graduates of foreign medical schools coming into this country to meet our health needs.

ADEQUACY OF FUNDING FOR NLM

Mrs. REID. I recently received a letter from the executive vice president of the Bank of America who serves as regent on the National Library of Medicine. He said he viewed with alarm what he considered to be inadequacy of funding for the library for the 5-year period 1968 through 1972.

Would you comment on this and tell us if there has been any effect on the information services?

Dr. MARSTON. I think it is clear the years you have touched on have been the years of tight budget in the Federal Government both under the past administration and under this administration, and it hasn't been possible to fund at the level that one could justify in looking at program opportunities alone.

I think the problem of the Library of Medicine-I would like to get Dr. Cummings to comment on this-is that they have been caught in the squeeze of having some programs which are absolutely essential in which there has been an unusually rapid escalation of costs.

Those uncontrollable increases put a much tighter squeeze on the so-called controllable parts of the budget, some of which are high priority items from the point of view of national need.

Dr. CUMMINGS. One example of this is reflected in the rising costs of acquiring books and journals. They have gone up at a rate of 13 percent per year during the period that is cited in this letter, which is twice the normal escalation of costs of business.

In addition there are more living physicians, scientists, and educators now than there were years ago and therefore there are greater demands for services. More people are available to ask for more

service.

I would say the most direct effect of the stable budget has been a reduction in the number of services that we are able to provide because of the cost escalation. This is reflected specifically, for example, in our having to close the library on Sundays for the first time in many, many years.

Mrs. REID. Have you received adverse response to the closing on Sunday?

Dr. CUMMINGS. I received complaints from the physicians and students who come to the Library on Sunday and find the doors locked. They let me know their displeasure.

RESEARCH INTO PROBLEMS OF THE AGING

Mrs. REID. In view of the increase in life expectancy, what research is being done in regard to special problems of the aging?

Dr. MARSTON. We have a center for aging research in Baltimore. Research in the aging areas is the responsibility of the National Institute of Child Health and Human Development. It is one of the areas Dr. LaVeck will be speaking to specifically when he appears. I would comment, though, if I may, that the problems of aging go beyond any specific Institute. Just because something is labeled aging

62-645 0-71-pt. 3—

does not assure that is where the needed knwoledge is going to come from.

The best overall chance of improving the prospects for a graceful and dignified and active life is to have a better understanding of the basic life processes which then gives us an opportunity to have a better understanding of where they go wrong and cause premature aging.

Premature deaths of the American male from cardiovascular disease is an aging problem, although the research is being done in the National Heart and Lung Institute. You do have a higher rate of death from a process that occurs to some extent in every one who lives and could be classified as an aging problem, too.

We work on problems where the expertise is. One could say the same thing about essentially all of our Institutes.

CAUSE OF THE RISING CANCER DEATH RATE

Mrs. REID. I read an article a short time ago which I think gives us food for thought in regard to cancer, the increased funds, and the feeling we are on the verge of a breakthrough of the dread disease; that although there are improved methods of treatment which should help to stem the number of annual deaths in cancer, the number of these deaths continues to rise more rapidly than the increase in the size of the population. Why would this be?

Dr. MARSTON. One of the big components is the increase—almost epidemic increase in death from lung cancer. When you look at the problems in the cancer field generally, this is the one that stands out both in terms of the rate of increase and also the number of deaths. One has to be sure of what one's goal is in looking at as complex a field as cancer research. We must put a considerable emphasis on preventing premature death and assuring dignified death and comfortable death. But the chances of preventing death is not a realistic goal of research in the biomedical areas.

The concern we have, and the opportunities we have, in cancer is to cure what is a frightening disease and a disease that kills young people as well as old people. I don't think-and the President was cautious not to overpromise-that someday we will wake and cancer will not exist anymore.

TIME FRAME FOR CANCER BREAKTHROUGH

Mrs. REID. But I have felt we are on the verge of important new findings in research on cancer. Isn't this true?

Dr. MARSTON. Yes, and I have spoken enthusiastically about the need to capitalize on the opportunities that have come out in a number of ways. I think there is an urgency about our doing this. But we are probably talking about decades and we are talking about different kinds of cancer. We will make progress in some cancers and we will not make progress at the same rate in other cancers.

At the same time we are improving our ability to diagnose and treat and prevent cancer, we are putting new chemicals out into the environment, many of which undoubtedly will have the ability to cause cancer. We need to be able to identify those hazards. They are being introduced in larger numbers and larger amounts and the problem of

identifying which ones are dangerous, which ones are not, is a major problem.

Mrs. REID. It is a vicious cycle.

Dr. MARSTON. It is. I think-and when Dr. Baker is here this point will come out again and again—that we have immense problems and we have made immense progress, and you can't have one without the other.

Sometimes when a problem is solved it opens up a whole new group of problems we didn't know existed. Sometimes they are encouraging and sometimes they are discouraging. I think it can be said that, as a whole, the field is advancing more rapidly than it has in the past, and there is a need for substantial increases in investment of human effort and financial support in this area at this time.

But we can't guarantee when there is going to be "an answer" or indeed whether there is going to be one answer rather than many

answers.

Mrs. REID. Thank you.

Mr. FLOOD. Mr. Conte?

BUDGET DEFICIENCIES

Mr. CONTE. You intimate on page 1 of your statement that the fiscal 1972 budget may not fulfill all your desires. Are there any major deficiencies in the budget requests that you would single out?"

Dr. MARSTON. That is a hard question to answer because it depends on how one defines "deficiencies"-or, rather, within what framework one judges the budget requests. I think this is a good budget but, as I said, it doesn't provide for everything we might have liked to see included. But I would not describe these things as major deficiencies. Solely on the basis of program considerations-that is on the basis of the importance of health research problems and the scientific opportunity to do more about them-there are, of course, a number of areas where more could be done if no limit were set on budget requests, if we didn't have to make choices or weigh priorities.

An obvious example is heart disease. As you know, the American Heart Association feels very strongly that we are not doing enough about heart disease. They are understandably unhappy that the budget request for a major attack on cancer is not matched by a similar request for cardiovascular diseases which, they point out, kill more people than cancer and are a field in which there has already been rapid progress and in which there is a high potential for further significant advances.

The point is that much of medical research is in a dynamic state with real opportunities for progress similar to that which has recently been so effectively publicized for cancer. Examples of such opportunities, disease by disease, will emerge, I am sure, as the Directors of the various Institutes testify.

Mr. CONTE. What major projects will be deferred under your budget requests?

Dr. MARSTON. This budget, like all budgets, has both increases for some programs and decreases for others. There are two general areas in which it would be fair to say that projects or, at least, additional projects are being deferred. One is the training grant area in which any budget increases have been deferred until a study of these programs, that is now underway, has been completed. The other is the

construction of health research facilities in which further grants will continue to be deferred partly because of the inflationary effect of construction projects and partly until a decision is made about the future level of Federal support for research which will give a clearer indication of the future need for additional research facilities.

In this connection, I should point out that the additional $100 million requested for the cancer conquest program does include up to $16 million for construction or modification of research facilities and $2 million for training grants.

EFFECT OF LATE AVAILABILITY OF 1971 APPROPRIATIONS

Mr. CONTE. How serious an administrative problem did the unavailability of 1971 appropriations until 2 months ago create for NIH? Dr. MARSTON. The most serious consequence was that it had the effect of keeping all the programs at their 1970 level during most of 1971. Receiving additional funds so late in the year-especially when program operators had reason to doubt whether the congressional increases would be apportioned and actually be available for expenditure-creates a disproportionately heavy administrative burden during the last few months of the year. This is, of course, especially true of programs for which new funds or proportionately large increases are provided, such as the $10 million increase for genetics research.

In our collaborative programs, the negotiation of research contracts is usually a fairly complex and time-consuming business and having only a few months in which to do it can create serious problems. Sometimes one can anticipate the actual availability of the additional funds by negotiating ahead of time but this isn't always possible, practical or prudent. But even in the regular research grant programs, in which the applications will already have been routinely reviewed, there can be quite a scramble to get all the paperwork done and the award notices in the mail before June 30.

"SEVEN LEAN YEARS"

Mr. CONTE. What programs suffered most as the result of the steady loss of momentum you experienced in your "seven lean years"?

Dr. MARSTON. The effect was felt across-the-board and, I may say, across the Nation and, indeed, the world. I would say that uncertainty and confusion about the Federal Government's attitude to biomedical research and its intent regarding levels of support has been the most. serious overall effect.

Its effect on program is illustrated by the progressive decline in the number of research projects supported. Close to half of the funds available to the Institutes are devoted to the funding of research project grants to investigators throughout the United States. This proportion has remained fairly constant. Funds for these grants went up slowly during those lean years but costs, as you well know, went up very rapidly. As a result, the number of research projects we were able to support declined steadily. In 1963 we were able to fund 15,200 research project grants; in 1970 we were able to fund only 11,300. This is a drop of more than 25 percent in the number of projects supported.

In this respect, some Institutes fared better than others. The ones that suffered the most, to answer your question, was the Institute of General Medical Sciences which mainly supports so-called basic

research that is vitally important to future progress in all fields of medical research. The number of projects that Institute was able to support fell from 2,200 to just over 1,100-a drop of just about 50 percent. Similarly, in the Dental Institute grants dropped from 450 in 1963 to 200 in 1970-that's a drop of 55 percent.

Cancer and Heart didn't do so well, either. Cancer research grants dropped by a third from 1,800 to 1,200. Heart research grants dropped almost as much: from 2,400 to 1,700. The experience of the Allergy and Arthritis Institutes was in line with the average for NIH as a wholethat is, a drop of about 25 percent. The Neurology Institute fared better. The number of grants it was able to support dropped by only 10 or 12 percent.

These figures do not tell the whole story, of course, but I think they illustrate the extent of the loss of momentum. The fact that we could support fewer and fewer projects had its greatest impact on new projects and new investigators. The number of new projects we were able to support fell from 2,700 in 1963 to 1,800 in 1970-that is down onethird. We were torn between our desire to assist young investigators just entering the biomedical research field and our reluctance to withdraw support from important ongoing work in order to make this possible. On the whole, we avoided making arbitrary decisions in this respect and let the normal review process take its course. Until this year, at least, the youngsters competed fairly well. One does, however, hear increasingly of talented, dedicated young investigators who have become discouraged. I hope the increases requested in this budget for 1972 will help to restore their confidence.

There is no way to measure the effect of this decline in support on the progress of research or to assess what accomplishments might have resulted if there had not been such a decline. A few of the unsuccessful grant applicants may have found support elsewhere. A few were probably able to continue their work-on a reduced scale or at a slower pace without additional project support. But there is no doubt that many good projects had to be abandoned or were never started-with what loss to our present or future ability to fight disease no one can say.

IMPACT OF CANCER CONQUEST PROGRAM

Mr. CONTE. How, specifically, will the patterns and directions of the biomedical research program change under the new cancer conquest program?

Dr. MARSTON. The principal impact of the new cancer conquest program will be a really major expansion of research, a heightening of effort and, I hope, an accleration of progress. That is obviously its purpose. The additional funds will make it possible for the Cancer Institute to put into effect some plans that were, heretofore, beyond its means. But much of the added thrust will be in extensions of ongoing activities. The need to expand these activities and, particularly, to take full advantage of the new leads and new research opportunities that have been uncovered led to the decision to add an extra $100 million to the cancer-research effort. I expect that coordinated, managed research programs-by this I mean collaborative research programs and contract research projects will be significantly expanded. At the same time, we will also give additional support