of cases and controls to the surveillance and followup system in Atlanta where each casepatient's status can be evaluated by a panel of expert physicians. It also underscores the importance of publicizing the appropriate laboratory tests for suspected cases of CFS. CFS cannot be diagnosed by Epstein-Barr Virus serologic tests, and that it remains a diagnosis of exclusion. This message should reduce morbidity from potentially treatable conditions which are currently being misdiagnosed as CFS or Chronic

Epstein-Barr Virus (CEBV). For appropriate management, CDC emphasized symptomatic treatment, healthy life style, appropriate reassurance, avoidance of potentially dangerous therapies that lack scientific justification and periodic reevaluations of the diagnosis.

CDC will develop methodologies for evaluating the type and onsets of neuropsychological abnormalities as well as the type of fatigue in patients with CFS and to apply these methodologies to patients identified in the pilot surveillance; initiate a case-control component into the surveillance system in Atlanta designed to look for associated immunologic findings in patients with CFS and risk factors for the development of CFS; and investigate suspected clusters of CFS that may be reported to CDC in order to better delineate this illness, clinically, virologically and epidemiologically.

National Institutes of Health (NIH)

Chronic fatigue syndrome (CFS) is a

multisystem syndrome characterized by months of debilitating fatigue frequently associated with recurrent sore throat, low grade fever, myalgia, headache, gastrointestinal symptoms and tender lymph nodes. Currently, the public health significance of CFS cannot be fully assessed without data on the prevalence of the syndrome and knowledge of its natural history. Furthermore, therapies cannot be

evaluated without clinical or laboratory markers of disease remission and without appropriate controls. Determination of the cause and mechanisms of pathogenesis require clinical and epidemiologic studies that incorporate well-defined cases and controls.

Aware of the dearth of scientifically sound information about the prevalence, incidence and cause(s) of CFS, the NIAID began to encourage research into the etiology and epidemiology of CFS with the organization of a workshop in 1985, the issuance of a Program Announcement in 1987, and the organization of a second workshop in 1988 that focused on research design and clinical definition.

The NIAID is currently supporting 4 studies (1 intramural, 3 extramural) which collectively address the most pressing research questions concerning CFS, such as prevalence, diagnosis, laboratory and clinical markers, natural history and prognosis.

The NIAID's long-term intramural study, with more than 150 CFS patients enrolled over time, is concerned with clinical evaluation, treatment, and understanding the biology of the syndrome. Investigators from the National Cancer Institute (NCI), the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute of Child Health and Human Development (NICHD) have collaborated in studies of this intramural CFS patient group.

A study of factors that
control reactivation of EBV
which has already led to the
identification of the gene
sequences responsible for
reactivation of EBV form
lymphocytes, and has
reported a specific EBV
immunologic defect that my
be significant. Research
into the mechanisms

underlying these findings
and the possible

significance in CFS patients
is ongoing.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health

Senator REID. Mr. Chairman, I have been working the past couple of years on child victims' rights. I have great interest in seeing the victim treatment, sex offender treatment programs have more attention directed toward them. Under the Mental Health Act of 1988, I understood there was supposed to be something done in this regard.

Do you know, Dr. Goodwin, if your agency plans anything regarding treatment programs for this condition?

Dr. GOODWIN. I would have to get that for you, but there are activities in that area in the research budgets. I am not sure about the treatment program.

In programs of the Office for Substance Abuse Prevention, a number of the community prevention demonstrations include child abuse, because child abuse is very frequently associated with substance abuse.

[The information follows:]

MENTAL HEALTH DEMONSTRATION PROJECTS

The Congress authorized a number of mental health demonstration projects in Public Law 100-690: "Anti-Drug Abuse Act of 1988". Specifically, this law authorized "demonstration projects for treatment and prevention relating to sex offenses" under section 520A.(a) of the PHS Act and "prevention services demonstration projects" under section 520A.(b). Conferees on the appropriations bill for fiscal year 1990 indicated that up to $4 million should be used for subsection (b) prevention demonstrations and subsection (a) youth suicide prevention demonstrations. No funds were identified for subsection (a) treatment and prevention projects relating to sex offenses.

However, the National Institute of Mental Health (NIMH) recognizes the importance of sex offense prevention and treatment to our public health mission and has an active research program in this area through its Antisocial and Violent Behavior Branch in the Division of Biometry and Applied Sciences. Supported with general research funds, this area currently receives almost $1.5 million for research of high scientific merit. One recently funded grant to the California Department of Mental Health, for example, under NIMH's initiative to enhance the capacity of State mental health departments to conduct research, is designed to strengthen that Department's evaluation of an innovative treatment program for sex offenders which is based on a relapse prevention model of treatment. This project should provide important new information of national significance on whether treatment can prevent recidivistic sex offenses.

Other noteworthy studies address classification schemes for rapists and child molesters, diagnostic assessments and outpatient treatment for child molesters, prediction of aggressive behavior toward women, evaluation of a curriculum for teaching young children how to prevent sexual victimization, and treatment of rape victims. The NIMH also will soon issue several new requests for applications (RFA) for prevention demonstrations. These RFA's will emphasize prevention demonstrations for child and adolescent mental disorders (such as conduct disorders), infants at high risk for future mental health problems, and youth at risk for suicide. In addition, NIMH will also initiate an RFA for community-based crisis intervention and case management demonstrations to prevent hospitalization of the chronically mentally ill. This effort will give priority attention to the special problems encountered by rural mental health delivery systems. While these areas constitute only several of the Institute's priorities, we believe they are critically important, timely, and, as indicated recently by Congress, merit special attention.

ADVANCES IN CANCER RESEARCH

Senator REID. We have talked a lot here this morning about AIDS. I would be interested in hearing from you, Dr. Mason, as to what has happened on a positive nature this past year regarding cancer research, if anything?

Dr. MASON. I think that there have been a number of developments in the field of cancer research, both in the epidemiology, the prevention, as well as treatment modalities. In the context of our presentation on AIDS and HIV infection, we gave a list of things, but that is only indirectly related to cancer per se.

I would think that on the hearing with the National Institutes of Health they would have detailed information on that, and I would be happy to get anything for the record on specific advances, because they have been significant in the past few years.

[The information follows:]

MAJOR RECENT ACCOMPLISHMENTS OF THE NATIONAL CANCER INSTITUTE

A historic gene transfer occurred this year at the NCI with two NCI scientists and one from NHLBI inserting new genetic material into human cells as an important step in creating gene therapy;

Adjuvant therapy was established as saving the lives of advanced colon cancer patients with early breast cancer, bladder, and head and neck cancers. Developed new diagnostic tests for specific subsets of breast cancer patients who would benefit;

It has been found that certain genetic abnormalities play an important role in the genetic events that culminate in lung cancer;

It has been shown that an accumulation of complex genetic alterations is associated with the progression of colorectal tumors from benign adenomatous polyps to frank carcinomas. This lays the groundwork for new diagnostic, prognostic, and treatment of colorectal tumors;

NCI scientists have discovered several proteins that my be involved in positive and negative regulation of tumor invasion and metastasis. These include the laminin receptor, autocrine motility factor, NM23 metastasis suppressor protein, type IV collagenase, and the newest discovery TIMP-2 metalloproteinase inhibitor;

Scientists at Frederick Cancer Research Facility have made several discoveries about the AIDS virus that take important steps toward developing a vaccine;

Using this supercomputer, the crystallographic structure of the HIV-1 protease has been created;

New insights into the human papilloma virus and its attack on suppressor cells in the development of cervical cancer-similar process at work in squamous cell cancer of the oral cavity;

NCI and FDA have embarked on joint programs, regular meetings and other actions designed to speed drug development in cancer and AIDS;

It has been found that high testosterone levels are related to prostate cancer-as is a high-fat, inadequately nourishing diet;

The Cancer Centers are being redirected and will add more community service and outreach activities and more participation in high priority clinical trials;

Investigational New Drugs were filled for 8 drugs (3 AIDS) and 11 new biological response modifiers; and

Recent discoveries have demonstrated that the N-myc oncogene is amplified in the neuroblastomas of pediatric patients and that the HER-2neu oncogene has been confirmed in both breast cancer and ovarian cancer.

ACCESS TO HEALTH CARE

Senator REID. One last thing, Mr. Chairman.

Senator Bumpers talked about preventive measures. In my office just a short time ago was one of the physicians that works in the largest hospital in Nevada, a place called Sunrise Hospital. He is in the neonatal unit. In fact, he established that.

He indicated that 30 percent of the babies in that unit are there as a result of lack of care prior to their having the babies, the mothers having the babies, indicating to me that in the relatively small area of Las Vegas that millions and millions of dollars in health care each year could be saved if especially teenage pregnant women would get some minimal care.

Dr. MASON. You have put your finger on what is one of the major problems in the United States in why we rank 22d. There of course has to be access. If a woman has no access to health care services, then of course the likelihood that she will deliver a low birth weight baby or a baby that is impaired in some way is very high.

But in addition to access, we need to have outreach. We need to simplify our programs through programs like one-stop shopping. And we are proud that a $63 million increase in our 1991 budget request is specifically to look at services in our community and migrant health centers, one-stop shopping, infant mortality case man