[Congressional Record Volume 143, Number 155 (Friday, November 7, 1997)]
[Senate]
[Pages S11943-S11947]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
NIH ENDORSES ACUPUNCTURE
Mr. HARKIN. Mr. President, earlier this week an expert scientific
panel at the National Institutes of Health strongly endorsed
acupuncture as an effective treatment for certain conditions. This is
the first time that the NIH has endorsed a major alternative therapy.
It is truly a breakthrough, and is just the type of advance that I
envisioned when I worked to establish the Office of Alternative
Medicine at the NIH.
The consensus conference held by NIH involved top scientists from
around the Nation, including those with expertise in acupuncture and
experts in research evaluation and design. These scientists, led by Dr.
David Ramsey, president of the University of Maryland, Baltimore,
objectively evaluated the evidence of acupuncture's efficacy and came
to a consensus that this therapy is safe and provides significant help
for a number of health problems.
They found that acupuncture is an effective treatment for
postoperative dental pain, postoperative and chemotherapy-induced
nausea, nausea during pregnancy, and other conditions. They also
identified a number of other conditions, including asthma, substance
addiction, stroke rehabilitation, headache, general muscle pain, low
back pain, carpal tunnel syndrome, for which acupuncture demonstrates
effectiveness but with a less degree of certainty.
I was dismayed to read that despite this consensus agreement after
rigorous evaluation of the scientific evidence, there is still a fringe
element in the medical community that refuses to acknowledge the facts.
These critics seem only to be interested in bad mouthing anything out
of what they consider to be the medical mainstream. While we all
benefit from a healthy dose of skepticism in the scientific process, I
hope in the future, this small group of critics take off their blinders
long enough to objectively look at the scientific evidence and give
credit where credit is due.
Mr. President, as I have said before, millions of Americans--more and
more each day--are using alternative medical therapies. In 1993, the
FDA reported that Americans were spending $500 million a year for
between 9 and 12 million acupuncture treatment visits. Unfortunately,
research has not kept pace. The NIH has failed to break through biases
that exist and devote the attention to this area that is needed. As a
result, American consumers have been denied information about the
effectiveness of the therapies they are using or thinking of using.
I am pleased to report that the conference report on the fiscal year
1998 Health and Human Services appropriations bill has agreed to
provide more than a 50-percent increase to the Office of Alternative
Medicine to expand efforts like this week's consensus conference on
acupuncture to other work and to investigate and validate complementary
and alternative therapies. Our report also guarantees that this
increase will be spent on grants and contracts that directly respond to
requests for proposals and program announcements issued by the Office
of Alternative Medicine.
Mr. President, this week's endorsement of acupuncture by NIH is a
positive step forward for the American public and for the medical
research in our Nation. I hope that it will lead not only to greater
acceptance of, and access to, cost effective acupuncture services, but
to increased willingness on the part of NIH and the medical community
to commit to the objective evaluation of a range of promising
complementary and alternative medical therapies.
Mr. President, I ask that the full text of the findings of this
historic NIH consensus panel be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
National Institutes of Health Consensus Development Statement
introduction
Acupuncture is a component of the health care system of
China that can be traced back for at least 2,500 years. The
general theory of acupuncture is based on the premise that
there are patterns of energy flow (Qi) through the body that
are essential for health. Disruptions of this flow are
believed to be responsible for disease. The acupuncturist can
correct imbalances of flow at identifiable points close to
the skin. The practice of acupuncture to treat identifiable
pathophysiological conditions in American medicine was rare
until the visit of President Nixon to China in 1972. Since
that time, there has been an explosion of interest in the
United States and Europe in the application of the technique
of acupuncture to Western medicine.
Acupuncture describes a family of procedures involving
stimulation of anatomical locations on the skin by a variety
of techniques. The most studied mechanism of stimulation of
acupuncture points employs penetration of the skin by thin,
solid, metallic needles, which are manipulated manually or by
electric stimulation. The majority of comments in this report
are based on data that came from such studies. Stimulation of
these areas by moxibustion, pressure, heat, and lasers is
used in acupuncture practice, but due to the paucity of
studies, these techniques are more difficult to evaluate.
Thus, there are a variety of approaches to diagnosis and
treatment in American acupuncture that incorporate medical
traditions from China, Japan, Korea, and other countries.
Acupuncture has been used by millions of American patients
and performed by thousands of physicians, dentists,
acupuncturists,
[[Page S11944]]
and other practitioners for relief or prevention of pain and
for a variety of health conditions. After reviewing the
existing body of knowledge, the U.S. Food and Drug
Administration recently removed acupuncture needles from the
category of ``experimental medical devices'' and now
regulates them just as it does other devices, such as
surgical scalpels and hypodermic syringes, under good
manufacturing practices and single-use standards of
sterility.
Over the years, the National Institutes of Health (NIH) has
funded a variety of research projects on acupuncture,
including studies on the mechanisms by which acupuncture may
have its effects, as well as clinical trials and other
studies. There is also a considerable body of international
literature on the risks and benefits of acupuncture, and the
World Health Organization lists a variety of medical
conditions that may benefit from the use of acupuncture or
moxibustion. Such applications include pre-vention and
treatment of nausea and vomiting; treatment of pain and
addictions to alcohol, tobacco, and other drugs; treatment of
pulmonary problems such as asthma and bronchitis; and
rehabilitation from neurological damage such as that caused
by stroke.
To address important issues regarding acupuncture, the NIH
Office of Alternative Medicine and the NIH Office of Medical
Applications of Research organized a 2\1/2\-day conference to
evaluate the scientific and medical data on the uses, risks,
and benefits of acupuncture procedures for a variety of
conditions. Cosponsors of the conference were the National
Cancer Institute, the National Heart, Lung, and Blood
Institute, the National Institute of Allergy and Infectious
Diseases, and National Institute of Arthritis and
Musculoskeletal and Skin Diseases, the National Institute of
Dental Research, the National Institute on Drug Abuse, and
the Office of Research on Women's Health and the NIH. The
conference brought together national and international
experts in the fields of acupuncture, pain, psychology,
psychiatry, physical medicine and rehabilitation, drug abuse,
family practice, internal medicine, health policy,
epidemiology, statistics, physiology, and biophysics, as well
as representatives from the public.
After 1\1/2\ days of available presentation and audience
discussion, an independent, non-Federal consensus panel
weighed the scientific evidence and wrote a draft statement
that was presented to the audience on the third day. The
consensus statement addressed the following key questions:
What is the efficacy of acupuncture, compared with placebo
or sham acupuncture, in the conditions for which sufficient
data are available to evaluate?
What is the place of acupuncture in the treatment of
various conditions for which sufficient data are available,
in comparison with or in combination with other
interventions (including no intervention)?
What is known about the biological effects of acupuncture
that helps us understand how it works?
What issues need to be addressed so that acupuncture may be
appropriately incorporated into today's health care system?
What are the directions for future research?
The primary sponsors of this meeting were the National
Human Genome Research Institute and the NIH Office of Medical
Applications of Research. The conference was cosponsored by
the National Institute of Diabetes and Digestive and Kidney
Diseases; the National Heart, Lung, and Blood Institute, the
National Institute of Child Health and Human Development, the
NIH Office of Rare Diseases; the National Institute of Mental
Health; the National Institute of Nursing Research; the NIH
Office of Research on Women's Health; the Agency for Health
Care Policy and Research; and the Centers for Disease Control
and Prevention.
1. What is the efficacy of acupuncture, compared with
placebo or sham acupuncture, in the conditions for which
sufficient data are available to evaluate?
Acupuncture is a complex intervention that may vary for
different patients with similar chief complaints. The number
and length of treatments and the specific points used may
vary among individuals and during the course of treatment.
Given this reality, it is perhaps encouraging that there
exist a number of studies of sufficient quality to assess the
efficacy of acupuncture for certain conditions.
According to contemporary research standards, there is a
paucity of high-quality research assessing efficacy of
acupuncture compared with placebo or sham acupuncture. The
vast majority of papers studying acupuncture in the
biomedical literature consist of case reports, case series,
or intervention studies with designs inadequate to assess
efficacy.
This discussion of efficacy refers to needle acupuncture
(manual or electroacupuncture) because the published research
is primarily on needle acupuncture and often does not
encompass the full breadth of acupuncture techniques and
practices. The controlled trials usually have only involved
adults and did not involve long-term (i.e., years)
acupuncture treatment.
Efficacy of a treatment assesses the differential effect of
a treatment when compared with placebo or another treatment
modality using a double-blind controlled trial and a rigidly
defined protocol. Papers should describe enrollment
procedures, eligibility criteria, description of the clinical
characteristics of the subjects, methods for diagnosis, and a
description of the protocol (i.e., randomization method,
specific definition of treatment, and control conditions,
including length of treatment, and number of acupuncture
sessions). Optimal trials should also use standardized
outcomes and appropriate statistical analyses. This
assessment of efficacy focuses on high-quality trials
comparing acupuncture with sham acupuncture or placebo.
Response rate
As with other interventions, some individuals are poor
responders to specific acupuncture protocols. Both animal and
human laboratory and clinical experience suggest that the
majority of subjects respond to acupuncture, with a minority
not responding. Some of the clinical research
outcomes, however, suggest that a larger percentage may
not respond. The reason for this paradox is unclear and
may reflect the current state of the research.
Efficacy for specific disorders
There is clear evidence that needle acupuncture is
efficacious for adult post-operative and chemotherapy nausea
and vomiting and probably for the nausea of pregnancy.
Much of the research is on various pain problems. There is
evidence of efficacy for postoperative dental pain. There are
reasonable studies (although sometimes only single studies)
showing relief of pain with acupuncture on diverse pain
conditions such as menstrual cramps, tennis elbow, and fibro-
myalgia. This suggests that acupuncture may have a more
general effect on pain. However, there are also studies that
do not find efficacy for acupuncture in pain.
There is evidence that acupuncture does not demonstrate
efficacy for cessation of smoking and may not be efficacious
for some other conditions.
While many other conditions have received some attention in
the literature and, in fact, the research suggests some
exciting potential areas for the use of acupuncture, the
quality or quantity of the research evidence is not
sufficient to provide firm evidence of efficacy at this time.
Sham acupuncture
A commonly used control group is sham acupuncture, using
techniques that are not intended to stimulate known
acupuncture points. However, there is disagreement on correct
needle placement. Also, particularly in the studies of pain,
sham acupuncture often seems to have either intermediate
effects between the placebo and Oreal' acupuncture points or
effects similar to those of the Oreal' acupuncture points.
Placement of a needle in any position elicits a biological
response that complicates the interpretation of studies
involving sham acupuncture. Thus, there is substantial
controversy over the use of sham acupuncture as control
groups. This may be less of a problem in studies not
involving pain.
2. What is the place of acupuncture in the treatment of
various conditions for which sufficient data are available,
in comparison with or in combination with other interventions
(including no intervention)?
Assessing the usefulness of a medical intervention in
practice differs from assessing formal efficacy. In
conventional practice, clinicians make decisions based on the
characteristics of the patient, clinical experience,
potential for harm, and information from colleagues and the
medical literature. In addition, when more than one treatment
is possible, the clinician may make the choice taking into
account the patient's preferences. While it is often thought
that there is substantial research evidence to support
conventional medical practices, this is frequently not that
case. This does not mean that these treatments are
ineffective. The data in support of acupuncture are as strong
as those for many accepted Western medical therapies.
One of the advantages of acupuncture is that the incidence
of adverse effects if substantially lower than that of many
drugs or other accepted medical procedures used for the same
conditions. As an example, musculoskeletal conditions, such
as fibromyalgia, myofascial pain, and ``tennis elbow,'' or
epicondylitis, are conditions for which acupuncture may be
beneficial. These painful conditions are often treated with,
among other things, anti-inflammatory medications (aspirin,
ibuprofen, etc.) or with steroid injections. Both medical
interventions have a potential for deleterious side effects,
but are still widely used, and are considered acceptable
treatment. The evidence supporting these therapies is no
better than that for acupuncture.
In addition, ample clinical experience, supported by some
research data, suggests that acupuncture may be a reasonable
option for a number of clinical conditions. Examples are
postoperative pain and myofascial and low back pain. Examples
of disorders for which the research evidence is less
convincing but for which there are some positive clinical
reports include addiction, stroke rehabilitation, carpal
tunnel syndrome, osteoarthritis, and headache. Acupuncture
treatment for many conditions such as asthma, addiction, or
smoking cessation should be part of a comprehensive
management program.
Many other conditions have been treated by acupuncture, the
World Health Organization, for example, has listed more than
40 for which the technique may be indicated.
3. What is known about the biological effects of
acupuncture that helps us understand how it works?
[[Page S11945]]
Many studies in animals and humans have demonstrated that
acupuncture can cause multiple biological responses. These
responses can occur locally, i.e., at or close to the site of
application, or at a distance, mediated mainly by sensory
neurons to many structures within the central nervous system.
This can lead to activation of pathways affecting various
physiological systems in the brain as well as in the
periphery. A focus of attention has been the role of
endogenous opioids in acupuncture analgesia. Considerable
evidence supports the claim that opioid peptides are released
during acupuncture and that the analgesic effects of
acupuncture are at least partially explained by their
actions. That opioid antagonists such as naloxone reverse the
analgesic effects of acupuncture further strengthens this
hypothesis. Stimulation by acupuncture may also activate the
hypothalamus and the pituitary gland, resulting in a broad
spectrum of systemic effects. Alteration in the secretion of
neurotransmitters and neurohormones and changes in the
regulation of blood flow, both centrally and peripherally,
have been documented. There is also evidence that there are
alterations in immune functions produced by acupuncture.
Which of these and other physiological changes mediate
clinical effects is a present unclear.
Despite considerable efforts to understand the anatomy and
physiology of the ``acupuncture points,'' the definition and
characterization of these points remains controversial. Even
more elusive is the scientific basis of some of the key
traditional Eastern medical concepts such as the circulation
of Qi, the meridian system, and the five phases theory, which
are difficult to reconcile with contemporary biomedical
information but continue to play an important role in the
evaluation of patients and the formulation of treatment in
acupuncture.
Some of the biological effects of acupuncture have also
been observed when ``sham'' acupuncture points are
stimulated, highlighting the importance of defining
appropriate control groups in assessing biological changes
purported to be due to acupuncture. Such findings raise
questions regarding the specificity of these biological
changes. In addition, similar biological alterations
including the release of endogenous opioids and changes in
blood pressure have been observed after painful stimuli,
vigorous exercise, and/or relaxation training; it is at
present unclear to what extent acupuncture shares similar
biological mechanisms.
It should be noted also that for any therapeutic
intervention, including acupuncture, the so-called ``non-
specific'' effects account for a substantial proportion of
its effectiveness, and thus should not be casually
discounted. Many factors may profoundly determine therapeutic
outcome including the quality of the relationship between the
clinician and the patient, the degree of trust, the
expectations of the patient, the compatibility of the
backgrounds and belief systems of the clinician and the
patient, as well as a myriad of factors that together
define the therapeutic milieu.
Although much remains unknown regarding the mechanism(s)
that might mediate the therapeutic effect of acupuncture, the
panel is encouraged that a number of significant acupuncture-
related biological changes can be identified and carefully
delineated. Further research in this direction not only is
important for elucidating the phenomena associated with
acupuncture, but also has the potential for exploring new
pathways in human physiology not previously examined in a
systematic manner.
4. What issues need to be addressed so that acupuncture may
be appropriately incorporated into today's health care
system?
The integration of acupuncture into today's health care
system will be facilitated by a better understanding among
providers of the language and practices of both the Eastern
and Western health care communities. Acupuncture focuses on a
holistic, energy-based approach to the patient rather than a
disease-oriented diagnostic and treatment model.
An important factor for the integration of acupuncture into
the health care system is the training and credentialing of
acupuncture practitioners by the appropriate state agencies.
This is necessary to allow the public and other health
practitioners to identify qualified acupuncture
practitioners. The acupuncture educational community has made
substantial progress in this area and is encouraged to
continue along this path. Educational standards have been
established for training of physician and non-physician
acupuncturists. Many acupuncture educational programs are
accredited by an agency that is recognized by the U.S.
Department of Education. A national credentialing agency
exists that is recognized by some of the major professional
acupuncture organizations and provides examinations for
entry-level competency in the field.
A majority of States provide licensure or registration for
acupuncture practitioners. Because some acupuncture
practitioners have limited English proficiency, credentialing
and licensing examinations should be provided in languages
other than English where necessary. There is variation in the
titles that are conferred through these processes, and the
requirements to obtain licensure vary widely. The scope of
practice allowed under these State requirements varies as
well. While States have the individual prerogative to set
standards for licensing professions, harmonization in these
areas will provide greater confidence in the qualifications
of acupuncture practitioners. For example, not all States
recognize the same credentialing examination, thus making
reciprocity difficult.
The occurrence of adverse events in the practice of
acupuncture has been documented to be extremely low. However,
these events have occurred in rare occasions, some of which
are life threatening (e.g., pneumothorax). Therefore,
appropriate safeguards for the protection of patients and
consumers need to be in place. Patients should be fully
informed of their treatment options, expected prognosis,
relative risk, and safety practices to minimize these risks
prior to their receipt of acupuncture. This information must
be provided in a manner that is linguistically and culturally
appropriate to the patient. Use of acupuncture needles should
always follow FDA regulations, including use of sterile,
single-use needles. It is noted that these practices are
already being done by many acupuncture practitioners;
however, these practices should be uniform. Recourse for
patient grievance and professional censure are provided
through credentialing and licensing procedures and are
available through appropriate State jurisdictions.
It has been reported that more than 1 million Americans
currently receive acupuncture each year. Continued access to
qualified acupuncture professionals for appropriate
conditions should be ensured. Because many individuals
seek health care treatment from both acupuncturists and
physicians, communication between these providers should
be strengthened and improved. If a patient is under the
care of an acupuncturist and a physician, both
practitioners should be informed. Care should be taken so
that important medical problems are not overlooked.
Patients and providers have a responsibility to facilitate
this communication.
There is evidence that some patients have limited access to
acupuncture services because of inability to pay. Insurance
companies can decrease or remove financial barriers to access
depending on their willingness to provide coverage for
appropriate acupuncture services. An increasing number of
insurance companies are either considering this possibility
or now provide coverage for acupuncture services. Where there
are State health insurance plans, and for populations served
by Medicare or Medicaid, expansion of coverage to include
appropriate acupuncture services would also help remove
financial barriers to access.
As acupuncture is incorporated into today's health care
system, and further research clarifies the role of
acupuncture for various health conditions, it is expected
that dissemination of this information to health care
practitioners, insurance providers, policymakers, and the
general public will lead to more informed decisions in regard
to the appropriate use of acupuncture.
5. What are the directions for future research?
The incorporation of any new clinical intervention into
accepted practice faces more scrutiny now than ever before.
The demands of evidence-based medicine, outcomes research,
managed care systems of health care delivery, and a plethora
of therapeutic choices makes the acceptance of new treatments
an arduous process. The difficulties are accentuated when the
treatment is based on theories unfamiliar to Western medicine
and its practitioners. It is important, therefore, that the
evaluation of acupuncture for the treatment of specific
conditions be carried out carefully, using designs which can
withstand rigorous scrutiny. In order to further the
evaluation of the role of acupuncture in the management of
various conditions, the following general areas for future
research are suggested.
What are the demographics and patterns of use of
acupuncture in the U.S. and other countries?
There is currently limited information on basic questions
such as who uses acupuncture, for what indications is
acupuncture most commonly sought, what variations in
experience and techniques used exist among acupuncture
practitioners, and whether there are differences in these
patterns by geography or ethnic group. Descriptive
epidemiologic studies can provide insight into these and
other questions. This information can in turn be used to
guide future research and to identify areas of greatest
public health concern.
Can the efficacy of acupuncture for various conditions for
which it is used or for which it shows promise be
demonstrated?
Relatively few high-quality, randomized, controlled trials
have been published on the effects of acupuncture. Such
studies should be designed in a rigorous manner to allow
evaluation of the effectiveness of acupuncture. Such studies
should include experienced acupuncture practitioners in order
to design and deliver appropriate interventions. Emphasis
should be placed on studies that examine acupuncture as used
in clinical practice, and that respect the theoretical basis
for acupuncture therapy.
Although randomized controlled trials provide a strong
basis for inferring causality, other study designs such as
used in clinical epidemiology or outcomes research can also
provide important insights regarding the usefulness of
acupuncture for various conditions. There have been few such
studies in the acupuncture literature.
Do different theoretical bases for acupuncture result in
different treatment outcomes?
Competing theoretical orientations (e.g., Chinese,
Japanese, French) currently exist
[[Page S11946]]
that might predict divergent therapeutic approaches (i.e.,
the use of different acupuncture points). Research projects
should be designed to assess the relative merit of these
divergent approaches, as well to compare these systems with
treatment programs using fixed acupuncture points.
In order to fully assess the efficacy of acupuncture,
studies should be designed to examine not only fixed
acupuncture points, but also the Eastern medical systems that
provide the foundation for acupuncture therapy, including the
choice of points. In addition to assessing the effect of
acupuncture in context, this would also provide the
opportunity to determine if Eastern medical theories predict
more effective acupuncture points, as well as to examine the
relative utility of competing systems (e.g., Chinese vs.
Japanese vs. French) for such purposes.
What areas of public policy research can provide guidance
for the integration of acupuncture into today's health care
system?
The incorporation of acupuncture as a treatment raises
numerous questions of public policy. These include issues of
access, cost-effectiveness, reimbursement by State, Federal,
and private payors, and training, licensure, and
accreditation. These public policy issues must be founded on
quality epidemiologic and demographic data and effectiveness
research.
Can further insight into the biological basis for
acupuncture be gained?
Mechanisms which provide a Western scientific explanation
for some of the effects of acupuncture are beginning to
emerge. This is encouraging, and may provide novel insights
into neural, endocrine and other physiological processes.
Research should be supported to provide a better
understanding of the mechanisms involved, and such research
may lead to improvements in treatment.
Does an organized energetic system exist in the human body
that has clinical applications?
Although biochemical and physiologic studies have provided
insight into some of the biologic effects of acupuncture,
acupuncture practice is based on a very different model of
energy balance. This theory may provide new insights to
medical research that may further elucidate the basis for
acupuncture.
How do the approaches and answers to these questions differ
among populations that have used acupuncture as a part of its
healing tradition for centuries, compared to populations that
have only recently begun to incorporate acupuncture into
health care?
conclusions and recommendations
Acupuncture as a therapeutic interventions is widely
practiced in the United States. There have been many studies
of its potential usefulness. However, many of these
studies provide equivocal results because of design,
sample size, and other factors. The issue is further
complicated by inherent difficulties in the use of
appropriate controls, such as placebo and sham acupuncture
groups.
However, promising results have emerged, for example,
efficacy of acupuncture in adult post-operative and
chemotherapy nausea and vomiting and in post-operative dental
pain. There are other situations such as addiction, stroke
rehabilitation, headache, menstrual cramps, tennis elbow,
fibromyalgia myofascial pain, osteoarthritis, low back pain,
carpal tunnel syndrome, and asthma where acupuncture may be
useful as an adjunct treatment or an acceptable alternative
or be included in a comprehensive management program. Further
research is likely to uncover additional areas where
acupuncture interventions will be useful.
Findings from basic research have begun to elucidate the
mechanisms of action of acupuncture, including the release of
opioids and other peptides in the central nervous system and
the periphery and changes in neuroendocrine function.
Although much needs to be accomplished, the emergence of
plausible mechanisms for the therapeutic effects of
acupuncture is encouraging.
The introduction of acupuncture into the choice of
treatment modalities that are readily available to the public
is in its early stages. Issues of training, licensure, and
reimbursement remain to be clarified. There is sufficient
evidence, however, of its potential value to conventional
medicine to encourage further studies.
There is sufficient evidence of acupuncture's value to
expand its use into correctional medicine and to encourage
further studies of its physiology and clinical value.
Mr. HARKIN. I yield the floor.
Mr. FEINGOLD addressed the Chair.
The PRESIDING OFFICER. The Senator from Wisconsin is recognized.
Mr. FEINGOLD. Mr. President, I would like to take this opportunity to
respond to my friends, the Senators from Vermont, Mr. Leahy and Mr.
Jeffords, who just spoke with regard to a recent decision by the
Federal District Court of Minnesota. It also gives me an opportunity to
not only present a different perspective on that ruling, but to also
hail the ruling, which is the first ray of hope that the dairy farmers
in the upper Midwest, and in particular the farmers in my home State of
Wisconsin, have had for a very, very long time.
I think the judge in this case ruled correctly. In the Minnesota Milk
Producers versus Dan Glickman, Secretary of the U.S. Department of
Agriculture, Federal Judge David Doty finally said what Wisconsin dairy
farmers have long known is the case, and that is that the current
Federal milk marketing order system is outdated and is, in fact,
illegal, given the realities of our national dairy market today. This
system was set up some 60 years ago, because at that time it was not
always possible for consumers in other parts of the country,
particularly the South and the Southeast, to get fresh milk because of
inadequate refrigeration and transportation technology. So this system
was set up on the basis of how far a farmer lived from Eau Claire, WI--
the supposed reserve supply of milk in the United States. In other
words, the closer a farmer lived to Eau Claire, WI, the less he got as
an add-on for his class I fluid milk. The system worked, and it
certainly provided the needed fresh milk for virtually every marketing
order in the country east of the Rocky Mountains.
Times have changed. During the past 60 years these areas, such as the
Northeastern, Southwestern and Southcentral regions of the United
States, are now able to produce enough milk to provide for their fluid
milk needs and then some. Yet there is still a gross discrepancy
between what a dairy farmer gets, let's say in Texas or Vermont, for
his or her class I milk, and what a farmer in Wisconsin gets for the
same type of milk. For example, farmers in Wisconsin may receive $1.20
per hundredweight in addition to the base price for milk, but in other
regions more distant from Wisconsin, dairy farmers might receive $2 or
$3 or even $4 more than Wisconsin farmers.
These are very serious disparities and these differentials have led
to an extremely unfair situation to the dairy farmers in the upper
Midwest. The decision by the district court this week finally says,
``Enough is enough.'' It takes note, in effect, of the fact that in the
last 17 years, Wisconsin alone has gone from having 45,000 dairy farms
to less than 25,000. We have lost over 1,000 dairy farms per year each
year. And when upper Midwest dairy farmers talk about all of the
problems facing their industry, the complaint that arises most often is
the unfairness of the Federal milk marketing order system.
In contrast to what the two Senators from Vermont were saying--one of
them actually indicated there had to be these disparities in order for
milk to be supplied to consumers--the fact is, current market
conditions and existing technologies no longer necessitate a system
that prices milk based on distance from Eau Claire. In fact, in recent
years, when our dairy farmers have tried to sell their milk in Chicago,
have been beaten out of that market by milk from southcentral and
southwestern producers. How can that be if these regions can't produce
enough milk for their own needs in that area? Obviously, they can meet
their needs and still afford to export milk to other regions because
they are receiving a higher class I milk price. And the result is that
this system subsidizes the farmers in the Southeast, Northeastern, and
regions of the United States and provides them an unfair advantage and
competitive advantage over our farmers in the upper Midwest. It has had
a lot to do, in my view and the view of almost every farmer in
Wisconsin, with the loss of so many of our dairy farms in our State.
It is ironic, at a time when the Federal Government, including
Congress with the passage of the 1996 farm bill, has made it a policy
to reduce Government pricing interference in agricultural markets, that
it is still interfering in a very serious and detrimental way with a
free and open national dairy market. This decision by the judge in the
U.S. District Court of Minnesota--a Federal court--is an excellent
decision. It is a decision that finally tells it like it is--and that
is that there is no legitimate basis for these discriminatory class I
price differentials which provide one farmer in the Northeastern part
of the United States and another farmer in Texas far more for the same
type of milk than the hard-working farmers in Wisconsin or Minnesota.
Mr. President, we in Wisconsin and the upper Midwest praise this
court ruling. We believe it is an important, proper and very overdue
decision. It gives us some hope that the remaining
[[Page S11947]]
farmers in our State, in the upper Midwest, will be allowed to survive
without the interference of an outdated and unfair system--in fact, as
now indicated by the court, a system that is unlawful, given the
changes in the dairy market and given the changes in the times.
Mr. President, this court decision was, at long last, the right one
and I look forward to the positive consequences that can flow from it.
I yield the floor.
Mrs. FEINSTEIN addressed the Chair.
The PRESIDING OFFICER. The Senator from California.
____________________