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edge of their operations, and together with the fact that in the National Science Foundation bill which has had the consideration of Congress in the past, and it is again having it in this session, there was this same provision in that.

Mr. EWING. From what I have heard our people say, I think on the whole it is working, I think, in 99 cases out of 100, or even more than that. It would work entirely satisfactorily in those cases. I know of one instance, and I do not know that it shows much one way or the other, but shortly after I went into office in the latter part of August-I had not been in but a very few days-I had a telephone call from Dr. Morris Fishbein of the American Medical Association, just raising Ned about a grant that had been made to an osteopath out in Kirksville, Mo., for a study. Well, I had never heard of it, and he said it must be political, the fellow could not be any good; the osteopaths did not have any scientific knowledge of any kind. Well, he said there had to be some politics in it.

So I looked it up, and I found that during the preceding July there had been a grant made to a doctor out there. It had something to do with muscles, which was right in the field of osteopathy, and the supporting data were completely convincing. I thought I would check up on the politics, so I called Watson Miller, who was Administrator before me, and he had never heard of it, and that took two politicians out, so there was only one other that could possibly—I did not want to classify Dr. Parran as one, but I did take the trouble of calling him, and he had never heard of it. So there was not any politics in that.

So I called Dr. Fishbein back and I said if it was any politics at all it was medical politics that was in it.

The CHAIRMAN. I think that your discernment in that respect is justified in many instances. I have a recollection, having been a member of the legislature of our State some years ago, and it was very clearly demonstrated to us that this thought of orthodoxy has been progressing and continuing. I think the homeopathic treatment had some difficulties in getting recognition, but once they were in and then the osteopaths came up for recognition, why, both branches of the medical profession joined against them. They have been taken in, and then finally the chiropractors wanted some recognition, and the three that I have already named combined together against the chiropractors because they were not orthodox.

So I say orthodoxy is a rather progressive disease, and it is a continuing one, evidently. I can very readily understand the point that you made, that we cannot pay too much attention to orthodoxy. Where you are dealing in a field particularly such as this, that is

true.

Mr. EWING. Coming into this field new from the law, but having a certain background from my experience as counsel for Merck of knowing what this is, what we do not know is just incredible. The possibilities of research in medicine are just unbelievable. There is a wholly new conception of research that has developed here, I would say, almost entirely almost since the war, or by reason of the war. Your earliest research was practically all done by drug houses wanting to develop a product that they could sell, and they did some magnificent work. That was the main reason for the research work.

Then with the founding of the Rockefeller Foundation in 1919, I think, you began to get a private fund going in for some great over-all research.

They you came to the atom, and you saw there the benefits of very large Government expenditures on a widespread scale.

And now we are moving into the period where we see that research has got to be conducted on a scale far more vast than any private institutions or any foundations or any universities alone can do.

Now, I feel very strongly that the place of Government in this is not to conduct the research itself, any more than is necessary. My feeling is that we ought to do the planning, and we ought to have the over-all picture, and we ought to know what ought to be done, and we ought to know what is being done, and the difference between the two makes the deficits that we should be working on.

Knowing those deficits, we should then go out and try to get industry to do it or a foundation or a university or a private scientists, or anything we can. The Government then should come in only to do those things that should be done but either cannot or will not be done by these other groups.

But that still leaves us a vast field that we will never fully occupy. But it is just incredible, what can be accomplished by this over-all approach.

The CHAIRMAN. We thank you, Mr. Ewing, for your presence before us. I particularly appreciate the willingness that you have had to emphasize your individual viewpoint as strongly as you have. That sometimes is not done by witnesses holding public office that come before the committee, and it is particularly agreeable to me to hear you unqualifiedly take a position and say that that is it.

The committee will recess until 2 o'clock.

(Whereupon, at 12:55 p. m., the hearing was recessed until 2 p. m., of the same day.)

AFTERNOON SESSION

(Whereupon at 2 p. m., the committee reconvened, pursuant to the taking of the noon recess.)

The CHAIRMAN. The committee will be in order.

The first witness this afternoon will be Dr. Leonard Scheele, the Surgeon General of the United States.

STATEMENT OF DR. LEONARD SCHEELE, THE SURGEON GENERAL OF THE UNITED STATES

I welcome the opportunity to appear before this committee on the several bills to provide for programs of research and control in diseases of the heart and circulation.

The five bills under consideration here, H. R. 3059, H. R. 3464, H. R. 3762, H. R. 5087, and H. R. 5159, all recognize that diseases of the heart and circulation are a prime public-health responsibility. Although the basic objective of all these measures is similar, we believe, as Mr. Ewing has indicated, that the latter three, H. R. 3762, H. R. 5087, and H. R. 5159, represent a more desirable approach to the problem of heart-disease research and control and would provide us with a more effective mechanism for dealing with this problem.

The latter three bills provide a framework for instituting a heartdisease program and enumerate the responsibilities of the Federal Government, through the Public Health Service, in carrying out that program. I shall, therefore, direct my comments particularly toward these bills.

We have already examined the provisions of each of these measures in some detail in the reports which the Administrator has submitted to your committee, and I merely wish here to review their broad outlines. Common to all of these bills are the establishment of a National Heart Institute to initiate, promote, and stimulate research in the cardiovascular diseases; the setting up of a National Heart Council to assist in coordinating heart-disease research throughout the Nation, and to advise the Surgeon General; and the provision of grants to the various States in order to aid them in setting up programs of heart-disease control, detection, and prevention. The bills would enable the Federal Government to establish, in the Institute or elsewhere, research fellowships and traineeships in the cardiovascular field and, in addition, to provide training and instruction through grantsin-aid to schools, hospitals, laboratories, and other public or nonprofit agencies.

I believe the provisions of these bills will pave the way for a fullscale, comprehensive attack on the Nation's No. 1 killer-heart disease. There is little need for me to repeat what has been and will be emphasized by many others, namely, the extent of the problem posed by these diseases and their effect on our economy. The tragic toll of heart diseases in terms of death, of suffering, of economic and social dislocation tells its own story.

We have not yet begun full-scale mobilization of our resources in the fight against this public health menace. As yet we have only a limited knowledge of the causes of the illnesses, of the best methods of treatment and cure, and of the most effective methods of detection and prevention of cardiovascular diseases. This is so mainly because the facilities for cardiovascular research have been pitifully inadequate in the past. Funds and facilities in heart disease research have lagged far behind the resources and money which have been made available for other illnesses, some of which are less prevalent and less deadly.

We feel, therefore, that it is very wise to set up a special program for heart disease research and control and to establish a special heart institute to concentrate the attention of the research resources of our country on this vital health problem. It is wise because it would provide us with the basic instruments we need to institute a broad and comprehensive heart-disease program. It is wise because without this machinery our attempts to combat these diseases could only be limited and incomplete.

These measures would clarify, supplement, and extend our present statutory authority in the cardiovascular field. They would accomplish these objectives through several tested and valuable methods.

First, they would provide specific authorization for a National Heart Council. On this council would be represented outstanding scientists and physicians in the cardiovascular field and public-spirited laymen with an active interest in heart-disease problems. This would provide the Public Health Service with the most excellent advice available for the conduct of the program.

Second, they would provide a program of grants-in-aid to medical schools and to other institutions for the support of improved teaching in the cardiovascular field in a manner similar to the program now being administered by the National Cancer Institute. This we have found to be extremely valuable in marshalling the teaching facilities available in the country in the field of cancer, and I am sure we can expect similar results for diseases of the heart and circulation.

Third, they authorize assistance for postgraduate clinical training in heart disease, which will improve the teaching and assure that the results of research will be available to practicing physicians.

Fourth, in setting up a National Heart Institute in the Public Health Service, these bills would assure appropriate emphasis on research on heart diseases in a research center within the Service.

Fifth, and especially important, these bills would provide a substantial program of financial assistance to research institutions outside government to promote heart research and to expand clinical and laboratory facilities for heart research. Also they would provide research training for young scientists.

Sixth, each of these measures, but particularly H. R. 5087 and H. R. 5159, would authorize a program of control to supplement the basic research. Such a program is, of course, as vital for the actual and potential victims of heart disease, as well as for community health programs in general, as are the research provisions themselves. These bills would enable the States, with financial and consultative assistance from the Public Health Service, to set up programs of heart-disease control, detection, and prevention. We consider it highly desirable that these two aspects of the full heart-disease program, namely, research and control, be combined in a single agency. This will not only assure coordination of the two components of any comprehensive heartdisease program but will serve to shorten the lag between basic and research services for the people, which is our ultimate goal in the field of public health.

Finally, these bills, if enacted, would make clear the will of the Congress to single out heart diseases for special consideration, and would serve to focus greater public attention on these diseases. Our experience with other health programs has proven that public sentiment is mobilized, that private and professional agencies are encouraged, and that the most practical and effective approach to the prevention and control of disease is adopted when such action is taken by the Congress. Recent experience in cancer detection, control, and research is a noteworthy case in point. Simultaneous with the expansion of the Federal program there has been stimulation of private agencies to a high level of activity, and as additional Federal funds have been made available, more private donations have been made than ever before.

I am convinced that we must arouse and mobilize all the people to the significance of these diseases if we are to achieve continuity of program and lasting results. I believe too that the legislative authority provided by these bills will make it easier to coordinate the activities of the Federal Government with those of the voluntary organizations, such as the American Heart Association, which have been performing such a valuable function in this field.

I am gratified to note that two of these measures, H. R. 5087 and H. R. 5159, make provision for raising the salary ceiling for those

research positions in the Public Health Service which require outstanding and specially qualified men. This provision is urgently necessary in the cardiovascular-disease field, where the key research positions must be filled by physicians and scientists who have the ability to direct and plan studies of the highest national import. Probably more than any other single factor, the participation of these men will guarantee sound scientific achievement in cardiovascular research. I believe, however, that the provisions authorizing the lifting of salary ceilings should be amended to follow statutory provisions relating to similar positions in the armed forces. I would suggest, therefore, that the Federal Security Administrator be authorized to establish positions as well as rates of compensation, and that such positions be included within the classified civil service. In this connection I might point out that Dr. Parran, in his testimony before your committee on the dental research bills, discussed this point in some detail and submitted supporting data for inclusion in the record of the hearings.

In addition to this recommended amendment, there are several other changes which I should like briefly to suggest.

First, the provisions authorizing appropriations for the construction of buildings and facilities to house the proposed National Heart Institute, which are contained in H. R. 3762 and H. R. 5087, have been made unnecessary by the inclusion in the 1949 appropriations for the Service of funds for the construction of a new clinical research center at Bethesda.

Second, it would be in the interests of uniformity to redraft the provisions in H. R. 5087 and 5159, relating to control grants, so as to conform to the pattern for other State grant programs under the basic Public Health Service Act, whereby the State agency is responsible for planning, organizing, and carrying out the program, while the Federal Government provides financial and technical assistance.

Third, although we favor the provisions contained in H. R. 5087 and H. R. 5159, which permit control grants to be made directly to nonprofit institutions, we believe these provisions might be somewhat modified so as to recognize the primary responsibility of the States in the formulation of control programs. This could be achieved by providing that such grants shall be made upon recommendation of the State health authorities, and that they shall be made directly only in those States where State control programs have not yet been developed or where there is legal prohibition against working through nonpublic agencies or institutions.

Finally, I should like to suggest that, if the committee acts favorably on these measures, the final bill be recast as an amendment to the basic Public Health Service Act (42 U. S. C., ch. 6A). This would allow the Service to avail itself of all the procedures, regulations, and machinery already established for other similar activities and programs. Furthermore, it would avoid unnecessary overlapping or duplication of statutory provisions. We have prepared a working draft of a bill in this form which we would be glad to submit for the use of your committee. This draft includes the other changes which I have previously recommended, as well as several other modifications which appear to be in the interests of consistency and uniformity.

With the tools that these bills or a corresponding amendment to our basic legislative authority would give us, with the renewed emphasis to the American people of the deep concern of the Congress with the

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