clarified their goals and program policies, the grant mechanisms were refined, and a stable administrative apparatus was developed. The grant mechanisms were well established and the direct operation was well underway by fiscal year 1956. The eight appropriations for the National Institutes of Health for that year totaled $98.5 million of which $40.5 million was for research grants and contracts, $17.3 million for training grants and fellowships, $28.3 million for direct research, $10.4 million for public health and disease control activities, and $2 million for administration and program management. The next step in the evolution of the NIH programs was the passage of the Health Research Facilities Act of 1956. This legislation, which authorized matching grants for the construction of research facilities, rounded-out the scope of NIH activities so that they then had available the essential mechanisms for the development of a meaningful research program national in scope. NIH could finance the training of scientists, it could enhance the physical plant available for scientific endeavors, and it could provide for the assistance needed in the actual conduct of research. The period of rapid program expansion was initiated after Mr. Folsom, who was then Secretary of HEW and deeply concerned about the consequences of serious illness, undertook a thorough inquiry into the quality of the NIH operations, the opportunities that existed for productive research, and the level of funding that would be required to take advantage of these opportunities. He came to the conclusion that the expansion of productive research should be limited only by the number of highly qualified scientists available. He proposed substantial increases in the NIH budget both for research and for training. The Congress immediately responded to his assessments of the problem. Broad program needs were immediately satisfied and from 1957 through 1963 the appropriations were increased, largely as the result of specific actions by the Congress, at a rate of approximately 30 percent per year. For 1965-which ended a decade of very rapid, across-the-board growth-the cost of this new complex enterprise was at the level of $1.0 billion. Program development since 1964 has not been as general or undifferentiated as it was during the period of rapid growth. Rather, this has been a period of selective development. The NIH has continued to support activities which, by scientific consensus, are considered to be important and relevant to serious disease problems. However, increasing staff time has been devoted to an analysis of the ongoing activities and deficient areas have been identified for special examination. Frequently it was found that these areas, though important, were not progressing because they did not conveniently fit into the usual discipline orientation of the academic enterprise. It became increasingly obvious that special organizational arrangements would be required if such fields were to flourish and to make their contributions to the complex of problems under study. Some of these program-problem areas are of sufficient importance to list as examples of this programing activity: Special problems that relate to the causation of cancer and the intimate interplay of chemicals and viruses; Problems of aging, many of which involve complex and inter-acting biological, psychological, environmental and social factors; Research in pharmacology and toxicology which is concerned not only with drug development and the identification and prevention of adverse reactions but also with the problems created by the increasing chemical hostility of the manmade environment in which we live; Development of the dental sciences to establish a sounder scientific base for the advancement of modern dentistry; Problems of child development which, as in the case of aging, involve a complex array of factors and which can result in life-long disabilities and vulnerabilities to disease; and, finally, Greater emphasis on special problems, such as deafness, and disease that can result in blindness. The definition of some of these broad problem areas led, very early, to the establishment of two non-categorical Institutes which became operational in 1963. The National Institute of Child Health and Human Development was established because the categorical, disease-oriented approach of the other Institutes is not well-suited to the exploration of problems that involve the complex problem of human development. A more comprehensive research approach is needed to shed light on this cycle of experience that is common to every human being. The creation of the National Institute of General Medical Sciences recognized that the categorical programs of the major Institutes depend on many commo areas of science no one of which could properly be assigned to an individua Institute. The vigor of these common areas is an important determinant of pros ress in each and every Institute. The new Institute was assigned responsibilit for the health and vigor of these common scientific undertakings. A new dimension was added to NIH by the Heart Disease, Cancer and Strok Amendments of 1965. The assignment to NIH of responsibility for the Regiona Medical Programs constitutes a major commitment to a program that, thoug research-related, is primarily service-oriented. This program grew out of the recommendations of the President's Commissio on Heart Disease, Cancer and Stroke. Simply stated, its purpose is to extend th excellence of medicine in the academic setting to the primary battle ground o disease where it occurs, that is, in a community setting. The present programs of the National Institutes of Health now comprise fiv major groups of activities: (1) The conduct of research in its own laboratory and clinical facilities and through contracts with other institutions; (2) The support of research through grants; (3) The support of training of highly-qualified scientists and clinicians for research careers; (4) The construction of health research facilities through matching grants; and (5) The support of a national program to strengthen medical service through the new Regional Medical Programs. I should like to indicate briefly how the $1,187,250,000 requested for FY 1968 is distributed among these five major activities. Funds for direct operations include $81.7 million for the conduct of research by the NIH scientific staff and $113 million for goal-oriented collaborative projects $644.5 million is for the support of research through grants; $194.6 million is for the training grants and fellowship programs; $35 million is requested for the Health Research Facilities Construction program; $59.4 million is for the new Regional Medical Program; $59 million is for other direct operations, program direction, administrative services and management of the extramural program. The bulk of the NIH budget is devoted to the support of medical research, and closely related activities, outside its own laboratories and clinics. However, funds requested for research conducted by NIH itself, are substantial. The extraordinary excellence of these scientific activities set the level of excellence of the whole enterprise. The competence and personal involvement of NIH scientists with the major research problems on the frontiers of the biosciences provides a solid and indispensable intellectual base for all other NIH activities. The Committee will wish to consider what role the NIH programs should play in the future and to decide in the light of the testimony for the various Institutes-what activities are desirable and feasible. I am confident that the amounts requested in the budget estimates will be amply justified by the benefits that will accrue to the people of this country from the activities that these funds will support. Dr. SHANNON. Mr. Chairman, the statement that I have submitted embraces the general development of medical research in the Nation and its relationship to the parallel development of the National Institutes of Health, and ends by outlining the activities that will be funded by the budget request which is before you. I thought it would probably be appropriate, with a number of new members on the committee, to address myself to the generalities of the program and put before you certain comparative measurements of research and development, the Federal role in research and development in the biomedical sciences, and particularly the role NIH plays in this and certain derivative considerations from these facts. Mr. FLOOD. What is biomedicine? This record should show the meaning of some of these medical terms. Dr. SHANNON. Biomedicine is a vernacular term, which has come into use during the past 10 or 15 years, that encompasses all the fields. of research that are relevant to the ultimate solution of the problems of medicine. These fields, necessarily, include many biological disciplines that are not directly concerned with specific considerations of the disease itself. It is a rather all-embracing term that includes behavioral, biological, and clinical research in one package. I think the term "biomedical research" probably is more descriptive of the total NIH activity than any other single term. Mr. Chairman, I have a series of relatively simple charts which will reproduce very well in black and white. We were able, through Mr. Fogarty's courtesy, 2 years ago, to insert similar charts in the record, because they highlight certain salient features of the operation and make the text much more understandable. Mr. FLOOD. Without objection, we will insert the charts at the appropriate places in the record as you progress with your testimony. (The first chart follows:) ALL RESEARCH AND DEVELOPMENT AS A PROPORTION OF GROSS NATIONAL PRODUCT NATIONAL EFFORT IN RESEARCH AND DEVELOPMENT Dr. SHANNON. The first chart, Mr. Flood, outlines the increase in all research and development, from all sources, in the period 1950–67. Mr. FLOOD. Represents what? Dr. SHANNON. All research and development, regardless of source, in the entire Nation in 1950 as contrasted to 1967. In 1950, the gross national product was $285 billion. Research and development amounted to $2.9 billion. In 1967, the estimated gross national product is $787 billion and it is estimated that $23 billion will be spent on research and development, again from all sources. Mr. FLOOD. How is that ratio standing up? Dr. SHANNON. It changes from 1 percent in 1950 to an estimated 3 percent in 1967, with the largest part of that change taking place subsequent to 1957. Mr. FLOOD. Of course, that 3 percent has built up over a series of years. Dr. SHANNON. During the past 15 years, more particularly during the past decade. MEDICAL RESEARCH AND DEVELOPMENT MEDICAL RESEARCH AS A PROPORTION OF The second chart portrays medical research and development as part of total research and development. Of the $2.9 billion for all research and development in 1950, $161 million was for medical research. Of the $23 billion in 1967 an estimated $2.3 billion will be expended for medical research and development. That represents a change from 6 percent of all research and development being in the medical sciences in 1950 Mr. FLOOD. How long have you been running this shop? Dr. SHANNON. Twelve years, sir. This represents an increase from 6 to 10 percent. Mr. FLOOD. Actually, the great percentage of this has come about during your tenure. Dr. SHANNON. Yes, sir. This chart is very important because the growth of research has too frequently been described as uncontrolled and unrestrained. The activity has been accused of having money to burn or overstuffed programs or money that cannot be used effectively. I would call to your attention the base in 1950, which was $161 million. If you divide that between 9 Institutes, such as we have today, it would be less than $20 million per Institute. If it were divided between the 80 medical schools and 40 dental schools, it would amount to $1.3 million per institution. It would support the work of less than 5,000 full-time scientists. On the basis of 50 States, it would amount to the expenditure of $3.2 million on medical research per State. In 1950, the medical schools, hospitals, and research institutions had recovered from World War II. They had reassembled their staffs. Broad use had been made of the GI bill of rights which had produced a very large reservoir of trained scientists for whom there was no support. Mr. FLOOD. This indicates that military service does not necessarily destroy an interest in proceeding with learning after service. Dr. SHANNON. I would agree, sir, that the motivation to learn subsequent to service is substantial. During the war I had a substantial number of young officers assigned to me, and more than 80 percent of them are now full professors spread across the Nation. Mr. FLOOD. In my class in college for my bachelor's degree in 1924, right after World War I, there were so many veterans that the nickname of the class was "The Soldats and the Gobs." Dr. SHANNON. Mr. Chairman, I graduated from college in 1925, and we, too, had a substantial number of people who were in college subsequent to service in World War I. The increase in medical research from 6 to 10 percent of all research and development is, in part, a reflection of the simple expansion of all technology and of all of our national ventures as we move into a new type of technically oriented society. But, in part, it remedies a gross deficiency, and reflects an appreciation of the very broad capabilities of medicine and medical research to provide new knowledge of direct relevance to the ills and ailments of our people. It represents a determination to launch a very broad attack on major areas of disease and disability that show marked opportunity for advancement. RESEARCH PROJECTS TERMINATED BY NIH Mr. FLOOD. Did you ever abandon a research project? Dr. SHANNON. Yes, sir. I left medical school in 1929 and had experience in a hospital in 1929 through 1931. I joined the staff of the department of physiology for the subsequent 9 years. I was heavily involved in radiophysiology which was then in process of developing most of the modern techniques that are now used in that field of research. I left it and joined the department of medicine and undertookMr. FLOOD. I mean at NIH. Dr. SHANNON. Oh, yes, sir. Mr. FLOOD. Suppose you provide at this point in the record a list of research projects that started out glowingly, but that you eventually abandoned. Dr. SHANNON. I can mention one that started off very glowingly but which washed out, although this is unusual. In the early days of my appearance before this committee, it appeared that glutamine, which is a derivative of amino acid, was likely to be the answer for |