[Congressional Record Volume 144, Number 145 (Tuesday, October 13, 1998)]
[House]
[Pages H10789-H10796]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
WOMEN'S HEALTH RESEARCH AND PREVENTION AMENDMENTS OF 1998
Mr. BILIRAKIS. Mr. Speaker, I move to suspend the rules and pass the
Senate bill (S. 1722) to amend the Public Health Service Act to revise
and extend certain program with respect to women's health research and
prevention activities at the National Institutes of Health and the
Centers for Disease Control and Prevention.
The Clerk read 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 NATIONAL
INSTITUTES OF HEALTH
SEC. 101. RESEARCH ON DRUG DES; NATIONAL PROGRAM OF
EDUCATION.
(a) Research.--Section 403A(e) of the Public Health Service
Act (42 U.S.C. 283a(e)) is amended by striking ``1996'' and
inserting ``2003''.
(b) National Program for Education of Health Professionals
and Public.--Title XVII of the Public Health Service Act (42
U.S.C. 300u et seq.) is amended by adding at the end the
following:
``education regarding des
``Sec. 1710. (a) In General.--The Secretary, 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 known as DES). To the
extent appropriate, such national program shall use
methodologies developed through the education demonstration
program carried out under 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.
``(b) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 1999 through 2003. 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. 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 2003''.
SEC. 103. RESEARCH ON CANCER.
(a) 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 2003''; and
(2) in subparagraph (B), by striking ``and 1996'' and
inserting ``through 2003''.
(b) 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 2003''.
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
[[Page H10790]]
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 are authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 1999 through 2003. 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 445H of the Public Health Service Act (42 U.S.C.
285e-10) is amended--
(1) by striking ``The Director'' and inserting ``(a) The
Director''; and
(2) by adding at the end the following subsection:
``(b) For the purpose of carrying out this section, there
are authorized to be appropriated such sums as may be
necessary for each of the fiscal years 1999 through 2003. 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. 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 NIH''.
TITLE II--PROVISIONS RELATING TO WOMEN'S HEALTH AT 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 2003''; and
(2) in paragraph (2), by striking ``through 1998'' and
inserting ``through 2003''.
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 2003''.
SEC. 203. NATIONAL BREAST AND CERVICAL CANCER EARLY DETECTION
PROGRAM.
(a) Services.--Section 1501(a)(2) of the Public Health
Service Act (42 U.S.C. 300k(a)(2)) is amended by inserting
before the semicolon the following: ``and support services
such as case management''.
(b) Providers of Services.--Section 1501(b) of the Public
Health Service Act (42 U.S.C. 300k(b)) is amended--
(1) in paragraph (1), by striking ``through grants'' and
all that follows and inserting the following: ``through
grants to public and nonprofit private entities and through
contracts with public and private entities.''; and
(2) by striking paragraph (2) and inserting the following:
``(2) Certain applications.--If a nonprofit private entity
and a private entity that is not a nonprofit entity both
submit applications to a State to receive an award of a grant
or contract pursuant to paragraph (1), the State may give
priority to the application submitted by the nonprofit
private entity in any case in which the State determines that
the quality of such application is equivalent to the quality
of the application submitted by the other private entity.''.
(c) Authorizations of Appropriations.--
(1) Supplemental grants for additional preventive health
services.--Section 1509(d)(1) of the Public Health Service
Act (42 U.S.C. 300n-4a(d)(1)) is amended by striking
``through 1998'' and inserting ``through 2003''.
(2) 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 2003''.
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 2003''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Florida (Mr. Bilirakis) and the gentleman from Ohio (Mr. Brown) each
will control 20 minutes.
The Chair recognizes the gentleman from Florida (Mr. Bilirakis).
General Leave
Mr. BILIRAKIS. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days within which to revise and extend their
remarks and include extraneous material on S. 1722.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Florida?
There was no objection.
Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I rise in strong support of S. 1722, the Women's Health
Research and Prevention Amendments of 1998. This legislation will
revise and extend a number of important women's health research and
prevention programs at the National Institutes of Health and the
Centers for Disease Control and Prevention.
Earlier this month, Mr. Speaker, I introduced the House companion
measure, H.R. 4683, with the gentleman from Virginia (Chairman Bliley),
the chairman of the Committee on Commerce. Both S. 1722 and the House
bill enjoy strong bipartisan support, including members of the
leadership and the chairman and ranking members of the committees of
jurisdiction. The American Cancer Society and the American Heart
Association have also endorsed this legislation.
In a recent letter, the Secretary of Health and Human Resources
expressed the administration's support for passage of the bill.
Secretary Shalala stated, ``The research, prevention and health
promotion activities that would be reauthorized are critical to the
health and well-being of the Nation's women.''
While noting that the bill does not include some of the
administration's legislative proposals on women's health, the Secretary
concluded that ``extension of the vital efforts that are addressed in
the bill should not be delayed.''
Mr. Speaker, both the NIH and the CDC play critical roles in efforts
to improve women's health through research, screening, prevention,
treatment, education and data collection. S. 1722 reauthorizes programs
at the NIH for vital research into the causes, prevention and treatment
of some of the major diseases affecting women, including osteoporosis,
breast and ovarian cancer and for research into the aging processes of
women.
In addition, the bill authorizes a new research program at the
National Heart, Lung and Blood Institute to target heart attacks,
strokes and other cardiovascular diseases in women, and this program
will advance research into cardiovascular disease, which is the leading
cause of death in women. In fact, one in ten American women between the
ages of 45 and 64 has some form of heart disease, and this increases to
one in five women over 65. According to the American Heart Association,
more than 500,000 American women die of cardiovascular diseases each
year.
NIH data indicates that 1.6 million women have had a stroke and
90,000 women die of strokes each year. In the past, the medical
community has focused on men in research, treatment and counseling for
heart disease and stroke. Clearly we need to do more to prevent and
treat these diseases in women.
S. 1722 also reauthorizes several major programs at the CDC for
prevention and education activities in women's health issues. These
include the
[[Page H10791]]
National Center for Health Statistics, the National Program of Cancer
Registries, the National Breast and Cervical Cancer Early Detection
Program, and the Centers for Research and Demonstration of Health
Promotion and Disease Prevention.
It is particularly important that we reauthorize these programs this
year, Mr. Speaker. While funding is currently available, the CDC relies
on its statutory authorization for certain critical activities. For
example, the National Center on Health Statistics relies on its legal
authority to ensure complete privacy of the data collected. Without
this authority, the center's ability to collect the data is threatened.
The Congressional Budget Office has issued a preliminary estimate of
the bill's cost, which totals $5.1 billion over five years. However,
and it is important to realize this, all of the spending authorized in
this bill is discretionary, subject to appropriation. The bill
reauthorizes programs that are already funded, already funded, with the
exception of the new cardiovascular disease program. However, NIH is
currently conducting research in this area and the new cardiovascular
research program will expand and coordinate those efforts.
Mr. Speaker, we have worked very, very hard to develop legislation
that enjoys strong bipartisan support. The bill does not purport to
address every woman's health concern, and there is clearly more work
ahead for our committee.
{time} 1645
To avoid unnecessary controversy and to speed reauthorization of
these important programs, however, it was necessary to maintain a
consensus-based approach in developing the bill.
The legislation also represents the work product of several Members.
Mr. Speaker, I want to take a moment to acknowledge their
contributions. Section 101, which establishes a national education and
research program regarding the drug DES, is modeled on legislation
introduced by the gentlewoman from New York (Ms. Slaughter).
Section 104, which promotes research related to cardiovascular
diseases in women, is similar to provisions of H.R. 2130 introduced by
the gentlewoman from California (Ms. Waters).
I also want to recognize the efforts of the gentleman from New York
(Mr. Lazio) to promote access to treatment for patients screened under
the CDC's National Breast and Cervical Cancer Early Detection Program.
At the urging of the gentleman from New York (Mr. Lazio) and the
American Cancer Society, provisions were added to section 203 of the
bill to emphasize the importance of case management services. This
language recognizes the critical role of case managers in assisting
breast cancer patients in obtaining access to treatment.
Mr. Speaker, I believe the Congress must play an active role in
promoting women's health research and prevention efforts. I am
particularly proud of the Committee on Commerce's role this year in
reauthorizing the Mammography Quality Standards Act, which ensures safe
and accurate mammography services for women.
The measure before us today reauthorizes a number of other critical
women's health programs, and I urge all Members to join me in
supporting passage of this important legislation.
Mr. Speaker, I reserve the balance of my time.
Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I am pleased to support S. 1722, the Women's Health
Research and Prevention Amendments of 1998. For far too long, women's
health issues have been neglected. The bill is a necessary step to
begin addressing critical health issues that are affecting women
exclusively or at highly disproportionate rates. Eighty percent of
Americans who suffer from osteoporosis are women. One in eight women
develop breast cancer, one in 25 will die of breast cancer, the second
leading cause of cancer deaths. Despite the misconception that women
rarely suffer from heart attacks, cardiovascular disease is the leading
cause of death among American women. These are only a few of the
devastating statistics concerning women's health issues that signal the
need for more research, treatment, and education to prevent women's
needless suffering.
H.R. 4683 and S. 1722 would extend research and prevention efforts of
the National Institutes of Health to explore some of the most dangerous
and critical diseases and conditions affecting women, including
osteoporosis, cancer, and cardiovascular disease, the leading causes of
death in American women.
The bill also extends women's health programs at the Centers for
Disease Control, such as the National Center for Health Statistics, the
National Program of Cancer Registries, and the National Breast and
Cervical Cancer Early Detection Program.
Expanding these programs will allow the CDC to conduct more research
to prevent and treat women's health issues, insure screening for early
detection of breast and cervical cancer, and curb premature morbidity
and mortality that lead to excessive health care costs.
The job will not be finished with the enactment of this bill alone.
Issues of quality and access need to be addressed. The Patients' Bill
of Rights should be enacted without further delay.
The National Partnership for Women and Families and more than 30
other women's organizations have listed numerous elements of the
Patients' Bill of Rights that are particularly important to the health
of women.
This bill would allow women to choose an OB-GYN as a primary health
provider, and have direct access to their services or to those of
allied health professionals, such as nurse midwives. The Patients' Bill
of Rights would require managed care companies to provide access to
clinical trials, a direct link between the research authorized by the
bill before us today and the actual receipt of health care by women.
Listen to what a couple of witnesses at our July hearing on the
Subcommittee on Health and Environment said about the importance of
clinical trials. Dr. Edison Liu of the National Cancer Institute said,
``Clinical trials are instrumental in these improvements. As examples,
within the last two years we have established new standards of optimal
therapy for women with node-negative and locally advanced breast
cancer, for women with advanced ovarian cancer, for melanoma, and for
childhood renal cancer. These new approaches to cancer therapy are the
direct result of the Nation's clinical trials system.''
Dr. Leonard Zwelling with the Anderson Cancer Center said at the same
hearing, ``Remember, all of the great approved cancer therapies in use
today were once being tested in the clinical trial setting. Without
clinical trials, we would have made no progress at all.''
The Patients' Bill of Rights would allow women to continue to see the
same provider throughout a pregnancy, even if the provider left the
plan or their employer changed plans. Prescription drugs that are
medically indicated but are not on an HMO's formulary would also be
covered. Drive-by mastectomies would be eliminated, performance and
quality measures would take the special needs of women into account, as
would data collections and plan summaries. Plans would be prohibited
from discriminating on the basis of sex. All of that is in the
Patients' Bill of Rights.
I would hope, Mr. Speaker, that we will authorize all NIH programs so
the research priorities of our Nation will be openly and equitably
addressed. Although S. 1722 deals with some of the health research
issues that impact women, it by no means addresses all of them. A
comprehensive reauthorization of NIH programs, coupled with passage of
the Patients' Bill of Rights, would achieve this objective.
Women are disproportionately affected by disease and conditions that
our medical community has the ability to halt. It is essential that we
do a better job in addressing women's health care issues. I commend the
gentleman from Florida (Chairman Bilirakis) for leading us to act on
solid bipartisan legislation. I commend the gentleman from Michigan
(Mr. John Dingell), ranking member of the full committee, for his work
on this issue, on women's health generally, and specifically, for his
leadership on the Patients' Bill of
[[Page H10792]]
Rights, legislation that this Congress should be addressing before it
adjourns.
I look forward to working with the gentleman from Florida (Mr.
Bilirakis), the gentleman from Michigan (Mr. Dingell), and others on
other pressing health care issues that are beyond the scope of this
bill.
Mr. Speaker, I reserve the balance of my time.
Mr. BILIRAKIS. Mr. Speaker, I yield 3 minutes to the gentleman from
Pennsylvania (Mr. Fox).
Mr. FOX of Pennsylvania. Mr. Speaker, I thank the gentleman for
yielding time to me.
Mr. Speaker, I appreciate the time to speak on behalf of the Women's
Health Research and Prevention Amendments of 1998. This is legislation
long overdue, and certainly the number one priority in the public
health interest. This legislation will help overall the women's health
research and prevention activities at the National Institutes of Health
and, of course, the Centers for Disease Control and Prevention of the
CDC.
Specifically, it will extend the research program on DES, the drug
widely prescribed years ago from 1938 to 1971, which has been shown to
be harmful to pregnant women and their children.
Moreover, the bill deals with research on osteoporosis, extends the
research program in that regard, and on Paget's Disease and related
bone disorders.
It also further will conduct research on cancer, breast cancer and
ovarian cancer especially. This is an area of great interest of mine.
Many people in Pennsylvania and across the country are trying to
support the additional efforts for breast cancer outreach, detection,
prevention, treatment. I just have to look to Suzanne Kay from my
district, who fought a long battle with breast cancer and it was her
life's hope, and I hope that we continue her dream, to have that cure
in our lifetime.
On ovarian cancer, we only have to look to Laurie Beecham from my
district, who has had a 9-year battle with ovarian cancer. This is
especially troublesome since ovarian cancer is so hard to detect and
has alluded us up until now. So with these additional women's health
research and prevention amendments, we will be able to win the war
against breast cancer, win the war against ovarian cancer.
This legislation goes further, Mr. Speaker, into research on heart
attacks, stroke and other cardiovascular diseases. The new
authorization is included to support research into something which has
been the leading cause of death in women, cardiovascular disease; long
overlooked. As prior speakers may have related, we have been looking,
from a male point of view, at heart disease but now this is an area of
interest we must pursue in order to be receiving the kind of
information that we can attack this cardiovascular disease and be
successful for women as well.
The aging processes in women, this legislation will also study the
effects and come up with cures regarding the diagnosis, disorders and
complications relating to menopause.
The legislation also goes into the National Center for Health
Statistics by producing data regarding systems to identify and address
a wide spectrum, Mr. Speaker, of health concerns from birth to death,
including overall health status, life-style, exposure to unhealthful
influences, the onset and diagnosis of illness and disability, and the
use of health care and rehabilitation services.
The National Program of Cancer Registries will be aided by this bill
because it will generate reliable cancer surveillance and data
collection to monitor trends, guide cancer control programs, to assist
in allocations of health resources, to advance population based health
services research.
Mr. Speaker, I just want to conclude by saying that we have just seen
a March Against Cancer here in Washington. We have our anti-cancer
caucus led by the gentleman from New York (Mr. Lazio), we have our
women's caucus, all working together.
With the passage of this legislation, S. 1722, we will be able to
move forward for women, for health care, for America. So I am pleased
to lend my support to this important legislation.
Mr. BROWN of Ohio. Mr. Speaker, I yield 3 minutes to the
distinguished gentleman from Michigan (Mr. Dingell). He has done great
work on all of these health care issues.
Mr. DINGELL. Mr. Speaker, I thank the gentleman from Ohio (Mr. Brown)
for yielding time to me.
Mr. Speaker, I rise in support of S. 1722, and H.R. 4683, its
identical version in the House, which is not at this moment before us.
I am pleased to be the cosponsor of this legislation recently
introduced by my good friend and colleague, the gentleman from Florida
(Mr. Bilirakis).
I do note, however, Mr. Speaker, that this is a very good bill,
worthy of support, but unfortunately in the haste of the conclusion of
this session it has not had the benefits of hearings or markup sessions
in the Subcommittee on Health and Environment or in the Committee on
Commerce. That normal and usual practice undoubtedly would have
improved the bill.
My colleagues on the committee from both sides of the aisle possess
great expertise in matters of this kind and they would have given
generously of their time and knowledge and thereby added greatly to the
quality of the legislation.
The legislation before us enjoys the support of many organizations
with strong credentials in the area of women's health issues. The
administration also supports the bills, but each of these supporters
would have welcome opportunities to come before the committee to convey
comments and concerns.
The hearings would have revealed that this bill is a bit limited in
scope, with many serious and controversial issues left unaddressed. In
the area of research, the bill does not address controversial issues
that affect women's health, such as sexually transmitted diseases.
Other than a few programs named, the bill does not address the broad
band of diseases that affect both genders and therefore, significantly,
women's health issues, as well as men's health issues. This is why
reauthorization of all NIH programs is urgently needed.
I hope that this bill begins that process and that we deal with NIH
in a more comprehensive and thorough going fashion in the next session.
Moreover, the bill does nothing to improve women's access to quality
health care. Women are the majority of enrollees in managed care plans.
Women have unique health care needs that go well beyond reproductive
health, and indeed their needs are quite different than those of men.
The National Partnership for Women and Families, along with more than
30 other organizations, has outlined a long list of women's health
issues that are addressed by the Patients' Bill of Rights, which
regrettably will not be passed by this Congress and which urgently
needs to be done.
Those include selection of an OB-GYN or allied health professional as
a primary care provider; access to clinical trials; gender specific
data; plan evaluation criteria, and a ban on gender discrimination by
HMOs. The legislation before us is regrettably silent on these issues.
Mr. Speaker, I support this bill. It is a good bill. It has,
regrettably, limitations, and we are now finding ourselves in a curious
procedural setting into which we need not have been cast had this
matter been brought up earlier and on which we had done perhaps a
better job of evoking hearings and all of the normal processes that are
undertaken in the Committee on Commerce.
It is important to know here today that as we pass a good bill, many
important women health care issues remain to be addressed. None of this
should be satisfied until this work is done.
Mr. BILIRAKIS. Mr. Speaker, I yield 4 minutes to the gentleman from
Oklahoma (Mr. Coburn).
Mr. COBURN. Mr. Speaker, every day when I am not here I practice
medicine, and 70 percent of my patients are women.
There are wonderful things in this bill. However, this bill comes up
short, especially in addressing cervical cancer in our country.
{time} 1700
Mr. Speaker, 43 percent of the young women in this country today are
carrying human papilloma virus. That is important. The reason that it
is important is because that causes 94 percent of the cancer of the
cervix to women in this country.
[[Page H10793]]
We also have in the bill a complete section on diethylstilbestrol,
which has not been used in almost 30 years in this country. The last
time it was used in any frequency was in the mid-1960s. The consequence
of cancer associated with that drug shows itself before the woman is 30
years of age. So, in fact what we are doing is authorizing a program
that is no longer needed with this bill.
My concerns, regardless of all the positive things in this bill, are
that we should make sure we reach beyond where we have been in the
past. And there is no question, breast cancer affects a vast majority.
My sister, my sister-in-law both had breast cancer as well as many
patients that I diagnose that disease in, and this bill is great in
that regard. This bill is great in cardiovascular health risks for
women. But it comes up very short in addressing a problem that is going
to burgeon and balloon on us.
Cervical cancer is going to grow at the rate of 10 or 15 percent per
year each year in the future. We have not instructed the CDC to do the
proper job with this bill. The CDC should have a program that mandates
human papilloma virus, the agent that causes cervical cancer, as a
reportable disease. They have refused to do that.
Mr. Speaker, 40 percent of the women in this country now have herpes.
It is also associated with anomalies and carcinomas of the reproductive
tract of women. We have done nothing to address that in this bill.
Mr. Speaker, I am going to support this bill, and I want us to move
forward with this. But I would like to have a colloquy with the
gentleman from Florida (Mr. Bilirakis), chairman of the committee, to
in fact see if we cannot address these issues and send out a
supplemental authorization in the next Congress so that we can impact
cervical cancer the way we are attempting to impact breast cancer in
this bill.
It is my hope that we will have a hearing so that what I have just
stated can be put in the Record by not me as a practicing physician,
but the scientists who know these issues well, and that that will
become a part of what we do in the future.
Mr. BILIRAKIS. Mr. Speaker, will the gentleman yield?
Mr. COBURN. I yield to the gentleman from Florida.
Mr. BILIRAKIS. Mr. Speaker, I would say that not only talking about
the scientific community, but certainly the gentleman's knowledge on
these areas certainly greatly exceeds that of ours, and I have no
reason to dispute what the gentleman says.
I have already indicated that what we try to do with this legislation
was try to work it out with the other body, with the other side, so
that we could have a piece of legislation which would be a good piece
of legislation, but certainly far from perfect.
So having said all of that, I assure the gentleman that we will
address those issues in the next Congress.
Mr. COBURN. Mr. Speaker, reclaiming my time, I thank the gentleman
for that assurance.
Mr. BROWN of Ohio. Mr. Speaker, I yield 2\1/2\ minutes to the
gentleman from Vermont (Mr. Sanders).
Mr. SANDERS. Mr. Speaker, I thank the gentleman from Ohio (Mr. Brown)
for yielding me this time.
Mr. Speaker, I am pleased today to support S. 1722, the Women's
Health Research and Prevention Amendments. I am an original cosponsor
of the House version, H.R. 4683, and I congratulate the gentleman from
Florida (Chairman Bilirakis) and the gentleman from Ohio (Mr. Brown),
the ranking member, for their efforts.
This is a good piece of legislation which authorizes or reauthorizes
a number of important acts. I am especially pleased that the National
Cancer Registries Act, which I introduced in 1992, is included for
reauthorization in this legislation.
Mr. Speaker, we all understand that cancer is a terrible disease
striking millions of Americans of all ages and from all walks of life.
The National Cancer Registries Act, which is being reauthorized now,
provides detailed information about who is coming down with cancer,
where they live, where they work, and how effective the treatment is
that they are receiving.
For years, cancer researchers wanted information, for example, about
the incidence of breast cancer in Vermont as opposed to the incidence
of breast cancer in another region. What might be the factors which
cause the difference in incidence rates? In other words, why is a
particular type of cancer more prevalent in one area of the country
than in another area?
Why within a given community is cancer more prevalent in one part of
that community than in another part of that community? In other words,
why are there certain hot spots that have developed?
All of that information is important because the more information
that researchers have, the better able they will be to understand what
might be causing different types of cancer, and also in developing
prevention efforts to stop the spread of cancer as well as better
treatments to treat cancer.
Clearly, the more detailed information that we have about cancer, the
better able we will be to understand the cause of this terrible disease
which is killing more than a half million Americans every year and will
account for one out of every four deaths in the United States this
year.
Mr. Speaker, I want to mention that several years ago when Senator
Leahy and I successfully introduced this legislation, we were given the
means to do so by a number of breast cancer survivors in the State of
Vermont, women who stood up and said, ``We are going to fight back.''
Among those were Joann Rathgeb, who passed away several years ago, and
Pat Barr and Virginia Soffa, who are continuing their battle against
cancer today.
Mr. BILIRAKIS. Mr. Speaker, how much time do we have remaining?
The SPEAKER pro tempore (Mr. Boehlert). The gentleman from Florida
(Mr. Bilirakis) has 7 minutes remaining, and the gentleman from Ohio
(Mr. Brown) has 9\1/2\ minutes remaining.
Mr. BILIRAKIS. Mr. Speaker, I reserve the balance of my time.
Mr. BROWN of Ohio. Mr. Speaker, I yield 1\1/2\ minutes to the
gentlewoman from New York (Ms. Slaughter).
Ms. SLAUGHTER. Mr. Speaker, I thank the gentleman from Ohio (Mr.
Brown) for yielding me this time, and I rise in strong support of this
legislation.
I am particularly proud to vote for it today. I an thankful for the
good work of the gentleman from Florida (Mr. Bilirakis) and the
gentleman from Ohio (Mr. Brown) for bringing this to us this afternoon.
This bill contains a vital section extending Federal research and
education on the drug diethylstilbestrol, or DES. It was prescribed to
pregnant American women from 1938 to 1971 in the mistaken belief that
it would prevent miscarriage. Not only did DES fail to impact
miscarriage rates, but it caused deformities and other health problems
in the reproductive systems of many of the children exposed in utero.
Touted as a ``wonder drug,'' DES was taken by women who believed they
were getting the best medical care in the world. But DES is now known
to cause a fivefold increased risk for ectopic pregnancy as well as a
threefold increase for a risk of miscarriage and preterm labor. One in
every 1,000 girls and women exposed to DES in utero will develop clear
cell of the vagina or cervix and will have to undergo treatment that
ends their fertility. Men exposed in utero have a higher incidence of
undescended testicles and fertility problems. Recent studies have
hinted, and this is one of the reasons that research is so important,
that DES may cause similar reproductive tract problems in a third
generation of grandsons and granddaughters.
In 1992, I was proud to sponsor the legislation that established the
first Federal research and education programs on DES. And last year, we
introduced H.R. 1788, the DES Education Research Amendments, to
authorize and expand the education efforts nationally.
Congress has a rare opportunity to act today to ensure that all men
and women exposed to DES are made aware of their special health risks
and needs. Further, we must continue research into the effects of DES,
research which is yielding such important insights into the effects of
environmental estrogens on the human body.
Mr. Speaker, I am proud to support S. 1722, and urge my colleagues to
do so as well.
Mr. BILIRAKIS. Mr. Speaker, I yield 4 minutes to the gentlewoman from
Maryland (Mrs. Morella).
[[Page H10794]]
Mrs. MORELLA. Mr. Speaker, I thank the gentleman from Florida (Mr.
Bilirakis) for yielding me this time.
Mr. Speaker, I rise in very strong support of what I call the B&B
bill, ``Bilirakis and Brown.'' I want to congratulate the gentleman
from Florida (Chairman Bilirakis) and the gentleman from Ohio (Mr.
Brown), the ranking member, for bringing this bill before us.
Why am I interested? Not only because as a woman, but I represent the
National Institutes of Health and work very closely with the Centers
for Disease Control, and I remember when we worked very hard and
inspired the National Institutes of Health to establish their Office of
Research on Women's Health, which has worked very effectively. Now
codified is the fact that women will be included in all clinical trials
and protocols, unless there is adequate reason why they would not be.
So, this bill really follows along beautifully, reauthorizing many of
the programs at NIH that really pretty much come under the jurisdiction
of the Office of Research on Women's Health and the Centers for Disease
Control in terms of research and prevention.
Just looking at it, for instance the DES bill, I am on a bill with
the gentlewoman from New York (Ms. Slaughter) dealing with DES. Much
more needs to be done. We need to do more research on it.
Osteoporosis. I am very pleased with the fact that in Medicare, bone
mass measurement standardization for osteoporosis is part of that. I
pushed it and am continuing to work on research for it. We know that
one out of every eight men will have an osteoporotic fracture over the
age of 50, and one out of every two women after the age of 50.
The research on cancer. Look at breast cancer. Mr. Speaker, 182,000
women will be touched by breast cancer, diagnosed having breast cancer
every year, and 46,000 of them are going to die because of that. Much
more is being done with that research.
We could cite all kinds of examples. For instance, at the Race for
the Cure to see those women wearing those pink hats, which means they
are survivors, and each year the numbers increase because each year we
do a lot more with research, making sure that quality mammograms are
available, notification.
Ovarian cancer is increasing, and yet we know now that it is
treatable. If we can learn how to detect it earlier, it can make a
difference between life and death.
Heart attack, stroke, cardiovascular diseases. Remember the famous
aspirin test where they used 43,000 male medical students to determine
the effect of aspirin on cardiovascular diseases, and used no women,
and yet they extrapolated from that that this is the way that women
would be responding to it. They did the same thing with coffee. They
did a test with how would coffee and caffeine affect cardiovascular
diseases, and it was done with all men.
Well, we know that it is the number one killer of men and women, but
it kills even more women than it does men. And with women, they get it
later and they die faster.
Mr. Speaker, these are the kinds of things that mean that this bill,
with its reauthorization, is critically important. Of course, aging
processes. Obviously, I stand here and I can say that I am a testament
to the fact that we need to do more work with regard to the aging
processes. And, of course, people are living longer lives, too.
The Office of Research on Women's Health. That is kind of a technical
amendment that is put in there to allow Dr. Varmus, for instance, to do
the appointing of the Advisory Committee on Research on Women's Health.
Also with regard to CDC, we had the gentleman from Vermont (Mr.
Sanders) speak. I am cosponsor of his legislation. I think it is
important that we look at the Cancer Registry and find out whether we
have some other facets or conditions that yield an extraordinary number
of cancer deaths in particular regions. So, in the CDC National Breast
and Cervical Cancer Early Detection Program, again looking at the
underserved women.
So, all in all, maybe as someone said, this bill could even go
further. But I think it is terrific. I think it is a great piece of
legislation. Again, I want to commend the authors of it, who have
worked very hard to make sure that here in this penultimate day of
session, that we have an opportunity to vote on it. So I congratulate
them and say let us move on.
Mr. BROWN of Ohio. Mr. Speaker, I yield 3 minutes to the gentlewoman
from California (Ms. Waters).
Ms. WATERS. Mr. Speaker, I rise today in strong support of H.R. 4683,
the Women's Health Research and Prevention Amendments of 1998.
I would like to thank the gentleman from Florida (Mr. Bilirakis),
chairman of the Subcommittee on Health and Environment of the Committee
on Commerce, and the gentleman from Ohio (Mr. Brown), ranking Democrat,
for sponsoring this most important bill here in the House.
This bill would bring much-needed attention to research and
prevention programs at the National Institutes of Health and the
Centers for Disease Control and Prevention that target the particular
health concerns of women, including osteoporosis, breast and ovarian
cancer and the aging process.
I am particularly pleased that in addition to the reauthorization of
these important programs, the bill includes a new research program at
the National Heart, Lung, and Blood Institute to target heart attack,
stroke, and other cardiovascular diseases in women.
{time} 1715
The language of this provision was drawn from the Women's
Cardiovascular Diseases Research and Prevention Act that I and Senator
Boxer introduced earlier in the Congress. I introduced this bill
because I strongly believe that aggressive steps needed to be taken to
combat this silent killer of American women.
There has been far too little focus on the number one killer of women
in the United States, cardiovascular disease. This is despite the fact
that more than 500,000 women die of heart attack, stroke and other
cardiovascular diseases. One in five females has some form of
cardiovascular disease. While all women are at risk, statistics show
that African American women are especially at risk. For African
American women between the ages of 35 and 74, the death rate from heart
attacks is twice that of Caucasian women. Yet studies show that four
out of five women are unaware of the threat of cardiovascular diseases.
It is tragic that the symptoms of women's heart disease often go
unrecognized or are often misdiagnosed. H.R. 4683 would target this
killer of American women. It would educate women and doctors about the
dire threat heart disease poses to them, educate doctors on the risks
and symptoms unique to women and improve research and services for
women in cardiovascular disease.
I want to thank the American Heart Association, the American Medical
Women's Association, the Washington Hospital Center and many other
organizations and individuals for all of their work on this issue, and
especially Dr. Davidson.
In particular, I want to recognize the work of the American Heart
Association. They have worked tirelessly to educate the public about
women's heart disease. They have launched a special initiative focusing
on women and heart disease and made the Women's Cardiovascular Diseases
Research and Prevention Act a centerpiece of their legislative
strategy.
Once again, I would like to thank the gentleman from Florida (Mr.
Bilirakis) for all that he has done and Senator Frist, who carried the
bill on the Senate side, for including heart disease in this important
women's health research and prevention bill.
Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentleman from
Pennsylvania (Mr. Fox).
Mr. FOX of Pennsylvania. Mr. Speaker, great credit is owed to the
gentleman from Florida (Mr. Bilirakis), chairman of the Subcommittee on
Health and Environment, for his leadership in moving this legislation
forward and really making a difference for all Americans. This
legislation obviously affects the women in our families, and we
certainly know that is the number one health care issue, funding for
the NIH, National Institutes of Health, and the Centers for Disease
Control. That kind of funding then goes to teaching hospitals, to
research centers all across the country, coming
[[Page H10795]]
forth with new discoveries on strategies to help women's health care.
My thanks again to the American Heart Association for what they are
doing to move forward, as the gentlewoman from California just
outlined. I also have to look to the Philadelphia Stroke Council, to
Toby Mazer, who has been a trailblazer in this area. Every one knows
that stroke is a brain attack. And what people may not know is there
are warning signs for stroke just like there are warning signs for
heart attack. What she is trying to do in her Philadelphia Stroke
Council is to make sure that we know about those warning signs, that
there is public education in that regard, that there are prevention
strategies. Just like every other major illness, we want to get people
to the hospitals as quickly as possible in that golden hour.
This legislation goes to the research to determine the reasons
underlying the prevalence of heart attack, stroke and other
cardiovascular diseases in women. This legislation will give us the
funding for basic research concerning the etiology and causes of
cardiovascular diseases in women. It also will give us the
epidemiological studies to address the frequency and natural history of
such diseases and the development of safe, efficient and cost-effective
diagnostic approaches.
Our thanks to the Linda Creed Foundation, the Susan Komen Foundation,
the National Ovarian Cancer Council and the American Cancer Society.
All of them have worked, together with the gentleman from Florida (Mr.
Bilirakis) and with the gentleman from Virginia (Mr. Bliley), to make
sure that working with the Senate legislation like this, which is going
to help us prevent cardiovascular disease, will in fact be an
accomplished fact. It will include applications of affected methods for
the control of blood pressure and obesity, information and education
programs for patients and health care providers regarding risk factors
associated with heart attack, stroke and other cardiovascular diseases.
I stand to support again this important legislation. And one last
item, Mr. Speaker, the cancer registry will help us with the regional
aspects of diseases and what we can do as States and regions to make
sure we are changing the environmental factors that may be affecting a
very large health care concern.
Mr. BROWN of Ohio. Mr. Speaker, I yield myself 2 minutes.
I want to point out as several of us have mentioned but discuss for
another moment part of this bill. The only part of this bill that is a
new authorization deals with research in heart attack, stroke and other
cardiovascular diseases in women. During a women's health seminar, a
program that my office put on in Medina, Ohio some time ago, a
cardiovascular surgeon, a female cardiovascular surgeon from Cleveland
pointed out to us something that I think women across the country are
too often unaware of. That is that while men more often have heart
attacks than women do, women are more often, more likely to die of
heart attacks than men because women do not really think of themselves
as likely victims of heart disease because our society, for whatever
reason, has led most of us to believe that men get heart attacks and
women get other diseases. And so I think it is particularly important
that more research is done on this.
It is particularly important that we do better education, among women
especially. Whether it is my mother in Mansfield, Ohio or whether it is
women across this country, they need to obviously be aware to look for
those symptoms, as men I think in society are conditioned to look at
those symptoms that might be leading up to a heart attack.
Mr. Speaker, I have no further requests for time, and I yield back
the balance of my time.
Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may
consume.
I would like to close strongly recommending an aye vote on this
legislation. It is really the result of a work in progress over a
period of time. We have recognized other Members who have introduced
pieces of legislation which we have incorporated in so many words into
this piece of legislation. And certainly my gratitude to Senator Frist
was mentioned. He has been very, very cooperative. We have worked with
him for quite some time on this. His staff, the gentleman from Virginia
(Mr. Bliley), the majority committee staff, the gentleman from Michigan
(Mr. Dingell) and the gentleman from Ohio (Mr. Brown) and their fine
staff over there. We were able to show what can be done, another
illustration of what can be done when Members are willing to sit around
the table and work in a bipartisan fashion.
Ms. DeLAURO. Mr. Speaker, I rise today in support of the Women's
Health Research and Prevention Amendments of 1998. This bill will make
significant contributions to research in many diseases which affect
women. I thank Chairman Bilirakis for his work in drafting this
legislation and moving it to the floor so quickly at the end of this
session.
Women's health research and has been ignored for far too long, and
this bill will add to the important progress we have made over the last
several years. As an ovarian cancer survivor, I am particularly pleased
that this bill will reauthorize programs into research for ovarian
cancer.
Currently there is no diagnostic test to detect ovarian cancer in the
early stages when it is highly curable. Instead, most cases of ovarian
cancer are found in the advanced stages, and nearly two-thirds of women
with the disease die within 5 years of diagnosis because their illness
was detected too late. This research will help the National Institutes
of Health to continue its work to improve early detection, find new
treatments, and one day find a cure.
But there are a number of other bills before this Congress which
would do just as much to promote women's health, and I am deeply
disappointed that we have not yet had the opportunity to act on them.
We have not yet taken any action to outlaw drive through mastectomies
by passing the Breast Cancer Patient Protection Act. I introduced this
bipartisan bill in the first days of the 105th Congress, and it has 219
cosponsors--Republicans and Democrats alike, enough to pass it today if
it was brought to the floor for a vote. This bill is vitally important
in ensuring that breast cancer patients get the care they need to
recover from this devastating surgery.
Congress has not yet acted to pass legislation that would ensure that
women with no health insurance, who are diagnosed with breast cancer
after getting a mammogram through the Breast and Cervical Cancer Early
Detection Program, have access to treatment. As it stands now, many
women who discover through this screening program that they have breast
cancer are left in the unfathomable position of being unable to afford
the treatment they need to survive.
Other important women's health bills we have yet to address include:
legislation which would provide coverage of reconstructive surgery
after mastectomies for breast cancer patients; legislation which would
outlaw genetic discrimination by insurance companies; and legislation
which would allow women to choose OB/GYNs as their primary care
physicians.
I am also disappointed that this bill does not expand the Centers for
Disease Control's WiseWoman project. During the 103rd Congress, we
started this demonstration project at three clinics which participated
in the Breast and Cervical Cancer Early Detection Program. WiseWoman
gives uninsured women access to better all-around health care, and
allows them to develop relationships with staff that keeps them going
back for fellow-up care.
The clinics participating in this project do more than just test for
breast and cervical cancer--they test for high blood pressure,
diabetes, and other illnesses. The WiseWoman program has been highly
successful in improving women's health and I would hope that as
Congress expands funding for the successful Breast and Cervical Cancer
Early Detection Program, we would expand the WiseWoman program as well.
This bill is a good first step in furthering a research agenda that
will improve women's lives. I hope that we can continue to work
together to pass all of these bills which are vital to the health of
American women.
Mr. BLILEY. Mr. Speaker, I am pleased the House will pass S. 1722,
``The Women's Health Research and Prevention Amendments of 1998.''
This bill revises and extends a number of important women's health
research and prevention programs at the National Institutes of Health
(NIH) and the Centers for Disease Control and Prevention (CDC). Mr.
Bilirakis and I introduced the companion measure to S. 1722, the
``Women's Health Research and Prevention Amendments of 1998.'' S. 1722
was introduced by Senator Bill Frist and enjoys strong
bipartisan support, including Senators Lott, Daschle, Jeffords and
Kennedy.
[[Page H10796]]
One of the most important programs reauthorized by this bill is the
National Breast and Cervical Cancer Early Detection Program. S. 1722
extends this important program, which provides for regular screening
for breast and cervical cancers to underserved women, prompt follow-up
if necessary, and assurance that the tests are performed in accordance
with current quality recommendations. The CDC supports activities at
the State and national level in the areas of screening referral and
follow-up services, quality assurance, public and provider education,
surveillance, collaboration and partnership development. S. 1722 would
assist CDC to be more aggressive in helping women fight the twin
scourges of breast and cervical cancer.
I am very proud that our Committee has done more than reauthorize the
National Breast and Cervical Cancer Early Detection Program. Just a few
weeks ago this committee led the effort on the floor to pass H.R. 4382,
the Bliley-Bilarikis Mammography Quality Standards Reauthorization Act
of 1998. This bill assured the safety, accuracy, and overall quality in
mammography services for the early detection of breast cancer. Women
who seek mammograms, however, must be assured that their results will
be accurate and not misleading. I am pleased that the President has
signed the Mammography Quality Standards Reauthorization Act of 1998
into law.
I urge my colleagues to join me in voting for S. 1722 ``The Women's
Health Research and Prevention Amendments of 1998'' and I urge the
President to sign this bill into law as well.
Mr. GILMAN. Mr. Speaker, I rise today in support of S. 1722, the
Women's Health Research and Prevention Amendments of 1998. Since
October is National Breast Cancer month, it is appropriate that this
legislation, that not only deals with breast cancer, but also cervical
and ovarian cancer and cardiovascular diseases, be brought to the floor
today.
This legislation will reauthorize many important programs at the
National Institutes of Health and the Centers for Disease Control which
have been instrumental in combating various diseases such as breast,
cervical and ovarian cancers and heart attacks and strokes. Studies
performed by NIH and the CDC have helped educate many women about the
advantages of early detection and prevention and have saved millions of
lives. Further funding for these programs will help to ensure that
research and studies of diseases affecting women continue.
Without past studies and demonstration projects, many women would not
have been informed about early detection and as a result would have
succumbed to the horrible effects of cancer and cardiovascular
diseases. This bill will not only educate the public, but will also
help educate the doctors and nurses who treat women about how these
diseases specifically attack women.
I applaud the efforts of my colleague, the gentleman from Florida,
Mr. Bilirakis, for bringing this important legislation forward today.
Accordingly, I urge my colleagues to support this significant
legislation.
Mr. BILIRAKIS. Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Boehlert). The question is on the motion
offered by the gentleman from Florida (Mr. Bilirakis) that the House
suspend the rules and pass the Senate bill, S. 1722.
The question was taken.
Mr. BILIRAKIS. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 5 of rule I and the
Chair's prior announcement, further proceedings on this motion will be
postponed.
____________________