going to be working very closely with you on this whole area of prevention.

Dr. ROPER. Right. If I can just put in a commercial now, when you think prevention think CDC. [Laughter.]

Senator HARKIN. You are right. Do not worry, I will.

I really want to also get a better handle on this. I was just talking to staff about this core support thing. You are right. We come in and we say we want you to focus on AIDS, we want you to focus on this and start targeting all these things. Not to say that is bad, but if we start going out there after all these individual things and your whole core support out there erodes, we might be setting ourselves up for a really bad situation if we have an outbreak here of whatever it might be.

Dr. ROPER. Yes, sir; and I surely do not want to be the CDC Director hauled before a committee of the Congress and beat upon for not being ready. We want to be prepared for even unexpected problems to come along.

Your colleague, Senator Bumpers, was down to see us back in January, and we took him through some of our laboratory facilities that are doing good work for the Nation. Those laboratories were designed in the fifties and are badly in need of upgrading to be state-of-the-art science. That is part of this issue about the core that I was telling you about.

Senator HARKIN. He beat me to it, but I want you to get ready for a visit by me. I am coming down there shortly. Dr. ROPER. Thank you, sir.

Senator HARKIN. I will give you plenty of notice.
Dr. ROPER. Give us 1 hour, and we will be ready.

CONFERENCE ON FARM SAFETY

Senator HARKIN. I will give you more notice than that.

I am glad you are doing that conference on the farm safety and stuff like that.

Dr. ROPER. It is a problem that has largely gone unrecognized, but farming is a very hazardous occupation, and we are anxious to highlight to the public what can be done to make tractors safer and a variety of other things.

RESEARCH PAPER ON FARM-RELATED INJURIES

Senator HARKIN. Remind me to send to Dr. Roper-a nurse in Iowa whose name is Carolyn Kern did a study.

Do I have it there? That is it. I did not know you had it. I was not prepared to talk about this, but Carolyn Kern did a research paper on farm-related injuries to children. It was a study that was not, how do I say, a full study, but just to see if there really is something there worth looking into. She wrote an article about it. Her conclusion substantiates the suspicion that farm safety for Iowa's children is a problem. She did it only in Iowa. I recommend it to you. Perhaps during your time in Iowa you might want to bring her in.

Dr. ROPER. I would love to visit with her.

Senator HARKIN. She is a registered nurse, and she is also the wife of a farmer and lives on a farm. When I was reading the arti

cle, it really is quite startling, the number of kids who are hurt on farms.

Again, I will just tell you that what has happened is that our machinery has gotten bigger, it has gotten quicker, it is more mechanized, and things just work a lot faster than they used to. A lot of these kids are out there and are either around the machinery or they are working on weekends and Saturdays and after school, and a lot of serious injuries are occurring to these kids. So I would really appreciate your looking at that. I will send along this study

Dr. ROPER. Just to make your point, if I could, Senator, 300 children per year die from farm-related accidents. That is a sizable number.

EDUCATION PROGRAM TO PREVENT FARM-RELATED INJURIES

Senator HARKIN. Are you looking at steps that should be taken to get a health or education program into schools that are basically in rural areas to prevent injuries to children living on farms?

Dr. ROPER. Yes, sir; part of this whole effort on farm safety and health is to develop educational outreach capabilities. In another part of CDC, over the last couple of years, we have developed close relationships with the schools in our HIV and AIDS education efforts. We are anxious to marry those to deliver messages on farm safety and health in the schools.

BIRTH DEFECTS FROM CHEMICALS IN FARMING

Senator HARKIN. One other thing. It is my understanding that birth defects are the leading cause of infant mortality in rural States and that studies have shown an association between those birth defects and chemicals used in farming.

Is CDC doing anything to look at this problem?

Dr. ROPER. Yes, sir; we have, as part of the farm safety and health activity, a study underway surveying the health problems on the farm, including birth defects. We will have more to report to you on that score later, but we are investigating it.

SMOKING

Senator HARKIN. Very good. I wanted to ask you about smoking, but I covered that pretty well with Dr. Mason. If you have any observations on this

Dr. ROPER. I would just say that your ardor, your ire, if you will, is appropriate. We ought to stop this Nation from killing so many people through smoking. It is a national tragedy that should be a real embarrassment to us. We have a long way to go.

TAX DEDUCTIBILITY FOR ADVERTISING TOBACCO

Senator HARKIN. Yes; we do, and I have stuck my neck out a couple of times on this, and I am going to stick it out again here today. I will probably get my head taken off, but that is all right. We have public policies in this country.

You know, right now we spend all this money in the Government to try to cut down on people smoking. We know it is a health risk.

We know from the figures it is a leading cause of death. Yet, we turn right around and make it a Federal policy that those who advertise tobacco products get a tax deduction for doing so. All advertising is deductible as a cost of doing business. But that is a policy of the Government to promote business activities in those areas.

This is outside of your bailiwick, but I am questioning it. I question whether or not we should look at this whole structure of the tax deductibility for advertising for tobacco. We have taken tobacco off the airways, but in your newspapers and magazines, all the things that kids get their hands on, young people, and read, tobacco is still glorified as socially acceptable. I am wondering if we should examine that policy.

Dr. ROPER. I appreciate your caveat.

Senator HARKIN. You do not have to comment.

Dr. ROPER. I would like to comment. I appreciate your caveat that I do not do tax policy, but I agree with your point earlier that we need to take a number of steps, as a Nation, to say that smoking and all of the things that go to support smoking are socially unacceptable. We are just not going to say that we look with favor or even tolerate such activities. That is the direction in which we are headed.

Secretary Sullivan has been by far the most outspoken Secretary on this issue, and this budget from the President which I have just quoted doubles the budget in the Office on Smoking and Health, the first increase in more than a decade.

We need to do much more, though, and it is directed at smoking on airlines, tax policy, vending machine availability, a whole variety of things that could be done if we were of a mind to say we are just going to make smoking, if not illegal, very hard to do.

Senator HARKIN. I do not know that we want to go so far as to make it illegal. Prohibition just does not work, but at least we could cut down on the glorification of tobacco as being socially acceptable, the usage of it for young people.

Dr. ROPER. Yes, sir.

Senator HARKIN. We ought to look at whatever ways we can to cut down on that.

Anyway, I was just throwing that out. I suppose I will hear more about what I just said later on.

Senator Bumpers.

Senator BUMPERS. Thank you, Mr. Chairman. Doonesbury is doing a pretty good job.

Senator HARKIN. Who?

Senator BUMPERS. Doonesbury. Do you not read Doonesbury?
Senator HARKIN. Yes, sure.

Senator BUMPERS. Maybe he is doing more good than all the money we are spending on educating people against the evils of smoking.

Senator HARKIN. What do you think, Senator Bumpers, about the tax deductibility for advertising tobacco? Is that something you think we should be looking at or not? I do not know. It occurs to me that on the one hand we are putting out all this money to stop it, and on the other hand we say you can write it off on your taxes. Senator BUMPERS. Do you have a bill in to do that? [Pause.] Do you have so many in you cannot remember? [Laughter.]

Senator HARKIN. For a number of years Congressman Brown and I on the House side did have a bill in on both alcohol and tobacco. Obviously we never got anywhere.

Senator BUMPERS. I think it is certainly constitutional, and it might be highly desirable.

You know, I have just read a book called "Barbarians at the Gate," which is a story that reads much more interestingly than "Gone With the Wind," on a leveraged buyout of the RJR-Nabisco Co. One of the reasons that Ross Johnson, who is president of the company, wanted to buy it was because the stock stayed static, and the company was just a cash cow. It made a lot of money, took in a lot of money; it was all cash and had a tremendous cash-flow. He was always agitated because the stock did not go up according to their profits. He says it was because the public reception was they were trying to sell cancer with Winston-Salem cigarettes.

It is an interesting story. I would recommend that book to anybody. It is one of the most fascinating books, and I think about the abuse Members of Congress take about ethics. I will go no further. I will just recommend that book to you.

Dr. Roper, first let me publicly thank you for the magnificent hospitality all of you extended to me while I was in Atlanta. Dr. ROPER. It was kind of you to come, sir.

DIARRHEA

Senator BUMPERS. It was very educational.

Just for the record, one of the things I learned there, Mr. Chairman, that I found fascinating was that 10 percent of all the hospital admissions of U.S. children are for diarrhea. About 500 kids die needlessly every year from this condition. When our babies were young, it was a real threat and it scared us to death all the time.

I saw just this morning, Dr. Roper, in this morning's Post about the shortage of rehydration salts in Peru where the cholera outbreak is so great. When I think about what a simple package that is, it is just incredible that anybody in any nation would be short on those little packages of rehydration salts, which solve a big percentage of the problems apparently.

Dr. ROPER. Yes, sir.

[Senator Harkin left the hearing for another, Senator Bumpers agreed to assume chair.]

MEASLE CASES

Senator BUMPERS [presiding]. Let me get down first of all to measles. Without going through ground that we covered in Atlanta and that you probably already covered before I got here, what does it look like right now? In 1990 preliminary estimates were about 25,000 measle cases, up from 18,000 in 1989. Where are we headed now so far in 1991?

Dr. ROPER. We are happy to report, though we do not fully have an explanation for it, that in 1991 cases are substantially down from what they were in 1990. We believe that is due in part to aggressive vaccination programs in the cities that have been hardest

hit with the epidemic. If this current pattern persists, we will have fewer cases of measles in 1991 than we had in 1990.

The principal problem, though, remains; that is, large numbers of young children, 1- and 2-year-olds, in inner-city poor neighborhoods who are not appropriately immunized against measles. That problem still remains whatever the up and down fluctuations may be.

LACK OF IMMUNIZATION

Senator BUMPERS. Just a very quick note, Dr. Roper. As you know, the Supreme Court has just recently sort of limited what people can do in the name of religious freedom. I must say I am ambivalent about it. It is an immensely complex thing, but I do not believe that people ought to be allowed to refuse immunizations for . their children on religious grounds, because that affects everybody else.

As you know, we have cases in this country right now, several cases of people who will not allow their children to be immunized, and that poses a real threat.

To get back to a more macro subject, are these measles outbreaks caused more by breakdown in the delivery system or because we have now discovered the vaccine is not as efficacious as we thought it was; or is it both?

Dr. ROPER. It may be some of both. It is dominantly a problem in the delivery system. We have work underway. CDC has the leaders in this area looking at how efficacious the measles vaccine is.

The problem we have is of children just not being immunized at all.

Senator BUMPERS. I am sorry, Dr. Roper?

Dr. ROPER. The problem is children just never getting any kind of shot, whether it is good, or bad, or indifferent. They are never immunized at least at the appropriate age, 15 months or, in some cases, 12 months.

Senator BUMPERS. Now we talked about how it is a problem in the inner city. On college campuses it is probably more a question of the vaccine not being as efficacious. Would that be a correct statement?

Dr. ROPER. Yes, sir.

Senator BUMPERS. In the inner cities and areas like the delta of Arkansas, Mississippi, and Louisiana, it is probably more of a delivery system problem.

Dr. ROPER. Right.

Senator BUMPERS. Where they never got their first shot.

Dr. ROPER. Right.

Senator BUMPERS. So we are going to have to make a twopronged attack on measles if we are going to succeed. Is that correct?

Dr. ROPER. Yes, sir; we have a problem of very young children not being immunized and then the need to give a second dose of measles to school enterers, junior high, or college age, along in there.