Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, I would like to take this opportunity to recognize an event in the 13th district that has become widely popular and enormously successful. The Fremont Festival of the Arts, sponsored by the Fremont Chamber of Commerce, will continue for this, its 17th year. This festival attracts over 400,000 attendees and will feature more than 750 artists, 40 culinary selections and 20 bands. This efforts is underwritten by the Fremont Chamber of Commerce and made possible by over 300 volunteers who give willingly of their time for the betterment of our community. It takes generous and concerned individuals like those volunteers to reach out and make a difference, ensuring promise and opportunity for this and future generations to enjoy. The spirit of community service is alive and thriving in Fremont, as in many communities throughout our nation. The City of Fremont has recently been recognized as an All- American City, an honor which was also promoted by the Fremont Chamber of Commerce. I am indeed proud to salute the efforts of the organizers of the Fremont Festival of the Arts for making my district a better place in which to live. I particularly would like to commend the efforts of David M. O'Hara, the volunteer Chairman of the Festival for his generous and untiring efforts on behalf of my constituents.

Mr. STARK

Mr. STARK. Mr. Speaker, with the Senate's impending vote to grant China permanent normal trade relations, and its anticipated passage, I oppose H.J. Res. 90, to withdraw Congressional approval of the agreement establishing the World Trade Organization (WTO). Relinquishing annual review of China's normal trade relations status leaves the WTO as our last resort to ensure that China abides by its agreements. Unfortunately, our means of last resort is unreliable and serves the interests of multinational corporations over the interests of consumers, workers and the environment. While I oppose the resolution before us today, I am far from offering my support of the world body that is supposed to serve U.S. interests. The biggest problem with the WTO is the way in which the U.S. and our trading partners have developed a narrow definition of trade. Trade encompasses labor, environmental standards, and consumers as well as the industries that manufacture the products for trade. It is high time that the WTO, with strong U.S. leadership, take into account the interests of the environment, consumers, workers and the oppressed when making the rules for trade. The WTO is in desperate need of reform. The U.S. is the largest beneficiary of trade. Meaningful reform will occur when the U.S. insists on meaningful reform in trade negotiations and in the world body that enforces the trade agreements. Under Article XX(b) of the General Agreement on Tariffs and Trade (GATT), a WTO member country may defend its environmental policy if it is ``necessary to protect human, animal or plant life and health.'' But in two cases--the Tuna-Dolphin and the Shrimp-Turtle cases--the WTO ruled that U.S. statute to prevent import of tuna or shrimp from countries that do not comply with U.S. law to protect dolphins and turtles, is in violation of the international trade agreement. Clearly, this exception clause is ineffective. The goal of the WTO must be to strengthen global environmental standards, not weaken them. Many developing countries have traditionally excluded food and medicine from their intellectual property rights laws in order to ensure that these basic necessities are accessible and affordable and not subject to private monopoly control. Under the WTO's Trade Related Aspect of Intellectual Property (TRIPs), however, corporations are able to maintain a 20-year monopoly on patents that are often funded through public sponsorship such as the medications to treat AIDs. The United Nations Development Program (UNDP) criticized the TRIPs Agreement in its 1999 Human Development Report. UNDP has determined that TRIPs rules prevent developing countries from obtaining the seeds for crops and prevents them from manufacturing affordable medicines. Corporations or individuals in industrialized countries currently hold 97 percent of all patents worldwide. While the developed world holds the majority of these patents, 95 percent of the AIDs victims reside in the developing world. Those who hold the patents hold a greater interest and influence in the proceedings of the WTO, while those who need the patents are not represented at all. Clearly, this is unfair and reforms are needed to correct this harmful unbalance in representation. The developed world makes the rules. The developed world must start to make these rules with the suffering of billions of fellow humans in mind. It will take the leadership of the United States to make consumers a priority when reforming and creating the rules under which we trade. We must give a voice to the voiceless. We can do this by continuing our membership in the World Trade Organization and seeking to change that organization.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise today to introduce the Fair Balance Prescription Drug Advertisement Act, a bill to deny tax deductions for unbalanced direct-to-consumer (DTC) pharmaceutical advertising placing more emphasis on product benefits than risks or failing to meet Federal Food, Drug and Cosmetic Act requirements. This bill will ensure that prescription drug advertisements provide the public with balanced information concerning product risks and benefits. For example, the bill requires that pharmaceutical ads utilize equivalent space and type size in print ads and equal air time in broadcast media--such as television, radio and telephone communication systems--for risks and benefit descriptions. Today, most drug advertising emphasizes product advantages while failing to clearly--if at all--explain often numerous potential disadvantages. By denying any tax deduction for such advertising, this bill will encourage drug companies to halt these harmful practices that have been shown to increase health care expenditures, mislead the public, adversely affect physician prescribing practices and lead to unnecessary injuries and deaths. Responsibilities of the FDA and Treasury Departments are to be clearly delineated through regulation. Since the FDA loosened its DTC advertising requirements in 1997, drug companies have doubled their advertising budgets and spent billions extolling the benefits of their products. DTC advertising increased nearly 20-fold during the 1990s. Last year, drug companies spent nearly $2 billion advertising to consumers, with $1.1 billion for television ads alone. As one would expect, such advertising has a direct impact on drug expenditures. DTC advertising leads to more physician office visits, increased patient requests for expensive, brand name drugs--even where a generic drug is available--and over-prescribing of optional ``lifestyle'' drugs. Americans spent more than $100 billion on prescription medicines last year--i.e., about 10 cents in every health care dollar. U.S. sales for the antihistamine Claritin, No. 1 in DTC advertising, were $2.3 billion last year, while the well-advertised heartburn medication, Prilosec, brought-in $3.8 billion in sales. Not surprisingly, drug spending increased at a rate of about 15%-18% last year and is on the rise. Contributing to overall increased expenditures, drug prices continue to soar. On average, prices for the 50 most-prescribed drugs for senior citizens increased at twice the rate of inflation over the past six years--with some drug prices increasing at four times the rate of inflation. Business Week reports that the hikes in drug prices are not only tied to new ``wonder pills,'' but also to the drug industry's bloated advertising budget. Such spending is particularly troublesome since consumers receive inadequate information about the drugs they purchase. More and more commonly, both television and print ads have become the subject of ridicule due to their inaudible or illegible short list of warnings. A recent cartoon in the Washington Post mocked the typical concluding remarks of a prescription drug TV ad: ``WARNING: This drug commercial will be followed by a disclaimer that may cause nausea, disgust, and serious doubts.'' A typical Washington Post newspaper ad for Prilosec highlights the drug benefits on a full-page, large print, color ad, and includes a prominent $10 rebate offer. Yet the most important drug information--warnings, contraindications, indications, usage, precautions and adverse reactions--appear on the next page of the paper, separated by two, full columns of World News and in type size that is almost too small to be read by the naked eye. Unfortunately, such advertising has become the norm. Although the Federal Food, Drug and Cosmetic Act and the Food and Drug Administration (FDA) regulations and guidelines currently regulate drug advertisements, pharmaceutical ads most often fail to provide the public with adequate information about potentially dangerous drug side effects. RxHealthValue is a new, independent group, representing more than 30 consumer groups, private employers, purchasers, health care providers, labor unions and academics. Last month, this organization recommended that the FDA ``develop standards for full disclosure of drug risks and benefits information for all prescription drugs advertised directly to consumers.'' The group also called for specifying that ``fair balance'' means that full disclosure of risks and side effects is given equal print or air time as the description of benefits in the same communication. I would also like to insert in the Record a May 3, 2000 USA Today article providing further evidence of the need for adequate information about drug risks. According to the article, less than 1% of physicians have seen a drug label in the last year. And ``in many cases, patients never even see the package insert, and when they do, the tiny typeface and medical jargon often leave them more confused than ever.'' These inserts are jam-packed with important warnings and most often go unnoticed. The article reports that drug labels are complex and fail to provide patients and doctors with critical information. Consequently, many patients and doctors fail to read drug labels, leading to inappropriate prescribing, illness and even death. The article also cites the recent withdrawals of Rezulin, Posicor, Duract and the anticipated removal of Propulsid as evidence that both patients and physicians are unaware of critical drug information. The FDA noted that after altering Rezulin's label to recommend monthly liver function tests, less than 10% of patients had the tests. And 85% of the 270 Propulsid-related adverse side-effects reported to the FDA (including 70 deaths) occurred in patients with risk factors already listed on the drug's label. Similarly, all but one of the 12 cases of adverse events (including four deaths) occurred among patients who took the drug for longer than the recommended ten days. Adding importance to the need to provide accurate, balanced advertising is the fact that the news media often misses the facts. According to a study featured in this month's issue of the New England Journal of Medicine (NEJM), newspaper and television medical reporting is often inadequate or incomplete. The NEJM found that the media often lacks or omits critical information about drug risks, overstates the benefits, cites medical experts without mentioning their affiliation with the drug industry, and fails to provide adequate information about drugs in general. The analysis of 207 recent news stories revealed more than half as completely silent about drug risks or side effects. It is clear both patients and medical professionals need comprehensive drug warning information. In the event that any drug company claims that changes in tax treatment will directly decrease their investment in research and/or lead to higher drug prices for consumers, I would refer to a recent study that proves how preferential their tax treatment really is today. The nonpartisan Congressional Research Service (CRS) analyzed the tax treatment of the pharmaceutical industry and found taxpayer financed credits contribute powerfully to lowering the average effective tax rate for drug companies--by nearly 40% relative to other major industries between 1990 to 1996. There should be a responsibility attached to such preferential tax treatment and accurate, balanced advertising on matters affecting people's lives should be an easy obligation to meet. The need for this bill is clear. In an environment where the Institute of Medicine (IOM) reported between 48,000 to 98,000 people die every year due to medical errors--with medication errors accounting for one out of 131 outpatient deaths and one out of 854 inpatient deaths--providing medical professionals and consumers balanced information about drug risks and side effects is critical. By denying tax deductions for unbalanced prescription drug ads, we can change pharmaceutical company behavior to ensure that their advertising includes clear, life-saving information that will better inform the American public, reduce health care expenditures and save lives. I look forward to working with my colleagues to make this a reality. [From USA Today, May 3, 2000] Complex Drug Labels Bury Safety Message (By Rita Rubin) If all the information that's supposed to be on prescription labels actually were printed there, pill bottles would have to be 2 feet high. At least. Most people don't have medicine cabinets the size of refrigerators. So drug labels have evolved into package inserts, those tightly folded sheets of paper covered with fine print detailing risks and benefits. In many cases, patients never even see the package insert, and when they do, the tiny typeface and medical jargon often leave them more confused than ever. Prescribing and taking medicine has never been more complicated, and critics say patients are becoming sick or dying as a result. Recent drug withdrawals suggest that doctors, never mind their patients, aren't keeping up. Either they're overlooking warnings scattered throughout inserts or they're not even reading the leaflets. ``Less than 1% of physicians have seen a label in the last year,'' cardiologist Robert Califf, director of Duke University's Clinical Research Center, estimated at a recent Food and Drug Administration advisory committee meeting. In less than two years, three widely prescribed drugs have been pulled from the market in part, at least, because doctors ignored the package inserts. A fourth will disappear from drugstore shelves this summer for the same reason. FDA critics say the agency, which regulates package inserts, expects too much of the leaflets. Instead of withholding approval of potentially dangerous drugs, critics say, the agency sends them to market with inserts jam-packed with warnings. ``Should we have relatively dangerous drugs and simply warn people that they might kill or seriously injure them?'' asks Thomas Moore, a health policy fellow at George Washington University in Washington, D.C. ``My perception is that the top management of the FDA seems to have a more permissive view than we have historically had.'' He and like-minded FDA-watchers are quick to tick off Propulsid, Rezulin, Posicor and Duract, four drugs whose inserts underwent multiple revisions as new safety concerns came to light. In each case, the manufacturer also mailed ``Dear Doctor'' letters to alert physicians of label changes. Apparently, though, some doctors never saw the warnings, and patients died. The last three drugs are now off the market, and Propulsid, which is used to treat severe heartburn, will follow them by mid-August. ``FDA has an almost ritualistic belief in labeling changes, as if they have some magical property to change behavior,'' says Jerry Avorn, chief of the division that tracks adverse medication events at the Brigham and Women's Hospital in Boston. ``There is very little data to support that belief.'' The FDA's own research backs Avorn. In a ``talk paper'' in January, the FDA noted that 85% of the 270 Propulsid-related adverse side effects reported to the agency--including 70 deaths--occurred in patients with risk factors already listed on the drug's label, such as congestive heart failure or use of antibiotics or antidepressants. And after Rezulin's label was changed in late 1997 to recommend monthly liver function tests, the FDA found that far fewer than 10% of patients had the tests. Apparently, even the agency's expert advisers don't always follow the package insert instructions. At the recent advisory committee meeting, an FDA staff member had to remind urologists on the panel about how to treat patients with Muse, an injectable impotence treatment. Instead of sending men home with a prescription, doctors are supposed to administer the first dose in their office so they can watch for possible side effects. Flawed system In many cases, package inserts ``are far from perfect,'' acknowledges Rachel Behrman of the FDA's medical policy office. ``We are working hard to improve that.'' Recognizing that patients as well as doctors need to read package inserts, the FDA hopes to make them ``more user- friendly, more informative, more consistent,'' she says. ``If you flip through the PDR, the Physicians Desk Reference, the medication bible that reprints package inserts for nearly all prescription drugs today, some of our labels are very good, and some are not.'' The older the drug, the more likely its package insert is to fall in the latter category, she says; until recent years, comprehensiveness superceded clarity. Still, ``the best available science is often not communicated adequately to practicing doctors to shape their prescribing decisions,'' says Avorn, who lectures Harvard Medical School students on the subject. Rezulin, a diabetes drug, looked so dangerous that Avorn and his colleagues advised diabetes doctors at their hospital to stop prescribing it a year before Parke-Davis, at the FDA's urging, pulled it from the market. ``I'm astonished that the additional year of product life even existed,'' Avorn says. Why does the FDA approve such medications and allow them to stay on the market? ``There are very strong economic and political pressures when a company has spent hundreds of millions of dollars to develop a drug,'' Avorn says. Wyeth-Ayerst Laboratories yanked Duract, a painkiller in the same class of drugs as ibuprofen, naproxen and others, from the market in June 1998 after reports of four deaths and eight transplants resulting from severe liver failure. According to the company, all but one of the cases occurred among patients who took the drug for more than 10 days, against the label's advice. Just two weeks before Duract came off the market, Roche Laboratories pulled Posicor, which is used to treat high blood pressure and chest pain. Taking Posicor with any of a number of commonly used drugs, including some heart disease treatments, could lead to potentially fatal heartbeat irregularities, the same problem that led to Propulsid's impending withdrawal. As with Propulsid, changes to Posicor's label were designed to minimize the drug interaction risk. ``In principle, drug interactions can be addressed by appropriate labeling; however, with respect to Posicor, Roche Laboratories believes that the complexity of such prescribing information would make it too difficult to implement,'' the company wrote in a ``Dear Doctor'' letter announcing Posicor's withdrawal. At least one drug, sorivudine for shingles, never made it to the U.S. market because of concerns about the effectiveness of label warnings. The pill was withdrawn in Japan after 15 users died in just its first month on the market. They had developed aplastic anemia, a blood disorder, after taking sorivudine with a common anti-cancer drug. Three years later, Bristol Myers Squibb representatives argued before an FDA advisory committee that a ``black box warning''--like the ones on cigarette packages--would adequately minimize sorivudine's risks. ``No one was convinced that it would work,'' says Raymond Woosley, chairman of pharmacology at Georgetown University in Washington, D.C., and a member of that committee, which recommended not approving sorivudine. Because a drug already on the market, acyclovir, provided a similar benefit with far less risk, the agency followed the advisory committee's recommendation, the FDA's Behrman says. ``We believed zero deaths was the only acceptable number.'' Risk vs. benefits Rezulin, on the other hand, was the first drug of its class. FDA officials have said the agency sought to remove that drug from the market only after similar, safer medications became available. ``I've heard that line, but I don't buy it,'' Avorn says. ``It's as if we don't have other medications to treat diabetes.'' The risk/benefit issue arose at the FDA advisory committee meeting, where panelists recommended approval of Uprima, which would be the second impotence pill on the market. Pre-market studies showed that the drug can trigger fainting, especially when taken with alcohol, so committee members suggested a black box warning against drinking on Uprima's label. But panel member Thomas Graboys, who had to leave the meeting early, says he would have voted against Uprima, partly because of concerns about the label's ability to protect patients. When the condition a drug treats isn't life-threatening, only the lowest level of risk is acceptable says Graboys, director of the Lown Cardiovascular Center at Brigham and Women's Hospital. Much inappropriate prescribing could be eliminated if doctors actually read package inserts or looked up the drugs in their PDRs before prescribing them, Woosley says. Instead, they rely on memory, a Herculean task when one considers that one doctor might prescribe scores of drugs. But that's what they're taught to do in medical school, Woosley says. Doctors wrote nearly 3 billion prescriptions last year; the number is expected to reach 4 billion annually by 2004. ``We've got to start by changing the way we teach people,'' he says. Among his students, ``the kid who gets the `A' is the one who says `I don't know, but I'll look that up and get back to you.' ''

Mr. STARK

Mr. STARK. Mr. Speaker, I have a rather personal interest in this legislation, and I have heard a lot from the chairman of the Committee on Ways and Means about what we owe our children, so I have come to the well this morning and apologize to my children, I have 5, and 10 grandchildren. I am probably one of the few Members of the House who started out poor. I used to say I was so poor as a kid I never slept alone until I was married. But through good luck and the action of commerce, I was able to amass what most of the people in my district would call a fortune. And I have not paid much tax on that. I pay income tax each year. I pay more income tax than you pay me salary, but most of what I have was accumulated through capital gains, and I have not sold it. I do not intend to. My kids will get it pretty much free. So I apologize because I am going to vote against this. Kids, to Jeff and Bea and Thekla and Sarah, Fortney and the 10 grandkids, you are going to have to pay some tax. This is a little family business, it might be 7 figures, but you are going to get a down payment on that from your mother and me of $1,350,000 free. You have not worked a day in your life for that. You have a college education, down payment on your homes, cars, but you have not worked worth squat. First you are going to get a million to a million and a half bucks. Then you are going to get half of the business free. You may have to pay 50 to 55 percent tax on the balance. Next you are going to get 10 years to pay off that balance at a below prime interest rate. And, kids, if you are so dumb that you cannot run that business with over a 50 percent down payment given to you and 10 years to pay off the balance at a low rate, you do not deserve it You ought to have been trained in this country to earn your own way and pay your taxes every day so that Dad can have a prescription drug benefit and a decent nursing home so you do not have to worry about taking care of me in my dotage. There are not very many Members of Congress that are going to pay any inheritance tax. This is a gift to the rich not for independent, smart kids as I have raised.

Mr. STARK

Mr. STARK. Mr. Chairman, reducing fraud and abuse in Medicare has been identified by the Majority Leader as a major initiative. The Budget Committee has a Medicare Fraud Task Force to look into ways to reduce Medicare fraud. The Ways and Means and Commerce Committee has held hearings on reducing Medicare fraud. And yet, this bill would actually reduce already appropriated funds for fighting fraud and abuse in Medicare by $50 million. These funds were appropriated in advance when the Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 and intended to fight Medicare fraud. This program has returned $17 for every dollar invested in it. Because of our fraud-fighting efforts, we have experienced the lowest growth in Medicare spending ever. Obviously, the Appropriations Committee disagrees with the Majority Leader and other Committee Chairmen who want to reduce Medicare fraud. Instead, the Committee would reduce our anti-fraud efforts. Evidently, the Committee feels that there is not enough fraud in Medicare, so we should let it grow. Second, Mr. Chairman, the General Accounting Office and others have issued numerous reports recently about the alarming abuses and poor quality of care of senior citizens in nursing homes--the care of our mothers and fathers and our constituents. GAO said that one in four nursing homes actually harm our senior citizens or place them in danger of being harmed. The GAO recommended stronger enforcement of quality standards. In Northern California, only 6 percent of nursing homes were found by State inspectors to be in full or substantial compliance with requirements. The President proposed additional funding to support a Nursing Home Initiative for enforcing nursing home standards more strictly. Yet this bill would eliminate the funding for this Nursing Home Initiative. Obviously, the Appropriations Committee simply does not care what happens to our senior citizens in nursing homes. Mr. Chairman, I urge my colleagues to support the DeLauro amendment to restore funds for fighting Medicare fraud and for the Nursing Home Initiative. Mr. Chairman, I submit into the Record a letter sent to me by the National Citizens' Coalition for Nursing Home Reform. National Citizens' Coalition for Nursing Home Reform, Washington, DC, June 1, 2000. Hon. Fortney ``Pete'' Stark, House of Representatives, Washington, DC. Dear Representative Stark: The National Citizens' Coalition for Nursing Home Reform (NCCNHR) urges you to vote no on the Labor/HHS/Education bill because it fails to provide funding for the Nursing Home Initiative. The Nursing Home Initiative was established to increase funding for improvement in nursing home quality nationwide. As part of the Nursing Home Initiative, new survey protocols were put in place such as improved federal oversight over state survey efforts, staggered inspections, and expedited investigation of resident complaints. For FY 2001, the Administration proposed a major funding increase that would invest $70.1 million in improving oversight of nursing homes. It would include (1) training surveyors in effective inspection of nursing homes; (2) surveying nursing homes during evenings and weekends; and (3) surveying substandard facilities more frequently than other facilities. However, in Subcommittee, the discretionary funding was virtually eliminated for the Initiative. By passing an appropriations bill without funding for the Nursing Home Initiative, the House would be ignoring overwhelming evidence of harm to residents that is occurring because of lack of adequate enforcement. The 1998 GAO report on California nursing homes showed that one in three facilities has violations that cause either actual harm to residents or place them at risk for serious injury or death. This report launched the Nursing Home Initiative to address the poor care in nursing homes. We cannot abandon these efforts, which are now beginning to have an effect. Otherwise, we are abandoning the most vulnerable and frail population in this country who need protection from a strengthened enforcement system. Sincerely, Sarah Greene Burger, Executive Director.

Mr. STARK

Mr. STARK. Mr. Speaker, even in an era of unprecedented budget surpluses, wasting Medicare dollars is unacceptable. The same procedures, carried out in a physician's office, an ambulatory surgical center or in a hospital outpatient department are reimbursed at widely different rates. These differences exist across medical specialties and do not consistently relate to the setting in which the service is provided and may vary up to 179%. (Table 1). The disparity in payments for equivalent services, regardless of setting, needs to be eliminated and payments reduced to the lowest levels. Mr. Speaker, there is simply no reason in the world for us to pay $1001 for glaucoma surgery in a hospital outpatient setting, when we can provide the same service for $415 in an ambulatory surgical center. The taxpayers, beneficiaries and Medicare can save billions of dollars in the years to come if we simply pay at the lowest of the hospital outpatient, ambulatory surgical center or doctor's office rate. We should pay at the lowest rate a service can be safely provided, regardless of setting. I have proposed this in H.R. 2115, and I urge the Members to consider this legislation as a way both save money and help beneficiaries.

Mr. STARK

Mr. STARK. Mr. Speaker, I have a rather personal interest in this legislation, and I have heard a lot from the chairman of the Committee on Ways and Means about what we owe our children, so I have come to the well this morning and apologize to my children, I have 5, and 10 grandchildren. I am probably one of the few Members of the House who started out poor. I used to say I was so poor as a kid I never slept alone until I was married. But through good luck and the action of commerce, I was able to amass what most of the people in my district would call a fortune. And I have not paid much tax on that. I pay income tax each year. I pay more income tax than you pay me salary, but most of what I have was accumulated through capital gains, and I have not sold it. I do not intend to. My kids will get it pretty much free. So I apologize because I am going to vote against this. Kids, to Jeff and Bea and Thekla and Sarah, Fortney and the 10 grandkids, you are going to have to pay some tax. This is a little family business, it might be 7 figures, but you are going to get a down payment on that from your mother and me of $1,350,000 free. You have not worked a day in your life for that. You have a college education, down payment on your homes, cars, but you have not worked worth squat. But you are going to get a million, a million and a half bucks. And then you are going to get half that business free and you may have to pay 50 percent, 55 percent on that tax if they appraise the business at its full value. And you are going to get 10 years to pay that off at a below prime rate interest rate. And, kids, if you are so dumb that you cannot run that business with over a 50 percent down payment given to you and 10 years to pay off the balance at a low rate, you do not deserve it. You ought to have been trained in this country to earn your own way and pay your taxes every day so that Dad can have a prescription drug benefit and I can have a decent nursing home so you do not have to worry about taking care of me in my dotage. There are not very many Members of Congress that are going to pay any inheritance tax, and do not believe them. This is a gift to the rich not for independent, smart kids like I have hoped I raised.

Mr. STARK

Mr. STARK. Mr. Speaker, I submit the following article for inclusion in the Congressional Record. It aptly describes my good friend and colleague, Representative Barbara Lee, as someone who makes a difference because she thinks globally and acts locally. Her compassion for those who are less fortunate is matched by her legislative skill. We are most fortunate to have her as part of the Bay Area delegation. [From the Oakland Tribune] Rep. Lee: Politician Who Makes a Difference (By Paul Cobb) Congresswoman Barbara Lee is one woman who does make a difference because she acts and thinks globally and locally simultaneously. During her young career in the United States Congress as a member of the powerful Banking and International Relations committees, she has often stood alone with her ``votes of conscience'' on Kosovo, Cuba, Colombia and Banking legislation. Connect the dots She has often disagreed with President Clinton, her own party and members of the Republican Party. Yet, she has won their respect by making them realize they need her because she knows how to meld pressing social and moral issues with practical, vital, economic and security interests. Schooled by the likes of Ron Dellums, former Oakland mayor Lionel J. Wilson, Willie Brown, John George, Gus Newport, Maudelle Shirek, Hazaiah Williams and Bishop Will Herzfeld, Congresswoman Lee knows how to ``connect the dots.'' She matches money to needs. Knowing that money, economic and financial interests are the mother's milk of politics, Lee has managed to stand alone in the fiery furnace of opposition to votes on the White House's agenda and still bring home the bread and bacon to her district. Oakland's port, schools, housing community development and health programs, such as AIDs funding have increased during her tenure. Even though she doesn't sound her own trumpet or spend excessive time raising funds for her own campaign coffers, she's not about to allow the vital concerns of her constituents to be drowned out by the noisy symbolism of political rhetoric. Last week the Leach/Lee World Bank AIDS Marshall Plan Trust Fund Act (H.R. 3519) passed the House by a unanimous voice vote. Lee has surprised and floored her fellow congresspersons and watchers with the passage of H.R. 3519 because she put together a bi-partisan effort around an explosive and contentious issue. And, what is more, she astounded legislative leaders on both sides of the aisle by expanding the understanding of the global AIDS crisis. By skillfully demonstrating that the AIDS scourge threatens our national security and financial institutions, she connected needs to resources. Lee garnered the support of Republican committee chair James Leach and thanked and acknowledged the leadership of former Congressman Dellums, now serving as chair of the President's Advisory Council on HIV/AIDS (PACHA) and a leader of the Constituency of Africa, for being ``my mentor and inspiration.'' Security interests Lee utilized her membership on the Domestic and International Monetary Policy Subcommittee to talk with the President, Secretary of Treasury, United Nations officials, World Bank, International Monetary Fund and other financial institutions to develop her plan to commit the U.S. to $500 million in seed money. The funds would then be leveraged 9:1 from funds donated by other G-7 nations and the private sector. ``If the moral and health arguments don't work, then the economic and security interests will,'' said Lee as she pointed to photos taken while she was a member of the California Assembly and Senate where she managed to get more than 60 legislative bills signed by then-Gov. Pete Wilson. With the support of Sens. Dianne Feinstein and Barbara Boxer, Lee says she will monitor the progress of her bill in the U.S. Senate. Lee confidently pointed to the portion of Oakland seen from her 10th floor office in the Dellums Federal Building and said, ``I know that the legislative process from bill to law and then to funding is dynamic. But I will be vigilant. No stone will go unturned because this disease knows no boundaries. The whole world is at risk to this AIDS pandemic of biblical proportion.'' Sen. John Kerry, D-Mass. introduced S2033 as a companion bill and its language has been included in the Helms/Biden Foreign Affairs Technical Assistance Act. Lee's proposed trust fund, housed at the World Bank, would use its leveraging capacity to increase the resources for the fund. Lee envisions esteemed world leaders such as Nelson Mandela and Ron Dellums as part of the fund's governance structure to assure that the monies go to needy regions. Giants' shoulders How did a newly elected congresswoman who represents the most left-of-center constituency in the country manage to get arch-conservative Republican Sen. Jesse Helms to support the intent of her legislation while simultaneously coordinating grassroots organizations and AIDS service organizations? ``With a lot of hard work,'' Lee said. ``I can stand up to the legislative leaders in both parties because I stand on the shoulders of giants who preceded me.'' With an earnestness and conviction she pointed to the photos depicting some of the causes, neighborhoods and political leaders she's worked for or with and said ``every time I walk past the Lionel Wilson Building. Elihu Harris Building, Judge Don McCull statue and into the Dellums Federal building, I'm humbled by the awesome responsibility. And, because I have been blessed to have been connected to all those giants, I won't lose my focus.'' Lee's office is encouraging the public to join the African American Walking Tour of Downtown Oakland Sunday, July 16, 2 p.m. to 4:30 p.m. She praised the African American Museum and Library (AAMLO), the Oakland Heritage Alliance (OHA), the Oakland Tours Program, and the Oakland Cultural Heritage Survey for collaborating on the tours. ``I want all children and families, especially African Americans, to tour these places because it reminds me of my childhood in El Paso, Texas when I first started seeking answers to the questions of who I was and where I came from,'' said Lee. She said she will invite her congressional colleagues, who will be in Oakland August 12 seeking solutions to issues of housing affordability, redlining, neighborhood reinvestment and undercapitalization, to also participate in the walking tours as well as Oakland's Chabot Science Center. Lee, a Mills College and University of California, Berkeley graduate, is also helping to find funding to make the Chabot Center a magnet for math, science and astronomy for children. ``I want the first astronauts to Mars to come from my district,'' she says. Eleven million of the world's 14 million AIDS deaths are in Africa. ``Africa is the epicenter of this epidemic. We need to declare a global state-of-emergency, like we pioneered in Alameda County, and provide the money to fund strategies to address the AIDS deaths,'' Lee said. ``This disease has plagued us like the Bubonic Plague once did and it knows no boundaries. It is not just found in Africa. It is moving swiftly in India, Eastern Europe, Asia, Latin America and the Caribbean as well,'' Lee said. And here in Alameda County, she warns of a corresponding calamity facing African Americans because she says the statistical profile of AIDS incidence shows a reversal of infection rates that once were 70 to 30 percent white to non- white that are now the exact opposite.

Mr. STARK

Mr. STARK. Mr. Chairman, I adamantly oppose H.R. 4576, the Defense Appropriations bill for Fiscal Year 2001. This bill spends $288.5 billion for defense programs. However, this amount does not include the $8.6 billion already passed by the House in the Military Construction Appropriations bill (H.R. 4425), nor does it include the $13 billion expected to be allocated for defense needs in the upcoming Energy and Water Appropriations bill. The three measures provide $310 billion on defense needs alone. Monday, the Washington Post reported that the Joint Chiefs of Staff are preparing to request increases in military spending of more than $30 billion per year over the next 10 years starting in FY 2002. The U.S. Congress must not yield to the whims of the Joint Chiefs and the demands of military contractors when the American people have real needs that Government can provide. This is the wrong time to throw money at pork-barrel defense projects such as the national missile defense (NMD) system and the F-22 program. The U.S. is experiencing unprecedented economic growth and the federal budget is balanced. Now is the time that we should provide health insurance for the eleven million children without it, provide a Medicare prescription drug benefit for 39 million Medicare beneficiaries, and ensure solvency of the Social Security and Medicare systems for the millions of baby boomers in their near retirement years. Let's make no mistake about priorities--the Republican majority has done nothing to extend the solvency of Medicare or Social Security in the 106th Congress. Now they want to squander hundreds of billions of dollars on high-cost, unreliable weapons systems. According to recent analysis by the General Accounting Office, the F- 22 aircraft program continues to encounter various problems with defects in the aircraft structure causing delays and fewer flight tests per month. In addition, the GAO analysis indicates that the Air Force has not been able to control F-22 costs. The GAO recommends that the F-22 low-rate production should be limited to approximately seven aircraft per year. Merry Christmas, Lockheed and Boeing--you get 10 unproven F-22s from Congress! The Department of Defense has spent $18 billion on the F-22 since the mid-1980's. The project is too expensive and simply not needed. The program was initiated in 1981 to meet the threat of next generation Soviet aircraft. However, that threat no longer exists. Last year's war in Kosovo illustrates why the U.S. does not need the F-22. The current fleet of F-15s and F-16s demonstrated U.S. dominance in the air in Kosovo. Proponents of the F-22 claim that the aircraft is far superior than the F-15 in air to air combat. This is yet to be determined, but given it is true, we never had air to air combat in Kosovo and we don't need anything superior. The Yugoslav Air Force never engaged the U.S. in air to air combat because they would have faced defeat much sooner. No nation in the world comes close to challenging U.S. air dominance. However, there are many countries that scoff at the U.S. for not providing health insurance to our children. Eliminating the 10 F-22s appropriated in today's bill will allow us to insure 1.6 million children currently without health insurance. Attention in recent months has focused on the military's readiness problems and difficulty recruiting and retaining quality people, yet today's appropriations bill continues to stress weapons over personnel and training. While funding for Operations and Maintenance, the so- called ``readiness'' account, goes up by 5% and the personnel account rises 2%, funding for the purchase of new weapons goes up over 16%. The U.S. spends two-and-a-half times what Russia, China and all potential threat countries spend on their militaries combined. We are preparing for World War III against a phantom enemy that cannot rival U.S. military strength. We could save $40 billion per year if we keep our current generation of sophisticated weapons systems; cut nuclear weapons to no more than 1,000 warheads; continue research and development programs on new technology rather than introduce it into the force; and cut back on deployments in Europe. This would enable my home state of California to provide health care for every uninsured child in the state and provide Head Start for 94,209 additional children. It would also give California $1.3 billion to rebuild our schools and enough to build 18,506 affordable housing units. I encourage my colleagues to dissect our annual defense spending and expose the facade that the GOP is helping the men and women in uniform. The leadership is helping those who line their campaign pockets. There are too many domestic needs to make pork-barrel defense spending our number one spending priority. I urge my colleagues to join me in voting no on the Defense Appropriations bill before us today.

Mr. STARK

Mr. STARK. Mr. Speaker, I submit for the Record several examples of unsolicited drug company ``freebies'' a Florida physician received in just one week. Over the years, I have received numerous examples of doctors being given free meals, cocktails, travel subsidies and recreational events--all financed by pharmaceutical companies. Drug companies spend billions a year promoting their products to physicians through these very questionable tactics instead of using this money for life-saving research and development. Last January, the Journal of the American Medical Association (JAMA) found that more than $11 billion is spent each year by drug companies promoting and marketing their products--with about $8,000 to $13,000 spent per year on each physician. JAMA concluded that present physician-industry interactions adversely affects prescribing and professional behavior. Additionally, a March USA Today article described a growing trend among pharmaceutically-financed advertising and marketing firms to sponsor physician continuing medical education (CME) courses that doctors in 34 states need to keep their licenses. These marketing firms are paid by drug companies that often hire faculty to teach these courses to push their sponsors' products. Such evidence of pharmaceutical waste, the adverse impact of drug company gifts on prescribing practices and the need for increased pharmaceutical R&D led me to introduce H.R. 4089, the Save Money for Prescription Drug Research Act of 2000. My bill would deny tax deductions to drug companies for certain gifts and benefits provided to physicians (other than product samples) and instead encourage drug companies to use those funds for a much more important use-- pharmaceutical research and development. Research and development is much more important than drug company promotions. Our nation has reaped great rewards as a result of pharmaceutical research. Pharmaceutical and biotech research have led to the discovery of lifesaving cures and treatments for ailments that would have cut lives short in earlier years. But drug companies can do more. Think of all the additional lives that could be saved if the pharmaceutical industry dedicated the resources now spent on physician promotions to R&D. Mr. Speaker, Congress has a responsibility to put an end to this pharmaceutical ``giftgiving'' and to encourage research and development of life-saving drugs. The drug industry's lobbying of physicians, which clearly leads to distorted, inappropriate, overprescribing of drugs, must be brought to an end.

Mr. STARK

Mr. STARK. Mr. Speaker, as one of two Members of Congress to oppose H.R. 3916, the telephone excise tax bill, I believe there is a need to explain the reasons for my vote. I opposed H.R. 3916 because this is just another fiscally irresponsible way for the Republicans to reduce federal revenues for the vital programs that the working families of this country rely on. The leadership of the 106th Congress doesn't care if it squanders $20 billion in tax revenues by repealing the telephone excise tax because it doesn't care if we have enough money to save Social Security and Medicare for future generations. But I do care and did not vote to repeal the excise tax. I never heard from one constituent asking me to repeal the federal excise tax on their phone service because it was a hardship. I did, however, hear from Bell Atlantic who will soon raise its phone rates and from big companies asking me to lower their phone bill. This bill will save the average family $34 per year--no wonder there wasn't a clamor from constituents demanding the repeal. I do hear from working families who want a better education for their children, and from seniors who want a Medicare prescription drug benefit. I also hear from families who don't have any health insurance for their children or who want a cleaner environment. EPA estimates it will cost billions of dollars over the next twenty years for municipal wastewater treatment programs. This funding assists local governments in the construction of projects to manage municipal wastewater. Untreated wastewater ends up in public drinking supplies, lakes and rivers. This untreated water is a major source of pollution for lakes and rivers and we need to address this problem now. Eleven million children are without health insurance. Children are the least expensive segment of our population to insure. Even though we all recognize this fact, Congress insists on giving another freebie to corporate America when we should be enacting my MediKids Health Insurance Act. The GOP does not have the interest of working families in mind with their legislative agenda. I refuse to contribute to their continual cause of promoting corporate interests. The U.S. taxpayers have told us their priorities, and eliminating the telephone excise tax was not one of them. We need these revenues for America's priorities. This bill recklessly cuts $20 billion in taxes that could be used for meaningful legislation; therefore I oppose H.R. 3916.

Mr. STARK

Mr. STARK. Mr. Speaker, I am pleased to yield 30 seconds to the gentlewoman from California (Ms. Waters), who recognizes that forced child labor is not stylish, even at the Gap.

Mr. STARK. Mr. Speaker, it is a great privilege to yield 5 minutes to the distinguished gentlewoman from California (Ms. Pelosi), who has been a leader for human rights, for dignity, and for fair trade with China for many years.

Mr. STARK. Mr. Speaker, I yield myself 3 minutes. Mr. Speaker, we have heard today from many of our colleagues who say they recognize that human rights in China are deplorable. They recognize that the environment is damaged by China wantonly without regard to what it will do to future generations. We recognize that political prisoners are imprisoned every day and that human rights and religion are trod upon. Everybody says that that is going on in China. There is no disagreement. Some people have said, Let's have a commission. Well, if you have been like me and served on a children's commission and a Medicare commission and a Social Security commission, you know that in this town to create a commission is to prevent anything from happening. I dismiss the idea of the Levin-Bereuter commission as a fig leaf which will do nothing to change China's behavior. But I would also like to suggest that the harm done to America may not be very great if the people who want most favored nation prevail; it is just who you are going to hurt and who you are going to help. Arguably those people pushing for most favored nation are trying to help General Electric and the huge corporations that are already the richest in history. And so if this passes, those corporations will all make two bits, 50 cents a share more in earnings. And that will help millions of Americans a few bucks here and a few bucks there, and it will probably help the CEOs of those corporations get another million or two in stock options. Who is it going to hurt? I will tell you who it is going to hurt. It is going to hurt probably a couple of hundred thousand Americans real bad. It is going to hurt those people who are going to lose their jobs overnight. They are going to get hurt 30 or 40,000 bucks because they are going to be out of work. They may lose their homes; they may lose a chance for their children to go to college. But I do not suppose anybody cares about them because the truth is those people may lose their jobs in 10 years, anyway, through the growth of technology because they do not have the training to keep up. They are the people who still work with their hands in factories, they still have minimum skills, they do heavy lifting in warehouses. They are the people that we are running higgeldy-piggeldy to eliminate from the workforce because they belong to unions and cost us a lot in benefits. So when you think about how you are going to vote, you can think about those families who may be looking for Hamburger Helper on the dinner table because Dad lost his job as a result of this, or you can think about the people who are already making millions of dollars in stock options and the people whose pensions are a little higher. If you are a Federal employee and in the C fund, your retirement is going to do a little better. That is it. It is as simple as all that. The big corporations get helped big time, and a few of our middle-class Americans have their lives destroyed if you vote for this terrible, terrible giveaway of our leverage to make China do the right thing.

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentlewoman from Ohio (Mrs. Jones). (Mrs. JONES of Ohio asked and was given permission to revise and extend her remarks.)

Mr. STARK. Mr. Speaker, I yield 1 minute to the distinguished gentleman from Michigan (Mr. Stupak). (Mr. STUPAK asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, the gentleman from Massachusetts (Mr. Tierney), who lives next to the area where a civil action was written, understands that passage of PNTR will lead the U.S. corporations doing business in China simply to be able to continue to avoid stringent environmental regulations. Mr. Speaker, I yield 1 minute to the gentleman from Massachusetts (Mr. Tierney). (Mr. TIERNEY asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentleman from New York (Mr. Owens). (Mr. OWENS asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, the gentlewoman from New York (Ms. Slaughter) understands that the average Chinese worker earns 108 bucks a year, hardly enough if they spent every nickel they earned every year in the United States to make a dent in our $80 billion trade deficit with China. Mr. Speaker, I yield 1 minute to the gentlewoman from New York (Ms. Slaughter).

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentlewoman from Connecticut (Ms. DeLauro), who realizes that we cannot negotiate with people who randomly kill prisoners to harvest human organs for sale.

Mr. STARK. Mr. Speaker, I yield such time as she may consume to the gentlewoman from North Carolina (Mrs. Clayton). (Mrs. CLAYTON asked and was given permission to revise and extend her remarks.)

Mr. STARK. Mr. Speaker, I yield 30 seconds to the gentlewoman from Illinois (Ms. Schakowsky), who recognizes that women in China are only allowed to have one child if they are married, and unmarried women are forced to have abortions.

Mr. STARK. Mr. Speaker I yield 30 seconds to the gentleman from Pennsylvania (Mr. Coyne), who recognizes that the 500,000 Bibles printed in Chinese in China is not even enough to provide one to each political or religious prisoner, much less leave any in the motel rooms. (Mr. COYNE asked and was given permission to revise and extend his remarks.)

Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentlewoman from Ohio (Ms. Kaptur), who understands that ADM may have to change its slogan to ``Supermarket to a More Polluted World'' if in fact this awful resolution passes.

Mr. STARK. Mr. Speaker, I yield 30 seconds to the gentleman from Illinois (Mr. Evans), who recognizes that China sells weapons to terrorists which may very well be turned on American civilians.