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where the community health center is not active and not funded, infant mortality is up.
I do not know if you have seen this report or not. Have you seen this study, Dr. Mason?
Dr. MASON. No; I do not believe I have.
Senator HARKIN. Please get your hands on it. I did not see it until last week myself. I was not even aware of it. I asked the inspector general specifically. I asked, is there a direct correlation between the activities of the community health center and infant mortality, and he said yes, their investigations and studies have shown that. So I hope you will look at that.
I say that because we were being asked to reprogram some money out of community health centers to help fund healthy start and out of maternal and child health block grants to fund it this year. I balk at that because these are two programs that are actively reducing infant mortality right now. So to the extent that this program targets 10 cities and rural areas, that's fine, but there is going to have to be some other place that money is going to have to come from, but not from maternal and child health care and not from the community health centers. That is just the point I am making.
Dr. MASON. I appreciate very much your point of view.
I have met with the officers and leaders of the National Community Health Center Organization, and one of the first things I did was tell them that in no way was our desire to move the increase, not to take money from them but to move the increase that was intended for fiscal year 1991 from community health centers in general, over 500 of them, to those 10 areas that will be identified.
We agree that the community health centers are doing a tremendous job, but to accomplish what we wanted to do in those 10 areas, we needed a critical mass of money. We needed enough money so that we do not just tinker around the edges. We know what to do, but nowhere in the United States have we been able to comprehensively do all of the things that need to be done if we are really going to have an impact upon infant mortality.
It was a sacrifice. We felt we needed a critical mass of money so that there would be enough resources in those 10 areas. Instead of tinkering with one or two of the things that we know need to be done, we could do them all and we could do them right. Let us be just like Roger Bannister when he broke the 4-minute mile. If we train properly and if we invest properly in those 10 areas, we can show the Nation that one can really do something in those cities and rural communities that have the highest infant mortality rates in the Nation.
That is why we wanted to redirect planned increases from over 500 areas averaging $40,000 and move that increase into these 10 areas where we could substantially increase it and do the job that every one of us wants to accomplish. Those are hard choices, and we recognize it.
INFANT MORTALITY RATES BY RACE
United States, 1970-88
Deaths per 1,000 Live Births
Regression lines fitted to 1970-81 rates
INFANT MORTALITY RATES BY RACE The next chart shows again what we are facing in the United States with regard to infant mortality. This chart on infant mortality rates by race has a number of key points in it. First of all, as you look at the dots, whether they are red or blue, you will see that we have a slowing of the rate of decrease.
Second, there is a dramatic disparity between white and black infant mortality in the United States, and as a result of these trends that you see depicted here, the United States is now in the 24th position among industrialized nations in infant mortality. We can do better, and I think we want to work together to accomplish this.
It is not just these deaths that we are concerned about. It is the 250,000 low birth weight babies that are born in this country, that not only run up high costs for neonatal intensive care, but even after we have invested all the dollars required in intensive care, we have to often put money into remedial education and supporting programs for the rest of the lives of these infants that had problems during gestation. We have to do more here, and this is a healthy start at accomplishing what we are capable of doing.
BREAST AND CERVICAL CANCER MORTALITY PREVENTION If we could go to the next chart, this is an illustration of CDC's breast and cervical cancer mortality prevention program. This shows how we are channeling funds so we can do something about these preventible deaths that are caused in women by breast and cervical cancer. This is a high priority of the Public Health Service.
Senator Adams. Before you move on from that, Doctor, if I might, you have spent a considerable amount of time both in this commit tee and elsewhere, and I was pleased to see the administration has requested additional funding for breast and cervical cancer mortality because we have found that it is rapidly increasing among older women. Being the chairman of the Subcommittee on Aging, and we find with women over 65 the morality rate and the breast cancer rate is going up at an exceedingly rapid rate.
I would like first just to ask you whether or not that is correct; and second, whether or not you are pressing ahead to use RU486. I know it had fallen victim to the abortion fight, but RU486 apparently is an effective and at least seems to be one of the most promising drugs for treating breast cancer. Is that
correct, Doctor? Dr. MASON. I am not sure that I can confirm that it is a particularly promising drug for the treatment of breast cancer. It is a promising drug for the treatment of some of the endometrial and carcinomas of the uterus. This is still experimental and being looked at largely in other countries. I do not think it has really been applied to breast cancer.
Senator ADAMS. But it has to cervical cancer?
Dr. MASON. For cervical endometrial cancers, it looks like it may have some usefulness there. At least it needs to be looked into further.
Senator ADAMS. What I am really asking, Doctor, is, given the potential lifesaving aspects of this, is the Department going to continue to support a ban on research on this drug?
Dr. MASON. The Department has never had a ban on research on the drug.
Senator ADAMS. Good. Then I can take that as a statement that you will continue with your research on the drug.
Dr. MASON. We have two items going on. We have intramural research, and we have research that is being done in the private or public sector. To move ahead in the context of the Food and Drug Administration, we need a sponsor who submits applications for that purpose and for purposes like treatment of cancer. I know of no ban on RU486.
Senator ADAMS. Thank you, Doctor.
DEATHS AMONG WOMEN FROM BREAST, CERVICAL AND LUNG CANCER
For the Period 1960-1989 220
CANCER OF THE BREAST Dr. MASON. I think this next chart illustrates your point on the increase in deaths among women from cancer of the breast. When you count the number of deaths that are going up, if you look at rates in our population then it is almost level, but the number of cases is going up.
What I really wanted to show is not only the number of deaths due to cancer of the breast in women but what has happened now with cancer of the lung, which is absolutely surpassing the number of deaths due to cancer of the breast. That comes back to our earlier discussion that tobacco is public health enemy No. 1 in the United States.
Dollars in Millions
IMMUNIZATION/VACCINE DEVELOPMENT 550 PHS Vaccine Development
$495 500 CDC Immunization
$192 $307 300
$187 $142 100 50 0
FY 1989 FY 1990 FY 1991 FY 1992
IMMUNIZATION AND VACCINE DEVELOPMENT If I could have the next chart, please. I do not want to spend time on this because you will be hearing from Dr. Roper, but I just wanted to indicate that immunization and vaccine development is a high priority, and we are delighted to see increases there. That is one of the administration's priorities. REPORTED MEASLES CASES, ,
UNITED STATES, 1950-1990*
1950 1952 1954 1956 1959 1960 1962 1964 1966 1969 1970 1972 1974 1976 1970 1900 1902 1901 1906 1900 1900 Through week 51, 1990.