into international medical research programs of the scope and magnitude demanded by world needs and pressed upon us by Russia's competing medical offensive.

Thank you very much, sir.

The CHAIRMAN. Mr. Connor, we certainly want to thank you for this very strong, most informative, and challenging statement. As a fellow lawyer, I will say that you have brought us a statement of statesmanship. This is really most constructive and has proved most helpful to our committee. You have drawn a very fine picture, for our benefit, of the situation of our country with reference to the Russians, and I have been particularly interested in all that you have had to say about the underdeveloped areas.

I had the privilege a week ago last night of hearing a report from the Johns Hopkins University team for MEDICO. They had gone out under the auspices of MEDICO to Lebanon and Jordan. They told us a most interesting story of what they had found there and what they had done there. I quite agree with you on the emphasis that you have placed on this matter of the underdeveloped areas. The side that wins those areas will be the side that will win this struggle. As you have so forcibly brought out here, through medical research we have such an opportunity-I might also use the word "weapon," really-for the winning of this struggle. Perhaps I had better use the word "instrumentality," because we are talking for peace, now, and not for anything else. You have brought us a fine statement.

Another thing I want to mention that you have emphasized very well is that to do the job that we seek to have done, that must be done for our country, we must have the cooperation of labor, doctors, scientists, private enterprise, private companies, private organizations, and Government, all working together for this great purpose.

Senator Case?

Senator CASE. Mr. Chairman, I want to second everything you have said about the testimony that Mr. Connor has given. He lived up, I think, to the advance billing and surpassed it.

I appreciate, too, the specific suggestions that you have made for the consideration of the committee in regard to directions that ought to be followed, and perhaps certain amendments to the bill for the purpose of strengthening it.

This bill is something that not only the Senator from Texas has joined our chairman in introducing, but also how many sponsors are there?

The CHAIRMAN. Fifty-eight.

Senator CASE. So we have a proprietary interest. We are very pleased to have any suggestions, both for its support and even more, perhaps, for its approval.

Mr. CONNOR. Thank you very much.

The CHAIRMAN. Senator Williams?

Senator WILLIAMS. Thank you very much, Mr. Chairman.

First, I do note Mr. Connor's concern that the Government might enter into product development or other contracts with foreign commercial firms, as described on page 2. I just wonder if there is any specific provision in the bill that leads you to any anxiety or concern that this might happen under this legislation.

Mr. CONNOR. Senator Williams, I think the present language would authorize such contracts with foreign commercial firms, and I think

that type of activity is unnecessary. I do not think it is really what is intended to fulfill the objectives of the bill, and it certainly would be appropriate, in my opinion, to have some language at least certainly until it is proved to be necessary such contracts for product development by foreign commercial firms or other similar commercial-type activities would not be supported, under the legislation.

Senator WILLIAMS. Well, as one of the 58 sponsors, I had not felt that that would be part of the program under this bill; but I am very glad to have your comments and your feeling that maybe additional language is necessary.

I wonder if you could, briefly, Mr. Connor, describe the development of the program with India for the production of streptomycin. You referred to it in your prepared statement, and I think it would be good to have it in the record at this point, just the stage-by-stage step in helping India in the best way possible to develop a medicine that is available and has been made available now, or shortly will be, for the people of India in meeting their infectious diseases.

Mr. CONNOR. I would be very glad to do so, and I will try to do it as briefly as possible.

Along about 1948 or 1949, the Government of India set up a government-owned corporation called Hindustan Antibiotics, Ltd., which became responsible for building a plant and producing penicillin. It took the Indian Government corporation some years to get going, and they eventually got into the production of penicillin, and by now are producing, marketing, and distributing penicillin on a satisfactory scale. But in the meantime the importance of streptomycin, and its derivative, dihydro streptomycin, in the treatment of tuberculosis became established, and since tuberculosis is a very important disease in India-in fact, one of the most important-the Indian Government expressed an interest in building a streptomycin plant alongside of the penicillin plant, and asked us, because of our early relationship with Dr. Waksman and his colleagues at Rutgers and our work with streptomycin and dihydro streptomycin, whether or not we would be interested in helping build and operate the plant.

At the same time, the Indian Government was considering a broad plan for putting the entire pharmaceutical and medicinal chemical industry in India into the public sector. We wanted to help the Indian people, but our early conversations with the Indian Government officials raised some doubts in our minds as to whether this was a wise move for them to make from the point of view of going ahead fastest with the development of that kind of an industry.

The negotiations continued for quite a time, and quite a few difficulties came up during them on both sides. There were quite a few questions raised as to the desirability of proceeding so far into the public sector with the pharmaceutical operations as was then intended. Along about that time we got wind of the fact that a Soviet medical research team was in India and had submitted a proposal for putting the entire pharmaceutical and medicinal chemical operation in the public sector under a plan whereby the Russians would finance the initial construction and operation of the industry, and then it would be run thereafter as a governmental activity completely.

Whatever doubts we may have had about the wisdom of taking the isks and going ahead were quickly resolved within our own organition, because we felt that even though there were risks to us in

helping the Indians build a streptomycin plant, that they would operate in the public sector, those risks were far outweighed by those that would be involved in letting the Russians do it for them. So we quickly concluded an arrangement with the Indian Government people whereunder we are providing the technical and engineering assistance in the construction of this streptomycin plant, which will be operated by the Indian Government agency upon its completion, and they will use process information and know-how that will be provided by our people going over from Rahway and other U.S. planets. In that way we will have a continuing relationship with the Indians, which we think will help us, over a period of time, convince them that more and more of these pharmaceutical cooperations really belong in the private sector rather than in the public sector.

And, in fact, as a result of the good will that was established during those negotiations, we have since received approval by the Indian Government for setting up a new private corporation in which some private Indian interests have an interest along with us, and we are now preparing to build a modern pharmaceutical and medicinal chemical manufacturing plant near Bombay for the production of steroids and diuril and some of the other new drugs that have resulted from our research program recently.

Senator WILLIAMS. Thank you very much. This is a good, graphic example of how our private sector and our private pharmaceutical industry can pick up with any answers found through research and carry forward an international program of bringing on the drug or whatever the cure is to the disease.

There is one further question. I do not know if you have even considered this. Senator Clark raised it yesterday, and I think it is good to raise it here, and it will be raised later. The bill calls for an authorization of $50 million, and Senator Clark's question, briefly, to two of the witnesses, I believe, was: "Do you feel that $50 million a year can be efficiently and effectively spent under this program if it is established as a program?"

Mr. CONNOR. Well, my personal opinion is that this program will grow gradually. I happen to have been working for the Government at the time the National Science Foundation legislation was being considered. In fact, I helped in the drafting of that legislation. And, as I recall it, the enabling legislation called for appropriations in the neighborhood of, say, $20 or $25 million, but for some years after the National Science Foundation was set up, the appropriations actually voted by Congress were under that figure, because the programs that were recommended in the early stages of the Foundation were not sufficiently large to warrant the type of appropriation that was authorized under the enabling act. So my answer would be that I do not think that $50 million worth of sound projects could be pulled together, certainly for the first year or two of the operation of the legislation, but as time goes on I think that this range of appropriations can be supported by projects that the Appropriations Committees of the House and the Senate would be willing to underwrite. Senator WILLIAMS. Well, I think this is the point that Senator Hill made yesterday, that the two steps, authorization and appropriations, are insurance against any waste under the program, and I appreciate the history that you have added to that.

Thank you very much.

The CHAIRMAN. I might say this, that there is no limit on the amount that can be appropriated to the National Institutes of Health. I refer now to the Cancer Institute, the Institute of Arthritis and Metabolic Diseases, the Heart Institute, the Institute of Neurological Diseases and Blindness, and others. The amount that can be appropriated is just such funds as the Congress authorizes to be appropriated. And as I said yesterday, of course, after the authorization is approved, the advocates of the bill have to go before the Appropriations Committee, as you well know, Mr. Connor, and there justify the sum that they may be asking for.

It might be that here we would want to follow the same precedent as has been established with reference to the other Institutes, that is, no fixed authorization, but authorizing Congress to appropriate just such sums as Congress in its wisdom sees fit. You may ask: What does that mean? They could appropriate a billion dollars? Well, theoretically that would be true.

But I think your answer to the Senator is good. You start out and try to be sensible about it, and then the funds grow. Has that been your experience? That they build?

Mr. CONNOR. Yes; it has. I know that you are thoroughly familiar with the growth of the projetcs in the National Institutes of Health, because those projects have to be justified before your appropriations subcommittee.

The CHAIRMAN. That is right.

Mr. CONNOR. And this would be one phase of that entire NIH program, I would think, coming before a committee that has great experience with the domestic end of medical research.

The CHAIRMAN. Well, Mr. Connor, we certainly want to thank you again, sir. We so much appreciate your appearance here this morning. Mr. CONNOR. Thank you, sir.

The CHAIRMAN. Our next witness will be Dr. Gunnar Gundersen. Doctor, we are very happy to have you here. We welcome you here as a very distinguished doctor in your own right and as the president and head of the American Medical Association, which is the great association of doctors of our country. We are delighted to have you here, sir.

Senator CASE. Mr. Chairman, I would like to join with you in welcoming Dr. Gundersen, at the same time apologizing to you and to him for my leaving before his testimony is given. I have a meeting of another committee on nominations that the President has sent up, and I simply must go, because I have questions to ask.

I shall read your testimony with great interest and care, and am sorry that I cannot be here to hear it in person.

The CHAIRMAN. Doctor, we would be delighted now to have you proceed in your own way, sir.

STATEMENT OF DR. GUNNAR GUNDERSEN, PRESIDENT, THE AMERICAN MEDICAL ASSOCIATION

Dr. GUNDERSEN. Thank you.

Mr. Chairman and members of the committee, I am Dr. Gunnar Gundersen, a practicing physician from La Crosse, Wis. I currently am serving as the president of the American Medical Association, on whose behalf this statement is presented.

In addition to my position with the AMA, I am a member of the Council of the World Medical Association, an organization of 53 national medical associations comprising a membership of more than half million physicians. This is in contrast to the World Health Organization, which is an agency, as you know, of the United Nations. With your permission, Mr. Chairman, I should like to discuss briefly the interest and activities of the American Medical Association in connection with international health, medical care and medical education, and the philosophy and position of the AMA with respect to the subject resolution which would establish a National Advisory Council for International Medical Research.

For many years the American Medical Association has played an active and far-reaching role in the international health field, because of its belief that physicians on every continent are dedicated to the assistance of all people regardless of race, color, creed, or social class in attaining the highest possible level of health.

Here briefly are a few of the ways in which the AMA has acted specifically upon this belief:

(1) The association helped to organize and support the World Medical Association in 1948, 11 years ago. We also approved and encouraged a U.S. committee to aid the World Medical Association financially. This committee has provided and is furnishing funds to help finance the WMA Secretariat, the publication of the World Medical Journal and specific scientific investigations.

(2) An AMA representative has served with the U.S. delegation to the assembly of the World Health Organization, a subsidiary of the United Nations representing governments in the field of medicine. (3) The journal of the American Medical Association is promoted in foreign countries, and now serves as an up-to-the-minute medical textbook for approximately 10,000 subscribers overseas. It can be found in every recognized medical library in the world. We feel that this weekly publication, Mr. Chairman, is the greatest medical publication in the world.

(4) Likewise, our nine specialty journals reach thousands of physicians outside the United States, providing them with the latest medical information on subjects relating to their specialties.

(5) The AMA has established, developed and maintained the valuable "Standard Nomenclature of Disease and Operations," the only international publication of its type.

(6) The AMA library staff compiles the Quarterly Cumulative Index Medicus, a publication providing pertinent information on medical periodicals, literature and books. Currently there are more than 1,300 foreign subscribers.

(7) Other AMA publications which have wide appeal among physicians abroad include "New and Nonofficial Remedies and Useful Drugs." This is an annual publication, keeping the whole drug field up to date. These publications provide physicians with information. on the actions, uses, limitations and dosages of new drugs.

(8) AMA medical films are loaned to medical societies all over the world. In the past 10 years the AMA has received approximately 775 unsolicited requests from 70 countries for medical films. While it was impossible to fill all the requests, hundreds of films have been provided on a loan basis.