going a strenuous process of self-analysis, at the direction of the President and with the leadership and support of Secretary Gardner. We have been assisted by a highly competent group of consultants under the chairmanship of Dr. John Corson of Princeton. We have tried as hard as possible to hold nothing sacred, to leave no assumption unexamined. Our aim has been to design a Public Health Service that can attract and retain the kind of competence our responsibilities require, and that will make the fullest use of the resources we have. We intend to shape an agency that will deliver its full measure of the Federal responsibility for the health of the American people. FUNCTION OF PUBLIC HEALTH SERVICE This work is nearing completion. I believe that we can polarize our activities around specific functions, aimed at the basic health goals of the Nation: The delivery of the best in health care to the American people; The most productive possible service to groups with special problems our children, the aged, the mentally ill are examples; The fullest possible application of existing knowledge to control, prevent or eradicate disease; The sharing of American knowledge and skills so that nations around the world can raise their levels of health. Further, I believe that we can modify our existing personnel systems so as to encourage productive and rewarding careers across a broad spectrum of Federal involvement in health. In achieving this, and in creating an organization oriented toward the future, I am convinced that health professionals of the highest quality will respond to the challenges of Federal service. ACCOMPLISHMENTS Against this backdrop of needs, let me now report on some of the more significant points of progress during the past year. You will, of course, hear more about our problems and our accomplishments from subsequent witnesses before your committee. MEDICAL CARE ADMINISTRATION Through a newly organized Division of Medical Care Administration, the Service is seeking improved methods of organizing and financing medical care. The new Division has specific responsibilities for professional health aspects of the health insurance for the aged program. We are making particular efforts at this time to insure the availability and quality of health insurance benefits, the first of which become redeemable as of July 1. The development of standards of provider participation is virtually complete. Plans from approximately half the States have been approved for participation in the new home health formula grant program designed to stimulate the development of new and improved home health services. MANPOWER ACTIVITIES To help overcome a critical shortage of education facilities for the health professions, 68 projects have been awarded grants totaling more than $150 million for the construction of teaching facilities in schools of medicine, dentistry, nursing, and other health professions. These projects will provide 2,442 additional first-year places for medicine, dentistry, public health, nursing, pharmacy, and optometry. New schools being established include eight medical; one dental; and one public health. Under the provisions of the Nurse Training Act of 1964 the Service is providing grant assistance to build new nursing schools, and to replace, renovate, expand, and equip existing facilities. The $3 million already invested in this program is creating space for up to 240 additional first-year nursing students. As of January 1966, 52 applications totaling more than $25 million have been submitted. Eleven have been approved. The Nurse Training Act also provides for continuation and expansion of the professional nurse traineeship program. Since 1956 this program has helped more than 25,000 nurses to prepare for teaching, supervision and administration or to improve and update professional skills. This fiscal year 100 schools of nursing have shared in $7,800,000 for long-term academic training to prepare an estimated 2,000 nursing teachers, supervisors, administrators, and specialists. A separate manpower program was established this year to investigate, estimate, and project national manpower needs for health services. Such action was recommended by the President's Commission on Heart Disease, Cancer, and Stroke and by the Second National Congress on Public Health Training. The program will join with other government, voluntary, and private allies in an effort to insure adequate numbers of medical and paramedical personnel in the right job at the right time and place. HEALTH FACILITIES Despite a reshaping of the Hill-Burton program and sound progress toward adequate health facilities, the tasks ahead require an intensification of present effort. Thus far the establishment of new programs and the revamping of old ones have permitted communities throughout the Nation to analyze and evaluate their health facility shortcomings. Tentative findings reveal a great number of hospitals in need of renovation, a problem especially grave in larger cities; a growing critical need in some areas for long-term care facilities; a lack of coordinated planning mechanisms for urban areas; and shortages and inadequacy of most facilities for the mentally retarded and mentally ill. Programs established by recent legislation are now beginning to bear fruit. The hospital modernization program, included in the HillBurton Amendments of 1965, is underway. State plans are being sub H mitted and projects are being approved. Funds included in this budget request, however, will only begin the tremendous task of renovating the many hospitals which are structurally or functionally obsolete. Efforts to assist State and local groups in the realistic planning of needed health facilities have resulted in the approval of 37 area wide planning projects in 19 States. The Hill-Burton program, 20 years in operation this year, continues to make inroads into the backlog of needed health facilities. The 8,000th project was approved in December. ARTIFICIAL KIDNEY Dramatic new developments in the treatment of chronic kidney failure has lead to the establishment of a kidney disease program in the Service. We recognize this as one of the most sensitive and challenging programs we have undertaken. However, with clear proof of new abilities to sustain productive life in thousands previously doomed to death, the Service will this year move to increase support for artificial kidney centers. Eight to ten new centers will be financed in 1966. The cost-reduction promise of home dialysis will be investigated. We are also extending our research effort to gain a better understanding of problems of kidney failure and to improve existing technology of kidney treatment. MENTAL RETARDATION This is the first year of a greatly expanded program of mental retardation project grants. About 90 projects will be supported in 1966-67. The principal goal is to accelerate the training of professional personnel. We have already approved nine construction grants totaling approximately $16.7 million to university affiliated clinical facilities to aid in the training of professional and technical manpower to care for the mentally retarded. Another nine construction grants, totaling $19.9 million, have been awarded to date for construction of mental retardation research facilities. The program of community-based mental retardation facilities is also taking shape. Most State plans have been approved, and grants are being awarded for construction projects. The construction phase of this program will be in full operation by the end of the fiscal year. PREVENTIVE SERVICES The best health care is prevention. Toward this goal we continue to support research to develop and refine the early diagnostic methods so vital in combating disease and disability. One of the most promising approaches is being developed with our support by the KaiserPermanente Medical Group in Oakland, Calif. Now in its third year, this project combines a series of 30 or more automated screening tests and computer read-out with periodic health examinations by a physician. This marriage of automated screening to periodic health examination promises eventually to produce a practical means for reorienting health care from the curative to the preventive. It has great potential for freeing physicians and other professionals to perform those duties for which they are specially qualified. We intend to explore this promise to the fullest. SMOKING AND HEALTH The National Clearinghouse on Smoking and Health, established this year, offers one of the few immediate prospects for primary prevention against chronic diseases. The current program is centered on the investigation and evaluation of improved methods for helping people to give up or avoid the cigarette habit. A series of community laboratories is being set up to test and demonstrate effective systems for organized community action. This activity will parallel and add weight to an accelerating national campaign to present the public with factual, scientific health data on the hazards of cigarette smoking. IMMUNIZATION In this fiscal year measles immunization has been added to the nationwide attack on polio, diphtheria, whooping cough, and tetanus. Ninety programs covering areas with more than 70 percent of the Nation's preschool population will be in operation this year. These are comprehensive immunization programs encompassing measles as well as the other four diseases. Measles is more vulnerable to immunization procedures than most communicable diseases. Present opportunities are unprecedented for control and eradication of this insidious enemy of children. Major emphasis in fiscal 1967 will be placed on achieving widespread public acceptance of the importance of measles immunization. By the end of the year, it is anticipated that 10 million preschool children will be protected against measles. Research related to the Nation's most common and most costly disease-acute respiratory illness-has been marked by three significant advances: (1) the successful field trial of a live oral vaccine against adenovirus type 4, which is the main cause of epidemics of severe acute respiratory disease at military training camps; (2) promising early results with an experimental vaccine against mycoplasma pneumoniae, a virus-like organism that is the major cause of primary atypical pneumonia among college students and military trainees; and (3) a major step toward development of a vaccine against respiratory syncytial virus, an organism which kills an estimated 5,000 infants a year. PUBLIC HEALTH SERVICE HOSPITALS The basic issues related to the Public Health Service hospital system are now resolved in accordance with the recommendations of the study conducted under the auspices of the Office of Science and Technology last year. We are now proceeding with a major modernization program for eight of the remaining general hospitals, to equip them to serve as a vitally important part of our health services program. It is our intention that these hospitals shall become models of excellence in the organization and delivery of medical care, and that they shall serve as demonstration centers for improvements in hospital organization and technology. In addition to high quality patient care, these facilities will contribute importantly to the training of health personnel and to the conduct of clinical research. REGIONAL MEDICAL PROGRAMS Encouraging progress in implementing the regional medical programs for heart disease, cancer, and stroke includes appointment of an outstanding physician, educator, and administrator-Dr. Robert Q. Marston-to head a newly established Division of Regional Medical Programs at the National Institutes of Health. Regulations and guidelines now close to completion-spell out the intent of the law to save lives and prevent disability through widespread application of recent advances in medical diagnosis and therapy. Preliminary discussions indicate that there is great interest in this program among medical schools, health officers and others. CANCER RESEARCH Continued intensive treatment with massive doses of existing and new drugs now appears capable of eradicating all cancer cells in several types of malignancy before the cells can be replaced by multiplication of surviving cells. One type of uterine cancer and Hodgkin's disease are two instances-in the latter case with the support of radiation. Such treatment, enhanced by blood platelet transfusions and various germ-free protective devices, has achieved a sixfold increase in the number of acute leukemia patients surviving 2 years or more. RESEARCH RELATED TO FAMILY PLANNING The National Institute of Child Health and Human Development is both conducting and supporting research activities relating to the development of new and better methods of family planning as a part of a much broader program of research in reproduction, with the ultimate goal of promoting the health of our population. Included are studies of the relative effectiveness of various contraceptive practices, as well as of the immediate and long-term effects of various contraceptive practices on the health of women and their offspring. A number of these studies involve collaboration with the community action and services programs of the Children's Bureau and the Division of Indian Health of the Public Health Service. OTHER RESEARCH DEVELOPMENTS The interrelationship of the various areas of biomedical research is well illustrated by the discovery that two drugs heretofore used to combat cancer are also effective against other diseases. One of the drugs has been found to relieve pain and improve joint function in patients with early nondegenerative inflammatory arthritis without evidence of serious side effects. The other drug has produced notable improvement in patients with chronic ulcerative colitis and regional enteritis on whom standard therapy had been ineffective. Development of technique to locate the part of the brain that causes the tremors in Parkinsonism-a disease of the nervous system that cripples thousands of Americans-will help the surgeon to work with greater accuracy on these patients. A genetic screening test now permits physicians to identify 75 percent of women who-though |