So I can see a series of special-purpose computers. If you use computers in the very broad sense that is, machines that can take physiological or oral information and digitize it-the opportunities for introducing them in a wider variety of situations are extraordinarly large. It extends the capability of the individual scientist in precisely the same way as other automated instruments have done. In the forties, when I was heavily involved in organic chemistry, the organic chemist would run a reaction and isolate it and test it. This would not infrequently take a week or two. At the present time, he runs the reaction and in the course of a few minutes runs an infrared curve and he is saved a week or two of time by an automated observation. Actually the automated observation is more precise than the other procedure. I talked about the increased cost of research. I said that about 5 percent was for increased sophistication of instrumentation and 5 percent for expansion. A good deal of the 5 percent for increased sophistication of science is going to the type of thing I am talking about. I would say that a substantial part of the increased cost of doing business in the biological field will, in the future, be spent on the mathematical formulation of problems and the use of machines that can deal with mathematical symbols. DISSEMINATION AND APPLICATION OF RESEARCH RESULTS Mr. FARNUM. Let us expand this outside the campus. Do you project in the future the use of this equipment through other locations around the country? Dr. KENNEDY. There is an interesting situation now developing in St. Louis. Radiologists are faced with the problem of computing whether their placement of radium needles for treating a tumor is optimal; i.e., adequate for treatment, yet not liable to result in overtreatment. The calculation of radiation dosage is a very laborious business; to do so precisely when computers first made such calculations feasible required about 30 minutes on a very large machine. One of the DRFR-supported instrumentation problem engineering centers got interested in this and first simplified the mathematics involved. But what was really interesting was their design of a special console with a lot of computing power which can be taken right into an operating room and there can begin the dosimetry calculation from data derived from X-ray pictures of where the radium needles have been implanted. If necessary, the data can, after preprocessing, be transmitted by telephone lines to a computing center far away from the Washington University medical complex, and the results which are returned to the medical center can then be displayed to the radiologist in a variety of pictorial forms. He can say, "How does this look from the front? Now let us turn this lady around, so we can look from all angles to see if the needles are so placed that she is being neither overtreated or undertreated." To get back to your question of getting research results disseminated and applied more widely, the director of this center has organized seven collaborating groups around the country to test out the programable console; in almost all these centers, there will be the requirement of remote inputs from an operating room to a large computer center. Some of the groups process directly through the Washington University Center in St. Louis, although they may be hundreds of miles away, until they can get their own programing completed and running. Mr. FARNUM. There are so many advantages from the use of this equipment, properly used and fully utilized; and with the expanding population and more tests and more samples that need to be done by einics, it becomes almost physically impossible for doctors and other skilled technicians to sit down and analyze the information and we are all familiar with the error factor that is present, particularly when we are tired. Last Monday, Mr. Chairman, I went to the George Washington University Engineering School where they have been working since 1958 proving out the known principle accepted by the medical profession of the electrocardiogram and the adaptation through computing systems to accept by data transmission EKGs in which they read them and provide instantaneous results and transmit the information back to the doctors in hospitals and clinics all over the country. Then we arrive at the point now where enough experimentation and demonstration has taken place that we have the practical problem of utilizing this information or utilizing the equipment broadly in the country, and we come to two problems: One is the cost factor because the prototype that was built cost a lot of money, then we come to mass manufacturing so the cost is small enough for the doctor to put it in his office. Then we have the problem of confidence that must be built up, through the use of this equipment, in the doctor's mind to accept the calculation versus the so-called eyeball determination of the doctor. So I am concerned about how we are going to use the equipment. for the benefit of man and how are we going to disseminate this information so we can use it. BUILDING CONFIDENCE IN MINDS OF MEDICAL PEOPLE What programs do you have in the institutes designed to build the confidence required in the minds of the medical people so they will accept the results of these experimentations? Dr. SHANNON. I think the most important single program, which will have a profound impact, is the regional medical program. It will provide the organizational linkage between hospitals and medical centers. I think this is going to bring into broader use the advances of science that we have. At least that is our expectation. Mr. FARNUM. In the previous discussion Chairman Fogarty talked about the money, what you had asked for versus what is being recommended in the budget, and you said you could not use more in this because the equipment you needed was not available. You are talking about the large configuration that is not available, is that right? Dr. HARRIS. We have received an increase this fiscal year over our budget for the last fiscal year. The difference between what was submited was practically all in terms of the purchase of the IBM computer configuration. This was deferred. In terms of the program use of computers we are, I think, facing an opportunity to put together a very good program for this coming fiscal year. Mr. FARNUM. What about in-line equipment? Do you need money for in-line equipment? There was a great need last year and I would ame as you get more of your research scientists interested in the use of this equipment that you will need more of this. What happens in this area? Dr. HARRIS. This is where we expect the bulk of our increases for this fiscal year to go, in the development of computer equipment associated with remote terminals, the communications involved, and the central facilities that will be necessary to handle remote terminals, and also programing systems that have to be developed. We expect in 1967; our activity in this area will be intense. Mr. FARNUM. There is a time element here. The people who will use it will have to understand it and use it even if the central system is not ready. What about this area? Dr. HARRIS. When we are talking about a process control type of computer, or a computer than can flash back medical information in seconds, these will have to be in the lab. We expect to have funds available during this fiscal year to promote that type of activity. One of the things going on now on the campus is an identification of what areas will be most appropriate for this. We expect the computer division will be heavily involved in this area. Dr. SHANNON. The fact of the matter is that the big push in this budget is to get the central shop into full operation. Mr. FARNUM. Will you have enough money for the gadgetry building that will be necessary? Dr. SHANNON. In that area I think we will be short. Mr. FARNUM. Thank you. JUSTIFICATION MATERIAL GENERAL RESEARCH AND SERVICES, NATIONAL INSTITUTES OF HEALTH Amounts available for obligation Transferred to "Office of the Surgeon General, salaries and expenses”.... 1966 total estimated obligations. 1967 estimated obligations__-. Total change....... $60, 469, 000 -2,000 60, 467, 000 67, 821, 000 +7, 354,000 INCREASES Mandatory: 1. Annualization of general schedule pay increase_ 2. Annualization of positions new in 1966–. 3. Annualization of commissioned officers' pay increase_ 4. Social security tax increase_-_ $32,000 114.000 Subtotal, mandatory increases_ Program: 1. Research grants. 2. Fellowships.... 3. Training grants-- 4. Collaborative studies_ 5. International research (3 positions). 6. Computer research and technology (7 positions). 7. Review and approval of grants.. 8. Program direction_____ Subtotal, program increases__-_ Payment to National Institutes of Health management fund for centrally furnished services: 14,000 1.000 161,000 4,075, 000 100,000 250.000 181,000 1,989,000 600,000 48,000 37,000 7,280,000 -13.000 16,000 3.000 7.444.000 Contract reprograming associated with new central computer (computer research and technology) –. -70,000 Transfer of the SEATO-Cholera research program to the National Research grants.-The increase of $4,075,000 includes $124,000 for noncompeting continuations, $56,000 for general research support grants, $5,000 for scientific evaluation, $2,100,000 for animal resources, $2 million for primate centers. offset by a decrease of $10,000 in new regular research grants and $200,000 in international centers for medical research and training. Fellowships.-The increase of $100,000 will provide for nine new awards at the predoctoral level. The awards will initiate a new program for the Division of Research Facility and Resources with the objective of providing specialized training related to laboratory animal programs. Training grants.-The increase of $250,000 will provide support for five new graduate training grants. This is a new program for the Division of Research Facilities and Resources. Collaborative studies.-The increase of $181.000 will provide for the increased costs of the communication component of the Toxicology-Pharmacology program. International research.—The increase of $1,989,000 and three positions will be used to initiate the United States-Japan cooperative medical science program. Computer research and technology. The increase of $600,000 and seven posi tions will provide for developmental work and equipment purchases associated with the introduction of remote computer stations and time sharing; computer usage and programing services associated with research and developmental fune tions; and for the initiation of new and expanded activities. Review and approval of grants.-The increase of $48.000 and two positions wil provide for additional staff needed to cope with the increased workload generated by the expanding research grant programs. Program direction.-The increase of $37.000 and two positions will provide for additional staff required for overall administration, planning, evaluation, and data processing. |