Senator HUGHES. The Chair calls Dr. Robert Parrott, chairman of the Department of Pediatrics, Childrens Hospital, Washington, D.C. Dr. Parrott is a member of the Committee on Infectious Diseases. He is here today representing the academy. Dr. Parrott, you may proceed with your testimony. STATEMENT OF ROBERT H. PARROTT, M.D., AMERICAN ACADEMY OF PEDIATRICS Dr. PARROTT. I am a pediatrician, a member of the Committee on Infectious Diseases of the American Academy of Pediatrics and I am also director of Children's Hospital of the District of Columbia and chairman of the Department of Child Health and Development, George Washington University Medical Center. For the American Academy of Pediatrics and for myself I am here to support the provisions and concepts of S. 3442 which would resurrect support for distinct authority and mandate to the Department of Health, Education and Welfare to eradicate those communicable diseases for which the tools of eradication exist. The academy supported the original Communicable Disease Control Amendments Act of 1972 and believes that specific authority and funding should be provided for these purposes in a continuous way, which would allow for program development that would lead to eradication of these diseases. Why are we concerned? Why a distinct authority on special funding? Our concern and frustration are that we know medically what can be, one in the instances of diphtheria, tetanus, and whooping cough as well as poliomyelitis, measles, and rubella. We know that immunization will work. Under the impetus of the earlier Vaccination Assistance Acts we have attained increased levels of protection against diphtheria, tetanus, and pertussis over those ever attained before. We have virtually wiped out poliomyelitis. We began a massive reduction in measles incidence including reduction in fatal encephalitis. We turned the tide of rubella infection with a resultant reduction in the horrible fetal wastage and anomalies that result from maternal rubella infection. But more needs to be done; we cannot relax. In the case of all of the above-mentioned diseases there is reason for concern that immunization levels are dropping, particularly among our less informed and helpless families, usually in our major cities. With the information and tools at hand we should not have even one case of measles, encephalitis, or one damaged heart as a result of rubella. Consider in the case of measles the estimates of Finkel for what was accomplished with immunization between 1963 and 1968: 9.7 million cases of measles were averted, 3.000 cases of mental retardation were prevented, 973 lives saved, 505,000 days of hospitalization were avoided and 32 million days of absence from school averted. It is estimated that this was worth $423 million. Continued strong support which is earmarked for these purposes is needed. We need more funds for vaccination assistance and information programs and particularly for outreach efforts to find pockets of unprotected children and protect them. Without a distinct authority directed to these problems the chance exists that they will become lost. in the massive HEW haystack, or in similar haystacks in the various States. Funds, in fact, have been reduced under previous authority. We ask renewed special attention to immunization on programs and fuller funding for these programs. We also direct our concern specifically to the need for the designation of similar authority in S. 3442 to awaken our country, its citizens and its medical establishment to the fact that gonorrhea and syphilis, those hush-hush diseases of the past, are present in epidemic proportions. We must and can mobilize our collective resources to eliminate these diseases before they become the plague of the 1970's. The facts are indeed frightening. It is estimated that there will be 600,000 reported cases of gonorrhea in 1 year and it is well known that only a limited number of cases are reported. How is it that such an epidemic could have taken hold in our country? Perhaps the problem is in part that we cannot as a nation of puritan heritage accept the idea that even our very young children could possibly have these so-called social diseases. Perhaps we cannot stomach the fact that this epidemic of diseases thought by most to be a thing of the ghetto is broadcast through every social and economic stratum in our country. We must take our heads out of the sand. A massive public-private effort is needed such as could be launched with the help of a special HEW authority and mandate in S. 3442-or, if necessary, in a separate bill such as S. 3187-We must: (1) open our eyes to the fact that gonorrhea and syphilis exist up and down the street from each of us; and (2) open our minds next to the need for much fuller sex and health care education for youngsters but also for all of us. Like it or not, the age of reproductive sex activity has become lower and the mores of our society are freer. There is little thought to the consequences. If this is so at least the preventable and treatable consequences must be made known to the public and then prevented and/or detected and treated. Because the problem is so broadcast and because both our general attitudes and knowledge are so limited, a public authority is needed. This can spur and finance a public-private effort to stem the tide. In brief, then, we ask your support for extension and broadening of the Communicable Diseases Control Amendments Act with special funding authority to permit a broad scale attack on communicable diseases in our country. Senator HUGHES. Parrott, thank you for your statement. Could you tell us why we cannot just rely on existing 314 authority? Dr. PARROTT. In our view, these are special problems, particular problems, and under the 314 authority they will be lost in the shuffle. They have been in the past in the proposed appropriations. For the upcoming year-not what I have heard this morning-but from what I had understood, there was a reduction in funding for these programs. I think I did hear Mr. DuVal this morning speak of revising the appropriations request. Senator HUGHES. As you put it in your statement, you feel they would just be lost in the haystack of bureaucracy. Dr. PARROTT. Yes, sir. I think there is another reason for a special act, which is to call public attention to the problems, both the prob lem of those diseases which can be eradicated by vaccination and the VD problem. I think a special act is more likely to lead to special public attention and special public education than programs which are carried out through 314 authority. Senator HUGHES. You mentioned 600,000 reported cases of gonorrhea. Do you have any way to make an estimate of what you feel the accurate figures would be? Dr. PARROTT. I suppose you could extrapolate from the figures that were just given a minute ago, but it is said that it is at least six times that by some authorities. The problem is very much wrapped up in what was being discussed a moment ago. I think, particularly for young people, the reported incidence is much lower than what actually goes on. Senator HUGHES. Senator Dominick. Senator DOMINICK. Thank you. Doctor, I will be very brief. One, there is a provision in the venereal disease bill for a separate State plan. Do you see any need for a separate State plan, or could it not be included in the comprehensive health plan? Dr. PARROTT. I think there could be similar advantages in having separate State plans, as there are advantages in having separate Federal legislation, that is, earmarking, calling public attention and local government attention to the problem. However, Senator, I am not familiar enough personally with how State plans are developed to be able to comment further on that. Senator DOMINICK. Most State plans, unless they have been brought in and approved, are stacked away in a warehouse somewhere, and no one ever sees them again. It strikes me if we had a comprehensive health plan, which we do in most States, we could just include this as part of that, so you would not have to go through the extra paper work. Do you see any objection to that really? Dr. PARROTT. No, not the way you put it. Senator DOMINICK. Secondly, do you have any comment and maybe this was what the chairman was referring to on this problem of the physician-patient privilege insofar as followup is concerned on venereal disease problems? Dr. PARROTT. You should know that this is a very peculiar problem for those who deal with children. Legally, a physician or a health service has been required to have parent's permission in carrying out any kind of treatment for a minor, for an individual under 21. To take the case of gonorrhea, about 20 percent of the gonorrhea is occurring in individuals under 20. Many young people will not seek treatment lest their parents learn about their problem. A number of States have introduced either legislation or regulations that eliminate the requirement for a physician or health service to get a parent's permission in the case of venereal disease treatment and in certain other types of treatment. But it is complex because many feel if one is going to attack the problem in the long run, attack the problem of teenage pregnancy, for example, and work out a program of real advantage to the family and the youngster, that it would be of advantage to get the family involved. 78-669 0-72—11 |