Dr. SHANNON. I think, sir, that you can probably read that chart better from your book copy than from where it stands. This is chart 3. The center bar of this chart is the same as the 1963 bar in chart 2. You will note the diversity of activity within our research and training program. These are shown in specific detail in the bar to the left of the chart. It is of the origin and nature of these various programs that I should like to speak now.

THE EVOLUTION OF PROGRAMS

The evolution and growth of the many activities which now comprise the operations of the National Institutes of Health is the result of a very interesting and, I believe, unique set of circumstances.

These programs have their beginning in the clear national disposition at the end of the war to mount a major attack upon disease and disability. This was reflected by the action of this committee under the leadership of men like Percy Priest and Charles A. Wolverton; the House Appropriation Subcommittee, first under the chairmanship of Frank Keefe of Wisconsin and then John Fogarty; and of Lister Hill and others in the Senate.

The several pieces of legislation bringing into being the categorial institute structure, which I have just mentioned, were forged in this period.

This was also a propitious time scientifically. During the course of the war, scientists had given convincing demonstration of what could be accomplished through concerted scientific attack. Released from their wartime assignments, there were large numbers of able investigators anxious to exploit the technological progress of the war years in the interest of human betterment. A pattern of Federal support for university research in the achievement of public purposes had been established. This was surely a very significant development.

At the same time, it was also clear that meaningful progress in the control of major health problems was impossible without new knowledge concerning the nature of disease and the underlying life processes. Only through research could such new knowledge and thus eventual control be obtained.

No Federal laboratory, however, could hope to encompass within its own walls the diversity of scientific skills or mount the magnitude of effort required if research into major disease problems was to be expanded.

It was in this setting of great opportunity and particular need, coupled with the passage of farsighted legislation which I referred to earlier, that the major expansion of the extramural research programs of the Public Health Service had their immediate beginnings. Thus was initiated what has been an extraordinarily productive joining of the scientific capability of non-Federal institutions with a Federal agency in the pursuit of a public purpose.

The needs to be met and the problems encountered in making most effective use of the further opportunities offered by this relationship have dominated the subsequent development of our programs

PROVIDING THE RESOURCES OF MANPOWER AND FACILITIES

The pursuit of knowledge, both fundamental and applied, which is needed for the ultimate solution of the complex problems of disease

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is a long-term process. Consequently, the support of research imposes the obligation to be concerned with future resources as well as with the adequacy of current support for ongoing research activity.

The further development of medical research requires full utilization of the existing body of biomedical scientists, but above all, it requires new men trained in the new knowledge, new fields, and new technology now developing so rapidly. Support of research training, therefore, became an essential concomitant of the Public Health Service research support program. This training has been provided in two ways:

Through research fellowships for predoctoral and postdoctoral training awarded to individuals selected in national competition;

Through training grants to institutions, which in turn select research trainees and provide for their stipends and instructional costs from the grant.

Authority for these programs is contained in the Public Health Service Act, as amended.

You will note from the chart that the combined expenditures for these training programs in fiscal year 1963 totaled $201 million, 22 percent of our total funds. These funds (with the exception of certain programs of the National Institute of Mental Health) are expended for the advanced training of research manpower. This is our investment in the future.

The blossoming of medical research in the early 1950's brought sharply into focus a major inadequacy of our academic institutions— space for research purposes. There had been little expansion of our academic plants since before the war and, in many institutions, since well before the depression period.

The crisis created by the GI training program had been met in a variety of emergency forms, since it involved only simple quantitative enlargement of instructional space. The expansion of research constituted a qualitative challenge or a qualitative change in two ways: Research was emerging as a major university function-no longer a subordinate professorial activity.

Modern research requires complex and specialized facilities and a variety of technical services.

The space needs of the physical sciences had been partially met through their long involvement in defense-related programs. But research facilities for medical and biological research were particularly inadequate. The prewar research plant in this area had been very limited. The rapid postwar change in the nature and extent of research in these fields created extraordinary new demands. Effective pursuit of promising new fields was being seriously hampered by space limitations. Although the Cancer and Heart Acts, together with the Omnibus Act, Public Law 81-692, provided limited construction authority, its use was confined to these categorical areas only.

This was the setting which generated the passage of the Health Research Facilities Act of 1956 (Public Law 835 of the 84th Congress) establishing a program of matching Federal grants for the construction of health research facilities.

Originally authorized for a period of 3 years, this program has now been extended three times, for a total of 10 years, and its initial authorization of $30 million, increased to $50 million in Federal funds annually.

In my concluding remarks, I will note that, despite the substantial assistance of this program, the need fof qualitative improvement and enlargement of our research plant in the health sciences still constitutes a major need not being met adequately by existing program levels.

THE STRENGTHENING OF INSTITUTIONS

Between 1956 and 1960, the funds expended for the support of research through NIH extramural programs increased by a factor of five. All of these funds were awarded in the form of grants for specific research projects. It was apparent that the concentration of support in the form of research project grants was adversely affecting the ability of universities and other research institutions to exert control over the content, emphasis, and direction of their own research programs in the biomedical sciences and thus to develop in accordance with their own interests and capablities in this area. A means to correct this imbalance was needed to provide research funds which gave greater latitude to the institution in determining their use in the development of their own research and research training programs in the health sciences.

This circumstance gave rise to a legislative proposal authorizing the Surgeon General to make grants for the general support of the health research and research training programs of institutions. This authority, enacted through Public Law 86-798, is the basis of our present general research support grant program.

We are now in the process of studying reports from the schools covering their use of funds under this program during its first year of operation. There has been high praise for this program from the institutions and we have been pleased with its operation thus far.

STABLE CAREERS IN RESEARCH

The further development of a vigorous national research program in the health sciences requires that every effort be made to attract and provide stable support for the best scientific minds and the ablest investigators. The importance of this need is reflected in the wording of section 301 (c) of the Public Health Service Act which authorizes the Surgeon General to:

Establish and maintain research fellowships in the Service with such stipends and allowances, including traveling and subsistence expenses, as he may deem necessary to procure the assistance of the most brilliant and promising research fellows from the United States and abroad.

Because of the short-term nature of support through research project grants, the tie to a specific and finite research activity, and the general unavailability of unrestricted fluid funds, most schools have been reluctant to provide tenure appointments for staff members whose salaries are derived either wholly or in part from research project grants.

The proportion of senior investigators so supported had become sufficiently large, as compared to scientists with stable institutional support, to create an unhealthy degree of instability as a built-in characteristic of the project system. Recruitment of the best minds for the biomedical sciences becomes difficult when the number of stable careers is small in relation to the total program.

To meet this situation, the Public Health Service initiated a special fellowship program to increase the number of stable full-time career opportunities for scientists of superior potential and capability in the health sciences. This program utilizing the classic concept of a fellow as an "incorporated member of a college" has been designated as the Public Health Service research career program. Two categories of awards under this program are available:

Career awards which enable institutions to finance fellowships favorable to the research productivity and development of established investigators of high competence for the duration of their careers. Awards are made on the basis of nationwide competition among candidates whose research in the biomedical sciences has won respect of scientific leaders in their fields.

Development awards to finance additional fellowships to encourage qualified scientists with demonstrated research ability to enter upon and continue in careers in health research and research training.

During fiscal year 1962, a total of 690 awards under this program were made. Of this total, 128 were at the career level and 562 were at the developmental level. Together, these awards involved a total expenditure of $10 million.

This program constitutes a new and, in many respects, a precedentbreaking venture in the provision of support for careers in the biomedical sciences. We believe that it will contribute substantially to the development of a sound medical research structure for the Nation as a whole.

THE DEVELOPMENT OF CLINICAL INVESTIGATION

The rapidly accelerating pace of biomedical research has created new facts and new technologies important to the control of disease and the preservation of health. Much of this information is obtained from the study of model systems, frequently laboratory animals, but its validity in terms of man can be established only through clinical investigation.

Systematic observation of man and his diseases by generations of physicians has, in little more than a single century, defined a host of discrete illnesses subject to precise diagnosis and increasingly effective treatment. The advances in clinical medicine have consistently capitalized on new information provided by scientists who explored nature for its own sake.

Increasing knowledge of the chemical pathways by which the body builds protoplasm and derives energy from food, of the complex interrelations among the various organs and organ systems mediated in the main by chemicals elaborated by specific tissues, has brought to the clinic a capability for even more precise diagnosis and such detailed understanding of disease processes as to provide approaches to therapy on a rational rather than empirical basis.

Exploration of this capability, however, requires highly specialized resources designed specifically to provide the essential laboratory backup to precise and detailed study at the bedside. While most hospitals perform some variety of chemical, hematological, and microbiological tests essential to good patient care, few of them can provide from their own resources the integrated facilities essential to the more sophiscated types of clinical investigation.

To remedy this problem, the National Institutes of Health, early in fiscal year 1960, initiated a series of research grants to bring about the establishment of special, discrete clinical research resources which would foster the collaborative research efforts of clinical investigators working either in a single categorical research area or in general fields. This we have called our Clinical Research Center program.

This program has involved the setting up, within an academic institution or hospital already extensively involved in medical and biological research, a special patient unit for research purposes.

These grants provide for the support of a stable and highly trained staff for such a unit and the supporting laboratory and ancillary technical facilities necessary for the high-quality clinical research investigations.

The Clinical Research Center program for this year involves the expenditure of $32 million in the support of 64 general clinical research units and 63 categorical research units throughout the country. We believe this program will constitute one of the most effective means of bringing directly into the clinical setting the fruits of research findings emerging from laboratory and animal studies, and of providing the facilities and services necessary to the scientific study of disease in that final crucial test vessel, the human being.

The complex and costly type of medical research conducted in the comparatively small, highly specialized clinical research centers is only one phase of clinical investigation. The need for observational types of research on larger numbers of patients not only persists but undoubtedly will increase.

The work accomplished in the centers, however, will define the critical points important to the observational team and will expedite their progress by providing direct methods for discriminating among different diseases with similar symptoms and for evaluating progress or arrest of disease in relation to specific therapy.

THE ENLARGEMENT OF RESEARCH RESOURCES

Research in biology and medicine has changed radically in the postwar years. Its conduct now involves large-scale and specialized animal facilities, the use of sophisticated and complex instrumentation and techniques derived from the physical sciences, the application of advanced mathematical and statistical concepts, and the making of numerous interdependent observations on large or specialized population groups. These developments have generated requirements for a variety of specialized and technical services and resources in support of major research operations.

The use of research grant funds to assist in meeting these needs has been one of the more recent developments in the NIH program. Steps were taken early in fiscal year 1960 to establish centers for research utilizing subhuman primates, accessible to investigators from several institutions. At the present moment, we are supporting seven such primate research facilities.

The increasing quantification of the life sciences has resulted in extensive efforts to adapt the capability of modern electronic data processing equipment and present-day computer technology to analysis and study of such data. Much of this activity is encompassed in what