problems of ignorance and inexperience in the use of modern medical services.

The removal of a different kind of barrier-the time lag between discovery and effective application of new knowledge is a goal of the regional medical program. In his health message this year, President Johnson stated:

Its purpose is to translate research into action, so that all of the people of our nation can benefit as rapidly as possible from the achievement of modern medicine.

Title I of H.R. 15758 extends the regional medical program through fiscal year 1973 and clarifies and improves certain aspects of the

program.

You will recall from your consideration of this legislation in the summer of 1965 that it was introduced as a result of the findings of the President's Commission on Heart Disease, Cancer, and Stroke. The Commission found that medical science has created the potential to reduce the heavy tolls of these diseases but that this potential was not being realized for many of our citizens.

The Interstate and Foreign Commerce Committee played a major role in clarifying both the nature of the program and the direction in which it was to go.

The basic objective of this program is to assure that the people of this Nation, wherever they may be, will benefit from the advances of medical science against the threats of heart disease, cancer, stroke, and related diseases.

As an additional dividend, this program will have an impact extending far beyond the control of specific diseases. The physicians and other health workers involved in the regional medical programs will be applying their new knowledge and new techniques to patients being treated under the medicaid, medicare, and other health programs. The lessons learned in the regional medical programs cannot help but enhance the quality and efficiency of these other activities.

The progress already made has justified our expectation that this program would significantly improve the effectiveness and quality of medical care for those who suffer from the major killer diseases.

The program is already bringing together diverse groups in the health field in an unprecedented fashion and in a manner that results in a consideration of the unfilled health needs of the region, rather than those of the individual institutions. Despite the present shortage of manpower, the program has been successful in recruiting throughout the Nation talented persons willing to make firm career commitments to achieving the goals of the program.

The programs have earned the support of the major health resources, professional and voluntary, at the national and regional levels. They have helped overcome hostilities and divisions which have existed in some cases for generations.

Indeed, there has been a positive response to this committee's mandate in the original legislation that this program would be community based that the responsibility for planning and organizing the operation of the program would belong to the region, not to the Federal Government.

As evidence of this response almost 1,000 medical institutions are participating in the regional medical programs, including every med

ical school and hundreds of hospitals. This involvement of medical schools and other teaching and research institutions helps develop close and continuous contact between medical advances and their application in the community.

Almost 800 health organizations are participating, including every State medical society, State health department, State heart association, and State cancer society.

Over 7,000 non-Federal-connected individuals are now actively engaged in the programs, including 1,800 employed either full- or part-time by the regional programs, over 1,900 members of the regional advisory groups required by the law who must advise on the development of the programs and approve all operational activities before they can be funded, and members of various subcommittees, task forces, and local action groups, who are contributing their time. This represents an involvement not only of the experts in the region but also the health personnel at the grassroots level, and this is illustrated in table I (p. 33) which is submitted with the testimony.

These people, institutions, and organizations are the forces which, with your support, will carry to fulfillment the high expectations for this program.

The scope of the program is enabling the regional groups to assess thoroughly the needs and opportunities within their region and to implement the steps that can be realistically undertaken to improve the diagnosis and treatment of the major diseases. By coping with these problems on a regional scale, the groups are able to plan for the most efficient use of specialized resources for service or training from the largest medical center to the isolated rural physician.

The regions have found that many different types of activities can contribute to objectives such as demonstrations of advanced diagnostic and patient-care techniques, training and continuing education of health personnel, development of communication and patient data networks, application of computer and other modern technology to health care, and research into better means for organizing and delivering improvements in health care.

The first planning grant was awarded less than 2 years ago. Today there are 53 regions which have received planning grants and include the entire population, except Puerto Rico, and an application from that Commonwealth is now being reviewed.

Eleven regions have received grants to support initial operational activities, and 13 other regions have submitted applications to begin the operational phase of their programs. To finance these activities there has been a rapid increase in the obligation of funds, and this is illustrated on table II, which is attached.

The involvement in the regional medical programs by local institutions and individuals has been enthusiastic. Within the next year all of the programs expect to enter the operational phase of their program. They are eager to continue the work they have begun.

In addition to extending the basic authorities of the regional medical program, the bill before you contains amendments to those authorities that would help the regions accomplish their goals more effectively. It contains a provision that would assure proper evaluation of the accomplishments of the program by providing that up to

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1 percent of the appropriation for any fiscal year beginning with 1970 may be used by the Secretary for the evaluation.

The bill makes clear that regional medical grants can be awarded to a combination of regional medical program agencies for carrying on a regional medical program.

Also, a new authority is added which would permit the awarding of grants to any public or private nonprofit agency or institution for services which will be of substantial value and use to any two or more regional medical programs. Such services might include producing education materials, developing evaluation techniques, creating uniform data-gathering systems, and other types of activities which cannot always be developed most efficiently on the basis of the needs of a single region.

The act is also amended to authorize the use of regional medical program grant funds to permit the full participation of Federal hospitals in regional medical programs as the important community resources which they in fact are.

Another amendment clarifies that a practicing dentist as well as a physician may refer a patient to a facility carrying out research, training, or demonstration activities which are supported by regional medical program funds. Dentists can play an important role in such areas as the early identification of oral cancer, and the amendment corrects an unforeseen limitation in the original act which does not permit such referrals.

An increase in the Advisory Council membership, from 12 members to 16, is provided in the bill, an expansion made necessary by the increasing workload of the Council in reviewing applications and the desirability of having members who reflect a broad diversity of

interests.

The bill also extends the provisions of the programs to Guam, American Samoa, and the Trust Territory of the Pacific Islands. The Hawaii regional medical program has indicated that it would be interested in including these areas in its program.

These provisions will strengthen regional medical programs and will provide the flexibility that will aid in making the most efficient use of all the health elements of the community in the program.

The committee has received copies of the Surgeon General's report on regional medical programs, which describes in detail the initial progress. I would like to submit for the record material which adds to that report and which will bring you up to date on the accomplishments of the regional medical programs.

May I submit that for the record, Mr. Chairman?

Mr. ROGERS. Without objection, it will be received. (The document referred to follows:)