Experience: Director, National Institutes of Health, September 1968-present; Administrator, Health Services and Mental Health Administration, April-September 1968; Associate Director, National Institutes of Health and Director, Division of Regional Medical Programs, 1966-68; vice chancellor, the University of Mississippi, and dean, school of medicine, 1965-66; director of the University of Mississippi Medical Center and dean, school of medicine, 1961-65; associate professor of medicine and assistant dean in charge of student affairs, Medical College of Virginia, 1959-61; assistant professor of bacteriology and immunology, University of Minnesota, 1958-59; assistant professor of medicine, Medical College of Virginia, 1954-57; assistant resident, Medical College of Virginia, 1953-54; assistant resident, Vanderbilt University Hospital, 1950-51; intern, Johns Hopkins University, 1949-50.

Association memberships: Alpha Omega Alpha; Association of American Medical Colleges (executive_council, 1964-67); American Federation for Clinical Research; Society for Experimental Biology and Medicine; Tissue Culture Association; American Society for Cell Biology; American Association for the Advancement of Science; Association of American Rhodes Scholars; American Medical Association; American Public Health Association Fellow; Association of American Physicians.

Special awards, citations, or publications: Rhodes scholar, 1947-49; Markle scholar, 1954-59.

Mr. FLOOD. You have some new people.

Dr. MARSTON. We have two Institute directors who are new since last year who will be testifying before the committee and who have come in to hear my initial testimony.

The first is Dr. Dewitt Stetten who is the Director of the National Institute of General Medical Sciences. And the second is Dr. David Rall who is the new Director of the National Institute of Environmental Health Sciences.

You know Dr. Sherman, the Deputy Director of the National Institutes of Health; Dr. Fenninger, the Associate Director for Health Manpower, NIH; Dr. Kenneth Endicott, who is the Director of the Bureau of Health Manpower Education; Dr. Cummings, the Director of the National Library of Medicine; Dr. Kennedy, who is the Associate Director for Program Planning and Evaluation, NIH; Mr. Richard Seggel, who is the Associate Director for Administration, NIH; Mr. Sharkey, the Director of Financial Management, NIH; Mr. Leland May, who is the Assistant Director of Financial Management, Budget, NIH. You know Mr. Miller who is the Deputy Assistant Secretary, Budget.

Mr. FLOOD. You have a prepared statement before us, Doctor. How do you wish to proceed?

Dr. MARSTON. I would like to read it.

Mr. FLOOD. Suppose you do.

AN NIH ORGANIZATIONAL OUTLINE

Dr. MARSTON. Perhaps it would be helpful again this year to make available to the members of the committee an outline of the organization of NIH with the dollars of the appropriations that the individual witnesses will be testifying for so that you can follow through as we proceed with the budget discussion.

Mr. FLOOD. This is an excellent chart and we will put it in the record.

(The chart follows:)

HEART AND LUNG
Dr. Theodore Cooper
$195 5 million

17

NATIONAL LIBRARY
OF MEDICINE

GENERAL STATEMENT

Dr. MARSTON. Mr. Chairman and members of the committee, I always welcome the opportunity to testify before this committee about the goals, the plans, and the needs of NIH in carrying out its responsibilities for medical research, education in the health professions, and biomedical communication. Today I am particularly pleased to do so because you have before you budget estimates for NIH which I feel I can defend not only with a good conscience but with some enthusiasm. This does not mean, of course, that the budget fulfills all our desires or even that it satisfies every identifiable need. In an activity so broad in scope and so varied in substance as that of NIH, it is inevitable that choices have to be made, that priorities must be weighed, and that some desirable-and readily justifiableprojects must be deferred. But the NIH budget as a whole-looked at as a measure of the Federal commitment to the support of medical research and education, rather than merely as a catalog of program estimates is an encouraging document.

COMPARISON WITH FISCAL YEAR 1970 AND FISCAL YEAR 1971

BUDGET LEVELS

To put the 1972 budget estimates into proper perspective, we must, I think, compare them with the 1970 level of the NIH programs. As you know, we operated during the first half of the current fiscal year (1971) under a continuing resolution which held the programs to their 1970 levels. The increases over that level only became available for obligation 2 months ago when the 1971 appropriations were apportioned by the Office of Management and Budget.

I must say, in all candor, that the apportionment was more generous than we had expected. All of the congressional increases, totaling nearly $147 million, will be available for obligation. The $15 million increase in funds for health facilities construction grants-which remain available until expended-is being held over until next year, but all the other increases are available now. And, what is equally important, they have become part of the budget base and were taken into account in preparing the 1972 estimates.

For NIH as a whole, the funds now available for 1971 provide an increase of more than $209 million over the operating level that obtained during 1970 and the first 8 months of fiscal 1971. The budget request for fiscal 1972 includes an overall increase of nearly $243 million. If the budget request is approved by the Congress, the total increase in the operating level will thus be a little over $452 million. This is an increase of a little over 31 percent in what is nominally a 2-year period. Actually, however, if this appropriation bill comes into effect before the end of this calendar year, a 31-percent increase in funds available for NIH programs will have come about in a little less than a year. The delayed congressional increases in the 1971 appropriations and the requested increases in the 1972 budget, will thus have a combined and cumulative effect on the NIH programs that marks, I believe, the beginning of a new and more vigorous phase in Federal support for both medical research and education in the health professions.

I am particularly hopeful that it will reestablish lost momentum in the research area. As you well remember, Mr. Chairman, the rapid expansion of biomedical research, for which the Congress was largely responsible, began in 1957 and covered a period of 7 years of great plenty. Unfortunately, beginning in 1964, the fortunes of NIH continued to follow that Biblical pattern and we have now had 7 lean years. During this latter period, especially during the past 4 or 5 years, there has been a slow but steady loss of momentum in existing programs and very little opportunity for the initiation of new ones to take advantage of new leads or to meet new needs. Our main concern has been to hold the line and this became increasingly difficult as the number of projects NIH was able to support continued to shrink due to the combined effects of expenditure restrictions and rising costsparticularly for clinical research involving bed patients. I believe that this downward trend can now be halted and I am enough of an optimist to hope that we may, once again, be at the beginning of the Biblical cycle.

INCREASES FOR RESEARCH

The 1972 budget estimates for the research Institutes and Divisions are based on 1971 appropriations that were $128.9 million higher than the 1970 operating level and they include requested increases that total an additional $125.6 million. This overall increase of $254.5 million for the research programs represents a 24 percent increase over their operating level in 1970 and the first half of 1971.

CANCER CONQUEST PROGRAM

The fact that $153 million-or three-fifths of the total increase in research funds is for cancer research, including the $100 million requested for the new cancer conquest program, will not detract from its effect on the momentum of biomedical research as a whole though it will, to some extent, change its pattern and directions-as, indeed, is the intent. Nearly doubling the funds available for cancer research reflects a choice of priorities-the recognition of a major national health concern and a determination to take advantage of what are thought to be new opportunities for making progress in the attack on cancer. Dr. Baker, the Director of the National Cancer Institute, will testify in detail about these opportunities.

The fear that so much emphasis on a particular group of diseases will distort or detract from research on other serious health problems, while not without foundation, can be exaggerated. Many factors, besides the availability of financial support, determine the directions of research: the existence or absence of enticing leads for further exploration; the scientific background, professional experience, and personal interests of the investigator; the opportunities for research, in terms of available facilities and, in the case of clinical research, an adequate supply of patients with the disease in question; and, in many cases, the intellectual challenge of a particular problem. I doubt that the interplay of these factors has ever produced a balanced pattern of research-if, indeed, balance could be defined in this context. Nor do I think that balance is important in research. The research programs of each of the Institutes must be judged on their own merits. The size of the Federal investment in various fields of

research must be based on the magnitude of the health hazard with which they are concerned, on the importance that the American public attaches to the mitigation or elimination of these hazards, and on the scientific opportunities that are at hand for fruitful research. The latter is particularly important because it is as foolish to force-feed a field in which there are very few leads as to starve a field in which leads are waiting for exploitation. The balance with which we should be most concerned is that between research opportunities and the availability of resources for their exploitation. The funds provided for the uncertain business of probing the unknown in relation to disease problems should reflect the state-of-the-art in the various biomedical disciplines and clinical research fields rather than well-intentioned but extraneous decisions based on political, economic or social factors.

Moreover, cancer research should not be viewed as an isolatedor isolatable-activity. The most important reason for keeping the cancer conquest program within the family of the National Institutes of Health is that cancer research is inescapably intertwined with various aspects of the research missions of the other Institutes. The complex questions to which biomedical research must address itself and the work that goes into their solution are almost never unique to a particular disease or confined to single scientific disciplines.

MEDICAL SCHOOL SUPPORT OF NIH RETAINING CANCER PROGRAM

Mr. FLOOD. I noticed in the paper this morning where a committee of distinguished members of the medical profession very strongly supported your position with reference to maintaining the research in NIH. Did you see that story?

Dr. MARSTON. Yes, sir. That position was taken, as I understand it, by every chairman of a Department of Medicine who was attending the clinical meeting at Atlantic City which is going on at this time. It is my understanding that, without exception, each person who is the chairman of a department signed the resolution as an individual. That was reported in the paper this morning.

Mr. FLOOD. If it is possible, could you get a copy of that resolution for inclusion in the record as part of your testimony?

Dr. MARSTON. Yes, sir.

(The information follows:)

[Telegram]

President RICHARD NIXON.

ATLANTIC CITY, N.J., May 2, 1971.

Secretary ELLIOT RICHARDSON.
Senator EDWARD KENNEDY.

We, the undersign chairmen of departments of medicine of the Nation's medical schools, have responsibility for the care of large numbers of our citizens with cancer and for much of the Nation's cancer research. We strongly endorse current efforts to strengthen the fiscal and organizational structure of the Nation's cancer programs. We believe that progress toward this goal can best be achieved through the framework of the National Institutes of Health, because solutions will surely require a cross-fertilization of many disciplines. While we are convinced that the Cancer Institute should remain within the National Institutes of Health and NIH a part of HEW, we recognize that the expanded cancer research effort may be facilitated by establishing the National Institutes of Health as a separate agency of the Government. A paramount consideration, however, is the preserva