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readily within 10 years, such a disease as atherosclerosis or essential hypertension might still very well not be solved in that period?
Dr. ANDRUS. I think they are much more imponderable than a disease which is caused by a direct infection. You can put your finger upon the infecting agent and do what you can to eliminate that. This is a much more complicated matter than such a disease.
Dr. WRIGHT. Dr. Jones has a word.
Dr. JONES. I would hope we would accept the fact that it is very dangerous to promise results in any of these frontier problems at any given time, but I think it is safe to say that new methods of approaching the study of some of these problems and new concepts and new opportunities to advance knowledge are existent today as never before in the history of the world. I think that is true not only of the disease stated in general, but of positive health. For instance, studies about the equilibrium, the chemical differentiations that go on to perform biological functions, are going at a rate now which is very exciting.
I think any scientist-though I do not classify myself as a scientistwho promises he is going to solve a given problem at a given time is very foolish. Any newspaperman who does is also foolish.
But the constant support of research in an increasingly better way, in bigger volume, is probably going to pay dividends such as we have not dreamed of. Our present state of contributions of the last 25 years have probably added more about human health and disease than all of the other periods of time put together. The hope of the support of research that we are doing now is that some of the things Mr. Laurence speaks of may come about.
I think that it would be probably very easy to justify the fact that it would be economic to support research at an even much greater level than we are now doing from both official and voluntary sources today, because the only way to evaluate research is by achievement, and the achievements of the past few years make it certain that with new opportunities, methods, and so forth, we are going to learn a lot.
The CHAIRMAN. Well, I assume that you have in mind that today we possess the knowledge of the past as a starting point for the future, so that the progress which is to be made in the future can very readily be much more rapid than it has been in the past because of the greater base from which you work.
Dr. JONES. That is right.
Dr. WRIGHT. Mr. Chairman, in the next section of our discussion we are going to try to analyze what is being done today, what the needs are, and what the direction for the future should be.
The CHAIRMAN. I am very much interested in that. I am glad you called my attention to it, because it will probably eliminate the necessity for a good many questions at this moment.
Mr. MOULDER. Mr. Chairman ?
The CHAIRMAN. Mr. Moulder.
Mr. MOULDER. Dr. Wright or Dr. Andrus: I was curious to know what difference there is, if any, in the prevalence of heart disease such as you have discussed here among women and men. If there is a difference, what are the statistics?
Dr. ANDRUS. The process I have been talking about, particularly atherosclerosis, is about four times as frequent in men as it is in
women up to the age of 50. After that it tends to even off. Men who survive into the ninth decade then having it become less common. Mr. MOULDER. Why is that?
Dr. ANDRUS. I cannot tell you, sir. The implication is that there is some sex-linked process of physiology that influences it. I mentioned in my remarks that this has been applied experimentally. If the disease is produced, as it can be in cockerels, by feeding them abnormal quantities of fatty substances and the cockerels are "feminized" by giving the female sex hormones, the disease literally clears up. Mr. MOULDER. That is the reason I asked the question.
You mentioned hormones. What information do you have on that? Dr. ANDRUS. The hormonal approach is being applied in a very minor way in man. It has complex and some nonacceptable side effects which have minimized its use, I think.
Mr. HINSHAW. Dr. Andrus, I am bothered in my hearing, I thought I heard you say atherosclerosis as opposed to arteriosclerosis. Dr. ANDRUS. Atherosclerosis?
Mr. HINSHAW. Yes. Will you distinguish between those two terms?
Dr. ANDRUS. Arteriosclerosis is used in two ways. In one it is a generic term applied to more or less a variety of diseases of the arteries, but that term is too inclusive to be accurate. There is a process which advances as we age in which the arteries become less elastic and that is a vascular disease which inevitably happens to all of us. The disease upon which I was concentrating my remarks is a particular disease which is not an inevitable consequence of age, and it is due to the disposition of fatty substances in the walls of the arteries. That has been given the term "atherosclerosis," which name comes from the name of the deposit itself. That is the killing disease. The CHAIRMAN. Are there any further questions, gentlemen?
I would like to ask just a question or two in this connection, because I understand Dr. McCormick is of the opinion he would be called by 2 o'clock. He had an engagement which he had to meet and so I will put this question with regard to this article by Mr. Laurence. This statement appears in the September 8, 1953, issue of Look magazine and is as follows:
The attack on diseases of the heart and blood vessels is moving forward on two fronts-the chemical and the surgical. On the chemical front, significant progress is being made. In surgery, we are making spectacular advances by changing new arteries for old and by learning to patch up old and damaged hearts.
In the last 5 years, chemistry has uncovered more and more evidence that heart conditions arise from the presence of specific chemical agents in the bloodstream, produced by some faulty chemical process of the body. These chemical agents now are being identified. They cause the arteries to lose their elasticity, and they narrow the channels which carry vital substances through the bloodstream. These conditions, in turn, lead to high blood pressure and damage to the heart muscle.
In the light of present progress it is possible to predict with certainty that within 10 years we will have established fully the causes that put these abnormal chemical agents in the bloodstream and arteries. In animal experiments, scientists have already succeeded in producing hardening of the arteries and then reversing the process back to normal. This knowledge is not yet ripe for application to humans. But beyond question it will be ready by 1963, if not earlier.
That is almost what you have said with regard to some accomplishments, although you are not inclined to be too definite as to the time in which it will be brought to fruition.
Dr. ANDRUS. That is true.
The CHAIRMAN. This article from Look by Mr. Laurence refers also to the discoveries by the National Heart Institute and to others on the subject, which you have touched upon, particularly this fatty matter in the arteries, and it is on that basis, I think, that he says within 10 years we may have it licked. That is probably what was the theory behind this article in Look magazine, as I gather from reading what I can of it very quickly.
Would you agree with that statement that on the chemical front significant progress is being made and that in surgery we are making spectacular advances by exchanging new arteries for old and by learning to patch up old and damaged hearts? I do not know in what sense he is using the word "damaged" in this instance.
Dr. ANDRUS. I think he is perhaps drawing conclusions about patching up the old and damaged hearts, but the surgeons can do some pretty wonderful things about the replacement of damaged arteries with arteries from other individuals, as Dr. Wright very well knows. The CHAIRMAN. Well, it is all very interesting what we hear on this subject, and without making too much of it, I hope you will not discourage too much the thought that in 1963 we will have 10 years added to our life.
Dr. ANDRUS. I hope for that, too.
The CHAIRMAN. Are there any other questions, gentlemen?
If not, who would the next witness be? Would it be Dr. McCormick?
Dr. WRIGHT. I think Dr. McCormick has come in and we would be very glad to have him give us his presentation.
The CHAIRMAN. I do not want to interfere with the regular presentation, but that notation was brought to me by the staff which stated that he desired to leave this afternoon.
I have here a very comprehensive statement on the background of Dr. McCormick which covers not only his activity in medicine but also in general practice in a very large way. It also gives the fraternal organizations to which he belongs. He is on a good many medical boards, and I would like for each of the witnesses who are here to feel perfectly free to make available to me their background to the fullest extent. They may wish to set it forth in these hearings. If that information is furnished to me I will do it and save your modesty by not requiring that you say these fine things about yourself, but if will present them to me and call them to my attention, I will see that they are used.
STATEMENT OF DR. EDWARD J. McCORMICK, TOLEDO, OHIO, PRESIDENT, AMERICAN MEDICAL ASSOCIATION
Dr. MCCORMICK. Mr. Chairman and members of the committee, I am very happy to be here today as the president of the American Medical Association.
I hope that I am not interrupting to any extent the proceedings of your committee by appearing at this time, but I want to make a formal
statement on behalf of the American Medical Association which I have prepared, and if the chairman so desires, I shall read this statement.
I am Dr. Edward J. McCormick, of Toledo, Ohio, where I am engaged in the active practice of medicine. I am president and a member of the board of trustees of the American Medical Association. I am appearing here today as a representative of that association to discuss our interest and activities in the field of medical research, and to offer to your committee our complete cooperation and the use of our facilities in connection with your current inquiry.
It is our understanding that this hearing has been initiated by your committee for the purpose of studying the causes, methods of control, and the extent of medical progress in connection with several specific diseases. It is apparent from the list of organizations which are scheduled to testify that complete and authentic information in this regard will be available to you.
For that reason it has been decided, with the approval of Mr. John H. Teeter, special consultant to your committee, not to present a separate statement with respect to each of the diseases to be covered. In addition to my statement, a representative from the Washington office of the American Medical Association will be in attendance for the entire hearing. If there are any questions which the committee may want to direct to the association, our representative will either supply the answer, or refer the request to our headquarters in Chicago for necessary action. Finally, at the conclusion of the initial phase of the hearings we will be happy to submit a written statement or send another witness to discuss in detail any controversial issues which may arise. It is our belief that this approach will conserve the time of the committee, and prevent duplications in the presentation of basic material.
The one exception to this plan will be made tomorrow when the subject of cancer is to be discussed. In view of the extensive work of the American Medical Association in this field, I have asked Dr. Paul Wermer, the secretary of our committee on research, to outline for you the activities of the association concerning cancer diagnosis, treatment, and research.
With these introductory remarks I should like to proceed to a brief statement concerning the composition, purposes, and program of our association.
The American Medical Association was founded on May 5, 1847, when 250 delegates representing more than 40 medical societies and 28 colleges, embracing medical institutions in 22 States and in the District of Columbia, met in Philadelphia, Pa. It has since grown from an organization of a few thousand to a membership of approximately 140,000, with 53 constituent State and Territorial medical associations and about 2,000 component county and district medical societies.
The American Medical Association is a physician's organization existing to serve the medical profession and the general public. Since its inception it has campaigned to elevate the standards of medical education, licensure, and public health; to maintain its high ethical standards; to oppose charlatanism; to promote clinical and scientific investigation, and to make available a better quality of medical service.
Although the American Medical Association acts collectively for physicians in the socioeconomic field of medicine, which includes ethics, laws and legislation, medical service, economic research, rural health and health education, primary emphasis is placed on its scientific activities.
During the year 1952 over 80 percent of our expenditure of approximately $10 million was devoted to this work. These activities are conducted largely by the council on medical education and hospitals, which is the council which has laid down the minimum standards for hospitals and for medical schools. The council on scientific assembly, which has to do with the great scientific meetings which we hold several times a year; the bureau of exhibits, of which I was chairman for several years, and many of you may have visited some of our meetings and seen the exhibits which we had on display.
I presume that probably nowhere in the world can one see so many of the recent advances in medicine depicted so that everyone can understand them as you can see them at our conventions and meetings as they are produced by the bureau of exhibits. Our committee on mental health, of course, is very active and is having a very large meeting here in Washington I believe during the next 2 weeks. Then we have our council on pharmacy and chemistry, the council on physical medicine and rehabilitation, and our council on foods and nutrition, our committee on cosmetics, our committee on research, bureau of investigation, and the chemical laboratory and microbiologic laboratory.
It would take considerable time for me to discuss in any detail the purposes and programs of these units of our association. Suffice it to say that all of their work is extremely important in advancing the science of medicine. The outstanding reputation of the members of these councils and committees for specialized scientific knowledge and integrity is well recognized. These men serve without remuneration and render unbiased decisions based on careful considerations of all available scientific evidence and expert opinion.
Through the Journal of the American Medical Association, published weekly, and the nine monthly scientific journals, as well as several special books, the association aids physicians in their search for new medical knowledge. These publications assist the medical profession in keeping abreast of medical developments, serve as an important means of postgraduate medical education and carry information on organization activities, as well as on Government services.
In addition to such interassociation groups, the American Medical Association has for many years engaged in a variety of cooperative undertakings with allied health agencies as well as with the State and Federal Governments. The operations of three such joint agencies which are currently in existence may be of interest to your committee. The National Research Council: This agency was established in its present form in 1916 by the National Academy of Sciences and organized with the cooperation of the National Scientific and Technical Societies of the United States. Its purpose is to promote research in the natural sciences and in their application to medicine and other useful arts with the object of increasing knowledge, strengthening the national defense, and contributing in other ways to the public welfare. To this end the Council furnishes professional and research