SIGNIFICANT ITEMS IN HOUSE AND SENATE APPROPRIATIONS COMMITTEE ITEM REPORTS ACTION TAKEN OR TO BE TAKEN 1967 Senate Report components of the NIMH grant programs, and the planning and operational grants made by the Division of Regional Medical Programs will be excluded in computing the contributions to the program for fiscal year 1968 and in determining the grantee institutions' entitlement to general research support grants. (1) The committee directs that the (1) The demonstration and service demonstration and service components of the NIMH grant programs be excluded in computing the Institute's contribution to the program for fiscal year 1968 and in determining the grantee institutions' entitlement to general research support grants. The committee also points out that neither the planning nor the operational grants made by the Division of Regional Medical Programs-which is primarily service- rather than research-oriented-should be included in the general reesarch support program calculations. INTRODUCTION The General Research Support grants program contributes to the development of research capabilities of institutions so that they may become effective partners with the Federal Government in the pursuit of biomedical research objectivies of national importance. This is accomplished by: (1) providing flexible general support to both health professions schools and other university graduate schools and components so as to enhance the effectiveness of the research projects underway at the institution, to redress imbalances in institutional research activities, and at the same time permit the development of institutional objectivies along self-articulated lines; and (2) support designed to accelerate the advancement of existing capabilities in health research and related graduate research training activities within institutions which have demonstrated an appropriate base for the achievement of scientific excellence. PROGRAM PLANS Traditional General Research Support Program.—This program will continue to provide encouragement to institutions to meet emerging opportunities in research, to explore new and unorthodox scientific ideas, and to use research funds in ways that will contribute to long range institutional development for the improvement of health research and of the research environment rather than depend on the specifics set out by research grants projects. It makes possible the recruitment of faculty and other professional personnel, the retention of senior investigators, and the support of research associates and research trainees in a variety of disciplines. In addition, general research support funds are used to initiate, support and expand research facilities, exclusive of construction costs, needed by many investigators within an institution. Other uses of general research support funds include the support of travel of scientists to professional meetings, the creation of new research and research training opportunities, the support of exploratory research projects by young investigators and the acquisition of costly apparatus necessary for the proper conduct of research activities. Under this program, approximately 296 separate awards are now made to schools of dentistry, medicine, osteopathy, pharmacy, public health and veterinary medicine, and to hospitals, research institutes, research fundations, and State and municipal health departments. Biomedical Sciences Support Grant Program.-This program extends general research support to non-health professions schools. The NIH has long recognized the importance to the nation of the contributions to the health sciences made by investigators and teachers in academic components not covered by the General Research Support program, as demonstrated by the fact that a significant proportion of NIH research project grants, graduate training grants, center grants, etc., go to these components. It is essential that flexible general research support funds be provided in order that the project-oriented funds may be utilized most effectively in these components, and that they may have the same benefits that now accrue to the health professions schools. Approximately 100 institutions are funded under this program in 1967. Health Sciences Advancement Award Program.-Funds were provided in 1966 to establish a program of grants for health sciences advancement purposes to institutions primarily graduate academic institutions. Unlike the General Research Support program which rewards attained excellence, this new program emphasizes promise and opportunity and is conceived to be a means for providing time-limited support for a well defined effort by the institutions to advance to a new level of achievement in research and research training in the health sciences. Approximately eight health sciences advancement awards will be made in 1967. DISTRIBUTION OF FUNDS BY PROGRAM AREA, IN 1968 The requested amount of $61.7 million, an increase of $10.0 million, would be distributed as follows: $43.2 million for General Research Support to approximately 310 institutions; $7.5 million for Biomedical Sciences Support Grants to approximately 115 institutions, and $11.0 million for health Sciences Advancement Awards to approximately 22 institutions. The following table illustrates the 1967-68 distribution of general research support grants as proposed in this estimate: DR. ROBERT Q. MARSTON, DIRECTOR, REGIONAL MEDICAL PROGRAMS DR. JAMES A. SHANNON, DIRECTOR, NATIONAL INSTITUTES OF HEALTH KARL D. YORDY, ASSISTANT DIRECTOR, DIVISION OF REGIONAL MEDICAL PROGRAMS JAMES LAWRENCE, FINANCIAL MANAGEMENT OFFICER, DIVISION OF REGIONAL MEDICAL PROGRAMS RICHARD L. SEGGEL, EXECUTIVE OFFICER, NATIONAL INSTITUTES CHARLES MILLER, FINANCIAL MANAGEMENT OFFICER, DR. WILLIAM H. STEWART, SURGEON GENERAL G. R. CLAGUE, ACTING CHIEF FINANCE OFFICER NA JAMES B. CARDWELL, DEPUTY ASSISTANT SECRETARY, BUDGET 1 Includes capital outlay as follows: 1966, $47,000; 1967, $50,000; 1968, $69,000. 2 Selected resources as of June 30 are as follows: Unpaid undelivered orders, 1966, $24,000; 1967, $24,000; 1968, $24,000. BIOGRAPHICAL SKETCH OF PRINCIPAL WITNESS Mr. FLOOD. We now have the regional medical programs about which we have heard a great deal down through the months. We have Dr. Robert Q. Marston, Director, regional medical programs. We have a biographical sketch of Dr. Marston which we shall insert in the record at this point. (The biographical sketch follows:) Name: Robert Q. Marston. Position: Associate Director, National Institutes of Health, and Director, Division of Regional Medical Programs. Birthplace and date: Toana, Virginia, February 12, 1923. Education: B.S., Virginia Military Institute, 1943; M.D., Medical College of Virginia, 1947; B.Sch. Oxon.), Oxford University, 1949; Intern, Johns Hopkins University, 1949-50; Assistant Resident, Vanderbilt University, 1950-51; Assistant Resident, Medical Colege of Virginia, 1953-54. Experience: Associate Director, National Institutes of Health, and Director, Division of Regional Medical Programs, 1966-Present; Vice Chancellor, University of Mississippi, and Dean, School of Medicine, 1965-66; Director, University of Mississippi Medical Center, and Dean, School of Medicine, 1961-65; Associate Professor of Medicine and Assistant Dean in Charge of Student Affairs, Medical College of Virginia, 1959–61; Assistant Professor of Bacteriology and Immunology, University of Minnesota, 1958-59; Assistant Professor of Medicine, Medical College of Virginia, 1954-57. Association memberships: American Medical Association, Association of American Medical Colleges, American Association for the Advancement of Science, American Federation for Clinical Research. Special honors: Rhodes Scholar, 1947-49; Markle Fellow, 1954-59. Mr. FLOOD. I see you have a statement, Dr. Marston. Do you have any backup people you want to introduce? Dr. MARSTON. Mr. Yordy, the Assistant Director of the Division of Regional Medical Programs is on my left, and Mr. Lawrence, behind me, is the budget officer for the Division. Mr. FLOOD. And over to the far left you have? Dr. MARSTON. Dr. Shannon. Mr. FLOOD. All right. Go ahead. GENERAL STATEMENT Dr. MARSTON. Mr. Chairman and members of the committee, a year ago I appeared before you on behalf of the regional medical programs for heart disease, cancer, stroke, and related diseases which were authorized by Public Law 89-239 only a few months previously in the fall of 1965. Now, 1 year later, you will be pleased to know that planning grants involving more than 80 percent of the population have been approved by the National Advisory Council. We are currently reviewing applications which will move this figure to over 98 percent of the population of the country. Four grants for initial operational activities have been awarded. Deeply involved in these activities are individuals representing the health professions, institutions, and organizations in these regions. I would like to call your attention to some of the objectives and plans outlined a year ago as a background against which to discuss the progress made during the last year and the plans for future action as the Nation moves into an even more vigorous phase in the implementation of this program. REGIONAL COOPERATIVE ARRANGEMENTS The principal purpose of this important new program is to provide the medical profession and the medical institutions of the Nation greater opportunity to make available to their patients the latest advances in the diagnosis and treatment of heart disease, cancer, stroke, and related diseases. This overall objective is to be accomplished through the planning and establishment of regional cooperative arrangements among medical institutions which can serve as the framework for linking programs of research, training, continuing education, and demonstration activities in patient care conducted by medical schools, medical organizations, research institutions, and hospitals. The regional cooperative arrangements are intended to assure close contact between the development of new medical knowledge and techniques in the environment of research and teaching and the delivery of high quality patient care in the hospital environment. There are a number of long-range factors and trends which led Congress to authorize this program. The most important of these factors is the impact of science on the nature of medicine and medical practice. The dynamic growth of medical research in this country during the past 20 years and the resulting advances in knowledge form a scientific base which is the beginning point for regional medical programs. Some of the other factors include the 40-year discussions on regionalization of medical services, the evolution of the medical schools with the accompanying development of great medical centers, the increase and upgrading of hospitals and health facilities with assistance from the Hill-Burton program, and the underlying social factors relevant to health concerns, including the rising expectations of the consumer of health services who increasingly is coming to expect modern medical science to have the solutions to his health problems. REPORT ON HEART DISEASE, CANCER, AND STROKE Over the years many public and private studies have been concerned with the problems this program seeks to solve. However, the immediate impetus for the introduction of legislation was the publication of the report of the President's Commission on Heart Disease, Cancer, and Stroke which focused on the relationship between science and service in medicine. The needs which were stressed by the President's Commission are in fact a statement of the great opportunities that exist for the improvement of the health of the American people. This committee, Mr. Chairman, deserves a full measure of the credit for the development of these opportunities. It is because we've seen the development of a great biomedical research effort, including the provision of modern medical facilities and the development of increased training opportunities for medical personnel, that we can seek to make more widely and promptly available the results of progress. The goals and purposes of regional medical programs represent unquestioned basic human needs. More than any other program I know, the primary question is not whether it would be good to have such programs but rather how well can they work. A detailed special progress report has already been submitted to the committee. It |