Senator MURRAY. That was set up in Arizona? Dr. HOLBROOK. No, sir; that is the national. Senator MURRAY. That is the national. Have Have you laboratories in Arizona where you are carrying on research of this character? Dr. HOLBROOK. Yes, sir.

Senator MURRAY. Where are they located?

Dr. HOLBROOK. At the University of Arizona.
Senator MURRAY. You are at the university?

Dr. HOLBROOK. I am practicing medicine there, but I work with the research problem.

Senator MURRAY. We are very glad to hear your statement here this morning, Doctor.

Dr. HOLBROOK. I have no prepared statement, but I would like to support strongly the bill. I also would like not to repeat the statements that have been made by previous testimony with regard to the importance, the size of the problem, the necessity of doing something about it.

I would like to make one point which I think has not been made, and that is with regard to the hope of research, which means that, if we can get the adequate appropriation for this problem, how bright the prospect may be.

I shall discuss for a moment the problem of rheumatoid arthritis. You have heard about rheumatic fever and various other problems. I will take rheumatoid arthritis to illustrate the problem.

Rheumatoid arthritis is perhaps the greatest crippler of them all, far as chronic joint diseases are concerned, and arthritis. Rheumatoid arthritis, very interestingly enough, despite all you have heard about the hopelessness of the situation, and all of which has been true in the past, but the disease is reversible. I call your attention to the interesting fact that perhaps 80 or more percent of all women who get pregnant who have rheumatoid arthritis get a remission of their disease. They get well during the pregnancy.

It is also true that people who accidentally or from a disease get jaundiced, perhaps 60 or 70 percent of them have a striking remissiou of the disease, so that it disappears entirely.

It is also true that a certain percentage who can take gold may get a dramatic remission of the disease.

It is also true that sometimes through transfusions or for any other reasons we have seen the disease become totally reversed, so that it goes back to normal. We now have a new compound, which you probably all read about; the compound E, which has been recently announced from the Mayo Clinic as a reversible instrument in rheumatoid arthritis.

I think we should understand that none of these, including compound E, do we understand anything about how they work. Compound E is undoubtedly not the answer; it is not a treatment at this time. Its cost is prohibitive; so that, lest you get the impression that the problem has been solved, I should like to put it in exactly the same category as these other mechanisms of remissions which we observe.

Now, I contrast that for you with the problems of cancer. Cancer is not reversible. Diseased hearts are not reversible. The paralysis that is terminal in infantile paralysis is not reversible.

I point this up to you to urge the necessity and the probability that, with these mechanisms of reversibility, and given the time, the money and the opportunity, this problem can and will be solved. I think it offers the Congress of the United States a high percentage of chance for a real dividend relatively early, because of the fact that this is reversible; and I am perfectly certain that we can find the mechanism, the exact way by which it is now reversed.

The fact that it is reversed, we do not know how; we do not understand the mechanism; we do not know what happens chemically, but I think it apparent- the urgency of the bill, the hope and belief of an early reward--and it stands out as a tremendous challenge now because of these facts which I have presented.

Senator MURRAY. That sounds like a very solid argument to me, Doctor. It seems to me that the Government should not hesitate at all to attempt to find out the cause of this disease.

Dr. HOLBROOK. That is right, sir.

Senator MURRAY. Especially where, as you point out, it is a disease which is not in the class of these other diseases that are not reversible; and, with the amount of money that we are appropriating here, we could make great progress in finding that cure.

Dr. HOLBROOK. I believe that very sincerely, Senator.

Senator MURRAY. I understand that this gold treatment has been given quite extensively around the country. Has it been successful with many people?

Dr. HOLBROOK. It has been successful in a fair percentage of the people who can take it. Gold is toxic, and there are lots of people who cannot take gold. It is also necessary to keep taking it. When you stop, the chances are that the disease comes back. It requires most careful medical observation during the treatment, and the percentage of people who can take it successfully is not too high. Senator PEPPER. It is very difficult to determine whether a person may be able to take it successfully; is that right?

Dr. HOLBROOK. Only by trying.

Senator PEPPER. That is very serious?

Dr. HOLBERT. Yes.

Senator MURRAY. I thank you for your statement, Doctor. I think the testimony we are getting here this morning should be very convincing to the Congress to find some way of setting up this program. Dr. HOLBROOK. I hope so.

Senator MURRAY. Dr. Stecher.

STATEMENT OF DR. ROBERT M. STECHER,
CLEVELAND, OHIO

Senator MURRAY. State your name and profession and address, Doctor.

Dr. STECHER. I am Robert M. Stecher, a physician from Cleveland, Ohio. I might be called a practicing doctor who specializes in arthritis and rheumatic diseases. I am assistant professor of medicine at Western Reserve University. I spend my full time at Cleveland City Hospital, where I see private patients in consultation, but I do take care of public patients, and I do maintain an arthritis clinic in Cleveland. I am director of the Arthritis and Rheumatism Founda

tion, I am president of the Cleveland Rheumatism Association, and I come to plead for support of this measure.

The previous witnesses have given testimony which I do not wish to repeat, but wish simply to state that I agree completely with what has been said. I might say that there is something to be said about the care of the patient. It has simply been symtomatic, it has not been effective. We have a clinic at city hospital which I have no doubt would be 10 times as big as it is not if we had a treatment which would be effective. Patients come, they find it is only palliative, they learn to buy aspirin at home, and they find it no longer necessary to

come.

There is no reason to believe that this problem cannot be solved if enough attention is put to it. Unfortunately, the arthritic has been no hazard to his associates as is true in the case of tuberculosis or leprosy or things like that; so there has been no incentive to protect the country against him.

The economic need has recently been pointed out, and I think it can be done. I think this plan is a very sound one because the efforts that have been made to raise money have been modest in comparison to the enormity of the problem, and I think it is going to be desirable to have not only big institutes and groups of people and teams working on this problem, but there must be facilities to support lone workers, if I may use the term, people who are not too conventional-I do not mean that they are not sound scientists, but who have ideas that are not completely in accord with the ideas of others, to let them try out and to put on the exploratory investigation, to get as many different ideas on the subject, and to offer opportunity for people who perhaps do not fit in completely into the conventional idea or the big institutes to make their demonstrations, and I urge sincerely that this bill be supported and the work go on.

Senator MURRAY. The cost of the disease to the country is tremendous.

Dr. STECHER. That is right.

Senator MURRAY. And the Government would be saving money for the country if we spent this small amount of money that is needed here for establishing this research.

Dr. STECHER. I am certain the sum total of community wealth would be increased if this burden and this expense and this sort of disability were alleviated or completely removed.

Senator PEPPER. Of course, many thousands of people suffer from rheumatism during their lives, but still are able to continue in life with some impaired vigor, of course, but if they could be cured, it would be a tremendous saving for them because they would be able to be more productive.

Dr. STECHER. That is correct.

Senator MURRAY. As it is, they are sometimes compelled to be absent from their business or from their profession, and so forth, and that is a loss.

Dr. STECHER. It is like running a train with the brake on. Senator MURRAY. I certainly agree with you, Doctor, that there is great need for this program, and I thank you for coming here. Dr. STECHER. Thank you, sir.

Senator MURRAY. Senator Pepper is here now and the Senator will make a statement himself.

STATEMENT OF HON. CLAUDE PEPPER, UNITED STATES
SENATOR FROM THE STATE OF FLORIDA

Senator PEPPER. Thank you very much, Mr. Chairman, for giving me this opportunity to testify on S. 705, S. 1651 and title II of S. 1679.

S. 705 would provide Federal financial aid to support research and training in diseases of arthritis and rheumatism and to aid the States through grants in the development of community programs for the control of these diseases, including the rehabilitation of victims of these diseases who have been left with residual deformities. The bill would establish a National Arthritis and Rheumatism Institute within the United States Public Health Service, and a National Arthritis and Rheumatism Council similar to that established under the National Heart Research Act.

S. 1651 would provide general authority to the Surgeon General to establish research institutes within the Public Health Service, National Advisory Councils, and research and training programs in rheumatism and arthritis, multiple sclerosis, cerebral palsy, and epilepsy, and other diseases.

Title II of S. 1679 would give to the Surgeon General authority similar to that in S. 1651. Title II specifically mentions poliomyelitis, diabetes, in addition to those already referred to in S. 1651.

of these bills provision is made for the erection of buildings, for traineeships and fellowships and the like. These programs would be similar to those already established by Congress for cancer, heart, mental, and dental diseases.

I should like to offer a bill which would be a substitute for S. 1651 and for title II of S. 1679. The main differences between my substitute and the two others are: (1) it adds blindness, diseases of the liver and thyroid, common colds and other virus diseases to the list of diseases specifically mentioned; (2) the substitute further, not only provides authority to the Surgeon General to establish institutes, but directs him to establish them and make it mandatory for him to set up national advisory councils upon the establishment of an institute; (3) in addition it provides for the establishment of information centers for the dissemination of information and for research into the rehabilitation of those who have been victims of these diseases who have been left with residual deformities.

This bill differs from the Magnuson and Priest research bills in many ways, among them that the Surgeon General is authorized and directed to establish three institutes; one for arthritis and rheumatism; one for the neurological diseases, such as epilepsy, cerebral palsy, multiple sclerosis; and one for blindness. He is also authorized and directed to establish institutes for other individual or groups of other diseases, including diabetes, diseases of the liver and thyroid, peptic ulcer, the common cold and other diseases.

This bill gives the same functions to the advisory councils established under it as those of the National Advisory Council of the Heart Institute. Unless these councils are given some legal authority and not purely advisory functions no one of any standing or importance will bother to work on them, as the Surgeon General and the Public Health Service may freely disregard their advice. Consequently, no action could be gotten as the Public Health Service is, as you know, not

anxious to establish additional institutes, though I cannot understand this as it only means the assigning of staff and the obtaining of appropriations in connection with these specific diseases. It does not necessarily mean that any building will be built at the Public Health Service in Bethesda in connection with these diseases or that any intramural research they might want to do will be interfered with.

The bill also changes the number of members on the cancer and mental health advisory councils from 6 scientific members to conform with the heart and dental advisory councils of 12 members, 6 of whom will be medical and scientific and 6 of whom shall be active in public affairs.

I would like to insert my substitute proposal at this point in the record.

(The matter referred to is as follows:)

A BILL To amend the Public Health Service Act to support research and training in rheumatism and arthritis, blindness, diabetes, multiple sclerosis, cerebral palsy and epilepsy, diseases of the liver and thyroid, peptic ulcer, the common cold and other virus diseases and other diseases

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That the purpose of this Act is to improve the health of the people of the United States through the conduct of researches, investigations, experiments, and demonstrations, and refresher courses for doctors, relating to the cause, prevention, and methods of diagnosis and treatment of rheumatism and arthritis, blindness, diabetes, multiple sclerosis, cerebral palsy and epilepsy, diseases of the liver and thyroid, peptic ulcer, the common cold and other virus diseases and other diseases, which are main causes of disability; and research into the rehabilitation of those who have been victims of those diseases who have been left with residual deformities; assist and foster such researches and other activities by public and private agencies, and promote the coordination of all such researches and activities and the useful application of their results; construction of research facilities; provide training in matters relating to such diseases; and develop, and assist States and other agencies in the use of, the most effective methods of prevention, diagnosis, and treatment of such diseases, including refresher courses for doctors and the establishment of information centers.

ESTABLISHMENT OF ADDITIONAL INSTITUTES

SEC. 2. (a) The heading of title IV of the Public Health Service Act (42 U. S. C., ch. 6A) is amended to read "Title IV-National Research Institutes."

(b) Title IV of such Act is further amended by adding immediately after part C the following new part:

"PART D-OTHER INSTITUTES

"ESTABLISHMENT OF INSTITUTES

"SEC. 431. The Surgeon General is authorized and directed with the approval of the Administrator to establish in the Public Health Service additional institutes for arthritis and rheumatism; for blindness; and for a neurological institute for neurological diseases such as epilepsy, cerebral palsy, multiple sclerosis; and for individual or groups of other diseases, to conduct and support scientific research and professional training relating to the cause, prevention, and methods of diagnosis and treatment of these particular diseases or groups of diseases (including diabetes, diseases of the liver and thyroid, peptic ulcer, the common cold and other virus diseases and other diseases. Any institute so established may in like manner be abolished and its functions transferred elsewhere in the Public Health Service upon a finding by the Surgeon General and the Advisory Council of such institute that a separate institute is no longer required for such purposes because adequate treatments and cures have been found. In lieu of the establishment of an additional institute with respect to every disease, the Surgeon General may expand the functions of any existing institute established under this Act so as to include functions with respect to a disease or diseases and to terminate such expansion and transfer the functions given such institute elsewhere in the Service upon a finding by the Surgeon General that adequate treatments and cures are