contribute to the most effective use of time and capability of foreign visitors. A minimum staff with appropriate language and procedural knowledge would be provided for this purpose. The above elements would compose the major functions proposed for the International Center. The Center could with time serve a substantially broader international role by serving as the instrument to carry out all the functions encompassed in the authorities made available to the President under P.L. 86-610. This matter presents a number of questions which need greater exploration or some operating experience before conclusions on such a broader role could be reached. FUNDING REQUIREMENTS AND SOURCES The proposal for the International Center for Advanced Study in the Health Sciences encompassing a program as outlined above is estimated to require a facility for the main structure which would provide approximately 123,000 gross square feet. This structure would provide for the following: 6 conference rooms for 50 people each. 6 conference rooms for 200 people each. 1 conference room for 100 people. Auditorium for 300 people. Translating facilities. Exhibit space. Reception lounge. Lobby and reservation area. Office space for a staff of 200. 15 living apartments for distinguished scholars-in-residence. 25 overnight sleeping units. Cafeteria with seating for approximately 300 persons. Multilevel parking for 400 cars. The estimated cost breakdown for the construction of this facility is as follows: Land acquisition. Planning Total $820,000 9, 330, 000 10, 150, 000 A preliminary analysis of the detail of these construction costs is contained in an attachment to this document. These estimates exceed prior calculations of the cost of an International Conference Center at NIH by a substantial amount. These increased cost are due to the following factors: a. Broadening the scope of the proposed facility to encompass a scholarsin-residence program and the administration of additional operating activities such as International Fellowship Program and the coordination of foreign visitors to NIII. b. The development of a design and architectural form of high quality consistent with the international stature of the activity and its identification as a memorial to the late Representative Fogarty. c. Expansion and addition of service elements related to the cafeteria, multi-level parking, reference, reading and reception facilities. d. Increased material and construction costs since the time of previous estimates. The estimated operating costs for this facility must be viewed as very tentative since full details of the operating programs have not been entirely fixed. Current estimates are as follows: The scholars-in-residence program. The fellowship program__. The international conference and seminar program_ Total $1,500, 000 7,250,000 2, 000, 000 500, 000 1, 500, 000 12, 750, 000 Not all of this amount would represent increased appropriation since some current NIH activities, e.g., the International Postdoctoral Fellowship Program, would be transferred to the Center. A preliminary rough estimate of such exist ing expenditure would total $2.0 million. Furthermore this total represents overall operating costs at the time all programs have reached their full operating level. It is expected that the development of these programs will be spread over a period of from three to five years. Thus the phasing of operating cost requirements might run roughly as follows: Fiscal year 1968: The assembly of staff and costs of initial arrange ments - Fiscal year 1969: Initiation of program_ Fiscal year 1970_. Fiscal year 1971. Fiscal year 1972__. $750,000 3, 000, 000 7,500,000 10, 000, 000 12, 750, 000 The source of funding for the planning and construction and initial operating costs is visualized as follows: a. It is proposed that some part if not all of the planning monies for this Center be sought through reappropriation of unobligated fiscal year 1967 balances in NIH program accounts. This would permit immediate initiation of planning activities. b. Full construction costs be sought as a supplement to or an amendment of the President's Budget for fiscal year 1968. c. These additional operating funds required for expenditure in fiscal 1968 would also be sought as a supplement to or an amendment to the President's 1968 budget. ORGANIZATIONAL AND PROGRAM RELATIONSHIPS It is proposed that the International Center for Advanced Study in the Health Sciences be located physically in Bethesda, Maryland, on the grounds of the National Institutes of Health. A suitable site east of the present Stone House building and west of the Library of Medicine is available for this purpose. It is planned that the International Center would be established as a component of the National Institutes of Health under the general supervision of the Director, NIH. Its plan of operation should provide for a Board of Advisors appointed by the President upon recommendation by the Secretary, reflective of the Federal, scientific and international interests to be served by the Center: The Center should be administered by a director chosen from candidates recommended by the Board. The position of the Director should be excepted from the Classification Act with a salary adequate to command the best talent in the Nation. There should be adequate provision for supergrade or other excepted positions for the supporting staff of the Center. The operating arrangements for the Center should provide for close working relationships with the National Library of Medicine and other Federal facilities in the Washington area. Further details on the operating plan for the conduct of the Center are in process of preparation. It would appear that no new legislative authority is required for the conduct of the programs of the Center if full use is made of the Presidential authorities contained in P.L. 86-610. Mr. LAIRD. Is there anything you wish to add at this time that is not in the material which has been inserted in the record? Dr. SHANNON. I understand that the Department is going to send you a document that is called proposal for an international center for advanced study in the health sciences, which is basically the document we sent to the Department. This traces the development of the need, the development of the idea, and mentions the individuals and events that have contributed to this development starting with Senator Hill in 1959, the International Health Research Act of 1960, the report of the group appointed by Dr. Burney to advise on the reorganization of the Public Health Service which pointed out that there was a need for an advanced study center. It quotes Mr. Fogarty's statement of 1963, and, I believe, some comments relative to the importance of international research to inter national relations by President Kennedy, Senator Humphrey's endorsement of John Fogarty's proposal, and then some of the discussions we had here in the appropriation hearings. I think it contains the whole historical background. It then touches on how the Center should be supported, what its program should be, and roughly what it would cost. I think it is a very complete document that will stand on its own feet. LETTER FROM DR. ROBERT C. BERSON Mr. LAIRD. I would like placed in the record a letter I recently received on this subject from Dr. Robert Berson. (The letter follows:) Congressman MELVIN R. LAIRD, House of Representatives, U.S. Capitol, Washington, D.C. ASSOCIATION OF AMERICAN MEDICAL COLLEGES, Washington, D.C., March 29, 1967. DEAR CONGRESSMAN LAIRD: When John Parks and I had the pleasure of being with you on February 15th, you indicated you would welcome suggestions about the proposed John E. Fogarty Memorial. In the interest of saving your time, I want to pass on our suggestions in writing, although we would, of course, be delighted to discuss it at any desired length. We have had some opportunity to discuss this matter with our colleagues on the Executive Council of the Association of American Medical Colleges, and know that they share our views. In our opinion, a very important and large part of this memorial should be a program of "Fogarty Fellowships" which would make it possible for members of the health team now in U.S. institutions to spend periods of study or research at NIH or in institutions in foreign countries, and for individuals now in foreign institutions to spend periods at NIH or in U.S. institutions. We think it would be useful if the terms were broad so that the fellowships would be available not only for senior medical scientists but also for members of the team at all stages of their development. There is a rather high degree of interest among medical students, residents and younger members of the faculty in U.S. institutions in opportunities to learn about and contribute to health problems in other lands. Some of us are convinced that such opportunities when the individual is relatively young, have a more constructive influence on his later development and attitude. A good many individuals find it difficult to adjust to, or make maximum utilization of, such opportunities when they are relatively late in their careers. It now seems quite clear that there are numbers of members of the "health team" such as nurses, physiotherapists, medical technologists, hospital administrators, health economists or medical sociologists who can make contributions through, and benefit from, such opportunities. No doubt, most of the fellowships should go to medical scientists or physicians, but we would hope that terms of reference of the program are sufficiently broad for fellowships to be awarded to some other members of the health team. John Fogarty was explicit in expressing an interest in an international center at NIH. We believe that a part of the memorial to him should be such a center, that it should provide reception facilities for visiting scholars, probably including temporary quarters and food services, as well as facilities for conferences, seminars and lectures. We hope NIH will recommend that a staff be organized to receive such visitors to plan an organized program of lectures, seminars and conferences, and that the present program of international postgraduate awards be administered through this staff. These things seem sound and desirable to us. Finally, we believe that a suitable memorial to this great American should be a substantial and stable program which can grow as its usefulness is demonstrated. Sincerely yours, ROBERT C. BERSON, M.D., PROPOSAL FOR EYE INSTITUTE Mr. LAIRD. Dr. Shannon, I have been receiving quite a few letters from doctors and scientists and various people who have dealt very closely with the National Institute of Neurological Diseases and Blindness. They are concerned about the efforts being made in some quarters to divide this Institute. As you know, some people want to create a separate Institute on Hearing, a separate Institute on Sight, a separate Institute on Speech, a separate Institute on Muscular Dystrophy, a separate Institute on Parkinsonism, a separate Institute on Multiple Sclerosis, a separate Institute on Mental Retardation. Most of the activities in these fields I have named-and I have named just a few of them-are now the responsibility of the National Institute of Neurological Diseases and Blindness. I wish you or someone on your staff could spend some time educating the people who want to divide these Institutes. Take them out there and show them how the National Institute of Neurological Diseases and Blindness actually operates. When you start dividing these Institutes into separate Institutes, just from my experience on this committee since the Department of Health, Education, and Welfare was created, you run into tremendous administrative expense. What is the administrative expense, without doing a bit of research, involved in the creation of a new Institute? Dr. SHANNON. I have looked into that in relation to this proposal. It costs about $300,000. Mr. LAIRD. Just to pay the Director and his immediate staff? Dr. SHANNON. And to get intramural teams and to provide the apparatus to develop a program and ride herd on even a small pro gram. Mr. LAIRD. I understand some legislation has been introduced to divide out the sight work or the eye work. Dr. SHANNON. There has been, indeed. Mr. FLOOD. There were about 50 or 60 bills in the House and more in the Senate. LETTER FROM DR. PAUL C. BUCY Mr. LAIRD. A great deal of effort is being made to get individuals to introduce these bills. It concerns me. I have a letter in my hand from Dr. Paul C. Bucy, professor of surgery at Northwestern University Medical School, a very thoughtful letter which I would like to put in the record at this point, in which he explains the difficulties of this idea of continuing to create separate Institutes out there. I would like you to discuss this a little bit from the standpoint of your background and experience with the National Institutes of Health. Mr. FLOOD. I think that letter should go in the record. I have one, I imagine pretty much the same letter. (The letter follows:) Hon. MELVIN LAIRD, House of Represesentatives Office Building, CHICAGO, ILL., February 10, 1967. DEAR CONGRESSMAN LAIRD: It has come to my attention that a determined effort is again being made to subdivide the National Institute of Neurological Diseases and Blindness (NINDB) by creating a separate Institute concerned with eye diseases. For almost 15 years I have been associated with NINDB in an advisory capacity. I believe that this experience has provided me with an above average understanding of the operations of that Institute. Of course, my associations with the Institute have always been as a civilian outsider, not as a member of its administration or staff. In my opinion the establishment of a new Institute to deal with eye diseases would be undesirable. The eye is intimately related to the nervous system. Except for conditions within the eye itself it is seldom possible to separate consideration of the eye from that of the nervous system. Basic research concerned with disorders of the eye and those of the nervous system are inseparable. An understanding of the eye itself and of its diseases requires an understanding of the nervous system. It is rational and desirable, therefore, that the Institute concerned with research having to do with the eye and the nervous system should be one-not two. Should a separate Institute for the eye be established the greatest loss would be to those concerned with the eye, not those concerned with the nervous system. Nevertheless, there would be a loss to both. NINDB has been an extremely well administered Institute. It has never shown even the slightest prejudice or preference for any of the component disciplines with which it is concerned-neurology, neurological surgery, ophthalmology, otolaryngology. In other words, the eye and its diseases has never suffered from being the concern of this Institute. To establish another Institute would require the creation of another complex administration within NIH. This would necessitate an additional large expenditure of public funds to create an unnecessary additional administration for this new Institute. This is probably the least important of the considerations, but it is not an unimportant one. If I believed that ophthalmology would benefit by the creation of a new Institute I would support it, but I do not believe this is the case. Though must also be given to further expansion of this tendency. If a new Institute is to be created for ophthalmology should other separate Institutes be created for otolaryngology and for neurological surgery? I believe this effort to divide NINDB should be avoided. Should you desire I would be happy to discuss this matter with you at any time. Sincerely yours, PAUL C. BUCY, M.D., Professor of Surgery (Neurosurgery), Northwestern University Medical School. Mr. FLOOD. As a matter of fact, Doctor, in case Mr. Laird is not aware of it, I believe you met as recently as yesterday or the day before at a conference with 15 or 20 Members of the House who introduced this bill, did you not? COMMENTS ON PROPOSAL BY DIRECTOR OF NIH Dr. SHANNON. Yes. Two days ago Assistant Secretary Lee, Assistant Secretary Huitt, and I met with Senator Hill, who is one of the sponsors of this legislation in the Senate, to discuss the advisability and the need for an expanded program, and the inadvisability of setting up a separate administrative organization to accomplish this objective. Yesterday, at the request of Representative Young of Texas, we had a somewhat similar conversation. I would judge there were 10 or 15 Members of Congress who had an interest in this legislation |