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overall operations of the two agencies so that this committee and the Congress will be better informed when dealing in the future with legislation affecting these two important agencies.
Also, this overall picture is badly needed in order to ascertain whether the different programs now administered by these two agencies are consistent and in balance with each other. As I have already indicated repeatedly in the course of hearings on the medical school construction legislation, which, incidentally, is on the floor of the House this afternoon, there is a serious question whether certain programs administered by NIH should remain open ended as they are at present, or whether they should be circumscribed more closely as is the case with other programs administered by the Public Health Service.
As I have stated, these other programs have not been subject to the same kind of criticism that has been made of the programs administered by NIH. This is an important aspect which I am very anxious for these hearings to fully explore.
Some of these matters were brought to my attention vividly recently in connection with these other health programs that we have, and particularly when I was before the Rules Committee a few days ago. It seems that there is a great concern among many people with respect to some of these programs and apparently some members who are very much interested in them, feel that nobody keeps up with things and nobody knows just what is going on overall in that agency, important as it is.
As they called to my attention the other day, within a matter of a few years, its expenditures have gone from roughly a few million dollars to nearly a billion dollars and, as the chairman of that committee said to me, “You don't know who is doing what and why," and I had to frankly confess that I didn't.
It may be our fault, and a part of it probably is, for not staying closer to the situation. We are all busy, as you are down there. However, it may also be partly your fault.
I think we should have the whole picture laid out in the record and brought together so we will know who is doing what and whether or not it is justified. You run a very important agency down there. We all know that. There is no more important department of our Government.
But, if we are to continue the good work and service for the American people, and maintain the repuation and the confidence of the people, and avoid what resulted last year-as you no doubt know, there was some controversy with another committee of Congress—I think we are going to have to have a better understanding of the organizational services and the programs.
Mr. Chairman, I do realize the task that you and this subcommittee have in view of the complexity of the problems, which I know you will explore. It is a great and important challenge. It is not my intention to try to rush these hearings to any premature conclusions whatsoever. I want you to take plenty of time, and I have in mind assigning another member or two of our staff to the subcommittee for the purpose of helping to explore these matters in cooperation with Dr. Terry and his staff.
I feel we should be diligent in exploring these ramifications in the best interests of the executive agencies and the interests of private and
public organizations which depend on and are affected by the programs administered by the Public Health Service and the Food and Drug Administration. Certainly, the objective of all of these programs is improving the health of the American people.
I apologize for taking all this time, but I did want to make it very clear what, in my judgment, we should do, and I believe that with your usual committee's work in this regard it will do another good job. I want you to know that I am in this
with you all the way. Mr. ROBERTS. Thank you, Mr. Chairman.
We have discussed the hearings and, as Dr. Terry knows, this committee is charged with most of the authorizing legislation having to do with the Public Health Service, and we feel, and I think the chairman will
agree, that some of the criticism that has been leveled at the Institutes and at the Public Health Service may or may not be justified, but we believe that, if the hearings are thorough enough and we can give you an opportunity to answer some of the charges that are being made, we can be of service not only to our committee, but to the Public Health Service and to the country.
I certainly want you to feel, while we may consider that we are looking for all of the facts, that we do not approach it in a destructive vein. It is meant to be constructive, and it is my hope, with the help of the other members of the subcommittee, and with the staff, and with the cooperation of the Surgeon General and his staff, that we can do a good job with these hearings. You
may proceed with your statement. Dr. TERRY. Thank you, Mr. Chairman and Mr. Harris.
I would like to say that I, personally, appreciate your comments. I am aware of your concern as you have expressed it in your statement, and I share that concern with you.
I, personally, am convinced that most oi che criticism which has been leveled at the Public Health Service and at the Institutes of Health is unjustified. I think there is no better way for us to learn the facts and for the public to learn the facts than a hearing of this sort.
I would not contend that we have never made any mistakes. I think the only people who do not make mistakes, Mr. Harris, are people who are dead or doing nothing. I hope the Public Health Service is neither of these.
Nevertheless, I am convinced that the mistakes that we have made have been honest and have been minor. The implications that have been made in the press and otherwise to the public relating to these few errors, omissions or commissions, have been greatly exaggerated and I feel that, as this hearing evolves, we can demonstrate to this committee what a fine job the National Institutes of Health and the rest of the Public Health Service has done.
It is for this reason that I welcome this opportunity.
(1) A brief review of the origins and evolution of the Public Health Service; and
(2) A presentation of the major functions which the Service now performs in carrying out its missions. I will try to highlight some of the shifts in emphasis and approach which have characterized our programs in recent years.
Tomorrow, according to the schedule, Mr. Chairman, which you and your staff have prepared, we expect to have bureau representa
tives, program representatives, here and to go into greater detail into particular areas. I shall be, and the members of my staff shall be, available to you and your committee at any time you want to go into whatever detail you feel is necessary to accomplish the purposes which we both share.
I. HISTORICAL HIGHLIGHTS
The Public Health Service had its origin 165 years ago. Then known as the U.S. Marine Hospital Service, its major function was to provide medical and hospital care for seamen of our merchant fleet, at that time the Nation's economic lifeline and a major element in its national defense.
For nearly a century this was the principal responsibility of the Service. Beginning in 1799, however, Congress authorized Federal officers to cooperate with State and local officials in the enforcement of their quarantine laws. In succeeding years many short-term laws were enacted that authorized our physicians to help communities curb unusually severe epidemics of cholera and yellow fever. In 1893 Congress gave the Service full responsibility for interstate and foreign quarantine, emphasizing cooperative relations with State health departments.
Science began to advance steadily during the last quarter of the 19th century. With the advent of bacteriology, precise knowledge about the causes and control of many diseases became possible. These circumstances demonstrated the value of a central organization for research, field studies, and practical assistance in the control of epidemics. The Service established its first laboratory about 75 years ago, that is, in 1887, at the Marine Hospital in Staten Island, N.Y., to apply new bacteriologic principles to the study of disease in this country.
This single-room laboratory, then called the Laboratory of Hygiene, quickly proved its worth. A modest research capability was developed, and before the turn of the century this activity was transferred to headquarters in Washington. Here it became the nucleus of the future National Institutes of Health.
At the turn of the century the production and interstate sale of vaccines, serums, and other biological products was increasing rapidly. In 1902, an act of Congress assigned to the Service a responsibility with respect to licensing and regulating the production and sale of biologics in interstate commerce.
An act of 1912 expanded the research program of the Service to include conditions other than communicable diseases, and specifically authorized studies of water pollution. This act also changed our name to the Public Health Service, reflecting the broadened functions for which the Service was responsible.
The act of 1912 also authorized the Service to assign health personnel to other Federal agencies on a reimbursable basis. The objective was to make highly trained professional workers available to agencies whose major responsibilities were not in medical and health fields, but who required some such work and support.
The next major development came with the passage of the Social Security Act of 1935 which authorized annual grants to the States for health purposes. This greatly stimulated development of the Nation's health services. It also strengthened the partnership of the Federal Government with the States and territories to protect and promote the health of the people.
In 1937, Congress established the first of the special Institutes, the National Cancer Institute. The National Cancer Act authorized, for the first time, grants-in-aid to universities or individuals for research. and included authority to award fellowships.
T'he Venereal Disease Control Act of 1938 enabled the Service to launch the first comprehensive national control program against a specific group of diseases, principally syphilis and gonorrhea.
During World War II, the Service was given responsibility for a number of emergency health and sanitation activities. These were of appreciable importance to the Nation's total defense effort. The war emergency delayed the development of programs which health and medical leaders agreed were necessary. On the other hand, many new forces were set in motion during the war which were to have a profound effect on the work of the Service.
Two, in retrospect, seem the most significant. First, there was a pent-up popular demand for better health and better health services. Second, wartime health research-pursued on a scale never before attempted-opened new trails for peacetime exploration. The war experience showed what could be accomplished through research.
New health programs developed rapidly after the close of World War II. Pages 18 and 19 in the committee print list many of these developments. More than 38 new programs have been established by legislation, by transfer from other agencies or by administrative action. Their consequences in terms of staff, budget and function-are shown in charts A and B.
(Charts A and B are as follows:)
PUBLIC HEALTH SERVICE PROGRAM TRENDS MILLIONS OF DOLLARS
1945 - 1963
BREAKDOWN FOR 1963 1500
Grants for construction $360,600,000
Grants for Training $ 214,352,000
Grants for Research $ 511,201,000
55 Fiscal Yoar
Jan. 15, 1963
Dr. TERRY. Many of these programs represented new functions and new approaches for the Service. Later in my remarks, and in the presentation that will follow, we will describe these programs in greater detail.
Even from this cursory review, I believe it is apparent that the history of the Service reflects the response of American society to the challenge of sickness and death in a constantly changing environment.
The programs of the Service are constantly being reoriented and revised; emphases change as health problems change--and as the environment changes. Fifty years ago, our preoccupation was with infectious diseases, their understanding and control. Today, they continue to have a major importance; however, a different set of diseases is now at the center of the health scene. Cancer, heart disease, mental illness, arthritis, accidents, and others, are now the major killers and cripplers.
The modern, technological, urbanized environment in which most of us now live also brings new health problems—air pollution, water pollution, pesticide hazards, radiological contaminants—with which we must be concerned. The activities of the Service must evolve, and we We believe they have evolved to meet these challenges. In this modern age, the only thing that remains constant is change.
What, then, is the Public Health Service today—and what is its mission? In the simplest terms, the Public Health Service is the principal Federal health agency broadly concerned with the health of the Nation; it is a truly national health agency, and its mission is to protect and promote the health of the people.