DEPARTMENTS OF LABOR, HEALTH AND HUMAN 

SERVICES, EDUCATION, AND RELATED AGENCIES 

APPROPRIATIONS FOR 2009 

HEARINGS 

BEFORE A 

SUBCOMMITTEE OF THE 

COMMITTEE ON APPROPRIATIONS 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

SECOND SESSION 

SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES 

DAVID R. OBEY, Wisconsin, Chairman 

NITA M. LOWEY, New York 

ROSA L. DELAURO, Connecticut 

JESSE L. JACKSON, JR., Illinois 

PATRICK J. KENNEDY, Rhode Island 

LUCILLE ROYBAL-ALLARD, California 

BARBARA LEE, California 

TOM UDALL, New Mexico 

MICHAEL HONDA, California 

BETTY MCCOLLUM, Minnesota 

TIM RYAN, Ohio 

JAMES T. WALSH, New York 

RALPH REGULA, Ohio 

JOHN E. PETERSON, Pennsylvania 

DAVE WELDON, Florida 

MICHAEL K. SIMPSON, Idaho 

DENNIS R. REHBERG, Montana 

NOTE: Under Committee Rules, Mr. Obey, as Chairman of the Full Committee, and Mr. Lewis, as Ranking 

Minority Member of the Full Committee, are authorized to sit as Members of all Subcommittees. 

CHERYL SMITH, SUE QUANTIUS, NICOLE KUNKO, 

TERI BERGMAN, CHARMAINE MERCER, and ANDRIA OLIVER, 

Subcommittee Staff 

PART 7 

STATEMENTS OF INTERESTED INDIVIDUALS AND 

ORGANIZATIONS 

( 

Printed for the use of the Committee on Appropriations 


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Part 7 


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DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, 

AND RELATED AGENCIES APPROPRIATIONS FOR 2009 


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DEPARTMENTS OF LABOR, HEALTH AND HUMAN 

SERVICES, EDUCATION, AND RELATED AGENCIES 

APPROPRIATIONS FOR 2009 

HEARINGS 

BEFORE A 

SUBCOMMITTEE OF THE 

COMMITTEE ON APPROPRIATIONS 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

SECOND SESSION 

SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES 

DAVID R. OBEY, Wisconsin, Chairman 

NITA M. LOWEY, New York 

ROSA L. DELAURO, Connecticut 

JESSE L. JACKSON, JR., Illinois 

PATRICK J. KENNEDY, Rhode Island 

LUCILLE ROYBAL-ALLARD, California 

BARBARA LEE, California 

TOM UDALL, New Mexico 

MICHAEL HONDA, California 

BETTY MCCOLLUM, Minnesota 

TIM RYAN, Ohio 

JAMES T. WALSH, New York 

RALPH REGULA, Ohio 

JOHN E. PETERSON, Pennsylvania 

DAVE WELDON, Florida 

MICHAEL K. SIMPSON, Idaho 

DENNIS R. REHBERG, Montana 

NOTE: Under Committee Rules, Mr. Obey, as Chairman of the Full Committee, and Mr. Lewis, as Ranking 

Minority Member of the Full Committee, are authorized to sit as Members of all Subcommittees. 

CHERYL SMITH, SUE QUANTIUS, NICOLE KUNKO, 

TERI BERGMAN, CHARMAINE MERCER, and ANDRIA OLIVER, 

Subcommittee Staff 

PART 7 

STATEMENTS OF INTERESTED INDIVIDUALS AND 

ORGANIZATIONS 

( 

Printed for the use of the Committee on Appropriations 

U.S. GOVERNMENT PRINTING OFFICE 

43–329 WASHINGTON : 2008 


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COMMITTEE ON APPROPRIATIONS 

DAVID R. OBEY, Wisconsin, Chairman 

JOHN P. MURTHA, Pennsylvania 

NORMAN D. DICKS, Washington 

ALAN B. MOLLOHAN, West Virginia 

MARCY KAPTUR, Ohio 

PETER J. VISCLOSKY, Indiana 

NITA M. LOWEY, New York 

JOSE ́ E. SERRANO, New York 

ROSA L. DELAURO, Connecticut 

JAMES P. MORAN, Virginia 

JOHN W. OLVER, Massachusetts 

ED PASTOR, Arizona 

DAVID E. PRICE, North Carolina 

CHET EDWARDS, Texas 

ROBERT E. ‘‘BUD’’ CRAMER, JR., Alabama 

PATRICK J. KENNEDY, Rhode Island 

MAURICE D. HINCHEY, New York 

LUCILLE ROYBAL-ALLARD, California 

SAM FARR, California 

JESSE L. JACKSON, JR., Illinois 

CAROLYN C. KILPATRICK, Michigan 

ALLEN BOYD, Florida 

CHAKA FATTAH, Pennsylvania 

STEVEN R. ROTHMAN, New Jersey 

SANFORD D. BISHOP, JR., Georgia 

MARION BERRY, Arkansas 

BARBARA LEE, California 

TOM UDALL, New Mexico 

ADAM SCHIFF, California 

MICHAEL HONDA, California 

BETTY MCCOLLUM, Minnesota 

STEVE ISRAEL, New York 

TIM RYAN, Ohio 

C.A. ‘‘DUTCH’’ RUPPERSBERGER, Maryland 

BEN CHANDLER, Kentucky 

DEBBIE WASSERMAN SCHULTZ, Florida 

CIRO RODRIGUEZ, Texas 

JERRY LEWIS, California 

C. W. BILL YOUNG, Florida 

RALPH REGULA, Ohio 

HAROLD ROGERS, Kentucky 

FRANK R. WOLF, Virginia 

JAMES T. WALSH, New York 

DAVID L. HOBSON, Ohio 

JOE KNOLLENBERG, Michigan 

JACK KINGSTON, Georgia 

RODNEY P. FRELINGHUYSEN, New Jersey 

TODD TIAHRT, Kansas 

ZACH WAMP, Tennessee 

TOM LATHAM, Iowa 

ROBERT B. ADERHOLT, Alabama 

JO ANN EMERSON, Missouri 

KAY GRANGER, Texas 

JOHN E. PETERSON, Pennsylvania 

VIRGIL H. GOODE, JR., Virginia 

RAY LAHOOD, Illinois 

DAVE WELDON, Florida 

MICHAEL K. SIMPSON, Idaho 

JOHN ABNEY CULBERSON, Texas 

MARK STEVEN KIRK, Illinois 

ANDER CRENSHAW, Florida 

DENNIS R. REHBERG, Montana 

JOHN R. CARTER, Texas 

RODNEY ALEXANDER, Louisiana 

KEN CALVERT, California 

JO BONNER, Alabama 

ROB NABORS, Clerk and Staff Director 

(II)


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(1) 

DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 

2009 

TESTIMONY OF INTERESTED INDIVIDUALS AND 

ORGANIZATIONS 

THURSDAY, MARCH 13, 2008. 

FISCAL YEAR 2009 FUNDING FOR THE INDEPENDENT 

LIVING PROGRAM OF THE REHABILITATION ACT OF 

1973, AS AMENDED (TITLE VII, PART C) 

WITNESS 

KELLY BUCKLAND, EXECUTIVE DIRECTOR, IDAHO STATE INDEPENDENT LIVING COUNCIL, BOISE, IDAHO, NATIONAL COUNCIL ON 

INDEPENDENT LIVING, DEPARTMENT OF HEALTH AND HUMAN 

SERVICES 

Mr. OBEY. Well, good morning, everyone. Let me go over a few 

things before we get started. First of all, please do not be surprised 

by the fact that we do not have more members of the Subcommittee 

here. As you can see, there is a Congressional ceremony going on 

in the Rotunda honoring U.S. military, and a number of members 

are over there. We had a choice of delaying this session or keeping 

it on schedule, and out of courtesy to the witnesses who have come 

from out of town, we thought it best to proceed with the original 

schedule. 

Secondly, please do not take any lack of comment from members 

of the Subcommittee as being a lack of interest. We are simply trying to keep the schedule on time, also taking into account that in 

this puzzle factory votes occur from time to time on the House floor 

that blow away any chance of having an orderly hearing. So we 

like to try to get a little bit ahead of the clock so that, if that occurs, we do not wind up discombobulating everybody at the end of 

the process. 

So we will try to restrain ourselves on this side of the table as 

much as possible and let you do the talking today, and we will, I 

hope, be thinking while you are talking. 

Mr. Walsh, do you have any comments before we proceed? 

Mr. WALSH. Mr. Chairman, I absolutely agree with everything 

you said. [Laughter.] 

Mr. OBEY. How about Mr. Simpson? 


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Mr. SIMPSON. I do not have anything. I agree with everything 

also. 

Mr. OBEY. Okay, then, our first witness, National Council on 

Independent Living, Kelly Buckland. 

Mr. BUCKLAND. Good morning, Mr. Chairman, members of the 

Committee, Representative Simpson. It is good to see you. My 

name is Kelly Buckland. I am honored to appear before you today 

to ask you to consider reaffirming your commitment to Americans 

with disabilities by increasing funding for Centers for Independent 

Living by $100,000,000. As the President of the National Council 

on Independent Living (NCIL) and as a person with a disability, 

I am dedicated to increasing the availability of the extremely costeffective services that centers provide. 

NCIL is the oldest cross-disability, national grassroots organization run by and for people with disabilities. NCIL envisions a world 

in which people with disabilities are valued equally and participate 

fully. 

Centers for Independent Living are non-residential, communitybased, non-profit organizations in all but five Congressional districts that are designed and operated by individuals with disabilities. They provide four core services: Advocacy, information referral, peer support, and independent living skills training. CILs are 

unique in that they operate in according to a strict philosophy of 

consumer control in which people with disabilities of any age directly govern and staff the Center. Each of the 336 federally funded 

Centers are unique because they reflect the interest of their individual communities. 

During fiscal years 2004 through 2006, Centers for Independent 

Living provided independent living services to over 3 million individuals with disabilities and moved 8,381 people out of nursing 

homes and other institutions. Beyond the direct services that they 

provide, Centers seek ways to broadly change traditional service 

delivery in their communities and throughout the Nation, including 

reform of the long-term care system. 

For over 30 years, Centers for Independent Living have sought 

community-based programs to assist people with disabilities. When 

services are delivered in an individual’s home, rather than a costly 

nursing facility or other institution, the result is tremendous cost 

savings to Medicaid and Medicare, while enabling people with disabilities to become independent, financially self-sufficient, and less 

reliant upon long-term government supports. 

Indeed, Mr. Chairman, research conducted in your home State of 

Wisconsin found that community-based services are at least 21 percent less expensive than nursing home placements. The success in 

Wisconsin reflects the system’s change activities that Centers for 

Independent Living are struggling to perform on their meager 

budgets. Such initiatives, if replicated nationwide through increased funding of the Independent Living program, will assist people to regain the right to live, work, and participate independently 

in society. 

NCIL estimates that to meet the current demand and overcome 

three years of funding cuts, appropriations for Independent Living 

will need to be increased by $100,000,000. Increased funding 

should be reinvested from the $160,000,000 that Centers have 


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saved the Federal Government over the last three years by moving 

people with disabilities out of costly nursing homes and other institutions. 

Supporting Centers in their mission to reintegrate people with 

disabilities into their communities is both morally sound and financially expedient. Vesting in Centers for Independent Living makes 

sense. In 2008, Centers are able to attract an additional 

$267,000,000 through grants, contracts, State funds, and a variety 

of other creative funding sources. In other words, we make the taxpayers’ money work for you and work for our consumers. 

Current funding levels barely sustain the day-to-day operations. 

Without increased funds, our vision to achieve full integration of 

people with disabilities into society will be undercut and taxpayers 

will continue to pay for costly nursing homes and bear the economic impact of continued dependence. 

Centers for Independent Living are an excellent service and a 

bargain for America. They help keep people active, engaged in their 

communities, and they save the taxpayer money. Funding Centers 

for Independent Living makes sense, common sense, and dollars 

and cents. 

Mr. Chairman, thank you again for this opportunity, and members of the Subcommittee, thank you. We will follow up with each 

of you and invite you to visit a Center for Independent Living so 

that you can see firsthand their contributions to your Congressional district. 

[The information follows:] 


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Mr. OBEY. Thank you very much. 

And let me apologize, because I forgot to do one other thing in 

setting the context for the testimony today. I want everyone to understand that I think virtually every member of this Subcommittee, 

on both sides of the aisle, will be very sympathetic to most of the 

causes that we hear addressed today. We have one specific problem: the appropriation bills that were signed last year by the President were some $22,000,000,000 below the level that this Committee eventually produced because the White House refused to 

budge on its overall funding levels for appropriation bills. 

This year, just to stay at the level of funding that was provided 

by those bills last year, we will have to add back roughly 

$26,000,000,000 that the President’s budget cuts from a variety of 

domestic programs. That makes it very difficult to be responsive 

sufficiently to the many good causes we will hear about today, and 

I just want people to be aware of what the root of the problem is 

as we address these issues. 

But thank you. It is good to see you again. I appreciate your coming. 

Mr. BUCKLAND. It is good to see you again, Mr. Chairman. Thank 

you. 

Mr. OBEY. If any member of the Committee has any comments 

or any questions at any time, please, just volunteer. 

Mr. SIMPSON. Well, Mr. Chairman, I just want to thank Kelly for 

coming out. I have known Kelly since, what, legislative days, years 

ago, it seems like. 

But thank you for taking the time to come out and testify. We 

appreciate it very much. 

Mr. BUCKLAND. Thank you, Representative Simpson. It is good to 

see you again. 

THURSDAY, MARCH 13, 2008. 

FISCAL YEAR 2009 FUNDING FOR OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, EMPLOYMENT 

AND TRAINING ADMINISTRATION, AND OFFICE OF 

LABOR MANAGEMENT STANDARDS 

WITNESS 

ARLENE HOLT BAKER, EXECUTIVE VICE PRESIDENT, AMERICAN FEDERATION OF LABOR-CONGRESS OF INDUSTRIAL ORGANIZATIONS 

(AFL–CIO) 

Mr. OBEY. And now American Federation of Labor and Congress 

of Industrial Organizations, or, as people know it, AFL–CIO, Arlene Holt Baker. 

Ms. BAKER. Good morning, Mr. Chairman and members of the 

Committee. I would like to thank you for this opportunity to testify 

this morning. My name is Arlene Holt Baker. I am the Executive 

Vice President of the AFL–CIO. The AFL–CIO is a federation that 

represents 56 affiliates and 10.5 million working families in all sectors in the United States economy. 

On behalf of the AFL–CIO, I thank you for the difficult work you 

do. The scarce resources over which this Subcommittee has jurisdiction cannot meet all the needs our Country faces. For the sake 


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of time, I am limiting my testimony to some of the most pressing 

priorities of the AFL–CIO; however, we will continue to engage the 

Appropriations Committee throughout the remainder of this Congress on a full range of funding issues. 

President Bush’s eighth and final budget to Congress overwhelmingly ignores the needs and priorities of working families. The 

Bush fiscal year 2009 budget preserves expensive tax cuts for the 

wealthy and dramatically boosts military spending, while cutting 

crucial programs for the most vulnerable Americans: Children, the 

elderly, the poor, and the sick. The President continues to propose 

major cuts in domestic appropriations and entitlements over the 

next five years, starting with $23,000,000,000 in fiscal year 2009, 

totaling a massive $474,000,000,000 in cuts over five years. 

Even though unemployment is on the rise and our economy is in 

serious distress, the President’s budget contains over 

$1,000,000,000 for cuts for job training and employment security 

programs. Under this proposal, job training programs for dislocated 

workers, young people, Native Americans, migrant and seasonal 

farm workers will all suffer major cuts, along with a program that 

enables low-income senior citizens to work with community-based 

organizations in neighborhoods across the Country. 

Although the President has proposed some reforms and a modest 

increase in funding the Trade Adjustment Assistance program, his 

reforms and his budget request fall far short of the essential improvements in the TAA bill already approved by a bipartisan majority in the House of Representatives, a bill he has irresponsibly 

vowed to veto. 

This Bush Administration budget continues to underfund many 

basic, important programs that have been enacted over decades to 

protect America’s workers from abusive employer practices. Yet, at 

the same time, the Bush Administration continues to seek even 

further increases in funding for offices of the Labor Department 

that have been politicized and that have institutionalized the harassment of union activists who are engaged in their fundamental 

and legal right to belong to a union and participate in the lawful 

exercise of that right. 

In particular, the Department should be halted from moving forward with the implementation of the intrusive 9-page disclosure 

form, the LM–30, which would provide an extreme and unfair burden on rank and file union members who perform representational 

tasks such as resolving shop floor disputes or conducting safety inspections. 

With this budget, the President has also turned his back on the 

brave men and women who responded to the devastating September the 11th attacks at the World Trade Center. These workers 

desperately need medical care, but the President’s budget will 

slash funding for the World Trade Center Medical Screening and 

treatment program by 77 percent, from $108,000,000 to just 

$25,000,000. 

And the President’s budget puts other workers at greater risk. 

Funding for the research agency, the National Institute for Occupational Safety and Health, will be cut 10 percent. At the Department 

of Labor, a small increase in funding has been requested for the 

Federal enforcement program for the Occupational Safety and 


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Health Administration, but the worker safety and health training 

program will be eliminated under the budget. And the budget proposes to reduce funding for coal mine safety enforcement and for 

the development of new mine safety standards at a time when coal 

mine catastrophes continue, and when the Mine Safety and Health 

Administration is already failing to meet the legal deadlines for 

issuing new protective standards. 

Although 47 million Americans lack health insurance and millions more need coverage and struggle every day with rising 

costs—— 

I see, Mr. Chairman, that the light is on. I will stop at this point 

and you can read the rest of it in the written testimony. We thank 

you for this opportunity to testify before the Committee. 

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Mr. OBEY. Thank you very much. Appreciate your coming. 

Ms. Jackson Lee. 

Ms. JACKSON LEE. Good morning. Good to see you. 

Ms. BAKER. Good morning. 

Ms. JACKSON LEE. Let me just ask you about the LM–30 disclosure form. Can you explain what it would take or what at least the 

AFL–CIO believes it would take to get rid of this form? Because 

I agree with you. 

Ms. BAKER. Well, our concern is that, as you know, the form before was basically a two-page form. This has increased to a ninepage form, and our rank and file members, who are basically shop 

stewards now, if they are participating in handling grievances on 

a shop floor and it goes over more than 250 hours a year, they now 

have to file a form and they also have to include personal financial 

information to show that there is no conflict of interest with banks 

that possibly their unions are doing business with. 

This certainly is not something a shop steward would do, and it 

would have such a chilling impact on shop stewards, and it would 

prevent them from doing their job. So we really think it should be 

rolled back to what was previously in place. This really is not necessary; it is burdensome. 

Mr. OBEY. Thank you very much. 

THURSDAY, MARCH 13, 2008. 

IMPACT AID TRANSITION PROGRAM 

WITNESS 

JONATHAN HAKE, CMSGT (RET.), DIRECTOR, MILITARY AND GOVERNMENT RELATIONS, AIR FORCE SERGEANTS ASSOCIATION 

Mr. OBEY. Next, Air Force Sergeants Association. 

Is it Jonathan Hake? 

Sergeant HAKE. Hake, yes, sir. 

Mr. OBEY. Thanks for coming. 

Sergeant HAKE. Good morning, Mr. Chairman and distinguished 

Committee members. On behalf of the 125,000 members of the Air 

Force Sergeants Association, I thank you for this opportunity. 

There are countless programs and their associated requirements 

before you, as you mentioned earlier, limited resources. We also realize that you are trusted to budget wisely, and the decisions you 

make are based on many factors, but I will confine my remarks to 

just two areas this morning. These are Impact Aid and tuition assistance. 

The first is Impact Aid. The program is essential to the quality 

of life of airmen that have school aged children from kindergarten 

to twelfth grade. Like many Americans, these service members 

want the best for their children. They want them to succeed. And 

a key element to that is a quality education. 

Public schools surrounding military installations and serving 

large service member populations often struggle because of local 

tax revenue shortfalls. Some school districts have noted that and 

increased taxes in their local areas. We think that is unfair to 

those residing around the installations and to those constituents. 

Some have even suggested we pay enrollment fees for public 


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schools, or some service members believe sending their children to 

a private school is the only option. Both of those options are expensive and enlisted members are at the low end of this pay scale. 

I see my time is up. 

Mr. OBEY. No, no, no, ignore that. She was just setting it and 

I think hit the wrong button, so ignore that. 

Sergeant HAKE. I am sorry. 

Both options are costly, and enlisted members, as you know, are 

at the low end of the pay scale, so these are not good options. 

Housing privatization is also something that Congress has done 

tremendous strides to get improvements of the quality of the housing for those that serve, but those may not always be considered 

Federal property. And if they are not Federal property, the difference in compensation and Impact Aid goes from $2,000 a child 

to $400 a child, which is a significant difference and would be devastating. 

As remarkable as it may seem, as you mentioned earlier, the cur- rent Administration has projected a budget $1,000,000 below what 

Congress appropriated last year. We find this very disappointing. 

We would ask the Committee to again this year take action in 

funding Impact Aid in 2009 at the level which you did in 2008. 

The second area I would like to highlight quickly is Transition 

Assistance Programs. The National Defense Authorization Act of 

1991 and associated public law established this program to help 

military members transition after their tour of duty. Transition Assistance Program employment workshops, VA Benefits Briefings, 

and the Disabled Transition Assistance Program provide valuable 

job placement assistance, training opportunities, and it really just 

helps those members of our society be better prepared for the challenges ahead. 

In the fiscal year 2009 budget request for the Department of 

Labor, the Administrator highlighted helping veterans transition 

as a priority, and yet only requested $5,000,000 more. We think, 

with the sustained high operations tempo, retaining soldiers, sailors, airmen, and Marines, will become a challenge, as it has been 

in the past, and the demand for these programs will grow. We urge 

this Committee to fully fund the requested increase and would welcome additional resources to meet the need. 

I will close by thanking you again, Mr. Chairman, for this opportunity to share our perspective. We appreciate the difficult choices 

this Committee must make and hope the information we have provided is helpful. Thank you. This concludes my statement. 

[The information follows:] 


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Mr. OBEY. Thanks for your time. 

THURSDAY, MARCH 13, 2008. 

ELEMENTARY AND SECONDARY SCHOOL COUNSELING 

PROGRAM GRANT (ESSCP) 

WITNESSES 

CAROLINE WILLIAMS, CURRICULUM SPECIALIST, MILWAUKEE PUBLIC SCHOOL DISTRICT, MILWAUKEE, WISCONSIN, AMERICAN 

SCHOOL COUNSELOR ASSOCIATION (ASCA) 

JANET L. MAYS, SCHOOL COUNSELOR, OLIVER WENDELL HOLMES K– 

8 SCHOOL, MILWAUKEE PUBLIC SCHOOL DISTRICT, MILWAUKEE, 

WISCONSIN 

Mr. OBEY. Next we have American School Counselor Association, 

Caroline Williams. Good morning. 

Ms. WILLIAMS. Thank you for giving us the opportunity to speak 

with you today. My name is Caroline Williams, and I am pleased 

to represent the American School Counseling Association and the 

100,000 school counselors across the Country. I am the School 

Counseling Curriculum Specialist for Milwaukee public schools and 

my district received an Elementary and Secondary School Counseling Program grant in 2006. With this funding, we hired additional school counselors who are currently implementing researchbased programs under a Comprehensive School Counseling Model. 

Some demographic risk indicators I would like to share. Milwaukee public schools is the largest school district in Wisconsin. It 

serves 87,360 students in 207 schools. Milwaukee public schools 

has a high student mobility rate and most recently has been sanctioned as a district in need of improvement. Most students in our 

district are economically disadvantaged; 71 percent qualify for free 

and/or reduced lunch. The homeless population in Milwaukee has 

increased since we received our grant. The total number of families 

recorded as homeless is currently 1,710 and is projected to rise to 

2,900 by the end of the school year. Milwaukee’s high crime and 

incarceration rate add to the backdrop of significant behavioral risk 

factors. 

Unfortunately, these problems do not affect all students equally. 

English language learners represent approximately 21.8 percent of 

our population. African-American students represent 57.4 percent 

of our student enrollment, but they also represent 71 percent of the 

homeless population. The suspension rate overall is 24 percent. 

These shocking demographic and behavioral risk factors truly represent a district that needs the type of discretionary funds provided 

under the Elementary and Secondary School Counseling Program. 

All elementary schools under the Elementary and Secondary 

School Counseling Program grant have insufficient school counseling staff. The number of schools without school counselors has 

grown consistently and significantly over the past five years. The 

current counselor to student ratio district-wide is one counselor to 

987 students, compared with the one counselor to 250 student ratio 

which is recommended by the American School Counselor Association and other organizations. 


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Less than 5 percent of elementary schools have counselors. The 

elementary school counselor to student ratio is one counselor to 

1,154 students. As a result of the Elementary and Secondary 

School Counseling Program funding, the elementary school counselors have been able to significantly increase the number of students served. We also have developed two critical documents, a district Comprehensive School Counseling Manual and a Parent/Student Conferencing Manual, that will be utilized by grant counselors. This is only our second year of the grant funding, and we 

have seen some marvelous new services provided to families that 

were left out in the past. 

On behalf of the students and families of Milwaukee public 

schools, I am very thankful for this funding and most definitely see 

the desperate need for its continuance. 

At this time, I would like to introduce Ms. Janet Mays, who is 

one of the counselors working with the grant. 

Ms. MAYS. Good morning. I am noticing the time. 

My name is Janet L. Mays, and for the past 10 years I have been 

the school counselor at Oliver Wendell Holmes School. Our school 

is a Title I school of 404 students; 23 percent are special education 

students, 98 percent receive free or reduced lunch. We are located 

in a high poverty neighborhood in an area where violence often occurs. 

We are extremely fortunate to have 1.5 school counselors now 

serving in our school as part of the Elementary and Secondary 

School Counseling Program. This reduces our student to counselor 

ratio to 263 to 1, having a tremendous positive impact on the lives 

of the students and their families in a variety of ways. 

As we strive to create an environment conducive to learning, our 

students and their families face many adverse challenges. For example, in less than one year, we had a second grader struck by a 

day care van and killed in front of the school as other children 

looked on, an eighth grader hit by stray bullets in her chest and 

face, and a sixth grader who saw his uncle shot and killed during 

a drive-by. Less than three weeks ago, five students were walking 

home from our Afterschool CLC Learning Program and they were 

caught in the crossfire between two cars on the corner of the playground. 

In each of these cases, students and their families were extremely traumatized and received immediate counseling support to 

work through the grief, the school social worker helped in assessing 

available community and family resources, and the school psychologist provided the staff with support needed to restore a sense of 

calm and security with students in their classrooms. The support 

staff worked in a seamless integration of service delivery to provide 

the most efficient, effective service delivery possible. While we 

could never have anticipated this number of incidents occurring 

with such frequency, our ability to meet this need would have not 

been possible without the assistance of the ESSCP funding. 

But our school is not just about crises. Like all school counseling 

programs, our fundamental goal is to help students overcome barriers to learning so they can achieve success in school and beyond. 

A family in our school was left homeless when they discovered that 

the person they were living with was selling drugs out of the home. 


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One of the children in this family managed to stay on the honor 

roll while living out of a car with her mother and four siblings. The 

team consisting of a school counselor, school social worker, and 

school psychologist made sure that the family had safe housing, 

food and clothing, as well as the mental health and counseling 

services they needed while working with the teachers to identify 

and integrate successful classroom strategies for these students. 

With decreasing amounts of money allocated for schools and increasing operational costs, many staff positions are being completely eliminated. But for at-risk children and families, building 

trusting, positive relationships are crucial to success and can only 

take place with stable staff. 

A few years ago, one of my students noticed that many of his favorite staff members did not return to school in the fall year after 

year. He came to me with tears in his eyes and asked, Ms. Mays, 

are you going to be back in the fall? I calmly reassured him that, 

God willing, I would return. The student is now a junior at a top 

high school, currently on the honor roll and working as a counselor 

at a summer camp. He is doing all of this while providing support 

for his aging grandmother, his primary caregiver. For many children and families, the school is a sanctuary and the staff is an alternative family, helping with even the most basic of needs. 

Funding from this grant has enabled us to implement proactive 

programming such as peaceful conflict resolution, problem-solving, 

manner skills for students. Partnerships have made it possible for 

us to have on-site full-time nursing services and annual dental 

services for students— 

Oh, I am sorry. I see that the time has been cut short. I thank 

you for taking the time and we appreciate everything that you do 

for our students. 

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Mr. OBEY. Thank you for coming and thank you for what you do. 

THURSDAY, MARCH 13, 2008. 

DEPARTMENT OF EDUCATION 21ST CENTURY 

COMMUNITY LEARNING CENTERS PROGRAM 

WITNESS 

PRISCILLA M. LITTLE, ASSOCIATE DIRECTOR, HARVARD FAMILY RESEARCH PROJECT 

Mr. OBEY. Next, Afterschool Alliance, Priscilla Little. 

Ms. ARGERSINGER. Good morning. I am Erica Argersinger, the 

Policy Director for the Afterschool Alliance. 

Millions of children benefit from the 21st Century Community 

Learning Centers, and I thank members of the Committee and the 

Chairman for your support in making quality afterschool programs 

available to our children. I am proud to introduce Priscilla Little, 

Associate Director of the Harvard Family Research Project, who 

will discuss the latest research on quality afterschool programs. 

Ms. LITTLE. Thank you and thank you for the opportunity to provide testimony today on Afterschool and the 21st Century Community Learning Centers Program. I have spent the past 10 years of 

my work at Harvard University devoted to building the knowledge 

base for Afterschool, compiling literally hundreds of research and 

evaluation studies into a national database and helping people understand what they are telling us about effective programming and 

how best to use research for policy practice. 

And I want to just tell you a very simple message. Afterschool 

programs are a critical component of children’s education and development, and, in part thanks to the 21st Century Grants Program, we have a good solid evidence base to support this claim. 

The 21st Century Program spawned new money, new programs, 

and new research and evaluation studies. In addition to the studies 

conducted of 21st Century Programs directly, many other evaluations that I have tracked, read, and written about include programs which receive 21st Century funding as one of many blended 

funding sources they have leveraged to support their work. 

Even though the 21st Century Program began in the 20th century, it was aptly named as a program that could support the development of the skills necessary for young people to support America’s effort to stay competitive in a 21st century global economy. 

Since its inception 10 years ago, we have learned a lot about the 

enormous potential for afterschool programs to support a range of 

positive learning and developmental outcomes, and let me just give 

you one example from the CS-funded Study of Promising Afterschool Programs. 

This study included 3,000 students participating in Afterschool 

nationwide, including some funded by 21st Century, and found that 

regular attendance in these afterschool programs over a two-year 

period was significantly associated with gains in standardized 

math test scores and better work habits. In addition to academic 

achievement outcomes, there are a host of positive behavioral, prevention, and health outcomes associated with participation, and I 

refer you to my written testimony for that information. 


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Do all afterschool programs deliver on these outcomes? Of course 

not. First, different programs target different sets of skills, and it 

is not appropriate to think one program can do it all. Second, we 

have learned a lot from the research about specific factors that 

make a big difference in whether or not programs can get these 

outcomes, and these map on to some key aspects of 21st Century. 

First, the research we have conducted at Harvard underscores a 

consistent pattern of winners and losers when it comes to access 

to afterschool opportunities, with middle and upper income children and youth getting access to and taking more advantage of enrichment outside of school. Twenty-first Century investments help 

level the playing field by targeting low income, poorly performing 

schools to ensure that all children and youth have access to programs, not just those who can afford them. 

Finally, we all know that learning does not stop when the school 

bell rings. Supporting learning throughout the day, throughout the 

year, and throughout a child’s life requires partnerships, and this 

is an area where 21st Century Programs are particularly strong. 

The typical 21st Century Program has six community partners who 

contribute to the project by providing services and resources not directly funded by the program itself. These partners serve to improve quality, help engage children and youth throughout the community, and help 21st Century Programs leverage additional resources for sustainability. 

In closing, I want to reiterate that we know a lot about what 

works for children and youth during the afterschool hours and underscore the importance of 21st Century Grants Program as a core 

educational and developmental support for our Nation’s children. I 

encourage you to use the research to make informed decisions 

about resource allocations and set reasonable expectations for participation in 21st Century Programs. Thank you very much. 

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Mr. OBEY. Thank you. 

I would simply point out that last year this Committee added $100,000,000 to the President’s Afterschool budget. This year he is 

recommending a cut of $281,000,000 and he is trying to turn it into 

a voucher program. Net result would be about one million kids 

presently on the program could be eliminated. 

Thank you for your testimony. 

Ms. LITTLE. Thank you for that. 

THURSDAY, MARCH 13, 2008. 

STUDENT FINANCIAL ASSISTANCE 

WITNESS 

EDITH L. BARTLEY, DIRECTOR OF GOVERNMENT AFFAIRS, UNITED 

NEGRO COLLEGE FUND 

Mr. OBEY. Next, United Negro College Fund, Edith Bartley. 

Ms. BARTLEY. Good morning, Chairman Obey and distinguished 

members of the Subcommittee. I am Edith Bartley, Director of Government Affairs for the United Negro College Fund. It is an honor 

and a privilege to appear before you today as you consider funding 

priorities relevant to the fiscal year 2009 Labor-HHS Education 

Appropriations. 

On behalf of UNCF and our 39 member institutions, I would like 

to thank you for your steadfast support of the Nation’s historically 

black colleges and universities. UNCF’s primary goal is to increase 

opportunities for access to higher education. During our 64-year existence, UNCF has raised more than $2,300,000,000 to support our 

member institutions. Today, UNCF supports more than 64,000 students at over 900 colleges and universities across the Nation. 

The Title III–B part of the Higher Education Act, entitled 

Strengthening Black Colleges and Universities, continues to be the 

primary source of institutional assistance for America’s HBCUs. 

UNCF hopes this Subcommittee will continue to support increases 

to the current authorization levels. 

During the last session of Congress, your Subcommittee supported $170,000,000 in additional Title III–B funding for HBCUs 

under the College Cost Reduction Act. These funds, $85,000,000 

per year for two years, were a significant lift for Congress and, at 

the same time, a wise investment. The majority of HBCU programs 

were level-funded during the 2008 House and Senate appropriations cycle, and the cut across the board left many programs funded at 2007 levels. 

The President’s fiscal year 2009 budget proposes that 

$85,000,000 of these funds be counted towards his $238,000,000 

level-funded proposal. UNCF urges the Committee to reject proposed cuts to HBCUs and push for the maximum funding possible. 

The President also proposes only a modest increase in Pell Grant 

funding. Remember, UNCF schools are small. HBCU endowments 

pale in comparison to majority institutions, and most students attending HBCUs are first generation college students who need the 

maximum level of scholarships and grants available in order to 

minimize incurring disproportionate levels of student loan debt. 


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UNCF requests that the members of the Committee push for increased appropriations to support increased Pell Grant levels. The 

average tuition at a UNCF member school is $20,657, which is, on 

average, half of the amount of tuition at a majority institution. 

However, roughly 70 percent of students at UNCF schools come 

from families with incomes below $30,000; and students at UNCF 

schools graduate with roughly $17,000 in undergraduate student 

loan debt. 

In addition to student and institutional aid, UNCF urges the 

Committee to support funding for the Digital and Wireless Technology Act. This bill, now attached to the House HEA bill, will help 

close the information and technology gap that exists between minority-serving institutions and majority schools. 

Finally, please remember HBCUs produce well-rounded, globally 

competitive graduates. In 2003, Xavier University, a UNCF school, 

produced as many successful African-American medical school applicants as the University of Maryland, Harvard, and Johns Hopkins African-American applicants. HBCUs and their graduates hold 

great significance within American history, the future of our Nation, and the African-American in particular. 

While many accounts funded within your Subcommittee are of 

great importance to UNCF, we have submitted a chart as part of 

our written testimony outlining our proposed funding levels for relevant programs, and we thank you for this opportunity and your 

continued support. 

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Mr. OBEY. Thank you. Again, let me point out that last year the College Cost Act enacted increases of $255,000,000 more for 

HBCUs. The President proposes to rescind $85,000,000 this year. 

Ms. BARTLEY. Yes. 

Mr. OBEY. Thank you much. 

Ms. BARTLEY. Thank you. 

THURSDAY, MARCH 13, 2008. 

FUNDING FOR MENTORING 

WITNESS 

MARGO S. PEDROSO, SENIOR VICE PRESIDENT, PUBLIC POLICY, MENTOR/NATIONAL MENTORING PARTNERSHIP 

Mr. OBEY. Next, MENTOR/National Mentoring Partnership, 

Margo Pedroso. 

Ms. PEDROSO. Mr. Chairman, Ranking Member Walsh, I appre- ciate the opportunity to testify in support of the $100,000,000 in 

Federal funding for youth mentoring. That is $50,000,000 each for 

the Department of Education’s Mentoring Programs Grants and 

the Department of Health and Human Services Mentoring for Children of Prisoners Program. I am here today on behalf of MENTOR/ 

National Mentoring Partnership. We are an advocate and a resource for youth mentoring programs around the Country and we 

work with a national network of mentoring partnerships about 

4100 mentoring programs around the Country. 

Youth mentoring is a simple, yet powerful concept: An adult provides guidance, support, and encouragement to help a young person 

achieve success in life. Numerous students document that highquality mentoring results in better attendance at school, it lowers 

dropout rates, and it decreases involvement with drugs and violent 

behaviors. We believe that mentoring is an effective strategy that 

addresses both the academic and non-academic needs of struggling 

young people. Further details on the outcomes for youth involved 

in mentoring relationships are in my written testimony. 

To get the kind of results I have just touched on, research shows 

that mentoring programs must operate high-quality programs following best practices; they must have well-trained staff; they must 

recruit and thoroughly screen and train their volunteers; and they 

must provide ongoing monitoring and support for mentoring relationships. When programs follow these proven practices, mentoring 

relationships last longer and are closer, and have strong positive 

impacts on young people. 

These effective practices come at a cost. We find that it is about $1,000 to $1,500 per child per year to run an effective mentoring 

relationship. The mentoring field must have continued access to 

Federal funds if we are going to be able to serve more children and 

serve them well. And we do need to serve more children. Just 17 

percent of the 17.6 million young people that could benefit from 

having a mentor are currently in mentoring relationships. Clearly, 

the demand for mentoring far exceeds what mentoring programs 

are currently able to provide. 

Since fiscal year 2004, Congress has wisely devoted approximately $100,000,000 each year to Federal funding, split between 


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the two programs I mentioned previously: The Department of Education’s Mentoring Programs Grants and Health and Human Services Mentoring Children of Prisoners Programs. Both of these are 

competitive grant programs that provide funding to local organizations to either start mentoring programs or expand the ones they 

already have. 

The President’s budget request for fiscal year 2009 proposes $50,000,000 for the Mentoring Children of Prisoners Program, a 

slight increase from the fiscal year 2008 funding level of 

$48,600,000. We support this request and encourage Congress to 

provide that $50,000,000. 

Unfortunately, the President’s proposed budget for fiscal year 

2009 would eliminate all funding for the Department of Education 

Mentoring Programs Grants. This program was funded at 

$48,500,000 in 2008 and we request that Congress restore the traditional level of $50,000,000 to this program. 

The proposed elimination of ED’s Mentoring Programs grants 

would have an extremely detrimental impact on mentoring: 164 

grantees from the fiscal year 2007 cohort would lose the final year 

of funding for their three-year grants, likely resulting from closure 

or downsizing of these programs and ending hundreds, if not thousands, of mentoring relationships. 

Besides the immediate impact, the elimination of this program 

would mean the end of the only authorized Federal program exclusively focused on providing mentors for young people at risk of failing academically. In the seven years the program has been in existence, 641 grants have been awarded to local organizations in every 

State, including urban, rural, and suburban settings. These grants 

have totaled nearly $300,000,000, and we estimate that around 

200,000 young people have benefitted from mentoring relationships 

during this funding. 

Eliminating this grant program will significantly impact the ability of mentoring programs to continue to serve children and will ultimately mean fewer children in mentoring relationships. We cannot afford to backslide and increase the mentoring gap. 

In conclusion, I respectfully request that Congress provide 

$50,000,000 each for Education’s Mentoring Programs and HHS’s 

Mentoring Children of Prisoners Program. On behalf of the thousands of mentoring programs and millions of young people in mentoring relationships today, I commend you for your past support of 

this funding and strongly encourage you to continue this wise investment in the future of our young people. Thank you. 

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Mr. OBEY. Thank you very much. 

THURSDAY, MARCH 13, 2008. 

BIOTERRORISM 

WITNESS 

DAVID FLEMING, M.D., DIRECTOR OF PUBLIC HEALTH FOR SEATTLEKING COUNTY, WASHINGTON, MEMBER, BOARD OF DIRECTORS, 

TRUST FOR AMERICA’S HEALTH, DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Mr. OBEY. Next, Trust for America’s Health, David Fleming. 

Dr. FLEMING. Mr. Chairman, members of the Committee, good 

morning. I am David Fleming. I am here as a Board Member of 

Trust for America’s Health, or TFAH. I am also the Director and 

Health Officer for the Health Department of Seattle-King County 

in the State of Washington. Thank you for the opportunity to be 

here today. 

I have been lucky in my career to work at the local, State, national, and international level in public health and to see public 

health practiced from a variety of perspectives. It is clear we are 

facing a time of unprecedented opportunity for saving lives, saving 

money, and improving health in our Nation; and that is good news, 

because Americans deserve a well-financed, modern, public health 

system. It is only rational that as we worry about rising health 

care costs and threats like pandemic influenza, that resources for 

public health should be on the rise. But we live in irrational times. 

The President’s fiscal year 2009 budget is proposing huge reductions in public health spending across this Country. The CDC’s 

budget would be cut by $433,000,000, continuing an alarming, potentially disastrous trend of disinvestment in the very programs 

that are saving lives and reducing health care costs. I am asking 

you not to let this happen. 

As a local health officer, let me give you a report directly from 

the front lines. Federal funding makes a critical difference in my 

community’s and every community’s ability to protect Americans 

from threats. Dollars you provide will be well spent. In fact, I urge 

you to attach to these resources clear accountabilities and 

deliverables for improving the health outcomes in our communities. 

The bottom line is that TFAH supports increased funding for a 

number of critical community-based programs, and I am submitting that for the record. 

In my remaining time, let me briefly outline two priorities. The 

first is chronic diseases, which account for 70 percent of deaths in 

this Country and almost 75 percent of health care spending. Most 

are preventable; they do not need to happen. 

In my community, we have an amazing federally-funded program 

called Steps. Using community outreach and mobilization, we are 

attacking asthma, diabetes, and obesity in the poorest parts of my 

county. In a few short years, the proportion of kids buying soda 

and junk food in schools has dropped 50 percent and asthma hospitalizations are dropping at 10 percent per year. 

Unfortunately, Federal funding for my county’s Steps program 

was eliminated in the 2008 budget. Many other Steps communities 


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around the Country are now facing the same prospect in the 2009 

budget. Please restore funding for Steps and other critical community-based chronic disease prevention programs. 

My second priority is preparedness. Recently, TFAH released its 

annual Ready or Not report on our Nation’s preparedness. The 

good news is we found significant improvement in State preparedness over prior years. The bad news is that there are many areas, 

like medical surge capacity, where we are woefully unprepared and 

we have a crisis in the making. 

Funding for the Preparedness Cooperative Agreements to States 

and localities has been drastically cut in recent years and the 2009 

budget proposes an additional 18 percent reduction. This greatly 

diminished Federal support for all-hazards approaches to preparedness puts programs that have been created and are now working 

in jeopardy, and puts the health and safety of the people in my 

community at risk. I ask you to restore these capacity-building 

grants to their fiscal year 2005 level of $919,000,000. 

Mr. Chairman, I appreciate this opportunity to testify because 

every day across this Country dedicated public health practitioners 

save lives, protect our community and our Nation. We have got the 

will; we have got the ability; we have got the passion. But we need 

resources to get this job done and we are looking to you for leadership. Thank you. 

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Mr. OBEY. Thank you again. Let me simply cite the record. The President proposed a $221,000,000 cut in this program last year. 

The omnibus appropriation bill, which we passed, instead added 

$393,000,000 to the President’s request for CDC. This year, as you 

say, he has again proposed a $475,000,000 cut. 

Dr. FLEMING. Thank you, Mr. Chairman. 

Mr. OBEY. Thank you very much. Appreciate your time. 

THURSDAY, MARCH 13, 2008. 

CENTERS FOR DISEASE CONTROL AND PREVENTION’S 

BUDGET FOR FISCAL YEAR 2009 

WITNESS 

GEORGES C. BENJAMIN, M.D., FACP, FACEP (EMERITUS), EXECUTIVE 

DIRECTOR OF THE AMERICAN PUBLIC HEALTH ASSOCIATION, 

WASHINGTON, D.C., CENTERS FOR DISEASE CONTROL AND PREVENTION COALITION, DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Mr. OBEY. Centers for Disease Control and Prevention Coalition, 

Dr. Georges Benjamin. 

Dr. BENJAMIN. Good morning, Mr. Chairman and Ranking Member Walsh. My name is Dr. Georges Benjamin, and I am the Executive Director of the American Public Health Association. But today 

I am here to speak to you on behalf of the CDC Coalition to express 

our views on the importance of providing adequate funding for the 

Centers for Disease Control and Prevention’s budget for fiscal year 

2009. The CDC Coalition is a group of over 100 groups committed 

to strengthening our Nation’s prevention programs. 

We, of course, have appreciated the Subcommittee’s support over 

the years, and we recognize how real tough it is to find money, and 

even tougher to prioritize spending. But as my good friend, David 

Fleming, just said, obviously, the CDC’s Federal funding provides 

the foundation for our core public health programs. Over 70 percent of these dollars go directly to communities and we believe that 

the CDC should be supported as an agency. So we are recommending an adequate level, at least for this year, of 

$7,400,000,000—which includes funding for the Agency for Toxic 

Substances and Disease Registry as well—for CDC’s core programs; 

and, of course, that would not include the dollars for Vaccines for 

Children Program. 

The CDC’s budget has actually shrunk since 2005, in terms of 

real dollars, by over almost 4 percent, over almost $500,000,000. 

The current Administration request for fiscal year 2009 cuts the 

CDC budget by $475,000,000 below the fiscal year 2008 level; increases cuts to State and local preparedness funding, as you heard, 

chronic disease programs, infectious disease programs and detection, including things like West Nile Virus; and control elimination 

of Preventive Health Services Block Grant. We believe this request 

is inadequate and, quite frankly, many of the cuts appear to be arbitrary in nature. 

Since 2005, these cuts in CDC we think worked in a very damaging way to decrease the capacity for the CDC and we just think 

these cuts are going in the wrong direction. 


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Just to point out, in California, the REACH Program. I mean, a small cut, but $125,000. Over $90,000,000 in the Preventive Health 

Services Block Grant. At least when I was in government looking 

at these kinds of budgets, this basically is a budget that has really 

no policy coherence whatsoever. And we hope that, as you are making these very, very difficult choices, you will be able to prioritize 

some funding back to the Centers for Disease Control and Prevention. 

With that, I will stop and be happy to take any questions you 

might have. 

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Mr. OBEY. Thank you very much. 

THURSDAY, MARCH 13, 2008. 

CENTERS FOR DISEASE CONTROL AND PREVENTION’S 

BUDGET FOR FISCAL YEAR 2009 

WITNESS 

BRYAN BECKER, M.D., PRESIDENT-ELECT, NATIONAL KIDNEY FOUNDATION (NKF), DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Mr. OBEY. Next, National Kidney Foundation, Dr. Bryan Becker. 

Dr. BECKER. Good morning, Mr. Chairman, members of the Subcommittee. I am President-Elect of the National Kidney Foundation 

and today is World Kidney Day. National Kidney Foundation patient advocates are visiting many of their Congressional delegations discussing chronic kidney disease. 

Twenty-six million Americans have chronic kidney disease and 

the prevalence of chronic kidney disease has gone up 30 percent 

over the last two decades in the United States. My great State of 

Wisconsin has enough people with chronic kidney disease to fill 

Lambeau Field, one of our signature landmarks. Unfortunately, 

most of the people with chronic kidney disease do not know that 

they have it. 

The Medicare End Stage Renal Disease Program, a marvelous 

program that treats patients with kidney failure with dialysis or 

transplantation, regardless of age or other disability, is the only 

disease-specific coverage under the program. But we are not talking about kidney failure; we are talking about chronic kidney disease. We are talking about patients that just have a mild degree 

of kidney dysfunction. And if we look at Medicare datasets, this 

number of individuals accounts for 21 percent of Medicare expenditures at present. 

Until 2005, there was no national public health program addressing early detection and treatment of chronic kidney disease. Congress provided $2,000,000 to initiate a chronic kidney disease program at the CDC in that year. NKF is requesting a very modest 

$3,000,000 for that program in fiscal year 2009. The kidney program will identify high-risk individuals, develop community-based 

systems for improved detection and treatment, and disseminate 

best practices for early detection and treatment. 

We know that early detection and appropriate treatment can 

limit chronic kidney disease and limit the number of people who 

develop kidney failure. The CDC has funded the development of 

the CKD surveillance system feasibility study and pilot programs 

and an expert panel which met last March has now laid the foundation for a true public health strategy for chronic kidney disease, 

including cooperative agreement with State-based screening demonstration projects. 

The modest request for additional funding will expand that infrastructure and increase the community-based demonstration 

projects, extending them even into CKD monitoring for progression 

of CKD. 

Individuals with diabetes, high blood pressure, cardiovascular 

disease, or a family history of chronic kidney disease are all at 


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great risk; and because CKD is asymptomatic early, we know detection is critical. The Chronic Kidney Disease Program at the CDC 

will help us improve our early diagnosis and enable health care 

providers to do what is right for this large set of patients in our 

Country. 

Thank you very much for your past support and consideration for 

this request. 

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Mr. OBEY. Thank you. Appreciate your time. 

THURSDAY, MARCH 13, 2008. 

CENTERS FOR DISEASE CONTROL AND PREVENTION 

(CDC)—NATIONAL INSTITUTE FOR OCCUPATIONAL 

SAFETY AND HEALTH (NIOSH) 

WITNESS 

JAMES K. BROWN, M.D., FRIENDS OF NIOSH, DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

Mr. OBEY. Next, Friends of NIOSH, Dr. James Brown. 

Dr. BROWN. Mr. Chairman, thank you for the opportunity to 

present testimony to the Subcommittee in support of funding for 

the National Institute of Occupational Safety and Health. My name 

is Jim Brown. I am Professor of Medicine at UC-San Francisco and 

a staff physician in lung disease at the San Francisco VA. I am testifying on behalf of the Friends of NIOSH, which is a coalition of 

business, labor, medical, professional, and educational organizations interested in helping the Nation reduce work-related illnesses 

and injury. For fiscal year 2009, Friends of NIOSH request a $50,000,000 increase for NIOSH. This increase would enable NIOSH to keep pace 

with the changing nature of work-related illnesses and ensure that 

research and education to prevent work-related disease and injuries remain a high priority. 

NIOSH is the primary Federal agency responsible for conducting 

research and making recommendations for prevention of work-related illnesses and injury. It collects information, collaborates with 

all stakeholders to identify the highest priority causes of these 

work-related problems, conducts biomedical research to find solutions, and translates the knowledge gained in solutions into products and services that improve the safety and health of workers in 

all sectors of the United States economy. 

It supports programs in every State. As part of these State activities, NIOSH evaluates workplace hazards and recommends solutions when requested by employers, workers, and government 

agencies. It builds State worker safety and health capacity through 

grants and cooperative agreements; it funds occupational safety 

and health research; and it supports occupational safety and health 

training programs. 

The many causes of occupational injury and illness represent a 

striking burden on American health and well-being, as reflected by 

the following observations: 

Each day, an average of 9,000 U.S. workers sustain disabling injuries on the job; 16 workers die from injuries suffered at work, 

and 137 workers die from work-related illness. 

In 2005, more than 4.2 million workers sustained work-related 

injuries and illnesses in the private sector alone. 

These are especially distressing statistics because most work-related fatalities, injuries, and illnesses are preventable with effective, professionally directed health and safety programs. 

Furthermore, we do not work in a static environment. Between 

2000 and 2015, the number of workers 55 years and older will inVerDate Aug 31 2005 01:49 Sep 13, 2008 Jkt 043329 PO 00000 Frm 00082 Fmt 6633 Sfmt 6602 E:\HR\OC\A329P2.XXX A329P2

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crease by 72 percent, to over 31 million workers. Work-related injury and fatality rates begin increasing at age 45, with rates for 

workers 65 years and older nearly three times as high as the average for all workers. 

We also constantly face new threats to worker health. The 

heightened awareness of terrorist threats, as well as the increased 

responsibilities of first responders and other homeland security 

professionals illustrate the need for strengthened workplace health 

and safety in the ongoing war on terror. 

NIOSH developed more effective methods to test for anthrax contamination in congressional offices. These procedures were quickly 

adopted by the Coast Guard, FBI, and government building contractors. 

In response to ongoing safety concerns regarding the tunnels 

under the U.S. Capitol, NIOSH was asked to evaluate health hazards in the tunnels for workers who maintain the plumbing that 

provide steam and water to Congress, Library of Congress, Supreme Court, and other Federal buildings. 

NIOSH took a lead role in the safety of 9/11 emergency responders in New York City and Virginia, with NIOSH trained professionals applying their technical expertise to meet immediate protective needs and safeguard the health of cleanup workers. NIOSH 

now administers awards to provide health screening of World 

Trade Center responders. 

Thank you for the opportunity to report the great need for research and training in occupational health and safety. Thank you. 

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Mr. OBEY. Thank you very much. 

Let me just point out last year the President requested $252,900,000. This Committee added $21,000,000 to his request. 

This year the President is suggesting a $28,000,000 cut. I have to 

say I am biased; I think that NIOSH is one of those agencies 

squeezed the most. 

I recall, a number of years ago, when I got Dr. Irving Selikoff to 

come to my district to do an epidemiological study on behalf of 

grain workers in one of my major cities because a number of them 

were having severe respiratory problems, and the CEO of that 

grain elevator went ballistic and swore to me that there were no 

problems whatsoever on the floor. Well, I had been in that grain 

elevator; I, myself, had had a severe reaction to the grain. So I simply suggested to him that he ought to change places with his workers for a week; let them sit in his office while he worked on the 

shop floor; he might have a different attitude about the problem. 

NIOSH is crucial to dealing with problems like that. Thank you 

very much. 

Dr. BROWN. Thank you, Mr. Chairman. 

THURSDAY, MARCH 13, 2008. 

HEALTH RESOURCES AND SERVICES ADMINISTRATION—CHILDREN’S HOSPITALS GRADUATE MEDICAL 

EDUCATION 

WITNESS 

JOSEPH WRIGHT, M.D., MPH, EXECUTIVE DIRECTOR, CHILD HEALTH 

ADVOCACY INSTITUTE, CHILDREN’S NATIONAL MEDICAL CENTER, 

WASHINGTON, D.C., THE NATIONAL ASSOCIATION OF CHILDREN’S 

HOSPITALS, ALEXANDRIA, VIRGINIA, DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Mr. OBEY. National Association of Children’s Hospitals, Joseph 

Wright. 

Dr. WRIGHT. Chairman Obey and Ranking Member Walsh, thank 

you for the opportunity to testify today in support of the Children’s 

Hospitals Graduate Medical Education Program. I am Dr. Joseph 

Wright, Executive Director of the Child Health Advocacy Institute 

at Children’s National Medical Center here in Washington, D.C., 

and have practiced pediatric emergency medicine for 18 years 

there. I am here today on behalf of the National Association of 

Children’s Hospitals and the 60 independent children’s teaching 

hospitals that qualify for CHGME funding, including Children’s 

National Medical Center. 

Congress established the CHGME program in 1999 to address a 

disparity in Federal graduate medical education support that existed between adult teaching hospitals and independent children’s 

teaching hospitals. Because independent children’s hospitals treat 

children and not the elderly, they are largely excluded from the 

predominant payer of graduate medical education: Medicare. 

Prior to CHGME, children’s teaching hospitals received one-two 

hundredth the Federal GME support that adult teaching hospitals 

received. Thanks to this Subcommittee’s leadership and the broad 

bipartisan Congressional support, the CHGME program currently 


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provides about 80 percent of the GME support that Medicare provides to adult teaching hospitals. 

CHGME funding has been absolutely essential to children’s hospitals and the future of pediatric medicine. Less than one percent 

of all independent teaching hospitals train 35 percent of all pediatricians and half of all pediatric subspecialists. CHGME hospitals 

provide half of all hospital care for seriously ill children in this 

Country and serve as the Nation’s premier pediatric research centers. 

CHGME has been remarkably successful in erasing the decline 

in a number of pediatric residencies that existed prior to its enactment. CHGME has enabled children’s hospitals to sustain and expand residency programs at a time of national pediatric workforce 

shortages. 

Since the program was instituted, CHGME recipient hospitals 

have accounted for more than 67 percent of the growth in the number of pediatric subspecialty trainees and 76 percent of the growth 

in the number of all pediatric residents. 

Since fiscal year 2000, the first year that we received CHGME 

support at my hospital, Children’s National has experienced a 30 

percent increase in the number of residents and fellows that we 

train. We have added specialties and now operate 17 ACGME accredited programs. 

Now, as you know, with only one exception, in fiscal year 2005, 

the President has consistently proposed to cut CHGME funding in 

his annual budget. This year, the President’s budget proposed the 

elimination of CHGME. Fortunately, this Subcommittee and Congress have consistently sustained the program’s funding. 

In 2006, Congress reauthorized the CHGME program with nearly unanimous approval, providing $330,000,000 in authorized funding. Last year, Congress appropriated $301,700,000 for the program. In its reauthorization, Congress reinforced the fact that 

CHGME is a targeted, fiscally-responsible, slow-growth program. 

In the last five years, CHGME’s funding has grown at an annual 

rate of just 0.8 percent, from $290,000,000 in fiscal year 2003 to 

less than $302,000,000 in fiscal year 2008. It operates under extensive data reporting requirements, which were further strengthened 

in its reauthorization. 

We deeply appreciate the support this program has received from 

so many members of this Subcommittee. We are grateful for the 

leadership of Chairman Obey and Ranking Member Walsh, and 

former Chairman Ralph Regula and Bill Young. CHGME is not 

only important to the Nation’s children’s hospitals, it is absolutely 

critical to all children’s health and the future of pediatric medicine 

in this Country. 

I ask that you please ensure continuation of the strong successful 

CHGME program that exists today by appropriating the fully authorized level of $330,000,000 for CHGME in fiscal year 2009. 

Thank you very much. 

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Mr. OBEY. Thank you. Again, last year, the President proposed a $100,000,000 cut in this program. This Committee restored the 

funds. For the coming year, the President is proposing to eliminate 

the entire $300,000,000 program. 

Thank you much. 

THURSDAY, MARCH 13, 2008. 

RURAL HEALTH 

WITNESS 

PAUL MOORE, PRESIDENT, NATIONAL RURAL HEALTH ASSOCIATION, 

MOORE, OKLAHOMA, DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Mr. OBEY. National Rural Health Association, Paul Moore. 

Mr. MOORE. Thank you, Mr. Chairman, Ranking Member Walsh, 

and distinguished members of the Subcommittee. I thank you for 

the opportunity to testify on the rural health safety net that is 

made up of programs in the Labor, Health and Human Services 

Education and Related Agencies appropriations bill. 

My name is Paul Moore, and I serve as the President of the National Rural Health Association. We are a national nonprofit member-driven organization whose mission is to improve the health of 

rural Americans. I have a long history of working with the programs under your jurisdiction in a number of health care roles: as 

a community pharmacist, as a hospital administrator, a home 

health administrator, an EMS administrator. 

Mr. Chairman, it will be no surprise to the members of this Subcommittee that rural health care providers and their communities 

tend to have fewer patients and also have less financial resources 

than their urban counterparts. It is often difficult to invest in the 

infrastructure, technologies, and activities that are needed to improve quality, expand delivery of care options, or even to recruit 

health care professionals. 

Yet, studies show that rural hospitals are leaders in the nationwide quality movement. With the right resources, these rural hospitals can provide care with even better quality outcomes than 

their urban counterparts. 

Other rural health providers have similar opportunities. The 

rural health safety net programs each have their own individual 

goals and objectives, but, in practice, they work together to provide 

the technical assistance and the resources needed by the rural 

health providers and their communities. 

These programs, which are outlined in my testimony, include 

such Federal initiatives as the Rural Health Outreach and Network Grants, the Rural Telehealth Grants, and the Small Hospital 

Improvement Program. These Federal programs and others highlighted in my written testimony have worked to provide the expertise, assistance, and guidance that we need. 

In regards to training, evidence clearly shows that if you provide 

training to medical students in a rural environment, they are likely 

to practice there. This is the only way we will be able to overcome 

the growing workforce crisis in rural America. Already, many rural 


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communities are in a health profession shortage area or medically 

underserved area. 

The long-term projections show that there are more retirements 

of rural health professionals than the number being trained to take 

their places. This calls for a radical rethinking of training, of recruitment, and care coordination, which is already underway. Programs such as the National Health Service Corps, Title VII, Title 

VIII must be continued and strengthened. 

Rural America is not asking for a lot. Our request is exceedingly 

modest. Excluding the community health centers, the programs 

making up the rural health safety net costs approximately 

$300,000,000. This is not enough money to have any significant impact on the overall Federal budget deficit or the fiscal environment; 

yet, it will have a huge impact on rural America. In the long run, 

the Federal Government will pay a much higher cost should it walk 

away from its commitment to monitor and to improve the health 

care in rural America. 

Mr. Chairman, it is clear that the rural health safety net programs that this Subcommittee oversees work. The evidence demonstrates that they improve all facets of the rural delivery system. 

But we must continue to fund and improve the programs. Without 

this, the future of 62 million rural Americans is at stake. 

I thank you for the opportunity to present to you today. Thank 

you. 

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Mr. OBEY. Thank you. And again let me point out, last year, the President proposed a $142,000,000, or 50 percent, cut to rural 

health programs. This Committee restored that funding and added 

$5,000,000 more. Again this year, the President is proposing a 

$112,000,000, or 82 percent, cut in the program. 

Thanks much. 

Mr. MOORE. Thank you, Mr. Chairman. 

THURSDAY, MARCH 13, 2008. 

FISCAL YEAR 2009 APPROPRIATIONS FOR THE NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND 

KIDNEY DISEASES 

WITNESS 

DEE GAILEY RYAN, NEPHCURE FOUNDATION, DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

Mr. OBEY. Next, on behalf of NephCure, Dee Gailey Ryan. 

Ms. RYAN. Chairman Obey and members of the Subcommittee, 

thank you for the opportunity to appear before you today. I am Dee 

Ryan, and my husband is Lieutenant Colonel John Kevin Ryan, 

U.S. Air Force and Iraq war veteran. I am here today to tell you 

about our six-year-old daughter Jenna. She is suffering from nephrotic syndrome, a medical problem caused by rare diseases of the 

kidney filter, which causes leakage of protein into the urine and 

can often cause kidney failure. 

Our physician tells us Jenna has one of two filter diseases called 

Minimal Change Disease or Focal and Segmental 

Glomerulosclerosis. According to a Harvard University report, 

there are presently 73,000 people in the United States who have 

lost their kidneys as a result of FSGS. 

Unfortunately, the causes of FSGS and other filter diseases are 

very poorly understood. In October of 2007, Jenna began to experience general swelling of her body, intermittent abdominal pain, fatigue, and general malaise. Then she developed a cough and her 

stomach became dramatically distended. We rushed Jenna to the 

emergency room, where her breathing became more and more labored and her pulse raced. She had symptoms of pulmonary edema, 

tachycardia, hypertension, and pneumonia. Her lab results showed 

a large amount of protein in the urine and a low concentration of 

the blood protein albumin, consistent with a diagnosis of FSGS. 

Jenna’s condition did not begin to stabilize for several frightening 

days. 

We are frightened by her doctor’s warnings that NS and its 

treatment are associated with growth retardation and other medical complications, including heart disease. Jenna has already developed hypercholesterolemia. This is a lot for a little girl in kindergarten to endure. 

Jenna’s prognosis is currently unknown because nephrotic syndrome can reoccur and NS has been known to commonly reappear 

even after a kidney transplant. Even with a transplant, FSGS can 

dramatically shorten one’s life span. 

Accompanying me at today’s hearing is Michael Levine. Michael’s 

son Matthew is desperately ill with FSGS. Without improvements 


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in treatments brought about by additional research, Matthew’s fate 

is uncertain. It is more than likely that Matthew will require a kidney transplant in the near future. And even then there is no guarantee at all that transplanted kidneys will reverse Matthew’s illness. 

As parents, we are working against the clock to find answers to 

these terrible disorders which seriously debilitate our children, tear 

our families apart, and keep us awake at night. 

Mr. Chairman, because the causes of FSGS and nephrotic syndrome are poorly understood, I am asking you to please significantly increase funding for the National Institutes of Health so 

that treatments can be found for Jenna, Matthew, and other people 

who suffer from FSGS and NS. 

Also, please support the establishment of a collaborative research 

network which would allow scientists to create a patient registry 

and biobank for NS/FSGS and that would allow coordinated studies 

of these deadly diseases for the first time. 

Finally, please urge the National Institute of Diabetes and Digestive and Kidney Disease to fund more grants on FSGS/NS research 

consistent with its recent program announcement entitled Grants 

for Basic Research in Glomerular Disease. 

Mr. Chairman and members of the Subcommittee, on behalf of 

Jenna, Matthew Levine, and the thousands of people suffering from 

NS and FSGS, thank you for this opportunity. We appreciate the 

opportunity to speak before the Subcommittee and for your consideration of our request. 

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Mr. OBEY. Thank you very much. Let me first of all say to Jenna, 

you have been a very good girl, very patient. We appreciate that. 

I want to thank all of you for sharing your stories with us. I 

know it is not an easy thing to do. 

We are happy to have Congressman Burgess here this morning. 

I understand you were busy in another Committee, but we are 

happy to have you here. 

Mr. BURGESS. If I might just—— 

Mr. OBEY. Sure. 

Mr. BURGESS. My relationship with Jenna is—— 

Mr. OBEY. Would you pass the mic down? 

Mr. BURGESS. And I appreciate the indulgence. Six years ago, 

when I was just a regular guy practicing medicine back in Texas, 

I delivered Jenna. She and her mother Dee are up here before you 

this morning to talk about her disease, nephrotic syndrome, which 

struck Jenna about four months ago. I thank the family for being 

here. I thank them for sharing their compelling story with you, and 

I hope the Committee will seriously take their recommendations. 

I will not take any more of your time. Thank you. 

Mr. OBEY. Thank you. 

I appreciate your coming, again, and I just want to put in context 

the request, because NIH, I think every member of this Subcommittee cares deeply about what happens to NIH budget. In fact, 

some of us were out at NIH last Monday for a site visit for most 

of the day. 

Last year, the Administration proposed to cut NIH by $475,000,000. The omnibus appropriation bill that we produced rejected that cut, adding $613,000,000 to the Administration’s budget, but the White House vetoed an additional $771,000,000. 

This year, the President has proposed to freeze the NIH budget, which would in effect mean about a $1,000,000,000 real cut, and 

we have been told by the chief at NIH, Dr. Zerhouni, that it would 

result in the loss of about 6,000 scientists who are presently working on NIH grants. 

So we will do the best we can on this. A lot is going to depend 

on how much funding we are allowed under the budget resolution, 

which is up on the floor today. 

But thank you all. I appreciate your coming and I am sure we 

wish you the very best of luck. 

Mr. Walsh. 

Mr. WALSH. I echo your comments. 

Mr. OBEY. Thank you. 

I have been told that we should expect a roll call between 11:00 

and 11:30. It looks we are going to make it before we get devoured 

by one of those. 

THURSDAY, MARCH 13, 2008. 

NATIONAL INSTITUTES OF HEALTH FISCAL YEAR 2009 

APPROPRIATIONS 

WITNESS 

ROBERT E. PALAZZO, PH.D., PRESIDENT, FEDERATION OF AMERICAN 

SOCIETIES FOR EXPERIMENTAL BIOLOGY, BETHESDA, MD, PROVOST, RENSSELAER POLYTECHNIC INSTITUTE, TROY, NY, DEPARTMENT OF HEALTH AND HUMAN SERVICES 


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Mr. OBEY. Next, the Federation of American Societies for Experimental Biology, Dr. Robert Palazzo. 

Mr. PALAZZO. Mr. Chairman, thank you for the opportunity to 

testify today. 

Mr. OBEY. Sure. 

Mr. PALAZZO. It is an honor to come before you representing the 

21 societies, more than 80,000 biomedical researchers of the Federation of American Societies for Experimental Biology. My name 

is Robert Palazzo. I am a Professor of Biology and the Provost of 

Rensselaer Polytechnic Institute, the oldest science and technology 

institute in the United States. 

In the interest of time, I would like to give a brief summary of 

the longer comments that have been submitted for the record. 

Although the members of this Committee are well aware, I think 

it bears repeating that the National Institutes of Health is the 

world’s premier sponsor of medical research and is the Federal 

agency responsible for conducting and supporting the basic and 

clinical science that drives the development of treatments and 

cures for diseases and injury. 

NIH funds more than 325,000 scientists at more than 3100 universities and institutions in every State across this Country. The 

researchers receiving NIH funds are united by a compelling desire 

to investigate the underlying biology of human disease and use this 

knowledge to improve our health and save lives. 

Chairman Obey, you have asked on a number of occasions, 

‘‘What have we lost by not adequately or fully funding programs 

like the medical research done at the NIH?’’ I think this is an important question, because it allows us to illustrate the sense of urgency felt by those of us who understand the critical mission of the 

NIH: emerging diseases and new health threats dominate our 

headlines, from drug-resistant staph infections to avian influenza 

and autism, all the while our aging population, under increasing 

pressure to meeting the challenges of Alzheimer’s Disease, 

osteoporosis, macular degeneration, and many others. 

During the next 25 years, the number of Americans with chronic 

diseases is projected to reach 46 million. That is roughly one in five 

Americans. Yet, just as the need to prevent diseases becomes greater and the opportunities to succeed become more numerous, I fear 

that our commitment to medical research may be dwindling. 

Never before has science been more poised to advance the discoveries that will improve our health. Yet, never before have we been 

more in danger of squandering our scientific talent and delaying 

critical breakthroughs. Flat-funding of NIH, combined with the effects of inflation, has eroded the purchasing power of the agency 

by more than 10 percent. With every excellent idea left unfunded, 

we stand to miss or delay critical discoveries that could lead to 

therapies for our most debilitating health conditions. 

The NIH funding situation threatens to affect an entire generation of young scientists. Young scientists watch their mentors 

struggle to maintain grant funding from the NIH and question 

whether they should invest in such a risky, albeit noble, career. 

Many of our best and brightest scientists are seeking more promising opportunities outside of the lab or in other nations like China 


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or Singapore. All these nations are increasing their investment in 

biomedical research even as we are pulling back. 

Importantly, Mr. Chairman, applications for R01 grants from 

previously unfunded scientists seeking their first grant showed an 

appreciable drop in 2007, declining by nearly 600 applications from 

the 2006 level. This is a 6 percent to 7 percent drop in those junior 

people seeking their first NIH grant. This represents the loss of 

hundreds of scientists and all of the talent and intellectual capital 

that they bring to the system. We have moved past the point where 

scientists are spending more time filling out applications doing research, and now we are at the point where many may be giving up. 

Congressmen, in closing, I would like to say that, without research, there is no hope. It was not long ago that a pronouncement 

of heart disease, AIDS, or breast cancer sounded a death knell. 

These are now treatable conditions and patients go on living long, 

happy lives years after the diagnosis. Infectious diseases that 

haunted our parents and grandparents—polio, measles, rubella, 

whooping cough—have been conquered by vaccines. Premature infants now survive to bring parents years of joy, rather than drawing their last desperate breath in the hospital. 

We can help Jenna. We can conquer FSGS and many other diseases. The foundation for these cures lies in the NIH; lies in the 

support that this Congress has shown for this agency in the last 

50 years. That hope is a direct result of your wisdom and the support of this House. 

With that, I will simply close. I would be happy to take any questions. 

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Mr. OBEY. Well, thank you very much. We appreciate your time, 

and I certainly agree with the points that you made. 

We just made it. So let me thank everybody for their patience. 

We will reconvene at 2:00 this afternoon for another round. Thank 

you. 

AFTERNOON SESSION

THURSDAY, MARCH 13, 2008. 

TESTIMONY OF INTERESTED INDIVIDUALS AND 

ORGANIZATIONS 

Mr. OBEY. Well, thank you, everyone for coming. This is the second panel of public witnesses that we have heard from today. In 

the first hearing, we were very lucky. We were halfway through 

the testimony of the last witness when the bells rang for a vote. 

We are not going to be so lucky this time. We are supposed to have 

a vote in about 15 minutes, and we may have more than one. 

But before I ask the witnesses to proceed, let me simply try to 

make a couple points and set the context. 

First of all, as I said in the first hearing, please do not take silence on this side of the table as an indication of disinterest. We 

are going to be very squeezed to get all these witnesses in, in between roll calls, and so we have had plenty of time to talk through 

the first part of this year. We are going to largely listen to you. I 

may make a comment from time to time to put in context what 

each of the witnesses is saying, but outside of that we will try to 

restrain ourselves. 

Secondly, I want people to understand what the position of this 

Subcommittee is. We do not have authority to put together any bill 

that we want. We have to live within the limits that are assigned 

to us by the budget resolution which is on the floor today. 

To put that in context, last year, the President succeeded, in his 

view, in holding the line against our bills which means that we 

wound up putting into law, appropriation bills which were approximately $22,000,000,000 below those that the Committee reported 

out initially. The President vetoed the flagship domestic bill which 

is this Labor-Health-Education Bill, and that resulted in substantially less funding for this bill. 

This year, the President is proposing a budget which, when you 

take into account the various offsets that we used last year that 

would not be available to us this year, what it means is that the 

President is, in essence, cutting the bills that he signed last year 

in terms of the accounts that we provided last year by roughly 

$26,000,000,000. 

The budget resolution today would allow us to restore most of 

those cuts, to fill most of those holes, but the White House is making quite clear that they will not sign bills at that enhanced level. 

So that is the context in which we have to make decisions, and 

that is the context in which you are testifying today. I do not especially like it, but I have a habit of facing reality. 


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So, with that, let me simply turn to Mr. Walsh for whatever comments he might make before we introduce the witnesses. 

Mr. WALSH. Thank you, Mr. Chairman, and thank you for bringing in all these expert witnesses from all around the Country. 

This is a very important part of the process because the decisions 

that we make do affect things. This bill especially has historically 

been referred to as the People’s Bill because there are more things 

that affect people and our quality of life in this bill than any other 

than the Congress works on. 

All of you are here because you appreciate the fact that democracy is not just a spectator sport. You have to roll up your sleeves 

and put on your sneaks or wingtips, whichever, and come down 

and fight for what you believe in. So we appreciate your coming 

here today. 

I agree with the Chairman. I am glad that the Congress has the 

power of the purse. I think we should fight for that power. The 

Constitution gave it to us. It does not belong at the White House. 

It belongs here. I believe that we are closer to the people. 

So we will listen to your priorities. We may not be able to meet 

them, but we will listen to them, and we will give you our best effort to create a bill that meets the needs of the Country. 

Mr. Chairman, with that, I yield back. 

Mr. OBEY. All right. I understand you want to introduce our first 

witness. 

Mr. WALSH. If you will, yes. Thank you, Mr. Chairman. 

It is my great pleasure to introduce Dr. Michael Miller from the 

State University of New York, Upstate Medical University in my 

hometown of Syracuse, New York. It is a marvelous hospital. It is 

also a teaching hospital and soon to have a children’s hospital attached, which we are very excited about. 

Dr. Miller is a Professor and Chair of the Neuroscience and 

Physiology Department. 

Dr. Miller, thank you very much for coming today. We welcome 

your testimony. 

THURSDAY, MARCH 13, 2008. 

SUNY UPSTATE MEDICAL CENTER 

WITNESS 

DR. MICHAEL W. MILLER 

Dr. MILLER. Well, good afternoon, and it is indeed an honor to 

speak to all of you. I would like to express a special appreciation 

to Mr. Walsh for his decades of service to Upstate New York and 

to our Country and for his inviting me to speak today. 

I speak on behalf of my institution, biomedical researchers across 

the Country and for what I believe is the health and well being of 

citizens of the United States. 

Seventy-eight years ago, Congress established the National Institutes of Health. It was a bold experiment, and I think we can all 

agree that it was a successful and continues to be a successful experiment. 


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NIH continues to have a number of successes. It discovers new 

knowledge and treatments that improve the health and save lives. 

It helps drive down the costs of healthcare, and it is an engine for 

economic growth. 

It returns approximately $7 on the investment dollar, and it is 

one of the few areas that I think we can argue where we have a 

leadership role in the world. 

Support for NIH has national impact. It is not just an entity that 

supports just medical schools. The extramural programs support 

the 150, roughly, allopathic and osteopathic medical schools, but it 

is not restricted to these institutions. 

It is also supporting activities that are going on at small schools 

like Hamilton College, Clarkson College and small places Upstate 

New York as well as larger institutions such as Binghamton University. These are places outside of districts that are covered in the 

areas where there are just the medical schools. 

All citizens benefit from NIH research, supported research: Improved life expectancy, work efficiency and quality of life of the citizens of the United States. 

About 10 years ago, Congress took a bold step and decided to 

double the NIH budget. This was a wonderful opportunity, and it 

was in response to a lot of successful arguments that people had 

made, saying that we would be able to have cures within five years 

for neurodegenerative disease, cancer, diabetes, virtually any disease of your choice. 

In essence, we told you what you wanted to hear. It may have 

been done innocently. People genuinely believe that because of the 

molecular biology revolution, that things were going to be going 

much faster. 

But I think that it was naive on the part of scientists and on 

Congress’ part, and the claims were foolhardy and shortsighted. We 

could not deliver within five years. 

It takes a considerable amount of time for drug development to 

occur. Just if you have a drug and you want to develop, it takes 

five to seven years just for that process alone, not to mention the 

time it takes to prepare with the basic science research that 

underlays that drug development. So really, from beginning to end, 

from concept to care delivery, it takes about 20 years. 

It could not be done within five years, and I think that it was 

not a good situation. Basically, Rome was not built in a day and 

what we need to do is to take a longer term view of things, and 

that is what I have come here to try and encourage Congress to 

take that view. 

I just want to give an example of some of the activities that I 

am involved with. I am the head of a new center on developmental 

exposure to alcohol research, and what that is involved with is the 

effects of alcohol on the fetus and on adolescents. 

I think that we can all agree that is a major clinical issue. In 

fact, alcohol costs the economy a quarter of a trillion dollars a year 

in all of its ramifications. 

Fetal Alcohol Spectrum Disorder affects 2 percent of all children 

that are born. Adolescent exposure to alcohol, three-quarters of the 

adolescent population has reported taking alcohol as an adolescent. 


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The cost of just that is $58,000,000,000 to the economy. It is not 

a small activity. 

The problem has been known since the 1970s, Fetal Alcohol 

Spectrum Disorder, but yet it has taken us 30 years to get to a 

point where we now have biomarkers to be able to understand the 

process and are now starting to develop approaches to be able to 

deal with ameliorating the problems. It takes a long time for this 

to happen. 

So what I am asking Congress to do are three things: Provide 

global support for biomedical research; to support dependable, reliable growth of the research enterprise; to return to the central precept that the original charter of the NIH delegation, the original 

charter which is to delegate and to trust NIH to be able to operate. 

Congress should appropriate the funds for NIH and then to let the 

people at NIH figure out the best way to use those funds. 

At the risk of suggesting that the research enterprise is the 

enemy, I would also argue that Congress should trust but verify. 

It should just not hand out the money willy-nilly. They also have 

to take responsibility for making sure that it is spent properly. So 

I think it is a handshaking operation, and we need both sides. 

As a final comment, I would just like to say that the expectations 

of immediate returns from investment was not well taken on either 

part of the equation, us as scientists or on Congress’ side. What we 

need for the best benefit of everybody is a consistent long-term 

commitment to biomedical research. 

I thank you for your time. 

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Mr. OBEY. Thank you for your time. 

Let me simply point out that the President’s fiscal year 2008 

budget proposed a $479,000,000 reduction to NIH compared to the 

appropriation level we provided in the fiscal year 2007 joint resolution. 

The bill the President vetoed provided for an $899,000,000 increase. The final omnibus bill still provided $133,000,000 over fiscal year 2007 which was $613,000,000 over the President’s request. 

The President’s fiscal year 2009 budget request fails to provide 

any increase at all for NIH, freezing the NIH budget at 

$29,200,000,000 which, as I indicated this morning, Dr. Zerhouni 

has told us will cost us the services of 6,000 scientists in the coming year. 

Thank you for coming. 

Dr. MILLER. Thank you. 

Mr. OBEY. Next, Mr. Terry Peel. 

THURSDAY, MARCH 13, 2008. 

BOSTON UNIVERSITY AMYLOID TREATMENT AND 

RESEARCH PROGRAM 

WITNESS 

TERRY R. PEEL 

Mr. PEEL. Some friends have joined me. Is that okay? 

Mr. OBEY. Well, I do not mind the two people on the ends, but 

I am concerned about the fellow in the middle. [Laughter.] 

Mr. PEEL. I understand this is your last hearing of the year and, 

recalling my prior service up here, this is a great day for the members but even a better day for the staff. 

Mr. Chairman, I appreciate the opportunity to appear today to 

talk to you about the rare disease and the troubling disease of amyloidosis. Appearing with me today is my wife, Ann, who has successfully undergone treatment for this disease. 

This Committee, the House Labor HHS Committee, starting with 

Mr. Regula as Chairman and now continuing with you, Mr. Obey 

as Chairman, has taken steps that have significantly changed the 

knowledge of this disease among the American public and also at 

NIH. We are asking you today to continue your efforts in providing 

report language that encourages NIH and the Centers for Disease 

Control to recognize this disease and work on the treatment, the 

care and prevention. 

Until Ann was diagnosed with this disease, we had never heard 

of amyloidosis, and that is true of most of the American public. In 

fact, most people die of amyloidosis before they even know that 

they have it, and others are diagnosed too late to have the treatment. 

The only treatment right now for amyloidosis is stem cell transplant and high dose chemotherapy. So, once you are diagnosed with 

this disease, you go through the risk of this type of procedure. Left 

untreated, the life expectancy for amyloidosis patients is 15 

months. 


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Ann has successfully obtained treatment for amyloidosis, and she 

has moved through a life and death struggle. We are now devoting 

our time to use this experience to help others. 

Dr. David Seldin is with us today. He is the Director of the Boston University Amyloid Treatment and Research Program, and it 

was Dr. Seldin and his team of professionals that actually saved 

Ann’s life. 

Now what is amyloidosis? Amyloidosis is a protein-folding disease in which proteins fold and clog up the organs in the simple 

explanation. They will clog up the heart, the kidney, the liver to 

a point where death occurs. 

The treatment, as I have said, there is no cure for it, but the 

treatment is high dose chemotherapy and stem cell transplant 

where the patient’s own stem cells are harvested in order to recover from the high dose of chemotherapy which brings you down 

to near death. 

What needs to be done about this disease? Only through more research is there hope of further increasing the survival rate and 

finding treatments to help more patients. Timely diagnosis is also 

of great concern to us, and early treatment is the key to success. 

Without a very sharp doctor here in Washington, identifying this 

disease, I am not sure Ann would be sitting here today. 

Through the leadership of this Committee, there has been increased basic and clinical research on amyloidosis. There has been 

increased funding for equipment and research, and the National 

Institutes of Health have now increased their involvement and interest in amyloidosis and identified it as a rare disease. 

What we are asking for you to do, Mr. Chairman, in the next 

steps is to continue the language that you have had in the report 

over the last several years, to continue to encourage the Centers 

for Disease Control and NIH to educate the American public and 

physicians, to provide funding in 2009 for research equipment and, 

finally, to assure that NIH is following through on the recommendations of the Committee. 

Treatment has proven very effective for Ann. We want to turn 

what has been a life-threatening experience for her into hope for 

others. 

Could Ann just say a couple words? 

Ms. PEEL. When you have your health, you have everything 

which is one of the most important things I learned during my experience. What began as a devastating diagnosis ended in treatment, resulting in my remission. 

One of my goals is to allow more people, early diagnosis and 

treatment, so they can lead healthy lives. The actions taken by this 

Committee are helping to do just that. 

Thank you. 

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Mr. OBEY. Well, thank you. 

Let me just ask the doctor one quick question. What percentage 

of physicians throughout the Country, do you think, are sufficiently 

aware of the disease and aware of the manifestations that would 

enable them to make a diagnosis? 

Dr. SELDIN. I think most physicians are aware, Mr. Chairman. 

I think the internet has made a great difference for patients with 

rare disease and their ability to seek out centers for treatment, but 

it is only through the support of the Congress and funding of National Institutes of Health research that we can continue to make 

advances. 

I think there are thousands of people alive today with this and 

other rare diseases because of what you have allowed NIH and the 

biomedical research community to do, millions of people living with 

cancer today, who would not be here without that support, and I 

hope you can continue the momentum to improve things for the 

American people in the future. 

Thank you. 

Mr. OBEY. Thank you. 

Next, PKD Foundation, Michael Haggard. 

THURSDAY, MARCH 13, 2008. 

PKD FOUNDATION 

WITNESS 

MICHAEL HAGGARD, BOARD MEMBER, POLYCYSTIC KIDNEY FOUNDATION 

Mr. HAGGARD. Thank you. Good afternoon, Mr. Chairman and 

members of the Subcommittee. 

My name is Michael Haggard, and I am on the Board of Trustees 

of the Polycystic Kidney Foundation. I am also a patient with polycystic kidney disease. 

The disease has run through my family as it does all who have 

PKD for generations. My maternal grandmother died when my 

mother was in college. I never met her. 

My uncle was diagnosed and became a nephrologist to find a cure 

for the disease. He died after receiving a kidney transplant from 

my grandfather, and my mother died of polycystic kidney disease 

three years ago this week. 

I am not here for myself. It is too late for me. I am here for 

Madison and Carson who are my two children, who have a 50 percent chance of receiving the gene from me and being diagnosed 

with PKD. I am here for all the children who cannot control the 

genes that their parents pass on to them. 

Polycystic kidney disease affects 600,000 Americans, 12.5 million 

people across the globe, and it is one of the world’s most prevalent 

life-threatening genetic diseases. Put another way, there are 1,400 

PKD patients in each one of your congressional districts. 

The majority of PKD patients will experience kidney failure, 

making dialysis or a kidney transplant the only way that they can 

survive. 

PKD is the number one genetic cause of kidney failure and costs 

the Federal Government $2,000,000,000 annually in the Medicare 


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budget. As Congress knows, end-stage renal disease is the number 

one increasing item in Medicare. 

I want to thank this Committee, as previous folks have testified, 

for your commitment to research, to the NIH because you have had 

a dramatic impact. Two years ago, the PKD Foundation testified 

before this Committee, and that was before we had 15 clinical 

trials ongoing right now. This gene was only discovered, the gene 

that causes PKD, 13 years ago. Right now, currently we have 17 

clinical trials going on. 

The PKD Foundation, which works with the NIH, has developed 

public and private partnerships to develop the research for this disease. Congress has responded. This Committee has responded with 

ever more progressive appropriations report language for PKD for 

18 consecutive years. 

Research in the PKD field is now at the point where we hope this 

Committee will include the proposed fiscal year 2009 report language which calls for the establishment of PKD centers and diagnostic treatment centers. We believe that these centers are really 

the next step in the progression of PKD research. 

They would increase the new diagnostic methods to treat PKD, 

the application of new therapeutic regimens, conduct pilot studies 

and these clinical trials, and coordinate all that data with the public and private partnerships, and streamline the appropriate clinical applications of effective treatments. 

We are pleased to report that Dr. Starr, who gave a speech to 

us last week at our awareness center, said PKD research is one of 

the most prevalent and most exciting research going on at the 

NIDDK and they have approved our report language. 

My time before you obviously is limited and there is an incredible 

group of folks to testify after me and before me. So we have submitted the written testimony. 

We realize that it is important for Congress, especially in light 

of everything that the Chairman has talked about with the freeze 

in funding, to see a return on investment. When you look at the 

return on investment in just a short time for PKD research, it is 

really one of those diseases that we are on the cusp of making a 

difference in. It is vitally important that this investment go on and 

we do not lose the scientific momentum that we have achieved. 

I do not want to leave behind the legacy for my family and generations to become this disease. The blessing and the cursing of 

this disease come in the genetic form, in the gene. Every night 

when I put my two kids to bed, one of the thoughts I always have 

is: Did I pass this disease on to them? 

The blessing of this disease is the genes because the scientists, 

because it is genetic, because of their discoveries, feel that they can 

make the advances and put it into clinical trials, which they have 

done, and get to the point where they can slow the progression of 

this disease. 

Thank you so much for all your efforts in the past, and I thank 

you for my time today. If you have any questions, I will be happy 

to answer them. 

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Mr. OBEY. Thank you very much. I appreciate your time. 

Mr. HAGGARD. Thank you, Mr. Chairman. 

Mr. OBEY. Let me say to Committee members, any time you 

want to ask a question, I am going to keep moving through witnesses unless somebody pulls my chain and lets me know they 

want to ask a question. 

All right. I understand that the gentlewoman from California 

would like to introduce the next witness. 

Ms. ROYBAL-ALLARD. Yes. Thank you, Mr. Chairman. 

Mr. Chairman, I would like to introduce Dr. Randy Pausch who 

will be testifying about the critical importance about funding pancreatic cancer research. Dr. Pausch is an award-winning teacher, 

researcher and computer scientist at Carnegie Mellon University. 

He is, more importantly, a husband, a father of three young children and a courageous and outspoken individual who is living with 

pancreatic cancer. In what time he has left, Dr. Pausch is trying 

to make a meaningful contribution to pancreatic cancer science. 

Just a couple of days ago, Dr. Pausch was discharged from the 

hospital, and I also understand on his way over here he was in an 

automobile accident. So it has taken him a great deal of strength 

and determination to be here to share his message with us today. 

So, thank you, Randy, for your courage and your unselfish giving 

of your precious time to share your story before this Subcommittee 

in hopes of saving the lives of others. 

THURSDAY, MARCH 13, 2008. 

PANCREATIC CANCER ACTION NETWORK 

WITNESS 

DR. RANDY PAUSCH 

Dr. PAUSCH. Thank you. 

I am here on behalf of the Pancreatic Cancer Action Network. 

Pancreatic cancer is a terrible, terrible disease. I became sort of 

an accidental celebrity because after I was diagnosed, and I want 

to be very clear, I am a terminal cancer patient. I am not even supposed to be alive today. 

In August, I was given three to six months. I have had a very 

fortunate response to the palliative chemo, but this is not going to 

last too much longer. 

As you said, I was in the hospital last Monday. I was diagnosed 

with congestive heart failure and renal failure. I said to the doctors, can I get healthy enough to go to D.C. on Thursday? 

We do not have advocates for this disease because they do not 

live long enough. We do not have a Michael J. Fox because people 

die too fast. Pancreatic cancer is absolutely ruthless. 

I became an accidental celebrity because I gave a lecture at Carnegie Mellon after I was diagnosed, as an academic tradition of the 

last lecture. Hypothetically, if you were going to die, what would 

you tell your students? I got to do it for real. 

I gave a lecture for my children, but I gave it in an academic setting. It got loose on YouTube and damned if six million people have 

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But I want you to understand that pancreatic cancer is one of 

those unusual diseases. The statistics are pretty clear. If you get 

it, you are dead within a year with a 75 percent chance. When you 

talk about survival, 4 percent of people make it to 5 years. 

When I presented first with symptoms, we thought I had hepatitis. When we got the diagnosis, my wife said, gee, I guess you 

would trade for hepatitis. 

I said, honey, I would trade for AIDS in a heartbeat, in a flash. 

I would love to trade for AIDS. 

This Subcommittee is pretty familiar with AIDS. You were some 

of the first funding that was provided. I do not think we have beaten AIDS, but I think we have made huge progress against the disease that many people thought would be impossible. 

Pancreatic cancer right now is the fourth leading killer amongst 

cancers. More interestingly, it is one of the only cancers you can 

point to and say, in the last 30 years, we have made no progress. 

That is terrible. 

There are so many cancers where you can see, particularly with 

childhood cancers, where the 4 percent survival became 90 percent 

survival. It makes me feel really good to be an American to see the 

researchers let loose and win like that. 

With pancreatic cancer, I learned a new word, nihilistic. It 

means given up, too hard. I do not believe in too hard. 

I believe that by funding pancreatic cancer research, we will be 

going after the hardest problem, and I am a trained researcher. I 

know that if you go after the hardest problem, you cannot go for 

the halfway solutions. 

I mean not that I am not a fan of chemotherapy and radiation, 

they have kept me alive, but the real answers are going to be in 

genetics and things like pancreatic cancer force you into those 

kinds of solutions because the halfway measures just are not good 

enough against that strong of a disease. 

This is a disease you cannot protect yourself against. I never 

smoked. I never drank. I exercised every day. I tried to eat right. 

It just comes like a thunderbolt out of the blue. 

Part of my job is to put a face on the disease. At the risk of being 

a little bit overly dramatic, I want to show you a picture. This is 

my family. 

This is Dylan. He is six years old. He loves dinosaurs. 

This is Logan. He is four. He is Super Logan. He has a cape. He 

runs around the house, saving everyone. 

This is Chloe. In May, she turns two. 

And, this is my widow. That is not a grammatical construction 

you get to use every day, but it is not many diseases where you 

know it will be fatal. 

I have metastasized to the liver and spleen which means that I 

have 100 percent chance of dying, and there is not anybody in the 

medical community who will not bet that I will not be dead by the 

end of the year. 

This woman is going to raise these three children by herself, very 

bravely, because I will not be there to help her. 

All I can ask today is that everyone keep in their minds that 

pancreatic cancer is a disease that I think we can beat, but it is 

going to take more continued courage and funding from our governVerDate Aug 31 2005 01:49 Sep 13, 2008 Jkt 043329 PO 00000 Frm 00155 Fmt 6633 Sfmt 6602 E:\HR\OC\A329P2.XXX A329P2

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ment to help protect us from the things that we cannot protect ourselves from. 

Thank you. 

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Mr. OBEY. Thank you very much for sharing your story. If I may 

simply say, I am somewhat familiar with the problem because my 

brother-in-law died of pancreatic cancer. 

Dr. PAUSCH. Sorry to hear that. 

Mr. OBEY. He worked for the Department of Transportation in 

State Government in Wisconsin, and he decided to take early retirement so he could spend full-time working for Tin Can Sailors, 

an organization that he helped set up after the Vietnam War. 

Before he retired, he took one last physical. Expecting no problems, he was shocked and his doctor simply said, I have a bad surprise for you. He spent the next two years, struggling before he 

was finally overcome by the disease. 

So I know how hard it is, and I think virtually everybody on this 

panel knows someone who has been in a similar situation. I simply 

want to assure you that we will do everything we possibly can to 

try to shape a bill that recognizes that it is more important to put 

funding into medical research than it is to put $51,000,000,000 in 

the pockets of millionaires in the form of a tax cut this year. 

I would simply point out again, to put this in context, between 

2007 and 2006, the number of NIH new and competing grants 

dropped by 891 grants. In 2007, this Committee added 1,194 grants 

to the NIH budget, but that change is being eroded this year by 

the loss of some 6,000 scientists that will occur if we pass the 

President’s budget. 

So I want to assure you we will do everything we can to try to 

change that picture. I admire your courage, and we all wish you 

very well. 

Anyone else have any other comment? 

Mr. Honda. 

Mr. HONDA. You are advocating more research and more study 

among the scientific community and the physicians. Where does 

one start? 

Reading the information here, there does not seem to be a starting point. Is there a starting point? 

Are there areas of research that should be looked at but are not 

being looked at, using computer science and the genome? Where do 

you start? 

Dr. PAUSCH. I think you put your finger on it. The human genome is the wildcard. Every researcher I have talked to has said 

that is an asset that we did not have even a couple of years ago. 

The thing that I find most tragic is when I talk to the young. I 

am a researcher myself, and I am trying to become the most informed pancreatic cancer patient in the world. I go and talk to the 

researchers, researcher to researcher. 

I will tell you it pretty much stinks when I meet a hotshot researcher, and I know I can just ask the question, which parent? We 

would not have gotten very far with breast cancer research if we 

had only limited it to people who went into it because they lost 

their mother. 

People right now who are young researchers are not heading toward pancreatic cancer research because it is wildly underfunded 

and it has always been underfunded. 

I think part of the trick is to seed the junior hotshots with the 

kind of grants that are provided for young researchers. I think this 


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is going to be cracked by somebody younger, somebody who comes 

at it with a genomic approach. There are a lot of good vaccinebased approaches that are quite exciting. 

But I think it is going to have to be a breakthrough. I do not 

think it is going to be another chemotherapy or radiation tweak. 

I firmly believe that there are plenty of bright people out there that 

want to attack it. What they need is they need the strong sense 

that the funding is there because I have been a junior researcher 

and I have looked over in computer science, what shall I work on, 

and I know that the smart people work on what there is money to 

work on because they are pretty ruthless in their careers and they 

should be. 

So I do not think it is at all the same game it was even 10 or 

15 years ago. I think that we have already made some strides in 

figuring out some of the genetic precursors, and there is no doubt 

there is a genetic component to this. As the previous speaker said, 

do not think I do not go to sleep every night without worrying 

about are these kids going to get my genes. 

People say, are you worried? 

I say, well, the good news is pancreatic cancer does not normally 

strike until later. If the money is there, I would bet everything that 

by the time my kids are my age, we will have it licked. If the 

money is not there, then I would not be very confident at all. 

I do not know if that answered your question or not. 

Mr. OBEY. Let me interrupt to simply say we have six minutes 

left to make the vote. So I think we are going to have to leave. 

Thank you again for your testimony. 

Dr. PAUSCH. Thank you. 

Mr. OBEY. We will have a 15 minute vote on the floor, and then 

after that we are told another 15 minute quorum call. So I hope 

we can be back here in about 20 minutes. 

[Recess.] 

THURSDAY, MARCH 13, 2008. 

HEPATITIS B FOUNDATION 

WITNESS 

DR. TIMOTHY M. BLOCK, PRESIDENT, HEPATITIS B FOUNDATION 

Mr. OBEY. Let’s see where we were. 

Mr. Block. 

Mr. BLOCK. Mr. Chairman and Committee members, I am accompanied by my wife, Joan, who is a nurse. 

Mr. OBEY. Good first name. 

Mr. BLOCK. We are off to a good start. 

Mr. Chairman, thank you and the Committee for the opportunity 

to speak today about the problem of hepatitis B. 

May I also note that Congressman Honda has been particularly 

sympathetic to the problem, and I hope after my testimony, others 

on the Committee, if not already, will also be convinced. 

My name is Dr. Timothy Block, and I am the volunteer President 

of the Hepatitis B Foundation which my wife, Joan, and I and another couple from Pennsylvania founded more than 18 years ago 


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because someone very close to us was affected. I am also a professor at Drexel University College of Medicine. 

The hepatitis B virus is the world’s major cause of liver cancer 

and, while other cancers are declining in rate in the United States, 

liver cancer is the fastest growing in incidence. If you can stop hepatitis B, you can stop most liver cancer. 

The numbers of people who are chronically infected with hepatitis B will knock your socks off. In the world, there are more than 

400 million people who are chronically infected, and most of these 

people were infected at birth from their mothers and they are unaware of their infection. 

Without intervention, as many as 100 million to 140 million of 

these individuals will die from an awful liver disease, most notably 

liver cancer, but pancreatic cancer has also increased in those with 

hepatitis B. 

In the United States, there are perhaps two million Americans 

who are chronically infected. Asians and African Americans are 

disproportionately affected. 

Every time I speak to a group this size, it turns out that someone 

in the room has been affected or knows someone who has but the 

news, of course, is not all grim, thanks to the work that has been 

done largely by the CDC and the National Institutes of Health. 

There is a vaccine to prevent infection. 

But for those people who are already infected, the vaccine is too 

late. They are not helped by that. Of course, there are now medications to control the disease, but for half the people who have hepatitis B, those medications do not work. 

One more thing, not everybody who is infected becomes sick. So 

if you know you have hepatitis B, that is still not enough. You do 

not know if you are going to get sick or not. The disease takes decades to declare itself. It is like having a time bomb inside you. 

This is probably because most cases of cirrhosis and liver cancer, 

which is caused by hepatitis B, are diagnosed late. The current 

methods to treat liver cancer are in the dark ages. In fact, there 

really are not any, and early diagnosis is also primitive. 

So we are just getting close to some solutions, but the decline in 

public health measures and scientific research that is happening 

today is threatening to allow these problems to come roaring back. 

May I give you just a few examples of what I am talking about? 

There was a recent crisis in a Nevada clinic where as many as 

40,000 people were placed at risk for infection with hepatitis B and 

other blood pathogens. This is a problem the Centers for Disease 

Control thinks might just be the tip of the iceberg. 

The frightening increase in liver cancer is another example of a 

threat. In the United States, there were 20,000 babies born to 

mothers with hepatitis B last year alone, and 1,200 of them will 

develop chronic hepatitis, this while there is an effective vaccine. 

So may I now call your attention to requests regarding the two 

Federal agencies that are most critical in our opinions to control 

hepatitis B. 

We strongly support Senator Reid’s request for supplemental 

funding dedicated to the Centers for Disease Control. We believe 

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est need for this increase. DVH has had flat funding for the past 

5 years, and we request a supplement of $7,000,000. 

In 2009, we ask that the CDC budget be restored to $7,400,000,000 with $50,000,000 dedicated to the Division of Viral 

Hepatitis. If this is too big an ask, we ask that at least $5,000,000 

be increased in the DVH budget which is really the minimum. 

Finally, the National Institutes of Health, we request a 6.7 per- cent increase in the fiscal year 2009 budget with $40,000,000 dedicated in addition for hepatitis B research. Right now, there is only 

$40,000,000 spent on hepatitis B compared to billions for HIV, 

which is so important, I know, and billions for biodefense. Forty 

million dollars for hepatitis B in addition will be transformational. 

In summary, may I just leave you with the words of Dr. Jay 

Hoofnagle of the NIH who said, we have this disease cornered. He 

said, at a recent meeting, we ask you that you not let it get away. 

I was just reading, before you guys came in, the quotes behind 

you by Dwight D. Eisenhower and Hubert Humphrey. I could have 

read those as my closing statement if I had enough time, but I 

thank you very much for the opportunity to speak. 

Thank you. 

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Mr. OBEY. Thank you very much. I appreciate your time. 

THURSDAY, MARCH 13, 2008. 

UNITED STATES PSYCHIATRIC REHABILITATION 

ASSOCIATION 

WITNESS 

MARCIE GRANAHAM, CHIEF EXECUTIVE OFFICER, UNITED STATES 

PSYCHIATRIC REHABILITATION ASSOCIATION; ACCOMPANIED BY 

PETER ASHENDEN 

Mr. OBEY. Next, U.S. Psychiatric Rehabilitation Association, 

Marcie Granaham. 

Ms. GRANAHAM. Good afternoon, Mr. Chairman, members of the 

Committee. I am very pleased to be here today. 

My name is Marcie Granaham. I am the Chief Executive Officer 

for the United States Psychiatric Rehabilitation Association, and I 

thank you for allowing me to speak today. 

USPRA’s mission is to improve the quality of psychiatric rehabilitation services, to educate the mental health workforce and to 

facilitate the community readjustment of people with psychiatric 

disabilities. 

USPRA and its members, the constituencies they serve are very 

pleased that the President’s 2009 budget will continue to fund programs that are critical to the mental health delivery system infrastructure, including those identified by both President Bush’s New 

Freedom Commission on Mental Health and the Institute of Medicine. 

However, our membership is extremely concerned with the overall proposed decrease in SAMHSA funding, specifically the proposed cuts to programs of regional and national significance. 

USPRA believes that as a Federal Agency, SAMHSA is uniquely 

positioned to advance the transformation of our Nation’s mental 

health system. SAMHSA and CMHS have been at the forefront of 

change from the funding that SAMHSA provides for progressive 

State programs to its investment in identifying evidence-based 

practices to its anticipation of future mental health workforce 

needs. 

For the past 27 years, recovery from mental illness has been a 

priority of SAMHSA and the National Institute on Disability and 

Rehabilitation Research that is within the U.S. Department of 

Education. 

To address this priority, NIDRR and SAMHSA established a decade-long interagency cooperative agreement to co-fund four centers 

called Rehabilitation Research and Training Centers whose mission 

is to conduct evaluations of services and systems and provide training and technical assistance to service providers and administrators. Two of those centers are mandated to focus on adult mental 

health illnesses, and the other two are on children’s services. 

These centers are internationally known for their substantive 

work in the area of mental illness and for their contributions to 

mental health policies, programs and systems. They have provided 

consultation to the White House, to members of Congress and to 

the Government Accountability Office. 


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Although USPRA does not personally receive CMHS funding 

under the programs of regional and national significance, I can attest to the value and the benefits that these programs provide. The 

Rehabilitation Research and Training Centers, also known as 

RRTCs, have been instrumental in conducting rigorous evaluations 

and studies designed to expand evidence-based practices as well as 

to identify newly emerging best practices. 

The RRTCs are charged with conducting the necessary scientific 

inquiry to ensure that the government spends taxpayer dollars on 

services that are both effective and cost-efficient. Without 

SAMHSA’s cofunding with NIDRR, these programs will end. 

Another important group of programs that are funded with 

SAMHSA under the programs of national significance are the consumer and consumer-supported technical assistance centers. These 

are charged with advancing the recommendations of the New Freedom Commission and the IOM for self-directed care, recovery and 

consumer and family-centered services. 

There are a total of five technical assistance centers that bring 

recovery-oriented illness self-management tools, such as the 

Wellness Recovery Action Planning or WRAP, into the mainstream. 

This is critically important because the survey of State mental 

health authorities conducted by the National Association of State 

Mental Health Program Directors found that in fiscal year 2002 to 

2003 the States spent less than 1 percent of their public mental 

health budgets on self-directed consumer-centered recovery-oriented services. In fact, a quarter of all States spend less than 

$200,000 a year on such services. 

At this time, I would like to introduce to the Committee, Mr. 

Peter Ashenden, who is the Executive Vice President of the Depression and Bipolar Support Alliance and an officer of USPRA. Mr. 

Ashenden also happens to be a person in mental health recovery. 

Mr. ASHENDEN. Good afternoon. Thank you very much for allowing me this opportunity to tell you my personal story. 

I was diagnosed with mental health issues almost 25 years ago. 

I know what it is like to isolate. I know what it is like to be paralyzed with major depression and clinical depression. I know what 

it is like to have no hope, no connections and no future. 

I have been there. I have done that. 

Many traditional treatments did not work for me. However, as a 

result of the development of psychiatric rehabilitation, I can sit before you today. 

I am the Executive Vice President of Depression and Bipolar 

Support Alliance, a national organization that has over 1,000 support groups, 450 chapters throughout the Country that are helping 

millions of people each and every year. 

Today, I am no longer a drain on the taxpayers. Today, I am a 

taxpaying citizen which has been a real turnaround in my life. 

You have the power to change the problem that we have identified. You have the power to save lives. You have the power to help 

individuals from being a drain on taxpayers, to being productive 

and taxpaying citizens. 

These programs of regional and national significance assist us to 

lead productive, integrated lives in the communities of our choice 


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instead of living in institutions, jails or being a plight on communities through homelessness. 

By assuring that these programs are not cut, you can help my 

peers to have their voice heard, to have safe and affordable housing, to have gainful and meaningful employment, to have social 

support and connections that so many of us want, and maybe even 

a date on a Saturday night as well as being a participant in our 

communities as fully taxpaying individuals. 

My written testimony covers the importance of the research and 

the importance of funding these programs. 

I ask you, please. I have a fear. 

Excuse me, I have a far more important statement to make here. 

That is to please help save lives. Please allow my peers to experience the hope and connections that I have as a result of hard work 

and the right supports. 

Please do not allow these cuts to occur. It will result in homelessness, institutionalization and death. 

Thank you very much for allowing me to share my personal story 

with you. 

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Mr. OBEY. Well, thank you both for your testimony and thank 

you, specifically, for sharing your story with us. 

Let me again point out the context in which you are testifying. The White House’s fiscal year 2008 budget requested $807,000,000 

for the Center for Mental Health Services at the Substance Abuse 

and Mental Health Services Administration. This was a cut of 

$77,000,000 or 9 percent below the level that we provided in the 

fiscal year 2007 joint resolution. 

This Committee increased the appropriation for the center to $911,000,000, an increase of $104,000,000 or 13 percent above the 

President’s level. 

But, again, the President this year is proposing to decrease the funding to $784,000,000, a cut of $127,000,000 or 14 percent below 

the 2008 level. 

That is the context in which you are testifying, and I appreciate 

your coming. 

Mr. ASHENDEN. Thank you very much for allowing us. 

Mr. OBEY. You bet. 

I understand Dr. Weldon would like to introduce the next witness. 

THURSDAY, MARCH 13, 2008. 

NORTHWESTERN UNIVERSITY’S FEINBERG SCHOOL OF 

MEDICINE 

WITNESS 

DR. RICHARD BURT, CHIEF, DIVISION OF IMMUNOTHERAPY, NORTHWESTERN UNIVERSITY, CHICAGO, ILLINOIS; ACCOMPANIED BY 

BARRY GOUDY 

Mr. WELDON. Yes. Thank you, Mr. Chairman. 

It is a pleasure for me to introduce Dr. Richard Burt at Northwestern University. He brought along a patient. 

I am very pleased that you have allowed the time for this. 

Dr. Burt is doing some very fascinating work on treating essentially incurable patients, people who have failed standard therapy, 

using a variety of different adult stem cell transplant methods. Indeed, he is actually, in some instances, the person the NIH turns 

to when they have a case they cannot fix. So it is a real honor to 

have Dr. Burt here, and he brought along a fascinating patient. 

Thank you for allowing the time for them to be here on the program, Mr. Chairman. I appreciate what you do. 

Dr. BURT. Chairman Obey and honored members of the Committee, Congressmen and Dr. Weldon, thank you. It is my honor 

and my pleasure to be here. 

I am the Chief of the Division of Immunotherapy at Northwestern University in the great City of Chicago. 

What I am known for in my field is translational research in 

stem cells. So I go from the laboratory with stem cells to preclinical 

animal models that often take many years of work and from that 

experience to the bedside, designing protocols, not pharmaceutical 

protocols but our own through the IRB, through data safety monitoring boards, through the FDA and then initiate those treatments 

on patients. 


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What I am in my heart, though, is a patient advocate. I spend 

a great deal of my time fighting with insurance companies and 

looking for money to do the work that we need to do, to do what 

I love to do, and I am here to tell you about something that is succeeding. 

At Northwestern University, we have treated over 200 patients 

now with autoimmune diseases with the blood stem cell. That is a 

type of adult stem cell that has been used for years to treat leukemias. It turns out it is also the immune stem cell. 

So the concept I had 20 years ago was very simple, a basic concept. It is that we could reboot your immune system just like you 

reboot a computer. We could remove this police force that was supposed to protect you from pathogens and has turned around and attacked your own body and regenerate a new one from the immune 

compartment. 

As it turns out, in the animal models and in human beings, by 

whatever design that is still being worked out, when it regenerates, 

the default is tolerance to self. We reestablish tolerance. 

As I mentioned, we have been doing this in over, now, 200 patients. We currently have five patients going through transplant for 

autoimmune diseases in-house today. 

We have treated patients and are treating patients with multiple 

sclerosis, systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis, Crohns disease, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, autoimmune-related 

retinitis and optic neuritis which causes blindness, polymyositis, 

different vasculitis, nerve vascular Behcet’s, nerve vascular ChurgStrauss, Wegener’s, primary biliary cirrhosis, we recently did a 

child with regressive autism, Devics and type 1 diabetes. 

We have been using, for the most part, autologous and now we 

are moving into cord blood and sibling. 

Before you, you should have some pictures of some patients just 

as evidence, pre-transplant and one year post-transplant of a patient with lupus. 

Here is an example of another patient pre- and one year posttransplant. These patients had failed pretty much all therapy. 

This is a patient suffering with severe ischemic ulcers throughout her body and internal organs. It was occurring in her heart as 

well, that would get infected, severely painful, on narcotic drips. 

Post-transplant, she has been in remission five years now. 

Here is a patient with systemic sclerosis, whose lungs were very 

inflamed. It was destroying her lungs. You see on the next scan, 

post-transplant, to your right, that brown glass haze in the periphery of the lungs is gone. That destruction of the lungs is stopped 

and, in some cases, improved if we get it early enough. 

I have put here a figure that we have just submitted to a journal 

of a patient who was going blind, referred to us from the University of California at Davis and Stanford. They had three different 

immune suppressive regimens. Her visual acuity was worsening. 

Got a transplant and since the transplant, off all therapy. Her vision is markedly improved. 

I wanted a patient of mine who has MS, who you cannot put in 

a picture here, to briefly give you a description of his own experience from this. 


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Mr. GOUDY. Hi. My name is Barry Goudy. Mr. Obey, thank you 

for the invitation. 

In 1995, I was diagnosed with multiple sclerosis. Though I received IV drips once a month and I also received weekly shots that 

I injected in myself, periodically I would fall out of remission and 

have exacerbations, go back into the hospital, and it would take 

more and more medicine to revive me and put me back out. 

Since I met Dr. Burt, I went through a stem cell transplant in 

Chicago at Northwestern, and I have been MS-free now for five 

years. 

I go back every year to Chicago for the protocol, and July 1st of 

this year will be the fifth year, and I live a normal, active, happy 

life. Stem cell research is very, very important. 

Thank you. 

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Mr. OBEY. Thank you. Well, thank you both for testifying. I appreciate your dropping by yesterday, and I appreciate Dr. Weldon 

bringing you to the attention of the Committee. I am happy to hear 

what you are doing. 

I am certainly happy to know what has happened to you. 

Mr. GOUDY. Thank you. 

Mr. OBEY. Any other comments? 

Mr. WELDON. I just had a quick question. You said you did one 

autistic case? 

Dr. BURT. Yes. 

Mr. WELDON. What was the result from that? 

Dr. BURT. I do not want this to become confused. The details are 

very important. This may not apply to the vast majority of autistic 

children. 

But what we selected were kids with regressive autism who developed normally, normal milestones and then had a setback and 

developed severe autism on their CARS score and had abnormal 

immune parameters and specific cyalate in the blood and 

autoantibodies to Purkinge fibers. 

We treated one such patient who, at this point, we have not yet 

published on but is behaving normally with no clinical manifestations of autism at this time. 

This is unpublished data and probably not the best format for me 

to release it. I do not want the press to get on it. [Laughter.] 

Mr. WELDON. Yes. Before you head back, if you could stop by my 

office, I may want to talk to you a little bit more about it. I meant 

to ask you about that earlier. Thanks. 

Dr. BURT. Thank you, Dr. Weldon. 

Mr. OBEY. Thank you both very much. 

Dr. BURT. Thank you, Mr. Obey. 

Mr. OBEY. You bet. 

THURSDAY, MARCH 13, 2008. 

AMERICAN ASSOCIATION FOR DENTAL RESEARCH 

WITNESS 

DR. MARC HEFT, PROFESSOR OF ORAL AND MAXILLOFACIAL SURGERY AND DIAGNOSTIC SCIENCES, UNIVERSITY OF FLORIDA 

Mr. OBEY. I understand Mr. Simpson would like to introduce the 

next witness. 

Mr. SIMPSON. Yes, I would like to welcome Dr. Heft to the Committee from the NIDCR and representing the dental profession and 

the work that the NIDCR does out of NIH. 

Welcome to the Committee. 

Mr. OBEY. I do not know that Mr. Simpson knows much about 

dentistry. 

Mr. SIMPSON. Well, this morning in the Energy Subcommittee, 

we had Dr. Orbach there who is a physicist. Since you cannot ask 

them intelligent questions because they know so much, I had to 

ask him if he understood why it was important to brush your teeth 

before you eat rather than after you eat, and he did not get the 

point. [Laughter.] 

Mr. OBEY. Please proceed. 


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Dr. HEFT. Mr. Chairman and members of the Committee, I am 

Mark Heft, Professor of Oral and Maxillofacial Surgery and Diagnostic Sciences at the University of Florida. My testimony is on behalf of the American Association of Dental Research. 

I thank the Committee for the opportunity to testify about the 

exciting advances in oral health science. 

Americans are living better and healthier lives into old age due 

to recent advances in healthcare including dental health and oral 

healthcare research. The National Institutes of Dental and 

Craniofacial Research has made this possible through research, research training and the dissemination of health information. 

Concerned that scientific opportunities were outpacing funding at 

the NIH, the U.S. Congress doubled the NIH budget from 1998 

through 2003 which led to a remarkable period of discoveries. 

However, flat funding over the past six years for the NIH has left 

researchers and their institutions vulnerable to the rising costs of 

biomedical research. We are also in jeopardy of losing the pipeline 

of the next generation of scientists. 

My testimony today will focus on our recent accomplishments in 

three areas and what still needs to be addressed in those areas. 

The first area is salivary diagnostics. For many oral and systemic 

diseases, early detection before clinical symptoms appear offer the 

best hope for successful treatment. Fortunately, research funded by 

the NIDCR is developing highly sensitive and accurate methods to 

detect oral and systemic conditions at their earliest stage, using saliva as a noninvasive diagnostic fluid. 

Saliva is easy and painless to collect, providing a major advantage over the use of blood or urine for diagnostics tests. The same 

biomarkers found in blood are also found in saliva. 

We are close to marketability for a diagnostic test for oral cancer. 

Other diagnostics tests are in the pipeline. 

The second area is tooth decay. Tooth decay continues to be a 

major health concern to millions of Americans. It is one of the main 

causes of poor oral health and pain throughout life and a major 

contributor to oral health disparities in this Country. 

Early childhood carries is a painful, costly and severe form of 

tooth decay and is particularly common among Alaska Native and 

American Indian children. We are calling for $1,000,000 per year 

for 3 years to NIDCR’s budget for research and clinical studies to 

address early childhood carries in cooperation with the Indian 

Health Service. 

The third area is oral and systemic diseases. Oral health plays 

a substantial role in general health and well being. For example, 

oral disease and conditions can greatly affect systemic conditions 

such as diabetes, may be linked to cardiovascular diseases and play 

a role in initiating early delivery in pregnancy. 

Oral bacteria associated with periodontal disease cause inflammation in the mouth. Scientists have uncovered a relationship between this inflammation and a higher risk of developing cardiovascular disease. Further, periodontal disease may also affect insulin resistance, glycemic control and the risk of developing other diabetic complications. Finally, preexisting gum disease in pregnancy 

is a risk factor for preterm or low birth weight babies. 

NIDCR-funded research is evaluating these relationships. 


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As you can see, Mr. Chairman, there are many research opportunities with an immediate impact on patient care that need to be 

pursued. Additional funds can help greatly in bringing these opportunities to fruition. Imagine a world where disease can be detected 

at its earliest possible moment with a quick, painless and noninvasive salivary-based test. 

Mr. Chair, a great amount of exciting research is underway, and 

the potential to improve oral health specifically and overall health 

in general is significant. Therefore, we are requesting a funding 

level of $438,000,000 for the NIDCR for fiscal year 2009. 

Thank you for the opportunity to testify today. 

Mr. OBEY. Thank you. I appreciate your time. 

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THURSDAY, MARCH 13, 2008. 

SCLERODERMA FOUNDATION 

WITNESS 

CYNTHIA CERVANTES 

Mr. OBEY. Next, the Scleroderma Foundation, Cynthia Cervantes. 

Ms. CERVANTES. Chairman Obey and the members of the Subcommittee, thank you for the opportunity to appear before you 

today, and I especially want to thank Congresswoman Sanchez and 

Congresswoman Roybal-Allard from the Los Angeles area. 

I am Cynthia Cervantes, and I am 13 years old and in eighth 

grade. I live in Southern California. 

Two years ago, I was diagnosed with scleroderma. Scleroderma 

literally means hard skin. What it does especially in my case, it 

causes my internal organs to harden and become smaller. 

Two years ago, I began to experience sudden weakness. My body 

would ache and my vision was blurry. Some days it was so bad I 

could barely get myself out of bed and go to school. 

I was taken to see a doctor after my feet became so swollen that 

calcium began to ooze out. It took the doctors one year to figure out 

exactly what was wrong with me because of how rare scleroderma 

is and how complicated the symptoms are. 

Once again, I have been told that there is no known cause for 

scleroderma which affects three times as many women as men. 

Generally, women are diagnosed between the ages of 25 and 45, 

but sometimes kids like me are affected early in life. There is no 

cure for scleroderma, but there are treatments, treatments that 

have been delivered with the support of the National Institutes of 

Health. 

Today, I have to take nine pills and one inhaler three times a 

day, and I always have to wear gloves and a sweater even on a hot 

day as part of my treatment. 

Every month, I also have to go to the doctors to get some more 

shots, and I have to eat a special diet because my scleroderma is 

making my internal organs contract and slip at an angle, because 

it helps me digest my food. 

I love to play basketball, but it is very difficult now because I become tired very quickly and it is hard to keep up with the other 

kids. 

The Scleroderma Foundation’s outreach program has been very 

helpful to me and my family. The Foundation provided us with materials to educate my teachers and others about my disease. Also, 

the local Southern California support groups the Foundation 

helped organize are helpful because they help show me that I can 

live a normal, healthy life and how to approach those who are curious about why I wear gloves even in hot weather. 

It really means a lot to me to be able to interact with other people in the same situation as me because it helps me feel less alone. 

Mr. Chairman, because no one knows what causes scleroderma 

and we have a great deal to learn about it in order to be able to 

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crease funding for the National Institutes of Health, so treatments 

can be found for other people like me who suffer from this sickness. 

I also ask that you make it known to the leaders of NIH and the 

institute which studies skin disease, NIAMSD, that you consider 

scleroderma research to be a priority. 

Mr. Chairman, on behalf of thousands of people suffering from 

scleroderma and the Scleroderma Foundation, I would like to thank 

you for the chance to speak before the Subcommittee and for your 

consideration of my request. Thank you. 

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Mr. OBEY. Thank you. 

Did either of you want to say anything? 

Let me simply say, you are in eighth grade. You are doing a 

whole lot better in the eighth grade than I did. [Laughter.] 

Mr. OBEY. I was kicked out of grade school when I was in eighth 

grade. 

I will yield to you just a second. I just want to say that we appreciate your coming here today. You did a fine job testifying, and I 

am glad that people who know about this disease were smart 

enough to pick a really good spokesman to explain the situation 

today. 

With that, let me yield to the gentlewoman from California. 

Ms. ROYBAL-ALLARD. Mr. Chairman, it was during the break that 

I learned that Cynthia was going to be here, and I want to thank 

her for her testimony. 

Also, she is a wonderful example of why I am so proud of the 

constituents of the 34th Congressional District. She is from the 

City of Huntington Park which I proudly represent. 

So, thank you for being here, Cynthia. 

Ms. CERVANTES. You are welcome. 

Mr. OBEY. Let me just point out when the Secretary of Health 

and Social Services was here, we were talking about the fact that 

every time this Committee appropriates money, people will point to 

the cost of appropriating the money, but they very seldom talk 

about the cost of not appropriating the money. 

As I understand it, if we take a look at what is being invested nationwide in this disease, it is about $12,000,000. That is a very 

small amount. If you compare that amount just to the economic 

cost of the disease, with everything from medical treatment to lost 

income to you name it, not to mention the human cost, I think it 

amply illustrates why we need to do far more than we are doing 

with respect not just to this disease but virtually everything else 

that NIH does. 

Thank you very, very much. 

Ms. CERVANTES. Thank you. 

THURSDAY, MARCH 13, 2008. 

PULMONARY HYPERTENSION ASSOCIATION 

WITNESS 

JOANNE SCHMIDT 

Mr. OBEY. Next, Pulmonary Hypertension Association, Joanne 

Schmidt. 

Ms. SCHMIDT. Good afternoon, Chairman Obey, members of the 

Subcommittee. On behalf of myself and the Pulmonary Hypertension Association, thank you for the opportunity to testify this 

afternoon. 

My name is Joanne Schmidt. I am from Huntington, New York, 

and I have pulmonary hypertension. 

Pulmonary hypertension refers to high blood pressure between 

the heart and the lungs, resulting in an enlarged heart that eventually loses its ability to pump. The disease is underdiagnosed, 


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deadly and incurable. PH can occur without a known cause or can 

be secondary to a number of other conditions including 

scleroderma, lupus and sickle cell. 

In my case, this devastating condition runs in my family. My 

mom’s sister was diagnosed with pulmonary hypertension in 1963 

at the age of 23. She died within six months. My brother was diagnosed in 1995 at the age of 34. Three years later when I was 34, 

I began to develop symptoms of PH, and I knew immediately what 

they were. 

I joined the Board of Trustees of the Pulmonary Hypertension 

Association in 2001. PHA is the Nation’s oldest and largest nonprofit organization dedicated to the PH community. 

I am also the founder and co-leader of the Long Island, New 

York support group. The group remains large and active. However, 

we unfortunately lose members to PH every year. 

I would like to extend my sincere thanks to the Subcommittee for 

your past support of pulmonary hypertension programs at the National Institutes of Health, Centers for Disease Control and Prevention and Health Resources and Services Administration. These initiatives have opened up many new avenues of promising research, 

helped educate hundreds of physicians in how to properly diagnose 

PH and raised awareness about the importance of organ donation 

and transplantation within the PH community. 

I am pleased to report that we are making good progress in our 

fight against this deadly disease. Six new therapies for the treatment of PH have been approved by the FDA in the past ten years. 

However, there is still a long way to go on the road to a cure, and 

biomedical research holds the promise of a better tomorrow for our 

patients. 

We are truly honored to have a great partner in the National 

Heart, Lung and Blood Institute, and I would like to take this opportunity to recognize the Director of NHLBI, Dr. Elizabeth Nabel, 

for all that she has done for our community. We are particularly 

excited about the two centers of excellence in PH that NHLBI initiated last year. 

For fiscal year 2009, the Pulmonary Hypertension Association 

joins with other members of the research and patient community 

in recommending a 6.5 percent increase for the NIH. We are very 

aware of the strong need for robust support of the NIH. 

A few years ago, leading PH researchers submitted a proposal to 

NIH, focused on the blood thinning drug, Warfarin, as a possible 

new treatment for PH. This concept was greeted enthusiastically 

within our community because it could reduce the cost of treating 

PH from hundreds of thousands of dollars a year to simply hundreds of dollars a year. 

The proposal received an excellent score but did not make the declining NIH payline. It is critical that studies like these move forward in the future. 

Finally, I would like to commend the Subcommittee for actively 

addressing the current backlog in Social Security Disability applications at the Social Security Administration. Many PH patients 

end up applying for disability coverage, and streamlining the benefits process would go a long way toward improving the quality of 

life for our most in need families. 


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Once again, Mr. Chairman, thank you so much for the opportunity to testify today. 

I would like to close by saying a special thank you to a great 

champion of the PH community and a true friend of everyone on 

Capitol Hill, the late Congressman Tom Lantos. Representative 

Lantos became a tireless advocate for our cause after his beautiful 

granddaughter, Charity, was diagnosed with pulmonary hypertension a few years ago. We miss him terribly, and we honor his 

legacy today. 

Thank you so much. 

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Mr. OBEY. Thank you very much. 

Let me simply say that I have a very good friend who happened 

to have testified before this Committee last week whose wife has 

the same problem. So we have seen it affect good people, up and 

close. 

You indicate that you want us to support an increase of 6.7 percent for NIH. I would dearly love to do that. 

We have to face the reality that last year the bill that we sent 

to the President, that he vetoed, provided a relatively small increase in NIH funding of $770,000,000, and we came within four 

votes of being able to override his veto. We got 66.2 percent of the 

votes. We needed 66.7. 

So we will be looking for ways to try to produce a bill which is 

veto-proof. If we cannot find that in this Congress, then we will 

have no choice but to simply pass a continuing resolution taking 

us through February, so we can get a new start with someone who 

will make compromises on these issues. 

Thank you very much. 

Ms. SCHMIDT. Thank you so much. 

THURSDAY, MARCH 13, 2008. 

TUBEROUS SCLEROSIS ALLIANCE 

WITNESS 

TOMMY LINDSEY, BOARD MEMBER, TUBEROUS SCLEROSIS ALLIANCE 

Mr. OBEY. Next, the Tuberous Sclerosis Alliance, Tommy 

Lindsey. 

Mr. LINDSEY. I did not have a chance, prior to coming in, to hand 

something over. Do you mind if I drop this off to you? 

Mr. OBEY. That is fine. Thank you. 

Mr. LINDSEY. First, I would like to say thank you for granting 

me this opportunity to speak before you today. 

I would like to give a special thanks to Ranking Member Walsh, 

even though he is not in the room at the moment, for being so supportive of our organization in the past and hopefully in the future 

as well. 

I would also like to make another point, that we have something 

in common. I was also kicked out of grade school. It was Catholic 

school and in kindergarten. 

Mr. OBEY. We will form a union. [Laughter.] 

Mr. LINDSEY. I am here today on behalf of the Tuberous Sclerosis 

Alliance. I am a current board member and, more importantly, a 

dad to a little boy, Tommy, who suffers from tuberous sclerosis. 

Tuberous sclerosis is a rare genetic disorder that causes the formation of tumors in all your vital organs, causing severe mental 

and physical retardation, sometimes death. It affects every major 

organ in the body. 

We all have these two genes that naturally suppress tumor 

growth. If either one or both happen to mutate, you lose the ability 

to fight off tumors. It is a one-third passed on mutation, two-thirds, 

spontaneous mutation. 


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My son happened to be a spontaneous. The sperm and the egg 

meet, the gene mutates, and you have this problem. 

Tommy was born with numerous tumors in his brain, two in his 

heart, one in each eye, and he has a bunch on his skin. We have 

to get him scanned every six months to be sure that he does not 

have any new tumors growing in any other organs, and this is 

going to go on for the rest of his life. 

They are benign in the sense that they are nonmalignant, but 

they are far from benign. 

Tommy was first diagnosed at five weeks old from a series of epileptic seizures which progressed over time. We brought him into 

the hospital at five weeks old because of the, for better lack of a 

word, oftency of his disease, if that is a word. 

It is very unknown even in the medical community. My wife and 

I were accused of shaken baby syndrome for three days because the 

medical doctors believed they were looking at blood spots in his 

brain. They did not realize they were looking at tumors. After a series of tests and MRIs, they realized they were looking at tumors, 

and Tommy was diagnosed with tuberous sclerosis. 

The diagnosis was very bleak. I was told that Tommy would 

never work. He would never talk. He would be both severely and 

physically retarded and that I should consider an institution. 

This was my five week old son. It was very hard to take. I was 

knocked on my butt. 

Growing up, I just want to tell you a little bit about myself. I 

grew up in the city limits, one of the five boroughs in New York. 

My father left when I was four. I was on welfare, food stamps, the 

whole works. I have two older sisters and my mom. We struggled 

our whole lives, growing up, but we have all done pretty well for 

ourselves as adults. 

I promised myself growing up that I would be a better father to 

my children once I had them, if that was at all possible, than my 

father was to me. Unbeknownst to me, I was going to wind up 

being this advocate and having a child handed to me that I was 

not prepared to be the advocate or father for. 

There is no cure for tuberous sclerosis. I realized that right 

away. I never once said, why me? 

I did say, why him, every day. I still do to this day because he 

bothered nobody. If anything, give it to me because I know that I 

can handle it from the way I was brought up and what I can deal 

with. 

Tommy, himself, has gone through a series of brain surgeries to 

control his epilepsy. Back in 2003, he had three brain surgeries 

over eleven days, where they removed a large tumor from his right 

frontal lobe. Those are the pictures that I just handed to you now. 

That is actually my son in the OR. Those are not just pictures from 

a textbook. 

He is on cocktails of anti-epileptic drugs on a daily basis. He has 

gone through 13, none with any help. 

I cannot stress the fact that something has to be done. We need 

more money. We need it. So is everybody else who has a request 

in this room. 


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We are requesting we get—I am sorry. I am a little nervous. I 

am usually not nervous. I am usually a pretty big ham. I am also 

known as the Forest Gump of tuberous sclerosis. 

You might remember me from three years ago. I was here with 

the Oscar-nominated actress, Julianne Moore, which I was fortunate enough to bump into in a chance meeting and get her to jump 

on board. She is now our national spokesperson. 

But what we are asking for is an increase of 6.7 percent which 

a few other people have mentioned today, in the NIH funding to 

help do more research for tuberous sclerosis. 

We have painted the Hill. Two weeks ago, we organized a march 

with constituents, family members, some members themselves who 

have tuberous sclerosis. We had a total of 290 meetings two weeks 

ago, asking the Appropriations Committee to appropriate 

$10,000,000 in the CDMRP for more research dollars for tuberous 

sclerosis. 

We believe it is a very modest request. At the present time, we 

were granted $4,000,000 in 2007, but for 2008 we are hoping to get 

that increased to $10,000,000. 

We are also asking that this Committee would be supportive and 

help us in funding a new program in the CDC to help us better understand the national prevalance of TSC and train individuals in 

the medical community to help us better understand tuberous sclerosis in general. 

One example was what I gave you earlier is that you have people 

going to the doctors. I live in a city, New York City, where some 

people consider are the best doctors in the world, some of the best 

doctors in the world, and I am being accused of shaken baby syndrome and being told to put my child in an institution. 

If we can better educate the medical community, the researchers 

in general, we can help treat these patients even if we cannot cure 

them which is obviously our main goal. We do not want to walk 

into a doctor’s office where people are told that you have to put 

your child into an institution. We want them to have an idea of 

what needs to be done. We need some kind of protocol. 

At the present time, everybody walks in like a guinea pig, and 

everybody just takes a shot in the dark to see what might work, 

what epileptic drugs. It is the number one genetic cause for epilepsy, number two genetic cause for autism. 

We do have a pathway now. We know the two genes that have 

caused tuberous sclerosis. If we cure tuberous sclerosis, we might 

help many of the people that walk through these doors that are requesting for help as well. 

The fact that it has a link to diabetes, there is a link to autism, 

a link to epilepsy, the link to cancer, the tumor gene itself. If we 

can find a way to cure or stop that tumor gene or somewhere down 

the line, we also will help find a way to stop and cure most cancers. 

In some meetings with some of the hierarchy in NIH and other 

people on the Hill and researchers, we have been told in meetings 

that tuberous sclerosis is curable. We just need the funding. We 

are told that because of the strides that have been made in such 

a short period of time, we are kind of like the hot, sexy disease 

right now, if you want to call it that, if there is a hot, sexy disease. 


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Researchers are coming to the Tuberous Sclerosis Alliance, putting in grant applications that we cannot fund. Over the years, we 

have funded over $12,000,000 in research grants on our own as a 

private organization. So we are not looking for a handout. We are 

actually looking for a partner with the government, and hopefully 

together we can make a difference. 

My son, Tommy, is my world. I never expected to get what was 

handed to me. I look at him every day, and I try to promise him. 

I promised myself I would be a better dad than my dad was. Now 

I have to promise my son that he was not born with tuberous sclerosis for no reason at all. If anything else, even if I cannot cure 

him, at least I can help the people coming in behind him. If that 

is going to be his legacy, if it is just a rationalization to make myself feel better, at least it is doing something. 

But I believe in this Committee. I believe in the United States 

Government because we do help people as a whole, even around 

the world, not just here. Everyone in this room, everyone on this 

Hill can make a difference. 

If you look back and we needed to build the atomic bomb, what 

did we do? We put the right people in the room, gave them the 

funding and said, do not come out until it is done. It was done. 

We wanted to send someone to the moon, same thing. 

If we want to cure tuberous sclerosis, which in turn will cure 

many other diseases, we need to do the same thing and we need 

more funding. I greatly urge you to support our tasks here the best 

you can. 

Thank you. 

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Mr. OBEY. Well, thank you very much. 

Let me simply say, I think you are a terrific father and a terrific 

spokesman. 

I would simply make the point that what we are going to have 

to do is simply get enough votes to overcome the White House resistance or else get the White House to agree to make significant 

compromises in their budget because, as you mentioned, I have not 

heard a single person here come in and say, why do not you guys 

get your act together and cut cancer research, but that is what the 

Congress and the President did two years ago. 

We just cannot afford many more years like that. Certainly, your 

son cannot. I know you cannot, but we appreciate your telling your 

story today. I know it is painful. 

THURSDAY, MARCH 13, 2008. 

AMERICAN ASSOCIATION OF COLLEGES OF NURSING 

WITNESS 

DR. JEANETTE LANCASTER, PRESIDENT, AMERICAN ASSOCIATION OF 

COLLEGES OF NURSING, DEAN, UNIVERSITY OF VIRGINIA SCHOOL 

OF NURSING 

Mr. OBEY. The American Association of Colleges of Nursing, Dr. 

Jeanette Lancaster. 

Dr. LANCASTER. Good afternoon, Mr. Chairman and Mr. Simpson. 

It is a pleasure to be here with this Subcommittee and the staff 

members who work so diligently to help you. 

I am the President of the American Association of Colleges of 

Nursing and the Dean at the University of Virginia School of Nursing, and I am here to speak on behalf of increased funding for Title 

VIII which I know you are very familiar with and you have been 

supportive to funding for nursing in the past. 

I guess the bottom line is we hear all of these difficult stories 

today that an investment in the profession of nursing is an investment in helping the people who have spoken today before me because without our graduates the care that they get will be severely 

limited compared to the care that they need. 

I do understand the difficult situation, and there is so much of 

a need in NIH and in HRSA for both the workforce and the research to report the new recoveries and advancements. 

As I think all of you know, we are in the middle of a decade-long 

nursing shortage. This is the most difficult shortage we have ever 

had. It is a complex shortage but to put it in the simplest terms, 

it is a total imbalance between demand and supply. 

The demand for healthcare is growing and it will grow even further as those of us who, regrettably, are entering the baby boom 

generation will need more healthcare. That comes at a time when 

our ability to supply new nurses is diminished compared to those 

times in the past. 

Now you might think well, that is because people do not want 

to become nurses, but that is really not the case at all. Last year, 

in our colleges of nursing, we documented the turning away of 

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In my State of Virginia, we turned away over 1,400 students who 

wanted to become a nurse. At the University of Virginia, we will 

admit 56 students directly from high school and competing for 

those 56 spots are 404 candidates. 

In every way you can, the school at which I am a dean, which 

is just reflective of the national situation, it is running this year 

a four to one to an eight to one ratio of those who wish to come 

and those who will be able to come. 

So it is not that people do not have an appetite to become a 

nurse. It is that we do not have the faculty to enable us to increase 

more nursing students. 

Historically, there are three things that prohibit us from increasing our class size: lack of clinical sites, lack of facilities to educate. 

Classroom seats, the fire marshal is very fussy about how many 

people you put in a classroom. 

Those can be overcome. Faculty are creative, and you can find 

new ways to put chairs in rooms. But what cannot be overcome 

simply is finding enough faculty to teach the students, and that is 

where Title VIII has been a big help. 

In fact, as I think back and I was thinking back a long time, I 

actually was supported in my master’s program in psychiatric nursing through Federal funds, Federal training funds which paid for 

tuition and fees for students to get master’s degrees in nursing. So 

many of us who are in the workforce now have been part of the 

Title VIII program. 

Basically, this program provides the funding to prepare nurses 

who can provide primarily healthcare services and many are those 

nurse practitioners, nurse anesthetists. It also provides funding for 

people who want to become faculty. That, of course, as I have already said, is the chief problem that we have in front of us is just 

the lack of funds. 

Just like NIH needs funds and not a single one of us in schools 

of nursing would deny that NIH does. We all know NIH needs 

funds, but the workforce development areas need funds as well. I 

do know that you know that. 

We are respectfully asking as a nursing community for 

$200,000,000 to support Title VIII. We do appreciate your attention 

and your thoughtfulness and your help to us in the past, and we 

fully appreciate the dilemma you are in. 

Thank you. 

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Mr. OBEY. Thank you. 

Again, to put it in context, the President’s fiscal year 2008 budg- et proposed to cut nurse training programs by $45,000,000. The 

House passed a bill last year and was able to add $60,000,000 to 

the President’s request. A vetoed conference report would have provided $63,000,000 more than the President asked for. 

The final bill that we were able to pass still contained $51,000,000 more than the President and $6,000,000 above the 

2007 level, but for the coming fiscal year, the President proposes 

to cut nurse education programs by $46,000,000 or 30 percent 

below the current level. So we start out in the hole again with this 

as we do with so many other programs. 

Dr. LANCASTER. That is right, and the cuts that the President is 

proposing are very heavily in advanced nursing education which 

would be the preparation of nurse practitioners and faculty, which 

are two huge demand needs in our Country. 

So we thank you. We wish you to take your vitamins daily and 

have the strength to do what you need to do. 

Mr. OBEY. My wife tells me that too. [Laughter.] 

Dr. LANCASTER. Well, if you do not, you are in the same boat 

with Al Roker and Matt Lauer. They announced today they do not 

take vitamins. We need to get after them. 

Mr. OBEY. Thank you very much. 

THURSDAY, MARCH 13, 2008. 

COALITION FOR HEALTH SERVICES RESEARCH 

WITNESS 

KENNETH E. THORPE, BOARD MEMBER, COALITION FOR HEALTH 

SERVICES RESEARCH; PROFESSOR OF HEALTH POLICY AT EMORY 

UNIVERSITY; EXECUTIVE DIRECTOR FOR THE PARTNERSHIP TO 

FIGHT CHRONIC DISEASE 

Mr. OBEY. Lastly, the Coalition for Health Services Research, 

Kenneth Thorpe. 

Mr. THORPE. Mr. Chairman, members of the Subcommittee, 

thank you for the opportunity to testify today on behalf of the Coalition for Health Services Research. 

My name is Ken Thorpe. I serve as a board member of the Coalition. I am also a Professor of Health Policy at Emory University 

in Atlanta and serve as the Executive Director for the Partnership 

to Fight Chronic Disease. 

The coalition represents the interests of 3,500 researchers and 

policy experts as well as 130 organizations that produce and use 

health services research. 

On February 14th of this year, I had the pleasure of testifying 

in front of this Subcommittee about the escalating challenges we 

face in healthcare: high and rising healthcare costs, rising numbers 

of uninsured, uneven quality of healthcare. I also talked a little bit 

about the underinvestment that we make in research and development to find solutions to these problems. 

For example, chronic diseases, as you have heard about many of 

these today, account for fully 75 percent of the over 

$2,000,000,000,000 we spend on healthcare. Healthcare spending 


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has been growing faster than our economy for many years and has 

projected to double in as little as 10 years. 

Despite what we spend, research tells us that we only receive the 

appropriate care about half the time. The bottom line is America 

spends more on healthcare than any other nation, but we are in 

poorer health. We are simply not getting what we pay for, and we 

are not investing in healthcare wisely. 

Health services research, the field in which I work, provides the 

data and evidence needed to make better decisions and develop effective policy to optimize healthcare financing, facilitating access to 

the delivery system and improve healthcare outcomes. Unfortunately, despite what we know and what we can learn from the 

health services research field, there is an erosion in Federal funding for this important field. 

For the last five years, the Coalition has been collecting information on Federal funding for health services research and data. 

From what the Federal agencies report, we know that Federal expenditures have remained constant over this time period at about 

$1,500,000,000 a year. This equates to just 0.075 percent of the 

$2,000,000,000,000 we spend in healthcare annually. 

Since 2003, the Federal funding has not increased. The field’s 

purchasing power has continued to decline, despite the increased 

need for better information and more innovative and effective solutions. 

If the Federal Government is going to start bending the cost 

curve and getting better care at better value, it will need to increase its investment in health services research. It is a true public 

good, provides essential tools to make needed improvements in our 

health system, improvements that will benefit all Americans. Most 

importantly, increasing Federal funding for health services will 

help us stave off the mounting challenges we face in healthcare 

and in healthcare entitlements. 

We ask that the Subcommittee strengthen the capacity of the 

health services research field to address the challenges America 

faces in providing high quality, cost-effective healthcare. 

AHRQ, the Agency for Healthcare Research and Quality, is the 

lead agency of our field, yet chronic underfunding combined with 

an increasingly earmarked budget threatens the agency’s ability to 

achieve its important mission. 

We recognize the budgetary context in which you are operating, 

yet we view these as substantial investments in finding solutions 

to our healthcare issues with respect to rising healthcare costs, reducing the number of uninsured and, indeed, providing better outcomes. 

With these needs in mind, we, along with 100 members of the 

organization, the Friends of AHRQ, recommend an increase in 

funding. It is a modest increase from its current level, which has 

been flat at around $325,000,000 a year, to about $360,000,000 for 

fiscal year 2009. Again, the idea is to highlight the funding gap, 

again to raise, as the Chairman has already done, the critical issue 

of what the costs are of not funding these appropriate research 

services at the appropriate levels. 

Taking your cue, another critical agency is the National Center 

for Health Statistics. This is a critical agency in terms of collecting 


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data and providing just essential information on births, deaths and 

other basic public health statistics. Again, we are asking for you to 

look seriously at increasing the funding for that organization as 

well. 

As you know, Mr. Chairman, Medicare and Medicaid and SCHIP 

together provide coverage to nearly 100 million Americans, comprising 45 percent of America’s total healthcare spending. It is imperative that we invest now in developing and testing new financing mechanisms to improve the cost and quality for the elderly, 

poor and other populations. We recommend that you provide at least $45,000,000 in discretionary research and development funding to help CMS evaluate 

Federal programs and analyze pay for performance and payment 

methods and improve care models. Such work, we believe, will pay 

dividends as you and other policymakers look to expand care and 

healthcare coverage to all Americans. 

Finally, I would like to discuss NIH as the principal funder of health services research, providing $921,000,000 or 3.3 percent of 

its entire budget for its work last year. While significant, this level 

is $17,000,000 less than the amount invested in the previous year. We recommend that at least $1,000,000,000 for NIH health services research, which represents 3.3 percent of the nearly 

$31,000,000,000 that the broader health community is seeking for 

NIH. 

In addition, we would hope NIH would increase the proportion 

of health services funding from 3.3 percent to 5 percent to assure 

that the discoveries from clinical trials that you have heard a lot 

of today are effectively translated into actual health services. 

Mr. Chairman, the accomplishments of health services research 

would not be possible without your leadership and the support of 

this Subcommittee. We view these as critical investments in solving the rising costs of healthcare in this Country, in dealing with 

the entitlement crisis, in finding new and more effective ways of 

providing healthcare to all of our citizens. 

We respectfully ask that you accept our recommendations, recognizing the substantial funding situation that you are dealing with, 

with the White House, for the Federal agencies that are funding 

health services research and health data. 

Thank you for giving me the opportunity to be here today. I actually was happy to be the last person testifying here because it gave 

me an opportunity to hear and learn a lot about the challenges that 

we face, not only in solving the healthcare cost and quality problem 

but the challenges in just the basic research and investing in disease prevention and disease promotion. So, thank you for inviting 

us to testify. 

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Mr. OBEY. Thank you. 

Just two points, you mention that this Country spends more than 

any other country on healthcare. Paul Krugman, in his new book, 

has pointed out that I believe he said almost 30 percent of every 

dollar spent on healthcare in this Country is spent not to deliver 

healthcare but in an effort to deny someone healthcare. Given your 

comment about the cost, I thought we ought to put that in the 

record. 

Secondly, again, in terms of the context, the President’s budget request for 2008 increased funding for the agency by $11,000,000 

or 3 percent. In the final 2008 appropriation bill, this Committee 

went a step further and provided a $5,000,000 or a 1.5 percent increase above the President. These are all very small numbers, but 

they are very important. 

The President’s request this year cuts the 2009 budget by $9,000,000 or a 2.7 percent reduction. To me, these expenditures 

are so small, but they are designed to tell us what works and what 

does not, which is fairly important if you are going to spend taxpayers’ money, I would think. 

To me, to cut this budget is penny-wise and pound-foolish. 

Mr. SIMPSON. I do not know if I got the message. Did you support 

the President’s actual bill? 

Mr. OBEY. I did not. 

Mr. SIMPSON. I am just kidding. As you know, I supported your 

actions to override the President’s veto because I think it was foolish on the White House’s part because this really is an investment 

in the future. I think, quite frankly, we do not do enough in 

healthcare research. We do not do enough in basic science research 

and other research as is necessary in this Country. 

But I was just curious. A lot of the organizations and groups that 

have come up today and testified have asked for a 6.7 percent increase in NIH funding. Do you know where that 6.7 percent comes 

from? 

I do not know where they came up with 6.7 percent. 

Mr. OBEY. Well, you will have to ask them. My request has always been to avoid a specific number like that because it creates 

false expectations. 

Mr. SIMPSON. Yes. Well, I was curious. 

Mr. OBEY. Very frankly, when we passed the bill out of the 

House, there were a number of health organizations who spent 

more time arguing about what little piece of the pie they got and 

did not get than they spent working on the House and the Senate 

to build enough votes to overcome the President’s veto. 

Mr. SIMPSON. That is right. 

Mr. OBEY. In the end, we wound up with a bill which was below 

the original House-passed bill. I tried to warn people that could 

happen. 

Mr. SIMPSON. Well, I was curious. As you know, the VSOs in the 

veterans area come together with kind of a VSO budget that they 

would like to see passed. I was wondering if these groups got together and talked about what they think is necessary in NIH and 

stuff. I am not criticizing it or anything. 

If that is where 6.7 percent came from, why is not it 5.5? Why 

not 9.5? 


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Mr. OBEY. I share their goal. 

Mr. SIMPSON. As do I. 

Mr. OBEY. But the question is under these circumstances, what 

is the best you can do without endangering your ability to deliver 

anything? 

Mr. SIMPSON. Yes. One of the real things we learned the other 

day, we knew it beforehand, when we went out to NIH. Chairman 

Obey took several of us out there, and we took a tour of NIH and 

some of the institutes out there. They called it the doubling of the 

NIH budget, those years when we attempted for five years to double the NIH budget. Now it is the undoubling of the NIH budget, 

quite frankly, because we are losing ground. 

If we had just gone up at a steady rate and had not looked at 

doubling, just gone up at a steady rate, a steady, modest rate, and 

done it over the full period of time, we would probably be ahead 

of where we are not. But we did the doubling and then everybody 

said, okay, that is done. 

Mr. OBEY. That is the problem. 

Mr. SIMPSON. Exactly. 

Mr. OBEY. I mean it is appalling to me that we spent the money 

that we spent to map the human genome, and we have made a concerted effort to greatly increase the NIH budget while we were 

doing that, and now that we have completed the job, we have the 

keys that can open a lot of doors, but somehow we appear not very 

anxious to go through those doors. 

Mr. SIMPSON. Exactly. 

Mr. OBEY. That just makes no sense to me. After we spent all 

of the money in a preliminary effort to get us into a position to 

really make some progress, now we are saying, well, we think we 

will take the slow train. 

Mr. SIMPSON. Well, I appreciate your leadership on this Committee and particularly in this area, Mr. Chairman. 

Mr. OBEY. And I appreciate your support, too. 

Thank you very much. We appreciate your coming. 

Mr. THORPE. Thanks for having us. 


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rfrederick on PRODPC68 with HEARINGInsert offset folio 576 here 43329A.384
459 


rfrederick on PRODPC68 with HEARINGInsert offset folio 577 here 43329A.385
460 


rfrederick on PRODPC68 with HEARINGInsert offset folio 578 here 43329A.386
461 


rfrederick on PRODPC68 with HEARINGInsert offset folio 579 here 43329A.387
462 


rfrederick on PRODPC68 with HEARINGInsert offset folio 580 here 43329A.388
463 


rfrederick on PRODPC68 with HEARINGInsert offset folio 581 here 43329A.389
464 


rfrederick on PRODPC68 with HEARINGInsert offset folio 582 here 43329A.390
465 


rfrederick on PRODPC68 with HEARINGInsert offset folio 583 here 43329A.391
466 


rfrederick on PRODPC68 with HEARINGInsert offset folio 584 here 43329A.392
467 


rfrederick on PRODPC68 with HEARINGInsert offset folio 585 here 43329A.393
468 


rfrederick on PRODPC68 with HEARINGInsert offset folio 586 here 43329A.394
469 


rfrederick on PRODPC68 with HEARINGInsert offset folio 587 here 43329A.395
470 


rfrederick on PRODPC68 with HEARINGInsert offset folio 588 here 43329A.396
471 


rfrederick on PRODPC68 with HEARINGInsert offset folio 589 here 43329A.397
472 


rfrederick on PRODPC68 with HEARINGInsert offset folio 590 here 43329A.398
473 


rfrederick on PRODPC68 with HEARINGInsert offset folio 591 here 43329A.399
474 


rfrederick on PRODPC68 with HEARINGInsert offset folio 592 here 43329A.400
475 


rfrederick on PRODPC68 with HEARINGInsert offset folio 593 here 43329A.401
476 


rfrederick on PRODPC68 with HEARINGInsert offset folio 594 here 43329A.402
477 


rfrederick on PRODPC68 with HEARINGInsert offset folio 595 here 43329A.403
478 


rfrederick on PRODPC68 with HEARINGInsert offset folio 596 here 43329A.404
479 


rfrederick on PRODPC68 with HEARINGInsert offset folio 597 here 43329A.405
480 


rfrederick on PRODPC68 with HEARINGInsert offset folio 598 here 43329A.406
481 


rfrederick on PRODPC68 with HEARINGInsert offset folio 599 here 43329A.407
482 


rfrederick on PRODPC68 with HEARINGInsert offset folio 600 here 43329A.408
483 


rfrederick on PRODPC68 with HEARINGInsert offset folio 601 here 43329A.409
484 


rfrederick on PRODPC68 with HEARINGInsert offset folio 602 here 43329A.410
485 


rfrederick on PRODPC68 with HEARINGInsert offset folio 603 here 43329A.411
486 


rfrederick on PRODPC68 with HEARINGInsert offset folio 604 here 43329A.412
487 


rfrederick on PRODPC68 with HEARINGInsert offset folio 605 here 43329A.413
488 


rfrederick on PRODPC68 with HEARINGInsert offset folio 606 here 43329A.414
489 


rfrederick on PRODPC68 with HEARINGInsert offset folio 607 here 43329A.415
490 


rfrederick on PRODPC68 with HEARINGInsert offset folio 608 here 43329A.416
491 


rfrederick on PRODPC68 with HEARINGInsert offset folio 609 here 43329A.417
492 


rfrederick on PRODPC68 with HEARINGInsert offset folio 610 here 43329A.418
493 


rfrederick on PRODPC68 with HEARINGInsert offset folio 611 here 43329A.419
494 


rfrederick on PRODPC68 with HEARINGInsert offset folio 612 here 43329A.420
495 


rfrederick on PRODPC68 with HEARINGInsert offset folio 613 here 43329A.421
496 


rfrederick on PRODPC68 with HEARINGInsert offset folio 614 here 43329A.422
497 


rfrederick on PRODPC68 with HEARINGInsert offset folio 615 here 43329A.423
498 


rfrederick on PRODPC68 with HEARINGInsert offset folio 616 here 43329A.424
499 


rfrederick on PRODPC68 with HEARINGInsert offset folio 617 here 43329A.425
500 


rfrederick on PRODPC68 with HEARINGInsert offset folio 618 here 43329A.426
501 


rfrederick on PRODPC68 with HEARINGInsert offset folio 619 here 43329A.427
502 


rfrederick on PRODPC68 with HEARINGInsert offset folio 620 here 43329A.428
503 


rfrederick on PRODPC68 with HEARINGInsert offset folio 621 here 43329A.429
504 


rfrederick on PRODPC68 with HEARINGInsert offset folio 622 here 43329A.430
505 


rfrederick on PRODPC68 with HEARINGInsert offset folio 623 here 43329A.431
506 


rfrederick on PRODPC68 with HEARINGInsert offset folio 624 here 43329A.432
507 


rfrederick on PRODPC68 with HEARINGInsert offset folio 625 here 43329A.433
508 


rfrederick on PRODPC68 with HEARINGInsert offset folio 626 here 43329A.434
509 


rfrederick on PRODPC68 with HEARINGInsert offset folio 627 here 43329A.435
510 


rfrederick on PRODPC68 with HEARINGInsert offset folio 628 here 43329A.436
511 


rfrederick on PRODPC68 with HEARINGInsert offset folio 629 here 43329A.437
512 


rfrederick on PRODPC68 with HEARINGInsert offset folio 630 here 43329A.438
513 


rfrederick on PRODPC68 with HEARINGInsert offset folio 631 here 43329A.439
514 


rfrederick on PRODPC68 with HEARINGInsert offset folio 632 here 43329A.440
515 


rfrederick on PRODPC68 with HEARINGInsert offset folio 633 here 43329A.441
516 


rfrederick on PRODPC68 with HEARINGInsert offset folio 634 here 43329A.442
517 


rfrederick on PRODPC68 with HEARINGInsert offset folio 635 here 43329A.443
518 


rfrederick on PRODPC68 with HEARINGInsert offset folio 636 here 43329A.444
519 


rfrederick on PRODPC68 with HEARINGInsert offset folio 637 here 43329A.445
520 


rfrederick on PRODPC68 with HEARINGInsert offset folio 638 here 43329A.446
521 


rfrederick on PRODPC68 with HEARINGInsert offset folio 639 here 43329A.447
522 


rfrederick on PRODPC68 with HEARINGInsert offset folio 640 here 43329A.448
523 


rfrederick on PRODPC68 with HEARINGInsert offset folio 641 here 43329A.449
524 


rfrederick on PRODPC68 with HEARINGInsert offset folio 642 here 43329A.450
525 


rfrederick on PRODPC68 with HEARINGInsert offset folio 643 here 43329A.451
526 


rfrederick on PRODPC68 with HEARINGInsert offset folio 644 here 43329A.452
527 


rfrederick on PRODPC68 with HEARINGInsert offset folio 645 here 43329A.453
528 


rfrederick on PRODPC68 with HEARINGInsert offset folio 646 here 43329A.454
529 


rfrederick on PRODPC68 with HEARINGInsert offset folio 647 here 43329A.455
530 


rfrederick on PRODPC68 with HEARINGInsert offset folio 648 here 43329A.456
531 


rfrederick on PRODPC68 with HEARINGInsert offset folio 649 here 43329A.457
532 


rfrederick on PRODPC68 with HEARINGInsert offset folio 650 here 43329A.458
533 


rfrederick on PRODPC68 with HEARINGInsert offset folio 651 here 43329A.459
534 


rfrederick on PRODPC68 with HEARINGInsert offset folio 652 here 43329A.460
535 


rfrederick on PRODPC68 with HEARINGInsert offset folio 653 here 43329A.461
536 


rfrederick on PRODPC68 with HEARINGInsert offset folio 654 here 43329A.462
537 


rfrederick on PRODPC68 with HEARINGInsert offset folio 655 here 43329A.463
538 


rfrederick on PRODPC68 with HEARINGInsert offset folio 656 here 43329A.464
539 


rfrederick on PRODPC68 with HEARINGInsert offset folio 657 here 43329A.465
540 


rfrederick on PRODPC68 with HEARINGInsert offset folio 658 here 43329A.466
541 


rfrederick on PRODPC68 with HEARINGInsert offset folio 659 here 43329A.467
542 


rfrederick on PRODPC68 with HEARINGInsert offset folio 660 here 43329A.468
543 


rfrederick on PRODPC68 with HEARINGInsert offset folio 661 here 43329A.469
544 


rfrederick on PRODPC68 with HEARINGInsert offset folio 662 here 43329A.470
545 


rfrederick on PRODPC68 with HEARINGInsert offset folio 663 here 43329A.471
546 


rfrederick on PRODPC68 with HEARINGInsert offset folio 664 here 43329A.472
547 


rfrederick on PRODPC68 with HEARINGInsert offset folio 665 here 43329A.473
548 


rfrederick on PRODPC68 with HEARINGInsert offset folio 666 here 43329A.474
549 


rfrederick on PRODPC68 with HEARINGInsert offset folio 667 here 43329A.475
550 


rfrederick on PRODPC68 with HEARINGInsert offset folio 668 here 43329A.476
551 


rfrederick on PRODPC68 with HEARINGInsert offset folio 669 here 43329A.477
552 


rfrederick on PRODPC68 with HEARINGInsert offset folio 670 here 43329A.478
553 


rfrederick on PRODPC68 with HEARINGInsert offset folio 671 here 43329A.479
554 


rfrederick on PRODPC68 with HEARINGInsert offset folio 672 here 43329A.480
555 


rfrederick on PRODPC68 with HEARINGInsert offset folio 673 here 43329A.481
556 


rfrederick on PRODPC68 with HEARINGInsert offset folio 674 here 43329A.482
557 


rfrederick on PRODPC68 with HEARINGInsert offset folio 675 here 43329A.483
558 


rfrederick on PRODPC68 with HEARINGInsert offset folio 676 here 43329A.484
559 


rfrederick on PRODPC68 with HEARINGInsert offset folio 677 here 43329A.485
560 


rfrederick on PRODPC68 with HEARINGInsert offset folio 678 here 43329A.486
561 


rfrederick on PRODPC68 with HEARINGInsert offset folio 679 here 43329A.487
562 


rfrederick on PRODPC68 with HEARINGInsert offset folio 680 here 43329A.488
563 


rfrederick on PRODPC68 with HEARINGInsert offset folio 681 here 43329A.489
564 


rfrederick on PRODPC68 with HEARINGInsert offset folio 682 here 43329A.490
565 


rfrederick on PRODPC68 with HEARINGInsert offset folio 683 here 43329A.491
566 


rfrederick on PRODPC68 with HEARINGInsert offset folio 684 here 43329A.492
567 


rfrederick on PRODPC68 with HEARINGInsert offset folio 685 here 43329A.493
568 


rfrederick on PRODPC68 with HEARINGInsert offset folio 686 here 43329A.494
569 


rfrederick on PRODPC68 with HEARINGInsert offset folio 687 here 43329A.495
570 


rfrederick on PRODPC68 with HEARINGInsert offset folio 688 here 43329A.496
571 


rfrederick on PRODPC68 with HEARINGInsert offset folio 689 here 43329A.497
572 


rfrederick on PRODPC68 with HEARINGInsert offset folio 690 here 43329A.498
573 


rfrederick on PRODPC68 with HEARINGInsert offset folio 691 here 43329A.499
574 


rfrederick on PRODPC68 with HEARINGInsert offset folio 692 here 43329A.500
575 


rfrederick on PRODPC68 with HEARINGInsert offset folio 693 here 43329A.501
576 


rfrederick on PRODPC68 with HEARINGInsert offset folio 694 here 43329A.502
577 


rfrederick on PRODPC68 with HEARINGInsert offset folio 695 here 43329A.503
578 


rfrederick on PRODPC68 with HEARINGInsert offset folio 696 here 43329A.504
579 


rfrederick on PRODPC68 with HEARINGInsert offset folio 697 here 43329A.505
580 


rfrederick on PRODPC68 with HEARINGInsert offset folio 698 here 43329A.506
581 


rfrederick on PRODPC68 with HEARINGInsert offset folio 699 here 43329A.507
582 


rfrederick on PRODPC68 with HEARINGInsert offset folio 700 here 43329A.508
583 


rfrederick on PRODPC68 with HEARINGInsert offset folio 701 here 43329A.509
584 


rfrederick on PRODPC68 with HEARINGInsert offset folio 702 here 43329A.510
585 


rfrederick on PRODPC68 with HEARINGInsert offset folio 703 here 43329A.511
586 


rfrederick on PRODPC68 with HEARINGInsert offset folio 704 here 43329A.512
587 


rfrederick on PRODPC68 with HEARINGInsert offset folio 705 here 43329A.513
588 


rfrederick on PRODPC68 with HEARINGInsert offset folio 706 here 43329A.514
589 


rfrederick on PRODPC68 with HEARINGInsert offset folio 707 here 43329A.515
590 


rfrederick on PRODPC68 with HEARINGInsert offset folio 708 here 43329A.516
591 


rfrederick on PRODPC68 with HEARINGInsert offset folio 709 here 43329A.517
592 


rfrederick on PRODPC68 with HEARINGInsert offset folio 710 here 43329A.518
593 


rfrederick on PRODPC68 with HEARINGInsert offset folio 711 here 43329A.519
594 


rfrederick on PRODPC68 with HEARINGInsert offset folio 712 here 43329A.520
595 


rfrederick on PRODPC68 with HEARINGInsert offset folio 713 here 43329A.521
596 


rfrederick on PRODPC68 with HEARINGInsert offset folio 714 here 43329A.522
597 


rfrederick on PRODPC68 with HEARINGInsert offset folio 715 here 43329A.523
598 


rfrederick on PRODPC68 with HEARINGInsert offset folio 716 here 43329A.524
599 


rfrederick on PRODPC68 with HEARINGInsert offset folio 717 here 43329A.525
600 


rfrederick on PRODPC68 with HEARINGInsert offset folio 718 here 43329A.526
601 


rfrederick on PRODPC68 with HEARINGInsert offset folio 719 here 43329A.527
602 


rfrederick on PRODPC68 with HEARINGInsert offset folio 720 here 43329A.528
603 


rfrederick on PRODPC68 with HEARINGInsert offset folio 721 here 43329A.529
604 


rfrederick on PRODPC68 with HEARINGInsert offset folio 722 here 43329A.530
605 


rfrederick on PRODPC68 with HEARINGInsert offset folio 723 here 43329A.531
606 


rfrederick on PRODPC68 with HEARINGInsert offset folio 724 here 43329A.532
607 


rfrederick on PRODPC68 with HEARINGInsert offset folio 725 here 43329A.533
608 


rfrederick on PRODPC68 with HEARINGInsert offset folio 726 here 43329A.534
609 


rfrederick on PRODPC68 with HEARINGInsert offset folio 727 here 43329A.535
610 


rfrederick on PRODPC68 with HEARINGInsert offset folio 728 here 43329A.536
611 


rfrederick on PRODPC68 with HEARINGInsert offset folio 729 here 43329A.537
612 


rfrederick on PRODPC68 with HEARINGInsert offset folio 730 here 43329A.538
613 


rfrederick on PRODPC68 with HEARINGInsert offset folio 731 here 43329A.539
614 


rfrederick on PRODPC68 with HEARINGInsert offset folio 732 here 43329A.540
615 


rfrederick on PRODPC68 with HEARINGInsert offset folio 733 here 43329A.541
616 


rfrederick on PRODPC68 with HEARINGInsert offset folio 734 here 43329A.542
617 


rfrederick on PRODPC68 with HEARINGInsert offset folio 735 here 43329A.543
618 


rfrederick on PRODPC68 with HEARINGInsert offset folio 736 here 43329A.544
619 


rfrederick on PRODPC68 with HEARINGInsert offset folio 737 here 43329A.545
620 


rfrederick on PRODPC68 with HEARINGInsert offset folio 738 here 43329A.546
621 


rfrederick on PRODPC68 with HEARINGInsert offset folio 739 here 43329A.547
622 


rfrederick on PRODPC68 with HEARINGInsert offset folio 740 here 43329A.548
623 


rfrederick on PRODPC68 with HEARINGInsert offset folio 741 here 43329A.549
624 


rfrederick on PRODPC68 with HEARINGInsert offset folio 742 here 43329A.550
625 


rfrederick on PRODPC68 with HEARINGInsert offset folio 743 here 43329A.551
626 


rfrederick on PRODPC68 with HEARINGInsert offset folio 744 here 43329A.552
627 


rfrederick on PRODPC68 with HEARINGInsert offset folio 745 here 43329A.553
628 


rfrederick on PRODPC68 with HEARINGInsert offset folio 746 here 43329A.554
629 


rfrederick on PRODPC68 with HEARINGInsert offset folio 747 here 43329A.555
630 


rfrederick on PRODPC68 with HEARINGInsert offset folio 748 here 43329A.556
631 


rfrederick on PRODPC68 with HEARINGInsert offset folio 749 here 43329A.557
632 


rfrederick on PRODPC68 with HEARINGInsert offset folio 750 here 43329A.558
633 


rfrederick on PRODPC68 with HEARINGInsert offset folio 751 here 43329A.559
634 


rfrederick on PRODPC68 with HEARINGInsert offset folio 752 here 43329A.560
635 


rfrederick on PRODPC68 with HEARINGInsert offset folio 753 here 43329A.561
636 


rfrederick on PRODPC68 with HEARINGInsert offset folio 754 here 43329A.562
637 


rfrederick on PRODPC68 with HEARINGInsert offset folio 755 here 43329A.563
638 


rfrederick on PRODPC68 with HEARINGInsert offset folio 756 here 43329A.564
639 


rfrederick on PRODPC68 with HEARINGInsert offset folio 757 here 43329A.565
640 


rfrederick on PRODPC68 with HEARINGInsert offset folio 758 here 43329A.566
641 


rfrederick on PRODPC68 with HEARINGInsert offset folio 759 here 43329A.567
642 


rfrederick on PRODPC68 with HEARINGInsert offset folio 760 here 43329A.568
643 


rfrederick on PRODPC68 with HEARINGInsert offset folio 761 here 43329A.569
644 


rfrederick on PRODPC68 with HEARINGInsert offset folio 762 here 43329A.570
645 


rfrederick on PRODPC68 with HEARINGInsert offset folio 763 here 43329A.571
646 


rfrederick on PRODPC68 with HEARINGInsert offset folio 764 here 43329A.572
647 


rfrederick on PRODPC68 with HEARINGInsert offset folio 765 here 43329A.573
648 


rfrederick on PRODPC68 with HEARINGInsert offset folio 766 here 43329A.574
649 


rfrederick on PRODPC68 with HEARINGInsert offset folio 767 here 43329A.575
650 


rfrederick on PRODPC68 with HEARINGInsert offset folio 768 here 43329A.576
651 


rfrederick on PRODPC68 with HEARINGInsert offset folio 769 here 43329A.577
652 


rfrederick on PRODPC68 with HEARINGInsert offset folio 770 here 43329A.578
653 


rfrederick on PRODPC68 with HEARINGInsert offset folio 771 here 43329A.579
654 


rfrederick on PRODPC68 with HEARINGInsert offset folio 772 here 43329A.580
655 


rfrederick on PRODPC68 with HEARINGInsert offset folio 773 here 43329A.581
656 


rfrederick on PRODPC68 with HEARINGInsert offset folio 774 here 43329A.582
657 


rfrederick on PRODPC68 with HEARINGInsert offset folio 775 here 43329A.583
658 


rfrederick on PRODPC68 with HEARINGInsert offset folio 776 here 43329A.584
659 


rfrederick on PRODPC68 with HEARINGInsert offset folio 777 here 43329A.585
660 


rfrederick on PRODPC68 with HEARINGInsert offset folio 778 here 43329A.586
661 


rfrederick on PRODPC68 with HEARINGInsert offset folio 779 here 43329A.587
662 


rfrederick on PRODPC68 with HEARINGInsert offset folio 780 here 43329A.588
663 


rfrederick on PRODPC68 with HEARINGInsert offset folio 781 here 43329A.589
664 


rfrederick on PRODPC68 with HEARINGInsert offset folio 782 here 43329A.590
665 


rfrederick on PRODPC68 with HEARINGInsert offset folio 783 here 43329A.591
666 


rfrederick on PRODPC68 with HEARINGInsert offset folio 784 here 43329A.592
667 


rfrederick on PRODPC68 with HEARINGInsert offset folio 785 here 43329A.593
668 


rfrederick on PRODPC68 with HEARINGInsert offset folio 786 here 43329A.594
669 


rfrederick on PRODPC68 with HEARINGInsert offset folio 787 here 43329A.595
670 


rfrederick on PRODPC68 with HEARINGInsert offset folio 788 here 43329A.596
671 


rfrederick on PRODPC68 with HEARINGInsert offset folio 789 here 43329A.597
672 


rfrederick on PRODPC68 with HEARINGInsert offset folio 790 here 43329A.598
673 


rfrederick on PRODPC68 with HEARINGInsert offset folio 791 here 43329A.599
674 


rfrederick on PRODPC68 with HEARINGInsert offset folio 792 here 43329A.600
675 


rfrederick on PRODPC68 with HEARINGInsert offset folio 793 here 43329A.601
676 


rfrederick on PRODPC68 with HEARINGInsert offset folio 794 here 43329A.602
677 


rfrederick on PRODPC68 with HEARINGInsert offset folio 795 here 43329A.603
678 


rfrederick on PRODPC68 with HEARINGInsert offset folio 796 here 43329A.604
679 


rfrederick on PRODPC68 with HEARINGInsert offset folio 797 here 43329A.605
680 


rfrederick on PRODPC68 with HEARINGInsert offset folio 798 here 43329A.606
681 


rfrederick on PRODPC68 with HEARINGInsert offset folio 799 here 43329A.607
682 


rfrederick on PRODPC68 with HEARINGInsert offset folio 800 here 43329A.608
683 


rfrederick on PRODPC68 with HEARINGInsert offset folio 801 here 43329A.609
684 


rfrederick on PRODPC68 with HEARINGInsert offset folio 802 here 43329A.610
685 


rfrederick on PRODPC68 with HEARINGInsert offset folio 803 here 43329A.611
686 


rfrederick on PRODPC68 with HEARINGInsert offset folio 804 here 43329A.612
687 


rfrederick on PRODPC68 with HEARINGInsert offset folio 805 here 43329A.613
688 


rfrederick on PRODPC68 with HEARINGInsert offset folio 806 here 43329A.614
689 


rfrederick on PRODPC68 with HEARINGInsert offset folio 807 here 43329A.615
690 


rfrederick on PRODPC68 with HEARINGInsert offset folio 808 here 43329A.616
691 


rfrederick on PRODPC68 with HEARINGInsert offset folio 809 here 43329A.617
692 


rfrederick on PRODPC68 with HEARINGInsert offset folio 810 here 43329A.618
693 


rfrederick on PRODPC68 with HEARINGInsert offset folio 811 here 43329A.619
694 


rfrederick on PRODPC68 with HEARINGInsert offset folio 812 here 43329A.620
695 


rfrederick on PRODPC68 with HEARINGInsert offset folio 813 here 43329A.621
696 


rfrederick on PRODPC68 with HEARINGInsert offset folio 814 here 43329A.622
697 


rfrederick on PRODPC68 with HEARINGInsert offset folio 815 here 43329A.623
698 


rfrederick on PRODPC68 with HEARINGInsert offset folio 816 here 43329A.624
699 


rfrederick on PRODPC68 with HEARINGInsert offset folio 817 here 43329A.625
700 


rfrederick on PRODPC68 with HEARINGInsert offset folio 818 here 43329A.626
701 


rfrederick on PRODPC68 with HEARINGInsert offset folio 819 here 43329A.627
702 


rfrederick on PRODPC68 with HEARINGInsert offset folio 820 here 43329A.628
703 


rfrederick on PRODPC68 with HEARINGInsert offset folio 821 here 43329A.629
704 


rfrederick on PRODPC68 with HEARINGInsert offset folio 822 here 43329A.630
705 


rfrederick on PRODPC68 with HEARINGInsert offset folio 823 here 43329A.631
706 


rfrederick on PRODPC68 with HEARINGInsert offset folio 824 here 43329A.632
707 


rfrederick on PRODPC68 with HEARINGInsert offset folio 825 here 43329A.633
708 


rfrederick on PRODPC68 with HEARINGInsert offset folio 826 here 43329A.634
709 


rfrederick on PRODPC68 with HEARINGInsert offset folio 827 here 43329A.635
710 


rfrederick on PRODPC68 with HEARINGInsert offset folio 828 here 43329A.636
711 


rfrederick on PRODPC68 with HEARINGInsert offset folio 829 here 43329A.637
712 


rfrederick on PRODPC68 with HEARINGInsert offset folio 830 here 43329A.638
713 


rfrederick on PRODPC68 with HEARINGInsert offset folio 831 here 43329A.639
714 


rfrederick on PRODPC68 with HEARINGInsert offset folio 832 here 43329A.640
715 


rfrederick on PRODPC68 with HEARINGInsert offset folio 833 here 43329A.641
716 


rfrederick on PRODPC68 with HEARINGInsert offset folio 834 here 43329A.642
717 


rfrederick on PRODPC68 with HEARINGInsert offset folio 835 here 43329A.643
718 


rfrederick on PRODPC68 with HEARINGInsert offset folio 836 here 43329A.644
719 


rfrederick on PRODPC68 with HEARINGInsert offset folio 837 here 43329A.645
720 


rfrederick on PRODPC68 with HEARINGInsert offset folio 838 here 43329A.646
721 


rfrederick on PRODPC68 with HEARINGInsert offset folio 839 here 43329A.647
722 


rfrederick on PRODPC68 with HEARINGInsert offset folio 840 here 43329A.648
723 


rfrederick on PRODPC68 with HEARINGInsert offset folio 841 here 43329A.649
724 


rfrederick on PRODPC68 with HEARINGInsert offset folio 842 here 43329A.650
725 


rfrederick on PRODPC68 with HEARINGInsert offset folio 843 here 43329A.651
726 


rfrederick on PRODPC68 with HEARINGInsert offset folio 844 here 43329A.652
727 


rfrederick on PRODPC68 with HEARINGInsert offset folio 845 here 43329A.653
728 


rfrederick on PRODPC68 with HEARINGInsert offset folio 846 here 43329A.654
729 


rfrederick on PRODPC68 with HEARINGInsert offset folio 847 here 43329A.655
730 


rfrederick on PRODPC68 with HEARINGInsert offset folio 848 here 43329A.656
731 


rfrederick on PRODPC68 with HEARINGInsert offset folio 849 here 43329A.657
732 


rfrederick on PRODPC68 with HEARINGInsert offset folio 850 here 43329A.658
733 


rfrederick on PRODPC68 with HEARINGInsert offset folio 851 here 43329A.659
734 


rfrederick on PRODPC68 with HEARINGInsert offset folio 852 here 43329A.660
735 


rfrederick on PRODPC68 with HEARINGInsert offset folio 853 here 43329A.661
736 


rfrederick on PRODPC68 with HEARINGInsert offset folio 854 here 43329A.662
737 


rfrederick on PRODPC68 with HEARINGInsert offset folio 855 here 43329A.663
738 


rfrederick on PRODPC68 with HEARINGInsert offset folio 856 here 43329A.664
739 


rfrederick on PRODPC68 with HEARINGInsert offset folio 857 here 43329A.665
740 


rfrederick on PRODPC68 with HEARINGInsert offset folio 858 here 43329A.666
741 


rfrederick on PRODPC68 with HEARINGInsert offset folio 859 here 43329A.667
742 


rfrederick on PRODPC68 with HEARINGInsert offset folio 860 here 43329A.668
743 


rfrederick on PRODPC68 with HEARINGInsert offset folio 861 here 43329A.669
744 


rfrederick on PRODPC68 with HEARINGInsert offset folio 862 here 43329A.670
745 


rfrederick on PRODPC68 with HEARINGInsert offset folio 863 here 43329A.671
746 


rfrederick on PRODPC68 with HEARINGInsert offset folio 864 here 43329A.672
747 


rfrederick on PRODPC68 with HEARINGInsert offset folio 865 here 43329A.673
748 


rfrederick on PRODPC68 with HEARINGInsert offset folio 866 here 43329A.674
749 


rfrederick on PRODPC68 with HEARINGInsert offset folio 867 here 43329A.675
750 


rfrederick on PRODPC68 with HEARINGInsert offset folio 868 here 43329A.676
751 


rfrederick on PRODPC68 with HEARINGInsert offset folio 869 here 43329A.677
752 


rfrederick on PRODPC68 with HEARINGInsert offset folio 870 here 43329A.678
753 


rfrederick on PRODPC68 with HEARINGInsert offset folio 871 here 43329A.679
754 


rfrederick on PRODPC68 with HEARINGInsert offset folio 872 here 43329A.680
755 


rfrederick on PRODPC68 with HEARINGInsert offset folio 873 here 43329A.681
756 


rfrederick on PRODPC68 with HEARINGInsert offset folio 874 here 43329A.682
757 


rfrederick on PRODPC68 with HEARINGInsert offset folio 875 here 43329A.683
758 


rfrederick on PRODPC68 with HEARINGInsert offset folio 876 here 43329A.684
759 


rfrederick on PRODPC68 with HEARINGInsert offset folio 877 here 43329A.685
760 


rfrederick on PRODPC68 with HEARINGInsert offset folio 878 here 43329A.686
761 


rfrederick on PRODPC68 with HEARINGInsert offset folio 879 here 43329A.687
762 


rfrederick on PRODPC68 with HEARINGInsert offset folio 880 here 43329A.688
763 


rfrederick on PRODPC68 with HEARINGInsert offset folio 881 here 43329A.689
764 


rfrederick on PRODPC68 with HEARINGInsert offset folio 882 here 43329A.690
765 


rfrederick on PRODPC68 with HEARINGInsert offset folio 883 here 43329A.691
766 


rfrederick on PRODPC68 with HEARINGInsert offset folio 884 here 43329A.692
767 


rfrederick on PRODPC68 with HEARINGInsert offset folio 885 here 43329A.693
768 


rfrederick on PRODPC68 with HEARINGInsert offset folio 886 here 43329A.694
769 


rfrederick on PRODPC68 with HEARINGInsert offset folio 887 here 43329A.695
770 


rfrederick on PRODPC68 with HEARINGInsert offset folio 888 here 43329A.696
771 


rfrederick on PRODPC68 with HEARINGInsert offset folio 889 here 43329A.697
772 


rfrederick on PRODPC68 with HEARINGInsert offset folio 890 here 43329A.698
773 


rfrederick on PRODPC68 with HEARINGInsert offset folio 891 here 43329A.699
774 


rfrederick on PRODPC68 with HEARINGInsert offset folio 892 here 43329A.700
775 


rfrederick on PRODPC68 with HEARINGInsert offset folio 893 here 43329A.701
776 


rfrederick on PRODPC68 with HEARINGInsert offset folio 894 here 43329A.702
777 


rfrederick on PRODPC68 with HEARINGInsert offset folio 895 here 43329A.703
778 


rfrederick on PRODPC68 with HEARINGInsert offset folio 896 here 43329A.704
779 


rfrederick on PRODPC68 with HEARINGInsert offset folio 897 here 43329A.705
780 


rfrederick on PRODPC68 with HEARINGInsert offset folio 898 here 43329A.706
781 


rfrederick on PRODPC68 with HEARINGInsert offset folio 899 here 43329A.707
782 


rfrederick on PRODPC68 with HEARINGInsert offset folio 900 here 43329A.708
783 


rfrederick on PRODPC68 with HEARINGInsert offset folio 901 here 43329A.709
784 


rfrederick on PRODPC68 with HEARINGInsert offset folio 902 here 43329A.710
785 


rfrederick on PRODPC68 with HEARINGInsert offset folio 903 here 43329A.711
786 


rfrederick on PRODPC68 with HEARINGInsert offset folio 904 here 43329A.712
787 


rfrederick on PRODPC68 with HEARINGInsert offset folio 905 here 43329A.713
788 


rfrederick on PRODPC68 with HEARINGInsert offset folio 906 here 43329A.714
789 


rfrederick on PRODPC68 with HEARINGInsert offset folio 907 here 43329A.715
790 


rfrederick on PRODPC68 with HEARINGInsert offset folio 908 here 43329A.716
791 


rfrederick on PRODPC68 with HEARINGInsert offset folio 909 here 43329A.717
792 


rfrederick on PRODPC68 with HEARINGInsert offset folio 910 here 43329A.718
793 


rfrederick on PRODPC68 with HEARINGInsert offset folio 911 here 43329A.719
794 


rfrederick on PRODPC68 with HEARINGInsert offset folio 912 here 43329A.720
795 


rfrederick on PRODPC68 with HEARINGInsert offset folio 913 here 43329A.721
796 


rfrederick on PRODPC68 with HEARINGInsert offset folio 914 here 43329A.722
797 


rfrederick on PRODPC68 with HEARINGInsert offset folio 915 here 43329A.723
798 


rfrederick on PRODPC68 with HEARINGInsert offset folio 916 here 43329A.724
799 


rfrederick on PRODPC68 with HEARINGInsert offset folio 917 here 43329A.725
800 


rfrederick on PRODPC68 with HEARINGInsert offset folio 918 here 43329A.726
801 


rfrederick on PRODPC68 with HEARINGInsert offset folio 919 here 43329A.727
802 


rfrederick on PRODPC68 with HEARINGInsert offset folio 920 here 43329A.728
803 


rfrederick on PRODPC68 with HEARINGInsert offset folio 921 here 43329A.729
804 


rfrederick on PRODPC68 with HEARINGInsert offset folio 922 here 43329A.730
805 


rfrederick on PRODPC68 with HEARINGInsert offset folio 923 here 43329A.731
806 


rfrederick on PRODPC68 with HEARINGInsert offset folio 924 here 43329A.732
807 


rfrederick on PRODPC68 with HEARINGInsert offset folio 925 here 43329A.733
808 


rfrederick on PRODPC68 with HEARINGInsert offset folio 926 here 43329A.734
809 


rfrederick on PRODPC68 with HEARINGInsert offset folio 927 here 43329A.735
810 


rfrederick on PRODPC68 with HEARINGInsert offset folio 928 here 43329A.736
811 


rfrederick on PRODPC68 with HEARINGInsert offset folio 929 here 43329A.737
812 


rfrederick on PRODPC68 with HEARINGInsert offset folio 930 here 43329A.738
813 


rfrederick on PRODPC68 with HEARINGInsert offset folio 931 here 43329A.739
814 


rfrederick on PRODPC68 with HEARINGInsert offset folio 932 here 43329A.740
815 


rfrederick on PRODPC68 with HEARINGInsert offset folio 933 here 43329A.741
816 


rfrederick on PRODPC68 with HEARINGInsert offset folio 934 here 43329A.742
817 


rfrederick on PRODPC68 with HEARINGInsert offset folio 935 here 43329A.743
818 


rfrederick on PRODPC68 with HEARINGInsert offset folio 936 here 43329A.744
819 


rfrederick on PRODPC68 with HEARINGInsert offset folio 937 here 43329A.745
820 


rfrederick on PRODPC68 with HEARINGInsert offset folio 938 here 43329A.746
821 


rfrederick on PRODPC68 with HEARINGInsert offset folio 939 here 43329A.747
822 


rfrederick on PRODPC68 with HEARINGInsert offset folio 940 here 43329A.748
823 


rfrederick on PRODPC68 with HEARINGInsert offset folio 941 here 43329A.749
824 


rfrederick on PRODPC68 with HEARINGInsert offset folio 942 here 43329A.750
825 


rfrederick on PRODPC68 with HEARINGInsert offset folio 943 here 43329A.751
826 


rfrederick on PRODPC68 with HEARINGInsert offset folio 944 here 43329A.752
827 


rfrederick on PRODPC68 with HEARINGInsert offset folio 945 here 43329A.753
828 


rfrederick on PRODPC68 with HEARINGInsert offset folio 946 here 43329A.754
829 


rfrederick on PRODPC68 with HEARINGInsert offset folio 947 here 43329A.755
830 


rfrederick on PRODPC68 with HEARINGInsert offset folio 948 here 43329A.756
831 


rfrederick on PRODPC68 with HEARINGInsert offset folio 949 here 43329A.757
832 


rfrederick on PRODPC68 with HEARINGInsert offset folio 950 here 43329A.758
833 


rfrederick on PRODPC68 with HEARINGInsert offset folio 951 here 43329A.759
834 


rfrederick on PRODPC68 with HEARINGInsert offset folio 952 here 43329A.760
835 


rfrederick on PRODPC68 with HEARINGInsert offset folio 953 here 43329A.761
836 


rfrederick on PRODPC68 with HEARINGInsert offset folio 954 here 43329A.762
837 


rfrederick on PRODPC68 with HEARINGInsert offset folio 955 here 43329A.763
838 


rfrederick on PRODPC68 with HEARINGInsert offset folio 956 here 43329A.764
839 


rfrederick on PRODPC68 with HEARINGInsert offset folio 957 here 43329A.765
840 


rfrederick on PRODPC68 with HEARINGInsert offset folio 958 here 43329A.766
841 


rfrederick on PRODPC68 with HEARINGInsert offset folio 959 here 43329A.767
842 


rfrederick on PRODPC68 with HEARINGInsert offset folio 960 here 43329A.768
843 


rfrederick on PRODPC68 with HEARINGInsert offset folio 961 here 43329A.769
844 


rfrederick on PRODPC68 with HEARINGInsert offset folio 962 here 43329A.770
845 


rfrederick on PRODPC68 with HEARINGInsert offset folio 963 here 43329A.771
846 


rfrederick on PRODPC68 with HEARINGInsert offset folio 964 here 43329A.772
847 


rfrederick on PRODPC68 with HEARINGInsert offset folio 965 here 43329A.773
848 


rfrederick on PRODPC68 with HEARINGInsert offset folio 966 here 43329A.774
849 


rfrederick on PRODPC68 with HEARINGInsert offset folio 967 here 43329A.775
850 


rfrederick on PRODPC68 with HEARINGInsert offset folio 968 here 43329A.776
851 


rfrederick on PRODPC68 with HEARINGInsert offset folio 969 here 43329A.777
852 


rfrederick on PRODPC68 with HEARINGInsert offset folio 970 here 43329A.778
853 


rfrederick on PRODPC68 with HEARINGInsert offset folio 971 here 43329A.779
854 


rfrederick on PRODPC68 with HEARINGInsert offset folio 972 here 43329A.780
855 


rfrederick on PRODPC68 with HEARINGInsert offset folio 973 here 43329A.781
856 


rfrederick on PRODPC68 with HEARINGInsert offset folio 974 here 43329A.782
857 


rfrederick on PRODPC68 with HEARINGInsert offset folio 975 here 43329A.783
858 


rfrederick on PRODPC68 with HEARINGInsert offset folio 976 here 43329A.784
859 


rfrederick on PRODPC68 with HEARINGInsert offset folio 977 here 43329A.785
860 


rfrederick on PRODPC68 with HEARINGInsert offset folio 978 here 43329A.786
861 


rfrederick on PRODPC68 with HEARINGInsert offset folio 979 here 43329A.787
862 


rfrederick on PRODPC68 with HEARINGInsert offset folio 980 here 43329A.788
863 


rfrederick on PRODPC68 with HEARINGInsert offset folio 981/1500 here 43329A.789
(i) 


smartinez on PROD1PC64 with HEARINGInsert graphic folio 001 here 43329.001
ii 


smartinez on PROD1PC64 with HEARINGInsert graphic folio 002 here 43329.002
iii 


smartinez on PROD1PC64 with HEARINGInsert graphic folio 003 here 43329.003
iv 


smartinez on PROD1PC64 with HEARINGInsert graphic folio 004 here 43329.004
(v) 


smartinez on PROD1PC64 with HEARINGInsert graphic folio 005 here 43329.005
vi 


smartinez on PROD1PC64 with HEARINGInsert graphic folio 006 here 43329.006
vii 


smartinez on PROD1PC64 with HEARINGInsert graphic folio 007 here 43329.007
viii 


smartinez on PROD1PC64 with HEARINGInsert graphic folio 008 here 43329.008