PROPOSED ENVIRONMENT HEALTH CENTER TRANSFER TO NIH

The Environmental Health Center I propose to transfer to the National Institutes of Health.

Mr. FLOOD. What is the difference?

Dr. STEWART. The Environmental Health Science Center program is an attempt to find out how lose doses of toxic substances affect human beings or living organisms. It does not make any difference whether it comes through air, water, food, or anything else. It is the total dose that one is exposed to.

Mr. FLOOD. Why would that be someplace else?

Dr. STEWART. Because it requires the kind of skills and scientists involved in very basic research. It is very closely related to the basic research that is now going on in the Cancer Institute, for example, in carcinogenesis and in the development of the Toxicology and Pharmacology Centers that the National Institute of General Medical Sciences is supporting. It does not make any difference whether the toxic substance is lead or drug. You are working on chemical compounds.

CONSTRUCTION DELAY IN ENVIRONMENTAL HEALTH CENTER

Mr. FOGARTY. Have you broken ground for the Environmental Health Center?

Dr. STEWART. No, sir; we have not broken ground for the Center. Mr. FOGARTY. What is holding this whole thing up?

Dr. STEWART. The program of requirements is now in the Bureau of the Budget, I believe.

Mr. FOGARTY. We will hear that this afternoon, I guess.

Dr. STEWART. That is the stage we are at.

It took an awful long time to get the program requirements and the reason is that when the decision was made to put it in the research triangle they also changed the program content and ideas that were built into this thing, and it took this time to develop this. We will be staffing about a hundred people in some temporary space which the research triangle is to build for us.

Mr. FLOOD. This goes to North Carolina?
Dr. STEWART. In the research triangle.

SUMMARY OF BUDGET REDUCTIONS

Mr. FOGARTY. You quote increases in the budget in some places, which really disguise the fact that some programs will get no increases at all and some will be sharply cut. In one area I talked about a minute ago, the Cancer Institute, I told you our committee is very much concerned and we are dissatisfied with the progress made in the last 3 or 4 years. Yet the budget makes absolutely no allowance for stepping up the fight against cancer.

An even more glaring example is the reduction in health research facilities. Do you want to say anything about these. It seems to me there should have been an increase in the Cancer Institute.

Mr. FLOOD. Do I agree with that!

Dr. STEWART. There is deception in those figures?

Mr. FOGARTY. There is deception in many of these figures you have here this year. And I don't think I'm talking about the same kind of deception you are.

Dr. STEWART. The computer machinery says we will not need as much money for the continuation grants at the Cancer Institute as we had anticipated before. There is also a decrease of $3.3 million in the cancer chemotherapy program.

So there is about $4 million for new grants and direct operations. Mr. FLOOD. It sounds as though we will have to bring the computers up here in a couple of years to testify before the committee instead of flesh and blood witnesses. It looks as though they are taking over. You can stay home and send up a machine.

Mr. FOGARTY. I think we have run late enough. We will quit now and come back at 2 o'clock.

Mr. FLOOD. The committee will be in order.

CIGARETTE SMOKING CAMPAIGN

Doctor, I have the impression, and it seems to be widespread, that the spearhead of the attack on the smoking of cigarettes has been blunted, just by sheer ennui or by proliferation of your Public Health Service interest into other areas. Perhaps you couldn't maintain that momentum indefinitely, but you had it generated to a very high degree. I doubt if there was a home in the country that wasn't discussing the problem at one time not too long ago. Now you never hear it mentioned, in the press, on the radio, television, or by anybody anyplace anywhere. It is passé almost overnight. In addition to that, in the New York Times today the Reynolds and Lorillard Co.'s announced great increases in profits and sales, especially in filter cigarettes, the highest on record, and so on. If all of the things that you people said, were so such a very, very short time ago, how do you account for this almost about-face? What happened? Was the rug pulled out from under you by someone? What happened?

Dr. STEWART. Mr. Flood, nobody has pulled the rug out from under us. We are keeping up as strong an effort as we possibly can in the cigarette-smoking campaign.

Mr. FLOOD. Nobody is paying any attention to you any more. You have lost your audience.

Dr. STEWART. Only in part I think, Mr. Flood. When the label came out on the cigarette packages January 1

Mr. FLOOD. That was a deal and a fake and a sham. They should have passed a bill which was what you people wanted. That was the fault of Congress. It was a beau geste and nothing else.

Dr. STEWART. We are working with the Interagency Committee on Smoking and Health, which includes the Cancer Society, other nongovernmental organizations.

Mr. FLOOD. I am sure you are doing everything within reason that you should do. I am not talking about that. I am talking about the seeming fact that you have lost your audience, you are no longer in the center of the ring.

Dr. STEWART. I think one has to keep up the information as much as possible. What we are trying to do is not only inform everybody—and I believe most citizens of the United States are aware now

of the hazard of smoking—but we are asking them to do more than be informed, we are asking them to make a decision and change their behavior.

CIGARETTE SALES GREATEST IN HISTORY

Mr. FLOOD. And their reply has been to buy more cigarettes and more cigarettes, and Lorillard and Reynolds announced today their biggest increase in sales in history, and the sales of filter cigarettes. are at an alltime peak as of today.

Dr. STEWART. It certainly looks like the people have not, even though they are informed, changed their behavior and stopped smoking. I think as far as the extent of young people taking on smoking this will be revealed in the statistics at a slower rate, because about a million a year reach that age, roughly. If we are having any impact there, it will take a little while to find out.

One more thing, Mr. Flood: These are figures of cigarette sales, and certainly they reflect sales have gone up. What we are trying to do is find out whether we really have had an impact on the cigarette smoking habit. We did a measure of smoking habits of a sample of the population prior to the label on the cigarettes. We will do a sample again, in May or June this year, leaving enough time for impact, and see if we had any effect on the smoking habits of the citizens.. We are particularly interested in that age group in the middle and latter teens as to whether there has been a decreasing number who are taking up smoking.

Mr. FLOOD. The point I am trying to make is for the purpose of emphasis I repeat-if this whole business of cigarette smoking is as dangerous to health as you were loudly beating the drums proclaiming it to be, the impetus is gone, the attack has been blunted, and you have. lost much of your audience. How you regain it-you may have to. talk to somebody on Madison Avenue. I don't know.

Dr. STEWART. You are quite right. We are certainly not in the same league as the advertisers of cigarettes are.

Mr. FLOOD. Even talking to you across the table here you don't seem to catch fire on this.

Dr. STEWART. I don't mean to give you any idea that I am not as concerned and interested in promoting this as anyone else.

Mr. FLOOD. I don't see you charging out of the corner when the bell rings even this afternoon. Is this the atmosphere which prevails: in the Department?

Dr. STEWART. No; it is not the atmosphere that prevails. I certainly have no intention of giving that atmosphere.

PROMOTION OF REGULAR PHYSICAL CHECKUPS

Mr. FLOOD. To what extent, if any, do you make a point in educating the public on the tremendous importance of annual or semiannual physical checkups? As I gave you this morning, I am the classicexample of the smart guy who didn't have it done. I am breathing. I am lucky I am here. I am ahead. By the grace of God only, certainly not through any of my efforts.

61-209-66-pt. 3- 4

Dr. STEWART. Mr. Flood, in our public information materials we advocate the physical examination, particularly for people over 40 years of age, and we do this in other information channels. But I think more important is our effort in finding out how one can examine everybody over the age of 40.

Mr. FLOOD. I understand that. I mean within the rule of reason. We apply that here.

Dr. STEWART. You recall this morning we talked a great deal about a method, perhaps, which might have wider application. There are just not enough resources in the United States to provide a physical examination of the conventional type to everybody over age 40. Similarly, there are not enough resources for everybody in the United States to see their dentist twice a year.

Mr. FLOOD. In other words, if everybody started out next Monday morning at 9 o'clock to get a physical examination it would be a pretty sad business, would it not?

Dr. STEWART. You would have long lines standing in the doctor's office. What we are looking for are ways in which the most sensitive screening tests applied to large numbers, through the use of technicians, can pick up things and have them interpreted by a physician. This way, instead of a physican examining each person individually in a conventional way, he is examining a quite large number.

SURGEON GENERAL'S EVALUATION OF CHECKUPS

Mr. FLOOD. Do you think this a good idea to have these checkups? Dr. STEWART. I think the checkup annually is a good idea for certain things that we do in the physical examination. Many of the others are untested and untried. Whether it does the physician any good to listen to your chest, for example, in an ordinary physical examination I think is quite doubtful. Or whether it does him any good to do some other things, I think is quite doubtful. But certain things are very important. What we need is a way to emphasize these important tests that are done and get them so they can be applied with the least amount of time of the physician, reserving for him more time for the interpretation and the followthrough and the care of what he finds, and this sort of thing.

VENEREAL DISEASE RATE

Mr. FLOOD. We are advised that the VD rate is swinging up again alarmingly, even with syphilis. Apparently the bugs are resisting the drugs that we thought were panaceas. Will you comment within reason on that and then will you place in the record at this point, or at the end of your statement, a chart of some kind which shows the increase in VD rate, if it has increased, by whatever years you wish to begin at and end at, for male and female, some kind of age bracket, and white and nonwhite, and I think maybe geographically?

Dr. STEWART. We certainly will, Mr. Flood.

(The information to be supplied follows:)

Cases and rates of primary and secondary syphilis, United States'

Number of primary and secondary syphilis cases and case rates per
100,000 population, United States, calendar year data

Increases in reported infectious syphilis result from one or more of the following factors:

(1) An actual increase in syphilis incidence.

(2) A percentage increase in physician reporting of cases they diagnose and treat.

(3) More effective methods of bringing existing cases to treatment while they are still in the infectious stage.

The reported increase of primary and secondary syphilis in 1965 over 1964 was 517 cases. Activities of public health workers brought 1,698 more cases to treatment in 1965 than 1964 and physicians reported 544 more cases. These factors, considered in conjunction with each other, suggest that the reported increase in 1965 should be attributed to more effective public health activity and to improved physician cooperation rather than to increased disease incidence.