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Dr. McCORMICK. Thank you, sir. The CHAIRMAN. Dr. Wright, you may proceed. Dr. WRIGHT. I believe Dr. Jones has something to say. Dr. JONES. Could I address myself to one remark that was asked of Dr. McCormick, and that is the question of the public moneys being used, to just say that if it had not been for the National Institutes of Health research programs of the past few years, it seems practically certain that medical science and work going on in voluntary and State institutions throughout the country indeed would have been very heavily handicapped. The method of administration of these grants is a technique which is known very little to the public and is probably one of the most extraordinarily successful ways in which public funds can be utilized with about as complete freedom as is possible.
For instance, the national advisory councils, after a review of applications by study sections of scientists, take final action or recommend then to the Surgeon General what is to be done, and he has the power of veto, which has been rarely used. In the operation of this very important program, in essence these are public moneys for research support awarded to scientists largely upon the advice of private citizens, other scientists, and public and private leaders of a very high type.
During the course of these hearings reference will be made to the accomplishments along this line and they are really almost unbelievable and of vital importance.
I would certainly hope that the private agencies in this instance here will get increased funds also, but we need both the private and the public and multiple sources in each if we are going to have the real opportunity for freedom of scientific development which we very badly need to foster more and more in this country.
The CHAIRMAN. With reference to what you have said, I noted particularly the testimony of Dr. McCormick. In his first few words he first indicated to me that there might be objection to expenditure of funds through governmental agencies, but as he progressed with his statement, it was made aware to me that he was not in opposition to what is being done through the Public Health and the research programs of the National Science Foundation.
I think what he did say finally was that they did not want to see too much governmental help, and I am not too fearful that you will ever get too much governmental help. I am hopeful that you will get considerable help as a matter of fact.
Dr. WRIGHT. Mr. Chairman, we should like to address ourselves now to the question of what is being done today by the various agencies. The CHAIRMAN. All right.
Dr. WRIGHT. Dr. Jones has already touched upon this briefly. I will divide this into what is being done by the American Heart Association, and in very brief outline form and then mention other agencies, and we will ask the United States Public Health Service to present a summary of what they are doing.
Five years ago, or more, the American Heart Association had very little money to give or to distribute for research purposes. But, in the last 5 to 8 years this has markedly increased as a result of the
annual solicitation of funds. It is expected that something in the realm of $2 million or more will be made available for research grants and fellowships, investigatorships and various other types of encouragement to research.
I would like to call to your attention a booklet which has been distributed to each of you entitled, “The Executive Staff Report of the Assembly”. On the front cover is the picture of a pie which is sliced as we slice our funds. As you will see for any moneys that come to the headquarters of the American Heart Association, we have an ironclad rule that 50 percent, or more, must be given for research. The rest may be divided among administration, public education, medical education, public health, and so forth, but more than 50 percent of every dollar that comes to the headquarters is devoted to research. It is committed before it goes into the pot, so to speak, by being placed in the special fund and cannot be diverted from that fund. That is a matter of policy in the Heart Association.
The money that is retained by the affiliates throughout the country is divided in various ways, but many of the affiliates apportion 50 percent, and some of them a considerably larger sum, for research. In some cases where they are just getting started and the amounts of money are very small, the proportion that goes for research today is not as great, but the total is growing very rapidly. Considering the money, as was pointed out a few minutes ago, that is expended in this country for many lesser causes, this is a very small amount of money, indeed. We recognize that.
Between the years 1949 to 1953, the number of fellowships that were awarded, and this is the way in which we educate young men to later take the leadership in the field of cardiovascular diseases, increased from 26 to 53, and the grants-in-aid in different institutions grew from 19 to 70. In addition, we have more senior workers and career investigators. This is a new approach in order to give a man a lifetime of security in his work in this field. It really is following along the line of what Dr. Jones has made an earnest plea for today.
We select with great care and the selection takes sometimes several years to pick an individual, one individual, from men who have done very outstanding work and who are in their young middle years and have established themselves and who wish to devote their entire working life to research without interruption either from having to earn a living and practice or to even teaching to an excessive amount or doing administrative work.
So far, since this has been established and in the period of about 4 or 5 years, only 3 such men have been selected. They have complete independence as to where they work and so forth. They can move from one university to another in order to improve the situation under which they may work. Their salary is good and they are kept ahead to a considerable degree in their department.
This is a new idea, but a very profitable one, and other organizations are watching to see how this may be useful to them and perhaps to emulate it.
The research grants in the American Heart Association in all of the various aspects, are made by having the applicant apply with a sponsorship. These applications are processed through a receiving committee which operates without pressure, even from the president,
as I can testify, because having been president, I think it is normally recognized that the president makes no approach whatsoever to the research committee in the interest of any particular investigator.
When a problem comes up before the committee any member of the group leaves the room during some period of discussion, if and when it is not appropriate for him to remain. It is about as unbiased as we can make it. · These grants are processed very carefully by the research committee. While I am sure some mistakes may
be made, they are honest mistakes and it is about as unbiased as it is possible to have it.
There is another folder here which you may refer to which is called the Fellowship and Research Grant Awards. I do not wish to read all of these names of the awards, but it is available for your observation and information. These are grants and awards which were made during 1952 or 1953.
The CHAIRMAN. I have looked through these two pamphlets to which you have just made reference. I think that there is a great deal of very worthwhile information contained in both of them, and it is my intention to make them a part of the record of this hearing as well as the general statement on heart disease which was prepared by the National Heart Institute, of the National Institutes of Health, Public Health Service, United States Department of Health, Education and Welfare, which will be made available to the committee. They will all be made a part of this hearing.
(The matter referred to is as follows:)
Prepared for hearings of the House Committee on Interstate and Foreign
Commerce, October 1, 1953, National Heart Institute, National Institutes of Health, Public Health Service, United States Department of Health, Education, and Welfare
THE SIGNIFICANCE OF HEART DISEASE
Heart disease is not one disease, but many. More than 20 kinds of diseases of the heart and blood vessels are included in the popular, widespread usage of the general term, "heart disease.”
Rheumatic, hypertensive, and arteriosclerotic heart disease-the 3 major forms-account for over 90 percent of the total heart-disease problem.
Secondly in significance insofar as number of deaths and cases is concerned are heart afflictions resulting from congenital defects, syphilis, diphtheria, pulmonary conditions, tuberculosis, diabetes, hyperthyroidism, parasites, anemias, trauma, tumors, toxic states, diseases of the endocrine glands, neurocirculatory asthenia, and others.
The following facts are staggering to the imagination but they only give the cold statistical evaluation of the problem. No tools are available to measure precisely the human suffering involved and these facts are only suggestive of the tremendous economic loss.
HEART DISEASE AS A CAUSE OF DEATH AND ILLNESS
1. Heart disease is the leading cause of death in the United States. 2. It causes more than 1 out of every 2 deaths each year. 3. More than 785,000 may die in 1953 from heart disease. 4. It is a leading cause of death in the childhood ages. 5. It causes around one-sixth of all deaths in the military ages, 20 to 39. 6. It causes some one-third of all deaths in the productive years, ages 35 to 54. 7. It causes about one-half or more of deaths in the ages 55 to 74. 8. It causes far over one-half of deaths in those 75 and over.
HEART DISEASE AS A CAUSE OF MANPOWER AND ECONOMIO LOSS
1. About 342 percent of all World War II selective-service registrants examined were rejected for heart disease.
2. Three hundred seventeen thousand five hundred men were in rejected classes as of August 1, 1945, because of heart disease.
3. About 80,000 men were given disability discharges from military service or died in service from heart disease in the war years 1942–45.
4. Rheumatic fever alone immobilized more than 40,000 men in the Armed Forces during World War II.
5. Rejections from military service for heart disease were high during the Korean conflict. In 1 area in 1 State, it was found that 1 out of every 8 men rejected, all under 26 years of age, were turned away because of organic heart ailments.
6. In the Navy alone, in World War II, 4 million man-days were lost because of rheumatic fever and rheumatic heart disease.
7. The actual or potential manpower contribution-to defense or the Nation's general productiveness-of 1 person in every 15 or 16 is limited to some degree because he or she has heart disease.
8. Approximately 176 million workdays are lost yearly because of heart disease.
9. At least 653,000 man-years are lost each year in industry alone owing to heart-disease disabilities.
10. About $2,124,209,000 was estimated to have been lost in 1951 in productivity as a result of heart disease.
11. Compensation and pension payments to veterans in 1950 because of heartdisease disabilities were $168,250,000.
12. The proportion of insurance claim payments for deaths from heart disease has been steadily rising, a company report shows. In 1951, one major company paid to beneficiaries on account of heart disease a total of $173,680,000. This sum was about 342 times the amount paid in 1931.
13. Of some 20,000 people who die each year of heart diseases in 1 State, according to an estimate, the known duration of the disabling phase of the disease was, on the average, at least 8 years.
14. At a hospital rate of $12 a day, according to an estimate and example cited by an authority, 1 patient with chronic heart disease costs $4,380 a year to maintain. This would mean that, if 50,000 patients with heart disease received hospital care for a year, the cost in 1 year would be $219 million.
15. Sixteen thousand dollars per case, or a total of $640 million was the cost of the cases of the 40,000 men inactivated by rheumatic fever alone in the World War II period.
16. Heart disease has incapacitated about one-fourth of the 150,000 persons who are beneficiaries of the federally aided program of assistance for permanently and totally disabled persons.
The following is one small indication of the importance of heart-disease disability :
The Bureau of Public Assistance of the Social Security Administration, Department of Health, Education, and Welfare, after a cross-section survey of 13,200 of 93,359 recipients of aid under its program for the permanently and totaly disabled in the age bracket 18–65, reported very recently that diseases of the heart were found more frequently than any other group of diseases or impairments.
Cardiovascular disease accounted for the major or secondary impairment in over 42 percent of the recipients, and was the major impairment in 37 percent of the total recipients; 25.5 percent of these were people in which the disease directly affected the heart, while the remainder suffered from general arteriosclerosis and arteriosclerotic complication in cerebral paralysis, and from hypertension without mention of heart involvement.
Almost 71 percent of the recipients with a disease of the heart were aged 55 or over. Over one-fourth, however, were in the age bracket 35–54.
For about 1 in every 4 of the recipients with heart disease the impairment was of 10 or more years' duration.
HEART DISEASE AS A CAUSE OF LOSS AND A BURDEN TO THE INDIVIDUAL, THE FAMILY,
AND THE COMMUNITY
Heart disease affects the individual, his family, and the community. Every case of heart disease, whether it results in immediate death, in severe and prolonged disability, or in less drastic effects, imposes a burden and causes loss. These and other considerations are involved in all cases of heart disease. The following illustrations show the specific meaning of this.
No. 1 A boy of 8 years has an attack of acute rheumatic fever. What does this mean for: The boy :
1. He suffers physical pain and undergoes the danger of psychological as well as physical crippling.
2. He must be kept in bed for prolonged periods, owing to the nature of the disease's effects in his case.
3. He will have to make many adjustments, even though the disease is eventually conquered in his instance, perhaps involving giving up cherished activities.
4. He may well lose his sense of belonging to his age group; he may drop out of or behind in school and never regain his place in that life. His family:
1. The whole character of the family's life must adapt to the presence of a dangerous, long-term illness in one of its members.
2. The costs of the illness may place severe strain upon the family income. 3. Sacrifices of many kinds will have to be made by the family.
4. An elder brother may not be able to go to college because of the financial burden of the illness upon the father's resources. The community :
1. The cost of home teaching help, if the community has a program for this.
2. The cost of home nursing, recreational and medical social services, if the community has a program for them.
3. Time and effort and organization for these and other things to help the rheumatic child.
4. Heavy hospital and other costs, perhaps, if the case becomes a charge upon the community.
No. 2 A mother develops high blood pressure and hypertensive heart disease. What does this mean: For the mother :
1. Pain and suffering, psychological as well as physical.
2. Cutting down on or abandoning many of the things she has been doing for her family.
3. Giving up. say, civic club activities in which she is especially interested and for which she performs a valuable community service.
4. Adjusting to a whole new way of life, living under and conquering as best she can the handicaps of the disability. For the family:
1. Accepting the tragic fact that their mother can no longer be the same and do the same things that she has done for years.
2. Not only taking up a larger share of home responsibilities, but also helping the mother to adjust to the illness.
3. Heavy expenses may be incurred.
5. Many new burdens will have to be carried by each member. For the community :
1. The loss of a valuable and hard-working community member.
2. The cost of helping her, through whatever appropriate services the community provides, to adjust to the disability.
3. The time and effort and organization, as well as the money, that this takes.
A man of 45 collapses one evening at home with a heart attack. It turns out to have been an acute coronary thrombosis or clot. But good medical treatment and care, good sense in following the physician's advices on his part, and nature's