APPENDIX A

STAFF MEMORANDUM ON FINDINGS OF HOOVER COMMISSIONS BEARING UPON PROBLEM OF INTERAGENCY COORDINATION OF BIOMEDICAL RESEARCH

OUTLINE OF MEMORANDUM

1

EARLIER STUDIES BY THE TWO HOOVER COMMISSIONS BEARING UPON THE PRESENT SENATE STUDY (INCLUDING ITS REVIEW OF INTERNATIONAL HEALTH)

A. Background-the subcommittee's approach in reviewing relevant documents: 1. Jurisdiction of committee as regards reorganization.

2. Jurisdiction as regards economy and efficiency.

3. Matters beyond committee's purview.

4. Limited findings of Hoover Commissions on international phase.

5. Relevance of Hoover findings on domestic activity to international phase.

6. Caution in appraising excerpts from diverse Hoover reports.

B. Summary of basic findings by the Hoover Commissions:

1. Stress on coordination by First Hoover Commission.

2. Stress on coordination by Second Hoover Commission.

3. Lack of subsequent agency action on coordination.

4. An additional matter for others' review-the Federal hospital system and medical research.

5. Preface to detailed chronology.

C. Detailed findings by the First Hoover Commission:

1. Findings by the Brookings Institution.

2. Report of committee on Federal medical services. (a) Suggestion for interagency coordination. (b) Suggestion for increased research.

3. Final report.

4. Suggestion for coordination of scientific research.

D. Detailed findings by the Second Hoover Commission:

1. Report of task force: (a) Cautions on judging research.

2. Report on medical services:

(a) Reasons for proposed Federal Advisory Council on Health.

(b) Comments on Food and Drug Administration and Department of Agriculture.

3. Committee's previous findings on inaction on certain recommendations of Second Hoover Commission.

A. BACKGROUND-THE SUBCOMMITTEE'S APPROACH IN REVIEWING RELEVANT

DOCUMENTS

The very first step taken by this subcommittee in its study was to examine pertinent literature. This included past Congressional hearings and reports, annual reports of Federal agencies and departments together with other executive branch documents, as well as books, magazine articles, monographs, and other background materials.

Inevitably, the subcommittee turned to one particular set of documents--those issued by and about the two Hoover Commissions on Organization of the Executive Branch of the Government.

The authority and competence of these two historic commissions, in expertly commenting on medical research or on other technical phases of Federal activity, are recognized throughout our Nation. While honest differences inevitably attended the policy findings of both commissions, the subcommittee felt that so far

1 A statement of background to this exhibit will be found on pp. 194-194.

as medical research and assistance might be concerned, few more significant guides could be presumed to exist than might be offered by these two commissions. Why we turned to the Hoover Commission reports will be apparent, too, in the light of the following facts.

1. Jurisdiction of committee as regards reorganization

Rule XXV of the Standing Rules of the Senate provides that the Senate ComImittee on Government Operations shall, among other activities consider: "all proposed legislation, messages, petitions, memorials, and other matters relating to the following subjects: (A) budgeting and accounting measures, other than appropriations; (B) reorganization in the executive branch of the Government***""

Accordingly, it is to this committee that there has been referred legislation relating to the findings and recommendations of the two Commissions on Organization of the Executive Branch of Government which had been headed by former President Herbert Hoover.

To a larger extent than any other group, this committee has followed up on the work of these two Commissions.

The chairman of the Committee on Government Operations, the Honorable John L. McClellan, personally served, it should be noted, on both the First and Second Hoover Commissions.

He was and is therefore in an advantageous position to evaluate those results of the Commissions' work, which are pertinent to this study. That is true, as well, of expert members of the professional staff.

This committee has, as a whole, considered more Hoover Commission bills than any other committee of the Congress.

It is understandable, therefore, why the Subcommittee on Reorganization and International Organizations would have turned at the very outset of its study to an examination of (a) the record of pertinent findings by the two Hoover Commissions, and (b) to the facts as regards subsequent action or inaction on these findings and recommendations.

2. Jurisdiction as regards economy and efficiency

It is still more understandable in the light of the facts that (a) rule XXV requires this committee's attention to Federal economy and efficiency; and (b) both Hoover Commissions reported on “lack of coordination and *** huge wastes in Federal medical services." (1)

3. Matters beyond committee's purview

Let it be clearly noted that the subcommittee does not purport to examine all of the many medical findings of the Hoover Commissions. Those findings were too complex, too technical, too vast, and, most important, too extensive beyond our present scope to be reviewed, much less followed up in our present limited study. But neither could the subcommittee ignore the valuable insight afforded by the commissions on those limited phases which are definitely within our present scope.

The subcommittee cannot too strongly stress that the legislative and executive branches will find in this instance, as in others, that the outstanding assemblies of scientists and laymen who served with and on both commissions provided vital yardsticks for current guidance.

These reports gave the subcommittee, in effect, many helpful clues, many leads, many pointers which could hardly be overestimated as regards helpfulness. 4. Limited findings of Hoover Commissions on international phase

It should be noted that only limited comments were made by both the Hoover Commissions as regards the international phase, as such, of health (which is the subcommittees' focus under its original resolution S. Res. 347, 85th Cong.). 1. First, as to medical research, the international phase had actually not developed to a significant enough degree even as late as 1955 to be singled out by the Second, much less the First, Hoover Commission.

2. On the phase of international medical assistance, the First Hoover Commission documented certain Federal activities in international health as of 1949. The world health phase was, however, still so comparatively limited that the commission did not make specific and detailed recommendations. Its historical summary of the growth of America's interest in health overseas was, however, very useful.

5. Relevance of Hoover findings on domestic activity to international phase Returning to medical research, the remarks by both Commissions on domestic research activity by Federal agencies are extremely pertinent to the international focus of our original study.

Proof of this relevance is clear. As the executive branch has constantly testified, the oversea phase of agencies' research is but an extension of their domestic operations. Oversea work is designed to fulfill their domestic responsibilities. The oversea phase constitutes even at this date but a small fraction of their domestic volume of work and expenditures.

For all of these reasons and others, what the Hoover Commission said about research activity at home is highly useful for our present purpose.

6. Caution in appraising excerpts from diverse Hoover reports

The reports of both Hoover Commissions should be read in entirety as regards the field of health if they are to be properly understood.

It is difficult to cull excerpts without bringing in considerable material which is extraneous for our purposes.

Nevertheless we have tried to extract the most relevant material, to report it within accurate context and yet not to encumber it with such other detailed information as might obscure the principal points within our own focus.

B. SUMMARY OF BASIC FINDINGS BY THE HOOVER COMMISSIONS

Among the important themes pertaining to medical research which recur in the reports to and by the two Hoover Commissions are the need for:

(a) scientific freedom for research, and yet

(b) improved efforts toward interagency coordination of research. This memorandum will highlight quotations bearing upon (b) coordination since it is the interagency phase, rather than intra-agency administration which is of deepest significance under our legislative authority.

1. Stress on coordination by First Hoover Commission

In 1948, a report prepared by the Brookings Institution for the Committee on Medical Care of the First Hoover Commission suggested the need for an interagency committee or secretariat which would, among other things, "plan research and programs based on such research in areas yet untouched by present health activities." (2)

In 1949, the Committee on Federal Medical Services stressed in its report: "*** some coordinating mechanism is needed under which research activities truly vital to national welfare may be considered." (3)

It continued:

"1. We recommend the establishment of a * **Committee on Medical Sciences for the continuing study and coordination of medical research activities of the nonmilitary Federal agencies, consisting of representatives of the Division of Research and Training of the new bureau (of National Health—ed.), of the Atomic Energy Commission, and of the Department of Agriculture.

"2. We recommend that representatives of this new committee, together with those of the Committee on Medical Sciences of the Research and Development Board, be appointed to a new Interagency Committee on Medical Sciences to review the broad programs of all Federal agencies as a whole." (4)

The report specifically suggested that in a proposed new National Bureau of Health, there be created a Division of Research and Training which would: "include among its activities direct conduct of laboratory and basic research, administration of grants-in-aid programs, and maintenance of a clearinghouse for research information. Behind these functions should lie an overall responsibility for planning an integrated research program for the Bureau with the advice and recommendations of the operating divisions." (5)

The report elaborated on the clearinghouse function as follows: "The clearinghouse function would have essentially two parts: (1) Collection and dissemination of information about and emanating from various research projects, whether or not they are under Federal aegis; and (2) maintenance of a Nationwide inventory of medical research and facilities by location, type, and sponsorship." (6)

2. Stress on coordination by Second Hoover Commission

In 1955, the Task Force on Federal Medical Services recommended establishment of a Federal Council on Health. It commented:

66 ** the task force feels that the Federal Council on Health could outline areas where research is needed and on occasion be a place of useful and economical clearance of information on medical research programs planned or in force in different agencies of the Federal Government." (7)

The commission, in its own final report, commented with regard to the diverse expenditures on research by various Federal agencies:

"These expenditures lack overall planning, and there is no one agency which has the responsibility for such planning." (8)

The commission then recommended that:

‘(a) *** the proposed Federal Advisory Council of Health be given responsibility for reviewing the health research programs of the Federal Government; and the making of appropriate recommendations to the President." (9)

3. Lack of subsequent agency action on coordination

The fact that the Second Hoover Commission made recommendations for coordination confirmed that insufficient, if any, action toward that end had occurred in the intervening years.

Similarly, in the 5 years since the report of the second Hoover Commission, our own Committee on Government Operations has reported that there has been little, if any, action on setting up an interagency mechanism for coordination in research.

4. An additional matter for others' review-The Federal hospital system and medical research

Both Hoover Commissions commented at great length on the vast Federal hospital system-Public Health Service hospitals, Veterans' Administration, Department of Defense, and other institutions.

The First Hoover Commission referred at one point to the virtually universally accepted concept of "research as an inseparable part of teaching and good medical care." (10)

It would not be feasible for this subcommittee to reiterate all that the two commissions stated as regards Federal hospitals in relation to Federal research, much less in relation to medical care itself.

Both commissions made many critical comments as to the alleged lack of coordination within and between segments of the Federal hospital system-a deficiency which may be presumed to affect in some ways their medical research, as well.

The subcommittee is not in a position to refer further to this interhospital problem. But it does note the problem's deep significance in terms of (a) the well-being of the considerable patient population (whose potential numbers include as many as 30 million Americans, according to the U.S. Bureau of the Budget); (b) financial costs; and (c) medical research yield.

The staff notes that the future of Federal biomedical research will in part depend on policies within and between Federal medical care institutions.

What these institutions do or do not do may in turn depend on the character of the administration of each segment of the Federal hospital system, on the policies adopted by the Congress and the executive branch as well as, most important, on the scientific skills within the system.

5. Preface to detailed chronology

We may now trace the chronology of the Hoover Commissions' findings and results in greater detail.

In doing so, we will reprint certain additional information (over and above findings on research per se) so as to convey to the reader a meaningful understanding of the context.

The staff stresses, however, that caution should be observed in appraising references to other than research. Such references have necessarily been selected to point up the research phase but are hardly complete in and of themselves and should be evaluated only in their full context.