to extend and approve the provisions relating to regional medical health programs.

I join my colleague, Dr. DeBakey, in strong recommendation for construction funds, and I will give one example of this later, which will illustrate the great need for construction funds in this program. What we are asking today is authorization for the next 5 years for these funds, with the hope that funds will be available, released from other sources, which will make the support of this program and so many other worthy programs before the Congress possible.

I would like to say just a few words about these programs. There has been a magnificent beginning already. I want to give evidence that the administration is excellent under Dr. Marston in the division of regional medical programs, and that the Council and advisory boards are composed of wise and courageous men who are not afraid to say no, nor are they not afraid to say yes, in the approval of programs that deserve approval.

I have the privilege as a member of the National Advisory Council to represent that council to the Regional Medical Programs Council; this is my second year of watching and listening with great appreciation and helping, when I am asked for help, in the deliberations of these advisory boards.

The regional medical program represents the first time in the history of American medicine where all segments of society concerned with the health of our people have come together to achieve a common goal of better health, preservation of lives, and the prolongation of good life for people who suffer from these dread diseases. This is a great triumph in itself, and would be worthy of the entire cost of this program if this were the only spin-off of what has been done.

The regional medical programs, quite simply, are concerned with bringing to every man, woman and child suffering from these dread diseases, and eventually, I hope, from all diseases, all that is known today that might save lives or prolong good life. This is accomplished in the simplest terms in two ways.

We begin with the community hospital and the doctor in practice. We give added strength first in manpower in trained personnel in those community hospitals, and, second, technical facilities for what is lacking. And we link these community hospitals with so-called "centers."

These centers are not buildings in one place. They are not in one building, but they represent a portion of a given region where there is a concentration of expertise in medical schools, teaching hospitals and research institutions, where there are facilities and manpower and expertise that cannot be duplicated endlessly.

The country just can't afford that.

If we can bring these two segments of the medical community together, the community hospitals and these medical complexes, and with good means of communication in the modern idiom for rendering diagnostic assistance and therapeutic advice, we will achieve something that in the field of cancer, and other fields, will bring great rewards.

I want to mention figures that I had the privilege of mentioning once before before this committee.

In cancer, if we could bring to every man, woman and child everything that is known in diagnosis and therapy today, there would be a saving of 100,000 to 300,000 who are destined to die of cancer this year.

In the field of heart disease and the field of stroke, this can be multiplied as evidences of what this program can accomplish.

For the remaining 200,000 of the 300,000 for whom we have nothing available today and who will die of cancer, we require research. The great research programs of the National Cancer Institute and the American Cancer Society and the many private institutions of the country will provide the research in the course of time which will bring answers to the problems which cannot be answered today.

But if we can focus our attention on those who can be saved with knowledge presently available, this goal is worthy enough.

I want to point out one example in regard to construction. You are familiar with the great returns from the privtae sector to the HillBurton Act and to the Health Facilities Construction Act, and so on. In those there has been an outpouring of private money. That will happen here, too, in those parts of the country where the private sector can aid. In those where the private sector is unable, this program should shoulder the entire burden, because human life is precious wherever it is.

There is one example that I learned about just before coming here. The community of Anchorage, Alaska, in response to the needs identified by the Washington-Alaska regional medical program, for high-energy radiation facilities closer than Seattle, Wash., is now conducting a campaign to build the facility. Solicited private funds will be used to construct the housing for the equipment, which is very expensive.

The equipment will be purchased by the regional medical program. The treatment center will be operated as a regional resource by the Providence hospital, as planned and approved by the local and and regional advisory groups.

The decision to support the activity involves cooperative arrangements at another level also, and of this I am very proud. The National Cancer Institute conducted the site visit, which gave assurance of the sound scientific and professional basis of this project. Here is a beautiful example of two segments of the National Institutes of Health cooperating.

I have just heard that the Anchorage Construction Trades Council, comprising 14 unions, have taken on the construction of the building, contributing more than one-half of the total cost from this one source alone. This is heart-warming, indeed, to see a community as a whole joining with a Federal program in aiding people suffering from cancer by providing a form of treatment that had been lacking in that part of the country.

The time has come now to recommend greater support for this program on the basis of the fine progress which has been made.

You have already heard from Dr. DeBakey in response to questions for the amount which is recommended for this year. May I mention two other figures?

By 1971 this program should be supported by an amount no less than $300 million, not counting construction. And we should reach

the figure of $500 million within 5 years' time if we are to utilize to the full the strength of what has been mobilized in the various regions of the country in behalf of the health of our own people.

I close these remarks, Mr. Chairman and gentlemen, confident in the belief that the leadership to the Congress offered by your committee will permit these regional medical programs to make a truly great contribution to the health of all of us.

Thank you.

(Dr. Farber's prepared statement follows:)

STATEMENT OF DR. SIDNEY FARBER, DIRECTOR OF RESEARCH, CHILDREN'S CANCER RESEARCH FOUNDATION, BOSTON, MASS.

Mr. Chairman and members of the Subcommittee on Public Health and Welfare, it is with gratitude that I acknowledge this opportunity to appear before you in strong support of H.R. 15758, the purpose of which is, among other things. "to amend the public health service act so as to extend and approve the provisions relating to Regional Medical Programs."

My name is Sidney Farber. I am founder and Director of the Children's Cancer Research Foundation in Boston, and Chairman of the Staff of the affiliated Children's Hospital Medical Center. For almost 44 years I have been associated with Harvard Medical School as a student and member of the Faculty, where I'am now the S. Burt Wolbach Professor of Pathology. My medical, research, and teaching activities have been devoted to children and to the field of cancer. At the present time I am President-elect of the American Cancer Society which derives its great strength in its struggle to control cancer, from more than 2 million volunteers in all parts of the country. Presently I am a member of the National Advisory Cancer Council of the National Institutes of Health, and represent that Council to the National Advisory Council on Regional Medical Programs. It was my privilege to serve as a Member of the President's Commission on Heart Disease, Cancer and Stroke, as Chairman of the Panel on Cancer. It was this Commission which produced the renowned DeBakey Report which culminated in the enactment of P.L. 89-239, the Heart Disease, Cancer and Stroke Amendment of 1965. It was my privilege, too, to testify before this Committee in support of the original enabling legislation.

Today I come before you in support of the extension of this program which represents one of the greatest opportunities in the history of medicine to prevent death from these dread diseases, and to prolong good and useful life for our people. May I summarize briefly a few points concerning the program as a whole, and that portion dealing with cancer in particular :

(1) A magnificent beginning in planning, and to a smaller extent in operations has already been made in this very short period of time. The Regional Medical Programs already show convincing evidence that for the first time in American history the various components of a given region of the country concerned with the health of our people can and will work together toward the achievement of a goal which has never been so broadly defined.

(2) The goal of the Regional Medical Programs, in a few words, is the provision for every man, woman and child suffering from any of these dread and related diseases, of all that is known as well as all sophisticated technical procedures for the prevention of death and the prolongation of good life. Fundamental to the achievement of these goals are developments in data collection and the perfection of better methods of delivery of medical care, as well as improvements in continuing education for the physician and education of the public. Making use of these invaluable tools, then, the Regional Medical Programs, in the case of cancer, are beginning to create meaningful relationships between community hospitals and those parts of the region where are located the medical schools, teaching hospitals, and research institutions concerned with cancer. The community hospitals must be strengthened by increasing the number of members of their staffs, specially trained in the various aspects of diagnosis and treatment of the many different diseases we call cancer, and the addition to their technical armamentarium of such special technical devices as radiotherapy units. and other diagnostic and therapeutic equipment.

In the medical school complex there will be concentrations of specialists in the many phases of cancer research, diagnosis and treatment to give expert assistance

to any doctor in the region in behalf of his patient. In such complexes where a critical mass of expertise is to be found, primary responsibilities will include continuing education with the help of technical equipment in the modern idiom, demonstrations of new techniques for diagnosis of treatment, and consultation services to the community hospitals and all doctors in the region, in addition to the conduct of research designed to provide solutions for problems in cancer which can not be satisfactorily handled on the basis of present knowledge.

(3) It has been estimated by experts that if we could make available to every patient with cancer in the country today all that is known concerning diagnosis and treatment, we could save 100,000 of the more than 300,000 who will die of cancer this year. This is without new knowledge emanating from research laboratories. It is a goal that can be achieved by the full development of these Regional Medical Programs in the field of cancer alone.

(4) As was the case with the Hill-Burton program, and also the Health Facilities Research Construction Program of the National Institutes of Health, investment of Federal money will be sure to call forth investment from the private sector. You will be interested I am sure in one experience in a part of our Country which has serious need for improvements in the field of cancer.

The commodity of Anchorage, Alaska, in response to the needs identified by the Washington-Alaska Regional Medical Program for high energy radiation treatment facility closer than Seattle, Washington, is now conducting a fund raising campaign. Solicited private funds will be used to construct housing for the equipment, which will be purchased by the Regional Medical Program. The treatment center will be operated as a regional resource by the Providence Hospital, as planned and approved by local and regional advisory groups. The decision to support the activity involves cooperative arrangements at another level also, for the National Cancer Institute conducted a site visit which gave assurance of the sound scientific and professional basis of this project. I heard just before coming here that the Anchorage Building and Construction Trades Council, comprising some 14 unions have taken on the construction of the building as a project, contributing more than one half of the total cost from this one source alone.

RECOMMENDATION

The time for increasing the support for these Regional Programs in Heart Disease, Cancer and Stroke has come on the basis of the truly splendid start that has been made. The upward trend of needs-almost double each year— is apparent as more programs reach the stage of actual operation. In fiscal 1967 only 4 programs were operating; in 1968, 20 more will reach that stage. Even to make possible the universal application of such a simple and established technique for detection of cancer of the uterus at the Papanicolaou smear, is an expensive procedure, but one that will be followed by the saving of thousands of lives of women each year. We should emphasize, too, that many segments of our system-in ghettos, rural areas, or old-age homes among others, have little or no access to modern scientific health technologies.

We are aware that particularly at this time priorities must be established and that choices must be made. It is our purpose today merely to point out the great good that will come if there is support of programs which have already demonstrated their ability to achieve the goals defined by the President's Commission on Heart Disease, Cancer and Stroke and put into law by the Congress of our Country on the recommendation of this Committee. From the time of the identification of these goals in P.L. 89-239, the Regional Medical Programs have captured the imagination and raised the expectations of the general public and the health provisions alike. Those who have studied the needs of this program most carefully recommend that the ceiling for the national program as a whole should reach the level of more than 500 million dollars within 5 years, and should certainly not be lower than 300 million dollars for 1971 if we are to utilize to the full the strength which has been mobilized in the varous regions of the country in behalf of the health of our own people.

I close these remarks confident in the belief that the leadership to the Congress offered by your Committee will permit these Regional Medical Programs to make a truly great contribution to the health of all of us.

Mr. ROGERS. Thank you very much, Dr. Farber. We are indebted to you for being here and giving us your opinion on this program.

Let me ask you, for instance, with the Children's Cancer Research Foundation, can you give us any example where a new treatment, perhaps, has been disseminated through a regional medical program?

Dr. FARBER. Yes, Mr. Chairman. The Children's Cancer Research Foundation, if I may speak of something with which I have been concerned for the last 21 years, is really a prototype of the Regional Medical Center program. It is a private foundation, assisted from the private sector and receives research funds from the National Cancer Institute and help from the American Cancer Society. It is supported by the entire New England community.

It provides expert care and diagnosis and treatment for children with leukemia and all forms of cancer, for any child sent by a doctor in the entire region. The doctor takes care of the patient at home and gives the tremendous moral and medical support required by a family which has a seriously ill child at home.

The foundation provides the techniques and equipment which are much too expensive to be in a doctor's office. It carries out all these expensive services without professional charge to the patient; at home the patient is the private patient of his private doctor.

In 21 years, Mr. Chairman, I have never had a complaint from a single doctor in this region. We have had remarkable cooperation, and the community as a whole has cooperated to support something which they considered absolutely necessary for the comfort, the wellbeing, and the mental peace of the family, as well as for the health of the child.

Mr. ROGERS. Have we had any real breakthroughs in this area, in the treatment of leukemia in children?

Dr. FARBER. Mr. Chairman, there has been very great progress. It was 20 years ago last November when the first chemical that could control leukemia, at least temporarily, was administered to a child for acute leukemia.

There is no cure for acute leukemia, but patients live good lives for several years, instead of a few weeks or a few months. And there are alive a few hundred patients, adults and children, about 1 percent, I estimate, of all the patients with leukemia treated, who have lived good lives for 10 to 15 years without evidence of the disease.

This is not a cure, in my opinion, but this is very heartwarming evidence that we are in the right direction in the use of chemicals, and many supportive programs, such as platelet transfusions and so forth. If we can keep good life going, the next forward step in research may come in time for that child.

We have other tumors in adults as well as children, which have responded to surgery, radio therapy, and chemotherapy. In one case of cancer of the kidney in children, we are now above 80 percent in longterm survivals because of the addition of chemical, in this case an antibiotic, to modalities of surgery, and radio therapy. We have accomplished what seemed impossible 20 years ago. Once spread to the lungs had occurred in this kind of tumor, there was a matter of 3 to 6 months of life ahead. We are now able, in about 60 percent of the children who have had spread of this cancer to the lungs, we are able to have complete destruction of the tumor using small amounts of radio therapy and an antibiotic. Life has continued in the longest patient for 13 years with no evidence of the return of the tumor.