I see nothing against this bill. I see nothing which would in any way interfere with the workings of the National Science Foundation. It sems to me, as I view it, from the studies I have made of the National Science Foundation, it is largely a question of a strategy board there. The 24 members of that foundation are to be appointed by the President. Well, these men are men who I think would fully cooperate with a heart council in working out the strategy to attach these problems, but the heart council would be more or less a council on grantsin-aid which would go to stimulate heart research. As a matter of fact, even in the field of surgery of the heart alone, they are just scratching the surface at the present time. Within the next 10 years, a great deal will be done on the subject of surgery on the heart valves and many of these things and circulatory diseases. So that we are just entering, I think, a new era from the standpoint of even the surgical approach to these research problems of the heart and blood vessels. The "blue baby" operation is a great contribution, and all within the last 2 or 3 years.

The research having to do with cancer is quite a different type of research from that which would have to do with heart. There are

many differences between these bills that will be worked out in detail, but I think that the National Cancer Act and the National Heart Act should be practically synonymous in the way the wording is set forth, because it would work out very well. It wouldn't be just a scrap of difference between these bills.

Senator SMITH. You would have no objection, then, to the suggestion I discussed with Dr. Scheele a minute ago about possibly overhauling the Public Health Act and having a uniform type of provisions concerning the Cancer Institute, Heart Institute, and any other institute.

Dr. ADAIR. I think it has great virtue.

Senator SMITH. It might be helpful to do it.

Dr. ADAIR. I take it Dr. Scheele felt it couldn't be done quickly enough.

Senator SMITH. That might be. We might want to have some interim legislation.

Dr. ADAIR. Yes. All I want to attest to chiefly is that I feel the Government appropriations have worked out to the great betterment of the American people. This morning, I think you, Senator Smith, brought out what the effect will be if the Govenment does this work. So far, it has not demonstrated that it has done any harm. From the $12,000,000 that we went after last year and got for the American Cancer Society, we are going to push that up to $16,000,000, in the hopes that we will get it. I think it is easily possible because the public is interested; it is almost demanding that something be done along these lines, and, curiously enough, heart disease has been very much neglected. There are very few specialists in this field, and I urge strongly that something be done to push the movement along.

I think, in the beginning, it is wise not to spend too much money the first year or two, because you have to develop your technicians, you have to develop your program, you have to develop enough men, you have to get scientists, and they are not made just overnight. There was a time, even last year, when the appropriations by Congress were higher; at one time, instead of $14,000,000, they went up to $21,000,000,

and we suggested that it be brought down because we wanted to stay within economical and reasonable grounds.

Senator DONNELL. Doctor, have you found it of value that the appointed members of the National Advisory Cancer Council are selected from authorities who are outstanding in the study, diagnosis, or treatment of cancer?

Dr. ADAIR. Yes, we feel it should be men who are experts in this field, not in the cancer field particularly, but in some field such as physics or chemistry or some area where they are known to be expert. Senator DONNELL. The bill that creates the National Advisory Cancer Council provides that the six appointed members shall be selected from leading medical or scientific authorities who are outstanding in the study, diagnosis or treatment of cancer. Have you regarded that as a wholesome provision of that bill?

Dr. ADAIR. We have.

Senator DONNELL. And you have found that it works very satisfactorily to have the council composed of men who are, to quote again the statute, "outstanding in the study, diagnosis, or treatment of cancer"?

Dr. ADAIR. I think so. I think it would be a great bore to an average businessman to sit for 3 days with us and listen to all this talk on chemistry or different types of treatment on what are we going to do to help the medical schools out and all these things. I think it would be pretty tough going for the average person. It would be a great waste of his time.

Senator DONNELL. Doctor, even though it may be advantageous to have some members of the health council taken from among laymen, do you not regard it as advisable that a very considerable proportion of the membership on the council should be persons who are outstanding in the study, diagnosis, or treatment of heart disease?

Dr. ADAIR. I do.

Senator DONNELL. This is purely curiosity, and you will pardon the question on it, but you referred to the new Barnard Cancer Hospital. Is that the one in St. Louis?

Dr. ADAIR. Yes. They are going to join up with the Washington University.

Senator DONNELL. Has that joinder been effected yet?

Dr. ADAIR. I have seen the articles of incorporation and I had the dean from the medical school here on the committee I had the other day, and he tells me that things are going through.

Senator DONNELL. Another thing, too, which I might just bring in in sort of an ancillary way. This heart bill provides for the use of funds toward making available research facilities of the service to appropriate public authorities, health officials, and so forth. Is there any great number of public hospitals for cancer over the country, that is to say, State-supported hospitals?

Dr. ADAIR. No; in Missouri-you have one there-and very few, as a matter of fact. The Fischel's Hospital at Columbia, Mo., is one example-it is well run and it is all right, but there are not many special cancer hospitals. However, they are coming along now. There has been the feeling on the part of many scientists that there should be possibly one great cancer hospital on the east coast, one in the Middle West, and one in the far West, such as the Memorial

Hospital associated with the Sloan-Kettering Institute, which is to open up within the next week.

Senator SMITH. Thank you very much, Dr. Adair. (Dr Adair submitted the following brief:)

TESTIMONY BEFORE THE HEALTH SUBCOMMITTEE OF THE SENATE COMMITTEE ON LABOR AND PUBLIC WELFARE REGARDING SENATE BILL S. 2215

(By Dr. Frank E. Adair, New York, N. Y., president, American Cancer Society 1945, 1946, and 1947; member, National Advisory Cancer Council 1945, 1946, and 1947; chairman, cancer committee of the American College of Surgeons 1937-47; attending surgeon, Memorial Hospital, New York City; associate professor of surgery, Cornell Medical School, New York City)

Gentlemen, I appear before your honorable committee, not as an expert on disease of the heart and blood vessels, but as one who has actively participated in the recent development of the cancer program in this country.

As president of the American Cancer Society, as chairman of the cancer work of the American College of Surgeons, as a member of the National Advisory Cancer Council to the Surgeon General of the United States Public Health Service, as a teacher and lecturer on the cancerous diseases, and finally as an active surgeon in this field, I have had a unique opportunity to be close to the laying of plans resulting in the ultimate development of the present program of both the voluntary and Federal movement.

I take it that I am asked to appear before you because I represent one of many who exemplify a highly successful experiment in health; and no field of health is more difficult than cancer because even today most of the causes of cancer are as yet not fully known. However, notable strides have been made in this field particularly within the past 5 years. The attack has been made on four fronts, namely:

1. The education of the public in the early signs of cancer leading to early diagnosis, early treatment and commonly to cure.

2. Prevention of cancer: There have been developed during the past 2 years approximately 180 cancer prevention or detection clinics, where the public in great numbers is obtaining a careful, comprehensive physical examination leading to the discovery of precancerous lesions which can be removed thus preventing further development of what will eventuate in a cancer. In these detection clinics it is found that approximately 12 percent of those applying already have fully developed cancer most of which are in the early stage and highly curable.

3. Service to the cancer patients is constantly improving as evidenced by the growth of cancer clinics under the American College of Surgeons now numbering about 415 as well as the growth of such special hospitals and cancer research institutions as the Memorial Hospital, the Sloan-Kettering Institute, the Jackson Research Laboratory, the new research department of the Massachusetts General Hospital, the James Ewing Cancer Hospital, the Florence Nightingale Cancer Hospital, the new Barnard Cancer Hospital, the M. D. Anderson Cancer Research Hospital, the Goldblatt Cancer Hospital of the University of Chicago. 4. Research: I think it can be safely stated that 5 years ago there were not over 200 full-time cancer research workers in the entire United States. Today under the stimulation of the committee on growth of the American Cancer Society, and the grants-in-aid program of the National Advisory Cancer Council of the Public Health Service, there are over 1,000 research scientists in the cancer field. Five years ago due to the great uncertainty of any security or tenure of employment it was not possible to get but few top-flight scientists. Today, however, the picture has completely changed and our brilliant young scientists are eagerly entering the cancer field. In the 19 panels of the committee on growth of the American Cancer Society will be found such noted scientists as Harvey, world renowned biologist of Princeton; Tuve, the inventor of the proximity fuse of the last war, famous physicist of the Carnegie Institution; and many other scientists internationally recognized as authorities. These scientists are giving their advice and time freely without charge.

5. Education in the medical school: Surveys made of medical graduates reveal that adequate coverage of the subject of cancer had not been given in the curriculum of the medical school. Deficiencies in knowledge of diagnosis and treatment were responsible for a lack of competence in cancer and for many

late diagnoses. Following a recognition of this condition a million and a half dollars were set aside from the $14,000,000, in the cancer budget of United States Public Health Service, for aid to the medical schools of this country to improve the teaching. Already $25,000, has been allocated in 1947 and 1948 to most of the medical schools for this purpose; and $5,000, to many of the dental schools for coordinating and improving the teaching of the subject.

It is obvious from the above discussion of what has taken place in one of the major causes of death during the past few years, that a similar approach on the part of Government and voluntary agencies has an excellent chance of affecting early detection, prevention and cure of hundreds of cases of heart and circulatory diseases, eventually leading to a marked reduction in the total number of deaths. Already the public and the medical profession have been greatly impressed with the effectiveness of this type of approach to a health problem-namely, a distinguished council, grants-in-aid method of obtaining research, an institute situated locally for research, developing a group of fellowships to go into a particular line of study, and care through a wide geographic distribution of sick people. In the heart field this idea should be duplicated in principle although many details will differ.

As I study bill S. 2215 I find nothing against it, and everything for it. The National Cancer Act has proven its great work. It demonstrates what democracy can do in a difficult area. We are even aiding research in both France and England in cancer and I feel sure that the National Heart Act will occupy a most important position in the solid over-all approach to the problem of the cardiovascular diseases. Furthermore I see no conflict between the proper workings of the National Heart Act and that great instrument the National Science Foundation bill. As I understand the latter, the National Science Foundation bill, as it would work out in the heart field would be largely a strategy or planning group. This should not conflict with the workings of the heart council of the Public Health Service with their development and stimulation of research in the heart field; to their grant-in-aid program; to their development of improved teaching in the medical schools; to the improved care of the heart case.

In spite of the fact that one in every three Americans dies of heart or circulatory diseases, there are curiously enough only a small number of physicians who actually specialize in these diseases.

Research in this group of diseases is of a very different character than research in the cancerous diseases. There is less need especially at present of great amounts of laboratory animal work in contrast to that in cancer. The great bulk of research in the beginning will probably be on the actual clinical case. This brings me to the point that much of the clinical research in the heart and circulatory diseases can be farmed out to university and special hospitals on a grant-in-aid basis, making it unnecessary at least at present to build a large heart hospital on the grounds of United States Public Health Service at Bethesda, Md. On the other hand, a national heart institute for research should be built at Bethesda in the very near future where research of all types including surgical research could be fully developed. The possibilities of a surgical approach to the diseases of the heart and heart valves and blood vessels has only been scratched. Much will be developed in this field within the next ten years. During the past 3 years, monumental contributions have been made to the surgery of the heart and blood vessels.

If every medical school in the United States would set aside 10 beds for an intensive study of the cardiovascular diseases and along with this develop a highly trained staff of alert physicians whose life is spent in this field, there would result enormous strides within a comparatively short time.

It is obvious that a Heart Council of distinguished cardiologists should be developed. There should be the same salary paid to the individual members of the Heart Council, the Cancer Council, and the Health Council. There is no good reason for the discrepancy in the salaries of the different councils.

During the developmental stage of the Heart Act program, instead of a heart hospital being built until more details of its exact needs are determined, twentyfive beds for heart and circulatory diseases could be included in the plans of the new public health hospital to be erected at Bethesda. This hospital will be the last work in combining the clinical care of cancer and mental diseases with the work of research groups in these fields. This program could be extended to include the heart research on patients.

In the heart and circulatory diseases fields a heart council, a heart research institute, hospital beds, including those sick from this disease, grants-in-aid for a fundamental research program, the development of research fellowships, and

the stimulation of the medical schools in this area of teaching, are all strongly urged upon your committee.

I have seen the entire cancer program of the Federal Government grow from $200,000 per year to $14,000,000 in 1947; and likewise the program of the voluntary agency, the American Cancer Society, grow from $36,000 per year to $12,000,000 collected in 1947. I strongly urge that your committee agree to accept bill S. 2215 as a constructive piece of greatly needed legislation.

Senator SMITH. I see where you gentlemen each have a statement. I think we would be interested, for the record, in just who the members of the group are and what is your relationship to each other as regards this bill.

STATEMENTS OF DR. ARLIE R. BARNES, MAYO CLINIC, ROCHESTER, MINN., PRESIDENT, AMERICAN HEART ASSOCIATION; DR. DAVID D. RUTSTEIN, PROFESSOR OF PREVENTIVE MEDICINE, HARVARD MEDICAL SCHOOL, BOSTON, MASS., BOARD OF DIRECTORS, AMERICAN HEART ASSOCIATION; DR. CHARLES A. R. CONNOR, MEDICAL DIRECTOR, AMERICAN HEART ASSOCIATION, MEDICAL DIRECTOR, AMERICAN COUNCIL ON RHEUMATIC FEVER OF THE AMERICAN HEART ASSOCIATION, MEMBER, NATIONAL HEART COMMITTEE; AND DR. T. DUCKETT JONES, MEDICAL DIRECTOR, HELEN HAY WHITNEY FOUNDATION, MEMBER, AMERICAN HEART ASSOCIATION, CHAIRMAN, EXECUTIVE COMMITTEE, AMERICAN COUNCIL ON RHEUMATIC FEVER OF THE AMERICAN HEART ASSOCIATION, MEMBER, NATIONAL HEART COMMITTEE

Senator SMITH. Dr. Barnes, are you the spokesman?

Dr. BARNES. I am the current president of the American Heart Association, Mr. Chairman, a certified specialist in the field of cardiovascular diseases.

Dr. JONES. I am medical director of the Helen Hay Whitney Foundation; member, executive committee, American Heart Association; chairman, executive committee, American Council on Rheumatic Fever of the American Heart Association; member, National Heart Committee.

Dr. RUTSTEIN. I am professor of preventive medicine, Harvard Medical School, Boston, Mass.; member, board of directors, American Heart Association. I am certified as a specialist in cardiovascular diseases. I am formerly the medical director of the American Heart Association and am now a member of the board of directors.

Dr. CONNOR. I am Dr. Connor, medical director, American Heart Association; medical director, American Council on Rheumatic Fever of the American Heart Association; member, National Heart Committee, and a certified specialist in cardiovascular diseases.

Dr. BARNES. Mr. Chairman, it is my privilege to speak on behalf of the American Heart Association to express our approval of the bill, S. 2215, under consideration.

May I say that this association was formed in 1924, and its objectives at that time were somewhat different than they are at the present time. The objectives were for the study of and the dissemination and application of knowledge concerning the causes, treatment, and prevention of heart disease; the gathering of information on heart disease; the