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78–131 2013

PENDING PUBLIC HEALTH LEGISLATION 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

SEPTEMBER 15, 2010 

Serial No. 111–154 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 


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COMMITTEE ON ENERGY AND COMMERCE 

HENRY A. WAXMAN, California, Chairman 

JOHN D. DINGELL, Michigan 

Chairman Emeritus 

EDWARD J. MARKEY, Massachusetts 

RICK BOUCHER, Virginia 

FRANK PALLONE, JR., New Jersey 

BART GORDON, Tennessee 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

BART STUPAK, Michigan 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

Vice Chairman 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

JANE HARMAN, California 

TOM ALLEN, Maine 

JANICE D. SCHAKOWSKY, Illinois 

CHARLES A. GONZALEZ, Texas 

JAY INSLEE, Washington 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

CHARLIE MELANCON, Louisiana 

JOHN BARROW, Georgia 

BARON P. HILL, Indiana 

DORIS O. MATSUI, California 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

CHRISTOPHER S. MURPHY, Connecticut 

ZACHARY T. SPACE, Ohio 

JERRY MCNERNEY, California 

BETTY SUTTON, Ohio 

BRUCE L. BRALEY, Iowa 

PETER WELCH, Vermont 

JOE BARTON, Texas 

Ranking Member 

RALPH M. HALL, Texas 

FRED UPTON, Michigan 

CLIFF STEARNS, Florida 

NATHAN DEAL, Georgia 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOHN B. SHADEGG, Arizona 

ROY BLUNT, Missouri 

STEVE BUYER, Indiana 

GEORGE RADANOVICH, California 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO MACK, California 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 


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SUBCOMMITTEE ON HEALTH

FRANK PALLONE, JR., New Jersey, Chairman 

JOHN D. DINGELL, Michigan 

BART GORDON, Tennessee 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

JANICE D. SCHAKOWSKY, Illinois 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

JANE HARMAN, California 

CHARLES A. GONZALEZ, Texas 

JOHN BARROW, Georgia 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

CHRISTOPHER S. MURPHY, Connecticut 

ZACHARY T. SPACE, Ohio 

BETTY SUTTON, Ohio 

BRUCE L. BRALEY, Iowa 

NATHAN DEAL, Georgia, 

Ranking Member 

RALPH M. HALL, Texas 

BARBARA CUBIN, Wyoming 

JOHN B. SHADEGG, Arizona 

STEVE BUYER, Indiana 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO MACK, California 

MIKE FERGUSON, New Jersey 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 


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C O N T E N T S 

Page 

Hon. Frank Pallone, Jr., a Representative in Congress from the State of 

New Jersey, opening statement .......................................................................... 1 

Hon. John Shimkus, a Representative in Congress from the State of Illinois, 

opening statement ................................................................................................ 2 

Hon. Gene Green, a Representative in Congress from the State of Texas, 

opening statement ................................................................................................ 3 

Hon. Lois Capps, a Representative in Congress from the State of California, 

opening statement ................................................................................................ 4 

Hon. Tammy Baldwin, a Representative in Congress from the State of Wisconsin, opening statement ................................................................................... 5 

Hon. Janice D. Schakowsky, a Representative in Congress from the State 

of Illinois, opening statement .............................................................................. 5 

Hon. Zachary T. Space, a Representative in Congress from the State of 

Ohio, opening statement ...................................................................................... 6 

Hon. John D. Dingell, a Representative in Congress from the State of Michigan, opening statement ....................................................................................... 55 

Hon. Joe Barton, a Representative in Congress from the State of Texas, 

opening statement ................................................................................................ 56 

WITNESSES

Lawrence Tabak, Principal Deputy Director, National Institutes of Health 

(NIH), U.S. Department of Health and Human Services ................................. 7 

Prepared statement .......................................................................................... 9 

Ileana Arias, Principal Deputy Director, Centers for Disease Control and 

Prevention (CDC), U.S. Department of Health and Human Services ............. 17 

Prepared statement .......................................................................................... 20 

Marcia Brand, Deputy Administrator, Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services ............... 29 

Prepared statement .......................................................................................... 31 

SUBMITTED MATERIAL

Committee memorandum ........................................................................................ 61 


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PENDING PUBLIC HEALTH LEGISLATION 

WEDNESDAY, SEPTEMBER 15, 2010 

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON HEALTH, COMMITTEE ON ENERGY AND COMMERCE, Washington, DC. 

The Subcommittee met, pursuant to call, at 4:02 p.m., in Room 

2123 of the Rayburn House Office Building, Hon. Frank Pallone, 

Jr. [Chairman of the Subcommittee] presiding. 

Members present: Representatives Pallone, Engel, Green, 

DeGette, Capps, Schakowsky, Baldwin, Barrow, Space, Matsui, 

Shimkus, Pitts, and Burgess. 

Staff present: Ruth Katz, Chief Public Health Counsel; Sarah 

Despres, Counsel; Purvee Kempf, Counsel; Naomi Seiler, Counsel; 

Katie Campbell, Professional Staff Member; Stephen Cha, Professional Staff Member; Emily Gibbons, Professional Staff Member; 

Virgil Miller, Professional Staff Member; Anne Morris, Professional 

Staff Member; Alvin Banks, Special Assistant; Clay Alspach, Minority Counsel, Health; and Ryan Long, Minority Chief Counsel, 

Health. 

OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY 

Mr. PALLONE. I call the meeting of the House subcommittee to 

order, and today we are having a hearing on a number of public 

health bills that are priorities of our committee members, so I will 

recognize myself for an opening statement. 

Given that this is the second hearing of the day, I am going to 

keep my remarks very brief so we can hear from the witnesses 

from the Department of Health and Human Services. I do want to 

express my gratitude to HHS, not only for providing helpful feedback and comments on the bills we plan to consider this week, but 

also for their flexibility with this hearing. The hearing was originally scheduled for yesterday, but the witnesses for HHS agreed to 

testify today, late in the day, to accommodate members’ schedules. 

We truly appreciate your true commitment to be accessible and 

available to the Energy and Commerce Committee, and look forward to your testimony. 

The legislation that you—that Health and Human Services will 

be commenting on today encompasses a broad number of public 

health priorities that will strengthen and enhance research-related 

pediatrics, heart diseases, multiple sclerosis, scleroderma, bone 

marrow failure, and cancer. Research and treatment is informed by 


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strong data, and so HHS will also comment today on legislation to 

improve the collection of data for health disparities. 

Finally, we will hear from the Department on the critical services 

that public health veterinarians provide in our communities to protect the public health. Congresswoman Tammy Baldwin and I have 

worked together on legislation to promote an adequate supply of 

public health veterinarians who work in subject areas that have an 

impact on human health by assuring access to grants and loans. 

I am pleased that our staff and the minority are finalizing consensus language on this shared goal. I would like to ask unanimous 

consent to enter into the record a letter from the Association of 

American Veterinary Medical Colleges, and the American Veterinary Medical Association on the revised version of H.R. 2999. 

Without objection, so ordered. 

[The information was unavailable at the time of printing.] 

[The Committee memorandum follows:] 

Mr. PALLONE. And I will yield to our ranking member, Mr. Shimkus. 

OPENING STATEMENT OF HON. JOHN SHIMKUS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS 

Mr. SHIMKUS. Thank you, Mr. Chairman. As I promised this 

morning, we would also just put on the record that we appreciate 

the folks from Health and Human Services showing up. We are 

still anxiously awaiting the presence of the secretary to help us discern her intentions on the healthcare law. It has been a long time 

since it has now been passed into the law, and she is involved in 

the administration of that. Numerous letters—and we would like to 

at least start addressing some of those issues, especially those that 

we know need to be fixed. We know there are provisions that need 

to be fixed. There are bipartisan discussions on both sides, and we 

should be about that business. 

But since that is not going to happen anytime soon, I want to 

thank you for also moving this to a time when members have no 

excuse for not being here. So if they are not here, they are absent. 

Fly-in days are a different position by most members, especially in 

this environment. At least now we can hold them accountable for 

not showing, because we all should be here. Again, I thank you for 

changing your schedule. 

We have been working hard on this whole list of 20 or so bills, 

and we are making great headway in trying to move these expeditiously. I am just going to lay out some of the general concerns. 

Spending in our national government is a primary concern of the 

population out there, I mean, at least in my district, and I think 

it is safe to say across the country. You can’t spend money, theoretically, by the civics books if you don’t authorize. Anytime you increase authorizations, you increase the ability to spend more 

money. So having said that, the compelling arguments increasing 

authorizations better be compelling. I hope to move, eventually, to 

a time when instead of having offsets, we move to auth-sets where 

we take an authorization and we remove one that doesn’t really 

hold water or isn’t applicable anymore. That would be a good signal 

to the public that we are not only trying to move government 

spending where it should go, but we are also recognizing the fact 


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that we probably authorize spending and spend money in inappropriate ways. 

What some of the negotiations are is looking at authorization levels and inflationary adjustments, and I think—in those areas I 

think we can get to some agreement. Some bills talk about additional granting to states. That is going to be a problem in this environment, getting Republican support for additional spending. 

I will end, there is also some that tread very close to abortion 

discussions and high amendment issues. We would think that that 

would not be helpful in moving bipartisan bills to the floor. 

With that, Mr. Chairman, I will stop and I will yield back my 

time. 

Mr. PALLONE. Thank you, Mr. Shimkus. We have some other 

members here. Mr.—the gentleman from Georgia, Mr. Barrow, was 

here first. 

Mr. BARROW. I thank the chairman. As Mr. Shimkus says, I have 

no excuse not to be here, but I have nothing to add to what has 

been said to set the table for our discussion here today, so I will 

waive an opening. Thank you. 

Mr. PALLONE. Thank you. And we have Mr. Green from Texas. 

OPENING STATEMENT OF HON. GENE GREEN, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. GREEN. Thank you, Mr. Chairman, and I have to admit, I 

wasn’t listening to my colleague from Illinois. I was actually outside, and I am glad I am here and present. 

I want to thank you for holding the hearing today on several 

pieces of healthcare legislation pending before the committee. I am 

a strong supporter and cosponsor of many of the bills, and I am 

glad we are moving these bills to the legislative process. 

I don’t want to take too much time, but I do want to point out 

one piece of legislation we will be discussing today. I have been 

working with Representative Hank Johnson on H.R. 5986, the Neglected Infections of Impoverished Americans Act of 2010 since we 

were marking up the health reform bill, and I included this legislation as an amendment. Recently Chairman Waxman and Representative Gingrey signed on the legislation as original cosponsors, and I would like to thank them for their efforts on the issue. 

H.R. 5986 would require HHS to submit a report to Congress on 

the current state of parasitic diseases that have been overlooked 

among the poorest Americans. The 2008 study by George Washington University and the Saving Vaccine Institute identified high 

prevalence rates of parasitic infections in the poorest areas of the 

United States and along our border regions. Scientists estimate 

there may be as many as 100 million infections and neglected diseases identified in our legislation, including chigas, cystic cirrhosis, 

toxicaras—anyway, there are a whole bunch of them, and I would 

ask for the full statement to be placed into the record. 

These diseases and other neglected diseases of poverty collectively infect over 1.7 billion people around the world, but they disproportionately affect minority and impoverished populations 

across the United States, producing effects ranging from asymptomatic infection to asthma-like symptoms, seizures, and death. 

This study is especially important, because these neglected disVerDate Mar 15 2010 13:23 Apr 04, 2013 Jkt 078131 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 E:\HR\OC\A131.XXX A131

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eases receive less financial support than they deserve. A mere 

$231,730 of research funding was allocated by the NIH since 1995. 

Discrepancy in funding is known as the 10/90 gap. A mere 10 

percent of the global health research dollars is directed towards 

diseases affecting 90 percent of the global population. The Neglected Infections of Impoverished Americans Act of 2010 would 

provide an update evaluation of the current dearth of the knowledge regarding epidemiology in these diseases and the socioeconomic health and development impact they have on our society. 

I want to thank our witnesses for appearing today, and I would 

like to submit two letters of support for H.R. 5986 for the record. 

One letter is from the University of Georgia and the other is from 

the University of South Alabama. Again, thank you, Mr. Chairman. 

I yield back my time. 

Mr. PALLONE. Without objection, so ordered on the two letters. 

[The information was unavailable at the time of printing.] 

Mr. PALLONE. Next is our subcommittee vice chair, Ms. Capps. 

Mrs. CAPPS. Thank you, Mr. Chairman, for holding this hearing. 

I would like also to ask unanimous consent to enter two letters in 

the record, one in support of H.R. 1032, and the other in support 

of H.R. 2941. 

Mr. PALLONE. Without objection, so ordered. 

[The information was unavailable at the time of printing.] 

OPENING STATEMENT OF HON. LOIS CAPPS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Mrs. CAPPS. So I am cosponsor of many of the bills before us 

today, and I urge us to act swiftly to pass them out of committee. 

I want to specifically thank you for including two bills that I have 

sponsored on the agenda. 

The first is H.R. 1032, the HEART for Women Act, which I am 

proud to say has broad bipartisan support, including every single 

Republican and Democratic woman on this committee. It focuses on 

expanding CDC’s WISE WOMAN program, which has been proven 

so effective in ensuring that FDA is evaluating all new drug and 

device applications for how they affect women and men differently. 

Working closely with the majority and the minority committee 

staffs, I feel confident that we have solid changes to this legislation 

that should make it sort of a no-brainer for unanimous passage. 

The other bill is H.R. 2408, the Scleroderma Research and 

Awareness Act, which also has strong bipartisan support and has 

been modified to address concerns of the minority and majority 

alike. H.R. 2408 would promote further NIH research into this debilitating disease and promote public awareness of scleroderma 

through the CDC. 

Thank you again for considering these bills in today’s hearing. I 

look forward to passing them out of committee, and ultimately the 

House. If you wouldn’t mind an additional statement, because unfortunately Congresswoman Eshoo had a family emergency, and I 

would like to voice my support for her legislation, H.R. 211, with 

the strong support of United Way and 251 bipartisan cosponsors, 

the calling for 211 act builds on existing state and local efforts to 

connect people with services and volunteer opportunities. The legislation provides federal matching grants augmenting existing fundVerDate Mar 15 2010 13:23 Apr 04, 2013 Jkt 078131 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 E:\HR\OC\A131.XXX A131

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ing from state and local governments, nonprofits, and the business 

community. With this bill, 211 will finally become a truly national 

system. 

I yield back. 

Mr. PALLONE. Without objection, so ordered. And all members of 

the subcommittee’s statements who desire to enter them into the 

record will be entered in the record without further—without any 

objection. 

The gentlewoman from Wisconsin, Ms. Baldwin. 

OPENING STATEMENT OF HON. TAMMY BALDWIN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF WISCONSIN 

Ms. BALDWIN. Thank you, Mr. Chairman. I have two bills before 

the committee today, and both are deeply important to me and 

many others. I am delighted that the committee is considering 

them. 

H.R. 2999, the Veterinary Public Health Workforce and Education Act, represents a comprehensive solution to ensuring that 

the veterinary public health workforce can meet vital public health 

challenges. We worked across the aisle to draft a manager’s amendment that will serve as a good first step, and help attract and retain more veterinarians into public health careers. I thank you, Mr. 

Chairman, for your support in this effort, as well and my friend 

and colleague from Pennsylvania, Mr. Murphy, who is a key leader 

in this legislation. 

Second, the Health Data Collection Improvement Act would authorize HHS to collect, where practical and appropriate, information on sexual orientation and gender identity for participants in 

health programs and health surveys. This is an issue that I have 

brought to this committee’s attention a number of times over the 

past few years. Currently, no federal health survey or federal 

health program collects data on sexual orientation or gender identity. As a result, we are left with gaping holes in our knowledge 

base on LGBT health. The federal government must have basic information on the health of all Americans in order to help address 

these issues, especially for those who may face discrimination and 

stigma in the healthcare system and outside the healthcare system. 

Again, thank you, Mr. Chairman, for considering these bills. I 

look forward to hearing from our witnesses today. I yield back. 

Mr. PALLONE. Thank you. The gentleman from—the gentlelady 

from Illinois, Ms. Schakowsky, care to make an opening statement? 

OPENING STATEMENT OF HON. JANICE D. SCHAKOWSKY, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS 

Ms. SCHAKOWSKY. Yes. Thank you, Mr. Chairman. I am in support of all of these bills, but I wanted to highlight H.R. 1210, the 

Arthritis Prevention, Control, and Cure Act, and thank its sponsor, 

Representative Eshoo, who couldn’t be here today, for her leadership. She is attending a family funeral. 

Forty-six point three million Americans, including 300,000 children, are living with this painful disease. Arthritis is the number 

one cause of disability in the United States, and costs our economy 


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$130 billion a year. I am cosponsor of H.R. 1210 because it helps 

address those problems, it includes competitive grants to support 

the prevention, control, and surveillance of arthritis, and gives NIH 

the authority to expand research activity surrounding juvenile arthritis. 

I look forward to hearing from our witnesses today, and to consideration and passage, we hope, of the Arthritis Prevention, Control, and Cure Act tomorrow. 

I yield back. 

Mr. PALLONE. Thank you. Gentleman from Ohio, Mr. Space. 

OPENING STATEMENT OF HON. ZACHARY T. SPACE, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF OHIO 

Mr. SPACE. Thank you, Mr. Chairman. I appreciate your efforts 

in holding this hearing on a number of important bills. 

Today, our subcommittee is taking into consideration a number 

of bills focused on improving public health efforts in our Nation, 

and addressing public health is no simple task right now. Childhood obesity rates are on the rise, diabetes is rapidly becoming epidemic. Long story short, there are a number of disturbing trends 

out there that give all of us significant concerns about the future 

of our healthcare system. 

That is why I am extremely pleased that Chairman Pallone has 

offered us today’s hearing as an opportunity to look at one of the 

bills that I have sponsored, along with my colleague from Nebraska, Mr. Terry, H.R. 6012. This legislation is designed to reduce 

the number of seniors in this country with undiagnosed diabetes, 

and it is easy to see why we are doing this. We are spending upwards of $200 billion a year now combating diabetes in all forms. 

That is more money than we spend in Iraq in any given year during our wars. 

Figuring out a way to deal with this in a commonsense way that 

also mitigates the extensive human suffering that accompanies this 

epidemic disease is vital, and I appreciate the opportunity to address it today and take this up tomorrow in the markup. 

I yield back. Thank you, Mr. Chairman. 

Mr. PALLONE. Thank you. I think that is all of the members that 

we have, so we will go to our witnesses. Welcome to the subcommittee hearing. Let me introduce each of you. 

Starting on my left is Dr. Lawrence Tabak, who is Principal Deputy Director of the National Institutes of Health with the U.S. Department of Health and Human Services. 

Then we have Dr. Ileana Arias, who is principal Deputy Director 

of the Centers for Disease Control and Prevention, again with the 

U.S. Department of Health and Human Services. 

Then we have Dr. Marcia Brand, who is Deputy Administrator 

for Health Resources and Services Administration with HHS. 

And then I have—my note here says available for SAMHSA-related questions is H. Westley Clark, who is—oh my. You have so 

many degrees I don’t even know where to begin. You are a doctor, 

M.D., a lawyer, M.P.H., CAS, FASAM, Director of the Center for 

Substance Abuse Treatment, Substance Abuse and Mental Health 

Services Administration at the Department again. 


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So we try to keep it to 5 minutes. Your statements will become 

part of the record. If you want to submit additional written comments, you may. 

I will start with Dr. Tabak. 

STATEMENTS OF LAWRENCE TABAK, PRINCIPAL DEPUTY DIRECTOR, NATIONAL INSTITUTES OF HEALTH (NIH), U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES; ILEANA 

ARIAS, PRINCIPAL DEPUTY DIRECTOR, CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), U.S. DEPARTMENT 

OF HEALTH AND HUMAN SERVICES; AND MARCIA BRAND, 

DEPUTY ADMINISTRATOR, HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA), U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

STATEMENT OF LAWRENCE TABAK 

Dr. TABAK. Mr. Chairman and members of the subcommittee, 

thank you. I am honored to attend this hearing with my colleagues 

to discuss issues relating to legislation pending before this committee today. 

NIH and its research partners, patients and their families, scientists and their research institutions have collaborated to produce 

scientific understanding and medical innovation that has prolonged 

lives, reduced human suffering, and improved the quality of life for 

millions. Due to NIH research, mortality from heart disease and 

stroke has been cut by more than half in the United States. Today’s new cancer therapies arrest the disease and prolong the life 

so cancer survivors number in the millions. Our blood supply is far 

safer because of tests for HIV and hepatitis B and C. 

NIH funded science has also helped people make lifestyle 

changes that promote health, such as eating less fat, exercising 

more and quitting smoking. These are a few examples of NIH funded discovery that have transformed medical care. 

NIH owes much of its success to the advocacy and strong support 

of millions of patients and their families. Historically, NIH has also 

been championed by Congress and has received strong bipartisan 

support. As a community, researchers on the NIH campus and 

around the country are very grateful for such support and are 

mindful of the responsibility we bear to be good stewards of the 

taxpayers’ investment in medical science. 

NIH has also been given the flexibility and indeed, the explicit 

responsibility to exercise the scientific communities’ best collective 

judgment in determining research priorities. These decisions are 

made in a dynamic matrix of scientific opportunity, public health 

needs, burden of disease, and the input and perspective offered by 

patients, their families and advocates, scientists, and public health 

experts. 

First and foremost, NIH must respond to public health needs, 

which are addressed through a complex balance among basic, 

transformative, and clinical sciences. 

Second, NIH applies stringent review provided by outside scientists who are experts in a given field, evaluating the quality of 

all research proposals considered. 


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Third, scientific history has repeatedly demonstrated that significant research advances occur when new findings, often completely 

unexpected, open up new experimental possibilities and pathways. 

Finally, we strive to ensure the diversity of NIH’s research portfolio as we simply cannot predict the next scientific revelation or 

anticipate the next opportunity. 

Having briefly discussed how NIH sets research priorities, I 

would like to review some of the research we are currently conducting in several of the disease areas that are addressed by the 

bills pending before the subcommittee. 

Juvenile idiopathic arthritis has no definitive cause and strikes 

children before they turn 16. The National Institute of Arthritis 

and Musculoskeletal and Skin Diseases funds a broad range of research, from basic studies of underlying mechanisms of arthritis to 

clinical studies exploring new treatment options. Scleroderma is a 

group of diseases in which the connective tissue that supports the 

skin and internal organs grows in a highly abnormal manner. 

NIMS has supported the Scleroderma Family Registry and DNA 

Repository, which has enabled researchers to conduct genome-wide 

association studies of scleroderma, which will provide insight into 

which genes are responsible for susceptibility to scleroderma, and 

which biological pathways may cause organ damage in the disease. 

Children deserve to be born healthy and to achieve their full potential for healthy and productive lives. NIH, led by the National 

Institute of Child Health and Human Development supports the 

bulk of research on normal and abnormal child health and development. The majority of NIH’s institutes and centers include pediatric research in their portfolios. 

Regarding the subcommittee’s interest in type 2 diabetes research for minority populations, NIH primarily through the National Institute of Diabetes and Digestive and Kidney Diseases is 

investing significant resources in multi-faceted research on this disease in minority populations, as well as obesity research. 

Let me conclude by offering the thanks of NIH, the biomedical 

research community, and the millions of American patients and 

their families for your unwavering dedication. I am personally 

grateful for your time and attention this afternoon, and look forward to your questions. 

Thank you. 

[The prepared statement of Dr. Tabak follows:] 


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TESTIMONY OF 

LAWRENCE A. TABAK, D.D.S., PH.D. 

PRINCIPAL DEPUTY DIRECTOR 

NATIONAL INSTITUTES OF HEALTH 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

BEFORE THE 

SUBCOMMITTEE ON HEALTH 

COMMITTEE ON ENERGY AND COMMERCE 

U.S. HOUSE OF REPRESENTATIVES 

SEPTEMBER 14, 2010 

FOR RELEASE UPON DELIVERY 
10 


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Introduction 

Mr. Chairman, Members of the Subcommittee, I am Dr. Lawrence A. Tabak, the 

Principal Deputy Director of the National Institutes of Health (NIH). I am honored to 

attend this hearing with my HHS Operating Division colleagues to offer NIH's technical 

assistance on bills that are currently being considered by the Health Subcommittee. 

I have been Principal Deputy Director of NIH for less than a month, but I have led the 

National Institute of Dental and Craniofacial Research for the past ten years and served as 

NIH Acting Deputy Director in 2008-09. Before joining NIH, I was the Senior Associate 

Dean for Research and Professor of Dentistry and Biochemistry & Biophysics in the 

School of Medicine and Dentistry at the University of Rochester in New York State. I 

have also been an NIH-funded investigator, working in the field of biochemistry to learn 

how some proteins become decorated with specific types of sugars and determine the 

roles played by these sugars. In my NIH lab, my tearn and I have continued to work on 

these questions. 

It is a privilege to represent NIH before you this afternoon. Because of the support of 

members of this Subcommittee, NIH is a multidisciplinary powerhouse of discovery and 

innovation. Nearly 85% of NIH's $31 billion FY 2010 budget is dedicated to research 

grants that involve approximately 325,000 research personnel at some 3,000 institutions 

in each of the 50 states. 

We appreciate the opportunity to discuss issues relating to legislation pending before this 

Committee today. We recognize that you have dedicated time and resources to 

incorporating our technical input, and we thank you for that. 

About the National Institutes of Health 

NIH and its research partners-patients and their families, scientists and their research 

institutions-have collaborated to produce scientific understanding and medical 

innovation that have prolonged lives, reduced human suffering and improved the quality 

oflife for millions. Due in part to NIH research, mortality from heart disease and stroke 

has been cut by more than halfin the U.S. Today's new cancer therapies arrest the 

disease and prolong human life so cancer survivors number in the millions. Our blood 

supply is fur safer because of tests for HIV and hepatitis B and C that arose from NIHfunded research. NIH-funded science has also helped people make lifestyle changes that 

promote health, such as eating less fat, exercising more, and quitting smoking. These few 

examples of NIH-funded discovery and medical innovation have transformed medical 

care. 

Whereas a generation or two ago, much of medicine was palliative care for acute and 

lethal diseases, today we are able to manage formerly fatal disorders as chronic illnesses. 

ln the balance of my testimony, I would like to discuss how the support of Congress has 

allowed NIH the scientific flexibility to pursue these advances, how we will benefit from 

today's scientific opportunities. with that continued support and flexibility and how we 

Testimony of Lawrence A. Tabak, D.D.S., Ph.D., Principal Depnty Director, NIH 

House Energy and Commerce Snbcommittee on Health 

September 14,2010 

Page I 
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are pursuing research initiatives that address conditions mentioned in the bills pending 

before the Subcommittee. 

Congressional Support, Allowing NIH Scientific Flexibility Equals NIH Success 

Support for biomedical research-and the hope of new diagnostics, therapies, and 

cures-is among Americans' strongest shared values. Nlli owes much of its success to 

the advocacy and strong support of millions of patients and their families. 

Historically Nlli has also been championed by Congress, and received strong, bipartisan 

support. As a community, researchers on the NIH campus and around the country are 

grateful for such support-and mindful of the responsibility we bear to be good stewards 

of the taxpayers' investment in medical science. 

Nlli has also been given the flexibility--and indeed the explicit responsibility-to 

exercise the scientific community's best collective judgment in determining research 

priorities. These decisions are made in a dynamic, continually shifting matrix of 

scientific opportunity, public health needs, burdens of disease, and the input, 

consultation, insight and perspective offered by patients and their families, scientists, and 

public health experts and patient advocates. 

Scientific/TeehnologicaI/Interdiseiplinaryffrans-NIH Initiatives 

The opportunities we see in today's multi- and interdisciplinary research and Nlli's transinstitute research initiatives are a further affirmation of scientific flexibility in guiding our 

nation's biomedical research portfolio. Science today is a far more collaborative, multidisciplinary and large-scale enterprise than when I was a newly appointed Assistant 

Professor. 

With the investment of the American people and the support of Congress, we have 

amplified the power of the molecular approach to health and disease over the past couple 

of decades and sparked a revolution in medicine. Advances in research technologies, 

such as high-throughput screening and dramatic new imaging techniques, have further 

accelerated this transformation. As Nlli Director Francis Collins has put it: 

The revolution now sweeping the field is the ability to be comprehensive-for 

example, to define all of the genes of the human or a model organism, all of the 

human proteins and their structures, all of the common variations in the genome, 

all of the major pathways for signal transduction in the cell, all of the patterns of 

gene expression in the brain, all of the steps involved in early development, or all 

of the components of the immune system. Further development of technologies 

in areas such as DNA sequencing, imaging, nanotechnology, proteomics, 

metabolomics, small-molecule screening, and RNA interference are ripe for 

aggressive investment. 1 

1 "Opportunities for Research and NIH," SCience, January 1, 2010. 

Testimony of Lawrence A. Tabak, D.D.S., Ph.D., Principal Deputy Director, NIH 

House Energy and Commerce Subcommittee on Health 

September 14, 2010 

Page 2 
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This technological revolution and the continuing need for interdisciplinary approaches 

have blurred the scientific boundaries among traditional scientific disciplines. On June 

15, Dr. Collins testified before you about the Human Genome Project, the Cancer 

Genome Atlas, and the Alzheimer's Disease Neuroimaging Initiative. These are the 

exciting new initiatives that are possible at this unique moment in our scientific and 

medical history, and promise new ways of understanding human biology and new hope 

for prevention, therapies; and cures. The scientific, medical and technological 

revolutions of today offer the possibility that we can now understand a disease 

comprehensively and raise the hope that we will be able to diagnose, prevent and 

ultimately treat many diseases-even tailoring a therapy for a patient based upon her 

unique genetic makeup. In our era, the era of molecular medicine, we are pursuing 

advances in myriad diseases as scientific opportunity and public health need dictate. 

I would like to offer a few principles that govern NIH research priority setting. 

How NIH Sets Priorities 

First and foremost, NIH must respond to public health needs which are addressed through 

a complex balance between basic, trans formative, and clinical sciences. The incidence, 

severity, cost and sheer human suffering associated with specific disorders are also 

factors in how we set research priorities. 

Secondly, NIH applies stringent review, provided by outside scientists who are experts in 

a given field, in ranking the scientific opportunity and quality of all research proposals 

considered. The rigor of this process is so competitive, and the number of applications is 

so large, that today fewer than one in five research proposals receives NIH funding. 

Even in the past, no more than one in three applications received NIH support. This 

intense competition has always assured that NIH research is of the highest scientific 

quality. 

Thirdly, scientific history has repeatedly demonstrated that significant scientific advances 

occur when new findings, often completely unexpected, open up new experimental 

possibilities and pathways. We are constantly assessing the research portfolio in light of 

what the latest science suggests. Frustratingly, not all disease or scientific problems are 

equally ripe for new advances, nor do such advances come at the same rate across the 

portfolio, no matter how pressing they might be for the public's health. 

Finally, we strive to ensure the diversity of NIH's research portfolio. We simply cannot 

predict the next scientific revelation or anticipate the next opportunity. If you think of 

scientific priority-setting as an innumerable number of questions that we might try to 

answer, a series of doors that we might open-but we cannot know what is behind any 

one door-you can appreciate the challenge of setting priorities and the need for a broad 

research portfolio. 

Testimony of Lawrence A. Tabak, D.D.S., Ph.D., Principal Deputy Director, NIH 

House Energy and Commerce Subcommittee on Health 

September 14,2010 

Page 3 
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NIH Research Activities Relevant to Pending Legislation: 

Having discussed how NIH sets research priorities, I would like to review some of the 

research we are currently conducting in several of the disease areas that are addressed by 

the bills pending before the Subcommittee. 

Juvenile Idiopathic Arthritis 

We know arthritis as a group of diseases that cause pain, swelling, stiffiless, and loss of 

motion in the joints. Juvenile idiopathic arthritis (JIA) is a type of arthritis with no 

definitive cause and which strikes children before they tum 16. 

There are multiple types of JIA that collectively are the most prevalent pediatric 

rheumatic illness, and among the most common causes of childhood disability in the 

United States. The National Institute of Arthritis and Musculoskeletal and Skin Diseases 

(NIAMS) funds a broad range of research, from basic studies of the underlying 

mechanisms of arthritis, to clinical studies exploring new treatment options. 

For example, the NIAMS supports scientists in a network of pediatric clinical research 

centers, known as the Childhood Arthritis and Rheumatology Research Alliance 

(CARRA). One NIAMS-supported project is a clinical trial examining the effect of 

early, aggressive therapy on polyarticular juvenile idiopathic arthritis (poly-JIA), a 

condition in which five or more joints are affected. This research focuses on the 

identification and testing of new combinations of drugs not previously tested in pediatric 

patients. 

In other research supported by the NIAMS, investigators have examined the challenges 

associated with diagnosing the various subtypes of JIA, in hopes of eventually allowing 

pediatric rheumatologists to tailor personalized treatments. 

NIH also recently used funds provided by the American Recovery and Reinvestment Act 

(ARRA) to support a Grand Opportunities (GO) grant to expand the existing CARRA 

network and improve the outcomes and quality oflife for all children with rheumatic 

diseases, including JIA. 

These research endeavors are just a few examples of the many NIH programs that share 

the goals ofRR. 12.10, the "Arthritis Prevention, Control, and Cure Act of2010." The 

NIH is committed to supporting research that seeks to improve the outcomes and quality 

of life for children with rheumatic disease. 

Scleroderma 

Scleroderma is a group of diseases in which the connective tissue that supports the skin 

and internal organs grows in a highly abnormal manner. In milder forms of scleroderma, 

this abnormal growth causes hard and tight skin in the patient. In other forms of 

Testimony of Lawrence A. Tabak, D.D.S., Ph.D., Principal Deputy Director, NIH 

House Energy and Commerce Subcommittee on Health 

September 14, 2010 

Page 4 
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sclerodenna, however, the problems are much more serious, affecting blood vessels and 

internal organs, such as the heart, lungs, and kidneys. 

To identifY the genetic changes that make an individual susceptible to scleroderma and 

provide a source of genetic material for researchers who study sclerodenna and other 

autoimmune diseases, NIAMS has supported the Sclerodenna Family Registry and DNA 

Repository. The Family Registry has enrolled approximately 4,000 participants. The 

infonnation collected allows researchers to conduct genome-wide association studies 

(OW AS) of scleroderma which will provide insights into what genes are responsible for 

susceptibility to sclerodenna, and which biological pathways may cause organ damage in 

the disease. 

The NIAMS also supports the Center for Research Translation in Sclerodenna that is 

examining the molecular basis of sclerodenna in order to understand its underlying 

causes. Investigators have already conducted detailed genetic analysis of blood samples 

from scleroderma patients, grouping them by ethnicity, gender, and autoantibodies-the 

immune system molecules that mistakenly attack the body they would nonnally protect 

from infection. In a promising step forward, this research has established the correlation 

of individual gene variants and disease subtype-specific autoantibodies. Such findings 

offer the hope of new and personalized treatment options for patients. 

NIAMS funds a broad range of research, from basic studies to translational clinical 

efforts. We share the hope for improved outcomes for sclerodenna patients that are 

conveyed in H.R. 2408, the "Scleroderma Research and Awareness Act" 

Diabetes research in minority populations 

There are three main types of diabetes: type 1, type 2, and gestational diabetes. Type 1 

is an autoimmune disease where the immune system attacks and destroys the insulinproducing beta cells in the pancreas. The pancreas then produces little or no insulin. 

Type 2 is the most common fonn of diabetes and is most often associated with older age, 

obesity, family history of diabetes, previous history of gestational diabetes, physical 

inactivity, and certain ethnicities. Finally, some women develop gestational diabetes late 

in pregnancy. Although this fonn of diabetes usually disappears after the birth of the 

baby, women who have had gestational diabetes have a 40 to 60 percent chance of 

developing diabetes (mostly type 2) within 5 to 10 years.2 

The NIH, primarily through the National Institute of Diabetes and Digestive and Kidney 

Diseases (NIDDK), is investing significant resources in multifaceted research on type 2 

diabetes in minority populations, as well as in obesity research. Obesity is a major risk 

factor for type 2 diabetes. Both disorders disproportionately affect minority populations. 

As part of the NIDDK-CDC National Diabetes Education Program, specific work groups 

address minority issues and include minority health professionals. The Work Groups 

include the African American/African Ancestry Work Group, the American Indian and 

2 Centers for Disease Control and Prevention (2007). National Diabetes Fact Sheet, 2007. Accessed from 

l:lJ:!n'-'Y~&"'£.1lQ\i~~:l!:!l1tt>Jl!Lt;!J1l1l!f:£.1QIlliQ[Q~!Lt1.!llill!iLl1 2010. 

Testimony of Lawrence A. Tabak, D.D.S., Ph.D., Principal Deputy Director, Nm 

House Energy and Commerce Subcommittee on Health 

September 14, 2010 

PageS 
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Alaska Native Work Group, the Asian American and Pacific Islander Work Group, and 

the Hispanic/Latino Work Group. The Diabetes Mellitus Interagency Coordinating 

Committee, led by the NIDDK, effectively coordinates diabetes activities across the 

Government, including diabetes issues in minority populations, through regular meetings, 

strategic planning, development and coordination of special programs, and through 

evaluation of ongoing diabetes efforts. The DMICC continues to improve the 

dissemination of information about diabetes and enhance coordination of federal efforts 

to advance diabetes research and improve the health of Americans with or at risk for 

diabetes. 

Title I ofH.R. 1995, the "Eliminating Disparities in Diabetes Prevention Access and Care 

Act," aims to increase research in diabetes disparities, as well as participation of health 

providers from minority communities in this research. While the Nlli is making great 

strides in our efforts to understand and address diabetes health disparities, we continually 

monitor the state of the science for new and important research opportunities that merit 

pursuit. 

Pediatric research 

Children deserve to be born healthy and to achieve their full potential for healthy and 

productive lives, free from disease or disability. Nlli, led by the National Institute of 

Child Health and Human Development (NICHD), supports the bulk of research on 

normal and abnormal child health and development. The majority of the Nlli's 27 

Institutes and Centers (ICs) include pediatric research in their portfolios. 

In FY 2009, the Nlli, through 22 Institutes and Centers (ICs), awarded about $3 billion in 

support of pediatric research activities across the country with another $500 million for 

pediatric research from funding under ARRA. This funding was distributed to the 

research community through the full range of available funding mechanisms, including 

investigator-initiated grants, contracts, and research networks, which allowed those with 

extensive scientific expertise at the Nlli and across the extramural scientific research 

community to determine which mechanism(s) might be best suited for the specific 

research needed to answer questions about children's health and development, diseases 

and conditions. Less commonly, where the scientific challenge warrants and with 

mindfulness of the significant ongoing investment involved, Nlli ICs (often in transinstitute collaboration) have created multidisciplinary centers of excellence or research 

networks for specific pediatric populations or conditions, such as autism, pediatric 

oncology, neonatology, and adolescents with HIV/AIDS, to name a few. 

In addition, a number of the Clinical and Translational Science Awards (CTSAs) sites 

include a strong emphasis on creating infrastructure to conduct pediatric clinical trials, 

which will allow pediatric researchers who focus on a wide variety of conditions to 

utilize this new resource and to conduct clinical trials efficiently and effectively. 

H.R. 758, the "Pediatric Research Consortia Establishment Act", would require NIH to 

establish new pediatric research consortia to suppJement ongoing research in these areas. 

Testimony of Lawrence A. Tabak, D.D.S., Ph.D., Principal Deputy Director, NIH 

House Energy and Commerce Subcommittee on Health 

September 14, 2010 

Page 6 
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We are constantly looking for new ways to push our pediatric research agenda to the next 

level, and appreciate the interest in exploring this area. 

These are but a few of the examples in which NIH is exploring the scientific areas under 

consideration by the Subcommittee today. Let me conclude my testimony by offering the 

thanks of NIH, the biomedical research community and millions of American patients 

and their families for your unwavering dedication. I am personally grateful for your time 

and attention this afternoon and look forward to your questions. 

Testimony of Lawrence A. Tabak, D.D.S., Ph.D., Principal Deputy Director, NIH 

House Energy and Commerce Subcommittee on Health 

September 14, 2010 

Page 7 
17 

Mr. PALLONE. Thank you, Dr. Tabak. 

Dr. Arias. 

STATEMENT OF ILEANA ARIAS 

Ms. ARIAS. Mr. Chairman, Ranking Member Shimkus, and members of the subcommittee, thank you for the opportunity to testify 

today along with my colleagues from the Department. 

This is an exciting time to be engaged in prevention and public 

health. We are currently improving our immunization programs, 

taking steps to reduce healthcare associated infections, rebuilding 

our Nation’s public health infrastructure, and supporting communities across America as they tackle critical problems like obesity 

and youth smoking. 

In the years ahead, millions more Americans will have coverage 

for preventive services. We are anxious to take advantage of these 

opportunities, and to track the health gains that this focus on prevention can bring. 

I am pleased to be here as you consider legislation to address 

certain health issues of concern. We appreciate the interaction that 

we have had with members of the subcommittee and staff on these 

bills, and we greatly appreciate the opportunity to share our public 

health expertise with you. 

CDC’s mission is to promote health and quality of life by preventing and controlling disease, injury, and disability. Working 

closely with our sister agencies, CDC is committed to reducing the 

health economic consequences of the leading causes of death and 

disability, thereby promoting a long, productive, and healthy life 

for all people in the country. Today I want to provide you with a 

broad perspective on CDC’s current efforts to achieve these goals, 

and to discuss CDC’s work that relates to many of the bills that 

you are considering. 

First, I would like to review a few of CDC’s current initiatives 

that demonstrate the range of public health challenges that we are 

facing. CDC has begun an effort to achieve measurable impact 

quickly in a few targeted areas, which we refer to as ‘‘Winnable 

Battles.’’ These Winnable Battles were selected based on the scope 

of the burden posed by these health threats, and equally importantly, CDC’s ability to make significant progress in improving relevant health outcomes. To date, CDC director Dr. Thomas Frieden 

and CDC leaders have identified six Winnable Battles, and have 

outlined a number of achievable priorities and opportunities for 

each of these. 

The six Battles are, first, prevention of HIV; second, motor vehicle collisions; third, the prevention of healthcare associated infections; fourth, the control of tobacco; fifth, prevention of teen pregnancy; and then lastly but not least, the prevention of obesity, the 

improvement of nutrition, physical activity, and food safety, which 

includes diabetes, a critical and costly health problem that the subcommittee is working to address today in three legislative initiatives advanced by Representatives Engel, DeGette, and Space. 

In many cases, we have known effective solutions; in others, such 

as gestational diabetes, work remains to identify the path to prevent the issue. 


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First, the CDC leadership has identified five strategic priorities 

to help achieve these Winnable Battles and to support other public 

health priorities. The first of these five priorities is applying effective policies. The science currently tells us that effective policies in 

areas such as tobacco control, motor vehicle safety, healthy eating, 

and physical activities in schools and communities can save lives 

and reduce healthcare costs. We are increasing our effectiveness in 

this area. The subcommittee today is considering a bill on methamphetamine education and treatment, which is very relevant to 

CDC’s effort to identify policy interventions that can reduce the 

health toll from overuse of prescription medications. 

Second, providing leadership in global health. Global public 

health investments have a direct benefit on U.S. public health and 

U.S. national security. Programs in AIDS, malaria, and pandemic 

preparedness have improved health systems throughout the world 

and strengthened our outbreak response. CDC has specifically created a new global health center to accelerate work in this area. 

Third, with the support of Congress and the public health and 

prevention fund, CDC is making investments that will significantly 

address the third priority, improving and strengthening surveillance, epidemiology, and laboratory capacity. This is essential and 

critical to our ability to identify health problems and to develop— 

and importantly to track the progress of solutions. Many of the 

bills being considered by the subcommittee today explicitly call for 

improvements in the availability of data on public health issues, 

such as Representative Burgess’ work with Mr. Van Hollen on surveillance of neurological diseases, Representative Baldwin’s initiative to expand data collection on sexual orientation and gender 

identity, Representative Eshoo’s proposal to advance arthritis surveillance, and Representative Johnson’s focus on neglected diseases, and Representative DeLauro’s initiative on birth defects. We 

are confident that any of these specific mandates would benefit 

from CDC’s current focus on improving national surveillance capacity. 

State, local, tribal, and territorial health agencies collect surveillance data, they conduct laboratory testing, and they investigate 

outbreaks and take public health action. They essentially are our 

boots on the ground. Because these CDC partners are critical to 

implementing public health programs across the country, many of 

the measures before the subcommittee today rely on grants to 

these agencies to achieve the bills purposes. These measures include Representative Space’s work to increase research and data 

collection on the widespread occurrence but unclear origins of gestational diabetes, and Representative Eshoo’s initiative to implement a State-based call-in system providing individuals with information about human services. We are confident that CDC’s focus 

on working with our partners to improve the performance of public 

health agencies would improve the capacity relative to these specific initiatives. 

Our final priority is to use the above strategies and the focus on 

Winnable Battles to have a significant impact on the leading 

causes of death, illness, injury, and disability. CDC would be interested in working with the subcommittee to ensure that any initiatives being considered today could build on successful efforts to adVerDate Mar 15 2010 13:23 Apr 04, 2013 Jkt 078131 PO 00000 Frm 00024 Fmt 6633 Sfmt 6633 E:\HR\OC\A131.XXX A131

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dress high-burden health problems. For example, this week CDC 

launched a campaign addressing prevention of gynecological cancers, and we will also be addressing heart disease through the 

WISEWOMAN program. These programs address cancer and heart 

disease, which are among the leading causes of death in our country. 

With the support of Congress we have made progress in addressing the Nation’s most pressing health needs, and the focus I have 

outlined above, supported by investments in the Recovery Act and 

the Affordable Care Act, we feel we are poised to accelerate these 

gains. 

I appreciate the opportunity to discuss CDC’s work with you, and 

look forward to working with the subcommittee as you consider the 

legislative initiatives before you. Thank you. 

[The prepared statement of Ms. Arias follows:] 


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Testimony before the 

Subcommittee on Health 

Committee on Energy and Commerce 

U.S. House of Representatives 

Pending Public Health Legislation 

Ileana Arias, PhD 

Principal Deputy Director' 

Centers for Disease Control and Prevention and 

Agency for Toxic Substances and Disease Registry 

U.S. Department of Health and Human Services 

ATSDR 

AGENCY FOR TOXIC SUBSTANCES 

AND DISEAse REGISTRY 

For Release upon Delivery 

Expected at 3:00 p.m. 

September 14, 2010 
21 


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Mr. Chairman, Ranking Member Shimkus, and members of the Subcommittee, thank you for the 

opportunity to testify today along with my colleagues from the Department of Health and Human 

Services (HHS). I am Dr. Ileana Arias, Principal Deputy Directorfor the Centers for Disease Control and 

Prevention (CDC). In this role, I am responsible for advising the Director, Dr. Thomas Frieden, on all 

scientific and programmatic activities of CDC. I have been at CDC since 2000. Prior to coming to my 

current position, I served as the Director of the National Center for Injury Prevention and Control at 

CDC. 

This is an exciting time to be engaged in prevention and public health. With investments from the 

American Recovery and Reinvestment Act we are improving our immunization programs, taking steps to 

reduce healthcare associated infections, and supporting communities across America as they tackle 

critical problems like obesity and youth smoking. With the Affordable Care Act's Prevention and Public 

Health Fund, we are expanding these efforts and making investments to improve our nation's public 

health infrastructure. Also through the Affordable Care Act, millions more Americans will soon have 

coverage for preventive services such as immunization, preventive screenings, and smoking cessation -

and we are anxious to track the health gains that this focus on prevention can bring. 

I am pleased to be here as you consider legislation to address certain health issues of concern, and the 

extent to which CDC can contribute to addressing these issues. We appreciate the interaction we have 

had with members of the Subcommittee and staff on these bills, and recognize that many of the bills 

you are addressing today reflect our technical input. As on other legislation that has been addressed by 

the Subcommittee this year and in the past, we greatly appreciate the opportunity to share our public 

health expertise with you. 

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Today, I want to provide you with a broad perspective on CDC's current work, and to discuss CDC's work 

that relates to many of the bills you are considering. CDC's mission is to promote health and quality of 

life by preventing and controlling disease, injury, and disability. Working closely with our sister agencies 

in the Department of Health and Human Services (HHS), CDC is committed to reducing the health and 

economic consequences of the leading causes of death and disability, thereby promoting a long, 

productive, healthy life for all people. 

Current CDC Priorities and Initiatives 

First, I'd like to review a few of CDC's current initiatives that demonstrate the range of public health 

chalk'!nges we, as an agency and a country, are facing. CDC has begun an effort to achieve measurable 

impact quickly in a few targeted areas, which we refer to as "Winnable Battles." These Winnable Battles 

were selected based on the scope of the burden posed by these public health threats and CDC's ability 

to make significant progress in improving relevant health outcomes. The charge for these Winnable 

Battles is to identify optimal strategies that are feasible and cost-effective, and to rally resources and 

partnerships to make a meaningful impact on health nationwide. By identifying these clear targets and 

by working closely with our public health partners, we can make significant progress in these areas. To 

date, CDC Director Dr. Thomas R. Frieden and CDC leaders have identified six Winnable Battles. For 

each of these areas, we have also outlined a number of achievable priorities and opportunities: 

HIV: tin estimated 1.1 million Americans are infected with HIV, and about lout of 5 ofthose who 

are infected is unaware of his or her status. Moreover, people are engaging in riskier sexual 

behaviors than they have over the previous decade, thereby increasing the rate of syphilis and HIV 

spread. To combat this trend, CDC has implemented programs designed to increase HIV status 

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awareness and improve linkages to care. CDC is also working with our Federal Partners to 

implement the National HIV/AIDS Strategy. 

• Motor vehicle collisions are the leading preventable cause of death among people between the 

ages of 1 and 34, killing almost 45,000 people annually and resulting in 4 million visits to emergency 

rooms. CDC has recently determined that motor vehicle collisions cost the United States $99 billion 

annually. To prevent these tragedies, CDC has worked diligently with its state and local partners to 

increase seat belt use, reduce Impaired driving, and implement graduated drivers license policies. 

Heafthcare-associated Infections (HAls): Each year HAls affect lin 20 hospita lized patients a nd cost 

our health care system billions of dollars. Yet, the three most common types of healthcareassociated Infections- those in the blood stream, the urinary tract, and surgical sites - are 

preventable. CDC has been working to prevent HAls by increasing surveillance; implementing 

prevention guidelines in hospitals, and encouraging prevention reimbursement policies. CDC is 

working In concert with our colleagues across HHS through the HHS Action Plan To Prevent 

Healthcare-Associated Infections. H.R. 3104, which this Subcommittee is currently considering, also 

relates to this issue. 

Tobacco use is the single most preventable cause of disease, injury and death in the United States 

and leads to tens of billions of dollars worth of medical expenses and lost productivity annually. 

Unfortunately, even those who choose not to use tobacco are negatively impacted by smoking; 22 

million children under the age of 11 are being exposed to second hand smoke. To win the battle 

against tobacco use, CDC focuses on influencing Individual behavior and changing the environment 

surrounding tobacco users. We are making significant investments in tobacco control programs 

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through the American Recovery and Reinvestment Act, as weil'as through the Prevention and Public 

Health Fund. 

Obesity, Nutrition, Physical Activity and Food Safety: Between 1980 and 2000, United States 

obesity rates in adults doubled and rates tripled in children. In recent years, we have slowed, but 

not reversed, the rapid rate of increase in the number of Americans who are obese. We know of 

interventions that can significantly reduce obesity rates and save lives. These interventions can take 

many forms, from changing community environments to better support healthy lifestyles, to health 

promotion campaigns such as the First Lady's "Let's Move" campaign. CDC's efforts to prevent 

obesity and promote physical exercise and good nutrition will also have a significant impact on 

diabetes, a critical and costly health problem that the Subcommittee is working to address today in 

three legislative initiatives (H.R. 1995, H.R. 5354, H.R. 6012). 

At the same time, the recent salmonella enteritidis outbreak and recall of shell eggs reinforces the 

importance of preventing foodborne illness. CDC participates in the PreSident's Food Safety 

Working Group with other agencies within and outside of HHS, with the goals of having safe food 

that does not cause us harm and enhancing our food safety systems. In particular, we are working 

to Improve CDC's ability to detect, respond to, and prevent foodborne illness. CDC'S work on food 

safety also focuses on the intersection of animal and human health. 

• Teen pregnancy rates in the United States are the highest of any industrialized nation and 82% of 

these pregnancies are unintended. Moreover, although teen birth rates declined from 1991 to 

2005, they rose for the next two years before declining again in 2008. Teen pregnancy is a 

significant public health concern not only because it perpetuates the cycle of poverty - a significant 

socioeconomic determinant of health - but also because babies born to teen mothers are more 

5 
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likely to die, to have low birth weights, or to be born prematurely. The CDC is working with its 

partners to deter teen pregnancy through science based approaches 

To help achieve these Winnable Battles and to support other public health priorities, CDC has identified 

five strategic priorities to further strengthen the nation's public health. I want to briefly address these 

five priorities, and also identify how they relate to many of the legislative initiatives being considered by 

the Subcommittee today: 

• Applying effective health policies: CDC is increasing its efforts to identify and advance policies that 

promote prevention and foster healthier environments throughout the country. Effective policies in 

areas such as tobacco control, motor vehicle safety, healthy eating, and physical activity in schools 

and communities can save lives and reduce health care costs. The Subcommittee is today 

considering H.R. 2818 (relating to methamphetamine education and treatment), which is relevant to 

CDC'S efforts to identify policy interventions that can reduce the health toll from overuse of 

prescription medications. 

Providing leadership In global health: Global public health investments have a direct benefit on U.S. 

public health and national security. Programs such as the President's Emergency Plan for AIDS Relief 

(PEPFARj, the President's Malaria Initiative (PMI), and the international pandemic influenza 

preparedness plans have improved health systems throughout the world and strengthened our 

outbreak response. CDC has created a new Global Health Center to enhance our efforts to build 

capacity at ministries of health; strengthen disease detection, surveillance, response, and laboratory 

capacity; and improve sustainability of public health programs. 

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Strengthening surveillance, epidemiology, and laboratory services: The ongoing systematic 

collection, analysis and interpretation of data on health and disease are essential to planning, 

implementing and evaluating public health practices. With the support of the Congress and the 

Public Health and Prevention Fund, CDC is making investments that will significantly improve our 

ability to monitor important public health indicators. Many of the measures being considered by 

the Subcommittee today directly address improving surveillance, or rely on improved data to guide 

interventions. These include H.R. 1362 (to enhance surveillance of neurological diseases), H.R. 1210 

(arthritis), H.R. 5986 (neglected diseases), and H.R. 5462 (birth defects). Additionally, the 

Subcommittee is considering legislation to expand data on sexual orientation and gender identity, 

and H.R. 6012 addresses the need for expanded data on disparities in diabetes. We are confident 

that any ofthese specific mandates, including additional mandates for data to address health 

disparities will benefit from CDC'S current focus on improving the overall surveillance infrastructure. 

• Strengthen the capacity of state, local, tribal, and territorial health agencies: State, local, tribal, 

and territorial health agencies collect surveillance data, conduct laboratory testing, investigate 

outbreaks, and take public health action. CDC has been working diligently to improve its technical, 

financial and direct assistance to these vital state and local partners. Because these CDC partners 

are critical to implementing public health programs across the United States, many of the measures 

before the Subcommittee today rely on grants to these agencies for performance offunctions 

important to achieving the bills' purposes. These measures include H.R. 1347 (to reduce 

concussions among school-aged children), H.R. 3212 (to study and prevent sudden unexplained 

infant death syndrome), and H.R. 211 (to implement a state based call-in system providing 

individuals with information about human services). We are confident that CDC'S focus on working 

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with our partners to improve the performance of public health agencies would improve capacity 

relative to these specific initiatives. 

Addressing the leading causes of Illness, injury and disability. The above priorities, as well as the 

Winnable Battles, taken together, can help achieve the goal of having a significant impact on the 

leading causes of illness, injury, and disability. As a nation, we have made significant investments in 

health care and public health, and we need to continually test our investments to ensure they are 

achieving the largest possible health gains. One of our priorities - in evaluating current programs, in 

implementing the Affordable Care Act, and In contemplating new investments - is to ensure that we 

can maintain our focus on tackling these significant issues. CDC would be interested in working with 

the Subcommittee to ensure that any initiatives being considered today could build on successful 

efforts to address high-burden health problems, and also contribute to the achievement of 

demonstrable health gains for the American people. For example, the Subcommittee is considering 

H.R. 2941 (Johanna's Law focusing on the prevention of gynecological cancers, a campaign that CDC 

has recently launched In response to previous Congressional action), and H.R. 1032 (the HEART Act, 

addressing women's heart health including through CDC's WISEWOMAN program), both of which 

relate to existing CDC programs designed to address cancer and heart disease - among the leading 

causes of death in our country. 
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Conclusion 

With the support of the Congress, we have made progress in addressing the nation's most pressing 

health needs, and with the focus 1 have outlined above - supported by Investments In the Recovery Act 

and the Affordable Care Act - we feel we are poised to accelerate these gains. I appreciate the 

opportunity to discuss CDC's work with you, and look forward to working with the Subcommittee as you 

consider the legislative initiatives before you. 

9-
29 

Mr. PALLONE. Thank you, Dr. Arias. 

Dr. Brand. 

STATEMENT OF MARCIA BRAND 

Ms. BRAND. Yes, good afternoon, Mr. Chairman—— 

Mr. PALLONE. I think it is either not on or not close enough to 

you. 

Ms. BRAND. Good afternoon—— 

Mr. PALLONE. A little closer. 

Ms. BRAND. Mr. Chairman—— 

Mr. PALLONE. Is it on? 

Ms. BRAND. Yes. 

Mr. PALLONE. Green light, OK. 

Ms. BRAND. Mr. Chairman, members of the subcommittee, thank 

you for the opportunity today to testify on behalf on the Secretary 

for Health and Human Services, Kathleen Sebelius, and Dr. Mary 

Wakefield, the Administrator of the Health Resources and Service 

Administration. I am Marcia Brand. I am the Deputy Administrator at HRSA and I am pleased to join my other Department colleagues appearing before you today. 

The Health Resources and Services Administration helps the 

most vulnerable Americans receive quality primary healthcare 

without regard to their ability to pay. HRSA works to expand access to healthcare for millions of Americans, the uninsured, the underserved, and the vulnerable. The individuals we serve include 

mothers and their children, those living with HIV and AIDS, and 

residents of rural areas. HRSA recognizes that people need to have 

access to primary healthcare, and through its programs and activities, the agency seeks to meet these needs. 

HRSA delivers on its obligation to address primary care access 

through six bureaus and 13 offices that comprise the agency. HRSA 

helps to train future nurses, doctors, and other health providers, 

placing them in areas of the country where health resources are 

scarce. The agency collaborates with government at the federal, 

state, and local levels, and also with community-based organizations to seek solutions to primary healthcare challenges. HRSA 

provides leadership and financial support to healthcare providers 

in every state and every U.S. territory. 

HRSA’s vision for the Nation is health communities and healthy 

people. Our mission is to improve health and achieve health equity 

through access to quality services, a skilled health workforce, and 

innovative programs. The agency seeks to further our vision and 

carry out our mission through our four major goals: improve access 

to quality care and services, strengthen the health workforce, build 

healthy communities, and improve health equity. 

At HRSA, we believe that primary case is more than having a 

place to go when you are sick. We view primary case as the Institute of Medicine does, providing integrated, accessible care services 

by clinicians who are accountable for addressing a large majority 

of personal healthcare needs, developing a sustained partnership 

with patients, and practicing in the context of family and community. 

In addition to supporting the provision of direct patient care, 

HRSA focuses on implementing programs that increase the number 


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of primary care providers, including the National Health Service 

Corps. HRSA programs train primary care providers, long-term 

care workers, and individuals skilled in providing care for the elderly. HRSA programs also support loans and scholarships that encourage disadvantaged individuals and those from diverse backgrounds to enter into the health profession. 

HRSA is committed to making sure that the U.S. has the right 

clinicians and the right skills working where they are needed most. 

HRSA-funded centers are often the practice sites for clinicians 

trained and supported through our programs. HRSA-funded health 

centers are community-based and patient-directed organizations 

that serve populations with limited access to healthcare. 

HRSA’s programs, however, are as diverse as the individuals, 

families, and communities that we serve. Among the innovative 

programs that we oversee are organ, bone marrow, and cord blood 

donation. The agency also coordinates activities related to rural 

health within the Department of Health and Human Services, and 

for 20 years, HRSA’s Ron White HIV/AIDS program has provided 

a legacy of care to persons living with HIV and AIDS. Our programs play a critical part in the Nation’s healthcare safety net. 

It seems fitting to close my overview of HRSA’s programs by noting that our Title V Maternal and Child Health Services Block 

Grant program, which is the Nation’s oldest federal state 

healthcare partnership, will be celebrating its 75th anniversary 

this year. Title V has provided a foundation and structure for ensuring the health of the Nation’s mothers and children. 

In closing, Mr. Chairman and members of the subcommittee, 

tens of millions of Americans get affordable healthcare and other 

assistance through HRSA’s programs and its 3,000 grantees. We 

are extremely proud of our programs and look forward to continuing to work with you to provide quality primary care for all. 

I appreciate the opportunity to testify today, and hope this testimony will inform the subcommittee’s future deliberations on the 

many important legislative proposals before you. 

I would be pleased to answer any questions you might have. 

[The prepared statement of Ms. Brand follows:] 


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Statement of 

Marcia K. Brand, Ph.D. 

Deputy Administrator 

Health Resources and Services Administration 

U.S. Department of Health and Human Services 

Before the 

Committee on Energy and Commerce/Subcommittee on Health 

U.S. House of Representatives 

Washington, D.C. 

September 14, 2010 
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Mr. Chairman, Memoers of the Subcommittee, thank you for the opportunity to testifY today on behalf of the 

Secretary for Health and Human Services and the Administrator of the Health Resources and Services 

Administration (HRSA). I am Dr. Marcia Brand, Deputy Administrator ofHRSA. I am pleased to join my 

other Department colleagues in appearing before you today. In my testimony today, I will provide an overview 

. ofHRSA, the programs we deliver and the people we serve. I will also touch upon the relationship between 

HRSA programs and certain bills under consideration by the Subcommittee. We appreciate your interest in 

HRSA and welcome the opportunity to work with you, Mr. Chairman, and the Subcommittee. 

Introduction 

HRSA Overview: The Health Resources and Services Administration helps the most vulnerable Americans 

receive quality primary health care without regard to their ability to pay. HRSA works to expand the health care 

of millions of Americans-- the uninsured, the underserved and the vulnerable. The individuals served include 

mothers and their children, those living with HIV/AlDS, and residents of rural areas. HRSA recognizes that 

people need to have access to primary health care and, through its programs and activities, the Agency seeks to 

meet these needs. HRSA takes seriously its obligation to diligently and skillfully implement laws that address 

primary care access. HRSA helps to train future nurses, doctors, and other clinicians, placing them in areas of 

the country where health resources are scarce. The Agency collaborates with government at the Federal, State, 

and local levels, and also with community-based organizations, to seek solutions to primary health care 

problems. 

HRSA also oversees organ, bone marrow and cord blood donation. It supports programs that compensate 

individuals harmed by vaccination and that provide low cost drugs to safety net providers. 

HRSA's Strategic Plan: HRSA's mission is to improve health and achieve health equity through access to 

quality services, a skilled health workforce and innovative programs. The Agency's strategic plan includes four 

major goals: 

1. Improve Access to Quality Care and Services 

2. Strengthen the Health Workforce 

3. Build Healthy Communities; and 

4. Improve Health Equity 

We at HRSA believe that primary care is more than having a place to go when you are sick. We view primary 

care as the Institute of Medicine (10M) does: providing integrated, accessible health care services by clinicians 

who are accountable for addressing a large majority of personal health care needs, developing a sustained 

partnership with patients, and practicing in the context of the family and the community. 

I will now describe some of the key programs administered by HRSA. 

National Health Service Corps 

In addition to supporting the provision of direct patient care, HRSA seeks to strengthen primary care by placing 

health care providers in communities where they are needed most. For example, the National Health Service 

Corps (NHSC), through scholarship and loan repayment programs, helps Health Professional Shortage Areas 

(HPSAs) in the U.S. obtain medical, dental, and mental health providers in order to meet the area's need for 

health care. 

Since its inception in 1970, more than 30,000 primary care physicians. nurse practitioners, certified nurse 

midwives, physician assistants. dentists, dental hygienists, and mental health professionals have served in the 

NHSC, expanding access to health services and improving the health of people who live in urban and rural 

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areas where health care is scarce. The NHSC recruitment tools of scholarships and loan repayments enable 

individuals motivated to provide high quality care for underserved people who in many instances have nowhere 

else to go for primary care services. to enter and complete health professions training that might otherwise be 

unaffordable to them, or to relieve them of some of the staggering debt burden they face. The Affordable Care 

Act will invest $1.5 billion dollars to expand the National Health Service Corps over the next tive years. 

About half of all NHSC clinicians work in HRSA-supported health centers, which deliver preventive and 

primary care services to patients regardless of their ability to pay. About 40 percent of health center patients 

have no health insurance. 

Health Professions 

In addition to directly assisting in the placement of primary care providers. HRSA supports the health 

profession programs that provide the in [rastructure for their education and training. HRSA' s health professions 

programs provide policy leadership and grant support for health professions workforce development-making 

sure the U.S. has the right clinicians. with the right skills, working where they are needed. 

HRSA's health professions programs are designed to address shortages throughout the country. These 

programs. which include a wide range of training programs, scholarships. loans. and loan repayments for health 

professions students and practitioners, are essential to producing health professionals who provide high quality. 

culturally competent health care. 

Through the Affordable Care Act, the U.S. Department of Health and Human Services has made a series of new 

investments worth $250 million to increase the number of health care providers and strengthen the primary care 

workforce. The investments in the primary care workforce announced in June oflhis year will be used to boost 

the supply of primary care providers in this country. The new investments will support the training and 

development of many new primary care providers over the next five years. Specitie activities include; 

$168 million in funding to create additional primary care residency slots to train more than 500 new 

primary care physicians by 2015: 

$32 million in funding to support physician assistant training in primary care with the goal of developing 

more than 600 new physician assistants. who can practice medicine as members of a team with their 

supervising physician. Physician assistants are trained in a shorter period oftime compared to 

phYSicians; 

$30 million to train an additional 600 nurse practitioners. including providing incentives for part-time 

students to become full-time and complete their education sooner; 

$5 million in funding to encourage States to plan and implement innovative strategies to expand their 

primary care workforce by 10 to 25 percent over ten years to meet increased demand for primary care 

services; and 

$15 million in funding for the operation of 10 nurse-managed health clinics that both provide 

comprehensive primary health care services to popUlations living in medically underserved 

communities, and assist in the training of nurse practitioners and other health care providers. 

Building on the earlier investments made by the American Recovery and Reinvestment Act and the Affordable 

Care Act. particularly for the National Health Service Corps, these investments will support the training and 

development of more than 16,000 new primary care providers over the next five years. 

Legislation introduced by members of this Subcommittee pertains to a wide range of public health training. 

One such measure, HR. 1210. the "Althritis Prevention. Control. and Cure Act of 2009," which is sponsored by 

Representative Eshoo, creates a system of loan repayments for pediatric rheumatologists who agree to provide 
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health care in an area where there is a shortage of pediatric rheumatologists. Another measure, H.R. 2999. "The 

Veterinary Public Health Workforce and Education Ac!," sponsored by Representative Baldwin, 

aims to increase and strengthen the veterinary public health workforce and training capacity in the United 

States. 

HRSA also supports public-private partnerships to encourage health professional training. For example, HRSA 

funds Area Health Education Centers (AHECs), which are academic and community partuerships that provide 

health career recruitment programs for high school students and also increase access to health care in medically 

underserved areas. AHECs address health care workforce issues by exposing students to health care career 

opportunities that they otherwise would not have encountered. establishing community-based training sites for 

students in service-learning and clinical capacities, providing continuing education programs for health care 

professionals, and evaluating the needs of under served communities. 

HRSA health professions programs also identiJ)' health professional shortage areas and work to address those 

shortages. There are programs that reach down into middle schools and high schools to expose promising 

students to health care careers and others that reach out to experienced clinicians to give them the skills needed 

to work where health care is scarce. The programs are as diverse as the health workforce. 

Maternal and Child Health 

HRSA also administers the Title V Maternal and Child Health (MCH) Services Block Grant program, which is 

the Nation's oldest Federal-State health care partnership. For 75 years. Title V has provided a foundation for 

ensuring the health of the Nation's mothers and children. Title V supported programs provide prenatal health 

services to more than 2 million women, and primary and preventive health care to more than 17 million 

children, including almost I million children with special health care needs. Today, State MCH agencies, 

which are located within State health departments. apply for and receive a Title V f(lfmula grant each year. 

Every $4 of Federal Title V money received must be matched by at least $3 of State andlor local money. This 

"match" results in there being more than $5 billion annually available for MCH programs at the State and local 

level. At least 30 percent of Title V Federal funds are earmarked for preventive and primary care services for 

children and at least 30 percent arc earmarked for services for children with special health care needs. 

The purpose of the Title V MCH Block Grant is to improve the health of all mothers and children consistent 

with the applicable health status goals and national objectives, and to provide and assure mothers and children 

(in particular those with low income or with limited availability of health services) access to quality maternal 

and child health services. 

The Affordable Care Act provided $100 million in FY 20]0 for grants to States and tribes to provide evidcncebased home visitation services to improve outcomes for children and families who reside in at-risk 

communities. Through the Maternal, Infant. and Early Childhood Home Visiting Program. nurses, social 

workers, or other professionals meet with at-risk families in their homes. evaluate the families' circumstances, 

and connect families to the kinds of help that can make a real ditference in a child's health. development, and 

ability to learn-such as health care, developmental services for children. early education, parenting skills. child 

abuse prevention, and nutrition education or assistance. Home visiting is a strategy that has been used by public 

health and human services programs to taster child development and address such problems as infant mortality. 

HRSA and ACF are working collaboratively on this program. 

Secretary Sebelius also announced this summer $4.9 million in grants to continue support for 51 Family-toFamily Health Intormation Centers in each State and the District of Columbia. Created in 2005, the centers are 

state-wide, family-nm organizations that provide information, education, training, outreach. and peer support to 

families of children and youth with special health care needs and the professionals who serve them. Funding 

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for the centers was extended through 2012 by the Affordable Care Act. The Family-to-Family Health 

Information Centers are staffed by family leaders with children having special health care needs. and who have 

expertise in Federal and State public and private health care systems. as well as by health professionals. 

Overall. these centers help families make more informed health care choices tor their children leading to better 

treatment decisions and improved outcomes. 

I would like to recognize a few bills introduced by members of the Subcommittee that support enhanced access 

and quality of care for our Nation' s mothers and children. and that also have synergies with programs at HRSA. 

H.R. 3212. which you introduced. Mr. Chairman. aims to improve the health of children and reduce the 

occurrence of sudden infant death syndrome. an issue that is a high priority at HRSA. and H.R. 1347, 

Representative Pascrell's "Concussion Treatment and Cares Tool Act", which addresses what we call more 

globally at HRSA traumatic brain injury. 

Division of Transplantation 

HRSA's Division of Transplantation provides federal oversight of national systems that support organ, bone 

marrow, and cord blood donation and allocation systems that ensure these life-saving gifts are given fairly and 

efficiently to the people who need them most. HRSA's cftorts to increase donation and transplantation mean 

the difference of lite and death for thousands of Americans and their families each year. HRSA's programs 

work to not only increase donation. but also improve the health outcomes ofthose who have transplants. 

The Organ Transplantation Program seeks to extend and enhance the lives of individuals with end-stage organ 

failure for whom an organ transplant is the most appropriate therapeutic treatment. The Program works towards 

achieving this goal by providing for a national system, the Organ Procurement and Transplantation Network 

(OPTN), to allocate and distribute donor organs to individuals waiting for an organ transplant. Today, there are 

108,000 individuals waiting for an organ transplant. Although a substantial number of transplants were 

performed in 2009, the demand for organ transplantation continues to far exceed the number of donor organs. 

Additionally. each year nearly 18,000 people in the U.S. are diagnosed with life-threatening illnesses where 

blood stem cell transplantation from a matched donor is their best treatment option. Often, the first choice 

donor is a sibling, but only 30 percent of people have a fully tissue-matched brother or sister. For the other 70 

percent, or approximately 12,600 people. a search for a matched unrelated adult donor or a matched umbilical 

cord blood unit must be performed. 

HRSA funds two major programs that facilitate the provision of blood stem cell units to individuals in need of a 

transplant. The C.W. Bill Young Cell Transplantation Program supports activities to increase the number of 

transplants for recipients suitably matched to biologically unrelated donors of bone marrow and cord blood. 

The National Cord Blood Inventory (NCBI) program supports the collection, processing and storage ofa 

genetically and ethnically diverse inventory of high-quality umbilical cord blood for transplantation, These 

cord blood units, as well as other units in the inventories of participating cord blood banks, are made available 

to physicians and patients for blood stem cell transplants through the C.W. Bill Young Cell Transplantation 

Program. 

At any given time, 6,000 people are searching for a matched bone marrow donor or cord blood unit. HRSA 

acknowledges Representative Matsui's work on this critical issue through 1l.R. 6081. the "Stem Cell 

Therapeutic Research Reauthorization Act" and through H.R. 1230, the "Bone Marrow Failure Disease 

Research and Treatment Act of 2009." 
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ORHPffelehealth 

The Office of Rural Health Policy within HRSA supports programs to increase access to health care for 

Americans living in rural areas. Recently. the Secretary announced $32 million to support rural health 

priorities, including funding for telehealth. These activities also dovetail with the President's Improving Rural 

Health Care Initiative in the Fiscal Year (FY) 2010 and 2011 budgets, which include a focus on telehealth 

services. 

In many rural communities, patients can only receive certain specialty services locally through the HRSAfunded telehealth program. That is. there are no local providers or traveling clinicians or non-HRSA funded 

telehealth programs to provide certain specialty services and patients must travel to obtain such services. 

Telehealth allows patients in underserved and remote areas to receive health care without traveling great 

distances; it is also frequently used for distance education and health care administration. The services provided 

via telemedicine range from primary care to highly specialized care found in leading academic medical centers. 

Of the $32 million in funds recently announced. more than $2 million was allocated for the Telehealth Network 

Grant Program, which helps communities build capacity to develop sustainable telehealth programs and 

networks. 

Additionally. more than $1 million was allocated for the Telehealth Resources Center Grant Program. which 

provides technical assistance to help health care organizations, networks and providers implement costeffective telehealth programs serving rural and medically underserved areas and populations, The program is 

designed for entities with a successful track record in helping to develop sustainable telehealth programs. 

We understand that Representative Butterfield. a strong supporter oftelehealth. intends to introduce a bill to 

reauthorize certain telehealth programs. 

Health Center Program 

Health centers are community-based and patient-directed organizations fhat serve populations with limited 

access to health care, These include low-income populations. the uninsured. those with limited English 

proficiency. individuals and families experiencing homelessness. and those living in public housing. These 

centers are designed to provide accessible. dignified health services to low-income people and their families, 

Community and consumer participation in the organization and a patient majority governing board were and 

continue to be the hallmark of the health center model. 

Here are some additional points about health centers; 

More than half of the nearly 19 million patients seen by health centers in 2009 were memhers of 

racial and ethnic minority groups. Nearly forty percent had no health insurance; a third were 

children. 

One out of every 17 people living in the U.S, now relies on a HRSA-funded clinic for primary care. 

Community health centers are an integral source of local employment and economic growth in many 

underserved and low-income communities. In 2009, community health centers across the nation 

injected more than $11 billion in operating expenditures directly into their local economies. 

Community health centers employ more than 9. J 00 physicians and more than 5.700 nurse 

practitioners, physician assistants. and certified nurse midwives in a multi-disciplinary clinical 

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workforce designed to treat the whole patient through culturally-competent, accessible. and 

integrated care. 

We appreciate this Subcommittee's support for the health center program and recognition of the value of health 

centers as providers of affordable, quality health care, 

The Affordable Care Act will invest $] I billion dollars over the next five years for the operation, expansion and 

construction of health centers throughout the Nation, On August 9th, Secretary Sebelius announced the 

availability of up to $250 million in grants for health center New Access Points, made available by the 

Affordable Care Act. These funds will support approximately 350 new service delivery sites in fiscal year 

20 II, A new access point is a new full-time service delivery site that provides comprehensive primary and 

preventive health care services. New access points improve the health status and decrease health disparities of 

the medically underserved populations to be scrved. Organizations eligible to compete include public or 

nonprofit private entities, including tribal, raith-based and community-based organizations that meet health 

center funding requirements. 

Health Disparities 

Eliminating health disparities is one of HRSA' s top priorities. When it comes to efforts to eliminate disparities 

in access to care and health outcomes, our largest programs do the heavy lifting: health centers, Ryan Wbite, 

health professions training, and maternal and child health. The largest portion ofthe individuals whose health 

care we support--more than 19 million people-are served through our network of I, I 00 health center grantees 

operating more than 7,900 service delivery sites in every State, the District of Columbia, Puerto Rico, the U.S. 

Virgin Islands, and the Pacific Basin. 

Whether it is clinicians who provide culturally competent care or understanding the unique needs and health 

concerns of the Lesbian, Gay, Bisexual and Transgender (LGBT) community, HRSA recognizes the importance 

of these efforts in addressing health disparities. Representative Baldwin's proposal aimed at LGBT data 

collection offers a remedy for addressing health disparities impacting the LGBT community, 

Another way to address disparities is to improve health outcomes, which is especially important to vulnerable 

communities, including individuals with chronic illnesses, children and the elderly. HRSA funded six patient 

navigator projects for a two-year demonstration, beginning in September 2008. to support non-medical health 

workers, especially in communities with significant health disparities and barriers to health services. The 

workers, also known as patient navigators, help people learn about chronic disease, such as cancer, diabetes, 

cardiovascular disease, obesity and asthma, then steer them into screening and treatment as needed. In addition, 

navigators assist people in finding and using community services that wiII help them manage chronic disease for 

longer, healthier lives. 

Like patient navigators, medical legal partnerships (MLPs) can help patients improve health outcomes by 

addressing unmet health-related legal needs, For example, MLPs could be valuable to health centers and their 

patients who need assistance navigating Federal and State rules and regulations. One study indicated that 90% 

of health center patients have unmet legal nceds. 

HRSA has some experience with MLPs, as IIRSA's Maternal and Child Health Bureau undertook an 

initiative in FY2010 to support a small MLP demonstration project. This project provides tools, resources and 

technical assistance to three Healthy Start Sites to determine ifMLP services can positively impact health 

indicators at these sites. 

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HRSA believes that the medical-legal partnership (MLP) model could potentially address challenges and issues 

that affect the health needs of vulnerable populations. And we note that H.R. 5961, Representative Maffei's 

and Representative Murphy's "Medical Legal Partnerships" legislation, aims to address this issue. 

HIV/AIDS 

As it relales to HlV/AIDS, HRSA 's Ryan White HIV/AIDS Program, which recently enlered its twentieth year 

of providing a legacy of care to persons living with HIV and AIDS, is a critical part of the health care safety 

net. I would like to acknowledge the essential efforts of this Subcommittee in the Program's reauthorization. 

Ryan White provides critical medical care and support services to uninsured, underinsured, and low-income 

people living with HIV/AIDS who have no other source of care. Through HRSA's HIV/AIDS Bureau, grants 

are awarded to cities, States, and local community-based organizations for the purpose of providing primary 

medical care and support services to individuals living with mv / A IDS. The program serves over a half 

million individuals living with HIV / AIDS who rely on us for life-saving, life extending care and treatment. 

Additionally, I would like to acknowledge the Administration's National HIV/AlDS Strategy. The Plan, which 

is a coordinated national response to the HIV epidemic, aims to accomplish three primary goals: 1) to reduce 

the number of people who become infected with HIV, 2) to increase access to care and optimizing health 

outcomes for people living with HIV, and 3) to reduce HIV-related health disparities. HRSA will remain 

involved in the Plan's implementation. 

Conclusion 

We are extremely proud of our programs and look forward to continuing to work with you, Mr. Chairman and 

Members of the Subcomminee, 10 provide quality primary health care for alL 

I appreciate the opportunity to testify today, and I hope this testimony will inform the Subcommittee's future 

deliberations on the many important legislative proposals before you. I would be pleased to answer any 

questions at this time. 
39 

Mr. PALLONE. Thank you, Dr. Brand. 

Dr. Clark, you were just here to answer questions, right? OK. So 

we will go to the questions and I will start with myself and recognize myself for 5 minutes. 

I wanted to ask about the veterinary bill, H.R. 299, because that 

is one of the ones that I am particularly concerned about. I will ask 

Dr. Brand—I will start with you. 

Your testimony describes HRSA’s work to support the training 

and education of health professionals. I would like to ask you about 

HRSA’s support for public health professionals. My understanding 

is that HRSA administers programs to promote the training and 

education in various ways, but how does this relate to this bill in 

particular? And if you could tell us how certain veterinarians with 

expertise in public health contribute to the public health workforce. 

Ms. BRAND. HRSA already provides support for veterinary 

schools through our health profession student loan program. Scholarships for disadvantaged students, our HCOP program, which is 

our Health Careers Opportunities Program, geriatric education 

centers, loans for disadvantaged students, and our Centers for Excellence Program. So we already have a relationship with a number 

of veterinary schools. 

We have also a new provision that would allow us to provide loan 

support for veterinarians and support their training, should those 

resources be made available. 

Mr. PALLONE. And then Dr. Arias and Dr. Tabak, is there anything you would like to add about the role of these veterinary public health professionals from either CDC or NIH perspectives, if 

you would? 

Dr. Arias. 

Ms. ARIAS. Sure. CDC clearly recognizes the relationship between veterinary issues, emerging issues among animals and then 

humans. In fact, H1N1 is the most recent example of how it is that 

what happens with animals is something that eventually can influence humans, which is what we are primarily charged with making 

sure we address. 

In addition to that, we continue to face the challenge of vectorborne illness, the most obvious of those currently is the spread of 

Dengue Fever, which first was a significant issue in Puerto Rico 

but now has crossed borders into Florida, making sure that we engage in whatever it is that we have to do in order to make sure 

that that spread does not continue. One of the things that we are 

committed to is making sure that we identify and rely on the professional expertise of all those who need to be brought to the table 

so that we can then address those health issues among humans in 

an effective way, and veterinary professionals are part of that. 

Mr. PALLONE. Thank you. 

Dr. Tabak. 

Dr. TABAK. Yes. I can tell you that the NIH, through the National Center for Research Resources, administers programs that 

are similar to the bills’ goals with regard to training in infectious 

disease and environmental research. These include training programs and career development programs specifically oriented to 

veterinarians receiving training in biomedical and translational research of public health significance, as well as providing funding 


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for the construction acquisition of equipment, and other capital 

costs related to the expansion of entities related to veterinary medicine, biomedicine, and public health. 

Mr. PALLONE. OK, thanks. 

Can I ask Dr. Clark—I have to ask you something, since that is 

why you are here, right? 

On the methamphetamine bill, H.R. 2818, it reauthorizes and enhances residential treatment programs for pregnant women and 

mothers. What need does this program meet that makes it different 

from other drug treatment programs, and does the bill only address 

meth? 

Dr. CLARK. The—we take no official position on the bill, per se, 

but we do recognize that the important issues associated with substance use and pregnant women, and the intergenerational transmission of substance abuse-related problems. We know that methamphetamine affects not only children, families, law enforcement, 

but the environment, so we have specific programs targeted to 

pregnant, postpartum, and parenting women, and this bill assists 

us in addressing that. 

Since 2002, we—through our existing pregnant, postpartum 

women program we have treated almost 4,700 women; 51.6 percent 

were pregnant. So this bill allows us to move what we have been 

doing in the field, to change the authorization to include outpatient 

care, and women who are parenting but who are not pregnant. And 

that is an important thing. 

I should note that our program has included care for 4,000 children, 58 percent of whom were in their mother’s custody, so that 

becomes an important issue, because as we are aware, reuniting 

families is an important issue where possible. So this bill would 

allow those issues to be addressed, and we are very much concerned about that, making sure that families can be reunited. We 

deal with the substance abuse issue, both in residential an outpatient settings, and the authorization associated with this bill 

broadens the scope of our current activity. 

Mr. PALLONE. OK, thank you. 

Mr. Shimkus. 

Mr. SHIMKUS. Thank you, Mr. Chairman. I would like for you, 

Dr. Brand and Dr. Arias, to send my warm regards to the Secretary and let her know I look forward to her coming sometime. 

She will eventually get here and we will eventually have an interesting day of addressing questions and concerns about implementation. It is important, because a lot of these—a lot of our consternation here is that the dust hasn’t settled on the law. The new law 

does give the Secretary a lot of authority and money to do a lot of 

things that a lot of these bills could do without authorization. So 

that is of concern. That is the point of some of these questions. 

Let me go to Dr. Arias first. I understand that CDC has been involved with arthritis research, education, and surveillance, including the implementation of a National Arthritis Action Plan. Would 

you describe these activities for us? 

Ms. ARIAS. I can get you more specific information that I think 

is going to be more helpful to you for the written record, but just 

broadly, it is to primarily provide education about arthritis, and 

then encourage the linkage of individuals afflicted with arthritis to 


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services that may be important for them in order to improve the 

quality of life. 

One of the significant concerns among individuals with arthritis, 

especially with increasing age, is the high risk for falls, and then 

unfortunately the negative health consequences associated with 

that. So not only because of the arthritic issues per se, but then 

the consequences for general health that unfortunately are true for 

those individuals. Our program then expands and looks at those 

issues as well. 

Mr. SHIMKUS. So we already have a plan to some extent, is that 

correct? 

Ms. ARIAS. I can get—to the extent that we have a plan, I will 

send that to you as follow-up. I know that we have the broad strategy as to be able to then identify individuals who are afflicted and 

make services either for prevention or—— 

Mr. SHIMKUS. Can you—when you also do this, can you send us 

how much money CDC is currently spending on this plan? We 

think you do have a plan, so—— 

Ms. ARIAS. Certainly, we can do that. 

Mr. SHIMKUS. Issue two on this is part of the arthritis bill talks 

about a $19 million funding for rheumatologists—pediatric 

rheumatologists, and it is our understanding—in fact, I have a 

pull-out here as to the big law—and here is the page—but in Section 5203 of the new healthcare law, there is—it looks like $30 million loan repayment program for pediatric specialists, loan repayment program. Would—this also could be available for—I mean, it 

is a pediatric specialist—pediatric rheumatologist would be a pediatric specialist, would it not? 

Ms. ARIAS. Yes, although I couldn’t speak to a repayment program, and I don’t know if her—— 

Mr. SHIMKUS. Well, that is why we need the Secretary here, because that is the part of the new law. 

Dr. Brand. 

Ms. BRAND. Well—— 

Mr. SHIMKUS. It is 5203. 

Ms. BRAND. Yes, sir. It creates the pediatric specialties loan repayment program, and HRSA does manage the loan repayment 

programs. I don’t believe any resources remain available for it, so 

it is—— 

Mr. SHIMKUS. Well, there is $20 million for each of the fiscal year 

2010 through 2013, which is part of the law—— 

Ms. SCHAKOWSKY. Excuse me, would the gentleman yield just for 

factual—— 

Mr. SHIMKUS. Sure, yes. 

Ms. SCHAKOWSKY. Let me just say that the $30 million that was 

originally in 2010—H.R. 2010 has been taken out. It is out of the 

bill, the bill that is before us now. 

Mr. SHIMKUS. You are talking about the $19 million. This is the 

healthcare law that we signed—— 

Ms. SCHAKOWSKY. No, I understand that, but there is no redundancy. I just wanted to make that point. 

Mr. SHIMKUS. Well, we have—unless you pulled it out from what 

we were provided right before the hearing, it is in here now. 


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Hopefully then as we move forward—that is our question. That 

is why we have hearings, to try to address redundancies, and if 

that is the case, we appreciate it. 

I also need to move to Dr. Arias again. In fiscal year 2011, the CDC budget justification request includes an increase of $79.4 million above the fiscal year 2010 omnibus for the World Trade Center 

program for a total of $150 million. Your budget justification states 

with this increase, CDC will continue to provide monitoring and 

treatment services for mental and physical health conditions related to World Trade Center exposures for both responders and eligible non-responders. The World Trade Center program is critical 

in meeting the ongoing and long-term special needs of individuals 

that were exposed to smoke, dust, debris, and psychological trauma 

from the World Trade Center attacks. This increase will enable 

CDC to continue providing these much needed services. 

The question some members are apparently unaware that CDC 

currently provides monitoring and treatment services for first responders of the World Trade Center related attacks, so you can— 

can you confirm that CDC does, in fact, currently provide monitoring and treatment services? 

Ms. ARIAS. We don’t provide services. We do provide technical assistance to develop a registry, and then the surveillance of individuals who were exposed and whatever health conditions they may 

present, but we don’t provide the services. 

Mr. SHIMKUS. And the services are provided where? 

Ms. ARIAS. The services are provided in New York City by community-based organizations, hospitals in that area. 

Mr. SHIMKUS. Great, thank you. My time is expired, but I will 

just put on the record, the First Lady’s Let’s Move program is a 

program that is not authorized but is funded by the—by HHS, 

through, I guess, by some discretionary funding and the like. So 

the point, again, for us is a lot of these things HHS has the authority to do, can do, and I will just put that on the record. 

I yield back my time. 

Mr. PALLONE. Our vice chair, Ms. Capps. 

Mrs. CAPPS. Thank you, Mr. Chairman. As some people know, I 

have been a very proud sponsor of the Heart for Women Act since 

2006, and a big component of this legislation is expanding the 

CDC’s WISEWOMAN program, which you referenced, Dr. Arias, in 

your testimony, which screens low income, uninsured, and underinsured women between the ages of 40 and 64 for cardiovascular 

disease. The program also provides outreach, referral, education, 

and counseling to the participants. 

Dr. Arias, would you please speak a bit about the success of the 

WISEWOMAN program? Is this considered a valuable and effective 

program, and does the CDC favor expanding it? 

Ms. ARIAS. We are very excited about the opportunity for more 

women to have access to basic screening and other preventive 

measures starting in 2014. We look forward to WISEWOMAN continuing as a vital complement to those services. WISEWOMAN currently provides for a specific health screening, but it is actually a 

broader effort to improve heart health among women. So in addition to those clinical preventive services, women in the program 

can also take advantage of lifestyle programs that target poor nuVerDate Mar 15 2010 13:23 Apr 04, 2013 Jkt 078131 PO 00000 Frm 00048 Fmt 6633 Sfmt 6633 E:\HR\OC\A131.XXX A131

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trition, physical inactivity, smoking. It includes programs such as 

cooking classes in order to improve nutrition, not just in those 

women but their families, fitness classes and competitions, and 

quit smoking classes. 

These are elements that are not part of clinical preventive services, and therefore we are committed to continuing making sure 

that these are provided and supported, since there is a significant 

need for them. It is important to recognize that having insurance 

coverage doesn’t necessarily mean that individuals receive recommended preventive services. 

So from our experience with WISEWOMAN, especially in the 

breast and cervical cancer screening program and our immunization program, we understand that it takes much more. And so we 

are looking forward to being able to provide even greater comprehensive response to a leading cause of death for women in the 

U.S. 

Mrs. CAPPS. Thank you. Actually, I will follow-up with a question 

but you kind of answered it. There are some who are saying—you 

know, question whether we need an expanded role for 

WISEWOMAN program into the future, because both immediate 

and long-term after 2014, when most of the new health reform law 

goes into effect. 

It talks a little bit more about ways that you see this being complimentary and not duplicative of the primary care that we expect 

everyone to be accessing. 

Ms. ARIAS. Yes, you are correct, and that is our intention. It has 

been our—we are very interested in making sure that we coordinate with clinical services, as we should in order to have a good 

response to health conditions. However, from a public health perspective, that is not our primary focus. It is really looking at the 

context in which those clinical services are made available and are 

accessed by individuals that can be supported in ways that the 

services themselves will not do. 

Mrs. CAPPS. So you—this is one of the areas—and I imagine that 

there are very many other ones as well, where programs in the 

community, that are based in the community that serve particular 

populations will only be enhanced by having more of your target 

group now also receiving primary care, and that this will be a symbiotic relationship rather than one competing or in any way duplicating what the other is doing. Rather, it will help to reinforce and 

actually extend the value of primary care that hopefully more 

women will be getting for themselves and for their families. 

Ms. ARIAS. Yes, that is exactly correct, and a major reason for 

why I said that this is a very exciting time for public health, as 

we look forward to how it is that we can bring down costs, improve 

the quality of life for every man, woman, and child in this country. 

Mrs. CAPPS. Thank you very much. I yield back, Mr. Chairman. 

Mr. PALLONE. The gentleman from Pennsylvania, Mr. Pitts. We 

went and visited your district to see the University of Pennsylvania—what do we call it—veterinary campus when we were looking at the—at Tammy’s bill. We went to the farm—all the farms 

and it was very interesting. Large animal farm, yes. It was great. 

Mr. PITTS. Thank you. You are welcome to come anytime. 


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Thank you, Mr. Chairman. Dr. Arias, you mentioned the 211 in 

passing and described it as a bill to implement a state-based callin system providing individuals with information about human 

services. 

Implement infers these programs do not exist. Are you aware of 

the programs that do exist? Forty-seven states already have these 

programs? 

Ms. ARIAS. We know that states have been moving in the direction of providing similar types of programs. Our staff have been 

primarily involved with committee staff on figuring out what is the 

best way of implementing the bill, if it should move forward in 

order to capitalize on what already has been done, and build upon 

what has been done. 

Mr. PITTS. Does the Administration support H.R. 211? 

Ms. ARIAS. I do not—there is no official policy on this bill or any 

of the bills, actually, that we are discussing today. It is a complex 

sort of decision-making process in terms of what are the kinds of 

things that will get supported and done, and we—and it usually involves coordinating among all of the agencies within the Department and then within the Administration, and that process has not 

been complete. 

Mr. PITTS. All right. Would the services provided by the 211 bill 

be considered an HHS health services program? 

Ms. ARIAS. Does HRSA want to comment on that? 

Mr. PITTS. Dr. Brand? 

Ms. BRAND. In terms of health services program, Health Resources and Services Administration? It is not, as I understand it, 

it is directed toward the CDC from the management up. It is not 

something that HRSA would do. There is, certainly, an interest in 

ensuring that folks have access to information about Health and 

Human Services for the underserved, and this is one vehicle for accomplishing that. But the Department hasn’t taken a position on 

this. 

Mr. PITTS. 211 programs are currently funded by states, and 

some states have chosen to allow these services to make referrals 

to abortion service providers. Many believe that the federal taxpayer funds should not be utilized to subsidize or refer for abortions. 

Would H.R. 211 allow states to receive federal funds for 211 services, and those services refer patients to abortion service providers? 

Ms. ARIAS. Most likely we will be consulting with other HHS 

agencies and other administrative agencies before making that determination. And again, the issue is whatever then is allowed by 

law, one, and the other by administrative regulations is what we 

would look to in terms of deciding what is it—what kinds of services actually do get covered and what wouldn’t get covered. 

Mr. PITTS. OK. H.R. 1347 requires HHS to establish concussion 

management guidelines that address the prevention, identification, 

treatment, and management of concussions in school-age children, 

including standards for student athletes to return to play after a 

concussion. 

How would these guidelines differ from CDC’s Heads Up program that Dr. Kapil testified about last week at the subcommittee’s 

field hearing in New Jersey? 


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Ms. ARIAS. The Heads Up program is a specific campaign to educate professionals and educate parents and athletic personnel on 

how to, number one, how to recognize concussion, how to manage 

them. The bill, in my understanding, is that it would be an extension of that. Currently we have provided those materials, we have 

generated those materials. They are available for use and that is 

as far as we have been able to take that program. 

Mr. PITTS. In developing the Heads Up educational materials, 

did CDC consult with outside experts? 

Ms. ARIAS. We did consult with both professional and then with 

education and with sports professionals in the context of the educational sector as well. 

Mr. PITTS. Does CDC have a grant program to states to conduct 

injury surveillance and develop strategic plans and engage in coalition building work to address injuries? 

Ms. ARIAS. We have a broad program to address—to essentially 

support state and local health departments. A lot of—well, a significant number of activities that they engage in are surveillance 

activities for the number of issues with both unintentional injury 

and intentional or violence. 

Mr. PITTS. And does—go ahead. Were you finished? 

Ms. ARIAS. I was going to add, it is a very small program. It is 

not a very comprehensive program. Currently there are only 30 

states that are being supported for a small amount, and again, 

they usually then often have enough to just support—to just focus 

on the surveillance activities. 

Mr. PITTS. OK, my time is up. Thank you, Mr. Chairman. 

Mr. PALLONE. The gentlewoman from Wisconsin, Ms. Baldwin. 

Ms. BALDWIN. Thank you, Mr. Chairman. Before I begin my 

questions, I would like to submit four items for the record. The first 

is a letter of support for H.R. 2999 and the manager’s amendment 

that we will be offering during tomorrow’s markup. The second is 

a small section out of the 1999 World Health Organization report 

titled ‘‘Future Trends in Veterinary Public Health,’’ and specifically, I just want to put into the record the scope of VPH in the 

21st century, because it contains a definition of veterinary public 

health that I think will be helpful to have in the committee record. 

And then two additional items in support of H.R. 6109. The first 

is testimony of the Human Rights Campaign submitted by Joe Solomon, he is president, and also an article entitled ‘‘How to Enclose 

the LGBT Health Disparities Gap’’ from the Center for American 

Progress. 

Mr. PALLONE. Without objection, so ordered. 

[The information was unavailable at the time of printing.] 

Ms. BALDWIN. Thank you, Mr. Chairman. 

First, I would like to—I would be interested in answers from all 

of our witnesses on this question, but perhaps we could start with 

Dr. Arias to respond more generally, and then move to Dr. Tabak 

for an update on the Institute of Medicine’s work. 

But is it your belief that the Department’s current understanding 

of LGBT health is sufficient to inform federal initiatives to reduce 

health disparities? Would legislation to ensure the voluntary collection of data on sexual orientation and gender identity as appropriate and practicable in programs and surveys that are supported 


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by the Department of Health and Human Services help to improve 

and expand the Department’s understanding? 

Start with you, Dr. Arias. 

Ms. ARIAS. Thank you. One of the things that, if you hang 

around with epidemiologists for any amount of time, you very 

quickly learn that measurement is key, key issue. Whatever gets 

measured is addressed. What doesn’t get measured doesn’t exist 

and doesn’t get addressed. 

One of the challenges that we face is not knowing and not having 

a sufficient understanding of LGBT health. CDC is committed not 

only to promoting and protecting health, but making sure that we 

address whatever health disparities or inequities may exist, and 

unfortunately, currently we don’t have enough information to be 

able to identify what those disparities are. 

Ms. BALDWIN. Thank you. Dr. Tabak, could you give us general 

comments and any update you have on the Institute of Medicine’s 

inquiry into this matter? 

Dr. TABAK. Yes, thank you. As you know, NIH determined that 

more information about research needs and gaps in this area were 

needed, and so commissioned a study by the Institute of Medicine, 

who is conducting a study and will be submitting a report on the 

state of knowledge regarding LGBT health, health risks, and protective factors and health disparities, and we expect that report in 

the spring of 2011. 

There are many challenges, obviously, that were made to conducting research and address health disparities in LGBT populations, and so we are looking forward to the IOM report, and continuing to work with the research community to address the research gaps and opportunities in this area. 

Ms. BALDWIN. Thank you. 

Dr. Brand? 

Ms. BRAND. Yes. HRSA agrees with CDC and NIH, and we don’t 

think we have sufficient understanding of LGBT issues, and we 

look forward to working with our colleagues at CDC and NIH to 

better understand those issues. 

Ms. BALDWIN. Thank you. We are also talking a little bit about 

veterinary public health and H.R. 2999. Dr. Brand, you were asked 

a little bit about current existing loan repayment programs in 

HRSA. 

I am specifically interested in how effective those have been in 

recruiting and retaining public health veterinarians? How many 

public health veterinarians have been able to access these funds, 

and is it your belief that you are reaching the full universe of public health veterinarians who could be working to meet our Nation’s 

public health needs? 

Ms. BRAND. It is clear that there are shortages of public health 

providers in all of the disciplines, and certainly, this is one of them. 

I would have to go back and ask my colleagues at HRSA to find 

out how effective we have been at reaching folks through these programs. 

These programs do a variety of activities. They recruit individuals and encourage them to go into health careers or stay in health 

careers or help offset their student expenses. It is not the direct 

loan that perhaps is suggested in the bill. 


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Ms. BALDWIN. I would just add briefly, we had a hearing on the 

full bill last session and it was so illuminating for me to realize 

how critical public health veterinarians were in responding to 

human health threats. I mean, you wouldn’t think of it intuitively, 

and then we found out so much about that. 

It is my understanding that a very small fraction of the currently 

available funds are actually directed to public health veterinarians, 

and we will follow-up after—in making the record full, but I am delighted, Mr. Chairman, that you have chosen to put this bill on the 

hearing docket, as well as the markup docket for tomorrow. 

Mr. PALLONE. Thank you. 

Mr. Burgess. 

You are recognized for whatever you like. 

Mr. BURGESS. Mr. Chairman, I would like to ask unanimous consent for the letters that we have received in support for the National Neurologic Disease Surveillance System Act of 2010, from 

the Alliance for Aging Research, the American Academy of Neurology, Distonia Medical Research Foundation, National Multiple 

Sclerosis Society, Parkinson’s Action Network, Research America, 

and the MS Coalition, the American Brain Coalition to be entered 

into the record. 

Mr. PALLONE. Without objection, so ordered. 

[The information was unavailable at the time of printing.] 

Mr. BURGESS. In addition, I ask unanimous consent for the letters we have received in support of the Gestational Diabetes Act 

of 2010 from the American Association of Colleges of Pharmacy, the 

American Diabetes Association, the American Association of Diabetes Educators, the American Congress of Obstetricians and Gynecologists, the American Medical Women’s Association, the Association of Women’s Health, Obstetric and Neonatal Nurses, and the 

Society for Women’s Health Research be entered. 

Mr. PALLONE. Without objection, so ordered. 

[The information was unavailable at the time of printing.] 

Mr. BURGESS. And finally, I ask unanimous consent that the letters we received in support for the Birth Defects Prevention Risk 

Reduction Awareness Act of 2010 from the American College of OB/ 

GYN, Allergy and Asthma Network, Mothers of Asthmatics, American Academy of Allergy, Asthma and Immunology, the American 

Academy of Pediatrics, the March of Dimes Foundation, Spina 

Bifida Association, and the Organization of Tetrology Information 

Specialists be also entered. 

Mr. PALLONE. Without objection, so ordered. 

[The information was unavailable at the time of printing.] 

Mr. PALLONE. Oh, I see. You were trying not to have that count 

towards your time. Was that the idea? 

Mr. BURGESS. I have learned under your guidance, Mr. Chairman. 

Mr. PALLONE. I see, OK. 

Mr. BURGESS. I would also ask unanimous consent that my opening statement be entered into the record. 

Mr. PALLONE. So ordered. 

[The information was unavailable at the time of printing.] 

Mr. BURGESS. I apologize for not being here at the start of the 

hearing. 


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Let me just ask you a question, Dr. Arias. You just said what 

gets measured gets addressed, in response to a previous question. 

Would you also agree that if we measure to address, registries will 

help tell us how we are doing? 

Ms. ARIAS. Part of our interest in surveillance activities is not 

only to identify what the problems are and who needs to be served 

in order to address those issues, but then also over time to be able 

to measure the effectiveness of whatever solutions are implemented 

or tried. 

Mr. BURGESS. So in other words, to make better decisions on how 

to spend the research dollars? 

Ms. ARIAS. Yes, sir. 

Mr. BURGESS. So the cost of providing these tools for surveillance 

would be a wise investment, so that we have the useful data and 

make the Federal Government better stewards of the billions of 

dollars of taxpayer’s money they are spending on medical research? 

Ms. ARIAS. Yes, sir. Certainly at CDC we do try to be good stewards of how it is that those federal dollars are invested. Again, the 

major issues that we look at when we make those decisions is, 

number one, what is the burden and so is it a significant problem 

that is going to address the greatest number of people, then the 

other is do we currently have strategies—evidence based strategies 

that will allow us to intervene. 

And so usually those two are critical issues, and then making 

sure that that investment is an optimal one. 

Mr. BURGESS. And Dr. Tabak, from the NIH perspective would 

you agree with that, that a surveillance system does help us measure—not just measure, but tell us how we are doing with those 

things that we are measuring? 

Dr. TABAK. Well, as you know the CDC is responsible for surveillance, but certainly that helps inform the situation, yes, sir. 

Mr. BURGESS. But referencing here specifically 1362, the National MS and Parkinson’s Disease Registries Act—and I trust, 

have you all had made available to you the amendment in the nature of a substitute that will be submitted during the markup later 

when we do that? Is that information that you have available? 

Dr. TABAK. I do not, sir. 

Mr. BURGESS. Well again, the concept would be to allow scientists to better leverage efforts to find better treatments and cures 

for this compendium of neurologic diseases. Again, Dr. Arias, I 

would assume that you would be in agreement with the general notion of that? 

Ms. ARIAS. Yes, we are. Generally we are very supportive of—and 

look for opportunities to cover as many things as we need to in 

order to be able to, again, make those sound investments with either current surveillance systems, or the development of those surveillance systems over time. 

Mr. BURGESS. And then Dr. Tabak, as we get further into development and understanding of the human genome we will be able 

then to cross reference to these surveillance systems of registries 

in order to help more patients and perhaps identify additional risk 

factors that were not previously anticipated. 

Dr. TABAK. Yes, of course. As you identify genetic linkages 

through genome-wide association studies, the idea then is to circle 


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back to patients to see how generalizable things are, and in fact, 

there is research currently being supported by NIH in this arena. 

Mr. BURGESS. Let me—Dr. Arias, let me just ask you, moving on 

to the Gestational Diabetes Act of 2009, H.R. 5354. Are there currently any demonstration grants going toward gestational diabetes 

education? 

Ms. ARIAS. We are currently working to strengthen state capacity 

for diabetes prevention programs. Prevention of type 2 diabetes is 

an outcome of addressing CDC’s Winnable Battle of obesity, nutrition, and physical activity. We do not have a specific gestational diabetes component to that, but are committed to addressing whatever the needs are within the broad framework of diabetes prevention. 

Mr. BURGESS. So you would agree that having a specific effort to 

look at gestational diabetes is an important part of our overall diabetes management? 

Ms. ARIAS. Again, what we would do is based on whatever 

science is available at that point in—at any particular point in 

time, giving us a good picture of where the issue is and what can 

be done about it to determine where is the best place to try to intervene. 

Mr. BURGESS. Let me just ask you, Dr. Arias, one last question 

in regards to H.R. 5462, the Birth Defects Prevention and Risk Reduction and Awareness Act. 

Are you familiar with the pregnancy risk information services as 

they exist in a handful of states, such as my home State of Texas? 

Ms. ARIAS. Yes, and we do support just a handful of states to actually collect information and do some educational work on pregnancy-related issues and birth issues. 

Mr. BURGESS. Well, I mean I was a practicing OB/GYN for 25 

years before I came to Congress. I will just tell you there are precious few places to go for the practitioner, and this really came 

home to me last August. We were all gearing up for H1N1 and 

what the impact of that was going to be, and in fact, on the phone 

with researchers at NIH one day, and really felt for the practitioner out there in the communities who was going to be seeing a 

great number of school teachers who possibly could become pregnant during the school year who were going to be teaching young 

children who might be reservoirs of H1N1. It really was a conundrum about how to advise this large subset of the population. Do 

you seek a vaccination or is this something that would become demanded by the pregnancy? It really put a big burden on providers. 

I can sympathize with the questions that they were going to get in 

a week or two when the school year started, and people came in— 

women came in and were questioning whether or not they should 

have the vaccine, and if they, in fact, knew they were pregnant, if 

the vaccine would be harmful. 

So it is so important to have this type of information that is literally just a phone call away when people are faced with making 

tough decisions. I do hope you will look on this legislation favorably. I think it is an important part of our—of what we provide— 

the services that we provide, not just to our patients but our providers out there as well. 


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Thank you, Mr. Chairman, for your indulgence. I will yield back 

the balance of my time. 

Mr. PALLONE. Thank you. No, you went 2 minutes over, but that 

is OK. We have a lot of time today. 

The gentlewoman from Colorado, Ms. DeGette. 

Ms. DEGETTE. Mr. Chairman, I just want to thank you for having this hearing today, in particular on the two bills which I am 

the primary sponsor, the Pediatric Research Consortia Establishment Act, H.R. 758, and H.R. 1995, the Eliminating Disparities in 

Diabetes Prevention, Access, and Care Act. And I also want to 

thank you for bringing up Mr. Space’s H.R. 6012 Diabetes Screening Utilization bill. These are all important bills that we have been 

working hard all year to try to pass. 

I also want to ask unanimous consent to introduce two letters— 

for the record two letters, one on H.R. 1995 from the American Diabetes Association, and the other one on H.R. 758 from the Federation of Pediatric Organizations. 

Mr. PALLONE. Without objection, so ordered. 

[The information was unavailable at the time of printing.] 

Ms. DEGETTE. Thank you. And I guess I can retroactively yield 

2 minutes of my time to Mr. Burgess, and with that, I will yield 

back. 

Mr. PALLONE. Thank you. No, she wasn’t serious. 

Next is—what about Doris? The gentleman from New York, Mr. 

Engel. 

Mr. ENGEL. Thank you very much, Mr. Chairman, and I stand 

behind everything that Dr. Burgess said. He and I have a bill 

which we are talking about today and will be voting on tomorrow, 

the Gestational Diabetes Act, known as the GEDI Act, which we 

sponsored together. I just want to, since I didn’t make an opening 

statement, make a mini opening statement now and just say that 

135,000 women in the U.S. are diagnosed with gestational diabetes 

each year, and it can occur in pregnant women who have never had 

diabetes before but who have had high blood sugar levels in pregnancy. And while gestational diabetes generally goes away after 

pregnancy, it can have significant health impacts upon both the 

mother and baby. 

In particular, women are at much higher risk of developing type 

2 diabetes in the future, and their children are at higher risk of 

obesity and/or the onset of type 2 diabetes as adults. That is why 

we introduced this act, and the bill aims to lower the incidents of 

gestational diabetes and prevent women afflicted with this condition and their children from developing type 2 diabetes. 

We need to have a greater understanding on how to prevent and 

treat this condition. There is currently an insufficient system for 

monitoring cases of gestational diabetes to uncover trends and target at-risk populations. In addition, new therapies and interventions to detect, treat, and slow the incident of gestational diabetes 

need to be identified and our bill will help us accomplish these 

goals. I know Dr. Burgess mentioned that all the groups that support this legislation, I am going to mention them again, the American Diabetes Association, the American Association of Colleges of 

Pharmacy, American Association of Diabetes Educators, the American Medical Women’s Association, the Association of Women’s 


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Health, Obstetric and Neonatal Nurses, and the Society for Women’s Health Research. 

Mr. Chairman, if Dr. Burgess hadn’t done it—I think he did as 

I was coming in the room—I would like to request unanimous consent that the letters of endorsement be entered into the record. 

Mr. PALLONE. I believe they all have. 

Mr. ENGEL. Thank you. Let me ask Dr. Arias, based on what I 

have said, can you tell me what support and outreach programs are 

currently available to those with gestational diabetes, and also, is 

there currently a system in place to monitor cases of gestational diabetes? 

Ms. ARIAS. Monitoring gestational diabetes specifically would be 

a new activity for us. As I mentioned earlier, we do comprehensive 

diabetes prevention work, and in the context of that, if the issue 

gets raised then we devote whatever resources we may have in 

order to address the issue. 

Mr. ENGEL. What more can be done in these areas, in your opinion? 

Ms. ARIAS. At the risk of being repetitive, it is surveillance, and 

making sure that we are very clear about not only the extent of the 

problem, but where the problem seems to be most and where it is 

that we need to focus in order to be most effective in addressing 

the issue from a population-based perspective. 

Mr. ENGEL. Thank you. Let me ask you one final question. Can 

you speak to the unique differences between gestational diabetes 

and other forms of diabetes like type 2, and is there a way to determine if a woman is at high risk to get gestational diabetes? 

Ms. ARIAS. I am afraid I am not a subject matter expert, and 

that is information that then we can follow up and send you. 

Mr. ENGEL. OK. Can anybody else attempt to answer that at all? 

No? OK. 

Well, I hope—Mr. Chairman, I will yield back the balance of my 

time. I hope that the committee can tomorrow pass this. This is obviously not a partisan bill, it is a very bipartisan bill, and gestational diabetes doesn’t happen with people belonging to one political party or another. It happens to Americans, and I think this is 

something whose time has come. We need to address this very serious issue. 

I yield back. 

Mr. PALLONE. Thank you, Mr. Engel. 

The gentlewoman from California, Ms. Matsui. 

Ms. MATSUI. Thank you, Mr. Chairman, for holding today’s hearing. Before I begin, I would like to ask unanimous consent to submit these letters of support from the National Marrow Donor Program and the Aplasic Anemia and MDS International Foundation 

for the record. 

Mr. PALLONE. Without objection, so ordered. 

[The information was unavailable at the time of printing.] 

Ms. MATSUI. I am so pleased that two of the bills that are most 

important to me are included in this hearing. Together, H.R. 1230, 

the Bone Marrow Failure Disease Research and Treatment Act, 

and H.R. 6081, the Stem Cell Therapeutic and Research Reauthorization, represent holistic approach to combat bone marrow failure 

diseases. If enacted, they will address new critical areas for reVerDate Mar 15 2010 13:23 Apr 04, 2013 Jkt 078131 PO 00000 Frm 00057 Fmt 6633 Sfmt 6633 E:\HR\OC\A131.XXX A131

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search, further awareness of the diseases in high incidences communities, and provide for a one-stop shop for adult stem cell treatment options. 

Dr. Tabak, one of the aspects that H.R. 1230, the Bone Marrow 

Failure Disease Research and Treatment Act, would provide for coordinated outreach and informational programs targeted to minority populations affected by these diseases, including information on 

treatment options and clinical trials research. 

Can you speak broadly about the challenges associated with ensuring minority participation in clinical trials? 

Dr. TABAK. Yes, thank you. We issue a 5-year strategic plan on 

health disparities which describes the agency’s priorities for addressing minority health and health disparities. As part of this, the 

new institute, the National Institute of Minority Health and Health 

Disparities, has committed to ensuring greater representation and 

participation of racial and ethnic minority populations, as well as 

other health disparity populations in research activities. They have 

done this through the establishment of a bioethics research infrastructure initiative, which is a network of bioethics centers around 

the United States. Both academic and other non-profit entities with 

a history of research and training engagement with health disparity communities provides a perfect platform for this initiative. 

And through this initiative, the NIMHD has dedicated about $15 

million in Recovery Act funds over the past 2 years, ’09 and ’10. 

Ms. MATSUI. Dr. Tabak, is it true that you—it is difficult getting 

minority participants in all sorts of clinical trials, and it is important to have research relevant to all groups. 

Dr. TABAK. It is very important to have research relevant to all 

groups. 

Ms. MATSUI. OK. Dr. Brand, I appreciate your mentioning these 

bills in your testimony. You mentioned that there are 6,000 people 

searching for a match bone marrow donor or cord blood unit at any 

time. Can you explain the relationship between the increased research and public education campaigns included in H.R. 1230, and 

on the potential future successes for the C.W. Beal Young Cell 

Transplant Program? 

Ms. BRAND. H.R. 1230, the Acquired Bone Marrow Failure and 

Treatment Act, provides for research on acquired bone marrow diseases, encourages outreach, and directs the Agency for Healthcare 

Research and Quality to examine best practices regarding diagnosing and providing care to individuals with acquired bone marrow disease. 

To do this, the Secretary may rely partly on the Stem Cell Therapeutic Database, which is authorized by H.R. 6081, the Stem Cell 

Reauthorization. The C.W. Beal Young Cell Transplantation Program and the National Cord Blood Injury—Inventory increase the 

number of transplants suitably matched to biologically unrelated 

donors, and supports the collection and storage of a genetically and 

ethically diverse inventory of high quality umbilical cord blood for 

transplantation. 

Additionally, the education outreach called for in H.R. 1230 

would help assist patients understand all their treatment options, 

including transplant, and help patients and physicians assist transplant as a treatment option early in the course of their disease. OpVerDate Mar 15 2010 13:23 Apr 04, 2013 Jkt 078131 PO 00000 Frm 00058 Fmt 6633 Sfmt 6633 E:\HR\OC\A131.XXX A131

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timal transplant outcomes are more likely to occur if the transplant 

is done before the patient’s health has deteriorated significantly. 

Ms. MATSUI. And Dr. Brand, one way to measure the success of 

the C.W. Beal Young Cell Transplantation Program is through the 

number of transplants performed. Can you tell us how the program 

has performed in this manner during the last 5 years in terms of 

the actual number of transplants, as well as the actual performance when compared to the part goals? 

Ms. BRAND. Cord blood stem cell transplants exceeded goals of 

4,500 in 2010, and we have reached over 5,000. Transplants for minority patients are up sharply. We exceeded our goal of 636 in fiscal year 2010, and we will facilitate 840 by the end of the fiscal 

year. I can provide you a 5-year summary for the record, but we 

have exceeded our targets every year. 

Ms. MATSUI. Thank you. One more question. Another important 

indicator describing how the program operates is survival rates 

over time. How are the survival rates over time changed for the 

transplants that the program facilitates? How do they compare to 

transplants for related donors? 

Ms. BRAND. Survival for standard risk patients now is at 70 percent at one year after transplant, compared to 50 percent in 2000 

and 42 percent in 1988. Standard risk patient survival after unrelated donor transplants now matches that for sibling donor transplants. 

Ms. MATSUI. OK, thank you. 

I yield back the balance of my time. 

Mr. PALLONE. Thank you. Gentlewoman from Illinois, Ms. Schakowsky. 

Ms. SCHAKOWSKY. Thank you, Mr. Chairman. I just have a couple of questions. 

Ms. Arias, I wanted to ask you, there are—as you know, there 

are 46 million people who suffer from arthritis, but in 2008, only 

12 states received funding for programs to prevent and control arthritis. How were these 12 states determined? I understand that 40 

states applied, but only 12 were funded. 

Ms. ARIAS. Yes, that is correct. We only had enough funding for 

12 states, and those were chosen on the base of a competitive process, so it was an evaluation of the applications and then the highest—strongest applications until we ran out of money essentially 

were supported. 

Ms. SCHAKOWSKY. But not all—would you say that the others 

were not worthy, necessarily, or—— 

Ms. ARIAS. No, no, not necessarily. Essentially we had a limited 

pot of funds and could not fund anymore than the 12 if we had 

wanted to. There were other applications that were worthy of funding and were recommended for funding, however there weren’t any 

funds available for them. 

Ms. SCHAKOWSKY. Well, along the same lines, Dr. Tabak—did I 

say that right? OK. In your testimony, you described the process 

that NIH uses to set priorities, and you say that ‘‘The rigor of this 

process is so competitive and the number of applications is so large 

that to date, fewer than one in five research proposals receives 

NIH funding.’’ So again, I want to ask you, does this mean that 

only one in five is worth pursuing, or again, is it funding limits 


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prevent the approval of research proposals that really do have the 

potential to be worthwhile? 

Dr. TABAK. The latter. We certainly, if we had the resources, 

would be very proud to support additional applications that we receive. 

Ms. SCHAKOWSKY. OK, thank you. That is why I look forward to 

the markup on H.R. 2010 that deals with arthritis, which affects 

so many Americans, and see if we can’t get some of these other 

worthy projects, and more particularly, we are short of pediatric 

rheumatologists, to try to get more of those to address this problem. 

Thank you, and I yield back. 

Mr. PALLONE. Thank you. I think all members have had a chance 

to ask questions, unless anyone else—well, let me thank you, first 

of all, for being here. We appreciate your input on this and as you 

know, we plan to move to the markup tomorrow so it was very useful to have you here today. Thank you very much. 

We—I don’t know if anybody said they have any written questions they were going to send you, but they still could—you still 

could get some written questions from members, so we would ask 

you to get back to us quickly. 

Anyone else? If not, without objection, the meeting of the subcommittee is adjourned. 

[Whereupon, at 5:27 p.m., the Subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 


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Statement of 

the Honorable John D. Dingell 

Subcommittee on Health Hearing on "Pending Public Health Legislation" 

September 15,2010 

Mr. Chairman, I thank you for holding this hearing today. There are a number of 

good bills before us, but I would like to foeus on two that are important to me and my 

distriet. 

The first is H.R. 2941, Johanna's Law Reauthorization. Johanna's Law, first 

enacted in 2007, is an education program that educates women and healthcare providers 

about gynecologic cancers. This law was nanled in memory of Johanna Silver Gordon, a 

Michigan public school teacher. Prior to being diagnosed with an advanced stage of 

ovarian cancer, Ms. Silver experienced symptoms that are common with this cancer. 

However, she learned these symptoms were warning signs too late - after her cancer 

diagnosis. 

Reauthorization of this law is vitally important. Each year, more than 71,000 

women are diagnosed with a gynecologic cancer, and approximately 26,500 women die 

from the disease. As with all cancers, early detection of gynecologic cancer is crucial for 

successful treatment. 

I applaud the Centers for Disease Control for carrying out the mission of 

Johanna's law. We must reauthorize this bill, so that their work can continue to help 

women across this country. 

The other bill of particular interest for me and my district is H.R. 2408, 

Scleroderma Research and Awareness Act. I have heard from constituents about their 

difficulties of living with this chronic and disabling condition. Its symptoms range from 

thickening of skin to shortness of breath, difficulty swallowing, stiff joints and even pain 

and damage to internal organs. 

This is a very complex disease making misdiagnosis very common. Therefore, 

more research is needed. I am pleased that my district is home to some of the leading 

experts on scleroderma. The University of Michigan's Scleroderma Progranl was 

established in 2004 and brings together specialists in rheumatology, internal medicine, 

pulmonary medicine, pediatrics and occupational therapy. Since it's inception they have 

been at the forefront of research and clinical care for this disease. 

H.R. 2408 will accelerate this type of work all across the country. I want to thank 

my colleague, Congresswoman Lois Capps, for her work on this bill and urge my 

colleagues to support this bill. 

Thank you, Mr. Chairman. I yield back the balance of my time. 
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STATEMENT OF THE HONORABLE JOE BARTON 

RANKING MEMBER COMMITTEE ON ENERGY AND 

COMMERCE 

HEALTH SUBCOMMITTEE HEARING: 

"PUBLIC HEALTH LEGISLATION" 

September 15,2010 

Thank you, Mr. Chairman. Today we will hear about 

a host of public health bills that will be marked up 

tomorrow. I thank the witnesses for coming today and look 

forward to their testimony. 

Many of these proposals have underlying merit. The 

question is, why are we in Congress deciding how to direct 

disease research instead of allowing scientists to do their 

jobs? The collective cost also makes one wonder whether 

the Majority understands the gravity of country's current 

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fiscal situation. These are not good times for many people, 

millions of whom have lost their jobs and their income 

during the last 18 months. And it won't be good times for 

their children and grandchildren, either, if we can't slow 

down the president's spending extravaganza and reduce his 

record deficits. 

One of the reasons that I and many others fought so 

hard to reform the National Institutes of Health was to stop 

politicizing the research funding process. I want funding to 

go where the promise of cures and treatments is brightest, 

with the priorities set by researchers instead of politicians. 

That's why I am unhappy to see the return of diseasespecific funding proposals. I understand why it happens, 

and I'm sure everyone else in the room does, too. It is very 

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difficult for a Member of Congress to tell sick people and 

their worried families that someone else will make a better 

decision on research than they can, or we can. As much as 

we want to say ''yes'' to those heart-wrenching requests, 

doing so returns us to the bad days when the special 

interests, not scientific merit, dictated where research funds 

went. I think that would sound the retreat from an effective 

policy that saves the maximum number of lives. 

Unfortunately, these many bills suggest that the 

Majority's still does not understand of our country's dire 

fiscal situation. This country currently faces a budget 

deficit of$1.3 trillion and national debt totaling over $13.5 

trillion. And although the Majority pushed through 

Obamacare, with its trillion dollars of spending, it seems 

that runaway spending is not enough. 

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The American people have to balance their 

checkbooks and prioritize their purchases. It is time for 

Congress to follow the example of the people we represent. 

We need to start making tough decisions just like the 

people back home do every day. 

Ifwe are afraid to cut an old, outdated program when 

we create a new one, we will never get the nation's budget 

in order. Ifwe create duplicative, unnecessary programs 

just because they seem like good politics, we will have 

failed. We work for everybody, but sometimes it seems 

like the ones most likely to be forgotten are the people who 

pay taxes and trust us to spend their money responsibly. 

With that responsibility comes choice. We should be 

prepared to make these choices because our nation's 

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economic future, our nation's ability to be a leader in the 

world" and the futures of our children and grandchildren, 

depend on it. 

Now, it is true that some of the bills we will hear 

about today represent substantial progress in reducing 

costs. I wish that were true of all of them. 

I look forward to hearing from the witnesses today and 

look forward to hearing from what their agencies are doing 

in these various areas of interest. Thank you, Mr. 

Chairman. I yield back the balance of my time. 

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HUNDRED CONGRESS 

«ongrt:~~ of tlJt 'l'tnittl:! ~tate~ 

~OIlSf of i"tprtllfntat!lm:i 

COMMITTEE ON ENERGY AND COMMERCE 

MEMORANDUM 

September ll, 2010 

To: Members of the Subcommittee on Health 

Fr: Democratic Health Subcommittee Staff 

Re: Hearing on pending public health legislation 

On Tuesdav. September 14. 2010 at 3:00 p.m. in room 2322 of the Ravburn 

House Office Building. the Subcommittee on Health will hold a legislative hearing on the 

following pending public health bills: 

• H.R. 211, Calling for 2-1-1 Act of2009 

• H.R. 758. Pediatric Research Consortia Establishment Act 

• H.R. 1032. Heart Disease Education, Analysis Research. and Treatment 

for Women Act 

• H.R. 1210. Arthritis Prevention. Control, and Cure Act 0[2009 

• H.R. 1230. Bone Marrow Failure Disease Research and Treatment Act of 

2009 

• H.R. 1362, National MS and Parkinson's Disease Registries Act 

• H.R. 1995. Eliminating Disparities in Diabetes Prevention Access and 

Care Act of2009 

H.R. 2408. Scleroderma Research and Awareness Act 

• H.R. 2818, Methamphetamine Education. Treatment. and Hope Act of 

2009 

H .R. 2941, Johanna' s Law Reauthorization 

• H.R. 2999. Veterinary Public Health Workforce and Education Act 

• H.R.5354, Gestational Diabetes Act of2009 

• H.R. 5462. Birth Defects Prevention. Risk Reduction. and Awareness Act 

of2010 

• H.R. 5986. Neglected Infections oflmpoverished Americans Act of2010 

• H.R. 6012, Diabetes Screening Utilization 

H.R. 6081. Stem Cell Therapeutic and Research Reauthorization Act of 

2010 
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• H.R. Telehealth Improvement and Expansion Act of2010 

• H.R. _, Health Data Collection Improvement Act 

I. H.R. 211, Calling for 2-1-1 Act of2009 

This bill requires the Secretary of Health and Human Services (HHS) to award a 

grant to each state (based on a formula to-be-developed by the Secretary) to make the 2-

J -J health and human services referral service available throughout the state. The bill 

specifies that the 2-1-1 service will be operated through a lead entity that either has 

previously had responsibility to carry out this service or meets certain criteria. It 

authorizes $150 million for each of fiscal years 2009 and 2010 and $100 million for each 

of fiscal years 2011-2014 to carry out the bill's activities. 

II. H.R. 758, Pediatric Research Consortia Establishment Act 

This bill requires the National Institutes of Health (NIH) to establish up to 20 

pediatric research consortia throughout the nation. Each consortium will be a 

collaborative effort involving a leading "hub" pediatric medical center and numerous 

supporting "spoke" institutions. The consortia will focus on both basic and translational 

research, as well as training for new researchers. Funding will be based on the likelihood 

of bringing together investigators from multiple disciplines to comprehensively address 

child health and lifelong genetically-based chronic illness. 

III. H.R. 1032, Heart Disease Education, Analysis Research, and Treatment for 

Women Act 

This bill codifies Food and Drug Administration (FDA) regulations that require 

the inclusion of women in clinical trials submitted to FDA to support an application tor a 

drug, device, or biologics approval. It requires that patient safety data reported to and 

among the network of patient safety databases be stratified by gender. In addition, the 

bill requires that the Department of Health and Human Services (HHS) carry out an 

education campaign about heart disease and women and reauthorizes the WISEWOMAN 

program at the Centers for Disease Control and Prevention (CDC). The bill authorizes 

the WISEWOMAN program at: $70 million for fiscal year 2010, $73.5 million for fiscal 

year 2011, $77 million for tiscal year 2012, $81 million for fiscal year 2013, and $85 

million for fiscal year 2014. 

IV. H.R. 1210, Arthritis Prevention, Control, and Cure Act of 2009 

This bill authorizes the Secretary of Health and Human Services (HHS) to 

develop and implement a National Arthritis Action Program, at a level of$32 million in 

fiscal year 2010, rising to $40 million in fiscal year 2014. The program would support 

control, prevention, surveillance, research, education, and outreach activities, through 

grants and direct support to public or private nonprofit entities and states. The bill further 

authorizes the Secretary to expand and intensify programs of the National Institutes of 

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Health (NIH) with respect to research and related activities concerning various forms of 

juvenile arthritis and related conditions. It also provides for the Centers for Disease 

Control and Prevention (CDC) to award grants or enter into cooperative agreements for 

the collection, analysis, and reporting of data on juvenile arthritis, and supports the 

development of a national juvenile arthritis population-based database. It authorizes $25 

million for each of the fiscal years 2010-2014 for these CDC surveillance activities. In 

addition, the bill requires the Secretary to provide grants to support pediatric 

rheumatology training at a level of$3.75 million for each of fiscal years 2010- 2014. It 

also directs the Secretary to establish and carry out a pediatric rheumatology loan 

repayment program, as needed. For the purposes of this subsection, the Secretary may 

reserve funding from amounts already appropriated to the Health Resources and Services 

Administration for the fiscal year involved. 

V. H.R. 1230, Bone Marrow Failure Disease Research and Treatment Act of 

2009 

This bill requires the Secretary of Health and Human Services (HHS), acting 

through the Director of the Centers for Disease Control and Prevention (CDC), to 

develop a system to collect data on acquired bone marrow failure diseases and to 

establish the National Acquired Bone Marrow Failure Disease Registry and allows the 

Secretary to award grants to, and enter to contracts and cooperative agreements with 

public or private nonprofit entities for the management of the Registry. It also requires 

the Secretary to conduct pilot studies to determine which environmental factors may 

cause acquired bone marrow failure diseases. It authorizes $3 million for each of fiscal 

years 2010-2014 to carry out these activities. The bill further requires the Secretary to 

establish outreach and information programs targeted to minority populations affected by 

such diseases and to award grants to, or enter into cooperative agreements with, entities 

to perfonn research on such diseases It authorizes $2 million for each of fiscal years 

2010-2014 to carry out these activities. Finally, the bill requires the Secretary, acting 

through the Director of the Agency for Healthcare Research and Quality (AHRQ), to 

award grants to entities to improve diagnostic practices and quality of care with respect to 

patients with acquired bone marrow failure diseases. 

VI. H.R. 1362, National MS and Parkinson's Disease Registries Act 

This bill requires the Secretary of Health and Human Services (HHS) to develop 

surveillance systems, in the form of registries, for both Multiple Sclerosis and 

Parkinson's disease. It also requires the Secretary to establish an advisory committee on 

Neurological Disease Registries to review and make recommendations to the Secretary 

on the surveillance activities authorized in this bill, including the development and 

maintenance of the systems. The bill authorizes $5 million for each of fiscal years 2010-

2014 to carry out the bill's activities. 

VII. H.R. 1995, Eliminating Disparities in Diabetes Prevention Access and Care 

Act of2009 

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This bill requires the National Institutes of Health (NIH) to expand, intensify, and 

support ongoing research and other activities with respect to pre-diabetes and diabetes in 

minority populations and carry out health care professional mentorship and education 

activities specific to diabetes. It also requires the Centers for Disease Control and 

Prevention (CDC) to conduct and support research and other activities with respect to 

diabetes in minority populations, conduct and support public education efforts, and carry 

out culturally-appropriate diabetes health promotion programs. In addition, the bill 

requires the Health Resources and Services Administration (HRSA) to conduct and 

support programs to educatc health professionals on diabetes in minority populations. It 

authorizes such sums as may be necessary for fiscal year 20 I 0 and each subsequent fiscal 

year to carry out the bill's activities. 

VIII. H.R. 2408, Scleroderma Research and Awareness Act 

This bill directs the Director of the National Institute of Arthritis and 

Musculoskeletal and Skin Diseases (NIAMSD) of the National Institutes of Health (NIH) 

to expand, intensifY and coordinate activities relating to scleroderma. It requires 

NIAMSD to research the causes and treatment of scleroderma and to establish a 

scleroderma patient registry at authorization levels of$25 million for fiscal year 2010, 

$30 million for fiscal year 2011 and $35 million for tiscal year 2012. It also requires the 

Director of the Centers for Disease Control and Prevention (CDC) to carry out an 

education campaign to increase awareness of scleroderma and authorizes $2.5 million for 

fiscal years 2010-2012 for this activity. 

IX. H.R. 2818, Methamphetamine Education, Treatment, and Hope Act of2009 

This bill expands and strengthens the Substance Abuse and Mental Health 

Services Administration (SAMHSA) activities to address the prevention and treatment of 

addiction to methamphetamine and other drugs. It refines an existing family-centered 

residential drug treatment program for pregnant and postpartum women and authorizes 

$20 million for fiscal year 2010, $21 million for fiscal year 20 II, $22 million for fiscal 

year 2012, $23 million for fiscal year 2013, and $24million for fiscal year 2014. The bill 

also requires support for a workplace-based drug information clearinghouse, and student 

involvement in prevention programs for methamphetamine and other drugs. 

X. H.R. 2941, Jobanna's Law Reauthorization 

This bill reauthorizes and expands the Center for Disease Control and Prevention 

(CDC) programs to educate women and healthcare providers about gynecologic cancers. 

It authorizes $16.5 million for the period of fiscal years 2010-2012 and such sums as are 

necessary for each subsequent fiscal year for these efforts. It further creates 

demonstration projects to evaluate research and outreach strategies for educating women 

and healthcare providers about gynecological cancers. For fiscal years 2010-2012, $15 

million is authorized for these activities; such sums as are necessary are authorized for 

each subsequent fiscal year. 

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Xl. H.R. 2999, Veterinary Public Health Workforce and Education Act 

This bill authorizes a competitive grant program for schools of veterinary 

medicine. Schools can use these grants for faculty recruitment, physical capacity 

expansion, or the development of curricula to retrain midcareer professionals. It 

authorizes $100 million for fiscal year 2010, $100 million for fiscal year 2011 and $50 

million for each of fiscal years 2012-2014 for these activities. The bill also establishes a 

loan repayment program whereby the federal government repays loans for veterinarians 

that make a four-year teaching commitment at a school of veterinary medicine. It 

authorizes $20 million for each of fiscal years 2010-2014 for this program. In addition, 

the bill creates two fellowship programs for public health veterinarians that would be 

administered by the Department of Health and Human Services (HHS) but would be 

available to all federal agencies that utilize public health veterinarians. It authorizes $2.5 

million for each of fiscal years 2010-2014 to support these fellowships. Finally, the- bill 

establishes a Division of Veterinary Medicine and Public Health at the Health Resources 

and Services Administration (HRSA). 

XII. H.R. 5354, the Gestational Diabetes Act of 2009 

This bill requires the Centers for Disease Control and Prevention (CDC) to 

conduct a multi-site gestational diabetes research project to expand and enhance 

surveillance data and public health research on gestational diabetes. It would award 

competitive grants to eligible entities for demonstration projects to build capacity with 

key stakeholders, establish new surveillance systems. and implement and evaluate 

evidence-based interventions to reduce the incidence of gestational diabetes and its 

recurrence and to prevent type 2 diabetes after pregnancy. It authorizes $5 million for 

each of fiscal years 2010- 2014 for these activities. In addition, the bill requires the 

CDC Director to conduct research on the epidemiology of gestational diabetes, and on 

screening methods at an authorization level of $5 million for each of fiscal years 2010-

2014. Finally, the bilI requires the CDC Director to encourage postpartum screenings 

after a diagnosis of gestational diabetes within CDC-funded state-based diabetes 

prevention and control programs. 

XIII. H.R. 5462, Birth Defects Prevention, Risk Reduction, and Awareness Act of 

2010. 

This bill requires the Secretary of Health and Human Services (HHS,) acting 

through the Director of the Centers for Disease Control and Prevention (CDC,) to 

establish and implement a birth defects prevention and public awareness program about 

pregnancy and breastfeeding information services. It requires CDC to award grants for 

the provision of, or campaigns to increase awareness about, pregnancy and breastfeeding 

information services. The bill also requires CDC to award grants for research on 

maternal exposures and maternal health conditions that may influence the risk of adverse 

pregnancy outcomes. It authorizes $5 million for fiscal year 2011, $6 million for fiscal 

year 2012, $7 million for fiscal year 2013, $8 million for fiscal year 2014 and $9 million 

for fiscal year 2015 to carry out the bill's activities. 

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XIV. H.R. 5986, Neglected Infections of Impoverished Americans Act of 201 0 

This bill requires the Secretary of Bealth and Human Services (HHS) to develop a 

report on the epidemiology and impact of, and appropriate funding required to address 

neglected infectious diseases of poverty in the United States. 

XV. H.R. 6012, Diabetes Screening Utilization Act 

This bill directs the Secretary of Health and Human Services (HHS) to review the 

utilization of diabetes screening benefits and identifY existing efforts by HHS agencies, 

and private and non-profit sectors to increase awareness of diabetes screening benefits. 

An annual report to Congress on these activities is required. 

XVI. H.R. 6081, Stem Cell Therapeutic and Research Reauthorization Act of 2010 

This bill reauthorizes the C.W. Bill Young Cell Transplantation Program, which 

includes the National Registry for adult donors of bone marrow, peripheral blood adult 

stem cells, and umbilical cord blood units; the Office of Patient Advocacy; and the Stem 

Cell Therapeutic Outcomes Database. It authorizes $30 million for each of fiscal years 

2011- 2014 and $33 million for flscal year 2015 for the program. The bill also 

reauthorizes the National Cord Blood Inventory (NCBT), a program that provides grants 

to public cord blood banks to assist them in collecting donated cord blood units that are 

then listed on the National Registry. $23 million for each of flscal years 2011- 2014 and 

$20 million for fiscal year 2015 is authorized for the NCB!. 

XVII. H.R. _, Telehealth Improvement and Expansion Act 0£2010 

This bill reauthorizes three telehealth programs currently administered by the 

Health Resources and Services Administration (HRSA), including (1) the telehealth 

network program, (2) the telehealth resource center program, and (3) incentive grants to 

coordinate telemedicine activities among the states. The bill also revises the 

requirements for funding priorities within both the telehealth network and telehealth 

resource center programs. It authorizes each of the three programs at $10 million for 

each of fiscal years 2012- 2016. 

XVIII. H.R. _, Health Data Collection Improvement Act 

This bill provides for the voluntary collection of data on sexual orientation and 

gender identity, as appropriate and practicable, in programs and surveys supported by the 

Department of Health and Human Services (BBS). It requires the Secretary to develop 

standards for the development of questions and the appropriate and confidential 

collection of such information. It also directs that this information be analyzed to assess 

disparities in health status and access to healthcare. 

xvnIl. Witnesses 

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The following witnesses have been invited to testify: 

Lawrence Tabak, D.D.S., Ph.D. 

Principal Deputy Director 

National Institutes of Health (NIH) 

Ileana Arias, Ph.D. 

Principal Deputy Director 

Centers for Disease Control (CDC) 

Marcia Brand Ph.D. 

Deputy Administrator 

Health Resources and Services Administration (HRSA) 

Available for SAMHSA related questions: 

H. Westley Clark, M.D., J.D. M.P.H., CAS, FASAM 

Director 

Center for Substance Abuse Treatment 

Substance Abuse and Mental Health Services Administration (SAMHSA) 

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