shown to be the most profoundly productive programs that we have supported. This is good fortune, sir, but it just so happens that those that were ridiculed because of their apparent context have turned out to be so highly productive. However, sir, I am not annoyed by criticism of this sort because I think it is inherent, when a technical man tries to give a title to a program, he cannot imply in the title the general area of impact that his research results will have, so the best he can do is to give a title that is descriptive of precisely what he wants to do, and this is what is misunderstood.

Mr. ROBERTS. I would say, Doctor, that I am annoyed quite a bit by some of the charges and that is one of the things that I want us to try to overcome in this hearing. I want us to try to make a showing that we can sustain, because I am sure you know that practically all of the authority that is being exercised through the Institutes comes through this subcommittee and this full committee and we want all of the facts that you can possibly give us.

There was one statement you made that I wanted you to develop somewhat and that is in the field of cancer.

Mr. ROGERS of Florida. Mr. Chairman.
Mr. ROBERTS. Mr. Rogers.

Mr. ROGERS of Florida. Before you get on that, may I just ask a question or two about what you have just covered

Mr. ROBERTS. Surely; I would be glad to yield.

Mr. ROGERS of Florida (continuing). And as to what I would like to have you be willing to discuss as we go into this very thoroughly. I am very anxious to go into great detail in your clinical centers, your research work, for instance, and I would like to know the number of your clinical research centers, primate centers, specific details, and the personnel involved.

In addition to the amount given for each clinical research center, like you picked out a prototype here, I would like to know what is allocated to the various ones.

In addition to that, I would like to know how much you give in regular fellowships perhaps or training grants for people who may be involved there in addition to the amounts of money covered in your clinical research centers, if that be the case.

Dr. SHANNON. Yes, sir.

Mr. ROGERS of Florida. The number of programs involved.

I would like to know, too, about the building. I understand you cannot go in and build a new research center, as such, but how much is being done and what moneys are being allocated for the actual construction of a portion of your center, whether you call it a revision, or new construction, whatever you call it, the actual construction that is going along.

Also, I would like to know who selects the grants. I believe your Advisory Councils are the ones who actually make your decision on your various grants.

Dr. SHANNON. Yes, sir.

Mr. ROBERTS. How often does this personnel change, how long have the present people on, how it is administered, your study sections, the operation of those.

Also, I would like to know what reports are given back to you, if they are, in a research project that is unsuccessful. Do you get this

report back to show that no one need go into that particular phase if they have covered this ground?

Dr. SHANNON. Mr. Rogers, now you are talking about the general grant program?

Mr. ROGERS of Florida. Yes; I realize I am covering this whole area. These are just some questions I would have, that I would want to go into in great detail, and how you coordinate this information between your various research groups where they know whether a particular group has covered this field, has made this approach, and whether it was successful or not, if this information is fed back to you and then made available, and to the extent generally that your reports are dispersed and made available.

These are some of the questions I have, if we could go into those in detail later on when you get into specific questions.

Dr. SHANNON. Be glad to, yes, sir.

Mr. ROGERS of Florida. Thank you.

Thank you, Mr. Chairman.

Mr. O'BRIEN. Mr. Chairman.

Mr. ROBERTS. The gentleman from New York.

Mr. O'BRIEN. I have a question that Mr. Rhodes requested that I ask.

Before doing that, would it be fair to state, Doctor, that research, if it is to amount to anything, must be accepted as a field honeycombed with blind alleys and that the research man may spend a great deal of money and a great deal of time in a field which at least for the time being is going to yield nothing? Is that not correct? Dr. SHANNON. Oh, yes, sir, unfortunately. I shouldn't say "unfortunately," because if the end objective was not unkown, there would be no purpose of the research, so that this is inevitable; yes, sir.

Mr. O'BRIEN. That is true whether this research is financed by the Federal Government, or by private industry, or by the universities? Dr. SHANNON. This is in the nature of the process; yes, sir.

Mr. O'BRIEN. I think that what happens to us here is that when the blind alley pops up we hear about the blind alley and we hear nothing about the alleys that lead to something.

Dr. SHANNON. Yes, sir.

Mr. O'BRIEN. Now, to get to Mr. Rhodes' question. He would like to know whether the different categorical institutes have substantially comparable responsibilities, or whether some of the institutes have responsibilities which go beyond conducting and supporting research?

Dr. SHANNON. The answer is "Yes," some of the institutes do go beyond supporting research.

Mr. O'BRIEN. That leads to his main question. He wants to know what the plans are if the legislation should be enacted for the Mental Health Institute, particularly if Congress should enact the mental health and mental retardation legislation which this subcommittee now has before us. Perhaps the question should go to Dr. Terry, or to you, Doctor, or both.

Dr. TERRY. This is a rather complicated question.

Mr. O'BRIEN. It is not mine. It is Mr. Rhodes'.

Dr. TERRY. This is a rather complicated question, Mr. O'Brien, in terms of trying to predict exactly what we are going to want to do years or 10 years much less even a year from now.

5

from now,

We feel that in the development of these programs we should take advantage of the opportunities for research developments when opportunities arise, should support the most promising areas in the area of research, and at the same time supporting the basic fundamental research which is necessary to keep the field alive.

As I mentioned in my statement earlier, too, we feel it is very important that these research results be transmitted to the people who need them and can use them; in other words, that this gets carried to the application stage and in many instances, when it reaches that stage, it also requires further research or exploration in terms of actual mechanisms of application.

I am not certain exactly what Mr. Rhodes wishes in asking a question like this. One of the things I think that is involved in this is the fact that, because of the serious shortage of personnel in the whole field of mental health, the Mental Health Institute has been given responsibilities which go beyond some of the other institutes in terms of training persons actually for service.

As an example, one of the portions of the Mental Health Institute program involves the taking of a general practitioner for a year who wishes to be able not to become a psychiatrist, but to do a much better job in the field of the general practice of medicine by virtue of training in the field of psychiatry.

We have a program which would allow us to pick this man up and support him during that year in a training circumstance, full-time training for a year, to make this man a much better practitioner.

We have also entered into the support of training of psychiatric nurses, of psychologists, and these sorts of people, many of whom make a partial contribution in the field of research, but many others make their primary impact in the area of the delivery of medical services.

This has come about because of the serious shortages that we have in this area and represents one of the things that you were asking about a little earlier in terms of a difference, in terms of some of the programs supported by this institute in comparison to some of the other institutes.

Mr. O'BRIEN. Thank you very much, gentlemen.

Mr. ROBERTS. Mr. Brotzman.

Mr. BROTZMAN. Just one question. Perhaps the chairman can help me. My questions would be somewhat along the line of my colleague from Florida.

Will we have an opportunity to get into specifics as we proceed along here to more closely analyze some of the various programs? I do not want to intrude upon your presentation, but I have certain questions and I do not want to take everybody's time to ask them out of order, but if we are going to proceed along the line as Mr. Rogers was asking his questions, I will have questions at that point.

Mr. ROBERTS. I will assure the gentleman that at the proper time there will be time for those specific questions to be answered.

Mr. BROTZMAN. I will yield to Mr. Springer. I think he has some specific questions.

Mr. SPRINGER. I do, but I do not think I can do it, Mr. Chairman, in the time allotted in view of the fact that there is a rollcall and I will forgo that until the next session.

Dr. SHANNON. Mr. Chairman, we are of course at the pleasure of the committee from the standpoint of the depth and the character of the inquiry they wish to consider, but it does occur to me that it might be helpful if we were able, and I think we can, to supply some supplementary information to the committee that may form a backdrop for some of these studies, and we would be glad to discuss with the committee staff the type of material you may wish that will make your inquiry, I think, more profitable and less cumbersome.

We would be glad to discuss with Mr. Borchardt the type of supplemental information you would like to have.

Mr. ROBERTS. I might say at this time we have a rollcall coming up and I just want to leave one question here that the chairman, Mr. Harris, asked me to ask for him, and that is would it be possible for you to submit to the subcommittee a listing of some subcategories into which the category of general research projects could be divided? Could that be done?

Dr. SHANNON. Yes, sir.

Mr. ROBERTS. I believe that the chairman related to a controversy that he had with Judge Smith, chairman of the Rules Committee, in which Judge Smith challenged Mr. Harris that he probably did not know what was going on at NIH these days. Mr. Harris agreed that he probably did not.

One of the problems here is to see whether it is not feasible to gain an understanding of what is going on without necessarily going into each regular research project, item by item.

Would you please see what you can do to help the subcommittee to gain this understanding by furnishing us a further categorical breakdown of this 50-percent item that I referred to?

Dr. SHANNON. This we would be glad to do; yes, sir. (The material mentioned appears on pp. 389-394.)

Mr. ROBERTS. I would like to announce at this time that the chairman of the full committee is seeking to get permission for the subcommittee to sit this afternoon and, as soon as I am able to get that information, I will communicate with the clerk of the committee, Mr. Williamson, so that Dr. Shannon, and Dr. Terry, and all of the other witnesses and the press will know.

If we are able to meet with the permission of the House we will meet at 2 o'clock in the Public Works hearing room. The regular hearing will be continued tomorrow morning in this same hearing room at 10 o'clock.

The committee is now in recess.

(Whereupon, at 11:10 a.m., the committee recessed to reconvene at 10 a.m., Friday, April 26, 1963.)

ORGANIZATION OF PUBLIC HEALTH SERVICE

FRIDAY, APRIL 26, 1963

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON PUBLIC HEALTH AND SAFETY

OF THE COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D.C. The subcommittee met at 10 a.m., pursuant to recess, in the caucus room, Cannon Building, Hon. Kenneth Roberts (chairman of the subcommittee) presiding.

Mr. ROBERTS. Our first witness today will be Dr. Aaron W. Christensen, Deputy Chief, Bureau of State Services, U.S. Public Health Service.

Dr. Christensen, you may proceed with your statement.

STATEMENTS OF AARON W. CHRISTENSEN, ASSISTANT SURGEON GENERAL, DEPUTY CHIEF, BUREAU OF STATE SERVICES, U.S. PUBLIC HEALTH SERVICE, AND M. ALLEN POND, ASSISTANT SURGEON GENERAL FOR PLANS; ACCOMPANIED BY STEPHEN J. ACKERMAN, BUREAU OF STATE SERVICES; DR. LUTHER L. TERRY, SURGEON GENERAL; AND DR. JAMES M. HUNDLEY, ASSISTANT SURGEON GENERAL FOR OPERATIONS

Dr. CHRISTENSEN. Thank you very much, Mr. Chairman.

I have with me Mr. Ackerman from the community health side of the Bureau of State Services to assist, if this is all right with you, sir. Mr. ROBERTS. Glad to have you.

Dr. CHRISTENSEN. I have a short statement which I would like to read, if I may.

The community health programs of the Public Health Service have as their major goal the rapid and effective application of health knowledge to meet personal health needs. This mission involves the strengthening of preventive, curative, and restorative services in States and communities. Our role is to encourage and stimulate the development of necessary health manpower, appropriate facilities, and improved methods and techniques for the delivery of health

care.

There is a growing gap between discovery and application of health knowledge between what is known and what is actually done. A few examples will serve to illustrate the price we are paying as a nation for our delay in putting knowledge to work.

Using what we know to the fullest extent, we could save 265,000 cancer patients each year-88,000 more than are currently saved. Among these would be the 10,000 women who die unnecessarily each year of cervical cancer.