trained scientist-clinicians and investigators are needed. By further increasing the number of research fellows, particularly those eligible for Research Career Development Awards-a broader based research attack on the problems of the nervous system and special senses could be undertaken. Because of the Institute's carefully laid program planning and development activities, many strong training centers have evolved, particularly in the clinical research disciplines of neurology, pediatric neurology, ophthalmology, and otolaryngology. These centers now have highly developed facilities and a full complement of able faculty and supporting staff. They are able to accommodate an increased number of scientist-physicians for training as teacher-investigators in the neurological and sensory fields. An additional investment in training stipends would capitalize on those facilities. In addition, the Institute could launch a number of new training programs designed to prepare candidates for careers in research and teaching and the community service aspects of neurology, ophthalmology, and otolaryngology. For example, in neurology, additional training sites can be developed as focal points for training in cerebrovascular disease. In opthalmology, adequately prepared physicians are being turned away because of a lack of available training environments. Pediatric neurologists continue to be a critical area of national shortage in programs aimed at the brain-injured child. In the preclinical sciences such as auditory physics, speech pathology, and sensory physiology, additional training programs at the postmasters and postdoctoral levels can be initiated to provide the essential science base for continuing development. DIRECT OPERATIONS 1966 appropriations. 1967 President's budget__ Proposed NCRND 1967 budget_ Increase over 1966 appropriations---. $8.841,000 9,478,000 10, 095, 000 1, 254, 000 Additional funds are required for the expanding laboratory of perinatal physiology, in Puerto Rico, for the development of a program for the study of deafness, and for the strengthening of studies of head injury and of regulatory mechanisms of the nervous system. The Institute's Collaborative Perinatal Program is proceeding according to plan. At its second scientific symposium held recently over 50 reports were presented and discussed. The reports provide new insight into the perinatal causes of cerebral palsy, mental retardation, and other neurological and sensory disorders of infancy and childhood. The characteristics of the "high risk" woman and the role of specific hazards such as incompetent cervix and toxoplasmosis are being defined. Of particular importance are the serological examinations, which have already provided fundamental knowledge regarding rubella and toxoplasmosis. The demands for data processing of information, of pathological specimens, and of sera, are at this time especially pressing. The Committee recommends that funds be included in the direct operations adequate for this crucial aspect of the study. In addition to funds needed for the Collaborative Perinatal Project, studies on the epidemiology of stroke and of head injury are urgently needed. Of particular importance is an all-out expansion of the facilities and program for the study of slow viruses which may relate to multiple sclerosis, amyotrophic lateral sclerosis, and the encephalitides of childhood. Included in this category also are funds required to support the Institute's new program of scientific information centers. Review and approval, intramural training and administration 1966 appropriations 1967 President's budget___ Proposed NCRND 1967 budget__. Increase over 1966 appropriation--- $2,639, 000 3, 009, 000 3,550, 000 911, 000 Adequate funds are requested for these activities essential to the maintenance of staff and the effective administration of this program. Mr. Chairman, I should like to express my appreciation for the opportunity to appear again before you as spokesman for the National Committee for Research in Neurological Disorders. Thank you. NINDB HISTORY OF OBLIGATIONS, FY 1954-67 130 120. -011 100 40000 MILLIONS OF DOLLARS 1954 55 56 57 58 59 60 61 62 63 64 65 66 67* *Fiscal year 1967 based on House Allowance CRITICAL NATURE OF SITUATION Dr. KANE. In presenting this budget, I should like to bring to the attention of the committee the truly critical nature of the present situation. I am informed that at the end of fiscal year 1966 there will still remain unfunded almost $6 million of approved research grant proposals. Taking into consideration the already strict criteria for approval being exercised by the study section and Council review 60-302-66-pt. 2- -59 procedures, little more than one-third of the research proposals now being reviewed have any prospect of ultimately receiving support. With limited support and increasing demands, the Council and staff of the Institute have faced a serious dilemma-either to deny support to promising young men who, having completed years of expensive research training, are now ready to undertake a research career, or, on the other hand, to discontinue the support of important ongoing projects. Either course results in an uneconomical waste of trained manpower which the Nation can ill afford. The ultimate effect of either is to cut off the flow of future scientists for the Nation's health research program. If our young men cannot be supported, they are quickly drawn off into other pursuits, less crucial to the national need than is medical research. Our program to develop new centers of excellence in underdeveloped geographical areas is particularly hard hit. The discontinuation of ongoing projects has an equally dampening long-range effect. Few men will be willing to undertake the exacting and lengthy training required for a modern research career, unless they have the strongest assurance that they can enjoy continuing support when their training is completed. The Nation's greatest health asset is this relatively small corps of highly trained scientists. The future health of the Nation will depend largely upon their accomplishments. ESTIMATE OF FUNDS REQUIRED Based upon the trend curves of the NINDB program, we can estimate with considerable accuracy the funds which will be required to provide this needed support. Starting from a base of $88 million in 1965, the Institute's actual program would have increased to almost $107 million in 1966 had funds been available-an increase of $19 million. Although some has already been lost, much of this program can still be activated. In addition, previous experience indicates that in 1967 there will be at least an equal increase above these programs and unpaid grants now in hand. It is thus evident that for NINDB to maintain the momentum of its natural growth, and to capitalize on the availability of the newly trained recruits to this dynamic new field of the study of the human brain and sense organs, a budget of at least $126 million will be required in 1967. If, in addition, we are to mount new programs against blindness, multiple sclerosis virus, and head injury, and to continue to develop the stroke program launched last year, the full amount of $142,100,000 included in the requested budget will be required. In other words, if we are to support the funding of the $6 million remaining unpaid this year, and in addition provide for projected additional requests of $19 million in 1967, an increase of $25 million for 1967 over 1966 will be required. In partial recognition of this need, the House has granted a $10-million increase. We strongly urge that at least the additional $15 million needed to permit the continuing healthy development of the Institute program be made available. Mr. Chairman, I should like to express my appreciation for the opportunity of appearing here again before you as spokesman for the National Committee for Research in Neurological Disorders. Senator HILL. Thank you, Dr. Kane. Do you have any questions, Senator Case? Senator CASE. No, Mr. Chairman. Senator HILL. We deeply appreciate your testimony and we will now proceed with Dr. Meyer. STATEMENT OF DR. JOHN S. MEYER, PROFESSOR AND CHAIRMAN, DEPARTMENT OF NEUROLOGY, WAYNE STATE UNIVERSITY COLLEGE OF MEDICINE STROKE PROGRAM Dr. MEYER. Mr. Chairman, Senator Case, and members of the committee, my name is Dr. John S. Meyer, professor and chairman, Department of Neurology, Wayne State University, Detroit, Mich. The major emphasis of my testimony today will be concerned with the stroke program of the U.S. Public Health Service. Stroke is caused by damage to the brain either by an interruption of its blood supply or by hemorrhage into its substance. The usual related causes are cerebral arteriosclerosis often associated with hypertension and diabetes. Stroke kills over 200,000 Americans each year and next to heart disease and cancer is now the third commonest killer of U.S. citizens. There are about half a million new stroke victims each year. I have been working in stroke research for over 15 years. The stroke area was, as you know, Senator Hill, almost totally rejected by the medical profession in those days. Stroke strikes down people in their most productive years and, since there are about 2 million people who have been disabled by stroke in the United States today, the economic cost is enormous. Furthermore, it is estimated that between 25 and 50 percent of patients in mental hospitals today are there because of brain deterioration due to cerebral arteriosclerosis. This was a matter of deep concern to the late Dr. Champ Lyons, professor of surgery at the University of Alabama, who, at the time of his tragic death, was making active plans to do something about these unfortunate people. He believed that restoring the cerebral circulation would cure some of their mental symptoms, and there is already some evidence to support this view. As Chairman of the Stroke Subcommittee of President Johnson's Commission on Heart Disease, Cancer, and Stroke, I have had the honor and good fortune to testify before your committee, Senator Hill, and through the wisdom of your committee and your colleagues in the Senate, prompt legislative action resulted. Since that time, for the past one and a half years, I have served as a member of the advisory council to the Surgeon General of the U.S. Public Health Service in relation to the National Institute of Neurological Diseases and Blindness, which is deeply concerned with the problem of stroke in this country. STROKE CENTERS We are proud to report that there are already eight stroke centers in the United States supported by the NINDB. These are located geographically in New York City, N.Y.; Minneapolis, Minn.; Detroit, Mich. These were the first three stroke centers started 5 years ago. Five more were recently approved and are already functioning. They are located in Miami, Fla.; Boston, Mass.; Baltimore, Md.; Durham, N.C., and Philadelphia, Pa. When the map of the United States is considered, there is an obvious need for many more. As pointed out by Congressman Fogarty, seven-eighths of the country have no regional stroke centers at all. I have made an unofficial poll of other scientists interested in the case of stroke, and found that 20 other centers have already applied and are completing applications to the NINDB for support of new stroke centers. These applications are of good quality and would cover other zones of the Middle West, other zones of New York State, including upper New York State, other areas of New England, the west coast, the far South, including Alabama, the intermediate South, the Washington-Baltimore area, and the Southwest. Five new stroke centers were approved and funded in the past year alone. Applications for a few more centers have been received and will be acted upon by the June Council of NINDB. Another eight applications for stroke centers are scheduled for 1967 action. I am only permitted to name those centers which have already been funded. I cannot be specific about pending applications which must remain confidential until the advisory council and the Surgeon General have taken action and they have been funded. UNFUNDED GRANTS There are, however, several problems. All of the funds allocated for stroke centers have been utilized this year and there is already a deficit of $300,000 of approved but unfunded grants. Senator HILL. You did not have the money for them? Dr. MEYER. No, sir; $300,000 worth this year. There are simply not enough funds to mount all of the applications received, and there are insufficient funds to expand the presently existing stroke centers which have been highly productive in terms of research, stroke training, and patient care demonstrations. The rapid growth of stroke programs has been nothing short of amazing, and they are now in a state comparable to the cardiovascular and cardiopulmonary centers of 2 or 4 years ago. Credit in part should be given the well laid plans of the joint council subcommittee representing the combined interests of the NINDB and the National Heart Institute. Incidentally, the success of these two Institutes is unparalleled in the history of NIH, as far as I know. It is also due, in part, to the productivity of the NINDB with their neurological sciences training program, which provided the cadre of scientists to launch these stroke programs. While NINDB has been a relatively young institute, there are evidences of very rapid growth in this previously neglected field, which I think could fairly be termed "a significant breakthrough." FLAWS IN PLANNING OF SUPPORT FOR PROGRAM There have been important flaws in the planning of support for the stroke program. Congress did not vote any budget increase to NINDB |