being supported by research grants from the National Institutes of Health. Intramural studies in this field are also being conducted at the National Institutes of Health. The National Institutes of Health embrace six subordinate institutes: Microbiological Institute National Mental Health Institute While some of the work of several of these institutes touches on problems relating to rheumatism and arthritis, the program of the Experimental Biology and Medicine Institute is particularly relevant. This institute has as its principal objective the improvement of methods of diagnosis, treatment, and prevention of dieseases through study of fundamental physiological and biochemical processes. The component units of this institute conduct basic research in nutrition, physiology, pathology, pharmacology, biochemistry, physical biology, and chemotherapy. The related activities of these specialized scientific skills provide a wide range of investigation appropriate for the pursuit of research program for the increase of our knowledge of the heterogeneous group of diseases classified under the terms of "arthritis and rheumatism." In addition to its present program in this field the Public Health Service is planning for an expanded research program in this area upon the completion of its new clinical research center at Bethesda. In the allocation of laboratory space, equipment, and patient facilities at the new center the Experimental Biology and Medicine Institute has been given allocations adequate to permit this epanded activity in the study of metabolic diseases. The wide range of adaptability and flexibility of these facilities for the synthesis of dietary, hormonal, vitamin, allergic, and constitutional factors in various diseases make the Experimental Biology and Medicine Institute a natural selection for the investigation and treatment of rheumatism and arthritis. The infectious factors in the causation of some types of rheumatism and arthritis can readily be studied in cooperation with the facilities and staff of the Microbiology Institute in the clinical center because of the unique close physical relationship of these two institutes in the center. In view of the fact that research in rheumatism and arthritis already has an adequate organizational basis within the Public Health Service the creation of an additional institute for this purpose would serve no effective purpose. On the contrary it would undoubtedly result in an expensive overlapping and duplication of administrative structure, personnel facilities, etc. We 2. It is true that in certain respects this bill would expand the present authority of the Public Health Service. For example, it would authorize construction grants for research facilities in the field of rheumatism and arthritis, as well as traineeships and training grants in this field. This additional authority would be comparable to that provided for cardiovascular disease by the National Heart Act. This Agency favors the extension of this authority beyond its present scope. believe, however, that such authority should be extended to the entire field of health research and should not be limited or assigned to specific diseases only. 3. With respect to grants to States for control purposes, the Public Health Service already has general statutory authority in this field and we are not in favor of creating additional statutory categories for health grants to States. While it may be necessary to raise or remove present statutory limitations on the amount of general health grants to States, and to perfect in certain other respects the provisions pertaining to these grants, the creation of additional categories for specific disease-control programs would only add to the administrative complexity of the present grant-in-aid structure in his field. Insofar as the bill refers to rheumatic fever, osteoarthritis, etc., in children, it should also be noted that programs of service are currently a part of the crippled children's programs organized by the States under the grant-in-aid provisions of title V, part II, of the Social Security Act administered by the Children's Bureau of the Social Security Administration in this Agency. 4. We note that the bill (sec. 2) enumerates as one of its purposes the "rehabilitation of those who have been victims of these diseases, who have been left with residual deformities." If this refers to vocational rehabilitation, there appears to be no provision in the bill to carry out this purpose. The Office of Vocational Rehabilitation of this Agency, however, administers under the Vocational Rehabilitation Act (Public Law 113, 78th Cong.), a program of grants-in aid to State vocational rehabilitation agencies. Persons with arthritis and rheumatism are usually handicapped for employment and are therefore basically eligible for vocational rehabilitation services, which include appropriate medical treatment if such treatment is likely to remove or substantially reduce the condition as an employment handicap. It is frequently rather difficult to determine with our present knowledge of these diseases which cases will be eligible for medical services and which may be made employable or more advantageously employable through the provision of other rehabilitation services. In general, we advise State agencies to accept only "burned out" cases of arthritis, i. e., those whose condition has become stabilized and is no longer active. Even with this group, methods of treatment are quite diverse and proceed largely on a trial-anderror basis. We hope, however, that the program of research now under way in the National Institutes of Health and outside with the aid of grants by the Public Health Service, may cast light on these problems. The bill has a number of technical deficiencies. In view of our substantive comment, however, we refrain from burdening your committee at this time with questions of technical draftsmanship. For the reasons discussed, while in full accord with the basic objectives of the bill, we cannot recommend its favorable consideration. We are advised by the Bureau of the Budget that for the reasons presented in the above report the eanctment of this bill would not be in accord with the President's program. In this connection the committee's attention is invited to the following statement of policy made in the President's 1950 budget message. "For the fiscal year 1950, I am recommending appropriations sufficient to double the general health grants to States, raising them to $22,000,000, in order that the States in turn may extend and strengthen local health services. These stronger health services are an essential part of our national health program. I recommend that the present statutory limitation on the amount of such general health grants to States be removed from the Public Health Service Act, so as to authorize in later years the provision of larger amounts for the further improvement and expansion of local public health services. It is clearly more desirable to follow this course than to add new and separate grant programs or to continue to expand existing specialized health programs.' Sincerely yours, " J. DONALD KINGSLEY, Acting Administrator. MARCH 25, 1949. Hon. ELBERT D. THOMAS, Chairman, Committee on Labor and Public Welfare, United States Senate, Washington 25, D. Č. MY DEAR SENATOR THOMAS: This will acknowledge receipt of your letter of February 4, 1949, inviting the Bureau to submit its views regarding S. 705, to amend the Public Health Service Act to support research and training in diseases of arthritis and rheumatism, and to aid the States in the development of community programs for the control of these diseases, and for other purposes. The bill would provide for a National Arthritis and Rheumatism Institute in the Public Health Service and would authorize the Surgeon General to conduct, assist, and foster through grants-in-aid, fellowships, traineeships, etc., researches, investigations, experiments, and demonstrations relating to the cause, prevention, and methods of diagnosis and treatment of arthritis and rheumatism. Appropriations are available to the National Institutes of Health for work and research in the various fields of medicine and public health and in accordance with existing law, including section 301 of the Public Health Service Act, such funds are available, on an over-all basis, for research work relating to all the diseases and impairments of man. In the interest of a well-rounded research program, as well as for reasons of sound administration, it would seem undesirable to establish a separate institute for diseases of arthritis and rheumatism, or for any other disease. Substantial sums are also available for general health grants to the several States. In this connection, it is significant that the President, in transmitting the budget for 1950, recommended appropriations sufficient to double the general health grants to States, raising them to $22,000,000, in order that the States in turn may extend and strengthen local health services. He also recommended that the present statutory limitation on the amount of such general health grants to States be removed from the Public Health Service Act, so as to authorize in later years the provision of larger amounts for the further improvement and expansion of local public health services, indicating his belief that this course of action is more desirable than adding new and separate grant programs or continuing the expansion of existing specialized health programs. In the light of these comments, it is felt that enactment of the proposal would not be in accord with the program of the President. Sincerely yours, FRANK PACE, Jr., Director. Senator MURRAY. We have a full schedule of witnesses and I will appreciate your cooperation in helping to expedite matters. I understand Senator Pepper, who is testifying this morning before Senator Hill's Subcommittee on Hospital Construction and Public Health Units, will give us the benefit of his views on this bill later in the hearing. Because of the many other Senate committees meeting at this time, Senators Humphrey, Neely, Taft, Smith, and Donnell will not be able to be here with us throughout this hearing, but will no doubt join us if it is possible. In any case, a transcript will be sent to each of the members of the subcommittee, and I know they will give it their most careful attention. The first witness this morning will be Mr. Ralph B. Rogers, Indian Motocycle Co., Springfield, Mass. I have been informed that Mr. Rogers is not here yet, so we will call Mr. H. J. McLaurin. Is Mr. McLaurin here? Mr. McLAURIN. Yes, sir. STATEMENT OF H. J. McLAURIN, H. J. McLAURIN & ASSOCIATES, DETROIT, MICH. Senator MURRAY. Give your full name and address and your profession or what organization you represent. Mr. McLAURIN. My full name is H. J. McLaurin, and my address is Detroit, Mich. My business connection is my own company, H. J. McLaurin & Associates in Detroit. It is an insurance business. Senator MURRAY. Proceed. Mr. McLAURIN. Arthritis and rheumatism is mankind's oldest chronic disease. It is a pitiful commentary that in our enlightened society it remains the most neglected of chronic ailments. At least 1 in every 20 Americans-and that means more than 7,000,000 of them-presently suffers from one form or another of rheumatic disease. Just think of it for a moment; that is almost as many individuals as comprised our Army and Marine Corps during World War II. That number of Americans is equal to the population of the world's largest city, New York; or it is equal to the combined populations of Chicago and Philadelphia. It is an unhappy instance that for centuries rheumatic disease has been the butt or the vehicle for comedians and humorists. It is an equally unhappy fact that arthritis and rheumatism does not, as a rule, kill its victims. If it were more commonly the terminal cause of death, those who suffer from the disease might receive more fortunate treatment at the hands of the world. For, as with cancer, heart disease, and tuberculosis, public apathy would then turn to public sympathy-and that in turn would bring an active public interest into this most neglected ailment. No, arthritis doesn't kill. It merely twists, maims, and wracks human beings until their arms and legs won't respond to the daily tasks of life. It only keeps its victims aware of feeling through the constancy of pain. The spine may be bent into a vicious arc, the hands and feet may go numb, the neck and head may be unable to rotate due to paralyzing stiffness, but the patient won't die. He will only wish he were dead. I do not know what facts it would take to focus the attention of this honorable committee upon the tragedy called rheumatic disease. I am not a physician, but that does not lessen my interest in the health of the American people. Any disease or ailment which can even. partially incapacitate 7,000,000 American lives seems to me to be deserving of our Government's keenest interest and efforts. Any disorder which can cause the average patient to lose 80 working days out of each year with a total manpower loss of 97,000,000 workdays annually is, to say the least, an unbelievable and fantastic tragedy. I say "tragedy" because more than half of that loss occurs in families with an annual income of $1,000 or less. It strikes those who can least absorb the costs of injury. For years we have been of the misguided notion that rheumatic disease is a disorder of the aging. To those who have been given the dubious privilege of witnessing children suffering from Still's disease, tuberculosis of the joints, spondylitis, and rheumatic fever, the shock is one not soon to be forgotten. The viciousness of rheumatic fever, for instance, can be judged from the fact that it kills twice as many children as infantile paralysis. Tuberculosis of the joints claims seven out of every eight patients below the age of 14 years. And Still's disease, which is a juvenile type of rheumatic arthritis, strikes during infancy and preschool years. In view of all the human, economic, and social upheaval wrought by these monstrous diseases, it seems incongruous that the greatest Nation on earth has not made efforts to conquer the disorder. Where does the blame for this unconcern belong? Oddly enough, no one person or group can be burdened with the blame of neglect. Medical science has learned much about the disease in recent years, but it is still far from knowing the causes or cure for arthritis. Only slight advances have been made in the fields of therapy and prevention. But they are slight indeed. To date, only $200,000 a year is spent on both reasearch and care of rheumatic patients. Relatively scant research has been done in these diseases by such basic sciencies as biochemistry, physiology, biophysics, pharmacology, and genetics. Here in the United States, the site of the greatest scientific and technological society ever known to man, we possess the world's finest investigators, researchers, modern laboratories, and adequate equipment. Yet, because we have not made available the necessary funds and a proper plan through which to organize this wealth of medical and scientific knowledge, the problem of rheumatic disease has remained to plague our society. And it will continue to remain a social burden until and unless a properly organized plan of attack supplied with ample funds necessary to make it function is put into motion. The plan needed to remedy this deficiency has been drawn. Interested groups of lay persons and members of the medical profession have organized the Arthritis and Rheumatism Foundation. Under its leadership, and with the aid of the National Research Council, a plan of coordinated research, education, and patient service has been worked out. Under that projected scheme a comprehensive program is aimed at discovering the cuases of rheumatic disease and to develop means for their prevention and alleviation. Funds are needed to provide for fellowships in the basic and clinical sciences. In that fashion a balanced supply of trained research workers will be made available. Well-established scientists who have been prevented by a lack of funds from carrying on their work must be supported to enable them to pursue promising projects. New research centers must be employed in the effort to run down the cause and control of rheumatic disease. In addition, special courses in arthritis and rheumatism must be made available for practicing physicians and graduate medical students. Patient facilities, additional hospital beds, and improved community programs must be increased to the point where rheumatic suffering is alleviated and finally eradicated. Only so vast a cooperative research attack can hope to defeat this human scourge. In time of war the Congress of the United States has never failed to provide the moneys necessary to pursue the fight to a victorious finish. That has always been a congressional duty within the purview of our Constitution. To provide "for the common welfare" is likewise a constitutional duty of Congress. In this fight against mankind's oldest and most neglected chronic disorder, Congress is likewise charged with the dual duty to provide for the common welfare and make available those funds with which to insure a victorious finish in the fight against our common enemy, rheumatic disease. The lines are drawn; the issues have been joined. There no longer remains a question of what needs to be done. There remains but one duty to perform, and that duty lies in the hands of Congress. Seven million afflcted Americans, and generations yet to come, depend on the wisdom of this honorable committee to help them exercise first-class citizenship. By providing the needed funds through the arthritis and rheumatism bill before you, yours is the historic chance for immortality as a farseeing legislative body. Failure to provide for the common welfare in public health is enough to negate any other worth-while activities of this or any American Congress. I respectfully urge this committee to support the arthritis and rheumatism bill without any downward revisions of its provisions. Senator MURRAY. I wish to compliment you on your statement, although you are not a doctor, as I understand it. Mr. McLAURIN. I am a layman. Senator PEPPER. You have given considerable study on this, and we are grateful to you for assembling these arguments you have presented here. It seems to me that anyone who understands this great scourge must agree that some effort should be made to find out its cause and to find some remedy for it if it can be done. So we are very thankful to you for coming. Mr. McLAURIN. May I add one word? |