NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT WITNESSES DR. GERALD S. LaVECK, DIRECTOR, NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT DR. JAMES A. SHANNON, DIRECTOR, NATIONAL INSTITUTES OF HEALTH CALVIN B. BALDWIN, JR., EXECUTIVE OFFICER, NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT GERALD S. ATCHISON, BUDGET OFFICER, NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT RICHARD L. SEGGEL, EXECUTIVE OFFICER, NATIONAL INSTITUTES OF HEALTH CHARLES MILLER, FINANCIAL MANAGEMENT OFFICER, NA TIONAL INSTITUTES OF HEALTH DR. WILLIAM H. STEWART, SURGEON GENERAL G. R. CLAGUE, ACTING CHIEF FINANCE OFFICER JAMES B. CARDWELL, DEPUTY ASSISTANT SECRETARY, BUDGET 1 Includes capital outlay as follows: 1966, $263,000; 1967, $865,000; 1968, $539,000. 2 Selected resources as of June 30 are as follows: Unpaid undelivered orders, 1965, $1,514,000 (1966 adjustments, $10,000); 1966, $2,013,000; 1967, $2,013,000; 1968, $2,013,000. BIOGRAPHICAL SKETCH OF PRINCIPAL WITNESS Mr. FLOOD. Dr. Gerald D. LaVeck, Director, National Institute of Child Health and Human Development, is before us. We have a biographical sketch of Dr. LaVeck which we will insert in the record at this point. (The document follows:) Name: Gerald D. LaVeck, M.D. Position Director, National Institute of Child Health and Human Development. Birthplace and date: Seattle, Washington; April 19, 1927. Education: 1948: B.S., University of Washington, Seattle. 1951: M.D., University of Washington School of Medicine. Experience: 1966-present: Director, National Institute of Child Health and Human Development. 1966-present: Acting Scientific Director, National Institution of Child Health and Human Development. 1965-present: Clinical Associate Professor in Pediatrics, Georgetown University School of Medcine, Washington, D.C. 1963-1966: Director, Mental Retardation Program, National Institute of Child Health and Human Development. 1962-1963: Head, Crippled Children's Service, Washington State Department of Health. 1963: Clinical Associate Professor of Pediatrics, University of Washington School of Medicine. 1961-1962: Clinical Director, Rainier School, Buckley, Washington. 1960-1963: Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. 1958-1961:Medical Director, Rainer School, Buckley, Washington. 1958-1960: Instructor in Pediatrics, University of Washington School of Medicine. 1957-1958: Instructor in Pediatrics and Fellow in Mental Retardation, Department of Pediatrics, Neurology and Neuropathology, University of Washington School of Medicine. 1956-1957: Resident in Pediatrics, Children's Orthopedic Hospital, Seattle, Washington. 1955-1956: Assistant Resident in Pediatrics, Child Health Center and King County (Washington) Hospital. 1953-1955: Senior Assistant Surgeon, U.S. Public Health Service, Epidemic Intelligence Service, Communicable Disease Center, Atlanta, Georgia. 1952-1953: Resident in Public Health, Seattle King County Department of Public Health. 1951-1952: rotating Intern, Vancouver General Hospital, Vancouver, British Columbia, Canada. Association memberships: Diplomate: American Board of Pediatrics. Fellow: American Academy of Pediatrics, American Public Health Association. Member: American Medical Association, American Association on Mental Deficiency, American Association for the Advancement of Science, Washington State Medical Association, Thurston County (Washington) Medical Society. Special awards, citations, or publications: Superior Service Award, U.S. Department of Health, Education, and Welfare, April 1966. Numerous papers and book contributions relating to infectious diseases, and mental retardation. GENERAL STATEMENT Mr. FLOOD. Doctor, you might proceed with your statement. Dr. LA VECK. Mr. Chairman and members of the committee, it is a privilege for me to appear before this committee for the first time as Director of the National Institute of Child Health and Human Development. For the benefit of those of you who are new to this committee, I would like to make two points which may help in understanding our budget request. First, we are a relatively young institute, having been established only a little over 4 years ago. Second, unlike those institutes which are primarily concerned with one category of diseases or part of the body, this Institute seeks to acquire new knowledge and deeper insight into the array of health problems and requirements of mothers and children and into the nature of the developmental processes of all individuals throughout the lifespan. The overall long-range objective of the Institute is improvement in the quality of human existence through greater scientific understanding of the developmental process. The achievement of this goal requires that the Institute study many complex and interrelated problems. Of necessity, to most effectively utilize its resources, the Institute has had to give priority to selected problem areas. I would like to discuss some of these areas today. INFANT MORTALITY There is a growing concern about infant mortality rates in the United States. The yearly decrease has slowed and leveled out so that there has not been an appreciable improvement in recent years. Mr. FLOOD. Insert in the record at this point a list of national infant mortality rates. How far down the scale are we? Dr. LAVECK. We are No. 14. Mr. FLOOD. Suppose you list the first 13. Dr. LAVECK. We have the material for the record. (The information follows:) 8. Switzerland (1964). 9. New Zealand__ 10. United Kingdom-- 11. Federal Republic of Germany (excluding West Berlin). 12. Eastern Germany (including East Berlin). 13. Canada 14. United States--- 1 Public Health Service, National Center for Health Statistics. 2 Provisional. Dr. LAVECK. Twelve other developed countries have lower infant mortality rates than the United States. In addition, large discrepancies exist between rates for various population groups within the United States. The Institute considers that the infant mortality problem in this country is sufficiently serious to warrant a major effort to identify and remedy the underlying causes. The Institute has become the focal point for the coordination, stimulation and support of basic research as it relates to this national problem. A major concern of this Institute is the stimulation and support of fundamental research which relates to various aspects of maternal and infant health and well-being. Program activities stress the identification of new knowledge which can contribute to man's better understanding of the infant mortality problem and ultimately to make it possible to correct, to the maximum extent possible, the causes of infant mortality. Program goals are three-fold and evolve around pregnancy maintenance and management, fetal survival and wellbeing, and disorders of infancy. In this area of Institute concern there have been some rewarding achievements. For example, progress has been made in recent years in the management of Rh hemolytic disease or erythroblastosis fetalis. Caused by an incompatibility of blood between mother and fetus, the condition is responsible for a large number of deaths among newborns. During the past year, an Institute grantee in New York summarized the success of using a technique called amniocentesis to reduce fetal deaths in Rh-affected pregnancies. First developed in New Zealand, this technique has become a highly successful aid in saving babies in these pregnancies. In amniocentesis, a needle is inserted into the amniotic sac, from which some of the fluid which surrounds the fetus is withdrawn. Analysis of the fluid indicates whether the fetus is in danger from Rh hemolytic disease. The procedure has the advantage of signaling the need for pregnancy intervention and transfusions. In about 400 pregnancies where Rh was a problem and amniocentesis was used, perinatal loss (stillbirths plus neonatal deaths) was 9 percent of the total number of Rh-affected babies. Prior to the time when amniocentesis was used in the management of Rh-sensitized pregnancies, perinatal loss due to Rh was 30 percent of the total number of Rh-affected babies. Of still greater interest are recent developments in the attempt to prevent the occurence of Rh-sensitization. Several Institute grantees, as well as scientists in England and Germany, have found that administration of anti-Rh antibody gamma globulin within a few hours after delivery of the first baby prevents the formation of antibodies. The first baby is rarely in danger in these pregnancies. However, passage of blood from the fetus to mother at delivery or before introduces fetal cells into the mother's blood which may start the slow development of anti-Rh antibody in the mother. Subsequent fetuses are thus affected by a reaction initiated by the first Rh-positive infant. Although these studies on an immunizing agent are in the preliminary stages, virtually total protection has been achieved in more than 250 women in clinical trials. The use of this agent promises to eliminate Rh incompatibility as a factor in infant mortality. BEHAVIORAL SCIENCES The scientific exploration of the entire life process is a research task of unprecedented scope. The role of the behavioral sciences in this exploration is clearly set forth in the legislative history and the law which establishes the Institute. The behavioral sciences are not just concerned with one phase of life or with one problem. Rather, behavioral studies begin at the reproductive level and extend logically through the period of adult maturation and aging. We are building a strong behavioral science program to make an integrated multidisciplinary approach to our basic mission-the study of man's life cycle. In examining the entire lifespan of human development, the behavioral sciences have an opportunity to enhance our understanding of what determines a particular behavior. This understanding may then lead to ways of improving behavior. For example, the Institute is supporting studies on the effects of environmental deprivation on central nervous system development. Recently a group from the University of California at Los Angeles has described studies with rats in which environmental conditions were sufficiently profound to alter brain weight and various biochemical systems. Rats maintained for 30 days after weaning under |