the study of the cause, prevention, diagnosis, and treatment of diseases of the heart and circulation.

Senator BRIDGES. Senator Donnell, I probably am not in a position to answer you technically as well as some of the other people who will appear here today, but I would say there were not a great number. There are some very notable examples in the case of men who have been in institutions who are giving of their time and energy and money for that purpose, but it has been wholly inadequate. But considering the little they have had to work with, they have really done a very generous and a very fine job.

Senator DONNELL. I have two other questions. One is: Has there been any estimate made of the probable expense of operating reasonably adequate facilities along the lines suggested in your bill?

Senator BRIDGES. No; I do not think there has been. There have been various estimates made up, but it was my idea that if the authorization went through, then before we put it into use the Appropriations Committee would go into some detail with justifications and estimates and see that under the broad authorization created in this bill, or any measure which you reported out, and if it should pass, we would see what amounts were needed to do it as economically as possible, yet in an adequate fashion, and I would not want to estimate until I heard the evidence on that, Senator Donnell.

Senator DONNELL. The one remaining question that I now ask is in regard to the composition of the National Heart Council. I notice that it consists of certain officials, and then 12 appointed members who will be leaders in the fields of fundamental sciences, medical sciences, education, or public affairs. Do you think that is a sufficiently definite statement to enable us to be reasonably sure that this Council will be composed of persons who are somewhat qualified at any rate along the line of consideration of heart problems, or do you think that should be somewhat more specific?

Senator BRIDGES. You might make it more specific. If anything it could be improved. I think that might be a very constructive criticism of the bill, that I have always found, as you have, that in broad grants of power it always depends upon the discretion of the people who administer or set the matter up, and in order to be absolutely sure you should probably be more specific, although it would generally depend on the will of the appointing power. If they had the desire they could under those provisions do a good job, but to be absolutely sure I think a constructive suggestion would be perhaps to be more specific. Senator DONNELL. I notice that the appointments are to be made, under this language, by the Surgeon General with the approval of the Federal Security Administrator. As I understand it, there is no requirement of law that the Federal Security Administrator be a member of the medical profession or that he need to be specially trained along medical lines.

Senator BRIDGES. No.

Senator DONNELL. Obviously, no appointment can be made without his approval.

Senator BRIDGES. I think that is a very constructive point you have raised there, and I would be perfectly willing to see it strengthened and made more specific.

Senator SMITH. Thank you very much, Senator.

Senator Ives is not here this morning.

Senator Pepper will be here later.

Is Representative Javits of New York here?

(No response.)

Senator SMITH. Is Representative Frank B. Keefe of Wisconsin here this morning?

(No response.)

Senator SMITH. Or Representative George A. Smathers of Florida?

(No response.)

Senator SMITH. There are some other Members of the House who have not yet arrived, but I see Mr. Ewing of the Federal Security Agency is here. We will ask him to appear at this time and give us his testimony on this bill.

Mr. Ewing, we are very glad to see you here this morning.
Will you give your statement at this time?

Mr. EWING. Thank you Senator.

STATEMENT OF HON. OSCAR R. EWING, FEDERAL SECURITY ADMINISTRATOR, WASHINGTON, D. C.

Mr. EWING. Mr. Chairman and gentlemen, S. 2215, the bill that is now before you, deals with a subject which is of utmost concern to the Nation's health. It is one in which I am particularly interested personally, and as Federal Security Administrator.

Heart disease is the greatest killer we have. More than 1 in every 3 deaths is due to a disease of the heart or circulation. In 1946, these illnesses killed almost 600,000 people in this country.

The amount of sickness, disability, and economic loss due directly to this group of diseases constitutes a health problem of the greatest magnitude. At least 9,000,000 persons are suffering from diseases of the heart and circulation. At least 152,000,000 workdays a year are lost as the result of these diseases. Heart diseases are commonly thought of as affecting the older groups in our population. While it is true that they take the heaviest toll among adults over 45 years of age, they also rank high as killers at all age levels above 5 years. Among children of school age, heart diseases (chiefly rheumatic fever) rank second only to accidents as a cause of death.

I believe that the extension of Federal aid to heart disease research and control is indispensable to any coordinated large-scale attack on this problem.

Dr. Scheele, the Surgeon General of the Public Health Service, will discuss in some detail the various measures necessary to an effective attack on the cardiovascular problem, and I would like merely to indicate here the broad outline of the problem. On the one hand we must find out the causes of the various types of heart diseases, develop simple and accurate methods of diagnosis, and learn the most effective means of preventing and treating the disease. This is the research phase of the program. On the other hand, we must develop organized community programs of heart disease detection and diagnosis so that the knowledge we now have, as well as the new knowledge we acquire as a result of research, can be rapidly and widely applied in saving the lives of potential victims of these diseases.

We know little about the causes of the various heart diseases and little about methods of prevention and cure. We simply must expand

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our knowledge through an extensive research program. Funds for cardiovascular research fall far short of the amounts which are available for less serious and less deadly ailments.

For example, we know cardiovascular diseases are our No. 1 killer. They kill 32 times as many people as cancer. As nearly as we can find out, last year the total expenditures of the Government, of industry, of foundations, of universities, of hospitals, all combined, for cancer research were about $26,000,000. On the other hand, total research expenditures for cardiovascular diseases were about $2,500,000. In other words, the disease that kills 31⁄2 times as many people as cancer only got 10 percent as much money for research. Now I do not for one instant argue that too much money was spent for cancer research; because it was not. But I do argue, as strongly as I know how, that not nearly enough money was spent on cardiovascular research.

I have had a dramatic experience in my own family during the last year. Mrs. Ewing had high blood pressure. It had developed over a period of some 3 years. She was gradually going to pieces and by this time last spring her condition was acute. She could not walk from here to the front of the building. She took no interest in anything. She was sluggish physically and mentally. It was obviously a very serious disintegration. We had been trying to find something that would help her but everything failed. Finally, it was suggested that she go down to Duke University and see Dr. Walter Kempner who had been specializing in the rice diet.

Mrs. Ewing went to Durham about the 1st of May last year. To us it seemed a last desperate attempt to do something. Actually, the results were miraculous. Today she is as well as she was when I first met her 35 years ago. She can walk 2 or 3 hours a day. She is interested in everything. All her old bright spontaneity has come back. Dr. Kempner has developed this rice diet over a period of years. He approached the problem purely from an empirical point of view. He was sure there was some relation between kidneys and high blood pressure. He did not know just what it was but he decided to tackle the problem by relieving the kidneys of as much of their work as possible. The kidneys eliminate salts and minerals so he took away all salts. The kidneys eliminate fats and proteins, so he took these away. He cut liquids down to a minimum. This only left the carbohydrates and the fruits. Of the carbohydrates, he found that rice puts only about 40 percent of the load on the kidneys as do the other carbohydrates. This is why he uses rice as the main item of the diet. In about two-thirds of the cases of high blood pressure which he has treated, Dr. Kempner gets similar startling results. In the other third of the cases, the patients show little, if any, improvement. The explanation of this may perhaps be that their type of blood pressure is in no way due to any failure on the part of the kidneys.

Now one further interesting development has come out of Dr. Kempner's work. In cases of hardening of the arteries, we know that for some reason the kidneys do not properly eliminate the fats and, as a result, minute particles of fat get into the blood stream to be deposited in the arteries or around the valves of the heart. This is arterial sclerosis or hardening of the arteries. Dr. Kempner has found that when a person with arterial sclerosis is put on a fat-free

diet over a long period of time, the fat deposits begin to dissolve and the arterial sclerosis condition actually is improved. This is the first thing that has ever been discovered which seems actually to turn back the degenerative processes of hardening of the arteries. This discovery has tremendous possibilities. If a fat-free diet will help a person get well who has hardening of the arteries, a reduction of fats in normal diet may prevent one from ever having hardening of the arteries. On the other hand, it may be possible to develop a drug that will so stimulate the action of the kidneys as to enable them to handle a normal fat load in such a way that no fat particles would ever get into the blood stream.

I got into this detail because it is an experience we have had in our own family.

We must recognize that facilities for cardiovascular research are pitifully inadequate. Less than 200 hospital beds in the United States are set aside for clinical research in diseases of the heart and circulation. There are in the entire United States only about 900 special hospital beds for convalescent cardiac patients. These beds are located in only eight States, and 344 of them are in New York State, alone.

The present picture with respect to personnel trained to carry out research in heart diseases and to apply advanced methods of prevention and control is also dark. Out of a total of 135,000 "effective physicians" only 199 limit their practice to diseases of the heart; another 439 give special attention to this field, making a total of 638 doctors who specialize in cardiology. Aid must be given for the training of more physicians and technical personnel to carry out the research projects and to apply the special knowledge and methods acquired through research.

Heart disease community control programs under public auspices are practically nonexistent. In order to make the benefits of our newly acquired knowledge as widely available as possible, we must greatly strengthen and expand the clinical facilities and increase the trained personnel available in the various communities of our Nation to bring the benefits of this knowledge to the people. The community programs should be primarily the responsibility of State and local government bodies working with the Federal Government in a relationship similar to that which has proved so successful in the tuberculosis, venereal disease, cancer, mental health, and other programs of the Public Health Service. These programs as they develop, like the analogous cancer control programs, tuberculosis programs, and so forth, will support, and in turn enlist the support of, the voluntary health agencies mutually interested in the control of cardiovascular diseases.

The provisions of S. 2215 for the post part seem well adapted toward achieving the objectives as I have outlined them above.

I believe that you have been advised that the Bureau of the Budget objects to certain aspects of this bill. That Bureau apparently takes no issue with the basic objectives of this bill. Their objections appear to be directed instead at the method of accomplishing those objectives. I for one am not greatly concerned about the form legislation on the subject might take. My interest is to get enough money and author

ity to do the job that so urgently needs to be done in the fields of cardiovascular diseases control and research.

One thing more, Mr. Chairman. You asked Senator Bridges a question about the need for Federal aid in this field. The facts of the matter are that in the whole field of medical research in the past we have had that done mainly in two ways. First, by private interests in the drug industry, and there, naturally, their research work was prompted by a desire to develop things that would make money. Then, there have been the foundations and universities which have conducted research.

Now, we are faced with the fact that the interest that industry can take in research and spend money on it is naturally limited. In the case of the foundations, their funds are gradually drying up, as we know, and they cannot carry on as extensive research as they have in the past; and, furthermore, the research fields are getting broader and broader at the same time their funds are shrinking as a result of fewer additions to their funds, and also the fact that the return on funds is lower and lower. If this thing is to be done not only in heart but in a lot of other things, Government has got to come into it more and more. I think it is only fair for me to state to this committee what my philosophy is as to the place the Government has in this whole field. First, however, let me say with respect to the questions of Senator Smith about the National Science Foundation, that I do not understand it is to have an operating program at all. It would be developing and coordinating programs and we would be doing the operations that might be done in the research field. They would be coordinating.

Senator SMITH. The purpose there is to give Federal aid to existing institutions, make arrangements with them to carry on in the field. They might even assist some of the Rockefeller Foundations or anything else that carries on the work that is needed. Of course, you are correct in saying that they would not operate any research directly. Mr. EWING. Yes. And what we do should be completely coordinated with what they do.

Now, I want to say this, that I believe the place that the Government should take in this is to plan what ought to be done over the whole field of research-talking of medical research, not merely heart but cancer, measles, blindness, deafness, every ill that human flesh is heir to. We ought to know what needs to be done-the Government ought to know that. The Government ought to know what is being done by industry, by the foundations, by the hospitals, or any other groups that may be working in this field. Now, all you have to do is to subtract the second from the first and you get the deficit. Then, Government ought to try to stimulate any one it can to work in those fields and get those deficits made up, and then only should they consider the deficits that remain, and take over doing only the things that someone else either cannot or will not do. And that still leaves a very large field.

Senator SMITH. Let me get this clear, just what you are proposing. You say "Government." Do you mean the Federal Security Agency, for example? Do you mean the Public Health Service, for example; or do you mean the National Science Foundation, in its field of research, to make this broad exploration of the whole field and find out where those deficits are?