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find that Title I of the bill does not propose to broaden the construction authority for Regional Medical Programs. During the initial hearings before the Interstate and Foreign Commerce Committee on Regional Medical Programs in 1965, there was much testimony that construction authority would be necessary if the requirements of the legislation were fully to be met. The committee in modifying the bill deleted the authority for new construction. In its report on the bill the committee reasoned that the program would not be jeopardized by the lack of such authority in its initial planning phases. Furthermore, the committee felt in those instances in which new construction might be required for Regional Medical Programs, other Federal sources of funding should be sought. Finally the committee in its report indicated its intention to review this question at the time of the legislation's extension.

Mr. Chairman, I would like to commend the committee's wisdom on this matter. In fact, the Regional Medical Programs have not been jeopardized during these past three years, during which they have organized themselves, planned their programs and begun to enter the operational phase.

However, this situation is rapidly changing. Already 12 of the 54 Regional Programs are operational and within the next year or so all of them will have begun operations. Accordingly, their needs for additional facilities will rapidly increase.

The Surgeon General's Report to the President and The Congress on Regional Medical Programs documents the case for limited Regional Medical Program construction authority. It is extremely important to understand that these facilities would principally be located in community hospitals, not our medical schools.

Examples of needed community hospital construction described in the report include class and conference rooms for regional continuing education programs, space for special demonstrations of community patient care, and expanded diagnostic laboratory facilities.

These needs are not now being met under existing Federal construction programs. There are two interrelated reasons for this:

(1) The competition for Federal funds for the construction of health facilities has grown enormously as a result of an overwhelming demand for such facilities.

(2) By definition, the nature of Regional Medical Program construction needs goes beyond the needs of a single institution to the needs of the region. Accordingly, it is unreasonable to assume that any single institution would be willing to divert its scarce funds for matching purposes when the benefits

of the facility are intended for many institutions. Since it is essential that there be no substantial distortion of the concept of Regional Medical Programs, I concur that rather strict limitations should be placed on this vitally needed construction authority. The kinds of limitations one finds in the Surgeon General's report, having to do with the amount of funds available for construction purposes, seem entirely reasonable to me.

Having considered the limitations, what kind of Regional Program projects are we working to generate? How does such a project work? An example of the effective implementation of the program involving community hospitals is provided by the Rochester (New York) Regional Medical Program which has inaugurated an initial five-part operational program in the area of cardiovascular disease. Each part is specifically designed to meet observed or expressed needs in the delivery of specialized medical care to the heart patient. One project will provide postgraduate training in cardiology for general practitioners and internists who practice medicine in the ten counties which make up this region. Ser. eral different training programs will be offered so as to best meet the indiridual needs of the physicians who will participate. This program is being persented in direct response to the requests of physicians for this type of assistance. One phase of this program includes visitations to peripheral hospitals by the cardiologists who will provide this instruction. Certain audio-visual equipment will be placed in these peripheral hospitals for continued use by the local physician.

A parallel program will present intensive month long courses to prepare professional nurses in the management of coronary care units. The growth in the number of coronary care units which provide essential medical care during the acute phases of cardiac illness, has created an urgent need for an increased number of well trained nurses; the latest advances in nursing techniques and moderu life-saving equipment demands specialized instruction in the nursing skills re

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quired. Hospitals in the region have already expressed their intent to have nurses participate in this program as soon as it is activated. The objectives of this program go beyond that of supplying specially trained nurses for coronary care units in general hospitals; every effort will be made to train coronary care unit nurses from the smaller community hospitals as well, even though they may not as yet have such a unit.

Three additional activities will also be pursued under this initial operational program. A regional laboratory will be established for education and training of medical personnel in the care of patients wnth thrombotic and hemorrhagic disorders. This is the first such facility in the region and will be based in one of the general hospitals participating in the Rochester Regional Medical Program. A region-wide registry of patients with myocardial infarction will be implemented which will gather uniform information from the coronary care units of participating hospitals and provide immediate as well as longitudinal data for analysis. A relatively small amount of funds has been made available to the region to develop the first learning center in the region where some of the educational programs in heart disease, cancer, and stroke may be presented to physicians and nurses.

The first year award for this multifaceted program in cardiology is $343,749.

Having described an example of what we are building, Mr. Chairman, I should like finally to say a word or two about the level of funding I believe essential if Regional Medical Programs are to have a fair chance to achieve their goal.

We all realize that the maintenance of health is assuming an increasingly important role in our socio-economic area of concern and activities. The health industry today accounts for an expenditure of $50 billion but it is scheduled soon to increase to an expenditure of $75 billion.

If the Regional Medical Program is to fulfill its function as the interface between the moving parts of this health care mechanism, it must continue to be able to influence that increasingly expensive device.

We would be short-sighted engineers, indeed, to derive authorization ceilings for the next five years of this program by looking backward at the cost of these programs at the time they were being planned. The cautious development of those programs has unleased a chain reaction of operational activity which will necessitate substantially increased funding levels. It is already clear that on the average these programs will be operating at a level of between $5 million and $10 million each within the next five years. It is, therefore, necessary that an authorization level of roughly $500 million be used as the yardstick with which one measures the funding levels of the program contemplated by this extension.

Mr. Chairman, I am indeed privileged to again have the opportunity to present my views to the committee which has done so much to shape health legislation in general and the Regional Medical Programs in particular.

Mr. Rogers. Our next witness is Sidney Farber, director of research, Children's Cancer Research Foundation, Boston, Mass.

Dr. Farber is also an old friend of the committee, and he was helpful in the formulation of the original legislation, having served as chairman of the Cancer Panel of the President's Commission.

Welcome back, Dr. Farber.



Dr. FARBER. Thank you. It is a great honor to be once more before this committee, where my memories are as heartwarming as any memories I have in my entire professional career. I join Dr. DeBakey and all our colleagues in expressing gratitude to this committee and Congress for starting what I regard as the most important program in the field of medicine in the history of our country that is applied directly to the care of the patient.

I speak strongly in favor 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 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. De Bakey 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.


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 ('ommission 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 pro. vision 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. Fundaniental 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

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