2 Figures are for two graduating classes and include senior students reported in 1946 Educational Number. The CHAIRMAN. Any further questions or observations, gentlemen? STATEMENT OF DR. JOHNSON MCGUIRE, CARDIAC LABORATORY, CINCINNATI GENERAL HOSPITAL, CINCINNATI, OHIO The CHAIRMAN. The next witness will be Dr. Johnson McGuire, cardiac laboratory, Cincinnati General Hospital, Cincinnati, Ohio. Dr. MCGUIRE. Mr. Chairman and gentlemen of the committee. The CHAIRMAN. I will have to ask another member of the committee to take over the presiding duties while I attend a meeting of the Rules Committee. I will return as quickly as possible. Dr. MCGUIRE. I have a very brief statement which incorporates my views with reference to these various bills and a final statement with reference to H. R. 6007, which I have not had an opportunity to read before making the following comments with reference to the other bills. Progress in the prevention and treatment of cardiovascular disease, which at present unquestionably is the captain of the men of death in the United States, is greatly handicapped by lack of adequate financial support. The bills enumerated above have as their objective a plan for an organization as well as financial assistance to support studies directed toward a reduction of mortality and morbidity from heart disease. I think no one could disagree with such objectives. Concerning the ideal methods for the prevention, diagnosis, and treatment of cardiovascular disease in the most efficient and economical manner certain comments seem pertinent. The fact should be emphasized that certain institutions, namely, the medical schools of nearly all universities, are already hard at work on problems related to cardiovascular disease and with proper financial support are capable of carrying on at a greatly accelerated pace the clinical and research studies enumerated as desirable objectives in the various bills. Furthermore it is believed that the National Research Council through its various committees is eminently qualified to recommend the recipients of grants-in-aid who would utilize such funds most effectively. Assuming that the above statements are correct it seems logical that a central coordinating agency under the Surgeons General of the Public Health Service should be established with the primary function of integrating the various problems under investigation. Since numerous cardiac laboratories and heart stations are already in functional operation in many of the universities and hospitals the question arises as to whether the construction of a hospital and research laboratory at the National Heart Institute is necessary. In none of the bills does there appear to be sufficient emphasis on the support of basic and preclinical sciences such as physics, organic chemistry, biochemistry, physiology, anatomy, pathology, bacteriology. Fundamental progress in better understanding of physical and chemical changes in disease states of the heart will largely depend on advances in knowledge in these fields rather than from clinicians or cardiologists and it is strongly recommended that every effort be made to support financially departments and individuals specializing in the basic sciences. In conclusion, I am strongly in favor of necessary legislation to afford governmental funds to support the study of heart disease and believe it proper and appropriate that this program be headed by the Surgeon General of the Public Health Service, but feel strongly that sufficient emphasis has not been placed on research now in progress at various universities nor on the outstanding contributions now being made by the National Research Council in approving or discouraging research projects after careful consideration of their merit. If this, or a similar bill, becomes law it is apparent that its success or failure will depend upon the selection of outstanding scientists for membership of the National Heart Council and it is earnestly recommended that the selection be made from nominations proposed by leading scientific societies such as the National Research Council, the Association of American Physicians, the American Society for Clinical Investigation, the Central Society for Clinical Research, the American Heart Association, the American Surgical Association, the American Pediatric Society and comparable societies in the fields of basic sciences. If such policies are adopted in my opinion great advances would be made toward attaining the objectives of reducing the mortality and morbidity from cardiovascular disease which now unquestionably represents the most important cause of death among all known diseases in the United States. This statement prepared only 3 days ago was made before I had had an opportunity to read H. R. 6007 introduced by Mr. Wolverton. Since this bill answers all of the criticisms and objections voiced in my statement, I should like to state my enthusiastic approval of H. R. 6007, National Science Foundation Act of 1948. That is all I have, Mr. Chairman. Mr. HALE. Thank you very much, Dr. McGuire. Are there any questions of the doctor? Mr. LEA. Mr. Chairman. Mr. HALE. Mr. Lea. Mr. LEA. I would like to know to whom you would furnish the grants-in-aid to carry out the purposes you have in mind; what class of students or research people? Dr. MCGUIRE. I think primarily to fellows, residents and associate professors and actually to the heads of departments, the deans in the various medical schools, and similar institutions, or their associates and assistants, primarily. Research is carried out in medical schools, in certain medical schools, in one department and other medical schools in another medical department. To answer your question, the deans of the various medical schools would be in the best position to recommend the particular departments that are peculiarly qualified in various universities for such grants-in-aid. Mr. LEA. Would you be in favor of grants-in-aid to under graduates? Dr. MCGUIRE. I would think that under very special circumstances, and certain universities, that occasionally a small grant-in-aid would be of value, but I should think that in a majority of cases the money would not be most wisely spent in that way. Medical students have very little opportunity in general and in most medical schools, have very little additional time, other than their own work entails, for much research. I think that it is unlikely that many significant outstanding contributions would be made at the undergraduate level. Certainly there are notable exceptions to that statement. Dr. Kefer, as a medical student first discovered undulant fever in a human being and some of the early work in insulin was done by a medical student. In general though I am sure that the funds would be most efficiently spent at the post graduate level. Mr. LEA. If we embark on the plan of general aid for under graduates, that would likely lead to a general plan of subsidization of education generally, would it not? Dr. MCGUIRE. Yes, I would think that might be the case. Mr. LEA. And that might result in the danger of so scattering our attempts, that it would defeat the real purpose in mind. Dr. MCGUIRE. I agree thoroughly, sir. The only possible such subsidy, would be if there are one or two small fellowships of three or four hundred dollars given to possibly two unusually deserving men in the class. That type of thing might be helpful. Other than that I would certainly not be in favor of such subsidy. Mr. LEA. Well, in the allotment of funds, to universities, to medical schools, would you favor the allotment on the basis of the qualifications that that particular school had or student had, or indiscriminate distribution on a geographical basis? Dr. MCGUIRE. I think, sir, it would be far better to have the application from each medical school or each department or section of that medical school carefully scrutinized by a board of experts who would pass on the merit or lack of merit of the proposed plan of investigation. This type of view is now being carried out by the National Research Council and I think it is a very effective method of separating the chaff from the wheat. Mr. LEA. Well, does not an ordinary medical school devote itself to instruction of all of the known abilities of the medical profession rather than the discovery of new methods of treatment? Dr. MCGUIRE. No, sir. Nearly all medical schools have departments and the majority of their departments are actively investigating new horizons. In general a department that is not doing research is not well regarded by other departments or other medical schools. Mr. LEA. Who does that research in an ordinary medical school? Dr. MCGUIRE. The research generally is directed by the professor of the department concerned and often carried out by his associates, assistant professors and fellows, sometimes by his resident physicians. Mr. LEA. Well, is the research actually done by the ordinary student or by a member of the faculty? Dr. MCGUIRE. The vast majority of the research is done by members of the faculty. Very often by relatively young members of the |