The CHAIRMAN. The first witness who will be heard this morning will be Frank B. Keefe. Prior to the making of his statement, I have here numerous reports that have been filed by different departments of government with the committee, relating to these bills to which I have just referred. These reports will be made a part of the hearings at this point. (The reports are as follows:) Hon. CHARLES A. WOLVERTON, COMPTROLLER GENERAL OF THE UNITED STATES, Washington, February 5, 1948. Chairman, Committee on Interstate and Foreign Commerce, House of Representatives. MY DEAR MR. CHAIRMAN: Further reference is made to your letter of January 22, 1948, acknowledged January 23, requesting a report on H. R. 5087, Eightieth Congress, entitled, "A bill to provide for research and control relating to diseases of the heart and circulation." The purpose of the bill is set out in section 2 as follows: "For the purpose of improving the health of the people of the United States through the conduct of researches, investigations, experiments, and demonstrations relating to the cause, prevention, and methods of diagnosis and treatment of diseases of the heart and circulation (hereafter in this Act referred to as 'heart diseases'); assisting and fostering such researches and activities by public and private agencies, and promoting the coordination of all such researches and activities and the useful application of their results; training research workers; training undergraduate and postgraduate personnel in matters relating to heart diseases; and developing, and assisting States and other agencies in the use of, the most effective methods of prevention, diagnosis, and treatment of heart diseases; there is hereby established in the Public Health Service (hereafter in this Act referred to as the 'Service'), a National Heart Institute (hereafter in this Act referrd to as the 'Institute')." Briefly, in order to carry out the said purposes, the bill would authorize the Surgeon General of the Public Health Service, under the supervision and direction of the Federal Security Administrator, to conduct researches, and so forth, relating to heart disease; cooperate with other agencies, and so forth, in research and control programs; make grants-in-aid to public or private agencies and to individuals for research, education, and control projects and programs; establish an information center; secure the assistance and advice of experts in the field of heart diseases; establish research fellowships and traineeships; treat voluntary patients; and, upon recommendation of the National Heart Council, adopt such additional means as he deems necessary or appropriate to carry out the purposes of the legislation. Further, the bill would create a national heart council consisting of the Surgeon General of the Public Health Service, the chief medical officer of the Veterans' Administration, the Surgeon General of the Army and the Surgeon General of the Navy, or their respective representatives, and 12 other members to be appointed by the Surgeon General of the Public Health Service, each member to receive compensation at a rate to be fixed by the Federal Security Administrator, not exceeding $75 per day, while attending conferences or meetings of the council or otherwise serving at the request of the Surgeon General of the Public Health Service. Section 5 of the bill would authorize grants-in-aid to States, political subdivisions of States, and to public and nonprofit institutions for the establishment of programs of prevention, and so forth, of heart diseases, payments to States to be made by the Secretary of the Treasury upon certification by the Surgeon General of the Public Health Service prior to audit or settlement by the General Accounting Office. Section 6 of the bill would authorize the acceptance of gifts for the purposes of the act. Section 7 would authorize necessary appropriations, including appropriations for the erection and equipment of buildings and facilities. This Office has no information as to the need or desirability of the proposed legislation and, therefore, I make no recommendation as to the merits of the bill, H. R. 5087. With respect to details of the bill there is noted the following: 1. It appears that the provisions of section 5 of the bill relating to grants-inaid "to States, counties, health districts, and other political subdivisions of the States and to public and nonprofit institutions for the establishment and maintenance of programs of prevention, treatment, and control of heart diseases" overlap to a considerable extent the provisions of section 3 (d) relating to grantsin-aid "to universities, hospitals, laboratories, and other public or private agencies and institutions, and to individuals for research, education, and control * * * projects and programs." 2. The language of section 3 (h) (1) appears to be incomplete or incorrect. 3. In line 16, page 7 (sec. 5 (c) of the bill), the word "where" apparently should we "were." 4. In line 4, page 10 (sec. 7 (b) of the bill), the word "title" presumably is intended to be "act." 5. The language of section 8 (a) does not appear clear or correct, perhaps because the characters "(1)" are misplaced. Sincerely yours, FRANK L. YATES, Acting Comptroller General of the United States. COMPTROLLER GENERAL OF THE UNITED STATES, Hon. CHARLES A. WOLVERTON, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives. MY DEAR MR. CHAIRMAN: Further reference is made to your letter of January 28, 1948, acknowledged January 30, requesting a report on H. R. 5159, Eightieth Congress, entitled "A bill to provide for research relating to diseases of the heart and circulation, including high blood pressure, in a supreme endeavor to develop speedily more effective methods of prevention, diagnosis, and treatment of such diseases, and for other purposes." Under date of February 5, 1948, this Office made a report to you on a similar— though not identical-bill, H. R. 5087. The purpose of the bill, H. R. 5159, is set out in section 2 as follows: "For the purpose of improving the health of the people of the United States through the conduct of researches, investigations, experiments, and demonstrations relating to the cause, prevention, and methods of diagnosis and treatment of diseases of the heart and circulation (hereafter in this Act referred to as 'heart diseases'); assisting and fostering such researches and activities by public and private agencies, and promoting the coordination of all such researches and activities and the useful application of their results; training research workers; training undergraduate and postgraduate personnel in matters relating to heart diseases; and developing, and assisting States and other agencies in the use of the most effective methods of prevention, diagnosis and treatment of heart diseases, including refresher courses for physicians; there is hereby established in the Public Health Service (hereafter in this Act referred to as the 'Service') a National Heart Institute (hereafter in this Act referred to as the 'Institute')." Briefly, in order to carry out the said purposes, the bill would authorize the Surgeon General of the Public Health Service, under the supervision and direction of the Federal Security Administrator, to conduct researches, etc., relating to heart disease; cooperate with other agencies, etc., in research and control programs; make grants-in-aid to public or private agencies and to individuals for research, education, and control projects and programs; establish an information center; secure the assistance and advice of experts in the field of heart diseases; establish research fellowships and traineeships; treat voluntary patients; and, upon recommendation of the National Heart Council, adopt such additional means as he deems necessary or appropriate to carry out the purposes of the legislation. Further, the bill would create a national heart council consisting of the Surgeon General of the Public Health Service, the chief medical officer of the Veterans' Administration, the Surgeon General of the Army and the Surgeon General of the Navy, or their respective representatives, and 12 other members to be appointd by the Surgeon General of the Public Health Service, each member to receive compensation at a rate to be fixed by the Federal Security Administrator, not exceeding $75 per day, while attending conferences or meetings of the council or otherwise serving at the request of the Surgeon General of the Public Health Service. Section 5 of the bill would authorize grants-in-aid to States, political subdivisions of States, and to public and nonprofit institutions for the establishment of programs of prevention, etc., of heart diseases, payments to States to be made by the Secretary of the Treasury upon certification by the Surgeon General of the Public Health Service prior to audit or settle 76054-48- -2 ment by the General Accounting Office. Section 6 of the bill would authorize the acceptance of gifts for the purposes of the act. Section 7 would authorize necessary appropriations. Unlike H. R. 5087, above referreed to, H. R. 5159 does not specifically authorize appropriations for erection and equipment of buildings and facilities for use of the institute. This office has no information as to the need or desirabilty of the proposed legislation and, therefore, I make no recommendation as to the merits of the bill H. R. 5159, but offer the following comment: 1. It appears that the provisions of section 5 of the bill relating to grants-inaid "to States, counties, health districts, and other political subdivisions of the States and to public and nonprofit institutions for the establishment and maintenance of programs of prevention, treatment, and control of heart diseases" overlap to a considerable extent the provisions of section 3 (d) relating to grants-inaid "to universitites, hospitals, laboratories, and other public or private agencies and institutions, and to individuals for research, education, and control projects and programs." ** * ** 2. The language of section 3 (h) (1) appears to be incomplete or incorrect. 3. The language of section 8 (a) does not appear clear or correct, perhaps because the characters "(1)" are misplaced. DEAR MR. WOLVERTON: I have your letter of the 22d of January in which you ask for an expression of my views on H. R. 5087, a bill to provide for research and control relating to diseases of the heart and circulation. On the medical aspects of the bill, I do not feel qualified to express an opinion except to observe that this group of diseases presents a constant and growing hazard to the health of our population. Section 7 of the bill would authorize the Federal Works Administrator to acquire land and construct suitable buildings and facilities in or near the District of Columbia, on the recommendation of the Surgeon General of the United States Public Health Service. With respect to this function, I would say that should the Congress authorize it I would, of course, execute the commission. There is a well understood and fruitful relationtionship between this Agency and the Public Health Service in respect to the building that the latter agency requires for its work. The elements of that relatioinship have been properly stated in section 7 (a) of the bill. The Director of the Bureau of the Budget advises me, however, that for reasons indicated in his letter of April 7, 1948, addressed to the Senate Committee on Labor and Public Welfare regarding S. 2215, H. R. 5087, which contains similar provisions, would not appear to be in accord with the program of the President. Sincerely yours, PHILIP B. FLEMING, Major General, United States Army Administrator. FEDERAL SECURITY AGENCY, Hon. CHARLES A. WOLVERTON, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington 25, D. C. DEAR MR. CHAIRMAN: This is in reply to your requests for our views on H. R. 3059, a bill to authorize and request the President to undertake to mobilize at some convenient place or places in the United States an adequate number of the world's outstanding experts and coordinate and utilize their services in a supreme endeavor to discover new means of treating, curing, and preventing diseases of the heart and arteries, and H. R. 3464, a bill "to provide for the mobilization of the scientific resources and knowledge of the United States for the purpose of seeking the causes and cure of cancer, heart disease, infantile paralysis, and other diseases of mankind." H. R. 3059 would authorize the President to mobilize an adequate number of the world's outstanding experts in heart diseases and to coordinate and utilize their services, through the Surgeon General of the United States or through an independent group appointed by the President, in discovering means of preventing, treating, and curing such diseases. H. R. 3464 would establish a Medical Research Agency as an independent agency to aid and conduct research on the cause and cure of cancer, heart diseases, diabetes, and other major diseases of mankind and to investigate the cause and spread of contagious and infectious diseases. There is no question about the need for intensive work in the fields covered by the above bills. I do not believe, however, that the method proposed by these bills for attacking the various diseases is sound. H. R. 3464 would establish a new and separate agency, and H. R. 3059 would permit the establishment of such an agency, to do work which the Public Health Service is equipped to do and has been doing, to the extent permitted by appropriations, for many years. It is our belief, as was indicated in our letter to you of March 25, 1947, with regard to H. R. 977, a bill similar to H. R. 3464, that the concentration of the essential health activities of the Federal Government within the fewest possible units of organization is more consistent with sound principles of public administration, and therefore better calculated to serve the public interest, than their diffusion among a large number of units. The segmentation of medical research would tend, we think, not only to needless duplication of effort in fields that necessarily overlap, but also to greater difficulty in effective coordination of closely related efforts. Any expansion of governmental activities might, therefore, be accomplished more efficiently and effectively by legislation placing new activities in, or expanding the existing activities of, the Public Health Service. For these reasons we would not recommend your favorable consideration of H. R. 3059 and H. R. 3464. The Bureau of the Budget advises that there is no objection to the submission of this report to your committee. Sincerely yours, OSCAR R. EWING, Hon. CHARLES A. WOLVERTON, FEDERAL SECURITY AGENCY, Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: This letter is in response to your request of June 10, 1947, for a report on H. R. 3762, a bill to provide for research relating to diseases of the heart and circulation and to aid in the development of more effective methods of prevention, diagnosis, and treatment of such diseases, and for other purposes. The bill would establish in the Public Health Service a National Heart Disease Institute to serve the following general purposes: (a) To conduct, coordinate, and make grants-in-aid to institutions to conduct research, investigations, experiments, and demonstrations in the field of heart diseases; (b) To provide for the training of personnel in the various phases of heart diseases both at the Institute and elsewhere through grants-in-aid; and (c) To assist States and localities to establish and maintain programs for the prevention, treatment, and control of heart diseases. Enactment of the bill, and a substantial appropriation thereunder, by the Congress would, it is believed, receive wide support from the general public. Improved control of infectious diseases and gains in pediatrics have permitted millions of persons to survive to an age where they become vulnerable to cardiovascular-renal diseases, cancer, diabetes, arthritis, and cerebral accidents. Of these, the cardiovascular disease group is the most important; it stands first in the list of causes of death in the United States. By 1940, it claimed between 9 and 10 million chronically ill persons, accounting for 30 percent of all the deaths in the 20 to 59 age group. The cardiovascular-renal diseases have accounted for 54 percent of all deaths in the age group above 60. The stepping up of research on heart and related diseases would, we believe, help to reduce the death and sickness rates and greatly aid in solving some of the socio-economic problems of this age group, which result in so much unemployment and dependency. Under the Public Health Service Act the Service is already doing considerable research in the field of heart diseases. Both the House of Representatives and the Senate have included in the appropriation bill for this agency for the fiscal year 1948 an appropriation to enable the Service to expand its facilities available for general medical research, including cancer and cardiovascular diseases, and this appropriation will enable the Service to expand its work in the cardiovascular field to some extent. H. R. 3762 would attack the problem of heart diseases in a comprehensive manner and would better enable the Service to perform its functions in the field of heart diseases, although it should be noted that the new authority the bill gives to the Public Health Service merely projects into the field of heart diseases the existing authority in other fields which the Congress has previously given us in the Public Health Service Act and amendments thereto. The bill would also permit the rapid expansion of our current studies in cardiovascular diseases, would provide for the much needed grants-in-aid for medical research by other medical research groups, and would serve to single out heart diseases as a subject for special action and to emphasize the interest of the Nation in the aims and purposes in the proposed legislation. There are certain changes in the bill to which I should recommend that your committee give consideration: It would seem to me desirable that the bill be recast as an amendment of the Public Health Service Act (42 U. S. C., ch. 6A). In recommending enactment of the bill which became the Public Health Service Act, your committee stressed the desirability of establishing "a compact and logically arranged law governing the Public Health Service," and we believe that to maintain consistency with that objective any new and permanent functions which may be entrusted to the Service should be created by amendment of the basic law rather than by independent enactment. In the present instance this might be done by amending section 217 of the Public Health Service Act to establish a National Heart Disease Council, amending section 314 to authorize grants to the States for work in the field of heart diseases and making appropriate changes elsewhere in the act to include such authority as the bill would confer on the Surgeon General with respect to heart diseases which he does not now possess. Section 8 of the bill relating to the construction of buildings would be temporary in operation and might well be left as part of the bill not to be incorporated into basic law. The bill provides that all functions under it should be carried out through the new National Heart Disease Institute. I recommend that this requirement be deleted, so as to permit future arrangement and rearrangement of administrative functions within the Public Health Service in the light of experience. Such flexibility would be in consonance with the present provisions of the Public Health Service Act regarding other functions of the Service. It is our belief that enactment of H. R. 3762, modified as suggested above, would meet a pressing need in the field of health, and I earnestly recommend its favorable consideration by your committee. Because of the request by a member of your committee's staff on June 16, 1947, that we send you our report on the bill as soon as possible, we have not had time to obtain the advice of the Bureau of the Budget as to the relationship of this bill to the program of the President. Sincerely yours, WATSON B. MILLER, FEDERAL SECURITY AGENCY, Hon. CHARLES A. WOLVERTON, Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: This letter is in response to your request of January 22, 1948, for a report on H. R. 5087, a bill to provide for research and control relating to diseases of the heart and circulation. |