High blood presure has been discussed many times today, and there are leads in that field that should be explored not only in the treatment, but in the prevention.

Finally, we come to the prevention of the complications of heart diseases and this is also a place where preventive medicine can be operative. An individual with heart disease may later develop complications which may be fatal, and there are leads in the prevention of such complications.

These bills, as mentioned, and they are specified by Dr. Connor in terms of the Javits bills, have my personal enthusiastic and unqualified support.

Before I end my testimony, if Mr. Heselton will be willing, I should like the privilege of answering the question which he asked of Dr. Scheele about the conflict with the National Science Foundation bill. Mr. HESELTON. I am always glad to hear about that.

Dr. RUTSTEIN. I would think there are several problems which need to be considered. First, you have a situation existing now in the United States Public Health Service as Dr. Scheele told you, with the fundamental basic law, and also the special laws that have to do with heart disease or cancer or mental hygiene, and with the Hospital Construction Act, and so on. There something has to be done. That is, if and when a national science bill is passed.

If this legislation is consistent with that legislation, whatever decisions are made for that legislation can also apply to the heart disease situation.

I, for one, would be very unhappy to think that the problem of handling heart diseases would be put off, because of the administrative complexity between two governmental agencies. I would think until every solution is worked out in the projected National Science Foundation, the same general principles could be applied to the heart disease situation, providing this legislation is similar to that in other health fields.

The second point is with relation to basic versus applied research. When you train a fellow, you can't tell whether he is going to do basic or applied research. You train him to be a clinical investigator or do some specific job. What job he finally gets to do would depend on the kind of a job he gets, and where he happens to go. But the basic training is not very much different whether he is going to do basic research or applied research.

So, the distinction between basic and applied research as far as training fellows are concerned, has no real important signficance.

Now, the question of the special commissions have been mentioned in the projected National Science Foundation bill, Mr. Wolverton, I was informed-perhaps erroneously-that in the latest draft of the bill the reference to the heart and cardiovascular commission had been deleted.

The CHAIRMAN. The National Science Foundation bill as passed by the Senate has left out all reference to the special commissions which were provided for in the bills which were passed in the last session of Congress, and which were provided for in the bill which I introduced in the House.

I have very great regret that they did so.

Mr. HESELTON. It might be added for the record that it has not passed the House.

The CHAIRMAN. Then I suppose that we can still hope that the Senate will show the good judgment this year that they did last

year.

At any rate, so far as I am concerned, hope springs eternal.

Dr. RUTSTEIN. I do not know where the term "intravascular" came from. The term has no significant meaning as far as heart or vascular disease is concerned, and it is not a commonly used term. I think the term is either cardiovascular disease or heart and vascular disease. The CHAIRMAN. I am informed that Senator Pepper was the author of that bill.

Dr. RUTSTEIN. I was curious as to where it arose. That is the completion of my testimony, sir.

Mr. HESELTON. I have a question in view of the information which you gave me, Doctor.

It rather strikes me when you say that you cannot tell the difference between basic and applied science when you are dealing with fellowships and scholarships, that you went further than I did.

Dr. RUTSTEIN. I did not say that, I said when you train a young person to go into the field of science, to go into research, you train him in one field, and at the time when you train him, you do not know what he is going to do where he is going to do his research, and after a fellow is trained under the provisions of this law. I do not think that you can say that "You cannot do basic research because you were trained under this law.".

Mr. HESELTON. Certainly, when you are reaching down, as you are attempting to do into the high schools, at least, you cannot conceivably pick out a candidate for a fellowship, or rather, a scholarship, and say "Now, your course of studies are confined to basic research."

Dr. RUTSTEIN. You cannot do that.

Mr. HESELTON. Now, you can carry the thought a step further, and you get into college; he cannot still differentiate in his training between what will ultimately be a man engaged in basic research as against applied research, and I seriously question-until you get well up into the graduate work, or perhaps beyond a graduate degree-that you can make that distinction.

Dr. RUTSTEIN. You are exactly correct; there is no question about it. Mr. HESELTON. You have helped me a lot. That is, you have helped me a lot but it is confusing me further on this point, when I say that there is a duplication between these two bills, and I say that I was trying to confine it to the field of basic research, but now you say that when I am talking about scholarships and fellowships, there is no way to distinguish it.

Dr. RUTSTEIN. We might look at it this way, sir, and that is this: During the war, as you know, there was a great loss in the production of scientific personnel and one of our great needs, both for national defense and for other purposes, is to develop scientific personnel.

I would not think there would be any conflict for a long while between those two bills in terms of training people. All they do is train different people, and I would not think it would be a serious conflict in the sense that all you do would be to get more training of scientific personnel.

Mr. HESELTON. I suppose the whole thing can be solved from the practical viewpoint. If you start with this bill, then the people

administering the scientific research bill would have to take into consideration that a certain effort had been made in this field, and perhaps in other fields the effort had not been made, and you would have to look at it that way.

Dr. RUTSTEIN. That is right.

Mr. HESELTON. I have one other question:

I do not know whether you would care to comment on the makeup of the commission ?

Dr. RUTSTEIN. I was in favor of the makeup of the commission in terms of the Javits bill. Mr. Keefe said that he would accept that provision in place of his own.

Mr. PRIEST. That provides for the same number on the council, but six of them shall be particularly qualified as specialists in this field. Dr. RUTSTEIN. Then it corresponds to the cancer bill.

Mr. PRIEST. I think Mr. Keefe said this morning they had come to an agreement whereby sections four and five of the Javits bill would be substituted for similar sections in his own, and otherwise it would stand.

Mr. HESELTON. Perhaps you can answer this question: I understand what fundamental science is, and what medical science and education would be, and why they should be included but I want to know how far public affairs goes.

Mr. PRIEST. I did not get the question.

Mr. HESELTON. I said I understood why we should provide for medical science and so on, but what is meant by the leaders in public affairs?

Mr. PRIEST. You are referring now to the Science Foundation bill? Mr. HESELTON. I am referring to the Keefe bill, if they have changed that.

The CHAIRMAN. I would say Bernard Baruch might come within that classification, and there might be some Members of Congress that would.

Dr. RUTSTEIN. I think that there is no such provision in the Javits bill.

Mr. HESELTON. I think that there should be a heavy representation from the medical field, but that the bill should include a vigorous representation from the lay field.

Dr. RUTSTEIN. I think it should be half and half.

The CHAIRMAN. If there are no further questions, we thank you, Doctor, for your appearance here today. We feel that we have been highly privileged today in the witnesses that have already appeared, and those who are to appear before we finish the afternoon session.

We have been highly favored because of the background of experience each one has brought to us, and I can assure you it is appreciated by the committee, and it will prove very helpful to us.

STATEMENT OF DR. T. DUCKETT JONES, REPRESENTING THE AMERICAN HEART ASSOCIATION, HELEN HAY WHITNEY FOUNDATION, NEW YORK, N. Y.

Dr. T. DUCKETT JONES. I am the medical director of the Helen Hay Whitney Foundation. This foundation is interested in research in rheumatic fever and-rheumatic heart disease, one of the major heartdisease problems. To occupy this position I am at present on leave

of absence as director of research in rheumatic fever and rheumatic heart disease at the House of the Good Samaritan, Boston, Mass., one of the few pioneer hospitals in this country devoted to the cure and study of rheumatic fever. I am also a member of the board of directors and the executive committee of the American Heart Association, chairman of the executive committee of the American Council on Rheumatic Fever of the American Heart Association, and a member of the National Heart Committee. I am a diplomate of the American Board of Internal Medicine, qualified in the subspecialty of cardiovascular diseases.

I should like to limit my remarks to the needs for funds for research in diseases of the heart and circulation. Pertinent data concerning the importance of this health problem has been presented. That which we do not know cannot be applied for the good of human beings. This indicates the need for new knowledge through research. Until such time as we no longer have heart deaths or heart crippling at an early age or in the productive period of life there will be a need for new knowledge. The immediacy for new knowledge is so frequently obvious to many citizens that it is difficult to understand why we have been so slow in making provisions for broadened investigations in this many faceted problem.

In strongly advocating the passage of this legislation, with changes suggested by Doctor Connor, we do not wish to imply any avoidance of the research financing responsibility of the national voluntary agency-the American Heart Association. We feel strongly that both public and voluntary research funds are urgently needed, and could well augment and complement one another. There is abundant evidence that the public will increase its contributions for research to voluntary agencies. We urgently hope that as in the instance of cancer, the healthy situation will occur of a considerable and simultaneous increase in public and voluntary research funds.

Concern has been expressed by both legislators and physicians concerning the trend toward selecting specific health problems for legislation. Your commitee must be aware of the tremendous impetus and accomplishment already given specific health problems by the Congress, and to mention cancer and mental health is sufficient. Few additional specific health problems of great importance remain in addition to heart disease. One might just as well face squarely the facts by mentioning another health problem of magnitude warranting specific consideration-namely, arthritis. This covers a number of medical conditions loosely grouped in the lay mind as "rheumatism," and they are responsible for much suffering, disability, and economic loss. It seems likely that this will ultimately need avaluation. In my opinion, the magnitude and health importance of diseases of the heart justify the special attention which the Congress is now giving the problem. The purposes of this special attention can be accomplished through various means. Separate heart legislation would have many advantages, but inclusion as an integral part of a National Science Foundation or as part of Public Health Law 410 would accomplish the purpose, provided there is a separate administrative structure and a separate council, some of the members of which are well qualified as having special knowledge in the heart disease field.

There is urgency and immediacy in the need for special heart consideration. This urgency is dependent upon two needs: (1) The de

velopment of research careers for bright and able young scientists working on long-range projects with their primary responsibility that of adding new knowledge. Few such careers exist at present. Men must be carefully selected and trained. This takes time; (2) facilities are meager throughout the country at present, and construction is essential to provide space for research and the training of wellqualified men for research and specialist qualification in this field, Every year of delay hence slows the process of ultimate accomplish

ment.

At the recent Senate hearings on S. 2215-the National Heart Act of Senator Bridges, Senator Pepper, Senator Ives, and Senator Murray—the American Heart Association representatives were asked to submit to the Subcommittee on Health of the Committee on Labor and Public Welfare of the United States Senate, after consultation with the members of the United States Public Health Service, its recommendation as to the initial year appropriation required for a national heart program. A copy of the recommendation is introduced for your information. After hurried consideration a total of $4,427,769 was proposed for the fiscal year 1949.

Further discussions have been held with United States Public Health Service representatives, and it is obvious to both of us that this sum will be thoroughly inadequate to initiate a program which would be really effective. The main feature of this initial proposal was funds for actual research grants-in-aid for projects already approved or to be readily approved from the experience of the United States Public Health Service. However, this would give no appreciable stability to research, would allow for no improvement in teaching in medical schools, would give no long-range stability to research projects, no funds for the construction of facilities, no appreciable administrative organization, and no control grants to States, such as have been so effective under the National Cancer Institute.

We would hence like to submit a new appropriation recommendation, much larger than the initial recommendation but broken down so as to make it readily evident that a larger sum is needed in order to begin an effective national heart program of more than a single year's duration. The necessity for the inclusion of new items and the longrange expenditure of funds in implementing such a program must be evident to Members of the Congress. We hence would strongly urge your careful consideration of the various items which control the sum of $15,302,769. This represents an increase of $12,658,681 over the present 1949 House approved estimate allowed the United States Public Health Service for its program in cardiovascular disease. While this may seem large, it would be possible by some such sum to begin an effective program of which we could be proud, and the benefit of which would be far reaching to the people of this country. I should like to stress also that this is a small sum compared with the importance of the problem in the future health and happiness of our country.

I should urge also that in order to implement this program, funds be made available until expended, or at least, as is true of present cancer funds, be made available for 4 years unless expended. Such qualification of available funds is essential if an effective program is to be developed.