[Congressional Record Volume 150, Number 57 (Thursday, April 29, 2004)]
[Senate]
[Pages S4696-S4697]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DeWINE:
  S. 2361. A bill to amend the Public Health Service Act to enhance 
research, training, and health information dissemination with respect 
to urologic diseases, and for other purposes; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. DeWINE. Mr. President, I rise to introduce the Training and 
Research in Urology Act--or the TRU Act. During my career in the U.S. 
Senate, I have supported the successful effort to double NIH research 
funding and have provided a strong voice for our children. This bill 
complements my past and continued efforts. It helps provide urologic 
scientists with the tools they need to find new cures for the many 
debilitating urologic diseases impacting men, women, and children. This 
legislation is important to my home State of Ohio and would impact 
positively many families in Ohio and nationwide who are afflicted with 
urologic diseases.
  Ohio is a leader in urologic research. Researchers at the Children's 
Hospital of Cincinnati, the Cleveland Clinic, Case Western Reserve, and 
Ohio State University have made great strides toward achieving 
treatments. The fact is that urologic conditions affect millions of 
children and adults. Urology is a physiological system distinct from 
other body systems. Urologic conditions include incontinence, 
infertility, and impotence--all of which are extremely common, yet 
serious and debilitating. As many as 10 million children--more than 
30,000 in Ohio--are affected by urinary tract problems, and some forms 
of these problems can be deadly. At least half of all diabetics have 
bladder dysfunctions, which can include urinary retention, changes in 
bladder compliance, and incontinence. Interstitial Cystitis (IC), a 
painful bladder syndrome, affects 200,000 people, mostly women. There 
are no known causes or cures, and few minimally effective treatments. 
Additionally, there are 7 million urinary tract infections in the U.S. 
each year.
  Incontenence costs the healthcare system $25 billion each year and is 
a leading reason people are forced to enter nursing homes, impacting 
Medicare and Medicaid costs. Urinary tract infection treatment costs 
total more than $1 billion each year. Many urologic diseases, 
incontinence, erectile dysfunction, and cancer, increase in aging 
populations. Prostate cancer is the most common cancer in American men, 
and African-American men are at a greater risk for the disease. 
Medicare beneficiaries suffer from benign prostatic hyperplasia (BPH), 
which results in bladder dysfunction and urinary frequency. Fifty 
percent of men at age 60 have BPH. Treatment and surgery cost $2 
billion per year.
  Research for urologic disorders has failed to keep pace. Further 
delay translates into increased costs--in dollars, in needless 
suffering, and in the loss of human dignity. Incontinence costs the 
healthcare system $23 billion each year, yet only 90 cents per patient 
is spent on research--little more than the cost of a single adult 
undergarment. In 2002, only $5 million of the $88 million in new 
initiatives from the National Institute of Diabetes and Digestive and 
Kidney Diseases (NIDDK) was designated to urologic diseases and 
conditions. Of that $5 million, no new initiatives were announced for 
women's urologic health problems. In 2001, we spent less than five 
cents per child on research into pediatric urologic problems. The 
medications currently used are very expensive and have unknown, long-
term side effects.

  The TRU Act establishes a Division of Urology at the NIDDK--the home 
of the urology basic science program--and expands existing research 
mechanisms, like the successful George O'Brien Urology Research 
Centers. This will give NIH new opportunities for investment in efforts 
to combat and vanquish these diseases.
  This legislation is necessary to elevate leadership in urology 
research at the NIDDK. When the Institute was created in its current 
form nearly 20 years ago, Congress specifically provided for three 
separate Division Directors. Regrettably, the current statute fails to 
provide the NIDDK with the flexibility to create additional Division 
Directors when necessary to better respond to current scientific 
opportunities. This prescriptive statutory language is unique to the 
NIDDK. For example, the National Cancer Institute and the National 
Heart, Lung, and Blood Institute do not have any statutory language 
regarding Division Directors.
  The basic science breakthroughs of the last decade are literally 
passing urology by. A greater focus on urological diseases is needed at 
the NIDDK and will be best accomplished with senior leadership with 
expertise in urology as provided in the TRU Act. This legislation is 
supported by the Coalition for Urologic Research & Education (CURE)--a 
group representing tens of thousands of patients, researchers and 
healthcare providers. I urge my colleagues to join me as cosponsors of 
the TRU Act.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2361

       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 ``Training and Research in 
     Urology Act of 2004''.

     SEC. 2. RESEARCH, TRAINING, AND HEALTH INFORMATION 
                   DISSEMINATION WITH RESPECT TO UROLOGIC 
                   DISEASES.

       (a) Division Director of Urology.--Section 428 of the 
     Public Health Service Act (42 U.S.C. 285c-2) is amended--
       (1) in subsection (a)(1), by striking ``and a Division 
     Director for Kidney, Urologic, and Hematologic Diseases'' and 
     inserting ``a Division Director for Urologic Diseases, and a 
     Division Director for Kidney and Hematologic Diseases''; and
       (2) in subsection (b)--
       (A) by striking ``and the Division Director for Kidney, 
     Urologic, and Hematologic Diseases'' and inserting ``the 
     Division Director for Urologic Diseases, and the Division 
     Director for Kidney and Hematologic Diseases''; and
       (B) by striking ``(1) carry out programs'' and all that 
     follows through the end and inserting the following:
       ``(1) carry out programs of support for research and 
     training (other than training for which National Research 
     Service Awards may be made under section 487) in the 
     diagnosis, prevention, and treatment of diabetes mellitus and 
     endocrine and metabolic diseases, digestive diseases and 
     nutritional disorders, and kidney, urologic, and hematologic 
     diseases, including support for training in medical schools, 
     graduate clinical training (with particular attention to 
     programs geared to the needs of urology residents and

[[Page S4697]]

     fellows), graduate training in epidemiology, epidemiology 
     studies, clinical trials, and interdisciplinary research 
     programs;
       ``(2) establish programs of evaluation, planning, and 
     dissemination of knowledge related to such research and 
     training;
       ``(3) in cooperation with the urologic scientific and 
     patient community, develop and submit to the Congress not 
     later than January 1, 2006, a national urologic research plan 
     that identifies research needs in the various areas of 
     urologic diseases, including pediatrics, interstitial 
     cystitis, incontinence, stone disease, urinary tract 
     infections, and benign prostatic diseases; and
       ``(4) in cooperation with the urologic scientific and 
     patient community, review the national urologic research plan 
     every 3 years beginning in 2009 and submit to the Congress 
     any revisions or additional recommendations.''; and
       (3) at the end of the section, by adding the following:
       ``(c) There are authorized to be appropriated $500,000 for 
     each of fiscal years 2004 and 2005 to carry out paragraphs 
     (3) and (4) of subsection (b), and such sums as may be 
     necessary thereafter.''.
       (b) Urologic Diseases Data System and Information 
     Clearinghouse.--Section 427 of the Public Health Service Act 
     (42 U.S.C. 285c-1) is amended--
       (1) in subsection (c), by striking the terms ``and 
     Urologic'' and ``and urologic'' each place either such term 
     appears; and
       (2) by adding at the end the following:
       ``(d) The Director of the Institute shall--
       ``(1) establish the National Urologic Diseases Data System 
     for the collection, storage, analysis, retrieval, and 
     dissemination of data derived from patient populations with 
     urologic diseases, including, where possible, data involving 
     general populations for the purpose of detection of 
     individuals with a risk of developing urologic diseases; and
       ``(2) establish the National Urologic Diseases Information 
     Clearinghouse to facilitate and enhance knowledge and 
     understanding of urologic diseases on the part of health 
     professionals, patients, and the public through the effective 
     dissemination of information.''.
       (c) Strengthening the Urology Interagency Coordinating 
     Committee.--Section 429 of the Public Health Service Act (42 
     U.S.C. 285c-3) is amended--
       (1) in subsection (a), by striking ``and a Kidney, 
     Urologic, and Hematologic Diseases Coordinating Committee'' 
     and inserting ``a Urologic Diseases Interagency Coordinating 
     Committee, and a Kidney and Hematologic Diseases Interagency 
     Coordinating Committee'';
       (2) in subsection (b), by striking ``the Chief Medical 
     Director of the Veterans' Administration,'' and inserting 
     ``the Under Secretary for Health of the Department of 
     Veterans Affairs''; and
       (3) by adding at the end the following:
       ``(d) The urology interagency coordinating committee may 
     encourage, conduct, or support intra- or interagency 
     activities in urology research, including joint training 
     programs, joint research projects, planning activities, and 
     clinical trials.
       ``(e) For the purpose of carrying out the activities of the 
     Urologic Diseases Interagency Coordinating Committee, there 
     are authorized to be appropriated $5,000,000 for each of 
     fiscal years 2004 through 2008, and such sums as may be 
     necessary thereafter.''.
       (d) National Urologic Diseases Advisory Board.--Section 430 
     of the Public Health Service Act (42 U.S.C. 285c-4) is 
     amended by striking ``and the National Kidney and Urologic 
     Diseases Advisory Board'' and inserting ``the National 
     Urologic Diseases Advisory Board, and the National Kidney 
     Diseases Advisory Board''.
       (e) Expansion of O'Brien Urologic Disease Research 
     Centers.--
       (1) In general.--Subsection (c) of section 431 of the 
     Public Health Service Act (42 U.S.C. 285c-5(c)) is amended in 
     the matter preceding paragraph (1) by inserting ``There shall 
     be no fewer than 15 such centers focused exclusively on 
     research of various aspects of urologic diseases, including 
     pediatrics, interstitial cystitis, incontinence, stone 
     disease, urinary tract infections, and benign prostatic 
     diseases.'' before ``Each center developed''.
       (2) Authorization of appropriations.--Section 431 of the 
     Public Health Service Act (42 U.S.C. 285c-5) is amended by 
     adding at the end the following:
       ``(f) There are authorized to be appropriated for the 
     urologic disease research centers described in subsection (c) 
     $22,500,000 for each of fiscal years 2004 through 2008, and 
     such sums as are necessary thereafter.''.
       (3) Technical amendment.--Subsection (c) of section 431 of 
     the Public Health Service Act (42 U.S.C. 285c-5(c)) is 
     amended at the beginning of the unnumbered paragraph--
       (A) by striking ``shall develop and conduct'' and inserting 
     ``(2) shall develop and conduct''; and
       (B) by aligning the indentation of such paragraph with the 
     indentation of paragraphs (1), (3), and (4).
       (f) Subcommittee on Urologic Diseases.--Section 432 of the 
     Public Health Service Act (42 U.S.C. 285c-6) is amended by 
     striking ``and a subcommittee on kidney, urologic, and 
     hematologic diseases'' and inserting ``a subcommittee on 
     urologic diseases, and a subcommittee on kidney and 
     hematologic diseases''.
       (g) Loan Repayment to Encourage Urologists and Other 
     Scientists to Enter Research Careers.--Subpart 3 of part C of 
     title IV of the Public Health Service Act (42 U.S.C. 285c et 
     seq.) is amended by inserting after section 434A the 
     following:


             ``Loan Repayment Program for Urology Research

       ``Sec. 434B. (a) Establishment.--Subject to subsection (b), 
     the Secretary shall carry out a program of entering into 
     contracts with appropriately qualified health professionals 
     or other qualified scientists under which such health 
     professionals or scientists agree to conduct research in the 
     field of urology, as employees of the National Institutes of 
     Health or of an academic department, division, or section of 
     urology, in consideration of the Federal Government agreeing 
     to repay, for each year of such research, not more than 
     $35,000 of the principal and interest of the educational 
     loans of such health professionals or scientists.
       ``(b) Limitation.--The Secretary may not enter into an 
     agreement with a health professional or scientist pursuant to 
     subsection (a) unless the professional or scientist--
       ``(1) has a substantial amount of educational loans 
     relative to income; and
       ``(2) agrees to serve as an employee of the National 
     Institutes of Health or of an academic department, division, 
     or section of urology for purposes of the research 
     requirement of subsection (a) for a period of not less than 3 
     years.
       ``(c) Applicability of Certain Provisions.--Except as 
     inconsistent with this section, the provisions of subpart 3 
     of part D of title III apply to the program established under 
     subsection (a) in the same manner and to the same extent as 
     such provisions apply to the National Health Service Corps 
     Loan Repayment Program established under such subpart.''.
       (h) Authorization of Appropriations for Urology Research.--
     Subpart 3 of part C of title IV of the Public Health Service 
     Act (42 U.S.C. 285c et seq.) (as amended by subsection (g)) 
     is further amended by inserting after section 434B the 
     following:


         ``Authorization of appropriations for urology research

       ``Sec. 434C. There are authorized to be appropriated to the 
     Director of NIH for the purpose of carrying out intra- and 
     interagency activities in urology research (including 
     training programs, joint research projects, and joint 
     clinical trials) $5,000,000 for each of fiscal years 2004 
     through 2008, and such sums as may be necessary thereafter. 
     Amounts authorized to be appropriated under this section 
     shall be in addition to amounts otherwise available for such 
     purpose.''.

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