to the development of ideas in medicine. Dr. Smythies' article on p. 689 of this issue graphically underlines the prominence of search in American thought. In our more strictly selective system, necessitated by relative poverty of money and facilities, many American investigators would hardly have had a chance. By full development of their talent, and by the efforts of great numbers, an immensely rich soil is being developed from which new research ideas can be harvested.

When new scientific approaches originate in this country they may be elaborated all too slowly by "one man and a boy" working in cramped space with makeshift equipment, whereas in the United States large teams at once get to work on every promising idea. Consequently we have depended on the United States for the development of new antibiotics; and to the United States, too, must go full credit for most of the progress in protection against poliomyelitis. These are advances well known to the man in the street, but far more important is the ferment of new biological ideas from which other discoveries will spring. Fundamental biological and physiological science in the United States is closely integrated with clinical research, and extensive laboratories are available not only to the basic medical scientists but also to clinicians for studying problems arising out of human disease. By contrast, medical research in this country is undergoing relative attrition despite an expanding economy. In the universities new building for medical and biological sciences is much more restricted than that for physical and technological subjects. There is no surgical animal research laboratory in any English university-though one is now nearing completion. There have been no new teaching hospitals in this country since the 1939-45 war; so even the application of the new methods developed here or elsewhere is frustrated or difficult. Careers in basic medical science have become unattractive in salary and prospects compared to the glamour of consultant medicine-once achieved. The young clinical trainee who engages in research is often terrified that he will thereby become labeled a "laboratory man" (derogatory only in this country) or too specialized for the next vacancy in a provincial hospital. The real gravity of our situation is underlined by the fact that some of our research directors and medical professors, as well as promising younger investigators, are leaving this country to work on the other side of the Atlantic, where they find that, in their laboratory and investigative work, they are given encouragement, lavish support, and almost unlimited opportunity. This is happening even though adaptation to the American way of life may be none too easy for the expatriate of mature years.

We may claim that, because of the very restriction of opportunities, there is a more concentrated selection of ability in British medicine that in American medical research, as in the American economy, there is much waste. Our professional leaders are in fact very highly selected, but if the scientific training of our young men continues to be discouraged our leaders will be selected from a dwindling field of applicants. Already our medical faculties often find great difficulty in filling their professorial chairs. We justly pride ourselves that under the NHS there are more specialists than ever before; but we should not pretend that this growth in specialist services will by itself keep British medicine in the forefront. We cannot maintain our standards without the vigorous pursuit of research in our medical schools, for even good routine will decline without the stimulus of critical thought engendered by investigative work. Scholarship alone-meaning the study of other people's thoughts-can never keep a profession alive. It failed in the Middle Ages and it would fail again

now.

With our smaller population and national income we naturally cannot spend as much money on research as the United States. But we could with advantage spend more than we do, and we should make sure that our resources are used with imagination. Poverty need not make us too despondent, or proud, to learn from the American system such useful lessons as the encouragement of research among all branches of the profession, including students. The clinical prizes offered by some regional hospital boards and the more ambitious studies being made by the College of General Practitioners recognize this need. Again, though we cannot compete with the generosity of American industry and trusts, we could perhaps foster a new age of patronage. Lord Nuffield has already shown us the way; two of the royal colleges have lately received princely gifts for research; and the mental health research fund, which supports some investigations into the problems Dr. Smythies mentions, offers an opportunity for ordinary citizens to make small contributions.

Our Commonwealth links no longer depend on the strength of our military force, but on our scientific, cultural, and commercial leadership. (Many of us can remember the uplift to the national pride and prestige of Canada which followed the discovery of insulin.) Supported by the basic disciplines of physiology, biochemistry, and microbiology, which in turn utilize techniques of physics and chemistry, medical science is a part of general science. Progress in one science inevitably impinges on all associated branches. Uneven progress of science is impossible, and thus the present policy of preferential development of the physical sciences seems to be utterly faulty. In the U.S.S.R., where the academician holds the highest place in society, there are signs of an intensified application of basic sciences to medical problems. In this country we have no lack of talent; but without more financial encouragement, more laboratories, and more facilities for research, we shall lose our best workers, and gradually the standards of medicine even at a practical level will decline.

The CHAIRMAN. Our next witness is Dr. Sidney Farber.

Doctor, we are delighted to have you here. I feel that I am welcoming an old friend. As you know, I have the privilege of being the chairman of the Subcommittee of the Appropriations Committee which handles all the appropriations for medical research and other medical programs, and I know of no one who has been a better, stauncher, or more helpful friend to our subcommittee than you have. We have called on you time and again, and you have always responded so wonderfully and always have been of such tremendous help and value to us. It is a privilege to welcome you here this morning. Wẹ are delighted to have you, and we would be glad to have you proceed in your own way.

STATEMENT OF DR. SIDNEY FARBER, PROFESSOR OF PATHOLOGY, HARVARD MEDICAL SCHOOL AND THE CHILDREN'S HOSPITAL, BOSTON

Dr. FARBER. I am deeply grateful for these remarks, Senator Hill. I am grateful to you for your great leadership in the field of health and medical research in this country.

The CHAIRMAN. Doctor, excuse me 1 minuto. Perhaps for the sake of the record I might state that you are professor of pathology at the Harvard Medical School, at the Children's Hospital, scientific director of the Children's Cancer Research Foundation, and chairman of the Cancer Chemotherapy National Committee.

Dr. FARBER. Thank you.

Mr. Chairman and members of the committee, I regard it as a privilege to appear in strong support for Senate Joint Resolution 41, so aptly named the Health for Peace Act, which, because of its certain effect upon the progress of medical research, will be regarded as one of the great landmarks in the history of medicine.

Indeed, because of the broad conception for which Senator Hill and his fellow sponsors are responsible, the impact of this bill will be felt far beyond medical research. It will make its mark on the history of the world.

In essence, this bill will make possible the correction of important deficits in financial support of medical research, training of investigators, and provision of research facilities outside the United States for the purpose of accelerating progress in the conquest of disease, the correction and prevention of crippling disorders, and the establishment of better health for people everywhere.

May I say a word or two about the bill itself: For greater effectiveness, I agree with my colleague, Dr. Ravdin, who spoke earlier this morning, that this should be set up within the Public Health Service, with exactly the same administrative arrangements, if possible, as obtain for all the other National Institutes of Health. It would appear logical to have the authority vested in the Surgeon General of the U.S. Public Health Service, with a council advisory to him, as is the case with all of the other National Institutes of Health.

If set up within the framework of the National Institutes of Health, with its rich tradition of devoted public service, admirable standards of research administration, and many years of successful conduct of the world's largest medical research endeavors, the proposed new Institute of International Medical Research should make a maximal contribution with the funds available. This would be possible because unnecessary duplication of effort could be avoided by utilizing the staffs, the administrative machinery, and the invaluable experience of the existing Institutes of Health.

Three other points concerning the structure of the bill might be mentioned. First, there should be maintained a maximum flexibility with grants, contracts, training programs, and fellowships, because of the international character of the program.

And second, permission should be arranged for the financing by the United States through these funds of research of international importance, and for the training of scientists and doctors from other countries in the United States, men who should then go back to their own countries.

And finally, it is obvious that the staff should be of the highest caliber-the staff of this new National Institute-with aliens as permanent staff or as consultants.

I think that last point would be of great importance in the success of the program.

I should like to speak, Mr. Chairman and gentlemen, in favor of the many splendid features of this bill which range in emphasis from vocational rehabilitation to research in the many categories of disease carried out in the several disciplines of science and medicine, and finally to support broad fields of science, basic to medicine, so-called basic research. May I applaud, too, the inclusive purposes which end with the statement:

To help mobilize the health sciences in the United States as a force for peace, progress, and good will among the various peoples and nations of the world. I speak with deep pleasure in favor of the bill because of long experience with medical research and investigators in many countries. May I speak personally, gentlemen, and state that for 31 years I have been a teacher in a large medical school, a member of the faculty, and a member of the staff of a large teaching children's hospital. And men and women have come from many parts of the world during these 31 years for training. I have learned much from them, and I have learned to have great respect for the abilities of peoples from many different parts of the world. For almost 4 years of my adult life as a scientist and as a physician, I have had training and have had the opportunity to study and conduct research in European laboratories and hospitals and medicals schools in Germany, in Belgium, with smaller opportunities in France and England and Austria and

the Scandinavian countries. And here, too, I have had first-hand opportunity to see the high standard of research that has been achieved. Students of the history of medicine are well aware of this. For the past 20 years I have been a member and director of the Belgian Educational Foundation, which was founded by Herbert Hoover, and this has had a great deal to do with the elevation of standards of research in education in Belgium with American support. I should like to make two points here. My own experience supports the statement that in no country in the world is there support for medical research commensurate with the enormity of the problems of disease and the potential of the scientists and doctors to find solutions to these problems. I regret to say that this generalization includes our own country, although through the heart-warming action of the Congress during the past 10 to 15 years we are far better off than any other country in the world.

And second, if we assume, as do well informed selfless doctors, as well as patients and their families, that in the field of health it makes no difference who makes the discovery responsible for the cure or abolition of a dread disease, nor where it is made, the true meaning of Senator Hill's bill becomes clear.

Students of the history of medicine know that no discovery is ever made without reference to the contributions of contemporary investigators or to those of the past, and this without restriction to national boundaries.

Although my own interest in medicine is broad, rehabilitation and health as a whole and particularly in disorders concerning children, I shall select for examples to illustrate my point today a few cases from the field of cancer research.

The largest single program of cancer research in this country is concerned with the discovery, the nature, and the application of chemicals, hormones, and antibiotics with anticancer activity. Next to the United States, Japan has the largest program of search for antibiotics with cancer-destroying properties. Their progress in this field in which they are so competent could be speeded up markedly if a sum of less than $1 million a year could be applied to the support of their most promising existing research endeavors.

Some of the most valuable chemicals with anticancer properties presently employed in the treatment of patients in this and other countries have come from one large institute of research in England. Were funds available on the same basis as is support for similar programs in this country, these gifted and highly productive scientists could do much more than is now possible.

I might add that I have in mind, in citing these examples, and in thinking of this program, that any help given through this new institute would be additive and would not take the place of funds presently given by those countries. And this same institute, the one to which I have just made reference, the Chester Beatty Institute for Cancer Research in London, was actually given a research grant through the National Cancer Institute several years ago of $150,000 a year, I believe, for each of 3 years. And because of this great encouragement to their research program, their board of trustees of the cancer hospital, with which they are associated, appropriated money from their own endowment fund to build a new research building, so that this added money could be used more effectively.

The CHAIRMAN. Doctor, we would certainly endeavor to make sure that these funds do not substitute for the funds of the particular country to which they were going. And then we most strongly hopeand I think past experience will encourage us to believe that these funds will be, as you have suggested, in this particular case, an incentive to the particular country to provide greater funds itself.

Dr. FARBER. I know you do have this in mind in your bill, Senator. In many countries, such as Italy, the amount of research support available is so small that men of great skill and intellect are compelled to carry on only token research concerning problems which are selected because they do not require manpower, equipment, or modern research facilities.

In a great basic research institute in Sweden, the fundamental work of a distinguished pathfinder in research concerning the cell could double his research activities, and the number of scientists trained in this field where trained men are so rare, with a relatively small increase in his budget.

The relatively large number of international congresses in the various disciplines and areas of medical science and practice provide the evidence that men from many countries of the world will work together and share their knowledge and experience.

In London last July, more than 2,000 representatives of 62 countries met for a week of free and open interchange of ideas, observations, and plans in the International Cancer Congress.

Three years ago in Oslo, Norway, through the sponsorship of the International Union Against Cancer, with the support of the Cancer Chemotherapy National Service Center of the National Cancer Institute, the first International Conference on Chemotherapy of Cancer was held. Thirty men and women from a number of different_countries, including for the first time Russia and Hungary and Japan, spent 5 days in exchange of knowledge and the making of plans for rapid communication of the results of research in this expanding field.

A second meeting in Tokyo and a third in Cambridge, England, last summer have followed. I am happy to report, Mr. Chairman and gentlemen, that the groundwork has been laid for frequent and rapid exchange of the results of research in this field between and among the many countries of the world.

I should like to report, too, that it was painfully obvious to those of us who attended these meetings that many of the gifted research workers in other countries were conducting programs which lagged sadly behind their ideas and the leads which they had uncovered, because of the lack of adequate support.

The great expansion of the clinical chemotherapy programs in cancer in this country during the past few years was made possible only because funds were appropriated by the Congress and allocated through the National Cancer Institute. We are confronted with the need for far greater expansion of these programs of clinical investigation of the effectiveness of the new anticancer chemicals, hormones, and antibiotics, which are coming from our research laboratories and our national cooperative program and from industry in heartening numbers. The contribution of clinical investigators throughout the world to the progress of our own program can be a tremendous one and will certainly speed the day of final decision.

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