much closer check on the fact that the environments they go into are indeed useful ones.

Senator MAGNUSON. They have made fine contributions, once they get into a hospital or into practice, haven't they?

Dr. MARSTON. These two points that I have talked about have been corrected. There is a mechanism to be sure that they really were competent to come, to speak the language, to give adequate care. Prior to that time there were some problems, but they have been straightened

out.

Senator MAGNUSON. I suppose if there was an oversupply of people, somebody would holler, "Don't let them in." But there isn't, and it doesn't look like there will be for a long time.

How do they come in, permanently or to do a specific job? What status of immigration is it?

MOTIVATION OF FOREIGN PHYSICIANS

Dr. MARSTON. They come in, really, in three categories. They come in for an educational experience, for instance, to work on a house staff, as in a residency for a period of time, and then to go back to their own country. This is mutually advantageous, both to the home country and

to us.

Then others come in for special purposes. They may come in for a time-limited job and plan to go back. Then increasing numbers have been coming in, in recent years, actually to live in this country and to become citizens.

PROBLEMS OF DEPENDENCY ON FOREIGN POSITIONS

The two problems that I think are raised is, first, whether this country should be dependent on physicians trained in other countries. What would happen if, for some reason that supply were cut off abruptly? We would then have problems that we had not anticipated.

A second problem is: Is it appropriate for this country to be dependent on less affluent nations to supply our needs?

There is another potential problem. The educational experience of many of the foreign-trained graduates is very different from the educational experience here. This may not make any difference; that is, any major difference, in the level of care in our communities as long as we have a majority of the people practicing there who are graduates of American medical schools and the tone and level of practice is maintained on the basis of the educational system here.

What would happen, in terms of the quality of care, if we moved from, say, a third of the residents in the teaching hospitals being foreign-trained to 100 percent or to 50 percent, or if in a community you had a large proportion of foreign-trained doctors. I don't think we know. But I think there is some reason to ponder about the fact that this might also raise problems that we don't see as long as the numbers are 50,000 out of 300,000.

REVISION OF IMMIGRATION LAWS

Senator MAGNUSON. Then we revised the immigration laws so the quotas would allow entrance of those with an ability to do certain things. I know that some come in under that provision. I know I have

received occasional letters from home where they have been in the medical school and then they want to bring their whole family over and stay. This is fine if they are making a contribution.

But some of the other countries have been complaining a little that we are taking away part of their resources. I think as long as there is a manpower shortage in the laboratories and in the allied professions, many of these people can be put to good use in these positions. It is a little more difficult for M.D.'s to get into private practice.

Dr. MARSTON. They do both. I think you would have to pay tribute to the 50,000 people who are filling a major gap here.

My two concerns are that I don't think we should be dependent on other countries for supplying our health manpower. And the second one, which I am less sure of, but I am concerned, is that if the proportion continues to go up, there may be communities that will not have the ties to the very strong educational and service systems that we have here.

Senator MAGNUSON. It will continue to go up unless we can catch up with the health manpower shortage through our own schools. Dr. MARSTON. Yes, sir.

Senator MAGNUSON. I don't see how you can stop it from going up, because the need is there. It would be pretty hard for any of us not to take a plea from some qualified person that might have been hung up on immigration or something, if some institution wrote us, or some clinic, and said, "We need Dr. 'X' and we need him badly." We would have to try and see that he got in here, and was able to work at his specialty.

Senator COTTON. But we don't succeed very well. I keep bringing up my own problem. We had a couple of small places in my State where there is no doctor at all, no doctor available for 20 or 25 miles. Somebody in these communities got the bright idea that they wanted to get some of these refugee M.D.'s. There was no danger of them having an impact on the mental standards in those areas, because situated in the center of the region is Hitchcock Clinic and Hitchcock Hospital. They weren't going to lower the standards if they had a couple of them come in.

I tried to help them, and the Board of Medicine of my State was just horrified. They wouldn't let them practice under any consideration. That is part of the attitude that I was talking about.

Sometimes you have men who are so afraid they will get contaminated if the standards are lowered that they let people suffer. I don't ask you to comment on that, but I just present it because it is along the lines that the chairman is talking about.

I didn't get to first base. But the roadblock was in the State, not the Federal Government.

Dr. MARSTON. We have actually given some support for training to the University of Miami-primarily, their school of medicine-for the training of refugee Cuban physicians.

NATIONAL MEDICAL AUDIO-VISUAL CENTER

Senator MAGNUSON. Before we go into the exact research in the institutes, looking at your chart, what is the audio-visual center? Dr. MARSTON. This is the National Library of Medicine. Senator MAGNUSON. It is an in-house program?

Dr. MARSTON. Yes, sir.

Senator MAGNUSON. Do they make films?

Dr. MARSTON. Yes, sir. Dr. Cummings is here.

Senator MAGNUSON. Do you make films to send out? Dr. Cummings? Dr. CUMMINGS. It produces some films. The prime service, however, is to announce, catalog, and distribute these films to health educational institutions to assist in training and education.

Senator MAGNUSON. They would be used, then, in the schools, or the regional medical centers where the doctors come for more training or more current information. Is that what it is?

Dr. CUMMINGS. We distribute about 100,000 audiovisual materials each year.

SCIENTIFIC ACTIVITIES OVERSEAS

Senator MAGNUSON. On page 15, unless you have gone into this, you say, "scientific activities overseas." Is that for information gathering? You use soft currencies, don't you?

Dr. MARSTON. Yes, sir. Public Law 480 funds. They are used for a variety of purposes in the Department.

As far as NIH programs, the $10.4 million that actually will be spent by NIH is used to carry out research in areas where the unique local conditions are such that we can not carry them out in this country.

Senator MAGNUSON. You have $32 million requested.

NIH PORTION OF P.I. 480 FUNDS

Dr. MARSTON. This is for the total for the Department, $32.4 million. That is allocated $10.4 million to NIH, $15.2 million to Health Services and Mental Health Administration, $4.8 million to the Environmental Health Service, $2 million to Food and Drug, and $800,000 to the Office of International Health.

So the appropriation for the whole Department is the figure you referred to.

Senator MAGNUSON. We were wondering about the difference between that and $3,455,000, last year. But you have it all in one place

now.

Dr. MARSTON. We put it all in one place for convenience.

Senator MAGNUSON. All right.

VIRUSES AND CANCER

Senator MAGNUSON. In cancer, Doctor, I suppose the testimony would be one of the exciting things that is going on in the role of viruses in cancer. Is that correct?

Dr. MARSTON. Yes, sir.

Senator MAGNUSON. We have been trying for many years to see a light at the end of the tunnel. I see that you are zeroing in on that portion of it.

Dr. MARSTON. Yes, sir.

Senator MAGNUSON. I think that is a wise thing to do.

It has shown great promise, hasn't it?

Dr. ENDICOTT. Yes, sir; but I think my successor is the one who should speak to it.

Dr. MARSTON. Dr. Carl Baker--and this is his first appearance before this committee, although he has been with the Cancer Institute since 1949 could describe some of the programs.

GRANTS FOR SCHOOLS OF PUBLIC HEALTH

Senator MAGNUSON. Before we go further into that, I have a couple or three more questions that I put aside.

How much is in there for grants to the schools of public health? Dr. ENDICOTT. The total amount in the request is $9,071,000. Senator MAGNUSON. Has that decreased from last year?

Dr. ENDICOTT. Yes, sir; that is a reduction of $400,000.

Senator MAGNUSON. Why did you reduce aid in this area? Weren't there enough applicants?

Dr. ENDICOTT. No, sir; it was a question of priority and the need to conserve funds.

Senator MAGNUSON. If you and I were to attend a conference of either Governors or mayors, which are now having conferences around the country, you would find that one of their great problems was they can't find trained people to handle the public-health departments. There are not too many people who want to get into public health; are there?

When a university establishes a department on this, there is often just a handful of students.

Dr. ENDICOTT. The principal difficulty is for physicians specializing in the field of public health. But there are many other types of health personnel trained in the schools of public health. There is no paucity of applicants in fields other than in the field of preventive medicine. Senator MAGNUSON. The city and State governments have a most difficult time. There is more pirating that goes on between cities and counties and States in that field than most anything else. It is almost as bad as with the urban renewal experts. Some cities are always holding out the carrot of more salary or something. But your program is still approximately the same as it was last year; isn't it? Dr. ENDICOTT. Yes, sir.

I might comment that we, too, in the Public Health Service have very great difficulty in recruiting men trained in public health. As a matter of fact, a substantial portion of our public-health experts have been trained at our expense after they joined the Public Health Service.

NIH SUPPORT FOR VETERINARIANS

Senator MAGNUSON. There doesn't seem to be the interest in that when people get out of medical school. I can understand why, but there is a great shortage.

I think I know what you are going to answer, but why did you cut out veterinarians? You can use one word first-priorities-and then explain it.

Dr. MARSTON. You have provided the answer to it. It was essentially a question of how to utilize funds that have to do with human disease and human health in the most effective fashion. In view of our mission at NIH, we put a higher priority on schools of medicine, osteopathy, dentistry, et cetera, then on schools of veterinary medicine.

Let me be sure that the committee understands, as I am sure it does, that the schools of veterinary medicine are fully entitled to apply for special project grants. They are fully entitled to apply for construction grants. This decrease is only in institutional support formula

grants.

49-433 0-70-pt. 5. -5

Senator MAGNUSON. Let me get this clear. What you are saying is that suppose you had a project—and I know the Cancer Institute has had these-in animal studies, you can still give a grant to a veterinary school for a specific project that you wanted looked into. Is that right? Dr. MARSTON. Yes, sir; we do that.

But in addition to that, they are eligible for special project grants under the health-manpower legislation, the thing referred to by Dr. Endicott. We are only eliminating the formula grants-that is the entitlement on the basis of numbers of students. We put a higher priority on medical students and dental students than we do on veterinary students against the background of our mission, which is the health of the American people.

I would like to say very clearly that in our NIH research programs and in other parts of the manpower program, we have always recognized the tremendous contributions that veterinarians and schools of veterinary medicine have made to the science base of medicine. We have supported them all over the country over the years. It is only when we had to make the difficult choice of allocating funds for this institutional-formula grant that we made the decision not to put it in veterinary-school-formula grants. They are still eligible for scholarships, loans, construction grants, special project grants, and for research grants throughout the whole of NIH.

Senator MAGNUSON. I am speaking just of one school I know of, Washington State, which has a long established veterinary school of some note. The dean of that school told me that they had only nine openings for every 100 applicants. That is how tight it is there. They could only handle nine out of 100 who are qualified. Maybe they had 300 qualified applications, but they could only take in 25 or so.

It seems to me that we ought to take a look at what the House did in this matter. The House put it back in, of course. The total is not too large an amount in relation to the total for health manpower, but this institutional formula grant is the one program that allows them the freedom to really improve the quality of instruction.

Do the Budget decision, and the language recommended by the Department only cover these formula grants?

Dr. MARSTON. Yes, sir. The second point of it is that I would make clear that the decision was only made on the basis of tight money.

VETERINARY SCHOLARSHIPS

Senator MAGNUSON. See if you can put into the record for us how many scholarships were given to veterinary students in 1970 and how many scholarships will this budget allow in this area, and the percentage of students.

Dr. MARSTON. Yes, sir.

I have the dollar figures. I don't have the numbers.

Senator MAGNUSON. We would like to get the numbers. You can break that down.

Dr. MARSTON. All right, sir.