Page images


: Commerce, Federal Aviation Agency, the Office of Emergency Planning, Tennes

see Valley Authority, Federal Trade Commission, and the Canal Zone Government.

In general the health-related activities of these agencies come as a byproduct of their other responsibilities. Nevertheless, their contributions are important to our overall effort to insure the well-being of our citizens.

Activities carried out by the agencies range in scope and size depending on their primary missions. Important in an overall appraisal is the Science Information Exchange operated by the Smithsonian Institution on bebalf of several agencies of the Federal Government. This exchange serves as a clearinghouse of current information about grant and contract recipients for research in medicine, biology, psychology, and other disciplines, the objectives of this research, and the location of the research project. This exchange helps Government agencies and individual researchers to avoid unintentional duplications of effort and to coordinate their research. The Office of Emergency Planning has broad responsibility for coordinating plans and programs for health activities of various Federal agencies for civil defense and defense mobilization.

The remainder of the agencies focus on health activities only as they are incidental to their other responsibilities,

Mr. Staats. I hope, Mr. Chairman, in this approach that we have been able to emphasize that the problems of program and organization in the health field extends beyond HEW. The large amount of money that is being spent requires study by both the President and the Congress. It must be examined in its totality rather than in terms of the program and the budget of the Department of Health, Education, and iVelfare alone.

Mr. ROBERTS. The Chair would like to state that this has been one of the best presentations we have had. I think you have done a wonderful service to our committee and to the country in this presentation,

It gives us for the first time a very fine instrument with which to locate these funds and what they are being used for, and I certainly think that the gentleman from Minnesota

would agree with me. Mr. NELSEN. Mr. Chairman, I would like to interrupt. The chairman and I just commented here in conversation that this was the most conclusive study that we have ever had presented to our committee and it gives us information that we have really been searching for and would require a great deal of time for us to dig up, and I want to congratulate you on the fine job that has been done in this respect.

Mr. Staats. I appreciate your statement, Mr. Chairman, and we are happy that we have been able to supply this information.

Mr. NELSEN. Mr. Chairman, may I interrupt? I have to go back to my office. Yesterday, I asked the question of Mr. Jones relative to the number of employees under civil service and those that were in appointive positions, and I would like to have the comparison made from 1960 to date. My purpose, I think, is obvious. That is that this Department is

technical one and I just want to be sure that we are not making too many political appointees in a Department so important to the health and welfare of the people.

I would like to have that comparison that goes from 1960 to date, the number under the classified service and the number that are politically appointed.

We understand that the top-level people must have some freedom and I agree to that, but I would like to see a comparison, Mr. Chairman.

Mr. Staats. If I may ask, for purposes of clarification, would you include in the classified service those in the Commissioned Public

a very

Health Corps?

[ocr errors][merged small][merged small][ocr errors][ocr errors][ocr errors]

ably also aware, that has a large built-in factor of continuations and supplementals so that, in looking at it for any succeeding year, something over 90 percent of a particular figure is essentially a built-in factor since NIH is making these grants on a 3- to 5-year basis.

Our concerns, then, in that area, are primarily on the dollar figures which the agency, would wish to devote to new research projects, comparing this with the factors that Mr. Staats has already talked about; what are likely to be the demands, are there capable researchers available to take on this level of new projects over and above the level that was achieved the year before, and then the judgmental factor as to the marginal return and how far we are to go in that area.

I have just one or two other comments.

Biologic standards, for instance, happens to appear first on the left-hand side of the NIH chart.

That activity has a specific appropriation and is an activity that pretty much stands on its own; we attempt to review that one by itself year in and year out.

We also try to shift our program review emphasis to meet emerging problems. This year, for instance, the mental health activities and the activities of the Institute of Mental Health received special attention because of the President's special message and special program for mental health and mental retardation, and in succeeding years perhaps other parts of the National Institutes would receive some special attention. But as the appropriations have grown, approaching the billion dollar level, with one staff member to concentrate in the area, we have had to more and more take the summary approach that

you find on the right-hand column of the chart and try to deal in large pieces of this very large and growing activity. Mr. ROBERTS. Thank you, sir.

Do you have any other suggestion as to how the Congress can be placed in a better position to evaluate these programs other than on the project by project basis which, of course, is impossible?

Mr. STAATS. I would like to say one or two things on that and there may be others here one could add.

As part of the study which Mr. Sutton referred to a while ago, we want to give particular attention to the impact of various programs on the universities because we do not think that you can separate out one research program from all of the other programs that the Federal Government carries on that may be affecting a single institution.

Institutions are, all of them, interested in strengthening their programs, they are interested in finding a way to cooperate with the Government, but in many cases this has resulted in a large number of different programs, different approaches dealing with the same university which has caused very serious problems for that institution.

So that, one factor, it seems to me, that we need to give greater consideration to, is to what all of this adds up to as to the effect on our institutions of higher learning. That is a matter of emphasis.

I would think, additionally, that we would agree that, as to the categories of the kind in the right-hand column here which are more by functions or components, such as research training programs, es; tramural research, collaborative studies, and so on, that we would feel that this is a more useful approach in evaluating what the agencies are doing.

[ocr errors][merged small][merged small][merged small][ocr errors][ocr errors][merged small]
[ocr errors][ocr errors]

Those are just two remarks.
I believe Mr. March has something he wanted to add.

Mr. MARCH, Mr. Chairman, as you look at this rather broad panorama and the difficulty of drawing firmly the priorities that the Congress and the executive branch ought to keep an eye on, a couple of thoughts occur to me concerning gaps in what we are presently doing. I think this is true for the Government as a whole.

When you get right down to it, we are rather at a very beginning stage in the business of measuring the return from various public activities.

Among the most difficult, of course, is research, but fundamentally, if we are ever to be very scientific in where we put the resources of the country, shall we say, among fields of research or as between research or, say, the practice of medicine, the choice of a dollar for research or å dollar for rendering medical care, we will have to strengthen the fundamental knowledge that goes toward evaluating the returns in the large.

From the point of view of economic return, looking over this field of health and the same is true of education, we have very little fundamental information and very little fundamental research going on in the Government and outside in the universities on these larger questions of where to put the resources.

Another area which is almost at a similar stage of underdevelopment in terms of fundamental across-the-board knowledge, in my observation from working in the Budget Bureau, is in this area of manpower.

Now, in the health area more than perhaps in any area of the programs that we touch upon, the bottleneck is the lack of trained or skilled manpower.

The manpower that you need for health tends to compete with, tends to come pretty much from the same sources as the manpower needed for scientific research and technological development across the board in the economy. This is particularly true in the research area. Yet, while we have some estimates about the supply of doctors and the shortage of doctors and researchers and NIH does try to make its projections, we have not in the Government as a whole really developed this process of balancing the supply and demand so that you can place these needs for skilled manpower in the broader setting of the total manpower picture and what the universities can produce. So, consequently, often we are counting on each other's manpower in expanding the programs. Perhaps in this latter area the program that the Labor Department was charged with, under the Manpower Development and Training Act, of developing a broad manpower picture, will prove eventually to be very helpful.

It seems to me anyway that if the Congress and if the executive branch are to zero in on these fundamental problems that you are asking about how much do you put in medical research-we have to at least get answers in these two categories.

I should like also to just mention quickly another third category of possible need for research which we are very cognizant of in the Budget Bureau. That is the area of intergovernmental financial relationships.

This is very pertinent in the health field, particularly in the care area ; how much of the responsibility and how much financial capacity


[merged small][ocr errors][ocr errors][ocr errors][merged small][merged small][ocr errors]

Mr. ROBERTS. Mr. Harris, the chairman of the full committee, raised a question at the beginning of the hearings as to whether it would not be advisable to place dollar ceilings and time limits on the authorizations for the appropriations for NIH just as the Congress has placed these limitations on other programs administered by the Public Health Service. Do you have

any comments on the effects which such limitations have and can you suggest any realistic ceilings in this respect? Mr. Staats. This thought has been suggested by various people

. We feel that the time and dollar limitations which have been placed on the construction programs of the Public Health Service have been very useful. It has served the purpose of causing a review and reappraisal of those programs periodically.

We have been less certain about the value of such a limitation in connection with the basic research programs of NIH; that is the grants made by NIH.

We do think that there would be merit in a periodic appraisal through hearings and through the development of reports from the agency to be sure that in this important area that periodically, say every 3 years or whatever the time period might be feasible, that there would be a careful reappraisal of the legislation which underlies the program as well as the direction of the program itself. This kind of reappraisal, we think, could be very useful.

. Mr. Surton. I think that is the general position that the Bureau has taken in many reports on legislative proposals. We suggest

, often, dollar limitations on construction programs but we think that, in the operating area or in the research area, the intangibles with respect to the universities, for example, are so great that there needs to be greater flexibility than the legislative process can always permit. Evaluation and review, particularly of new programs that have recently been authorized, though, is exceedingly valuable and I think we would particularly endorse the review on the 3- to 5-year basis of the newer programs. The committee should assure that the grams are carrying out the objectives that were originally intended.

Mr. Roberts. I have been wondering, particularly in programs that are authorized by this subcommittee, if at the beginning of each new Congress it would not be well to let the departments know perhaps a month or so ahead that we would like to have a kind of a review, not detailed but at least get a good look at what has transpired in a 2-year period prior to the beginning of a new session.

I think that could very well be done without too much trouble and without too much expense.

I think it would give us a lot of information, too, that we need in looking at administration bills and at various proposals that come before our subcommittee.

Finally, I have a question which relates to another subject in which the parent committee is interested, and that is the ratings of radio and TV programs.

Since your Bureau is heavily involved in statistics, do you use any sampling techniques for securing your data ?

Mr. STAATS. We do not directly collect data, as you know, Mr. Chairman. It would be an unusual case where the Bureau of the Budget would directly go to the public for data itself. This would

[ocr errors]


Mr. SUTTON. I can supplement what Mr. Staats has said. In the Labor Welfare Division of the Bureau there is one examiner who spends substantially but not all of his time on the National Institutes of Health budget which is now approaching a billion dollars.

We do not give a great amount of attention to the amounts that go into each institute. In other words, we look to the professional judgment of the Public Health Service and in turn to the many advisers that it utilizes in its study sections and advisory councils to advise them on the emphasis that should be given to various diseases, such as how much emphasis should be given to cancer research. Instead, we look more at the general questions of Federal Government and university relations, the overall support being given to research projects vis-a-vis more general grants to an institution to develop a program, for example, to an institution that has not had medical research before.

We look to new programs that are coming along, particularly new programs to support facilities, to support manpower.

These are the areas where our major emphasis is given. And, finally, we look, too, at the relationship between the programs that are carried on at the NIH and the programs carried on in these other agencies that are also operating in the field of medical research and the life sciences-programs, for example, of the National Science Foundation in the area of the life sciences and the programs of NIH.

They are dealing with the same universities. These requests need to be coordinated in an agency such as the Bureau where this coordination can be best effected.

Mr. Roberts. Mr. Sutton, you mentioned the relationships of the institutes and the universities in the grant field.

Now, while I do not accept as valid per se the criticism that has been made, yet I do think that it is a question that we have to look at very carefully. That is where we have people in the scientific community who also are serving on advisory councils and who are officially connected with universities and colleges who are receiving some type of research grant from NIH.

Do you have any suggestion as to how we might improve that situation? Mr. Sutton. I have no suggestion at the moment. The Bureau of the Budget is launching a study of its own to look particularly at the comparative practices of various Federal agencies and of some outside foundations in the administration and review of research grant programs. I think we have a lot to learn.

NIH problems have been, of course, magnified perhaps. They have been publicized by the efforts and studies, and very good studies, I think, made by the House Government Operations Committee, but we must all look upon NIH as an agency that has had great growing pains and I think is dealing with many of its problems in a very suc

Some of these problems are still under study. We see that there sa role for the Bureau of the Budget to look at NIH problems, paricularly as they relate to those of other agencies. We are just in the process of launching a comparative study of grant dministration among Federal agencies. We liope that a good deal

essful way.

« PreviousContinue »