eral by the National Advisory Health Council and he has authority to secure such experts as may be desired for this purpose. There already has been established by the National Institute of Health of the service a cardiovascular study section, composed of specialists in heart disease, which is regularly available for consultation and advice with regard to research activities and proposals relating to that field. Action has already been taken by the Congress, upon the President's budget recommendations, making available funds, to construct a large clinical research laboratory building at the National Institute of Health, which will stress research in cardiovascular diseases. Section 2 (d) of the bill would authorize grants-in-aid for education, including grants for construction of educational facilities. While there is little doubt that improvement and expansion of medical and related education is needed to provide adequate trained personnel to improve the Nation's health, the advisability of providing for such aid on the basis of each disease category is questioned. It would seem that Federal aid to education, at least in the health field and probably in the total field of higher education, should be approached on an integrated basis. The bill would establish within the Public Health Service a National Heart Institute and would change the name of the National Institute of Health to the National Institutes of Health. In the medical research field, the premium is upon the closest possible interchange of information and ideas, and upon flexibility in the assignment and use of personnel and equipment. To achieve this close working relationship, the Congress has authorized the construction of a great new medical research center at Bethesda which is to house in one building scientists and doctors working on a wide variety of medical research problems. Cancer, cardiovascular diseases, and mental health will be three of the principal points of emphasis, but a great many other types of research will be extensively pursued. When the building is complete, it will house three institutes: The National Institute of Health, the National Cancer Institute, and the National Institute of Mental Health. What seems to us to be already needed is not the building of additional organizational walls within this great new institution by the creation of a new institute for each disease, creating greater rigidity and more overhead cost for each institute. Rather what seems important is the exercise of every effort toward the closest possible organizational relationship of the men and women who are being brought together in the new research center. Section 7 (f) of the bill would authorize the payment of salaries up to $15,000 for the services of specially qualified scientific and professional personnel concerned with research activities in the National Institute of Health, one bureau in the Public Health Service. While the National Institute of Health is the main research bureau of the Service, much valuable research is carried on by other bureaus of the Service. This provision should not be extended to the one bureau, but should be service-wide. The emphasis placed upon and expenditures made by the Public Health Service for research in and control of cardiovascular diseases is progressively increasing. The rate by which these activities can be expanded is limited by the number of qualified persons in the cardiovascular field. Most of the basic authority which enactment of S. 2215 would provide already exists in the Public Health Service Act. Provision for graduated expansion of adequately planned programs under existing law would appear to make for a more integrated and effective attack on cardiovascular diseases. At some early date, it would be necessary to increase the $30,000,000 limitation in section 314 (c) of the existing law to provide additional grants to States for State and local control activities. Sincerely yours, FRANK PACE, Jr., FEDERAL SECURITY AGENCY, Hon. ROBERT A. TAFT, Chairman, Committee on Labor and Public Welfare, United States Senate, Washington 25, D. C. DEAR MR. CHAIRMAN: This letter is in response to your letters of March 1, 1948, addressed to me and to the Surgeon General of the Public Health Service, requesting a report on S. 2215, a bill to provide for research and control relating to diseases of the heart and circulation. The bill would establish in the Public Health Service a National Heart Institute to serve the following general purposes: 1. To conduct, coordinate, and make grants-in-aid to institutions to conduct research, investigations, experiments, and demonstrations in the field of heart diseases; 2. To provide for the training of personnel in the various phases of heart diseases both at the Institute and elsewhere through grants-in-aid; and 3. To assist States and localities to establish and maintain progress for the prevention, treatment, and control of heart diseases. This bill also would create a National Heart Council of 16 members to give advice on the conduct of the Institute's program and to make recommendations regarding requests for grants-in-aid. In no field of health is there greater need for research than in that of the diseases of the heart and circulation. These diseases constitute the most frequent cause of death, accounting for 1 out of every 3 deaths in the United States. In addition, cardiovascular diseases are a major cause of disability; every year they result in an appalling economic loss in manpower and productivity. Despite its prominence as a cause of death and disability, heart disease has so far received relatively little emphasis in medical research. It has been estimated that only about 7 cents per death is now being spent on research in cardiovascular disease. The enactment of legislation such as S. 2215 would contribute materially to the correction of this gross underemphasis on cardiovascular research. It would strengthen and extend the present authority of the Public Health Service to launch a comprehensive attack on heart disease, and, by highlighting the determination of the Congress to support the conquest of this disease, it would assure continuity and accelerated progress for the heart research program which has already been approved by the present Congress for the National Institute of Health. S. 2215 is also commendable for its recognition that research alone is not enough. The bill specifically provides for augmenting research activities with related programs of professional training, remedial or control services, and public education. By establishing the new National Heart Institute within the Public Health Service, the bill would insure the coordinated administration of these interrelated components of a comprehensive program, as well as related programs in other fields of health. There are, however, several respects in which I believe the bill might be improved. The objective of section 7 (f), namely, to enable the Service to obtain the services of outstanding scientific and professional personnel, is indeed commendable. In the interests of clarity, however, it is recommended that the Federal Security Administrator be specifically authorized to establish positions, as well as rates of compensation; that such positions be included within the classified civil service of the United States, but that appointments to such positions be made without competitive examination; and that rates of compensaion as well as qualifications of appointees be subject to review by the Civil Service Commission. These changes would make the provisions of this section comparable with legislation authorizing similar positions in the Army and Navy. We should also like to suggest that this bill ultimately be recast as an amendment to the Public Health Service Act (42 U. S. C., ch. 6A). This would be consistent with the provision of "a compact and logically arranged law governing the Public Health Service"-a purpose which was stressed in enacting the bill which became the Public Health Service Act. If this suggestion meets with your approval, we shall be glad to provide such technical assistance as you may request in recasting the bill. The bill does not specifically authorize the appropriation of funds to construct buildings necessary in connection with the operation of the new institute. I believe it would be desirable specifically to authorize the appropriation of such funds (which will be in addition to those already appropriated for the construction of a research hospital at Bethesda) for the construction of laboratory and clinical research buildings and facilities, including necessary living quarters for personnel, and to set forth the relationship between the Federal Works Agency and the Public Health Service in the accomplishment of this construction. In adidtion, there are several other changes which could be made to improve the bill, and we should be glad to assist the committee, if it so desires, in making these improvements. It is our belief that the enactment of S. 2215, modified as suggested above, would be a major step toward meeting the urgent problem of heart disease. I therefore earnestly recommend its favorable consideration by your committee. Pursuant to established procedure, our proposed report on H. R. 5087, a bill very similar to S. 2215, was submitted to the Bureau of the Budget and that Bureau, by letter dated April 7, 1948, advised me that the "legislation would not appear to be in accord with the program of the President," for reasons set forth in the letter to you of the same date on S. 2215 from the Acting Director of the Bureau of the Budget. I gather from a reading of this letter that the Acting Director's objections go principally to the methods of accomplishing the basic purposes of S. 2215, rather than to the purposes themselves, and that the Bureau of the Budget is generally in sympathy with the objectives of S. 2215. Sincerely yours, OSCAR R. EWING, Senator DONNELL. Senator Pepper will be the next witness. STATEMENT OF HON. CLAUDE PEPPER, UNITED STATES SENATOR FROM THE STATE OF FLORIDA Senator PEPPER. Mr. Chairman, and gentlemen of the committee, the sponsors of S. 2215, Senator Bridges of New Hampshire, Senator Murray of Montana, Senator Ives of New York, and I, are deeply grateful to you for holding hearings on S. 2215. We believe it is time that the Congress took cognizance of the concern of the American people about diseases of the heart and arteries. I am not going to take the time of the committee to account for the statistics on this terrible scourge, but I should like to place in the printed record of the hearings a statement showing the facts about heart and circulation illnesses. I offer this for the record, Mr. Chairman. I do not believe it has been put in. (The statement submitted by Senator Pepper is as follows:) DISEASES OF THE HEART AND CIRCULATION I. How many people die of diseases of the heart and circulation every year in the United States? 1. The No. 1 killer of our people is heart disease (1). 2. More than 1 in every 3 deaths is due to a disease of the heart or circulation (2). 3. Five hundred and eighty-eight thousand four hundred and fifty-one human beings died of diseases of the heart and circulation in 1946 (3). 4. Sixty million Americans now alive will die of diseases of the heart and circulation unless new treatments and cures are found (4). 5. During World War II, 1,967,468 people died in the United States of diseases of the heart and circulation (4). This is nearly 8 times as many people as were killed in action in the armed forces (5). II. How many people are suffering from diseases of the heart and circulation in the United States? 1. Between 9,000,000 and 10,000,000 people are suffering from diseases of the heart and circulation (6). 2. In contrast with this, 670,302 Americans were wounded in action in World War II (7). 3. A total of at least 152.000,000 work days a year are lost because of diseases of the heart and circulation (4). III. How do deaths from diseases of the heart and circulation compare with deaths from other diseases? 1. Forty-two percent of all deaths are caused by diseases of the heart and circulation (2). 2. Diseases of the heart and circulation kill: (a) Over three times as many people as cancer (8). (b) Over 11 times as many people as tuberculosis (8). -3 (c) One thousand six hundred people every day, more people than die of infantile paralysis or diphtheria in a whole year (8). (d) Eleven thousand three hundred and eight people every week, more people than die of appendicitis in a year (8). IV. How many doctors specialize in diseases of the heart? 1. Only 199 doctors limit their practice to diseases of the heart; another 439 give special attention to this field. This makes a total of only 638 doctors who specialize in cardiology (9). V. What facilities are available for special care of people with diseases of the heart and circulation? 1. For the minimum number of 9,000,000 people suffering from diseases of the heart and circulation, there are in the entire United States only about 909 beds for convalescent cardiac patients, divided as follows (10): Cardiac homes for children___ Foster homes for children_. General homes for adults_. 237 103 261 (a) These beds are located in only 8 States, and 344 of the 909 beds are in New York City (10). 2. There are less than 200 beds set aside for clinical research in diseases of the heart and circulation (11). 3. In contrast with this, about 86,429 beds are available for tuberculosis patients, not including those in Army, Navy, Marine and Veterans Administration hospitals and preventoria (12). VI. How much money is available every year for research in this field? 1. About $2,339,500 a year, and certainly less than $3,000,000, divided as follows: (a) Government funds: (1) Two hundred and forty nine thousand five hundred dollars is being spent during the fiscal year 1947-48 within the United States Public Health Service (13). (2) Seven hundred and twenty-five thousand dollars has been distributed this year by the United States Public Health Service in grants-in-aid and research fellowships (13). Total, $974,000. (b) Nongovernmental funds: (1) Six hundred and fifteen thousand dollars was spent in 1944 by nongovernmental agencies throughout the country (14). (2) About $200,000 is being spent by the Whitney Foundation this year. (3) About $550,000 a year is available from a research fund organized by the life insurance companies of the United States (15). Total, $1,365,000. Total all funds, $2,339,500. 2. In other words, we are spending only a "cut rate" $3.98 per death annually for research to find the causes and cures of the greatest killer of our people. VII. How does this compare with what we spend on other research? 1. In contrast with the total of less than $3,000,000 being spent for research diseases of the heart and circulation: (a) Congress appropriated a total of $52,489,520 for the Research Administration of the Department of Agriculture alone (16). (b) Twenty-nine million eight hundred and sixty-six thousand two hundred dollars was allocated by Congress in 1947 for research and control of plant and animal diseases, to the Department of Agriculture alone (17). (c) For industrial research, to improve manufactured products (excluding atomic energy): American industry is spending $450,000,000 a year; the United States Government spends $625,000,000 a year; universities and other agencies are spending $85,000,000 a year. This means that Americans are spending a total of $1,160,000,000 for industrial research, but less than $3,000,000 to save the lives of people suffering from diseases of the heart and circulation (17). 2. We live in an economy where, in 1945, American manufacturers spent these amounts for industrial research: Bendix Aviation Corp.: For research and engineering Allis-Chalmers Manufacturing Co.: For development, testing, and experimental expenditures__ $18, 150, 000 (18) 3, 286, 234. 79 3. $16,379,000 is being spent in the field of cancer research, the second cause of death in the United States. (Much of this has become available within the last year.) This contrasts with less than $3,000,000 for diseases of the heart and circulation, the first cause of death. 4. The total amount available from all sources for research in diseases of the heart and circulation is less than one-fourth the amount voted by the United States Senate for forest trails for the current fiscal year (19). 5. $1,529,300,000 is spent annually for personal care, including cosmetics and barber and beauty-shop services, in contrast with less than $3,000,000 spent for research in diseases of the heart and circulation (20). VIII. Is heart disease primarily a disease of old age? 1. No. At least 30 percent of all deaths in the 20-59 age group are caused by cardiovascular diseases (21). 2. In 1944 more children died of diseases of the heart than the total number of deaths of people of all ages from infantile paralysis (22). (a) Among children under 15, more than twice as many died of diseases of the heart in 1944 as died of infantile paralysis (23). IX. Do people of the United States think more research in this field is necessary? 1. Eighty-three percent of the people questioned in a recent poll were in favor of the Government's appropriating $100,000,000 for research in tuberculosis and diseases of the heart and circulation; and 80 percent were willing to pay more taxes for research and study to find new diagnoses and treatments of these diseases (24). REFERENCES (1) National Office of Vital Statistics (1 out of 2.37 deaths in 1946; 1 out of 2.38 deaths in 1945). (2) National Office of Vital Statistics: Total deaths 1946, 1,395,617; deaths from diseases of the heart and circulation, 588,451. (3) Forty-two percent of the total deaths in 1946 were caused by diseases of the heart and circulation; 42 percent of 143,000,000 (estimated United States population) is 60,060,000. (4) National Office of Vital Statistics. (5) Killed in action in World War II: Army, 176,432; Navy (died overseas), 72,269; total, 249,701 (World Almanac, 1948, p. 551). (6) Dr. Rolla E. Dyer, Director, National Institute of Health; estimate based on analysis of the health of the Nation 1940 (memorandum dated May 28, 1947). (7) Wounded casualties in World War II: Army, 571,822; Navy, 98,480; total, 670,302 (World Almanac 1948, p. 551). (8) National Office of Vital Statistics: 1946 deaths: Cancer, 182,005; tuberculosis, 50,911; infantile paralysis, 1,845; diphtheria, 1,259; appendicitis, 5,285; stomach ulcers, 8,164. (9) American Medical Association, letter dated August 13, 1947. (10) Miss Margaret Matheson, executive secretary, New York Heart Association, letter dated March 26, 1947, enclosing excerpt from report prepared by Dr. Robert L. Levy, published by the New York Academy of Medicine, entitled "Convalescent Care", pages 64-69, 1940. (11) Fact brought out in hearings before Senators Bridges and Pepper on need for additional research funds for heart disease, by group of heart specialists, April 24, 1947. (12) Hospital bed census conducted by USPHS, Tuberculosis Control Division in 1946. Includes beds in United States and Territories. (13) Dr. Rolla E. Dyer, National Institute of Health (letter dated December 12, 1947). (14) Survey made in 1944 by Dr. H. M. Marvin, American Heart Association. (15) Dr. Francis Dieuaide, Life Insurance Medical Research Fund. Roughly, about $1,200,000 has been spent over a period of about 2 years from this fund, what was organized in 1945. (16) United States Budget, fiscal year ending June 30, 1948. (17) "Science and public policy. A report to the President," by the President's Scientific Research Board, volume 1, page 12. August 27, 1947. (18) National Industrial Conference Board. (19) $11,000,000 was voted by the Senate for year (New York Times, July 15, 1947). forest trails for the current fiscal |