skipped altogether. The delay in 
diagnosis of possible cancers and other health disorders will 
be something that we will be seeing and living with in the 
future.
    My first question is to Dr. Lloyd-Jones. One of the other 
effects that we have seen is the staggering increase in BMI 
among school-aged children. Dr. Jones, can you please speak 
about what impacts this will have from a general and from a 
cardiovascular health standpoint, and provide any 
recommendations on how we, as a legislative body, can address 
this?
    Dr. Lloyd-Jones. Well, thank you, Congressman. This is a 
really critically important issue.
    And as you point out, you know, we have looked at data that 
showed that 45 percent of Americans delayed routine healthcare 
in the summer of 2020, and it is still running around 20 
percent saying that they are going to delay, related to the 
virus and their concerns about coming into healthcare 
facilities. And that plays out in our children, as well.
    As you pointed out, we have seen significant weight gains 
in Americans across the board during the pandemic because of 
changes in eating habits, because of forced sedentariness, as 
we have been home more. And unfortunately, that plays out in 
the COVID-19. We saw that, on average, in the first year of the 
pandemic, American adults gained 19 pounds--on average--which 
is really a striking setback to our public health.
    And that--we have seen that in children, as well. When 
children get obese early in life, it drives not only immediate 
metabolic changes, it puts them at risk for type 2 diabetes--
usually a disease of adults--puts them at risk for higher blood 
pressures, puts them at risk for worse cholesterol. And we know 
that each of those things is time dependent. The longer you are 
exposed to those things, the worse your vascular changes, the 
damage to your heart and your arteries, and the earlier the 
onset of those diseases will be, in terms of heart attack and 
stroke.
    So it is really a tragedy that we are seeing much heavier 
children, and we were already one of the most obese nations in 
the world, with regard to our children and our adults. But we 
are going to see this play out now over decades, because it is 
so hard to lose the weight once it has been gained, and that 
will drive earlier and more rapid rises in blood pressure, 
blood sugar, cholesterol, and other metabolic problems that 
will play out. And we will see, unfortunately, increases in 
cardiovascular disease, event rates, and death.
    Mr. Joyce. Dr. Jones, I think you make an excellent point 
in--we will see this play out over decades.
    But immediately, right now, we have seen increases in 
overdose deaths, some of the largest in our Nation's history. 
Losing over 95,000 Americans to overdoses in 2020 is an 
unacceptable number. And we need to work fast to reverse this 
deadly trend.
    In Pennsylvania the availability of illicit drugs, 
specifically fentanyl, is a crushing blow to our local 
communities. We know these drugs are easy to get and fast to 
kill.
    During the COVID-19 pandemic, the opioid epidemic has 
further spiraled out of control. While Congress recently did 
just extend the scheduling of fentanyl analogues until early 
next year, we, as a committee, must make this ban permanent, 
and I would hope to see our committee activity on this 
lifesaving policy very shortly.
    Thank you, and I yield back.
    Ms. Schrier. The gentleman yields. I want to thank you, Dr. 
Joyce, always my friend and my colleague, for raising such 
important points about both of those things, the opioid 
epidemic and children's health.
    I would like to now recognize my friend Ms. Blunt Rochester 
from Delaware for 5 minutes.
    You are recognized.
    Ms. Blunt Rochester. Thank you, Madam Chairwoman, for the 
recognition, and thank you to the witnesses for being here 
today to discuss the critical public health issues of cancer 
prevention, children's health, cardiac health, and oral health. 
The issues we are discussing today impact Americans of all 
backgrounds, but none more than heart disease.
    Heart disease is the leading cause of death in the United 
States, and by 2035 nearly half of the U.S. population will 
have some form of heart disease. If left untreated, heart 
disease can turn fatal because of serious cardiac events like 
heart attack, heart failure, and stroke.
    In addition to costing the country billions of dollars 
annually, serious cardiac events can also disrupt the long-term 
quality of life of survivors and families because of the 
physical, emotional, and financial trauma that accompany these 
events.
    Fortunately, we have evidence-based interventions like 
cardiac and pulmonary rehabilitation that can help those who 
have suffered get their lives back on track. Cardiac 
rehabilitation programs help patients recover more quickly by 
supporting them through supervised exercise training, emotional 
support, and lifestyle education.
    However, despite the clear benefits of cardiac 
rehabilitation, only one in four Medicaid patients eligible 
will ever receive it, simply because many patients are not 
being referred by their clinicians. Congress addressed this 
referral gap in 2018 by authorizing physician assistants, nurse 
practitioners, and clinical nurse specialists--advanced 
practice providers, or APPs, for short--to supervise cardiac 
and pulmonary rehabilitative care beginning in 2024.
    APPs are already delivering this level of care. For 
example, some physician assistants order and supervise cardiac 
stress tests, pacemakers, and defibrillators, and some nurse 
practitioners already perform the care planning and oversee the 
care delivery for patients with complex cardiac conditions.
    But the question is, why wait? Let's remove the Federal 
barrier. This is why I was so pleased to be leading the 
Increasing Access to Quality Cardiac Rehabilitation Care Act, 
H.R. 1956, with Congressman Smith. This legislation will build 
on the previous success in 2018 and eliminate obstacles that 
prevent patients from beginning this critical therapy by 
allowing APPs to supervise and order these vital programs.
    I want to thank Dr. Lloyd-Jones for his enduring support of 
this legislation.
    And can you elaborate on how allowing advanced practice 
providers to supervise and order cardiac and pulmonary 
rehabilitative care could decrease disparities in access for 
those in rural and underserved communities?
    Dr. Lloyd-Jones. Certainly. Well, thank you so much, 
Congressman Blunt Rochester, and thank you for your sponsorship 
of this critically important bill.
    You know, APPs are people that we work with every day as 
physicians. They are highly trained, and they are really--you 
know, some people call them physician extenders, but they are 
much more than that, and they are a critical part of our 
healthcare system.
    Simply put, there just aren't enough doctors, and doctors 
aren't doing enough to order cardiac rehab in the first place 
for the 1.1 million heart attack survivors we have every year. 
And so we are talking about a lot of people here.
    So it is a lack of referral. We need APPs to be writing 
those prescriptions. And it is clear who is eligible for this 
intervention.
    We also need APPs because, to start and maintain a cardiac 
rehab program, you need nurse practitioners, you need exercise 
physiologists on site monitoring the patients. But what you 
don't really need is a physician every time. Yes, you need 
access to a physician. They need to be, you know, available to 
be called if there is a problem. But APPs know exactly what to 
do if there is an urgent or emergent situation. They know how 
to call 9-1-1. They know how to administer basic life support, 
and they know how to give CPR immediately and often much more 
quickly and better than a physician could do if one waited 
around for the physician to arrive.
    So I think that is a critically important feature of this 
bill, and we are very much in support of it.
    Ms. Blunt Rochester. Thank you so much.
    And Dr. DuBois, I am working on legislation to promote the 
use of preventive healthcare services like routine screenings 
and examinations which have been delayed or foregone because of 
the pandemic. In your testimony you note that we are still not 
back to prepandemic levels. Can you briefly elaborate on what 
the consequences of that may be for individuals and for our 
society?
    Dr. DuBois. Thank you. Well, that is a great question and a 
big concern of mine, because the screenings did go down 
dramatically, especially each time we had the surges. It is 
really going to delay diagnoses in that, you know, when that 
delay happens, it makes the outcome much worse, because it is 
harder to treat these cancers when they, you know, present at a 
much later stage.
    We are trying to encourage everybody we can to get back in 
and get on their screening regimens. And it has improved 
considerably since the first surge, but it is still not back up 
to normal levels, and we are continuing to do whatever we can 
through our societies, through the press, public education to 
make that happen. But anything Congress can do would be well 
received because this is still a problem.
    Ms. Blunt Rochester. Thank you so much, Dr. DuBois, and we 
are working on it.
    Thank you, Madam Chair, and I yield back the balance. I 
have no time, but I yield it back.
    Ms. Schrier. The gentlewoman yields. Thank you very much to 
my colleague, Ms. Blunt Rochester.
    I would like to now recognize for 5 minutes the gentlelady 
from Minnesota, Ms. Craig.
    Ms. Craig. Thank you so much, Madam Chair, and thank you to 
this committee for holding this important, important hearing 
this afternoon.
    Witnesses, just thank you for being here, for sharing your 
stories, your expertise. I have to say, though, a special thank 
you to Congressman Rick Nolan. It is so good to see you, and 
thank you for sharing your story and putting your pain and your 
family's experience into progress.
    I know Katherine, just like you, was a woman of grit, a 
woman of love, of empathy. And just on a personal level, I will 
never forget that last moment I saw you and President Joe Biden 
embrace just after Beau had passed away, and it just--an 
enormous amount of empathy for what you and your family have 
gone through.
    You know, in Minnesota and nationally, lung cancer is the 
leading cause of cancer deaths. It is also one of the most 
commonly diagnosed types of cancer. Despite that commonality 
and lethality, we have made woefully little progress, compared 
to other cancer types.
    We know that early detection saves lives, yet no-cost 
screening for lung cancer is limited, and those over the age of 
55 with a history of smoking. In his testimony, Dr. DuBois 
points out that incremental progress is being made by the 
USPSTF in recommending screening of lung cancer, which, of 
course, could be beneficial for women and African Americans, 
who tend to smoke fewer cigarettes than White men yet still 
have a rate--high risk of developing lung cancer.
    Dr. DuBois, what other factors besides smoking history 
should be studied in women ages 40 to 49 to increase the 
scientific data available for policymakers like ourselves?
    Dr. DuBois. Well, thank you very much for that question. 
Some of the things that are related to increased risk in the 
younger population are secondhand smoke exposure, and some of 
that is not always collected properly or, you know, put into 
the record or documented to allow us to know what degree of 
risk that is.
    There's also things like radon exposure and other 
environmental exposures that increase risk in that younger 
population.
    And then there is also a segment of those individuals who 
have genetic risk factors and a history of lung cancer in their 
families that would need to undergo some genetic testing to 
sort that out.
    So there are other factors, and, you know, that is just one 
of the issues with the way the task force works. They really 
set things, really, based on age, because they really look at 
the population as a collective instead of these individual, 
higher-risk groups.
    Ms. Craig. Thank you so much.
    Congressman Nolan, I just want to ask. Katherine fought. 
She fought all the way through the very end of her life. Can 
you talk just for a minute about that fight and why she so 
strongly believed that she had such purpose at her end of life, 
and the mantel that you have now taken up for her?
    Mr. Nolan. Thank you for that question. I could not have 
ever been more proud of her.
    She--I said earlier she said that she would gladly go 
through all that she had endured, as so many others have, if it 
could result in the passage of this screening to provide early 
detection, because it is so critical in saving and extending 
lives.
    And in her final moments we were with her. And she said--I 
said, ``Katherine, the great mystery is--for many of us--is not 
knowing what is going to happen to us here when our life is 
over.'' But I said, ``Wherever that is, I want to be with you 
there soon.''
    Her last words and wishes were, she said, ``No, Dad, not 
until this bill gets passed.''
    So I am so grateful to the committee for considering this 
and the other important legislation and, in particular, for a 
beautiful young woman's last dying wishes to pass this bill, 
because she knew it would save so many lives. And she said she 
would undergo everything she has gone, including the finality 
of it in losing her life, because she knew it would save so 
many thousands--tens, if not hundreds of thousands of people, 
465,000 people dying every day from lung cancer. Thank you.
    Ms. Craig. Congressman, this committee looks forward to 
taking up this fight with you on her behalf.
    Thank you, and I yield back.
    Mr. Nolan. Thank you.
    Ms. Schrier. The gentlewoman yields. Thank you for those 
moving comments.
    I would like to thank our witnesses today for your 
participation in today's hearing, and I will submit the 
following statements for the record.
    The list here is provided, and, with your permission, I 
will waive the reading of these. Thank you.
    [The information appears at the conclusion of the hearing.]
    Ms. Schrier. Members have 10 business days to submit 
additional questions for the record.
    Witnesses, please respond promptly to any questions that 
you receive.
    At this time, the subcommittee is adjourned. Thank you.
    [Whereupon, at 2:15 p.m., the subcommittee was adjourned.]
    [Material submitted for inclusion in the record follows:]
    
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