- 47 The Division also prepared 1 special report, 1 technical memorandum, and 3 background papers: O New Developments in Biotechnology: Ownership of Human Tissues and Cells (Special Report) o Technology-Dependent Children: Hospital v. Home Care (Technical Memorandum) Health Case Study #37: Nurse Practitioners, Physician Assistants, and Children's Mental Health: Problems and Services O Public Perceptions of Biotechnology In addition, the Division produced 14 staff papers and testified 10 times. Listed below are several examples of direct legislative use of the Division's work: Biological Applications 1. Several Senators, led by Senator Chiles, Chairman Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, Senate Committee on Appropriations, relied extensively on the findings of OTA's report, Losing a Million Minds: Confronting the Tragedy of Alzheimer's Disease and Other Dementias, in their requests for funding provisions for Alzheimer's disease in P.L. 99-660, the Omnibus Health Act. The report has been widely cited as justification for legislation concerning Alzheimer's disease and other dementias at both state and federal levels. Because of expertise developed during this assessment, P.L. 99660 stipulated that the Director of OTA appoint a citizens advisory panel on Alzheimer's disease to advise the Secretary of DHHS, a newly created interagency Council on Alzheimer's Disease, and the Congress. 2. OTA staff for Losing a Million Minds worked jointly with the Congressional Clearinghouse on the Future to conduct a congressional staff briefing on the subject of federal policies related to dementia. Staff of OTA's assessment of New Developments in Biotechnology provided This large assessment is composed of several pieces that have been used by different committees: Findings from Ownership of Human Tissues and Cells prompted the Committee on Science, Space, and Technology to request that the Department of Health and Human Services review existing regulations for the protection of human subjects in research with respect to policy options outlined by OTA. DHHS responded that it favored the "Take No 48 OTA testified before the Subcommittee on Hazardous Wastes and Toxic Substances, Senate Committee on Environment and Public Works, on information derived from its background paper, Public Perceptions of Biotechnology. OTA also testified before this subcommittee on Field Testing Engineered Organisms: Genetic and Ecological Issues, and briefed staff of the House Committee on Energy and Commerce, Subcommittee on Investigations and Oversight, and the House Committee on Science, Space, and Technology on background information, potential topics for oversight hearings, rosters of witnesses for hearings, and possible legislation related to release of genetically engineered organisms to the environment. As part of the study of U.S. Investment in Biotechnology, OTA staff consulted with staff from the Senate Committee on Agriculture, Nutrition, and Forestry, and the Senate Committee on the Judiciary, Subcommittee on Technology and the Law in planning the committees' hearings on agricultural biotechnology, which were held in November 1987. OTA staff assisted congressional staff in the selection of witnesses and the preparation of questions for the hearings. Staff from the House Committee on Science, Space, and Technology have sought OTA staff expertise on agency biotechnology budgets as they conducted oversight investigations of agencies funding deliberate release field trials. Throughout the summer, OTA worked with staffs of Senators Domenici, Kennedy, and Chiles as they attempted to reconcile their respective versions of an Omnibus Biotechnology Bill. Staff assigned to the study of Patenting Life assisted staff of the House Committee on the Judiciary, Subcommittee on Courts, Civil Liberties, and the Administration of Justice, in developing topic areas and identifying potential witnesses for their series of four hearings on patents and the constitution, with particular reference to patenting animals. 3. The House Committee on Science, Space, and Technology was assisted by staff of OTA's assessments of biotechnology and Mapping Our Genes during preparation of hearings, held July 1987, on medical applications of biotechnology. 4. As part of the ongoing assessment of Confronting Infertility, OTA presented testimony on the reproductive health of veterans to the Subcommittee on Hospitals and Health Care, House Committee on Veterans' Affairs, during its hearing on H.R. 3161, a bill to provide care for veterans with service-connected disabilities affecting procreation. Staff of the Senate Committee on Veterans' Affairs consulted periodically with OTA concerning S. 6, the Senate counterpart of H.R. 3161. During the first session of the 100th Congress, OTA prepared rosters of potential witnesses for committees planning hearings on various aspects of infertility, including the House Select Committee on Children, Youth, and Families (Alternative Reproductive Technologies), the House Committee on Post Office and Civil Service, Subcommittee on Civil Service (Federal Employees Family Building Act), and the House Committee on Energy and Commerce, Subcommittee on Transportation, Tourism, and Hazardous Materials (Surrogate Motherhood). 49 Food and Renewable Resources 5. Publication of the OTA report, Technologies to Maintain Biological Diversity, was followed by two hearings on that subject, with OTA's testimony as the lead during the first hearing before the Subcommittee on Natural Resources, Agriculture Research, and the Environment, House Committee on Science, Space, and Technology. Several of the options for congressional action illustrated in the report were incorporated into draft legislation which was the topic of the second hearing. In addition, OTA staff suggestions were solicited to assist in the above hearings and in drafting legislation. OTA expects to provide additional support in refining the draft legislation. 6. The OTA report, Integrated Renewable Resource Management for U.S. Insular Areas, provided a congressional option outlining the need to establish a new Subcommittee in the House Committee on Interior and Insular Affairs. Later this committee established a new Subcommittee on Insular and International Affairs. One of their first activities was release of the OTA report to the public, during which the Chairman reported that consideration of the assessment options would be part of their first year agenda. Subsequently, the Subcommittee held two days of hearings on the report, with OTA testimony as the lead, designed to uncover insular and federal reactions to the report. 7. The OTA report, Continuing the Commitment: Agricultural Development in the Sahel, was used extensively during the bipartisan, bicameral staff discussions on reauthorization of the Foreign Assistance Act of 1961. These discussion took place over several months and OTA staff participated in several working groups throughout the period. OTA's findings and options were part of various legislative proposals and OTA suggested additional experts to draw into the process. Pending legislation would draw upon OTA for an evaluation of certain new provisions' effectiveness and for identifying private voluntary organizations that provide sound technical assistance. The House Committee on Foreign Affairs, Subcommittee on Africa, again drew upon this work when issues raised by OTA were included in oversight questions directed to the Agency for International Development. 8. The OTA report, Technology, Public Policy, and the Changing Structure of American Agriculture, has been used by the House Committee on Agriculture in considering amendments to the Food and Security Act of 1985. Specific amendments included changes in dairy, feedgrains, and credit titles. Information from the report was cited as rationale for not making changes in dairy and feedgrains titles. Information on agricultural credit has been used in debate of separate legislation to provide federal funds for the Farm Credit Association. 9. Staff of OTA's assessment of Technology and Public Policy to Enhance - 50 Health 10. The congressionally-mandated Task Force on Technology Dependent Children has used OTA's technical memorandum, Technology Dependent Children, as the basis for its deliberations, adopting OTA's definition of technology dependence and its estimates of incidence and prevalence. OTA has also briefed staff of the Senate Committee on Finance on the study and responded to informal requests for assistance in developing legislation for such children under the catastrophic health insurance bill. Pending legislation (in the Budget Reconciliation package) mandates a more general OTA study of disabled and chronically ill children. 11. As part of its ongoing assessment of Healthy Children, OTA has held discussions and meetings with staff of the Senate Committee on Labor and Human Resources on coverage of preventive services for children under various legislative proposals. The results of the assessment regarding the potential of alternative preventive strategies for reducing health care costs or improving health outcomes for children are expected to be used in discussions regarding the bill dealing with preventive services that was recently introduced into the committee. 12. At the suggestion of the House Committee on Appropriations and with the support of the Technology Assessment Board, OTA established an AIDSRelated Activities project in June 1987, in order to anticipate and advise Congress on AIDS issues without necessarily waiting for Committee requests to conduct specific studies. On October 19, 1987, based partly on information provided to OTA by staff of the Subcommittee on Regulation and Business Opportunities, House Committee on Small Business, OTA assessed the accuracy of AIDS antibody testing, which pointed out the need to monitor laboratories performing AIDS antibody testing and the problem of significant errors in testing if populations with very small percentages of antibody-positive persons were to be tested. Introduction of legislation to monitor laboratories engaged in AIDS antibody testing is expected, and the OTA analysis will also be used in the continuing legislative debates on whether mandatory testing of selected populations is warranted or not. 13. A 1980 report on Compensation for Vaccine-Related Injuries played an instrumental role in passage of legislation in the 99th Congress to compensate for injuries from childhood vaccination programs. Establishing the funding levels was postponed until the 100th Congress. The Congressional Budget Office, based on OTA's analysis, estimated that over 200 cases would be compensated yearly. OTA, at the request of the House Committee on Energy and Commerce, reexamined its data and pointed out that the 200 cases represented OTA's high estimate, and that its best-guess estimate was 60-80 compensation cases yearly. The House decided to authorize payments for up to 150 cases per year. 14. OTA presented testimony in three House and Senate Committee hearings on the President's initiative on drug testing of the federal work force. OTA's testimony emphasized the variability initially allowed by federal agencies on whom to test and the types of drugs which could be tested for, and on the need for proficiency and certification programs for laboratories performing urine drug testing, because of past and current - 51 studies on how poorly these labs have performed. OTA continues to advise congressional staff (e.g., Senate Committee on Veterans' Affairs) as the federal drug testing program is being implemented. 15. Publication of OTA's assessment of Indian Health Care led to requests for two follow-on studies. OTA produced a paper on Clinical Staffing for the House Committee on Energy and Commerce and later testified before that committee, as well as the House Committee on Interior and Insular Affairs and the Senate Select Committee on Indian Affairs. The House version of related legislation included the principal OTA suggestion that loan repayment through service in underserved areas rather than continuing with NHSC scholarships be adopted. OTA also studied the Health Status of Native Hawaiians, and its analysis and findings were used by the Senate Select Committee on Indian Affairs to introduce a bill to fund demonstration programs to improve the health of Native Hawaiians. 16. As a result of OTA's workshop and staff paper on Bone Marrow Transplantation Using Unrelated Donors, the House Committee on Energy and Commerce has proposed legislation (to amend the Organ Transplant Act) to transfer responsibility for a national registry of potential bone marrow donors from the Navy to the National Institutes of Health. 17. During preparation of the OTA case study, Nurse Practitioners, Physician Assistants, and Certified Nurse-Midwives: A Policy Analysis, OTA staff testified before the Subcommittee on Compensation and Employee Benefits, House Committee on Post Office and Civil Service, on whether the care provided by these practitioners was of sufficient quality to warrant direct reimbursement. The subcommittee was considering the issue of mandating reimbursement for these providers under the Federal Employees Health Benefits Program (legislation was introduced and reported out to the full committee). The House Committee on Energy and Commerce, Subcommittee on Health and the Environment, used a draft of the case study in preparing legislation regarding the issue of reimbursement for physician assistants. Legislation requiring reimbursement for physician assistants in specific settings was enacted as part of the Omnibus Reconciliation Act of 1986. 18. The House Committee on Government Operations, Subcommittee on Government 19. OTA has discussed its report on Identifying and Regulating Carcinogens with staff of the Senate Committee on Governmental Affairs, which is planning to hold hearings on regulatory reform, particularly concerning |