Dr. SHANNON. It would just be my judgment that relatively few will go into that. That is the best I can say.

Mr. NATCHER. The committee will adjourn until 2 o'clock.

Mr. NATCHER. The committee will come to order.

SUMMARY OF BUDGET REQUEST FOR GENERAL RESEARCH AND SERVICES

First, under "General research and services," I notice the adjusted appropriation is $71,968,000 and the request for 1968 is $81,141,000, which is an increase of $9,173,000.

INTERNATIONAL ACTIVITIES

The big increase is for research grants, $7,739,000, and $2,489,000 of this amount is for an increase of about one-third in the international field. Now, as you know, Dr. Shannon and Dr. Kennedy, research is becoming suspect in some quarters and international activities have been for some time in this category.

What else would you like to say in regard to this particular increase? Is it absolutely necessary at this time?

Dr. SHANNON. Well, sir, let me discuss the specific program in the international field first.

This was discussed at length with the Bureau of the Budget in arriving at these estimates, primarily in terms of the program content of what we propose to do; in part in relation to our own domestic objectives; and in part in relation to the way in which these activities will make available information about health problems in critical areas of the world where other approprations address thmselves to other problems. I have primarily in mind DOD and AID, of course.

This figure was arrived at, in conjunction with the total figure for research grants that we were allowed to request, as part of the total program. These funds will be used to support American scientists in programs of general concern to the American people. Administratively they will be pulled together in such a fashion as to serve the dual purpose of making information available not only for domestic purposes but also for those purposes that we have abroad, particularly in Southeast Asia.

The program content relates to very broad domestic programs. I have mentioned tuberculosis and leprosy. Leprosy is a minor problem in most areas and is, perhaps, only important in Puerto Rico. But these two diseases are so related, one to the other, that it is very useful to study them together.

INSECT-BORNE VIRAL DISEASES

The second area of deep concern is the so-called insect-borne viral diseases. These are of grave consequence to the United States. We are expending substantially more than this amount in the general program on these problems. We are expending a substantial sum in Panama. Panama serves as a land bridge, it serves as a bird flight area, where a number of diseases transmitted from north to south in the hemisphere tend to converge. It is an ideal location to study some of these diseases in their more common habitat.

For example, we see each summer epidemics of equine encephalitis, eastern encephalitis, St. Louis or mountain or western encephalitis. These are diseases that invade in epidemic form. It is true that they are mainly important economically, to our cattle and horse industries, but they do spill over into the human population. Then they withdraw at the end of the infection season and tend to disappear from the United States as a continuing year-round type of infection. It is our attempt to understand the movement of diseases such as this that makes these general studies of very broad relevance.

NUTRITION STUDIES

We spoke at some length, in relation to the child health appropriation, about a program in Guatemala that attempted to relate certain problems of nutrition to problems of human development. In the Japanese-American program there is a somewhat parallel study that is planned for Chiang Mai, which is north of Bangkok, where a somewhat analogous situation will be studied, where the relationships of poor protein nutrition, and perhaps dietary deficiencies in vitamins and the like, complicated by infection and parasitism, lead to broad problems in human nutrition.

It is possible to study these problems in a definite manner in isolated populations of this sort-in specific villages-which it would be quite impossible to study in this way in our own country.

We have problems of food supplementation in which this Nation is quite heavily involved, at the present time, through the school lunch program, in an attempt to get food to the so-called urban poor or, indeed, the rural poor. The basis upon which these programs are operated and what can be expected of them assumes that we have a sound general knowledge of what our food needs are. But, indeed, there is very little scientific evidence to show what are the key elements that must be considered in manipulating diets for their general dietary adquacies.

CHOLERA

We feel that studies done outside the United States can provide this type of information much better than is possible in the very complex society in which we live.

Some of the problems in the Japanese-American program are now quite serious problems to our very substantial investment of U.S. nationals in these areas. Cholera is one of these.

Actually, the bulk of the funds that are being spent in cholera research by NIH come from AID funds that are assigned for use in Southeast Asia. Very little of our money goes into it.

As a result of this type of study over the past 4 or 5 years, it now begins to emerge that it is not unlikely that we may come up with a high specific antitoxin.

We have at the present time some 450,000 troops at risk in an area where cholera is not unknown. We have very large commitments in terms of other civilians, both Government officials and those engaged in industrial aid out there. This disease is spreading. It is now fairly extensive in the Philippines, it has been observed in Bangkok, it is now in the Near East, and, indeed, earlier in the history of our own Nation it was in epidemic form in the United States.

So that I think, taking a broad view of national interest, that it makes sense to attempt to bring the modern methods of science to bear on the solutions of this disease and, indeed, the solution would appear to be in sight.

PARASITIC DISEASES

Much the same talking not so much about the immediate purposes as the general purposes of the United States- can be said of the diseases that come under the category of parasitic diseases. While— malaria, filariasis, or schistosomiasis only affect a small segment of our domestic population generally, that is, in Puerto Rico-they do constitute very broad threats to the substantial number of Americans who are now working overseas. Our activities in this particular program provide that additional edge that permits some controlled studies that are not possible in the normal range of domestic researchgrant projects.

We are talking about a sum of money in the Office of International Research that amounts to about $7.1 million, of which about $5 million is for grants. I do not know our precise figure for research grants in general but it would be, at this stage, something in excess of $600 million. So we are talking about a small fraction of the research grants that we feel will have profound impact both on some of our domestic disease problems as well as some of the problems that U.S. nationals face when going abroad.

Mr. Chairman, I would say research and development is now amounting to a very substantial sum in this Nation. I believe the aggregate sum is about $23 billion, of which some $16 or $17 billion is derived from Federal funds. I think it is very important to realize, too, though, that the funds from the Federal Government going to the support of the type of activity we are discussing here are largely concentrated within the budgets of the National Institutes of Health.

You may recall that I tried to impress on the committee our conviction that when one breaks the general budget down-first into categories, then into the major disease entities that compose the category, then into the major disease-one gets a more accurate picture of the money that is being expended in terms of causation, cure, and understanding the disease. The figures that I presented to the committee, first, for the Heart Institute, then for heart disease and then hypertension, ended up by our allocating $9 million to the study of the causation of a serious disease that affects 15 percent of all adults.

In the past 10 years, as a result of money of that general order of magnitude, it has been possible to develop treatment methods so that deaths due to hypertension have been cut by something like 45 percent in the past 10 years. This permits now the swing of emphasis to causation, in the hope of clarifying causation to provide definitive answers for prevention.

I would be the last one, Mr. Chairman, either to minimize the importance of medical research or to minimize the very broad support that the people, through its Congress, are now giving to medical research.

On the other hand, the problems are great, the stakes are very high, and I think that the very extensive progress, in disease area after disease area, warrants the substantial confidence of the American people in the biomedical sciences.

That is a long statement, sir, but I feel it.

REGULAR PROJECT GRANTS

Mr. NATCHER. You are doing all right, Dr. Shannon.

For your regular project grants you have an increase of $1,653,000 but I notice that $3,744,000 is needed to finance noncompeting continuation grants. So you will actually have to cut back by $2,091,000 on new projects.

Now tell us a little about the type of research that you are conducting here and give us a few examples of some of your worthwhile results. Talk to us about this sizable cutback, Dr. Shannon.

Dr. SHANNON. Yes, sir. That is a combination of research project grants to former international postdoctoral fellows and those program areas that normally would be encompassed within the Japanese-American program. But, if I may confess some confusion, I would like to analyze this further before commenting. As I told Mr. Moyer this morning, I spent some 3 hours in preparing for this and I told him I was sure the committee would be confused because when I finished I was pretty confused.

Mr. NATCHER. Suppose you do, Dr. Shannon, prepare a statement

now.

EXPLANATION OF RESEARCH GRANT REDUCTION AND STATEMENT ON UNITED STATES-JAPAN COOPERATIVE MEDICAL SCIENCE PROGRAM

Dr. SHANNON. When it comes to the substance of what is cut out, I would have to refer to the detailed records.

Mr. NATCHER. And in preparing this statement, not only tell about the cutback of the $2,091,000 but also put some details in the record regarding the United States-Japan cooperative program.

Dr. SHANNON. This I would be delighted to do.

(The information follows:)

The question concerning the $2,091,000 reduction relates to a table which shows a net increase of $2,259,000 for research grants. The reduction of $2,091,000 is associated with continuing research grant commitments for two programs with the only significant change occurring in the U.S.-Japan Cooperative Medical Science Program. The table reflects increased needs for continuations of grants awarded in 1967. It also reflects a reduced need for new grants to be initiated in 1968. Although there is a reduction in new grant requirements, the combination of continuation and new reflects a need for a total program increase. JANUARY 1967.

REPORT TO CONGRESS PURSUANT TO SECTION 5(h) OF PUBLIC LAW 86-610 (THE INTERNATIONAL HEALTH RESEARCH ACT OF 1960)

UNITED STATES-JAPAN COOPERATIVE MEDICAL SCIENCE PROGRAM

General background

President Johnson and Prime Minister Sato, mindful of the many areas of human health which are of great concern to all the peoples of Asia, agreed on January 13, 1965 to undertake a greatly expanded program of cooperation in medical science. As a first step to implement this agreement, they arranged to convene a conference of the foremost medical scientists from the United States and Japan to work out the details of the new program. The U.S.-Japanese Joint Planning Committee held a planning conference in Tokyo on April 19-21. 1965. This was followed by a Joint Committee Meeting in Honolulu during October 4-7, 1965 and subsequently in Hakone, Japan during August 17-19, 1966. Public Health Service Delegation of Authority Number 118 was granted on May 5, 1966, to authorize the Director, National Institutes of Health and the Chief, Office of International Research, NIH to perform specified functions relating to the United States-Japan Cooperative Medical Science Program.

78-317-67-pt. 5—47

The scope of the United States-Japan CMS program

The program is concerned with the diseases of great health importance in Asian countries. These diseases or categories of diseases include: cholera, tuberculosis, leprosy, virus diseases (arbovirus, respiratory virus, smallpox, and rabies), parasitic diseases (schistosomiais and filariasis), and malnutrition.

The area of Asia to be considered under the program is not rigidly defined, but it is understood that it may include the Republic of Korea on the north and India and Pakistan on the west, as well as other adjacent countries in the far eastern area.

Primary emphasis will be placed on medical research as the basis for advanced knowledge necessary to effective action. Field research may be undertaken when deemed necessary or desirable.

The program will operate initially within a bilateral governmental framework. Nevertheless, it may involve the participation of scientists of third countries, of appropriate facilities in such countries, and collaboration with international or other organizations.

Organization

The United State and Japanese Governments have appointed members to constitute a U.S.-Japan Cooperative Medical Science Committee. The United States delegation to this Committee is appointed by the Secretary of State for a period not to exceed four years. The delegation, in addition to representing the U.S. at meetings of the Joint Committee, advises the Secretary of State on the scope, direction and other broad aspects of the program and develops plans and proposals to assure that the program meets all the purposes for which it was established. It has designated the six areas of research mentioned above and established Panels in each disease category to implement the research program. A list of the Committee members is attached.

Appointments to Panels have been made by the Director, NIH, and each Panel consists of no more than five members. The period of appointment will not exceed three years and may be renewed. Consultants may be nominated by each Panel for appointment by the Committee in keeping with the scientific requirements. A list of the Panel members is attached.

The Department of State is responsible for the foreign policy and foreign relation aspects of the Program and the Department of Health, Education, and Welfare is responsible for the scientific conduct of the Program.

The United States and Japan maintain separate secretariats. The Office of International Research, National Institutes of Health, functions as the U.S. Secretariat.

Financial support for the program

The United States and Japan share the costs of the program. Projects of U.S. scientists will be supported by the United States and those of the Japanese scientists by Japan. The exchange of scientists between the two countries is encouraged as a matter of principle and is to be supported by official or unofficial agencies of either country.

The National Institutes of Health, based on the delegated authority under P.L. 86-610, will provide for the support of scientific projects, will be responsible for the organization, funding, and conduct of all scientific meetings held in the United States, and will provide financial support to the United States Panel members and consultants for attendance at meetings related to the U.S.-Japan C.M.S. Program.

Implementation of the program

In order to discuss and recommend measures to carry out the program agreed upon by President Johnson and Prime Minister Sato, a Joint Planning Meeting was held in Tokyo in April, 1965.

On the basis of the recommendations made at that Meeting to the Government of the United States and to the Government of Japan, the opening Conference of the United States-Japan Cooperative Medical Science Committee and its Panels was held in Honolulu on October 4-7, 1965.

Convened at this Conference were the meetings of the Committee, of the Panels on each of the diseases selected at the Planning Meeting; (a) cholera, (b) tuberculosis, (c) leprosy, (d) certain respiratory and insect-borne virus diseases, and (e) the parasitic diseases, schistosomiasis and filariasis, and the Plenary Session which all the members of the Committee and its Panels attended.