[Congressional Record Volume 144, Number 22 (Friday, March 6, 1998)]
[Senate]
[Pages S1510-S1516]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FRIST (for himself, Mr. Lott, Mr. Jeffords, Mr. Kennedy, 
        Mr. Gregg, Mr. Dodd, Mr. Enzi, Mr. Harkin, Mr. Hutchinson, Ms. 
        Mikulski, Ms. Collins, Mr. Bingaman, Mr. McConnell, Mr. 
        Wellstone, Mrs. Murray, Mr. Reed, Ms. Snowe, Mr. Nickles, Mr. 
        Mack, Mrs. Boxer, Mr. Daschle, Mr. Chafee, Mrs. Feinstein, Mr. 
        Roth, Mr. Specter, Mr. D'Amato, Mr. Domenici,  and Mr. 
        Santorum):
  S. 1722. A bill to amend the Public Health Service Act to revise and 
extend certain programs with respect to women's health research and 
prevention activities at the National Institutes of Health and the 
Centers for Disease Control and Prevention; to the Committee on Labor 
and Human Resources.


     the women's health research and prevention amendments of 1998

  Mr. FRIST. Mr. President, I am very pleased to introduce today, with 
the majority leader, the Women's Health Research and Prevention 
Amendments of 1998. The purpose of this bill is to increase awareness 
of some of the most pressing diseases and health issues that women in 
our country face. This bill focuses on women's health research and 
prevention activities at the National Institutes of Health and the 
Centers for Disease Control and Prevention.
  Our goal, in introducing this bill today, is to create greater 
awareness of women's health issues and to highlight the critical role 
our public health agencies--the NIH, the National Institutes of Health, 
and the CDC, the Centers for Disease Control and Prevention--play in 
providing a broad spectrum of activities to improve women's health, 
including research, screening, health data management, prevention and 
treatment of diseases, and broad health education.
  This bill reauthorizes programs at the National Institutes of Health 
for vital research activities into the causes, prevention, and 
treatment for some of the major diseases affecting women, including 
osteoporosis, breast cancer, ovarian cancer, as well as research into 
the aging processes of women.
  Let me cite just a few statistics to illustrate the need for further 
research into these health issues.
  Osteoporosis is a health threat for 28 million Americans, 80 percent 
of whom are women. One in every two women over the age of 50 years will 
have an osteoporosis-related fracture.
  One out of every eight women will develop breast cancer over the 
course of their lifetimes, and 1 in 25 will die of breast cancer.
  Ovarian cancer is the fourth leading cause of death from cancer among 
women. One of the most troubling aspects of ovarian cancer is the 
challenge we have in diagnosing this disease earlier and earlier. We 
know that a late diagnosis results in a worse outcome. The 
reauthorization of these research programs will help assure scientific 
progress in our fight against these diseases and will lessen their 
burden on women and their families.
  For far too long, women in this country have been neglected in many 
of our research clinical studies. I am very pleased that, since 1993, 
we have developed guidelines to include women and minorities in NIH-
sponsored trials. However, we must continue to do more. We must 
continue to review our women's health research agenda to set future 
research priorities and to incorporate new scientific knowledge 
regarding women's health. We must continue to focus and coordinate all 
our efforts in research areas, including clinical trial research 
design, genetic factors, the aging process, and other gender-based 
differences.
  I am also pleased in this bill that we authorize a new research 
program at the National Heart, Lung, and Blood Institute at the NIH to 
target heart attack, stroke, and other cardiovascular diseases in 
women. This program, originally introduced by my colleague, Senator 
Boxer, will advance research into cardiovascular diseases--the leading 
cause of death in the United States in women. More than 500,000 
American women will die annually from cardiovascular diseases. 
Cardiovascular diseases--that is, diseases of the heart and the blood 
vessels--kill almost twice as many American women as all other cancers.
  One of the biggest myths in medicine is that heart disease is only a 
male problem. When we think of a heart attack, many people associate it 
with men. Even in my own studies during my internship and residency in 
medicine--not that long ago--all the models, the pictures that were 
used in textbooks, the warning signs on TV--always pictured a man.
  However, since 1984, the number of cardiovascular disease deaths in 
women has exceeded those of men. And in 1995, 50,000 more women died of 
heart disease than men. The program we are including in the bill today 
will expand the research programs at NIH to concentrate more on 
cardiovascular diseases in women.
  Our bill reauthorizes several programs at the Centers for Disease 
Control and Prevention for prevention and education activities on 
women's health issues. We are reauthorizing the National Center for 
Health Statistics, the National Program of Cancer Registries, the 
National Breast and Cervical Cancer Early Detection Program, the 
Centers for Research and Demonstration of Health Promotion and Disease 
Prevention, and the Community Programs on Domestic Violence.
  CDC's programs provide critical health services in each of our States 
and in our communities to detect, prevent, and diagnose diseases such 
as breast and cervical cancer. For the past 7 years, the National 
Breast and Cervical Cancer Early Detection Program has provided 
critical cancer screening services to underserved women, especially 
low-income women, elderly women, and members of racial and ethnic 
minority groups. CDC supports early detection programs in all 50 
States, in 5 territories, in the District of Columbia, and in 14 
American Indian/Alaskan Native organizations. Through March 1997, more 
than 1.3 million screening tests have been provided by this one 
program.
  CDC programs provide critical data and statistics about women's 
health that assist us in making informed policy decisions about health 
care. The National Center for Health Statistics often provides the only 
national data on the health status of U.S. women and their use of 
health care. A recent report by the National Center for Health 
Statistics entitled ``Women: Work and Health'' summarized the data on 
health conditions affecting working women. This report is the first 
comprehensive survey on work-related

[[Page S1511]]

health issues encountered by the more than 60 million women in the 
American labor force.
  I thank the majority leader for his leadership on this issue and for 
his efforts in the introduction of this bill. I am pleased to state 
that this bill is bipartisan. We have included provisions that are the 
product of the efforts of many of my colleagues--Senators Snowe, 
Harkin, Boxer, and many others. We have the support of nearly the full 
Senate Labor and Human Resources Committee, and over 27 Members of the 
Senate are original cosponsors of this bipartisan bill. The level of 
support for this bill is a real testament to the need to combat the 
diseases affecting women and to maintain those crucial health services 
that help prevent these diseases.
  This bill, again, is introduced to generate discussion of these 
important programs. We intend to consider these programs within the 
context of the upcoming NIH reauthorization bill to be introduced over 
the next several months. I encourage all Members and constituencies to 
review the current programs and to provide input as we set the future 
agenda of women's health research and prevention in this Nation.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1722

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Women's Health Research and 
     Prevention Amendments of 1998''.
TITLE I--PROVISIONS RELATING TO WOMEN'S HEALTH RESEARCH AT THE NATIONAL 
                          INSTITUTES OF HEALTH

     SEC. 101. EXTENSION OF PROGRAM FOR RESEARCH AND AUTHORIZATION 
                   OF NATIONAL PROGRAM OF EDUCATION REGARDING THE 
                   DRUG DES.

       (a) In General.--Section 403A(e) of the Public Health 
     Service Act (42 U.S.C. 283a(e)) is amended by striking 
     ``1996'' and inserting ``2001''.
       (b) National Program for Education of Health Professionals 
     and Public.--From amounts appropriated for carrying out 
     section 403A of the Public Health Service Act (42 U.S.C. 
     283a), the Secretary of Health and Human Services, acting 
     through the heads of the appropriate agencies of the Public 
     Health Service, shall carry out a national program for the 
     education of health professionals and the public with respect 
     to the drug diethylstilbestrol (commonly know as DES). To the 
     extent appropriate, such national program shall use 
     methodologies developed through the education demonstration 
     program carried out under such section 403A. In developing 
     and carrying out the national program, the Secretary shall 
     consult closely with representatives of nonprofit private 
     entities that represent individuals who have been exposed to 
     DES and that have expertise in community-based information 
     campaigns for the public and for health care providers. The 
     implementation of the national program shall begin during 
     fiscal year 1999.

     SEC. 102. RESEARCH ON OSTEOPOROSIS, PAGET'S DISEASE, AND 
                   RELATED BONE DISORDERS.

       Section 409A(d) of the Public Health Service Act (42 U.S.C. 
     284e(d)) is amended by striking ``and 1996'' and inserting 
     ``through 2001''.

     SEC. 103. RESEARCH ON CANCER.

       (a) In General.--Section 417B(a) of the Public Health 
     Service Act (42 U.S.C. 286a-8(a)) is amended by striking 
     ``and 1996'' and inserting ``through 2001''.
       (b) Research on Breast Cancer.--Section 417B(b)(1) of the 
     Public Health Service Act (42 U.S.C. 286a-8(b)(1)) is 
     amended--
       (1) in subparagraph (A), by striking ``and 1996'' and 
     inserting ``through 2001''; and
       (2) in subparagraph (B), by striking ``and 1996'' and 
     inserting ``through 2001''.
       (c) Research on Ovarian and Related Cancer Research.--
     Section 417B(b)(2) of the Public Health Service Act (42 
     U.S.C. 286a-8(b)(2)) is amended by striking ``and 1996'' and 
     inserting ``through 2001''.

     SEC. 104. RESEARCH ON HEART ATTACK, STROKE, AND OTHER 
                   CARDIOVASCULAR DISEASES IN WOMEN.

       Subpart 2 of part C of title IV of the Public Health 
     Service Act (42 U.S.C. 285b et seq.) is amended by inserting 
     after section 424 the following:


   ``heart attack, stroke, and other cardiovascular diseases in women

       ``Sec. 424A. (a) In General.--The Director of the Institute 
     shall expand, intensify, and coordinate research and related 
     activities of the Institute with respect to heart attack, 
     stroke, and other cardiovascular diseases in women.
       ``(b) Coordination With Other Institutes.--The Director of 
     the Institute shall coordinate activities under subsection 
     (a) with similar activities conducted by the other national 
     research institutes and agencies of the National Institutes 
     of Health to the extent that such Institutes and agencies 
     have responsibilities that are related to heart attack, 
     stroke, and other cardiovascular diseases in women.
       ``(c) Certain Programs.--In carrying out subsection (a), 
     the Director of the Institute shall conduct or support 
     research to expand the understanding of the causes of, and to 
     develop methods for preventing, cardiovascular diseases in 
     women. Activities under such subsection shall include 
     conducting and supporting the following:
       ``(1) Research to determine the reasons underlying the 
     prevalence of heart attack, stroke, and other cardiovascular 
     diseases in women, including African-American women and other 
     women who are members of racial or ethnic minority groups.
       ``(2) Basic research concerning the etiology and causes of 
     cardiovascular diseases in women.
       ``(3) Epidemiological studies to address the frequency and 
     natural history of such diseases and the differences among 
     men and women, and among racial and ethnic groups, with 
     respect to such diseases.
       ``(4) The development of safe, efficient, and cost-
     effective diagnostic approaches to evaluating women with 
     suspected ischemic heart disease.
       ``(5) Clinical research for the development and evaluation 
     of new treatments for women, including rehabilitation.
       ``(6) Studies to gain a better understanding of methods of 
     preventing cardiovascular diseases in women, including 
     applications of effective methods for the control of blood 
     pressure, lipids, and obesity.
       ``(7) Information and education programs for patients and 
     health care providers on risk factors associated with heart 
     attack, stroke, and other cardiovascular diseases in women, 
     and on the importance of the prevention or control of such 
     risk factors and timely referral with appropriate diagnosis 
     and treatment. Such programs shall include information and 
     education on health-related behaviors that can improve such 
     important risk factors as smoking, obesity, high blood 
     cholesterol, and lack of exercise.
       ``(d) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there is authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 1999 through 2001. The authorization of 
     appropriations established in the preceding sentence is in 
     addition to any other authorization of appropriation that is 
     available for such purpose.''.

     SEC. 105. AGING PROCESSES REGARDING WOMEN.

       Section 445I of the Public Health Service Act (42 U.S.C. 
     285e-11) is amended by striking ``and 1996'' and inserting 
     ``through 2001''.

     SEC. 106. OFFICE OF RESEARCH ON WOMEN'S HEALTH.

       Section 486(d)(2) of the Public Health Service Act (42 
     U.S.C. 287d(d)(2)) is amended by striking ``Director of the 
     Office'' and inserting ``Director of the National Institutes 
     of Health''.
  TITLE II--PROVISIONS RELATING TO WOMEN'S HEALTH AT THE CENTERS FOR 
                     DISEASE CONTROL AND PREVENTION

     SEC. 201. NATIONAL CENTER FOR HEALTH STATISTICS.

       Section 306(n) of the Public Health Service Act (42 U.S.C. 
     242k(n)) is amended--
       (1) in paragraph (1), by striking ``through 1998'' and 
     inserting ``through 2002''; and
       (2) in paragraph (2), by striking ``through 1998'' and 
     inserting ``through 2002''.

     SEC. 202. NATIONAL PROGRAM OF CANCER REGISTRIES.

       Section 399L(a) of the Public Health Service Act (42 U.S.C. 
     280e-4(a)) is amended by striking ``through 1998'' and 
     inserting ``through 2002''.

     SEC. 203. NATIONAL BREAST AND CERVICAL CANCER EARLY DETECTION 
                   PROGRAM.

       (a) Grants.--Section 1501(b) of the Public Health Service 
     Act (42 U.S.C. 300k(b)) is amended--
       (1) in paragraph (1), by striking ``nonprofit''; and
       (2) in paragraph (2), by striking ``that are not nonprofit 
     entities''.
       (b) Preventive Health.--Section 1509(d) of the Public 
     Health Service Act (42 U.S.C. 300n-4a(d)(1)) is amended by 
     striking ``through 1998'' and inserting ``through 2002''.
       (c) General Program.--Section 1510(a) of the Public Health 
     Service Act (42 U.S.C. 300n-5(a)) is amended by striking 
     ``through 1998'' and inserting ``through 2002''.

     SEC. 204. CENTERS FOR RESEARCH AND DEMONSTRATION OF HEALTH 
                   PROMOTION.

       Section 1706(e) of the Public Health Service Act (42 U.S.C. 
     300u-5(e)) is amended by striking ``through 1998'' and 
     inserting ``through 2002''.

     SEC. 205. COMMUNITY PROGRAMS ON DOMESTIC VIOLENCE.

       Section 318(h)(2) of the Family Violence Prevention and 
     Services Act (42 U.S.C. 10418(h)(2)) is amended by striking 
     ``fiscal year 1997'' and inserting ``for each of the fiscal 
     years 1997 through 2002''.

  Mr. LOTT. Mr. President, this morning I am very pleased to join 
Senator Frist of Tennessee, who is an outstanding Senator, and also a 
doctor, who has been very helpful to me, and a lot of Senators, since 
he joined this body, in introducing legislation entitled ``The Women's 
Health Research and Prevention Act.''

[[Page S1512]]

  The bill authorizes and reauthorizes a collection of first-class 
research and prevention programs in the National Institutes of Health 
and the Centers for Disease Control and Prevention.
  Breast cancer is the leading cause of death in women between the ages 
of 40 and 55. About one out of every eight women in the United States 
will, unfortunately, develop breast cancer during their lifetime. And 
so the Frist-Lott bill reauthorizes breast and ovarian cancer research 
and education programs at NIH.
  Osteoporosis is a disease in which bones become fragile and more 
likely to break. My wife is beginning to confront this particular 
problem. As women age, they lose bone mass and are at risk of 
debilitating accidents such as fractures. This bill extends 
osteoporosis research and education programs at NIH.
  Women's health, though, means more than just health issues specific 
to women. Heart disease, for instance, the No. 1 killer in the U.S. of 
women, of course, also affects men in great numbers. Hypertension, a 
leading cause of heart disease, is two to three times more common in 
women than in men.
  In addition to these three key research areas, our bill continues 
programs in the Centers for Disease Control, including the National 
Program of Cancer Registries and the National Early Detection Program 
for breast and cervical cancer.
  Senator Frist, the Senate's only doctor, and an outstanding heart 
surgeon himself, provided the details of the bill. Senator Frist is 
chairman of the Senate Public Health Subcommittee of the Senate Labor 
Committee, and is one of the Senate's key leaders on all of our health 
issues.
  I am pleased that he is also serving on our Medicare commission that 
had its first meeting yesterday, including a meeting with the 
President.
  I have often turned to him for advice and guidance on health matters, 
and will continue to do so in the future. I believe that just this 
morning Senator Frist attended a meeting regarding Medicare, and that 
will be helpful in this effort. I know it will be a bipartisan effort.
  I encourage colleagues on both sides of the aisle to cosponsor this 
important legislation.
  This morning I was made aware that Senator Mack is a cosponsor, and 
Senator D'Amato. We are inviting all Members to join us in this very 
serious and very important issue that we need to act on in order to 
reauthorize some of these programs and authorize new ones.
  I thank Senator Frist for his leadership in this area, and I yield 
the floor.
  Mr. JEFFORDS. Mr. President, I rise to recognize Senator Frist for 
taking an important step that brings together a number of Government 
programs of research, treatment and disease prevention for women. Over 
the past several years, Congress and the Nation have become 
increasingly concerned about women's health. I appreciate the 
leadership and the expertise that Dr. Frist brings to Congress about 
these issues. We have much to learn about recognizing and treating the 
medical needs of women.
  In the first session of the 105th Congress, at least 21 bills 
relating to women's health were introduced and referred to the Senate 
Labor and Human Resources Committee. At our committee hearing on 
women's health last July, we heard about important advances being made 
in research. We also heard about significant gaps of knowledge which 
need to be filled. More importantly, we recognize how important it is 
to get information about scientific advances to the public and their 
health care providers.
  Thus, I am pleased the provisions of this bill provide for research 
and for public and professional education. We know that once the 
information is out to the public and health care professionals, we need 
screening programs, closely followed by access to treatment. The bill 
provides for important patient services.
  Finally, once common conditions are well recognized, detected and 
treated, we need data to track our progress in disease prevention and 
to alert us to new help in illness trends. This bill provides for these 
functions through the support for cancer registries, information 
systems, and program evaluation. It is my hope that having women's 
issues collected together in one bill will focus the attention of 
Congress and the Nation on vigorous support of the woman's health 
initiative.
  I am pleased to join Senator Frist in sponsoring this legislation.
  Mr. KENNEDY. Mr. President, I commend Senator Frist for his 
leadership on the bill we are introducing today, ``The Women's Health 
Research and Prevention Amendments of 1998.'' This bill is a bipartisan 
effort to extend and strengthen several important women's health 
programs at the National Institutes of Health and the Centers for 
Disease Control and Prevention.
  In recent years, women's health has begun to receive the high 
priority it deserves. Five years ago government guidelines were finally 
eliminated that specifically excluded women from many clinical trials. 
Increasingly, Congress has given higher priority to funds to address 
breast cancer and other women's health issues. We also established the 
Office of Women's Health within the Department of Health and Human 
Services, in order to develop and implement a national agenda for 
women's health. These successes, however, have revealed that there is 
much more to be done.
  The bill we are introducing today is an attempt to fill some of the 
gaps in research and prevention that we have identified in women's 
health. It is time for Congress to acknowledge that women's health 
involves a wider range of issues, and that the magnitude of these 
issues varies greatly with age. Car crashes and unintended injuries are 
the leading killer of women in their teens and twenties. Cancer is the 
leading killer of women between the ages of 25 and 64. Heart disease is 
the leading killer among women over 65.
  The nation's agenda on women's health must also address other key 
issues that are more common among women but affect men too, such as 
osteoporosis, depression, and auto-immune diseases, and illnesses that 
manifest themselves differently in men and women, such as heart 
disease, substance abuse, AIDS, and violence.
  Our legislation extends important research and prevention activities 
now being carried out by the National Institutes of Health and the 
Centers for Disease Control and Prevention in areas traditionally 
considered women's health issues, such as breast and ovarian cancer, 
osteoporosis, and domestic violence. It also calls for greater research 
efforts on heart attacks, strokes, and other cardiovascular diseases, 
in recognition of the serious effects of these diseases on women.
  Our bill also provides continued support for academic health centers 
to conduct research and demonstration projects related to health 
promotion and disease prevention to improve quality of life, and to 
curb premature mortality and illness that contribute to excessive 
health costs. These academic health centers are effective in informing 
women and their physicians of steps they can take to prevent serious 
illness and injury, especially in cases involving chronic and 
debilitating physical illness, such as arthritis and osteoporosis, 
which put women at high risk for bone fractures.
  In order to enable researchers to monitor health trends among women 
and to help policymakers make informed decisions on the allocation of 
resources, it is essential for accurate and timely statistical and 
epidemiological data to be available. Our bill will provide continued 
support of the CDC's National Center for Health Statistics, which 
provides valuable data related to overall health status, lifestyle, 
onset and diagnosis of illness and disability, and use of health care 
and rehabilitation services.
  It is also important to understand differences between racial and 
ethnic groups. For example, black women have far higher death rates 
from heart disease, cancer, stroke and diabetes than white women. 
Minority women suffer the most from AIDS. More than half of new female 
cases of AIDS over the past decade were found among blacks. For other 
chronic diseases, black women have the highest rates of hypertension, 
while Native American women have higher rates of asthma and chronic 
bronchitis. This bill will enable the National Center for Health 
Statistics to continue its important work on the health of ethnic and 
racial populations, and improve methods to collect data on these 
subgroups in

[[Page S1513]]

order to understand and address their various health needs more 
effectively.
  Too many health needs of women continue to be neglected by the 
nation's health care system. The cost of this national neglect, both in 
dollars and in lives, is staggering. This bill is an excellent starting 
point for strengthening current programs and pursuing new initiatives 
to address urgent national priorities in women's health. I look forward 
to working with my colleagues and with the women's health community to 
enact the strongest legislation we can to deal with these vital issues.
  Mr. HARKIN. Mr. President, I am pleased today to join many of my 
colleagues in support of the ``Women's Health Research and Prevention 
Amendments of 1998.'' This legislation, introduced by my distinguished 
colleague, Senator Bill Frist, and cosponsored by nearly all the 
members of the Committee on Labor and Human Resources, is an important 
step forward in the study and prevention of diseases and conditions 
unique to women.
  In the late 1980's, I learned that there was an embarrassing lack of 
research on diseases and conditions prevalent in women. In addition, 
the General Accounting Office (GAO) reported that women were routinely 
excluded from medical research studies at NIH. Because of this 
information, in 1990, I fought for legislation creating the Office of 
Research on Women's Health at the National Institutes of Health (NIH). 
Since its creation, the Office successfully worked to ensure that 
research focuses on women's health and that women be included in 
clinical trials.
  Senator Frist's legislation builds upon the base of research and 
prevention knowledge we have developed over the past few years. The 
bill reauthorizes essential programs relating to women's health 
research at NIH and the Centers for Disease Control and Prevention 
(CDC).
  I am particularly proud of the reauthorization of the programs 
promoting research and education on the drug ``diethylstilbestrol,'' 
otherwise known as DES. This drug was prescribed to pregnant American 
women from 1938 to 1971 in the mistaken belief that it would prevent 
miscarriage. But DES is now known to cause a five-fold increased risk 
of ectopic pregnancy, as well as a three-fold increased risk of 
miscarriage. I was proud to introduce legislation in 1992 that 
established a pilot program through NIH to test ways to educate the 
public and health professionals about how to deal with DES exposure. 
Last year I introduced legislation that would give people across the 
nation access to information developed through this pilot program. I am 
pleased that this bill has been incorporated in the ``Women's Health 
Research and Prevention Amendments of 1998.''
  In addition, I am pleased that the bill extends research programs for 
basic and clinical research and education efforts with respect to 
cancer, particularly breast cancer and ovarian cancer. I have fought 
for a long time for increased funding for breast cancer research. 
During my tenure as Chairman of the Subcommittee on Appropriations that 
handles NIH we provided dramatic increases in funding for breast cancer 
research.
  This legislation also extends important research at NIH on 
osteoporosis, Paget's disease and related bone disorders, and research 
on cardiovascular diseases in women. It reauthorizes programs at the 
National Institute on Aging, including research into the aging 
processes of women, with particular emphasis on the effects of 
menopause and the complications related to aging and the loss of 
ovarian hormones in women.
  CDC also plays an important role in the prevention diseases and 
conditions in women. This legislation would extend CDC's collection of 
statistical and epidemiological information, which is often the only 
national data available on the health status of American women and 
their use of the health care system. The bill extends CDC's National 
Cancer Registries Program, which provides funds to states to enhance 
their cancer surveillance data needed to monitor trends and serve as 
the foundation of a national comprehensive cancer control strategy.
  I am particularly proud that this legislation extends the National 
Breast and Cervical Cancer Early Detection Program. In 1990 I worked to 
start and fund this program which provides mammography and cervical 
cancer screening to low income women without insurance. This program 
has provided vital access to services for thousands of women across the 
country.
  In addition, the bill would extend authorization for grants to 
academic health institutions for research on health promotion and 
disease prevention. A number of these institutions are working together 
to develop strategies for prevention of cardiovascular disease in 
women. Finally, the bill reauthorizes grants administered by CDC to 
non-profit private organizations to establish projects in local 
communities to coordinate intervention and prevention of domestic 
violence.
  Mr. President, the research into and prevention of diseases prevalent 
in women is an investment in our daughters, wives, mothers, and 
sisters. It is an investment in our future.
  Mr. BINGAMAN. Mr. President, I rise today to join Senator Frist and 
my other colleagues in introducing the Women's Health Research and 
Prevention Amendments of 1998.
  This legislation allows us to reauthorize key women's health research 
and prevention programs at the National Institutes of Health and the 
Centers for Disease Control and Prevention. These programs represent a 
cross section of the current research projects at the federal level 
that have a direct impact on women's lives here in the United States.
  While in the last decade, interest and commitment to women's health 
has been heightened in the Congress, much work remains. We have taken 
steps to ensure that women will be included in health care research in 
the U.S. Prior to 1993, research in women's health was inadequate. Most 
of the health care studies were conducted only on Anglo men. Quite 
simply, research studies on men cannot be generalized to women. We know 
that there are gender and ethnic differences when it comes to health 
and illness. The time has come to further address the major causes of 
morbidity and mortality among women: heart disease, osteoporosis, 
breast cancer, and colorectal cancer.
  This bill will provide the basis for looking at the research needs in 
the spectrum of women's health and as we go to hearings on the bill I 
am hopeful that additional women's health issues can be addressed.
  There is another facet to women's health research that must be 
considered. It is imperative that we ensure that studies are 
representative of all women in the United States, including African 
American, Hispanic, Native American and Asian women. We need research 
that is culturally sensitive. We must support efforts of community 
based outreach that allows for recruitment and retention of minority 
women into research and this should be a factor when projects are 
planned and conducted.
  Mr. President, this legislation has provisions relating to women's 
health research at the NIH in the disease specific issues of 
diethylstilbestrol (DES), osteoporosis, breast and ovarian cancer. It 
expands and allows for increased coordination of research activities 
with respect to heart attack, stroke, and other cardiovascular diseases 
in women at the National Heart, Lung, and Blood Institute. This program 
is critical since cardiovascular disease is the leading cause of death 
for women in the United States.
  Finally, Mr. President, I wanted to take the opportunity to 
specifically highlight one particular CDC program in the bill. This 
legislation addresses the Health Promotion and Disease Prevention 
Research Centers Program at the CDC and will extend authorization for 
grants to our academic health institutions for research in the areas of 
health promotion and disease prevention.
  The CDC's Prevention Research Center Program is an innovative, 
extramural link of federal, academic, state, and community based 
agencies.
  For my home state of New Mexico, this CDC project has been 
particularly useful. In New Mexico a prevention center has been able to 
focus on health risks and promoting health through applied research at 
the community level. The project and grant have provided the 
opportunity to address areas often overlooked such as rural population

[[Page S1514]]

needs and Native American and Hispanic health needs.
  In New Mexico about one of every three American Indian adults has 
diabetes. The demonstration project has allowed for the promotion of 
health lifestyles to combat the epidemic of adult onset diabetes. The 
project has facilitated the formation of a true partnership between the 
Navajo nation, nineteen pueblos in New Mexico, the New Mexico 
Department of Health, the University of New Mexico, and the New Mexico 
State Department of Education. There has been training of community 
health workers on disease prevention strategies most applicable to 
American Indian communities. This program is a model for increasing 
collaboration among established agencies and nontraditional community 
partners. It is a culturally sensitive approach that is having a 
direct, positive impact on the health of New Mexicans. The creative 
approach at CDC of a community based demonstration and application 
project coupled with evaluation of strategies through research is 
unique, successful, and should be reauthorized.
  Mr. President, in closing, I look upon this bill as the important 
first step to reauthorize programs at both the CDC and NIH. I look 
forward to working with Senator Frist on these and other issues of 
import to women's health.
  Mr. WELLSTONE. Mr. President, I rise today to join my colleague from 
Tennessee and others in introducing the ``Women's Health Research and 
Prevention Amendments of 1998,'' as an original cosponsor. This bill 
reauthorizes funding to extend and enhance many fine programs at the 
National Institutes of Health and the Centers for Disease Control and 
Prevention. I am pleased to join in this important effort.
  Mr. President, I would like to commend Senator Frist for his work in 
developing this legislation to strengthen and expand Federal efforts to 
promote women's health. While there is still some work to be done to 
improve the bill as it moves through the normal legislative process, I 
believe this bill offers a good start and provides a solid foundation 
on which to build historic improvements in NIH research programs on 
breast cancer, heart attack, menopause, and other areas. Let me outline 
briefly a few critical issues that are not addressed by the bill, but 
which I hope to see addressed as we move forward.
  One notable gap is in the area of substance abuse. I believe this 
bill could be an important complement to the Substances Abuse Treatment 
Parity Act (S. 1147), which I introduced last September to improve 
access to equitable medical care to treat the disease of alcohol and 
other drug dependencies. Substance abuse is a widespread health concern 
for many women, who also experience associated health, psychological, 
and family problems. For example, expectant mothers and mothers with 
small children can be helped with treatment and support services. This 
is an investment for them, but as importantly for their children, who 
would have the opportunity to grow up in a healthy, chemical-free home 
environment. We have to take the problem of substance abuse as 
seriously as we do other aspects of women's health.
  Important information about this national problem will be highlighted 
in an upcoming five-part PBS series by Bill Moyers, where treatment 
programs such as the Hazelden program in my state of Minnesota are 
highlighted. In working with these and other treatment programs in 
Minnesota, I have learned a great deal about the problems of substances 
abuse, but also about the hope and success that occurs when effective 
treatments are available. The Women's Health Research and Prevention 
Amendments Act could be substantially improved by an additional focus 
on substance abuse programs.
  Another notable gap is in the area of mental health and behavioral 
science. On page one of the New York Times today was an article on the 
criminalization of mental illness. The problem is that we as a nation 
have needed to focus on the humane, dignified treatment of mental 
illness, and having failed in that, more and more people who are 
suffering from mental illness are winding up in prisons where they are 
out of sight, but where they are not getting the care they need. We 
need to treat mental health as seriously as we treat cancer and heart 
disease, because mental illness can be just as serious, chronic, and 
life-destroying as other diseases.
  I intend to work closely with Senator Frist and others on the 
committee to improve the bill by including a recognition of the role 
that behavioral science and psychological factors have in the 
development of and recovery from disease. Many of the diseases 
mentioned in the bill are scientifically linked to behavioral or 
psychological factors that can be critical to prevention and recovery. 
Women also suffer unduly from specific mental health problems and 
experiences, such as depression and domestic violence. Depression, for 
example, is a pervasive and impairing illness which affects women at 
roughly twice the rate of men. Domestic violence places a significant 
resource and economic strain on our justice, health, and human services 
systems. Research conducted at urban hospitals has show that about 25% 
of emergency room visits by women resulted from domestic assaults. 
Women who have been raped or battered have significantly great physical 
health problems, as well as increased vulnerability to psychological 
and emotional suffering. My wife Sheila and I have worked for years to 
improve the federal response to the epidemic levels of domestic 
violence across the country; I want to make sure this bill adequately 
addresses these issues.
  Mr. President, it is my commitment to work closely with the committee 
to enhance these and other areas that are critical to women's health. A 
strong focus on research and prevention of mental illness and substance 
abuse for women is an important investment in the health of the nation 
and of the health and well being of countless families.
  Mr. NICKLES. Mr. President, I want to speak today on the Women's 
Health Research and Prevention Amendments of 1998 introduced by my 
colleagues Senator Frist and Majority Leader Lott. This bill would 
amend the Public Health Service Act to revise and extend certain 
programs with respect to women's health research and prevention 
activities at the National Institutes of Health and the Centers for 
Disease Control and Prevention.
  Education and Research are the key to providing the best health care 
for women and for that matter, all Americans. The Women's Health 
Research and Prevention Amendments promote precisely that. Just two 
examples are the extension of NIH research programs for basic and 
clinical research and education efforts with respect to cancer, breast 
cancer, and ovarian and related cancer; and the extension of the CDC 
National Breast and Cervical Cancer Early Detection Program. These are 
the kinds of programs that will improve women's health.
  I am pleased to be a cosponsor of the Women's Health bill because I 
believe that research is the best way for Congress to respond to the 
concern over women's health issues and health issues generally. I make 
this point, Mr. President, because I have been disappointed that 
Congress has recently put on lab coats and begun practicing medicine. 
We have gotten into the dangerous habit of legislating clinical 
procedures which are not based in science or research but rather driven 
by social opinion and special interests.
  You only have to look back to the end of the 104th Congress to 
illustrate my point. A majority of Congress supported an effort last 
year to mandate that all insurance plans cover 48-hour maternity stays 
in hospitals. However, serval months following the passage of that 
legislation an article appeared in the Journal of the American Medical 
Association stating that the ``content does not solve the most 
important problems regarding the need for early postpartum/postnatal 
services. The legislation may give the public a false sense of 
security. It may call into question the reasonableness of relying on 
legislative mechanisms to micro manage clinical practice.''
  In other words, Congress made a nice, laudable attempt. We said we 
are going to mandate 48 hours, but it has had no appreciable 
improvement on the quality of health care. It appears that our so-
called victory in passing 48 hours may have in fact done more harm than 
good in helping women and newborns. This experience, and others like 
it, should have taught us what not to do.

[[Page S1515]]

  It should have taught us that before we endeavor to decide what is 
the best therapy, procedure, or treatment for any one disease, let us 
look for a minute at what we are doing. What are the unintended 
consequences of federal mandates on health insurance companies 
regarding treatments and coverage of services?
  Let's take breast cancer as another example. Various bills have been 
introduced in the last few months that mandate a length of stay for 
mastectomies or require coverage of an inpatient stay for women 
undergoing breast cancer surgery for an unspecified length of time, to 
be determined by the physician.
  Were Congress to legislate in favor of one form of treatment over 
another, we are sending the message that one treatment is preferable to 
the other. Treatments are constantly changing. Health care needs to be 
flexible and should not lock doctors in to a specific approach. 
Shouldn't we allow medical research to decide the best course of 
action? If the federal government mandates a specific treatment, length 
of stay or procedure, that then becomes the standard.
  In addition, employing mandates in the place of valid research runs 
the risk of discouraging innovative treatments. For example, recent 
improvements in anesthesiology are a result of patient appeals to cut 
down on nausea and vomiting after breast surgery as well as a desire to 
recover at home.
  Longer mandated stays could discourage doctors and patients from 
developing the best possible plan for recovery. Patients may choose to 
stay in the hospital for an extended period of time out of fear or lack 
of knowledge and risk infection. Patients may have the false idea that 
longer hospital stays equal the best possible treatment when, in fact, 
recent research indicates that is not necessarily the case.
  According to a November 6, 1996, article in The Wall Street Journal, 
The Johns Hopkins Breast Center in Baltimore, which has gradually 
eliminated inpatient stays for some women undergoing certain types of 
mastectomies, has found that outpatient mastectomies are associated 
with lower infection rates and high levels of satisfaction among women. 
We have the responsibility to arm patients with the kind of sound 
research and education this legislation provides, not prescriptive 
mandates from Dr. Congress.
  Lillie Shockeney, R.N. the Education and Outreach Director at the 
Johns Hopkins Hospital Breast Center and a breast cancer survivor, 
summed up best in a Finance Committee hearing on November 5, 1997. ``. 
. . I am concerned that it [S. 249, The Women's Health and Cancer 
Rights Act of 1997] doesn't solve the real medical dilemma that women 
battling breast cancer are faced with today. We need to be striving to 
improve patient care for patients undergoing breast cancer surgery 
rather than unknowingly promote keeping it at status quo. We need to be 
promoting the development of a comprehensive patient education program 
and have teams of health care professionals dedicated to striving to 
improve the care and treatment provided to women with breast cancer.''
  Mr. President, I want to congratulate Senator Frist and Senator Lott 
for bringing this issue before us in such a responsible and proactive 
bill. These programs go a long way to serve women. I thank the chair 
and encourage my colleagues to support this common sense legislation.
  Mrs. BOXER. Mr. President, I am very pleased to join my colleagues in 
introducing the Women's Health Research and Prevention Amendments of 
1998. This is a bipartisan initiative, which is important, because 
promoting the health of American women is a bipartisan concern. I 
commend the Senator from Tennessee for his leadership on this bill. He 
has done a tremendous job in building crucial and broad support for it.
  I am particularly pleased that the bill includes a title on 
cardiovascular disease in women, which incorporates legislation I 
introduced last June, the Women's Cardiovascular Diseases Research and 
Prevention Act (S. 349). It is appropriate to include it in this 
comprehensive legislation because cardiovascular disease is the number 
one killer of women in the United States, a fact many Americans simply 
don't realize.
  The statistics are alarming. More than 500,000 women and girls die 
from cardiovascular disease each year. Heart attacks and strokes are 
the leading causes of disability in women. More than 1 in 5 females 
have some form of cardiovascular disease. Of women and girls under age 
65, approximately 20,000 die of heart attacks each year. Cardiovascular 
disease claim about as many lives each year as the next eight leading 
causes of death combined. More than 2,600 Americans die each day from 
cardiovascular diseases; that's an average of one death every 33 
seconds. Cardiovascular diseases kill more women each year than does 
cancer. Heart attacks kill more than 5 times as many females as does 
breast cancer. Stroke kills twice as many women as does breast cancer. 
Each year since 1984, cardiovascular diseases have claimed the lives of 
more females than males. In 1993, of the number of individuals who died 
of such diseases, 52 percent were female, and 48 percent were male.
  Yet for years, women have been under-represented in studies about 
heart disease and stroke. Models and tests for detection have largely 
been conducted on men, and some doctors do not recognize cardiovascular 
symptoms that are unique to women.
  The bill we are introducing today authorizes necessary funding to the 
National Heart, Lung and Blood Institute to expand and intensify 
research, prevention, and educational outreach programs for heart 
attack, stroke and other cardiovascular diseases in women. This 
legislation will aid our Nation's doctors and scientists in developing 
a coordinated and comprehensive strategy for fighting this terrible 
disease.
  This bill will help ensure that women are well represented in future 
cardiovascular studies and that their doctors are well informed about 
symptoms that are unique to women. It will also promote women's 
awareness of risk factors, such as smoking, obesity and physical 
inactivity, which greatly increase their chances of developing 
cardiovascular disease.
  This legislation is a critical component in our efforts to draw 
attention and resources to cardiovascular disease, which strikes so 
many of our grandmothers, mothers, aunts and daughters. Through it, and 
in collaboration with many dedicated groups such as the American Heart 
Association, we can and will beat this devastating disease.
  The Women's Health Research and Prevention Amendments of 1998 
reauthorize several programs that are of great importance to American 
women, including research on osteoporosis, cancer, aging, and the drug 
DES. The bill extends authorization for programs that promote health, 
prevent disease, and reduce domestic violence. I encourage the leaders 
to bring this legislation to the floor as quickly as possible, so that 
we can move forward in our efforts to promote the health of women 
across the nation.
  Mr. DASCHLE. Mr. President, I am pleased to join my colleagues from 
both sides of the aisle in support of the Women's Health Research and 
Prevention Amendments of 1998, a bill that responds to a fundamental 
weakness in our health care system: the relative paucity of research 
devoted to women's health issues. As we learn about the unique health 
care needs of women, we have an historic opportunity to redress the 
unjustified disparity in the level of effort and resources invested in 
women's health.
  This measure extends several targeted initiatives of the National 
Institutes of Health (NIH), including research on osteoporosis; breast, 
cervical and ovarian cancer; and heart disease as it affects women.
  This research is clearly needed. While heart disease is the leading 
cause of death among women, there is inadequate understanding of how 
heart disease manifests in our female population. Indeed, a recent 
study showed that 2 out of 3 doctors were not aware that the risk 
factors for heart disease are different for women than they are for 
men, and 9 out of 10 did not know the symptoms vary according to 
gender.
  Like cardiovascular research, efforts to understand and treat 
osteoporosis are critically important. More than 28 million Americans, 
80 percent of whom are women, suffer from or are at-risk for 
osteoporosis. Half of all women age

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50 or over will suffer a bone fracture due to osteoporosis. Research 
into the causes, treatment and prevention of osteoporosis is a smart 
public health investment.
  An equally strong case can be made for the other NIH research 
initiatives extended by this bill. Whether the focus is breast cancer, 
a disease which takes the lives of 44,000 women each year, or ovarian 
cancer, which currently has a tragically low survival rate, the 
research priorities identified for inclusion in this bill represent 
some of the most important initiatives of any kind that we, as a 
nation, can undertake.
  The bill also extends key women's health initiatives at the Centers 
for Disease Control: One that I believe is particularly important is 
the CDC National Breast and Cervical Cancer Early Detection program. 
Over 1.5 million screening tests have been provided by the program, 
which began its seventh year in 1998. As a result, more than 23,000 
women were able to fight back against an otherwise silent killer. The 
CDC early detection program is now operational in all 50 states. More 
than 100 women are screened in my own state each month.
  Another very important program reauthorized by this bill is CDC's 
Community Programs on Domestic Violence initiative.
  Domestic violence is a threat to women, to children and to the family 
unit. It is shockingly prevalent and tragically under-reported. Studies 
indicate that one-quarter of all women in the United States experience 
domestic violence at some point in their life, and that 92 percent of 
them do not discuss these incidents with their physician. We need to 
recognize the problem for what it is--a crime, a killer, and a public 
health threat--and fight it with every tool we have at our disposal. 
Through the CDC program, non-profit organizations apply for resources 
to combat domestic violence in communities throughout the country. 
Local efforts to increase public awareness, dispel the myth that 
domestic violence is a private family matter, and help women and 
children who fall victim can, case-by-case, make a tremendous 
difference in the lives of millions of present and potential victims.
  This bill continues the effort to bridge the gender gap in the 
quality of research, data, and care. It asserts the fact that women 
have unique health care needs and addresses areas of particular 
importance to women's health. It also affirms the value of health 
research generally and recognizes the important role research plays in 
both improving health outcomes and decreasing health costs for many 
diseases. I am proud to be part of this effort.
                                 ______