In summing up, I am in favor of S. 1875, giving the President the authority to take any action he may consider necessary or proper to achieve the desired results. I believe that decentralization and creation of a number of research centers would be preferable to concentration and that the Federal aid could be best administered through an independent agency in complete charge of the project, responsible to the President.

Gentlemen, I would like to ask you for the opportunity to comment on a few points. The first question was brought up, whether there are at present enough basic ideas upon which we could enlarge. I think there are not. I think we have to get ideas from everywhere, and whoever is in a position to "deliver the goods" should do so.

I mentioned that I believe that there are quite a large number of capable scientists who would be glad to join. One of the most difficult decisions, so I think, would be to decide whether to reject a proposed project. I mention that because quite a few important discoveries have been made on ideas which were absolutely new and probably would have been rejected by some agencies because they were unconventional. I therefore do not think the "show" should have a "boss." Everyone who is capable and productive and who presents a fairly reasonable approach to the idea, should get some chance to get a crack at it.

Senator PEPPER. Doctor, we thank you very much for coming and giving us your views.

Dr. LAZLO. Thank you, sir.

(Dr. Lazlo filed with the subcommittee the program of the American Association for Cancer Research, Inc., at its thirty-seventh annual meeting at Atlantic City, N. J., March 11-12, 1946. Dr. Lazlo also presented for the record copies of statements made by him before the Committee on Foreign Affairs on May 7 and 8, 1946; which statements are as follows:)

STATEMENT OF DR. DANIEL LAZLO, NEOPLASTIC DIVISION, MONTEFIORE HOSPITAL, NEW YORK, N. Y.

The following statement is submitted to the Committee on Foreign Affairs, House of Representatives, at the hearings on H. R. 4502.

Mr. Chairman, Congressmen, and members of the Committee on Foreign Affairs, I am greatly honored to be called upon to testify before your committee on the proposed legislation H. R. 4502. It is a great step forward that you gentlemen are here to discuss legislation and Federal aid to fight cancer. You propose concentration and coordination of national and international resources, spiritual and material, toward this aim. The need for such legislation is indeed pressing. When Congress authorized the President to create a National Institute of Cancer several years ago as a division of the National Public Health Service, it recognized first the need of Federal support to investigate cancer. Your proposed legislation is a desirable and essential extension of this public responsibility.

Cancer affects every nation in the world. Althought the greatest incidence Is in the groups of middle age, children are not exempt.

Cancer research must be done by a team. Biologists, pathologists, bacteriologists, chemists, physicists, diagnosticians, surgeons, radiotherapists, and many other experts are needed for such a team.

The facilities for cancer research in our country are wholly insufficient. True, there are a few experimental laboratories where scientists of world renown can and do work and struggle in inadequate security and with lack of funds. They are dependent mainly upon philanthropic support, which is not always forthcoming and seldom enough. We have a few cancer hospitals. Our

facilities for treatment and care of advanced cancer patients are unbelievably and shockingly limited.

There are prevention clinics for the early diagnosis of cancer, but these are only a few. We have at present no national coordination of scientific efforts in this field.

In spite of all these limitations, great progress has been made in the past decade. It is, therefore, predictable that organization, coordination, and financity support of national and international research, so fruitful in destructive fields of science, should lead us to immeasurable gains in constructive fields.

The hospital with which I am associated is a general hospital, maintained by philanthropists, and it has recognized that it could best serve its cancer patients by creating an independent division of neoplastic diseases. It has set aside a sizable number of its beds for this purpose; it admits curables as well as incurables. It has as a team, all the scientists of the general hospital, and is willing to engage in experimental research in cancer. With the rapid advances in basic and applied medical sciences, the coordination of efforts of various scientists around such centers should lead to fruitful results.

Gentlemen of this committee, your legislative proposal is unique. You are determined to help fight cancer, this is your mission as it is the mission of the thousands of my colleagues in this field. It is not true that patients suffering from advanced cancer, though at times a prey of pain, are willing to die. They beg you to help them. Your support will, I am convinced, give them hope and, perhaps even more important, advance the prevention of such cases in the future.

STATEMENT OF DANIEL LASZLO, M. D., MONTEFIORE HOSPITAL, NEW YORK, N. Y.

Members of the Committee on Foreign Affairs, I strongly favor the passage of the proposed legislation, H. R. 4502. My reasons are listed in the prepared statement, which I herewith submit. Surgeon General Parran elaborated in his testimony on the urgent needs of Federal support in the fight of cancer.

In the course of the hearing, several factors were mentioned, which need some clarification:

1. Is cancer a specialty and can we expect to train "cancer specialists" in sufficient numbers in a comparatively short time?

It is my opinion that cancer is not a specialty. Investigative and clinical work on cancer requires a team of various specialists, such as biologists, chemists, physicists, bacteriologists, pathologists, diagnosticians, surgeons, radio therapists, and many others. These experts combined make the "cancer specialists." They are trained in our various colleges in sufficient numbers.

2. Is it desirable to concentrate all investigative work into one central organization or is it preferable to spread it among many research centers?

Those who favor centralization recall the successful national efforts in harnessing atomic energy. However, as one expert stated yesterday, the cancer problem appears to be a greater one in 1946, than the problem of nuclear fission appeared to be in 1940. Whereas in 1940 the theoretical foundation for the atomic work was known, no such knowledge exists today on cancer. Therefore, I feel, that the time for a vast central organization has not yet come. 3. Can the physician be expected to contribute to the solution of the cancer problem or shall he wholly depend upon the experts in the various branches of basic sciences?

The past experiences have proven that physicians can be expected to contribute materially to the solution. They were the ones who solved quite a few baffling problems. To mention only a few examples: Robert Koch, a small-town doctor, who discovered the tuercle bacillus; Banting, the discoverer of insulin; Minot, the discoverer of the liver principle; Goldberger, the pioneer in the work on pellagra.

4. Are there places available, where research centers for cancer could be established without great delay? My answer is yes. I propose to conduct a survey of our medical institutions and select those which are best equipped to carry on research in cancer. The present lack of such is not an expression of the lack of interest of these institutions in the cancer field, but a lack of funds to carry out such investigations.

5. What would be some of the desirable criteria for the establishment of research centers in a medical institution? (a) First-grade medical staff.

(b) A number of beds earmarked for the admission of curable and incurable cancer patients.

(c) Follow-up clinic and cancer prevention clinic.

(d) Some laboratory space.

Full-time laboratory experts would soon be attracted to work in such centers,* especially if long-term contracts could be offered.

6. It is my opinion that a cancer center is better placed in a general institution than it is when isolated. In the first case, it gives and receives stimulation from the various scientific branches with which it is associated.

7. While our main efforts should be directed toward prevention and cure of cancer, the treatment of the advanced cancer patients cannot be neglected. They belong in a general hospital, which alone is equipped to handle them. I am all against the separation of these in homes of incurables. Our provisions for the care of advanced stages of cancer are at the present time, shockingly limited.

May I summarize:

I urge you, gentlemen, to pass this bill which will help to expand the very fruitful work of our National Cancer Institute; which will support our existing privately endowed institutions and which will create a number of new research centers all over the country. These will attract foreign scientists to work in this country. Centralization is suggested at a later stage after more fundamental knowledge has been accumulated.

Senator PEPPER. Dr. Harold P. Rusch, of the University of Wisconsin, director of the McArdle Memorial Laboratory for Cancer Research. We will welcome your statement on the bill or the subject, Dr. Rusch.

Dr. RUSCH. Thank you.

STATEMENT BY DR. HAROLD P. RUSCH, DIRECTOR, MCARDLE MEMORIAL LABORATORY FOR CANCER RESEARCH, UNIVERSITY OF WISCONSIN, MADISON, WIS.

Dr. RUSCH. It appears obvious from the comments made during these hearings that there is entire agreement concerning the purpose of bill S. 1875. Since there is unanimity of opinion about the necessity of more cancer research let us proceed at once to set in motion the machinery that will result in the realization of the true purpose of the bill. I suggest, therefore, that no pronounced changes be made in bill S. 1875. Details of administration can be worked out at a later date by such group as the President may authorize. Certainly we have every reason to believe that such body will be a democratic one. In my opinion, however, two changes that will improve rather than cripple the bill should be made prior to its introduction on the floor: (1) The words "place or places" should be substituted for "place"; and (2) any sum of money authorized to carry out the provisions of the act should be available until spent.

Mr. Neely has already indicated his willingness to substitute the words "place or places" instead of "place", but I wish now to say a few words emphasizing the importance of decentralizing research.

It is my opinion that fundamental research will flourish best in a number of separate laboratories; it can be accelerated but not forced. There is no satisfactory method of predicting just where an important discovery will be made except that it can occur only where research is fostered. No single institution has a monopoly on scientific discovery; instead achievement in science, more often than not, is the result of the sustained thinking of many minds in many places driving for a common goal. The creative spirit of man cannot successfully be localized or nationalized.

Nowhere is the individuality of scientific discovery better demonstrated than in the field of cancer research. The first intimations of carcinogenic substances were heard in England at the time of the •Revolutionary War; many years later they were questioned in Germany; then taken up in Japan in 1915 and returned again to London where the final proof of the carcinogenic potency of certain pure chemical hydrocarbons was announced. Soon after the report from England work in this field spread to this country where it was taken up at Harvard, at Michigan, as well as other places, and within a few years over 170 chemicals of varying degrees of carcinogenic activity were described. The story concerning the cancer-producing properties of the azo dyes is very similar, the early tentative questionings came from Germany, definite proof was made in Japan, and important contributions and refinements have been made recently at the University of Wisconsin and the Memorial Hospital in New York. The finding that certain types of mammary cancer in mice could be transmitted through the milk of susceptible mothers to suckling mice was first observed at Bar Harbor, and the eventual characterization of the active agent in the milk as a particle with virus-like properties was continued at the University of Minnesota. Investigators at the University of Chicago and Yale have made outstanding contributions on the relationship of endocrines to tumor growth and characterization of enzyme patterns in neoplastic cells has been receiving the full attention of experts in this field at the University of Wisconsin and the National Cancer Institute. Other examples may be cited but these should suffice to illustrate that no single group has monopolized the field of fundamental research.

Furthermore, the localization of experts in cancer research in one center would have an adverse effect on the training of young people for future work in this field. Such training requires a period of years and is best conducted in laboratories that are closely associated with educational institutions where close contact and cooperation with the basic sciences can easily be achieved. We cannot afford to kill the goose that lays the golden egg.

It appears to me that the plan best adapted to accomplishing most in the least time would be the support of existing centers for cancer research. There are perhaps seven or eight such institutions in the United States and in addition there should be an expansion of some groups in two or three universities which have not been formally organized as cancer departments. The values of these laboratories has been amply proven, but few people are cognizant of their important discoveries. Scientists from these institutions have had a dominant role in the elucidation of the cause of many cancers; they have discovered the carcinogenic qualities of many pure chemicals, of ultraviolet rays, and of some viruses; they have extended our knowledge of the biochemical nature of the cancer cell; they have gained some information on the mechanism of the carcinogenic process and have found some factors that inhibit the reaction; and they have clarified certain relationships of endocrines to tumor development. Such fundamental studies have enriched all branches of medical knowledge. Of only slightly less interest than the experiments themselves is the fact that most of these remarkable discoveries were made by a mere handful of men during the past 15 years when research was

handicapped both by insufficient financial assistance and by the war. Nevertheless, the discovery of so much by so few cannot help but arouse a feeling of optimism for the future of an adequately supported program.

At the present moment, there are not enough trained personnel available to justify a vast expenditure of money for research alone. Instead funds could be used to great benefit in the beginning for training programs and for construction. As investigators become available they could be added to the staffs of the various centers. Coordination among the several institutions could be accomplished by the free dissemination of knowledge through conferences held at regular intervals and through scientific literature. Cooperation at the operative level should be especially stressed. The avoidance of duplication at this level is not a serious problem, since in a field as complicated as this, duplication is seldom achieved even when it is attempted.

On the basis of the accomplishments of the past small-scale programs, the future of more ambitious planning is very encouraging. Although no definite predictions can be made concerning means of curing and preventing cancer it is safe to state that cancer will always remain the most hideously persistent and the most persistently hideous enemy of mankind if nothing is done. We must be determined to conquer this thing that steals upon men and without warning strikes down the strong and the weak alike. By one thing alone can this conquest come and that is by the tireless painstaking efforts of scientists provided with adequate weapons.

Senator PEPPER. Doctor, we thank you very much for coming here and giving us the benefit of your views on the subject.

Dr. RUSCH. I was very happy to have the opportunity to present my views.

Senator PEPPER. If you care to submit anything further at any time, we will be glad to hear it.

Dr. RUSCH. Thank you.

Senator PEPPER. Mr. Harry Read, executive assistant to the secretary-treasurer, CIO. While Mr. Read is coming, I will read a letter, dated July 1, addressed to me:

The Railway Labor Executives' Association, consisting of the chief executive officers of 19 national and international railway labor organizations representing approximately 85 percent of the railway workers in the United States, is on record in support of S. 1875, the bill relating to methods of curing and preventing cancer, which is now before the subcommittee of which you are chair

man.

We believe that the problem of preventing and curing this dreadful disease is one on which our Nation should take the leadership as is contemplated by the pending bill. We favor the simple but comprehensive provisions of the measure authorizing the President to arrange for the mobilization of the efforts of the world's experts in order that plans and programs can be carried forward to a conclusion.

We believe that the amount which the bill would authorize to be appropriated for this purpose is reasonable and should be adopted.

It is sincerely hoped that the committee will favorably report the bill as quickly as possible.

We will appreciate it if this letter can be included in the record of your hearings.

Yours very truly,

T. C. CASHEN, Chairman.