UNSPECIFIED HOUSE INCREASE Senator COTTON. The House put it up to $227 million? Dr. BAKER. $227,383,000, yes, sir. Senator COTTON. Your request is to go back to $207 million? Senator COTTON. I looked in the House report to see what they printed up, where their increase was. Can you tell me where that is? Dr. BAKER. They did not specify exactly what the $25 million increase over the 22 million was for. I think in the discussions, when they asked what would more money be used for, that I answered it would be used to cover approved but unfunded regular research-project grants and centers grants. I would use $5 million for chemotherapy (this was at a $20-million add-on figure), and that I would use about $3 million in chemical carcinogenesis causation and prevention research. I presume on that basis that is what the understanding was. Senator COTTON. In other words, the House attitude was reflected in the chairman's question and Dr. Marston's reply. The chairman asked if we give you some more, could you use it in pursuing some other very attractive and hopeful fields. And Dr. Marston said yes. BUDGETARY STRINGENCIES So, in other words, the $207 million request is something you are compelled to make? Dr. MARSTON. Sir? Senator COTTON. This request that we got back from the House figure to $207,319,000 is something you are compelled to make under the rules of the game by the Bureau of the Budget. Is that right? Dr. MARSTON. I think it reflects, Senator Cotton, the position that even under tight fiscal constraints the Department is willing to be responsive to the House Appropriations Committee's interest in being sure that these programs do not slip from where they were a year ago. Also, it raises the question of whether it would be wise under the types of budget constraints that we all have, to go from a $21 million increase to a $46 million increase in the Cancer Institute alone. The question, as I understand it, from Senator Magnuson, is, are there scientific opportunities to be exploited by putting more dollars in the Cancer Institute at present. The answer is yes, there are opportunities. Quite frankly, that could be said about every institute at NIH. Senator Corrox. I was not trying to read something in your answer that was not there. But you feel, with the pressure on heart and lung and these other institutes, if you start in taking the House figure for cancer, if you were fairly consistent with the others, it would lead to a series of raises that would be substantial? Dr. MARSTON. Yes. If you were to ask me the same question about each of the other institutes-whether there were opportunities in these other areas, scientific opportunities, for effective work, for which NIH could effectively utilize additional funds-I would also have to say yes. ! I expect this has been the case almost every year peared before you. that we have ap RESEARCH POLICY OF NOT GOING BACKWARD Senator COTTON. I guess it is not entirely fair to you or your problem to say that this request for $207,319,000 is not your independent judgment, but the policy laid down by the Department and by the administration. You don't need to answer that if you don't want to. Dr. MARSTON. We have been involved in the discussions. I have made a number of public speeches over the last 2 years that the first priority from my standpoint in the research area, even in these tight times, is to keep from going backwards. $207 million not only keeps us from going backward in the Cancer Institutes, but it allows us to move forward in the specific area of virus cancers. Senator COTTON. I understand that position, and I should not have asked the question, anyway. PRIORITY OF SAVING HUMAN LIFE Let me ask you in a different way that won't embarrass you. Of all these institutes, of course, that includes heart, lung, and these others. When it comes to the matter of trying to open up new frontiers and save human life from what is a real fatal, generally fatal, disease, is there any one of them more important or as important as cancer? Dr. MARSTON. I think the answer to that is in our action. The largest increase that we are presenting to this committee is in the Cancer Institute. That was a recommendation that did come from our review of our total program. There are substantial increases in other institutes, which we also think are important. But I think the answer is that it is very important to have strong support in the cancer area. EFFECT OF POSSIBLE SENATE INCREASE Senator COTTON. Even if the committee gave you $10 million more over the $207 million, it would not bring it up to the House figure of $227 million. But it would be pretty useful, would it not? Dr. MARSTON. Yes, sir; and I think it would be a useful investment. in the cancer area. I would say and I want to be completely honest about what I think you are asking me-if you came to me and said, "Here is an additional $10 million, spend it in the best fashion you can in the support of research," I am not sure that that would necessarily result in putting all of that money into the Cancer Institute, because-and I think this is the other question that you were asking me-there are other areas where there are opportunities for increased effort too. Now, we made a deliberate decision to make our largest increase in the Cancer Institute after considerable thought and under a tight budget. UTILIZATION OF POSSIBLE UNSPECIFIED SENATE INCREASE SELECTIVE DISTRIBUTION Senator COTTON. I have just one more, and I won't ask any more. Supposing the chairman of this committee came to you and said, "We have looked this over, and we can only give you for all the institutes $10 million to put somewhere." Where would you put it? Dr. MARSTON. I can answer that in either of two ways. The first thing that I would prefer to do is to go back and reexamine the priorities. The virus area, which has concerned me most of all has been partially alleviated by the action of the House and by the Department's action. I would consider the broad support of biomedical science which, Dr. Baker said, has been absolutely essential in being able to get to the point of helping the program in the virus area. The most direct answer is that we would distribute a $10-million increase, if that were available, over more than one institute. And we would be highly selective in trying to support programs that we think merit a real increase in effort. Senator COTTON. In view of the rather substantial increase in cancer, there is no particular place you would put it? You would distribute it? Dr. MARSTON. There are several places we would put it. But we would not put it all in the Cancer Institute. This is not to say that there is not a good opportunity in several areas in cancer. Senator COTTON. These questions have been repetitious. But you know what I am getting at, don't you? Dr. MARSTON. Yes, sir; I do. I think it is the type of discussion that is particularly helpful in working out these really very tough problems from your side and ours, too. COMMITTEE DEPENDENCE ON PROFESSIONAL TESTIMONY Senator COTTON. We are utterly and completely dependent on you for knowledge. We have no knowledge from a layman's standpoint. If we want to get some light on possibly doing something more, we have to depend on you. Dr. MARSTON. Yes, sir; and there are always tough questions, but they are very fair questions and are ones that I welcome. Senator COTTON. One was unfair. I will see that that is taken out of the record. Senator MAGNUSON. We depend on them, but sometimes they can't give us the right answers. Dr. MARSTON. I hope we always do. Senator MAGNUSON. Not because they don't want to, but with Mr. Cardwell sitting there. [Laughter.] HOUSE INCREASE: INCREASE IN CANCER CENTERS With regard to the House increase, it is my understanding that the House was thinking that we could proceed faster with the establishment of more cancer centers. This does not have anything to do with research proper but with the physical establishment of these centers, where there would be more accessible treatment. I think that maybe that is what they were thinking about. They didn't say so in their report. I envision that at these centers there would be places where you practice prevention. I think you will agree with me, doctor, that one of the real problems in cancer is that none of us seem to think we need to go and find out about it before it starts. Prevention and early detection are even bigger fields than treatment of the disease. Dr. BAKER. On your statement that centers are placed where research is not done, this is not the way we look at centers. We think the best of care and best of research for many forms of cancer can be done in a cancer center. Senator MAGNUSON. There has to be research involved in everything. EARLY DISCOVERY OF CANCER: TYPE VARIANCES Dr. BAKER. In the forefront of chemotherapy, in the leukemia chemotherapy reasearch that I mentioned, the best in research and the best in care are indistinguishable. It is done, like Dr. Holland's group in Buffalo, as the forefront of the mix of research and care. And the center for many forms of cancer is the best place to get that done, both research-wise and care-wise. Senator MAGNUSON. I understand that. I did not mean that you weren't doing research. You are doing research every day no matter where you are. Somebody is doing something. I was thinking of the availability of these facilities-that is not particularly your function-their availability for tests and treatment. Maybe you will have to get into that too. LEUKEMIA CHEMOTHERAPY RESEARCH AND CARE I understand from you people that your percentages of cure go pretty high if there is an early discovery. Dr. BAKER. Yes, sir; this varies with the type of cancer, but certainly these Pap smears have demonstrated this to a large extent in cervical cancer. PAP TESTS Senator MAGNUSON. How many women have had the Pap tests in the United States? Dr. BAKER. About 20 million women have gotten it at least once in the past year. Totally to date, over 45 million women have had at least one test. Some have gotten it more than once. Senator MAGNUSON. There is a instance where we have not covered as many as we should. Dr. BAKER. Yes, sir. Senator MAGNUSON. Sometimes women don't know the test is available. Sometimes it is a fact that a lot of people don't get to a doctor's office, very often; they don't think about it. That test should be available, I think, to every woman in the United States, and she should know that it is available to her. I think that maybe what the House was thinking about, too. SUBCOMMITTEE RECESS What we will have to do before we get into the Heart Institute, since we have a vote coming up in 10 minutes, is recess until 10:30 tomorrow morning. We will recess until 10:30 tomorrow. (Whereupon, at 3:15 p.m. Wednesday, August 12, the subcommittee was recessed, to reconvene at 10:30 a.m. on Thursday, August 13.) |