3. A total of at least 152,000,000 workdays a year are lost because of diseases of the heart and circulation.* III. How do deaths from diseases of the heart and circulation compare with deaths from other diseases? 1. 42 percent of all deaths are caused by diseases of the heart and circulation.2 2. Diseases of the heart and circulation kill: (c) 1,600 people every day, more people than die of infantile paralysis or diphtheria in a whole year. (d) 11,308 people every week, more people than die of stomach ulcers in a year, and twice as many as die of appendicitis in a year. IV. How many doctors specialize in diseases of the heart? 8 1. Only 199 doctors limit their practice to diseases of the heart; another 439 give special attention to this field. This makes a total of only 638 doctors who specialize in cardiology." V. What facilities are available for special care of people with diseases of the heart and circulation? 1. For the minimum number of 9,000,000 people suffering from diseases of the heart and circulation, there are in the entire United States only about 909 beds for convalescent cardiac patients, divided as follows: Cardiac homes for children_. 10 237 103 261 (a) These beds are located in only 8 States, and 344 of the 909 beds are in New York City.10 2. There are less than 200 beds set aside for clinical research in diseases of the heart and circulation." 3. In contrast with this, about 86,429 beds are available for tuberculosis patients, not including those in Army, Navy, Marine, and Veterans' Administration hospitals, mental and prison hospitals and preventoria.12 VI. How much money is available every year for research in this field? 1. About $2,339,500 a year, and certainly less than $3,000,000, divided as follows: (a) Government funds: 1. $249,500 is being spent during the fiscal year 1947-48 within the United States Public Health Service.13 2. $725,000 has been distributed this year by the United States Public Health Service in grants-in-aid and research fellowships." Total__ (b) Nongovernmental funds: $974, 500 1. $615,000 was spent in 1944 by nongovernmental agencies throughout the country." 14 2. About $200,000 is being spent by the Whitney Foundation this year. 3. About $550,000 a year is available for a research fund organized by the life-insurance companies of the United States.15 Total__ Total, all funds. $1, 365, 000 2, 339, 500 2. In other words, we are spending only a "cut-rate" $3.98 per death annually for research to find the causes and cures of the greatest killer of our people. 4 National Office of Vital Statistics. 8 National Office of Vital Statistics: 1946 deaths, cancer, 182,005; tuberculosis, 50,911; infantile paralysis, 1,845; diphtheria, 1,259; appendicitis, 5,285; stomach ulcers, 8,164. 9 American Medical Association letter dated August 13, 1947. 10 Miss Margaret Matheson, Executive Secretary, New York Heart Association. Letter dated March 26, 1947, enclosing excerpt from report prepared by Dr. Robert L. Levy, published by the New York Academy of Medicine, entitled "Convalescent Care," pp. 64-69. 1940. 11 Fact brought out in hearings before Senators Bridges and Pepper on need for additional research funds for heart disease, by group of heart specialists, April 24, 1947. 12 Hospital-bed census conducted by USPHS Tuberculosis Control Division in 1946; includes beds in United States and territories. 13 Dr. Rolla E. Dyer, National Institute of Health. (Letter dated December 12, 1947.) 14 Survey made in 1944 by Dr. H. M. Marvin, American Heart Association. 15 Dr. Francis Dieuaide, Life Insurance Medical Research Fund. Roughly, about $1,200,000 has been spent over a period of about 2 years from this fund, which was organized in 1945. VII. How does this compare with what we spend on other research? 1. In contrast with the total of less than $3,000,000 being spent for research in diseases of the heart and circulation: (a) Congress appropriated a total of $52,489,520 for the Research Administration of the Department of Agriculture.16 (b) $29,866,200 was allocated by Congress in 1947 for research and control of plant and animal diseases, to the Department of Agriculture alone.1 (c) For industrial research, to improve manufactured products (excluding atomic energy): American industry is spending $450,000,000 a year; the United States Government spends $625,000,000 a year; universities and other agencies are spending $85,000,000 a year. This means that Americans are spending a total of $1,160,000,000 for industrial research, but less than $3,000,000 to save the lives of people suffering from diseases of the heart and circulation." 2. We live in an economy where, in 1945, American manufacturers spent these amounts for industrial research: Bendix Aviation Corp.: For research and engineering (approximate) __. Allis-Chalmers Manufacturing Co.: For development, testing, and experimental expenditures_ 18 $18, 150, 000. 00 18 3, 286, 234, 79 3. $16,379,000 is being spent in the field of cancer research-the second cause of death in the United States. (Much of this has become available within the last year.) This contrasts with less than $3,000,000 for diseases of the heart and circulation, the first cause of death. 4. The total amount available from all sources for research in diseases of the heart and circulation is less than one-fourth the amount voted by the United States Senate for forest trails for the current fiscal year." 19 5. $1,529,300,000 is spent annually for personal care, including cosmetics and barber and beauty-shop services, in contrast with less than $3,000,000 spent for research in diseases of the heart and circulation.20 VIII. Is heart disease primarily a disease of old age? 1. No. At least 30 percent of all deaths in the 20-59 age group are caused by cardiovascular diseases.21 2. In 1944 more children died of diseases of the heart than the total number of deaths of people of all ages from infantile paralysis.22 (a) Among children under 15, more than twice as many died of diseases of the heart in 1944 as died of infantile paralysis.23 IX. Do people of the United States think more research in this field is necessary? 1. 83 percent of the people questioned in a recent poll were in favor of the Government's appropriating $100,000,000 for research in tuberculosis and diseases of the hear and circulation; and 80 percent were willing to pay more taxes for research and study to find new diagnoses and treatments of these diseases." FACT SHEET III WHAT IS THE NEED FOR CONGRESSIONAL LEGISLATION AGAINST DISEASES OF THE HEART AND CIRCULATION 1. How many people in our country die of diseases of the heart and circulation? (a) More than 1 out of 3 of our people now die from these diseases (1). 16 United States Budget, fiscal year ending June 30, 1948. 17 Science and Public Policy-A Report to the President, by the President's Scientific Research Board, vol. I, p. 12). August 27, 1947. 18 National Industrial Conference Board. 19 $11,000,000 was voted by the Senate for forest trails for the current fiscal year (New York Times, July 15, 1947). 20 America's Needs and Resources, by J. Frederic Dewhurst & Associates. (Twentieth Century Fund Survey.) 1947. P. 703. Figure is for 1942. 21 Dr. Rolla E. Dyer, director National Institute of Health (memorandum dated May 28, 1947). 22 National Office of Vital Statistics: Deaths of children under 15 from heart disease, 1944, 1,866; total deaths from infantile paralysis, 1944, 1,361. 23 National Office of Vital Statistics: Deaths of children under 15 from infantile paralysis, 1944. 758. 24 Pilot poll conducted by Research Associates, New York City, January 1947. (b) 588,451 Americans died of these diseases in 1946 (1). (c) 60,000,000 Americans now living will die of these diseases unless new treatments and cures are found (2). 2. How many of our people are disabled, in varying degrees, by diseases of the heart and circulation? (a) About 9,000,000 (3), or about 1 in every 16 people. 3. Is there a national heart institute in the United States Public Health Service like the National Cancer Institute? No. (a) There is no National Heart Institute and the United States Public Health Service has only $974,500 this year to spend for research on diseases of the heart and circulation (4). (b) The National Cancer Institute in the United States Public Health Service has $14,000,000 of Federal funds this year to spend on cancer research, education, control, and other action against cancer (5), of which $7,544,000 is for research. 4. How much money is being spent in this country from all sources on research for new treatments and cures of diseases of the heart and circulation which cause one out of three deaths? (a) Less than $3,000,000 a year of private and Government funds or only $3.98 per death from these diseases, it is estimated (4) (6) (7). (b) Our Government spends only $1.65 per death for the No. 1 killer of our people (8). 5. How does this compare with what the United States Government spends on research and control of plant and animal diseases? (a) The United States Department of Agriculture has $29,866,200 this year to spend on research and control of plant and animal diseases (9). (b) This is about 10 times as much as the amount spent from all sources on diseases of the human heart and circulation. 6. How many beds for clinical research in diseases of the heart and circulation are there in the United States? (a) Only about 200 beds in the whole country for the 9,000,000 sufferers (10). (b) Only 909 special beds for convalescent cardiac patients, located in only 8 States, with 344 of the 909 beds in New York City (11). 7. How many doctors specialize in the field of heart disease? (a) Only 199 doctors limit their practice to diseases of the heart; another 439 give special attention to this field (12). This makes a total of only 638 doctors out of a total of 135,942 effective physicians (13) who specialize in cardiology. 8. How would the creation of a national heart institute with large sums for research, medical educational facilities, and services help to change this situation? (a) Such an institute would give grants-in-aid to qualified institutions for research into better treatments and cures. (b) It would give similar grants for refresher courses for doctors, and for better teaching to medical students. (c) It would give grants for construction of research facilities. (d) It would promote coordination of research of all work in these fields. (e) It would make available for prompt use new information in these fields. (f) It would make grants-in-aid to States for prevention, treatment, and control of these diseases, and for training of personnel for State and local health work. (g) All these would go a long way toward saving some of the almost 600,000 people who die from heart and arterial diseases every year, almost 25 percent of whom are under 60 years of age, and whose productive life could be extended for the betterment of our national economy, and their own health and happiness. 9. How do the people of the United States feel about Government expenditures for such purposes? (a) 83 percent of the people polled by the Research Associates in a pilot poll conducted in 1947 said "Yes" to the question: "Do you think Congress should put aside $100,000,000 to be used in research on tuberculosis and diseases of the heart and arteries? (14) (b) 80 percent of the people in the same poll said "Yes" to the question: "Would you be willing to pay more taxes for research and study to find new diagnoses and treatments of these diseases?" 10. Is there hope for better treatments and cures through research in these fields? Yes; science has already made these important advances: (a) Prevention of recurrences of attacks of acute rheumatic fever by the use of sulfa drugs. (b) The surgical relief and, in certain instances, cure of congenital heart defects. (c) The lowering of blood pressure and the relief of symptoms in some cases by surgical treatment of high-blood pressure. (d) The use of sulfa drugs, penicillin, and streptomycin in the prevention and treatment of a type of heart disease known as subacute bacterial endocarditis. But many new research leads are not being adequately followed for lack of funds, and (a) Diseases of the heart and circulation are still the No. 1 killer of our people. (b) One person dies every minute of diseases of the heart and circulation (15). (c) Diseases of the heart and circulation take a greater death toll than the five next leading causes of death combined (16). (d) They cause more than 300 times as many deaths as infantile paralysis (17). (e) One person in every 16 suffers from diseases of the heart and circulation (18). (f) Nearly one out of every two deaths after the age of 45 is caused by heart diseases (19). (g) It is no respecter of ages and is the leading fatal disease among children from 5 to 19 years old (19). REFERENCES (1) National Office of Vital Statistics (1 out of 2.37 deaths in 1946; 1 out of 2.38 deaths in 1945). (2) 42 percent of the total deaths in 1946 were caused by diseases of the heart and circulation; 42 percent of 143,000,000 (estimated United States population) is 60,060,000. (3) Dr. Rolla E. Dyer, director, National Institute of Health; estimate based on analysis of health of the Nation, 1940 (memorandum dated May 28, 1947). (4) Dr. Rolla E. Dyer, director, National Institute of Health (letter dated December 12, 1947). (5) Dr. Leonard A. Scheele, director, National Cancer Institute (letter dated September 25, 1947). (6) United States Public Health Service. Nongovernmental agencies in United States. (7) Life insurance companies of United States (Dr. Francis Total___. 1 See (4). 2 Survey made in 1944 by Dr. H. M. Marvin, American Heart Association. (8) $974,500 for 588,451 deaths. (9) United States budget, fiscal year ending June 30, 1948. 1 $974, 500 615, 000 550,000 200, 000 2, 339, 500 (10) Fact brought out in hearings before Senators Bridges and Pepper on need for additional research funds for heart disease, by group of heart specialists, in Senate hearing, April 24, 1947. (11) Miss Margaret Matheson, executive secretary, New York Heart Association. (12) American Medical Association, letter dated August 13, 1947. (13) Journal of American Medical Association, volume 121, page 1163 (1943): Total registered physicians, 1943: 179,039; difference represents those not practicing because of advanced age, physical disabilities, and other reasons. (14) Pilot poll conducted by Research Associates, New York City, January 1947. (15) 525,600 minutes in a year; 588,451 deaths. (16) Cancer, 182,005; deaths associated with childbirth, 145,094 (1945); accidental, 98,003; nephritis, 81,701; pneumonia, influenza, 62,324. (17) 300 times 1,845 (infantile paralysis deaths 1946) equals 553,500. (18) 9,000,000 sufferers: 143,000,000 population. (19) New York heart campaign booklet, Open Your Heart. STATEMENT OF DR. WILLARD C. RAPPLEYE, M. D., DEAN, FACULTY OF MEDICINE, COLUMBIA UNIVERSITY, NEW YORK, N. Y. Mr. HALE. The next witness we have is Dean Rappleye of the College of Physicians and Surgeons, New York City. Dr. Rappleye. Dr. RAPPLEYE. Mr. Chairman and members of the committee, as to my qualifications, I am dean, faculty of medicine, and professor of medical economics, Columbia University, president, Josiah Macy, Jr., Foundation; chairman of the board of directors, Health Insurance Plan of Greater New York; formerly president and chairman of the Executive Council Association of American Medical Colleges; president, Advisory Board for Medical Specialties; president, Advisory Council of Medical Education; director of study, Commission on Medical Education; commissioner of hospitals, city of New York; professor of hospital administration, Yale University, School of Medicine; director of hospitals and professor of hospital administration, University of California. The main purpose of my brief memorandum is to try to present very succinctly the practical application of such a bill and to outline what can be done in a single university that is in a position and prepared to go ahead with the program, and I have just a short statement. In order to carry out the purpose outlined in the National Heart Disease Act, it will be necessary in any well-rounded program to provide three major features to insure the success of the undertaking. The first is a competent staff of senior investigators in the several fields of inquiry which are fundamental to an understanding of the mechanisms of cardiovascular disease, better knowledge of which will permit improvements in the diagnosis, treatment, and prevention of cardiac disabilities. Previous speakers have outlined the scientific and clinical problems in the disorders of the circulation. The second requisite is adequate laboratory and clinical facilities for the conduct of research into the underlying problems and their clinical applications. The third feature is the provision of opportunities for the training of young investigators, medical school teachers, and public health and hospital personnel. A long-term program must put emphasis upon the recruitment and development of well-qualified young men and women who will be able to undertake research studies in this important field and who will then be prepared to go into the medical schools, hospitals, research institutes, and other organizations to carry on both investigation and instruction. The three conditions emphasized as essential in the successful operation of the proposed legislation can be met in the beginning only in those few large medical school centers which already have most of the elements required for such a program. These factors may be illustrated in such an institution as I stated a moment ago, in public institutions such as Columbia University. Under its auspices are a large staff of well-qualified leaders in research in the fields of physiology, biochemistry, pathology, biophysics, public health, radiology, anatomy, bacteriology, immunochemistry, psychiatry, neurology, pharmacology, medicine, surgery, and the other clinical fields related to diseases of the heart and blood vessels. The departments are now responsible also for the training of undergraduate 76054-48- -10 |