There are many examples that could be given from the splendid institutions in the country and in other parts of the world where greatest advances have been made. The word "cancer" does not apply to a single disease. It includes many different diseases, which may be unrelated, all of which are called cancer, so we may have to answer your question instance by instance as we record success.

Mr. ROGERS. I think that is encouraging, and I think it is well for us to spread on the record some of these examples, so where you have a technique that is successful, this can be spread quickly through a regional medical program-at least that is the theory-that it can get to the local doctors and hospitals. And although we may not have the necessary treatment there, it can be arranged for and the treatment prescribed.

Dr. FARBER. We hope these regional programs will provide for the community hospital the expertise and the equipment which will take care of the vast majority of patients with cancer, leaving for the centers the new problems which require far greater outlay in equipment and manpower.

Mr. ROGERS. Thank you.

Are there any questions?

Mr. KYROS. I want to join with you in welcoming Dr. Farber here. Mr. NELSEN. I was interested in your statement that many patients. have gone as long as 13 years with no evidence of recurrence.

Is there any specific number of years that the medical profession assumes to be past the danger point in radiation treatment of a tumor? Dr. FARBER. This varies from tumor to tumor.

In the case of the kidney tumor I mentioned, I have experience for more than 40 years with this kind of tumor. If there is no recurrence or evidence of tumor 2 years after initiation of therapy, we may assume with a high degree of certainty that the patient will remain in good health. In the case of other tumors, cancer of the breast, for example, although most patients will remain well if they have been well for 10 years, all of us-Dr. Carter, too, I am sure-have seen patients who have had recurrences 18 to 20 years later.

So we must give a different answer for each kind of tumor.

Mr. NELSEN. I had in mind a case that I am well aware of, that hap pens to be my son who had a brain tumor. It is now 5 years since the radiation treatment was given, and he has been in very good health since this operation was performed.

I am always watching, of course. This was 5 years ago, and it would seem he is in very good health at this time.

Dr. FARBER. I am sorry to learn you have this personal experience, Mr. Nelsen. I would say the story you give is encouraging. If there is no evidence of tumor after 5 years, this looks very hopeful.

Mr. ROGERS. Dr. Carter?

Mr. CARTER. I want to say thank you for an interesting and informative and I started to say "persuasive" presentation, but instead of that, I am going to say that so far as I am concerned, I am a believer and am fully persuaded in what you say.

Thank you.

Dr. FARBER. Thank you very much, Dr. Carter.

Mr. SKUBITZ. Doctor, I have one statement.

You made the statement, I believe, that if we could make available to every man, woman and child the evidence that we have on cancer, 100,000 lives would be saved this year or any year. Is this correct?

Dr. FARBER. That is correct.

Mr. SKUBITZ. Of course, I recognize the task we have in trying to get to every individual, but don't we have a central clearing agency of some sort where information is collected?

Dr. FARBER. Yes, we do, through the National Cancer Institute and the American Cancer Society, but the problem is complex. May I mention a few of the complexities?

First, we must have the patient come to his doctor early. This is No. 1. The American Cancer Society particularly has had a great educational program for many years in the attempt to have patients come much earlier than is now the case. If we could apply the cytologic diagnostic test, for example, to every woman today, we could save thousands of lives, literally thousands, because here is a form of cancer of the uterus which can be cured by surgery, or radiotherapy.

But if we can't get the patient examined properly and regularly, we cannot save lives.

There is a further point that should be made. It is that there is a lack of facilities in many of the community hospitals of the country where there are good men and well trained men and devoted doctors, but without expensive facilities and without all of the supportive therapy that is extremely costly, one cannot do as much for the patient as we hope to do when these regional medical programs bring support to every community hospital that is connected with every center, and every center connected with every other center.

There are many reasons of this kind, but if this country decided today that it was worthwhile saving these 100,000 lives by bringing the financial support and the administrative relationships that would be required, these lives could be saved.

Mr. SKUBITZ. Maybe I misunderstood you. I thought you were saying that one of our first problems is trying to bring about an awareness in the individual of what the danger signals are, and if they could recognize them, and then get to the proper place for proper medical attention, they would be saved. Am I right?

Dr. FARBER. That is point No. 1. Part of it is what the individual patient will do, and part of it is what the doctor will do. But if these patients come to hospitals which do not have facilities, the doctor, who is already tremendously overburdened with the tremendous amount of good that he is doing in general practice, will be unable to give the optimal treatment, because the facilities are lacking, because of the expense of supportive therapy, because of the number of experts in many fields of medicine, surgery, and laboratory science, are not available for the patient.

But if a patient should receive everything that is known today, he will stand a far, far better chance in such a place than he can. otherwise.

Mr. SKUBITZ. Thank you, Doctor.

Mr. ROGERS. Thank you very much, Dr. Farber, for your excellent testimony.

Our distinguished colleague, Congressman Kuykendall, will introduce the next witness. We are pleased to have our colleague with us at the committee here and are delighted that you will introduce our next witness.

STATEMENT OF HON. DAN KUYKENDALL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TENNESSEE

Mr. KUYKENDALL. Thank you, Mr. Chairman. It is a real privilege to be with the subcommittee for a few moments, and a particular privilege to introduce a man who for several reasons, I think, is peculiarly qualified to testify on this particular bit of legislation. I think he is qualified for several different reasons.

First, if not foremost, is the fact that our city and area of Memphis is very much a regional city, probably more so than any major city outside of the crowded area of the eastern seaboard, where within 125 miles of our city we have five States. And we have run into problems of Hill-Burton, because of implications of not getting benefits from a regional concept.

We proudly announce that Memphis is a major medical center around our fine university. And Dr. Cannon himself is one of the outstanding surgeons and, maybe more particularly pertinent to this hearing, one of the major contributors to medical education in the whole Nation, having been one of the leaders in the field of medical education for quite some years.

So it is a privilege to introduce my fellow Memphian, a good friend and a leading educator, Dr. Bland Cannon, of Memphis.

Reluctantly, I have to leave now, and go to my committee.

Mr. ROGERS. We understand.

Dr. Cannon, we are pleased to have you and welcome you to the committee.

I understand you have an associate, Dr. Henry Brill.

Dr. CANNON. Yes. I would like to ask Dr. Ruhe, Dr. Brill, and Mr. Harrison to accompany me to the witness table.

Mr. ROGERS. We welcome all of you to the committee and will be pleased to receive your testimony. It is my understanding, Dr. Cannon, that you are representing the American Medical Association in giving your testimony.

STATEMENTS OF DR. BLAND W. CANNON, MEMBER OF COUNCIL ON MEDICAL EDUCATION, AND DR. HENRY BRILL, MEMBER OF COMMITTEE ON ALCOHOLISM AND DRUG DEPENDENCE, AMERICAN MEDICAL ASSOCIATION; ACCOMPANIED BY BERNARD HARRISON, DIRECTOR, LEGISLATIVE DEPARTMENT, AND DR. WILLIAM RUHE, DIRECTOR, DIVISION OF MEDICAL EDUCATION

Dr. CANNON. That is correct, Mr. Chairman.

I am a practicing neurological surgeon and a member of the American Medical Association's Council on Medical Education.

With me to present the views of the American Medical Association on H.R. 15758 is Dr. Henry Brill, of Brentwood, N.Y. Dr. Brill is chairman of the AMA's Committee on Alcoholism and Drug Dependence.

Mr. Bernard Harrison is director of AMA's Legislative Department, and Dr. William Ruhe is director of AMA's Division of Medical Education.

The three parts of H.R. 15758 affect three programs of special interest to the American Medical Association. I will comment on the first part which relates to the extension of the regional medical program. The second part proposes an extension of the program for grants for health services for migratory workers. The third part proposes a new program for alcoholic and narcotic addict rehabilitation. Dr. Brill will provide the subcommittee with the association's views on the latter two subjects.

STATEMENT OF DR. BLAND W. CANNON

Dr. CANNON. One hundred and twenty-one years ago, as a result of the concern of the profession with problems relating to the quality of medical education and health care, the AMA was founded. Since that day in 1847, organized medicine has encouraged methodologies of health care which it believes will best provide improved health care for all patients.

The increased longevity which the American people enjoy today is a tribute to medical advances and their application to the health care of the American people. The American physician today is prepared to render the best medical care in the world because he is a product of a constantly improving pattern of the finest medical education and research; because his opportunities for postgraduate education are unexcelled anywhere; and because he has been armed with matchless and ever-advancing diagnostic and therapeutic techniques.

I have made the previous statement, Mr. Chairman, because it should be clear that while we constantly strive for improvement so that what we have today will be better than yesterday, and what we obtain tomorrow will still be better than today, we must not lose sight of the remarkable accomplishments that have been made in health care by our medical educators, medical researchers, and practicing physicians. In July 1965, when Dr. James Z. Appel, who was then president of the association, appeared before the full Interstate and Foreign Commerce Committee to testify on the bill to establish the regional medical program concept, he voiced the association's concern with certain provisions of the bill then before the committee. Because of the amendments made by the committee, much of our concern was quieted. RMP began auspiciously and, since that time, continues to promise a hopeful future.

But there are still some who would like to see the regional medical program as an instrument by which the organization and delivery of health care to the American people could be changed in some revolutionary manner. Importantly, this does not appear to be the view of those in the administration charged with the implementation of Public Law 89-239.

Dr. Dwight L. Wilbur, president-elect of the AMA, in addressing the conference-workshop on regional medical programs on January 18, 1968, noted that on an earlier occasion Dr. R. Q. Marston, director of the regional medical programs, had said that RMP faces the challenge of influencing the quality of health services without exercising Federal

or State governmental control over current patterns of health activities. Dr. Wilbur then said:

If the program in fact is clearly one designed to catalyze and to facilitate the development of better programs than now exist to serve patients and their physicians, it will undoubtedly receive enthusiastic cooperation from the medical profession and related groups.

Such support is evidenced by the participation in RMP by some of our outstanding physicians and by constituent medical societies of the AMA. In five of the 54 regions, a State medical society is the program grantee. These are Georgia, the District of Columbia, Nebraska, Minnesota and Pennsylvania. In many of the other regional programs, the state medical society is an active participant.

We view with favor the early progress of RMP, its ability to build on existing patterns of medical care (sometimes adding new features or changing old ones as local demands and resources make possible) and the local flexibility which allows the program to make a real contribution to the health care of our nation.

At the same time, we recognize that the concept of the regional medical program is still in its very early stage of existence and that it is difficult to appraise the program. We do not know, for example, how much this program adds to the stress on an already overtaxed supply of available medical manpower. There is some concern that the proliferation of Federal health programs substantially contributes to the rise in health care costs. For this reason, we are pleased that H.R. 15758 provides for an evaluation of the program. We would suggest, however, that the evaluation begin July 1, 1968, rather than July 1, 1970, since evaluation should be an integral part of the planning. We also suggest that the subcommittee consider further amending section 102 to provide that the evaluation shall be made by a nongovernment agency.

Sections 103, 104, and 106 contain provisions which we believe to be salutary. Section 103 provides for the inclusion of the territories under RMP; section 104 makes combination of regional medical program agencies eligible for planning and operational grants; and section 106 adds a new provision under which grants could be made to public or nonpofit private institutions for services needed by, or which will be of substantial use to, any two or more regional medical programs. We recommend the adoption of all three changes.

As to other amendments, we recommend that the subcommittee delete the open-end authorization for funds for the 4 fiscal years ending after June 30, 1969. In view of the fact that we are still dealing with a relatively untried program, we believe it would be wise to limit the authorization to such sums as this subcommittee may determine to be reasonable, rather than to provide for "such sums as may be necessary for the next 4 fiscal years." Further, with the same concern, we urge the subcommittee to extend the program for a total of 3 years rather than the 5-year extension provided in the bill. Both of the previous witnesses have mentioned 1971 as a landmark in the activation of the program.

Finally, we note that section 105 provides for an increase in the number of Advisory Council members from 13 to 17. As this change is made by the subcommittee, we would suggest the further amend