Well, when I was a student I was taught that the cell was the ultimate unit of life and it had cytoplasm, it had a nucleus and contained many elements. I was taught that an element was the simplest form of matter, that if you had gold or lead or bromine as an element, that was it, it could not be broken down into anything more simple. All of those concepts are archaic, obsolete today. A single cell is a universe with tremendous complexities, including the electrons. It has enzymes, many chemicals, DNA, RNA, and all of these are ultramicroscopic structures. It is no longer true that an element is an indivisible part of matter because we know now that you can have many forms of lead, iron, gold. When they are reacted upon with electron energy, atomic energy, they become radioisotopes and you can have 14 different kinds of gold and 17 different kinds of sulfur. They are all sulfur, with different atomic weights. All these concepts are new and we have to live with them, and the old ones are obsolete.

Now, molecules make up cells, cells make organs, organs become systems, and systems become human beings. The more we learn of the tiny elements within the cell, the quicker we will understand life and health and disease.

Now, how does this come about? By research, of course. But we are in trouble in our research program not only in the Institute but in the entire body of NIH. It is a disaster to sit in these National Advisory Councils and have before you applications which have been approved not only by study sections but by councils and with good priorities, which can't be funded for lack of money.

Mr. FLOOD. Suppose you sat here.

Dr. TRAEGER. Yes. Well, do not think for a minute, Mr. Chairman. that I am not cognizant of your problems. I know that the world is beating you over the head for the Federal dollar and it becomes a question of congressional judgment. However, I am biased, I admit it. Mr. FLOOD. This is not immoral.

Dr. TRAEGER. I am interested and have been all my life in preserving the only resource that we have in this country, and that is our population, and there are just too many sick people, too many crippled people for me to sit back and be content with the status quo. After all, to get anything done you have to have people, manpower, and every sick person, every disabled person, every crippled person means that much less manpower, it means that much less money in taxes, it means that much more drain on the economy, whether it is local economy, State or Federal economy.

I really believe this. You know, you have all seen it. My goodness, when I was an intern we used to lose seven out of 10 people with pneumonia. We don't lose pneumonia patients any more-a few perhans, that are misdiagnosed. I haven't seen an operation for a mastoid infection in my hospital in over 20 years. I haven't seen a case of typhoid fever in 20 years. We very rarely have any problems with pernicious anemia which in my day was 100-percent fatal. So the record is a good one. We have been able to save the lives of thousands and millions of people but there are an awful lot more, many more millions who have diseases which are crippling and disabling and fatal which we have to deal with, and I am not going to quit until we find the answers.

Mr. FLOOD. Don't.

Dr. TRAEGER. Now, sure, there are more medical schools being contemplated but the scientific manpower-now we come to the manpower problem. This is being absorbed about as rapidly as it is being formed. There are today many unfilled areas for research activities, but there isn't enough money to pay for the researchers. What happens? These men who are research-oriented, who want to do research and who are gifted; they apply for research grants or even training grants and they are turned down-not on the basis of merit, but because there is no money. What happens? We lose them. They go to work for ColgatePalmolive and make toothpastes and soaps and perfumes and make tremendously more money in industry than they would in research, but they have to live. They are willing to work in research, to come down here for a pittance.

I know many men in NIH who have been in industry and who have made a great deal of money, salaries up to $50,000 a year, who have come back to NIH to work for one-fourth, one-fifth the salary because they are motivated.

I do not expect the Federal dollar to compete with the industrial dollar but I do expect that the Federal Government will understand the urgent importance of research and the development of manpower for research. Otherwise we are squandering our money in manpower and in the ultimate conquering of these diseases. There are lots of them. Now, I have been working in arthritis for 38 years. I am not too sure that I know the natural history of the disease. Every possible lead, ever possible opportunity, every possible idea has been explored and will continue to be explored.

In my prepared statement there are evidences of this type of exploration. We have some promising leads just as we have in cancer, promising leads. But it is a difficult disease. It is a dreary disease. It is hard to get people interested in it because it goes on and on and on and it cripples an awful lot of people, millions of them. But I am not hopeless about it any more than I was hopeless about pernicious anemia 30 years ago.

The answer is there. Somebody will find it. It may be tomorrow, it may be just like in the case of John Enders-in the cultivation of polio virus on monkey kidney extracts. These things have happened before. They will happen again. But they can't happen unless we keep pounding and pounding.

In order to help the situation, the National Institute of Arthritis and Metabolic Disease has set up training programs and special training programs for advanced research. But here again the roadblock is funding.

Now, I know that these Institutes were developed by Congress. In your infinite wisdom and in your compassion for pleas such as I am making now, our budget has been increased. I remember when the first annual budegt was $800,000. It wasn't even a budgetary line item. But as a result of research and added research and instrumentation we have done a good job. We have changed the entire complexion of medical education and research by the congressional support of the National Institutes of Health. It is an enviable position for Congress to be in as creators of this type of organization. But as I say we are

almost too successful in that there is so much to do, so many ways to go. we need so many more people and so many more instruments and we just haven't got the money to pay for it. It is frustrating.

In the final analysis we are dealing with our greatest resourcesthe human being.

Now, one of the things that people talk about is how do you get research down to where it is going to be used? How are you going to get the knowledge which has been developed by research to the people who need it, to the scientists and to the practicing physicians? Well, this Institute has had a unique development.

They produced unique, current-awareness publications: the Diabetes Literature Index, the Arthritis and Rheumatic Disease Abstracts. the Kidney Failure and Artificial Kidney Bibliography, and Gastroenterology Abstracts and Citations.

Mr. FLOOD. The witness is showing a series of pamphlets and brochures dealing with the titles as he has indicated.

Dr. TRAEGER. Now, what do these do, why are they useful? Many times as council members we have had research grant applications, that come to us, turned down because the applicant was not familiar with the literature. To go to the library and dig out the literature on one aspect of research science takes hundreds of hours. That is done for him, he doesn't have to do that any more. Time is saved. Unnecessary reduplication of research is avoided. Scientists and doctors are kept up to date with what is going on and what has been done. This gives you a jumping-off place. This has been done. You might get an idea what more needs to be done in an area.

Well, I haven't talked about the individual research problems which the Institute is saddled with. I have tried to bring to you an overall picture of the enormity of the problem in this Institute, dealing as it does with these enormous categories of diseases, millions of patients, the need for not only the status quo but the urgent demand, the urgent necessity for expanding research, expanding training, expanding manpower.

Throughout the years, the Congress has been more than liberal and tremendously cooperative. I have lived with this program since its inception, Mr. Chairman, since 1950. It has done a good job. But we are running out of funds and we have got to have a little more fiscal push.

Now, the cooperation that we are getting from medical schools, medical centers, research areas, voluntary health agencies, have all added to the impetus of the biomedical research field, but it boils down to the root of the National Institutes of Health, which are the creations of the Congress.

As I say, I sympathize with you for having to sit here and listen to us yak at you for the Federal dollar. But, believe me, Mr. Chairman and members of the committee, I believe in what I have just told you. and in the citizens' budget presented to you.

Mr. FLOOD. I am sure you do.

Dr. TRAEGER. Thank you for the privilege of appearing before you. Mr. FLOOD. Thank you for helping us.

STATEMENT OF DR. PAUL PATTERSON ON CYSTIC FIBROSIS

(Dr. Patterson's biography follows:)

Date of Birth: April 25, 1916.

Birthplace: Bloomington, Illinois.

Premedical education: University of Illinois, B.S., B.A., 1937.

Medical education: University of Illinois, College of Medicine, M.D., 1941.
Internship: Kansas City General Hospital, Kansas City, Missouri.

Pathology internship, 1941-1942.

Research and Education Hospital of the College of Medicine, University of
Illinois, Rotating internship 1942–1943.

Military Service: U.S. Navy and Marine Corps, 1945-1946.

Northern Permanente Foundation; Vancouver, Washington, Head Resident Pediatrician, 1943-1944.

Children's Clinic of Seattle; Seattle, Washington, Director and Pediatrician, 1944-1945.

King's County Hospital; Seattle, Washington Acting Head of Department of Pediatrics, 1945.

Research and Educational Hospitals, University of Illinois, Research on Cystic Fibrosis, Fellow and Postgraduate in Pediatrics, 1946-1947.

Children's Medical Center; Boston, Massachusetts:

Fellow in Pediatrics with Dr. Harry Shwachman, 1947–1949.
Research Associate, Department of Clinical Pathology, 1949–1952.

Assistant Physician (full time) doing research on Cystic Fibrosis, 1949-1952.
Director, Diagnostic Laboratory, 1950-1952.

Harvard Medical School; Boston, Massachusetts:

Research Fellow in Pediatrics, 1947-1949.

Assistant in Pediatrics, 1949-1951.

Instructor in Pediatrics, 1951-1952.

New York State Department of Health, Division of Laboratories and Research; Albany, New York, Research Associate, Virus Laboratory, 1952-1953.

Albany Medical Center Hospital; Albany, New York:

Atending Pediatrician, 1952-1953.
Pediatrician-in-chief, 1953-present.

Albany Medical College of Union University, Albany, New York:

Assistant Professor of Pediatrics, 1952-1953.

Professor and Chairman of Department of Pediatrics, 1953-present.

Member of the consultative staff of 16 hospitals.

Medical Director of Albany Study Center for Learning Disabilities.

Director of National Cystic Fibrosis Research Foundation's Care, Teaching and Research Center at Albany Medical College.

One of the founding members of the medical team at the inception of the original Mucoviscidosis Research Foundation. First chairman of the Medical Education, Fellowship, and Legislative Committees of the General Medical and Scientific Council.

Vice-chairman of the General Medical and Scientific Council of the NCFRF. Author of over 100 scientific publications and chapters in medical texts. Member of several medical societies and national and state committees pertaining to the health and welfare of children.

Married and has four daughters. Is a licensed radio amateur; collector of antique guns; and formerly president of the Society of American magicians.

Mr. FLOOD. We next will hear from Dr. Paul Patterson on the question of cystic fibrosis.

He is chairman of the department of pediatrics, Albany Medical College of Union University, also chairman of the General Medical and Scientific Advisory Council of the National Cystic Fibrosis Research Foundation.

Dr. Patterson.

Dr. PATTERSON. Thank you.

I wish to testify to the need for more research and training in cystic fibrosis in the framework of the Institute of Arthritis and Metabolic Diseases.

Cystic fibrosis is one of the major metabolic disorders for which this institute is responsible. Essentially, cystic fibrosis is a disease of children but it is now seen with increasing frequency among adolescents and adults. It is a disease of the glands which affects the lungs and the digestive system, and invariably leads to malnutrition and chronic lung disease. And then, far too often, it takes its toll in term of death of many children and young adults.

Mr. FLOOD. If it appears in young adolescents and young adults it has been a continuing condition from infancy?

Dr. PATTERSON. That is right. Through methods of control these children have been permitted to live longer.

Mr. FLOOD. This isn't something they acquire in later childhood? Dr. PATTERSON. No. It is a recessive gene present at birth. In fact, more children annually die from cystic fibrosis than from measles and from many of the other well-known diseases.

Early diagnosis and early application of intensive prophylactic and therapeutic regimes have reduced mortality and morbidity in recent years but the outlook for most patients with advanced cases of the disease is still bad.

Mr. FLOOD. Can this be diagnosed in the fetus?

Dr. PATTERSON. No. In the newborn, yes, but not before birth.
Mr. FLOOD. Why not?

Dr. PATTERSON. The only method we have for diagnosing it now, definitively, is through what is called the sweat test, in which electrodes are placed on the arms and a drug called pilocarpine is infused into the skin. This causes the sweat glands to sweat, and then we collect that sweat and analyze it for salt, sodium chloride.

Mr. FLOOD. That is after birth.

Dr. PATTERSON. Yes.

We have no means at the present time to diagnose it before birth, even though it would be of benefit to all of us sometimes to do this because these children are sometimes born with obstructed bowels which require surgery immediately.

Mr. CASEY. Would the chairman yield?

You can make a forecast of a possibility by examination of the parents, though, can you not?

Dr. PATTERSON. There has been just recently a research tool which is not applicable for screening at the moment, of examining and finding within a potential parent a substance in the blood which may reflect a carrier state of cystic fibrosis but is not generally available as a tool yet, Mr. Casey.

To improve the prospects for children we need to develop a more simple and more effective means of therapy for the disease and the only way we can do this is by broadening the basis for research.

I am sure that you gentlemen would be willing to provide the funds for that research in the Institute of Arthritis and Metabolic Diseases and for the professional training that would necessarily be needed along with it if you felt that there were sufficient leads at hand to offer a reasonable expectation of worthwhile results.