coming from the Appropriations subcommittee, we have provided for fiscal year 1949, $1,875,000 for research grants, $150,000 for research fellows and fellowships, $257,009 for intramural research, to impleinent the work which is being carried on out at Bethesda under existing programs. We have awarded $100,000 for expenditure in connection with certain typing of serums. We have provided $84,310 for epidemiological studies and assistance to State services, $119,110 for demonstrations, and some $57,859 for technical development.

Now, that is a good start, and represents an increase in appropriations under existing law of from $135,768 in 1946 to $2,644,088 contemplated for expenditure in fiscal year 1949. But the expenditure of that money does not permit a well-rounded program because there are certain very definite gaps.

For example, there is nothing provided for in existing law for construction grants for research facilities, as is true under the cancer and mental health programs. There is nothing in existing law that provides control grants to institutions under existing law, such as in the other two programs. There is nothing that provides for trainees, and traineeships, under existing law, and we are not authorized to make appropriations for that purpose as we are under the cancer and mental health control programs. And nothing is authorized to permit grantsin-aid to the upbuilding of teaching facilities and improvement of the teaching facilities in the medical schools of the country under existing law, as is possible under the cancer control and mental health pro

grams.

So I think that I can say that so far as my committee is concerned, we are hamstrung, so to speak, by existing law in proceeding in the line of appropriations which we consider to be absolutely a minimum of necessity if we are to attack this problem of heart disease on the broad front that we believe it should be attacked.

So in the legislation that is before you, provision is made for filling in these gaps of authority so that the Appropriations Committee can consider the entire, whole program in making appropriations, and set it up on a broad front.

Some people say, "Why is it necessary, in view of the contemplated action with respect to the National Science Foundation Act?" which this commitee has given great consideration to. I simply want to say that so far as I am able to observe and understand, the National Science Foundation Act as it is presently written and proposed, contemplates entering on a broad front the field of general research, and does not contemplate the activated action program that is carried on under the cancer research or the mental health acts or as is proposed under the authority contained in the legislation now pending.

Some say that since both acts would provide for basic research and for granting fellowships to promising scientists, we should not bring this heart program out of the general authority of Public Law 410, but should leave the matter to be dealt with in the National Science Foundation bill. It seems that there is a marked difference which becomes clear when the two bills are compared. The stated purpose of the Science Foundation is to foster and support basic research, while that of the Heart Act is to improve the public health by research, investigations, and demonstrations as to the cause, prevention and diagnosis and treatment of the diseases of the heart and circulation.

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In other words, the program envisaged by the legislation which is now proposed goes far beyond the field of basic research, which is fundamental and vital, of course, and must be encouraged and must be carried on, but it envisages an action program that will bring to the people of America today the accumulated knowledge that has been gained as a result of research in the past, and research that will be gained, if the National Science Foundation bill passes, in the basic sciences that affect this disease, and bring them by an action program directly to the people of America who are dying by untold thousands as a result of heart disease.

I think it is clear that to accomplish the objectives of the Heart Act, major efforts over and above basic studies will have to be made in the fields of applied and developmental research, and this is not a function of the proposed Science Foundation but it is a logical and necessary function of the Public Health Service.

Now, the national heart bill establishes traineeships for applied clinical diagnosis and treatment of heart disease, and authorizes assistance to the various States in the use of the most effective methods of prevention, diagnosis and treatment of heart disease. Neither of these can be functions of the National Science Foundation as the bill is written.

The national heart bill also authorizes grants-in-aid to universities, hospitals and other institutions. These, too, would not be available under the National Science Foundation Act.

May I call your attention, gentlemen, to the fact that the Congress this year, by a unanimous vote without one dissenting vote, either in the Committee on Appropriations or on the floor of the Congress, in the House or the Senate, has recognized one of the basic things that is wrong in this whole program of research and development and control of disease, and that is the lack of suitable and proper clinical facilities that must be utilized and carried on if we are to bring the benefits of accumulated knowledge to the people of America.

So in the cancer appropriation this year we have set up a building program to provide clinical facilities, not only this great hospital center out here at Bethesda, which is to be devoted to mental health, heart disease, and cancer, but we have provided a building program to provide clinical facilities at the very centers of research throughout the country where research is going on. And thus we accomplish two purposes, namely, to provide the clinical research in the institution where the research is going on, remove it from the mere character of a rat control and study program and utilize human patients by providing them with the very best of care that science can give; and at the same time, through the daily recording of evidence by the researchers, perhaps finally unfold and succeed in determining what is the true cause of that disease.

So under the authority which you have granted to the committee when you passed the National Mental Health Act and the Cancer Control Act, we are proceeding on a broad front; and we are asking and I speak not only as a Member of Congress but I speak as the chairman of the committee whose obligation it will be to implement this program with funds-and I believe I speak for the entire committee in saying that we are asking this committee to give us the basic authority to proceed along the lines which I have indicated in order that we can bring this heart program into the fullest development.

May I say that there are a couple of fundamental differences between the Javits bill and the bill which I introduced and the one which was introduced by Mr. Smathers. The differences relate to the make-up and the functions of the Heart Control Council that is described in section 4 of H. R. 5087. I have gone over that matter very carefully with the people that are interested throughout the country in this project, and so far as I am concerned, I have no ax to grind except to try and get a program that will work in the public interest; and I am perfectly willing that the comparable provision of the Javits bill, when the committee comes to considering the writing of a bill, be substituted for the provision which is contained in the bill which I introduced. In other words, the Javits bill contains the historic set-up as to the functions and power of the National Advisory Council, which gives to the Council the power to initiate projects and grants, and restricts the Surgeon General to the point that he cannot initiate a project or a grant without the approval of the National Advisory Council. It is exactly as the program is working under the National Mental Health Act and the Cancer Control Act today.

Another question might arise as to the make-up of the Advisory Council that is suggested in this legislation.

Mr. PRIEST. May I ask a question? That is section 4 in both bills, I believe. Which one of the bills follows the pattern in the Mental Health Act?

Mr. KEEFE. The Javits bill.

Mr. PRIEST. Thank you, sir.

Mr. KEEFE. I have no objection, when the committee considers this program, to careful consideration of the make-up of the National Heart Council, so as to insure that that Council shall be of proper and suitable character, because it has broad powers and it is very proper that it should be a proper representation of people skilled in the field of heart disease, as well as those interested generally as laymen.

There is one other thing, and then I shall finish. In the bill which I presented to the committee, some question has arisen with respect to section 5, with respect to the authorization of the Surgeon General to make grants-in-aid to States, counties, health districts, and other political subdivisions of the States; and in subsection (d) of section 5, it is provided that the money so paid to any State shall be expended solely in carrying out the purpose for which the grant is made and in accordance with plans presented by the health authority of such State and approved by the Surgeon General.

I want to make it perfectly clear that in every one of our actions in connection with these various Public Health Service programs, we have insisted at all times that the historic relationship between the Federal Government and the States must be maintained, and I would very bitterly oppose any effort upon the part of the United States Public Health Service to circumvent the State public health services. and deal directly with any political subdivisions of the State. The record may clearly show that I am certain that that is the attitude of the subcommittee of the Committee on Appropriations with respect to that problem, and we have insisted upon it in every appropriation that we have made. If there is any question as to that matter arising from the language in section 5, I would want it understood that it is my

intent in presenting this bill that that historic relationship shall be maintained and that there shall be no direct relationship between the Public Health Service and a local municipality that has the effect of circumventing the authority of the State public health services.

In section 7, provision was made in this bill for the construction of the hospital out at Bethesda. That can be eliminated from the bill, because both Houses of Congress have now provided the money, and that hospital is going forward under the appropriation that is contained in the 1949 Appropriations Act, and no further authority is needed for that purpose.

I trust, gentlemen of the committee, that the people who will follow, Congressman Javits and a very distinguished group of people from the country who are here in the interest of this program, will present some of the details to you which I should not attempt to cover in this opening statement. I am exceedingly interested in this program, and I hope the committee will bring a bill to the Congress, and I know that if it does it will receive the unanimous approval of both Houses of Congress, and the Appropriations Committee will then be permitted to proceed in the attack on a broad front of this great problem in which we are rather curtailed by limitations of present authority.

Mr. DOLLIVER. Congressman Keefe, in connection with the State-aid program of the Federal Public Health Service, in your wide experience in the Appropriations Committee, have you heard criticisms that the money provided by the Federal Government has failed to reach the local level, but has all been absorbed at the State level of health services?

Mr. KEEFE. I may say that I have had no such complaint come to me. Mr. DOLLIVER. That is all, Mr. Chairman. Thank you.

The CHAIRMAN. Mr. Keefe, it would be very helpful to the committee, in view of the numerous bills that have been introduced by Members of Congress dealing with this same question, if some effort would be made, on completion of these hearings, by the different sponsors of legislation to the end that if possible some agreement be made between the different sponsors as to what is considered good in one bill or what they prefer as to another bill, such as you have indicated in your testimony when you made reference to section 4. You suggest that the Javits bill in that respect be substituted in place of your own; that is, with respect to section 4.

Mr. KEEFE. If I may be so rude as to interrupt there.

The CHAIRMAN. If I may finish in just a moment.

I would suggest that these different bills not only present these different questions which it seems to me that it might be possible for the sponsors to eliminate, or some of the differences, by agreement between themselves, but in addition to that the different agencies of Government that have made reports on these bills, such as the Federal Scurity Agency, the Comptroller General, and the Treasury. They all make suggestions that should be incorporated in one or the other of the several bills. I think if those replies to the committee from those departments of Government have not been brought to the attention of the sponsors of the legislation, it might be helpful if they would look at the suggestions that have been made by these different departments, to the end that they may express their opinions with respect to the suggested changes made by these departments. In this way the

committee will have a composite view of the different sponsors of the legislation, to the end that the bill that this committee will finally give consideration to may be broad enough to include the good points of all and eliminate questionable parts of the different bills.

Mr. KEEFE. May I say to the chairman that we have anticipated that very thing. I have discussed this matter at length with the proponents of the so-called Javits bill and the Smathers bill. There is no difference between us at all. I have indicated the points of differentiation as between the bills, and we are in complete accord and complete agreement as to what those changes should be, and I have tried to indicate what they should be; and there will be some language submitted as a result of conferences which we have had with the general counsel and authorities of the Public Health Service in connection with their testimony. which I think will clarify the matter.

Now, as to the Klein bill, that bill is a very broad and general bill, and authorizes and requests the President to mobilize an adequate number of the world's outstanding experts in the supreme endeavor to discover new means of treating, curing, and preventing diseases of the heart and arteries, and authorizes $100,000,000. There are no administrative provisions set forth in the bill, and I find that it is not the approach that is contained in either the Javits or Smathers bill or the one which I presented, nor the Bridges bill that was considered in the Senate.

The Hand bill, H. R. 3464, seeks to provide for the mobilization of scientific resources for the purpose of seeking the causes and cure of cancer, heart disease, infantile paralysis, and other diseases of mankind. It is a most general bill, and it proposes to establish an independent agency to be known as the Medical Research Agency, under the general direction of a Board consisting of the Surgeon General of the Public Health Service, with four other members, and the functions of the proposed independent agency are very broadly and generally defined. There is an appropriation of $5,000,000 for the organization and establishment of the agency, and annual appropriations without ceilings are authorized.

That bill, again, does not deal with the specific problem that we have here involved, but seeks to reach out and gather together the whole program of research embodied in the mental-health bill and the cancer-research bill and a lot of other programs that are currently being carried out, and does not deal specifically with this heart problem as it is dealt with in the bill before us.

So far as the Bridges bill in the Senate, the Javits bill, the Smathers bill, and my own bill, there is no difference between us whatsoever.

The CHAIRMAN. Except in matters of detail, probably.

Mr. KEEFE. The chairman will understand and the members of the committee realizes that when the final writing of this bill is done, when that stage is reached, it will of necessity mean amendment of Public Law 410, as amended, and there will have to be some technical changes in the wording of the bill, of course, to conform to the spirit of amendment that will be necessary to present the bill as a well-rounded bill; and the General Counsel of the Public Health Service and the Federal Security Agency, that have worked on this, are prepared to submit the language to the committee.