Segment 1 Of 2 Next Hearing Segment(2)
SPEAKERS CONTENTS INSERTS
Page 1 TOP OF DOC Segment 1 Of 2
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 1999
Wednesday, February 4, 1998.
TESTIMONY OF MEMBERS OF CONGRESS AND OTHER INTERESTED INDIVIDUALS AND ORGANIZATIONS
WITNESSES
HUGH DOWNS, ABC 20/20
DR. MICHAEL EHRLICH, M.D., AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS
Mr. PORTER. The subcommittee will come to order.
This is our seventh session of public witnesses, and we have heard approximately 120 witnesses over the last three days of hearings. We will have hearings this morning, this afternoon, and tomorrow, with additional public witnesses.
Let me say that we have done our very best to accommodate as many witnesses as we possibly can. We realize that there are more who would like to testify, and we do our very best to include as many as possible and to give everyone a chance.
We would admonish witnesses that because we have so many in each panel, we would ask that you keep your remarks to five minutes. Witnesses have been very good at doing that. The staff is a little tough because they've obtained a timing device, which you will hear, to remind you when the time is up. At some point in the morning I will probably give my ''sermonettes number one and two'' about the budget process, which some of you have heard many times over now, but let me thank each one of you for coming to testify. It helps us a great deal, and I can tell you that as far as the Chair is concerned, I learn a great deal from our public witnesses.
Page 2 PREV PAGE TOP OF DOC Segment 1 Of 2
We have scheduled you early because this is a time when votes do not interrupt us, or are less likely to interrupt us. As a matter of fact, up to this point we have not been interrupted at all, and that allows us to hear everyone on our panel without having to run to the floor and cast votes, where we lose a great deal of time. I hope that that happens today; it may not, because there are matters being debated on the floor this morning, and we probably will have recorded votes at some point during the day.
With all that said, our first witness is Hugh Downs of ABC's 20/20, testifying on behalf of the American Academy of Orthopaedic Surgeons.
Hugh, it's nice to see you. Please make yourself at home.
Let me say that it is, in my judgment, extremely important that people who are well-known to the American people stand up for the things that they believe in and make them known to the public. It captures the public imagination, and we very much appreciate your coming here and spending your valuable time to inform us of your concerns regarding orthopaedic matters and the orthopaedic surgeons. Thank you very much.
Mr. DOWNS. Thank you, Mr. Chairman and members of the subcommittee. I am Hugh Downs, anchor of ABC News' 20/20. I am accompanied by Dr. Michael Ehrlich, who is Chairman of the Committee on Research of the American Academy of Orthopaedic Surgeons, and he is available to answer any medical questions that you might have afterwards.
He also has a prepared statement that will be submitted for inclusion in the record.
Page 3 PREV PAGE TOP OF DOC Segment 1 Of 2
It is a real honor for me to speak before this subcommittee in support of the research being conducted at the National Institute of Arthritis and Musculoskeletal and Skin Diseases. This Institute supports basic and clinical research on many of the most debilitating diseases affecting the Nation's health. Your past investments are paying off, and a continued investment in biomedical research will offer the potential for individuals to resume a productive, functional, pain-free lifestyle which is so important to all of us, of which I am a prime example.
Two years and six days ago, I had bilateral knee replacement at Massachusetts General in Boston. The deterioration over a 15-year period had reached a point where if I walked seven or eight city blocks, I was ready to sit on a curb and wait for a cab because the pain was too overwhelming. It's a source of shame that I don't have a Heismann Trophy to show for ruined knees, but the fact is it was a series of dumb accidents that caused me to fetch up lame. An automobile accident in 1948 stove in my right knee. In 1966, an off-field landing—if you could call it that—in a light plane jammed both knees to the point of mild injury. During an off-trail caper in 1971 in the Tonto National Forest in Arizona, my horse and I parted company and I landed, left knee first, on a stump.
These injuries all appeared to heal, and I had trouble at that time—and up to that time—believing that there was such a thing as a permanent injury. My philosophy was that you got hurt, and then you got well.
Well, I learned that this was not true after the final folly in the saga of my knee joints. In 1981, I ran down 34 flights of stairs in a foot race with my grandson, who at that time was 10 years old. Before I got to the bottom, I knew that I had done something very bad to my right knee. In the ensuing weeks, favoring that knee threw enough strain on the left one to harm it, and recovery was not in the cards.
Page 4 PREV PAGE TOP OF DOC Segment 1 Of 2
Disappearance of the cartilage, with subsequent bone erosion and traumatic arthritis, got a foothold and began to whittle away at my quality of life. Over the years I adjusted and accommodated, and being a denier of some skill, I convinced myself that the feelings produced by that sorry state of my legs were annoyance and not pain, and that was okay, up to a point.
On getting medical advice about whether and when to consider total joint replacement, the answer that orthopedists always gave was, ''You'll know when.'' Well, they were right, and I knew when in the early months of 1995. The date was set for January 27, 1996, to get total joint replacement in both knees.
From what I knew of the technology and the current skills of orthopaedic surgeons, I expected a lot from this operation, and I got more than I expected. First of all, it was possible to avoid general anaesthesia. I was able to watch the entire procedure, which was an extremely educational experience.
I was able to be back in the studio and anchoring 20/20 13 days after the operation, getting around on crutches. As a result of the physical therapy and continuing regimen, I recovered muscles that had atrophied over the years, notably quadriceps, and the pain, of course, disappeared almost instantly. I am amused when people ask me now whether weather changes affect my knees and if I can feel it. I have to remind them that there are no nerves in an artificial joint, and this is a real silver lining.
After 10 months I found I could run upstairs again. That's something I hadn't done for 12 years. All this was possible because of research. Knees, I am told, are very tricky. The first hip replacement was done in 1914, but the first total knee replacement was 1968, and the rapid progress in the techniques and materials that followed are really impressive. This would not have been possible without the kind of research that produces breakthroughs and improves every aspect of such a procedure.
Page 5 PREV PAGE TOP OF DOC Segment 1 Of 2
However, I find it curious—somebody told me recently that 60 percent of the total joint replacements are performed on women. I think this may be an area that may need to be pursued. I'm not sure I know why that is.
I am, obviously, an enthusiastic booster of orthopaedic work, having had successful surgery on the lower spine. It was a fusion in the lumbar region, L4–5, in 1965. In my neck, I had a cervical procedure, C5–6, a bone spur removal, in 1968, in addition to the knee replacements two years ago.
My bionic constitution, with two and a half pounds of cobalt chromium in my knees, sets off airport security machines more or less automatically. That inconvenience is an easy trade for the agony that I used to have, limping through those things, when I didn't set them off.
Mr. Chairman, I want to thank you for the opportunity to appear before the subcommittee today and register my support for a continued Federal investment in research, which will allow the remarkable progress and achievements in musculoskeletal research to continue. I believe these are the ''good old days'' of medicine, right now, and I'm sure they're going to get even better.
Thank you.
Mr. PORTER. Thank you, Mr. Downs.
Page 6 PREV PAGE TOP OF DOC Segment 1 Of 2
Can I ask the doctor what the 60 percent reason is? Because you've got my curiosity up.
Dr. EHRLICH. Women do have a higher incidence of osteoarthritis, sir, than men in the population. In fact, it will afflict about one out of every four adults over the age of 45. That is why the incidence is high.
Mr. PORTER. I think I will launch into ''sermonette number one,'' if I may, and simply say that this subcommittee has put biomedical research, as you may know, at a very, very high priority. We think that it is among the best-spent money in America in Government because the payback in health care cost savings is huge, and the improvements, obviously, in the quality and length of life are evident to anyone who looks at it.
I believe that the subcommittee will continue to put it at a high priority. Many of our witnesses have been testifying that what we really ought to do—and we agree with this—is to increase funding for biomedical research, indeed all basic research funded by Government, double over the next five years.
I believe that this is possible to do, but it depends in large part on what the Budget Committee gives us to work with. I have been asking all of our witnesses to consider that impacting the budget process, as well as impacting the appropriations process, is very, very important in determining what we have to work with and what we can do in respect to funding biomedical research.
So I am asking all of you to go see John Kasich and tell him that this is important, and perhaps we can get the kind of allocations that will allow us to do the kinds of things that we think are necessary to provide the resources to our research scientists who engage in further breakthroughs in all these areas. They can make a real difference in people's lives.
Page 7 PREV PAGE TOP OF DOC Segment 1 Of 2
We can't tell you how much we appreciate your coming here to highlight this for us. I think it makes all the difference with the American people; after all, the policies that are done in Washington are done in response to what the American people want us to do, and if they believe that this is a high priority, it will find its way at the highest priority in our deliberations.
Mr. Stokes.
Mr. STOKES. Thank you, Mr. Chairman.
Mr. Chairman, I don't have any questions, but I certainly want to take this opportunity to express my appreciation to Mr. Downs for his appearance here today and to say to him that I, like so many other Americans, have sat in front of my TV set on so many occasions and admired the manner in which you have brought the news and other commentary into all of our homes.
I also might share with you the fact that, being a grandfather, a few years ago I was trying to play basketball with 10-and 12-year-old grandsons, and in trying to show off and make a three-pointer, I threw one knee out of place and wound up with arthroscopic surgery. The tragedy was, I didn't make the shot. [Laughter.]
It's a real pleasure to have you here. Thank you so much.
Mr. DOWNS. Thank you so much.
Page 8 PREV PAGE TOP OF DOC Segment 1 Of 2
[The prepared statements of Hugh Downs and Michael G. Ehrlich, M.D., follows:]
"The Official Committee record contains additional material here."
Tuesday, February 3, 1998.
WITNESSES
DR. DEBORAH PROTHROW-STITH, M.D., NATIONAL COALITION OF SURVIVORS OF VIOLENCE (YOUTH VIOLENCE PREVENTION)
HELEN BASSETT
Mr. PORTER. Dr. Deborah Prothrow-Stith, Associate Dean and Professor, Harvard School of Public Health, representing the National Coalition of Survivors of Violence, Youth Violence Prevention.
Dr. Prothrow-Stith.
Dr. PROTHROW-STITH. Thank you very much, Chairman Porter, for allowing us to come before the subcommittee. I want to have this opportunity to give particular thanks to Congressman Stokes for his work on health. When I heard that he was retiring, I knew that one of the Generals in the efforts to promote health in America would be retiring.
Page 9 PREV PAGE TOP OF DOC Segment 1 Of 2
I want to wish you the best, but I want you to know how much we're going to miss you. We hope that you will enjoy retirement and keep us in your prayers as we continue some of this work. We will come to see you and get your advice, but we will miss you, and I wanted you to know that.
What we would like to do this morning is share with you three things.
The first is that the epidemic of youth violence in the United States, considered a public health epidemic, is not over. We have been celebrating reductions in violence and violent crimes in the United States; those reductions are primarily among adults. Young children and teenagers are still becoming more and more involved in some pretty tragic episodes. Now is not the time to retreat. We have some prevention that works, and now is the time for the Federal Government to continue the kind of efforts that it has put in this regard.
The second point is that prevention works. Across the country we have school-based programs, community-based programs, collaborations between public health and police and social service agencies that work, and Boston is an example of this. We had two and a half years in Boston where we had zero deaths to children 16 and younger by firearms. We had had 30 in the three years prior. It is remarkable that we had zero. And policing has something to do with what happened in Boston, but for 15 years public health people and community people have been working with police, and really set the stage for that decline.
The second point is that success can work. Prevention can work; we've had those successes, and Boston is an example.
Page 10 PREV PAGE TOP OF DOC Segment 1 Of 2
The third point that I would like to make is that Federal agencies have been working together in a way that is pretty remarkable and somewhat new. We are really impressed with the way DOE, CDC, OJJDP and NCH have come together to do some training around violence prevention and to fund that. It is important because CDC's Injury Center really reflects the growth in looking at violence as a public health problem, and those successes are directly connected to that growth.
I have with me Helen Bassett, who is from Minneapolis, and is the founding treasurer of the National Coalition of Survivors. This group reminds me of Mothers Against Drunk Driving. The issue of violence for them is one that we must continue to address, and I would like her just to say a few words.
Ms. BASSETT. Thank you.
Good morning, Mr. Chairman and panel. I, too, will miss you, Congressman Stokes, and my best to you as well.
I am happy for this opportunity and I am thankful to Dr. Prothrow-Stith for her work that she does in violence prevention. She is a champion for us who are out in the communities, losing children.
I wanted to say that in Minneapolis, you may have heard, we have had some success as well. Attorney General Janet Reno was in Minnesota two weeks or so ago and applauded the efforts of the public-private partnership there. I am active with the group that she brought lauds to, Minnesota Heals, and what I would say is that the prevention side of that are partners around the table in Heals, which includes business and public health and others. We have the resources for law enforcement and we're happy for those. We need help on the community side for public health and for prevention, because it's parents like myself who have lost loved ones who could easily go the way of prosecution and talk about more punishment, but in the end, in the long term, is that really going to save our children? The answer to that is no.
Page 11 PREV PAGE TOP OF DOC Segment 1 Of 2
We want to save our children, make no mistake about that, and we are ready to partner with whomever we need to partner, if that's law enforcement, if that's business. Whoever that is, we stand ready, but we cannot partner without adequate resources, and those resources we want in prevention and intervention, because our kids can be saved. They are not a lost generation; they are not unsalvageable. At 9 years old, 10 years old, 12, 13, 14, they are still children, just as your children are still children and just as your grandchildren are still children. They are our children, and we absolutely want them saved.
Dr. PROTHROW-STITH. We will be working with Congressman Stokes' staff to really think about the appropriation for CDC and the Injury Center in particular, but we really appreciate this opportunity to make sure that the issue stays on your agenda, and say that the epidemic is not over. There may be a second wave in rural communities and a third wave involving girls and violence. Now is not the time to stop our efforts.
Thank you.
Mr. PORTER. Thank you very much. We hear what you're telling us and its importance. We will do the very best that we can to provide the resources that are needed to get us past this ongoing problem for our country and for our kids. I think all of us feel that way. You already heard my sermonette about how we get those resources, but we'll do our very best.
Thank you for testifying.
Mr. Stokes.
Page 12 PREV PAGE TOP OF DOC Segment 1 Of 2
Mr. STOKES. Thank you, Mr. Chairman.
I would just like to take a moment to express my appreciation both to Dr. Deborah Prothrow-Stith and to Ms. Bassett for their very kind and warm remarks.
But also to say, Mr. Chairman, that I've had the pleasure over a number of years now working directly with Dr. Stith. I am very appreciative of the fact that I've had the benefit of her counsel and her expertise, particularly in the area of violence and violence prevention, in the work that she's done with reference to violence in the African American community as it relates to youth. Of course, she is also the author of a very excellent work relative to this subject.
I just want to say to both of you that it's a pleasure to have had you here this morning. I don't know of any subject that is more important than preventing violence in our society, and I appreciate the reception that the Chairman has given you. I'm sure we'll work with him to try to see if we can't do even more in this area in terms of our appropriations process.
Thank you very much for coming.
Dr. PROTHROW-STITH. Thank you.
Mr. PORTER. Thank you, Mr. Stokes.
Page 13 PREV PAGE TOP OF DOC Segment 1 Of 2
[The prepared statement of Deborah Prothrow-Stith, M.D., follows:]
[CLERK'S NOTE.—Information required pursuant to clause 2(g)(4) of Rule XI of the Rules of the House of Representatives was not received from this witness or from an entity represented by this witness.]
"The Official Committee record contains additional material here."
Tuesday, February 3, 1998.
WITNESS
ARNOLD MITCHEM, NATIONAL COUNCIL OF EDUCATIONAL OPPORTUNITY ASSOCIATIONS
Mr. PORTER. Our next witness is Dr. Arnold Mitchem, Executive Director, National Council of Educational Opportunity Associations, testifying on behalf of those associations.
Dr. Mitchem.
Dr. MITCHEM. Good morning, Mr. Chairman, members of the subcommittee——
Mr. PORTER. I'm sorry, I neglected to recognize my colleague from Texas, Mr. Bonilla.
Page 14 PREV PAGE TOP OF DOC Segment 1 Of 2
Mr. BONILLA. Thank you, Mr. Chairman.
I would just like, before you offer your testimony, to point out to those on the subcommittee who may not know your background and what you're doing, and for those who are here with us at the hearing today, about the outstanding work that you're doing and how you overcame such great odds. I know that you are known officially, of course, as Dr. Arnold Mitchem, but most of your friends call you Mitch. A lot of people may not know that you overcame significant odds to be where you are today, having helped so many young people in communities across the country. Growing up in the 1940s and 1950s on Chicago's West Side, then you had a case of polio when you were younger which also caused you to not have as much use out of your arm as you would like to have, and in spite of having all those things going against you, you graduated from the University of Southern Colorado and then received your Ph.D. from Marquette.
The National Journal—I enjoyed that article about you recently—did a wonderful piece entitled, ''Making Miracles, One at a Time.'' I think that's an appropriate title for the work that you do, and specifically with the TRIO program that your organization has strongly represented.
As you know, I can identify with you to some degree. I was also born in a housing project on the west side of San Antonio. No one in my family had ever had an opportunity to attend a university. The TRIO program helps students that come from families like yours and mine to get that first step to go to college. It's a transitional program in which I believe very strongly. It just helps give you that boost to get started; it's almost like getting a jump start, to get your life going into a university.
Page 15 PREV PAGE TOP OF DOC Segment 1 Of 2
I thought people should know that today before you began your testimony, so welcome, Mitch.
Dr. MITCHEM. Well, thank you very much, Mr. Bonilla. That was very kind and it is deeply appreciated. Thank you.
Mr. Chairman, members of the subcommittee, on behalf of the National Council of Educational Opportunity Associations I wish to thank each of you for your support of postsecondary education, and the TRIO programs in particular. I would also like to take this opportunity to acknowledge you, Mr. Stokes, for the historic role that you have played over the decades in building a very strong and positive consensus for these programs.
I want to make two points today. First, we need to invest in TRIO programs in order to ensure that more TRIO students can succeed in a more complex and expensive higher education environment.
Second, we need to take a serious look at the erosion of per student funding, particularly in Student Support Services, and its connection with the retention of low income students in higher education.
Now, in order to expand the services provided by TRIO programs to reach more students, and to provide more intensive services, NCEOA is requesting a $655 million appropriation for fiscal year 1999. This increase will allow TRIO programs to serve an additional 51,000 youth and adults who are seeking or who are currently pursuing a college education.
Page 16 PREV PAGE TOP OF DOC Segment 1 Of 2
Before I go any further, I want to pause again to applaud the steps this subcommittee has taken in past fiscal years to increase resources which help needy students attend and graduate from college, for increasing the maximum Pell Grant to an all-time high of $3,000, for increasing work study funds, and, of course, for increasing the TRIO funding to $529.6 million, with the significant role that this committee played in conference with the Senate last year. In my view, your dollars have been well spent. In the case of Upward Bound, national evaluations show us now that Upward Bound makes a difference in a student's aspirations and preparations for college. We also know that our Talent Search and Educational Opportunity Centers continue to play a vital role in advising low income families and providing supplemental educational services. The latter, gentlemen, is critical, because studies show that without some intervention, only 28 percent of students from low income families complete the college prep sequence, compared to 65 percent of upper income students who do so without any intervention. No doubt, with increased support Talent Search will enable more low income students to complete a college prep curriculum.
My second point is that over the past two decades the number of Student Support Services projects has grown dramatically, from 121 to over 800 today, and the number of students served per year from 30,000 in 1970 to more than 175,000 today. The national evaluations of Student Support Services programs show that these programs are having a highly significant effect in terms of the retention of their students in college. Students in Student Support Services were 22 percent more likely to be retained through their third year of attendance at the college where they began than were similar nonparticipants, and had a 77 percent chance of continuing for a third year in college.
The last point is especially significant and stands in sharp contrast to some data we have from the National Center for Education Statistics. They found that more than 53 percent of students from the lowest income quartile who entered college had not achieved a degree or a certificate and were no longer enrolled four years later.
Page 17 PREV PAGE TOP OF DOC Segment 1 Of 2
The ability of Student Support Services programs to continue to have such a dramatic impact on the retention of low income students depends upon their ability to deliver intensive and effective services. This ability, gentlemen, stands at risk today, and it stands at risk because the funding for Student Support Services participants has declined from its peak in 1990 dollars of $1,123 in 1970, to a low of $507 per participant in 1981. For fiscal year 1996, the per participant funding is now $867.
Thus, I ask you to take this into consideration as you consider our request.
Again, Mr. Porter, Mr. Bonilla, Mr. Stokes, thank you very much for giving me this opportunity.
Thank you again, Mr. Bonilla, for those very, very kind comments.
Mr. PORTER. Thank you, Dr. Mitchem.
I think you have in Mr. Stokes and Mr. Bonilla two really strong advocates for the programs that you have mentioned. Lou has been there on the TRIO program, and the members of the subcommittee believe that it is one of the best programs that we know of for getting results for young people, and have been very supportive. Henry, of course, has been there very strongly on our side of the aisle.
I think that in our deliberations there are going to be at least two strong voices, and maybe more. All of us hear you very strongly and appreciate very much your coming here to testify and reminding us of the importance of these programs to young people.
Page 18 PREV PAGE TOP OF DOC Segment 1 Of 2
Dr. MITCHEM. Thank you very much, Mr. Porter.
Mr. PORTER. Mr. Stokes.
Mr. STOKES. Thank you, Mr. Chairman. I will just take a moment.
I would just like to concur with the accolades that were accorded you by Mr. Bonilla. I certainly cannot improve upon the fine treatment he gave of what you have meant to this country and to the field of education. In the years that I've worked with you, I don't know of anyone in the field of education in this country for whom I have greater respect and higher admiration than I have for you.
At the same time, I want to commend Chairman Porter and the other members of this subcommittee. While for years I have been an advocate on behalf of TRIO programs, the type of increases that we've received over the years could not have been achieved had it not been for the receptivity on the part of the Chairman and the other members of this subcommittee, all of whom have been very sensitive to the types of concerns that you have expressed here today. During the time that I am accorded here, the rest of this term, I look forward to working with them in trying to continue that type of response to the needs of disadvantaged, and in particular minority, children who fall in this range.
Thank you very much.
Mr. PORTER. Thank you, Dr. Mitchem.
Page 19 PREV PAGE TOP OF DOC Segment 1 Of 2
[The prepared statement of Arnold L. Mitchem follows:]
[CLERK'S NOTE.—Information required pursuant to clause 2(g)(4) of Rule XI of the Rules of the House of Representatives was not received from this witness or from an entity represented by this witness.]
"The Official Committee record contains additional material here."
Tuesday, February 3, 1998.
WITNESS
NINA SHOKRAII, REPRESENTING HIMSELF
Mr. PORTER. Our next witness is Nina Shokraii, Education Policy Analyst, The Heritage Foundation, testifying on her own behalf.
Ms. SHOKRAII. Mr. Chairman and members of the committee, thank you very much for inviting me today to discuss with you ways to reform education programs within your committee's jurisdiction. I will concentrate on three specific programs, and I offer my recommendations on how to make them more effective by sending them to States—and, more importantly, to families and parents.
The programs that I am going to focus on are impact aid, bilingual education, and Title I.
Page 20 PREV PAGE TOP OF DOC Segment 1 Of 2
With impact aid, I recommend voucherizing and sending the entire program to the Department of Defense. This program was established during World War II, providing support to school districts affected by Federal activities, mostly related to relocation of military personnel.
Because Federal lands are not subject to local taxation, local education agencies receive payments to compensate for revenue losses that resulted from the Federal Government's acquisitions of significant portions of their district's tax base. Today the program receives about $615 million, and it has really, in our opinion, outgrown its usefulness. Since this program is largely designed around children of Federal Government workers who tend to relocate a lot, we feel that it's best to tie the money to the children who move around with their parents from one military base to another military base, and I would like for the money to follow the child from the school to any school of choice, be it public, private or parochial. Transferring this money to the Department of Defense at a $1,000 voucher per child as part of an expanded compensation package would save an average of $285 million. It would also assure that the areas most affected by this influx of students receive the most amount of money.
The second program I will focus on is bilingual and immigrant education. We recommend block granting it to the States. This program was started in 1967 as part of the Elementary and Secondary Education Act. Initially, Congress did not limit bilingual education support to any one particular instructional method. As you know, in 1974, upon the establishment of the Office of Bilingual Education and Minority Languages, this policy was reversed. Congress mandated at that point that schools use transitional bilingual education instruction methods by which students are introduced to English while receiving their coursework in their native tongue. The Department of Education itself has found that using this method has so far been detrimental to the extent that it takes the kids about six additional years to learn English.
Page 21 PREV PAGE TOP OF DOC Segment 1 Of 2
Now, the Federal dollars really are only 3 percent of the entire budget of bilingual education, but the Federal mandate and influence in local school districts has made it so that a lot of these school districts are relying more and more on bilingual education instead of other instructional methods. This is actually despite a lot of Hispanic opposition to this program. I'm sure you've heard of the California initiatives by now. Last February, dozens of working-class Latino parents boycotted a school in Los Angeles, protesting that they basically did not want their kids taught in bilingual education courses because they were not learning English. As a result, there was an initiative on the California ballot this year which gives the option of enrolling children in bilingual education courses to the parents of those children. Support for this initiative, according to the Los Angeles Times in October, was 84 percent amongst Latino parents.
By sending this $261 million program to States, the Governors can use the money to develop whatever programs they deem most appropriate and effective in teaching English as a second language, not one mandated by the Federal Government.
Finally, with Title I, we are big advocates of voucherizing this program. This program provides funding for local education agencies and schools in areas with high poverty rates. The program benefits approximately 5 million low-achieving students, but unfortunately, three decades and over $100 billion later, the only two longitudinal studies of the program have shown that this program has not been successful in helping children overcome poverty's negative impacts.
As you know, we are big advocates of school choice. The only two school choice programs existing in this country that help low income minorities primarily are in Milwaukee and Cleveland, and the studies of those programs by Harvard Professor Paul Peterson and University of Texas at Austin Professor Jay Greene have shown that both of those programs are extremely beneficial in teaching low income kids and increasing their academic achievements. In Milwaukee, for instance, the researchers concluded that after staying in the program for five years, the gap in test scores between whites and blacks—and minorities, excuse me—narrowed by 33 to 50 percent, to the point that if these trends continued, that gap would ultimately disappear.
Page 22 PREV PAGE TOP OF DOC Segment 1 Of 2
In Cleveland, the researchers studied two specific schools that were solely designed to take care of the vouchered children, and they found that the kids who were accepted to this school increased their reading scores by 15 percentile points and their math scores by 5 percentile points, just after being in the program for a year. Now, a year is really not long enough to measure anything, but studies have shown that in the inner cities, especially in places like Cleveland, just being able to maintain your test score at the level that it was when you first started is a big accomplishment. So the fact that these children did better by these percentile points is extremely significant.
Mr. Chairman, sending these three programs to States as a block grant, or to families as a voucher, instead of bureaucrats, will save the American people money while improving the academic futures of our children, especially those from disadvantaged backgrounds.
Mr. PORTER. Ms. Shokraii, thank you for your testimony. I have to say that you are in the wrong store. We are appropriators and we have to do what the authorizers tell us, and until we have authority to do the kinds of things that you've suggested, making Title I a voucher program and basically the same with bilingual and impact aid, we have to continue funding them through the existing programs that are authorized by law.
So your message is really one, in the first instance, at least, for the authorizing committee that sets up the law.
Let me say that a lot of what you said, I agree with, and I think other members of the committee do; others don't. Let me talk about impact aid, though, because this is a subject that I think I know a fair amount about.
Page 23 PREV PAGE TOP OF DOC Segment 1 Of 2
Impact aid ought to be, in my judgment, an entitlement program. It's an absolute obligation of the Federal Government to support kids whose parents don't pay the local property taxes that fund the school system, and I think the Federal Government has to meet that obligation. I have in my district the largest primary naval training facility in the world at Great Lakes in North Chicago, Illinois. Like many military bases, the community around it is a very poor community, the third poorest in our State. They don't have a good base on which to tax in the first place, and with 50 percent of the kids in the school system coming from the military base, they absolutely are dependent upon the Government providing some share of the funding, or the school system could not exist. In fact, it almost went bankrupt about four years ago when the Federal Government payments were so low that it actually voted itself into bankruptcy because it had no funds left, until we could straighten that out.
You might think that Defense wants this program. They absolutely do not. They don't consider themselves responsible for the education of military kids; they think that's a local responsibility, which it is, and they don't want to get involved with it. Therefore if you tell Defense that you want them to take the program—I'm talking about our colleagues in the committees—they will say, ''No way, we don't want it.''
So if I were to make a change in this program, I would make it an entitlement. I would suggest, by the way, that a $1,000 voucher is way, way short of what the Federal Government has to provide for kids. In this very poor school district that I just described to you in North Chicago, in one of the poorest cities in Illinois, the cost of educating that child is about $6,500, and that's about the lowest in the region. And $1,000 would not do anything to get that kid that education because, again, the school system would simply go bankrupt. It's way short of the Federal Government's obligation, and thank goodness we are providing more money than that, and not shifting the costs of those kids onto local taxpayers who simply can't afford it.
Page 24 PREV PAGE TOP OF DOC Segment 1 Of 2
That was sermonette number three, I think.
Anybody else? Mr. Miller.
Mr. MILLER. I'm glad that we actually have speakers coming before the committee that raise questions about how we spend money, and I commend you for allowing them to participate in this process because, as you know, 98.5 percent—or something like that—are here advocating more spending and more programs, which are good programs and we do support them. But we need to have organizations and individuals willing to step forward and say, hey, we should look at some of these programs.
I admire you for coming. I appreciate it, and thank you for being here today.
Mr. PORTER. Let me emphasize that, Dan.
I think Mr. Miller is absolutely right. We've had a number of witnesses now from Heritage and from AEI and others who are interested in this process and giving us their analysis, and you're one of them, and we very much do appreciate it. I wish we could respond to some of the things you said. The bilingual program, for example, I think you're exactly right on that. I think Henry would agree with what you said, although I certainly don't speak for him. But our subcommittee doesn't have the authority to do what you want us to do, and you've got to get Bill Goodling's subcommittee to look into these matters and see if they can make some changes that make sense for the country and for the kids that we serve.
Page 25 PREV PAGE TOP OF DOC Segment 1 Of 2
Thank you very much.
[The prepared statement of Nina Shokraii follows:]
"The Official Committee record contains additional material here."
Tuesday, February 3, 1998.
WITNESSES
VERA DORSEY, CITY OF COMPTON, CALIFORNIA
ROBERT THOMAS
Mr. PORTER. Vera Dorsey, Director, Department of Employment and Training Services, testifying on behalf of the city of Compton, California.
Ms. DORSEY. Good morning. I bring you greetings from the city of Compton, from the Mayor, City Council and the citizens of Compton, California. We thank you for the opportunity to be here today to testify.
On a personal note, from my Mayor, Council and citizens, Mr. Stokes, we learned recently of your retirement, and I was asked to make sure that they give you warm wishes for a healthful, restful, peaceful, and relaxed retirement.
Page 26 PREV PAGE TOP OF DOC Segment 1 Of 2
Mr. Chairman and members of the subcommittee, on behalf of the Mayor and City Council of the city of Compton, California, I would like to thank you for the opportunity to provide testimony related to the city's Department of Employment and Training Services, also referred to as DETS, and the pervasive and very serious challenges facing our community, reducing illiteracy, unemployment, and moving many of our residents from welfare to work.
For the sake of time, I have abbreviated my written remarks, and I urge the members of the committee to review my full statement when time permits.
Mr. Chairman, last week the President stood before a national audience and proclaimed that America was experiencing record economic growth and low unemployment. Unfortunately, the rising tide of economic prosperity has yet to reach the battered shores of Compton, California. While we are resilient and determined to bring about an economic regenesis within Compton, city leaders continue to grapple with a stagnant local economy and double digit unemployment levels. While the Los Angeles County unemployment rate is 5.8 percent, and the State and national rates are 5.5 and 4.4 percent respectively, the unemployment rate in Compton is an appalling 14.7 percent, three times the State and county rates and nearly four times the national rate. Additionally, more than 40 percent of the city's residents receive some type of public assistance.
Over the last two years, DETS has been working towards redesigning its service delivery system in response to Federal and State initiatives geared toward development of a nationwide career center system. DETS is slated to open Compton's one-stop career and human services center this summer. At the same time, the agency is preparing to mount a slate of services for hard-to-serve welfare clients under the new welfare-to-work program passed last year by Congress. Under this workforce program, DETS will provide services which will aid welfare clients in becoming self-sufficient by transitioning them to employment opportunities which offer long-term job retention.
Page 27 PREV PAGE TOP OF DOC Segment 1 Of 2
Clearly, the program priorities described above provide DETS with ample challenges and a significant workload. Moreover, management and staff are acutely aware that the current financial resources are still insufficient to meet the overwhelming employment and training needs of the community. It is in this vein, Mr. Chairman, as the committee considers funding priorities for fiscal year 1999 Labor/HHS/Education appropriations bills, that the city of Compton respectfully urges the committee to support the following recommendations.
Number one, Compton urges the committee to support, above the Administration's fiscal year 1999 request, funding for youth training grants proposed at $130 million, and summer youth employment and training programs proposed at $871 million, as well as providing funding for new out-of-school youth programs proposed at $250 million.
Over the last several years, Federal workforce funding for youth programs has vacillated. With nearly 30 percent of Compton residents between the ages of 13 and 20, DETS continues to struggle to identify solutions for youth employment needs in light of decreased and unstable Federal youth funding. Increased youth funding is desperately needed in order to promote a positive work ethic in youth during their high school years. Such programs also serve as a means of promoting diversion activities for adjudicated youth and others who are at risk of dropping out of school or participating in nonproductive or illegal activities.
Number two, Compton recommends that the committee continue to support adult training grants, proposed at $1 billion, and increase the Federal one-stop career center program, proposed at $146.5 million. Recently, Congress has attempted to pass legislation to consolidate a wide variety of Federal unemployment and training programs. As stated previously, Compton has taken a leadership role in developing a one-stop center delivery system for its residents; however, this role has brought the financial burden of covering the lion's share of costs for implementing and maintaining the center and associated support systems. Although Congress has made recent appropriations for one-stop system development, additional resources are needed to ensure that all local centers have sufficient financial resources necessary to operate a well-functioning one-stop system of delivery.
Page 28 PREV PAGE TOP OF DOC Segment 1 Of 2
Compton recommends that the committee continue to support the Department's welfare-to-work initiatives.
Finally, Mr. Chairman, Compton requests that you support the Administration's request for $250 million, to be split evenly between the Department of Labor and the Department of Education, for the purpose of school-to-work, and $1.5 billion for educational opportunity zones that will aid urban and rural schools with high concentrations of children from low income families.
Mr. Chairman, this concludes my testimony. Again, thank you for the opportunity to express the views and recommendations of the city of Compton, California.
Are there any questions?
Mr. PORTER. Ms. Dorsey, thank you for your testimony.
I was asking the staff to provide me with the figures in the President's budget, but my recollection on youth training, for example, and summer youth, was that the President had level-funded those from the previous year, and that on one-stop, he had actually cut it. I may be wrong; I'm trying to get the figures right now. Is that what you saw in his figures?
Ms. DORSEY. I'm not quite sure that it had been cut.
Mr. PORTER. I was surprised when I saw them because I thought the President would put them at a higher priority, and he hadn't in his own budget. The difficulty often in Congress is that if the President doesn't give weight to these kinds of programs, Congress tends to take his advice on it. So I'm a little bit concerned about his budget on these items.
Page 29 PREV PAGE TOP OF DOC Segment 1 Of 2
Mr. THOMAS. Mr. Chairman, I'm Robert Thomas, from the City Council as well.
Mr. PORTER. Yes.
Mr. THOMAS. We do realize that he did ask for level funding, but if you would look in Ms. Dorsey's full statement, she outlines why there is a need for increased funding for both those programs pertaining to youth training, as well as summer jobs. I think she touched on it briefly in her statement, saying that roughly 30 percent of Compton's residents are between the ages of 13 and 20. Most of them, especially during the summer, have nothing to do, and as you know, there are plenty of other things to do for kids outside of doing the right thing. What we're trying to do is bring about a positive change; instead of being involved in gangs and drugs, to have programs that they can come into and get involved with. I don't know if you know, but Shaquille O'Neal has just opened up a manufacturing plant and has hired kids and has them working within Compton——
Mr. PORTER. That's great.
Mr. THOMAS [continuing]. There are a lot of children who have never worked and who have dropped out of school who are now considering going back to finish their education because they've received a job from this plant and other activities.
Mr. PORTER. You know what I would like to see, and maybe I'm wrong in this—you can correct me if I am—but I think often, and this applies to a lot of different programs, we've gone through a process over a number of years of trying to attract votes for programs by giving some of the money to everybody. I'm not sure that these programs are on that formula, but I can tell you this, that I think we've got to get over that. We've got to put the money where the problems are, and we've got to address those problems forcefully instead of sending the money all of the country where, in some places, it's not needed at all; it simply makes their local tax burden less.
Page 30 PREV PAGE TOP OF DOC Segment 1 Of 2
Mr. THOMAS. That's what we're saying about the unemployment.
Mr. PORTER. Exactly. You've got serious problems that need to be addressed; you need the resources, and in many cases we're sending them places that don't need them at all. I can't do anything about that as an appropriator, but I would hope that you would also—I just told the previous witness the same thing—impact Mr. Goodling and the authorizing committee that have authority over these matters, because I think we need to do a much better job of targeting these resources to where they are most needed.
Mr. Stokes.
Mr. STOKES. Mr. Chairman, you're absolutely correct, and they're absolutely correct. The problem is a political one, as you and I know. Oftentimes for these types of programs, in order to get them passed to affect the areas where they're needed, we've got to get the votes for them. Therefore, the money winds up going to other places where it's not even needed.
Mr. PORTER. Lou, I would hope that somehow we're past that, but you probably are right. I just hope this country gets the idea that we've got to get these problems solved.
Thank you both for your testimony.
Ms. DORSEY. Thank you very, very much.
Page 31 PREV PAGE TOP OF DOC Segment 1 Of 2
Mr. PORTER. You came a long way to testify, too.
Ms. DORSEY. It's very important to us.
Mr. PORTER. That means it's important, right.
[The prepared statement of Vera Blanche-Dorsey follows:]
[CLERK'S NOTE.—Information required pursuant to clause 2(g)(4) of Rule XI of the Rules of the House of Representatives was not received from this witness or from an entity represented by this witness.]
"The Official Committee record contains additional material here."
Tuesday, February 3, 1998.
WITNESS
DR. JOHN L. SEVER, M.D., ROTARY INTERNATIONAL
Mr. PORTER. Dr. John Sever, Professor of Pediatrics, Children's National Medical Center and George Washington University Medical Center, testifying on behalf of Rotary International.
Dr. Sever, nice to see you.
Page 32 PREV PAGE TOP OF DOC Segment 1 Of 2
Dr. SEVER. Nice to see you, sir.
Chairman Porter, Mr. Stokes, members of the subcommittee, thank you for this opportunity to testify on behalf of Rotary International in support of the effort to eradicate polio and the activities of the U.S. Centers for Disease Control and Prevention. As you mentioned, I am Dr. John Sever; I am Professor of Pediatrics and Infectious Diseases at the Children's National Medical Center here in Washington, D.C., and I am here today representing a broad coalition of health advocates for children, including Rotary International, the March of Dimes Birth Defects Foundation, the American Academy of Pediatrics, Task Force for Child Survival and Development, and the U.S. Committee for UNICEF, to seek your continued support for the global program to eradicate polio.
Allow me first, on behalf of Rotary International and the coalition, to express our sincere gratitude to you and this committee for your support. For 1997 and 1998, you recommended $47.2 million be allotted each year for polio eradication activities of the Centers for Disease Control and Prevention. This investment makes the United States the leader among donor nations in the drive to eradicate this crippling disease.
The target year is the year 2000, and that's a thousand days remaining between now and the end of year 2000, to defeat this disease in countries where the polio virus still causes death and disability. The eradication of polio has been and will be achieved through your leadership, and it will not only save lives but also save our financial resources.
Eradicating polio will save the United States at least $230 million annually. We must continue to immunize children in this country for polio, although there has been no polio in this hemisphere for more than five years. When polio is eradicated worldwide, however, which we're very close to, we will be able to stop immunization, and this will result in an average saving of over $230 million annually.
Page 33 PREV PAGE TOP OF DOC Segment 1 Of 2
Thanks to your appropriations, the international effort to eradicate polio has made tremendous advances during the past two years. Preliminary estimates that are reported for polio cases in 1997, the last year that this information is available for, indicate there were approximately only 3,500 cases anywhere in the world, and we're well on the way to eradicating polio by the year 2000, as has been projected.
The CDC is participating very actively in eradication efforts, particularly in those two areas where polio remains, South Asia and Africa. The United States' commitment to polio eradication has stimulated other countries to increase their support. Belgium, Canada, Finland, France, Italy, Korea, Norway, Sweden, Switzerland, Japan, Australia, Denmark, and the United Kingdom are among those countries which have followed America's lead and have recently announced special grants for polio eradication.
By the time polio has been eradicated, Rotary International will have expended over $400 million on that effort. This is the largest private contribution ever made to a public health initiative.
For fiscal year 1999, we respectfully request that you provide $67.2 million for the targeted polio eradication efforts of the Centers for Disease Control and Prevention. This is an increase of $20 million over the fiscal year 1998 level, and it is $20 million more than the President's fiscal year 1999 budget request, which was submitted by the President before WHO released the latest estimates of unmet polio eradication needs. The additional $20 million is particularly needed to meet the enormous costs of eradicating polio in its final pockets of strongholds, in sub-Saharan Africa.
Page 34 PREV PAGE TOP OF DOC Segment 1 Of 2
Of this amount, $6 million would be used to purchase vaccines which are needed for these mass immunizations; $5 million would be provided for operational support of national immunization days in countries such as Liberia, Somalia, and the Democratic Republic of the Congo, which are difficult countries to work in but need to have the disease eradicated to complete the job.
A further $9 million would go to develop an Africa-wide polio surveillance system and strengthen and expand the existing network of regional and national laboratories to document the eradication of polio.
Without this additional appropriation, we may not be able to eradicate polio by the target date.
In conclusion, polio eradication is an investment, but few investments are as risk-free or can guarantee such an immense return. The world will begin to break even on this investment in polio eradication only two years after the virus had been vanquished. The financial and humanitarian benefits of polio eradication will then accrue forever. This will be our gift to the children of the 21st century.
I thank you for this opportunity to testify and I appreciate your support.
Mr. PORTER. Dr. Sever, first let me apologize because I think I have mispronounced your name two or three times, and the reason is that I know someone with the same name at home who pronounces it Sever. It's SEV-er.
Page 35 PREV PAGE TOP OF DOC Segment 1 Of 2
Dr. SEVER. Thank you, sir. I answer to anything.
Mr. PORTER. Secondly, I'd like to say how strongly I admire the work of Rotary International in taking on this tremendous challenge, and the success that you've achieved and the resources that you've put into it. I think Rotary is on what I consider the cutting edge of the future in public-private partnerships to achieve specific worthwhile ends. I think it's an example for other organizations across our country as to what can be done if people work together. You, of course, have a worldwide membership, but people working together can really put their sights on getting something accomplished. You've just done a wonderful job, and we on the subcommittee want to continue to be as supportive as we possibly can. I can tell you that we will do our very best to do exactly that.
Dr. SEVER. Thank you, sir.
Mr. PORTER. Thank you, Dr. Sever.
[The prepared statement of John Sever, M.D., follows:]
"The Official Committee record contains additional material here."
Tuesday, February 3, 1998.
WITNESSES
GLORIA E. REICH, AMERICAN TINNITUS ASSOCIATION
Page 36 PREV PAGE TOP OF DOC Segment 1 Of 2
DAN PURJES
Mr. PORTER. Gloria E. Reich, Executive Director, American Tinnitus Association, testifying on behalf of the association.
Dr. Reich.
Ms. REICH. Good morning, Chairman Porter.
I am hearing impaired and I experience tinnitus. It is a condition that is shared by more than 50 million Americans. With me today is Dan Purjes from New York. Dan is Chairman of Josephthal & Company and Hearing Innovations, Inc., and a member of our board of directors. In just a few moments he will tell you about his tinnitus.
Tinnitus is most often described as the perception of sound when there is no external sound present. It can take many forms and be described in many ways. It can strike people of all ages, and for the most part, it doesn't go away.
For the 50 million Americans who experience tinnitus, about 10 million to 15 million suffer severely and seek help through the health care system. There are still many questions that remain unanswered. The mechanism that causes tinnitus is unknown, and that fact alone makes it impossible to properly diagnose and treat this elusive symptom.
Furthermore, the personal and social consequences of tinnitus, particularly depression and anxiety disorders, have generally been ignored in favor of a more strictly hearing-based approach, relying on the definition of tinnitus as a symptom of auditory dysfunction. Many people who are the most troubled by tinnitus have relatively normal hearing and are thus deprived the cachet of a legitimate illness. Their head noises are for the most part subjective and idiopathic, and poorly understood, not only by themselves but by the health professionals who treat them.
Page 37 PREV PAGE TOP OF DOC Segment 1 Of 2
The mission of the American Tinnitus Association is to promote relief, prevention, and the eventual cure for tinnitus for the benefit of present and future generations. Since our inception in 1971, we have seen more than 3,000 scholarly papers, a dozen books, and the formation of workshops, seminars, and support groups to aid tinnitus management. Effective treatments for tinnitus have also proliferated, and most patients can now expect a reasonable degree of relief for this symptom. However, from the point of view of the tinnitus sufferer, research still hasn't produced a cure, and a cure, let me assure you, is what sufferers want.
Three years ago the National Institute on Deafness and Other Communication Disorders conducted a tinnitus workshop and recommended strategies for research. Last year they funded five studies about tinnitus that addressed these issues. Most recently, they awarded $1.5 million to Doctors Salvi and Lockwood in Buffalo, New York, to study the activity in the brain that may be triggering tinnitus. The Salvi-Lockwood studies and four of the five previous studies were initially funded by ATA with grants that enabled the investigators to produce the pilot data necessary to qualify for Federal grants. These events represent a great stride forward for tinnitus research within the NIDCD, and for that we are truly grateful. Just five years ago the word ''tinnitus'' was not even mentioned in the NIDCD plan.
The tinnitus community is very grateful to you, Congressmen and Congresswomen, for providing the necessary funding for the NICDC to undertake these projects. We hope this is just the beginning.
It is extremely important for Congress not only to fund medical research, but to require that the Institutes receiving that funding really respond to the public's need. Hearing problems, and tinnitus specifically, are the most prevalent health issue in this country, but receive little attention in comparison to the more visible life-threatening diseases. Additionally, in an effort to contain medical costs, insurers—both public and private—effectively deny most people treatment for their hearing problems.
Page 38 PREV PAGE TOP OF DOC Segment 1 Of 2
We know people are concerned because whenever there is a public mention, our phone lines ring off the hook. This week we have received thousands of calls just from one mention in a syndicated column.
There is a great social cost on society from tinnitus. Up to 15 percent of the people who have it are forced to change jobs or quit their jobs, and these people could be productive members of society if they were relieved of that problem. We ask you to generously support the funding for the National Institute on Deafness and Other Communication Disorders, and to urge them to fund more studies about tinnitus.
Now I would like to introduce Dan Purjes.
Mr. PURJES. Congressman Porter, thank you for the opportunity to address the committee.
A few months ago my friend, an attorney, called me late one night, saying he was sitting on the edge of his bed with a revolver in his hand, about to blow his brains out. He had just come down with tinnitus, with a ringing sound in the ears, it made his life unbearable. Doctors told my friend he may have to live with tinnitus for the rest of his life, and he could not face the prospect of lifelong suffering.
Over 30 years ago my hearing was damaged in a head injury. Since that time I have had to live with this constant high-pitched hissing sound in my head, 24 hours a day, every day of the year.
Page 39 PREV PAGE TOP OF DOC Segment 1 Of 2
It is urgent that you support the research of the National Institute on Deafness and Other Communication Disorders through increased funding. People are dying by their own hands, and many more are suffering endlessly while they hope for a cure. I'm one of the lucky ones; I've learned to cope with this condition, though it interferes with my hearing. Many others are so intensely afflicted, the sound in their head is so loud and debilitating, that they end their lives because today there is still no glimmer of a cure. Fortunately, my friend was not one of them, but how close he came that night when he called for my help and understanding, I will never forget. I ask that you give your understanding and help.
It is estimated that over the coming years, something like one-third to one-half of all Americans will suffer hearing impairment of one kind or another. I have been active in this field, and we desperately need additional funding for more research.
Thank you.
Mr. PORTER. Mr. Purjes, thank you very much for your testimony.
Dr. Reich, do you suffer from this disease also, personally?
Dr. REICH. I hear the tinnitus, yes; is that what you're asking?
Mr. PORTER. Yes. I'm asking whether you have tinnitus, as well.
Page 40 PREV PAGE TOP OF DOC Segment 1 Of 2
Dr. REICH. I consider myself one of the people who are naturally habituated to it. It's there, but it's not an issue in my life.
Mr. PORTER. It's there, as in Mr. Purjes' case, 24 hours a day, always?
Dr. REICH. Absolutely. I can always call it up and listen to it.
Mr. PORTER. As I assume you know, we had William Shatner here last year who talked about his tinnitus and what it meant in his life and his career. We consider it, obviously, a very serious matter that affects a lot of people in our country, millions and millions of people, and I think NIDCD takes it very seriously as well and is doing everything it can to put it at a high priority. We certainly will continue to press them on that.
We'll do our best to get the funds that they need. You heard sermonette number one or two earlier; we ask you to take that to heart. We'll do our best to put this at a high priority.
Thank you for testifying.
Dr. REICH. We very much appreciate your help. We know that you have been doing it, and thank you very much.
Mr. PORTER. Thank you.
Page 41 PREV PAGE TOP OF DOC Segment 1 Of 2
Mr. PURJES. Thank you.
Mr. PORTER. Thank you, Mr. Purjes.
[The prepared statement of Gloria E. Reich and Dan Purjes follows:]
"The Official Committee record contains additional material here."
Tuesday, February 3, 1998.
WITNESS
DR. TALMADGE E. KING, JR., AMERICAN LUNG ASSOCIATION/AMERICAN THORACIC SOCIETY
Mr. PORTER. Our next witness is Talmadge E. King, Jr., M.D., F.A.C.P, F.C.C.P., President of the American Thoracic Society and Chief, Medical Services, San Francisco General Hospital, testifying on behalf of the American Lung Association and the American Thoracic Society.
Dr. King.
Dr. KING. Chairman Porter, I want to thank you for your leadership in supporting biomedical research. Without your leadership and the strong bipartisan support of this committee, many of the recent advances would not have been possible.
Page 42 PREV PAGE TOP OF DOC Segment 1 Of 2
I am here on behalf of the American Lung Association and the American Thoracic Society to speak about the importance of biomedical research in public health programs. This year marks the 50th anniversary of the National Heart, Lung, and Blood Institute. The NHLBI has been steward to phenomenal advances in research and public health. We are pleased by this progress, but note that more work needs to be done. We would like to highlight two areas of concern regarding the fiscal year 1999 budget, and two threats to public health that we need to address.
The first note of caution is with the Administration's fiscal year 1999 budget proposal. While encouraged with the investment in research in public health programs, we are concerned that much of the Administration's budget is predicated on revenues from the tobacco deal. Enactment of the tobacco deal is neither imminent, nor is it necessarily in the best interests of America. I strongly urge Congress and the Administration to make funding decisions based on the normal appropriations process.
The second concern is with NIH's management budget. For the past two years NIH's management budget has gotten smaller, while the programs have gotten bigger. To be good stewards, NIH will need appropriate resources to manage their growing research portfolio. We encourage the committee to be mindful of this when providing funds for NIH.
Mr. Chairman, although we are making progress in prevention and cures of many lung diseases, I want to focus my comments on two diseases—one new public threat, and one old.
The new public threat is asthma. Asthma is on the rise. An estimated 14.6 million Americans have asthma. Since 1984, the prevalence of childhood asthma has risen 72 percent. Asthma is expensive. Currently, asthma costs the U.S. over $12 million a year. Asthma kills; in 1994, 5,487 children died as a result of an acute asthma attack. That is over a 100 percent increase from 1979. A disproportionate share of these deaths were in African American families, with an age-adjusted rate three times higher than that of whites.
Page 43 PREV PAGE TOP OF DOC Segment 1 Of 2
Research is bringing answers, and with answers come hope for new treatments and cures for asthma. Within the foreseeable future we expect researchers to fully describe the unique combination of genetic and environmental factors that can successfully address the prevention and cure of asthma. To get to a cure will require a continued commitment to funding asthma research at NIH.
Asthma also requires a public health response. Supporting asthma surveillance, reducing exposure to environmental asthma triggers, and patient education are needed to control asthma. CDC must play a role in providing the public health response to asthma. This will likewise require a funding commitment.
The old disease is tuberculosis. Tuberculosis has been with us literally since the dawn of man. Although tuberculosis is a preventable and curable disease, it persists as a health care problem in the United States and globally. Worldwide, there are over 7.5 million new cases of active tuberculosis and 3 million deaths annually. The newest twist on this old disease is the development of multi-drug resistant strains, or MDR–TB. In the United States, some strains of MDR–TB are resistant to as many as seven drugs. Recent investment in domestic TB control programs are beginning to pay off. While the data is still preliminary, we expect the CDC will announce a fifth straight year of decline in domestic TB rates.
The good news is a direct result of efforts by CDC and public health officials. It is important to continue this area of support throughout the period necessary to establish control of TB.
Page 44 PREV PAGE TOP OF DOC Segment 1 Of 2
Progress is also being made globally. In fiscal year 1998, the Foreign Operations Appropriations Subcommittee provided USAID with funds for international TB control. To ensure appropriate coordination between U.S. domestic TB control, research, and international efforts, we strongly encourage CDC, NIH, and USAID to enter a formal interagency cooperative agreement regarding U.S. TB control activities.
We also recommend that USAID, in conjunction with CDC, NIH, the World Health Organization, and voluntary professional organizations, develop an international plan to eliminate TB.
Mr. Chairman, thanks largely to the generous support of this committee, the research and public health communities continue to make advances against lung disease. We urge this committee to continue to supply us with the tools that we need to achieve a world free of lung disease.
Thank you for this opportunity to testify and for your ongoing support.
Mr. PORTER. Dr. King, thank you for your testimony. I have to say that I agree with you, that it's very unlikely that we're going to have—and not a desirable thing to have—a tobacco deal that allows the industry to escape liability for damage already caused. I don't think there's going to be any such deal this year, and a lot of the spending in the President's budget, of course, is supported by that revenue source and others that I believe will not materialize. That means it's going to be much tougher for us to get the kind of allocation that we need to do the things that we put at a high priority.
Page 45 PREV PAGE TOP OF DOC Segment 1 Of 2
I did hear you very clearly about the management at NIH. When NIH was provided a substantial increase in a budgetary environment in 1995 for fiscal year 1996, that was very much against what was happening in almost every other line item in our budget. We felt that NIH had to take the same burden of restraints on management costs as every other agency under our jurisdiction. We recognize that that has had a pretty heavy bit at NIH in terms of management. They've managed to deal with it quite well, but it is still a great difficulty.
But we will take into account your concern in that area, and we appreciate your expressing it to us.
Asthma and TB, obviously, are very serious diseases. My sister suffers from asthma, so I know a bit about it firsthand. We will do the best that we possibly can to provide the funds that are needed to address these diseases of the lungs that affect so many Americans.
Thank you for testifying.
Dr. KING. Thank you.
[The prepared statement of Talmadge King, Jr., M.D., follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. You all heard the series of bells that have gone off. What it is is a series of votes on the House floor. I don't know how many votes are involved, at least two. What we are going to do is take one more witness, and then we're going to have to take a recess. I hope that the members can stay. I will come back as quickly as I possibly can and resume the hearing and stay until we complete our morning panel, but obviously it's going to set us back at least 25 minutes, maybe longer. I regret that. This is the first vote that we've had, but there's nothing that we can do about it.
Page 46 PREV PAGE TOP OF DOC Segment 1 Of 2
Tuesday, February 3, 1998.
WITNESS
B. R. ''PETE'' KENNEMER, NATIONAL COUNCIL FOR COMMUNITY BEHAVIORAL HEALTHCARE
Mr. PORTER. B.R. ''Pete'' Kennemer, Chairman, Board of Directors of the National Council for Community Behavioral Healthcare, and Executive Director, Western Arkansas Counseling and Guidance Center, testifying on behalf of the National Council for Community Behavioral Healthcare.
Mr. Kennemer, you're not going to get your testimony in before I'm going to have to leave, unfortunately. I thought we were a little bit ahead of the second bell but obviously we're not. If you start, I would have to leave in the middle of it, so I'm afraid that this is probably the time for me to declare the subcommittee in recess. We'll get back as quickly as we can.
We stand in recess until the end of this series of votes.
[Recess.]
Mr. PORTER. Mr. Kennemer, welcome.
Page 47 PREV PAGE TOP OF DOC Segment 1 Of 2
Mr. KENNEMER. Thank you, Mr. Chairman.
My name is Pete Kennemer, and I am the Chairman of the National Council for Community Behavioral Healthcare, or NCCBH. Thank you for the opportunity to testify before you today concerning the need for the Federal Government to make an increased investment in the provision of community-based mental health and addiction services. Specifically, we are asking for an increase of $80 million for the Community Mental Health Performance Partnership Block Grant (Mental Health PPG) which has been level funded at $275 million for the last four years. We are also asking for increases of $10 million in the Projects for Assistance in Transition from Homelessness (PATH) and $200 million for the Substance Abuse Performance Partnership Block Grant.
NCCBH, organized in 1970, is a national trade association representing community behavioral healthcare through its diverse membership of nearly 800 community-based behavioral health provider organizations (community mental health centers), including state and regional associations of providers, networks of providers, and public authorities (State, county and local) which are responsible for the delivery of behavioral healthcare. NCCBH members comprise the spectrum of community behavioral healthcare from inpatient care and intensive outpatient treatment, to addiction treatment, residential programs, and funding of services. In many areas, our members are the gateway to accessing the public health system through both inpatient and ambulatory systems of care.
One of NCCBH's members is my own organization, the Western Arkansas Counseling and Guidance Center (WACGC), located in Fort Smith, Arkansas. It is one of 15 community mental health centers (CMHCs) in Arkansas and it is similar to the more than 600 CMHCs throughout the United States which provide services to those with mental illness and addiction disorders.
Page 48 PREV PAGE TOP OF DOC Segment 1 Of 2
WACGC's founding mission in 1960 was to provide affordable psychological services to the citizens of Sebastian and Crawford Counties in western Arkansas. Today, WACGC provides a wide range of coordinated behavioral healthcare services in its 15 locations throughout the six counties it now serves. We provide a comprehensive network of quality behavioral healthcare services to help prevent mental illness and treat the emotionally disturbed. Our programs are designed to be consumer sensitive, outcome oriented, and cost effective.
Like other community mental health centers across the country, WACGC provides a continuum of services through its network of 15 treatment locations. Services provided include: outpatient care, acute care, individual, group and family therapy, medication management, testing, community support, psychosocial rehabilitation, residential services, vocational and educational services, supported employment, and referrals to primary care physicians, external programs and agencies.
As President and CEO of WACGC, I know first-hand of the great need for services funded through the Community Mental Health Performance Partnership Grant (formerly known and the Community Mental Health Block Grant). In fiscal year 1997, my home State of Arkansas received $2,232,840 through the Mental Health PPG and $300,000 through the PATH program. Last year, WACGC received $224,585 of those Mental Health PPG funds (which accounts for 3.5 percent of our $6.543 million budget) with out about $88,000 of that being used for children's programs.
Although the block grant represents a relatively small portion of program spending for my organization, it provides stability for our center—and others like it—which require a reliable source of funding to ensure continuity of care for our clients. Block Grant funds are often used to fund services where gaps may exist in programs or they act as seed money for new programs offering innovative services. However, in some States it provides up to 39.5 percent of the community mental health services budget—a significant base for stability.
Page 49 PREV PAGE TOP OF DOC Segment 1 Of 2
An example of how WACGC used Mental Health PPG funds during the last year is a nine-year old child, his mother and two brothers who moved into our service area from another State. The boy, ''Brian,'' not his real name, has a history of multiple hospitalizations and special education placements due to behavior problems which include fire setting, physical aggressiveness toward other children and teachers, and poor academic performance.
Through case management and our juvenile services program, partially funded by the Mental Health PPG, WACGC was able to coordinate treatment for Brian and his whole family. Transportation, child care and temporary food assistance were found through fee community resources for Brian's hard-working mother who held down two jobs. Individual and family therapy was successful in teaching effective parenting skills, finding an after-school program, teaching Brian coping skills and determining better medication levels for him.
After several months, Brian's behavior improved dramatically. He became less aggressive, stopped playing with fire, running away from home, and hitting his brothers. Peer relations and frustration tolerance improved, as did task completion and eventually his own self-confidence. His mother also benefitted by learning to take charge of her destiny. She is now better equipped to identify problems, seek help, and is more skilled and setting limits with all of her children. She has since bought a car and is independently going to a community college. Her family is functioning at a higher level, consuming fewer services and is in a position to make positive contributions to their community.
As you can see, services provided through the Mental Health PPG not only improve the lives of those treated, by have the potential to improve the quality of life for entire communities. By providing critical care in a coordinated, timely manner, we are more likely to avoid the long-term costs of more serious health and safety problems which are the results of an over-extended system of care.
Page 50 PREV PAGE TOP OF DOC Segment 1 Of 2
Over the last 30 years, a growing body of evidence has demonstrated that most people with mental illnesses can be treated more efficiently and more cost-effectively in community settings than in traditional psychiatric hospitals. However, funding to organizations which provide these services through the Mental Health PPG have been left out in the cold.
In 1993, the first year that community mental health spending by the States surpassed State spending at psychiatric hospitals, the Mental Health PPG received $300.1 million on Federal appropriations. Since that time, its annual funding was reduced to $275.4 million for fiscal 1995 through 1998. If inflation is taken into account, funding has actually decreased by more than $56 million per annum, despite the fact that the demand for community based services has significantly increased since that time.
Adding to the pressures of an already under-funded program, at least 13 States have closed an additional 21 State hospitals and six more States are planning to close eight more hospitals over the next two years, with four more States planning to merge two or more hospitals.
Beginning in fiscal year 1998, many State mental health agencies face additional extraordinary and unanticipated new budgetary pressures as a result of the Balanced Budget Act of 1997. The Act included restrictions on the use by States of Medicaid Disproportionate Share (DHS) to support State psychiatric hospitals and other mental health facilities.
Because many States included mental health DSH as a revenue in their general revenue funds, we believe that the withdrawal of DSH funds will have a negative effect on community mental health services as well as on State-supported psychiatric hospitals. The National Association of State Mental Health Program Directors (NASMHPD) estimates that the new DSH restrictions will result in a loss to the public mental health system of $116 million in fiscal year 1999 and $1.5 billion over the five year period 1998–2002.
Page 51 PREV PAGE TOP OF DOC Segment 1 Of 2
Another threatening drain on overall State mental health budgets is the recent Supreme Court decision in Kansas v. Hendricks which opens the door to the civil commitment to State psychiatric hospitals of thousands of sexually violent criminal offenders, even if they do not have a diagnosable mental illness. At least 14 States currently have some form of law providing for the civil commitment of dangerous sex offenders and another 41 States submitted amicus curiae briefs in support of the Kansas law. Many of those States are expected to adopt similar laws within the next year.
Even further, a number of other factors which have led to dramatic changes to our Nation's public mental health system in the last decade can only exacerbate the problem of under-funding: the number of inpatient hospital beds has decreased; a growing number of States have privatized their public mental health system through Medicaid managed care for persons with severe mental illness; and eligibility rules for Supplemental Security Income (SSI) have had great impact on both adults and children. All these changes have compounded the pressure on the already strained local and State public mental health systems.
Now, more than ever, Federal investment in community-based care is needed to provide the most essential services to our most vulnerable populations. Recent estimates show that the $275.4 million in Federal funds now appropriated to the Mental Health PPG is an increasingly critical source of funding for State and local mental health departments. Moreover, these dollars are being asked to fund a wider and more diverse array of community-based services.
In order to provide the services which are so essential to our communities and to keep up with the overwhelming demand for those services, my organization's programs and the others like it across the country need an increase in Federal funding to the Mental Health PPG and the PATH programs.
Page 52 PREV PAGE TOP OF DOC Segment 1 Of 2
The PATH formula grant program, which helps States provide flexible, community-based services to persons who are homeless and mentally ill or who have a dual diagnosis of mental illness and substance abuse, are often the only monies available to communities to support the three levels of service necessary for success with homeless people who have serious mental illnesses, outreach to those who are not being served, engagement of the individuals in treatment services, and transition of consumers to mainstream mental health treatment, housing and support services.
A 1994 study by the National Association of State Mental Health Program Directors (NASMHPD) documented that roughly 127,231 homeless persons with mental illness were being served by PATH services. This is far below the most conservative estimation of the number in need.
An increase in Federal appropriations are necessary in fiscal year 1999 to achieve four purposes: one, health care coordination, particularly for services related to HIV/AIDS, tuberculosis, hepatitis, and other communicable diseases and dental care; two, training of persons to work with people with a mental illness/substance abuse dual diagnosis; three, housing support services; and four, increased capacity.
Although NCCBH and its member organizations were pleased to learn that the President's Balanced Budget Recommendations for fiscal year 1999 include a funding increase of $200 million for the Substance Abuse Performance Partnership Block Grant, we were terribly disappointed to see that the recommendation has left funding for the Mental Health PPG at 1995 levels and the PATH program at 1998 levels.
Page 53 PREV PAGE TOP OF DOC Segment 1 Of 2
On behalf of NCCBH, I respectfully request that this subcommittee recommend an increase in funding for the Mental Health PPG for fiscal year 1999 by at least $80 million, an increase in funding for the PATH program by at least $10 million and an increase of $200 million for the Substance Abuse Performance Partnership Block Grant.
As a final note, NCCBH would like to recognize SAMHSA's leadership in convening a consortium of mental health consumer and professional groups like ours in helping to raise awareness about mental illness and to dispel the negative perceptions and stigma surrounding behavioral disorders. On Saturday, May 2, 1998, NCCBH is co-sponsoring a one-mile walk through Washington, D.C., to educate and alert people that appropriate mental health services can prevent minor behavioral health disorders from compounding and that there is the promise of recovery for many people who have serious mental illnesses. You will be hearing more about this effort in the coming months.
Once again, I thank you for this opportunity to present our requests to your subcommittee concerning fiscal year 1999 appropriations. I would be happy to answer any questions you may have or provide further information at your request.
[The prepared statement of B.R. Pete Kennemer follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Mr. Kennemer, we appreciate your good testimony. You can be assured that the subcommittee will give it every consideration.
Page 54 PREV PAGE TOP OF DOC Segment 1 Of 2
Wednesday, February 4, 1998.
WITNESS
ROBERT A. WEINBERG, THE JOINT STEERING COMMITTEE FOR PUBLIC POLICY
Mr. PORTER. Our next witness is Dr. Robert A. Weinberg, Professor of Biology at the Whitehead Institute for Biomedical Research at the Massachusetts Institute of Technology.
Dr. Weinberg, welcome, and we look forward to your testimony.
Dr. WEINBERG. Thank you, Mr. Chairman, and members of the subcommittee. I am Robert Weinberg, and I am here today as representative of the Joint Steering Committee for Public Policy and 25,000 of my colleagues in the basic biomedical research community, particularly my own Society, the American Society for Cell Biology. I thank you and your colleagues for the opportunity to present my views to you today.
My own research is carried out at the Whitehead Institute for Biomedical Research, closely affiliated with MIT in Cambridge, Massachusetts. For the past three decades, I have been involved in research on the molecules inside the human cell; much of my research focuses on the molecular and genetic origins of human cancer. Last year, I was deeply honored to be presented with the National Medal of Science by President Clinton.
Page 55 PREV PAGE TOP OF DOC Segment 1 Of 2
I focus today on cancer research, using it as an example. It is only one of a dozen major human diseases that are now under successful attack by the research community. Like the others, autoimmune diseases, Alzheimer's, genetic and metabolic diseases and heart disease, cancer is finally revealing its secrets. The fallout from the discovery 40 years ago of the genetic code has descended on us, and now affects, indeed revolutionizes, our understanding of virtually every human disease. Two centuries from now, those looking back will say that we lived during a time of major scientific revolution.
Still, I don't want to talk today about a century or two of future progress. My vision is limited to the next decade, or at most two. That time line is dictated by the delay between initial scientific discovery at the lab bench, and the resulting impact of that discovery on patient treatment in the clinic. In my own career, as an example, a discovery made in my lab in 1981 has only this year resulted in a new, and apparently highly successful treatment for breast cancer. By the same token, the basic research findings that are now in hand will only have their full impact on medical practice sometime over the next decade.
I would like to generalize from my own personal experience to that of the research community as a whole. Over the past two decades, my colleagues and I have generated a rich storehouse of information on how cancer begins. Over the next decade, we will draw on this information to develop what I believe will be a number of dramatic new cures for cancers. These advances will flow directly from the rich scientific knowledge base that we have assembled since 1980, most of it deriving from research supported by our Government and enabled by this subcommittee.
Page 56 PREV PAGE TOP OF DOC Segment 1 Of 2
We now have a clear vision of how to kill tumor cells by forcing them to commit suicide, or by strangling their blood supply, or by crippling their ability to multiply without limit. We have the cells use to stoke their own growth; we have uncovered the molecular clock that prevents normal cells from growing without limit, and in broken form, allows cancer cells to multiply until they become lethal threats. These discoveries are just now being converted into treatments that will be effective in the treatment of people with cancer.
I want to talk today about how all this can happen, or perhaps, how we may forego the opportunity for it to happen. In spite of the stunning opportunities that I've just mentioned, we are not prepared to take advantage of this rich knowledge bank that we have accumulated. Indeed we have now a data base to convert this basic research into a variety of cures over the next several decades.
Ironically, at a time when we're poised so beautifully to take advantage of all this basic research information we've gained over this period of time, one thing is not in place, and we're not prepared in the way we should be. Ten, 15, 20 years ago, the young, the smartest and the best of the young people were pounding down the doors of our laboratories trying to get in. And that's changed now.
Sadly, over the last 10 years, the best and the brightest are no longer flocking to do basic research. The reason being that careers in basic biomedical research are no longer attractive, not because the problems are not compelling, not because there aren't exciting opportunities to make really big advances, but simply because the career of being a researcher has become extraordinarily unattractive, for the simple reason that the career path is strewn with too many obstacles. The university departments are having difficulties to support the training grants to support the training of Ph.D. students. Laboratories have become outmoded.
Page 57 PREV PAGE TOP OF DOC Segment 1 Of 2
The biggest obstacle is the fact that research funding has become so tight that most young people see correctly at present that the chances of their launching a career and having a career after having gone through eight or ten years of post-undergraduate research are remote, 20 percent probability.
Therefore, the best and the brightest are becoming lawyers, some are becoming clinicians, some are becoming bond salesmen on Wall Street. They're making good livings, but they aren't staffing the laboratories when we're going to desperately need them, 5, 10, 15, 20 years from now. We've not been able to bring up a new generation of young researchers to take advantage of the enormous opportunities that have been generated by the last two decades of research, much of which, the great bulk of which was funded through appropriations of this subcommittee.
So I want to make a plea that we begin to recognize the central role played by young people in the age range between 20 and 40 years. They are the people who drive research forward. Yet they are a dwindling research. The quality of them has gone down because of the reasons I've just mentioned.
One other problem, to close, has come to the fore, in the last five years. The ultimate development of cures for a variety of these diseases is going to depend on what is known as clinical research. Clinical research which is carried out by young physicians who are trained both in laboratory science and in the art of medicine.
These young people are skilled in understanding basic biomedical research findings and developing new kinds of treatments and yet, clinical research is suffering grievously over the last five years, largely because of the fact that the restructuring of health care has really pulled the carpet from under those who in the past have been able to divert clinical revenues to support research.
Page 58 PREV PAGE TOP OF DOC Segment 1 Of 2
Therefore, even more than basic biomedical research, which I represent, clinical research in this country is under enormous threat, because the funds that have traditionally made it possible have now in many areas virtually evaporated because of managed health care.
So I would like to put in a plea as well for that area. It's not my own bailiwick, but an area that is going to need attendance to over the next years if indeed we are going to take advantage of these research opportunities to develop new kinds of treatments for a wide variety of diseases. The information is there, but our ability to effect cures is now under threat for the reasons I've just described.
Thank you for the opportunity to present these views, sir.
[The prepared statement of Robert A. Weinberg follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Dr. Weinberg, I think you've presented very compelling testimony and put your finger on things that we had better be worrying about and addressing and solving. The training grants and infrastructure that you mentioned, obviously, we can address directly.
The tightness of research funding, it's fascinating that we have, if you look historically at NIH, the rate of increase over its whole 50 year history has been at about 3 percent real terms. We have been doing actually a little bit better than that in the last couple of years with low inflation.
Page 59 PREV PAGE TOP OF DOC Segment 1 Of 2
Mr. WEINBERG. Indeed.
Mr. PORTER. But you're exactly right, that the number of grants that can be funded as a percentage of those that are competed and determined to be worthy of funding has gone down. The chance of getting a proposal funded is less, even in the face of increasing amounts of money.
That's because there is so much good research that is available if only we had the funds to do it. What that tells me, and I think a lot of people, is that we have to make a renewed commitment to really increase funding for NIH and basic research and not to look at the historic 3 percent real terms, but see if we can actually double the funding over the next five years, and attract the kind of young people and the kind of talent that is there, but is going elsewhere, as you point out, very forcefully.
So that's to me a very high priority. Unfortunately, I don't have direct jurisdiction over it, but I'll do everything I possibly can to influence our Budget Committee to take this and run with it.
I said yesterday, and I'll say it again today, I think the chances of doing that this year are probably not very strong. We can lay a foundation this year and get into peoples' minds that this is important, and what it means to our country, and what it means in terms of lost opportunity, if we don't do it.
I'm doing everything I can, and I think other members of the subcommittee are as well, to do exactly that. I know you're doing that, and members of the research community and the patient advocacy groups and the pharmaceutical and biotech industries and the like, all I think are raising consciousness of the American people about this subject and why it ought to be a priority for the country.
Page 60 PREV PAGE TOP OF DOC Segment 1 Of 2
On the clinical research side, again, you're exactly right, the revolution that's gone on in the last few years in how we deliver health care has led managed care not to contract with our academic medical centers, and they are in tough shape in terms of funds to carry on their very important work. We are going to have to, again, it's not my jurisdiction, it's the jurisdiction of the authorizing committees, they're going to have to do something to address this problem and do it forcefully.
I can do some. I can direct some resources there. But you really need a whole new way of providing a funding base so that clinical research can continue in the way it has in the past. If we don't do that, I think we're all going to be in real trouble.
So your testimony is excellent, you put your finger exactly on the same problems I think we have to face. All I can say is that we're putting these on a high priority and doing everything possible to address them.
We thank you for coming here to testify.
Mr. WEINBERG. Mr. Chairman, we have to build for the next generation. We need the young people.
Mr. PORTER. Absolutely. Can I ask you one question before you leave? When did MIT begin to do biomedical research?
Mr. WEINBERG. Seriously in the late 1950s. We now have one of the best, at the risk of sounding self-aggrandizing, one of the best departments in the country. But we started up really almost exactly 40 years ago.
Page 61 PREV PAGE TOP OF DOC Segment 1 Of 2
Mr. PORTER. Right after I left. I was a student once at MIT.
Mr. WEINBERG. I didn't know that. A Tech man.
Mr. PORTER. Yes. Absolutely.
Thank you, sir.
Wednesday, February 4, 1998.
WITNESS
JOE MAUDERLY, LOVELACE RESPIRATORY RESEARCH INSTITUTE
Mr. PORTER. Joe Mauderly, Director of External Affairs, Lovelace Respiratory Research Institute, testifying in behalf of the Institute. Dr. Mauderly.
Dr. MAUDERLY. Thank you, Mr. Chairman. I appreciate the opportunity to describe to you a new initiative that has special significance for the country. I'm here to propose that the Departments of Health and Human Services and Labor participate in an interagency effort called the National Environmental Respiratory Center, which is aimed at understanding the health risks of combined exposures to multiple or mixed pollutants.
Page 62 PREV PAGE TOP OF DOC Segment 1 Of 2
I don't need to recount the importance of respiratory disease to the Nation. My colleague, Dr. King, whom I know well, put that eloquently earlier. It is a very serious problem.
We also need to remember that occupational lung disease is a part of that problem, in fact, it's the number one work-related illness in terms of its severity, frequency and preventability, if you will.
Now, the relationship between air contaminants, be they environmental or occupational, and respiratory disease, is really not very well understood, despite the publicity and the work that's been done. Air pollutants are known to aggravate respiratory illness, and that's easy to understand.
What we don't understand very well at all is their potential contribution to causing respiratory illness. There is evidence from our lab and others that inhaled contaminants can contribute to causation of diseases like asthma and other respiratory illness.
One part of this problem is that it's so difficult to understand the relative roles of different materials that people breathe. Different pollutants can have the same effect, some pollutants can enhance the effect of others. It's largely unknown but very plausible and generally agreed by the scientific community that mixtures of pollutants, each at their individually acceptable level, might have an unexpected or unacceptable aggregate risk that we don't really understand at all.
Page 63 PREV PAGE TOP OF DOC Segment 1 Of 2
Present environmental and work place air quality regulations address pollutants one at a time. That's a problem, because that's not true. Nobody ever breathes just one pollutant at a time. And that's intuitively understandable.
When you think about it, under our present strategy, it would be considered that an individual breathing all environmental and occupational pollutants, all at the same time, each within their maximum allowable concentration, would have no greater health risk than if they were breathing one of them. Yet that doesn't really pass the laugh test.
The real issue is not the regulation or their legislative basis. We know that can be changed. The real issue is that we don't have an understanding. There's a lack of research in the area of combined exposures to multiple inhaled materials.
Now, this kind of research is difficult. It takes some special capabilities. It's not incentivized by the alternate prioritization of single air pollutants that is prevalent in the research community driven by regulatory issues. The National Environmental Respiratory Center is a new interagency, interdisciplinary initiative that's designed to catalyze a new body of research to address this issue.
The effort was begun this year with start-up funding in the EPA appropriation, but no single agency has the responsibility for this issue. The Center is established at the Lovelace Respiratory Research Institute, which is an independent, non-profit research institute totally focused on respiratory disease, in part because Lovelace happens to be one of the organizations in the country that has substantial experience in combined exposure studies. It also manages a recently privatized Federally-owned facility that's ideal as serving as a physical location for this center.
Page 64 PREV PAGE TOP OF DOC Segment 1 Of 2
The mission of the Center is to stimulate and facilitate and also participate in a national initiative that will be long range aimed at understanding the health effects of mixtures of pollutants in the environment and the work place. The Center will conduct research, it will be guided by a competitive peer review process. That will be an intramural program. It has no intention of being another granting agency.
The Center will maintain information resources available to Congress, agencies, researchers and the public. The Center will play an important role in assisting agencies and facilitating communication, planning and coordination to define this issue and define research approaches that will be needed to solve it. Especially in bringing communication to occur between health scientists and atmospheric scientists, which do not talk to each other nearly as much as they need to. And will make specialized facilities available.
Now, it's very appropriate for the Department of Health and Human Services and Labor to participate in the Center. NIH, NIHS, NCI, has recognized this. It's especially appropriate for NIOSH, because of occupational concerns for mixed exposures are recognized in its strategic plan. But there's very little research support actually in this area. It's a very complicated problem.
So Mr. Chairman, we seek your committee's help in encouraging the agencies under your purview to recognize the issue and to participate in moving this initiative forward.
Thank you for the opportunity to testify.
Page 65 PREV PAGE TOP OF DOC Segment 1 Of 2
[The prepared statement of Joe Mauderly follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Dr. Mauderly, where is Lovelace Institute?
Dr. MAUDERLY. It's in Albuquerque, New Mexico.
Mr. PORTER. Albuquerque. When was it established?
Dr. MAUDERLY. Lovelace is an organization that goes back to the pre-World War II era. It developed a substantial research component as well as a health care activity in the post-war era.
Mr. PORTER. I'm sorry, I meant the National Respiratory Health Center. When was that established?
Dr. MAUDERLY. The National Environmental Respiratory Center is being established as we speak. The initial funding was in this year's EPA appropriation. So it's a new initiative.
Mr. PORTER. Was that initial funding in the EPA appropriation according to an authorization that was previously passed?
Dr. MAUDERLY. That was language that was put in the appropriation along with funding for a number of other centers and activities related to air pollution issues.
Page 66 PREV PAGE TOP OF DOC Segment 1 Of 2
Mr. PORTER. What I think I'm hearing, I just want to get the concept that you want us to encourage certain agencies under the jurisdiction of these three Departments and under the jurisdiction of the subcommittee, to look into support for the work of the Center.
Dr. MAUDERLY. That's right, the work of the Center and related support. I'm asking and encouraging your awareness of the issue, the awareness of the agencies of the issue, in general, as well as specific support for the Center. We know that 20 years from now, we can't be addressing either work place or environmental air contaminants one at a time in isolation as we have been for years. This is an initiative to move us forward into designing another paradigm.
Mr. PORTER. Well, we appreciate very much your testimony today. You've educated me on the existence of the Center and what Lovelace does, and I appreciate that very much.
Dr. MAUDERLY. Thank you.
Mr. PORTER. We'll do our best.
Wednesday, February 4, 1998.
Page 67 PREV PAGE TOP OF DOC Segment 1 Of 2
WITNESS
KENNETH G. McINERNEY, COMMITTEE FOR EDUCATION FUNDING
Mr. PORTER. Kenneth G. McInerney, President, Committee for Education Funding, testifying in behalf of the Committee. Mr. McInerney.
Mr. MCINERNEY. Good morning, Mr. Chairman. I am Ken McInerney.
Mr. PORTER. Unfortunately, it's afternoon.
Mr. MCINERNEY. Good afternoon. [Laughter.]
I am Ken McInerney, of the National Association of Student Financial Aid Administrators. I'm here today as the President of the Committee for Education Funding, which is a non-partisan coalition founded in 1969 with the goal of achieving adequate Federal financial support for our Nation's educational system.
The Committee is the largest coalition of educational associations in existence, with over 90 members, whose interests range from preschool to adult and post-graduate education in both public and private systems.
Let me first begin, Mr. Chairman, by recognizing the outstanding efforts of you and members of your subcommittee in making education funding a priority during the last two fiscal years. We are particularly appreciative of the strong, bipartisan support education programs have enjoyed in this subcommittee. We look forward to helping you make this a tradition that reaches many years into the future.
Page 68 PREV PAGE TOP OF DOC Segment 1 Of 2
During the past two years, Federal discretionary education spending has grown by $7 billion, which has helped restore cuts enacted in the previous two fiscal years, and provided growth and investment in critical programs that expand educational opportunities for Americans in all stages of life. These increases, however, must be considered in a larger context. Over the past 15 years, deficit reduction efforts forced cuts in Federal education funding, both as a share of the total Federal budget and as a share of the total support for education.
America now faces a host of new challenges to our educational systems, including rising enrollments, more students with special needs, increasing teacher shortages, overcrowded, unsafe and outdated facilities, rapidly advancing technology and continued access to post-secondary education for low income students.
Mr. Chairman, as we begin the debate on fiscal year 1999 funding, which I note will affect the 1999–2000 school year for many programs, the Committee for Education Funding asks that you and your subcommittee, to carry forward your momentum from the previous two fiscal years, and make a comparable investment in America's children, youth and adults in fiscal year 1999.
The United States today has a unique opportunity and a strong incentive to invest in the future. The American economy has never known such sustained growth. We have never been so free from external threat or domestic crisis. We enjoy the highest standard of living in the world. We have slashed Federal deficits and can anticipate years of surpluses, ac