laillillill * E 0 @1 11 I IIIQIIIII fill fill Decemb er 19, 1974 CONGRESSIONAL Rr@,CORD-SENATE S 22261 ment, shall in addition to its governing I do not denigrate it or exprm any major advances against arthritis in the Na- body, have a separate governing body for feeling that it should be reJ@, bemuse tional Institute of Arthritis, Metabolism, and health planning. It is my understanding of that. There is a lot in this bill that is Digestive Diseases, in concert with Other that the governing body for health plan- very sound and very good. But it simply 1-titUtes of the National Institutes of ning of such a public body or unit of lo- Presents a serious problem to which we Health. cal goverr=ent would be appointed and will need to address ourselves, and to NATIONAL COMMISSION ON ARTHRITIS; subject to removal by the governing body which we do not address ourselves ade- ARTHRITIS PLAN ' of the Health Systems Agency? quotely in this bill. SEC. 3. (a) The Secretary of Health, Edu- Mr. KENNEDY. That is correct. cation, and Welfare (hereinafter in this sec- The PRESI]DING OFFICER. The ques- tion referred to as the "Secretary"), after Mr. JAVRIS. It is my understanding that the governing body for health plan- tion is on agreeing to the conference re- consulting with the Director of the National ning would be subject to the laws and Port (putting the question). Institutes of Health, shall, within @ty days regulations of the Health Systems The conference report was agreed to. of the date of the enactment of this section, Agency. Mr. KENNEDY. Mr. President, I move establish a National Commission on Arthritis Mr. KENNEDY to reconsider the vote by which the con- End Related Musculoskeletal Diseases (here- . That is also correct. ference report was agreed Ito. inafter in this section referred to as the Mr. JAVMB. Furthermore, am I cor- "Conunission"). rect In my understanding that hi carry- Mr. ROBERT C. BYRD. I move to lay (b) The Commission shall be composed of ing out the responsibilities prescribed in that motion on the table. eighteen members as follows: subparagraph b(3) (B) of section 1512, The motion to lay on the table was (1) Six members appointed by the Secre- the governing body for health planning agreed to. tary who are scientists, physicians, or other would be subject to the rules and @ngs health professionals not in the employment of the Federal Government, who represent Of the Health Systems Agency and that NATIONAL ARTHRITIS ACT OF 1974 the Various specialties and disciplines in- the health system plans developed pur- volving arthritis and related musculoskeletal SUant to section 1513 and annual lmple- Mr- KENNEDY' Mr- President, I ask diseases (hereinafter in this section col- glentation Plan would be submitted to the Chair to lay before the Senate a mes- lectively referred to as "arthritis"), and of the Health Systems Agency for approval? sage from the House of Representatives whom at least two are practicing clinical Mr. Dy. This is correct. on S. 2854. rheumatoiogists, at least one is an ortho- The PRESMING oniCER (Mr. HAS- pedic surgeon, and at least one Is an allied' Mr. JAVrrS. I thank my colleague. KELL) laid before the Senate the amend- health professional. The PRESI]DIENG OMCER. The ques- tion ment of the House of Representatives to (2) Four members appointed by the Secre- ts On agreeing to the conference tary from the general public, of whom St report. the bill (S. 2854) to ainend the Public sident, I set In on - (3) One member appointed by the Secre- Mr. JAVITS. Mr. pre Health Service Act to expand the au least two Buffer from arthritis. & considerable amotmt of @ oonfer- thority of the National @titute of Ar- tary, from members of the National Arthritis, ence. One of the big things dealt with in @tis, Metabolism, and Digestive M- Metabolism, Digestive Disease Advisory the conference which was s, matter of eases in order to advance a national at- Council, whose primary interest Is in the very considerable moment to public hos- tack on arthritis as follows: field of rheumatology. Pl@. which axe really municipal hos- Strike out all after the enacting clause, (4) The Director of the National Insti- Pit0s, was the question of mo-demimtion, and insert: tutes of Health or his designee, the Director which Is terribly urgent. SHORT TITLE of the National Institute of Arthritis, Metab- SECTION 1. This Act may be cited as the olism, and Digestive Diseases or his designee, emtbhley weohnofte@ restricted V@ WNSICL- 'National Arthritis Act of 1974". the Directors, or their designees, of the Na- was permitted to be done, so tional Institute of Allergy and Infectious that it now permits only mod tion FINDINGS AND DECLAITATION OF PURPOSE Diseases and the National institute of Gen. Which r@ @ Imminent in _ SEC. 2. The Congress makes the following emi Medical Science, the Associate Director respect of the structure w@h is to be "ndinp- for Arthritis and Related Musculoskeletal modernize(L (1) Arthritis end related museulogketgl Diseases of such Institute, end the chief Even with that diseases constitute major health problems in medical officer of the Veterans, Administra- tat'014 a @tat'on the United States in that they a=ct more tion and the Secretary of D Of 22 percent was imposed on moneys ap- efense or their than twenty million Americans and we the designees, each of whom shall serve -as ex propriated under that particular part Ot greatest single cause of chronic pain and officto, nonvoting members. the bill which could be devoted to @ disability (c) The members of the Commission shall . This was @ another @ta- (2) The complications of arthritis lead to select a chairman from among their own tion on a @tation, making It even more many other serious health problems and number. The. Commission shau:drst meet on difficult for @ very mmtial wtIvity to Other Severe physical disabilities in persons a date specified by the Secretary, not later Uke place. Of all ages with the disease. particularly than 30 days after the Commission Is estab- Mr. President, anyone who has a big children and adolescents. lished, and thereafter shall meet at the call (3) The annual cost of arthritis to the na- of the Chairman of the Commission (but not city.in his St& we all do-md has ti-al economy In 1970, from medical ewe less often than three times). ' @ any personal OPPO@TY to Visit expenses and lost wages, was $9,2oo,ooo,ooo, (d) The Director of the National Institute the municipal or public hospitals must and number Of workdays lost in that year of Arthritis, Metabol@ and Digestive be as depressed as I am about their condi- totaled over 14.5oo,ooo. Diseases shall- tion. Really, there is, on the whole, a very. (4) Uncontrolled arthritis significantly de- (1) designate a member of the stAff of such very serious deficiency in the whole hos- creases the quality of life and has a major Institute to act as Executive Secretary of negative economic, social, and psychological the Commission, and pital system of the a=try. While we must be conte Impact on the families of Its victims and (2) provide the Commission with Such rit with the society generally' full-time professional and clerical staff, such Provisions made by this bill, I would hope (5) Athletic and other types of joint in- Information, and the services of such con. very much that the respective commit- juries Involving trauma can lead to arthritis. sultants as may be necessary to assist it in tees ('-Oncemed in the exercise of their (6) The development of advanced methods carrying out effectively its function under legislative Oversight would look into the of diagnosis and treatment Of arthritis and this section. col=tion of the municipal bOsPi@ and quality trained health professionals in ar- (e) Members of the Commission who are so-called public hospitau, and if it JS thritis deserves the highest national priority. officers or employees of the Federal Govern- found that this Provision Contained in (7) There Is a critical shortage of medical ment shall serve as members of the Com- the conference report is inadequa@and facilities and properly trained health pro- mission without compensation In addition to I deeply feel it very likely to be lnade- fessionsis and allied health professionals in that received in their regular public em- quate, considering its restriction@that the United States for arthritis research, pre- Ployment. Members of the Commission who an effort will be made here to help with vention, treatment, care, and rehabilitation are not officers or employees of the Federal programs. Government shall each receive the daily it on the Federal level. equivalent of the rate in effect for grade I did wish to call to the at (8) The citizens of the United States 0-18 of the General Schedule for each day tention of should have a full understanding of the na- (including traveltime) they are engaged ill the Senate the very serious conditions ture of the human, social, and economic im- the performance of their duties as members which face those of us who represent nact of arthritis and should be encouraged to of the Comznission. All members, while so States with big cities in this particular ;@ek early diagnosis and treatment to pre- serving away from their homes or regular reg@ and the very sharply limited ef- vent or mitigate physical disability resulting places of busftiess, may be allowed travel fort to health which is contained In this from arthritis. expenses, including per them In lieu of bill. (9) There Is great potential for making subsistence, In the same manner as such ex- S 22262 CONGRESSIONAL RECORD -SENATE December 19, 1974 penses are authorized -by section 5703. title collection, @rELge, and retrieval of research ARTHRITIS COORDINATING COMMITTEE, DEMON- 5, United States Code, for persons In the and t nt data In order to facilitate col- STRATION PROJECTS, AND COMPREHENSIVE Government Service employed in t- labomttve and o=pamtive studies of large ARTHRITIS CENTERS tently. patient populations; SEC. 4. Part D of title IV of the Public (f) The commission Shall survey Federal. (11) programs to establish a system for Health Service Act Is amended by adding at State, and local health programs and activi- the collection, analysis, and d nation the end thereof the following new sections: ties relating to arthritis and assess the ade- of data useful In the screening, prevention, "ARTHRITIS COORDINATING COMMITTEE quacy, technical soundness, and coordina- diagnosis, and treatment of arthritis, in- tion of such programs and activities, AU cluding the establishment of a national data "SEC. 437. (a) In order to improve coordi- 5- nation of all activities in the National In- Federal departments and agencies admlni -storage bank to collect, catalog, and store, tering health programs and activities relat- and facilitate retrieval and dissen-Anation Of stitutes of Health, in the DepartmentL of ing to arthritis shall provide such C4Dopera- Health, Education, and Welfare, and in other tion and assistance relating to such pro- information as to the practical application departments and agencies of the Federal. of research and other activities pertaining to grams and activities as is reasonably neces- arthritis; Government relating to Federal health pro- sary for the Commission to make such sur- grams and activities relating to arthritis, the vey and assessment. (12) programs for the education (includ- Secretary shall establish an Arthritis Coordi- (g) The Commission shall formulate a Ing continuing education programs and de- nating Committee to be composed of repre- velopment of new techniques and curricula) long-range plan (hereinafter in this section f scientists, bioengineers, physicians an- entatives of the Department of Health, referred to as the "Arthritis Plan") with e practice of Education, and Welfare (including the Food specific recommendations for the use and gaged in general practice, th and Drug Administration) and of the Vet. family medicine, or other primary care ape- organization of national resources to combs,t lialtie,, surgeons, Including orthopedic sur- erans' Administration, the Department of Defense, and other Federal departments and arthritis. The Arthritis Plan shall be based geons, and other health and allied health on a survey investigating the incidence and the fields and agencies Involved In research, health serv- prevalence of arthritis and Its economic professionals and educators in ices, or rehabilitation programs affecting specialities requisite to screening, early de- arthritis. This committee shall include the and social consequences, and on an evalua- tection, diagnosis,'tres6tment, and preven- Directors (or their designated representa- d tiou of scientific information respecting an tion of arthritis and rehabilitation of In- tives) of each of the Institutes of the Na- the national resources capable of dealing dividuals who suffer from arthritis; tional Institutes of Health Involved In exth- with arthritis. The Arthritis Plan shall in cludQ a comprehensive program for the Ns (13) programs for public education and ritis related research. The Committee shall counseling relating to arthritis, Including be chaired by the Associate Director estab- ti6nal Institute of Arthritis, Metabolism, and Digestive Diseases (hereinafter in this see- public information campaigns on current de- lished pursuant to section 434(e) and shall tion referred to as the "Institute") and plans velopments in diagnostic and treatment pro- prepare a report not later than sixty days fo,: Federal, State, @ local P@ms. cedilires and programs to discourage the pro- -after the end of each fiscal year as possible, which program and programs shall, as ap- motion and use of unapproved and ineffec- for the Secretary detailing the work of the propriate,, provide for- tive diagnostic, preventive, treatment, and committee In seeking to improve coordina- (1) investigation into the epidemiology, control methods and unapproved and inef@ tion of departmental and Interdepartmental etiology, and prevention and control Of fective drugs and devices; activities relating to arthritis during the (14) a program for the acceleration of in- preceding fiscal year. Such report shall in- arthritis, Including the social, ' environ- Men@ behoVIOMI, nutritional, and b@ ternation I cooperation in and exchange of clude- knowledg: on research, screening, early de- "(1) a description of the work of the com. logical control of arthritis: (2) studies and research into the basic tection, diagnosis, treatment, prevention, and mittee in coordinating the research activities and of the National Institutes of Health relating biological processes and mechanisms in control of arthritis, volved with arthritis, including abnormali- (15) coordination of the research programs to arthritis during the preceding year, and ties of the immune, musculoskeletal, caxdio- relevant to arthritis of other Institutes of "(2) a description of the work of the com- vascular, gastrointestinal, urogenital, p-Lil- the National Institutes of Health, the De- mittee in promoting the coordination of Fed- monary, and nervous systems, the skin, and partment of Health, Education, and Welfare, -eml health programs and activities relating the eyes; and other Federal and non-Federal entities. to arthritis-to assure the adequacy of such (3) research Into the development, trial (h) The Commission may hold such hear- programs and to provide for the adequate and evaluation of techniques, orthopedic tngs, take such testimony,- and sit at such coordination of such programs and activities. and other surgical procedures, and drugs time and places as it deems advisable. (b) The Committee shall meet at the call (including drugs intended for use by chil- (1) (1) The Commission shall prepare for of the chairman, but not less often than four dre,n) used In the diagnosis early detection, each of the Institutes of the National In- times a year. treatment, prevention, and control of stitutes of Health whose activities are to be 'ARTX-TRITIS SCREENING, DrrEcTiow, PREVENTION, arthritis: affected by the Arthritis Plan estimates of AND REFEITRAL DEMONSTRATION PROJEwrs; (4) proUsnis that will apply scientific necessary expenditures to carry out each AND DATA BANK and technological methodologies and proc- such Institute's part of the comprehensive esws Involving biological, physical, and en- program included in the Plan. The estimates "SEC. 438. (a) The Secretary, acting gineering sciences to deal with all facets shall be prepared for the fiscal year ending through the Assistant Secretary for Health, of arthritis, including traumatic arthritis: June 30, 1976, and for each of the next two may make grants to public and nonprofit (5).programs for the conduct and direc- fiscal years. entities to establish and support projects for tion of field studies, large-scale testing, eval- the development and demonstration of meth- (2) Within five days after the Budget Is ods for arthritis, screening, detection, preven- nation, and demonstration of preventive, di- transmitted by the President to Congress for tioii, and referral, end for the dissemination agnostic, therapeutic, rehabilitative, and the fiscal year ending June 30, 1976, and for of these methods to health and allied health control approaches to arthritis, including each of the next two fiscal years, the Secre- studies of the effectiveness and use of home professions. Activities under such projects. tary shall transmit to the Committees on Shall be coordinated with (1) lPederal. State, care programs, mobile care units, conununity Appropriations of @he House of Represents- R. local, and regional health agencies, (2) cen- rehabilitation facilities, and other appro- tives and the Senate, the Committee on L pri@ conununity public health and social bor and Public Welfare of the Senate, and ters assisted under section 439, and (3) the services; the Committee on Commerce and Health of data bank under subsection (c). (6) studies of the feasibility of, and pos- the United States House of Representatives 11(b) Projects under this section shall in- stble benefits accruing from, the organiza- an estimate of the amounts requested 'for clude programs which- tion and training of teams of health and al- arthritis research by each of the Institutes (1) emphasize the development and dem- lied health professionals In the treatanent for which estimates were prepared under onstration of new and Improved methods and rehabilitation of Individuals who suffer paragraph (1) and a comparison of such of screening and early detection, referrdl, and from arthritis amounts with such estimates. diagnosis of Individuals with a risk of devel- (7) @@ to evaluate available re- (j) (1) The Commission shall publish and oping arthritis, asymptoniatic arthritis, or sources for the rehabilitation of Individuals transmit directly to the Oongress (without, Symptomatic arthritis" who suffer from arthritis; prior administrative approval or review by 11(2) emphasize the development and' (8) programs to develop new and improved the Office of Management and Budget or any. demonstration of new and Improved methods methods of screening and referral for arth- other Federal department or agency) the for patient referral from local hospitals and ritis, and particularly for the early detee- Arthritis Plan within two hundred and ten physicians to appropriate centers for early tion of arthritis; days after the date on which funds are first diagnosis and treatment; (9) programs to establish standards and appropriated for the Commission.' 11 (3) emphasize the development and dem- crlteria for measurement of the severity and (2) The Commission shall cease to exist onstration of new and improved methods of rehabilitative potential of disabilities result- on the thirtieth day following the date of standardizing patient data and recordkeep- Ing from arthritis; the submission of the Arthritis Plan pur- Ing; and (10) programs to develop a uniform de- suant to paragraph (1) of this subsection. (4) emphasize the development and dem- scriptive vocabulary for use In basic and (k) There are authorized to be appropri- onstration of new and improved methods of clinical research and a standardized clinical ate-d, without fiscal year Iiinitation, to carry dissemination of knowledge about the proj- patient data set for arthritis to standardize out the purposes of this section $2,000,000. ects and methods referred to in the preceding S 22263 Deceniber 19, 1974 CONGRESSIONAL RECORD -SENATE "The Advisory Council paragraphs of this subsection to health and and diagnosis of lndiii(lual- with a risk of shall review app - allied health professionals. developing arthritis, asymptomatic arthritis, cations made to the Director for grants for " (e) (1) AS soon as practicable after the or symptomatic arthritis, research projects related to arthritis and date of enactment of this section the Sec- "(2) dis,3emtn@ the results of research, related niusculoskeletill diseases and shall retary, through the Assistant Secretary for screening, and other activities, and develop recommend to the Director for approval those Health, shall establish the Arthritis Screen- means of standardizing patient data and applications and contracts which the Council ing end Detection. Data Bank for the recordkeeping, and determines will best carry out the purposes collection, storage, analysis, retrieval, and " (3) develop community consultative serv- of this part. The Advisory Council shall also dissemination of data useful in screening, ices to facilitate the referral of patients to review and evaluate the arthritis programs prevention, and early detection involving centers for treatment. under this part and shall recommend to the patient populations with asyinptomatic and "(e) The Secretary shall, Insofar as prac- Directoi such changes In the administration symptomatic types of arthritis, including ticable, provide for an equitable geographical of such programs as it determines are nqces- where possible, data involving general popu- distribution of centers assisted under this rary." lations for the purpose of detection of in- section. The Secretary shall give appropriate dividuals with a risk of developing arthritis. consideration to the need for centers espe- Mr. KENNEDY. Mr. President, I am I,( 2) The Secretary shall provide for stand- cially suited to meeting the needs of children going to yield to the distinguished Sen- ardization of patient data and recordkeeping affected by arthritis. ator from CalifGmia who hits been the for the collection, storage, analysis, retrieval. 11(f) The Secretary shall evaluate on all sponsor, prime sponsor, of this legisla- and dissemination of such data in coopertl- annual basis the activities of renters re- tion, and has been tireless in his pursuit tion with projects under this section and ceiving support under this section and shall of the objectives of this bill, in seeing centers assisted under section 439, and other report to the appropriate, committees o persons engaged in arthritis programs. Congress the results of his evaluation f not only that the hearings were held, and 'O' "(d) There are authorized to be appro- later than four months after the end of each @ho @haired the hearings, but he has priated to carry out this section $2,o66,ooo fiscal year. piayea an extremely important role in for fiscal year ending June 30, 1975, $3,000,- "(g) No center may receive more than seeing to its successful conclusion. 000 for fiscal year ending June 30, 1976, and three grants under this section. This reaches an issue which Is a health $4,000,000 for fiscal year ending June 30, "(h) For purposes of this section, there are hazard to millions of Americans. It is of .1977. authorized to be appropriated $11,000,000 for prime concern to senior citizens and to "compREFrENsivr. ARTHRITIS CENTERS fiscal year ending June 30, 1975, $13,000,000 their children, and all those who care for fiscal year ending June 30, 1976, and $15,- about good and decent health and who "SEC. 439. (a) The Secretary, acting 000,000 for fiscal year ending June 30, 1977. through the Assist4Liit Secretary for Health have seen the problems, the tragedy, of Not less than 20 per celitum of the funds ap- may, after consultation with the National propriated for each fiscal year under this, those afflicted with arthritis. Advisory Council established under section shall be used for the purposes of establishing I think all Americans who are so,. inter- 434 (a) and consistent with the Arthritis Plan developed pursuant to the National Arthritis new centers." ested, owe a very great debt of gratitude ASSOCIATE DIRECTOR, ANNUAL REPORT, RESEARCH to the distinguished Senator from Cali- Act of 1974, provide for the development, FUNDING, ADVISORY COUNCIL fornia. modernization, and operation (including C. 5. (a) Section 434 of the Public Health NATIONAL ARTHRITIS ACT as the 6E staffing and other operating costs such I Service Act is amended by adding at the end Mr. CRANSTON. I thank the Senator costs 6t patient care required for research, of centers for arthritis research, screening the following new subsections: from Massachusetts very much for his detection, diagnosis, prevention, control, and 11(e) There Is established within the In- wonderful cooperation on this measure. treatment, for education related to arthritis, stitute the position of Associate Director for Without his help, this measure would not Individuals who Arthritis and Related Muscxiloskeletal Dis- and for rehabilitation of suffer from arthritis. For purposes of this ease& (hereinafter in this part referred to as have gone through the Senate and,%,ould section, the term 'modernization, means the the 'Associate Director'), who shall report not no* be back for final passage-I am alteration, remodeling, improvement, expan- directly to the Director of such Institute and deeply grateful to him for his coopera- sion, and repair of existing buildings and who, under the supervision of the Director tioil and his leadership. the provision of equipment for such build- of such Institute, shall be responsible for I believe that virtually every Senator ings to the extent necessary to make them programs regarding arthritis and related on the floor is a cosponsor of this meas- suitable for use as centers described in the musculoskeletal diseases (hereinafter in this preceding sentence. part collectively referred to as 'arthritis') ure. We had 76 sponsors in all in the 11(b) Each center assisted under this see- within such Institute. Senate. tion shank 11(f) The Director of the Institute shall, as Mr. President, I believe the Senate 1) (A) use the facilities of a single in- soon as practicable, but not later than sixty should accept S. 2854, the National stitution or a consortium of cooperating in- days, after the end of each fiscal year, pre- Arthritis Act, with the House amend- stitutioiis, and (B) meet such qualifications pare, III consultation with the National Ad- ment. However, there are a number of as may be prescribed by the Secretary; and - visory Council, and submit to the President clarifying and perfecting amendments, "(2) conduct- and to the Congress a report. Such report and three amendments of a more sub- "'(A) basic and clinical research Into the shall, include (1) a proposal for the Insti- cause, diagnosis, early detection, prevention, tute's activities under the Arthritis iPlail stantive nature, which I believe are essential to insure that congressional control, and treatment of, arthritis and corn- formulated under the National Arthritis Act plications resulting from arthritis, including of 1974 and activities under other provisions intent is clear and t6 insure that the research into implantable biomaterlals and of law during the next five years, with an programs authorized by the legislation biomechanical and other orthopedic pro- estimate for such additional staff positions call be administered effectively. I do not cedures and in the development of other and appropriations as may be required to wish to delay enactment of this measure diagnostic and treatment methods; pursue such activities, and (2) a program and, for that reason, I am not at this "(S) training programs for physicians and evaluation section, wherein the activities and time offering them to S. 2854 as passed other health and allied professionals in cur- accomplishments of the Institute during the rent methods of diagnosis, screening and preceding fiscal year shall be measured by the House. Instead, I will offer them early detection, prevention, control, and against the Dlrector's proposal for that year in a concurrent resolution which I hope treatment of arthritis; for activities under the Arthritis Plan.". the Senate adopts today. I have assur- "(C) information and continuing educa- (b) Section 431 of such Act is amended by ances from Members in the House that tion programs for physicians and other health adding at the end thereof the following sub- they will make every effort to take up and allied health professionals who provide section: the concurrent resolution before we ad- call for patients with arthritis; and "(c) Of the sums appropriated for any journ and pass it so that the National "(D) programs for the dissemination of fiscal year under this Act for the National -Arthritis Act when enacted, will reflect Information- Institutes of Health, not less than $500,000 these changes. "(I) on the importance of early detection shall be obligated for basic and clinical of arthritis, of seeking prompt treatment, Mr. President, this matter of the con- orthopedic research conducted within the and of following an appropriate regimen; resolution has been cleared on National Institute of Axthritts, Metabolism, cUrrenT, end End Digestive Diseases which relates to the both sides of the aisle. "(it) to discourage the promotion and use methods of preventing, controlling and treat- Mr. President, 1, therefore, ask unani- Of unapproved and Ineffective diagnostic, pre- ing arthritis and related musculoskeletal dis- mous consent that I be recognized In or- ventive, treatment, and control methods and eases, Including research In implantable bio- der to submit and call up this concurrent unapproved and ineffective drugs and materials and blomeclianical and other resolution immediately after the Senate devices. orthopedic procedures and research In the "(e) Each center assisted under this see- development of new and Improved ortho- concurs in the House, amendment to S. tion may conduct programs to- pedic treatment methods." 2854. "(1) develop new and improved methods (e) Section 434(b) of such Act Is amended The PRESIDING OFVICER. Without of screening and early detection, referral, by addi ng at the end thereof the following: objection, It Is so ordered. S 22264 CONGRESSIONAL'RECORD - SENATE December 19, 1974 GENERAL PuRposz or THE NATIONAL riocL The bill as passed b@ the House and us find the causes and the cures of ar- ARTMrrrg ACT currently before the Senate reduced this thritis, Mr. President. Mr. CRANSTON. Mr. President, the amount to $50 million over a 3-year pe- Mr. President. in addition, onither bill before us today offers a means of riod in an effort, to limit expenditures, major target of research is effective developing a concerted attack against a consistent with congressional desire to treatment of arthritis. Because there is disease which is, unfortunately, too f@ keep the budget within reasonable no successful form of treatment, many miliar to too many of us. It Is estimated bounds. I believe ff the amounts author- arthritis suff erers become victims of that some 50 million Americans have ized In S. 2854 are appropriated we can false cures, quack remedies, and exploita- some form of arthritis. It is known that have an effective program. I will be rec- tion by the unscrupulous. 20 million Americans suffer from ommending to the Appropriations Com- EFFORTS TO PREVENT QUACIC ARTHTL@ CURES arthritis severe enough that they seek a mittee that these amounts be appropri- The bill would require the establish- 'physician's help. ated in the appropriate fiscal year 1975 ment of regular public information pro- Arthritis afflicts all ages -and all income supplemental appropriations act and in grams to disseminate information on the leve@although it hits hardest those the appropriations acts for both succeed- itatus of diagnostic and treatment pro- with low income@ it also strikes women Ing fiscal years. cedures In order to discourage the pro- twice as frequently as men. Over one- The special needs of children who suf - motion of such "quack" remedies. It also third of retired persons, and over 10 fer from arthritis was vividly brought to encourages the dissemination of Infor- percent of those working suffer from the attention of the committee members mation on unapproved and ineffective arthritis. in both Houses. To emphasize Congres- diagnostic end treatment methods and But arthritis also takes its toll among sional concern with the devastating ef - ineff ective drugs or devices. the very young. Some quarter of a million fects of arthritis on children the bill One way in which this information children suffer from juvenile rheumatoid directs the secretary to give appropriate Could be disseminated Is through doctors' arthritis, the most devastating form of consideration to the need for centers offices. 'Me average patient has full faith arthritis. especially suited to meeting the needs of in his doctor and if the doctor waxns Mr. President, despite the prevalence children affected by arthritis. In ad- him of the danger of Ineffective "cures" of this disease, it is little understood. We dition, the arthritis plan developed by the patient will be much les's receptive to do not now have the capability to cure the Commission must provide for re- trying something new without talldng it it, nor do we know how to prevent it. search into drugs intended for use by over with his doctor. A pampl-det Placed This is because we do not know what children' in the primary-care physican's office causes it. The House has added a new provision. waiting room would carry with it the The toll of arthritis in human suffer- with which I fully concur which f the doctor's approval, and re- weight o Ing and pain is great. In economic terms quires the establishment of an Intra- could dissuade the patient from experl- the cost to the Nation in medical bills mural orthopedic program within the menting with tmapproved "cures." and lost wages is estimated at $9.2 billion. National Institute of Arthritis, Metabo- When the distinguished chairman of The proportions of the impact of lism, and Digestive Diseases. This Is the Committee on Labor and Public Wel- arthritis on the Nation's health, social, vitally important to the 13 million per- fare, Senator WILLIAMS, was chairman of and economic programs are sufficient to sons afflicted with osteoarthritis and the the Subcommittee on Frauds and Mis- require a planned strategy to counter 5 million Persons crippled by rheumatoid representations Affecting the Mderly. of this disease. arthritis, since orthopedic procedures are t@ Committee on Aging, that subcom- a now considered as one of the best means mittee conducted Intensive hearings on S. 2854 presents a means of developing this strategy. of treatment being developed by current frauds against the elderly. One of the Mr. President, I would like to re- day research. findings of these hearings was that there emphasize my total agreement with the Presently, the institute has no or'r,'no- are a large number of frauds perpetrated statement made by Congressman Paul pedic program to provide leadership in against the aging citizen who suffers Rogers, chairman of the Subconunittee this area. from arthritis. The provisions in S. 2654 This situation will be corrected by this reflect the commitment which we share on Public Health and the Environment provision. of the House Committee on Interstate with the distinguished Senator from New and Foreign Commerce yesterday when DTSCUSSRON-LONG-RANGE ARTEMITIS PLAN Jersey (Mr. WILLIAMS) to provide pro- the National Arthritis Act was adopted Mr. President, S. 2854 provides for the tection to arthritis victims. The distin- in the House, in wl)ich he pointed out establishment of a Commission to de- guished Senator from New York (@. that the programs authorized by S. 2854 velOP a long-range plan to combat JAVITS) also has a keen interest in this are in addition to and supplementary to arthritis and makes certain minor or- problem and during the hearings art programs currently being carried on ganizational refinements to the admin- S. 2854, sugi@sted the broad outlines of @d er the authorities of the Public istration of HEW programs In order to the language pertaining to this protec- Health Service Act. place appropriate emphasis on research tion which has been accepted and Is In- The programs and authorization levels in arthritis and to Insure that there is cluded in the bilL' proposed by S. 2854 are new programs coordination among all programs related ARTHRMS SCREMING, EARLY DETECTION, and new appropriations authorizations to arthritis so that each can benefit from PR@NTY.ON, AND CONTROL PROGRAMS requiring additional Federal financial the breakthroughs of the other. Mr. President, the proposed National A report developed 2 years ago by a Arthritis Act also provides for the estab- support and are not intended to replace or reduce the current arthritis programs prestigious group of rheumatologists, lishment of artl-iritis screening, early de- carried on in HEW under section 301, or orthopedic surgeons, and other leaders tection, prevention and control programs under title IV, part D, or under other in the medical profession, developed a which, consistent with the arthritis plan: authorities of the Public Health Service list of major research goals in the study can be provided through State, @ocbl, and Act. The programs proposed by this bill of arthritis and related diseases. other public or private nonprofit agen- are irAended to supplement the existing These goals were: cles. I believe the establishment of these HEW programs In NIH. It is necessary Determination of whether a viral agent programs directed at improved diagnos@. to continue our existing arthritis pro- is the cause of arthritis and, if so, its tic and treatment techniques is crucial gram and to carry out these new pro- identification; since early detection of arthritis can save grams at their authorization levels. Clarification of the Involvement of the years of pain and disability. otherwise, we cannot expect to effee- Immune system in the development, of COMPREHENSRVZ ARTHRITIS CENTERS tively combat arthritis. rheumatoid arthritis; The legislation would also authorize The original arthritis bill I introduced Identification of the mechanisms of support for ongoing arthritis centers and in the Senate with Senator Javits and @mmation, the early manifestation for the establishment, again consistent Senator Williams Included an approt)ria- of most forms of arthritis; with the arthritis plan, of comprehensive tions authorization of a total of $75.5 Improvement of techniques for re- arthritis centers to provide an opportu- mill@!on over a 3-year period, and the placement of hips and. other joints; and nity for intensive, interdisciplinary basic original bill Introduced in the House Statistical surveys of arthritis Ilici- and clinical research in arthritis. These called for a total of over $80 million for dence. centers would also offer a unique oppor- @l- - - @.- -I- -- - @ ---- -- @f +ha@. "nale wr6tilcl hpln tiinitv fnr tra.ining In- and demonstra- Dece?)tbe)- 19, 1974 CONGRESSIONAL R@@ CORD-SENATE S 22265 tion of, screening, advanced diagnostic Senator from New iei.,;ey (Mr. WILLXAMS) arthritis cures. The Committee on La- prevention, treatment, and control Pro-- and, of course the distinguished Senator bor and Public Welfare, of which I am grams for arthritis. - from Masachusetts (Mr. KENNEDY) for ranking minority member, learned dur- The Arthritis Foundation in its report the leadership and dedication they have ing thd course of hearings on this meas- entitled "Professional Manpower In devoted to the deliberations on the Na- ure that $435 million is spent each year Rheumatology" states: tional Activities Act. Their assistance on such quackery and this amount would Most physicians who care for rheumatic has been invaluable and accounts in appear to be merely the "tip of the Ice- disease patients are not specifically trained large measure for. the fact that today berg" according to the experts. I believe for the task.... Specialists In rheumatology we are ready to Send the bill to the Presi- this is a financial waste, but even more treat only 3.1 percent of those afflicted with dent f or signature. important, ineffective and potentially rheumatic disease. Other specialists and pri- harmful remedies can exacerbate arth- mary-care physicians see about seven mi .. on I believe we are ready to vote on the ritis or cause increased and unnecessary rheumatic disease patieiit@yet more thn motion to concur in the House arnend- 70 percent of these physicians have little or ment. disabilities, and even death. no formal education in the complexities of Mr. KENNEDY. Mr. President, I move The provision I authored provides for distinguishing among various rheumatic dLs- that we concur In the I-louse amendment. programs for the dissemination of in- eases and instituting appropriate modern Mr. JAVITS. Mr. President, Is this the formation to the general public to dis- modes of treatment. House amendment on the conference courage the promotion and use of un- Mr. President, the centers proposed by report? approved and ineffective diagnostic, pre- S. 2854 could serve as a locale for con- Mr. CRANSTON. This is the House ventive, treatment and control methods tinuing education programs for primary- amendment to the Senate bill. and unapproved and ineffective drugs care ph@cians who are the normal entry The PRESIDING OFFICER. The ques- and devices. In addition, the National point Into the health care system for tion.is on agreeing to the motion to con- Co on on Arthritis is directed to the symptoms of the various forms of cur in the House amendment to S. 2854. develop a long-range plan which shall arthritis sufferers. Better knowledge of The motion was agreed to. include programs of this type. It is our arthritis can mean great savings in tim: I TS addressed the Chair. hope that a vigorous program of public Mr: IAVI lost in applying early treatment Of th CRANSTON. Mr. President, under information will go far, to alleviate the disease, and in early detection of the the unanimous-consent agreement- problem of quackery. more severe forms of arthritis which re- The PRESIDING OFFICER. The Sen- Also, I believe that organized medicine quire the care of a specialist. ator from California obtained a unani- must become a leader in speaking out These centers can also provide oppor- mOus-cOnsent agreement to be recognized about the problem of quackery. The re- tunlties for Interdisciplinary training In for the purpose of bringing up a resolu- sPOnsibility to Protect the public must tion immediately following the adoption not be left to public officials who do not the treatment of arthritis patients and, of that motion. have the medical expertise to evaluate through such training, the more efficient utilization of the skills of the specialist, Mr. JAVITS. Mr. President, will the alleged "cures". the nurse, the physical therapist, and Senator yield to me? I urge my colleagues to support the health support personnel in long term Mr. CRANSTON. I yield. National Arthritis Act, as amended, and treatment and rehabilitation programs. Mr. JAVITS. Mr. Pres ent, I urge my allow us to advance a national attack on colleagues to concur In the House amend- arthritis. Treatment of arthritis cannot be con- ments to the Senate-passed National I thank my college. fined only to the patient, but because of Arthritis Act (S. 2854). The PRESIDING OFFICER. The Sen- the pervasive nature of the disease In @ ator from California (Mr. CRANSTON). The House amendments are, in essence, pronounced stages, counseling must be technical and conforming amendments provided to the family as well. The suc- which adopt all of the provisions of the SENATE CONCURP.ENT RESOLUTION cessful treatment of arthritis results from Senate-passed bill. 127-AUTHORIZING THE- BECRE- a joint enterprise of family, patient, and health care personnel. It can best be fos- Since I joined with Senators CRAN- TARY OF THE SENATE TO MAKE tered by an organized, Interdisciplinary STON and WILLr.Ams in introducing this TECHNICAL CORRECTIONS IN THE legislation, It has been cosponsored by ENROLLMENT OF THE BILL (S. program such as that which would be 75 Senators evidencing the deep public 2854) created by S. 2854. concern about this crippling disease. Dur- DATA BANK ing hearings, all witnesses, with the ex- Mr. CRANSTON. @. President, I send The bill also provides for the establish- ception of those from the administration, to the desk a concurrent resolution Co- ment of an arthritis screening and detec- joined in urging prompt passage. sponsored by Senators KENNEDY, WIL- tion data bank, and for the dissemination Arthritis is a major health problem LIAMS, SCHWEDCER, and JAVITS, and ask of the data collected and processed in co- in the United States. An estimated 20 for its immediate consideration. operationwith the centers and programs million Americans suffer from arthritis The PRESIDING OFFICER (Mr. HAS- LL). The clerk will state the concurrent developed under the authorities of S. 2854 severe enough that they seek a PhYsi- KE or through other appropriate means. cian's help. . Arthritis effects all age resolution. Testimony presented to the Senate com- groups, from the youngest to the most Mr. CRANSTON. Mr. President, I ask mittee by Dr. Evelyn Hess of the Univer- senior. For example, an estimated 75,00(y unanimous consent that the reading of e of 17 are af- the resolution be dispensed with. sity of Cincinnati, was very convincing as Americans under the ag t The PRESIDING OF7ICER. Without to the need for an organized system for flirted. However, senior citizens are hi e objection it is so ordered. data collection and dissemination on all hardest At least half of those over th aspects of arthritis. Existence of such a age of 6'5 have evidence of arthritis, and The concurrent resolution Is as follows: system would add substantially to the 700,000 have a moderate to severe form Resolved by the Senate (the House of Rep- dissemination of information on new of the disease. resentatives concurring), That th@ Secretary treatment methods, as well as the body This bill reflects a deep concern that of the Senate be authorized to make the 6f 4@pidemiologic Information. the Federal Government has not been following corrections in the enrollment of I would like to express my gratitude for providing adequate leadership In re- the bill, S. 2854, to expand the authority rol of the National Institute of Arthritis, Metab- the cooperation which has been given by search, screening, detection and cont olism, and Digestive Diseases In order to House Commerce Committee Harley programs and the.development of nec- advance a national attack on arthritis: Staggers and Congressman PAUL ROGERS essary educational programs with respect On page 1, line 5, insert "(hereinafter in in our joint efforts to work out a bill to arthritis. I believe this legislation will th Is Act collectively referred to as 'arthritis') which would be acceptable to both assure that the Federal Government after "diseases". Houses. Their kindness and responsive- launches an effective all-out attack on , On page 2, line 5, insert a comma and ness has been Invaluable In our discus- this painful and crippling disease. including $2,500,000,000 In medical ex- sio-ns, and has enabled us to come to a peiises," after '1$9,200,000,000,11. I am pleased that the House amend- On page 3, between lines 7 and 8, insert satisfactory agreement. ments accept the provision in the Senate the following new subsection: I would also like again to express my passed bill which I authored with respect (b) It Is therefore the purpose of this Act thanks to the distinguished Senator from to "quackery'@the serious problem of to ertablish- New York (Mr. JAvrTs), the distinguished unapproved and Ineffective alleged (1) a long-range plan- S 22266 CONGRESSIONAL RECORD-SENATE December 19, 1974 (A) to expand and coordinate the national mission of the plan which might result will expect to complete its voting on the research, treatment, and control effort against from appropriations acts being out of nomination of Mr. Rockefeller by about arthritis; for sequence with the Commission's calendar 5 or 10 minutes after 8 o'clock,, which is (B) to advance educational activities or work page. Very soon. patients, professional and allied health per- sonne-1) and the public which will elert the The third amendment would reallocate I have also been told by the Sergeant citizens of the United States to the early in- the appropriations authorizations so that at Arms of this body that approximately dications of arthritis; and authorizations for fiscal yeax 1975, which 2 hours will be needed to prepare this (C) to emphasize the significance of early now has only 6 remaining months, would Chamber for the visit of the President detection and proper control of these diseases be reduced, and the 2 succeeding years of the United States and the soon-to-be and of the complications which May evolve authorizations would be commensurately Vice President of the United States. I from them; increased. The Increases are explained @ will soon move to recess until 10 p.m.,I (2) centers for arthritis screening, de- follows: would think that the swearing-in cere- tection, diagnosis, prevention, control, treat- ment, education, rehabilitation, and research [Millions of dollars] - mony would require 30 to 45 minutes- and training programs; and hopefully, less than 30 minutes. But af- (3) programs to develop new and improved Fiscal year- ter that ceremony, the Senate will re- methods of arthritis screening, detection, Authorization 1975 1976 1977 sume its session. prevention, and referral and to establish a It is still possible that the Senate could central arthritis screening and detection adjourn sine die this evening. Otherwise,- data bank. 1. Commission on Arthritis On page 4, lines 17 and 18, strike out "chief and Musculoskeletal I would not say that we should come Diseases (s 3(k)), back into session tonight..We will come ec' medical officer" and insert in lieu thereof House amendment ---- 2.0 (to remain available back into session and see where we go "Chief Medical Director". until expended) On page 11, lines 12 and 13, strike out "on Senate bill ---------- 5 . 5 --------- from there. which funds are first appropriated for the Senateamendment--- 1. 5 (to remain available I also want to notify Senators that commission." and insert in lieu thereof "Of 2. Screening oroiects and until expended) there will be at least the proposal made, the first meeting of the Commission, as pre- data ban@ (see 438(d) once we get back into session, that the sciibed in section 3(c) of this Act,". of PHS Act), House amendment --- 2 3 4 Senate proceed to act on, two measures, On page 11, line 19, strike out 11$2,000,000." Senat:,bill - --- 5 10 15 without any amendments thereto. and insert in lieu thereof $1,500,000.". Senat Mewdrwi@t- 1.5 4 4 One measure would be H.R. 11796. an On page 11, line 20, strike out ,DEMoN- 3. Comprehensive Arthritis Centers (sec. 439(h) of STRAIION" after "CommirrEB.". act to provide for the duty-free entry of On page 13, line 12, strike out "DEMON- PHS Act)' a 3.60-meter telescope and associated ar- Houseamendmint---- 11 13 15 STRATION" after "REPER@". Senate bill- -- 10 15 20 ticles for the use of the Canada-France- on page 13, line 19, Insert "the " after Senate amewdlwiwt--- 5 16 18 Hawaii telescope project at Mauna Kea. Hawaii. On page 13, line 23, Insert "established" Note: 3-year grand total: The other measure would be H.R. 8214, after "bank". House amendment -------------- $50. ------------- 7 5. an act to modify the tax treatment of On page 15, line 18, strike out "$2,000,000-- Senate bill ------------------- and Insert in lieu thereof 11$1,500,000"; Senate amendment --------------------------- 50.0 members of the Armed Forces of. the United States and civilian employees and on line 14, strike out '1$3,000,000" and The net consequence, Mr. President who are prisoners of war or missing in Insert In lieu thereof "$4,000,000". is no increase, of course, in the total sums action, and for other purposes. On page 15, line 24, Wmrt "new and exist- that are authorized. I would like all Senators to be noti- ing" after "of". On page 17, lines 19 and 22, strike out the Mr. President, I ask that we now act fled that, Immediately when the Senate comma and insert In lieu thereof a semi- on the concurrent resolution if no One goes back Into session, the proposal will colon. else wishes to speak. be made to dispose of those two matters, 001, The PRESIDING OFFICER. The ques- On page 18, line 13, strike out "$11,000,0 without any amendments beyond the two and Insert In lieu thereof 11$5,000,000"; on tion is on agreeing to the concurrent line 14, strike out 11$13,000,00011 end Insert in resolution. matters themselves. So Senators are so lieu thereof "$16,000,000"; and on line 15, alerted. The concurrent resolution was agrees strike out "$15,000,000" and insert in lieu Mr. GRIFFIN. Mr. President, will the thereof "$18,000,000". to. acting majority leader yield? Mr. CRANSTON. I thank the Chair. Mr. ROBERT C. BYRD. I yield. On page 20, line 5, strike out "and related The PRESIDING OFFICER. What I. miisculoskeletal diseases" after "arthritis". .. Mr. GRIFFIN. I think the Senate *rill One page 20, liens 12 and 13, strike out tne will of the Senate? be interested in knowing that the other "and related musculoskeletal diseases" after body has confirmed the nomination of "arthritis" on line 12. RECESS FOR 10 MINUTES Nelson Rockefeller to be Vice President Mr. CRANSTON. Mr. President, just to by a vote of 287 to 128, with one voting. give a brief explanation, the majority of Mr, ROBERT C. BYRD. Mr. President, ,present." - the amendments included In the con- I move that the Senate stand in recess Mr. LONG. Mr. President, will the current resolution, Mr. President, are of for 10 minutes. Senator yield? a purely technical, clarifying, and per- The motion was agreed to, and at 7:40 fecting nature. At this time, I would like p.m., the Senate recessed until 7:50 p.m.; Mr. GOLDWATER. Mr. President, will whereupon, the Senate reassembled when the Senator yield? to briefly explain the three amendments called to order by the Presiding Officer Mr. ROBERT C. BYRD. Mr. President, of a more substantive nature. The first (Mr. HASKELL). I believe that Mr. LONG asked first. I yield would correct an oversight in the draft- Mr. ROBERT C. BYRD. Mr. President, to him, and I ask unanimous consent Ing of the bill in the House, where in the I suggest the absence of a quorum. that I retain my right to the floor. findings section, it is not stated that the The PRESIDING OFFICER. The clerk The PRESIDING OFFICER. Without term "arthritis and related musculo- skeletal diseases" should thereinafter be will call the roll. objection, it is so ordered. refei+ed to as "arthritis," making clear The second assistant legislative clerk Mr. LONG. Mr. President, perrnifme to proceeded to call the roll. I explain that it would be unfortunate, and that in the findings and in the work of Mr. ROBERT C. BYRD. Mr. President, I think it would reflect badly upon the the Commission and In the mission given the Commission to develop an arthritis I ask unanimous consent that the order Senate and Congress, if Congress ad- plan, attention should be given to arth- for the quorum call be rescinded. Joumed without passing this prisoners- ritis and related musculoskeletal diseases. The PRESIDING OFFICER (Mr. of-war bill. The prisoners of war have The second amendment would change SPARKMAlq). Without objection, it is so been held hostage long enough. the date of submission of the arthritis ordered. - Senators will recall that we Initially plan by the Commission to 210 days after ORDER OF BUSINESS TODAY reported out the prisoners-of-war bill the first meeting of the Commission, Mr. ROBERT C. BYRD. Mr. President, with some amendments on other subjects rather than 210 days after funds are first I am going to move shortly to recess the which we thought would correct some in- appropriated for the Commission. I be- Senate until 10 p.m. equities. That became 'the subject of lieve this is an important change and I have been informed by the-Sergeant other amendments added on the floor, would avoid any undue delay in the sub- at Arms of the other body that the House until the bill became so burden ed with