[Congressional Record Volume 145, Number 149 (Thursday, October 28, 1999)]
[Extensions of Remarks]
[Pages E2207-E2208]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       DR. SYDNEY E. SALMON ACCESS TO CANCER CLINICAL TRIALS ACT

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                            HON. MATT SALMON

                               of arizona

                    in the house of representatives

                       Thursday, October 28, 1999

  Mr. SALMON. Mr. Speaker, I rise to pay tribute to Dr. Sydney Salmon, 
who passed away recently after a three year bout with pancreatic 
cancer. Dr. Salmon served as the Director of the Arizona Cancer Center 
at the University of Arizona from its founding in 1976 until last year. 
During that time, he built the Center into one of the pre-eminent 
research facilities in the world and emerged as a national figure in 
cancer clinical research. A noted innovator and academic, Dr. Salmon 
invented numerous medical techniques that

[[Page E2208]]

have had a major impact on biology, and he authored nearly 400 
scholarly papers.
  Although ailing with cancer, Dr. Salmon set aside time to educate me 
about a fatal flaw--literally--in our health care system that 
contributes to cancer's carnage. He informed me that our system 
discourages patients eligible for cancer clinical trials, the most 
effective type of care for many with cancer, from enrolling. I learned 
that if it were not for clinical trials, we wouldn't have the 
successful treatments that we enjoy today.
  Dr. Salmon inspired me to develop the Access to Cancer Clinical 
Trials Act, which today I rename the ``Dr. Sydney E. Salmon Access to 
Cancer Clinical Trials Act'' in his memory. I am both proud and duty 
bound to honor a great man with this legislation. The act guarantees 
cancer patients access to any federally approved cancer clinical trial 
by requiring insurers to pay the routine patient costs--blood work, 
physician visits, etc.--that would be covered if the patient was in the 
standard treatment of care. The measure would not require health 
insurers to pay for the cost of new drugs, securing informed consent, 
collecting and managing data or complying with research-related 
paperwork. All of these costs would be paid by the sponsor of the 
clinical trial.
  For many cancer patients, cancer clinical trials are not only the 
best option, they are the only option. If we increase participation in 
cancer clinical trials we increase the survival rate and provide hope 
for those afflicted with this horrible disease.
  Unlike the managed care bill that recently passed the House, the 
Sydney Salmon Clinical Trials Act isn't limited to trials sponsored by 
government agencies, but also covers FDA trials. Coverage of FDA trials 
is a critical component of anti-cancer legislation. Two-thirds of 
trials are FDA-approved trials. Moreover, it is not enough to only 
cover trials conducted by government agencies when we know that many of 
the most important advances occur in private trials. The proper policy 
is to encourage participation in all trials that meet stringent 
guidelines, not just those sponsored by government agencies. I will 
urge the House-Senate Conference that ultimately develops the final 
managed care reform package to include language guaranteeing all cancer 
patients access to safe and federally approved clinical trials.
  Participation in cancer clinical trials is dangerously low. Twenty 
percent of cancer patients are qualified candidates for clinical 
trials, yet only 3 percent participate in them. One of the major 
reasons for this disparity is the uncertainty regarding whether routine 
patient care costs will be covered by managed care companies.
  The decline in enrollment in trials at the Arizona Cancer Center 
corresponds with the rise of managed care. In 1995, the Center enrolled 
398 cancer patients in 169 different clinical trials. In 1998, the 
numbers dropped to 246 patients enrolled in 158 studies.
  Managed care companies might be excused for their policy on cancer 
clinical trials if studies suggested that the cost of covering routine 
expenses were prohibitive and would increase the ranks of the 
uninsured. This is not the case. A Mayo Clinic study revealed that the 
costs of clinical trials averaged a trivial five percent more than 
standard therapy.
  But not trivial are the costs of not permitting patients to enroll in 
clinical trials. Research is thwarted, the war on cancer is hindered 
and patients who have no other hope for treatment needlessly suffer. 
The advances in treatment that clinical trials develop--virtually all 
standard therapies evolved from clinical trials--ultimately reduce the 
cost of providing care by reducing treatment costs. As evidence of the 
effectiveness of clinical trials, consider that for most childhood 
cancers the survival rate is nearly 75 percent, in large part because 
80 percent of children participate in clinical trials. Insurance 
companies seem to be suffering from an acute case of myopia when it 
comes to covering these state-of-the-art treatments.
  As a conservative Republican, I've always been opposed to mandates. 
But the federal government has an obligation to support research and 
development. Unless Congress acts, and acts decisively, vital research 
opportunities will be lost. Some 40 major cancer groups support the 
approach taken in the Dr. Sydney E. Salmon Access to Cancer Clinical 
Trials Act. Congress should listen to the cancer community and ratify 
this approach.

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