Now, there is one other thing that comes back to the point about medical schools that I am not sure everyone appreciates in this connection and that is this: Assume that we build an institute in the medical school to do research. You have to do more than build the institute and support the local research in order to make it not a losing proposition for the medical school to allow it to go on, because the facts of the matter are that the administrative costs of bearing this adjunct, if you look at a medical school, are quite out of proportion with the 8 percent which I believe is the usual overhead figure that is given in research grants awards; so that the medical schools have gotten themselves into the bad situation of not being able to live without research money, and they are going into the red more heavily the more research money they take.

I do not know what the solution to this is, but if medical research is going to continue as it has in the past to be centered largely-I am not saying totally or that it should be totally-around medical schools, schools of medical education, then I believe our most crying need is to do something to relieve the medical schools and to get them on a sound economic and businesslike operating budget and something that will pay its way at least as it goes.

I do not think anyone proposes to make money out of medical

education.

I would say those are the great needs.

Dr. WRIGHT. I think Dr. Wilkins has really expressed what has been in the minds of all of us. Perhaps he has picked the great needs with reference to the other specialties, too, so I will ask the other two speakers not to repeat these statements, since I am sure they are in agreement. If they disagree they may state so. But if they wish to add to them, taking up some other aspect of the particular fields, I should like to be able to call on them if I may, sir.

Dr. Jones?

STATEMENT OF DR. T. DUCKET JONES, MEDICAL DIRECTOR, HELEN HAY WHITNEY FOUNDATION, NEW YORK CITY-Resumed

Dr. JONES. I would like to clarify one of Dr. Wilkins' remarks. I am sure it is absolutely true that the amount of money and the direct relationship to returns in relation to knowledge is not possible, but I hope you did not mean by that that more funds were not needed. Dr. WILKINS. No. I am sure you do not get knowledge without funds.

Dr. JONES. I would agree with the remarks he has made with that change and emphasis; and I would like to add 1 or 2 more things. I think that we have done up to now a really inadequate job. I am not criticizing anyone. I mean this is what has developed in the last few years. It is inadequate in the way in which we give continuity and stability to those workers who have shown themselves worthy, by the repetitive nature of the short-term grants, which are very disastrous to any operating research group; and I think we have not yet developed a satisfactory program whereby we can be certain that we are getting the very best potential personnel for research and utilizing them well. I think that is the key for future expansion, and that something could be done.

There is one other feature that I think Dr. Wilkins intended to stress very heavily, and that is that this is a question, as far as rheumatic fever is concerned, of the point of weakness in the present direc tion of attack. It makes me think of the fact that I certainly do not know the answer to rehumatic fever. I serve on a good many boards. I would hate to think that in serving on any research fund committing group that I did so with the thought that I voted "yes" on a given grant because it was going to give the answer to the rheumatic-fever problem. All I can do is express faith and confidence in the very able workers who have or possibly can contribute to knowledge.

Hence I think that there is very grave danger in limiting the number of fund-granting agencies for medical research to any very limited group of human beings or agencies. In other words, the freedom of scientific inquiry is greatly heightened when the authoritative control of the acquisition of knowledge is put in multiple agency or group hands rather than concentrated in a single authority, because no one is divinely ordained in this respect, and unless he were he could not predivine what was coming from any given grant.

I think it has been obvious from this discussion today that there are a number of agencies which are vitally interested in getting increased funds from the private individuals of this country; in getting, if possible, an increased volume of high-quality research; and in insuring that they are and will be spending funds well.

There are also multiple sources within the Government agencies. I am sure not only the Public Health Service, which has been concentrated upon today, but others have some interest in this field. I hope that there will be no grouping of everything under one single pattern of administrative control because when we do that then we obliterate the opportunity for the little-known person, and he may be the man who is going to bring us possible knowledge of great importance for the future.

Dr. WRIGHT. Thank you, Dr. Jones. Dr. Andrus?

STATEMENT OF DR. E. COWLES ANDRUS, JOHNS HOPKINS UNIVERSITY, AND PRESIDENT-ELECT OF THE AMERICAN HEART ASSOCIATION-Resumed

Dr. ANDRUS. Well, speaking of the field of arteriosclerosis I think there are two great needs at present. First is a means of diagnosing the disease before the accident, such as a heart attack, which is a consequence of the disease cripples the individual. To put it another way, some means of characterizing those individuals who have atherosclerosis and are liable to these accidents.

In the second place, there is the need to gain some means of affecting the progress of the disease, to slow it down or to stop it.

Now, that problem shares with all the other problems that have been mentioned today in the need for new knowledge, and that means research. If we sound insatiable in our desires for more funds, there is a limit, of course, to what can be fruitfully employed, but there is a real need to collect the brains that can do this job, to create a favorable climate of opportunity for the younger, more imaginative investigators in the field. When a man demonstrates that he can do this work and that he can be productive, do not make him peddle

his idea from year to year in order to get a grant that he has to work to renew a year from now, but give him stability and continuity of resources so that he can forget that phase of the problem long enough to get on with his job. That, I think, is an essential.

Thank you.

Dr. WRIGHT. I think that we have largely concluded what we had in mind in terms of our outline. The recommendations have been made as we went along. We would be glad to try to answer any questions of the committee, sir.

The CHAIRMAN. With reference to this last phase of the testimony, Dr. Wilkins emphasizes the inadequacy of support for medical education, the thought that was expressed by Dr. Jones was as to the necessity of having some assistance diversified, and there was the point you have just made, Dr. Andrus, about emphasizing stability and continuity of service or help; and those questions are not new to this committee. In our study of the inadequacy of physicians, from the standpoint of numbers-I am not speaking otherwisethe committee has been made aware of some startling information in that respect. I remember a statement made before us in one of our hearings not too long ago that there were not appreciably any more men being graduated in medicine today than at the commencement of this century. That struck me as a rather unusual situation. There was some explanation that was made of it, however, by saying that in the early part of this century the tests and the types of college were not the same as they are at the present time; that at that ime there were colleges in existence which were issuing licenses very quickly and not with the consideration which now prevails; and that that had something to do with the large number who entered the practice of medicine at that time as compared to the present.

Now, with respect to a lack of hospitals, this committee gave consideration to that subject. This committee originated the Hospital Construction Act which, so far as money has been appropriated to it, has done a pretty good job, particularly in its benefit to communities which were not able to build hospitals. We have left that very largely to the States to determine, as to where the money which comes from Federal sources should be expended.

I mentioned what has been referred to by Dr. Wilkins and Dr. Jones and Dr. Andrus as a matter that this committee has given consideration to and will continue to give consideration to. It is a very serious

matter.

When you come down to the inadequacy or insufficiency of physicians, you run across the fact that after a physician has gone through several years of preparatory study, including college as well as the medical school, that it has brought him along pretty well in life and has cost him a great deal of money, and the tendency is to practice where there will be a return commensurate with the time preparing and the expense incident to it, with the result that we find doctors very largely gravitating toward urban centers rather than to rural areas. Therefore, we have figures with respect to the number of doctors in New York or Philadelphia or places of that size and even less that are astounding when you compare them to the number of physicians in some localities in different parts of the United States, and particularly the rural districts.

So there are a lot of problems connected with this, and I should like to assure you gentlemen who have rendered such a great service to us today in coming here at such great inconvenience to yourselves that this committee is conscious of a lot of these problems and is endeavoring to give them its best consideration with the hope that some day maybe we will be able to give the relief that so many of us feel should be granted.

Dr. Wright, speaking to you and to each of the others who has appeared here today I do not know how to find words which will adequately express our feelings of thanks and appreciation to you and those who have assisted you today in presenting this matter to this committee. You have performed not only a fine service to the profession that you honor but you have performed, in my opinion, a very fine patriotic service in your willingness to come here and give this committee the benefit of your thought in these matters. It is for that reason that I feel that any words I can utter are very inadequate in expressing to you and those who have come with you our thanks and our appreciation for the help you have given to us today.

I do not want to preclude anybody else from saying anything they wish or asking any questions they wish, but I did want to have you know, speaking not only for myself but for the committee, how much we appreciate the help you have given this committee.

Dr. WRIGHT. May I reply by saying we have been very deeply appreciative of the fine spirit of friendship and kindness with which you have received what we have had to say. I have been in many hearings here, but I must say that our reception today is an all-time high in that regard. It has been very fine, and I am sure we are all very grateful indeed.

The CHAIRMAN. Any further comments or questions, gentlemen? Mr. CARLYLE. Mr. Chairman, I would like to say that the hearing today has been very, very wholesome and helpful.

The CHAIRMAN. I am glad to hear it. I am sure that is true with all of us.

Is there anything further? Well, then, I suppose that concludes the hearing on heart disease for today. It may be that we will be calling for some additional service, especially from some committees that you may have at work who can give us answers to some questions which may arise in our minds as we go on with this study the next 2 or 3 weeks; and I am certain you will be glad to help us in that respect. Dr. WRIGHT. I am sure that the American Heart Association and all of its facilities are at your service, sir.

The CHAIRMAN. Thank you. I hope we have not kept anybody from keeping his transportation assignment.

Dr. WRIGHT. I think not.

(Thereupon, at 4: 10 p. m., Thursday, October 1, 1953, an adjournment was taken until 10 a. m., Friday, October 2, 1953.)

HEALTH INQUIRY

(Cancer)

FRIDAY, OCTOBER 2, 1953

HOUSE OF REPRESENTATIVES,

COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D. C.

The committee met pursuant to adjournment at 10 a. m. in the committee room of the House Committee on Interstate and Foreign Commerce, Hon. Charles A. Wolverton (the chairman), presiding.

The CHAIRMAN. The committee will come to order.

This hearing has been arranged for the purpose of reviewing and considering the progress that has been made in the investigation and control of cancer. This is one of the most serious diseases with which the human race is afflicted. I am told that it is the second leading cause of death from disease in the United States; second only to heart disease, which we discussed yesterday. This committee intends to find out what has been done about cancer in the past, where we stand on this problem today, and what can and should be done from now on in order to achieve effective control of this disease in the shortest possible time.

The members of this committee are not medical scientists, nor are they engaged in any other way professionally in cancer work. We have, therefore, called upon a number of eminent people in that field to tell us what is being done about cancer and to consult with us and advise us on this problem as one of common concern which affects all of us individually either directly or indirectly.

These people are scientists, public health administrators, physicians, and lay professional workers in both Government and voluntary agencies and organizations. This is their work, and they are best equipped to tell us about it. During the time available to us today the committee is looking forward to having an intensive discussion on all aspects of the cancer problem. We want to know what the magnitude of the problem is, how many people get cancer, what the financial drain is on the families of cancer victims, and what this means to the Nation in terms of lost production. We want to know what is being done to discover cancer cases early enough to treat them successfully, and what progress has been made in methods of treatment. We would like to know whether cancer can be prevented, and how. We want to hear the story of cancer research by both Government and nongovernment institutions, organizations, and individuals; and what the prospects are for learning more about this disease and developing better methods of dealing with it.

The various organizations invited to be represented here today have prepared written statements, copies of which are available to