of them they can only do certain things, and are only trained to that level, and then there is the next higher level, and then, finally, the physician who would be roughly comparable to ours.

Most of their graduates are women because it is a Government policy that the male manpower can serve their country best by going into engineering and some of the hard sciences. Most of the medical sciences and health sciences are now covered by women.

We have some difficulty in getting exact statistics, but when they are producing at the rate of three times annually, I think that the point can be well made that they are already up with us and are outstripping us in that respect, and, sir, I think there is a real danger as far as our country is concerned.

At Geneva, at the World Health Organization, the Soviet representatives time after time stood up and said to the new African countries and other nations:

We now have established free institutes in medicine where you can come and get trained, and we will pay your expenses.

There is no charge. This is free. The word "free" kept coming again.

Not only do we do that, but we will be very happy to supply the emerging nations with manpower to help them with their problems of smallpox and leprosy

and so forth. In many countries they have accepted this help, in one or two countries to the regret of the recipient country. But, nevertheless, I think it is a real threat to their country because they say to a man, "You learn the language. You stay until we tell you to come back." This is one of the most serious threats.

If we can't supply enough medical manpower for our own country, I don't see quite how we are going to meet that challenge in the years to

come.

Mr. BROCK. Will the witness yield?

Dr. COGGESHALL. I surely will.

Mr. BROCK. The witness has stated:

to the regret of that country in supplying manpower in the fight against smallpox and diseases.

What did the witness mean?

Dr. COGGESHALL. The regret I referred to there was because of the health personnel going in there and exceeding their role as health educators and health assistants. They engage in all sorts of activity, sir.

Mr. ROBERTS. In other words, what you are saying is that the Russians are using, we might say, their physicians to win over these people to the cause of communism?

Mr. COGGESHALL. That is my opinion, sir, without any qualification.

An individual can go into a foreign country on a health mission and be of great service. He is practically never accused of imperialism or any political motives. The great reputation of one of the greatest health foundations in the country, the Rockefeller Foundation, was based on their international health program. They went in and helped people. They would never engage in any political situations, and people over the world have learned to respect their health personnel.

We have great difficulty in supplying enough health personnel for our international program. We have no difficulty in getting volunteers, and they must be volunteers, to go in and spend a month or sometimes months, but they must come back home. The Soviets have no such problem. They said on the floor, before the 85 nations that were represented in Geneva, "We will give you the help. It is free.” Or, "You can come to us and we will train you and it is free."

Mr. ROBERTS. In other words, you would say that our activity in this particular field, that is the point 4 program, has probably been very effective and the Russians are now more or less trying to improve on what we have done with relation to other countries in the world? Dr. COGGESHALL. That is my opinion, sir.

I have seen ICA in operation. I think it is doing a good job in most places. I have been on committees that examined in detail these programs, and, although you can find exceptions where there has been poor management and improper behavior, the program as a whole has been very good. But each time a study has been conducted in relation to the efficiency of our point 4 or ICA programs, the report has always come back to say:

The principal need that is not present is qualified personnel that will go and ștay and do a job there with the people.

Mr. ROBERTS. Isn't it true that the medical and health activity that we have engaged in as a part of our foreign aid or mutual security program has been probably the least expensive, but one of the most effective means of keeping people on our side in this cold war?

Dr. COGGESHALL. That is my opinion, sir. I am not in position to compare it to some of our other military programs and so forth, but, having been in the field of international health and knowing many of the foreign health leaders on a personal basis, I am told by them that what you have said is true; namely, that our technical assistance, for instance, in ICA has been one of the most productive and helpful programs and a program that will keep them allied with us.

Mr. ROBERTS. One other question and I am through, and I apologize to the members of the subcommittee for taking so much time. Are we keeping up, in your opinion, with the expanding growth of our population?

Dr. COGGESHALL. We are not, sir. We can't possibly keep up unless there is an acceleration. I think that we have kept up to the present time.

It is not generally appreciated how near the breaking point we are. If the population figures are correct, every time we make a medical advance we really create more problems because we prolong life expectancy to the point where more medical help is needed.

Industry, each year, with studies based on economics, shows that it is to their benefit financially to have more medical help. The armed services and all the Federal agencies need more medical help. Our international health program which I think deserves a great deal of attention—and it is the only way that we are going to compete with our enemies-needs more and more help. But there simply is not enough assistance at the wellspring here from which this talent comes to keep pace with the needs, and I answer you unequivocally, we are falling behind.

Mr. ROBERTS. Doctor, you speak here today as a representative of the Association of American Medical Colleges?

Dr. COGGESHALL. Yes, sir; I speak in that capacity. Also, I am responsible for one of the 85 medical schools in this country supplying talent. I speak also as a former special assistant to the Secretary of HEW, and I have followed this problem with great personal interest since I have had this responsibility.

Mr. ROBERTS. Do you know what would be the attitude of the American College of Surgeons with reference to this legislation?

Dr. COGGESHALL. I have asked the question of the American College of Surgeons. They are for it. Dr. Ravdin, who is now the president, has appeared before your committee, has urged-I am not sure of the institutional grant-the amendment of the Research Facilities Act to include educational facilities.

Mr. ROBERTS. And what do you think will be the attitude of the American Medical Association ?

Dr. COGGESHALL. Again, I am not their spokesman. I can tell the committee that I spoke to Dr. Blasingame from Texas, who is the executive secretary. He said:

Our position is that we favor the construction bill on the basis that it is a one-shot item.

The institutional grants, I am not sure that they have taken a position on. On the scholarship bill that you are going to hear, they are for this in principle, Dr. Blasingame told me, and I said, "Supposing I am asked this question." He said:

You can state that whether we will appear in person or write a letter is yet to be decided by the board.

Mr. ROBERTS. Thank you, Doctor.

Do any of the gentlemen on the subcommittee have any questions? Mr. DEVINE. Are there 3,300 foreign students that come to this country and are trained here?

Dr. COGGESHALL. No, sir. I am sorry if I left that impression. These are 3,300 graduates that come over to complete their training, and that is about the number that appear here each year.

Mr. DEVINE. And about 1,500 stay here, and the rest go back?
Dr. COGGESHALL. About 1,800 last year were licensed.

Mr. DEVINE. Do they not tend to tax our already overloaded educational facilities?

Dr. COGGESHALL. Most of these come over as interns and residents. They go to community hospitals where the hospitals have difficulty filling internships. Some of them do engage in research, but the large majority of them come over for internships and residencies.

Mr. DEVINE. Can you give us any figure indicating how many foreign students are in the area that we are dealing with here today that are using facilities that perhaps would be utilized by American students?

Dr. COGGESHALL. I am sorry, sir. I would rather not guess. I don't know. We are encouraging many of them to come. I think it is a fine idea if they go back to their own homes and go back as leaders and investigators there.

Mr. DEVINE. That is all well and good from the international standpoint, but one of the points you have made was the route Germany

traveled and the problem they had in trying to expedite the medical program, primarily because their facilities were overtaxed.

I am wondering if we are perhaps discouraging some of our own students from going into medicine to facilitate the international aspect.

Dr. COGGESHALL. We are discouraging a lot of our students from going into medicine. There are hard facts to show, as Dr. Berson will point out in a moment, that all students can no longer afford to study medicine because of the long time it takes and the competition for other disciplines, the physical sciences and so forth, that actually pay each one for studying. These are the two principal reasons, but I would prefer that Dr. Berson cover that point.

Mr. DEVINE. Would you say that we are producing approximately 7,200 physicians a year?

Dr. COGGESHALL. Yes; physicians. I am not referring to dentists. That's right.

Mr. DEVINE. And that the ratio today is about the same as it was a decade ago?

Dr. COGGESHALL. That is right, and Russia is producing about 21,000 to 22,000.

Mr. DEVINE. With all due respect to your colleagues that you meet in your Geneva meetings and elsewhere, I have never been too inclined to believe anything the Russian says about any subject.

Dr. COGGESHALL. On that point I will go right down the line with you, but I think there are some ways of finding this out.

I will give you an example of why I believe it to be true. You visit a spa in Russia today, say comparable to Hot Springs. You find 15 or 25 physicians. There are physicians all over the place, where, in similar circumstances in this country, we have none.

Mr. DEVINE. That is all, Mr. Chairman.

Mr. ROBERTS. Mr. O'Brien.

Mr. O'BRIEN. Doctor, apparently it is your judgment that until we do something in the construction field, the institutional grants, and perhaps scholarships, we will be wasting our time by not fully utilizing this pool of knowledge we have created by the money we have spent, the Government and private people, in the field of research; is that correct?

Dr. COGGESHALL. By your definition, I agree. That is correct. That is my feeling.

Mr. O'BRIEN. And that will get worse as time goes on?

Dr. COGGESHALL. I attempted to point out that it is a lopsided affair here. A vigorous, healthy, well-manned and well-organized research program has been very essential and very effective, but, on the other hand, that has gone so far forward to the neglect of training all this talent that we are getting into a difficult situation, and this applies to the dental schools, the medical schools, and the schools of public health.

So I would say again that I would like to see very serious consideration given to the institutional grant. This lets each school do the things that they need most. One school may not need animal quarters, but here they do, and this will allow them to do this. It will stabilize their research.

Today the man on the faculty has a private contract to do his research. This institutional research will lend great stability, and I think it would be one of the most useful things Congress could do.

Mr. O'BRIEN. I was not criticizing what we have done in research. It just seems a shame that we don't utilize what we have already acquired.

You mentioned priority. Don't you consider the institutional grants or construction aid more important at this stage than the scholarship grants?

Dr. COGGESHALL. Yes, sir. I would consider the No. 1 priority the institutional grants, based on 10 or 11 years' experience with trying to get educational facilities lined up with the Research Facilities Act.

I think I give that No. 1 priority because of its great usefulness. And, No. 2, the possibility of immediate action, scholarships are very essential, but I think we could go along without assistance there a little bit longer than we can in the other two areas.

Mr. O'BRIEN. The thought I had in mind was, in spite of the high cost of medical education and the diversion of people to other fields, if you have the facilities you would still have a substantial increase in the number of students because there are more applicants at most medical colleges than they can accept.

Dr. COGGESHALL. That is right.

Mr. O'BRIEN. That is all. Thank you.

Mr. BROCK. Doctor, since the pharmacy profession is an important element of the medical arts field, would you favor including pharmaceutical colleges in H.R. 6906?

Dr. COGGESHALL. Pharmaceutical colleges, sir? I don't know whether I would or not. I do not have a pharmaceutical college in my own institution.

I can speak very positively as for the medical schools, the dental schools, and the schools of public health, but I am not sufficiently informed, sir, to answer that question. My initial impression is "No."

Mr. BROCK. You agree that they are very important to the medical profession and many graduates of the pharmaceutical colleges go into research in biology, pharmacology, bacteriology, and all the sciences that are important to the medical profession?

Dr. COGGESHALL. I do agree that they are very important members of our society. I wish more of them were engaged in research and similar activities. I am not sufficiently informed. I do not want to give a negative recommendation. I would rather abstain on that question because I am not sufficiently informed to give you an opinion. Mr. BROCK. Thank you very much.

Mr. ROBERTS. Thank you very much, Doctor.

Dr. COGGESHALL. I appreciate the privilege of appearing before you. Thank you very much.

Mr. ROBERTS. I believe you inserted your formal statement at the beginning?

Dr. COGGESHALL. Yes, sir.

Mr. ROBERTS. Our next witness is Dr. Robert C. Berson of the Medical College of Alabama, from Birmingham, Ala.