STATEMENT OF JOHN T. CONNOR, PRESIDENT, MERCK & CO., INC.

Mr. CONNOR. Thank you very much, Senator Williams and Senator Case. I am overwhelmed.

The CHAIRMAN. Mr. Connor, these gentlemen said they liked you because you started out as a lawyer. I am a little partial to the lawyers, too. But I may say my main reason for liking you is because I think you agree with me on medical research. And you know they say if a fellow agrees with you about a matter, he thinks he is the smartest man in the world and you are the next smartest.

Certainly we are delighted to have you here this morning, and we would be happy to have you proceed in your own way.

Mr. CONNOR. Thank you very much, Mr. Chairman.

I appreciate very much the opportunity of testifing before this committee on the International Medical Research Act of 1959.

As you indicated, I am wholeheartedly in support of the aims and purposes of this bill. The International Medical Research Act stirs the imagination with its opportunities for a new breakthrough in international relations as well as in medical research. It can give a new dimension to foreign affairs and a new versatility to United States foreign policy. It can excite the universal support and enthusiasm for an international program that America has not seen since inauguration of the point 4 program of technical assistance.

There are three principal areas in which the program established by this bill will operate the Free World nations of Western Europe and Japan, the Soviet Union, and finally the underdeveloped countries. Each presents a different potential and each calls for a different approach.

May I consider first the industrialized nations of Western Europe and Japan. There is now underway fruitful joint medical research and exchange of personnel and data with those nations. Some of it is being done under grants from our National Institutes of Health in Belgium, Great Britain, Denmark, Finland, France, Italy, Germany, and other European countries. Further interchange takes place in the exchange program and in international gatherings where American scientific and medical personnel share views and information. Many pharmaceutical and chemical firms have worked out licensing arrangements whereunder our new drugs and chemicals have been made available under suitable arrangements to commercial manufacturing firms in those countries, and many of their new developments have been made available to American firms for production and marketing in the United States and elsewhere. And many such American firms, like Merck, Sharp & Dohme International Divisions, have expensive production, marketing, and other operations of their own throughout the Free World.

This exchange of medical information and findings with Western European and Japanese scientists in their university and governmental laboratories coincides with the objectives of the International Medical Research Act and should be expanded and increased to the maximum extent possible.

In doing so, however, I trust that our Government will not use our tax funds to enter into product development or other contracts with reign commercial firms because, as their competitor, I can assure that they are fully capable from a financial and technical point

of view of supporting their own chemical and biological research and development programs, in the same way that the American pharmaceutical firms support their own research and development programs. Naturally enough, I would like to preserve the "private sector" to the full extent possible, as I believe every American does.

The second area of possible medical research cooperation will be with Soviet Russia. I earnestly hope for the growth of cooperative efforts with the Soviet Union in the development and exchange of scientific and medical knowledge, and by so doing to contribute to improved understanding and communication between the peoples of the United States and Russia.

Cooperation can take the form of a greatly expanded exchange of research scientists, teachers, and students; a fuller interchange of medical and scientific literature and joint efforts on basic research projects.

But, based upon my own personal experience as General Counsel of the Office of Scientific Research and Development and later as an official of the Department of the Navy during and right after World War II, I feel compelled to sound a note of caution. Any such cooperation with the Russians in this medical research field should, in my opinion, be initiated on a small scale. It should be developed gradually, step by step. We should have safeguards that the plan is in fact reciprocal.

Certainly we should not lightly, trade away the important technical resources of our pharmaceutical and chemical industries, which constitute an invaluable national asset which can be used by our country to good advantage. I want to emphasize that our pharmaceutical and chemical developments are 'way ahead of the Russians. Although Russia undoubtedly has the technical skill and resources to catch us, in time, I would make them take that time and expend their own effort for this purpose. If we do so, Mr. Chairman, they will have less time. for their missile developments.

I have been talking about the problems of cooperation with the Soviet Union. I want now to talk about competition with the Russians, which is the hard reality of our relations with them and probably will be for some time to come.

The decisive relationships in world affairs in the next few years are likely to be those relationships fashioned by the United States and Russia with the newly developing and largely uncommitted nations of the world. This is the third area which I think demands priority attention because here is the area of desperate need for health and medical progress; the area likely to produce fresh answers to many of the age-old scourges of man as well as to newly discovered or newly developing diseases; and the area of sharpest competition with the medical offensive of Soviet Russia.

The uncommitted nations, conscious of their new status, sensitive of their national entity, suspicious of past colonial policies among the nations of the West, are insistent upon sharing in the benefits of modern science and technology. They are largely pragmatic in their approach to the overtures of the United States and of Russia. They are less likely to be influenced by words than to be impressed by the deeds that will help raise their levels of health, education, and productivity, improve their standard of living, and assist them in crossing the threshold into the 20th century.

The newly developing countries know that the essential foundation for the advancement of any nation, even before education and vocational training, is the health of its people. And we can expect that a vital phase of the competition with Russia in the underdeveloped areas will be in the field of medicine and medical research. It may well be the deciding factor in building friendships among the uncommitted nations.

This is natural in lands where the life expectancy is half our own; where each year a third of the babies die during the first year of life; where typhoid fever and smallpox are still prevalent even in the capital cities. In these lands, what will be a greater force in international relations than those actions that promise freedom from constant illness and suffering, greater vigor and productivity, and longer life?

The productivity of peoples debilitated and weakened by disease, disability, and malnutrition is a fraction of the productivity of American workers. India loses a billion man-days of work each year from tuberculosis alone. Malaria costs additional millions of man-days in India, in Thailand, in the Philippines, in the Latin American countries. Other diseases take their toll.

The developing nations lie largely in the "disease belt" that girdles the earth and creates a reservoir of disease that in these modern times lies perilously close to our own shores and our own homes. This disease belt is dangerous to the United States. We have lost much of the natural immunity to disease common to people who have survived to maturity in less protected environments.

The developing areas hold out a vital contribution to medical research under the proposed International Medical Research Act. They provide different cultures and different settings for carrying out research into environment and into population groups, which many medical authorities believe will help bring answers to the treatment and cure of cancer, heart disease, hypertension, and other diseases and disabilities that up to now have baffled us. Research oriented physicians operating in these areas can contribute substantially to progress in medical research.

We can be sure that Communist Russia is moving to exploit the health and medical needs of the underdeveloped countries as she has exploited other needs and aspirations of these peoples.

Mr. Chairman, the rising expectations of the people of the uncommitted countries for a better life is the most powerful political force in the world today. The Soviet Union understands this fully.

There are many indications that Russia is moving into the inviting vacuums in health programs over the world. Russia has shown a fondness for "impact programs" which result in prompt, visual results. We have word of Soviet health teams active in north Africa and south Asia. We hear of a cobalt radiation machine sent to Thailand, hospitals for Ethiopia and Burma and Indonesia. Even poor Poland, not able to care for the sick among its own population, has to contribute to this Communist foreign relations program.

The Soviet Union has built enormous medical resources within her own borders. She has slashed her mortality rate 75 percent since before the revolution and has lengthened the life expectancy of the average izen until it is now within reaching distance of our own. By 1956 already had 25 percent more doctors per capita than we and still

she is turning new ones out of medical school at the rate of 16,000 a year, or better than twice the 7,000 doctors graduated in the United States last year.

What does the Soviet Union plan to do with this rising supply of doctors, so many of whom are trained in the languages and cultures of Asia, Africa, and the Middle East? Reports from inside Russia indicate that she is sending about 2,000 of them a year to the underdeveloped countries. We should ask ourselves, Mr. Chairman, how many converts per month each of these medical missionaries will account for as he or she, because many of them are women-peddles the gospel of communism in return for the promise of good health? The survival of the free world may well depend on how soon we face up to the implications of this question. To me, they seem clear. They call for a bold new medical aid program for the underdeveloped

countries.

This will require an aggressive dynamic mobilization of all of America's medical resources-the highly trained members of our private medical profession as well as U.S. Public Health Service personnel, the medical schools and research institutes, the foundations and the pharmaceutical and medicinal chemical industry.

The United States does not regiment and dispense her resources, including human resources, at the will of an all-powerful state. We cannot, and we do not wish to commandeer our economy, our professions, and our people as pawns in a game of chess.

But under our free system, we do have in America resources we can draw upon in this war against disease. We have resources of the heart and the spirit, resources drawn from our national tradition of generosity and humanitarianism, from our heritage of Christian ideals. To those spiritual resources, we are able to join the excellent material resources of 20th century medicine-in people with medical skills and techniques, in medical facilities and equipment, and in effective drugs.

America's physicians have already expressed their active concern for this problem, as individuals, like Dr. Ravdin, whose testimony the committee just heard, through the American Medical Association and through voluntary groups such as MEDICO. It is my firm belief that the program provided for in the Health for Peace Act will be successful only as it enlists the support and utilizes the services of private medicine.

We have another important asset in this competition with the Soviet Union. The pharmaceutical and medicinal chemical industry constitutes one of our strongest national resources. Through its research, the industry has accumulated a valuable store of knowledge and knowhow. We are far ahead of Russia. I have searched diligently and I have yet to unearth a single important development by Russia in pharmaceuticals. All the new discoveries and developments in modern drugs antidiabetics, vitamins, sulfa drugs, antibiotics, hormones, mental health drugs were developed among the nations of the West. Recently my own company was able to forestall a major move in the Russian health offensive in India by helping the Indian Government build a modern streptomycin plant. We have also recently financed a rehabilitation training fellowship in India through Dr. Howard Rusk's world rehabilitation fund, and we are now in the process of planning further productions and other activities in the Far East. In doing so, we not only advance our own commercial interests, but we

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bring to people who need them the medicines resulting from our extensive research program, and incidentally, I think, advance the foreign relations of the United States.

The bill before you is primarily a research bill. It is my hope that your committee can provide in the bill, or declare in its report, that special attention be given to research, research training, and fellowships in the underdeveloped areas of the world.

Senator YARBOROUGH. Mr. Chairman, may I interrupt for just a moment?

I am forced to leave to go to an executive meeting of another committee, and I did not want to leave without expressing to Mr. Connor my appreciation for this statement. I think it is one of the most informative and challenging statements I have heard about our relationship in medicine with other nations, and some warnings that are given there. I think it is a very valuable statement to the committee. I regret, Mr. Chairman, that I will not be able to be here to the end and to hear the other witnesses.

The CHAIRMAN. You may proceed, Mr. Connor.

Mr. CONNOR. We know the interest in all fields of medicine generated in the United States in recent years by the dramatic forward thrust in medical research. The activities of this committee and its appropriations counterpart have done much to make this possible. The program of research advanced in this legislation can generate on a worldwide basis, but particularly in the underdeveloped countries, the same awareness of medical research, bringing interest and support for all medical activities, and accelerated progress in the conquest of disease.

I respectfully urge that the committee make provision in the legislation for the following functions and activities:

1. Research teams to survey the health problems of the newly developing areas, country by country, and establish priorities for the medical research and assistance that can be most fruitful in each country. Every effort should be made to enlist leading private physicians and research specialists as members of these teams. The research teams should secure the views and cooperation of the medical profession of the country in which they work.

2. Research in the science of public health, as provided in the legislation, of such scope and nature as to give added emphasis to the importance of public health and elevate it to equal partnership with the curing of disease. Fundamental needs for sanitation, pure water nutrition and preventive medicine are problems of survival for the great mass of the peoples of the underdeveloped areas.

3. Expanded training of nurses, hospital and clinical technicians, and other members of an effective health team. Trained primarily for research under this program, they would form a permanent cadre of medical personnel in their countries. They would provide essential supporting personnel made necessary by the greatly expanded training programs for doctors, research specialists, and others provided for in the bill.

I appreciate the opportunity of appearing before the committee and offering my views and suggestions on this vital measure. It is my hope, Mr. Chairman, that the International Medical Research t of 1959 will be approved expeditiously by the Congress, and it will enable the United States to move quickly and forcefully