[Congressional Record (Bound Edition), Volume 146 (2000), Part 17]
[Senate]
[Pages 24746-24754]
[From the U.S. Government Publishing Office, www.gpo.gov]


[[Page 24746]]

                  CARDIAC ARREST SURVIVAL ACT OF 2000

  Mr. JEFFORDS. Mr. President, I ask unanimous consent that the Senate 
now proceed to the consideration of Calendar No. 572, H.R. 2498.


  The PRESIDING OFFICER. The clerk will report the bill by title.
  The assistant legislative clerk read as follows:

       A bill (H.R. 2498) to amend the Public Health Service Act 
     to provide for recommendations of the Secretary of Health and 
     Human Services regarding the placement of automatic external 
     defibrillators in Federal buildings in order to improve 
     survival rates of individuals who experience cardiac arrest 
     in such buildings, and to establish protections from civil 
     liability arising from the emergency use of the devices.

  There being no objection, the Senate proceeded to consider the bill.


                           Amendment No. 4344

  Mr. JEFFORDS. Mr. President, Senator Frist has an amendment at the 
desk, and I ask for its consideration. It has been cleared on both 
sides.
  The PRESIDING OFFICER. The clerk will report the amendment.
  The assistant legislative clerk read as follows:

       The Senator from Vermont [Mr. Jeffords], for Mr. Frist, for 
     himself, Mr. Kennedy, Mr. Jeffords, Mr. Dodd, Mr. Enzi, Mr. 
     Harkin, Mr. Hutchinson, Ms. Mikulski, Ms. Collins, Mr. 
     Wellstone, Mrs. Murray, Mr. Gorton, and Mr. Graham, proposes 
     an amendment numbered 4344.

  (The text of the amendment is printed in today's Record under 
``Amendments Submitted.'')
  Mr. JEFFORDS. Mr. President, I ask unanimous consent that the 
amendment be agreed to.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 4344) was agreed to.
  Mr. FRIST. Mr. President, I am pleased the Senate has passed, H.R. 
2498, the Public Health Improvement Act of 2000, a bill which combines 
a number of critical bills improving the health of our citizens.
  Title I of this measure contains a bill which passed the Senate 
Health, Education and Pensions Committee on June 14, 2000, the Public 
Health Threats and Emergencies Act of 2000. This important legislation, 
which I drafted with my colleague, Senator Kennedy, is the culmination 
of three hearings and forums and a GAO report over the last two years 
which demonstrated the need to improve our public health infrastructure 
and address the growing threats of antimicrobial resistance and 
bioterrorism.
  The conclusion is clear: we need to improve our public health 
infrastructure to be able to respond in a timely and effective manner 
to these and other threats. For too long, we have not provided adequate 
funding to maintain and improve the core capacities of our nation's 
public health infrastructure. As the GAO report found, many State and 
local public health agencies lack even the basic equipment of a fax 
machine or answering machine to assist in their work and improve 
communications.
  Besides improving our core public health capacity, this Act addresses 
two specific problems faced by the nation: antimicrobial resistance and 
bioterrorism.
  The first, antimicrobial resistance is a growing public health 
problem. As a heart and lung transplant surgeon, I know all too well 
that the most common cause of death after the transplantation of a 
heart or lung is not rejection, but infection. One hundred percent of 
transplantation patients get infections following surgery. Infection is 
the most common complication following surgery, the leading cause for 
rehopitalization, and the most expensive aspect of treatment post-
transplantation. Antibiotics are a mainstay of treatment, yet we are 
seeing increasingly resistant bacteria which are not killed by most 
first-line antimicrobials.
  The second issue addressed by this act, bioterrorism, poses a 
significant threat to our country's strategic well-being. As a nation 
we are presently more vulnerable to bioweapons than other more 
traditional means of warfare. Bioweapons pose considerable challenges, 
different from those of standard terrorist devices, including chemical 
weapons.
  The mere term ``bioweapon'' invokes visions of immense human pain and 
suffering and mass casualties. Pound for pound, ounce for ounce, 
bioagents represent one of the most lethal, but also covert, weapons of 
mass destruction known. Victims of a covert bioterrorist attack do not 
necessarily develop symptoms upon exposure to the bioagent as the onset 
may be delayed for days after the bioweapon is dispersed.
  As a result, exposed individuals will likely show up in emergency 
rooms, physician offices, or clinics with nondescript symptoms or ones 
that mimic the common cold or flu. Physicians and other health care 
providers will likely not attribute these symptoms to a bioweapon. If 
the bioagent is communicable, such as small pox, many more people may 
be infected in the interim, including our health care workers. As 
Stephanie Bailey, the Director of Health for Metropolitan Nashville and 
Davidson County pointed out in our hearing on bioterrorism, ``many 
localities are on their own for the first 24 to 48 hours after an 
attack before Federal assistance can arrive and be operational. This is 
the critical time for preventing mass casualties.''
  If experts are correct in their belief that a major bioterrorist 
attack is a virtual certainty, then it is no longer a question of 
``if'' but rather ``when''. In fact, my home town of Nashville last 
year joined an ever-increasing number of cities to receive and respond 
to a package suspected to contain anthrax. Thankfully, this was a hoax.
  The Public Health Threats and Emergencies Act provides greater 
resources and coordination to improve our public health infrastructure 
and bolster our preparedness against antimicrobial resistance and 
bioterrorism.
  To strengthen public health infrastructure's ability to fulfill its 
core functions and respond to emerging threats and emergencies, the 
bill authorizes the establishment of voluntary performance goals for 
public health systems, grants to public health agencies for assessments 
and core capacity building, and funding to rebuild and remodel the 
facilities of the Centers for Disease Control and Prevention, CDC.
  To combat antimicrobial resistance, the bill authorizes a task force 
to coordinate Federal programs related to antimicrobial resistance and 
to improve public education on antimicrobial resistance; National 
Institutes of Health (NIH) research into new therapeutics against and 
improved diagnostics for resistant pathogens; and grants to detect, 
monitor, and combat antimicrobial resistance.
  To prevent and respond to bioterrorism, the bill authorizes: two 
interdepartmental task forces to address the joint issues of research 
needs and the public health and medical consequences of bioterrorism; 
NIH and CDC research on the epidemiology of bioweapons and the 
development of new vaccines or therapeutics for bioweapons; and grants 
to improve the ability of public health agencies, hospitals, and health 
care facilities to detect, diagnose, and respond to bioterrorism.
  We must act now to improve our basic capacities to address all public 
health threats, including antimicrobial resistance and bioterrorism. 
This legislation provides State and local public health agencies the 
necessary resources so that we better protect the health and well-being 
of our Nation's citizens.
  The Public Health Improvement Act also improves our nation's medical 
research infrastructure through two bills that I co-authored: the 
Clinical Research Enhancement Act and the Twenty-First Century Research 
Laboratories Act.
  As a physician, I am aware of the need to translate laboratory 
discoveries into advances in patient care, but I was troubled by 
numerous reports and analyses showing insufficient support for patient-
oriented research in the United States. The ``Clinical Research 
Enhancement Act,'' which I also drafted with Senator Kennedy, addresses 
this issue by establishing intramural and extramural clinical research 
fellowship programs and a continuing education clinical research 
training program at the NIH. In addition, the bill provides grants for 
the establishment of general clinical research centers, which provide 
the infrastructure for clinical research, including clinical training 
and career enhancement.

[[Page 24747]]

  The ``Twenty-First Century Research Laboratories Act,'' which I 
drafted with Senator Harkin improves our research infrastructure that 
is central to our continued leadership in medical research. 
Unfortunately, many research facilities are outdated, and future 
increases in federal funding for the NIH must include support for the 
renovation and construction of extramural research facilities and the 
purchase of state-of-the-art laboratory instrumentation. To renovate 
biomedical and behavioral research facilities, the bill authorizes 
grants or contracts to public and nonprofit private entities to expand, 
remodel, renovate, or alter existing research facilities or construct 
new research facilities, including centers of excellence. In addition, 
it provides grants to public and non-profit private entities for the 
purchase of high-end, state-of-the art laboratory instrumentation.
  The ``Public Health Improvement Act'' also includes important public 
health bills such as the ``Cardiac Arrest Survival Act,'' the ``Rural 
Access to Emergency Devices Act,'' the ``Lupus Research Act,'' the 
``Prostate Cancer Research and Protection Act,'' as well as important 
critical pieces of legislation improving organ donation and 
procurement.
  The ``Cardiac Arrest Survival Act,'' which Senator Gorton introduced, 
allows the Secretary of HHS to make recommendations with respect to 
placing automated external defibrillators, AEDs, in federal building 
and to expand liability protection to persons or organizations who use 
AEDs. The ``Rural Access to Emergency Devices Act,'' which Senator 
Collins introduced would improve access to AEDs in small communities 
and rural areas to boost the survival rates of individuals in those 
communities who suffer cardiac arrest. In many small and rural 
communities limited budgets and the fact that so many rely on volunteer 
organizations for emergency services can make acquisition and 
appropriate training in the use of these life-saving devices 
problematic. This legislation is intended to increase access to AEDs 
and trained local responders for smaller towns and rural areas where 
those first on the scene may not be paramedics or others who would 
normally have AEDs. With more than 700 people dying of sudden cardiac 
arrest each day, up to 30 percent of which could be saved through 
immediate medical attention, including defibrillation and 
cardiopulmonary resuscitation, it is my hope this provision will lead 
to increased placement and use of this life saving equipment.
  Senator Bennett introduced the Lupus Research Act, to require the 
Director of the National Institute of Arthritis and Musculoskeletal and 
Skin Diseases to expand and intensify research and related activities 
of the Institute regarding lupus. Lupus is a disorder of the immune 
system that affects between 1,400,000 and 2,000,000 Americans. Many 
with the disease are either misdiagnosed or not diagnosed at all. Lupus 
is often life threatening and is nine times more likely to affect women 
than men. The symptoms of lupus make diagnosis difficult because they 
are sporadic and imitate the symptoms of many other illnesses. If 
diagnosed properly, the majority of lupus cases can be controlled with 
proper treatment. This measure will increase research into this disease 
so that it may be more effectively diagnosed and treated.
  Title VI of the Public Health Improvement Act contains the Prostate 
Cancer Research and Protection Act, which I introduced last year. Each 
year an estimated 37,000 American men will die, and 179,300 will be 
diagnosed with prostate cancer, the second leading cause of cancer-
related death in American men. Cancer of the prostate grows slowly, 
without symptoms, and thus is often undetected until it's in its most 
advanced and incurable stage. It is critical that men are aware of the 
risk of prostate cancer and take steps to ensure early detection. The 
``Prostate Cancer'' bill expands the authority of the CDC to carry out 
activities related to prostate cancer screening and overall awareness 
and surveillance of the disease. The bill also extends the authority of 
the NIH to conduct basic and clinical research in combating prostate 
cancer.
  Finally, I would like to talk about provisions of great personal 
significance to me relating to organ procurement and donation. Last 
year, more than 21,000 lives were saved through transplantation in the 
United States. However, the demand for transplants has more than 
tripled in the past ten years, and 16 people die each day before they 
can receive a transplant. As a transplant surgeon, I can't express 
enough to my colleagues and the nation how important organ donation is. 
That is why the ``Public Health Improvement Act'' includes a resolution 
recognizing the need for increased organ and tissue donation and the 
important role that families play in the process. The resolution 
designates November 23, 2000, Thanksgiving Day, as a day to ``Give 
Thanks, Give Life'' and to discuss organ and tissue donation with other 
family members. It encourages families to use the time of Thanksgiving, 
a time dedicated to spending time with one another, to discuss this 
critical life-saving issue among themselves so that they may make 
informed decisions should the occasion to donate arise. Thanksgiving is 
a time to reflect on our blessings, and it represents the perfect 
opportunity for family members to discuss this simple act that can give 
life to those most in need.
  The bill also includes the ``Organ Procurement Organization 
Certification Act,'' which was drafted by Senators Collins and Dodd. 
Organ Procurement Organizations, OPOs, approach families regarding 
organ donation and arrange transportation of organs and transplant 
surgery logistics. They must currently be recertified every two years 
by the Health Care Financing Administration, HCFA, in order to qualify 
for Medicare reimbursement. This bill requires HCFA to change the 
standards for recertification to account for variation in the number of 
potential donors in a given state and extends the current certification 
cycle from two to four years.
  Mr. President, I am pleased that the Senate has passed this bill, 
which represents the work of many Senators which I have mentioned in my 
remarks. I am thankful to all my colleagues for their support and 
willingness to help improve the public health of this nation. I would 
especially like to thank Senators Jeffords and Kennedy and 
Representatives Tom Bliley, Michael Bilirakis, John Dingell and Sherrod 
Brown, and their excellent staffs for all the hard work and dedication 
that has gone into negotiating this package of bills. I would also like 
to thank Mr. Bill Baird and Ms. Daphne Edwards of the Office of Senate 
Legislative Counsel, for their tireless work and great expertise in 
drafting this bill. I would like to thank my Staff Director of the 
Public Health Subcommittee, Anne Phelps, and my Health Advisors Dave 
Larson and Mary Sumpter Johnson for their work in making this bill 
possible. Finally, I would like to thank the many groups who have 
worked on the various provisions in this bill for their support, and I 
look forward to enactment of this bill this year.
  Mr. President, I ask unanimous consent to place in the record a 
summary of the Public Health Improvement Act and letters of support for 
the Public Health Threats and Emergencies Act, which is incorporated in 
the Public Health Improvement Act.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

               The Public Health Improvement Act of 2000


               TITLE I--Emerging Threats to Public Health

       Most Americans live longer, healthier lives today than ever 
     before. However, the nation also faces grave new threats 
     that, if unmet, will imperil the extraordinary medical 
     progress made in recent decades. These emerging threats 
     include new or resurgent infectious diseases, dangerous 
     microbes resistant to antibiotics, and bioterrorist attacks. 
     The provision under this Title strengthens the nation's 
     capacity to detect and respond to these serious public health 
     threats by:
       Improving the capacity of national, state, and local public 
     health agencies to detect and respond effectively to 
     infectious disease outbreaks and other public health 
     emergencies;

[[Page 24748]]

       Enhancing the nation's ability to detect and control the 
     spread of disease-causing microbes that are resistant to 
     antibiotics; and
       Upgrading the nation's preparedness for the public health 
     and medical consequences of bioterrorist attacks.
     Improving the Capacity of Public Health Agencies to Combat 
         Disease Emergencies
       Drug resistant diseases such as malaria and tuberculosis 
     continue to claim millions of lives across the world and will 
     pose an increasing danger to this country in years to come. 
     The recent outbreak of West Nile Fever in the Northeast is an 
     ominous warning of emerging infectious diseases. New plagues 
     like Ebola virus pose new threats to population around the 
     world, including the United States.
       To respond effectively to these growing threats, we must 
     strengthen the capacity of our public health agencies to 
     detect, diagnose, and contain infectious disease outbreaks. 
     Many of these agencies lack the basic computer equipment to 
     share data electronically on disease outbreaks and cannot 
     perform simple lab tests to diagnose infections. Most 
     agencies don't have a complete assessment of their current 
     capacities and needs. To meet these challenges, Title I 
     establishes grant programs to allow state and local public 
     health agencies to:
       Assess their current capacities and identify their areas of 
     greatest need.
       Upgrade the ability of public health labs to identify 
     disease-causing microbes.
       Improve and expand electronic communication networks.
       Develop plans to respond to public health emergencies.
       Train public health personnel.
     Revitalizing Centers for Disease Control and Prevention
       The mission of the federal Centers for Disease Control and 
     Prevention (CDC) is to prevent and control disease, injury, 
     and disability. However, most of CDC's laboratory facilities 
     are in a state of disrepair and require immediate 
     modernization. If nothing is done, these facilities may be 
     severely outmatched by undiscovered biological threats 
     encountered in the future. To better defend against and 
     combat the public health threats of the 21st century, this 
     bill authorizes funding to CDC for construction and 
     renovation of facilities.
     Combating Antimicrobial Resistance
       The widespread use of antibiotics beginning in the 1940's 
     provided--for the first time in history--effective treatments 
     for infectious diseases. These miracle drugs have saved 
     countless lives, but today they are increasingly prescribed 
     or used inappropriately. Antibiotics that once had the power 
     to cure dangerous infections are now often useless, because 
     microbes have become resistant to all but the newest and most 
     expensive drugs. Some ``superbugs'' are impervious to any 
     current pharmaceutical treatment.
       Resistance to antibiotics takes a heavy toll on patients 
     across the nation. The World Health Organization (WHO) 
     estimates that 14,000 Americans per year, or one American 
     every 38 minutes, die from drug-resistant infections. The 
     financial burden of antibiotic resistance is also staggering. 
     WHO estimates that the United States spends $10 billion a 
     year treating antibiotic-resistant infections--and this 
     burden will grow heavier as more and more microbes become 
     resistant. To meet the grave and growing problem of 
     antimicrobial resistance, the provisions under Title I:
       Directs HHS to conduct a nationwide campaign to educate 
     patients and doctors about the appropriate use of 
     antibiotics;
       Authorizes HHS initiatives to monitor and contain the 
     spread of resistant microbes;
       Authorizes grants for public health agencies to combat 
     antimicrobial resistance;
       Establishes demonstration grants for hospitals and clinics 
     to promote the judicious use of antibiotics and to control 
     the spread of resistant infections.
     Protecting the Public Health Against Bioterrorist Attacks
       The Office of Emergency Preparedness estimates that 40 
     million Americans could die if a terrorist released smallpox 
     into the population. An Anthrax attack could kill 10 million 
     people. The nation must be prepared to resist these threats 
     as vigorously if they were an invading army. To enhance the 
     ability of the nation's public health agencies to respond to 
     acts of bioterrorism against the civilian population, the 
     provisions under Title I:
       Establishes grants to train health care professional in 
     recognizing and treating illnesses caused by such attacks;
       Improves coordination among federal agencies to develop 
     public health countermeasures against bioterrorism, such as 
     stockpiles of necessary drugs; and
       Reauthorizes an existing provision that allows the 
     Secretary of HHS to protect the public health in the event of 
     a bioterrorist attack or other disease emergency.


                TITLE II--CLINICAL RESEARCH ENHANCEMENT

       Clinical research is needed to translate the discoveries 
     made in the laboratory into advances in patient care. 
     Numerous reports and analyses have proven that there is 
     insufficient support for patient-oriented research in the 
     United States. Title II will address these issues by:
       Establishing intramural and extramural clinical research 
     fellowship programs and a continuing education clinical 
     research training program at NIH.
       Providing statutory authority to the Director of the 
     National Center for Research Resources to award grants for 
     the establishment of general clinical research centers. These 
     centers provide the infrastructure for clinical research, 
     including clinical training and career enhancement. The 
     activities of the GCRCs will be expanded through the 
     increased use of telecommunications and telemedicine.
       Establishing the Mentored Patient-Oriented Research Career 
     Development Awards. These grants support clinical 
     investigators in the early phases of their independent 
     careers by providing salary and other support for a period of 
     supervised study.
       Establishing the Mid-Career Investigator Awards in Patient-
     Oriented Research. These grants provide support for mid-
     career level clinicians to allow them protected time to 
     devote to clinical research and to act as mentors for 
     beginning clinical investigators.
       Establishing the Graduate Training in Patient-Oriented 
     Research Awards. These two-year grants provide stipend, 
     tuition, and institutional support for individuals in 
     advanced degree programs in clinical research.
       Creating a clinical research educational loan repayment 
     program to encourage recruitment of new clinical 
     investigators.


             TITLE III--Research Laboratory Infrastructure

       The National Institutes of Health (NIH) is the principal 
     source of federal funding for medical research at research 
     institutions in the United States. The infrastructure of our 
     research institutions is central to our continued leadership 
     in medical research, but many research facilities are 
     outdated and inadequate. Future increases in federal funding 
     for the NIH must include increased support for the renovation 
     and construction of extramural research facilities and the 
     purchase of state-of-the-art laboratory instrumentation.
       To renovate biomedical and behavioral research facilities, 
     Title III authorizes the Director of the National Center for 
     Research Resources (NCRR) at the NIH may make grants or 
     contracts to public and nonprofit private entities to expand, 
     remodel, renovate, or alter existing research facilities or 
     construct new research facilities, including centers of 
     excellence. In addition, the provision under this Title would 
     also provide grants to public and non-profit private entities 
     for the purchase of high-end, state-of-the art laboratory 
     instrumentation.


                   TITLE IV--Cardiac Arrest Survival

       More than 700 people die each day from sudden cardiac 
     arrest, but immediate medical attention could save up to 30 
     percent of these victims through immediate medical response, 
     including defibrillation and cardiopulmonary resuscitation. 
     Title VI will increase public awareness about automated 
     external defibrillators and encourage their use.

             Part A--Recommendations for Federal Buildings

     Placement of AEDs in Federal Buildings
       The Secretary of HHS shall make recommendations with 
     respect to placing automated external defibrillators (AEDs) 
     in federal buildings that include procedures for:
       Implementing appropriate nationally recognized training 
     courses in performing CPR and in using AEDs;
       Proper maintenance and testing of the devices, according to 
     manufacturer guidelines;
       Ensuring direct involvement of a licensed medical 
     professional and coordination with EMS in the oversight of 
     training and notification when the devices are used; and
       Ensuring that the local EMS agent is notified regarding the 
     location and type of device.
     Extending Good Samaritan Protections
       This legislation establishes Good Samaritan protection for 
     any person who provides emergency medical care through the 
     use of an AED unless the person engages in willful or wanton 
     misconduct, gross negligence, reckless misconduct or a 
     conscious, flagrant indifference to the rights or safety of 
     the victim. This legislation does not supersede any existing 
     or future law of any state.
       Organizations that purchase for defibrillators are extended 
     the same Good Samaritan protection unless they are grossly 
     negligent or engaged in willful or wanton misconduct, if (1) 
     they have notified local emergency personnel regarding the 
     placement of the device; (2) the AED is properly maintained 
     and tested in accordance with the manufacturer's guidelines; 
     and (3) employees of the acquirer who are expected users 
     received proper training.
     Part B--Rural Access to Emergency Devices
       This legislation is intended to improve access to automated 
     external defibrillators (AEDs) in small communities and rural 
     areas to boost the survival rates of individuals in those 
     communities who suffer cardiac arrest. In many small and 
     rural communities limited budgets and the fact that so many 
     rely on volunteer organizations for emergency services can 
     make acquisition and appropriate training in the use of these 
     life-saving devices problematic. This legislation is intended 
     to increase access to AEDs and

[[Page 24749]]

     trained local responders for smaller towns and rural areas 
     where those first on the scene may not be paramedics or 
     others who would normally have AEDs.
       Under this legislation, the Secretary of HHS, acting 
     through the Rural Health Outreach Office of the Health 
     Resources and Services Administration (HRSA), shall award 
     grants to community partnerships consisting of local 
     emergency responders, police and fire departments, hospitals 
     and other community organizations to enable them to purchase 
     AEDs and to provide defibrillator and basic life support 
     training through the American Heart Association, the American 
     Red Cross, or other national recognized training courses. The 
     bill authorizes $25 million a year over three years for this 
     purpose.


                    TITLE V--Lupus Research and Care

       Lupus is a disorder of the immune system that affects 
     between 1,400,000 and 2,000,000 Americans and many more with 
     the disease are either misdiagnosed or not diagnosed at all. 
     Lupus is often life threatening and is nine times more likely 
     to affect women than men. The symptoms of lupus make 
     diagnosis difficult because they are sporadic and imitate the 
     symptoms of many other illnesses. If diagnosed properly, the 
     majority of lupus cases can be controlled with proper 
     treatment.
       Provisions under this Title would require the Director of 
     the National Institute of Arthritis and Musculoskeletal and 
     Skin Diseases to expand and intensify research and related 
     activities of the Institute regarding lupus. Requires the 
     Director to coordinate such activities with similar 
     activities conducted by other national research institutes 
     and agencies of NIH; and conduct or support research to 
     expand the understanding of the causes of, and to find a cure 
     for, lupus, including research to determine the reasons 
     underlying the elevated prevalence of the disease among 
     African-American and other women. The provisions also creates 
     grants for the establishment, operation, and coordination of 
     effective and cost-efficient systems for the delivery of 
     essential services to individuals with lupus and their 
     families.


           TITLE VI--Prostate Cancer Research and Prevention

       This year 37,000 American men will die, and 179,300 will be 
     diagnosed with prostate cancer, the second leading cause of 
     cancer-related death in American men. Cancer of the prostate 
     grows slowly, without symptoms, and thus is often undetected 
     until its most advanced and incurable stage. It is critical 
     that men are aware of the risk of prostate cancer and to take 
     steps to ensure early detection.
       The provisions under this Title expands the authority of 
     the Centers for Disease Control and Prevention (CDC) to carry 
     out activities related to prostate cancer screening and 
     overall awareness and surveillance of the disease. The bill 
     also extends the authority of the National Institutes of 
     Health to conduct basic and clinical research in combating 
     prostate cancer.


               TITLE VII--Organ Procurement and Donation

       Last year, there were almost 22,000 transplants, nearly 
     double the roughly 13,000 transplants performed ten years 
     ago. Unfortunately, the demand for transplants has more than 
     tripled in the past ten years from 19,095 in 1989 to 72,255 
     in 1999.
       Last year, 6,125 patients were removed from the OPTN 
     waiting list due to death, an increase of over 350% in the 
     last ten years. Moreover, since 1988, 38,574 patients have 
     died before they could receive a transplant, and the yearly 
     figures only continue to increase. OPOs are organizations 
     that approach families regarding organ donation and arrange 
     transportation of organs and transplant surgery logistics. 
     (OPOs are not responsible for the allocation of organs.) Each 
     state has one or two OPOs that cover non-overlapping 
     geographic regions. Currently, OPOs must be recertified every 
     two years by the Health Care Financing Administration (HCFA) 
     in order to qualify for Medicare reimbursement. Because 
     Medicare funds make up a large percentage of OPO budgets, 
     decertification essentially shuts down an OPO.
       Requires HCFA to change the standards for recertification 
     to account for variation in the number of potential donors in 
     a given state, extends the current certification cycle from 
     two to four years, ensures rights of OPOs, and reinstates 
     certification for all OPOs who were decertified in April.
       The bill also recognizes the need for increased organ and 
     tissue donation and the important role that families play in 
     the process--noting that designation as an organ donor on a 
     driver's license or similar instrument does not ensure 
     donation. The provision designates Thanksgiving as a day to 
     ``Give Thanks, Give Life'', and encourages families to use 
     the time of Thanksgiving to discuss organ and tissue donation 
     to foster informed decisions among family members if the 
     occasion to donate arises.


         TITLE VIII--Alzheimer's Clinical Research and Training

       To address the devastating disease of Alzheimer's, the 
     provisions under this Title would authorize NIH to establish 
     a program to enhance clinical research relating to the 
     treatment of individuals with Alzheimer's disease. The 
     provisions would also provide support to clinicians for 
     research, study, and practice at centers of excellence in 
     Alzheimer's disease research and treatment.


 TITLE IX--Sexually Transmitted Disease Clinical Research and Training

       In an effort to develop treatment for sexually transmitted 
     diseases, the provisions under this Title would authorize NIH 
     to establish a program to enhance clinical research relating 
     to the treatment and care of individuals with sexually 
     transmitted diseases. The provisions would also provide 
     support to promising clinicians for research, study, and 
     practice at centers of excellence in sexually transmitted 
     disease research and treatment.


                   TITLE X--Miscellaneous Provisions

       Technical amendment to the Children's Health Act of 2000 
     which corrects an inaccurate citation to a provision in the 
     Code of Federal Regulations.
                                  ____

                                               September 21, 2000.

     Re The Public Health Threats and Emergencies Act

     U.S. Senate,
     Washington, DC.
       Dear Senator: Senators Bill Frist and Ted Kennedy have 
     joined in introducing a bipartisan bill that addresses a 
     pressing issue in public health. The organizations below join 
     in urging you to cosponsor S. 2731, ``The Public Health 
     Threats and Emergencies Act,'' and to support its prompt 
     passage.
       Our nation faces grave new health threats in the 21st 
     century. New or resurgent infectious diseases, such as West 
     Nile virus, hantavirus, and Lyme disease, are on the upswing, 
     and the globalization of our economy makes the importation of 
     threatening new microorganisms highly likely. An increasing 
     number of microbes that cause serious disease have developed 
     resistance to existing antibiotics, so that formerly 
     treatable infections, such as staphylococcus and 
     tuberculosis, may rapidly become incurable. In addition, our 
     national security is directly threatened by biological 
     weapons, such as smallpox and anthrax, which could devastate 
     large populations if used for terrorism and mass destruction.
       Our public health system, a collaboration among federal, 
     state and local governments, who must work closely with 
     private medical providers, bears the awesome responsibility 
     for protecting the population from these serious threats. 
     However, the public health system is not uniformly well 
     prepared to detect disease outbreaks rapidly or respond to 
     them effectively. Preparing our nation to address these 
     threats requires revitalizing public health agencies with 
     trained personnel, up-to-date equipment and technology, and 
     development of new systems to monitor and respond to disease.
       The Public Health Threats and Emergencies Act authorizes 
     steps that are widely agreed to be essential to preparing for 
     new public health threats. It enjoys bipartisan support in 
     both the Senate and the House and the endorsement of leading 
     experts in public health and bioterrorism. Please co-sponsor 
     S. 2731 and enable the public health system to respond 
     effectively to deadly public health threats before they 
     strike on a widespread basis.
            Sincerely,
         American College of Preventive Medicine, American Lung 
           Association, American Public Health Association, 
           American Society for Microbiology, American Thoracic 
           Society, Association of American Medical Colleges, 
           Association for Professionals in Infection Control and 
           Epidemiology, Association of Public Health 
           Laboratories, Association of Schools of Public Health, 
           Association of State and Territorial Health Officials, 
           Council of State and Territorial Epidemiologists, Food 
           and Environment Program, Union of Concerned Scientists, 
           Infectious Disease Society of America, National 
           Association of Counties, National Association of County 
           and City Health Officials, National Association of 
           Local Boards of Health, National Association for Public 
           Health Statistics and Information Systems, National 
           Environmental Health Association, Partnership for 
           Prevention, Physicians for Social Responsibility, 
           Research! America.
                                  ____

                                                    Association of


                                    American Medical Colleges,

                               Washington, DC, September 19, 2000.
     Hon. Bill Frist,
     U.S. Senate, Washington, DC.
       Dear Senator Frist: The Association of American Medical 
     Colleges strongly supports the Public Health Threats and 
     Emergencies Act of 2000, S. 2731. The AAMC represents the 
     nation's 125 allopathic medical schools, nearly 400 major 
     teaching hospitals and health care systems, more than 87,000 
     faculty in 91 professional and scientific societies, and the 
     nation's 67,000 medical students and 102,000 residents.
       This legislation is needed to strengthen the nation's 
     public health infrastructure and improve our preparedness at 
     a time when we are confronted by significant threats to the 
     health of the American people: new and reemerging infectious 
     diseases; increasing

[[Page 24750]]

     antimicrobial resistance, and the growing menace of 
     bioterrorism. We must take steps now to restore and 
     strengthen the capacity of our public health system, which 
     has been eroded by inadequate funding. This legislation will 
     provide the resources to revitalize our ability to respond to 
     these public health emergencies with trained personnel, 
     state-of-the-art equipment and technology, and the 
     development of new systems to monitor and combat these deadly 
     diseases. The bill also authorizes needed funding to rebuild 
     and remodel the facilities of the Centers for Disease Control 
     and Prevention. In addition, this bill will coordinate 
     federal research and education efforts, and provide grants to 
     improve the capacity of institutions to detect and respond to 
     antimicrobial resistance and bioterrorism.
       We commend you and Senator Kennedy for your leadership in 
     sponsoring this legislation that addresses a critical set of 
     issues affecting the health and safety of the American 
     people, and urge the Senate to pass S. 2731 before the end of 
     the current session.
           Sincerely,
     Jordan J. Cohen, M.D.
                                  ____

                                           National Association of


                             County and City Health Officials,

                                    Washington, DC, July 13, 2000.
     Senator Bill Frist,
     Subcommittee on Public Health, Health, Education, Labor, and 
         Pensions, Committee, U.S. Senate, Washington, DC.
       Dear Senator Frist: The National Association of County and 
     City Health Officials (NACCHO) is very pleased to support S. 
     2731, the ``Public Health Threats and Emergencies Act'' that 
     you have introduced. This groundbreaking proposal provides a 
     vigorous and rational approach to improve our nation's public 
     health system and its preparedness to meet the public health 
     threats of the 21st century. You are doing a great service by 
     recognizing that strengthening the underlying infrastructure 
     of public health is essential to protecting the health of all 
     Americans.
       NACCHO is the organization representing the almost 3000 
     local public health agencies--in cities, counties and towns--
     that serve on the front lines in protecting and promoting the 
     nation's health. We are extraordinarily grateful for your 
     keen understanding of public health threats and your 
     commitment to addressing them skillfully and constructively. 
     NACCHO looks forward to working with you to ensure that the 
     promise of your legislation is fulfilled. Thank you for your 
     continuing foresight and leadership.
           Sincerely,
                                 Stephanie B.C. Bailey, MD, MSHSA,
     President, NACCHO and Director of Health.
                                  ____



                           Association of Public Laboratories,

                                   Washington, DC, August 3, 2000.

       Re ``Public Health Threats and Emergencies Act'', S. 2731

     Hon. William H. Frist,
     U.S. Senate, Senate Dirksen Office Building, Washington, DC.
     Hon. Edward M. Kennedy,
     U.S. Senate, Senate Russell Office Building, Washington, DC.
       Dear Senators Frist and Kennedy: The Association of Public 
     Health Laboratories (APHL) supports S. 2731 introduced June 
     14, 2000 to amend Title III of the Public Health Services Act 
     for enhancing the Nation's capacity to address public health 
     threats and emergencies. APHL is a professional association 
     organized to promote the role and contributions of public 
     health laboratories in support of the public health 
     objectives of disease prevention and health promotion.
       Public health laboratories represent a first line of 
     defense in the rapid recognition and prevention of the spread 
     of communicable diseases. These public health laboratories 
     provide essential services for disease surveillance and 
     prevention as well as identification of new and re-emerging 
     infectious disease agents that threaten the public's health 
     and welfare. Besides the 56 State and Territorial Public 
     Health Laboratories, and the Federal (CDC) laboratories, 
     nearly 1,000 local health departments also provide some level 
     of direct public health laboratory services.
       All sectors of the public health infrastructure (disease 
     control and prevention, maternal and child health, 
     environmental health, epidemiology, emergency preparedness 
     and response) are critically linked to the local, state and 
     federal public health laboratory ``system''. These public 
     health laboratories provide early warning signals of health 
     risks, compile data to solve outbreak investigations, and 
     identify causes of disease to aid in treatment and 
     prevention. This leadership, through science and through 
     service, promotes health and quality of life by preventing 
     and controlling disease, birth defects, disability and death 
     resulting from interactions between people and their 
     environment. Clearly, the nation's public health laboratories 
     play a vital role in disease prevention programs and are 
     central to the national public health infrastructure. The 
     loss of these laboratories, or the diminishment of their 
     abilities, will surely create a serious public health crisis.
       As new public health challenges arise, the effectiveness of 
     the national public health system's response will depend on 
     the efficacy of public health laboratories. It is evident 
     that the advent of new or re-emerging diseases and outbreaks 
     (including West Nile Fever Virus, Hantavirus infection, HIV/
     AIDS, Legionellosis, Lyme Disease, antimicrobial-resistant 
     communicable disease agents, genetic disorders, E. coli 
     O157:H7 infections, environmental exposures and potential 
     bioterrorism activities) presents a tremendous challenge to 
     the public health system, and particularly to public health 
     laboratories. Facing these challenges will require critical 
     development or enhancement of the functions, 
     responsibilities, staffing and capability of these 
     laboratories.
       The public health laboratory must maintain expertise and 
     flexibility to investigate disease outbreaks; conduct special 
     disease surveillance activities; determine immunity levels 
     for a variety of vaccine preventable diseases; and to provide 
     laboratory support as part of the state's disaster 
     preparedness plan for response to emergencies. This includes 
     ensuring that a well trained and equipped cadre of personnel 
     are available to quickly respond to public health emergencies 
     and on-going laboratory surveillance activities at the local, 
     state and federal levels.
       APHL also supports the revitalization of laboratories 
     within the Centers for Disease Control and Prevention (CDC) 
     as an important component of this bill as these laboratories 
     have been, and will remain, a critical partner with state and 
     local laboratories in disease prevention and diagnosis.
       We applaud the proactive stance taken through this bill to 
     evaluate and enhance the public health laboratories 
     infrastructure to protect the health and welfare of our 
     nation's population and look forward to working with you on 
     this effort. Please fell free to contact APHL's executive 
     director, Scott J. Becker, at 202-822-5227 as needed.
           Sincerely,
                                             Ronald L. Cada, DrPH,
     President, APHL.
                                  ____

                                           National Foundation for


                                          Infectious Diseases,

                                     Bethesda, MD, August 2, 2000.
     Hon. William Frist,
     U.S. Senate, Dirksen Building,
     Washington, DC.
       Dear Senator Frist: The National Foundation for Infectious 
     Diseases (NFID) is a national, not-for-profit organization 
     whose mission is professional and public education about, and 
     support of research into the causes, treatments, and 
     prevention of infectious diseases. I am writing on behalf of 
     the NFID Board of Directors and Board of Trustees to endorse 
     S. 2731, the Public Health Threats and Emergencies Act of 
     2000. This bill, introduced by you and Senator Kennedy, seeks 
     to strengthen the public health infrastructure in the United 
     States by improving surveillance, recognition, treatment, 
     control, and prevention of infectious diseases. The bill 
     specifically, and importantly, singles out antimicrobial 
     resistance and bioterrorist threats, and outlines programs to 
     address these growing public health concerns.
       As you are aware, infectious diseases now are the third 
     most common cause of death in the United States. National and 
     global infectious diseases threats continually emerge, 
     highlighted most recently by the epidemic of West Nile Virus 
     in New York City last summer. However, one need look no 
     farther than the devastating human immunodeficiency virus 
     pandemic to recognize the vulnerability of human populations 
     to emergent microbial pathogens. The alarming rise in 
     antimicrobial resistance and the possibility of bioterrorist 
     attacks upon the civilian population have increasingly 
     captured the attention of public health officials, 
     clinicians, legislative officials, and the general public.
       It is within the context of these concerns that the NFID 
     wholeheartedly supports the efforts taken by you and Senator 
     Kennedy. Building the capacity to respond to natural and 
     intentional infectious diseases threats will require 
     substantial funding and your commitment to increase the 
     needed support is to be lauded.
       The NFID is pleased to work with you to accomplish your 
     goals and would be happy to continue to be involved as S. 
     2731 moves forward. If I can be of assistance in the future, 
     please do not hesitate to call me at (301) 656-0003 X 13 or 
     fax at (301) 907-0878.
           Sincerely yours,
                                         William J. Martone, M.D.,
     Senior Executive Director.
                                  ____



                            American Society for Microbiology,

                                     Washington, DC, July 5, 2000.
     Hon. William Frist,
     U.S. Senate, Dirksen Building,
     Washington, DC.
       Dear Senator Frist: The American Society for Microbiology 
     (ASM), which represents over 42,000 microbiologists and 
     infectious disease experts, is writing to endorse S. 2731, 
     the Public Health Threats and Emergencies Act of 2000.
       The ASM applauds the initiative which you and Senator 
     Kennedy have taken to respond to emerging public health 
     threats, particularly the alarming trend toward antimicrobial 
     resistance among pathogenic microorganisms. Your commitment 
     to significantly strengthening the public health

[[Page 24751]]

     system to respond to the potential threat of bioterrorism is 
     very reassuring for the country and the microbiological 
     community. The Society especially commends your efforts in 
     drafting legislation to increase needed support for the 
     public health needs of the nation. Public Health Agency plans 
     to address antimicrobial resistance and improve the public 
     health infrastructure urgently require additional funding to 
     be successful.
       The ASM is pleased to work with you towards achieving this 
     goal. The ASM would like to continue to be involved in the 
     process as S. 2731 moves forward. Please do not hesitate to 
     call on the ASM at anytime. We stand ready to be of 
     assistance to you and your staff.
           Sincerely,
                                           Gail H. Cassell, Ph.D.,
     Chair, Public and Scientific Affairs Board.
                                  ____

                                      American Society of Tropical


                                         Medicine and Hygiene,

                                       Boston, MA, August 8, 2000.
     Hon. William Frist,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Frist: The American Society of Tropical 
     Medicine and Hygiene commends you and your colleague Senator 
     Edward Kennedy for introducing S. 2731, ``The Public Health 
     Threats and Emergencies Act of 2000,'' legislation that will 
     bolster the public health infrastructure and the national 
     response to new and re-emerging health threats.
       The American Society of Tropical Medicine and Hygiene is a 
     professional society of 3,500 researchers and practitioners 
     dedicated to the prevention and treatment of infectious and 
     tropical infectious diseases. The collective expertise of the 
     Society is in the areas of basic molecular science, medicine, 
     vector control, epidemiology, and public health.
       The Society believes a strong federal commitment to 
     domestic and international research, prevention and treatment 
     activities targeted towards infectious and tropical 
     infectious disease, whether naturally occurring or resulting 
     from a deliberate terrorist act, is absolutely critical to 
     protecting our nation's health and national security 
     interests. S. 2731 represents an important step in protecting 
     the public from the most serious health and security threats 
     of the 21st Century--infectious disease, antimicrobial 
     resistance, and bioterrorism--by providing resources and the 
     leadership mechanism across federal agencies to launch a 
     comprehensive, coordinated attack against these killers.
       The American Society of Tropical Medicine and Hygiene 
     strongly supports S. 2731 and looks forward to working with 
     you to advance this initiative and pursue additional 
     prevention strategies to control these health threats from 
     exacting a greater burden on domestic and global health.
       Thank you for your ongoing efforts to address these 
     critical public health issues.
           Sincerely,
                                            Dyann F. Wirth, Ph.D.,
     Past President.
                                  ____



                                           SmithKline Beecham,

                                  Philadelphia, PA, June 20, 2000.
     Hon. William Frist,
     U.S. Senate,
     Washington, DC.
     Hon. Edward M. Kennedy,
     U.S. Senate,
     Washington, DC.
       Dear Senators Frist and Kennedy: I am writing on behalf of 
     SmithKline Beecham to commend you upon introduction of your 
     legislation, ``The Public Health Threats and Emergencies 
     Act'', designed to address the threat of antibiotic 
     resistance, public health emergencies and bioterrorist 
     attacks. As emphasized this week in a new report by the World 
     Health Organization, resistance to antibiotics is increasing 
     rapidly, threatening to recreate the preantibiotic era when 
     bacterial infections killed and maimed routinely.
       While antibiotics are a crucial tool to fighting disease, 
     it is important that they be prescribed judiciously. To this 
     end, SmithKline Beecham has worked in partnership with 
     medical and public health organizations, such as the U.S. 
     Centers for Disease Control and Prevention, in an effort to 
     ensure that antibiotics are prescribed appropriately, and 
     that attention is paid to prescribing antibiotics that are 
     most effective against the most prevalent disease-causing 
     bacteria. We note that your bill furthers this type of 
     activity by encouraging federal agencies and professional 
     organizations and societies to develop and implement 
     educational programs fostering public awareness of the threat 
     of resistance and the prudent use of antibiotics.
       America must do its part to help preserve the effectiveness 
     of our current pharmaceutical arsenal against infection and 
     our country must quickly develop an effective strategy 
     against this growing public health threat. The Public Health 
     Threats and Emergencies Act is a major step toward 
     accomplishing this important goal. For our part, SmithKline 
     Beecham is committed to investing heavily in state of the art 
     approaches to new antibiotic discovery in order to have the 
     best possible chance of combating antibiotic resistance. We 
     feel that more needs to be done to foster research and 
     development of new lines of defense against resistance 
     microbes.
       We look forward to working with you on this important 
     issue. I thank you for the opportunity to comment on your 
     bill, and applaud you for your initiative.
           Sincerely,
                                        Jean-Pierre Garnier, Ph.D.
                                          Chief Executive Officer.

  Mr. KENNEDY. Mr. President, the Public Health Improvement Act of 2000 
will bring far-reaching benefits to the health of millions of 
Americans. I commend my colleagues, Senator Jim Jeffords and Senator 
Bill Frist, for their leadership in bringing this important measure to 
the Senate floor today. The leadership of our colleagues in the House 
was also essential in developing this groundbreaking bill, and I thank 
Representatives Tom Bliley, John Dingell, Michael Bilirakis, and 
Sherrod Brown for their dedication and skillful work in bringing this 
legislation forward.
  The Act will help the nation meet many of the health challenges we 
face at the beginning of the 21st century. Few of these are more grave 
than the ominous threat of attack with a biological weapon. Like the 
lethal mushroom cloud of a nuclear bomb, a haze of anthrax spores 
released by a terrorist over one of our major cities could bring death 
and disease to millions of Americans. Chilling revelations from the 
former Soviet Union and other nations have revealed extensive and 
sophisticated programs to use deadly microbes as weapons of mass 
destruction. Just this week, we heard alarming news from Uganda about 
the deadly outbreak of Ebola fever. Yet viruses like Ebola were a 
subject of research in bioweapons programs whose aim was to make these 
viruses even deadlier and more contagious.
  Senator Frist and I have held numerous hearings in the Public Health 
Subcommittee on these public health threats. Witness after witness 
testified that the best way to defend the nation against these deadly 
biological weapons threats is to strengthen the ability of public 
health agencies to respond at the local, state and national levels. 
Given the importance of these agencies in safeguarding the health of 
the nation, we were appalled to hear that many public health agencies 
are underfunded, ill-equipped and poorly prepared to respond to these 
modern disease threats. In this electronic era, when we can send an e-
mail message from Cape Town to Cape Cod in the blink of an eye, our 
nation's public health agencies often lack equipment as basic as a fax 
machine. At a time when scientists have deciphered the entire DNA 
sequence of the human genetic code, many of the nation's public health 
laboratories cannot conduct simple genetic tests to identify deadly 
microbes rapidly and accurately. Yet, in a disease emergency, swift 
action can keep a local outbreak from becoming a national epidemic. A 
few lost hours can mean thousands more lost lives.
  To counter the threat of infectious disease outbreaks--whether 
naturally occurring or resulting from bioterrorist attacks--we must 
strengthen our public health defenses. Expert testimony provided to our 
committee showed how much work needs to be done. We must begin by 
defining and assessing the capacities that public health agencies need 
to fight infectious diseases. Our bill authorizes grants to these 
agencies to enable them to assess their ability to respond effectively 
to infectious disease threats.
  Once assessments have been completed, state and local public health 
agencies will become eligible to receive grants to strengthen their 
capacity to fight infectious disease threats. While only a few states 
that have already completed capacity assessments will be eligible for 
these grants in the first year of this program, more and more states 
will become eligible in the years to come.
  Strengthening the nation's public health agencies will also assist in 
countering the threats posed by microbes that have become resistant to 
antibiotics. Not long ago, doctors were confident that most microbes 
could be easily treated with antibiotics. In recent years, however, 
this confidence has

[[Page 24752]]

been shaken by the rise of deadly infections that cannot be cured by 
antibiotics. The World Health Organization estimates that 14,000 
Americans die every year from drug-resistant infections, and that 
fighting these infections costs the United States $10 billion per year. 
These figures are distressing, and they are sure to become even more 
alarming in the future, as the number of resistant infections 
increases.
  We must clearly do more to halt that upward spiral. If we act now to 
contain the spread of antibiotic resistance, we can buy enough time for 
new antibiotics to be developed that provide additional defenses 
against microbes that are becoming increasingly resistant to the 
current generation of drugs. This legislation supports efforts to use 
existing drugs more carefully, monitor drug-resistant infections more 
diligently, and conduct research to find the next generation of 
antimicrobial treatments.
  The existing interagency task force on antimicrobial resistance has 
made a good start in tackling these problems. This group has carefully 
brought together federal agencies with special responsibilities in 
areas related to antimicrobial resistance, and has sought the advice of 
experts in formulating its Action Plan. Our legislation provides 
statutory authorization for this task force to continue its essential 
work. The activities already underway or planned by the task force will 
do much to invigorate federal efforts to fight antimicrobial 
resistance, and our committee will watch carefully to make sure that 
these promising plans are translated into effective action.
  The Food and Drug Administration has a special responsibility to 
protect the public from the growing threat of drug-resistant microbes 
in our nation's food supply. Numerous scientific studies have provided 
compelling evidence that there is a link between the overuse of 
antibiotics in food animals and the alarming increase in drug-resistant 
microbes found in meat and poultry. The FDA deserves credit for 
carefully gathering information about the risk of using antibiotics in 
food animals. The agency now has an opportunity to act decisively on 
this information, by setting regulatory thresholds for the presence of 
drug-resistant microbes in food at levels which will protect the public 
health. Both consumers and producers will benefit if the nation can be 
assured that its food supply is safe and uncontaminated. I am sure that 
many members of our committee and our colleagues in Congress will pay 
close attention to the decisions that the FDA makes on this important 
issue in the months to come.
  Countering emerging public health threats is only one part of this 
important legislation. The Act also includes important provisions to 
strengthen clinical research. These provisions, which the Senate 
approved last November as the Clinical Research Enhancement Act, will 
begin to reverse the alarming decline in the number of health 
professionals who conduct research directly related to the needs of 
patients. These provisions will also provide clinical researchers with 
the facilities they need to conduct their important work.
  Numerous expert reports and analyses have proven that support for 
patient-oriented research is inadequate in the United States. Too 
often, talented health professionals are deterred from careers in 
clinical research because of inadequate grant funding or the extreme 
financial pressure of high educational debt. In addition, there are too 
few clinical research centers which conduct high quality patient-
oriented research. The Act addresses these deficiencies by authorizing 
grants for clinical researchers throughout their careers, by providing 
relief from the education debt burden that keeps many health 
professionals from pursuing careers in clinical research, and by 
authorizing grants to establish general clinical research centers.
  This legislation is not intended to single out any individual area of 
medical research for special study or emphasis. Instead, it provides 
broad support for clinical research so that clinical researchers can 
pursue whichever avenues of medical research have the greatest medical 
need or offer the most promising opportunities. In introducing and 
passing this legislation, it is our strong view that awards under the 
Act should be granted to investigators who show the greatest promise 
and who are conducting research of the greatest scientific or health 
value, regardless of the specific diseases or conditions they may be 
studying.
  The Clinical Research Enhancement Act will bear fruit now and in the 
coming years as new medical advances move more rapidly from the 
laboratory of the researcher to the bedside of the patient. The skill 
and dedication of the nation's clinical researchers deserve this 
support, and it is long overdue.
  The Act will also revitalize the nation's biomedical research 
facilities. Continued progress in medicine depends on modern and well-
maintained research facilities--yet the nation's basic biomedical 
research facilities are in an alarming state of disrepair. To restore 
and rebuild the nation's biomedical research infrastructure, the Act 
incorporates the provisions originally passed in the Senate last year 
as the Twenty-First Century Research Laboratories Act. I commend 
Senator Harkin for his leadership on these needed provisions. I also 
commend our colleague, Representative Michael Bilirakis, for 
introducing and championing this legislation in the House.
  Earlier this year, the National Science Foundation conducted a 
comprehensive study of the nation's research facilities. The shocking 
facts uncovered by the analysis demonstrate the need for this important 
legislation. Over 60 percent of the universities and research 
institutions studied by the NSF had inadequate laboratory space in the 
biomedical sciences. The NSF found that 5 percent of the laboratory 
space at the nation's research institutions is in such poor condition 
that it needs immediate replacement. An additional 18 percent--or 4.6 
million square feet of lab space--needs major repairs and renovations. 
Funding for such construction has not kept pace with the significant 
budget increases provided to the NIH in recent years. As a result, 54 
percent of all research institutions have had to defer needed 
construction for research and development due to insufficient funding, 
resulting in a backlog of more than $2.1 billion in deferred 
construction.
  Funding from state, local and institutional sources can meet a 
significant proportion of this shortfall. But federal resources are 
needed too, to revitalize the nation's biomedical research 
laboratories. Under this legislation, NIH will be authorized to provide 
merit-based grants for construction or revitalization of essential 
laboratory facilities.
  The Act also authorizes grants to institutions to purchase the 
sophisticated scientific instruments that are increasingly required to 
conduct top quality biomedical research. As scientists learn more and 
more about the fundamental processes of life, advances in research rely 
increasingly on complex and expensive scientific instruments. In a 
matter of moments, an advanced DNA sequencer can find out vital 
information about the genes that affect health and disease. New 
microscopes and imaging devices can provide snapshots inside the body 
or within a single cell.
  The Federation of American Societies for Experimental Biology 
recently released a detailed survey about the needs of the nation's 
biomedical research institutions for scientific equipment. Over 80 
percent of NIH grant recipients believed that shared scientific 
equipment and core facilities are essential to their research--but more 
than half felt that NIH's grant support is inadequate for purchases of 
this needed equipment. Future progress in medicine will increasingly 
depend on sophisticated and expensive equipment. Congress has a 
responsibility to accelerate this progress by providing adequate 
federal support for equipment.
  The Act also includes the House-passed Lupus Research and Care 
Amendments of 2000. These provisions authorize new resources for lupus 
research and new programs for treating this cruel disease. Lupus 
disproportionately affects women, and it affects African-American women 
in particular.

[[Page 24753]]

Patients with lupus suffer a debilitating variety of symptoms that 
include inflammation of the joints, kidney failure, painful skin 
rashes, neurological impairments and many other painful conditions. 
While lupus is rarely fatal, it can often result in a lifetime of pain 
or disability for persons with the disease. There is no known cure for 
lupus, but the Act will advance our understanding of this disease, and 
provide assistance to persons who suffer from its consequences.
  The Act will also improve the treatment and detection of prostate 
cancer, by incorporating the provisions of the Prostate Cancer Research 
and Prevention Act that was passed by the Senate last November. Too 
often, men with prostate cancer go untreated because they fail to take 
advantage of screening procedures that detect the early symptoms of 
this deadly disease. Early detection is the key to surviving prostate 
cancer, and these provisions will assist the efforts of the Department 
of Health and Human Services to promote widespread screening for this 
disease.
  The Act also reflects the nation's commitment to improving the 
treatment and understanding of Alzheimer's disease and sexually 
transmitted diseases, by authorizing fellowships for clinical 
scientists conducting research in these areas. Large numbers of 
Americans today have friends or relatives who suffer from the 
terrifying loss of mental abilities brought on by Alzheimer's disease. 
We have made a significant investment in basic research, and we must 
ensure that the new treatments produced by research are brought rapidly 
to patients suffering from this disease. I commend my colleague from 
Massachusetts, Representative Ed Markey, for introducing the 
Alzheimer's Clinical Research and Training Awards Act of 2000, which 
has been incorporated into this Act. This measure authorizes clinical 
research awards to health professionals for research, study and 
practice at centers of excellence for Alzheimer's disease research and 
treatment. The Act includes a similar provision to increase support for 
health professionals engaged in clinical research on sexually 
transmitted diseases, which will improve the understanding and 
treatment of these disorders.
  Taken together, the provisions of the Public Health Improvement Act 
of 2000 will improve the lives of millions of Americans and help 
safeguard the nation's health in the years ahead. This significant 
legislation will help revitalize the capacity of the nation's public 
health agencies to respond effectively to public health emergencies, 
such as infectious disease outbreaks or bioterrorist attacks. It will 
help bridge the gap between discoveries made in the laboratory and 
improvements in patient care by providing new support for talented 
health professional to pursue careers in patient-oriented clinical 
research. This legislation will help rebuild the nation's laboratory 
infrastructure, which is in an alarming state of decay and disrepair. 
The Act also gives new emphasis to research into the causes and 
treatment of lupus, prostate cancer, Alzheimer's disease and sexually 
transmitted diseases. The Public Health Improvement Act of 2000 can 
help lay a firm foundation for more effective public health in a wide 
variety of areas, and I urge my colleagues to approve this much needed 
legislation.


                          amending section 319

  Mr. FRIST. Mr. President, the Public Health Improvement Act of 2000 
incorporates provisions that I originally introduced with my colleague, 
Senator Kennedy, as the Public Health Threats and Emergencies Act. The 
Act reauthorizes and amends Section 319 of the Public Health Service 
Act. This Section reauthorizes the ``Public Health Emergency Fund,'' 
from which the Secretary of Health and Human Services may expend funds 
in the event of a public health emergency. The Public Health Emergency 
Fund is a separate and distinct fund from the existing Public Health 
and Social Services Emergency Fund, which is now used to fund other 
programs within the Department of Health and Human Services. It is our 
intent that the provisions of Section 319 of the Public Health Service 
Act apply to the Public Health Emergency Fund, and not to the Public 
Health and Social Services Emergency Fund.
  Since public health emergencies may present unanticipated costs, the 
sponsors of the Act did not specify a dollar amount in authorizing 
appropriations for the Public Health Emergency Fund. However, we 
believe that a fund should exist from which expenditures can be made in 
the event of a public health emergency and appropriations made 
accordingly, so that monies need not be diverted from existing programs 
when emergencies arise, as is often now the case.
  Mr. KENNEDY. I thank my colleague, Senator Frist, for his thoughtful 
remarks regarding the Public Health Threats and Emergencies Act, and I 
agree with them strongly.


                      weapons of mass destruction

  Mr. SESSIONS. Mr. President, I would like to engage the distinguished 
Senator from Tennessee in a brief colloquy to clarify language in the 
Public Health Improvement Act of 2000 as it pertains to public health 
countermeasures to a bio-terrorist attack.
  I commend my colleague for bringing such an important measure to the 
Senate floor. His legislation addresses several weaknesses that persist 
today in the pre-crisis and consequence management phases of an attack 
by a terrorist using a weapon of mass destruction, WMD. Since the end 
of the cold war, our nation has strived to address how we might cope 
with an event the likes of which we have never seen on our soil; an 
event that could easily produce thousands of civilian casualties. To 
this end the government has taken some steps to train responders, 
provide them needed equipment, and in rare cases created exercises to 
test systems and response capabilities. The nation is making strides, 
and government is spending billions on all sorts of related programs. 
Yet, I think we remain adrift and ill-prepared to address both the 
cause and effect of a WMD event, particularly one involving a 
biological weapon.
  American's Public Health system is second to none. It has the 
inherent capacity to thoroughly plan, properly train, and expertly 
execute tasks associated with a crisis. My colleague's experience in 
the field of medicine takes the need for planning and training for a 
bio-terrorist event to the next level by requiring the establishment of 
two interagency working groups. Each is designed to bring the expertise 
resident in the government today forward in a constructive manner which 
will allow agencies to set in motion processes that will result in 
increased planning, preparedness and most importantly response.
  One of the failures of WMD programs found elsewhere in the nation and 
elsewhere in the government is the unnecessary proliferation of new 
bureaucracies created to manage new programs, grants, and training 
programs at the expense of producing qualified graduates. Therefore, I 
believe in this instance that it is extremely important to use existing 
Public Health Service training facilities, particularly those with WMD 
training programs in place whenever practical to respond to the 
training needs of medical professionals outlined in this legislation. 
Does the Senator from Tennessee agree that these PHS facilities, which 
already have the infrastructure in place to implement weapons of mass 
destruction training and related activities, should be considered as an 
eligible applicant of any grants or new training initiatives initiated 
by the Secretary?
  Mr. FRIST. The Senator from Alabama is correct. Using current 
facilities and training programs would provide our health care 
professionals the most efficient way of training as many medical 
personnel as possible in the shortest amount of time.
  Mr. SESSIONS. Mr. President, I would like to thank my colleague for 
his hard work on this issue. I, too, look forward to working with my 
friend from Tennessee and other colleagues on this important issues.

                          ____________________


   Mr. JEFFORDS. Mr. President, I ask unanimous consent that the bill be 
read a third time and passed, as amended, the motion to reconsider be 
laid

[[Page 24754]]

upon the table, and that any statements relating to the bill be printed 
in the Record.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The bill (H.R. 2498), as amended, was read the third time and passed.

                          ____________________