Dr. DOAN. Yes; we are very happy to support what has been said already this afternoon from our area, as to this work in metabolism and especially rheumatism.

We have a chapter there that is headed up medically by the members of our faculty, who are concerned in that area. We have a very active clinic, a very active division of the department of medicine, devoted to research and the application of treatment to these diseases. Therefore, everything that has been said this afternoon with reference to this specialty we would certainly support, and we would say we are very grateful to have a part in the organized movement and to have at Ohio State University the leadership in our own faculty.

(Discussion off the record.)

The CHAIRMAN. Proceed, Doctor.

Dr. DOAN. Mr. Chairman and gentlemen, I am very appreciative of speaking from the point of view of Ohio State University as a landgrant university, with reference to this attempt to meet the problems of health, especially as they appertain to cancer and other subjects which you are having your hearings about this week and last week.

We have tried to make our contribution with reference to the shortage of doctors which has been mentioned here this afternoon. Since 1945 the State legislature in Ohio has appropriated and we have expended in new facilities some $172 million. That has trebled our hospital facilities.

We have this fall accepted our fourth class of 150 medical students each, which is just double the number we had prior to World War II, so that we now have in our medical school in the undergraduate years 600 medical students as of this year. We will graduate our first class of 150 next fall.

More than that, we have rejuvenated our nursing school and there have been in the last 2 years 150 each in our freshmen nursery classes. This is leading to the bachelor of arts degree in nursing.

Both from the standpoint of increased nursing supply and from the standpoint of increased physicians the university at Columbus has really taken seriously the challenge of the modern postwar medical

era.

When it came to the research activities, these funds have been primarily given for the facilities for basic teaching of medical education, and we have, incidentally, 175 interns in residence; a fifth class, if you please, which is training in our expanded hospital facilities at Ohio State University.

When it came to having this good fuselage, basically to provide more medical and nursing care, the research activities, of course, came in. My first interest personally is research, since I was at the Rockefeller Institute for 5 years in a laboratory right next to Dr. Rhoads when he at that time was beginning his work in research which led to the basic study of cells and cancer. So that the research activities in the college of medicine at the university are the first responsibility of such a faculty, because if we do not have the facts we neither can apply them to the patients who come to us nor can we teach them to our students. Therefore, every member of our faculty is an active investigator.

We asked the Federal Government after this expenditure of funds by the State government for $12 million for a cancer research unit, through the National Advisory Cancer Council. We also asked for

funds from the National Advisory Heart Council, as they also were concerned with the extension of cardiac research, cardiological research. We were told that with the demands that were made from other worthwhile institutions across the country our allocation would be $300,000 out of the $12 million we requested. We thanked them very heartily for that and said, "That will be our nest egg."

We went to the legislature which was in session at that time-the Ohio State Legislature-and told them we had to have $300,000 against a program that we felt was of tremendous importance. They said, "We will raise this." And they passed within a month's time this legislation and this fund was granted in the amount of $300,000 for construction: $180,000 for research in cancer from the State legislature for the university for the equipment of this unit for specific research.

Well, in the meantime, the Korean war started and the money just halved when we got our plans in construction value. Therefore, when the contracts-even revised contracts and bids were given, we were $67,000 short of the amount to build the first unit of what we had hoped to be an important research unit, and it was irreducible in its

size.

At a State university all the money must be available before the contract can be let-there is no escalator clause which can be used. So, the Kettering Foundation-Mr. C. E. Kettering-being a member of the board of trustees, gave the $67,000 necessary to let this contract. Therefore, our cancer research unit, dedicated May 9, this year, represents Federal funds, State funds, and private funds, which I think is the way our approach to the answer to these problems should be made these days. There should be at each level responsibilities met from the State, the Federal Government, and from private foundations and private individuals.

We are having an increased number of private gifts donated, market for cancer research at Ohio State University because, I think, we have a good educational institution supported by the State. We have had from the National Institutes of Health in the various areas very important subsidies, both at the teaching level and at the research level. Having been honored with the service as chairman of the anatomological study section, when it was carried on under Dr. Dyer some 7 years ago and for 5 years having served on that from the standpoint of the requests coming in for worthy research projects, I certainly want to testify to the extreme value that it has been to us, both from the standpoint of the receiving end and from the standpoint of the advisory end in those diseases which have to do with the diseases in terms of the allocation of these funds, specifically that you grant. I want to say that I think it is a most magnificent program. This program gives us the kind of unity which is really going to bring answers to these questions.

In terms of cancer, I am extremely optimistic. My own field is leukemia, which is one phase of the cancer problem.

When I began 30 years ago in this field, all of the acute leukemia cases were fatal within 2 to 4 weeks. Everyone I saw in 1930 of the acute leukemia cases were fatal within a very short time. Now, we expect to get remissions lasting from 6 months to 2 years, and it would seem reasonable that if one can prolong life and restore one to a normal

physical state from 2 to 4 weeks or 2 years, why could not it be for 20 years? That is what we ask ourselves.

It would seem that the greatest jump would be to get the first remissions-get the establishment of these abnormal cells back to normal again, and I really believe the studies that are being made at Memorial in New York, where there are these many new synthetic agents being made chemically, and we in our own laboratory have synthesized over 250 chemicals with radioactive isotopes with the aid of our own cyclotron and of course the work that is going on at Oak Ridge, we have some 20 of those that have in our preliminary studies with animal tumors given promise enough for trial in the human. So, we are going on with clinical studies very shortly with those in order to approach it from the metabolic point of view, from the chemical point of view and from the isotope point of view-the three main roads down which research is moving with an increase in tempo, I believe that not only will we have these acute leukemias back within 2 years, but I hope we will be able to see them indefinitely remitted. It is no worse now to have a chronic lekemia than a mild case of diabetes or arthritis. We can control leukemia-chronic leukemia-in 90 percent of the cases and they usually die of something else.

Mr. DOLLIVER. What are the measures which you take in leukemia? Dr. DOAN. Do you mean the acute? There is a different approach to each, and as to whether it is a metabolic or the cancerous condition. We have studied that matter very intensively. In the 1,600 consecutive cases of leukemia that I have personally seen within the last 20 years, we think only 400 of those, or 25 percent, are true malignancies in terms of a malignant disease. The others are metabolic, or they come under the category of pernicious anemia, which was thought to be a cancer to start with. It is a deficiency disease, and many of the chronic leukemias have the same characteristics for white cells, and yet we know as much about what it takes to mature a young white cell to maturity as we know about red cells. With vitamin B12 and folic acid we will have the answer to chronic leukemia. We do not have to study and solve the problem of malignant diseases to cure the so-called leukemia. So that is the approach there.

If we get a mild overproduction of cells, as in chronic leukemia, we have to use a supressive or destructive agent if we cannot control it by the metabolic activities. We are looking for an enzymatic material much like insulin is for diabetes, and if we get that we should be well on our way. We believe the enzymes that are necessary to break down proteins for body synthesis, which gradually decrease in their productivity just as the material necessary to prepare red muscle meat for red-cell generation needs to be supplied. When we have that, then these cells will mature, and we are on the road to that with the amino acids and the various enzymes that break down proteins to amino acids and fatty acids to get a better understanding of what is necessary for these cells.

If that does not help, then we have to use mild suppressive agents such as deep X-ray, if it is in small doses, of radioactive phosphorus, P32, which is very effective in very chronic types of conditions. We have cured chronic leukemia as long as 20 years with mild radiation or radioactive phosphorus.

There are other chemicals which we can use. One of the other mild suppressives which will differentially suppress the abnormality of the white cells without destroying other cells-and that is the criteria of an agent that will specifically depress a cell that has a little more stimulus than a cell which does not, is the folic acid. In the acute leukemia, of course, as you have already heard, the folic-acid antagonists are very effective in the acute sarcoma.

The new purine which which was shared with us in the early days in the work which has been done by Dr. Rhoads has added markedly to our armament in the acute leukemia cases, and a still further new unit has been made available within the last 6 weeks. So with cortisone, with ACTH, with folic acid, with nitrogen mustard, and with these new agents, any one of which may be specific for a short time. for an individual but not in the same individual from time to time, we can prolong the life and usefulness of many of these patients, both children and adults, for matters of months or of a few years.

It simply means, from the standpoint of trying to say so, that the progress made in this field, I think, is as great today and is as promising as the antibiotics in the field of infectious diseases. I feel just that way, and I have been right close to it for 30 years.

The CHAIRMAN. Doctor, your presence has indeed been very encouraging. You speak with a note of optimism that we are glad to hear, because, after all, while these studies are interesting from the standpoint of detailed information that is provided, after all, what we are seeking is something that will alleviate the condition so far as the public is concerned.

When you speak as you do here today, it is very encouraging, because it is really observable that you have optimism which is an optimism and belief that is not based on pollyanna optimism, but optimism based upon studies which you have made in long contact with the problem. You are able to look ahead and speak in the optimistic way that you do.

The presentation which you have made suggests that chemistry and physics and biology and all the biosciences are all assuming partnership with the doctors in the modern attack on disease. I think it is very fortunate that in your activities you can have a combination of these working together, so to speak, which promise the results that enable you to be optimistic.

We certainly are indeed indebted to you for your appearance here today. What you have stated adds very materially to what we have heard on Friday and Saturday of last week. It gives the committee additional encouragement to press on when men of your standing come here voluntarily as you have and give us the benefit of the information that you have gained through years of study, and years of activity. At times undoubtedly you have been discouraged and at other times you have been encouraged, all of which goes to make up the experience that brings you here today and gives us your optimistic view which you have expressed. We are indeed grateful to you.

Dr. DOAN. May I just add that even as we have been cooperating with other agencies in funds, so every unit of research-each research group across this country is as close as the telephone, and time and again we have had from our laboratory communications to others

and they to us, and the great thing in this free country of ours is that not only is there an interchange of financial support, but the information which one group gets on the Pacific coast, that group on the east coast also receives. It is just as quickly flashed as was the football game on Saturday from California to us and as the baseball game which is now going on in New York to us. So, we are in an age when every combined effort, you and ourselves combined, are going to solve this problem, I am sure, in the best interest of humanity. Thank you.

The CHAIRMAN. We thank you that you included this committee in what you hope will be the ultimate results.

Dr. DOAN. I certainly do.

Mr. HESELTON. Doctor, several times there have been references to isotopes and you made reference to it. I am sorry you did not explain what that is. I would like to have a brief description of what it is.

Dr. DOAN. Radioactive istopes are produced in the uranium pile or in the cyclotron. In 1939 or 1940 Ernest Laurence in California established a large cyclotron that was able to crack the atom and produce certain elements that had radioactivity. Following this, John Laurence, his brother, went from Yale with a man trained in my department, to California and gave the very first product of the new large cyclotron there to a human patient with radioactive phosphorus. That is an element that during the first 14 days of its creation loses one-half of its radioactivity, whereas radium may have years or millions of years of activity.

This is a temporary activity that is given for radioactivity and phosphorus is metabolized by bones, and in leukemia the overgrowth of cells is largely in the bone marrow. Therefore, this phosphorus, just as it metabolized with calcium in making the skeleton, is deposited in the skeleton and bombards like a machinegun those cells near it which are growing at an abnormal pace. Well, by adjusting the dosage of the ammunition, like putting a brake band on and putting a brake just so tight, will just slow that process down so that the person who is being overburdened by too active a process, will be brought down to normal, we have to reline the brake bands with a little more of this radioactive phosphorus.

Then, came cobalt-60, which is a radioactive cobalt, which has a 5year life and can be used much less as the radium, but can be substituted as a gamma-ray treatment for use in cancer that cannot be removed. Then, we come to radioactive gold, which is the least tarnishing of metals-one one that is least radioactive. Now, we can make gold which has two and one-half days' life of radioactivity in nylon thread and when one gets a tumor that cannot be removed surgically because it involves a main blood vessel, one can sew into that tissue these little bits of radioactive gold with an exact dosage. So, if we are wise enough to know just what the dose for that given unit is, it is like the electric chair. You try to get just the cells that are still cancerous out just like we do an abnormal member of societyget him out before he cuts other people out. That has been developed to a high stage, both cobalt and gold isotopes. This is material that is inert material which is placed in the pile at Oak Ridge, brought to our laboratories then by air and are produced there and used. We have had over 100 patients that we have used this supplement of