I will say, apart from specific projects that warrant developmental research there are several program areas that require stimulation by NIH in order that the required research move ahead. These, in general, are program areas which cannot be handled in the ordinary way within the discipline-structured academic institutions with which NIH usually deals. This may be either because the institutions lack the necessary physical and technical resources or that programs cannot relate in a general realistic way to the institutional, i.e., to the educational goals of the institution. Some of these problems are research in areas such as aging, pharmacology, toxicology, broad problems of deafness and blindness, developmental sciences, behavioral sciences, the developmental sciences of a biological, emotional, or intellectual character, and the behavioral sciences as there relate to problems of population dynamics and population control. Now, in isolating areas that could go forward with substantial gains in the absence of budget constraints, I could mention a series of programs that fall in what I would call the general area of bioengineering or engineering development. But I would like to mention some that do not fall in that area, that one does not ordinarily think of in terms of broad possibilities for development. These are less engineer-oriented. They are substantially longer term in objective. But they indeed are more probing and clarifying. In this category, one would include such things as the molecular basis for the transfer of genetic information and the ultimate inquiries of how such transfer mechanisms can be modified, and the further exploration of current knowledge in fields relating to virology as a means of clarifying intracellular difficulties. This study must be done not as an abstraction but as an essential type of activity if we are to clarify the causation of disease in the central nervous system through broad inquiry into the mechanics and operation of a number of systems that involve long-term consequences of such diseases as scrapie in the goat or rubella in the human. I would say that our present capabilities would provide for broad and systematic exploitation of current knowledge that relates to the interaction of chemicals in a number of biological systems. These relate at one end of the spectrum to the evolution of a more rational system, the evolution of therapeutic agents, and at the other end, clarification of the specific causes of toxic environment and how these produce deleterious effects which find expression in overt disease. One could go on to list a number of these. One area I was going to talk to, but I am sure I do not have to because Mr. Gorman is the next witness, has to do with the developing of a broad science base for understanding of mental illness in whatever way it is reflected. I think that whether these be biological, behavioral, or environmental studies, these problems warrant much more serious and much more adequate study than they are receiving today. I would like, in discussing our development from 1956 through 1964, to characterize it as general development. Our development since that time has been to try to select areas that, because of their peculiar pertinence to health, really warrant a very purposeful effort. This was not done necessarily by our own full-time staff, but through mechanisms that are evolved through the full-time staff, to bring together the best scientific brains of the Nation to outline strategy in relation to particular broad problems. Senator HARRIS. Without objection we will place in the record the written answers that you alluded to to these questions, which go into some more detail. (The document referred to follows:) EXHIBIT 4 CURRENT STATUS REGIONAL MEDICAL PROGRAMS TO COMBAT HEART DISEASE, CANCER, STROKE, AND RELATED DISEASES AUTHORIZED BY PUBLIC LAW 89-239 The principal purpose of the grant program authorized by Public Law 89-239 is to provide the medical profession and the medical institutions of the Nation greater opportunity to make available to their patients the latest advances in the diagnosis and treatment of heart disease, cancer, stroke, and related diseases. This overall objective is to be accomplished through the planning and establishment of regional cooperative arrangements among medical institutions, which can serve as the framework for programs of research, training, continuing education, and demonstration activities in patient care conducted by medical schools, medical organizations, research institutions, and hospitals. The regional cooperative arrangements are intended to assure close contact between the development of new medical knowledge and techniques in the environment of research teaching and the delivery of high-quality patient care in the hospital and community environment. Considerable progress has been made during the past year in implementing this new program in regions throughout the Nation. The law authorizes grants for the planning of regional medical programs, and the activity conducted in the regions to this date has been in the planning phase. As of April 7, 1967, 37 planning grants have been awarded. These 37 regions cover approximately 65 percent of the Nation's population. Planning grant applications have been received covering all of the regions of the Nation except two. Some of these applications have been reviewed and grant awards will be made in the coming month. In all of these regions, cooperative arrangements involving medical schools, hospitals, practicing physicians, and official health agencies have been established. These cooperative arrangements help to assure that the major health resources of the region will be involved in the planning and that the operational activities which emerge from the planning process will be more effectively implemented. Each of the regions has designated a regional advisory group which is broadly representative of the health interests of the region as well as members of the public. The advisory groups, required by the law, will advise on the development of the plans and the implementation of the regional medical programs and must, under the law, approve all operational activities. These regional advisory groups are now functioning and include more than 1,400 of the Nation's health leaders. The National Advisory Council on Regional Medical Programs recently recommended approval of the first four grants for the operational phase of regional medical programs. These four grants will be awarded in the immediate future. Examples of the types of activities included in these operational programs are: programs of continuing education for physicians and other health personnel in order to assure the rapid transmission of the latest advances in medical knowledge, the utilization of electronic communication networks between medical centers and outlying community hospitals for the purposes of training and diagnosis, the uses of central computer facilities for the physiologic monitoring of acutely ill cardiovascular patients in outlying hospitals, the provision of assistance to community hospitals in establishing intensive coronary care units and the training of nursing staff for the effective operation of these units, the development of mechanisms for the wider application of advanced diagnostic techniques in these disease fields, and the development of information and data systems which will permit the effective evalaution of the activities undertaken. These initial operational grants are supporting the first steps in the implementation of a coordinated regional program that will explore and utilize a variety of techniques and mechanisms for bringing the benefits of the advances in medical science to patients afflicted with heart disease, cancer, stroke, and related diseases. The full-scale operational programs will evolve over several years and will utilize the information gained from the initial operational experiences. Attached is a list of the regions for which planning grants have been awarded as of April 7, 1967. Also attached is a map indicating the regions for which grants have been awarded or for which applications are being reviewed. A brief chronology showing the development of the program is included. |