range clinical research. One of the things we have been able to do in the cancer program through this particular facet of the program is to assist many of our universities in actually setting up bed space which they can hold for research. We have the regular range of beds to do the day-to-day work, which can't be stopped, but for the first time on an increasing scale we are going to have some beds that the research people can call their own to put patients in as they require. They can keep them there as they require without the pressure of having to move the patients out because that bed must earn $10 or $12 or $17 on the average to make ends meet for the hospital. That we are doing in this program. I may point out that the language in three of these bills would provide for a similar program in the heart field.

Now, on the side of cancer control, it was pointed out that we must do something with the knowledge we have today, in spite of the fact that our knowledge of cancer is inadequate in terms of saving lives.

Nevertheless, we can save a great many lives and we can save a great many more than can be saved now. We think 25 percent more or even a third more.

Mr. DOLLIVER. In the cancer field?

Dr. SCHEELE. Yes, so a part of the program is directed at education, although a relatively small part because the American Cancer Society is preeminently suited for this work, because it has its grass roots right down in the community. That particular phase of our program has been a very minor one, actually, because it is being covered by the voluntary organizations.

However, we have been able to give grants to the States in the traditional pattern set up in the Public Health Service in 1935 to assist them in providing community services in the cancer field. These services include cancer diagnostic clinics and cancer treatment clinics and now the so-called cancer detection centers where one goes to have periodic physical examinations, hoping that if cancer is developing it will be picked up early so they may bring about a cure.

Those are the programs which we direct from the center. They are not programs which we push down to the communities, but they are programs which the community wants. The community asks the State Health Department for funds, and from State funds or local funds or from Federal funds available there these programs are carried on.

We also undertake to demonstrate some of the newer techniques in cancer control. In the early stages of research, before the results are completely accepted or while we are still sort of pilot-running, we will run a small program of demonstrations. You will see one here in Washington in tuberculosis at the moment. We do the same sort of thing in cancer, moving on out as soon as it becomes an accepted thing. We have demonstrated to the people's satisfaction something that they should pick up. We provide a consultation service in cancer control. Beyond that, we have only one other activity in the cancer field and that is the one which we mentioned earlier, the training of men by providing clinical traineeships. There are some 80 men in hospitals and universities, getting special work in the cancer field. We are in addition providing grants to medical schools to enable them better to integrate their cancer teaching to the end that the men coming out will be better able to cope with the problem than they have been in the past.

We operate a small clinic in our Baltimore Marine Hospital for Public Health Service beneficiaries. That is the range of our activities.

The House of Representatives and the Senate seem to have confidence in us because you have pushed our appropriations forward. Two years ago we had only $500,000, and later $1,700,000, then we went to $12,000,000, and now it is proposed for this year to appropriate $22,000,000.

We feel that the same pattern would be created by these heart bills and we feel there would be no difference in the way the heart work will be carried on as compared with the cancer program which is a going program.

Mr. DOLLIVER. Let me ask you about one or two details and then I will have no further questions. I remember a number of years ago that the Veterans' Administration set up a cancer clinic in Hines Hospital in Chicago, and it was stated that it was the largest cancer clinic in the world, and they were carrying on research there. Has your organization or has the Cancer Institute had anything to do with that either directly or in a cooperative way, or with any other parallel groups, or any group of the Government such as the armed services?

Dr. SCHEELE. We have had relatively little to do with them in a formal way. In the case of Hines Hospital, I might point out that that still is the largest cancer facility in the world, the largest single aggregate of cancer patients is there. The Veterans' Administration itself has not carried on extensive laboratory-research programs, but they have carried on continuous clinical-research investigations. To the extent that the men in their facilities have had opportunity to work in research, they have tried to improve methods and they have tried to take some of the newer methods of therapy as first reported and attempt to assay them, so to speak. That, they have been able to do without any financial assistance from us. They have been able to obtain their appropriations directly, and they have not required any support from us.

I happen personally to have worked in that facility, in Hines, on a cooperative study back before the war when we decided in cooperation with the Veterans' Administration that we had there a source of material which might be useful in studying the so-called epidemiology of cancer. We were trying to go back into the personal history of those men and women who were there to try to pick up the background factors in their lives which might somehow or other have had something to do with the fact that cancer developed, to see if we could get similar situations in a large enough group that it might be statistically significant.

Mr. DOLLIVER. Was that study that you made of that particular problem in connection with the National Cancer Institute?

Dr. SCHEELE. Yes, sir; it was really a National Cancer Institute study with the Veterans' Administration making their facility available as a laboratory.

Mr. DOLLIVER. The point I wanted to emphasize and that you have just brought out, is that the effort of the Hines Cancer Clinic and the National Cancer Institute are in no way at cross purposes but they are cooperating.

Dr. SCHEELE. Yes; that is right.

Mr. DOLLIVER. Can we say that same thing about any other Government services that are studying the problem of cancer?

Dr. SCHEELE. Yes, sir, I can; and the other group is the Atomic Energy Commission. They have a substantial program of cancer research support. This year it amounts to $5,000,000.

To show you how little competition there is, we had a request from one of our major universities for a grant in the amount of $200,000 to enable them to install a betatron. That is one of these new supervoltage machines used in research work. They are very costly. This is the first instance and the only instance in which a Surgeon General of the Public Health Service has ever reversed an opinion of his advisory council. In this case the council recommended this grant, which meant the Surgeon General could give it. In this instance he did not give it because it was learned subsequent to the time that the Council recommended it that the Atomic Energy Commission was moving itno this field on a fairly substantial basis, setting up betatrons in several of its research centers in the United States and in a few universities. The Public Health Service did not want to be overlapping and competitive with the Atomic Energy Commission, so we did not support this particular project.

Now the Army and the Navy and the Indian hospitals are the only other substantial group of Federal hospitals. Their research in the cancer field is relatively limited again to clinical research. Some research is going on with super voltage in Walter Reed Hospital in terms of improving X-ray therapy. They are doing some research with the material called nitrogen mustard, which was one of the materials evolved during the last war, which is showing some value in the treatment of lukemia and Hodgkin's disease.

They are also doing research with some of the isotopes coming from Oak Ridge, as are most of our principal universities and most of our principal clinical research centers. So there is no overlap with those

groups.

Mr. DOLLIVER. We have now referred to the other governmental agencies in this field, and now there are several private funds which are private in nature by way of bequests and foundations and societies, that are interested in this field, including some insurance companies. What do you have to say as to the relationship of the National Cancer Institute to these efforts? Is there duplication there or cooperation, or is there any cross-purposes there? I would like you to develop that point, please.

Dr. SCHEELE. There is exceedingly good cooperation. The only organization with a substantial research grant program is actually the American Cancer Society which Mr. Adams represented this morning. I sit on the board of that society and therefore I assist them in my small way in the formulation of basic policy. We have sitting with our Council whenever it meets there the man in charge of guiding their research program, Dr. Rhodes of Memorial Hospital, who is also the head of the Committee on Growth of the National Research Council. We exchange information on grants pending, and we cross-check to see we don't have duplicate requests. We do the same with the other foundations which have cancer-grant proposals. Their number is very limited and they are very much smaller than the American Cancer Society in terms of dollars available in any given year.

We send out information on the grants we are giving to some 15 or 16 foundations which have some interest, minor or major, in the cancer field. Then we have one other means of avoiding overlaps and that is the very composition of these various panels and groups of experts who advise us.

Dr. Huggins and Dr. Morton and Dr. Stone and Dr. Warren, four members of our six-man National Advisory Cancer Council, are also on the Committee on Growth. So we have a good cross-check there.

Even if we did not have all of these cross-checks, the problem is not as real a problem as it might seem at first blush. The range of problems which exist in cancer is so vast that even with all of the scientists we have today almost no two would come up with an approach to a specific problem which would be identical, and so long as there is the least variation they are different experiments even though they may be on the same phase of cancer, say lukemia, or breast cancer. We have many, many kinds of breast cancer; just saying breast cancer is not saying it is the same thing. We have breast cancer which originates in the nipple, breast cancer which originates in the skin, and breast cancer which originates in the sweat glands. We have some which originates in a duct and some outside the duct, and they are all considerably different. To have two grants to men who are working on cancer of the breast doesn't mean there is an overlap. The same thing applies in the heart diseases. The range of problems in heart is so vast that just the accidental chance of duplication of effort is almost an impossibility. There are a few instances where we want repetition, and there are a few instances where we actually seek repetition. Take Dr. Huggins' work on the female sex hormone and prostatic cancer. That is an instance where we now want a large series of cases so that we can be absolutely positive without a doubt.

We have another program where we are trying to do the same thing and get a lot of duplication, and that is in the treatment of female breast cancer with male sex hormones. So far we have no cures and yet we want to get a real evaluation of that. The committee on therapeutics of the American Medical Association serves as a center, and we are cooperating with them, many institutions throughout the country are cooperating, and we are all treating our patients in a sort of standard way and we are all keeping records on our patients so that instead of having 10 cases here and 15 there, fragmentary, we will within a couple of years have hundreds of cases which can be added and which will give us real substantial answers.

Mr. DOLLIVER. Thank you very much, Doctor.

Mr. HESELTON. Doctor, referring to section 4 (a) where the National Heart Council is created, I notice that after the provision for the appointments of the Surgeon General, and so on, there is provision for the appointment of 12 members by the Surgeon General, with the approval of the Federal Security Administrator.

I have in mind the difficulty that confronted us last year in terms of appointments provided for, I believe on the creation of the foundation. At any event there was objection raised by the executive department as to that sort of a provision. Have you given any consideration to that?

Dr. SCHEELE. We have not given it any consideration because this exactly duplicates, in terms of the relationships with the Adminis

trator, the provisions of law relating to the National Advisory Council, the National Advisory Mental Health Council, and the National Advisory Health Council, and our Hospital Council. It is identical with the pattern that has been established since 1937 in the Public Health Service and no objection has been raised up to this point.

Mr. HESELTON. I thought it would be important to bring that out because in the terms of the examination of the veto message on the National Science Foundation I was informed that there were very definite precedents for this type of machinery. So long as it appears in the record, if you do have precedent, I think that is a satisfactory answer to that.

I have reread this noon H. R. 5087 and H. R. 6007, which is the 1948 version of the National Science Foundation Act. Throughout both pieces of legislation the word "research" appears time and again. You referred to it in your testimony. I would like to ask in the first instance where research is used in H. R. 5087. are you referring to basic research or applied research or both?

Dr. SCHEELE. Both of them, sir.

Mr. HESELTON. That being true and having in mind that provision is also made in this bill for the granting of scholarships, research fellowships, and so on, for research in institutions, and I believe in some other instances duplicating some of the provisions of the National Science Foundation so far as basic research is concerned, and having in mind that the provisions of the bill which, of course, has not yet been reported or considered by this committee, there still are provisions granting scholarships and graduate fellowships in medical sciences, and there is provision for the division of medical research, and there are provisions for scholarships as well as graduate fellowships in medical sciences under 10-A, and so on.

I am not clear as to why there is not the possibility of some fundamental duplication if we assume that Congress this year might choose to pass another bill in the field of scientific research.

Dr. SCHEELE. I would like to point out that in this particular instance these bills call attention to research fellowships and scholarships, as you call them, but actually they are merely duplicating the authority which is now written into Public Law 410, the basic Public Health Service Act. The Public Health Service is carrying on at this very moment a substantial research fellowship program with hundreds of fellows under appointment at this moment, not only in cancer but throughout the entire range of medicine. So in a sense it is a duplication.

Mr. HESELTON. Throughout the extensive consideration given to the National Science Foundation by this committee last year, one of the real reasons for the enactment of that type of legislation was because there was so much scattered research throughout the field of Government and elsewhere, and possibly much of it wasteful and duplicated. If it is true and I know it is true-you say there are research fellowships and scholarships already in existence, wouldn't it also follow that if this bill became law with the authority for additional research fellowships, if the National Foundation Act became law, you would superimpose a third structure.

I assume the National Science Foundation Act, if it became law, would be the basic science research legislation and the policy of this