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I am not sure that any national agency could more than partially accomplish this because what scientists read is really difficult to control or be sure of and I am sure it should not be controlled.
I do think some effort could be made to do what can be appropriately done toward improving transmission of knowledge.
Now, at the practical level, I am quite certain that anything which comes from the cancer field which would be relevant to heart in an applied way, and vice versa, would be very quickly picked up by individuals or brought to the attention of individuals who are responsible for the application of that knowledge. Well, the physician is primarily, ultimately responsible, but the agencies that are interested I think —both public and private-will unquestionably get that information quite quickly as soon as it is reasonably proved.
I would like to say that though I am interested in one phase of heart disease, I am aware of the fact that great progress comes when a new principle is discovered, although its practical aspect may be far-reaching and can pick different directions from that of any one interest.
For instance, the hormones in the last several years have been applied in several particular areas of health problems, but the probability is that the importance of the steroid hormones will exceed that of the adrenal cortex in its function and capacity as knowledge from its physical capacity to produce various substances is determined. It is thus of far greater importance across the board to human stability and equilibrium, health, and disease, than it is to any one particular disease syndrome.
It is very heartening that, with this tremendous and necessary interest in a particular category, in the past 2 or 3 years as you would go to medical and scientific meetings, you would find that the programs of all had the same thing in them. That is the scientific area which is growing as of the moment and which can be used in a wide variety of things and ways.
I am not at all certain that any very extensive coordination-other than attempts to improve communication, and certainly not to control in any way these features—could be effective. But, that is my personal opinion, and it may be entirely erroneous.
Dr. WRIGHT. Mr. Chairman, with reference to this, I believe there are methods by which a cross-fertilization of minds takes place very well in the medical field today. We have, as Dr. Jones mentioned, many medical meetings—some of which are more or less specialized meetings and others which are of a very broad character—so that the various specialists get together with the men who are working in other fields.
It is rare that a new finding of any importance is in existence today more than a few months before it is presented before one of these meetings and then soon published. So, there is not too great a lag between use in one field by trained scientists and use in another field by trained scientists. The biggest lag is in the length of time necessary to establish the absolute validity of application of those findings to general medicine.
It is ill-advised to utilize these new findings widely until they are all of an established value. Yet, it may take from 1 to 3 years to prove this point.
Therefore, we feel it is very important for doctors to attend meetings because this is where the very essence of what you have requested is accomplished most rapidly.
I should like, if we have your permission, to have Dr. Wilkins present his material on hypertension and Dr. Andrus to present his material on arteriosclerosis, because many of these problems are of a broad nature and apply to all fields of research.
The CHAIRMAN. We shall certainly be glad to hear that, and it may be that the questioning of Dr. Jones has been longer and more in detail than will be necessary as the other witnesses proceed. We are trying to establish a basis, if possible, for increased activity from a Federal, State, and legislative standpoint and we are sort of groping here and seeking information and hoping that out of it all there will come something that will be helpful and improve the situation.
It is gratifying to hear yourself and Dr. Jones state that there is this disposition to pass on from one to the other the information that becomes available as a result of a particular research which has been made and which may have a greater application to some other subject of research.
In that connection, I am wondering whether with the establishments which we have now in the Federal Government there is a place for them in this picture to participate in the way of cooperating in making certain that these developments and this research information which comes from different research programs is available and is usable by other research workers.
Of course, we have the Public Health Service through its National Institutes of Health and other Government agencies covering many of these diseases, such as the National Science Foundation that is interested in basic, fundamental science. We hope that as time goes on, such information will become generally available.
In other words, we have these Federal agencies in existence and it was my thought that they might be helpful and if so, in what way? That is what I really had in my mind, to find out whether first there was a necessity and second whether there is a way that we can improve the situation even beyond the manner which you have set forth as already being done.
Dr. WRIGHT. We have discussed this to some degree. I think it is fair to state that we feel that for the present the framework is there, but perhaps they have not had the opportunity to develop the possibilities to the fullest degree as might be done in the future.
In other words, the National Institutes of Health have really just begun to function in a major way in terms of long-term planning and they need—I am sure-more help to implement their programs. Perhaps, if that type of support were forthcoming we could develop a long-range production for this type work. Does that answer your question? The point is that it is doubtful whether a new—and an entirely different program—is necessary in terms of introduction. We now have a framework that is set up that is not fully functioning to capacity as yet and it may take a few years to evaluate its ultimate achievements.
The CHAIRMAN. I am not speaking from the standpoint of new organizations. I would not be very optimistic as to the creation of new agencies, but I do have in mind that we do have organizations of a general character such as the National Science Foundation whose
whole purpose has been to be a sort of coordinating agency as well as an instrument to bring about an increasing interest in basic science.
I am hopeful that maybe there is something which you had that could be utilized to an advantage, but let us have in mind—and I am speaking informally—let us have in mind as we go on with these hearings on the heart today, and the next day cancer, and so forth and so on—let us keep in mind the objective. The objective is to improve the conditions that exist at the present time either by prevention or otherwise or by research. Let us keep our thoughts entirely on the point as to whether there is something that we can do.
You people through your activities and your interest and by your experience have learned what could be done or what would be helpful. That is the thing I am anxious for this committee to head up if possible as a result of these hearings.
Dr. JONES. Mr. Chairman, could I add one thought about that? The CHAIRMAN. Yes, sir.
Dr. Jones. I am quite certain that in the minds of most of us here that the question of basic research is ever present and it is the means by which our greatest and most significant advances come.
The National Science Foundation, in all of its statements that I have seen, has unequivocally shown a tremendous interest in basic fundamental research in broad scientific areas, and I would certainly hope that the Congress in its wisdom will see fit to give them adequate funds so that they can do it.
The Public Health Service from a health point of view is also interested in basic medical research and I hope that there is no competitive pattern or that one ever develops. I am sure that both of those agencies could, if they are given the opportunity, do a great deal of stimulating and crossfertilization of ideas, because just as work in one particular vertical health problem may result in advantages which are helpful to others, just so is work in the natural sciences—chemistry, physics, biology, and so forth-of great importance and pertinence to methods used in health knowledge. Their information devices can be of tremendous mutual help.
However, there is one great disseminating lack in our total situation now, and I hesitate to mention it because I do not think basic research from a scientific point of view is adequately being supported today in relation to what its opportunities are and what its needs are.
In the late twenties Fleming in England made some very direct simple observations on penicillin and its ability to have a freer bacterial growth. Those observations were recorded scientifically but they lay fallow for a good many years until Dr. Florey at Oxford became impressed with them. He became impressed with their practical importance and then he and his coworker did a very extensive repetitious study and advanced the work from the point of view of its ultimate practicability. That resulted in the beginning of the large volume of developing culture work which resulted in first penicillin and naturally most of our other presently important antibiotics, once it had been opened up. I have not the remotest idea what the cost of that development work was. It certainly was in the nature of a great many millions of dollars and that was done largely through Government support because of its pertinence to our war effort, and through Office of Scientific Research and Development. At any rate, it would have been of such magnitude as to have made just the straight private-enterprise development all but impossible at a rate which we saw happen.
There is presently no government or private venture so far as I am aware in those areas that presently are importantly relevant to our emergent situation that can take basic knowledge once it is acquired and expend the tremendously greater funds that are necessary for developmental measures and studies.
I think on that score that the atom bomb is perhaps the most magnificent example, because the nuclear physics knowledges which came, came over a long period of years from basic scientists primarily in Europe and from some in this country; this is irrespective of whether it should or should not have been developed, because that is not my prerogative to discuss here. But the cost of the initial bomb was à tremendous amount of money, and I know of several very important areas now in which work of a very exciting nature is going on in which large developmental funds are needed. Those funds are just not available from any ordinary source, and I would wish that the committee could help in this.
But I would hope that this would be done only with the understanding that basic science does itself need further support.
The main question is whether or not some such concepts, medical developmental measures, might not be pursued because I think they could help in bringing to the health of the people a number of measures of a good deal of importance.
The CHAIRMAN. I will conclude my questioning, because it may be that some other members of the committee would like to question you further, by asking this question to either you or Dr. Wright or anyone else present:
Would you say, Doctor, that, if there are any outstanding advances with reference to disease, the scientific and medical publications and the men themselves responsible for them will disseminate that information or knowledge to the public? In other words, is there or could there or should there be or would there be any holding back of the truth, so to speak?
Dr. JoNEs. I am not aware of any holding back. I think that the scientist himself would speak directly to the public and I am certain that, through presentations at his scientific associations and with the present agencies that are interested, such information if it is very important would probably very soon appear.
Sometimes the New York Times has scientific data far ahead of its publication in any medical journal.
The CHAIRMAN. Thank you, Doctor.
Are there any other members of the committee who would like to ask any questions at this time?
If not, we will proceed with your next witness, Dr. Wright.
Dr. WRIGHT. Thank you, sir. I am going to ask Dr. Robert Wilkins, of Boston, to speak on the problems that have to do with high blood pressure and hypertensive heart disease.
The CHAIRMAN. That is a very appropriate matter to Members of Congress.
STATEMENT OF DR. ROBERT W. WILKINS, VICE PRESIDENT,
AMERICAN HEART ASSOCIATION, MASSACHUSETTS MEMORIAL HOSPITAL, BOSTON, MASS.
Dr. WILKINS. Mr. Chairman, I was very much interested in your introductory remarks about the change that is taking place in the life expectancy of our population, particularly with reference to infectious diseases.
I think most of us were rather startled and perhaps disappointed in Dr. Wright's presentation because those statistics might seem to indicate a poor record in the field that we represent. If anything, the cited figures imply that all aspects of the heart disease problem are on the increase.
You are asking here, in essence, what are the reasons that we are not making progress if we are not and where do we stand in some of these matters. I think the next two subjects that we are going to discuss-hypertension or high blood pressure and arteriosclerosis or hardening of the arteries—are different diseases and different types of diseases from the kinds that you mentioned in your introduction, such as pneumonia, influenza, typhoid, or even the kind that Dr. Jones has talked about. Dr. Jones interest in rheumatic fever serves to bridge the
gap between these infectious or more or less acute infectious diseases and these chronic or what sometimes are called degenerative diseases such as high blood pressure and hardening of the arteries.
The fact is that these diseases-taking high blood pressure as an example-run an average course of 20 years. I think it is necessary to point out that this is different from pneumonia which lasts a week. There you either get well or you do not get well, but it is not a chronic problem of the other sort.
Secondly, we have no information whatever to indicate that high blood pressure has anything to do with infection except where that infection has involved the kidney. This brings us to the question of what do we know about high blood pressure and what is high blood pressure?
High blood pressure simply means a high pressure in the arteries of the body-from those big vessels that lead out of the heart to those, progressively smaller, that reach all parts of the body—all carrying blood. There is always some pressure in them. There is the normal pressure. There is the pressure which can be too high.
I think you could liken it in some ways to a hot-water circulating heating system in your home, where the pump in the cellar pumps the hot water from the furnace up to your radiators and then returns it again to be reheated.
If for some reason the valves to the radiators should be shut down part way, increasing the resistance to the flow of water from the pump, then either the flow of water would decrease or the pressure would have to rise. If you did not want to get a lesser amount of heat in your house, you would have to put more juice into your pump and make it
pump harder to get the same amount of heat from the water. The pressure in the system would put a strain on at least two points in the system: the pipes and the pump. In a similar way in high blood pressure, when the pressure rises in the arteries, it places a strain on the arteries which are the pipes and on the pump which is the heart