COST TO RESTORE TRAINING GRANTS TO LAST YEAR'S LEVEL Mr. LAIRD. How much would those 31 training grants cost? Dr. SHANNON. In round figures, $50,000 or $60,000 apiece, on the average. Mr. LAIRD. How much would it be for each Institute, the total amount involved here? Dr. SHANNON. It would be a cutback of three or four training grants. Mr. LAIRD. Insert that in the record. Dr. SHANNON. Yes. The average training grant is in the range of $50,000. Mr. LAIRD. For the record, if we could have it by Institute. (The information follows:) The decrease of 31 grants in 1968 is the net result of increases of 39 grants in six institutes and decreases of 70 grants in four institutes. If these 31 grants were distributed among the four institutes with decreases, in proportion to the amount of the decrease, the distribution, and the cost of the grants would appear as follows: The decrease in the number of Training grants that will be supported in 1968 is due primarily to increases in the average cost of on-going training programs. These cost increases are the result of program expansion in established training programs, stipend and allowance increases, and general cost of living increases. Dr. SHANNON. I am not happy to see training cut back but it was not a question of whether we cut here or there but how much we cut in both places. THE JOHN E. FOGARTY INTERNATIONAL CENTER Mr. LAIRD. Dr. Shannon, on the 18th of January 1967, we had on the floor of the House of Representatives eulogies to the late chairman of this committee, the Honorable John E. Fogarty, of Rhode Island. At that time I suggested on the floor of the House the establishment by this Congress of the John E. Fogarty International Center for Advanced Study in the Health Sciences. I would like at this point to insert the statement in the record which I made, with the chairman's permission. Mr. FLOOD. Without objection it is so ordered. (The statement follows:) Mr. LAIRD. Mr. Speaker, JOHN FOGARTY's deep and devoted interest in international health and his conviction that through international exchange in the health sciences, a significant contribution could be made, not only to the solution of health problems but also to the advancement of world peace is, perhaps, best epitimized in his remarks before a panel on Health for Peace during the meeting of our Citizens Committee for the World Health Organization held in Washington in September 1963. The final paragraph of JOHN's remarks is of particular significance and I should like to quote it here: “In concluding my remarks I would like to set forth an idea and a view which I feel to be of the greatest importance and significance. Instead of a curtailment of the programs and activities of the United States in the field of international health research. I should like to see a plan to bring into being at Bethesda a great international center for research in biology and medicine dedicated to international cooperation and collaboration in the interests of the health of mankind as so boldly envisaged by the President. The center would encompass conference facilities, laboratory and study space, and living quarters to permit the assembly for discussion, study, and research of the outstanding health scientists of the world. I visualize this center associated with the great facilities of the National Institutes of Health and the National Library of Medicine as representing the visible and tangible embodiment of this Nation's devotion to the use of science for peaceful purposes and the good of mankind." I can think of no more fitting and lasting tribute to this great humanitarian, than the establishment by this Congress of such a center-the John E. Fogarty Internation Center for Advanced Study in the Health Sciences. I have talked with most of the members of our committee about this and they have all been enthusiastic in their support. I am sure that support will be unanimous, both in our committee and in the entire Congress. Not only will such an institution be a living embodiment of the spirit and aspirations of JOHN FOGARTY, but it will serve a needed and valuable role in securing the progress of science in the cause of the well being of all mankind. REQUEST TO THE DEPARTMENT FOR INFORMATION AND PLANS Mr. LAIRD. On the 24th of March the staff assistant to this committee addressed a letter to the Department of Health, Education, and Welfare informing the Department that we would like to have as much background material as we possibly could get, I also had discussed the center and requested that NIH and the Department of Health, Education, and Welfare develop material for submission to this committee at the time of our budget hearings on the 1968 budget. This was about 2 months ago. I would like to include at this point in the record the letter to the Department and also the reply signed by Mr. James B. Cardwell, Deputy Assistant Secretary, Budget, of the Department of Health, Education, and Welfare, a rather unsatisfactory reply to say the least to be received by a congressional committee. (The letters referred to follow :) Mr. JAMES F. KELLY, MARCH 24, 1967. Assistant Secretary, Comptroller, Department of Health, Education, and Welfare, Washington, D.C. DEAR MR. KELLY: Both Mr. Flood and Mr. Laird have asked me whether any materials have been furnished by HEW that would provide a basis for a Committee determination with regard to financing the International Center for Advanced Study in the Health Sciences which the President mentioned in his Message on Education and Health. As you know, Mr. Laird has proposed the establishment of such a Center as a memorial to John E. Fogarty. Mr. Laird has informed Mr. Flood of his desire to discuss this proposal with the NIH representatives when they are before the Subcommittee in the course of the current appropriation hearings. I should like very much to provide Mr. Flood and the other Committee Members with as much factual information about the plans for the International Center as I can as a basis for this discussion. Would you please arrange to have prepared and submitted to the Subcommittee by April 3, such plans and information as you consider appropriate to this purpose. Sincerely yours, ROBERT MOYER, Staff Assistant, Labor-HEW Subcommittee. 78-317-67-pt. 5—5 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Mr. ROBERT MOYER, Staff Assistant, Labor-HEW Subcommittee, House of Representatives, Washington, D.C. DEAR MR. MOYER: This is in reply to your letter of March 24. The Public Health Service has submitted a proposal for the establishment and financing in 1968 of an International Center for Advanced Study in the Health Sciences. The proposal has been reviewed and approved by the Department. It was delivered to the Bureau of the Budget this morning. Since it has not, as yet, been reviewed by the Bureau of the Budget, we are not at this time able to furnish it to the Committee in time for the Surgeon General's testimony. We have been advised, however, that the Bureau of the Budget will, consistent with the President's message, give the matter prompt attention. Their objective is to place an Administration approved financing plan before the Subcommittee prior to the time of your "mark-up." If possible, they hope to have a proposal in your hands before NIH completes its testimony-now scheduled for a week from today. This will depend on how quickly they can gather comments from other interested Departments and agencies. Sincerely yours, JAMES B. CARDWELL, Deputy Assistant Secretary, Budget. Mr. LAIRD. Anybody reading that letter will see very readily that it is an effort to delay submitting this material until too late to be discussed in these hearings. So I am going to have to ask you questions directly. I will ask these questions of you as the Director of the National Institutes of Health as one who has had long association with international health programs. I well remember your association with the World Health Organization to get programs going on there. I remember Mr. Fogarty's efforts at WHO to support that program even at the time the U.S. Government was supporting WHO's programs in the field of health and medical activities 100 percent. I would like you to outline your views and your suggestions regarding the establishment of such an international center and also to outline fully the background of this concept for an international center at the National Institutes of Health. I realize that it is most important to have this outline by you. You have been Director of NIH longer than anyone else and you have had a longer association with this idea and the discussions surrounding it than anyone else. What you say will have great bearing on what this committee does in this 1968 budget. Mr. KELLY. Could I comment before Dr. Shannon answers? I do not mean Dr. Shannon should not fully answer your question, but I think there is a misunderstanding as to the content of the letter sent to the committee. There is no interest on our part to deny the committee the information. Rather, what we have endeavored to do is to expedite executive branch consideration of the plans for this international center, which the President indicated would be transmitted to the Congress, in order that we could present it to you as the President's recommendation, and we still hope we will have this before you in order that you can consider it in acting on this budget. Mr. LAIRD. Well, if it has not cleared the Bureau of the Budget at this time and if it has not cleared the State Department at this time, I would think it would not by the time this bill gets on the floor of the House. We cannot wait that long. Mr. KELLY. We were unable to get it before the Bureau of the Budget until day before yesterday. Mr. LAIRD. What do you have from State? Mr. KELLY. That will be done by the Bureau of the Budget. Mr. LAIRD. From past experience with the State Department that will take at least 6 months. Mr. CARDWELL. It is my understanding the Bureau of the Budget has circulated the proposal to all interested agencies and Dr. Shannon and others have a meeting set up for Monday to go to the Bureau of the Budget to discuss the proposal. DEPARTMENTAL PROPOSAL Mr. LAIRD. Will you put in the record at this point what Dr. Shannon submitted? Mr. CARDWELL. Yes. Mr. LAIRD. And what you submitted to the Bureau of the Budget? Mr. CARDWELL. Substantially the same. In substance they are substantially the same. (The information follows:) A PROPOSAL FOR AN INTERNATIONAL CENTER FOR ADVANCED STUDY IN THE HEALTH SCIENCES BACKGROUND The proposal for the establishment of an International Center relating to the biomedical sciences at the National Institutes of Health has a number of antecedents. The earliest formal expression of such a possibility was the introduction by Sentor Hill late in the 85th Congress of Senate Joint Resolution 199 providing for the establishment of a National Institute of International Research at the National Institutes of Health. There was no action on this resolution in the 85th Congress. The same resolution was reintroduced by Senator Hill in the first session of the 86th Congress (February 2, 1959) as S.J. Res. 41, which passed the Senate in May of 1959. In addition to authorizing the establishment of a National Institute for International Medical Research as a part of the National Institutes of Health, this resolution provided for the encouragement and support of the "rapid international interchange of knowledge and information concerning disease and disability, including the holding of international conferences... and the support, on an international basis, of research training through fellowship and training grants." The International Health Research Act of 1960 After extensive consideration by the House Interstate and Foreign Commerce Committee, including two series of hearings, S.J. Res. 41 was passed by the House in a substantially altered form and was enacted as P.L. 86-610, The International Health Research Act of 1960. Although the title of the Act still retained the statement "An Act to establish a National Institute of International Medical Research . . ." there was no provision for this entity in the actual terms of the law. This new law, for the first time provided a clear distinction between the purposes to be served in providing support for research and related scientific activities beyond the boundaries of the United States. Two major purposes were cited: 1. To advance the status of the health sciences in the United States and thereby the health of the American people through cooperative endeavors with other countries in health research and research training. 2. To advance the international status of the health sciences through cooperative enterprises in health research, research planning and research training. Significantly the terms of the law separated the responsibility for the achievement of these two objectives. The responsibility for achieving objective (1)— advancing the status of the health sciences in the U.S. through overseas activity-was given to the Surgeon General of the PHS and the Secretary of HEW. The exercise of authorities directed toward objective (2)-advancing the international status of the health sciences-was limited to the President but with provision for the delegation of this function to HEW and only to HEW. Despite repeated approaches on the part of HEW, the President has made no general delegation of his authorities under this Act. In fact, only on two occasions has the President actually exercised these authorities; once in the award of a grant for research planning to the Pan American Health Organization in 1961; the other in the delegation to NIH in 1965 of authority to utilize funds in the execution of the Joint Japanese-American Life Sciences Research Program. The section of P.L. 86-610 to be administered by the President is pertinent in the context of the current proposal because it encompasses broad authority to establish and maintain fellowships in foreign countries and to finance international scientific meetings and conferences in the United States and abroad as well as to engage in other research support, training and assistance activities as the President may deem appropriate to achieve international purposes. A center for advanced study The establishment of a Center for Advanced Study at NIH-but with no particular reference to international considerations-was one of the recommendations contained in the "Final Report of the Study Group on the Mission and Organization of the Public Health Service" issued in June of 1960. In this Report the following statement was made: "In view of the fundamental scientific orientation of the National Institutes of Health, better means and facilities are needed for encouraging advanced, creative, speculative thought, ranging across the full panorama of new findings and concepts emerging from current scientific endeavor which may have meaning in biology and medicine. Such opportunity would be afforded by the establishment of a Center for Advanced Study. This Center would permit the inductive exploration of these matters in an atmosphere removed from program, laboratory, and administrative distractions. Ideas and syntheses having basic impact upon the future development of the medical and biological sciences and the nature of health action in the future should emerge. Those with the ablest minds, inside or outside the Public Health Service, would be sought." The Study Group responsible for the development of this report was appointed by Dr. LeRoy Burney who was then Surgeon General and had as one of its members Dr. William H. Stewart, the present Surgeon General. Related ideas President Kennedy frequently stressed the importance of an international approach to the solution of health problems. In his Special Message to the Congress on National Health Needs, on February 28, 1962, he said: "It is imperative that we help fulfill the health needs and expectations of less developed nations, who look to us as a source of hope and strength in fighting their staggering problems of disease and hunger. Mutual efforts toward attaining better health will help create mutual understanding. Our foreign assistance program must make maximum use of the medical and other health resources, skills and experience of our nation in helping these nations advance their own knowledge and skill. We should, in addition, explore every possibility for scientific exchange and collaboration between our medical scientists and those of other nations-programs which are of benefit to all who participate and to all mankind." The following year, in his Special Message on Improving the Nation's Health sent to the Congress on February 7, 1963, he said: "We must continue our collaborative efforts with other nations in the global struggle against disease. Over the past few years the United States has rapidly expanded its international medical research activities and support. We have also been instrumental in encouraging research under the aegis of the World Health Organization. These efforts are consistent with and in furtherance of our goals of world peace and betterment, and it is important that they be continued." In his address before the 18th General Assembly of the United Nations, on September 20, 1963, President Kennedy said: "The effort to improve the conditions of man, however, is not a task for the few. It is the task of all nations-acting alone, acting in groups, acting in the United Nations, for plague and pestilence, and plunder and pollution, the hazards of nature, and the hunger of children are the foes of every nation. The earth, the |