medical students, hospital residents, practicing physicians, and young scientists. In addition to the senior members of the staff who are responsible for the care and treatment of patients and the direction. of research there are about 50 younger members devoting as much of their time and effort, as the present facilities will permit, to investigations in cardiovascular problems. The resources and personnel of the existing departments of the medical school are a broad and firm foundation on which to build an enlarged research and teaching program. It can be done promptly and with the minimum of expenditure because most of the essential elements are already provided. The hospitals of the Columbia-Presbyterian Medical Center provide active teaching and research wards. These facilities under Columbia University are supplemented at Bellevue Hospital and Goldwater Memorial Hospital for Chronic Diseases, in which the university appointees comprise the hospital staffs on its services in those hospitals. The university would be in a position to make a far more effective contribution to the over-all opportunities if it had additional laboratory facilities for the investigation of the underlying problems of cardiovascular disease. These same facilities are essential also for training young investigators upon whom future progress will be so largely dependent. Translated into practical terms this means that Columbia University is in a position to make an important contribution to the national problem of heart and circulatory diseases without delay if the necessary laboratories can be provided and the present research activities can be enlarged to accommodate more of the younger promising investigators. An estimate of the cost of the capital expenditures and the annual operating additional budget can be set down briefly as follows: I. CAPITAL EXPENDITURES A. One floor addition to existing laboratories under the faculty of medicine of Columbia University, contiguous with the wards of the Presbyterian Hospital and in close association with Babies Hospital, Neurological Institute and the other hospital facilities at the medical center. This laboratory addition would be an extension of the existing medical-school laboratories of physiology, biochemistry, pharmacology, neurology, biophysics, pathology, anatomy, bacteriology, medicine, and surgery. It would provide over 18,000 square feet of space for which tentative plans have already been formulated. Estimated cost, current figures, $750,000. B. Rearrangement and extension of present animal quarters for experimental studies on aging, nutrition, isotope studies, endocrine research, metabolism, and so forth. Estimated cost, $250,000. C. Total capital expenditures, $1,000,000. II. ANNUAL RESEARCH PROGRAM IN ADDITION TO PRESENT EXPENDITURES OF MEDICAL SCHOOL IN THE BASIC SCIENCES AND CLINICAL DEPARTMENTS A. Forty research fellowships in the medical sciences and clinical fields, ranging from $3,600 to $6,000 per year depending upon qualifications, experience, and background of the individual, $180,000. B. Technical assistants and helpers, 50 at $3,000, average compensation, $150,000. C. Supplies and animals, $100,000. D. Total annual operating budget, $430,000. Columbia University already possesses many of the essential features for a major contribution to the national program of cardiovascular disorders and is ready and prepared to go into such a program if the financial support indicated were to be made available. The university could serve as one of several major training centers to prepare qualified investigators for important positions in the future in other institutions and agencies in the country and, at the same time, through its present large staff of investigators make important advances in the field of cardiovascular disorders as they affect individual and public health. That ends my statement, Mr. Chairman. Mr. HALE. Are there any questions of Dean Rappleye? Mr. LEA. Mr. Chairman. Mr. HALE. Mr. Lea. Mr. LEA. Doctor, by what method would you select the trainees, the young men or women who would be selected for special research work? Dr. RAPPLEYE. Well, we would select them as we do today for all of the younger men in the staffs. We secure their previous training and qualifications. Usually they apply or are recommended. I might say that there is a great number of young men and women with competent training and background, well qualified, who are endeavoring to go into research fields such as this and other divisions of medical science. Mr. LEA. If Federal funds were provided would you consider it a wise investment to finance these men and women, especially selected young men and women? Dr. RAPPLEYE. I think it is the most important investment the Government can make in any form of education, to train these young men and women. Mr. LEA. Would you favor a general subsidization of medical schools, regardless of the specialists to which you have referred? Dr. RAPPLEYE. You are speaking of undergraduate medical students? Mr. LEA. Yes. Dr. RAPPLEYE. There is not any doubt but that many well-qualified students do not go through medical school, because of the excessive cost there in time and money. So that I am in complete agreement with the proposal that there should be some form of scholarship aid for undergraduate medical students, those who are deserving and need it, in addition to that a fellowship program if handled, of course, at graduate level, after the student has completed either his basic science training or in the case of medicine after he has completed his internship. Mr. LEA. Well, in attempting that course of aid would it be accomplished by selective approval of the most promising group or would you attempt to do it by general contribution to the medical schools? Dr. RAPPLEYE. I think in the long run it is better to make, in general, contributions to medical schools which have now the vast experience in the selection of students so that your selection would continue to be, we believe, as active, and as accurate and as fair, as it has been in the past. I think we do have a number of students who cannot go through medical school because they cannot afford it. Those students ought to be helped. But, we are familiar with those groups, who cannot continue their studies because they are not able to finance themselves. Mr. LEA. But is it not true that in accomplishing the other purpose we must largely rely on especially qualified groups rather than by general contributions to education? Dr. RAPPLEYE. Well, if I understand your question, sir, in the research field the men who have shown predisposition and qualifications for going further with research, I would say, a majority of students do not have those qualifications. They are not qualified to go ahead. It is that selective process at the graduate level that is very important and which will hold the hope of doing anything constructive in the long run in fields of science and scientific investigation.' Mr. LEA. I feel a fear, a danger, that we may have against adopting a plan which may lead to general subsidization of education by the Federal Government, and that is what I have in mind. Dr. RAPPLEYE. I think all of us in education have those reservations, sir, too, because of the excessive cost that would be involved together with the great many other ancillary considerations that would come up in any form of general subsidy of education. I think there would be some risk in it. Mr. LEA. If the efforts of the Federal Government could be concentrated on means which are most effective and which would contribute to that end, it might produce better results than a general scheme of subsidization which would lead probably to much dissipation of Federal aid. Dr. RAPPLEYE. I am sure of that. I am sure it ought to be concentrated where it is likely to produce very favorable scientific inquiry and training. Mr. LEA. That is all. The CHAIRMAN. Are there any further questions? Doctor, you made quite a detailed statement as to the additional research facilities which it would seem to you would be necessary at Columbia. You indicated that the over-all cost might be $1,000,000. Have you given any thought to, or formed any estimates, as to what might be the over-all national need? Dr. RAPPLEYE. I have not multiplied that out, but there are, as you know, 69 medical schools in the United States and many of them are concerned with similar problems. A good many of them are not large enough, perhaps, at the beginning to undertake the over-all complete program of investigation in cardiovascular diseases. One could only make a wild guess as to the amount of money necessary to establish research laboratories. I have given no thought to it from the stand point of national figures, but certainly as indicated by one of the earlier speakers today, that program ought to be started on a rather modest basis for a few years, partly, until we can get enough trained workers to go into the institutes. There is experience, to some extent, in some field, where they have gone ahead and built more rapidly than there are people to fill the positions, and I think the program of stepping up gradually from X millions to Y millions in 5 to 10 years would seem to be a more sensible way to go at it, with gradual evolution of the over-all national program. I think the easiest part, in some ways, would be to build the plants. The real problem is getting the men, and that is going to take time although there are a nuclei of these competent investigators in 30 or 40 of these fine medical schools of the country, and as you know, we have about the best medical schools in the world in this country. I am avoiding your direct question, Mr. Chairman, on how much it would cost, because I have not tried to figure it out. The CHAIRMAN. I can readily understand why you would not be able to give a definite figure if you had not made a particular study of that phase, because it would be necessary, of course, to consider what schools are conducting this sort of research; the scope of the work that they are doing and to what extent there is possibility of expansion. So that it is more or less an individual school proposition that would have to be considered. Dr. RAPPLEYE. Well, reference may be made to the remarks in answer to a question from this side of the table earlier, to one of the earlier speakers, and that is the fact that this group of men in the American Heart Association and other groups working in the National Research Council, are now making such a study and within the next few weeks or months it ought to be completed and figures ought to be available as to what the schools of the country, medical institutions of the country, will need in the way of facilities and added budgets to take care of their own immediate needs. We among others have answered those questionnaires. So that I think all of that information will be available shortly through this clearinghouse which will give very much needed information. The question is a good one, because we have to know. You have to know what it is going to cost ultimately. The CHAIRMAN. In your opinion, is there any conflict between the provisions of a bill such as those we are considering at the present time, providing for a Heart Research Foundation as compared with a National Science Foundation bill? Dr. RAPPLEYE. I see no conflict, as I understand the bills. I have read them. I do not see any real conflict there. As a matter of fact there has been a great integration in these various efforts in training and scientific endeavor and that is one of the main factors, one of the main features of the National Science Foundation bill, so that something can easily be accomplished if some of these programs are allowed to go forward. They ought to go forward rather promptly, as has been again so clearly stated this morning here and an effort should be made to get these things going promptly. The CHAIRMAN. The National Science Foundation bill as passed by the House and Senate last year provided for the appointment of special commissions to study and make a survey and report with respect to heart, cancer, and polio, and there may have been other diseases. However the bill as passed by the Senate yesterday eliminated that special designation of special commissions and has adopted general language, the effect of which would be to give the Foundation authority of appointing special commissions to make special studies, without making any specific reference to the types of diseases that I have just mentioned. Would it seem to you that it would be better to have the specific designations, or just a general designation? Dr. RAPPLEYE. Perhaps I do not know much about the bill-but it would strike me as being a valuable thing to have those major commissions designated in the bill. Now, if they are not designated in that bill-and as I understand-the National Science Foundation when it starts functioning, while it itself can create such commissions, or can come back for an amendment later to have them set up-and I would assume administratively under any program such commissions will have to be set up. That will be the only way of going ahead and administering these major health problems of the country, it seems to me. The CHAIRMAN. Well, it would seem to me that when you give a general authorization without designating any specific studies or surveys to be made and leave it to the discretion of the National Science Foundation, they may or may not recognize the importance of these particular diseases which I think Congress recognized as important. Certainly you folks in the medical field have recognized them as important. Representatives of the medical profession and others have come before the committee asking that a Research Foundation be set up for specific purposes, indicating that they are extremely interested in this type of legislation. It seems to me that with Congress indicating what we consider to be important in the way of research to be conducted by the Foundation that it has created an obligation to set up such commissions. That might be a surer way of having it done. Now, with the formation of such commissions, the questions such as I propounded to you a moment ago could be taken care of. In other words, the special commission would make the study that would determine not only what was best to be done, in what way the research should be conducted, but the over-all costs. I am a bit disappointed that the Senate changed the language as it had been previously agreed upon, to the more general language to which I refer. Dr. RAPPLEYE. Another thing, if I may add it without knowing a great deal about these things, it would strike me that the general practice under such a bill will mean that they will scatter their shots at the beginning and there will also be considerable delay in getting 'started on some of these important elemental studies. That is what is going to happen. It will take them a long time to make up their minds that these are the things that have to go to be done first; and if they are designated as you indicated just now by the Congress itself as to what is regarded nationally as important, it will probably get us off to a much more prompt start in getting at some of these problems, because I think if you generalize you may miss that. Mr. HALE. Thank you for that statement. |