ments with other supplementary documents in the record at the appropriate place.

For the purpose of the record, your total appropriation for fiscal year 1969 was $1,409,052,500. Is that correct?

Mr. CARDWELL. That is correct, Mr. Chairman.

Senator MAGNUSON. The budget estimate for fiscal year 1970, $1,452,065,000.

Mr. CARDWELL. That is correct, including manpower.

Senator MAGNUSON. The House recommended $1,453,106,000, which is $44 million over the 1969 figure and $1,041,000 over the budget. We will be glad to hear from you, Doctor.

Dr. MARSTON. Thank you, Mr. Chairman. I am pleased to have the opportunity to appear before you this year in a new role. Although my association with NIH is not new-I first worked there in 1951 and, more recently, served for nearly 3 years as an Associate Director of NIH and as Director of the regional medical programs while that was part of NIH-I have been the Director of NIH for just over a year which is a very short time for a post that during the past 81 years has had only eight incumbents.

Senator MAGNUSON. They are more durable than in most agencies. in the past.

Dr. MARSTON. Yes, sir. However, the newness of my role here today is not due primarily to my own recent appointment but to the fact that I am here to testify about the goals, plans and needs of what is, in fact, a new organization, operating in a new departmental framework, under a new administration.

ORGANIZATION OF NIH

As a result of the reorganization of the health functions of the Department that was announced last April, NIH is now not only the mainstay of biomedical research in this country but also has responsibility for Federal support of education in the health professions and for biomedical communications. The new NIH consists of three major components:

The Research Institutes and Divisions-to which we still sometimes refer, collectively, as the old NIH.

The former Bureau of Health Manpower which has been somewhat reorganized and given a new name-it is now the Bureau of Health Professions Education and Manpower Training.

The National Library of Medicine.

As the organization of the expanded NIH is not only new but also somewhat complex and as its activities are funded through 21 items in the bill, I should like to submit for the committee's use-and for the record-an organization chart which has been specifically prepared for these hearings. It shows: The relationships of the various Institutes and Divisions to the functions of NIH; which Institutes and Divisions have separate appropriations, and the amount requested for each in the budget; and the name of the witness who will testify for each of these appropriation requests.

Senator MAGNUSON. We will put that in the record so we can look

at it.

Dr. MARSTON. This chart gives the basic organization. In the middle portion are the research institutes and divisions with the names of the

witnesses who will be appearing before you in the next few days and the amounts of the request in the 1970 budget. On the left-hand side is the Bureau of Health Professions Education and Manpower Training. Dr. Leonard Fenninger will give most of the testimony for that area. Dr. Endicott has recently been appointed as the next Director of the Bureau and his name appears in parenthesis. He takes over as Director of the Bureau on the 9th of November and Dr. Fenninger will move into my office as an Associate Director of the National Institutes of Health.

On the right is the National Library of Medicine, whose roots go back far into the history of this country. Dr. Martin Cummings, the Director of the National Library of Medicine, will be presenting its programs to you as they are shown below there.

Senator MAGNUSON. Why do you have Consumer Protection and Environmental Health Service in this chart?

Dr. MARSTON. We start with the Department and the three components of Public Health Service. Everything on this page enclosed in solid lines is part of NIH. The two boxes in broken lines are just to show the other two health components of the Department.

Senator MAGNUSON. Doctor, your shop has grown a good deal since 1938 when I was involved in helping to established the National Cancer Institute. I am interested in how particular Institutes come into being. Does it correlate with research needs in the country?

Dr. MARSTON. In a general way, yes, sir. To be quite accurate, I suppose I would have to say that the creation of a new Institute has usually lagged somewhat behind the need for stimulating research in its particular area.

The various Institutes have come into being in several different ways. The Congress took the initiative for starting several of them-not only the Cancer Institute, as you point out, but also the Heart Institute, the Neurology Institute and, more recently in the creation' of the National Eye Institute by taking the "blindness" component out of the name and the activities of what was the National Institute of Neurological Diseases and Blindness.

You will recall that President Kennedy took the initiative in asking for the creation of the Child Health Institute which the Congress authorized in 1962.

Several of the Institutes have evolved by what a biologist would call mitosis-the splitting of a cell into several new ones. The Arthritis Institute, the Allergy Institute, the Dental Institute and the Division of Biologics are all direct descendants of the old Hygienic Laboratory which in 1930 became the National Institute of Health-that is Institute without the "s."

The National Institute of General Medical Sciences grew out of the grant-making activities for noncategorical research of the Division of Research Grants. It was first set up as an independent Division of General Medical Science and then, some years later, was given Institute status.

To come back to your question, Senator Magnuson, each of these steps was taken to meet a recognized need for an organization that would be focused on some particular disease area or group of biomedical research problems.

Senator MAGNUSON. You know I get a lot of letters urging that we fund research for this particular disease or that particular disease. Now, I, as a lay person, can't tell which disease is more important than the other. Do you think there should be separate research institutes for some of the other major diseases?

Dr. MARSTON. No, sir, I do not. The 10 Institutes that already exist adequately cover the broad spectrum of disease and biomedical research problems. None of the Institutes interprets its mission very narrowly and NIH has never had trouble finding a logical and proper home for any worthwhile research project. On the contrary, the Division of Research Grants, which has the job of assigning the researchgrant applications to the various Institutes, sometimes has difficulty in making that decision because many projects are equally appropriate to the mission and program of two, or even three, Institutes.

There is pressure for creating new Institutes focussed on particular diseases not because NIH is unable or unwilling to support research in these areas but because some people feel that a higher priority should be given to work on this or that disease. They hope that, if there were a separate Institute, the projects they are interested in would not have to compete with other projects. And they also hope, of course, that the existence of a separate Institute-and a separate appropriation therefor-would induce Congress to make more funds available for their area of special interest. To some extent they may be right.

A further proliferation of Institutes would, however, drive up the administrative, or over-head costs and it would, I think, unnecessarily complicate the management of NIH which is already a fairly complex organization.

I cannot, in all honesty, see a need for further Institutes at this time. Moreover, in a period of stringent budgets, the creation of additional Institutes would, I think, have a deleterious effect on the total NIH program, rather than a helpful one. I would rather see more funds for the existing organization than more organization for the existing funds.

Are there any other questions, Mr. Chairman?

Senator MAGNUSON. No. We will put the chart in the record at this point.

(The information follows:)

TOP STAFF OF NIH

Dr. MARSTON. At this point, Mr. Chairman, I should also like to introduce the top staff of the new NIH who are here with me today. Dr. John Sherman is the Deputy Director of NIH.

Dr. Robert Berliner is the Deputy Director for Science and is also acting as Associate Director for Direct Research.

Dr. Leonard Fenninger is the Director of the Bureau of Health Professions Education and Manpower Training. However, Dr. Fenninger has just been appointed to the new post of Associate Director for Health Manpower. He will be succeeded as Director of the Bureau by Dr. Kenneth Endicott who is now Director of the Cancer Institute. Dr. Martin Cummings is the Director of the National Library of Medicine.

Dr. Ronald Lamont-Havers is the Associate Director for Extramural Research and Training.

Mr. Richard Seggel is Associate Director for Administration. Dr. Thomas Kennedy is Associate Director for Program Planning and Evaluation.

RELATIONSHIP OF RESEARCH AND EDUCATION

The three major components of NIH have distinct but complementary functions. The principal reason that led the Department to bring these activities together was succinctly stated in the Department's press release announcing NIH's broadened authority and new role. It said:

Modern biological science and health professions education are so intimately inter-related that their effective and efficient management within this Department requires that they be the responsibility of a single operational unit. This will now be the NIH.

The intimate relationship is partly due to the fact that biomedical research and health professions education are largely carried out in the same institutions. For the most part, they require the same kind of facilities and depend on people with the same professional qualifications. While the interplay of research and graduate education is helpful to both, it is not equally helpful to both. It is possible to perform firstclass research in an institution which has little or no responsibility for formal education. In fact, NIH's own intramural research activity at Bethesda is an outstanding example of such an institution. However, it is not possible to provide a first-class professional education for scientists in an institution in which little or no research is conducted. Especially at the more advanced levels of professional education, the methods, techniques, and the intellectual discipline of research are an essential part of the educational process. Progress in most scientific disciplines is now so rapid that a new scientist-and I included physicians in that term-must have a keen awareness of the directions of research in his field. His exposure to the potentials and limitations of research must begin as an integral part of his professional education. In fact, as a well-known physician has pointed out, "The faculties developed by doing research are those most needed in diagnosis."