Bill Frist

Mr. FRIST

Mr. FRIST. Madam President, I rise to accomplish two objectives: To speak in response to the pending amendment and to briefly introduce what I plan to do later tonight. In the interest of time, I will try to achieve both of those objectives in the next 15 minutes. If the Chair will notify me when I have 3 minutes remaining.

Mr. FRIST

Mr. FRIST. Mr. President, I am pleased to join today with my colleagues Senators Jeffords, Breaux, and Gregg in introducing crucial legislation, the Patient Safety and Quality Improvement Act. Each year, as many as 98,000 people in the United States die as a result of medical errors. More Americans die each year from medical errors than from breast cancer, AIDS, or motor vehicle accidents. As a physician who has taken the Hippocratic oath ``To do no harm,'' the status quo is simply unacceptable. As the Institute of Medicine wrote in its landmark 1999 report, To Err is Human: ``[I]t is simply not acceptable for patients to be harmed by the same health care system that is supposed to offer healing and comfort.'' The legislation we are introducing today will go a long way toward preventing many of these tragedies. Although a variety of patient safety initiatives are underway in the private sector as well as within the Department of Health and Human Services, and in the states, Congress has an important role to play in reinforcing, encouraging, and enhancing these efforts. The major contribution of this legislation is to foster an open, collaborative environment where doctors, nurses, and other health professionals can share information freely and analyze it thoroughly. Health care providers should not be punished for trying to learn from their mistakes, reduce medical errors, and improve the quality of care they deliver to patients. As a physician and a scientist, I know first hand about the enormous complexities of medicine today and the intricate system in which providers deliver care. I also recognize the need to examine medical errors closely in order to determine where the system has failed patients, and how it can be improved. Yet, adequate protections do not exist today to foster this type of learning and improvement environment. For example, hospitals currently rely upon Mortality and Morbidity Conference to share information about medical errors that occur with respect to individual patients. Unfortunately, because these conferences are focused on events involving individual patients within a single hospital, it is impossible to address system-wide quality and safety problems that may exist across hospital systems and within broader communities. Fear of litigation is the primary barrier to sharing and analyzing information that could save lives and improve treatment within the broader health care community. We have seen this type of non-punitive reporting model work to vastly improve safety in other situations. In 1975, the Federal Aviation Administration established the Aviation Safety Reporting System, ASRS, to encourage pilots, controllers, flight attendants, mechanics, and the public to voluntarily report actual or potential discrepancies and deficiencies involving the safety of aviation operations. Because this information was widely shared and analyzed, the ASRS helped to significantly improve aviation safety in the United States. The risk of dying in a domestic jet flight decreased from one in two million in 1967 to 1976 to only one in eight million in the 1990s. The Institute of Medicine, as well as many experts who have testified before Congress during the past few years, have strongly recommended that Congress provide the same type of legal protections for information gathered and reported to improve health care quality and increase patient safety. Without these protections, patient safety improvements will continue to be hampered by fears of retribution and recrimination. If we are to change the health care culture from ``name, shame, and blame'' to a culture of safety and continuous quality improvement, we must provide these basic protections. In extending these protections, we have tried to encourage widespread voluntary error reporting while continuing to allow access to medical records and other information that should be available to patients for litigation or other purposes. Protecting data reported to a certified patient safety reporting system does not mean that such information cannot be obtained through other avenues if it is important to securing redress for harm. At the same time, information generated by this new reporting system designed specifically to reduce errors and broadly benefit patients should not become fodder for increased litigation. Moreover, the legislation expressly allows for patient safety information to be disclosed in the context of a disciplinary proceeding or criminal case where it is 1. material to the proceeding; 2. within the public interest; and 3. not available from any other source. I want to thank Senators Jeffords, Breaux, and Gregg for their support, and input into this legislation. I look forward to working with them, Senator Kennedy, and my other colleagues in both the House and Senate, to pass legislation that will advance patient safety efforts. I also value the leadership of the Bush Administration on this critical issue. The Administration's efforts to improve patient safety are underscored by the commitment, support and direct involvement of both Secretary Thompson of the Department of Health and Human Services and Secretary O'Neill of the Department of Treasury in helping to shape this legislation. Americans take pride in offering the most advanced medical care in the world. A bounty of new devices, new treatments, and new techniques offer the hope of living longer and healthier than ever before. Yet, medical mistakes continue to take thousands of lives and cost billions of dollars each year. We must not let the miracle of modern medicine be extinguished by medical errors. This bill will make the changes in culture and communications that are needed to increase the safety of America's health care system, and improve the quality of care delivered to America's patients.

Mr. FRIST

Mr. FRIST. Mr. President, I am pleased to join today with my colleagues Senators Jeffords, Breaux, and Gregg in introducing crucial legislation, the Patient Safety and Quality Improvement Act. Each year, as many as 98,000 people in the United States die as a result of medical errors. More Americans die each year from medical errors than from breast cancer, AIDS, or motor vehicle accidents. As a physician who has taken the Hippocratic oath ``To do no harm,'' the status quo is simply unacceptable. As the Institute of Medicine wrote in its landmark 1999 report, To Err is Human: ``[I]t is simply not acceptable for patients to be harmed by the same health care system that is supposed to offer healing and comfort.'' The legislation we are introducing today will go a long way toward preventing many of these tragedies. Although a variety of patient safety initiatives are underway in the private sector as well as within the Department of Health and Human Services, and in the states, Congress has an important role to play in reinforcing, encouraging, and enhancing these efforts. The major contribution of this legislation is to foster an open, collaborative environment where doctors, nurses, and other health professionals can share information freely and analyze it thoroughly. Health care providers should not be punished for trying to learn from their mistakes, reduce medical errors, and improve the quality of care they deliver to patients. As a physician and a scientist, I know first hand about the enormous complexities of medicine today and the intricate system in which providers deliver care. I also recognize the need to examine medical errors closely in order to determine where the system has failed patients, and how it can be improved. Yet, adequate protections do not exist today to foster this type of learning and improvement environment. For example, hospitals currently rely upon Mortality and Morbidity Conference to share information about medical errors that occur with respect to individual patients. Unfortunately, because these conferences are focused on events involving individual patients within a single hospital, it is impossible to address system-wide quality and safety problems that may exist across hospital systems and within broader communities. Fear of litigation is the primary barrier to sharing and analyzing information that could save lives and improve treatment within the broader health care community. We have seen this type of non-punitive reporting model work to vastly improve safety in other situations. In 1975, the Federal Aviation Administration established the Aviation Safety Reporting System, ASRS, to encourage pilots, controllers, flight attendants, mechanics, and the public to voluntarily report actual or potential discrepancies and deficiencies involving the safety of aviation operations. Because this information was widely shared and analyzed, the ASRS helped to significantly improve aviation safety in the United States. The risk of dying in a domestic jet flight decreased from one in two million in 1967 to 1976 to only one in eight million in the 1990s. The Institute of Medicine, as well as many experts who have testified before Congress during the past few years, have strongly recommended that Congress provide the same type of legal protections for information gathered and reported to improve health care quality and increase patient safety. Without these protections, patient safety improvements will continue to be hampered by fears of retribution and recrimination. If we are to change the health care culture from ``name, shame, and blame'' to a culture of safety and continuous quality improvement, we must provide these basic protections. In extending these protections, we have tried to encourage widespread voluntary error reporting while continuing to allow access to medical records and other information that should be available to patients for litigation or other purposes. Protecting data reported to a certified patient safety reporting system does not mean that such information cannot be obtained through other avenues if it is important to securing redress for harm. At the same time, information generated by this new reporting system designed specifically to reduce errors and broadly benefit patients should not become fodder for increased litigation. Moreover, the legislation expressly allows for patient safety information to be disclosed in the context of a disciplinary proceeding or criminal case where it is 1. material to the proceeding; 2. within the public interest; and 3. not available from any other source. I want to thank Senators Jeffords, Breaux, and Gregg for their support, and input into this legislation. I look forward to working with them, Senator Kennedy, and my other colleagues in both the House and Senate, to pass legislation that will advance patient safety efforts. I also value the leadership of the Bush Administration on this critical issue. The Administration's efforts to improve patient safety are underscored by the commitment, support and direct involvement of both Secretary Thompson of the Department of Health and Human Services and Secretary O'Neill of the Department of Treasury in helping to shape this legislation. Americans take pride in offering the most advanced medical care in the world. A bounty of new devices, new treatments, and new techniques offer the hope of living longer and healthier than ever before. Yet, medical mistakes continue to take thousands of lives and cost billions of dollars each year. We must not let the miracle of modern medicine be extinguished by medical errors. This bill will make the changes in culture and communications that are needed to increase the safety of America's health care system, and improve the quality of care delivered to America's patients.

Mr. FRIST

Mr. FRIST. Mr. President, we have learned a lot about terrorism since September of last year. We have learned that terrorists prey on vulnerability. Our vulnerability becomes their target. This bill reduces our vulnerability when it comes to this threat of bioterrorism and thus reduces the likelihood of an attack by reducing our vulnerability and reduces the potential damage an attack may cause by improving and strengthening our response. We have learned the goal of a bioterror attack is not only to hurt people directly but to paralyze them, to cause panic. This bill will calm the nerves and keep order in the event there is another bioterror attack. This bill addresses prevention and preparedness, as well as response. Indeed, this bill touches all areas of preparedness: Protecting our food and water, boosting medical stockpiles, and supporting our local communities and public health infrastructure. This bill emphasizes the local response and local preparedness. It recognizes that it is local people who will respond in the event of a bioterror attack. It is about whom you call when you suspect something, whom you call if you are worried about bioterrorism: The family doctors, the emergency workers, the health care professionals. Today, with this legislation we make the first people on the scene our first priority. Over 3 months after the tragedies of September 11 and slightly more than 60 days after the anthrax attacks, Congress provided a record $3 billion in emergency bioterrorism funding. This was in December of last year. This was a historic investment. As we have learned since that time, it must be only a downpayment toward ensuring that America is fully prepared to respond to bioterrorism and other public health risks. Today, we take another important and very necessary step toward securing our Nation with the Public Health Security and Bioterrorism Preparedness and Response Act. It is a cohesive and comprehensive framework to improve our public health system and thereby reduce our vulnerability. I, too, thank Senator Kennedy and Senator Gregg for their leadership and their tremendous contributions to this conference report. I thank our colleagues in the House of Representatives, primarily Chairman Tauzin and Representative Dingell, for their huge and important efforts. Yesterday's overwhelming vote in the House in favor of passing this conference agreement demonstrates this legislation is truly broad and bipartisan. There is no question we live today in a more dangerous world, much more dangerous than we envisioned before September 11, much more dangerous than we had envisioned before the anthrax-laden letters were delivered across the east coast. We are not unprepared for a bioterror attack, but we are clearly underprepared. This bill goes a long way in boosting that preparedness and reducing the vulnerabilities. We know terrorists around the world, including al-Qaida, are intent on using biological weapons against us. We know more than a dozen nations--including Iraq, North Korea, Libya, Syria--have the capability to produce chemical and biological weapons, and many have stockpiled such biological weapons in the past. We know thousands of Soviet scientists who have the expertise to develop biological weapons are, today, unemployed, and potentially available to the highest bidder. Yes, the risk is real. We know the risk is increasing. The National Intelligence Council warns: The biological warfare capabilities of state and non-state actors are growing worldwide. This trend leads us to believe that the risk of an attack against the United States, its interests and allies will increase in the coming years. This bill is the foundation and framework for our response. Iraq launched a robust biological program in 1985 and has admitted to producing large quantities of agents and weapons, including 19,000 liters of botulinum--in fact, 10,000 liters loaded into munitions--and 8,500 liters of anthrax--and 6,500 were loaded into munitions. During the gulf war, Iraq weaponized 100 bombs and 15 missile warheads with botulinum, and 50 bombs and 10 missile warheads with anthrax. Nonstate actors are also a threat. CIA Director George Tenet has been quoted recently in the New York Times as saying: Documents recovered from al-Qaida facilities in Afghanistan show that Osama bin Laden was pursuing a sophisticated biological weapons research program. U.S. forces discovered a facility in southern Afghanistan near Kandahar that was being built to produce biological agents. Our vulnerabilities remain high. This bill addresses reducing those vulnerabilities. Most public health departments in the United States do not have staff fully trained in bioterrorism. A recent report showed that one-third of public health departments serving 25,000 or fewer people had no Internet access, and one-quarter of public health staff had no electronic or e-mail. Today more than 99 percent of food imported into this country is never inspected. The American people, with passage of this legislation, should rest easier, knowing that our Government is taking the steps necessary to respond to this threat at the local level, at the State level, and at the national level. This legislation will ensure that we continue to act both rapidly and appropriately to secure the Nation against future attacks on our freedom. What does the bill do? The conference agreement provides the resources necessary to improve the training of those first responders, to those doctors, to nurses, to public health officials at the local level. They are the first line of defense. The bill authorizes $300 million both in 2002 and 2003 to strengthen the capabilities of the Centers for Disease Control and Prevention and modernize its facilities. The bill enhances our national research capabilities and helps speed the development of needed drugs, of needed vaccines, diagnostic tests, and other priority countermeasures. And the bill helps ensure that our national strategic pharmaceutical stockpile is adequate to meet the needs of America. The October anthrax-laden letters underscored the importance of coordination, the importance of communication. The conference agreement puts in place structures to ensure improved government coordination, as well as improved collaboration between government and the private sector. The legislation helps us develop the state-of-the-art communication infrastructure so we can more readily and more rapidly identify and treat infectious disease outbreaks. It also helps ensure that our children and other vulnerable populations are better prepared. This conference agreement will significantly improve our ability to protect our water supply, our food supply, our Nation's agriculture, and it will help better track and regulate the use of dangerous pathogens within our borders. The bill focuses on what happens at the local level, at the community level. If you are suspicious, if an attack occurs, you pick up the telephone, you call somebody, or go to a local facility. This bill underscores the importance of support at the local level. The legislation will provide significant new resources, $1.6 billion in the year 2003 alone, to strengthen our State and local public health systems. We have underinvested in our public health infrastructure in the last 30 years in this country. As the title of the bill makes clear, this legislation will not only improve our ability to respond to bioterrorism but to other public health risks, and emergencies as well, whether they be from other intentional acts of terrorism, nuclear attacks, chemical accidents or attacks, or from naturally occurring infectious disease outbreaks, the so-called dual use of the investment that we put in public health today. I am proud to be part of this legislation. I believe that years from now America will look back upon this bill as landmark legislation, a landmark achievement, a turning point in our commitment to strengthening our defenses, focusing on biological threats. As has been mentioned by my colleagues, I am very pleased with the reauthorization of what is called the Prescription Drug User Fee Act. This important law helps make it possible for the Food and Drug Administration to hire additional manpower and expertise to speed the drug approval process so consumers can benefit more quickly in a safe way from life-saving drugs. I am also pleased this agreement includes the Frist-Kennedy Emergency Access to Defibrillator Act, an act which has passed the Senate earlier this year, a provision which will provide annual grants to deploy lifesaving cardiac heart defibrillators in more public buildings. My colleague, Senator Gregg, has already recognized so many people who have participated in such an admirable way to this bill. There are items that I, too, would like to have included in this particular bill that are not in the final package, items that I think we must continue to address in the Senate and in committee. I believe we need more certainty if private industry truly is to become a partner in combating bioterrorism. To harness the genius, to harness the resources of private companies in these efforts, we should continue to find ways to protect companies from frivolous lawsuits and provide pharmaceutical research companies and others the certainty that they will not face antitrust enforcement simply because they are collaborating with the Government and their business partners to more rapidly and more rationally develop vaccines and other countermeasures. This is a solid bill. It combines sound policy and enhanced resources to better prepare our Nation and to provide security to the American people. Once again, I commend Senator Kennedy for his dedication and leadership. In many ways, this legislation builds upon a foundation we began about 3 years ago as we began, in a bipartisan way, to develop this issue of bioterrorism. He and I agree that protecting the American people from bioterrorist attacks and other public health threats and emergencies does require a robust, a reinvigorated public health system. I also thank and commend the ranking member of the Senate HELP Committee, Senator Gregg, as well as the other Senate Republican conferees he has previously mentioned, Senator Enzi and Senator Tim Hutchinson, for the tremendous work he is doing in the agricultural and rural elements of the bill. Other Members, Senators Roberts, DeWine, Collins, and Hatch, also were instrumental in drafting this important legislation. Finally, it is difficult to pass legislation of this magnitude without the assistance and diligence of dedicated staff. Most of those staff members have been recognized already. I do want to thank members of my own staff, in particular Dean Rosen, Helen Rhee, Shana Christrup, and Doug Campos-Outcalt, a fellow in my office. I would also like to recognize the contributions of Vince Ventimiglia, Katy French, and Steve Irizzary of Senator Gregg's staff; David Nexon, Paul Kim, David Bowen, and David Dorsey of Senator Kennedy's staff; Raissa Geary of Senator Enzi's staff; Kate Hull of Senator Hutchinson's staff; and Mike Seyfert and Lisa Meyer of Senator Roberts' staff. Finally, with this bill we will take away one of the most formidable weapons in the terrorist arsenal, and that is our own vulnerability. I yield the floor.

Mr. FRIST

Mr. FRIST. Mr. President, the name Pat Boone rings synonymous with musical success. Pat has registered 60 songs on the musical charts with eighteen reaching the Top Ten and six reaching Number One. His recording career has spanned five decades--from the 1950s to the 1990s--and compilation albums are reaching a new generation of fans in the 21st century. Indeed, few entertainers can claim a more sustained career of success than Pat Boone. Pat's success has even extended beyond music. He starred in fifteen films for 20th Century Fox. He hosted two weekly television variety shows--the Pat Boone Chevy Showroom and the Pat Boone Show. He has been a constant presence on radio both as a musician and as a show host. He has also found time to write several books about teenage life and, more recently, religion and family. Pat donated all proceeds from his first book--Twixt Twelve and Twenty--to the Northeastern Institute of Christian Education. This was a sign of good things to come. Throughout his career, Pat Boone has generously given his support to countless charitable organizations. Perhaps most notably, he has served as spokesman, national chairman, and host of the Easter Seal Society Telethon for almost two decades. Though Pat has attained worldwide fame, he has never forgotten his Tennessee roots. This is especially true for his charity work on behalf of Bethel Bible Village. For the last 25 years, Pat has been the celebrity host of the Bethel Bible Village Spectacular Golf Tournament. He has helped raise more than $1.3 billion for Bethel and bring it national recognition as a premier facility for the care of troubled and at-risk children. Pat Boone is one of the most successful entertainers of our time; he's also one of the most caring and compassionate community leaders in America today. Pat has always put community first--whether it's the close-knit community of his family or the broader community of charitable organizations. I offer this statement to Pat Boone in recognition of a career of success and gratitude for a life of giving.

Mr. FRIST

Mr. FRIST. Mr. President, I rise today to commemorate the running of the Credit Union Cherry Blossom Ten Mile Run on April 7, 2002. Fifty-eight credit unions, credit union associations, and credit union leagues sponsored this Washington, DC institution, which coincides with the annual spring rites of the tidal basin cherry blossoms. This is the first year that Credit Unions have sponsored the race. I want to commend the over 7,032 finishers, and especially the over 3,500 registered runners who were member of credit unions. A special congratulations to Public Health Service Federal Credit Union for winning the credit union team competition. Additionally, I am proud of 350 plus credit union employees who arrived at the race in the chilly, pre-dawn hours to serve as volunteers helping administer the race. It was also great to see Health and Human Services Secretary Tommy Thompson participate. The Cherry Blossom Run has taken place during the spring blooming of Washington's historic cherry trees for 30 years. Starting out as a small family event with 141 finishers it is now a world-class event that includes some of the world's foremost long distance runners. I want to congratulate this year's winners: Men's, Rueben Cheruiyot, 47:12; Women's, Luminita Talpos, 52:50. This year, in conjunction with the race, credit unions raised over $60,000 for the Children's Miracle Network and donations are still being collected. This was a great event and credit unions should be proud of the role they played. Washingtonians and runners around the world are looking forward to the 2003 Credit Union Cherry Blossom 10 Mile run.

Mr. FRIST

Mr. FRIST. Mr. President, I rise to join with my colleagues Senators Biden, Helms, and Kennedy in introducing the Global Pathogen Surveillance Act of 2002. This bipartisan legislation will help ensure that we are better prepared globally to deal with biological threats and attacks. The Global Pathogen Surveillance Act of 2002 authorizes enhanced bilateral and multilateral activities to improve the capacity of the United States and our partners in the international community to detect and contain infectious diseases and biological weapons. The Global Pathogen Surveillance Act will enhance the training, upgrade equipment and communications systems, and provide additional American expertise and assistance in international surveillance. To better prepare our nation to meet the growing threat of bioterrorism, we must put in place and maintain a comprehensive framework including prevention, preparedness and consequence management. To accomplish this goal, we not only need to strengthen our local public health infrastructure domestically, but to work with our friends and neighbors in the global community to prevent, detect, and appropriately contain and respond to bioterrorist activities outside our borders. This is truly a global responsibility. Infectious diseases, such as smallpox, do not respect borders. If we can prevent their spread in other countries around the world, we can better protect our citizens here at home. I applaud Senators Helms and Biden for their leadership in this area. I look forward to working with them, and all of my colleagues to ensure that we provide appropriate authorities and funding to improve our international efforts to detect and contain infectious diseases and offensive biological threats.

Mr. FRIST

Mr. FRIST. Mr. President, I rise to join with my colleagues Senators Biden, Helms, and Kennedy in introducing the Global Pathogen Surveillance Act of 2002. This bipartisan legislation will help ensure that we are better prepared globally to deal with biological threats and attacks. The Global Pathogen Surveillance Act of 2002 authorizes enhanced bilateral and multilateral activities to improve the capacity of the United States and our partners in the international community to detect and contain infectious diseases and biological weapons. The Global Pathogen Surveillance Act will enhance the training, upgrade equipment and communications systems, and provide additional American expertise and assistance in international surveillance. To better prepare our nation to meet the growing threat of bioterrorism, we must put in place and maintain a comprehensive framework including prevention, preparedness and consequence management. To accomplish this goal, we not only need to strengthen our local public health infrastructure domestically, but to work with our friends and neighbors in the global community to prevent, detect, and appropriately contain and respond to bioterrorist activities outside our borders. This is truly a global responsibility. Infectious diseases, such as smallpox, do not respect borders. If we can prevent their spread in other countries around the world, we can better protect our citizens here at home. I applaud Senators Helms and Biden for their leadership in this area. I look forward to working with them, and all of my colleagues to ensure that we provide appropriate authorities and funding to improve our international efforts to detect and contain infectious diseases and offensive biological threats.

Mr. FRIST

Mr. FRIST. Mr. President, in the coming weeks the Senate will consider legislation to prohibit human cloning. In advance of that important debate, which will center upon this intersection of values, of ethics as it crosses with science, many have begun studying in a very careful way this complex issue. A number of colleagues have come forward and asked me, personally, about this issue, in part because of my medical background, but also in large part because they know I am a strong advocate for and a strong supporter of stem cell research, as long as that stem cell research is conducted within a framework of a comprehensive, ethical, and moral oversight system. The question I hear most is the following: Can one truly be an advocate for stem cell research and, at the same time, oppose human cloning experimentation? After an in-depth study of this issue from a policy standpoint, from the standpoint of being a Senator and looking at that legislation as a science, from a medical standpoint, I believe the answer to this question is yes. Until now, the overall human cloning debate has been presented almost as an absolute choice between, on the one hand, medical science and the hope for cures and, on the other, ethical restraint. This is an oversimplification that does not do justice to the clinical, scientific, philosophical, moral, ethical, and spiritual complexities underlying this discussion. I am glad to see that a number of my colleagues and people around the country have not locked into this false choice, but rather have stayed back to examine these in our deliberations. After carefully considering all of the evidence brought forward in hearings and on the floor in support of human embryo research cloning experimentation, after considering the medical progress being made and that will be made through stem cell research, and after considering the overwhelming ethical concerns about human embryo cloning experimentation, I conclude that a comprehensive ban on all human cloning is the right policy at this time. I intend to support legislation consistent with this policy, and I will encourage my colleagues to do likewise. As we move forward, one must understand the fundamental fact that I hope plays out over the next several days and weeks in the discussion. It is important; that is, embryonic stem cell research and human embryo cloning research are not the same thing. Human embryo research cloning--called therapeutic or research embryo cloning--is an experimental technique often confused with but distinct from stem cell research. The promise of stem cell research, for Parkinson's disease, Alzheimer's disease, diabetes, spinal cord injuries, autoimmune disorders, cardiovascular disease--the promise of stem cell research and the science can and will progress with a ban on human cloning embryo experimentation. Most serious observers--I don't want do say all--agree that human reproductive cloning should be banned, must be banned. Indeed the legislation that will come to this floor will ban reproductive cloning. It is dangerous and it is unethical. The question this body will be debating is whether or not this ban on human reproductive cloning should extend to all human embryo cloning. The issue is not cloning of DNA, that is going to continue no matter what; not cloning of molecules, that is going to continue; not cloning of cells other than cells that become or are an embryo, that is going to continue. That is not yet fully understood and, in truth, we have not debated the legislation on this floor. But that will become apparent. The House of Representatives has already overwhelmingly passed strong bipartisan legislation comprehensively banning human embryo research cloning experimentation and reproductive cloning. Now is the time for the Senate to do so. Those who favor human research cloning experiments often point to its potential to develop tissues that will not be rejected. In fact, on the next chart--which I will not deal with today, but will come back to-- are the arguments, the overall claims that human research cloning, or human cloning research is necessary to prevent immune rejection and is necessary for other reasons. As a heart transplant surgeon, one who spent many years of my life transplanting hearts, this immune phenomenon is something I will come back to the floor and talk about because it is very important for us to address. Advocates for human embryo research cloning and so-called therapeutic embryonic cloning experiments say it will increase the number of embryonic stem cells. We will talk about that. They say it will further basic biological knowledge. Again, we will come back and talk about that as the debate proceeds. There are facts that will need to be presented. But moving away from the scientific standpoint, if you look at the overall ethical and moral concern, it is this: Regardless of our religious background, most of us--maybe I should say many, but I believe most of us--are extremely uncomfortable today with the idea of creating cloned human embryos, doing an experiment on them, and destroying the human embryo. That is the state of the science. That is the state of the art. If one supports human research or therapeutic cloning, given where we are today--our understanding of science--you are in support of purposefully creating an embryo, of removing the cells, and thereby destroying that embryo. The other concerns which people will talk about--although I think this is the concern that most people will start with--will be concerns about women's health. Human cloning clearly will create a market for women's eggs. That is going to create powerful incentives for women to undergo an intense regimen of superovulation drugs and surgery, with potentially devastating side effects. As a physician and a policymaker who struggles, especially since I have come to Washington, with this inherent tension between scientific progress and ethical concerns, I think there are two fundamental questions that this body needs to answer, and the American people need to answer: No. 1, does the scientific potential of human embryo cloning experimentation justify this purposeful creation of human embryos which must, by definition, be destroyed in the experiments? The second question is: Does the promise of human embryonic stem cell research-- and, again, this is separate from cloning--in any way depend on the experimental research cloning, the human cloning research technique or tool? To both of those questions I answer no. At this point in the evolution of this new science, I believe there is no justification for the purposeful creation and destruction of human embryos in order to experiment with them, especially when the promise and success of stem cell research does not--does not--depend on the experimental research cloning technique. As my colleagues know, I am a strong supporter of stem cell--including embryonic stem cells-- research, as long as that stem cell research is conducted within an ethical and moral framework. Last August, President Bush outlined a scientific and ethically balanced policy that allows Federal funding, through the National Institutes of Health, for embryonic stem cell research, using nearly 80 stem cell lines. This has, indeed, opened the door to a significant expansion of embryonic stem cell research within this ethical and moral framework. A lot of people do not realize today that there are no restrictions-- whether there should be or should not be is not the subject of the legislation that will come to the floor--but it is important to realize there are no restrictions on private research using embryonic stem cells from embryos left over after in vitro fertilization procedures. Thus, when you come to that argument of just having a technique which produces more embryos, I would argue that there is simply no compelling need for any other source of embryonic stem cells today. The state of the science and the state of the research we will be addressing again on the floor as we go forward. But given the serious ethical concerns on human embryonic cloning research, given the fact that there is a lack of significant research in animal models--and again most people do not realize that we are talking about human cloning experimentation creating human embryos. This research has not even been conducted in animal models at this juncture. Thus, I find no compelling justification for allowing human cloning, reproductive or research, today. It is important also--and I will very quickly go through this--to be clear that we are talking about a ban on reproductive cloning along with a ban on what is called research or therapeutic cloning, but it is all human embryo cloning. But the bill allows other types of cloning research to continue--many people do not realize that--whether it is cloning to produce animals, cloning to produce plants, cloning any cell other than a human embryo, cloning of DNA and RNA, proteins or any other molecule. In fact, I will not go through the entire list now. The point is, the cloning science continues. The ban is on the cloning of the human embryo: the purposeful creation of an embryo for human reproduction or for experimentation and its ultimate destruction, which is what we are banning today. I would indeed argue that any potential benefit of cloning should be carried out--should be demonstrated in animal models before going to the human model. I wanted to make the statement today based on my assessment of where we are. There will be plenty of time to debate this later. With that I will close. I want to say, once again, I will support legislation to ban all forms of human embryo cloning, reproductive, research and therapeutic, when the issue comes before the Senate. I, indeed, will urge my colleagues to do likewise. I yield the floor.

Mr. FRIST

Mr. FRIST. Mr. President, I rise today to introduce the ``Vaccine Affordability and Availability Act.'' The United States has succeeded in dramatically reducing the incidence of disease through the use of vaccines. In some cases, we've even been able to eradicate specific diseases, including smallpox. Smallpox, which has killed more people than any other disease or war in history, has been eradicated by the research, development and deployment of vaccines. Still, our success should not and must not dampen our resolve for combating disease with vaccines. Many vaccine-preventable diseases are still increasing morbidity and mortality due to a lack of public awareness about the existence and effectiveness of vaccines, and, in some cases, due to a shortage of certain vaccines. The goal of this bill is to improve how we vaccinate people in America today. It would reduce the cost of vaccines, make vaccines more accessible, enhance vaccine education, and streamline the vaccine compensation program. I urge all of my colleagues, on both sides of the aisle, to support this bill and, in so doing, support the prevention of disease and the saving of lives. We must strengthen our immunization system. We need only look at the experiences of three developed countries, Great Britain, Sweden and Japan, when they allowed their immunization rates to drop due to fear associated with the pertussis, whooping cough, vaccine. In Great Britain, a decrease in pertussis immunizations in 1974 resulted in an epidemic of more than 100,000 cases of pertussis and 36 deaths by 1978. In Japan between 1974 and 1979, pertussis vaccination rates fell from 70 percent, with 393 cases and no deaths, to around 20 to 40 percent, with 13,000 cases and 41 deaths. In Sweden between 1981 and 1985, the annual incidence rate of pertussis per 100,000 children 0-6 years of age increased from 700 cases to 3,200 cases. Low diphtheria immunization rates in the former Soviet Union for children and the lack of booster immunizations for adults have increased diphtheria from 839 cases in 1989 to nearly 50,000 cases and 1,700 deaths in 1994. As the General Accounting Office, GAO, described in a March 2000 report, infectious diseases are responsible for nearly half of all deaths worldwide for people under the age of 44. The report further states that immunizing children against infectious diseases is ``considered to be one of the most effective public health initiatives ever undertaken'' in the United States and the number of people in the United States contracting vaccine-preventable diseases has been reduced by more than 95 percent. Every year, millions of children are safely vaccinated, preventing thousands of childhood deaths and even more debilitating illnesses. While vaccines save lives and save the nation from lifelong medical costs associated with contracting vaccine- preventable diseases, no product is risk-free. When Congress passed the National Childhood Vaccine Injury Act in 1986, it recognized that ``[v]accination of children against deadly, disabling, but preventable infectious diseases has been one of the most spectacularly effective public health initiatives this country has ever undertaken.'' Congress further noted that the ``[u]se of vaccines has prevented thousands of children's deaths each year and has substantially reduced the effects resulting from disease.'' Congress further recognized that the cost of litigation initiated on behalf of children claiming vaccine-related injuries has resulted in an enormous increase in the price of vaccines and a significant reduction in the number of vaccine manufacturers in the U.S. market. The Advisory Commission on Childhood Vaccines, ACCV, was established pursuant to the 1986 National Childhood Vaccine Injury Act to advise the Secretary of HHS on ways to improve the Vaccine Injury Compensation Program, which was also established in the same law. Meeting minutes from a September 2001 ACCV meeting best sum up the integral connection between vaccine supply, production, and liability concerns that our bill seeks to address: ``The vaccine supply in the United States is becoming quite fragile. Over the last 20 to 30 years, there has been a significant decrease in the number of vaccine manufacturers. As a result, there is a relatively small group of manufacturers with limited manufacturing capability. This fragility compromises the ability to meet current vaccine needs and limits capacity to respond to emergencies.'' In the early 1980s, lawsuits alleging vaccine-related injury or death threatened vaccine production, availability, cost and even the development of new vaccines. Coupled with already low profit margins, the vaccine market became unstable. Gross sales of the DTP vaccine in 1980 for all manufacturers fell to about $3 million. If even a few of the vaccinated children experienced adverse reactions to the DTP vaccine and recovered $1 million each, for a lifetime of mental impairment, then damages would easily exceed total sales. Costs associated with researching new vaccines and the uncertainty created by liability once the vaccine was approved by the Food and Drug Administration and marketed, further jeopardized future vaccine development. In an attempt to address liability projections, manufacturers either raised their prices, the DTP vaccine rose from $.19 in 1980 to more than $12.00 by 1986, or left the vaccine market entirely. By the mid- 1980's, the number of manufacturers of DTP vaccine declined from seven to one and the Nation experienced a critical shortage of vaccine. As a result, we stopped immunizing 2 year olds, leaving them vulnerable to whooping cough, diphtheria, and tetanus. In 1986, Congress established the Vaccine Injury Compensation Program, VICP, as part of the National Childhood Vaccine Injury Act. The VICP was created to address two major goals: To provide compensation to those who suffered rare but serious side effects from vaccines and to stabilize the vaccine production and supply market. The VICP was established as a Federal ``no-fault'' compensation system to compensate individuals who have been injured by certain covered childhood vaccines. While vaccine-injured parties are required to file claims under the VICP before filing lawsuits, proof requirements are much lower than in court and procedures are simplified for injuries that are listed on the Vaccine Injury Table. The balance that was struck was that the burden of proving causation was significantly reduced for VICP claimants, while the litigation burden on manufacturers and administrators of covered vaccines is decreased. The Vaccine Affordability and Availability Act seeks to ensure the VICP balance between fairness to claimants seeking compensation for vaccine-related injury or death and stability for continued vaccine production is strengthened. It further addresses the concerns of claimants who file for compensation under VICP, in large part based on recommendations made by the Advisory Commission on Childhood Vaccines, ACCV. Because family plays such an important role in the rehabilitation and treatment of a child injured by a vaccine, the legislation allows VICP awards to cover family counseling and guardianship costs. Additionally, the bill raises the payment ceiling on two capped payments that have not been raised since the VICP was implemented in 1988. The legislation also lengthens the filing deadline so that petitioners may have more time to adequately assess the life care and medical needs of a vaccine-injured child before filing and adjudicating a VICP claim. It also allows claimants to recover interim costs before final judgment is reached, to ease the financial strain on petitioners for costs associated with filing a VICP claim. The bill also broadened the membership criteria so that an adult who has been injured by a vaccine may participate on the ACCV. Finally, the legislation makes clear that all of these changes apply to pending and future VICP claims. Today, only two American companies and two European companies sell vaccines in the United States. The United States is currently experiencing shortages in 5 of the 9 recommended childhood vaccines, for which there are only four manufacturers licensed to sell in the United States. Once again, the threat of liability and the cost of litigation pose challenges to the stability of our vaccine supply. According to the March 18, 2002 edition of Forbes magazine, the profit margin for vaccines is very slim. Just one of the pending class action lawsuits seeks $30 billion in damages. The entire global value of the vaccine market, all around the world, is only $5 billion. The ``Vaccine Affordability and Availability Act'' simply ensures that the VICP's goal of stabilizing the vaccine market is not jeopardized. In establishing the VICP in 1986, Congress sought to ensure that individuals claiming injury from covered vaccines must first file for compensation under the VICP. Some individuals, however, have attempted to evade this requirement by arguing, for example, that a preservative used in a vaccine, and included in the vaccine's product license application and product label, is not itself a ``vaccine'' so the VICP restrictions do not apply to claims for injuries caused by preservatives. This bill restates the original intent of the law, that a vaccine is all the ingredients and components which are approved by FDA to be in the product. The bill makes necessary clarifications to the VICP to ensure that unwarranted litigation does not again destabilize the vaccine market causing the few manufacturers licensed to sell vaccines in the United States to leave the market resulting in even more serious shortages of essential vaccines. It clarifies that a vaccine-injured person must timely file a petition and complete the VICP process before third parties may bring a civil action in connection with that person's injuries. The bill adopts the ACCV recommendation that clarifies that certain well-defined medical conditions such as structural lesions and genetic disorders may be considered to be ``factors unrelated,'' and therefore non-compensable under VICP, to a vaccine, even if the exact defect in the gene, for example, is unknown. The legislation also clarifies that vaccine manufacturers and administrators cannot be sued unless there is evidence that a vaccine has caused present physical harm, they cannot be sued for medical monitoring to look for some theoretical future harm. The bill clarifies the definition of manufacturer to specify that a vaccine includes all components or ingredients of the vaccine and clarifies the existing law to ensure that any component or ingredient listed in a vaccine's product license application or label will not be considered to be an adulterant or contaminant. As with the changes we are making for VICP claimants, these changes would apply to pending and future VICP claims. This bill also requires that the Secretary of HHS prioritize, acquire and maintain a 6-month supply of vaccines to address future vaccine shortages and delays in production and authorizes new funds for this purpose. By authorizing additional funding for grants to State and local governments to increase influenza immunization rates for high risk populations and by authorizing funding to increase immunization rates for adolescents and adults who are medically underserved and at- risk for vaccine-preventable diseases, this bill seeks to meet the challenge of improving adolescent and adult immunization rates. Finally, it ensures that colleges, universities and prisons are given information about the availability of a vaccine for bacterial meningitis and that health care clinics and providers are given information about the availability of hepatitis A and B vaccines. In summary, the ``Vaccine Affordability and Availability Act'' clarifies, updates, and streamlines the existing Vaccine Injury Compensation Program to address concerns of petitioners to the program, to ensure that we are better prepared for normal market shortages and delays in production and that unwarranted litigation does not further destabilize our vaccine supply. I urge my colleagues to support this much needed legislation to improve the way the VICP operates for claimants seeking compensation and for manufacturers and administrators of vaccines seeking greater certainty in liability exposure, which, in turn, will stabilize vaccine production. This bill will help to ensure that the balance between the two very important goals of the Vaccine Injury Compensation Program is maintained: To provide for fair and expeditious compensation for persons injured by covered vaccines; and to ensure a stable supply of vaccines by avoiding unwarranted litigation relating to vaccine-related injuries and deaths. I urge my colleagues to support and pass this much needed legislation at a time when liability concerns once again threaten our vaccine supply. I ask unanimous consent the text of the bill be printed in the Record.

Mr. FRIST

Mr. FRIST. Mr. President, I rise today to introduce the ``Vaccine Affordability and Availability Act.'' The United States has succeeded in dramatically reducing the incidence of disease through the use of vaccines. In some cases, we've even been able to eradicate specific diseases, including smallpox. Smallpox, which has killed more people than any other disease or war in history, has been eradicated by the research, development and deployment of vaccines. Still, our success should not and must not dampen our resolve for combating disease with vaccines. Many vaccine-preventable diseases are still increasing morbidity and mortality due to a lack of public awareness about the existence and effectiveness of vaccines, and, in some cases, due to a shortage of certain vaccines. The goal of this bill is to improve how we vaccinate people in America today. It would reduce the cost of vaccines, make vaccines more accessible, enhance vaccine education, and streamline the vaccine compensation program. I urge all of my colleagues, on both sides of the aisle, to support this bill and, in so doing, support the prevention of disease and the saving of lives. We must strengthen our immunization system. We need only look at the experiences of three developed countries, Great Britain, Sweden and Japan, when they allowed their immunization rates to drop due to fear associated with the pertussis, whooping cough, vaccine. In Great Britain, a decrease in pertussis immunizations in 1974 resulted in an epidemic of more than 100,000 cases of pertussis and 36 deaths by 1978. In Japan between 1974 and 1979, pertussis vaccination rates fell from 70 percent, with 393 cases and no deaths, to around 20 to 40 percent, with 13,000 cases and 41 deaths. In Sweden between 1981 and 1985, the annual incidence rate of pertussis per 100,000 children 0-6 years of age increased from 700 cases to 3,200 cases. Low diphtheria immunization rates in the former Soviet Union for children and the lack of booster immunizations for adults have increased diphtheria from 839 cases in 1989 to nearly 50,000 cases and 1,700 deaths in 1994. As the General Accounting Office, GAO, described in a March 2000 report, infectious diseases are responsible for nearly half of all deaths worldwide for people under the age of 44. The report further states that immunizing children against infectious diseases is ``considered to be one of the most effective public health initiatives ever undertaken'' in the United States and the number of people in the United States contracting vaccine-preventable diseases has been reduced by more than 95 percent. Every year, millions of children are safely vaccinated, preventing thousands of childhood deaths and even more debilitating illnesses. While vaccines save lives and save the nation from lifelong medical costs associated with contracting vaccine- preventable diseases, no product is risk-free. When Congress passed the National Childhood Vaccine Injury Act in 1986, it recognized that ``[v]accination of children against deadly, disabling, but preventable infectious diseases has been one of the most spectacularly effective public health initiatives this country has ever undertaken.'' Congress further noted that the ``[u]se of vaccines has prevented thousands of children's deaths each year and has substantially reduced the effects resulting from disease.'' Congress further recognized that the cost of litigation initiated on behalf of children claiming vaccine-related injuries has resulted in an enormous increase in the price of vaccines and a significant reduction in the number of vaccine manufacturers in the U.S. market. The Advisory Commission on Childhood Vaccines, ACCV, was established pursuant to the 1986 National Childhood Vaccine Injury Act to advise the Secretary of HHS on ways to improve the Vaccine Injury Compensation Program, which was also established in the same law. Meeting minutes from a September 2001 ACCV meeting best sum up the integral connection between vaccine supply, production, and liability concerns that our bill seeks to address: ``The vaccine supply in the United States is becoming quite fragile. Over the last 20 to 30 years, there has been a significant decrease in the number of vaccine manufacturers. As a result, there is a relatively small group of manufacturers with limited manufacturing capability. This fragility compromises the ability to meet current vaccine needs and limits capacity to respond to emergencies.'' In the early 1980s, lawsuits alleging vaccine-related injury or death threatened vaccine production, availability, cost and even the development of new vaccines. Coupled with already low profit margins, the vaccine market became unstable. Gross sales of the DTP vaccine in 1980 for all manufacturers fell to about $3 million. If even a few of the vaccinated children experienced adverse reactions to the DTP vaccine and recovered $1 million each, for a lifetime of mental impairment, then damages would easily exceed total sales. Costs associated with researching new vaccines and the uncertainty created by liability once the vaccine was approved by the Food and Drug Administration and marketed, further jeopardized future vaccine development. In an attempt to address liability projections, manufacturers either raised their prices, the DTP vaccine rose from $.19 in 1980 to more than $12.00 by 1986, or left the vaccine market entirely. By the mid- 1980's, the number of manufacturers of DTP vaccine declined from seven to one and the Nation experienced a critical shortage of vaccine. As a result, we stopped immunizing 2 year olds, leaving them vulnerable to whooping cough, diphtheria, and tetanus. In 1986, Congress established the Vaccine Injury Compensation Program, VICP, as part of the National Childhood Vaccine Injury Act. The VICP was created to address two major goals: To provide compensation to those who suffered rare but serious side effects from vaccines and to stabilize the vaccine production and supply market. The VICP was established as a Federal ``no-fault'' compensation system to compensate individuals who have been injured by certain covered childhood vaccines. While vaccine-injured parties are required to file claims under the VICP before filing lawsuits, proof requirements are much lower than in court and procedures are simplified for injuries that are listed on the Vaccine Injury Table. The balance that was struck was that the burden of proving causation was significantly reduced for VICP claimants, while the litigation burden on manufacturers and administrators of covered vaccines is decreased. The Vaccine Affordability and Availability Act seeks to ensure the VICP balance between fairness to claimants seeking compensation for vaccine-related injury or death and stability for continued vaccine production is strengthened. It further addresses the concerns of claimants who file for compensation under VICP, in large part based on recommendations made by the Advisory Commission on Childhood Vaccines, ACCV. Because family plays such an important role in the rehabilitation and treatment of a child injured by a vaccine, the legislation allows VICP awards to cover family counseling and guardianship costs. Additionally, the bill raises the payment ceiling on two capped payments that have not been raised since the VICP was implemented in 1988. The legislation also lengthens the filing deadline so that petitioners may have more time to adequately assess the life care and medical needs of a vaccine-injured child before filing and adjudicating a VICP claim. It also allows claimants to recover interim costs before final judgment is reached, to ease the financial strain on petitioners for costs associated with filing a VICP claim. The bill also broadened the membership criteria so that an adult who has been injured by a vaccine may participate on the ACCV. Finally, the legislation makes clear that all of these changes apply to pending and future VICP claims. Today, only two American companies and two European companies sell vaccines in the United States. The United States is currently experiencing shortages in 5 of the 9 recommended childhood vaccines, for which there are only four manufacturers licensed to sell in the United States. Once again, the threat of liability and the cost of litigation pose challenges to the stability of our vaccine supply. According to the March 18, 2002 edition of Forbes magazine, the profit margin for vaccines is very slim. Just one of the pending class action lawsuits seeks $30 billion in damages. The entire global value of the vaccine market, all around the world, is only $5 billion. The ``Vaccine Affordability and Availability Act'' simply ensures that the VICP's goal of stabilizing the vaccine market is not jeopardized. In establishing the VICP in 1986, Congress sought to ensure that individuals claiming injury from covered vaccines must first file for compensation under the VICP. Some individuals, however, have attempted to evade this requirement by arguing, for example, that a preservative used in a vaccine, and included in the vaccine's product license application and product label, is not itself a ``vaccine'' so the VICP restrictions do not apply to claims for injuries caused by preservatives. This bill restates the original intent of the law, that a vaccine is all the ingredients and components which are approved by FDA to be in the product. The bill makes necessary clarifications to the VICP to ensure that unwarranted litigation does not again destabilize the vaccine market causing the few manufacturers licensed to sell vaccines in the United States to leave the market resulting in even more serious shortages of essential vaccines. It clarifies that a vaccine-injured person must timely file a petition and complete the VICP process before third parties may bring a civil action in connection with that person's injuries. The bill adopts the ACCV recommendation that clarifies that certain well-defined medical conditions such as structural lesions and genetic disorders may be considered to be ``factors unrelated,'' and therefore non-compensable under VICP, to a vaccine, even if the exact defect in the gene, for example, is unknown. The legislation also clarifies that vaccine manufacturers and administrators cannot be sued unless there is evidence that a vaccine has caused present physical harm, they cannot be sued for medical monitoring to look for some theoretical future harm. The bill clarifies the definition of manufacturer to specify that a vaccine includes all components or ingredients of the vaccine and clarifies the existing law to ensure that any component or ingredient listed in a vaccine's product license application or label will not be considered to be an adulterant or contaminant. As with the changes we are making for VICP claimants, these changes would apply to pending and future VICP claims. This bill also requires that the Secretary of HHS prioritize, acquire and maintain a 6-month supply of vaccines to address future vaccine shortages and delays in production and authorizes new funds for this purpose. By authorizing additional funding for grants to State and local governments to increase influenza immunization rates for high risk populations and by authorizing funding to increase immunization rates for adolescents and adults who are medically underserved and at- risk for vaccine-preventable diseases, this bill seeks to meet the challenge of improving adolescent and adult immunization rates. Finally, it ensures that colleges, universities and prisons are given information about the availability of a vaccine for bacterial meningitis and that health care clinics and providers are given information about the availability of hepatitis A and B vaccines. In summary, the ``Vaccine Affordability and Availability Act'' clarifies, updates, and streamlines the existing Vaccine Injury Compensation Program to address concerns of petitioners to the program, to ensure that we are better prepared for normal market shortages and delays in production and that unwarranted litigation does not further destabilize our vaccine supply. I urge my colleagues to support this much needed legislation to improve the way the VICP operates for claimants seeking compensation and for manufacturers and administrators of vaccines seeking greater certainty in liability exposure, which, in turn, will stabilize vaccine production. This bill will help to ensure that the balance between the two very important goals of the Vaccine Injury Compensation Program is maintained: To provide for fair and expeditious compensation for persons injured by covered vaccines; and to ensure a stable supply of vaccines by avoiding unwarranted litigation relating to vaccine-related injuries and deaths. I urge my colleagues to support and pass this much needed legislation at a time when liability concerns once again threaten our vaccine supply. I ask unanimous consent the text of the bill be printed in the Record.

Mr. FRIST

Mr. FRIST. Mr. President, John Eisenberg, director of the Agency for Healthcare Research and Quality, AHRQ, succumbed to a brain tumor this past Sunday. Although John had battled his illness for months, his death was a disturbing shock to many. He had done so much to improve healthcare in this Nation, and I know there was much more he wanted to do. Still, John leaves a legacy--both professional and personal--so large that it cannot and will not be forgotten. John Eisenberg was an outstanding public servant. He did not play partisan politics. Nor could he be corrupted by power. Simply put, he was passionate about people. It was his mission to improve the quality of health care in America. He dedicated his life to that mission as the director of the Agency for Healthcare Research and Quality, as a founder of the Congressional Physician Payment Review Commission, and as a member and leader of countless other societies, associations, and institutes. For John, public service was more than his job; it was his life's calling, which he answered with distinction and excellence. I consider myself privileged to have worked with John Eisenberg for many years and on many issues. He taught me so much not just about improving the quality of healthcare, but about being a leader by transforming the way people think about issues and institutions. I know he had an impact on leaders in all branches of government, and men and women at all levels of government respected him. And as for the medical community: John was one of them. I have heard this often and, even with the event of his passing, I still hear it today. As a physician, John Eisenberg saved the lives of many. As a leader, he enhanced the lives of millions. As a friend, he touched the lives of us all. The largeness of his life and legacy will endure in our memories and warm our hearts for many years to come. John Eisenberg will be known as more than one of the good ones, but one of the best there ever was and ever will be.

Mr. FRIST

Mr. FRIST. Madam President, I came to Washington to the U.S. Senate in my heart to serve my home state of Tennessee and this great nation, but after arriving my steps have also taken me far from the floor of the United States Senate--on medical mission trips to Sudan, Africa, and most recently, in January, to Uganda, Kenya, and Tanzania. The purpose of my trip just a few weeks ago was to learn, for myself, more about the human impact that a simple virus is having on the destruction of a continent. Not a family. Not a community. Not a state. Not a country. But an entire continent. The statistics behind this global plague are shocking: Each year, a staggering three million people die of AIDS. Someone dies from the disease every ten seconds. About twice that many, 5.5 million, or two every ten seconds, become infected. That's 15,000 a day. And what's even more tragic is that 6,000 of those infected each day are young--between ages 15 and 24. Globally, as many as 40 million are infected. Africa is hit particularly hard. Of those infected, 70% are in Africa. In Botswana alone, one out of every three individuals is infected. And the toll on families is incalculable. 13 million children have been orphaned by AIDS, mostly in Africa. Projections for the next ten years are sobering--the orphan population may well grown to 40 million--the number equivalent to all children living east of the Mississippi River here in the U.S. But Africa is not alone. India, with over 4 million cases, is on the edge of an explosive epidemic. China is estimated to have as many as 10 million infected persons. The Caribbean sadly boasts one of the highest rates of infection of any region in the world. Eastern Europe and Russia report the fastest growth of AIDS cases, 11 times over during a three year period. And even worse--90 percent of those infected do not know they have the disease. There is no cure. There is no vaccine. And it is increasing in numbers. As ranking member of the African Affairs subcommittee of the Foreign Relations Committee, I have a commitment to increase public awareness of the HIV pandemic in Africa, and most importantly, to develop a strategy to combat and eradicate the disease from the continent and the world. What I saw and learned in Uganda, Kenya, and Tanzania was extraordinary--coming face-to-face with the human tragedy of HIV/AIDS, and lives cut far too short. Madam President, Africa has lost an entire generation. In Nairobi, Kenya, I visited the Kibera slum. With a population of over 750,000, one out of five of those who live in Kibera are HIV/AIDS positive. As I walked the crowded, dirty pathways sandwiched between hundreds of thousands of aluminum shanties, I was amazed that everyone was a child, or very old. The disease had wiped out the parents--the most productive segment of the population--teachers, military personnel, hospital workers, law enforcement officers. In Arusha, Tanzania, I met Nema whose name means ``Grace.'' She sells bananas to survive and provide for her year and a half old son, Daniel. When Daniel cried from hunger, Nema kissed his hand because she had nothing to give him but her love. Margaret, also in Arusha, whose symptoms first came on in 1990. When her husband died, despite her illness, she found the strength to fight his family to keep the family property. Thanks to her brothers, she has a house for her six children. And I had the privilege of visiting with Tabu, a 28-year-old prostitute, who was leaving Arusha to return to her village to die. She stayed an extra day to meet with us, and I will never forget her cheerful demeanor and mischievous smile as we met in her small stick- framed mud hut, no more than 12 by 12. Her two sisters are also infected, another sister has already died. Tabu will leave behind an eleven year old daughter, Adija. At home in Tennessee, or even here in Washington, D.C., Uganda and Tanzania feel very far away. But the plague of HIV/AIDS and the chaos, despair and civil disorder it perpetrates only leads to the demise of democracy in a country, in a continent, in the world. Without civil institutions, there is disorder. Last year in South Africa, one in every 200 teachers died of AIDS. In Kenya, 75 percent of deaths on the police force are from AIDS. HIV-related deaths among hospital workers in Zambia have increased 13 times in over a decade. In the wake of these losses, economies are devastated. Botswana's economy is projected to shrink by 30 percent in ten years. Kenya's economy will see a 15 percent decline. Family incomes in the Ivory Coast have declined by 50 percent while expenditures for health care have risen by 4000 percent. The orphans of Africa are left without parents, without teachers, without role models and leaders. They are susceptible to recruitment by criminal organizations, revolutionary militias, and terrorists. Terrorism could become a way of life--not only for maniacal cults but for a generation. September 11 taught us how small our world really is. And how great the responsibility before us. And that is why I'm devoting much of my time in the U.S. Senate to the issue of global HIV/AIDS, and in particular, to the impact of the disease in Africa. Just as our great nation is the leader in the war on terrorism, we must also continue to lead in the global battle against AIDS as we work to build a better, safer world. Then where do we go from here? It seems to me there are three key ingredients: leadership, prevention and treatment, and funding. I would like to elaborate a moment on each. The good news is we know a lot about how to reverse the epidemic. And as a first step, it takes strong leadership at all levels, but as with most things in life, that leadership must start at the top. President Museveni in Uganda, with whom I spent some time on my trip, has not been bashful about speaking very publicly to the citizens of his country about HIV/AIDS. Bakili Muluzi, President of Malawi, was in my office here in Washington just a few weeks ago. He told me that he opens every speech to his countrymen with an admonition about HIV/AIDS. These two presidents underscore the need to bring the disease out into the light, helping to eliminate the stigma often associated with the disease, and opening the way for public education. Others have also been doing their part--governments, the U.N., the World Bank, world leaders, corporations and philanthropies. From President Bush to Kofi Annan and Secretary Powell, world leaders support a call to action, and all recognize the need to do more. It's also leadership from people as unlikely as Bono, lead singer of the Irish rock band, U-2. With his passion for Africa and his ``bully pulpit'' as a celebrity, he's a credible and accomplished spokesperson on the issue. He joined us in Uganda and Kenya for a couple of days, and I was impressed with his knowledge, his commitment, his caring. It's the role of leadership at all levels to ensure that our efforts are well coordinated, understanding the importance of enlisting all stakeholders in the fight against HIV/AIDS. We must coordinate within national governments as well as across them. We must leverage our precious resources and avoid duplication of effort. As I saw first-hand in east Africa, many of the best ideas come from those working in the trenches to fight this disease. Local community participation is essential to this process, and local leadership is critical, particularly as we work to prevent and treat the disease. Let me cite a couple of examples. In Tanzania, Sister Denise Lynch runs the Uhai Center for the Roman Catholic Diocese of Arusha, providing a range of services to village schools and churches. Father Bill Freida, a physician at St. Mary's Hospital in Kenya, tells me they serve over 400 patients a day, and their chapel and bakery are anchors for the community. And Dr. Ebenezer Mawasha, also in Tanzania, promotes the teaching of spiritual and moral values in addition to health and hygiene education. The work that these individuals have accomplished, coupled with their faith and commitment, are a true inspiration to me. And their efforts in preventing the disease will have positive repercussions in the years to come. Their leadership on the ground, in the trenches, each and every day, is fundamental to our ultimate success. I also want to salute the leadership of those with the CDC and U.S. AID on the ground in east Africa. President Museveni told me that our government's investment in Uganda, for example, of $120 million over the last ten years has been instrumental in their success in bringing new infection rates from 32 percent to just over 6 percent. Our presence through these two federal agencies is making a difference. Until science produces a vaccine, prevention through behavioral change and awareness is the key. And once again, cultural stigmas must be overcome. With a combination of comprehensive national plans, donor support and community-based organizations, progress can be made. Uganda, Thailand and Senegal are these examples of solid success. We must encourage people to be tested, for here is our real opportunity to save countless lives. The more people know about infection, the more likely they are to do something about it. I believe we should increase investments in rapid HIV testing kits and counseling for developing countries. Access to these testing tools helps to reinforce prevention messages and guide treatment options. As I saw in Africa, testing centers become centers of hope for a community, a place where those struggling with HIV/AIDS can share ideas, support each other, learn coping strategies, and receive medical treatment and nutritional support. I was particularly impressed with the work in the Kibera slum of Nairobi at the Kibera Self-Help Programme, run by the Centers for Disease Control. Officials there told me that a negative test provides a powerful incentive to stay healthy, and gives people an opportunity to receive counseling on risk behavior that will ultimately save lives. A positive test removes the burden of not knowing and allows for timely treatment and counseling, an important first step in living longer and healthier lives. In recent months, pharmaceutical companies sent a message of hope by slashing prices on anti-retrovirals for poor countries. Other treatment regimens may make an ever bigger difference in extending life and holding families together. Just as importantly, the hope of some kind of treatment will encourage more people to have themselves tested. And there are other potential public health advantages to treatment that require further research and evaluation. Treatment with anti-retroviral drugs lowers the amount of virus in the blood, potentially decreasing the risk of transmission, both among adults and mother to child transmissions. In addition, access to treatment and drugs is also needed for opportunistic infections, such as tuberculosis. For all the damage that HIV/AIDS does, TB kills more people in Africa with AIDS than any other opportunistic infection. CDC officials in Kenya told me TB has increased six times over in the last ten years, and it's impossible to separate HIV and TB. I've seen first hand in Sudan the reemergence of TB in strains more resistant, move virulent, than any we've seen before. And finally, support of health care delivery systems, with a special emphasis on personnel training, is essential to effective treatment programs. Let me add that on the subject of vaccines we must continue to search for the tools to finally reverse the spread of HIV/AIDS. Research and development must continue, and I'm pleased to report that NIH currently has over two dozen vaccine candidates in the pipeline. Someday, and hopefully very soon, we will have a vaccine to prevent this disease. In sum, I believe there are eight goals we must pursue in this global fight. 1. We must continue to encourage the political, religious and business leaders of the world to unit in an international commitment to halt the spread of HIV/AIDS and to help those who are afflicted with the disease. 2. We must continue to embrace the new Global Fund for HIV/AIDS, TB, and Malaria. This is not a UN fund, or an American fund. It is a new way of doing business. 3. We must better leverage America's public health care resources and talent to address the challenge. There must be a ``call to cure'' for our health care professionals to use their talent and expertise. 4. We should encourage and empower coalitions of governments, multi- lateral institutions, corporations, foundations, scientific institutions and NGO's to fill the gap between the available resources and the unmet needs for prevention, care and treatment. 5. We must continue to put community-based organizations, both religious and secular, at the forefront of action on the ground by getting funds to them quickly so they can most effectively do their jobs in reaching out those who need help most. 6. We must make certain that international research efforts on disease affecting poor countries is reinforced in a manner that assures the best scientific work in the world will lead to real benefits for the developing world--at a cost they can afford. 7. We must focus on prevention, and also support care and treatment options that combine reasonable cost pharmaceuticals with appropriately structured health care delivery systems. 8. Finally, we must do all we can to provide comfort to the families and orphans affected, to give them hope and dignity. I can still hear young Daniel's cries of hunger and know that his young mother will not live to see him grow into adolescence, much less manhood; can see Sister Denise as she patiently and capably answers my many questions about the best ways we can help; still hear the pride in Father Freida's voice as he describes his hospital as a place to provide dignity and comfort to the inflicted and dying; and I think of Tabu who has returned to her home village to face death. These images will remain with me; these images strengthen my resolve to win the fight against HIV/AIDS. History will judge us as to how we as a nation, as a global community, address and respond to this most devastating and destructive public health crisis we have seen since the bubonic plague ravaged Europe over 600 years ago. The task before us looms large, but by pulling together, with leadership from all, we will eliminate the scourge of HIV/AIDS from the face of the globe in our lifetime.

Mr. FRIST

Mr. FRIST. Madam President, I rise once again today to speak on the critical issue of genetic discrimination and to proudly join my colleagues, Senators Snowe, Jeffords, Collins, Enzi, DeWine, Hagel, and Gregg in introducing the Genetic Information Nondiscrimination Act of 2002. The threat of genetic discrimination, both in the workplace and with respect to health insurance coverage, is one of the most troublesome Congress faces. As our scientific knowledge has improved, the threat of discrimination has increased. As a physician, as a medical researcher, and ranking member of the Subcommittee on Public Health, I have a long and deep interest in this issue, and I believe we have a unique responsibility to ensure that medical and scientific progress does not result in individual harm. For example, I am deeply troubled by reports of women declining genetic testing out of fear that they may lose their health insurance, even though a genetic test might reveal that a woman is not at high risk and therefore allow her to make more informed health care choices. When I first joined Senator Snowe to introduce legislation banning genetic discrimination in health insurance in 1998, almost one-third of women offered a test for breast cancer risk at the National Institutes of Health declined, citing concerns about health insurance discrimination. If unchecked and unregulated, this fear of discrimination clearly has the potential to prevent individuals from participating in research studies or taking advantages of new genetic technologies to improve their medical care. Scientific advances hold the promise of higher quality medical care, yet there is a pressing need for federal legislation to reassure the public that learning this information will not result in a loss of health insurance coverage or in the loss of a job. I am committed to a bipartisan legislative solution, and have worked extensively towards this goal with Senator Snowe, Jeffords, and a number of the members of this Committee over the past several years. I believe that, together, we have made an important step in addressing this through the Genetic Information Nondiscrimination in Health Insurance Act, which has been passed by the Senate on three separate occasions. Today, we are building on that work, and on the solid foundations established in law by the Civil Rights Act, Americans with Disabilities Act, and Health Insurance Portability and Accountability Act. The Genetic Information Nondiscrimination Act of 2002 builds upon our progress in the health insurance area and expands our previous legislation to address the threat of employment discrimination and health insurance based on genetic information. Moreover, the bill incorporates the most recent scientific understandings in the field of genetics research in establishing protections and defining relevant terms. I believe that it is incumbent upon us to pass legislation this year that is comprehensive, consistent, reasonable and fair. I am troubled by some legislative approaches that would place these new protections outside of the established framework of our time-tested civil rights laws and that would establish separate protections against genetic discrimination than exist for other types of discrimination. The bill today meets that standard of providing strong protections that are consistent with the current state of scientific knowledge, as well as current law. I commend my colleagues for their commitment to this issue. I also commend President Bush for his commitment to ensuring strong protections against genetic discrimination and for calling attention to this critical matter. Through this important legislation, we have the opportunity to dispel the threat of discrimination based on an individual's genetic heritage, and I look forward to working with my colleagues to enact this legislation this year.

Mr. FRIST

Mr. FRIST. Madam President, I rise once again today to speak on the critical issue of genetic discrimination and to proudly join my colleagues, Senators Snowe, Jeffords, Collins, Enzi, DeWine, Hagel, and Gregg in introducing the Genetic Information Nondiscrimination Act of 2002. The threat of genetic discrimination, both in the workplace and with respect to health insurance coverage, is one of the most troublesome Congress faces. As our scientific knowledge has improved, the threat of discrimination has increased. As a physician, as a medical researcher, and ranking member of the Subcommittee on Public Health, I have a long and deep interest in this issue, and I believe we have a unique responsibility to ensure that medical and scientific progress does not result in individual harm. For example, I am deeply troubled by reports of women declining genetic testing out of fear that they may lose their health insurance, even though a genetic test might reveal that a woman is not at high risk and therefore allow her to make more informed health care choices. When I first joined Senator Snowe to introduce legislation banning genetic discrimination in health insurance in 1998, almost one-third of women offered a test for breast cancer risk at the National Institutes of Health declined, citing concerns about health insurance discrimination. If unchecked and unregulated, this fear of discrimination clearly has the potential to prevent individuals from participating in research studies or taking advantages of new genetic technologies to improve their medical care. Scientific advances hold the promise of higher quality medical care, yet there is a pressing need for federal legislation to reassure the public that learning this information will not result in a loss of health insurance coverage or in the loss of a job. I am committed to a bipartisan legislative solution, and have worked extensively towards this goal with Senator Snowe, Jeffords, and a number of the members of this Committee over the past several years. I believe that, together, we have made an important step in addressing this through the Genetic Information Nondiscrimination in Health Insurance Act, which has been passed by the Senate on three separate occasions. Today, we are building on that work, and on the solid foundations established in law by the Civil Rights Act, Americans with Disabilities Act, and Health Insurance Portability and Accountability Act. The Genetic Information Nondiscrimination Act of 2002 builds upon our progress in the health insurance area and expands our previous legislation to address the threat of employment discrimination and health insurance based on genetic information. Moreover, the bill incorporates the most recent scientific understandings in the field of genetics research in establishing protections and defining relevant terms. I believe that it is incumbent upon us to pass legislation this year that is comprehensive, consistent, reasonable and fair. I am troubled by some legislative approaches that would place these new protections outside of the established framework of our time-tested civil rights laws and that would establish separate protections against genetic discrimination than exist for other types of discrimination. The bill today meets that standard of providing strong protections that are consistent with the current state of scientific knowledge, as well as current law. I commend my colleagues for their commitment to this issue. I also commend President Bush for his commitment to ensuring strong protections against genetic discrimination and for calling attention to this critical matter. Through this important legislation, we have the opportunity to dispel the threat of discrimination based on an individual's genetic heritage, and I look forward to working with my colleagues to enact this legislation this year.

Mr. FRIST

Mr. FRIST. Madam President, I would like to take this time to congratulate Bono and the band U2 on receiving four Grammy Awards at last night's ceremony. While music listeners across the globe recognize Bono's music is well deserving of such accolades, I believe that another aspect of his career is also deserving of recognition. I was first introduced to Bono when he came by my office to talk about Africa and the struggles many third world countries face, including the issues of debt relief and the global HIV/AIDS epidemic. As chair of the Senate subcommittee on African Affairs and an active participant in medical missionary work in Africa, I was interested in learning how a rock star could contribute to international policy. I quickly found out that Bono was much more than a music icon. He is a serious person, well versed in the many issues that plague third world countries. More importantly, I found a person who was willing to use his time and talent to champion issues that will help end poverty and disease throughout the world. In January, Bono joined me on my trip to Uganda, where we visited health centers and AIDS clinics to learn how countries are coping with what's become the world's greatest health crisis. In a region where over half the population is under 15, Bono was able to carefully balance compassion and pragmatism. He asked the hard questions that countries like Uganda now face and how we, as a world, can aid in the fight. His interest was genuine. His commitment to making a difference was concrete. And because of his efforts, countries like Uganda and many others have a viable spokesperson committed to ending their strife. U2's music has always been one of compassion and humanity, committed as much to what their lyrics say as to how the music sounds. But this higher level of political consciousness goes far beyond U2's music. It's a part of their advocacy efforts and apparent in their ability to stay committed to the issues they support. Just as U2 is still being honored for their music after 25 years, I fully expect them to also be remembered for their efforts to improve international policy 25 years from now. Taking home four of music's most prestigious honors is, in itself, an inspiring feat. But it's Bono and U2's ability to be a voice for a lost generation that deserves the real honor.

Mr. FRIST

Mr. FRIST. Mr. President, on this Valentine's Day, National Donor Day, I rise to speak on the critical issue of organ donation. It is with great pleasure that I join with my colleagues Senators Dodd, Hutchinson, Jeffords, and Enzi to introduce the Organ Donation and Recovery Improvement Act. This far-reaching, comprehensive legislation includes a number of new steps intended to improve organ donation and recovery efforts nationwide and increase the number of organs available for transplants each year. This legislation is further complemented by a resolution that I, and a number of my colleagues are introducing today to commemorate today as National Donor Day and call attention to the important issue of organ donation. This year, more than twenty-two thousand Americans will receive an organ transplant. This is due to the rapid and tremendous advancements in our knowledge and in the science of organ transplantation. As a heart and lung transplant surgeon before coming to the Senate, I have had the opportunity to watch the field develop tremendously over the past three decades. I remember my own experiences, of conducting some of the first transplants using hearts and lungs, and know the tremendous progress that has been made since that time. And I know the hundreds of my own patients who have benefitted from improved lives due to advances in transplantation. Advances in our knowledge and the science have allowed us to transplant individuals who were once not considered candidates. But such advances have meant a staggering increase in the number of patients waiting for a transplant, while the number of donated organs has failed to keep pace. In fact, there are almost 80,000 patients waiting for a transplant today, a four-fold increase from just over a decade ago. Many of them may die before they can receive a transplant. More needs to be done. We must look for other ways to improve organ donation, to identify eligible organs and work with families to help them better understand the value of donation. Secretary Thompson already has made great progress in this area. I commend him for making organ donation a top priority at the Department of Health and Human Services. His initiative holds great promise. In particular, I applaud his call to recognize donor families through a medal of honor, something I have long supported through my own legislation, the Gift of Life Congressional Medal Act. I also welcome the Secretary's commitment to more closely scrutinize the role that organ donor registries play in the donation process. The legislation I am introducing today builds on these efforts through a broad range of initiatives intended to improve organ donation and recovery, enhance our knowledge base in these fields, and encourage novel approaches to this growing problem. The Organ Donation and Recovery Improvement Act is designed to improve the overall process of organ donation and recovery. The bill also seeks to remove potential barriers to donation, while identifying and focusing on best practices in organ donation. Let me briefly highlight a few key provisions of the legislation. First, the bill establishes a grant program for demonstration projects intended to improve donation and recovery rates and ensures that the projects' results will be evaluated quickly and disseminated broadly. The bill also provides for the placement and evaluation of organ donation coordinators in hospitals, a model that has worked with success in other countries. In addition, the legislation expands the authority of the Agency for Healthcare Research and Quality to conduct important research, including research on the recovery, preservation and transportation of organs and tissues. As we all know, the science of organ transplantation has been improved and refined over and over again since its inception. Yet all too often organ donation efforts are conducted under the same conditions and understandings as they were twenty years ago. This must change, and the legislation Senator Dodd and I are introducing today will help establish a strong evidence-based approach to enhance organ donation and recovery and improving our understanding of this process. The bill also includes several important provisions affecting living organ donation. First, it attempts to reduce potential financial disincentives toward serving as a living donor by allowing for the reimbursement of travel and other expenses incurred by living donors and their families. Importantly, the bill also takes steps towards evaluating the long- term health effects of serving as a living donor by asking the Institute of Medicine to report on this issue, as well as through the establishment of a living donor registry intended to track the health of individuals who have served as living organ donors. There remain important questions surrounding how this registry should be structured, and I look forward to working with my colleagues and the experts in the field to finalize the details before any legislation is enacted. Finally, I would like to address the issue of prospective organ donor registries. I am supportive of donor registries and feel they have an important role to play in improving organ donation rates. Moreover, I am pleased by the actions taken by some states to establish and enhance such registries. However, I am concerned that too great a focus has been placed on registries at a time when a number of questions surrounding registries remain unanswered and their effectiveness has not been fully evaluated. Therefore, the bill establishes an advisory committee to study this question and to report to Congress on the usefulness and success of organ donor registries and potential roles for the federal government to play in encouraging and improving such programs. The Frist-Dodd Organ Donation and Recovery Improvement Act is supported by a wide range of patient and organ transplantation organizations. I am pleased that the bill is supported by the American Society of Transplantation, National Kidney Foundation, American Liver Foundation, North American Transplant Coordinators Organization, Patient Access to Transplantation Coalition, TN Donor Services, New Mexico Donor Services, and Golden State Donor Services. I thank them for their hard work and dedication to this issue. Organ donation is one of the most important issues before us today. Each year, thousands of donors and families make the important decision to give consent and give the gift of life. We must recognize and honor their sacrifice, and, in so honoring, work to increase donation rates and allow more families to receive this gift of life each year. Hundreds of my own patients are alive today because of this gift. Let us work together to allow more patients and families to experience this miracle. I thank Senators Dodd, Hutchinson, Jeffords and Enzi for joining me in this effort, and look forward to working with them and my other colleagues to pass this important legislation this year.

Mr. FRIST

Mr. FRIST. Mr. President, on this Valentine's Day, National Donor Day, I rise to speak on the critical issue of organ donation. It is with great pleasure that I join with my colleagues Senators Dodd, Hutchinson, Jeffords, and Enzi to introduce the Organ Donation and Recovery Improvement Act. This far-reaching, comprehensive legislation includes a number of new steps intended to improve organ donation and recovery efforts nationwide and increase the number of organs available for transplants each year. This legislation is further complemented by a resolution that I, and a number of my colleagues are introducing today to commemorate today as National Donor Day and call attention to the important issue of organ donation. This year, more than twenty-two thousand Americans will receive an organ transplant. This is due to the rapid and tremendous advancements in our knowledge and in the science of organ transplantation. As a heart and lung transplant surgeon before coming to the Senate, I have had the opportunity to watch the field develop tremendously over the past three decades. I remember my own experiences, of conducting some of the first transplants using hearts and lungs, and know the tremendous progress that has been made since that time. And I know the hundreds of my own patients who have benefitted from improved lives due to advances in transplantation. Advances in our knowledge and the science have allowed us to transplant individuals who were once not considered candidates. But such advances have meant a staggering increase in the number of patients waiting for a transplant, while the number of donated organs has failed to keep pace. In fact, there are almost 80,000 patients waiting for a transplant today, a four-fold increase from just over a decade ago. Many of them may die before they can receive a transplant. More needs to be done. We must look for other ways to improve organ donation, to identify eligible organs and work with families to help them better understand the value of donation. Secretary Thompson already has made great progress in this area. I commend him for making organ donation a top priority at the Department of Health and Human Services. His initiative holds great promise. In particular, I applaud his call to recognize donor families through a medal of honor, something I have long supported through my own legislation, the Gift of Life Congressional Medal Act. I also welcome the Secretary's commitment to more closely scrutinize the role that organ donor registries play in the donation process. The legislation I am introducing today builds on these efforts through a broad range of initiatives intended to improve organ donation and recovery, enhance our knowledge base in these fields, and encourage novel approaches to this growing problem. The Organ Donation and Recovery Improvement Act is designed to improve the overall process of organ donation and recovery. The bill also seeks to remove potential barriers to donation, while identifying and focusing on best practices in organ donation. Let me briefly highlight a few key provisions of the legislation. First, the bill establishes a grant program for demonstration projects intended to improve donation and recovery rates and ensures that the projects' results will be evaluated quickly and disseminated broadly. The bill also provides for the placement and evaluation of organ donation coordinators in hospitals, a model that has worked with success in other countries. In addition, the legislation expands the authority of the Agency for Healthcare Research and Quality to conduct important research, including research on the recovery, preservation and transportation of organs and tissues. As we all know, the science of organ transplantation has been improved and refined over and over again since its inception. Yet all too often organ donation efforts are conducted under the same conditions and understandings as they were twenty years ago. This must change, and the legislation Senator Dodd and I are introducing today will help establish a strong evidence-based approach to enhance organ donation and recovery and improving our understanding of this process. The bill also includes several important provisions affecting living organ donation. First, it attempts to reduce potential financial disincentives toward serving as a living donor by allowing for the reimbursement of travel and other expenses incurred by living donors and their families. Importantly, the bill also takes steps towards evaluating the long- term health effects of serving as a living donor by asking the Institute of Medicine to report on this issue, as well as through the establishment of a living donor registry intended to track the health of individuals who have served as living organ donors. There remain important questions surrounding how this registry should be structured, and I look forward to working with my colleagues and the experts in the field to finalize the details before any legislation is enacted. Finally, I would like to address the issue of prospective organ donor registries. I am supportive of donor registries and feel they have an important role to play in improving organ donation rates. Moreover, I am pleased by the actions taken by some states to establish and enhance such registries. However, I am concerned that too great a focus has been placed on registries at a time when a number of questions surrounding registries remain unanswered and their effectiveness has not been fully evaluated. Therefore, the bill establishes an advisory committee to study this question and to report to Congress on the usefulness and success of organ donor registries and potential roles for the federal government to play in encouraging and improving such programs. The Frist-Dodd Organ Donation and Recovery Improvement Act is supported by a wide range of patient and organ transplantation organizations. I am pleased that the bill is supported by the American Society of Transplantation, National Kidney Foundation, American Liver Foundation, North American Transplant Coordinators Organization, Patient Access to Transplantation Coalition, TN Donor Services, New Mexico Donor Services, and Golden State Donor Services. I thank them for their hard work and dedication to this issue. Organ donation is one of the most important issues before us today. Each year, thousands of donors and families make the important decision to give consent and give the gift of life. We must recognize and honor their sacrifice, and, in so honoring, work to increase donation rates and allow more families to receive this gift of life each year. Hundreds of my own patients are alive today because of this gift. Let us work together to allow more patients and families to experience this miracle. I thank Senators Dodd, Hutchinson, Jeffords and Enzi for joining me in this effort, and look forward to working with them and my other colleagues to pass this important legislation this year.

Mr. FRIST

Mr. FRIST. Mr. President, I rise to speak about a bill being introduced today by Senator Collins, a bill that would expand loan forgiveness for math, science and special education teachers. I am proud to be a cosponsor of this legislation. At this time, I would like to share with you some startling statistics regarding the status of teaching skills in our country. More than 1 in 4 high school math teachers and nearly 1 in 5 high school science teachers lack even a minor in their main teaching field. About 56 percent of high school students taking physical science are taught by out-of-field teachers, as are 27 percent of those taking math. And these percentages are much greater among high-poverty areas. Among schools with the highest minority enrollments, for example, students have less than a 50 percent chance of getting a science or math teacher who hold both a license and a degree in the field being taught. One survey taken among 40 large urban schools, for instance, showed that more than 90 percent of them had an immediate need for a certified math or science teacher. This shortage of strong math and science teachers is having a direct effect on the performance of our students. The most recent NAEP science section results showed that the performance of fourth- and eighth-grade students remained about the same since 1996, but scores for high school seniors changed significantly: up six points for private school students and down four for public school students, for a net national decline of three points. Moreover, a whopping 82 percent of twelfth- grade students are not proficient in science and the achievement gaps among eighth-graders are appalling: Only 41 percent of white, 7 percent of African-American and 12 percent of Hispanic students are proficient. The disappointing overall results for seniors on the science section of the NAEP prompted Education Secretary Rod Paige to call the decline ``morally significant.'' He warned, ``If our graduates know less about science than their predecessors four years ago, then our hopes for a strong 21st century workforce are dimming just when we need them most.'' I couldn't agree with the Secretary more. An enormous improvement in mathematics and science education at the K-12 level is necessary if today's students want good jobs and the United States wants to stay competitive in the world economy. With globalization, that means that the good jobs will go to the people who can do them best. If those people are not in the United States, then those jobs will also not be in the United States. At present, the law allows 195,000 immigrants to enter the United States on H-1B visas each year in order to take jobs that cannot be filled by workers in the United States. We have to do more to make sure that our students are learning math and science skills. And to do so, we must improve the quality of our Nation's math and science teachers. These sentiments are echoed by the National Research Council in its 2001 ``Educating Teachers of Science, Mathematics, and Technology'' report. The Council notes: If the Nation is to make the continuous improvements needed in teaching, we need to make a science out of teacher education--using evidence and analysis to build an effective system of teacher preparation and professional development. President Bush has taken note of the startling statistics I shared with you today, and that is why he has provided $45 million in his budget to expand loan forgiveness for math and science teachers from $5,000 to $17,500 for those teachers who commit to teach for 5 consecutive years in high-need schools. The President also provided this expansion of loan forgiveness for special education teachers in his proposal. I wrote like to praise Senator Collins for following his lead and introducing a bill to provide the authorizing language to make his proposal become a reality. I am very proud to be an original cosponsor of the bill. The bill would provide that $17,500 of loans would be forgiven for those that have math, science, engineering and special education majors or graduate degrees, have been certified to teach in their states, and agree to teach in a school with a 50 percent or higher rate of poverty. The bill is very simple, but it could make a tremendous difference for many of our young students' lives. I have had the benefit of an amazing education in my lifetime and also have had the wonderful opportunity of being inspired by tremendously talented and dedicated teachers. I want to make sure that all children have that same opportunity: to be inspired by smart, gifted and devoted teachers who actually know and understand math and science. These teachers make a difference. They can lead a child to like math, to like science, or they can cause a child to forever stray from the life sciences and run toward the liberal arts. Our society needs more engineers, more technicians, more doctors and more scientists. We as a society should do all we can to encourage kids to enter these professions. That means we have to start early and make sure that those individuals who have the ability to shape their knowledge actually encourage them to become future scientists, not dissuade them from ever considering it. And, having spoken with so many teachers, school board members and educators who must grapple with the demands of the special education students, no one can underestimate the need to encourage more of our best and brightest to teach special need children. I hope others join Senator Collins and me in this effort to make a difference in a young child's future. Please cosponsor this initiative and help us to pass this important legislation.

Mr. FRIST

Mr. FRIST. Mr. President, I rise to speak about a bill being introduced today by Senator Collins, a bill that would expand loan forgiveness for math, science and special education teachers. I am proud to be a cosponsor of this legislation. At this time, I would like to share with you some startling statistics regarding the status of teaching skills in our country. More than 1 in 4 high school math teachers and nearly 1 in 5 high school science teachers lack even a minor in their main teaching field. About 56 percent of high school students taking physical science are taught by out-of-field teachers, as are 27 percent of those taking math. And these percentages are much greater among high-poverty areas. Among schools with the highest minority enrollments, for example, students have less than a 50 percent chance of getting a science or math teacher who hold both a license and a degree in the field being taught. One survey taken among 40 large urban schools, for instance, showed that more than 90 percent of them had an immediate need for a certified math or science teacher. This shortage of strong math and science teachers is having a direct effect on the performance of our students. The most recent NAEP science section results showed that the performance of fourth- and eighth-grade students remained about the same since 1996, but scores for high school seniors changed significantly: up six points for private school students and down four for public school students, for a net national decline of three points. Moreover, a whopping 82 percent of twelfth- grade students are not proficient in science and the achievement gaps among eighth-graders are appalling: Only 41 percent of white, 7 percent of African-American and 12 percent of Hispanic students are proficient. The disappointing overall results for seniors on the science section of the NAEP prompted Education Secretary Rod Paige to call the decline ``morally significant.'' He warned, ``If our graduates know less about science than their predecessors four years ago, then our hopes for a strong 21st century workforce are dimming just when we need them most.'' I couldn't agree with the Secretary more. An enormous improvement in mathematics and science education at the K-12 level is necessary if today's students want good jobs and the United States wants to stay competitive in the world economy. With globalization, that means that the good jobs will go to the people who can do them best. If those people are not in the United States, then those jobs will also not be in the United States. At present, the law allows 195,000 immigrants to enter the United States on H-1B visas each year in order to take jobs that cannot be filled by workers in the United States. We have to do more to make sure that our students are learning math and science skills. And to do so, we must improve the quality of our Nation's math and science teachers. These sentiments are echoed by the National Research Council in its 2001 ``Educating Teachers of Science, Mathematics, and Technology'' report. The Council notes: If the Nation is to make the continuous improvements needed in teaching, we need to make a science out of teacher education--using evidence and analysis to build an effective system of teacher preparation and professional development. President Bush has taken note of the startling statistics I shared with you today, and that is why he has provided $45 million in his budget to expand loan forgiveness for math and science teachers from $5,000 to $17,500 for those teachers who commit to teach for 5 consecutive years in high-need schools. The President also provided this expansion of loan forgiveness for special education teachers in his proposal. I wrote like to praise Senator Collins for following his lead and introducing a bill to provide the authorizing language to make his proposal become a reality. I am very proud to be an original cosponsor of the bill. The bill would provide that $17,500 of loans would be forgiven for those that have math, science, engineering and special education majors or graduate degrees, have been certified to teach in their states, and agree to teach in a school with a 50 percent or higher rate of poverty. The bill is very simple, but it could make a tremendous difference for many of our young students' lives. I have had the benefit of an amazing education in my lifetime and also have had the wonderful opportunity of being inspired by tremendously talented and dedicated teachers. I want to make sure that all children have that same opportunity: to be inspired by smart, gifted and devoted teachers who actually know and understand math and science. These teachers make a difference. They can lead a child to like math, to like science, or they can cause a child to forever stray from the life sciences and run toward the liberal arts. Our society needs more engineers, more technicians, more doctors and more scientists. We as a society should do all we can to encourage kids to enter these professions. That means we have to start early and make sure that those individuals who have the ability to shape their knowledge actually encourage them to become future scientists, not dissuade them from ever considering it. And, having spoken with so many teachers, school board members and educators who must grapple with the demands of the special education students, no one can underestimate the need to encourage more of our best and brightest to teach special need children. I hope others join Senator Collins and me in this effort to make a difference in a young child's future. Please cosponsor this initiative and help us to pass this important legislation.

Mr. FRIST

Mr. FRIST. That is correct.

Mr. FRIST. Mr. President, I am thankful to be able to come to the floor today, along with many of my colleagues, to announce the Senate passage of the Frist-Kennedy Bioterrorism Preparedness Act of 2001. Over the past several weeks, we have been working in a bipartisan manner to address this critical issue, and I am grateful for the work of Senators Gregg, Kennedy, and others. Everyone has worked very hard to get us to this point, and I will continue to work with them in conference to ensure final passage of this crucial legislation. I am also thankful for the work of my colleagues to ensure that there is an appropriate level of funding for bioterrorism preparedness and response activities that will be available immediately. I commend Senators Stevens, Byrd, Specter, Inouye, and Roberts and others for their strong support in securing the necessary funding. With the passage of the latest appropriations bills, we have secured well over $2.5 billion for bioterrorism activities in addition to those provided for agroterrorism. I am also pleased with the level of funding for State and local preparedness and response activities--at least $1 billion--which is one of my top priorities. However, our efforts cannot end when the funding is secured. We must provide greater guidance and authorities through an authorization bill, which is why final passage of a bioterrorism authorization bill is equally important. Both the House and the Senate have signaled the need for increased authorization with the passage of the Tauzin-Dingell Public Health Security and Bioterrorism Response Act of 2001 and the Frist-Kennedy Bioterrorism Preparedness Act of 2001. We must work together in conference to ensure final passage. A variety of increased authorizations are necessary to protect our food supply, prevent agroterrorism, develop appropriate countermeasures, and ensure appropriate State and local preparedness and response. For example, in the Frist-Kennedy Bioterrorism Preparedness Act of 2001, we have greatly expanded the ability to protect our Nation's food supply by increasing authorities for the Department of Agriculture and the Food and Drug Administration. We need to ensure that our food supply is safe. With 57,000 establishments under its jurisdiction and only 700-800 food inspectors, including 175 import inspectors for more than 300 ports of entry, the Food and Drug Administration (FDA) needs increased resources for inspections of imported food. Our legislation grants FDA needed authorities to ensure the safety of domestic and imported food. It allows FDA to use qualified employees from other agencies and departments to help conduct food inspections. Any domestic or foreign facility that manufactures or processes food for use in the U.S. must register with FDA. Importers must provide at least four hours notice of the food, the country of origin, and the amount of food to be imported. FDA's authority is made more explicit to prevent ``port-shopping'' by marking food shipments denied entry at one U.S. port to ensure such shipments do not reappear at another U.S. port. This bill also gives additional tools to FDA to ensure proper records are maintained by those who manufacture, process, pack, transport, distribute, receive, hold or import food. The FDA's ability to inspect such records will strengthen their ability to trace the source and chain of distribution of food and to determine the scope and cause of the adulteration or misbranding that presents a threat of serious adverse health consequences or death to humans or animals. Importantly, the bill also enables FDA to detain food for a limited period of time while FDA seeks a seizure order if such food is believed to present a threat of serious adverse health consequences or death to humans or animals. The FDA may also debar a person who engages in a pattern of seeking to import such food. This important legislation also includes several measures to help safeguard the nation's agriculture industry from the threats of bioterrorism. Toward this end, it contains a series of grants and incentives to help encourage the development of vaccines and antidotes to protect the nation's food supply, livestock, or crops, as well as preventing crop and livestock diseases form finding their way to our fields and feedlots. It also authorizes emergency funding to update and modernize USDA research facilities at the Plum Island Animal Disease Laboratory in New York, the National Animal Disease Center in Iowa, the Southwest Poultry Research Laboratory in Georgia, and the Animal Disease Research Laboratory in Wyoming. Also, it funds training and implements a rapid response strategy through a consortium of universities, the USDA, and agricultural industry groups. No one has worked harder on these agricultural provisions than my colleague Senator Roberts. I know he understands deeply the threat that we face in these areas and has helped provide real leadership in pointing the way to solutions. Additionally, the Frist-Kennedy ``Bioterrorism Preparedness Act of 2001'' expands our nation's stockpile of smallpox vaccine and critical pharmaceuticals and devices. The bill also expands research on biological agents and toxins, as well as new treatments and vaccines for such agents and toxins. Since the effectiveness of vaccines, drugs, and therapeutics for many biological agents and toxins often may not ethically be tested in humans, this crucial legislation ensures that the FDA will finalize by a date certain its rule regarding the approval of new priority countermeasures on the basis of animal data. Priority countermeasures will also be given expedited review by the FDA. Because of the limitations on a market for vaccines for these agents and toxins, our legislation gives the Secretary of HHS authority to enter into long-term contracts with sponsors to ``guarantee'' that the government will purchase a certain quantity of a vaccine at a certain price. This legislation also provides a limited antitrust exemption to allow potential sponsors to discuss and agree upon how to develop, manufacture, and produce new priority countermeasures, including vaccines, and drugs. Federal Trade Commission and the Department of Justice approval of such agreements is required to ensure such agreements are not anti-competitive. I appreciate the work of Senator Hatch and his advice in crafting the antitrust language. These FDA authorities and market incentives--which can only be provided by additional authorizing legislation--are critical to the rapid development of vaccines and other countermeasures. I want to thank Senators Hutchinson and Collins for their important work with this portion of the bill. Both the House and Senate bills also include protections, similar to those currently provided to those who join the National Guard, to help protect the employment rights of medication volunteers within the National Disaster Medical Response System (NDMS). The bills also extend necessary liability protections to those volunteers. Senator Enzi provided beneficial advice about how to craft this portion of the legislation. Moreover, both bills contain additional measures to assist with the tracking and control of biological agents and toxins. With respect to the control of biological agents and toxins, the Secretary of Health and Human Services is required to review and update a list of biological agents and toxins that pose a severe threat to public health and safety and to enhance regulations regarding the possession, use and transfer to such agents or toxins. Again, these needed protections will not go into effect until we pass authorizing language. Although the ``Public Health Threats and Emergencies Act of 2000'' established basic grant programs to assist with strengthening the public health infrastructure, the language was based on the assumption that each year five more states would receive enough money to be prepared for a bioterrorist attack. Given the recent set of events, we cannot wait 10 more years for our public health infrastructure to be strengthened. We must put in place a mechanism to ensure that every state has sufficient funding to improve their public health infrastructure so that they are able to respond to a potential biological attack. I agree that we must provide resources necessary to develop smallpox and other needed vaccines, drugs, and biologics to counter potential biological agents. But it is even more important that we provide needed resources to those who will be on the front-lines in responding to a potential attack. Hospitals and other medical facilities must become better prepared to respond and to deal with the public health emergency after such an attack. And doctors, nurses, firefighters, police, and emergency medical response personnel need better training and equipment to combat biological threats and provide needed treatment. Therefore, the two new grant programs included in the ``Bioterrorism Preparedness Act''--the State Bioterrorism grant program and the Designated Bioterrorism Response Medical Center program--are essential. Finally, our legislation would also ensure that we enhance coordination among local, state and federal agencies responsible for responding to a biological attack, and that this response appropriately deals with the special needs of children and other vulnerable populations. Almost half of all public health departments serve jurisdictions whose emergency response plans do not address incidents of bioterrorism. Agencies have not determined a single list of biological agents likely to be used in a biological attack, several agencies have not been consulted in crafting the list or determining an overall emergency response plan, and agencies have developed programs to provide assistance to state and local governments that are similar and potentially duplicative. The Bioterrorism Preparedness Act of 2001 establishes an Assistant Secretary for Emergency Preparedness at HHS to coordinate all functions with the Department relating to emergency preparedness, including preparing for and responding to biological threats or attacks. It also creates a federal interdepartmental Working Group on Bioterrorism that consolidates and streamlines the functions of two existing working groups first established under the ``Public Health Threats and Emergencies Act of 2000.'' Recent reports regarding the treatment of children during the anthrax scare, including the cutaneous anthrax case in a 7 month old boy, have highlighted the need to more fully address the special needs of children when responding to bioterrorism attacks. Within the Frist- Kennedy ``Bioterrorism Preparedness Act of 2001,'' numerous provisions were added to specifically address this critical issue, with the emphasis on streamlining the language so that the children's health and welfare issues were considered in concert with the general provision of services. These provisions include a specific reference that the vaccines, therapies and medical supplies within the stockpile appropriately address the health needs of children and other vulnerable populations; requiring the Working Group to take into consideration the special needs of children and other vulnerable populations; establishing the National Task Force on Children and Terrorism--an advisory committee of child health experts on infectious disease, environmental health, toxicology, and other relevant professional disciplines--to offer advice to the Secretary; along with other crucial additions. I want to thank Senators Dodd, DeWine, Collins, and Clinton for their assistance in crafting appropriate language to address the special needs of children and other vulnerable populations. Along with my colleagues, I am appreciative of the steps we have taken thus far to ensure that we are prepared to respond to biological threats or attacks, and I look forward to continuing to work with them to ensure final passage of bioterrorism authorization legislation. I want to thank Senator Jeffords and Senator Bob Smith for their input and advice regarding water safety and how we should more adequately protect our nation, Senators Sessions and Shelby for their important input on the various training activities, and Senator Lieberman for his crucial input regarding our disease surveillance and coordination infrastructure. I look forward to continuing to work with all of the Senators and their staff. I must also commend Senator Kennedy again for his efforts. He has been a true partner on this bill and the Frist-Kennedy ``Public Health Threats and Emergencies Act of 2000,'' which we signed into law last year. Finally, I want to thank my staff--Allen Moore, Dean Rosen, Helen Rhee, Craig Burton, Allison Winnike, and Shana Christrup--as well as the staff of other Senate offices for all of their efforts, including Vince Ventimiglin, Katy French and Steve Irizarry of Senator Gregg's staff; David Nixon, David Bowen, David Dorsey, and Paul Kim of Senator Kennedy's staff; John Mashburn of Senator Lott's staff; Stacey Hughes of Senator Nichles' staff; Abby Kral of Senator DeWine's staff; Claire Bernard and Priscilla Hanley of Senator Collins' office; Kate Hull of Senator Hutchinson's staff; Raissa Geary of Senator Enzi's staff; Laura O'Neill of Senator Session's office; Debra Barrett and Jim Fenton of Senator Dodd's staff; and Bruce Artim and Patty DeLoatche of Senator Hatch's staff. Their tireless work has been essential in assisting us in getting this far.

Mr. FRIST. I concur with Senator Kennedy's remarks regarding this standard as it applies to the food safety provisions in this bill. As 21 C.F.R. 7.41 regarding health hazard evaluation makes clear, the FDA evaluation will take into account a list of factors, one of which is ``an assessment of hazard to various segments of the population, including children, livestock, etc. who are expected to be exposed to the product being considered with particular attention paid to the hazard to those individuals who may be at greatest risk.'' I believe these provisions will help protect the safety and security of our food supply.

Mr. FRIST. I agree and you have my commitment to do the same.

Mr. FRIST

Mr. FRIST. Mr. President, I rise today to discuss the introduction of a very important bill to address the nursing workforce shortage. At the beginning of November, we reported two different bills from the Senate HELP Committee designed to address the nursing shortage in this country, the Hutchinson-Mikulski ``Nursing Employment and Education Development Act'' and the Kerry-Jeffords ``Nursing Reinvestment Act.'' I was an original cosponsor of the Hutchinson legislation and a strong supporter of that bill. At that time, I voiced my concern that we are marking up two rather similar proposals to deal with the nursing shortage, and I requested that the differences be worked out before the bill was discussed on the Senate floor. I am happy today to report the the final reconciliation is complete, and we have a consensus bill that firmly addresses the nursing workforce shortage issue. I thank Senator Hutchinson for his hard work in ensuring that we could reach this point. We are in the midst of a direct care workforce shortage. Not only are fewer people entering and staying in the nursing profession, but we are losing experienced nurses at a time of growing need. Today, nurses are needed in a greater number of settings, such as nursing homes, extended care facilities, community and public health centers, professional education, and ambulatory care facilities. Nationwide, health care providers, ranging from hospitals and nursing homes to home health agencies and public health departments, are struggling to find qualified nurses to provide safe, efficient, quality care for their patients. That's why it is important to have a new Nursing Corps, which will provide scholarships to qualified individuals in exchange for direct care service in a variety of settings as well as to allow others to know about the numerous possibilities within the profession by authorizing public service announcements. Though we have faced nursing shortages in the past, this looming shortage is particularly troublesome because it reflects two trends that are occurring simultaneously: 1. A shortage of people entering the profession; and 2. The retirement of nurses who have been working in the profession for many years. Over the past five years, enrollment in entry-level nursing programs has declined by twenty percent, mirroring the declining awareness of the nursing profession among high school graduates. Consequently, nurses under the age of thirty represent only ten percent of the current workforce. By 2010, forty percent of the nursing workforce will be older than fifty years old and nearing retirement. If these trends continue, we stand to lost vast numbers of nurses at the very time that they will be needed to care for the millions of baby boomers reaching retirement age. To deal with the increased need for nurses to care for the elderly, this bill has a provision to assist with both the necessary training and educational development of gerontological nurses as well as to strengthen the ability of nurses to obtain additional training and certification through the career ladders program. Further, greater efforts must be made to recruit more men and minorities to this noble profession. Currently, only ten percent of the registered nurses in the United States are from racial or ethnic minority backgrounds, even though these individuals comprise twenty- eight percent of the total United States population. In 2000, less than six percent of the registered nurses were men. We must work to promote diversity in the workforce, not only to increase the number of individuals within the profession, but also to promote culturally competent and relevant care. Within the combined nursing shortage bill, one grant program directly addresses the need to increase funding for the training of minority and disadvantaged students to make it easier for individuals to enter the nursing profession. Even if nursing schools could recruit more students to deal with the shortage, many schools could not accommodate higher enrollments because of faculty shortages. There are nearly four hundred faculty vacancies at nursing schools in this country. And, an even greater faculty shortage looms in the next ten to fifteen years as many current nursing faculty approach retirement and fewer nursing students pursue academic careers. Therefore, I strongly support the two provisions to assist with faculty development and training, the fast track nursing faculty loan program and the stipend and scholarship program. In addressing these direct care staffing shortages, we must work together to develop innovative solutions to address this growing issue. As reported in the Memphis Commercial Appeal on May 10, there are steps that Congress can take to increase funding for specific programs and reduce regulatory requirements. However, a comprehensive strategy must also include other sectors of the health care system, hospitals, health care professionals, educators, and the general public, to successfully deal with this looming shortage. That's why it is important to also include a provision to deal with developing retention strategies and best practices in nursing staff management. I am extremely supportive of this legislation, and I want to thank Senator Hutchinson again for his hard work in addressing this critical issue. I also want to commend my other colleagues, including Senator Mikulski, for her efforts. Senator Hutchinson clearly has shown tremendous leadership in this area. He understands the need to address the nursing shortage issue, and he is largely responsible for getting us to this point today.