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workers might apply their skills to the field of cancer or to problems of heart disease with specialized goals relating to a specific area or category, we then have a different conception and we find these same people working now expertly, because of their basic training, in 1 area with 1 broad goal where a number of people with different kinds of specialized training are needed.

Mr. Fogarty. I don't quite follow that. I am a bricklayer, and I would not make a very good carpenter.

Dr. FARBER. That may be.
Mr. FOGARTY. Or vice versa.

Dr. FARBER. But, as a bricklayer, you could now enter, if you wanted to build a house made of bricks or a factory made of bricks or the National Cancer Institute made of bricks, and join with different kinds of other experts in the making and in the specific goal. The fact that you are trained basically in bricklaying would permit you to join any group of other experts, no matter how many or how specialized, for any kind of purpose wherever they needed bricklaying.

Mr. FOGÁRTY. As long as you stick to bricklaying, yes. If you are going to get into these other fields, it would not.

Dr. FARBER. But, as expert a bricklayer as you might be, you could not build a house by yourself without a carpenter or plumber.

Mr. FOGARTY. No one person can do all the things required and be good at all of them.

Dr. FARBER. That is right. But, as long as we are training people to be physicists or biologists or experimental pathologists, without any reference to the cancer problem or the heart-disease problem or neurological disease, we have had very little support for such people, and not all of these basic people who are beginning to get specialized training and interest in the sciences which we can use in many fields are interested, at first, in cancer or heart disease.

In order to support them and their research in areas that are not separable into one specific category, this area of general research grants in noncategorical grants has sprung up, and in addition an area of training grants for the training of such people has been developed this past year.

This area has grown to include a number of other fields which are not specifically supported. Some of these areas include pathology, pharmacology, genetics, physiology, research pediatrics, research anesthesiology, research survey, epidemiology, and biometry, and others. These are in addition to the basic ones of physics, biology and chemistry as applied to the problems of medicine and health.

At the present time the research-grants field in this general area has an appropriation of $912 million.

We have investigated this ourselves and have found that they are several million dollars short this year of their ability to provide support for grants which are acceptable to the Council.

In the field of training grants in this general area they have $21/2 million and they are roughly six to seven hundred thousand dollars short already of trainee-grant money to support applications which can be approved. This is a program, this second one, which is less than a year old and just beginning to grow.

We have investigated this general area with great care because this is the feeding ground for the scientists we later want in cancer and

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the other categorical fields. It is also a feeding ground for scientists who are doing work of tremendous importance to science without reference to any specific disease.

For these reasons we would like to make the following recommendations:

First, that the $912 million appropriation for general research grants be increased to $20 million; second, that the $212 million training grant program in general training grants be increased to $10 million.

We believe this amount of money not only can be spent wisely in each case but that the results will be of tremendous importance to science as a whole and to the various categorical areas in later years. These are the men we need so badly.

Mr. FOGARTY. We will insert your prepared statement on this in the record at this point.

(The statement referred to follows:)

STATEMENT OF DR. SIDNEY FARBER, PROFESSOR OF PATHOLOGY, HARVARD MEDICAL

SCHOOL, AT THE CHILDREN'S HOSPITAL, FEBRUARY 25, 1958, ON "NONCATEGORICAL RESEARCH AND TRAINING GRANTS"

The committee's attention is next invited to grants for research projects and research training included under General Research and Services, National Institutes of Health. These grants are more readily recognized throughout the country as the general research grants and the general research training grants of the Division of Research Grants.

These general, or noncategorical grants, support basic research and training programs in the medical and related biological fields where the emphasis is entirely upon the successful acquisition of new knowledge for its own sake and for the training of scientists as fundamental investigators in one or another of the fields related to academic medicine. In addition, these general research and training grants also support work in such areas as fertility, reproduction, child health research, public health research, nursing, accident prevention, and so forth. Here is the Public Health Service source of support for fundamental or basic research and training which cannot be identified as the responsibility of any single Institute and yet is recognized as the feeder program for all of them.

The National Institutes of Health and the universities join hands in recognition of the urgency of having a type of research grant which leaves certain of the investigators free to extend the boundaries of knowledge without any concern for the immediacy of results or their relation to a disease or crippling condition. This committee is fully aware that the Institutes all seek to provide the maximum permissible support of fundamental investigation related to their own special program areas. These Institutes all recognize full well, however, the necessity to provide for the needs in the noncategorical basic science areas, which are of common interest to all of them and which must be continuously encouraged and supported lest there be a drying up of the very well spring of fundamental knowledge.

Although I am obviously one of those who argues that it is necessary to stimulate work in cancer research and other special areas, I strongly urge continuing precaution to guarantee that those scientists interested in knowledge for its own sake, feel completely free to request funds for those investigations in which they are most interested-encouraged through the availability of general research grants to pursue the path their intellectual curiosity dictates, and thereby to add to the fundamental data essential to any continued progress in the attack on disease. Unless we are ever alert to promote more fundamental research as supported directly by the Division of Research Grants, there will be a decreasing amount of new basic data for exploitation by the scientists striving to resolve problems in cancer, heart, and other categorical areas.

It is absolutely imperative that this basic research be conducted, and that the basic research investigator be adequately protected with financial security: it is also apropriate that the record show something of the importance of basic research to the problems of application in the improvement of health and in the

conquest of disease. The general research grants program has traditionally filled the role as the "feeder" of basic research findings into the programs of the categorical Institutes. As a member both of the Pathology Study Section and of the National Advisory Cancer Council, I have been in a position to see literally hundreds of grants, initially supported by the Division of Research Grants, later develop into research of specialized interest and be transferred to the appropriate Institute for support.

From my own experience and observation and upon some investigation of the need for increased support in these basic medical and related biological sciences, I am confident that a total of $20 million could be wisely appropriated for research projects included under "General research and services, National Institutes of Health.” This would be an increase of about $10.5 million over the funds provided in the President's budget. Of this total, at least $10 million is badly needed by scientists engaged in fundamental researches in such disciplines as biochemistry, physiology, pathology, genetics, and the interdisciplinary scientific area of cellular bioligy. In this latter area, in particular, large sums are needed in order to stimulate, encourage, and provide suitably for the research-team approach to problems of normal and abnormal cellular metabolism and pathology.

I am convinced that as much as $3 million could be profitably used in pediatric research and related investigations, both clinical and nonclinical, including fertility, reproduction, growth, and development.

The other general areas for which the Division of Research Grants is responsible include the tremendously important area of general public health research, such as broadly based epidemiological studies of various industrial and environmental problems and accident prevention. In these large and complex areas I feel certain that at least $7 million is needed to advance and expand programs now underway consistent with the proven public need and national welfare. If the committee wishes detailed information concerning the manner in which the $20 million would be expended, I am certain that the officials of the National Institutes of Health could readily provide very close estimates based upon this total sum.

The general research training grant program is equally as important as the genral research grant program. A continuing flow of well-trained investigators in the sciences basic to medicine is essential, not only to conquest of research in these basic medical sciences, but also to any substantial progress in the attack on health problems. Further, and most importantly, this is the only training grant program of the Public Health Service which is primarily responsible for assisting in the support of training in the sciences basic to medicine. The categorical training programs of the Institutes have their own separate and important roles to play. In operation, the general research training grant program will serve to strengthen and extend the effectiveness of the specialized programs of the Institutes and will feed into them an ever-increasing number of well-trained basic scientists.

This training program will promote the development of scientific skills in all areas where there is a major shortage of research trained manpower; such areas include pathology, pharmacology, genetics, physiology, research pediatrics, research anesthesiology, research surgery, epidemiology and biometry, and other disciplines which cannot be appropriately provided this type of support through the categorical training grants programs of the Institutes.

From my experience as a consultant to the Surgeon General and as a professor of pathology at Harvard Medical School, I have noted that it takes somewhat more than $1 million per year to fund adequately the initial stages of a national training program in a basic discipline related to medicine. It is obvious, therefore, that at least a total of $10 million will be needed in order that this program which represents the primary support of basic medical and related sciences can be maintained during the next fiscal year. The sum will exceed the President's budget by about $7:5 million dollars and will for the first time provide support for research training in those departments whose training needs have not fallen within the scope of the programs of the categorical Institutes. The need for training grant funds in these basic medical areas has been repeatedly brought to the public's notice by articles and speeches by many leaders in the fields of biology, medicine, chemistry, physics, etc., and have been the subject of scores of editorials and articles. The training of the next generation of investigators in the sciences fundamental to medicine and health will largely stem from this program.

From the outstanding departments in the leading medical schools of our country are coming applications for this type of training grant support, and I know that their requirements will far, far exceed the limited funds provided in the President's budget for fiscal year 59. Everywhere I go I hear prominent scientists enthusiastically applaud the 1958 activation of this general research training grant program. I am firmly convinced that the requested increase in appropriations for these grants will be a most wise and far-seeing investment by the Congress in the future health and welfare of this country.

Mr. FOGARTY. There are some Members of Congress who still maintain when we bring this bill on the floor that here we are spending $55 million or $60 million for research in cancer, and yet we do not know how to diagnose most cases of cancer, do not know how to cure it, have not developed a vaccine, and 250,000 people still will die of it this year and 250,000 people died of it 10 years ago.

What is the best answer we can give to that kind of statement? Dr. FARBER. First, we are curing

Mr. FOGARTY. They might not go into all the details I did. They might say we are spending $55 million a year. We have been building this thing up for 10 or 12 years and still 250,000 people are dying of cancer. They think we are throwing money away.

Dr. FARBER. I think there are many of us who are alive today having had cancer some years ago because we were cured by surgeons, and I am one of them. We are curing about 25 percent of all the patients with cancer today by the use of surgery and radiotherapy.

The figures, I think, are quite clear. About 25 percent more could be cured with the same kind of treatment if we had better diagnostic methods and if we could diagnose early enough. There is great need for a good diagnostic test.

That could take care of 50 percent if we had that diagnostic test.

For the remainder, I think we have to have not only a diagnostic test to tell us when cancer is there in a routine study so we can examine people frequently and find cancer before it has spread to the rest of the body, but we also must find methods of preventing the occurrence of cancers that are disseminated or diffused from the very beginning, such as leukemia, Hodgkins disease, and so on.

There has been tremendous progress in the field of cancer research, even in the years since you have been a Member of the Congress, since you first became a Member and chairman of this committee.

The field of chemotherapy alone has been responsible for prolonging lives of people. I mentioned even in the case of acute leukemia we have increased survival from a few weeks to a few months to many months and even years; one patient has lived as long as 8 years and 2 months with acute leukemia. This is because of research in the field of chemotherapy of cancer.

We cannot permit ourselves to neglect the fact that we are dealing with a problem which has perplexed mankind for thousands of years. We have had mathematics and astronomy for thousands of year. The mind of man was really greatly advanced in ancient times, but not advanced enough despite their great knowledge of astronomy and mathematics to make any headway against the cancer problem then.

In the last 10 years we have made as much progress as in all time prior to the last ten years, and those who are serious students of cancer research can evaluate this and can point to gain after gain which gets us nearer to the many goals in the field of cancer.

I say many goals because the probability is great that we are dealing with many different diseases all grouped under the word "cancer and we may have to find many different cures.

There have been many forms of cancer which have been cured completely since I was a medical student that we could not cure at all before. I would be happy to document this for the record or with any member of the committee.

Mr. FOGARTY. I wish you would document it further when you get a chance.

Dr. FARBER. I should do that and I will welcome that opportunity.
Mr. FOGARTY. Do you have anything further, Dr. Farber?
Dr. FARBER. Thank you very much.

I do want to express to you and the members of your committee the thanks of all of us associated with the National Cancer Institute program, Mr. Chairman. It is the leadership of the Congress which has made possible the great advances in our research. The record of your committee in improving the health of our people has been a notable one.

Mr. FOGARTY. As usual we are very happy to have heard you again this year, Doctor. You always do a fine job.

WEDNESDAY, FEBRUARY 26, 1958.

HEART RESEARCH

WITNESSES

DR. IRVING S. WRIGHT, PROFESSOR OF CLINICAL MEDICINE, CORNELL UNIVERSITY MEDICAL COLLEGE; CONSULTANT TO SURGEON GENERAL OF THE UNITED STATES ARMY; PHYSICIAN, NEW YORK HOSPITAL, IN CHARGE OF VASCULAR RESEARCH LABORATORIES; PAST PRESIDENT, AMERICAN HEART ASSOCIATION; MEMBER,

NATIONAL ADVISORY HEART COUNCIL DR. E. COWLES ANDRUS, PHYSICIAN IN CHARGE OF ADULT CARDIAC

CLINIC, JOHNS HOPKINS SCHOOL OF MEDICINE

Mr. FOGARTY. The committee will come to order. Do you have a prepared statement?

Dr. WRIGHT. I had better provide information from the notes.

Mr. FOGARTY. That will be fine. For the record give your name and whom you represent.

STATEMENT OF DR. IRVING S. WRIGHT

Dr. Wright. I am Dr. Irving S. Wright, professor of clinical medicine, Cornell University Medical College; past president of the American Heart Association; a member of the National Advisory Heart Council, and consulting physician in the field of cardiovascular diseases as well as chief of research and investigation in the area of vascular diseases at the New York Hospital.

I desire to make this statement speaking as a private citizen.
Mr. FOGARTY. Go ahead, Doctor.

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