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Mr. DEROUNIAN. Do you think, Doctor, in the heart-disease field as well as in all the other serious disease fields, sufficient stress has been placed to educate children in the public schools as to the rudiments of the disease so that they will grow up with these things in mind and try to take care of themselves as they go? I do not know how practical that might be but it seems to me if you trained a child as to what he should watch for in these diseases-assuming he does not get a complex and become a hypochondriac—he certainly ought to be able to take care of himself to a greater extent than without knowing about it.

Dr. WILKINS. You have practically answered the question yourself. You have touched on the danger point and one that the Heart Association is particularly sensitive to, and that is the fear aspect or the hypochondriacal tendency of people who get centered on their own health, which may be a disease itself. I think something could be done educationalwise along this line whether at the school-child age—that is below college age-or not. I would have considerable reservation to make except on very general health rules and on a hopeful positiveapproach basis. The name "heart” and “heart disease is enough in the daily papers to put the fear of the Lord into anybody who knows the meaning of it, and children are not insusceptible to this. I have three children myself, so I know how they respond to this. Children know enough I think right now about the fear aspect of heart disease. If your educational program could turn that around and build it up on a positive basis it might be worthwhile. I am not enough of an expert in child education to speak any further on that point.

Mr. DEROUNIAN. Thank you very much.

Mr. CARLYLE. Doctor, are we as far advanced in this country in producing medicine that is used to reduce high blood pressure as some of the other countries of the world?

Dr. WILKINS. I think we are, sir. I think that the lines of communication between this country and foreign countries have improved very, very strikingly in the past 5 to 10 years. I doubt myself if anything is known about drug treatment, speaking about that one point of high blood pressure, that we do not know about very soon.

Mr. CARLYLE. I gained the impression that a drug was being imported into this country from some country in Europe that was used quite extensively now in tablet form and by way of injection to reduce high blood pressure. Do you know anything about that?

Dr. WILKINS. That is correct, Mr. Carlyle, but the very fact that we can get the drug in quantity, and I think we have it, is significant. As a matter of fact, the drug to which you have reference, I believe, was first used clinically in this country, not in the country in which it was developed, for the treatment of high blood pressure.

Now, chemically it was developed in a foreign country, but I think that our clinicians were pretty quick on the uptake.

Mr. CARLYLE. Is it a new drug ?

Dr. WILKINS. Yes, it is a relatively new drug. It was developed in 1944, but as Dr. Jones brought out, penicillin was developed 20 years before it was adequately used.

Mr. CARLYLE. After it has been used and the blood pressure has been reduced is it then that the rice diet is used ?

Dr. WILKINS. I did not get the latter part of your question, Mr. Carlyle.

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Mr. CARLYLE. I say after this drug has been used and the blood pressure has been reduced, then the rice diet is used ?

Dr. Wilkins. No; I do not think so. That would depend on the patient and on the doctor who was immediately managing the case. After all, the patient and the doctor must cooperate in this. I have had many patients who have refused to take any sort of dietary treatment. Therefore, there is the question of whether it is practical or not practical to put into effect any sort of diet. Therefore, say that the kidneys had been affected by high blood pressure, one could not put those persons on a low sodium diet.

Dr. WRIGHT. By way of dissemination of the knowledge and experience in the field of cardiovascular diseases it may be of interest to the members of the committee to know that in the last year the InterAmerican Congress was held in Buenos Aires, which 700 leading cardiologists from all over the Western Hemisphere attended. A week later one was held in London, England, at which members of the PanEuropean Congress met.

Next year in this city of Washington we will have a meeting of the International Congress with the American Heart Association and National Heart Institute as cohosts, in which numbers of outstanding people working in this field will assemble, from all the countries of the world from which they are permitted to leave, for that very purpose of disseminating knowledge and exchanging views, and this is a project for which plans are being laid at present.

Mr. CARLYLE. So, Doctor, you find that there is a free exchange of information among the doctors of the countries of the world?

Dr. WRIGHT. Very free. I think the relationship between doctors today results in perhaps a more rapid interchange of information than in most fields of human activity, except for the countries where little or no information is permitted to be sent out.

The CHAIRMAN. Are there any other questions of Dr. Wilkins?
Mr. HESELTON. Mr. Chairman.
The CHAIRMAN. Mr. Heselton.

Mr. HESELTON. What is your opinion as to the nature and quality of research in this particular field?

Dr. WILKINS. I think that it has improved a great deal.

Formerly I happened to be chairman of the section of the American Heart Association on high blood pressure and at that time we had recently reviewed what we had conceived to be the needs for research in this field with the existing bricks and mortar laboratories then available. A careful study was done and the report of the committee was that $2 million a year could be well spent in addition to what was being spent by the existing facilities, this without expanding them at all.

Now, as to quality, the quality depends on the individual, after all, not the number of people coming into a general field. This means the training of youngsters, and brings me back, and I am sure you will hear this many times again in these hearings, to the matter of medical schools and the training of medical students, interns, residents, and

the line, research workers, if you will. I am sure that the quality and quantity, but particularly the quantity, could be improved by basic educational processes. I think what we have done so far as compared with what should be done perhaps, shows that considerable is left to

on up

be done. This is a very, very difficult field, one we are more or less just breaking into.

Mr. HESELTON. Have you reached that goal of $2 million ?

Dr. WILKINS. No. That goal was nowhere reached because that is for one subject alone, high blood pressure.

That figure is one that was in addition to what was already being done, and this was in 1950, 3 years ago, so that I am sure we have not increased the high blood pressure research by that amount.

Mr. HESELTON. Thank you.
The ('HAIRMAN. Are there any further questions, gentlemen ?
Mr. WILLIAMS. Mr. Chairman.
The CHAIRMAN. Mr. Williams.

Mr. WILLIAMS. I would like to ask one question. I note in a lot of magazines I have read conflicting articles on quite a number of subjects. For instance, on the effects of smoking on the human system, as to whether or not it produces lung cancer or heart trouble, and so forth. Other articles I have read would minimize that. Should not there be some way for these various organizations to get together and coordinate their work, possibly to the extent that the public would know which ones of these articles were authoritative and which was just merely shelling of the woods? How is the public to know which side to believe?

Dr. WILKINS. If you have a free press you cannot keep people from printing what they want to print so that I think you accept that evil with the good which I personally conceive to be the greater of a free, undirected press.

There are, however, valid and reliable sources of information. To wit, in the heart field we have the Heart Association as a reliable source.

I can testify, speaking again as an individual observing the national group, that the setup in the Heart Association has been most carefully and rigorously controlled, if you will, or guided would be a better word, toward providing only good, authentic information through all bureaus or department of the Heart Association. I think we are all extremely sensitive to the fact that the Heart Association has great responsibilities to the public to see that the information that it puts out is accurate.

Now, you say how do you decide that? We have a rule that no publication of the American Heart Association can appear without having gone through both our committee on publications and our committee on public relations, and if there is any doubt about it it must get approval by the board of trustees itself because we are so conscious of this.

Furthermore, I think Dr. Wright reminded you that we were speaking here this morning as individuals, not as representatives of the association because no one can speak for the association until what he has said, or is going to say, has been approved by these same boards. Therefore, if you want to get reliable facts on the heart you can trust the Heart Association, you can trust the National Heart Institute, and you can trust perhaps a couple of, or several other, accredited informational sources.

Dr. WRIGHT. In further development of this answer, if I may, the American Heart Association provides a service to writers wishing to write authoritative and correct articles for publication.

If such an author requests those services from the Heart Association, carefully selected authorities in that field are given as references and it is arranged for the author to interview those individuals. They then have a chance to review the medical facts which are checked by the publications group within the American Heart Association, and those articles, and there are many of them, are as really authoritative as it is possible to produce them.

We have, of course, no control whatsoever over newspaper or magazine writers who persist on going off on their own. They can write any kind of nonsense they wish. There is no way to check them I know of in a free press.

Mr. WILLIAMS. That is very true, except that most of these articles are signed by doctors. You can pick up the Reader's Digest today, and you will read that the antihistamines are still a very dangerous thing for the public to fool with, and next week you will pick up one signed by a doctor saying that they are the greatest thing in the world, that people should just use them universally, but in a case like that I am wondering if there should not be some kind of a code of ethics or something among men in the profession. In other words, shouldn't they police themselves to the extent that a doctor would be in violation of a regular code of ethics to publish for public dissemination or public reading about an article or medicine or facts or something which has not definately been established? In other words, where it would be purely an opinion, or an individual opinion on his part, should not the profession take action like the lawyers can against a disbarred lawyer, for instance?

Dr. WRIGHT. Actually that is very frequently done.
Mr. WILLIAMS. Do you not have a code of that kind?

Dr. WILKINS. With such an article appearing very frequently the doctor is taken to task by the proper authorities, but it is very difficult to do it before the article appears, and it is unfortunate that so much unreliable material is published, but we are trying to do the best we can to fight it.

Dr. ANDRUS. There are some areas in which doctors, I assume, have an honest difference of opinion on medical affairs just as in other affairs.

Mr. WILLIAMS. Do you think the public suffers from reading those articles by doctors as to the effect, for instance, of tobacco on the human body, where it probably has never definitely established whether it is bad or good!

Dr. ANDRUS. I think the medical profession suffers certainly.
Mr. DEROUNIAN. What about smoking?
Dr. WILKINS. What about smoking?
Mr. DEROUNIAN. Is it harmful, or is it not?

Dr. WILKINS. The best answer I know for that question is one which is not original with me, it is Dr. Proger's favorite answer. He says it does not hurt not to smoke.

Dr. WRIGHT. I think I can dilate a little further on this question.

There are individuals who, for one reason or another, have developed that disease known commonly as Buerger's disease, thrombo-angitis obliterans, a disease of the arteries, and there is no question whatsoever but in those cases it is very serious for them to smoke. If they continue to smoke they will probably lose one extremity after another.

The CHAIRMAN. I guess whether it is right or wrong or good or bad depends very much on the individual, and he would have to depend upon his individual doctor for advice.

Dr. WRIGHT. That is correct, and there are some diseases in which it is known to be harmful and others in which it is controversial.

The CHAIRMAN. I do not want to let the committee get into a discussion as to whether a certain cigarette will give you a scratch in your throat.

I can understand the concern some members have. Whether it is for themselves or for the chairman, I am not certain with respect to that. However, to me it is an individual problem that has to be settled by the individual and the advice of the individual physician.

Mr. CARLYLE. Mr. Chairman.
The CHAIRMAN. Mr. Carlyle.

Mr. CARLYLE. Doctor, I am not sure that you told us what percent of the people in this country suffer from high blood pressure.

Dr. WILKINS. It is roughly 10 percent of the total population. It is roughly half of the people between 40 and 60. Those figures I cannot be exact about. I do not think we really know. Hypertension, high blood pressure, usually is a sympton produced. If you do not happen to have had a physical examination you would not know you had it. That is typical because it is discovered quite incidentally, as when you have an insurance examination, and so forth, so as to the exact figures really those are estimates.

Dr. WRIGHT. Are there any other questions, gentlemen!

Mr. DEROUNIAN. I have a question here. It says, Is drinking whisky prescribed for heart disease? My father_takes brandy once a day. He is 80 years old. He is not a drinker. I just wonder whether that is a legitimate prescription of a doctor?

Dr. WILKINS. I think the chairman's answer as to tobacco would cover that, too.

Dr. WRIGHT. The answer is that it is prescribed.

The CHAIRMAN. Well, if we have satisfied the desires of the committee and those who wish to drink, if there are no further questions we will recess. I find that in this life you usually take the advice of the person who tells you to do the thing that you actually wish to do. Are there any other questions, gentlemen? If not, this would be a good time probably for us to adjourn for the noon recess. What length of time would you suggest? I see that we are not moving as fast as we expected we would, and I do hope to complete this hearing with these gentlemen this afternoon. They are all appearing here from their particular activities in life; they have made sacrifices in coming, and we do not wish to hold them longer than is absolutely necessary, so I am hopeful that we can conclude with them this afternoon. Would an hour be sufficient for lunch; would that be detrimental to health?

Dr. WRIGHT. No, sir.
The CHAIRMAN. If not we will adjourn for 1 hour.
(Thereupon, at 12:40 p. m., the committee recessed.)

AFTERNOON SESSION

(The committee reconvened at 1:30 p. m., pursuant to recess.)
The CHAIRMAN. The committee will come to order.
Dr. Wright, whom do you wish to call as the next witness?

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