STATEMENT OF HON. ELLIOT L. RICHARDSON, SECRETARY, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, ACCOMPANIED BY DR. ROBERT Q. MARSTON, DIRECTOR, NATIONAL INSTITUTES OF HEALTH, AND STEPHEN KURZMAN, UNDER SECRETARY OF HEW

Secretary RICHARDSON. Thank you very much, Mr. Chairman and members of the committee.

On my right I am sure all of you recognize the Director of the NIH Dr. Marston.

We are very grateful to the committee for affording us this opportunity to present considerations underlying the provisions of S. 1828, as introduced by Senator Dominick.

As preliminary remarks of members of the committee have emphasized, there is broad agreement on the very high priority to be attached to mobilizing resources for exploitation and potential breakthroughs in the field of cancer. There is certainly basic agreement that in order to do this, there is needed not only additional money, but an organizational setting designed to maximize the opportunity for the achievement of such potential breakthroughs.

As Senator Javits has said, the one difference that has existed between us to this point is the organizational framework that will best serve an expanded cancer research program, and at the same time port biomedical research in other areas.

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The bill before you, S. 1828, represents the administration's best thinking as to how best and most effective to combine these efforts.

As you just reminded us, Mr. Chairman, the President did, in his state of the Union message, call for a total national commitment to an intensive campaign to find a cure for cancers, and then followed this by a proposal in his health message on February 18 for the establishment of a conquest program within the National Institutes of Health, but under its own director; the establishment, also, of a new advisory committee to advise him as well as to advise the Director of the program and other officials concerning this effort.

In order to get the intensified cancer-research campaign underway without delay, the request for the additional $100 million was included in the second supplemental appropriation bill, which the Congress passed on May 24. These funds will therefore be available for obligation on July 1. The legislative authorities for the organization of the new cancer effort are contained in the bill now before you.

The aim of this bill is succinctly set forth by its short title: "An Act to Conquer Cancer." This is not, of course, meant to suggest that we can legislate an end to cancer and it is, indeed, very important that the public should realize that no grant of authority, no form of organization, and no appropriation of funds can assure an end to cancer or produce any of the crucial understandings of the process of malignancy on which cancer cures and cancer prevention depend. But we can, through this legislation, set the stage for a broadened and strengthened national research effort and provide what we believe to be the best machinery for its stimulation, direction, and support.

The bill will establish a cancer-cure program, within the National Institutes of Health, which, in the words of the bill, "shall have as its

objective the conquest of cancer at the earliest possible time." The program will be administered by a director who will be appointed by the President, with the advice and consent of the Senate, and who will serve under the direction of the President. This provision is designed-To give concrete expression to the national commitment to an intensive campaign to find a cure for cancer;

To keep the President in direct contact with the progress and problems of an endeavor which he regards as of great national importance; and

To insure that the Director of this new program will have the authority needed to carry out his formidable task.

The important point, Mr. Chairman, is that the cancer-cure program will have the full support of the President's power, prestige, and personal interest and that the Director of the cancer-cure program will report directly to the President.

As stated in the bill, the new cancer-cure program will be "within the National Institutes of Health" and will act "in coordination with the other programs and activities of the National Institutes of Health." This is an essential feature of the President's proposal. Its primary purpose is to keep cancer research in close and constant contact with the mainstream of biomedical research of which it is an integral part. Such contact is, in fact, essential. Cancer research has in the past profited greatly from work done in other fields and, as you know, some of the most promising leads in the search for the causes and the cellular mechanics of cancer have come from work done in other fields. For example, many of the recent advances in work on cancer and viruses are direct outgrowths of concepts, techniques, methods, and information derived from the general field of virology, particularly the development in conquering poliomyelitis. Many of the outstanding virologists from the polio and other virology fields are now working on cancer virology problems. It would be foolhardy indeed to suppose that this interdependence of the medical sciences will not continue in the future. To create the optimum conditions for a major attack on cancer, the relationships that have been so productive in the past must be maintained. Moreover, the indivisibility of knowledge and understanding in the life sciences is such that research on other diseases will also have much to gain from close contact with a greatly expanded cancer research effort.

Establishing the cancer-cure program as a commonwealth among the research institutes in the National Institutes of Health will have many mutual advantages. Maintaining the natural alliance between the various scientific disciplines and the categorical research diseasecontrol missions will avoid the disruptive effect on the medical research community of scattered responsibilities for Federal leadership and support. It will continue to be possible to monitor the overall pattern of research support and to avoid competition and duplication between research programs sponsored by various institutes. It avoids the necessity of setting up a wholly new service and supporting structure for the cancer-cure program.

The effect of the plan proposed by the President will be to give the cancer-cure program a great deal of autonomy and independence for the management of the program while retaining it as an integral part

of our overall medical-research machinery and recognizing its interdependence with other fields of biomedical research. It is very important as you, Mr. Chairman, pointed out during your earlier hearings-that the enlarged cancer research effort should not be at the expense of research on other diseases and that it should not have the effect of draining competent researchers and research resources from work on other disease problems. The independence of the cancer-cure program must therefore be paralleled by a close association with other aspects of biomedical research.

The cancer-cure program must clearly have access to the funds and resources necessary to accomplish its mission in the shortest possible time. As the President has already announced his intention to ask for whatever funds can be effectively used, there is little to be gained by subjecting the budget requests of the cancer-cure program to progressive layers of budget review. It is therefore the President's intent that the Office of Management and Budget will give budget guidelines directly to the cancer-cure program-as it does to all agencies at the beginning of a budget cycle.

Senator KENNEDY. Do you have any idea about what that might be over the period of these next few years, Mr. Secretary? Have you thought about what magnitude that might be?

Secretary RICHARDSON. I think Marston could give you a better

answer.

Senator KENNEDY. I would be glad to let you go through your complete statement if you prefer and come back to that.

Secretary RICHARDSON. Well, I think it would be fine to deal with it now.

Dr. MARSTON. Obviously we have given a great deal of thought to this and have focused primarily on what the constraints are likely to be over the next few years in achieving the objectives of the bills that are before this committee.

It seems clear that before the funding level itself becomes the critical constraint, that the problem of manpower emerge as a major problem and this underlines the need in looking at a program of this type to make the plans that will be needed and long in advance anticipate such problems. The specific dollar amounts at this time I could not give you.

We have looked at the problems that would be raised by a very rapid expansion in the early years by a more gradual expansion along the lines of the $50 million increase last year and the $100 million increase this year, which amounts to a doubling-almost a doubling of the program for cancer research, and quite frankly over about a 6 month period of time, and have looked at the various aspects and the implications of it.

I think the important point is that these discussions at NIH and the National Cancer Institute have been against the background of the President's instructions to us to design the best program without a primary focus on fiscal constraint over the next few years.

Secretary RICHARDSON. I would just add, Mr. Chairman, that certainly when the new director of this program is appointed, under whatever organizational structure, and with the new advisory boards that are called for within the bill before the committee, that undoubt

edly this advisory body and the new director will, building on the view of the subject that NIH has already undertaken, be in a position to give more concrete answers to the budgetary long-range structure, picking up on the budgetary process.

The cancer cure program will formulate its budget and submit it directly to the OMB for the President's approval. It would not be submitted as agencies within HEW would do so ordinarily through the processes of the Department itself.

The Director of the cancer cure program will, of course, defend the program's budget before the Congress. Subject to the limitations imposed by the Congress, the Director of the cancer cure program will have full authority to reallocate funds among program activities within his overall budget. This flexibility is necessary if the program is to be able to respond promptly to changing priorities or unanticipated research opportunities.

The cancer cure program will have responsibility for developing a coordinated and concerted attack on all forms of this disease-to the extent that research can be coordinated in this very difficult field where progress still depends so much on fortuitous and serendipitous discoveries. The Director and his planning staff will need to be fully aware of relevant research activities in all parts of the Federal Government, in the academic and medical communities, in the industrial sector, and as much as possible, internationally. To this end, the Director of the program will be given an opportunity to review and comment on the program plans and budget request for cancer-related activities of the other NIH institutes and research divisions.

In order that the cancer cure program may build up the resources needed to carry out its mission as rapidly as possible-and without diverting them from other medical research programs-the bill authorizes the cancer cure program "to acquire, construct, improve, repair, operate, or maintain cancer centers, laboratories, research or other necessary facilities and equipment." The bill would also authorize the Director of the cancer cure program to allocate whatever funds, within the program's appropriation, he considered necessary for these purposes.

The Director of the cancer cure program and the Director of the National Institutes of Health would also be expected to work out mutually agreeable arrangements for the use of the central facilities and services at the National Institutes of Health by the cancer cure program. These facilities range from beds and laboratory space in the Clinical Center in Bethesda to animal breeding and holding space at the National Institutes of Health farm in Poolesville.

The services range from the use of the computer facilities to grounds maintenance. An agreement would be negotiated for the equitable sharing of the facilities and their maintenance costs. Such an agreement between National Institutes of Health and the National Institutes of Mental Health covering the latter's intrar.ural research program-which has continued to use National Institutes of Health facilities has worked very smoothly during the past 4 years; a similar agreement with the cancer cure program should work equally well. Any needs of the cancer cure program that cannot reasonably be met by National Institutes of Health would be met from other sources. As

the National Cancer Institutes has its own still relatively new buildIng and is already an integral part of National Institutes of Health, the continued use of common facilities and services should create no problems.

The sharing of services is advantageous to the cancer cure program because it will avoid the expense and delay of establishing separate services and it helps the rest of National Institutes of Health by spreading their cost over a larger base. The sharing of facilities has a more important justification; it promotes the free interchange of ideas and cross-fertilization of research within the National Institutes of Health community which is one of the most persuasive reasons for leaving the cancer cure program within the National Institutes of Health.

The bill sets up a Cancer Cure Advisory Committee to advise the President, the secretary and the director of the cancer cure program on ways and means of conquering cancer. This Committee will be composed of outstanding scientists and distinguished lay members whose task will be to provide the President with their most thoughtful and carefully weighed advice on the needs of the cancer cure program; to provide sound assessments of scientific opportunities and recommendations for areas of emphasis to the director of the cancer cure program; to set general criteria for the development and implementation of plans and activities of the cancer cure program.

The present National Advisory Cancer Council would be retained as the working arm of the Cancer Cure Advisory Committee. The Counch would retain its present legal status and would retain its responsibility for the review of grant applications. Members of the National Advisory Cancer Council would be ex officio members of the Cancer Cure Advisory Committee. This provision will make it possible to continue to utilize the capabilities of the group that has been deeply involved in cancer research policy and has played a major role in the development of the active program already in being.

The present National Cancer Institute will become a part of the cancer cure program to provide the latter with a working nucleus and to make it possible to build the expanded cancer research effort on existing capabilities. These capabilities in terms of the scientific capabilities. These capabilities-in terms of the scientific competence of investigators in the cancer field, in terms of facilities for cancer research, and in terms of programs for the support of research and research training-are impressive. It is the existence of these capabilities. the research accomplishments to date, and the vigor and vitality of present programs that makes it possible to consider launching an expanded effort of the kind now proposed.

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Mr. Chairman, at this point I propose to skip over to my prepared statement, but wuld appreciate having inserted the intervening portions as if they had been read.

Senator KENNEDY. The whole statement will be included in the record.

Secretary RICHARDSON. Thank you.

Turning to the closing paragraph on page 13, I would like to note that we have been asked to testify on the amendments to S. 34 proposed by Senators Nelson, Cranston, and Schweiker. These amendments, in fact, constitute a separate bill. The issues involved are very