11. Nutrition and care of young children in Peru. III. Yurimaguas, a jungle town. Huenemann, R. L., and C. Collazos Ch. J. Am. Dietet. Assoc., 30, 1101 (1954).

12. Nutrition and care of young children in Peru. IV. Chacan and Vicos, rural communities in the Andes. Huenemann, R. L., C. Collazos Ch., D. M. Hegsted, Y. Bravo, A. Castellanos, A. Dieseldorff, M. Escobar, I. Moscoso, P. L. White, and H. S. White. J. Am. Dietet. Assoc., 31, 1121 (1955).

13. Growth and development of Peruvian children. I. Carquin and San Nicholas. Trulson, M. F., C. Collazos Ch., and D. M. Hegsted. Pediatrics, 17, 510 (1956).

14. Growth and development of Peruvian children. II. Children from two areas-jungle and coastal. Trulson, M. F., C. Collazos Ch., and D. M. Hegsted. J. Am. Dietet. Assoc., 33, 1019 (1957).

15. La Composicion de los Alimentos Peruanos. Collazos Ch., C., P. L. White, H. S. White, E. Vinas, E. Alvistur, R. Urquieta, J. Vasquez, C. Diaz, A. Quiroz, A. Roca, and D. M. Hegsted. De Los Anales De La Facultad De Medicina (first edition), XXXV, 1 (1953).

16. La Composicion De Los Alimentos Peruanos. Collazos Ch., C., P. L. White, H. S. White, E. Vinas, E. Alvistur, R. Urquieta. J. Vasquez, C. Diaz, A. Quiroz, A. Roca, D. M. Hegsted, and R. B. Bradfield. De Los Anales De La Facultad De Medicina (second edition), XL, 3 (1957).

17. La Familia Peruana. Collazos Ch., C., and staff. istry of Health, Peru, 1, 3 (1954).

Published by the Min

18. A dietary survey in the Santa Cruz area of Bolivia. Huenemann, R. L., H. A. Bruch, and R. T. Scholes. Am. J. Tropical Med. Hyg., 6, 21 (1957).

19. The health survey for a peasant community. R. T. Scholes and K. T. Scholes. J. Am. Dietet. Assoc., 30, 1 (1954).

20. The serum lipoprotein and cholesterol concentrations of Central and North Americans with different dietary habits. Mann, G. V., A. Munoz, and N. S. Scrimshaw. Am. J. Med., 19, 25 (1955).

21. Serum Lipoprotein and cholesterol concentrations. Comparison of rural Costa Rican, Guatemalan, and United States populations. Scrimshaw, N. S., M. Trulson, C. Tejada, D. M. Hegsted, and F. J. Stare. Circulation, 15, 805 (1957).

22. The quantitative appraisal of atherosclerosis. Gore, I., and C. Tejada. Am. J. Path., 33, 875 (1957).

23. The beta-lipoprotein and cholesterol concentrations in sera of Nigerians. Mann, G. V., B. M. Nicol, and F. J. Stare. Brit. Med. J., 2, 1008 (1955).

24. Relation between caloric intake, body weight, and physical work: Studies in an industrial male population in West Bengal. Mayer, J., P. Roy, and K. P. Mitra. Am. J. Clin. Nutrition, 4, 169 (1956).

25. The cystine and methionine content of the hair of malnourished children. Wysocki, A. P., G. V. Mann, and F. J. Stare. Am. J. Clin. Nutrition, 2, 243 (1954).

26. Clinical Malnutrition in Italy in 1945. Nutritional status of selected population groups. Metcoff, J., and A. J. McQueeney. New England J. Med., 235, 451 (1946).

27. Dietary survey on Rarotonga, Cook Islands. I. General description, methods and food habits. Fry, P. C. Am. J. Clin. Nutrition, 5, 42, 1957).

28. Dietary survey on Rarotonga, Cook Islands. II. Food consumption in two villages. Am. J. Clin. Nutrition, 5, 260 (1957). Fry, P. C.

29. Dietary survey on Rarotonga, Cook Islands. III. Feeding practices and growth of Rarotongan children from birth through six years. Fry, P. C. Am. J. Clin. Nutrition, 5, 634 (1957).

30. Nutritional survey in Norris Point, Newfoundland. Metcoff, J., G. A. Goldsmith, A. J. McQueeney, R. F. Dove, E. McDevitt, M. A. Dove, and F. J. Stare. J. Lab. Clin. Med., 30, 475 (1945).

31. Comparison of aortic atherosclerosis in the United States, Japan, and Guatemala. Gore, I., A. E. Hirst, and Y. Koseki. Am. J. Clin. Nutrition, 7, 50 (1959).

32. Nutritional conditions in Holland. Stare, F. J. Nutrition Reviews, 3, 225 (1945).

The CHAIRMAN. The committee will stand in recess until 10 a.m. in the morning.

(Whereupon, at 12:15 p.m., the committee recessed, to reconvene at 10 a.m. Thursday, February 26, 1959.)

INTERNATIONAL HEALTH AND MEDICAL RESEARCH

ACT OF 1959

THURSDAY, FEBRUARY 26, 1959

U.S. SENATE,

COMMITTEE ON LABOR AND PUBLIC WELFARE,

Washington, D.C.

The committee met, pursuant to adjournment, at 10:10 a. m., in room 4232, New Senate Office Building, Hon. Lister Hill (chairman) presiding.

Present: Senators Hill (presiding), Yarborough, and Williams. Committee staff members present: Stewart E. McClure, chief clerk; William G. Reidy and Raymond Hurley, professional staff members. The CHAIRMAN. The committee will kindly come to order.

As our first witness this morning, we are happy to welcome Dr. Cornelius P. Rhoads.

Dr. Rhoads is director of the Memorial Hospital for treatment of cancer and allied diseases, also medical director of the Sloan-Kettering Institute. He has been before the committee a number of time in the past. He has always been most helpful.

You have given us very helpful testimony, Doctor, and we are certainly delighted to have you here this morning. We will be glad to have you proceed in your own way with reference to Senate Joint Resolution 41, the international medical research resolution.

STATEMENT OF DR. CORNELIUS P. RHOADS, MEDICAL DIRECTOR, SLOAN-KETTERING INSTITUTE

Dr. RHOADS. Senator Hill, I have not prepared a written statement, but rather would prefer to present my points of view in a relatively informal fashion.

The CHAIRMAN. Do not let that disturb you at all. I have heard you testify many times, and I know how you handle the situation, whether your statement is prepared or not prepared.

Dr. RHOADS. My only competence, of course, is in the field of cancer and cancer research, although it is true that this field has many contacts with and is pertinent to other areas of health and scientific activity.

I would prefer, then, to confine my comments on the bill to my own observations, which have been principally in Europe and to a limited extent in other countries, and to limit my remarks to my field, which is cancer.

I do not need to tell you of the importanct of the cancer problem. Because of the increasing average age of the population, the annual death rate from cancer and the annual incidence rate are steadily

rising, despite the vigorous efforts which have been made. We are not at the moment winning this battle.

The CHAIRMAN. Doctor, may I interrupt you there? Do you think that is due to a greater incidence of cancer? Or is it due to better diagnosis?

Dr. RHOADS. I am sure that it is due to increasing incidence. This matter has been carefully studied by excellent authorities, particularly those of the National Cancer Institute, and improvement in diagnosis does not appear to be a major factor.

The bill which I am asked to testify to, as I read it, seeks to accomplish two things. It proposes to establish a council analogous to the other councils of the Public Health Service, to be chaired by the Surgeon General, to be called the National Advisory Council, and to have 16 members nominated by the Surgeon General. This is, of course, conventional procedure which has been proved by my experience to be a practical working plan.

Secondly, it proposes to establish in the Public Health Service, the National Institute for International Medical Research.

In support of this bill, you have set down three important points. First, that disease is a common enemy and means for abating it should be sought without regard to national boundaries.

Second, you state that advances in the control of disease and disability can be stimulated by support on an international basis.

The third point the bill makes is that whereas agencies now exist which could be regarded as functioning somewhat in this field, adequate machinery does not exist to mobolize the needed personnel and talent to be employed in the interests of these other agencies.

I would like to discuss these three points in order.

The first, that disease is a common enemy, has two deep implications here which I think are not adequately specified in the bill. One is that if this bill is favorably acted upon, it will give opportunity for the development of scientific personnel on a worldwide basis far beyond what is now possible. This, in my opinion, is an enormously important matter for international welfare.

Secondly, this could have an enormous impact upon international relations.

I feel capable of speaking to both of these points, because at our own institute in New York City, with aid from the National Cancer Institute of the United States Public Health Service, we have at the moment I believe 58 foreign scientists who have come to us to gain new competence and we hope new inspiration, and to carry back these gains and put them to use in the countries from which they came. These men and women come not only from Western Europe but from all over the world.

We have found that the very fact of having these ambitious, energetic young scientists at our institution has had a profoundly useful effect upon our own program, and we hope it has been useful for them, as well. They do bring with them an enthusiasm for learning and a determination for accomplishment which sometimes surpasses that of our own personnel, who have had far greater opportunities.

We have kept in touch now, over the years, with some several hundred individuals from other countries who have come to our cancer center for training. Almost without exception, when they have re

turned to their homelands they have demonstrated such superior ability, that they have come into commanding and guiding positions, in forwarding the total control of disease elsewhere.

I think this is weighty evidence that to bring good young people here has a tremendously lasting and significant importance to medical research.

I am sure, furthermore, that from the point of view of international understanding, the potential impact of this program is tremendous I personally have experienced the result. I can go now into almost every country and find old friends whom we have come to know in New York at our center. And they are glad to have us.

The CHAIRMAN. Doctor, excuse me one minute. How are the expenses of the personnel who come to your center from countries abroad financed?

Dr. RHOADS. We finance them almost in any way we can. Fulbright method funds are used as far as possible. The Public Health Service gives us a substantial sum, which we may expend on our own initiative on what is called training grants to research workers. Then we go out and beg money here and there to supplement these rather limited grants, as may be required.

We

If a research worker who is brought to New York on the standard sum of $3,000 a year turns out to have a wife and four children, it is very difficult for him to eat, and someone has to help him out. have had generous friends who have been able to do this for us. The CHAIRMAN. I want to bring out, Doctor, that there is a precedent for providing Government funds for this purpose.

Dr. RHOADS. Yes, sir.

The CHAIRMAN. We are doing that today, but we are doing it on what we call a very, very small scale; is that not right?

Dr. RHOADS. Yes. We have in our institute $100,000 a year from the Public Health Service, which we may expend upon our recommendation and the approval of the Public Health Service for such training grants. The amounts, however, are limited and must be standardized. We make up the difference. So it becomes a joint operation, private and public.

The second part of your bill says 66*** advance *** can be stimulated." In discussing this, I would make two points. First, one must be sure that the gains, the advances, in practical terms, fully repay the taxpayers' money which is to be expended; and second, we must be sure that this program will not detract from or interfere with existing programs.

I have gone to great pains in the past 2 years to think about these matters. I have had at least one member of my scientific staff in Europe in some other area all these past 2 years examining the facts pertinent to these two considerations.

We are satisfied that the potential for progress is enormous. I think I can assure you personally that the real gain in terms of useful scientific advance is worth far more than the money which will be spent.

Second, we do not believe that this program would detract from or interfere with existing work. It certainly would not do so if properly administered by the procedures established. On the contrary, we know of many situations in Europe, and some in South

America, where new work could be immediately complementary to the programs presently underway. We do not see a serious possibility of confusion or handicapping of the work here.

The third point made concerned existing agencies. You, I am sure, are aware that the existing agencies are in large part public health agencies as contrasted with research agencies. They were set up to approach on a useful scale immediately accessible problems, such as the control of malaria. What is proposed here is sufficiently different so that in our opinion this special Council and special Institute is distinctly necessary.

You are aware, I am sure, at the present time that we are expending money abroad.

The CHAIRMAN. Oh, yes.

Dr. RHOADS. But this is not done with the sort of planning and orderly control which is specified in your bill.

The CHAIRMAN. You think we ought to have that plan, do you not, Doctor, and a control?

Dr. RHOADS. Yes, sir; I do, very distinctly so.

Are the potential gains clearly worth this expenditure, and I presume, more adequate expenditure in the future? We can find in almost every European city and almost every European university brilliant young people who simply are not able to conduct scientific work, except on a kitchen scale, because they do not have the opportunity. Now, the lack of opportunity is due to two factors. One is due to lack of money. In certain of the Scandinavian countries, and in Denmark, and to some extent in Belgium, funds which were adequate for research 10 years ago are available; but they are not adequate for the kind of research which has to be done to achieve the end result which are demanded today.

Second, existing organizations for the disbursement of funds in Europe do not have the orderly structure provided by your bill. Furthermore, your bill provides for a management function which to me and to others who have looked into this matter, is exceedingly important.

We are certain that the scientific work so supported will be mutually useful, to us and to others. We are certain it will give enormous stimulus to scientific thinking on the part of Government as well as on the part of scientific personnel. We are sure that if properly handled by an American agency, and not made a football of European politics, we can accomplish the end which you wish to accomplish.

My staff is engaged in a constant survey of European opportunities. We have a staff member in Brussels all the time because this city is a natural center. Brussels has a cancer institute. We have supplied many of the personnel for that institute. And my man there, who is a visiting professor at the University of Brussels, spends about half his time on the road, traveling Western Europe. He has not yet been into Russia, but one other man on my staff has.

Everywhere we have found a strong expression of the point of view of other scientists that they crave opportunity, and given opportunity, could make important contributions. This ability to contribute we have confirmed. The lack of opportunity we have confirmed, by personal study in the local institutions in every one of the European countries.