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nition throughout the world that the security and welfare of the human race are interdependent within each geographic area of the world and that the security and welfare of each geographic area of the world is dependent upon the security and welfare of the world as a whole.

Some of this recognition has been forced upon us by the technological advances of the 20th century, which have created a shrinking world in terms of communications, transportation, trade, and devastating effects of modern weapons of warfare. Mankind through the ages has been forced, for practical purposes, to develop social concepts to fit the realities of his changing environment.

I, for one, and I am sure this concept is shared by the great majority of people in the world regardless of their race, religions, nationalities, or professions, believe this growing recognition of mutual interdependence has not resulted solely from practical necessity. I believe it also represents our ability as our society matures to give fuller expression to a feeling that is as old as mankind itself— to the desire to share with and help one's neighbor.

In the field of research, health, medicine, and rehabilitation, we have a uniquely effective area of service and of responsibility for working toward international understanding. Health, including rehabilitation services for the handicapped, is fundamental to the prime democratic concept of equal opportunity for all. A world in which good health is enjoyed by but a few cannot be a politically stable world. How can the man who is doubled up by pain and disability stand up and fight militantly for the principles of democracy and freedom? Unless he can work and produce, how can he enjoy the fruits of his own labor and become a customer for the goods which all of the world wants to sell him? Unless he can produce and earn and then buy from the rest of the world, how can his standards of living be increased?

Good health is fundamental to economic self-sufficiency. Dr. Charles W. Mayo summed up this relationship aptly when he said with great simplicity: "Poverty makes people sick-sickness makes people poor."

The International Health and Medical Research Act of 1959 would be a major contribution toward breaking this chain described by Dr. Mayo.

This legislation, known popularly as the health-for-peace bill, would create within the National Institutes of Health a new National Institute of International Medical Research with an annual appropriation of $50 million.

These funds would be used to encourage and support research and the exchange of information on research, the training of research personnel, and the improvement of research facilities throughout the world.

The bill would authorize grants to support such activities ranging from research in basic science to research in rehabilitation. Grants could be made to foreign and American universities and research organization and to voluntary and governmental international agencies such as the World Health Organization.

Under the plan, a national advisory council for international medical research, composed of nongovernmental leaders, would establish policies, make recommendations and approve grants and loans under the program.

The existing specialized institutes within the National Institutes of Health e.g., National Heart Institute, National Cancer Institute, National Institute of Neurological Diseases and Blindness, National Institute of Arthritis and Metabolic Diseases, and others) and the Office of Vocational Rehabilitation and the Children's Bureau would serve as the technical groups to advise the new National Advisory Council for International Medical Research on specific projects within their particular area of interest and competence.

The program would not replace any of our current programs of multilateral international health activities through the World Health Organization or UNICEF or any of our bilateral activities conducted through the International Cooperation Administration.

Nor would it supplant the research programs being conducted in the United States through the National Institutes of Health. It would enhance these activities and at the same time provide a mechanism and funds for uniting science throughout the world in a greatly expanded global attack on disease and disability.

The key factor in grants from the new National Institute for International Medical Research, over and above the usual criteria applied to research projects, would be their international implications.

though there are innumerable corollary values in the International Health edical Research Act of 1959, it is based primarily on recognition of the at research in health, medicine and rehabilitation is so highly complex

and interrelated that victory over any disease or disability can be achieved only through the research results of many scientists, clinicians, public health specialists and vocational rehabilitation specialists throughout the world.

In his state of the Union message in January 1958, President Eisenhower proposed a “science for peace" plan to “attain a good life for all." As the first step in such a program, the President invited the Soviet Union to join the current 5-year program for the global eradication of malaria. The President then stated our willingness to pool our efforts with the Russians in other campaigns against cancer and heart disease. "If people can get together on such projects," he asked, "is it not possible that we could then go on to a full-scale cooperative program of science and peace?"

A very modest start toward the general objectives of the plan is already underway with the $300,000 grant made by the United States to the World Health Organization for a preliminary study to lay the groundwork for medical research on an international basis. This grant was announced by Dr. Milton Eisenhower, president of Johns Hopkins University, as the personal representative of his brother, the President, at the annual World Health Organization assembly in Minneapolis in June.

Dr. Eisenhower said at the time that the United States was prepared to give such a program "substantial support." Earlier this month (February 1959) the Executive Board of the World Health Organization meeting in Geneva approved a six-point program for extended medical research drawn up by the Director General of the World Health Organization, Dr. M. G. Candau, as the result of the instructions he received at the World Health Assembly in Minneapolis last June.

Last September in a speech before the General Assembly of the United Nations, Secretary of State John Foster Dulles pledged that the President would seek funds from this current session of the Congress for international health programs. Following that statement there appeared in the press reports that Secretary of Health, Education, and Welfare Arthur Flemming had gathered together a group to work out a plan for an international health program which President Eisenhower would incorporate as his international health recommendations in a special health message to the incoming 86th Congress.

In August 1958, your chairman, Senator Lister Hill, introduced Senate Joint Resolution 199. Similar legislation was then introduced in the House of Representatives by Representative John E. Fogarty. Since last August, Senator Hill has sought and received the advice and suggestions of many of you on this Committee on Labor and Public Welfare, other Members of the Senate and the House of Representatives, responsible officials within the executive branch of the Government, national and international agencies concerned with health, medicine, and rehabilitation, our colleges, universities, and research institutions, and many, many individual citizens. These suggestions have been carefully considered and many are included in the International Health and Medical Research Act of 1959.

REHABILITATION

I should now like to shift to the second of the two major points I shall discuss with you this morning ** rehabilitation services of the physically handicapped. As most of you know, this is the area of service to which I have dedicated my life for nearly the past 20 years and in which an increasing percentage of my time, resources and energies have been devoted to the international aspects of rehabilitation services for the handicapped.

In this country and in the other developed parts of the world we have seen a remarkable growth of interest in rehabilitation in the last decade. This interest has not been prompted by humanitarian motives alone. It has resulted from the growing incidence of physical disability resulting from prolongation of the life span, increased public assistance costs because of disability, and our need for manpower in our expanding economy.

But what lies behind the interest of Indonesia, Korea, the Philippines, Mexico, India, Burma, and Thailand in the provision of rehabilitation services for their handicapped? It is not the need for manpower, for these nations have far more manpower than they can profitably utilize in their present stage of industrial development. It is not to reduce public assistance costs, for few of these nations have any social schemes whereby the disabled become a responsibility of the State. It is not to reduce demands for medical, hospitalization, and social services, for the chronically ill and disabled in most of these nations are wards of their families rather than of the State.

The real reason is that many of these nations, particularly those of the AfricaAsia area, have, after years of colonization, recently achieved the long-sought dream of political independence. Now they are desperately looking for ways of proving to the world,and more importantly to themselves, that they have the political and social maturity to justify their political independence.

There has been a tendency in some international health programs to establish such high priorities for the first two phases of medicine-prevention and definitive medicine and surgery-that the third phase of medicine-rehabilitation from the bed to the job-has been neglected. În countries with advanced rehabilitation programs, such programs have provided their social and economic worth through reducing the time of invalidism of the individual thereby saving in the cost of hospital or institutional care, sickness benefits, and disability pensions, and most importantly, restoring the disabled individual to a useful life in productive employment.

In nations at an early stage of economic, industrial and social development, particularly when mass problems of public health and unemployment or underemployment are present, rehabilitation to some has seemed a problem of less urgency. The economic and social values of rehabilitation may be present to a lesser degree in these nations than those in an advanced economic, industrial and social development, but the importance of rehabilitation from the standpoint of humanitarianism and human rights and liberty is far, far greater. I cite to you a statement made by one of the most eminent scientists and health authorities in Asia, Hon. Paulino J. Garcia, M.D., Chairman, National Science Development, Republic of the Philippines. Dr. Garcia, then minister of health for the Republic of the Philippines, said before the Tenth World Assembly, May 20, 1957, in Geneva: "It is a fact that the rehabilitation of our tens of thousands disabled is an imperious need. It is a fact that my country and many others want to establish rehabilitation services."

Many leaders throughout the world, not only in Asia but in Africa and South America, share the view stated by Dr. Garcia. When then Premier U Nu visited the United States, he stated publicly that of what he had seen in the United States, the thing he wanted most for his country were rehabilitation services. Happily through a grant from the Rockefeller Foundation, a team of five Burmese were brought to the United States for training in rehabilitation. They are now back in Burma where with the aid of the United Nations, International Labor Organization, World Veterans Federation, World Rehabilitation Fund, and the International Society for the Welfare of Cripples, two rehabilitation centers are in operation.

I visited Burma for a week last November as a consultant to the United Nations. At that time I saw and helped develop a number of significant research projects in rehabilitation which could be conducted at these two centers. Preliminary information on these projects is already in the hands of the Director, Office of Vocational Rehabilitation, and these research projects could be initiated within a very short time if the International Health and Medical Research Act of 1959 is enacted and becomes law.

We in the United States provide world leadership in rehabilitation but we have no monopoly on creative imagination, ingenuity, and research potentials. In the scores of visits I have made to rehabilitation programs over the world there has not been a single instance in which I have not learned something new which could be utilized here in the United States to make our own programs more effective. Through these visits I know of scores of significant research projects which could be implemented rapidly if this legislation is adopted which would have significant value to our own rehabilitation efforts here at home.

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Through outstanding research work in prosthetics conducted through the Prosthetics Research Board of the National Academy of Sciences in cooperation with the Veterans' Administration and the Office of Vocational Rehabilitation, we have the finest artificial limbs the world has ever seen. Yet, two of the most significant developments in prosthetics in recent years have come from Germany-the suction socket and the Heidelberg arm.

The work being done in rehabilitation of the brain injured in Finland: with blind persons with other physical handicpas in the Soviet Union; in plastic surgery and rehabilitation for lepers in Hong Kong and Vellore, India; in occupational health and employment of handicapped workers in the Scandinavian nations; in geriatric rehabilitation in Australia and the Scandinavian ions; in the use of bamboo for braces in Hong Kong; in the socio-medicocomic areas of disability evaluation, workmen's compensation, pensions, and

disability benefits in many nations—all of these and many other examples could be given of fruitful areas of research which could be immediately developed if this legislation is passed.

I have been in the Far East four times in the past 5 years. On my last trip, which was this past November and December, I visited, observed, and was consulted about rehabilitation services for the handicapped in New Zealand, Australia, Thailand, the Philippines, Hong Kong, Japan, and Korea, as well as Burma. In each of these countries, there is tremendous interest in extending and strengthening rehabilitation services for the handicapped.

Irrespective of national barriers, race, language, dogma or culture, physical disability creates the same economic, social, and personal burdens everywhere in the world. Rehabilitation services to help the handicapped to help themselves is one of America's most potent instruments for making friends. Our present need for enduring friendships with other countries has never been so great. Rehabilitation offers a unique opportunity for increasing understanding between peoples.

This is one of among many, many valid reasons why I firmly believe statutory provision for the inclusion of vocational rehabilitation must be contained in the International Health and Medical Research Act of 1959. I have the same basic belief about inclusion of the resources, skills, and program of the Children's Bureau. Dr. Martha Elliot, Harvard School of Public Health who is both a former Director of the Children's Bureau and a former Deputy Director General of the World Health Organization will speak on this point later in these hearings.

It is natural for all of us to take improved agriculture, industry, and utilities for granted. Men regard these developments as somewhat remote from their immediate personal problems. The child formerly confined to bed or wheelchair, however, wins an entirely new future when he enters school with normal youngsters; equally important, his family has firsthand reasons to know how and why their life is transformed. The man who had to crawl, and now walks to work, never forgets his conquest over what seemed hopeless difficulties, nor who helped him.

With a relatively small investment in research in rehabilitation, a tremendous impact on the individual lives of human beings throughout the world can be made. Among the crippled, paralyzed, palsied, blind, deaf, mute, arthritic, rheumatic, tuberculous, cardiac, and malformed are members of the great majority of every family in the world.

It is no longer uncommon in America to see handicapped men and women holding responsible positions in industry, operating businesses, and following successful careers in the arts and the professions. Only a few years ago in most States, equally capable people with the same handicaps were considered hopelessly disabled, destined for lifelong dependency upon family help, public relief, or private charity.

Our own emphasis on rehabilitation in the United States under the leadership of our public agency, the Office of Vocational Rehabilitation, has demonstrated the values which we, in a democracy, place upon human worth and capabilities and the right of every citizen in a democracy, irrespective of his physical limitations, to the inherent dignity of an individual human being. The politically uncommitted nations of the world plus our friends in many of the less developed areas of the world look to the United States for help in their search to place a higher value on human worth.

The International Health and Medical Research Act of 1959 is essentially a humanitarian program directed toward a global assault on mankind's most important enemies disease and disability. But it has tremendous political implications for its rehabilitation aspects emphasize our belief in the United States of America that man's mission on earth is to heal and not to hurt, to build and not to destroy.

CONCLUSION

It is most significant that when your chairman, Senator Hill, introduced the International Health and Medical Research Act of 1959, 59 of you gentlemen here and your colleagues in the Senate joined him in cosponsoring this important legislation. Today there is widespread interest and support of this legislation in all walks of life in the United States. The people of the United States have demonstrated, through their willingness to contribute both tax and voluntary funds, their firm belief in the value of research in health, medicine, and rehabilitation. Most, I am confident, will also agree that while we and

the rest of the world are spending billions of dollars for research for instruments of death and destruction in our struggle for survival, we should spend a few millions positively on promoting health, happiness, and human understanding in our struggle for peace.

Over 300 years ago an English philosopher once said "If every man would but mend a man, the world would all be mended." The International Health and Medical Research Act of 1959 is a significant step toward this goal.

The CHAIRMAN. May I say that tomorrow morning the committee will convene at 10 a.m. We have a number of distinguished witnesses: Dr. I. S. Ravdin, vice president in charge of medical affairs, University of Pennsylvania; Mr. John T. Connor, president of Merck & Co.; Dr. Gunnar Gunderson, president, American Medical Association; Dr. Sidney Farber, Children's Hospital; and Dr. Frederic J. Stare, Harvard School of Public Health.

I very much hope that we may be able to start our meeting promptly at 10 o'clock, because we have five witnesses, all of them very distinguished men, and I am sure we want to hear from them.

We will now stand in adjournment until 10 a.m. in the morning. (Whereupon, at 12:30 p.m., the committee recessed, to reconvene at 10 a.m., Wednesday, February 25, 1959.)

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