It is believed that the United States Public Health Service is preeminently fitted, both with respect to its professional components and the purpose for which it was established and has been expanded, to be entrusted with the responsibility of inaugurating this program and then making certain that it is effectively continued to the extent permitted by modern skills and available resources. It is true that many universities, hospitals, and foundations of various types have been conducting laudable and productive activities along parallel lines; however, it is believed that the material assistance and integration which this bill will furnish would not serve as a justifiable basis for a charge of excessive paternalism in Government.

That this proposed legislation would result in a rise in the general health level of the Nation would seem to be a logical prediction. Likewise, it is felt fully warranted to assume that the benefit to that segment of our population which carries on the Government's work would be reflected in a material increase in the total efficiency of Government. The Commission is in hearty accord with the intent and general format of the bill and recommends its enactment. Although wishing to detract in no way from the above comments, it is felt advisable to transmit one observation for whatever value it may be to your committee. The Commission has been advised by the Federal Personnel Council that the Personnel Legislation Committee of that organization is of the opinion that the language used in section 7 (b) of the bill with respect to provisions for personal services by contract is not sufficiently restrictive. It was stated that the committee has gone on record as not cbjecting to contract provisions for scientific and professional personnel, but they, have, however, consistently objected to any extensive securing of secretarial, stenographic, and related services by means other than the recognized appointment procedures. The Commission does not desire at this time to recommend any specific changes in this connection. However, should your committee desire to give consideration to the point raised, we shall be glad to furnish additional specific comments along any lines requested. The Commission has not been advised as to the relationship of the proposed legislation to the program of the President.

By direction of the Commission:

Very sincerely,

HARRY B. MITCHELL, President.

The CHAIRMAN. Mr. Keefe, we will be pleased to hear from you at this time.

STATEMENT OF HON. FRANK B. KEEFE, MEMBER OF THE UNITED STATES HOUSE OF REPRESENTATIVES FROM THE STATE OF WISCONSIN

Mr. KEEFE. Mr. Chairman, I appreciate the courtesy of the committee in permitting me to address the committee in behalf of H. R. 5087, and the general purposes of H. R. 3762 introduced by Mr. Javits and H. R. 5159 introduced by Mr. Smathers. The bills introduced by myself and Mr. Smathers are practically identical.

Mr. Chairman, I shall not devote any time to a discussion of the matters with which these bills purport to deal. I am convinced that every member of this committee and every Member of the Congress is thoroughly aware of the tremendous inroads that the diseases of the heart are making upon the American people. I could call attention to many, many instances that would dramatize the problem, but I am sure that every member of the committee is as aware as I am of the necessity for a concentrated attack upon the problem that is presented in the devastation as affecting our people resulting from diseases of

the heart.

I know that the members of this committee are fully aware of the consuming interest which I have in matters affecting public health, and as chairman of the subcommittee of the Appropriations Com

mittee in charge of all appropriations for the United States Public Health Service, I want the committee to know that that committee has at all times been unanimous and the full Appropriations Committee has at all times been unanimous in implementing the magnificent legislation that has been passed to the Congress and passed unanimously as a result of the actions of this committee. I refer, of course, to the National Mental Health Act which we are implementing for the first time this year in a broad way, dealing with problems of mental health. We expect that as a result of the authority granted to the Appropriations Committee by the passage of he National Mental Health Act, we will be able in a short time to make remarkable progress in the field of mental health.

I refer also to the steps that have been taken by the committee of which I have the honor to be chairman, in implementing the National Cancer Act, and to provide the funds necessary to carry forward that great program.

Now, it must be understood right at the start that there is no attitude on the part of the committee or the Congress that has for its ultimate purpose, or any purpose, the elimination of private efforts in this field. I believe that the stimulation which has been given by the Congress to the cancer research program has resulted in dramatizing the necessity for concentrated action across the country to deal with that problem; and as a result, the efforts of the National Cancer Society and related private philanthropic organizations have been augmented and stimulated rather than injured by the efforts of the Congress and the Public Health Service to assist in dealing with that very grave problem.

So, I am certain that the statistics will indicate that in the field of cancer research and in the field of research and control in mental health, the action of the Congress in pointing the way to the dramatic possibilities that are inherent in those programs will cause the American people to give liberally of private funds and private charity and private endowment in order that we may on a very wide and unified and cooperative front attempt to deal with these problems.

The specific bill that is before us proposes to establish a heart-control program based upon the pattern which this committee has put into force in connection with the mental health and the cancer-control programs.

I am fully aware of the fact that there are some people who may say, "Why is it that you are seeking to enact this legislation when you have under the provisions of Public Law 410, as amended, a rather broad general authority to deal with all matters affecting public health?" May I say to the committee that a careful analyis of the authority that is vested in the United States Public Healh Service under the provisions of Public Law 410, as amended, clearly discloses that there are certain gaps that need to be filled in if we are to have a well-rounded program. You filled in those gaps with respect to mental health and you filled them in with respect to the attack on cancer, and we are asking that those same gaps be filled in with respect to diseases of the heart in order that we may proceed in a well-rounded program to attack that specific problem.

There are, may I say, provisions in existing law that permit certain appropriations to be made. In the bill which just passed the Congress

coming from the Appropriations subcommittee, we have provided for fiscal year 1949, $1,875,000 for research grants, $150,000 for research fellows and fellowships, $257,009 for intramural research, to implement the work which is being carried on out at Bethesda under existing programs. We have awarded $100,000 for expenditure in connection. with certain typing of serums. We have provided $84,310 for epidemiological studies and assistance to State services, $119,110 for demonstrations, and some $57,859 for technical development.

Now, that is a good start, and represents an increase in appropriations under existing law of from $135,768 in 1946 to $2,644,088 contemplated for expenditure in fiscal year 1949. But the expenditure of that money does not permit a well-rounded program because there are certain very definite gaps.

For example, there is nothing provided for in existing law for construction grants for research facilities, as is true under the cancer and inental health programs. There is nothing in existing law that provides control grants to institutions under existing law, such as in the other two programs. There is nothing that provides for trainees, and traineeships, under existing law, and we are not authorized to make appropriations for that purpose as we are under the cancer and mental health control programs. And nothing is authorized to permit grantsin-aid to the upbuilding of teaching facilities and improvement of the teaching facilities in the medical schools of the country under existing law, as is possible under the cancer control and mental health programs.

So I think that I can say that so far as my committee is concerned, we are hamstrung, so to speak, by existing law in proceeding in the line of appropriations which we consider to be absolutely a minimum of necessity if we are to attack this problem of heart disease on the broad front that we believe it should be attacked.

So in the legislation that is before you, provision is made for filling in these gaps of authority so that the Appropriations Committee can consider the entire, whole program in making appropriations, and set it up on a broad front.

Some people say, "Why is it necessary, in view of the contemplated action with respect to the National Science Foundation Act?" which this commitee has given great consideration to. I simply want to say that so far as I am able to observe and understand, the National Science Foundation Act as it is presently written and proposed, contemplates entering on a broad front the field of general research, and does not contemplate the activated action program that is carried on under the cancer research or the mental health acts or as is proposed under the authority contained in the legislation now pending.

Some say that since both acts would provide for basic research and for granting fellowships to promising scientists, we should not bring this heart program out of the general authority of Public Law 410, but should leave the matter to be dealt with in the National Science Foundation bill. It seems that there is a marked difference which becomes clear when the two bills are compared. The stated purpose of the Science Foundation is to foster and support basic research, while that of the Heart Act is to improve the public health by research, investigations, and demonstrations as to the cause, prevention and diagnosis and treatment of the diseases of the heart and circulation.

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In other words, the program envisaged by the legislation which is now proposed goes far beyond the field of basic research, which is fundamental and vital, of course, and must be encouraged and must be carried on, but it envisages an action program that will bring to the people of America today the accumulated knowledge that has been gained as a result of research in the past, and research that will be gained, if the National Science Foundation bill passes, in the basic sciences that affect this disease, and bring them by an action program directly to the people of America who are dying by untold thousands as a result of heart disease.

I think it is clear that to accomplish the objectives of the Heart Act, major efforts over and above basic studies will have to be made in the fields of applied and developmental research, and this is not a function of the proposed Science Foundation but it is a logical and necessary function of the Public Health Service.

Now, the national heart bill establishes traineeships for applied clinical diagnosis and treatment of heart disease, and authorizes assistance to the various States in the use of the most effective methods of prevention, diagnosis and treatment of heart disease. Neither of these can be functions of the National Science Foundation as the bill is written.

The national heart bill also authorizes grants-in-aid to universities, hospitals and other institutions. These, too, would not be available under the National Science Foundation Act.

May I call your attention, gentlemen, to the fact that the Congress this year, by a unanimous vote without one dissenting vote, either in the Committee on Appropriations or on the floor of the Congress, in the House or the Senate, has recognized one of the basic things that is wrong in this whole program of research and development and control of disease, and that is the lack of suitable and proper clinical facilities that must be utilized and carried on if we are to bring the benefits of accumulated knowledge to the people of America.

So in the cancer appropriation this year we have set up a building program to provide clinical facilities, not only this great hospital center out here at Bethesda, which is to be devoted to mental health, heart disease, and cancer, but we have provided a building program to provide clinical facilities at the very centers of research throughout the country where research is going on. And thus we accomplish two purposes, namely, to provide the clinical research in the institution where the research is going on, remove it from the mere character of a rat control and study program and utilize human patients by providing them with the very best of care that science can give; and at the same time, through the daily recording of evidence by the researchers, perhaps finally unfold and succeed in determining what is the true cause of that disease.

So under the authority which you have granted to the committee when you passed the National Mental Health Act and the Cancer Control Act, we are proceeding on a broad front; and we are asking-and I speak not only as a Member of Congress but I speak as the chairman of the committee whose obligation it will be to implement this program with funds-and I believe I speak for the entire committee in saying that we are asking this committee to give us the basic authority to proceed along the lines which I have indicated in order that we can bring this heart program into the fullest development.

May I say that there are a couple of fundamental differences between the Javits bill and the bill which I introduced and the one which was introduced by Mr. Smathers. The differences relate to the make-up and the functions of the Heart Control Council that is described in section 4 of H. R. 5087. I have gone over that matter very carefully with the people that are interested throughout the country in this project, and so far as I am concerned, I have no ax to grind except to try and get a program that will work in the public interest; and I am perfectly willing that the comparable provision of the Javits bill, when the committee comes to considering the writing of a bill, be substituted for the provision which is contained in the bill which I introduced. In other words, the Javits bill contains the historic set-up as to the functions and power of the National Advisory Council, which gives to the Council the power to initiate projects and grants, and restricts the Surgeon General to the point that he cannot initiate a project or a grant without the approval of the National Advisory Council. It is exactly as the program is working under the National Mental Health Act and the Cancer Control Act today.

Another question might arise as to the make-up of the Advisory Council that is suggested in this legislation.

Mr. PRIEST. May I ask a question? That is section 4 in both bills, I believe. Which one of the bills follows the pattern in the Mental Health Act?

Mr. KEEFE. The Javits bill.

Mr. PRIEST. Thank you, sir.

Mr. KEEFE. I have no objection, when the committee considers this program, to careful consideration of the make-up of the National Heart Council, so as to insure that that Council shall be of proper and suitable character, because it has broad powers and it is very proper that it should be a proper representation of people skilled in the field of heart disease, as well as those interested generally as laymen.

There is one other thing, and then I shall finish. In the bill which I presented to the committee, some question has arisen with respect to section 5, with respect to the authorization of the Surgeon General to make grants-in-aid to States, counties, health districts, and other political subdivisions of the States; and in subsection (d) of section 5, it is provided that the money so paid to any State shall be expended solely in carrying out the purpose for which the grant is made and in accordance with plans presented by the health authority of such State and approved by the Surgeon General.

I want to make it perfectly clear that in every one of our actions in connection with these various Public Health Service programs, we have insisted at all times that the historic relationship between the Federal Government and the States must be maintained, and I would very bitterly oppose any effort upon the part of the United States Public Health Service to circumvent the State public health services and deal directly with any political subdivisions of the State. The record may clearly show that I am certain that that is the attitude of the subcommittee of the Committee on Appropriations with respect to that problem, and we have insisted upon it in every appropriation that we have made. If there is any question as to that matter arising from the language in section 5, I would want it understood that it is my