Average beds occupied in Army facilities worldwide paid from BP 2400

Mr. LAIRD. General Heaton, you probably won't be before us when we get to the research section of the budget, will you?

General HEATON. No, sir.

Mr. LAIRD. In this whole area of medical research, you have the responsibility for the Army program. Is that not true?

General HEATON. The Army medical program; yes, sir.

Mr. LAIRD. The Army medical research program?

General HEATON. Yes, sir.

Mr. LAIRD. Our Government is spending over a billion dollars in the area of medical research during this year. Most of the funds are allocated through the NIH, the budgets for the three services, and the AEC. We have seen marked increases in the last few years.

What coordination do you have with the National Institutes of Health and the other services in your medical research program? General HEATON. You mean about a duplication of effort? Mr. LAIRD. That is right.

General HEATON. If there is a duplication in any effort at all with our research, I would think that our people would correlate it with the NIH.

Mr. LAIRD. Do you have anyone who sits in at the meetings of the National Cancer Council or the Heart Council that approves the grants for the NIH?

General HEATON. The chief cardiologist at Walter Reed does sit in on the Heart Council at NIH.

Mr. LAIRD. What about the Cancer Institute?

General HEATON. I do not believe we have anybody at the National Cancer Institute. When he is invited he does.

Mr. LAIRD. Do you think that in this whole area of medical research, there should be a little better coordination in the efforts our Government is making?

General HEATON. At the defense level I think there is the area for the various screening of these enterprises, not down at our level.

Mr. LAIRD. Do you think it is worthwhile to run the medical research grants through one central council in these various areas rather than all the agencies going on their own and making their own determinations as to the projects they will fund?

General HEATON. Well, I would not know, Mr. Congressman, about that. I think it is working out very well as far as Army medicine is concerned. We channel ourselves on what we feel is to the best interests of the Army, which we know and we certainly can use an awful lot more money than we have. If you have one central agency for all of these various enterprises of which you speak, there would

be an awful fight on for this or that amount of money, I presume, to justify their own interests.

Mr. LAIRD. In the area of testing biological items, what kind of a screening do you have on the tests that are going on, say, at the NIH, so that you are not making the same tests?

General HEATON. My chief of Army medical research will sit in on various councils of endeavor at the NIH in conjunction with General Trudeau's people, who as you know is the head of the Army research, overall.

Mr. LAIRD. In questioning General Trudeau last year, I found that was pretty much left up to you. I was left with the impressionGeneral HEATON. Medically, yes.

Mr. LAIRD (continuing). That the medical research program was something separate and they really did not get into it too much. You were not here that particular day so I could not question you about it. I was given the impression that this program was really run out of your shop and not out of General Trudeau's shop.

General HEATON. In the ensuing year we have all been placed under General Trudeau. Engineers, medical, signal, are all under General Trudeau.

Mr. LAIRD. So this is something new this year?

General HEATON. Yes, sir.

I must hasten to add, General Trudeau gives us all latitude possible. Medically speaking, the Army, Navy, and Air Force are all screened at the level of Dr. Frank Berry. He was Assistant Secretary of Defense for Health and Medicine.

Mr. LAIRD. So you think there is adequate screening so that we do not have duplication of effort in the field of testing and in the field of basic research and in the field of applied research?

General HEATON. I think there is adequate screening; yes, sir. I think so.

Mr. LAIRD. Thank you.

Mr. ANDREWS. Mr. Lipscomb?
Mr. LIPSCOMBв. No questions.

Mr. ANDREWS. Mr. Weaver?

DRUGS SUPPLIED BY FOREIGN COUNTRIES

Mr. WEAVER. General Heaton, a moment ago you discussed the various drugs.

Could you tell me whether foreign countries which provide us with drugs have to meet the same standards as American firms do under the pure food and drug laws?

General HEATON. They have to comply with our own standards; yes, sir.

Mr. WEAVER. Are there any countries other than Italy that have provided drugs for the armed services?

General HEATON. I do not know of any.

General HARTFORD. NO.

Mr. WEAVER. Does the patient have any freedom of choice in the selection of these drugs? Some are manufactured by American manufacturers and some by Italian manufacturers. Would the patient have any preference as to what he might want?

General HARTFORD. NO. I do not think that we would say we are going to give you an Italian drug as against an American. Is that what you mean?

Mr. WEAVER. Yes.

General HARTFORD. If they want it, but I do not think it has ever been brought up to my knowledge.

Mr. WEAVER. What would be your personal recommendation as to how foreign drugs compare with those manufactured in the United States?

General HEATON. They compare very good. Yes, sir.

EFFECT OF SMOKING

Mr. WEAVER. Could you take a moment and give me your professional opinion and judgment on smoking and its effects? General HEATON. I had to quit smoking 21/2 years ago.

Mr. WEAVER. I wondered whether you smoked.

General HEATON. I had to quit smoking 211⁄2 years ago because of a duodenal ulcer hemorrhage. I think I was entitled to have a hemorrhage after what we had been through. I take no credit for cessation of smoking when you are sick. If General Fitch would lay that cigarette down, he is a well man, and say, "I am never going to smoke again," that takes guts and courage.

General FITCH. I will take you up on that.

General HEATON. I don't want to get in a controversy with American Tobacco or any of them, but I cannot help but be impressed. Mr. WEAVER. We hear so many different and conflicting reports that I would like to have an expression of your views.

General HEATON. We are impressed with cancer of the lung. We have a very fine officer at Walter Reed today smoking two packs of cigarettes a day with a cancer of the lung about the size of a pea. It is completely out of bounds on operation. More often than not, when you have operated on a cancer of the lung, that individual will give you a history of at least two packs, or close to two packs of cigarettes a day. Rare will be the case of a nonsmoker in cancer of the lung. Mr. FLOOD. Why is it so prevalent with the male?

General HEATON. It is much more prevalent with the male than with the female. Bill Renoff, professor of surgery at Hopkins, does not give much credence to smoking and cancer of the lung, because of the fact that it is not a very high incidence with women. I think, sir, my own humble opinion, that men inhale more and deeper than a

woman.

MOBILE UNIT CHEST X-RAYS

Mr. WEAVER. Could you also tell me whether chest X-rays as they are taken generally by your service and the other services and as they are taken in these small mobile units on the street for civilians would show up a cancerous condition within the lungs?

General HEATON. Generally speaking, they are very, very reliable, yes, sir, very reliable. I must admit that sometimes, and it is most unfortunate, we can go back and pick up that lesion, two or three back, when we operate for cancer of the lung, but with the increase in our knowledge of X-ray reading and interpretations, our X-ray

specialists in turn have become very, very proficient in interpretation of these chest films and great reliability can be attached to their judgment.

You get a suspicious area; to be sure you don't want to operate on all suspicious areas-you may have a chance to watch it for 2 or 3 weeks and put it on anti-TB drugs, but in that period of time it will really show up whether it is cancer or not, or whether it is suspicious or not, by the fact that it will not regress under this administration of drugs.

Mr. ANDREWS. The time of the gentleman has expired.

Mr. WEAVER. That is all I have. Thank you.

Mr. ANDREWs. Mr. Minshall.

Mr. MINSHALL. General, at the outset, I want to compliment you on the fine testimony you have given here today, and especially on some of the free medical advice that you have given to some of our colleagues. I know that most of my colleagues, because of the nature of the setup on the Hill, with Admiral Calver, go out to Bethesda for their medical examinations.

I am one of the exceptions, not only because of my Army background, but because I know of the nature of the work that you do at Walter Reed. I go out there for my annual physical and they have always given me the finest of treatment, the most excellent care, and their cooperation and hospitality has always been tops.

PERSONNEL LOSSES AMONG MEDICAL OFFICERS AND NURSING CORPS

Getting back on the track, I was very much interested in the losses you have in your officers and in the Nursing Corps. I wonder if you would go into that in a little more detail.

General HEATON. We lose a lot of these youngsters, these nurses, on account of marriage to young men.

Mr. WEAVER. You cannot blame them for that.

General HEATON. No, sir. I do not censor them at all. I believe that would be probably the greatest cause of our inability to hold these young ladies that we take in the Army Nurse Corps. As they go along in years we are much more apt to have them stay with us, because of our educational features for them and, we will say nursing in the Armed Forces gets in their blood and they like our way of medical care.

As far as doctors are concerned, we get back to the silver again. It is mainly money. Your constituents will say, "I do not like to be moved around so much. My wife and family like stability." There are just as many wives and families that want travel. It gets back to the common denominator in American life of more money.

That is my only explanation of why we cannot hold them.

Mr. MINSHALL. Do the officers in the Medical Corps have any extra emoluments in the way of pay allowances and any other advantages from staying in the service and if so, will you state them right now? General HEATON. Yes, sir. It goes up to $250 a month, depending on years of service, an extra emolument for a medical officer.

Mr. MINSHALL. Do you have any recommendations? Do you think that should be increased in an effort to hold them or don't you think you could compete?

General HEATON. I do not think raising it to $500 a month would hold them, Mr. Minshall. I really don't. I don't know, of course. There is a lot of money being made outside in medicine.

Mr. ANDREWS. Will the gentleman yield?

Mr. MINSHALL. Yes, sir.

OFF-DUTY MEDICAL PRACTICE PROHIBITED

Mr. ANDREWS. General, do you have any of your medical men who practice on the weekend or off hours or do you have any regulation prohibiting that?

General HEATON. We cannot do that, sir.

We used to be able to practice on the side in areas that were, we will say, remote for adequate medical care, such as, well, Schofield Barracks, Hawaii, and in the Philippines and in Fort Huachuca, Ariz., for instance, Nogales, or Camp Stephen B. Little, but nowhere in the world presently do we practice privately.

Mr. MINSHALL. In other words, you feel that even going up to $500 a month extra wouldn't help you hold a lot of these fine men that you have trained and officer material ?

It does hamper your operation, does it not, to lose these 91 percent? General HEATON. Those are the individuals that we lost. The 3013 we have now are the 2-year individuals in this pipeline and those 91 percent we lost. Those are 2-year men, mostly civilian doctrinated, you see. They have graduated from civilian medical schools, interned in civilian hospitals, had residences in civilian hospitals. (Additional information is as follows:)

I believe that compensation should be commensurate with responsibility and should promote parity both within and among the several services. The pay structure must be such that no branch of service, nor any group within a branch, would be unduly benefited or adversely affected.

It is inescapable that a pay system must provide for some exceptional emoluments for various circumstances and reasons, but it is obviously desirable to limit the deviations from the regular scale.

I believe that the present levels of special pay for medical officers are equitable and necessary. I would not want the emoluments of medical officers to be disproportionately higher or inequitable in relation to the pay of our brother officers in the combat arms and other branches.

Mr. SHEPPARD. Will you yield for a question?

Mr. MINSHALL. Yes.

Mr. SHEPPARD. I was discussing with my chairman and perhaps I did not hear you correctly. In response to the gentleman's question about practice, I understood there was a private practice in which your statement was for some time back that was not in existence. Do you know whether or not that is an order emanating from higher authority wherein you are prohibited, or was it done automatically within the jurisdiction of your own office or at the Secretary level? What is the picture generally speaking if you know?

General HEATON. It is an Army regulation.

Mr. SHEPPARD. But it is not mandatory from higher echelon?
General HEATON. Higher than the Army?

Mr. SHEPPARD. I mean the Secretary level.

General HEATON. I would think so.

General DUFF. The Army regulation is by order of the Secretary of the Army.