to time as something believed to require special attention should arise, our set-ups of a special commission would meet that need.

Dr. SCHEELE. In general, we agree with you very much on that. We, too, feel that uniformity would have advantages.

Senator SMITH. I think a little legislative editing here might be helpful with regard to our whole Public Health Act.

Dr. SCHEELE. Yes, sir. If the committee saw fit to report this bill out, as we have just said, there should be an amendment to Public Law 410, and it will require a considerable amount of rewording to make it that way.

Senator SMITH. I would agree with you. I think it would be better to do that, to make it conform with the same procedure you have for your cancer. Then you would have a regular formula that you are dealing with. I have had people call me up and write me and ask if we are going to do anything for people with arthritis-something else was suggested-and that, of course, is the objection that the Budget Bureau has to the whole thing. They think that we are just setting up one commission after another, when possibly one research over-all commission might be better to deal with all these matters. I am open minded on that, but I would like to have the benefit of your expert judgment.

Dr. SCHEELE. We agree with you on that. We would make this stipulation only, that in our opinion, there is need for stressing the importance of heart disease and an appropriation by the Congress which is tied to heart specifically. We now have certain authorizations which are represented in the bill, certain other ones we have not had. We have more general language giving us authority within the regular Public Law 410 that we now have in cancer only through appropriation language. Our authorization for aid to medical schools comes in appropriation language. Our assistance in construction of research in laboratories and research facilities is authorized through appropriations language, not through basic law. If those things could be written into Public Law 410 on a general basis, it would be very excellent. Then if there were specific legislation to emphasize the concept that the heart is important and that a program of research and control has the approval of the Congress, then I think we would have exactly what the health of our Nation needs.

Senator SMITH. I am wondering whether, in the light of this discussion, we do not need a committee in the Public Health Service to think in terms of over-all revision of the Public Health Act, in an effort to cover these matters, and this the approach rather than to enact separate bills-then really get an over-all bill that is inclusive enough to do the job. We all want the job done. It is a question of the machinery to do it.

Dr. SCHEELE. I believe that, in terms of time, it would be undesirable to wait. I think that we would find it would take several years to work through the cumbersome machinery of modifying Public Law 410 as a whole although we feel a number of modifications are very necessary. Meanwhile, we would have lost the opportunity— which I hope is here now-to hit this heart problem directly.

Now we have another sort of thing that comes up. We do have a National Advisory Health Council. Its members are charged with looking over the whole range of needs in medical research. They are

presently not doing very much about heart control; they are doing a little bit about heart research, but again, without the benefit of a top level group interested particularly in heart disease. In the Science Foundation bill you recognized heart specifically by designating a commission. You recognized the importance of that disease. I feel today that without waiting for this long process of clearance. within our own agency, clearance within the Bureau of the Budget, and then clearance here in the Congress, we need the more or less categorical approach to the heart problems. But to come back to your concept, I feel that if you were willing to accept this bill before you, it would immediately correct some of the deficiencies of Public Law 410, for example, this matter of salaries for our scientists throughout the entire Public Health Service. There are many, many other points throughout the bill where one might broaden the present authorization for the Service to move forward in such matters as medical education, assisting medical schools, assisting dental schools and other professional schools. Such authority might be written in here, of course, if it is not broadened so far that as to detract from the special emphasis of the bill on the heart problem.

Senator SMITH. Of course, this letter of the Bureau of the Budget is a little embarrassing to us. You have adequate authority under the public health bill now to do all the things that you are asking to do in this particular legislation, and we will have to meet that objection. I will ask Mr. Webb to come down here and give us his views first hand.

Dr. SCHEELE. Yes, if you will. Without this bill the Public Health. Service does not have all of the authority it needs for the control aspects of the heart program. Some of it is provided for under section 314 (c) of Public Law 410, but to the extent of dealing only with State health agencies. We are not in position, as I just pointed out in my testimony here, to deal directly with non-profit hospitals and with an organization like the National Heart Association in terms of a joint program. That provision is not in Public Law 410 at present.

We have no provision in 410 which would enable us to assist medical schools in terms of teaching grants for heart disease. Likewise, we have no authority clearly covering traineeships, so-called, as we do in cancer and mental health.

I would also like to point out that very recently, and after Public Law 410 was passed, the Congress did feel that the mental health needs of the country were such that Public Law 410 should be clarified in terms of the mental health field, and they did add in this field some of these additional opportunities to attack the problem.

We do not now have authority to give funds for construction of urgently required research facilities in Public Law 410. We have that in only one of our operating programs at the present time— concer-but through appropriations language rather than through basic law. And I think the Bureau of the Budget has recognized that in their statement.

Despite the fact that our basic Public Health Service legislation may be considered adequate to cover most of the major objectives so well outlined here, I feel that this bill, or a corresponding amendment to our basic legislative authority, is extremely desirable. It is

necessary in order to emphasize to the people of this country the great interest and deep concern of the Congress and the Federal Government in the No. 1 cause of death and disability-heart disease. It is necessary in order to strengthen and expand our program of research, of control, of traineeships, of fellowships, and of demonstration, education, and training.

Without the additional legislative authority that the bill would confer, it would be difficult to coordinate the activities of the Federal Government with those of the voluntary health organizations, such as the American Heart Association. This we feel to be of the most vital importance. All agencies in this field, public and private, voluntary and professional, Federal and local, must work together toward the common goal-that of obtaining the basic information necessary, the epidemiological facts, the facilities for detection, prevention, and treatment, and finally bringing the benefits of all our findings to the victims of heart diseases. We must work toward the day when they may again be active, producing members of our society.

I feel that this measure, by emphasizing and affirming our determination to meet this vital national health problem, will point the way for a program of heart-disease investigation and control to be one of the major objectives of the Public Health Service in the years

to come.

Senator SMITH. We are very grateful to you, Doctor, for your testimony. Before we dispose of this bill, if we do, we will probably want to talk to you again. I mean I think that probably some members of your staff have been thinking about this and how we can bring it together. I have the type of mind that likes to see things arranged in an orderly way, and similar problems dealt with in similar ways.

I cannot see any sound argument for different sections here dealing with cancer from those dealing with heart. Why the set-up of the council should be different in one case from another I can't see. It may be that in our Science Foundation that we may have some things that will coordinate with it. Thank you very much.

Dr. SCHEELE. Thank you.

Senator SMITH. Congessman Javits is here. He has a statement to make. He is the author of the bill in the House along similar lines. Mr. Javits, it is a pleasure to see you here.

STATEMENT OF HON. JACOB K. JAVITS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK

Mr. JAVITS. Thank you, Senator. I appreciate very much being here.

May I say I am authorized to state for the record that Representative Frank Keefe of Wisconsin associates himself with me in the presentation before this committee.

I am the author of H. R. 3762, which I introduced on June 9, 1947, in the House. I think it was the first bill there which called attention to this subject, and my reason for introducing it at that time. was twofold. First, I found it to be a subject which had been primarily overlooked, though it was the No. 1 killer for reasons other than accident in the United States, and second, I was deeply interested in it through the representations of the American Heart Association.

Senator SMITH. Is that identical with our S. 2215?

Mr. JAVITS. It is not, Senator, and I would like to point it out very briefly, because I understand that the representatives of the American Heart Association, who are here, will do it in a much more specialized way.

Senator SMITH. I have on my list of witnesses here Hon. George A. Smathers, Representative from Florida. Is he associated with you in this bill?

Mr. JAVITS. He has a different bill, but I think it is substantially on the same line. The difference between my bill and that of Representative Keefe, which is substantially similar to the Senate bill, is that we spell out for the National Heart Disease Council, which is to be worked under my bill and under this bill as well, very much more detailed responsibilities. One particular point upon which we give them a very specific power-that is, I do in my bill-which is not found either in the Keefe bill or in the Senate bill is contained in section 5 (b) of my bill. It gives them the power not only to review applications from any university, hospital, laboratory, or other institution or agency, whether public or private, but also to certifythat one word "certify" to the Surgeon General the approval of the Council of grants-in-aid to be made in connection with research projects.

Now the Senate bill and the House bill, which parallels it, by Representative Keefe, use the word "advise" the American Heart Association, and the doctors and specialists in this field will inform the comittee as to why they believe that they would have powers making them feel they carry greater responsibilities in encouraging more adequate participation of their top people if they had the authority to certify. They feel that this would give them official say in what is done far greater than just the opportunity to advise or recommend, as contained in the Senate bill.

Senator DONNELL. Mr. Javits, there is another difference that I observed between your bill and the one before us here that I think is of certain interest and probable importance, and that is the qualification of the appointive members of the Council. As I understand it, you provide on page 5 that the 12 appointed members shall be outstanding persons who have had wide experience and have demonstrated competence in scientific matters, and 6 of the 12 shall be selected from leading medical or scientific authorities who are outstanding in the treatment of heart disease, whereas in the pending bill before us, the 12 appointed members shall be leaders in the fields of fundamental sciences, medical sciences, education, or public affairs, and nothing said at all as to anybody having to do with heart disease.

Mr. JAVITS. I didn't mention it in my presentation because I didn't want to steal the thunder of the doctors who will follow, but they made a great point of that, and I was thoroughly in accord with the necessity for having technicians. This is a technical problem; hence, technicians. I might say to the Senator that the Senator has found the key to the word "certify" which I just described. The key lies in the fact that you will have technicians on the Council, as I have suggested it, who are competent to certify and who are entitled to very much more attention to what they say than just "advise."

There is one other point, Senator, and I will be just 2 minutes, unless the Senators have some questions to ask. There is one other

point I would like to call to the attention of the committee, and that is a study which I had made by the Library of Congress which analyzes what has been done in other countries very much poorer, I might say, than our own, and it indicates that in France, Czechoslovakia, Rumania, Mexico, Argentina, Brazil, and Uruguay, there are very well articulated programs involved in the aid of the governments to deal with the problem of heart disease.

I might also say that the enormous public reaction the bill I put in received, aside from the American Heart Association-just enormous numbers of individuals around the country, who have said, "Well, thank God here is somebody thinking about this very, very trying problem to us and our families" has been very gratifying. If it will be of any use to the committee, I shall be more than glad to make a copy of this Library of Congress study available to the committee.

Senator SMITH. Is it very long?

Mr. JAVITS. It is very short.

Senator SMITH. I think we will be glad to have it. We will put it in as part of your testimony.

(The Library of Congress study referred to is as follows:)

OFFICIAL MEASURES TOWARD RESEARCH, CARE, AND ASSISTANCE FOR HEART-DISEASE PATIENTS IN CERTAIN FOREIGN COUNTRIES

France, Czechoslovakia, and several Latin-American countries lead the world in official steps toward the study of, and aid to, victims of heart disease. The nearest approach to official aid in countries of the British Commonwealth is in Canada, where a clinic for heart disease was established by the Red Cross, which works in collaboration with the Department of Public Hygiene. This clinic was established in 1925 in Toronto, at the Children's Hospital. Other members of the family come frequently for examinations, especially in cases of rheumatic cardiacs.1

FRANCE

The names of Henri Vaguez2 and Professor Lian3 are internationally known for their work, both in France and abroad, toward public and official assistance for cardiacs. Realization of their efforts of years came in the form of the establishment in Paris of a center with clinical and hospital service in the Hospital Tenon, in the installation of dispensaries in Paris in 1929,* in the establishment of the Institute Endocardiac, and in the accomplishments of the association L'Aide aux Cardiaques in numerous countries as well as France.

This association was in its third year when, in 1931, the French Governmental Office of National Social Hygiene collaborated with it in documentation work concerning heart disease."

L'Aide Aux Cardiaques

7

Henri Vaquez, the founder of the L'Aide aux Cardiaques in France visited a number of countries and promoted the idea. His zeal and eloquent faith were such that a half dozen countries founded similar organizations. One of the principal motives of these organizations is to secure legislation which will benefit the cardiacs.

1 Smith, George, and A. P. Hart. Sur les Cliniques Pour les maladies du Coeur au Canada, Leur Avenir et Leur Organisation, Office International d'Hygiene Publique, Bulletin Mensuel, 1931, vol. 3, pp. 1419-1422.

2 Revue Medico-Sociale et de Protection de L'Enfance, Paris, 1939-40, vol. 7, p. 284.

3 Bruxelles Medicale, 1937, vol. 17, p. 1500.

La Semana Medica, Buenos Aires, 1939, p. 711.

5 Congreso Medico Gremial y Social, 2d Cong., 1936, p. 445.

Rapport du Conseil D'Administration sur le Fonctionnement et l'Activité de l'Office National d'Hygiene Sociale du ler Janvier au 31 Decembre 1930, Journal Officiel Annexe, 1931, pp. 589, 592.

Archivos Latino-Americanos de Cardiologia y Hemotologia, 1930-31, vol. 1, p. 246.