became a problem in immunology. Quite independently, other scientists were working on the fundamental biology of the immune process. For example, they found that new born animals do not form antibodies and are therefore tolerant of their own tissues. They learned that it is possible to suppress the formation of antibodies with certain drugs and with radiation. Furthermore, it is gradually becoming possible to type tissues like kidneys in much the same way as we type blood groups. As a result of 15 years of intensive laboratory research on these problems in immunology, we are now just beginning to be able to make successful kidney transplants in non-twins. In the 18th century, Italian physicist, Galvani observed a frog leg to twitch when certain combinations of metal were applied to it. He not only began the field of electro chemistry, but also made the first of a series of researches into the nature of bio-electric phenomena which has continued to this day. He certainly had no idea that his work would bear a direct relationship to the most modern form of treatment of patients suffering from heart attacks. Yet, the coronary care units which are now being built up throughout this country with the support of NIH funds would not have been possible without the basic researches carried out by Galvani and his scientific descendants. These coronary care units, which allow a continuous electronic monitoring of the electrical activity in the heart, and thus permit instantaneous detection and treatment of abnormalities, have reduced mortality from acute myocardial infarction by as much as 20%. Basic research on the genetics of bacteria and on viruses which infect bacteria have provided an astounding breakthrough in our understanding of the molecular basic of inheritance during the past 15 years. More recent work on the way in which the genetic material of micro-oranisms can be modified by chemical and psychical agents has opened up exciting new possibilities for control of the abnormal cell division which occurs in cancer. Innumerable similar examples could be cited. Perhaps I am particularly sensitive to the connection between basic research and clinical medicine because of my own career. I began my work at the Harvard Medical School 20 years ago on the role of salt in the development of experimental high blood pressure in rats. I soon realized that it was hopeless to understand the role of salt in this disease before we understood much more adequately the way in which normal cells regulate their salt composition. I therefore became interested in the functions of cell membranes. The exceedingly thin layer which divides the inside from the outside of all living cells. The way in which membranes control the movement of the positively charged ions, sodium and potassium, is very important in many cellular functions. These functions include the way in which nerve, skeletal muscle, cardiac muscle and smooth muscles (like those which control the size of small arteries and thus the blood pressure) can conduct impulses and transmit them from one cell to another. Membrane transport of sodium and potassium ions also underlies the capacity of glands like the kindey, the pancreas, the salivary glands, the microscopic glands which line the wall of the intestine, even the lacrimal glands which form tears, can produce their characteristic secretions. Indeed, without this regulated transport of sodium and potassium ions, the cells of the human body would tend to swell up and burst. Clearly, any fundamental progress in understanding this process would be of enormous value in many different aspects of medicine. Quite recently, we have been working in our laboratory with an antibiotic which is formed by a bacterium and which has the capacity to make artificial and natural membranes highly selective for potassium as compared with sodium. It is entirely possible that this compound may provide an important clue to understanding how human cell membranes distinguish between sodium and potassium and also how to design drugs which can accomplish this selection. Thus, the work of a micro-biologist interested only in bacteria and antibiotics may ultimately prove to be of great value in the treatment of membrane diseases of the heart and the brain. I may note in passing that, for the first time in my experience, scientists in the Soviet Union are making important contributions in the field of the physiology and the biochemistry of cell membranes. A similar statement can be made about France. In both cases, these developments are undoubtedly related to a marked increase in the investment which these nations have made in basic medical research. The world is not standing still. If we wish to maintain our present position of leadership in medicine, we must increase our investment in basic medical science. It is for you gentlemen to decide whether this matter is of sufficient concern not only to our citizens, but to people throughout the world to justify the kind of national effort which the United States can and, in my opinion, should make. The record HEALTH RESEARCH FACILITIES Following the Korean war, it became obvious that it was necessary to increase the amount of medical research carried on in the United States was required. It became particularly evident that we needed more laboratories in which our medical scientists could work. The Congress in its wisdom responded to this need by starting the Health Research Facilities Program in 1956. Since that time, this program has granted approximately $400,000,000 to more than 400 institutions for the construction of health research facilities in every state of the Union. Medical schools, dental schools, schools of pharmacy, hospitals and research institutes have all participated on a 50-50 matching basis with the Federal Government in this construction effort. With this response, we were able to meet the challenge of the times and assume a position of leadership in world medical science. Recognizing the value of this achievement and also taking note of the increasing needs for expansion of the program, the Congress passed the Health Research Facilities Act of 1965. The provisions of this act were based on a careful study of the needs of the Nation for construction of new and renovation of old health research facilities during the fiscal years 1967, 1968 and 1969. As a result of this study, you and your colleagues voted to allocate the sum of $280,000,000 for this purpose during the three year period. In direct opposition to these recommendations of the Congress, the President and his budgetary advisors recommended for expenditure on health research facilities only $21,000,000 in fiscal year 1967 and $35,000,000 for fiscal year 1968. Apparently, this group felt that the needs of the Nation for health research facilities had been largely met and that no substantial further expenditures were or are required. This decision on the part of the President has been a source of amazement to me and to my fellow medical scientists. I would therefore like to take a moment of your time to set the record straight on the national need for health research facilities. The requirements Because of the peer review system used by the NIH to obtain advice with regard to the quality of applications for support, I have had an opportunity to visit many institutions which have applied for grants from the Health Research Facilities Branch (HRFB) during the past three years. The severity of review of these projects is indicated by the fact that between 30 and 40% of the applications are disapproved on the basis of the relatively low quality of the medical research performed by the applicant institutions. Despite this conservative stewardship of the funds placed at its disposal, the HRFB has been totally unable to meet the demonstrated needs of medical scientists for adequate working space. By the end of fiscal year 1967, there will be more than $85,000,000 worth of approved but unfunded grants for health research facilities. These applications have received and passed the most careful review by their scientific peers. In each case, the applicant institution has been visited and been found on direct examination to seriously need and deserve on merit additional health research space. These institutions have not been able to proceed in efforts to meet the needs of the Nation for more basic medical rsearch simply because of lack of funds. I would like to emphasize that this lack of funds available to support construction is not limited to Federal sources. Throughout its history, the Health Facilities Program has operated with 50-50 matching. During recent years, it has become increasingly difficult for universities, hospitals, and research institutes to acquire the required non-federal funds which are necessary for such a project. It seems to me that this is short-sighted policy. A research facility which costs $5,000,000 for construction requires about $5,000,000 per year for operation. The first ten years of medical research in such a facility would thus cost about $50,000,000. Frequently, the entire project is stopped at the outset because the applicant institution cannot produce the required 2.5 million dollars for matching the construction grant. Thus, the nation is deprived of an investment in medical research because the applicant institution cannot produce in one lump sum approximately 5% of the ten year cost of the effort. It seems to me very much in the national interest to attempt to work out as soon as possible a matching formula which prevents these serious delays in beginning needed projects for construction of health research facilities. It is important to recognize that decisions which you gentlemen make in the next few months with regard to this appropriation will have important effects on our medical research effort not just this year but in five and ten years. The reason for this is that there is a considerable lag between the time when an institution is able to formulate its plans for extension of research facilities and when research programs to be carried out in the new laboratories can begin. For example, approximately three years elapse between the time when an application is approved and funded and when the facility can be occupied and used. Furthermore, failure to meet the needs now simply adds to accumulated but unfunded applications. Thus, based on recent past experience, it can confidently be predicted that at least $60,000,000 of approved applications will accumulate during fiscal year 1968. If the President's recommendations are followed, this will mean there will be $110,000,000 of approved but unfunded applications at the end of that year. It is with these considerations in mind that I have formulated the following recommendations with regard to the Health Research Facilities appropriation. Recommendation I recommend that the sum of $170,000,000 be appropriated for the construction of health research facilities during the fiscal year 1968. This sum, which incidentally conforms with the recommendations of the Congress as expressed in the Health Research Facilities Act of 1965, will allow funding the approved but as yet unpaid applications which have accumulated as a result of the reduced appropriation last year. This sum includes not only $145,000,000 for the construction of laboratories and related general research facilities but also the sums of $13,000,000 for construction of animal resources, $5,000,000 for construction of primate centers, and $6,000,000 for mental retardation centers. The latter three items will require new legislation whereas the former sum can be allocated under the provisions of the existing act. A special word about the need for animal resources and primate centers is in order. Experimental animals are absolutely essential for modern medical research. Because of the urgent need for construction of laboratory space, it has frequently been very difficult for research institutions to produce the additional funds for construction of animal facilities. It is extremely important that this situation be improved as soon as possible in order to assure continued humane living conditions for experimental animals and to provide an increased supply of such animal for legitimate scientific purposes. The record GENERAL RESEARCH SUPPORT As the size of the research effort carried on in universities, hospitals, and research institutes has grown, it has become increasingly clear that broad institutional support for such efforts provides a needed flexibility which the traditional individual grant system cannot meet. For example, it is frequently very difficult for peers outside of an institution to evaluate the progress of young investigators. This can be done best by his colleagues at the home institution. Furthermore, there are many hidden general expenses which make the cost of maintaining a total research establishment excessive in relation to the supply of individual grant funds. The provision of an adequate supply of experimental animals is a case in point. Recognizing these institutional needs for funds to provide a base from which individual research efforts can be mounted, the NIH instituted the program of General Research Support Grants. The magnitude of this grant to a given medical school is in direct proportion to the size and number directly supported research projects carried out in the institution. This form of research support has proved to be enormously valuable in all of the schools of medicine in the United States. I am certain that I speak for all of the Deans of such schools when I congratulate you and your colleagues for your creative support in this venture. Requirements In order to maintain the General Research Support Grant in its present relation to project supported research and in order to provide support for new medical schools, it is essential that the magnitude of the appropriation for this program be increased. Recommendation Accordingly, I recommend that the appropriation for the General Research Support Grant be increased from the $61,700,000 recommended in the President's budget to $70,000,000. Of this sum, I recommend that $46,000,000 should go to the General Research Support Program directly and that $12,000,000 each go to the Bio-medical Sciences Support Program and to the Health Sciences Advancement Award Program. The Health Sciences Advancement Award, which singles out on a competitive basis worthy institutions which are capable of making a major advance in their research capability, seems to me a particularly valuable activity of the NIH, one which deserves encouragement. There is a quality of critical mass required for outstanding basic research. Frequently, a substantial investment in one institution can yield many times its original value by allowing the institution to increase the size and competence of its faculty above this critical value. CLINICAL RESEARCH CENTERS The Clinical Center Program of the NIH, both in the form of general clinical centers and clinical centers for specialized activities such as coronary care units, have proven to be very successful in promoting improved modern clinical care. Research involving patients is of necessity a team effort. These clinical centers have provided the support necessary to gather experts in various related disciplines who can then work together on specific areas of mutual concern, for example, cardiac diseases, metabolic diseases, etc. I strongly recommend continued and increased support for this activity. I Provided by allocation from the research budgets of the various National Institutes of Health. 2 Appropriated independently under the Health Research Facilities Construction Act. Dr. TOSTESON. At the outset of this afternoon's long and rather arduous activities from your point of view, you mentioned seals. Seals are a kind of whale and whales have had, as you know, a long history in the economic and cultural life of our country. You can talk about whales, but I would like to request perhaps a different role. I think I would prefer the role of Captain Ahab, that singular whaling man who went over the seven seas looking for a white whale called Moby Dick. My ship I would take to be laboratories, medical research laboratories of the country and my quarry, my whale, the ignorance about fundamental biological phenomena which stands between us and the cure of diseases which continue to plague our citizens. I am particularly grateful to talk to you about the General Services appropriation for the NIH because it is in many ways fundamental to all of the research activities supported by the agency. It is always easier and more pleasant to talk about the spires rather than the foundation, to talk about the fellows who throw passes and make touchdowns than the guys who block and tackle in the line. I would submit that no one has ever tried to build a skyscraper or beat the Green Bay Packers without giving careful attention to the fundamentals. Now, my position about the appropriation for these fundamental basic aspects of general research support by the NIH can be said in a very few words. I consider the health of our citizens to be the most valuable asset of our country. By health I do not mean the mere absence of disease, but the capacity of each of the citizens of our country to fulfill the total potentialities of his person, the path toward a complete achievement for greater health of our citizens I think is very clear. It has been demonstrated by what amounts to now four centuries of scientific research beginning approximately at the time of the Renaissance. It is particularly clear because of the programs that the NIH has supported in the past 20 years. It is the path of basic medical research. Despite the unprecedented advances of the past 20 years, it is my opinion that many more challenging problems lie before us rather than behind us. Because of the fantastic increase in our population, because of the increasing numbers of older persons who have different sorts of medical problems, because of the almost unbelievable and growing complexities of our society, the need for more medical research and better medical research is increasing and is increasing at an increasing rate, I think all we have to do is to consider such developments as: the pollution of our atmosphere; the continuing introduction into common usage of new chemicals-food additives, new drugs-about which we often know too little; the new social relations which emerge from the vast urban centers that are growing throughout the land. All of these insure the introduction of new medical problems, not to mention all the ones that we have not solved as yet. In order to meet this challenge, we need more scientists, more laboratories, more technicians working in facilities which are equipped with the most sophisticated modern instruments. Such an effort requires money. My purpose here this afternon is to urge you and your colleagues in total sincerity and seriousness to meet this urgent need by increasing the appropriation for the General Research and Services budget of the NIH. A review of the record of the Congress in supporting these activities over the past 20 years might lead one to conclude that the intensity of my concern is baseless. However, I share with many of my colleagues the fear that a false complacency has grown up over the past several years about the relation between the needs and the present level of support of basic medical research. Mr. FLOOD. Do you read the election returns, Doctor? |