It should be mentioned, also, that through this same mechanism the chemical compounds available today for the temporary control of many different forms of cancer, including leukemia, can be made available to research centers elsewhere in the world as part of the care of patients with advanced cancer.

I should like to turn finally to brief mention of one other area of cancer research which might be used as an illustration of subject matter for this new institute. This concerns geographic pathology and epidemiology of cancer.

This area of cancer research, which could be put into actual operation on a large scale, is called geographic pathology, or the distribution of disease by geographical sites.

A beginning was made recently in a meeting called in Bethesda at the National Cancer Institute with authorities from Denmark, Norway, Finland, England, France, and this country, who discussed longterm plans for the study of the different forms of cancer in various parts of the world, and their survival statistics following treatment of different kinds. Without such important studies, evaluation of discoveries in therapy will rest upon insecure grounds. From such studies, too, important leads can be obtained concerning possible causative factors for the many forms of cancer in man.

In closing, Mr. Chairman and gentlemen of the committee, I wish to express my deep appreciation for your wisdom and efforts in making this bill possible. I feel certain that the great good which will come will be felt throughout the entire field of medicine, and without qualification I wish to end in strong support of this splendid move.

The CHAIRMAN. Doctor, as I said in the beginning, you are always tremendously helpful. You have certainly brought us a very fine presentation, one that will prove most helpful to us in endeavoring to pass this legislation. We are most grateful to you.

I wonder, as chairman of the National Cancer Chemotherapy Committee, if you would give us a picture of the work of that committee. I think, perhaps, the work of that committee here in the United States might give us some picture of what we might contemplate on the international scene. Am I right about that?

Dr. FARBER. Thank you, Senator Hill.

The Cancer Chemotherapy National Committee is a voluntary organization which represents a number of groups interested in cancer chemotherapy. These include the National Cancer Institute, the American Cancer Society, the Damon Runyan Fund, industry, as represented by a member on this committee, the Food and Drug Administration, the Veterans' Administration, and the Atomic Energy Commission.

The CHAIRMAN. In other words, here you have Government and private organizations, laymen, doctors, and scientists, all working together.

Dr. FARBER. All working together. And this group is advisory to the Cancer Chemotherapy Service Center, which was organized through the act of Congress and through the appropriation which came originally from your committee and that of Mr. Fogarty just years ago.

5

This Cancer Chemotherapy National Service Center is based in Bethesda. It has a staff of its own, but its guidance comes from

citizens, scientists, and physicians from all over the country. There are about 500 such advisers, who participate in the research and stimulate the research in this field.

Industry has a special committee which advises the National Chemotherapy Committee, so that the participation of industry has been strong from the very beginning.

This program is concerned with the search for chemical compounds and the making of chemical compounds, and antibiotics, which come in the main from industry, hormones, and hormonelike substances, which come in the main from industry, the testing of these materials against various forms of cancer in experimental animals. And I might say that 40,000 such chemicals and hormones and antibiotics were tested for cancer-destroying properties in this national program last year through the service center.

And finally, after suitable studies have been made concerning the safety and activity of these materials, the final candidate compounds are administered to human beings with complete safety, human beings with advanced cancer, as part of the total care of these human beings, these patients, in more than 400 clinical groups in this country.

I might say that despite the vast progress in the growth of this program in this country, the number of patients available for such study, patients who need this, because nothing else is available, is still too small to keep up with the large number of candidate compounds which will come from industry, from our research programs in academic institutions, and from any other source. And this is one very practical and immediate manner of linking up international programs with something that is going in such a magnificent manner in this country, and which was started in this country.

The CHAIRMAN. It would be impossible for anyone today to estimate how much or what valuable information you might find if your program had a more direct and better tie-in with research going on in other places; is that not true?

Dr. FARBER. I agree with that, Senator.

Senator WILLIAMS. I appreciate your excellent statement, Doctor. The CHAIRMAN. Doctor, you are a true, tried, and proven friend, and we are certainly deeply grateful to you.

Dr. FARBER. Thank you, Mr. Chairman.

The CHAIRMAN. We will now hear from Dr. Fredrick J. Stare, of the Harvard School of Public Health, Boston, Mass.

You were with us before our Appropriation Subcommittee last spring, and we are delighted to have you here again, Doctor, and we would be glad now to have you proceed in your own way.

STATEMENT OF DR. FREDERICK J. STARE, PROFESSOR OF NUTRITION AND CHAIRMAN, DEPARTMENT OF NUTRITION, HARVARD SCHOOL OF PUBLIC HEALTH

Dr. STARE. Gentlemen, my name is Frederick J. Stare, and I am in charge of the department of nutrition at Harvard University, a member of the staff of the Peter Bent Brigham Hospital in Boston, and in the last, I think, 10 or 15 years I have had the opportunity to have a fair amount of experience in different parts of the world, ex

perience actually connected with various types of health and medical research activities.

Now, the proposed legislation that you are considering has the complete, unqualified, and enthusiastic support of myself and the several other members of Harvard's Department of Nutrition that have had some research experience in international health and medical researches.

Our cooperative research experiences in these fields-and I do not mean "touristing"-include researches on the calcium needs of man, which we have done in Peru, on various types of tropical anemias, which we have done in Peru, on the nutritional qualities of vegetable protein, which we have done in Peru, on nutritional surveys on the various health and nutritional status of the peoples in parts of Peru and Bolivia; some growth and development studies of Peruvian children; other nutritional researches that we have been involved in in Indonesia, the Cook Islands, and Guam; some studies on diet and atherosclerosis, which we have done in Guatemala and Costa Rica and Jamaica and Colombia, in Japan, and in Nigeria; and some studies we have done on energy needs and industrial productivity in India.

And I have appended to this brief statement a list of 32 published research papers that have resulted from cooperative studies in international health and medical research conducted by our staff.

The CHAIRMAN. Doctor, we will have that list appear at the conciusion of your remarks. (See p. 85.)

Dr. STARE. All right.

Visits to medical and health laboratories and consultation on researches of mutual interest by members of our staff include in addition to the countries already mentioned Mexico, Ecuador, Bolivia, Venezuela, Brazil, French West Africa, Liberia, Ghana, Union of South Africa, Uganda, Kenya, Northern Rhodesia, Egypt, Italy, France, Sweden, Philippines, and Thailand. So I think we can say that from our personal experiences we know that we can learn as much or more than we can give to others in this field.

The CHAIRMAN. In other words, Doctor, this is definitely a two-way street?

Dr. STARE. It definitely is a two-way street.

The CHAIRMAN. And you are speaking from your own personal experience and personal knowledge?

Dr. STARE. Yes. I think we have learned as much or probably more from these things than we have given.

It has been our experience that unquestionably the peoples of all races, creeds, colors, levels of intellectual and economic status, and brand of politics, are interested in, cooperate with, and welcome health and medical researches.

This is truly a significant piece of legislation. I have often saidand I suppose, I am sure, rather naively-that if some of you gentlemen had simply put a rider on our foreign aid bill since the origin of point 4, 10 percent of whatever sums were voted for foreign aid would automatically have gone and would go for research in health, we would at this time have a healthier world, a more understanding world, and a happier world.

I have three specific suggestions to make with regard to this bill as now written:

One, the bill as now written omits any specific mention of health impairments related to poor nutrition, commonly called malnutrition. Malnutrition relates to undernutrition, as evidenced in many health impairments. For example, in many types of anemias; in a severe, frequently fatal disease of young children, prevalent in large parts of the world, and known as kwashiorkor disease. Malnutrition also relates to fatness or obesity, prevalent in this country, but in other countries as well. Malnutrition has a significant role to play in the greatest killer of mankind in this and other countries of Western civilization, as well as the urban areas of Eastern civilization. I refer, of course, to the cardiovascular diseases, particularly to coronary heart disease and strokes.

Now, I am sure that those who drafted this enlightened bill thought that malnutrition would be included in section 2, paragraph 1, statement A; also in statements C and D of this paragraph.

The CHAIRMAN. Doctor, would you excuse me there?

I can assure you that your assumption there is right. We have certainly contemplated and intended that malnutrition would be included in this act along with all these other matters.

Dr. STARE. But the thing that disturbs me, Senator Hill, is this next statement, and that is that our rather extensive experience in international health and medical research, which has brought us into some contact with the point 4 activities of our Government for the last few years carried on under the terminology of ICA, have led us to the opposite conclusion.

The CHAIRMAN. You go right ahead and give us all your suggestions as to how you would like to have this question of malnutrition expressly and definitely and specifically embodied in this legislation. Dr. STARE. I will; but if it is not mentioned in there, the trouble that you run into is that we have unfortunately too many unenlightened administrators, inertia rather than energy.

The CHAIRMAN. They are neither doctors nor lawyers; right?
Dr. STARE. Right. Timidity

The CHAIRMAN. Excuse me. I believe I should predicate that remark by saying that we had a little discussion about lawyers here earlier this morning.

Dr. STARE. Too many people involved with these activities have timidity rather than boldness, and no confidence. Obviously, this does not apply to all in our past international health activities, but unfortunately to many. And just as with rehabilitation, if nutrition is not mentioned specifically in this bill, it will take many months and much time to get the average administrators to get up enough courage to decide that research in nutrition as it relates to health and disease may properly be included in this historic bill.

The CHAIRMAN. Doctor, before you came in this morning, we had a very fine discussion about the situation in the underdeveloped areas. There is no greater problem in those areas than malnutrition, is there? Dr. STARE. That is right.

Therefore, because of the importance of nutritional researches in relation to every word of statement A of paragraph 1 of section 2, page 3, I suggest that statement A be followed by a new statement B, which might read:

The causes, diagnosis, treatment, and prevention of malnutrition both as such and as related to other diseases and health impairments.

The present statements B, C, and D on page 3 then become statements C, D, and E.

Further, I suggest the insertion of a comma and the word "malnutrition" on page 3 in line 22, following the word "disability."

On page 10, following line 13, the insertion of the following

sentence:

Encourage and support research, investigations, and experiments conducted in countries other than the United States related to malnutrition as referred to in paragraph 2 hereof.

On page 10, line 14, the number "2" would be then changed to "3"; line 17, the numeral "2" to "3"; and line 18, the numeral "3" to "4."

Now, my second specific suggestion is that while the intent of this bill is to encourage international health and medical research, many if not most of these studies will be cooperative efforts with laboratories in the United States. Much of the research will be done abroad, but some of the planning, determinations, and evaluation of results can better be done at home; for example, in our research on atherosclerosis in certain primitive tribes in Nigeria, the blood samples were analyzed at Harvard, where staff and equipment were available for such analysis; the same applied to our work in Guatemala and Costa Rica.

In connection with some of our research in Indonesia, samples of hair from children were sent to our laboratories for analysis. We currently receive aortas and other specimens of blood vessels from Japan and Jamaica.

Í believe that as this bill is now written, it might preclude the financial support of such necessary cooperative work with researches that are clearly international, or at least the usual administrator would chant the familiar phrase, "It can't be done."

Hence, I suggest a sentence added somewhere-perhaps at the end of section 10, page 13-to the effect:

It is understood that the research activities authorized herein may include cooperative and coordinated activities within the United States, for example, analysis of samples from abroad when such analysis can be done more efficiently and accurately in the United States; the analysis of data, including statistical data, obtained on research surveys abroad; the preparation of scientific reports on the results of international researches. Support of such cooperative and coordinated activities of international health and medical researches is clearly within the intent of this legislation.

Third. My last specific suggestion is an earnest plea to the Secretary and the Surgeon General, both extremely able men, to find an outstanding individual to be the Director of this new institute. Personality, tact, and understanding are of more importance in dealing with international activities of any kind than with domestic. Some worthwhile personal research somewhere in an individual's career is highly desirable for an individual to head a research institute. Imagination, boldness, and confidence are necessary qualities for a man to direct successfully this type of research. Let us not simply move an average health worker who has gone from one committee to another for the last 10 or more years, or one who has been primarily an administrator of programs in applied public health, and put him in charge of a research institute. There are good men, within and without the Government, and let us try hard to get one of them for this important position.