Congressional Record, Volume 143 Issue 114 (Wednesday, September 3, 1997)

[Congressional Record Volume 143, Number 114 (Wednesday, September 3, 1997)]
[Senate]
[Pages S8710-S8720]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS ACT, 1998

The Senate continued with the consideration of the bill.

Amendment No. 1056

The PRESIDING OFFICER (Mr. Abraham). Under the previous order, the
Senate will now vote on amendment No. 1056 offered by the Senator from
Arizona. The yeas and nays have been ordered. The clerk will call the
roll.
The bill clerk called the roll.
Mr. NICKLES. I announce that the Senator from Arkansas [Mr.
Murkowski] is necessarily absent.
The PRESIDING OFFICER. Are there any other Senators in the Chamber
who desire to vote?
The result was announced--yeas 25, nays 74, as follows:

[Rollcall Vote No. 213 Leg.]

YEAS--25

Allard
Ashcroft
Breaux
Brownback
Cochran
Coverdell
Faircloth
Feinstein
Gorton
Gramm
Hatch
Helms
Hutchinson
Hutchison
Inhofe
Kyl
Lott
Mack
McCain
McConnell
Nickles
Roberts
Sessions
Shelby
Thurmond

[[Page S8711]]

NAYS--74

Abraham
Akaka
Baucus
Bennett
Biden
Bingaman
Bond
Boxer
Bryan
Bumpers
Burns
Byrd
Campbell
Chafee
Cleland
Coats
Collins
Conrad
Craig
D'Amato
Daschle
DeWine
Dodd
Domenici
Dorgan
Durbin
Enzi
Feingold
Ford
Frist
Glenn
Graham
Grams
Grassley
Gregg
Hagel
Harkin
Hollings
Inouye
Jeffords
Johnson
Kempthorne
Kennedy
Kerrey
Kerry
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lugar
Mikulski
Moseley-Braun
Moynihan
Murray
Reed
Reid
Robb
Rockefeller
Roth
Santorum
Sarbanes
Smith (NH)
Smith (OR)
Snowe
Specter
Stevens
Thomas
Thompson
Torricelli
Warner
Wellstone
Wyden

NOT VOTING--1

Murkowski

The amendment (No. 1056) was rejected.
Mr. SPECTER. Mr. President, I move to reconsider the vote.
Mr. HARKIN. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
The PRESIDING OFFICER. The Senate will please come to order so the
Senator from Pennsylvania may be recognized.
Mr. SPECTER. Mr. President, after consulting with the majority
leader, it is our intention to proceed with a series of amendments and
to have perhaps two stacked votes at about 7 o'clock. We have next up
an amendment that will just take a moment or two, a very brief
amendment by Senator McCain. Then we are going to follow that with a
brief amendment by Senator Nickles.
Will that require a rollcall vote, Senator Nickles? It will.
Then we have an amendment by Senator Lieberman, and then we will be
in a position to, we hope, have a list of amendments which will be
limited so we can proceed to see precisely how we will finish the bill.
Mr. WARNER. Mr. President, will the Senator entertain a unanimous-
consent request, a brief one?
Mr. SPECTER. Yes.
Mr. WARNER. I thank the manager.
The PRESIDING OFFICER. The Senator from Virginia.

Explanation of Absence--Vote on Amendment No. 1057

Mr. WARNER. Mr. President, I was absent this morning during the vote
on the Harkin amendment. Had I been here, I would have voted with the
distinguished Senator from Iowa. I was at the funeral of a friend, an
employee of 35 years, who passed on, and I was privileged to give the
eulogy.
The PRESIDING OFFICER. The Senator from Minnesota.
Mr. WELLSTONE. Mr. President, I have an amendment I would send to the
desk on behalf of myself and Senator McCain.
The PRESIDING OFFICER. Is there objection to setting aside the
pending amendment?
Mr. WELLSTONE. I ask unanimous consent the pending amendment be set
aside.
The PRESIDING OFFICER. Without objection, it is so ordered.

Amendment No. 1074

(Purpose: To provide for the establishment of a program for research
and training with respect to Parkinson's disease)

The PRESIDING OFFICER. The clerk will report the amendment.
The assistant legislative clerk read as follows:

The Senator from Minnesota [Mr. Wellstone], for himself,
Mr. McCain, Mr. Craig, Mr. Burns, Mr. Durbin, Mr. Ford, Mr.
D'Amato, Mr. Breaux, Ms. Moseley-Braun, Mr. Santorum, Mr.
Johnson, Ms. Snowe, Mr. Reid, Mr. Hollings, Mr. Torricelli,
Mr. Faircloth, Mr. Levin, Mr. Lautenberg, Mr. Hatch, and Mr.
Bryan, proposes an amendment numbered 1074.

Mr. WELLSTONE. Mr. President, I ask unanimous consent that the
reading of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

At the appropriate place, insert the following:

SEC. . PARKINSON'S DISEASE RESEARCH.

(a) Short Title.--This section may be cited as the ``Morris
K. Udall Parkinson's Research Act of 1997''.
(b) Finding and Purpose.--
(1) Finding.--Congress finds that to take full advantage of
the tremendous potential for finding a cure or effective
treatment, the Federal investment in Parkinson's must be
expanded, as well as the coordination strengthened among the
National Institutes of Health research institutes.
(2) Purpose.--It is the purpose of this section to provide
for the expansion and coordination of research regarding
Parkinson's, and to improve care and assistance for afflicted
individuals and their family caregivers.
(c) Parkinson's Research.--Part B of title IV of the Public
Health Service Act (42 U.S.C. et seq.) is amended by adding
at the end the following:

``parkinson's disease

``Sec. 409B. (a) In General.--The Director of NIH shall
establish a program for the conduct and support of research
and training with respect to Parkinson's disease (subject to
the extent of amounts appropriated under subsection (e)).
``(b) Inter-Institute Coordination.--
``(1) In general.--The Director of NIH shall provide for
the coordination of the program established under subsection
(a) among all of the national research institutes conducting
Parkinson's research.
``(2) Conference.--Coordination under paragraph (1) shall
include the convening of a research planning conference not
less frequently than once every 2 years. Each such conference
shall prepare and submit to the Committee on Appropriations
and the Committee on Labor and Human Resources of the Senate
and the Committee on Appropriations and the Committee on
Commerce of the House of Representatives a report concerning
the conference.
``(c) Morris K. Udall Research Centers.--
``(1) In general.--The Director of NIH shall award Core
Center Grants to encourage the development of innovative
multidisciplinary research and provide training concerning
Parkinson's. The Director shall award not more than 10 Core
Center Grants and designate each center funded under such
grants as a Morris K. Udall Center for Research on
Parkinson's Disease.
``(2) Requirements.--
``(A) In general.--With respect to Parkinson's, each center
assisted under this subsection shall--
``(i) use the facilities of a single institution or a
consortium of cooperating institutions, and meet such
qualifications as may be prescribed by the Director of the
NIH; and
``(ii) conduct basic and clinical research.
``(B) Discretionary requirements--With respect to
Parkinson's, each center assisted under this subsection may--
``(i) conduct training programs for scientists and health
professionals;
``(ii) conduct programs to provide information and
continuing education to health professionals;
``(iii) conduct programs for the dissemination of
information to the public;
``(iv) separately or in collaboration with other centers,
establish a nationwide data system derived from patient
populations with Parkinson's, and where possible, comparing
relevant data involving general populations;
``(v) separately or in collaboration with other centers,
establish a Parkinson's Disease Information Clearinghouse to
facilitate and enhance knowledge and understanding of
Parkinson's disease; and
``(vi) separately or in collaboration with other centers,
establish a national education program that fosters a
national focus on Parkinson's and the care of those with
Parkinson's.
``(3) Stipends regarding training programs.--A center may
use funds provided under paragraph (1) to provide stipends
for scientists and health professionals enrolled in training
programs under paragraph (2)(B).
``(4) Duration of support.--Support of a center under this
subsection may be for a period not exceeding five years. Such
period may be extended by the Director of NIH for one or more
additional periods of not more than five years if the
operations of such center have been reviewed by an
appropriate technical and scientific peer review group
established by the Director and if such group has recommended
to the Director that such period should be extended.
``(d) Morris K. Udall Awards for Excellence in Parkinson's
Disease Research.--The Director of NIH shall establish a
grant program to support investigators with a proven record
of excellence and innovation in Parkinson's research and who
demonstrate potential for significant future breakthroughs in
the understanding of the pathogensis, diagnosis, and
treatment of Parkinson's. Grants under this subsection shall
be available for a period of not to exceed 5 years.
``(e) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated $100,000,000 for fiscal year 1998, and such sums
as may be necessary for each of the fiscal years 1999 and
2000.''.

Mr. WELLSTONE. Mr. President, I could talk at some length about this
amendment, and I will not. I will just make a few introductory
comments, and then my colleague, Senator McCain, will speak on this.
We have, I believe, close to 66, or thereabouts, cosponsors. This
amendment, which I am very proud to offer today, is really an amendment
that is

[[Page S8712]]

named after Mo Udall, who was a very distinguished Representative in
the House of Representatives and somebody that many people here have a
great deal of love and respect for.
This amendment would call for 10 Parkinson's research centers. This
would be $100 million a year. The reason for this amendment is that
Parkinson's disease is a devastating neurological disease. Probably my
colleagues are very familiar with it. They may have had a loved one who
suffered from it. I had two parents who suffered from Parkinson's
disease.
Mr. President, what happens with people with Parkinson's is that
there is a tremendous problem with shaking, people have difficulty
walking, and many people have really found it difficult to be, if you
will, their own lobbyist. People have found it difficult to speak for
themselves.
But what has happened in the last several years is that there has
been a wonderful group of people who have come here. The Udall family
has been very, very important in this whole struggle. In addition, Joan
Samuelson, with the Parkinson's Action Network, has been really
critical to this. They have come here and I think have met with
Senators, Democrats and Republicans alike. This is a bipartisan effort
we have on the floor of the Senate. They have essentially said to all
of us, ``Time is not on our side. We have the research that we can
point to. It is such promising research. We are on the cuspis of major
breakthroughs, but if we do not at least increase this funding for
research for many of us, we really will not have that much of a
future.''
Mr. President, there are a million people in our country, men and
women who struggle with Parkinson's disease. Up to now, we have been
spending about $30 per person. It is a really shamefully low amount of
money that we have spent. Very little has been invested.
But now these men and women, this community, has come to the Nation's
Capital. They have met with all of us, and they have made their case. I
am very honored to offer this amendment with Senator McCain. I hope we
will get very, very strong support.
Mr. President, I ask unanimous consent to add as original cosponsors
to this amendment Senator Craig, Senator Burns, Senator Durbin, Senator
Ford, Senator D'Amato, Senator Breaux, Senator Moseley-Braun, Senator
Santorum, Senator Johnson, Senator Snowe, Senator Harry Reid, Senator
Hollings, Senator Torricelli, Senator Faircloth, Senator Levin, and
Senator Lautenberg.
The PRESIDING OFFICER. Without objection, it is so ordered.

Amendment No. 1074, As Modified

Mr. WELLSTONE. Mr. President, I ask unanimous consent to send a
modification to the desk, along with the cosponsors.
The PRESIDING OFFICER. The Senator has a right to modify his
amendment, the yeas and nays not having been ordered.
The amendment, as modified, is as follows:

At the appropriate place, insert the following:

SEC. . PARKINSON'S DISEASE RESEARCH.

(a) Short Title.--This section may be cited as the ``Morris
K. Udall Parkinson's Research Act of 1997''.
(b) Finding and Purpose.--
(1) Finding.--Congress finds that to take full advantage of
the tremendous potential for finding a cure or effective
treatment, the Federal investment in Parkinson's must be
expanded, as well as the coordination strengthened among the
National Institutes of Health research institutes.
(2) Purpose.--It is the purpose of this section to provide
for the expansion and coordination of research regarding
Parkinson's, and to improve care and assistance for afflicted
individuals and their family caregivers.
(c) Parkinson's Research.--Part B of title IV of the Public
Health Service Act (42 U.S.C. 284 et seq.) is amended by
adding at the end the following:

``parkinson's disease

``Sec. 409B. (a) In General.--The Director of NIH shall
establish a program for the conduct and support of research
and training with respect to Parkinson's disease (subject to
the extent of amounts appropriated under subsection (e)).
``(b) Inter-Institute Coordination.--
``(1) In general.--The Director of NIH shall provide for
the coordination of the program established under subsection
(a) among all of the national research institutes conducting
Parkinson's research.
``(2) Conference.--Coordination under paragraph (1) shall
include the convening of a research planning conference not
less frequently than once every 2 years. Each such conference
shall prepare and submit to the Committee on Appropriations
and the Committee on Labor and Human Resources of the Senate
and the Committee on Appropriations and the Committee on
Commerce of the House of Representatives a report concerning
the conference.
``(c) Morris K. Udall Research Centers.--
``(1) In general.--The Director of NIH shall award Core
Center Grants to encourage the development of innovative
multidisciplinary research and provide training concerning
Parkinson's. The Director shall award not more than 10 Core
Center Grants and designate each center funded under such
grants as a Morris K. Udall Center for Research on
Parkinson's Disease.
``(2) Requirements.--
``(A) In general.--With respect to Parkinson's, each center
assisted under this subsection shall--
``(i) use the facilities of a single institution or a
consortium of cooperating institutions, and meet such
qualifications as may be prescribed by the Director of the
NIH; and
``(ii) conduct basic and clinical research.
``(B) Discretionary requirements.--With respect to
Parkinson's, each center assisted under this subsection may--
``(i) conduct training programs for scientists and health
professionals;
``(ii) conduct programs to provide information and
continuing education to health professionals;
``(iii) conduct programs for the dissemination of
information to the public;
``(iv) separately or in collaboration with other centers,
establish a nationwide data system derived from patient
populations with Parkinson's, and where possible, comparing
relevant data involving general populations;
``(v) separately or in collaboration with other centers,
establish a Parkinson's Disease Information Clearinghouse to
facilitate and enhance knowledge and understanding of
Parkinson's disease; and
``(vi) separately or in collaboration with other centers,
establish a national education program that fosters a
national focus on Parkinson's and the care of those with
Parkinson's.
``(3) Stipends regarding training programs.--A center may
use funds provided under paragraph (1) to provide stipends
for scientists and health professionals enrolled in training
programs under paragraph (2)(B).
``(4) Duration of support.--Support of a center under this
subsection may be for a period not exceeding five years. Such
period may be extended by the Director of NIH for one or more
additional periods of not more than five years if the
operations of such center have been reviewed by an
appropriate technical and scientific peer review group
established by the Director and if such group has recommended
to the Director that such period should be extended.
``(d) Morris K. Udall Awards for Excellence in Parkinson's
Disease Research.--The Director of NIH shall establish a
grant program to support investigators with a proven record
of excellence and innovation in Parkinson's research and who
demonstrate potential for significant future breakthroughs in
the understanding of the pathogenesis, diagnosis, and
treatment of Parkinson's. Grants under this subsection shall
be available for a period of not to exceed 5 years.
``(e) Authorization of Appropriations.--For the purpose of
carrying out this section and section 301 and title IV of The
Public Health Service Act with respect to direct Parkinson's
disease research, there are authorized to be appropriated a
total of $100,000,000 for fiscal year 1998, and such sums as
may be necessary for each of the fiscal years 1999 and 2000.

Mr. WELLSTONE. I defer to my colleague from Arizona, and I thank him
for his--I am not going to use the word ``leadership'' because many
people always talk about Senator McCain's leadership--but for his
emotional and personal involvement. He is a Senator who is very
connected to people. I thank him for all of his work. I hope we will
get a good, strong vote.
Mr. McCAIN addressed the Chair.
The PRESIDING OFFICER. The Senator from Arizona.
Mr. McCAIN. Mr. President, I thank my friend from Minnesota. He is a
man of great spirit, a man of great commitment. When the Senator from
Minnesota gets involved in an issue, he is heard from. I believe his
involvement in this issue is important and, indeed, critical. I don't
think it is inappropriate to mention that the life of the Senator from
Minnesota has been touched in the most graphic and dramatic fashion by
this disease we are discussing today. I thank the Senator from
Minnesota.
Mr. President, I support Senator Wellstone's amendment. Scientists
have made tremendous new discoveries and progress in regard to
Parkinson's disease, which clearly illustrates how close we are to
finding a cure and treatment for this deadly disease. According to a
wide array of experts, we

[[Page S8713]]

are on the verge of substantial, groundbreaking scientific discoveries
in the next few years regarding the cause and potential cure of
Parkinson's disease.
The most recent scientific discovery of a gene abnormality that
causes some cases of Parkinson's disease has provided researchers with
a powerful new tool for understanding Parkinson's disease. This is the
kind of breakthrough that makes a strong case for ensuring adequate
funding for Parkinson's research.
I don't come to the floor very often on a situation like this, but
there is a gross inequity here and one that needs rectification. I find
it gravely disturbing that despite the significant progress scientists
are making in the field of Parkinson's, the National Institutes of
Health continuously fail to provide an appropriate amount of funding
for Parkinson's research, which is why the Senator from Minnesota and I
are here.
During fiscal year 1996, the National Institutes of Health spent $32
million for direct Parkinson's research. That is about $32 for each of
the approximately 1 million Parkinson's patients--$32 for each of the
approximately 1 million Parkinson's patients. Compare this to the
$2,143 per AIDS victim; $338 per cancer victim; or $200 per breast
cancer victim; or $81 per Alzheimer's victim; $74 per heart disease
victim, not including the additional funding just adopted as an
amendment to this bill.
Obviously, funding for Parkinson's research is grossly inadequate
compared to support which other diseases receive at NIH. By failing to
provide scientists with adequate funding, we are potentially letting a
cure for this dreadful disease slip further and further into the
future. This amendment will ensure that our scientific researchers have
available the necessary funding and support to proceed as quickly as
possible to combat Parkinson's.
Mr. President, the Senator from Minnesota has described what this
legislation would do, including the establishment of 10 Morris K. Udall
Centers for Research on Parkinson's Disease throughout the Nation,
create a national Parkinson's disease clearinghouse and other things.
Approximately 1 million Americans are afflicted with Parkinson's
disease. Parkinson's is a debilitating, degenerative disease which is
caused when nerve centers in an individual's brain lose their ability
to regulate body movements. People afflicted by this disease experience
tremors, loss of balance and repeated falls, loss of memory, confusion
and depression. Ultimately, this disease results in total incapacity of
an individual, including the inability to speak. This disease knows no
boundaries, does not discriminate and strikes without warning.
This amendment is supported by the National Parkinson's Foundation,
the American Parkinson's Disease Association and Parkinson's Action
Network. These organizations, as well as many other individuals
involved in grassroots support activities, have worked long and hard to
achieve widespread support for this authorization bill in both the
House and Senate.
The Mo Udall Parkinson's Research and Education Act, which is the
basis for this amendment, has 64 cosponsors in the Senate and
approximately 240 cosponsors in the House. Mr. President, we cannot
afford to lose this opportunity to continue the momentous progress in
finding the cause for a cure for this terrible illness. On behalf of
the millions of Americans afflicted with Parkinson's and their families
and friends, I urge my colleagues to support this measure.
Mr. President, I ask unanimous consent that Senator Hatch be added as
an original cosponsor of the amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. McCAIN. Mr. President, finally, I would like to thank the people
that I mentioned earlier--the National Parkinson's Foundation, the
American Parkinson's Disease Association, and Parkinson's Action
Network. Without the help of these organizations, we would not be here
today.
Finally, I know sometimes amendments have a tendency to be dropped in
conference. The Senator from Minnesota and I feel very strongly about
this amendment, and that is why we feel it is necessary that we have a
rollcall vote on this issue. I hope that the managers of the bill will
see the way clear to preserve this amendment in conference, as it is
supported by, as I mentioned, now 65 of our colleagues in the Senate
and over 240 Members of the House.
Mr. President, I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The yeas and nays were ordered.
Mr. McCAIN. I yield the floor.
Mr. WELLSTONE addressed the Chair.
The PRESIDING OFFICER. The Senator from Minnesota.
Mr. WELLSTONE. Mr. President, I want to add one final word to what my
colleague, Senator McCain, has had to say. Above and beyond the
organizations that Senator McCain recognized for their fine work, and
above and beyond Mo Udall, this amendment comes from legislation which,
as I said, is really named after Mo Udall, for reasons I don't need to
explain to any colleague. I also would like to thank, but I want to do
this carefully, Muhammad Ali, who has been very courageous, and I use
that word carefully. Muhammad Ali struggles with Parkinson's, and he
could have chosen to have had the world or the country have only seen
him as he was when he was in his prime as a boxer. Instead, he has been
very public, very visible and a very, very strong advocate, not just
for himself but for many, many other people.
Mr. President, I say to my colleagues, and I know that my colleague
from Indiana is going to have a second-degree amendment which I think
really adds strength to this and he has some very thoughtful and
important questions to raise or comments to make, but I am going to end
on a personal note. I want to say to everybody here that we really do
need to have a strong vote, and we need to keep this in conference.
When Senator McCain was talking about this disorder and what it does
to people, I remember when L-Dopa, the first drug, came out. My father
was in the original pilot group. For a while, L-Dopa helped, but then
it reached the point where it did not. With my father, Leon Wellstone,
at the very end, he not only could not walk, and he was a writer and
his hand would shake and he could not type, but, in addition, he could
not even speak.
It can be so ravaging to people. It can be so devastating. The reason
we have brought this amendment to the floor is that it is an equity
question. So precious little has been invested in Parkinson's research
at the very time when there is such potential for big breakthroughs.
I want to make it clear to everybody that we have had the Parkinson's
community come here to Washington, and they have come year after year
for the last 3 or 4 years that they have been working on this. Each
time, we make progress, and then at the very end, for some reason, they
get shut out.
So I make a plea to people on the basis of please vote for this
funding. It is just a matter of elementary fairness and justice. It is
just a matter of equity. Please don't shut people out. I just don't
want to see people who have been so courageous and who have come here
and have struggled so hard not be successful in this Senate and in this
House of Representatives. We have to pass this legislation. It really
would be a wonderful vote, and it really would make a huge difference
in the lives of many of our neighbors and many of our friends who are
men and women of enormous worth and enormous dignity and enormous
substance. Nothing I say is said out of pity, it is said out of respect
for the dignity of people. I just would like to say one more time, I
hope we will get a huge vote for this amendment. I yield the floor.
Mr. SPECTER addressed the Chair.
The PRESIDING OFFICER. The Senator from Pennsylvania.
Mr. SPECTER. Mr. President, this amendment to provide a statutory
program for research and training with respect to Parkinson's, I think,
is well founded.
We have worked within the subcommittee to increase the funding for
the National Institute of Neurological Disorders and Stroke which
included language in the Senate report highlighting the importance of
further activity on Parkinson's disease research. And the activities of
the sponsors of

[[Page S8714]]

this amendment, whom I commend, will direct greater intensive effort on
Parkinson's, which is a horrible disease. It has afflicted many, many
people.
With the enactment of this amendment, I think we will be taking a
firm stand to show the emphasis that the Senate, hopefully, ultimately
the full Congress, will place on additional research and resources
being directed against Parkinson's.
There is a great deal that could be said. We have a number of other
amendments, so I will limit my comments to those brief remarks.
Mr. HARKIN addressed the Chair.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. HARKIN. I want to concur with what the chairman just said about
this amendment. Obviously, all of us are very concerned about the lack
of, shall we say, appropriate funding levels for research into the
causes and interventions and cures of Parkinson's disease. This is
something that I have been very close to for the last several years. I
know that both Senator McCain and Senator Wellstone have been leaders
on this issue in the Senate. And I congratulate them and commend them
for their leadership on the issue of proper funding for Parkinson's
research.
There have been some recent breakthroughs in the causes of
Parkinson's, some recent breakthroughs in genetic tracing, some recent
breakthroughs in possible interventions, early interventions for those
who are detected early with the onset of Parkinson's disease.
This is a quantum increase. It is not out of bounds. Certainly the
incidents of Parkinson's disease in this country and around the globe
warrants the type of investment in research that the amendment
anticipates. It remains to be seen whether or not we can accommodate
this huge increase within the confines of the conference. I can assure
the authors of the amendment that this Senator, and I am sure that
Senator Specter, will do what we can to maintain this type of a level
for Parkinson's research. What the disposition will be on the House
side, obviously, we have no control over that. But I want to commend
both Senator McCain and Senator Wellstone for their leadership on this
issue and hope that we can do what we can in conference to keep the
funding level up for Parkinson's research.
I yield the floor.
Mr. COATS addressed the Chair.
The PRESIDING OFFICER. The Senator from Indiana.
Mr. COATS. Mr. President, I want to add my support to this. I have
been a supporter of additional funds for Parkinson's. But in the
process of all of this, and serving on the committee, I have raised, on
a number of occasions, my concerns that we are making decisions about
which diseases, which research centers at NIH receive the funds. We are
making that decision, I think, in well-intended ways, in ways that we
hope will direct funds to provide breakthroughs and better research and
hopefully cures for some of these diseases, yet I have been concerned
we are doing it on a piecemeal basis.
I am concerned that those organizations which have the greatest
lobbying clout, who have been able to contact the most Senators or
Congressmen, the ones who have generated the most support at home or
who are best organized have become those that are rewarded by passage
of legislation like this, and that those who do not have the lobbying
expertise, the lobbying clout, do not have the same kind of friends in
Congress that others have and end up being shorted. As a consequence,
we are making decisions on the basis of anecdotal evidence--and some
scientific evidence--but on the basis of political decisions as much as
scientific decisions.
Medical research is a complicated field. NIH is a wonderful
organization that attempts to direct funds in ways that will ensure
that research dollars are going into those areas where the best results
can be obtained. And yet, in my visits to NIH, and talking with a
number of people out there, and my observation of the process here, it
is clear that those funds are not always directed in the most
expeditious manner, not always directed in ways that provide the most
hope in terms of finding breakthroughs and in finding cures.
Having said that, there is no question that Parkinson's research over
the years has been shorted. In 1994, it had a funding rate of $26 per
patient, the lowest of all the major diseases, yet it affects one
million or more Americans. Its direct funding in 1994 was only $26
million, the lowest dollar number of all the major diseases.
So I think it is important that we recognize that here is a
debilitating disease that affects a million or more Americans, that has
had a personal impact on many of us and our families, that has
generated a very effective organization that supports research,
increased funding for research, but at the same time I think we have to
acknowledge or we should acknowledge and recognize that this is not the
best way to go about allocating funds for research at NIH, that the
lobby group that is the most effective or the Members who are in the
best position to direct the funds because of their committee positions
or whatever, that is not the way that we ought to be allocating
research dollars.

We ought to be doing it on a meritorious basis, one that is supported
by medical science, one that receives the recommendation of independent
researchers or an independent body or medical experts that certainly
have more expertise in this area than we do. I say that because if you
look at the list of diseases and the centers and the way we fund those,
there is clearly an imbalance. We clearly are directing funds to areas
where research is unnecessary or is duplicated. We clearly are not
directing funds to areas where we need research.
I have discussed this with NIH officials. I have been told--and will
not quote any names--but I have been told by people who are in a
position to know, they are duplicating and in some cases tripling the
amount of funds going into the same research simply because they are
directed by the Congress to fund that specific disease. And, of course,
any duplication or triplication or every excess dollar that has to be
spent because it is politically directed to be spent and not medically
necessary or scientifically required and going to meritorious studies
is a dollar that does not go into some other research, whether it is
direct research or indirect research, that could offer potentially
life-saving breakthroughs in other diseases.
Just an example or two. All of us have heard about Parkinson's, and
we are going to increase Parkinson's here. And I am going to support
that increase. I will say this. This is the last specific research
dollar increase that I am going to support until we have an outside
organization that can give us some recommendations as to how to
allocate our money. This ``disease of the month'' or who has the best
lobby or who has the most influential friends in Congress is not the
way that we ought to be directing research funds. But I have been a
long-time supporter of Parkinson's.
They have made their case. But I have told them I am not going to
continue on this basis. I will support the bill this year, but I am
going to be adding shortly an amendment that Senator Frist will speak
to, of which I would like to add him as a cosponsor, which will
initiate this study so that we would have a report so that in next
year's appropriations process we have before us the information we need
in order to make rational decisions, meritorious decisions rather than
just simply political decisions. I don't mean just simply political
decisions, but decisions that are not wholly supported by medical
science.
Very few people have heard of polycystic kidney disease, PKD. I had
not heard of it until I was visited by a friend of mine who introduced
me to the disease. PKD receives a ridiculously low appropriation, and
yet PKD is a disease that affects 500,000 Americans. It affects their
kidneys in a way that they do not function. And yet, as a Government,
because kidney dialysis is covered under Medicaid and Medicare, we
spend untold millions of dollars in paying the bills for kidney
dialysis when we provide virtually nothing for research in an area
where some amazing advances are possible, according to the medical
researchers, that can eliminate this disease and save the taxpayer
literally billions of dollars.
But because PKD is something that has not generated a huge lobbying
effort, does not have influential friends in Congress in key positions,
PKD continues to get the short end of the stick

[[Page S8715]]

in terms of research dollars. And yet, if there was ever an area where
we ought to be directing research funds, if the medical science says we
have an opportunity here to utilize these effectively and provide
research, if there is ever an area that can free up funds that we can
use for more research, in Parkinson's and other areas, or to help with
the Medicare funding or Medicaid funding or Medicare funding, it ought
to be in polycystic kidney disease, because the Government, we have
agreed we are going to pay for transfusions on dialysis, we are going
to pay for those out of Federal funds. And so year after year after
year we pay billions of dollars to provide very costly and very
difficult relief for people suffering from this disease, and yet we
give them virtually nothing in terms of their research.
As a consequence of all that, and through discussions we have had in
committee with some NIH scientists and researchers, I think we are
coming to a consensus here that we ought to initiate a process by which
we can coordinate our research dollars in a way that it gives us an
effective use of those dollars and gives us the best chance to provide
the best research in the best ways.
This amendment that I am going to offer shortly would require a
comprehensive review of NIH and congressional policies and procedures
for establishing priorities for research dollars. And that review has
to be independent of the agency. The amendment requires that the agency
contract with the Institute of Medicine, which I think is a highly
respected and reputable institution, to conduct the study according to
the statutory specifications, and requires a report to Congress within
6 months so that the authorizing and the appropriating committees for
next year's cycle will have that information before them before they
make their decisions.
It raises critical questions about how we ought to direct research
dollars, talks about how much funding that would be appropriate, and
the statutory changes that will be needed to change NIH policies and
procedures.
The Institute of Medicine is particularly directed to focus on the
factors and criteria used by NIH to make disease funding allocations,
to focus on the process by which the funding decisions are made, the
mechanisms for public input and the impact of congressional statutory
directives.
Again, as I said, Dr. Olonow, from NIH, who testified before our
committee, thought that this was an appropriate way to proceed. The
funding is drawn from NIH's general administrative funds. None of these
funds will come from existing research dollars. This amendment is not
opposed by NIH. I think it will give us a means of making wiser
decisions about how we appropriate dollars in the future.

Amendment No. 1075

(Purpose: To provide for the conduct of a comprehensive, independent
study of National Institutes of Health research priority setting)

Mr. COATS. Mr. President, I now offer this amendment by sending it to
the desk, and ask unanimous consent that Senator Frist be added as an
original cosponsor.
The PRESIDING OFFICER. Without objection, it is so ordered.
Is there objection to setting aside the pending amendments so the
Coats amendment would be considered as a first-degree amendment?
Mr. WELLSTONE. We have no objection.
The PRESIDING OFFICER. Without objection, it is so ordered. The clerk
will report the amendment.
The legislative clerk read as follows:

The Senator from Indiana [Mr. Coats], for himself and Mr.
Frist, proposes an amendment numbered 1075.

Mr. COATS. Mr. President, I ask unanimous consent that further
reading of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:
On page 49, after line 26, add the following:

comprehensive independent study of nih research priority setting

Sec. . (a) Study by the Institute of Medicine.--Not later
than 30 days after the date of enactment of this Act, the
Secretary of Health and Human Services shall enter into a
contract with the Institute of Medicine to conduct a
comprehensive study of the policies and process used by the
National Institutes of Health to determine funding
allocations for biomedical research.
(b) Matters To Be Assessed.--The study under subsection (a)
shall assess--
(1) the factors or criteria used by the National Institutes
of Health to determine funding allocations for disease
research;
(2) the process by which research funding decisions are
made;
(3) the mechanisms for public input into the priority
setting process; and
(4) the impact of statutory directives on research funding
decisions.
(c) Report.--
(1) In general.--Not later than 6 months after the date on
which the Secretary of Health and Human Services enters into
the contract under subsection (a), the Institute of Medicine
shall submit a report concerning the study to the Committee
on Labor and Human Resources and the Committee on
Appropriations of the Senate, and the Committee on Commerce
and the Committee on Appropriations of the House of
Representatives.
(2) Requirement.--The report under paragraph (1) shall set
forth the findings, conclusions, and recommendations of the
Institute of Medicine for improvements in the National
Institutes of Health research funding policies and processes
and for any necessary congressional action.
(d) Funding.--Of the amount appropriated in this title for
the National Institutes of Health, $300,000 shall be made
available for the study and report under this section.

Mr. COATS. Mr. President, I appreciate the support and the efforts
that Senator Wellstone has provided. We have discussed this matter on a
number of occasions. He is, I believe, willing to accept the amendment
and supports what we are trying to do.
I know Senator Frist and maybe others would like to speak on the
Coats amendment. I yield the floor.
The PRESIDING OFFICER (Ms. Collins). The Senator from Minnesota.
Mr. WELLSTONE. Madam President, could I add Senator Bryan as an
original cosponsor of the Wellstone-McCain amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. WELLSTONE. I thank my colleague from Indiana and also my
colleague from Tennessee for their thoughtful and important amendment,
and I thank them for their support.
The PRESIDING OFFICER. The Senator from Tennessee is recognized.
Mr. FRIST. I rise to commend my colleagues, Senators Wellstone and
McCain, for their excellent leadership on this issue and their
commitment to improving the lives of patients suffering from
Parkinson's disease.
I would like to recognize at this time the important efforts of all
of the advocacy groups who have done such a wonderful job in educating
people broadly, increasing the awareness about the devastation of this
disease, and the continued need for research, and to the causes and to
the treatments and to the eventual cure of Parkinson's disease. It is
in large part due to these efforts, this broad effort at the grassroots
level across this country that there has been increased focus on
Parkinson's disease and Parkinson's research at the National Institutes
of Health.
I want to reiterate and support the words of my colleague from
Indiana who has expressed some concern with regard to the process of
how these decisions are made and are brought forward, and thus our
amendment which he has put forward. As chair of the subcommittee on
public health and safety that has jurisdiction over the majority of the
public health agencies, including the National Institutes of Health, I
must state today, because I believe we should not be placing
authorizing legislation on an appropriations bill but should rather be
considering this particular bill within the overall NIH reauthorization
process.
I, along with my fellow committee members, Senators Jeffords and
Coats, have discussed at length the critical role our public health
agencies play in improving the health and well being of American
citizens. We have a strong commitment to push forward authorization
legislation for each of the National Institutes of Health's vital
programs, but we have to do this in a systematic way through a coherent
process, one in which we would be able to give thoughtful review and
comparative review to the programs that we establish.
Thus, although I am very supportive of increasing funding in support
for Parkinson's research, my preference very clearly would have been to
work

[[Page S8716]]

with my colleague and to include this bill within our overall NIH
reauthorization bill that would address the various concerns.
I also want to reiterate what my colleague from Indiana has said,
that we have to be very careful because once again we are falling into
this risky area of establishing a precedent that once again we take a
disease either of the week or of the month or of the year or in
reflection or in response to a very strong advocacy group and react to
that individual disease without consideration of this larger process.
Every week people come to my office with multiple voices requesting
more funds to be allocated to research in a variety of diseases. It
might be heart disease, lung disease, kidney disease or pancreatic
disease or neurological research. Again, each comes forward making a
very strong case. As a physician, and as one who is empathetic and who
has treated many of these diseases, my initial response is to say we
should increase funding, and if we do increase funding we will find a
cure, better treatment or relieve suffering.
The problem is that is exactly the way the system works today. I am
concerned that if we continue to appropriate as we are today, disease
by disease, we are sending an inaccurate or wrong message to our
patient groups. Therefore, we come in today with this amendment, to
have a comprehensive study of talking, of discussing exactly how these
decisions of prioritization, of research, should be made.
As a physician and as a researcher, I understand the many, many
complex factors that must be considered in determining the priorities
for research and the enormous difficulty that exists in making
decisions of heart disease versus lung disease versus renal disease
versus pancreatic disease versus Parkinson's disease. Indeed, each of
us in this Chamber, if you came and asked us, would have different
priorities based on our own personal circumstances, who we know who has
come to see us, who in our family has suffered from a particular
disease, and then we are asked to turn around and vote on particular
pieces of legislation to be supported by the available research
dollars.
My fellow members of the Senate Labor Committee and I have discussed
the issue of the priority-setting process within the NIH in two
hearings, one on May 1 and the other on July 24. In those hearings we
engaged the various committee members in the dialog about the process
at the National Institutes of Health regarding funding allocation
decisions and what should be the appropriate congressional role in
directing Federal biomedical research dollars. Our committee members
have expressed concern, as again so well articulated by the Senator
from Indiana, that Congress should take caution in micromanaging
biomedical research by establishing legislative mandates for specific
areas of research without a thorough comparative review of other
diseases, of other interests.
We have to be honest with ourselves that there is genuine
disagreement among various constituencies about how NIH funds should be
distributed among the various institutes and agencies at the NIH.
Indeed, there has been much discussion over the need for increased
Parkinson's research, and I recognize that disputes have taken place
regarding over what the exact amount of research dollars currently
spent on Parkinson's disease should be.
As legislators, we have a responsibility, an obligation to the
American people to assess the overall strategy, the overall system, the
overall process of prioritizing our research dollars. We must do that
to ensure the public trust in the decisionmaking process as the NIH
addresses the health needs of the Nation.
However, we must ensure that we are funding the best scientific
opportunities through the appropriate process. I believe we all have
the same goal, to use our resources in the very best way possible to
reduce the burden of illness and human suffering. Our challenge is to
figure out the system, the process, the path for best achieving that
goal. I believe the best way to answer these questions is to ensure
that the process at the NIH is working, that the public has a vote in
that process.
The amendment we are offering today supports a study to be undertaken
by the Institute of Medicine of the National Academy of Science to
conduct a comprehensive independent study of the policies and the
processes used by the NIH to determine how they allocate funds for
biomedical research. The study will look at those factors or criteria
that are used to determine funding allocations for disease research,
the process by which these research funding decisions are made, the
mechanisms for public input into the priority-setting process, to make
sure we hear from the public, and lastly, the impact of the statutory
directives on research funding decisions.
The report of the study will set forth the findings and the
recommendations and the conclusions of the Institute of Medicine for
improvements in this process, and the Institute of Medicine will submit
the report to both the Senate and the House authorizing committee and
Appropriations Committees within 6 months.
I believe this is the best way to address this challenge of
prioritizing research. It is my goal that we ensure that the process
and the policies at the NIH appropriately address funding allocation
and research decisions. The scientific community is equipped to help
set the Nation's research priorities.
In conclusion, I again want to state my preference on the underlying
amendment would have been to work with my colleagues in the Senate
within the overall NIH reauthorization process to resolve the various
issues rather than legislating on the appropriations bill today.
However, I do support the underlying bill to support the increase in
Parkinson's research, and I urge my colleagues to support our amendment
to initiate this comprehensive independent study of NIH policies and
processes for making funding decisions in the future.
I yield the floor.
The PRESIDING OFFICER. The Senator from Vermont is recognized.
Mr. JEFFORDS. I speak in favor of the Coats amendment and I urge its
adoption. I do have problems with the underlying amendment. On the
other hand, I recognize that the large majority of Members desire to
tell NIH what they should be doing with respect to Parkinson's disease.
I also recognize it is a serious problem for those that have
Parkinson's disease, and many of my friends across the country do so.
I think the Coats amendment is an important addition to let NIH know
that they have to at least be more forthcoming with respect to the
processes they use in determining how they should expend the money in
research. I, therefore, commend Senator Coats for bringing this to our
attention, and as a way to prevent the need for amendments such as the
underlying amendment as we move toward the future.
I yield the floor.
The PRESIDING OFFICER. The Senator from Pennsylvania is recognized.
Mr. SPECTER. Parliamentary inquiry. What is the status of the pending
issue before the Senate?
The PRESIDING OFFICER. The pending question is the Coats amendment
numbered 1075.
Mr. SPECTER. Further inquiry, Madam President. Has the amendment
offered by Senator McCain and Senator Wellstone been set aside?
The PRESIDING OFFICER. It has been set aside.
Mr. SPECTER. Madam President, the amendment offered by the
distinguished Senator from Indiana is acceptable to this side of the
aisle. It calls for a study which I think is well-founded, and we are
prepared to accept it.
I commend my colleague from Indiana for offering the amendment.
The PRESIDING OFFICER. The question is on agreeing to amendment
numbered 1075, offered by the Senator from Indiana.
The amendment (No. 1075) was agreed to.
Mr. SPECTER. Madam President, if we can proceed with sequencing, I
have just discussed with the Senator from Indiana a subsequent
amendment which he intends to offer and he is prepared to accept a 20-
minute time limit, equally divided, so we can proceed to a vote on that
amendment in relatively short order.
I believe we will have to get concurrence from my colleague, Senator
Harkin.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.

[[Page S8717]]

Mr. SPECTER. I ask unanimous consent that the order for the quorum
call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. SPECTER. I think we will be able to work out a time agreement, 20
minutes equally divided, but we have to check on the other side of the
aisle.
Why do we not proceed at this time, and then we will work on that
time agreement. I suggest my colleague from Indiana proceed with his 10
minutes at this time.
Mr. COATS. If I could state to the Senator, before we have an
agreement, why do I not just, while we are working on the agreement,
why do I not begin? I could probably pretty much make my statement, and
I might not need the full 10 minutes in the agreement. I will be glad
to yield back. There are a certain amount of things I want to say.
Until we hear from the other side----
Mr. HARKIN. I think if we might, the Senator from Indiana would go
ahead and make some remarks and at least at the beginning outline what
his amendment is about. That will certainly alert offices. If we do not
hear, in a decent amount of time, that some people are objecting to a
time limit, we will go ahead with an agreement.
Mr. SPECTER. I think that arrangement is acceptable.
Why do we not proceed on that basis, with the Senator from Indiana
proceeding with his argument, and we will try to solidify that time
agreement as we hotline it or allow Members to know what we are doing
generally.
The PRESIDING OFFICER. The Senator from Indiana is recognized.
Mr. COATS. The amendment I will offer, and I will hold offering it
until such time as an agreement can be at least reached on the other
side, this amendment is something that we have debated before. I think
it is an important debate. I think it does not require that we make a
lengthy debate because it has been discussed and debated.
I want to make sure that each Senator is aware of a certain practice
and the implications of that practice before they cast their final vote
on the Parkinson's research or any other research that might involve
the use of fetal tissue. The amendment says, briefly, notwithstanding
any other provision of law, none of the amounts subject to the
provisions of subsection (e) of the Morris K. Udall Parkinson's
Research Act of 1997 may be expended for any research which utilizes
human fetal tissues, cells, or organs obtained from a living or dead
embryo or dead fetus during or after an induced abortion. The
subsection does not apply to human fetal tissues, cells, or organs
obtained from a spontaneous abortion or an ectopic pregnancy.
We just debated, and I believe will vote tonight or tomorrow, and
certainly it will pass and I will vote for it, the provision offered by
the Senator from Minnesota to increase funding for Parkinson's
research. I was pleased the Senate accepted the amendment I just
offered to provide a study which will give us guidance in terms of how
we can direct research funds in the future.
But on the question of Parkinson's research, it is important that we
address an issue that a lot of people do not like to talk about but it
is an issue that I think is relevant and one that is important, and
that is that in certain research--and I believe it is very limited
research, and fortunately it is research that is much more limited than
it was in the past because it has not shown that much promise--the
implantation of human fetal tissue has been one of the means by which
researchers have attempted to address the symptoms of Parkinson's
disease.
Now, from a practical standpoint it is important to understand that
the amendment here only affects use of fetal tissue, the use of funds
to provide fetal tissue research for Parkinson's disease. There are a
number of other diseases, diabetes and others, that use fetal tissue
research, and that is a subject for a separate time. This only applies
to that particular section of the Udall bill and it simply says that
funds that we will appropriate cannot be used for fetal tissue
research. It does not affect research in other areas. It does not
affect indirect research that affects Parkinson's.
Frankly, I do not know that this should even be an issue in
Parkinson's, and I cannot speak with scientific authority, but to the
best of my knowledge fetal tissue research has held very little and is
diminishing in importance in terms of Parkinson's research.
The Parkinson's Action Network has issued a statement, and I will
quote from that statement that says:

Even those involved with fetal tissue research readily
acknowledge that the result of their research will not use
human fetal tissues. Current work is intended only to
demonstrate the capability. Ultimately, another source of
fetal material must be found.

That is the statement from the Parkinson's Action Network.
So we are not even talking about direct use here as a potential cure
or alleviation of circumstances of Parkinson's. One of the reasons for
that is that human tissue has consistently been found to be unsanitary
or not fit for clinical use.
Now, the good news is that there are other sources of tissue that
have shown some promise that are not from induced abortions. There are
xenografts, fetal pig tissue, that at this time and to my understanding
are believed to be more useful than human tissue.
There are human cell lines that are more promising sources of tissue
than tissue derived from abortions. Genetically engineered cell
research has shown significant promise. And tissue that is derived from
miscarried pregnancies is now being utilized as a substitute for
utilizing fetal tissue from induced abortions.
So I want my colleagues to understand, we are not trying to impede
significant research on Parkinson's from the limited amount of research
that does come from fetal tissue. There are alternative means of
obtaining tissue, whether it is animal tissue, whether it is human cell
lines, whether genetically engineered, or whether it is actual fetal
tissue, but fetal tissue obtained from miscarriages, from spontaneous
abortions, which are miscarriages, but also from ectopic pregnancies.
So there are alternatives to obtain the material necessary for this
research.
In addition, the research seems to be moving away from fetal tissue
and even new tissue toward more promising areas of research in
Parkinson's disease. Implanted brain stimulators work for some but
obviously do not work for all. Surgical pallidotomies, proton therapy,
genetic-based therapy--these are all alternatives to the fetal tissue
research.
So, therefore, just from a practical standpoint, regardless of how
you feel about the ethical question, I think there is a real basis to
avoid the controversy and to avoid the profound ethical questions and
concerns that arise from the utilization of human fetal tissue through
induced abortions.
What are those ethical questions that we ought to be asking
ourselves? Many of us in the Senate--I am included in this--either have
parents, children, spouses, relatives, friends, or colleagues who have,
unfortunately, incurred a neurological disease in which fetal tissue
transplantation has offered some hope of treatment. So it is not a
subject that we ought to lightly dismiss.
I just outlined why I think in the area of Parkinson's research that
it is really not even a major issue any more. But I think we have to
address the question of the wrenching dilemma that it ought to pose--
that is posed--by the issue of human tissue research. Therefore, I
think we ought to be searching for a path that serves both public
health needs and concerns and the questions of moral principle, a path
that offers hope for breakthroughs in research, for cures, for
alleviating symptoms, but a path which also shows ethical insight.
Scientific research does not occur in a moral vacuum. I think it has
to be guided by something that is more than just practically possible
or feasible research. It has to be guided by some ethical
considerations that I think each of us need to ask ourselves.
In this regard, the ethical questions, I believe, are the following:
Question No. 1: Will the use of tissue from elective abortions create
an irreversible economic and an institutional bond between abortion
centers and biomedical science?
Just think for a minute. If medical research becomes dependent on
widespread abortion, a vested interest would clearly be created in a
substantial uninterrupted flow of human fetal

[[Page S8718]]

tissue. Medical science would be dependent on continued legal abortion
on demand. Does that create an ethical dilemma? I would argue that it
does. The reason that it does is that there is no way that we could
provide sufficient tissue from spontaneous abortions, miscarriages, or
ectopic pregnancies because we know that if tissue transplants are the
cure for diabetes, Parkinson's, Alzheimer's, and other neurological
trauma, then we are talking about between 34 million and 20 million
fetuses a year necessary to supply the need for the fetal tissue to
address the problem.
So just on this basis alone, it seems that we need to look at
alternative ways to generate fetal tissue without elective abortions--
to look at cell cultures, use of animal tissue, and other research that
I have just mentioned. We have an ethical nightmare, a potential
ethical nightmare that we will face if we can't address ourselves to
alternatives.
Another question is: By what right is this fetal tissue obtained?
Certainly the remains of the fetus in elective abortions are not
donated in the traditional sense of the word. The fetus can't give
consent. It is instead provided by the very people who have made the
decision to end the life of the fetus. Can the person who ends the life
be morally permitted to determine the use of the organs in the life
that that person just ended?
Mr. SPECTER. If the distinguished Senator will yield for a moment.
Mr. COATS. I would be happy to yield to the Senator.
Mr. SPECTER. Madam President, we have been checking with various
Senators to see if we could reach a unanimous-consent agreement, and it
now appears that we will not be able to make that determination very
fast. Senators are waiting to find out what is going to happen with
respect to the vote and we had earlier talked about stacked votes at 7.
It now appears we cannot have stacked votes. So we will set the vote at
7 o'clock by agreement with the other side of the aisle on the
Wellstone-McCain, McCain-Wellstone amendment so we will at least
proceed with that vote at that time, and by 7 we should be in a
position to know what we will be able to do about a unanimous-consent
agreement here and further scheduling.
I thank my colleague from Indiana for yielding.
The PRESIDING OFFICER. Does the Senator make a request that the vote
occur at 7 p.m?
Mr. COATS. Yes.
The PRESIDING OFFICER. Is there objection?
Mr. WELLSTONE. Madam Chair, I will not object, but might I inquire,
the amendment that we have introduced, Wellstone-McCain, McCain-
Wellstone, this precludes a second-degree amendment, I gather. Is that
correct?
Mr. SPECTER. Madam President, parliamentary inquiry as to whether it
precludes a second-degree amendment.
The PRESIDING OFFICER. The present agreement would not preclude a
second-degree amendment.
Mr. WELLSTONE. Madam Chair, I ask unanimous consent that this vote at
7 preclude a second-degree amendment.
Mr. SPECTER. I agree with that modification, Madam President.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. COATS addressed the Chair.
The PRESIDING OFFICER. The Senator from Indiana.
Mr. COATS. Madam President, I regret that we were not able to obtain
an agreement. I will finish my statement very shortly here and then
offer the amendment. I certainly would agree to set it aside so that
the Senator from Pennsylvania can continue with what other business he
has. We obviously will have to address this issue in greater detail at
another time, either later this evening or tomorrow.
Mr. SPECTER. Madam President, I think it may still be possible to
have a time agreement, but we could not get that determination. Rather
than await that determination to get back-to-back votes, I decided we
ought to get the vote set at 7 and perhaps we could have a time
agreement entered into after that. We will decide when to have the
vote, but perhaps we can have a time agreement. We have a great many
amendments pending, and to the extent we can have limited time
agreements, we ought to try to do that.
I thank my colleague from Indiana.
Mr. COATS addressed the Chair.
The PRESIDING OFFICER. The Senator from Indiana is recognized.
Mr. COATS. Let me return to the question of the ethical dilemma that
is posed with utilization of fetal tissue in research. There is a broad
ethical question that affects all neurological research or any research
that utilizes human fetal tissue. I have tried to raise some of the
questions that I think ought to give all of us pause before we sign off
on the use of human fetal tissue in medical research.
Does it create an irreversible economic and institutional bond been
abortion centers and biomedical science? That is a legitimate question.
Because if the cure or alleviation of symptoms for neurological
diseases, diseases including Alzheimer's and Parkinson's and diabetes
and other neurological trauma, is dependent on utilization of human
fetal tissue, then we are talking about the need to supply fetal tissue
patches or pieces from up to 20 million abortions, induced abortions a
year. That poses a profound ethical question.
Second, the question is, by what right will we obtain this fetal
tissue? We obtain it with the consent of the very person who has made
the decision to end the life of the fetus from which the fetal tissue
will be derived. So there is no such thing as consent of the human
species, the human being, the human person whose life is ended to
provide the fetal tissue in the name of medical science.
And is it really possible to separate the practice of abortion from
its use in biomedical research? Are researchers merely using the
results of abortion, or are they dictating its practice?
There are real concerns about how fetal tissue is derived, how it is
procured. A report issued by the University of Minnesota Center for
Bioethics has stated that in Sweden, ``Doctors say they have obtained
brain tissues with a forceps before the fetus was suctioned out of the
mother. That raises the question of whether the fetus was killed by the
harvesting of brain tissue or by abortion.''
Janice Raymond, professor of women's studies and medical ethics at
the University of Massachusetts, has testified that doctors are already
altering the methods of abortion in order to get the tissue that they
desire, and I quote from her.

Doctors who are eager to get good tissue samples must put
women at additional risk of complication by altering the
methods of performing abortions and by extending the time it
takes to perform the conventional abortion procedure.

Dorie Vawter of the Center for Bioethics at the University of
Minnesota has reaffirmed this observation, noting that some clinics
currently alter abortion methods for tissue harvesting--slowing down
the abortion procedure, reducing the pressure of the suction machine,
and increasing the size of dilation instruments, all practices which
place women at additional risk.
And so in the harvesting of human tissue, the human tissue has to be
at a certain condition. I talked a few moments ago about how much of
this tissue is unfit for effective use in Parkinson's research or other
neurological research. And now we have testimony of people who are
altering the procedures of obtaining the human fetal tissue so that the
human fetal tissue is in a better condition for this research. But in
doing so they place the health of the woman who is carrying the child,
from whom the fetal tissue is derived, at greater health risk.
And then I think we have to ask probably the most difficult of
questions, and that is, are we encouraging abortion by covering it with
a veneer of compassion?
Dr. Kathleen Nolan, formerly of the Hastings Center, writes,

Lifesaving cures resulting from the use of cadaveric
material might make abortion, and fetal death, seem less
tragic. Enhancing abortion's image could thus be expected to
undermine efforts to make it as little needed and little done
procedure as possible.

This is a very real concern because often people come up to me and
say: Why do you offer amendments? Why do you think that utilization of
fetal tissue should be restricted to noninduced abortions, because it
does so much good, it holds so much potential.
Look at the ethical question involved. Is taking a life, is killing a

[[Page S8719]]

fetus in order to obtain material that is useful in providing research
which offers promising health benefits to individuals, is that not one
of the most profound ethical and moral questions that we have to face?
And so I think when we look at a question like this, we clearly have
to understand, as Stephen Post said,

Ultimately, it is the specter of a society whose medical
institutions are inextricably bound up with elective abortion
and whose people come to believe that for their own health
they have every right to feed off the unborn, that gives
pause.

Arthur Caplan of the University of Minnesota expresses these concerns
in another way.

This is the ultimate issue of generational justice. You're
not just asking for the pocketbooks of the young--you're
asking for their body parts.

Now, fortunately, Madam President, we have alternatives available to
us. I have listed those alternatives. In the case of Parkinson's, and
that is the issue we are facing here--we will address the other issue
at another time--but in the case of Parkinson's research, we are
learning that fetal tissue research is of diminishing importance and of
diminishing effectiveness.
We are learning that there are more viable alternatives that hold far
greater benefit and hope for breakthroughs in treating Parkinson's than
fetal tissue. And so while I think it is appropriate that we are
focusing on increasing funds for research in Parkinson's, I believe it
is also appropriate that we place this most limited of restrictions on
this research, both for practical reasons because it offers very little
hope of any research breakthroughs and because this tissue can be
obtained by other alternatives without taking human life, without
inducing abortions. Fetal tissue cells from human fetuses can be
obtained through miscarriages, spontaneous abortions, ectopic
pregnancies, but the other forms of research, the xenografts from
animal tissue, which are now being found to be more useful than human
tissue, human cell lines, genetically engineered cells, and then all
the other more promising means of research in Parkinson's, I think
allow us to say that at least in this area we will not pursue and we do
not need to pursue the utilization of human fetal tissue.

Amendment No. 1077

(Purpose: To prohibit the use of funds for research that utilizes human
fetal tissue, cells, or organs that are obtained from a living or dead
embryo or fetus during or after an induced abortion)

Mr. COATS. So with that, Madam President, I send my amendment to the
desk and ask for its consideration with the understanding that it may
be possible to enter into an agreement that would limit the time.
The PRESIDING OFFICER. Is there objection to setting aside the
pending amendment? Hearing no objection, it is so ordered.
The clerk will report the amendment.
The legislative clerk read as follows:

The Senator from Indiana [Mr. Coats], for himself and Mr.
Nickles, proposes an amendment numbered 1077.

Mr. COATS. Madam President, I ask unanimous consent that reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

At the appropriate place, insert the following:
Sec. . Limitation on Use of Funds.--Notwithstanding any
other provisions of law, none of the amounts subject to the
provision of subsection (e) of the ``Morris K. Udall
Parkinson's Research Act of 1997'' may be expended for any
research that utilizes human fetal tissue, cells, or organs
that are obtained from a living or dead embryo or fetus
during or after an induced abortion. This subsection does not
apply to human fetal tissue, cells, or organs that are
obtained from a spontaneous abortion or an ectopic pregnancy.

Mr. COATS. Madam President, I yield the floor.
Mr. HARKIN. Madam President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
Mr. KENNEDY. Will the Senator withhold.
Mr. HARKIN. I withdraw that.
The PRESIDING OFFICER. The Senator from Massachusetts is recognized.

Privilege Of The Floor

Mr. KENNEDY. Madam President, I ask unanimous consent that Susan
Hammersten, a fellow in my office, be granted the privilege of the
floor during the pending Labor, HHS appropriations bill.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. KENNEDY. Madam President, I strongly support the amendment that
Senator McCain and Senator Wellstone have offered. More research is
clearly needed if we are to conquer this debilitating disease that
afflicts more than a million Americans.
I strongly disagree, however, that this is an appropriate place to
revisit the issue of fetal tissue research, and I urge the Senate to
defeat the Coats amendment.
The earlier ban on fetal research was lifted 4 years ago, and that
action was deeply justified. The ban was lifted by the administration
and Congress after careful consideration and exhaustive debate.
Research involving fetal tissue holds the potential to provide
tremendous advances in treatments and cures for a long list of
debilitating conditions such as Parkinson's disease, Alzheimer's
disease, Huntington's disease, diabetes, multiple sclerosis, epilepsy,
blindness, leukemia, hemophilia, sickle cell anemia, spinal cord
injuries, deficiencies of the immune system, birth defects, and certain
conditions causing intractable pain. The list goes on and on.
It is no wonder, then, that opposition to a ban on fetal tissue
research is supported by a wide range of organizations dedicated to
improving the health of Americans, including the Alzheimer's
Association, the Epilepsy Foundation of America, the Cystic Fibrosis
Foundation, the Parkinson's Disease Foundation, and the Society for
Pediatric Research.
Four years ago, Congress decided that the benefits of this research
far outweighed the unsubstantiated fears and concerns that the need for
fetal tissue would lead to increases in abortions. The vote in the
Senate to lift the ban was a resounding 93 to 4.
The bill enacted in 1993 established rigorous standards to safeguard
against any possibility that fetal tissue research would influence
individual decisions about abortion. Those safeguards are in place and
they are working--and working well.
A 1997 GAO study of the safeguards reports that ``the act's
documentation requirements were met'' and that ``there have been no
reported violations in the acquisition of human fetal tissue for use in
transplantation.''
The safeguards are working not just in research on Parkinson's
disease, but in all research involving fetal tissue. It is irrational
and inappropriate to revisit this debate by singling out research on
Parkinson's disease for excessive restrictions.
Since 1993, the NIH has awarded more than $23 million in grants for
research involving the study, analysis, and use of human fetal tissue.
The research that is being carried out today is producing effective
solutions that can end the suffering associated with a wide variety of
illnesses, and it makes no sense, no sense at all, to restrict it.
One other point should be made. The research being conducted today
with fetal tissue is also providing new techniques such as specialized
cell lines and genetically engineered cells. In fact, the development
of these new technologies may well eliminate the need for using fetal
tissue for research purposes. Ironically, the best way to achieve the
goal of the Coats amendment is to defeat the Coats amendment, and I
urge the Senate to do so.
My Republican colleagues have argued that women will decide to have
an abortions in order to donate tissue for research.
These claims are unfounded and uncorroborated. The substantial
history of fetal tissue research--extending back at least 30 years to
the development of the polio vaccine--shows no evidence--and no
evidence has been presented here to the Senate this evening--that the
results have encouraged abortion.
American women for various personal and entirely unrelated reasons
choose to have over 1 million legal abortions each year. These legal
abortions will continue to be performed in the future, regardless of
the extent of fetal tissue research.
Congress enacted stringent safeguards to address this claim. No woman
can know in advance if the remains from her abortion would or even

[[Page S8720]]

could be used for research purposes. A woman may not be approached for
consent to donate the aborted tissue until after she has made the
decision to have an abortion.
Safeguards established by the NIH have eliminated any potential
incentives for abuse. No profit can be derived from providing the
tissue for research. No family member or friend can benefit from a
woman's abortion. A woman may not designate who will be the recipient
of the tissue.
This issue has been reviewed and studied as to the effectiveness of
the rules and regulations which have been established. It is
effectively working and working well. This amendment would have an
adverse impact in terms of the real potential for making significant
progress in areas of research, and it would not be justified in terms
of providing the kind of restrictions that are included in the Coats
amendment. For that reason, I hope the Coats amendment will not be
accepted.
Madam President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. WELLSTONE. Madam President, I ask unanimous consent that the
order for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

Amendment No. 1074, as modified

Mr. WELLSTONE. Madam President, on the Wellstone-McCain/McCain-
Wellstone amendment, I ask unanimous consent that Senator Boxer be
added as a cosponsor.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. WELLSTONE. Madam President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. WELLSTONE. Madam President, I ask unanimous consent that the
order for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. WELLSTONE. Mr. President, I ask unanimous consent that Senator
Robb be listed as a cosponsor of the Wellstone-McCain / McCain-
Wellstone amendment.
The PRESIDING OFFICER (Mr. Brownback). Without objection, it is so
ordered.
Mr. WELLSTONE. I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. WELLSTONE. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
The question is on agreeing to amendment No. 1074, as modified. The
yeas and nays have been ordered. The clerk will call the roll.
The bill clerk called the roll.
Mr. NICKLES. I announce that the Senator from Alaska [Mr. Murkowski]
is necessarily absent.
Mr. FORD. I announce that the Senator from Hawaii [Mr. Inouye] is
necessarily absent.
The result was announced--yeas 95, nays 3, as follows:

[Rollcall Vote No. 214 Leg.]

YEAS--95

Abraham
Akaka
Allard
Baucus
Bennett
Biden
Bingaman
Bond
Boxer
Breaux
Brownback
Bryan
Bumpers
Burns
Byrd
Campbell
Chafee
Cleland
Coats
Cochran
Collins
Conrad
Coverdell
Craig
D'Amato
Daschle
DeWine
Dodd
Domenici
Dorgan
Durbin
Faircloth
Feingold
Feinstein
Ford
Frist
Glenn
Gorton
Graham
Gramm
Grams
Grassley
Gregg
Hagel
Harkin
Hatch
Helms
Hollings
Hutchinson
Hutchison
Inhofe
Johnson
Kempthorne
Kennedy
Kerrey
Kerry
Kohl
Kyl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lott
Lugar
Mack
McCain
McConnell
Mikulski
Moseley-Braun
Moynihan
Murray
Nickles
Reed
Reid
Robb
Roberts
Rockefeller
Roth
Santorum
Sarbanes
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Specter
Stevens
Thomas
Thompson
Thurmond
Torricelli
Warner
Wellstone
Wyden

NAYS--3

Ashcroft
Enzi
Jeffords

NOT VOTING--2

Inouye
Murkowski

The amendment (No. 1074), as modified, was agreed to.
Mr. WELLSTONE. I move to reconsider the vote.
Mrs. FEINSTEIN. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Mr. CRAIG. Mr. President, each year a small portion of the Medicare
budget is devoted to HCFA's Office of Research and Demonstrations for
Activities that help guide Medicare policymaking on coverage, financing
and other operational issues. This year the Appropriations Committee
has approved $47 million for this purpose, an increase, of $3 million
over the last year.
The Appropriations Committee has urged the Secretary of Health and
Human Services to use a portion of this research budget to conduct a 2-
year demonstration project on coverage of medical nutrition therapy by
registered dietitians under Medicare part B. I would like to take this
opportunity to reiterate my support for this project and to urge the
Secretary to move expeditiously to initiate this program.
Research has shown that medical nutrition therapy is an effective way
to save health care dollars and improve patient outcomes. By reducing
and shortening hospital admission, preventing and controlling medical
complications and limiting the need for physician follow-up visits,
medical nutrition therapy can lower the cost of treating a variety of
diseases. Of particular note are the savings that have been documented
for patients with diabetes and cardiovascular disease, two ailments
that account for a staggering 60 percent of all Medicare expenditures.
As we continue efforts to modernize and improve the Medicare Program,
we should not overlook medical nutrition therapy as an important way to
save program dollars and improve patient treatment options. A
demonstration project in this area will help us understand how we can
best integrate this important service into any future Medicare
improvements.

amendment no. 1057

Mr. MOYNIHAN. Mr. President, earlier today I voted to support Senator
Harkin's amendment to fund the Food and Drug Administration's ``Youth
Tobacco Initiative'' regulations. When this amendment was first offered
on July 23, 1997, I voted to table it. I was concerned at that time
that the offset was a tax; taxes fall under the jurisdiction of the
Ways and Means and Finance Committees. I am pleased that Senator Harkin
changed the offset so that I was able to vote for the amendment today.
I am a strong supporter of the Food and Drug Administration's efforts
to reduce the number of young people who begin smoking cigarettes each
year. I believe that the money designated for that purpose today is
crucial to the success of those efforts.
The PRESIDING OFFICER. Who seeks recognition?
Mr. WELLSTONE addressed the Chair.
The PRESIDING OFFICER. The Senator from Minnesota.
Mr. WELLSTONE. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. LOTT. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

____________________