Tom Price

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Madam Speaker, I'm pleased to rise today in celebration of World Hemophilia Day in which we recognize the serious challenges of those worldwide who suffer from hemophilia, a day in which we raise awareness to fight for a cure. Hemophilia is a rare genetic disorder in which the blood doesn't clot causing excessive bleeding and easy bruising. Without proper treatment, it can lead to organ damage, serious joint and muscle problems, and terrible pain. Those with hemophilia often live in a world unknown to others, anxious about even minor injuries or cuts because what is minor for most people can be a major problem for those with hemophilia. As a physician, I'm confident that with attention, diligence, innovation, and scientific progress, we will improve the lives of those afflicted with this troubling disease and realize a cure. Madam Speaker, hemophilia is a daunting condition requiring vigilant care, but we see a day where patients need not fear its pain or its consequences. I'm proud to stand today in support of World Hemophilia Day.

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Madam Speaker, once again this misguided Democrat majority is looking to set a record. But like their tally for broken promises and historic tax increases, this isn't a record of which anyone should be proud. No, Madam Speaker, this Democrat leadership is overseeing the record price of gasoline. Today, the national average for gas reached $3.44 a gallon, an all- time high. The American people want to know what Congress is going to do about it, but a crisis of leadership in this Congress continues to leave American families struggling to fill up their tank. Under this leadership, the price at the pump has shot up more than a dollar a gallon in just 16 months. Now on the campaign trail, they talked about a commonsense plan to bring down gasoline prices. Yet instead of easing the pain at the pump, this majority offers only more gas taxes and less domestic production, and the gas bill only rises. Madam Speaker, the American people demand relief, and their pleas are being ignored. That is the definition of leadership lacking.

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Thank you, Mr. Speaker. Mr. Speaker, today is April 15th. It's a momentous day for Americans as all Americans know it's Tax Day. And it's a day that Americans tend to focus a little more attention on the amount of money that they send to Washington. And it's a lot of money. It's a lot of money, Mr. Speaker. And most folks that I talk to say that would be okay, a lot of them have said that would be okay if they were getting good things for their money, if they were seeing progress happen here in Washington. But that's just not the case. I, like most of my colleagues, go home every weekend. I went home last weekend, and what I hear from my constituents is what is happening? Where is the leadership in Washington? Mr. Speaker, I believe there is a crisis in leadership in Washington and here in the House of Representatives. Whether it is supporting our troops, the leadership here apparently is determined that they are going to use our military troops as pack mules to carry their special projects across the finish line. Mr. Speaker, that's leadership lacking. Whether it's protecting our Nation in the area of intelligence, this leadership believes that our intelligence community doesn't need to have the tools necessary to tell what the bad guys are going to do before they do it. Mr. Speaker, that's leadership lacking. You have heard a lot about gas prices this morning. Sixteen months ago when this leadership took charge, a barrel of gasoline cost about $52, $53 a barrel. Today, it is about $112, $113 a barrel. Mr. Speaker, that's leadership lacking. What's changed in Washington since that time? New leadership here in the House of Representatives. Mr. Speaker, that's not the kind of change that America voted for. We need to work together in the area of energy. We need to make certain that we, as Americans, conserve more. We need to make certain that we utilize American resources for Americans. There's incredible resources in our land. We could utilize those resources in environmentally sensitive and technologically sound ways to make certain that we decrease our dependence on foreign oil. And finally, Mr. Speaker, we need to make certain that we accelerate the use of alternative fuel, not picking winners and losers like this leadership in this majority wants to do, pick ethanol and raise the gas prices significantly by that, raise food prices around the world because of the action of this leadership. Mr. Speaker, that's leadership lacking. Where else is leadership lacking here in the House? Well, Mr. Speaker, it is in helping our friends around the world. We have a former President meeting with Hamas terrorists. Where is the outcry from this leadership saying that that's not the correct thing to do for a former leader of our Nation? In the area of fair trade, free trade, last week this leadership decided they were going to take one of our friends, Colombia and South America, who have worked with us time and time again, one of the glimmering hopes for democracy in South America, and what does this leadership do? Kick them in the teeth. It is not just me saying that. Headlines all across the Nation last week: Financial Times, ``A setback on trade in Washington;'' Knoxville News Sentinel, ``House Democrats holding free trade hostage;'' Corpus Christi Caller Times, ``Congress should pass Colombia trade deal;'' Charleston Post Courier, ``Politics trump free trade;'' Orange County Register, ``Trading on ignorance;'' the Plain Dealer, ``Sidetracking American trade deal hurts U.S. businesses and workers;'' the Chicago Tribune, ``Caving on Colombia;'' Los Angeles Times, ``Pelosi plays politics;'' The Oklahoman, ``Pelosi's ploy: Colombia Deal Succumbs to Politics;'' New York Times, ``Time for the Colombian Free Trade Pact;'' the Denver Post, ``Historical failure on Colombia trade pact;'' San Francisco Chronicle, ``Trade pandering;'' New York Post, ``Pelosi's Putrid Sellout;'' Seattle Times, ``The Washington 6: tampering with trade;'' the Boston Herald, ``The Pelosi Doctrine: Duck;'' Las Vegas Review Journal, ``Trade Talks;'' National Review, ``Free Choice;'' St. Louis Post-Dispatch, ``The Politics of Trade;'' Washington Post, ``Drop Dead, Colombia;'' and the Wall Street Journal, ``Pelosi's Bad Faith.'' Mr. Speaker, there is a crisis of leadership here in Washington, here in this House of Representatives. The American people are paying attention. The American people want positive change. The American people want us to work together. I call on the Speaker of this House to bring forward the free trade deal with Colombia, to work together on gas prices, to make certain that we pass a Foreign Intelligence Surveillance Act that allows our intelligence communities to act positively. Mr. Speaker, I call on our leadership to be responsible.

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Madam Speaker, I have a parliamentary inquiry.

Mr. PRICE of Georgia. Madam Speaker, isn't it true the Chair has ruled multiple times on the fact that a bill reported promptly out of the House may return to the House floor at the discretion of the committee, and the fact that the Ways and Means Committee brought this to the floor, it could easily do so within a relatively short period of time, a matter of days?

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Madam Chairman, I move to strike the last word.

Mr. PRICE of Georgia. I appreciate that, and I appreciate the opportunity to come to the floor today to talk about an issue that is of vital concern and importance to the American people. It may not have been what the majority party wanted to talk about today, but it's what the American people want to talk about and that's energy. I don't know if anybody had an opportunity to walk outside the United States Capitol today, but you heard trucks with their horns blaring outside the Capitol, and they were doing so because they were objecting to the leadership in this Congress and the lack of action on energy prices and gas prices. That noise resonates across this land, Madam Chairman. Resonates across the land. I had a group of high school students in my office today, and they wanted to know what we were doing about energy. They'd heard that this Congress had passed the Energy Efficiency Act. They wanted to know about the particulars of that act. And so we reviewed the particulars of that act, and I said, how much more gas do you think will get to the pumps in communities across this Nation if we increase the taxes on American oil companies? Well, these are bright high school kids. They said, well, not much more. And they're absolutely right, Madam Chairman, because the Energy Efficiency Act that this Congress passed in this session, in this term, will produce no energy. No new energy.

Mr. PRICE of Georgia. I'm pleased to yield to the gentleman from California.

Mr. PRICE of Georgia. Reclaiming my time, I appreciate your comments. And if you think about what has changed in the last 15 months in terms of leadership here in Washington, it's not the other end of Pennsylvania Avenue. The only thing that's changed during the period of time when crude oil has gone from $56 a barrel to $112 a barrel, the only thing that's changed in terms of the leadership in Washington is the leadership in Congress. That's the only thing that's changed. There must be a cause and effect here somewhere, Madam Chairman, because gas prices are increasing, and the leadership has been woeful in not attempting to deal with this issue. And so I would ask my colleagues to bring to the floor issues that are of paramount importance to the American people. The issue that's of paramount importance in my district is energy and gas prices. And this Congress is doing nothing about it, in spite of the proclamations and promises made during the previous election. So, Madam Chairman, there are wonderful solutions out there, there are positive solutions. Conservation: We can do a whole lot more to incentivize individuals to conserve. Utilizing American resources for Americans, there's a novel thought, Madam Chairman. There are incredible resources that we have. And we've got the technology and the American ingenuity to do it in an environmentally sensitive way, and we ought to. We ought to. This leadership ought to allow that kind of issue to come to the floor. And finally, alternative fuel. It's imperative that we have the kind of research and development and incentivizing alternative fuel formation in this Nation in ways that we've never done before, not pick winners and losers, which is what Washington tends to want to do, but to incentivize a system that would provide for wonderful, entrepreneurial, visionary, enthusiastic individuals all across this Nation who have the intelligence and the foresight and the desire to help America prevail in our energy independence. So, Madam Chairman, I come to the floor today with a level of frustration by the inability of this leadership, apparently, to address the concerns of the American people, to address the concerns of those high school students that were in my office this morning, to address the concerns of those truckers, who continue out there outside the Capitol blaring their horns and saying, wake up. Wake up, Madam Speaker, wake up leadership in this Congress, wake up and address the issues that are of paramount importance to the American people. The paramount issue today is energy and gasoline prices, and we must, as a Congress, address that issue in a positive way. Announcement by the Chairman

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Madam Speaker, it is now 5:10 p.m. on a Thursday afternoon. And for most individuals across this Nation, this is about the end of the fourth working day of the week. For the House, we've just completed less than two full days of work, but if you stretch it, it's really a little over two. Where's the House now? They've gone home. Where was the House on Monday? Home. Now, that's important because there are important things to do at home. But Madam Speaker, it's important to appreciate that there are major issues that the American people are demanding that Congress address. We heard about one of them this afternoon: Gas prices. Gas prices significantly increased over the last 12 to 15 months, and this Congress has done nothing except raise taxes on American oil producers. But the reason I want to bring focus to the issue of Congress going home is that we are now 55 days into a unilateral disarmament for our Nation. That is right, Madam Speaker. Fifty-five days ago, this House, the leadership in the House, chose to allow some amendments to the Foreign Intelligence Surveillance Act to expire. Now, what did those amendments do? Those amendments which were adopted shortly after 9/11 allowed, e-d, past tense, allowed our intelligence community to listen or surveil or intercept phone or electronic communication between, Madam Speaker, between a foreign individual in a foreign land talking or communicating to a foreign individual in a foreign land. That is right, Madam Speaker. If an individual who wishes to do our Nation harm is speaking to another individual who wishes to do us harm, up until 55 days ago, we had an opportunity in this Nation to determine to listen to, to know what kind of communication that was. But 55 days ago, this leadership in this House chose to let that expire. Now why did they choose to let that expire? Well, what they believe is that American trial lawyers ought to have the ability to sue communications companies who share that information with the United States government, with our intelligence community, the folks trying to keep us safe. Madam Speaker, back in my district, the Sixth District of Georgia, the people don't understand the kind of leadership that would have the mentality to not allow our intelligence community to listen to a potential terrorist talking to another potential terrorist outside the United States. Not to an American, but to somebody who is not an American citizen. Consequently, Madam Speaker, we are now utilizing the same rules that we had in effect on September 10, 2001. Madam Speaker, you hear a lot of talk about crises across this Nation, and our friends on the other side of the aisle talk about the crisis in this and the crisis in that. I'll tell you what we've got a crisis of in this Congress, Madam Speaker, and that is a Congress of irresponsibility, a crisis of irresponsibility and a leadership that refuses to allow this Congress to do its number one job, which is to protect our citizens and our constituents. Madam Speaker, I call on the Speaker and I call on the majority leader and I call on the majority party in the House of Representatives to bring the Protect America Act to the floor. It's a bill that has bipartisan support. A majority of individuals in the House have said they will support it. It would pass if it were brought up today. But what were we talking about today? Bills that didn't have to do with the security of the United States. I urge the Speaker and the majority leader to bring that bill to the floor, allow it to pass as it has in the Senate, in a bipartisan way, so that we can return home and tell our constituents that we acted positively to assist in protecting them and their families.

Mr. PRICE of Georgia

Mr. PRICE of Georgia. I thank my friend and colleague from Georgia, Congressman Deal, for his leadership on this issue and for the time today. I also want to express my gratitude and thanks to Representative Gordon, who was extremely cooperative and helpful and productive throughout this entire process. I want to thank the American College of Pathology and all of the pathologists across the Nation who are working day in and day out to make certain that they provide quality care for the patients for whom they are charged. Madam Speaker, I include in the Record a copy of an article by Dr. George Nagy that documents the dysfunctional federally mandated proficiency test in cytopathology. The Dysfunctional Federally Mandated Proficiency Test in Cytopathology--A Statistical Analysis Proficiency testing in cytopathology and in other disciplines should be based on firm statistical and scientific foundations, because test theory in general is a heavily statistical subject. Statistical considerations have demonstrated that the design of ``short'' proficiency tests in cytopathology, including the current federally mandated test, fundamentally is unsound because of the lack of sufficient validity and reliability. Examinees too frequently are misclassified by such short-format tests: Competent examinees fail the test in surprisingly high numbers, whereas most of the examinees who have insufficient cytologic skills eventually pass the test after the allowed retakes. Only dichotomous tests are suitable for accurate computation of the effects of test design on reliability, but the statistical conclusions also are generalizable to nondichotomous tests. In conclusion, the current federally mandated proficiency test cannot reliably measure the level of expertise of cytologists and, thus, cannot assure that only adequately skilled individuals evaluate Papanicolaou test samples. To render the test suitable for its intended purpose, the authors believe that complete redesign of the test, with the participation of experts in modern test theory, would be advisable. Proficiency testing in cytopathology (PTC), which was established in the 1991 regulations to implement the Clinical Laboratory Improvement Amendments of 1988 (CLlA'88), has only recently been enforced on a national scale. For more than a decade, during which logistical hurdles hampered the development of a national program for PTC, there was not much incentive to think about the value and potential of PTC or its theoretical background or to worry that the test design was so poor. In 2004, however, the Center for Medicare and Medicaid Services announced that a national PTC program developed by the Midwest Institute for Medical Education had been approved and that the regulations finally would be enforced on a national level. Suddenly, the shortcomings of the test were everyone's problem. What followed was a flurry of comments, articles, proposals, and Internet discussions about the PTC and its future. Although the testing has proceeded nationwide in conformity with the original regulations, the dust has not yet settled on the subject. The professional organizations agree that PTC, as prescribed in CLIA'88, is inadequate and is in great need of improvement if indeed it should remain in place at all. Regarding the projected revisions, it is a real impediment that some regulatory authorities that are in a position to make decisions about the implementation of PTC apparently are not familiar with most of the theoretical implications of test theory, which is an exceedingly complicated subject. So long as the test is mandatory for every practitioner of gynecologic cytopathology in the United States, it is in the best interest of all participants for PTC to become a scientifically well-founded, valid, and reliable quality assurance method. In the current article, we have attempted to shed light on some gaps in the knowledge about the theoretical underpinnings of PTC that seem to endure in the cytopathology literature. test theory is statistical Test theory is a heavily statistical subject. Virtually all aspects of test theory have been investigated in depth almost exclusively by educators and psychologists, which is understandable, because testing is a central issue in their disciplines. Unfortunately, this valuable body of literature apparently has been disregarded completely by the federal authorities that are responsible for PTC regulations. The statistical apparatus used in modern test theory is formidable. Many books and articles written about the subject use highly sophisticated mathematical tools, including differential and integral calculus and matrix algebra. One of the reasons for the high degree of mathematization of test theory in psychology and education science is that these disciplines deal largely with intangibles, like motivation, intelligence, understanding, and adaptability, which are not directly measurable. Such entities must be studied indirectly, through measurements of other quantities. That is why psychological test theory introduced the concept of ``constructs'' that can substitute for and represent the kinds of abstract attributes mentioned above. Even so, the highly complicated mathematical and statistical tools that have been promoted in educational and psychological test theory fulfill mainly academic purposes. Most actual problems in everyday testing can be solved on a practical level that does not use highly complicated mathematical methods but, at the same time, does not disregard basic statistical principles. testing in the physical and biologic sciences Cytopathology, unlike educational science or psychology, is an applied natural science, and this is one of the reasons why PTC can be performed without the application of overly sophisticated mathematical tools. Interpretation of Papanicolaou smears, reproduction of cytologic diagnoses, and measurement of false-negative proportions, among others, are very complex tasks. By comparison, technically, it is a comparatively straightforward matter to evaluate the examinees' ability to assign diagnostic categories to cytologic changes observed on a slide or computer screen. Thus, abstract constructs hardly are needed in PTC. Nevertheless, a certain level of mathematical and statistical understanding by the designers of the test is crucial if a fair and scientifically valid system of PTC is to be established. Most pathologists, including ourselves, do not have rigorous training in statistics; therefore, if PTC is to continue, then the regulatory authorities ought to contract with experts in statistics and test theory who, through interaction with knowledgeable cytopathologists and cytotechnologists, would design an equitable and scientifically well-founded system for the nationwide PTC. We do not mean to suggest that statisticians have not participated in the design of cytology testing programs. In fact, the College of American Pathologists' (CAP) Interlaboratory Comparison Program for Cervicovaginal Cytology was designed, implemented, and monitored with the extensive help of statistical expertise. However, this educational endeavor was not intended to be a PTC program as envisioned in the federal regulations. In fact, its original, scientifically and statistically supported structure ironically prevented its use as a PTC program because of the specific requirements of the federal regulations. short tests and reliability One of the central problems in the practice of PTC is reliability, and the reliability of PTC is related closely to the size of the test sets (the number of the test items or challenges in 1 test set). ``Short'' tests, which require the evaluation of relatively small numbers of slides, are characterized by a high misclassification rate. (The pervasive effect of sample size on the reliability of statistical inference is the reason why pollsters use large samples: The larger the sample, the narrower are the confidence limits in relative terms. The statistical estimates inferred from a single sizable sample that has been chosen by randomization will approach the true parameters of the population.) Short tests will not prevent the frequent failure of competent examinees or the passing of examinees who have less than desirable skill levels. Already in 1991 one of us (G.K.N.), in a report that was written with D.C. Collins, emphasized that the expected misclassification rate of such short tests can be surprisingly high and that, in the case of dichotomous tests, this rate can be calculated (or approximated) through the use of the binomial theory of statistics. (A dichotomous test evaluates the responses to test items as ``right'' or ``wrong,'' without using intermediate results or weighing of answers. The PTC system used in New York State for 36 years was dichotomous and so was the original Interlaboratory Comparison Program in Cervicovaginal Cytology. The CLIA'88-mandated PTC is not dichotomous.) This so-called ``simple binomial error model'' was described in test theory initially in the 1950s. The results of the CLIA'88 mandated national PTC in 2005 dramatically demonstrated the effect of misclassification during short tests, as described previously. According to the data from the National Cytology Proficiency Testing Update, 9% of the examinees failed the test when they attempted it for the first time. However, when this group that supposedly had inferior skills retook the test, curiously, the failure rate for this second attempt was similar to that for the entire original group (10%). It appears that the cytologic skills among those examinees who had failed originally improved miraculously, allowing 90% of them to pass the examination, although all of them initially failed. It is hard to believe that a short remedial training between the first and second attempt could result in such an impressive real improvement. The only plausible scientific explanation is the well-known statistical phenomenon, the Galtonian ``regression toward the mean.'' The majority of failures during the first attempt were the consequence of misclassification because of the poor validity and reliability of the short test and were not caused by the insufficient skills of those who failed. The failure rate in all groups of examinees is about the same on the first attempt and on the second attempt, and previous failures do not seem to matter much. Essentially, the results of the CLIA'88-mandated PTC mostly mirror the statistical chances and not the examinees' skills. Of course, multiple other variables beyond regression toward the mean, including experience gained in the technique of the test, differences in the difficulty of particular test sets, and even increased skills after remedial training, etc, also may play a role in the improvement of test results at the second attempt for individual examinees. However, to date, we do not have any data or even a plausible explanation concerning how any of these other factors, with the exception of regression toward the mean, could produce such a consistent result. The Simple Binomial Error Model Misclassification of examinees by any short test, including the CLIA'88-mandated PTC, can be demonstrated by means of an analogy. Strictly speaking, this analogy is applicable only to dichotomous testing systems. However, in this sense, dichotomous and non dichotomous systems are correspondent. For statistical or evaluation purposes, non dichotomous systems can be made dichotomous at any time, even after the tests have been carried out. For example, an answer can be evaluated as correct only if it falls into the appropriate single category (``success'') and all other answers are rated as wrong (``failure''). Another solution to this problem in PTC would be to restrict the number of diagnostic categories to 2, with 1 category, for instance, ``negative for premalignant or malignant changes'' and the second category ``premalignant or malignant lesions are present.'' This is the approach used in the original CAP PAP program with its ``100 series'' and ``200 series.'' The CLIA'88 regulations concerning PTC, with their 4 diagnostic categories and complicated scoring system, do not fit into the dichotomous scheme. Despite this fact, the conclusions drawn by using the binomial error model regarding PTC are applicable to any short test to a large extent. Example of Simple Binomial Error Model For the purpose of illustration, let us suppose, that in a large population (for instance, that of an entire country), the results from a scrupulous statistical survey using many thousands of questionnaires and proper randomization indicate that the proportion of individuals who like to watch television (TV) is 90%. Because the survey is conducted in a scientific way and the sample size is very large, this result is considered highly accurate. The basic question on which the analogy with PTC will be based is, ``What can we expect if we ask 10 randomly selected individuals in this population about their attitude toward TV?'' The most probable result will be that, in this population, 9 of 10 individuals will like TV. However, it is reasonable to expect that, in many samples that consist of 10 individuals, all 10 individuals are TV fans; whereas, in other similar samples, there may be only 8, 7, or 6 such individuals. However, it is hardly conceivable that we will identify as few as only 1 or 2 fans in a sample of 10 individuals if the principle of random selection is followed. Random selection is important. For example, a nonrandom sample, like one that consists exclusively of nuns in convents, would not yield a statistically valid reflection of the entire population; indeed, we may identify only 1 or 2 individuals in such a sample who like to watch TV. Exclusive selection of nuns or members of any other group with some special interest would not be compatible with the principle of randomness. However, to select a nun occasionally in a sample, with a frequency roughly corresponding to the proportion of nuns in the entire population, would be appropriate. There is a statistical method that uses the so-called ``binomial formula'' for calculating the probability of encountering 10, 9, 8, 7, etc, TV fans in a sample of 10 individuals from our postulated population. (This method is not detailed in the current article, but an explanation can be found in any elementary statistical textbook). The probabilities even can be looked up in tables that are found at the end of statistical books. Under the circumstances outlined above (with a 90% proportion of TV fans in a sample size of 10 individuals). the probabilities of identifying 10, 9, 8, 7, and 6 TV fans in a random sample of 10 individuals are 0.35, 0.39, 0.19, 0.06, and 0.01, respectively. The probability of identifying 5 TV fans under the above- described circumstances in a truly random sample of 10 individuals is exceedingly small. The succession of numbers described above represents a ``probability distribution,'' which can be observed in a histogram. This distribution is interpreted as follows: If, from this very large population, we take numerous random samples, each consisting of 10 individuals, and ask about their preferences for TV; then we will find that 35% of the samples would include 10 fans, 39% of the samples would include 9 fans, 19% of the samples would include 8 fans, and so on. If we change the size of the sample, then the magnitudes of the single probabilities and their distribution also will change and, along with them, the probability distribution. If we choose sample sizes of 100 individuals instead of 10, then the probabilities will be clustered much more tightly around the value of 90% than was the case in the smaller samples. The larger the size of the sample, the more reliable is the estimation; in other words, the observed value in every sample approaches the real population parameter. It is virtually unimaginable that there will be only 50 or 60 TV fans among 100 randomly selected individuals from this population. (Distribution data for such large samples are not provided even in the tables of larger statistical reference books: They are not needed, because the probability distribution for large samples can be found by the so-called ``normal approximation of the binomial distribution.'' To perform this method is mathematically simple, but the results may be slightly inaccurate. There are complex Web-based Internet tools, however, that calculate these probabilities very accurately.) Of course this holds true only if the randomness principle is strictly observed. How can we apply the reasoning described above to the issue of sample sizes in PTC? Fortunately, the results of these binomial calculations can be generalized. The reason why we can do this is that, if the ``experiment'' qualifies as binomial, then the specifics of the experiment, whether they are related to liking TV or to success in PTC, have no bearing on the values of the probabilities or on the probability distribution. True Scores At this point, we need to review the term ``true score,'' a concept that is used widely in modern test theory. The true score of a hypothetical examinee is defined as the average of the observed or measured scores that would be obtained over an infinite number of repeated testing by the same test, provided that the examinee's skills remain indefinitely stable. For actual examinees, the true score can be estimated with a small error margin, but its exact value is essentially unknowable. For instance, if a cytologist screens 100,000 cervical smears, and if his or her diagnoses are correct 98,000 times, then the approximation of his or her true score is 0.98. Because the accurate determination of the true score would require an infinite number of repeat testing, which is not feasible, this true score of 0.98 remains an approximation. Obviously, we can be rather sure that, when the same individual screens the next 100,000 preparations, the approximation of his or her true score will not remain the same: The chances of this are infinitesimally small. The estimate of the true score will almost certainly change slightly, for instance to 0.97 or to 0.99, and so on, for each successive trial. It has to be emphasized that assignment of an exact ``true score'' to a cytologist is somewhat arbitrary for further reasons. It cannot be expected that anybody's cytologic skills will remain invariant for a prolonged time. We can hope, of course, that the professional prowess of cytologists improves over time. Furthermore, everybody who has ever screened cytology specimens knows that screening performance depends on many factors, some of which are extraneous to the level of cytology skills. On a ``good'' day, a cytologist may function on a 0.98 score level; whereas, on a different, ``bad'' day, he or she might be less ``proficient.'' Even his or her experience with particular kinds of cytologic presentations on the previous day, for example, having seen an unusual presentation of high-grade squamous intraepithelial lesion on a quality-assurance review, could affect decision-making on the current day. Of course, these and other psychological variables (eg, the effects of anxiety or tiredness during tests or routine work) cannot be factored into the statistical considerations. Nagy and Collins, describing this concept, used the term ``competence level'' instead of ``true score'' in their 1991 article. Direct measurement of the true score is not possible. What we have after an evaluation of test results is the ``observed score,'' which is related to the true score but is not identical to it. It can be considered an estimate of the true score. Comparison of TV Preference and PTC Results TV preference and PTC results can be compared as follows: The values derived by the binomial formula are determined only by the number of trials and the probability of success. If the ``experiment'' qualifies as binomial, then the specifics of the experiment have no bearing on the numerical results. (In statistical parlance, any methods or procedures that yield raw data are called experiments.) In our TV example, the number of trials (the sample size) is 10, and the probability of success is 0.9. These 2 data are sufficient to calculate the probability distribution for this specific case. Let us consider now an example of PTC in which these specifics are the same as described above. The PTC design prescribes 10 slide test sets (number of trials). A cytologist who performs routine screening and customarily renders accurate diagnoses 9000 times among 10,000 screened slides has an approximate true score of 0.9. (In other words, the probability of success is 0.9.) When this cytologist attempts to pass this particular PTC, then the probability distribution of the possible correct answers will be identical to the probability distribution observed in the TV example, because the specifics of the TV experiments are the same. If this hypothetical cytologist attempts the test many times, then he or she will read 10 slides correctly in 35% of the tests, 9 slides correctly in 39% of the tests, and so on. The numerical values in the 2 experiments are identical. We also should note that, if an examinee reads 10 slides or 9 slides correctly:which happens in 74% of events under the circumstances described above, then he or she passes the test. However, this individual, who essentially has an adequate true score, will fail a dichotomous PTC 26% of the time because of the low validity and reliability of the test. The phenomenon of failure in this case can be called ``type 1 error.'' (The null hypothesis is that ``the cytoscreener is competent.'') A valid and reliable test is expected to pass virtually all cytoscreeners with true scores on the 0.9 level; however, any dichotomous test that consists of 10 slides or challenges will misclassify approximately 26% of such individuals. It is obvious that this test does not really meet the expectation to determine the competence of an examinee who had a true score of 0.9. It needs to be reiterated here that binomial calculations can be performed only for dichotomous tests. The probabilities for some well ordered, nondichotomous tests may be calculated by the use of more complicated multinomial assessments. Limitations of the Simple Binomial Error Model The binomial error model provides only a rough appraisal of the statistical factors that need to be taken into account in the design of PTC. One of the drawbacks of the model, as mentioned above, is that it is applicable only to dichotomous testing systems. However, the simplicity, transparency, and mathematical calculability of dichotomous setups counterbalance every other consideration. The dichotomous test design makes it possible to assess the impact of test set size on test validity and reliability and to calculate confidence intervals. Thus, the use of a dichotomous test would confer greater predictability and practicability to PTC. The effects on test validity and reliability of a haphazard design, like the CLIA'88-mandated PTC, hardly are calculable by scientific-statistical means. We do not state that dichotomous designs would solve every problem inherent in every type of test, including PTC. However, given that all other conditions of the testing are equal, dichotomous tests have insurmountable advantages over nondichotomous tests. Size of Test Sets and Rate of Misclassification Figures (not shown) illustrate the probability distributions of correct diagnoses for variable test set sizes and for examinees with different theoretical ``true scores.'' An ideal and flawless PTC would fail all examinees with true scores of 0.85, but no test design can fulfill such requirements. The reliability of the tests improves, however, as the test sets get larger. For examinees with true scores of 0.85 or 0.8, the accuracy of the test increases in parallel with the increasing size of the test sets. (The failure rates become larger for larger test sets.) Visualization of the effect of sample size on misclassification also is possible by tabulation. The more slides the test set contains, the lower the misclassification rate. There appear to be anomalies at the set sizes of 9 and 19, in which the misclassification rate decreases for examinees with low true scores and increases for the more competent examinees. A test set that consists of 9 or 19 slides would be a very impractical choice. If the passing level is set at 90% (eg, 9 correct answers for 10 slides in dichotomous tests), as it is the general practice for PTCs, then 1 error is allowed for a 10-slide set. Under these circumstances, to pass a test based on 9-slide sets with a 90% passing grade would be incomparably more difficult than to pass a test based on a 10-slide set, because a single mistake would mean an error >10% and, consequently, a failure. The situation is similar for 19- or 29-slide sets. The greater grade of difficulty with a 9-slide test set is reflected in the smaller passing rates for both competent and less competent examinees. (This circumstance, paradoxically, improves the accuracy of the test for the participants with low true scores.) For these reasons, if the passing level is set at 90%, then only decimal-based test set sizes (10, 20, 30, etc. slides or challenges) should be used. Another observable phenomenon is the ``law of diminishing returns,'' in which, as the number of slides in the test sets is increases, the misclassification rates decrease. However, the rate of decrease is not level but trails off with increasingly larger set sizes. For instance, misclassification of examinees with a true score of 0.8 is almost halved, from 38% to 20%, when the number of slides in the sets increases from 10 to 20. The next step, from a 20- slide set to a 30-slide set, is accompanied by a smaller relative improvement, and so on. An important conclusion that can be drawn is that, when the number of slides is increased in the test sets, the decrease in the misclassification rate is more precipitous if the true score is 0.8 or 0.85, ie, on the side of the table for less competent examinees, than if the true score is 0.95. From our viewpoint, this is an advantage. The basic purpose of PTC is not the confirmation of the proficiency of the average cytologist who performs well but the identification of individuals who may have problems with expertise and need remediation. The type 1 error, the failure of competent examinees, is less consequential than the type 2 error, the passing of less competent examinees. The simple binomial model is more suitable to investigate the latter than the former in the set-size ranges that are prevalent in the practice of

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Mr. Speaker, it's now 1:48 p.m. on Thursday afternoon. Throughout the Nation, folks are finishing the day shift, getting ready to finish the day shift. People who work the afternoon shift are getting ready for work. Those who work the night shift are probably snoozing a little bit so they can get up in a few moments and start it all over again this evening. And where's the House, Mr. Speaker? The House has gone home. The House has gone home. Now, why is that important? Well, we have just finished 2 weeks at home talking to constituents about issues great and small. They're concerned about a lot of things, Mr. Speaker. They're concerned about gas prices. They're concerned about the housing situation. And in my district, the Sixth District of Georgia, I get constant questions about national security: What is Congress doing to make certain that our Nation is safe? And that's important because, Mr. Speaker, today is the 48th day, the 48th day, of a unilateral disarmament on behalf of the Democrat leadership of the House of Representatives. Why do I say that? Well, Mr. Speaker, we are at the 48th day now where the Protect America Act has been allowed to expire. This isn't going to happen in the future. This has happened. This Speaker, this Democrat leadership, has allowed the Protect America Act to expire. Now, what's the Protect America Act? Well, it's an act, a portion of amendments that were adopted to the Foreign Intelligence Surveillance Act shortly after 9/11. And what this portion of it allows that was allowed to expire is for the United States, our intelligence community, to listen or intercept electronic communication or phone communication between a foreign individual in a foreign land talking to a foreign individual in a foreign land. Not an American citizen, not on American soil. That means, Mr. Speaker, what they would be allowed to do is to listen to a potential terrorist or a terrorist talking to another potential terrorist or a terrorist outside the United States. Mr. Speaker, I asked every single group that I spoke with at home for 2 weeks, who believes that our intelligence community ought not have the authority to do that, to listen to a terrorist talking to another terrorist outside the United States, talking potentially about how to do you, me, and our Nation harm? I didn't find a single individual who didn't think that was the right thing to do. But this leadership, this Speaker, this Democrat leadership has allowed that act to expire. Why? Because they believe that trial lawyers ought to have the ability to represent foreign individuals in the same way that the United States Constitution protects Americans. Mr. Speaker, that's wrong. Many in my district and I believe also that it's a dereliction of duty. It's an abrogation of duty. It's a violation of the oath that we take as Members of the House of Representatives to uphold the Constitution and to protect and defend the United States of America. Mr. Speaker, I call on this leadership, I call on this Speaker, to allow this House to vote on the Protect America Act, a bill, amendments that the Senate passed 68-29, in a bipartisan way; a bill that the majority of this House, the majority, Democrats and Republicans combined, have said they will support if allowed to vote on the floor. Mr. Speaker, this is essential to the protection of the United States of America and to reverse the unilateral disarmament that has come about because of the leadership of the majority party. Mr. Speaker, I call on this leadership to bring this bill up as soon as we come back next week and do the people's business.

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Madam Speaker, I object to the vote on the ground that a quorum is not present and make the point of order that a quorum is not present.

Mr. PRICE of Georgia. Madam Speaker, pursuant to clause 2(a)1 of rule IX, I hereby notify the House of my intention to offer a resolution as a question of the privileges of the House. The form of my resolution is as follows: H. Res. -- Whereas on December 11, 2007, a bipartisan group of 21 State attorneys general wrote to Senate Majority Leader Reid and Senate Minority Leader McConnell regarding the FISA Amendments Act of 2007 (S. 2248); Whereas this bipartisan group of State attorneys general represents the States of Alabama, Arkansas, Colorado, Florida, Georgia, Kansas, Nebraska, New Hampshire, North Carolina, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Utah, Virginia, West Virginia, Washington, and Wisconsin; Whereas the State attorneys general stated that protecting communications carriers from ``unprecedented legal exposure is essential to domestic and national security. State, local and federal law enforcement and intelligence agencies rely heavily on timely and responsive assistance from communications providers and other private parties; indeed, this assistance is utterly essential to the agencies' functions. If carriers and other parties run the risk of facing massive litigation every time they assist the government or law enforcement, they will lack incentives to cooperate, with potentially devastating consequences for public safety''; Whereas on February 5, 2008, the Director of the Federal Bureau of Investigation testified before the Senate Select Committee on Intelligence that ``in protecting the homeland . . . it's absolutely essential we have the support, willing support of the communications carriers''; Whereas in the same hearing, Director Mueller further stated ``[m]y concern is that if we do not have this immunity, we will not have that willing support of the communications carriers''; Whereas on March 4, 2008, a bipartisan group of 25 State attorneys general wrote to the Speaker of the FISA Amendments Act of 2007; Whereas this bipartisan group of State attorneys general represents the States of Alabama, Alaska, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Kansas, Maryland, Michigan, Nebraska, New Hampshire, North Carolina, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Utah, Virginia, Washington, and West Virginia; Whereas the State attorneys general stated they ``are our states' chief law enforcement officials and therefore responsible for taking whatever action is necessary to keep our citizens safe''; Whereas the State attorneys general also stated ``[a] bipartisan majority of the United States Senate recently approved S. 2248. But until it is also passed by the House of Representatives, intelligence officials must obtain FISA warrants every time they attempt to monitor suspected terrorists in overseas countries. Passing S. 2248 would ensure our intelligence experts are once again able to conduct real-time surveillance. As you know, prompt access to intelligence data is critical to the ongoing safety and security of our nation.''; Whereas on February 12, 2008, after passage of S. 2248, the Senate amended the bill H.R. 3773 with the text of S. 2248 and sent the amended bill back to the House for its consideration; Whereas the State attorneys general concluded that with ``S. 2248 still pending in the House of Representatives, our national security is in jeopardy.''; Whereas all Members of the House of Representatives have a responsibility to provide the intelligence community and Federal law enforcement with all the necessary and appropriate tools to keep Americans and the homeland safe; Whereas all Members of the House of Representatives have a responsibility to ensure they are not impeding the efforts of State and local law enforcement to use all the necessary and appropriate tools to keep Americans and the homeland safe; Whereas according to the calendar distributed to Members by the House majority, the House of Representatives is scheduled to be in recess during the two-week period beginning on March 17, 2008; and Whereas it would bring discredit to the House of Representatives to adjourn for two weeks without considering the amendments to H.R. 3773 now pending before the House: Now, therefore, be it Resolved, That the House of Representatives-- (1) should immediately consider a motion to concur in the Senate amendment to the bill, H.R. 3773; and (2) should not adjourn for the Easter District Work Period prior to consideration of a motion to concur in the Senate amendment to the bill, H.R. 3773.

Mr. PRICE of Georgia. Madam Speaker, I rise to a question of the privileges of the House and offer the resolution just noticed.

Mr. PRICE of Georgia. I do, Madam Speaker.

Mr. PRICE of Georgia. Madam Speaker, we are now 27 days, 27 days into a unilateral disarmament. We are not doing our job in the House of Representatives. We are not fulfilling our oath, and we are not protecting the American people. This brings discredit on the House of Representatives. The underlying bill simply allows the American intelligence community to make certain that they are able to listen or surveil on terrorists in a foreign land speaking to another terrorist or suspected terrorist in a foreign land. My constituents don't understand why the House isn't acting on this. They believe the House is bringing discredit on the Nation. Americans don't understand. The Senate has acted responsibly. It is imperative that the majority of the House be given an opportunity to vote on this issue. The majority of the House has said that they would pass this bill. Not bringing this bill to the floor for a vote brings discredit and abrogates our responsibility as Representatives of the United States of America. I urge the Speaker and I urge my colleagues to allow this to come to the floor for a vote.

Mr. PRICE of Georgia. Madam Speaker, I appeal the ruling of the Chair.

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Madam Speaker, reserving the right to object, I appreciate the comments of my friend from Texas on our concern about our not conducting our business in secret. We share those concerns. Although this isn't unprecedented, it is an extraordinary act for this Congress to take. I think it is important that many of us, at least on this side of the aisle, believe the necessity for this is because the Protect America Act has not been brought to the floor and the House hasn't been allowed to vote on it. Consequently, we believe that it is important to have a discussion that hopefully will allow our friends, many of our friends on the other side of the aisle, to see the imperative of moving forward with the Protect America Act and allowing H.R. 3773 with the Senate amendments to be voted on on this floor of the House. So I will be supporting moving into the secret session, because I believe that it is a step that will allow our colleagues on the other side of the aisle to appreciate and understand the imperative of having a vote on the floor of the House to the Senate amendments and concur in those Senate amendments to H.R. 3773. Madam Speaker, I withdraw my reservation.

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Mr. Speaker, pursuant to clause 2(a)1 of rule IX, I hereby notify the House of my intention to offer a resolution as a question of the privileges of the House. The form of my resolution is as follows: H. Res.-- Whereas in an interview published by National Journal Magazine on March 7, 2008, John Brennan, a foreign policy adviser to Sen. Barack Obama (D-IL) and former CIA official who once served as head of the National Counterterrorism Center, stated, ``There is this great debate over whether or not the telecom companies should in fact be given immunity for their agreement to provide support and cooperate with the government after 9/11 . . . I do believe strongly that they should be granted that immunity, because they were told to do so by the appropriate authorities that were operating in a legal context, and so I think that's important . . . And I know people are concerned about that, but I do believe that's the right thing to do . . . I do believe the Senate version of the FISA bill addresses the issues appropriately;''; Whereas a bipartisan group of 25 state attorneys general recently wrote a letter to House of Representatives leaders in support of the Senate bill's passage, stating in part ``A bipartisan majority of the United States Senate recently approved S. 2248 . . . But until it is also passed by the House of Representatives, intelligence officials must obtain FISA warrants every time they attempt to monitor suspected terrorists in overseas countries. Passing S. 2248 would ensure our intelligence experts are once again able to conduct real-time surveillance. . . . With S. 2248 still pending in the House of Representatives, our national security is in jeopardy;''; Whereas Ret. Admiral Bobby R. Inman, former director of the National Security Agency and deputy director of the CIA told the Austin-American Statesman last month that Americans are more vulnerable without the Protect America Act and ``the only way for the country to prevent future terrorists attacks is to increase its ability to eavesdrop on their communication;''; Whereas Glenn Sulmasy, a Harvard national security expert, wrote in the February 15 edition of The Tampa Tribune that ``the global technologies of cell phones, computers, the internet, and other such means of communication--which were not, and could not have been, envisioned by the drafters of FISA in the 1970s--have changed the way information moves around the world. . . . Herein lie the gaps meant to be filled'' by the Protect America Act of 2007; Whereas in its bipartisan findings the Senate Select Committee on Intelligence concluded in Oct. 2007 that ``electronic communication service providers acted on a good faith belief that the President's program, and their assistance, was lawful;''; Whereas 20 Senate Democrats supported final passage of S. 2248, including Senate Intelligence Chairman Jay Rockefeller (D-WV) and Kent Conrad (D-ND), Chairman of the Senate Budget Committee; Whereas on February 12, 2008, after passage of S. 2248, the Senate amended the bill H.R. 3773 with the text of S. 2248 and sent the amended bill back to the House of Representatives for its consideration; Whereas Sen. Kent Conrad (D-ND) wrote in a Feb. 28 letter to the editor of The Fargo Forum, ``The FISA law needed reform to account for modern information technology, current patterns of communication and the nature of the threats facing our country. . . . [The bipartisan Senate bill] does include strong privacy safeguards and considerable judicial oversight to ensure that our fundamental freedoms are protected. . . . Leaving [telecommunications companies] completely subject to civil litigation could cause problems in vital intelligence collection in the future;''; Whereas 21 House of Representatives Democrats expressed support for the bipartisan Senate FISA bill in a Jan. 28 letter to Speaker Pelosi stating that, ``we have it within our ability to replace the expiring Protect America Act by passing strong, bipartisan FISA modernization legislation that can be signed into law and we should do so--the consequences of not passing such a measure could place our national security at undue risk;''; Whereas in an editorial published by the Charleston Post and Courier on February 29, 2008, House of Representatives Democrat leadership was described as ``indeed causing a potentially dangerous gap in the nation's defenses'' and ``creating an unnecessary cloud of uncertainty in a critical area of intelligence operations where there should be great clarity.''; and Whereas the failure of the House of Representatives to expeditiously consider the bipartisan Senate-passed Foreign Intelligence Surveillance Act of 1978 Amendments Act of 2008 has brought discredit to the House of Representatives: Now, therefore, be it Resolved, That the House of Representatives should immediately consider a motion to concur in the Senate amendment to the bill, H.R. 3773.

Mr. PRICE of Georgia. Mr. Speaker, I rise to a question of the privileges of the House and offer the resolution just noticed.

Mr. PRICE of Georgia. I do.

Mr. PRICE of Georgia. Mr. Speaker, we are now 25 days into a unilateral disarmament, a disarmament that doesn't make any sense to our constituents in each and every district across this Nation. The Senate voted 68-29, 68-29.

Mr. PRICE of Georgia. Mr. Speaker, I would draw my colleague's attention to the context in the stated ``whereas'' that on at least one occasion, if not countless others across this Nation, in the Charleston Post and Courier, it was written that the House of Representatives' Democrat leadership was described as ``indeed causing a potentially dangerous gap in the Nation's defenses'' and ``creating an unnecessary cloud of uncertainty in a critical area of intelligence operations where there should be great clarity.'' There have been multiple articles and multiple references across this Nation as to why this House of Representatives is bringing discredit to the House and also not fulfilling its responsibility, in fact, abrogating its responsibility and its duty. An abrogation of duty by this House of Representatives brings discredit to the House, and, therefore, this is a question of privilege.

Mr. PRICE of Georgia. Mr. Speaker, I appeal the ruling of the Chair.