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The following are examples, suggesting important areas of work and achievement.
Heart disease and employment
Since economic pressures are so immediate in most cases of cardiovascular disease, it is only natural that increasing emphasis is being placed on programbuilding efforts to keep the heart patient on the job or to help him adjust to a different job more suited to his capacities.
This is an extremely complex problem. It involves the national defense program, business and industry, labor organizations, the farm, the family. Until now the work capacities of heart patients have not been adequately utilized, mainly through ignorance of what they can do, and because of the too widely held belief that a heart ailment condemns a patient to a life of invalidism.
The fact is that the person with heart disease is not really handicapped in the literal sense when he works under the proper conditions. If he is selectively placed in a job that fits within his cardiac reserve, and receives proper medical supervision, continued employment is often possible without harmful effect. A large number of cardiac patients can and do work and many more are employable. Through its cardiac-in-industry committee, the association has provided guidance and materials to stimulate the establishment of local cardiac-in-industry committees and programs by affiliated heart associations and their chapters. In every community where the need is indicated, establishment of a work classification clinic is being encouraged as the facility best able to provide many of the services required to fit the cardiac comfortably in a job.
The work classification unit is concerned with finding out the work capacity of patients referred to it, based on medical diagnosis; with evaluation of the patient's economic and family situation; and with matching the patients' capacities to the various types of jobs for which they may be suited. The units are usually established as part of a cardiovascular clinic or they are set up at a rehabilitation center.
Local cardiac-in-industry committees, established by heart associations to direct the employment and rehabilitation programs in their areas, are composed of physicians, employers, representatives of labor, and other interested agencies in the community. Besides organizing work classification units and rehabilitation facilities where needed, they are sponsoring conferences on the problems of the cardiac worker and in many other ways are trying to arouse their communities to effective action.
Rheumatic fever programs
In addition to scientific advances in the prevention of rheumatic fever through the use of antibiotic drugs, the development of community programs for rheumatic fever patients has done much to reduce the ravages of the disease and to contribute to the optimistic outlook in this field. The American Heart Association is intensifying its efforts to develop complete programs to meet the needs of the young patients by drawing upon the various community services, agencies, and facilities that are required.
Reporting on the progress being made in these programs, the association's new booklet, Heart Disease in Children, states, "As a result of rheumatic fever programs, improved health services, and educational programs among parents, school people, social workers, and nurses, more children are brought to physicians in the early stage of the infection when it is most important that they be kept in bed under medical supervision."
A committee of the association's council on rheumatic fever and congenital heart disease is engaged in the preparation of a report based on a 2-year survey of rheumatic fever programs. The purpose of the report will be to set standards for the development by heart associations of rheumatic fever programs that will assure proper services and facilities to patients. As another means of assisting heart associations in developing such programs, the association has continued a joint project with the Helen Hay Whitney Foundation which maintains a clearinghouse and collection center for information on rheumatic fever facilities and programs throughout the country.
Because rheumatic fever ranks high as a cause of heart disease among children of school age, an important part of a rheumatic fever program is the school health program. The school physician, nurse, and teacher may often play an important role in detecting new cases or recurrences, in referring the child to the family physician or clinic for treatment, and in cooperating with the physician afterward in proper management of the child.
Some heart associations are promoting routine examinations of all schoolchildren entering the first grade as a measure of mass screening for rheumatic or congenital heart disease.
Several associations have sponsored the establishment of a cardiac case registry, a compilation of data on cardiac children and those suspected of having heart disease. This index provides a method of following the children through the school years, and is used to insure continuing medical observation and treatment where needed and to adjust education to the child's physical status when necessary.
The chief source of income to the American Heart Association and its affiliates is the heart fund campaign, in which the public is asked for voluntary contributions every February. Additional sources of funds are memorial gifts, legacies and bequests, and other year-round donations.
The 1953 heart fund campaign, the fifth of the association's national fundraising efforts, reached the highest total yet attained. The successful results. of the 1953 drive are viewed as an expression of steadily increasing public confidence in the voluntary program to combat the cardiovascular diseases. The 5-year record of receipts is as follows:
Remarkable changes have taken place in the past 30 years in the attitude of both physicians and the general public toward diseases of the heart and blood vessels. Until comparatively recently, fear and fatalism were the prevailing attitude; a verdict of heart disease was considered tantamount to a death sentence. This situation has been drastically and rapidly changed.
As Dr. Paul White, of Boston, a founder and past president of the American Heart Association, has put it: "Those of us doctors who graduated from medical school 30 to 40 years or more ago look back now at the almost unbelievable ignorance about heart disease that then existed. More knowledge has come since then than had been acquired in all the centuries before. *
The program of the American Heart Association and its affiliates has made substantial contributions to this great forward movement in knowledge about the cardiovascular disease. The major principles which have guided its thinking and action during the 5 years since its reorganization in 1948 may be summarized under these four points:
1. This is essentially a medical movement, dedicated to the advancement of medical knowledge through research. The fruits of this research must be brought by the quickest and most effective means to the practicing physician and through him to the patient-the ultimate reason for the association's existence.
2. The basic aim is to build a truly effective partnership between physician and layman in order to assure that the program will be soundly conceived as well as efficiently administered and adequately supported.
3. It is essential to stimulate and endeavor to coordinate the activities of appropriate community resources in building programs designed to prevent the cardiovascular diseases and to provide care for those who are afflicted by them.
4. A responsible public awareness of the importance of the cardiovasculardisease problem must be created, together with an objective, hopeful attitude based on knowledge.
It is true that significant advances have been made in the diagnosis, prevention, treatment, and, in some cases, the cure of various forms of cardiovascular disease.
Among the important scientific advances may be listed the prevention of theumatic fever by the use of penicillin or sulfa drugs, the surgical treatment of certain congenital and acquired heart abnormalities, the surgical and medical treatment and improved methods of management of patients with high blood pressure, the use of anticoagulants in reducing mortality and preventing complications following attacks of coronary thrombosis.
Another outstanding development is the use of antibiotics in the prevention and treatment of subacute bacterial endocarditis, a form of heart disease which was once fatal in almost every case.
There have been many advances in the medical and surgical treatment of diseases affecting the blood vessels in the arms and legs.
These accomplishments, although important, are small in comparison with the job that remains to be done. The basic causes of the most common types of heart disease remain unknown. Their discovery, and the progress in prevention and therapy that will follow, still remain in the future.
Dr. WRIGHT. Now, there are other private agencies which make a real contribution to medical research.
It is impossible to list all of the foundations from which money is obtained for individual investigators. The life-insurance medicalresearch fund gives large grants during each year, amounting last year, I think, to about $800,000 or more.
I say that from various private sources money is beginning to come into the heart field, but when we are talking about a group of diseases that affect 10 million people, $2 million, or $5 million is 50 cents a head for the people that have the diseases, and that does not seem excessive. In fact, it seems almost miscroscopic.
In addition to these private groups, of course, is the great contribution made by the Public Health Service, and in this particular area of special interest is the National Heart Institute.
Now, I should like to ask Dr. Watt to speak regarding the National Heart Institute.
STATEMENT OF DR. JAMES WATT, DIRECTOR, NATIONAL HEART INSTITUTE, NATIONAL INSTITUTES OF HEALTH, PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, WASHINGTON, D. C.
Dr. WATT. Mr. Chairman, I am Dr. James Watt.
The CHAIRMAN. Will you give your name in full and position for the record?
Dr. WATT. I am Dr. James Watt, Director of the National Heart Institute. I am a regular corps officer of the United States Public Health Service, and have been for number of years.
The work of the National Heart Institute has been given to you in considerable detail in the general statement, titled "Heart Disease," which the chairman has indicated will be made a part of the record of this hearing.
We are a little apologetic about the length of this statement which we submitted, but the importance of this problem is such that we believe detail is desirable and should be considered.
Our own program, representing Federal portion in the partnership of resources against heart diseases parallels and complements in many areas that of the American Heart Association. Our activities are divided into two broad areas, first those in the grants field and second those in our own research operations within the Public Health Service. This comprises, as you are quite aware, the actual budget structure for appropriation purposes.
I have with me a brief budget history of the National Heart Institute, which I would like to submit for the record if you feel that this would be useful. It is a summary of the appropriations of the National Heart Institute since its inception, following its enabling act in 1948.
The CHAIRMAN. That will be accepted and made a part of the record.
(The matter referred to is as follows:)
National Heart Institute-Appropriations from inception of the program (excluding contract authority)
Dr. WATT. I would like to summarize rather briefly the division in our activities.
One major division is the research grants area.
Dr. Jones referred to it earlier and gave you a brief summary of how this research-grants mechanism operates. We believe that it truly keeps this research program in the hands of the men who are doing the research.
The scientists from the universities and the various other research organizations throughout the country come to our study-section meetings and pass, in an objective fashion, on these research grants.
They are submitted by the individual through the institution or organization in which he works and thence come to the study sections. The applications are reviewed by scientists on the basis of scientific merit.
The council, another group of individuals, another group of people, also meets and reviews these.
They do not spend time duplicating the work of the study sections, but rather their job is to look at these applications in relation to need, in relation to the development of a program, in relation to actually bringing to bear the full weight of our resources on the important phases of the program.
The two groups of organizations complement each other. Scientific judgment of the study section is essential, but also it is important to have with it the judgment of both professional people and laymen looking at the overall picture of the problem and the available resources. Our councils do have, in addition to the professional mem
bers, leaders in community service throughout the country. The doctors in this help us develop the actual program itself.
Dr. Jones is a member of the Heart Council, and Dr. Andrus is soon to be one of our council members, and has also participated in the grant program in many ways. He is at present in a research. laboratory made possible by Federal construction grant money.
We have with us today, if there are any detailed questions you would like to have answered, Dr. J. Franklin Yeager, who is in charge of the research-grant program as well as the teaching-grant program of the National Heart Institute.
The intramural research work done largely at Bethesda both in the Clinical Center and in the other research laboratory buildings is another important part of the Heart Institute program.
I shall speak chiefly of projects being carried on now.
Dr. Berliner who is chairman of our committee of laboratory chiefs is also here and he can give you some comments on the different types of scientific work that is going on.
We have a number of laboratories, some of whose names may not very directly relate to cardiovascular disease. For example, Dr. Berliner on my left is in charge of the laboratory of kidney and electrolyte metabolism.
Superficially, this might seem a little off from cardiovascular disease, but I am sure from the statement you heard earlier about the relationship of the kidney to hypertension you see that there is a direct relationship between studies involving the kidney and its functions and the study of cardiovascular disease. Some others are the laboratories of chemistry of natural products, cellular physiology, and chemical pharmacology.
This only gives a beginning idea of the many things that go on in the Heart Institute.
I could go on talking for a long time, but most of the information is in our prepared statement. I believe it would be much better to let you ask specific questions. If you wish to go into any of the details of the program any of the three of us who are here will be glad to take part in it.
The CHAIRMAN. Mr. Dolliver.
Mr. DOLLIVER. You have been the Director of the Heart Institute for several years; have you not?
Dr. WATT. Less than a year. Dr. Van Slyke, who is here, was the original Director of the Heart Institute and he is now Associate Director of the National Institutes of Health.
Mr. DOLLIVER. How long have you been in your present capacity? Dr. WATT. Since the 1st of December.
Mr. DOLLIVER. Since the 1st of December?
Dr. WATT. Yes, sir.
Mr. DOLLIVER. I am sure, as a matter of public interest that we would be glad to know the number of people that are engaged in this kind of work directly under you, Doctor.
Dr. WATT. At the present time?
Mr. DOLLIVER. I am talking about the grants to the different universities and the work at the Institute.
Dr. WATT. Would you like to have that by just the different types of scientists and different types of workers?