that OIR would be the focal point for United States-Japanese direct operations at NIH.

Mr. FOGARTY. What is this table I have in front of me? It says in the first column your original request for international research, direct operations, was $1,945,000. The request of the Bureau of the Budget was $1,909,000. The last column shows the President's budget, $3,209,000. What does this mean?

Dr. SHANNON. This means that in the process of developing the budget, the arrangement for the Japanese-American cooperative studies came at a later date than the figure shown in the first three columns. The figure for that study was negotiated in the latter part of December and early in January and was added to the base figure of $1,909,000. At that time, to tell the whole story, we had asked for $11 million to support the program. We were permitted to provide for $9 million, of which the $2 million 1967 allowance was for the direct operation, the rest came from our grant allowances to Allergy and Infectious Diseases and Arthritis and Metabolic Diseases and it shows up in their budgets.

COMPUTER RESEARCH AND TECHNOLOGY

Mr. FOGARTY. Mr. Farnum is interested in the next item, computer research and technology. You asked for $8 million and come out with $3 million.

Dr. SHANNON. This is due to a delay in our ability to acquire the computer configuration.

Mr. FOGARTY. Then you are not disappointed with the reduction? Dr. SHANNON. We are just disappointed that we cannot get the computer when we had hoped.

Dr. HARRIS. There is about $4 million for the purchase of it.

SPECIFIC USES OF INCREASE FOR DIRECT OPERATIONS OF INTERNATIONAL

RESEARCH

Mr. FOGARTY. The justifications don't give much in the way of specifics on how this will be used. Do you have the details on this $1,989,000?

Mr. GRANT. Yes, sir; we do.
Mr. FOGARTY. Tell us about it.

in personnel.

There is only an increase of three

Mr. GRANT. In the $1,989,000 we would use $350,000 for virus studies, $210,000 for cholera, $260,000 for parasitic diseases, $100,000 for TB, $80,000 for leprosy, $700,000 for nutrition, $400,000 for conferences, and $89,000 for administration.

Mr. FOGARTY. The budget for the international centers for medical research and training doesn't seem to fit in with this picture.

Mr. GRANT. It is not within the $1,989,000.

Mr. FOGARTY. There is a proposal to cut them back to $2.8 million. How do you explain that?

Mr. GRANT. We feel within the figure proposed for the President's budget we have sufficient operating flexibility, and there is no proposal at the present time to add a sixth ICMRT.

NEW FELLOWSHIP AND TRAINING PROGRAMS

Mr. FOGARTY. Would you care to comment on the request for funds to set up a new fellowship program and a new training program? Dr. KENNEDY. Are these the quarter of a million dollars and the $100,000 items?

Mr. FOGARTY. That is right.

Dr. KENNEDY. The Division of Research Facilities and Resources budget requests $250,000 for training grants and $100,000 for fellowship grants. We again are interested in upgrading and expanding the number of people who are competent in the area of laboratory animal medicine and laboratory animal care.

Mr. FOGARTY. These are new programs?

Dr. KENNEDY. These are new programs for us, that is right. They are modest starts. One of the things we want to do is to make available to veterinarians interested in laboratory animal medicine the kinds of opportunities for postdoctoral training, either in a formal training grant program or under research fellowships, that the NIH offers to medical doctors and other scientists who need further postdoctoral training. We feel that many of these people ought to know a good deal more about fields such as nutrition, biochemistry, pathology, pharmacology, et cetera. We also believe that this program will complement the larger program that Dr. Shannon outlined to upgrade the whole quality of laboratory animal care throughout the Nation and thereby blunt the kind of criticisms that are coming to public attention these days.

Dr. SHANNON. Even on a tight budget we felt that we had to make a start in these areas. If we are really as earnest as we say we are about providing for more effective care of laboratory animals, then we should be willing to provide funds for the beginning of this type of activity, even though we take funds away from other activities.

BUDGET REDUCTIONS IN HEART, CANCER, AND STROKE

Mr. FOGARTY. Do you mean away from cancer? This is the most conservative cancer budget I have seen.

Dr. SHANNON. I wouldn't say away from cancer, but away from the aggregate of all other budgets.

Mr. FOGARTY. Cancer was hit, I guess, harder than anybody else, weren't they? Almost everything connected with heart, cancer, and stroke has been hit the hardest in this budget, if you compare the original requests with what is in the budget before us.

Dr. SHANNON. Yes, sir.

Mr. FOGARTY. And you were the only guy last year that defended this heart-cancer-stroke program, to the degree I felt it should be defended. Now we find the worst cuts in this budget are in this area. How do you account for that?

Dr. SHANNON. I don't make the budget allowances.

Mr. FOGARTY. I know you don't. What do you think about this budget? The deepest cuts are in that area of heart, cancer, and stroke. We were told last year these problems cause about 70 percent of all the deaths in the country.

In answer to Mr. Flood last year you did a good job in defending this program. Now you are coming in with this budget. How do you make these things add up?

Dr. SHANNON. All I can say, sir, is that with the ceilings we wer given, we have done the best we can in distributing the funds wher they will do the most good.

Mr. FOGARTY. Yes, but in heart, cancer, and stroke you made big point last year. This was the area to really go to work on.

What do you think Dr. De Bakey is going to say when he takes look at these figures?

Dr. SHANNON. I would like to make a comment on that.

Mr. FOGARTY. Go ahead.

Dr. SHANNON. He is a grantee and this would have to be off th record because a research grant is in process.

(Discussion off the record.)

REGIONAL MEDICAL PROGRAMS

Mr. FOGARTY. What you asked for the regional medical program was cut about 50 percent; is that right?

Mr. CARDWELL. That is correct.

Mr. FOGARTY. You ask for $92 million and come out with less that 50 percent of it.

MINIATURE HEMODIALYZER

Mr. FOGARTY. On page 12 you mention a miniature hemodialyze that has been developed. Tell us something more about that.

Dr. KENNEDY. This development is from one of the DRFR-sup ported clinical research centers under Dr. Bleumle at the University o Pennsylvania. I think both you and the members of the commit tee are well aware generally of the progress that has been made in sus taining life of patients with serious-to-terminal kidney diseases and severe uremia by the use of the artificial kidney. Dr. Scribner in Seattle pioneered this area.

The interesting development that is under test up in Philadelphi is an example of industrial engineering development leading to remark able miniaturization. The apparatus responsible for filtering ou noxious and toxic substances from body fluids is actually reduced t the dimensions of a 3-inch cube.

Mr. FOGARTY. That may have been reduced by them but the rest o the apparatus hasn't been reduced by much since they started on thi problem.

Dr. KENNEDY. I think that the new development is a sharp reduc tion in size. They are able to maintain an efficient

Mr. FOGARTY. I saw one working in a home and there is an awful lo of apparatus.

Dr. KENNEDY. I agree.

Mr. FOGARTY. What is outstanding about this one at Pennsylvania Dr. KENNEDY. Size reduction.

Mr. FOGARTY. We saw these things that were made out of cellophane Dr. SHANNON. This is the thing that has been reduced to a very small size. However, we don't know whether it is going to work.

The developmental program to reduce not only the size, but the cos of the operation, is centered in the Arthritis Institute. Additional funds were made available last year to develop the program. The reason why it crops up in this appropriation is that this is a striking example of the indirect benefit of a general clinical center. The main

program is centered in the Arthritis Institute and they have a special report which I believe they have submitted.

RECOMMENDATIONS FOR KIDNEY PROGRAM EXPANSION

Mr. FOGARTY. If we decide to put $5 or $10 or $20 million more in this area, where should it go?

Dr. SHANNON. Well, Mr. Fogarty, my belief is and I know I won't get concurrence on this-that the present problem of bad kideys is being temporized with by these artificial kidneys. I think we Lust go forward and develop more effective ones to bring the cost from about $10,000 down to within reach of the ordinary person, and this is where the developmental program is going in arthritis. But the final solution to the problem is either in the prevention of the disease that destroys the kidneys or the ability to transplant into the human a kidney that will not be rejected.

Mr. FOGARTY. I think we all agree about prevention. That goes as well for heart problems. The objective is to prevent coronary attacks, 't it?

Dr. SHANNON. Yes, sir.

If you are going to put a substantial sum in the kidney program, it would make more sense to me if a substantial part of it were put into the organ-transplant area-which is going very vigorously now but can be pursued at a much more intense rate aimed at the suppression of the rejection phenomena to make possible the introduction of a new organ.

Mr. FOGARTY. I think that is good, too, but what about these poor people who have this problem and can't afford to pay for it or they are not in a position to travel to a hospital 300 or 400 or 500 miles? When I was in Seattle they had people coming in there from hundreds of miles away to get this treatment. But they can't take nearly all of the people that need this treatment to live. We live in the richest country in the world. Why should we let people die when we can do something about it?

Dr. SHANNON. Well, indeed, we can but the cost is much more than 20 or 30 million because

Mr. FOGARTY. What is the difference how much it costs?

Dr. SHANNON. Let me give you some figures. It has been variously calculated that as many as 10,000 people die from faulty kidneys a year. If you have a device to save these people, then you accumulate this caseload until it becomes a

Mr. FOGARTY. On this machine I thought it was in the neigborhood of 3,500 or 4,000 a year that could be saved if these machines were available throughout the country.

Dr. SHANNON. If you save 4,000 this year, you have 4,000 more next year so you have 8,000 to take care of. The third year you will have 12

Mr. FOGARTY. Well, so what?

Dr. SHANNON. This is a social decision, Mr. Fogarty. It is not a medical decision.

Mr. FOGARTY. But these lives can be saved.

Dr. SHANNON. These lives can be saved.

Mr. FOGARTY. All these people that I have heard about who are on this machine are working every day.

Mr. FOGARTY. Many have never lost a day's work since they hav been on the machine.

Dr. SHANNON. That is correct.

Mr. FOGARTY. They can do this at night and go to work as a me chanic the next day. I don't see why in the world we can't spend few million dollars more to get these programs into areas in th country that don't have them now.

Dr. SHANNON. All I wish to point out, Mr. Fogarty, is that o balance it costs somewhere between $10,000 to $13,000 a year. This is cumulative cost. This is not a temporary phenomenon and the tota cost to do this job is really astronomical.

Mr. FOGARTY. Who cares about the cost when it comes to savin lives? I don't care. I think this is another good example of interna tional medical research. Dr. Scribner picked this up at a meeting in Holland, didn't he?

Dr. SHANNON. Yes, this came from Holland.

Mr. FOGARTY. The three original patients he had, he said cost $20, 000 a year. Now they have it down to $10,000. He thinks that in the near future they can bring it down to $7,000 or $8,000 and in a hom down around $6,000. But for all these people coming to Seattle, i is costing them $10,000 a year to stay alive.

Isn't this program a good example of what we were talking abou this morning about international fellowships and the exchange of research?

Dr. SHANNON. Yes. Dr. Kolff is now in this country. He is at tached to the Cleveland clinic.

Mr. FOGARTY. What about the transplanting of other parts of the body?

Dr. SHANNON. The other two organs that have been tried in recen years and not very successfully, I might say-are the lung and the liver. There you have not only the rejection phenomenon but nervou control of the organs is likely to make it complicated. The best chance one has through organ transplant is in the renewal field. That is a very simple procedure because basically the kidney is a device that is self-regulating. There is no doubt kidneys can be transplanted They start to function immediately. The problem is that they ar rejected at a later time.

Mr. FOGARTY. Mr. Farnum.

CENTRAL COMPUTING SYSTEM AT NIH

Mr. FARNUM. Dr. Harris, can you tell us a little bit about the prog ress that has been made in the last year in the central computing sys tem at NIH?

Dr. HARRIS. Yes. I think we made progress in several areas in particular. For example, in the clinical center pathology area w have been able to accelerate this year at a rate to bring us to wher we would not otherwise have been until about 1969. We will, by this summer, have tripled the number of tests on line. We have greatly expanded the programing facilities and the purchase of analytica equipment.

In addition, in the clinical center we are getting into the areas of automation of patient care activities. In order to proceed as rapidly as we can, we expect before the end of this fiscal year to have initiated