people are away ahead of the Congress. We should have had this legislation in here at the time when every man, woman and child, almost, in America was alerted to this problem by just one simple little radio program, which raised over $1,500,000 of private funds for the American Heart Association showing that the interest of the American people in this program, and all of the editorials and all of the comments from all over the country that has come to me, is entirely unanimous.

May I say to the gentleman it has been my privilege to speak in various parts of this country, and it is one of the most wonderful experiences that has come to me in my service in the Congress when I find a unanimity of sentiment and attitude on the part of that public, without regard to politics, that they want their tax money spent for this purpose, and they will be taxed willingly for the purpose that is envisaged in this program.

Thank you very much.

The CHAIRMAN. The next witness will be Mr. Javits.

STATEMENT OF HON. JACOB K. JAVITS, MEMBER OF THE UNITED STATES HOUSE OF REPRESENTATIVES FROM THE STATE OF NEW YORK

Mr. JAVITS. Mr. Chairman, may I say that I appreciate again the opportunity to appear before you to testify on this particular bill, as I did last year in connection with the National Science Foundation bill. Last year mine was the only bill which provided for a National Heart Disease Institute, within the National Institute of Health, which was before the committee and before the Congress.

This year other distinguished members, Representatives Keefe and Smathers, and Senator Bridges, Senator Ives, Senator Murray, and Senator Pepper, have introduced similar legislation.

I would like to pay a special tribute to Congressman Keefe, who has taken on this effort in a spirit of real leadership, and to assure the committee that it is my intention to follow his leadership and to work out in agreement with him a draft of a bill which will be the unanimous. view of all of the Members who have introduced this type of legislation. We have in substance agreed upon such a bill, that bill being Congressman Keefe's bill, with the inclusion of sections 4 and 5 of my bill as part of it.

Sections 4 and 5, just to spell them out a little more in detail, provide that 6 of the 12 public members of the Advisory Council shall be men skilled in this particular field of heart disease research; and section 5 provides that the Advisory Council shall certify, rather than just recommend or advise, the particular projects which are entitled to support under this legislation.

I am glad to see that those sections have been accepted.

My bill was drawn with the American Heart Association, which is composed of physicians especially skilled in this field. They drew this bill with me and believe that these particular sections, 4 and 5, upon which they fixed their special attention, will be the most likely to carry out the basic purposes of the legislation. Hence the ideas adopted for inclusion in the bill to be recommended by all of the sponsors to the committee do not represent any particular idea of mine alone; it rep

resents the endorsement of the people who have been working, and working very hard and extremely ably, as the committee will itself hear when they present their testimony, in this field.

There are just two other points that I would like to stress to the committee in connection with this legislation. I orginally got the idea for introducing this legislation because I saw, just as other laymen must have seen, the enormous amount of emphasis which has been placed upon raising money for research in cancer and infantile paralysis, and yet here is a disease, heart disease, that not only kills three times as many people as cancer, which is the next highest killer, but also disables an enormous number of people. It is estimated, for example, that heart disease is responsible for the loss of 150,000,000 workdays annually, and is a disease that strikes very hard at the young. Öne out of every 10 rejected for military service in the war by Selective Service was turned down because of cardiovascular diseases, and it causes more deaths among children. 10 to 15 years of age than any other disease.

Yet in this particular field we have been the most remiss in financing research, and this goes both for the public as well as for the Government. When you compare the money spent for research in other diseases with the money spent for research in heart, the same thing appears.

I would just like to read to the committee that part of my statement which deals with that subject.

Although an appropriation of over $14,000,000 has been provided for cancer research during fiscal 1948, aside from the $25,000,000 provided for cancer research in the appropriation for the Atomic Energy Commission, and although about $15,000,000 was made available for research and treatment of infantile paralysis, only about $3,000,000 was available last year for research on diseases of the cardiovascular system.

I think it is that public emphasis, taking the two factors-one, that heart disease is three times as great a killer of human beings and as great a disabler of human beings as the next most lethal disease, cancer, and taking into account the fact that diseases far less deadly are getting 5 and 10 times as much attention in terms of money-was the reason for my original interest in this particular field. I believe that it is that condition of inequity in the public interest which deserves the attention of the committee.

I have just one final point. We are all interested in the public supporting our campaign for research as well as the Government supporting them. The American Heart Association has done much but it has not obtained nearly the importance and nearly the amount of public support which programs for cancer research and programs for infantile paralysis research have attained.

We feel, and feel very sincerely, and we are convinced, that with an emphasis on this problem by government, such as would come about if this legislation were favorably reported by the committee, and then adopted by the Congress-and I might say I join Congressman Keefe in feeling that adoption by the Congress in both Houses would be unanimous once the committee decided that this was the right thing to do-if the Government fixes its attention upon this disease as it has upon cancer and as it has upon mental health, it will result in fixing public attention upon it, and we will find a very

much broader base of public support for research and efforts in connection with heart diseases than we ever found before.

Mr. Chairman, that completes my statement, and I would like leave to file a statement with any material which may suggest itself by virtue of a review of the comments of the various Government departments.

The CHAIRMAN. You will have that privilege.

Are there any questions, gentlemen?

Mr. HALE. I would like to know, Mr. Javits, in connection with this legislation and with cancer legislation and with scientific research legislation, and so on, what the proper boundaries are between Federal endeavor and Federal appropriations, private endeavor and private appropriations, and possibly State endeavor and State appropriations. Can you enlighten me on that point?

Mr. JAVITS. The Federal endeavor, as its pattern is laid out in the Public Health Act, of which this would, as Congressman Keefe said, be an amendment, is plainly to give grants-in-aid, to private agencies and to give grants-in-aid to governmental agencies. Really, it is a stimulating activity; it is an activity which causes other activities to be brought about, and it is a planning activity and a coordinating activity.

Then you have got your States, which are really in the treatment field, and you have got your private agencies which are in the research field. It is all of the difference between founding a hospital and giving it the ability to engage not only in treating patients but in research which will endeavor to find the causes for and the cures of the disease.

I think that we are no longer speculating in that field, because we are actually doing it in connection with mental health and cancer now. The Federal Government is working out a pattern, as I am sure, Congressman Hale, the technicians who will follow me, as well as the representatives of the Public Health Service, will make clear in terms of the actual dynamics of operation and exactly how the money is used.

Mr. HALE. How can a committee like this tell how much to authorize and how can the Appropriations Committee know how much to appropriate on a thing like heart disease? I do not suppose that, with any authorization, we are going to put a stop to heart disease in the next fiscal year.

Mr. JAVITS. Like so many problems with which the Congress has to deal, we are faced with a problem and we have to, as reasonable men, do something about it. The way it has been done in the past is that a program has been brought in for a particular fiscal year, as to what the Public Health Service felt could be accomplished within reason within that fiscal year, and then both this committee and the Appropriations Committee have apportioned it, taking some over-all view as to what we ought to spend on the whole effort in medical research and what part of that ought to be allocated to heart disease. Certainly we cannot find the cure for that disease in the year, and certainly we are not embarking on a program that might cost $2,000,000,000 to mobilize all of the scientific resources of the United States for this one purpose.

But there is a middle ground, and that middle ground is conditioned by the practical programs which are brought in as to what they feel could be the most helpful toward the ultimate result in this particular

fiscal year. The Appropriations Committee has not had any trouble making appropriations for the other areas in which active research is engaged in, and I do not believe it will in this.

Mr. HALE. Then your practical answer is that our measure should be the recommendation of the Public Health Department, is that right?

Mr. JAVITS. Our recommendation, I would say, should be compounded of three parts: First, our view as to what ought to be spent in the whole field of medical research; and second, the recommenda tions as to what can practically be done in a particular year, which will come from the Public Health Service as well as this Advisory Council which we are authorizing under this bill; and third, the appraisal of this committee and the appraisal of the Appropriations Committee as to what can practically be done, whether it can be done. They have got to review the facts on that score, which they always do.

Mr. LEA. Mr. Javits, I take it there is no doubt about the importance of heart trouble. But are not the figures you have been giving here illustrating the enormous number of deaths due to heart trouble, rather misleading in this respect: The heart, I think you will agree, is the central and vital organ of the body, but its ailments are primarily not in the heart itself, but result as reactions from other organs of the body. For instance, kidney disease and liver and the stomach and the lungs, rheumatic fever, and other diseases, have their reactions in the heart, but the heart is the secondary cause and these other diseases are the primary cause. Is that not true?

Mr. JAVITS. That is true, but it does not apply to the figures which I gave. The figures which I gave, and I will give the Congressman the exact figure, are premised upon 587,000 deaths directly attributable to heart disease in the year 1945, of men, women, and children. That does not try to account for the fact that the heart stops when anybody dies for any cause. It deals with deaths directly attributable to diseases of the heart.

Now, the figure is only important by way of comparison, and that is the only way I gave it to the committee, by way of comparison with the pervasiveness of this killer as compared to other diseases, and it certainly stands No. 1. In other words, whether the figure is 587,000 or some other. If there are some differences between the doctors as to what is a death directly attributable to heart disease, the same differences occur with respect to others. The point is that this is far and away the No. 1 killer, and yet it has had, relatively speaking, the least attention; that was the point I was trying to get across to the committee.

Mr. LEA. Do your figures discriminate between heart diseases that originate on account of the defects of the heart itself, and those cases where the heart failure is due to the reaction of other organs of the body?

Mr. JAVITS. I would have to refer the Congressman respectfully to the technicians who will testify, but I think one fact is very clear, that this is far and away the No. 1 killer, and that was the main point I wanted to bring out.

Mr. LEA. I do not disagree with that.

Mr. JAVITS. I think the doctors will enlighten the Congressman as to the technics of it.

Mr. PRIEST. I have one question. I understood you to say earlier that you and other sponsors of the legislation had agreed generally on a bill that would be Mr. Keefe's bill with sections 4 and 5 of your bill replacing similar sections in his bill; is that in substance your proposal?

Mr. JAVITS. Yes. It does not include a concurrence fromCongressman Hand and Congressman Klein, because their bills seemed to us to be quite in a different field; but if the committee so desires, and I gather from the chairman that the chairman would view that with favor, I have little doubt that Congressman Keefe and I can get the concurrence of Congressman Hand and Congressman Klein.

Might I just finish that answer by saying that Congressman Keefe and Congressman Smathers and I have conferred together, and we are of one mind.

Mr. PRIEST. I have one further question with reference to paragraph (c) on page 7, that is paragraph (c) of section 5. That is with reference to the authority of the Council to certify to the Surgeon General its approval on applications for grants-in-aid. The question is, can the Surgeon General authorize grants-in-aid without this certification, or as you understand it, is it mandatory that the certification be made before an allocation of funds could be made?

Mr. JAVITS. There is no prohibition in the bill on the Surgeon General, and as a matter of law I would say that he could, he has complete power. But I take the word "certify" to be the expression of the clear intent of Congress that it wants him, except in the most extraordinary circumstances, to first get the approval, to wit, the certification of the Council.

Mr. PRIEST. I think it is a proper provision, and I merely wanted your interpretation of the provision.

Mr. JAVITS. Exactly.

Mr. PRIEST. That is all, Mr. Chairman.

The CHAIRMAN. Are there any questions, gentlemen?

Thank you, Mr. Javits, for your appearance this morning.

Is Mr. Klein present?

Is Mr. Hand present?

Mr. Smathers, I understand, will appear tomorrow.

It was the intention of the Chair to have called as our next witness Mr. Oscar Ewing, Administrator of the Federal Security Agency, and following him Dr. Leonard Scheele. It has come to my attention that Mr. James Adams, chairman of the executive committee of the American Cancer Society, has an engagement this afternoon and tomorrow that would prevent him from being present.

With all due modesty that is so characteristic of Mr. Adams, he has hesitated to appear before Mr. Ewing and Dr. Scheele have testified, but I have improessed upon him that if he does not do it now, he may not have an opportunity to appear. I know Mr. Ewing and Dr. Scheele will understand the reason that I am not carrying out entirely the wishes of Mr. Adams in calling him before I call these other two gentlemen.

Mr. Adams, will you come forward?

This is Mr. James Adams, chairman of the executive committee of the American Cancer Society, of New York. I personally have such a high regard for Mr. Adams and the fine work that he has done