port of such research activities), there will be more Americans living than there would have been if there had been no war. In other words, the number of American lives saved as a result of these new medical discoveries will in a few years exceed the number of our boys killed in the war. This is not to imply that the war is a blessing in disguise. I agree with Franklin that there never was a good war or a poor peace. But I do wish to imply, and with the greatest possible emphasis, that intelligent research in biology, medicine, and public health, reinforced by the efforts of physicists, chemists, and other pure scientists, is immensely worth while and deserves much more support than it received in the prewar era.

In the prewar years medical research in this country was supported by the foundations and Federal Government to the extent of about $5,000,000 a year. To this must be addd the regular research appropriations to medical schools and to State, county, and city health institutions-possibly $10,000,000. Thus, $15,000,000 is the approximate amount we contribute each year in support of medical research; that is, about 11 cents per person per year. During the war the annual Federal expenditure for medical research has been about $30,000,000. It could and should have been much more, except for the urgent necessity for diverting most of our physical scientists to the more urgent problems of devising destructive and protective weapons for winning the war. Our total annual

expenditure for industrial research is about $275,000,000, and for the peak year of war, we spent considerably more than $1,000,000,000 for research on the weapons, devices, and techniques of war. We should not decry these large expenditures for industry and war. We should, and probably shall, double the prewar support of industrial research. But it is vastly more important that we increase Federal support of biological, medical, and public health research-indeed, that we really undertake such research on a magnificent scale.

The victims of cancer, and their friends and relatives, cry aloud from all parts of the world for a mass attack upon the scourge of cancer. The United States has the scientific and financial resources to undertako a comprehensive research program for the conquest of this dread disease. This conquest may require a long and costly campaign.

Even if the campaign costs as much as a modern battleship and is only partially successful, such that the victims of cancer will be reduced by only a few percent, it will be thoroughly just fi›d. The record of research in conquering or mitigating diphtheria, smallpox, yellow fever, diabetes, and scores of other human maladies would lead us to hope for, or even expect, a much greater reward. In view of the probable magnitude of the cancer research project, involving all phases of fundamental and clinical research relevant to the problem, and in view, also, of the probable beneficent results which would come from such a project, the proposed amount of the appropriation in the Neely-Pepper cancer bill, namely $100,000,000, is not excessive; it probably would support an adequate research program over a period of 10 years. Less than this would be penurious and might prove to be only a half measure.

I favor the simple form of the bill, authorizing the President to appoint an independent commission, representative of all interested groups to plan and carry out the purposes and intert of the bill.

The present situation calls for prompt and positive action. The public is now overwhelmingly in favor of the bill; it may lose interest if it is long delayed. I urge therefore that the bill be reported out promptly, favorably and, I hope, unanimously. The bill should be passed without complicating amendments so that the President and the commisssion can undertake the problem in a manner similar to that which the OSRD employed so effectively in solving quickly and magnificently numerous war research problems in such diverse fields as blood plasma, radar, and the atomic bomb.

OLYMPIA, WASH., June 28, 1946.

JULIUS JAY PERLMUTTER,

Chairman, Cancer Committee, New York, N. Y.:

Re Neely-Pepper cancer bill. Urge full appropriation and that bill be reported out quickly and favorably in present form.

MON C. WALLGREN, Governor.

Senator CLAUDE PEPPER,

Senate Office Building, Washington, D. C.

NEW YORK, N. Y., June 25, 1946.

MY DEAR SENATOR: It was my pleasure to receive an invitation to attend your hearings on the Pepper cancer research bill from our good friend, Julius Perlmutter, of Sponsors of Government Action Against Cancer.

In view of the fact that my son is to be married on July 2, I shall be unable to attend any of the hearings. However, I shall appreciate your expressing my views for the record.

1. I am definitely and unequivocally in favor of Government action against

cancer.

2. I am in favor of the size of the appropriation-$100,000,000-as requested in your bill as the minimum amount necessary to undertake to find the solution to this grave problem.

3. I am in favor of the bill's being acted upon in its present simple language, unencumbered by amendments for specific obligations, appointments, or commitments.

4. I am unequivocally in favor of the President's appointment of a new and independent commission to program, plan, and carry out the purposes and intent of the Pepper bill. I would not like to see this new fund turned over to any present existing governmental agency.

I should like to implore the committee through you to give this bill its prompt and unanimous action and support so that a great service can be rendered to all humanity.

Respectfully,

MORRIS W. HAFT.

JULIUS JAY PERLMUTTER,

INDIANAPOLIS, IND., June 26, 1946. Chairman, Sponsors of Government Action Against Cancer, New York, N. Y.:

Impossible for me to attend committee meeting on cancer drive. You may quote me as favoring any legislation which will assist in the fight against cancer. RALPH F. GATES, Governor of Indiana.

Senator PEPPER. Our next witness is Dr. Harry B. Fried good, president, Cancer Research Foundation of California, Beverly Hills,

Calif.

STATEMENT OF DR. HARRY B. FRIEDGOOD, PRESIDENT, CANCER RESEARCH FOUNDATION OF CALIFORNIA, BEVERLY HILLS, CALIF.

Senator PEPPER. Doctor, you have heard what I have said about the statements of the other witnesses. Insofar as you can conserve time by filing any written statement that you have, I should be glad to have you do it, because I am particularly anxious to hear the personal views of you distinguished gentlemen who have come here today, and some of the details that we do not need to concentrate upon at this time can well appear in the written statement. I am vitally interested in what you have to say about the general objectives of the bill, how much money should be appropriated and how much should be made available from time to time, and what you think the nature and character of the organization should be to carry on this research. Those, it seems to me, are the three essential questions that we have to answer. I have been encouraged by the comment that some of the members of the committee generally, such as Senator George and others, have made; and those three things are the things that we have to formulate before we get a bill. I do want to get your

views on those three things and anything else that you would like to tell us.

Dr. FRIEDGOOD. I made a few notes on the plane en route to Washington, because I did not think, until yesterday, that I would be able to attend these hearings. I have no statement to file, but, with your permission, will mail one as soon as I return to California.

Senator PEPPER. We will be glad to have you do that.

Dr. FRIEDGOOD. Relatively recent scientific discoveries have brought under therapeutic control such diseases as pneumonia, which used to outrank cancer as a killer. What I am wondering about is this: Are the countermeasures against cancer commensurate with the magnitude of the disaster which confronts one out of every eight of us? If our people were confronted with a similar national emergency by such diseases as smallpox or leprosy, just imagine what their reactions would be. As a matter of fact, several months ago one or two cases of smallpox appeared in a west coast city. Within a matter of a few hours hundreds of thousands of frantic citizens were lined up to receive the protection of vaccination, not only within the city limits, but in coastal communities a thousand miles away.

If 17,000,000 Americans were earmarked to die of leprosy or smallpox, would we accept the fearful news with national complacency, or would we mobilize our scientific forces for an all-out attack? Those who die of cancer are just as dead as those who succumb to smallpox or leprosy.

A recent Gallup Poll has disclosed there are encouraging signs that public indifference to the cancer problem has vanished.

For some unknown reason the public has heretofore accepted cancer as an inevitable curse of mankind. This hopelessness, born of superstition, is now in the process of being dispelled. When the public learns that in certain instances cancer is a contagious, transmissable disease in animals, it will demand to know whether human cancers can be similarly contracted. When the public learns that a high calorie, high carbohydrate diet predisposes mice to the development of certain types of cancer, it will show a strong interest in the investigation of this point in human beings, especially when it becomes aware of the fact that cancer is more prevalent among obese people than those of normal weight, and that the incidence of cancer among diabetics, who are notoriously overweight, is much higher than in the population at large. When the public learns that animals are being immunized successfully against cancer, I suspect that its reaction will be much the same as that which it has shown in the case of smallpox.

These avenues of approach to the solution of the cancer problem have just been opened. They are yet to be explored.

It might be worth while to survey some of the general problems which confront scientists who are engaged in, or would like to devote their lives to, research in cancer. These are three in number:

First and foremost is the complexity of the research problem on the nature of cancer growth. We must think of cancer research in the broadest sense; that is, an investigation of the fundamental nature of normal and abnormal cellular growth. Nothing is to be gained and much to be lost by underestimating the magnitude of the cancer problem. The problem presented by cancer growth is the

problem at the core of the enigma of life itself. It is through a knowledge of the development, growth, and function of normal cells that we shall find the answer to the way in which abnormal cells victimize and kill a human being.

There has been a good deal of talk about mobilizing cancer research in the way that the atomic bomb project was mobilized. I think most of us would agree that the comparison is not exactly parallel. Most of the information about the nucleus of the atom and what led to the eventual solution of the problem was known by 1940. The atomic bomb presented an engineering problem that required great skill and a great deal of money. The job was done magnificently. But the cancer problem does not present a similar situation at all. We do not know anything about the nucleus of the cancer cell, as Dr. Bayne-Jones pointed out. We have a long way to go.

The complexity of the problems of normal and abnormal cellular growth demand the closest collaboration between biologists, biochemists, biophysicists, and other highly specialized scientists who have much to contribute to the study of living protoplasm.

In general, there are two types of research which should be organized-fundamental research and applied research. Provision should be made for both, because they are interdependent. Fundamental research is aimed at an understanding of natural biological, biophysical, and biochemical phenomena without reference to any immediate practical benefits to mankind. The main objective of fundamental research is to foster and develop new concepts and ideas which can be used intelligently by those who are trained in applied research. Applied research has as its goal the specific solution of a given problem through the practical application of existing or newly developed knowledge. It may look like wasted effort to spend a lot of time and money on research which has no immediate practical application, but a moment's consideration discloses that applied research, by definition, depends upon the success of fundamental research. An excellent example of the point I am making is to be found in the cancer research field already. The X-rays were discovered and studied by physicists who were not originally concerned with the cancer problem; yet years later the X-rays became an important therapeutic weapon against cancer.

Another way of stating what I have in mind is that the problem of cancer should not be considered the exclusive property of those who quite properly consider themselves cancer specialists. There are still too many unknown fundamental questions which must be answered by highly specialized scientists, who may never have seen a cancer patient.

The third problem of which I wish to speak enjoys a high priority among investigators of cancer. The development of diagnostic methods for the earliest possible detection of cancer is of the utmost importance today because of the limitations of present forms of therapy, which must be instituted early in the game if they are to be effective at all. As a matter of fact, the early diagnosis of cancer will continue to be essential even after the nature of this disease is thoroughly understood. It will always be necessary to make the diagnosis

1

as early as possible in order to treat it effectively before it spreads throughout the body and gets beyond control.

In recognition of the importance of this aspect of the cancer problem, and because there was a dearth of organized cancer research on the west coast, a group of public-spirited citizens and research-minded physicians organized the Cancer Research Foundation of California on April 26, 1945, when Frank M. Jordan, secretary of state of the State of California, endorsed its articles of incorporation.

An important body of knowledge is being accumulated from these investigations and particularly from those that have flourished independently at other medical centers, such as the Memorial Hospital in New York City. It is now known that one type of cancer growth may, in certain circumstances, be detected long before it becomes obvious to the physician who examines a suspected case by the most careful clinical procedures. In the case of cancer of the cotex of the adrenal glands one may make the diagnosis in most cases by quantitative and qualitative analysis of certain fatty substances, called ketosteroids, which are excreted into the urine of normal, as well as afflicted, individuals. In the case of cancer of the adrenal glands, these steroid substances often change quantitatively in a characteristic fashion which can be recognized chemically. Laboratory evidence indicates furthermore that there may also be a shift from the normal in the urinary steroid pattern in other forms of cancer. The nature and extent of these changes are in the process of being explored experimentally. Our studies along this line are at a standstill because we do not have adequate financial assistance.

That which is already known about methods for the early diagnosis of cancer is a mere drop in the bucket compared with what remains to be learned.

The challenge is there, but it cannot be accepted because the physical facilities and money, which are necessary, are not available. How can this situation be remedied?

If we are to achieve our ultimate aim, the control and cure of cancer, our scientific forces must be mobilized, they must be organized and coordinated effectively, and they must be given enough money to do what has to be done without restraint. We must save lives, not money; we must spare suffering, not expense.

This vision must be translated into action on much the same scale as that which served so successfully in solving the know-how of the atomic bomb, although the problems are significantly different fundamentally. There is only one agency which can undertake such a gigantic project, and that agency is the Government of the United States.

The officers and directors of the Cancer Research Foundation of California have instructed me to place them on record to the effect that they are wholeheartedly in favor of the avowed and expressed purposes of the Pepper-Neely bills.

The sponsors of Government action against cancer are proposing that the Government of the United States create an agency, which will be empowered to go about its business with the grim intent of killing cancer before cancer kills 17,000,000 of us who are now living.

How are we to go about implementing an organization on the vast scale that the cancer problem demands?