EFFECTS OF AMPUTATIONS Senator POTTER. What happens in the case of amputations? Does that put an additional strain upon the heart to circulate the blood in that extremity there which has been amputated? Dr. WATT. No, sir; I do not believe there is a specific strain put upon a heart by the amputation. I think that the problem, of course, with the amputee is the strain that is put on him as an individual in learning how to live with this disabling operation. Senator POTTER. Quite commonly you will find that an amputee has difficulty with circulation. Now I would assume that you have to have that new tract that develops or is there anything that can be done to aid circulation? Dr. WATT. I am not quite sure I understand your question, Senator Potter. In the amputated limb, of course, you have to preserve the blood supply to that portion which remains, the stump of it. This is sometimes very difficult technically because you want to save as much stump as possible, and, at the same time, you do not want to leave it without an adequate blood supply. This presents a technical difficulty to the operator. As I understand your question with respect to difficulty of circulation, it presents more of a medical problem of how the man would adjust with the difficulty after the operation. Senator POTTER. I never refer to personal problems, but I, for the first time in 10 years, had to have some surgery on one of my legs. In the first place, I was on my leg too soon after the operation, and I opened up the incision, but I had difficulty in having that heal because of circulation. And I was wondering and I understand it is quite a normal thing to have happen. Dr. WATT. That is a problem of circulation to the amputated stump. For example, in the arm you have two major arteries coming down the arm supplying the blood, and they then go out to the individual fingers. Depending on where you cut, you can use the remnants for good, effective circulation, or you may not be able to. You may have to sew these arteries together. Sometimes the pressure on the stump prevents adequate circulation, and this is largely a local problem rather than one involving the general circulation. It is one related to the injury itself rather than to the cardiovascular system. Most of the difficulty from a circulatory point of view is in the local problem of how to relate the blood vessels to the portion of the limit which is saved. Senator HILL. Doctor, we will see if we cannot, arrange to bring the whole subcommittee out to the National Institutes of Health. I want to ask about your budget here. The budget allowed $17,278,000, and the House made that allowance. Do you have any very urgent needs in addition to those which will be taken care of by that amount of money? Dr. WATT. We believe that this is a step in the right direction, Senator Hill. This has been part of our plan of increase, as you know, for the past several years, and this fits in with the plan of development. We will be able to support a very solid, basic research program with this budget this year. Senator HILL. There is nothing very special or anything you feel that is compelling or very much needed in any additional funds which may be necessary? Dr. WATT. Senator Hill, we have a program here which is, I believe, a good one. I believe that we can do a really good job with the amount we have before us now. Senator HILL. Of course, you and I-and maybe I should not ask you to agree on this-know that money in and of itself cannot do the job. Money is a very necessary factor, but you have to have the factors of scientific knowledge and scientific talent and genius and industry and application and patience and a few other things to do these jobs, do you not? Dr. WATT. In a word, you have to have people who are really dedicated to this cause-and we have such a group of dedicated people at the National Heart Institute. TRIBUTE TO CONGRESSMAN KEEFE, OF WISCONSIN Senator POTTER. I am sure you remember Congressman Keefe of Wisconsin who was interested in this program, and the ironies and the tragedies of the situation of this kind, and he died of cardiac disease. Senator HILL. He was a very fine Congressman, and he was very much interested in these health matters. He made many fine contributions to health matters, and I remember some of the battles that he led on the floor of the House. His leaving Congress was a great loss. Is there anything further that you would like to add, Doctor? Dr. WATT. Senator Hill, there is one point that may be submitted. We were requested in the House Appropriations Committee to submit for the record how we would use these additional funds should there be an opportunity for this. This is made a matter of record in our testimony, at that time. Senator HILL. Briefly, would you tell us about it? What would you put as the No. 1 item if you had sufficient funds? RESEARCH AND TRAINING GRANTS Dr. WATT. We have two major areas in which we will use these additional funds. One is in the research grants area, and approximately half of the amount will go into research grants, particularly emphasizing high blood pressure and arteriosclerosis research. The second major item is the training grant area. These two items are, respectively, $420,000 in research grants, and $380,000 in our training grants. The latter is for personnel in the research fields and in the training of physicians. In our direct research the emphasis is on high blood pressure and arteriosclerosis-we plan for that $180,000. The other $20,000 is to give us the additional personnel that would be used for the handling of the grants program. That is the program we propose. RESEARCH ON TOBACCO Senator POTTER. Is there any research being conducted now to determine what effect, if any, tobacco has on the heart? Dr. WATT. One of the more important problems is how to attack that as a problem. It has been demonstrated rather definitely, I believe and I think this would be generally agreed to by all that. those people who smoke heavily belong to a group of people who die somewhat younger than the general mass of the population. Is heavy smoking simply a test, a means of selecting people with a poor risk of living, or is there an actual direct effect of smoking on human life? That is the problem today. A development which I think is most important in this field is joint planning by the National Cancer Institute, the National Cancer Society, the American Heart Association, and the National Heart Institute. Representatives have met together four times now within the last several months to plan jointly a means of attacking this problem. At the last meeting it was agreed that a group of people, expert in problem solving, scientific problem solving, would be selected and asked to sit down with this problem and make recommendations as to how we can best bring about a solution. This is the result of common interest of those four organizations. Senator POTTER. In other words, your facts today are that a person who is an excessive smoker may be in the range of the shorter-lived individuals rather than the nonsmoker? Dr. WATT. I would say the facts are that groups of people who are excessive smokers have, on the average, less expectancy of life than groups who are nonsmokers. There are a number of long-lived people who smoke heavily, obviously. We do not know whether this group factor represents certain specific differences within those individuals or just what factor is involved. APPEARANCES ON TELEVISION Senator HILL. Doctor, are you not on the TV, helping to educate the public, giving the information about this? Dr. WATT. Yes, sir. I had a very interesting experience the last 3 months. I have been doing a show twice a week since the 1st of February. It is a 5-minute show called "The Doctor Reports." It is part of a news program in the evening. Senator HILL. It is just a public service? Dr. WATT. It is public service. The station has been giving the time as a public service feature. It started off with 4 shows and extended to 8, and now it is 3 months, and I was told last night that they wanted me to keep on on the night that they did not have a ball game. Senator HILL. What time of the night do you come on? Dr. WATT. It is 11:10 to 11:15. It follows the Matthew Warren show on WTTG. Senator HILL. I am sure that is a fine service. Are there any other questions? Are there any other comments that you would like to add, Doctor? Dr. WATT. No, sir. Senator HILL. It is very nice to have had you here. We now come to the dental health activities. Dr. Knutson, we are very glad to have you here, and we will be glad to have you proceed in your own way. DENTAL HEALTH ACTIVITIES STATEMENTS OF DR. JOHN KNUTSON, CHIEF DENTAL OFFICER, PUBLIC HEALTH SERVICE; DR. WILLIAM H. SEBRELL, DIRECTOR, NATIONAL INSTITUTES OF HEALTH; DR. C. J. VAN SLYKE, ASSOCIATE DIRECTOR, NATIONAL INSTITUTES OF HEALTH; DR. W. PALMER DEARING, DEPUTY SURGEON GENERAL; ROY L. HARLOW, CHIEF FINANCE OFFICER; AND JAMES F. KELLY, BUDGET OFFICER, HEW APPROPRIATION ESTIMATE Dental health activities: For expenses not otherwise provided for, necessary to enable the Surgeon General to carry out the purposes of the Act with respect to dental diseases and conditions, [$1,990,000] $2,136,000. PREVENTION AND CONTROL OF DENTAL DISORDERS Dr. KNUTSON. Mr. Chairman and members of the committee, you have before you a detailed statement justifying the dental health activities, and I am prepared to give a brief abstract of that statement. Senator HILL. All right, you may proceed. Dr. KNUTSON. This item is concerned with efforts directed toward preventing, treating, and controlling a wide variety of dental disorders which afflict more than 90 percent of the American people, and includes such conditions as tooth decay, pyorrhea, crooked or disfigured teeth, cleft lip and palate, and oral cancer. COST OF DENTAL HEALTH SERVICES The staggering economic burden of this group of diseases and conditions is evident from the fact that approximately $1 out of every $6 expended for personal health services by the American people is spent for dental health services. Despite this huge expenditure, less than half of our people are receiving adequate dental care. |