The MacNeil/Lehrer NewsHour

MR. LEHRER: Good evening. Leading the news this Tuesday, the cost of bailing out the savings & loans got raised again and Pres. Bush offered the Soviets $1.5 billion in grain credits. We'll have the details in our News Summary in a moment. Judy Woodruff is in New York tonight. Judy.

MS. WOODRUFF: On the NewsHour tonight we start with efforts by Congressional Republicans to salvage a civil rights bill. We have a News Maker interview with Sen. John Danforth, author of a key compromise proposal. Then a look at tomorrow's big election in the Russian republic, and we spend the rest of the program on two of the biggest killers of American women and ask whether doctors and researchers are doing all they can in the way of prevention. On breast cancer we have a four way debate and on heart disease, Tom Bearden has a documentary report. NEWS SUMMARY

MR. LEHRER: The price tag on the savings & loan bailout increased again today. The man who raised it was Charles Bowsher, head of the General Accounting Office. He told a Senate committee the agency in charge of the bailout, the Resolution Trust Corporation, had already spent more than the $80 billion appropriated by Congress. The RTC is trying to close, take over or merge 684 failed savings & loans. At today's hearing, Senators asked Bowsher how much more that will cost.

MR. BOWSHER: I think it'll be at least 50 billion, and it might be as high as 75 -- as they have used themselves.

SPOKESMAN: We've been in for 80 and we're in for another 50 or 75 more.

SPOKESMAN: Yeah. You're looking at 150 billion through '92, in the ballpark.

MR. LEHRER: The Federal Deposit Insurance Corporation issued its quarterly report on commercial banks today. It showed earnings down 8.8 percent over the same time last year. FDIC Chairman William Seidman said the recession was to blame. He said recovery for the banking industry is not likely until the end of the year. Pres. Bush also talked about the recession today. He did it in a speech to a convention of advertising executives in Nashville, Tennessee. The speech was transmitted from the White House by satellite.

PRES. BUSH: I am bullish on the economy, not overly optimistic, not Pollyannish about it, but while some sectors are still sluggish, on the whole, a turnaround in the economy appears to be in the making. I don't want to be in the prediction business. What a President says on this can adversely affect markets and all of that. But according to the just released May unemployment report, over half of all industries added to their payroll industrial production has also been rising, and such upward trends will continue according to the Index of Leading Indicators.

MR. LEHRER: The United States had a foreign trade surplus in the first quarter of 1991 for the first time in almost nine years. The Commerce Department said the surplus amounted to $10.2 billion but said it was mostly due to the 22.7 billion Saudi Arabia and other countries paid for the Gulf War. Today's report deals with the so- called current account that is the broadest measure of foreign trade. Judy.

MS. WOODRUFF: The Bush administration has decided to give the Soviet Union $1 1/2 billion in credit guarantees to permit the purchase of U.S. grain. Pres. Bush informed Pres. Gorbachev about the decision today. White House Spokesman Marlin Fitzwater said the program would come in three stages, $600 million in guarantees this month, 500 million in October, and the final 400 million next February. Fitzwater spoke in the White House briefing room.

MR. FITZWATER: In making this decision, the President took into consideration the record of the Soviet government in meeting its official obligations. The President's decision also followed assurances from the Soviet government that the grains made available through the credit guarantees would be fairly distributed among Soviet republics and the Baltic states. The President's decision reflects the administration's desire to promote a continued positive evolution in the U.S.-Soviet relationship. In particular, we hope that this assistance will help to stabilize the food situation in that country.

MS. WOODRUFF: Soviet hardliners made a last ditch effort to smear Boris Yeltsin on the eve of the Russian republics' first Presidential election. Yeltsin is the front runner among six candidates for the post. Communist Party newspapers today published reports attempting to link him with a billion dollar scandal. The party has endorsed former Soviet Prime Minister Nikolai Rishkov. But polls show him a distant second to Yeltsin. We'll have more on the story later in the program.

MR. LEHRER: An Amnesty International official said today trials in Kuwait of suspected Iraqi collaborators are defective at every critical stage. He testified before a congressional committee. Another human rights official said violent emotional reaction to the Iraqi occupation has now given way to organized torture and sometimes killings. Oil well fire fighter Red Adair also had bad news about Kuwait for Congress. He told Senators, reports that Kuwait's oil fires could be put out within a year were a bunch of malarkey. He said it might take five years to put out the 500 wells still burning. He also said fire fighting efforts would go faster if Kuwait provided enough water and other supplies.

MS. WOODRUFF: That's it for our summary of the day's news. Just ahead on the NewsHour, a compromise on a civil rights bill, tomorrow's election in the Russian republic, and two of the biggest health threats to American women, breast cancer and heart disease. NEWS MAKER

MR. LEHRER: Civil rights and Sen. John Danforth are our lead story tonight. The political war over a civil rights bill moved this week to the Senate. Sen. Danforth, Republican of Missouri, is leading a compromise effort to end the blood letting. We will talk to him right after this backgrounder by Roger Mudd.

PRES. BUSH: We have a good record on civil rights and we had a good history of fair play. And I want a fair, strong anti- discrimination bill that will guarantee workers' rights, women's rights, workplace rights, but will not create quotas.

JOHN JACOBS, National Urban League: [June 3, 1991] The ugly truth behind the quota smear is that cynical political leaders are trying to turn a civil rights issue into a political issue that plays on irrational fears and latent racism. For the sake of what they think are extra votes, they are willing to abandon America's ideals of fairness, subvert civil rights protections, and encourage racial divisions.

MR. MUDD: It was in the midst of that politically charged atmosphere that the House debated civil rights last week. The main battle was between a bill sponsored by the House Democratic leadership and a bill sponsored by the White House. Both were designed to reverse parts of several 1989 Supreme Court decisions which had made it harder for employees to sue for discrimination. The Democratic plan would ease some of the tough standards for employees who felt they were victims of discrimination. It would also put a limit of $150,000 on punitive damages awarded to women, but not to other minorities who could prove discrimination. The Democratic bill would specifically outlaw job quotas for minorities. The Republican bill would have eased some of the tough standards on employers who discriminate. Only in cases of deliberate sexual harassment could women collect damages, but not more than $150,000. The Republican bill contains no mention of quotas. In last week's debate, the Republicans insisted the Democratic proposal was a quota bill.

REP. HYDE: The practical and predictable consequences of this bill, notwithstanding its contrary assertions, is to institutionalize color, ethnic and gender preferences under the false flag of civil rights. By stacking the deck against employers, they've made this a quota bill and as Lady MacBeth said, "All the perfumes of Arabia won't sweeten it."

REP. GEPHARDT: It's the first time that an administration has tried to divide America on the basis of race in order to score points in a political campaign. Well, while we're disappointed by their actions, we're not surprised.

MR. MUDD: As expected, the Democratic leadership bill passed the House but it fell 15 votes short of the minimum needed to override the veto Pres. Bush has promised. And without a veto proof bill, both sides claim victory. The climate on Capitol Hill remained edgy and partisan.

MR. LEHRER: And that brings us to Sen. Danforth, author of a compromise supported also by eight other Republicans. He joins us from Capitol Hill. Senator, welcome.

MR. MacNeil: Thank you, Jim.

MR. LEHRER: First, how does your bill differ from this one that passed the House last week?

SEN. DANFORTH: I'm not sure how badly you want to know, because this is lawyer stuff largely, very, very technical. What we tried to do, the basic strategy, is to hit the reasonable middle, to have a balanced proposal that gives employees who have been discriminated against a reasonable opportunity to make the case in court, and if they've been injured to recover. On the other hand, to give employers an opportunity to defend themselves without resorting to quotas.

MR. LEHRER: Well, let me ask --

SEN. DANFORTH: So the basic strategy was to hit the middle.

MR. LEHRER: And you feel you have?

SEN. DANFORTH: I feel that we have and I think one of the gratifying things is that in the last week since we introduced the legislation we received a lot of positive comments from a whole variety of people, Republicans and Democrats, who think that we're trying to do the right thing.

MR. LEHRER: Is your bill a quota bill?

SEN. DANFORTH: Our bill is definitely not a quota bill. We are trying to make it clear that under no set of circumstances would we favor a quota bill or do we want that kind of result. We want it possible for aggrieved people who have been discriminated against to make a case. We don't want them to be shut out of the courthouse. On the other hand, we want employers to be able to defend themselves to show that their practices are matters of business necessity, that whatever they're doing is justified, without having to resort to quotas.

MR. LEHRER: Well, the Republicans, your colleagues in the House, said that the Democratic version, the one that passed last week, left the employers with no other choice than to instill or to institute quotas that they, in fact, wanted to avoid having to pay off under that law. Does your bill change that in some way?

SEN. DANFORTH: Well, I think it does. Without getting into a characterization of what the House bill did or did not do, what we are trying to do is to allow the employers to be able to demonstrate that whatever their employment practices are they're justified by business necessity, that their practices have a manifest relationship to the effectiveness of a person doing the job or to the interests of the business. So the idea is to have a balanced approach. If the employee is truly being discriminated against, then the employee should have his or her day in court. On the other hand, the employer should not have to have very artificial hiring practices in order to create some numerical balance.

MR. LEHRER: Senator, why are you trying so hard to reach a compromise?

SEN. DANFORTH: I think that there is a very widespread view in this country on the question of fairness in employment. People want to be hired and want others to be hired on the basis of how they can do the job, not on the basis of race or religion or gender, and they also don't want to be shut out of the workplace or be discriminated either for or against on the basis of those reasons. So I think that when we have a broad national consensus, we should try to remove the issue from partisan politics. We should try to resolve it in a way that I think meets the national consensus. I think this is a case where the politicizing of the issue instead of building on the national consensus has tended to fragment the country and I think that that's the worst thing politicians can do. I think that the basic task for those of us in the public forum in elected politics is to try to build bridges and to try to build a consensus in the country and to build on that consensus, and not attempt to create issues or take advantage of the issues that may be polarizing and that may be of advantage politically, but that are very bad for the country.

MR. LEHRER: I take it then that you believe that this debate that has gone on these last few weeks, particularly in the last several days, has not been healthy for the country?

SEN. DANFORTH: I think that the debate has been very bad for the country and there are very few debates that I would say that about, but I think that this is a case where it has been bad. This country really depends on all kinds of people, all kinds of groups and races and religions having a reasonable accommodation to each other and having a basic standard of fairness in dealing with each other. One of the pieces of conventional wisdom in elected politics is that the more you try to strongly define a position, take a position which is extremely clear, the better off you are. So the polarizing issues, the political consultants tell you the polarizing issues are advantageous. Be clear, be combative, hit the hot buttons, win the election. But I think that in the case of race or religion or gender or disability, in the case of the basic fairness of the system, that kind of polarizing issue is a very big problem and is very bad for the country.

MR. LEHRER: So when in this case both sides accused the other of trying to make political hay out of this, what you're suggesting is that there is political hay to be made because the issue is so divisive, is that correct?

SEN. DANFORTH: There is political hay to be made and, you know, I have heard people say that this shows up in the polls. We can win seats. We can win seats in the House and win seats in the Senate by playing the race card or by playing the quota card in politics. I think it's not worth the seats. I think that it's just too much damage to the country. I want to say this also, Jim. I am absolutely convinced that the President wants to resolve this. I think that he is making a very good faith effort. I think that his own legislation while it's not going to become law is a serious effort to try to resolve this and from my discussions with the President, while this was a live issue last year, I think he also wants to get it out of partisan politics.

MR. LEHRER: Has he signed on to your bill?

SEN. DANFORTH: No, but the good news is that there was a very extensive discussion at the staff level that began at 1 o'clock this afternoon and lasted almost five hours.

MR. LEHRER: This afternoon?

SEN. DANFORTH: Yes. And it will resume again tomorrow, going into with very great detail line by line into the proposed legislation. I think that that's constructive. I think we're now at a point where we're trying to work out the differences.

MR. LEHRER: The word has been, as you know, Senator, that the President really hasn't been the complete problem, that two of his key staff members, Chief of Staff John Sununu and his White House Counsel, Boyden Gray, have been the real stumbling blocks. Can you confirm that?

SEN. DANFORTH: Well, I've spoken with Gov. Sununu a number of times in general terms. I mean, we have not gone into the details, but in very general terms, and I also worked with him last year in considerably more detail about the legislation. And he has encouraged me to try to work something out. That doesn't mean that he signed on. That clearly is not the case. He's representing the President. He represents him very ably. But Gov. Sununu last year put a lot of time into working something out and he has been very encouraging in my effort so far, not signing on, but at least in trying to accomplish something.

MR. LEHRER: How would you read the sentiment on the other side, your fellow Missourian -- we just saw him on a clip -- the House Majority Leader, Richard Gephardt, in the Senate, Sen. Kennedy, who's leading the other side -- how do those people, how are they reacting to your bill?

SEN. DANFORTH: Sen. Kennedy has used the word "constructive." He has some problems with some of the points in the bill and I would expect that, and I would expect that also from the White House. But he has stated that it's constructive. Congressman Gephardt spoke to me about this late last week, very warmly about it, and the good news is that we've received such favorable comments from Democrats and from Republicans and really from all kinds of people. I think that there is a generally held view in the country and here in Washington as well, generally held, not universally, that we should try to resolve this issue, that we should try to come up with balanced legislation that deals with the problems that were created by the Supreme Court, that we should not favor an approach which discriminates against people or in favor of people because of their race or other reasons. So I think it's been a very positive response. That's not to say that there aren't mountain ranges to cross in the future. There certainly are, but it's been very positive.

MR. LEHRER: How are you going to -- finally, how are you going to resolve this political thing? How are you going to get political people to back off of a political advantage that they might otherwise get?

SEN. DANFORTH: Well, it's a very fluid situation. I'm not really sure what the answer to that is. It's sort of one step at a time. We start out with nine Republican Senators who co-sponsored this and they have really been heroes, and then we move on from them step by step and there has been some interest among some Democrats in possibly joining on or at least being supportive. The discussions are going forward with the administration and somehow we hope it all works out.

MR. LEHRER: And shame each person as you go one step at a time.

SEN. DANFORTH: One step at a time.

MR. LEHRER: All right. Senator, thank you very much. FOCUS - SMEAR CAMPAIGN

MS. WOODRUFF: Next tonight the election of a president of Russia. Tomorrow for the first time in history, Russian voters in the Soviet Union's largest republic will choose a president. Boris Yeltsin, the current president, has a commanding lead. But as Gaby Rado of Independent Television News reports, that has not silenced his opposition.

MR. RADO: Today's Soviet press has turned their lackluster presidential campaign into a dirty one. The right wing newspapers have revived some old allegations against Boris Yeltsin and they've chosen this moment to publish a damaging report by the Soviet prosecutor general which may be politically motivated. Pravda resorts to tabloid style tactics, so-called experts analyze the Russian leader and find him power hungry, and inconsistent. Yeltsin's also been criticized for refusing to take part in last night's pre-election TV debate. An empty chair was pointedly left for him on the studio floor. The other, more obscure, candidates tried to make capital out of it.

VLADIMER ZHIRINOVSKY, Candidate Russian Presidency: [Speaking through Interpreter] I can't ignore your remarks about the absence of the candidate. Millions of viewers are now watching solely to see all six candidates here. If at the moment he's on a night plane going somewhere, it shows his utter disrespect for millions of people.

MR. RADO: The elusive Yeltsin has, however, found the time to put in an appearance at his old power base, the city of Sverdlosk in the Urals. It was here that he rose from a job as a construction engineer to that of first Communist Party secretary, and it was here that he was noticed by Mikhail Gorbachev. Not that there was anything in Sverdlosk which could be called election fever; the only bit of passion was displayed by a woman objecting to some of Yeltsin's campaign literature. The candidates in this election have kept their campaigns low key throughout to show the voters they have no big party machine behind them. Last night tens of thousands gathered in the center of Moscow to show that they considered a Yeltsin victory a forgone conclusion. But the Russian leader refused to take part in that event too. His tactic is clearly to stay aloof, above the fray, to behave in a presidential manner. That's why he has decided to ignore the smear campaign against him.

ANDREI KORTUNOV, U.S./Canada Institute: Past experience at least showed that it is sometimes counterproductive because people do not believe what they read in Pravda, they don't believe what they see on the central TV, if it is directed against Yeltsin, and moreover, their conclusion is that if the party officials are trying to undermine Yeltsin, it means that basically Yeltsin is a person who got elected.

MR. RADO: Government-run television is accused of an anti-Yeltsin bias in its campaign coverage. The nightly news program Vremya has run an election update slot for two weeks now. There's a certain lack of polish, but the candidates' personalities and policies have emerged. Nikolai Rishkov, Yeltsin's main rival, who's backed by mainstream Communists, is often filmed in front of a portrait of Lenin. Badeem Bakatil, a former interior minister, is shown amongst ordinary people. He calls himself a common sense candidate and his main appeal is his relative youth and moderate politics. But few people doubt that Yeltsin will be the first popularly elected Russian president. The question is whether he'll win on the first round. The bigger mandate the people of Russia give Yeltsin, the stronger his hand will be in his future dealings with the Kremlin. One interesting effect these elections have had has been to put Mr. Gorbachev out of the limelight and that is of course exactly what the new post of Russian president is designed to do. Mr. Gorbachev has had a working relationship with Boris Yeltsin ever since they signed an agreement in April, but the Soviet leader won't want Mr. Yeltsin to win the presidency by too high a margin.

MR. LEHRER: Still to come on the NewsHour tonight, two women's medical stories, treating breast cancer and women and heart disease. FOCUS - BREAST CANCER

MS. WOODRUFF: We do devote the rest of tonight's program to two of the biggest killers of American women, heart disease and breast cancer, breast cancer first. New statistics show that an astonishing number of women are getting breast cancer and 1/3 of them are dying from it. What also is new is that women with the disease are getting more vocal and more active in urging federal and state governments to do more about it. A coalition of such groups surfaced today in Washington armed with the latest statistics. In 1960, one women in twenty would get the disease. Today it's one in nine. In all, there will be 175,000 cases of breast cancer this year and more than 44,000 deaths. Currently, the National Cancer Institute spends $77 million or less than 5 percent of its $1.6 billion budget on breast cancer research. A growing number of women don't think that's enough. And today breast cancer activists took their cause to the halls of Congress, holding a noon rally at the capital to call for a change in research priorities, and for more funding for breast cancer research.

REP. PAT SCHROEDER, [D] Colorado: No more nice. We're now going to get tough. We really want to see by the year 2000 that we have got the statistics on breast cancer turned around. We've got the research going in the right way. This is a very solvable problem.

MS. WOODRUFF: Breast cancer activists also want the National Cancer Institute to undertake studies on ways to prevent breast cancer, such as eating less fat and other changes in diet. And they called for increased availability of mammograms to allow for early detection of breast cancer. We begin with three different views on the battle against breast cancer. Pam Onder is one of the founders of the Breast Cancer Coalition, a national umbrella organization of activist groups. She is herself a breast cancer patient whose cancer is in remission and she is the president of the Greater Washington Chapter of the National Coalition of Cancer Survivors. Dr. Michael Friedman is the associate director for cancer therapy evaluation at the National Cancer Institute. And Dr. Susan Love is a breast surgeon and the director of the Faulkner Breast Center in Boston. Dr. Love is also a surgical oncologist at the Dana Farber Cancer Institute in Boston. And, Dr. Love, I want to begin with you. Were you at today's rally at the capital?

DR. LOVE: I certainly was, yes.

MS. WOODRUFF: What was the main message that you and the others in your group were trying to get across?

DR. LOVE: The message that we're trying to get across is breast cancer is really at epidemic proportions now and we can't put up with that anymore. We need more research money and we need to change the way that the research money is being allocated so that we really can make a difference and change the statistics. The mortality of breast cancer is the same now as it was 60 years ago. Now that's intolerable and we can't put up with that anymore.

MS. WOODRUFF: And you're saying it's primarily a research problem?

DR. LOVE: Oh, I think it is a research problem. We've made some small inroads. We know that early detection will help about 30 percent of women. But that's only 30 percent. And there are still a lot of women who will do their mammograms and find the tumor as early as they can and yet still will have had it spread. And we don't have the treatments to cure them right now. We need to really get the basic mechanisms of breast cancer so that we can treat it in a much more subtle way than surgery, chemotherapy and radiation, as we've been doing.

MS. WOODRUFF: Pam Onder, as someone who's had personal experience with breast cancer, do you agree with Dr. Love's assessment?

MS. ONDER: Oh, absolutely. I think that the message that we gave loud and clear this afternoon is that we have to solve breast cancer. Breast cancer needs to stop and it needs to stop in this generation before it goes on to our beautiful daughters and all the rest of the young women.

MS. WOODRUFF: What do you mean when you say it has to stop? I noticed one of the goals that the group was -- spoke about today was finding a cure --

MS. ONDER: Right.

MS. WOODRUFF: -- for breast cancer by the year 2000. Is that realistic?

MS. ONDER: Oh, it really doesn't matter if it's realistic or not. It's attainable and we will do it. I think that, as Susan was saying,all we know now how to do is poison, slash, and burn. And there's no preventative mechanism for breast cancer. I ran the marathon the year before I was diagnosed. I had a great diet. It's not in my family. It's just really something, you know, that shouldn't have happened at my age.

MS. WOODRUFF: Dr. Love, what do you mean when you and Ms. Onder and others refer to "poison, slash, and burn?" What are you talking about?

DR. LOVE: Well, we've been using basically the same treatments, chemotherapy, radiation therapy, and surgery, for breast cancer in variations for the last several years. And I think that those are very crude ways to deal with the disease. And they're the things that you use at the very end stage of the disease. Most breast cancers have been present for about eight to ten years by the time you can detect them on a mammogram or feeling a lump. And what we need is some kind of treatment that can intervene at year one or two, something in molecular genetics, something in genetic engineering that'll change things around. We have to get away from treating things at the end of the disease and really back to the very early stages.

MS. WOODRUFF: Dr. Friedman, let me bring you in at this point, with the National Cancer Institute. What about this principal point we're hearing here that not enough is being spent on research and that the preventive measures ought to be aimed at the very early stages of cancer, rather than at the end?

DR. FRIEDMAN: The rationale for preventing disease rather than treating disease is so solid for every kind of human illness that one can hardly argue with it here. In the past, it's been very difficult to identify those appropriate measures which might prevent or stop breast cancer at an early stage. I think we have some clues now. The opportunities are extremely bright and there are several large projects which either have been initiated or should be initiated shortly. All the physicians who care for breast cancer patients and all those who expect to care for breast cancer patients in the future are unsatisfied by the treatments we currently have. We must do better.

MS. WOODRUFF: When you say there are several large projects underway, what are you referring to?

DR. FRIEDMAN: There are at least three that come to mind quickly. The first is a Vitamin A type of trial which is being performed in women who are at some risk of breast cancer in order to see whether this Vitamin A compound can prevent breast cancer. And that's a study approximately halfway through its anticipated accrual. We expect it'll be several more years before we have firm information about that study. A second very large study is due to be initiated rather shortly. It will be using a drug called Tomoxathon. It's a hormonal way of trying to prevent breast cancer in women who have an increased risk of breast cancer. And there's a third, much more ambitious, very large trial, which is coordinated under Dr. Healy, the new director of the National Institutes of Health. As part of her overall effort to emphasize women health issues, this will be diet as a preventative.

MS. WOODRUFF: Well, Dr. Love, if all this is underway, then what is the complaint?

DR. LOVE: Well, one of the complaints is the diet study, for example, was first set up about five or six years ago. It's been approved and unapproved and it's been approved and never been funded so that we've had the potential or at least the study written to do a low fat diet as a prevention trial for years now and we haven't done it. And now, in fact, what's going to happen is that trial which was specific to breast cancer is going to be subsumed by this larger study of the NIH. It will be part of a larger goal and it's going to take much longer to find the answers that we want to know about breast cancer. So, yes, they have good plans, but we're not doing enough, we're not doing it fast enough, and. you know, we've been dragging our feet.

MS. WOODRUFF: What about that, Dr. Friedman, that these other tests specifically designed to look into the causes of breast cancer should have or might have gotten underway years ago and haven't?

DR. FRIEDMAN: Well, I think Dr. Love is correct when she says that these studies have been discussed for a number of years. It represents I think a real dilemma in the scientific community. The advisers to the National Cancer Institute argued, some passionately in favor of and some very much against those studies. That was a dilemma that we were forced to try and resolve. I disagree though with the idea that this new larger study will somehow be less precise or less valuable. In fact, I think it has the promise of being much more valuable. Not only will it tell us about breast cancer, but also other major causes of morbidity and mortality in women. And that comprehensive view I think has a tremendous appeal.

MS. WOODRUFF: Why can't you be satisfied with that, Dr. Love?

DR. LOVE: Well, I think that it's very important and it's certainly very exciting that a large amount of money is finally going to be put to women's health. I just think it's going to take a lot longer when you're looking at these large, larger issues rather than specific issues to come to an answer. And I think had we focused on breast cancer in women who are high risk for breast cancer and diet at a much -- even four or five years ago, we'd be starting to have some answers right now, instead of still developing the questions.

MS. WOODRUFF: Ms. Onder, when you look at the issue here, when you look at what you'd like to see being done, how big a role does the government, the federal government -- I know you all have lobbied at the various state levels -- but how big a role can the federal government play in all this?

MS. ONDER: Well, I think that that was one of the reasons that the Breast Cancer Coalition came into being is that we have not been on the federal agenda. If you look to see how our moneys are being spent, it's not towards breast cancer. And the Breast Cancer Coalition wants every woman in the United States to have access to joining the BCC and learning what they can do to empower themselves as patients and to find the medical care that they need. And if anyone is interested, they can find out more about the BCC with the 800 number, which is 1-800-221-2141, or contacting NAPCO, which is in New York City.

MS. WOODRUFF: I was just going to say on your point on not enough money being spent on breast cancer research, what about that particular point, Dr. Friedman?

DR. FRIEDMAN: I think that the investigators and the various research institutions, the clinicians who care for these patients would all agree that there are many more opportunities today than they can take advantage of both basic science opportunities and clinical opportunities for helping patients today. This is a situation which is very vexing because there are other major malignancies where that same argument can be made. But I absolutely agree with those individuals who say there are good ideas, important hypotheses to be researched, promising leads to be followed which can't be followed now because there simply aren't resources sufficient to support all the investigators and all the lines of investigation.

MS. WOODRUFF: Is that a legitimate argument from your standpoint, Dr. Love?

DR. LOVE: Absolutely right. And I think we've put, again, a lot of money into studies that are looking at should we use five chemotherapy drugs or five, should we do radiation first and then chemo or chemo first and then radiation, and what we need to do is take the money into really basic research and figure out what is the cause of breast cancer so that we can solve it and cure it really in a way that we can't with the tools we have available to us right now.

MS. WOODRUFF: All right. We want to add a congressional perspective on the issue now and we do that by adding to the discussion U.S. Rep. Mary Rose Oakar. She led the fight for Medicare coverage of mammograms last year and she's introduced legislation this year to increase breast cancer research by $50 million at the National Cancer Institute. Congresswoman Oakar, you've been listening to this discussion.

REP. OAKAR: I certainly have.

MS. WOODRUFF: How do you respond to two of the points that I hear being made, No. 1, that the Cancer Institute ought to be spending more money on breast cancer research as opposed to other kinds of breast cancer, and that in general, the priorities are wrong?

REP. OAKAR: Well, I don't blame the Cancer Institute as much as I blame Congress and the President of the United States and the administration. I mean, the fact is that the advisory board that Dr. Friedman referred to recommended, four out of the five grants recommended by the advisory board for breast cancer research were rejected because we only put, Judy, $17 million out of the money that you talked about to basic research to find a cure for breast cancer. And we've had hearings where some doctors are very optimistic that if they got the resources they could, indeed, find a cure not by the year 2000, but within the next five years. So that's one of the goals. So I don't buy the argument that we're doing all we can. That is, frankly, baloney. The fact is as Dr. Love said this is an epidemic. By the time this show is over, two women will have died of breast cancer. Every 11 minutes a woman finds out she has breast cancer. And yet, this disease is not treated as an epidemic and it is one. And we want to find a cure for it. We want prevention and early detection and we want women to have an informed decision and know all their options when they do have to get treated for breast cancer.

MS. WOODRUFF: But as I read the numbers, the money that NCI, the Cancer Institute, is now spending on breast cancer research is more than they're spending on lung cancer, more than they're spending on various colo rectal cancer and other cancers, at least in the material that I was reading today.

REP. OAKAR: Well, we shouldn't pit other cancers against breast cancer. We should take it, each cancer as a separate entity the way we've done for AIDS. I mean, take the issue of AIDS. And I support AIDS research very, very strongly. But the fact is that today because of the coalitions across the country lobbying Congress and the administration we have a budget of 1.7 billion, which is by the way bigger than the entire National Cancer Institute for all cancer diseases. I mean, when you consider the fact that so many women die of breast cancer in this country unnecessarily, when you consider the fact that younger women are getting breast cancer at increasing proportions, and I think when you consider the fact that we should be absolutely ashamed ofourselves that the only thing we can find in the budget, in this massive budget is a limited amount of money for research to find a cure for these types of cancers, certainly breast cancer is one of the leading fears and one of the leading diseases as it relates to women. And there is, Judy, a cultural bias when it comes to female dominated diseases. My colleagues will say I'm wrong, but I've got to tell you there is one and that's why we have to fight 'em now. We just have to fight about it. We can no longer be courteous about it.

MS. WOODRUFF: When you say there's a cultural bias, are you saying your male colleagues in the Congress because this is a disease that strikes women -- what are you suggesting?

REP. OAKAR: Well, I'm saying that if you examine how we've even done clinical trials, the women's caucus in conjunction with Rep. Waxman had a GAO study, only 13 percent of all clinical trials included women. Why were women excluded from the aspirin? Twenty- one thousand individuals took aspirin. We don't even know whether that's effective for women because no women were there. Why when they give out grants, do we have breast cancer grants related to men? They don't even use female mice with respect to some of these kinds of diseases. And I think this is terrible.

MS. WOODRUFF: Let me turn to Dr. Friedman. You're in the therapy side of this rather than the research end necessarily, but what about this point that a lot more money might be being spent on this if men were making more of the decisions?

DR. FRIEDMAN: I think you mean if women were making more of the decisions.

MS. WOODRUFF: I'm sorry. If women were making more of the decisions.

DR. FRIEDMAN: I'll be happy to give you -- but I think you're absolutely right, we should be gender blind about this, and it's a very sensitive topic. It is with no sense of arrogance that I try and respond to these points. Women's issues and women's diseases are of enormous importance to the National Cancer Institute. And although Rep. Oakar is correct that some clinical trials did not include women, the therapeutic trials in the National Cancer Institute have been splendid examples of women being included in studies. More than half of all the patients being treated on clinical trials are women and breast cancer is the single largest disease which occupies our attention. This is not because it's a gender related issue, but because of so many important scientific opportunities. The second point I'd like to make, very briefly if I may, is that although the prevention is extremely important and we do want to devote a lot of attention to it, the 44,000 women who die every year of breast cancer also wish to have better therapy today for them. And we feel this obligation very deeply.

MS. WOODRUFF: What about that, Dr. Love?

DR. LOVE: I think that that's true, but again I think we've probably maximized what we can do with the therapies that we have at hand. And if we're going to change things for those 44,000 women, we have to change it with new innovative treatment, not more drugs and different ways of giving chemo, but new biological response modifiers, new ways of dealing with the disease, rather than the same old thing.

MS. WOODRUFF: Dr. Friedman, I want to come back to you on another point that Congresswoman Oakar made, that doctors have testified before Congress that if the money were there, they could find a cure, not just by the end of the century but in the next four or five years. Do you share that view?

DR. FRIEDMAN: It's important I think to look at breast cancer not as one disease, not as a single entity, but as a whole universe of diseases. There are many different kinds of breast cancer. For some of these diseases, we do extraordinarily well today. For others we do completely unsatisfactory jobs, a very poor job and we do better. We have already shown that we can cure certain populations with breast cancer, especially those with early disease, and the obstacles that we face in those patients who have more virulent, more difficult disease, remains. I wouldn't want to say what the time lines would be, but I share the optimism that we will continue in a regular basis to make solid advances. I think that's completely likely.

REP. OAKAR: But, Judy, can I just interrupt and say we will never find a cure if on the agenda of Congress and the administration is such a limited resource when it comes to this disease. I mean, there is no question that when you compare what we give for AIDS, which I am very supportive of, but now we have had a full corps press with respect to finding a cure and arresting that disease. I want the same thing done for breast cancer and I see no reason why in the budget we shouldn't have a line item saying that we will designate the necessary funds. We don't want to see five out of six or four out of five grants rejected that were recommended, because how will we ever know what the outcome of that research will have been? And women are angry about it.

MS. WOODRUFF: Are you pointing to a single culprit when you talk about those grants being rejected, just quickly?

REP. OAKAR: I am pointing to the fact that we, the reason they were rejected primarily is because we only give $77 million totally. That's for detection, that is for research, that is for education, and so forth, for breast cancer. That is minuscule when you consider the fact that one out of nine women get breast cancer today and that 45,000 women will die of it. It is absolutely outrageous and women and their families ought to be angry and make Congress and the United States President do what we should be doing with respect to this issue.

MS. WOODRUFF: Well, we do thank all of you for joining us this evening. Dr. Love, Ms. Onder, Dr. Friedman, and Congresswoman Oakar, thank you all. FOCUS - HEART TROUBLE

MR. LEHRER: Now women and heart disease, an ailment most often associated only with men. Tom Bearden reports.

MR. BEARDEN: When Teri Pauly first suffered chest pains and shortness of breath, she blamed it on her two pack a day smoking habit and a busy schedule. But when the pain persisted, she told her family physician.

TERI PAULY: I mentioned that I had a burning in my chest, a burning in the center part of my chest, and what was that, you know, this was the person I should ask, and well, it was probably indigestion, and a heavy antacid, over-the-counter antacid was suggested and perhaps I should learn to relax a little more, learn to deal with stress a little better.

MR. BEARDEN: Over the course of the next two years, Pauly's condition worsened. She switched physicians and was again told to watch her stress level. She tried to slow down but only felt worse.

TERI PAULY: I couldn't go up a flight of stairs easily, let alone carry anything, but I was going on the idea that it was indigestion, that it was stress, that it was this, that it was that. At one point I was even convinced that it was my shoes.

PHYSICIAN: You say your left arm hurts from what?

MS. PAULY: I don't know.

MR. BEARDEN: It was Pauly's third physician, Dr. Lowell Brown, who finally spotted warning signs of a far more serious illness. He referred her to a fourth doctor, a cardiologist, who instantly recognized the signs. Teri Pauly had heart disease.

MS. PAULY: He said, Teri, you've got blockage. And the left main which feeds the left half of your heart, that little piece of spaghetti, was almost about 95 to 98 percent blocked.

MR. BEARDEN: Pauly and her doctors never suspected heart disease for two reasons. She was young and she was a women. Heart disease is still viewed by society and much of the medical community as a man's problem. But that notion of heart disease is misleading. Heart disease is the No. 1 killer of women in this country. In fact, it kills more women than all cancers combined. What makes the diagnosis tricky is that the typical woman who gets heart disease is ten to twenty years older than the typical man and the question some experts are now asking is are women suffering preventable early death because doctors fail to recognize some of the early warning signs of heart disease like chest pain or angina?

DR. RENEE HARTZ, Heart Surgeon: It used to be felt that women who were having angina, one of the oldest quotes from the early 1900s was that women just had gas.

MR. BEARDEN: Dr. Renee Hartz, a cardio thoracic surgeon, cites a longstanding medical myth that women don't get heart disease.

DR. HARTZ: The reason that this whole myth started was that years ago when the population didn't live as long, not as many women got heart disease because the life expectancy wasn't as long. Now with the whole population aging, women are definitely manifesting this disease more often because in the first place they get their symptoms 10 years older than men.

MR. BEARDEN: Hartz, one of the nation's few female heart surgeons, says the disease can be even more deadly in women. Women have a higher risk in bypass surgery and are more likely to die in the first year after a heart attack. Those facts are troubling to cardiologist Nanette Wenger. She thinks it's tougher to recommend heart surgery to a woman because of the extra unknowns.

DR. NANETTE WENGER, Cardiologist: When I have a patient and I say I really would like to do coronary arteriography, you don't do arteriography unless you consider surgery, and then the patient says, well, what are the risks, and I have to tell them that at the moment female gender is the highest risk attribute to not do well with surgery.

MR. BEARDEN: The conventional medical wisdom says women don't do as well on the operating table because they are often older than male patients and because their arteries are smaller. But Dr. Steven Kahn, a cardiologist at Cedar Sinai Hospital in Los Angeles, conducted a study challenging those two beliefs.

DR. STEVEN KAHN, Cardiologist: We found that pretty much all of the difference in risk of surgery was due to women being sicker when they were sent for bypass. And we didn't find that there was any intrinsic difference between men and women in terms of their risk. So if women were operated on earlier, at the same stage that men are operated on, there was a potential that the risks would be equivalent, that the benefit would be about the same.

MR. BEARDEN: Intrigued by the findings, Kahn and his team examined why women who undergo surgery are sicker.

DR. KAHN: It seemed that women had to manifest some very significant abnormalities, something very serious before they were sent to bypass surgery. In contrast, the men were more likely to undergo the screening tests, for example, a man might have an executive physical every year, have a treadmill once a year, and finding abnormal result on a treadmill get sent for heart catheterization and undergo bypass surgery. That scenario seemed to be more common in men than in women.

MR. BEARDEN: Both men and women find themselves at risk of heart disease for the same reasons, smoking, high cholesterol, stress, and genetics. But a woman's risk increases dramatically after menopause, a time when women stop producing their female hormones which are thought to provide a natural protection to the heart.

DR. HARTZ: Most women don't have an internist for a long time. Gynecologist is their main doctor for most of their life until something serious medically happens to them, and this is one part of the medical hierarchy that we need to educate about not only symptoms in women but about educating women as to how to prevent the disease, because it's universal. It's universal. As many women will die of heart disease as men.

MR. BEARDEN: Dr. Kahn says some doctors don't find heart disease in women because they're not looking for it?

DR. KAHN: It turns out that physicians much more often ascribed women's symptoms to psychiatric reasons, psychological reasons, or what we call somatic complaints, other complaints that don't have to do with the heart. And men's complaints, on the other hand, were much more often ascribed to being due to the heart.

MR. BEARDEN: Pauly says that's exactly what happened with her first doctor.

MS. PAULY: He suggested at one point that I take a tranquilizer. I really found it offensive. And I found it offensive because it was a kind of patting on the head, it's all in your head, therefore, let's treat your head. And I knew that what I was telling this person was not in my head.

DR. WENGER: [Talking to Patient] Have you been having any hurting in your chest with this or has it all been down here?

MR. BEARDEN: A correct diagnosis is even more difficult because of the fact that there is a shortage of heart disease research on women.

DR. NANETTE WENGER: Unfortunately, the diagnostic tests and all the therapies, including drugs, that physicians all around the country and I use day in and day out for women, all of that information is based on studies that were conducted predominantly or exclusively in middle aged men. And we are taking a great leap of faith in applying that information to women and particularly older women, but that is all the information that we have.

MR. BEARDEN: Dr. Bernadine Healy is the director of the National Institutes of Health, the government agency responsible for 32 percent of the medical research done in the country.

DR. BERNADINE HEALY, NIH: Our research agenda is driven by the scientific opportunities and by the needs of the population in terms of their health. We don't divvy it up, however, in terms of race or gender.

MR. BEARDEN: But Dr. Wenger thinks such gender specific studies are crucial in the understanding of heart disease.

DR. WENGER: The major difference in risk features is that women have oral contraceptive use at younger age and post menopausal hormone replacement therapy at older age and a hormonal change in- between. That plus hysterectomy plus pregnancy may be features unique to women that do relate to coronary disease and none of them have been examined appropriately.

MR. BEARDEN: Dr. Healy believes the delay in research may reflect the public's attitude toward women.

DR. HEALY: I think that culturally our society has changed. I think back in the '70s and '80s many of us, including women, didn't like to emphasize that there were biological differences between men and women, that perhaps emphasizing the differences implied that perhaps we weren't as equal.

MR. BEARDEN: Healy hopes to change that. Under her direction, the NIH has implemented a huge study of women's illnesses and the prevention and treatment of heart disease will be given a high priority. In the three years since her bypass surgery, Teri Pauly's life has changed dramatically. She has eliminated smoking, a stressful job, and a high fat diet. She says responsible health care is also up to women themselves.

MS. PAULY: You know, in the '60s we learned to smoke cigarettes and take birth control pills and in the '70s we learned to take care of our careers, we all went back to school, and in the '80s, we all learned to take care of our relationships and join support groups. Well, maybe in the '90s, maybe now is the time for women to realize we can take care of our own health care too. We can jump in there and make decisions that relate to us, that we have a right to a full and equal partnership in our own health care.

MR. BEARDEN: Women may soon find themselves armed with a greater ability to challenge the medical community as the questions now being raised about gender differences and heart disease are finally answered. RECAP

MS. WOODRUFF: Again, the main stories of this Tuesday, the cost of the nation's savings & loan bailout rose again. The head of the General Accounting Office said at least $50 billion more in taxpayer money will be needed next year alone. And the Bush administration announced that it will grant a Soviet request for $1.5 billion in credit guarantees to buy U.S. grain. Good night, Jim.

MR. LEHRER: Good night, Judy. We'll see you tomorrow night. I'm Jim Lehrer. Thank you and good night.