RECOMMENDATION FOR RESEARCH GRANTS SUPPORT, FISCAL 1959, BY CITIZEN'S COMMITTEE (SEE TABLE II)

The Citizen's Committee voted unanimously for an increase in research grants to be computed as follows:

1. Fiscal 1958 figure, plus an increase to 25 percent in indirect costs (total of $22,890,250-direct costs $18,312,200, and overhead $4,578,050).

Plus an increase of 8 percent to adjust for increase in salaries and cost of supplies since fiscal 1958 (total of $24,721,470).

Plus 30 percent of this total figure for new money for research grants ($7,416,441), plus 25 percent of this increase $1,854,110, making the total $33,992,021).

2. If it should be determined that the overhead figure is 35 percent the following Citizen's recommendation would be made:

Fiscal 1958 figure, plus an increase to 35 percent in indirect costs (total of $24,721,470-direct costs $18,312,200, overhead $6,409,270).

Plus an increase of 8 percent to adjust for increase in salaries and cost of supplies since fiscal 1958 (total $26,699,187).

Plus 30 percent of this total figure for new money for research grants ($8.009,756, plus 35 percent of this increase $2,803,414, making total of $37,512,357).

TABLE II.-National Cancer Institute budget obligations by activity, 1958 and 1959

RESEARCH FELLOWSHIPS AND TRAINING GRANTS

The next item concerns training grants.
Mr. FOGARTY. Research fellowships?

Dr. FARBER. Research fellowships. Here there is an increase of $400,000 recommended by the citizens' group over last year's level or the President's budget for fiscal 1959. This has been an extremely important feature of the National Cancer Institute program and has been a very fine and worthwhile expenditure of money.

"Training grants for research in cancer" comes next and an increase of $1,500,000 is recommended. This brings the total to $6,050,000.

The citizens' group spoke with deep appreciation of what has been accomplished with these training grants for the training of research workers in the several fields of cancer and earnestly recommends that this increase be granted.

FIELD INVESTIGATIONS

The State control programs remain unchanged. Finally in the first group of grants there is the item for "Field investigations" where there is an increase of $500,000 recommended specifically for the training of cytologists for the Papanicolou work, grants in the several fields of diagnostic studies of the kind carried out in field investigations for cancer control, and development of new diagnostic procedures, some of which might fall into the same category as those described by the previous witness for gastroenterology.

The experts in this field believe that an additional half-million dollars can be used very wisely in the expansion of the program of field investigations.

May we now turn, Mr. Chairman, to the direct operations?

INTRAMURAL RESEARCH

The first of this concerns intramural research of the National Cancer Institute itself. I should like to speak with deep appreciation for the high caliber of the many fine research programs now being carried out in the National Cancer Institute itself. It was felt by the Citizen's Committee that no important expansion should be recommend for the breadth of research in the National Cancer Institute. It was, however, voted unanimously that the sum of $500,000 be added to the intramural research programs in order to permit them to follow rapidly and effectively the important research leads which they have uncovered in the field of the possible role of filterable viruses in the causation of cancer.

This work is extremely interesting and valuable. I would use the word exciting. It is mainly for that purpose that this increase in our own research operations is recommended.

I would like to suggest parenthetically that any expansion of the role of the National Cancer Institute in the field of cancer research would logically be found in a relationship of the NCI to the expansion of research throughout the country. That is the feeling of the committee.

Dr. FARBER. In the field of review and approval of grants, there is an increase of $34,000, and with the increased number of grants that seems to be a very fair increase.

And there is an administrative increase of $50,000 to help take care of the increased administrative costs in running a larger pro

gram.

There is no increase in the field of professional and technical assistance recommended.

CANCER CHEMOTHERAPY PROGRAM

Now we come to the largest single program of the National Cancer Institute, which at the present time constitutes approximately one-half of the total budget. This is the cancer chemotherapy program. Dr. Ravdin has spoken about the contracts with industry. It is true that the greatest stumbling block we have to the great gains we have made in effecting these contracts with industry is in connection with the matter of patent policy. It is hoped that steps will be taken by the Government to effect a solution rapidly, which will be of so much assistance in the field of cancer chemotherapy.

Afer reviewing those contracts with great care as chairman of the committee, I have no hesitation in saying that the provision of funds for contracts with industry and with other institutions of the country represented one of the greatest forward steps in our entire cancer research program. It has been gratifying to see what industry has done. They have provided millions of their own money above our contracts for this great program of cancer chemotherapy. There are a number of first rate industrial laboratories that we are certain will want to enter this program. They have the chemicals and the antibiotics and the scientists that can help develop the chemicals and antibiotics for use in man. We feel that an addition of $7 million to this contract program for both industry and the institutions will be a very wise expenditure of public funds.

Mr. FOGARTY. Doctor, I asked the same question this morning of the neurological people because of the statement made by Dr. Shannon on four projects in the Institutes of Health. He said:

. And while I would be the last to attempt to define the ultimate dimension to which they should aspire in years to come, I do feel that for a period of 12 to 18 months these 4 programs-cancer chemotherapy, drugs against hypertension, studies of the perinatal period, and the psychopharmacology of mental illnessshould preferably remain at their present levels.

What do you want to say about that?

Dr. FARBER. I have great respect for Dr. Shannon, of course. On this point I would say that the opinion of all of us in the cancer chemotherapy program who have been closely connected with the advancement of this great program is that this is the time to exploit the leads we have uncovered. This is not the time to stand still, because if we do stand still and do not bring in all the industrial groups that have what we want to know, we will slide backward quite rapidly and delay the progress of this program. I speak with deep conviction on this point. We are familiar with the point of view that the time has come to stand on the mountain peak and look back. I do not think we have done enough mountain climbing to stop for the view. That would only delay this program. We must go forward.

Dr. RAVDIN. There is another aspect of this. These funds are not all being used for the development of chemicals. When this program started we had the total resources in this country for making available mice, which are essential in this type of work in the preliminary studies, undesirable as these animals may be for some studies, I think 400,000 mice. We have had to provide for a very sharp increase in the number of these animals by industrial contracts or you might call them contracts of any kind, they are not through a grant mechanism-and at the present time, under the auspices of the National Cancer Institute, we have provided for 1,600,000 mice a year, a 4-fold increase in a period of 2 years, and with a constant increase in the number of available agents which must be screened in mice until better methods of screening are found, we shall have to continue to use mice and we must use them in large numbers. We are using them in many of the screening tests with three tumors. It might be perferable to use them in a wider spectrum than we are now doing, just as we are trying to use them in wider spectra of human tumors.

In Wisconsin recently there was first developed through the research of Dr. Charles Heidelberger a chemical known as 5-fluorouracil. It was used by Dr. Heidelberger-it was limited in amounton a few tumors, and although there were high expectations, in some cases where this chemical was used it did not prove to be helpful. An associate of Dr. Heidelberger's working in the Department of Surgery, Dr. Anthony Curreri, used it in a group of patients with lung cancer and the results were striking. We have used this agent in a variety of tumors with variable results, but in the last few weeks we have used it in a child with osteogenic sarcoma, which usually is fatal, with absolutely brilliant results, with complete disappearance of the tumor. You must have a wide spectrum of tumors in which to use it in the fundamental program as concerns the experimental animals, and we are firmly of the belief that while an agent may very favorably affect a certain type of tumor, it may not affect the wide spectra of tumors in general, and a single chemical may not be effective in a wide variety of tumors.

I do not know if I have made my point or not.

Mr. FOGARTY. I think it was a good point that you made.

Dr. Farber, is there anything else you want to say on that point? Dr. FARBER. I think a summarizing sentence could be that our program is increasing in momentum and it would be disastrous to slow it down or stop it. There are no exceptions to this view among the citizens who are working and advising in the program itself. The increase in administrative cost of the cancer chemotherapy center we have as a separate item. That is $750,000.

Mr. FOGARTY. Why is it a separate item?

Dr. FARBER. Because we did not know where to put it, and we wanted to point it out. This is for the Center and for all its activities to pay for the greatly increased cost of the many meetings of a huge number of citizens that come from all over the country. Dr. Ravdin's clinical program has the largest number of people in it. We want to include provision for higher salaries for Dr. Endicott's staff. We do not know the mechanism but would like to recommend this increase to improve the work being done by Dr. Endicott, Director of the Cancer Chemotherapy Center. We would like to have more $19,000 positions so that Dr. Endicott can keep the good people he has now and increase the number of these good people.

Mr. FOGARTY. There is nothing we can do about that. That has to go through the legislative committee to have jobs established at that level.

Dr. FARBER. Dr. Endicott does need a larger staff and he does require a great deal more help in carrying out the administrative provisions of this rapidly growing program.

We leave an unobligated balance reserve because we understand that may be extremely valuable and we

Mr. FOGARTY. It is going back to the Treasury. It was lost because of the dilatory techniques of the Bureau of the Budget and it has been lost and cannot be recovered. That is the way I understand it. Dr. FARBER. I did not understand it. Thank you.

CHEMICAL AND HORMONAL DIAGNOSTIC TESTS

May I speak about the last item in this budget which concerns a new program. We would like to suggest that this new program, concerned with the development of chemical and hormonal diagnostic tests be regarded as an extremely important contribution which this appropriation can make. We would like to recommend that this program be a voluntary planned program similar to the cancer chemotherapy program, with both research grant provisions and contract provisions.

Mr. FOGARTY. Contracts with whom?

Dr. FARBER. With institutions or industry.

Mr. FOGARTY. I think you should tell us how this would work. Dr. FARBER. The reason for this special program is that we are badly in need of information concerning the level of chemical enzyme systems and hormones in the body in the normal individual as well as in a patient with cancer, and a patient with cancer who is receiving treatment by hormones or chemicals or antibiotics. Such information is not available today. This is in the field of biochemistry and biology and can be described as basic research. The need for this is now being demonstrated very clearly because of the great gains in the chemotherapy field. We would like to be able to choose the precise chemical or hormone which a given patient requires and to give it in the precise manner required to prevent whatever the tumor is doing to the body.

These methods can be developed by scientists working alone. We believe they can be developed more rapidly, while these scientists retain their academic freedom, if they work in some volunteer plan which worked so successfully in the cancer chemotherapy field. We hope the result will be the development of a simple diagnostic test for cancer that can be performed by technicians and technical devices. We want to start this program slowly the first year. It will take time for tooling up and for the finding out of what research workers can be drawn in such a program. We put down the sum of $1.5 million merely to get this started, with the understanding that if we cannot get tooled up in the first year that money obviously will not be spent. I would predict if we are successful in the first breakthrough in this new field, that the cost, whatever it may be, will be cheerfully granted because of the enormity of the importance of the goal. This is a new program and we have called it by the short name, which should be shorter, the development of chemical, hormonal, and cancer diagnostic tests.

Mr. FOGARTY. You people have been talking about developing some kind of diagnostic test for some time. Not much has been accomplished so far?

Dr. FARBER. I know you understand the great importance of the work that has been done by Dr. Papanicolaou. What we have not had has been any success in the development of a really accurate cancer diagnostic test on the blood. There could be no greater boon to all of us than the availability of such a test. And while we would in no way interfere with the academic freedom of research workers who want to work alone, we believe if we have a program of this kind with people responsible for the administration of the program informing the re