showing no symptoms themselves-are carriers of progressive muscular dystrophy and transmit this disease to half of all their sons. AIR POLLUTION Within 10 weeks after passage of the amendments to the Clean Air Act, the Federal Register carried the proposed rules setting emission standards on new passenger cars and light trucks, both domestic and imported models. These nationwide standards will became effective with the 1968 model year, that is, in the fall of 1967. By that time we will be engaged in a motor vehicle testing program to assure that the standards are maintained. For the past 2 years, the Federal Government has provided direct financial assistance to the State, regional, and local air pollution control programs. We have awarded or committed for awards during the current fiscal year all of the $9,180,000 appropriated to assist State, regional, and local air pollution control programs. During the first half of the current fiscal year we have convened two abatement conferences at the request of States affected by pollution from sources outside their legal jurisdiction. A third interstate pollution conference is planned for the immediate future. SOLID WASTES The Solid Waste Disposal Act has resulted in an extraordinary display of interest among municipal officials throughout the Nation; we have received, primarily through Members of the Congress, hundreds of letters about the program indicating that this legislation recognized an urgent problem in our cities and metropolitan areas. We have established a special organization to implement this legislation and have communicated with all of the Governors of the States to explain the program and ask their help. We have almost completed the necessary regulations for administration of the grant provisions. Through a joint agreement with the TVA and Johnson City, Tenn., we plan to operate an experimental plant to do composting of all the refuse, mixed with new sewage sludge, for a city of 33,000 people to test the feasibility of this process on a larger scale. SUMMARY These few highlights are illustrative only. They serve to demonstrate progress and they also suggest the dimensions of the challenge ahead of us. For they are, for the most part, only beginnings. The obstacles ahead are many: stubborn scientific frontiers that remain uncrossed, shortages of manpower needed to deliver the benefits of scientific knowledge already achieved, unequal distribution of existing services, organizational patterns not yet adapted to the requirements of modern medical science, inefficiencies in our means of communication with the professions and the public, and many more. Yet I believe that we are on our way, and that a Public Health Service reoriented to the public need and provided with the resources specified in the budget now before you can contribute in greater measure to the health of the American people. The total proposed budget of the Public Health Service for fiscal year 1967 is $2,456,714,000. The comparable amount for fiscal year 1966 is $2,181,101,799. The requested increase of $275,612,201 would support our programs at a level 13 percent above that provided in 1966. About 75 percent of the 1967 estimate is for grant programs for research, training, fellowships, construction of facilities, and disease prevention and control. The remaining 25 percent is for research contracts and for direct operations in the broad areas of research, training, care of legal beneficiaries, construction of intramural facilities, and disease prevention and control. Some increase is proposed for each category in both grants and direct operations. When the directors of the various categorical programs appear before the committee they will discuss goals and objectives in detail and explain the purposes for which increases are requested. Mr. Chairman, that completes my statement. I shall be happy to answer any questions I can. TABLE ON NIH BUDGET Mr. FOGARTY. Who is responsible for this table? Mr. CARDWELL. It is prepared by the Public Health Service and cleared through the Office of the Secretary. Mr. FOGARTY. You can tell the Secretary you are taking them all back and getting new ones as soon as you can with NIH broken down, Institute by Institute. Also arrange the Institutes on a seniority basis, starting with Cancer. This committee always has been opposed to combining the Institutes, and I would think that the Public Health Service and the Secretary should know that. Mr. CARDWELL. Yes, sir. Mr. FOGARTY. We have always thought each of these Institutes is important enough to deserve separate treatment. When can we get new tables? Mr. CARDWELL. By tomorrow morning or earlier. Mr. FOGARTY. Can you get them today? Mr. CARDWELL. We will put somebody to work on them right now. Mr. FOGARTY. This committee always has been opposed to pulling together all these institutes in any form. It has been tried in the past, and tried by some individual members of the committee, but the majority of the committee has always been strongly opposed. (The revised table, showing each Institute separately, follows:) MOVE OF SURGEON GENERAL'S OFFICE TO BETHESDA Mr. FOGARTY. Dr. Stewart, what would seem like a small thing— your move to Bethesda-has caused about as much comment as anything since you have been in office. Whose idea was the move? yours or the Secretary's. Dr. STEWART. I proposed it to the Secretary. Mr. FOGARTY. Why? Dr. STEWART. Several reasons, Mr. Fogarty. When I came into office I found that the Bureau of Community Health was scheduled to move to the two buildings in Virginia, the Surgeon General's Office was scheduled to move out of the north building, all of this the result of the space needs of an expanding department, and the Bureau of Medical Services had moved to Silver Spring about 2 years earlier. When the Bureau of Community Health moves to Virginia, the elements of Community Health which are in Silver Spring will be moved to Virginia to consolidate that Bureau together. At the present time we are located in six buildings in Southeast Washington, two of which are scheduled to be torn down, two temporary buildings, in 1966. Then there is an expansion of the entire Department involved. At that time my office was scheduled to move to the south building. RELATIONS OF SURGEON GENERAL'S OFFICE AND NIH Secondly, we began to look at the problems of the Public Health Service. There is one which I was well aware of before I came into office; it is still there and we are addressing ourselves to it. This has been the unhappy relationships between the Surgeon General's Office and NIH. It seemed to me that with the experience that I have had in NIH and with the cordial and mutual respect that Jim Shannon and I have for each other that by moving to NIH I could work more informally with Jim and his staff and make our organization more efficient in the whole area. This I think can be done without changing any organizational charts around. Mr. FOGARTY. You have not given me a good reason yet. What is the next reason? Dr. STEWART. The next reason is that Dr. Shannon feels, has felt, and I think with a fair amount of justification, that in the role of NIH in the total field of bioscience he has had the problem of what he calls layering. The Surgeon General's Office was in the way if he needed to work with the Office of Education, the National Science Foundation, on the major supporters of the biosciences in the university area. He is quite right. I think by this move and working closer together I could help with that problem which Jim has. Ï intend to use Jim as the principal scientific man for the Public Health Service. Mr. FOGARTY. So you will not run both? Dr. STEWART. I have no intention of running both. NIH is part of the Public Health Service, a major research bureau. Dr. Shannon is the Director of it. PHS OFFICES IN WASHINGTON METROPOLITAN AREA Mr. FOGARTY. At how many different locations are Public Health Service offices located in the metropolitan area? Dr. STEWART. I can't give you an exact figure, Mr. Fogarty. It is in the twenties. It is 25 or 26, I believe. Mr. FOGARTY. Do you have any long-range plans for centralization? Dr. STEWART. No; we have no long-range plans at all, at the moment, in facilities development. Mr. FOGARTY. Do you think some study should be made of this? REORGANIZATION OF THE SERVICE Mr. FOGARTY. What plans do you have for reorganizing the Service? Of course, I get the Environmental Health Letter every two weeks. Dr. STEWART. So do I. Mr. FOGARTY. Mr. Fishbein has a bestseller here, I guess---the one dated February 1. His entire front page talks about the exclusive story he has on the sweeping reorganization of the Public Health Service. Dr. STEWART. Mr. Chairman, I did write the memorandum to the Secretary. This was giving my ideas as to what is needed in the reorganization of the Public Health Service. There are many other memorandums which have been prepared, and staff papers. All of these are being looked at, reviewed, studied, analyzed by the Committee headed by Dr. Corson. They have not finished their study yet but they are pretty close to it. ENHANCING FLEXIBILITY OF STATE HEALTH GRANTS Mr. FOGARTY. Then you are familiar with this article in the Wall Street Journal of January 19, I presume, "Federal Therapy--New Surgeon General Seeks Measures To Widen Health Care Goals Include Strengthening State Health Units and Less Stress on Single Diseases." What did they mean by that? That may not be in your langauge. It is written by a writer named Spivak. Dr. STEWART. I believe what he has reference to is the development of a legislative proposal we will have. You will recall last year Congress extended section 314(c) for 1 year, the categorical State grants, directed a study of the formual grants, and directed us to come up with a proposal for the State grant programs in the future. So far as the categorical diseases go, one of the problems the State health departments have been complaining about is that our State grants, many of them, are for a specific disease, like heart disease control, cancer control, or something else, so they must then spend the money directly for these purposes and they have no flexibility to fit into what they see as the needs in their State. We hope we can devise a system of State grants which will give the State health departments the responsibility and some more flexibility in carrying out the health services programs. PROPOSED REORGANIZATION OF PHS Mr. FOGARTY. Regarding the Fishbein letter, I will insert this front page at this point in the record. |