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    PLEASE NOTE: The following transcript is a portion of the official hearing record of the Committee on Government Reform. Additional material pertinent to this transcript may be found on the web site of the committee at [http://www.house.gov/reform]. Complete hearing records are available for review at the committee offices and also may be purchased at the U.S. Government Printing Office.

61–437 CC



before the




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JUNE 10, 1999

Serial No. 106–61

Printed for the use of the Committee on Government Reform

Available via the World Wide Web: http://www.house.gov/reform

DAN BURTON, Indiana, Chairman
STEPHEN HORN, California
JOHN L. MICA, Florida
BOB BARR, Georgia
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LEE TERRY, Nebraska
DOUG OSE, California
PAUL RYAN, Wisconsin
HENRY A. WAXMAN, California
TOM LANTOS, California
ROBERT E. WISE, Jr., West Virginia
PAUL E. KANJORSKI, Pennsylvania
CHAKA FATTAH, Pennsylvania
DANNY K. DAVIS, Illinois
JOHN F. TIERNEY, Massachusetts
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HAROLD E. FORD, Jr., Tennessee
BERNARD SANDERS, Vermont (Independent)

KEVIN BINGER, Staff Director
DANIEL R. MOLL, Deputy Staff Director
DAVID A. KASS, Deputy Counsel and Parliamentarian
CARLA J. MARTIN, Chief Clerk
PHIL SCHILIRO, Minority Staff Director

    Hearing held on June 10, 1999
Statement of:
Gordon, James, M.D., Center for Mind Body Medicine, Washington, DC; Susan Silver, George Washington University Integrative Medical Center; Daniel Beilin, OMD, LAC, Aptos, CA; Edward Trimble, M.D., Head, Surgery Section, Division of Cancer Treatment and Diagnosis, National Cancer Institute; and Jeffrey White, Director, Office of Complementary and Alternative Medicine, National Cancer Institute
Mack, Priscilla, executive co-chair of the National Race for the Cure; and Michio Kushi, the Kushi Institute, Brookline, MA
Zarycki, Carol, New York; N. Lee Gardener, Ph.D., Raleigh, NC; and Linda Bedell-Logan, Saco, ME
Letters, statements, etc., submitted for the record by:
Bedell-Logan, Linda, Saco, ME, prepared statement of
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Beilin, Daniel, OMD, LAC, Aptos, CA, prepared statement of
Burton, Hon. Dan, a Representative in Congress from the State of Indiana, prepared statement of
Cummings, Hon. Elijah E., a Representative in Congress from the State of Maryland, prepared statement of
Gardener, N. Lee, Ph.D., Raleigh, NC, prepared statement of
Kushi, Michio, the Kushi Institute, Brookline, MA, prepared statement of
Mack, Priscilla, executive co-chair of the National Race for the Cure, prepared statement of
Mink, Hon. Patsy T., a Representative in Congress from the State of Hawaii, prepared statement of
Sanders, Hon. Bernard, a Representative in Congress from the State of Vermont, prepared statement of
Silver, Susan, George Washington University Integrative Medical Center, prepared statement of
Slaughter, Hon. Louise, a Representative in Congress from the State of New York, prepared statement of
Towns, Hon. Edolphus, a Representative in Congress from the State of New York, prepared statement of
Trimble, Edward, M.D., Head, Surgery Section, Division of Cancer Treatment and Diagnosis, National Cancer Institute, prepared statement of
Zarycki, Carol, New York, prepared statement of


House of Representatives,
Committee on Government Reform,
Washington, DC.
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    The committee met, pursuant to notice, at 10:37 a.m., in room 2154, Rayburn House Office Building, Hon. Dan Burton, (chairman of the committee) presiding.
    Present: Representatives Burton, Gilman, Morella, Horn, Mica, Biggert, Ose, Chenoweth, Waxman, Mink, Norton, Cummings, Kucinich, Schakowsky, and Sanders.
    Staff present: Kevin Binger, staff director; Daniel R. Moll, deputy staff director; Barbara Comstock, chief counsel; David Kass, deputy counsel and parliamentarian; S. Elizabeth Clay, professional staff member; Mark Corallo, director of communications; Carla J. Martin, chief clerk; Lisa Smith-Arafune, deputy chief clerk; Laurel Grover, staff assistant; Nicole Petrocino, legislative aide; Phil Schiliro, minority staff director; Phil Barnett, minority chief counsel; Sarah Despres, minority counsel; Ellen Rayner, minority chief clerk; Jean Gosa, minority staff assistant; and Andrew Su, minority research assistant.
    Mr. BURTON. Good morning. A quorum being present, the Committee on Government Reform will come to order.
    I ask unanimous consent that all Members' and witnesses' written opening statements be included in the record. Without objection, so ordered.
    We will have other Members—I see some of them coming in right now—joining us, so they will be coming in just a few moments.
    We are here today to talk about a subject that has probably touched every family in America, cancer. Specifically, today we are going to talk about women's cancers. At hearings in the future, we will be talking about some of the major concerns that men have, prostate cancer. I have talked to Michael Milken's staff. We are going to be talking to Senator Dole's staff. We will be talking to the minority also about people that they might want to have testify about men's problems, prostate cancer and other issues, as well as diets that might assist men in fighting this dreaded disease as well.
    But today, we are going to be talking about women's cancers. In this country, every 64 minutes a woman is diagnosed with a reproductive tract cancer. One in eight women today will get breast cancer, one in eight. It is an absolute epidemic. Some people believe that that figure will grow to as many as one in three or four.
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    This is turning out to be a very busy week in Washington for cancer issues. Last Sunday, over 60,000 people participated in the National Race for the Cure, sponsored by the Susan B. Komen Breast Cancer Foundation. This foundation has done a phenomenal job raising awareness of breast cancer and raising money for research and treatment. I applaud their work, and my colleagues do as well.
    Today the Government Reform Committee will receive testimony from researchers, health care providers, and patients on the role of early detection and complementary and alternative health practices in women's cancers. This coming weekend, the Center for Mind, Body, Medicine, and the University of Texas, Houston Medical School, in cooperation with the National Cancer Institute and the National Center for Complementary and Alternative Medicine is conducting the second annual comprehensive cancer conference. They will bring together researchers, practitioners, and patients, to discuss research advances and patient needs in both conventional and alternative medicine.
    This week, this same week, 1,355 women in America will lose their lives to one of these cancers. Overall, more than 10,000 men, women, and children, will die from cancer in America this week, 10,000. We say to their families and loved ones, we in Congress recognize that the war on cancer declared by President Richard Nixon in 1971 is far from over. We cannot, after 28 years and tens of billions of dollars in research declare victory, because we are not yet close.
    My wife suffered from breast cancer several years ago. Thankfully, she is a 5-year survivor. Last year, I lost my mother and my step-father to lung cancer. So I know, as well as many of my colleagues, what families go through when loved ones have to fight cancer. Every additional year a patient lives is a victory. Every new treatment, drug, or surgical technique is a potential victory. However, we have not won this war on cancer. But we will not give up.
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    The committee has been working to break through barriers of institutional bias to get more research done in complementary and alternative therapies for cancer, and to improve the information available to the public from the Federal Government on treatment options. We cannot abide by institutional biases within the Government that says something is not acceptable because it is alternative or unconventional. We must ensure that there is a balance between genetics, drug development, natural product development, and alternative therapy research within the National Cancer Institute.
    To combat this bias, I am introducing the ''Inclusion of Alternative Approaches in Cancer Research Act.'' This bill, my bill, would ensure that every advisory group of the National Cancer Institute would have at least one member who is an expert in complementary and alternative medicine. One leading drug treatment for breast cancer and ovarian cancer, Taxol, was originally derived from the yew tree and was developed through the natural products program. It is important to continue to look to nature for other opportunities for drug development. It would be a shame if reductions in funding for the natural product drug program resulted in missing the next Taxol that might save lives.
    I have previously mentioned that less than 1 percent of the National Cancer Institute's $2.7 billion annual budget goes to research in complementary and alternative medicine. That is very disappointing. Unfortunately, the director of that institute does not see the need to change that ratio, and told me in December that he has no plans to extend that, even though half of America's cancer patients will include a complementary or alternative treatment in their plan to fight cancer. I believe that since we are giving them $2.7 billion, 1 percent is not enough. We will do everything in our power to make sure that more of those funds are given to alternative and complementary research.
    Taxol, Tamoxifen, and other drugs are important tools in the fight against cancer, so are pap smears and mammograms, and so is an integrated treatment plan. We have been pleased with the assistance we have received from several of the professional medical associations involved in these areas, including the Society for Gynecological Oncology, and the American Society of Clinical Pathologists.
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    Dr. Edward Trimble will present information on the National Cancer Institute's research in early detection and the integration of complementary and alternative health practices in women's cancers. Cancer is a disease, but its victims are heros and heroines. They are people, real people with families, jobs, and communities. They make a difference in our lives. People like Sally McClain, from Indianapolis, IN, who lost her life to breast cancer that metastasized to her spine. Sally was a friend of Claudia Keller on my staff. She also was the daughter of a man who taught me in high school, who was a good friend of mine. It is a shame that one so young should die so young because of a disease like this. But Sally didn't give up the fight, not one single day. Or Lynn Lloyd, a high school English teacher in Montgomery County, MD. After two bouts with breast cancer, she is now hospitalized with cancer in her brain and her lungs. Even when she was receiving chemotherapy last year, she scheduled it around her classes so she could keep teaching and stay involved with her students. Now that's real dedication. Most of her students didn't even realize that she was battling cancer until her most recent hospitalization.
    We are honored today to have another one of those heroines with us, a lady that's a very, very good friend of mine. Her husband and I were elected to Congress together back in 1982. We are going to miss Senator Mack in the U.S. Senate. His lovely wife, Ms. Priscilla Mack, is the executive co-chair of the National Race for the Cure. As a breast cancer survivor, she knows from personal experience the importance of early detection. She has worked hard to raise awareness about women's cancer issues. With the energy that Ms. Mack brings to this fight, we will hopefully begin winning more of these battles, saving more lives, getting research funded that will get the answers about prevention, early diagnosis, treatment, and hopefully one day very soon, a cure.
    Biomedical research already knows that there is not a magic bullet cure for cancer. What we do know at this time is that the earlier cancer is diagnosed, the greater the chances of long-term survival. That is why pap smears are such an effective tool in saving lives. We do know from good research and practice, that when someone develops a holistic cancer treatment plan, including attention to mind, body, and spirit, then recovery is more likely, with better quality of life and extended life as well.
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    Dr. James Gordon, director of the Center for Mind Body Medicine here in Washington, and an internationally recognized leader in the field of complementary medicine and alternative medicine, will be testifying also about advances in complementary and alternative medicine cancer research.
    When Jane Seymour, a very prominent movie star, testified before our committee in February, she shared the story of several of her friends who had gone the conventional route of cancer treatment and then been told by their doctors that they had done everything they could and it was in essence hopeless. They were basically told to go home and die. These women did not accept that death sentence. They sought other healthcare professionals and advice from friends and family on other approaches to treating cancer. They learned, as many others have, that in order to survive the conventional treatments for cancer, radiation and chemotherapy, that a body needs to be strengthened through good nutrition. I am delighted that Michio Kushi is here today to talk to us about the macrobiotic diet, and that the importance of nutrition is essential in cancer patients. Mr. Kushi is recognized throughout the world as the foremost authority in this field. The Smithsonian Institute has just opened the Michio Kushi family collection on the history of macrobiotics and alternative and complementary health practices at the National Museum of American History.
    We'll also be hearing from Susan Silver of the new Center for Integrative Medicine at George Washington University. This center has developed a program for women in cancer treatment with an integrative approach.
    Dr. Daniel Beilin is here today to update us on a new tool in the arsenal of early detection, regulation thermography. This low cost test can be used as a complement to mammography for early detection of changes in breast tissue. It has been used in Germany, I believe, for about 10 years extensively. It is also proving to be a valuable tool in detecting other cancers like ovarian cancer and prostate cancer. We are looking into advances in research in prostate cancer, as I said earlier, and we plan to have a hearing early this fall.
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    We expanded this investigation to cover all women's cancers because there is so much that needs to be done in breast cancer and other areas as well. For example, there is no reliable early detection test for ovarian cancer; 75 percent of ovarian cancers are not detected until the late stage, three or four, and there is only a 25 percent survival rate of more than 5 years. However, of those that are discovered in early stages, there is a 95 percent survival rate of more than 5 years.
    The symptoms of ovarian cancer are vague. They are bloating, sudden weight gain, gas, pressure, and lethargy. There is research to indicate that eating lots of meat and animal fats may increase a woman's risk of ovarian cancer. We need more good research in these areas to find solutions. The members of this committee on both sides of the aisle are very involved in these areas, including Congresswoman Mink, who introduced H.R. 961, the Ovarian Cancer Research and Information Amendments of 1999.
    Linda Bedell-Logan's sister died from cancer. During her battle, Linda's sister, like many cancer patients, suffered with lymphedema. Linda, who was involved in healthcare, researched her sister's treatment options and learned about combined decongestive therapy. As a result of this experience, she has helped many cancer patients gain access to this treatment by getting their insurance companies to cover the costs. Lymphedema is a serious complication for many cancer survivors. It causes swelling, usually in an arm or leg. It can be very painful, and it reduces a cancer survivor's quality of life.
    We are also going to hear from two cancer survivors. Their stories show the struggles that women face with cancer and how they go through them, the need to develop an individualized treatment plan to find reliable information on all treatment options, and to be comfortable with the treatment choices they make. Lee Gardener and Carol Zarycki are two more cancer heroines. I hope I pronounced your names correctly. If I didn't, correct me when you come forward. Even though they have faced the most daunting enemy you can imagine, they have recovered, returned to living and to helping others face cancer.
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    The hearing record will remain open until July 25th for all those who wish to make written submissions on the record.
    [The prepared statement of Hon. Dan Burton follows:]
    [The official committee record contains additional material here.]

    Mr. BURTON. I now recognize my friend Mr. Waxman, for his opening statement.
    Mr. WAXMAN. Thank you very much, Mr. Chairman. I am pleased that we are having this hearing on such an important issue. Breast cancer is the second leading cause of cancer death among women. Cervical cancer will kill close to 5,000 women this year. At least another 20,000 women will die this year from uterine and ovarian cancers.
    The real issues before us are how can we safely and effectively prevent, detect, and treat cancer, and how can we make sure that all women have access to good treatments and to accurate information about their treatment choices? Proper screening techniques can and have lowered mortality rates for breast and cervical cancer. We must continue to work hard to ensure that women have access to the screening techniques currently available, and we must continue to educate women about the importance of being screened for these cancers. But this is not enough. We also have to make sure that healthcare providers follow up with women, notify them of their test results, and encourage them to return for further tests if necessary. We also have to make sure that quality treatments are available to all women.
    At the same time, we need to continue to research better ways to detect cancers. Currently there is no good test for ovarian cancer, the fifth leading cause of cancer death among women in the United States. While mammography has been proven to reduce the number of breast cancer deaths in women over 50 years old by at least 30 percent, it has not been as effective in reducing cancer deaths among younger women. We need to continue to research screening techniques.
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    We should also be looking at ways to prevent cancer. In 1993, I sponsored legislation that mandated a study of why certain localities were experiencing elevated incidence of breast cancer and elevated mortality rates. Studies such as these are important tools in understanding why women get cancers and how to prevent it. We need to know whether the causes are environmental, genetic, dietary, and any other plausible theory. We need to understand what is going on, and why some localities, for no reason that we can otherwise understand, seem to produce an extraordinarily high number of breast cancers.
    We must concentrate our efforts on developing safe and effective ways to prevent cancer, to detect cancer, and to cure cancer. We need to make sure that these therapies are available to all women. We have an extraordinarily high rate of Americans who lack insurance; 42 million was the last figure of uninsured people in this country. No one is served by battling over the relative merits of alternative versus traditional medicine. Instead, our goal should be to develop the most safe and effective therapies possible, regardless of how they are classified.
    Mr. Chairman, I am pleased that we are going to hear from so many important witnesses today. I want to apologize in advance, because I have a conflict in my schedule. There is a markup in another committee, so I won't be here to listen to all of the witnesses. But I will have an opportunity to review the testimony, and, I look forward to doing that, and to working with you and our colleagues to accomplish the goals that we all share.
    Mr. BURTON. Thank you, Mr. Waxman.
    Mr. Mica.
    Mr. MICA. Thank you, Mr. Chairman. I don't have a formal opening statement, but I want to congratulate you on conducting this hearing, and again reminding us of the importance of early detection, prevention, and treatment. I again compliment you on this, and also reserve some time to introduce one of our witnesses. Thank you.
    Mr. BURTON. Thank you, Mr. Mica.
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    Mr. Sanders.
    Mr. SANDERS. Thank you very much, Mr. Chairman. Mr. Chairman, I think you know as well as anybody that this has been a very contentious committee over the last couple of years. You have heard that, I know.
    Mr. BURTON. You're kidding.
    Mr. SANDERS. Yes, I know. You and Mr. Waxman know that. It is very nice to see us getting away from that type of partisan hostility to focus on an issue of enormous concern to every man, woman, and child in this country. I thank you very much and the staff very much for putting on this hearing.
    The remarks that you have made and Mr. Waxman have made cover a lot of what my opening statement was going to be. But I just want to say a few additional words. You know, first of all, the fact that we are having a hearing on cancer today, probably 30 years ago, there would never have been a hearing like this because people said well cancer, we don't know why it happens. God strikes somebody and that's the way it goes. There is no cause for cancer. In fact, we don't even talk about cancer. It's such a terrible thing. We use the ''C'' word, but we don't even talk about it because there is just nothing that can be done about it.
    So as a result of the work of a lot of people, we have come a long way. We are now beginning to take a rational look at the causes of cancer and how we can effectively treat it. Just think, not so many years ago, when you and I were younger, we watched on television and we saw physicians telling us the particular brand of cigarette they smoked. Remember that? Telling us that they liked this brand of cigarette. That was physicians advertising cigarettes. Well, we have come a long way from that ''conventional'' wisdom of doctors telling us about which cigarettes to smoke.
    Twenty or thirty years ago, forty years ago, breast feeding was told to women and mothers as to be a terrible thing. You certainly don't want to do that. That was physicians. That was the norm. That was what doctors were telling mothers.
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    I can remember 15 years ago in the city of Burlington, talking to one of the leading physicians at our local hospital. I said, ''Well what do you think about diet and disease?'' ''Oh, there's no connection between diet and disease. It doesn't matter what you eat.'' Now I think every American understands the important connection between diet and disease. Every day, we are learning more and more about the relationship between indoor air, between pollution in general, between stress and disease, the fact that there is not a huge gap between mind and body, as you indicated. People who are depressed, people who are under stress are more likely to come down with a variety of illnesses than other people.
    We have also learned in recent years that some of those therapies and treatments that people around the world have been practicing for thousands of years are not quite as crazy as some of our ''leading specialists'' have told us. It was maybe 20 years ago—I may be wrong, it was James Reston of the New York Times ended up in China, and he was ill. They practiced acupuncture on him. Suddenly acupuncture became acceptable in the United States, where for years our leading specialists had told us what a quacky and ridiculous idea that was.
    My point is that we are learning more and more about causes and treatments. I think this hearing is an important part in that process. I agree with you that we should be doing a lot more in expanding the Office of Alternative Medicine, for example. I should tell you that we had Wayne Jonas, who was the very capable head of that office in Vermont a couple of years ago. Five hundred people came out to a town meeting on alternative health in the State of Vermont on a snowy day in the central part of the State.
    I am working on legislation, I know many other people are, to begin expanding complementary healthcare, making sure that Americans have access to that type of care. The other point I would make is that one of the very sad aspects of what is going on in this country today is even when there are treatments available for cancer, we have millions of people who do not have health insurance. So I would hope that we will join the rest of the industrialized world, and on this issue you and I may disagree or we may not, but the time is now that the United States should join the rest of the world and have a national healthcare system, guaranteeing healthcare to all people. What is the sense of having treatments out there if you have millions of people who cannot afford that treatment?
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    Where we do agree is I think we should expand and broaden our knowledge in terms of complementary healthcare. Europe is already way ahead of us, maybe less dependency on some powerful drugs if there are natural cures out there. Mostly as I think you have indicated, let's study what's going on out there. Let's learn. Maybe the treatments don't work, fine. But there is nothing wrong with exploring all of the options that are out there.
    So I really do appreciate your holding this hearing, and look forward to working with you.
    [The prepared statement of Hon. Bernard Sanders follows:]
    [The official committee record contains additional material here.]

    Mr. BURTON. Thank you very much, Mr. Sanders.
    Mrs. Morella.
    Mrs. MORELLA. Thank you, Mr. Chairman. I want to thank you also for holding this important hearing. During my tenure in Congress, I have been very actively involved in women's health issues, as you know, as a member of the Congressional Caucus on Women's Issues, and former chair. I have been working with my colleagues very diligently to increase the funding for women's health, including breast, ovarian, and cervical cancer research. As Chair of the Technology Subcommittee of the Science Committee, I have been working to facilitate technology transfers between Government agencies and the private sector. Efforts such as missiles to mammograms, that project between the Public Health Service, the Department of Defense, the intelligence community and NASA, are critically important in applying new technologies to the fight against breast cancer.
    The Congressional Caucus for Women's Issues has spent a great number of years attempting to address the neglect of women's health research at the National Institutes of Health, which as you know, is in my district. The caucus asked the General Accounting Office back in 1989 to investigate the NIH policy regarding the inclusion of women in clinical studies. Women had been routinely excluded from many studies, such as the physicians health study, which studied the effects of aspirin on heart disease on 22,000 male physicians. Just this week, however, I found it astounding. I read in the Washington Post that ''drinking at least two cups of caffeinated coffee a day lowers a man's risk of developing gallstones.'' Now more than 46,000 men took part in this study that spanned a decade. But what about women?
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    In 1990, the caucus introduced omnibus legislation, the Women's Health Equity Act, which included the establishment of the Office of Research on Women's Health, and the requirement that women and minorities be included in all the clinical trials and protocols wherever appropriate in research studies funded by NIH. That has been working. In the fall of 1990, in a meeting of caucus members, NIH announced the formation of that office and quite frankly, we codified it in Congress, so it is a permanent office. Since that time, great progress has been made in funding for women's health concerns, particularly breast, ovarian, cervical cancer, osteoporosis, and the Women's Health Initiative. For example, breast and ovarian cancer funding at NCI, the National Cancer Institute, has more than quadrupled since 1990.
    Recently, I initiated a letter to the House Subcommittee on Defense Appropriations, asking for continued funding for the Department of Defense peer-reviewed breast cancer research program for fiscal year 2000. You know that we have 223 Members of this House who have signed onto that letter.
    However, our job is far from over. Despite great strides in women's health research, we still have to be vigilant, have to address issues that aren't receiving public attention and research priority that they deserve. That is why I think we are all open to the suggestions and enhancing alternative medicines too.
    More than 14,000 women will die of ovarian cancer this year. Early detection is essential in the treatment of ovarian cancer. Yet there is no reliable early detection test. We know that if diagnosed and treated early, the survival rate for ovarian cancer is 95 percent. However, there are no obvious signs or symptoms until late in its development, and only about 25 percent of all cases are detected at the localized stage. Congresswoman Mink has been very much involved in that project.
    There are 2.6 million women living with breast cancer in the United States today. Each year, approximately 175,000 women are diagnosed, 43,300 women will die of breast cancer, which is the leading cancer among women. Despite these frightening statistics, there are only three methods for detecting breast tumors, self examination, a clinical breast exam by a physician, and the mammogram.
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    I do want to comment that the first panelist is Priscilla Mack, as you mentioned. I am just very proud of the fact that she is the executive co-chair of the Susan G. Komen Race for the Cure. I have a picture of Priscilla that was taken of my running in the race just last Saturday. It was the 10th anniversary; 67,000 people ran in that race, bringing in a great deal of money which will help with all the research projects. I am sure you will tell us about that.
    As an aside, since we are all affected in some way by cancers that affect women, my sister died 23 years ago of cancer. At that time, we began raising her six children, I think successfully.
    Lung cancer kills more women than breast cancer. Yet there has been very little emphasis on lung cancer in general. In 1998, 23,000 women died of lung cancer. Between 1974 and 1994, there was a 147 percent increase in women diagnosed with lung cancer. Lung cancer tends to be a silent disease, and there are no good early detection programs in place for women or for men.
    So, Mr. Chairman, I applaud you for holding this important hearing on the early detection and alternative treatment of women's cancers. I look forward to the testimony from the experts and from those who have had some experience. Again, I applaud you. Thank you. I yield back.
    Mr. BURTON. Thank you, Mrs. Morella. I was looking at this picture of you in the race. What was your time? [Laughter.]
    Mr. Kucinich.
    Mr. KUCINICH. Thank you very much, Mr. Chairman. Thank you for your continuing leadership in this area and for the participation of members on this panel, as well as our guests here today.
    Over 500 years ago, people thought the Earth was flat. It caused many not to want to go on a voyage that could cause them to fall off the corner of the Earth. Today there are still people who think that illness and disease is something that's outside of us and that we can turn our health over to other people who will then tell us how we can be healthy. But through the work of people like Michio Kushi, who is one of the panelists today, we have learned that we have the ability to take responsibility for our own health. What a miracle that is. Think about that for a moment. That the conditions which create disease may come from things that we do. So if that is in fact the truth, how empowering it is that we can have some control over the conditions which are internal to our disease and which become externalized and can cause us to have a debilitation in our quality of life.
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    Mr. Kushi, in joining this panel today, brings to it a tremendous amount of experience in his work as one of the foremost proponents in the world of macrobiotics. As all of the students of Greek and of medicine know, macrobiotics comes from the word ''macros'' and ''bios'' in Greek, which means a great life or long life. That was a term that was coined by Hippocrates about 2,500 years ago.
    Today people know macrobiotics in a much more popularized way through foods like brown rice and seitan, which is a wheat cutlet, whole wheat sourdough bread, vegetable sushi, and rice cakes. The standard macrobiotic diet has been practiced widely throughout history by all major civilizations and cultures. The diet centers on whole cereal grains and their products and other plant qualities.
    Over the last 30 years, Michio Kushi has taught throughout the United States and abroad, giving lectures and seminars on diet, health consciousness, and the peaceful meeting of eastern and western philosophies. In 1978, Mr. Kushi and his wife, Adaline, founded the Kushi Institute, which is an educational organization for the training of future leaders of society, including macrobiotic teachers, counselors, and cooks. The Kushis in 1986 founded One Peaceful World. It is an organization which provides information on macrobiotics and helps to guide society toward world health and world peace.
    Now one of the things that I think ought to be called to the attention of the Members before we begin hearing from the witnesses because many of you are already aware of this, later this year, the National Institute of Health is expected to issue a long-awaited study on the macrobiotic approach to cancer, which is currently being completed by researchers at the University of Minnesota and at Harvard University. Another report, which is a case control study from Italy, shows that macrobiotics can significantly lower the risk of breast cancer. That report is awaiting publication.
    The American Cancer Society describes macrobiotics as ''the most popular anti-cancer diet'' today. On its Internet site, the American Cancer Society states,
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    Macrobiotics may help prevent some cancers. It may reduce the risk in developing cancers that appear related to higher fat intake such as colon cancer and possibly some breast cancers. The macrobiotic diet, like other fat free diets, can lower blood pressure, and perhaps reduce the chance of heart disease. Taking part in a macrobiotics program may provide some sense of balance with nature and harmony with the total universe, and as such, promote a sense of calmness and reduce stress.

    So when we think in terms of health today, perhaps rather than thinking in terms of simply winning a war with cancer, we can also look toward changing the analogy and talk about prevention of cancer, because some see cancer as a lack of balance. As we bring our bodies more into their natural harmony, as Mr. Kushi I'm sure will be testifying about, we can find that conditions of health can be created where some may have thought previously it was impossible to do so.
    So this hearing today, through the testimony of the witnesses and through the testimony of other experts, such as Mr. Kushi, will be an exercise in raising the Nation's consciousness over the importance of looking at alternatives to healthcare, the importance of finding better ways to treat disease, and the importance of giving individuals an opportunity to reclaim power in their own lives to improve the quality of their lives, and through their courage and example, give others hope that they can do the same.
    So, with that, Mr. Chairman, I thank you very much for your efforts in calling these hearings. I look forward to the testimony of the witnesses. I am awaiting a call to go to the floor for the debate on the Kosovo spending bill, so I may not be able to be here the whole time, but I appreciate being here now.
    Mr. BURTON. Thank you, Mr. Kucinich. You have been a big help. I appreciate your continued assistance.
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    I might just hold up before our next member speaks, that these are some of the books that Mr. Kushi has, co-written by Mr. Alex Jack. Here's a book also, ''Let Food Be Thy Medicine.'' There are a number of books out like this. I am not just touting these particular books. I don't get a commission. But I think it's really important for anybody who is watching on television, who is in the audience, to take a look at some of these books because change in diet I think has been proven, and will be proven in the future, to be a real help in preventing various forms of cancer.
    With that, Ms. Norton.
    Ms. NORTON. Thank you, Mr. Chairman. May I, like my colleagues, thank you and compliment you on your initiative in holding this hearing. As a Chair last year, along with Nancy Johnson of the Women's Caucus, I am particularly appreciative for this effort.
    The Women's Caucus has perhaps devoted more of its time to cancer, and especially breast cancer but other forms as well, including ovarian cancer, than it has to any other women's issue. Last year, when Tamoxifen was announced as a drug that had proved so effective in treating breast cancer that they were stopping the trials and letting it go forward, we held a whole hearing on that with the Surgeon General, the FDA, and others coming in, including women who had participated in the trials.
    The progress in dealing with women's cancers is so extraordinarily hopeful today. Just yesterday a major controversy resurfaced that arose last year about whether women should begin to have mammograms at 40 or 50, where the women in Congress took the position that they should begin at 40. Where there is some difference among the experts, then for goodness sakes, let's err on the side of the expert that may save the most lives. Now there is an additional study just announced yesterday that affirms 40 as the age that you should start mammograms.
    Just today, I believe—again, I'm thinking it was yesterday, perhaps reported yesterday—a study again reported confusion among women and families about the role of estrogen. We are told that estrogen in fact does tend to be a factor in some breast cancer, but those are the breast cancers that are easiest to combat, and that apparently it is not as much of a factor as we thought.
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    We all know that the most effective thing that a woman and a family can do to prevent breast cancer is early screening, and that an early mammogram could not be more important. We had come to the point where breast cancer was breaking down along income lines and insurance lines. I am very pleased at the way in which mammograms, or mammography, has become available to low income women and minority women who were being left out, and therefore, being subjected to discovery of their cancers much later, when they are often not curable.
    The fact is that breast cancer, for example, and ovarian cancer are becoming curable diseases based almost entirely on early detection. Therefore, the emphasis on prevention in this hearing could not be more important. We are learning that cancer is many different diseases that act like, or at least a disease that acts like many different diseases. I am going to say for that reason, cancer is nothing to play around with. Prevention and, once the disease sets in, responsible treatment is going to be very important. The notion of alternative medicine, it seems to me, is critical here. If you believe that prevention is the best cure, the developing science on the role of fat and diet must be taken very seriously, not only with respect to women's cancers, but generally.
    What I would like to leave the hearing with—and I hope to be able to stay through most of it, I am going to have to come and go because of other hearings—is with what I regard as the great need. That is a word that I will take from what the chairman said. He used the word ''integration.'' That is to say the integration of so-called alternative medicine with traditional medicine as is practiced largely in the West. The fact is, that the reason that we are able to cure so much cancer has to do with the genius of American medicine. Now if we look further into alternative medicine, we may find the genius that enables us to help prevent cancer. Then we will be able to bring the two together in a successful integration.
    I would hate to see the development of polar notions of medicine, that there's alternative medicine, and then there's the other medicine. That is a tragedy. That is a false dichotomy. Moreover, we should not allow different sets of standards to develop for testing what is effective. Women have a right to know from their government what is effective, whether it comes out of nature in some pure sense or whether it is manufactured by a pharmaceutical company, and the role of government is to make sure that somehow, we can do our best work by finding safe, economical ways to integrate so-called alternative medicine with more traditional medicine so those words disappear and it's all medicine.
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    Finally, Mr. Chairman, let me say that with the members of the Women's Caucus, I went to the Labor, HHS, Appropriations Committee where we go every year. Instead of talking about the diseases of women, I proposed a new program which I call LIFE. I chose that acronym for lifetime improvement in food and exercise, because I am appalled at the way in which, particularly the baby-boomers and children, are setting themselves up for cancer, diabetes, arthritis, and every deadly disease known to man through overweight and obesity. The notions of fat and diet are very important, but they are important because of the natural ways in which they prevent disease.
    I look forward to what our witnesses will have to say about not only their experiences, but also about these ways of preventing similar experiences. If I could just say on a personal note that I particularly am pleased to welcome Mrs. Connie Mack, because her husband and I have worked as closely together as I have with any Member of the Senate or the House. He is not of my party. He has been extraordinary in the way in which he has used his problem-solving skills to work with me on tax matters. I know any man that is as good as that must have an awfully good woman for a wife.
    Thank you, Mr. Chairman.
    Mr. BURTON. I am sure that Priscilla guides him in everything he does.
    Mrs. Mink.
    Mrs. MINK. Thank you, Mr. Chairman. I, too, want to join my colleagues in commending you for calling these hearings on such an important matter as the discussion on the needs for early detection and discussions of other kinds of preventive measures that could be taken with respect to women's health issues.
    Mr. Chairman, for 8 years I have been trying to get the Congress to focus on the one issue that I thought was terribly neglected, having to do with the research necessary for finding some way in which we could detect the presence of ovarian cancer early enough to assure that the life of the woman could be saved. I discovered in 1991 through efforts by researchers at NIH and elsewhere, that only $8 million of the entire NIH budget was devoted in any respect to the research needed in ovarian cancer. Notwithstanding efforts of hundreds of women on this specific issue, we have only risen to a paltry level of $40 million. I have legislation, and Mr. Chairman, in which I invite your cosponsorship, calling for a budget of $150 million, which even by itself is modest if we are to really put the research efforts that are there to discover a reliable early detection test that could save lives.
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    It is important to talk about prevention and all the other aspects of your hearing today, but it seems to me that with the scientific knowledge and the intelligence and training and research capabilities of our health researchers throughout the country, that we ought to be able to find a reliable test that could save thousands of lives of women who are diagnosed today, too late to have their lives saved. So many of these women are young, just beginning in their life situation. It is something which I feel very, very strongly about that has been neglected.
    Mr. Chairman, this is really the first hearing in all these years of effort to call attention to this deplorable situation and neglect, that we have allowed. I have been to the Appropriations Committee, as my colleague here has indicated, every year, asking for earmarked money for this research effort. The Appropriations Committee has refused to earmark any money for ovarian cancer research. They have included report language, but never any earmarked money.
    So I urge my colleagues to consider the legislation that is before this body, and join me in cosponsoring. I believe it is essential, and I believe that we are on the threshold of a research breakthrough. What is required is a commitment on the part of this Congress to steer our health research industry to focus on this very, very pathetic neglect. If we can clone sheep and mice and other things with our incredible intellectual capability, it seems to me that within a few short years, we ought to be able to come up with a reliable
test that could save thousands of lives each year. I implore this committee to continue this effort in calling attention to this serious health research neglect.
    Thank you, Mr. Chairman.
    [The prepared statement of Hon. Patsy T. Mink follows:]
    [The official committee record contains additional material here.]
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    Mr. BURTON. Thank you. I will be happy to cosponsor your legislation. I think Dr. Beilin may have some information that might be helpful in the research toward these cancers.
    Mrs. MINK. Thank you. Thank you, Mr. Chairman.
    Mr. BURTON. Are there any other Members that wish to be heard? Mr. Ose. Mr. Cummings.
    Mr. CUMMINGS. Thank you very much, Mr. Chairman. As I look down our list of witnesses, it makes my heart glad to know that they are all in this room. They are special people who have decided that they want to touch other people's lives and are doing so every day. So I thank them for being with us today. I look forward to your testimony.
    Mr. Chairman, I am also pleased that this hearing regarding detection and treatment of women's cancers has been scheduled today. The medical and scientific community has made tremendous breakthroughs in the early detection and treatment of women's cancers in the past few years. Even with all the options currently available for the early detection and treatment, the estimates for new incidences of these cancers are unacceptable. The National Cervical Cancer Coalition estimates that 2 million American women will be diagnosed with breast or cervical cancer in the 1990's, and half a million will lose their lives. A disproportionate number of deaths will occur among minorities and women of low income.
    It is interesting that in my district in Baltimore, sits Johns Hopkins Hospital. Johns Hopkins does a tremendous job of outreach, but at the same time, I know many women who are dying of these cancers every year. Virtually all of these deaths can be prevented by making life saving screening services available to all women at risk. Common barriers to early detection screening include, and this is very interesting, women attempting to escape knowledge that they have cancer, prohibitive costs and unawareness of the availability of low cost programs, lack of access to transportation to screening locations, communication barriers, lack of physician referrals, and lack of childcare.
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    The Breast and Cervical Cancer Mortality Prevention Act of 1990 authorized the Center for Disease Control to implement a national cancer screening program. Through September 1996, the CDC has provided more than 1.2 million screening tests to low income, uninsured, or under-insured minority women.
    Alternative and complementary approaches to treating these cancers have also gained momentum. In 1998, the National Center for Complementary and Alternative Medicine was established within the National Institutes of Health. This has effectively engaged traditional biomedical research in the evaluation of alternative medical treatment using scientific models. However, until more is known about the many alternative and complementary treatments, conventional treatment methods hold the most promise. We hope for a cure in the near future. In the absence of a cure, the ability to implement a national program to detect and treat women's cancers depends in large part on the involvement of various partners in State and local governments, physicians, national and private sector organizations, and consumers.
    In the spirit of greater understanding and education of varied treatments of this disease, I look forward to hearing the experiences and opinions of today's witnesses. Thank you.
    [The prepared statements of Hon. Elijah E. Cummings, Hon. Edolphus Towns, and Hon. Louise Slaughter follow:]
    [The official committee record contains additional material here.]

    Mr. BURTON. Thank you, Mr. Cummings.
    We have two votes on the floor. We should be back here in about 15 minutes. I apologize to the people who will be giving testimony, but we will get right to you, just as soon as we get back. So please excuse us. We stand in recess to the call of the gavel, about 15 minutes.
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    Mr. BURTON. The committee will come to order.
    Sorry for the delay. We had some votes on the floor of the House. I am sure Members will be coming back in here as they leave the floor.
    I would like for our first series of witnesses, Ms. Mack and Mr. Kushi, to come forward please and take their seats. Ms. Mack, you can sit on the left. Mr. Kushi can sit on the right.
    I think I will recognize my colleague from Florida for an introduction.
    Mr. MICA. Thank you, Mr. Chairman. I am, indeed, delighted to have this opportunity to introduce someone very special to me. For the past two decades, I have known the Mack family. I had an opportunity to be a friend and also recently to be a colleague of Senator Mack. I think that there have been several comments already about the Mack family. Certainly Senator Mack is a gentleman. We have a gentlelady with us today, his wife. Both are very accomplished in their particular areas of endeavor.
    The Mack family, like many American families, and we have also heard that among our Members of Congress cited today, have been afflicted by the rages and ravages of cancer. Their family, the Mack family, has been victimized by this disease. Mrs. Mack, Priscilla Mack is a cancer survivor. What is great about Priscilla Mack is that she took this adversity and this disease and she turned it into a personal campaign of public awareness, a public education effort to have millions and millions of American women become aware of the need for prevention, self-examination, and the problems that are related to breast cancer.
    So I am, indeed, delighted and privileged to introduce a leader in our State and in our Nation. She is really our first lady in Florida in the fight against cancer, and really our first lady in the Nation who has brought to the public, to the American women, the need again for early prevention, detection, and treatment.
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    So, Mr. Chairman, thank you for this honor and welcome, Mrs. Mack.
    Mr. BURTON. Thank you, Mrs. Mack. I can recall back when Connie and I first got elected in 1908.
    Mrs. MACK. It seems that long.
    Mr. BURTON. It was 1982. Connie came over to my condo over in Alexandria. We sat on the floor and watched Chariots of Fire. You were down in Florida at the time. So Connie and I have been good friends for a long time, as well as you. I remember watching your boy grow up. So I am really happy you are here today.
    Mr. Kushi, we are very happy you are here today. I am going to read your book. Hopefully that will save my life for a couple of years.
    So we will start off with you, Mrs. Mack.

    Ms. MACK. Mr. Chairman, members of the committee, I would like to thank you for the opportunity to appear before the Committee on Government Reform, and I commend you for holding this important hearing. I am here both as a breast cancer survivor, as well as executive co-chairman of the Susan G. Komen Breast Cancer Foundation's National Race for the Cure.
    In October 1991, I was diagnosed with breast cancer. Prior to the time of my diagnosis, I had followed all the recommendations with regard to having annual mammograms and clinical breast exams. However, it was through breast self-exam that I discovered my lump in my left breast. I underwent a modified mastectomy, followed by 6 months of preventative chemotherapy, 5 years of Tamoxifen. In May, the following year, I completed my reconstructive surgery.
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    I also want to note that I had had my mammogram 9 months before I found my lump. I had had my clinical exam 3 months before I found my lump. Early detection saved my life through my breast self-exam. Today I am a breast cancer survivor.
    My goal is to share with as many women as possible the lessons I have learned as a breast cancer survivor. The most important lesson is a simple one, educate yourself. When confined to the breast, the 5-year survival rate is more than 95 percent. But women have to do three things, and through the American Cancer Society, of which I work also in Florida, we call it triple touch. You'll see when I mention these three things, why triple touch saved my life. One is your breast self exams monthly. Two, mammograms, as indicated by your physician. Three, your clinical exams. My message to women is simple but important. Early detection saved my life, and it can save yours too.
    One of my efforts to help in the fight against breast cancer is my work on behalf of the Susan G. Komen Breast Cancer Foundation's National Race for the Cure. Since its inception 10 years ago, the race has grown to the world's largest 5K walk/run. The 10th Anniversary Komen National Race for the Cure took place this last Saturday, June 5, with the record number of 66,148 participants. I also found out that 43,000 crossed the finish line. I believe Congresswoman Morella was 1 of those 43,000.
    We were honored that Vice President Al Gore and Tipper Gore served as our honorary chairs for the race. Breast cancer survivors took part in a special salute to survivors which began with an inspirational walk at the foot of the Washington Monument. We also had a large bipartisan contingency of Washington lawmakers and more than 2,500 participants from 72 countries around the world. Most importantly, thousands of my breast cancer survivors, wearing pink T-shirts, all participated from all across this great land.
    Last year, the Komen National Race for the Cure awarded $1.8 million in grants to 24 Washington, DC, area hospitals, research centers, breast health organizations, and the national grant programs of the Susan G. Komen Breast Cancer Foundation. These grants provide funding for breast health programs including research, screening, treatment, and education programs.
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    This year, we are pleased to announce that we will give approximately $2.5 million in grants, to be awarded from this year's race. Since its inception, the Susan B. Komen Breast Cancer Foundation has raised more than $136 million through the work of its local affiliates in more than 100 communities across the country.
    Once again, let me offer my heartfelt thanks to the many Members of the Senate and the House of Representatives who participate in the Komen National Race for the Cure series throughout the year. With each advance we make in finding a cure for breast cancer, we are one step closer to winning the race.
    I would like to, before I close, mention to you all how cancer has touched our lives personally. Through this all, I want you to keep in mind that many of us are alive today because of early detection. My husband's mother was a 25-year breast cancer survivor. My husband's brother died of melanoma at the age of 35. His was not detected early. My daughter is a 10-year survivor of cervical cancer. Early detection saved her life. Because it was detected early, we now have a third grandson after the fact. She is in perfect health. My husband was diagnosed with melanoma right after he was elected to the Senate. Early detection and due to the profound experience we had with his brother, early detection saved my husband's life. Then I was diagnosed with breast cancer. Early detection saved my life. Unfortunately, Connie's mother died of renal cancer. Connie's father died of esophageal cancer. My stepmother died of ovarian cancer.
    When we say early detection until we find a cure saves lives, meaningful things like this hearing and all that the doctors and the researchers are doing, I pray to God we'll end this dreaded disease.
    Mr. Chairman, I thank you for the opportunity to appear before this committee.
    [The prepared statement of Ms. Mack follows:]
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    [The official committee record contains additional material here.]

    Mr. BURTON. Thank you very much, Priscilla. It is good seeing you again. I was not aware of all the tragedies that your family had to endure. We have had some ourselves, but, that's a lot. So you are to be commended, and Connie is to be commended, for all the extra efforts you put forth to help out.
    Mr. Kushi.
    Mr. KUSHI. Thank you very much for this opportunity, Mr. Chairman and committee members, I very much appreciate the fact that conventional medicine has developed its technology with the goal of diagnosing and treating various illness. We desire the continuous support of the physical and the other approaches that conventional medicine offers for the treatment of sickness.
    On the other hand, the conventional approach is a symptomatic approach, and therefore, does not focus on revealing or applying understanding of the cause which underlies disease. No. 2, professionals engaged in the practice of conventional medicine often lack an understanding and support of other healthcare approaches. No. 3, conventional treatment, including its methods of diagnosis has always produced side effects. This is especially true when treatments are over-applied, and often results in the severe suffering of those who receive such treatments. Four, conventional methods of diagnosis and medical treatment are always expensive and often beyond the average person's income. As a result, costs often become the responsibility and burden of the government, the public, and the insurance systems.
    Based upon these points, the tendency of individuals to search out these alternative approaches, so-called alternative and complementary health practices, has increased over the past many years beginning, commencing from about 40 years ago. Currently, approximately 50 percent of those who are suffering from disease are searching for and receiving unconventional methods of treatment.
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    As a demonstration of these trends, consider the example of cancers that affect women. One, over the past 40 years, it has been my experience, as well as that of my associates, that many women are hesitant to receive chemotherapy, radiation, and the other intensive treatments. Two, many women who receive conventional care seek alternative methods as a result of intense suffering, both physical and emotional, that they experience by conventional medical treatment. They seek out milder approaches. Three, many patients desire to know the cause of the cancer from which they are suffering, yet they do not receive satisfactory answers.
    The causes of women's cancer, as is true of the majority of physical and emotional sicknesses, lie in daily lifestyle and dietary practices. For example, in the case of breast cancer, the major causes are over-consumption of high-fat foods, including dairy food and simple carbohydrates such as refined sugar and sweets. In the case of ovarian cancer, the major dietary factors are the over-consumption of eggs and poultry, as are high fat, high cholesterol animal foods.
    In the case of uterine cancer, dietary causes include over-consumption of animal foods and heavy dairy fats such as those found in cheese. In the case of cervical cancer, similar to prostate cancer in men, the primary dietary factors are the over-consumption of oily and greasy foods, salty foods, hard baked flour products, and heavy animal foods. In the case of thyroid cancer, the primary causes are the over-consumption of eggs, poultry, dairy fats, and hard baked flour products. In the case of pancreatic cancer, consumption of poultry, cheese, shellfish, and hard baked flour products are contributing factors.
    In the case of skin cancer, causes include over-consumption of oily foods, sweets, and dairy fat, high-fat foods. In the case of leukemia and lymphoma, dietary causes include over-consumption of dairy fats, sugar, and sweets, as well as oily and greasy foods. Over-consumption of stimulants and aromatic substances, such as hot spices, alcoholic beverages, and caffeine, accelerate the spread of the cancer condition.
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    Other lifestyle factors, such as cigarette smoking, physical inactivity, exposure to high levels of electromagnetic fields or radiation, and the consumption of chemically treated foods and water also contribute to the development of cancers. Non-organic chemically cultivated agriculture, irradiation, microwave cooking, and similar methods of unnatural food production and artificial processing, as well as daily unnatural lifestyle, are potential factors as well.
    The macrobiotic approach, which attempts to correct these undesirable characteristics of the current American lifestyle and dietary behaviors, has been practiced by many individuals since the 1960's. Beginning as a grassroots movement, the macrobiotic approach has led to the initiation of the natural food movement and organic agriculture. The macrobiotic approach continues to gain popularity, and currently influences many millions of people. As a healthcare practice, this approach has helped to prevent disease and speed recovery times associated with numerous sicknesses, including many types of women's cancers.
    Among those in today's audience, the following six or seven ladies are present that have experienced various types of cancer and also have recovered through the macrobiotic approach: Chris Akbar, a former physicist from Pennsylvania, who recovered 14 years ago from inflammatory breast cancer, which is predicted to have a lifetime of 2 or 3 months; Marlene McKenna, a mother of five, radio/television commentator, and investment broker from Rhode Island, who recovered 16 years ago from malignant melanoma spread to the small intestines; Judy MacKenney, a clothing designer from Florida, who recovered 8 years ago from non-Hodgkins lymphoma, stage 4; Kathleen Powers, Stone Mountain, GA, diagnosed in 1985 with endometrial cancer, stage 4, and diagnosed in 1993 with non-Hodgkins lymphoma, stage 3, terminal; Debora Wright, Athens, GA, diagnosed in 1995 with infiltrating ductal cancer, stage 2B; Lynn Mazur, Arlington, VA, diagnosed in 1989, Hodgkins lymphoma, stage 4B; Lizzz Klein, Tampa, FL, diagnosed in 1985, 30 various kinds of symptoms, including brain damage and breast cancer, suspected results due to breast implants; Mr. Norman Arnold, a business leader and philanthropist from South Carolina, who recovered 17 years ago from pancreatic cancer spread to the lymph and liver.
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    These ladies and gentleman will be available for interview later, if you wish. Not only have they survived their illnesses, but they have actively contributed to society for many years following recovery, without recurrence of cancer. The majority of those cases were all terminal. These people are only a few examples of many who have recovered from cancer. In addition, many hundreds of women and men have received benefits from the macrobiotic approach.
    The National Institutes of Health made a small grant of about $30,000 to the School of Public Health at the University of Minnesota. This fund was applied for the collecting of data and gathering of medical records. The data are now under review by a research group from Harvard Medical School and oncologists from Beth Israel Deaconess Medical Center in Boston.
    In contrast to the conventional approaches, the macrobiotic approach also includes—not denying the conventional approach also, but also such practices as oriental herb medicine, acupuncture, moxibustion, and shiatsu massage, as well as other physical body care, emotional meditation, and psychological therapy practices, as they are necessary.
    We highly recommend that the Government support the following: One, please make available public education regarding a proper healthy way of eating, mainly using grain and vegetable bases; and more natural lifestyles.
    Two, increase funds available for research regarding the effectiveness of alternative and complementary approaches for both prevention and recovery, including diet and lifestyle as the base.
    Three, make recommendations to all health facilities and medical schools to accommodate healthful menus and cooking instructions, as well as to teach a proper healthy lifestyle.
    Four, advise selected hospitals or healthcare centers to establish a pilot plan for macrobiotic diet or similar diet and lifestyle, together with data creation as a clinical trial.
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    Five, please advise medical and healthcare professionals of simple, practical ways of diagnosis, based upon oriental diagnoses of the face, pulse, meridians, and vibration, in order to effect low-cost, early detection.
    Six, establish community-based and school-based educational programs, including school lunch programs and high school home economics classes, to recover home cooking and healthy lifestyles.
    Seven, we would be happy to cooperate with such governmental efforts or public efforts by dispatching or sending well-experienced macrobiotic educators, counselors, and cooking instructors to any potential facilities. We recommend the funding of educational training centers at the level of college or professional schools.
    Women are, in my humble opinion, strong opinion, the center of love, beauty, health, and longevity, and happiness among humankind. Home and family are the base for health and happiness. If this country establishes these ways of health and happiness, and prevents and treats physical and emotional disorders in a more natural way, America will become a symbol of health and happiness for the entire planet. America will become a leading light for all humankind, beyond the establishments of power, politics, and economies. This is the way of a great America, to open a new era
of humanity for the 21st century. In this way, America will become the creator of one peaceful world for a healthy mankind.
    Thank you very much for this wonderful opportunity.
    [The prepared statement of Mr. Kushi follows:]
    [The official committee record contains additional material here.]

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    Mr. BURTON. Sounds like some people like you quite a bit. I don't even get that kind of applause when I go home. [Laughter.]
    First of all, let me ask a few questions here.
    Ms. Mack, when you had your breast cancer, did you have it in any of your lymph nodes?
    Ms. MACK. No, I did not. It was diagnosed early enough. I had no lymph node involvement. Therefore, my prognosis was much better.
    Mr. BURTON. Did you have any chemotherapy?
    Ms. MACK. Yes, I did. I had 6 months of preventative chemotherapy. At the time I was diagnosed, the protocol for breast cancer without node, lymph node involvement, had gone to 6 months of preventive chemotherapy following a mastectomy. That wasn't done even a year before. Usually they didn't follow along with anything. And then the 5-years of Tamoxifen after that.
    Mr. BURTON. Did you have radiation, too?
    Ms. MACK. No, I did not.
    Mr. BURTON. Did not have to have radiation?
    Ms. MACK. No, I did not.
    Mr. BURTON. I recall when my wife had her breast cancer and she did have it in five of her lymph nodes, and that's why the prognosis was not that good. One of the most tragic things that people go through is, when they start, women start to lose their hair after the chemotherapy. So I just wish everybody in America could have the opportunity to share the kinds of pain, mental pain, that women and their husbands go through when that sort of thing occurs, in addition to the other side effects of cancer that affect the family life.
    You are to be commended for what you are doing. We really appreciate it. I am sure other Members will have questions for you.
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    I do want to ask Mr. Kushi a few questions. You have—apparently a lot of these people had diseases that would have been deemed terminal illnesses before they went on your program. Some of those people you mentioned had lymphatic cancer and they also had cancer that had spread into the stomach and into the pancreas. I heard one that said the liver, which I always thought was a terminal situation. How do you account for the reversal of their problems? Is it strictly because of the macrobiotic diet you talked about?
    Mr. KUSHI. All cancers are heavily related to and caused by daily eating. For example, pancreatic cancer, as I mentioned, is caused by heavy poultry eating.
    Mr. BURTON. Poultry?
    Mr. KUSHI. Poultry and egg eating, and also shellfish eating, and hard-baked flour, et cetera; of course heavy fatty, oily foods. So now when we approach this cancer, we must reduce, eliminate or reduce those foods which we're eating, and we are recommending more grain, vegetables, and other healthy ones. We try to eliminate as soon as possible from her body or the patient's body the effects of accumulated fat and those accumulated bad influences.
    Mr. BURTON. How do you eliminate that? Some people talk about these like chelation therapy. Do you just do it by diet?
    Mr. KUSHI. Through the diet, a very simple way. I would like to present maybe one example.
    Mr. BURTON. Sure. Go ahead.
    Ms. AKBAR. Hi. My name is Chris Akbar. I am one of Michio's assistants in Boston. In 1985, I was diagnosed with inflammatory breast cancer at Yale-New Haven Hospital. I was a grad. student working on a Ph.D. in physics at the time. My diet consisted primarily of ice cream, chocolate, cheese omelets, and pizzas. I was very fat. I weighed 170 pounds. Primarily dairy food and sweets.
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    I discovered a red hot inflammation in my breast, very painful. I went and had penicillin for 2 weeks and nothing happened. Then I had a mammogram that showed nothing. I had ultrasound; it showed nothing. I finally had a surgical biopsy. They told me I had inflammatory breast cancer. This was in 1985. They told me I had 2 or 3 months to live. They said it was the most lethal; it was immediately in my lymphatic system.
    I said ''Why do I have cancer?'' to my doctors. This was at Yale Medical School, and they had a lot of research there. They said, ''It's genetic.'' But nobody ever had cancer in my whole family.
    Then I said, ''What can I eat? I am huge. I am obese. What can I eat?'' They said, ''Don't lose an ounce, because if you lose any weight, the cancer is going to be killing you even faster, if your body is starting to waste away. So have some Chocolate Ensure, which is made out of basically sugars and oils.'' They served us chocolate-covered donuts in the waiting lounge of the radiation laboratory where I was going. I thought something was a little bit strange.
    Anyway, I started chemotherapy the next day. It was CAF. It was adriamycin, 5-FU, and cytoxan. Adriamycin made my hair fall out within 3 weeks, and I was devastated by that, plus nauseated. I went through menopause at the age of 33, basically, because of the drugs. Then I did radiation twice a day for 6 weeks. That was a very intense experience also.
    Meanwhile, I had read a book about macrobiotics. It was by a physician from Philadelphia who had prostate cancer that had spread throughout his bones. He was basically a hopeless case. He was the chairman of Methodist Hospital. He picked up some hitchhikers who were hippies back in the late 1960's who said ''Try a macrobiotic diet, it will save your life.'' Well, he did. After 1 year of macrobiotics, he was completely cancer-free, with no other medical treatment. He was on a gourmet French diet, with heavy fats, heavy meats, heavy sauces, wine, everything. He was from Philadelphia and he went to Le Bec Fin Restaurant, basically.
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    I was on a gourmet chocolate diet. I said this is the cause of my problem. I really think dairy food goes to the mammary part of my body and creates a problem. It just makes sense. I picked up a book, the Cancer Prevention Diet Book you have. It said, ''Dairy food and sweets is the primary cause of breast cancer.'' That was the main thing I was doing. It said, ''Stop those things and start taking some things to clean it out.''
    Well, I came to Michio for counseling. His wife had just done her cookbook. I said this is my bible. I am just going to follow this book. I did. Michio gave me very simple remedies. He gave me a plaster made out of barley and cabbage that I just put on my breast every night. In 5 days, I felt the tumor getting smaller and softer. He gave me something to reduce my weight, simple vegetables like daikon, which is a long white radish, and carrots. I just grated them and ate that every day. I lost 50 pounds within like 2 months. All this fat came off of me.
    I had a really bad pancreas from so many eggs and cheese I had eaten. He gave me a simple drink made out of cabbage, carrots, onions, and squash, called Sweet Vegetable Drink. I took that and my pancreas cleaned out. I no longer had sweet cravings. I didn't want chocolate every afternoon at 4. I had chronic constipation. I think that is often associated with breast cancer, because the toxins sort of buildup in your body and you can't eliminate them. He gave me something to strengthen my intestines, a simple like oriental drink made out of a white powder, a root powder, like a starch that strengthened my intestines.
    I just did his diet. I never have touched, in 14 years since, I haven't touched any ice cream or chocolate or dairy food or meat, and I don't miss it at all, or sugar. After 2 months, I got incredible diarrhea one night. I wondered what was happening. The next morning I had realized that my entire tumor that was hanging on here was completely discharged out of my body naturally.
    What had happened was in your intestines, when you eat, the nutrients from the foods that you are eating are absorbed and it changes the quality of your blood. If you are taking these things like I mentioned, these macrobiotic-type things, it actually goes through like a solvent and goes in and through your body and cleans everything out. So as I was losing all of this fat, everything was literally, along with the tumor, was just absolutely discharged out of my body. It was very effective.
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    I am a scientist, so I kept very careful records of what I was doing and how my body was reacting. I found if I took any extra oils—he had told me oil is like throwing oil onto a flame, which was this inflammatory tumor—if I ate any oil, the redness would come back. In fact, it did, the inflammation. I could actually cause the inflammation to come back. I just literally eliminated all of that stuff that caused the cancer, took these things, these vegetables and grains and beans and seaweeds, and whatever, to clean out. Literally it flushed out of my body and saved my life.
    So in 2 months, when I was supposed to be dead even with the medical treatments, it saved my life. It was so effective. It literally used the food as a cleaner to go through and clean out my body, very effective. I was really impressed. So I'm alive; 14 years later, here I am.
    Mr. BURTON. I would guess you would be impressed.
    Mr. KUSHI. Those friends, besides many hundreds of other people, have been experiencing similar ways.
    Mr. BURTON. Well thank you, Doctor.
    My time has expired. Let me yield now to my colleague, Ms. Norton.
    Ms. NORTON. Thank you very much. Both of these testimonies have been very, very impressive and very important.
    I would like to know, Mr. Kushi, what is your training or your background that led you to the development of your approach?
    Mr. KUSHI. Fortunately, I was not in medical school. I was a political science student, international law. After the end of the war, the World War, I wanted to have world peace. So I became a world federalist. Mr. Norman Cousins and a friend sponsored me, and I came at the age of 23 years old to America, 50 years ago. Then while I was studying in Columbia University's graduate course, accumulating various kinds of documents, the drafts of world constitutions and other related documents, I started to wonder whether even if this world government, world federation is born, how about sickness, how about love, how about sharing of people, how about prejudice or discrimination, those mental problems. And then I wondered, unless those things were corrected, there is no world peace.
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    So I started to search for a solution, including visiting Dr. Einstein and Mr. Norman Cousins and various others, Thomas Mann, and so forth. But there were no active clear answers. But we have made religions, hoping to make people better. But between religions, then fights arise. Then we hoped education had high expectations, and also material prosperity; then again, unfortunately, sickness spread, crime spread.
    So I started to—I gave up all political science studies and I started standing on a corner in New York's Times Square. Since I had been here, I started to watch people. What is humanity; what is humanity? It took 2 1/2 months; then I understood. Everyone had been, mankind has been made by two factors: one, environment, and two, what we eat.
    What we eat is entirely in our hands, freedom. Individual people are freely choosing, freely cooking and so forth. Now if proper diet is eaten, and the environment, certain clean environment is done, then happy conditions come. If not, then sickness arises, crime arises, violence arises. So then I found that in the American diet of the 19th century, 20th century, comparing 19th century and 20th century, tremendous change occurred. More increase in animal food. More increase in dairy food. More increase in refined sugar. More increase in mass production of food, agricultural products, et cetera, and so forth.
    Exactly parallel with this change of diet, heart disease is increasing, cancer is increasing, and various kinds of so-called degenerative diseases are increasing, as well as so-called virus diseases and also mental problems have increased. So I wanted to change our current way we're eating. Then we began the so-called natural food movement and cooking classes. This is my background.
    Ms. NORTON. It is certainly true, particularly when studying populations of different countries, research has begun to show the associations that you indicate. I also note that in your testimony you seem to have an integrative approach as well. You indicate the debt we owe to conventional medicine, and then you indicate that there are certain things that medical schools and others can do to integrate these approaches in order to get better results for people who have the disease or to prevent the disease.
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    May I ask if the people who are under your care, if you require that they not engage in conventional treatment or if some of them have also been engaged in conventional treatment while being involved with your diet?
    Mr. KUSHI. Those things are up to the patient. The entirety of patients have entire freedom. However, because the cause is diet and lifestyle, so basically the cure is, basically the diet, proper diet and proper lifestyle. Then in addition to that correction, patients, if they want chemotherapy or radiation or acupuncture or herbal medicine, that's fine. They can attach these. But I hope this treatment can be mild and not overdosed. Because in my opinion, and in other people's opinions, by overdose of chemotherapy, overdose of radiation, this often affects so much the suffering of the patients, not only suffering, I wonder maybe shortening their life also. A moderate approach, I hope, the medical treatment can take.
    Ms. NORTON. I just want to say to Mr. Kushi, I think increasingly many people adopt the point of view you just expressed, that the treatment is worse than the cure, and many people forego such treatments.
    I just want to say in closing to Ms. Mack, how important her leadership has been, that when you have come forward and others like you have come forward, you cannot imagine the effect you have had on people who would not otherwise come forward. By doing the race, there are women whose attention we could not possibly get except through the dramatic intervention of well-known women who are first, willing to indicate that they have had the disease, and then willing to show that the disease can be defeated. I certainly want to thank you for that.
    I have a sister who is now president of a college, who has had breast cancer and feels herself entirely cured. Since I am her sister, not only do I want her to be cured for that reason, but because this thing may also run in families. I certainly appreciate the leadership you have given to this work.
    Thank you, Mr. Chairman.
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    Mr. BURTON. Thank you, Ms. Norton.
    Mr. Mica.
    Mr. MICA. Thank you, Mr. Chairman.
    Mrs. Mack, I just had a couple of questions. First of all, your leadership has been tremendous in the private sector in providing awareness and also raising funds. You cited in your testimony how much money had been raised privately just by the activities you have been involved in. Maybe you could comment to the committee on your suggestions for research and for funding, and what do you think would be an appropriate private-public mix of funds?
    Ms. MACK. Well, I believe the Congress is doing an awful lot in the doubling of the moneys for NIH which Connie has been involved with. Getting the funding doubled for NIH will help all diseases. I believe that all that we do in research is where we are going to find the true answer to not just cancer, but all other diseases, and through research, through alternative medicines. Research in every way is going to make the difference. Public and private, we all have to work together. It is a large problem. The Government can't do it alone, and neither can the private sector. I think whenever we can partner and whenever we can work together, the cures and the research will come to make a difference.
    Mr. MICA. One of the other things that I wanted to ask about was that you had talked about awareness and self examination. There seems to be somewhat of a lack of public awareness. How do you think we should best approach these campaigns from a private sector's standpoint or public or a combination? What do you think is most effective in getting the message that you are trying to get out to women and others?
    Ms. MACK. Well, I believe it is through hearings like this, through races, through advocacy, that all the women in this room, and all the people in the cancer communities do. We are blessed in this country with many generous, wonderful people who raise money in the private sector, but also our Congress and our administration, work diligently to find the answers to cancer, in particular, and diseases in particular. But I just think we have to continue. We can't sit, rest on our laurels. We have to continue to be out front and continue the fight, and to make more people aware.
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    I mean, as obvious or as outfront as I have been and Dr. Kushi and everyone else, there are many, many people out there who haven't heard a word we have said. We have to continue to get to the underserved. We have to continue to get the message out that early detection, until we find a cure, is the way to deal with most diseases if you find it, or prevention through ways that have been proven to make a difference. It takes a lot of money. It takes a lot of time, and it takes a lot of heart. Through public and private, we can do it together. We cannot do it alone.
    Mr. MICA. Thank you.
    Mr. Kushi, you spoke quite a bit about diet and changes in lifestyle and prevention. What do you see as the role of research today and how important do you think that is in finding a cure for cancer or addressing cancer treatment?
    Mr. KUSHI. There are many approaches for cancer treatment and many ways we should also examine, and research should be done. However, as I pointed out, basic problems of cancer and other disease are what we are eating and daily life. Therefore, do research to associate diet and daily life with cancer, and if more research goes there and finds what kinds of results are coming, such as test in the clinical trials, in the hospital, this and that, et cetera; and data accumulation. For example, it's very easy to confirm that blood pressure comes down or cholesterol comes down, it is very easy by changing diet. Same thing, like for diabetes, it is very easy to offset, even though insulin has been consumed. Situations are also very easy by dietary control.
    In a similar way, if you subject patients to a study about this type of cancer, or just study this type of sickness, how diet is related. I suppose I or someone else, we will be very happy to confirm that this kind of diet will offset or reduce or prevent that; while, if the current way of eating continues together with any medical treatment, how different outcomes will result. It is very clear, you can see that. Then after you have accumulated those data, then you can apply these clinical tests in the hospitals, you can apply it in other health clinics. Those data can be created easily in 6 months, 1 year, or at most 2 years' time, enough data which we can convince the people who are watching the healthcare field and educational field.
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    Mr. MICA. Thank you, Mr. Chairman. I yield back.
    Mr. BURTON. Thank you, Mr. Mica.
    Mrs. Mink.
    Mrs. MINK. Thank you, Mr. Chairman. I want to compliment both of our witnesses. You have very inspirational messages, not just to this committee and the Congress, but to the American people at large.
    I detect the common theme of both of your testimonies, is a sense of personal responsibility. In your case, Mrs. Mack, your detection was by yourself through self examination. The message there is that notwithstanding all the medical instruments that are now available for detecting breast cancer, there is really no substitute for the once-a-month self-examination procedure.
    In your case, Mr. Kushi, the knowledge that what you eat is what you are, I think, is an important message that we have to take very, very seriously. I do think that the points you make in your testimony, Mr. Kushi, have been well expressed by nutrition experts, by people in the medical profession who are constantly hammering on your diet, don't eat fats and stay away from this or that. So I think the general message is not that different in terms of the medical profession and what you are espousing.
    The point, however, of getting the message earlier in life, particularly in places like the school lunch program in our schools and in our training programs. I have been told that medical doctors have less than one course subject on nutrition and the diet. They go out and they are treating patients with very serious illnesses, with very little perception about the importance of diet. So I think we have to carry the message to the professionals and convince them that the words they expound about diet truly have meaning. I think that that is what you have brought to this committee. I commend you for your work and for your leadership, and commend your book. I will get a copy and read it from cover to cover. Thank you very much.
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    Mr. KUSHI. Thank you.
    Mr. BURTON. Thank you, Mrs. Mink.
    Mrs. Morella.
    Mrs. MORELLA. Thank you, Mr. Chairman. It is a pleasure to have heard both of you and to Mr. Kushi, to have had the women who have appeared here and gentleman to comment on the successes.
    Priscilla Mack, you are so right. You know, over and over again, you said early diagnosis makes the difference. I am pleased that in my area with the American Cancer Society, with a number of hospitals involved, with Hadassa, we have been bringing a program called Check it Out to high schools, and inviting the 11th and 12th grade females to come together in an assembly and to learn self-examination. They ask very graphic questions. They learn it not only so they can get into the habit of doing it, but so that they can be the messenger, to bring the message to their older sisters, their mothers, their grandmothers, their friends. I guess that this is something from what you said, in terms of how you even discovered that you had a challenge, it is through the self detection.
    So I want you to know how much I appreciate what you have done, and the fact that you have brought an enthusiasm and such strength to the whole concept of research and our own personal involvement, and certainly the Komen Race for the Cure. No wonder the money has doubled over the last year, because we have had inspirational people. So thank you.
    I am interested, Mr. Kushi, whether or not first of all, these people who are such great testimonials to the concept of the dietary facet of it, do they come to you as a last resort? And how do they hear about you? Do you have any centers in Maryland?
    Mr. KUSHI. Your home, I hope your house will become a center in the near future.
    First of all, many people are coming to see me or my associates, or teachers. Many of them have already received medical treatment. They were declared—no way, terminal cases, or they themselves were dissatisfied with the results of the medical treatment. Those people come. Of those people who come, maybe 40 percent of people are this type.
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    Second is the people who got sickness and got diagnosed. Then they start before they receive conventional treatment, they start to search for alternative ways and come to us. That is the second approach. That may be about 30 percent or so.
    Another number of people for the sake of keeping their health, for the sake of precaution, they also come. And people who have come to us because they found at that time maybe stage one, two, or three of cancer, different stages. But as I said, and as you know, many women are hesitant to go in for drastic treatment. So before receiving treatment, they search. Otherwise, after they receive some drastic treatment, then they still are told there is no hope. Then they start to search.
    Mrs. MORELLA. Do they hear about you basically through your book?
    Mr. KUSHI. Yes, through words, through books.
    Mrs. MORELLA. Word of mouth, words spread.
    Mr. KUSHI. Yes, that's right. We are not a commercial venture, so we never advertise. But through books, through education, and also our educational center, the Kushi Institute in Massachusetts. However, through that dedication for many years, many graduates have come. I develop those teachers. Throughout the world, several thousand teachers are out there. In this country, many States, many cities have also macrobiotic teachers. They are doing cooking classes, they are doing health advice or various social work.
    Mrs. MORELLA. You would, it seems to me, suggest that doctors, that all doctors, all of the health practitioners include as part of their treatment that there be the recognition of how food as well as exercise and other moderate lifestyles, the role that food plays.
    Now she mentioned some of the mixtures that you made. I mean do you have to have it in mixture form? Can you just have like good vegetables and have a list of dos and don'ts? Does it have to be mixed in a certain proportion?
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    Mr. KUSHI. It depends on the condition. For example, you know, like colon cancer, that more is caused by beef and pork and cheese, eggs. Eliminating that effect, then we need like grated daikon, grated carrots, green leafy vegetable juice, and so forth. More opposite factors we bring, and other factors to balance the condition. In the case of, like I would say intestinal problems, then there, traditionally the oriental countries have been using kuzu and also pickled plums, which are very good for digestion; and also, suppose, if you want to straighten out pancreatic cancer, then you better have sweet vegetables like cabbage, carrots, squash and onions: those finely chopped in equal amounts, and with three or four times water, cooked 25 minutes. That's a sweet vegetable drink. Drink every day, one cup, two cups. That makes it easy to solve the cancer.
    In the same way, our approach is, No. 1, the safest approach. No. 2, cost value is low. No. 3, at home they can practice and use foods, food which they can get very easy. Using them, they make home remedies.
    Mrs. MORELLA. I guess I am going to have to buy the book. Thank you very much.
    Thank you, Mr. Chairman.
    Mr. BURTON. Mr. Cummings.
    Mr. CUMMINGS. Thank you very much, Mr. Chairman.
    To Ms. Mack, I want to thank you for being a leader in this area. So often what happens is, I think it was Martin Luther King, Sr., who said that you cannot lead where you do not go, and you cannot teach what you do not know. So often people go through difficulties. Once they get through their difficulties, they almost act like it never happened. But not only have you remembered, but you have acted on them to try to help other people. I think that there is no greater thing that we can do as human beings than to use our pains and our problems to turn them around and use them as a passport to help other people. So I thank you for your leadership.
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    As I was looking at the statement of our good friend Mr. Kushi, I just want to ask you a few questions because I am truly fascinated. Mr. Chairman, I am so glad you had this panel because I did not expect it to be so interesting. [Laughter.]
    Mr. BURTON. Are you inferring that this committee is not interesting? [Laughter and applause.]
    Mr. CUMMINGS. One of the things that you talk about is cost,* [see below] that so many people, they can't get healthcare because of the cost. I guess they may not have insurance or whatever. I am sure it must be very frustrating to you and probably I'm sure you too, Ms. Mack, when you are on this mission to help people and to know that cost of treatment is something that because people can't afford certain treatments, that people are literally not only suffering, but dying. I mean that must be a very frustrating thing for you all. I just would like for you all to comment on that.
    Mr. KUSHI. I agree, and for example, more in conventional medicine, doctors learn in medical school training there is no single course for nutrition, and diet; but by eating we form blood, we form our limbs, we form all sides of our bodies. Without understanding that, there is no way to understand cause.* [It seems that Mr. Kuchi heard ''cause'' instead of ''cost'' in the question of Mr. Cummings. Therefore, he addresses the frustrations of symptomatic medicine where ''cause'' is not eliminated.] Therefore, all patients are frustrated. If treated with a symptomatical approach, symptoms maybe might be temporarily eliminated; but then the cause still continues, still taking heavy meat, et cetera. Then again, symptoms come back 2 years later, 3 years later, all very shortly. Again, in the hospitals, even in hospitals, what are patients fed in there? They are fed the cause of the sickness, that beef or ice cream or whatever. This is a very ironic situation!
    While trying to help sickness, they are creating more sickness, and endless heavy treatment, more increasing chemotherapy; more radiation is needed; and doctors themselves, I know, many doctors are frustrated. Why should we not open our eyes to the cause. Without knowing the cause, there is no way of cure. That's the medicine of symptoms, but not cure. But cause is, day to day our own way of eating, our own way of lifestyle! There probably, our thinking, consciousness must change. We want to have the prosperity, we want to have that. Our thinking must need to change, but at the same time, we can begin from day to day life now.
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    We lost family cooking, with all outside fast food and this and that, et cetera; and together we are losing family cooking. Our family relations between father and mother and the children are becoming more and more troubled. Also in school, the concentration of students becomes troubled. The school lunch program is more fatty food, more heavy food, more sugary food. They can't concentrate in the school. Then unless we bring back to America and the entire world, which is influenced by America, good way of eating again, there is no way to solve this. America and other countries are all sinking down physically and economically.
    Mr. CUMMINGS. I must tell you that you already had an impact on me. I have gone back there to the little room here to eat my potato chips, roast beef, and my Coke, and I could hardly get it down. [Laughter and applause.]
    As a matter of fact, I left three-fourths of the bag of potato chips out there. I think I am going to throw them in the trash.
    Mr. KUSHI. Let us think of our ancestors, your ancestors, all mankind's ancestors. Traditionally, we have been eating whole grains day to day. Right? Either bread form or rice form or whatever, and then vegetables, then beans. From beans, bean products we have been getting more vegetable quality proteins. Some countries may be getting seaweed, and so forth, a mineral source. Then we are doing home cooking. Animal food, like beef, our ancestors consumed much, much less. I have no objection to having that, animal food, but much less percentage, and not like currently, like antibiotics—or hormone-treated beef, and so forth. Then we didn't have cancer in the 19th century, 18th century. Why not? The tremendous change in the diet. Tremendous decline of what we are eating!
    Mr. CUMMINGS. Thank you very much. Thank you, Mr. Chairman.
    Mr. BURTON. Thank you, Mr. Cummings. I didn't know you were a standup comedian, but you are pretty good. [Laughter.]
    Mrs. Biggert.
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    Mrs. BIGGERT. Thank you, Mr. Chairman.
    Mr. Kushi, your diet seems to be quite the opposite of several diets that are popular right now in this country as far as losing weight.
    Mr. KUSHI. For example?
    Mrs. BIGGERT. Like the Zone diet or sugar busters, those high protein diets, which are high in fat, animal and dairy. But do you think that these type of diets then will contribute to greater cancer risks?
    Mr. KUSHI. To certain period, for certain period, to certain symptoms they maybe contribute. But what macrobiotics recommends is very traditional, thousands of years or maybe a million years, mankind's experience, generations to generations, whole grain and vegetables, beans, et cetera. And that is the base. It then depends on climate, depends on where you live. Cooking methods change, and also combination of vegetables, combination of foods change. But the base is there, grains and vegetable base. Animal food you can add 5 percent, 10 percent, depends on your condition. Fruits also you can add, it depends on the seasons.
    Suppose we didn't have in Washington, DC, our 20th century banana, because it simply didn't grow here. Now we are taking a banana every day. Or sugar, we didn't have sugar cane. We are not growing it here. All climates are different. Therefore, we need for those things to have moderation—tropical products, et cetera. That means environmental consideration is needed.
    Mrs. BIGGERT. What about the role of exercise then?
    Mr. KUSHI. Oh yes. The role of exercise is great. However, recently they are recommending that some special exercise is very popular now, certain types of exercises. I would say yes, you may do so. However, more important is day to day work, day to day active living. I am recommending to the sick people, the people who are sick and my associates, I am recommending every day with hot wet towel squeeze, scrubbing their whole bodies twice, morning and night, making blood circulation active, and so forth. Then take a walk at least a half hour, taking a walk if they can walk. Then if they can do any light exercise, fine. But not strenuous exercise. Then every day, singing a song, happy song—''You Are My Sunshine'' or whatever, not a depressing song—every day. That opens the chest and makes the breath and circulation better, and the emotions up. Also I am recommending people wear cotton clothing, and more cotton bedsheets and pillow case, instead of synthetic ones; and more also putting green plants in the home, which emit oxygen and keep the house better. Also, this may be a problem now, not using a computer much if you are sick.
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    Mrs. BIGGERT. It sounds like a whole positive attitude.
    Mr. KUSHI. Yes. Also microwave cooking is very questionable, microwave cooking. Now 75 percent of the American families are using microwave cooking. This is a big problem, question. Traditional cooking, like charcoal cooking, or the gas stove is much, much better. Furthermore, the like electromagnetic environment it is better to examine. Also, as home family cooking will be recovered, and I hope they have a chance, the whole family has a chance some evenings at dinner time, to talk to each other. They should sleep not at midnight, more like 10 or 11, and so forth. In other words, healthy, normal healthy life!
    Mrs. BIGGERT. Thank you.
    Mrs. Mack, I really appreciate your testimony and your presence here after the Race for the Cure last Saturday. It is amazing how across the country this type of activity is being conducted. I know in Illinois we had a big event there. I have to say that we didn't have quite the 66,000 people that were here in Washington, DC. But I think that does so much to raise the consciousness of the problem.
    But in your work with breast cancer survivors, are there characteristics that you find that people have in common that are successfully overcoming their cancers?
    Ms. MACK. Well, I will have to speak only for myself and the people I speak to, my impression of that. But I find like Mr. Kushi says, if you have a higher power and you do everything on your behalf that you can do to further your recovery, take care of yourself to find out what's out there to take care of it, and then what you can't do, let go and let God handle. Also, if you can do that and you have the serenity to do the right things for yourself and have that positive attitude, I find that through all of these things, we are changing the mindset that cancer is a deathnell. When we continue to do that, we also bring to that good mental health, which also affects your physical health.
    Mrs. BIGGERT. Thank you. Thank you, Mr. Chairman.
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    Mr. BURTON. Well, thank you, Priscilla. You have been lovely as always, and we really appreciate your comments, especially the last ones you made. I think those are very important about having the higher power, the supreme being. A little prayer doesn't hurt. It doesn't hurt a bit. It kind of calms the soul and helps stabilize everything.
    Mr. Kushi, I pledge to you, every morning I am going to start singing ''You Ain't Nothing But a Hound Dog'' so I can get myself off to the right start.
    Let me thank you both. I think it has been very, very enlightening. We really appreciate it. Mr. Kushi, your book, I am going to recommend it to a number of my colleagues. I think they would like to read it as well. So thank you both very much.
    Mr. KUSHI. May I just add one thing about diagnosis? Very simple. For the family, to know where diagnosis is about cancer conditions, in the beginning stage. At this place,* [Mr. Kushi points to the outside edge of his hand, below the little finger] if green color comes out, then we have to suspect in the near future cancer may begin.
    Mr. BURTON. Here?
    Mr. KUSHI. Yes. In the case of breast cancer, this center, green straight line * [Mr. Kushi points to an imaginary line running down the center of the underside of his arm, up through the center of the palm, to his middle finger] comes, in the case of risk. This begins 6 months before cancer, one of the symptoms. This is an acupuncture meridian, the so-called ''heart governor'' meridian. It goes across this breast. If that meridian is clogged from the breast, then down the arm, it then becomes a green color in the case of cancer.
    In the case of the uterine cancer or ovarian cancer, here * [Mr. Kushi grasps his chin with his thumb and index finger] if we have a very fatty, large deposit, and especially a hard one, then uterine cancer, ovarian cancer or cervical cancer is very suspected. Prostate cancer too, is very suspected for men.
    Mr. BURTON. Right here under the chin?
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    Mr. KUSHI. This. It's because low in the head reflects low in the body. It's very accurate. Various simple way of detection are available also, as information for home use.
    Mr. BURTON. Thank you, Doctor, very much. Thank you both. We really appreciate it. Thank you all those who are applauding. I appreciate that as well.
    We would like to now have Dr. Gardener, Ms. Zarycki, and Ms. Bedell-Logan come forward, please.
    Dr. Gordon, since you have time constraints and you have to leave right away, you said you have a relatively brief statement you would like to make. So we will allow you to do that. Then we will go right to our ladies.
    Dr. GORDON. Sure. I wanted to be able to stay around for questions though, if you would like to ask the questions too. I just was saying that I have to be back there by 3.
    Mr. BURTON. In that case, if you wouldn't mind, Dr. Gordon, I think we will go ahead with this panel, and then we'll hold you, because I think we will be finished by 3.
    Dr. GORDON. OK, great.
    Mr. BURTON. Let's start with Ms. Zarycki. Did I pronounce that correctly?
    Ms. ZARYCKI. It's Zarycki.
    Mr. BURTON. Zarycki, I'm sorry.

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    Ms. ZARYCKI. I was going to say good morning, but it's really good afternoon.
    Mr. BURTON. Well, these hearings sometimes run a little ways into the afternoon, but they are very important.
    Ms. ZARYCKI. Yes, they are. Thank you for the opportunity to testify regarding complementary and alternative practices, which I will call CAM, and the role of women's cancer treatment. I am Carol Zarycki, an advocate and breast cancer survivor of 2 years. In my written testimony, I have outlined issues and instances where we as patients have had to do most of our own research in seeking out CAM protocol. I will highlight some of these points and summarize my personal approach.
    I am speaking for myself and other patients and advocates whom I'll call we, to request legislation for CAM medical research and funding rather than to continue regulation of standard allopathic treatments, the costs of which are ultimately borne by the taxpayer and the Government, and which do not show an increase in cancer survivor statistics. We are tired of hearing about measures such as time to recurrence, tumor regression rate, or time to disease progression, when the real issue is preventing cancer in the first place. We would like to see a shift of funding and research attention to the review of a standard cancer protocol that is less toxic, better targeted, and more effective, while at the same time, focusing on CAM therapies.
    The role of insurance coverage is a primary factor in the CAM choice process, and needs to be addressed, not just for patented drugs or diseases with a name, thereby endorsing insurance coverage, but for natural alternative treatments, so that we don't have to invent new names for new types of cancers. We need to have access to treatments and clinical trials that will work with us as individuals rather than be limited in choices. Some toxic medical procedures given routinely can leave the immune system in deep disrepair, making one more susceptible to recurring disease for this very reason. Ironically then, one would have to seek alternative treatment not covered by insurance to alleviate or attempt to alleviate this previously non-existing damage.
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    Information needs to be made available so that individuals are fully informed of options and possible treatment outcomes, including quality of life and survival rates for the treatments they are choosing. Most women given Tamoxifen do not need the drug, and may even get the danger of side effects of blood clots in the legs or lungs, uterine cancer, strokes or heart attacks. A few of these women will have disease progression or recurrence anyway.
    New legislation is required for alternative therapies in cases where old or even new drugs may not demonstrate an increased survival rate or even a better rate of progression-free survival.
    There needs to be a recognition of chemicals in the environment and their effect on hormones from the fish we eat to our plastic-bottled drinking water. Our country regularly imports fruits, vegetables, and foods that have been treated by toxic methods, even when the imported food is labeled organic. Since it has been demonstrated that hormonal imbalances are an underlying factor in a growing number of breast and reproductive cancers, wouldn't it make sense to research natural hormones rather than add synthetic tamoxifen, raloxifine or premarin to an already overloaded hormonal system?
    Evidence-based testing methods and not just scientific competition within the medical community, without regard for the population being studied, need to be employed. Trials which indicate life extension should additionally be able to demonstrate that this means for more than a few weeks, and should also discuss quality of life issues.
    Non-toxic and non-invasive methods of cancer detection should be standardized, instead of encouraging mammograms which strongly increase a woman's chances of getting breast cancer in her lifetime. Also, for younger women with dense breasts and therefore, unidentifiable or undetectable cancer, mammograms can weaken the still growing tissues, thereby promoting future malignancies.
    A focus on preventive measures which strengthen the immune system rather than early detection methods, which can also be too late detection, and with their own set of risks and hazards, can be incorporated into an individual's lifestyle. Allopathic medicine used on its own needs to clinically understand the traumas and debilities it is in itself creating, not curing. We want to be able to live in peace with the treatment decisions we are making, without fear that mammograms, therapies, toxic and synthetic drugs are doing a potential future harm to another part of our bodies. We do not want to hear about 5 or 10 year guidelines that we are being measured against, but rather experience peace by knowing about immune strengthening practices which will eliminate the need for these guidelines and also the topic of recurrence.
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    We are requesting a sharing of both conventional and alternative medicine, so that it can truly be called an integrative complementary medical practice. We must try a new approach because the old ways are simply not effective in reducing mortality rates. We must try a new approach because the old ways are simply not saving our best friends' lives.
    For my personal approach and upon initial diagnosis, I spoke to my herbalists, each of whom had started their practices due to family members' involvement with cancer. I contacted local and national organizations, including SHARE in New York City, becoming involved in support groups and informational workshops. I spoke with whomever I came in contact with who had gone through a similar experience. I started keeping a daily journal, prayed more, and learned about meditation. I made appointments with alternative naturopaths and noted visualization authors. I began juicing and nutritional therapy, checked out nutritional cleansing, enzyme and vitamin therapies, started ancient Eastern practices of Qi Gong and Jin Shin Jitsu, went to healing services and ceremonies of different cultures, bought more herbal books, and took classes to begin making my own combinations. I became a devout fan of acupuncture and studied homeopathy. I wouldn't say I did anything radically alternative, but then some consider meditation or acupuncture radical.
    I began to teach others what I was learning about my favorite non-toxic personally tested alternative methods of healing. I have been blessed with a team of surgeons, oncologists, and alternative practitioners who have come into my life exactly when I needed them, and with whom I continue to discuss alternative information and ideas, even though they express doubt about the methods I am using.
    There is, I found, a fine line between being cured and being healed. While we all want to think of ourselves as being cured or on the way to finding new cures, the only way this can happen is by allowing a healing to take place on all levels, mind, body, and spirit, and which standard allopathic medicine does not fully address. This is a highly individual process involving reflection and recognition of our relationship with surroundings, why we are here, and what we are called here to learn, and then working with this process rather than fighting it or attaching blame. When we approach this awareness, we have already begun to heal and our own energy, spirit, vital force, qi, and prana, are strengthened from within, turning the healing process into a curative journey. Thank you.
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    [The prepared statement of Ms. Zarycki follows:]
    [The official committee record contains additional material here.]

    Mr. BURTON. Thank you very much, Ms. Zarycki.
    Ms. GARDENER. I wanted to say thank you, Mr. Dan Burton, and also committee members, for your role as David in confronting Goliath. I appreciate and admire you.
    I had originally planned to sort of talk about my story and that's not what happened. But my story has led me to where I am now, the place I am now, and to what I have to share with you.
    I also have an intimate knowledge as a result of my personal odyssey with breast cancer, of both conventional and non-conventional approaches. I probably would have just—I knew nothing about breast cancer or cancer really, but that people died from it, and was frightened by it. But ended up really very much using both of them in depth.
    Up front, I want to say two things. I do not think any one approach, any one approach within either of those systems also, is right for anyone or for everyone. I have suffered no irreparable harm from any non-conventional approach, despite having had extensive exposure to many. I feel that every one of them has helped me in some way, some more than others. I say that because I know that's a concern that a lot of people have and a reservation they have about supporting the use of non-conventional therapies or making them available to people.
    On the other hand, unfortunately, I have to say that—well, let me preface it by saying that I think that conventional physicians, most of them are very well-meaning and competent in what they do. I think they are often more fearful of cancer than the patients, and perhaps it's because they are being expected to cure something that they know they really don't understand. So that can be a very frightening thing, and maybe can lead them to be very rigid in the way they treat us as patients, feeling like we can't have any deviations and we can't waste any time because they are really so very frightened themselves.
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    But basically in contrast to my experience with non-conventional approaches, I do feel that I have suffered considerable and irreparable harm because of my treatment with conventional methods. I think most of us have. Some of us are more willing to acknowledge it than others because there's kind of a cognitive dissonance there that we want to believe that what we did was the best and that everything is OK, and we want to minimize I think, the price we have paid in many instances.
    Of course some people have had less treatment than others. I guess part of my situation too is that I do not feel that if my point of view had been respected, I don't believe I would have ever ended up with the number of very invasive kinds of procedures that I did have to undergo, from which I continue to suffer the effects. One of them is lymphedema, which no one has mentioned so far, can be life threatening because if you have chronic swelling of the limb, there is a rare type of sarcoma which is a very lethal kind of cancer that can develop. It is rare, but all of these things are statistics.
    So I guess every day there are people who conventional medicine has sent home to die that are finding their way back to life, even after they have had, been subjected to the often times brutal procedures of conventional medicine. I just wish I didn't have to say these things. I really do. I wish that my experience had been different, and I wish the experiences of many, many of my friends, some of whom I have lost and some of whom I have seen go through terrible suffering, who have sometimes made it through and survived. I wish I didn't have to say these things and have those perceptions.
    I wanted to say a lot of things which I am not going to have time to say. I guess maybe I can say that—it's hard to, and I know everyone is wanting to go and I am too, because I have had a peach to eat today, that's it. I guess maybe let me say this. I think we have to find another way to approach cancer than conventional approaches, because conventional approaches are based on killing cancer. That does not guarantee in any way that it is going to heal us or keep us alive. There are no guarantees made of that. It is kind of like killing alligators instead of draining the swamp. We are not dealing with causation, and we are not dealing with healing. I had planned to give you some evidence to back up some of that, but we won't have time for that.
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    I'll just, in ending here, I will say that if anything that you hear today makes a difference to you or enough of a difference to you, then you will have to do something to make some changes. You will have to make some choices. I believe that when we choose, we are not choosing just for ourselves. We have to keep in mind that we are choosing really now for all because it is one world. We are starting to realize that, and see that vision I think more and more, that we are choosing for the human race and for the survival of Earth.
    In one sense, both David and Goliath are within us, within each individual. So we have to decide whom we are going to serve, whom we are going to choose to serve. I do pray that each of us will choose well for the well-being of all of us.
    [The prepared statement of Ms. Gardener follows:]
    [The official committee record contains additional material here.]

    Mr. BURTON. Thank you very much. Any information that you want to submit for the record, we can enter that into the record, even though you haven't had a chance. Maybe during questions and answers, we can cover some of that.
    Ms. Bedell-Logan.
    Ms. BEDELL-LOGAN. Thank you, Mr. Chair, for this opportunity. In 1987, my sister was diagnosed with a Ewing's Sarcoma in the calf of her right leg. The protocol for Ewing's is amputation, chemotherapy, and radiation. This was a very aggressive cancer. Thankfully, the physicians found it in time. I remember her fear of having her leg amputated at 25 years old.
    We were in her room when an oncologist came in and said that there was a new experimental treatment for Ewing's Sarcoma where they would take a tube and slide it down through her vein, starting at the groin, and drop chemotherapy directly on her tumor. She was told that the likelihood of survival would not be changed, and that it very well may save her leg. On the strength of this, my sister opted for the new therapy.
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    At the beginning of the fourth treatment that she had, the technician couldn't get the tube down through her groin any longer, and they took her down to sonogram and found a grapefruit-sized tumor right where they had been going down with the tube. Because of the obstruction of the tumor, my sister developed massive bilateral lymphedema in both legs, which is a swelling of the limbs due to the inability for lymphatic fluid to move in and out of the limb appropriately. This is a very debilitating and very painful process, and because of that pain, the surgeons cut incisions into my sister's thighs and put permanent drains in them to continue to drain the lymphatic fluid. Both of these sites became extremely infected, and my sister was put on large doses of morphine and antibiotics and was dead in 4 months.
    After her death, we found out that she had been a guinea pig. They had never done this procedure in this hospital before, and the physicians were not trained to perform the procedure appropriately. We have also found out that the worst thing you can do to a lymphedema patient is cut into them. This was never subjected to randomized control trials, and it's not used today as standard protocol.
    A month after my sister's death, I started working for Medicare. My goal was to get into the trenches of the healthcare system to find out what makes it tick. I received an excellent education from the Federal Government, and went to work after that for a very large family practice and urgent care center. I have seen the system work from the perspective of the patient, the payer, and the provider.
    I opened my company, Solutions in Integrative Medicine, 10 years ago. My company provides billing and practice management, consulting, and education services for patients, providers, and insurance companies. We have been at the forefront of a change, actively advocating for patients whose insurance companies denied payment for effective, but unconventional services. One of the things that I have heard here today was talk about the uninsured. For those people who are insured, there is a very big problem with getting coverage for anything outside of opening a flower with a hammer.
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    We have been instrumental in developing the administrative and clinical basis for coverage of a host of integrative therapies, often at greatly reduced cost. But this effort has been very tedious, which makes it difficult to make a large enough impact for global change. One of the problems with research is that the researchers sit in their ivory towers and do research, and come up with sometimes very good outcomes for randomized control trials, but we can't implement them at the insurance level. Sometimes it takes 10 years to get a randomized control trial accessible to patients.
    The U.S. Public Health Service estimates that 70 percent of the current healthcare budget is spent on the treatment of approximately 33 million chronically ill individuals. As the population ages, such conditions will consume an even larger portion of the national healthcare dollar. With this in mind, my company's vision is to change the perspective of the healthcare industry by providing professional education to insurance carriers, Medicare, physicians, and patient consumers.
    An example of this education is lymphedema. Twenty percent of all women who have breast cancer, axillary lymph node dissection, mastectomy, will have lymphedema. Those numbers are even higher for men with prostate cancer. These survivors have now contracted lymphedema, the three consequences of lymphedema are swelling, recurrent infections, and tumor formations, called lymphangeosarcoma, which is untreatable. The lymphedema patients who do not receive early intervention may develop elephantiasis, which can lead to amputation of a limb.
    Prompt treatment by specially trained lymphedema therapists who manually drain the engorged tissue has been shown to save limbs, save lives, and save healthcare dollars. The therapy is called combined decongestive therapy [CDT]. It has been a standard treatment in Europe for decades. But today, it is considered an experimental therapy in the United States, and is not a typically covered service. In the United States, our standard approach is to use expensive pumps that mechanically compress and decompress the affected limb, even though this therapy has been shown to have little benefit. In fact, it can press lymphatic fluid in the wrong direction and lead to a worsening of symptoms. For this reason, mechanical pumps for lymphedema have actually been banned in European countries.
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    In the past 2 years, we have been able to begin educating the insurance industry about CDT. We have been able to obtain coverage for Medicare patients in Maine, New Hampshire, Vermont, Massachusetts, and Florida, as well as many commercial insurance beneficiaries all over the country. This type of education and common sense is extremely important when it comes to medicine. Unfortunately, the rest of the public receives conventional treatment, costing insurance companies millions of dollars each year.
    The treatment of lymphedema is just an example of the education and common sense needed in the insurance industry. The illusion is that the best medical practices are based on the result of randomized control trials. It was recently estimated that only 15 percent of medicine today has been subjected to randomized control trials. It is a sad fact that since there is little to be gained by drugs or medical equipment companies from the lymphedema treatment regimen I described earlier, little attention or marketing is focused on such common sense therapies. This is why healthcare cannot simply be left to the private sector. Too often the perverse incentives of our system lead to short-term thinking and pharmaceutical band-aids, rather than comprehensive chronic disease management. The result, strangely, is poor quality healthcare at a higher cost. Those who can break out of the system can afford to pay out of pocket. Integrative medicine is becoming rich people's medicine.
    We must put prevention of chronic illness in the hands of patients, treatment of chronic disease in the hands of integrative medicine teams, and acute and traumatic episodes in the hands of conventional medical providers.
    I will say in closing that my brother died of AIDS in 1994. He was diagnosed in 1980. He was on the television show, 48 Hours, as one of the longest living AIDS patients in the country. They asked him how he did it. He said, ''I stayed away from conventional medicine. I used my conventional medicine doctors to help me decide what were the best alternative treatments for me, and did nothing but alternative therapies,'' and he lived 14 years with a very high quality of life, and died of Karposi Sarcoma. Thank you.
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    [The prepared statement of Ms. Bedell-Logan follows:]
    [The official committee record contains additional material here.]

    Mr. BURTON. Well, thank you very much. That last, not the last thing that you said, but the second-to-last thing that you talked about was very interesting. You are saying that in Europe, they have been using for lymphedema a different approach and it's been done for a good many years, and they have actually outlawed or done away with the pumps that are still being used as conventional medicine here in the United States?
    Ms. BEDELL-LOGAN. That is correct.
    Mr. BURTON. How do you account for that? You mentioned the pharmaceutical companies and some of the companies that produce these things. Do you think it is because of influences of these institutions?
    Ms. BEDELL-LOGAN. I do. In 1997, which I have the report with me, Medicare spent on the East Coast alone, $13 million on pnuematic pumps. Most of those pumps are contraindicated. This is because when lymphatic fluid is simply pushed from the arm or the leg back into the body, it can create genital lymphedema in men and it can create lymphedema built up in the chest of women, which can create lymphangeosarcoma.
    What these specially trained therapists do, who are trained by the Vodder method, which was really born in Germany, is they manually through a massage technique open up the passages for the lymphatic fluid to move out of the arm appropriately, and then they bandage the patient with a compression bandage to stop the arm or leg from filling back up.
    Through this process, they are actually teaching the patients to take care of themselves at home. We don't want to have patients keep coming back and coming back for treatment because that is not cost-effective. But what we do want to do is make sure that these patients are completely self-sufficient in taking care of their own lymphedema. There is no cure for lymphedema, but we can certainly——
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    Mr. BURTON. Minimize it.
    Ms. BEDELL-LOGAN. Minimize it, exactly.
    Mr. BURTON. So through massage and through the bandaging?
    Ms. BEDELL-LOGAN. Exactly. It is a very inexpensive treatment. They usually last anywhere between 2 to 4 weeks, depending on the severity of the case.
    Mr. BURTON. Well, now some women are told by their doctors to wrap their arms or put a casing on their arm every day. Are you talking about that as well?
    Ms. BEDELL-LOGAN. That can be helpful with minimal lymphedema. But when lymphedema becomes fibrotic and the limb gets very hard, the compression bandaging doesn't work unless those fibrosis are broken down through massage therapy.
    Mr. BURTON. Through massage therapy.
    Ms. BEDELL-LOGAN. Right.
    Mr. BURTON. OK. Thank you.
    Ms. Zarycki, you were very critical of a lot of the conventional thinking. I presume you have done a lot of study on this. How did you come to all these conclusions that you came to? It's very interesting to me.
    Ms. ZARYCKI. I initially used conventional treatment. When I first started out, I wanted to take a chance and explore alternative options. I was told by a myriad of conventional doctors that I went to that basically it was OK if I did alternative and it was OK if I did some herbs and this and that, but if I really wanted to make an impact and to live, I should really go with conventional treatment and I should not wait, and if I wanted to do alternative, I could always do that later. That was the comment that I got.
    So instead of feeling like I had time to do more research, I felt like I really had to jump in and do the standard treatment. So in a sense, it would have been nice if both of those practices could have worked together as they do in other countries, as they do around the world, but not always in this country.
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    Mr. BURTON. From a personal standpoint, how do you account for those in Europe having more advanced treatments or optional treatments and the United States doesn't?
    Ms. ZARYCKI. I think they are more open to research than we are, and I think that they are putting funding in other areas and concentrating it in other areas, rather on prevention more so than we are. We are using machines for detection when we should be using ourselves and our own inner energies to understand and work with our immune systems.
    Mr. BURTON. You don't think that the companies that manufacture pharmaceuticals and products are exerting any influence here in the United States, or you haven't had that experience?
    Ms. ZARYCKI. Well, I feel that is a large part of it, yes, in terms of the conventional side, sure. It is all tied together. But when they start getting the funding and when the smaller alternative organizations don't have a chance and they don't have the money to run any trials, clinical trials, randomized trials, that is what is happening in this country. So that is why we need more funding to go for those sorts of efforts.
    Mr. BURTON. For alternative therapies?
    Ms. ZARYCKI. Yes.
    Mr. BURTON. Dr. Gardener, you mentioned that you suffered a great deal because you weren't exposed to or aware of alternative therapies and you continue to suffer because of those. Do you want to elaborate?
    Can you pull the mic closer? I can't hear you.
    Ms. GARDENER. No, that's not what I said.
    Mr. BURTON. OK. I must have misunderstood.
    Ms. GARDENER. Yes. I said it was not because I wasn't aware of them. I became aware of them. But it was because I was not—conventional medicine, first of all, did not respect my right to make choices about myself, about my own situation. It started out, for example, I wanted to have a needle biopsy of the lump, and they wanted to take it out right away.
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    Mr. BURTON. In the form of a mastectomy?
    Ms. GARDENER. No. No, not before they did a biopsy, no. Not before they did a biopsy.
    Mr. BURTON. They didn't want to do a needle biopsy?
    Ms. GARDENER. They didn't want to do a needle biopsy. They wanted to just remove the lump. I wanted to just have a piece of it taken out, to see if it might be cancerous. At that point, we had no idea. I was in very excellent health. I had never felt better, in a sense. I have heard other people say that too, just before they are diagnosed.
    Mr. BURTON. OK. Thank you very much.
    Mrs. Mink.
    Mrs. MINK. Thank you very much. I certainly compliment all three of you for your very interesting and informative, provocative testimony. I know the time doesn't permit me to go into details of what you have to offer this committee and the Congress. I do have one or two points that I think need clarification.
    Carol Zarycki, on your page 4 of your testimony, you said that you were personally not planning to have mammogram followups, and went on to discus the reasons for that conclusion. You heard earlier that there is still overwhelming dependence on mammograms, and that it is one of the major educational thrusts that the medical field is promoting and all the people that are into breast cancer are promoting. I would like to hear some amplification on the reasons you have come to, your own personal conclusion.
    Ms. ZARYCKI. Well, I think mainly, using it as a personal experience, I suffered immense pain and suffering and that had continued on after a mammogram. That had nothing to do with just having a mammogram for having your breast analyzed. So the intense pain and the trauma and that sort of thing which can lead to a chronic condition, is something that women aren't really made aware of.
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    The other thing is that I think as we know, not all mammograms detect all cancers. So in other words, it can be a hit or miss situation. So why should I not subject myself to more immune-enhancing procedures, such as daily breast massage, which is much more immune enhancing when used with a castor oil and almond oil base and protects the person, and we can start our daughters and our children and our nieces on these. It will protect them. It will protect their endocrine, their reproductive systems. If anything is going to protect us, we need to strengthen our bodies. So why tear ourselves apart with machines and biopsies and synthetic drugs when we should be building up our systems.
    Ms. GARDENER. Could I speak to that also?
    Mrs. MINK. Yes, please.
    Ms. GARDENER. Also we know that mammography is extremely ineffective for young women. Even for myself, I was not that young, but my lump which was very easy to feel, did not show up on a mammogram. Also, there is I know of one researcher at the University of North Carolina, who submitted a proposal, and this is an established researcher, well published, et cetera, who submitted a proposal to the Department of Defense to have funding to study sub-populations of women who were particularly susceptible to the radiation from mammograms. There is considerable evidence which was the support for this proposal, that there are these sub-populations in which breast cancer is increased when they are subjected to mammograms.
    There are alternatives such as thermography, which are completely non-invasive and completely harmless.
    Mrs. MINK. So what is your comment then on the lowering of the age to 40 years for suggested annual mammograms?
    Ms. GARDENER. I don't plan to have any mammograms the rest of my life. I tell my daughter not to have them. I think they are dangerous and potentially very damaging. I think there are alternatives equally or more effective.
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    Mrs. MINK. I thank you for those personal comments. I want to add to the record that I was astonished to find that nurses in one particular hospital that I am familiar with, all indicated to me that they were not going to take any of the mammograms, for precisely the reasons that you have indicated. So it strikes me that we really need to open up the dialog on this issue and not put such tremendous reliance on this one technique as the way to make sure that we have early diagnosis and early detection of breast cancer.
    Mrs. Mack certainly reemphasized your point, that notwithstanding the fact that she had had the mammogram and other clinical examinations, it was her own self examination that detected her cancer. So I think there is a great deal in your testimony that needs to set our thinking machines back on again in this very, very critical and vital area.
    Ms. Bedell-Logan, one point that disturbs me which some of my constituents point out to me frequently, is that when they participate in trials or other types of research endeavors, that they are not covered by their insurance, not covered by Medicare, not covered by any health plan, and that they have to assume the costs of these trials individually and personally. Is that your personal understanding to what happens in these medical trials?
    Ms. BEDELL-LOGAN. Absolutely. What we have been doing with insurance companies to try to bring randomized control trials that are very positive to a point of coverage and accessibility for patients much sooner than they are right now, is by creating relationships with insurance companies at the integrative medicine center level, where we treat that particular treatment as a petri dish at that one place. So the insurance company covers that particular service for a period of time, and we measure the outcome of a number of patients using that particular service. The patients get reimbursed for what they do, what they get out of those services, and we look to see what the long-term outcomes are.
    But this is, as I said, one center at a time. It is tedious and very slow. But in the big picture, it can take up to 10 years to get a randomized control trial accessible to patients. That is extremely frustrating. It's frustrating for researchers. A lot of the healthcare dollars that are going toward research, by the time they actually get accessible to patients, there is something better that can be used. So it's really, to a degree, a waste.
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    Mrs. MINK. Mr. Chairman, that is really a very, very important point that we need to pursue why it is that our health policies established by Congress do not recognize the important contributions that these health trials, research trials are making to the ability of cures and other kinds of processes being developed. Unless they are covered by the medical insurance plans and health insurance plans, even our own Federal insurance plans, or Medicare, Medicaid, it is a real gap in our policy understanding.
    Mr. BURTON. Why don't I work with you, and maybe we can draft some amendments to some of the healthcare legislation?
    Mrs. MINK. I would be very happy to. I believe there is a bill pending somewhere, but it needs to really be focused.
    Mr. BURTON. I will have Beth check on that. But let me just say before I yield to my colleague, Mrs. Morella, my wife had a tumor in her breast for the estimated 7 to 8 years that was not picked up by mammograms. She picked it up by accident through physical examination. When she told me about it, I said to her, you really ought to have the doctor check it. She thought it was a fibrous tumor. She went to the doctor and almost walked out of the office without having it checked because she didn't think it was anything, and of course it was. Not only had she had it, but it had spread to her lymph nodes. So they miss about 15 percent of them. That is why you cannot look at a mammogram as a panacea, as these ladies have mentioned.
    Incidently, our next panel is going to talk about some alternative machines, I believe, that are being used in Europe through heat that will tell whether or not there's a cancer present. We ought to take a look at those too. So I hope you will stick around for the next panel.
    Mrs. Morella.
    Mrs. MORELLA. Thank you, Mr. Chairman. I want to thank the three of you for putting a personal face on it and giving us your experiences. As I try to pull this together, it seems to me we are saying first of all, self examination is probably the best way of diagnosing or noting that there is a problem with breast cancer. I also, and I'm going to let you all comment on these observations, second, that there is not enough research that is being done on alternative therapies. Third, is there a problem that researchers who are doing research on medicine, maybe the conventional medicine, don't want to share? I mean do we have a problem of territoriality and possessiveness? I mean should there be some sharing? And then how do people find out about alternative therapies? Should they just experiment, read a book?
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    Finally, do you see a role for diet, exercise, as we heard on the previous panel? What kind of a role does that play? I guess that gets you started, and then if I have more time, I will fire away with some more questions. I guess you could do it in any order that you want.
    Ms. ZARYCKI. I will start out. I will just say that I think, as you mentioned, I think sharing is very important. I have come up with the same question between the two communities, because I in some instances had to be a go-between. I would ask my conventional doctor and tell him something that I was doing alternatively, that an alternative doctor would tell me, and they had worked at the same organization. I said well, why don't you two talk. He said, ''No, no. Why don't you arrange a meeting for us. I don't have time to talk to him.'' So I would get comments like that.
    So my question was, do they really each just want to stay in their own little area of expertise, or do they really not know about each other's expertise? That was my question throughout the whole process. I think it may be half and half. I am not sure. So I think that's real important in terms of sharing. I mean it would be wonderful to share all the information together and come up with some better protocol.
    Mrs. MORELLA. It could also be difficult for a person to make a determination about what alternative therapy to use too.
    Ms. ZARYCKI. Well, when you are first diagnosed, you are kind of hit with everything. My whole learning in this has been if you want to find something, you will. So you have to trust yourself and in a sense, just in the beginning it's very hard, which obviously a lot of us kind of go to whatever seems to be the appropriate thing, which it is at the time. But eventually, you learn about a lot of different things, and then you learn specifically what works. Then you learn that there is a lot out there in terms of the alternative field, but it's not necessarily for breast or women's reproductive cancers. So while I see a lot of my friends doing a lot of different things, a lot of those things may not be as specific as we can be. So I feel my personal responsibility, and I do that with colleagues and friends, and I do that on a personal basis now, is to inform them as to what they really need to do, not to add negative information into their system, be it in the way of a supplement that they may not need or a lot of different things that are just thrown out there on the market as a marketing tool.
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    Mrs. MORELLA. And diet? Do you want to comment?
    Ms. ZARYCKI. Diet is very important. I initially started out looking at a few different programs that basically eliminated fat, eliminated meats, eliminated dairy, a lot of that. Then I integrated that. I spoke to a few different noted practitioners and noted people who had successfully gotten rid of cancers. They all have very positive programs. What I found worked best for me is not to take just one specific program and say I am only going to stick with this program and I am never going to eat this or that, but to really combine them and to use them all and come up with my own program. That is what I teach others today.
    Mrs. MORELLA. I would like to give Dr. Gardener and Ms. Bedell-Logan an opportunity to quickly comment on it too.
    Ms. GARDENER. You ask some great questions, and a lot of them very quickly. Self exam is best. OK, I have to really question that. First of all, early detection is too late. We need to get it way before that. Thermography actually, if we could start to use that, that would actually detect things much before you could even find your own tumor, find your own lump.
    In the 1960's, they were doing trials—and thermography came out of the space satellite age, Sputnik and all that. They were using it to be able to sense. Anyway, sorry. I got off into a tangent. But basically, they were finding a lot of false positives. So they said well, this isn't working, we need to find something else. We are getting too many. False positives are when you say the person has a problem and they don't. OK?
    What they did in a followup study of those that they had assessed was that they found that really those people did develop a significantly higher rate. They did develop breast cancer. So this was in effect a very early detector of cancer. Those are studies that were being done in conjunction with radiologists.
    Also, the problem that you said about researchers, not enough research. I have to say we need not more research, necessarily, but better research. We need to look at interactions. Right now we have rigorous trials, but they are very simplistic. The answer is not simplistic. I know about breast cancer, and we need to look at psychosocial factors, diet, environment, exposures, all of that sort of thing. So we need international sophisticated studies.
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    The third thing, researchers don't want to share. Many people are not aware that a publicly funded, Government-funded study, that data that is collected is not available to any other researchers unless those researchers choose to share it with them. There are precedents now, an increasing number of research centers who are putting their data on the web. It is called public use data bases. That is something that can help us to break down the real barriers to progress that exist now because of political turf issues and wanting results to come out the way you want them to come out, basically. It is research but it's not science. Then the role of diet and exercise—lifestyle is critical.
    Ms. BEDELL-LOGAN. Let me take 30 seconds, if that's OK.
    Mr. BURTON. Sure, go ahead.
    Ms. BEDELL-LOGAN. Self-care and diet, in my opinion, only works for those people who really believe they are going to get cancer. Most people don't. So it takes a wake-up call to stop eating sugar and fat and all of that.
    Second, the research needs to be more pointed and integrated with complementary and alternative medicines, so that we get all sides of the research instead of just one. I believe we have disease in this country called academic constipation. I think we need a legislative colonic to change that. [Laughter.]
    Third, I think we need to heal the business of healing and really get information out to the public as to what is going on in this country.
    Mr. BURTON. Legislative colonic? Well, you know, you hear everything up here after a while.
    Mr. Cummings.
    Mr. CUMMINGS. Thank you very much, Mr. Chairman. I, as I was sitting here, I was trying to listen very carefully to the last two responses. I guess when I sit here and I think about this being the most powerful country in the world, and we're able to do all kinds of things, and here you are here before this Congress of the United States and we can't solve all problems, but certainly we are here to solve problems and lift up the people of this great country.
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    I was just wondering, and sort of piggy back on what you just answered, but a little bit more specific. Sometimes I do believe that there is a disconnect between the public and the Congress. Sometimes I think we don't get it. I speak for all of us. At some point and on different issues, we don't get it. You all have been kind enough to come here and open your lives to us. Believe it or not, open your lives to America, because C–SPAN is covering this. So this is your moment.
    What do you want us to do? What would you like to see us do as the folks who represent you, the 435 of us on this side and the 100 in the Senate? I mean what do you want to see us do? And do you think we get it? Ms. Bedell-Logan.
    Ms. BEDELL-LOGAN. First, I would like to see the Access to Medical Treatment Act looked at a little more closely. I think it is an extremely important bill. I think it needs some attention. Raising the Office of Alternative Medicine to NCCAM was an extremely smart move on the part of the legislation.
    I think that you are right. There is definitely a disconnect between the people and Congress. So many people just don't know what happens here, but they do know what happens at home. What was very interesting in my personal experience is that my sister, who had a very treatable cancer, was dead in 6 months, and my brother who had a terminal illness, was dead in 14 years. We need to get that kind of information out to patients.
    One of the worst things and one of the best things that has happened recently is the Internet. Unfortunately, it can be a very scary thing to surf the Internet about cancer treatments when a patient has no idea what of it is bunk and what of it is actually real. So I think that to a degree, people are getting scared to death, literally. In order to really change that, we have to start to take conventional medicine and move it into an area that allows patient access to the types of things that will soothe the soul as well as the physical body. We don't have those things available to us right now. In every single oncology center, there should be an acupuncturist who controls nausea, instead of giving people contra-indicated medications. There should be a massage therapist in every emergency room, to be dealing with migraine headaches. All of these things, we tend to open flowers with a hammer, as I said earlier. Adverse drug reactions are a huge part of that.
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    What I believe that is going to start with is things like the Access to Medical Treatment Act, which I hope is very much supported in this room. Thank you.
    Mr. BURTON. Would the gentleman yield, real briefly?
    Mr. CUMMINGS. Certainly.
    Mr. BURTON. Let me just say that I met with Congressman DeFazio this morning—yesterday. We are working to get the Access to Medical Treatment Act in proper form. We will be contacting all of you. If you are so inclined, we would love to have you as cosponsors. He will be the primary sponsor. He is the one who came up with the idea. It is a Democrat sponsor. I will be a cosponsor, and we will see if we can't get enough Members to move that thing through.
    Mr. CUMMINGS. I am so inclined, Mr. Chairman. I think that, just to say to you, I think that's wonderful that we can move in a bipartisan manner.
    That is what I want you all to understand, that you put a face on what we do here. I mean sometimes things happen, something happens over here, something happens in Iowa, something happens in Baltimore, something happens in Nevada, and all these things are happening and here we have an opportunity. You represent so many people who are in pain. That is why your testimony here is so very, very important. We just want you to understand that we hear you and we want to connect. We want to get it. So I want to thank you.
    May I just ask one more question? I would like to have Ms. Zarycki, could you answer that same question? I think the doctor had pretty much answered the last time.
    Ms. ZARYCKI. Sure.
    Mr. CUMMINGS. What would you like to see us do as a Congress?
    Ms. ZARYCKI. I think most importantly, since in this country, women faced with cancers initially go to conventional doctors and for conventional treatment, I would just like them to be aware of all the options and to let people, and let us know as patients what options are out there in terms of other things that they may not be promoting, but at least make us aware of them. I think that is all we're asking, so that we can each make our own choices, because it really is an individual process for each of us.
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    Mr. CUMMINGS. So I take it if you don't—somebody, I mean you hear this all the time, Mr. Chairman, the statement that the best patient is the well-informed patient, the one who goes out there and learns as much about his or her illness and whatever, so that they can ask the right questions and I guess do the right things. I guess that's another thing that the American people have to do. Would you all agree with that?
    Ms. BEDELL-LOGAN. I don't really, because I have heard many physicians say to me that the informed patients are the ones who cause the most trouble, so to speak. What happens in many cases is that patients come in after reading off the Internet about acupuncture and herbs and all of this, and their doctors say, ''We don't know anything about that. That's not efficacious.'' My sister had a bottle of garlic on her nightstand, and the oncologist walked in the room and threw it in the trash and said, ''We don't want to give you false hopes. Garlic isn't going to help you.''
    What we need is a healing between the complementary, alternative medicine community and the conventional medicine community so that each one of those sectors of medicine come together and know what the other person is doing. There is nothing more frustrating than a physician getting caught with his shorts down by not knowing what acupuncture does. The physicians get very frustrated, and they say it doesn't work because they don't understand it. We need to change our medical education, which is a huge part of this process as well.
    Mr. CUMMINGS. Thank you, Mr. Chairman.
    Mr. BURTON. Thank you, Mr. Cummings.
    The National Cancer Institute gets $2.7 billion, and less than about 1 percent of that is used on alternative therapy research. I think what we need to do is get them to realize that there is a strong sentiment in the hinterlands that we take a hard look at these alternative therapies, and maybe more money should be taken from that budget for alternative therapy research as well as conventional research.
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    So thank you, ladies, very, very much. We really appreciate your testimony.
    We will now go to our last panel. I think this will be a very enlightening panel as well. We have Dr. Edward Trimble with the National Cancer Institute; Daniel Beilin, from Aptos, CA. I have never heard of that one before, Doctor; Susan Silver, from George Washington University Integrative Medicine Center; and James Gordon, M.D., Center for the Mind Body Medicine out of Washington, DC.
    Thank you all for being so patient. Dr. Gordon has to leave very shortly, so Dr. Gordon, we'll start with you.

    Dr. GORDON. Thank you very much, Mr. Chairman. I am really glad to be here. I appreciate the Members who are here. It has been wonderful listening to the presentations and listening to the dialog and seeing the composition of these panels, because what we have here is the kind of integration that we are talking about and that you are talking about. We have on this panel, we have conventional physicians, people who work with complementary and alternative therapies, we have patients, and patient advocates, and people who are using healing systems of other cultures. I think it is exactly this kind of integration that we need in our healthcare system.
    I am a physician. I work here in Washington, DC. I have a private practice. I also for the last 9 years, I have founded and have led a non-profit called the Center for Mind Body Medicine. I was for 10 years before that, a research psychiatrist at the National Institute of Mental Health. I was the first chair of the Advisory Council to NIH's Office of Alternative Medicine.
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    I have been interested in therapies other than conventional therapies for 35 years. In fact, I was reminiscing with Michio Kushi that I met him some 35 years ago when I was a medical student at Harvard and his teacher, George Osawa, had come over to this country and was bringing macrobiotics here. So this is a movement with some history, and I have some history with this movement.
    I want to focus today on what I hope is one specific answer to some of the questions that are being raised, which is the comprehensive cancer care conference integrating complementary and alternative therapies that you mentioned when you introduced me at the beginning, which is a conference that was created by the Center for Mind Body Medicine, but is now cosponsored by the National Cancer Institute and by the National Center for Complementary and Alternative Medicine, as well as the University of Texas.
    This conference is particularly relevant here. Incidently, I would like to invite anybody who would like to come to please come to this conference. We are in pre-conference workshops now. The conference begins tomorrow morning at 9 at the Hyatt Regency in Crystal City. We welcome everybody, whether or not they can afford the full fee. We have generous scholarships and no one is ever turned away from any of our activities for lack of money. So I want to invite you to participate in this.
    This conference was in a very real sense created to answer some of the questions that have been raised here, and questions that have been raised particularly by women. The questions are, are there any things other than conventional cancer care that I can use for my treatment, complementary or alternative? How do I know if any of them work? How do I know if they are safe? How do I integrate them with complementary and alternative care? Who do I find who knows something about these things? How can I inform my oncologist about them? And how can I get them paid for?
    So we created this conference last year and brought together about 120 presenters from all over the world. This year we have about 130 presenters. What we are doing is trying to answer these questions in a thoughtful way. We are having people like Michio Kushi. In fact, the study that you heard about on macrobiotic treatment of cancer, an early phase of that study was presented last year. We are having the people who are doing the most interesting work in complementary and alternative therapies present their work to the pillars of the American cancer establishment who are open-minded, who are interested in critiquing the work, interested in creating a dialog, and interested in developing the most effective kind of cancer care.
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    I particularly want to acknowledge the National Cancer Institute as well as the National Center for Complementary and Alternative Medicine, and Dr. Klausner, who at one of your hearings actually came up to me and said, ''We love the conference you are doing. Is there anything we can do?'' I said yes, you can cosponsor it and help support it. He said great. Dr. Wittis, his deputy director, who participated with us last year, and Dr. Jeffrey White, who is here, who has developed a whole series of panels for this year's conference. We hope we will continue to collaborate with them on this conference in the years ahead.
    What we have done is both to have the material presented and critiqued at the conference. If you look through the program, you will see the whole variety of plenary sessions and panels that are presented. Then we have also put this information, the presentations together with the critiques, up on our website, which is www.cmbm.org, www.cmbm.org. So the information is there.
    I think the kind of information that the last panelists were looking for, and that I think everybody with cancer is looking for, is let me see the best that is being done around the world, not only in the United States, but in Germany and China and Japan and South America. Let me see it presented, and let me see some people who really know their stuff scientifically, but who are open-minded, take a look at this literature and tell me what they think, and then let me make up my own mind.
    I say this conference began with questions about these therapies for cancer, and that those questions were mostly asked by women. I am talking of course about cancers that women have, but I am also talking about cancers in other members of the family. The Office of Alternative Medicine, 60 to 70 percent of the calls the office receives were about questions about cancer. Most of those calls were from women. In my practice, at our center, it's women not only asking about themselves, but asking about their husbands and parents and children. So women are the ones who are doing much of the investigation. It is their questions we are trying to answer.
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    Let me just share with you three broad areas where I think it is very important to make advances and to make changes, and then I will be happy to answer some questions before I have to leave to go back and give a talk there. The first has to do with this issue of sharing knowledge. We have knowledge available on our website. The National Cancer Institute is beginning to provide some of that knowledge as well. We need to make knowledge, the best possible information about these complementary and alternative therapies available, just as we need to make the best possible information about conventional therapies available.
    Second or as part of that issue of sharing knowledge, I spoke with Dr. Klausner about a year ago and I want to continue speaking with him about training oncologists, physicians, nurses, oncology nurses to provide this kind of counseling, to provide enough time, enough emotional support, enough thoughtful guidance, and enough information about complementary and alternative therapies so that each person who comes who has cancer can have that kind of guidance. This is crucial. I think it is a missing element. People often feel pressured into doing one or another kind of therapy. I think there needs to be a time for reflection. We are very eager at the Center for Mind Body Medicine to create a training program for these counselors. We do it at our center. We believe it needs to be done at a national level so that every patient with cancer should have this kind of informed, sensitive counselor available for a significant period of time. When I work with people with cancer, I spend about an hour and a half to 2 hours with them, discussing their options, discussing their feelings about both conventional and alternative treatment. So that's No. 1, knowledge and how to share it.
    No. 2 is the creation of healing partnerships. Again, this is a theme that I have heard this morning. This requires that we spend more time with patients, and especially that oncologists spend more time with patients. I know a number of oncologists in town. There are oncologists whom every one of my patients loves and loves to go see, and there are oncologists whom they dread seeing. The characteristics of the ones whom they love to see are that these are generally extremely kind people, they are people who take time, they are people who listen to questions, and they are people who if they tend to have preconceptions or areas of ignorance, they say ''I don't know. I would really like to find out more.'' Or ''I may be a little prejudiced. Maybe you could help me see this more clearly, or who should I talk to.''
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    So I think this is crucial, that from the side of the practitioners, and of course not just oncologists, all of us who are physicians, I think that we need to share information. This needs to be encouraged, that all physicians should be sharing the best possible information about all the treatments they do, whether it is for cancer or any other condition, whether it's conventional, complementary, or alternative.
    I also think that it is important that we encourage, and in this instance, women particularly. Women have been the leaders in the movement for self care and in the movement for creating healing partnerships with their physicians. They are the ones who first said, ''What's going on down there, you tell me. I'm not ignorant. I want to know what's happening. I want to take part in my care.'' I think we need to encourage this, not only at the clinical level, but at the national level. I think it is very important, not only that people who are expert in complementary and alternative therapies, but that women like the panelists who are on the last panel, be part of the advisory committees to the different institutes and centers at NIH.
    Finally, or not finally, next to last, coming to the issue of research. Research is crucial, but there need to be new and more imaginative models of research. Coming out of last year's cancer conference, Nicholas Gonzales presented a very interesting, very promising therapy for the treatment of pancreatic cancer, a comprehensive therapy. NCI responded and agreed to fund, and is funding a clinical trial of this therapy, a very comprehensive alternative therapy which is being funded by NCI, and studied by Columbia University. This is the kind of partnership we need. We need to expand from studying single modalities to looking at comprehensive approaches, and we also need to understand that each person who has cancer is an individual, and that an approach that may work for one may not work for others. We need to design research to accommodate that individuality.
    We also need to understand that there is a great deal, and this was brought out in the first panel, that all of us, and anyone who has cancer can do on her or his own behalf, and we need to study those therapies and put much more of an emphasis and much more of a financial emphasis on some of those mind body therapies, changes in attitude, meditation, relaxation, group support, nutrition, exercise, and to really see what is possible for people to do on their own behalf.
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    Finally, I would like to echo the suggestion, and I know your strong feeling, that it is time to pass the Access to Medical Treatment Act. It is time to open up the arena of treatment to all therapies that are offered by responsible people, and to understand that people can assume in partnership with a variety of healers, responsibility for their own care. Thank you very much.
    Mr. BURTON. Thank you. We will push very hard to get that passed. We'll try to get as many cosponsors as possible.
    We are going to have a vote. I would like to have one more of our witnesses speak. Ms. Silver, would you like to go ahead and speak? Then we will run and vote, and we will come right back and try to not have any more unnecessary demands on your time.
    Dr. GORDON. I am going to have to go, though, when you break for the vote. I am sorry I do, but I have to speak at 3 in Virginia.
    Mr. BURTON. That's OK, Dr. Gordon. I am going to try to see you tomorrow anyhow, so we'll talk further.
    Dr. GORDON. Terrific. Thank you.
    Mr. BURTON. Ms. Silver.
    Ms. SILVER. Thank you for the opportunity to address the committee today. All of us who work in the field of complementary and alternative medicine are grateful for the visibility and the validation that you bring to the field by holding this hearing. The Center for Integrative Medicine is a division of the Medical Faculty Associates of the George Washington University Medical Center. Our program includes research, education, and clinical services. Patient care began in April 1998, and from the outset, we included a program for patients with cancer. That program is called the Quality of Life program, and it serves as an adjunct to conventional cancer treatment.
    We share the committee's interest in research and the current level of knowledge about complementary and alternative medicine and its effectiveness in people with cancer. We have submitted two research proposals to NIH to investigate the use of reiki and guided imagery by patients with breast cancer and those undergoing radiation. As we all know, research is in its early stages. Thanks to the Center for Complementary and Alternative Medicine at NIH, the pace at which we receive documentation of complementary and alternative medicine's effectiveness will increase as researchers are supported in investigating these vital questions.
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    At the Center for Integrative Medicine, we are as anxious as anyone for those results. In the meantime though, we ask whether we can proceed with unproven, and note that I said unproven rather than disproven, modalities to assist cancer patients. Our answer is a resounding yes. We have asked ourselves this fundamental question: How can we enhance the quality of life of the person as patient?
    Traditionally, on assuming the role of patient, a person has willingly surrendered quality of life, her sense of orientation and personal control in exchange for a cure. But we are beginning to suspect that surrender may be self defeating. We would suggest that successful medical outcomes are diminished when the patient lacks control, information, and support. Conversely, if these inputs are maximized, the patient may recover more quickly and completely, and have a higher quality of life, whatever the ultimate outcome.
    Most cancer patients say that from the moment of their diagnosis, everything in life is changed. A life that was going on routinely is suddenly out of control. The entire focus on the what if's of cancer treatment and its outcome.
    The Quality of Life program of the Center for Integrative Medicine can assist the patient throughout the course of her illness. At whatever stage of the illness the relationship with the center is initiated, we help determine and meet the patient's needs and goals in a comprehensive way. For patients newly diagnosed and awaiting treatment, we offer stress reduction with a focus on personal control and empowerment, immune system enhancement to help combat the disease, relief from symptoms caused by anxiety or depression as appetite loss, nausea, or sleeplessness.
    For patients undergoing aggressive curative treatment, we offer relief from side effects of treatments, such as nausea or post-operative pain, immune system enhancement to help maximize the effectiveness of the treatment, relaxation and stress reduction to help restore the mind and body between enervating treatments.
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    For patients in remission, we offer stress reduction during periods of watchful waiting, rebuilding of stamina and flexibility following medical and surgical treatments, and resumption of healthful diet and nutrition, with added emphasis on cancer prevention.
    For patients who experience a relapse, all of the services and objectives of the pre-treatment and treatment phase program can be resumed with even greater intensity. For patients with illnesses not responsive to curative treatment, we offer control of pain and symptoms of a progressive illness, mobilization of the powers of the mind to maximize quality of life, and reduction of stress to allow for end-of-life planning and resolution. Overall, the Center for Integrative Medicine aims to restore a sense of control and well-being, and offer the patient the freedoms to heal physically, emotionally, and spiritually.
    Let me offer just two examples of cases in which we are treating women with cancer. The first is a patient with recurrent endometrial cancer. Immediately following surgery, she was referred to our medical center for radiation. Thanks to an active partnership with the Division of Radiation Oncology, the Center for Integrative Medicine was called into the case as the patient came for her initial consultation. Along with vital information about her radiation treatment, the patient was given information about the center and the role of complementary medicine in easing her way through the course of illness. She was given a meditation tape focused on breathing and relaxation exercises that incorporate the details of the radiation experience.
    In the following weeks, the patient participated in meditation and reiki and used both skills to reduce stress during treatment and to assist her in sleeping through the night. As the radiation progressed, side effects became extremely bothersome. Stomach and intestinal upset were frequent. But a combination of acupuncture and nutritional guidance got them under control.
    As the radiation neared completion, the patient began focusing on the future. She requested further nutrition counseling, both to help restore her energy following treatment, and on a larger scale, sought advice on a diet that would do most to prevent a recurrence of her cancer. After 28 successive days of radiation therapy, the patient suddenly felt apprehensive about what to do without it. She had grown attached to her radiation team and to the routine of daily radiation appointments. But she found comfort and support in the relationships that she had formed with the providers in the Center for Integrative Medicine. She continues to practice the modalities that she learned and is looking forward to adding yoga to her routine to help build stamina and regain flexibility. She intends to check in with her complementary medicine team indefinitely for encouragement and renewal.
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    The second patient is a young woman with advanced breast cancer. At the time of diagnosis, she was offered several treatment options, and chose the most aggressive. She is currently undergoing high dose chemotherapy. Before her first treatment, the patient learned reiki and guided imagery. As she faced her initial dose of chemotherapy, she used both modalities actively to reduce her fear and the anticipatory side effects that she experienced. Today, as she continues in treatment, the center's reiki provider meets her at the oncology clinic and practices reiki with her as the medication is administered. Nausea and vomiting seemed inevitable side effects of her treatment, but the patient has found substantial relief with acupuncture.
    This patient's prognosis is guarded. However, she has expressed confidence in the center's ability to maximize her wellness and comfort. She has learned skills for stress reduction and relaxation that she will utilize throughout her life. Whatever the outcome, feels empowered to maintain control of her life.
    Let me say again that the Center for Integrative Medicine offers an adjunctive program of care for women with cancer. We are keenly aware of the remarkable advances in oncology, through medicine, surgery, and radiation. We are in partnership with specialists who practice those techniques. But the goal and the value of our program is this. We change the experience of the cancer patient by placing her at the center of care and treating the whole person, mind, body and spirit.
    Our patients convince us daily of the benefits that the center offers. But what of the patients we never see? The Center for Integrative Medicine operates on a fee-for-service basis, and our patients rarely have insurance coverage for our treatments. Consequently, our program is accessible only to those with the greatest financial wherewithal. Personally, I find it heart breaking to tell callers who are filled with hope, and sometimes desperation, that our services are out of their reach. That is an every day occurrence. I hasten to add that our providers offer a remarkable amount of pro bono care. But the reality remains that to be viable, the center must charge for its services.
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    The issue for payment for complementary and alternative medicine is inextricably linked to research and policy. Only when research demonstrates the efficacy and cost benefit of alternative medicine will it be incorporated into mainstream third party coverage. We need your leadership to harness the demand of millions of Americans to press for pure science, pilot programs, and demonstration projects that will assess the real value of complementary and alternative medicine. We need mandated benefits that will expand the scope of private and public insurance policies to even the most basic complementary modalities. We need Medicare to act as a model by including alternative medicine in its coverage. The Medical Nutrition Therapy Act of 1999, H.R. 1187, would mandate nutrition counseling as a core benefit of Medicare for the purpose of disease management.
    Mr. BURTON. Pardon me, Ms. Silver. We have a vote on the floor. Would you mind——
    Ms. SILVER. I have just about four more sentences.
    Mr. BURTON. All right. Go ahead.
    Ms. SILVER. That bill is languishing, pending major reform of Medicare.
    Mr. BURTON. And the bill number on that again is?
    Ms. SILVER. The House version is H.R. 1187. On the Senate side, it's S. 660.
    Mr. BURTON. OK.
    Ms. SILVER. As we meet here today, 60 million Americans are utilizing complementary and alternative medicine. A substantial number of them are women with cancer. As the Center for Integrative Medicine treats our small share, we are guided by the principle that wellness during illness is not a contradiction in terms.
    Again, I would like to thank the committee for the opportunity to address you today. In a larger sense, I want to thank you on behalf of those who so urgently need our help.
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    [The prepared statement of Ms. Silver follows:]
    [The official committee record contains additional material here.]

    Mr. BURTON. Thank you, Ms. Silver.
    Dr. Beilin and Dr. Trimble, we will be back in just a few minutes. We have one vote on the floor. I am anxious to hear from both of you, so we will be right back.
    Mr. BURTON. I want to first of all thank you for your patience. This has been a very, very long day. I am a little disappointed that what you are going to tell us is probably very, very significant and we didn't have you on earlier in the program. Nevertheless, I can assure you that what you tell us today will be taken to heart and used, and we will talk to the various agencies about it.
    So let's start, I guess go down the list with you, Dr. Beilin.
    Dr. BEILIN. OK. Thank you very much, Mr. Chairman, and members of the committee. Thank you for the opportunity to be here today. My name is Dr. Dan Beilin, OMD, LAc. I have a doctorate in herbal and oriental medicine, and hold a degree in physiology, as I was physiologist at the UCLA Department of Gastroenterology. I am in private practice in California in European complementary medicine and oriental medicine. I have been working in cooperation with a group of doctors and a radiologist, who have been measuring changes in the skin and the nervous system of patients who develop devastating diseases, such as cancer and autoimmune disorders. We have found a high correspondence between the nervous system's ability to control metabolism and circulation, also referred to as thermoregulation or heat regulation, and the growth of tumors and other degenerative disorders.
    In complementary medicine, we try to step back one step and view the patient in terms of the interactions between the internal organs and tissues. Traditional orthodox medicine too often focuses on a single organ of the body, when in reality, many organs are involved in a subtle or not-so-subtle manner in the advancement of a particular disease state. Yet when we look at the body as a collection of systems, each interrelated with the others, we can actually begin to search for the cause of illness. Fortunately, I believe that we are approaching a technology which will provide a bird's eye view of the body as a whole, providing information about multiple organ expression and painting a picture of biological processes that may bring us closer to finding the cause of such diseases as breast cancer.
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    One technology is called regulation thermography, developed in Germany and legally marketed in the United States now. Regulation thermography offers a serious addition to the arsenal of physicians evaluating patients at risk of cancer or cancer recurrence. It works by taking temperature measurements of neurologically controlled points on the skin often above the organ in question, stressing the body with cool air, and then taking a second measurement of the same points. Computer software analyzes the response of the points and their adaptation to the rapid temperature change. More than 25 years of experience has demonstrated a relationship between such responses in organ pathology. The test is non-invasive, painless, and the machine is small enough to fit into a briefcase.
    Regulation thermography is not intended to be a substitute for mammography or other methods of cancer detection. What it does do is provide information to the practitioner about the environment in the body that could be contributing to the cancer growth, allowing the practitioner to design a treatment strategy utilizing the principles of alternative and complementary medicine, staying within the constraints of good science.
    I prepared a few slides that better illustrate the theory behind regulation thermography and its contribution to cancer detection and treatment. So if you will check the monitors, the first slide is the idea of terrain versus tumor. Here, we see a large box, which represents healthy cells and fluids of the body. The small box represents a tumor which has grown for some reason and has now been diagnosed say by a mammogram. Medicine as of 1999, today, has given special attention to the destruction of the tumor, whether by surgery, chemotherapy, or radiation, but has neglected the internal environment that has contributed to the development of that tumor. Until recently, there have not been scientifically verifiable methods for measuring the factors in that tumor terrain. But this is critical if we are to develop therapeutic approaches aimed at treating the whole patient, not simply mounting a frontal attack on the tumor alone.
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    The second slide illustrates how we are internally wired, that the internal organs, such as the stomach, pancreas, liver or prostate, are capable of talking to the nervous system by taking precise measurements of skin temperature as we stress the body, similar to a stress ECG by the cardiologist, we can see how the organs and other tissues of the body behave around that stress. Changes in the way the body behaves to stress can indicate the possible presences of pathologies or pre-pathologies. German and Swiss researchers have gathered data over the last 20 years which have established normal values for stress reactivity in every skin region. Furthermore, many disease states have been documented for their patterns of skin dysfunction over the whole body.
    Mr. Chairman, this is a method that is objective, reproducible, and very serious consideration for inclusion into every new complementary medicine hospital and program. It measures the pattern of response to stress which takes place in the terrain of the body. The information gathered can act as a marker test for lifestyle change prescription effect and preventive measures that have the potential to cut the increasing cost of cancer care.
    In slide three, we see a thermogram above done with this new technology. Above, a normal thermogram, and below, a chaotic thermogram. You can see how there is a complete disruption of a certain pattern. The top one looking homogeneous, the next looks mixed up, showing a lack of regulation, of homeostasis or balance by the organs and nervous system. This is the whole body, with data taken from 80 points.
    In the next slide, this is a study done by Professor Wagner in Germany. We see this, that 63 patients on the left bar with confirmed breast cancer by pathology, were sent to blind doctors doing clinical exams alone, with mammography added, and then with regulation thermography in conjunction with mammography. Interestingly, a higher percentage of tumors were identified using regulation thermography in conjunction with mammography than with mammography alone.
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    This and other studies conducted in Europe demonstrate that dynamic thermography can be a valuable tool in helping to diagnose the presence of occult disease. In fact, some studies suggest that in some cases, regulation thermography offers a viable alternative to mammography. If proven true, this would particularly be useful in geographic regions lacking mammography facilities or as a preliminary screening device for the family physician. In addition, studies suggest that regulation thermography may be able to detect the changes in the body that may preface the development of cancer. With regard to breast cancer and other types of tumors, research indicates that most tumors have taken at least 5 years from their inception to develop into a viewable size. What has occurred to the body's immune mechanisms during those years which creates the pre-tumor and then tumor? What do we know about the fertility of our inner soil, if you will, which nourishes or depletes the development of tumors? For these reasons, I strongly urge consideration for funding for studies in the United States.
    On the last slide, of course breast cancer is not the only disease for which this technology may be utilized. Here is a statistical average of three patients with a progression of PSAs used as a prostate marker, and their corresponding thermogram of the prostate points taken by this method. Note the correspondence of a higher PSA, say on the left is 12.53, to the higher degree of rigidity of response seen in the thermogram are quite evident. When we see the lowering of the PSA, we see a better thermograph coming out as a result.
    The point I make is that complementary medicine is not only comprised of non-scientifically based methods. It has in the past been shunned from the mainstream, but the effect has been to throw the baby out with the bath water. In recent years, Congress has taken important steps to address this issue, primarily through the creation of the Center for Alternative Medicine at the NIH, and the provision of increased funding for research in alternative medicine. Many leading teaching hospitals and other medical centers have established programs focused on researching and using alternative and complementary therapy. One of the roles for the Center of Alternative Medicine should be to act to bring these integrative centers together for advanced research on key technology, such as regulation thermography, and to provide additional funding for research so that the valuable alternative therapies will assume their proper place within the entire healthcare system.
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    Finally in closing, I also recognize that Congress this year will be dealing with the critical issue of patient rights with regard to Government funded and private healthcare plans. Unfortunately, alternative medicine has been neglected in the coverage decisionmaking of many healthcare programs. I ask you while considering this critical legislation, to keep in mind the proven benefits of alternative medicine, and the desires of a significant portion of the American public to have access to such treatment.
    Thank you, Mr. Chairman, for inviting me here today. I appreciate this wonderful opportunity to share my opinions regarding present and future trends in medicine. I hope we can work together in the future.
    [The prepared statement of Dr. Beilin follows:]
    [The official committee record contains additional material here.]

    Mr. BURTON. Dr. Beilin, before we go to Dr. Trimble, I hope when we get to the questions and the answers, that you will talk about, I think it was a proton device that can attack prostate cancer?
    Dr. BEILIN. There is a type of hyperthermia that is a local hyperthermia device that is being reviewed right now.
    Mr. BURTON. I want to ask you about that when we get to the questions and answers.
    Dr. Trimble, thank you, sir, for being so patient with us today.
    Dr. TRIMBLE. Chairman Burton, members of the Committee on Government Reform, thank you for inviting me to represent the National Cancer Institute at this hearing. I am head of the surgery section at the Division of Cancer Treatment and Diagnosis at the NCI. Sitting behind me today is Dr. Jeffrey White, who is Director of the NCI's Office of Complementary and Alternative Medicine.
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    By training, I am an obstetrician/gynecologist and gynecologic oncologist. My own patients include many women with cervical, uterine, ovarian, and breast cancer. My experiences in medicine as well as my own experiences caring for family members with cancer have made clear to me the importance of a holistic approach in cancer care.
    The NCI is committed to fostering the integration of complementary and alternative medicine into modern cancer care. In 1989, we funded key research conducted by Dr. David Spiegel and his colleagues at Stanford and the University of California which demonstrated that psychosocial support prolonged long survival in women with metastatic brain cancer. Working with the National Center for Complementary and Alternative Medicine, we have established a cancer advisory panel for the National Cancer Institute. This panel, which meets three times a year, includes members from the conventional and the CAM cancer research community. This panel will help advise the NCI's Office of Complementary and Alternative Medicine run by Dr. White, on how best to evaluate CAM therapies, how to develop accurate CAM information for the public. We are also working with the National Center for Complementary and Alternative Medicine and other NIH institutes to establish centers for CAM research across the United States.
    I would like to mention a few examples of the NCI's commitment to complementary and alternative approaches in cancer research. As Chairman Burton mentioned, for many years, the NCI has had a program evaluating natural products for anti-cancer activity. One of these products, Taxol, which is found in the bark of the Pacific yew tree, has been shown to improve survival significantly for women with breast, ovarian cancer. We have extended our study of natural products from plants to marine products. We are currently evaluating another natural product, shark cartilage, among patients with breast and lung cancer. We have evaluated chrono-biology, the delivery of chemotherapy timed to a person's circadian rhythms, in women with uterine cancer. We funded an important study conducted at the Harvard Medical School and published last week in the New England Journal of Medicine, which showed that new use of alternative medicine was a marker for greater psycho-social distress and worse quality of life in women with newly diagnosed breast cancer. We have started an unconventional innovations program to spur the development of new technology in the diagnosis and treatment of cancer.
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    We have heard some discussion of the problems of lymphedema today. We have recently opened two phase III trials evaluating the safety of sentinel lymph node biopsy in women with breast cancer. If this is proved safe and efficacious, then we will be able to eliminate the need for axillary lymph node dissection, and spare these women the risk of lymphedema.
    We are pleased to cosponsor the workshop described by Dr. Gordon, which opens tomorrow, on the integration of complementary and alternative therapy in cancer care. We look forward to continued interaction with the complementary and alternative medicine community in our efforts to improve prevention, screening, early diagnosis, treatment, and quality of life for women with cancer. I would be happy to answer any questions you might have.
    [The prepared statement of Dr. Trimble follows:]
    [The official committee record contains additional material here.]

    Mr. BURTON. Thank you, Dr. Trimble. Let me start with you. I am not sure I understood exactly what you just said about the lymph nodes. Is there a non-invasive way to check the lymph nodes? Is that what you are saying? So you don't have to remove them? So that you would not run the risk of lymphedema?
    Dr. TRIMBLE. What has been shown in smaller studies is that by the use of either a dye or a radioactive material, one can find the one or two lymph nodes to which the cancer drains. Those lymph nodes are removed and then examined microscopically. If those lymph nodes are not involved by cancer, then that person does not need a full axillary lymph node dissection. So that's the theory that supports our trial, in which half the people would get a full lymph node dissection, and the other——
    Mr. BURTON. Let me just ask you, in some cases, they don't take out all the lymph nodes. They just take out some of them. If they take out some of the lymph nodes, don't people run the risk of getting lymphedema, even though they haven't taken them all?
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    Dr. TRIMBLE. Well, the risk of—you are correct. There is a risk of lymphedema with only removing some. But in, let's say when a full axillary lymphedectomy is performed, then 20 to 30 lymph nodes may be removed. Whereas in the new sentinel lymph node procedure, only one or two lymph nodes are removed. So the incidence of lymphedema following that sentinel node procedure is almost nothing.
    Mr. BURTON. I see. OK. So instead of taking out 20 or 25 and then finding 5 that had cancer cells in them, you would just take out those that you were able to pinpoint through the radiation?
    Dr. TRIMBLE. Right. Pinpoint that those are the ones that are closest to the cancer. That is where the lymph fluid would drain from that tumor.
    Mr. BURTON. I see. OK. All right.
    Dr. Beilin, you and I talked before the hearing. We were talking about other forms of cancer, such as prostate cancer. You told me that in Europe, they are using a new technology that would eliminate, in many cases, the need for, let's say, in prostate cancer, the prostate to be removed. You could just attack the cancer and part of the prostate. Is that correct?
    Dr. BEILIN. Well, I hesitate to say eliminate the need for it, because every case is individual, and I think that we need a lot more research to be done. But currently there are a number of hyperthermia devices, one in particular is made in Spain, that is going through FDA review right now to be brought over. That involves a penetrating radio frequency hyperthermia that heats tissue beneath the surface of the skin that specifically could be directed toward tumor. There is fair science behind it. So there is a stack of literature that is available privately now, because it's being FDA reviewed by the company. That's just all I know about it.
    Mr. BURTON. How long has that been used in Europe?
    Dr. BEILIN. It's about 6-year-old technology that's now getting to be big in Europe.
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    Mr. BURTON. If it's 6 years in Europe, they must have records on this.
    Dr. BEILIN. Yes, they do.
    Mr. BURTON. Well, does the FDA here in the United States ever solicit those records, or do they just start all over from scratch?
    Dr. BEILIN. That is a very interesting question. My impression with working with the FDA that I have done with the regulation thermography is that they look at most cases as new, and that they do not ask for studies that have been done in foreign countries such as Germany, Switzerland, countries that have the integrity of medicine that we do here. There are countries that are developed in the Western world just like ours, and I think that there should be some kind of movement to accept or at least be interested in the review of previous research that's been done abroad with such things as diagnostic early screening equipment.
    Mrs. Mack, who spoke earlier, she said she did an early detection by palpation, by just feeling. Well, the tumor, when it is 1 centimeter in diameter is already multi-celled with thousands of cancer cells. That is not really early detection. We are talking about recognizing patterns of disarray and the control of tissue 5 years before it would be visable by other methods. So I think we need a little bit of creative expansion in our paradigm.
    Mr. BURTON. Let me ask you about our paradigm. So there are two examples of where the FDA is looking at new technologies that have been used in Europe from anywhere from 6 to 10 years.
    Dr. BEILIN. From 6 to 15 years.
    Mr. BURTON. From 6 to 15 years.
    Now you are here from the FDA, are you not? Do we have anybody here from the FDA today? You are from the FDA? Could you come up to the table, please? Are you prepared to answer any questions? You are only here to monitor the hearing?
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    Well, I will give you a question. We have been told in the last 24 hours of two cases, one involving the instrument involving hyperthermia, and the other instrument we're talking about as far as early detection is concerned, even before it's readily apparent through mammography or through physical testing, that these have been used in Europe for 15 years in one case, and 6 years in another, and they have not yet been approved by the FDA, and they could be a real adjunct to our therapies and research here in the United States and early detection. I would like for you to have the head of the FDA give me a written reason on why they are dragging their feet on these two things. OK? I would like to have that as quickly as possible.
    Dr. BEILIN. Mr. Chairman, if I may add that recently, the FDA has made some changes that are actually positive in that they have granted new areas of possible registration of instruments, diagnostics and treatment that has allowed for marketing approvals more readily than they used to. So at the same time, they may seem slow to acknowledge technologies that have existed with good data, they are also moving in the right direction, from what I can tell.
    Mr. BURTON. Well, I'm glad to hear that, but we still have technologies that could really, really help, at least from every appearance that I have seen, that they are still dragging their feet on. I just hate to see any bureaucracy get in the way of progress that is going to help save lives.
    Ms. Silver, let me just ask you one question, and I'll yield to my colleague. In your statement, and I am trying to recall exactly how you put it, but you indicated that if there's new treatments or new things that people could take who have an illness that's very severe, they should be able to go ahead and take it even though there hasn't been approval yet if their life is at risk. Did I understand you correctly?
    Ms. SILVER. I was referring to the complementary and alternative modalities that we practice in our center. In other words, those have not been proven, by and large. But they have not been disproven. That is to say that no one has suggested or proven that those modalities cause harm or are not efficacious. They have simply not been studied. So for that reason, we ask the question should we withhold those modalities, knowing as we do anecdotally that they can be effective with patients.
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    Mr. BURTON. And your answer is what?
    Ms. SILVER. Our answer is we don't want to withhold those modalities.
    Mr. BURTON. And you do go ahead and use them at the current time?
    Ms. SILVER. We do use them.
    Mr. BURTON. Are you having trouble with the FDA because you do that?
    Ms. SILVER. No, no. These are non-invasive, apart from acupuncture, but the other modalities are non-invasive modalities. Many of them are mind body techniques that people can use routinely. So there is no oversight, as it were, because these are not drugs and they are not invasive procedures. But we also don't want to hold out false hope. We don't want to claim that any of these things is effective. We certainly don't claim that we cure cancer. We do say though that we can change the quality of life of a patient with some of these modalities, and our patients agree that their quality of life has been improved.
    Mr. BURTON. Do you have some questions?
    Ms. CHENOWETH. Mr. Chairman, I just want to thank you so much, for your continuing work in this area and your leadership nationally in this area. It is so very important to us in looking at American health and the role of Government in helping the American people stay healthy and to help them have access to the resources that help them stay ahead of the fight before the disease catches up with them.
    I experienced a very difficult passing of my own mother through radical, as a result of radical surgery because of cancer. So I have strong feelings about this, and am very grateful to you, Mr. Chairman, and to your witnesses. I think that we in this committee need to focus, as you are doing, on helping Government get out of the way. You know, first do no harm is not only a good motto for physicians, but also for legislators. I am afraid that some of our policies that we have implemented have caused harm to the individual in not being able to take control of their life. I am concerned that whenever we try to help, we end up interfering and making the lives of our constituents harder. That is simply unacceptable.
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    Too often, access to public treatments is cutoff because the Federal Government is unsure of its safety. But to people with terminal or potentially terminal illnesses, this seems to be a cruel joke, as it was in the case of my family. I think we need, as you have begun, to seriously question the role of Government in relating to certain institutions that may either help or prevent access to either new treatments or to education and information that will help us prevent disease. So thank you very, very much, Mr. Chairman for this hearing.
    I want to ask Dr. Trimble, could you explain to me what circadian rhythms are?
    Dr. TRIMBLE. Well, circadian rhythms——
    Ms. CHENOWETH. In relation to a patient receiving chemotherapy.
    Dr. TRIMBLE. Right. Circadian rhythms refer to any of the natural rhythms, whether that is day and night or the seasons and how they affect a person's physiology and the functions of their body.
    In this case, we have some preliminary research suggesting that you could decrease the toxicity of chemotherapy if you gave one of the medicines, doxorubicin, at 6 a.m., and the other one, Cisplatin, at 6 p.m. So in a small study, it seemed as though there was less damage to the nerves and less damage to the bone marrow if you staggered the chemotherapy that way.
    The NCI sponsored a large study in which half the women received their chemotherapy at any old time, whenever it was ready, prepared by the pharmacy. The other half got it at 6 a.m., and 6 p.m. Then they looked to see whether there was any difference in the toxicity and damage to nerves or to bone marrow. Unfortunately, in the larger study, there was no difference between the two. But we did think it was an important question and we are continuing to look and see how we can decease the toxicity of our therapies.
    Ms. CHENOWETH. You know, Dr. Trimble, American women and probably women in most of the Western countries, subject themselves to some unpleasantries, mammograms, pap smears. We are careful about self-examination for breast cancer. With 14,500 deaths from ovarian cancer though in 1999, I am deeply concerned that there is no early detection program for this type of cancer. Seventy-five percent of ovarian cancers are not detected until the later stages of disease. So I wanted to ask you, what is the National Cancer Institute doing to help women be able to detect ovarian cancer before it reaches the critical stages?
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    Dr. TRIMBLE. Well this is obviously an extremely important area that we have been working on for some time. We are making a number of efforts to try to improve screening and early detection of ovarian cancer. We are funding a very large trial, the PLCO trial, involving 73,000 women and 73,000 men. The women are being, half of them are being screened with ultrasound and a blood test, CON–25 blood test, for ovarian cancer. So that is a test of the best available technology that we have, versus standard medical care.
    We are also trying to develop some new tests. We have announced an initiative called the Early Detection Research Network, which is an opportunity for us to encourage laboratory research and clinical research into coming up with new tests, new screening tests for a variety of cancers. I know for this particular initiative, there are seven laboratories in the United States which specialize in ovarian cancer that have put together an application just to focus on detecting earlier tests in ovarian cancer.
    In addition, the NCI is committed to funding what is called a SPORE or potentially more than one SPORE in ovarian cancer. We have a SPORE, which stands for Special Program of Research Excellence, in breast cancer and colon cancer, prostate cancer. It has been a very successful program. It is designed to bring research from the bench to the bedside. Nine centers have applied for that program. Those applications will be reviewed at the end of this month.
    So between these three initiatives, we think we are putting a lot of time and attention and money into trying to find a better screening. But you are absolutely right. We need a better screening.
    Ms. CHENOWETH. Thank you, Dr. Trimble. I see that my time is up, but I had some questions for Dr. Beilin. So with the chairman's permission, I would like to submit them in writing.
    Mr. BURTON. No, you can ask the questions. If you would just yield to me though, I have a question that I would like to add and then I will let you proceed. Will you yield to me?
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    Ms. CHENOWETH. We're on.
    Mr. BURTON. Dr. Beilin, this device that they have used in Europe for 15 years that you demonstrated with your slides earlier, would it detect something like ovarian cancer?
    Dr. BEILIN. In some cases. You know, there's no device that is going to be 100 percent or even maybe 80 percent, but there are cases that have been found when they haven't been found in any other way. We send them in. We refer them to radiology or to ultrasound, and do CA–125, the normal blood tests. So we are able to in a small percentage, reveal more than would have normally in other ways been revealed.
    Mr. BURTON. I presume it is the same for prostate cancer or cervical cancer, or any other kind of cancer?
    Dr. BEILIN. There are more cases found, but it's not a system that in any way could be used 100 percent of the time. That's just not the way to think about these things.
    Mr. BURTON. But it would be a good adjunct?
    Dr. BEILIN. It would be a great adjunct, and the cost is very little. The machines are costing less than $15,000, which is about a tenth of any of the other medical scanning or radiological devices.
    Mr. BURTON. Dr. Trimble, I don't want to put you on the spot or the people over at NCI on the spot, but I can't understand why at FDA there's new technologies that have been used for 15 years with some modicum of success, a modicum of success in Europe, that have not been approved by FDA that could help you in detecting early cancer in places like my colleague was just talking about, cervical cancer and ovarian cancer. It seems to me that the bureaucracy isn't working together and there's no communication back and forth.
    I mean if this has been going on for 15 years, even if it would only help one-tenth of 1 percent of the women who have ovarian cancer, it is something that should be looked at. Does your agency ever talk to FDA or look at these things that are going on in Europe and elsewhere?
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    Dr. TRIMBLE. Well, we have very close relations with the FDA, particularly in the areas of chemotherapeutic drugs. We have worked closely with them to design really international systems for monitoring toxicity of drugs and response to chemotherapy, in part so that as products are developed in Europe, we might be able to use that data to submit it to the FDA for approval, so we would not have delays waiting for data to come in on patients in the United States.
    Mr. BURTON. Have you ever heard of this machine before that's been used in Europe?
    Dr. TRIMBLE. I work in the division of cancer treatment, so we have been focused on treatment. We have opened several new initiatives in imaging, one for unconventional imaging. We have also recently funded the American College of Radiology to set up an imaging network to evaluate new imaging in the treatment of cancers. I met yesterday with Dr. Beilin to discuss how this particular technology could be integrated into our research portfolio.
    Mr. BURTON. As well as the other technology he was talking about, the heat device? You talked to him about that as well?
    Dr. TRIMBLE. No. I did not talk to him about that yesterday, but we would be happy to talk with him.
    Mr. BURTON. I wish you would, because it sounds like it's very promising, and it's been used for 6 years in Europe and it's not moving very fast through FDA.
    Can I make a request, and if you would write this down I would really appreciate it. I would like to request that the NCI provide a list to our committee of the cancer treatments, including drugs, devices, and other therapies that are available in Europe and Canada that are not available in the United States. The reason I am asking for that is because I have a feeling that you, and I'm sure you are very dedicated scientists as well as your colleague back there, but I have a feeling because there is so much on your plate right now, a lot of these things that are happening in other parts of the world that may have been going on for some time, may not have been really explored. As a result, some of those things, may be a good idea that might help us.
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    I can remember after World War II, we were bringing all the rocket scientists over here from Germany, many of whom should have been strung up, to help us with our rocket program because they were so far advanced and so far ahead of us. I would just like to know if you could give us a list of all these drugs, devices, and other therapies that are available in Canada and Europe that are not available here, because if we get that list, then we can start seeing what might be helpful. Then we can talk to you about those.
    This is not in any way to denigrate the work you are doing. It is just to say that there might be some adjuncts out there that could be helpful to you.
    Dr. BEILIN. Mr. Chairman, if I might ask the question of Dr. Trimble.
    Mr. BURTON. Sure.
    Dr. BEILIN. What is the status of mistletoe, because mistletoe therapy is being used in many oncology clinics in Europe? From what I understand, is that our drug companies here are trying to recreate a patentable mistletoe to be used as chemotherapy, but without the original mistletoe therapy with the research results that they have gotten being acceptable by FDA.
    Mr. BURTON. Before you answer that question, Dr. Trimble, this is one of the things that really bothers a number of people in Congress, because many people in Congress, including myself, suspect that some of the pharmaceutical companies have undue influence at the Food and Drug Administration and some of our National Health Institutions. I hope that's not the case, but we have that concern. When we hear things like what he just mentioned, that there is a therapy or a substance that is being used like mistletoe in Europe to help in areas like chemotherapy, and instead of using that or exploring what Europeans have done, which is very cost-effective and inexpensive, we have got the pharmaceutical companies trying to come up with something that is patentable from some synthetic property, some synthetic thing. The FDA then tests it, runs it through, they get a 6, 7, 8, or 9 year patent—I don't know how long the patents run on those things—so that they can make money. Who suffers? The patients do when there might be something much less expensive that's on the market over in Europe. Those are things that really bother people in this country.
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    Anyway, go ahead. I'll let you answer.
    Dr. TRIMBLE. Well first, I'll take a pass on the mistletoe because I do not know anything about it. We will get back to you. But that is not an area that I have studied.
    Mr. BURTON. OK. Well that would fall under the category of all the questions I just asked.
    Dr. TRIMBLE. Yes. No, I can comment or I would like to comment on our interaction with our colleagues in Europe and elsewhere. The National Cancer Institute has made a sincere effort to exchange information with colleagues from around the world. We sponsor a meeting in conjunction with the European Organization for Research and Treatment of Cancer every 2 years, to discuss new drug development. We have regular meetings with colleagues in Japan. We also have been strengthening the ties between our clinical researchers in this country, those in Canada, and those in Europe.
    Approximately 3 weeks ago, at the national meeting of the American Society for Clinical Oncology in Atlanta, I participated in a meeting to discuss trials in ovarian, cervical, and uterine cancers with representatives from Australia, Scotland, England, Norway, Sweden, Germany, Austria, and Italy. This is something that is happening in many other cancer sites as well. So we are definitely trying to find out what is going on elsewhere around the world, and make sure that people in the United States have access to the best ideas, wherever they are from.
    Mr. BURTON. Dr. White, I understand that you may know something about the question that was asked about mistletoe?
    Dr. WHITE. Yes. I can tell you a little bit about what we have done in this area. As you probably know, the National Center for Complementary and Alternative Medicine has 10 or I guess now 13 centers that it funds for various different diseases. It has a cancer center at the University of Texas, Houston, which we, NCI, co-funds with the NCCAM. That center is actually doing a phase I study of mistletoe in advanced esophageal cancer. They also have done a variety of pre-clinical studies with other herbal approaches that are used outside the United States predominantly.
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    There are a variety of different preparations of mistletoe that are used in Europe and in Australia and various places. This is using one of those five or six that are available.
    Mr. BURTON. How long has it been used in Europe, do you know?
    Dr. WHITE. I don't know when it first started. The last randomized clinical trial that I am aware of that was done in Europe was published in 1988.
    Mr. BURTON. 1988?
    Dr. WHITE. Yes.
    Mr. BURTON. That was 11 years ago. And we haven't gone through the studies yet on it here in the United States?
    Dr. WHITE. Well, there has not been a study done in the United States, that I am aware of. But the review of that material, as I said, has been done at the University of Texas.
    Mr. BURTON. You know, I have had cancer in my family. I have had people appear at this table here who have little children who are dying, and there's alternative therapies available to them, and we run into stonewalls with some of the agencies, FDA or others, and even doctors who have used some of these therapies they have tried to put out of business. When we hear of therapies, technologies, or simple products like mistletoe, that's being used in Europe with some effectiveness, and people are dying here, and I have to look at these kids and their parents, or some men that had Hodgkins disease that was going to be terminally ill, and he had to go outside the bounds of what's considered law and order to be treated, it really boggles your mind and bothers you. I just can't understand why we are having this kind of a problem.
    If there is a technology or some substance that can be used in Europe and is being used for 10, and you said 11 years ago they were testing this and using it, why is it that the United States, the most advanced country in the history of civilization, is 11 years behind, 15 years behind in this other area, 6 years behind in another area, and when I ask these questions, they say of the FDA, this young lady that's sitting back there, she says, ''Well we'll check on it and get back to you.'' But there really isn't any answer. I just don't understand it.
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    It seems to me that Dr. Trimble and you, Dr. White, and others, ought to be constantly looking at these alternative therapies along with the Food and Drug Administration, to try to make sure that we are giving the American consumer, the American patient, the very best opportunity to live a healthy life and to survive if they are in big trouble. I know you are trying to do that. But it seems to me that some place the golf club is missing the ball. That is why I asked that question of Dr. Trimble, that we get a list of all the cancer treatments they are using in Canada and Europe, and the devices and the other therapies, so that we can at least look at them and see what the heck is going on over there that we are not doing.
    It is really frustrating to me when I hear this kind of stuff. Go ahead.
    Dr. WHITE. Yes. I would just like to put a little bit of perspective on the mistletoe issue. I understand the broader scope of what it is that you are saying, but specifically on mistletoe, the largest clinical trial that I am aware of was a randomized trial with three arms on it, one arm that patients did not receive any supplemental care after their surgery—this is for breast cancer. Another arm received standard chemotherapy, plus or minus radiation therapy for their breast cancer. This is all adjuvant therapy. The third arm received mistletoe.
    The mistletoe arm did better than no therapy, but the chemotherapy arm did better than no therapy. The mistletoe arm did no better than chemotherapy. So I think it's not—so we're talking about first of all, adjuvant therapy. So this is not in advanced forms of cancer. Second, it is not something that represented in that study a step above what was already available to the patients.
    Mr. BURTON. Dr. Beilin.
    Dr. BEILIN. If I may comment that there are statistics being gathered an immunologist and oncologist colleague in Austria for the Germanic countries. They have discovered that statistics seem to be coming out that using chemo plus complementary therapy such as mistletoe together resulting, like in breast cancer, the number is 25 percent less recurrence rates when you use both together. So I think that those kind of statistics need to kind of leap over here so that we can begin to take the best and to integrate them and add them together to have an additive effect. That same statistic came out for prostate and melanoma.
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    Dr. WHITE. Is that published information?
    Dr. BEILIN. I believe so. I can lead you to it.
    Dr. WHITE. I would be happy to review that.
    Mr. BURTON. Well see, this is the kind of communication that every American would like to see all the time, not just at the table here at a hearing.
    So let me just ask two more questions, then I'll yield to my colleague. Then we'll wrap this up, because we have all been here a long, long time. The NCI gets $2.7 billion, $2.7 billion for cancer research. You are spending less than 1 percent of that on alternative therapies. We are hearing things here today that indicate that there are some alternative therapies with promise. I am sure you are going to give me a list of other things that have promise that we're going to get from Europe. Why is it that we only spend $20 million out of $2.7 billion on alternative therapies when half of the Americans who have problems are using and trying to find alternative therapies. It just doesn't make any sense to me. Can you give me an answer to that, Dr. Trimble? Why are we only spending $20 million?
    Dr. TRIMBLE. Well, as I know that Mr. Chairman, that you have had some discussions with my director, Dr. Klausner, on this issue. We realize that we need to provide the American public with accurate information on complementary and alternative medicine, and we need to provide them with accurate appraisal of these techniques in terms of whether they work so that people in the United States can decide for themselves whether they wish to avail themselves of various complementary and alternative medicine techniques.
    Mr. BURTON. But I think you are making my point. We need to spend more money than just less than 1 percent on that. Wouldn't you agree with that?
    Dr. TRIMBLE. Well, I agree that we need to do more research. To that end, we have agreed to co-fund with the other institutes, centers for alternative medicine research across the United States. We are actively soliciting new ideas that we can test at these centers and through with their existing cancer centers. So we hope that we can make more information available and have more and better treatment which combine standard treatment, complementary medicine and alternative medicine for the people of the United States.
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    Mr. BURTON. Let me yield to my colleague. She has to leave.
    Ms. CHENOWETH. Dr. Trimble, could you commit to us how much the National Cancer Institute will dedicate to alternative medicine studies and research?
    Dr. TRIMBLE. No. That's above my pay level to make that kind of a commitment. I will commit that we are actively recruiting studies. We have committed to setting up centers to study complementary and alternative medicine. We will continue to forge a joint approach with our colleagues in other medical disciplines in this area.
    Ms. CHENOWETH. Mr. Chairman, I wonder as a member of your committee, if I might ask that you would ask whoever is in the pay grade——
    Mr. BURTON. Dr. Klausner.
    Ms. CHENOWETH. Dr. Klausner, how much? I would like to know as a Congressman.
    Mr. BURTON. I think what we ought to do is as the Congress take a look at the amount of money we are appropriating for NCI, and talk to the people on the Appropriations Committee. Maybe since NCI of their own volition isn't going to authorize more money for alternative therapies, maybe we should just specify in the appropriations bill how much you have to spend for that. If we did that, maybe that would break the log jam. But I will try to talk to Dr. Klausner. I want you to make a note that we do that.
    I don't have any other questions. Do you have any other questions?
    Ms. CHENOWETH. Mr. Chairman, I just wanted to share on the record with you an observation that I have made. You know, we broke all the barriers down when we passed NAFTA and GATT. Now we have the World Trade Organization. We are importing 22 percent of our beef that comes from foreign countries, and we don't know where. They have certainly different standards than we have. Yet we are consuming that beef not knowing that it's coming from foreign countries. Forty percent of our lamb sometimes comes from 7,000 miles away and we don't seem to ask a question about that. You know, we have toys that come from China, and we have hotwheels that come from Malaysia, and we have dog bones that come from Argentina. Nobody seems to worry about that in this whole global economy.
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    But what about getting information from Europe that we can use on a par the studies and benefit from them? It just seems absolutely incredible to me that we always have to reinvent the wheel when it comes to medicine. Yet in every other arena in this global economy, but medicine, and freedom from medicine, and freedom from the institutions of the individuals sometimes when we make that choice, is what is sorely lacking.
    I am afraid this Congress unfortunately is supporting the institutions and the patients have become a byproduct or just a necessary function for the institutions, instead of the institutions being a necessary function to better healthcare.
    So, Mr. Chairman, I would love to work with you on perhaps requiring something in NAFTA or GATT that would mandate that these studies be accepted by FDA on a par.
    Mr. BURTON. We'll take a look at it. I will get together with you and we will have Beth look into it, and see if we can't maybe do some of that.
    Ms. CHENOWETH. Thank you.
    Mr. BURTON. I think that at the very least, those technologies should not languish for 6, 7, 8, 10, 15 years before they are utilized here in the United States.
    I was just informed that shark cartilage, for instance, I think Dr. Trimble said they are testing that, 7 years ago they started talking about it and we are just now doing it. So it seems like there is a lot of foot dragging.
    Well, I don't have any other questions for you. Thank you, Mr. White. You weren't scheduled to speak, but we do appreciate your coming before us. Dr. Trimble, Dr. Beilin, thank you very much. Ms. Silver, thank you very much. I want to thank you once again for your patience.
    We stand adjourned.
    [Whereupon, at 3:45 p.m., the committee was adjourned.]
    [Additional information submitted for the hearing record follows:]
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    [The official committee record contains additional material here.]