STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
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STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
(Senate - March 06, 1998)
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STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. LEAHY:
S. 1721. A bill to provide for the Attorney General of the United
States to develop guidelines for Federal prosecutors to protect
familial privacy and communications between parents and their children
in matters that do not involve allegations of violent or drug
trafficking conduct and the Judicial Conference of the United States to
make recommendations regarding the advisability of amending the Federal
Rules of Evidence for such purpose; to the Committee on the Judiciary.
parent-child privilege study legislation
Mr. LEAHY. Mr. President, I recently spoke on the floor about the
disgust that I share with most Americans about the tactics of Special
Prosecutor Kenneth Starr and the disturbing spectacle of hauling a
mother before a grand jury to reveal her intimate conversations with
her daughter in a matter, which--even if all the allegations about the
daughter's conduct were true--do not pose grave threats to the public
safety. This matter does not, for example, involve any allegations of
violence or drug trafficking conduct.
In this instance, as in others, Mr. Starr has scurried to apply all
of the legal weapons at his command, but none of the discretion that he
is obligated to exercise as one invested with almost unchecked legal
authority. I also expressed my intent to introduce legislation to study
whether, and under what circumstances, the confidential communications
between a parent and his or her child should be protected. A number of
professional relationships of trust are already protected by legal
privileges, but not familial relationships. This is the legislation I
introduce today.
Currently, under Rule 501 of the Federal Rules of Evidence,
privileges are ``governed by the principles of the common law as they
may be interpreted by the courts of the United States in the light of
reason and experience.'' Thus, in the absence of any Supreme Court
rules or federal statutes, courts look to the United States
Constitution and the principles of federal common law to determine the
applicability and the scope of privileges.
Legal academicians have expressed support for a parent-child
testimonial privilege. The public policy reasons favoring such a
privilege are numerous and relate to the respect we accord to
fundamental family values. Recognition of such a privilege could foster
and
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protect strong and trusting family relationships, preserve the family,
safeguard the privacy of familial communications and intimate family
matters against undue government intrusion, and promote a healthy
environment for the psychological development of children.
Despite these myriad reasons, there are indeed cases and
circumstances when parents should be compelled in court to share what
they know from their children. Indeed, courts have generally not been
receptive to the parent-child privilege. Only four States--Idaho,
Massachusetts, Minnesota, and New York--have adopted either by statute,
or by judicial recognition, some form of a parent-child privilege. No
Federal Court of Appeals have recognized this privilege nor has any
State Supreme Court that has considered the issue. In my own State of
Vermont, such a privilege is not recognized.
To my mind, and as a former prosecutor, prosecutors should show
restraint before putting parents in the untenable position of making a
legal determination as to whether their children should come to them
for advice, or whether the parents instead should feel legally
pressured to refer their own children to professional therapists, or
lawyers, or doctors in order to protect the confidentiality of the
child's communications. To be sure, there are some categories of cases,
particularly cases involving grave threats to the public safety, such
as violent or drug trafficking crimes, where the government can and
should appropriately seek testimony from a parent about what a child
has said. But we should all be clear about when prosecutors should also
show restraint.
Courts have recognized privilege claims in a variety of professional
relationships, ranging from attorneys to priests to psychotherapists.
Yet the relationship between parent and child--the most fundamental
relationship in our society--is generally not so protected in any
circumstances. As one New York court explained:
It would be difficult to think of a situation which more
strikingly embodies the intimate and confidential
relationship which exists among family members than that in
which a troubled young person, perhaps beset with remorse and
guilt, turns for counsel and guidance to his mother and
father. There is nothing more natural, more consistent with
our concept of the parental role, than that a child may rely
on his parents for help and advice. Shall it be said to those
parents, ``Listen to your son at the risk of being compelled
to testify about his confidences?''--In re Application of
A, 61 A.D.2d 426, 403 N.Y.S.2d 375, 378 (1978).
We should consider the sorts of circumstances and the types of cases
in which prosecutors should be asked to show some restraint before
turning to parents to provide evidence against their children. That is
why my bill calls for a study and report by the Justice Department on
what these circumstances should be, and to develop prosecutorial
guidelines accordingly. Specifically, these guidelines should identify
when the communications between parents and their children should carry
the same protections as preferred professional relationships, and the
circumstances and types of cases when those communications should be
subject to government scrutiny.
We cannot rely on the courts to formulate an appropriate parent-child
privilege. The Third Circuit recently declined to recognize the parent-
child privilege, noting that:
The legislature, not the judiciary, is institutionally
better equipped to perform the balancing of the competing
policy issues required in deciding whether the recognition of
a parent-child privilege is in the best interests of society.
Congress, through its legislative mechanisms, is also better
suited for the task of defining the scope of any prospective
privilege. . . . In short, if a new privilege is deemed
worthy of recognition, the wiser course in our opinion is to
leave the adoption of such a privilege to Congress.--In re
Grand Jury Proceedings (Impounded), 103 F.3d 1140, 1148, 1153
(3d Cir. 1996).
Likewise, the Seventh Circuit Court of Appeals has made clear that
``courts have been reluctant to create new privileges, preferring to
leave such matters to the legislature despite any policy reasons
supporting recognition of a particular privilege.'' United States v.
Riley, 653 F.2d 1153, 1160 (7th Cir. 1981).
Congress should accept this challenge. My bill is a start to the
process of seeking expert input on the significant question of when the
government may not compel parents to betray the confidences of their
children, and when because of compelling need or the nature of the case
or circumstances, parents should be required to reveal the substance of
what their children have told them.
Thus, the bill I introduce today directs the Attorney General to
develop Federal prosecutorial guidelines to protect familial privacy
and parent-child communications in matters that do not involve
allegations of violent or drug trafficking conduct. In addition, the
legislation would direct the Judicial Conference to undertake a study
and then give us a report on whether the Federal Rules of Evidence
should be amended to explicitly recognize a parent-child privilege in
cases not involving violent or drug trafficking conduct, and, if so, in
what circumstances that privilege should apply.
While we should endeavor to provide the maximum protection for
parent-child communications, we should also be careful not to unduly
obstruct law enforcement. Nor should the rule be susceptible to
litigious mischief.
Accordingly, the Attorney General and the Judicial Conference will
need to address, as part of the study and report called for in my bill,
a series of important questions, including:
(1) What communications should be considered confidential for
purposes of the privilege and, specifically, should the privilege apply
in both criminal and civil proceedings?
(2) Should such a privilege apply only to unemancipated minors, or
also to adult children?
(3) Should only the child's communications be protected, or should a
parent's communications to a child also receive protection?
(4) Should such a privilege extend beyond a child's natural parents
to include step-parents or grandparents?
(5) Should such a privilege be subject to rebuttal if the government
establishes a compelling need for the information?
This legislation is the first step in evaluating the merits and
difficulties inherent in protecting familial privacy and the parent-
child relationship against unwarranted intrusions by the government and
by overzealous prosecutors. The public and these families themselves
should not have to endure repeated scenes of mothers being marched into
grand jury inquisitions to reveal intimate talks they may have had with
their children about their private relationships. This is a far cry
from allegations concerning violent or drug trafficking conduct. Let us
find out what the Justice Department and Judicial Conference recommend
about how we can best protect child-parent confidences in ways that
comport with American notions of family, fidelity, and privacy, without
compromising our public safety and the integrity of our judicial
system.
I ask unanimous consent that a copy of the bill be printed in the
Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 1721
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. CONFIDENTIALITY OF PARENT CHILD COMMUNICATIONS IN
JUDICIAL PROCEEDINGS.
(a) Study and Development of Prosecutorial Guidelines.--The
Attorney General of the United States shall--
(1) study and evaluate the manner in which the States have
taken measures to protect the confidentiality of
communications between children and parents and, in
particular, whether such measures have been taken in matters
that do not involve allegations of violent or drug
trafficking conduct;
(2) develop guidelines for Federal prosecutors that will
provide the maximum protection possible for the
confidentiality of communications between children and
parents in matters that do not involve allegations of violent
or drug trafficking conduct, within any applicable
constitutional limits, and without compromising public safety
or the integrity of the judicial system, taking into
account--
(A) the danger that the free communication between a child
and his or her parent will be inhibited and familial privacy
and relationships will be damaged if there is no assurance
that such communications will be kept confidential;
(B) whether an absolute or qualified testimonial privilege
for communications between a child and his or her parents in
matters that do not involve allegations of violent or drug
trafficking conduct is appropriate to provide the maximum
guarantee of
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familial privacy and confidentiality without compromising
public safety or the integrity of the judicial system; and
(C) the appropriate limitations on a testimonial privilege
for such communications between a child and his or her
parents, including--
(i) whether the privilege should apply in criminal and
civil proceedings;
(ii) whether the privilege should extend to all children,
regardless of age, unemancipated or emancipated, or be more
limited;
(iii) the parameters of the familial relationship subject
to the privilege, including whether the privilege should
extend to stepparents or grandparents, adopted children, or
siblings; and
(iv) whether disclosure should be allowed absent a
particularized showing of a compelling need for such
disclosure, and adequate procedural safeguards are in place
to prevent unnecessary or damaging disclosures; and
(3) prepare and disseminate to Federal prosecutors the
findings made and guidelines developed as a result of the
study and evaluation.
(b) Report and Recommendations.--Not later than 1 year
after the date of enactment of this Act, the Attorney General
of the United States shall submit a report to Congress on--
(1) the findings of the study and the guidelines required
under subsection (a); and
(2) recommendations based on the findings on the need for
and appropriateness of further action by the Federal
Government.
(c) Review of Federal Rules of Evidence.--Not later than
180 days after the date of enactment of this Act, the
Judicial Conference of the United States shall complete a
review and submit a report to Congress on--
(1) whether the Federal Rules of Evidence should be amended
to guarantee that the confidentiality of communications by a
child to his or her parent in matters that do not involve
allegations of violent or drug trafficking conduct will be
adequately protected in Federal court proceedings; and
(2) if the rules should be so amended, a proposal for
amendments to the rules that provides the maximum protection
possible for the confidentiality of such communications,
within any applicable constitutional limits and without
compromising public safety or the integrity of the judicial
system.
______
By Mr. FRIST (for himself, Mr. Lott, Mr. Jeffords, Mr. Kennedy,
Mr. Gregg, Mr. Dodd, Mr. Enzi, Mr. Harkin, Mr. Hutchinson, Ms.
Mikulski, Ms. Collins, Mr. Bingaman, Mr. McConnell, Mr.
Wellstone, Mrs. Murray, Mr. Reed, Ms. Snowe, Mr. Nickles, Mr.
Mack, Mrs. Boxer, Mr. Daschle, Mr. Chafee, Mrs. Feinstein, Mr.
Roth, Mr. Specter, Mr. D'Amato, Mr. Domenici, and Mr.
Santorum):
S. 1722. A bill to amend the Public Health Service Act to revise and
extend certain programs with respect to women's health research and
prevention activities at the National Institutes of Health and the
Centers for Disease Control and Prevention; to the Committee on Labor
and Human Resources.
the women's health research and prevention amendments of 1998
Mr. FRIST. Mr. President, I am very pleased to introduce today, with
the majority leader, the Women's Health Research and Prevention
Amendments of 1998. The purpose of this bill is to increase awareness
of some of the most pressing diseases and health issues that women in
our country face. This bill focuses on women's health research and
prevention activities at the National Institutes of Health and the
Centers for Disease Control and Prevention.
Our goal, in introducing this bill today, is to create greater
awareness of women's health issues and to highlight the critical role
our public health agencies--the NIH, the National Institutes of Health,
and the CDC, the Centers for Disease Control and Prevention--play in
providing a broad spectrum of activities to improve women's health,
including research, screening, health data management, prevention and
treatment of diseases, and broad health education.
This bill reauthorizes programs at the National Institutes of Health
for vital research activities into the causes, prevention, and
treatment for some of the major diseases affecting women, including
osteoporosis, breast cancer, ovarian cancer, as well as research into
the aging processes of women.
Let me cite just a few statistics to illustrate the need for further
research into these health issues.
Osteoporosis is a health threat for 28 million Americans, 80 percent
of whom are women. One in every two women over the age of 50 years will
have an osteoporosis-related fracture.
One out of every eight women will develop breast cancer over the
course of their lifetimes, and 1 in 25 will die of breast cancer.
Ovarian cancer is the fourth leading cause of death from cancer among
women. One of the most troubling aspects of ovarian cancer is the
challenge we have in diagnosing this disease earlier and earlier. We
know that a late diagnosis results in a worse outcome. The
reauthorization of these research programs will help assure scientific
progress in our fight against these diseases and will lessen their
burden on women and their families.
For far too long, women in this country have been neglected in many
of our research clinical studies. I am very pleased that, since 1993,
we have developed guidelines to include women and minorities in NIH-
sponsored trials. However, we must continue to do more. We must
continue to review our women's health research agenda to set future
research priorities and to incorporate new scientific knowledge
regarding women's health. We must continue to focus and coordinate all
our efforts in research areas, including clinical trial research
design, genetic factors, the aging process, and other gender-based
differences.
I am also pleased in this bill that we authorize a new research
program at the National Heart, Lung, and Blood Institute at the NIH to
target heart attack, stroke, and other cardiovascular diseases in
women. This program, originally introduced by my colleague, Senator
Boxer, will advance research into cardiovascular diseases--the leading
cause of death in the United States in women. More than 500,000
American women will die annually from cardiovascular diseases.
Cardiovascular diseases--that is, diseases of the heart and the blood
vessels--kill almost twice as many American women as all other cancers.
One of the biggest myths in medicine is that heart disease is only a
male problem. When we think of a heart attack, many people associate it
with men. Even in my own studies during my internship and residency in
medicine--not that long ago--all the models, the pictures that were
used in textbooks, the warning signs on TV--always pictured a man.
However, since 1984, the number of cardiovascular disease deaths in
women has exceeded those of men. And in 1995, 50,000 more women died of
heart disease than men. The program we are including in the bill today
will expand the research programs at NIH to concentrate more on
cardiovascular diseases in women.
Our bill reauthorizes several programs at the Centers for Disease
Control and Prevention for prevention and education activities on
women's health issues. We are reauthorizing the National Center for
Health Statistics, the National Program of Cancer Registries, the
National Breast and Cervical Cancer Early Detection Program, the
Centers for Research and Demonstration of Health Promotion and Disease
Prevention, and the Community Programs on Domestic Violence.
CDC's programs provide critical health services in each of our States
and in our communities to detect, prevent, and diagnose diseases such
as breast and cervical cancer. For the past 7 years, the National
Breast and Cervical Cancer Early Detection Program has provided
critical cancer screening services to underserved women, especially
low-income women, elderly women, and members of racial and ethnic
minority groups. CDC supports early detection programs in all 50
States, in 5 territories, in the District of Columbia, and in 14
American Indian/Alaskan Native organizations. Through March 1997, more
than 1.3 million screening tests have been provided by this one
program.
CDC programs provide critical data and statistics about women's
health that assist us in making informed policy decisions about health
care. The National Center for Health Statistics often provides the only
national data on the health status of U.S. women and their use of
health care. A recent report by the National Center for Health
Statistics entitled ``Women: Work and Health'' summarized the data on
health conditions affecting working women. This report is the first
comprehensive survey on work-related
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health issues encountered by the more than 60 million women in the
American labor force.
I thank the majority leader for his leadership on this issue and for
his efforts in the introduction of this bill. I am pleased to state
that this bill is bipartisan. We have included provisions that are the
product of the efforts of many of my colleagues--Senators Snowe,
Harkin, Boxer, and many others. We have the support of nearly the full
Senate Labor and Human Resources Committee, and over 27 Members of the
Senate are original cosponsors of this bipartisan bill. The level of
support for this bill is a real testament to the need to combat the
diseases affecting women and to maintain those crucial health services
that help prevent these diseases.
This bill, again, is introduced to generate discussion of these
important programs. We intend to consider these programs within the
context of the upcoming NIH reauthorization bill to be introduced over
the next several months. I encourage all Members and constituencies to
review the current programs and to provide input as we set the future
agenda of women's health research and prevention in this Nation.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 1722
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Women's Health Research and
Prevention Amendments of 1998''.
TITLE I--PROVISIONS RELATING TO WOMEN'S HEALTH RESEARCH AT THE NATIONAL
INSTITUTES OF HEALTH
SEC. 101. EXTENSION OF PROGRAM FOR RESEARCH AND AUTHORIZATION
OF NATIONAL PROGRAM OF EDUCATION REGARDING THE
DRUG DES.
(a) In General.--Section 403A(e) of the Public Health
Service Act (42 U.S.C. 283a(e)) is amended by striking
``1996'' and inserting ``2001''.
(b) National Program for Education of Health Professionals
and Public.--From amounts appropriated for carrying out
section 403A of the Public Health Service Act (42 U.S.C.
283a), the Secretary of Health and Human Services, acting
through the heads of the appropriate agencies of the Public
Health Service, shall carry out a national program for the
education of health professionals and the public with respect
to the drug diethylstilbestrol (commonly know as DES). To the
extent appropriate, such national program shall use
methodologies developed through the education demonstration
program carried out under such section 403A. In developing
and carrying out the national program, the Secretary shall
consult closely with representatives of nonprofit private
entities that represent individuals who have been exposed to
DES and that have expertise in community-based information
campaigns for the public and for health care providers. The
implementation of the national program shall begin during
fiscal year 1999.
SEC. 102. RESEARCH ON OSTEOPOROSIS, PAGET'S DISEASE, AND
RELATED BONE DISORDERS.
Section 409A(d) of the Public Health Service Act (42 U.S.C.
284e(d)) is amended by striking ``and 1996'' and inserting
``through 2001''.
SEC. 103. RESEARCH ON CANCER.
(a) In General.--Section 417B(a) of the Public Health
Service Act (42 U.S.C. 286a-8(a)) is amended by striking
``and 1996'' and inserting ``through 2001''.
(b) Research on Breast Cancer.--Section 417B(b)(1) of the
Public Health Service Act (42 U.S.C. 286a-8(b)(1)) is
amended--
(1) in subparagraph (A), by striking ``and 1996'' and
inserting ``through 2001''; and
(2) in subparagraph (B), by striking ``and 1996'' and
inserting ``through 2001''.
(c) Research on Ovarian and Related Cancer Research.--
Section 417B(b)(2) of the Public Health Service Act (42
U.S.C. 286a-8(b)(2)) is amended by striking ``and 1996'' and
inserting ``through 2001''.
SEC. 104. RESEARCH ON HEART ATTACK, STROKE, AND OTHER
CARDIOVASCULAR DISEASES IN WOMEN.
Subpart 2 of part C of title IV of the Public Health
Service Act (42 U.S.C. 285b et seq.) is amended by inserting
after section 424 the following:
``heart attack, stroke, and other cardiovascular diseases in women
``Sec. 424A. (a) In General.--The Director of the Institute
shall expand, intensify, and coordinate research and related
activities of the Institute with respect to heart attack,
stroke, and other cardiovascular diseases in women.
``(b) Coordination With Other Institutes.--The Director of
the Institute shall coordinate activities under subsection
(a) with similar activities conducted by the other national
research institutes and agencies of the National Institutes
of Health to the extent that such Institutes and agencies
have responsibilities that are related to heart attack,
stroke, and other cardiovascular diseases in women.
``(c) Certain Programs.--In carrying out subsection (a),
the Director of the Institute shall conduct or support
research to expand the understanding of the causes of, and to
develop methods for preventing, cardiovascular diseases in
women. Activities under such subsection shall include
conducting and supporting the following:
``(1) Research to determine the reasons underlying the
prevalence of heart attack, stroke, and other cardiovascular
diseases in women, including African-American women and other
women who are members of racial or ethnic minority groups.
``(2) Basic research concerning the etiology and causes of
cardiovascular diseases in women.
``(3) Epidemiological studies to address the frequency and
natural history of such diseases and the differences among
men and women, and among racial and ethnic groups, with
respect to such diseases.
``(4) The development of safe, efficient, and cost-
effective diagnostic approaches to evaluating women with
suspected ischemic heart disease.
``(5) Clinical research for the development and evaluation
of new treatments for women, including rehabilitation.
``(6) Studies to gain a better understanding of methods of
preventing cardiovascular diseases in women, including
applications of effective methods for the control of blood
pressure, lipids, and obesity.
``(7) Information and education programs for patients and
health care providers on risk factors associated with heart
attack, stroke, and other cardiovascular diseases in women,
and on the importance of the prevention or control of such
risk factors and timely referral with appropriate diagnosis
and treatment. Such programs shall include information and
education on health-related behaviors that can improve such
important risk factors as smoking, obesity, high blood
cholesterol, and lack of exercise.
``(d) Authorization of Appropriations.--For the purpose of
carrying out this section, there is authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 1999 through 2001. The authorization of
appropriations established in the preceding sentence is in
addition to any other authorization of appropriation that is
available for such purpose.''.
SEC. 105. AGING PROCESSES REGARDING WOMEN.
Section 445I of the Public Health Service Act (42 U.S.C.
285e-11) is amended by striking ``and 1996'' and inserting
``through 2001''.
SEC. 106. OFFICE OF RESEARCH ON WOMEN'S HEALTH.
Section 486(d)(2) of the Public Health Service Act (42
U.S.C. 287d(d)(2)) is amended by striking ``Director of the
Office'' and inserting ``Director of the National Institutes
of Health''.
TITLE II--PROVISIONS RELATING TO WOMEN'S HEALTH AT THE CENTERS FOR
DISEASE CONTROL AND PREVENTION
SEC. 201. NATIONAL CENTER FOR HEALTH STATISTICS.
Section 306(n) of the Public Health Service Act (42 U.S.C.
242k(n)) is amended--
(1) in paragraph (1), by striking ``through 1998'' and
inserting ``through 2002''; and
(2) in paragraph (2), by striking ``through 1998'' and
inserting ``through 2002''.
SEC. 202. NATIONAL PROGRAM OF CANCER REGISTRIES.
Section 399L(a) of the Public Health Service Act (42 U.S.C.
280e-4(a)) is amended by striking ``through 1998'' and
inserting ``through 2002''.
SEC. 203. NATIONAL BREAST AND CERVICAL CANCER EARLY DETECTION
PROGRAM.
(a) Grants.--Section 1501(b) of the Public Health Service
Act (42 U.S.C. 300k(b)) is amended--
(1) in paragraph (1), by striking ``nonprofit''; and
(2) in paragraph (2), by striking ``that are not nonprofit
entities''.
(b) Preventive Health.--Section 1509(d) of the Public
Health Service Act (42 U.S.C. 300n-4a(d)(1)) is amended by
striking ``through 1998'' and inserting ``through 2002''.
(c) General Program.--Section 1510(a) of the Public Health
Service Act (42 U.S.C. 300n-5(a)) is amended by striking
``through 1998'' and inserting ``through 2002''.
SEC. 204. CENTERS FOR RESEARCH AND DEMONSTRATION OF HEALTH
PROMOTION.
Section 1706(e) of the Public Health Service Act (42 U.S.C.
300u-5(e)) is amended by striking ``through 1998'' and
inserting ``through 2002''.
SEC. 205. COMMUNITY PROGRAMS ON DOMESTIC VIOLENCE.
Section 318(h)(2) of the Family Violence Prevention and
Services Act (42 U.S.C. 10418(h)(2)) is amended by striking
``fiscal year 1997'' and inserting ``for each of the fiscal
years 1997 through 2002''.
Mr. LOTT. Mr. President, this morning I am very pleased to join
Senator Frist of Tennessee, who is an outstanding Senator, and also a
doctor, who has been very helpful to me, and a lot of Senators, since
he joined this body, in introducing legislation entitled ``The Women's
Health Research and Prevention Act.''
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The bill authorizes and reauthorizes a collection of first-class
research and prevention programs in the National Institutes of Health
and the Centers for Disease Control and Prevention.
Breast cancer is the leading cause of death in women between the ages
of 40 and 55. About one out of every eight women in the United States
will, unfortunately, develop breast cancer during their lifetime. And
so the Frist-Lott bill reauthorizes breast and ovarian cancer research
and education programs at NIH.
Osteoporosis is a disease in which bones become fragile and more
likely to break. My wife is beginning to confront this particular
problem. As women age, they lose bone mass and are at risk of
debilitating accidents such as fractures. This bill extends
osteoporosis research and education programs at NIH.
Women's health, though, means more than just health issues specific
to women. Heart disease, for instance, the No. 1 killer in the U.S. of
women, of course, also affects men in great numbers. Hypertension, a
leading cause of heart disease, is two to three times more common in
women than in men.
In addition to these three key research areas, our bill continues
programs in the Centers for Disease Control, including the National
Program of Cancer Registries and the National Early Detection Program
for breast and cervical cancer.
Senator Frist, the Senate's only doctor, and an outstanding heart
surgeon himself, provided the details of the bill. Senator Frist is
chairman of the Senate Public Health Subcommittee of the Senate Labor
Committee, and is one of the Senate's key leaders on all of our health
issues.
I am pleased that he is also serving on our Medicare commission that
had its first meeting yesterday, including a meeting with the
President.
I have often turned to him for advice and guidance on health matters,
and will continue to do so in the future. I believe that just this
morning Senator Frist attended a meeting regarding Medicare, and that
will be helpful in this effort. I know it will be a bipartisan effort.
I encourage colleagues on both sides of the aisle to cosponsor this
important legislation.
This morning I was made aware that Senator Mack is a cosponsor, and
Senator D'Amato. We are inviting all Members to join us in this very
serious and very important issue that we need to act on in order to
reauthorize some of these programs and authorize new ones.
I thank Senator Frist for his leadership in this area, and I yield
the floor.
Mr. JEFFORDS. Mr. President, I rise to recognize Senator Frist for
taking an important step that brings together a number of Government
programs of research, treatment and disease prevention for women. Over
the past several years, Congress and the Nation have become
increasingly concerned about women's health. I appreciate the
leadership and the expertise that Dr. Frist brings to Congress about
these issues. We have much to learn about recognizing and treating the
medical needs of women.
In the first session of the 105th Congress, at least 21 bills
relating to women's health were introduced and referred to the Senate
Labor and Human Resources Committee. At our committee hearing on
women's health last July, we heard about important advances being made
in research. We also heard about significant gaps of knowledge which
need to be filled. More importantly, we recognize how important it is
to get information about scientific advances to the public and their
health care providers.
Thus, I am pleased the provisions of this bill provide for research
and for public and professional education. We know that once the
information is out to the public and health care professionals, we need
screening programs, closely followed by access to treatment. The bill
provides for important patient services.
Finally, once common conditions are well recognized, detected and
treated, we need data to track our progress in disease prevention and
to alert us to new help in illness trends. This bill provides for these
functions through the support for cancer registries, information
systems, and program evaluation. It is my hope that having women's
issues collected together in one bill will focus the attention of
Congress and the Nation on vigorous support of the woman's health
initiative.
I am pleased to join Senator Frist in sponsoring this legislation.
Mr. KENNEDY. Mr. President, I commend Senator Frist for his
leadership on the bill we are introducing today, ``The Women's Health
Research and Prevention Amendments of 1998.'' This bill is a bipartisan
effort to extend and strengthen several important women's health
programs at the National Institutes of Health and the Centers for
Disease Control and Prevention.
In recent years, women's health has begun to receive the high
priority it deserves. Five years ago government guidelines were finally
eliminated that specifically excluded women from many clinical trials.
Increasingly, Congress has given higher priority to funds to address
breast cancer and other women's health issues. We also established the
Office of Women's Health within the Department of Health and Human
Services, in order to develop and implement a national agenda for
women's health. These successes, however, have revealed that there is
much more to be done.
The bill we are introducing today is an attempt to fill some of the
gaps in research and prevention that we have identified in women's
health. It is time for Congress to acknowledge that women's health
involves a wider range of issues, and that the magnitude of these
issues varies greatly with age. Car crashes and unintended injuries are
the leading killer of women in their teens and twenties. Cancer is the
leading killer of women between the ages of 25 and 64. Heart disease is
the leading killer among women over 65.
The nation's agenda on women's health must also address other key
issues that are more common among women but affect men too, such as
osteoporosis, depression, and auto-immune diseases, and illnesses that
manifest themselves differently in men and women, such as heart
disease, substance abuse, AIDS, and violence.
Our legislation extends important research and prevention activities
now being carried out by the National Institutes of Health and the
Centers for Disease Control and Prevention in areas traditionally
considered women's health issues, such as breast and ovarian cancer,
osteoporosis, and domestic violence. It also calls for greater research
efforts on heart attacks, strokes, and other cardiovascular diseases,
in recognition of the serious effects of these diseases on women.
Our bill also provides continued support for academic health centers
to conduct research and demonstration projects related to health
promotion and disease prevention to improve quality of life, and to
curb premature mortality and illness that contribute to excessive
health costs. These academic health centers are effective in informing
women and their physicians of steps they can take to prevent serious
illness and injury, especially in cases involving chronic and
debilitating physical illness, such as arthritis and osteoporosis,
which put women at high risk for bone fractures.
In order to enable researchers to monitor health trends among women
and to help policymakers make informed decisions on the allocation of
resources, it is essential for accurate and timely statistical and
epidemiological data to be available. Our bill will provide continued
support of the CDC's National Center for Health Statistics, which
provides valuable data related to overall health status, lifestyle,
onset and diagnosis of illness and disability, and use of health care
and rehabilitation services.
It is also important to understand differences between racial and
ethnic groups. For example, black women have far higher death rates
from heart disease, cancer, stroke and diabetes than white women.
Minority women suffer the most from AIDS. More than half of new female
cases of AIDS over the past decade were found among blacks. For other
chronic diseases, black women have the highest rates of hypertension,
while Native American women have higher rates of asthma and chronic
bronchitis. This bill will enable the National Center for Health
Statistics to continue its important work on the health of ethnic and
racial populations, and improve methods to collect data on these
subgroups in
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order to understand and address their various health needs more
effectively.
Too many health needs of women continue to be neglected by the
nation's health care system. The cost of this national neglect, both in
dollars and in lives, is staggering. This bill is an excellent starting
point for strengthening current programs and pursuing new initiatives
to address urgent national priorities in women's health. I look forward
to working with my colleagues and with the women's health community to
enact the strongest legislation we can to deal with these vital issues.
Mr. HARKIN. Mr. President, I am pleased today to join many of my
colleagues in support of the ``Women's Health Research and Prevention
Amendments of 1998.'' This legislation, introduced by my distinguished
colleague, Senator Bill Frist, and cosponsored by nearly all the
members of the Committee on Labor and Human Resources, is an important
step forward in the study and prevention of diseases and conditions
unique to women.
In the late 1980's, I learned that there was an embarrassing lack of
research on diseases and conditions prevalent in women. In addition,
the General Accounting Office (GAO) reported that women were routinely
excluded from medical research studies at NIH. Because of this
information, in 1990, I fought for legislation creating the Office of
Research on Women's Health at the National Institutes of Health (NIH).
Since its creation, the Office successfully worked to ensure that
research focuses on women's health and that women be included in
clinical trials.
Senator Frist's legislation builds upon the base of research and
prevention knowledge we have developed over the past few years. The
bill reauthorizes essential programs relating to women's health
research at NIH and the Centers for Disease Control and Prevention
(CDC).
I am particularly proud of the reauthorization of the programs
promoting research and education on the drug ``diethylstilbestrol,''
otherwise known as DES. This drug was prescribed to pregnant American
women from 1938 to 1971 in the mistaken belief that it would prevent
miscarriage. But DES is now known to cause a five-fold increased risk
of ectopic pregnancy, as well as a three-fold increased risk of
miscarriage. I was proud to introduce legislation in 1992 that
established a pilot program through NIH to test ways to educate the
public and health professionals about how to deal with DES exposure.
Last year I introduced legislation that would give people across the
nation access to information developed through this pilot program. I am
pleased that this bill has been incorporated in the ``Women's Health
Research and Prevention Amendments of 1998.''
In addition, I am pleased that the bill extends research programs for
basic and clinical research and education efforts with respect to
cancer, particularly breast cancer and ovarian cancer. I have fought
for a long time for increased funding for breast cancer research.
During my tenure as Chairman of the Subcommittee on Appropriations that
handles NIH we provided dramatic increases in funding for breast cancer
research.
This legislation also extends important research at NIH on
osteoporosis, Paget's disease and related bone disorders, and research
on cardiovascular diseases in women. It reauthorizes programs at the
National Institute on Aging, including research into the aging
processes of women, with particular emphasis on the effects of
menopause and the complications related to aging and the loss of
ovarian hormones in women.
CDC also plays an important role in the prevention diseases and
conditions in women. This legislation would extend CDC's collection of
statistical and epidemiological information, which is often the only
national data available on the health status of American women and
their use of the health care system. The bill extends CDC's National
Cancer Registries Program, which provides funds to states to enhance
their cancer surveillance data needed to monitor trends and serve as
the foundation of a national comprehensive cancer control strategy.
I am particularly proud that this legislation extends the National
Breast and Cervical Cancer Early Detection Program. In 1990 I worked to
start and fund this program which provides mammography and cervical
cancer screening to low income women without insurance. This program
has provided vital access to services for thousands of women across the
country.
In addition, the bill would extend authorization for grants to
academic health institutions for research on health promotion and
disease prevention. A number of these institutions are working together
to develop strategies for prevention of cardiovascular disease in
women. Finally, the bill reauthorizes grants administered by CDC to
non-profit private organizations to establish projects in local
communities to coordinate intervention and prevention of domestic
violence.
Mr. President, the research into and prevention of diseases prevalent
in women is an investment in our daughters, wives, mothers, and
sisters. It is an investment in our future.
Mr. BINGAMAN. Mr. President, I rise today to join Senator Frist and
my other colleagues in introducing the Women's Health Research and
Prevention Amendments of 1998.
This legislation allows us to reauthorize key women's health research
and prevention programs at the National Institutes of Health and the
Centers for Disease Control and Prevention. These programs represent a
cross section of the current research projects at the federal level
that have a direct impact on women's lives here in the United States.
While in the last decade, interest and commitment to women's health
has been heightened in the Congress, much work remains. We have taken
steps to ensure that women will be included in health care research in
the U.S. Prior to 1993, research in women's health was inadequate. Most
of the health care studies were conducted only on Anglo men. Quite
simply, research studies on men cannot be generalized to women. We know
that there are gender and ethnic differences when it comes to health
and illness. The time has come to further address the major causes of
morbidity and mortality among women: heart disease, osteoporosis,
breast cancer, and colorectal cancer.
This bill will provide the basis for looking at the research needs in
the spectrum of women's health and as we go to hearings on the bill I
am hopeful that additional women's health issues can be addressed.
There is another facet to women's health research that must be
considered. It is imperative that we ensure that studies are
representative of all women in the United States, including African
American, Hispanic, Native American and Asian women. We need research
that is culturally sensitive. We must support efforts of community
based outreach that allows for recruitment and retention of minority
women into research and this should be a factor when projects are
planned and conducted.
Mr. President, this legislation has provisions relating to women's
health research at the NIH in the disease specific issues of
diethylstilbestrol (DES), osteoporosis, breast and ovarian cancer. It
expands and allows for increased coordination of research activities
with respect to heart attack, stroke, and other cardiovascular diseases
in women at the National Heart, Lung, and Blood Institute. This program
is critical since cardiovascular disease is the leading cause of death
for women in the United States.
Finally, Mr. President, I wanted to take the opportunity to
specifically highlight one particular CDC program in the bill. This
legislation addresses the Health Promotion and Disease Prevention
Research Centers Program at the CDC and will extend authorization for
grants to our academic health institutions for research in the areas of
health promotion and disease prevention.
The CDC's Prevention Research Center Program is an innovative,
extramural link of federal, academic, state, and community based
agencies.
For my home state of New Mexico, this CDC project has been
particularly useful. In New Mexico a prevention center has been able to
focus on health risks and promoting health through applied research at
the community level. The project and grant have provided the
opportunity to address areas often overlooked such as rural population
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needs and Native American and Hispanic health needs.
In New Mexico about one of every three American Indian adults has
diabetes. The demonstration project has allowed for the promotion of
health lifestyles to combat the epidemic of adult onset diabetes. The
project has facilitated the formation of a true partnership between the
Navajo nation, nineteen pueblos in New Mexico, the New Mexico
Department of Health, the University of New Mexico, and the New Mexico
State Department of Education. There has been training of community
health workers on disease prevention strategies most applicable to
American Indian communities. This program is a model for increasing
collaboration among established agencies and nontraditional community
partners. It is a culturally sensitive approach that is having a
direct, positive impact on the health of New Mexicans. The creative
approach at CDC of a community based demonstration and application
project coupled with evaluation of strategies through research is
unique, successful, and should be reauthorized.
Mr. President, in closing, I look upon this bill as the important
first step to reauthorize programs at both the CDC and NIH. I look
forward to working with Senator Frist on these and other issues of
import to women's health.
Mr. WELLSTONE. Mr. President, I rise today to join my colleague from
Tennessee and others in introducing the ``Women's Health Research and
Prevention Amendments of 1998,'' as an original cosponsor. This bill
reauthorizes funding to extend and enhance many fine programs at the
National Institutes of Health and the Centers for Disease Control and
Prevention. I am pleased to join in this important effort.
Mr. President, I would like to commend Senator Frist for his work in
developing this legislation to strengthen and expand Federal efforts to
promote women's health. While there is still some work to be done to
improve the bill as it moves through the normal legislative process, I
believe this bill offers a good start and provides a solid foundation
on which to build historic improvements in NIH research programs on
breast cancer, heart attack, menopause, and other areas. Let me outline
briefly a few critical issues that are not addressed by the bill, but
which I hope to see addressed as we move forward.
One notable gap is in the area of substance abuse. I believe this
bill could be an important complement to the Substances Abuse Treatment
Parity Act (
S. 1147), which I introduced last September to improve
access to equitable medical care to treat the disease of alcohol and
other drug dependencies. Substance abuse is a widespread health concern
for many women, who also experience associated health, psychological,
and family problems. For example, expectant mothers and mothers with
small children can be helped with treatment and support services. This
is an investment for them, but as importantly for their children, who
would have the opportunity to grow up in a healthy, chemical-free home
environment. We have to take the problem of substance abuse as
seriously as we do other aspects of women's health.
Important information about this national problem will be highlighted
in an upcoming five-part PBS series by Bill Moyers, where treatment
programs such as the Hazelden program in my state of Minnesota are
highlighted. In working with these and other treatment programs in
Minnesota, I have learned a great deal about the problems of substances
abuse, but also about the hope and success that occurs when effective
treatments are available. The Women's Health Research and Prevention
Amendments Act could be substantially improved by an additional focus
on substance abuse programs.
Another notable gap is in the area of mental health and behavioral
science. On page one of the New York Times today was an article on the
criminalization of mental illness. The problem is that we as a nation
have needed to focus on the humane, dignified treatment of mental
illness, and having failed in that, more and more people who are
suffering from mental illness are winding up in prisons where they are
out of sight, but where they are not getting the care they need. We
need to treat mental health as seriously as we treat cancer and heart
disease, because mental illness can be just as serious, chronic, and
life-destroying as other diseases.
I intend to work closely with Senator Frist and others on the
committee to improve the bill by including a recognition of the role
that behavioral science and psychological factors have in the
development of and recovery from disease. Many of the diseases
mentioned in the bill are scientifically linked to behavioral or
psychological factors that can be critical to prevention and recovery.
Women also suffer unduly from specific mental health problems and
experiences, such as depression and domestic violence. Depression, for
example, is a pervasive and impairing illness which affects women at
roughly twice the rate of men. Domestic violence places a significant
resource and economic strain on our justice, health, and human services
systems. Research conducted at urban hospitals has show that about 25%
of emergency room visits by women resulted from domestic assaults.
Women who have been raped or battered have significantly great physical
health problems, as well as increased vulnerability to psychological
and emotional suffering. My wife Sheila and I have worked for years to
improve the federal response to the epidemic levels of domestic
violence across the country; I want to make sure this bill adequately
addresses these issues.
Mr. President, it is my commitment to work closely with the committee
to enhance these and other areas that are critical to women's health. A
strong focus on research and prevention of mental illness and substance
abuse for women is an important investment in the health of the nation
and of the health and well being of countless families.
Mr. NICKLES. Mr. President, I want to speak today on the Women's
Health Research and Prevention Amendments of 1998 introduced by my
colleagues Senator Frist and Majority Leader Lott. This bill would
amend the Public Health Service Act to revise and extend certain
programs with respect to women's health research and prevention
activities at the National Institutes of Health and the Centers for
Disease Control and Prevention.
Education and Research are the key to providing the best health care
for women and for that matter, all Americans. The Women's Health
Research and Prevention Amendments promote precisely that. Just two
examples are the extension of NIH research programs for basic and
clinical research and education efforts with respect to cancer, breast
cancer, and ovarian and related cancer; and the extension of the CDC
National Breast and Cervical Cancer Early Detection Program. These are
the kinds of programs that will improve women's health.
I am pleased to be a cosponsor of the Women's Health bill because I
believe that research is the best way for Congress to respond to the
concern over women's health issues and health issues generally. I make
this point, Mr. President, because I have been disappointed that
Congress has recently put on lab coats and begun practicing medicine.
We have gotten into the dangerous habit of legislating clinical
procedures which are not based in science or research but rather driven
by social opinion and special interests.
You only have to look back to the end of the 104th Congress to
illustrate my point. A majority of Congress supported an effort last
year to mandate that all insurance plans cover 48-hour maternity stays
in hospitals. However, serval months following the passage of that
legislation an article appeared in the Journal of the American Medical
Association stating that the ``content does not solve the most
important problems regarding the need for early postpartum/postnatal
services. The legislation may give the public a false sense of
security. It may call into question the reasonableness of relying on
legislative mechanisms to micro manage clinical practice.''
In other words, Congress made a nice, laudable attempt. We said we
are going to mandate 48 hours, but it has had no appreciable
improvement on the quality of health care. It appears that our so-
called victory in passing 48 hours may have in fact done more harm than
good in helping women and newborns. This experience, and others like
it, should have taught us what not to do.
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It should have taught us that before we endeavor to decide what is
the best therapy, procedure, or treatment for any one disease, let us
look for a minute at what we are doing. What are the unintended
consequences of federal mandates on health insurance companies
regarding treatments and coverage of services?
Let's take breast cancer as another example. Various bills have been
introduced in the last few months that mandate a length of stay for
mastectomies or require coverage of an inpatient stay for women
undergoing breast cancer surgery for an unspecified length of time, to
be determined by the physician.
Were Congress to legislate in favor of one form of treatment over
another, we are sending the message that one treatment is preferable to
the other. Treatments are constantly changing. Health care needs to be
flexible and should not lock doctors in to a specific approach.
Shouldn't we allow medical research to decide the best course of
action? If the federal government mandates a specific treatment, length
of stay or procedure, that then becomes the standard.
In addition, employing mandates in the place of valid research runs
the risk of discouraging innovative treatments. For example, recent
improvements in anesthesiology are a result of patient appeals to cut
down on nausea and vomiting after breast surgery as well as a desire to
recover at home.
Longer mandated stays could discourage doctors and patients from
developing the best possible plan for recovery. Patients may choose to
stay in the hospital for an extended period of time out of fear or lack
of knowledge and risk infection. Patients may have the false idea that
longer hospital stays equal the best possible treatment when, in fact,
recent research indicates that is not necessarily the case.
According to a November 6, 1996, article in The Wall Street Journal,
The Johns Hopkins Breast Center in Baltimore, which has gradually
eliminated inpatient stays for some women undergoing certain types of
mastectomies, has found that outpatient mastectomies are associated
with lower infection rates and high levels of satisfaction among women.
We have the responsibility to arm patients with the kind of sound
research and education this legislation provides, not prescriptive
mandates from Dr. Congress.
Lillie Shockeney, R.N. the Education and Outreach Director at the
Johns Hopkins Hospital Breast Center and a breast cancer survivor,
summed up best in a Finance Committee hearing on November 5, 1997. ``.
. . I am concerned that it [
S. 249, The Women's Health and Cancer
Rights Act of 1997] doesn't solve the real medical dilemma that women
battling breast cancer are faced with today. We need to be striving to
improve patient care for patients undergoing breast cancer surgery
rather than unknowingly promote keeping it at status quo. We need to be
promoting the development of a comprehensive patient education program
and have teams of health care professionals dedicated to striving to
improve the care and treatment provided to women with breast cancer.''
Mr. President, I want to congratulate Senator Frist and Senator Lott
for bringing this issue before us in such a responsible and proactive
bill. These programs go a long way to serve women. I thank the chair
and encourage my colleagues to support this common sense legislation.
Mrs. BOXER. Mr. President, I am very pleased to join my colleagues in
introducing the Women's Health Research and Prevention Amendments of
1998. This is a bipartisan initiative, which is important, because
promoting the health of American women is a bipartisan concern. I
commend the Senator from Tennessee for his leadership on this bill. He
has done a tremendous job in building crucial and broad support for it.
I am particularly pleased that the bill includes a title on
cardiovascular disease in women, which incorporates legislation I
introduced last June, the Women's Cardiovascular Diseases Research and
Prevention Act (
S. 349). It is appropriate to include it in this
comprehensive legislation because cardiovascular disease is the number
one killer of women in the United States, a fact many Americans simply
don't realize.
The statistics are alarming. More than 500,000 women and girls die
from cardiovascular disease each year. Heart attacks and strokes are
the leading causes of disability in women. More than 1 in 5 females
have some form of cardiovascular disease. Of women and girls under age
65, approximately 20,000 die of heart attacks each year. Cardiovascular
disease claim about as many lives each year as the next eight leading
causes of death combined. More than 2,600 Americans die each day from
cardiovascular diseases; that's an average of one death every 33
seconds. Cardiovascular diseases kill more women each year than does
cancer. Heart attacks kill more than 5 times as many females as does
breast cancer. Stroke kills twice as many women as does breast cancer.
Each year since 1984, cardiovascular diseases have claimed the lives of
more females than males. In 1993, of the number of individuals who died
of such diseases, 52 percent were female, and 48 percent were male.
Yet for years, women have been under-represented in studies about
heart disease and stroke. Models and tests for detection have largely
been conducted on men, and some doctors do not recognize cardiovascular
symptoms that are unique to women.
The bill we are introducing today authorizes necessary funding to the
National Heart, Lung and Blood Institute to expand and intensify
research, prevention, and educational outreach programs for heart
attack, stroke and other cardiovascular diseases in women. This
legislation will aid our Nation's doctors and scientists in developing
a coordinated and comprehensive strategy for fighting this terrible
disease.
This bill will help ensure that women are well represented in future
cardiovascular studies and that their doctors are well informed about
symptoms that are unique to women. It will also promote women's
awareness of risk factors, such as smoking, obesity and physical
inactivity, which greatly increase their chances of developing
cardiovascular disease.
This legislation is a critical component in our
Major Actions:
All articles in Senate section
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
(Senate - March 06, 1998)
Text of this article available as:
TXT
PDF
[Pages
S1508-S1533]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. LEAHY:
S. 1721. A bill to provide for the Attorney General of the United
States to develop guidelines for Federal prosecutors to protect
familial privacy and communications between parents and their children
in matters that do not involve allegations of violent or drug
trafficking conduct and the Judicial Conference of the United States to
make recommendations regarding the advisability of amending the Federal
Rules of Evidence for such purpose; to the Committee on the Judiciary.
parent-child privilege study legislation
Mr. LEAHY. Mr. President, I recently spoke on the floor about the
disgust that I share with most Americans about the tactics of Special
Prosecutor Kenneth Starr and the disturbing spectacle of hauling a
mother before a grand jury to reveal her intimate conversations with
her daughter in a matter, which--even if all the allegations about the
daughter's conduct were true--do not pose grave threats to the public
safety. This matter does not, for example, involve any allegations of
violence or drug trafficking conduct.
In this instance, as in others, Mr. Starr has scurried to apply all
of the legal weapons at his command, but none of the discretion that he
is obligated to exercise as one invested with almost unchecked legal
authority. I also expressed my intent to introduce legislation to study
whether, and under what circumstances, the confidential communications
between a parent and his or her child should be protected. A number of
professional relationships of trust are already protected by legal
privileges, but not familial relationships. This is the legislation I
introduce today.
Currently, under Rule 501 of the Federal Rules of Evidence,
privileges are ``governed by the principles of the common law as they
may be interpreted by the courts of the United States in the light of
reason and experience.'' Thus, in the absence of any Supreme Court
rules or federal statutes, courts look to the United States
Constitution and the principles of federal common law to determine the
applicability and the scope of privileges.
Legal academicians have expressed support for a parent-child
testimonial privilege. The public policy reasons favoring such a
privilege are numerous and relate to the respect we accord to
fundamental family values. Recognition of such a privilege could foster
and
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protect strong and trusting family relationships, preserve the family,
safeguard the privacy of familial communications and intimate family
matters against undue government intrusion, and promote a healthy
environment for the psychological development of children.
Despite these myriad reasons, there are indeed cases and
circumstances when parents should be compelled in court to share what
they know from their children. Indeed, courts have generally not been
receptive to the parent-child privilege. Only four States--Idaho,
Massachusetts, Minnesota, and New York--have adopted either by statute,
or by judicial recognition, some form of a parent-child privilege. No
Federal Court of Appeals have recognized this privilege nor has any
State Supreme Court that has considered the issue. In my own State of
Vermont, such a privilege is not recognized.
To my mind, and as a former prosecutor, prosecutors should show
restraint before putting parents in the untenable position of making a
legal determination as to whether their children should come to them
for advice, or whether the parents instead should feel legally
pressured to refer their own children to professional therapists, or
lawyers, or doctors in order to protect the confidentiality of the
child's communications. To be sure, there are some categories of cases,
particularly cases involving grave threats to the public safety, such
as violent or drug trafficking crimes, where the government can and
should appropriately seek testimony from a parent about what a child
has said. But we should all be clear about when prosecutors should also
show restraint.
Courts have recognized privilege claims in a variety of professional
relationships, ranging from attorneys to priests to psychotherapists.
Yet the relationship between parent and child--the most fundamental
relationship in our society--is generally not so protected in any
circumstances. As one New York court explained:
It would be difficult to think of a situation which more
strikingly embodies the intimate and confidential
relationship which exists among family members than that in
which a troubled young person, perhaps beset with remorse and
guilt, turns for counsel and guidance to his mother and
father. There is nothing more natural, more consistent with
our concept of the parental role, than that a child may rely
on his parents for help and advice. Shall it be said to those
parents, ``Listen to your son at the risk of being compelled
to testify about his confidences?''--In re Application of
A, 61 A.D.2d 426, 403 N.Y.S.2d 375, 378 (1978).
We should consider the sorts of circumstances and the types of cases
in which prosecutors should be asked to show some restraint before
turning to parents to provide evidence against their children. That is
why my bill calls for a study and report by the Justice Department on
what these circumstances should be, and to develop prosecutorial
guidelines accordingly. Specifically, these guidelines should identify
when the communications between parents and their children should carry
the same protections as preferred professional relationships, and the
circumstances and types of cases when those communications should be
subject to government scrutiny.
We cannot rely on the courts to formulate an appropriate parent-child
privilege. The Third Circuit recently declined to recognize the parent-
child privilege, noting that:
The legislature, not the judiciary, is institutionally
better equipped to perform the balancing of the competing
policy issues required in deciding whether the recognition of
a parent-child privilege is in the best interests of society.
Congress, through its legislative mechanisms, is also better
suited for the task of defining the scope of any prospective
privilege. . . . In short, if a new privilege is deemed
worthy of recognition, the wiser course in our opinion is to
leave the adoption of such a privilege to Congress.--In re
Grand Jury Proceedings (Impounded), 103 F.3d 1140, 1148, 1153
(3d Cir. 1996).
Likewise, the Seventh Circuit Court of Appeals has made clear that
``courts have been reluctant to create new privileges, preferring to
leave such matters to the legislature despite any policy reasons
supporting recognition of a particular privilege.'' United States v.
Riley, 653 F.2d 1153, 1160 (7th Cir. 1981).
Congress should accept this challenge. My bill is a start to the
process of seeking expert input on the significant question of when the
government may not compel parents to betray the confidences of their
children, and when because of compelling need or the nature of the case
or circumstances, parents should be required to reveal the substance of
what their children have told them.
Thus, the bill I introduce today directs the Attorney General to
develop Federal prosecutorial guidelines to protect familial privacy
and parent-child communications in matters that do not involve
allegations of violent or drug trafficking conduct. In addition, the
legislation would direct the Judicial Conference to undertake a study
and then give us a report on whether the Federal Rules of Evidence
should be amended to explicitly recognize a parent-child privilege in
cases not involving violent or drug trafficking conduct, and, if so, in
what circumstances that privilege should apply.
While we should endeavor to provide the maximum protection for
parent-child communications, we should also be careful not to unduly
obstruct law enforcement. Nor should the rule be susceptible to
litigious mischief.
Accordingly, the Attorney General and the Judicial Conference will
need to address, as part of the study and report called for in my bill,
a series of important questions, including:
(1) What communications should be considered confidential for
purposes of the privilege and, specifically, should the privilege apply
in both criminal and civil proceedings?
(2) Should such a privilege apply only to unemancipated minors, or
also to adult children?
(3) Should only the child's communications be protected, or should a
parent's communications to a child also receive protection?
(4) Should such a privilege extend beyond a child's natural parents
to include step-parents or grandparents?
(5) Should such a privilege be subject to rebuttal if the government
establishes a compelling need for the information?
This legislation is the first step in evaluating the merits and
difficulties inherent in protecting familial privacy and the parent-
child relationship against unwarranted intrusions by the government and
by overzealous prosecutors. The public and these families themselves
should not have to endure repeated scenes of mothers being marched into
grand jury inquisitions to reveal intimate talks they may have had with
their children about their private relationships. This is a far cry
from allegations concerning violent or drug trafficking conduct. Let us
find out what the Justice Department and Judicial Conference recommend
about how we can best protect child-parent confidences in ways that
comport with American notions of family, fidelity, and privacy, without
compromising our public safety and the integrity of our judicial
system.
I ask unanimous consent that a copy of the bill be printed in the
Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 1721
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. CONFIDENTIALITY OF PARENT CHILD COMMUNICATIONS IN
JUDICIAL PROCEEDINGS.
(a) Study and Development of Prosecutorial Guidelines.--The
Attorney General of the United States shall--
(1) study and evaluate the manner in which the States have
taken measures to protect the confidentiality of
communications between children and parents and, in
particular, whether such measures have been taken in matters
that do not involve allegations of violent or drug
trafficking conduct;
(2) develop guidelines for Federal prosecutors that will
provide the maximum protection possible for the
confidentiality of communications between children and
parents in matters that do not involve allegations of violent
or drug trafficking conduct, within any applicable
constitutional limits, and without compromising public safety
or the integrity of the judicial system, taking into
account--
(A) the danger that the free communication between a child
and his or her parent will be inhibited and familial privacy
and relationships will be damaged if there is no assurance
that such communications will be kept confidential;
(B) whether an absolute or qualified testimonial privilege
for communications between a child and his or her parents in
matters that do not involve allegations of violent or drug
trafficking conduct is appropriate to provide the maximum
guarantee of
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familial privacy and confidentiality without compromising
public safety or the integrity of the judicial system; and
(C) the appropriate limitations on a testimonial privilege
for such communications between a child and his or her
parents, including--
(i) whether the privilege should apply in criminal and
civil proceedings;
(ii) whether the privilege should extend to all children,
regardless of age, unemancipated or emancipated, or be more
limited;
(iii) the parameters of the familial relationship subject
to the privilege, including whether the privilege should
extend to stepparents or grandparents, adopted children, or
siblings; and
(iv) whether disclosure should be allowed absent a
particularized showing of a compelling need for such
disclosure, and adequate procedural safeguards are in place
to prevent unnecessary or damaging disclosures; and
(3) prepare and disseminate to Federal prosecutors the
findings made and guidelines developed as a result of the
study and evaluation.
(b) Report and Recommendations.--Not later than 1 year
after the date of enactment of this Act, the Attorney General
of the United States shall submit a report to Congress on--
(1) the findings of the study and the guidelines required
under subsection (a); and
(2) recommendations based on the findings on the need for
and appropriateness of further action by the Federal
Government.
(c) Review of Federal Rules of Evidence.--Not later than
180 days after the date of enactment of this Act, the
Judicial Conference of the United States shall complete a
review and submit a report to Congress on--
(1) whether the Federal Rules of Evidence should be amended
to guarantee that the confidentiality of communications by a
child to his or her parent in matters that do not involve
allegations of violent or drug trafficking conduct will be
adequately protected in Federal court proceedings; and
(2) if the rules should be so amended, a proposal for
amendments to the rules that provides the maximum protection
possible for the confidentiality of such communications,
within any applicable constitutional limits and without
compromising public safety or the integrity of the judicial
system.
______
By Mr. FRIST (for himself, Mr. Lott, Mr. Jeffords, Mr. Kennedy,
Mr. Gregg, Mr. Dodd, Mr. Enzi, Mr. Harkin, Mr. Hutchinson, Ms.
Mikulski, Ms. Collins, Mr. Bingaman, Mr. McConnell, Mr.
Wellstone, Mrs. Murray, Mr. Reed, Ms. Snowe, Mr. Nickles, Mr.
Mack, Mrs. Boxer, Mr. Daschle, Mr. Chafee, Mrs. Feinstein, Mr.
Roth, Mr. Specter, Mr. D'Amato, Mr. Domenici, and Mr.
Santorum):
S. 1722. A bill to amend the Public Health Service Act to revise and
extend certain programs with respect to women's health research and
prevention activities at the National Institutes of Health and the
Centers for Disease Control and Prevention; to the Committee on Labor
and Human Resources.
the women's health research and prevention amendments of 1998
Mr. FRIST. Mr. President, I am very pleased to introduce today, with
the majority leader, the Women's Health Research and Prevention
Amendments of 1998. The purpose of this bill is to increase awareness
of some of the most pressing diseases and health issues that women in
our country face. This bill focuses on women's health research and
prevention activities at the National Institutes of Health and the
Centers for Disease Control and Prevention.
Our goal, in introducing this bill today, is to create greater
awareness of women's health issues and to highlight the critical role
our public health agencies--the NIH, the National Institutes of Health,
and the CDC, the Centers for Disease Control and Prevention--play in
providing a broad spectrum of activities to improve women's health,
including research, screening, health data management, prevention and
treatment of diseases, and broad health education.
This bill reauthorizes programs at the National Institutes of Health
for vital research activities into the causes, prevention, and
treatment for some of the major diseases affecting women, including
osteoporosis, breast cancer, ovarian cancer, as well as research into
the aging processes of women.
Let me cite just a few statistics to illustrate the need for further
research into these health issues.
Osteoporosis is a health threat for 28 million Americans, 80 percent
of whom are women. One in every two women over the age of 50 years will
have an osteoporosis-related fracture.
One out of every eight women will develop breast cancer over the
course of their lifetimes, and 1 in 25 will die of breast cancer.
Ovarian cancer is the fourth leading cause of death from cancer among
women. One of the most troubling aspects of ovarian cancer is the
challenge we have in diagnosing this disease earlier and earlier. We
know that a late diagnosis results in a worse outcome. The
reauthorization of these research programs will help assure scientific
progress in our fight against these diseases and will lessen their
burden on women and their families.
For far too long, women in this country have been neglected in many
of our research clinical studies. I am very pleased that, since 1993,
we have developed guidelines to include women and minorities in NIH-
sponsored trials. However, we must continue to do more. We must
continue to review our women's health research agenda to set future
research priorities and to incorporate new scientific knowledge
regarding women's health. We must continue to focus and coordinate all
our efforts in research areas, including clinical trial research
design, genetic factors, the aging process, and other gender-based
differences.
I am also pleased in this bill that we authorize a new research
program at the National Heart, Lung, and Blood Institute at the NIH to
target heart attack, stroke, and other cardiovascular diseases in
women. This program, originally introduced by my colleague, Senator
Boxer, will advance research into cardiovascular diseases--the leading
cause of death in the United States in women. More than 500,000
American women will die annually from cardiovascular diseases.
Cardiovascular diseases--that is, diseases of the heart and the blood
vessels--kill almost twice as many American women as all other cancers.
One of the biggest myths in medicine is that heart disease is only a
male problem. When we think of a heart attack, many people associate it
with men. Even in my own studies during my internship and residency in
medicine--not that long ago--all the models, the pictures that were
used in textbooks, the warning signs on TV--always pictured a man.
However, since 1984, the number of cardiovascular disease deaths in
women has exceeded those of men. And in 1995, 50,000 more women died of
heart disease than men. The program we are including in the bill today
will expand the research programs at NIH to concentrate more on
cardiovascular diseases in women.
Our bill reauthorizes several programs at the Centers for Disease
Control and Prevention for prevention and education activities on
women's health issues. We are reauthorizing the National Center for
Health Statistics, the National Program of Cancer Registries, the
National Breast and Cervical Cancer Early Detection Program, the
Centers for Research and Demonstration of Health Promotion and Disease
Prevention, and the Community Programs on Domestic Violence.
CDC's programs provide critical health services in each of our States
and in our communities to detect, prevent, and diagnose diseases such
as breast and cervical cancer. For the past 7 years, the National
Breast and Cervical Cancer Early Detection Program has provided
critical cancer screening services to underserved women, especially
low-income women, elderly women, and members of racial and ethnic
minority groups. CDC supports early detection programs in all 50
States, in 5 territories, in the District of Columbia, and in 14
American Indian/Alaskan Native organizations. Through March 1997, more
than 1.3 million screening tests have been provided by this one
program.
CDC programs provide critical data and statistics about women's
health that assist us in making informed policy decisions about health
care. The National Center for Health Statistics often provides the only
national data on the health status of U.S. women and their use of
health care. A recent report by the National Center for Health
Statistics entitled ``Women: Work and Health'' summarized the data on
health conditions affecting working women. This report is the first
comprehensive survey on work-related
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health issues encountered by the more than 60 million women in the
American labor force.
I thank the majority leader for his leadership on this issue and for
his efforts in the introduction of this bill. I am pleased to state
that this bill is bipartisan. We have included provisions that are the
product of the efforts of many of my colleagues--Senators Snowe,
Harkin, Boxer, and many others. We have the support of nearly the full
Senate Labor and Human Resources Committee, and over 27 Members of the
Senate are original cosponsors of this bipartisan bill. The level of
support for this bill is a real testament to the need to combat the
diseases affecting women and to maintain those crucial health services
that help prevent these diseases.
This bill, again, is introduced to generate discussion of these
important programs. We intend to consider these programs within the
context of the upcoming NIH reauthorization bill to be introduced over
the next several months. I encourage all Members and constituencies to
review the current programs and to provide input as we set the future
agenda of women's health research and prevention in this Nation.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 1722
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Women's Health Research and
Prevention Amendments of 1998''.
TITLE I--PROVISIONS RELATING TO WOMEN'S HEALTH RESEARCH AT THE NATIONAL
INSTITUTES OF HEALTH
SEC. 101. EXTENSION OF PROGRAM FOR RESEARCH AND AUTHORIZATION
OF NATIONAL PROGRAM OF EDUCATION REGARDING THE
DRUG DES.
(a) In General.--Section 403A(e) of the Public Health
Service Act (42 U.S.C. 283a(e)) is amended by striking
``1996'' and inserting ``2001''.
(b) National Program for Education of Health Professionals
and Public.--From amounts appropriated for carrying out
section 403A of the Public Health Service Act (42 U.S.C.
283a), the Secretary of Health and Human Services, acting
through the heads of the appropriate agencies of the Public
Health Service, shall carry out a national program for the
education of health professionals and the public with respect
to the drug diethylstilbestrol (commonly know as DES). To the
extent appropriate, such national program shall use
methodologies developed through the education demonstration
program carried out under such section 403A. In developing
and carrying out the national program, the Secretary shall
consult closely with representatives of nonprofit private
entities that represent individuals who have been exposed to
DES and that have expertise in community-based information
campaigns for the public and for health care providers. The
implementation of the national program shall begin during
fiscal year 1999.
SEC. 102. RESEARCH ON OSTEOPOROSIS, PAGET'S DISEASE, AND
RELATED BONE DISORDERS.
Section 409A(d) of the Public Health Service Act (42 U.S.C.
284e(d)) is amended by striking ``and 1996'' and inserting
``through 2001''.
SEC. 103. RESEARCH ON CANCER.
(a) In General.--Section 417B(a) of the Public Health
Service Act (42 U.S.C. 286a-8(a)) is amended by striking
``and 1996'' and inserting ``through 2001''.
(b) Research on Breast Cancer.--Section 417B(b)(1) of the
Public Health Service Act (42 U.S.C. 286a-8(b)(1)) is
amended--
(1) in subparagraph (A), by striking ``and 1996'' and
inserting ``through 2001''; and
(2) in subparagraph (B), by striking ``and 1996'' and
inserting ``through 2001''.
(c) Research on Ovarian and Related Cancer Research.--
Section 417B(b)(2) of the Public Health Service Act (42
U.S.C. 286a-8(b)(2)) is amended by striking ``and 1996'' and
inserting ``through 2001''.
SEC. 104. RESEARCH ON HEART ATTACK, STROKE, AND OTHER
CARDIOVASCULAR DISEASES IN WOMEN.
Subpart 2 of part C of title IV of the Public Health
Service Act (42 U.S.C. 285b et seq.) is amended by inserting
after section 424 the following:
``heart attack, stroke, and other cardiovascular diseases in women
``Sec. 424A. (a) In General.--The Director of the Institute
shall expand, intensify, and coordinate research and related
activities of the Institute with respect to heart attack,
stroke, and other cardiovascular diseases in women.
``(b) Coordination With Other Institutes.--The Director of
the Institute shall coordinate activities under subsection
(a) with similar activities conducted by the other national
research institutes and agencies of the National Institutes
of Health to the extent that such Institutes and agencies
have responsibilities that are related to heart attack,
stroke, and other cardiovascular diseases in women.
``(c) Certain Programs.--In carrying out subsection (a),
the Director of the Institute shall conduct or support
research to expand the understanding of the causes of, and to
develop methods for preventing, cardiovascular diseases in
women. Activities under such subsection shall include
conducting and supporting the following:
``(1) Research to determine the reasons underlying the
prevalence of heart attack, stroke, and other cardiovascular
diseases in women, including African-American women and other
women who are members of racial or ethnic minority groups.
``(2) Basic research concerning the etiology and causes of
cardiovascular diseases in women.
``(3) Epidemiological studies to address the frequency and
natural history of such diseases and the differences among
men and women, and among racial and ethnic groups, with
respect to such diseases.
``(4) The development of safe, efficient, and cost-
effective diagnostic approaches to evaluating women with
suspected ischemic heart disease.
``(5) Clinical research for the development and evaluation
of new treatments for women, including rehabilitation.
``(6) Studies to gain a better understanding of methods of
preventing cardiovascular diseases in women, including
applications of effective methods for the control of blood
pressure, lipids, and obesity.
``(7) Information and education programs for patients and
health care providers on risk factors associated with heart
attack, stroke, and other cardiovascular diseases in women,
and on the importance of the prevention or control of such
risk factors and timely referral with appropriate diagnosis
and treatment. Such programs shall include information and
education on health-related behaviors that can improve such
important risk factors as smoking, obesity, high blood
cholesterol, and lack of exercise.
``(d) Authorization of Appropriations.--For the purpose of
carrying out this section, there is authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 1999 through 2001. The authorization of
appropriations established in the preceding sentence is in
addition to any other authorization of appropriation that is
available for such purpose.''.
SEC. 105. AGING PROCESSES REGARDING WOMEN.
Section 445I of the Public Health Service Act (42 U.S.C.
285e-11) is amended by striking ``and 1996'' and inserting
``through 2001''.
SEC. 106. OFFICE OF RESEARCH ON WOMEN'S HEALTH.
Section 486(d)(2) of the Public Health Service Act (42
U.S.C. 287d(d)(2)) is amended by striking ``Director of the
Office'' and inserting ``Director of the National Institutes
of Health''.
TITLE II--PROVISIONS RELATING TO WOMEN'S HEALTH AT THE CENTERS FOR
DISEASE CONTROL AND PREVENTION
SEC. 201. NATIONAL CENTER FOR HEALTH STATISTICS.
Section 306(n) of the Public Health Service Act (42 U.S.C.
242k(n)) is amended--
(1) in paragraph (1), by striking ``through 1998'' and
inserting ``through 2002''; and
(2) in paragraph (2), by striking ``through 1998'' and
inserting ``through 2002''.
SEC. 202. NATIONAL PROGRAM OF CANCER REGISTRIES.
Section 399L(a) of the Public Health Service Act (42 U.S.C.
280e-4(a)) is amended by striking ``through 1998'' and
inserting ``through 2002''.
SEC. 203. NATIONAL BREAST AND CERVICAL CANCER EARLY DETECTION
PROGRAM.
(a) Grants.--Section 1501(b) of the Public Health Service
Act (42 U.S.C. 300k(b)) is amended--
(1) in paragraph (1), by striking ``nonprofit''; and
(2) in paragraph (2), by striking ``that are not nonprofit
entities''.
(b) Preventive Health.--Section 1509(d) of the Public
Health Service Act (42 U.S.C. 300n-4a(d)(1)) is amended by
striking ``through 1998'' and inserting ``through 2002''.
(c) General Program.--Section 1510(a) of the Public Health
Service Act (42 U.S.C. 300n-5(a)) is amended by striking
``through 1998'' and inserting ``through 2002''.
SEC. 204. CENTERS FOR RESEARCH AND DEMONSTRATION OF HEALTH
PROMOTION.
Section 1706(e) of the Public Health Service Act (42 U.S.C.
300u-5(e)) is amended by striking ``through 1998'' and
inserting ``through 2002''.
SEC. 205. COMMUNITY PROGRAMS ON DOMESTIC VIOLENCE.
Section 318(h)(2) of the Family Violence Prevention and
Services Act (42 U.S.C. 10418(h)(2)) is amended by striking
``fiscal year 1997'' and inserting ``for each of the fiscal
years 1997 through 2002''.
Mr. LOTT. Mr. President, this morning I am very pleased to join
Senator Frist of Tennessee, who is an outstanding Senator, and also a
doctor, who has been very helpful to me, and a lot of Senators, since
he joined this body, in introducing legislation entitled ``The Women's
Health Research and Prevention Act.''
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The bill authorizes and reauthorizes a collection of first-class
research and prevention programs in the National Institutes of Health
and the Centers for Disease Control and Prevention.
Breast cancer is the leading cause of death in women between the ages
of 40 and 55. About one out of every eight women in the United States
will, unfortunately, develop breast cancer during their lifetime. And
so the Frist-Lott bill reauthorizes breast and ovarian cancer research
and education programs at NIH.
Osteoporosis is a disease in which bones become fragile and more
likely to break. My wife is beginning to confront this particular
problem. As women age, they lose bone mass and are at risk of
debilitating accidents such as fractures. This bill extends
osteoporosis research and education programs at NIH.
Women's health, though, means more than just health issues specific
to women. Heart disease, for instance, the No. 1 killer in the U.S. of
women, of course, also affects men in great numbers. Hypertension, a
leading cause of heart disease, is two to three times more common in
women than in men.
In addition to these three key research areas, our bill continues
programs in the Centers for Disease Control, including the National
Program of Cancer Registries and the National Early Detection Program
for breast and cervical cancer.
Senator Frist, the Senate's only doctor, and an outstanding heart
surgeon himself, provided the details of the bill. Senator Frist is
chairman of the Senate Public Health Subcommittee of the Senate Labor
Committee, and is one of the Senate's key leaders on all of our health
issues.
I am pleased that he is also serving on our Medicare commission that
had its first meeting yesterday, including a meeting with the
President.
I have often turned to him for advice and guidance on health matters,
and will continue to do so in the future. I believe that just this
morning Senator Frist attended a meeting regarding Medicare, and that
will be helpful in this effort. I know it will be a bipartisan effort.
I encourage colleagues on both sides of the aisle to cosponsor this
important legislation.
This morning I was made aware that Senator Mack is a cosponsor, and
Senator D'Amato. We are inviting all Members to join us in this very
serious and very important issue that we need to act on in order to
reauthorize some of these programs and authorize new ones.
I thank Senator Frist for his leadership in this area, and I yield
the floor.
Mr. JEFFORDS. Mr. President, I rise to recognize Senator Frist for
taking an important step that brings together a number of Government
programs of research, treatment and disease prevention for women. Over
the past several years, Congress and the Nation have become
increasingly concerned about women's health. I appreciate the
leadership and the expertise that Dr. Frist brings to Congress about
these issues. We have much to learn about recognizing and treating the
medical needs of women.
In the first session of the 105th Congress, at least 21 bills
relating to women's health were introduced and referred to the Senate
Labor and Human Resources Committee. At our committee hearing on
women's health last July, we heard about important advances being made
in research. We also heard about significant gaps of knowledge which
need to be filled. More importantly, we recognize how important it is
to get information about scientific advances to the public and their
health care providers.
Thus, I am pleased the provisions of this bill provide for research
and for public and professional education. We know that once the
information is out to the public and health care professionals, we need
screening programs, closely followed by access to treatment. The bill
provides for important patient services.
Finally, once common conditions are well recognized, detected and
treated, we need data to track our progress in disease prevention and
to alert us to new help in illness trends. This bill provides for these
functions through the support for cancer registries, information
systems, and program evaluation. It is my hope that having women's
issues collected together in one bill will focus the attention of
Congress and the Nation on vigorous support of the woman's health
initiative.
I am pleased to join Senator Frist in sponsoring this legislation.
Mr. KENNEDY. Mr. President, I commend Senator Frist for his
leadership on the bill we are introducing today, ``The Women's Health
Research and Prevention Amendments of 1998.'' This bill is a bipartisan
effort to extend and strengthen several important women's health
programs at the National Institutes of Health and the Centers for
Disease Control and Prevention.
In recent years, women's health has begun to receive the high
priority it deserves. Five years ago government guidelines were finally
eliminated that specifically excluded women from many clinical trials.
Increasingly, Congress has given higher priority to funds to address
breast cancer and other women's health issues. We also established the
Office of Women's Health within the Department of Health and Human
Services, in order to develop and implement a national agenda for
women's health. These successes, however, have revealed that there is
much more to be done.
The bill we are introducing today is an attempt to fill some of the
gaps in research and prevention that we have identified in women's
health. It is time for Congress to acknowledge that women's health
involves a wider range of issues, and that the magnitude of these
issues varies greatly with age. Car crashes and unintended injuries are
the leading killer of women in their teens and twenties. Cancer is the
leading killer of women between the ages of 25 and 64. Heart disease is
the leading killer among women over 65.
The nation's agenda on women's health must also address other key
issues that are more common among women but affect men too, such as
osteoporosis, depression, and auto-immune diseases, and illnesses that
manifest themselves differently in men and women, such as heart
disease, substance abuse, AIDS, and violence.
Our legislation extends important research and prevention activities
now being carried out by the National Institutes of Health and the
Centers for Disease Control and Prevention in areas traditionally
considered women's health issues, such as breast and ovarian cancer,
osteoporosis, and domestic violence. It also calls for greater research
efforts on heart attacks, strokes, and other cardiovascular diseases,
in recognition of the serious effects of these diseases on women.
Our bill also provides continued support for academic health centers
to conduct research and demonstration projects related to health
promotion and disease prevention to improve quality of life, and to
curb premature mortality and illness that contribute to excessive
health costs. These academic health centers are effective in informing
women and their physicians of steps they can take to prevent serious
illness and injury, especially in cases involving chronic and
debilitating physical illness, such as arthritis and osteoporosis,
which put women at high risk for bone fractures.
In order to enable researchers to monitor health trends among women
and to help policymakers make informed decisions on the allocation of
resources, it is essential for accurate and timely statistical and
epidemiological data to be available. Our bill will provide continued
support of the CDC's National Center for Health Statistics, which
provides valuable data related to overall health status, lifestyle,
onset and diagnosis of illness and disability, and use of health care
and rehabilitation services.
It is also important to understand differences between racial and
ethnic groups. For example, black women have far higher death rates
from heart disease, cancer, stroke and diabetes than white women.
Minority women suffer the most from AIDS. More than half of new female
cases of AIDS over the past decade were found among blacks. For other
chronic diseases, black women have the highest rates of hypertension,
while Native American women have higher rates of asthma and chronic
bronchitis. This bill will enable the National Center for Health
Statistics to continue its important work on the health of ethnic and
racial populations, and improve methods to collect data on these
subgroups in
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order to understand and address their various health needs more
effectively.
Too many health needs of women continue to be neglected by the
nation's health care system. The cost of this national neglect, both in
dollars and in lives, is staggering. This bill is an excellent starting
point for strengthening current programs and pursuing new initiatives
to address urgent national priorities in women's health. I look forward
to working with my colleagues and with the women's health community to
enact the strongest legislation we can to deal with these vital issues.
Mr. HARKIN. Mr. President, I am pleased today to join many of my
colleagues in support of the ``Women's Health Research and Prevention
Amendments of 1998.'' This legislation, introduced by my distinguished
colleague, Senator Bill Frist, and cosponsored by nearly all the
members of the Committee on Labor and Human Resources, is an important
step forward in the study and prevention of diseases and conditions
unique to women.
In the late 1980's, I learned that there was an embarrassing lack of
research on diseases and conditions prevalent in women. In addition,
the General Accounting Office (GAO) reported that women were routinely
excluded from medical research studies at NIH. Because of this
information, in 1990, I fought for legislation creating the Office of
Research on Women's Health at the National Institutes of Health (NIH).
Since its creation, the Office successfully worked to ensure that
research focuses on women's health and that women be included in
clinical trials.
Senator Frist's legislation builds upon the base of research and
prevention knowledge we have developed over the past few years. The
bill reauthorizes essential programs relating to women's health
research at NIH and the Centers for Disease Control and Prevention
(CDC).
I am particularly proud of the reauthorization of the programs
promoting research and education on the drug ``diethylstilbestrol,''
otherwise known as DES. This drug was prescribed to pregnant American
women from 1938 to 1971 in the mistaken belief that it would prevent
miscarriage. But DES is now known to cause a five-fold increased risk
of ectopic pregnancy, as well as a three-fold increased risk of
miscarriage. I was proud to introduce legislation in 1992 that
established a pilot program through NIH to test ways to educate the
public and health professionals about how to deal with DES exposure.
Last year I introduced legislation that would give people across the
nation access to information developed through this pilot program. I am
pleased that this bill has been incorporated in the ``Women's Health
Research and Prevention Amendments of 1998.''
In addition, I am pleased that the bill extends research programs for
basic and clinical research and education efforts with respect to
cancer, particularly breast cancer and ovarian cancer. I have fought
for a long time for increased funding for breast cancer research.
During my tenure as Chairman of the Subcommittee on Appropriations that
handles NIH we provided dramatic increases in funding for breast cancer
research.
This legislation also extends important research at NIH on
osteoporosis, Paget's disease and related bone disorders, and research
on cardiovascular diseases in women. It reauthorizes programs at the
National Institute on Aging, including research into the aging
processes of women, with particular emphasis on the effects of
menopause and the complications related to aging and the loss of
ovarian hormones in women.
CDC also plays an important role in the prevention diseases and
conditions in women. This legislation would extend CDC's collection of
statistical and epidemiological information, which is often the only
national data available on the health status of American women and
their use of the health care system. The bill extends CDC's National
Cancer Registries Program, which provides funds to states to enhance
their cancer surveillance data needed to monitor trends and serve as
the foundation of a national comprehensive cancer control strategy.
I am particularly proud that this legislation extends the National
Breast and Cervical Cancer Early Detection Program. In 1990 I worked to
start and fund this program which provides mammography and cervical
cancer screening to low income women without insurance. This program
has provided vital access to services for thousands of women across the
country.
In addition, the bill would extend authorization for grants to
academic health institutions for research on health promotion and
disease prevention. A number of these institutions are working together
to develop strategies for prevention of cardiovascular disease in
women. Finally, the bill reauthorizes grants administered by CDC to
non-profit private organizations to establish projects in local
communities to coordinate intervention and prevention of domestic
violence.
Mr. President, the research into and prevention of diseases prevalent
in women is an investment in our daughters, wives, mothers, and
sisters. It is an investment in our future.
Mr. BINGAMAN. Mr. President, I rise today to join Senator Frist and
my other colleagues in introducing the Women's Health Research and
Prevention Amendments of 1998.
This legislation allows us to reauthorize key women's health research
and prevention programs at the National Institutes of Health and the
Centers for Disease Control and Prevention. These programs represent a
cross section of the current research projects at the federal level
that have a direct impact on women's lives here in the United States.
While in the last decade, interest and commitment to women's health
has been heightened in the Congress, much work remains. We have taken
steps to ensure that women will be included in health care research in
the U.S. Prior to 1993, research in women's health was inadequate. Most
of the health care studies were conducted only on Anglo men. Quite
simply, research studies on men cannot be generalized to women. We know
that there are gender and ethnic differences when it comes to health
and illness. The time has come to further address the major causes of
morbidity and mortality among women: heart disease, osteoporosis,
breast cancer, and colorectal cancer.
This bill will provide the basis for looking at the research needs in
the spectrum of women's health and as we go to hearings on the bill I
am hopeful that additional women's health issues can be addressed.
There is another facet to women's health research that must be
considered. It is imperative that we ensure that studies are
representative of all women in the United States, including African
American, Hispanic, Native American and Asian women. We need research
that is culturally sensitive. We must support efforts of community
based outreach that allows for recruitment and retention of minority
women into research and this should be a factor when projects are
planned and conducted.
Mr. President, this legislation has provisions relating to women's
health research at the NIH in the disease specific issues of
diethylstilbestrol (DES), osteoporosis, breast and ovarian cancer. It
expands and allows for increased coordination of research activities
with respect to heart attack, stroke, and other cardiovascular diseases
in women at the National Heart, Lung, and Blood Institute. This program
is critical since cardiovascular disease is the leading cause of death
for women in the United States.
Finally, Mr. President, I wanted to take the opportunity to
specifically highlight one particular CDC program in the bill. This
legislation addresses the Health Promotion and Disease Prevention
Research Centers Program at the CDC and will extend authorization for
grants to our academic health institutions for research in the areas of
health promotion and disease prevention.
The CDC's Prevention Research Center Program is an innovative,
extramural link of federal, academic, state, and community based
agencies.
For my home state of New Mexico, this CDC project has been
particularly useful. In New Mexico a prevention center has been able to
focus on health risks and promoting health through applied research at
the community level. The project and grant have provided the
opportunity to address areas often overlooked such as rural population
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needs and Native American and Hispanic health needs.
In New Mexico about one of every three American Indian adults has
diabetes. The demonstration project has allowed for the promotion of
health lifestyles to combat the epidemic of adult onset diabetes. The
project has facilitated the formation of a true partnership between the
Navajo nation, nineteen pueblos in New Mexico, the New Mexico
Department of Health, the University of New Mexico, and the New Mexico
State Department of Education. There has been training of community
health workers on disease prevention strategies most applicable to
American Indian communities. This program is a model for increasing
collaboration among established agencies and nontraditional community
partners. It is a culturally sensitive approach that is having a
direct, positive impact on the health of New Mexicans. The creative
approach at CDC of a community based demonstration and application
project coupled with evaluation of strategies through research is
unique, successful, and should be reauthorized.
Mr. President, in closing, I look upon this bill as the important
first step to reauthorize programs at both the CDC and NIH. I look
forward to working with Senator Frist on these and other issues of
import to women's health.
Mr. WELLSTONE. Mr. President, I rise today to join my colleague from
Tennessee and others in introducing the ``Women's Health Research and
Prevention Amendments of 1998,'' as an original cosponsor. This bill
reauthorizes funding to extend and enhance many fine programs at the
National Institutes of Health and the Centers for Disease Control and
Prevention. I am pleased to join in this important effort.
Mr. President, I would like to commend Senator Frist for his work in
developing this legislation to strengthen and expand Federal efforts to
promote women's health. While there is still some work to be done to
improve the bill as it moves through the normal legislative process, I
believe this bill offers a good start and provides a solid foundation
on which to build historic improvements in NIH research programs on
breast cancer, heart attack, menopause, and other areas. Let me outline
briefly a few critical issues that are not addressed by the bill, but
which I hope to see addressed as we move forward.
One notable gap is in the area of substance abuse. I believe this
bill could be an important complement to the Substances Abuse Treatment
Parity Act (
S. 1147), which I introduced last September to improve
access to equitable medical care to treat the disease of alcohol and
other drug dependencies. Substance abuse is a widespread health concern
for many women, who also experience associated health, psychological,
and family problems. For example, expectant mothers and mothers with
small children can be helped with treatment and support services. This
is an investment for them, but as importantly for their children, who
would have the opportunity to grow up in a healthy, chemical-free home
environment. We have to take the problem of substance abuse as
seriously as we do other aspects of women's health.
Important information about this national problem will be highlighted
in an upcoming five-part PBS series by Bill Moyers, where treatment
programs such as the Hazelden program in my state of Minnesota are
highlighted. In working with these and other treatment programs in
Minnesota, I have learned a great deal about the problems of substances
abuse, but also about the hope and success that occurs when effective
treatments are available. The Women's Health Research and Prevention
Amendments Act could be substantially improved by an additional focus
on substance abuse programs.
Another notable gap is in the area of mental health and behavioral
science. On page one of the New York Times today was an article on the
criminalization of mental illness. The problem is that we as a nation
have needed to focus on the humane, dignified treatment of mental
illness, and having failed in that, more and more people who are
suffering from mental illness are winding up in prisons where they are
out of sight, but where they are not getting the care they need. We
need to treat mental health as seriously as we treat cancer and heart
disease, because mental illness can be just as serious, chronic, and
life-destroying as other diseases.
I intend to work closely with Senator Frist and others on the
committee to improve the bill by including a recognition of the role
that behavioral science and psychological factors have in the
development of and recovery from disease. Many of the diseases
mentioned in the bill are scientifically linked to behavioral or
psychological factors that can be critical to prevention and recovery.
Women also suffer unduly from specific mental health problems and
experiences, such as depression and domestic violence. Depression, for
example, is a pervasive and impairing illness which affects women at
roughly twice the rate of men. Domestic violence places a significant
resource and economic strain on our justice, health, and human services
systems. Research conducted at urban hospitals has show that about 25%
of emergency room visits by women resulted from domestic assaults.
Women who have been raped or battered have significantly great physical
health problems, as well as increased vulnerability to psychological
and emotional suffering. My wife Sheila and I have worked for years to
improve the federal response to the epidemic levels of domestic
violence across the country; I want to make sure this bill adequately
addresses these issues.
Mr. President, it is my commitment to work closely with the committee
to enhance these and other areas that are critical to women's health. A
strong focus on research and prevention of mental illness and substance
abuse for women is an important investment in the health of the nation
and of the health and well being of countless families.
Mr. NICKLES. Mr. President, I want to speak today on the Women's
Health Research and Prevention Amendments of 1998 introduced by my
colleagues Senator Frist and Majority Leader Lott. This bill would
amend the Public Health Service Act to revise and extend certain
programs with respect to women's health research and prevention
activities at the National Institutes of Health and the Centers for
Disease Control and Prevention.
Education and Research are the key to providing the best health care
for women and for that matter, all Americans. The Women's Health
Research and Prevention Amendments promote precisely that. Just two
examples are the extension of NIH research programs for basic and
clinical research and education efforts with respect to cancer, breast
cancer, and ovarian and related cancer; and the extension of the CDC
National Breast and Cervical Cancer Early Detection Program. These are
the kinds of programs that will improve women's health.
I am pleased to be a cosponsor of the Women's Health bill because I
believe that research is the best way for Congress to respond to the
concern over women's health issues and health issues generally. I make
this point, Mr. President, because I have been disappointed that
Congress has recently put on lab coats and begun practicing medicine.
We have gotten into the dangerous habit of legislating clinical
procedures which are not based in science or research but rather driven
by social opinion and special interests.
You only have to look back to the end of the 104th Congress to
illustrate my point. A majority of Congress supported an effort last
year to mandate that all insurance plans cover 48-hour maternity stays
in hospitals. However, serval months following the passage of that
legislation an article appeared in the Journal of the American Medical
Association stating that the ``content does not solve the most
important problems regarding the need for early postpartum/postnatal
services. The legislation may give the public a false sense of
security. It may call into question the reasonableness of relying on
legislative mechanisms to micro manage clinical practice.''
In other words, Congress made a nice, laudable attempt. We said we
are going to mandate 48 hours, but it has had no appreciable
improvement on the quality of health care. It appears that our so-
called victory in passing 48 hours may have in fact done more harm than
good in helping women and newborns. This experience, and others like
it, should have taught us what not to do.
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It should have taught us that before we endeavor to decide what is
the best therapy, procedure, or treatment for any one disease, let us
look for a minute at what we are doing. What are the unintended
consequences of federal mandates on health insurance companies
regarding treatments and coverage of services?
Let's take breast cancer as another example. Various bills have been
introduced in the last few months that mandate a length of stay for
mastectomies or require coverage of an inpatient stay for women
undergoing breast cancer surgery for an unspecified length of time, to
be determined by the physician.
Were Congress to legislate in favor of one form of treatment over
another, we are sending the message that one treatment is preferable to
the other. Treatments are constantly changing. Health care needs to be
flexible and should not lock doctors in to a specific approach.
Shouldn't we allow medical research to decide the best course of
action? If the federal government mandates a specific treatment, length
of stay or procedure, that then becomes the standard.
In addition, employing mandates in the place of valid research runs
the risk of discouraging innovative treatments. For example, recent
improvements in anesthesiology are a result of patient appeals to cut
down on nausea and vomiting after breast surgery as well as a desire to
recover at home.
Longer mandated stays could discourage doctors and patients from
developing the best possible plan for recovery. Patients may choose to
stay in the hospital for an extended period of time out of fear or lack
of knowledge and risk infection. Patients may have the false idea that
longer hospital stays equal the best possible treatment when, in fact,
recent research indicates that is not necessarily the case.
According to a November 6, 1996, article in The Wall Street Journal,
The Johns Hopkins Breast Center in Baltimore, which has gradually
eliminated inpatient stays for some women undergoing certain types of
mastectomies, has found that outpatient mastectomies are associated
with lower infection rates and high levels of satisfaction among women.
We have the responsibility to arm patients with the kind of sound
research and education this legislation provides, not prescriptive
mandates from Dr. Congress.
Lillie Shockeney, R.N. the Education and Outreach Director at the
Johns Hopkins Hospital Breast Center and a breast cancer survivor,
summed up best in a Finance Committee hearing on November 5, 1997. ``.
. . I am concerned that it [
S. 249, The Women's Health and Cancer
Rights Act of 1997] doesn't solve the real medical dilemma that women
battling breast cancer are faced with today. We need to be striving to
improve patient care for patients undergoing breast cancer surgery
rather than unknowingly promote keeping it at status quo. We need to be
promoting the development of a comprehensive patient education program
and have teams of health care professionals dedicated to striving to
improve the care and treatment provided to women with breast cancer.''
Mr. President, I want to congratulate Senator Frist and Senator Lott
for bringing this issue before us in such a responsible and proactive
bill. These programs go a long way to serve women. I thank the chair
and encourage my colleagues to support this common sense legislation.
Mrs. BOXER. Mr. President, I am very pleased to join my colleagues in
introducing the Women's Health Research and Prevention Amendments of
1998. This is a bipartisan initiative, which is important, because
promoting the health of American women is a bipartisan concern. I
commend the Senator from Tennessee for his leadership on this bill. He
has done a tremendous job in building crucial and broad support for it.
I am particularly pleased that the bill includes a title on
cardiovascular disease in women, which incorporates legislation I
introduced last June, the Women's Cardiovascular Diseases Research and
Prevention Act (
S. 349). It is appropriate to include it in this
comprehensive legislation because cardiovascular disease is the number
one killer of women in the United States, a fact many Americans simply
don't realize.
The statistics are alarming. More than 500,000 women and girls die
from cardiovascular disease each year. Heart attacks and strokes are
the leading causes of disability in women. More than 1 in 5 females
have some form of cardiovascular disease. Of women and girls under age
65, approximately 20,000 die of heart attacks each year. Cardiovascular
disease claim about as many lives each year as the next eight leading
causes of death combined. More than 2,600 Americans die each day from
cardiovascular diseases; that's an average of one death every 33
seconds. Cardiovascular diseases kill more women each year than does
cancer. Heart attacks kill more than 5 times as many females as does
breast cancer. Stroke kills twice as many women as does breast cancer.
Each year since 1984, cardiovascular diseases have claimed the lives of
more females than males. In 1993, of the number of individuals who died
of such diseases, 52 percent were female, and 48 percent were male.
Yet for years, women have been under-represented in studies about
heart disease and stroke. Models and tests for detection have largely
been conducted on men, and some doctors do not recognize cardiovascular
symptoms that are unique to women.
The bill we are introducing today authorizes necessary funding to the
National Heart, Lung and Blood Institute to expand and intensify
research, prevention, and educational outreach programs for heart
attack, stroke and other cardiovascular diseases in women. This
legislation will aid our Nation's doctors and scientists in developing
a coordinated and comprehensive strategy for fighting this terrible
disease.
This bill will help ensure that women are well represented in future
cardiovascular studies and that their doctors are well informed about
symptoms that are unique to women. It will also promote women's
awareness of risk factors, such as smoking, obesity and physical
inactivity, which greatly increase their chances of developing
cardiovascular disease.
This legislation is a critical component in our efforts to draw
attention and
Amendments:
Cosponsors:
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
Sponsor:
Summary:
All articles in Senate section
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
(Senate - March 06, 1998)
Text of this article available as:
TXT
PDF
[Pages
S1508-S1533]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. LEAHY:
S. 1721. A bill to provide for the Attorney General of the United
States to develop guidelines for Federal prosecutors to protect
familial privacy and communications between parents and their children
in matters that do not involve allegations of violent or drug
trafficking conduct and the Judicial Conference of the United States to
make recommendations regarding the advisability of amending the Federal
Rules of Evidence for such purpose; to the Committee on the Judiciary.
parent-child privilege study legislation
Mr. LEAHY. Mr. President, I recently spoke on the floor about the
disgust that I share with most Americans about the tactics of Special
Prosecutor Kenneth Starr and the disturbing spectacle of hauling a
mother before a grand jury to reveal her intimate conversations with
her daughter in a matter, which--even if all the allegations about the
daughter's conduct were true--do not pose grave threats to the public
safety. This matter does not, for example, involve any allegations of
violence or drug trafficking conduct.
In this instance, as in others, Mr. Starr has scurried to apply all
of the legal weapons at his command, but none of the discretion that he
is obligated to exercise as one invested with almost unchecked legal
authority. I also expressed my intent to introduce legislation to study
whether, and under what circumstances, the confidential communications
between a parent and his or her child should be protected. A number of
professional relationships of trust are already protected by legal
privileges, but not familial relationships. This is the legislation I
introduce today.
Currently, under Rule 501 of the Federal Rules of Evidence,
privileges are ``governed by the principles of the common law as they
may be interpreted by the courts of the United States in the light of
reason and experience.'' Thus, in the absence of any Supreme Court
rules or federal statutes, courts look to the United States
Constitution and the principles of federal common law to determine the
applicability and the scope of privileges.
Legal academicians have expressed support for a parent-child
testimonial privilege. The public policy reasons favoring such a
privilege are numerous and relate to the respect we accord to
fundamental family values. Recognition of such a privilege could foster
and
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protect strong and trusting family relationships, preserve the family,
safeguard the privacy of familial communications and intimate family
matters against undue government intrusion, and promote a healthy
environment for the psychological development of children.
Despite these myriad reasons, there are indeed cases and
circumstances when parents should be compelled in court to share what
they know from their children. Indeed, courts have generally not been
receptive to the parent-child privilege. Only four States--Idaho,
Massachusetts, Minnesota, and New York--have adopted either by statute,
or by judicial recognition, some form of a parent-child privilege. No
Federal Court of Appeals have recognized this privilege nor has any
State Supreme Court that has considered the issue. In my own State of
Vermont, such a privilege is not recognized.
To my mind, and as a former prosecutor, prosecutors should show
restraint before putting parents in the untenable position of making a
legal determination as to whether their children should come to them
for advice, or whether the parents instead should feel legally
pressured to refer their own children to professional therapists, or
lawyers, or doctors in order to protect the confidentiality of the
child's communications. To be sure, there are some categories of cases,
particularly cases involving grave threats to the public safety, such
as violent or drug trafficking crimes, where the government can and
should appropriately seek testimony from a parent about what a child
has said. But we should all be clear about when prosecutors should also
show restraint.
Courts have recognized privilege claims in a variety of professional
relationships, ranging from attorneys to priests to psychotherapists.
Yet the relationship between parent and child--the most fundamental
relationship in our society--is generally not so protected in any
circumstances. As one New York court explained:
It would be difficult to think of a situation which more
strikingly embodies the intimate and confidential
relationship which exists among family members than that in
which a troubled young person, perhaps beset with remorse and
guilt, turns for counsel and guidance to his mother and
father. There is nothing more natural, more consistent with
our concept of the parental role, than that a child may rely
on his parents for help and advice. Shall it be said to those
parents, ``Listen to your son at the risk of being compelled
to testify about his confidences?''--In re Application of
A, 61 A.D.2d 426, 403 N.Y.S.2d 375, 378 (1978).
We should consider the sorts of circumstances and the types of cases
in which prosecutors should be asked to show some restraint before
turning to parents to provide evidence against their children. That is
why my bill calls for a study and report by the Justice Department on
what these circumstances should be, and to develop prosecutorial
guidelines accordingly. Specifically, these guidelines should identify
when the communications between parents and their children should carry
the same protections as preferred professional relationships, and the
circumstances and types of cases when those communications should be
subject to government scrutiny.
We cannot rely on the courts to formulate an appropriate parent-child
privilege. The Third Circuit recently declined to recognize the parent-
child privilege, noting that:
The legislature, not the judiciary, is institutionally
better equipped to perform the balancing of the competing
policy issues required in deciding whether the recognition of
a parent-child privilege is in the best interests of society.
Congress, through its legislative mechanisms, is also better
suited for the task of defining the scope of any prospective
privilege. . . . In short, if a new privilege is deemed
worthy of recognition, the wiser course in our opinion is to
leave the adoption of such a privilege to Congress.--In re
Grand Jury Proceedings (Impounded), 103 F.3d 1140, 1148, 1153
(3d Cir. 1996).
Likewise, the Seventh Circuit Court of Appeals has made clear that
``courts have been reluctant to create new privileges, preferring to
leave such matters to the legislature despite any policy reasons
supporting recognition of a particular privilege.'' United States v.
Riley, 653 F.2d 1153, 1160 (7th Cir. 1981).
Congress should accept this challenge. My bill is a start to the
process of seeking expert input on the significant question of when the
government may not compel parents to betray the confidences of their
children, and when because of compelling need or the nature of the case
or circumstances, parents should be required to reveal the substance of
what their children have told them.
Thus, the bill I introduce today directs the Attorney General to
develop Federal prosecutorial guidelines to protect familial privacy
and parent-child communications in matters that do not involve
allegations of violent or drug trafficking conduct. In addition, the
legislation would direct the Judicial Conference to undertake a study
and then give us a report on whether the Federal Rules of Evidence
should be amended to explicitly recognize a parent-child privilege in
cases not involving violent or drug trafficking conduct, and, if so, in
what circumstances that privilege should apply.
While we should endeavor to provide the maximum protection for
parent-child communications, we should also be careful not to unduly
obstruct law enforcement. Nor should the rule be susceptible to
litigious mischief.
Accordingly, the Attorney General and the Judicial Conference will
need to address, as part of the study and report called for in my bill,
a series of important questions, including:
(1) What communications should be considered confidential for
purposes of the privilege and, specifically, should the privilege apply
in both criminal and civil proceedings?
(2) Should such a privilege apply only to unemancipated minors, or
also to adult children?
(3) Should only the child's communications be protected, or should a
parent's communications to a child also receive protection?
(4) Should such a privilege extend beyond a child's natural parents
to include step-parents or grandparents?
(5) Should such a privilege be subject to rebuttal if the government
establishes a compelling need for the information?
This legislation is the first step in evaluating the merits and
difficulties inherent in protecting familial privacy and the parent-
child relationship against unwarranted intrusions by the government and
by overzealous prosecutors. The public and these families themselves
should not have to endure repeated scenes of mothers being marched into
grand jury inquisitions to reveal intimate talks they may have had with
their children about their private relationships. This is a far cry
from allegations concerning violent or drug trafficking conduct. Let us
find out what the Justice Department and Judicial Conference recommend
about how we can best protect child-parent confidences in ways that
comport with American notions of family, fidelity, and privacy, without
compromising our public safety and the integrity of our judicial
system.
I ask unanimous consent that a copy of the bill be printed in the
Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 1721
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. CONFIDENTIALITY OF PARENT CHILD COMMUNICATIONS IN
JUDICIAL PROCEEDINGS.
(a) Study and Development of Prosecutorial Guidelines.--The
Attorney General of the United States shall--
(1) study and evaluate the manner in which the States have
taken measures to protect the confidentiality of
communications between children and parents and, in
particular, whether such measures have been taken in matters
that do not involve allegations of violent or drug
trafficking conduct;
(2) develop guidelines for Federal prosecutors that will
provide the maximum protection possible for the
confidentiality of communications between children and
parents in matters that do not involve allegations of violent
or drug trafficking conduct, within any applicable
constitutional limits, and without compromising public safety
or the integrity of the judicial system, taking into
account--
(A) the danger that the free communication between a child
and his or her parent will be inhibited and familial privacy
and relationships will be damaged if there is no assurance
that such communications will be kept confidential;
(B) whether an absolute or qualified testimonial privilege
for communications between a child and his or her parents in
matters that do not involve allegations of violent or drug
trafficking conduct is appropriate to provide the maximum
guarantee of
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familial privacy and confidentiality without compromising
public safety or the integrity of the judicial system; and
(C) the appropriate limitations on a testimonial privilege
for such communications between a child and his or her
parents, including--
(i) whether the privilege should apply in criminal and
civil proceedings;
(ii) whether the privilege should extend to all children,
regardless of age, unemancipated or emancipated, or be more
limited;
(iii) the parameters of the familial relationship subject
to the privilege, including whether the privilege should
extend to stepparents or grandparents, adopted children, or
siblings; and
(iv) whether disclosure should be allowed absent a
particularized showing of a compelling need for such
disclosure, and adequate procedural safeguards are in place
to prevent unnecessary or damaging disclosures; and
(3) prepare and disseminate to Federal prosecutors the
findings made and guidelines developed as a result of the
study and evaluation.
(b) Report and Recommendations.--Not later than 1 year
after the date of enactment of this Act, the Attorney General
of the United States shall submit a report to Congress on--
(1) the findings of the study and the guidelines required
under subsection (a); and
(2) recommendations based on the findings on the need for
and appropriateness of further action by the Federal
Government.
(c) Review of Federal Rules of Evidence.--Not later than
180 days after the date of enactment of this Act, the
Judicial Conference of the United States shall complete a
review and submit a report to Congress on--
(1) whether the Federal Rules of Evidence should be amended
to guarantee that the confidentiality of communications by a
child to his or her parent in matters that do not involve
allegations of violent or drug trafficking conduct will be
adequately protected in Federal court proceedings; and
(2) if the rules should be so amended, a proposal for
amendments to the rules that provides the maximum protection
possible for the confidentiality of such communications,
within any applicable constitutional limits and without
compromising public safety or the integrity of the judicial
system.
______
By Mr. FRIST (for himself, Mr. Lott, Mr. Jeffords, Mr. Kennedy,
Mr. Gregg, Mr. Dodd, Mr. Enzi, Mr. Harkin, Mr. Hutchinson, Ms.
Mikulski, Ms. Collins, Mr. Bingaman, Mr. McConnell, Mr.
Wellstone, Mrs. Murray, Mr. Reed, Ms. Snowe, Mr. Nickles, Mr.
Mack, Mrs. Boxer, Mr. Daschle, Mr. Chafee, Mrs. Feinstein, Mr.
Roth, Mr. Specter, Mr. D'Amato, Mr. Domenici, and Mr.
Santorum):
S. 1722. A bill to amend the Public Health Service Act to revise and
extend certain programs with respect to women's health research and
prevention activities at the National Institutes of Health and the
Centers for Disease Control and Prevention; to the Committee on Labor
and Human Resources.
the women's health research and prevention amendments of 1998
Mr. FRIST. Mr. President, I am very pleased to introduce today, with
the majority leader, the Women's Health Research and Prevention
Amendments of 1998. The purpose of this bill is to increase awareness
of some of the most pressing diseases and health issues that women in
our country face. This bill focuses on women's health research and
prevention activities at the National Institutes of Health and the
Centers for Disease Control and Prevention.
Our goal, in introducing this bill today, is to create greater
awareness of women's health issues and to highlight the critical role
our public health agencies--the NIH, the National Institutes of Health,
and the CDC, the Centers for Disease Control and Prevention--play in
providing a broad spectrum of activities to improve women's health,
including research, screening, health data management, prevention and
treatment of diseases, and broad health education.
This bill reauthorizes programs at the National Institutes of Health
for vital research activities into the causes, prevention, and
treatment for some of the major diseases affecting women, including
osteoporosis, breast cancer, ovarian cancer, as well as research into
the aging processes of women.
Let me cite just a few statistics to illustrate the need for further
research into these health issues.
Osteoporosis is a health threat for 28 million Americans, 80 percent
of whom are women. One in every two women over the age of 50 years will
have an osteoporosis-related fracture.
One out of every eight women will develop breast cancer over the
course of their lifetimes, and 1 in 25 will die of breast cancer.
Ovarian cancer is the fourth leading cause of death from cancer among
women. One of the most troubling aspects of ovarian cancer is the
challenge we have in diagnosing this disease earlier and earlier. We
know that a late diagnosis results in a worse outcome. The
reauthorization of these research programs will help assure scientific
progress in our fight against these diseases and will lessen their
burden on women and their families.
For far too long, women in this country have been neglected in many
of our research clinical studies. I am very pleased that, since 1993,
we have developed guidelines to include women and minorities in NIH-
sponsored trials. However, we must continue to do more. We must
continue to review our women's health research agenda to set future
research priorities and to incorporate new scientific knowledge
regarding women's health. We must continue to focus and coordinate all
our efforts in research areas, including clinical trial research
design, genetic factors, the aging process, and other gender-based
differences.
I am also pleased in this bill that we authorize a new research
program at the National Heart, Lung, and Blood Institute at the NIH to
target heart attack, stroke, and other cardiovascular diseases in
women. This program, originally introduced by my colleague, Senator
Boxer, will advance research into cardiovascular diseases--the leading
cause of death in the United States in women. More than 500,000
American women will die annually from cardiovascular diseases.
Cardiovascular diseases--that is, diseases of the heart and the blood
vessels--kill almost twice as many American women as all other cancers.
One of the biggest myths in medicine is that heart disease is only a
male problem. When we think of a heart attack, many people associate it
with men. Even in my own studies during my internship and residency in
medicine--not that long ago--all the models, the pictures that were
used in textbooks, the warning signs on TV--always pictured a man.
However, since 1984, the number of cardiovascular disease deaths in
women has exceeded those of men. And in 1995, 50,000 more women died of
heart disease than men. The program we are including in the bill today
will expand the research programs at NIH to concentrate more on
cardiovascular diseases in women.
Our bill reauthorizes several programs at the Centers for Disease
Control and Prevention for prevention and education activities on
women's health issues. We are reauthorizing the National Center for
Health Statistics, the National Program of Cancer Registries, the
National Breast and Cervical Cancer Early Detection Program, the
Centers for Research and Demonstration of Health Promotion and Disease
Prevention, and the Community Programs on Domestic Violence.
CDC's programs provide critical health services in each of our States
and in our communities to detect, prevent, and diagnose diseases such
as breast and cervical cancer. For the past 7 years, the National
Breast and Cervical Cancer Early Detection Program has provided
critical cancer screening services to underserved women, especially
low-income women, elderly women, and members of racial and ethnic
minority groups. CDC supports early detection programs in all 50
States, in 5 territories, in the District of Columbia, and in 14
American Indian/Alaskan Native organizations. Through March 1997, more
than 1.3 million screening tests have been provided by this one
program.
CDC programs provide critical data and statistics about women's
health that assist us in making informed policy decisions about health
care. The National Center for Health Statistics often provides the only
national data on the health status of U.S. women and their use of
health care. A recent report by the National Center for Health
Statistics entitled ``Women: Work and Health'' summarized the data on
health conditions affecting working women. This report is the first
comprehensive survey on work-related
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health issues encountered by the more than 60 million women in the
American labor force.
I thank the majority leader for his leadership on this issue and for
his efforts in the introduction of this bill. I am pleased to state
that this bill is bipartisan. We have included provisions that are the
product of the efforts of many of my colleagues--Senators Snowe,
Harkin, Boxer, and many others. We have the support of nearly the full
Senate Labor and Human Resources Committee, and over 27 Members of the
Senate are original cosponsors of this bipartisan bill. The level of
support for this bill is a real testament to the need to combat the
diseases affecting women and to maintain those crucial health services
that help prevent these diseases.
This bill, again, is introduced to generate discussion of these
important programs. We intend to consider these programs within the
context of the upcoming NIH reauthorization bill to be introduced over
the next several months. I encourage all Members and constituencies to
review the current programs and to provide input as we set the future
agenda of women's health research and prevention in this Nation.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 1722
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Women's Health Research and
Prevention Amendments of 1998''.
TITLE I--PROVISIONS RELATING TO WOMEN'S HEALTH RESEARCH AT THE NATIONAL
INSTITUTES OF HEALTH
SEC. 101. EXTENSION OF PROGRAM FOR RESEARCH AND AUTHORIZATION
OF NATIONAL PROGRAM OF EDUCATION REGARDING THE
DRUG DES.
(a) In General.--Section 403A(e) of the Public Health
Service Act (42 U.S.C. 283a(e)) is amended by striking
``1996'' and inserting ``2001''.
(b) National Program for Education of Health Professionals
and Public.--From amounts appropriated for carrying out
section 403A of the Public Health Service Act (42 U.S.C.
283a), the Secretary of Health and Human Services, acting
through the heads of the appropriate agencies of the Public
Health Service, shall carry out a national program for the
education of health professionals and the public with respect
to the drug diethylstilbestrol (commonly know as DES). To the
extent appropriate, such national program shall use
methodologies developed through the education demonstration
program carried out under such section 403A. In developing
and carrying out the national program, the Secretary shall
consult closely with representatives of nonprofit private
entities that represent individuals who have been exposed to
DES and that have expertise in community-based information
campaigns for the public and for health care providers. The
implementation of the national program shall begin during
fiscal year 1999.
SEC. 102. RESEARCH ON OSTEOPOROSIS, PAGET'S DISEASE, AND
RELATED BONE DISORDERS.
Section 409A(d) of the Public Health Service Act (42 U.S.C.
284e(d)) is amended by striking ``and 1996'' and inserting
``through 2001''.
SEC. 103. RESEARCH ON CANCER.
(a) In General.--Section 417B(a) of the Public Health
Service Act (42 U.S.C. 286a-8(a)) is amended by striking
``and 1996'' and inserting ``through 2001''.
(b) Research on Breast Cancer.--Section 417B(b)(1) of the
Public Health Service Act (42 U.S.C. 286a-8(b)(1)) is
amended--
(1) in subparagraph (A), by striking ``and 1996'' and
inserting ``through 2001''; and
(2) in subparagraph (B), by striking ``and 1996'' and
inserting ``through 2001''.
(c) Research on Ovarian and Related Cancer Research.--
Section 417B(b)(2) of the Public Health Service Act (42
U.S.C. 286a-8(b)(2)) is amended by striking ``and 1996'' and
inserting ``through 2001''.
SEC. 104. RESEARCH ON HEART ATTACK, STROKE, AND OTHER
CARDIOVASCULAR DISEASES IN WOMEN.
Subpart 2 of part C of title IV of the Public Health
Service Act (42 U.S.C. 285b et seq.) is amended by inserting
after section 424 the following:
``heart attack, stroke, and other cardiovascular diseases in women
``Sec. 424A. (a) In General.--The Director of the Institute
shall expand, intensify, and coordinate research and related
activities of the Institute with respect to heart attack,
stroke, and other cardiovascular diseases in women.
``(b) Coordination With Other Institutes.--The Director of
the Institute shall coordinate activities under subsection
(a) with similar activities conducted by the other national
research institutes and agencies of the National Institutes
of Health to the extent that such Institutes and agencies
have responsibilities that are related to heart attack,
stroke, and other cardiovascular diseases in women.
``(c) Certain Programs.--In carrying out subsection (a),
the Director of the Institute shall conduct or support
research to expand the understanding of the causes of, and to
develop methods for preventing, cardiovascular diseases in
women. Activities under such subsection shall include
conducting and supporting the following:
``(1) Research to determine the reasons underlying the
prevalence of heart attack, stroke, and other cardiovascular
diseases in women, including African-American women and other
women who are members of racial or ethnic minority groups.
``(2) Basic research concerning the etiology and causes of
cardiovascular diseases in women.
``(3) Epidemiological studies to address the frequency and
natural history of such diseases and the differences among
men and women, and among racial and ethnic groups, with
respect to such diseases.
``(4) The development of safe, efficient, and cost-
effective diagnostic approaches to evaluating women with
suspected ischemic heart disease.
``(5) Clinical research for the development and evaluation
of new treatments for women, including rehabilitation.
``(6) Studies to gain a better understanding of methods of
preventing cardiovascular diseases in women, including
applications of effective methods for the control of blood
pressure, lipids, and obesity.
``(7) Information and education programs for patients and
health care providers on risk factors associated with heart
attack, stroke, and other cardiovascular diseases in women,
and on the importance of the prevention or control of such
risk factors and timely referral with appropriate diagnosis
and treatment. Such programs shall include information and
education on health-related behaviors that can improve such
important risk factors as smoking, obesity, high blood
cholesterol, and lack of exercise.
``(d) Authorization of Appropriations.--For the purpose of
carrying out this section, there is authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 1999 through 2001. The authorization of
appropriations established in the preceding sentence is in
addition to any other authorization of appropriation that is
available for such purpose.''.
SEC. 105. AGING PROCESSES REGARDING WOMEN.
Section 445I of the Public Health Service Act (42 U.S.C.
285e-11) is amended by striking ``and 1996'' and inserting
``through 2001''.
SEC. 106. OFFICE OF RESEARCH ON WOMEN'S HEALTH.
Section 486(d)(2) of the Public Health Service Act (42
U.S.C. 287d(d)(2)) is amended by striking ``Director of the
Office'' and inserting ``Director of the National Institutes
of Health''.
TITLE II--PROVISIONS RELATING TO WOMEN'S HEALTH AT THE CENTERS FOR
DISEASE CONTROL AND PREVENTION
SEC. 201. NATIONAL CENTER FOR HEALTH STATISTICS.
Section 306(n) of the Public Health Service Act (42 U.S.C.
242k(n)) is amended--
(1) in paragraph (1), by striking ``through 1998'' and
inserting ``through 2002''; and
(2) in paragraph (2), by striking ``through 1998'' and
inserting ``through 2002''.
SEC. 202. NATIONAL PROGRAM OF CANCER REGISTRIES.
Section 399L(a) of the Public Health Service Act (42 U.S.C.
280e-4(a)) is amended by striking ``through 1998'' and
inserting ``through 2002''.
SEC. 203. NATIONAL BREAST AND CERVICAL CANCER EARLY DETECTION
PROGRAM.
(a) Grants.--Section 1501(b) of the Public Health Service
Act (42 U.S.C. 300k(b)) is amended--
(1) in paragraph (1), by striking ``nonprofit''; and
(2) in paragraph (2), by striking ``that are not nonprofit
entities''.
(b) Preventive Health.--Section 1509(d) of the Public
Health Service Act (42 U.S.C. 300n-4a(d)(1)) is amended by
striking ``through 1998'' and inserting ``through 2002''.
(c) General Program.--Section 1510(a) of the Public Health
Service Act (42 U.S.C. 300n-5(a)) is amended by striking
``through 1998'' and inserting ``through 2002''.
SEC. 204. CENTERS FOR RESEARCH AND DEMONSTRATION OF HEALTH
PROMOTION.
Section 1706(e) of the Public Health Service Act (42 U.S.C.
300u-5(e)) is amended by striking ``through 1998'' and
inserting ``through 2002''.
SEC. 205. COMMUNITY PROGRAMS ON DOMESTIC VIOLENCE.
Section 318(h)(2) of the Family Violence Prevention and
Services Act (42 U.S.C. 10418(h)(2)) is amended by striking
``fiscal year 1997'' and inserting ``for each of the fiscal
years 1997 through 2002''.
Mr. LOTT. Mr. President, this morning I am very pleased to join
Senator Frist of Tennessee, who is an outstanding Senator, and also a
doctor, who has been very helpful to me, and a lot of Senators, since
he joined this body, in introducing legislation entitled ``The Women's
Health Research and Prevention Act.''
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The bill authorizes and reauthorizes a collection of first-class
research and prevention programs in the National Institutes of Health
and the Centers for Disease Control and Prevention.
Breast cancer is the leading cause of death in women between the ages
of 40 and 55. About one out of every eight women in the United States
will, unfortunately, develop breast cancer during their lifetime. And
so the Frist-Lott bill reauthorizes breast and ovarian cancer research
and education programs at NIH.
Osteoporosis is a disease in which bones become fragile and more
likely to break. My wife is beginning to confront this particular
problem. As women age, they lose bone mass and are at risk of
debilitating accidents such as fractures. This bill extends
osteoporosis research and education programs at NIH.
Women's health, though, means more than just health issues specific
to women. Heart disease, for instance, the No. 1 killer in the U.S. of
women, of course, also affects men in great numbers. Hypertension, a
leading cause of heart disease, is two to three times more common in
women than in men.
In addition to these three key research areas, our bill continues
programs in the Centers for Disease Control, including the National
Program of Cancer Registries and the National Early Detection Program
for breast and cervical cancer.
Senator Frist, the Senate's only doctor, and an outstanding heart
surgeon himself, provided the details of the bill. Senator Frist is
chairman of the Senate Public Health Subcommittee of the Senate Labor
Committee, and is one of the Senate's key leaders on all of our health
issues.
I am pleased that he is also serving on our Medicare commission that
had its first meeting yesterday, including a meeting with the
President.
I have often turned to him for advice and guidance on health matters,
and will continue to do so in the future. I believe that just this
morning Senator Frist attended a meeting regarding Medicare, and that
will be helpful in this effort. I know it will be a bipartisan effort.
I encourage colleagues on both sides of the aisle to cosponsor this
important legislation.
This morning I was made aware that Senator Mack is a cosponsor, and
Senator D'Amato. We are inviting all Members to join us in this very
serious and very important issue that we need to act on in order to
reauthorize some of these programs and authorize new ones.
I thank Senator Frist for his leadership in this area, and I yield
the floor.
Mr. JEFFORDS. Mr. President, I rise to recognize Senator Frist for
taking an important step that brings together a number of Government
programs of research, treatment and disease prevention for women. Over
the past several years, Congress and the Nation have become
increasingly concerned about women's health. I appreciate the
leadership and the expertise that Dr. Frist brings to Congress about
these issues. We have much to learn about recognizing and treating the
medical needs of women.
In the first session of the 105th Congress, at least 21 bills
relating to women's health were introduced and referred to the Senate
Labor and Human Resources Committee. At our committee hearing on
women's health last July, we heard about important advances being made
in research. We also heard about significant gaps of knowledge which
need to be filled. More importantly, we recognize how important it is
to get information about scientific advances to the public and their
health care providers.
Thus, I am pleased the provisions of this bill provide for research
and for public and professional education. We know that once the
information is out to the public and health care professionals, we need
screening programs, closely followed by access to treatment. The bill
provides for important patient services.
Finally, once common conditions are well recognized, detected and
treated, we need data to track our progress in disease prevention and
to alert us to new help in illness trends. This bill provides for these
functions through the support for cancer registries, information
systems, and program evaluation. It is my hope that having women's
issues collected together in one bill will focus the attention of
Congress and the Nation on vigorous support of the woman's health
initiative.
I am pleased to join Senator Frist in sponsoring this legislation.
Mr. KENNEDY. Mr. President, I commend Senator Frist for his
leadership on the bill we are introducing today, ``The Women's Health
Research and Prevention Amendments of 1998.'' This bill is a bipartisan
effort to extend and strengthen several important women's health
programs at the National Institutes of Health and the Centers for
Disease Control and Prevention.
In recent years, women's health has begun to receive the high
priority it deserves. Five years ago government guidelines were finally
eliminated that specifically excluded women from many clinical trials.
Increasingly, Congress has given higher priority to funds to address
breast cancer and other women's health issues. We also established the
Office of Women's Health within the Department of Health and Human
Services, in order to develop and implement a national agenda for
women's health. These successes, however, have revealed that there is
much more to be done.
The bill we are introducing today is an attempt to fill some of the
gaps in research and prevention that we have identified in women's
health. It is time for Congress to acknowledge that women's health
involves a wider range of issues, and that the magnitude of these
issues varies greatly with age. Car crashes and unintended injuries are
the leading killer of women in their teens and twenties. Cancer is the
leading killer of women between the ages of 25 and 64. Heart disease is
the leading killer among women over 65.
The nation's agenda on women's health must also address other key
issues that are more common among women but affect men too, such as
osteoporosis, depression, and auto-immune diseases, and illnesses that
manifest themselves differently in men and women, such as heart
disease, substance abuse, AIDS, and violence.
Our legislation extends important research and prevention activities
now being carried out by the National Institutes of Health and the
Centers for Disease Control and Prevention in areas traditionally
considered women's health issues, such as breast and ovarian cancer,
osteoporosis, and domestic violence. It also calls for greater research
efforts on heart attacks, strokes, and other cardiovascular diseases,
in recognition of the serious effects of these diseases on women.
Our bill also provides continued support for academic health centers
to conduct research and demonstration projects related to health
promotion and disease prevention to improve quality of life, and to
curb premature mortality and illness that contribute to excessive
health costs. These academic health centers are effective in informing
women and their physicians of steps they can take to prevent serious
illness and injury, especially in cases involving chronic and
debilitating physical illness, such as arthritis and osteoporosis,
which put women at high risk for bone fractures.
In order to enable researchers to monitor health trends among women
and to help policymakers make informed decisions on the allocation of
resources, it is essential for accurate and timely statistical and
epidemiological data to be available. Our bill will provide continued
support of the CDC's National Center for Health Statistics, which
provides valuable data related to overall health status, lifestyle,
onset and diagnosis of illness and disability, and use of health care
and rehabilitation services.
It is also important to understand differences between racial and
ethnic groups. For example, black women have far higher death rates
from heart disease, cancer, stroke and diabetes than white women.
Minority women suffer the most from AIDS. More than half of new female
cases of AIDS over the past decade were found among blacks. For other
chronic diseases, black women have the highest rates of hypertension,
while Native American women have higher rates of asthma and chronic
bronchitis. This bill will enable the National Center for Health
Statistics to continue its important work on the health of ethnic and
racial populations, and improve methods to collect data on these
subgroups in
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order to understand and address their various health needs more
effectively.
Too many health needs of women continue to be neglected by the
nation's health care system. The cost of this national neglect, both in
dollars and in lives, is staggering. This bill is an excellent starting
point for strengthening current programs and pursuing new initiatives
to address urgent national priorities in women's health. I look forward
to working with my colleagues and with the women's health community to
enact the strongest legislation we can to deal with these vital issues.
Mr. HARKIN. Mr. President, I am pleased today to join many of my
colleagues in support of the ``Women's Health Research and Prevention
Amendments of 1998.'' This legislation, introduced by my distinguished
colleague, Senator Bill Frist, and cosponsored by nearly all the
members of the Committee on Labor and Human Resources, is an important
step forward in the study and prevention of diseases and conditions
unique to women.
In the late 1980's, I learned that there was an embarrassing lack of
research on diseases and conditions prevalent in women. In addition,
the General Accounting Office (GAO) reported that women were routinely
excluded from medical research studies at NIH. Because of this
information, in 1990, I fought for legislation creating the Office of
Research on Women's Health at the National Institutes of Health (NIH).
Since its creation, the Office successfully worked to ensure that
research focuses on women's health and that women be included in
clinical trials.
Senator Frist's legislation builds upon the base of research and
prevention knowledge we have developed over the past few years. The
bill reauthorizes essential programs relating to women's health
research at NIH and the Centers for Disease Control and Prevention
(CDC).
I am particularly proud of the reauthorization of the programs
promoting research and education on the drug ``diethylstilbestrol,''
otherwise known as DES. This drug was prescribed to pregnant American
women from 1938 to 1971 in the mistaken belief that it would prevent
miscarriage. But DES is now known to cause a five-fold increased risk
of ectopic pregnancy, as well as a three-fold increased risk of
miscarriage. I was proud to introduce legislation in 1992 that
established a pilot program through NIH to test ways to educate the
public and health professionals about how to deal with DES exposure.
Last year I introduced legislation that would give people across the
nation access to information developed through this pilot program. I am
pleased that this bill has been incorporated in the ``Women's Health
Research and Prevention Amendments of 1998.''
In addition, I am pleased that the bill extends research programs for
basic and clinical research and education efforts with respect to
cancer, particularly breast cancer and ovarian cancer. I have fought
for a long time for increased funding for breast cancer research.
During my tenure as Chairman of the Subcommittee on Appropriations that
handles NIH we provided dramatic increases in funding for breast cancer
research.
This legislation also extends important research at NIH on
osteoporosis, Paget's disease and related bone disorders, and research
on cardiovascular diseases in women. It reauthorizes programs at the
National Institute on Aging, including research into the aging
processes of women, with particular emphasis on the effects of
menopause and the complications related to aging and the loss of
ovarian hormones in women.
CDC also plays an important role in the prevention diseases and
conditions in women. This legislation would extend CDC's collection of
statistical and epidemiological information, which is often the only
national data available on the health status of American women and
their use of the health care system. The bill extends CDC's National
Cancer Registries Program, which provides funds to states to enhance
their cancer surveillance data needed to monitor trends and serve as
the foundation of a national comprehensive cancer control strategy.
I am particularly proud that this legislation extends the National
Breast and Cervical Cancer Early Detection Program. In 1990 I worked to
start and fund this program which provides mammography and cervical
cancer screening to low income women without insurance. This program
has provided vital access to services for thousands of women across the
country.
In addition, the bill would extend authorization for grants to
academic health institutions for research on health promotion and
disease prevention. A number of these institutions are working together
to develop strategies for prevention of cardiovascular disease in
women. Finally, the bill reauthorizes grants administered by CDC to
non-profit private organizations to establish projects in local
communities to coordinate intervention and prevention of domestic
violence.
Mr. President, the research into and prevention of diseases prevalent
in women is an investment in our daughters, wives, mothers, and
sisters. It is an investment in our future.
Mr. BINGAMAN. Mr. President, I rise today to join Senator Frist and
my other colleagues in introducing the Women's Health Research and
Prevention Amendments of 1998.
This legislation allows us to reauthorize key women's health research
and prevention programs at the National Institutes of Health and the
Centers for Disease Control and Prevention. These programs represent a
cross section of the current research projects at the federal level
that have a direct impact on women's lives here in the United States.
While in the last decade, interest and commitment to women's health
has been heightened in the Congress, much work remains. We have taken
steps to ensure that women will be included in health care research in
the U.S. Prior to 1993, research in women's health was inadequate. Most
of the health care studies were conducted only on Anglo men. Quite
simply, research studies on men cannot be generalized to women. We know
that there are gender and ethnic differences when it comes to health
and illness. The time has come to further address the major causes of
morbidity and mortality among women: heart disease, osteoporosis,
breast cancer, and colorectal cancer.
This bill will provide the basis for looking at the research needs in
the spectrum of women's health and as we go to hearings on the bill I
am hopeful that additional women's health issues can be addressed.
There is another facet to women's health research that must be
considered. It is imperative that we ensure that studies are
representative of all women in the United States, including African
American, Hispanic, Native American and Asian women. We need research
that is culturally sensitive. We must support efforts of community
based outreach that allows for recruitment and retention of minority
women into research and this should be a factor when projects are
planned and conducted.
Mr. President, this legislation has provisions relating to women's
health research at the NIH in the disease specific issues of
diethylstilbestrol (DES), osteoporosis, breast and ovarian cancer. It
expands and allows for increased coordination of research activities
with respect to heart attack, stroke, and other cardiovascular diseases
in women at the National Heart, Lung, and Blood Institute. This program
is critical since cardiovascular disease is the leading cause of death
for women in the United States.
Finally, Mr. President, I wanted to take the opportunity to
specifically highlight one particular CDC program in the bill. This
legislation addresses the Health Promotion and Disease Prevention
Research Centers Program at the CDC and will extend authorization for
grants to our academic health institutions for research in the areas of
health promotion and disease prevention.
The CDC's Prevention Research Center Program is an innovative,
extramural link of federal, academic, state, and community based
agencies.
For my home state of New Mexico, this CDC project has been
particularly useful. In New Mexico a prevention center has been able to
focus on health risks and promoting health through applied research at
the community level. The project and grant have provided the
opportunity to address areas often overlooked such as rural population
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needs and Native American and Hispanic health needs.
In New Mexico about one of every three American Indian adults has
diabetes. The demonstration project has allowed for the promotion of
health lifestyles to combat the epidemic of adult onset diabetes. The
project has facilitated the formation of a true partnership between the
Navajo nation, nineteen pueblos in New Mexico, the New Mexico
Department of Health, the University of New Mexico, and the New Mexico
State Department of Education. There has been training of community
health workers on disease prevention strategies most applicable to
American Indian communities. This program is a model for increasing
collaboration among established agencies and nontraditional community
partners. It is a culturally sensitive approach that is having a
direct, positive impact on the health of New Mexicans. The creative
approach at CDC of a community based demonstration and application
project coupled with evaluation of strategies through research is
unique, successful, and should be reauthorized.
Mr. President, in closing, I look upon this bill as the important
first step to reauthorize programs at both the CDC and NIH. I look
forward to working with Senator Frist on these and other issues of
import to women's health.
Mr. WELLSTONE. Mr. President, I rise today to join my colleague from
Tennessee and others in introducing the ``Women's Health Research and
Prevention Amendments of 1998,'' as an original cosponsor. This bill
reauthorizes funding to extend and enhance many fine programs at the
National Institutes of Health and the Centers for Disease Control and
Prevention. I am pleased to join in this important effort.
Mr. President, I would like to commend Senator Frist for his work in
developing this legislation to strengthen and expand Federal efforts to
promote women's health. While there is still some work to be done to
improve the bill as it moves through the normal legislative process, I
believe this bill offers a good start and provides a solid foundation
on which to build historic improvements in NIH research programs on
breast cancer, heart attack, menopause, and other areas. Let me outline
briefly a few critical issues that are not addressed by the bill, but
which I hope to see addressed as we move forward.
One notable gap is in the area of substance abuse. I believe this
bill could be an important complement to the Substances Abuse Treatment
Parity Act (
S. 1147), which I introduced last September to improve
access to equitable medical care to treat the disease of alcohol and
other drug dependencies. Substance abuse is a widespread health concern
for many women, who also experience associated health, psychological,
and family problems. For example, expectant mothers and mothers with
small children can be helped with treatment and support services. This
is an investment for them, but as importantly for their children, who
would have the opportunity to grow up in a healthy, chemical-free home
environment. We have to take the problem of substance abuse as
seriously as we do other aspects of women's health.
Important information about this national problem will be highlighted
in an upcoming five-part PBS series by Bill Moyers, where treatment
programs such as the Hazelden program in my state of Minnesota are
highlighted. In working with these and other treatment programs in
Minnesota, I have learned a great deal about the problems of substances
abuse, but also about the hope and success that occurs when effective
treatments are available. The Women's Health Research and Prevention
Amendments Act could be substantially improved by an additional focus
on substance abuse programs.
Another notable gap is in the area of mental health and behavioral
science. On page one of the New York Times today was an article on the
criminalization of mental illness. The problem is that we as a nation
have needed to focus on the humane, dignified treatment of mental
illness, and having failed in that, more and more people who are
suffering from mental illness are winding up in prisons where they are
out of sight, but where they are not getting the care they need. We
need to treat mental health as seriously as we treat cancer and heart
disease, because mental illness can be just as serious, chronic, and
life-destroying as other diseases.
I intend to work closely with Senator Frist and others on the
committee to improve the bill by including a recognition of the role
that behavioral science and psychological factors have in the
development of and recovery from disease. Many of the diseases
mentioned in the bill are scientifically linked to behavioral or
psychological factors that can be critical to prevention and recovery.
Women also suffer unduly from specific mental health problems and
experiences, such as depression and domestic violence. Depression, for
example, is a pervasive and impairing illness which affects women at
roughly twice the rate of men. Domestic violence places a significant
resource and economic strain on our justice, health, and human services
systems. Research conducted at urban hospitals has show that about 25%
of emergency room visits by women resulted from domestic assaults.
Women who have been raped or battered have significantly great physical
health problems, as well as increased vulnerability to psychological
and emotional suffering. My wife Sheila and I have worked for years to
improve the federal response to the epidemic levels of domestic
violence across the country; I want to make sure this bill adequately
addresses these issues.
Mr. President, it is my commitment to work closely with the committee
to enhance these and other areas that are critical to women's health. A
strong focus on research and prevention of mental illness and substance
abuse for women is an important investment in the health of the nation
and of the health and well being of countless families.
Mr. NICKLES. Mr. President, I want to speak today on the Women's
Health Research and Prevention Amendments of 1998 introduced by my
colleagues Senator Frist and Majority Leader Lott. This bill would
amend the Public Health Service Act to revise and extend certain
programs with respect to women's health research and prevention
activities at the National Institutes of Health and the Centers for
Disease Control and Prevention.
Education and Research are the key to providing the best health care
for women and for that matter, all Americans. The Women's Health
Research and Prevention Amendments promote precisely that. Just two
examples are the extension of NIH research programs for basic and
clinical research and education efforts with respect to cancer, breast
cancer, and ovarian and related cancer; and the extension of the CDC
National Breast and Cervical Cancer Early Detection Program. These are
the kinds of programs that will improve women's health.
I am pleased to be a cosponsor of the Women's Health bill because I
believe that research is the best way for Congress to respond to the
concern over women's health issues and health issues generally. I make
this point, Mr. President, because I have been disappointed that
Congress has recently put on lab coats and begun practicing medicine.
We have gotten into the dangerous habit of legislating clinical
procedures which are not based in science or research but rather driven
by social opinion and special interests.
You only have to look back to the end of the 104th Congress to
illustrate my point. A majority of Congress supported an effort last
year to mandate that all insurance plans cover 48-hour maternity stays
in hospitals. However, serval months following the passage of that
legislation an article appeared in the Journal of the American Medical
Association stating that the ``content does not solve the most
important problems regarding the need for early postpartum/postnatal
services. The legislation may give the public a false sense of
security. It may call into question the reasonableness of relying on
legislative mechanisms to micro manage clinical practice.''
In other words, Congress made a nice, laudable attempt. We said we
are going to mandate 48 hours, but it has had no appreciable
improvement on the quality of health care. It appears that our so-
called victory in passing 48 hours may have in fact done more harm than
good in helping women and newborns. This experience, and others like
it, should have taught us what not to do.
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It should have taught us that before we endeavor to decide what is
the best therapy, procedure, or treatment for any one disease, let us
look for a minute at what we are doing. What are the unintended
consequences of federal mandates on health insurance companies
regarding treatments and coverage of services?
Let's take breast cancer as another example. Various bills have been
introduced in the last few months that mandate a length of stay for
mastectomies or require coverage of an inpatient stay for women
undergoing breast cancer surgery for an unspecified length of time, to
be determined by the physician.
Were Congress to legislate in favor of one form of treatment over
another, we are sending the message that one treatment is preferable to
the other. Treatments are constantly changing. Health care needs to be
flexible and should not lock doctors in to a specific approach.
Shouldn't we allow medical research to decide the best course of
action? If the federal government mandates a specific treatment, length
of stay or procedure, that then becomes the standard.
In addition, employing mandates in the place of valid research runs
the risk of discouraging innovative treatments. For example, recent
improvements in anesthesiology are a result of patient appeals to cut
down on nausea and vomiting after breast surgery as well as a desire to
recover at home.
Longer mandated stays could discourage doctors and patients from
developing the best possible plan for recovery. Patients may choose to
stay in the hospital for an extended period of time out of fear or lack
of knowledge and risk infection. Patients may have the false idea that
longer hospital stays equal the best possible treatment when, in fact,
recent research indicates that is not necessarily the case.
According to a November 6, 1996, article in The Wall Street Journal,
The Johns Hopkins Breast Center in Baltimore, which has gradually
eliminated inpatient stays for some women undergoing certain types of
mastectomies, has found that outpatient mastectomies are associated
with lower infection rates and high levels of satisfaction among women.
We have the responsibility to arm patients with the kind of sound
research and education this legislation provides, not prescriptive
mandates from Dr. Congress.
Lillie Shockeney, R.N. the Education and Outreach Director at the
Johns Hopkins Hospital Breast Center and a breast cancer survivor,
summed up best in a Finance Committee hearing on November 5, 1997. ``.
. . I am concerned that it [
S. 249, The Women's Health and Cancer
Rights Act of 1997] doesn't solve the real medical dilemma that women
battling breast cancer are faced with today. We need to be striving to
improve patient care for patients undergoing breast cancer surgery
rather than unknowingly promote keeping it at status quo. We need to be
promoting the development of a comprehensive patient education program
and have teams of health care professionals dedicated to striving to
improve the care and treatment provided to women with breast cancer.''
Mr. President, I want to congratulate Senator Frist and Senator Lott
for bringing this issue before us in such a responsible and proactive
bill. These programs go a long way to serve women. I thank the chair
and encourage my colleagues to support this common sense legislation.
Mrs. BOXER. Mr. President, I am very pleased to join my colleagues in
introducing the Women's Health Research and Prevention Amendments of
1998. This is a bipartisan initiative, which is important, because
promoting the health of American women is a bipartisan concern. I
commend the Senator from Tennessee for his leadership on this bill. He
has done a tremendous job in building crucial and broad support for it.
I am particularly pleased that the bill includes a title on
cardiovascular disease in women, which incorporates legislation I
introduced last June, the Women's Cardiovascular Diseases Research and
Prevention Act (
S. 349). It is appropriate to include it in this
comprehensive legislation because cardiovascular disease is the number
one killer of women in the United States, a fact many Americans simply
don't realize.
The statistics are alarming. More than 500,000 women and girls die
from cardiovascular disease each year. Heart attacks and strokes are
the leading causes of disability in women. More than 1 in 5 females
have some form of cardiovascular disease. Of women and girls under age
65, approximately 20,000 die of heart attacks each year. Cardiovascular
disease claim about as many lives each year as the next eight leading
causes of death combined. More than 2,600 Americans die each day from
cardiovascular diseases; that's an average of one death every 33
seconds. Cardiovascular diseases kill more women each year than does
cancer. Heart attacks kill more than 5 times as many females as does
breast cancer. Stroke kills twice as many women as does breast cancer.
Each year since 1984, cardiovascular diseases have claimed the lives of
more females than males. In 1993, of the number of individuals who died
of such diseases, 52 percent were female, and 48 percent were male.
Yet for years, women have been under-represented in studies about
heart disease and stroke. Models and tests for detection have largely
been conducted on men, and some doctors do not recognize cardiovascular
symptoms that are unique to women.
The bill we are introducing today authorizes necessary funding to the
National Heart, Lung and Blood Institute to expand and intensify
research, prevention, and educational outreach programs for heart
attack, stroke and other cardiovascular diseases in women. This
legislation will aid our Nation's doctors and scientists in developing
a coordinated and comprehensive strategy for fighting this terrible
disease.
This bill will help ensure that women are well represented in future
cardiovascular studies and that their doctors are well informed about
symptoms that are unique to women. It will also promote women's
awareness of risk factors, such as smoking, obesity and physical
inactivity, which greatly increase their chances of developing
cardiovascular disease.
This legislation is a critical component in our
Major Actions:
All articles in Senate section
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
(Senate - March 06, 1998)
Text of this article available as:
TXT
PDF
[Pages
S1508-S1533]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. LEAHY:
S. 1721. A bill to provide for the Attorney General of the United
States to develop guidelines for Federal prosecutors to protect
familial privacy and communications between parents and their children
in matters that do not involve allegations of violent or drug
trafficking conduct and the Judicial Conference of the United States to
make recommendations regarding the advisability of amending the Federal
Rules of Evidence for such purpose; to the Committee on the Judiciary.
parent-child privilege study legislation
Mr. LEAHY. Mr. President, I recently spoke on the floor about the
disgust that I share with most Americans about the tactics of Special
Prosecutor Kenneth Starr and the disturbing spectacle of hauling a
mother before a grand jury to reveal her intimate conversations with
her daughter in a matter, which--even if all the allegations about the
daughter's conduct were true--do not pose grave threats to the public
safety. This matter does not, for example, involve any allegations of
violence or drug trafficking conduct.
In this instance, as in others, Mr. Starr has scurried to apply all
of the legal weapons at his command, but none of the discretion that he
is obligated to exercise as one invested with almost unchecked legal
authority. I also expressed my intent to introduce legislation to study
whether, and under what circumstances, the confidential communications
between a parent and his or her child should be protected. A number of
professional relationships of trust are already protected by legal
privileges, but not familial relationships. This is the legislation I
introduce today.
Currently, under Rule 501 of the Federal Rules of Evidence,
privileges are ``governed by the principles of the common law as they
may be interpreted by the courts of the United States in the light of
reason and experience.'' Thus, in the absence of any Supreme Court
rules or federal statutes, courts look to the United States
Constitution and the principles of federal common law to determine the
applicability and the scope of privileges.
Legal academicians have expressed support for a parent-child
testimonial privilege. The public policy reasons favoring such a
privilege are numerous and relate to the respect we accord to
fundamental family values. Recognition of such a privilege could foster
and
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protect strong and trusting family relationships, preserve the family,
safeguard the privacy of familial communications and intimate family
matters against undue government intrusion, and promote a healthy
environment for the psychological development of children.
Despite these myriad reasons, there are indeed cases and
circumstances when parents should be compelled in court to share what
they know from their children. Indeed, courts have generally not been
receptive to the parent-child privilege. Only four States--Idaho,
Massachusetts, Minnesota, and New York--have adopted either by statute,
or by judicial recognition, some form of a parent-child privilege. No
Federal Court of Appeals have recognized this privilege nor has any
State Supreme Court that has considered the issue. In my own State of
Vermont, such a privilege is not recognized.
To my mind, and as a former prosecutor, prosecutors should show
restraint before putting parents in the untenable position of making a
legal determination as to whether their children should come to them
for advice, or whether the parents instead should feel legally
pressured to refer their own children to professional therapists, or
lawyers, or doctors in order to protect the confidentiality of the
child's communications. To be sure, there are some categories of cases,
particularly cases involving grave threats to the public safety, such
as violent or drug trafficking crimes, where the government can and
should appropriately seek testimony from a parent about what a child
has said. But we should all be clear about when prosecutors should also
show restraint.
Courts have recognized privilege claims in a variety of professional
relationships, ranging from attorneys to priests to psychotherapists.
Yet the relationship between parent and child--the most fundamental
relationship in our society--is generally not so protected in any
circumstances. As one New York court explained:
It would be difficult to think of a situation which more
strikingly embodies the intimate and confidential
relationship which exists among family members than that in
which a troubled young person, perhaps beset with remorse and
guilt, turns for counsel and guidance to his mother and
father. There is nothing more natural, more consistent with
our concept of the parental role, than that a child may rely
on his parents for help and advice. Shall it be said to those
parents, ``Listen to your son at the risk of being compelled
to testify about his confidences?''--In re Application of
A, 61 A.D.2d 426, 403 N.Y.S.2d 375, 378 (1978).
We should consider the sorts of circumstances and the types of cases
in which prosecutors should be asked to show some restraint before
turning to parents to provide evidence against their children. That is
why my bill calls for a study and report by the Justice Department on
what these circumstances should be, and to develop prosecutorial
guidelines accordingly. Specifically, these guidelines should identify
when the communications between parents and their children should carry
the same protections as preferred professional relationships, and the
circumstances and types of cases when those communications should be
subject to government scrutiny.
We cannot rely on the courts to formulate an appropriate parent-child
privilege. The Third Circuit recently declined to recognize the parent-
child privilege, noting that:
The legislature, not the judiciary, is institutionally
better equipped to perform the balancing of the competing
policy issues required in deciding whether the recognition of
a parent-child privilege is in the best interests of society.
Congress, through its legislative mechanisms, is also better
suited for the task of defining the scope of any prospective
privilege. . . . In short, if a new privilege is deemed
worthy of recognition, the wiser course in our opinion is to
leave the adoption of such a privilege to Congress.--In re
Grand Jury Proceedings (Impounded), 103 F.3d 1140, 1148, 1153
(3d Cir. 1996).
Likewise, the Seventh Circuit Court of Appeals has made clear that
``courts have been reluctant to create new privileges, preferring to
leave such matters to the legislature despite any policy reasons
supporting recognition of a particular privilege.'' United States v.
Riley, 653 F.2d 1153, 1160 (7th Cir. 1981).
Congress should accept this challenge. My bill is a start to the
process of seeking expert input on the significant question of when the
government may not compel parents to betray the confidences of their
children, and when because of compelling need or the nature of the case
or circumstances, parents should be required to reveal the substance of
what their children have told them.
Thus, the bill I introduce today directs the Attorney General to
develop Federal prosecutorial guidelines to protect familial privacy
and parent-child communications in matters that do not involve
allegations of violent or drug trafficking conduct. In addition, the
legislation would direct the Judicial Conference to undertake a study
and then give us a report on whether the Federal Rules of Evidence
should be amended to explicitly recognize a parent-child privilege in
cases not involving violent or drug trafficking conduct, and, if so, in
what circumstances that privilege should apply.
While we should endeavor to provide the maximum protection for
parent-child communications, we should also be careful not to unduly
obstruct law enforcement. Nor should the rule be susceptible to
litigious mischief.
Accordingly, the Attorney General and the Judicial Conference will
need to address, as part of the study and report called for in my bill,
a series of important questions, including:
(1) What communications should be considered confidential for
purposes of the privilege and, specifically, should the privilege apply
in both criminal and civil proceedings?
(2) Should such a privilege apply only to unemancipated minors, or
also to adult children?
(3) Should only the child's communications be protected, or should a
parent's communications to a child also receive protection?
(4) Should such a privilege extend beyond a child's natural parents
to include step-parents or grandparents?
(5) Should such a privilege be subject to rebuttal if the government
establishes a compelling need for the information?
This legislation is the first step in evaluating the merits and
difficulties inherent in protecting familial privacy and the parent-
child relationship against unwarranted intrusions by the government and
by overzealous prosecutors. The public and these families themselves
should not have to endure repeated scenes of mothers being marched into
grand jury inquisitions to reveal intimate talks they may have had with
their children about their private relationships. This is a far cry
from allegations concerning violent or drug trafficking conduct. Let us
find out what the Justice Department and Judicial Conference recommend
about how we can best protect child-parent confidences in ways that
comport with American notions of family, fidelity, and privacy, without
compromising our public safety and the integrity of our judicial
system.
I ask unanimous consent that a copy of the bill be printed in the
Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 1721
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. CONFIDENTIALITY OF PARENT CHILD COMMUNICATIONS IN
JUDICIAL PROCEEDINGS.
(a) Study and Development of Prosecutorial Guidelines.--The
Attorney General of the United States shall--
(1) study and evaluate the manner in which the States have
taken measures to protect the confidentiality of
communications between children and parents and, in
particular, whether such measures have been taken in matters
that do not involve allegations of violent or drug
trafficking conduct;
(2) develop guidelines for Federal prosecutors that will
provide the maximum protection possible for the
confidentiality of communications between children and
parents in matters that do not involve allegations of violent
or drug trafficking conduct, within any applicable
constitutional limits, and without compromising public safety
or the integrity of the judicial system, taking into
account--
(A) the danger that the free communication between a child
and his or her parent will be inhibited and familial privacy
and relationships will be damaged if there is no assurance
that such communications will be kept confidential;
(B) whether an absolute or qualified testimonial privilege
for communications between a child and his or her parents in
matters that do not involve allegations of violent or drug
trafficking conduct is appropriate to provide the maximum
guarantee of
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familial privacy and confidentiality without compromising
public safety or the integrity of the judicial system; and
(C) the appropriate limitations on a testimonial privilege
for such communications between a child and his or her
parents, including--
(i) whether the privilege should apply in criminal and
civil proceedings;
(ii) whether the privilege should extend to all children,
regardless of age, unemancipated or emancipated, or be more
limited;
(iii) the parameters of the familial relationship subject
to the privilege, including whether the privilege should
extend to stepparents or grandparents, adopted children, or
siblings; and
(iv) whether disclosure should be allowed absent a
particularized showing of a compelling need for such
disclosure, and adequate procedural safeguards are in place
to prevent unnecessary or damaging disclosures; and
(3) prepare and disseminate to Federal prosecutors the
findings made and guidelines developed as a result of the
study and evaluation.
(b) Report and Recommendations.--Not later than 1 year
after the date of enactment of this Act, the Attorney General
of the United States shall submit a report to Congress on--
(1) the findings of the study and the guidelines required
under subsection (a); and
(2) recommendations based on the findings on the need for
and appropriateness of further action by the Federal
Government.
(c) Review of Federal Rules of Evidence.--Not later than
180 days after the date of enactment of this Act, the
Judicial Conference of the United States shall complete a
review and submit a report to Congress on--
(1) whether the Federal Rules of Evidence should be amended
to guarantee that the confidentiality of communications by a
child to his or her parent in matters that do not involve
allegations of violent or drug trafficking conduct will be
adequately protected in Federal court proceedings; and
(2) if the rules should be so amended, a proposal for
amendments to the rules that provides the maximum protection
possible for the confidentiality of such communications,
within any applicable constitutional limits and without
compromising public safety or the integrity of the judicial
system.
______
By Mr. FRIST (for himself, Mr. Lott, Mr. Jeffords, Mr. Kennedy,
Mr. Gregg, Mr. Dodd, Mr. Enzi, Mr. Harkin, Mr. Hutchinson, Ms.
Mikulski, Ms. Collins, Mr. Bingaman, Mr. McConnell, Mr.
Wellstone, Mrs. Murray, Mr. Reed, Ms. Snowe, Mr. Nickles, Mr.
Mack, Mrs. Boxer, Mr. Daschle, Mr. Chafee, Mrs. Feinstein, Mr.
Roth, Mr. Specter, Mr. D'Amato, Mr. Domenici, and Mr.
Santorum):
S. 1722. A bill to amend the Public Health Service Act to revise and
extend certain programs with respect to women's health research and
prevention activities at the National Institutes of Health and the
Centers for Disease Control and Prevention; to the Committee on Labor
and Human Resources.
the women's health research and prevention amendments of 1998
Mr. FRIST. Mr. President, I am very pleased to introduce today, with
the majority leader, the Women's Health Research and Prevention
Amendments of 1998. The purpose of this bill is to increase awareness
of some of the most pressing diseases and health issues that women in
our country face. This bill focuses on women's health research and
prevention activities at the National Institutes of Health and the
Centers for Disease Control and Prevention.
Our goal, in introducing this bill today, is to create greater
awareness of women's health issues and to highlight the critical role
our public health agencies--the NIH, the National Institutes of Health,
and the CDC, the Centers for Disease Control and Prevention--play in
providing a broad spectrum of activities to improve women's health,
including research, screening, health data management, prevention and
treatment of diseases, and broad health education.
This bill reauthorizes programs at the National Institutes of Health
for vital research activities into the causes, prevention, and
treatment for some of the major diseases affecting women, including
osteoporosis, breast cancer, ovarian cancer, as well as research into
the aging processes of women.
Let me cite just a few statistics to illustrate the need for further
research into these health issues.
Osteoporosis is a health threat for 28 million Americans, 80 percent
of whom are women. One in every two women over the age of 50 years will
have an osteoporosis-related fracture.
One out of every eight women will develop breast cancer over the
course of their lifetimes, and 1 in 25 will die of breast cancer.
Ovarian cancer is the fourth leading cause of death from cancer among
women. One of the most troubling aspects of ovarian cancer is the
challenge we have in diagnosing this disease earlier and earlier. We
know that a late diagnosis results in a worse outcome. The
reauthorization of these research programs will help assure scientific
progress in our fight against these diseases and will lessen their
burden on women and their families.
For far too long, women in this country have been neglected in many
of our research clinical studies. I am very pleased that, since 1993,
we have developed guidelines to include women and minorities in NIH-
sponsored trials. However, we must continue to do more. We must
continue to review our women's health research agenda to set future
research priorities and to incorporate new scientific knowledge
regarding women's health. We must continue to focus and coordinate all
our efforts in research areas, including clinical trial research
design, genetic factors, the aging process, and other gender-based
differences.
I am also pleased in this bill that we authorize a new research
program at the National Heart, Lung, and Blood Institute at the NIH to
target heart attack, stroke, and other cardiovascular diseases in
women. This program, originally introduced by my colleague, Senator
Boxer, will advance research into cardiovascular diseases--the leading
cause of death in the United States in women. More than 500,000
American women will die annually from cardiovascular diseases.
Cardiovascular diseases--that is, diseases of the heart and the blood
vessels--kill almost twice as many American women as all other cancers.
One of the biggest myths in medicine is that heart disease is only a
male problem. When we think of a heart attack, many people associate it
with men. Even in my own studies during my internship and residency in
medicine--not that long ago--all the models, the pictures that were
used in textbooks, the warning signs on TV--always pictured a man.
However, since 1984, the number of cardiovascular disease deaths in
women has exceeded those of men. And in 1995, 50,000 more women died of
heart disease than men. The program we are including in the bill today
will expand the research programs at NIH to concentrate more on
cardiovascular diseases in women.
Our bill reauthorizes several programs at the Centers for Disease
Control and Prevention for prevention and education activities on
women's health issues. We are reauthorizing the National Center for
Health Statistics, the National Program of Cancer Registries, the
National Breast and Cervical Cancer Early Detection Program, the
Centers for Research and Demonstration of Health Promotion and Disease
Prevention, and the Community Programs on Domestic Violence.
CDC's programs provide critical health services in each of our States
and in our communities to detect, prevent, and diagnose diseases such
as breast and cervical cancer. For the past 7 years, the National
Breast and Cervical Cancer Early Detection Program has provided
critical cancer screening services to underserved women, especially
low-income women, elderly women, and members of racial and ethnic
minority groups. CDC supports early detection programs in all 50
States, in 5 territories, in the District of Columbia, and in 14
American Indian/Alaskan Native organizations. Through March 1997, more
than 1.3 million screening tests have been provided by this one
program.
CDC programs provide critical data and statistics about women's
health that assist us in making informed policy decisions about health
care. The National Center for Health Statistics often provides the only
national data on the health status of U.S. women and their use of
health care. A recent report by the National Center for Health
Statistics entitled ``Women: Work and Health'' summarized the data on
health conditions affecting working women. This report is the first
comprehensive survey on work-related
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health issues encountered by the more than 60 million women in the
American labor force.
I thank the majority leader for his leadership on this issue and for
his efforts in the introduction of this bill. I am pleased to state
that this bill is bipartisan. We have included provisions that are the
product of the efforts of many of my colleagues--Senators Snowe,
Harkin, Boxer, and many others. We have the support of nearly the full
Senate Labor and Human Resources Committee, and over 27 Members of the
Senate are original cosponsors of this bipartisan bill. The level of
support for this bill is a real testament to the need to combat the
diseases affecting women and to maintain those crucial health services
that help prevent these diseases.
This bill, again, is introduced to generate discussion of these
important programs. We intend to consider these programs within the
context of the upcoming NIH reauthorization bill to be introduced over
the next several months. I encourage all Members and constituencies to
review the current programs and to provide input as we set the future
agenda of women's health research and prevention in this Nation.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 1722
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Women's Health Research and
Prevention Amendments of 1998''.
TITLE I--PROVISIONS RELATING TO WOMEN'S HEALTH RESEARCH AT THE NATIONAL
INSTITUTES OF HEALTH
SEC. 101. EXTENSION OF PROGRAM FOR RESEARCH AND AUTHORIZATION
OF NATIONAL PROGRAM OF EDUCATION REGARDING THE
DRUG DES.
(a) In General.--Section 403A(e) of the Public Health
Service Act (42 U.S.C. 283a(e)) is amended by striking
``1996'' and inserting ``2001''.
(b) National Program for Education of Health Professionals
and Public.--From amounts appropriated for carrying out
section 403A of the Public Health Service Act (42 U.S.C.
283a), the Secretary of Health and Human Services, acting
through the heads of the appropriate agencies of the Public
Health Service, shall carry out a national program for the
education of health professionals and the public with respect
to the drug diethylstilbestrol (commonly know as DES). To the
extent appropriate, such national program shall use
methodologies developed through the education demonstration
program carried out under such section 403A. In developing
and carrying out the national program, the Secretary shall
consult closely with representatives of nonprofit private
entities that represent individuals who have been exposed to
DES and that have expertise in community-based information
campaigns for the public and for health care providers. The
implementation of the national program shall begin during
fiscal year 1999.
SEC. 102. RESEARCH ON OSTEOPOROSIS, PAGET'S DISEASE, AND
RELATED BONE DISORDERS.
Section 409A(d) of the Public Health Service Act (42 U.S.C.
284e(d)) is amended by striking ``and 1996'' and inserting
``through 2001''.
SEC. 103. RESEARCH ON CANCER.
(a) In General.--Section 417B(a) of the Public Health
Service Act (42 U.S.C. 286a-8(a)) is amended by striking
``and 1996'' and inserting ``through 2001''.
(b) Research on Breast Cancer.--Section 417B(b)(1) of the
Public Health Service Act (42 U.S.C. 286a-8(b)(1)) is
amended--
(1) in subparagraph (A), by striking ``and 1996'' and
inserting ``through 2001''; and
(2) in subparagraph (B), by striking ``and 1996'' and
inserting ``through 2001''.
(c) Research on Ovarian and Related Cancer Research.--
Section 417B(b)(2) of the Public Health Service Act (42
U.S.C. 286a-8(b)(2)) is amended by striking ``and 1996'' and
inserting ``through 2001''.
SEC. 104. RESEARCH ON HEART ATTACK, STROKE, AND OTHER
CARDIOVASCULAR DISEASES IN WOMEN.
Subpart 2 of part C of title IV of the Public Health
Service Act (42 U.S.C. 285b et seq.) is amended by inserting
after section 424 the following:
``heart attack, stroke, and other cardiovascular diseases in women
``Sec. 424A. (a) In General.--The Director of the Institute
shall expand, intensify, and coordinate research and related
activities of the Institute with respect to heart attack,
stroke, and other cardiovascular diseases in women.
``(b) Coordination With Other Institutes.--The Director of
the Institute shall coordinate activities under subsection
(a) with similar activities conducted by the other national
research institutes and agencies of the National Institutes
of Health to the extent that such Institutes and agencies
have responsibilities that are related to heart attack,
stroke, and other cardiovascular diseases in women.
``(c) Certain Programs.--In carrying out subsection (a),
the Director of the Institute shall conduct or support
research to expand the understanding of the causes of, and to
develop methods for preventing, cardiovascular diseases in
women. Activities under such subsection shall include
conducting and supporting the following:
``(1) Research to determine the reasons underlying the
prevalence of heart attack, stroke, and other cardiovascular
diseases in women, including African-American women and other
women who are members of racial or ethnic minority groups.
``(2) Basic research concerning the etiology and causes of
cardiovascular diseases in women.
``(3) Epidemiological studies to address the frequency and
natural history of such diseases and the differences among
men and women, and among racial and ethnic groups, with
respect to such diseases.
``(4) The development of safe, efficient, and cost-
effective diagnostic approaches to evaluating women with
suspected ischemic heart disease.
``(5) Clinical research for the development and evaluation
of new treatments for women, including rehabilitation.
``(6) Studies to gain a better understanding of methods of
preventing cardiovascular diseases in women, including
applications of effective methods for the control of blood
pressure, lipids, and obesity.
``(7) Information and education programs for patients and
health care providers on risk factors associated with heart
attack, stroke, and other cardiovascular diseases in women,
and on the importance of the prevention or control of such
risk factors and timely referral with appropriate diagnosis
and treatment. Such programs shall include information and
education on health-related behaviors that can improve such
important risk factors as smoking, obesity, high blood
cholesterol, and lack of exercise.
``(d) Authorization of Appropriations.--For the purpose of
carrying out this section, there is authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 1999 through 2001. The authorization of
appropriations established in the preceding sentence is in
addition to any other authorization of appropriation that is
available for such purpose.''.
SEC. 105. AGING PROCESSES REGARDING WOMEN.
Section 445I of the Public Health Service Act (42 U.S.C.
285e-11) is amended by striking ``and 1996'' and inserting
``through 2001''.
SEC. 106. OFFICE OF RESEARCH ON WOMEN'S HEALTH.
Section 486(d)(2) of the Public Health Service Act (42
U.S.C. 287d(d)(2)) is amended by striking ``Director of the
Office'' and inserting ``Director of the National Institutes
of Health''.
TITLE II--PROVISIONS RELATING TO WOMEN'S HEALTH AT THE CENTERS FOR
DISEASE CONTROL AND PREVENTION
SEC. 201. NATIONAL CENTER FOR HEALTH STATISTICS.
Section 306(n) of the Public Health Service Act (42 U.S.C.
242k(n)) is amended--
(1) in paragraph (1), by striking ``through 1998'' and
inserting ``through 2002''; and
(2) in paragraph (2), by striking ``through 1998'' and
inserting ``through 2002''.
SEC. 202. NATIONAL PROGRAM OF CANCER REGISTRIES.
Section 399L(a) of the Public Health Service Act (42 U.S.C.
280e-4(a)) is amended by striking ``through 1998'' and
inserting ``through 2002''.
SEC. 203. NATIONAL BREAST AND CERVICAL CANCER EARLY DETECTION
PROGRAM.
(a) Grants.--Section 1501(b) of the Public Health Service
Act (42 U.S.C. 300k(b)) is amended--
(1) in paragraph (1), by striking ``nonprofit''; and
(2) in paragraph (2), by striking ``that are not nonprofit
entities''.
(b) Preventive Health.--Section 1509(d) of the Public
Health Service Act (42 U.S.C. 300n-4a(d)(1)) is amended by
striking ``through 1998'' and inserting ``through 2002''.
(c) General Program.--Section 1510(a) of the Public Health
Service Act (42 U.S.C. 300n-5(a)) is amended by striking
``through 1998'' and inserting ``through 2002''.
SEC. 204. CENTERS FOR RESEARCH AND DEMONSTRATION OF HEALTH
PROMOTION.
Section 1706(e) of the Public Health Service Act (42 U.S.C.
300u-5(e)) is amended by striking ``through 1998'' and
inserting ``through 2002''.
SEC. 205. COMMUNITY PROGRAMS ON DOMESTIC VIOLENCE.
Section 318(h)(2) of the Family Violence Prevention and
Services Act (42 U.S.C. 10418(h)(2)) is amended by striking
``fiscal year 1997'' and inserting ``for each of the fiscal
years 1997 through 2002''.
Mr. LOTT. Mr. President, this morning I am very pleased to join
Senator Frist of Tennessee, who is an outstanding Senator, and also a
doctor, who has been very helpful to me, and a lot of Senators, since
he joined this body, in introducing legislation entitled ``The Women's
Health Research and Prevention Act.''
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The bill authorizes and reauthorizes a collection of first-class
research and prevention programs in the National Institutes of Health
and the Centers for Disease Control and Prevention.
Breast cancer is the leading cause of death in women between the ages
of 40 and 55. About one out of every eight women in the United States
will, unfortunately, develop breast cancer during their lifetime. And
so the Frist-Lott bill reauthorizes breast and ovarian cancer research
and education programs at NIH.
Osteoporosis is a disease in which bones become fragile and more
likely to break. My wife is beginning to confront this particular
problem. As women age, they lose bone mass and are at risk of
debilitating accidents such as fractures. This bill extends
osteoporosis research and education programs at NIH.
Women's health, though, means more than just health issues specific
to women. Heart disease, for instance, the No. 1 killer in the U.S. of
women, of course, also affects men in great numbers. Hypertension, a
leading cause of heart disease, is two to three times more common in
women than in men.
In addition to these three key research areas, our bill continues
programs in the Centers for Disease Control, including the National
Program of Cancer Registries and the National Early Detection Program
for breast and cervical cancer.
Senator Frist, the Senate's only doctor, and an outstanding heart
surgeon himself, provided the details of the bill. Senator Frist is
chairman of the Senate Public Health Subcommittee of the Senate Labor
Committee, and is one of the Senate's key leaders on all of our health
issues.
I am pleased that he is also serving on our Medicare commission that
had its first meeting yesterday, including a meeting with the
President.
I have often turned to him for advice and guidance on health matters,
and will continue to do so in the future. I believe that just this
morning Senator Frist attended a meeting regarding Medicare, and that
will be helpful in this effort. I know it will be a bipartisan effort.
I encourage colleagues on both sides of the aisle to cosponsor this
important legislation.
This morning I was made aware that Senator Mack is a cosponsor, and
Senator D'Amato. We are inviting all Members to join us in this very
serious and very important issue that we need to act on in order to
reauthorize some of these programs and authorize new ones.
I thank Senator Frist for his leadership in this area, and I yield
the floor.
Mr. JEFFORDS. Mr. President, I rise to recognize Senator Frist for
taking an important step that brings together a number of Government
programs of research, treatment and disease prevention for women. Over
the past several years, Congress and the Nation have become
increasingly concerned about women's health. I appreciate the
leadership and the expertise that Dr. Frist brings to Congress about
these issues. We have much to learn about recognizing and treating the
medical needs of women.
In the first session of the 105th Congress, at least 21 bills
relating to women's health were introduced and referred to the Senate
Labor and Human Resources Committee. At our committee hearing on
women's health last July, we heard about important advances being made
in research. We also heard about significant gaps of knowledge which
need to be filled. More importantly, we recognize how important it is
to get information about scientific advances to the public and their
health care providers.
Thus, I am pleased the provisions of this bill provide for research
and for public and professional education. We know that once the
information is out to the public and health care professionals, we need
screening programs, closely followed by access to treatment. The bill
provides for important patient services.
Finally, once common conditions are well recognized, detected and
treated, we need data to track our progress in disease prevention and
to alert us to new help in illness trends. This bill provides for these
functions through the support for cancer registries, information
systems, and program evaluation. It is my hope that having women's
issues collected together in one bill will focus the attention of
Congress and the Nation on vigorous support of the woman's health
initiative.
I am pleased to join Senator Frist in sponsoring this legislation.
Mr. KENNEDY. Mr. President, I commend Senator Frist for his
leadership on the bill we are introducing today, ``The Women's Health
Research and Prevention Amendments of 1998.'' This bill is a bipartisan
effort to extend and strengthen several important women's health
programs at the National Institutes of Health and the Centers for
Disease Control and Prevention.
In recent years, women's health has begun to receive the high
priority it deserves. Five years ago government guidelines were finally
eliminated that specifically excluded women from many clinical trials.
Increasingly, Congress has given higher priority to funds to address
breast cancer and other women's health issues. We also established the
Office of Women's Health within the Department of Health and Human
Services, in order to develop and implement a national agenda for
women's health. These successes, however, have revealed that there is
much more to be done.
The bill we are introducing today is an attempt to fill some of the
gaps in research and prevention that we have identified in women's
health. It is time for Congress to acknowledge that women's health
involves a wider range of issues, and that the magnitude of these
issues varies greatly with age. Car crashes and unintended injuries are
the leading killer of women in their teens and twenties. Cancer is the
leading killer of women between the ages of 25 and 64. Heart disease is
the leading killer among women over 65.
The nation's agenda on women's health must also address other key
issues that are more common among women but affect men too, such as
osteoporosis, depression, and auto-immune diseases, and illnesses that
manifest themselves differently in men and women, such as heart
disease, substance abuse, AIDS, and violence.
Our legislation extends important research and prevention activities
now being carried out by the National Institutes of Health and the
Centers for Disease Control and Prevention in areas traditionally
considered women's health issues, such as breast and ovarian cancer,
osteoporosis, and domestic violence. It also calls for greater research
efforts on heart attacks, strokes, and other cardiovascular diseases,
in recognition of the serious effects of these diseases on women.
Our bill also provides continued support for academic health centers
to conduct research and demonstration projects related to health
promotion and disease prevention to improve quality of life, and to
curb premature mortality and illness that contribute to excessive
health costs. These academic health centers are effective in informing
women and their physicians of steps they can take to prevent serious
illness and injury, especially in cases involving chronic and
debilitating physical illness, such as arthritis and osteoporosis,
which put women at high risk for bone fractures.
In order to enable researchers to monitor health trends among women
and to help policymakers make informed decisions on the allocation of
resources, it is essential for accurate and timely statistical and
epidemiological data to be available. Our bill will provide continued
support of the CDC's National Center for Health Statistics, which
provides valuable data related to overall health status, lifestyle,
onset and diagnosis of illness and disability, and use of health care
and rehabilitation services.
It is also important to understand differences between racial and
ethnic groups. For example, black women have far higher death rates
from heart disease, cancer, stroke and diabetes than white women.
Minority women suffer the most from AIDS. More than half of new female
cases of AIDS over the past decade were found among blacks. For other
chronic diseases, black women have the highest rates of hypertension,
while Native American women have higher rates of asthma and chronic
bronchitis. This bill will enable the National Center for Health
Statistics to continue its important work on the health of ethnic and
racial populations, and improve methods to collect data on these
subgroups in
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order to understand and address their various health needs more
effectively.
Too many health needs of women continue to be neglected by the
nation's health care system. The cost of this national neglect, both in
dollars and in lives, is staggering. This bill is an excellent starting
point for strengthening current programs and pursuing new initiatives
to address urgent national priorities in women's health. I look forward
to working with my colleagues and with the women's health community to
enact the strongest legislation we can to deal with these vital issues.
Mr. HARKIN. Mr. President, I am pleased today to join many of my
colleagues in support of the ``Women's Health Research and Prevention
Amendments of 1998.'' This legislation, introduced by my distinguished
colleague, Senator Bill Frist, and cosponsored by nearly all the
members of the Committee on Labor and Human Resources, is an important
step forward in the study and prevention of diseases and conditions
unique to women.
In the late 1980's, I learned that there was an embarrassing lack of
research on diseases and conditions prevalent in women. In addition,
the General Accounting Office (GAO) reported that women were routinely
excluded from medical research studies at NIH. Because of this
information, in 1990, I fought for legislation creating the Office of
Research on Women's Health at the National Institutes of Health (NIH).
Since its creation, the Office successfully worked to ensure that
research focuses on women's health and that women be included in
clinical trials.
Senator Frist's legislation builds upon the base of research and
prevention knowledge we have developed over the past few years. The
bill reauthorizes essential programs relating to women's health
research at NIH and the Centers for Disease Control and Prevention
(CDC).
I am particularly proud of the reauthorization of the programs
promoting research and education on the drug ``diethylstilbestrol,''
otherwise known as DES. This drug was prescribed to pregnant American
women from 1938 to 1971 in the mistaken belief that it would prevent
miscarriage. But DES is now known to cause a five-fold increased risk
of ectopic pregnancy, as well as a three-fold increased risk of
miscarriage. I was proud to introduce legislation in 1992 that
established a pilot program through NIH to test ways to educate the
public and health professionals about how to deal with DES exposure.
Last year I introduced legislation that would give people across the
nation access to information developed through this pilot program. I am
pleased that this bill has been incorporated in the ``Women's Health
Research and Prevention Amendments of 1998.''
In addition, I am pleased that the bill extends research programs for
basic and clinical research and education efforts with respect to
cancer, particularly breast cancer and ovarian cancer. I have fought
for a long time for increased funding for breast cancer research.
During my tenure as Chairman of the Subcommittee on Appropriations that
handles NIH we provided dramatic increases in funding for breast cancer
research.
This legislation also extends important research at NIH on
osteoporosis, Paget's disease and related bone disorders, and research
on cardiovascular diseases in women. It reauthorizes programs at the
National Institute on Aging, including research into the aging
processes of women, with particular emphasis on the effects of
menopause and the complications related to aging and the loss of
ovarian hormones in women.
CDC also plays an important role in the prevention diseases and
conditions in women. This legislation would extend CDC's collection of
statistical and epidemiological information, which is often the only
national data available on the health status of American women and
their use of the health care system. The bill extends CDC's National
Cancer Registries Program, which provides funds to states to enhance
their cancer surveillance data needed to monitor trends and serve as
the foundation of a national comprehensive cancer control strategy.
I am particularly proud that this legislation extends the National
Breast and Cervical Cancer Early Detection Program. In 1990 I worked to
start and fund this program which provides mammography and cervical
cancer screening to low income women without insurance. This program
has provided vital access to services for thousands of women across the
country.
In addition, the bill would extend authorization for grants to
academic health institutions for research on health promotion and
disease prevention. A number of these institutions are working together
to develop strategies for prevention of cardiovascular disease in
women. Finally, the bill reauthorizes grants administered by CDC to
non-profit private organizations to establish projects in local
communities to coordinate intervention and prevention of domestic
violence.
Mr. President, the research into and prevention of diseases prevalent
in women is an investment in our daughters, wives, mothers, and
sisters. It is an investment in our future.
Mr. BINGAMAN. Mr. President, I rise today to join Senator Frist and
my other colleagues in introducing the Women's Health Research and
Prevention Amendments of 1998.
This legislation allows us to reauthorize key women's health research
and prevention programs at the National Institutes of Health and the
Centers for Disease Control and Prevention. These programs represent a
cross section of the current research projects at the federal level
that have a direct impact on women's lives here in the United States.
While in the last decade, interest and commitment to women's health
has been heightened in the Congress, much work remains. We have taken
steps to ensure that women will be included in health care research in
the U.S. Prior to 1993, research in women's health was inadequate. Most
of the health care studies were conducted only on Anglo men. Quite
simply, research studies on men cannot be generalized to women. We know
that there are gender and ethnic differences when it comes to health
and illness. The time has come to further address the major causes of
morbidity and mortality among women: heart disease, osteoporosis,
breast cancer, and colorectal cancer.
This bill will provide the basis for looking at the research needs in
the spectrum of women's health and as we go to hearings on the bill I
am hopeful that additional women's health issues can be addressed.
There is another facet to women's health research that must be
considered. It is imperative that we ensure that studies are
representative of all women in the United States, including African
American, Hispanic, Native American and Asian women. We need research
that is culturally sensitive. We must support efforts of community
based outreach that allows for recruitment and retention of minority
women into research and this should be a factor when projects are
planned and conducted.
Mr. President, this legislation has provisions relating to women's
health research at the NIH in the disease specific issues of
diethylstilbestrol (DES), osteoporosis, breast and ovarian cancer. It
expands and allows for increased coordination of research activities
with respect to heart attack, stroke, and other cardiovascular diseases
in women at the National Heart, Lung, and Blood Institute. This program
is critical since cardiovascular disease is the leading cause of death
for women in the United States.
Finally, Mr. President, I wanted to take the opportunity to
specifically highlight one particular CDC program in the bill. This
legislation addresses the Health Promotion and Disease Prevention
Research Centers Program at the CDC and will extend authorization for
grants to our academic health institutions for research in the areas of
health promotion and disease prevention.
The CDC's Prevention Research Center Program is an innovative,
extramural link of federal, academic, state, and community based
agencies.
For my home state of New Mexico, this CDC project has been
particularly useful. In New Mexico a prevention center has been able to
focus on health risks and promoting health through applied research at
the community level. The project and grant have provided the
opportunity to address areas often overlooked such as rural population
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needs and Native American and Hispanic health needs.
In New Mexico about one of every three American Indian adults has
diabetes. The demonstration project has allowed for the promotion of
health lifestyles to combat the epidemic of adult onset diabetes. The
project has facilitated the formation of a true partnership between the
Navajo nation, nineteen pueblos in New Mexico, the New Mexico
Department of Health, the University of New Mexico, and the New Mexico
State Department of Education. There has been training of community
health workers on disease prevention strategies most applicable to
American Indian communities. This program is a model for increasing
collaboration among established agencies and nontraditional community
partners. It is a culturally sensitive approach that is having a
direct, positive impact on the health of New Mexicans. The creative
approach at CDC of a community based demonstration and application
project coupled with evaluation of strategies through research is
unique, successful, and should be reauthorized.
Mr. President, in closing, I look upon this bill as the important
first step to reauthorize programs at both the CDC and NIH. I look
forward to working with Senator Frist on these and other issues of
import to women's health.
Mr. WELLSTONE. Mr. President, I rise today to join my colleague from
Tennessee and others in introducing the ``Women's Health Research and
Prevention Amendments of 1998,'' as an original cosponsor. This bill
reauthorizes funding to extend and enhance many fine programs at the
National Institutes of Health and the Centers for Disease Control and
Prevention. I am pleased to join in this important effort.
Mr. President, I would like to commend Senator Frist for his work in
developing this legislation to strengthen and expand Federal efforts to
promote women's health. While there is still some work to be done to
improve the bill as it moves through the normal legislative process, I
believe this bill offers a good start and provides a solid foundation
on which to build historic improvements in NIH research programs on
breast cancer, heart attack, menopause, and other areas. Let me outline
briefly a few critical issues that are not addressed by the bill, but
which I hope to see addressed as we move forward.
One notable gap is in the area of substance abuse. I believe this
bill could be an important complement to the Substances Abuse Treatment
Parity Act (
S. 1147), which I introduced last September to improve
access to equitable medical care to treat the disease of alcohol and
other drug dependencies. Substance abuse is a widespread health concern
for many women, who also experience associated health, psychological,
and family problems. For example, expectant mothers and mothers with
small children can be helped with treatment and support services. This
is an investment for them, but as importantly for their children, who
would have the opportunity to grow up in a healthy, chemical-free home
environment. We have to take the problem of substance abuse as
seriously as we do other aspects of women's health.
Important information about this national problem will be highlighted
in an upcoming five-part PBS series by Bill Moyers, where treatment
programs such as the Hazelden program in my state of Minnesota are
highlighted. In working with these and other treatment programs in
Minnesota, I have learned a great deal about the problems of substances
abuse, but also about the hope and success that occurs when effective
treatments are available. The Women's Health Research and Prevention
Amendments Act could be substantially improved by an additional focus
on substance abuse programs.
Another notable gap is in the area of mental health and behavioral
science. On page one of the New York Times today was an article on the
criminalization of mental illness. The problem is that we as a nation
have needed to focus on the humane, dignified treatment of mental
illness, and having failed in that, more and more people who are
suffering from mental illness are winding up in prisons where they are
out of sight, but where they are not getting the care they need. We
need to treat mental health as seriously as we treat cancer and heart
disease, because mental illness can be just as serious, chronic, and
life-destroying as other diseases.
I intend to work closely with Senator Frist and others on the
committee to improve the bill by including a recognition of the role
that behavioral science and psychological factors have in the
development of and recovery from disease. Many of the diseases
mentioned in the bill are scientifically linked to behavioral or
psychological factors that can be critical to prevention and recovery.
Women also suffer unduly from specific mental health problems and
experiences, such as depression and domestic violence. Depression, for
example, is a pervasive and impairing illness which affects women at
roughly twice the rate of men. Domestic violence places a significant
resource and economic strain on our justice, health, and human services
systems. Research conducted at urban hospitals has show that about 25%
of emergency room visits by women resulted from domestic assaults.
Women who have been raped or battered have significantly great physical
health problems, as well as increased vulnerability to psychological
and emotional suffering. My wife Sheila and I have worked for years to
improve the federal response to the epidemic levels of domestic
violence across the country; I want to make sure this bill adequately
addresses these issues.
Mr. President, it is my commitment to work closely with the committee
to enhance these and other areas that are critical to women's health. A
strong focus on research and prevention of mental illness and substance
abuse for women is an important investment in the health of the nation
and of the health and well being of countless families.
Mr. NICKLES. Mr. President, I want to speak today on the Women's
Health Research and Prevention Amendments of 1998 introduced by my
colleagues Senator Frist and Majority Leader Lott. This bill would
amend the Public Health Service Act to revise and extend certain
programs with respect to women's health research and prevention
activities at the National Institutes of Health and the Centers for
Disease Control and Prevention.
Education and Research are the key to providing the best health care
for women and for that matter, all Americans. The Women's Health
Research and Prevention Amendments promote precisely that. Just two
examples are the extension of NIH research programs for basic and
clinical research and education efforts with respect to cancer, breast
cancer, and ovarian and related cancer; and the extension of the CDC
National Breast and Cervical Cancer Early Detection Program. These are
the kinds of programs that will improve women's health.
I am pleased to be a cosponsor of the Women's Health bill because I
believe that research is the best way for Congress to respond to the
concern over women's health issues and health issues generally. I make
this point, Mr. President, because I have been disappointed that
Congress has recently put on lab coats and begun practicing medicine.
We have gotten into the dangerous habit of legislating clinical
procedures which are not based in science or research but rather driven
by social opinion and special interests.
You only have to look back to the end of the 104th Congress to
illustrate my point. A majority of Congress supported an effort last
year to mandate that all insurance plans cover 48-hour maternity stays
in hospitals. However, serval months following the passage of that
legislation an article appeared in the Journal of the American Medical
Association stating that the ``content does not solve the most
important problems regarding the need for early postpartum/postnatal
services. The legislation may give the public a false sense of
security. It may call into question the reasonableness of relying on
legislative mechanisms to micro manage clinical practice.''
In other words, Congress made a nice, laudable attempt. We said we
are going to mandate 48 hours, but it has had no appreciable
improvement on the quality of health care. It appears that our so-
called victory in passing 48 hours may have in fact done more harm than
good in helping women and newborns. This experience, and others like
it, should have taught us what not to do.
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It should have taught us that before we endeavor to decide what is
the best therapy, procedure, or treatment for any one disease, let us
look for a minute at what we are doing. What are the unintended
consequences of federal mandates on health insurance companies
regarding treatments and coverage of services?
Let's take breast cancer as another example. Various bills have been
introduced in the last few months that mandate a length of stay for
mastectomies or require coverage of an inpatient stay for women
undergoing breast cancer surgery for an unspecified length of time, to
be determined by the physician.
Were Congress to legislate in favor of one form of treatment over
another, we are sending the message that one treatment is preferable to
the other. Treatments are constantly changing. Health care needs to be
flexible and should not lock doctors in to a specific approach.
Shouldn't we allow medical research to decide the best course of
action? If the federal government mandates a specific treatment, length
of stay or procedure, that then becomes the standard.
In addition, employing mandates in the place of valid research runs
the risk of discouraging innovative treatments. For example, recent
improvements in anesthesiology are a result of patient appeals to cut
down on nausea and vomiting after breast surgery as well as a desire to
recover at home.
Longer mandated stays could discourage doctors and patients from
developing the best possible plan for recovery. Patients may choose to
stay in the hospital for an extended period of time out of fear or lack
of knowledge and risk infection. Patients may have the false idea that
longer hospital stays equal the best possible treatment when, in fact,
recent research indicates that is not necessarily the case.
According to a November 6, 1996, article in The Wall Street Journal,
The Johns Hopkins Breast Center in Baltimore, which has gradually
eliminated inpatient stays for some women undergoing certain types of
mastectomies, has found that outpatient mastectomies are associated
with lower infection rates and high levels of satisfaction among women.
We have the responsibility to arm patients with the kind of sound
research and education this legislation provides, not prescriptive
mandates from Dr. Congress.
Lillie Shockeney, R.N. the Education and Outreach Director at the
Johns Hopkins Hospital Breast Center and a breast cancer survivor,
summed up best in a Finance Committee hearing on November 5, 1997. ``.
. . I am concerned that it [
S. 249, The Women's Health and Cancer
Rights Act of 1997] doesn't solve the real medical dilemma that women
battling breast cancer are faced with today. We need to be striving to
improve patient care for patients undergoing breast cancer surgery
rather than unknowingly promote keeping it at status quo. We need to be
promoting the development of a comprehensive patient education program
and have teams of health care professionals dedicated to striving to
improve the care and treatment provided to women with breast cancer.''
Mr. President, I want to congratulate Senator Frist and Senator Lott
for bringing this issue before us in such a responsible and proactive
bill. These programs go a long way to serve women. I thank the chair
and encourage my colleagues to support this common sense legislation.
Mrs. BOXER. Mr. President, I am very pleased to join my colleagues in
introducing the Women's Health Research and Prevention Amendments of
1998. This is a bipartisan initiative, which is important, because
promoting the health of American women is a bipartisan concern. I
commend the Senator from Tennessee for his leadership on this bill. He
has done a tremendous job in building crucial and broad support for it.
I am particularly pleased that the bill includes a title on
cardiovascular disease in women, which incorporates legislation I
introduced last June, the Women's Cardiovascular Diseases Research and
Prevention Act (
S. 349). It is appropriate to include it in this
comprehensive legislation because cardiovascular disease is the number
one killer of women in the United States, a fact many Americans simply
don't realize.
The statistics are alarming. More than 500,000 women and girls die
from cardiovascular disease each year. Heart attacks and strokes are
the leading causes of disability in women. More than 1 in 5 females
have some form of cardiovascular disease. Of women and girls under age
65, approximately 20,000 die of heart attacks each year. Cardiovascular
disease claim about as many lives each year as the next eight leading
causes of death combined. More than 2,600 Americans die each day from
cardiovascular diseases; that's an average of one death every 33
seconds. Cardiovascular diseases kill more women each year than does
cancer. Heart attacks kill more than 5 times as many females as does
breast cancer. Stroke kills twice as many women as does breast cancer.
Each year since 1984, cardiovascular diseases have claimed the lives of
more females than males. In 1993, of the number of individuals who died
of such diseases, 52 percent were female, and 48 percent were male.
Yet for years, women have been under-represented in studies about
heart disease and stroke. Models and tests for detection have largely
been conducted on men, and some doctors do not recognize cardiovascular
symptoms that are unique to women.
The bill we are introducing today authorizes necessary funding to the
National Heart, Lung and Blood Institute to expand and intensify
research, prevention, and educational outreach programs for heart
attack, stroke and other cardiovascular diseases in women. This
legislation will aid our Nation's doctors and scientists in developing
a coordinated and comprehensive strategy for fighting this terrible
disease.
This bill will help ensure that women are well represented in future
cardiovascular studies and that their doctors are well informed about
symptoms that are unique to women. It will also promote women's
awareness of risk factors, such as smoking, obesity and physical
inactivity, which greatly increase their chances of developing
cardiovascular disease.
This legislation is a critical component in our efforts to draw
attention and
Amendments:
Cosponsors:
