that $6 million in additional contract funds be appropriated for this end.

DENTAL EDUCATION

The needs of special care patients, including those affected with AIDS and the elderly will be met only if enough dentists develop the necessary clinical and management skills to treat them in the coming decades. General practice residencies, geriatric training, and the geriatric education center programs are critical to the training of faculty and the development of curriculum that will prepare dentists to meet the needs of these patients. The association recommends that general dentist residencies be funded at $8 million for fiscal year 1992, and the geriatric training and education programs be funded at $26 million.

DISEASE PREVENTION

Disease prevention activity at the Centers for Disease Control focuses on the control and the prevention of oral diseases. As you know, DDPA has become the national leader in water fluoridation, the most effective means for preventing tooth decay. However, its most recent efforts have also addressed infectious control in dentistry. DDPA is responsible for investigating the transmission of infectious diseases such as AIDS and hepatitis B in dental settings.

PREPARED STATEMENT

Following such investigations, DDPA works with State and local governments and private organizations in implementing and evaluating dental infection control programs. For fiscal year 1992 it is requested that the DDPA be funded at $2.3 million. This funding level will also allow DDPA to work with the National Institute of Dental Research on the adult oral health initiatives noted earlier. This completes my statement. Thank you, Mr. Chairman. [The statement follows:]

STATEMENT OF DR. JAMES N. CLARK

Mr. Chairman and Members of the Subcommittee:

On

I am Dr. James N. Clark, a trustee of the American Dental Association and a private practitioner in Dubuque, Iowa. behalf of the 150,000 Association members, thank you for this opportunity to testify in support of federal funding for dental research, education and disease prevention.

The

Dental Research: The improved oral health status of today's citizens is principally a factor of dental research. advanced technology and expanded knowledge of disease, which have made American dentistry the world standard, derive from research research traditionally funded by the federal government through the National Institute of Dental Research.

NIDR's most significant achievements over the past four decades — in instrumentation, restorative materials development and preventative measures have been in research directed largely

to the treatment and ultimate elimination of caries and periodontal diseases. Control of the incidence of caries, especially in young people, and reduction of the severity of periodontal diseases once the primary cause of tooth loss in adults -- realizes an estimated savings in treatment costs of $5 billion annually.

-

These successes do not obviate the need for continued research in caries and periodontal diseases, but they have allowed an expansion of the research focus of NIDR. As described to the Committee last year, NIDR has embarked on two new major initiatives:

● Research addressing the needs of special care patients, the victims of systemic diseases, and systemic treatments, that adversely affect their oral health, and

The Research and Action Program for Improving Oral Health of Adults and Older Americans.

Prominent in these initiatives is increased exploration of oral cancers, acute and chronic pain, and disorders affecting taste, smell and swallowing, as well as continued AIDS research. With respect to the latter effort, NIDR seeks identification of a factor in saliva that appears to inhibit the AIDS virus from infecting cells.

To continue NIDR's traditional disease research and to advance these two new initiatives, the Association recommends that $126,500,000 be appropriated for research grants.

To accelerate the transfer of new technology to dental practice, seven additional research centers are needed. To fund their establishment and the 23 centers currently operational, an appropriation of $30 million is requested.

The Association strongly supports the additional research into the safety and efficacy of water fluoridation recommended in the NIDR Long-Range Research Plan, and in the report of the special subcommittee of the Committee to Coordinate Environmental Health and Related Programs. For this purpose, an appropriation of $5 million is requested.

The recent controversy over the possible harmful effects of dental amalgam on health heightens the need for acceleration of NIDR's research into the neurological effects and the effects on kidney function and metabolism of elemental mercury, as well as

the safety and efficacy of new restorative materials. The Association recommends that $6 million in additional funds be appropriated toward this end.

In summary, to fully support NIDR in FY 1992, in the efforts described, and in its essential related activities in management and support, intramural research, research and development contracts, training and career development, the Association requests that a total of $247,500,000 be appropriated.

Dental Education: The needs of special patient populations and the elderly will be met only if sufficient dentists develop the special clinical and management skills to treat them in the coming decades. General practice residencies prepare dentists to meet these needs in the immediate future. The Geriatric Training and the Geriatric Education Centers programs assure that faculty and appropriate curriculum will be available for education over the long term.

The Association recommends that General Dentistry Residencies be funded at $8 million for FY 1992 and that the Geriatric Training and Geriatric Education Centers programs be funded at $26 million.

Current dental education costs averaging in excess of $50,000 for four-years, exclusive of living expenses are creating barriers that even the most determined students from low-income families would find insurmountable in too many instances without the programs funded under the Disadvantaged Assistance authority: the Health Career Opportunity Program and the Financial Assistance to Disadvantaged Health Professions Students Program. The Association recommends funding of $40 million under the Disadvantaged Assistance authority.

The Exceptional Financial Need (EFN) scholarship program remains critical to increasing opportunities for talented minority students to attend professional schools and especially in the disciplines that are most costly. We recommend that $18 million be appropriated for the EFN program.

Lastly, the educational institutions need to be supported through continued funding of Biomedical Research Support Grants (BRSG), severely reduced in recent years, but nonetheless essential to maintaining our most research-intensive institutions. We ask that the BRSG program be funded at $56 million.

Disease Prevention: The Dental Disease Prevention Activity, Center for Prevention Services, Centers for Disease Control, directs its national efforts toward assisting state and local governments and private organizations in planning, implementing and evaluating dental disease prevention and control programs. Internationally, it collaborates with the World Health Organization in assessing, developing and disseminating information on infection control in dentistry and in conducting an assessment of determinants of oral health. For FY 1992, it is requested that the DDPA be funded at $2.3 million. This would permit the Activity to assist the Center for Infectious Diseases with technical expertise in investigating cases involving dental procedures and work practices. It would also support the Activity's participation with NIDR in the adult oral health initiatives.

Agency for Health Care Policy and Research: The Agency is currently engaged in studies of dental practice variations and appropriateness of care, effectiveness and efficiency of oral health care systems, statistical methods, consumer and professional evaluations of dental practice, evaluation of

to

guidelines for diagnostic procedures, and measurement of oral health status. To continue these studies and to pursue a principal objective of the Research and Action program eliminate the demographic barriers to dental care appropriation of $150 million is requested for FY 1992.

Infection Control:

― an

Finally, Mr. Chairman, the Occupational

Safety and Health Administration's Final Rule on Occupational Exposure to Bloodborne Pathogens is expected to be promulgated in September.

The Association believes it is critical to effective implementation of this rule in the nation's 100,000 dental offices that clear, detailed instructions be developed and distributed in a timely fashion.

OSHA advises that it is planning a brochure for this purpose at an estimated publishing cost of $15,000. The Association has agreed to underwrite the distribution cost.

In addition, OSHA is planning to produce a 10-minute instructional video tape on implementation of the Final Rule in dental offices, at a cost of $30,000.

Accordingly, an appropriation of $45,000 is requested for these two projects.

Senator HARKIN. Thank you very much, Dr. Clark. The association's budget request is $247 million for NIDR and the President's request is $160.9 million. Is that correct?

Dr. CLARK. Yes, sir.

Senator HARKIN. Well, I am, again, a strong supporter of the National Institute on Dental Research.

Dr. CLARK. And we certainly have appreciated that support, sir. Senator HARKIN. And again, as you know my thrust is preventative care and I can see the tremendous strides that we have made in preventing tooth decay in this country among our young people. It has been a great step forward.

Dr. CLARK. In our written statement it is pointed out and we say the American public saves $5 billion annually because of preventive dental treatment.

Senator HARKIN. Well, I appreciate what you have done, and we will do our best in getting this budget together. Dr. CLARK. Thank you very much.

Senator HARKIN. Thank you very much, Dr. Clark.

STATEMENT OF JOHN SCHOTT, EXECUTIVE DIRECTOR, INDEPENDENT TELEVISION SERVICE

Senator HARKIN. Next would be John Schott, executive director of the Independent Television Service.

Mr. SCHOTT. Thank you very much, Mr. Chairman and members of the subcommittee and staff. My thanks very much for your belief in the creative vision of independent film and video producers across this country, and thanks, as well, for your support of the Independent Television Service, which is dedicated to funding and distributing the best of this independent work to public television. The Independent Television Service is intent on redirecting public television to the original founding vision of public television.

At a time now when public television dollars are going more and more to major prime-time series, whose increasingly entertain

ment-oriented subjects are often carefully designed to attract large national audiences, corporate sponsors, and new members, the Independent Television Service promises to bring viewers something very different. Our express mission is to create genuine and widespread diversity and innovation in programming and to attract new audiences to public television, including those who are presently unserved and underserved by television, that is, particularly rural and regional audiences, people of color, and programming for children.

Put simply, ITVS seeks to create a public service television, not merely a public television, and to offer viewers programming of substance which speaks directly to their lives, and in response to the many different communities from which they have come. We are looking to serve the heterogeneous needs of this country, and not merely the homogeneous audiences for the sake of ratings.

Now, ITVS was mandated by Congress to be up and operating in 1988, however, it has taken over 2 years of negotiation with the Corporation for Public Broadcasting to agree to appropriate contractual terms for its creation, terms which guarantee ITVS its proper autonomy. And so we come now to Congress with two requests.

In the first case, a request that Congress clarify its language for the funding of ITVS. In the 1988 legislation, the request was the congressional language appropriated $6 million for independent producers, and then "invited the Corporation for Public Broadcasting to provide appropriate additional support for its service." Now those rather seemingly harmless words, "appropriate support", have been the subject of a great deal of friction and controversy between ITVS.

And so, in order to provide a more productive working relationship in the future, we would invite Congress to suggest that it intends, in fact, in its appropriation, to ask CPB to offer ITVS an aggregate amount, that would be the total amount of funding for both-for independent producers and for overhead of the service, for promotion, and for packaging costs. That would go a long way to developing a productive relationship between CPB and ITVŠ.

And second, for the 1994 appropriation, we would invite an increase of our funding from the current 1992 level of $8 million to $15 million. Now this may seem like a rather dramatic increase, but it has to be seen in light of a couple of facts. In the first case, PBS is now under a constant and very wide ranging process of restructuring, and so the allocation of new programming dollars, this would be part of a reallocation.

And second, we are not seeking new funds from public television, but rather, carving out of funds already offered to public television for a mission which, I believe, many people within the system, and certainly people in Congress, believe is important.

Had ITVS been funded at the time that Congress requested, it would now be offering viewers programs which deliver on its promise and would have given you demonstrable reason to request an increase in funding for its crucial work. We trust however, that this committee will see the importance, even at this date, of making an increased commitment to ÏTVS funding beyond the startup amount