EXHIBIT 8 Senator CLAUDE PEPPER, NEW YORK 21, N. Y., June 24, 1946. United States Senate, Committee on Foreign Relations, Washington, D. C. DEAR SENATOR PEPPER: This will acknowledge your telegram of June 21, 1946. I am, indeed, heartily in accord with the aims of your bill for governmental support of cancer research as represented in your bill S. 1875. I regret, however, that due to short notice received, I am unable to rearrange my professional commitments to permit my attendance at the committee's meeting on June 27. I am, however, enclosing herewith a written expression of my opinions on this subject, which I trust you will be able to present for me to the committee. With all good wishes, I am, Sincerely yours, IRA I. KAPLAN, M. D. REASONS FOR PASSING OF CANCER RESEARCH BILL (S. 1875) (By Ira I. Kaplan, M. D., Director, Radiation Therapy Department, Bellevue Hospital; Clinical Professor of Surgery, New York University Medical College) I am a clinician actively engaged for the past quarter of a century in caring for the treating cancer patients; therefore, my recommendations are not based on hearsay or theory but upon solid facts experienced in my daily work. The cancer section of Bellevue Hospital, the largest municipal hospital in the world, has been under my jurisdiction for over 20 years. This has permitted me to see patients previously treated or cared for in practically every hospital of the city or by physicians throughout the country. Several thousand patients pass through our service yearly, and based on the knowledge acquired from caring for them I have formed the following conclusions. Cancer is no longer a local, private, or municipal responsibility; it is a national burden. Funds available for cancer have always been inadequate and divided in such manner as to inhibit coordinated effort. As a remedy the proposed national cancer bill offers a beginning toward a real effort proposing the greatest possibility of producing results. I do believe if a group of trained scientists are mobilized in a coordinated effort to attack the cancer problem we will see the achievement we have all been looking forward to. As I already stated, I am a practical clinician mainly interested in practical matters associated with the active care and treatment of cancer, and so I am anxious that certain conditions be provided for in the implementing of the cancer bill. Millions of our citizens are preyed upon by medical quacks of all sorts, but in no field of disease is their activity so pitifully scandalous as in cancer. But how are the poor victims to know whether a supposed cancer remedy is safe and effective? I suggest that under the cancer bill there be set up an organization that shall investigate proposed cancer cures and to make definite pronouncements as to the worth of all remedial methods to the public for cure of cancer and to have the power to ban all fraudulent propositions. All too often because of the blandishments of quacks proper care is delayed and even avoided beyond the time when acknowledged therapeutic measures are possible and in some instances this has been the direct cause of the victim's death. One of our most difficult problems is the caring for chronic cancer patients, especially those in the middle-class economic level. With few exceptions the homes and institutions under voluntary auspices refuse admissions to applicants suffering from chronic illness such as cancer. Over one-third of all chronically ill cancer cases are receiving totally inadequate care and only about one-fifth receive a modicum of efficient care. The governmental agencies as at present constituted offer little more. I propose that under this bill provision be made to care for in a proper manner the chronically ill cancer patient in centers especially established for this purpose throughout the country. The cost to the patient to depend upon his economic ability to pay. Cancer care and treatment is costly and uses up no matter what accumulated savings a victim and his family have. Only under a sympathetic Government agency can hopeless cancer victims receive humane and hygienic care until the Lord sees fit to end their misery. One further point. To seek the cure of cancer we should know its cause. This requires intensive research by trained scientists and clinicians whose coordinated efforts are left untrammeled by the absence of worry about economic security. As you also no doubt know, cancer is best controllable in its early stage. If we can have some means of early diagnosis, some test that will enable us to recognize the earliest signs of cancer or the possibility of cancer development, then we can defeat cancer. Combined concentrated efforts of a group of trained scientists unworried by economic factors under Government auspices will provide the certainty of such achievement. In this care and treatment aspect of cancer, social service is a real necessity. Providing for a national social service and visiting nurse department covering the care of patients and their families throughout the Nation will be of immeasurable aid in relieving the misery usually associated with cancer. Supplies and dressings are costly where cancer is concerned. National provision for the victims worthy of charitable assistance is necessary. This, too, should be included in the provisions of this bill. To sum it all up, if we are to succeed in conquering the dreadful cancer Scourge a coordinated effort is necessary under national auspices. The appropriations should be made without restrictions so that actual work can be carried on unrestrained by rules and regulations, aid given uninstintinglyused when and if needed-at once or over a period of time, depending on the exigencies of conditions determined by a group of selected scientists chosen for their knowledge and experience in cancer. I trust this explains to you my thoughts in this worthy matter. It is along the lines of action proposed by the sponsors of Government action against cancer, with whom I associate myself for support of the cancer bill now before your committee. I hope this data will help you decide to act favorably on the S. 1875 bill, which I am convinced is one of the most worth-while life-saving acts possible for the Government to carry through. The objectives of any cancer-control program are the cure of existing cancer and the prevention of cancer. To realize these objectives, a completely integrated program, including hospitalization, facilities, approved tumor clinics, tumor-diagnosis service, detection clinics, an educational program, research into the causes of the disease, improvement of methods of diagnosis and treatment, and statistical studies is necessary. This, the proposed bill, would provide and only under Government support would such a plan succeed. Senator CLAUDE PEPPER, EXHIBIT 9 JULY 2, 1946. Chairman, Senate Foreign Affairs Subcommittee, Senate Office Building, Washington, D. C.: At the request of sponsors Government action against cancer, I submit the following statement to be included in the record of the hearings of bill S. 1875. Although it is, obvious that not money, but human ingenuity, will find the true cancer remedy; nevertheless, the success of cancer research depends first and entirely on money. The study of cancer is very expensive. Special apparatus, chemicals, animals, their care and food, all that has to be paid in thousands of dollars. Last, not least, people who concentrate their full time on cancer research must somewhere get money to make a living. The search for the cancer remedy is purely empirical. Thus, methods of treatment which were assumed to be promising after careful examination were found to be useless. Although the time and money spent for that research seem to be used up unprofitably, nevertheless no other way exists for the progress. Nobody can forsee which of the various ideas finally will be verified as the only right one. Every reasonable project must be examined and prejudice or partiality in this direction retard the progress. We must be prepared that millions of dollars will be spent on unsuccessful investigations, but if the amount of money is sufficient to sponsor all projects, the final success of the endeavor is evident. There can be no doubt that systematic research will lead to the discovery of the right approach to the problem and, in consequence, the cancer remedy will be secured for the suffering mankind. The funds of the various cancer foundations are so limited that nobody outside the small circle of the affiliated people can get any substantial support for research. It is imperative that a big fund is created which will enable the President to sponsor every action which promises to bring the desired result. The appropriation included in the bill comprises just the minimum necessary for these purposes. The simplicity of the bill in its present form assures that all interested factors will profit from the money. A new and independent commission representing all prominent research people and all interested groups should help the President to carry out the purposes and intent of the bill. The bill should be reported as quickly as possible because cancer does not defer its deadly effects. Human dignity demands that it will be accepted unanimously so that the President and the Commission can proceed without delay. HENRY K. WACHTEL, M. D., EXHIBIT 10 Senator CLAUDE PEPPER, ST. LOUIS, Mo., June 26, 1946. Senate Office Building, Washington, D. C. MY DEAR SENATOR PEPPER: As I have already advised by wire, I will be unable to attend the hearing on Senate bill 1875. I am taking the liberty of sending you under separate cover a copy of the statement which I intended to make. This statement is essentially the same as that made before the Committee on Foreign Affairs of the House of Representatives, Mr. Bloom's committee. I would like to have this statement and the accompanying charts incorporated into the minutes of the committee. If that cannot be done I hope you can find the time to read the statement and examine the charts. I thank you very much for the invitation to appear before your committee. With kindest personal regards, Sincerely yours, SHERWOOD MOORE, M. D., Director, Mallinckrodt Institute of Radiology, Professor of Radiology, Washington University School of Medicine, STATEMENT OF SHERWOOD MOORE, M. D. What I have to say is repetition of statements made before the House Committee on Foreign Affairs. Since that occasion I have had two experiences which perhaps will be of interest. I was requested by the Veterans Hospital at Jefferson Barracks, Mo., to help give radiation treatment to veterans having malignant diseases. This request was made because the veterans' treatment center at Hines Hospital and the Army and Navy Hospital at Little Rock, Ark., could not provide treatment for the number of cases arising at Jefferson Barracks. It is a terrible fact that there are 12 veterans there in need of radiation treatment and are on a waiting list. I have just had the sad experience of treating a patient with cancer of the uterus, the second wife of a man whose first wife died of cancer of the uterus just 2 years ago. Any views or opinions which I express here must be considered as being entirely personal and not as representing the views of the organizations or institutions with which I happen to be connected. There are two minor objections to this bill: the sum asked for is too small, and the implication contained in it that there are superior "exports" to be found outside of our own country. At the risk of seeming captious and chauvinistic, I should like to point out that this continent, and probably this country, have perhaps the greatest experts in the field of cancer to be found in the world. There is at hand here one of the greatest, if not the greatest, institutions for the study of cancer in existencethat is the National Cancer Institute at Bethesda, Md. I would like to have it clearly understood that I have no endorsement whatsoever for so-called socialized medicine or state medicine, as these terms are commonly understood. On the other hand, everyone realizes that conditions or diseases which menace the health and welfare of the people are, and have been in the past, matters of concern to the state. This national concern in a national exigency probably extends back into prehistory. You will immediately recall the regulations for the control of leprosy in Biblical times, and much laterfrom the ninth to the fifteenth centuries-the efforts made by the rulers of Great Britain, for the common weal, to care for lepers. No one will question the governmental right to apply custodial care to the insane and to control contagion, human, animal, and plant. It must be said, however, that as far as our knowledge goes, the element of contagion in cancer does not exist. On the other hand, there is a great increase in the occurrence of cancer nor can anyone familiar with this aspect of medicine deny this increase or attribute it to "better diagnosis" alone. Undoubtedly, diagonsis is much more accurate now than it has been in the past, but this accuracy cannot account for the increased incidence of cancer. I think it would undoubtedly be true that if the autopsy reports of 50 years ago could be compared with a similar number of autopsies today there would definitely be more cases of cancer now than at the earlier period. I take it that all present are aware of the fact that cancer is the second most frequent cause of death in this country. I quote from a publication of the American Cancer Society: "Cancer is a personal threat to every single one of us. There is one chance in eight that you yourself will be its victim-yes, one chance in six, if you are past 45. Many you know and love will develop this dread disease, and unless helped in time, die of it. "Cancer killed 607,000 Americans between Pearl Harbor and VJ-day. Think of it-more than twice as many Americans as were killed or listed missing in action in World War II. "Cancer is killing Americans at the rate of 175,000 every year, 478 every day, 20 every hour, 1 every 3 minutes. And the rate is constantly increasing. "Contrary to general belief, cancer is no respecter of ages. It strikes young and old alike. Cancer is the greatest and cruelest killer of American women between the ages of 35 and 55. * * *" Nor is that all. The mortality statistics for the city of New York indicate that malignant diseases commonly classed under the term cancer cause more deaths among children than does appendicitis. This is a shocking fact. The source of this information is Dr. Frank E. Adair, of New York, president of the National Cancer Society. But death is not the worst feature of cancer. Paradoxically, it can be said that it is the only favorable thing about this terrible disease. The suffering which it causes both in length of time and in intensity, and mental as well as physical, places it in a category to itself. Statistics are readily available as to the number of deaths from cancer in this country, but there is no unit of measurement for the suffering which it causes. And the suffering is not confined to the victim himself or herself; it spreads to the family. In addition to the sorrow of watching a loved one suffer and die, a family history of cancer causes great apprehension and mental suffering to the members in whom the disease does not develop; every physician is familiar with these sufferers from cancerphobia. Many physicians, in fact, believe that there are many more deaths from cancer in this country than the statistics indicate. For many cases of cancer are not reported by the attending physician because of a fear of the effect on the family. It is perfectly clear, from the discrepancy between the statistics on cancer deaths in the State of Connecticut, where such deaths are reportable, and the statistics for the country as a whole, that the national figures are inaccurate. Cancer transcends State lines, as is shown by these charts which were made some time ago for an entirely different purpose. I may say that these are the figures for only one hospital group, almost certainly not the largest in the city of St. Louis. The figures also show the increased incidence of cancer in the localities referred to. That the demands for radiation treatment for cancer are on the increase is revealed by the fact that in the year ending April 1, 1945, there had been 480 calls for radiation treatment of one sort or another in the institution with which I am connected; by April 1, 1946, there were 827. If I have not already done so, I should like to point out that this institution is not by any manner of means unique. As I have also intimated, it probably does not give service to as many cancer patients as other institutions in St. Louis, and probably its experience does not differ at all from the experience of institutions of similar size in communities of like population anywhere in this country. The study and care of cancer patients is too costly and too large an enterprise to be undertaken by any of the lesser divisions of government, municipal, county, or State, even in those units which have superior facilities; for example, Massachusetts, Connecticut, New York, or Missouri. Nor can philanthropy care for the problem. It is my judgment that cancer is a national menace and should be so declared by the Congress of the United States, and the problem should be placed in the hands of the United States Public Health Service, for the reasons which have preceded. At the risk of being repetitious, I would state that I do not believe in governmental paternalism but that the cancer situation certainly calls for a modification of that general stand. I wholeheartedly endorse Governor Neely's bill, H. R. 4502, but I must confess to a greater liking for Mr. Stevenson's bill, H. R. 3939. This preference derives from the fact that Mr. Stevenson's bill calls for $500,000,000 instead of the $100,000,000 proposed by Governor Neely. It also provides for the care of this disease by the United States Public Health Service. However, it has one drawback: It overemphasizes poliomyelitis, which, in comparison with cancer, may be described as of relatively rare occurrence. Do these sums shock you? A booklet published by the Department of Agriculture in 1940, called Technology on the Farm, shows that the Federal and State Governments-with ample justification, of course-had spent $250,000,000 for the eradication of tuberculosis in cattle. Dr. Roswell Pettit, of Ottawa, Ill., a member of the Illinois Cancer Society, is the source of information to the effect that a bill for $75,000 to the Illinois Legislature, for the purpose of studying cancer, revealed the fact that $500,000 had been given by the legislature for the study of brucellosis, commonly known as Bang's disease of cattle also, of course, a justifiable expenditure of public funds. I fully realize the contagious element and the jeopardy to the human animal from both of these diseases, but that does not modify by one particle my view on the necessity and justification for a large expenditure of money on the cancer problem. 1 And, in any event, however much we may spend on cancer, we need not look for a sudden solution to the problem and therefore for an early eradication of the disease. Results can only come from long-time study of the most intensive sort. Amelioration of the disease in the last half century seems almost imperceptible until one looks back over a lifetime of practice. I have pointed out elsewhere that it is within my memory that a diagnosis of cancer of the womb or cancer of the mouth could be made at the door of a dwelling or of a hospital ward from the stench alone. Meanwhile, the disease has become much more frequent; the population lives longer and therefore there would be more cases of cancer, but the increase is not entirely because the disease is supposed to be one of late life. Compare the New York City statistics on the relative number of deaths from cancer and appendicitis. And in one morning recently I saw a 7-year old child with cancer of the vagina, a 22-year-old girl with a returned cancer of the parotid gland, a 24-year-old young man with cancer of the blood, and a woman of 28 with a returned cancer of the breast with a spread to the spine and brain. Earlier diagnosis with appropriate treatment will undoubtedly save many lives. However, that is not the whole solution' either; if there is a solution it will be found in the research laboratory. Pending that time we are confronted with the problems of reducing the suffering of these people. There should be Federal support for cancer research much larger than now exists. There should also be Federal provision for both the victim of cancer and members of his or her family if they are indigent. The decision as to who is indigent should be left to local administration; for example, by some agency similar to the draft boards. Due consideration should be given to the density of population and to transportation facilities and their interrelationship. The medical profession and the public both need better education than has generally prevailed in the past, but that will not solve the underlying problem. To sum up, as I see it, cancer is enough on the increase that it can justly be considered a national menace. It should be dealt with on a national scale by the United States Public Health Service, and a long-term program for the study, prevention, and care of cancer should be financed with Federal funds. If left to lesser governmental units the problem would be subject to the caprice of local agencies. As a beginning, there should be Federal hospitals located at "strategic" points for the care of cancer in all stages, they serve as "pilot plants" and as a stimulus to private philanthropy and to local governments, municipal, county, or State for emulation. They would also have a beneficial influence on the educa 1 Blair, Moore, Byers, Cancer of the Face and Mouth, Mosby, St. Louis, 1941, p. 356. |