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Mr. DOLLIVER. That would be all right.

Dr. Watt. Could we submit that for the record to go with this budget material, Mr. Dolliver? Mr. DOLLIVER. That would be very good. Dr. WATT. All right, sir. (The matter referred to is as follows:)

National Heart Institute personnel

Research staff :

Professional (medical officers, chemists, physicists, etc.)
Technical assistants (biological, chemical, electronics, etc. aides)

103
137

240

Total--
Research-and-training-grants staff:

Professional (doctors of science)
Other (clerical, typists, stenographers, etc.) -

Total_
Administrative staff:

Professional (Director, executive officer) -
Technical and clerical (fiscal analyst, secretaries, etc.).

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12

Total_ Mr. DOLLIVER. Now, there is a subject that maybe you do not wish to answer, and maybe you cannot answer, but I think it would be very excellent if it could be answered and come from this hearing What do you consider the outstanding accomplishment or accomplishments in this field that have come about as the result of the activities of the Heart Institute?

I realize it has been in existence a relatively short time and maybe you cannot put your finger on any direct answer to that question. If you could I am sure it would be of great interest to me, and I believe others as well.

Dr. Watt. That is a tough one to answer, since so many of the developments that occur are really evaluated by hindsight rather than foresight. You look at a new fact today, and you hope it is going to be the key, a rather broad part of the picture. Ten years from now you look back and say, "How could I have been so foolish?” On the other hand maybe you have a key fact worked out. I would be very happy to mention a few of the items that appear to be of particular importance now.

Mr. DOLLIVER. Please do not mistake the purpose of my question. It is not to embarrass you in the slightest, Doctor.

Dr. Watt. Yes, I understand. I am perfectly happy to try to answer. As I say, we really do not think of findings in terms of what is the most and "bestest” of any given time, so it sort of takes you a little unaware when you are asked that question.

I would say this, that some of the studies being run now in the field of atherosclerosis, the field Dr. Andrus talked about, have some of the most exciting possibilities. I think that is probably the work referred to in the article quoted by Mr. Wolverton.

Mr. DOLLIVER. Would you care to be specific at that point?

Dr. WAIT. It is a study of the factors which enter into the metabolism of the protein and fat molecules which are in the blood stream. The study actually is beginning to get at the mechanism by which the body takes a big fat molecule and breaks it down into a small harmless

molecule. This involves the study of enzymes, involves organic chemists, and involves a very complicated form of physical work. The ultra centrifuge is used at extremely high speeds for an opposite purpose for which the centrifuge is usually used. The centrifuge you think of as a device to throw heavy particles to the bottom of a tube you are spinning. Actually, Dr. Gofman who came up with this idea, reversed that process, and he used the centrifuge to float particles. This was made possible by adjusting the specific gravity of the fluid in which the blood serum was placed.

It is a technique of study which has let the scientists examine these molecules called lipoproteins, to see how_frequently they occur and in what kind of individuals they occur. It has also let them use the enzymes to determine how to split them, how to improve the method of handling them.

Mr. DOLLIVER. Let me see if I can paraphrase your statement correctly. I have not the scientific language at my command that you have, but what you have said, in substance, is that your researchers have gone into the blood stream and you have tried to analyze the various ingredients there of the blood ?

Dr. WATT. Right.

Mr, DOLLIVER. To determine how the blood converts certain elements that go into the body into useful or nonuseful deleterious substances that may result in arteriosclerosis or other diseases. Does that somewhere nearly paraphrase it?

Dr. Watt. That is awfully close to being exact. The only variation I would make is that at the moment we do not know which is the cause and which is the effect. We know these substances are present in atherosclerosis. Is there something which causes both of them, or is one the cause of the other?

Mr. DOLLIVER. In other words you do not know whether it is the cause or the effect?

Dr. Watt. We do not know whether it is a hen-and-egg relationship or something else, a third factor which causes both of them.

Mr. DOLLIVER. I take it, too, that in this research into this particular item you are using all of the facilities of chemistry, physics, electronics, radiology, and atom-smashing elements, all of those kinds of things that are available to the modern scientist?

Dr. Watt. Yes, sir, we are, and we are just beginning to use a facility which is just being completed, a clinical center which will let the Public Health Service for the first time actually have at the National Institutes of Health a clinical facility as well as laboratory facilities. This is the first time we have been able to do the total job in the one place, and it makes that unique situation there. We hope that it will be used not only by the Public Health Service, but by everybody.

Mr. DOLLIVER. By the way, have you any patients over there at the present time?

Dr. WATT. Yes, we have patients now. There is a schedule of buildup, which will carry us to somewhere between 200 and 250 patients in total by the end of this fiscal year. Heart is going to have on a scheduled basis approximately one-fifth of the total space, and, as the total increases, the heart patients will increase at about that ratio.

Mr. DOLLIVER. Do you have any other example you would like to give us ?

Dr. Wart. Could Dr. Berliner speak on 1 or 2 subjects, Mr. Dolliver, which I think that you would be interested in?

Dr. BERLINER. If I may I would like first
The CHAIRMAN. Will you give your name in full and your position?

STATEMENT OF DR. ROBERT W. BERLINER, CHAIRMAN, COMMIT

TEE OF LABORATORY CHIEFS, NATIONAL HEART INSTITUTE, BETHESDA, MD.

Dr. BERLINER, Dr. Robert Berliner, Chairman of the Committee of Laboratory Chiefs of the National Heart Institute.

I would like first to echo what Dr. Watt has said about trying to pick out what is important today, because it is very difficult to say what, by the evidence, actually may turn out to be valid in the future and what may turn out to be just something which was of interest at the time.

I think that from the point of view of immediate possible applications, I would also select the material that Dr. Watt has referred as the thing which was the best bet at the moment—often, however, that turns out to be not the case. I think that if I were to pick out an item which in the long run might be a very good bet to contribute immensely to our knowledge in the field, we might go into things which would appear to have no relationship whatever to heart disease. Such items as the work in the laboratory on cellular physiology, where there has been some excellent work done on the mechanism of protein synthesis, that is the mechanism of building up materials from which the body is made and studies of the way in which energy is converted for use in processes of that sort.

Such things, at the moment, of course, have very little obvious connection with heart disease.

On the other hand, we can go over to things which are more obviously connected with heart disease and discuss some of the studies of drugs used in the treatment of heart disease which, for the moment are of considerable importance. If we should arrive at the point where we really understand heart disease and could do something about curing it and preventing it these drugs would probably fall by the wayside, such things, for example, as study of anticoagulant drugs, a field in which Dr. Wright has done a lot. Studies in the laboratory of chemical pharmacology have considerably improved the understanding of the way these drugs are handled in the body and it provided leads for the synthesis of new, safer and more effective drugs for the same purpose. I do not know if that covers it sufficiently or not.

Mr. DOLLIVER. That is very good, unless you wish to add something more. That satisfies me, Mr. Chairman.

Dr. Watt. I would like to add the one point, it is very difficult to get a picture across with words particularly in a field where descriptive terms are not entirely familiar ones. We can get around this problem by demonstration and one of the things that we are always glad to do is show what we are doing.

År. DOLLIVER. I was out there a few years ago, and I went through the Institute. So, I have already accepted your invitation.

Dr. Wart. If there is anyone who would like to see some of these researches we are talking about, we are only too glad to talk to them

where we can point and say, “This is what I am talking about right here."

The CHAIRMAN. I think, so far as our committee is concerned, we would be interested in having as much information as you would feel necessary to give if this were the appropriating committee.

Dr. WATT. I think we have done that, Mr. Wolverton, in the statement we have submitted earlier, particularly in the National Heart Institute program section of the statement.

Dr. Jones. It might be advisable for a non-Public Health officer, to speak on the general subject of what they are doing at Bethesda.

It has been my pleasure to know a little bit about it largely as a member of the heart council.

I am quite certain that the most important feature of the National Institutes of Health in the intramural program is the fact that they now have proper facilities and a tremendously able staff which has been finally assembled solely to go to work, and they have made no contributions which I think they themselves can speak about. But there is one thing absolutely certain and that is that if any service which has an intellectual interest, which medical research and its support has, does not have an opportunity to work effectively itself and have the research opportunities, I think it becomes a completely sterile operation. I would be certain that in the future as the Bethesda group develops, and they now have interrelations with the various agencies throughout the country and by means of exchange personnel, we will find that not only that it is a very active, effective producer of scientific knowledge, but it is also a means whereby the entire level of Public Health Service function is improved and heightened by the mere fact that it has people of great research competence working with them as colleagues and contributors to the total function of health, education, and service. I think that in its organization in the past few years and with the present practices it really bespeaks the type of development in this country which is of great importance to science and that will give a very good account of itself.

Dr. WRIGHT. I should like to echo those remarks. I believe it will serve as a very great focal point for all medical research, although I strongly believe that we should not attempt to focus all medical research in any one area, as I think everyone here is in agreement, but should have support in many areas and many medical schools. Still to have this Institute here growing strong will represent fine intercommunication as well as a productive research unit in itself.

The CHAIRMAN. The confidence that you express with reference to the future usefulness and accomplishments of the Institute fall in a very pleasing way upon the ears of this committee because this committee, you realize, inaugurated the National Institutes research activity that we have out at Bethesda. So it is very pleasing to note that it meets with the approval of those who are best able to judge, and that they have confidence in its future.

Mr Heselton.

Mr. HESELTON. Perhaps this question should be addressed to Dr. Wright rather than to Dr. Watt or possibly it should be addressed to all of you. It is not intended to be embarrassing either.

I think you do appreciate, from what the chairman said, that one of the responsibilities of this committee in these hearings is not only to find what is good and what is encouraging, but also to have the very frank advice of people as to where there are any weaknesses, if there are any, and also to know where emphasis has, perhaps, been misplaced, if that is the case.

Have you anything to say about that feature?

Dr. WRIGHT. I would not hesitate to criticize under these circumstances, but as a matter of fact I think considering the limited period of development and the relatively limited resources to date, that they have done a magnificient job. I believe that I have no criticism or any suggestion for improvement. With what is being attempted or planned, 5 years from now it would be very good to take a careful survey of the situation to see where it could be improved.

Mr. HESELTON. I was not confining my question to you, but rather to the question as to whether you feel there is any weakness in our program today, the association program, the Institute program or any other program.

Dr. WRIGHT. I had expected to take that up as a separate subject, but I will be very glad to take it up now if you desire.

Mr. HESELTON. No; I wanted to have that information.

Dr. WRIGHT. I wish to ask for a discussion of the community service aspects of the association throughout the country. I will ask Mr. R. 0. Betts, the executive director of the Heart Association, to paint with a broad brush the steps which have been taken by our community service in the handling of this great problem.

Mr. HESELTON. It is a great pleasure to see Mr. Betts here. I have great admiration for what he is doing. He was at Amherst College while I was there. He is also a resident of New Jersey.

The CHAIRMAN. I do not know whether his brilliance depends upon being with you in college or a resident of New Jersey.

STATEMENT OF R. O. BETTS, EXECUTIVE DIRECTOR, AMERICAN

HEART ASSOCIATION

Mr. BETTS. I am R. O. Betts, executive director of the American Heart Association.

These few remarks will be confined to the subject of what the American Heart Association is attempting to do to apply the new knowledge that is gained for the benefit of people who are suffering from heart disease.

At the very beginning of our association's activities, when it was reorganized in 1949, when it came to considering the application of preventive measures we had very little precedent on which to proceed.

The same questions and measures that were applicable in the fields of the infectious diseases did not seem to apply to our particular problem, so that our distribution of community service proceeded very cautiously and slowly into this difficult field. So much so that in January of 1950 there was called the First National Conference on the Cardiovascular Diseases, which was held here in Washington, jointly sponsored by the American Heart Association and the National Heart Institute. There was a great deal of very valuable information available, and the arrival at a common agreement achieved through that conference which was attended not only by physicians, but people in the ancillary professions, as they are called, as well. Nursing, medical and social work, and the whole public were all represented.

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