STATEMENT OF THE HONORABLE NANCY PELOSI SUBCOMMITTEE ON HUMAN RESOURCES AND INTERGOVERNMENTAL RELATIONS JULY 28, 1989 MR. CHAIRMAN, I THANK YOU FOR HOLDING THIS IMPORTANT HEARING SUBCOMMITTEE'S ONGOING OVERSIGHT OF THE FEDERAL GOVERNMENTS'S LEADERSHIP ON THE AIDS ISSUE. TODAY WE WILL HEAR FORM PEOPLE ACROSS THE COUNTRY ABOUT THE DISPROPORTIONATE SHARE OF AIDS CASES. WE ARE MORE THAN EIGHT YEARS INTO THIS EPIDEMIC AND MORE THAN 100,000 AMERICANS HAVE BEEN DIAGNOSED WITH AIDS. YET IT IS NOT AT ALL CLEAR THAT OUR FEDERAL GOVERNMENT HAS ANY PLAN ON HOW TO RESPOND TO THE SERVICE NEEDS GENERATED BY THIS, THE MAJOR EPIDEMIC OF THIS CENTURY. MR. CHAIRMAN, LAST WEEK I INTRODUCED THE AIDS HEALTH CARE SERVICES ACT OF 1989. THIS LEGISLATION WOULD AUTHORIZE $250 MILLION FOR THE DEVELOPMENT OF COMPREHENSIVE SERVICE DELIVERY SYSTEMS FOR PEOPLE WITH AIDS AND SYMPTOMATIC HIV INFECTION. HOPE IS THAT CONGRESS WILL ACT SOON TO ADDRESS THIS PRESSING NEED. TODAY'S HEARING WILL HELP BUILD THE CASE. I LOOK FORWARD TO HEARING THE TESTIMONY OF THE DISTINGUISHED WITNESSES. MY 보 MS. PELOSI. Thank you. To commend you not only for holding these hearings but for beginning the testimony of our witnesses with a person who has AIDS, because to define the problem, there is no better way than the firsthand experience of a person with AIDS and how she or he relates to community-based services. As you know, in our city of San Francisco, we have been on the forefront of coming up with innovative ideas from the community, but the fact is that so many in the community have been working so long that we will be faced with burnout if we don't have a full partner in the Federal Government. This makes your hearings today and Tuesday so very important. In addition to submitting my statement for the record, I again want to commend you and thank you for holding these hearings and thank our witnesses for starting off in such an appropriate manner this morning. Thank you, Mr. Chairman. Mr. WEISS. Thank you so much. Our first panel of the morning will be comprised of Dr. Peter S. Arno; Dr. Lawrence S. Brown, Jr.; and Dr. Paul S. Jellinek. [Witnesses sworn.] Mr. WEISS. Dr. Arno, I think we will begin with you. Again, we have your entire prepared statement which will be submitted in its entirety into the record. If you will please keep your oral presentation to about 7 minutes, that will be very good. STATEMENT OF PETER S. ARNO, PH.D., HEALTH ECONOMIST, DEPARTMENT OF EPIDEMIOLOGY AND SOCIAL MEDICINE, MONTEFIORE MEDICAL CENTER, ALBERT EINSTEIN COLLEGE OF MEDICINE Dr. ARNO. Chairman Weiss and members of the subcommittee, I am Peter Arno, a health economist in the department of epidemiology and social medicine at Montefiore Medical Center and Albert Einstein College of Medicine in the Bronx. I am pleased to have the opportunity to participate at this hearing on the new challenges we face in dealing with the AIDS epidemic in 1989 and beyond. Medical intervention in HIV disease has far-reaching implications for the health care system of the United States. Several factors are enabling the medical community to begin intervention prior to a patient's AIDS diagnosis. The case for expanding therapeutic strategies aimed at asymptomatic HIV-infected individuals is compelling. First, epidemiological data suggests that in the absence of intervention a large percentage of those infected will ultimately progress to having PCP and to end-stage AIDS. Second, since there is in-vitro evidence that drugs such as zidovudine can block retroviral replication, it is possible that drugs of this kind will decrease infectivity and conceivably slow the spread of the epidemic. Third, the growing incidence of nonopportunistic infections associated with the presence of HIV, such as syphilis, tuberculosis, and bacterial pneumonia, may be better contained if effective antiretroviral agents are added to regimens currently in use for the primary treatment of these illnesses. It has already been shown that early treatment for PCP can delay or prevent the onset of this condition. Providing adequate ambulatory care for large numbers of asymptomatic HIV-infected individuals and coordinating inner-city health care facilities will be of critical importance. The capacity of care centers to fulfill their task, by providing adequate HIV testing, counseling, laboratory monitoring, medications, and overall primary health care, is currently inadequate. Moreover, these centers can expect an increase in the number of clients since many recipients of HIV-related services will be new patients who have not previously needed close ambulatory attention. In New York, San Francisco, Los Angeles, Houston, Miami, Newark, and other cities with large numbers of HIV-infected individuals, the managerial challenge will be particularly complex. These difficulties are compounded because a growing number of persons with HIV infection are intravenous drug users [IVDU's], their sexual partners, and families who live in neighborhoods that are the most medically underserved and understaffed. The costs of early treatment, estimated to be in the neighborhood of $5 billion per year for the United States, $800 million for New York City and $100 million for San Francisco will require a major financial commitment at all levels of government and the private sector. The enormous financial burden of early HIV intervention is in part artificial. The bulk of expenditures is tied to the price of pharmacologic agents. Though drug companies have a legitimate need to recoup their investments on experimental pharmaceutical agents, the public also expects to obtain life-saving drugs at reasonable prices. In the case of zidovudine and pentamidine, the most widely prescribed AIDS treatment drugs, their high prices do not accurately reflect their development or production costs. Their price is in fact supported by the provisions of the Orphan Drug Act, which has proven to be extremely profitable for some pharmaceutical companies. It is estimated that under the provisions of the act and current tax laws, drug companies are able to reduce their tax liability on clinical trials by approximately 70 percent of all company expendi tures. The prospect of early medical intervention holds great promise for extending the lives of large numbers of individuals who are infected with this deadly virus. Prolonging the asymptomatic stage of illness also offers the possibility that more refined and effective treatment will be available to infected individuals in the future. With early intervention we have an opportunity, albeit a timelimited one, to begin rational planning and avoid the crisis driven policymaking that has characterized the AIDS epidemic for the last 9 years. Thank you. [The prepared statement of Dr. Arno follows:] ORAL STATEMENT BY PETER S. ARNO, PH.D. DEPARTMENT OF EPIDEMIOLOGY AND SOCIAL MEDICINE ALBERT EINSTEIN COLLEGE OF MEDICINE BRONX, NEW YORK 10467 BEFORE THE COMMITTEE ON GOVERNMENT OPERATIONS JULY 28, 1989 Introduction P. 1 Chairman Weiss and members of the Subcommittee, I am Peter Arno, a health economist in the Department of Epidemiology and Social Medicine at Montefiore Medical Center and Albert Einstein College of Medicine in the Bronx. I am pleased to have the opportunity to participate at this hearing on the new challenges we face in dealing with the AIDS epidemic in 1989 and beyond. Early medical intervention in HIV disease has far-reaching implications for the health care system of the United States. Several factors will soon position the medical community to begin intervention prior to a patient's AIDS diagnosis. The case for expanding therapeutic strategies aimed at asymptomatic HIV-infected individuals is compelling. First, epidemiological data suggest that in the absence of intervention, a large percentage of those infected will ultimately progress to having PCP and to end-stage AIDS. 1-4 Second, since there is invitro evidence that drugs such as zidovudine can block retroviral replication, it is possible that drugs of this kind will decrease infectivity, and conceivably slow the spread of the epidemic.4,5 Third, the growing incidence of non-opportunistic infections associated with the presence of HIV - syphilis5, tuberculosis,6,7 and bacterial pneumonia8 - may be better contained if effective anti-retroviral agents are added to regimens currently in use for the primary treatment of these illnesses. It has already been |