tion of the integrity of the National Institutes of Health, which has played so critical a role in cancer in particular, and in the entire biomedical area. Signed, Dr. Robert Abernathy, University of Arkansas School of Medicine, Little Rock. Dr. Philip K. Bondy, Yale University School of Medicine, New Haven, Conn. Dr. Evan Calkins, State University of New York, E. J. Meyer Memorial Hospital, Buffalo. Dr. George Cartwright, University of Utah College of Medicine, Salt Lake City. Dr. Leighton E. Cluff, University of Florida College of Medicine, Gainesville. Dr. William W. Engstrom, Marquette University, School of Medicine, Milwaukee, Dr. Saul Farber, New York University, College of Medicine, New York, N.Y. Dr. Mario Garcia-Palmieri, University of Puerto Rico, School of Medicine, San Dr. Kenneth Gardner, University of Hawaii, School of Medicine, Honolulu. Dr. James Hammarsten, University of Oklahoma, School of Medicine, Oklahoma, Dr. A. McGehee Harvey, Johns Hopkins University, School of Medicine, Balti- Dr. Halsted R. Holman, Stanford University, School of Medicine, Palo Alto, Dr. Alexander Leaf, Harvard Medical School, Massachusetts General Hospital, Dr. James Leonard, University of Pittsburgh, School of Medicine, Pittsburgh, Pa. Dr. Henry D. McIntosh, Baylor University College of Medicine, Houston, Tex. Dr. Robert G. Petersdorf, University of Washington School of Medicine, Seattle. Dr. Arnold Relman, University of Pennsylvania School of Medicine, Philadelphia. Dr. Theodore B. Schwartz, Rush Medical College, Chicago, Ill. Dr. Donald Seldin, University of Texas Southwestern Medical School, Dallas. Dr. Sol Sherry, Temple University School of Medicine, Philadelphia, Pa. Dr. Lloyd H. Smith, Jr., University of California School of Medicine, San Francisco, Calif. Dr. Gene H. Stollerman, School of Medicine, University of Tennessee, Memphis. Dr. James F. Sullivan, Creighton University School of Medicine, Omaha, Nebraska. Dr. Scott N. Swisher, Jr., Michigan State University College of Human Medicine, East Lansing. Dr. Alvin R. Tarlov, University of Chicago, Chicago. Dr. George W. Thorn, Harvard Medical School, Peter Bent Brigham Hospital, Boston, Mass. Dr. Oscar A. Thorup, Jr., Arizona University School of Medicine, Tucson. Dr. William S. Tisdale, University of Vermont College of Medicine, Burlington. Dr. James Warren, Ohio State University College of Medicine, Columbus. Dr. Ralph H. Williams, University of New Mexico School of Medicine, Dr. William Williams, State University of New York, Syracuse, N. Y. Dr. Robert Wise, Jefferson Medical College, Philadelphia. Dr. Lawrence E. Young, University of Rochester, Rochester, New York. Dr. Stuart Bondurant, Albany Medical College, Albany, N.Y. Dr. Solomon A. Berson, Mt. Sinai School of Medicine, New York, N.Y. Dr. Eugene Braunwald, University of California, LaJolla. Dr. Joseph Shipp, University of Nebraska College of Medicine, Omaha. Dr. William N. Valentine, University of California at Los Angeles, Medical Center, Los Angeles. RESEARCH LEADS INTO VIRAL CARCINOGENESIS Dr. MARSTON. The present excitement about the role of viruses in causing cancer-which is one of the reasons for feeling that the time is ripe for a cancer conquest program-illustrates the way in which progress in one field of research depends on work being done in another. Virologists, who for years have been mainly concerned with unravelling the mysteries of infectious diseases, such as the common cold, for which viruses are thought to be responsible, have provided the leads and are now doing much of the work in viral carcinogenesis. Further refinement of this work is now leading deep into the basic sciences of molecular biology and genetics. For example, a very important development of the past year is the discovery that the cell chemical known as DNA is not the sole and unique determinant of genetic patterns it was heretofore thought to be. It has now been shown that RNA, the chemical messenger that carries instructions inherent in DNA's "code," can, in some cases, dictate how DNA is formed and thus itself control the cell. A series of rapid developments led to the discovery that an enzyme that uses RNA as a blueprint to make DNA is present in more than 30 different viruses that can cause various forms of cancer in birds, mice, cats, and monkeys. Last November one of our own scientists reported that he had found this enzyme in the white blood cells of patients with acute leukemia and it has since been found in patients with breast cancer. It is also known that certain classes of drugs inhibit the activity of this enzyme, at least in the laboratory. However, the next link in this very promising chain of events was the disappointing discovery that the enzyme can also be found in normal cells-which poured cold water on what had been a very hot lead in the search for the mechanism by which a virus can cause some forms of cancer. But further research now seems to show that there is a significant difference between the enzyme found in normal cells and that found in malignant cellsand the trail is once more warm. COMPLEX NATURE OP MEDICAL RESEARCH In so complex a field as medicine in which so much basic information is still lacking, progress frequently involves a few steps forward and a few steps back. For this reason, the aspect of the cancer conquest program that concerns me most is the danger of overpromiseconcern, Mr. Chairman, which I know you share. The progress that has been made in cancer research in recent years is impressive and highly encouraging. It has, as the President said in his health message, opened "many new lines of inquiry and many new opportunities for breakthrough." But he wisely pointed out that the technological challenge of the space program holds no parallel for the more basic scientific challenge of biomedical research and he added that "scientific breakthrough * * * often cannot be forced-no matter how much money and energy is expended." That is a point of which the public should be constantly reminded. In previous appearances before this committee I have emphasized the indispensability of research in the basic biomedical sciences to future progress in applied clinical research on human disease problems. As Sir Francis Bacon said more than 350 years ago, "Knowledge and human power are synonymous, since the ignorance of the cause frustrates the effect." In the field of medicine, the painstaking and often frustrating burden of assembling the necessary knowledge still rests largely with those engaged in so-called basic research. As the public and national purpose of the research institutes of NIH is to promote the health of the American people through research, they must maintain a judicious balance between empirical, frontal attacks on disease problems which do sometimes yield practical, though often imperfect, results-and the more analytical and circuitous search for an understanding of the nature of disease. Clearly, the NIH programs must be responsive to national aspirations but the response must not be allowed to deflect them from the dogged pursuit of the scientific knowledge which alone can lead to real solutions of disease problems. As Prof. Joel H. Hildebrand, the eminent chemist at the University of California, has said: "Science is not a sacred cow that sometimes works miracles, but a workhorse that carries loads." IMPORTANCE OF GENETICS RESEARCH Among the basic science activities of special importance at this stage in the evolution of medical knowledge is genetics research for which this committee provided an additional $10 million to launch a special program of project grants. In accordance with the committee's wishes, I appointed an Inter-Institute Coordinating Committee on Genetics chaired by Dr. Berliner, Deputy Director for Science, and consisting of the Directors of the National Institute of General Medical Sciences, the National Institute of Child Health and Human Development, the National Institute of Allergy and Infectious Diseases and the National Institute of Arthritis and Metabolic Diseases, and Dr. Lamont-Havers, Associate Director for Extramural Re search and Training. This committee has recommended that awards. be made for 162 applications that have been approved and given high priority by the advisory councils of seven of the Institutes. These awards will total $7,750,000 bringing the amount invested in the genetics program this year to about $60 million. The increase provided by this committee has made it possible to fund all high-priority applications in genetics of which we previously had a considerable backlog. Dr. Stetten, who rejoined NIH last fall as the new Director of the National Institute of General Medical Sciences which has the major responsibility for the genetics program, will be glad to answer any questions you may have about the future course of these activities. SICKLE-CELL ANEMIA In addition to the basic biomedical sciences, there are many areas in more immediately disease-related research in which a number of the Institutes share a common interest. One such area is sickle-cell anemia, an hereditary blood disease that is one of the most common long-term illnesses among black children and young adults. No permanently effective treatment has yet been discovered and most of the victims of sickle-cell anemia die before their 30th year. One of the scientists on the intramural research staff of the Arthritis Institute has done pioneer work on the molecular nature of this disease and four Institutes are at present supporting research on sickle-cell anemia through their grant programs: the Arthritis Institute which supports work focused on the metabolic nature of the disease; the Heart and Lung Institute which is concerned with blood abnormalities; The National Institute of General Medical Sciences which supports research on the basic biochemistry involved; and the Child Health Institute which is concerned with the diagnosis and treatment of childhood diseases. Their total investment this year is about $1.5 million. Because of the importance of this disease to the black community and because there has recently been a promising advance in the management of acute crises of sickle-cell anemia, the budget request for the Heart Institute includes an additional $5 million to expand work in this area by all of the interested Institutes. I appointed a small task force, representing the three Institutes most directly concerned, which drew up plans for the expanded sickle-cell anemia program that the President announced in his health message. Dr. Cooper, Director of the Heart and Lung Institute will be glad to describe this program in more detail. ADVANCES IN COMBATING VIRAL HEPATITIS Another area that spreads well beyond the interests of a single Institute is in research on the type of hepatitis that sometimes results from blood transfusions or the use of blood products. Here, I am happy to say, we seem to be on the verge of major advances. You may have seen recent newspaper stories about preliminary reports from Dr. Saul Krugman of New York University which indicate that it may-and here I emphasize the word "may"-now be possible to develop a vaccine for this type of viral hepatitis which causes about 50,000 illnesses a year. There have also been some promising developments in devising tests to determine whether blood is free of this hazard. Six components of NIH are involved in research on hepatitis: The Division of Biologics Standards is responsible for establishing and maintaining standards of quality and safety for all biologic products which, of course, includes human blood for transfusion, products prepared from blood, and the test materials and methods used to assure that they meet the required standards. The national blood resource program of the National Heart and Lung Institute is responsible for improving blood resources and their usage, including the development of new technology to insure the safety of these uses. The National Institute of Allergy and Infectious Diseases is responsible for research on the causative agents of viral hepatitis, for development of new methods for detecting hepatitis virus, for vaccine development and for the production and distribution of reference reagents. The National Institute of Arthritis and Metabolic Diseases has a general responsibility for research in liver diseases including clinical diagnosis, medical management and the fundamental processes underlying these diseases. The Clinical Center, which is a major user of blood and blood products, is an intrinsic part of our research effort on hepatitis. BLOOD PRODUCTS Mr. FLOOD. What is a blood product as distinguished from blood? Dr. MARSTON. There are a number of blood products. Particles in the blood, such as platelets, are sometimes used in transfusions, particularly in patients with leukemia where the platelet count may have gone down either because of the disease or the treatment. Mr. FLOOD. Are they solid? Dr. MARSTON. Yes, sir; they are solid small particles that prevent bleeding when you have a cut. These are particles that come out of the blood. Mr. FLOOD. Are they taken orally? Dr. MARSTON. No, sir; these have to be given intravenously. There are other types. None of them are taken orally. Sometimes patients need albumen, sometimes they need a product such as gamma globulin which is now about the only thing one can do to help protect against contacts with another form of hepatitis, infectious hepatitis. Many people going to parts of the world having an even higher incidence than here will have a shot of gamma globulin which is a useful protection. Mr. FLOOD. Is it a prophylactic or cure? Dr. MARSTON. In the case of gamma globulin it is almost always a prophylactic although it is used in some children and also in some adults who have a deficiency in their inmmue mechanism and have repeated infections. They may actually be treated with repeated injections of gamma globulin to supply some of the protective antibodies from other people because they are unable to make them themselves. |